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Perspectives on the assessment and treatment of adult ADHD in hypersexual men

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Abstract

This article reviews the current body of research on adult ADHD and hypersexual behavior. Drawing on perspectives from the fields of psychology and neuroscience, several suggestions are offered to explain why individuals with ADHD may be vulnerable to engaging in hypersexual behavior. Assessment guidelines are provided to help clinicians differentiate characteristics of hypersexuality from adult ADHD. Finally, recommendations are made for the treatment of adult ADHD in hypersexual patients.

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... ADHD leads to executive deficits, lower tolerance for boredom, and increased risk-taking. ADHD has been found to be a vulnerability factor for the development of addiction, particularly SA [17]. However, the association between SA and ADHD has been little explored to date. ...
... Additionally, patients with the combination of the two types of disorders are more likely to also have a substance use disorder than individuals with an anxiety disorder without ADHD [52]. Individuals with ADHD seek relief from their anxiety according to the self-medication hypothesis [17,53]. The same assumption could be made with SA. ...
... Furthermore, a history of addictive disorders was also associated with a history of probable ADHD. This is consistent with the literature: patients with SA compared to those without SA have more addictive disorders [17], as is also the case for those with ADHD compared to those without ADHD [15,16]. The association of ADHD and addictive disorders in patients with SA may also be explained by the self-medication hypothesis, with the addictive behaviour developing to cope with the symptoms and difficulties associated with ADHD [17,53]. ...
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Introduction: Since the first description of sex addiction (SA) by Carnes, research on this problematic behaviour has continued to grow, and the association with attention-deficit hyperactivity disorder (ADHD) appears to be frequent. This study aimed to estimate the frequency of a history of probable ADHD in a population of patients with SA and to explore the factors associated with it. Methods: One hundred 85 patients referred to the Nantes University Hospital for SA between 2011 and 2020 were included. Patients completed the Sexual Addiction Screening Test (SAST) or its revised version (SAST-R) to establish the presence of SA. As the SAST-R was not validated in French, we conducted a validation study for the French version. ADHD was screened using the Wender-Utah Rating Scale in childhood and the Adult ADHD Self-Report Scale in adulthood. A multivariate logistic regression model was used to identify factors associated with the presence of a history of probable ADHD. Results: Childhood ADHD was identified in 36% of patients with SA. Factors associated with the presence of a history of probable ADHD were a low education level, an earlier age of onset of problematic sexual behaviour, another addictive disorder, an anxiety disorder, impulsivity (high negative urgency score), and high scores on harm avoidance and novelty-seeking temperament scales. Furthermore, the French version of the SAST-R displayed good psychometric properties, especially excellent sensitivity. Conclusion: The frequency of a history of probable ADHD among patients with SA is consistent with the literature and close to the highest range. Specific personality traits in patients with both SA and a history of probable ADHD could induce lasting problems of adaptation, which may precipitate the development of SA or maintain it.
... Besides mood disorders and anxiety disorders [5,8,[18][19][20][21], attention deficit hyperactivity disorder (ADHD) is a highly comorbid disorder with hypersexuality: 17%-67% of individuals with hypersexuality reported some patterns of ADHD [21]. Fewer studies examined the associations of problematic pornography use and psychiatric disorders [22][23][24], but similar relationship patterns can be observed as mood disorders and anxiety disorders showed highly comorbidity with problematic pornography use [23]. ...
... Besides mood disorders and anxiety disorders [5,8,[18][19][20][21], attention deficit hyperactivity disorder (ADHD) is a highly comorbid disorder with hypersexuality: 17%-67% of individuals with hypersexuality reported some patterns of ADHD [21]. Fewer studies examined the associations of problematic pornography use and psychiatric disorders [22][23][24], but similar relationship patterns can be observed as mood disorders and anxiety disorders showed highly comorbidity with problematic pornography use [23]. ...
... Although high comorbidity can be observed between hypersexuality and adult ADHD symptoms, a relatively low number of studies examined their associations and even fewer aimed to identify why individuals with ADHD may be more vulnerable to develop hypersexuality than general populations [21]. Formerly, it was hypothesized that the hyperactive-impulsive aspect of ADHD may be a key as to why hypersexuality showed high comorbidity with ADHD as studies shows moderate, positive associations between impulsivity and hypersexuality [5][6][7][25][26][27]. ...
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Introduction: Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent comorbid disorders in hypersexuality; however, previous studies only examined the associations of ADHD and hypersexuality among men seeking treatment. Although problematic pornography use (PPU) might be considered the most frequent manifestation of hypersexuality, no previous research examined its association with ADHD symptoms. Aim: To (i) examine ADHD symptoms in relation to hypersexuality and PPU and (ii) identify possible similarities and differences in relationship with hypersexuality and PPU in a large, non-clinical sample between both sexes. Methods: Multi-group structural equation modeling was conducted to investigate the hypothesized associations among adult ADHD symptoms, hypersexuality, and PPU between men and women (N = 14,043 participants; women = 4,237; mean age = 33.5 years, SD = 10.9). Main Outcome Measures: Adult ADHD symptoms were assessed in relation to hypersexuality and PPU via self-reported measures. Results: Results indicated that hypersexuality had positive and moderate association with problematic pornography use among women (r[14041] = .50, p < .01) and positive and strong association among men (r[14041] = .70, p < .01). ADHD symptoms had positive and moderate associations with hypersexuality in both men and women (β = .50, p < .01; β = .43; p < .01; respectively). Regarding men, ADHD symptoms had a positive, moderate association with PPU (β = .45, p < .01), whereas ADHD symptoms had a positive, but weak, association with PPU in the case of women (β = .26, p < .01). Clinical Implications: When men have high levels of hypersexuality or PPU, ADHD should be assessed as a potential comorbid disorder. With regard to women, ADHD should be assessed as a potential comorbid disorder only in the case of hypersexuality. Strength & Limitations: Applying self-report methods have possible biases that should be taken into account when interpreting the present findings. However, the present study was conducted on a large community sample and examined the differentiated role of ADHD symptoms in hypersexuality and PPU, not only in men but also in women, that has never been addressed in the literature. Conclusion: ADHD symptoms might play an important role in the severity of hypersexuality between both sexes, whereas ADHD symptoms might only play a stronger role in PPU among men but not women. The findings corroborate previous results that PPU may not be unambiguously considered as a subcategory of hypersexuality. In addition, potential background mechanisms behind problematic pornography use should be examined separately between men and women.
... This study found a moderate and positive association between ADHD and PPU, which was slightly higher than in recent previous studies [18]. As suggested, pornography use might be a negative reinforcement for individuals with ADHD, since they may experience peer rejection, problems in romantic relationships, and employment difficulties, which may make them vulnerable to use pornography as a way of 'escaping' or 'avoiding' emotional discomfort [69]. Moreover, one of the potential reasons for the stronger association in this study compared to previous work [18] might relate to the different cultural context where the samples were recruited. ...
... Additionally, sensation seeking refers to the tendency to seek various novel, complex and arousing sensory stimulations, and openness toward new experiences [76]. There is evidence that the prefrontal cortex (PFC) is hyperactive in individuals with ADHD [77,78], which is linked to attention deficits and the difficulty of staying focused for a prolonged time, and the sensation seeking observed in ADHD was interpreted as an autoregulatory attempt to create a stimulating environment in order to stabilize vigilance, which may explain the higher need for sexual desire, masturbation, or viewing pornography in individuals with ADHD [69]. ...
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Investigating the relationship between attention-deficit/hyperactivity disorder (ADHD) symptoms and impulsivity will benefit our understanding of the concept of problematic pornography use (PPU), and revealing predisposing and malleable moderators of PPU will be beneficial for its prevention and intervention. The current study not only aimed to observe these relationships, but also explored the potential moderating role of physical exercise in the general population. A total of 600 Chinese adults (Mage = 32.31, SDage = 12.40, 39.8% women) were recruited and completed an online survey. The results showed that participants with regular exercise scored lower than those without exercise on ADHD, impulsivity, and PPU (all ps < 0.001). Using latent moderated structural equations (LMS), the findings revealed that the relationship between ADHD symptoms and PPU was mediated by impulsivity, and physical exercise moderated this relationship (B = −0.14, p = 0.048). Specifically, when individuals’ physical exercise was higher than 0.84 standard deviations above the mean, the positive predictive effect of impulsivity on PPU was not significant. These findings indicate the important role of impulsivity in the relationship between ADHD and PPU, and physical exercise could be a meaningful component of interventions among individuals experiencing PPU.
... Emotional distraction or suppression motivations were unrelated to the FPU but had a positive, weak association with PPU. This finding was in line with those in previous studies about problematic sexual behaviors (Reid et al., 2011;Wéry & Billieux, 2016) and with the self-medication hypothesis (Khantzian, 1997;Reid, Davtian, Lenartowicz, Torrevillas, & Fong, 2013); individuals may use pornography to reduce their negative feelings, which in turn may contribute to the severity of PPU. ...
... Motivations to reduce stress had positive, weak associations with the FPU, and they had the strongest positive associations with PPU. Stress reduction motivations may contribute similarly or to a higher degree to the development of PPU as emotional distraction or suppression, in line with a self-medication hypothesis (Khantzian, 1997;Reid et al., 2013). To summarize, pornography may seem an easily accessible, affordable, seemingly anonymous and fast way (Cooper, 1998;Young et al., 2000) to diminish stress, but it may also generate even more stress as a result of developing PPU. ...
Article
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Although pornography viewing is widespread among Internet users, no scales for measuring pornography use motivations (PUM) have been developed and psychometrically tested for use in general populations. The present work aimed to construct a measure that could reliably assess a wide range of PUM in nonspecific populations. Self-report data of 3 separate samples (N1 = 772 [51% women], N2 = 792 [6% women], N3 = 1,082 [50% women]) were collected and analyzed using confirmatory factor analysis, measurement invariance testing, and structural equation modeling (SEM). The most common PUM were identified based on a literature review and qualitative analysis (N1): sexual pleasure, sexual curiosity, emotional distraction or suppression, stress reduction, fantasy, boredom avoidance, lack of sexual satisfaction, and self-exploration. Items were constructed, and confirmatory factor analyses (N2 and N3) yielded strong psychometric properties. Further corroborating the structural validity of the Pornography Use Motivations Scale (PUMS), gender-based measurement invariance was tested, and associations of the frequency of pornography use (FPU), problematic pornography use (PPU), and PUM were examined. Men—compared to women—demonstrated higher scores on all motivations except for sexual curiosity and self-exploration. Based on the results of SEM, we found that sexual pleasure, boredom avoidance, and stress reduction motivations showed positive, weak-to-moderate associations with FPU. Motivations relating to stress reduction, emotional distraction or suppression, boredom avoidance, fantasy, and sexual pleasure had positive, weak-to-moderate associations with PPU. The PUMS is a reliable scale to assess the most common PUM in general populations.
... Pornography presents distorted portrayals of sexual relationships, which can misinform children about healthy sexual behavior [106,107], consent, and affect self-esteem and body image [108,109]. This is especially concerning for individuals with SEN, such as those with ADHD, who may be more prone to hypersexuality and compulsive pornography use [110][111][112]. This can in turn lead to psychological distress and damaged relationships [113][114][115]. ...
Article
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Children with special educational needs (SEN) experience developmental trajectories that require close attention, especially as they are highly vulnerable to sexual violence. Ensuring their well-being requires systemic attention to their needs. However, literature on children with SEN has critical limitations including insufficient focus on their sexual health education (SHE), inattention to parents’ perspectives, and a dearth of multilevel approaches to understanding SHE, particularly in conservative contexts like Malaysia. Using Bronfenbrenner’s Ecological Systems Theory, this study explored parents’ perspectives on SHE for their children with SEN across different layers of the socio-ecological environment. We interviewed 14 Malaysian parents of school-going children with SEN aged 4 to 24 years and conducted thematic analysis. At the individual level (child characteristics), we found that children with SEN receive unstructured and inconsistent SHE and are perceived as unready for SHE. At the microsystem level (family and school), parents displayed a belief-action gap towards SHE, and feared for their children’s sexual safety. The mesosystem (interactions between microsystems) highlighted the lack of teacher-parent collaboration in SHE delivery. Within the exosystem (external policies), parents noted a deficiency in stringent policies, leading parents to rely on unverified resources for SHE delivery. Finally, at the macrosystem level (cultural and societal influences), Malaysia’s diverse religious and cultural beliefs shape SHE implementation. This study emphasizes the importance of socio-cultural factors in SHE for children with SEN and stresses prioritizing their needs in policymaking and practice. It also calls for developing parent-centered programs and culturally tailored resources to improve parental awareness and knowledge.
... Finally, there appears to be a positive correlation between pornography addiction and conditions such as Attention-Deficit Hyperactivity Disorder (ADHD) (Reid et al., 2013;Zimbardo & Coulombe, 2016), depression (Weaver et al., 2011), anxiety (Voon et al., 2014), and even inclinations towards suicide (Zimbardo & Coulombe, 2016). The act of consuming pornography can become compulsive and uncontrollable for some individuals. ...
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This study aims to develop the Online Pornography Addiction Scale (OPAS) using the behavioral addiction model and to explore the relationships between the scale, demographic variables, psychosocial variables, and pornography viewing behaviors. Two studies were conducted, the first of which involved two phases. The findings from Study 1a and Study 1b reveal that the OPAS comprises 23 items organized into four sub-scales: Compulsiveness-Uncontrollability, Psychosocial Effects, Sexual Effects, and Tolerance-Withdrawal. Overall, the scale demonstrates consistency and reliability. The results of Study 2 indicate that the OPAS correlates with gender, access to professional support, levels of hopelessness, communication with partners, degree of religious affiliation, engagement with sexual videos, frequency of pornography consumption, time devoted to pornography viewing, longest duration without pornography, impact of pornography on sexual experiences, and influence of pornography on daily life. Communication with partners of the opposite sex, engagement with sexual videos, impact on daily life, and religious affiliation levels are also significant predictors of the OPAS score. These findings are discussed in relation to relevant literature.
... Moreover, among the various psychopathological vulnerability factors related to PPU and the influence of psychopathological symptoms in its development, studies have been conducted mainly on compulsive sexual behavior disorder (CSBD) (ICD-11, WHO, 2019), hypersexual disorder (HD) (Draft of the DSM-5, American Psychological Association [APA], 2013), or sexual addiction. These studies have shown the presence of psychiatric comorbidities of PPU, especially anxiety and depressive symptomatology (Ballester-Arnal, Castro-Calvo, Giménez-García, Gil-Juliá, & Gil-Llario, 2020;Chiclana, Contreras, Carriles, & Rama, 2015;Wéry, Vogelaere, et al., 2016), attention-deficit/hyperactivity disorder (ADHD) (Blankenship & Laaser, 2004;Reid, Carpenter, & Hook, 2016;Reid, Davtian, Lenartowicz, Torrevillas, & Fong, 2013;Walton, Cantor, & Lykins, 2017), and obsessive-compulsive disorder (OCD) (Fuss, Briken, Stein, & Lochner, 2019;Levi et al., 2020). Thus, these disorders are considered risk factors for the development of problematic sexuality (Reid et al., 2012;Wéry & Billieux, 2017). ...
Article
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Background and aims: Risk factors for problematic pornography use (PPU) need targeted studies. This study aims to examine sociodemographic and psychopathological factors that may predict PPU. Methods: 1,001 French adults (Mage = 25.56) were assessed via an online survey. Results and discussion: Male gender, attention-deficit/hyperactivity (ADHD) and obsessivecompulsive (OCD) symptoms are significant predictors of PPU. The tendency toward impulsivity of people with ADHD symptoms and the tendency toward compulsivity of people with OCD symptoms could explain their link with PPU. Conclusions: As sexual addiction, PPU lies on the impulsive–compulsive scale and could be classified as a behavioral addiction.
... Approximately 50% of individuals with compulsive sexual behaviors report some types of psychiatric disorders besides CSBD (Kraus et al., 2016b), with mood disorders (31%-72%), anxiety disorders (33%-47%), attention deficit hyperactivity disorder (17%-67%), and substance use disorder (14%-41%) being the most commonly reported ones (Blankenship & Laaser, 2004;Kafka & Hennen, 2002;Raymond, Coleman, & Miner, 2003;Reid, 2007;Reid, Carpenter, Gilliland, & Karim, 2011;Reid, Davtian, Lenartowicz, Torrevillas, & Fong, 2013;Scanavino et al., 2013;, while only 10% of self-diagnosed individuals with CSBD report any type of personality disorder (Raymond et al., 2003). Similarly, mood disorders (71%), substance use disorders (41%), and anxiety disorders (40%) were reported to be the most prevalent among problematic pornography users; while for example, attention deficit hyperactivity disorder was reported only by 3% of the participants in a sample of treatment-seeking men (Bőthe, Koós, Tóth-Király, Orosz, & Demetrovics, 2019;Grubbs et al., 2015;Kraus, Potenza, Martino, & Grant, 2015;Willoughby, Busby, & Young-Petersen, 2019;Willoughby, Carroll, Nelson, & Padilla-Walker, 2014). ...
Chapter
The present chapter addresses the many faces of cybersex and describes the mental health challenges of various sexual activities using new technologies. This includes a range of sexual behaviors, from Internet use to sex with robots. In many cases, cybersex use is not problematic and not associated with personal distress or functional impairment. However, in those cases where people lose control over their cybersexual behavior or harm others we discuss diagnostic criteria as well as differential diagnoses and ways to evaluate the given behavior. The chapter also addresses the current state of research regarding the psychobiology as well as pharmacological and psychotherapeutic treatment options of cybersexual behaviors that are associated with mental health issues.
... This is surprising as the data does not support the general idea that the impulsivity and hyperactivity of ADHD have a strong influence on hypersexual behaviour. One can speculate that the hypoactivity of the prefrontal cortex (PFC), found in individuals with ADHD (Hoogman et al., 2017;Rubia et al., 2014), which is linked to attention deficits and to the difficulty to stay focused for a prolonged time may also explain the higher need for sexual desire, masturbation, or viewing pornography, all distracting stimuli (Reid et al., 2013). Studies that may support this hypothesis are those showing increased activation in the inferior frontal areas in patients with hypoactive sexual desire disorder (HSDD) which suggested that greater activity in the brain areas mediated inhibitory executive control, self-focus attention, and judgments about one's own subjective experience. ...
Article
Subjects with ADHD suffer from inattention, hyperactivity, and impulsivity. Clinicians often assume that specific symptoms of ADHD are bound to affect sexual desire by increasing the frequency of hypersexuality. There is a lack of knowledge about the comorbidity between ADHD, hypersexuality, and paraphilias. The aim of this article was to provide a review of the literature on the association of ADHD and hypersexuality and paraphilias and to discuss the screening and the management of these syndromes when associated with ADHD. A systematic review of the literature was performed in PubMed, PsychInfo, and Embase databases. The studies reviewed show that some individuals who suffer from ADHD report hypersexuality and paraphilias, but no clear data emerged supporting the idea that hypersexuality and paraphilias are more frequent in an ADHD population. On the other hand, some studies showed a high prevalence of ADHD in hypersexual and paraphilic subjects. This is the first systematic review of hypersexuality and paraphilias in individuals with ADHD. However, the results are limited by differences in the methodology and measurement instruments for hypersexuality and paraphilias as well as by the small number of studies and the small sample sizes of many studies.
... 84 Moreover, the variation of sexual dysfunction with intimate partners as well as pornography among the current sample was high, suggesting significant heterogeneity within the PPU sample itself, 85 thereby highlighting the need to investigate PPU's aetiological underpinnings. 85,86 ...
Article
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Background Although problematic pornography use (PPU) will soon be diagnosable through the International Classification for Diseases, 11th revision, its clinical profile remains contentious. The current study assessed whether PPU may be characterized by various symptoms sometimes observed among online recovery forums that currently lack empirical assessment, such as heightened cognitive-affective issues following pornography use and sexual dysfunction with partners as a result of escalating use. Method Cross-sectional surveys were completed by male PPUs ( N = 138, mean age = 31.75 years, standard deviation = 10.72) recruited via online recovery communities and Amazon Mechanical Turk. Multiple regression analysis was performed using the Problematic Pornography Use Scale as the dependent variable and variables of interest (Arizona Sexual Experiences Scales modified for partnered sex and pornography use, Brunel Mood Scale, Social Interaction Anxiety Scale, and the Tolerance subscale from the Problematic Pornography Consumption Scale) and potential confounders (eg, comorbid psychopathology) as independent variables. Results Current levels of pornography use, indicators of tolerance and escalation, greater sexual functioning with pornography, and psychological distress were uniquely associated with PPU severity, while cognitive-affective issues after pornography use, impulsivity and compulsivity were not. Although sexual dysfunction did not predict PPU severity, nearly half the sample indicated sexual dysfunction with intimate partners. Conclusions The present findings suggest that PPU may be characterized by tolerance and escalation (as per substance addiction models), greater sexual responsivity toward pornography, and psychological distress. Meanwhile, the high rate of partnered sexual dysfunction observed suggests that PPU might be somewhat separable from other forms of compulsive sexual behavior.
... Besides the aforementioned potential adverse consequences, high rates of other psychological and psychiatric problems were reported concerning PPU. Mood disorders (31-72%), anxiety disorders (33-47%), substance use disorders (14-41%), and attention deficit hyperactivity disorder (ADHD) (3-67%) are reported to be comorbid and prevalent among problematic pornography users or individuals with CSBD (Blankenship & Laaser, 2004; B} othe, Ko os, T oth-Kir aly, Orosz, & Demetrovics, 2019; Grubbs, Volk, Exline, & Pargament, 2015;Kafka & Hennen, 2002;Kraus, Potenza, Martino, & Grant, 2015;Nelson, Padilla-Walker, & Carroll, 2010;Raymond, Coleman, & Miner, 2003;Reid, 2007;Reid, Carpenter, Gilliland, & Karim, 2011;Reid, Davtian, Lenartowicz, Torrevillas, & Fong, 2013;Scanavino et al., 2013;W ery et al., 2016;Willoughby, Busby, & Young-Petersen, 2019;Willoughby, Carroll, Nelson, & Padilla-Walker, 2014). Nevertheless, evidence-based treatments offered for problematic pornography have remained scarce worldwide. ...
Article
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Background and aims: The past-year prevalence of problematic pornography use (PPU) was 1-6% in adult populations. As a result of treatment obstacles and barriers, such as unaffordable treatments, only a minority of problematic pornography users may seek treatment. Having a free, online, self-help program may overcome treatment barriers and may help those individuals who cannot receive traditional or offline treatment for PPU. Although the effectiveness of such online programs reducing substance use and problematic gambling have been reported, no prior study has examined the efficacy of an online self-help intervention aiming to reduce PPU. Methods: This two-armed randomized controlled trial (RCT) will examine the effectiveness of an online self-help program (Hands-off) to reduce PPU, while also considering psychopathological comorbidities. The six-week intervention condition includes six core modules developed to reduce PPU based on motivational interviewing, cognitive behavioral therapy, mindfulness, and wise social-psychological intervention techniques. The target sample size is 242 participants. Self-report questionnaires will be administered at baseline, right after the end of the intervention, at one-month, and three-month follow-ups after the end of the intervention. The primary outcome will be the level of PPU. Secondary outcomes will include pornography use frequency, pornography craving, pornography use-avoidance self-efficacy, sex mindset, sexual satisfaction, negative and positive emotions, and life satisfaction. Data will be analyzed on an intention-to-treat basis using linear mixed models. Results: Results will be reported at conferences and published in a scientific peer-reviewed journal. The participants will be sent a lay-person-friendly summary of the results via e-mail.
... As theses exclusion criteria might limit the generalizability of our results to a broader population, the findings of this study must be interpreted with caution. Another potential limitation in this study was the lack of a control group consisting of adults with attention deficit hyperactivity disorder (ADHD), which has been reported as a common co-occurring diagnosis in approximately 25% of hypersexual men (Reid, Davtian, Lenartowicz, Torrevillas, & Fong, 2013). Given that response inhibition has been commonly observed in the ADHD population, it is plausible that our findings may be attributable to ADHD rather than hypersexuality per se. ...
Article
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Background and aims Individuals with problematic hypersexual behavior (PHB) are unable to control their sexual cravings, regardless of other situational factors. This inability to control cravings is a common trait in patients with neurological pathologies related to response inhibition. Until recently, however, it was unclear whether individuals with PHB have decreased inhibition and altered neural responses in the brain regions associated with inhibition compared to healthy control individuals, especially in the presence of distracting sexual stimuli. In this study, we examined the neural and psychological underpinnings of inhibition in individuals with PHB. Methods Thirty individuals with PHB and 30 healthy subjects underwent functional magnetic resonance imaging while performing a modified go/no-go task with neutral or sexual backgrounds used as distractors. Results Individuals with PHB showed poorer response inhibition than healthy subjects, especially when sexual distractors were present. Further, compared to healthy control subjects, individuals with PHB showed decreased activation in the right inferior frontal gyrus (IFG) and reduced functional connectivity between the IFG and the pre-supplementary motor area (preSMA) when response inhibition was required. Finally, the reduced activation and connectivity were more pronounced in the presence of sexual distractors than in the presence of neutral distractors. Discussion These findings suggest that individuals with PHB show reduced ability to inhibit responses that might be related to lower IFG activation and IFG-preSMA connectivity during response inhibition. Our results provide insights into the neurobiological underpinnings of poor response inhibition in individuals with PHB.
... We suggest that clinicians assess possible emotional abuse and neglect, as well as sexual abuse in men with HD. Moreover, our data show that symptoms of comorbid adult ADHD were increased in men with HD and it has been suggested that these patients are likely to benefit from pharmacotherapy and behavioral therapy combined [75]. As a reduction of the use of dysfunctional emotion regulation strategies was seen in our sample, a cognitive-behavioral therapy should also focus on dysphoric mood states and impulsivity in men with HD [76]. ...
... Reid [29] have shown that individuals with ADHD were more likely to be in the contemplation stage than subjects presenting with alternative diagnoses, indicating ambivalence about treatment. Reid et al. [30] have further reviewed the explanations for the observation that individuals with ADHD may be vulnerable to engaging in compulsive sexual behavior. In their view, many of the associated characteristics of ADHD, such as increased peer rejection, problems in romantic relationships and employment difficulties, may make them vulnerable to CSB as a way of 'escaping' or 'avoiding' emotional discomfort. ...
Article
Background: There is a high rate of ADHD among individuals with compulsive sexual behavior disorder (CSBD). There is also evidence for an association between compulsive sexual behavior disorder, sensation seeking and attachment difficulties. Problematic pornography use may be considered as a subtype of CSBD hence it merits investigation. The aim of the current study was to investigate the relationships between ADHD, attachment style, sensation seeking and problematic use of pornography online in the general population. Methods: The sample was comprised of 85 participants [38 men (44.7%) and 47 women (55.3%)] with mean age 25. 66 (SD = 4.63) and 26.42 (SD = 6.94) years, respectively. There were 30 participants (35%) with ADHD and 55 participants (65%) without ADHD. They were recruited on-line via social network sites. They filled in a demographic questionnaire, Zukerman's Sensation Seeking Scale, Experience in Close Relationship (ECR) questionnaire that assessed anxious and avoidant attachment and the Cyber Pornography Use Inventory (CPUI). Results: Individuals with self-reported ADHD had higher scores of avoidant attachment on the ECR and CPUI compared with individuals without ADHD. Multivariate linear regression analysis has indicated that male gender, ADHD and anxious attachment on the ECR contributed significantly to the variance of cyber pornography use, and explained 34% of the variance. Conclusions: The results indicate that males with ADHD and anxious attachment show an extensive use of pornography online. Males with ADHD who have difficulties in close relationship may use online pornography excessively that in turn may exacerbate their difficulty in forming secure attachment at adult life, a finding that has major clinical implications.
... We suggest that clinicians assess possible emotional abuse and neglect, as well as sexual abuse in men with HD. Moreover, our data show that symptoms of comorbid adult ADHD were increased in men with HD and it has been suggested that these patients are likely to benefit from pharmacotherapy and behavioral therapy combined [75]. As a reduction of the use of dysfunctional emotion regulation strategies was seen in our sample, a cognitive-behavioral therapy should also focus on dysphoric mood states and impulsivity in men with HD [76]. ...
Article
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Problems arising from hypersexual behavior are often seen in clinical settings. We aimed to extend the knowledge about the clinical characteristics of individuals with hypersexual disorder (HD). A group of people who fulfilled the proposed diagnostic criteria for HD (men with HD, n = 50) was compared to a group of healthy controls (n = 40). We investigated differences in sociodemographic, neurodevelopmental, and family factors based on self-report questionnaires and clinical interviews. Men with HD reported elevated rates of sexual activity, paraphilias, consumption of child abusive images, and sexual coercive behavior compared to healthy controls. Moreover, rates of affective disorders, attachment difficulties, impulsivity, and dysfunctional emotion regulation strategies were higher in men with HD. Men with HD seem to have experienced various forms of adverse childhood experiences, but there were no further differences in sociodemographic, neurodevelopmental factors, and family factors. Regression analyses indicated that attachment-related avoidance and early onset of masturbation differentiated between men with HD and healthy controls. In conclusion, men with HD appear to have the same neurodevelopment, intelligence levels, sociodemographic background, and family factors compared to healthy controls, but they report different and adverse experiences in childhood, problematic sexual behavior, and psychological difficulties.
... The model must go beyond reinventing new terms for existing constructs and elucidate how such terminology diverges from commonly understood concepts. For example, Walton et al. (2017) introduce cognitive abeyance as part of their model but it is unclear how this term is substantially different from that of cognitive dissociation or a model of attention (or attention bias) that may be focused, or inhibited, on a given stimulus depending on its salience-something that has been proposed elsewhere as an attentional model of hypersexual behavior (Reid,Davtian,Lenartowicz,Torrevillas,& Fong, 2013). Whileresearchcanhighlightwhichisthemoreparsimonious model,nothingisdescribedaboutthemechanismofactionassociated with cognitive abeyance or how such a mechanism exerts itseffectsonhypersexualbehaviordifferentlyfrommechanisms described in the vast array of existing research about attentional networks or even models of impulsivity. ...
... Although a full review of research correlating (or failing to correlate) IP use with social and personal problems is beyond the scope of this paper, existing studies associate IP use with greater anxiety (Voon et al., 2014), shyness (Luster, Nelson, Poulsen, & Willoughby, 2013), depression (Weaver et al., 2011), poorer academic performance (Beyens, Vandenbosch, & Eggermont, 2015), ADHD (Reid, Davtian, Lenartowicz, Torrevillas, & Fong, 2013), and relationship dissatisfaction (Morgan, 2011). Researchers have also linked IP use with arousal, attraction, and sexual performance problems, including difficulty orgasming and erectile dysfunction (ED) (Sutton, Stratton, Pytyck, Kolla, & Cantor, 2015;Wéry & Billieux, 2016;Voon et al., 2014, Porto, 2016, negative effects on partnered sex (Poulsen, Busby, & Galovan, 2013;Sun, Bridges, Johnason, & Ezzell, 2014), a need for stronger pornographic material (Wéry & Billieux, 2016), and a preference for using IP to achieve and maintain arousal rather than having sex with a partner (Sun, Miezan, Lee, & Shim, 2015). ...
Article
There’s growing evidence that today’s streaming pornography videos are sui generis, with unique properties such as inexhaustible sexual novelty at a swipe, effortless escalation to more extreme material, and accessibility by youthful viewers, and that these unique properties are giving rise to severe symptoms in some consumers. Formal research on internet pornography (IP) has thus far failed to illuminate the phenomenon adequately. The usual correlation studies cannot establish which related factor causes another (or whether an effect is bi-directional). Yet establishing causation is critically important lest symptoms caused by IP overuse be confounded with evidence of psychological traits and indications of mental disorders. The most effective way to reveal the effects of IP is to ask study participants to give up IP use for an extended period and compare them with controls. A possible research design is described.
... Also excluded were (i) results from studies examining medically induced hypersexuality from dopaminergic therapy to relieve motor manifestations in Parkinson disease and (ii) hypersexuality resulting from (hypo)manic episodes in bipolar disorder. However, because attention-deficit/hyperactivity disorder, 26 substance use disorders, 8 and mood and anxiety disorders 27 are often comorbid with hypersexuality, they were included. Paraphilic hypersexuality studies were included only when researchers explicitly contrasted it with non-paraphilic hypersexuality. ...
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Introduction: Despite the rejection of hypersexual disorder (HD) as a new diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), clinical and research interest in HD continues. Aim: To systematically review the existing scientific literature on the conceptualization and assessment of HD and out-of-control sexual behavior. Methods: Studies were identified from PsychInfo, PubMed, JSTOR, Google Scholar, and Scholar's Portal using an exhaustive list of key terms. Of 299 total articles identified and screened, 252 were excluded, and 47 are included in this review. Main outcome measures: To review two categories of articles: HD conceptualization and HD psychometric assessment. Results: First, results of the review of theoretical conceptualizations of HD reflected a large proportion of the peer-reviewed literature devoted to discussing conceptualizations of HD without reaching consensus. Second, results of the review of HD psychometric assessments were analyzed using Hunsley and Mash's (2008) criteria to evaluate psychometric adequacy of evidence-based assessment measurements. The six most researched measurements of HD were evaluated, including the Hypersexual Disorder Screening Inventory, the Hypersexual Behavior Inventory, the Sexual Compulsivity Scale, the Sexual Addiction Screening Test, the Sexual Addiction Screening Test-Revised, and the Compulsive Sexual Behavior Inventory. Psychometric properties of the scales are reviewed, evaluated, and discussed. Conclusion: The Hypersexual Disorder Screening Inventory, the measurement proposed for the clinical screening of HD by the DSM-5 workgroup, currently has the strongest psychometric support. Future research and clinical directions are discussed in light of findings after the literature review and synthesis. Montgomery-Graham S. Conceptualization and Assessment of Hypersexual Disorder: A Systematic Review of the Literature. Sex Med Rev 2017;5:146-162.
... For example, many studies examining the neurobiological mechanisms or substrates associated with hypersexual behavior neglect to control for adult attention deficit hyperactive disorder (ADHD) as a possible confound [6]. This is especially disconcerting, given that prevalence rates for ADHD in this population range from 23 to 28% [7]. Subsequently, it is difficult to know whether hypersexual behavior constitutes a distinct construct or whether it is a manifestation of existing pathology, such as impulsive behavior common among individuals with ADHD. ...
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While progress has been made towards classifying compulsive sexual behavior as an addiction, the field needs to bring greater clarity to creating uniform definitions of this construct, applying research that controls for confounds and establishing divergent validity from related psychiatric phenomena such as paraphilic disorders.
... Deficient inhibition of prepotent behavior assessed using Bstop-signal^tasks has been associated with attention-deficit hyperactivity disorder and trait impulsivity [43,44]. Interestingly, ADHD has also been linked to hypersexuality with approximately 23 % of treatment-seeking patients meeting criteria for an inattentive presentation [45]. Impulsivity in drug users has been linked to increased discounting of delayed large rewards in favor of immediate small rewards [46]. ...
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Hypersexual behavior is an emerging construct that is receiving increased attention from both clinicians and researchers. Several theoretical perspectives exist about hypersexuality and its associated characteristics. Although the role of impulsivity and how it might be linked to hypersexuality are still being investigated, this article attempts to highlight some of the important concepts related to impulsivity and how they differ from compulsivity. Findings from the field of neuroscience and psychology are integrated to give readers a broader perspective about existing perspectives about the etiology and mechanisms that might link impulsivity with hypersexual behavior. A theoretical model of sexuality impulsivity among hypersexual individuals is discussed, and we conclude by offering some future possibilities for researchers attempting to understand this construct.
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Development of sexual identity during adolescence is a major process of transition in individual life which in cases of ADHD specifically interacts with other ontogenetic, pathological and psychosocial conditions. According to recent findings growing consumption of internet pornography mainly in male ADHD population is closely related to compulsive sexual behavior and hypersexuality. Recent findings also indicate that consumption of internet pornography in ADHD individuals and other sexual activities may serve as a mood-altering “self-medication” which may help to cope with stressful events and decrease depression and anxiety. Taken together recent findings indicate that internet pornography consumption mainly in ADHD individuals is closely related to stressful experiences, anxiety, depression and identity problems in partnerships which significantly increase their vulnerability to the so-called “problematic pornography use” and other forms of addictive sexual behavior. From this developmental perspective “problematic pornography use” in ADHD individuals represents significant epidemiological problem which requires further research mainly with focus on clinical diagnostics and treatment.
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Children with autism spectrum disorder frequently exhibit inappropriate sexual behaviors, such as excessive masturbation. However, research on the control and management of excessive masturbation in these children is very limited. In this presentation, excessive masturbation that responded to treatment with methylphenidate is described in a young boy diagnosed with autism spectrum disorder and comorbid attention deficit hyperactivity disorder.
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Background Pornography use may become problematic for 1–6% of the people and may be associated with adverse consequences leading to treatment-seeking behavior. Although the identification of the central symptoms of problematic pornography use (PPU) may inform treatment strategies, no prior study has applied the network approach to examine the symptoms of PPU. Aim To explore the network structure of PPU symptoms, identify the topological location of pornography use frequency in this network, and examine whether the structure of this network of symptoms differs between participants who considered and those who did not consider treatment. Methods A large-scale online sample of 4,253 men (Mage = 38.33 years, SD = 12.40) was used to explore the structure of PPU symptoms in 2 distinct groups: considered treatment group (n = 509) and not-considered treatment group (n = 3,684). Outcomes Participants completed a self-report questionnaire about their past-year pornography use frequency and PPU measured by the short version of the Problematic Pornography Consumption Scale. Results The global structure of symptoms did not differ significantly between the considered treatment and the not-considered treatment groups. 2 clusters of symptoms were identified in both groups, with the first cluster including salience, mood modification, and pornography use frequency and the second cluster including conflict, withdrawal, relapse, and tolerance. In the networks of both groups, salience, tolerance, withdrawal, and conflict appeared as central symptoms, whereas pornography use frequency was the most peripheral symptom. However, mood modification had a more central place in the considered treatment group’s network and a more peripheral position in the not-considered treatment group’s network. Clinical Implications Based on the results of the centrality analysis in the considered treatment group, targeting salience, mood modification, and withdrawal symptoms first in the treatment may be an effective way of reducing PPU. Strengths & Limitations The present study appears to be the first to analyze the symptoms of PPU using a network analytic approach. Self-reported measures of PPU and pornography use frequency might have introduced some biases. Conclusion The network of PPU symptoms was similar in participants who did and those who did not consider treatment because of their pornography use, with the exception of the mood modification symptom. Targeting the central symptoms in the treatments of PPU seems to be more effective than focusing on reducing pornography use. Bőthe B, Lonza A, Štulhofer A, et al. Symptoms of Problematic Pornography Use in a Sample of Treatment Considering and Treatment Non-Considering Men: A Network Approach. J Sex Med 2020;XX:XXX–XXX.
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Purpose of Review: Here we review potential therapeutic approaches for treating compulsive sexual behaviors (CSB; also known as hypersexual disorder).We present the therapeutic goals of several psychological and, pharmacological treatment approaches, and state of the research on their effectiveness. Recent Findings: To date, no systematic studies with control groups have been conducted in the field of CSB treatment; however, there are documented case studies and small-sample studies indicating potential effectiveness of pharmacological treatment with naltrexone and SSRIs as well as mindfulness, CBT, and 12-step-based treatment approaches. Summary: There is a whole field of CSB treatment waiting for systematic scientific investigation. Future research on CSB treatment should take in account a possibility of individual differences in psychological and neural mechanisms underlying CSB and help inform optimal selection of treatment modality for each patient.
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Review of the current state with respect to DSM-5 proposal for hypersexual disorder.
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Research on nonparaphilic hypersexual behavior has increased in recent years. In the present article, the authors conducted a methodological review of empirical studies that evaluated a treatment for nonparaphilic hypersexual behavior. The authors reviewed several characteristics of the extant studies, including the participants, research designs, treatments evaluated, assessment of nonparaphilic hypersexual behavior, and outcomes. Despite several attempts to explore treatments aimed at attenuating the symptoms of nonparaphilic hypersexual behavior, the findings from this review indicate that much of the outcome research in the field contains significant methodological limitations. The authors conclude by offering recommendations to enhance future outcome research among investigators working with hypersexual populations.
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Two studies examined the correlational relationships between self-reported mindfulness and impulsivity in samples of 347 and 227 university students. Using multidimensional measures of both mindfulness and impulsivity, results from both studies indicate that several aspects of mindfulness are negatively correlated with elements of impulsivity, even after controlling for trait-level negative affect in Study 1 and current general distress in Study 2. However, the relationships between different facets of mindfulness and types of impulsivity varied in strength and significance level. These results suggest that mindfulness skills may be related to the ability to refrain from maladaptive impulsive behavior in the presence of negative affect or distress and that specific mindfulness skills may be most helpful in addressing different types of impulsive behaviors.
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This study used the Symptom Checklist to examine the psychological symptom patterns among hypersexual patients (n = 59) at intake compared to a control group of non-hypersexual individuals (n = 55). Group membership for the hypersexual group was assigned based on the individual's chief complaint at intake and on elevated scores on the Hypersexual Behavior Inventory. A discriminant function analysis of between-group differences was statistically significant and post-hoc univariate tests revealed several distinct features associated with the hypersexual group compared to the controls. These findings are discussed in the context of treatment implications for clinicians working with patients seeking help for hypersexual behavior.
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Review of the current state with respect to DSM-5 proposal for hypersexual disorder.
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Men and women have been seeking professional assistance to help control hypersexual urges and behaviors since the nineteenth century. Despite that the literature emphasizes that cases of hypersexuality are highly diverse with regard to clinical presentation and comorbid features, the major models for understanding and treating hypersexuality employ a "one size fits all" approach. That is, rather than identify which problematic behaviors might respond best to which interventions, existing approaches presume or assert without evidence that all cases of hypersexuality (however termed or defined) represent the same underlying problem and merit the same approach to intervention. The present article instead provides a typology of hypersexuality referrals that links individual clinical profiles or symptom clusters to individual treatment suggestions. Case vignettes are provided to illustrate the most common profiles of hypersexuality referral that presented to a large, hospital-based sexual behaviors clinic, including: (1) Paraphilic Hypersexuality, (2) Avoidant Masturbation, (3) Chronic Adultery, (4) Sexual Guilt, (5) the Designated Patient, and (6) better accounted for as a symptom of another condition.
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Symptoms of childhood attention-deficit/hyperactivity disorder (ADHD) can persist into adulthood, although the majority of adults remain undiagnosed and untreated. Untreated ADHD can adversely affect school and work achievements, diminish self-confidence, damage interpersonal relationships, and significantly reduce quality of life. Psychologists can contribute significantly to meeting the need for diagnosis and treatment of adults with ADHD. Diagnosis is complicated; current guidelines were originally developed for diagnosing children, and symptoms are expressed differently in adults. In addition, many adults with ADHD have comorbid psychiatric disorders with overlapping symptoms. Correctly diagnosing ADHD requires a multifaceted approach to determine the chronicity, pervasiveness, and impairment critical to diagnosis. Psychologists can also focus therapy on changing environmental conditions, both internally and externally. A “difference” model, rather than a “defect” model, may empower participation in treatment medically and behaviorally. Collaboration with physicians to monitor responses to medicine—positive and adverse—during pharmacotherapy can improve the success of and adherence to treatment. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Introduction. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for hypersexual disorder (HD) have been proposed to capture symptoms reported by patients seeking help for out-of-control sexual behavior. The proposed criteria created by the DSM-5 Work Group on Sexual and Gender Identity Disorders require evaluation in a formal field trial. Aim. This DSM-5 Field Trial was designed to assess the reliability and validity of the criteria for HD in a sample of patients seeking treatment for hypersexual behavior, a general psychiatric condition, or a substance-related disorder. Method. Patients (N = 207) were assessed for psychopathology and HD by blinded raters to determine inter-rater reliability of the HD criteria and following a 2-week interval by a third rater to evaluate the stability of the HD criteria over time. Patients also completed a number of self-report measures to assess the validity of the HD criteria. Main Outcome Measures. HD and psychopathology were measured by structured diagnostic interviews, the Hypersexual Behavior Inventory, Sexual Compulsivity Scale, and Hypersexual Behavior Consequences Scale. Emotional dysregulation and stress proneness were measured by facets on the NEO Personality Inventory—Revised. Results. Inter-rater reliability was high and the HD criteria showed good stability over time. Sensitivity and specificity indices showed that the criteria for HD accurately reflected the presenting problem among patients. The diagnostic criteria for HD showed good validity with theoretically related measures of hypersexuality, impulsivity, emotional dysregulation, and stress proneness, as well as good internal consistency. Patients assessed for HD also reported a vast array of consequences for hypersexual behavior that were significantly greater than those diagnosed with a general psychiatric condition or substance-related disorder. Conclusions. The HD criteria proposed by the DSM-5 Work Group on Sexual and Gender Identity Disorders appear to demonstrate high reliability and validity when applied to patients in a clinical setting among a group of raters with modest training on assessing HD. Reid RC, Carpenter BN, Hook JN, Garos S, Manning JC, Gilliland R, Cooper EB, McKittrick H, Davtian M, and Fong T. Report of findings in a DSM-5 Field Trial for hypersexual disorder. J Sex Med 2012;9:2868–2877.
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Mindfulness may be conceptualised as a dispositional trait which differs across individuals. Previous research has independently identified both attachment security and emotion regulation abilities as correlates of dispositional attachment. We investigated the relationship between the three concepts in a sample of 192 participants who had previously had no mindfulness training. Participants completed the Five Factor Mindfulness Questionnaire (FFMQ), the Experiences in Close Relationships Scale-Revised (ECR-R) and the Difficulties in Emotion Regulation Scale (DERS) online. Exploratory factor analysis revealed a 2-factor solution accounting for 52% of the variance across scores on these measures. The first factor accounted for 36% of the variance and loaded highly on emotion regulation and mindfulness subscales. The second factor accounted for 16% of the variance and loaded highly on emotion regulation, attachment and mindfulness subscales. We called the first factor ‘conscious awareness of emotional states’ and the second factor ‘metacognition of emotional states’. The results confirmed that both emotional regulation abilities and attachment security were related to dispositional mindfulness.
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This article reports the findings of a study investigating which facets of psychopathology are most strongly associated with hypersexual behavior among a patient sample (N = 151). Psychopathology was measured using the Restructured Clinical scales and the PSY-5 scales of the MMPI-2, and hypersexual behavior was measured using the Sexual Compulsivity Scale. Regression analysis revealed that Demoralization was the strongest predictor of scores on a mea-sure of hypersexuality, with Hypomanic Activation on the RC scales and Disconstraint on the PSY-5 scales making additional modest, but statistically significant, contributions. Although some MMPI-2 scales were significantly elevated, an important finding of the cur-rent investigation is the lack of elevations across many MMPI-2 scales. The results of these findings are addressed and recommen-dations for future research are discussed.
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Mental health professionals may erroneously assume that clients seeking help for hypersexual behavior are ready to begin working on their issues at the outset of treatment. Prochaska and DiClemente (e.g., 1983, 1984) proposed the transtheoretical model (TTM) stages of change to advance their belief that clients move through several stages when attempting to alter specific target behaviors. If a clini-cian gets ahead of a client by administering interventions that are improperly matched with the client's readiness to change, treat-ment may be prematurely terminated or high levels of resistance may be encountered during therapy. In this study, clients (N = 67) who were referred for treatment in a specialty outpatient clinic for hypersexual behavior completed the Sexual Compulsivity Scale (Kalichman et al., 1994; Kalichman & Rompa, 1995, 2001) and the Stages of Change Scale (McConnaughy, DiClemente, Prochaska, & Velicer, 1989; McConnaughy, Prochaska, & Velicer, 1983). The data collected from these measures revealed that 70% (n = 47) of clients who expressed an interest in receiving help with issues re-lated to hypersexuality also had high levels of ambivalence about the changes they desired to make and that individuals with ADHD were significantly (chi-square, p ≤ .001) more likely to be in the contemplation stage than subjects presenting with alternative diag-noses. Implications for these finding are discussed and suggestions for future research are offered. Mental health professionals may erroneously assume that clients seeking help for hypersexual behavior are ready to begin working on their issues at the outset of treatment.
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A study with three component parts was performed to assess the effectiveness of neurofeedback treatment for Attention Deficit/Hyperactivity Disorder (ADHD). The subject pool consisted of 23 children and adolescents ranging in age from 8 to 19 years with a mean of 11.4 years who participated in a 2-to 3-month summer program of intensive neurofeedback training. Feedback was contingent on the production of 16–20 hertz (beta) activity in the absence of 4–8 hertz (theta) activity. Posttraining changes in EEG activity, T.O.V.A. performance, (ADDES) behavior ratings, and WISC-R performance were assessed. Part I indicated that subjects who successfully decreased theta activity showed significant improvement in T.O.V.A. performance; Part II revealed significant improvement in parent ratings following neurofeedback training; and Part III indicated significant increases in WISC-R scores following neurofeedback training. This study is significant in that it examines the effects of neurofeedback training on both objective and subjective measures under relatively controlled conditions. Our findings corroborate and extend previous research, indicating that neurofeedback training can be an appropriate and efficacious treatment for children with ADHD.
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This study evaluated the effectiveness of an 8-week mindfulness training for children aged 8-12 with ADHD and parallel mindful parenting training for their parents. Parents (N = 22) completed questionnaires on their child's ADHD and ODD symptoms, their own ADHD symptoms, parenting stress, parental overreactivity, permissiveness and mindful awareness before, immediately after the 8-week training and at 8-week follow-up. Teachers reported on ADHD and ODD behavior of the child. A within-group waitlist was used to control for the effects of time and repeated measurement. Training was delivered in group format. There were no significant changes between wait-list and pre-test, except on the increase of teacher-rated ODD behavior. There was a significant reduction of parent-rated ADHD behavior of themselves and their child from pre-to posttest and from pre- to follow-up test. Further, there was a significant increase of mindful awareness from pre-to posttest and a significant reduction of parental stress and overreactivity from pre-to follow-up test. Teacher-ratings showed non-significant effects. Our study shows preliminary evidence for the effectiveness of mindfulness for children with ADHD and their parents, as rated by parents. However, in the absence of substantial effects on teacher-ratings, we cannot ascertain effects are due to specific treatment procedures.
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Research on the effectiveness and mechanisms of mindfulness training applied in psychotherapy is still in its infancy (Erisman & Roemer, 2010). For instance, little is known about the extent and processes through which mindfulness practice improves emotion regulation. This experience sampling study assessed the relationship between mindfulness, emotion differentiation, emotion lability, and emotional difficulties. Young adult participants reported their current emotional experiences 6 times per day during 1 week on a PalmPilot device. Based on these reports of emotions, indices of emotional differentiation and emotion lability were composed for negative and positive emotions. Mindfulness was associated with greater emotion differentiation and less emotional difficulties (i.e., emotion lability and self-reported emotion dysregulation). Mediational models indicated that the relationship between mindfulness and emotion lability was mediated by emotion differentiation. Furthermore, emotion regulation mediated the relationship between mindfulness and both negative emotion lability and positive emotion differentiation. This experience sampling study indicates that self-reported levels of mindfulness are related to higher levels of differentiation of one's discrete emotional experiences in a manner reflective of effective emotion regulation.
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This article reviews the current evidence base for the diagnosis, assessment, and treatment of hypersexual conditions. Controversy concerning this diagnosis is discussed. Terminology and diagnostic criteria, as well as psychological, psychopharmacological, and other treatment approaches, are presented.
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Hypersexual Disorder is proposed as a new psychiatric disorder for consideration in the Sexual Disorders section for DSM-V. Historical precedents describing hypersexual behaviors as well as the antecedent representations and proposals for inclusion of such a condition in the previous DSM manuals are reviewed. Epidemiological as well as clinical evidence is presented suggesting that non-paraphilic "excesses" of sexual behavior (i.e., hypersexual behaviors and disorders) can be accompanied by both clinically significant personal distress and social and medical morbidity. The research literature describing comorbid Axis I and Axis II psychiatric disorders and a purported relationship between Axis I disorders and Hypersexual Disorder is discussed. Based on an extensive review of the literature, Hypersexual Disorder is conceptualized as primarily a nonparaphilic sexual desire disorder with an impulsivity component. Specific polythetic diagnostic criteria, as well as behavioral specifiers, are proposed, intended to integrate empirically based contributions from various putative pathophysiological perspectives, including dysregulation of sexual arousal and desire, sexual impulsivity, sexual addiction, and sexual compulsivity.
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Objective: Despite growing interest in adult attention deficit hyperactivity disorder (ADHD), little is known about its prevalence or correlates. Method: A screen for adult ADHD was included in a probability subsample (N=3,199) of 18-44-year-old respondents in the National Comorbidity Survey Replication, a nationally representative household survey that used a lay-administered diagnostic interview to assess a wide range of DSM-IV disorders. Blinded clinical follow-up interviews of adult ADHD were carried out with 154 respondents, oversampling those with positive screen results. Multiple imputation was used to estimate prevalence and correlates of clinician-assessed adult ADHD. Results: The estimated prevalence of current adult ADHD was 4.4%. Significant correlates included being male, previously married, unemployed, and non-Hispanic white. Adult ADHD was highly comorbid with many other DSM-IV disorders assessed in the survey and was associated with substantial role impairment. The majority of cases were untreated, although many individuals had obtained treatment for other comorbid mental and substance-related disorders. Conclusions: Efforts are needed to increase the detection and treatment of adult ADHD. Research is needed to determine whether effective treatment would reduce the onset, persistence, and severity of disorders that co-occur with adult ADHD.
Book
Attention Deficit/Hyperactivity Disorder (ADHD) is a disorder that afflicts anywhere from 2 to 5 percent of the adult population (roughly 8-10 million Americans). Among several therapeutic treatment approaches available as a supplement or alternative to medication, Cognitive Behavioral Therapy (CBT) has emerged as the most successful and has the strongest current evidence base of support, while integrative treatment programs that combine CBT and prescription drugs have shown even more promise. in this volume, Ramsay and Rostain provide an overview of symptoms, assessment and diagnosis issues for adult ADHD. Utilizing research, case examples, and a combined biological and psychosocial treatment approach, the authors discuss the many complicated factors that go into treatment, relapse prevention, and long-term management of adult ADHD, including particular focus on comorbidity and medication issues.
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Attention-Deficit/Hyperactivity Disorder (ADHD) can persist into adulthood with a continuation of the pattern of childhood psychopathology, cognition and functioning. Adult comorbidities include substance use disorders, antisocial personality disorder, anxiety, and depression. Studies have shown that as in children, methylphenidate treatment for adults can lead to a robust, dose-dependent improvement in ADHD symptoms. Future research is needed to evaluate the safety and efficacy of long-term treatment with methylphenidate (MPH).
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Attention-Deficit Hyperactivity Disorder (ADHD) is a common, genetically transmitted neurological disorder, with onset in childhood, probably mediated by decreased brain dopaminergic functioning. The first author was one of the earliest to describe the persistence of symptoms into adulthood. Prevalence and natural history data suggest that of the 3 to 10% of children diagnosed with ADHD, one- to two-thirds (somewhere between 1 and 6% of the general population) continue to manifest appreciable ADHD symptoms into adult life. This paper describes how ADHD in adults can be readily diagnosed and treated, despite resembling or coexisting with other psychiatric disorders. The Wender Utah diagnostic criteria address adult characteristics of the disorder. Informant and patient interviews and rating scales are used to determine the psychiatric status of the patient as a child, make a retroactive diagnosis of childhood ADHD, and establish the current diagnosis of the adult. Stringent diagnosis is key to determining effective treatment. Dopamine agonist stimulant medications appear to be the most effective in treating ADHD. About 60% of patients receiving stimulant medication showed moderate-to-marked improvement, as compared with 10% of those receiving placebo. The core symptoms of hyperactivity, inattention, mood lability, temper, disorganization, stress sensitivity, and impulsivity have been shown to respond to treatment with stimulant medications. Non-dopaminergic medications, such as the tricyclic antidepressants and SSRIs have generally not been useful in adults with ADHD in the absence of depression or dysthymia. Pemoline is no longer appoved for use in these patients, despite early favorable reports. Appropriate management of adult patients with ADHD is multimodal. Psychoeducation, counseling, supportive problem-directed therapy, behavioral intervention, coaching, cognitive remediation, and couples and family therapy are useful adjuncts to medication management. Concurrent supportive psychosocial treatment or polypharmacy may be useful in treating the adult with comorbid ADHD.
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This article describes treatment of a female problem gambler using mindfulness-based cognitive therapy (MBCT). The treatment protocol was adapted for problem gamblers from the manualized MBCT intervention developed by Segal, Williams, and Teasdale. Gambling behavior and mindfulness practice were monitored using daily diary entries maintained by the participant. The Beck Anxiety Inventory, Beck Depression Inventory—II, and the Five Facet Mindfulness Questionnaire were administered at pretreatment, posttreatment, 4-week follow-up, and 10-week follow-up phases. The Client Satisfaction Questionnaire was also used to assess acceptability of the intervention. The participant abstained from gambling, and anxiety and depression scores significantly reduced to subclinical levels over the assessment period. Exploration of mindfulness facets revealed that MBCT for problem gambling (MBCT-PG) may be useful in promoting acceptance of distressing thoughts and emotions. However, the participant did not maintain an intensive mindfulness-meditation practice over the follow-up phase of the intervention. The clinical implications of this case study are discussed.
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p>Rather than being a condition that affected children invariably "outgrow" as they mature, it is now recognized that attention-deficit/hyperactivity disorder is common in adults. Rates vary between studies. However, it appears that in most cases, attention-deficit/hyperactivity disorder (ADHD) persists into adolescence and on into adulthood, although changing partially in its symptomatic expression. ABOUT THE AUTHOR Nicholas Weiss, MD, is Health Sciences Assistant Clinical Professor, Langley Porter Hospital and Clinics, University of California, San Francisco. Address correspondence to: Nicholas Weiss, MD, 401 Parnassus Avenue, San Francisco, CA 94143; fax: 415-476-7163; or e-mail: Nicholas.Weiss@ucsf.edu . Dr. Weiss has disclosed no relevant financial relationships. EDUCATIONAL OBJECTIVES Explain the symptoms of attention-deficit/hyperactivity disorder (ADHD) and diagnose the disorder in adults. Describe the risks and benefits of various classes of medications and of cognitive-behavioral therapy in adult ADHD. Discuss pharmacologic treatment for adults with uncomplicated ADHD and for adults with ADHD complicated by psychiatric and/or medical comorbidities. </OL
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Based upon a variety of neurobiological conceptualizations, a limited number of studies have been performed to assess the response of hypersexual behavior to psychopharmacologic therapy. In the present article, we conducted a review of empirical studies that evaluated a psychopharmacologic treatment for hypersexual behavior. Study characteristics reviewed include the participants, research designs, pharmacologic agent(s) examined and dosage(s), medication side effects, comorbid psychiatric illness, assessment of hypersexual behavior, and outcomes. Several studies report significant attenuation of hypersexual symptoms with pharmacologic treatment. However, significant methodological limitations narrow the rigor of these findings. Considerations for comorbidity and recommendations for enhancement of future outcome research are provided.
Book
Recent years have seen tremendous advances in understanding and treating Attention-Deficit/Hyperactivity Disorder (ADHD). Now in a revised and expanded third edition, this authoritative handbook brings the field up to date with current, practical information on nearly every aspect of the disorder. Drawing on his own and others' ongoing, influential research - and the wisdom gleaned from decades of front-line clinical experience - Russell A. Barkley provides insights and tools for professionals working with children, adolescents, or adults. Part I presents foundational knowledge about the nature and developmental course of ADHD and its neurological, genetic, and environmental underpinnings. The symptoms and subtypes of the disorder are discussed, as are associated cognitive and developmental challenges and psychiatric comorbidities. In Parts II and III, Barkley is joined by other leading experts who offer state-of-the-art guidelines for clinical management. Assessment instruments and procedures are described in detail, with expanded coverage of adult assessment. Treatment chapters then review the full array of available approaches - parent training programs, family-focused intervention for teens, school- and classroom-based approaches, psychological counseling, and pharmacotherapy - integrating findings from hundreds of new studies. The volume also addresses such developments as once-daily sustained delivery systems for stimulant medications and a new medication, atomoxetine. Of special note, a new chapter has been added on combined therapies. Chapters in the third edition now conclude with user-friendly Key Clinical Points. This comprehensive volume is intended for a broad range of professionals, including child and adult clinical psychologists and psychiatrists, school psychologists, and pediatricians. It serves as a scholarly yet accessible text for graduate-level courses. Note: Practitioners wishing to implement the assessment and treatment recommendations in the Handbook are advised to purchase the companion Workbook, which contains a complete set of forms, questionnaires, and handouts, in a large-size format with permission to photocopy. (PsycINFO Database Record (c) 2012 APA, all rights reserved)(jacket)
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Sexual addiction does not exist in isolation. As with most addictions, there can be co-occurring disorders. This study was conducted to investigate whether or not there is a connection between sexual addiction and attention deficit hyperactivity disorder (ADHD). This article will discuss the results of the study as well as the limitations of the instruments used. The importance of trauma model treatment with sexual addiction and ADHD will be considered. The need for further research will also be addressed. The term ADHD will be used throughout the article except where specific quotes use other terminology. The DSM-IV uses the term Attention Deficit/Hyperactivity Disorder and identifies a combined type, a predominantly inattentive type and a predominantly hyperactive type.
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This case details the use of cognitive behavior therapy in treating a 41-year-old gay man’s sexually addictive behavior. At assessment, he perceived his sexual behavior to be out of his control and it was particularly interfering with his work life. Motivational interviewing was combined with a number of cognitive behavioral techniques, including a behavior change program, distraction, enhancing metacognitive awareness, and cognitive restructuring, over the course of six therapy sessions. Using self-report, the intervention led to a significant reduction in sexual behavior. Frequency of sexual partners and the amount of time spent online during working hours reduced. The case highlights effectiveness of cognitive behavior therapy and motivational interviewing in reducing sexually addictive behavior and installing a sense of control in patients.
Article
The aim of this study was to investigate the nature of hypersexuality and the personality factors associated with the desire for and experience of high frequency sexual behavior. Participants in the study were 69 male and 93 female university students. Respondents reported on their desire for and experience of masturbation, oral sex, sexual intercourse, pornography, indecent phone calls or letters, prostitution, exhibitionism, voyeurism, as well as providing self-report measures which evaluated their levels of state and trait anxiety, depression, obsessive and compulsive symptoms and fear of intimacy. The results demonstrated that subjects who engaged in high-frequency voyeurism were more depressed than low-frequency voyeurs. Respondents in the high-frequency sexual deviant desire and behavior groups appeared to have more obsessive-compulsive symptoms in comparison to the low-frequency deviant sexual behavior and desire groups. Increased psychopathology was not associated with high-frequency non-deviant sexual behaviors and desires. This finding raised the question of whether labels such as sexual compulsion and addiction are merely pathologizing illegal sexual behavior.
Article
This study evaluated the prevalence of depression among male sex addicts against the general male population. This research utilized the high estimate of 12% for male depression in the general population as reported by the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 20001. American Psychiatric Association. 2000. Diagnostic and statistical manual of mental disorders , (4th ed., text rev.), Washington, DC: Author. [CrossRef]View all references). This research had 418 participants, 220 of whom qualified as male sexual addicts residing in the United States. Participants were recipients of a free sexual recovery e-mail newsletter from www.sexaddict.com. A score of 14 or higher on the Sexual Addiction Screening Test operationally defined sexual addiction. A score of 14 or higher on the Beck Depression Inventory (BDI) operationally defined depression. Male sex addicts had a 28% prevalence rate of depression. The hypothesis of male sex addicts having higher scores on the BDI was upheld. An exploratory hypothesis, that participants having received treatment for sexual addiction would have lower depression scores, was upheld.
Article
This study investigated distinct emotions in a sample of men (n = 103) seeking help for hypersexual behavior compared to a control group of college students (n = 100) using the Hypersexual Behavior Inventory and the Differential Emotions Scale. Significant differences between groups emerged on several domains of emotion and hypersexual behavior. Self-hostility was the most significant predictor of hypersexual behavior. These findings suggest that self-critical affect, such as shame, might exert an influence in precipitating or perpetuating hypersexual behavior.
Article
Gestalt therapy is a natural fit for the treatment of sexual compul-sivity, because the sine qua non of gestalt theory is awareness or connection, whereas the hallmark of sexual compulsivity is a lack of awareness or disconnection. This article provides an overview of gestalt therapy and demonstrates how it can be an effective tool in the treatment of sexual compulsivity. The gestalt concepts of awareness, perception, experiment, and polarity are discussed. A case study illustrates their practical application; Using gestalt methods, a breakthrough was achieved.
Article
When at least one member of a couple is sexually addicted, restoring trust and building intimacy can be very difficult. These couples must work as hard on their recovery together as a couple as they do on their individual recoveries. A number of key characteristics of these relationships can be understood and allowed to inform the work that needs to proceed. Relationships develop very much as individuals do. Margaret Mahler's developmental model is helpful in understanding this process for couples. The 12 steps can be applied to couple recovery in order to facilitate the work of intimacy and trust building.
Article
Nonparaphilic sexual addictions (NPSAs), which are characterized by repetitive sexual thoughts and behaviors, have been proposed as an obsessive-compulsive spectrum disorder. In the present study we examined the functional differences in repetitive sexual thoughts and compulsive behaviors between patients with OCD (n = 6) and with NPSAs (n = 6). Compared to patients with NPSAs, those with OCD reported significantly more fear and avoidance related to their sexual thoughts. Individuals with NPSAs reported higher levels of sexual arousal associated with their thoughts and a greater degree of sexual pleasure from performing compulsive behaviors. These preliminary findings challenge the notion that NPSAs are related to OCD. Results are discussed in terms of their implications for treatment using cognitive-behavioral procedures.
Article
Introduction. Patients seeking help for hypersexual behavior often exhibit features of impulsivity, cognitive rigidity, and poor judgment as well as deficits in emotion regulation and excessive preoccupation with sex. Some of these characteristics are also common among patients presenting with neurological pathology associated with executive dysfunction. Exploring relationships between dysregulated sexual behavior and executive deficits will enhance our understanding of hypersexuality. Aim. This study sought to assess whether patients seeking help for hypersexual behavior exhibit executive deficits as measured by standardized neuropsychological tests of executive functioning when compared with healthy controls. Methods. Executive deficits were assessed in a sample of male patients (N = 30) seeking help for hypersexual behavior compared with a nonhypersexual community sample of men (N = 30) using neuropsychological tests of executive functioning. Using multivariate statistics, differences between the groups were examined. Main Outcome Measures. Sexual activity measured by the Hypersexual Behavior Inventory and the Compulsive Sexual Behavior Inventory. Executive functions measured through neuropsychological testing using several subtests of Delis–Kaplan Executive Function System: Color–Word Interference Test, the Tower Test, the Trail Making Test, the Verbal Fluency Test, as well as the Wisconsin Card Sorting Test. Psychopathology was assessed using the Mini International Neuropsychiatric Interview, and cognitive ability was assessed using the Wechsler Adult Intelligence Scale. Results. Significant differences on measures of hypersexuality were observed. However, the groups failed to exhibit significant differences across neuropsychological tests of executive functioning even after controlling for cognitive ability. Conclusions. These results contradict a previous finding of executive deficits among hypersexual men measured by self-report. The lack of executive deficits suggests that this population may exhibit domain-specific aspects of impulsivity, poor judgment, and risky behavior that are not generalizable to other domains of life. Furthermore, our findings fail to support a conceptualization of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, proposed hypersexual disorder based on models of executive dysfunction. Reid RC, Garos S, Carpenter BN, and Coleman E. A surprising finding related to executive control in a patient sample of hypersexual men. J Sex Med 2011;8:2227–2236.
Article
Sixty-three hyperactive adults aged 21–33 and 41 matched normal controls were evaluated for their psychiatric status by means of (a) psychiatric interviews and histories using the DSM-II diagnosis; (b) psychiatric interviews carried out “blind” as to which group the subject belonged, using the SADS-L diagnosis; and (c) by means of self-rating scales. Each subject was assigned a number on the Global Assessment Scale of the SADS which measures general overall functioning. Results indicated that about half of the probands continued to have mild to severely disabling continuing symptoms of the syndrome. A significant percentage (23%) of the hyperactive adults had an Antisocial Personality Disorder on both the modified SADS-L and the DSM-I diagnostic criteria. Schizophrenia and alcoholism or alcohol abuse was not found more commonly in the hyperactive group. There was evidence that the hyperactives had more overall psychopathology and functioned generally less well than did normal controls.
Article
Mindfulness-based stress reduction (MBSR) has been found to reduce psychological distress and improve psychological adjustment in medical, psychiatric, and nonclinical samples. We examined its effects on several processes, attitudes, and behavior patterns related to emotion regulation. Fifty-six adults were randomly assigned to MBSR or to a waiting list (WL). Compared with WL completers (n = 21), MBSR completers (n = 20) reported significantly greater increases in trait mindfulness and decreases in absent-mindedness, greater increases in self-compassion, and decreases in fear of emotions, suppression of anger, aggressive anger expression, worry, and difficulties regulating emotions. The WL group subsequently received MBSR, and the two groups combined showed significant changes on all of these variables from pre-MBSR to post-MBSR, and on all except the 2 anger variables from pre-test to 2-month follow-up, as well as significant reductions in rumination. An 8-week mindfulness training program might increase mindful awareness in daily life and have beneficial impact on clinically relevant emotion regulation processes.
Article
Earlier evidence suggests comorbid attention-deficit disorder (ADHD) among those seeking treatment for hypersexual behavior. This article examines which facets of ADHD symptoms are most strongly associated with hypersexual behavior among a patient sample of men (N = 81). ADHD diagnosis was made by 2 clinicians, and symptom characteristics were measured using the Conners' Adult ADHD Rating Scale and the Sexual Compulsivity Scale. Among ADHD symptoms, inattentive features were most prevalent. A stepwise regression analysis revealed that the Problems with Self-Concept subscale of the Conners' Adult ADHD Rating Scale was the strongest predictor of scores on the Sexual Compulsivity Scale. Surprisingly, subscales that measured traits of impulsivity, inattention, memory problems, and hyperactive restlessness did not contribute additional predictive variance in the statistical model. The results of these findings suggest that clinicians should exercise caution in assuming that common characteristics of ADHD, such as impulsivity and hyperactivity, exert the strongest influence on hypersexual behavior. Rather, our results provide evidence that the associated features of ADHD, such as problems with low self-esteem, might be more salient factors in influencing hypersexuality severity among patients with comorbid hypersexual behavior and ADHD.
Article
Identification of attention deficit hyperactivity disorder (ADHD) in adults presents a number of problems because there is no one specific diagnostic test for the condition. Given this challenge, clinicians often struggle between restrictive and exclusionary diagnostic methods or overinclusive acceptance that ADHD is a prevalent and disabling problem. A modified version of the Attention Deficit Hyperactivity Rating Scale was administered to 468 students at a large midwestern university. Analysis of the results suggested that the degree of ADHD symptoms in college students is modest and indicated that cutoff scores of 4 for current symptoms of inattention and hyperactivity-impulsivity would be sufficient to identify a college student as distinct from the norm. Although it would be premature to accept the calculated thresholds completely, clinicians should be aware of these differences when evaluating college students for ADHD.
Article
Alterations in working memory, default-mode network (DMN), and dopamine transporter have all been proposed as endophenotypes for attention-deficit/hyperactivity disorder (ADHD). Despite evidence that these systems are interrelated, their relationship to each other has never been studied in the context of ADHD. In order to understand the potential mediating effects of task-positive and task-negative networks between DAT1 and diagnosis, we tested effects of genotype and diagnosis on regions of positive and negative BOLD signal change (as measured with fMRI) in 53 adults with ADHD and 38 control subjects during a working memory task. We also examined the relationship of these responses to ADHD symptoms. Our results yielded four principal findings: 1) association of the DAT1 9R allele with adult ADHD, 2) marginal DAT1 association with task-related suppression in left medial PFC, 3) marginal genotype×diagnosis interaction in the dorsal anterior cingulate cortex, and 4) correlation of DMN suppression to ADHD symptoms. These findings replicate the association of the 9R allele with adult ADHD. Further, we show that DMN suppression is likely linked to DAT1 and to severity of inattention in ADHD. DMN may therefore be a target of DAT1 effects, and lie on the path between the gene and inattention in ADHD.
Article
Functional and structural neuroimaging have identified abnormalities of the brain that are likely to contribute to the neuropathophysiology of attention-deficit/hyperactivity disorder (ADHD). In particular, hypofunction of the brain regions comprising the cingulo-frontal-parietal cognitive-attention network have been consistently observed across studies. These are major components of neural systems that are relevant to ADHD, including cognitive/attention networks, motor systems, and reward/feedback-based processing systems. Moreover, these areas interact with other brain circuits that have been implicated in ADHD, such as the "default mode" resting state network. The ADHD imaging data related to cingulo-frontal-parietal network dysfunction will be selectively highlighted here to help facilitate its integration with the other information presented in this special issue. Together, these reviews will help shed light on the neurobiology of ADHD.
Article
Although shame and facets of neuroticism have independently been linked to hypersexuality, the present study extends these findings by exploring pathways among these variables, using structural equation modeling in a patient sample of hypersexual adult men (N = 95). Results suggested that the domain of neuroticism, as represented by the NEO Personality Inventory-Revised, was a significant direct predictor of hypersexuality, with specific variance from the facet of impulsivity adding additional predictive power. Shame's bivariate association with hypersexuality was also significant, but in a predictive path model the effect of shame on hypersexuality was indirectly mediated through neuroticism and was not an independently significant predictor. Implications for treatment suggest that clinicians working with this population should evaluate precipitating risk factors to consider whether shame is activating neurotic coping or if other stressors might be influencing emotional instability that can trigger hypersexuality. Independent of the general distress associated with neuroticism, the literature on impulsivity might provide other valuable insights and direction for working with hypersexual men.
Article
Feasibility, acceptability, and efficacy of a Dialectical Behavioral Therapy (DBT) -based method developed in Germany were evaluated in a Swedish outpatient psychiatric context. Fifty-one adults with ADHD on stable medical treatment or on no medication were randomized to the DBT-based skills training (n=26) or a parallel loosely structured discussion group (n=25). Self-rating scales were administered before randomization and after the treatment. Feasibility and participant satisfaction were good in both groups while skills training was perceived as more logical and effective for ADHD-related problems. The analyses of the individuals who completed the treatment and remained stable with regard to medication (n=19 in skills training; n=18 in control group) showed a significant reduction in ADHD symptoms in the skills training group, but not in the control group. No reduction of comorbidity was observed in any of the groups. The treatment was feasible in an outpatient psychiatric context, well tolerated, and significantly reduced ADHD symptoms in on-treatment individuals who remained stable regarding medication status.
Article
Two online surveys were conducted to assess the relationship between trait disinhibition, impulsivity, mindfulness and adverse psychological symptoms. In study 1 adult females (n=196; mean age=21 yrs) completed the Three-Factor Eating Questionnaire (TEFQ-R21), the Hospital Anxiety and Depression Scale and a measure of dispositional mindfulness. In study 2 adult females (n=190; mean age=26 yrs) completed the same measures as in study 1 with the addition of the Barratt Impulsivity Scale. In both studies it was predicted that mindfulness would be negatively related to trait disinhibition controlling for adverse psychological symptoms. The second study addressed the additional hypothesis that the relationship between mindfulness and trait disinhibition would be mediated by impulsivity. Regression analyses indicated that mindfulness was negatively related to and explained 11% of variation in trait disinhibition (study 1). This relationship was replicated and extended in study 2 whereby impulsivity mediated the relationship between mindfulness and trait disinhibition. The findings warrant experimental and in vivo investigations of the potential causal relationships between mindfulness, impulsivity and eating behaviours.
Article
This review examines recent advances in conceptualizing and treating hypersexual disorders. Studies on hypersexual disorders, inferred from research on their associated descriptors, suggest that these disorders have a strong relationship to a number of areas of functioning, in particular, self-regulation and sexually offensive behavior. The proposed inclusion of hypersexual disorders in the upcoming Diagnostic and Statistical Manual of Mental Disorders-V may address many of the current issues related to the lack of empirical research on hypersexuality. Although there have been some gains made on understanding hypersexuality, there remains a lack of consensus and empirical research on hypersexual disorders. There are also an insufficient number of controlled studies on the efficacy of pharmacological and psychological treatments for hypersexual behavior problems.
Article
Despite the prevalence of problematic Internet pornography viewing and the breadth of intervention approaches to potentially address it, no studies to address this problem have been reported to date. An emerging treatment approach, Acceptance and Commitment Therapy (ACT), holds promise as a treatment for Internet pornography viewing because of its focus on processes hypothesized to underlie this maladaptive behavior. In the first experiment on the treatment of problematic Internet pornography viewing, 6 adult males who reported that their Internet pornography viewing was affecting their quality of life were treated in eight 1.5-hour sessions of ACT for problematic pornography viewing. The effects of the intervention were assessed in a multiple-baseline-across-participants design with time viewing pornography as the dependent variable. Treatment resulted in an 85% reduction in viewing at posttreatment with results being maintained at 3-month follow-up (83% reduction). Increases were seen on measures of quality of life, and reductions were seen on measures of OCD and scrupulosity. Weekly measures of ACT-consistent processes showed reductions that corresponded with reductions in viewing. Large reductions were seen on a measure of psychological flexibility, and minor reductions were seen on measures of thought-action fusion and thought control. Overall, results suggest the promise of ACT as a treatment for problematic Internet pornography viewing and the value of future randomized trials of this approach.
Article
To investigate the concurrent validity and reliability of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), a short structured diagnostic interview for DSM-IV and ICD-10 psychiatric disorders in children and adolescents. Participants were 226 children and adolescents (190 outpatients and 36 controls) aged 6 to 17 years. To assess the concurrent validity of the MINI-KID, participants were administered the MINI-KID and the Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (K-SADS-PL) by blinded interviewers in a counterbalanced order on the same day. Participants also completed a self-rated measure of disability. In addition, interrater (n = 57) and test-retest (n = 83) reliability data (retest interval, 1-5 days) were collected, and agreement between the parent version of the MINI-KID and the standard MINI-KID (n = 140) was assessed. Data were collected between March 2004 and January 2008. Substantial to excellent MINI-KID to K-SADS-PL concordance was found for syndromal diagnoses of any mood disorder, any anxiety disorder, any substance use disorder, any ADHD or behavioral disorder, and any eating disorder (area under curve [AUC] = 0.81-0.96, kappa = 0.56-0.87). Results were more variable for psychotic disorder (AUC = 0.94, kappa = 0.41). Sensitivity was substantial (0.61-1.00) for 15/20 individual DSM-IV disorders. Specificity was excellent (0.81-1.00) for 18 disorders and substantial (> 0.73) for the remaining 2. The MINI-KID identified a median of 3 disorders per subject compared to 2 on the K-SADS-PL and took two-thirds less time to administer (34 vs 103 minutes). Interrater and test-retest kappas were substantial to almost perfect (0.64-1.00) for all individual MINI-KID disorders except dysthymia. Concordance of the parent version (MINI-KID-P) with the standard MINI-KID was good. The MINI-KID generates reliable and valid psychiatric diagnoses for children and adolescents and does so in a third of the time as the K-SADS-PL.