Real Your Brain on Porn excerpted a few lines from ICD-11 comments section. The comment was by MAC (it was not an official WHO statement) and was in a comment rejecting a request to "delete CSBD".

A key excerpt conveniently omitted by Real Your Brain on Porn:

"The ICD-11 approach is consistent with the findings of a recent review of the neurobiology of compulsive sexual behaviour (CSB), which concluded that growing evidence suggested that CSB shared many similarities with addiction but more work was to elucidate specific mechanisms. However, the authors supported its inclusion in ICD-11 because this provides a framework for further study and ultimately refinement of the diagnostic classification for CSBD."

ENTIRE MAC COMMENT
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The rationale for compulsive sexual behaviour disorder (CSBD) and its placement in the grouping of impulse control disorders was first described by the Working Group on Obsessive-Compulsive and Related Disorders, reporting to the Mental Health TAG and consisting of global experts in the area:
Grant, J. E., Atmaca, M., Fineberg, N. A., Fontenelle, L. F., Matsunaga, H., Reddy, Y.C. J., Simpson, H. B., Thomsen, P. H., van den Heuvel, O. A., Veale, D., Woods, D. W., & Stein, D. J. (2014). Impulse control disorders and “behavioural addictions” in the ICD-11. Word Psychiatry, 13, 125-127. doi: 10.1002/wps.20115

A more explicit explanation of the rationale, placement, and definition for CSBD was recently provided by 11 leading global authors on the topic, consisting of scientists and practitioners with direct experience treating or studying compulsive sexual behaviour:
Kraus, S.W., Krueger, R.B., Briken, P., First, M.B., Stein, D.J., Kaplan, M.S., Voon, V., Abdo, C.H.N., Grant, J.E., Atalla, E., & Reed, G.M. (2018). Compulsive sexual behaviour disorder in the ICD-11. World Psychiatry, 17, 109-110.

These groups have both argued that CSBD identifies a clinically important population in need of health services and that the consequences of the condition can be severe—even sometimes fatal—if left untreated. Inclusion of CSBD allows for greater access to health care services for those affected by the condition and is also expected to de stigmatize help seeking for affected persons.

In terms of placement of the entity, although the term ‘sex addiction’ has been taken up by the popular media, the Working Group concluded that available evidence did not support this conceptualization. Instead, a more incremental approach was recommended, placing the category in the grouping of impulse control disorders, with repeated difficulties in repeated controlling one’s sexual impulses and behavior as the core diagnostic feature. In this regard, the proposal mischaracterizes the approach introduced in ICD-11.

The ICD-11 approach is consistent with the findings of a recent review of the neurobiology of compulsive sexual behaviour (CSB), which concluded that growing evidence suggested that CSB shared many similarities with addiction but more work was to elucidate specific mechanisms. However, the authors supported its inclusion in ICD-11 because this provides a framework for further study and ultimately refinement of the diagnostic classification for CSBD. See:

Kowalewska, E., Grubbs, J.B., Potenza, M.N., Gola, M., Draps, M., & Kraus, S.W. (2018) Neurocognitive mechanisms in compulsive sexual behavior disorder. Current Sexual Health Reports, 10, 255-264.

In terms of the expressed concern about misuse, the definition clearly states that ‘Distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviours is not sufficient to meet this requirement.’

Overall, the links provided in this proposal are dated, and lead to material that was posted prior to the publication of the rationale and definition of ICD-11 CSBD in World Psychiatry. Most are discussions of “sexual addiction” or “pornography addiction.” As noted, materials related to the ICD-11 make very clear that CSBD is not intended to be interchangeable with sex addiction, but rather is a substantially different diagnostic framework.

RECOMMENDATION: MSAC recommends rejection of the proposal {to delete CSBD}
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