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Bőthe B, Koós M, Nagy L, Kraus SW, Demetrovics Z, Potenza MN, Michaud A, Ballester-Arnal R, Batthyány D, Bergeron S, Billieux J, Briken P, Burkauskas J, Cárdenas-López G, Carvalho J, Castro-Calvo J, Chen L, Ciocca G, Corazza O, Csako R, Fernandez DP, Fernandez EF, Fournier L, Fujiwara H, Fuss J, Gabrhelík R, Gewirtz-Meydan A, Gjoneska B, Gola M, Grubbs JB, Hashim HT, Islam MS, Ismail M, Jiménez-Martínez MC, Jurin T, Kalina O, Klein V, Költő A, Lee CT, Lee SK, Lewczuk K, Lin CY, Lochner C, López-Alvarado S, Lukavská K, Mayta-Tristán P, Milea I, Miller DJ, Orosová O, Orosz G, Ponce FP, Quintana GR, Quintero Garzola GC, Ramos-Diaz J, Rigaud K, Rousseau A, De Tubino Scanavino M, Schulmeyer MK, Sharan P, Shibata M, Shoib S, Sigre Leirós VL, Sniewski L, Spasovski O, Steibliene V, Stein DJ, Strizek J, Štulhofer A, Ünsal BC, Vaillancourt-Morel MP. Compulsive sexual behavior disorder in 42 countries: Insights from the International Sex Survey and introduction of standardized assessment tools. J Behav Addict 2023; 12:393-407. [PMID: 37352095 PMCID: PMC10316175 DOI: 10.1556/2006.2023.00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/25/2023] Open
Abstract
Background and aims Despite its inclusion in the 11th revision of the International Classification of Diseases, there is a virtual paucity of high-quality scientific evidence about compulsive sexual behavior disorder (CSBD), especially in underrepresented and underserved populations. Therefore, we comprehensively examined CSBD across 42 countries, genders, and sexual orientations, and validated the original (CSBD-19) and short (CSBD-7) versions of the Compulsive Sexual Behavior Disorder Scale to provide standardized, state-of-the-art screening tools for research and clinical practice. Method Using data from the International Sex Survey (N = 82,243; Mage = 32.39 years, SD = 12.52), we evaluated the psychometric properties of the CSBD-19 and CSBD-7 and compared CSBD across 42 countries, three genders, eight sexual orientations, and individuals with low vs. high risk of experiencing CSBD. Results A total of 4.8% of the participants were at high risk of experiencing CSBD. Country- and gender-based differences were observed, while no sexual-orientation-based differences were present in CSBD levels. Only 14% of individuals with CSBD have ever sought treatment for this disorder, with an additional 33% not having sought treatment because of various reasons. Both versions of the scale demonstrated excellent validity and reliability. Discussion and conclusions This study contributes to a better understanding of CSBD in underrepresented and underserved populations and facilitates its identification in diverse populations by providing freely accessible ICD-11-based screening tools in 26 languages. The findings may also serve as a crucial building block to stimulate research into evidence-based, culturally sensitive prevention and intervention strategies for CSBD that are currently missing from the literature.
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Affiliation(s)
- Beáta Bőthe
- Département de Psychologie, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
- Département de Psychologie, Université de Montréal, Montréal, Canada
| | - Mónika Koós
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Léna Nagy
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Shane W. Kraus
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
| | - Marc N. Potenza
- Yale University School of Medicine, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - Aurélie Michaud
- Département de Psychologie, Université de Montréal, Montréal, Canada
| | - Rafael Ballester-Arnal
- Departmento de Psicología Básica, Clínica y Psicobiología, University Jaume I of Castellón, Spain
| | - Dominik Batthyány
- Institute for Behavioural Addictions, Sigmund Freud University Vienna, Austria
| | - Sophie Bergeron
- Département de Psychologie, Université de Montréal, Montréal, Canada
| | - Joël Billieux
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
- Center for Excessive Gambling, Addiction Medicine, Lausanne University Hospitals (CHUV), Lausanne, Switzerland
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Julius Burkauskas
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania
| | - Georgina Cárdenas-López
- Virtual Teaching and Cyberpsychology Laboratory, School of Psychology, National Autonomous University of Mexico, Mexico
| | - Joana Carvalho
- William James Center for Research, Departamento de Educação e Psicologia, Universidade de Aveiro, Aveiro, Portugal
- CPUP: Center for Psychology at University of Porto, Portugal
| | - Jesús Castro-Calvo
- Department of Personality, Assessment, and Psychological Treatments, University of Valencia, Spain
| | - Lijun Chen
- Department of Psychology, College of Humanity and Social Science, Fuzhou University, China
| | - Giacomo Ciocca
- Section of Sexual Psychopathology, Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Ornella Corazza
- Department of Clinical, Pharmaceutical and Biological Sciences, University of Hertfordshire, United Kingdom
- Department of Psychology and Cognitive Science, University of Trento, Italy
| | - Rita Csako
- Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
| | | | | | - Loïs Fournier
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Hironobu Fujiwara
- Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Decentralized Big Data Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
- The General Research Division, Osaka University Research Center on Ethical, Legal and Social Issues, Osaka, Japan
| | - Johannes Fuss
- Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Roman Gabrhelík
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Addictology, General University Hospital in Prague, Czech Republic
| | - Ateret Gewirtz-Meydan
- School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
| | - Biljana Gjoneska
- Macedonian Academy of Sciences and Arts, Republic of North Macedonia
| | - Mateusz Gola
- Institute of Psychology, Polish Academy of Sciences, Poland
- Institute for Neural Computations, University of California San Diego, USA
| | | | | | - Md. Saiful Islam
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
- Centre for Advanced Research Excellence in Public Health, Dhaka, 1342, Bangladesh
| | | | - Martha C. Jiménez-Martínez
- Universidad Pedagógca y Tecnológica de Colombia, Colombia
- Grupo de Investigación Biomédica y de Patología, Colombia
| | - Tanja Jurin
- Department of Psychology, Humanities and Social Sciences, University of Zagreb, Croatia
| | - Ondrej Kalina
- Department of Educational Psychology and Psychology of Health, Pavol Jozef Safarik University in Kosice, Slovakia
| | - Verena Klein
- School of Psychology, University of Southampton, United Kingdom
| | - András Költő
- Health Promotion Research Centre, University of Galway, Ireland
| | - Chih-Ting Lee
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sang-Kyu Lee
- Department of Psychiatry, Hallym University Chuncheon Sacred Heart Hospital, South Korea
- Chuncheon Addiction Management Center, South Korea
| | - Karol Lewczuk
- Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Christine Lochner
- SAMRC Unit on Risk & Resilience in Mental Disorders, Stellenbosch University, South Africa
| | | | - Kateřina Lukavská
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty of Education, Department of Psychology, Charles University, Prague, Czech Republic
| | | | | | | | - Oľga Orosová
- Department of Educational Psychology and Psychology of Health, Pavol Jozef Safarik University in Kosice, Slovakia
| | | | | | | | - Gonzalo R. Quintana
- Departamento de Psicología y Filosofía, Facultad de Ciencias Sociales, Universidad de Tarapacá, Arica, Arica y Parinacota, Chile
| | | | - Jano Ramos-Diaz
- Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Perú
| | | | - Ann Rousseau
- Leuven School for Mass Communication, KU Leuven, Leuven, Belgium
| | - Marco De Tubino Scanavino
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, Brazil
- Experimental Pathophisiology Post Graduation Program, Faculdade de Medicina, Universidade de São Paulo, Brazil
- Excessive Sexual Drive and Prevention of Negative Outcomes Associated to Sexual Behavior Outpatient Unit (AISEP), Institute of Psychiatry, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | | | - Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Mami Shibata
- Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sheikh Shoib
- Department of Psychology, Shardha University, India
| | - Vera L. Sigre Leirós
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
- Institute of Legal Psychiatry, Lausanne University Hospitals (CHUV), Lausanne, Switzerland
| | | | - Ognen Spasovski
- Faculty of Philosophy, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
- Faculty of Philosophy, University of Ss. Cyril and Methodius in Trnava, Slovak Republic
| | - Vesta Steibliene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania
| | - Dan J. Stein
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, South Africa
| | | | - Aleksandar Štulhofer
- Department of Sociology, Faculty of Humanities and Social Sciences, University of Zagreb, Croatia
| | - Berk C. Ünsal
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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Boumparis N, Haug S, Abend S, Billieux J, Riper H, Schaub MP. Internet-based interventions for behavioral addictions: A systematic review. J Behav Addict 2022; 11:620-642. [PMID: 36495471 PMCID: PMC9872535 DOI: 10.1556/2006.2022.00054] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 05/01/2022] [Accepted: 07/12/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND AIMS Behavioral addictions are a public health problem that causes harm to both individuals and society. Internet-based interventions offer potential benefits over face-to-face therapy for the treatment of behavioral addictions, including their accessibility, perceived anonymity, and low costs. We systematically reviewed the characteristics and effectiveness of these interventions. METHODS A systematic literature search was conducted in: PubMed, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials. A standardized methodological quality assessment was performed on all identified studies via the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. RESULTS Twenty-nine studies were assessed in this systematic review. Between them, considerable heterogeneity was noted in various study characteristics, including screening tools, inclusion criteria, and outcome measures. Attrition rates also ranged widely (9-89%), as did study quality, with three of the 29 studies rated strong, 12 moderate, and 14 weak methodologically. Twenty-two studies focused on gambling disorder, most revealing significant within-group effects for the assessed intervention on gambling-related symptoms and four of these studies identified significant between-group effects. Behavioral addictions studied in the remaining studies included gaming disorder, internet use disorder, hoarding disorder, and pornography use disorder, revealing generally-promising, albeit limited results. CONCLUSIONS Internet-based interventions seem promising at reducing gambling problems, but too few studies have been published, to date, for conclusions to be drawn for other behavioral addictions. Internet-based interventions targeting other behavioral addictions - like gaming disorder, internet use disorder, hoarding disorder, and pornography use disorder - remain under-examined, warranting considerable additional research to assess their effectiveness.
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Affiliation(s)
- Nikolaos Boumparis
- Swiss Research Institute for Public Health and Addiction at the University of Zurich, Switzerland,Corresponding author. E-mail:
| | - Severin Haug
- Swiss Research Institute for Public Health and Addiction at the University of Zurich, Switzerland
| | - Stefanie Abend
- Swiss Research Institute for Public Health and Addiction at the University of Zurich, Switzerland
| | - Joël Billieux
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland,Centre for Excessive Gambling, Addiction Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Michael P. Schaub
- Swiss Research Institute for Public Health and Addiction at the University of Zurich, Switzerland
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González-Bueso V, Santamaría JJ, Caro-Pérez O, Fernández D, Baño-Alcazar M, Jiménez-Murcia S, Håkansson A, Del Pino-Gutiérrez A, Ribas J. Compulsive Sexual Behavior Online and Non-online in Adult Male Patients and Healthy Controls: Comparison in Sociodemographic, Clinical, and Personality Variables. Front Psychiatry 2022; 13:839788. [PMID: 35592380 PMCID: PMC9110760 DOI: 10.3389/fpsyt.2022.839788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/28/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND AIMS Compulsive sexual behavior (CSB) is characterized by a persistent pattern of failure to control sexual impulses, resulting in repetitive sexual behavior over a prolonged period that causes marked discomfort in personal, family, social, school, work or in other functional areas. The evolution of the worldwide incidence of this disorder warrants further studies focused on examining the characteristics of the affected people. The purpose of this study was to compare online compulsive sexual behavior (when the problematic sexual practices were online) and non-online compulsive sexual behavior (when the problematic sexual practices were in-person) patients (OCSB and non-OCSB, respectively), and healthy controls in terms of sexual behavior, sociodemographic variables and psychopathology and personality characteristics. METHOD A sample of 80 CSB male patients consecutively admitted to our Behavioral Addictions Unit and 25 healthy male controls, participated in the study. The CSB group was comprised by 36 online CSB patients (mean age 42.25, SD: 10.0) and 44 non-online CSB patients (mean age 43.5, SD: 11.9). Scores on the Sexual Compulsivity Scale, Temperament and Character Inventory-Revised, Symptom CheckList-90 Items-Revised, State-Trait Anxiety Index, and additional demographic, clinical, and social/family variables related to sexual behaviors between the three groups were compared. RESULTS When compared with healthy controls, both clinical groups showed higher psychopathology in all measures as well as higher harm avoidance and self-transcendence and lower self-directness and cooperativeness. When comparing OCSB and non-OCSB patients, results showed that non-OCSB patients exhibited higher prevalence of sexually transmitted diseases, higher percentage of homosexual and bisexual orientation and higher scores in anxiety and in sexual impulse control failure. CONCLUSION Both online and non-online CSB patients may experience a variety of comorbid psychological and medical problems. Patients with non-OCSB may suffer more consequences that are negative. Therefore, these results should be considered when designing the most convenient therapeutic approach. Whether sexual orientation plays a role in treatment needs and treatment response in CSB, should be further explored in future studies.
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Affiliation(s)
- Vega González-Bueso
- Atención e Investigación en Socioadicciones (AIS), Mental Health and Addictions Network, Generalitat de Catalunya, Sistema Sanitari Integral d'Utilització Pública de Catalunya (SISCAT), Barcelona, Spain
| | - Juan José Santamaría
- Atención e Investigación en Socioadicciones (AIS), Mental Health and Addictions Network, Generalitat de Catalunya, Sistema Sanitari Integral d'Utilització Pública de Catalunya (SISCAT), Barcelona, Spain
| | - Oriol Caro-Pérez
- CELBIOTECH_Paper Engineering Research Group, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Daniel Fernández
- Department of Statistics and Operations Research (DEIO), Universitat Politècnica de Catalunya BarcelonaTec (UPC), Barcelona, Spain.,Institute of Mathematics of UPC - BarcelonaTech (IMTech), Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Marta Baño-Alcazar
- Atención e Investigación en Socioadicciones (AIS), Mental Health and Addictions Network, Generalitat de Catalunya, Sistema Sanitari Integral d'Utilització Pública de Catalunya (SISCAT), Barcelona, Spain
| | - Susana Jiménez-Murcia
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Anders Håkansson
- Division of Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Malmö Addiction Center, Competence Center Addiction, Region Skåne, Malmö, Sweden
| | - Amparo Del Pino-Gutiérrez
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, University of Barcelona, Barcelona, Spain
| | - Joan Ribas
- Atención e Investigación en Socioadicciones (AIS), Mental Health and Addictions Network, Generalitat de Catalunya, Sistema Sanitari Integral d'Utilització Pública de Catalunya (SISCAT), Barcelona, Spain
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Bőthe B, Koós M, Nagy L, Kraus SW, Potenza MN, Demetrovics Z. International Sex Survey: Study protocol of a large, cross-cultural collaborative study in 45 countries. J Behav Addict 2021; 10:632-645. [PMID: 34534102 PMCID: PMC8997233 DOI: 10.1556/2006.2021.00063] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/17/2021] [Accepted: 08/16/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Limitations of research into sexuality and compulsive sexual behavior disorder (CSBD) include the use of simplistic methodological designs and the absence of quality and unified measurements, empirically supported theoretical models, and large, collaborative studies between laboratories. We aim to fill these gaps with the International Sex Survey (ISS, http://internationalsexsurvey.org/). METHODS The ISS is a large-scale, international, multi-lab, multi-language study using cross-sectional survey methods, involving more than 40 countries. Participants responding to advertisements complete a self-report, anonymous survey on a secure online platform. Collaborators from each country collect a community sample of adults with a minimum sample size of 2,000 participants with a gender ratio of approximately 50-50% men and women, including diverse individuals with respect to sexuality and gender. The ISS includes a wide range of sociodemographic questions and scales assessing a diverse set of sexual behaviors, pornography use, psychological characteristics, and potential comorbid disorders. Analyses are conducted within a structural equation modeling framework, including variable (e.g., measurement invariance tests) and person-centered approaches (e.g., latent profile analysis). DISCUSSION AND CONCLUSIONS The ISS will provide well-validated, publicly available screening tools, helping to eliminate significant measurement issues in the field of sexuality research and health care. It will provide important insights to improve the theoretical understanding of CSBD as well as help to identify empirically supported treatment targets for prevention and intervention programs. Following open-science practices and making study materials open-access, the ISS may serve as a blueprint for future large-scale research in addiction and sexuality research.
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Affiliation(s)
- Beáta Bőthe
- Département de Psychologie, Université de Montréal, Montréal, Canada,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary,Corresponding author. E-mail: ,
| | - Mónika Koós
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary,Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Léna Nagy
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary,Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Shane W. Kraus
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Marc N. Potenza
- Yale University School of Medicine, New Haven, CT, USA,Connecticut Council on Problem Gambling, Wethersfield, CT, USA,Connecticut Mental Health Center, New Haven, CT, USA
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary,Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
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