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Blanc JV, Burdairon JD, Malandain L, Ferreri F, Mouchabac S, Adrien V. Attachment and Mental Health of Men Having Sex with Men Engaging in Chemsex: Is Substance Abuse Only the Tip of the Iceberg? JOURNAL OF HOMOSEXUALITY 2024; 71:2875-2894. [PMID: 37815854 DOI: 10.1080/00918369.2023.2266086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Gay and bisexual men and other men who have sex with men (GBMSM) with problematic chemsex (a specific sexualized drug use pattern) face several health issues. The aim of this monocentric observational study was to assess the mental health history and attachment style (AS) within 71 GBMSM seeking care for problematic chemsex. Attachment style (AS) was evaluated using the Relationship Scales Questionnaire. 82% of the cohort (58) had at least one mental health disorder (among depression, anxiety, alcohol use disorder or hypersexuality). 9.9% were admitted to intensive care due to chemsex use. Traumas were frequent, with 31% reporting childhood sex abuse and 24% declaring having attempted suicide. 62 (87%) had insecure AS: 38% preoccupied, 23% fearful and 24% dismissing. Users with a positive self model (N = 24) had fewer comorbidities (63% vs 92%, p = .003) and practiced more chemsex alone (75% vs 33%, p < .001) than users with negative self model (N = 47). Users with a positive other model (N = 35) practiced more slamsex (injections of substance in a sexual context) (80% vs 50%, p = .008) and had fewer comorbidities (71% vs 92%, p = .027) than users with a negative other model (N = 36). Attachment theory is a way to provide holistic and tailored and harm reduction.
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Affiliation(s)
- Jean-Victor Blanc
- Department of Psychiatry and Addiction Medicine, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Jean-Del Burdairon
- Department of Psychiatry, Pôle Hospitalo-Universitaire Psychiatrie Paris 15e, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Léo Malandain
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin, University Paris Cité, Paris, France
| | - Florian Ferreri
- Department of Psychiatry and Addiction Medicine, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
- Infrastructure for Clinical Research in Neurosciences (iCRIN) Psychiatry, Paris Brain Institute, Paris, France
| | - Stéphane Mouchabac
- Department of Psychiatry and Addiction Medicine, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
- Infrastructure for Clinical Research in Neurosciences (iCRIN) Psychiatry, Paris Brain Institute, Paris, France
| | - Vladimir Adrien
- Department of Psychiatry and Addiction Medicine, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
- Infrastructure for Clinical Research in Neurosciences (iCRIN) Psychiatry, Paris Brain Institute, Paris, France
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Mestre-Bach G, Potenza MN. Current Understanding of Compulsive Sexual Behavior Disorder and Co-occurring Conditions: What Clinicians Should Know about Pharmacological Options. CNS Drugs 2024; 38:255-265. [PMID: 38485889 DOI: 10.1007/s40263-024-01075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 04/02/2024]
Abstract
Compulsive sexual behavior disorder (CSBD) has recently been recognized as a psychiatric disorder. Pharmacological treatments for CSBD have received little study and thus have limited empirical support. The main objective of the present work is to review existing literature on the efficacy of different drugs on the symptomatology of CSBD, including the subtype of problematic pornography use (PPU). The main pharmacological approaches to treating CSBD have included opioid antagonists (naltrexone and nalmefene), selective serotonin reuptake inhibitors (paroxetine, citalopram, fluoxetine, and sertraline), mood stabilizers (topiramate), tricyclic antidepressants (clomipramine), serotonin antagonist and reuptake inhibitors (nefazodone), and N-acetylcysteine. Since people with CSBD may experience different co-occurring disorders, these should be considered when choosing the best pharmacological treatment. Pharmacological therapy for CSBD/PPU has been suggested as an adjunct to psychological therapies, which, for the moment, have the most empirical evidence. However, to evaluate the efficacy of most of the drugs presented in this narrative review, data to date have only been available from case studies. Thus, empirical support is scant and generalizability of results is limited, highlighting the need for more research in this area.
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Affiliation(s)
- Gemma Mestre-Bach
- Instituto de Investigación, Transferencia e Innovación, Universidad Internacional de La Rioja, La Rioja, Spain
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, One Church Street, Rm 726, New Haven, CT, 06510, 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.
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA.
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Miller JC, Brooks MA, Wurzel KE, Cox EJ, Wurzel JF. A Guide to Expanding the Use of Buprenorphine Beyond Standard Initiations for Opioid Use Disorder. Drugs R D 2023; 23:339-362. [PMID: 37938531 PMCID: PMC10676346 DOI: 10.1007/s40268-023-00443-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 11/09/2023] Open
Abstract
Buprenorphine has become an important medication in the context of the ongoing opioid epidemic. However, complex pharmacologic properties and varying government regulations create barriers to its use. This narrative review is intended to facilitate buprenorphine use-including non-traditional initiation methods-by providers ranging from primary care providers to addiction specialists. This article briefly discusses the opioid epidemic and the diagnosis and treatment of opioid use disorder (OUD). We then describe the basic and complex pharmacologic properties of buprenorphine, linking these properties to their clinical implications. We guide readers through the process of initiating buprenorphine in patients using full agonist opioids. As there is no single recommended approach for buprenorphine initiation, we discuss the details, advantages, and disadvantages of the standard, low-dose, bridging-strategy, and naloxone-facilitated initiation techniques. We consider the pharmacology of, and evidence base for, buprenorphine in the treatment of pain, in both OUD and non-OUD patients. Throughout, we address the use of buprenorphine in children and adolescent patients, and we finish with considerations related to the settings of pregnancy and breastfeeding.
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Affiliation(s)
- James C Miller
- Psychiatry Residency Spokane, Providence Sacred Heart Medical Center and Children's Hospital, 101 W Eighth Ave, Spokane, WA, 99204, USA
| | - Michael A Brooks
- Psychiatry Residency Spokane, Providence Sacred Heart Medical Center and Children's Hospital, 101 W Eighth Ave, Spokane, WA, 99204, USA
| | - Kelly E Wurzel
- Psychiatry Residency Spokane, Providence Sacred Heart Medical Center and Children's Hospital, 101 W Eighth Ave, Spokane, WA, 99204, USA
| | - Emily J Cox
- Providence Research Network, Renton, WA, USA
| | - John F Wurzel
- Psychiatry Residency Spokane, Providence Sacred Heart Medical Center and Children's Hospital, 101 W Eighth Ave, Spokane, WA, 99204, USA.
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Huang S, Nyman TJ, Jern P, Santtila P. Actual and Desired Masturbation Frequency, Sexual Distress, and Their Correlates. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3155-3170. [PMID: 37365448 DOI: 10.1007/s10508-023-02641-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023]
Abstract
We investigated the prevalence of problematic masturbation using different criteria. We also investigated if masturbation-related distress was associated with sexual abuse history, family attitudes towards sexuality during childhood, and depression and anxiety symptoms. Here, 12,271 Finnish men and women completed a survey reporting masturbation frequency, desired masturbation frequency, sexual distress, childhood sexual abuse, sex-positive family background, as well as depression and anxiety symptoms. Among both sexes, those whose masturbation frequency did not match with desired frequency experienced more sexual distress. Different conceptualizations of problematic masturbation resulted in different proportions of individuals categorized as having it (i.e., 8.3% of men and 2.7% of women experienced self-perceived problematic masturbation, that is masturbating more than they desired and experiencing sexual distress; 2% of men and 0.6% of women masturbated more frequently than average and meanwhile experienced self-perceived problematic masturbation; 6.3% of men and 2.1% of women masturbated less frequently than average but still experienced self-perceived problematic masturbation). Moreover, among both sexes, self-perceived problematic masturbation was positively associated with childhood sexual abuse, depression, and anxiety, while negatively associated with a sex-positive family background. Our results point to the complexity of defining problematic masturbation. Causes of sexual distress related to masturbation need to be carefully examined case by case to choose an appropriate clinical approach.
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Affiliation(s)
- Sijia Huang
- Faculty of Arts and Sciences, NYU Shanghai, 1555 Century Avenue, Pudong New Area, Shanghai, 200122, China.
| | - Thomas J Nyman
- Faculty of Arts and Sciences, NYU Shanghai, 1555 Century Avenue, Pudong New Area, Shanghai, 200122, China
| | - Patrick Jern
- Department of Psychology, Faculty of Arts, Psychology, and Theology, Åbo Akademi University, Turku, Finland
| | - Pekka Santtila
- Faculty of Arts and Sciences, NYU Shanghai, 1555 Century Avenue, Pudong New Area, Shanghai, 200122, China
- NYU-ECNU Institute for Social Development, NYU Shanghai, Shanghai, China
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Fiandor-Montesino J, Kusakavitch M, Kakarlapudi R, Puthiyathu M. Management of Concurrent Bipolar I Disorder and Compulsive Sexual Behavior Disorder: A Case Report. Cureus 2023; 15:e45016. [PMID: 37829967 PMCID: PMC10565711 DOI: 10.7759/cureus.45016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/14/2023] Open
Abstract
Pornography addiction is not currently recognized in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V), but it can be broadly classified under compulsive sexual behavior disorder (CSBD) in the International Classification for Diseases (ICD). An increased incidence of CSBD has been reported in patients with bipolar I disorder (BPI) as an independent compulsion, not secondary to mania. Due to the ambiguity of identifying pornography addiction in the DSM-V, approved treatment for patients with a concurrent diagnosis of CSBD in the context of BPI is limited. We report the case of a patient with CSBD with concurrent BPI and investigate the treatment strategy taken in an inpatient setting. Though there are no FDA-approved treatment strategies currently approved for patients with concurrent CSBD and BPI, selective serotonin reuptake inhibitors, mood stabilizers, naltrexone, and cognitive behavioral therapy can be used in combination for maximal benefit.
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Affiliation(s)
| | - Melanie Kusakavitch
- Medicine, College of Osteopathic Medicine, University of New England, Portland, USA
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Pharmacological Treatments for Compulsive Sexual Behaviors Among Offending Individuals. CURRENT ADDICTION REPORTS 2022. [DOI: 10.1007/s40429-022-00460-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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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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Baltodano-Calle MJ, Onton-Díaz M, Gonzales GF. Androgens, brain and androgen deprivation therapy in paraphilic disorders: A narrative review. Andrologia 2022; 54:e14561. [PMID: 35995581 DOI: 10.1111/and.14561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/26/2022] [Accepted: 08/04/2022] [Indexed: 11/27/2022] Open
Abstract
Sexual delinquency is a global problem where those with paraphilic disorders, such as paedophiles, are more likely to commit and reoffend. Androgen deprivation therapy (ADT) has been suggested as a solution. The objective of this narrative review is to present current information on its risks, benefits and limitations as a treatment for paraphilias. The importance of testosterone in sexual function, the effect of its deficiency by age or by pharmacological treatment (anti-androgens, GnRH agonists and GnRH antagonists) and the effect of testosterone replacement therapy will be reviewed. The relationship between androgens, brain, sexual behaviour and pathophysiology of paraphilic disorders will also be explored. ADT reduces sexual urges, but has adverse effects and, because its reversible nature, it does not ensure less recidivism. Likewise, the research quality of ADT drugs is limited and not enough to support their use. Child sex offenders, and not paraphilic subjects who have not committed assaults, show signs of elevated prenatal exposure to androgens and a higher methylation state of the androgen receptor gene. Sexual behaviour is regulated by subcortical (hypothalamus, brainstem and spinal cord) and cortical structures of the brain, in addition to brain circuits (dopaminergic, serotonergic). Those with paraphilic disorders show abnormalities at these levels that could relate to the risk of sexual offences. In conclusion, androgens represent a significant part of the pathophysiology of paraphilias and therefore, ADT seems promising. Nonetheless, more studies are needed to make definite conclusions about the efficacy of long-term ADT in paraphilic patients.
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Affiliation(s)
| | - Melisa Onton-Díaz
- Faculty of Medicine, Cayetano Heredia Peruvian University., Lima, Peru
| | - Gustavo F Gonzales
- Laboratorio de Endocrinología y Reproducción, Laboratorios de Investigación y Desarrollo (LID), Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru.,Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru.,Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Peru
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Efrati Y, Shukron O, Epstein R. Early Maladaptive Schemas Are Highly Indicative of Compulsive Sexual Behavior. Eval Health Prof 2020; 44:142-151. [PMID: 33353416 DOI: 10.1177/0163278720983428] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Unlike the consequences of compulsive sexual behavior (CSB) and the profile of people with CSB that were extensively studied, the cognitive distortions that might be responsible to the development and maintenance of CSB are less understood. In Study 1 (n = 68), we examined intercorrelations between CSB and early maladaptive schemas among a sample with clinical CSB (Sexaholic Anonymous; SAs). In Study 2 (sex offenders; n = 103, and violence offenders; n = 81), we examined the intercorrelations between CSB and early maladaptive schemas among a sample with a sexual deviance but non-clinical levels of CSB. Results revealed that early maladaptive schemas are highly indicative of CSB severity. We discuss the implication of the study for the study and therapy of CSB.
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Affiliation(s)
- Yaniv Efrati
- 269918Beit-Berl College, Israel.,61154Orot-Israel College, Israel
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Malandain L, Blanc JV, Ferreri F, Giorgiadis T, Mosser S, Mouchabac S, Thibaut F. First case report of tDCS efficacy in severe chemsex addiction
. DIALOGUES IN CLINICAL NEUROSCIENCE 2020; 22:295-297. [PMID: 33162773 PMCID: PMC7605017 DOI: 10.31887/dcns.2020.22.3/lmalandain] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chemsex is an escalating public health issue among men who have sex with men, with
potentially severe somatic and psychiatric consequences. Given the limited knowledge and
lack of treatment recommendations available in this area, we proposed the use of
noninvasive brain stimulation in order to reduce problematic chemsex behavior. This is
the first open-label case report of a positive effect of transcranial direct current
stimulation (tDCS) in a patient who was complaining of severe chemsex addiction. Total
disappearance of chemsex behavior occurred after 5 days of daily sessions of right
prefrontal cortex stimulation and did not return after 8 months of follow-up. The
strengthening of dorsolateral prefrontal cortex activity may have modulated limbic
pathways and reduced incentive salience and craving of both sexual addiction and
concomitant illicit drug use.
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Affiliation(s)
- Léo Malandain
- University Hospital Cochin (site Tarnier), Paris, France
| | | | - Florian Ferreri
- University Hospital Saint-Antoine, Paris, France; Sorbonne University, Paris, France
| | | | | | | | - Florence Thibaut
- University Hospital Cochin (site Tarnier), Paris, France; Faculty of Medicine Paris Descartes (University of Paris); INSERM U1266, Institute of Psychiatry and Neurosciences, Paris, France
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