Paraphilias and Sexual Offending in Compulsive Sexual Behavior in the Sex@Brain-Study

This article examines the co-occurrence of Compulsive Sexual Behavior Disorder (CSBD) with paraphilic interests, paraphilic behaviors, and sexual offending in group of 47 men with CSBD compared with 38 men without CSBD in a German-speaking sample. Paraphilic interests were more frequent in men with CSBD (89%) as compared to men without CSBD (36%). Furthermore, sexual offending (acted out at least rarely) was more frequent in CSBD (83%) as compared to men without CSBD (44%). Sexual offending without paraphilic interest was not significantly more common in CSBD as compared to men without CSBD (36 vs. 23%). Both logistic regression results and path analyses suggest that, although CSBD and paraphilic interests are associated, paraphilic interests/arousal mediate the relationship between CSBD and sexual offending. However, as these two constructs are statistically associated, it is important to assess possible sexual offending in patients with CSBD. The main clinical implications that follow from this study are (a) to include an accurate diagnosis of paraphilic interests and offending behaviors in the diagnosis of CSBD, (b) clinicians should reflect on their own values in relation to paraphilias and sexual offending, and (c) to adopt a non-judgmental approach to strengthen the therapeutic bond.