Compulsive Sexual Behavior Disorder (CSBD)
Sexual Addiction Screening Test (SAST-R)
The SAST-R screens for sexual behaviour patterns that warrant clinical assessment. What it measures, and what an elevated score does and does not establish.
Clinically reviewed by Ian Birdwell, LPC, CSAT · 2026-08-19 · Next review 2027-08-19
The SAST-R is a screening questionnaire designed to identify patterns of sexual behaviour that may warrant clinical assessment. It is the most widely used instrument in this field, developed by Patrick Carnes and colleagues as a revision of the original Sexual Addiction Screening Test. It indicates whether a clinical conversation is warranted. It does not diagnose.
What it measures
The SAST-R asks about the features that distinguish a compulsive pattern from a high but unproblematic sex drive: preoccupation, loss of control, escalation, failed attempts to stop, concealment, and continuation despite accumulating consequences.
Those are the same domains the ICD-11 uses to define compulsive sexual behaviour disorder, which is why the instrument remains clinically useful even though it was built inside the addiction framework rather than the WHO's. We explain that distinction in CSBD vs. sex addiction.
Alongside a core set of items, the revised version includes subscales developed for different populations, since the behaviours that indicate a problem differ across groups.
What a result means
An elevated score indicates that the pattern being described resembles the pattern the instrument was built to detect. That is genuinely useful information and it is the limit of what it tells you.
It does not establish that you have CSBD, because:
- Screening instruments are designed to over-identify rather than under-identify. That is the correct trade-off for a screener and it means false positives are expected.
- The instrument cannot distinguish CSBD from its differentials. Someone with obsessive-compulsive disorder and intrusive sexual content may score high while having a clinically different condition requiring different treatment.
- It cannot separate genuine functional impairment from moral distress. The ICD-11 is explicit that distress arising only from moral disapproval does not meet the threshold.
A low score is equally not a clearance. Under-reporting on an instrument about concealed sexual behaviour is not a flaw in the questionnaire; it is a predictable feature of the condition it is screening for.
Where it fits at Iron Ridge
The SAST-R is one of the instruments used at intake and repeated across the clinical arc — baseline, week 4, week 8, and six-month follow-up — so that movement is measured rather than recalled.
It informs the formulation. The formulation is made by a clinician assessing against the ICD-11 6C72 criteria, taking history, and considering the co-occurring conditions that usually drive the behaviour.
If you want to start somewhere
The confidential CSBD self-assessment on this site takes a few minutes and nothing is stored. It is informational rather than diagnostic, and whether you do anything with the result is entirely your decision.
If the questions are uncomfortable to answer honestly, that is worth noticing. It is frequently the most informative part of the exercise.
This page is part of the Compulsive Sexual Behavior Disorder (CSBD) clinical hub.
Frequently asked questions
What is the SAST-R?
The Sexual Addiction Screening Test, Revised — a screening questionnaire developed by Patrick Carnes and colleagues to identify patterns of sexual behaviour that may warrant clinical assessment.
Does a high SAST-R score mean I have a sex addiction?
No. It indicates the pattern resembles what the instrument was built to detect. Screening instruments are designed to over-identify, and the SAST-R cannot distinguish CSBD from conditions like OCD with sexual content.
Does a low score mean I do not have a problem?
Not necessarily. Under-reporting on an instrument about concealed sexual behaviour is a predictable feature of the condition it screens for, not a flaw in the questionnaire.
What does the SAST-R actually measure?
Preoccupation, loss of control, escalation, failed attempts to stop, concealment, and continuation despite consequences — broadly the same domains the ICD-11 uses to define CSBD.
How does Iron Ridge use it?
As one instrument among several at intake, repeated at week 4, week 8, and six-month follow-up so change is measured rather than recalled. It informs the formulation; it does not constitute it.
You do not have to be ready to change to reach out.
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