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Briken P, Bőthe B, Carvalho J, Coleman E, Giraldi A, Kraus SW, Lew-Starowicz M, Pfaus JG. Assessment and treatment of compulsive sexual behavior disorder: a sexual medicine perspective. Sex Med Rev 2024; 12:355-370. [PMID: 38529667 PMCID: PMC11214846 DOI: 10.1093/sxmrev/qeae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 03/27/2024]
Abstract
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.
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Affiliation(s)
- Peer Briken
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center, Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Beáta Bőthe
- Department of Psychology, Université de Montréal, Montréal, QC H3C 3J7, Canada
- Centre de Recherche Interdisciplinaire Sur Les Problèmes Conjugaux Et Les Agressions Sexuelles, Montréal, QC H3C 3J7, Canada
| | - Joana Carvalho
- William James Center for Research, Department of Education and Psychology, University of Aveiro, Aveiro 3810-193, Portugal
| | - Eli Coleman
- Eli Coleman Institute for Sexual and Gender Health, University of Minnesota, Minneapolis, MN 55454, United States
| | - Annamaria Giraldi
- Sexological Clinic, Mental Health Center, Copenhagen University Hospital, Mental Health Services, Copenhagen CPH 2200, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Shane W Kraus
- Department of Psychology, University of Nevada Las Vegas, Las Vegas, NV 5030, United States
| | - Michał Lew-Starowicz
- Department of Psychiatry, Centre of Postgraduate Medical Education, Warsaw 01-809, Poland
| | - James G Pfaus
- Center for Sexual Health and Intervention, Czech National Institute of Mental Health, Klecany 25067, Czech Republic
- Department of Psychology and Life Sciences, Faculty of Humanities, Charles University, Prague 18200, Czech Republic
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Stein DJ, Nielsen K, Hartford A, Gagné-Julien AM, Glackin S, Friston K, Maj M, Zachar P, Aftab A. Philosophy of psychiatry: theoretical advances and clinical implications. World Psychiatry 2024; 23:215-232. [PMID: 38727058 PMCID: PMC11083904 DOI: 10.1002/wps.21194] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024] Open
Abstract
Work at the intersection of philosophy and psychiatry has an extensive and influential history, and has received increased attention recently, with the emergence of professional associations and a growing literature. In this paper, we review key advances in work on philosophy and psychiatry, and their related clinical implications. First, in understanding and categorizing mental disorder, both naturalist and normativist considerations are now viewed as important - psychiatric constructs necessitate a consideration of both facts and values. At a conceptual level, this integrative view encourages moving away from strict scientism to soft naturalism, while in clinical practice this facilitates both evidence-based and values-based mental health care. Second, in considering the nature of psychiatric science, there is now increasing emphasis on a pluralist approach, including ontological, explanatory and value pluralism. Conceptually, a pluralist approach acknowledges the multi-level causal interactions that give rise to psychopathology, while clinically it emphasizes the importance of a broad range of "difference-makers", as well as a consideration of "lived experience" in both research and practice. Third, in considering a range of questions about the brain-mind, and how both somatic and psychic factors contribute to the development and maintenance of mental disorders, conceptual and empirical work on embodied cognition provides an increasingly valuable approach. Viewing the brain-mind as embodied, embedded and enactive offers a conceptual approach to the mind-body problem that facilitates the clinical integration of advances in both cognitive-affective neuroscience and phenomenological psychopathology.
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Affiliation(s)
- Dan J Stein
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Kris Nielsen
- School of Psychology, Te Herenga Waka-Victoria University of Wellington, Wellington, New Zealand
| | - Anna Hartford
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Anne-Marie Gagné-Julien
- Centre for Research in Ethics, Canada Research Chair in Epistemic Injustice and Agency, Université du Québec à Montréal, Montreal, Canada
| | - Shane Glackin
- Department of Sociology, Philosophy and Anthropology, University of Exeter, Exeter, UK
| | - Karl Friston
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Peter Zachar
- Department of Psychology, Auburn University Montgomery, Montgomery, AL, USA
| | - Awais Aftab
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Bőthe B, Potenza MN, Demetrovics Z. Debates on Compulsive Sexual Behavior Disorder: A Call for Global and Interdisciplinary Perspectives. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1215-1220. [PMID: 38418717 DOI: 10.1007/s10508-024-02836-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Beáta Bőthe
- Département de Psychologie, Université de Montréal, Succursale Centre-Ville, C.P. 6128, Montréal, QC, H3C 3J7, Canada.
- Centre de Recherche Interdisciplinaire sur les Problèmes Conjugaux et les Agressions Sexuelles, Montréal, QC, Canada.
| | - Marc N Potenza
- 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
| | - Zsolt Demetrovics
- Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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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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Briken P, Wiessner C, Štulhofer A, Klein V, Fuß J, Reed GM, Dekker A. Who feels affected by "out of control" sexual behavior? Prevalence and correlates of indicators for ICD-11 Compulsive Sexual Behavior Disorder in the German Health and Sexuality Survey (GeSiD). J Behav Addict 2022; 11:900-911. [PMID: 36006765 PMCID: PMC9872532 DOI: 10.1556/2006.2022.00060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIMS The purpose of this study was to examine the prevalence and correlates of indicators consistent with Compulsive Sexual Behavior Disorder (CSBD)-defined and operationalized according to the ICD-11 guidelines-in a large (n = 4,633; 50.5% male; 49,5% female) probability-based German national sample. METHODS Participants were asked if they had ever experienced "intense and recurring sexual impulses or sexual urges that I had difficulty controlling and resulted in sexual behavior" over a period of several months. Those who reported this experience were queried about the associated distress. RESULTS Overall, 4.9% of men [95% CI = 3.9-6.1] and 3.0% of women [95% CI = 2.3-3.9] reported experiences consistent with ICD-11 diagnostic requirements for lifetime diagnosis. In the 12 months preceding the study, 3.2% of men [95% CI = 2.4-4.2] and 1.8% of women [95% CI = 1.2-2.5] reported experiences consistent with CSBD requirements. Compared to controls and participants who reported elements of compulsive sexuality but without accompanying distress, strict religious upbringing was most prevalent in the CSBD group. The CSBD group was more likely to view sexual practices like men having sex with men as unacceptable and to report the belief that pornography has negative impacts on their sex life and life in general. Compared to the other two groups, the CSBD group was significantly more likely to have received psychiatric treatment for depression or another mental health problem during the past 12 months. DISCUSSION AND CONCLUSIONS The current study provides novel and important insights into the prevalence and characteristics of CSBD in the general population.
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Affiliation(s)
- Peer Briken
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical-Centre Hamburg-Eppendorf, Germany,Corresponding author. Tel.: +49 (40) 7410-54564; fax: +49 (40) 7410-56406. E-mail:
| | - Christian Wiessner
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical-Centre Hamburg-Eppendorf, Germany,Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Aleksander Štulhofer
- Department of Sociology, Faculty of Humanities and Social Sciences, University of Zagreb, Croatia
| | - Verena Klein
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical-Centre Hamburg-Eppendorf, Germany
| | - Johannes Fuß
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical-Centre Hamburg-Eppendorf, Germany,Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Geoffrey M. Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA,Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Arne Dekker
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical-Centre Hamburg-Eppendorf, Germany
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Reed GM, First MB, Billieux J, Cloitre M, Briken P, Achab S, Brewin CR, King DL, Kraus SW, Bryant RA. Emerging experience with selected new categories in the ICD-11: complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. World Psychiatry 2022; 21:189-213. [PMID: 35524599 PMCID: PMC9077619 DOI: 10.1002/wps.20960] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Geoffrey M Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Michael B First
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Joël Billieux
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
- Center for Excessive Gambling, Addiction Medicine, Lausanne University Hospitals, Lausanne, Switzerland
| | - Marylene Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Peer Briken
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sophia Achab
- Outpatient Treatment Unit for Addictive Behaviors ReConnecte, Geneva University Hospitals, Geneva, Switzerland
- Psychological and Sociological Research and Training Unit, Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Daniel L King
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia
| | - Shane W Kraus
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
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Liberg B, Görts-Öberg K, Jokinen J, Savard J, Dhejne C, Arver S, Fuss J, Ingvar M, Abé C. Neural and behavioral correlates of sexual stimuli anticipation point to addiction-like mechanisms in compulsive sexual behavior disorder. J Behav Addict 2022; 11:520-532. [PMID: 35895609 PMCID: PMC9295238 DOI: 10.1556/2006.2022.00035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/25/2022] [Accepted: 04/21/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Compulsive sexual behavior disorder (CSBD) is characterized by persistent patterns of failure to control sexual impulses resulting in repetitive sexual behavior, pursued despite adverse consequences. Despite previous indications of addiction-like mechanisms and the recent impulse-control disorder classification in the International Classification of Diseases (ICD-11), the neurobiological processes underlying CSBD are unknown. METHODS We designed and applied a behavioral paradigm aimed at disentangling processes related to anticipation and viewing of erotic stimuli. In 22 male CSBD patients (age: M = 38.7, SD = 11.7) and 20 healthy male controls (HC, age: M = 37.6, SD = 8.5), we measured behavioral responses and neural activity during functional magnetic resonance imaging (fMRI). The main outcomes were response time differences between erotic and non-erotic trials and ventral striatum (VS) activity during anticipation of visual stimuli. We related these outcomes with each other, to CSBD diagnosis, and symptom severity. RESULTS We found robust case-control differences on behavioral level, where CSBD patients showed larger response time differences between erotic and non-erotic trials than HC. The task induced reliable main activations within each group. While we did not observe significant group differences in VS activity, VS activity during anticipation correlated with response time differences and self-ratings for anticipation of erotic stimuli. DISCUSSION AND CONCLUSIONS Our results support the validity and applicability of the developed task and suggest that CSBD is associated with altered behavioral correlates of anticipation, which were associated with ventral striatum activity during anticipation of erotic stimuli. This supports the idea that addiction-like mechanisms play a role in CSBD.
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Affiliation(s)
- Benny Liberg
- Department of Clinical Neuroscience, Osher Center, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Görts-Öberg
- ANOVA Clinic, Karolinska University Hospital, Stockholm, Sweden,Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Jussi Jokinen
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Josephine Savard
- ANOVA Clinic, Karolinska University Hospital, Stockholm, Sweden,Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
| | - Cecilia Dhejne
- ANOVA Clinic, Karolinska University Hospital, Stockholm, Sweden,Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Arver
- ANOVA Clinic, Karolinska University Hospital, Stockholm, Sweden,Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Johannes Fuss
- Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Martin Ingvar
- Department of Clinical Neuroscience, Osher Center, Karolinska Institutet, Stockholm, Sweden
| | - Christoph Abé
- Department of Clinical Neuroscience, Osher Center, Karolinska Institutet, Stockholm, Sweden,Quantify Research, Stockholm, Sweden,Corresponding author. Tel.: +468 52483265. E-mail:
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Koós M, Fuss J, Klein V, Demetrovics Z, Bőthe B. Sexual Motivations Underlying Compulsive Sexual Behavior in Women and Men From Germany and Hungary. J Sex Med 2022; 19:170-181. [PMID: 34906543 DOI: 10.1016/j.jsxm.2021.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 10/26/2021] [Accepted: 11/08/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND There are ongoing debates about conflicting models on how to conceptualize compulsive sexual behavior. At the heart of these discussions is the question about the sexual motivations underlying compulsive sexual behavior, as different models assume different motivations. AIM The aim of the present study was to understand sexual motivations underlying compulsive sexual behavior and their relation to the most prominent conceptualizations of compulsive sexual behavior (eg, compulsive sexual behavior disorder [CSBD], sex addiction). METHODS We used self-reported data from 2 large samples of Hungarian and German populations (N = 9814). The Sexual Motivation Scale (SexMS), a 24-item self-report measure based on self-determination theory, was used to assess a diverse set of sexual motivations. Compulsive sexual behavior was assessed with the 19-item Compulsive Sexual Behavior Disorder Scale (CSBD-19), that is based on the ICD-11 diagnostic guidelines of CSBD. We used structural equation modeling to examine the hypothesized associations between sexual motivations and compulsive sexual behavior and examined potential gender differences in these associations. OUTCOMES Compulsive sexual behavior was assessed in relation to a set of sexual motivations. RESULTS Amotivation had the strongest positive association with compulsive sexual behavior, but integrated, introjected, and intrinsic motivations were also positively related to it. Importantly, these associations did not differ for women and men, and between the 2 samples. CLINICAL IMPLICATIONS Future research and treatment should also consider sexual motivations that are not listed among the ICD-11 guidelines for CSBD, including high levels of sexual interest, continuing the behavior despite having little satisfaction from it and coping with sex. STRENGTHS & LIMITATIONS Although we used large samples of general populations in 2 Western countries, this motivational background of compulsive sexual behavior awaits replication in a clinical sample of individuals experiencing CSBD. CONCLUSION The identified sexual motivations underlying compulsive sexual behavior are relevant for assessing and treating patients as motivations may be integrated into psychotherapeutic interventions. Koós M, Fuss J, Klein V, et al. Sexual Motivations Underlying Compulsive Sexual Behavior in Women and Men From Germany and Hungary. J Sex Med 2022;19:170-181.
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Affiliation(s)
- Mónika Koós
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
| | - Johannes Fuss
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute of Forensic Psychiatry and Sex Research, University Duisburg-Essen, Essen, Germany
| | - Verena Klein
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
| | - Beáta Bőthe
- Département de Psychologie, Université de Montréal, Montréal, Canada
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Kor A, Djalovski A, Potenza MN, Zagoory-Sharon O, Feldman R. Alterations in oxytocin and vasopressin in men with problematic pornography use: The role of empathy. J Behav Addict 2022; 11:116-127. [PMID: 35040806 PMCID: PMC9109630 DOI: 10.1556/2006.2021.00089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/16/2021] [Accepted: 12/17/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Addictive behaviors share clinical, genetic, neurobiological and phenomenological parallels with substance addictions. Despite the prevalence of compulsive sexual behaviors, particularly problematic pornography use (PPU), how neuroendocrine systems relate to PPU is not well understood. Preclinical studies demonstrate alterations in oxytocin and arginine vasopressin (AVP) function in animal models of addiction, but no human study has tested their involvement in PPU. METHOD Participants included 122 males; 69 reported PPU, and 53 were demographically-matched participants without PPU. Plasma oxytocin and AVP levels and oxytocin-to-AVP balance were measured at baseline. Salivary oxytocin was assessed at baseline and in response to four videos depicting neutral/positive social encounters. Participants reported on empathy and psychiatric symptoms. RESULTS Baseline plasma AVP levels were elevated in men with PPU, and the ratio of oxytocin-to-vasopressin suggested AVP dominance. Men with PPU reacted with greater oxytocin increases to presentation of neutral/positive social stimuli. Decreased empathic tendencies were found in men with PPU, and this reduced empathy mediated links between oxytocin and pornography-related hypersexuality. Structural equation modeling revealed three independent paths to pornography-related hypersexuality; two direct paths via increased AVP and higher psychiatric symptoms and one indirect path from oxytocin to pornography-related hypersexuality mediated by diminished empathy. CONCLUSIONS Findings are among the first to implicate neuropeptides sustaining mammalian attachment in the pathophysiology of pornography-related hypersexuality and describe a neurobiological mechanism by which oxytocin-AVP systems and psychiatric symptomatology may operate to reduce empathy and lead to pornography-related hypersexuality.
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Affiliation(s)
- Ariel Kor
- Interdisciplinary Center, Herzlia, Israel
| | - Amir Djalovski
- Center for Developmental Social Neuroscience, Interdisciplinary Center, Herzlia, Israel
| | - Marc N. Potenza
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Connecticut Mental Health Center, New Haven, CT, USA,Connecticut Council on Problem Gambling, Wethersfield, CT, USA,Department of Neuroscience, Yale University, New Haven, CT, USA
| | - Orna Zagoory-Sharon
- Center for Developmental Social Neuroscience, Interdisciplinary Center, Herzlia, Israel
| | - Ruth Feldman
- Interdisciplinary Center, Herzlia, Israel,Center for Developmental Social Neuroscience, Interdisciplinary Center, Herzlia, Israel,Child Study Center, Yale University School of Medicine, New Haven, CT, USA,Corresponding author. E-mail:
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10
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Fiorillo A, Javed A. Education and training in psychiatry in low- and middle-income countries during and after the COVID-19 pandemic. Asia Pac Psychiatry 2021; 13:e12500. [PMID: 34873838 DOI: 10.1111/appy.12500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy.,Chair, WPA Section on Education in Psychiatry, World Psychiatric Association
| | - Afzal Javed
- WPA President, World Psychiatric Association (WPA), Geneva, Switzerland
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11
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Hall P. The moral maze of sex & porn addiction. Addict Behav 2021; 123:107054. [PMID: 34320446 DOI: 10.1016/j.addbeh.2021.107054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/30/2021] [Accepted: 07/12/2021] [Indexed: 11/28/2022]
Abstract
Sex addiction, a term first coined in the early 80s, has always been met with controversy. Some say the label of addiction is an excuse used by those who have lost their moral compass or refuse to accept responsibility for their sexual choices. Others claim the label is used to pass moral judgement on those whose sex lives or internet viewing habits do not fit societally prescribed norms. The acceptance by WHO of CSBD (Compulsive Sexual Behaviour Disorder) into ICD11 was heralded as a moral victory by the sex addiction naysayers who claimed WHO's position 'proved' it wasn't an addiction; conversely sex addiction professionals claimed victory saying that finally this was a step in the right direction. This paper will explore the divide and provide insight on how using a pure medical model of addiction has contributed and fueled the debate. An alternative model for conceptualization from a biopsychosocial perspective will be provided to suggest ways of moving forward that could ease the controversies as well as opening new areas for research and most importantly, greater understanding and empathy for clients.
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Affiliation(s)
- Paula Hall
- Sexual & Relationship Psychotherapist UKCP Reg, Acc COSRT(Snr), MBACP Accred, The Laurel Centre, London, UK.
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12
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Sampogna G, Fiorillo A, Wasserman D. How to improve the quality of World Psychiatric Association educational activities? Results from an online survey with World Psychiatric Association zonal representatives. Asia Pac Psychiatry 2021; 13:e12497. [PMID: 34873846 DOI: 10.1111/appy.12497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The World Psychiatric Association (WPA), a global association representing 145 psychiatric societies in 121 countries, has a specific focus on education and learning, promoting educational programs on a regular basis. Education in mental health is a continuously evolving phenomenon, although it happens quite often that it is still based on a knowledge formed in the last century and with the latest scientific updates mainly available in English. The WPA is constantly committed in improving and updating the type of educational materials available and ready to be disseminated worldwide. METHODS An online survey has been developed and sent to the 18 WPA zonal representatives in order: to evaluate the educational needs for mental health, to translate materials into native languages or inclusivity, and to prioritize educational activities to be developed by the WPA in the next years. RESULTS Fifteen out of the 18 zonal representatives participated in the study. According to the public mental health perspective, collaboration with general practitioners (GPs) (80%), communities/stakeholders (66.7%) and programs for promoting mental health in schools (53.3%) are the most prioritized activities carried out. Programs for suicide prevention (86.7%) and promotion of mental health and well-being in the general population (66.7%) are considered as the most relevant to be implemented. From the healthcare perspective, new knowledge on pharmacological and non-pharmacological interventions (73%) was requested. The educational packages are mostly available in the English language, although respondents prioritize the translation of WPA educational material into, at least, Spanish and French. The most preferred formats for educational activities are webinar live (80%) and key opinion lectures (66.7%). CONCLUSIONS These findings represent the first step in the continuing promotion of education carried out by the WPA. We aim to run these kinds of initiatives from time to time in order to adapt themes and topics of these materials to the real educational needs of all mental healthcare professionals worldwide.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy.,Chair WPA Section on Education in Psychiatry, World Psychiatric Association, Geneva, Switzerland
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden.,WPA President Elect, World Psychiatric Association, Geneva, Switzerland
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13
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Fiorillo A, Falkai P. The ICD-11 is coming to town! Educational needs, paradigm shifts and innovations in mental health care practice. Eur Psychiatry 2021; 64:e73. [PMID: 34814954 PMCID: PMC8715279 DOI: 10.1192/j.eurpsy.2021.2254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
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Giuseppe P. PROFESSIONAL TRAINING TO THE USE OF THE ICD-11 CHAPTER ON MENTAL DISORDERS. ACTAS ESPANOLAS DE PSIQUIATRIA 2021; 49:286-287. [PMID: 34734644 PMCID: PMC9330281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 12/05/2022]
Abstract
The ICD-11 chapter on mental disorders has now been finalized. The most important changes in this chapter with respect to the ICD-10, and the most significant differences from the DSM-5, have been described comprehensively.
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Affiliation(s)
- Piegari Giuseppe
- WHO Collaborating Centre for Research and Training in Mental Health, University of Campania L. Vanvitelli, Naples, Italy
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15
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Jacobs T, Geysemans B, Van Hal G, Glazemakers I, Fog-Poulsen K, Vermandel A, De Wachter S, De Win G. Associations Between Online Pornography Consumption and Sexual Dysfunction in Young Men: Multivariate Analysis Based on an International Web-Based Survey. JMIR Public Health Surveill 2021; 7:e32542. [PMID: 34534092 PMCID: PMC8569536 DOI: 10.2196/32542] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/24/2021] [Accepted: 09/17/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Expanding access to the internet has resulted in more and earlier consumption of online pornography. At the same time, a higher prevalence of erectile dysfunction (ED) among young men is seen. Increased pornography consumption has been suggested as a possible explanation for this rise. OBJECTIVE The aim of this study was to better understand associations between problematic pornography consumption (PPC) and ED. METHODS A 118-item survey was published online, and data collection took place between April 2019 and May 2020. Of the 5770 men who responded, the responses from 3419 men between 18 years old and 35 years old were analyzed. The survey used validated questionnaires such as the Cyber Pornography Addiction Test (CYPAT), International Index of Erectile Function (IIEF-5), and Alcohol Use Disorders Identification Test-Concise (AUDIT-C). The estimated amount of porn watching was calculated. Univariable and multivariable analyses were performed. For the multivariable analysis, a logistic regression model using a directed acyclic graph was used. RESULTS According to their IIEF-5 scores, 21.48% (444/2067) of our sexually active participants (ie, those who attempted penetrative sex in the previous 4 weeks) had some degree of ED. Higher CYPAT scores indicating problematic online pornography consumption resulted in a higher probability of ED, while controlling for covariates. Masturbation frequency seemed not to be a significant factor when assessing ED. CONCLUSIONS This prevalence of ED in young men is alarmingly high, and the results of this study suggest a significant association with PPC. TRIAL REGISTRATION Research Registry researchregistry5111; https://tinyurl.com/m45mcaa2.
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Affiliation(s)
- Tim Jacobs
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Björn Geysemans
- Department of Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium
| | - Guido Van Hal
- Department of Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium
| | - Inge Glazemakers
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Alexandra Vermandel
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Stefan De Wachter
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Gunter De Win
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Urology, University Hospital Antwerp, Edegem, Belgium
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16
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Zivari-Rahman M, Ghanbari S, Shokouhi-Moghadam S. Psychometric Properties of the Youth Pornography Addiction Screening Tool. ADDICTION & HEALTH 2021; 13:207-220. [PMID: 35178193 PMCID: PMC8818307 DOI: 10.22122/ahj.v13i4.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/02/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Addiction to pornography in the virtual world can seriously affect the mental, psychological, social, and family health of individuals and easy access to the Internet and cyberspace has intensified addiction to virtual pornography. Knowledge of the status of phenomena requires an accurate and scientific measurement tool with appropriate validity and reliability, so this study was conducted with the aim to study the Youth Pornography Addiction Screening Tool (YPAST). METHODS This study was carried out using the descriptive-exploratory method. The statistical population of the study included all students aged 18 to 30 years studying in the universities of Hamadan, Iran, in the academic year 2020-2021. Using stratified random sampling method, 480 individuals were selected from Bu-Ali Sina University, Islamic Azad University, and Payame Noor University of Hamadan Province. To collect data, the YPAST was utilized. The Cronbach's alpha coefficient, exploratory factor analysis (EFA) with Varimax rotation, and confirmatory factor analysis (CFA) were used to analyze the data. FINDINGS The YPAST consists of the 3 components of lack of control over pornographic behavior, regret after pornography use, and pornography for sexual arousal. These 3 factors together explained 61.16% of the total variance of pornography addiction in cyberspace, with the first, second, and third factors explaining 22.98%, 21.79%, and 16.39% of the variance, respectively. The CFA results showed that the scale items were of appropriate factor loads and higher than 0.40 on each factor, and the study measurement model in the first and second order factor analysis was of an acceptable fit. Therefore, the YPAST had an appropriate and acceptable structural validity among young people. The total validity coefficient of the YPAST was 0.88 and that of the first, second, and third factors were 0.94, 0.93 and 0.88, respectively. The YPAST has 3 factors. CONCLUSION The YPAST can be a powerful and accurate tool for measuring youth pornography addiction and it can be used with confidence in various situations to measure youth virtual pornography addiction. In addition, it seems that the scale items have a proper coherence and fluency, which, as a unified and integrated set of different aspects, can measure virtual pornography addiction among young people with high accuracy.
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Affiliation(s)
| | - Siroos Ghanbari
- Department of Educational Sciences, Bu-Ali Sina University, Hamadan, Iran
| | - Solmaz Shokouhi-Moghadam
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran,Correspondence to: Solmaz Shokouhi-Moghadam; Neuroscience Research Center, Neuroscience Research Center, Institute of
Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran;
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17
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Affiliation(s)
- Luigi Giuliani
- WHO Collaborating Centre for Research and Training in Mental HealthUniversity of Campania L. VanvitelliNaplesItaly
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18
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Epstein S. Cultivated co-production: Sexual health, human rights, and the revision of the ICD. SOCIAL STUDIES OF SCIENCE 2021; 51:657-682. [PMID: 33928808 DOI: 10.1177/03063127211014283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
STS scholars frequently have shown how science and sociopolitical arrangements are 'co-produced', typically tracing how scientific actors themselves keep 'science' and 'politics' far apart. Revealing co-production is therefore deemed the work of the STS analyst, who unearths linkages that the actors might be unaware of, or might ignore or deny. By contrast, the creation of a new chapter on 'sexual health' in the recent revision of the International Classification of Diseases (ICD) offers a case of what might be termed 'cultivated co-production'. Neither oblivious to the linkages between science and politics nor invested in obscuring them, the designers of the sexual health chapter sought support for their work by demonstrating, transparently, how science, ethics, and human rights might properly be aligned. The intentional and visible character of co-production in this case indicates awareness of the need to manage the contested nature of gender and sexuality at a transnational level. It also reflects two changes in the organization of medical politics and medical classification: a widespread recognition of the necessity of reaching out to lay stakeholders and advocates, and the rise of an emphasis on 'conventions' as the backbone of transnational biomedical consensus processes.
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19
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Biedermann SV, Asmuth J, Schröder J, Briken P, Auer MK, Fuss J. Childhood adversities are common among trans people and associated with adult depression and suicidality. J Psychiatr Res 2021; 141:318-324. [PMID: 34304035 DOI: 10.1016/j.jpsychires.2021.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/23/2021] [Accepted: 07/13/2021] [Indexed: 11/20/2022]
Abstract
Trans people suffer from increased rates of depression and suicidality even after gender-affirming medical interventions. The present study aims to examine the prevalence of childhood adversities in patients with gender dysphoria and to analyze its impact on adult depression and suicidality. Participants meeting diagnostic criteria of Gender Dysphoria were recruited in a cross-sectional multicenter study at four German health-care centers. Childhood adversities were assessed with the Childhood Trauma Questionnaire (CTQ) and additional single items for other childhood adversities. Associations between childhood adversities and adult depression and suicidality were calculated using regression analyses. A large majority of participants reported childhood adversities, and only 7% endorsed no adversities in the CTQ. Over 30% reported severe to extreme childhood adversities. One-fourth reported parents exhibiting violent behavior while bullying by peers was experienced by 70%. These adversities were associated with an increased risk for adult depression and suicidality. Time since beginning of hormonal therapy did not show a significant influence neither on depression nor on suicidality. Childhood adversities are common and associated with adult depression and suicidality in trans people. Adequately addressing these childhood adversities and providing trauma-informed mental health care might ameliorate the mental health burden in trans people.
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Affiliation(s)
- Sarah V Biedermann
- Department of Psychiatry and Psychotherapy, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Germany.
| | - Janina Asmuth
- Department of Psychiatry and Psychotherapy, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Johanna Schröder
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Matthias K Auer
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, 80336, Munich, Germany
| | - Johannes Fuss
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Germany
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20
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Mascherek A, Reidick MC, Gallinat J, Kühn S. Is Ejaculation Frequency in Men Related to General and Mental Health? Looking Back and Looking Forward. Front Psychol 2021; 12:693121. [PMID: 34434144 PMCID: PMC8382266 DOI: 10.3389/fpsyg.2021.693121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Despite its relevance for human sexuality, literature on potential effects of ejaculation frequency and masturbation on general and mental health outcomes is sparse. Reasons for this knowledge gap include a general lack of interest, but also methodological challenges and still existing superstition. This paper reconciles literature from various fields to extract relevant information on how ejaculation frequency effects general and mental health outcomes. Culture-bound syndromes have been reported in countries still strictly tabooing or condemning masturbation. Masturbatory guilt describes a phenomenon in individuals experiencing a discrepancy between moral standards and own behavior with respect to masturbation. Abstinence is one aspect under study in the area of fertility treatment. Specific time frames and their respective implications on quality of sperm remain inconclusive. Limited temporal resolution capacities hamper the precise study of brain structures directly activated during ejaculation. The relation between ejaculation frequency and hormonal influences remains poorly understood. Future research that specifically addresses ejaculation frequency and potential mental and general health outcomes is needed. In contrast to extracting knowledge as a byproduct from other studies with a different focus, this enables sound study designs and could provide evidence-based results which could then be further discussed and interpreted.
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Affiliation(s)
- Anna Mascherek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mirjam Christina Reidick
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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21
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Lewczuk K, Nowakowska I, Lewandowska K, Potenza MN, Gola M. Frequency of use, moral incongruence and religiosity and their relationships with self-perceived addiction to pornography, internet use, social networking and online gaming. Addiction 2021; 116:889-899. [PMID: 32955140 DOI: 10.1111/add.15272] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/18/2020] [Accepted: 09/11/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Moral incongruence involves disapproval of a behavior in which people engage despite their moral beliefs. Although considerable research has been conducted on how moral incongruence relates to pornography use, potential roles for moral incongruence in other putative behavioral addictions have not been investigated. The aim of this study was to investigate the role of moral incongruence in self-perceived addiction to: (i) pornography; (ii) internet addiction; (iii) social networking; and (iv) online gaming. DESIGN A cross-sectional, preregistered, online survey using multivariable regression. SETTING Online study conducted in Poland. PARTICIPANTS 1036 Polish adults aged between 18 and 69 years. MEASUREMENTS Measures included self-perceived behavioral addiction to pornography, internet use, social networking and online gaming and their hypothesized determinants (moral incongruence, frequency of use, time of use, religiosity, age and gender). FINDINGS Higher moral incongruence (β = 0.20, P < 0.001) and higher religiosity (β = 0.08, P < 0.05) were independently associated with higher self-perceived addiction to pornography. Additionally, frequency of pornography use was the strongest of the analyzed predictors (β = 0.43, P < 0.001). A similar, positive relationship between high moral incongruence and self-perceived addiction was also present for internet (β = 0.16, P < 0.001), social networking (β = 0.18, P < 0.001) and gaming addictions (β = 0.16, P < 0.001). Religiosity was uniquely, although weakly, connected to pornography addiction, but not to other types of addictive behaviors. CONCLUSIONS Moral incongruence may be positively associated with self-perception of behavioral addictions including not only pornography viewing, but also internet use, social networking and online gaming.
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Affiliation(s)
- Karol Lewczuk
- Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland
| | - Iwona Nowakowska
- Institute of Psychology, The Maria Grzegorzewska University, Warsaw, Poland
| | | | - Marc N Potenza
- Department of Psychiatry and Child Study Center, School of Medicine, Yale University, New Haven, Connecticut, USA.,Department of Neuroscience, Yale University, New Haven, Connecticut, USA.,Connecticut Council on Problem Gambling, Wethersfield, Connecticut, USA.,Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Mateusz Gola
- Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California, San Diego, California, USA.,Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
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22
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Grubbs JB. Commentary on Lewczuk et al : Moral incongruence, disapproval and behavioral 'addiction'. Addiction 2021; 116:900-901. [PMID: 33314391 DOI: 10.1111/add.15326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/02/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Joshua B Grubbs
- Bowling Green State University, Department of Psychology, Bowling Green, OH, USA
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23
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Fuß J, Voulgaris A, Briken P. Schuldfähigkeit bei Personen, die wegen Nutzung von Missbrauchsabbildungen angeklagt sind. FORENSISCHE PSYCHIATRIE PSYCHOLOGIE KRIMINOLOGIE 2020. [DOI: 10.1007/s11757-020-00624-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
ZusammenfassungDie Nutzung von Missbrauchsabbildungen (umgangssprachlich „Kinderpornografie“) und damit im Zusammenhang stehende Straftaten haben in den letzten Jahren an Bedeutung gewonnen. Der vorliegende Aufsatz beleuchtet die gängigen forensisch-psychiatrischen Kriterien zur Einschätzung der Schuldfähigkeit bei Personen, die wegen des Erwerbs, Besitzes oder der Verbreitung kinderpornografischer Schriften angeklagt sind. Liegt aus forensisch-psychiatrischer Perspektive eine schwere Sexualpathologie vor, die die psychiatrischen Voraussetzungen für eine sog. schwere andere seelische Abartigkeit erfüllt, so wird sich der Gutachter die Frage einer Steuerungsminderung stellen. Im Fall von Delikten im Zusammenhang mit der Nutzung von Missbrauchsabbildungen lassen sich die Kriterien aus den Mindestanforderungen jedoch aus Sicht der Autoren schlecht anwenden. Ein weiteres Problem bei der Begutachtung ist, dass sich die angeklagten Straftaten häufig über einen längeren Zeitraum verteilen und daher der Sachverständige ggf. nach überdauernden psychopathologischen Hinweisen einer geminderten Steuerungsfähigkeit suchen muss. Die sexuelle Dranghaftigkeit, die motivationale Steuerungsfähigkeit und die Desaktualisierungspotenz sind hilfreiche Konzepte, um die Steuerungsfähigkeit in diesem Zusammenhang einzuschätzen. Eine überdauernde forensisch-relevante Steuerungsminderung, die sich ggf. über mehrere Jahre hingezogen hat, wird im Zusammenhang mit der Nutzung von Missbrauchsabbildungen in der Regel nicht vorliegen und eher einen Sonderfall darstellen.
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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: 103] [Impact Index Per Article: 25.8] [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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25
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Kowalewska E, Gola M, Kraus SW, Lew-Starowicz M. Spotlight on Compulsive Sexual Behavior Disorder: A Systematic Review of Research on Women. Neuropsychiatr Dis Treat 2020; 16:2025-2043. [PMID: 32943868 PMCID: PMC7478918 DOI: 10.2147/ndt.s221540] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/07/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE OF REVIEW World Health Organization recently included compulsive sexual behavior disorder (CSBD) to the upcoming 11th edition of International Classification of Diseases (6C72). Despite the potential benefits of this decision (eg, the acceleration of research in the field will allow the development of effective treatments), previous research focused mainly on men, and as a result, we do not have an accurate clinical picture of compulsive sexual behavior (CSB) among women. Therefore, in this systematic review, we aim to present available knowledge on this topical subject. Literature search was conducted in the guideline of PRISMA methodology. Studies were identified from multiple databases including Academic Search Ultimate, SocINDEX, PsycARTICLES, PsycINFO, PubMed, and MEDLINE. Out of a total of 10,531 articles identified and screened, 58 were included in this review. Included studies covered the following topics: prevalence and etiology of CSB, behavioral and cognitive processes involved, comorbidities, personality traits, psychosocial and interpersonal difficulties, traumatic experiences, and treatments. RECENT FINDINGS Available studies indicate that CSB symptom severity is lower in women than in men. Overall, women reported consuming pornography less often than men and exhibit lower rates of feeling urges to these materials. CSB symptoms (including problematic pornography use) have been found to be positively related to trait psychopathy, impulsivity, sensation seeking, attention-deficit/hyperactivity disorder symptoms, obsessive-compulsive disorder, pathological buying, sexual dysfunctions, general psychopathology, child sexual abuse, while negatively related to dispositional mindfulness. SUMMARY Conclusions that can be drawn from prior studies are considerably limited. There are no accurate estimates of the CSB prevalence or severity among women, and studies have been mostly conducted on non-clinical populations, which has limited application for women diagnosed with CSBD.
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Affiliation(s)
- Ewelina Kowalewska
- Department of Psychiatry, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Mateusz Gola
- Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California, San Diego, CA, USA
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Shane W Kraus
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
| | - Michal Lew-Starowicz
- Department of Psychiatry, Centre of Postgraduate Medical Education, Warsaw, Poland
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26
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Repetitive Transcranial Magnetic Stimulation as a Potential Tool to Reduce Sexual Arousal: A Proof of Concept Study. J Sex Med 2020; 17:1553-1559. [DOI: 10.1016/j.jsxm.2020.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/27/2020] [Accepted: 05/03/2020] [Indexed: 11/23/2022]
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Bőthe B, Potenza MN, Griffiths MD, Kraus SW, Klein V, Fuss J, Demetrovics Z. The development of the Compulsive Sexual Behavior Disorder Scale (CSBD-19): An ICD-11 based screening measure across three languages. J Behav Addict 2020; 9:247-258. [PMID: 32609629 PMCID: PMC8939427 DOI: 10.1556/2006.2020.00034] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/05/2020] [Accepted: 05/10/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Compulsive Sexual Behavior Disorder (CSBD) is included in the eleventh edition of The International Classification of Diseases (ICD-11) as an impulse-control disorder. AIMS The aim of the present work was to develop a scale (Compulsive Sexual Behavior Disorder Scale-CSBD-19) that can reliably and validly assess CSBD based on ICD-11 diagnostic guidelines. METHOD Four independent samples of 9,325 individuals completed self-reported measures from three countries (the United States, Hungary, and Germany). The psychometric properties of the CSBD-19 were examined in terms of factor structure, reliability, measurement invariance, and theoretically relevant correlates. A potential threshold was determined to identify individuals with an elevated risk of CSBD. RESULTS The five-factor model of the CSBD-19 (i.e., control, salience, relapse, dissatisfaction, and negative consequences) had an excellent fit to the data and demonstrated appropriate associations with the correlates. Measurement invariance suggested that the CSBD-19 functions similarly across languages. Men had higher means than women. A score of 50 points was found as an optimal threshold to identify individuals at high-risk of CSBD. CONCLUSIONS The CSBD-19 is a short, valid, and reliable measure of potential CSBD based on ICD-11 diagnostic guidelines. Its use in large-scale, cross-cultural studies may promote the identification and understanding of individuals with a high risk of CSBD.
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Affiliation(s)
- Beáta Bőthe
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary,Département de Psychologie, Université de Montréal, Montréal, QC, Canada,Corresponding author. Department of Psychology, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montréal, QC, H3C 3J7, Canada E-mail: . Tel.: +1 438 833 3038
| | - Marc N. Potenza
- 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
| | - Mark D. Griffiths
- Psychology Department, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
| | - Shane W. Kraus
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Verena Klein
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Fuss
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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Luciano M, Sampogna G, Del Vecchio V, Giallonardo V, Palummo C, Pocai B, Steardo L, Zinno F, Rebello T, Reed GM, Fiorillo A. The Italian ICD-11 field trial: clinical utility of diagnostic guidelines for schizophrenia and related disorders. Int J Ment Health Syst 2020; 14:4. [PMID: 31998405 PMCID: PMC6979076 DOI: 10.1186/s13033-020-0338-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background The 11th revision of the International Classification of Diseases and Related Disorders (ICD-11) has been released. In order to test the clinical consistency and the clinical utility of the proposed guidelines the World Health Organization (WHO) has carried out the Ecological Implementation Field Studies in various countries. In this paper the results of the Italian field trials on the clinical utility of the ICD-11 diagnostic guideline concerning schizophrenia and related disorders will be presented. Methods In Italy, field trials have been carried out at the Department of Psychiatry of the University of Campania “L. Vanvitelli”. All patients showing any psychotic symptom and referring to the outpatient and inpatient units have been recruited. Patients were interviewed by two clinicians with whom they had not had any prior clinical contact. At the end of each interview, clinicians were asked to complete 12 questions about the clinical utility of the diagnostic guidelines as applied to each patient. Results Fourteen clinicians and 100 patients have been involved. The ICD-11 clinical guidelines were perceived as easy to use, with an adequate goodness of fit, clear and understandable and with an adequate level of details and specificity to describe the essential features of the diagnoses. Clinicians rated very positively their usefulness in describing the threshold between patient’s disorder and normality. Despite still very positive, the guidelines have been perceived as less useful to select a treatment, to assess patients’ prognosis and to communicate with other mental health professionals. Conclusions The 11th revision of the chapter on Mental, Behavioural and Neurodevelopmental Disorders has made substantive changes to the conceptualization of mental disorders which could have impacted on their reliability and clinical utility. Results of the Italian field studies, in line with those reported by the international sample, highlight that ICD-11 has been rated as highly clinically useful by participating clinician, more than the ICD-10. This could be considered a good reason to be optimistic about the implementation of the ICD-11 among global clinicians. Trial registration The study has been approved by the Ethical Review Board of the University of Campania “L. Vanvitelli” (N. 416, 2016)
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Affiliation(s)
- Mario Luciano
- WHO Collaborating Center for Research and Training in Mental Health, University of Campania "L. Vanvitelli", Naples, Italy
| | - Gaia Sampogna
- WHO Collaborating Center for Research and Training in Mental Health, University of Campania "L. Vanvitelli", Naples, Italy
| | - Valeria Del Vecchio
- WHO Collaborating Center for Research and Training in Mental Health, University of Campania "L. Vanvitelli", Naples, Italy
| | - Vincenzo Giallonardo
- WHO Collaborating Center for Research and Training in Mental Health, University of Campania "L. Vanvitelli", Naples, Italy
| | - Carmela Palummo
- WHO Collaborating Center for Research and Training in Mental Health, University of Campania "L. Vanvitelli", Naples, Italy
| | - Benedetta Pocai
- WHO Collaborating Center for Research and Training in Mental Health, University of Campania "L. Vanvitelli", Naples, Italy
| | - Luca Steardo
- 2Dipartimento di Scienze della Salute, Università della Magna Graecia, Catanzaro, Italy
| | - Francesca Zinno
- WHO Collaborating Center for Research and Training in Mental Health, University of Campania "L. Vanvitelli", Naples, Italy
| | - Tahilia Rebello
- 3WHO Collaborating Centre for Capacity Building and Training in Global Mental Health, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY USA
| | - Geoffrey M Reed
- 3WHO Collaborating Centre for Capacity Building and Training in Global Mental Health, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY USA
| | - Andrea Fiorillo
- WHO Collaborating Center for Research and Training in Mental Health, University of Campania "L. Vanvitelli", Naples, Italy
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Lewczuk K, Gorowska M, Li Y, Gola MK. Mobile Internet Technologies, Ecological Momentary Assessment, and Intervention-Poison and Remedy for New Online Problematic Behaviors in ICD-11. Front Psychiatry 2020; 11:807. [PMID: 32903803 PMCID: PMC7438912 DOI: 10.3389/fpsyt.2020.00807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/27/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Karol Lewczuk
- Institute of Psychology, Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Monika Gorowska
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yonghui Li
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Mateusz Kazimierz Gola
- Swartz Center for Computational Neuroscience, Institute for Neural Computation, University of California, San Diego, San Diego, CA, United States.,Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
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Lewczuk K, Glica A, Nowakowska I, Gola M, Grubbs JB. Evaluating Pornography Problems Due to Moral Incongruence Model. J Sex Med 2019; 17:300-311. [PMID: 31818724 DOI: 10.1016/j.jsxm.2019.11.259] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/28/2019] [Accepted: 11/03/2019] [Indexed: 01/23/2023]
Abstract
INTRODUCTION To date, multiple models of problematic pornography use have been proposed, but attempts to validate them have been scarce. AIM In our study, we aimed to evaluate the Pornography Problems due to Moral Incongruence model proposing that self-appraisals of pornography addiction stem from (i) general dysregulation, (ii) habits of use, and (iii) moral incongruence between internalized norms and behavior. We investigated whether the model can be used to adequately explain the self-perceptions of addiction to pornography (model 1) and a broader phenomenon of problematic pornography use (model 2). METHODS An online, nationally representative study was conducted on a sample of 1036 Polish adult participants, of whom, 880 declared a lifetime history of viewing pornography. MAIN OUTCOME MEASURE The outcomes were self-perceived pornography addiction, problematic pornography use, avoidant coping, frequency of pornography use, religiosity, moral disapproval of pornography, and related variables. RESULTS Our results indicated that avoidant coping (an indicator of general dysregulation), frequency of pornography use (indicator of habits of use), and the distress connected with incongruence between own sexual behavior and internalized norms, attitudes and beliefs positively contributed to self-perceived addiction (model 1) as well as problematic pornography use (model 2). This broadly confirms the basic shape of the PPMI model. There were, however, notable differences between the models. Moral incongruence related distress was only weakly related to self-perceived addiction (β = 0.15, P < .001), with a stronger relation for problematic pornography use (β = 0.31, P < .001). When controlling for other factors, religiosity weakly predicted problematic pornography use (β = 0.13, P < .001), but not self-perceived addiction to pornography (β = 0.03, P = .368). Frequency of pornography use was the strongest predictor of both self-perceived addiction (β = 0.52, P < .001) and problematic pornography use (β = 0.43, P < .001). CLINICAL IMPLICATIONS Factors proposed within the PPMI model are distinctly relevant intervention targets, and they should be considered in the process of diagnosis and treatment. STRENGTHS & LIMITATIONS The presented study is the first to evaluate PPMI model. Its main limitation is that it has a cross-sectional design. CONCLUSION The PPMI model is a promising framework for investigating the factors related to self-perceived addiction and problematic pornography use. Despite the differences between the models and in the strength of specific predictors, (i) dysregulation, (ii) habits of use, and (iii) moral incongruence all uniquely contribute to self-perceived addiction and problematic pornography use. Lewczuk, K., Glica, A., Nowakowska, I., et al. Evaluating Pornography Problems Due to Moral Incongruence Model. J Sex Med 2020;17:300-311.
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Affiliation(s)
- Karol Lewczuk
- Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland.
| | - Agnieszka Glica
- Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland; Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Iwona Nowakowska
- Institute of Psychology, The Maria Grzegorzewska University, Warsaw, Poland
| | - Mateusz Gola
- Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California, San Diego, USA; Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Joshua B Grubbs
- College of Arts and Science, Bowling Green State University, Bowling Green, USA
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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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