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Etiology or bias? The difficulty in explaining internalized homonegativity’s connection to compulsive sexual behavior disorder—commentary to Droubay et al. (2025)
Droubay et al. recently reported an association between internalized homonegativity (IH) and compulsive sexual behavior disorder (CSBD) among sexual minority individuals, adjusting for varied sexual behavior frequencies. They interpret this finding as supporting a biasing explanation: that individuals with higher IH may inaccurately self-perceive their sexual behavior as dysregulated, despite not exhibiting genuine CSBD symptomology. While this interpretation highlights an important concern in the assessment of CSBD among sexual minorities, we argue that their analytic approach does not adequately address alternative explanations. Specifically, an existing etiological explanation suggests that IH may contribute to emotion dysregulation and the maladaptive use of sex as a coping strategy, subsequently resulting in CSBD. We contend that the approach used by Droubay et al. does not sufficiently distinguish between these separate explanations, nor does it provide evidence favoring one over the other. Thus, we provide recommendations for future research involving cognitive interviewing and other approaches that may clarify whether the observed association between IH and CSBD is best explained by etiology, bias, or both.
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