A Network Approach to Hypersexuality: Insights and Clinical Implications

From hyper- to hypo-: ADHD medications & sexual dysfunction

BACKGROUND

Although attention-deficit/hyperactivity disorder's (ADHD's) impact on academic and social outcomes is well documented, its influence on sexual health, especially in adolescents, remains poorly understood and adolescents with ADHD are at higher risk for high-risk sexual behaviors (HRSBs) and sexual dysfunction, which prior research has indicated may be somewhat influenced by medication.

AIM

To define the relationship between ADHD treatment and sexual dysfunction in adolescents, focusing on the effects of stimulant versus non-stimulant medications and gender differences.

METHODS

Using de-identified electronic medical records from the TriNetX platform, this retrospective cohort study analyzed over 600 000 adolescents with ADHD. Patients were divided into male and female cohorts and further classified by stimulant, non-stimulant, or no medication use. Propensity score matching was applied to control for demographic factors. Sexual outcomes were identified using ICD-10 codes, including HRSBs, erectile dysfunction in males, and dyspareunia in females.

OUTCOMES

The primary outcomes of interest were HRSB with both opposite- and same-sex partners, paraphilia disorder, increased libido, hyper/compulsive sexual behavior, ejaculatory dysfunction, erectile dysfunction, contraception use, and dyspareunia.

RESULTS

Stimulant medications were linked to increased libido and hypersexual behaviors, especially in males, who also reported higher rates of erectile dysfunction. Females on stimulants exhibited higher rates of contraceptive use and slightly elevated libido. Non-stimulant medications showed fewer sexual side effects.

CLINICAL IMPLICATIONS

The findings underscore the need for clinicians to carefully consider the sexual side effects of ADHD medications, particularly stimulants, when developing treatment plans for adolescents, and gender differences in sexual dysfunction and high-risk sexual behaviors suggest that tailored interventions are necessary to address the unique needs of male and female patients.

STRENGTHS AND LIMITATIONS

The limitations of this paper include its retrospective nature and the fact that the data collected were self-reported. Additionally, the lack of diversity in the patient population is a limitation.

CONCLUSIONS

Stimulant medications may exacerbate certain sexual dysfunctions, particularly in males, while non-stimulant treatments have milder effects; gender-specific differences suggest distinct sexual health impacts for males and females and clinicians should consider the potential sexual side effects of ADHD medications, particularly in adolescents, and further research is needed to explore the long-term effects of ADHD treatments on sexual health.

Problematic pornography use and novel patterns of escalating use: A cross-sectional network analysis with two independent samples

Modern internet pornography allows users to harness sexual novelty in numerous ways, which can be used to overcome desensitisation through increasing volume of use (quantitative tolerance), progressing to more stimulating genres (qualitative escalation), skipping between stimuli (tab-jumping), delaying orgasm ('edging'), and engaging in pornographic binges. However, existing research has not yet evaluated how these potentially reciprocal consumption patterns relate to problematic pornography use (PPU). To this end, we recruited two independent samples of male pornography users (N1 = 1,356, Mage = 36.86, SD = 11.26; N2 = 944, Mage = 38.69, SD = 12.26) and examined the relationships between these behavioural dimensions and self-reported difficulties in controlling one's pornography use. Data were analysed through the network analysis approach (using Gaussian graphical models). As hypothesised, i) quantitative tolerance was centrally placed within the overall network, and ii) acted as a statistical bridge node between other patterns of pornography use (e.g., pornographic binges), and all measured facets of PPU. Our results are consistent with other emerging literature suggesting that tolerance, pornographic binges, tab-jumping, and edging behaviours as relevant features ofPPU, and that upscaling overall usage may connect broader patterns of use with problematic engagement. Clinical and theoretical implications, as well as future research directions, are discussed.

Assessment and treatment of compulsive sexual behavior disorder: a sexual medicine perspective

INTRODUCTION

The addition of compulsive sexual behavior disorder (CSBD) into the ICD-11 chapter on mental, behavioral, or neurodevelopmental disorders has greatly stimulated research and controversy around compulsive sexual behavior, or what has been termed "hypersexual disorder," "sexual addiction," "porn addiction," "sexual compulsivity," and "out-of-control sexual behavior."

OBJECTIVES

To identify where concerns exist from the perspective of sexual medicine and what can be done to resolve them.

METHODS

A scientific review committee convened by the International Society for Sexual Medicine reviewed pertinent literature and discussed clinical research and experience related to CSBD diagnoses and misdiagnoses, pathologizing nonheteronormative sexual behavior, basic research on potential underlying causes of CSBD, its relationship to paraphilic disorder, and its potential sexual health consequences. The panel used a modified Delphi method to reach consensus on these issues.

RESULTS

CSBD was differentiated from other sexual activity on the basis of the ICD-11 diagnostic criteria, and issues regarding sexual medicine and sexual health were identified. Concerns were raised about self-labeling processes, attitudes hostile to sexual pleasure, pathologizing of nonheteronormative sexual behavior and high sexual desire, mixing of normative attitudes with clinical distress, and the belief that masturbation and pornography use represent "unhealthy" sexual behavior. A guide to CSBD case formulation and care/treatment recommendations was proposed.

CONCLUSIONS

Clinical sexologic and sexual medicine expertise for the diagnosis and treatment of CSBD in the psychiatric-psychotherapeutic context is imperative to differentiate and understand the determinants and impact of CSBD and related "out-of-control sexual behaviors" on mental and sexual well-being, to detect forensically relevant and nonrelevant forms, and to refine best practices in care and treatment. Evidence-based, sexual medicine-informed therapies should be offered to achieve a positive and respectful approach to sexuality and the possibility of having pleasurable and safe sexual experiences.

Identifying Relationships Between Difficulties with Emotion Regulation and Compulsive Sexual Behavior

Emotion dysregulation is an associated feature of compulsive sexual behavior disorder (CSBD), now recognized by the World Health Organization. Previous studies have identified associations between trait emotion dysregulation and CSBD. Given that difficulties with emotion regulation (DERS) is comprised of several facets (e.g., difficulty with impulse control and lacking awareness of one's feelings when upset), and that these facets differentially relate to other mental health concerns, the present study aimed to examine how DERS facets relate to compulsive sexual behavior (CSB). The present study also considered interpersonal emotion regulation via attachment avoidance and attachment anxiety. Hierarchical regression was conducted, first accounting for demographic covariates, then adding attachment styles, and finally all DERS subscales. Results indicated that, among a large, diverse, online U.S. sample (N = 915; Mage = 39.21, SD = 0.81; 54.3% men), difficulty controlling impulses when upset, difficulty with clarity of emotions, and non-acceptance of emotions were significantly positively associated with CSB (small to moderate effects). Attachment anxiety and avoidance were also significantly positively associated with CSB, although their effects were minimal when adding DERS facets. Overall, this study supports the theorized impact of emotion dysregulation on CSB. Assessment of individual differences in DERS and intervening on these concerns are important for treating CSB.

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.

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.

H is for hypersexual: Sexuality in youths with ADHD

Background

Recent research into the association between ADHD and hypersexuality has been extremely skewed toward male patients and contribute to stigma against individuals engaging in same sex sexual behaviors. We sought to expand research on this important relationship and to address these shortcomings.

Methods

Using data from the TriNetX database, we created two patient cohorts of patients 21 years or younger, separated by presence or absence of ADHD diagnosis. We analyzed disorders of sexual behavior, comorbid psychiatric illness, and medication type. Those with ADHD were subdivided into same-sex high risk sexual behavior (HRSB) and opposite-sex HRSB. The ADHD group was analyzed based on the presence or absence of any disorder of sexuality. The outcomes measured were disorders of sexual behavior, comorbid psychiatric illness, and medication type.

Results

In a study of 1,355,184 analyzed patient records, patients ADHD were more likely to have all measured outcomes. Orientation of HRSB did not impact for disorders of sexual behavior, but individuals with same-sex HRSB were at higher risk for comorbid psychiatric illness. Those with hypersexuality and ADHD were a higher risk for psychiatric illnesses.

Conclusion

Our study is the largest to date examining associations between hypersexual behaviors and ADHD. Increased awareness of this association may aid in addressing some problematic behaviors before they become detrimental to the individuals with ADHD or others within their lives.

Symptoms of problematic pornography use among help-seeking male adolescents: Latent profile and network analysis

BACKGROUND AND AIMS

Little data exist on exploring the subgroups and characteristics of problematic pornography use (PPU) in help-seeking adolescents. The aims of the study were to classify the subgroups among help-seeking male adolescents, explore their similarities and differences, and uncover their core symptoms.

METHODS

A total of 3,468 Chinese male adolescents (Mage = 16.64 years, SD = 1.24) who were distressed about their pornography use were recruited. The Problematic Pornography Consumption Scale, the Brief Pornography Screen Scale, and Moral Disapproval of Pornography Use were used to classify them. The General Health Questionnaire, the Pornography Craving Questionnaire, and the Sexual Compulsivity Scale were used to investigate participants' negative consequence related to their pornography use; and the Online Sexual Activity Questionnaire (OSAs) and time spent on pornography use every week were considered as quantitative indicators.

RESULTS

Help-seeking male adolescents could be divided into 3 profiles, namely, self-perceived problematic (SP, n = 755), impaired control (IC, n = 1,656), and problematic use groups (PPU, n = 1,057). Frequency of OSAs was important for the identification of SP individuals, while negative consequences were more effective in identifying individuals with objective dysregulated behavior. Salience and mood modification were shared by all groups; however, in addition to this, the SP and PPU groups also showed withdrawal symptoms.

DISCUSSION AND CONCLUSION

This study's results provide support for the presence of different profiles of help-seeking individuals and information on potential intervention targets among adolescents which is lacking in the literature.

Compulsive Sexual Behavior Disorder should not be classified by solely relying on component/symptomatic features •

The paper by Sassover and Weinstein (2022) contributes to a timely and complex debate related to the classification of Compulsive Sexual Behavior Disorder (CSBD). The recent inclusion of CSBD as an impulse-control disorder in the ICD-11 has generated debate since a competitive view is that CSBD should rather be classified as an addictive disorder. Sassover and Weinstein (2022) reviewed existing evidence and concluded it does not support the conceptualization of CSBD as an addictive disorder. Although we agree regarding the relevance and timely nature of considering the classification of CSBD, we respectfully disagree with the position that relying on the components model of addiction (Griffiths, 2005) is the optimal approach for determining whether or not CSBD is an addictive disorder. In this commentary, we discuss potential pitfalls of relying on the components model to conceptualize CSBD as an addictive disorder and argue that considering a process-based approach is important for advancing this timely debate.

Contradicting classification, nomenclature, and diagnostic criteria of Compulsive Sexual Behavior Disorder (CSBD) and future directions •

Building on the conclusions of the debate papers by Gola et al. (2022) and Sassover and Weinstein (2022), the present commentary further addressed the contradictions between the current classification, nomenclature, and diagnostic criteria of Compulsive Sexual Behavior Disorder (CSBD) with elaborating on the potential roles impulsivity and compulsivity may play in CSBD, and how these characteristics may relate to addictive behaviors in particular. Moreover, it briefly discussed how the classification of CSBD might impact research and clinical practice and proposed potential future research directions that may help to reach a consensus on the classification and core symptoms of CSBD.

Compulsive Sexual Behavior and Alcohol Use Disorder Treated With Naltrexone: A Case Report and Literature Review

Compulsive sexual behavior (CSB) or sexual addiction is a term that generally indicates excessive and uncontrolled sexual behavior. This may lead to subjective distress, social and occupational impairment, or legal and financial consequences. Often, this condition is underreported and untreated. Until now there are no FDA-approved medications for sexual addiction or compulsive sexual behaviors. However, the therapeutic benefits of selective serotonin reuptake inhibitors (SSRIs) and naltrexone are known. This is a case of a 53-year-old male with a history of extensive alcohol use, alcohol withdrawal seizure, and delirium tremens. The patient was treated with naltrexone 50 mg/day for alcohol use disorder. The patient reported that his “sexual compulsion” also reduced after the medication and there was an improvement in both alcohol addiction and self-reported compulsive sexual behavior. This case report also includes a literature review of pharmacotherapy, especially naltrexone, for the treatment of sexual addiction/compulsive sexual behavior. The literature review has shown that patients’ symptoms were improved in different doses without side effects, and based on this and our experience, it can be said that naltrexone is effective in the reduction and remission of the symptoms of CSB or sexual addiction.

A Network Comparison of Motives behind Online Sexual Activities and Problematic Pornography Use during the COVID-19 Outbreak and the Post-Pandemic Period

Many researchers have considered whether online sexual activities (OSAs) increased over the course of the COVID-19 pandemic and whether these have led to an increase in problematic pornography use (PPU). This study investigated the impact of COVID-19 on PPU through pornography use motivations (PUMs) and OSAs to develop a better understanding of the mechanism and changes affecting PPU. Two groups of Chinese adults were recruited during the initial months of the pandemic (April 2020, n₁ = 496) and the post-pandemic period (October 2021, n₂ = 504). A network analysis was conducted to compare the structures of PPU symptoms among the two groups. The results showed that PUMs and OSAs were stronger predictors of PPU during the pandemic than post-pandemic (R²_pandemic = 57.6% vs. R²_{post-pandemic} = 28.7%). The motives of fantasy, sexual pleasure, stress reduction, and self-exploration were the prominent motivations during these two periods, but we found distinct PPU-related communities. PPU, sexual pleasure, and viewing sexually explicit materials (a type of OSAs) constituted a community during the pandemic but not in the post-pandemic’s network. The present study indicated that the pandemic may not have been the only factor impacting the higher rate of PPU. Instead, the higher frequency of OSAs during the pandemic may have been a strategy to cope with stress and to safely satisfy sexual desire.

Visual Event-Related Potentials under External Emotional Stimuli in Bipolar I Disorder with and without Hypersexuality

Hypersexuality is related to functions of personality and emotion and is a salient symptom of bipolar I disorder especially during manic episode. However, it is uncertain whether bipolar I disorder with (BW) and without (BO) hypersexuality exhibits different cerebral activations under external emotion stimuli. In 54 healthy volunteers, 27 BW and 26 BO patients, we administered the visual oddball event-related potentials (ERPs) under external emotions of Disgust, Erotica, Fear, Happiness, Neutral, and Sadness. Participants' concurrent states of mania, hypomania, and depression were also evaluated. The N1 latencies under Erotica and Happiness were prolonged, and the P3b amplitudes under Fear and Sadness were decreased in BW; the P3b amplitudes under Fear were increased in BO. The parietal, frontal, and occipital activations were found in BW, and the frontal and temporal activations in BO under different external emotional stimuli, respectively. Some ERP components were correlated with the concurrent affective states in three groups of participants. The primary perception under Erotica and Happiness, and voluntary attention under Fear and Sadness, were impaired in BW, while the voluntary attention under Fear was impaired in BO. Our study indicates different patterns of visual attentional deficits under different external emotions in BW and BO.

Present hedonism and future time perspectives predicting hypersexuality and problematic pornography use

The Time Perspective (TP) theory (i.e., the psychological experience regarding time) was often examined in association with different addictive behaviors, and the different TPs (i.e., Past Positive, Past Negative, Present Hedonistic, Present Fatalistic, and Future TPs) demonstrated different relationship patterns with them. However, most studies were conducted in relation to substance use-related disorders, leaving crucial knowledge gaps concerning the associations between TPs and potential behavioral addictions. The aim of the present study was to examine the associations between the five TP dimensions, hypersexuality, and problematic pornography use (PPU), considering potential gender differences. Participants from two independent samples (N₁ = 554; N₂ = 453) completed a self-report survey on TPs and sexual behaviors. Structural equation modeling results indicated that the Present Hedonistic TP had a positive, moderate, and the Future TP had a negative, weak association with hypersexuality in both samples. Only the Present Hedonistic TP had a significant, positive, weak-to-moderate association with PPU across the samples. The explained variances of the models were higher in case of hypersexuality (28 and 27%, respectively), than in case of PPU (1 and 14%, respectively). No significant gender differences were observed. In line with previous findings concerning other predictors of hypersexuality and PPU, the results of the present study suggest that hypersexuality and PPU may differ from each other in terms of their TP background. Yet, present hedonism, which is related to impulsivity, may play an important role in both problematic sexual behaviors, suggesting that interventions focusing on this TP might be successful in reducing hypersexuality and PPU.

Hands-off: Feasibility and preliminary results of a two-armed randomized controlled trial of a web-based self-help tool to reduce problematic pornography use

BACKGROUND AND AIMS

Despite problematic pornography use (PPU) being prevalent, no previous study has examined the effectiveness of evidence-based interventions for PPU, using rigorous methods. Using a two-armed randomized controlled trial study design, we examined the feasibility and initial effectiveness of a six-week online PPU intervention.

METHODS

We recruited 264 participants (3.8% women, M age = 33.2, SD = 10.6) who were randomized and assigned to either the self-help intervention (n = 123) or waitlist control condition (n = 141), and completed self-report questionnaires at baseline and after the end of the intervention (six-week follow-up). Multivariable linear regression models were generated and tested on a complete case basis to investigate possible treatment effects. Participants provided quantitative and qualitative feedback regarding the intervention's content and appearance.

RESULTS

Participants evaluated all modules positively in the intervention in general. There were differential dropout rates (89.4% in intervention vs. 44.7% in control group) with an overall follow-up rate of 34.5%. The intervention group reported significantly lower levels of PPU (P < 0.001, d = 1.32) at the six-week follow-up. Moreover, they reported lower pornography use frequency (P < 0.001, d = 1.65), self-perceived pornography addiction (P = 0.01, d = 0.85), pornography craving (P = 0.02, d = 0.40), and higher pornography avoidance self-efficacy (P = 0.001, d = 0.87) at the six-week follow-up.

DISCUSSION AND CONCLUSIONS

The present study was only a first step in rigorous treatment studies for PPU, but the findings are promising and suggest that online interventions for PPU might help reduce PPU in some cases, even without the guidance of therapists, by reducing treatment barriers.

Exploring Hypersexuality Pathways From Eye Movements: The Role of (Sexual) Impulsivity

BACKGROUND

Impulsivity is regarded as a key factor underpinning hypersexuality like-conditions. However, impulsivity is a multifaceted construct, and existing research has not been capturing such complexity, which includes the effects of domain-general and domain-specific impulsivity in hypersexuality.

AIM

The aim of this study was to test the predictive role of specific impulsivity domains, ie, domain-general and domain-specific, in hypersexuality and its associated consequences.

METHODS

Fifty-five men and 58 women went through an emotional Go/-no-Go task (including sexual, high-valence positive, and neutral pictures), aimed at capturing domain-general and domain-specific impulsivity. Ocular metrics were further considered in order to increase the validity of the experimental task, and provide a metric of attention capturing. The study was carried out in a community sample.

OUTCOMES

Self-reported (general)impulsivity and commission errors toward high-valence positive and sexual pictures (signaling domain-general and domain-specific impulsivity, respectively) were settled as independent variables, along with Time to First Fixation to stimuli, capturing early/uncontrolled attention. Scores on hypersexuality and negative consequences emerging from hypersexual behavior were settled as outcome variables.

RESULTS

Self-reported (general)impulsivity was the only predictor of hypersexuality scores, while negative consequences were best accounted by higher fixation time to sexual pictures. In all, findings did not support the role of domain-specific impulsivity (ie, sexual impulsivity) in hypersexuality.

CLINICAL TRANSLATION

Findings tentatively suggest that hypersexuality, as captured at the community level, may be best positioned within the general spectrum of psychopathology, thus influencing educational and clinical intervention protocols aimed at addressing hypersexuality related complaints. Protocols would be expected to primarily target general psychopathology phenomena, rather than specific sexual aspects.

STRENGTHS & LIMITATIONS

This study implemented an innovative approach to capture different impulsivity domains, thus adding to previous literature in the field. However, the current study precludes the generalization of findings to clinical samples, where psychological comorbidities are expected to impact results. Further, findings must be read with caution given to limited effect sizes.

CONCLUSION

While hypersexuality was related to self-reported (general) impulsivity, findings on the negative consequences associated with hypersexual behavior mirrored response patterns found in depression. Such evidence aligns with the assumption that hypersexuality related phenomena might be better positioned in the psychopathology domain, rather than simply framed as a specific sexual problem. Carvalho J, Rosa PJ, Štulhofer A. Exploring Hypersexuality Pathways From Eye Movements: The Role of (Sexual) Impulsivity. J Sex Med 2021;18:1607-1614.

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.

Development of a structure-validated hypersexuality scale in Chinese university students

BACKGROUND

Hypersexuality is associated with many psychiatric disorders and creates enormous burden for the affected individual, family and society. There are numerous inventories measuring behavioral, emotional or stressful features of hypersexuality, we still need a structure-validated questionnaire to measure hypersexuality in a comprehensive way.

METHODS

Based on previous inventories and related clinical descriptions of hypersexuality, we designed a matrix of 72 items related to hypersexual experience, and we invited 282 heterosexual university students who experienced hypersexuality at least once life-long to answer the matrix.

RESULTS

Through exploratory factor analyses and exploratory structural equation modeling, we constructed a Hypersexuality Scale, with a satisfactory model structure of five factors (or scales, 4 items for each scale) of hypersexuality, and named them as the Negative Impact, Emotional Coping, Uncontrolled Behavior, Post-sex Regret, and Increased Interest. Most inter-correlations of these factors were significant but in low or medium levels in all participants. Male students scored significantly higher on Negative Impact and Increased Interest than females did.

CONCLUSIONS

The five scales described in this study might help to understand hypersexuality, and the Hypersexuality Scale might be applied to the clinical conditions related to hypersexuality.

Properties of the Problematic Pornography Consumption Scale (PPCS-18) in community and subclinical samples in China and Hungary

Several scales assessing problematic pornography use (PPU) are available. However, in most previous studies, primarily nonclinical and Western samples were used to validate these scales. Thus, further research is needed to validate scales to assess problematic pornography use across diverse samples, including subclinical populations. The aim of the present study was to examine and compare the psychometric properties of the PPCS-18 in Hungarian and Chinese community samples and in subclinical men. A sample of Chinese community men (N1 = 695), a sample of subclinical men who were screened for PPU using the Brief Pornography Screen (N2 = 4651), and a sample of Hungarian community men (N3 = 9395) were recruited to investigate the reliability and validity of the PPCS-18. Item-total score correlation, confirmatory factor analyses, reliability, and measurement invariance tests showed that the PPCS-18 yielded strong psychometric properties among Hungarian and Chinese community men and indicated potential utility in the subclinical men. The network analytic approach also corroborates that the six factors of the PPCS-18 can reflect the characteristic of the participants from different cultural contexts, and participants from community and subclinical populations. In sum, the PPCS-18 demonstrated high generalizability across cultures and community and subclinical men.

The negative consequences of hypersexuality: Revisiting the factor structure of the Hypersexual Behavior Consequences Scale and its correlates in a large, non-clinical sample

Introduction

Despite the growing literature about hypersexuality and its negative consequences, most studies have focused on the risk of sexually transmitted infections (STI’s), resulting in relatively few studies about the nature and the measurement of a broader spectrum of adverse consequences.

Methods

The aim of the present study was to examine the validity and reliability of the Hypersexual Behavior Consequence Scale (HBCS) in a large, non-clinical population (N = 16,935 participants; females = 5854, 34.6%; M_age = 33.6, SD_age = 11.1) and identify its factor structure across genders. The dataset was divided into three independent samples, taking into consideration gender ratio. The validity of the HBCS was investigated in relation to sexuality-related questions (e.g., frequency of pornography use) and the Hypersexual Behavior Inventory (Sample 3).

Results

Both the exploratory (Sample 1) and confirmatory (Sample 2) factor analyses (CFI = 0.954, TLI = 0.948, RMSEA = 0.061 [90% CI = 0.059–0.062]) suggested a first-order, four-factor structure that included work-related problems, personal problems, relationship problems, and risky behavior as a result of hypersexuality. The HBCS showed adequate reliability and demonstrated reasonable associations with the examined theoretically relevant correlates, corroborating the validity of the HBCS.

Conclusion

Findings suggest that the HBCS may be used to assess consequences of hypersexuality. It may also be used in clinical settings to assess the severity of hypersexuality and to map potential areas of impairment, and such information may help guide therapeutic interventions.

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.

Occurrence and clinical characteristics of Compulsive Sexual Behavior Disorder (CSBD): A cluster analysis in two independent community samples

BACKGROUND AND AIMS

Compulsive Sexual Behavior Disorder (CSBD) is characterized by a persistent failure to control intense and recurrent sexual impulses, urges, and/or thoughts, resulting in repetitive sexual behavior that causes a marked impairment in important areas of functioning. Despite its recent inclusion in the forthcoming ICD-11, concerns regarding its assessment, diagnosis, prevalence or clinical characteristics remain. The purpose of this study was to identify participants displaying CSBD through a novel data-driven approach in two independent samples and outline their sociodemographic, sexual, and clinical profile.

METHODS

Sample 1 included 1,581 university students (females = 56.9%; Mage = 20.58) whereas sample 2 comprised 1,318 community members (females = 43.6%; Mage = 32.37). First, we developed a new composite index to assess the whole range of CSBD symptoms based on three previously validated scales. Based on this new composite index, we subsequently identified individuals with CSBD through a cluster analytic approach.

RESULTS

The estimated occurrence of CSBD was 10.12% in sample 1 and 7.81% in sample 2. Participants with CSBD were mostly heterosexual males, younger than respondents without CSBD, reported higher levels of sexual sensation seeking and erotophilia, an increased offline and especially online sexual activity, more depressive and anxious symptoms, and poorer self-esteem.

CONCLUSIONS

This research provides further evidence on the occurrence of CSBD based on an alternative data-driven approach, as well as a detailed and nuanced description of the sociodemographic, sexual, and clinical profile of adults with this condition. Clinical implications derived from these findings are discussed in detail.

Emotional Intimacy and Distress About Sexual Difficulties in Partnered Older European Men and Women: A Network Analysis

Although research in older individuals' sexual health is steadily increasing, the nature of, and predictors related to, their distress about changes in sexual function have not been well-studied. Using data from sexually active and partnered 1,047 Norwegian and Danish women and men aged 60-75 years, this study employed network analysis to explore the structure of older individuals' sexual distress and the role of emotional intimacy. Men's network of sexual distress facets was more densely interconnected than women's network. Higher emotional intimacy was associated with lower sexual distress levels across gender. The findings have implications for sexual health interventions targeting older people.

The dynamics of adolescents' pornography use and psychological well-being: a six-wave latent growth and latent class modeling approach

Despite increasing concerns that pornography decreases adolescents' well-being, existing empirical support for this position is largely limited to cross-sectional studies. To explore possible links between adolescent pornography use and psychological well-being more systematically, this study focused on parallel dynamics in pornography use, self-esteem and symptoms of depression and anxiety. A sample of 775 female and 514 male Croatian high school students (M_{age at baseline} 15.9 years, SD 0.52) from 14 larger secondary schools, who were surveyed 6 times at approximately 5-month intervals, was used for the analyses. The longitudinal data were analyzed using latent growth curve and latent class growth modeling. We observed no significant correspondence between growth in pornography use and changes in the two indicators of psychological well-being over time in either female or male participants. However, a significant negative association was found between female adolescents' pornography use and psychological well-being at baseline. Controlling for group-specific trajectories of pornography use (i.e., latent classes) confirmed the robustness of findings in the both female and male samples. This study's findings do not corroborate the notion that pornography use in middle to late adolescence contributes to adverse psychological well-being, but do not rule out such a link during an earlier developmental phase-particularly in female adolescents. The findings have ramifications for educational and adolescent health specialists, but also for concerned parents.

Online Porn Addiction: What We Know and What We Don't-A Systematic Review

In the last few years, there has been a wave of articles related to behavioral addictions; some of them have a focus on online pornography addiction. However, despite all efforts, we are still unable to profile when engaging in this behavior becomes pathological. Common problems include: sample bias, the search for diagnostic instrumentals, opposing approximations to the matter, and the fact that this entity may be encompassed inside a greater pathology (i.e., sex addiction) that may present itself with very diverse symptomatology. Behavioral addictions form a largely unexplored field of study, and usually exhibit a problematic consumption model: loss of control, impairment, and risky use. Hypersexual disorder fits this model and may be composed of several sexual behaviors, like problematic use of online pornography (POPU). Online pornography use is on the rise, with a potential for addiction considering the "triple A" influence (accessibility, affordability, anonymity). This problematic use might have adverse effects in sexual development and sexual functioning, especially among the young population. We aim to gather existing knowledge on problematic online pornography use as a pathological entity. Here we try to summarize what we know about this entity and outline some areas worthy of further research.

The Role of Religiosity in Adolescents' Compulsive Pornography Use: A Longitudinal Assessment

Despite increasing concerns that adolescent men are vulnerable to developing compulsive pornography use, little research has been done in this area. Given recent theorizing and research concerning moral incongruence, we hypothesized that symptoms of compulsive pornography use should generally be associated with higher levels of pornography use and increased growth in male adolescent pornography use over time, but that this pattern would be attenuated among very religious participants. These hypotheses were tested with mixed effects growth models using two independent panel samples of male Croatian adolescents. As expected, adolescent men who reported features of compulsive pornography use tended to exhibited higher levels of pornography use. However, contrary to expectations, increased growth in pornography use was limited to more religious compulsive users. Compared to nonreligious compulsive users, these adolescents started with lower initial levels of pornography use and their use increased over time at a greater rate of change. This study's results are the first to suggest that some adolescent men who report high levels of pornography use tend to exhibit symptoms of compulsive use, which highlights a need for counseling and therapeutic attention. Our findings also have implications for the emerging theory of moral incongruence.