Clinical relevance of the proposed sexual addiction diagnostic criteria: relation to the Sexual Addiction Screening Test-Revised

Investigating the Relationship of Childhood Traumas and Sexual Guilt with Sexual Addiction in Iranian Prostitutes

Background

Prostitution is a social phenomenon, and its underlying factors require more scholarly attention. This study aimed to investigate the relationship of childhood traumas and sexual guilt with sexual addiction in Iranian prostitutes.

Methods

This was a cross-sectional study conducted on prostitutes who visited a health promotion center in Khorasan Razavi province, Iran in 2020. A total of 100 women agreed to participate in the study. Data collection tools included the Sexual Addiction Screening Test (SAST), Mosher Sex-Guilt Scale, and Childhood Trauma Questionnaire (CTQ). Data were analyzed using Pearson's correlation coefficient and multiple regression analysis.

Findings

The age of the participants ranged from 23 to 42, with a mean age of 33.54±8.9 years. About 40% of the participants were divorced, 13% were married, 27% were single, and 10% were widows. The findings indicated that 84% of the prostitutes met the criteria for sexual addiction according to SAST. Emotional abuse (r=0.41, P<0.001), physical abuse (r=0.32, P<0.001), sexual abuse (r=0.33, P<0.001), emotional neglect (r=0.52, P<0.001), and physical neglect (r=0.37, P<0.001) had a positive and significant relationship with sexual addiction in prostitutes. There was no correlation between sexual guilt and sexual addiction (r=0.13, P=0.09). Furthermore, the linear regression results showed that emotional neglect was the only variable positively associated with sexual addiction (β=0.5, P<0.001).

Conclusion

The findings of this study suggested that childhood traumas can predict sexual addiction in female prostitutes.

Measuring craving: A systematic review and mapping of assessment instruments. What about sexual craving?

BACKGROUND AND AIMS

Craving is central in the definition of addictive disorders because of its diagnostic and prognostic value. Its measurement is essential in clinical practice. Previous reviews provided a better overview of existing instruments; however, they do not consider emerging substances and behaviors such as sexual addictions. Our objectives were threefold: (1) to provide a systematic review of craving assessment instruments and their psychometric characteristics within a transdiagnostic approach, (2) to highlight and map their conceptual relationships and (3) to identify potential sexual craving assessment instruments.

METHODS

The review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The PubMed, Embase, PsychInfo and Cochrane/Central databases were searched for publications that met the following inclusion criterion: validation studies of craving assessment instruments, regardless of target substance or behavior. The original search identified 4561 references and included 147 articles. Each selected study was a peer-reviewed publication.

RESULTS

This review provides a synthesis of the psychometric properties of 36 original instruments and identified 93 variations of these instruments (e.g. translations). We were able to highlight five transdiagnostic families of instruments, each corresponding to a conceptual model. Only one instrument for assessing craving in the domain of compulsive sexual behavior, focused on pornography use, has been identified: the Pornography Craving Questionnaire.

CONCLUSION

This review mapped all craving assessment instruments from a transdiagnostic perspective, finding 36 original instruments and 93 variations. The evolution of instruments to measure craving mirrors the evolution of the concept of craving which has progressively integrated cognitive, conditioning and sensory dimensions, and attests to the importance of the context of assessment. Development of an instrument to measure 'sexual craving' is needed and could be based on the data from our review.

Should problematic sexual behavior be viewed under the scope of addiction? A systematic review based on DSM-5 substance use disorder criteria

Despite similarities between compulsive sexual disorder and substance use disorder, the issue whether problematic sexual behavior should be viewed within an addiction framework continues to be a subject of debate with no consensus regarding its conceptualization and diagnosis criteria. Examining the presence of addiction criteria among clinical and no clinical samples in the existing literature could permit to ascertain clinical validity of sex addiction diagnosis and support its overlapping feature with other addictive disorders. The aim of this systematic review was to examine this issue by assessing DSM-5 criteria of substance use disorder among individuals engaged in problematic sexual activity. Methods: Using PRISMA criteria, three databases were comprehensively searched up to April 2022, in order to identify all candidate studies based on broad key words. Resulting studies were then selected if they examined problematic sexual behavior within the framework of DSM-5 addiction criteria. Results: Twenty articles matched the selection criteria and were included in this review. DSM-5 criteria of addictive disorders were found to be highly prevalent among problematic sex users, particularly craving, loss of control over sex use, and negative consequences related to sexual behavior. Exposition to sexual cues was also shown to trigger craving, with an association to problematic use and symptom severity. Conclusions: More studies should been done to assess homogeneously according to the DSM-5 criteria the addiction-like features of problematic sexual behaviors in clinical and no-clinical populations. Furthermore, this work argues for the need of further research to examine the extent to which anti-craving interventions could be effective in improving clinical outcomes.

Time Goes Back-Time Perspective in Polish Men with Compulsive Sexual Behavior Disorder and Risky Sexual Behavior

Many relationships between time perspective and a propensity to engage in risky behaviors or developing addictions have been demonstrated. The aim of our study was to determine the differences in intensity of individual time perspectives in people with compulsive sexual behavior disorder (CSBD) and risky sexual behavior (RSB). The analysis includes 425 men: 98 CSBD (age M = 37.99 years), 63 RSB (age M = 35.70 years), 264 without CSBD and RSB features constituting the control group (age M = 35.08 years). We used the Zimbardo Time Perspective Inventory, the Sexual Addiction Screening Test-Revised, the Risky Sexual Behavior Scale and a self-constructed survey. The comparative analysis showed a higher intensity of past-negative (p = 0.040), a lower of past-positive (p < 0.001) and a present-fatalistic (p = 0.040) outlook in the CSBD group compared to the control group. Compared to the participants with RSB, the CSBD group was characterized by a higher intensity of past-negative (p = 0.010), a lower of past-positive (p = 0.004) and a present-hedonistic perspective (p = 0.014). The RSB group also achieved higher results from the present-hedonistic perspective (p = 0.046) compared to the control group. The CSBD patients indicate a stronger tendency to focus on negative past compared to non-CSBD men, both taking and not taking RSB. The time perspective profiles of RSB men are similar to those who do not engage in RSB. The distinguishing feature of men with RSB without CSBD is a greater ability to enjoy current experiences.

Logistic Regression With Machine Learning Sheds Light on the Problematic Sexual Behavior Phenotype

OBJECTIVES

There has been a longstanding debate about whether the mechanisms involved in problematic sexual behavior (PSB) are similar to those observed in addictive disorders, or related to impulse control or to compulsivity. The aim of this report was to contribute to this debate by investigating the association between PSB, addictive disorders (internet addiction, compulsive buying), measures associated with the construct known as reward deficiency (RDS), and obsessive-compulsive disorder (OCD).

METHODS

A Canadian university Office of the Registrar invited 68,846 eligible students and postdoctoral fellows. Of 4710 expressing interest in participating, 3359 completed online questionnaires, and 1801 completed the Mini-International Neuropsychiatric Interview. PSB was measured by combining those screening positive (score at least 6) on the Sexual Addiction Screening Test-Revised Core with those self-reporting PSB. Current mental health condition(s) and childhood trauma were measured by self-report. OCD was assessed by a combination of self-report and Mini-International Neuropsychiatric Interview data.

RESULTS

Of 3341 participants, 407 (12.18%) screened positive on the Sexual Addiction Screening Test-Revised Core. On logistic regression, OCD, attention deficit, internet addiction, a family history of PSB, childhood trauma, compulsive buying, and male gender were associated with PSB. On multiple correspondence analysis, OCD appeared to cluster separately from the other measures, and the pattern of data differed by gender.

CONCLUSIONS

In our sample, factors that have previously been associated with RDS and OCD are both associated with increased odds of PSB. The factors associated with RDS appear to contribute to a separate data cluster from OCD and to lie closer to PSB.

Three Quarks for Hypersexuality Research

In some areas of sex research, we note room for methodological improvement of research practices. In particular, in the field of hypersexuality research, where societal norms have been influential, methodological improvement might advance goals of objectivity in research. We propose that hypersexuality research should: firstly, take into account relevant subpopulations; secondly, use Item Response Theory (IRT) to construct item banks for measurement instruments; and, thirdly, measure sexual desire and related important constructs where and how they play out—in daily life, changing from moment to moment. We show that comparing relevant subpopulations can lead to depathologizing normative, but highly frequent, sexual behavior. Using IRT can lead to more precise measurement instruments by assessment of characteristics of individual items. Measuring sexual desire as an inherently fluctuating process in everyday life, and as part of emotion regulation processes, can direct research towards relevant associations other research methods might miss. Bringing into practice our three proposals for improvement can procure a number of advantages. We illustrate these advantages mainly for the field of hypersexuality research, but our suggestions might also be beneficial for sex research in general.

The circle of gain and loss: Iranian women's life stories of suffering from compulsive sexual behaviour

This qualitative study aimed to explore Iranian women's life stories living with compulsive sexual behaviour. Data were collected between 2014 and 2016 in two cities. Forty-four semi-structured interviews were conducted by using theoretical sampling and constant comparative analysis. Four thematic categories were constructed from the data, including "scars left on the spirit and mind,"; "bizarre beliefs regarding sexuality and gender,"; "compensation for emptiness and the loss,"; and "difficulty in emotional regulation." This paper shows how abusive patterns of relationships in childhood could lead to sexual compulsivity. The paper results can direct our attention to the importance of health and social care and training to recognise abusive situations and support these children.

Compulsive Sexual Behavior and Alcohol Use Disorder Treated With Naltrexone: A Case Report and Literature Review

Compulsive sexual behavior (CSB) or sexual addiction is a term that generally indicates excessive and uncontrolled sexual behavior. This may lead to subjective distress, social and occupational impairment, or legal and financial consequences. Often, this condition is underreported and untreated. Until now there are no FDA-approved medications for sexual addiction or compulsive sexual behaviors. However, the therapeutic benefits of selective serotonin reuptake inhibitors (SSRIs) and naltrexone are known. This is a case of a 53-year-old male with a history of extensive alcohol use, alcohol withdrawal seizure, and delirium tremens. The patient was treated with naltrexone 50 mg/day for alcohol use disorder. The patient reported that his “sexual compulsion” also reduced after the medication and there was an improvement in both alcohol addiction and self-reported compulsive sexual behavior. This case report also includes a literature review of pharmacotherapy, especially naltrexone, for the treatment of sexual addiction/compulsive sexual behavior. The literature review has shown that patients’ symptoms were improved in different doses without side effects, and based on this and our experience, it can be said that naltrexone is effective in the reduction and remission of the symptoms of CSB or sexual addiction.

Emerging experience with selected new categories in the ICD-11: complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder

Among the important changes in the ICD-11 is the addition of 21 new mental disorders. New categories are typically proposed to: a) improve the usefulness of morbidity statistics; b) facilitate recognition of a clinically important but poorly classified mental disorder in order to provide appropriate management; and c) stimulate research into more effective treatments. Given the major implications for the field and for World Health Organization (WHO) member states, it is important to examine the impact of these new categories during the early phase of the ICD-11 implementation. This paper focuses on four disorders: complex post-traumatic stress disorder, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. These categories were selected because they have been the focus of considerable activity and/or controversy and because their inclusion in the ICD-11 represents a different decision than was made for the DSM-5. The lead authors invited experts on each of these disorders to provide insight into why it was considered important to add it to the ICD-11, implications for care of not having that diagnostic category, important controversies about adding the disorder, and a review of the evidence generated and other developments related to the category since the WHO signaled its intention to include it in the ICD-11. Each of the four diagnostic categories appears to describe a population with clinically important and distinctive features that had previously gone unrecognized as well as specific treatment needs that would otherwise likely go unmet. The introduction of these categories in the ICD-11 has been followed by a substantial expansion of research in each area, which has generally supported their validity and utility, and by a significant increase in the availability of appropriate services.

Social communication disorder and behavioural addiction: Case report and clinical implications

BACKGROUND

Social communication disorder (SCD) is a neurodevelopmental disorder that includes communication difficulties. Literature linking SCD and addictions is scarce, and there are only a few case reports regarding the co-occurrence of addiction and autism disorder spectrum, and only one of them addressed behavioural addictions.

CASE PRESENTATION

We report MC's case, who displayed an SCD and sexual addiction (SA). Clinical and neuropsychological evaluations suggested an alteration of social cognition, especially of affective theory of mind. This article also presents the adaptation made of the usual treatment.

DISCUSSION

This case report illustrates the importance of social cognition abilities in the development and maintenance of behavioural addictions, and specifically SA. It also highlights the possible comorbidity of these two disorders and the possibility to work on social cognition as an alternate therapy in the treatment of behavioural addictions.

CONCLUSIONS

The co-occurrence of SCD and a behavioural addiction triggered clinical adaptations and implications that may affect a patient's treatment presenting one of these disorders.

Variability of Pornographic Content Consumed and Longest Session of Pornography Use Associated With Treatment Seeking and Problematic Sexual Behavior Symptoms

INTRODUCTION

Most of the previous studies on problematic pornography use and related behavior have focused on such descriptors of pornography use habits as frequency or time devoted to pornography use.

AIM

We argue that this constitutes a narrow view and indicators that characterize other aspects of explicit content consumption, namely (i) longest session of pornography viewing (which may be related to binge behavior), as well as (ii) variability of consumed pornographic content, can also be useful indicators.

METHODS

An online study based on a sample of 132 heterosexual men seeking treatment for problematic pornography use, referred by therapists after their initial visit and 437 non-treatment seekers in the control group.

MAIN OUTCOME MEASURES

The main outcomes of this study are reported longest, non-stop session of viewing pornography, variability in consumed pornographic content (including paraphilic and violent pornography), actual treatment seeking for problematic pornography use and severity of symptoms, and average weekly time devoted to pornography use.

RESULTS

Our analysis showed that longest session of viewing pornographic content as well as the variety of consumed pornography influenced the decision to seek treatment and the severity of symptoms even when the sheer amount of time devoted to pornography use was controlled.

CONCLUSION

This is one of the few studies examining the role of engagement in prolonged sessions of pornography use and the variability of consumed pornographic content in the clinical context of problematic sexual behavior. The study's main limitations are its relatively narrow method of operationalization of variability of pornographic content and longest session of pornography viewing, as well as its cross-sectional, online, and anonymous character. As the described factors have an important influence on treatment seeking and the severity of experienced symptoms, they should be considered in the process of assessing compulsive sexual behavior disorder and related symptoms. Lewczuk K, Leśniak J, Lew-Starowicz M, et al. Variability of Pornographic Content Consumed and Longest Session of Pornography Use Associated With Treatment Seeking and Problematic Sexual Behavior Symptoms. Sex Med 2021;9:100276.

A Case-Control Study on Behavioral Addictions and Neurocognition: Description of the BANCO and BANCO2 Protocols

INTRODUCTION

Only two behavioral addictions (BAs) are currently recognized in international classifications (gambling disorder: GbD; gaming disorder: GmD), while some of them await further investigation (food addiction: FA; sexual addiction: SA). Neurocognitive functioning is considered a risk factor for BAs. Research is quite abundant for GbD and highlights specific deficits in several cognitive functions. Nevertheless, grey areas still exist. The aim of this research programme is to investigate the neurocognitive profiles of patients presenting with various BAs and to establish parallels between different forms of BA to achieve a common addiction concept.

METHODS AND ANALYSIS

This research program is composed of two studies sharing the same methodology but focusing on different samples: the BANCO study aims to include 30 individuals with a GbD, whereas the BANCO2 study aims to include 30 individuals with a GmD, 30 with a SA, and 30 with a FA. Moreover, for each BA group, 30 healthy controls will be recruited, matched by sex, age and education level. Several cognitive tasks will be completed by participants. Cue reactivity and physiological responses, as well as clinical data regarding addiction characteristics and personality, will also be investigated. A composite score based on the cognitive tasks will be computed using principal component analysis (PCA). Overall cognitive performance and detailed performance on the different cognitive tasks will be compared between individuals with BAs and their matched healthy controls using linear models with random effects. Comparisons will also be made between BA groups to investigate specific alterations associated with each disorder.

DISCUSSION

The results of this research programme will impact both research and clinical areas by (i) providing new knowledge for discussions regarding the inclusion of BAs under the spectrum of addictive disorders; (ii) improving understanding of addiction mechanisms in general; (iii) providing clarity in the grey areas in neurocognitive research on BAs and improving the understanding of less studied BAs, (iv) guiding clinicians to propose therapeutic alternatives and complementary programmes.

TRIAL REGISTRATION

BANCO study (ClinicalTrials.gov NCT03202290); BANCO2 study (ClinicalTrials.gov NCT03967418).

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.

Sexual addiction 25 years on: A systematic and methodological review of empirical literature and an agenda for future research

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.

Three Diagnoses for Problematic Hypersexuality; Which Criteria Predict Help-Seeking Behavior?

This study aimed to assess the best combination of indicators of problematic hypersexuality (PH), in a survey (n = 58,158) targeting individuals wondering if they were sex addicted. The survey allowed for testing of criteria from three theoretical models used to conceptualize PH. Factor analyses for women and men yielded an interpretable grouping of indicators consisting of four factors. In subsequent logistic regressions, these factors were used as predictors for experiencing the need for help for PH. The factors Negative Effects and Extreme positively predicted experiencing the need for help, with Negative Effects as the most important predictor for both women and men. This factor included, among others, withdrawal symptoms and loss of pleasure. The Sexual Desire factor negatively predicted the need for help, suggesting that for the targeted population more sexual desire leads to less PH. The Coping factor did not predict experiencing the need for help. Outcomes show that a combination of indicators from different theoretical models best indicates the presence of PH. Therefore, a measurement instrument to assess existence and severity of PH should consist of such a combination. Theoretically, this study suggests that a more comprehensive model for PH is needed, surpassing existing conceptualizations of PH.

[French validation of the Sexual Addiction Screening Test (SAST-Fr)]

INTRODUCTION

The Sexual Addiction Screening Test (SAST) is one of the most frequently used tools on the international level for assessing sexual addiction. This study aimed to translate the English version of the SAST, and adapt and test the psychometric properties of its French version (the SAST-Fr) by establishing its factor structure, internal consistency and convergent validity.

METHODS

Three hundred ninety eight voluntary participants were recruited online through specialized forums. Participants completed a sociodemographic questionnaire, the SAST-Fr and the diagnostic criteria of sexual addiction proposed by Goodman. We tested the psychometric properties of SAST-Fr through an exploratory factorial analysis, especially its internal consistency, using the Kuder-Richardson alpha (KR-20) given that the items were dichotomous. We also performed correlation analyses of Bravais-Pearson on numerical variables. Finally, we studied the predictive validity of Goodman's score in predicting SAST-Fr criteria using a ROC (Receiver Operating Characteristics) analysis.

RESULTS

Mean age of participants was 29.08 years (±11.30) and included 54% of women (n=215). Statistical analysis had shown that SAST-Fr had a one-factor structure explaining 31% of the variance, an excellent internal consistency (KR-20=0.90). We found significant correlation between SAST-Fr item scores and PEACCE scores (r=0.87; P<0.001) and Goodman's criteria (r=0.79; P<0.001).

CONCLUSION

Our results indicate that the psychometric properties of the French version of the SAST are comparable to its original English version with a one-factor structure. The SAST-Fr is a reliable and valid questionnaire to assess symptoms of sexual addiction.

Spanish validation of the Sexual Addiction Screening Test

BACKGROUND AND AIMS

Sexual addiction is a pathological behavior characterized by a combination of excessive sexual desire and impaired ability to control it. Its incidence ranges between 1.2% and 32.2%, although this number may vary depending on the screening tool used. This wide variability is largely due to the use of non-validated instruments (e.g., structural validity relying on exploratory analyses, instruments translated without an additional validation process, or instruments validated in another format). To deal with these limitations, this study tested the psychometric properties of the Spanish paper-and-pencil and online versions of the Sexual Addiction Screening Test (SAST).

METHODS

A total of 2,528 participants (1,163 males) completed the Spanish version of the SAST, along with other instruments assessing sexual compulsivity (1,585 = paper-and-pencil, 943 = online).

RESULTS

The exploratory factor analysis yielded a four-factor structure explaining 57.39% of the variance for the SAST paper-and-pencil version. This factor structure was then verified for the online version through the use of confirmatory factor analysis [χ2(264) = 441.59; χ2/df = 1.66; RMSEA = 0.02; CFI = 0.94; IFI = 0.94]. This methodology was also used to support measurement invariance (configural, metric, and scalar invariance) according to gender. The reliability of the total score ranged from .82 to .85. Similarly, correlations with related scales were positive and significant (r between .22 and .71). Temporal stability 1 year after the first application was 0.65 (paper-and-pencil format) and 0.60 (online version).

CONCLUSION

These results, together with the absence of questionnaires translated into Spanish to assess this construct, justify the use of the SAST in the evaluation of sexual addiction in Spanish-speaking countries.

Altered Prefrontal and Inferior Parietal Activity During a Stroop Task in Individuals With Problematic Hypersexual Behavior

Accumulating evidence suggests a relationship between problematic hypersexual behavior (PHB) and diminished executive control. Clinical studies have demonstrated that individuals with PHB exhibit high levels of impulsivity; however, relatively little is known regarding the neural mechanisms underlying impaired executive control in PHB. This study investigated the neural correlates of executive control in individuals with PHB and healthy controls using event-related functional magnetic resonance imaging (fMRI). Twenty-three individuals with PHB and 22 healthy control participants underwent fMRI while performing a Stroop task. Response time and error rates were measured as surrogate indicators of executive control. Individuals with PHB exhibited impaired task performance and lower activation in the right dorsolateral prefrontal cortex (DLPFC) and inferior parietal cortex relative to healthy controls during the Stroop task. In addition, blood oxygen level-dependent responses in these areas were negatively associated with PHB severity. The right DLPFC and inferior parietal cortex are associated with higher-order cognitive control and visual attention, respectively. Our findings suggest that individuals with PHB have diminished executive control and impaired functionality in the right DLPFC and inferior parietal cortex, providing a neural basis for PHB.

Should compulsive sexual behavior be considered an addiction?

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.

Attention-deficit/hyperactivity disorder in relation to addictive behaviors: a moderated-mediation analysis of personality-risk factors and sex

INTRODUCTION

Research has shown that those with attention-deficit/hyperactivity disorder (ADHD) have an increased risk for addiction disorders like alcoholism and substance abuse. What is less clear is the mechanism(s) whereby ADHD gives rise to increased engagement in addictive behaviors, and whether there are sex differences in the ADHD-addiction propensity. Both ADHD and addictions have also been associated with personality traits such as impulsivity, reward seeking, anxiousness, and negative affect. In this study, we tested a moderator-mediation model, which predicted that both sex and ADHD-symptom status would make independent contributions to the variance in personality risk and in addictive behaviors, with males, and those with diagnosed ADHD, scoring higher on both dependent variables. Our model also predicted that the effect of sex and ADHD-symptom status on addictive behaviors would be via the mediating or intervening influence of personality-risk factors.

METHODS

A community-based sample of young men and women took part in the study. Among these individuals, 46 had received a lifetime diagnosis of ADHD. The non-diagnosed participants were dichotomized into a high-ADHD-symptom group (n = 83) and a low-symptom group (n = 84).

RESULTS

We found that a high-risk personality profile may, in part, account for the relationship between ADHD symptomatology and the use/abuse of a broad range of addictive behaviors. However, we found no sex differences in personality risk for addiction or in the use of addictive behaviors; nor did sex moderate the relationships we assessed.

CONCLUSION

While ADHD status showed a strong relationship with both dependent variables in the model, we found no difference between those who had been diagnosed with ADHD and treated with stimulants, and their high-symptom non-diagnosed/non-treated counterparts. These results add support to claims that the treatment of ADHD with stimulant medication neither protects nor fosters the risk for substance abuse disorders.