25 Years of Contention: A Literature Review and the Reliability and Validity of a Diagnostic Instrument for Impulsive-Compulsive Sexual Behavior
Grose, Rose G.
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The goal of this study is to improve diagnosis of Impulsive-Compulsive Sexual Behavior (1- CSB). Currently, the Structured Clinical Interview for the Diagnostic and Statistical Manual (SCID) is the gold standard for clinical diagnosis, yet it does not include modules for the sexual disorders or for I -CSB because it is not yet included in the American Psychiatric Association's (APA) diagnostic manual. Development of a SCID-like interview that is shown to be valid and reliable in differentiating patients with 1-CSB from psychiatric controls would be a crucial step in standardizing the symptomology, terminology, and assessment of this disorder. A review of the literature and a discussion of the debate over terminology, critiques of the construct, and key theoretical perspectives on symptoms, consequences, comorbidity and possible causes precedes a description of the proposed study. This review begins with the social construction of normal and abnormal sexuality over time, specifically in relation to psychology and the AP A's Diagnostic and Statistical Manual (DSM). Critics of the concept of I -CSB argue, generally, that diagnosis is a means to label individuals with deviant sexual behavior as pathological. However, many clinicians and researchers recognize that it is not just frequency or type of sexual behavior that determines whether a person has problematic fantasies, urges or behaviors, as opposed to 1-CSB. They argue the distinction lies in the relationship a person has with his or her sexual behavior, and whether it causes distress and dysfunction. Key theoretical perspectives including sexual addiction, compulsive sexual behavior, impulse spectrum disorders, paraphilia related disorders, and personality disorders are analyzed with the conclusion that 1-CSB is the most appropriate terminology to date. Commonalities exist between theoretical perspectives pertaining to the negative consequences of I -CSB, comorbidity, possible causes and prevalence. All clinicians and researchers would agree that there is a substantial lack of empirical evidence and that more research is required. Diagnostic tools are limited and reflect the incompleteness of research and data. The proposed study is designed to further the understanding of I -CSB and diagnosis.