Глобальное состояние исследований и тенденции навязчивого сексуального поведения: всеобъемлющий библиометрический анализ.

Introduction

Compulsive sexual behavior disorder (CSBD), also known as problematic sexual behavior, excessive sexual behavior, sexual addiction (SA), hypersexual disorder (HD), sexual compulsivity, sexual impulsivity, or out-of-control sexual behavior, has a long research history across many countries, dating back thousands of years ( Turner et al., 2022 ). These concepts refer to various labels for the same phenomenon, reflecting researchers' understanding of problematic sexual behavior within different theoretical frameworks ( Sassover & Weinstein, 2020 ). Since Carnes coined the term ‘SA’ in the 1980s ( Carnes, 1983 ), the related terminology and precise etiological classification of this syndrome have been controversial in clinical practice and the scientific literature, involving classifications such as obsessive-compulsive disorders (OCDs), impulse control disorders (ICDs), paraphilia-related disorders, hypersexuality, or behavioral addiction disorders ( Antons et al., 2022 ). Initially, CSBD included or combined behaviors such as excessive sexual intercourses with consenting partners, masturbation, excessive visits to prostitutes, visiting strip clubs, using telephone hotlines, and watching pornography ( Bancroft, 2008 ; Reid et al., 2012 ). However, the rapid development of the internet has increased the availability and accessibility of sexual rewards, resulting in a broader range of activities and content, and introducing new challenges related to dysregulated sexual behaviors, such as cybersex and problematic pornography use (PPU) ( Hernández-Mora Ruiz Del Castillo, Bonnet, & Varescon, 2023 ; Lewczuk, Wójcik, & Gola, 2022 ; Wéry & Billieux, 2017 ; Zarate, Allen, Kannis-Dymand, Karimi, & Stavropoulos, 2023 ).

The clinical relevance of CSBD supports its inclusion as a distinct psychiatric condition. Initially introduced as ‘SA’ in the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-Ⅲ-R), this classification was excluded from DSM-Ⅳ due to insufficient evidence ( American Psychiatric Association, 1987 , 1994 ). Although ‘HD’ was proposed for inclusion in DSM-V, it was ultimately rejected ( American Psychiatric Association, 2013 ; Kafka, 2010 ). In 2019, the World Health Organization officially recognized CSBD as a diagnosis (Code: 6C72) in the eleventh revision of the International Classification of Diseases (ICD-11) ( World Health Organization, 2020 ), characterized by persistent and repetitive sexual thoughts, urges, or behaviors that are difficult to control over an extended period (six months or more) and result in substantial distress clinically or impairment of some important domains of functioning ( Kraus et al., 2018 ). The ICD-11 inclusion has sparked debate regarding CSBD's classification, nomenclature, and diagnostic criteria ( Brand et al., 2020 ; Bőthe, Koós, & Demetrovics, 2022 ). While the evidence remains inconclusive ( Gola et al., 2020 ; Sassover & Weinstein, 2020 ), its recognition is anticipated to enhance clinical support and foster research progress ( Derbyshire & Grant, 2015 ; Kraus, Martino, & Potenza, 2016 ). To rigorously distinguish between frequently conflated concepts, this manuscript will adopt the principles of using CSBD-related terminology from previous studies ( Turner et al., 2022 ). If sexual behaviors do not lead to personal distress, are not associated with risks of harm to others, or if these factors were not assessed, the term ‘CSB’ will be used. If sexual behaviors are accompanied by personal distress, social, professional, or personal repercussions, or are associated with risks of harm to others, the term ‘CSBD’ will be used.

Estimating the prevalence of CSBD remains challenging due to inconsistent diagnostic criteria, cultural influences, and methodological variability ( Sassover & Weinstein, 2020 ). Early investigations often employed frequency-based metrics ( e.g. , orgasm count) without assessing distress or impairment, likely overestimating CSB prevalence—8–13% in males and 5–7% in females ( Grubbs, Kraus, & Perry, 2019 ; Klein, Schmidt, Turner, & Briken, 2015 ; Långström & Hanson, 2006 ; Ross, Månsson, & Daneback, 2012 ). More recent estimates suggest a prevalence of 3–6% in the general population ( Kraus et al., 2018 ). Despite the release of DSM-5 and ICD-11 criteria, prevalence rates remain imprecise. Recent studies conducted in Western, educated, industrialized, rich, and democratic (WEIRD) nations have reported prevalence rates ranging from 3% to 10% in males and 2% to 7% in females ( Dickenson, Gleason, Coleman, & Miner, 2018 ; Lewczuk, Wizła, et al., 2022 ; Muthukrishna et al., 2020 ). Prevalence in non-WEIRD regions may be underestimated due to sociocultural constraints. CSBD may be as common as mood or substance use disorders but remains underrecognized. Certain subgroups exhibit notably higher prevalence rates compared to the general population. For instance, males tend to present higher incidence rates—frequently associated with pornography consumption—whereas females report more interpersonally focused sexual behaviors ( Erez, Pilver, & Potenza, 2014 ; Karila et al., 2014 ; Öberg, Hallberg, Kaldo, Dhejne, & Arver, 2017 ). Additionally, elevated prevalence has been observed among young people ( Testa, Mestre-Bach, Chiclana Actis, & Potenza, 2023 ), sexual minorities ( Borgogna, Griffin, Grubbs, & Kraus, 2022 ; Gleason, Finotelli, Miner, Herbenick, & Coleman, 2021 ), individuals with trauma histories ( Marshall & Marshall, 2006 ; Slavin, Scoglio, Blycker, Potenza, & Kraus, 2020 ), those engaging in chemsex ( Achterbergh et al., 2020 ; Íncera-Fernández, Gámez-Guadix, & Moreno-Guillén, 2021 ; Malandain et al., 2020 ), and people living with HIV ( Karila et al., 2014 ).

Research interest in CSBD has grown significantly in recent years, reflecting increased recognition of its impact on physical, mental, and social health. Despite this expanding body of literature, the research landscape remains fragmented, characterized by limited interdisciplinary collaboration and an overrepresentation of studies from WEIRD countries, which results in the neglect of diverse sociocultural contexts that may shape the expression and interpretation of CSBD ( Bőthe et al., 2021 ; Chen & Jiang, 2020 ; Klein, Savaş, & Conley, 2022 ). Additionally, many existing studies remain theoretical, with insufficient empirical investigation into the longitudinal course, risk factors, and the treatment efficacy ( Briken & Turner, 2022 ; Grubbs & Kraus, 2021 ). Addressing these gaps and fostering greater interdisciplinary and cross-cultural research will be crucial to advancing the field and developing a more comprehensive understanding of CSBD. Given the growing clinical and research interest, understanding the scope and evolution of the scientific literature related to CSBD, as well as exploring existing research gaps and future research directions, are essential to achieving a comprehensive understanding of CSBD, advancing the research field, and guiding future research and clinical practice. Bibliometrics applies mathematical and statistical methods to analyze changes in the quantity, distribution, and patterns of published articles, using scientific knowledge map as visual representations to examine research trends and hotspots within a specific field in both temporal and spatial dimensions ( Pritchard, 1969 ; Shiffrin & Börner, 2004 ). Although the field of CSBD has garnered considerable scientific attention after ICD-11 recognized it as a distinct disorder, it is still in the early stages of research development. Over the past few decades, researchers have become increasingly interested in the occurrence and progression of CSBD, resulting in a yearly increase in relevant literature. However, no bibliometric analysis has been conducted in this field. Therefore, there is an urgent need to synthesize the current research status of CSBD and predict emerging keywords and trends. This study aims to evaluate the current research status and trends of CSBD to assist researchers in identifying research hotspots and provide a foundation for future studies.

Methods

Data sources

A bibliometrics analysis was conducted based on the Science Citation Index Expanded and Social Sciences Citations Index of the Web of Science Core Collection (WoSCC) database ( https://www.webofscience.com/wos/woscc/basic-search ), which is widely regarded as a primary resource for accessing specific literature citations ( Kulkarni, Aziz, Shams, & Busse, 2009 ). The included publications were required to meet the following criteria: (ⅰ) CSBD-related search strategy ( Supplementary materials Table S1 ); (ⅱ) publication timeframe: January 1, 2000, to December 31, 2024; (ⅲ) only “Article” or “Review” was selected as the document type; (ⅳ) only publications in English were included.

A total of 3,040 publications were initially identified. Of the retrieved literature, 662 non-article or non-review publications, and 117 publications in languages other than English were excluded. Full-record file from the included publications were downloaded, including title, abstract, keywords, year of publication, countries/regions, journal, authors, affiliated institutions, and references. The records were stored in TXT format, containing full texts and cited references, for further analyses. To avoid the impact of database updates, all bibliometric data were downloaded annually, with the last retrieval occurring on December 31, 2024. The process of bibliographic retrieval and collection is illustrated in Supplementary materials Fig. S1 .

Bibliometric and visualization analyses

In this study, Microsoft Excel (Version 2021), VOSviewer (Version 1.6.20, https://www.vosviewer.com/ ) ( van Eck & Waltman, 2010 ), CiteSpace (Version 6.3.R1, https://citespace.podia.com/ ) ( Chen, 2006 ; Chen & Song, 2019 ), Scimago Graphica (Version 1.0.43, https://www.graphica.app ) ( Hassan-Montero, De-Moya-Anegón, & Guerrero-Bote, 2022 ), and Pajek (Version 5.19, http://mrvar.fdv.uni-lj.si/pajek/ ) ( Batagelj & Mrvar, 2004 ) were used for data analysis and bibliometric visualization. First, we divide the history of CSBD research into three stages based on key research milestones over the past 25 years. The first stage (2000–2009) preceded the proposal of the HD diagnosis for DSM-Ⅴ. The second stage (2010–2017) occurred before the introduction of the CSBD diagnosis in ICD-11. The third stage (2018–2024) followed the proposal of the CSBD diagnosis in ICD-11. We then conducted a quantitative analysis of annual and stage-specific publication volumes using the statistical analysis function of the WoSCC database and visualized the results in Microsoft Excel. Second, we used VOSviewer, a literature analysis and visualization tool, to examine countries/regions, institutions, authors, journals, references, and keywords. This analysis aimed to generate a comprehensive bibliometric knowledge map from multiple perspectives, applying co-citation and network analysis principles ( Díaz-Faes, Bowman, & Costas, 2019 ). VOSviewer automatically optimizes label placement to prevent overlap and enhance readability. It also prioritizes labeling based on node weight ( e.g. , frequency of occurrence), meaning that less influential nodes may appear in the visualization without labels. Furthermore, Scimago Graphica was utilized alongside VOSviewer to visualize national publication output on a map. Pajek and VOSviewer were subsequently joint used to analyze complex nonlinear networks, thereby providing enhanced visualization of author keywords. Finally, CiteSpace was used to conduct burst detection on citations and keywords, resulting in burst citation maps to identify abrupt surges in research interest on specific timelines within the CSBD field.

Sensitive analyses

Since many authors in the included studies are affiliated with multiple institutions, this may introduce potential bias in the analysis of institutions and countries/regions. To address this, we conducted a sensitivity analysis. In the modified full-record file, each author retained only one primary affiliated institution. We then reanalyzed institutions and countries/regions using this adjusted dataset to minimize potential bias. Additionally, as the list of core authors may change across different research stages, we performed a second sensitivity analysis by examining core authors at each stage. This allowed us to explore variations in key contributors over time.

Ethics

Data were retrieved from publicly available bibliographic information in WoSCC, and the extraction of these data did not involve any interaction with human subjects or animals. Therefore, no ethical issues were associated with the use of these data, and no Ethics Committee approval was necessary.

Results

Overall trend

The quantity of publications reflects both the development and the growing scholarly interest in CSBD research. The findings of this study indicate a consistent upward trend in CSBD research from 2000 to 2024, as illustrated in Fig. 1 . A total of 2,261 original articles about CSBD were identified, showing a gradual increase in output in the first two stages, followed by a significant surge after the proposal of the new CSBD diagnosis for ICD-11 in the third stage with publications accounted for 51.30% of the total. Furthermore, a total of 2,420 institutions and 6,473 authors have made contributions in the CSBD research field. Notably, to avoid reinforcing adverse competition and the phenomenon of “publish or perish” in the CSBD field, detailed results and discussion of analyses of institutions and authors can be found in the supplementary materials ( Supplementary materials Text S1 and S2 , Table S2–S5 , and Figs S2 and S3 ).

Annual output of research on compulsive sexual behavior disorder from 2000 to 2024

Analysis of countries/regions

To compare the contributions of various countries/regions more effectively, England, Northern Ireland, Scotland, and Wales were combined into the United Kingdom (UK) to align statistical analysis with international conventions. A total of 77 countries/regions contributed to CSBD research, and the top 10 productive countries/regions ranked by publication volume are shown in Supplementary materials Table S6 . Among them, the US dominates the publication landscape, exhibiting a significantly higher output and the highest number of citations. Following are Canada and the UK, with similar number of publications and citations. China ranks seventh, but its publications receive far fewer citations than the other nine countries/regions. Sensitivity analysis results indicate that authors with multiple institutional affiliations have minimal impact on the analysis of countries/regions. The only change in the top 10 productive countries/regions was a two-place drop in Australia's ranking ( Supplementary materials Table S7 ).

After the primary data collation, a graphical representation was constructed for those countries/regions with a minimum of five publications (as depicted in Fig. 2A ). Collaborative efforts are evident across multiple countries/regions, with a notable emphasis on the close connection between the North American and European countries/regions within the collaboration network. In addition, there are also positive cooperative relationships between the North American and European countries/regions with Israel, Australia, China, and Brazil. Two network co-occurrence maps were generated to examine the output of national publications and cooperative relationships using the Scimago Graphica software. Fig. 2B provides a visual representation of the top 35 countries/regions based on publication volume. In this graph, a larger circle indicates more publications, while a more intense red color indicates greater collaboration with other countries/regions. The thickness and hue of the connecting lines between countries/regions reflect the level of intensity in research collaboration. Furthermore, as depicted in Fig. 2C , the geographical disparities are predominantly observed in North America and Europe.

The visualization of countries/regions on compulsive sexual behavior disorder research. (A) The co-authorship network visualization map of productive countries/regions; (B) The cooperative relationships between various countries/regions; and (C) Geographical distribution map of publications

Analysis of publications and co-cited references

The number of times an article is cited can reflect its influence; generally, more citations indicate greater perceived importance. Supplementary materials Table S8 lists the top 10 most-cited publications, except for those without links to other publications. These publications indicate that the research in the first stage focused more on the fundamental theory of CSBD and the manifestation of CSB as secondary to other diseases, gradually shifting towards further research on addictive behavior in the last two stages. The co-citation of references is an important metric reflecting both the impact of a publication and its foundational role in the research field. Using VOSviewer software, a total of 71,546 co-cited references were detected within the past twenty-five years. Among these, 21 references garnered co-citation counts exceeding 100, signifying their notable recognition and scholarly significance. Supplementary materials Table S9 lists the top 10 co-cited references. Notably, there were three publications that were among both the top 10 most-cited publications and the top 10 co-cited references ( Bancroft & Vukadinovic, 2004 ; Kafka, 2010 ; Weintraub et al., 2006 ). Using a minimum co-citation threshold of 50, a total of 122 co-cited documents were chosen to create a network diagram. The co-citation visualization map of references is presented in Supplementary materials Fig. S4A . Furthermore, a citation burst analysis was conducted on the literature referenced in the past twenty-five years, using Citespace software to identify and visualize the top 25 publication bursts, as depicted in Supplementary materials Fig. S4B . This study presented widely cited academic articles within a specific time frame through citation bursts analysis, revealing shifts in research focus.

Analysis of journals

The statistical analysis of academic journals pertaining to CSBD research provides valuable insights into the scholarly influence of these publications. In total, 707 academic journals published articles related to CSBD, with Archives of Sexual Behavior ( ASB ) ranking first, followed by the Journal of Behavioral Addictions ( JBA ) and the Journal of Sexual Medicine ( JSX ). The top 10 journals with the most publications are shown in Supplementary materials Table S10 along with their journal impact factors (JIFs) for 2023. Nearly one-fourth of the publications were published in the top 10 journals (560 publications, 24.77%). According to Bradford's Law, the top 10 journals by publication volume are considered core journals in this field ( Brookes, 1969 ). They can serve as a preferred venue for researchers to submit and access articles related to CSBD. The JIFs of these journals varied, with the JBA having the highest JIF of 6.6. In terms of Journal Citation Reports Category Quartile for 2023, most of the journals were classified into Q1 (70%) or Q2 (30%). Subsequently, a visualization analysis of academic journals related to CSBD research was conducted, and 54 journals were divided into four clusters based on journals with eight or more publications, as shown in Fig. 3A . The four clusters of journals represent different types of journals, with the red cluster mainly consisting of journals related to phycology and psychiatry, the green cluster mainly consisting of journals related to sex research, the yellow cluster consisting of journals related to children and adolescents, and the blue cluster consisting of journals related to neurology. Furthermore, the examination of publication trends within the top 10 journals pertaining to CSBD research reveals a noticeable uptick in scholarly interest in this area over the past few years ( Fig. 3B ). Among these journals, ASB , JBA , and Current Addiction Reports stand out as the top three publications experiencing the most rapid growth in output over the third stage.

The visualization of journals on compulsive sexual behavior disorder research from 2000 to 2024. (A) Network visualization map of journals; (B) Trend of annual publication volume for the top 10 journals

Analysis of keywords

According to the analysis results of VOSviewer, a total of 3,792 author keywords occurred in 2,261 articles. The top 10 keywords by frequency are presented in Table 1 , with terms such as ‘compulsive sexual behavior disorder’ and ‘hypersexuality’ showing frequencies exceeding 300. After applying a keyword filtering process with a minimum frequency threshold of 12, a total of 82 keywords were identified. Subsequently, a keyword co-occurrence network diagram was generated ( Fig. 4A ), with 82 keywords were grouped into five clusters to illustrate their significant correlations. Cluster one (yellow) includes ‘pornography’, ‘PPU’, ‘behavioral addiction’, ‘addiction’, ‘internet addiction’, and ‘gaming disorder’, relating to the competing conceptualizations of CSBD. Cluster two (green) includes ‘CSBD’, ‘SA’, ‘depression’, ‘anxiety’, ‘personality’, ‘mental health’, and ‘substance use’, relating to comorbidities involving CSBD and other psychiatric disorders. Cluster three (red) encompasses terms such as ‘sexual behavior’, ‘sexual offending’, ‘child sexual abuse’, ‘problematic sexual behavior’, and ‘paraphilia’, primarily focusing on the assessment, risk factors, and treatment of CSBD. Cluster four (blue) includes ‘sexuality’, ‘gender’, ‘women’, ‘masculinity’, ‘sexual satisfaction’, ‘sexual health’, and ‘sexual dysfunction’, relating to gender differences and sexual health among individuals with CSBD. Cluster five (purple) includes ‘hypersexuality’, ‘impulsivity’, ‘Parkinson's disease’, ‘dopamine agonist’, and ‘dopamine dysregulation syndrome’, summarizing the characteristics of CSB secondary to neurological diseases.

Table 1. Top 10 keywords of compulsive sexual behavior disorder research from 2000 to 2024 Rank Keyword Occurrences TLS 1 compulsive sexual behavior disorder 332 701 2 hypersexuality 320 609 3 impulsivity 190 430 4 pornography 175 327 5 sexuality 162 252 6 sexual addiction 154 323 7 Parkinson's disease 144 293 8 problematic pornography use 144 246 9 behavioral addiction 119 258 10 addiction 90 180 10 men who have sex with men 90 147 Note : TLS, total link strength.

Top 10 keywords of compulsive sexual behavior disorder research from 2000 to 2024

Note : TLS, total link strength.

The visualization of keywords on compulsive sexual behavior disorder research from 2000 to 2024. (A) The co-occurrence map of keywords; (B) The timeline view of keywords; (C) The citation burst detection of the top 25 keywords

Note : CBT, cognitive behavior therapy; COVID-19, Corona Virus Disease 2019; CSBD, compulsive sexual behavior disorder; DSM-5, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; fMRI, functional Magnetic Resonance Imaging; HIV, Human Immunodeficiency Virus; ICD-11, the eleventh revision of the International Classification of Diseases; MSM, men who have sex with men; PPU, problematic pornography use.

Moreover, VOSviewer and Pajek software were jointly used to generate an overlay visualization map of keywords, as depicted in Fig. 4B . The overlay visualization incorporated a temporal component into the analysis, where darker colors represented earlier occurrences and brighter colors represented more recent occurrences, providing valuable insights into the progression of CSBD research. It is evident that research on CSB secondary to neurological disorders was conducted in the first two stages, while research on new forms of CSBD such as PPU was conducted in the third stage. Fig. 4C listed the top 25 keywords with the strongest burst. The keyword with the earliest detected burst strength was ‘Parkinson's disease’. The top three keywords with the strongest burst were ‘Parkinson's disease’ (21.25), ‘PPU’ (18.53), and ‘Impulse control disorder’ (18.09). It is worth noting that the keywords ‘PPU’, ‘Consumption’, ‘Pornography use’, ‘Addictive behavior’, and ‘Symptom’ experienced bursts from 2021 to 2024, indicating their potential as emerging frontiers in CSBD research.

Discussion

Overall trend

This study analyzed 2,261 publications related to CSBD in WoSCC from 2000 to 2024 using bibliometric and visual analysis methods, summarizing the current research status and hotspots in this field, providing guidance for researchers, and offering new insights into potential future research directions. Overall, the research field concerning CSBD is in a nascent stage, with publications and citations experiencing rapid growth. Based on key milestones in the past 25 years of research, the history of CSBD research was divided into three stages. The growth pattern observed across these stages reflects sustained progress in CSBD research within the fields of sexual medicine and psychiatry. The first stage was marked by a relatively stagnant trend, with gradual growth and an annual output of fewer than 60 articles. The second stage showed a consistent increase in output, although the growth rate remained modest over the 8-year period. The third stage saw a significant surge in output, surpassing 130 articles annually, peaking in 2022, followed by a slight decline after 2023.

Research hotspots and frontiers

High-frequency keywords are crucial for helping researchers identify the research landscape, trace evolutionary trends in specific fields, and guide their research focus. According to the co-occurrence analysis of author keywords, CSBD-related research can be divided into five categories: (Ⅰ) competing conceptualizations of CSBD; (Ⅱ) comorbidity between CSBD and other psychiatric disorders; (Ⅲ) assessment, risk factors, and treatment; (Ⅳ) gender differences and sexual health; and (Ⅴ) CSB caused by neurological diseases. Additionally, based on the results of the visualization analysis, the research hotspots during the first two stages (2000–2017) primarily focused on CSB secondary to other conditions, comorbidities between CSBD and other conditions, and the treatment of CSBD. Recently (the third stage, 2018–2024), the research hotspots have shifted to exploring the formation mechanisms, risk factors, psychopathological analyses of CSBD and PPU, as well as the ongoing debate over the classification of CSBD.

Competing conceptualizations of CSBD

Ever since Carnes described excessive sexual behavior as ‘SA’ and widely disseminated it to the public ( Carnes, 1983 ), there has been controversy in the academic community ( Gold & Heffner, 1998 ; Levine & Troiden, 1988 ). In critiquing the ‘SA’ framework, many scholars proposed alternative models, including the impulsivity model, the compulsivity model, and the sexual disorder model ( Kingston & Firestone, 2008 ). With the emergence of the internet, the widespread adoption of personal computers, and the digitization of sexuality in the first stage, individuals increasingly used the internet to access pornographic materials, which further accelerated the growth of SA-related research ( Cooper, Boies, Maheu, & Greenfield, 2000 ; Cooper, Putnam, Planchon, & Boies, 1999 ; Delmonico, 1997 ; Garcia & Thibaut, 2010 ). These studies directly led to the proposal of HD for inclusion in DSM-Ⅴ as a sexual disorder ( Kafka, 2010 ). Despite successful field trials, it was ultimately rejected due to insufficient empirical evidence, potential misuse of the proposed diagnosis, and other criticisms ( Kafka, 2014 ; Reid et al., 2012 ). However, this proposal significantly increased the empirical literature related to HD in the second stage, ultimately facilitating the inclusion of CSBD in ICD-11 ( World Health Organization, 2020 ). In the third stage, controversy has emerged in academia regarding the classification of CSBD as an ICD in ICD-11, with numerous researchers advocating for its classification as a behavioral addiction ( Fuss, Lemay, et al., 2019 ; Grubbs, Hoagland, et al., 2020 ; Reed et al., 2022 ).

Clinically, substantial evidence indicates that CSBD/HD shares core features with substance use and addictive disorders, including compulsivity, loss-of-control, continued engagement despite adverse consequences, craving, and distress ( Carnes, Hopkins, & Green, 2014 ; Starcke, Antons, Trotzke, & Brand, 2018 ). Researchers have emphasized these symptoms as central to conceptualizing CSBD within an addiction framework, supported by empirical studies showing strong associations with craving and other addiction markers like repeated quit attempts and cue reactivity ( Shirk, Saxena, Park, & Kraus, 2021 ; Hormes, 2017 ; Pistre, Schreck, Grall-Bronnec, & Fatseas, 2023 ). Furthermore, the inclusion of moral incongruence in the ICD-11 diagnostic criteria for CSBD diagnosis has generated debate. While religious and moral beliefs affect treatment-seeking ( Grubbs, Perry, Wilt, & Reid, 2019 ; Lewczuk, Szmyd, Skorko, & Gola, 2017 ), some scholars argue moral conflict alone shouldn't preclude diagnosis ( Gola et al., 2020 ). Cultural factors significantly shape perceptions of moral incongruence ( Lewczuk, Glica, Nowakowska, Gola, & Grubbs, 2020 ), highlighting the need for research that differentiates genuine behavioral dysregulation from culturally mediated disapproval ( Bőthe et al., 2025 ). Moreover, neurobiological evidence also supports an addiction framework. CSBD involves heightened activity in regions tied to sensitization, habituation, impulse control, and reward ( e.g. , the fronto-temporal cortices, amygdala, and ventral striatum), as well as observable structural brain changes ( Gola & Draps, 2018 ; Gola et al., 2017 ; Görts et al., 2023 ; Voon et al., 2014 ). Although further research is warranted, preliminary neurochemical evidence suggests that treatments such as naltrexone—traditionally used for substance and gambling addictions—may also reduce CSBD symptoms ( Raymond, Grant, & Coleman, 2010 ). Collectively, these findings strongly support CSBD's classification as a behavioral addiction.

Following the DSM-Ⅴ’s rejection of HD, especially after DSM-V and ICD-11 classified gambling disorder and gaming disorder as behavioral addictions, increasing evidence has fueled arguments that CSBD should be categorized similarly ( Gola & Potenza, 2018 ; Kor, Fogel, Reid, & Potenza, 2013 ; Kowalewska et al., 2018 ; Kraus, Voon, & Potenza, 2016 ; Potenza, Gola, Voon, Kor, & Kraus, 2017 ; Stark, Klucken, Potenza, Brand, & Strahler, 2018 ). In response to the ongoing debate, the JBA invited scholars to debate the theme of “Behavioral Addiction in ICD-11” in 2022, focusing heavily on CSBD. Sassover and Weinstein (2020) argued that current evidence is insufficient to classify CSBD as a behavioral addiction, a position echoed by Bőthe, Koós, and Demetrovics (2022) , who emphasized the roles of impulsivity and compulsivity and called for further research. However, Gola et al. (2020) highlighted strong parallels between CSBD and addictive disorders and proposed that CSBD could be reclassified with additional empirical support. They also noted important clinical distinctions between HD and CSBD standards, especially regarding sexual behavior, exclusion criteria, moral incongruence, and diminished sexual pleasure. Additionally, Rumpf and Montag (2022) compared diagnostic criteria for CSBD, gaming disorder, and gambling disorder, identifying shared features such as loss of control, prioritization of behavior, and persistence despite negative outcomes. Reviewing the areas outlined by Brand et al. (2020) , they concluded that empirical and phenomenological evidence supports classifying CSBD as an addictive behavior. Debates also explored whether CSBD fits better under OCDs or ICDs. Rumpf and Montag (2022) argued against these models, noting that OCD symptoms are driven by negative state avoidance without positive reward, while ICDs, like pyromania and kleptomania, involve behavior shifts unlike the sustained behavior characteristic of addiction. Thus, CSBD may not align well with either OCDs or ICDs frameworks.

Despite the growing body of evidence, some studies still argue that there is insufficient data to classify CSBD as a behavioral addiction, highlighting the need for further research in several areas ( Borgogna & Aita, 2022 ; Bőthe, Koós, & Demetrovics, 2022 ; Castro-Calvo et al., 2022 ; Sassover & Weinstein, 2020 ). First, to improve our understanding of CSBD, research should focus on exploring the psychological, social, environmental, and neurocognitive mechanisms underlying the disorder. Current studies are often cross-sectional and lack representativeness, so more longitudinal, qualitative, and experimental designs are needed, with advanced statistical methods to refine theoretical models ( Grubbs, Hoagland, et al., 2020 ; Kowalewska, Gola, Kraus, & Lew-Starowicz, 2020 ). Larger international collaborations can create comprehensive databases to enhance our understanding of CSBD's underlying mechanisms, enabling further investigation into causal relationships ( Brand, 2022 ). Second, neuroscience research on CSBD remains limited, with small sample sizes and challenges in neuroimaging techniques, such as measurement errors ( Elliott et al., 2020 ; Turner, Paul, Miller, & Barbey, 2018 ). Future studies should focus on larger-scale research to explore potential neurobiological mechanisms, although neuroscience alone cannot determine CSBD's nature ( Grubbs, Hoagland, et al., 2020 ). Additionally, considering that PPU and compulsive masturbation are key behaviors in CSBD, researchers may classify PPU as a subtype of CSBD. A recent study categorized individuals with CSBD into two subtypes based on reinforcement sensitivity ( Golder et al., 2023 ), suggesting that further exploration of CSBD subtypes could lead to more personalized and clinically relevant treatments tailored to individual differences.

Comorbidity with other psychiatric disorders

Across all three stages, there is ample evidence that CSBD often co-occurs with other psychiatric disorders, complicating its diagnosis. CSB should only be diagnosed as CSBD if it is not secondary to another condition, as CSB can be a symptom of various disorders ( Turner et al., 2022 ). Many individuals with CSBD also experience other psychiatric conditions, and patients with other disorders may exhibit CSB symptoms ( Ballester-Arnal, Castro-Calvo, Giménez-García, Gil-Juliá, & Gil-Llario, 2020 ). Large-scale studies across different cultures also support the significant comorbidity between CSBD and other disorders ( Briken et al., 2022 ; Engel et al., 2019 ; Scanavino et al., 2018 ; Schöttle, Briken, Tüscher, & Turner, 2017 ; Snaychuk et al., 2022 ). First, emotional disorders, particularly anxiety and depression, are the most common comorbidities with CSBD ( Lew-Starowicz, Lewczuk, Nowakowska, Kraus, & Gola, 2020 ). Individuals with affective symptoms or those facing adverse life events may engage in CSB to cope with negative emotions ( Ross et al., 2012 ; Wéry et al., 2016 ). However, negative mood states and relationship issues stemming from CSB can worsen emotional symptoms, creating a cycle that sustains both ( Koós et al., 2020 ). CSB is also common in bipolar disorder, often preceding the first manic episode and recurrent episodes ( Van Meter, Burke, Youngstrom, Faedda, & Correll, 2016 ). It remains unclear whether CSBD is a comorbidity or a symptom of hypomanic/manic episodes that resolves once the episode ends.

Second, comorbidities between CSBD and substance use or addictive behaviors are common too ( Kafka & Hennen, 2002 ), with alcohol abuse being most prominent ( Ballester-Arnal et al., 2020 ; Reid & Meyer, 2016 ). However, only individuals with cocaine use disorder show significantly higher rates of CSB ( Stavro, Rizkallah, Dinh-Williams, Chiasson, & Potvin, 2013 ), possibly due to dopamine's disinhibitory effects on sexual behavior ( Dominguez & Hull, 2005 ; Pfaus, 2009 ). CSBD is also frequently linked to behavioral addictions such as gambling disorder, gaming disorder, and compulsive shopping ( Mestre-Bach et al., 2024 ; Mestre-Bach, Granero, Fernández-Aranda, Potenza, & Jiménez-Murcia, 2023 ; Tang, Kim, Hodgins, McGrath, & Tavares, 2020 ; Wéry et al., 2016 ). In addition, CSBD frequently co-occurs with ADHD, especially the inattentive subtype ( Bőthe, Tóth-Király, et al., 2019 ; Engel et al., 2019 ; Reid, 2007 ; Reid, Carpenter, Gilliland, & Karim, 2011 ). A recent German study found that about one-quarter of adults with ADHD reported CSB ( Hertz et al., 2022 ), with overlapping mechanisms likely involving impulsivity and emotional regulation difficulties ( Soldati et al., 2021 ). Beyond the conditions mentioned, CSBD also shows comorbidities with OCDs ( Fuss, Briken, Stein, & Lochner, 2019 ), eating disorders ( Castellini et al., 2020 ), autism ( Schöttle et al., 2017 ; Turner, Briken, & Schöttle, 2017 ), and other psychiatric disorders ( Stefanou, Vittore, Wolz, Klingberg, & Wildgruber, 2020 ). However, research remains limited and heterogeneous. Additionally, personality disorders, particularly type B and obsessive-compulsive personality disorders, are also prevalent among individuals with CSBD ( Ballester-Arnal et al., 2020 ; Carpenter, Reid, Garos, & Najavits, 2013 ). Further research is needed to clarify whether CSBD is a comorbidity or merely a symptom in these conditions.

Assessment, risk factors, and treatment

Numerous reviews have noted that various instruments are used to assess self-reported CSB, but behavior heterogeneity and differences in theoretical frameworks have led to significant inconsistencies ( Fernandez & Griffiths, 2021 ; Grubbs, Hoagland, et al., 2020 ; Montgomery-Graham, 2017 ; Turner et al., 2022 ; Turner, Schöttle, Bradford, & Briken, 2014 ). In the first stage, few scales have been thoroughly validated, and many studies still rely on single-item measures ( e.g. , “I am addicted to pornography”) or clinical interviews without detailed assessments ( Grubbs, Hook, Griffin, Penberthy, & Kraus, 2018 ; Grubbs, Kraus, & Perry, 2019 ; Rissel et al., 2017 ). This lack of unified instruments hampers cross-study comparisons ( Bőthe et al., 2021 ). However, measurement practices are gradually converging based on the DSM-Ⅴ’s HD criteria and ICD-11's CSBD criteria ( Kafka, 2010 ; World Health Organization, 2020 ).

In the second stage, following the proposal of HD criteria, the 19-item Hypersexual Behavior Inventory and the 13-item Compulsive Sexual Behavior Inventory were widely validated, although both predate and only partially align with CSBD criteria ( Ballester-Arnal, Castro-Calvo, Gil-Julia, Giménez-García, & Gil-Llario, 2019 ; Bőthe, Kovács, et al., 2019 ; Miner, Raymond, Coleman, & Swinburne Romine, 2017 ; Reid, Garos, & Carpenter, 2011 ). In the third stage, newer tools, such as the 19-item CSBD scale (CSBD-19), its short version (CSBD-7), and the CSBD Diagnostic Inventory (CSBD-DI), explicitly reference CSBD criteria and demonstrate robust psychometric properties across cultural contexts ( Bőthe et al., 2020 , 2023 ; Grubbs et al., 2023 ). Given PPU's prominence within CSBD, several validated instruments like the Problematic Pornography Consumption Scale and the Brief Pornography Screen have also been developed ( Bőthe, Tóth-Király, Demetrovics, & Orosz, 2021 ; Bőthe, Tóth-Király, et al., 2018 ; Chen et al., 2021 ; Kraus et al., 2020 ). Since 2021, the International Sex Survey Consortium—which spans more than 40 countries across five continents—has conducted several large-scale, cross-cultural, cross-sectional studies to validate CSBD-related measurement tools ( Bőthe et al., 2023 , 2024 ; Bőthe et al., 2021 ; Castro-Calvo et al., 2024 ; Lin et al., 2024 ; Nagy et al., 2025 ), it also aims to identify populations at high risk for developing maladaptive sexual behaviors, investigate the mechanisms underlying these behaviors, and explore potential risk and protective factors associated with maladaptive sexual patterns ( Bőthe et al., 2021 ). In the future, newly developed and validated instruments should be used in additional research and clinical settings. More high-quality, internationally standardized assessment studies are also needed in representative, longitudinal, and clinical samples to help identify risk and protective factors and to inform prevention and intervention efforts ( Reed et al., 2022 ).

Current evidence offers only a limited understanding of the risk and protective factors for CSBD, complicating efforts to distinguish its antecedents, correlates, and mediators, and contributing to ongoing debate about its etiology ( Briken & Turner, 2022 ; Grubbs, Hoagland, et al., 2020 ). Biologically, differences in genetic, limbic, cortical, and neuroendocrine systems may influence susceptibility to CSBD, interacting with past experiences and social factors ( Chatzittofis et al., 2022 ). Psychologically, childhood trauma, including sexual or emotional abuse, has been identified as a potential antecedent ( Kingston, Graham, & Knight, 2017 ; Knight & Graham, 2017 ; Slavin et al., 2020 ). Socially, factors like early pornography exposure, loneliness, and religious moral incongruence may drive dysfunctional coping through sexual behaviors ( Seyedzadeh Dalooyi, Aghamohammadian Sharbaaf, Abdekhodaei, & Ghanaei Chamanabad, 2023 ). Despite growing evidence, many biological, psychological, and social predictors remain underexplored. Future research should more precisely identify risk factors to clarify CSBD's complex etiology.

To guide treatment development, researchers have proposed explanatory models of CSBD based on OCDs, ICDs, and behavioral addiction ( Garcia & Thibaut, 2010 ; Kingston & Firestone, 2008 ). Briken (2020) further developed a comprehensive framework using Bancroft's dual control and sexual threshold models, suggesting that CSBD stems from an imbalance in the interaction between excitatory and inhibitory factors. This model organizes etiological, correlating, and mediating factors, providing therapeutic targets to restore balance. These theoretical models suggest that CSBD may be subdivided into two subgroups: one driven primarily by cue reactivity associated with increased ventral striatum activity (more likely to respond to naloxone) and another using sexual behavior as a coping mechanism for negative emotions (more likely to respond to selective serotonin reuptake inhibitors) ( Savard, 2021 ). In the first two stages, researchers focused on medication and traditional core components of cognitive behavioral therapy (CBT), such as cognitive restructuring. Entering the third stage, researchers began to use new approaches, including third-wave CBT ( e.g. , mindfulness) and alternative treatment methods ( e.g. , art therapy) ( Antons et al., 2022 ). Overall, treated individuals generally show symptom reduction compared to controls ( Bőthe, Baumgartner, Schaub, Demetrovics, & Orosz, 2021 ; Crosby & Twohig, 2016 ; Hallberg et al., 2019 ). However, research quality remains low, with samples heavily skewed toward WEIRD, male populations ( Grubbs, Hoagland, et al., 2020 ), risking inappropriate generalization ( Griffin, Way, & Kraus, 2021 ). Future studies should recruit more diverse populations and follow CONSORT guidelines for rigorous randomized controlled trials ( Savard, Görts Öberg, Dhejne, & Jokinen, 2022 ).

Gender differences and sexual health

Gender differences are a crucial area in CSBD research, highlighting disparities in prevalence, manifestation, and impact ( Grubbs, Hoagland, et al., 2020 ). In the first two stages, many studies found CSBD was more prevalent among cisgender males, which subsequently directed research attention toward male-specific risk factors ( Briken et al., 2022 ; Bőthe, Vaillancourt-Morel, et al., 2022 ; Dickenson et al., 2018 ; Erez et al., 2014 ). In the third stage, there has been a notable increase in research on women and gender-diverse individuals, driven by recognition that although the reported prevalence of CSBD appears lower in these groups, they may experience similarly adverse consequences ( Koós et al., 2020 ; Kowalewska et al., 2020 ; Kürbitz & Briken, 2021 ). Among women, CSBD is typically motivated by emotional or relational factors and may be underreported due to shame or differing symptom patterns ( Dhuffar & Griffiths, 2016 ; Kowalewska, Bőthe, & Kraus, 2024 ; McKeague, 2014 ). Cultural norms also play a significant role in shaping gender differences—men may normalize excessive sexual activity, while women tend to face greater stigma and are less likely to seek help ( Amin, Kågesten, Adebayo, & Chandra-Mouli, 2018 ; Borgogna, McDermott, Berry, & Browning, 2020 ; Levert, 2007 ). Women are more likely to use sexual behavior as a coping mechanism for emotional distress, whereas men are generally driven by sexual arousal ( Bőthe, Bartók, et al., 2018 ). These gender-specific patterns highlight the importance of adopting gender-sensitive approaches in both research and clinical treatment.

The link between CSBD and sexual health—particularly sexual satisfaction and dysfunction—has become one of the major focus in the third stage. Individuals with CSBD often report reduced sexual satisfaction, driven by emotional distress, escalating behaviors, guilt, and intimacy difficulties ( Khayer, Zarei, Damghanian, Bőthe, & Farnam, 2024 ; Starks, Grov, & Parsons, 2013 ; Stulhofer, Busko, & Landripet, 2010 ). CSBD has also been associated with sexual dysfunction, especially in men, where excessive sexual drive and impaired control may disrupt normal functioning ( Briken et al., 2024 ). Notably, PPU has been linked to erectile dysfunction, potentially due to overstimulation from pornography ( Grubbs & Gola, 2019 ). Emerging treatments like imaginal retraining show promise in reducing PPU and restoring function ( Baumeister, Gehlenborg, Schuurmans, Moritz, & Briken, 2024 ). Longitudinal studies are needed to clarify causal relationships and evaluate the long-term effects of various treatments.

CSB secondary to neurological diseases

There is a lot of evidence from the first two stages that patients with neurological diseases often experience changes in sexual activity, which can negatively affect daily functioning and cause distress for both patients and caregivers ( Ciurli, Formisano, Bivona, Cantagallo, & Angelelli, 2011 ; Tayim, Barbosa, & Panicker, 2024 ). CSB is notably associated with neurodegenerative conditions such as brain injury, Alzheimer's disease, and Huntington's disease ( Latella et al., 2021 ). Additionally, treatments involving dopamine agonists or levodopa, commonly used for Parkinson's disease and conditions like restless leg syndrome and pituitary adenoma, have been linked to CSB, especially at higher doses ( Martinkova, Trejbalova, Sasikova, Benetin, & Valkovic, 2011 ; Seeman, 2015 ). In these cases, CSB often manifests through verbal or physical behaviors with sexual intent ( Latella et al., 2021 ). However, the characteristics of CSB differ across neurological diseases ( Mendez & Shapira, 2013 ; Tayim et al., 2024 ; Turner, Schöttle, Krueger, & Briken, 2015 ). In terms of phenomenology, sexual compulsivity or impulsivity is more common in Parkinson's disease, while sexual disinhibition predominates in dementia ( Latella et al., 2021 ; Nakum & Cavanna, 2016 ). Prevalence also varies—Kleine-Levin syndrome shows rates up to 40%, compared to about 11% in Parkinson's and dementia ( Arnulf et al., 2008 ; Canevelli et al., 2017 ; Nakum & Cavanna, 2016 ; Wang et al., 2016 ). However, CSB is frequently under-recognized and under-reported in these populations due to stigma and sensitivity surrounding sexual behavior ( Bostwick, Hecksel, Stevens, Bower, & Ahlskog, 2009 ; de Oliveira & Carvalho, 2020 ), making phenotypic analysis more complex.

Moreover, in terms of pathophysiology, changes in sexual desire and behavior following brain injury are often attributed to dysregulation of dopaminergic circuits, particularly the mesolimbic and mesocortical pathways ( Mutarelli, Omuro, & Adoni, 2006 ; Simpson, Blaszczynski, & Hodgkinson, 1999 ; Simpson, Tate, Ferry, Hodgkinson, & Blaszczynski, 2001 ). The mesocortical pathway is critical for decision-making, while the mesolimbic pathway governs reward learning. Dysfunctions in these circuits contribute to sexual impulsivity and compulsivity. ICDs can arise after exposure to specific rewards, becoming compulsive over time ( Everitt & Robbins, 2005 ). Initially, unexpected rewards strongly activate the ventral striatum, elevating dopamine levels and emotional responses ( Hikida, Kimura, Wada, Funabiki, & Nakanishi, 2010 ). With repetition, these behaviors may transition into habits linked to persistent desire ( Cardinal, Parkinson, Hall, & Everitt, 2002 ). Furthermore, research on treatment strategies for neurological conditions suggests that CSB may arise as an unintended side effect of therapy rather than as a direct symptom of the underlying disease ( Marshall & Briken, 2010 ; Torrisi et al., 2017 ). The complex interplay between pharmacological interventions and disease-related neurobiological changes underscores the need for further investigation into the pathogenesis of CSB. Multimodal research approaches—including neuroimaging, behavioral analysis, impulse control assessment, pharmacological challenge studies, and neurochemical profiling—are essential for elucidating the underlying mechanisms ( Tayim et al., 2024 ).

Geographical disparities

Publication volume and citation impact

CSBD has garnered global attention (77 countries/regions), with 6,473 researchers from 2,420 institutions contributing, most of whom are from WEIRD countries/regions. Among the top 10 productive countries/regions, nine are classified as WEIRD, and their publications account for a substantial proportion of the total output. The US, as one of the most developed nations, leads with a significantly higher number of publications and citations compared to other countries, highlighting its major contribution to the field. Canada, the UK, and Germany have also made notable contributions, with higher average citation rates indicating strong research quality and influence. This trend may reflect the broader development and prioritization of sexology research within these regions ( Beccalossi, Fisher, & Funke, 2023 ). Furthermore, sensitivity analysis showed minimal impact from authors with multiple affiliations, though Australia's ranking dropped by two places, suggesting that cross-national collaborations of Australian scholars are enhancing fairness in CSBD research. Several factors contribute to the dominance of WEIRD countries/regions. First, WEIRD countries/regions tend to exhibit greater openness toward discussions of sexual health, mental health, and behavioral disorders ( Klein et al., 2022 ). Research on sexual behavior, particularly regarding compulsivity and addiction, faces less stigma, facilitating data collection, publication, and the acquisition of ethical approval. In contrast, in many non-WEIRD countries/regions, topics such as CSBD are often considered morally sensitive, taboo, or politically contentious, thereby inhibiting research interest and scholarly output. Second, funding, training, and infrastructure for behavioral and mental health research are heavily concentrated in WEIRD societies, where specialized grants, research centers, and clinical trials focused on issues such as CSBD and PPU are predominantly located in Europe, North America, and Oceania ( Dorrough, Froehlich, & Eriksson, 2022 ; Klein et al., 2022 ). However, non-WEIRD countries/regions typically prioritize research in areas such as infectious diseases, nutrition, or basic health care, rather than “niche” psychological conditions like CSBD. Moreover, the global scientific system remains heavily centered around WEIRD norms, which influence determinations of which research topics are deemed worthy of study, which methodologies are considered “rigorous,” and which populations are viewed as the “default” for generalization ( Brady, Fryberg, & Shoda, 2018 ). This systemic bias can marginalize culturally specific manifestations and interpretations of CSBD. Consequently, research from non-WEIRD contexts often struggles for recognition unless it aligns with Western theoretical frameworks, and even when such studies offer valuable insights, they face higher barriers to visibility, citation, and academic legitimacy. Additionally, current models and treatments for CSBD are predominantly Western-centric, potentially limiting their applicability to non-WEIRD populations whose expressions of CSBD may vary according to cultural, social, or religious factors.

In addition to the nine WEIRD countries/regions, China—a non-WEIRD country with a traditionally conservative cultural background—has exhibited substantial growth in CSBD research in recent years ( Chen, 2022 ). China's emergence as the seventh most productive country in this field can be largely attributed to long-term governmental efforts promoting sex education, scientific literacy, and broader cultural transformations concerning sexual attitudes ( Lin, 2018 ). The sexual culture of the Chinese population has shifted considerably; attitudes and behaviors have become increasingly liberal, with individuals now more willing to disclose personal experiences in surveys ( Su, Zheng, & Zheng, 2024 ). These developments suggest that policy support, public funding, and national-level advocacy are essential for advancing research on CSBD. However, despite a substantial number of publications, China's citation counts and average citations per paper remain significantly lower than those of the other top 10 countries/regions. Several factors may account for this discrepancy. First, cultural context significantly influences how CSBD is conceptualized and framed. Dominant Western models often define the prevailing paradigms in this field, hindering the recognition of culturally distinct perspectives unless they offer novel theoretical contributions. Second, although Chinese sexual culture has become more open, social sensitivities and political constraints persist, limiting both data collection and the depth of critical inquiry—factors that may hinder research quality and visibility. Furthermore, established citation networks in Western academia often favor intra-group referencing, thereby reinforcing a cycle of marginalization of research from peripheral regions. To address these challenges, it is imperative to encourage greater participation of Chinese researchers in international collaborations, support the publication of work in high-impact international journals, and foster original, theory-driven contributions that can broaden and enrich the global discourse on CSBD.

Collaboration networks

As illustrated by the cooperative relationships and geographical distribution in Fig. 2 , there is a robust collaborative network among North American and European countries/regions, with the US, Canada, and the UK exhibiting the most extensive international partnerships. This high degree of collaboration can be attributed to a convergence of cultural, societal, historical, and academic factors that collectively promote scholarly exchange and joint research initiatives. These WEIRD countries/regions share numerous sociocultural similarities, particularly in their openness to discussing sexual behavior and mental health, thereby enhancing the feasibility and social acceptance of CSBD research. Moreover, these countries typically maintain well-established academic infrastructures in sexual health, which creates favorable conditions for cross-national collaboration. Their long-standing traditions in psychology, psychiatry, and sexology have fostered the development of extensive academic networks, further supported by the concentration of prestigious academic journals, research institutions, and international conferences within these regions. These platforms serve as key venues for the dissemination of research, exchange of ideas, and formation of collaborative partnerships, reinforcing the dominance of WEIRD countries/regions in the global CSBD research landscape.

Research characteristics of various countries/regions

A detailed examination of CSBD-related publications across countries/regions reveals that each has cultivated specific research priorities, spanning epidemiological investigations, neuroscience, clinical studies, psychometric tool development and validation, and cultural or ethical analysis. First, countries such as the US, Canada, and Australia have prioritized large-scale, population-based, self-reported epidemiological surveys, frequently focusing on CSBD symptoms, PPU, and moral incongruence ( Bőthe, Tóth-Király, Griffiths, Potenza, Orosz, & Demetrovics, 2021 ; Dickenson et al., 2018 ; Grubbs, Kraus, et al., 2020 ; Rissel et al., 2017 ). Spain has also contributed significantly through community- and student-based surveys, particularly those emphasizing internet-mediated sexual behaviors ( Castro-Calvo, Gil-Llario, Giménez-García, Gil-Juliá, & Ballester-Arnal, 2020 ). Second, in the field of neuroscience, Germany, the US, and China have played leading roles, with Germany recognized as a leader in experimental neuroscience related to CSBD. This prominence is supported by its strong traditions in cognitive neuroscience, state-of-the-art neuroimaging infrastructure, and rigorous studies employing techniques such as functional MRI and electroencephalogram ( Müller & Antons, 2023 ; Prantner et al., 2024 ). The US has furthered neuroimaging research linking CSBD to addiction models ( Draps et al., 2020 ; Draps, Kowalczyk-Grębska, Marchewka, Shi, & Gola, 2021 ; Gola et al., 2017 ), while China has shown rapid progress, particularly in event-related potential (ERP) studies focusing on PPU ( Qu, Li, & Wang, 2024 ; Wang & Li, 2023 ; Wang et al., 2024 ). Third, in clinical research, the US and Germany have been instrumental in the development and evaluation of treatment approaches. Italy, by contrast, has sustained a psychodynamic and case-study-based approach ( Altin, De Leo, Tribbia, Ronconi, & Cipolletta, 2024 ; Cuppone et al., 2021 ). Additionally, Canada, Germany, Spain, the US, and the UK have significantly contributed to the development and validation of psychometric tools for CSBD. Notably, the US and the UK focus on the creation of new instruments targeting constructs such as PPU ( Kraus et al., 2020 ; Kraus & Rosenberg, 2014 ; Marshall & Miller, 2024 ; Reid, Li, Gilliland, Stein, & Fong, 2011 ), while Canada, Germany, and Spain emphasize cross-cultural adaptation and validation of existing tools ( Fernandez & Griffiths, 2021 ; Grubbs, Hoagland, et al., 2020 ; Villena-Moya et al., 2024 ). Finally, cultural and ethical dimensions of CSBD research are particularly evident in publications from the US, Israel, the UK, and France. The US and Israel, influenced by strong religious contexts, have produced extensive research on the interface between religiosity and CSBD. The US emphasizes moral incongruence stemming from religious beliefs ( Gleason et al., 2023 ; Grubbs, Perry, et al., 2019 ), whereas Israeli research explores the broader relationship between religious belief systems and manifestations of CSBD or PPU ( Efrati, 2019 ; Efrati, Kolubinski, Marino, & Spada, 2021 ; Zilberman, Yadid, Efrati, Neumark, & Rassovsky, 2018 ). In contrast, the UK and France address CSBD through secular ethical frameworks, examining how sexual behavior-related moral issues are shaped by prevailing social norms and values ( Chagraoui & Thibaut, 2016 ; Hall, 2021 ).

The divergence in predominant research foci across countries/regions can be attributed to a complex interplay of factors ( Marginson & Rhoades, 2002 ). First, research outputs often reflect the established disciplinary strengths and methodological preferences of each country/region. Researchers typically employ familiar theoretical frameworks and tools, thereby shaping the direction of their investigations. Second, sociocultural differences significantly influence how CSBD is conceptualized. Cultural norms surrounding sexuality affect whether CSBD is framed primarily as a moral concern, a psychiatric disorder, or a neurobiological dysfunction. In some societies, CSBD may be morally pathologized, whereas in others, it may be understood through a neurocognitive or behavioral lens ( Grubbs, Kraus, et al., 2020 ). Moreover, national funding structures and research agendas play a pivotal role in determining scientific priorities. For instance, the German Research Foundation tends to prioritize foundational experimental science, fostering Germany's leadership in neuroscience and neuroimaging research ( Brand et al., 2021 ). In contrast, the National Institutes of Health in the US, alongside private foundations, invest substantially in clinical interventions and large-scale epidemiological studies. These funding dynamics have contributed to the US's broad emphasis on treatment development and public health surveillance ( Volkow et al., 2018 ). Additionally, public health priorities are region-specific. Canada emphasizes the impact of internet pornography on diverse populations, aligning with its multicultural policy environment and digital health initiatives, while Australia focuses on adolescent digital behaviors, reflecting national concerns surrounding youth mental health and technology use.

Strategies for addressing geographical disparities

Geographical disparities in CSBD research necessitate a comprehensive, multilevel strategy to ensure the development and implementation of effective interventions, particularly in underrepresented regions such as Asia, Africa, and Latin America. At the macro level, systemic change can promote greater equity in research opportunities and resources. Key strategies include the establishment of a global CSBD research alliance, the provision of dedicated funding and technical support from international institutions to researchers in underrepresented regions, the development of culturally inclusive diagnostic tools and treatment models, and the promotion of greater regional diversity in academic publishing, including policies that encourage journals to prioritize research from and about these regions. At the meso level, efforts should focus on enhancing research capacity and institutional infrastructure within non-WEIRD countries and regions. Governments and non-governmental organizations ought to prioritize and invest in research on CSBD and behavioral addictions. Establishing regional research centers may serve as enduring platforms for scholarly inquiry, while strategic partnerships with institutions in WEIRD countries/regions can facilitate mentorship, co-publication, and capacity building. Furthermore, dedicated funding for PhD and postdoctoral researchers from underrepresented regions to participate in international exchanges and mentoring programs can foster the development of local expertise and support long-term research autonomy. At the micro level, individual researchers and research practices can play a crucial role in fostering inclusivity. Scholars in WEIRD countries/regions should be encouraged to proactively engage collaborators from underrepresented regions, and academic journals should promote equity in peer review processes while providing editorial and linguistic support for non-native English-speaking researchers. Importantly, CSBD research must reflect sensitivity to local cultural, sexual, and ethical norms, eschewing the imposition of WEIRD-centric frameworks as universal standards. Ultimately, addressing global inequities in CSBD research requires coordinated action across multiple levels—including systemic, national, institutional, and individual domains. These efforts must be grounded in long-term commitment, cultural humility, and the recognition that inclusive, context-sensitive approaches are essential for effective global health research.

Limitations

Similar to other bibliometric studies, this study has several limitations. First, this study included only publications from WoSCC, and the potential incompleteness of this database may have resulted in the omission of relevant articles, leading to minor deviations in the results. Second, only English publications were included in this study, which may have led to the exclusion of high-quality articles in other languages. Additionally, the continuous updates of WoSCC may lead to slight discrepancies between the results of this study and the actual state of the field, potentially excluding some recently published high-quality studies. Furthermore, bibliometric approaches have limitations in assessing the individual quality of a research article. However, consistent with previous similar studies, these limitations must be acknowledged, though they do not affect the overall trends depicted in this study. Despite these limitations, the results of this study provide valuable insights into the research focus and trends in CSBD-related fields, serving as important references for researchers and offering significant leads and concepts for future research.

Conclusions

Using bibliometrics and visualization analyses, this study comprehensively explored the current research status, global research trends and hotspots in the research field of CSBD and predicted future research directions. In summary, the CSBD is a highly promising research area that has attracted the interest of many researchers in recent years. Currently, although CSBD-related research is surging, its typology, epidemiology, neurobiology, assessment and treatment are still in their infancy. The future directions of CSBD-related research lie in addressing the current gaps in knowledge by expanding study populations, developing high-quality methodologies, exploring innovative treatment approaches, and investigating the complex interactions of biological, psychological, and social factors. These efforts will not only improve the understanding of CSBD-related concepts but also promote culturally sensitive, effective prevention, and intervention strategies, ultimately enhancing the quality of life for individuals experiencing these conditions.

Supplementary material

Funding Statement

Funding sources : This study was supported by the Basic Scientific Research Project of Liaoning Provincial Department of Education (LJ112410159075 to Ziqi Wang).

Footnotes

Authors' contribution: Ziqi Wang contributed to the study design, obtaining funding, and study supervision. Wenwen Zhang, Pengshuo Wang, Boyuan Gao, and Ziqi Wang participated in collecting data, analysis/interpretation of data, writing, review, and revision of the manuscript. All authors discussed the presented content and agreed on the final version.

Conflict of interest: The authors declare no conflict of interest.

Contributor Information

Wenwen Zhang, Email: wwzhang_official@163.com.

Pengshuo Wang, Email: kyleonaz@163.com.

Boyuan Gao, Email: 2760712972@qq.com.

Ziqi Wang, Email: wangzq@cmu.edu.cn.

References