DSM-IV Axis I Psychopathology in Males with Non-Paraphilic Hypersexual Disorder

The World Federation of Societies of Biological Psychiatry guidelines on the assessment and pharmacological treatment of compulsive sexual behaviour disorder

OBJECTIVES

The current guidelines aim to evaluate the role of pharmacological agents in the treatment of patients with compulsive sexual behaviour disorder (CSBD). They are intended for use in clinical practice by clinicians who treat patients with CSBD.

METHODS

An extensive literature search was conducted using the English-language-literature indexed on PubMed and Google Scholar without time limit, supplemented by other sources, including published reviews.

RESULTS

Each treatment recommendation was evaluated with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. Psychoeducation and psychotherapy are first-choice treatments and should always be conducted. The type of medication recommended depended mainly on the intensity of CSBD and comorbid sexual and psychiatric disorders. There are few randomised controlled trials. Although no medications carry formal indications for CSBD, selective-serotonin-reuptake-inhibitors and naltrexone currently constitute the most relevant pharmacological treatments for the treatment of CSBD. In cases of CSBD with comorbid paraphilic disorders, hormonal agents may be indicated, and one should refer to previously published guidelines on the treatment of adults with paraphilic disorders. Specific recommendations are also proposed in case of chemsex behaviour associated with CSBD.

CONCLUSIONS

An algorithm is proposed with different levels of treatment for different categories of patients with CSBD.

Contradicting classification, nomenclature, and diagnostic criteria of Compulsive Sexual Behavior Disorder (CSBD) and future directions •

Building on the conclusions of the debate papers by Gola et al. (2022) and Sassover and Weinstein (2022), the present commentary further addressed the contradictions between the current classification, nomenclature, and diagnostic criteria of Compulsive Sexual Behavior Disorder (CSBD) with elaborating on the potential roles impulsivity and compulsivity may play in CSBD, and how these characteristics may relate to addictive behaviors in particular. Moreover, it briefly discussed how the classification of CSBD might impact research and clinical practice and proposed potential future research directions that may help to reach a consensus on the classification and core symptoms of CSBD.

Should compulsive sexual behavior (CSB) be considered as a behavioral addiction? A debate paper presenting the opposing view

BACKGROUND AND AIMS

Compulsive sexual behavior disorder (CSBD) has been a long debated issue. While formerly the discussion was about whether to regard CSBD as a distinctive disorder, the current debate is dealing with the classification of this phenomenon. One of the prominent voices in this field considers CSBD as a behavioral addiction and proposes CSBD to be called and diagnosed as sexual addiction (SA). This present debate paper will review the existing evidence supporting this view and it will argue against it.

RESULTS

We have found that a great deal of the current literature is anecdotal while empirical evidence is insufficient. First, the reports about the prevalence of CSBD are contradictory. Additionally, the field mainly suffers from inconsistent defining criteria of CSBD and a consensus which symptoms should be included. As a result, the empirical evidence that does exist is mostly about some symptoms individually and not on the disorder as a whole construct.

CONCLUSIONS

We conclude that currently, there is not enough data supporting CSBD as a behavioral addiction. Further research has to be done, examining CSBD phenomenology as a whole construct and based on a homogeneous criterion.

Revisiting the Role of Impulsivity and Compulsivity in Problematic Sexual Behaviors

Impulsivity and compulsivity are transdiagnostic features associated with clinically relevant aspects of psychiatric disorders, including addictions. However, little research has investigated how impulsivity and compulsivity relate to hypersexuality and problematic pornography use. Thus, the aims of the present study were to investigate (a) self-reported impulsivity and compulsivity with respect to hypersexuality and problematic pornography use and (b) the similarities and possible differences between hypersexuality and problematic pornography use in these domains. Utilizing structural equation modeling (SEM) in a large community sample (N = 13,778 participants; female = 4,151, 30.1%), results indicated that impulsivity (β = .28, β = .26) and compulsivity (β = .23, β = .14) were weakly related to problematic pornography use among men and women, respectively. Impulsivity had a stronger relationship (β = .41, β = .42) with hypersexuality than did compulsivity (β = .21, β = .16) among men and women, respectively. Consequently, impulsivity and compulsivity may not contribute as substantially to problematic pornography use as some scholars have proposed. On the other hand, impulsivity might have a more prominent role in hypersexuality than in problematic pornography use. Future research should examine further social and situational factors associated with problematic pornography use.

Normative and Clinical Self-Perceptions of Sexuality and Their Links to Psychopathology among Adolescents

BACKGROUND

Compulsive sexual behavior (CSB) has been linked to psychopathology among adults. Only preliminary research has been conducted on adolescents. In our study, we examined whether CSB is linked to psychopathology among adolescents or whether it is a part of normal sexual development. We also, examined potential risk and resiliency factors that might influence this link.

METHODS

The study population included 311 high school students (184 males and 127 females) aged 16-18 years who completed self-report measures regarding CSB, psychopathology, temperament, and attachment orientations.

RESULTS

Adolescents with clinical CSB had more severe psychopathologies than nonclinical ones (with moderate and low levels of CSB) and were unable to utilize resilience factors (i.e., low negative affectivity, high effortful control, and/or attachment security).

CONCLUSIONS

Low and moderate levels of CSB seem to be part of the normal development of sexuality among adolescents. Clinical CSB seems to be a deviation from this normal development.

Mood changes after watching pornography on the Internet are linked to tendencies towards Internet-pornography-viewing disorder

Internet-pornography-viewing disorder (IPD) is considered one type of Internet-use disorder. For IPD's development, it was assumed theoretically that a dysfunctional use of Internet pornography to cope with depressive mood or stress might be considered to be a risk factor. To address the effect of Internet pornography use on mood, an online study with three measuring points with a sample of male participants was conducted. Participants were investigated regarding their tendencies towards IPD, personal use of Internet pornography, general mood, perceived stress, and their Internet pornography use motivation. Moreover, participants were asked regarding their current mood, sexual arousal, and need to masturbate before and after they watched Internet pornography self-determinedly in a private environment. Data showed that tendencies towards IPD were associated negatively with feeling generally good, awake, and calm and were correlated positively with perceived stress in daily life and using Internet pornography for excitation seeking and emotional avoidance. Self-determined use of Internet pornography in their private environment was accompanied by changes in mood and indicators of sexual arousal. Moreover, tendencies towards IPD were negatively related to mood before and after Internet-pornography use as well as an actual increase of good and calm mood. The results showed effects of watching Internet pornography on mood and sexual arousal which can be considered having reinforcing effects for the user. Thus, the results are in line with theoretical assumptions on IPD's development, in which the positive (and negative) reinforcement received by Internet-pornography use is related to cue-reactivity and craving reactions.

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Investigation of mood and sexual arousal before and after self-determined Internet pornography use in private environment

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Watching pornography was associated to changes in mood and indicators of sexual arousal

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Current mood as well as changes in mood were associated to symptoms of Internet-pornography-viewing-disorder