Introduction
The Compulsive Sexual Behavior Disorder–Diagnostic Inventory (CSBD-DI) is a brief, self-administered screening instrument designed to assess symptoms of Compulsive Sexual Behavior Disorder (CSBD) based on the formal ICD-11 criteria. Following the inclusion of CSBD in the International Classification of Diseases as an impulse control disorder, the development of psychometrically sound tools became highly critical for modern behavioral addiction frameworks. An international, multi-institutional academic authorship team led by Joshua B. Grubbs First published this instrument in 2023, and it fills a vital gap in contemporary clinical research. Although it is a relatively new tool, the inventory has rapidly gained substantial empirical traction, accumulating over 55 citations in scientific literature within its first few years.
This article delves into the CSBD-DI‘s core features, scoring mechanics, and practical applications within clinical and research settings. Furthermore, it aims to provide researchers, psychometricians, and clinicians with actionable insights for enhancing patient assessment and improving care pathways under modern diagnostic frameworks.
Key Features of the Compulsive Sexual Behavior Disorder–Diagnostic Inventory (CSBD-DI)
Purpose and Use
The primary purpose of the CSBD-DI is to provide a reliable self-report screening instrument that directly aligns with the modern ICD-11 diagnostic criteria for CSBD. Specifically, the tool evaluates clinical constructs within a behavioral addiction framework rather than relying on outdated moral or subcultural assumptions. Through this targeted approach, researchers can effectively gather epidemiological data, while clinicians can rapidly identify individuals who exhibit symptom escalation.
Target Population
Researchers validated the normative data for the CSBD-DI in adults aged 18 years and older. Because the clinical presentation of impulse control issues varies across lifespans, the tool is actively utilized among diverse demographic cohorts, including:
- Young Adults (18–24 years).
- Middle-Aged Adults (25–44 years)
- Older Adults (45–64 years)
- Seniors (65+ years)
Structure
Structurally, the final version of the CSBD-DI consists of 7 items. These items assess the symptoms of Compulsive Sexual Behavior Disorder across the following specific domains and sub-domains:
- Loss of control
- Salience
- Continuation despite consequences
- Distress/impairment
The final 7 CSBD-DI items evaluate the core ICD-11 symptoms of Compulsive Sexual Behavior Disorder, specifically covering:
- Excessive preoccupation with sexual fantasies, urges, or behaviors.
- Unsuccessful attempts to reduce or control them.
- Continued sexual behavior despite risk of physical or emotional harm.
- Significant personal distress.
- Functional or interpersonal impairment.
- Repeated sexual behavior despite little or no pleasure or satisfaction.
Notably, a 9-item version titled “CSBD-DI with Additional Coping Items” exists, which features two supplementary questions (Items 8 and 9) that assess using sexual behavior to cope with negative affect or stress. However, this main article does not include or review these two coping-related items; they are strictly available within the appendix version and are not counted in the total score
Scoring Method
The CSBD-DI utilizes a unique multiple-choice categorical response format paired with binary scoring. Each of the core items features three distinct temporal response options:
- Current Endorsement = 1 point: this has been true for at least 6 months during the last 12 months.
- Lifetime-Only Endorsement = 0 points: this has been true in my lifetime but not during the last 12 months.
- Never Endorsement = 0 points: This has never been true of me.
To calculate the final total score, researchers sum the binary values across items 1 through 7, creating an overall score range from 0 to 7. Regarding clinical cut-off scores, a total score of ≥1 is highly suggestive of a need for further comprehensive clinical evaluation. While diagnostic accuracy studies indicate that an alternative cut-off score of 2 significantly improves specificity, it simultaneously reduces overall sensitivity. Therefore, clinicians should never use this inventory as a standalone diagnostic tool.
Administration Format
Because modern research demands extreme structural flexibility, Researchers and clinicians can seamlessly administer the CSBD-DI across multiple modalities. This efficiency ensures high compliance rates. Validated administration options include:
- Paper-based forms
- Digital (Online) testing suites
- In-person interviews
- Phone or video consultations
Crucially, the questionnaire is self-administered and takes less than 5 minutes to complete. This brief administration window makes it an exceptionally efficient asset for large-scale epidemiological studies and rapid clinical intakes.
Applications of the Compulsive Sexual Behavior Disorder–Diagnostic Inventory (CSBD-DI)
The structural brevity and psychometric strength of this inventory translate directly into distinct practical applications:
- Screening: It functions as an agile front-line screening mechanism to capture the prevalence of compulsive sexual behaviors within community and clinical settings.
- Research: Because it exhibits measurement invariance across several languages, it serves as an ideal instrument for large-scale, international collaborative research.
Languages and availability
To date, the formal development and cross-national validation studies have secured the availability of the CSBD-DI in several primary languages:
- English
- German
- Portuguese
- Polish
- Hungarian
This linguistic diversity is vital for researchers conducting cross-cultural behavioral addiction comparisons across the Americas and Europe.
Crucially, the CSBD-DI is completely free to use and the authors distribute it under an Open Access license model
Reliability and Validity
The CSBD-DI is recognized as a moderately to highly reliable tool across diverse cultural contexts, with its psychometric soundness strongly supported by extensive cross-national data. For the final 7-item scale, internal consistency remains exceptionally stable across seven global samples, where reported Cronbach’s alpha values ranged from 0.70 to 0.87, and coefficient omega ranged from 0.68 to 0.87. Specifically, the reported alpha values include:
- Malaysia (α = 0.70)
- Germany (α = 0.78)
- United States Study 1 (α = 0.79)
- United States Study 2 (α = 0.80)
- Poland (α = 0.82)
- Hungary Study 1 (α = 0.82)
- Hungary Study 2 (α = 0.87)
Furthermore, robust structural validity has been established through confirmatory factor analysis (CFA) and rigorous cross-language measurement invariance testing. Various studies have further supported its convergent validity, showing appropriate and positive correlations with related older measures of sexual health, such as:
HBI, CSBI-13, CSBD-19, BPS, CPUI-4, and PPCS-6.
Additionally, Receiver Operating Characteristic (ROC) analyses strongly support its screening utility in diverse clinical ecosystems.
Validation evidence comes from diverse contexts, including:
- The original validation study link.
- Validation study of the Brazilian Portuguese version study link.
Limitations and Considerations
Despite its strengths, the CSBD-DI has a few limitations:
- Self-report measure: Because the questionnaire is a self-administered screening instrument, responses rely entirely on subjective personal interpretation rather than objective clinician observation.
- Cultural Bias: Although the tool exhibits measurement invariance across several populations, potential cultural bias must be considered when interpreting behavioral addiction frameworks outside western contexts.
- Language Barriers: The formal validation is restricted to specific languages (English, German, Portuguese, Polish, and Hungarian), leaving language barriers for populations outside these validated translations.
- Limited Validation Studies: As a relatively new scale published in 2023, it still requires ongoing research to further establish its long-term specificity and sensitivity across diverse clinical ecosystems.
- Age Restrictions (Not Suitable for All Age Groups): The normative validation data is strictly limited to adults aged 18 years and older, making it unsuitable for children and adolescents.
- Social Desirability Bias: Due to the highly sensitive and private nature of sexual behavior, respondents may underreport symptoms or alter their answers to align with social expectations.
Other Versions And Related Questionnaires
The authors provided an expanded 9-item tool in the publication appendix titled “CSBD-DI with Additional Coping Items.” This version appends items 8 and 9 to investigate whether individuals use sexual behaviors specifically to cope with negative affect or stress. However, these two supplementary coping items are entirely excluded from the final diagnostic total score.
To establish comprehensive psychological profiles, researchers routinely administer this tool alongside related metrics, including:
- HBI-19: Hypersexual Behavior Inventory-19.
- CSBI-13: Compulsive Sexual Behavior Inventory-13.
- CSBD-19: Compulsive Sexual Behavior Disorder Scale.
- BPS: Brief Pornography Screen.
- CPUI-4: Cyber-Pornography Use Inventory-4.
- PPCS-6: Problematic Pornography Consumption Scale-6.
Additional Resources
- The original validation study link.
- You can access the questionnaire as a PDF through this link.
- For clinical inquiries, translation access, or academic permissions, contact Joshua B. Grubbs at JoshuaGrubbsPhD@gmail.com , the corresponding author of the questionnaire.
Frequently Asked Questions (FAQ)
- Who can use the CSBD-DI?
Clinicians, researchers, and healthcare providers use the CSBD-DI for patients aged 18 and older with suspected compulsive sexual behavior patterns. - How long does it take to complete the CSBD-DI?
Patients typically take less than 5 minutes to complete the CSBD-DI, which makes it highly feasible for use in clinical and research settings. - How is the CSBD-DI administered?
Healthcare teams can administer the questionnaire via paper, digital, or interview formats—offering flexibility in usage across different environments. - Is there any cost to using the CSBD-DI?
The CSBD-DI is free for use under an Open Access license model.
A Word from ResRef about the Compulsive Sexual Behavior Disorder–Diagnostic Inventory (CSBD-DI)
The CSBD-DI is a brief, ICD-11-aligned self-report screening instrument for assessing symptoms of Compulsive Sexual Behavior Disorder. It has strong initial international validation evidence across multiple samples and languages, but positive results should be interpreted as indicating need for further clinical evaluation rather than as a standalone diagnosis.
References
- Grubbs JB, Reid RC, Bőthe B, Demetrovics Z, Coleman E, Gleason N, Miner MH, Fuss J, Klein V, Lewczuk K, Gola M, Fernandez DP, Fernandez EF, Carnes S, Lew-Starowicz M, Kingston D, Kraus SW. Assessing compulsive sexual behavior disorder: The development and international validation of the compulsive sexual behavior disorder-diagnostic inventory (CSBD-DI). J Behav Addict. 2023 Mar 13;12(1):242-260. link.
- I Finotelli Junior, (211) TRANSLATION, SEMANTIC EQUIVALENCE, AND CULTURAL ADAPTATION OF THE COMPULSIVE SEXUAL BEHAVIOR DISORDER DIAGNOSTIC INVENTORY (CSBD-DI), The Journal of Sexual Medicine, Volume 21, Issue Supplement_6, December 2024, qdae161.168, link.
