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A new avenue to pathologize sexual minority populations? Internalized sexual stigma and endorsement of compulsive sexual behavior disorder
Abstract Limited research has evaluated how the ICD-11’s new compulsive sexual behavior disorder (CSBD) diagnosis might impact lesbian, gay, and bisexual (LGB) persons. LGB persons with internalized sexual stigma might be particularly prone to feel their sexual behaviors are dysregulated. Our primary objective was to explore the relationship between internalized sexual stigma and endorsement of CSBD among LGB adults (N = 496) matched to U.S. nationally representative norms. First, we constructed OLS regression models wherein a CSBD screening measure (i.e. CSBD-19) served as the outcome variable and internalized sexual stigma as the focal predictor. Second, we assessed endorsement of CSBD directly by asking questions from the essential (required) features of the diagnosis. We constructed a logistic regression model, coding participants as having met or not met criteria. Our hypotheses were supported across both steps. Internalized sexual stigma was robustly associated with CSBD-19 scores in the main OLS model and likewise associated with increased odds of meeting essential diagnostic criteria—with those who scored highest versus lowest having 32-fold increased odds, even controlling for sexual behavior. Findings underscore the need for practitioners to approach assessment with caution, utilizing a person-in-environment lens, while medical bodies need to consider potential iatrogenic harms of CSBD. LAY SUMMARY This study suggests that internalized sexual stigma is significantly associated with endorsement of “compulsive” sexual behavior and meeting diagnostic criteria for the World Health Organization’s new compulsive sexual behavior disorder among U.S. lesbian, gay, and bisexual adults—even after accounting for sexual behavior frequency. Implications for practice are discussed.
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