Table A1.
Composite index to assess CSBD symptoms
| Symptom | Description | Scale | Item |
| Loss of control | ICD-11: Persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behavior. | HBI | My sexual behavior controls my life. |
| HBI | My sexual cravings and desires feel stronger than my self-discipline. | ||
| SCS | I sometimes get so horny I could lose control. | ||
| SCS | I feel that sexual thoughts and feelings are stronger than I am. | ||
| SCS | I have to struggle to control my sexual thoughts and behavior. | ||
| SAST | Do you have trouble stopping your sexual behavior when you know it is inappropriate? | ||
| SAST | Do you feel controlled by your sexual desire? | ||
| SAST | Do you ever think your sexual desire is stronger than you are? | ||
| Neglect |
ICD-11: Repetitive sexual activities becoming a central focus of the person's life to the point of neglecting health and personal care or other interests, activities and responsibilities. DSM-5: Time consumed by sexual fantasies, urges or behaviors repetitively interferes with other important (non-sexual) goals, activities and obligations. |
HBI | I sacrifice things I really want in life in order to be sexual. |
| HBI | My sexual thoughts and fantasies distract me from accomplishing important tasks. | ||
| HBI | My sexual activities interfere with aspects of my life, such as work or school. | ||
| SCS | I sometimes fail to meet my commitments and responsibilities because of my sexual behaviors. | ||
| Unable to stop | ICD-11: Numerous unsuccessful efforts to significantly reduce repetitive sexual behavior. DSM-5: Repetitive but unsuccessful efforts to control or significantly reduce these sexual fantasies, urges or behaviors. |
HBI | Even though I promised myself I would not repeat a sexual behavior, I find myself returning to it over and over again. |
| HBI | My attempts to change my sexual behavior fail. | ||
| SAST | Have you made efforts to quit a type of sexual activity and failed? | ||
| SAST | Have you attempted to stop some parts of your sexual activity? | ||
| SAST | Have you felt the need to discontinue a certain form of sexual activity? | ||
| Continued engagement despite interference | ICD-11: Continued repetitive sexual behavior despite adverse consequences or deriving little or no satisfaction from it DSM-5: Repetitively engaging in sexual behaviors while disregarding the risk for physical or emotional harm to self or others. |
HBI | I engage in sexual activities that I know I will later regret. |
| HBI | I do things sexually that are against my values and beliefs. | ||
| HBI | Even though my sexual behavior is irresponsible or reckless, I find it difficult to stop. | ||
| SCS | My sexual thoughts and behaviors are causing problems in my life. | ||
| SCS | My desires to have sex have disrupted my daily life. | ||
| SAST | Have you ever felt degraded by your sexual behavior? | ||
| SAST | When you have sex, do you feel depressed afterwards? | ||
| SAST | Has anyone been hurt emotionally because of your sexual behavior? | ||
| SAST | Has your sexual behavior ever created problems for you or your family? | ||
| SAST | Has your sexual activity interfered with your family life? | ||
| Coping | DSM-5 (criterion A2): Repetitively engaging in sexual fantasies, urges or behaviors in response to dysphoric mood states (e.g., anxiety, depression, boredom, irritability). DSM-5 (criterion A3): Repetitively engaging in sexual fantasies, urges or behaviors in response to stressful life events. |
HBI | I use sex to forget about the worries of daily life. |
| HBI | Doing something sexual helps me feel less lonely. | ||
| HBI | I turn to sexual activities when I experience unpleasant feelings (e.g., frustration, sadness, anger). | ||
| HBI | When I feel restless, I turn to sex in order to soothe myself. | ||
| HBI | Doing something sexual helps me cope with stress. | ||
| HBI | Sex provides a way for me to deal with emotional pain I feel. | ||
| HBI | I use sex as a way to try and help me deal with my problems | ||
| SAST | Has sex been a way for you to escape your problems? | ||
| Preoccupation, salience, and self-perceived sexual problems | Salience: “When the particular activity [sex] becomes the most important activity in the person's life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings) and behavior (deterioration of socialized behavior)” (Griffiths, 2005, p. 193). | HBI | I feel like my sexual behavior is taking me in a direction I don't want to go. |
| SCS | I find myself thinking about sex while at work. | ||
| SCS | I think about sex more than I would like to. | ||
| SAST | Do you often find yourself preoccupied with sexual thoughts? | ||
| SAST | Do you feel that your sexual behavior is not normal? | ||
| SAST | Do you ever feel bad about your sexual behavior? |