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Briken P, Bőthe B, Carvalho J, Coleman E, Giraldi A, Kraus SW, Lew-Starowicz M, Pfaus JG. Assessment and treatment of compulsive sexual behavior disorder: a sexual medicine perspective. Sex Med Rev 2024; 12:355-370. [PMID: 38529667 DOI: 10.1093/sxmrev/qeae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 03/27/2024]
Abstract
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.
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Affiliation(s)
- Peer Briken
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center, Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Beáta Bőthe
- Department of Psychology, Université de Montréal, Montréal, QC H3C 3J7, Canada
- Centre de Recherche Interdisciplinaire Sur Les Problèmes Conjugaux Et Les Agressions Sexuelles, Montréal, QC H3C 3J7, Canada
| | - Joana Carvalho
- William James Center for Research, Department of Education and Psychology, University of Aveiro, Aveiro 3810-193, Portugal
| | - Eli Coleman
- Eli Coleman Institute for Sexual and Gender Health, University of Minnesota, Minneapolis, MN 55454, United States
| | - Annamaria Giraldi
- Sexological Clinic, Mental Health Center, Copenhagen University Hospital, Mental Health Services, Copenhagen CPH 2200, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Shane W Kraus
- Department of Psychology, University of Nevada Las Vegas, Las Vegas, NV 5030, United States
| | - Michał Lew-Starowicz
- Department of Psychiatry, Centre of Postgraduate Medical Education, Warsaw 01-809, Poland
| | - James G Pfaus
- Center for Sexual Health and Intervention, Czech National Institute of Mental Health, Klecany 25067, Czech Republic
- Department of Psychology and Life Sciences, Faculty of Humanities, Charles University, Prague 18200, Czech Republic
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Schippers EE, Smid W, Hoogsteder L, de Vogel V. Factor Analysis With Unusual Sexual Interests: A Replication Study in a Representative Population Sample. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2024; 36:464-485. [PMID: 37729612 DOI: 10.1177/10790632231200841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
A previous study found a variety of unusual sexual interests to cluster in a five-factor structure, namely submission/masochism, forbidden sexual activities, dominance/sadism, mysophilia, and fetishism (Schippers et al., 2021). The current study was an empirical replication to examine whether these findings generalized to a representative population sample. An online, anonymous sample (N = 256) representative of the Dutch adult male population rated 32 unusual sexual interests on a scale from 1 (very unappealing) to 7 (very appealing). An exploratory factor analysis assessed whether similar factors would emerge as in the original study. A subsequent confirmatory factor analysis served to confirm the factor structure. Four slightly different factors of sexual interest were found: extreme, illegal and mysophilic sexual activities; light BDSM without real pain or suffering; heavy BDSM that may include pain or suffering; and illegal but lower-sentenced and fetishistic sexual activities. The model fit was acceptable. The representative replication sample was more sexually conservative and showed less sexual engagement than the original convenience sample. On a fundamental level, sexual interest in light BDSM activities and extreme, forbidden, and mysophilic activities seem to be relatively separate constructs.
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Affiliation(s)
- Eveline E Schippers
- Forensic Care Specialists, Utrecht, Netherlands
- Faculty of Psychology and Neuroscience, section Forensic Psychology, Maastricht University, Maastricht, Netherlands
| | - Wineke Smid
- Forensic Care Specialists, Utrecht, Netherlands
| | - Larissa Hoogsteder
- Forensic Care Specialists, Utrecht, Netherlands
- Faculty of Social and Behavioral Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Vivienne de Vogel
- Forensic Care Specialists, Utrecht, Netherlands
- Faculty of Psychology and Neuroscience, section Forensic Psychology, Maastricht University, Maastricht, Netherlands
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Brown A, Barker ED, Rahman Q. Psychological and Developmental Correlates of Paraphilic and Normophilic Sexual Interests. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2023; 35:428-464. [PMID: 36063449 DOI: 10.1177/10790632221120013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The classification of sexual fantasies and behaviors (here referred to as 'sexual interests') has historically been divided into 'paraphilic' and 'normophilic'. However, studies on paraphilic interests are often limited to clinical or forensic samples and normophilic interests are rarely assessed in tandem. Previous research has found mixed results for psychological and other correlates of sexual interests, potentially due to inconsistency in operationalism and measurement of fantasies and behaviors. The aim of the current study was to quantify correlates of sexual interests via the Sexual Fantasies and Behaviors Inventory, containing factors related to general fantasies/behaviors, normophilia, power dynamics, sadomasochism, and courtship paraphilias, using a large (N = 4280) non-clinical sample. Psychological, developmental, sexual, and demographic correlates were investigated via bivariate correlations, mean difference testing, and multiple regression. Sexual interest domains were largely unrelated to psychopathology and developmental factors. Sociosexuality and more accepting attitudes towards sadomasochism was generally related to more arousal to/engagement in normophilic and paraphilic domains. More autism spectrum disorder traits were related to decreased normophilic interests. Psychopathic traits, sexual sensation seeking, and sexual compulsivity were related to paraphilia dimensions, especially courtship paraphilias and domination/sadism; the former was also associated with negative attitudes about establishing consent. Men, non-monogamous, and non-heterosexual participants indicated greater sexual fantasies and behaviors compared to women (except in the case of submission and masochism), monogamous, and heterosexual participants, respectively.
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Affiliation(s)
- Ashley Brown
- Psychology Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Edward D Barker
- Psychology Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Qazi Rahman
- Psychology Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
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Marchetti I. The Structure of Compulsive Sexual Behavior: A Network Analysis Study. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1271-1284. [PMID: 36735169 PMCID: PMC10102046 DOI: 10.1007/s10508-023-02549-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 05/11/2023]
Abstract
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.
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Affiliation(s)
- Igor Marchetti
- Department of Life Sciences, Psychology Unit, University of Trieste, 34128, Trieste, Italy.
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Castro-Calvo J, Giménez-García C, García-Barba M, Gil-Llario MD, Ballester-Arnal R. Atypical Sexual Interests in Compulsive Sexual Behavior: Results From a Phallometric Study. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2023; 35:164-187. [PMID: 35482997 DOI: 10.1177/10790632221098358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The link between Compulsive Sexual Behavior (CSB) and atypical sexual interests is elusive. This study aimed to provide preliminary insights into the relationship between both aspects. The study sample comprised 61 self-identified straight men. CSB was measured through a composite self-report index assessing symptoms of CSB, whereas sexual interests -atypical and normophilic- were assessed objectively through penile plethysmography. The CSB index had small, non-significant correlation with greater sexual response to different sexual stimuli (rgeneral sexual responsiveness=.127 [95% CI: -.137, .384]). In terms of overall sexual interest, increased scores on the CSB index had small, non-significant correlation with a higher preference for younger sexual stimuli (r = -.098 [95% CI: -.499, .215]) and persuasive sex (r = .10 [95% CI: -.168, .316]). Finally, CSB had a moderate correlation with sexual response when presented with stimuli depicting "female toddler coercive" (r = .27 [95% CI: -.083, .544]). We conclude that our findings do not support the hypotheses that CSB is significantly related to an increased arousability across sexual stimuli. The study findings also suggest that CSB may be, to a small degree, predisposed to experience sexual attraction toward children. Given the preliminary nature of the study, these conclusions warrant further research. Alternative explanations for the study findings related to the particular components of CSB that may be related to typical and atypical sexual interests are also considered.
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Affiliation(s)
- Jesús Castro-Calvo
- Dpto. Personalidad, Evaluación y Tratamientos Psicológicos, 16781Universitat de València, Estudi General, Spain
| | - Cristina Giménez-García
- Dpto. Psicología Básica, Clínica y Psicobiología, 16748Universitat Jaume I, Castellón, Spain
| | - Marta García-Barba
- Dpto. Psicología Básica, Clínica y Psicobiología, 16748Universitat Jaume I, Castellón, Spain
| | - María Dolores Gil-Llario
- Dpto. Psicología Evolutiva y de la Educación, 16781Universitat de València. Estudi General, Spain
| | - Rafael Ballester-Arnal
- Dpto. Psicología Básica, Clínica y Psicobiología, 16748Universitat Jaume I, Castellón, Spain
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Glica A, Wizła M, Gola M, Lewczuk K. Hypo- or hyperfunction? Differential relationships between compulsive sexual behavior disorder facets and sexual health. J Sex Med 2023; 20:332-345. [PMID: 36763943 DOI: 10.1093/jsxmed/qdac035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/24/2022] [Accepted: 11/10/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous studies linking compulsive sexual behavior disorder (CSBD) and sexual health have shown mixed results, which could be due to the fact that different CSBD facets may have differential relationships with sexual functioning. AIM As CSBD is a multidimensional disorder, we wanted to investigate whether distinct CSBD domains are differentially related to sexual health. METHODS Two online studies were conducted-the first on a convenience sample (812 Polish participants; mean [SD] age, 22.07 [5.91] years) and a replication study on a representative sample of Polish adults (n = 1526; 43.02 [14.37]). Hierarchical regression was employed with sexual functioning as a predicted variable and CSBD symptoms as predictors. OUTCOMES The Compulsive Sexual Behavior Disorder Scale was used to assess CSBD symptoms, and the Arizona Sexual Experience Scale was used to measure sexual dysfunction. RESULTS In study 1, CSBD salience (β = -.20, P < .001) predicted hyperfunction (ie, stronger sex drive, easier sexual arousal, easier vaginal lubrication/penile erection, easier ability to reach an orgasm, and more satisfying orgasms). Yet, CSBD negative consequences (β = .15, P = .001) and dissatisfaction (β = .22, P < .001) predicted hypofunction (ie, weaker sex drive, more difficulties in sexual arousal, greater difficulties in vaginal lubrication/penile erection, less ability to reach an orgasm, and less satisfying orgasms). Similar results were found in study 2: salience (β = -.26, P < .001) and relapse (β = -.11, P = .004) predicted hyperfunction, while negative consequences (β = .12, P < .001) and dissatisfaction (β = .12, P < .001) predicted hypofunction. CLINICAL IMPLICATIONS Our results stress the importance of assessing the severity of each group of symptoms in patients with CSBD to better understand possible difficulties in their sexual functioning. STRENGTHS AND LIMITATIONS Our studies are the first to evaluate the effects of each CSBD domain on sexual health. We also replicated results obtained from a convenience sample on a representative sample. The cross-sectional design of the current studies does not allow causal relations to be tested, so future longitudinal research should be carried out. We also gathered data from a general population-thus, it is important to replicate these results on patients diagnosed with CSBD. CONCLUSION Our research points out the differential impact of CSBD domains on sexual health: salience and relapse are related to sexual hyperfunction, while negative consequences and dissatisfaction to hypofunction.
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Affiliation(s)
- Agnieszka Glica
- Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland.,Laboratory of Language Neurobiology, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Magdalena Wizła
- Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland
| | - Mateusz Gola
- Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California, San Diego, CA, United States.,Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Karol Lewczuk
- Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland
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Turner D, Briken P, Grubbs J, Malandain L, Mestre-Bach G, Potenza MN, Thibaut F. The World Federation of Societies of Biological Psychiatry guidelines on the assessment and pharmacological treatment of compulsive sexual behaviour disorder. DIALOGUES IN CLINICAL NEUROSCIENCE 2022; 24:10-69. [PMID: 37522807 PMCID: PMC10408697 DOI: 10.1080/19585969.2022.2134739] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/18/2022] [Accepted: 10/03/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The current guidelines aim to evaluate the role of pharmacological agents in the treatment of patients with compulsive sexual behaviour disorder (CSBD). They are intended for use in clinical practice by clinicians who treat patients with CSBD. METHODS An extensive literature search was conducted using the English-language-literature indexed on PubMed and Google Scholar without time limit, supplemented by other sources, including published reviews. RESULTS Each treatment recommendation was evaluated with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. Psychoeducation and psychotherapy are first-choice treatments and should always be conducted. The type of medication recommended depended mainly on the intensity of CSBD and comorbid sexual and psychiatric disorders. There are few randomised controlled trials. Although no medications carry formal indications for CSBD, selective-serotonin-reuptake-inhibitors and naltrexone currently constitute the most relevant pharmacological treatments for the treatment of CSBD. In cases of CSBD with comorbid paraphilic disorders, hormonal agents may be indicated, and one should refer to previously published guidelines on the treatment of adults with paraphilic disorders. Specific recommendations are also proposed in case of chemsex behaviour associated with CSBD. CONCLUSIONS An algorithm is proposed with different levels of treatment for different categories of patients with CSBD.
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Affiliation(s)
- Daniel Turner
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joshua Grubbs
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
| | - Leo Malandain
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin (site Tarnier) AP-HP, Paris, France
| | - Gemma Mestre-Bach
- Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, La Rioja, Spain
| | - Marc N. Potenza
- Departments of Psychiatry and Neuroscience and Child Study Center, Yale School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Florence Thibaut
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin (site Tarnier) AP-HP, Paris, France
- INSERM U1266, Institute of Psychiatry and Neurosciences, University of Paris Cité, Paris, France
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Savard J, Görts Öberg K, Dhejne C, Jokinen J. A randomised controlled trial of fluoxetine versus naltrexone in compulsive sexual behaviour disorder: presentation of the study protocol. BMJ Open 2022; 12:e051756. [PMID: 36691245 PMCID: PMC9171192 DOI: 10.1136/bmjopen-2021-051756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/19/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Compulsive sexual behaviour disorder is a new disorder in the International Classification of Diseases (ICD-11), and is associated with negative consequences in different areas of life. Evidence for pharmacological treatment of compulsive sexual behaviour disorder is weak and treatment options are limited. This proposed study will be the largest and the first randomised controlled trial comparing the efficacy and tolerability of two active drugs in compulsive sexual behaviour disorder. METHODS AND ANALYSIS Eighty adult participants with compulsive sexual behaviour disorder according to ICD-11 will be randomised to receive either naltrexone 25-50 mg or fluoxetine 20-40 mg for 8 weeks, followed by 6 weeks without treatment. The study will be conducted in a subspecialised outpatient sexual medicine unit at Karolinska University Hospital, Stockholm, Sweden. The study is financed by grants and entirely independent of the manufacturers.Exclusion criteria include severe psychiatric or psychical illness, changes to concurrent medication and non-compatible factors contraindicating the use of either drug. The primary outcome measure is the Hypersexual Disorder: Current Assessment Scale (HD: CAS), and tolerability will be assessed by the Udvalg for Kliniske Undersogelser side effect rating scale (UKU), drug accountability, adherence to treatment and drop-out rate. Participants will complete questionnaires at regular intervals, with the main endpoint for efficacy after 8 weeks (end of treatment) and after 14 weeks (follow-up). Blood chemistry will be repeatedly collected as a safety precaution and for research purposes. The results will be analysed using an appropriate analysis of variance model or a mixed model, depending on the distribution of HD: CAS and the extent of missing data. ETHICS AND DISSEMINATION The Swedish Ethical Review Authority and the Swedish Medical Products Agency have approved the study on 27 May 2020 and 4 June 2020, respectively (ref. no. 2020-02069 and ref. no. 5.1-2020-48282). Findings will be published in peer-reviewed journals and presented at relevant conferences. TRIAL REGISTRATION NUMBER 2019-004255-36.
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Affiliation(s)
- Josephine Savard
- Department of Clinical Sciences/Psychiatry, Umea University, Umea, Sweden
- ANOVA clinic, Karolinska University Hospital, Stockholm, Sweden
| | - Katarina Görts Öberg
- ANOVA clinic, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Dhejne
- ANOVA clinic, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jussi Jokinen
- Department of Clinical Sciences/Psychiatry, Umea University, Umea, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Peters JR, Pullman LE, Kingston DA, Lalumière ML. Orgasm Frequency (Total Sexual Outlet) in a National American Sample. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1447-1460. [PMID: 35165803 DOI: 10.1007/s10508-021-02241-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 06/14/2023]
Abstract
There has been renewed interest in the conceptualization and diagnosis of conditions marked by excessive sexuality. Researchers and clinicians have often utilized orgasm frequency (e.g., total sexual outlet) as an indicator of hypersexuality. Indeed, some have proposed seven or more (7+) orgasms by any means in a typical week as indicating hypersexuality. Most studies utilizing this criterion, however, have examined clinical or judicial samples of men, as opposed to general population samples. The purpose of the current study was to provide representative population data of total sexual outlet (TSO) for people varying in age, relationship status, and sex, while also examining the impact of the phrasing of the questions (i.e., time frame). A total of 1029 participants were recruited online via a Qualtrics panel, consisting of 442 males and 587 females, from diverse regions across the USA. Results indicated that between 10.3 and 16.7% of the sample met the 7+ criterion for hypersexuality, with considerable variation by age, relationship status, sex, and less variation by wording of the question. Results are discussed in terms of the applicability of the 7+ cut-off for identifying elevated TSO. Results from this survey could be useful to researchers and clinicians looking for comparison data for their research and clinical assessment results.
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Affiliation(s)
- Joshua R Peters
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Lesleigh E Pullman
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON, K1N 6N5, Canada
| | - Drew A Kingston
- HOPE Program, San Diego, CA, USA
- Institute of Mental Health Research, Royal Ottawa Health Care Group, Ottawa, ON, Canada
- Department of Psychiatry, McMaster University, Hamilton, ON, Canada
| | - Martin L Lalumière
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON, K1N 6N5, Canada.
- Institute of Mental Health Research, Royal Ottawa Health Care Group, Ottawa, ON, Canada.
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Ronis ST, Knight RA, Vander Molen L. The Covariation of Sexual Fantasies and Behaviors Among Self-Identified Sexually Aggressive Criminal and Noncriminal Samples. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2022; 66:517-537. [PMID: 31884839 DOI: 10.1177/0306624x19895905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study examined the association of sexually appetitive fantasies and sexually coercive behaviors among adult men convicted of nonsexual crimes (n = 159) and adult men with no criminal histories (n = 219). Individuals completed the Multidimensional Assessment of Sex and Aggression (MASA) and, on the basis of these reports, were classified whether or not they had ever attempted to assault or coerce someone sexually. Consistent with fewer opportunities to engage in sexual behavior, individuals with criminal histories reported generally less preoccupation, compulsivity, and frequency than did noncriminal individuals. Regardless of criminal history, self-identified sexually coercive men reported significantly more sexually appetitive fantasy and behavior in general and sexually deviant behavior in particular than did noncoercive males. Implications of these findings for research, theory, and dispositional decisions are discussed.
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Mascherek A, Reidick MC, Gallinat J, Kühn S. Is Ejaculation Frequency in Men Related to General and Mental Health? Looking Back and Looking Forward. Front Psychol 2021; 12:693121. [PMID: 34434144 PMCID: PMC8382266 DOI: 10.3389/fpsyg.2021.693121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Despite its relevance for human sexuality, literature on potential effects of ejaculation frequency and masturbation on general and mental health outcomes is sparse. Reasons for this knowledge gap include a general lack of interest, but also methodological challenges and still existing superstition. This paper reconciles literature from various fields to extract relevant information on how ejaculation frequency effects general and mental health outcomes. Culture-bound syndromes have been reported in countries still strictly tabooing or condemning masturbation. Masturbatory guilt describes a phenomenon in individuals experiencing a discrepancy between moral standards and own behavior with respect to masturbation. Abstinence is one aspect under study in the area of fertility treatment. Specific time frames and their respective implications on quality of sperm remain inconclusive. Limited temporal resolution capacities hamper the precise study of brain structures directly activated during ejaculation. The relation between ejaculation frequency and hormonal influences remains poorly understood. Future research that specifically addresses ejaculation frequency and potential mental and general health outcomes is needed. In contrast to extracting knowledge as a byproduct from other studies with a different focus, this enables sound study designs and could provide evidence-based results which could then be further discussed and interpreted.
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Affiliation(s)
- Anna Mascherek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mirjam Christina Reidick
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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12
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Schippers EE, Smid WJ, Huckelba AL, Hoogsteder LM, Beekman ATF, Smit JH. Exploratory Factor Analysis of Unusual Sexual Interests. J Sex Med 2021; 18:1615-1631. [PMID: 37057429 DOI: 10.1016/j.jsxm.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/23/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Unusual sexual interests are largely intercorrelated, yet not much is known about underlying patterns of clusters between various sexual interests. AIM To identify underlying clusters of unusual sexual interests using exploratory factor analysis. METHODS We conducted exploratory factor analysis with self-reported interest in a wide variety of unusual sexual acts for an online, international sample (N = 669; 61% female), and for women and men separately. Factor regression weights were correlated to self-reported sex life satisfaction, sexual outlet, and psychiatric symptoms. OUTCOMES Participants rated the attractiveness of 50 unusual sexual activities, and reported on their sex life satisfaction (Arizona Sexual Experiences Scale), sexual outlet, and symptoms regarding ADHD (Adult ADHD Self-Report Screening Scale for DSM-5), depression, anxiety, and stress (Depression, Anxiety, and Stress Scale). RESULTS We identified 5 factors of unusual sexual interests that were largely comparable for women and men: submission/masochism, forbidden sexual activities, dominance/sadism, mysophilia (attraction to dirtiness or soiled things), and fetishism. For women, unusual sexual interests related to more psychiatric symptoms and higher sexual outlet, whereas this relation was less explicit for men. CLINICAL IMPLICATIONS Different factors of unusual sexual interests may serve different underlying functions or motivations, for instance related to sexual, and emotional regulation. A better understanding of the nature of unusual sexual interests is important to be able to influence sexual interests that are unwanted or cause damage to others. STRENGTHS & LIMITATIONS Strength of this study include its anonymity, the avoidance of sexual orientation effects, and the possibility to indicate only a slight endorsement toward sexual items. Limitations include the sample's generalizability and the truthfulness of online responding. CONCLUSION Unusual sexual interests could be clustered into 5 factors that were largely comparable for women and men: submission/masochism, forbidden sexual activities, dominance/sadism, mysophilia, and fetishism. Schippers EE, Smid WJ, Huckelba AL, et al. Exploratory Factor Analysis of Unusual Sexual Interests. J Sex Med 2021;18:1615-1631.
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Affiliation(s)
- Eveline E Schippers
- Forensic Care Specialists, Utrecht, the Netherlands; Department of Psychiatry, and GGZ inGeest, Amsterdam University Medical Centers, Free University Amsterdam, Amsterdam, the Netherlands.
| | | | - Anna Laura Huckelba
- Department of Experimental and Applied Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Aartjan T F Beekman
- Department of Psychiatry, and GGZ inGeest, Amsterdam University Medical Centers, Free University Amsterdam, Amsterdam, the Netherlands
| | - Jan H Smit
- Department of Psychiatry, and GGZ inGeest, Amsterdam University Medical Centers, Free University Amsterdam, Amsterdam, the Netherlands
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Elbert MJ, Drury AJ, DeLisi M. Child pornography possession/receipt offenders: developing a forensic profile. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2021; 29:93-106. [PMID: 35693384 PMCID: PMC9186365 DOI: 10.1080/13218719.2021.1904447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Child pornography possession/receipt offenders are a controversial offender group due to mixed and occasionally divergent evidence about their risk profile, offending history and psychopathology. Using a population of male offenders who ever perpetrated a sexual offense from a federal jurisdiction in the central United States, the current study developed an exploratory post hoc empirical profile of these offenders. The profile has some success in the validation component of our study and showed significant associations with self-reported sexual abuse of child victims ages 3-12 years, but non-significant associations to adolescent and adult victims. It significantly linked to the conceptually expected victim group and the significant statistical effect withstood controls for generally robust indicators of antisocial conduct including antisocial personality disorder, arrest onset, total adverse childhood experiences, age and race. We view the findings as exploratory and encourage additional empirical study of this important offender group.
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Affiliation(s)
- Michael J. Elbert
- United States Probation, Southern District of Iowa, Des Moines, IA, USA
| | - Alan J. Drury
- United States Probation, Southern District of Iowa, Des Moines, IA, USA
| | - Matt DeLisi
- Department of Sociology and Criminal Justice, Iowa State University, Ames, IA, USA
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14
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Chan HC(O. Risky Sexual Behavior of Young Adults in Hong Kong: An Exploratory Study of Psychosocial Risk Factors. Front Psychol 2021; 12:658179. [PMID: 33828516 PMCID: PMC8019819 DOI: 10.3389/fpsyg.2021.658179] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/19/2021] [Indexed: 11/13/2022] Open
Abstract
There is limited knowledge of the prevalence and nature of risky sexual behavior (RSB) among young adults in Hong Kong. This cross-sectional study explored the psychosocial risk factors of RSB with a sample of 1,171 Hong Kong university students (aged 18-40 years). Grounded in the theoretical propositions of several criminological theories (i.e., the theories of self-control, general strain, social learning, social control, and routine activity), engagement in three types of RSB (i.e., general, penetrative, and non-penetrative) was studied alongside a range of psychosocial risk factors. Relative to female participants, male participants reported significantly higher mean levels of general, penetrative, and non-penetrative RSB. Male participants also reported significantly higher mean levels of negative temperament, use of alcohol and other drugs, and paraphilic interests than female participants, who reported significantly higher mean levels of self-control and social bonds than their male counterparts. The results of multivariate analyses (i.e., OLS regressions) revealed that, to a large extent, the male and female participants shared a similar set of psychosocial risk factors (i.e., use of alcohol and other drugs, and paraphilic interest) for their involvement in general, penetrative, and non-penetrative RSB. Furthermore, a high level of negative temperament was significantly associated with penetrative RSB for both genders, while a high level of perceived neighborhood disorganization was found to be an important factor in the participation of females in general, penetrative, and non-penetrative RSB. The findings of this study may have important implications for practice in regard to reducing, if not entirely preventing, the tendency to engage in RSB.
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Affiliation(s)
- Heng Choon (Oliver) Chan
- Teaching Laboratory for Forensics and Criminology, Department of Social and Behavioral Sciences, City University of Hong Kong, Hong Kong, China
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15
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Abstract
Subjects with ADHD suffer from inattention, hyperactivity, and impulsivity. Clinicians often assume that specific symptoms of ADHD are bound to affect sexual desire by increasing the frequency of hypersexuality. There is a lack of knowledge about the comorbidity between ADHD, hypersexuality, and paraphilias. The aim of this article was to provide a review of the literature on the association of ADHD and hypersexuality and paraphilias and to discuss the screening and the management of these syndromes when associated with ADHD. A systematic review of the literature was performed in PubMed, PsychInfo, and Embase databases. The studies reviewed show that some individuals who suffer from ADHD report hypersexuality and paraphilias, but no clear data emerged supporting the idea that hypersexuality and paraphilias are more frequent in an ADHD population. On the other hand, some studies showed a high prevalence of ADHD in hypersexual and paraphilic subjects. This is the first systematic review of hypersexuality and paraphilias in individuals with ADHD. However, the results are limited by differences in the methodology and measurement instruments for hypersexuality and paraphilias as well as by the small number of studies and the small sample sizes of many studies.
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16
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Sexual addiction 25 years on: A systematic and methodological review of empirical literature and an agenda for future research. Clin Psychol Rev 2020; 82:101925. [PMID: 33038740 DOI: 10.1016/j.cpr.2020.101925] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 12/16/2022]
Abstract
In 1998, Gold and Heffner authored a landmark review in Clinical Psychology Review on the topic of sexual addiction that concluded that sexual addiction, though increasingly popular in mental health settings, was largely based on speculation, with virtually no empirical basis. In the more than two decades since that review, empirical research around compulsive sexual behaviors (which subsumes prior research about sexual addiction) has flourished, ultimately culminating in the inclusion of a novel diagnosis of Compulsive Sexual Behavior Disorder in the eleventh edition of the World Health Organization's International Classification of Diseases. The present work details a systematic review of empirical research published between January 1st, 1995 and August 1st, 2020 related to compulsive sexual behaviors, with a specific focus on evaluating the methodologies of that literature. This review yielded 371 papers detailing 415 individual studies. In general, the present review finds that, although research related to compulsive sexual behaviors has proliferated, much of this work is characterized by simplistic methodological designs, a lack of theoretical integration, and an absence of quality measurement. Moreover, the present review finds a virtual absence of high-quality treatment-related research published within this time frame. Implications of these findings for both clinical practice and future research are discussed.
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17
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Thibaut F, Cosyns P, Fedoroff JP, Briken P, Goethals K, Bradford JMW. The World Federation of Societies of Biological Psychiatry (WFSBP) 2020 guidelines for the pharmacological treatment of paraphilic disorders. World J Biol Psychiatry 2020; 21:412-490. [PMID: 32452729 DOI: 10.1080/15622975.2020.1744723] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objectives: The primary aim of these guidelines is to evaluate the role of pharmacological agents in the treatment and management of patients with paraphilic disorders, with a focus on the treatment of adult males. Because such treatments are not delivered in isolation, the role of specific psychotherapeutic interventions is also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients, including sexual offenders, with paraphilic disorders. The aim of these guidelines is to bring together different views on the appropriate treatment of paraphilic disorders from experts representing different countries in order to aid physicians in clinical decisions and to improve the quality of care.Methods: An extensive literature search was conducted using the English-language-literature indexed on MEDLINE/PubMed (1990-2018 for SSRIs) (1969-2018 for hormonal treatments), supplemented by other sources, including published reviews.Results: Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. The type of medication used depends on the severity of the paraphilic disorder and the respective risk of behaviour endangering others. GnRH analogue treatment constitutes the most relevant treatment for patients with severe paraphilic disorders.Conclusions: An algorithm is proposed with different levels of treatment for different categories of paraphilic disorders accompanied by different risk levels.
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Affiliation(s)
- Florence Thibaut
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin, University of Paris, INSERM U1266, Institute of Psychiatry and Neurosciences, Paris, France
| | - Paul Cosyns
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - John Paul Fedoroff
- Division of Forensic Psychiatry, The Royal Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Kris Goethals
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp and University Forensic Centre, Antwerp University Hospital, Antwerp, Belgium
| | - John M W Bradford
- The Royal Institute of Mental Health Research, University of Ottawa, McMaster University, Ottawa & Hamilton, ON, Canada
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18
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Briken P. An integrated model to assess and treat compulsive sexual behaviour disorder. Nat Rev Urol 2020; 17:391-406. [DOI: 10.1038/s41585-020-0343-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2020] [Indexed: 12/12/2022]
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19
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Abstract
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.
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Affiliation(s)
- Leo Malandain
- Department of Adult Psychiatry and Medical Psychology, Saint-Antoine Hospital, Sorbonne Université, AP-HP, Paris, France.
| | - Jean-Victor Blanc
- Department of Adult Psychiatry and Medical Psychology, Saint-Antoine Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Florian Ferreri
- Department of Adult Psychiatry and Medical Psychology, Saint-Antoine Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Florence Thibaut
- University Hospital Cochin (site Tarnier), Paris University, AP-HP, Paris, France
- INSERM U1266, Institute of Psychiatry and Neurosciences, Paris, France
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20
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Kingston DA, Olver ME, Levaque E, Sawatsky ML, Seto MC, Lalumière ML. Establishing Canadian metrics for self-report measures used to assess hypersexuality. CANADIAN JOURNAL OF HUMAN SEXUALITY 2020. [DOI: 10.3138/cjhs.2019-0055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We examined the prevalence of hypersexuality in two combined Canadian adult community samples totalling 1,857 respondents (female n = 960, male n = 835, other n = 60, missing n = 2). Participants were recruited from social media to complete an online sexual behaviour survey that included two measures of compulsive sexual behaviour disorder— the Sexual Compulsivity Scale (SCS) and Hypersexual Behaviour Inventory (HBI)—as well as sexual behaviour and interest items. Respondents also reported their total sexual outlets (TSO)—defined by number of orgasms experienced weekly—as a third potential indicator of hypersexuality. Canadian men and women reported multiple sexual outlets per week that tended to be higher than previous reports. Men tended to report a larger number and higher frequency of various sexual behaviour than women, including higher rates of compulsive sexual behaviour disorder, which varied depending on the measure employed. Implications for establishing sexuality norms and conceptualizing hypersexuality and compulsive sexual behaviour disorder are discussed.
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Affiliation(s)
- Drew A. Kingston
- HOPE program, San Diego, CA
- The Royal’s Institute of Mental Health Research, Ottawa, ON
| | - Mark E. Olver
- Department of Psychology, University of Saskatchewan, Saskatoon, SK
| | - Enya Levaque
- School of Psychology, University of Ottawa, Ottawa, ON
| | | | | | - Martin L. Lalumière
- The Royal’s Institute of Mental Health Research, Ottawa, ON
- School of Psychology, University of Ottawa, Ottawa, ON
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21
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Philippe FL, Vallerand RJ, Beaulieu-Pelletier G, Maliha G, Laventure S, Ricard-St-Aubin JS. Development of a Dualistic Model of Sexual Passion: Investigating Determinants and Consequences. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:2537-2552. [PMID: 31414330 DOI: 10.1007/s10508-019-01524-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 07/18/2019] [Accepted: 07/23/2019] [Indexed: 06/10/2023]
Abstract
In empirical research, sexual passion has frequently been conceptualized as the interdependent dynamics experienced with a partner and as following a unidimensional continuum of intensity. A recent theoretical model conceptualized sexual passion as an intrapersonal motivation, which can energize both partnered and non-partnered sexual behaviors (Philippe, Vallerand, Bernard-Desrosiers, Guilbault, & Rajotte, 2017). This model also departs from the typical unidimensional continuum by positing the existence of two types of sexual passion: harmonious sexual passion (HSP) and obsessive sexual passion (OSP). The purpose of the present research was to extend the development of such a dualistic model by examining key theoretical determinants and consequences of each type of sexual passion. Study 1 provided empirical evidence of discriminant validity for such a model with respect to key-related constructs in the sex literature (e.g., sexual desire, hypersexuality, self-determined motives). The results of Study 2 showed that both types of sexual passion were associated with a high engagement in various sexual activities, but that only HSP combined it with couple adjustment. Finally, Study 3 indicated that both HSP and OSP were associated with common as well as distinct determinants, while being conducive to different personal and interpersonal consequences. Overall, there were very few moderations by biological sex. The results of these three studies provide empirical support for the sexual passion model and pave the way for new research directions.
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Affiliation(s)
- Frederick L Philippe
- Department of Psychology, University of Quebec at Montreal, Montreal, QC, H3C 3P8, Canada.
| | - Robert J Vallerand
- Department of Psychology, University of Quebec at Montreal, Montreal, QC, Canada
| | | | - Gabrielle Maliha
- Department of Psychology, University of Quebec at Montreal, Montreal, QC, Canada
| | - Samuel Laventure
- Department of Psychology, University of Montreal, Montreal, QC, Canada
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22
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Davis KA, Knight RA. The Relation of Childhood Abuse Experiences to Problematic Sexual Behaviors in Male Youths Who Have Sexually Offended. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:2149-2169. [PMID: 30627932 DOI: 10.1007/s10508-018-1279-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 05/22/2018] [Accepted: 07/15/2018] [Indexed: 06/09/2023]
Abstract
Psychological abuse and sexual abuse, either alone or in combination, have been implicated as developmental antecedents of problematic sexual thoughts and behaviors in studies of sexually aggressive males (Jesperson, Lalumière, & Seto, 2009; Knight & Sims-Knight, 2011; Levenson & Grady, 2016; Seto & Lalumière, 2010). Recently, psychological abuse perpetrated by a male caregiver has emerged as strongly associated with subsequent hypersexuality in adult males who had sexually offended. In a study of 529 adult male sexual offenders, Kingston, Graham, and Knight (2017) found that male caregiver psychological abuse was the most prominent correlate of hypersexual thoughts and behaviors in adulthood, above and beyond the effects of other abuse types, such as physical abuse and sexual abuse. Consequently, we hypothesized that, among juveniles who had sexually offended, higher self-reported levels of childhood psychological and sexual abuse, in contrast to other types of childhood maltreatment experiences, would covary with higher subsequent levels of normophilic sexualized thoughts and behaviors. Consistent with Kingston et al., Male Caregiver Psychological Abuse accounted for a significant amount of the variance in subsequent reported hypersexuality in this juvenile sample. Furthermore, this factor also emerged as a significant correlate of deviant sexual behaviors and fantasies, such as paraphilic interests and pedophilic preference. Sexual Abuse was also found to be significantly associated with hypersexuality. These findings provide additional support for the demonstrated relation between psychological abuse by a male caregiver and subsequent problematic sexual thoughts and behaviors. These data are also consistent with other research that suggests a gender symmetry effect in the impact of parental discipline and the differential effect of male caregiver abuse on male children.
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Affiliation(s)
- Kathryn A Davis
- Department of Psychology, MS 062, Brandeis University, Waltham, MA, 02454-9110, USA
| | - Raymond A Knight
- Department of Psychology, MS 062, Brandeis University, Waltham, MA, 02454-9110, USA.
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23
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Cherkasskaya E, Rosario M. The Relational and Bodily Experiences Theory of Sexual Desire in Women. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1659-1681. [PMID: 29926262 DOI: 10.1007/s10508-018-1212-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 03/22/2018] [Accepted: 04/03/2018] [Indexed: 06/08/2023]
Abstract
We review the theory and research on women's sexual desire and present a theory that incorporates internalized representations of relational and bodily experiences into our understanding of the full range of desire in women. To this end, we move away from the current tendency to focus on low sexual desire in women and instead consider desire on a spectrum or continuum from absent or diminished to high desire across multiple sexual orientations, including heterosexual, bisexual, and lesbian. We review definitions of sexual desire, as well as the epidemiology and etiology of hypoactive sexual desire, the most prevalent sexual complaint in women, including the biological, psychological, and relationship correlates of inhibited sexual desire. Subsequently, we examine the research on highly sexual women, who tend to experience high levels of sexual desire, sexual agency, and sexual esteem, and distinguish between high sexual desire and hypersexuality. We introduce two important constructs that are integrated into the Relational and Bodily Experiences Theory (RBET) of sexual desire in women: attachment and sexual body self-representations, suggesting that women's internalized representations of self and other that stem from childhood and their capacity to embody their sexual bodies are integral to our understanding of the phenomenology of sexual desire in women. RBET calls for further research into the links between attachment, sexual body self-representations, and desire, and suggests that clinical interventions for sexual desire difficulties in women should emphasize internalized working models of relationships (i.e., attachment) and integrate bodily based approaches.
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Affiliation(s)
- Eugenia Cherkasskaya
- Counseling and Psychological Services/Columbia Health, Columbia University, Alfred Lerner Hall, 8th Floor, 2920 Broadway, Mail Code 2606, New York, NY, 10027, USA.
| | - Margaret Rosario
- Department of Psychology, City University of New York-City College and The Graduate Center, New York, NY, USA
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24
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Wurtele SK, Simons DA, Parker LJ. Understanding Men's Self-Reported Sexual Interest in Children. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:2255-2264. [PMID: 29667036 DOI: 10.1007/s10508-018-1173-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 12/13/2017] [Accepted: 02/05/2018] [Indexed: 06/08/2023]
Abstract
A few studies have found that even in the general population, a minority of adults-men as well as women-report some sexual interest in a young age group. The purpose of the present study was to identify factors associated with self-reported sexual interest in children among a community-based sample of men. Using an online survey methodology, we examined the extent to which different types of childhood adversities (witnessing parental violence, sexual, physical, and emotional abuse), atypical childhood sexual experiences, and participants' self-reported likelihood of engaging in a variety of sexual behaviors (heightened sexual interest) were related to sexual interest in children (SIC) reported by a non-forensic/non-clinical sample of 173 men. Data were analyzed using hierarchical multiple regression. After controlling for physical and emotional abuse and witnessing parental violence, self-reported experiences of childhood sexual abuse (CSA) significantly increased the amount of variance explained in SIC scores. However, only early masturbation and current heightened sexual interests contributed significantly to the final model. Total variance explained by the model as a whole was 24% (adjusted R2 = 20%). Early masturbation and heightened sexual interests significantly mediated the relationship between CSA and SIC scores. Findings add to the small but growing body of literature examining the etiology of pedophilic sexual interests in non-clinical samples.
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Affiliation(s)
- Sandy K Wurtele
- Department of Psychology, University of Colorado, Colorado Springs, Colorado Springs, CO, 80918, USA.
| | - Dominique A Simons
- Office of Behavioral Health, Colorado Department of Human Services, Denver, CO, USA
| | - Leah J Parker
- Department of Psychology, University of Colorado, Colorado Springs, Colorado Springs, CO, 80918, USA
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25
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Castellini G, Rellini AH, Appignanesi C, Pinucci I, Fattorini M, Grano E, Fisher AD, Cassioli E, Lelli L, Maggi M, Ricca V. Deviance or Normalcy? The Relationship Among Paraphilic Thoughts and Behaviors, Hypersexuality, and Psychopathology in a Sample of University Students. J Sex Med 2018; 15:1322-1335. [DOI: 10.1016/j.jsxm.2018.07.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/08/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
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26
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Walton MT, Cantor JM, Bhullar N, Lykins AD. Hypersexuality: A Critical Review and Introduction to the "Sexhavior Cycle". ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:2231-2251. [PMID: 28687897 DOI: 10.1007/s10508-017-0991-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 04/03/2017] [Accepted: 04/12/2017] [Indexed: 05/03/2023]
Abstract
An empirical review of hypersexuality is timely as "compulsive sexual behavior" is being considered as an impulse control disorder for inclusion in the forthcoming International Classification of Diseases, 11th ed. Specifically, hypersexuality has been conceptualized in the literature as the inability to regulate one's sexual behavior that is a source of significant personal distress. Various theoretical models have been posited in an attempt to understand the occurrence of hypersexuality, although disagreement about these divergent conceptualizations of the condition has made assessment and treatment of hypersexual clients more challenging. Theories of sexual compulsivity, sexual impulsivity, dual control (sexual inhibition/excitation), and sex addiction are critically examined, as are the diagnostic criteria for clinically assessing hypersexuality as a sexual disorder. Our discussion of hypersexuality covers a diversity of research and clinical perspectives. We also address various challenges associated with reliably defining, psychometrically measuring, and diagnosing hypersexuality. Furthermore, literature is reviewed that expresses concerns regarding whether hypersexuality (conceptualized as a disorder) exists, whether it is simply normophilic behavior at the extreme end of sexual functioning, or alternatively is a presenting problem that requires treatment rather than a clinical diagnosis. Following our literature review, we developed the "sexhavior cycle of hypersexuality" to potentially explain the neuropsychology and maintenance cycle of hypersexuality. The sexhavior cycle suggests that, for some hypersexual persons, high sexual arousal may temporarily and adversely impact cognitive processing (cognitive abeyance) and explain a repeated pattern of psychological distress when interpreting one's sexual behavior (sexual incongruence). We also suggest that further research is required to validate whether hypersexuality is a behavioral disorder (such as gambling), although some presentations of the condition appear to be symptomatic of a heterogeneous psychological problem that requires treatment.
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Affiliation(s)
- Michael T Walton
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW, 2351, Australia
| | - James M Cantor
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Navjot Bhullar
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW, 2351, Australia
| | - Amy D Lykins
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW, 2351, Australia.
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Bouchard KN, Dawson SJ, Lalumière ML. The effects of sex drive and paraphilic interests on paraphilic behaviours in a nonclinical sample of men and women. CANADIAN JOURNAL OF HUMAN SEXUALITY 2017. [DOI: 10.3138/cjhs.262-a8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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28
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Pornography Addiction in Adults: A Systematic Review of Definitions and Reported Impact. J Sex Med 2017; 13:760-77. [PMID: 27114191 DOI: 10.1016/j.jsxm.2016.03.002] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 02/18/2016] [Accepted: 03/06/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Self-perceived pornography addiction (SPPA) has increasingly emerged as a concept in research and popular culture, and commentators warn of the reported negative impact that it has. Despite this, "pornography or porn addiction" is not a formally recognized disorder and there is disagreement among researchers regarding its definition or even its existence. Therefore, how SPPA is operationalized often varies, and this is likely to influence the conclusions made about the impact of SPPA. AIM This review aimed to examine what the supposed impact of SPPA is, and how the concept is operationalized. METHODS A systematic review of quantitative and qualitative peer-reviewed journal articles was conducted. The following databases were searched up to November 2015: CINAHL (2001-2015), Embase (1974-2015), Medline (1946-2015), PsychARTICLES (1980), and PsychInfo (1806-2015). Terms used were porn*, sexually explicit material, SEM, erotic*, nonparaphilic, cyberpornography, addict*, problematic, excess*, compul*, impul*, impact, effec*, behav*, and cause. An asterisk after a term means that all terms that begin with that root were included in the search. MAIN OUTCOME MEASURES A review of the the current literature pertaining to SPPA and its reported impact. RESULTS We found that SPPA is most frequently operationalized as excessive pornography use and negative consequences. As a result, researchers tended to focus on the frequency of pornography use and related impact as determinants of SPPA. SPPA is reported to affect users and their partners in similar ways, such as increased feelings of isolation and relationship breakdowns. However, we found some methodologic limitations of the primary studies, which limit the strength of the conclusions that can be drawn. Limitations include the lack of representative samples and inadequate measurements of SPPA and its impact. CONCLUSION There still exist a debate regarding the definition and etiology of SPPA as distinct from self-perceived sex addiction. As such, the research landscape is shaped by different theoretical perspectives. Without evidence to suggest one theoretical position as superior to another, clinicians might be at risk of recommending treatment that is in line with their theoretical perspective (or personal biases) but at odds with the motivations driving an individual to engage in particular sexual behaviors. In light of these findings, the review concludes with recommendations for future research.
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Wéry A, Vogelaere K, Challet-Bouju G, Poudat FX, Caillon J, Lever D, Billieux J, Grall-Bronnec M. Characteristics of self-identified sexual addicts in a behavioral addiction outpatient clinic. J Behav Addict 2016; 5:623-630. [PMID: 27774812 PMCID: PMC5370367 DOI: 10.1556/2006.5.2016.071] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background and aims Research on sexual addiction flourished during the last decade, promoted by the development of an increased number of online sexual activities. Despite the accumulation of studies, however, evidence collected in clinical samples of treatment-seeking people remains scarce. The aim of this study was to describe the characteristics (socio-demographics, sexual habits, and comorbidities) of self-identified "sexual addicts." Methods The sample was composed of 72 patients who consulted an outpatient treatment center regarding their sexual behaviors. Data were collected through a combination of structured interviewing and self-report measures. Results Most patients were males (94.4%) aged 20-76 years (mean 40.3 ± 10.9). Endorsement of sexual addiction diagnosis varied from 56.9% to 95.8% depending on the criteria used. The sexual behaviors reported to have the highest degree of functional impairment were having multiple sexual partners (56%), having unprotected sexual intercourse (51.9%), and using cybersex (43.6%). Ninety percent of patients endorsed a comorbid psychiatric diagnosis, and 60.6% presented at least one paraphilia. Conclusions Results showed highly different profiles in terms of sexual preferences and behaviors, as well as comorbidities involved. These findings highlight the need to develop tailored psychotherapeutic interventions by taking into account the complexity and heterogeneity of the disorder.
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Affiliation(s)
- Aline Wéry
- Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium,Internet and Gambling Disorders Clinic, Department of Adult Psychiatry, Cliniques Universitaires Saint-Luc, Brussels, Belgium,Corresponding authors: Aline Wéry; Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université catholique de Louvain, Place du Cardinal Mercier, 10, B-1348 Louvain-la-Neuve, Belgium; Phone: +32 (0)10 47 45 46; Fax: +32 (0)10 47 37 74; E-mail: ; Marie Grall-Bronnec; CHU de Nantes, Department of Addictology and Psychiatry, Hôpital Saint-Jacques, 85, rue Saint-Jacques, 44093 Nantes cedex 1, France; Phone: +33 (0)2 40 84 61 16; Fax: +33 (0)2 40 84 61 18; E-mail:
| | - Kim Vogelaere
- Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Gaëlle Challet-Bouju
- CHU de Nantes, Clinical Investigation Unit “Behavioral Addictions and Complex Mood Disorders,” Department of Addictology and Psychiatry, Nantes, France,Université de Nantes, EA 4275 SPHERE “MethodS for Patients-centered outcomes and HEalth Research,” Nantes, France
| | - François-Xavier Poudat
- CHU de Nantes, Clinical Investigation Unit “Behavioral Addictions and Complex Mood Disorders,” Department of Addictology and Psychiatry, Nantes, France
| | - Julie Caillon
- CHU de Nantes, Clinical Investigation Unit “Behavioral Addictions and Complex Mood Disorders,” Department of Addictology and Psychiatry, Nantes, France,Université de Nantes, EA 4275 SPHERE “MethodS for Patients-centered outcomes and HEalth Research,” Nantes, France
| | - Delphine Lever
- CHU de Nantes, Clinical Investigation Unit “Behavioral Addictions and Complex Mood Disorders,” Department of Addictology and Psychiatry, Nantes, France
| | - Joël Billieux
- Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium,Internet and Gambling Disorders Clinic, Department of Adult Psychiatry, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Marie Grall-Bronnec
- CHU de Nantes, Clinical Investigation Unit “Behavioral Addictions and Complex Mood Disorders,” Department of Addictology and Psychiatry, Nantes, France,Université de Nantes, EA 4275 SPHERE “MethodS for Patients-centered outcomes and HEalth Research,” Nantes, France,Corresponding authors: Aline Wéry; Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université catholique de Louvain, Place du Cardinal Mercier, 10, B-1348 Louvain-la-Neuve, Belgium; Phone: +32 (0)10 47 45 46; Fax: +32 (0)10 47 37 74; E-mail: ; Marie Grall-Bronnec; CHU de Nantes, Department of Addictology and Psychiatry, Hôpital Saint-Jacques, 85, rue Saint-Jacques, 44093 Nantes cedex 1, France; Phone: +33 (0)2 40 84 61 16; Fax: +33 (0)2 40 84 61 18; E-mail:
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Should Sexual Offending Be Considered an Addiction? Implications for Prevention and Treatment Approaches. CURRENT ADDICTION REPORTS 2016. [DOI: 10.1007/s40429-016-0120-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Taktak Ş, Yılmaz E, Karamustafalıoglu O, Ünsal A. Characteristics of paraphilics in Turkey: A retrospective study-20years. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 49:22-30. [PMID: 27180212 DOI: 10.1016/j.ijlp.2016.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 05/02/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This study is carried out to research the frequency of occurrence and the characteristics of paraphilic cases in Turkey and forensic aspects of them and to explain forensic psychiatric studies of people show paraphilic actions and assess them from legal aspects. METHOD This research is done by studying a total of 101,208 cases who were sent to Istanbul Forensic Medicine Institute (FMI) by the judicial organs of 4th Specialization Board between 1984 and 2004 to decide whether they show paraphilic actions or not. When choosing the cases of pedophilic actions, incest incidents were excluded and 307 incidents were taken into assessment. RESULTS The male subjects are 97.4%, 39.7% of them are 19-29years old, 10% of them are over age 60, 59% of the subjects are single, 36.5% of them are unemployed, 71.7% of the incidents have no physical disorder. The subjects who were imprisoned before were 20.2% and 22.1% of them had undergone psychiatric treatment before the incident. Twenty separate diagnosis are determined by the FMI for the subjects. There were mental retardation, schizophrenia and various personality disorders on the top the diagnosis list. The paraphilia type of the incidents are pedophilia (60.3%), exhibitionism (8.1%), pedophilia and exhibitionism (7.5%) and fetishism (5.9%). It was determined that there were more than one paraphilia type in 40 incidents (13%). FMI decided that 54.7% of them have criminal responsibility, 25.1% of them have no criminal responsibility, and 20.2% of them have reduced criminal responsibility. CONCLUSION There were 20 separate type of diagnosis for the incidents. It is understood that paraphilic incidents do not seek for help although they have the symptoms of disorder and they are exposed to psychiatric assessment only when they face a criminal inquiry. This suggests that there are more paraphilic incidents in the society than what we encounter.
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Affiliation(s)
- Şafak Taktak
- Psychiatry and Forensic Medicine Departments, Ahi Evran University Education and Research Hospital, Turkey.
| | - Ebru Yılmaz
- Forensic Medicine Department, Forensic Medicine Institution, Istanbul, Turkey
| | | | - Ayla Ünsal
- Nursing Department, School of Health, Ahi Evran University, Turkey
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Kühn S, Gallinat J. Neurobiological Basis of Hypersexuality. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2016; 129:67-83. [PMID: 27503448 DOI: 10.1016/bs.irn.2016.04.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Until now, hypersexuality has not found entry into the common diagnostic classification systems. However it is a frequently discussed phenomenon consisting of excessive sexual appetite that is maladaptive for the individual. Initial studies investigated the neurobiological underpinnings of hypersexuality, but current literature is still insufficient to draw unequivocal conclusions. In the present review, we summarize and discuss findings from various perspectives: neuroimaging and lesion studies, studies on other neurological disorders that are sometimes accompanied by hypersexuality, neuropharmacological evidence, genetic as well as animal studies. Taken together, the evidence seems to imply that alterations in the frontal lobe, amygdala, hippocampus, hypothalamus, septum, and brain regions that process reward play a prominent role in the emergence of hypersexuality. Genetic studies and neuropharmacological treatment approaches point at an involvement of the dopaminergic system.
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Affiliation(s)
- S Kühn
- University Clinic Hamburg-Eppendorf, Clinic and Polyclinic for Psychiatry and Psychotherapy, Hamburg, Germany; Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany.
| | - J Gallinat
- University Clinic Hamburg-Eppendorf, Clinic and Polyclinic for Psychiatry and Psychotherapy, Hamburg, Germany
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Walton MT, Lykins AD, Bhullar N. Sexual Arousal and Sexual Activity Frequency: Implications for Understanding Hypersexuality. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:777-782. [PMID: 26969320 DOI: 10.1007/s10508-016-0727-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Michael T Walton
- School of Behavioural Cognitive and Social Sciences, University of New England, Armidale, NSW, 2351, Australia
| | - Amy D Lykins
- School of Behavioural Cognitive and Social Sciences, University of New England, Armidale, NSW, 2351, Australia.
| | - Navjot Bhullar
- School of Behavioural Cognitive and Social Sciences, University of New England, Armidale, NSW, 2351, Australia
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34
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Stinson JD, Becker JV. Pedophilic Disorder. SEXUAL OFFENDING 2016. [DOI: 10.1007/978-1-4939-2416-5_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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35
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Kingston DA. Hypersexuality Disorders and Sexual Offending. SEXUAL OFFENDING 2016. [DOI: 10.1007/978-1-4939-2416-5_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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Blum K, Badgaiyan RD, Gold MS. Hypersexuality Addiction and Withdrawal: Phenomenology, Neurogenetics and Epigenetics. Cureus 2015; 7:e348. [PMID: 26623203 PMCID: PMC4627834 DOI: 10.7759/cureus.348] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Hypersexuality has been defined as abnormally increased sexual activity. Epidemiological and clinical studies have shown that this non-paraphilic condition consists of "excessive" sexual behaviors and disorders accompanied by personal distress and social and medical morbidity. It is a very controversial and political topic in terms of how best to categorize it as similar or not similar to addictive behaviors including substance abuse. Hypersexual disorder is conceptualized as a non-paraphilic sexual desire disorder with impulsivity. Pathophysiological perspectives include dysregulation of sexual arousal and desire, sexual impulsivity, and sexual compulsivity. The nucleus accumbens, situated within the ventral striatum, mediates the reinforcing effects of drugs of abuse, such as cocaine, alcohol, nicotine, and food as well as music. Indeed, it is believed that this structure mandates behaviors elicited by incentive stimuli. These behaviors include natural rewards like feeding, drinking, sexual behavior, and exploratory locomotion. An essential rule of positive reinforcement is that motor responses will increase in magnitude and vigor if followed by a rewarding event. Here, we are hypothesizing that there is a common mechanism of action (MOA) for the powerful effects drugs, music, food, and sex have on human motivation. The human drive for the three necessary motivational behaviors "hunger, thirst, and sex" may all have common molecular genetic antecedents that, if impaired, lead to aberrant behaviors. We hypothesize that based on a plethora of scientific support hypersexual activity is indeed like drugs, food, and music that activate brain mesolimbic reward circuitry. Moreover, dopaminergic gene and possibly other candidate neurotransmitter-related gene polymorphisms affect both hedonic and anhedonic behavioral outcomes. There is little known about both the genetics and epigenetics of hypersexuality in the current literature. However, we anticipate that future studies based on assessments with clinical instruments combined with genotyping of sex addicts will provide evidence for specific clustering of sexual typologies with polymorphic associations. There have been some studies using electrophysiological techniques that do not support the view that hypersexuality is indeed similar to substance abuse and other behavioral addictions. The authors are also encouraging both clinical and academic scientists to embark on research using neuroimaging tools to examine natural dopaminergic agonistic agents targeting specific gene polymorphisms to "normalize" hypersexual behavior.
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Affiliation(s)
- Kenneth Blum
- Department of Psychiatry, McKnight Brain Institute, University of Florida
| | - Rajendra D Badgaiyan
- Department of Psychiatry, and Laboratory of Advanced Radiochemistry, University of Minnesota School of Medicine
| | - Mark S Gold
- Departments of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA
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Blum K, Badgaiyan RD, Gold MS. Hypersexuality Addiction and Withdrawal: Phenomenology, Neurogenetics and Epigenetics. Cureus 2015; 7:e290. [PMID: 26251766 PMCID: PMC4524748 DOI: 10.7759/cureus.290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 07/27/2015] [Indexed: 12/12/2022] Open
Abstract
Hypersexuality is now part of the DSM-V and has been defined as abnormally increased sexual activity. Epidemiological and clinical studies have shown that this non-paraphilic condition consists of “excessive” sexual behaviors and disorders accompanied by personal distress and social and medical morbidity. Hypersexual disorder is conceptualized as primarily a non-paraphilic sexual desire disorder with impulsivity. Pathophysiological perspectives include dysregulation of sexual arousal and desire, sexual impulsivity, sexual addiction, and sexual compulsivity. The nucleus accumbens, situated within the ventral striatum, mediates the reinforcing effects of drugs of abuse, such as cocaine, alcohol, nicotine, and food as well as music. Indeed, it is believed that this structure mandates behaviors elicited by incentive stimuli. These behaviors include natural rewards like feeding, drinking, sexual behavior, and exploratory locomotion. An essential rule of positive reinforcement is that motor responses will increase in magnitude and vigor if followed by a rewarding event. Here, we are hypothesizing that there is a common mechanism of action (MOA) for the powerful effects drugs, music, food, and sex have on human motivation. The human drive for the three necessary motivational behaviors “hunger, thirst, and sex” may all have common molecular genetic antecedents that, if impaired, lead to aberrant behaviors. We hypothesize that based on a plethora of scientific support hypersexual activity is indeed like drugs, food, and music that activate brain mesolimbic reward circuitry. Moreover, dopaminergic gene and possibly other candidate neurotransmitter-related gene polymorphisms affect both hedonic and anhedonic behavioral outcomes. There is little known about both the genetics and epigenetics of hypersexuality in the current literature. However, we anticipate that future studies based on assessments with clinical instruments combined with genotyping of sex addicts will provide evidence for specific clustering of sexual typologies with polymorphic associations. The authors are also encouraging both clinical and academic scientists to embark on research using neuroimaging tools to examine natural dopaminergic agonistic agents targeting specific gene polymorphisms to “normalize” hyper- or hyposexual response.
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Affiliation(s)
- Kenneth Blum
- Department of Psychiatry, McKnight Brain Institute , University of Florida
| | - Rajendra D Badgaiyan
- Department of Psychiatry, and Laboratory of Advanced Radiochemistry, University of Minnesota ,School of Medicine, Minneapolis , MN., USA
| | - Mark S Gold
- Departments of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA
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Graham FJ, Walters GD, Harris DA, Knight RA. Is Hypersexuality Dimensional or Categorical? Evidence From Male and Female College Samples. JOURNAL OF SEX RESEARCH 2015; 53:224-38. [PMID: 26169176 DOI: 10.1080/00224499.2014.1003524] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The recent attempt to introduce hypersexual disorder into the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), has increased empirical scrutiny of the construct. Consensus on its definition and underlying structure remains elusive. Whereas some conceptualizations favor a categorical latent structure, others speculate that hypersexual behavior is dimensional. Research on the latent structure of hypersexual behavior, however, has been sparse. This is unfortunate, because determination of the latent structure can contribute to more accurate assessment, diagnosis, and understanding of etiological process. To date the only study on hypersexuality's latent structure found consistent evidence of a dimensional structure for males but less clear results for females. In the present study the Multidimensional Inventory of Development, Sex, and Aggression (MIDSA), a self-report, contingency-based inventory, was administered to 1,146 college students. Four indices of hypersexual behavior and six indices of sexual compulsivity were analyzed, using three taxometric methods (mean above minus below a cut [MAMBAC], maximum covariance [MAXCOV], and latent mode factor analysis [L-Mode]). Evidence supported a dimensional latent structure for hypersexuality in male and female samples. Future assessments of hypersexuality must focus on adequate reliability and discriminant validity across the continuum of sexual behavior rather than on attempts to differentiate between arbitrarily developed diagnostic categorizations.
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Brom M, Both S, Laan E, Everaerd W, Spinhoven P. The role of conditioning, learning and dopamine in sexual behavior: a narrative review of animal and human studies. Neurosci Biobehav Rev 2013; 38:38-59. [PMID: 24211372 DOI: 10.1016/j.neubiorev.2013.10.014] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 10/22/2013] [Accepted: 10/29/2013] [Indexed: 12/24/2022]
Abstract
Many theories of human sexual behavior assume that sexual stimuli obtain arousing properties through associative learning processes. It is widely accepted that classical conditioning contributes to the etiology of both normal and maladaptive human behaviors. Despite the hypothesized importance of basic learning processes in sexual behavior, research on classical conditioning of the sexual response in humans is scarce. In the present paper, animal studies and studies in humans on the role of pavlovian conditioning on sexual responses are reviewed. Animal research shows robust, direct effects of conditioning processes on partner- and place preference. On the contrast, the empirical research with humans in this area is limited and earlier studies within this field are plagued by methodological confounds. Although recent experimental demonstrations of human sexual conditioning are neither numerous nor robust, sexual arousal showed to be conditionable in both men and women. The present paper serves to highlight the major empirical findings and to renew the insight in how stimuli can acquire sexually arousing value. Hereby also related neurobiological processes in reward learning are discussed. Finally, the connections between animal and human research on the conditionability of sexual responses are discussed, and suggestions for future directions in human research are given.
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Affiliation(s)
- Mirte Brom
- Institute of Psychology, Clinical, Health and Neuropsychology Unit, Leiden University, The Netherlands; Department of Psychosomatic Gynaecology and Sexology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Stephanie Both
- Department of Psychosomatic Gynaecology and Sexology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ellen Laan
- Department of Sexology and Psychosomatic Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Walter Everaerd
- Department Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Philip Spinhoven
- Institute of Psychology, Clinical, Health and Neuropsychology Unit, Leiden University, The Netherlands; Department of Psychiatry, Leiden University Medical Center, The Netherlands
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Real E, Montejo Á, Alonso P, Manuel Menchón J. Sexuality and obsessive-compulsive disorder: the hidden affair. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/npy.12.72] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rettenberger M, Dekker A, Klein V, Briken P. Klinische und forensische Aspekte hypersexuellen Verhaltens. FORENSISCHE PSYCHIATRIE PSYCHOLOGIE KRIMINOLOGIE 2012. [DOI: 10.1007/s11757-012-0194-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Problems of Self-Concept in a Patient Sample of Hypersexual Men With Attention-Deficit Disorder. J Addict Med 2011; 5:134-40. [DOI: 10.1097/adm.0b013e3181e6ad32] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Although shame and facets of neuroticism have independently been linked to hypersexuality, the present study extends these findings by exploring pathways among these variables, using structural equation modeling in a patient sample of hypersexual adult men (N = 95). Results suggested that the domain of neuroticism, as represented by the NEO Personality Inventory-Revised, was a significant direct predictor of hypersexuality, with specific variance from the facet of impulsivity adding additional predictive power. Shame's bivariate association with hypersexuality was also significant, but in a predictive path model the effect of shame on hypersexuality was indirectly mediated through neuroticism and was not an independently significant predictor. Implications for treatment suggest that clinicians working with this population should evaluate precipitating risk factors to consider whether shame is activating neurotic coping or if other stressors might be influencing emotional instability that can trigger hypersexuality. Independent of the general distress associated with neuroticism, the literature on impulsivity might provide other valuable insights and direction for working with hypersexual men.
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Reid RC, Li DS, Gilliland R, Stein JA, Fong T. Reliability, validity, and psychometric development of the pornography consumption inventory in a sample of hypersexual men. JOURNAL OF SEX & MARITAL THERAPY 2011; 37:359-85. [PMID: 21961444 DOI: 10.1080/0092623x.2011.607047] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This article reports the psychometric evaluation of the Pornography Consumption Inventory (PCI), which was developed to assess motivations for pornography use among hypersexual men. Initial factor structure and item analysis were conducted in a sample of men (N = 105) seeking to reduce their pornography consumption (Study 1), yielding a 4-factor solution. In a second sample of treatment-seeking hypersexual men (N = 107), the authors further investigated the properties of the PCI using confirmatory factor analytic procedures, reliability indices, and explored PCI associations with several other constructs to establish convergent and discriminant validity. These studies demonstrate psychometric evidence for the PCI items that measure tendencies of hypersexual men to use pornography (a) for sexual pleasure; (b) to escape, cope, or avoid uncomfortable emotional experiences or stress; (c) to satisfy sexual curiosity; and (d) to satisfy desires for excitement, novelty, and variety.
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Affiliation(s)
- Rory C Reid
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles 90024, USA.
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Winters J, Christoff K, Gorzalka BB. Dysregulated sexuality and high sexual desire: distinct constructs? ARCHIVES OF SEXUAL BEHAVIOR 2010; 39:1029-1043. [PMID: 20143148 DOI: 10.1007/s10508-009-9591-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 11/04/2009] [Accepted: 11/04/2009] [Indexed: 05/28/2023]
Abstract
The literature on dysregulated sexuality, whether theoretical, clinical or empirical, has failed to differentiate the construct from high sexual desire. In this study, we tested three hypotheses which addressed this issue. A sample of 6458 men and 7938 women, some of whom had sought treatment for sexual compulsivity, addiction or impulsivity, completed an online survey comprised of various sexuality measures. Men and women who reported having sought treatment scored significantly higher on measures of dysregulated sexuality and sexual desire. For men, women, and those who had sought treatment, dysregulated sexuality was associated with increased sexual desire. Confirmatory factor analysis supported a one-factor model, indicating that, in both male and female participants, dysregulated sexuality and sexual desire variables loaded onto a single underlying factor. The results of this study suggest that dysregulated sexuality, as currently conceptualized, labelled, and measured, may simply be a marker of high sexual desire and the distress associated with managing a high degree of sexual thoughts, feelings, and needs.
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Affiliation(s)
- Jason Winters
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada.
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Garcia FD, Thibaut F. Sexual Addictions. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2010; 36:254-60. [DOI: 10.3109/00952990.2010.503823] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Oliveira Júnior WMD, Abdo CHN. Unconventional sexual behaviors and their associations with physical, mental and sexual health parameters: a study in 18 large Brazilian cities. ACTA ACUST UNITED AC 2010; 32:264-74. [PMID: 20585745 DOI: 10.1590/s1516-44462010005000013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2009] [Accepted: 10/27/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE There have been many studies investigating paraphilias and sexual compulsion, but thus far little data about prevalence of unusual sexual practices that are subthreshold for these diagnoses. The associations between unconventional sexual behavior and sociodemographic and health parameters were investigated. METHOD A cross-sectional study of 7,022 individuals (45.4% of women) was carried out using a self-administered questionnaire that compared individuals carrying at least one reference of unconventional sexual behavior (group 1) with individuals without such reference (group 2). RESULTS Women's mean age was 35.0 vs. 35.9 years (p < 0.05) and men's mean age was 36.5 vs. 37.8 years (p < 0.05) being lower in group 1 than in group 2, respectively. More men (52.3%) than women (30.4%) (p < 0.001) presented unconventional sexual behavior. Fetishism (13.4%) and voyeuristic behavior (13.0%) were more frequent. Unconventional sexual behavior was associated with male gender, single or separated marital status, black or mulatto race, elementary and high school educational level, history of posttraumatic stress disorder treatment, alcohol dependence, emergency contraception, difficulty at the beginning of sexual life, sexual violence, bisexuality, and performance of anal or oral intercourse. CONCLUSION Unconventional sexual behaviors are important because they are associated with poorer health status and lower educational levels.
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Mann RE, Hanson RK, Thornton D. Assessing risk for sexual recidivism: some proposals on the nature of psychologically meaningful risk factors. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2010; 22:191-217. [PMID: 20363981 DOI: 10.1177/1079063210366039] [Citation(s) in RCA: 263] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Risk assessment and treatment for sexual offenders should focus on individual characteristics associated with recidivism risk. Although it is possible to conduct risk assessments based purely on empirical correlates, the most useful evaluations also explain the source of the risk. In this review, the authors propose that the basic requirements for a psychologically meaningful risk factor are (a) a plausible rationale that the factor is a cause of sexual offending and (b) strong evidence that it predicts sexual recidivism. Based on the second of these criteria, the authors categorize potential risk factors according to the strength of the evidence for their relationship with offending. The most strongly supported variables should be emphasized in both assessment and treatment of sexual offenders. Further research is required, however, to establish causal connections between these variables and recidivism and to examine the extent to which changes in these factors leads to reductions in recidivism potential.
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Affiliation(s)
- Ruth E Mann
- National Offender Management Service, England and Wales, London, UK.
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Reid RC, Karim R, McCrory E, Carpenter BN. Self-reported differences on measures of executive function and hypersexual behavior in a patient and community sample of men. Int J Neurosci 2010; 120:120-7. [PMID: 20199204 DOI: 10.3109/00207450903165577] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients seeking help for hypersexual behavior often exhibit features of impulsivity, cognitive rigidity, poor judgment, deficits in emotion regulation, and excessive preoccupation with sex. Some of these characteristics are also common among patients presenting with neurological pathology associated with executive dysfunction. These observations led to the current investigation of differences between a group of hypersexual patients (n = 87) and a non-hypersexual community sample (n = 92) of men using the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) and the Hypersexual Behavior Inventory (HBI). Significant differences between the groups emerged on eight subscales and all of the general indices of executive functioning with the most dramatic differences on BRIEF-A's Shift, Emotional Control, Initiate, and Plan/Organize subscales. Hypersexual behavior was positively correlated (r = .37, p < .01) with global indices of executive dysfunction and several subscales of the BRIEF-A. These findings provide preliminary evidence supporting the hypothesis that executive dysfunction may be implicated in hypersexual behavior.
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Affiliation(s)
- Rory C Reid
- Brigham Young University, University of California, Los Angeles, California, USA.
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Knight RA. Is a diagnostic category for paraphilic coercive disorder defensible? ARCHIVES OF SEXUAL BEHAVIOR 2010; 39:419-426. [PMID: 19888645 DOI: 10.1007/s10508-009-9571-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
There is a proposal to establish a paraphilic coercive disorder as a new paraphilia in the DSM-V. The empirical data do not, however, support the hypothesis that a distinct syndrome exists that comprises males who are sexually aroused by the coercive elements of rape per se. Purported evidence for this syndrome has centered on the results of phallometric studies. Higher plethysmographic responses of rapists to coercive rape scenarios may, however, be better explained by the failure of coercive elements to inhibit arousal to sexual aspects of the stimuli rather than by arousal specifically to the coercive elements. In addition, sexual fantasies about forcing sex and about struggling victims are highly correlated with sadistic fantasies and have not been shown to identify a syndrome that can be discriminated from sadism. Finally, taxometric evidence strongly supports the hypothesis that the underlying components of rape are distributed as dimensions and do not constitute a separate taxon. Consequently, the criteria purported to categorize rapists into the proposed syndrome would have to be arbitrarily determined. Not only does there seem to be little empirical justification for the creation of this new syndrome, the inclusion of this disorder among the paraphilias would have serious potential for misuse. It would imply endorsement of Paraphilia, NOS, nonconsent, which is currently inappropriately employed in civil commitment proceedings to justify commitment.
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Affiliation(s)
- Raymond A Knight
- Department of Psychology, MS 062, Brandeis University, Waltham, MA 02454-9110, USA.
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