Setting research priorities for compulsive sexual behavior (CSB) research – A CHNRI project (Study 2)

Preregistration: Setting research priorities for compulsive sexual behavior (CSB) research – A CHNRI project: People with lived experience Note: The present CHRNI project includes two studies. Study 1 focuses on researchers and mental health professionals, while Study 2 focuses on individuals with lived experience. These two studies are preregistered individually but are included in the project’s main OSF folder. I. Project’s working title Setting research priorities for compulsive sexual behavior (CSB) research – A CHNRI project: People with lived experience II. Members of the research team Principal investigator (PI): ● Beáta Bőthe, PhD; Université de Montréal (Canada) Co-investigators (Co-Is): ● Zsolt Demetrovics, PhD, DSc; University of Gibraltar (Gibraltar) ● Andrea Czako, PhD; University of Gibraltar (Gibraltar) ● Mónika Koós, PhD; University of Duisburg-Essen (Germany) Student co-investigators (Co-Is): ● Léna Nagy, MA; Eötvös Loránd University (Hungary) ● Marianne Danella; Université de Montréal (Canada) ● Campbell Ince; Monash University (Australia) International advisory board: ● Stephanie Antons, PhD, Msc; University of Duisburg-Essen (Germany) ● Lijun Chen, PhD; Fuzhou University (China) ● David Fernandez, PhD, MClinPsych; Nottingham Trent University (Malaysia) ● Ateret Gewirtz-Meydan, PhD; University of Haifa (Israel) ● Yasser Khazaal, MD; University of Montreal (Canada) & University of Lausanne (Switzerland) ● Karol Lewczuk, PhD; Cardinal Stefan Wyszynski University in Warsaw (Poland) ● Gemma Mestre-Bach, PhD; UNIR Universidad Internacional de La Rioja (Spain) ● Dan Miller, PhD; James Cook University (Australia) ● Marc Potenza, MD, PhD; Yale University School of Medicine (US) ● Marco Scanavino MD, PhD; Universidade de São Paulo (Brazil) ● Dan Stein, PhD; University of Cape Town (South Africa) III. Background and research questions Compulsive sexual behavior disorder (CSBD; also referred to as sex addiction, hypersexual disorder/hypersexuality, sexual compulsivity, sexual impulsivity, or out-of-control sexual behaviors) is included in the 11th revision of the International Classification of Diseases (ICD-11) (World Health Organization, 2022). However, this diagnosis is still new with several theoretical and methodological limitations and essential questions that have yet to be addressed (e.g., Grubbs et al., 2020). Since resources for CSB research are limited, research priorities need to be established for the next 10 years (2025–2035) to inform the research community about the most striking questions relevant to the current needs and goals of the global CSB landscape. Research priorities set by a wide community of key stakeholders (e.g., researchers, healthcare providers, and individuals with lived experience) should also be helpful for the goals of policy and decision-makers, funding organizations, health organizations, and those working in treatment and prevention settings related to CSB. In Study 2 of this project, the aim is to engage people with lived experience (PLE) of CSB in identifying research priorities for the next decade (2025–2035). The involvement of PLE is essential to ensure that the perspectives and needs of those directly affected by CSB are incorporated into the research agenda. The long-term goals of this phase are to: (1) empower PLE by giving them a platform to share their insights on the challenges and unmet needs related to CSB; (2) identify critical areas of CSB research, prevention, and treatment that have been overlooked or inadequately addressed; and (3) foster a more inclusive and holistic understanding of CSB, which can inform the development of evidence-based policies and interventions. Additionally, the study seeks to promote greater societal awareness and reduce the stigma surrounding CSB by ensuring that the voices of those most affected are heard in the research process. By integrating the lived experience of participants, this study will contribute to more relevant, actionable, and person-centered research priorities, ultimately improving treatment access, support systems, and the overall well-being of those affected by CSB. As with Study 1, given the exploratory nature of the study, we have not formulated any a priori hypotheses, but instead aim to generate knowledge that can drive future research and inform policy development. IV. Study design Definition of CSB For the purpose of the study, we use the definition of CSB from the 11th revision of the International Classification of Diseases (World Health Organization, 2024): “Compulsive sexual behavior (CSB) disorder is characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behavior. Symptoms may include repetitive sexual activities becoming a central focus of the person’s life to the point of neglecting health and personal care or other interests, activities, and responsibilities; numerous unsuccessful efforts to significantly reduce repetitive sexual behavior; and continued repetitive sexual behavior despite adverse consequences or deriving little or no satisfaction from it. The pattern of failure to control intense, sexual impulses or urges and resulting repetitive sexual behavior is manifested over an extended period of time (e.g., 6 months or more), and causes marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. Distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviors is not sufficient to meet this requirement. CSB may be expressed in a variety of behaviors, including sexual behavior with others, masturbation, use of pornography, cybersex (internet sex), telephone sex, and other forms of repetitive sexual behavior (World Health Organization, 2024).” Procedure The study adopts the Child Health and Nutrition Research Initiative (CHNRI) methodology to establish our research priorities and gaps in CSB-related research, following the methodology of a previous CHNRI project on gambling disorder (https://osf.io/rhjg7/). The CHNRI method is a rigorous and transparent process developed originally to define global child health and nutrition research priorities and subsequently was used in several other health domains (Rudan et al., 2017). The CHNRI method is an exercise engaging key stakeholders (e.g., researchers, healthcare providers, and individuals with lived experience), completed in two to three phases. In the first phase, stakeholders are asked to list the most pressing research questions that require greater attention (i.e., research priorities). In the second phase, expert researchers and mental health professionals are asked to evaluate the research questions previously compiled across stakeholder groups using a standardized set of criteria. The study is planned to be conducted in 2025. The timeframe of research priorities we wish to identify should be relevant within the next 10 years (2025–2035). All surveys will be administered via Qualtrics. All data obtained from participants will be encrypted and can only be accessed by the PI and Co-Is. All data will be securely locked and password protected. Participants who who have been struggling with CSBs will be recruited by using digital advertisements on platforms like Google, sexuality blogs (e.g., Society for Sex Therapy and Research; https://sstarnet.org/), and online newspapers (see precedent at Bőthe et al., 2020), as well as leverage university social media pages, which have proven effective in reaching younger populations with elevated rates of problematic behaviors (Griffiths, 2012; Ince et al., 2023). Additionally, we will explore ethically recruiting participants from online forums focusing on CSBs on platforms like Reddit by seeking moderator approval, ensuring compliance with community guidelines (Ince et al. 2020; Ince et al. 2023) We will add 10 additional languages to the original English version of the survey as we did in Study 1. These languages were selected based on the following criteria, in the same way as described in Study 1: ● The six official languages of the WHO – English, Arabic, Chinese, Spanish, French, and Russian (https://www.who.int/about/policies/multilingualism). ● Languages spoken by the core team and members of the international advisory board: English, French, Hungarian, German, Polish, Spanish, Chinese (Mandarin), Hebrew, and Portuguese. Eligibility criteria for PLE participants: must be at least 18 years old, have experienced difficulties related to CSB either currently or within the past five years (based on self-report), and provide informed consent to participate in the study. There is no financial compensation for study participation. Participants will complete a sociodemographic questionnaire that includes their year of birth, gender identity, sexual orientation, highest level of education, country of residence, current place of residence (e.g., city, town, village), socioeconomic status, primary racial identity, and current religious affiliation. To ensure the inclusion of eligible participants, the survey will also report on their lived experience with CSBs within the past five years (i.e., "Are you currently, or have you in the last 5 years, struggled with compulsive sexual behavior?"). After the sociodemographic questions, participants will answer a set of questions about their experiences with CSBs, including potential manifestations: types of sexual behaviors they have experienced as problematic (e.g., masturbation with pornography, casual sexual encounters); duration of symptoms: Length of time they have experienced CSBs symptoms (measured in weeks, months, or years); treatment history: Whether they have sought professional help for CSBs, types of treatment received (e.g., psychotherapy, group therapy, medication), and barriers to accessing treatment if applicable; and

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