Factors associated with compulsive sexual behavior in a national probability web-based aged 18-59 years sample from Japan: a cross-sectional survey.

Background: Compulsive sexual behavior disorder (CSBD) involves persistent, repetitive sexual behaviors that continue despite efforts to stop, leading to significant distress or impairment in personal, family, social, educational, and occupational functioning. Most compulsive sexual behavior (CSB) research focuses on Western countries, leaving its characteristics in Japan largely unexplored. Although treatment-seeking behavior for CSB is documented in Western contexts, there is a need to understand this behavior in Japan to improve mental health services. Aims: This cross-sectional study aimed to clarify association between CSB, sociodemographic factors, maximum sexual behavior duration, life satisfaction, negative consequences, psychological co-morbidities, and treatment-seeking behaviors in Japan. Methods: Participants were recruited from a national probability-based sample of adults aged 18-59 in Japan using a web-based questionnaire, with proportional representation of sex assigned at birth, age groups, and residential areas. A total of 1094 respondents (43.69% heterosexual cisgender men, M age = 39.9 ± 11.6) were included. Outcomes: Participants completed the Compulsive Sexual Behavior Disorder Scale-19 (mean score = 24.35 ± 9.27), reporting sexual behavior frequency, time spent on sexual behaviors, life satisfaction, negative consequences related to sexual behaviors, treatment-seeking behaviors, and comorbid conditions such as depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and Adult Attention-deficit Hyperactivity Disorder (ADHD) (Adult Attention-deficit Hyperactivity Disorder Self-Report Scale). Results: Individuals at high risk of CSBD (n = 28; 2.56%), based on the CSBD-19 cut-off score, were more likely to be cisgender heterosexual men than women (chi-squared test). Compared to low-risk individuals, those at high risk spent more maximum duration on pornography and masturbation, lower life satisfaction in health and intimate relationships, experienced negative consequences in various life domains (eg, sleep, social activities, work, family life, finances, and physical health), and exhibited symptoms of depression, anxiety, and ADHD. Three individuals at high risk of CSBD reported seeking treatment. Clinical Implications: Individuals at high risk of CSBD experience negative consequences and psychological co-morbidities, making it critical to investigate contributing factors to provide effective treatment for CSB in Japan. Strengths and Limitations: This study contributes to limited research on CSB in non-Western cultures using a nationally probability-based sample in Japan. The measures lacked detail, so future studies should include more specific questions to evaluate treatment-seeking and other conditions. The small sample size limits the generalizability of the findings when comparing high- and low-risk CSBD groups. Conclusion: This study identified characteristics of individuals at high risk of CSBD in Japan, highlighting the need to develop a support system specific to CSB to ensure effective treatment.