ArticlePDF Available

Abstract

During the last decade, there has been heated debate regarding whether compulsive sexual behaviour should be classified as a mental/behavioural disorder. Compulsive sexual behaviour disorder has been proposed for inclusion as an impulse control disorder in the ICD-11. It is characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges, resulting in repetitive sexual behaviour over an extended period (e.g., six months or more) that causes marked distress or impairment in personal, family, social, educational, occupational or other important areas of functioning.
to support it. However, these factors must be considered when
deciding what is immediately implementable, versus that which
requires a supportive framework which has yet to be created.
All digital health research and claims are informative. Some
offer immediate solutions to health care that should be imple-
mented today and others highlight the potential of what may
be possible. However, blurring the line between actual and aspi-
rational can be counterproductive. Claiming that aspirational
digital health research is ready for immediate use can lead to
immediate negative results and broad disappointment. It may
even inadvertently contribute to digital health “hype” and foster
undue skepticism for the field.
However, ignoring digital health technologies with good evi-
dence for real-world implementation is a missed opportunity
for improving patient outcomes. Appreciating how aspiration-
al research can guide, inform, and inspire current efforts is
also important. Likewise, appreciating the real world success
of actualized efforts can help guide aspirational research to be
more translatable into health care systems.
There is no superior designation, as both ends of the actual
and aspirational spectrum have critical roles that cannot be sepa-
rated. However, the value of both depends upon correct identifi-
cation of where any given project lies on this spectrum – and
further consideration of populations sampled and incentives
used are critical to determining this.
John Torous
1
, Joseph Firth
2
1
Department of Psychiatry and Division of Clinical Informatics, Beth Israel Deaconess
Medical Center, Harvard Medical School, Boston, MA, USA;
2
NICM, School of Science
and Health, Western Sydney University, Sydney, Australia
1. Lee JM, Hirschfeld E, Wedding J. JAMA 2016;315:1447-8.
2. Eyre HA, Singh AB, Reynolds C. World Psychiatry 2016;15:21-2.
3. Walch OJ, Cochran A, Forger DB. Sci Adv 2016;2:e1501705.
4. Kroenke K, Spitzer RL, Williams JB. J Gen Intern Med 2001;16:606-13.
5. Place S, Blanch-Hartigan D, Rubin C et al. J Med Internet Res 2017;19:e75.
6. Gustafson DH, McTavish FM, Chih MY et al. JAMA Psychiatry 2014;71:
566-72.
7. Ford JH II, Alagoz E, Dinauer S et al. J Med Internet Res 2015;17:e201.
DOI:10.1002/wps.20464
Compulsive sexual behaviour disorder in the ICD-11
During the last decade, there has been heated debate regarding
whether compulsive sexual behaviour should be classified as
a mental/behavioural disorder. Compulsive sexual behaviour
disorder has been proposed for inclusion as an impulse control
disorder in the ICD-11
1
. It is characterized by a persistent pattern
of failure to control intense, repetitive sexual impulses or urges,
resulting in repetitive sexual behaviour over an extended period
(e.g., six months or more) that causes marked distress or impair-
ment in personal, family, social, educational, occupational or
other important areas of functioning.
The pattern is manifested in one or more of the following: a)
engaging in repetitive sexual activities has become a central focus
of the person’s life to the point of neglecting health and personal
care or other interests, activities and responsibilities; b) the person
has made numerous unsuccessful efforts to control or signifi-
cantly reduce repetitive sexual behaviour; c) the person continues
to engage in repetitive sexual behaviour despite adverse conse-
quences (e.g., repeated relationship disruption, occupational con-
sequences, negative impact on health); or d) the person continues
to engage in repetitive sexual behaviour even when he/she derives
little or no satisfaction from it.
Concerns about overpathologizing sexual behaviours are
explicitly addressed in the diagnostic guidelines proposed for
the disorder. Individuals with high levels of sexual interest and
behaviour (e.g., due to a high sex drive) who do not exhibit
impaired control over their sexual behaviour and significant
distress or impairment in functioning should not be diagnosed
with compulsive sexual behaviour disorder. The diagnosis
should also not be assigned to describe high levels of sexual
interest and behaviour (e.g., masturbation) that are common
among adolescents, even when this is associated with distress.
The proposed diagnostic guidelines also emphasize that com-
pulsive sexual behaviour disorder should not be diagnosed bas-
ed on psychological distress related to moral judgments or
disapproval about sexual impulses, urges or behaviours that
would otherwise not be considered indicative of psychopathol-
ogy. Sexual behaviours that are egodystonic can cause psycho-
logical distress; however, psychological distress due to sexual
behaviour by itself does not warrant a diagnosis of compulsive
sexual behaviour disorder.
Careful attention must be paid to the evaluation of individu-
als who self-identify as having the disorder (e.g., calling them-
selves “sex addicts” or “porn addicts”). Upon examination, such
individuals may not actually exhibit the clinical characteristics
of the disorder, although they might still be treated for other
mental health problems (e.g., anxiety, depression). Additionally,
individuals often experience feelings such as shame and guilt in
relationship to their sexual behaviour
2
, but these experiences
are not reliably indicative of an underlying disorder.
The proposed diagnostic guidelines also assist the clinician
in differentiating compulsive sexual behaviour disorder from
other mental disorders and other health conditions. For example,
although bipolar disorder has been found at elevated rates
among individuals with compulsive sexual behaviour disor-
der
3
, sexual behaviours must be persistent and occur indepen-
dently of hypomanic or manic episodes to provide a basis for a
possible diagnosis of the disorder. A diagnosis of compulsive
sexual behaviour disorder should not be made when the be-
haviour can be explained by other medical conditions (e.g., de-
mentia) or by the effects of certain medications prescribed to
treat specific medical conditions (e.g., Parkinson’s disease)
4
or
is entirely attributable to the direct effects of illicit substances
World Psychiatry 17:1 - February 2018 109
on the central nervous system (e.g., cocaine, crystal metham-
phetamine).
Currently, there is an active scientific discussion about wheth-
er compulsive sexual behaviour disorder can constitute the
manifestation of a behavioural addiction
5
. For ICD-11, a rela-
tively conservative position has been recommended, recogniz-
ing that we do not yet have definitive information on whether
the processes involved in the development and maintenance
of the disorder are equivalent to those observed in substance
use disorders, gambling and gaming
6
. For this reason, compul-
sive sexual behaviour disorder is not included in the ICD-11
grouping of disorders due to substance use and addictive be-
haviours, but rather in that of impulse control disorders. The
understanding of compulsive sexual behaviour disorder will
evolve as research elucidates the phenomenology and neuro-
biological underpinnings of the condition
7
.
In the absence of consistent definitions and community-
based epidemiological data, determining accurate prevalence
rates of compulsive sexual behaviour disorder has been diffi-
cult. Epidemiological estimates have ranged up to 3-6% in
adults
8
, though recent studies have produced somewhat lower
estimates of 1 to 3%
9
. The more restrictive diagnostic require-
ments proposed for ICD-11 would be expected to produce low-
er prevalence rates.
In general, men exhibit the disorder more frequently than
women, although robust data examining gender differences
are lacking. Additionally, higher rates of the disorder have
been noted among individuals with substance use disorders.
Among treatment seekers, the disorder negatively impacts
occupational, relationship, physical health and mental health
functioning. However, systematic data are lacking regarding
the prevalence of the disorder across different populations
and associated socio-cultural and socio-demographic factors,
including among non-treatment seekers.
Growing evidence suggests that compulsive sexual behaviour
disorder is an important clinical problem with potentially seri-
ous consequences if left untreated. We believe that including
the disorder in the ICD-11 will improve the consistency with
which health professionals approach the diagnosis and treat-
ment of persons with this condition, including consistency
regarding when a disorder should not be diagnosed. Legitimate
concerns about overpathologizing sexual behaviours have been
carefully addressed in the proposed diagnostic guidelines. We
posit that inclusion of this category in the ICD-11 will provide a
better tool for addressing the unmet clinical needs of treatment
seeking patients as well as possibly reduce shame and guilt
associated with help seeking among distressed individuals.
The proposed diagnostic guidelines will be tested in interna-
tional multilingual Internet-based field studies using standard-
ized case material, which will help to assess the generalizability
of the construct across different regions and cultures, and clini-
cians’ ability to distinguish it from normal variations in sexual
behaviour and from other disorders. Additional field studies in
clinical settings will provide further information about the clini-
cal utility of the proposed diagnostic guidelines for the disorder
among clinical populations.
Shane W. Kraus
1
, Richard B. Krueger
2
, Peer Briken
3
, Michael B. First
2
,
Dan J. Stein
4
, Meg S. Kaplan
2
, Valerie Voon
5
, Carmita H.N. Abdo
6
,
Jon E. Grant
7
, Elham Atalla
8
, Geoffrey M. Reed
9,10
1
Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA;
2
Department
of Psychiatry, Columbia University, College of Physicians and Surgeons and New York
State Psychiatric Institute, New York, NY, USA;
3
Institute for Sex Research and
Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Ger-
many;
4
Department of Psychiatry, University of Cape Town and Groote Schuur Hos-
pital, Cape Town, South Africa;
5
Department of Psychiatry, University of Cambridge,
Cambridge, UK;
6
Department of Psychiatry, Faculty of Medicine, University of S~
ao Paulo,
S~
ao Paulo, Brazil;
7
Department of Psychiatry and Behavioral Neuroscience, University of
Chicago, Chicago, IL, USA;
8
Primary Care and Public Health Directorate, Ministry of
Health, Manama, Bahrain;
9
Department of Mental Health and Substance Abuse, World
Health Organization, Geneva, Switzerland;
10
Global Mental Health Program, Columbia
University Medical Center, New York, NY, USA
1. Grant JE, Atmaca M, Fineberg NA et al. World Psychiatry 2014;13:125-7.
2. Gilliland R, South M, Carpenter BN et al. Sex Addict Compulsivity 2011;18:
12-29.
3. Raymond NC, Coleman E, Miner MH. Compr Psychiatry 2003:44:370-80.
4. Weintraub D, Koester J, Potenza MN et al. Arch Neurol 2010;67:589-95.
5. Griffiths MD. Addict Res Theory 2012:20:111-24.
6. Kraus SW, Voon V, Potenza MN. Addiction 2016;111:2097-106.
7. Kraus SW, Voon V, Potenza MN. Neuropsychopharmacology 2016;41:
385-6.
8. Kuzma JM, Black DW. Psychiatr Clin N Am 2008;31:603-11.
9. Klein V, Rettenberger M, Briken P. J Sex Med 2014;11:1974-81.
DOI:10.1002/wps.20499
Decline in suicide mortality after psychiatric hospitalization for
depression in Finland between 1991 and 2014
Depression is the most important mental disorder in terms
of suicide mortality. Numerous studies over time have esti-
mated the lifetime risk of suicide in depression, including a
recent Danish national study
1
. Organization of services and
treatment practices for depression have undergone major
changes over the past decades, including remarkable growth
in the use of antidepressants, emphasis on community-based
services, and deinstitutionalization. Temporal trends in suicide
mortality among psychiatric patients with depression can be
expected, but have not been investigated.
We followed a Finnish population-based cohort of depres-
sive patients (N556,826), with a first lifetime hospitalization
due to depression between 1991 and 2011, up to the end of the
year 2014 (maximum follow-up: 24 years). Here we report both
cumulative risk of suicide and temporal trends in suicide mor-
tality.
110 World Psychiatry 17:1 - February 2018
... The ICD-11 also states that distress entirely related to moral judgments and disapproval about sexual impulses, urges or behaviors is not sufficient to meet the distress criterion. Overall, a conservative approach was taken for the ICD-11 in classifying CSBD as an impulse control disorder instead of an addictive disorder because there is (to date) insufficient evidence to determine whether the processes involved in the development and maintenance of the disorder are equivalent to other recognized forms of addiction (Kraus et al., 2018). ...
... While the current ICD-11 CSBD diagnosis is a good starting point for unified assessment of the disorder, more research on its precise phenomenology and neurobiological underpinnings is needed to determine whether it should be re-classified as an addictive disorder in future iterations of diagnostic manuals (Griffiths, 2022;Kraus et al., 2016Kraus et al., , 2018Sassover & Weinstein, 2022). Determining whether CSBD (and by extension, PPU) is best conceptualized as an addictive disorder is important to ensure that appropriate pharmacological and psychological treatments are delivered depending on the specific neurobiological mechanisms and clinical features involved Briken & Turner, 2022;Kingston, 2015;Kor et al., 2013;Lew-Starowicz & Coleman, 2022;Potenza et al., 2017). ...
Article
Full-text available
Little is known about whether withdrawal-like symptoms manifest when regular pornography users attempt to abstain from pornography. The present study used a randomized controlled design to examine whether (1) negative abstinence effects that may be potentially reflective of withdrawal-related symptoms manifest when a non-clinical sample of regular pornography users attempt to abstain from pornography for a 7-day period and (2) these negative abstinence effects would only manifest (or manifest more strongly) for those with higher levels of problematic pornography use (PPU). A total of 176 undergraduate students (64.2% female) who were regular pornography users (defined as having used pornography ≥ three times a week in the past 4 weeks) were randomly assigned to an abstinence group (instructed to attempt abstinence from pornography for 7 days, n = 86) or a control group (free to watch pornography as usual, n = 90). Participants completed measures of craving, positive and negative affect, and withdrawal symptoms at baseline and each night of the 7-day period. Contrary to the confirmatory hypotheses, there were no significant main effects of group (abstinence vs. control) or group × PPU interaction effects on any of the outcome measures, controlling for baseline scores. These findings indicate that no evidence of withdrawal-related symptoms was found for abstaining participants, and this was not dependent on level of PPU. However, exploratory analyses showed a significant three-way interaction (group × PPU × past 4-week frequency of pornography use [FPU]) on craving, where an abstinence effect on craving was found at high levels of PPU only once past 4-week FPU reached the threshold of daily use. While these exploratory findings should be interpreted with caution, they suggest that abstinence effects could potentially manifest when there is a combination of high PPU and high FPU-a hypothesis that warrants investigation in future prospective abstinence studies.
... Prior research demonstrates that an increase in hypersexual and sensation seeking behaviors is associated with increased pornography viewing (e.g., Kraus et al., 2018;Peter & Valkenburg, 2008). This helped formulate the first part of the Hypothesis 1, that "increased pornography viewing scores are associated with increased hypersexuality and sensation seeking … scores." ...
Article
The current study explored men’s (N = 1,298) reports of sexual behaviors, hypersexuality, pornography use, pornography avoidance self-efficacy, and sensation seeking with respect to men’s sexual orientation (heterosexual = 68.5%, gay = 11.2%, bisexual = 16.0%, and uncertain = 4.3%). Results revealed that heterosexual men reported less frequent pornography viewing and higher pornography avoidance self-efficacy than gay, bisexual, and uncertain men. Heterosexual men reported lower hypersexuality than bisexual and uncertain men. Differences in sensation seeking behaviors by sexual orientation did not reach significance. Future research should examine factors contributing to hypersexual behaviors, sensation seeking, and pornography using behaviors and avoidance self-efficacy among men identifying with different sexual orientations.
... In summary, most studies have found prevalence rates between 8% and 13% for men and between 5% and 7% for women; however, distress or interpersonal problems due to CSB were not assessed strictly in these previous studies. Meanwhile, many clinicians and researchers estimate the prevalence of CSB qualifying for a diagnosis of a psychiatric disorder (e.g., CSBD) to be between 3% and 6% in the general population (Odlaug et al. 2013;Kraus et al. 2018). ...
Article
Objectives The current guidelines aim to evaluate the role of pharmacological agents in the treatment of patients with compulsive sexual behaviour disorder (CSBD). They are intended for use in clinical practice by clinicians who treat patients with CSBD. Methods An extensive literature search was conducted using the English-language-literature indexed on PubMed and Google Scholar without time limit, supplemented by other sources, including published reviews. Results Each treatment recommendation was evaluated with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. Psychoeducation and psychotherapy are first-choice treatments and should always be conducted. The type of medication recommended depended mainly on the intensity of CSBD and comorbid sexual and psychiatric disorders. There are few randomised controlled trials. Although no medications carry formal indications for CSBD, selective-serotonin-reuptake-inhibitors and naltrexone currently constitute the most relevant pharmacological treatments for the treatment of CSBD. In cases of CSBD with comorbid paraphilic disorders, hormonal agents may be indicated, and one should refer to previously published guidelines on the treatment of adults with paraphilic disorders. Specific recommendations are also proposed in case of chemsex behaviour associated with CSBD. Conclusions An algorithm is proposed with different levels of treatment for different categories of patients with CSBD.
Article
The consequences of sexual addiction (hereafter SA) and compulsive sexual behavior (hereafter CSB) are manifold and can be challenging to qualify and quantify accurately. Individuals suffering from SA/CSB and their intimate partners typically encounter a host of devastating ramifications. The purpose of this comment piece is to highlight selected ongoing and often life-altering impacts, many of which will haunt affected relationships for long periods of time following discovery and disclosure. It is common knowledge that SA/CSB is almost always underpinned by pornography consumption. Given that the majority of pornography is now accessed on mobile devices suggests that modern technology plays a significant role in contributing to, sustaining, and escalating SA/CSBs. Our comment also presents an unsolicited letter from a self-identified sex addict, which laments the real-life consequences of SA/CSB.
Article
In the current study we sought to identify sexual behavior profiles and examine the levels of childhood abuse history and trauma measures in each profile. The study was conducted among a large non-clinical sample of men and women (n = 806). Latent profile analysis was employed to identify distinct profiles of sexual behaviors and then childhood abuse, posttraumatic stress disorder (PTSD), depression, and anxiety, and motives for engaging in sex were assessed in each profile. Four distinct profiles of sexual behavior were identified: hyposexual individuals, hypersexual porn users, porn users, and within usual ranges (WURs). Hypersexual porn users had significantly more childhood trauma (emotional, physical, and sexual) than WURs, significantly greater PTSD symptom than WURs and hyposexual individuals, and significantly greater anxiety and depression as compared with all other groups. The hyposexual individuals had significantly lower scores on all motives for engaging in sex than did porn users or hypersexual porn users. Hypersexual porn users and porn users reported coping and peer-pressure as motives for engaging in sex more than did WURs or hyposexual individuals. Clinicians working with survivors of childhood abuse should consider directly targeting these different maladaptive sexual behaviors by addressing PTSD symptoms, affective disorders, and motives for engaging in sex.
Article
Black women are underrepresented in the research on compulsive sexual behavior (CSB). The absence of research poses questions for therapists supporting Black women who present with CSB as they have unique specificities, which can also influence how CSB is formulated in this population. This paper recommends a thorough assessment for CSB following the ICD-11 diagnostic criteria and also explains and provides guidance on the usefulness of assessing for racism and discrimination. The paper discusses the specificities experienced by Black women, such as Adultification, Invisibility, Microaggressions, Colorism, and Intergenerational Trauma and how they can influence Black women in the United Kingdom. This article will present a case study to illustrate the importance of understanding the specificities of Black women with CSB.
Thesis
Ce travail de thèse a pour objet l’exploration des capacités de cognition sociale (CS) dans les deux addictions comportementales (ACs) actuellement reconnues dans les classifications internationales : le jeu d’argent pathologique (JAP) et le jeu vidéo pathologique (JVP).La réalisation de deux revues de littérature systématiques a permis de démontrer la rareté des études faisant le lien entre CS et ACs. Cependant, les études trouvées ont suggéré la présence de difficultés pour les patients atteints de ces ACs sur certaines composantes de la CS. Par ailleurs, les éléments cliniques rapportés par ces patients confirmaient la présence de difficultés interpersonnelles.Ces éléments témoignaient de la nécessité d’explorer le profil de CS des patients avec un diagnostic de JAP ou JVP pour améliorer d’une part la compréhension des processus addictifs, et d’autre part de proposer des soins ciblant les difficultés mises en évidence. Nous avons ainsi mené trois études sur des joueurs de jeux vidéo ou de jeux d’argent, présentant ou non une addiction.La première étude a démontré des particularités dans le traitement attentionnel des informations sociales chez des joueurs de poker en comparaison de sujets contrôles. La seconde étude a mis en évidence un lien entre les difficultés d’identification des émotions faciales et le JAP, ainsi que des particularités sur le plan de la métacognition sociale en lien avec le JVP. Enfin, les résultats préliminaires de la troisième étude incluant des patients en début de prise en charge pour un JAP ont montré l’importance de prendre en compte les données rapportées par les patients dans le cadre de la CS.Ces résultats sont discutés au regard des aspects cliniques et scientifiques, et mis en perspective avec de futures recherches possibles.
Article
Full-text available
Although substantial advances have been made in the field, only scant research has been conducted on substance use among women. In the current study (n = 132), we examined possible intermediate processes that could underline the high comorbidity between substance use disorders (SUDs), compulsive sexual behavior (CSBD), and risky sexual behaviors (RSB) among women: emotion regulation, distress, and perceived social support (PSS). Results indicate that women with SUDs have more prevalent RSB and higher CSBD symptoms than healthy controls. Using a model with SUD as a dependent measure, intermediate factors as mediators, and CSBD and RSB as outcomes, we found that women with SUDs had more significant sensations of distress and lowered PSS than healthy controls. However, only distress mediated the association between SUDs, CSBD, and RSB. The findings provide insights into the intermediate processes that intertwined addictive behaviors and an opportunity for developing novel and successful treatments for women.
Article
Compulsive sexual behavior (CSB) is associated with poor affect regulation and difficulties in interpersonal relationships. People experiencing CSB may engage in ineffective coping and have poor social support. The current study tested relationships between several coping orientations and sources of perceived social support (from significant others, friends, and family) among men seeking treatment for CSB and other sexual health and relationship concerns. Results indicated that religion and self-blame coping orientations predicted greater CSB concerns. Social support from friends and coping with humor were associated with lower CSB. These findings identify potential areas of intervention to target CSB-related concerns.
Article
Full-text available
There is evidence that compulsive sexual behavior (CSB) is linked with childhood trauma in women and men. This study has investigated the relationships between childhood abuse and neglect and compulsive sexual behavior in a mostly female sample who use dating applications for sex. Participants were 200 adults (164 women and 36 men) mean age 26.88 years (SD = 6.45) range 19–58, 74% were single, 19.5% married, 6.5% divorced or separated. Questionnaires were administered by Google forms and included a demographic questionnaire, the Sexual Addiction Screening Test (SAST) and the Childhood Trauma Questionnaire (CTQ). There were positive associations between childhood sexual abuse (CSA), physical and mental abuse and physical neglect, (but not emotional neglect) and CSB. Multiple regression analysis revealed that ratings of child abuse (all apart from emotional neglect) have explained 57% of the variance of sexual addiction scores. This study shows that CSA, mental and physical abuse and physical neglect have been related to CSB. These findings may have clinical implications for understanding and treatment of CSB.
Article
Full-text available
Aims: To review the evidence base for classifying compulsive sexual behavior (CSB) as a non-substance or 'behavioral' addiction. Methods: Data from multiple domains (e.g. epidemiological, phenomenological, clinical, biological) are reviewed and considered with respect to data from substance and gambling addictions. Results: Overlapping features exist between CSB and substance use disorders. Common neurotransmitter systems may contribute to CSB and substance use disorders, and recent neuroimaging studies highlight similarities relating to craving and attentional biases. Similar pharmacological and psychotherapeutic treatments may be applicable to CSB and substance addictions, although considerable gaps in knowledge currently exist. Conclusions: Despite the growing body of research linking compulsive sexual behavior (CSB) to substance addictions, significant gaps in understanding continue to complicate classification of CSB as an addiction.
Article
Full-text available
Neuropsychopharmacology, the official publication of the American College of Neuropsychopharmacology, publishing the highest quality original research and advancing our understanding of the brain and behavior.
Article
Full-text available
Although clinical accounts and studies of persons with compulsive/ addictive behavior often address shame, and sometimes guilt, no study examines the interplay of shame and guilt in maintenance of hypersexual behavior. Persons seeking treatment for compulsive pornography use (n = 177) reported shame, guilt, hypersexuality, and motivations to change through anonymous, online surveys. A path model demonstrated significant positive relationships between shame-proneness and hypersexuality, and between guilt-proneness with both motivation to change and preventive behaviors. Results suggest that shame and guilt have contrasting, complementary relationships related to the maintenance of hypersexual behavior and the motivation to change unwanted practices.
Article
Full-text available
An association between dopamine-replacement therapies and impulse control disorders (ICDs) in Parkinson disease (PD) has been suggested in preliminary studies. To ascertain point prevalence estimates of 4 ICDs in PD and examine their associations with dopamine-replacement therapies and other clinical characteristics. Cross-sectional study using an a priori established sampling procedure for subject recruitment and raters blinded to PD medication status. Three thousand ninety patients with treated idiopathic PD receiving routine clinical care at 46 movement disorder centers in the United States and Canada. The Massachusetts Gambling Screen score for current problem/pathological gambling, the Minnesota Impulsive Disorders Interview score for compulsive sexual behavior and buying, and Diagnostic and Statistical Manual of Mental Disorders research criteria for binge-eating disorder. An ICD was identified in 13.6% of patients (gambling in 5.0%, compulsive sexual behavior in 3.5%, compulsive buying in 5.7%, and binge-eating disorder in 4.3%), and 3.9% had 2 or more ICDs. Impulse control disorders were more common in patients treated with a dopamine agonist than in patients not taking a dopamine agonist (17.1% vs 6.9%; odds ratio [OR], 2.72; 95% confidence interval [CI], 2.08-3.54; P < .001). Impulse control disorder frequency was similar for pramipexole and ropinirole (17.7% vs 15.5%; OR, 1.22; 95% CI, 0.94-1.57; P = .14). Additional variables independently associated with ICDs were levodopa use, living in the United States, younger age, being unmarried, current cigarette smoking, and a family history of gambling problems. Dopamine agonist treatment in PD is associated with 2- to 3.5-fold increased odds of having an ICD. This association represents a drug class relationship across ICDs. The association of other demographic and clinical variables with ICDs suggests a complex relationship that requires additional investigation to optimize prevention and treatment strategies. clinicaltrials.gov Identifier: NCT00617019.
Article
Full-text available
Research into CSB is hindered by the lack of a generally accepted definition and reliable and valid assessment tools. Despite these limitations, evidence indicates that CSB is relatively common in the general adult population, causes substantial personal distress, and is a source of significant psychosocial disability. CSB appears to begin early in life, to have a male preponderance, and to run a chronic or episodic course. It is also commonly associated with psychiatric comorbidity, typically mood, anxiety, substance use, and personality disorders. Further research is needed to better our understanding of the disorder and improve our ability to develop specific interventions.
Article
Introduction: Hypersexual behavior has been a controversial and much disputed issue in the field of sexual medicine. However, only little attention has been paid to hypersexual behavior in women. Therefore, to date there is limited knowledge on the behavioral patterns of hypersexuality in women. Aims: The purpose of the present study was to examine which sexual behavioral patterns are associated with self-reported indicators of hypersexuality in a female online sample. The second aim was to evaluate the association between hypersexuality and sexual risk behavior in women. Methods: In total, 988 women participated in an online survey. Logistic regression analysis was conducted to examine the association between sexual behavioral patterns and hypersexuality. Furthermore, correlation analyses were calculated in order to identify the relationship between sexual risk behavior and hypersexuality. Main outcome measures: Indicators of hypersexual behavior were measured by the Hypersexual Behavior Inventory (HBI). In addition, current and present impersonal sexual activities were investigated. Sexual risk behavior was assessed using the Sexual Sensation Seeking Scale (SSSS). Results: High masturbation frequency, number of sexual partners, and pornography use were associated with a higher degree of hypersexual behavior in women. Furthermore, the HBI total score was positively correlated to sexual risk behavior. Conclusion: The results of the current study do not support the idea of previous research that hypersexual women are typically engaged in more passive forms of sexual behavior. Rather female hypersexuality seems to be more characterized by impersonal sexual activity. An association between hypersexual behavior and sexual risk behavior was identified. The implications of these findings for potential prevention strategies and therapeutic interventions are discussed.
Article
Psychiatric classifications have traditionally recognized a number of conditions as representing impulse control disorders. These have included pathological gambling, intermittent explosive disorder, kleptomania, pyromania, and trichotillomania.
Article
The advent of the Internet has added another medium in which people can engage in sexual behavior. This ranges from the passive consumption of online pornography to the interactive exchange of sexual content in cybersex chat rooms. It is believed that access, affordability, and anonymity are critical factors that make the Internet viable for the acquisition, development, and maintenance of online sexuality. For some, sexual behaviors online are used as a complement to their offline sexuality, whereas for others, they serve as a substitute, potentially resulting in Internet sex addiction, which can be conceptualized as the intersection between Internet addiction and sex addiction. The current literature suggests that there does not appear a clear dividing line between these psychopathologies. The aim of this review was therefore to provide a comprehensive overview of the empirical studies that have investigated Internet sex addiction in adults. Based on the five qualitative and nine quantitative studies conducted in Western countries that were identified, it was concluded that engaging in sexual behaviors on the Internet can go awry and result in Internet sex addiction, as it can lead to a wide variety of negative consequences for the individuals affected. Particular attention is drawn to the implications for future research in order to establish the pathological status of Internet sex addiction as a sub-form of Internet addiction, that shares characteristics of real life sex addiction, but that is not to be equated with it. Accordingly, the need for a clear diagnostic framework to clinically assess Internet sex addiction is emphasized as the first step toward understanding the potentially psychopathological qualities and repercussions of sexual behaviors on the Internet.
Article
In recent years there has been an increase in identifying and treating a clinical syndrome that has been given many different names, including compulsive sexual behavior (CSB). The purpose of this study was to determine the prevalence of psychiatric disorders in a sample of individuals with CSB, as evaluated by a structured psychiatric interview. A secondary focus of this research was to determine if individuals with CSB exhibit obsessive-compulsive characteristics or exhibit impulse control problems. Participants were 23 men and two women who responded to newspaper advertisements and met criteria for CSB according to diagnostic criteria established and assessed by expert clinicians. The Structured Clinical Interview for DSM-III, patient version (SCID-P) and the Structured Clinical Interview for Axis II Disorders (SCID-II) were used to interview all participants. To study compulsive or impulsive traits the authors developed a semistructured interview. Standardized rating scales were also administered. Eighty-eight percent of the sample met diagnostic criteria for an axis I disorder at the time of the interview, and 100% of the sample met criteria for an axis I disorder at some time in their lives. The most common diagnoses were mood and anxiety disorders. The sample exhibited more traits of impulsivity than compulsivity. The data are consistent with the suggestion proposed by others that argues for conceptualizing these disorders as impulsive/compulsive spectrum disorders. Attention must be given to addressing these traits, as well as to the treatment of other axis I and axis II disorders, when treating CSB.
  • Jm Lee
  • E Hirschfeld
  • J Wedding
Lee JM, Hirschfeld E, Wedding J. JAMA 2016;315:1447-8.