Interpersonal violence, early life adversity, and suicidal behavior in hypersexual men

Patterns of Sexual Risk Behaviors and Sexuality-Related Risk Factors among Young Adults in Germany: Implications for Prevention and Therapy

Sexual risk behavior (SRB) includes behavioral (sex without contraception, sexualized substance use, sex work, sexual partner violence, other sexual activities that harm oneself or others) and affective subtypes (sexuality-related feelings of shame/guilt, relationship impairments) and leads to psychosocial and health-related consequences. Young adults comprise a vulnerable group regarding the development of SRB. The study aimed to identify SRB patterns among young adults and their relation to sexuality-related risk factors. A cross-sectional online survey measured behavioral and affective aspects of SRB with nine items. Latent class analysis was conducted to identify patterns of SRB. Gender, sexual orientation, age of first intercourse, number of sexual partners, hypersexuality, and sexual dysfunction were captured as risk factors via multinomial logistic regression. Within this convenience sample (n = 609; nfemale = 365; nmale = 245; Mage = 23.1 years), the SRB patterns unremarkable (67%; low values in all SRB subtypes), shame-ridden (17%; high values in sexual feelings of shame/guilt) and risky sexual behavior (16%; high values in all subtypes of SRB, especially sexualized drug use) were identified. The shame-ridden and risky patterns were strongly associated with higher hypersexuality values, the risky pattern moreover with being non-heterosexual, of younger age at first sexual experience, and a higher number of sexual partners. Male and sexual minority participants demonstrated SRB more often than females and heterosexuals. Within prevention and treatment of SRB, it seems beneficial to address sexuality-related feelings of shame/guilt and addictive patterns (concerning sexual behaviors/substances) via gender- and diversity-sensitive measurements.

Influence of psychological inflexibility and mindfulness on hypersexuality and sexual satisfaction in a Spanish sample

Sexual satisfaction is tremendously relevant to wellbeing and quality of life. Inversely, hypersexuality may increase the risk of psychological distress, unprotected sex, and marital problems. This study attempts to explore the sociodemographic variables related to hypersexuality and the relationship between hypersexuality and sexual dissatisfaction with psychological inflexibility, cognitive fusion, body awareness, bodily dissociation, and mindfulness skills in the Spanish population. The sample was made up of 530 participants between 18 and 67 years of age. In total, 5.5% displayed hypersexuality, more likely in males, lesbians and gay men, singles, and students. An online survey was conducted including standardized questionnaires as follows: AAQ-II, CFQ, SBC, MAAS, NSSS-S, and HBI. Significant moderate positive correlations were found between hypersexuality and psychological inflexibility, cognitive fusion, and bodily dissociation, and an inverse moderate correlation with mindfulness skills. Moderate negative correlations were found between sexual satisfaction and bodily dissociation. Linear regression showed psychological inflexibility was the variable with the most weight on hypersexuality, while bodily dissociation was the variable with the most influence on sexual dissatisfaction. This study suggests lesbians and gay men, males, and singles may show an increased vulnerability toward engaging in hypersexual behavior and provides justification for interventions focused on psychological inflexibility and mindfulness skills to treat hypersexuality and improve sexual satisfaction.

Sexual Addiction Disorder— A Review With Recent Updates

Sexual addiction, hypersexuality, sexual compulsivity, and sexual impulsivity are all terms that describe a psychological disorder that is characterized by a person’s inability to control his or her sexual behavior. This spectrum of symptoms are often referred to as sexual addiction disorder. Whether excessive sexual behavior should be regarded as an addiction, or a compulsion, or an impulse control disorder is arguable, as each label indicates a specific etiological model and treatment plan. Sexual addiction disorder has been largely ignored by the clinicians, although it causes significant emotional and behavioral problems among the patients. Fortunately, in the recent years, this disorder is gaining recognition, and attempts have been made to understand it through research. The present article aims to systematically review and summarize the recent understanding and research on phenomenology, clinical characteristics, etiology, assessment, and management of sexual addiction disorder.

Neurochemical and Hormonal Contributors to Compulsive Sexual Behavior Disorder

Purpose of Review

Compulsive sexual behavior disorder has been recently included in the 11th revision of the International Classification of Diseases (ICD-11), and the possible contribution of neurochemical and hormonal factors have been reported. However, relatively little is known concerning the neurobiology underlying this disorder. The aim of this article is to review and discuss published findings in the area.

Recent Findings

Evidence suggests that the neuroendocrine systems are involved in the pathophysiology of compulsive sexual behavior. The hypothalamus-pituitary adrenal axis, the hypothalamus-pituitary–gonadal axis, and the oxytocinergic system have been implicated.

Summary

Further studies are needed to elucidate the exact involvement of neuroendocrine and hormonal systems in compulsive sexual behavior disorder. Prospective longitudinal studies are particularly needed, especially those considering co-occurring psychiatric disorders and obtaining hormonal assessments in experimental circumstances with appropriate control groups.

Prevalence of Suicidal Behavior and Associated Clinical Correlates in Patients with Behavioral Addictions

Addictive disorders are characterized by severe consequences, including suicidal events, but most studies investigating the association between addiction and suicidal risk have focused on substance use disorders and gambling disorder at the expense of the rest of behavioral addictions. This study examined the prevalence and the associated clinical correlates of suicidal ideation and suicide attempts in a sample of patients with a diagnosis of behavioral addiction. The total sample consisted of 4404 individuals: 4103 of these patients with gambling disorder, 99 with gaming disorder, 44 with sex addiction, and 158 with buying–shopping disorder. All of them were assessed consecutively at a specialized hospital unit for the treatment of behavioral addictions. Participants attended two clinical interviews and completed self-reported questionnaires to explore clinical features of behavioral addictions, personality traits, psychopathological symptomatology, suicidal behavior, and sociodemographic variables. The highest prevalence of suicidal ideation was found in patients with gambling disorder (22.9%), followed by buying–shopping disorder (18.4%), sex addiction (18.2%), and gaming disorder (6.1%). The highest prevalence of suicide attempts was registered for sex addiction (9.1%), followed by buying–shopping disorder (7.6%), gambling disorder (6.7%), and gaming disorder (3.0%). Female gender and unemployment constituted two relevant sociodemographic factors associated with suicidal risk in gambling disorder, gaming disorder, and buying–shopping disorder. Lack of family support appeared as a relevant risk factor, except for gaming disorder. These results pointed out that suicide is a prevalent behavior in behavioral addictions, and clinicians and researchers need to pay particular attention to the specificities of each behavioral addiction when assessing suicidal risk.

Adolescents who solely engage in online sexual experiences are at higher risk for compulsive sexual behavior

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.

The Structure, Covariates, and Etiology of Hypersexuality: Implications for Sexual Offending

PURPOSE OF REVIEW

A substantial increase in research on the structure, covariates, and etiology of hypersexuality has emerged during the last decade. It is the goal of this review to summarize and integrate this research and to indicate some practical implications for clinical and forensic practice, especially as applied to those who have sexually offended.

RECENT FINDINGS

Studies from the last half-decade converge on the conclusion that hypersexuality has both problematic and high sexual drive components. Both aspects have consistently been found to be distributed dimensionally and not categorically. Each subdimension covaries differentially with specific types of impulsivity. In addition to sexual abuse, psychological or emotional abuse has emerged to be a potent developmental antecedent of hypersexuality. Current research has focused on the problematic dimension of hypersexuality and has neglected to specify the criteria for high sexual drive. Lacking are large-scale representative and clinical samples that provide determination of optimal cutoffs for treatment and dispositional decisions for both dimensions of hypersexuality. Research on the etiology of both aspects of hypersexuality is in its infancy, and more differentiated assessments of developmental abuse histories are required.

Predicting problematic pornography use among male returning US veterans

Problematic Pornography Use (PPU) is the most common problem behavior among individuals with compulsive sexual behavior (CSB). Previous research suggests US veterans are at a greater risk of engaging in PPU. The present study sought to investigate further PPU among male military veterans. Data from 172 male veterans who endorsed ever watching pornography and completed the Problematic Pornography Use Scale (PPUS) were included in the study. Participants completed self-report questionnaires, including demographic information, psychiatric co-morbidities, impulsivity, as measured by the UPPS-P, pornography-related behaviors, and pornography craving as measured by Pornography Craving Questionnaire (PCQ). Younger age and lower educational attainment were associated with higher PPUS scores. Depression, anxiety, post-traumatic stress disorder (PTSD), insomnia, and impulsivity were positively associated with higher PPUS scores. There was no statistically significant association between PPU with suicidal ideation or alcohol use disorder. In the multivariable hierarchical regression, depression, frequency of use, and higher PCQ scores were associated with higher PPUS scores, although only the latter two remained significant in the final model. Understanding the risk factors via more frequent screening for PPU will help with the development of treatment protocols for this problematic behavior.

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

Introduction

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

Methods

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

Results

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

Conclusion

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

Exposure to Early Life Adversity and Interpersonal Functioning in Attempted Suicide

BACKGROUND

Early life adversity (ELA) may lead to an increased risk for mental health problems including suicidal behavior. ELA alters biological stress systems that affect behavior and control within the individual that in turn will affect interpersonal behavior. Strained relations and interpersonal conflicts leading to rejection and isolation have been shown to be factors for suicidal behavior. Difficulties in interpersonal relationships are a common reason for seeking help in psychiatric care. In the present study, we examined relationship between different types of interpersonal problems and adverse childhood experiences in patients with a recent suicide attempt.

METHOD

The study included 181 recent suicide attempters. We assessed early life adversity and specific interpersonal problems by using the Karolinska Interpersonal Violence Scale and the Inventory of Interpersonal problems respectively.

RESULTS

Suicide attempters with high levels of early life adversity expressed a more socially avoidant, non-assertive, and exploitable personal style even after adjustment for comorbidities with personality disorder and substance use disorder.

CONCLUSIONS

Patients with a recent suicide attempt with high levels of early life adversity tend to isolate themselves, of being introvert, and having difficulties to open up and confide in others. They report low self-confidence and self-esteem and problems with feeling and expressing anger. These behaviors complicate interaction with others and make establishment of solid relationships more difficult. In regards to detection of suicidal communication and treatment of suicidal patients, this may lead to misinterpretations and difficulties to fully benefit from treatment given or for professionals to provide the appropriate treatment. Clinicians should closely investigate the presence of early life adversity in suicidal patients and pay attention to their personal style and their difficulties in interpersonal exchange.

Child Sexual Abuse and Compulsive Sexual Behavior: A Systematic Literature Review

PURPOSE OF REVIEW

Information on potential risk factors and clinical correlates of compulsive sexual behavior (CSB) may help inform more effective prevention and treatment measures. Sexual victimization, specifically, child sexual abuse (CSA), has been associated with CSB.

RECENT FINDINGS

This systematic review describes 21 studies on the relationship between CSA and CSB. Most studies identified a significant association between CSA and CSB. However, variability in measurements, potential differences in links among community versus clinical samples, relevance of research among college samples, lack of support for gender-related differences, and the need for more longitudinal designs were identified.

SUMMARY

Research would benefit from more formalized assessments of CSB across different populations. Prevention efforts should be aimed toward individuals who experienced CSA and/or other abuse, particularly if they report engaging in risky sexual behavior. Individuals with CSB who have experienced sexual abuse may benefit from trauma-focused treatment.

Role of Personality Characteristics and Sexual Orientation in the Risk for Sexual Addiction Among Israeli Men: Validation of a Hebrew Sex Addiction Scale

Men having sex with men are known to exhibit heightened sexual activity. This raises the conjecture that different sexual orientations exhibit different levels of sex addiction risk, which is also affected by personality. The present study examined the prevalence of the sex addiction risk within the context of sexual orientation and personality in Israeli men while also validating the Hebrew Bergen-Yale Sex Addiction Scale (HBYSAS). Results based on 177 participants showed that the HBYSAS is appropriate for assessing the risk for sex addiction in Israeli men. Furthermore, results showed that sex addiction risk varied with individuals’ sexual orientation while being modestly associated with higher neuroticism and lower conscientiousness.

The Psychometric Properties of the Hypersexual Behavior Inventory Using a Large-Scale Nonclinical Sample

The conceptualization of hypersexuality has begun to converge as a result of proposed diagnostic criteria. However, its measurement is still diverse. The Hypersexual Behavior Inventory (HBI) is one of the most appropriate scales used to assess hypersexuality, but further examination is needed to test its psychometric properties among different clinical and nonclinical groups, including samples outside of the United States. The aim of the present study was to investigate the reliability and the generalizability of HBI and to determine a cutoff score on a large, diverse, online, nonclinical sample (N = 18,034 participants; females = 6132; 34.0%; M_age = 33.6 years, SD_age = 11.1). Confirmatory factor analysis (CFA) and reliability indices provided support for the structure of the HBI and demonstrated excellent reliability. Employing latent profile analysis (LPA), seven classes emerged, but they could not be reliably distinguished by objective sexuality-related characteristics. Moreover, it was not possible to determine an adequate cutoff score, most likely due to the low prevalence rate of hypersexuality in the population. HBI can be reliably used to measure the extent of hypersexual urges, fantasies, and behavior; however, objective indicators and a clinical interview are essential to claim that a given individual may exhibit features of problematic sexual behavior.