The Relationship between Boredom Proneness, Attachment Styles and Compulsive Sexual Behavior

Assessment and treatment of compulsive sexual behavior disorder: a sexual medicine perspective

INTRODUCTION

The addition of compulsive sexual behavior disorder (CSBD) into the ICD-11 chapter on mental, behavioral, or neurodevelopmental disorders has greatly stimulated research and controversy around compulsive sexual behavior, or what has been termed "hypersexual disorder," "sexual addiction," "porn addiction," "sexual compulsivity," and "out-of-control sexual behavior."

OBJECTIVES

To identify where concerns exist from the perspective of sexual medicine and what can be done to resolve them.

METHODS

A scientific review committee convened by the International Society for Sexual Medicine reviewed pertinent literature and discussed clinical research and experience related to CSBD diagnoses and misdiagnoses, pathologizing nonheteronormative sexual behavior, basic research on potential underlying causes of CSBD, its relationship to paraphilic disorder, and its potential sexual health consequences. The panel used a modified Delphi method to reach consensus on these issues.

RESULTS

CSBD was differentiated from other sexual activity on the basis of the ICD-11 diagnostic criteria, and issues regarding sexual medicine and sexual health were identified. Concerns were raised about self-labeling processes, attitudes hostile to sexual pleasure, pathologizing of nonheteronormative sexual behavior and high sexual desire, mixing of normative attitudes with clinical distress, and the belief that masturbation and pornography use represent "unhealthy" sexual behavior. A guide to CSBD case formulation and care/treatment recommendations was proposed.

CONCLUSIONS

Clinical sexologic and sexual medicine expertise for the diagnosis and treatment of CSBD in the psychiatric-psychotherapeutic context is imperative to differentiate and understand the determinants and impact of CSBD and related "out-of-control sexual behaviors" on mental and sexual well-being, to detect forensically relevant and nonrelevant forms, and to refine best practices in care and treatment. Evidence-based, sexual medicine-informed therapies should be offered to achieve a positive and respectful approach to sexuality and the possibility of having pleasurable and safe sexual experiences.

The Psychology of Kink: A Cross-Sectional Survey Investigating the Association Between Adult Attachment Style and BDSM-Related Identity Choice in China

BDSM is a type of sexual preference that includes bondage and discipline, dominance and submission, and sadism and masochism. Research has identified three specific power exchange roles in the practice of BDSM: dominance, submission, and switch. It has also been suggested that attachment style potentially influences BDSM interests. This study investigated the potential roles of attachment style in driving BDSM identity. A questionnaire was completed by a cross-sectional Chinese sample (n = 3310, age range 18-30 years), including 1856 BDSM practitioners (436 men, 1420 women). To assess attachment style, the questionnaire included a Chinese translation of the Adult Attachment Scale as well as items surveying BDSM interests. Compared to non-BDSM practitioners, attachment styles were not significantly different from BDSM practitioners. However, practitioners with different BDSM identities showed a significant difference in their attachment styles. Secure and avoidant attachment styles were associated with dominance, whereas submissiveness recorded high average scores of separation anxiety in both males and females. BDSM identities based on gender revealed that 60.5% of female practitioners assumed the role of submissiveness and this group recorded the highest average scores of separation anxiety among all groups. These results show that BDSM identity is related to attachment style. However, the results did not support the hypothesis that attachment styles potentially drive BDSM identities. Further research is needed to explore other psychological processes that drive BDSM identities in order to provide guidance for BDSM practitioners in choosing suitable identities, thereby helping practitioners to choose suitable identity partners and avoid negative experiences during BDSM participation.

Identifying Relationships Between Difficulties with Emotion Regulation and Compulsive Sexual Behavior

Emotion dysregulation is an associated feature of compulsive sexual behavior disorder (CSBD), now recognized by the World Health Organization. Previous studies have identified associations between trait emotion dysregulation and CSBD. Given that difficulties with emotion regulation (DERS) is comprised of several facets (e.g., difficulty with impulse control and lacking awareness of one's feelings when upset), and that these facets differentially relate to other mental health concerns, the present study aimed to examine how DERS facets relate to compulsive sexual behavior (CSB). The present study also considered interpersonal emotion regulation via attachment avoidance and attachment anxiety. Hierarchical regression was conducted, first accounting for demographic covariates, then adding attachment styles, and finally all DERS subscales. Results indicated that, among a large, diverse, online U.S. sample (N = 915; Mage = 39.21, SD = 0.81; 54.3% men), difficulty controlling impulses when upset, difficulty with clarity of emotions, and non-acceptance of emotions were significantly positively associated with CSB (small to moderate effects). Attachment anxiety and avoidance were also significantly positively associated with CSB, although their effects were minimal when adding DERS facets. Overall, this study supports the theorized impact of emotion dysregulation on CSB. Assessment of individual differences in DERS and intervening on these concerns are important for treating CSB.