Cross-Cultural Adult ADHD Assessment in 42 Countries Using the Adult ADHD Self-Report Scale Screener

OBJECTIVE

We analyzed adult ADHD symptoms in a cross-cultural context, including investigating the occurrence and potential correlates of adult ADHD and psychometric examination of the Adult ADHD Self-Report Scale (ASRS) Screener.

METHOD

Our analysis is based on a large-scale research project involving 42 countries (International Sex Survey, N=72,627, 57% women, Mage=32.84; SDage=12.57).

RESULTS

The ASRS Screener demonstrated good reliability and validity, along with partial invariance across different languages, countries, and genders. The occurrence of being at risk for adult ADHD was relatively high (21.4% for women, 18.1% for men). The highest scores were obtained in the US, Canada, and other English-speaking Western countries, with significantly lower scores among East Asian and non-English-speaking European countries. Moreover, ADHD symptom severity and occurrence were especially high among gender-diverse individuals. Significant associations between adult ADHD symptoms and age, mental and sexual health, and socioeconomic status were observed.

CONCLUSIONS

Present results show significant cross-cultural variability in adult ADHD occurrence as well as highlight important factors related to adult ADHD. Moreover, the importance of further research on adult ADHD in previously understudied populations (non-Western countries) and minority groups (gender-diverse individuals) is stressed. Lastly, the present analysis is consistent with previous evidence showing low specificity of adult ADHD screening instruments and contributes to the current discussion on accurate adult ADHD screening and diagnosis.

Compulsive Sexual Behavior Disorder and Problematic Pornography Use in Cisgender Sexual Minority Individuals: The Associations with Minority Stress, Social Support, and Sexualized Drug Use

Compulsive Sexual Behavior Disorder (CSBD), recently recognized in the ICD-11 as an independent disorder, has been shown to be more prevalent in sexual minorities. However, we still lack studies investigating which factors contribute to CSBD and related behaviors in this group. In our cross-sectional study, we investigated the relationships between characteristics potentially contributing to CSBD and problematic pornography use (PPU) in sexual minority individuals: sexual minority stress (internalized sexual stigma, discrimination experiences, and openness about one's sexual orientation), perceived social support, and sexualized drug use (also more prevalent in sexual minorities). We adjusted for gender, age, sexual orientation, and the frequency of sexual behaviors. Cisgender sexual minority participants (n = 198, 72.7% men, 27.3% women; Mage = 27.13, SD = 7.78) completed an online survey. We conducted a two-step linear regression. In the first step, we introduced sociodemographic variables and the frequency of sexual activities. In the second step, we placed the predictors of main interest: perceived social support, minority stress measures, and the frequency of sexualized drug use. Our results showed that social support was negatively related to CSBD, while experiences of discrimination due to sexual orientation and engagement in sexualized drug use were associated with higher CSBD symptom severity. Internalized sexual stigma related to greater PPU severity. The discussed relationships were weak to moderate in strength. Implications of current results for therapy and diagnosis of CSBD in sexual minorities are discussed. The role of minority stressors and other factors specific to sexual minorities requires further exploration to design well-suited therapeutic interventions.

Effectiveness of emotion regulation strategies measured by self-report and EMG as a result of strategy used, negative emotion strength and participants' baseline HRV

We investigated how emotion regulation (ER) effectiveness-on both a self-reported rating as well as emotional expression (corrugator supercilii muscle activity) level-is affected by the characteristics of the situation (low vs. high negativity), the strategy used (reinterpretation, distraction, suppression, no regulation control condition) and individual dispositions (low vs. high baseline Heart Rate Variability) as well as their interaction. For this purpose, 54 adult women participated in a laboratory study. All the included factors significantly influenced both corrugator activity and appraisals of pictures' negativity (in specific experimental conditions). For example, for high HRV participants, (1) distraction, suppression and reinterpretation significantly decreased corrugator activity compared to the control condition, and (2) distraction decreased appraised picture negativity for high negativity photos. For low HRV participants, distraction and suppression were most effective in decreasing corrugator responses, while suppression was more effective than reinterpretation in decreasing perceived picture negativity in the high negativity condition. Subjectively reported effort and success in applying ER strategies were also dependent on manipulated and dispositional factors. Overall, our results lend support to the flexible emotion regulation framework, showing that emotion regulation effectiveness relies on situational context as well as individual dispositions and their interaction.

Hypo- or hyperfunction? Differential relationships between compulsive sexual behavior disorder facets and sexual health

BACKGROUND

Previous studies linking compulsive sexual behavior disorder (CSBD) and sexual health have shown mixed results, which could be due to the fact that different CSBD facets may have differential relationships with sexual functioning.

AIM

As CSBD is a multidimensional disorder, we wanted to investigate whether distinct CSBD domains are differentially related to sexual health.

METHODS

Two online studies were conducted-the first on a convenience sample (812 Polish participants; mean [SD] age, 22.07 [5.91] years) and a replication study on a representative sample of Polish adults (n = 1526; 43.02 [14.37]). Hierarchical regression was employed with sexual functioning as a predicted variable and CSBD symptoms as predictors.

OUTCOMES

The Compulsive Sexual Behavior Disorder Scale was used to assess CSBD symptoms, and the Arizona Sexual Experience Scale was used to measure sexual dysfunction.

RESULTS

In study 1, CSBD salience (β = -.20, P < .001) predicted hyperfunction (ie, stronger sex drive, easier sexual arousal, easier vaginal lubrication/penile erection, easier ability to reach an orgasm, and more satisfying orgasms). Yet, CSBD negative consequences (β = .15, P = .001) and dissatisfaction (β = .22, P < .001) predicted hypofunction (ie, weaker sex drive, more difficulties in sexual arousal, greater difficulties in vaginal lubrication/penile erection, less ability to reach an orgasm, and less satisfying orgasms). Similar results were found in study 2: salience (β = -.26, P < .001) and relapse (β = -.11, P = .004) predicted hyperfunction, while negative consequences (β = .12, P < .001) and dissatisfaction (β = .12, P < .001) predicted hypofunction.

CLINICAL IMPLICATIONS

Our results stress the importance of assessing the severity of each group of symptoms in patients with CSBD to better understand possible difficulties in their sexual functioning.

STRENGTHS AND LIMITATIONS

Our studies are the first to evaluate the effects of each CSBD domain on sexual health. We also replicated results obtained from a convenience sample on a representative sample. The cross-sectional design of the current studies does not allow causal relations to be tested, so future longitudinal research should be carried out. We also gathered data from a general population-thus, it is important to replicate these results on patients diagnosed with CSBD.

CONCLUSION

Our research points out the differential impact of CSBD domains on sexual health: salience and relapse are related to sexual hyperfunction, while negative consequences and dissatisfaction to hypofunction.

The Relation of Sexual Attitudes to Hypersexuality and Problematic Pornography Use

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 (M_age = 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.

Withdrawal and tolerance as related to compulsive sexual behavior disorder and problematic pornography use - Preregistered study based on a nationally representative sample in Poland

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.

The relation of perceived social support to compulsive sexual behavior

We conducted two studies to investigate the links between perceived social support, problematic pornography use (PPU) and compulsive sexual behavior disorder (CSBD). In Study 1 (n=807, convenience sample recruited via social media) we collected preliminary data and in Study 2 (n=1526) we checked whether the results replicate in a sample representative of the Polish adult population. In both studies participants completed the Brief Pornography Screen, Compulsive Sexual Behavior Disorder Scale and Multidimensional Scale of Perceived Social Support. In Study 1 and 2, general social support was a weak protective factor against CSBD (β = -0.15 and β = -0.10) and PPU (β = -0.12 and β = -0.09 respectively, all p values ≤ .001) adjusting for gender, age, sexual orientation and relationship status. The results for three domains of social support (from friends, significant other and family), however, largely differed between the two studies. In Study 1, perceived friends' support weakly protected against PPU and CSBD symptoms. In Study 2 higher support from friends weakly predicted lower CSBD symptoms among men; and stronger family support predicted lower PPU. Support from a significant other was weakly related to lower CSBD for women in Study 1. The conducted studies provided evidence that perceived social support is a protective factor against problematic sexual behavior; however, its predictive power is limited and further studies are needed to assess the importance of various domains of social support in the development of CSBD and PPU symptoms.

Perspective: Can psychedelic-assisted therapy be a promising aid in compulsive sexual behavior disorder treatment?

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.