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Compulsive Sexual Behavior

Inventory: A Preliminary
Study of Reliability and
Validity
Eli Coleman, Michael Miner, Fred Ohlerking,
Nancy Raymond
Published online: 02 Feb 2011.

To cite this article: Eli Coleman, Michael Miner, Fred Ohlerking, Nancy
Raymond (2001) Compulsive Sexual Behavior Inventory: A Preliminary Study of
Reliability and Validity, Journal of Sex & Marital Therapy, 27:4, 325-332, DOI:
10.1080/009262301317081070

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 Journal of Sex & Marital Therapy, 27:325–332, 2001
Copyright © 2001 Brunner-Routledge
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Compulsive Sexual Behavior Inventory:

A Preliminary Study of Reliability
and Validity
ELI COLEMAN, MICHAEL MINER, FRED OHLERKING,
and NANCY RAYMOND
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Program in Human Sexuality, University of Minnesota, Minneapolis, Minnesota, USA

This preliminary study was designed to develop empirically a scale

of compulsive sexual behavior (CSB) and to test its reliability and
validity in a sample of individuals with nonparaphilic CSB (N =
15), in a sample of pedophiles (N = 35) in treatment for sexual
offending, and in a sample of normal controls (N = 42). Following
a factor analysis and a varimax rotation, those items with factor
loadings on the rotated factors of greater than .60 were retained.
Three factors were identified, which appeared to measure control,
abuse, and violence. Cronbach’s alphas indicated that the subscales
have good reliability. The 28-item scale was then tested for validity
by a linear discriminant function analysis. The scale successfully
discriminated the nonparaphilic CSB sample and the pedophiles
from controls. Further analysis indicated that this scale is a valid
measure of CSB in that there were significant differences between
the three groups on the control subscale. Pedophiles scored signifi-
cantly lower than the other two groups on the abuse subscale, with
the other two groups not scoring significantly differently from one
another. This indicated that pedophiles were more abusive than
the nonparaphilic CSB individuals or the controls. Pedophiles scored
significantly lower than controls on the violence subscale.
Nonparaphilic individuals with compulsive sexual behavior scored

Eli Coleman, Michael Miner, Fred Ohlerking, and Nancy Raymond are affiliated with the
Program in Human Sexuality, University of Minnesota Medical School. A grant from the
Minnesota Department of Corrections and funds from the University of Minnesota Medical
School, Departments of Psychiatry and Family Practice supported this research. The authors
would like to thank Michael Ross, Ph.D., MPH, Ross Crosby, and Deb Finstad for their
assistance in data analysis. The first author thanks Philip Colgan, Ph.D., for his assistance in
developing the original items from which the scale was eventually derived .
Address correspondence to Eli Coleman, 1300 S. 2nd St. #180, Minneapolis, MN 55454,
USA. E-mail: colem001@tc.umn.edu

325
 326 E. Coleman et al.

slightly lower on the violence subscale, although not significantly

different. As a preliminary study, there are several limitations to
this study, which should be addressed, in further studies with larger
sample sizes.

Compulsive sexual behavior (CSB) is a disorder in which the individual ex-

periences intense sexually arousing fantasies, urges, and associated sexual
behaviors that are intrusive, driven, and repetitive. Individuals with this dis-
order are (a) lacking in impulse control, (b) often incur social and legal
sanctions, (c) cause interference in interpersonal and occupational function-
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ing, and (d) create health risks (Coleman, 1991). CSB can be divided into
two basic types, paraphilic and nonparaphilic. Paraphilias are nonnormative
behavior involving recurrent and distressing fantasies. Nonparaphilic CSB
falls under the category of sexual disorder not otherwise specified, with the
description of “distress about a pattern of repeated sexual relationships in-
volving a succession of lovers who are experienced by the individual only as
things to be used.” (p. 538; Nonparaphilic CSB involves normative sexual
behavior that is engaged in an excessive and compulsive manner; Coleman,
1991).
There have been a few attempts to develop scales to identify individuals
with CSB (e.g., Carnes, 1991; Kafka, 1997; Kalichman, Adair, Rompa, Multhauf,
Johnson & Kelly, 1994; Kalichman & Rompa, 1995), with various limitations
in methodology and abilities to generalize.
The previous attempts to develop a scale of CSB failed to incorporate all
of the major components of this clinical phenomenon. Therefore, the first
author developed a scale that consisted of items related to sexual control
and items measuring various aspects of behavior that have been found clini-
cally to be associated with CSB—both paraphilic and nonparaphilic types.
This scale was developed to create a standardized, reliable, and valid
tool to assist clinicians in distinguishing individuals who meet a threshold of
clinical pathology of CSB as well as to offer a tool to use in future studies of
this phenomenon. We hypothesized that the paraphilic and nonparaphilic
CSB groups would not differ significantly in terms of this measure of CSB but
would differ significantly from control subjects.

METHODS

Participants
For the paraphilic group, we elected to study a group of individuals who
had a diagnosis of pedophilia and who were recruited from sexual-offender
treatment programs. All participants were evaluated by one of the authors
for the presence or absence of pedophilia.
 Compulsive Behavior Inventory 327

Thirty-five men were enrolled in the study. The average age was 36
years (Caucasian: 31 [89%]; African American: 3 [9%]; Other: 1 [2%]). Thirteen
(37%) were not working because of restriction of residential treatment; 8
(23%) were laborers; 5 (14%) were technical workers; 4 (11%) worked for a
small business; 2 (6%) were clerical workers; and 3 (9%) were unemployed.
Twenty-four (69%) had completed high school; 6 (17%) had a college de-
gree; and 5 (14%) had not completed high school.
Participants with nonparaphilic CSB were recruited through advertise-
ments in local newspapers. Potential participants that met the following cri-
teria were enrolled in the study:
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1. Participant engages in nonparaphilic CSB as defined by the authors above;

2. Participant experiences a lack of control over urges and fantasies related
to the above behavior;
3. Urges and fantasies cause marked distress and significantly interfere with
occupational functioning, social activities, or relationships with others;
4. Participant is bothered by symptoms for the last six months;
5. Participant does not meet diagnostic criteria of a paraphilia as defined in
the DSM-IV (American Psychiatric Association, 1994).

Fifteen male participants met criteria and were enrolled in the study (All
participants were evaluated by one of the authors. The average age of the
participants was 38 years (Caucasian: 14 [93%]; African American: 1 [7%]).
Four (27%) identified themselves as technical workers, four (27%) as clerical
workers, 3 (20%) as professionals or executives. Of the remaining 4 partici-
pants, 2 were unemployed, 1 worked in small business, and 1 was retired.
Six (40%) had a college degree, 6 (40%) had partial college training, 2 (13%)
had graduate or professional degrees, and 1 participant had not completed
high school.
Control participants also were recruited through newspaper advertise-
ments. Those reporting prior diagnosis of psychological disorders were ex-
cluded. Forty-two male controls were enrolled in the study. The average age
of the 42 participants was 43 years (Caucasian: 40 [95%]; African American: 1;
Other: 1). Thirty (71%) described themselves as being professionals or ex-
ecutives, and 5 (12%) described themselves as clerical workers. Of the re-
maining 7 participants, 3 were technical workers, 2 were laborers, 1 was
unemployed, and 1 participant’s employment data was not collected. Eigh-
teen (43%) had completed high school, 13 (31%) had a college degree, and
11 (26%) had some postgraduate training.

Procedures
This inventory consisted of 42 items related to sexual control and various
aspects of behavior that have been found clinically to be associated with
CSB—both paraphilic and nonparaphilic types. Participants were asked to
 328 E. Coleman et al.

rate their responses ranging from 1 = Very Frequently to 5 = Never. Scores

were totaled. Lower scores were indicative of higher compulsive sexual be-
havior; higher scores indicated lower compulsive behavior.

Statistical Analysis
A factor analysis was performed using the principal components method for
determining factor solution, followed by a varimax rotation. Factor retention
was determined using the scree criteria, and items with factor loadings ex-
ceeding 0.60 on the rotated factors were retained for the final scale. The
reliability of the retained factors then were tested using Cronbach’s alpha.
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Then the data were exposed to a linear discriminant function analysis that
explored the ability to separate the CSB individuals from the controls. Fi-
nally, three ANOVAs were performed to explore mean differences for each
of the study groups on the identified subscales.

RESULTS

Item and Scale Selection

The scree plot resulting from a principal components analysis of the entire
sample indicated that a three factor solution best fit the data. This three-
factor solution explained 58% of the variance in the data, with factor 1 ex-
plaining the major portion (42%). factor 2 had an eigenvalue of 4.26 (10.1%
of the variance), whereas factor 3 had an eigenvalue of 2.46 (5.9% of the
variance). Retention of items on the three factors was determined by the
magnitude of the factor loading and then by the face validity of that item.
Thus, 13 items were retained on factor 1; 8 items were retained on factor 2;
and 7 items were retained on factor 3. The factors appear to measure control,
abuse, and violence (see Table 1).
In order to further explore the reliability of the factors derived from the
principal components analysis, the internal consistency of each scale was
computed using Cronbach’s alpha. These computations indicate that each of
the scales have very good reliability (a = 0.96 for control; a = 0.91 for abuse;
and a = 0.88 for violence).

Indications of Validity
The initial test of the validity of the above three-factor scale was to expose
the data to a linear discriminant function analysis. We tested the ability of the
scale to distinguish between groups considered to have issues of CSB from
those who did not. Thus, the pedophile and nonparaphilic sexual compulsives
were combined into one group (sexual compulsives). The classification ma-
 Compulsive Behavior Inventory 329

TABLE 1. Item and Factor Loadings for Each Rotated Factor

Factor Item Loading
Factor 1: Control
Eigenvalue = 16.66

How often have you had trouble controlling your sexual urges? .85
Have you felt unable to control your sexual behavior? .85
How often have you used sex to deal with worries or problems in your life? .84
How often have you felt guilty or shameful about aspects of your sexual
behavior? .83
How often have you concealed or hidden your sexual behavior from others? .82
How often have you been unable to control your sexual feelings? .82
How often have you made pledges or promises to change or alter your sexual
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behavior? .81
How often have your sexual thoughts or behaviors interfered with the formation
of friendships? .72
How often have you developed excuses and reasons to justify your
sexual behavior? .78
How often have you missed opportunities for productive and enhancing activities
because of your sexual activity? .78
How often have your sexual activities caused financial problems for you? .69
How often have your felt emotionally distant when you were engaging in sex
with others? .68
How often have you had sex or masturbated more than you wanted to? .67

Factor 2: Abuse
Eigenvalue = 4.26

Were you sexually abused as a child? .78

Were you physically abused as a child? .77
Other than parents or siblings, did you experience sexual activity as a child
with someone more than 4–6 years older than you? .77
Did you have sexual experiences with any of your siblings? .75
Have you been forced to have sex with a stranger, casual acquaintance or friend? .66
How often have you been arrested or legally apprehended for your sexual
behavior? .62
Have you forced anyone against his or her will? .61
Did you have sexual experiences with either of your parents? .61

Factor 3: Violence
Eigenvalue = 2.46

Have you ever hit, kicked, punched, slapped, thrown, chocked, restrained,
or beaten any of your sexual partners? .83
Have you given others physical pain for sexual pleasure? .75
In fighting, have you been hit, kicked, punched, slapped, thrown, chocked,
restrained, or beaten by your current or most recent partner? .74
Have you received physical pain for sexual pleasure? .68
Have you received money to have sex? .65
Have you been forced to have sex with your husband, wife, or lover? .65
Have you been watched masturbating or having sex without giving permission? .63
 330 E. Coleman et al.

trix indicated that 92% of the cases were correctly classified, with one of the
normal controls incorrectly classified as compulsive and six compulsives
classified as controls.
In order to further explore the validity of this scale, the three subscales
were used as dependent variables in ANOVAs exploring group differences
between the three study groups. A significant effect for group was found for
the control subscale, F3,99 = 33.2. p < 0.0001. Pairwise comparisons indicated
that pedophiles scored significantly lower than the other two groups on this
subscale (see Table 2), whereas none of the other groups differed from one
another. Finally, there was a significant overall effect for the violence subscale,
F2, 89 = 4.48, p < 0.02. Pairwise comparisons indicated that controls were
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significantly higher than pedophiles, but that compulsives did not differ from
either controls or pedophiles.

DISCUSSION

This article presents the psychometric properties of a clinically relevant and

empirically derived instrument to assess CSB. Twenty-eight items were iden-
tified through a factor analysis that formed three subscales: sexual impulse
control, abuse, and violence. The CSB Inventory seems to reasonably dis-
criminate individuals with CSB from controls.
In order to test the validity of the CSB Inventory, we have chosen to
explore the ability of the test to discriminate between groups that differ in
terms of their CSB and then to look at mean differences between these
groups on the three identified subscales (Nunnally, 1978). Our data provides
strong indications of validity. When we were classifying individuals with
CSB and controls, the overall classification accuracy was greater than 92%,
and there was only one false positive.
The results of the subscale analyses give further indications of the valid-
ity of the CSB Inventory. An inability to control sexual impulses is thought to
be a salient characteristic of CSB (Coleman, 1991). Noncompulsive men scored
high on this scale, indicating that they have fewer problems with controlling
sexual urges than either the pedophiles or the nonparaphilic compulsives.

TABLE 2. Mean Scale Scores for Study Groups

Scale Group
Pedophiles Compulsives Controls
Mean SD Mean SD Mean SD
Control 36.2 a 9.9 31.7 b 9.8 57.2 b 3.4
Abuse 31.1 a 7.2 37.7 b 2.8 39.6 b 0.7
Violence 32.6 a 4.6 33.7 c 2.0 34.7 b 0.8
Groups with different superscripts significantly different at p < .05 such that a < b,
c
no difference between either of the other groups.
 Compulsive Behavior Inventory 331

The abuse scale measures both being a victim and a perpetrator of

abuse. The pedophilic group is lower on this scale, indicating that they are
more involved with these behaviors than are the controls or nonparaphilic
compulsives. Since pedophiles are defined by this interest and participation
in abusive behaviors, this provides evidence for the validity of this subscale.
The violence subscale, which measures sexual interest and involvement
in physically violent and/or painful behaviors, again shows indication of
validity, because differences are found between controls and pedophiles.
The nonparaphilic compulsives score between these two groups and do not
differ from either the pedophiles or the controls.
Therefore, our hypothesis that the two CSB groups would differ from
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controls was only partially confirmed. Clearly, the overall scale correctly
classified 92% of the overall sample into CSB and control. The two CSB
groups differed from controls on the basis of the control subscale but not in
terms of the abuse or violence subscales of the CSB Inventory. The majority
of the variance of the scale was accounted for by the control subscale. When
we examine the subscales and the kinds of behaviors that the pedophiles
and nonparaphilic CSB participants have been engaged in, it makes sense
that the nonparaphilic CSB group is more similar to the controls.
Although our data offer evidence of criterion-related validity, they are
postdictive in nature. We administered the CSB Inventory and used test scores
to determine membership in intact groups. This method appears appropriate
in constructing a test to be used for diagnostic purposes.
This scale was developed on a small and select sample of men. Al-
though the sample size is well within the range recommended for multivari-
ate analysis of number of variables plus 50 (Harris, 1985), the more common
convention is 5 to 10 subjects per variable. The small sample sizes and meth-
ods of recruitment limit generalizability of this study. Certain factors, includ-
ing disparities in education between the samples, may explain some of the
differences between groups, although this seems unlikely because of the
nature of the differences. Furthermore, the paraphilic sample was rather
homogeneous, at least with respect to behavior, whereas the nonparaphilic
group was more heterogeneous. There clearly is a need for cross-validation
with large, more diverse, and independent samples to replicate our factor
structure, refine the instrument, and further explore its validity.

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