Evaluation and treatment of sex addiction

Development of a risk assessment tool for Japanese sex offenders: The Japanese Static-99

In Japan, sexual offending, especially paraphilic sexual offending, has become a major problem, and approximately 3000 people are arrested for frotteuristic and voyeuristic behavior each year. Considering the repetitive nature of such behaviors, determining the recidivism risk is imperative. Globally, Static-99 is one of the most widely used actuarial risk assessment tools to predict recidivism among sex offenders. However, sexual offending is largely influenced by social and cultural backgrounds, and whether risk factors identified in the West are applicable to other countries is unknown. Therefore, we developed a Japanese version of the Static-99 and examined its reliability and validity with 167 Japanese paraphilic sex offenders. The results showed good internal consistency (Cronbach's alpha coefficient = 0.88) and predictive accuracy (area under the curve = 0.76). The results indicate that the Japanese Static-99 can be used with Japanese sex offenders. Moreover, risk factors identified in the Western context are applicable to Japanese sex offenders despite the different nature and manifestations of their offending.

Mapping the links between sexual addiction and gambling disorder: A Bayesian network approach

Contemporary literature and recent classification systems have expanded the field of addictions to include problematic behaviours such as gambling and sexual addiction. However, conceptualisation of behavioural addictions is poorly understood and gender-based differences have emerged in relation to how these behaviours are expressed. The current research conducted partial-correlation and Bayesian network analyses to assess the symptomatic structure of gambling disorder and sexual addiction. Convenience community sampling recruited 937 adults aged 18 to 64 years (315 females, Mage = 30.02; 622 males, Mage = 29.46). Symptoms of problematic behaviours were measured using the Online Gambling Disorder Questionnaire (OGDQ) and the Bergen Yale Sex Addiction Scale (BYSAS). Results indicate distinct gender-based differences in the symptom networks of sexual addiction and gambling disorder, with a more complex network observed amongst men for both conditions. Addiction salience, withdrawal and dishonesty/deception were important components of the addictive network. Interpersonal conflict was more central for women while intrapsychic conflict a more prominent issue for men. Differences in the two symptom networks indicate separate disorders as opposed to a single underlying construct. Treating practitioners and community initiatives aimed at addressing sexual addiction and disordered gambling should consider gender, when designing educational or therapeutic interventions.

Time Goes Back-Time Perspective in Polish Men with Compulsive Sexual Behavior Disorder and Risky Sexual Behavior

Many relationships between time perspective and a propensity to engage in risky behaviors or developing addictions have been demonstrated. The aim of our study was to determine the differences in intensity of individual time perspectives in people with compulsive sexual behavior disorder (CSBD) and risky sexual behavior (RSB). The analysis includes 425 men: 98 CSBD (age M = 37.99 years), 63 RSB (age M = 35.70 years), 264 without CSBD and RSB features constituting the control group (age M = 35.08 years). We used the Zimbardo Time Perspective Inventory, the Sexual Addiction Screening Test-Revised, the Risky Sexual Behavior Scale and a self-constructed survey. The comparative analysis showed a higher intensity of past-negative (p = 0.040), a lower of past-positive (p < 0.001) and a present-fatalistic (p = 0.040) outlook in the CSBD group compared to the control group. Compared to the participants with RSB, the CSBD group was characterized by a higher intensity of past-negative (p = 0.010), a lower of past-positive (p = 0.004) and a present-hedonistic perspective (p = 0.014). The RSB group also achieved higher results from the present-hedonistic perspective (p = 0.046) compared to the control group. The CSBD patients indicate a stronger tendency to focus on negative past compared to non-CSBD men, both taking and not taking RSB. The time perspective profiles of RSB men are similar to those who do not engage in RSB. The distinguishing feature of men with RSB without CSBD is a greater ability to enjoy current experiences.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

A motivation model of sex addiction - Relevance to the controversy over the concept

An integrative model of sexual addiction is presented, involving a combination of models based upon (i) incentive motivation theory and (ii) the dual organisation of the control of behavior. The model is related to ongoing arguments about the validity of the notion of addiction when applied to sexual behavior. It is suggested that the evidence strongly favors the viability of an addiction model of sex. Strong similarities to the classical addiction to hard drugs are observed and features can be better understood with the help of the model. These include tolerance, escalation and withdrawal symptoms. It is argued that other candidates for accounting for the phenomena, such as obsessive-compulsive behavior, faulty impulse control, high drive and hypersexuality do not fit the evidence. The role of dopamine is central to the model. The model's relevance to stress, abuse, development, psychopathy, fantasy, sex differences, evolutionary psychology and the interaction with drug-taking is shown.

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.

Online Sex Addiction: A Qualitative Analysis of Symptoms in Treatment-Seeking Men

BACKGROUND

Problematic sexual internet use has been attracting increasing research attention in recent years. However, there is a paucity of qualitative studies about how this problem manifests on a daily basis in the clinical population and whether the phenomenon should fall within the hypersexual, compulsive-impulsive, or addictive spectrums of disorders.

METHODS

Twenty-three semi-structured interviews, including AICA-C clinical interviews, were conducted with men who were in treatment for problematic internet sex use (aged 22-53; Mage = 35.82). The interview structure focused on the patterns of sexual behavior in question, their development, the manifestation of symptoms, and other associated psychosocial problems. A thematic analysis was applied as the main analytical strategy.

RESULTS

Typical problematic patterns included pornography use and cybersex, together with continuous masturbation for several hours several times a week. This pattern emerged relatively early in young adulthood and became persistent for years. The majority of participants fulfilled the criteria for behavioral addiction (as defined, e.g., by the components model of addiction), with loss of control and preoccupation being the most pronounced and withdrawal symptoms being the least. Together with the onset of erectile dysfunction, negative consequences were reported as being slowly built up over years and typically in the form of deep life dissatisfaction, regret, and feelings of unfulfilled potential.

DISCUSSION AND CONCLUSION

The Addiction model is relevant for describing the difficulties in treatment-seeking men who suffer from problematic sexual internet use. However, the manifestations of the additional criteria are nuanced. In the case of negative consequences, their onset might be very slow and not easily reflected. While there was evidence of several forms of tolerance, potential withdrawal symptoms in online sex addiction need further attention to be verified.

Assessment and treatment of hypersexuality: a review

Hypersexuality is defined under various terms in the DSM and ICD diagnostic classifications. However, it can be challenging to differentiate between hypersexuality as one of the symptoms of a mental disorder and hypersexual disorder as a primary diagnosis. In this article, we explore the physiology, assessment and treatment of hypersexual disorder, and consider its aetiology and epidemiology. In addition, we highlight the paucity of evidence in the literature about licensed or specific pharmacological recommendations for its treatment and the poor awareness of hypersexuality in clinical and research practice. Further research is recommended to identify more precise guidance for the pharmacological management of hypersexuality.

Hypersexuality and Impulsivity in Self-Referred Men With Sexual Interest in Minors: Are They Related? Do They Change During Treatment? An Exploratory Pilot Study

Introduction

Studies on characteristics of self-referred men with sexual interest in minors (SIM) and treatment approaches in this group of patients are still relatively rare.

Aim

The aim of this exploratory pilot study was to investigate hypersexuality and impulsivity as 2 dynamic risk factors that could possibly change during treatment in self-referred men with SIM.

Methods

Data were collected at the “Kein Täter Werden (means: not become an offender)” network site in Hamburg. Using self-report questionnaires, the extent of hypersexuality and impulsivity was analyzed with the samples’ pretreatment data via descriptive statistics and compared with nonclinical samples of other studies. The relation between hypersexuality and impulsivity was analyzed via Spearman's correlation coefficient with pretreatment data (N = 77). Intragroup analysis compared hypersexuality and impulsivity from pre- and posttreatment (n = 29).

Main Outcome Measures

Hypersexual Behavior Inventory and Barratt Impulsiveness Scale Version 11.

Results

The degree of generalized impulsivity in the SIM group was comparable to that in nonclinical samples while the degree of hypersexuality was considerably higher than in nonclinical samples. Sixty-four percent of the participants were in the range of clinically relevant hypersexuality. Impulsivity and hypersexuality were weakly positively correlated with each other. During treatment hypersexuality significantly decreased while impulsivity did not differ significantly between before beginning treatment and after (partial) completion.

Conclusion

Hypersexuality, but not impulsivity, was pronounced in the group of self-referred men with SIM and should be targeted in treatment. In order to improve treatment outcome regarding risk reduction in self-referred men with SIM, a focus on treatment approaches that were developed to treat hypersexuality can be expected to be effective while focusing on generalized impulsivity may be less relevant.

Lampalzer U, Tozdan S, von Franqué F, et al. Hypersexuality and Impulsivity in Self-Referred Men With Sexual Interest in Minors: Are They Related? Do They Change During Treatment? An Exploratory Pilot Study. Sex Med 2021;9:100429.

Problematic Pornography Use: Legal and Health Policy Considerations

Purpose of Review

Reports of sexual violence, especially towards women and children, are rapidly increasing. At the same time, rates of problematic pornography use (PPU) are accelerating across the world too. The purpose of this review is to consider the recent research on PPU and its contribution to sexual violence. The article offers guidance to governments on possible health policy interventions and legal actions to prevent the development of PPU and to reduce the incidence of sexual violence in society.

Recent Findings

Working from the consumer’s point of view, we identify PPU and ask how much pornography is needed to cause PPU. We examine how PPU drives sexual offending in children, adolescents and adults. The impact of PPU on some consumers’ behaviour suggests significant links to domestic violence. Sexual strangulation is highlighted as an example. Artificial intelligence algorithms play a key role in the pornography industry and appear to be driving escalation to more violent material, inducing high levels of sexual dysfunction in consumers and creating appetites for viewing child sexual abuse material (CSAM).

Summary

Easy access to internet pornography has led to an increase in PPU and sexual violence. Diagnoses and treatments for PPU are examined, as are legal transgressions of a civil and criminal nature arising from PPU. Legal remedies and government policy implications are discussed from the point of view of the precautionary principle. Strategies covered include age verification for pornography, public health campaigns and embedded health and legal warnings for users at the start of pornography sessions along with lessons for pupils about pornography’s impact on the brain.

Sexual Addiction and Associated Factors: The Role of Emotion Dysregulation, Impulsivity, Anxiety and Depression

The present research aimed to study the relationship between emotion dysregulation, impulsivity, anxiety, depression and sexual addiction. A survey was conducted among 398 voluntary subjects recruited online through specialized forums. The participants completed validated questionnaires. Our results showed that individuals with sexual addiction reported more difficulty regulating emotions and higher levels of impulsivity than those individuals who were not defined as having a sexual addiction. In addition, anxiety and depression were significantly associated with sexual addiction. Furthermore, anxiety and depression seemed to partially mediate the links between impulsivity, emotion dysregulation and this addiction. Finally, emotion dysregulation and impulsivity had mediating effects on the relationship between anxious-depressive affects and sexual addiction. Despite the limitations of this study, our results seem to be consistent with the literature on sexual addiction and have clinical and research implications.

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.

Cognitive processes related to problematic pornography use (PPU): A systematic review of experimental studies

INTRODUCTION

Some people experience symptoms and negative outcomes derived from their persistent, excessive, and problematic engagement in pornography viewing (i.e., Problematic Pornography Use, PPU). Recent theoretical models have turned to different cognitive processes (e.g., inhibitory control, decision making, attentional bias, etc.) to explain the development and maintenance of PPU, but empirical evidence derived from experimental studies is still limited. In this context, the present systematic review aimed to review and compile the evidence around cognitive processes related to PPU.

METHODS

A systematic review was performed in accordance with PRISMA guidelines to compile evidence regarding cognitive processes related to PPU. We retained and analyzed 21 experimental studies addressing this topic.

RESULTS

Studies were focused on four cognitive processes: attentional bias, inhibitory control, working memory, and decision making. In brief, PPU is related to (a) attentional biases toward sexual stimuli, (b) deficient inhibitory control (in particular, to problems with motor response inhibition and to shift attention away from irrelevant stimuli), (c) worse performance in tasks assessing working memory, and (d) decision making impairments (in particular, to preferences for short-term small gains rather than long-term large gains, more impulsive choice patterns than non-erotica users, approach tendencies toward sexual stimuli, and inaccuracies when judging the probability and magnitude of potential outcomes under ambiguity).

CONCLUSION

This systematic review offers a comprehensive overview of the current state of knowledge regarding the cognitive features related to PPU, and points out new areas that warrants further research.

Pharmacotherapy of Sexual Addiction

PURPOSE OF REVIEW

We reviewed recent data on sexual addiction and its treatment. We examined the different definitions of this disorder, related to the pathophysiological mechanisms. We addressed the pharmacological treatment of sexual addiction.

RECENT FINDINGS

Hypersexual behavior can be considered an addictive disorder. Sexual addiction is accompanied by significant psychiatric and addictive comorbidities and is responsible for life impairment. A comprehensive and efficient treatment must be proposed. Selective serotonin reuptake inhibitors seem the first-line pharmacological treatment for sexual addiction. Naltrexone could be another therapeutic option. Psychotherapy and preferentially cognitive-behavioral therapy should be used in association with pharmacotherapy and treatments of comorbidities.

Peripherally Physiological Responses to External Emotions and Their Transitions in Bipolar I Disorder With and Without Hypersexuality

Hypersexuality is associated with psychiatric disorders such as mania; however, it remains unclear whether bipolar I disorder with (BW) or without (BO) hypersexuality demonstrates different responses to external emotional stimuli and their transitions that were composed of pictures and sounds of same domain. In 21 BW patients, 20 BO patients, and 41 healthy volunteers, we administered polygraph tests (electrocardiogram, electromyogram, electrooculogram, and galvanic skin response) to measure transitions from a primer emotion (i.e., external disgust, erotica, fear, happiness, neutral, and sadness) to a noncongruent emotion (out of the remaining five) and to the primer emotion again (repeat-primer). We also evaluated participants' concurrent states of mania, hypomania, and depression. With neutral as the noncongruent emotion, the heart rate difference in BW was greater than in controls when responses to the primer erotica were subtracted from responses to the repeat-primer erotica, or when to the primer sadness were subtracted from the repeat-primer sadness. The difference of the masseter electromyographic activity in BW was lower than in BO and controls when responses to the noncongruent happiness were subtracted from responses to the repeat-primer neutral, and was lower than in BO when to the noncongruent neutral were subtracted from the repeat-primer erotica. The eyeball movement difference was greater in BW than in BO and controls when responses to the noncongruent sadness were subtracted from responses to the repeat-primer neutral. The heart rate difference when responses to the primer happiness were subtracted from responses to the noncongruent neutral was negatively correlated with mania in BO. BW and BO patients behaved differently to external emotions and their transitions, particularly regarding erotica and sadness, which might characterize unique pathophysiological processes of the two bipolar I disorder subtypes.

Sexual addiction, compulsivity, and impulsivity among a predominantly female sample of adults who use the internet for sex

BACKGROUND AND AIMS

Compulsive sexual behavior is characterized by extensive sexual behavior and unsuccessful efforts to control excessive sexual behavior. The aim of the studies was to investigate compulsivity, anxiety and depression and impulsivity and problematic online sexual activities among adult males and females who use the Internet for finding sexual partners and using online pornography.

METHODS

Study 1- 177 participants including 143 women M = 32.79 years (SD = 9.52), and 32 men M = 30.18 years (SD = 10.79). The Sexual Addiction Screening Test (SAST), the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Spielberger Trait-State Anxiety Inventory (STAI-T STAI-S) and Beck Depression Inventory (BDI). Study 2- 139 participants including 98 women M = 24 years (SD = 5) and 41 men M = 25 years (SD = 4). The impulsivity questionnaire (BIS/BAS), Problematic online sexual activities (s-IAT-sex) and Sexual Addiction Screening Test (SAST).

RESULTS

Study 1- Multiple regression analysis has indicated that a model which included BDI, Y-BOCS, and STAI scores contributed to the variance of sexual addiction rates, and explained 33.3% of the variance. Study 2- Multiple regression analysis indicated that BIS/BAS and s-IAT scores contributed to the variance of sexual addiction rates, and explained 33% of the variance.

DISCUSSION AND CONCLUSIONS

Obsessive-compulsive symptoms contributed to sexual addiction among individuals who use the Internet for finding sexual partners. Impulsivity and problematic online sexual activity contributed to ratings of sex addiction. These studies support the argument that sex addiction lies on the impulsive-compulsive scale and could be classified as a behavioral addiction.

The Exacerbating Impact of Moral Disapproval on the Relationship Between Pornography Use and Depression, Anxiety, and Relationship Satisfaction

Using an online sample of participants in committed relationships, support was found for a moderated mediation model in which depression mediated the relationship between pornography use and relationship satisfaction, and this indirect effect was moderated by level of moral disapproval. Results indicate that, among consumers of pornography, their level of moral disapproval exacerbates adverse intra- and interpersonal outcomes such as distress and decreased relationship satisfaction. These results extend the empirical literature that examines the conditional effects of moral disapproval of pornography use to relational outcomes.

A Network Approach to Hypersexuality: Insights and Clinical Implications

BACKGROUND

In spite of a growing interest in research on hypersexuality, consensus about its etiology and best treatment strategy has not been achieved.

AIM

To further the empirical and clinical understanding of hypersexuality by exploring the structure of its symptoms using a network analytic approach.

METHODS

In 2014, an online survey advertised as focusing on Internet pornography, sexual health, and relationships was carried out among Croatian men and women aged 18-60 years (M_age = 31.1 years, SD = 9.67). In a sample of 3,028 participants, we applied a network analytic approach to explore the structure of hypersexuality symptoms. In the network, nodes represented hypersexuality symptoms and associated sexual behaviors, while their connections were operationalized as partial correlations. 4 Research questions were addressed: (1) does the hypersexuality network differ between genders; (2) which symptoms are centrally positioned; (3) what is the topological location of pornography use; and (4) are there distinct clusters ("communities") of symptoms in the network?

OUTCOMES

We estimated and plotted hypersexuality networks by gender using items from the Hypersexual Disorder Screening Inventory and the Hypersexual Behavioral Consequences Scale, as well as indicators of sexual desire, pornography use, sexual intercourse, and masturbation frequency.

RESULTS

The structure of the hypersexuality network was surprisingly similar in women and men, both in terms of symptom centrality and the clustering of symptoms. Psychological distress and negative emotions triggered by sexual fantasies and/or behaviors, together with a loss of control over sexual feelings, occupied central positions in the networks. Pornography use was located peripherally in both the men's and women's hypersexuality networks.

CLINICAL TRANSLATION

Psychological distress and negative emotions triggered by sexual fantasies and/or behaviors constituted the core of the hypersexuality network, which makes them potential prime targets for clinical intervention and calls for normalization of (presumably self-stigmatized) sexual expression through affirmative therapy and interventions that enhance self-care, self-compassion, and adaptive coping mechanisms.

STRENGTHS & LIMITATIONS

This is the first network analytic approach to hypersexuality. Apart from its novel insights about the structure of hypersexuality, the study employed several methods to assure reliability and robustness of findings. Considering that networks were estimated in a convenience-based community sample, the findings might not generalize to clinically distressed individuals.

CONCLUSION

Our results demonstrate the usefulness of network analytics to hypersexuality in a non-clinical sample and we encourage future clinical and longitudinal explorations of hypersexuality using this novel approach. Werner M, Štulhofer A, Waldorp L, et al. A Network Approach to Hypersexuality: Insights and Clinical Implications. J Sex Med 2018;15:373-386.

The contribution of personality factors and gender to ratings of sex addiction among men and women who use the Internet for sex purpose

BACKGROUND AND AIMS

Sex addiction is characterized by excessive sexual activity on the Internet. We have investigated the contribution of the Big Five personality factors and sex differences to sex addiction.

METHODS

A total of 267 participants (186 males and 81 females) were recruited from Internet sites that are used for finding sexual partners. Participants' mean age was 31 years (SD = 9.8). They filled in the Sexual Addiction Screening Test (SAST), the Big Five Index, and a demographic questionnaire.

RESULTS

Men have shown higher scores of sex addiction than women (Cohen's d = 0.40), they were more open to experiences (Cohen's d = 0.42), and they were less neurotic than women (Cohen's d = 0.67). Personality factors contributed significantly to the variance of sex addiction [F(5, 261) = 6.91, p < .001, R² = .11]. Openness to experience (β = 0.18) and neuroticism (β = 0.15) had positive correlations with SAST scores, whereas conscientiousness (β = -0.21) had a negative correlation with SAST scores, and personality traits explained 11.7% of the variance. A parallel moderation model of the effect of gender and personality traits on sex addiction explained 19.6% of the variance and it has indicated that conscientiousness had a negative correlation with SAST scores. Greater neuroticism was associated with higher scores of SAST in men but not in women.

DISCUSSION AND CONCLUSIONS

This study confirmed higher scores of sex addiction among males compared to females. Personality factors together with gender contributed to 19.6% of the variance of ratings of sex addiction. Among men, neuroticism was associated with greater propensity for sex addiction.

Where the Mind Cannot Dare: A Case of Addictive Use of Online Pornography and Its Relationship With Childhood Trauma

Dysfunctional use of cybersex has often been conceptualized as a "behavioral addiction" sharing common traits with substance addiction. We describe the case of a treatment-seeking man, who displayed addictive use of pornography. The case is presented from two perspectives: (1) a symptom-based approach inspired by the addiction model of excessive sexual behaviors and (2) a process-based approach aimed to identify the psychological processes and risk factors that may foster the development of addiction-like symptoms. This article shows how case conceptualization according to a process-based approach is likely to result in psychological intervention that targets the specific processes and risk factors involved in addictive cybersex use.

Spanish validation of the Sexual Addiction Screening Test

BACKGROUND AND AIMS

Sexual addiction is a pathological behavior characterized by a combination of excessive sexual desire and impaired ability to control it. Its incidence ranges between 1.2% and 32.2%, although this number may vary depending on the screening tool used. This wide variability is largely due to the use of non-validated instruments (e.g., structural validity relying on exploratory analyses, instruments translated without an additional validation process, or instruments validated in another format). To deal with these limitations, this study tested the psychometric properties of the Spanish paper-and-pencil and online versions of the Sexual Addiction Screening Test (SAST).

METHODS

A total of 2,528 participants (1,163 males) completed the Spanish version of the SAST, along with other instruments assessing sexual compulsivity (1,585 = paper-and-pencil, 943 = online).

RESULTS

The exploratory factor analysis yielded a four-factor structure explaining 57.39% of the variance for the SAST paper-and-pencil version. This factor structure was then verified for the online version through the use of confirmatory factor analysis [χ2(264) = 441.59; χ2/df = 1.66; RMSEA = 0.02; CFI = 0.94; IFI = 0.94]. This methodology was also used to support measurement invariance (configural, metric, and scalar invariance) according to gender. The reliability of the total score ranged from .82 to .85. Similarly, correlations with related scales were positive and significant (r between .22 and .71). Temporal stability 1 year after the first application was 0.65 (paper-and-pencil format) and 0.60 (online version).

CONCLUSION

These results, together with the absence of questionnaires translated into Spanish to assess this construct, justify the use of the SAST in the evaluation of sexual addiction in Spanish-speaking countries.

The Role of Pleasure Neurobiology and Dopamine in Mental Health Disorders

Recent evidence and research has demonstrated that the pleasure response and associated neurotransmitters and brain circuits play a significant role in substance use disorders (SUDs). It was thought that negative behaviors associated with SUDs resulted from negative choices, but it is now known that chemical changes in the brain drive those behaviors. Several mental health disorders (e.g., eating disorders, non-suicidal self-injury, compulsive sex behaviors, internet gaming, gambling) are also thought to involve those same pleasure responses, neurotransmitters, and brain regions. Studies have shown that the use of naltrexone, a dopamine antagonist, can reduce symptoms of these disorders. It is important for nurses to understand the underlying physiology of mental health disorders that are thought to have an addictive or craving component. This understanding can help reduce stigma. Educating patients about likely neurobiological causes for their disorders can also help reduce guilt and shame. Nurses should educate patients about these disorders and evidence-based treatments, including off-label use of naltrexone. [Journal of Psychosocial Nursing and Mental Health Services, 55(9), 17-21.].

Testing the Effectiveness of Cognitive Analytic Therapy for Hypersexuality Disorder: An Intensive Time-Series Evaluation

The evidence base for treatment of hypersexuality disorder (HD) has few studies with appropriate methodological rigor. This study therefore conducted a single case experiment of cognitive analytic therapy (CAT) for HD using an A/B design with extended follow-up. Cruising, pornography usage, masturbation frequency and associated cognitions and emotions were measured daily in a 231-day time series. Following a three-week assessment baseline (A: 21 days), treatment was delivered via outpatient sessions (B: 147 days), with the follow-up period lasting 63 days. Results show that cruising and pornography usage extinguished. The total sexual outlet score no longer met caseness, and the primary nomothetic hypersexuality outcome measure met recovery criteria. Reduced pornography consumption was mediated by reduced obsessionality and greater interpersonal connectivity. The utility of the CAT model for intimacy problems shows promise. Directions for future HD outcome research are also provided.

Is High Sexual Desire a Facet of Male Hypersexuality? Results from an Online Study

Despite a growing number of studies, hypersexuality remains controversial and empirically elusive. Using a group comparison approach, this study revisited the claim that hypersexuality cannot be reliably distinguished from high sexual desire. An online survey, advertised as focusing on pornography use and sexual health, was carried out in 2014 among 1,998 Croatian men aged 18 to 60 years (M_age = 34.7, SD = 9.83). Membership in the hypersexuality group (HYP; n = 57) was determined using the Hypersexual Disorder Screening Inventory and the Hypersexual Behavior Consequences Scale. The highest values on two indicators of sexual desire/interest set membership in the high sexual desire group (HSD; n = 70). The overlap between the groups was negligible (n = 4). Compared to the rest of the sample, men in the HYP group had significantly higher odds of being single, not exclusively heterosexual, religious, depressed, prone to sexual boredom, experiencing substance abuse consequences, holding negative attitudes toward pornography use, and evaluating one's sexual morality more negatively. In contrast, the HSD group differed from controls only in reporting more positive attitudes toward pornography use. The study findings point to a distinct phenomenology of HSD and HYP in men. Clinical implications of the findings are briefly discussed.

Meditation Awareness Training for the Treatment of Sex Addiction: A Case Study

Background Sex addiction is a disorder that can have serious adverse functional consequences. Treatment effectiveness research for sex addiction is currently underdeveloped, and interventions are generally based on the guidelines for treating other behavioral (as well as chemical) addictions. Consequently, there is a need to clinically evaluate tailored treatments that target the specific symptoms of sex addiction. It has been proposed that second-generation mindfulness-based interventions (SG-MBIs) may be an appropriate treatment for sex addiction because in addition to helping individuals increase perceptual distance from craving for desired objects and experiences, some SG-MBIs specifically contain meditations intended to undermine attachment to sex and/or the human body. The current study conducts the first clinical investigation into the utility of mindfulness for treating sex addiction. Case presentation An in-depth clinical case study was conducted involving an adult male suffering from sex addiction that underwent treatment utilizing an SG-MBI known as Meditation Awareness Training (MAT). Following completion of MAT, the participant demonstrated clinically significant improvements in addictive sexual behavior, as well as reductions in depression and psychological distress. The MAT intervention also led to improvements in sleep quality, job satisfaction, and non-attachment to self and experiences. Salutary outcomes were maintained at 6-month follow-up. Discussion and conclusion The current study extends the literature exploring the applications of mindfulness for treating behavioral addiction, and findings indicate that further clinical investigation into the role of mindfulness for treating sex addiction is warranted.

Opioid antagonists in broadly defined behavioral addictions: a narrative review

INTRODUCTION

Naltrexone (NTX), a mu-opioid receptor antagonist, has been approved for the treatment of alcoholism and opioid dependence. More recently, however, NTX and a related drug, nalmefene (NMF), have also shown positive results for the treatment of gambling disorders.

AREAS COVERED

In this study, we reviewed the trials testing the effect of opioid antagonists (OA) in gambling disorders and in other broadly defined behavioral addictions, including selected DSM-5 disruptive, impulse-control, and conduct disorders, obsessive-compulsive and related disorders, eating disorders, and other conditions not currently recognized by official classification schemes. We found six randomized controlled trials (RCTs) of OA in gambling disorder, two RCTs of OA in trichotillomania (hair pulling disorder), two RCTs of OA in binge eating disorder, and one RCT of OA for kleptomania. We also reviewed case reports on hypersexual disorder, compulsive buying and skin picking disorders.

EXPERT OPINION

The reviewed data supported the use of OA, namely NTX and NMF, in gambling disorder (both) and kleptomania (NTX). We did not find enough evidence to support the use of NTX or NMF in trichotillomania (hair pulling disorder), excoriation (skin-picking) disorder, compulsive buying disorder, hypersexual disorder, or binge eating disorder.

Implicit associations in cybersex addiction: Adaption of an Implicit Association Test with pornographic pictures

Recent studies show similarities between cybersex addiction and substance dependencies and argue to classify cybersex addiction as a behavioral addiction. In substance dependency, implicit associations are known to play a crucial role, and such implicit associations have not been studied in cybersex addiction, so far. In this experimental study, 128 heterosexual male participants completed an Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998) modified with pornographic pictures. Further, problematic sexual behavior, sensitivity towards sexual excitation, tendencies towards cybersex addiction, and subjective craving due to watching pornographic pictures were assessed. Results show positive relationships between implicit associations of pornographic pictures with positive emotions and tendencies towards cybersex addiction, problematic sexual behavior, sensitivity towards sexual excitation as well as subjective craving. Moreover, a moderated regression analysis revealed that individuals who reported high subjective craving and showed positive implicit associations of pornographic pictures with positive emotions, particularly tended towards cybersex addiction. The findings suggest a potential role of positive implicit associations with pornographic pictures in the development and maintenance of cybersex addiction. Moreover, the results of the current study are comparable to findings from substance dependency research and emphasize analogies between cybersex addiction and substance dependencies or other behavioral addictions.

Syndemic production and sexual compulsivity/hypersexuality in highly sexually active gay and bisexual men: further evidence for a three group conceptualization

Among gay and bisexual men (GBM), a syndemic describes a situation in which negative conditions (e.g., childhood sexual abuse, intimate partner violence, depression, polysubstance use) co-occur such to amplify HIV risk. Research has suggested that sexual compulsivity (SC) may also be a syndemic condition. Between 2011 and 2013, 368 highly sexually active (9+ male partners in 90 days) GBM completed a survey of syndemic factors as well as measures of sexual compulsivity (Sexual Compulsivity Scale [SCS]) and hypersexuality (hypersexual disorder screening inventory [HDSI]). Based on scores on the SCS and HDSI, participants were organized into three groups-negative on both ("Neither SC nor HD"); positive on the SCS only ("SC Only"), and positive on both the SCS and the HDSI ("Both SC and HD"). We found support for the utility of a three-group classification of sexual compulsivity/hypersexuality as one of the syndemic factors that contribute to HIV risk. The average number of syndemic factors experienced was lowest among those who experienced Neither SC nor HD and highest among the group that experienced Both SC and HD, with those experiencing SC Only falling between the two other groups. This study provided further evidence that sexual compulsivity/hypersexuality is a contributing factor to the syndemics model of HIV risk for GBM and that considering three levels of severity (i.e., SC along with HD) led to stronger model predictions than considering SC alone. SC/HD severity provides another modifiable target for HIV prevention intervention development.

Examining the psychometric properties of the Yale-Brown Obsessive-Compulsive Scale in a sample of compulsive pornography users

OBJECTIVE

The current study evaluated several psychometric properties of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) (Goodman et al., 1989) adapted for compulsive sexual behavior (CSB) in a sample of 103 men seeking treatment at a private and a public university clinic in the United States.

METHOD

Measures of mental health functioning were collected from patients on two separate appointments: the initial screening and the follow-up appointment.

RESULTS

All patients reported using pornography compulsively, and approximately half of the sample also reported a history of having frequent anonymous sex with strangers. Results found that the adapted Y-BOCS had good internal consistency reliability, moderate mean inter-item correlations, and good test-retest reliability. Results from a multiple regression analysis also found that affect dysregulation (depression and anxiety), particularly among single, impaired men, was significantly associated with more severe sexual obsessive and compulsive features. Approximately 94% of the sample met criteria for at least one psychiatric disorder, and 57% of men met criteria for two or more psychiatric disorders.

CONCLUSIONS

Findings from the current study suggest the CSB-Y-BOCS is a reliable measure of obsessive and compulsive symptoms associated with CSB, and clinicians and researchers could use this scale to aid in the assessment and treatment of problematic sexual behaviors.

Risk factors of Internet addiction and the health effect of internet addiction on adolescents: a systematic review of longitudinal and prospective studies

Internet gaming addiction was included in the latest version of the DSM-V as a possible disorder recently, while debate is still on-going as to whether the condition called "Internet Addiction" (IA) could be fully recognised as an established disorder. The major contention is how well IA could fulfil the validation criteria as a psychiatric disorder as in other well-established behavioural addictions. In addition to various proposed validation criteria, evidence of risk and protective factors as well as development of outcomes from longitudinal and prospective studies are suggested as important. A systematic review of available longitudinal and prospective studies was conducted to gather epidemiological evidence on risk and protective factors of IA and the health effect of IA on adolescents. Nine articles were identified after an extensive search of the literature in accordance to the PRISMA guidelines. Of these, eight provided data on risk or protective factors of IA and one focused solely on the effects of IA on mental health. Information was extracted and analysed systematically from each study and tabulated. Many exposure variables were studied and could be broadly classified into three main categories: psychopathologies of the participants, family and parenting factors, and others such as Internet usage, motivation, and academic performance. Some were found to be potential risk or protective factors of IA. It was also found that exposure to IA had a detrimental effect on the mental health of young people. These results were discussed in light of their implications to the fulfilment of the validation criteria.