Compulsive sexual behavior disorder and paraphilic disorders in a large Brazilian community sample: an online investigation.

BACKGROUND

The International Classification of Diseases 11th Revision (ICD-11) includes Compulsive Sexual Behavior Disorder (CSBD) among impulse control disorders, aiming to standardize diagnostic criteria and improve the understanding of problematic sexual behaviors across cultures. However, few large-scale studies have investigated CSBD and its association with Paraphilic Disorders (PD) in Latin American populations.

OBJECTIVE

To investigate the occurrence of high-risk CSBD in a large Brazilian community sample, examine its association with paraphilic interests and disorders, and evaluate associated sociodemographic and clinical factors.

METHODS

This cross-sectional online study included 5,227 Brazilian adults recruited through convenience sampling between September 2022 and April 2023. Participants completed sociodemographic questionnaires, a Brazilian Portuguese version of the CSBD-19, and a translated inventory assessing paraphilic interests and disorders based on DSM-5-TR criteria. Descriptive statistics, chi-squared tests, linear discriminant analysis, and multivariate backward stepwise logistic regression were performed.

RESULTS

The prevalence of high-risk CSBD (CSBD-19 > 50) was 5.4% (n = 282). The mean CSBD-19 score was 30.4 (SD = 9.7), increasing to 56.4 (SD = 6.1) among individuals classified as high risk. Male sex was strongly associated with high-risk CSBD (OR = 3.32, 95%CI: 2.45-4.50, p < 0.001). Significant associations were also identified for sexual sadism disorder (OR = 2.69, 95%CI: 1.79-4.07), paraphilic disorder involving specific body characteristics (OR = 2.46, 95%CI: 1.49-4.04), zoophilic interest (OR = 2.39, 95%CI: 1.70-3.37), partialism disorder (OR = 2.00, 95%CI: 1.17-3.42), and paraphilia-related distress (OR = 1.94, 95%CI: 1.44-2.61). Linear discriminant analysis demonstrated that the Negative Consequences domain showed the strongest discriminative contribution for high-risk CSBD classification (ω = 1.23).

CONCLUSIONS

This study contributes to more inclusive research on compulsive sexual behavior disorder (CSBD) by investigating a large Brazilian sample, including individuals with diverse sexual orientations and gender identities. Using the ICD-11 framework, the estimated prevalence of high-risk CSBD was 5.4%, a rate comparable to those reported for other common mental health conditions. The study also supports the psychometric applicability of the Brazilian Portuguese version of the CSBD-19 for future epidemiological and cross-cultural research in Latin American populations. Further longitudinal and nationally representative studies are needed to clarify causal pathways, psychiatric comorbidities, minority stress influences, and the neurobiological and psychosocial mechanisms underlying the relationship between CSBD and paraphilic disorders.