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Grant Weinandy JT, Lee B, Hoagland KC, Grubbs JB, Bőthe B. Anxiety and Compulsive Sexual Behavior Disorder: A Systematic Review. JOURNAL OF SEX RESEARCH 2023; 60:545-557. [PMID: 35482896 DOI: 10.1080/00224499.2022.2066616] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The inclusion of the novel diagnosis of Compulsive Sexual Behavior Disorder in the forthcoming 11th edition of the International Classification of Diseases has spurred increasing interest in the clinical profile of the disorder. Such attention has included a focus on potential comorbidities, risk factors, or symptoms resulting from such behaviors, including anxiety. Anxiety disorders have long been noted as comorbid with many other diagnoses, such as posttraumatic stress disorder, obsessive compulsive disorder, and substance use disorders. This review aims to understand the relationship between anxiety and compulsive sexual behavior in adults and adolescents, based on available quantitative studies. A search of PsycInfo and PubMed revealed 40 studies which quantitatively assessed a relationship between an anxiety measure and a Compulsive Sexual Behavior Disorder measure, including dissertations and published articles using clinical and community samples. A qualitative synthesis and risk of bias analysis of the studies was conducted, rather than a meta-analysis, due to the variety of methods. Overall, studies were primarily cross-sectional and the relationship between these two constructs was unclear, likely due to several factors, including inconsistent measurement of Compulsive Sexual Behavior Disorder, lack of gender diversity, and very little longitudinal data. Directions for future research are discussed.
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Affiliation(s)
| | - Brinna Lee
- Department of Psychology, Bowling Green State University
| | | | | | - Beáta Bőthe
- Département de Psychologie, Université de Montréal
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2
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Kamolova M, Chen YL, Etuk R, Sacco SJ, Kraus SW. Differences within: Hypersexuality, Sensation Seeking and Pornography Viewing Behaviors in a Sample of Heterosexual, Gay, Bisexual, and Uncertain Men. SEXUAL HEALTH & COMPULSIVITY 2022. [DOI: 10.1080/26929953.2022.2162652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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3
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Turner D, Briken P, Grubbs J, Malandain L, Mestre-Bach G, Potenza MN, Thibaut F. The World Federation of Societies of Biological Psychiatry guidelines on the assessment and pharmacological treatment of compulsive sexual behaviour disorder. DIALOGUES IN CLINICAL NEUROSCIENCE 2022; 24:10-69. [PMID: 37522807 PMCID: PMC10408697 DOI: 10.1080/19585969.2022.2134739] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/18/2022] [Accepted: 10/03/2022] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Daniel Turner
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joshua Grubbs
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
| | - Leo Malandain
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin (site Tarnier) AP-HP, Paris, France
| | - Gemma Mestre-Bach
- Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, La Rioja, Spain
| | - Marc N. Potenza
- Departments of Psychiatry and Neuroscience and Child Study Center, Yale School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Florence Thibaut
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin (site Tarnier) AP-HP, Paris, France
- INSERM U1266, Institute of Psychiatry and Neurosciences, University of Paris Cité, Paris, France
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4
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Snaychuk LA, Ferrão YA, Fontenelle LF, Miguel EC, de Mathis MA, Scanavino MDT, Kim HS. Co-Occurring Obsessive-Compulsive Disorder and Compulsive Sexual Behavior: Clinical Features and Psychiatric Comorbidities. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:4111-4123. [PMID: 36066680 DOI: 10.1007/s10508-022-02412-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/18/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
Obsessive-compulsive disorder (OCD) commonly co-occurs with other psychiatric conditions. Though research is limited, there is preliminary evidence that OCD also co-occurs with compulsive sexual behavior (CSB). Yet, few studies have investigated the demographic, clinical, and psychiatric comorbidities associated with co-occurring OCD and CSB. To address this gap, the current study aimed to evaluate rates of co-occurring OCD and CSB, identify demographic and clinical factors associated with comorbid OCD and CSB, and assess associated psychiatric comorbidity. Participants (N = 950) were patients of a large multisite treatment for OCD. Standardized self-report measures were used to assess demographic and clinical characteristics such as anxiety, depression, and severity and dimensions of OCD. Semi-structured interviews including the SCID were used to assess psychiatric comorbidities. A total of 36 (3.8%) of participants met the criteria for CSB. Binary logistic regression analysis revealed that males were significantly more likely to present with CSB than females and CSB was associated with greater psychiatric comorbidity, particularly impulse control disorders. These findings suggest that individuals with co-occurring OCD and CSB may have more complex treatment needs, and more tailored interventions may be necessary.
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Affiliation(s)
- Lindsey A Snaychuk
- Department of Psychology, Toronto Metropolitan University, 350 Victoria St., Toronto, ON, M5B 2K3, Canada
| | - Ygor A Ferrão
- Clinical Neurosciences Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Leonardo F Fontenelle
- Departamento de Psiquiatria e Medicina Legal, Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB/UFRJ) e Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
- Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | | | - Maria A de Mathis
- Institute of Psychiatry, Universidade de São Paulo, São Paulo, Brazil
| | | | - Hyoun S Kim
- Department of Psychology, Toronto Metropolitan University, 350 Victoria St., Toronto, ON, M5B 2K3, Canada.
- University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, ON, Canada.
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5
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Islam MS, Tasnim R, Sujan MSH, Bőthe B, Ferdous MZ, Sikder MT, Siddique MAB, Toma TY, Kamruzzaman S, Sakib MN, Pinky KN, Islam MR, Anter FS, Hossain A, Hossen I, Kraus SW, Potenza MN. Validation and Evaluation of the Psychometric Properties of the Bangla Version of the Brief Pornography Screen in Men and Women. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00903-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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6
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Wizła M, Kraus SW, Lewczuk K. Perspective: Can psychedelic-assisted therapy be a promising aid in compulsive sexual behavior disorder treatment? Compr Psychiatry 2022; 115:152303. [PMID: 35334305 DOI: 10.1016/j.comppsych.2022.152303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/24/2021] [Accepted: 03/01/2022] [Indexed: 11/03/2022] Open
Abstract
Recently, there has been an increase in studies yielding evidence for psychedelics' anxiolytic and anti-depressive qualities. Preliminary evidence for treatment in substance addiction is also available. In our manuscript, we present a perspective on the possible effectiveness and mechanisms of action of psychedelics' introduction in the treatment of Compulsive Sexual Behavior Disorder (CSBD) and other p roblematic sexual behaviors, which are considered representative of the so-called "behavioral addiction" category. Evidence for the efficacy of Mindfulness Based Interventions in CSBD treatment is promising. Psychedelics- and mindfulness-induced states share common characteristics on both a subjective and objective level. One of the proposed mechanisms regards reduction of experiential avoidance through the promotion of exposure and acceptance. On the neurophysiological level, a shift from higher- to lower-level association regions and an impact on 5- HT2A receptors is observed. Elaborated mechanisms explain the possible enhancement of therapeutic processes by psychedelics. Psychedelics' relative safety and low addictive potential support their introduction into traditional forms of therapy for CSBD and other out of control behaviors.
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Affiliation(s)
- Magdalena Wizła
- Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland.
| | - Shane W Kraus
- Department of Psychology, University of Nevada, Las Vegas, NV, USA.
| | - Karol Lewczuk
- Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland.
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7
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González-Bueso V, Santamaría JJ, Caro-Pérez O, Fernández D, Baño-Alcazar M, Jiménez-Murcia S, Håkansson A, Del Pino-Gutiérrez A, Ribas J. Compulsive Sexual Behavior Online and Non-online in Adult Male Patients and Healthy Controls: Comparison in Sociodemographic, Clinical, and Personality Variables. Front Psychiatry 2022; 13:839788. [PMID: 35592380 PMCID: PMC9110760 DOI: 10.3389/fpsyt.2022.839788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/28/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND AIMS Compulsive sexual behavior (CSB) is characterized by a persistent pattern of failure to control sexual impulses, resulting in repetitive sexual behavior over a prolonged period that causes marked discomfort in personal, family, social, school, work or in other functional areas. The evolution of the worldwide incidence of this disorder warrants further studies focused on examining the characteristics of the affected people. The purpose of this study was to compare online compulsive sexual behavior (when the problematic sexual practices were online) and non-online compulsive sexual behavior (when the problematic sexual practices were in-person) patients (OCSB and non-OCSB, respectively), and healthy controls in terms of sexual behavior, sociodemographic variables and psychopathology and personality characteristics. METHOD A sample of 80 CSB male patients consecutively admitted to our Behavioral Addictions Unit and 25 healthy male controls, participated in the study. The CSB group was comprised by 36 online CSB patients (mean age 42.25, SD: 10.0) and 44 non-online CSB patients (mean age 43.5, SD: 11.9). Scores on the Sexual Compulsivity Scale, Temperament and Character Inventory-Revised, Symptom CheckList-90 Items-Revised, State-Trait Anxiety Index, and additional demographic, clinical, and social/family variables related to sexual behaviors between the three groups were compared. RESULTS When compared with healthy controls, both clinical groups showed higher psychopathology in all measures as well as higher harm avoidance and self-transcendence and lower self-directness and cooperativeness. When comparing OCSB and non-OCSB patients, results showed that non-OCSB patients exhibited higher prevalence of sexually transmitted diseases, higher percentage of homosexual and bisexual orientation and higher scores in anxiety and in sexual impulse control failure. CONCLUSION Both online and non-online CSB patients may experience a variety of comorbid psychological and medical problems. Patients with non-OCSB may suffer more consequences that are negative. Therefore, these results should be considered when designing the most convenient therapeutic approach. Whether sexual orientation plays a role in treatment needs and treatment response in CSB, should be further explored in future studies.
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Affiliation(s)
- Vega González-Bueso
- Atención e Investigación en Socioadicciones (AIS), Mental Health and Addictions Network, Generalitat de Catalunya, Sistema Sanitari Integral d'Utilització Pública de Catalunya (SISCAT), Barcelona, Spain
| | - Juan José Santamaría
- Atención e Investigación en Socioadicciones (AIS), Mental Health and Addictions Network, Generalitat de Catalunya, Sistema Sanitari Integral d'Utilització Pública de Catalunya (SISCAT), Barcelona, Spain
| | - Oriol Caro-Pérez
- CELBIOTECH_Paper Engineering Research Group, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Daniel Fernández
- Department of Statistics and Operations Research (DEIO), Universitat Politècnica de Catalunya BarcelonaTec (UPC), Barcelona, Spain.,Institute of Mathematics of UPC - BarcelonaTech (IMTech), Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Marta Baño-Alcazar
- Atención e Investigación en Socioadicciones (AIS), Mental Health and Addictions Network, Generalitat de Catalunya, Sistema Sanitari Integral d'Utilització Pública de Catalunya (SISCAT), Barcelona, Spain
| | - Susana Jiménez-Murcia
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Anders Håkansson
- Division of Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Malmö Addiction Center, Competence Center Addiction, Region Skåne, Malmö, Sweden
| | - Amparo Del Pino-Gutiérrez
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, University of Barcelona, Barcelona, Spain
| | - Joan Ribas
- Atención e Investigación en Socioadicciones (AIS), Mental Health and Addictions Network, Generalitat de Catalunya, Sistema Sanitari Integral d'Utilització Pública de Catalunya (SISCAT), Barcelona, Spain
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8
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Prevalence of Suicidal Behavior and Associated Clinical Correlates in Patients with Behavioral Addictions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111085. [PMID: 34769603 PMCID: PMC8583661 DOI: 10.3390/ijerph182111085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/17/2022]
Abstract
Addictive disorders are characterized by severe consequences, including suicidal events, but most studies investigating the association between addiction and suicidal risk have focused on substance use disorders and gambling disorder at the expense of the rest of behavioral addictions. This study examined the prevalence and the associated clinical correlates of suicidal ideation and suicide attempts in a sample of patients with a diagnosis of behavioral addiction. The total sample consisted of 4404 individuals: 4103 of these patients with gambling disorder, 99 with gaming disorder, 44 with sex addiction, and 158 with buying–shopping disorder. All of them were assessed consecutively at a specialized hospital unit for the treatment of behavioral addictions. Participants attended two clinical interviews and completed self-reported questionnaires to explore clinical features of behavioral addictions, personality traits, psychopathological symptomatology, suicidal behavior, and sociodemographic variables. The highest prevalence of suicidal ideation was found in patients with gambling disorder (22.9%), followed by buying–shopping disorder (18.4%), sex addiction (18.2%), and gaming disorder (6.1%). The highest prevalence of suicide attempts was registered for sex addiction (9.1%), followed by buying–shopping disorder (7.6%), gambling disorder (6.7%), and gaming disorder (3.0%). Female gender and unemployment constituted two relevant sociodemographic factors associated with suicidal risk in gambling disorder, gaming disorder, and buying–shopping disorder. Lack of family support appeared as a relevant risk factor, except for gaming disorder. These results pointed out that suicide is a prevalent behavior in behavioral addictions, and clinicians and researchers need to pay particular attention to the specificities of each behavioral addiction when assessing suicidal risk.
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9
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Firoozikhojastehfar R, Asgari K, Kalantari M, Raisi F, Shahvari Z, Bayat Kharadmand A. Family Duty in Negligent Society: A Qualitative Study on Iranian Sex Addicts. SEXUAL HEALTH & COMPULSIVITY 2021. [DOI: 10.1080/26929953.2022.2037033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Griffin KR, Way BM, Kraus SW. Controversies and Clinical Recommendations for the Treatment of Compulsive Sexual Behavior Disorder. CURRENT ADDICTION REPORTS 2021. [DOI: 10.1007/s40429-021-00393-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Savard J, Hirvikoski T, Görts Öberg K, Dhejne C, Rahm C, Jokinen J. Impulsivity in Compulsive Sexual Behavior Disorder and Pedophilic Disorder. J Behav Addict 2021; 10:839-847. [PMID: 34280126 PMCID: PMC8997222 DOI: 10.1556/2006.2021.00044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 05/23/2021] [Accepted: 06/13/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Impulsivity is regarded as a risk factor for sexual crime reoffending, and a suggested core feature in Compulsive Sexual Behavior Disorder. The aim of this study was to explore clinical (e.g. neurodevelopmental disorders), behavioral and neurocognitive dimensions of impulsivity in disorders of problematic sexuality, and the possible correlation between sexual compulsivity and impulsivity. METHODS Men with Compulsive Sexual Behavior Disorder (n = 20), and Pedophilic Disorder (n = 55), enrolled in two separate drug trials in a specialized Swedish sexual medicine outpatient clinic, as well as healthy male controls (n = 57) were assessed with the Hypersexual Behavior Inventory (HBI) for sexual compulsivity, and with the Barratt Impulsiveness Scale (BIS) and Connors' Continuous Performance Test-II (CPT-II) for impulsivity. Psychiatric comorbidity information was extracted from interviews and patient case files. RESULTS Approximately a quarter of the clinical groups had Attention-Deficit/Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder. Both clinical groups reported more compulsive sexuality (r = 0.73-0.75) and attentional impulsivity (r = 0.36-0.38) than controls (P < 0.05). Based on results on univariate correlation analysis, BIS attentional score, ADHD, and Commissions T-score from CPT-II were entered in a multiple linear regression model, which accounted for 15% of the variance in HBI score (P < 0.0001). BIS attentional score was the only independent positive predictor of HBI (P = 0.001). DISCUSSION Self-rated attentional impulsivity is an important associated factor of compulsive sexuality, even after controlling for ADHD. Psychiatric comorbidity and compulsive sexuality are common in Pedophilic Disorder. CONCLUSION Neurodevelopmental disorders and attentional impulsivity - including suitable interventions - should be further investigated in both disorders.
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Affiliation(s)
- Josephine Savard
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden,ANOVA, Karolinska University Hospital, Stockholm, Sweden,Corresponding author. ANOVA, Karolinska University Hospital, 171 76, Stockholm, Sweden. Tel.: (+46)8-517 732 00. fax: (+46)8-517 718 14. E-mail:
| | - Tatja Hirvikoski
- Department of Women’s and Children’s Health, Pediatric Neuropsychiatry Unit, Centre for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet, Stockholm, Sweden,Habilitation & Health, Stockholm Health Care Services, Region Stockholm, Sweden,Centre for Psychiatry Research, Region Stockholm, Stockholm, Sweden
| | - Katarina Görts Öberg
- ANOVA, Karolinska University Hospital, Stockholm, Sweden,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Dhejne
- ANOVA, Karolinska University Hospital, Stockholm, Sweden,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Christoffer Rahm
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Jussi Jokinen
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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12
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Sexual addiction 25 years on: A systematic and methodological review of empirical literature and an agenda for future research. Clin Psychol Rev 2020; 82:101925. [PMID: 33038740 DOI: 10.1016/j.cpr.2020.101925] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 12/16/2022]
Abstract
In 1998, Gold and Heffner authored a landmark review in Clinical Psychology Review on the topic of sexual addiction that concluded that sexual addiction, though increasingly popular in mental health settings, was largely based on speculation, with virtually no empirical basis. In the more than two decades since that review, empirical research around compulsive sexual behaviors (which subsumes prior research about sexual addiction) has flourished, ultimately culminating in the inclusion of a novel diagnosis of Compulsive Sexual Behavior Disorder in the eleventh edition of the World Health Organization's International Classification of Diseases. The present work details a systematic review of empirical research published between January 1st, 1995 and August 1st, 2020 related to compulsive sexual behaviors, with a specific focus on evaluating the methodologies of that literature. This review yielded 371 papers detailing 415 individual studies. In general, the present review finds that, although research related to compulsive sexual behaviors has proliferated, much of this work is characterized by simplistic methodological designs, a lack of theoretical integration, and an absence of quality measurement. Moreover, the present review finds a virtual absence of high-quality treatment-related research published within this time frame. Implications of these findings for both clinical practice and future research are discussed.
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13
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Ince C, Yücel M, Albertella L, Fontenelle LF. Exploring the clinical profile of problematic pornography use. CNS Spectr 2020; 26:1-10. [PMID: 32690117 DOI: 10.1017/s1092852920001686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND 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. METHOD 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Campbell Ince
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Murat Yücel
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Lucy Albertella
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Leonardo F Fontenelle
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
- Obsessive, Compulsive and Anxiety Spectrum Research Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
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14
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Kraus SW, Gola M, Grubbs JB, Kowalewska E, Hoff RA, Lew-Starowicz M, Martino S, Shirk SD, Potenza MN. Validation of a Brief Pornography Screen across multiple samples. J Behav Addict 2020; 9:259-271. [PMID: 32644937 PMCID: PMC8939429 DOI: 10.1556/2006.2020.00038] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 04/05/2020] [Accepted: 05/16/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS To address current gaps around screening for problematic pornography use (PPU), we initially developed and tested a six-item Brief Pornography Screen (BPS) that asked about PPU in the past six months. METHODS AND PARTICIPANTS We recruited five independent samples from the U.S. and Poland to evaluate the psychometric properties of the BPS. In Study 1, we evaluated the factor structure, reliability, and elements of validity using a sample of 224 U.S. veterans. One item from the BPS was dropped in Study 1 due to low item endorsement. In Studies 2 and 3, we further investigated the five-item the factor structure of the BPS and evaluated its reliability and validity in two national U.S. representative samples (N = 1,466, N = 1,063, respectively). In Study 4, we confirmed the factor structure and evaluated its validity and reliability using a sample of 703 Polish adults. In Study 5, we calculated the suggested cut-off score for the screen using a sample of 105 male patients seeking treatment for compulsive sexual behavior disorder (CSBD). RESULTS Findings from a principal components analysis and confirmatory factor analysis supported a one-factor solution which yielded high internal consistency (α = 0.89-0.90), and analyses further supported elements of construct, convergent, criterion, and discriminant validity of the newly developed screen. Results from a Receiver Operating Characteristic (ROC) curve suggested a cut-off score of four or higher for detecting possible PPU. CONCLUSIONS The BPS appears to be psychometrically sound, short, and easy to use in various settings with high potential for use in populations across international jurisdictions.
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Affiliation(s)
- Shane W. Kraus
- Department of Psychology
,
University of Nevada, Las Vegas
,
Las Vegas
,
NV
,
USA,
Corresponding author's e-mail:
| | - Mateusz Gola
- Institute of Psychology
,
Polish Academy of Sciences
,
Warsaw
,
Poland,Swartz Center for Computational Neuroscience, Institute for Neural Computations
,
University of California San Diego
,
San Diego
,
CA
,
USA
| | - Joshua B. Grubbs
- Department of Psychology
,
Bowling Green State University
,
Bowling Green
,
OH
,
USA
| | - Ewelina Kowalewska
- Department of Psychiatry
,
Centre of Postgraduate Medical Education
,
Warsaw
,
Poland
| | - Rani A. Hoff
- Department of Psychiatry
,
Yale University School of Medicine
,
New Haven
,
CT
,
USA,Northeast Program Evaluation Center
,
VA Connecticut Healthcare System
,
West Haven
,
CT
,
USA
| | - Michał Lew-Starowicz
- Department of Psychiatry
,
Centre of Postgraduate Medical Education
,
Warsaw
,
Poland
| | - Steve Martino
- Department of Psychiatry
,
Yale University School of Medicine
,
New Haven
,
CT
,
USA,VISN 1 New England MIRECC, VA Connecticut Healthcare System
,
West Haven
,
CT
,
USA
| | - Steven D. Shirk
- VISN 1 New England MIRECC, VA Connecticut Healthcare System
,
West Haven
,
CT
,
USA,University of Massachusetts Medical School
,
Worcester
,
MA
,
USA
| | - Marc N. Potenza
- Department of Psychiatry
,
Yale University School of Medicine
,
New Haven
,
CT
,
USA,Connecticut Council on Problem Gambling
,
Wethersfield
,
CT
,
USA,Connecticut Mental Health Center
,
New Haven
,
CT
,
USA,Department of Neuroscience and Child Study Center
,
Yale University School of Medicine
,
New Haven
,
CT
,
USA
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15
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Moisson J, Potenza MN, Shirk SD, Hoff RA, Park CL, Kraus SW. Psychopathology and Hypersexuality among Veterans with and without Histories of Alcohol‐use Disorders. Am J Addict 2019; 28:398-404. [DOI: 10.1111/ajad.12941] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/10/2019] [Accepted: 07/20/2019] [Indexed: 01/10/2023] Open
Affiliation(s)
- Jonathan Moisson
- Department of PsychiatryYale University School of Medicine New Haven Connecticut
- Faculté de médecine Xavier BichatUniversité de Paris Paris France
| | - Marc N. Potenza
- Department of PsychiatryYale University School of Medicine New Haven Connecticut
- Connecticut Mental Health Center New Haven Connecticut
- Connecticut Council on Problem Gambling Wethersfield Connecticut
| | - Steven D. Shirk
- VISN 1 New England MIRECCEdith Nourse Rogers Memorial Veterans Hospital Bedford Massachusetts
- Deparment of Psychiatry and Population and Quantitative Health SciencesUniversity of Massachusetts School of Medicine Worcester Massachusetts
| | - Rani A. Hoff
- Department of PsychiatryYale University School of Medicine New Haven Connecticut
- Northeast Program Evaluation CenterVA Connecticut Healthcare System West Haven Connecticut
| | - Crystal L. Park
- Department of Psychological SciencesUniversity of Connecticut Storrs Connecticut
| | - Shane W. Kraus
- VISN 1 New England MIRECCEdith Nourse Rogers Memorial Veterans Hospital Bedford Massachusetts
- Department of PsychologyUniveristy of Nevada Las Vegas Nevada
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16
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Fuss J, Briken P, Stein DJ, Lochner C. Compulsive sexual behavior disorder in obsessive-compulsive disorder: Prevalence and associated comorbidity. J Behav Addict 2019; 8:242-248. [PMID: 31079471 PMCID: PMC7044559 DOI: 10.1556/2006.8.2019.23] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/20/2019] [Accepted: 04/07/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND AIMS Compulsive sexual behavior disorder (CSBD) will be included in ICD-11 as an impulse-control disorder. CSBD also shares clinical features with obsessive-compulsive spectrum disorders (OCSDs) and behavioral addictions. There has been relatively little systematic investigation of CSBD in obsessive-compulsive disorder (OCD), the paradigmatic compulsive disorder. We aimed to determine prevalence of CSBD in OCD, and its associated sociodemographic and clinical features, including associated comorbidity, to learn more about the nature of CSBD. METHODS Adult outpatients with current OCD (N = 539) participated in this study. The Structured Clinical Interview for OCSDs was used to diagnose OCSDs (Tourette's syndrome, compulsive shopping, pathological gambling, kleptomania, pyromania, intermittent explosive disorder, self-injurious behavior, and CSBD). Prevalence rates of OCSDs in male versus female patients as well as comorbid disorders in OCD patients with and without CSBD were compared. RESULTS Lifetime prevalence of CSBD was 5.6% in patients with current OCD and significantly higher in men than women. OCD patients with and without CSBD were similar in terms of age, age of onset of OCD, present OCD illness severity, as well as educational background. Lifetime prevalence rates of several mood, obsessive-compulsive, and impulse-control disorders were considerably elevated in patients with lifetime CSBD. DISCUSSION AND CONCLUSIONS A substantive number of OCD patients suffered from CSBD. CSBD in OCD was more likely comorbid with other mood, obsessive-compulsive, and impulse-control disorders, but not with disorders due to substance use or addictive behaviors. This finding supports conceptualization of CSBD as a compulsive-impulsive disorder.
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Affiliation(s)
- Johannes Fuss
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dan J. Stein
- MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | - Christine Lochner
- MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
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17
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Kraus SW, Sturgeon JA, Potenza MN. Specific Forms of Passionate Attachment Differentially Mediate Relationships Between Pornography Use and Sexual Compulsivity in Young Adult Men. ACTA ACUST UNITED AC 2019. [DOI: 10.1080/10720162.2018.1532362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Shane W. Kraus
- VISN 1 New England MIRECC, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts
- Division of Addiction Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
| | - John A. Sturgeon
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Marc N. Potenza
- Departments of Psychiatry and Neuroscience and Child Study Center, Yale University School of Medicine, New Haven, Connecticut
- Connecticut Council on Problem Gambling, Wethersfield, Connecticut
- Connecticut Mental Health Center, New Haven, Connecticut
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18
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Same Same but Different: A Clinical Characterization of Men with Hypersexual Disorder in the Sex@Brain Study. J Clin Med 2019; 8:jcm8020157. [PMID: 30704084 PMCID: PMC6406591 DOI: 10.3390/jcm8020157] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 11/17/2022] Open
Abstract
Problems arising from hypersexual behavior are often seen in clinical settings. We aimed to extend the knowledge about the clinical characteristics of individuals with hypersexual disorder (HD). A group of people who fulfilled the proposed diagnostic criteria for HD (men with HD, n = 50) was compared to a group of healthy controls (n = 40). We investigated differences in sociodemographic, neurodevelopmental, and family factors based on self-report questionnaires and clinical interviews. Men with HD reported elevated rates of sexual activity, paraphilias, consumption of child abusive images, and sexual coercive behavior compared to healthy controls. Moreover, rates of affective disorders, attachment difficulties, impulsivity, and dysfunctional emotion regulation strategies were higher in men with HD. Men with HD seem to have experienced various forms of adverse childhood experiences, but there were no further differences in sociodemographic, neurodevelopmental factors, and family factors. Regression analyses indicated that attachment-related avoidance and early onset of masturbation differentiated between men with HD and healthy controls. In conclusion, men with HD appear to have the same neurodevelopment, intelligence levels, sociodemographic background, and family factors compared to healthy controls, but they report different and adverse experiences in childhood, problematic sexual behavior, and psychological difficulties.
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19
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Varo C, Murru A, Salagre E, Jiménez E, Solé B, Montejo L, Carvalho AF, Stubbs B, Grande I, Martínez-Arán A, Vieta E, Reinares M. Behavioral addictions in bipolar disorders: A systematic review. Eur Neuropsychopharmacol 2019; 29:76-97. [PMID: 30420190 DOI: 10.1016/j.euroneuro.2018.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/18/2018] [Accepted: 10/23/2018] [Indexed: 12/16/2022]
Abstract
Clinical and epidemiological research suggests that behavioral addictions (BA) are associated with a wide range of psychiatric disorders. However, the relationship between BA and bipolar disorders (BD) has not been thoroughly explored. The aim of this systematic review was to critically summarize and evaluate the current available evidence regarding a possible association between BA and BD. A systematic review of major electronic databases according to PRISMA guidelines was conducted from inception to 31st December 2017. We sought quantitative studies data concerning prevalence of comorbidity, features and treatment related to BA-BD comorbidity. Data were narratively synthesized. Of the 1250 studies returned from the search, a total of 28 articles were included in this review. BA may be overrepresented in BD samples, and the other way around. Pathological gambling and kleptomania were the most prevalent conditions followed by compulsive buying, compulsive sexual behavior and internet addiction. BA was also associated with other mood disorders, anxiety disorders and substance use disorder. BD-BA comorbidity was related with more severe course of illness. Studies on treatment strategies for BD-BA comorbidity are rather limited; only one randomized controlled trial that fulfilled inclusion criteria was identified. Methodological heterogeneity in terms of design and results among studies was found. BD-BA commonly co-occurs although there is a need for rigorous studies. Routine screening and adequate assessment may be helpful in BD patients to identify individuals at risk for BA and to effectively manage the complex consequences associated with BA-BD comorbidity.
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Affiliation(s)
- C Varo
- Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - A Murru
- Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - E Salagre
- Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - E Jiménez
- Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - B Solé
- Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - L Montejo
- Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - A F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - B Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom
| | - I Grande
- Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - A Martínez-Arán
- Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - E Vieta
- Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - M Reinares
- Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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20
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Kraus SW, Martino S, Potenza MN, Park C, Merrel JD, Hoff RA. Examining Compulsive Sexual Behavior and Psychopathology Among a Sample of Postdeployment U.S. Male and Female Military Veterans. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000147] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Shane W. Kraus
- VISN 1 New England MIRECC, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts
| | - Steve Martino
- Department of Psychiatry, Yale University School of Medicine, and VISN 1 New England MIRECC, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Marc N. Potenza
- Department of Psychiatry, Yale University School of Medicine, and Department of Neurobiology, Child Study Center, CASAColumbia, and Connecticut Mental Health Center, Yale University School of Medicine
| | - Crystal Park
- Department of Psychological Science, University of Connecticut
| | - Jeremy D. Merrel
- VISN 1 New England MIRECC, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Rani A. Hoff
- Department of Psychiatry, Yale University School of Medicine, and VISN 1 New England MIRECC, VA Connecticut Healthcare System, West Haven, Connecticut
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21
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Antonio N, Diehl A, Niel M, Pillon S, Ratto L, Pinheiro MC, Silveira D, Otani TZ, Otani V, Cordeiro Q, Ushida R. Sexual addiction in drug addicts: The impact of drug of choice and poly-addiction. Rev Assoc Med Bras (1992) 2017; 63:414-421. [PMID: 28724038 DOI: 10.1590/1806-9282.63.05.414] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 11/20/2016] [Indexed: 11/21/2022] Open
Abstract
Objective: To compare the risk of comorbid sexual addiction in a sample of individuals with a diagnosis of substance dependence, stratifying the sample by drug of choice as well as by mono versus polysubstance addiction. Method: All data were collected at Santa Casa de São Paulo, Brazil. The study sample comprised all alcohol or drug dependents admitted to the Addiction Treatment Unit between November 2013 and August 2014. A generalized linear model with a binomial distribution was performed to compare the odds of having a Sexual Addiction Screening Test (SAST) score greater than 6 points in the subgroups analyzed. Results: A total of 133 participants were included in our analysis, all reporting cocaine/crack and/or alcohol as drug of choice. Polysubstance addicts had a significant higher risk of a positive screening for sexual addiction compared to monosubstance addicts, age-sex adjusted odds ratios of sexual addiction being respectively 2.72 (95CI 1.1-6.71) and 0.37 (95CI 0.15-0.91). The odds of a SAST score greater than 6 was not statistically different between the cocaine/crack and alcohol groups, respectively 0.38 (95CI 0.14-1.02) and 2.67 (95CI 0.98-7.25). We found a significant relation between stronger drug addiction and greater levels of sexual addiction in the cocaine/crack group (p=0.0012), but not in the alcohol group. Conclusion: Our study reinforces the importance of assessing sexual behavior of drug addicts in clinical practice, especially considering users of multiple substances or with severe dependence.
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Affiliation(s)
- Nelson Antonio
- Center for Integrated Mental Health (CAISM), Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil
| | - Alessandra Diehl
- Psychiatric Department. Sexuality Studies Group (Gesex), Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Marcelo Niel
- Center for Integrated Mental Health (CAISM), Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil
| | - Sandra Pillon
- Psychiatric Nursing and Social Science Department, Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Lilian Ratto
- Center for Integrated Mental Health (CAISM), Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil
| | - Maria Carolina Pinheiro
- Center for Integrated Mental Health (CAISM), Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil
| | | | - Thais Zelia Otani
- Center for Integrated Mental Health (CAISM), Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil
| | - Victor Otani
- Center for Integrated Mental Health (CAISM), Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil
| | - Quirino Cordeiro
- Center for Integrated Mental Health (CAISM), Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil
| | - Ricardo Ushida
- Center for Integrated Mental Health (CAISM), Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil
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22
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Affiliation(s)
- Gayle Brewer
- School of Psychology, University of Liverpool, Liverpool, UK
| | - Paul Tidy
- School of Psychology, University of Central Lancashire, Preston, UK
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23
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Kraus SW, Voon V, Potenza MN. Should compulsive sexual behavior be considered an addiction? Addiction 2016; 111:2097-2106. [PMID: 26893127 PMCID: PMC4990495 DOI: 10.1111/add.13297] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/30/2015] [Accepted: 01/04/2016] [Indexed: 12/16/2022]
Abstract
AIMS To review the evidence base for classifying compulsive sexual behavior (CSB) as a non-substance or 'behavioral' addiction. METHODS Data from multiple domains (e.g. epidemiological, phenomenological, clinical, biological) are reviewed and considered with respect to data from substance and gambling addictions. RESULTS Overlapping features exist between CSB and substance use disorders. Common neurotransmitter systems may contribute to CSB and substance use disorders, and recent neuroimaging studies highlight similarities relating to craving and attentional biases. Similar pharmacological and psychotherapeutic treatments may be applicable to CSB and substance addictions, although considerable gaps in knowledge currently exist. CONCLUSIONS Despite the growing body of research linking compulsive sexual behavior (CSB) to substance addictions, significant gaps in understanding continue to complicate classification of CSB as an addiction.
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Affiliation(s)
- Shane W. Kraus
- VISN 1 Mental Illness Research Education and Clinical Centers, VA Connecticut Healthcare System, West Haven, CT USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Valerie Voon
- University of Cambridge, Cambridge, United Kingdom
| | - Marc N. Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
- Department of Neurobiology, Child Study Center and CASAColumbia, Yale University School of Medicine, New Haven, CT USA
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24
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25
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26
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Miner MH, Romine RS, Raymond N, Janssen E, MacDonald A, Coleman E. Understanding the Personality and Behavioral Mechanisms Defining Hypersexuality in Men Who Have Sex With Men. J Sex Med 2016; 13:1323-1331. [PMID: 27486137 PMCID: PMC4996734 DOI: 10.1016/j.jsxm.2016.06.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Hypersexuality has been conceptualized as sexual addiction, compulsivity, and impulsivity, among others, in the absence of strong empirical data in support of any specific conceptualization. AIM To investigate personality factors and behavioral mechanisms that are relevant to hypersexuality in men who have sex with men. METHODS A sample of 242 men who have sex with men was recruited from various sites in a moderate-size mid-western city. Participants were assigned to a hypersexuality group or a control group using an interview similar to the Structured Clinical Interview for the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition. Self-report inventories were administered that measured the broad personality constructs of positive emotionality, negative emotionality, and constraint and more narrow constructs related to sexual behavioral control, behavioral activation, behavioral inhibition, sexual excitation, sexual inhibition, impulsivity, attention-deficit/hyperactivity disorder, and sexual behavior. MAIN OUTCOME MEASURES Hierarchical logistic regression was used to determine the relation between these personality and behavioral variables and group membership. RESULTS A hierarchical logistic regression controlling for age showed a significant positive relation between hypersexuality and negative emotionality and a negative relation with constraint. None of the behavioral mechanism variables entered this equation. However, a hierarchical multiple regression analysis predicting sexual behavioral control indicated that lack of such control was positively related to sexual excitation and sexual inhibition owing to the threat of performance failure and negatively related to sexual inhibition owing to the threat of performance consequences and general behavioral inhibition CONCLUSION Hypersexuality was found to be related to two broad personality factors that are characterized by emotional reactivity, risk taking, and impulsivity. The associated lack of sexual behavior control is influenced by sexual excitatory and inhibitory mechanisms, but not by general behavioral activation and inhibitory mechanisms.
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Affiliation(s)
- Michael H Miner
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA.
| | | | - Nancy Raymond
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA; Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Erick Janssen
- Institute for Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Flanders, Belgium
| | - Angus MacDonald
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Eli Coleman
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
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27
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Kraus SW, Martino S, Potenza MN. Clinical Characteristics of Men Interested in Seeking Treatment for Use of Pornography. J Behav Addict 2016; 5:169-78. [PMID: 27348557 PMCID: PMC5387768 DOI: 10.1556/2006.5.2016.036] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 04/16/2016] [Indexed: 01/03/2023] Open
Abstract
Background and aims This study examined the prevalence of, and factors associated with, men's interest in seeking treatment for use of pornography. Methods Using an Internet-based data-collection procedure, we recruited 1,298 male pornography users to complete questionnaires assessing demographic and sexual behaviors, hypersexuality, pornography-use characteristics, and current interest in seeking treatment for use of pornography. Results Approximately 14% of men reported an interest in seeking treatment for use of pornography, whereas only 6.4% of men had previously sought treatment for use of pornography. Treatment-interested men were 9.5 times more likely to report clinically significant levels of hypersexuality compared with treatment-disinterested men (OR = 9.52, 95% CI = 6.72-13.49). Bivariate analyses indicated that interest-in-seeking-treatment status was associated with being single/unmarried, viewing more pornography per week, engaging in more solitary masturbation in the past month, having had less dyadic oral sex in the past month, reporting a history of seeking treatment for use of pornography, and having had more past attempts to either "cut back" or quit using pornography completely. Results from a binary logistic regression analysis indicated that more frequent cut back/quit attempts with pornography and scores on the Hypersexual Behavior Inventory - Control subscale were significant predictors of interest-in-seeking-treatment status. Discussion and conclusions Study findings could be used to inform current screening practices aimed at identifying specific aspects of sexual self-control, impulsivity, and/or compulsivity associated with problematic use of pornography among treatment-seeking individuals.
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Affiliation(s)
- Shane W. Kraus
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
- VISN 1 New England MIRECC, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Steve Martino
- VISN 1 New England MIRECC, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Marc N. Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Neurobiology, Child Study Center, CASAColumbia and Connecticut Mental Health Center, Yale University School of Medicine, New Haven, CT, USA
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28
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Parsons JT, Rendina HJ, Moody RL, Ventuneac A, Grov C. Syndemic production and sexual compulsivity/hypersexuality in highly sexually active gay and bisexual men: further evidence for a three group conceptualization. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1903-13. [PMID: 26081246 PMCID: PMC4561029 DOI: 10.1007/s10508-015-0574-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 01/14/2015] [Accepted: 01/14/2015] [Indexed: 05/10/2023]
Abstract
Among gay and bisexual men (GBM), a syndemic describes a situation in which negative conditions (e.g., childhood sexual abuse, intimate partner violence, depression, polysubstance use) co-occur such to amplify HIV risk. Research has suggested that sexual compulsivity (SC) may also be a syndemic condition. Between 2011 and 2013, 368 highly sexually active (9+ male partners in 90 days) GBM completed a survey of syndemic factors as well as measures of sexual compulsivity (Sexual Compulsivity Scale [SCS]) and hypersexuality (hypersexual disorder screening inventory [HDSI]). Based on scores on the SCS and HDSI, participants were organized into three groups-negative on both ("Neither SC nor HD"); positive on the SCS only ("SC Only"), and positive on both the SCS and the HDSI ("Both SC and HD"). We found support for the utility of a three-group classification of sexual compulsivity/hypersexuality as one of the syndemic factors that contribute to HIV risk. The average number of syndemic factors experienced was lowest among those who experienced Neither SC nor HD and highest among the group that experienced Both SC and HD, with those experiencing SC Only falling between the two other groups. This study provided further evidence that sexual compulsivity/hypersexuality is a contributing factor to the syndemics model of HIV risk for GBM and that considering three levels of severity (i.e., SC along with HD) led to stronger model predictions than considering SC alone. SC/HD severity provides another modifiable target for HIV prevention intervention development.
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Affiliation(s)
- Jeffrey T Parsons
- Department of Psychology, Hunter College of the City University of New York, 695 Park Ave., New York, NY, 10065, USA,
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29
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DSM-IV Axis I Psychopathology in Males with Non-Paraphilic Hypersexual Disorder. CURRENT ADDICTION REPORTS 2015. [DOI: 10.1007/s40429-015-0060-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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30
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Abstract
BACKGROUND AND AIMS Compulsive sexual behavior (CSB) is a common disorder featuring repetitive, intrusive and distressing sexual thoughts, urges and behaviors that negatively affect many aspects of an individual's life. This article reviews the clinical characteristics of CSB, cognitive aspects of the behaviors, and treatment options. METHODS We reviewed the literature regarding the clinical aspects of CSB and treatment approaches. RESULTS The literature review of the clinical aspects of CSB demonstrates that there is likely a substantial heterogeneity within the disorder. In addition, the treatment literature lacks sufficient evidence-based approaches to develop a clear treatment algorithm. CONCLUSIONS Although discussed in the psychological literature for years, CSB continues to defy easy categorization within mental health. Further research needs to be completed to understand where CSB falls within the psychiatric nosology.
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Affiliation(s)
- Katherine L. Derbyshire
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA,* Corresponding author: Katherine L. Derbyshire, BS; Department of Psychiatry & Behavioral Neuroscience, University of Chicago, 5841 S. Maryland Avenue, MC 3077, Chicago, IL 60637, USA; Phone: +1-773-702-9066; Fax: +1-773-834-6761; E-mail:
| | - Jon E. Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
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Examining the psychometric properties of the Yale-Brown Obsessive-Compulsive Scale in a sample of compulsive pornography users. Compr Psychiatry 2015; 59:117-22. [PMID: 25732412 DOI: 10.1016/j.comppsych.2015.02.007] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/06/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The current study evaluated several psychometric properties of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) (Goodman et al., 1989) adapted for compulsive sexual behavior (CSB) in a sample of 103 men seeking treatment at a private and a public university clinic in the United States. METHOD Measures of mental health functioning were collected from patients on two separate appointments: the initial screening and the follow-up appointment. RESULTS All patients reported using pornography compulsively, and approximately half of the sample also reported a history of having frequent anonymous sex with strangers. Results found that the adapted Y-BOCS had good internal consistency reliability, moderate mean inter-item correlations, and good test-retest reliability. Results from a multiple regression analysis also found that affect dysregulation (depression and anxiety), particularly among single, impaired men, was significantly associated with more severe sexual obsessive and compulsive features. Approximately 94% of the sample met criteria for at least one psychiatric disorder, and 57% of men met criteria for two or more psychiatric disorders. CONCLUSIONS Findings from the current study suggest the CSB-Y-BOCS is a reliable measure of obsessive and compulsive symptoms associated with CSB, and clinicians and researchers could use this scale to aid in the assessment and treatment of problematic sexual behaviors.
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Oldenburg CE, Perez-Brumer AG, Biello KB, Landers SJ, Rosenberger JG, Novak DS, Mayer KH, Mimiaga MJ. Transactional sex among men who have sex with men in Latin America: economic, sociodemographic, and psychosocial factors. Am J Public Health 2015; 105:e95-e102. [PMID: 25790381 DOI: 10.2105/ajph.2014.302402] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed factors associated with engagement in transactional sex among men who have sex with men recruited from one of the largest Internet sites for men seeking social or sexual interactions with other men in Latin America. METHODS We constructed multilevel logistic regression models to analyze factors associated with engagement in transactional sex in 17 Latin American countries in 2012. RESULTS Of 24 051 respondents, 1732 (7.2%) reported being paid for sexual intercourse in the past 12 months. In a multivariable model, higher country-level unemployment was associated with increased odds of transactional sex (adjusted odds ratio [AOR] = 1.07 per 1% increase in unemployment; 95% confidence interval [CI] = 1.00, 1.13). Individual or interpersonal factors associated with increased odds of engagement in transactional sex included self-reported HIV (AOR = 1.33; 95% CI = 1.04, 1.69) or sexually transmitted infection (AOR = 1.33; 95% CI = 1.11, 1.59), childhood sexual abuse history (AOR = 1.75; 95% CI = 1.48, 2.06), intimate partner violence (past 5 years, AOR = 1.68; 95% CI = 1.45, 1.95), and sexual compulsivity (AOR = 1.77; 95% CI = 1.49, 2.11). CONCLUSIONS Structural-level economic interventions and those that address individual and interpersonal factors may improve HIV prevention efforts among men who have sex with men who engage in transactional sex.
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Affiliation(s)
- Catherine E Oldenburg
- Catherine E. Oldenburg is with the Department of Epidemiology, Harvard School of Public Health, Boston, MA. Amaya G. Perez-Brumer is with the Department of Sociomedical Sciences, Columbia University, New York, NY. Katie B. Biello and Kenneth H. Mayer are with the Fenway Institute, Fenway Health, Boston, MA. Stewart J. Landers is with John Snow, Inc., Boston, MA. Joshua G. Rosenberger is with the Department of Global and Community Health, George Mason University, Fairfax, VA. David S. Novak is with the OLB Research Institute, Online Buddies, Inc., Cambridge, MA. Matthew J. Mimiaga is with the Department of Psychiatry, Massachusetts General Hospital, Boston
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Julio RS, Friedman RK, Cunha CB, De Boni RB, Cardoso SW, Torres T, Alves CA, Castro C, Fernandes NM, Veloso VG, Grinsztejn B. Unprotected sexual practices among men who have sex with women and men who have sex with men living with HIV/AIDS in Rio de Janeiro. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:357-365. [PMID: 25318623 DOI: 10.1007/s10508-014-0357-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/19/2014] [Accepted: 05/26/2014] [Indexed: 06/04/2023]
Abstract
Combined antiretroviral therapy is now acknowledged for preventing new HIV infections, besides decreasing mortality and morbidity. However, in many Latin America countries the epidemic is still driven by unprotected sexual intercourse. This study aims to describe sexual practices related to HIV/STD and to evaluate factors associated to unprotected sex among men who have sex with women (MSW) and men who have sex with men (MSM) under care at a reference center for HIV in Rio de Janeiro, Brazil. A cross-sectional study, nested in a Brazilian clinical cohort, evaluated the sexual practices of 404 sexually active HIV-positive MSW and men who have MSM. Approximately 30 % of them reported unprotected sexual practices during the 6 months prior to the interview. Most frequent risky practices reported were unprotected vaginal sex among MSW and unprotected receptive anal sex among MSM. Factors increasing the chance of unprotected sexual practices among MSW were the partner's desire of becoming pregnant (OR 2.81; CI 95 %: 1.36-5.95). To have received comments about excessive consumption of alcohol (OR 2.43; CI 95 %: 1.01-5.83), illicit drug use (OR 4.41; CI 95 %: 1.75-11.60) and lived in marital situation (OR 2.10; CI 95 %: 1.09-4.08) were significantly associated with unsafe sexual practices among MSM. The results highlight that health care of men living with HIV, as well as the prevention strategies, must consider the particularities of sexual behavior practiced by people who differ in sexual orientation.
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Affiliation(s)
- Renata Siqueira Julio
- Superintendência Regional de Saúde de Varginha/Centro Universitário do Sul de Minas, Varginha, Minas Gerais, Brazil
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do Amaral MLS, Abdo CHN, Tavares H, Scanavino MDT. Personality among sexually compulsive men who practice intentional unsafe sex in São Paulo, Brazil. J Sex Med 2014; 12:557-66. [PMID: 25411152 DOI: 10.1111/jsm.12761] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION There is evidence of an association between the practice of intentional unsafe sex among men who have sex with men (MSM) and sensation seeking and impulsivity. However, other aspects of personality have been less frequently investigated. AIMS This study aims to investigate the association between the practice of intentional unsafe sex and personality traits in individuals who sought treatment and met the criteria for compulsive sexual behavior in São Paulo, Brazil. METHODS The sample consisted of 69 sexually compulsive MSM. The participants underwent psychiatric evaluation and an interview to define intentional condomless sex and completed self-report instruments. MAIN OUTCOME MEASURES The participants completed the following measures: the Temperament and Character Inventory and the Sexual Compulsivity Scale. RESULTS Twenty-five participants (36%) reported intentional unsafe sex with casual partners, of whom 84% were gay and 16% bisexual (P<0.05). Fifteen (22%) individuals reported being HIV positive, and 11 (73%) of them practiced intentional unprotected anal intercourse (P<0.05). The mean of sexual compulsivity was associated with men who engaged in intentional unsafe sex (P=0.01). Men who reported intentional unsafe sex scored significantly higher on the novelty seeking temperament dimension (P<0.05) and scored significantly lower on the self-directedness character dimension (P<0.001). However, self-directedness predicted intentional unsafe sex in the multiple logistic regression (P=0.001). CONCLUSIONS Sexually compulsive individuals who practiced intentional unsafe sex presented lower self-directedness than the group who did not engage in intentional unsafe sex, which suggests less autonomy regarding life itself. To the best of our knowledge, this is the first study to consider intentional unsafe sex in sexually compulsive men.
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Affiliation(s)
- Maria Luiza S do Amaral
- Department and Institute of Psychiatry, Clinicas' Hospital (HC), University of São Paulo Medical School (FMUSP), São Paulo, Brazil
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Borgermans L, Vrijhoef B, Vandevoorde J, De Maeseneer J, Vansintejan J, Devroey D. Relevance of hypersexual disorder to family medicine and primary care as a complex multidimensional chronic disease construct. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2013; 2013:519265. [PMID: 24066230 PMCID: PMC3771452 DOI: 10.1155/2013/519265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 07/25/2013] [Indexed: 05/17/2023]
Abstract
Hypersexual disorder (HD) is not defined in a uniform way in the psychiatric literature. In the absence of solid evidence on prevalence, causes, empirically validated diagnostic criteria, instruments for diagnosis, consistent guidelines on treatment options, medical and psychosocial consequences, and type of caregivers that need to be involved, HD remains a controversial and relatively poorly understood chronic disease construct. The role of family medicine in the detection, treatment, and followup of HD is not well studied. The purpose of this paper is to describe the complexity of HD as a multidimensional chronic disease construct and its relevance to family medicine and primary care.
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Affiliation(s)
- Liesbeth Borgermans
- Department of Family Medicine, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Bert Vrijhoef
- Scientific Center for Care and Welfare, Tilburg University, 5000 LE Tilburg, The Netherlands
| | - Jan Vandevoorde
- Department of Family Medicine, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Jan De Maeseneer
- Department of Family Medicine and Primary Care, University Ghent, 9000 Ghent, Belgium
| | - Johan Vansintejan
- Department of Family Medicine, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Dirk Devroey
- Department of Family Medicine, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
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