Kingsley Mayowa Okonoda, Erefagha Leonardo Allagoa*
Compulsive sexual behaviours are relatively rare and are not known to be associated with social phobias, with an intense scientific debate on going if it constitutes a behavioral addiction. Compulsive sexual behaviours otherwise known as Hypersexuality/problematic sexual behaviour and is identified by a persistent pattern of failure to control repetitive, intense urges, fantasies and behaviours of a sexual nature over an extended period of time that causes marked impairment in multiple areas of functioning, in this case, especially educational functioning. Phobic anxiety disorders also known as social phobias are a group of conditions in which anxiety is triggered typically in well- defined situations that are not currently dangerous with resulting avoidance of such situations. Nevertheless, CSB is not captured in DSM V and ICD10, although, diagnostic criteria were proposed during DSM V revision, it is not currently recognized in the DSMV. Although, CSB has been proposed for inclusion in ICD 11 as an impulse control disorder, rather than as a mental and behavioural disorder as previously debated, in addition, strict diagnostic guidelines were instituted due to concerns of over pathologizing sexual behaviours. This presents a diagnostic and treatment dilemma for the psychiatrist when a patient presents with symptoms of Compulsive sexual behaviours with or without anxiety, since there are presently no diagnostic and treatment guidelines. We present the case of a 23 year old 3rd year medical student with a 5 year history of compulsive masturbation, persistent pornography viewing, failure to resist impulses and fantasies with accompanying intense distress especially following periods of abstinence and a two year history of recurrent panic attacks in social settings in which women were triggers complicated by depressive symptoms, symptoms significantly impaired most areas of functioning particularly his academics.
A diagnosis of Social Phobia/Social Anxiety disorder with episodic panic attacks and compulsive sexual behaviours and mild depressive episode was made because patient met criteria according to ICD 10 and proposed ICD 11. Mental state examination shows anxious mood, congruent with affect, depersonalization, derealization as well as anxious ruminations. Within a year, after commencement of an SSRI, Atenolol and Lisonopril and CBT all anxiety symptoms resolved with marked reduction in the frequency of pornography viewing as well as compulsive masturbation with associated fantasies. This case report lends voice to the on-going debate about the inclusion of compulsive sexual behaviours as a mental and behavioural disorder Dependence syndrome in diagnostic classification systems as well as the need for development of standardized appropriate treatment modalities. This case report will highlight Compulsive Sexual Behaviours, rationale for its inclusion as an addiction in classification systems and treatment approaches to the disorder.