Compulsive sexual behavior disorder in Bangladesh: a case-based exploration of clinical presentations and treatment

Abstract

The new ICD-11 classification for compulsive sexual behavior disorder (CSBD) is defined by strong, repetitive sexual urges that result in a recurrent pattern of sexual conduct that is accompanied by suffering or impairment. This case series examines three Bangladeshi patients with CSBD across distinct developmental stages (childhood, early & late adulthood), demonstrating the disorder’s heterogeneous manifestations and multifactorial etiology. The AB-C model – affective dysregulation, behavioral addiction, and lack of cognitive control – provides a framework for understanding these presentations, with emotional states like boredom and stressful situations. Comorbidities aligned with prior research included mood disorders such as depression in Case 1 and anxiety in Case 2, reinforcing connections between CSBD and broader psychiatric vulnerabilities. Treatment combined cognitive-behavioral therapy (CBT) targeting maladaptive sexual scripts, pharmacotherapy (SSRIs for impulsivity/OCD; lowdose antipsychotics for obsessive thoughts), and culturally adapted family interventions. CBT’s effectiveness in addressing behavioral reinforcement cycles was particularly evident in Case 3’s pornography-to-risky-sex progression. Sociocultural factors profoundly influenced presentations; stringent sexual norms in Bangladesh exacerbated shame, delayed help-seeking, and complicated clinical discussions, especially for female patients and childhood cases. Despite its limitations, the series highlights the clinical complexity of CSBD, underscoring the need for integrated biopsychosocial approaches. It advocates for clinician training in culturally sensitive, nonjudgmental assessment, particularly in conservative settings where sexual health stigma remains prevalent. The cases also highlight the evolving impact of digital accessibility on CSBD phenotypes, necessitating updated therapeutic strategies addressing online sexual behaviors.

Bang J Psychiatry 2025;39(1): 24-28