The Relationship Between Hypersexual Behavior, Sexual Excitation, Sexual Inhibition, and Personality Traits

Sexual Excitation and Inhibition Moderate the Strength of Concordance Between Paraphilic Interests and Behaviors

The concordance between paraphilic interest and behavior is moderate to strong in previous studies. In the present study, we examined whether sexual excitation (SE) and sexual inhibition (SI) moderate the concordance between paraphilic interest and behavior, across several paraphilic themes. We expected that stronger concordance would be found at high levels of SE and weaker concordance would be found at high levels of SI, for both men and women. We expected stronger effects when high levels of SE are combined with low levels of SI and when low levels of SE are combined with high levels of SI, for both genders. To test this, we sampled 219 men and 351 women (Mage = 28.42, SDage = 10.58) and conducted moderated moderation analyses with bootstrapping, separately for each gender and paraphilic theme. Consistent with our hypotheses, for paraphilic themes where SE was a significant moderator, the concordance between paraphilic interest and behavior was stronger at higher levels of SE. In contrast, for themes moderated by SI, the concordance was weaker at higher levels of SI. Sexual excitation and sexual inhibition only moderated concordance between paraphilic interest and behavior for masochism and voyeurism in women, in the expected direction: the highest concordance was observed at higher SE/lower SI and the lowest concordance was observed at lower SE/higher SI. SE and SI moderated concordance between paraphilic interest and behavior across several different paraphilic themes for men and women, suggesting that different sexuality traits may be involved across genders and across themes.

Magnetoencephalographic correlates of pornography consumption: Associations with indicators of compulsive sexual behaviors

Pornography consumption is highly prevalent but can develop into problematic sexual behavior with severe negative emotional consequences. Neurobiological studies indicate that compulsive sexual behaviors (CSB) are associated with altered brain structure and function in processing pornography. This study investigated the neuroaffective mechanisms underlying exposure to erotic and explicit pornographic images and their relationship to CSB-relevant symptoms. Whole-head magnetoencephalography (MEG) assessed brain activity during passive viewing of opposite- and same-sex erotic and pornographic images in healthy heterosexual and homosexual women and men (N = 50). Correlations of estimated event-related neural activity with indicators of CSB (hypersexuality, sexual sensation seeking, problematic pornography use, and time spent on pornography use), mood and anxiety, as well as with subjective picture ratings of hedonic valence and emotional arousal were analyzed. Responses of brain regions to sexual content revealed hyper- and hypoactivation and were related to problematic pornography consumption, hypersexuality, time spent on pornography use, and perceived subjective arousal. The neural activation towards erotic and pornographic content revealed further significant associations with depression and anxiety scores. The findings suggest an involvement of prefrontal and temporo-parietal cortex regions in the divergent processing of sexual content in relation to indicators of CSBD. Insight into the neurobiological factors underlying CSB can contribute to a more precise clinical conceptualization of this problem and may promote the development of more effective therapeutic interventions.

The Relevance of Hypersexuality and Impulsivity in Different Groups of Treatment-Seekers With and Without (Exclusive) Pedophilia

Hypersexuality and impulsivity are regarded as risk factors for sexual offending against children. Studies exploring these factors in undetected men who offended or are at risk of offending are rare. This study aims to investigate hypersexuality and impulsivity in treatment-seeking men with and without a diagnosis of (exclusive) pedophilia who committed child sexual abuse (CSA), consumed child sexual abuse images (CSAI), or feel at risk of offending sexually. Data were obtained from three child abuse prevention projects in Bamberg, Germany. We employed self-report (BIS-11, HBI), objective measures (TSO), and risk assessment tools (STABLE-2007). We computed Bayesian ordinal logit and binomial generalized linear models to explore differences between groups and to predict lifetime CSA and CSAI. Hypersexuality scores were particularly pronounced in patients with exclusive and non-exclusive pedophilia. Patients without pedophilia scored similarly to nonclinical samples. Impulsivity measures did not consistently differ between groups. We could not predict lifetime CSA and CSAI using impulsivity and hypersexuality measures. Sexual rather than general impulsivity seems to be an issue in men with pedophilia. The motivation to offend in patients without pedophilia is discussed.

Interplay between sexual excitation and inhibition: impact on sexual function and neural correlates of erotic stimulus processing in women

Background

As outlined by the dual control model (DCM), individual differences in the regulation of sexual arousal following sexual stimulation depend on two distinct neurophysiological processes: sexual excitation (SE) and sexual inhibition (SI). Although associations with sexual function, behavior, and cue processing have been demonstrated in previous research, underlying neural correlates remain insufficiently explored. Moreover, interactive effects of SE/SI as proposed by the DCM, as well as factors impacting SE/SI properties, such as the use of oral contraceptives (OCs), have not received adequate attention in existing research.

Methods

90 healthy, sexually active women (n = 51 using OCs, n = 39 naturally cycling) completed an Emotional-Picture-Stroop-Paradigm (EPSP) while a 64-channel EEG was recorded. LPP amplitudes toward erotic and neutral stimuli were consecutively computed as a marker of motivational salience and approach motivation. Additionally, women provided self-reports of SE/SI and sexual function. Moderation analyses were performed to assess interactive effects of SE/SI in predicting LPP amplitudes and sexual function.

Results

Sexual function was negatively associated with SI levels but unrelated to SE. Higher SI was associated with reduced LPP amplitudes in response to erotic stimuli. This negative association was, however, attenuated for women high in SE, suggesting interactive effects of SE/SI. Furthermore, women using OCs reported lower SE compared to naturally cycling women.

Conclusion

The observed findings provide additional psychophysiological evidence supporting the DCM and underscore the relevance of interactive SE/SI effects in stimulus processing and approach motivation. They also highlight the possible impact of OCs on psychosexual variables that warrants further research.

Compulsive sexual behavior disorder in an inpatient sample with substance use disorder

Background

Several studies indicate that compulsive sexual behavior disorder (CSBD) shares core elements with substance use disorder (SUD). These findings support the assumption of common mechanisms in addiction, which may lead to a higher tendency in patients with SUD to have comorbid CSBD. Nevertheless, this relationship between CSBD and SUD is poorly understood to date.

Aim

This study aimed to compare the prevalence of CSBD and its subtype pornography use disorder (PUD) between a SUD group and a matched control group. Herein, we aimed to test whether patients with SUD are more likely to have a comorbid CSBD/PUD. We further hypothesized that a higher CSBD/PUD prevalence in patients with SUD is accompanied by more pronounced CSBD- and PUD-related personal characteristics.

Methods

We assessed CSBD, PUD, and related personal characteristics in an inpatient SUD sample (N = 92) and a healthy control sample matched by age, gender, and educational level.

Outcomes

Primary outcomes were the diagnoses of CSBD/PUD as assessed by questionnaires. CSBD/PUD-related personal characteristics were the early onset of problematic pornography consumption, relationship status as a single person, a high sexual motivation, a high level of time spent watching pornography, and a high degree of problematic pornography consumption (Problematic Pornography Consumption Scale, short version).

Results

There was no significant difference between groups regarding CSBD prevalence (SUD sample, 3.3%; control sample, 7.6%) and PUD prevalence (SUD sample, 2.2%; control sample, 6.5%). We found relationship status as a single person and the sexual motivation dimension of importance of sex to be the only CSBD-related personal characteristics that were more pronounced in the SUD sample than the matched control group.

Clinical Implications

Results indicate no higher tendency for patients with SUD to develop comorbid CSBD/PUD, yet important vulnerabilities (eg, emotional dysregulation) should be considered when treating addictive disorder to prevent possible symptom displacement.

Strengths and Limitations

A strength of the study is that we compared a sample of patients with SUD with a matched control sample and used an instrument based on ICD-11 criteria for CSBD. Possible limitations are significant differences between the groups because of the restrictions in an inpatient clinic that may have influenced responses (eg, roommates) and that the control group was not screened for SUD. Therefore, the results should be interpreted with some caution.

Conclusion

We found no evidence of an overcomorbidity of SUD and CSBD/PUD. However, a higher rate of vulnerability factors for CSBD/PUD in the SUD sample might suggest some similarities between SUD and CSBD/PUD.

Two subtypes of compulsive sexual behavior disorder

Models explaining addictive behaviors such as the Interaction of Person-Affect-Cognition-Execution (I-PACE) model emphasize the importance of reinforcement mechanisms for developing and maintaining these behaviors, including compulsive sexual behavior disorder (CSBD) as well as personal characteristics as vulnerability factors. This study aimed to determine whether there are CSBD subtypes distinguished by reinforcement sensitivity. We hypothesize that one subtype is sensitive to positive reinforcement (C+subtype) and one is sensitive to negative reinforcement (Ȼ-subtype). We calculated a cluster analysis with data from 62 patients with CSBD and tested differences between the identified clusters by t-test. The sample consisted only of men. Cluster variables were: the sensitivity to the Behavioral Inhibition and Approach System (BIS/BAS), the severity of depressive symptoms (BDI-II), the severity of Trait Anxiety (STAI-T), Sexual Sensation Seeking (SSSS), Thrill- and Adventure-Seeking (SSS-V subscale), Disinhibition (SSS-V subscale), Experience Seeking (SSS-V subscale), and Boredom Susceptibility (SSS-V subscale). Between-cluster differences were analyzed for Trait Sexual Motivation (TSMQ) and Sexual Compulsivity (SCS). The results showed a two-cluster solution with cluster 1 representing patients sensitive to negative reinforcement (Ȼ-subtype) and cluster 2 representing patients sensitive to positive reinforcement (C+subtype). No significant difference in symptom severity of Sexual Compulsivity between clusters was found. Cluster 2 showed higher Importance of Sex and a higher motivation to seek sexual encounters than cluster 2. We found a two-cluster solution regarding reinforcement sensitivity in patients with CSBD. This may have clinical implications regarding individual therapy by focusing on the underlying maintenance mechanisms.

Trait mindfulness and personality characteristics in a microdosing ADHD sample: a naturalistic prospective survey study

Background

Microdosing (MD), repeatedly taking psychedelics in small, non-hallucinogenic amounts, has been practiced by individuals to relieve attention deficit hyperactivity disorder (ADHD) symptoms. Generally, adults diagnosed with ADHD have lower levels of mindfulness and differ in personality structure from non-ADHD adults. How MD affects mindfulness and personality in adults with ADHD remains unexplored.

Aim

This study aimed to investigate the effects of 4 weeks of MD on mindfulness and personality traits in adults diagnosed with ADHD and those experiencing severe ADHD symptoms. It was expected that mindfulness and the personality traits conscientiousness, extraversion, agreeableness, and openness would increase and neuroticism would decrease after 4 weeks of MD compared to baseline. It was explored if using conventional ADHD medication alongside MD and/or having comorbidities influenced MD-induced effects.

Methods

An online prospective naturalistic design was used to measure participants before MD initiation and 2 and 4 weeks later. Validated self-report measures were used assessing mindfulness (15-item Five Facet Mindfulness Questionnaire) and personality traits (10-item version of the Big Five Inventory) at three time points.

Results

The sample included n = 233, n = 66, and n = 44 participants at the three time points, respectively. Trait mindfulness, specifically description and non-judging of inner experience, was increased, and neuroticism was decreased after 4 weeks of MD compared to baseline. The remaining personality traits remained unchanged. Using conventional medication and/or having comorbid diagnoses did not change the MD-induced effects on mindfulness and personality traits after 4 weeks.

Conclusion

MD induced changes in otherwise stable traits. Future placebo-controlled studies are warranted to confirm whether these changes occur in a controlled setting.

The Dual Control Model of Sexual Response: A Scoping Review, 2009-2022

The Dual Control Model proposes that sexual arousal and related processes are dependent on the balance between sexual excitation and sexual inhibition, and that individuals vary in their propensity for these processes. This scoping review provides an overview and discussion of the questionnaires used to measure the propensities for sexual excitation and inhibition, their translation and validation in other languages, and their application in empirical research on topics ranging from sexual desire and arousal, sexual (dys)function, sexual risk taking, asexuality, hypersexuality, and sexual aggression. A total of 152 papers, published between 2009 and 2022 and identified using online databases, were included in this review. The findings, consistent with those reviewed by Bancroft et al. (2009), suggest that sexual excitation is particularly relevant to sexual desire and responsivity and predictive of asexuality and hypersexuality. Sexual inhibition plays a role in sexual dysfunction. sexual risk taking, and sexual aggression, although often in interaction with sexual excitation. Suggestions for the further development of the model and for future studies are discussed.

The Structure of Compulsive Sexual Behavior: A Network Analysis Study

Compulsive sexual behavior is a phenomenon characterized by a persistent failure to control intense, repetitive sexual impulses or urges, resulting in repetitive sexual behavior that causes marked distress or impairment in personal, familial, social, educational, or occupational areas of functioning. Despite its major impact on mental health and quality of life, little is known about its internal structure and whether this phenomenon differs across genders, age groups, and risk status. By considering a large online sample (n = 3186; 68.3% males), ranging from 14 to 64 years old, compulsive sexual behavior was explored by means of network analysis. State-of-the-art analytical techniques were adopted to investigate the pattern of association among the different elements of compulsive sexual behavior, identify possible communities of nodes, pinpoint the most central nodes, and detect differences between males and females, among different age groups, as well as between individuals at low and high risk of developing a full-blown disorder. The analyses revealed that the network was characterized by three communities, namely Consequence, Preoccupation, and Perceived Dyscontrol, and that the most central node was related to (perceived) impulse dyscontrol. No substantial differences were found between males and females and across age. Failing to meet one's own commitments and responsibilities was more central in individuals at high risk of developing a full-blown disorder than in those at low risk.

Automatic attention to sexual stimuli: exploring the role of neuroticism and sexual excitation/inhibition through event-related potentials

BACKGROUND

Previous findings have shown that neuroticism is a higher-order vulnerability factor in the development and maintenance of sexual dysfunctions and can have an impact on the attentional processing of sexual stimuli; however, the influence of psychosexual dimensions on the early automatic phases of such cognitive processes has not been established yet.

AIM

To examine the mediating role of sexual inhibition/excitation propensity in the relationship between neuroticism and automatic attention to visual erotica and to identify the neuroelectric correlates of such a process.

METHODS

We analyzed the answers provided by 58 individuals on the Neuroticism subscale of the NEO Personality Inventory-Revised and the Sexual Inhibition/Excitation Scales. Event-related potentials (ERPs) were recorded during a modified oddball paradigm containing romantic and sexually explicit pictures. Parallel mediations were performed to simultaneously test the mediating role of sexual inhibition/excitation in the relationship between neuroticism and each ERP.

OUTCOMES

Three early attention ERP components (P1, P2, and N2) were assessed.

RESULTS

Findings revealed an indirect effect of neuroticism on automatic attention, via sexual inhibition due to threat of performance failure (SIS1), for romantic and sexually explicit stimuli. This effect was significant only for component N2, which showed increased amplitudes and earlier latencies in participants with high SIS1.

CLINICAL IMPLICATIONS

Sexual stimuli, due to their emotional valence and arousal potential, might be perceived as virtually threatening by individuals with neuroticism, who may benefit from strategies that decrease hyperarousal and sympathetic activation.

STRENGTHS AND LIMITATIONS

This was one of the first studies to analyze neuroelectric activity associated with automatic attention toward sexual stimuli in relation to personality and sexual excitation/inhibition propensity. Nevertheless, the limited number of participants demands caution in generalizing the results.

CONCLUSION

These results provide a better understanding of the relationship between personality and sexual cognition and open new avenues of research in relation to other automatic cognitive phenomena related to human sexual behavior.

Hypo- or hyperfunction? Differential relationships between compulsive sexual behavior disorder facets and sexual health

BACKGROUND

Previous studies linking compulsive sexual behavior disorder (CSBD) and sexual health have shown mixed results, which could be due to the fact that different CSBD facets may have differential relationships with sexual functioning.

AIM

As CSBD is a multidimensional disorder, we wanted to investigate whether distinct CSBD domains are differentially related to sexual health.

METHODS

Two online studies were conducted-the first on a convenience sample (812 Polish participants; mean [SD] age, 22.07 [5.91] years) and a replication study on a representative sample of Polish adults (n = 1526; 43.02 [14.37]). Hierarchical regression was employed with sexual functioning as a predicted variable and CSBD symptoms as predictors.

OUTCOMES

The Compulsive Sexual Behavior Disorder Scale was used to assess CSBD symptoms, and the Arizona Sexual Experience Scale was used to measure sexual dysfunction.

RESULTS

In study 1, CSBD salience (β = -.20, P < .001) predicted hyperfunction (ie, stronger sex drive, easier sexual arousal, easier vaginal lubrication/penile erection, easier ability to reach an orgasm, and more satisfying orgasms). Yet, CSBD negative consequences (β = .15, P = .001) and dissatisfaction (β = .22, P < .001) predicted hypofunction (ie, weaker sex drive, more difficulties in sexual arousal, greater difficulties in vaginal lubrication/penile erection, less ability to reach an orgasm, and less satisfying orgasms). Similar results were found in study 2: salience (β = -.26, P < .001) and relapse (β = -.11, P = .004) predicted hyperfunction, while negative consequences (β = .12, P < .001) and dissatisfaction (β = .12, P < .001) predicted hypofunction.

CLINICAL IMPLICATIONS

Our results stress the importance of assessing the severity of each group of symptoms in patients with CSBD to better understand possible difficulties in their sexual functioning.

STRENGTHS AND LIMITATIONS

Our studies are the first to evaluate the effects of each CSBD domain on sexual health. We also replicated results obtained from a convenience sample on a representative sample. The cross-sectional design of the current studies does not allow causal relations to be tested, so future longitudinal research should be carried out. We also gathered data from a general population-thus, it is important to replicate these results on patients diagnosed with CSBD.

CONCLUSION

Our research points out the differential impact of CSBD domains on sexual health: salience and relapse are related to sexual hyperfunction, while negative consequences and dissatisfaction to hypofunction.

The Relationship Between Alcohol and Drug Use, Compulsive Sexual Behavior, and Condomless Anal Sex in Men Who have Sex with Men: Analysis of Retrospectively-Reported Sexual Behavior

Men who have sex with men (MSM) are disproportionately impacted by HIV in the United States, and substance use and compulsive sexual behavior (CSB) are contributors to HIV risk behavior. This study sought to examine the direct and interactive effects of concurrent substance use and CSB on condomless anal sex (CAS) in a community sample of MSM (N = 200) utilizing a 90-day timeline follow-back assessment. Results indicated CSB did not directly increase risk for CAS when controlling for substance use and age. There was limited evidence for a direct effect of concurrent alcohol use on CAS, and no evidence for an interaction effect with CSB. The relationship between concurrent drug use and CAS was moderated by CSB, such that concurrent drug use was positively associated with CAS for those who screened positive for CSB, while the association was non-significant for those who screened negative. Implications and limitations of these findings are discussed.

Hypersexual behaviour among young adults in Germany: characteristics and personality correlates

BACKGROUND

Hypersexual behaviour (HB) is characterized by recurring unsuccessful efforts to control intense, repetitive sexual impulses that result in sexual activities and manifest in the behaviour of the concerning individual over an extended period. This study aims to describe the characterization of HB among the target group, identify personality correlates, and associations between HB and a lack of sexual education and reflection during school time.

METHODS

A cross-sectional design was used to survey the participants (age 18-27; n = 609) online who were recruited via a web forum for addiction selfcare, a website for casual sex dating, Facebook and the mail distribution of the University of Applied Science Nordhausen (Germany). Standardised questionnaires were used to measure the key variables in the study. The sexual behaviour (masturbation, pornography consumption, promiscuity), several personality tendencies, and retrospective information about sexual education of the participants during school time were investigated. Correlation and binomial logistic regression were used to analyse the data with HB as the outcome variable.

RESULTS

10.5% (n = 64) of the participants were identified as hypersexual. The assignment to male sex, a problematic pornography consumption, and impulsive tendencies were determined as predictors of HB. Strong correlates were identified between HB and promiscuity, and impairments in important areas of life. Weak to moderate correlates comprise between HB and all investigated personality traits, and several aspects of sexual risk behaviour. No association was found between HB and a lacking sexual education during school time. The descriptive analysis revealed further sexual problems within the sample (e.g. feelings of shame and guilt, sexual risk behaviour, sexual dysfunction).

CONCLUSION

Young adults should get more attention as a vulnerable group for the development of hypersexuality in sexual education, prevention and therapy. Regarding to its treatment, HB therefore should be considered together with its associations with sociodemographic information, personality traits, and psychosocial factors.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

A Learning Experience? Enjoyment at Sexual Debut and the Gender Gap in Sexual Desire among Emerging Adults

Gender differences in experience of first intercourse are among the largest in sexuality research, with women recalling less pleasure and satisfaction than men. This "enjoyment gap" has not been considered in explanations of gender differences in sexual desire. Yet, reinforcement and incentive learning feature prominently in recent models of women's sexual desire, and nonhuman animal models demonstrate their impact at sexual debut. We examined whether women's lower sexual desire is explained by their gender or by gendered experience of enjoyment at sexual debut. Emerging adults (N = 838) provided retrospective accounts of physical (orgasm) and affective (satisfaction) enjoyment at (hetero)sexual debut. We replicated gender differences across behavioral, general, and multidimensional measures of trait sexual desire; however, they were contingent on experience and measurement method. When its cognitive multidimensional properties were appreciated, women's sexual desire varied with experience of orgasm at sexual debut and diverged from men's only when orgasm did not occur. Such effects were not observed for satisfaction, nor for men. Nor did effects of a control event - masturbatory debut - extend beyond solitary sexual desire. Findings underscore the importance of orgasm equality, and suggest its absence at sexual debut may play an unacknowledged role in differentiating sexual desire.

Relational and Trait Factors Mediate the Associations between Women's Intoxication-Related Unwanted Sexual Experiences, Pleasure, and Desire

Despite documented negative sexual health sequelae of unwanted sexual contact (USC), it is unclear why individuals who have experienced USC within the context of intoxication (intoxication-related USC) are at particular risk for poor sexual functioning. Intoxication-related USC may impact relational factors like relationship satisfaction, as trauma symptoms interfere with emotional closeness during sex. Additionally, although individual traits - such as sexual excitation and sensation seeking - affect the relationship between trauma and sexual functioning, it is unknown whether these factors differentially impact those who have experienced intoxication-related USC. Finally, because presence of a partner may evoke trauma-related symptoms during partnered (dyadic) sexual activity, mediators may differ across solitary versus dyadic sexual pleasure and desire. We tested relational and individual trait mediators of the association between intoxication-related USC and solitary and dyadic sexual pleasure and desire in a sample of heterosexual and sexual minority women. Trait factors consistently mediated the association between intoxication-related USC and both dyadic and solitary desire and pleasure, while relational factors such as emotional closeness were inconsistently related to sexual wellbeing. If replicated, these findings would suggest that trait factors may be useful targets for clinical sexual wellness interventions among sexuality-diverse women who have experienced intoxication-related USC.

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)

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.

Dopamine, Erectile Function and Male Sexual Behavior from the Past to the Present: A Review

Early and recent studies show that dopamine through its neuronal systems and receptor subtypes plays different roles in the control of male sexual behavior. These studies show that (i) the mesolimbic/mesocortical dopaminergic system plays a key role in the preparatory phase of sexual behavior, e.g., in sexual arousal, motivation and reward, whereas the nigrostriatal system controls the sensory-motor coordination necessary for copulation, (ii) the incertohypothalamic system is involved in the consummatory aspects of sexual behavior (penile erection and copulation), but evidence for its role in sexual motivation is also available, (iii) the pro-sexual effects of dopamine occur in concert with neural systems interconnecting the hypothalamus and preoptic area with the spinal cord, ventral tegmental area and other limbic brain areas and (iv) D₂ and D₄ receptors play a major role in the pro-sexual effects of dopamine. Despite some controversy, increases or decreases, respectively, of brain dopamine activity induced by drugs or that occur physiologically, usually improves or worsens, respectively, sexual activity. These findings suggest that an altered central dopaminergic tone plays a role in mental pathologies characterized by aberrant sexual behavior, and that pro-erectile D₄ receptor agonists may be considered a new strategy for the treatment of erectile dysfunction in men.

Sexual Motivations Underlying Compulsive Sexual Behavior in Women and Men From Germany and Hungary

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.

Sex Drive as a Possible Mediator of the Gender Difference in the Prevalence of Paraphilic Interests in a Nonclinical Sample

There is a general gender difference in paraphilic interests, such that men report more interest (and greater engagement) in a variety of paraphilic behaviors. Using a nonclinical sample, Dawson et al. (Sexual Abuse, 28(1):20-45, 2016, https://doi.org/10.1177/1079063214525645 ) found that the gender difference in paraphilic interests was eliminated when scores on measures of sex drive were used as mediators. However, their measures of sex drive were about more than just sex drive and included a measure of hypersexuality (i.e., distress, perceived lack of control, and problematic consequences of one's sexuality). This study had two aims: to replicate Dawson et al.'s mediation results (using the same measures and scoring methods), and to discern the effect of sex drive itself (by replacing their measure of hypersexuality with a measure of sex drive). A nonclinical sample of 517 men and 615 women completed an online questionnaire. As expected, men reported less repulsion than women for most paraphilic themes. The gender difference in paraphilic interests was reduced (but not eliminated) both when reproducing Dawson et al.'s analysis and when examining a mediation model focused on sex drive specifically. The same results were obtained when examining the paraphilic interest with the largest gender difference (i.e., voyeurism). A full mediation effect was obtained in an unplanned supplementary analysis using a factor score (derived from eight measures) putatively assessing sex drive. While the main findings are consistent with Dawson et al.'s conclusions that sex drive is a possible mediator, they also suggest that other factors need to be considered to help explain the gender difference in the prevalence of paraphilic interests.

Common Features in Compulsive Sexual Behavior, Substance Use Disorders, Personality, Temperament, and Attachment-A Narrative Review

Do addictions share common traits of an “addictive personality” or do different addictions have distinct personality profiles? This narrative review examines the differences in the associations between substance use disorder (SUD) and compulsive sexual behavior disorder (CSBD), on the one hand, and personality traits, attachment dispositions, and temperament, on the other hand. We found that both people with a SUD and people with CSBD tended to be more spontaneous, careless, and less reliable, to place self-interest above getting along with others, to show emotional instability and experience negative emotions such as anger, anxiety, and/or depression, to be less able to control their attention and/or behavior, and to be engulfed with a constant sensation of “wanting”. Only people with CSBD, but not SUD, noted concerns with their social ties, fear of losing close others, and/or trusting others around them. Results also suggested that people with a SUD and people with CSBD share high commonalities in personality traits and temperament, yet there are noted differences in their social tendencies, especially with close others. People with CSBD reported more concerns with possible relationship losses compared to people with SUD issues, who may be more worried about losing their source of escapism.

Individual Differences in Testosterone and Self-Control Predict Compulsive Sexual Behavior Proneness in Young Males

The ability to control sexual urges and impulses is essential to achieve individual and social harmony. Failing to regulate sexual behavior can lead to the interference with daily life goals, sexual diseases transmission and moral violations, among others. The dual control model of sexual response proposes that an imbalance between sexual excitation and sexual inhibition mechanisms may lead to sexual dysregulation, thereby explaining problematic sexual behavior. Interindividual differences in self-control and testosterone levels are likely to modulate sexual regulation mechanisms, but these individual features have scarcely been studied in the context of compulsive sexual behavior. This study investigated the role of sexual excitation and inhibition, self-control and testosterone levels in predicting individuals' proneness to display compulsive sexual behavior. Seventy healthy young males provided a saliva sample for testosterone measurements and filled in questionnaires on self-control, sexual excitation, sexual inhibition, sexual compulsivity and sexual behavior. High testosterone levels and low self-control were associated with higher sexual compulsivity scores. Additionally, testosterone levels and sexual inhibition negatively predicted the frequency of sexual behavior with a partner. The results of our study highlight the joint role of psychological traits and testosterone levels in compulsive sexual behavior proneness, providing implications regarding the prevention and treatment of this condition in young males.

Validation and Psychometric Evaluation of the Italian Version of the Bergen-Yale Sex Addiction Scale

Excessive problematic sexual behavior in the form of compulsive sexual behavior disorder (CSBD), hypersexuality (HS), and sex addiction has gained increasing credibility in recent years and has led to the development of various psychometric instruments to assess such behavior. However, there is still considerable controversy over the operational definition of such concepts and whether they can be used interchangeably to describe the behavior. One recently developed tool is the Bergen-Yale Sex Addiction Scale (BYSAS) based on the "components model of addiction." The present study validated the Italian version of the BYSAS. The BYSAS was administered to a large Italian-speaking sample of Italian adults [N = 1230, aged 18 to 67 years] along with psychometric instruments assessing the "Big Five" personality traits, self-esteem, depression, and two other measures of addictive sexual behavior (i.e., PATHOS and Shorter PROMIS Questionnaire-Sex Subscale). Confirmatory factorial analysis supported a one-factor solution. Furthermore, the scale had good internal consistency (Cronbach's α = 0.787). The BYSAS was positively associated with extroversion, openness to experience, depression, and problematic sexual behavior, and negatively associated with self-esteem, conscientiousness, emotional stability, agreeableness, and age. Based on the findings, the BYSAS is a brief, psychometrically reliable and valid measure for assessing sex addiction among Italian adults.

Sexual Inhibition and Sexual Excitation Scales in Men: Psychometric Properties of a Polish Adaptation

The present study aimed to develop a Polish version of the Sexual Inhibition/Sexual Excitation Scale (SIS/SES-PL) and explore its psychometric validity in a sample of 498 men aged between 18 and 55 years. We used exploratory and confirmatory factor analyses to obtain the best model fit. Out of the 45 items in the original scale, 32 items with eight subscales and three higher-order factors: (sexual excitation [SES], sexual inhibition due to performance failure [SIS1], and sexual inhibition due to performance consequences [SIS2]) were included in the SIS/SES-PL. The SIS/SES-PL was found to have a good and satisfactory fit (comparative fit index = .87; Tucker-Lewis Index = .85; root mean square error of approximation = .054; χ² = 1108.7; p < .001; test-retest reliability Cronbach's alpha = .93). A small correlation between age and the SIS1 and SIS2 scores was detected. However, forward multiple regression analysis revealed a significant correlation only between age and SIS1 [β = .23, p < .001, R² for model = .05; F(1, 494) = 27.52, p < .001]. Furthermore, a moderate correlation between SIS1 and SES2, as well as SIS1 and general inhibition properties (measured using the Behavioral Inhibition Scale), was noted. In the case of SIS2, only small effects were observed, with the highest values for engaging in risky sexual behavior. Out of the total number of 42 variables, a moderate correlation between SES and the following was described: importance of sex, hypersexual behaviors, frequency of masturbation, frequency of sexual activities per month, sexual risk-taking, high promiscuity (measured using the Sociosexual Orientation Inventory Revised-Drive), general activation properties (measured using the Behavioral Activation Scale), neuroticism, and erotophilic tendencies (measured using the Sexual Opinion Survey-Short Form). The results of the study allowed us to conclude that the SIS/SES-PL might be a useful tool for tailoring therapy for men with sexual problems, as well as in the field of clinical research on sexual inhibition and excitation. Furthermore, it is a reliable and useful tool for measuring propensities for sexual excitement and inhibition.

Validation of the Sexual Inhibition/Sexual Excitation Scales (SIS/SES) in Italy: Assessing Gender and Age Differences of Sexual Functioning

The Sexual Inhibition Scales and Sexual Excitation Scales (Janssen et al., 2002a), based on the dual control model by Bancroft and Janssen (2000), are part of a 45-item self-report questionnaire evaluating individual tendencies to sexual inhibition or excitation according to three factors: two inhibition factors, SIS1, threat of performance failure, and SIS2, threat of performance consequences, and one excitation factor, SES. In this paper, we aimed to validate and explore psychometric properties of the SIS/SES in a sample of 2260 Italian men and women aged 18 to 75 years. Confirmatory factor analyses showed that the three-factor structure proposed in the original version of the scales fit with our sample. Moreover, our data confirmed the results of the original validation sample: Women scored higher on the SIS and lower on the SES than men did, but no significant differences appeared in the factor scores by age group, except for a gender × age interaction, where younger women had higher SIS2 scores. The SIS/SES appeared to be an effective, appropriate cross-cultural measurement of human sexuality in Italian samples, also shedding light on sexual arousal differences in women and men in our country. We also discuss clinical and therapeutic aspects.

Is Compulsive Sexual Behavior Different in Women Compared to Men?

The inclusion of Compulsive Sexual Behavior Disorder (CSBD) in the ICD-11 has sparked research interest on this topic in recent years. This review aims to investigate gender differences in Compulsive Sexual Behavior (CBD) and persons with CSBD. While impulsivity and psychiatric comorbidity play a role in persons with CSBD regardless of gender, some gender differences can be identified. CSBD is more prevalent in men, with a higher rate of reported sexual behaviors and higher scores on questionnaires measuring CSBD related symptoms. Neuroticism and stress vulnerability seem to play a more important role in the symptomatology of CSBD in women. While it seems plausible that childhood adversities play a role in the development of CSB, the manner with respect to how these adversities affect men and women differently is still to be explored. More clinical studies including the female CSBD population are required to infer clinical implications.

Validation of the French-Canadian Version of the Sexual Inhibition and Sexual Excitation Scales-Short Form (SIS/SES-SF): Associations With Sexual Functioning, Sociosexual Orientation, and Sexual Compulsivity

Introduction

The Dual control model proposes that both excitatory and inhibitory processes are responsible for the human sexual response.

Aim

To validate the French-Canadian translation of the Sexual Inhibition and Excitation Scales-Short Form (SIS/SES-SF) by exploring its factor structure and by investigating its capacity to retrospectively predict sexual functioning and behaviors, namely, sociosexual orientation and sexual compulsivity.

Methods

A French-Canadian translation of the SIS/SES-SF was created using forward-backward translation. A community sample of 362 men and 420 women completed an online survey. The factor structure and the measurement invariance between men and women was explored using Exploratory Structural Equation Modeling. Predictive power of the scales was tested using Multiple Linear Regression models using a corrected threshold (P< .008).

Main outcome measures

Sexual functioning was assessed using the International Index of Erectile Function and the Female Sexual Function Index while sexual compulsion and sociosexual orientation were measured using the Sexual Compulsion Scale and the Revised Sociosexual Orientation Inventory, respectively.

Results

The original three-factor solution of the SIS/SES-SF was replicated. All three scales showed acceptable internal consistency and good temporal stability. Yet, results only supported configural measurement invariance between men and women, suggesting that their scores cannot be directly compared. Overall, for both men and women, higher sexual excitation (SES) was significantly predictive of better sexual functioning, while higher sexual inhibition due to threat of performance failure (SIS1) was a significant predictor of lower sexual functioning. Both sexual compulsivity and sociosexual orientation were significantly predicted by higher SES and lower sexual inhibition due to threat of performance consequences (SIS2).

Conclusion

These results support the cross-cultural transferability of the SIS/SIS-SF and the Dual control model to French-Canadian men and women, higlighting the utility for clinicians to evaluate both excitatory and inhibitory factors associated with sexual dysfunction and sexual behaviors. Nolet K, Guay JP, Bergeron S. Validation of the French-Canadian Version of the Sexual Inhibition and Sexual Excitation Scales-Short Form (SIS/SES-SF): Associations With Sexual Functioning, Sociosexual Orientation, and Sexual Compulsivity. Sex Med 2021;9:100374.

Sexual Excitation and Sexual Inhibition in the Context of Sexual Risk-Taking

The current study examined the roles of sexual excitation and sexual inhibition in the context of sexual risk-taking among heterosexual women and men to better understand the link between sexual arousal and sexual risk-taking. We set out to determine which factors in the Sexual Excitation and Sexual Inhibition Inventory for women and men (SESII-W/M) were most predictive of sexual response and sexual risk-taking behavior. Participants (N = 266, women = 166) completed the SESII-W/M instrument and responded to items assessing their sexual risk-taking intentions and their risk-taking indicators. A sub-sample (n = 133, women = 83) also completed a sexual arousal manipulation. Sexual excitation was linked with higher levels of self-reported sexual arousal (among women and men) and greater risk-taking intentions (among women only). However, controlling for gender, sexual inhibition was a better predictor of sexual risk-taking intentions, compared to sexual excitation. The Dual Control Model offers unique insights into conceptualizations of sexual response to erotic stimuli and behavioral risk-taking. These findings can inform more effective interventions to promote risk reduction through sex positive approaches that capitalize on the pleasure enhancing capabilities of safer sex strategies.

The Modulatory Role of Cortisol in the Regulation of Sexual Behavior in Young Males

The proneness to be sexually aroused, to perform sexual acts, or to be sexually disinhibited during a particular mood varies across individuals. However, the physiological mechanisms underlying this specific and variable relationship between mood and sex-related processes are poorly understood. We propose that cortisol may act as an important moderator in this as it has shown to influence sexual arousal and to play a neuromodulatory role during emotion regulation. Here, we conducted a functional magnetic resonance imaging study in a sample of young males to investigate whether cortisol modulates the neural response during the approach of sexual stimuli in an approach-avoidance task and whether this potential relationship explains the individual differences in sexual inhibition and in mood-related sexual interest and activity. We revealed that cortisol associates with the anteromedial prefrontal cortex activation during the approach towards sexual stimuli. Moreover, this anteromedial prefrontal cortex response was dependent on individual differences in sexual inhibition and the improvements of negative mood as a result of sexual activity. The anteromedial prefrontal cortex is already known to process bottom-up information, reward, and risk estimation. The neuromodulatory role of cortisol within this region during sexual approach may represent a previously unknown yet key element in the regulation of sexual behavior in young males.

Spotlight on Compulsive Sexual Behavior Disorder: A Systematic Review of Research on Women

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.

Validación de las Escalas de Inhibición y Excitación Sexual (SIS/SES-SF) en colombianos

Las escalas SIS/SES-SF han sido desarrolladas para medir la inhibición y la excitación sexual. El objetivo del presente estudio fue adaptar y validar estas escalas en población colombiana. Para esto, se realizó la adaptación cultural y validación de contenido de las escalas por medio del juicio de siete expertos, y se validaron psicométricamente sobre una muestra de 2125 participantes (1000 hombres y 1125 mujeres). Los hombres contestaron al International Index of Erectile Function y la Premature Ejaculation Diagnostic Tool; mientras que el total de la muestra contestó al Sexual Desire Inventory, al Massachusetts General Hospital-Sexual Functioning Questionnaire y a la Sexual Inhibition/Sexual Excitation Scales-Short Form, todo ello junto a una batería sociodemográfica. El muestreo se realizó de forma virtual a través de Facebook. Los índices de las escalas mostraron una apropiada validez y fiabilidad. Además, para ambos sexos, las escalas mostraron un nivel de invarianza estricto. Las relaciones significativas con las otras medidas dan cuenta de su validez de criterio. Se sugiere el uso del instrumento para continuar con la investigación del Modelo de Control Dual dentro de la sexualidad en Latinoamérica.

The relevance of sexual biographies in individuals convicted of child sexual abuse offenses for the development of pedosexual interests and sexual recidivism

In the literature concerning the etiology of pedosexual interests, the potential role of early sexual experiences in childhood and adolescence has been discussed. Several studies demonstrated a link between own sexually abusive experiences in childhood and sexual offending later in life which tends to be even stronger for pedosexual offenders. Furthermore, some findings indicate associations between other developmental factors and deviant sexual interests in adulthood. For the present study, sexual biographical data of N = 223 imprisoned men convicted of sexual offenses against children from Austria was analyzed to retrospectively examine whether own sexually abusive experiences and non-abusive forms of early sexual experiences and behaviors are linked to subsequent pedosexual interests and to sexual recidivism. Previous findings concerning the link between own sexually abusive experiences during childhood and subsequent pedosexual interests could partly be replicated. Furthermore, early masturbation behavior characteristics as well as non-abusive prepubescent sexual experiences were linked to indicators of pedosexual interests and also to sexual recidivism. Exclusively pedophilic men showed the strongest accumulation of early sexual experiences and behaviors. Implications of the findings for theory and risk assessment are discussed.

Impulsivity and the Experience of Desire in the Choice of Erotic Stimuli

(1) Background: the relationship between erotic desire and personality factors is still relatively understudied. (2) Objective: to study the influence of the experience of desire, as well as impulsivity in the choice of videos, as the behavioral variable in the experimental trial. (2) Method: the sample consisted of 48 adult subjects, who took part in an experimental study that involved watching videos. (3) Results: the linear regression analysis revealed that the behavior involved in choosing videos is predicted by the sexual desire felt at the time of the trial, and not by stable personality factors, such as impulsivity or general self-report levels of sexual desire. (4) Conclusion: it is observed that the specific moment or situation and the behavior have a bigger impact on the erotic desire experienced at the time of the test than certain personality traits, as well as the previous and habitual levels of erotic desire of which an individual reports.

Sexual Responsivity and the Effects of Negative Mood on Sexual Arousal in Hypersexual Men Who Have Sex With Men (MSM)

BACKGROUND

A number of studies have found that hypersexuality is associated with a high propensity for sexual excitation. In comparison, less is known about the relationship between hypersexuality and sexual arousal at the state level. Also, previous research has revealed a relationship between hypersexuality and negative mood. However, the possibility that sexual response might not be as negatively impacted by negative mood in hypersexual individuals has, as yet, not been tested.

AIM

The purpose of this study was to investigate sexual responsivity and the effects of negative mood on sexual arousal in hypersexual men who have sex with men (MSM).

METHODS

A total of 211 MSM were assigned to a hypersexuality (N = 81) or a control (N = 130) group using an interview patterned with a semi-structured Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders format. Participants filled out questionnaires and were shown neutral, sexual, and anxiety- and sadness-inducing films.

OUTCOMES

Changes in penile circumference and self-reported sexual arousal were the primary outcomes analyzed in this study.

RESULTS

Controlling for age and HIV status, no differences were found in genital response between hypersexual and non-hypersexual men. Also, the 2 groups did not differ in subjective sexual arousal. Moreover, no effects of negative mood were found. Time series clustering analyses revealed 3 groups-low responders and slow and fast high responders. Sexual excitation, but not sexual compulsivity or pornography use, predicted cluster membership.

CLINICAL TRANSLATION

Hypersexual MSM may benefit more from an exploration of motivational and behavioral, as compared to psychophysiological, mechanisms underlying possible links between (negative) mood and sexual behavior.

STRENGTHS & LIMITATIONS

Strengths of the study include its sample size, making it one of the larger psychophysiological sex studies; the use of clinical interviews for group assignment; the inclusion of genital response measures; and the application of time series clustering to examine differences among participants. Limitations include possible sample heterogeneity and the reliance on researcher-selected stimuli.

CONCLUSION

Given the lack of any effects of negative mood on sexual response in hypersexual MSM, future studies could explore in more depth possible motivational and behavioral effects, including, for example, the impact of negative mood on the tendency to seek out sex as a form of distraction or for validation or emotional support. Janssen E, Prause N, Romine RS, et al. Sexual Responsivity and the Effects of Negative Mood on Sexual Arousal in Hypersexual Men Who Have Sex With Men (MSM). J Sex Med 2020;17:1751-1760.

Sexual attraction modulates interpersonal distance and approach-avoidance movements towards virtual agents in males

How does sexual attraction alter social interaction behavior? We examined the influence of sexual orientation on locomotor approach-avoidance behavior and interpersonal distance. We immersed androphilic and gynophilic male subjects into a virtual environment and presented various male and female virtual persons. In the first experiment, subjects took a step forward (approach) or backward (avoidance) in response to the sex of the virtual person. We measured reaction time, peak velocity, and step size, and obtained ratings of sexual attractiveness in every trial. In the second experiment, subjects had to approach the virtual person as if they were to engage in a social interaction. Here, we analyzed interpersonal distance and peak velocity of the approaches. Our results suggest that sexual attraction facilitates the approach response and reduces the preferred interpersonal distance. We discuss our findings in terms of proxemics, current findings in sex research, and the applicability of our novel task in other fields of psychological research.

An Exploratory Study on the Central Nervous Correlates of Sexual Excitation and Sexual Inhibition

The Sexual Inhibition/Sexual Excitation Scales (SIS/SES) measure sexual excitation and sexual inhibition proneness. We used SIS and SES scores of 62 heterosexual teleiophilic men (M_age 34.3, SD = 9.9) to predict brain activation levels during the presentation of male and female visual sexual stimuli in a magnetic resonance imaging (MRI) scanner. Statistical analyses revealed significant correlations. SES and SIS1 scores were positively associated with brain activation in various brain regions during the presentation of both male and female stimuli. SIS2 turned out to be a weaker predictor of brain activation, still revealing one significant correlation in the right lateral orbitofrontal cortex. Significant regions for SES and SIS1 were, among others, primary and supplementary motor areas, the caudate nucleus, the dorsal anterior cingulate cortex, anterior insula, and prefrontal areas. Our study can be seen as an exploratory investigation of SIS and SES with means of functional brain imaging. The results provide a promising contribution to the assertion of neurophysiological systems of sexual inhibition and excitation proneness.

Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies

An update of the chapter on Mental, Behavioral and Neurodevelopmental Disorders in the International Classification of Diseases and Related Health Problems (ICD) is of great interest around the world. The recent approval of the 11th Revision of the ICD (ICD-11) by the World Health Organization (WHO) raises broad questions about the status of nosology of mental disorders as a whole as well as more focused questions regarding changes to the diagnostic guidelines for specific conditions and the implications of these changes for practice and research. This Forum brings together a broad range of experts to reflect on key changes and controversies in the ICD-11 classification of mental disorders. Taken together, there is consensus that the WHO's focus on global applicability and clinical utility in developing the diagnostic guidelines for this chapter will maximize the likelihood that it will be adopted by mental health professionals and administrators. This focus is also expected to enhance the application of the guidelines in non-specialist settings and their usefulness for scaling up evidence-based interventions. The new mental disorders classification in ICD-11 and its accompanying diagnostic guidelines therefore represent an important, albeit iterative, advance for the field.

A Validation Study of the German Version of the Sexual Inhibition/Sexual Excitation Scales-Short Form

The dual control model of human sexual behavior proposes that sexual responses involve an interaction between sexual excitatory and sexual inhibitory systems. The Sexual Inhibition/Sexual Excitation Scales (SIS/SES; Janssen, Vorst, Finn, & Bancroft, 2002) as well as its short form (SIS/SES-SF; Carpenter, Janssen, Graham, Vorst, & Wicherts, 2011) assess individual propensities to become sexually excited and sexually inhibited. The present study utilized a dataset of 2221 German-speaking adults (n = 1214 women and n = 987 men) to examine the psychometric properties of the German version of the SIS/SES-SF. The results of the confirmatory factor analysis indicated that the three factors suggested in the original version can be generally replicated within the current study. Analyses of measurement invariance for gender revealed that the general three-factor structure as well as factor loadings can be regarded as equal for men and women. However, scalar invariance could not be fully obtained, indicating that the intercepts of some items were different for men and women. Taken together, the results of the presents study provide further evidence for the psychometric properties of the German version of the SIS/SES-SF.

Approach and Avoidance Biases Toward Sexual Stimuli and Their Association with the Dual Control Model of Sexual Response in Heterosexual Men

Many models of human behavior work in an interaction of a dual system. While one system usually represents controlled and reflective behavioral responses, the other system reflects automatic and impulsive actions. In the impulsive system, positive stimuli initiate approach reactions and negative cues avoidance reactions. Besides stimulus valence, the behavioral response triggered by the impulsive system is influenced by personality (e.g., the propensity to react with approach or avoidance biases in a specific situation). The present study applied a computerized Approach-Avoidance Task (AAT; Rinck & Becker, 2007) to assess automatic behavioral approach and avoidance biases toward sexual and neutral stimuli in heterosexual men (N = 40). Individual AAT-performance was furthermore related to sexual excitation (SES) and the two sexual inhibition factors (SIS1 and SIS2) as proposed by the Dual Control Model of sexual response (Bancroft & Janssen, 2000). Against our hypotheses, participants did not show a stronger approach bias toward sexually preferred (i.e., images of women) than sexually not preferred stimuli (i.e., images of men or children). However, stronger approach biases toward images of women were positively associated with sexual excitation and negatively correlated with sexual inhibition due to a threat of performance failure (SIS1) even after controlling for potential confounds (i.e., general behavioral activation and inhibition). The results support the importance of the influence of dispositional traits measured with the Dual Control Model of sexual response on approach and avoidance biases toward sexually preferred stimuli in heterosexual men.

Exploring the Impact of Personal and Partner Traits on Sexuality: Sexual Excitation, Sexual Inhibition, and Big Five Predict Sexual Function in Couples

Sexual difficulties are common among women and men and are associated with various mental and physical health problems. Although psychological traits are known to impact sexual attitudes and behavior, sexuality- and personality-related traits have not been jointly investigated to assess their relevance for sexual functioning in couples. The aim of this study was to investigate how psychological traits of two partners influence women's and men's sexual function. Data from 964 couples, representative of the adult population in Germany, were analyzed. Sexual function was assessed with the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF). Sexuality-related traits were measured with the Sexual Excitation/Sexual Inhibition Inventory for Women and Men (SESII-W/M). Personality was measured with self-report and partner-rating versions of the Big Five Inventory (BFI). Sexual excitation was a positive and sexual inhibition was a negative predictor of sexual function in both genders. Women whose partners were sexually inhibited reported lower sexual function. Conscientious individuals reported better sexual function. Women whose partners were more conscientious also had better sexual function. Assessing partner-related factors may be helpful to identify predisposing and maintaining factors of sexual dysfunctions, especially in women.

Same Same but Different: A Clinical Characterization of Men with Hypersexual Disorder in the Sex@Brain Study

Problems arising from hypersexual behavior are often seen in clinical settings. We aimed to extend the knowledge about the clinical characteristics of individuals with hypersexual disorder (HD). A group of people who fulfilled the proposed diagnostic criteria for HD (men with HD, n = 50) was compared to a group of healthy controls (n = 40). We investigated differences in sociodemographic, neurodevelopmental, and family factors based on self-report questionnaires and clinical interviews. Men with HD reported elevated rates of sexual activity, paraphilias, consumption of child abusive images, and sexual coercive behavior compared to healthy controls. Moreover, rates of affective disorders, attachment difficulties, impulsivity, and dysfunctional emotion regulation strategies were higher in men with HD. Men with HD seem to have experienced various forms of adverse childhood experiences, but there were no further differences in sociodemographic, neurodevelopmental factors, and family factors. Regression analyses indicated that attachment-related avoidance and early onset of masturbation differentiated between men with HD and healthy controls. In conclusion, men with HD appear to have the same neurodevelopment, intelligence levels, sociodemographic background, and family factors compared to healthy controls, but they report different and adverse experiences in childhood, problematic sexual behavior, and psychological difficulties.