Table 6.
A proposed algorithm for pharmacological treatment of CSBD without any chemsex practice and without any paraphilic disorder, based on Briken and Turner (2021) and Thibaut et al. (2020).
| Level of severity |
Treatment |
| LEVEL 1 – mild and mild to moderate | |
| Aim: support the control of sexual fantasies, compulsions, and behaviours without risk of self-harm or harm to others | Psychoeducation (prevention of unwanted pregnancies, STIs; education about the risks associated with CSB) Motivational interviewing Psychotherapy, preferentially CBT or ACT (level C of evidence) Treatment of co-occurring depressive or anxiety disorders or addictive or other psychiatric disorders if any Reduce levels of stress and impulsivity and improve self-esteem |
| LEVEL 2a – moderate | |
| Aims: support the control of sexual fantasies, compulsions, and behaviours Specifiers: Presence of co-occurring depression or anxiety disorder No satisfactory results at level 1 |
Psychotherapy, preferentially CBT or ACT SSRIa: dosage gradually increased at the same level as prescribed in OCD (e.g., sertraline 50–200 mg/day or fluoxetine 20–80 mg/day or paroxetine 20–60 mg/day) (level B of evidence) |
| LEVEL 2b – moderate | |
| Aim: support the control of sexual fantasies, compulsions, and behaviours Specifiers: Presence of co-occurring alcohol or substance misuse, other addictive behaviours No satisfactory results at level 1 |
Psychotherapy, preferentially CBT or ACT Naltrexoneb 50–200 mg/day (level B of evidence) |
| LEVEL 3 – severe | |
| Aim: support the of control severe CSBD symptoms Specifiers: No satisfactory results at level 2a and 2b |
Psychotherapy, preferentially CBT or ACT Add naltrexoneb (50–200 mg/day) to SSRIa or SSRIa to naltrexoneb (e.g. sertraline 50–200 mg/day or fluoxetine 20–80 mg/day or paroxetine 20–60 mg/day) (level C of evidence) |
aBe careful in case of adolescents; there is an increased risk of suicide for SSRIs noted across age groups. National guidelines on antidepressant use monitoring may apply.
bContraindications of naltrexone: acute hepatitis or severe hepatocellular insufficiency; concomitant use of opioids; pregnancy, lactation; suicidal risk; severe kidney failure; hypersensitivity to naltrexone or one of its components; individuals under 18 or over 65 years of age (French Health Authority 2015).