Prevalence and determinants of online-sex use in the German population

The Associations Between Attachment Insecurity and Compulsive Sexual Behavior Disorder or Problematic Pornography Use: The Mediating Role of Emotion Regulation Difficulties

Compulsive sexual behavior disorder (CSBD) was previously considered an attachment disorder, while emotion dysregulation was thought to potentially be a key characteristic of it. However, this theoretical model was not tested in previous empirical research. In our cross-sectional study, we tested whether emotional regulation (ER) difficulties can be adopted as an explanatory mechanism for the relationships between attachment avoidance and anxiety, as well as CSBD and its most prevalent behavioral presentation-problematic pornography use (PPU). Participants (n = 1002; Mage = 50.49 years, SD = 13.32; men: 50.2%) completed an online survey regarding the investigated variables. In mediation analyses, attachment avoidance and anxiety were treated as simultaneous predictors, ER difficulties as a mediating variable, with CSBD/PPU severity as dependent variables. Emotion regulation difficulties and attachment anxiety had a direct positive effect on both CSBD and PPU. The direct effect of attachment avoidance on PPU was non-significant, and significant for CSBD depending on the measure used. Moreover, all the relationships between both insecure attachment dimensions and CSBD/PPU symptom severity were at least partially mediated by ER difficulties. Our results corroborate the theoretical claim that ER difficulties may be a useful framework for explaining the impact of attachment insecurity on CSBD/PPU. Theoretical and practical implications of the findings are discussed.

The impact of Internet pornography on children and adolescents: A systematic review

OBJECTIVES

Young people's exposure to online pornographic material has increased in the past years. Its impact is a complex topic but an important issue due to growing concerns. Therefore, we reviewed the literature on Internet pornography consumption and its impact on children and adolescents. Furthermore, we examined young people's thoughts about pornography and their reasons for consumption.

METHOD

We performed a systematic literature search in the online databases ERIC, PsycARTICLES, PsycINFO, and PSYNDEX for peer-reviewed articles in English, published between 2000 and 2022 and additionally identified secondary references.

RESULTS

We could determine associations between pornography consumption and demographic variables (e.g., age, gender), personal characteristics (e.g., [sexual] sensation seeking, sexual interest and experience, general risk behavior), environmental variables (e.g., peers, family), attitudes (e.g., gender role attitudes, permissive sexual attitudes), behavior (e.g. sexual risk behaviour, sexting) and sexual aggression (e.g., sexual cybervictimization, grooming). Moreover, we found that girls have a more negative attitude towards pornography than boys who have an ambivalent opinion on the subject. Most adolescents are aware that the majority of pornographic material is exaggerated and unrealistic. Furthermore, pornography is not only watched out of curiosity and for sexual arousal but also used as a source of sexual information, especially by minority groups.

DISCUSSION

Many effects that impair children's development have been documented. The results found in this review are often contradictory. Therefore, further replication studies are needed. In addition, we propose several preventive measures, e.g., sexual health education at schools for both heterosexuals and LGBT (Lesbian, Gay, Bisexual, and Transgender) people.

Cybersex and Attachment Styles: Proposal of the Emotional and Relational Aspects in Cybersex Activities (ERACA) Questionnaire

The current study presents the development and the initial validation of a new questionnaire to assess individual differences in emotional and relational aspects related to cybersex activities (i.e., the ERACA). A total of 246 adults (105 females, mean age = 31.89 years, SD = 10.03) coming from the general adult population participated in the study. The items of the ERACA were developed considering the extant literature, and an exploratory factor analysis approach indicated a three-factor structure (i.e., the gratification of the Self through the objectification of other people, the gratification of the Self through relational aspects, betrayal, and infidelity). The associations between the dimensions of the ERACA and dimensional measures of both attachment styles and online sexual behaviors indicated that different aspects related to the quality of the relationships play a different role in individual differences concerning emotional and relational aspects of cybersex activities. The discussion emphasizes the potential usefulness of the ERACA questionnaire for both research purposes and from a health-promoting point of view.

Usefulness of antegrade foam sclerotherapy for portal hypertensive variceal bleeding

PURPOSE

This study investigates the usefulness of antegrade variceal embolization using sclerosant foam to evaluate technical success and clinical outcomes in cases of hypertensive variceal bleeding.

METHODS

A total of 16 patients underwent percutaneous antegrade variceal embolization using foam sclerotherapy from August 2019 to January 2022. Among the patients, 12 cases were of gastroesophageal varices, two were rectal varices, and one case each was duodenal and jejunal varices, respectively. Sodium tetradecyl sulfate (STS) foam was used as a detergent for variceal bleeding sclerotherapy at various anatomical locations. The detergent was used in a foam form to promote clinical outcomes and enable the effective embolization of the entire blood vessel wall, including the ventral side, against gravity. Furthermore, STS foam could be used to help sufficiently deliver the drug to distal segments. A balloon catheter was also used to block the antegrade flow and prevent the dilution of the sclerosant. Technical success was defined as the completion of sclerotherapy for variceal bleeding as planned before the procedure to achieve the disappearance of variceal bleeding. Clinical success was defined as the complete obliteration of varices without recurrent bleeding during the follow-up period after the procedure.

RESULTS

Technical success was 81.3%, and clinical success was 84.6%. Additionally, 15/16 of the procedures were emergencies, and there were no complications related to the procedure.

CONCLUSION

Antegrade foam sclerotherapy using 3% STS for variceal bleeding is clinically safe and effective. Moreover, antegrade foam sclerotherapy can be a useful treatment option for patients with active variceal bleeding in emergency cases.

A short-term manual for webcam-based telemedicine treatment of Internet use disorders

In recent decades, the number of people who experience their Internet use behavior as problematic has risen dramatically. In Germany, a representative study from 2013 estimated the prevalence of Internet use disorder (IUD) to be about 1.0%, with higher rates among younger people. A 2020 meta-analysis shows a global weighted average prevalence of 7.02%. This indicates that developing effective IUD treatment programs is more critical than ever. Studies show that motivational interviewing (MI) techniques are widely used and effective in treating substance abuse and IUDs. In addition, an increasing number of online-based health interventions are being developed to provide a low-threshold treatment option. This article presents a short-term online-based treatment manual for IUDs that combines MI techniques with therapy tools from cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT). The manual includes 12 webcam-based therapy sessions, each lasting 50 min. Each session is framed by a standardized beginning, conclusion, outlook, and flexible session content. In addition, the manual contains example sessions to illustrate the therapeutic intervention. Finally, we discuss the advantages and disadvantages of online-based therapy compared to analog treatment settings and provide recommendations for dealing with these challenges. By combining established therapeutic approaches with an online-based therapeutic setting based on flexibility and motivation, we aim to provide a low-threshold solution for treating IUDs.

Individual cortisol response to acute stress influences neural processing of sexual cues

BACKGROUND AND AIMS

Problematic pornography use can be conceptualized as an impulse control disorder or alternatively as a behavioral addiction. Stress is an important trigger in addiction, but less is known about the neural effect of stress in problematic pornography use. Therefore, we aimed at investigating the effect of stress during the anticipation and viewing of sexually explicit material while considering person characteristics related to potentially being at risk for developing problematic pornography use.

METHODS

In an fMRI study (n = 157 men, age: mean = 25.46, SD = 4.11) we used a sexual incentive delay task. A social stress test was used to induce stress in half of the participants. Salivary cortisol was repeatedly measured and person characteristics were considered moderating the effects of cortisol response.

RESULTS

We found no group differences in the neural responses during the anticipation phase, but a higher reactivity to sexual stimuli in the dACC in the stress group. Acute stress activated a pronounced cortisol response, which positively correlated with neural activations in the reward system (NAcc, dACC) to sexual cues. Further, the individual time spent on pornography use moderated the effect of cortisol in some regions of the reward system (dACC, mOFC).

DISCUSSION AND CONCLUSIONS

Our results suggest that acute stress related increases in cortisol can enhance the incentive value of cues announcing sexual stimuli. This might explain why acute stress is considered a trigger of pornography use and relapse and why individual stress response might be a risk factor for developing a problematic pornography use.

Sexually Explicit Online Media Use and Sexual Behavior among Sexual Minority Men in Portugal

Introduction: This study aimed to describe sexually explicit online media (SEOM) use among men who have sex with men (MSM) in Portugal and to examine any associations between exposure to SEOM depicting unprotected anal intercourse and engaging in unprotected anal sex. Methods: This study recruited 1577 MSM living in Portugal with Internet access, who ranged in age from 18 to 74 years old (M_age = 35.69, SD_age = 11.16). Participants were recruited via websites, e-mail and social media. 67.3% (n = 1061) of sample participants self-identified as gay, and 32.7% (n = 516) claimed to be bisexual. The survey included four categories of questions/measurements, encompassing demographic information, SEOM use, explicit imagery of protected/unprotected anal sex and sexual behavior. Results: The study results suggest that Portuguese MSM frequently use SEOM and that they possess a stated preference for SEOM displaying unprotected anal sex. Furthermore, this study’s findings indicate that self-identified gay men more frequently engage in unprotected sex than self-identified bisexual men. Finally, the study revealed that a preference for viewing SEOM displaying unprotected sex and higher levels of arousal attributed to direct SEOM exposure are significant predictors of having receptive anal sex without condoms.

Cybersex addiction: an overview of the development and treatment of a newly emerging disorder

Cybersex addiction is a non-substance related addiction that involves online sexual activity on the internet. Nowadays, various kinds of things related to sex or pornography are easily accessible through internet media. In Indonesia, sexuality is usually assumed taboo but most young people have been exposed to pornography. It can lead to an addiction with many negative effects on users, such as relationships, money, and psychiatric problems like major depression and anxiety disorders. A few instruments may be used to detect cybersex behavior. This review was aimed to provide a comprehensive discussion about cybersex addiction in Indonesian society and the importance of its screening for this condition to enable its early detection and subsequent management. 

Cybersex use and problematic cybersex use among young Swiss men: Associations with sociodemographic, sexual, and psychological factors

BACKGROUND AND AIMS

Cybersex use (CU) is highly prevalent in Switzerland's population, particularly among young men. CU may have negative consequences if it gets out of control. This study estimated prevalence of CU, frequency of CU (FCU), and problematic CU (PCU) and their correlates.

METHODS

A non-selective sample of young Swiss men (N = 5,332, mean age = 25.45) completed a questionnaire assessing FCU and PCU, sociodemographics (age, linguistic region, and education), sexuality (being in a relationship, number of sexual partners, and sexual orientation), dysfunctional coping (denial, self-distraction, behavioral disengagement, and self-blame), and personality traits (aggression/hostility, sociability, anxiety/neuroticism, and sensation seeking). Associations were tested using hurdle and negative binomial regression models.

RESULTS

At least monthly CU was reported by 78.6% of participants. CU was associated positively with post-secondary schooling (vs. primary schooling), German-speaking (vs. French-speaking), homosexuality, bisexuality (vs. heterosexuality), more than one sexual partner (vs. one), dysfunctional coping (except denial), and all personality traits except sociability, but negatively with being in a relationship (vs. not), age, and sociability. FCU was associated positively with homosexuality, bisexuality, no or more than one sexual partner, dysfunctional coping (except denial), and all personality traits except sociability, but negatively with age, being in a relationship, and sociability. PCU was associated positively with bisexuality, four or more sexual partners, dysfunctional coping, and all personality traits except sociability, but negatively with German-speaking and sociability.

DISCUSSION AND CONCLUSIONS

CU should be viewed in light of its associations with sociodemographic, sexual, and psychological factors. Healthcare professionals should consider these aspects to adapt their interventions to patients' needs.

Contribution of sexual desire and motives to the compulsive use of cybersex

BACKGROUND AND AIMS

Cybersex is increasingly associated with concerns about compulsive use. The aim of this study was to assess the roles of motives and sexual desire in the compulsive use of cybersex.

METHODS

The sample consisted of 306 cybersex users (150 men and 156 women). The participants were assessed using the Compulsive Internet Use Scale (CIUS) adapted for cybersex, the Cybersex Motives Questionnaire (enhancement, coping, and social motives), and the Sexual Desire Inventory-2 (dyadic and solitary sexual desire).

RESULTS

For both genders, coping motive was associated with CIUS score. For women, an additional association with social motives was found whereas an association with sexual desire was found for men.

CONCLUSION

The study showed gender differences in the contributors to sex-related CIUS scores.

Same Same but Different: A Clinical Characterization of Men with Hypersexual Disorder in the Sex@Brain Study

Problems arising from hypersexual behavior are often seen in clinical settings. We aimed to extend the knowledge about the clinical characteristics of individuals with hypersexual disorder (HD). A group of people who fulfilled the proposed diagnostic criteria for HD (men with HD, n = 50) was compared to a group of healthy controls (n = 40). We investigated differences in sociodemographic, neurodevelopmental, and family factors based on self-report questionnaires and clinical interviews. Men with HD reported elevated rates of sexual activity, paraphilias, consumption of child abusive images, and sexual coercive behavior compared to healthy controls. Moreover, rates of affective disorders, attachment difficulties, impulsivity, and dysfunctional emotion regulation strategies were higher in men with HD. Men with HD seem to have experienced various forms of adverse childhood experiences, but there were no further differences in sociodemographic, neurodevelopmental factors, and family factors. Regression analyses indicated that attachment-related avoidance and early onset of masturbation differentiated between men with HD and healthy controls. In conclusion, men with HD appear to have the same neurodevelopment, intelligence levels, sociodemographic background, and family factors compared to healthy controls, but they report different and adverse experiences in childhood, problematic sexual behavior, and psychological difficulties.

Sexual Desire, Mood, Attachment Style, Impulsivity, and Self-Esteem as Predictive Factors for Addictive Cybersex

BACKGROUND

An increasing number of studies are concerned with various aspects of cybersex addiction, the difficulty some persons have in limiting cybersex use despite a negative impact on everyday life.

OBJECTIVE

The aim of this study was to assess potential links between the outcome variable cybersex addiction, assessed with the Compulsive Internet Use Scale (CIUS) adapted for cybersex use, and several psychological and psychopathological factors, including sexual desire, mood, attachment style, impulsivity, and self-esteem, by taking into account the age, sex, and sexual orientation of cybersex users.

METHODS

A Web-based survey was conducted in which participants were assessed for sociodemographic variables and with the following instruments: CIUS adapted for cybersex use, Sexual Desire Inventory, and Short Depression-Happiness Scale. Moreover, attachment style was assessed with the Experiences in Close Relationships-Revised questionnaire (Anxiety and Avoidance subscales). Impulsivity was measured by using the Urgency, Premeditation (lack of), Perseverance (lack of), Sensation Seeking, Positive Urgency Impulsive Behavior Scale. Global self-esteem was assessed with the 1-item Self-Esteem Scale.

RESULTS

A sample of 145 subjects completed the study. Addictive cybersex use was associated with higher levels of sexual desire, depressive mood, avoidant attachment style, and male gender but not with impulsivity.

CONCLUSIONS

Addictive cybersex use is a function of sexual desire, depressive mood, and avoidant attachment.

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

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

Factor structure of the Cybersex Motives Questionnaire

BACKGROUND AND AIMS

The Internet is widely used for sexual activities and pornography. Little is known, however, about why people look for meetings and sexual interactions through the Internet and about the correlates of cybersex addiction. The goal of this study was to construct a questionnaire for cybersex motives [Cybersex Motives Questionnaire (CysexMQ)] by adapting the Gambling Motives Questionnaire to cybersex use and validating its structure.

METHODS

Two online samples of 191 and 204 cybersex users were collected to conduct a principal component analysis (PCA) on the first sample and a confirmatory factor analysis (CFA) on the second. Cronbach's α and composite reliability were computed to assess internal consistency. Correlations between the CysexMQ and the Sexual Desire Inventory (SDI) were also evaluated.

RESULTS

Two competing models were retained from the PCA, one with two factors and the other with three factors. The CFA showed better fit for the three-factor solution. After three cross-loading items were removed, the results showed that a final 14-item three-factor solution (enhancement, coping, and social motives) was valid (adjusted goodness-of-fit index: 0.993; normed-fit index: 0.978; Tucker-Lewis index: 0.985; comparative fit index: 0.988; root mean square error of approximation: 0.076). Positive correlations were found between the different motives and the subscales of the SDI.

DISCUSSION

The results suggest that the CysexMQ is adequate for the assessment of cybersex motives.