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Psychological and behavioral factors of losing control over sexual behavior and entering into treatment

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  • University of California, San Diego / Polish Academy of Sciences, Warsaw
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... Osoby poszukujące pomocy psychologicznej w związku z nałogowymi zachowaniami seksualnymi najczęściej zgłaszają trudności związane z kontrolą czasu spędzanego na oglądaniu pornografii (przeważnie internetowej), częstotliwością masturbacji (zdarza im się wpadać w wielogodzinne ciągi oglądania pornografii, którym towarzyszy wielokrotna masturbacja lub w wyniku nagłego pobudzenia masturbują się w toaletach publicznych). Część osób zgłasza problemy związane z utratą kontroli nad częstotliwością korzystania z płatnych usług seksualnych oraz ilością wydawanych na to pieniędzy lub z angażowaniem się w przygodne (nierzadko ryzykowne) kontakty seksualne [6][7][8][9][10][11][12]. Wspólnym mianownikiem powyższych symptomów jest ich kompulsywny charakter oraz niemożność zaprzestania danego typu zachowań mimo wielu prób i kosztów, z jakimi się one wiążą. ...
... Mimo obszernej liczby prac klinicznych w tym temacie, mechanizmy problemów z kontrolą zachowań seksualnych nie zostały jeszcze dobrze poznane. W literaturze określa się te problemy jako: sexual dependence [17], sexual addiction [6, 7, 18-22], hypersexuality [23-29], compulsive sexual disorder [30-34], paraphilia-related disorder [35, 36], sexual impulsivity [35, 37], nymphomania, out of control sexual behavior [38] lub compulsive sexual behavior [11,39,40,41]. Wielość etykiet odzwierciedla brak konsensusu co do tego, jaką rolę w powstawaniu symptomów odgrywają mechanizmy kompulsywne, a jaką impulsywne, na ile traktować ten problem jako nałóg, a na ile jako zaburzenie popędu seksualnego. ...
... Może wynikać ona z faktu dość rygorystycznego doboru osób badanych do grupy klinicznej, zakładającego spełnienie kryteriów zaburzenia hiperseksualnego oraz korzystanie z pomocy psychologicznej lub seksuologicznej w związku z nałogowymi zachowaniami seksualnymi. Z przeprowadzonych przez nas badań [11] wiemy, że osoby, które zdecydowały się sięgnąć po pomoc w związku z nałogowymi zachowaniami seksualnymi, charakteryzują się istotnie wyższym wskaźnikiem nietypowych kompulsywnych zachowań (tj. oglądanie pornografii w miejscu pracy, w obecności innych osób, które nie wiedzą o tym, że pacjent ogląda pornografię, masturbowanie się w toaletach publicznych itp.) niż użytkownicy pornografii niedoświadczający problemów. ...
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Introduction. Addictive sexual behaviours are gaining more and more attention from researchers. There are actually 25 different questionnaires for assessing the level of loss of control over sexual behaviours (LoCoSB). None of them have been adapted and validated in a Polish language version. Aim. The main aim of this work was to make such an adaptation of the Sexual Addiction Screening Test-Revised (SAST-R; the most popular and questionnaire). Methods. For the purpose of psychometric features examination and validation of the Polish version of SAST-R (SAST-PL-M), we recruited 116 heterosexual men receiving psychological treatment due to LoCoSB and meeting the criteria for hypersexual disorder. The control group consisted of 442 heterosexual males having never looked for any psychological or psychiatric help due to LoCoSB. Results. SAST-PL-M has high reliability (Cronbach's alpha = 0.904) and good filtering characteristics for identification of people who are potentially experiencing difficulty with control over sexual behaviours (the ROC curve for a threshold of 5 out of a maximum 20 points is characterised by a sensitivity of 99.1% and a specificity of 78.3%). Conclusions. SAST-PL-M can be used as an efficient screening test for symptoms of LoCoSB in clinical and research setups. Results below 5 points indicate a high probability of no problems, while more than 5 points can indicate the need for additional clinical interviews.
... Osoby poszukujące pomocy psychologicznej w związku z nałogowymi zachowaniami seksualnymi najczęściej zgłaszają trudności związane z kontrolą czasu spędzanego na oglądaniu pornografii (przeważnie internetowej), częstotliwością masturbacji (zdarza im się wpadać w wielogodzinne ciągi oglądania pornografii, którym towarzyszy wielokrotna masturbacja lub w wyniku nagłego pobudzenia masturbują się w toaletach publicznych). Część osób zgłasza problemy związane z utratą kontroli nad częstotliwością korzystania z płatnych usług seksualnych oraz ilością wydawanych na to pieniędzy lub z angażowaniem się w przygodne (nierzadko ryzykowne) kontakty seksualne [6][7][8][9][10][11][12]. Wspólnym mianownikiem powyższych symptomów jest ich kompulsywny charakter oraz niemożność zaprzestania danego typu zachowań mimo wielu prób i kosztów, z jakimi się one wiążą. ...
... Mimo obszernej liczby prac klinicznych w tym temacie, mechanizmy problemów z kontrolą zachowań seksualnych nie zostały jeszcze dobrze poznane. W literaturze określa się te problemy jako: sexual dependence [17], sexual addiction [6, 7, 18-22], hypersexuality [23-29], compulsive sexual disorder [30-34], paraphilia-related disorder [35, 36], sexual impulsivity [35, 37], nymphomania, out of control sexual behavior [38] lub compulsive sexual behavior [11,39,40,41]. Wielość etykiet odzwierciedla brak konsensusu co do tego, jaką rolę w powstawaniu symptomów odgrywają mechanizmy kompulsywne, a jaką impulsywne, na ile traktować ten problem jako nałóg, a na ile jako zaburzenie popędu seksualnego. ...
... Może wynikać ona z faktu dość rygorystycznego doboru osób badanych do grupy klinicznej, zakładającego spełnienie kryteriów zaburzenia hiperseksualnego oraz korzystanie z pomocy psychologicznej lub seksuologicznej w związku z nałogowymi zachowaniami seksualnymi. Z przeprowadzonych przez nas badań [11] wiemy, że osoby, które zdecydowały się sięgnąć po pomoc w związku z nałogowymi zachowaniami seksualnymi, charakteryzują się istotnie wyższym wskaźnikiem nietypowych kompulsywnych zachowań (tj. oglądanie pornografii w miejscu pracy, w obecności innych osób, które nie wiedzą o tym, że pacjent ogląda pornografię, masturbowanie się w toaletach publicznych itp.) niż użytkownicy pornografii niedoświadczający problemów. ...
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Objectives: Addictive sexual behaviours are gaining more and more attention from researchers. There are actually 25 different questionnaires for assessing the level of loss of control over sexual. The main aim of this work was to make such an adaptation of the Sexual Addiction Screening Test-Revised (SAST-R; the most popular and questionnaire). behaviours (LoCoSB). None of them have been adapted and validated in a Polish language version. Methods: For the purpose of psychometric features examination and validation of the Polish version of SAST-R (SAST-PL-M), we recruited 116 heterosexual men receiving psychological treatment due to LoCoSB and meeting the criteria for hypersexual disorder. The control group consisted of 442 heterosexual males having never looked for any psychological or psychiatric help due to LoCoSB. Results: SAST-PL-M has high reliability (Cronbach's alpha = 0.904) and good filtering characteristics for identification of people who are potentially experiencing difficulty with control over sexual behaviours (the ROC curve for a threshold of 5 out of a maximum 20 points is characterised by a sensitivity of 99.1% and a specificity of 78.3%). Conclusions: SAST-PL-M can be used as an efficient screening test for symptoms of LoCoSB in clinical and research setups. Results below 5 points indicate a high probability of no problems, while more than 5 points can indicate the need for additional clinical interviews. SAST-PL-M results may be successfully referred to the results of SAST-R when used with heterosexual male populations for research purposes.
... In contrast, other data suggest that some patients seeking treatment for CSB do not have other impulsive behaviors or comorbid addictions beyond their struggles with sexual behaviors. This is consistent with findings from a large online survey of men and women suggesting relatively weak relations between impulsivity and some aspects of CSB (problematic pornography use) and stronger relations with others (hypersexuality) [108,109]. Similarly, in a study using different measures of individuals with problematic pornography use (mean time of weekly pornography use = 287.87 min) and those without (mean time of weekly pornography use = 50.77 ...
... Currently, CSBD constitutes a heterogeneous disorder, and further refinement of CSBD criteria should distinguish between different subtypes, some of which may relate to the heterogeneity of sexual behaviors problematic for individuals [33,108,124]. Heterogeneity in CSBD may in part explain seeming discrepancies which are noticeable across studies. Although neuroimaging studies find multiple similarities between CSB and substance and behavioral addictions, additional research is needed to fully understand how neurocognition relates to the clinical characteristics of CSB, especially with respect to sexual behaviors subtypes. ...
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Purpose of Review The current review summarizes the latest findings concerning neurobiological mechanisms of compulsive sexual behavior disorder (CSBD) and provides recommendations for future research specific to the diagnostic classification of the condition. Recent Findings To date, most neuroimaging research on compulsive sexual behavior has provided evidence of overlapping mechanisms underlying compulsive sexual behavior and non-sexual addictions. Compulsive sexual behavior is associated with altered functioning in brain regions and networks implicated in sensitization, habituation, impulse dyscontrol, and reward processing in patterns like substance, gambling, and gaming addictions. Key brain regions linked to compulsive sexual behavior features include the frontal and temporal cortices, amygdala, and striatum, including the nucleus accumbens. Summary Despite much neuroscience research finding many similarities between CSBD and substance and behavioral addictions, the World Health Organization included CSBD in the ICD-11 as an impulse-control disorder. Although previous research has helped to highlight some underlying mechanisms of the condition, additional investigations are needed to fully understand this phenomenon and resolve classification issues surrounding CSBD.
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Introduction: Sexual arousability is defined as an ability to react with sexual arousal in response to external and internal stimuli. Sexual arousablity measuring is important for research purposes and for diagnostics of sexual dysfunctions. Self-Assessment techniques can be used for such measurement. Due to absence of Polish-language psychometric tools dedicated for sexual arousability measuring we adapted Sexual Arousability Inventory. Material and methods: Psychometrical characteristic of Polish version of SAI (SAI-PL) was examined in the study with 132 participants (42 females, 90 males) and validation with behavioral factors was performed on the group of 39 heterosexual males consuming pornography on the weekly basis. Results: SAI-PL has almost identical characteristics as original SAI (high internal consistency, the same factorial structure and high reliability). Conclusions: Polish version of SAI can be successfully used for research purposes as well as in clinical setups.
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Objectives: Addictive sexual behaviours are gaining more and more attention from researchers. There are actually 25 different questionnaires for assessing the level of loss of control over sexual. The main aim of this work was to make such an adaptation of the Sexual Addiction Screening Test-Revised (SAST-R; the most popular and questionnaire). behaviours (LoCoSB). None of them have been adapted and validated in a Polish language version. Methods: For the purpose of psychometric features examination and validation of the Polish version of SAST-R (SAST-PL-M), we recruited 116 heterosexual men receiving psychological treatment due to LoCoSB and meeting the criteria for hypersexual disorder. The control group consisted of 442 heterosexual males having never looked for any psychological or psychiatric help due to LoCoSB. Results: SAST-PL-M has high reliability (Cronbach's alpha = 0.904) and good filtering characteristics for identification of people who are potentially experiencing difficulty with control over sexual behaviours (the ROC curve for a threshold of 5 out of a maximum 20 points is characterised by a sensitivity of 99.1% and a specificity of 78.3%). Conclusions: SAST-PL-M can be used as an efficient screening test for symptoms of LoCoSB in clinical and research setups. Results below 5 points indicate a high probability of no problems, while more than 5 points can indicate the need for additional clinical interviews. SAST-PL-M results may be successfully referred to the results of SAST-R when used with heterosexual male populations for research purposes.
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Here is the reference for this chapter. MacKinnon, D. P., Cheong, J., Pirlott, A. G. (2012) In Cooper, H., Camic, P. M., Long, D. L., Panter, A. T., Rindskopf, D., Sher, K. J. (Eds.) (2012). APA handbook of research methods in psychology, Vol 2: Research designs: Quantitative, qualitative, neuropsychological, and biological., (pp. 313-331). Washington, DC, US: American Psychological Association.
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Department of Psychiatry, Harvard Medical School, Boston,MA, USAOnline publication date: 27 April 2010To cite this Article Kafka, Martin P.(2010) '“What is Sexual Addiction?” A Response to Stephen Levine', Journal of Sex &Marital Therapy, 36: 3, 276 — 281To link to this Article: DOI: 10.1080/00926231003719707URL: http://dx.doi.org/10.1080/00926231003719707
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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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We examined exposure to Internet pornography before the age of 18, as reported by college students (n = 563), via an online survey. Ninety-three percent of boys and 62% of girls were exposed to online pornography during adolescence. Exposure prior to age 13 was relatively uncommon. Boys were more likely to be exposed at an earlier age, to see more images, to see more extreme images (e.g., rape, child pornography), and to view pornography more often, while girls reported more involuntary exposure. If participants in this study are typical of young people, exposure to pornography on the Internet can be described as a normative experience, and more study of its impact is clearly warranted.
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Importance Since pornography appeared on the Internet, the accessibility, affordability, and anonymity of consuming visual sexual stimuli have increased and attracted millions of users. Based on the assumption that pornography consumption bears resemblance with reward-seeking behavior, novelty-seeking behavior, and addictive behavior, we hypothesized alterations of the frontostriatal network in frequent users.Objective To determine whether frequent pornography consumption is associated with the frontostriatal network.Design, Setting, and Participants In a study conducted at the Max Planck Institute for Human Development in Berlin, Germany, 64 healthy male adults covering a wide range of pornography consumption reported hours of pornography consumption per week. Pornography consumption was associated with neural structure, task-related activation, and functional resting-state connectivity.Main Outcomes and Measures Gray matter volume of the brain was measured by voxel-based morphometry and resting state functional connectivity was measured on 3-T magnetic resonance imaging scans.Results We found a significant negative association between reported pornography hours per week and gray matter volume in the right caudate (P < .001, corrected for multiple comparisons) as well as with functional activity during a sexual cue–reactivity paradigm in the left putamen (P < .001). Functional connectivity of the right caudate to the left dorsolateral prefrontal cortex was negatively associated with hours of pornography consumption.Conclusions and Relevance The negative association of self-reported pornography consumption with the right striatum (caudate) volume, left striatum (putamen) activation during cue reactivity, and lower functional connectivity of the right caudate to the left dorsolateral prefrontal cortex could reflect change in neural plasticity as a consequence of an intense stimulation of the reward system, together with a lower top-down modulation of prefrontal cortical areas. Alternatively, it could be a precondition that makes pornography consumption more rewarding.
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Perceived addiction to Internet pornography is increasingly a focus of empirical attention. The present study examined the role that religious belief and moral disapproval of pornography use play in the experience of perceived addiction to Internet pornography. Results from two studies in undergraduate samples (Study 1, N = 331; Study 2, N = 97) indicated that there was a robust positive relationship between religiosity and perceived addiction to pornography and that this relationship was mediated by moral disapproval of pornography use. These results persisted even when actual use of pornography was controlled. Furthermore, although religiosity was negatively predictive of acknowledging any pornography use, among pornography users, religiosity was unrelated to actual levels of use. A structural equation model from a web-based sample of adults (Study 3, N = 208) revealed similar results. Specifically, religiosity was robustly predictive of perceived addiction, even when relevant covariates (e.g., trait self-control, socially desirable responding, neuroticism, use of pornography) were held constant. In sum, the present study indicated that religiosity and moral disapproval of pornography use were robust predictors of perceived addiction to Internet pornography while being unrelated to actual levels of use among pornography consumers.
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The authors aimed to validate a brief measure of perceived addiction to Internet pornography refined from the 32-item Cyber Pornography Use Inventory, report its psychometric properties, and examine how the notion of perceived addiction to Internet pornography might be related to other domains of psychological functioning. To accomplish this, 3 studies were conducted using a sample of undergraduate psychology students, a web-based adult sample, and a sample of college students seeking counseling at a university's counseling center. The authors developed and refined a short 9-item measure of perceived addiction to Internet pornography, confirmed its structure in multiple samples, examined its relatedness to hypersexuality more broadly, and demonstrated that the notion of perceived addiction to Internet pornography is very robustly related to various measures of psychological distress. Furthermore, the relation between psychological distress and the new measure persisted, even when other potential contributors (e.g., neuroticism, self-control, amount of time spent viewing pornography) were controlled for statistically, indicating the clinical relevance of assessing perceived addiction to Internet pornography.
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Hypersexuality disorder has not been added to the list of psychiatric disorders for the Diagnostic and Statistical Manual of Mental Disorders (DSM) V, to be published in May 2013. The evolution of the concept of hypersexuality disorder and its series of different models call into question the controversial context within which its inclusion is considered for the DSM V. A brief contextual analysis makes clear that the creation of this concept follows moral norms and psychosocial values. The construction of hypersexuality disorder in terms of a diagnostic entity rests on the clash of social forces at play in the development process. This article lays the foundation to contemplate the manner in which entities for psychiatric disorders are constructed.
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This paper highlights a few of the ways that the Internet is having a profound effect on sexuality. For the sake of simplicity, and to better elucidate the points, the Internet's effect on sexuality is divided into the three broad categories: negative patterns, positive connections, and commercial aspects. In addition, three of the key factors that combine to give the Internet its power are delineated. They include Access, Affordability, and Anonymity or as they are called here the "Triple A". Finally, suggestions for how the field should deal with this phenomena are offered.
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Internet sex addiction typically involves viewing, downloading, and trading online pornography or engagement in adult fantasy role-play rooms. Adult Web sites comprise the largest segment of electronic commerce catering to a wide variety of sexual interests. Given the widespread availability of sexually explicit material online, Internet sex addiction is the most common form of problem online behavior among users. Using research and illustrative case studies, this chapter explores how sexually explicit material enters our homes, schools, and business, and examines the risk factors that lead to addiction. As new users are more at risk to become hooked on online porn or adult sex chat rooms, this chapter presents a model that shows the progressive stages of development underlying Internet sex addiction and how the Internet enables sexually explicit behavior to develop. Finally, this chapter reviews current treatment practices associated with the disorder and the implications of new mobile technologies.
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A growing number of clients are presenting in therapy with problems related to their on-line sexual habits. Adults who had used the Internet for sexual pursuits at least once ( N = 9,177) completed a 59-item on-line survey. Men and women generally behaved differently, and most (92%) indicated their on-line sexual behaviors were not problematic. Heavy users (8%) reported significant problems typically associated with compulsive disorders. Problems were highly correlated with time spent on-line for sex. Results are discussed in terms of their research and practice implications, including diagnosis and treatment. Recommendations are made for outreach prevention programs and future policies. (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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Readers who want a less mathematical alternative to the EQS manual will find exactly what they're looking for in this practical text. Written specifically for those with little to no knowledge of structural equation modeling (SEM) or EQS, the author's goal is to provide a non-mathematical introduction to the basic concepts of SEM by applying these principles to EQS, Version 6.1. The book clearly demonstrates a wide variety of SEM/EQS applications that include confirmatory factor analytic and full latent variable models.
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This article examines the adequacy of the “rules of thumb” conventional cutoff criteria and several new alternatives for various fit indexes used to evaluate model fit in practice. Using a 2‐index presentation strategy, which includes using the maximum likelihood (ML)‐based standardized root mean squared residual (SRMR) and supplementing it with either Tucker‐Lewis Index (TLI), Bollen's (1989) Fit Index (BL89), Relative Noncentrality Index (RNI), Comparative Fit Index (CFI), Gamma Hat, McDonald's Centrality Index (Mc), or root mean squared error of approximation (RMSEA), various combinations of cutoff values from selected ranges of cutoff criteria for the ML‐based SRMR and a given supplemental fit index were used to calculate rejection rates for various types of true‐population and misspecified models; that is, models with misspecified factor covariance(s) and models with misspecified factor loading(s). The results suggest that, for the ML method, a cutoff value close to .95 for TLI, BL89, CFI, RNI, and Gamma Hat; a cutoff value close to .90 for Mc; a cutoff value close to .08 for SRMR; and a cutoff value close to .06 for RMSEA are needed before we can conclude that there is a relatively good fit between the hypothesized model and the observed data. Furthermore, the 2‐index presentation strategy is required to reject reasonable proportions of various types of true‐population and misspecified models. Finally, using the proposed cutoff criteria, the ML‐based TLI, Mc, and RMSEA tend to overreject true‐population models at small sample size and thus are less preferable when sample size is small.
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There are widespread concerns that on the internet, adolescents are especially vulnerable and take more risks than adults. However, research supporting this concern is still missing. The aim of this study was to explore whether (a) unwanted online sexual solicitation, (b) risky sexual online behavior, and (c) the perception of risks and benefits of risky sexual online behavior vary for males and females in adolescence and adulthood. We conducted an online survey with a representative sample of 1765 Dutch adolescents (grouped as 12–13-, 14–15-, and 16–17-year olds) and 1026 Dutch adults (grouped as 18–29-, 30–50-, and 50–88-year olds). Results indicated that adolescents were more at risk of becoming a victim of unwanted online sexual solicitation than adults. However, they did not engage in more online sexual risks than adults. As expected, females were sexually solicited more often than males but took fewer online sexual risks than males. Across all adolescent and adult age groups, perceived risks of risky sexual online behavior were high while perceived benefits were low. Contrary to earlier theories, adolescents did not perceive fewer risks or more benefits of risky sexual online behavior than adults.
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