ANNALS OF CLINICAL PSYCHIATRY

ANNALS OF CLINICAL PSYCHIATRY 2013;25(3):193-200 RESEARCH ARTICLE

Compulsive sexual behavior in young adults

Brian L. Odlaug, MPH BACKGROUND: Compulsive sexual behavior (CSB) is estimated to affect 3%
Katherine Lust, PhD, MPH
to 6% of adults, although limited information is available on the true preva-
Liana R.N. Schreiber, BA
Gary Christenson, MD lence and impact of CSB in young adults. This epidemiological study aims to
Katherine Derbyshire, BS estimate the prevalence and health correlates of CSB using a large sample of
Arit Harvanko, BA students.
David Golden, BA
Jon E. Grant, JD, MD, MPH
METHODS: The survey examined sexual behaviors and their consequences,
stress and mood states, psychiatric comorbidity, and psychosocial functioning.

RESULTS: The estimated prevalence of CSB was 2.0%. Compared with respon-
dents without CSB, individuals with CSB reported more depressive and anxi-
ety symptoms, higher levels of stress, poorer self-esteem, and higher rates of
social anxiety disorder, attention-deficit/hyperactivity disorder, compulsive
buying, pathological gambling, and kleptomania.

CONCLUSIONS: CSB is common among young adults and is associated with

symptoms of anxiety, depression, and a range of psychosocial impairments.
Significant distress and diminished behavioral control suggest that CSB often
may have significant associated morbidity.

KEYWORDS: health, hypersexuality, impulse control disorders, prevalence, sex,

young adult
CORRESPONDENCE
Brian L. Odlaug, MPH
Department of Public Health, Faculty
of Health and Medical Sciences  INTRODUCTION
University of Copenhagen
Øster Farimagsgade 5A, DK-1014
Although not classified as a formal psychiatric disorder according to DSM-5
Copenhagen K, Denmark
or the International Statistical Classification of Diseases and Related Health
E-MAIL
Problems, 10th Revision (ICD-10), non-paraphilic compulsive sexual behav-
brod@sund.ku.dk; odlaug@uchicago.edu
ior (CSB) (also referred to as sexual addiction, hypersexuality, and hyper-

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 CSB IN YOUNG ADULTS
sexual disorder) has been described, in some form, in the
medical literature since the 18th century.1,2 CSB has been
recognized for a long time as being associated with signifi-
cant distress, feelings of shame and embarrassment, and
psychosocial dysfunction.2 Significant controversy exists
surrounding the correct classification of CSB as a psy-
chiatric disorder, and there are currently no agreed upon
diagnostic criteria for CSB.3 Experts have yet to agree on
whether it should be included as a formal disorder at all.4
Recent publication of the DSM-5 by the American
Psychiatric Association shows that Hypersexual disorder is
not included in this new edition, underscoring the need for
research into this poorly understood condition.1 Proposed
criteria have included excessive, uncontrollable, culturally
abnormal sexual behavior, urges, and/or thoughts, result-
ing in adverse consequences, marked distress, and/or
impairment in social or occupational functioning.3,5 The
repetitive thoughts and excessive engagement in behav-
ior have been likened to the symptoms often noted in the
obsessive-compulsive spectrum of disorders.6 Others have
argued that CSB should be classified as an addiction or
failure of self-regulation based upon the impulsive, exces-
sive, uncontrolled engagement in the behavior with del-
eterious outcomes.7 Regardless of classification, research-
ers generally agree that individuals with CSB commonly
report low self-esteem, intimacy problems, social anxiety,
psychological distress, interpersonal conflicts, and general
impulsivity.5
No epidemiological studies of non-paraphilic CSB
have been performed in the community. Estimates of CSB
prevalence in the adult US population are hypothesized
to range from 3% to 6%, although no data were offered to
support these estimates.8 Within collegiate samples, one
study assessing impulse control disorders on a private col-
lege campus (N = 791) found that 3.7% of students reported
symptoms consistent with current non-paraphilic CSB.9
Another study of 240 college students found that 17.4% of
students had sexually addictive traits worthy of further eval-
uation and treatment, although rates of CSB were not explic-
itly reported.10 Similar current rates (1.7% and 4.4%) have
been reported in psychiatric inpatients.11,12 These studies
were small and failed to examine the relationship of sexual
behavior to other aspects of mental health (eg, levels of dis-
tress or depression), overall functioning, and problematic
behaviors (eg, drinking, drug use, Internet use). One study
of gay, lesbian, and bisexual individuals in a community
sample (N = 1,543) reported a CSB rate of 27.9%, but that
study included both paraphilic and non-paraphilic sexual
194 August 2013 | Vol. 25 No. 3 | Annals of Clinical Psychiatry
behavior when defining CSB.13 A more accurate prevalence
estimate would help indicate non-paraphilic CSB’s impact
on the individual and society, and if the prevalence is sub-
stantial, potentially could intensify interest in finding treat-
ments. In addition, ascertaining baseline prevalence would
help distinguish the contributions of differing or changing
social conditions from biological factors in CSB. To estab-
lish a more accurate prevalence estimate and understand
the relationship between CSB and psychosocial factors in
young adults in a university population, we conducted a
large, Internet-based survey using a validated screening
instrument embedded in a structured interview.
METHODS
Design of 2011 College Student Computer
Use Survey
As a collaboration between the Department of Psychiatry
and Boynton Health Service at the University of Minnesota,
the College Student Computer Use Survey (CSCUS) was
designed to assess a variety of physical and mental health
behaviors. The survey included questions about sexual
behaviors and their consequences, stress and mood states,
overall functioning, and the respondent’s demographic
information. A clinically validated screening instrument,
the Minnesota Impulse Disorders Interview (MIDI), also
was included to classify respondents as either having CSB
or not. (See the assessment section for CSB criteria.) All
study procedures were carried out in accordance with the
Declaration of Helsinki and were approved by the institu-
tional review board of the University of Minnesota, Human
Subject Code number 1005M81734.
Subjects
A random sample of students at a large public Midwestern
university was recruited to complete the 2011 CSCUS.
Between April 2011 and May 2011, these randomly selected
students received an email inviting them to participate. The
email contained a link to a webpage that displayed the IRB-
approved informed consent page for the on-line survey.
After viewing a webpage displaying the informed consent
document, students either could continue with the survey
if they indicated participant consent or opt out. As an incen-
tive for participation, all participants were entered into a
drawing for gift certificates valued at $1,000, $500, and $250
at a variety of stores. In addition, for those who fully com-
pleted the survey, 3 portable music players were awarded
 ANNALS OF CLINICAL PSYCHIATRY
TABLE 1
Demographics of 1,837 university students grouped by compulsive sexual behavior
CSB
Variable (n = 36)
Age, Mean (± SD) [range], years 23.64 ± 6.16
[18 to 53]
Sex, (% male) 23 (63.9)
Race/ethnicity, n (%)
White 24 (66.7)
Marital status, n (%)
Single/divorced/widowed/separated 21 (58.3)
Married/partner/engaged/committed 15 (41.7)
Relationship
aPearson’s chi-squared.
bn= 1,807.
cDegrees of freedom.
Effect size: d = Cohen’s d.
by random selection. Surveys were completed anony-
mously. A total of 6,000 students were invited to participate
in the survey; 2,108 completed the survey, a response rate
of 35.1%, which compares favorably with rates in national
health surveys.14 A respondent was defined as a person who
fully or partially completed the survey.
Assessments
The survey consisted of 54 questions concerning demo-
graphic characteristics, physical and mental health behav-
iors including stress, depression, body mass index (BMI),
exercise habits, as well as perceived attractiveness and aca-
demic performance variables such as grade point average
(GPA). In addition to formal mental health diagnoses, par-
ticipants were presented with a list of mental health con-
ditions and asked if they ever had been diagnosed with a
mental health disorder.
To estimate the prevalence of CSB, we used the
Minnesota Impulsive Disorders Interview (MIDI).15 The
MIDI screens for CSB, compulsive buying, kleptomania,
trichotillomania, intermittent explosive disorder, and
pathological gambling. We also screened for excoriation
(skin picking disorder) using criteria established by Arnold
et al.16 Questions about CSB, based on previous research,5
included: 1) Do you or others that you know think that
you have a problem with being preoccupied excessively
with some aspect of your sexuality or being overly sexually
active; 2) Do you have out-of-control or distressing sexual
fantasies; 3) Do you have out-of-control or distressing
sexual urges; 4) Do you engage in repetitive sexual behav-
ior that you feel is out of control or causes you distress.
AACP.com Annals of Clinical Psychiatry | Vol. 25 No. 3 | August 2013
No CSB
(n = 1,801) Statistic P Effect size
22.64 ± 5.12 0.6965a,b .4862
[18 to 58]
739 (41.0) 7.596c .006 0.06
1,438 (79.8) 3.337c .052
1,063 (59.2) 0.01c .921
735 (40.8)
Subjects were considered to be a positive CSB screen if they
answered “yes” to question 1 and either question 2, 3, or 4.
For purposes of this study, we used the MIDI as a self-report
screen for current ICDs, similar to a survey conducted in a
previous college sample study.9 In adults and adolescents,
the MIDI has demonstrated excellent classification accu-
racy compared to diagnostic instruments.11,17 Diagnostic
criteria for trichotillomania, gambling disorder, intermit-
tent explosive disorder, and kleptomania are consistent
with the DSM-5, and criteria for compulsive buying18 and
excoriation (skin picking) disorder16 are consistent with
previous research. Subjects were characterized as having a
formal impulse control disorder if they met full criteria for
that disorder.
In addition to the MIDI, we used the following instru-
ments to survey respondents:
Patient Health Questionnaire (PHQ-9).19 The PHQ-9
is a 9-item, client-administered scale based directly upon
the diagnostic criteria for major depressive disorder in
the DSM-IV. It assesses current symptoms and functional
impairment to aid in making a preliminary diagnosis
of depression. It also provides a measure of depression
severity.
Perceived Stress Scale (PSS).20 The PSS is a 10-item,
valid and reliable, self-report measure assessing the degree
to which individuals find their lives to be unpredictable,
uncontrollable, and stressful. Respondent answered each
question on a 5-point Likert scale (ranging from “never” to
“very often”) based on experiences of the previous month.
Scores range from 0 to 40 with higher scores indicating
greater life stress.
195
 CSB IN YOUNG ADULTS
TABLE 2
Behaviors associated with compulsive
sexual behavior (CSB)
Behavior, n (%) CSB (n = 36)
Out of control sexual fantasies 36 (100)
Out of control sexual urges 36 (100)
Out of control sexual behaviors 19 (54.3)
Time spent on online pornography (per day)
None 15 (41.6)
<1 hour 13 (36.1)
1 to 3 hours 5 (13.9)
4 to 5 hours 1 (2.8)
6 to 8 hours 2 (5.6)
>8 hours 0 (0.0)
Internet Addiction Test (IAT).21 The IAT is a 20-item,
self-report assessment that measures the impact of Internet
use on various life domains. It has demonstrated high
validity, reliability, and good internal consistency. Subjects
answer items on a 5-point Likert scale with higher scores
suggesting greater Internet use problems. Research has
indicated that Internet users with complete control over
their usage score between 0 to 19 points, while those with
mild, moderate, and significant Internet use problems
score between 20 to 49, 50 to 79, and 80 to 100 points,
respectively. In addition to the IAT, subjects were asked
about time spent engaging in various Internet activities. For
the purpose of this study, we examined Internet pornogra-
phy use among individuals screening positive for CSB vs
non-CSB students.
Data analysis
We examined distribution characteristics of all variables.
Only participants with complete data on the dependent
variable were included in analyses (n = 1,837; 30.6%).
Baseline demographic data were evaluated for differences
between those with complete data and those without
complete data using t tests for parametric data and Mann-
Whitney U tests for nonparametric data. Participants were
divided into 2 groups: CSB and no CSB. The analyses
included: 1) descriptive and comparison statistics for the
sample’s demographics, 2) the prevalence of CSB, and 3)
cross-tabulation and t test comparisons of those classified
as having CSB vs the remaining respondents in terms of
demographics, health behaviors, and functioning. As an
exploratory study, significance was set to P ≤ .05. For clini-
196 August 2013 | Vol. 25 No. 3 | Annals of Clinical Psychiatry
cally significant results at the .05 level, Cohen’s d effect sizes
are reported where 0.2, 0.5, and 0.8 are generally considered
to be small, medium, and large effect sizes, respectively.
RESULTS
Of the 6,000 students who received the invitation to par-
ticipate in the survey, 2,108 completed the survey (35.1%
response rate). The mean age was 22.6 ± 5.02 [range 18 to
58]. Although most subjects were white (n = 1,650; 78.3%),
229 (10.9%) identified themselves as Asian American,
42 (2.0%) as Hispanic, 25 (1.2%) as African American,
26 (1.2%) as African, 85 (4.0%) as “other,” and 51 (2.4%
non-responders.
For the purpose of this study, analysis is based on
only respondents who identified themselves as male or
female, responded to the questions related to impulse
control, and provided valid responses to the questions
about being diagnosed with a psychiatric disorder within
their lifetime. As such, the final sample used in this study
included 1,837 students, 1,075 (58.5%) of which were
women and 762 (41.5%) male. Sex distribution in this
study was consistent with the overall prevalence of males
(42.4%) and females (57.6%) attending the university in
the spring of 2011.
Of the 1,837 subjects included in this analysis, 36
(2.0%) met criteria for current CSB. Rates of CSB differed
significantly between men (n = 23; 3.0%) and women (n
= 13; 1.2%) (P = .006; d = .06) (TABLE 1). All 36 (100%) of
the subjects with CSB reported having “out-of-control
sexual fantasies,” “out-of-control sexual urges,” and more
than one-half (n = 19; 54.3%) reported out-of-control
sexual behaviors (TABLE 2). Furthermore, 8 (22.3%) of the
CSB group reported Internet pornography use of ≥1 hour
each day.
Subjects with CSB reported significantly higher stress
levels as measured by the Perceived Stress Scale (P < .001;
d = .79), higher depressive symptoms as measured by the
Patient Health Questionnaire (P < .001; d = .54), viewed
themselves as less attractive (P = .001; d = .47), and higher
BMI ratings in males (P = .017; d = .29), compared with
the non-CSB cohort of students. Individuals with CSB
were also significantly more likely to report more days
out of the past month with poor mental health com-
pared to non-CSB students (mean 11.17 ± 17.34 days vs
6.13 ± 7.29 days; P = .0001; d = .38), including the occur-
rence of panic/anxiety attacks (n = 4 [11.1%]; P = .021;
 ANNALS OF CLINICAL PSYCHIATRY

TABLE 3
Health and performance indices grouped by compulsive sexual behavior
CSB No CSB
Health variable (n = 36) (n = 1,801) Statistic P Effect size
Grade point average (GPA) 3.21 ± .46 3.35 ± .47 t = 1.7458 .08 0.30
df = 1802
SE = 0.08
Body mass index (BMI) 26.57 ± 10.6 24.23 ± 4.29 t = 2.3998 .017 0.29
Males df = 747
SE = 0.975
Female 23.41 ± 4.49 23.34 ± 4.56 t = 0.055 .9561
df = 1062
SE = 1.272
Perceived Stress Scale 21.16 ± 6.5 15.96 ± 6.7 4.3755a,b <.0001 0.79
PHQ-9 7.71 ± 6.23 4.79 ± 4.39 3.7969a,c .0002 0.54
Internet Addiction Test 39.39 ± 16.4 29.63 ± 10.98 5.00a,d <.0001 0.70
Perceived attractiveness, (1-10 scale,
1 = least attractive; 10 = most attractive)
Attractiveness of self 6.03 ± 1.93 6.83 ± 1.43 3.29a,e .001 0.47
Attractiveness to others 6.92 ± 1.93 7.38 ± 1.38 1.955a,f .051
(N) days within the past 7 days engaged in
being physically active for at least 30 minutes 3.17 ± 2.08 3.27 ± 2.18 0.2729a,g .785
(N) days poor physical health, (past 30 days) 4.71 ± 6.39 3.35 ± 6.25 1.2744a,h .203
(N) days poor mental health, (past 30 days) 11.17 ± 17.34 6.13 ± 7.29 t = 3.8726 .0001 0.38
df = 1706
SE = 1.301
All values are mean ± SD.
a
Degrees of freedom.
b
n = 1,743.
c
n = 1,749.
d
n = 1,712.
e
n = 1,820.
f
n = 1,812.
g
n = 1,823.
h
n = 1,821.
CSB: compulsive sexual behavior; PHQ-9: Patient Health Questionnaire; SD: standard deviation.

d = .05). Students with CSB also scored much higher on

the Internet Addiction Scale (39.39 ± 16.4) compared
to those without CSB (29.63 ± 10.98; P < .0001; d = .70);
however, both groups scored within the mild problematic
Internet use range (TABLE 3).
Individuals who met criteria for CSB were signifi-
cantly more likely to report lifetime social anxiety disor-
der (n = 6 [16.7%]; P = .001; d = .09) (TABLE 4). In regard
to concomitant impulse control disorders as assessed
by the MIDI, CSB subjects were significantly more likely
to screen positive for compulsive buying (22.2% vs 3.3%;
P < .0001; d = .14), pathological gambling (8.3% vs 0.6%;
P = .0022; d = .12), and kleptomania (2.8% vs 0%; P = .0196;
d = .16) than non-CSB subjects, respectively (TABLE 4).
DISCUSSION
To our knowledge, this is the first formal examination of
the prevalence and health correlates of CSB in a large
sample of college students. Our results suggest that 2.0%
of university students report symptoms consistent with
CSB, a rate slightly lower than the 3.7% found in a previ-
ous college sample study9 and lower than the speculated
3% to 6% rate proposed by other researchers (for a review,
see reference 22). In our sample, and consistent with pre-
vious research,9 the majority (63.9%) of individuals meet-
ing CSB criteria were male and reported out-of-control
sexual fantasies, out-of-control sexual urges, and approx-

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 CSB IN YOUNG ADULTS

TABLE 4
Lifetime psychiatric diagnosis grouped by compulsive sexual behavior
SELF-REPORTED DIAGNOSES CSB No CSB
Non-impulse control disorders (n = 36) (n = 1,801) Statistic P Effect size
Major depressive disorder 9 (25.0) 324 (18.0) 1.169a .279
Bipolar disorder 1 (2.8) 20 (1.1) 0.868a .352
Anorexia nervosa 0 (0.0) 44 (2.4) 0.901a .342
Bulimia nervosa 0 (0.0) 33 (1.8) 0.692a .406
b
Schizophrenia 0 (0.0) 1 (0.1) 1.000
Generalized anxiety disorder 4 (11.1) 166 (9.2) 0.151a .698
Social anxiety disorder 6 (16.7) 73 (4.1) 13.644a .001 0.09
Substance use disorder 1 (2.8) 33 (1.8) 0.150a .699
Obsessive-compulsive disorder 1 (2.8) 37 (2.1) 0.091a .763
Attention-deficit/hyperactivity disorder 3 (8.3) 74 (4.1) 1.568a .210
Posttraumatic stress disorder 0 (0.0) 38 (2.1) 0.776a .378
b
Borderline personality disorder 0 (0.0) 2 (0.1) 1.000
Any lifetime diagnosis 15 (41.7) 494 (27.4) 3.572a .059
RESULTS OF THE MIDI CSB No CSB
Impulse control disorders (n = 36) (n = 1,801) Statistic P
b
Hair pulling disorder (trichotillomania) 2 (5.6) 23 (1.3) .0845
b
Pathological gambling 3 (8.3) 11 (0.6) .0022 0.12
b
Compulsive buying 8 (22.2) 59 (3.3) <.0001 0.14
b
Intermittent explosive disorder 1 (2.8) 4 (0.2) .0944
b
Kleptomania 1 (2.8) 0 (0.0) .0196 0.16
b
Excoriation (skin picking) disorder 4 (11.4) 73 (4.1) .0562
a
Pearson’s chi-squared.
b
Fisher exact test.
CSB: compulsive sexual behavior; MIDI: Minnesota Impulse Disorders Interview.

imately half engaged in out-of-control sexual behaviors.
These findings are of potential importance for 3 reasons:
first, because if the sexual behavior is “out of control,” it
may impede healthy sexual choices. Previous research
has found sexually compulsive behavior is associated
with higher-risk sexual behavior.23 The “out-of-control”
behavior reported in this survey therefore may have
resulted in transmission of sexually transmitted diseases
as well as shame and poor self-respect. Second, because
approximately half of the students with CSB struggled with
only urges and fantasies, (albeit urges and fantasies associ-
ated with psychosocial dysfunction), they may not perceive
their urges and fantasies as a legitimate reason for possible
treatment. Finally, although a majority of students screen-
ing positive for CSB were male, a substantial proportion of
students with CSB were female (n = 13; 36.1%). This is simi-
lar to the 22.2% of subjects who were female and screened
positive for CSB in the Black et al study5 of 36 CSB subjects
and 22.9% of females in the Seegers study10 of 240 college
students who met criteria for a “need to seek further evalu-
ation and treatment” for sexual addiction. Although sexual
compulsivity has been shown to be higher in male college
students,23 our results and previous research clearly illus-
trate and underscore the importance of screening both
female and male students for CSB. Because proper sexual
health screening is lacking in the medical field, especially in
educational institutions,24 greater education around sexual
compulsivity (including intrusive urges and thoughts as
well as sexual behavior) in both male and female students
is critical to the identification and potential treatment of
CSB in this age cohort.
CSB and the Internet
Consistent with previous research, we found that individu-
als with CSB spend more time on the Internet, qualifying
as having “mild problematic” Internet usage. This is con-
sistent with previous research, which found that of 9,265
Internet users, 4.6% met criteria for CSB.25 Previous reports
have found sexual compulsivity to have a strong link to the
amount of time spent pursuing online sexual activities;25 it

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 ANNALS OF CLINICAL PSYCHIATRY
also has been positively associated with perceived problem-
atic online sexual activity.25 Although a majority of subjects
(58.4%) with CSB reported using Internet pornography, it
was a minority (22.3%) that reported ≥1 hour of use daily.
Although it is possible that Internet pornography is a main
outlet for some students with CSB, the fact that such a low
percentage of students reported engaging in this behavior
for ≥1 hour suggests that other forms of sexual engagement
or preoccupation are present in most of this cohort. It is also
possible that due to the wide availability of sexual outlets
on the Internet, time spent on Internet sex sites may not be
a particularly useful measure of CSB symptom severity or
dysfunction. For those wishing to engage in sexual behav-
ior, sexual partners could be found with relatively little time
spent on the Internet. Unfortunately, accessing the Internet
for sexual behaviors may be particularly problematic and
dangerous in young adults given the tremendous public
health concern about sexually transmitted disease and
sexual violence, as well as the well-documented associa-
tion between sexual compulsivity and risky sexual behav-
ior.26 Colleges and universities should consider using the
Internet for public health announcements regarding CSB.
Health correlates and CSB
We also found that CSB students had lower GPAs, more
problems with anxiety disorders, and were more likely to
have higher levels of stress compared to non-CSB univer-
sity students. This is consistent with previous research on
clinical samples of individuals with CSB that found high
rates of anxiety and ADHD in individuals with CSB.27 Past
work also suggests that poor mental health can have a sig-
nificant impact on overall academic performance28 and
underscores a public health need for academic institutions
to provide awareness and treatment resources for students
endorsing compulsive sexual symptoms. A limited amount
of research has investigated the concept of perceived attrac-
tiveness and BMI in CSB. We found that individuals with
CSB believed themselves less attractive, and that males
with CSB have higher BMIs. Research on Internet addic-
tion has found that a preoccupation with being overweight
was a predictor of problematic Internet use29 and therefore,
it is possible that perceived appearance or low self-esteem
factors into the development of CSB. Further exploration of
this topic is merited in future research projects.
The exclusion of hypersexual disorder from DSM-51
is an acknowledgement to our limited understanding of
the course, prognosis, and treatment of this disorder in the
psychiatric community and continued skepticism over the
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legitimacy of hypersexuality as a disorder at all. While not
formally indicated for further study, advancements in our
understanding of this complex, heterogeneous, and often
controversial disorder would undoubtedly benefit both cli-
nicians and patients.
Limitations
Several limitations must be acknowledged in this study.
First, CSB rates were based on a self-report scale without
a formal, in-person clinical evaluation and thus, CSB rates
may be under- or over-reported. Follow-up interviews
with students screening positive for CSB on the self-report
measure would likely result in the exclusion of some of the
cohort from having CSB. Due to the potential shame and
embarrassment involved in endorsing CSB, an anonymous
survey may provide more accurate prevalence estimations
due to the anonymity of completing the assessment.
Second, the proportion of our sample that was white
was significantly higher than recent US census data, mak-
ing the interpretation of results to the general population
difficult. Future research in university and college settings
should strive for a more population-representative sample
in an effort to generalize results to a wider young adult
audience.
Finally, given the heterogeneity of sexual compulsivity,
future research should examine the many religious, moral,
and cultural differences in college and community sam-
ples as considerations for perceived uncontrolled sexual
behavior.
CONCLUSIONS
The relative paucity of information surrounding CSB, espe-
cially in young adults, coupled with the significant potential
for chronic medical consequences resulting from engaging
in these behaviors is a cause of concern. Public health ini-
tiatives directed at adolescents and young adults that illus-
trate the consequences of unfettered sexual activity and the
existance of viable treatments are important. These initia-
tives should target educators and administrators who have
direct contact with this population so that they may better
recognize and intervene with young adults who may be
struggling. Finally, because of the heterogeneity of sexual
compulsivity, future research should examine the many
religious, moral, and cultural differences among college
and community samples as considerations for perceived
uncontrolled sexual behavior. ■
199
 CSB IN YOUNG ADULTS

DISCLOSURES: Mr. Odlaug receives grant support from
the Trichotillomania Learning Center, is a consultant to
Lundbeck Pharmaceuticals, and receives honoraria and
royalties from Oxford University Press. Dr. Grant receives
grant/research support from the National Institute of Mental
Health, the National Institute on Drug Abuse, the National
Center for Responsible Gaming, Forest Pharmaceuticals,
Roche Pharmaceuticals, Transcept Pharmaceuticals,
Psyadon Pharmaceuticals and the University of South
Florida, and receives honoraria/royalties from Springer,
Oxford University Press, American Psychiatric Publishing,
Inc., Norton Press, and McGraw Hill. Dr. Lust, Ms. Schreiber,
Dr. Christenson, Ms. Derbyshire, Mr. Harvanko, and Mr.
Golden report no financial relationship with any company
whose products are mentioned in this article or with manu-
facturers of competing products.
ACKNOWLEDGEMENTS: This research was supported, in part,
by a Center for Excellence in Gambling Research grant by
the National Center for Responsible Gaming, an American
Recovery and Reinvestment Act (ARRA) Grant from the
National Institute on Drug Abuse (1RC1DA028279-01)
to Dr. Grant, and internal funding from Boynton Health
Services, University of Minnesota.

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Brian L. Odlaug, MPH Liana R.N. Schreiber, BA Arit Harvanko, BA

Department of Public Health Department of Psychiatry Department of Psychiatry
Faculty of Health and Medical Sciences University of Minnesota Medical Center University of Minnesota Medical Center
University of Copenhagen Minneapolis, MN, USA Minneapolis, MN, USA
Copenhagen, Denmark
Gary Christenson, MD David Golden, BA
Department of Psychiatry and Behavioral
Boynton Health Services Boynton Health Services
Neuroscience
University of Minnesota University of Minnesota
University of Chicago
Minneapolis, MN, USA Minneapolis, MN, USA
Chicago, IL, USA
Katherine Derbyshire, BS Jon E. Grant, JD, MD, MPH
Katherine Lust, PhD, MPH
Department of Psychiatry and Behavioral Department of Psychiatry and Behavioral
Boynton Health Services
Neuroscience Neuroscience
University of Minnesota
University of Chicago University of Chicago
Minneapolis, MN, USA
Chicago, IL, USA Chicago, IL, USA

200 August 2013 | Vol. 25 No. 3 | Annals of Clinical Psychiatry