Moving Forward on Hypersexuality

What should be included in the criteria for compulsive sexual behavior disorder?

Compulsive sexual behavior disorder (CSBD) is currently defined in the eleventh revision of the International Classification of Diseases (ICD-11) as an impulse control disorder. Criteria for hypersexual disorder (HD) had been proposed in 2010 for the fifth revision of Diagnostic and Statistical Manual (DSM-5). In this article, we compare differences between HD and CSBD and discuss their relevance.Significant differences between HD and CSBD criteria include: (1) the role of sexual behavior as a maladaptive coping and emotion regulation strategy listed in criteria for HD but not in those for CSBD; (2) different exclusionary criteria including bipolar and substance use disorders in HD but not in CSBD, and (3) inclusion of new considerations in CSBD, such as moral incongruence (as an exclusion criterion), and diminished pleasure from sexual activity. Each of these aspects has clinical and research-related implications. The inclusion of CSBD in the ICD-11 will have a significant impact on clinical practice and research. Researchers should continue to investigate core and related features of CSBD, inlcuding those not included in the current criteria, in order to provide additional insight into the disorder and to help promote clinical advances.

Establishing Canadian metrics for self-report measures used to assess hypersexuality

We examined the prevalence of hypersexuality in two combined Canadian adult community samples totalling 1,857 respondents (female n = 960, male n = 835, other n = 60, missing n = 2). Participants were recruited from social media to complete an online sexual behaviour survey that included two measures of compulsive sexual behaviour disorder— the Sexual Compulsivity Scale (SCS) and Hypersexual Behaviour Inventory (HBI)—as well as sexual behaviour and interest items. Respondents also reported their total sexual outlets (TSO)—defined by number of orgasms experienced weekly—as a third potential indicator of hypersexuality. Canadian men and women reported multiple sexual outlets per week that tended to be higher than previous reports. Men tended to report a larger number and higher frequency of various sexual behaviour than women, including higher rates of compulsive sexual behaviour disorder, which varied depending on the measure employed. Implications for establishing sexuality norms and conceptualizing hypersexuality and compulsive sexual behaviour disorder are discussed.

High-Frequency Pornography Use May Not Always Be Problematic

BACKGROUND

Previously, variable-centered analytic approaches showed positive, weak-to-moderate associations between frequency of pornography use (FPU) and problematic pornography use (PPU). However, person-centered studies are sparse in the literature, and these could provide insight into whether there are individuals who use pornography frequently and do not experience problems or whether there are individuals with comparable high-frequency use who differ on reported experiencing of negative consequences.

AIM

The aims of the present study were (i) to identify profiles of pornography use based on FPU and PPU by applying a person-centered analytic approach and (ii) to examine whether the identified profiles could be distinguished based on theoretically relevant demographic and psychological constructs.

METHODS

Latent profile analyses were conducted on 3 nonclinical samples recruited from general websites and a pornography site (study 1: N = 14,006; study 2: N = 483; study 3: N = 672).

RESULTS

Results were consistent across all studies. 3 distinct pornography-use profiles emerged: nonproblematic low-frequency pornography use (68-73% of individuals), nonproblematic high-frequency pornography use (19-29% of individuals), and problematic high-frequency use (3-8% of individuals). Nonproblematic and problematic high-frequency-use groups showed differences in several constructs (ie, hypersexuality, depressive symptoms, boredom susceptibility, self-esteem, uncomfortable feelings regarding pornography, and basic psychological needs).

CLINICAL TRANSLATION

FPU should not be considered as a sufficient or reliable indicator of PPU because the number of people with nonproblematic high-frequency use was 3-6 times higher than that with problematic high-frequency use. These results suggest that individuals with PPU use pornography frequently; however, FPU may not always be problematic.

STRENGTHS & LIMITATIONS

Self-report cross-sectional methods have possible biases that should be considered when interpreting findings (eg, underreporting or overreporting). However, the present research included 3 studies and involved large community samples and visitors of a pornography website. The present study is the first that empirically investigated pornography-use profiles with a wide range of correlates using both severity of PPU and FPU as profile indicators on specific and general samples.

CONCLUSION

The present study is a first step in the differentiated examination of pornography-use profiles, taking into consideration both PPU and FPU, and it provides a foundation for further clinical and large-scale studies. Different psychological mechanisms may underlie the development and maintenance of FPU with or without PPU, suggesting different treatment approaches. Therefore, the present results may guide clinical work when considering reasons for seeking treatment for PPU. Bőthe B, Tóth-Király I, Potenza MN, et al. High-Frequency Pornography Use May Not Always Be Problematic. J Sex Med 2020;17:793-811.

A mindful model of sexual health: A review and implications of the model for the treatment of individuals with compulsive sexual behavior disorder

BACKGROUND AND AIMS

Mindfulness-based approaches, derived from centuries of eastern philosophy and practice, have been increasingly incorporated into western medicine. For example, data support the efficacy of mindfulness-based therapies to reduce stress and promote mental health.

METHODS

In this study, we briefly review models and approaches to sexual health in the context of considering compulsive sexual behavior disorder, describe mindfulness-based approaches to stress, addiction, and compulsive sexual behaviors, and present a Mindful Model of Sexual Health (MMSH) that incorporates elements of eastern and western philosophies. We further illustrate the clinical utility of the MMSH in a clinical case description.

RESULTS

We propose the MMSH as a holistic and integrative model that honors and acknowledges individual differences and provides mindfulness-based tools and practices to support individuals to proactively manage, balance, and promote sexual and mental health. The MMSH may be used as a framework to organize information regarding physical, mental, emotional, sexual, and relational health, as well as a conceptual map offering navigational skills to access information within one's mind/body to make informed decisions to promote well-being regarding sexual satisfaction and health. In its organizational structure, the MMSH is divided into eight domains that are theoretically linked to biological functions and may be used to identify and overcome barriers to sexual health through mindful inquiries in clinical practice or educational settings.

DISCUSSION AND CONCLUSION

Given its focus on awareness of interoceptive processes through mind/body connectedness, the MMSH may resonate with a wide range of individuals, including those with compulsive sexual behavior disorder.