Glossary: the language of CSBD, recovery and partner care

Treatment for compulsive sexual behavior has its own vocabulary, and much of it is used loosely. These are the terms you will meet on this site, in assessments and in treatment, defined the way our clinicians use them. Each one links to a fuller explanation.

A

Accountability. In recovery, the practice of making your behavior visible to people who know your history, such as a group, a clinician or a sponsor, rather than managing it alone. See Accountability and community.

ACT (acceptance and commitment therapy). A therapy that teaches a man to notice urges and difficult feelings without acting on them, and to act on what he values instead. One of the modalities used in the Iron Ridge program. See ACT for CSBD.

Aftercare. The plan and support that follow an intensive program: usually weekly therapy, continuing group or peer support, and the relapse-prevention plan written during treatment. See Aftercare.

APSATS. The Association of Partners of Sex Addicts Trauma Specialists, the professional body that trains and certifies clinicians in partner trauma. Its Multidimensional Partner Trauma Model is the basis of the Iron Ridge Partner & Family Program. See Partner & Family Program.

B

Betrayal trauma. The injury a person suffers when someone they depend on deceives them in a way that threatens the relationship, such as years of hidden sexual behavior. It is a recognized trauma response, not an overreaction, and it is treatable. See What is betrayal trauma?.

Boundaries. Limits a partner sets on what he or she will accept and what he or she will do if they are crossed. A boundary describes the partner's own action; it is not a rule imposed on the other person. See Establishing boundaries.

C

CBT (cognitive behavioral therapy). A structured therapy that maps the thoughts, feelings and small decisions leading to a behavior, and builds alternatives at each step. See CBT for CSBD.

CCPS. Certified Clinical Partner Specialist, the APSATS credential for clinicians who treat partners of people with compulsive sexual behavior. "CCPS-C" means the clinician is a candidate completing the certification. See Partner & Family Program.

Clinical arc. The sequence the eight weeks follow at Iron Ridge: stabilization first, then the work underneath the behavior, then relapse prevention. See The clinical arc.

Codependency. An older model that treated partners as contributors to the problem. The current standard of care, the partner trauma model, treats a partner as someone responding to an injury instead. See What is betrayal trauma?.

Compulsive sexual behavior disorder (CSBD). The World Health Organization's diagnosis, ICD-11 code 6C72: a persistent pattern of failing to control intense, repetitive sexual urges or behavior over an extended period, typically six months or more (a guideline clinicians use, not a strict cutoff), causing significant distress or impairment. See What is compulsive sexual behavior?.

Continued use despite harm. Carrying on with the behavior after it has cost a marriage, a job, money, health or legal standing, and after you have seen that it will cost more. One of the ICD-11 features of CSBD. See Continued use despite harm.

CSAT. Certified Sex Addiction Therapist, a post-licensure specialty credential from IITAP. A CSAT is already a licensed therapist and has completed additional training and supervision specific to compulsive sexual behavior. See What is a CSAT?.

CSBI. The Compulsive Sexual Behavior Inventory, a screening and research questionnaire developed by Eli Coleman and colleagues that measures loss of control and its consequences. It does not diagnose. See The CSBI.

D

Discovery. The moment a partner learns about the hidden behavior, whether he or she found it or was told. Partners often call the date "D-Day." What follows is often a period of acute betrayal trauma. See Safety and stabilization.

Disclosure (therapeutic disclosure). A structured, prepared account of the full history of the behavior, given to a partner with both people's clinicians involved. It exists because partial, unplanned disclosures restart the injury each time. See Rebuilding trust.

Dissociation. Feeling numb, detached or outside yourself, such as losing the drive home. A common response in partners after discovery. See Dissociation.

DSM-5-TR. The American Psychiatric Association's diagnostic manual. It does not include CSBD or "sex addiction," which is why US clinicians document the pattern under related diagnoses. See DSM-5-TR coding for CSBD.

E

Escalation. The way the pattern tends to move over time: more time, more often, more risk, or content and contact further from what a man would once have chosen. See Escalation.

F

Failed attempts to stop. Repeatedly deciding to stop or cut back, and not holding to it. One of the clearest signs that a behavior has become compulsive. See Failed attempts to stop.

G

Group therapy. Clinician-led therapy with a small group of men working on the same pattern. At Iron Ridge, men attend group three times a week; it is the core of the program. See Group therapy.

H

Hypersexuality. A description of sexual thought and behavior that feels like too much. On its own it is not a diagnosis; it can come from CSBD, a bipolar mood episode, medication or neurological causes. See Hypersexuality, explained.

Hypervigilance. A state of constant scanning for danger: checking phones, reading tone, being unable to switch off. One of the most common partner symptoms after discovery. See Hypervigilance.

I

ICD-11. The World Health Organization's International Classification of Diseases, 11th Revision. It lists CSBD as 6C72, in the chapter on impulse control disorders. See ICD-11 6C72 criteria.

IFS (internal family systems). A therapy that works with the different "parts" of a person, including the part that reaches for the behavior and the part that is ashamed of it. See Internal family systems.

IITAP. The International Institute for Trauma and Addiction Professionals, which trains and certifies CSATs and keeps a public directory of them. See What is a CSAT?.

Integrity abuse. A proposed clinical construct from Dr. Omar Minwalla, not a diagnosis. It names the sustained system of deception as an injury in its own right, not just a by-product of the sexual behavior. See Integrity abuse disorder.

Intensive outpatient program (IOP). A level of care between weekly therapy and residential treatment: nine to twelve clinical hours a week, usually for about eight weeks, while living at home and working. Iron Ridge is an IOP. See CSBD IOP.

Intimacy disorder. A clinical framing, not a diagnosis, from the CSAT literature: compulsive sexual behavior understood as a way of managing closeness, delivering intensity without the risk of being known. See Intimacy disorder.

Intrusive thoughts. Images and thoughts about the betrayal that arrive without permission, often more vivid than anything a partner was told. See Intrusive thoughts and images.

L

Loss of control. Doing more, or for longer, than you meant to, or doing it after deciding not to. The central feature of the ICD-11 definition. See Loss of control.

Love addiction. A compulsive pattern of pursuit, fantasy and intensity in romantic relationships, closely tied to attachment. It is a recognized clinical pattern but not a standalone diagnosis. See Love addiction.

M

Moral incongruence. Distress about sexual behavior that conflicts with a person's faith or values. ICD-11 says that distress arising entirely from moral judgments does not, on its own, meet the threshold for CSBD. See CSBD vs. moral incongruence.

Multidimensional Partner Trauma Model (MPTM). The APSATS model of partner care. It begins with safety and stabilization before trauma work and before any couple work. See Partner & Family Program.

O

Out-of-network. Iron Ridge has no contracts with insurance companies. Clients can use their PPO's out-of-network benefits, either through out-of-network billing or a superbill, or pay privately with no claim filed. See Insurance and superbills.

P

Partial hospitalization (PHP). Most of every day at a facility, sleeping at home. Rarely indicated for compulsive sexual behavior alone. Iron Ridge does not provide it. See Treatment options.

PCI. The Pornography Consumption Inventory, developed by Rory Reid and colleagues. It measures why someone uses pornography, not how much, and it does not diagnose. See The PCI.

Porn addiction. The everyday term for compulsive pornography use. Clinically, it is usually assessed as a form of compulsive sexual behavior. See Pornography addiction.

Preoccupation. Thinking about, planning or anticipating the behavior to the point that it crowds out work, relationships and rest. See Preoccupation.

Private pay. Paying for treatment directly, with no insurance claim filed and no diagnosis sent to an insurer. See Pricing.

R

Rebuilding trust. The slow process, after the full truth is known, in which consistent honesty and changed behavior over time give a partner reasons to trust again. See Rebuilding trust.

Recovery coaching. Structured, non-clinical support from a CSAT-informed coach. It is not therapy and does not diagnose or treat. See Recovery coaching.

Relapse. A return to the behavior after a period of stopping. A relapse is an event; what decides whether it becomes a return to the old pattern is what happens next, starting with whether it stays secret. See Relapse prevention.

Residential treatment. Living at a treatment facility, usually for thirty to ninety days. Indicated for a small number of men, such as those who also need medical detox. See Residential programs.

S

Safety and stabilization. The first phase of partner recovery: sleep, basic functioning, physical and emotional safety, and managing acute symptoms before deeper trauma work. See Safety and stabilization.

SAST-R. The Sexual Addiction Screening Test, Revised, developed by Patrick Carnes and colleagues. The most widely used screening questionnaire in the field. It indicates whether an assessment is warranted; it does not diagnose. See The SAST-R.

Secret sexual basement. Dr. Omar Minwalla's term for the concealed sexual life a man builds and maintains over years, a structure in its own right rather than a by-product. It is a descriptive framework, not a diagnosis. See The secret sexual basement.

Sex addiction. The widely used term and treatment framework for compulsive sexual behavior. It is not a formal diagnostic category; the diagnosis is CSBD. See CSBD vs. sex addiction.

Sobriety (sexual sobriety). In CSBD treatment, sobriety does not mean no sex. It is a written, personal definition separating the behavior a man wants to stop from the sexual life he wants to keep or build. See Defining sobriety.

Superbill. An itemized statement of services, with diagnosis and procedure codes, that a client can submit to their insurer for possible out-of-network reimbursement. Submitting one creates a claim on the insurer's record. See Insurance and superbills.

T

Three circles. A tool used in 12-step fellowships to define sobriety: an inner circle of behaviors to stop, a middle circle of warning signs, and an outer circle of healthy behaviors to build. See 12-step fellowships.

Tolerance. When the behavior produces less of the feeling it used to, so it takes more or riskier versions to get the same effect. See Tolerance.

Trauma bond. An attachment that forms or intensifies through cycles of harm and relief. It explains why learning more about the deception can make leaving harder, not easier. See Trauma bond.

Triggers. Reminders, such as a song, a place or a notification tone, that bring the betrayal back in seconds. See Triggers and flashbacks.

12-step fellowships. Peer support groups for compulsive sexual behavior, such as SA, SAA, SLAA and SCA. They are not treatment, and many men find them useful alongside it. See 12-step fellowships.

W

Weekly outpatient therapy. One session a week with one clinician, ideally a CSAT. Enough for an early pattern, and the usual step-down after an intensive program. See Outpatient therapy.

Withdrawal. The agitation, insomnia, irritability, cravings and low mood many men report in the first weeks after stopping. It is not a chemical withdrawal; it is a regulation system missing the tool it relied on. See Withdrawal symptoms.

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