Abstract Introduction Compulsive Sexual Behaviour Disorder (CSBD) has been newly conceptualized in ICD-11. Increasing evidence suggests gender-specific associated factors. Comprehensive investigations examining mentalized affectivity, body experience, and mental health correlates simultaneously across genders in large samples are lacking. Objective To exploratorily investigate 1) gender differences in CSBD prevalence, 2) gender-specific associations between psychological factors and CSBD, and 3) gender-specific predictors of CSBD risk in a large online sample. Methods A quota sample of German individuals approximating population representativeness regarding gender, age, education, and federal state distribution (N=8,583; 49.7% women; ages 18-75 years) completed an online survey in October/November 2024. CSBD indication according to ICD-11 criteria was assessed using distress ratings and lasting symptom presence in the past year. Participants were classified into control (92.1%), subclinical (4.0%), or clinical CSBD (3.9%) groups. Psychological measures included Patient Health Questionnaire-2 (PHQ-2), Generalized Anxiety Disorder-2 (GAD-2), Sexual Distress Scale (SDS), Brief-Mentalized Affectivity Scale (B-MAS), Body Experience Questionnaire (Fragebogen zum Erleben des eigenen Körpers; FBeK-9), Experiences in Close Relationships (ECR-RD8), sexual abuse history questionnaire (SAHQ), and problematic eating behaviour items. All analyses were run separately for women and men: age-adjusted polytomous logistic regression exploratorily examined 17 predictors, and non-parametric group comparisons used Kruskal-Wallis tests with effect size estimation (η2). Results Men demonstrated nearly twice the clinical CSBD prevalence compared to women (5.0% vs. 2.6%); including subclinical presentations, rates were 10.2% vs. 5.4% (χ2=70.25, p0.001). CSBD associated with younger age in women (Clinical M=38.5 vs. Control M=46.1 years, χ2=39.48, p0.001) but not men (χ2=0.54, p=0.764); 30.2% of men with clinical CSBD were over 60 years, and CSBD prevalence remained comparable across all age decades (ranging from 3.8% to 6.3%). Depression and anxiety showed similar effects across genders (women: Depression Clinical OR=1.42, Anxiety Clinical OR=1.54; men: Depression Clinical OR=1.43, Anxiety Clinical OR=1.45). Body insecurity/discomfort was the strongest psychological predictor in both genders (women: Clinical OR=2.16; men: Clinical OR=2.06). Sexual distress effects were stronger in men (η2=0.057) than women (η2=0.029). Sexual abuse history (SAHQ under 14) showed moderate associations (women: Clinical OR=1.26; men: Clinical OR=1.29). Clinical CSBD showed higher emotion identification scores in both genders (women: M=20.3 vs. 18.6, χ2=30.01, p0.001; men: M=17.9 vs. 16.9, χ2=18.28, p0.001) but lower emotion processing scores (women: M=16.2 vs. 17.6, χ2=21.76, p0.001; men: M=16.9 vs. 17.5, χ2=7.68, p=0.022) and expression scores (women: χ2=5.59, p=0.061; men: χ2=21.61, p0.001). Conclusions This large-scale study found gender-specific patterns in CSBD prevalence and age distribution. Clinical CSBD prevalence was 5.0% in men and 2.6% in women, with younger women at higher risk while men show stable prevalence across the lifespan. Body insecurity/discomfort emerged as the strongest predictor across genders. Participants with clinical CSBD showed enhanced emotion identification but impaired emotion processing and expression, suggesting specific deficit patterns regarding emotion. Results highlight the need for gender-sensitive assessment and treatment approaches across the lifespan. Disclosure No
Koops et al. (Mon,) studied this question.