Compulsive sexual behavior disorder (CSBD) was included in the ICD-11 as an impulse control disorder, yet pharmacological treatment options remain limited. Naltrexone, an opioid receptor antagonist approved for alcohol and opioid use disorders, has shown promise for compulsive sexual behaviors, though the extended-release injectable formulation has not been evaluated for this indication.

A 54-year-old married man with longstanding compulsive sexual behavior presented with acute symptom escalation following job loss, including compulsive pornography use, financial concealment, occupational impairment, and secondary depressive symptoms. Despite desvenlafaxine 50 mg and weekly psychotherapy incorporating motivational interviewing, cognitive-behavioral, and mindfulness-based techniques, he achieved inadequate symptomatic benefit. Extended-release naltrexone (Vivitrol) 380 mg intramuscular injection monthly was initiated as augmentation, chosen for more consistent receptor occupancy than oral formulations. Symptom severity was assessed using the Compulsive Sexual Behavior Inventory-13 (CSBI-13) and Hypersexual Behavior Inventory-19 (HBI-19) at baseline and monthly over three months. Hepatic function was monitored throughout.

The patient demonstrated substantial improvement on both measures. CSBI-13 scores decreased from 65/65 at baseline to 25/65 at one month (61.5% reduction), stabilizing at 35/65 by month three (46.2% total reduction). HBI-19 scores decreased from 91/95 to 49/95 at one month (46.2% reduction), remaining stable at 47/95 through month three (48.4% total reduction). Liver enzymes remained within normal limits and no adverse events were reported.

This case suggests extended-release naltrexone may be an effective augmentation strategy for CSBD unresponsive to antidepressant pharmacotherapy and psychotherapy. Controlled trials are needed to establish efficacy.

Although problematic pornography use (PPU) will soon be diagnosable through the International Classification for Diseases, 11th revision, its clinical profile remains contentious. The current study assessed whether PPU may be characterized by various symptoms sometimes observed among online recovery forums that currently lack empirical assessment, such as heightened cognitive-affective issues following pornography use and sexual dysfunction with partners as a result of escalating use.

Cross-sectional surveys were completed by male PPUs (N = 138, mean age = 31.75 years, standard deviation = 10.72) recruited via online recovery communities and Amazon Mechanical Turk. Multiple regression analysis was performed using the Problematic Pornography Use Scale as the dependent variable and variables of interest (Arizona Sexual Experiences Scales modified for partnered sex and pornography use, Brunel Mood Scale, Social Interaction Anxiety Scale, and the Tolerance subscale from the Problematic Pornography Consumption Scale) and potential confounders (eg, comorbid psychopathology) as independent variables.

Current levels of pornography use, indicators of tolerance and escalation, greater sexual functioning with pornography, and psychological distress were uniquely associated with PPU severity, while cognitive-affective issues after pornography use, impulsivity and compulsivity were not. Although sexual dysfunction did not predict PPU severity, nearly half the sample indicated sexual dysfunction with intimate partners.

The present findings suggest that PPU may be characterized by tolerance and escalation (as per substance addiction models), greater sexual responsivity toward pornography, and psychological distress. Meanwhile, the high rate of partnered sexual dysfunction observed suggests that PPU might be somewhat separable from other forms of compulsive sexual behavior.