A look at “Compulsive sexual behavior disorder (CSBD) and problematic pornography use (PPU): A comprehensive, interdisciplinary, and expert-informed narrative review with suggested future directions” by Campbell Ince, Beáta Bőthe and 27 international colleagues (2026)
“Sex addiction” and “porn addiction” are phrases that get thrown around a lot, often with a hefty side of shame. But what does the science actually say? This enormous review (nearly 70 pages, by 29 researchers and clinicians from around the world) tries to pull it all together.
What they found
First, some history. For centuries, out-of-control sexual behaviour was framed as a moral failing. The World Health Organization now recognises Compulsive Sexual Behaviour Disorder in its diagnostic manual, the ICD-11. In essence, it means a persistent pattern of failing to control intense sexual urges, which carries on despite causing significant distress or problems in life.
How common is it? Estimates bounce around a lot depending on how it’s measured, from about 3% to over 10% of adults in different studies. A large 42-country survey put the average at around 5%.
One of the most interesting ideas is moral incongruence. Some people feel “addicted” to porn not because their use is out of control, but because it clashes with their values, often religious ones. The resulting guilt and distress can look like addiction without actually being it. Telling the two apart matters, because they need quite different kinds of help.
On treatment, CBT has the most research behind it. Acceptance and commitment therapy (ACT) looks promising, particularly for people struggling with moral incongruence, where trying to suppress thoughts can backfire. Medication has mostly been tested in small studies, and recent trial evidence suggests therapy may outperform medication alone.
For LGBTQIA+ readers, there’s an important point. Most research has historically focused on straight, cisgender men. The authors warn that the stress of being queer in a hostile world, such as internalised stigma, hiding one’s identity or discrimination, can be mistaken for compulsive sexual behaviour. That risks pathologising perfectly ordinary sex lives. They also caution against automatically labelling porn use among LGBTQ young people as problematic, since many turn to it for information they can’t get elsewhere.
A grain of glitter ✨
This is impressively thorough and refreshingly balanced. It notes, for instance, that CBT’s dominance may reflect how easy it is to study, rather than proof it’s better than relational therapies. It also acknowledges that porn has both potential harms and potential benefits.
But a few caveats apply. Despite its size, it’s still a narrative review, so the experts chose what to include, and many of the authors are leading voices in the very research being reviewed. Whether “addiction” is the right way to think about this at all is still hotly debated. The American diagnostic manual, the DSM-5, doesn’t include it. And with so few rigorous treatment trials, recommendations remain tentative. The authors themselves describe the field as still in its early days.
Why this matters
If you’re worried about your sexual behaviour or porn use, the first question isn’t “am I an addict?” A better one is: “Is this causing me real problems, or is it clashing with values I’ve been taught?” Both are valid reasons to seek support, but they lead down different paths. For queer clients especially, good therapy should untangle shame and minority stress from genuine difficulty, not mistake one for the other.
No unicorn should be made to feel ashamed of its sparkle. But if the sparkle is running the show, it’s okay to ask for help taking the reins back.