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Wizła M, Lewczuk K. The Associations Between Attachment Insecurity and Compulsive Sexual Behavior Disorder or Problematic Pornography Use: The Mediating Role of Emotion Regulation Difficulties. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:3419-3436. [PMID: 38898361 PMCID: PMC11390895 DOI: 10.1007/s10508-024-02904-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 04/25/2024] [Accepted: 05/17/2024] [Indexed: 06/21/2024]
Abstract
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.
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Affiliation(s)
- Magdalena Wizła
- Institute of Psychology, Cardinal Stefan Wyszynski University, Wóycickiego 1/3, 01-938, Warsaw, Poland.
| | - Karol Lewczuk
- Institute of Psychology, Cardinal Stefan Wyszynski University, Wóycickiego 1/3, 01-938, Warsaw, Poland
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Shan D, Song Y, Zhang Y, Luo P, Dai Z, Dai Z. Associations between masturbation frequency, anxiety, and sleep disturbances during the COVID-19 era. Int J Impot Res 2024:10.1038/s41443-024-00961-z. [PMID: 39128938 DOI: 10.1038/s41443-024-00961-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 07/15/2024] [Accepted: 07/31/2024] [Indexed: 08/13/2024]
Abstract
The COVID-19 pandemic has markedly influenced people's lifestyle and sexual behaviors, including masturbation patterns. This study delved into how masturbation frequency could impact anxiety levels, sleep quality, and somatic symptoms post-masturbation among Chinese adults during this period. From December 2022 to January 2023, we conducted a cross-sectional survey, gathering data via WenJuanXing, a leading online survey platform in China. This platform facilitated the recruitment of a diverse cohort, spanning various age groups and geographical locations. Masturbation frequency among participants was subjectively categorized into three levels: 'lesser' (a few times over the past year), 'moderate' (once to three times a month), and 'greater' (weekly to almost daily). To assess anxiety levels and sleep quality, we employed the Generalized Anxiety Disorder 7-item (GAD-7) scale and the Pittsburgh Sleep Quality Index (PSQI), respectively. Among 1500 participants, we received 1423 valid responses. Among these, 65% (n = 930) reported engaging in masturbation in the past year, of whom 87.5% reported subjectively experiencing various levels of fatigue post-masturbation. These 930 responses were subsequently analyzed in-depth (e.g., non-parametric test and pathway analysis), with ages ranging from 18 to 54 years (mean age = 30.5, SD = 7.42). Notably, our findings indicate that participants with greater masturbation frequency exhibited higher anxiety levels [GAD-7 median score: 6 (lesser) vs. 4 (moderate) vs. 8 (greater), p < 0.001, Cohen's f = 0.41] and poorer sleep quality [PSQI median score: 5 (lesser) vs. 4 (moderate) vs. 7 (greater), p < 0.001, Cohen's f = 0.46]. A rough positive correlation between masturbation frequency and PSQI score was also observed (β = 0.16, p < 0.001). These results suggest potential mental and sleep benefits at moderate frequencies, especially in contrast to greater frequencies. However, the cross-sectional design and subjective categorization of masturbation frequency in our study limit our ability to draw definitive causal conclusions. These limitations highlight the need for future longitudinal research employing more precise categorizations of masturbation behavior, such as frequency, to delve deeper into these relationships and understand their underlying mechanisms.
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Affiliation(s)
- Dan Shan
- Department of Biobehavioral Sciences, Columbia University, New York, NY, USA.
| | - Yuming Song
- School of Medical Imaging, Hebei Medical University, Shijiazhuang, China
| | - Yanyi Zhang
- Chinese Association of Sexology (ChAS), Guangzhou, China
| | - Pincheng Luo
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Zijie Dai
- Division of Biosciences, Faculty of Life Sciences, University College London, London, UK
| | - Zhihao Dai
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
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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 PMCID: PMC11214846 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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Jennings TL, Gleason N, Pachankis JE, Bőthe B, Kraus SW. LGBQ-affirming clinical recommendations for compulsive sexual behavior disorder. J Behav Addict 2024; 13:413-428. [PMID: 38592797 PMCID: PMC11220820 DOI: 10.1556/2006.2024.00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/28/2024] [Accepted: 03/14/2024] [Indexed: 04/11/2024] Open
Abstract
Background and aims Since the inclusion of Compulsive Sexual Behavior Disorder (CSBD) in the International Classification of Diseases (11th ed.), there has been little effort placed into developing clinical recommendations for lesbian, gay, bisexual, and queer (LGBQ) clients with this condition. Thus, we develop preliminary clinical recommendations for mental health professionals working with LGBQ clients who may be struggling with CSBD. Methods The present paper synthesizes the CSBD literature with advances in LGBQ-affirming care to develop assessment and treatment recommendations. These recommendations are discussed within the context of minority stress theory, which provides an empirically supported explanation for how anti-LGBQ stigma may contribute to the development of mental health conditions in LGBQ populations. Results Assessment recommendations are designed to assist mental health professionals in distinguishing aspects of an LGBQ client's sociocultural context from CSBD symptomology, given recent concerns that these constructs may be wrongly conflated and result in misdiagnosis. The treatment recommendations consist of broadly applicable, evidence-based principles that can be leveraged by mental health professionals of various theoretical orientations to provide LGBQ-affirming treatment for CSBD. Discussion and Conclusions The present article provides theoretically and empirically supported recommendations for mental health professionals who want to provide LGBQ-affirming care for CSBD. Given the preliminary nature of these recommendations, future research is needed to investigate their clinical applicability and efficacy.
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Affiliation(s)
- Todd L. Jennings
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Neil Gleason
- Department of Psychology, University of Washington, Seattle, WA, USA
| | | | - Beáta Bőthe
- Department of Psychology, University of Montréal, Montréal, QC, CAN
| | - Shane W. Kraus
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
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Vera Cruz G, Aboujaoude E, Liberacka-Dwojak M, Wiłkość-Dębczyńska M, Rochat L, Khan R, Khazaal Y. How much online pornography is too much? A comparison of two theoretically distinct assessment scales. Arch Public Health 2024; 82:79. [PMID: 38816773 PMCID: PMC11137999 DOI: 10.1186/s13690-024-01294-5] [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: 08/04/2023] [Accepted: 04/15/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Online pornography use, an ever more common activity, has raised myriad psychosocial and clinical concerns. While there is a need to screen for and measure its problematic dimension, there is a debate about the adequacy of existing assessment tools. OBJECTIVE The study compares two instruments for measuring pathological online pornography use (POPU) that are based on different theoretical frameworks-one in line with DSM-5 criteria and the six-component addiction model and one in line with ICD-11 criteria. METHODS An international sample of 1,823 adults (Mean age = 31.66, SD = 6.74) answered an online questionnaire that included the Short Version of the Problematic Pornography Consumption Scale (PPCS-6) and the Assessment of Criteria for Specific Internet-Use Disorders (ACSID-11). Factorial, correlational, and network analyses were conducted on the data. RESULTS Both tools adequately screened for online "addictive" behavior, but the ACSID-11 was superior in assessing the degree of clinical risk. CONCLUSION Depending on the specific aim of the assessment (screening vs. clinical diagnostics), both online pornography measurement tools may be useful.
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Affiliation(s)
- Germano Vera Cruz
- Department of Psychology, CRP-CPO, University of Picardie Jules Verne, Amiens, France.
| | - Elias Aboujaoude
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
- Program in Internet, Health and Society, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | | | | | - Lucien Rochat
- Department of Mental Health and Psychiatry, Specialized Facility in Behavioral Addiction ReConnecte, University Hospitals of Geneva, Geneva, Switzerland
| | - Riaz Khan
- Department of Mental Health and Psychiatry, Frontier Medical College Abbottabad, Bahria University Islamabad, Islamabad, Pakistan
| | - Yasser Khazaal
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.
- Research Centre, University Institute of Mental Health at Montreal and Department of Psychiatry and Addiction Montreal University, Montreal, Canada.
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Bőthe B, Nagy L, Koós M, Demetrovics Z, Potenza MN, Kraus SW. Problematic pornography use across countries, genders, and sexual orientations: Insights from the International Sex Survey and comparison of different assessment tools. Addiction 2024; 119:928-950. [PMID: 38413365 DOI: 10.1111/add.16431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/14/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND AND AIMS Problematic pornography use (PPU) is a common manifestation of the newly introduced Compulsive Sexual Behavior Disorder diagnosis in the 11th edition of the International Statistical Classification of Diseases and Related Health Problems. Although cultural, gender- and sexual orientation-related differences in sexual behaviors are well documented, there is a relative absence of data on PPU outside Western countries and among women as well as gender- and sexually-diverse individuals. We addressed these gaps by (a) validating the long and short versions of the Problematic Pornography Consumption Scale (PPCS and PPCS-6, respectively) and the Brief Pornography Screen (BPS) and (b) measuring PPU risk across diverse populations. METHODS Using data from the pre-registered International Sex Survey [n = 82 243; mean age (Mage) = 32.4 years, standard deviation = 12.5], a study across 42 countries from five continents, we evaluated the psychometric properties (i.e. factor structure, measurement invariance, and reliability) of the PPCS, PPCS-6, and BPS and examined their associations with relevant correlates (e.g. treatment-seeking). We also compared PPU risk among diverse groups (e.g. three genders). RESULTS The PPCS, PPCS-6, and BPS demonstrated excellent psychometric properties [for example, comparative fit index = 0.985, Tucker-Lewis Index = 0.981, root mean square error of approximation = 0.060 (90% confidence interval = 0.059-0.060)] in the confirmatory factor analysis, with all PPCS' inter-factor correlations positive and strong (rs = 0.72-0.96). A total of 3.2% of participants were at risk of experiencing PPU (PPU+) based on the PPCS, with significant country- and gender-based differences (e.g. men reported the highest levels of PPU). No sexual orientation-based differences were observed. Only 4-10% of individuals in the PPU+ group had ever sought treatment for PPU, while an additional 21-37% wanted to, but did not do so for specific reasons (e.g. unaffordability). CONCLUSIONS This study validated three measures to assess the severity of problematic pornography use across languages, countries, genders, and sexual orientations in 26 languages: the Problematic Pornography Consumption Scale (PPCS, and PPCS-6, respectively), and the Brief Pornography Screen (BPS). The problematic pornography use risk is estimated to be 3.2-16.6% of the population of 42 countries, and varies among different groups (e.g. genders) and based on the measure used.
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Affiliation(s)
- Beáta Bőthe
- Département de Psychologie, Université de Montréal, Montréal, Canada
| | - Léna Nagy
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Mónika Koós
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
| | - Marc N Potenza
- Yale University School of Medicine, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - Shane W Kraus
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
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Mestre-Bach G, Potenza MN. Current Understanding of Compulsive Sexual Behavior Disorder and Co-occurring Conditions: What Clinicians Should Know about Pharmacological Options. CNS Drugs 2024; 38:255-265. [PMID: 38485889 DOI: 10.1007/s40263-024-01075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 04/02/2024]
Abstract
Compulsive sexual behavior disorder (CSBD) has recently been recognized as a psychiatric disorder. Pharmacological treatments for CSBD have received little study and thus have limited empirical support. The main objective of the present work is to review existing literature on the efficacy of different drugs on the symptomatology of CSBD, including the subtype of problematic pornography use (PPU). The main pharmacological approaches to treating CSBD have included opioid antagonists (naltrexone and nalmefene), selective serotonin reuptake inhibitors (paroxetine, citalopram, fluoxetine, and sertraline), mood stabilizers (topiramate), tricyclic antidepressants (clomipramine), serotonin antagonist and reuptake inhibitors (nefazodone), and N-acetylcysteine. Since people with CSBD may experience different co-occurring disorders, these should be considered when choosing the best pharmacological treatment. Pharmacological therapy for CSBD/PPU has been suggested as an adjunct to psychological therapies, which, for the moment, have the most empirical evidence. However, to evaluate the efficacy of most of the drugs presented in this narrative review, data to date have only been available from case studies. Thus, empirical support is scant and generalizability of results is limited, highlighting the need for more research in this area.
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Affiliation(s)
- Gemma Mestre-Bach
- Instituto de Investigación, Transferencia e Innovación, Universidad Internacional de La Rioja, La Rioja, Spain
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, One Church Street, Rm 726, New Haven, CT, 06510, 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.
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA.
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Bőthe B, Potenza MN, Demetrovics Z. Debates on Compulsive Sexual Behavior Disorder: A Call for Global and Interdisciplinary Perspectives. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1215-1220. [PMID: 38418717 DOI: 10.1007/s10508-024-02836-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Beáta Bőthe
- Département de Psychologie, Université de Montréal, Succursale Centre-Ville, C.P. 6128, Montréal, QC, H3C 3J7, Canada.
- Centre de Recherche Interdisciplinaire sur les Problèmes Conjugaux et les Agressions Sexuelles, Montréal, QC, Canada.
| | - Marc N Potenza
- Yale University School of Medicine, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - Zsolt Demetrovics
- Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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Qu S, Li R, Wang J. Increased sensitivity for negative emotional images in individuals with problematic pornography use. Front Psychol 2024; 15:1287455. [PMID: 38605833 PMCID: PMC11007122 DOI: 10.3389/fpsyg.2024.1287455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
Background Despite the frequent comorbidity of affective and addictive disorders, the significance of affective dysregulation in problematic pornography use (PPU) is commonly disregarded. The objective of this study is to investigate whether individuals with PPU demonstrate increased sensitivity to negative emotional stimuli in comparison to healthy controls (HCs). Methods Electrophysiological responses were captured via event-related potentials (ERPs) from 27 individuals with PPU and 29 HCs. They completed an oddball task involving the presentation of deviant stimuli in the form of highly negative (HN), moderately negative (MN), and neutral images, with a standard stimulus being a neutral kettle image. To evaluate participants' subjective feelings of valence and arousal, the Self-Assessment Manikin (SAM) was employed. Results Regarding subjective evaluations, individuals with PPU indicated diminished valence ratings for HN images as opposed to HCs. Concerning electrophysiological assessments, those with PPU manifested elevated N2 amplitudes in response to both HN and MN images when contrasted against neutral images. Additionally, PPU participants displayed an intensified P3 response to HN images in contrast to MN images, a distinction not evident within the HCs. Discussion These outcomes suggest that individuals with PPU exhibited heightened reactivity toward negative stimuli. This increased sensitivity to negative cues could potentially play a role in the propensity of PPU individuals to resort to pornography as a coping mechanism for managing stress regulation.
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Affiliation(s)
- Shuangyi Qu
- School of Psychology, Chengdu Medical College, Chengdu, Sichuan, China
| | - Ruiyu Li
- School of Psychology, Chengdu Medical College, Chengdu, Sichuan, China
| | - Jianfeng Wang
- School of Psychology, Chengdu Medical College, Chengdu, Sichuan, China
- Sichuan Applied Psychology Research Center, Chengdu Medical College, Chengdu, Sichuan, China
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Villena-Moya A, Granero R, Chiclana-Actis C, Potenza MN, Blycker GR, Demetrovics Z, Bőthe B, Steward T, Fernández-Aranda F, Jiménez-Murcia S, Mestre-Bach G. Spanish Validation of the Long and Short Versions of the Problematic Pornography Consumption Scale (PPCS and PPCS-6) in Adolescents. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:673-687. [PMID: 37845419 DOI: 10.1007/s10508-023-02700-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 06/26/2023] [Accepted: 09/06/2023] [Indexed: 10/18/2023]
Abstract
Although 1-14% of adolescents may experience problematic pornography use (PPU), psychometrically sound instruments for assessing PPU in Spanish-speaking adolescents are scarce. Given the advantages of the different forms of the Problematic Pornography Consumption Scale (PPCS), the aim of the present study was to assess the psychometric properties of the PPCS and PPCS-6, and to examine associations between PPU and age among boys and girls. Two school-based adolescent samples were recruited in Spain (n = 650; Mage = 16.0 [SD = 1.1]; 50% girls and 50% boys) and Mexico (n1, 160; Mage = 15.8 [SD = 1.1]; 68% girls) to assess the psychometric properties of the PPCS and PPCS-6. Confirmatory factor analysis was applied and convergent and discriminant validity with other measures related to PPU was also tested. The results provided empirical support for the six-factor structure of the PPCS and the one-factor structure of the PPCS-6. Boys with older age showed higher levels of tolerance than girls on the PPCS in both countries. Both the PPCS and the PPCS-6 may be considered valid psychometric instruments for the assessment of PPU in Spanish-speaking adolescents from Spain and Mexico.
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Affiliation(s)
- Alejandro Villena-Moya
- Centro de Investigación, Transferencia e Innovación, Universidad Internacional de la Rioja, La Rioja, 26006, Spain
- Unidad de Sexología Clínica y Salud Sexual de la Consulta Dr. Carlos Chiclana, Madrid, Spain
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III, Barcelona, Spain
- Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Chiclana-Actis
- Centro de Investigación, Transferencia e Innovación, Universidad Internacional de la Rioja, La Rioja, 26006, Spain
- Unidad de Sexología Clínica y Salud Sexual de la Consulta Dr. Carlos Chiclana, Madrid, Spain
| | - Marc N Potenza
- Department of Psychiatry and Child Study Center, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
- Department of Neuroscience, Yale University, New Haven, CT, USA
| | - Gretchen R Blycker
- College of Nursing, University of Rhode Island, Kingston, RI, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Zsolt Demetrovics
- Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Beáta Bőthe
- Département de Psychologie, Université de Montréal, Montréal, QC, Canada
- Département de Psychologie, Université du Québec á Trois-Rivières, Trois-Rivières, QC, Canada
| | - Trevor Steward
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Fernando Fernández-Aranda
- Ciber Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III, Barcelona, Spain
- Department of Clinical Psychology, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Ciber Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III, Barcelona, Spain
- Department of Clinical Psychology, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Gemma Mestre-Bach
- Centro de Investigación, Transferencia e Innovación, Universidad Internacional de la Rioja, La Rioja, 26006, Spain.
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Efrati Y. Parental practices as predictors of adolescents' compulsive sexual behavior: a 6-month prospective study. Eur Child Adolesc Psychiatry 2024; 33:241-253. [PMID: 36763182 DOI: 10.1007/s00787-023-02155-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/26/2023] [Indexed: 02/11/2023]
Abstract
Compulsive sexual behavior (CSB) is a prevalent disorder among adolescents. To date, most studies focused on the self-report assessment of individuals without assessing possible parental practices that might alleviate or exacerbate adolescents' CSB. In the present research, I adopted the family systematic approach, which considers the effects of family context on children's and adolescents' development and examined whether and how parental (fathers' and mothers') support giving, communication, and restrictive mediation relate to children's current and future severity of CSB. The sample comprised 300 Israeli families [triad of mothers, fathers, and one adolescent (39% boys, 61% girls; age 14-18)]. Results indicate that maternal support and paternal quality of communication with children significantly predicted lower severity of current and future CSB, respectively. These findings highlight an important and understudied topic in the hope of motivating additional researchers and practitioners to adopt a familial, microsystem perspective on healthy sexual development-a perspective that holds great promise in promoting normal sexual development and in decreasing risky sexual behaviors.
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Affiliation(s)
- Yaniv Efrati
- Faculty of Education, Bar Ilan University, Ramat Gan, Israel.
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12
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Wang J, Li H. Emotional processing deficits in individuals with problematic pornography use: Unpleasant bias and pleasant blunting. J Behav Addict 2023; 12:1046-1060. [PMID: 37921890 PMCID: PMC10786232 DOI: 10.1556/2006.2023.00058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/25/2023] [Accepted: 09/23/2023] [Indexed: 11/05/2023] Open
Abstract
Background and aims A growing body of evidence indicates a connection between emotional processes and the emergence and progression of addiction. However, scant research has examined the involvement of emotional processing within the framework of problematic pornography use (PPU). This study aimed to examine the electrophysiological and subjective differences in emotional processing between male individuals with PPU and healthy controls (HCs) following exposure to everyday affective images. Methods Event-related potentials (ERPs) were recorded from 42 PPU participants (mean age = 20.14 years, SD = 1.35) and 45 HCs (mean age = 20.04 years, SD = 1.45) during an oddball task, in which unpleasant, pleasant, and neutral images were presented as deviant stimuli, while a neutral kettle image served as the standard stimulus. The Self-Assessment Manikin (SAM) was employed to assess participants' subjective experience on the dimensions of valence and arousal. Results Regarding subjective measures of emotion, individuals with PPU reported lower valence ratings for unpleasant images compared to HCs. In terms of electrophysiological measures of emotion, PPU participants reported larger P2 amplitudes for unpleasant pictures compared to both pleasant and neutral pictures. Moreover, HCs showed enhanced P3 amplitudes in response to pleasant images compared to neutral images, whereas this effect was not observed in PPU participants. Discussion and Conclusion These findings indicate that individuals with PPU may display deficits in emotional processing characterized by enhanced responsiveness to negative stimuli and attenuated responsiveness to positive stimuli. The heightened sensitivity to negative stimuli may contribute to the inclination of individuals with PPU to engage in pornography as a coping mechanism for stress regulation. Conversely, their diminished sensitivity to positive stimuli presents a challenge in seeking alternative natural rewards to counter potentially addictive behaviors.
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Affiliation(s)
- Jianfeng Wang
- Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, 610066, China
- School of Psychology, Chengdu Medical College, Chengdu, 610500, China
| | - Hong Li
- Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, 610066, China
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Milrod X, Monto M. Is Sex Cam Use a Substitute for "Real Sex?" Attitudes and Experiences of Consumers Using Adult Cam Platforms. JOURNAL OF SEX RESEARCH 2023:1-14. [PMID: 38035593 DOI: 10.1080/00224499.2023.2284349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Adult webcam sites with live performers who provide viewer interactive experiences are a rapidly increasing form of sexual entertainment or "sextech." The opportunity to engage with performers during synchronous contact without health risks represents a novel form of transactional sex. This study sought to understand viewer preferences in performers, and how viewers perceive webcam use is affecting their sex lives and their mood. Participants (N = 10,570) responded to a link on the adult webcam platform Chaturbate.com and completed a 93-item survey. Simple frequencies and descriptive statistics were used to characterize responses. Most viewers identified as heterosexual (75.1%) men (94.2%). Two-fifths (40.3%) had no sexual partners over the past 12 months. Exploratory factor analysis showed that respondents' preferred qualities in performers clustered around an ideal sexual partner, an emotional connection, power dynamics, and compliance with viewers' wishes. Respondents generally agreed that webcam use made them better educated about sex (66.0%) and feel better about their sex lives (54.6%), though about one-fourth reported less positive experiences. The majority (72.2%) felt watching cams was less satisfying than sex away from screen and only 19.1% defined watching cams as "real sex." Over half (64.0%) perceived their webcam use as having positive effects on their mood, while a moderate proportion perceived negative emotional consequences. Findings suggest that a majority of viewers experience their webcam activities as a means of obtaining sexual release, but that this is not considered actual sex. Future research should explore additional consequences of long-term use of transactional webcam sex.
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Chen L, Wang D, Wang H, Zhang Y, Jiang X. Moderating Role of Sexual Attitudes in the Association between Online Sexual Activity and Problematic Pornography Use: Evidence from the Chinese Community and Help-Seeking Men. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2023; 35:555-572. [PMID: 38601807 PMCID: PMC10903587 DOI: 10.1080/19317611.2023.2257688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 09/05/2023] [Indexed: 04/12/2024]
Abstract
Objectives This study aimed to investigate the moderating role of sexual attitudes in the association between online sexual activity (OSA) and problematic pornography use (PPU) in the Chinese context. Specifically, we examined whether incongruence stemming from attitudes (i.e., disapproval of nonmarital and casual sex but engaging in OSA) amplifies the perception of PPU. Methods We recruited two samples of Chinese men, one from the community (N1 = 525) and the other comprising help-seeking individuals (N2 = 578). Results Sexual attitudes moderate the relationship between OSA and PPU in both samples, with the predictive influence of OSA on PPU weakening among individuals with a relatively permissive attitude (scored one SD above the mean of sexual attitudes), and strengthened among individuals with a relatively conservative attitude (scored one SD below the mean of sexual attitudes). Conclusions In the conservative sexual cultural context of China, a relatively conservative sexual attitude might strengthen the association between OSA and PPU.
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Affiliation(s)
- Lijun Chen
- Department of Psychology, Fuzhou University, Fuzhou, China
| | - Dian Wang
- Department of Psychology, Fuzhou University, Fuzhou, China
| | - Haihua Wang
- Department of Psychology, Fuzhou University, Fuzhou, China
| | - Ying Zhang
- Department of Physical Education, Fuzhou University, 2 Wulongjiangbei Avenue, Fuzhou, Fujian Province, 350108, China
| | - Xiaoliu Jiang
- Department of Social Psychology, Zhou Enlai School of Government, Nankai University, Tianjin, China
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15
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Golder S, Markert C, Psarros R, Discher JP, Walter B, Stark R. Two subtypes of compulsive sexual behavior disorder. Front Psychiatry 2023; 14:1248900. [PMID: 38025451 PMCID: PMC10666180 DOI: 10.3389/fpsyt.2023.1248900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Models explaining addictive behaviors such as the Interaction of Person-Affect-Cognition-Execution (I-PACE) model emphasize the importance of reinforcement mechanisms for developing and maintaining these behaviors, including compulsive sexual behavior disorder (CSBD) as well as personal characteristics as vulnerability factors. This study aimed to determine whether there are CSBD subtypes distinguished by reinforcement sensitivity. We hypothesize that one subtype is sensitive to positive reinforcement (C+subtype) and one is sensitive to negative reinforcement (Ȼ-subtype). We calculated a cluster analysis with data from 62 patients with CSBD and tested differences between the identified clusters by t-test. The sample consisted only of men. Cluster variables were: the sensitivity to the Behavioral Inhibition and Approach System (BIS/BAS), the severity of depressive symptoms (BDI-II), the severity of Trait Anxiety (STAI-T), Sexual Sensation Seeking (SSSS), Thrill- and Adventure-Seeking (SSS-V subscale), Disinhibition (SSS-V subscale), Experience Seeking (SSS-V subscale), and Boredom Susceptibility (SSS-V subscale). Between-cluster differences were analyzed for Trait Sexual Motivation (TSMQ) and Sexual Compulsivity (SCS). The results showed a two-cluster solution with cluster 1 representing patients sensitive to negative reinforcement (Ȼ-subtype) and cluster 2 representing patients sensitive to positive reinforcement (C+subtype). No significant difference in symptom severity of Sexual Compulsivity between clusters was found. Cluster 2 showed higher Importance of Sex and a higher motivation to seek sexual encounters than cluster 2. We found a two-cluster solution regarding reinforcement sensitivity in patients with CSBD. This may have clinical implications regarding individual therapy by focusing on the underlying maintenance mechanisms.
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Affiliation(s)
- Sarah Golder
- Department for Psychotherapy and Systems Neuroscience, University of Giessen, Giessen, Germany
| | - Charlotte Markert
- Department for Psychotherapy and Systems Neuroscience, University of Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, University of Giessen, Giessen, Germany
- Center for Mind, Brain and Behavior (CMBB), Phillips-University Marburg and Justus-Liebig-University Giessen, Marburg/Giessen, Germany
| | - Rhea Psarros
- Department for Psychotherapy and Systems Neuroscience, University of Giessen, Giessen, Germany
| | - Julian Peter Discher
- Department for Psychotherapy and Systems Neuroscience, University of Giessen, Giessen, Germany
| | - Bertram Walter
- Department for Psychotherapy and Systems Neuroscience, University of Giessen, Giessen, Germany
- Center for Mind, Brain and Behavior (CMBB), Phillips-University Marburg and Justus-Liebig-University Giessen, Marburg/Giessen, Germany
| | - Rudolf Stark
- Department for Psychotherapy and Systems Neuroscience, University of Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, University of Giessen, Giessen, Germany
- Center for Mind, Brain and Behavior (CMBB), Phillips-University Marburg and Justus-Liebig-University Giessen, Marburg/Giessen, Germany
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16
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Rahm-Knigge RL, Gleason N, Mark K, Coleman E. Identifying Relationships Between Difficulties with Emotion Regulation and Compulsive Sexual Behavior. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3443-3455. [PMID: 37670204 DOI: 10.1007/s10508-023-02690-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/04/2023] [Accepted: 08/16/2023] [Indexed: 09/07/2023]
Abstract
Emotion dysregulation is an associated feature of compulsive sexual behavior disorder (CSBD), now recognized by the World Health Organization. Previous studies have identified associations between trait emotion dysregulation and CSBD. Given that difficulties with emotion regulation (DERS) is comprised of several facets (e.g., difficulty with impulse control and lacking awareness of one's feelings when upset), and that these facets differentially relate to other mental health concerns, the present study aimed to examine how DERS facets relate to compulsive sexual behavior (CSB). The present study also considered interpersonal emotion regulation via attachment avoidance and attachment anxiety. Hierarchical regression was conducted, first accounting for demographic covariates, then adding attachment styles, and finally all DERS subscales. Results indicated that, among a large, diverse, online U.S. sample (N = 915; Mage = 39.21, SD = 0.81; 54.3% men), difficulty controlling impulses when upset, difficulty with clarity of emotions, and non-acceptance of emotions were significantly positively associated with CSB (small to moderate effects). Attachment anxiety and avoidance were also significantly positively associated with CSB, although their effects were minimal when adding DERS facets. Overall, this study supports the theorized impact of emotion dysregulation on CSB. Assessment of individual differences in DERS and intervening on these concerns are important for treating CSB.
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Affiliation(s)
- Ryan L Rahm-Knigge
- Department of Family Medicine and Community Health, Eli Coleman Institute for Sexual and Gender Health, University of Minnesota Medical School, 1300 South 2nd Street, Suite 180, Minneapolis, MN, 55415, USA.
| | - Neil Gleason
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Kristen Mark
- Department of Family Medicine and Community Health, Eli Coleman Institute for Sexual and Gender Health, University of Minnesota Medical School, 1300 South 2nd Street, Suite 180, Minneapolis, MN, 55415, USA
| | - Eli Coleman
- Department of Family Medicine and Community Health, Eli Coleman Institute for Sexual and Gender Health, University of Minnesota Medical School, 1300 South 2nd Street, Suite 180, Minneapolis, MN, 55415, USA
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Efrati Y, Spada MM. Development and Validation of the Metacognitions about Sex Scale: Exploring its Role as a Mediator between Negative Affect, Emotion Dysregulation Strategies, and Compulsive Sexual Behavior Disorder. JOURNAL OF SEX & MARITAL THERAPY 2023; 50:76-93. [PMID: 37878755 DOI: 10.1080/0092623x.2023.2259894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Metacognitions about sex are theorized to shape cognitive appraisal, coping mechanisms, and regulation or dysregulation before, during, and/or after exposure to sexual stimuli. In our study, we examined the construct structure and validity of the Metacognitions about Sex Scale (MSS) among a sample of adolescents. We estimated the convergent validity of the MSS by factors: negative affect, dysregulated thoughts, and impulsivity, and compulsive sexual behavior (CSB). We also ran a structural equation model in which we examined the possibility that metacognitions about sex would mediate the association between negative affect, dysregulated thoughts, and impulsivity on the one hand, and CSB on the other. The study population included 662 adolescents (252 boys and 410 girls, M = 16.70, SD = 1.32) between 13-18 years of age. The analyses indicated that the factorial structure of the MSS comprised the two expected factors. We also found that positive and negative metacognitions about sex significantly mediated the effect of negative affect, dysregulated thoughts, and impulsivity on CSB. The findings provide evidence that MSS among Israeli adolescents are psychometrically appropriate for use by researchers and practitioners in the prevention and treatment of CSB.
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Affiliation(s)
- Yaniv Efrati
- Bar-Ilan University, Faculty of Education, Ramat Gan, Israel
| | - Marcantonio M Spada
- Division of Psychology, School of Applied Sciences, London South Bank University, London, UK
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18
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File D, File B, Bőthe B, Griffiths MD, Demetrovics Z. Investigating mental representations of psychoactive substance use and other potentially addictive behaviors using a data driven network-based clustering method. PLoS One 2023; 18:e0287564. [PMID: 37856517 PMCID: PMC10586681 DOI: 10.1371/journal.pone.0287564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/07/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND AND AIMS The aim of the present study was to examine the mental representations of the use of different substances and other potentially addictive behaviors in order to explore meaningful similarities and differences that may contribute to a better understanding of behavioral addictions' representations and diagnostic criteria. METHODS The authors mapped the mental and emotional representations of 661 participants (70.5% women; Mage = 35.2 years, SD = 11.7) to the concept "your most disturbing excessive activity" using free-word associations combined with a network-based clustering method. RESULTS The network analyses identified four distinct mental representations, three implicating dominantly negative (Guilt/Shame/Relief, Addiction/Health, and Procrastination/Boredom) and one dominantly positive emotion (Stress/Relaxation). The distribution of Addiction/Health and Procrastination/Boredom representations were different across substance use and problem behaviors, indicating meaningful differences in the underlying cognitive evaluation processes. The Addiction/Health representation was more frequent for substances, while for other addictive behaviors, the Procrastination/Boredom representation was more frequent, and its frequency increased with the self-reported intensity of the behavior. Guilt/Shame/Relief was equally common for both substances and behaviors, but importantly, for substances its' likelihood increased with the intensity of use. CONCLUSION The common part of representations for substance use and other potentially addictive behaviors supports the scientific viewpoint, that real addictions can exist even in the absence of psychoactive drugs. Based on the results, a novel proposition is posited, that a more appropriate indicator of tolerance for problem behaviors might be the perceived amount of time wasted on the activity rather than the actual time spent.
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Affiliation(s)
- Domonkos File
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Bálint File
- Wigner Research Centre for Physics, Budapest, Hungary
| | - Beáta Bőthe
- Département de Psychologie, Université de Montréal, Montreal, Canada
| | - Mark D. Griffiths
- Psychology Department, International Gaming Research Unit, Nottingham Trent University, Nottingham, United Kingdom
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
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19
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Brand M, Potenza MN. Behavioral addictions in the ICD-11: An important debate that is anticipated to continue for some time. J Behav Addict 2023; 12:585-589. [PMID: 37682725 PMCID: PMC10562818 DOI: 10.1556/2006.2023.00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 09/10/2023] Open
Abstract
The Journal of Behavioral Addictions featured a debate on the topic of "behavioral addictions in ICD-11" in 2022. Three main debate papers were published and a total of eleven commentaries. One main topic of considerations in the three debate papers and in the majority of commentaries was compulsive sexual behavior disorder. The debate was balanced, collegial and conducted at a high scientific level. Although there are some disagreements regarding specific details, all authors consider more research on behavioral addictions as important. This scientific debate has been and continues to be enormously important to behavioral addiction research and clinical practice.
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Affiliation(s)
- Matthias Brand
- General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany
| | - Marc N. Potenza
- Departments of Psychiatry, Neuroscience and Child Study, Yale University School of Medicine, New Haven, USA
- Connecticut Council on Problem Gambling, Wethersfield, USA
- Connecticut Mental Health Center, New Haven, USA
- Wu Tsai Institute, Yale University, New Haven, USA
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20
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Efrati Y. Risk and protective factor profiles predict addictive behavior among adolescents. Compr Psychiatry 2023; 123:152387. [PMID: 37037172 DOI: 10.1016/j.comppsych.2023.152387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/17/2023] [Accepted: 04/04/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND AND AIMS Internet gaming disorder (IGD), compulsive sexual behavior (CSB), and problematic social network usage (PSNU) are prevalent disorders among adolescents. Research indicates an increase in the number of adolescents engaging in daily gaming, sex, and the use of social networks, as well as an increase in the number of adolescents diagnosed with these disorders. The current study aims to detect unique profiles of risk and protective factors and examine whether these profiles could explain the different severities of IGD, CSB, and PSNU among adolescents. METHOD The sample comprised 544 Jewish Israeli adolescents from the general community (age 14-18), who were asked about risk (childhood adversity, childhood trauma, depression, anxiety, stress, post-traumatic stress, self-concealment, internalized stigma) and protective (parent-adolescent communication,) factors and addictive behaviors (IGD, CSB, and PSNU). RESULTS Adolescents were classified into three different clusters based on their risk and protective factors: "at risk" (n = 48, 8.82%), "moderate" (n = 400, 73.53%), and "resilient" (n = 96, 17.65%). The "at risk" group had significantly greater severity of addictive behaviors (IGD, CSB, and PSNU) than did the "moderate" or "resilient" groups, and the "moderate" group had significantly greater severity of addictive behaviors than the "resilient" group. CONCLUSIONS The findings highlight the fact that protective and risk factor profiles are highly indicative of various addictive behaviors among adolescents. The current research expands knowledge about addictive behaviors by providing a more individualized approach to understanding addictive behaviors among adolescents.
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Testa G, Mestre-Bach G, Chiclana Actis C, Potenza MN. Problematic Pornography Use in Adolescents: From Prevention to Intervention. CURRENT ADDICTION REPORTS 2023. [DOI: 10.1007/s40429-023-00469-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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22
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Efrati Y. Compulsive Sexual Behavior in Adolescents: The Roles of Personality, Attachment Orientations, Cognitive Mechanisms, and Psychopathology. COGNITIVE THERAPY AND RESEARCH 2023. [DOI: 10.1007/s10608-023-10359-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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23
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Lewczuk K, Wizła M, Gola M. The Relation of Sexual Attitudes to Hypersexuality and Problematic Pornography Use. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:411-430. [PMID: 35896936 PMCID: PMC9328619 DOI: 10.1007/s10508-022-02358-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 05/02/2023]
Abstract
Previous studies have shown that specific attitudes related to moral convictions can have an important role in the development and maintenance of problematic sexual behavior symptoms. However, although other types of attitudes, like sexual attitudes, are potentially highly relevant, they have not yet been studied in this role. We investigated how four dimensions of sexual attitudes: Permissiveness, Birth Control, Communion and Instrumentality, contribute to problematic pornography use (PPU) and hypersexual disorder (HD) symptoms, controlling for religiosity, sex, age and relationship status. The study was administered through an online questionnaire and based on a representative sample of n = 1036 (Mage = 43.28, SD = 14.21; 50.3% women) Polish adult citizens. When adjusting for other variables, higher sexual Permissiveness positively predicted HD and PPU among both men (HD: β = .26, p < .001; PPU: β = .22, p < .001) and women (HD: β = .44, p < .001; PPU: β = .26; p < .001). Sexual Instrumentality positively, although weakly, contributed to HD severity among men (β = .11, p < .05). Attitudes reflecting higher support for responsible sexuality (Birth Control subscale) negatively and weakly predicted HD among women (β = - .11, p < .05). Permissiveness was also the only sexual attitude dimension that consistently predicted a higher frequency of sexual activity among men and women. Based on the cutoff criteria proposed by the authors of the used screening instruments (≥ 53 points for the Hypersexual Behavior Inventory and ≥ 4 points for the Brief Pornography Screen), the prevalence of being at risk for HD was 10.0% (men: 11.4%, women: 8.7%) and for PPU was 17.8% (men: 26.8%, women: 9.1%). Our results point to a significant contribution of sexual attitudes to problematic sexual behavior symptoms, which was not encapsulated by the previously studied influence of religious beliefs, although most of the obtained relationships were relatively weak. Particularly, a consistent link between permissive attitudes and both HD and PPU among men and women may indicate that permissive attitudes can potentially contribute to the development and maintenance of problematic sexual behavior. The prevalence of being at risk for PPU (and to some degree HD) in the current representative sample was high. Such results raise questions about the appropriateness of the proposed cutoff criteria and the risk of overpathologizing normative sexual activity, if the cutoff thresholds are not tailored adequately. The results have implications for the assessment, diagnosis and theory of problematic sexual behavior.
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Affiliation(s)
- Karol Lewczuk
- Institute of Psychology, Cardinal Stefan Wyszynski University, Wóycickiego 1/3, 01-938, Warsaw, Poland.
| | - Magdalena Wizła
- Institute of Psychology, Cardinal Stefan Wyszynski University, Wóycickiego 1/3, 01-938, Warsaw, Poland
| | - Mateusz Gola
- Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California, San Diego, CA, USA
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
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Lewczuk K, Wizła M, Glica A, Potenza MN, Lew-Starowicz M, Kraus SW. Withdrawal and tolerance as related to compulsive sexual behavior disorder and problematic pornography use - Preregistered study based on a nationally representative sample in Poland. J Behav Addict 2022; 11:979-993. [PMID: 36269607 PMCID: PMC9881655 DOI: 10.1556/2006.2022.00076] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/27/2022] [Accepted: 09/16/2022] [Indexed: 12/31/2022] Open
Abstract
Background The addiction model of compulsive sexual behavior disorder (CSBD) and problematic pornography use (PPU) predicts the presence of withdrawal symptoms and increased tolerance for sexual stimuli in the disorder phenotype. However, clear empirical evidence supporting this claim has largely been lacking. Methods In the preregistered, nationally representative survey (n = 1,541, 51.2% women, age: M = 42.99, SD = 14.38), we investigated the role of self-reported withdrawal symptoms and tolerance with respect to CSBD and PPU severity. Results Both withdrawal and tolerance were significantly associated with the severities of CSBD (β = 0.34; P < 0.001 and β = 0.38; P < 0.001, respectively) and PPU (β = 0.24; P < 0.001 and β = 0.27; P < 0.001, respectively). Of the 21 withdrawal symptom types investigated, the most often reported symptoms were frequent sexual thoughts that were difficult to stop (for participants with CSBD: 65.2% and with PPU: 43.3%), increased overall arousal (37.9%; 29.2%), difficult to control level of sexual desire (57.6%; 31.0%), irritability (37.9%; 25.4%), frequent mood changes (33.3%; 22.6%), and sleep problems (36.4%; 24.5%). Conclusions Changes related to mood and general arousal noted in the current study were similar to the cluster of symptoms in a withdrawal syndrome proposed for gambling disorder and internet gaming disorder in DSM-5. The study provides preliminary evidence on an understudied topic, and present findings can have significant implications for understanding the etiology and classification of CSBD and PPU. Simultaneously, drawing conclusions about clinical importance, diagnostic utility and detailed characteristics of withdrawal symptoms and tolerance as a part of CSBD and PPU, as well as other behavioral addictions, requires further research efforts.
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Affiliation(s)
- Karol Lewczuk
- Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland
- Corresponding author. E-mail:
| | - Magdalena Wizła
- Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland
| | - 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
| | - Marc N. Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - Michał Lew-Starowicz
- Department of Psychiatry, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Shane W. Kraus
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
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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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Korchia T, Boyer L, Deneuville M, Etchecopar-Etchart D, Lancon C, Fond G. ADHD prevalence in patients with hypersexuality and paraphilic disorders: a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 2022; 272:1413-1420. [PMID: 35551451 DOI: 10.1007/s00406-022-01421-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/22/2022] [Indexed: 11/30/2022]
Abstract
Hypersexuality and paraphilic disorders have been associated with increased ADHD in several studies. To determine the prevalence of ADHD in hypersexuality and paraphilic disorders. Three databases (Medline, Web of Science and Google Scholar) were explored. Using random effects models, we calculated the pooled estimate of ADHD prevalence. The leave-1-out method and subgroup analyses were carried out to identify sources of heterogeneity. Seven studies from three countries (N = 730 patients with hypersexuality) were included (including five US studies). The overall estimate of the prevalence of ADHD in patients with hypersexuality or paraphilic disorders was 22.6% (95% interval: 17-29.4) with high heterogeneity (I2 = 63%). No publication bias was observed according to Egger's test. We found no significant difference in ADHD prevalence between the following subgroups: hypersexuality vs. paraphilic disorders, studies exploring the history of childhood ADHD vs. adult ADHD, US studies vs. others. The French study was a source of heterogeneity with a much lower rate than others (4.5%) but did not significantly change the prevalence estimate. Removing this study increases the prevalence to 25%. We found no association between the year of publication and ADHD prevalence. ADHD is much more frequent in populations with hypersexuality or paraphilic disorders compared to the general population. It should be systematically screened. The subgroup analyses were not sufficient to identify all sources of heterogeneity, other sources should be explored in further studies.
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Affiliation(s)
- Théo Korchia
- Department de Psychiatrie Universitaire, EA 3279: Aix-Marseille Université, CEReSS - Health Service Research and Quality of Life Center, Hôpitaux Universitaires de Marseille, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Laurent Boyer
- Department de Psychiatrie Universitaire, EA 3279: Aix-Marseille Université, CEReSS - Health Service Research and Quality of Life Center, Hôpitaux Universitaires de Marseille, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Manon Deneuville
- Department de Psychiatrie Universitaire, EA 3279: Aix-Marseille Université, CEReSS - Health Service Research and Quality of Life Center, Hôpitaux Universitaires de Marseille, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Damien Etchecopar-Etchart
- Department de Psychiatrie Universitaire, EA 3279: Aix-Marseille Université, CEReSS - Health Service Research and Quality of Life Center, Hôpitaux Universitaires de Marseille, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Christophe Lancon
- Department de Psychiatrie Universitaire, EA 3279: Aix-Marseille Université, CEReSS - Health Service Research and Quality of Life Center, Hôpitaux Universitaires de Marseille, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Guillaume Fond
- Department de Psychiatrie Universitaire, EA 3279: Aix-Marseille Université, CEReSS - Health Service Research and Quality of Life Center, Hôpitaux Universitaires de Marseille, 27 Boulevard Jean Moulin, 13005, Marseille, France.
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27
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A Bridge of Distress: Distress as the Critical Mediator Between Substance Use Disorders and Compulsive Sexual Behavior Disorder Among Women. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00964-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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28
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Oberheim ST, DePue MK, Liu R. Content development and initial psychometric analysis of the problematic hypersexuality scale. JOURNAL OF ADDICTIONS & OFFENDER COUNSELING 2022. [DOI: 10.1002/jaoc.12113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- S. Tyler Oberheim
- Counselor Education University of Florida Gainesville Florida USA
- School of Professional Studies University of Tennessee at Chattanooga Chattanooga Tennessee USA
| | - M. Kristina DePue
- Counselor Education University of Florida Gainesville Florida USA
- Department of Human Development Family Science, and Counseling, University of Nevada Reno Nevada USA
| | - Ren Liu
- Counselor Education University of Florida Gainesville Florida USA
- Department of Quantitative Methods Measurement, and Statistics, University of California Merced, Merced California USA
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Borgogna NC, Aita SL. Another failure of the latent disease model? The case of compulsive sexual behavior disorder •. J Behav Addict 2022; 11:615-619. [PMID: 36112489 PMCID: PMC9872533 DOI: 10.1556/2006.2022.00069] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/19/2022] [Accepted: 08/27/2022] [Indexed: 02/03/2023] Open
Abstract
Recent debates have evolved regarding the classification/conceptualization of compulsive sexual behavior disorder (CSBD). Conclusions regarding an agreed upon CSBD model are hindered by reliance on the latent disease model. Competing biological-based frameworks are moving forward to replace latent disease classification more broadly but have been met with limited success. We suggest that CSBD researchers move towards developing dimensional, transtheoretical, process-based models. We further suggest additional research, particularly mixed methods and longitudinal studies. Finally, we request that federal funding bodies take a more active role in supporting CSBD research.
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Affiliation(s)
- Nicholas C. Borgogna
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, United States,Corresponding author. E-mail:
| | - Stephen L. Aita
- Veterans Affairs Maine Healthcare System, Augusta, ME, United States
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Coleman E, Jennings T, Gleason N, Danielson S, Nielsen KH, Miner MH, Rahm-Knigge RL. The Relationship between Compulsive Sexual Behavior, Religiosity, and Moral Disapproval. JOURNAL OF SEX & MARITAL THERAPY 2022; 49:314-330. [PMID: 36086799 DOI: 10.1080/0092623x.2022.2117746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Compulsive sexual behavior (CSB) is associated with religiosity and moral disapproval for sexual behaviors, and religiosity and moral disapproval are often used interchangeably in understanding moral incongruence. The present study expands prior research by examining relationships between several religious orientations and CSB and testing how moral disapproval contributes to these relationships via mediation analysis. Results indicated that religious orientations reflecting commitment to beliefs and rigidity in adhering to beliefs predicted greater CSB. Additionally, moral disapproval mediated relationships between several religiosity orientations and CSB. Overall, findings suggest that religiosity and moral disapproval are related constructs that aid in understanding CSB presentations.
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Affiliation(s)
- Eli Coleman
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Todd Jennings
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Neil Gleason
- Department of Clinical Psychology, University of Washington, Seattle, WA, USA
| | - Samuel Danielson
- Department of Clinical Psychology, Minnesota State University, Mankato, MN, USA
| | - Katja H Nielsen
- Department of Clinical Psychology, Minnesota State University, Mankato, MN, USA
| | - Michael H Miner
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ryan L Rahm-Knigge
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
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31
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Lochner C, Albertella L, Kidd M, Kilic Z, Ioannidis K, Grant JE, Yücel M, Stein DJ, Chamberlain SR. The COVID-19 pandemic and problematic usage of the internet: Findings from a diverse adult sample in South Africa. J Psychiatr Res 2022; 153:229-235. [PMID: 35841819 PMCID: PMC9239549 DOI: 10.1016/j.jpsychires.2022.06.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 05/03/2022] [Accepted: 06/24/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The coronavirus disease 19 (COVID-19) has led to increased reliance on the internet. How problematic usage of the internet (PUI) and COVID-19 related stress and other clinical variables relate, is unknown. We hypothesised that higher PUI level would be significantly associated with higher levels of: (i) pandemic-related stress; and (ii) impulsive and compulsive symptoms and traits. METHODS An online community-based cross-sectional survey was used for data collection. Relationships between PUI level and other variables were characterised using correlational analyses. Regression analyses determined the cumulative explanatory power of variables, with partial least squares structural equation modelling (PLS-SEM) to explore path loadings. ANOVA was used to investigate PUI level at varying lockdown levels. RESULTS Data from 2110 participants (64.5% female), aged 18-64 years (mean: 24.3, SD: 8.1) suggested that approximately a quarter (n = 489, 23.2%) had medium to high level internet use problems. Impulsive and compulsive symptoms and traits, pandemic-stress, and age were all significantly related to PUI (p < 0.01). These associations (medium effect sizes) cumulatively explained 29% of PUI variance. PLS-SEM indicated significant contributory effects, with the association between age and PUI level mediated by impulsivity, pandemic-stress and compulsivity. DISCUSSION Pandemic-stress, impulsive-compulsive symptoms and traits and age were related to PUI level. Enhancing resilience to stress, particularly in vulnerable populations, through lifestyle changes and implementation of adaptive coping strategies, is key to reduce risk for PUI during the COVID-19 pandemic and beyond.
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Affiliation(s)
- Christine Lochner
- SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Western Cape, South Africa.
| | - Lucy Albertella
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Victoria, Australia
| | - Martin Kidd
- Centre for Statistical Consultation, Stellenbosch University, Western Cape, South Africa
| | - Zelal Kilic
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Konstantinos Ioannidis
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom,Cambridge and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Jon E. Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Murat Yücel
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Victoria, Australia
| | - Dan J. Stein
- SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Samuel R. Chamberlain
- Department of Psychiatry, University of Cambridge, and Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK,Department of Psychiatry, University of Southampton; and Southern Health NHS Foundation Trust, Southampton, UK
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32
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Klein S, Krikova K, Antons S, Brand M, Klucken T, Stark R. Reward Responsiveness, Learning, and Valuation Implicated in Problematic Pornography Use — a Research Domain Criteria Perspective. CURRENT ADDICTION REPORTS 2022. [DOI: 10.1007/s40429-022-00423-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Purpose of Review
Problematic pornography use (PPU) describes a pattern of behavior characterized by excessive time spent using or thinking about pornography and continued use despite negative consequences. To help advance the understanding of transdiagnostic underlying psychological and neurobiological mechanisms in PPU, we aim to review existing evidence on these mechanisms focusing on positive valence systems within the transdiagnostic Research Domain Criteria (RDoC) framework.
Recent Findings
Reward anticipation processes seem to be increased in individuals with PPU symptoms when they anticipate sexual stimuli compared with other rewards. Studies further suggest that the initial neural and attentional responses to sexual rewards compared with different control stimuli are also increased in individuals with PPU symptoms, as are conditioned responses in sexual reward learning paradigms. Sexual reward valuation studies point towards an increased neural value differentiation with increasing PPU symptoms.
Summary
The current state of evidence indicates that positive valence systems are altered in persons with PPU. This framework of organizing evidence may aid in elucidating PPU development and maintenance as well as planning future studies.
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33
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Coleman E, Rahm-Knigge RL, Danielson S, Nielsen KH, Gleason N, Jennings T, Miner MH. The Relationship between Boredom Proneness, Attachment Styles and Compulsive Sexual Behavior. JOURNAL OF SEX & MARITAL THERAPY 2022; 49:172-188. [PMID: 35695090 DOI: 10.1080/0092623x.2022.2086511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Affect regulation is associated with compulsive sexual behavior (CSB) despite ongoing debate about its inclusion in diagnostic criteria. Previous studies on two specific affect regulation constructs - boredom proneness and attachment styles - suggest that affect regulation is associated with CSB. We tested a moderation model of the effects of attachment anxiety and attachment avoidance on the relationship between boredom proneness and CSB. Results indicate that the relationship between boredom proneness and CSB is stronger at higher levels of attachment anxiety, with no interaction between boredom proneness and attachment avoidance. Overall findings support the importance of affect regulation in conceptualizing and treating CSB.
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Affiliation(s)
- Eli Coleman
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Ryan L Rahm-Knigge
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Samuel Danielson
- Department of Clinical Psychology, Minnesota State University, Mankato, Minnesota, USA
| | - Katja H Nielsen
- Department of Clinical Psychology, Minnesota State University, Mankato, Minnesota, USA
| | - Neil Gleason
- Department of Clinical Psychology, University of Washington, Seattle, Washington, USA
| | - Todd Jennings
- Department of Psychology, University of Nevada, Las Vegas, Nevada, USA
| | - Michael H Miner
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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34
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Reed GM, First MB, Billieux J, Cloitre M, Briken P, Achab S, Brewin CR, King DL, Kraus SW, Bryant RA. Emerging experience with selected new categories in the ICD-11: complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. World Psychiatry 2022; 21:189-213. [PMID: 35524599 PMCID: PMC9077619 DOI: 10.1002/wps.20960] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Among the important changes in the ICD-11 is the addition of 21 new mental disorders. New categories are typically proposed to: a) improve the usefulness of morbidity statistics; b) facilitate recognition of a clinically important but poorly classified mental disorder in order to provide appropriate management; and c) stimulate research into more effective treatments. Given the major implications for the field and for World Health Organization (WHO) member states, it is important to examine the impact of these new categories during the early phase of the ICD-11 implementation. This paper focuses on four disorders: complex post-traumatic stress disorder, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. These categories were selected because they have been the focus of considerable activity and/or controversy and because their inclusion in the ICD-11 represents a different decision than was made for the DSM-5. The lead authors invited experts on each of these disorders to provide insight into why it was considered important to add it to the ICD-11, implications for care of not having that diagnostic category, important controversies about adding the disorder, and a review of the evidence generated and other developments related to the category since the WHO signaled its intention to include it in the ICD-11. Each of the four diagnostic categories appears to describe a population with clinically important and distinctive features that had previously gone unrecognized as well as specific treatment needs that would otherwise likely go unmet. The introduction of these categories in the ICD-11 has been followed by a substantial expansion of research in each area, which has generally supported their validity and utility, and by a significant increase in the availability of appropriate services.
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Affiliation(s)
- Geoffrey M Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Michael B First
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Joël Billieux
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
- Center for Excessive Gambling, Addiction Medicine, Lausanne University Hospitals, Lausanne, Switzerland
| | - Marylene Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Peer Briken
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sophia Achab
- Outpatient Treatment Unit for Addictive Behaviors ReConnecte, Geneva University Hospitals, Geneva, Switzerland
- Psychological and Sociological Research and Training Unit, Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Daniel L King
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia
| | - Shane W Kraus
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
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Wizła M, Kraus SW, Lewczuk K. Perspective: Can psychedelic-assisted therapy be a promising aid in compulsive sexual behavior disorder treatment? Compr Psychiatry 2022; 115:152303. [PMID: 35334305 DOI: 10.1016/j.comppsych.2022.152303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/24/2021] [Accepted: 03/01/2022] [Indexed: 11/03/2022] Open
Abstract
Recently, there has been an increase in studies yielding evidence for psychedelics' anxiolytic and anti-depressive qualities. Preliminary evidence for treatment in substance addiction is also available. In our manuscript, we present a perspective on the possible effectiveness and mechanisms of action of psychedelics' introduction in the treatment of Compulsive Sexual Behavior Disorder (CSBD) and other p roblematic sexual behaviors, which are considered representative of the so-called "behavioral addiction" category. Evidence for the efficacy of Mindfulness Based Interventions in CSBD treatment is promising. Psychedelics- and mindfulness-induced states share common characteristics on both a subjective and objective level. One of the proposed mechanisms regards reduction of experiential avoidance through the promotion of exposure and acceptance. On the neurophysiological level, a shift from higher- to lower-level association regions and an impact on 5- HT2A receptors is observed. Elaborated mechanisms explain the possible enhancement of therapeutic processes by psychedelics. Psychedelics' relative safety and low addictive potential support their introduction into traditional forms of therapy for CSBD and other out of control behaviors.
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Affiliation(s)
- Magdalena Wizła
- Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland.
| | - Shane W Kraus
- Department of Psychology, University of Nevada, Las Vegas, NV, USA.
| | - Karol Lewczuk
- Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland.
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36
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Smaniotto B, Le Bigot J, Camps FD. "Pornography Addiction": Elements for Discussion of a Case Report. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1375-1381. [PMID: 34786657 DOI: 10.1007/s10508-021-02133-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/28/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Abstract
Can Internet pornography use (IPU) lead to addiction? "Pornography addiction" is a highly controversial concept within the scientific community. In the absence of consensus, international classifications do not consider that the concept meets the criteria to be recognized as a distinct diagnostic entity. However, the term "pornography addiction" has now become common parlance and is therefore present in the discourse of patients seeking therapy to address what they perceive as problematic pornography consumption. Drawing on a brief case vignette, presenting the case of a man who views himself as a pornography addict, we offer a critical review of this concept. Different diagnostic hypotheses will be considered. Beyond the diagnostic process, we consider the issue of "perceived addiction" and its relationship with "moral incongruence." From a psychotherapeutic view, we suggest that patients who self-identify as "porn addicts" must be supported using a more comprehensive approach that goes beyond their symptomatic behavior or the manner in which they present or perceive themselves. The proposed therapy did not seek or require an end to the behavior. The therapy approach focused on exploring the patient's history in an attempt to understand the construction of his sexuality and morality. In the case analyzed, focusing on the source of moral incongruence led to the disappearance of IPU and all associated suffering.
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Affiliation(s)
- Barbara Smaniotto
- Research Center in Psychopathology and Clinical Psychology - CRPPC, Institute of Psychology, Lyon 2 University, 5 Avenue Pierre-Mendès-France, 69676, Bron Cedex, France.
| | - Jeanne Le Bigot
- Mental Health Association of the 13 District in Paris [Association de Santé Mentale du 13ème - ASM13], Paris, France
| | - François-David Camps
- Research Center in Psychopathology and Clinical Psychology - CRPPC, Institute of Psychology, Lyon 2 University, 5 Avenue Pierre-Mendès-France, 69676, Bron Cedex, France
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37
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Okabe Y, Ito D. Psychometric Properties of the Problematic Pornography Use Scale in a Japanese Sample. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1221-1235. [PMID: 34853978 DOI: 10.1007/s10508-021-02141-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 05/10/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
Problematic pornography use (PPU) is the inability to control the use of pornography and is considered a form of compulsive sexual behavior. It can have a negative effect on one's life and is an important clinical and social issue. In Japan, there is no assessment tool to measure PPU and very little research has been done. The Problematic Pornography Use Scale is one of the scales assessing the severity of PPU. This study validated a Japanese version of the Problematic Pornography Use Scale (PPUS-J) and examined its psychometric properties in a sample of 1011 individuals through an online survey (502 men, 509 women; Mage = 35.9 years, SD = 13.75). The results of the confirmatory factor analysis indicated that the four factors in the original scale were consistent with the factors in the PPUS-J, and strict invariance could be assumed for male and female participants. With regard to reliability, internal consistency indices were appropriate both at the overall and subscale levels for male and female participants. The PPUS-J showed good convergent and divergent validity due to the relationship between the subscales and other measures such as the Sexual Compulsivity Scale. These results demonstrate the validity of the PPUS-J for assessing problematic pornography use in a Japanese sample. Given the paucity of studies conducted in non-Western cultures and on women, this study will be useful in advancing research on PPU across different cultures. Future studies should examine test-retest reliability of the PPUS-J and its use with clinical groups.
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Affiliation(s)
- Yushun Okabe
- Graduate School of Education, Hyogo University of Teacher Education, 942-1 Shimokume Kato-city, Hyogo, 673-1494, Japan.
| | - Daisuke Ito
- Department Clinical Psychology, Graduate School of Education, Hyogo University of Teacher Education, 1-5-7 Higashikawasaki-cho, Kobe, Hyogo, Japan
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38
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Koós M, Fuss J, Klein V, Demetrovics Z, Bőthe B. Sexual Motivations Underlying Compulsive Sexual Behavior in Women and Men From Germany and Hungary. J Sex Med 2022; 19:170-181. [PMID: 34906543 DOI: 10.1016/j.jsxm.2021.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 10/26/2021] [Accepted: 11/08/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND There are ongoing debates about conflicting models on how to conceptualize compulsive sexual behavior. At the heart of these discussions is the question about the sexual motivations underlying compulsive sexual behavior, as different models assume different motivations. AIM The aim of the present study was to understand sexual motivations underlying compulsive sexual behavior and their relation to the most prominent conceptualizations of compulsive sexual behavior (eg, compulsive sexual behavior disorder [CSBD], sex addiction). METHODS We used self-reported data from 2 large samples of Hungarian and German populations (N = 9814). The Sexual Motivation Scale (SexMS), a 24-item self-report measure based on self-determination theory, was used to assess a diverse set of sexual motivations. Compulsive sexual behavior was assessed with the 19-item Compulsive Sexual Behavior Disorder Scale (CSBD-19), that is based on the ICD-11 diagnostic guidelines of CSBD. We used structural equation modeling to examine the hypothesized associations between sexual motivations and compulsive sexual behavior and examined potential gender differences in these associations. OUTCOMES Compulsive sexual behavior was assessed in relation to a set of sexual motivations. RESULTS Amotivation had the strongest positive association with compulsive sexual behavior, but integrated, introjected, and intrinsic motivations were also positively related to it. Importantly, these associations did not differ for women and men, and between the 2 samples. CLINICAL IMPLICATIONS Future research and treatment should also consider sexual motivations that are not listed among the ICD-11 guidelines for CSBD, including high levels of sexual interest, continuing the behavior despite having little satisfaction from it and coping with sex. STRENGTHS & LIMITATIONS Although we used large samples of general populations in 2 Western countries, this motivational background of compulsive sexual behavior awaits replication in a clinical sample of individuals experiencing CSBD. CONCLUSION The identified sexual motivations underlying compulsive sexual behavior are relevant for assessing and treating patients as motivations may be integrated into psychotherapeutic interventions. Koós M, Fuss J, Klein V, et al. Sexual Motivations Underlying Compulsive Sexual Behavior in Women and Men From Germany and Hungary. J Sex Med 2022;19:170-181.
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Affiliation(s)
- Mónika Koós
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
| | - Johannes Fuss
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute of Forensic Psychiatry and Sex Research, University Duisburg-Essen, Essen, Germany
| | - Verena Klein
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
| | - Beáta Bőthe
- Département de Psychologie, Université de Montréal, Montréal, Canada
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Koós M, Orosz G, Demetrovics Z, Bőthe B. Present hedonism and future time perspectives predicting hypersexuality and problematic pornography use. Front Psychiatry 2022; 13:914919. [PMID: 36081467 PMCID: PMC9447492 DOI: 10.3389/fpsyt.2022.914919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
The Time Perspective (TP) theory (i.e., the psychological experience regarding time) was often examined in association with different addictive behaviors, and the different TPs (i.e., Past Positive, Past Negative, Present Hedonistic, Present Fatalistic, and Future TPs) demonstrated different relationship patterns with them. However, most studies were conducted in relation to substance use-related disorders, leaving crucial knowledge gaps concerning the associations between TPs and potential behavioral addictions. The aim of the present study was to examine the associations between the five TP dimensions, hypersexuality, and problematic pornography use (PPU), considering potential gender differences. Participants from two independent samples (N1 = 554; N2 = 453) completed a self-report survey on TPs and sexual behaviors. Structural equation modeling results indicated that the Present Hedonistic TP had a positive, moderate, and the Future TP had a negative, weak association with hypersexuality in both samples. Only the Present Hedonistic TP had a significant, positive, weak-to-moderate association with PPU across the samples. The explained variances of the models were higher in case of hypersexuality (28 and 27%, respectively), than in case of PPU (1 and 14%, respectively). No significant gender differences were observed. In line with previous findings concerning other predictors of hypersexuality and PPU, the results of the present study suggest that hypersexuality and PPU may differ from each other in terms of their TP background. Yet, present hedonism, which is related to impulsivity, may play an important role in both problematic sexual behaviors, suggesting that interventions focusing on this TP might be successful in reducing hypersexuality and PPU.
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Affiliation(s)
- Mónika Koós
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary.,Institute of Psychology, Faculty of Education and Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Gábor Orosz
- Université d'Artois, Unité de Recherche Pluridisciplinaire Sport Santé Société, France
| | - Zsolt Demetrovics
- Institute of Psychology, Faculty of Education and Psychology, Eötvös Loránd University, Budapest, Hungary.,Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
| | - Beáta Bőthe
- Département de Psychologie, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,Département de Psychologie, Université de Montréal, Montreal, QC, Canada
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Blinka L, Ševčíková A, Dreier M, Škařupová K, Wölfling K. Online Sex Addiction: A Qualitative Analysis of Symptoms in Treatment-Seeking Men. Front Psychiatry 2022; 13:907549. [PMID: 35873234 PMCID: PMC9302710 DOI: 10.3389/fpsyt.2022.907549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Problematic sexual internet use has been attracting increasing research attention in recent years. However, there is a paucity of qualitative studies about how this problem manifests on a daily basis in the clinical population and whether the phenomenon should fall within the hypersexual, compulsive-impulsive, or addictive spectrums of disorders. METHODS Twenty-three semi-structured interviews, including AICA-C clinical interviews, were conducted with men who were in treatment for problematic internet sex use (aged 22-53; Mage = 35.82). The interview structure focused on the patterns of sexual behavior in question, their development, the manifestation of symptoms, and other associated psychosocial problems. A thematic analysis was applied as the main analytical strategy. RESULTS Typical problematic patterns included pornography use and cybersex, together with continuous masturbation for several hours several times a week. This pattern emerged relatively early in young adulthood and became persistent for years. The majority of participants fulfilled the criteria for behavioral addiction (as defined, e.g., by the components model of addiction), with loss of control and preoccupation being the most pronounced and withdrawal symptoms being the least. Together with the onset of erectile dysfunction, negative consequences were reported as being slowly built up over years and typically in the form of deep life dissatisfaction, regret, and feelings of unfulfilled potential. DISCUSSION AND CONCLUSION The Addiction model is relevant for describing the difficulties in treatment-seeking men who suffer from problematic sexual internet use. However, the manifestations of the additional criteria are nuanced. In the case of negative consequences, their onset might be very slow and not easily reflected. While there was evidence of several forms of tolerance, potential withdrawal symptoms in online sex addiction need further attention to be verified.
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Affiliation(s)
- Lukas Blinka
- Institute for Research on Children, Youth, and Family, Faculty of Social Studies, Masaryk University, Brno, Czechia
| | - Anna Ševčíková
- Institute for Research on Children, Youth, and Family, Faculty of Social Studies, Masaryk University, Brno, Czechia
| | - Michael Dreier
- Outpatient Clinic for Behavioral Addictions, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Katerina Škařupová
- Institute for Research on Children, Youth, and Family, Faculty of Social Studies, Masaryk University, Brno, Czechia
| | - Klaus Wölfling
- Outpatient Clinic for Behavioral Addictions, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Common Features in Compulsive Sexual Behavior, Substance Use Disorders, Personality, Temperament, and Attachment-A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010296. [PMID: 35010552 PMCID: PMC8751077 DOI: 10.3390/ijerph19010296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/24/2021] [Accepted: 12/25/2021] [Indexed: 12/23/2022]
Abstract
Do addictions share common traits of an “addictive personality” or do different addictions have distinct personality profiles? This narrative review examines the differences in the associations between substance use disorder (SUD) and compulsive sexual behavior disorder (CSBD), on the one hand, and personality traits, attachment dispositions, and temperament, on the other hand. We found that both people with a SUD and people with CSBD tended to be more spontaneous, careless, and less reliable, to place self-interest above getting along with others, to show emotional instability and experience negative emotions such as anger, anxiety, and/or depression, to be less able to control their attention and/or behavior, and to be engulfed with a constant sensation of “wanting”. Only people with CSBD, but not SUD, noted concerns with their social ties, fear of losing close others, and/or trusting others around them. Results also suggested that people with a SUD and people with CSBD share high commonalities in personality traits and temperament, yet there are noted differences in their social tendencies, especially with close others. People with CSBD reported more concerns with possible relationship losses compared to people with SUD issues, who may be more worried about losing their source of escapism.
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Sharpe M, Mead D. Problematic Pornography Use: Legal and Health Policy Considerations. CURRENT ADDICTION REPORTS 2021; 8:556-567. [PMID: 34518793 PMCID: PMC8426110 DOI: 10.1007/s40429-021-00390-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 11/30/2022]
Abstract
Purpose of Review Reports of sexual violence, especially towards women and children, are rapidly increasing. At the same time, rates of problematic pornography use (PPU) are accelerating across the world too. The purpose of this review is to consider the recent research on PPU and its contribution to sexual violence. The article offers guidance to governments on possible health policy interventions and legal actions to prevent the development of PPU and to reduce the incidence of sexual violence in society. Recent Findings Working from the consumer’s point of view, we identify PPU and ask how much pornography is needed to cause PPU. We examine how PPU drives sexual offending in children, adolescents and adults. The impact of PPU on some consumers’ behaviour suggests significant links to domestic violence. Sexual strangulation is highlighted as an example. Artificial intelligence algorithms play a key role in the pornography industry and appear to be driving escalation to more violent material, inducing high levels of sexual dysfunction in consumers and creating appetites for viewing child sexual abuse material (CSAM). Summary Easy access to internet pornography has led to an increase in PPU and sexual violence. Diagnoses and treatments for PPU are examined, as are legal transgressions of a civil and criminal nature arising from PPU. Legal remedies and government policy implications are discussed from the point of view of the precautionary principle. Strategies covered include age verification for pornography, public health campaigns and embedded health and legal warnings for users at the start of pornography sessions along with lessons for pupils about pornography’s impact on the brain.
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Affiliation(s)
- Mary Sharpe
- The Reward Foundation, The Melting Pot, 15 Calton Road, Edinburgh, EH8 8DL UK.,Lucy Cavendish College, University of Cambridge, Cambridge, CB3 0BU UK
| | - Darryl Mead
- The Reward Foundation, The Melting Pot, 15 Calton Road, Edinburgh, EH8 8DL UK
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Sassover E, Abrahamovitch Z, Amsel Y, Halle D, Mishan Y, Efrati Y, Weinstein A. A study on the relationship between shame, guilt, self-criticism and compulsive sexual behaviour disorder. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02188-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Diagnostic and Classification Considerations Related to Compulsive Sexual Behavior Disorder and Problematic Pornography Use. CURRENT ADDICTION REPORTS 2021. [DOI: 10.1007/s40429-021-00383-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Purpose of Review
There are ongoing debates about specific features of compulsive sexual behavior disorder (CSBD) relating to classification and diagnoses. We aim to address current discussions relating to potential subtypes of CSBD, the aspect of compulsivity in CSBD, and the aspect of moral incongruence and CSBD.
Recent Findings
CSBD includes multiple specific sexual behaviors that might be related to specific psychological processes. Problematic pornography use may be considered a subtype of CSBD, which may have multiple parallels with addictive behaviors. The feature of compulsivity in CSBD may be different from compulsivity in other disorders and may be differently involved in early versus later stages of CSBD. Moral incongruence is important to consider in the context of CSBD, although moral disapproval is not a general exclusion criterion for diagnosing CSBD.
Summary
Considering the current debates of specific features of CSBD, future research and clinical practice may benefit from a trans-diagnostic approach to contribute to a more fine-grained understanding of the multiple facets of CSBD.
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Efrati Y, Amichai-Hamburger Y. Adolescents who solely engage in online sexual experiences are at higher risk for compulsive sexual behavior. Addict Behav 2021; 118:106874. [PMID: 33647708 DOI: 10.1016/j.addbeh.2021.106874] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/07/2021] [Accepted: 02/07/2021] [Indexed: 01/20/2023]
Abstract
In addition to its expression offline, sexual behavior is frequently expressed online. Some adolescents solely engage in online sexual activities, whereas others in offline and online activities, or have no sexual experience at all. In the current research, we examined whether those who solely engage in online sexual activities are at greater risk for compulsive sexual behavior. In Study 1 (n = 164), we examined differences in compulsive sexual behavior (CSB) and risky sexual action tendencies between study groups. In Study 2 (n = 713), we statistically replicated the classification into different sexual behaviors and examined differences between the clusters in CSB, social tendencies and socio-demographic measures. Results indicated that adolescents who only engaged in online sexual activities had significantly higher percentage of clinical CSB, were less likely boys and more likely to be religious. There were not more prone to risky sexual behavior, however. The current research expands the knowledge about offline or online sexually related activities among adolescence.
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Affiliation(s)
| | - Yair Amichai-Hamburger
- The Research Center for Internet Psychology (CIP), Sammy Ofer School of Communication, The Interdisciplinary Center (IDC) Herzliya, Herzliya 46150, Israel
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Bőthe B, Vaillancourt-Morel MP, Bergeron S. Hypersexuality in Mixed-Sex Couples: A Dyadic Longitudinal Study. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2139-2150. [PMID: 34189627 DOI: 10.1007/s10508-021-01959-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 06/13/2023]
Abstract
Emotion dysregulation and intimacy problems are theoretically underpinned correlates of hypersexuality (i.e., uncontrollable sexual urges, fantasies, and behaviors resulting in distress and impairment in different areas of functioning), but the directionality of these associations has not been established, as work in this area has relied on cross-sectional designs. Moreover, although hypersexuality may have significant adverse effects on romantic relationships and approximately half of treatment-seeking individuals are in a relationship, prior studies almost exclusively involved samples of men, regardless of their relationship status. The aim of the present study was to examine the directionality of associations between both partners' emotion dysregulation, physical (i.e., partnered sexual frequency) and relationship intimacy, and hypersexuality using a longitudinal, dyadic framework. Self-reported data of 267 mixed-sex couples (Mage_men = 29.9 years, SD = 8.2; Mage_women = 27.7 years, SD = 6.7) at baseline (T1) and six-month follow-up (T2) were analyzed using a crossed-lagged model within an actor-partner interdependence framework. Prior greater emotion dysregulation (T1) in both men and women was associated with their own later greater hypersexuality (T2). Women's prior greater hypersexuality (T1) was associated with their later lower relationship intimacy (T2). Lower levels of intimacy were not significantly associated with later hypersexuality. No partner effects were found in relation to hypersexuality. Findings suggest that men and women may use sexual behaviors to cope with negative emotions, which could, in turn, lead to hypersexuality. Intimacy problems did not precede hypersexuality, although women's hypersexuality may reduce their own relationship intimacy over time.
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Affiliation(s)
- Beáta Bőthe
- Département de Psychologie, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montréal, QC, H3C 3J7, Canada.
| | | | - Sophie Bergeron
- Département de Psychologie, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montréal, QC, H3C 3J7, Canada
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Okabe Y, Takahashi F, Ito D. Problematic Pornography Use in Japan: A Preliminary Study Among University Students. Front Psychol 2021; 12:638354. [PMID: 33935889 PMCID: PMC8085335 DOI: 10.3389/fpsyg.2021.638354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Problematic pornography use is considered an addictive behavior, which is an important clinical issue. Despite considerable research interest in problematic pornography use worldwide, to the best of our knowledge, there are no extant studies on the subject in Japan. Therefore, despite the fact that many people in Japan use pornography, the difference between problematic and non-problematic users among Japanese people is not known. OBJECTIVE This study aimed to identify the characteristics of problematic pornography use among Japanese students, to the best of our knowledge. Specifically, we examined general psychopathological symptoms, sexual compulsivity, depression, anxiety, and low effortful control. METHODS The participants were 150 college students aged 20-26 years (mean age = 21.5, SD = 1.21, males: n = 86, females: n = 64) at a university in midland Japan. An online questionnaire was administered that included items on pornography usage patterns, impaired control of pornography use, sexual compulsivity, depression, anxiety, and effortful control. RESULTS Most men (97%) and approximately one-third of women (35.9%) used pornography at least once in the past month. Some users reported significant daily-life problems due to difficulty in controlling pornography use (5.7%). Participants with impaired control of pornography use had higher depression, anxiety, and sexual compulsivity, and lower effortful control than pornography users without impaired control. CONCLUSION Some Japanese students reported significant daily-life problems due to impaired control of pornography use. The characteristics of individuals with impaired control are consistent with previous studies. The results of this study suggest that individuals with impaired control may have poor mental health, and that there is need for further research and development of treatment systems to manage this issue in Japan. Further research exploring a more varied sample in Japan is required to effectively examine problematic pornography use.
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Affiliation(s)
- Yushun Okabe
- Institute of Education, Shinshu University, Nagano, Japan
| | | | - Daisuke Ito
- Graduate School of Education, Hyogo University of Teacher Education, Kato, Japan
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Draps M, Kowalczyk-Grębska N, Marchewka A, Shi F, Gola M. White matter microstructural and Compulsive Sexual Behaviors Disorder - Diffusion Tensor Imaging study. J Behav Addict 2021; 10:55-64. [PMID: 33570504 PMCID: PMC8969848 DOI: 10.1556/2006.2021.00002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/30/2020] [Accepted: 12/27/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND AND AIMS Even though the Compulsive Sexual Behavior Disorder (CSBD) was added to the ICD-11 under the impulse control category in 2019, its neural mechanisms are still debated. Researchers have noted its similarity both to addiction and to Obssesive-Compulsive Disorder (OCD). The aim of our study was to address this question by investigating the pattern of anatomical brain abnormalities among CSBD patients. METHODS Reviewing 39 publications on Diffusion Tensor Imaging (DTI) we have identified main abnormalities specific for addictions and OCD. Than we have collected DTI data from 36 heterosexual males diagnosed with CSBD and 31 matched healthy controls. These results were then compared to the addiction and OCD patterns. RESULTS Compared to controls, CSBD individuals showed significant fractional anisotropy (FA) reduction in the superior corona radiata tract, the internal capsule tract, cerebellar tracts and occipital gyrus white matter. Interestingly, all these regions were also identified in previous studies as shared DTI correlates in both OCD and addiction. DISCUSSION AND CONCLUSIONS Results of our study suggest that CSBD shares similar pattern of abnormalities with both OCD and addiction. As one of the first DTI study comparing structural brain differences between CSBD, addictions and OCD, although it reveals new aspects of CSBD, it is insufficient to determine whether CSBD resembles more an addiction or OCD. Further research, especially comparing directly individuals with all three disorders may provide more conclusive results.
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Affiliation(s)
- Małgorzata Draps
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland,Corresponding author. E-mail:
| | | | - Artur Marchewka
- Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Feng Shi
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Mateusz Gola
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland,Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California San Diego, San Diego, USA
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