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Predicting Problematic Pornography Use among Male Returning US Veterans
Abstract
Problematic Pornography Use (PPU) is the most common problem behavior among individuals with compulsive sexual behavior (CSB). Previous research suggests US veterans are at a greater risk of engaging in PPU. The present study sought to investigate further PPU among male military veterans. Data from 172 male veterans who endorsed ever watching pornography and completed the Problematic Pornography Use Scale (PPUS) were included in the study. Participants completed self-report questionnaires, including demographic information, psychiatric co-morbidities, impulsivity, as measured by the UPPS-P, pornography-related behaviors, and pornography craving as measured by Pornography Craving Questionnaire (PCQ). Younger age and lower educational attainment were associated with higher PPUS scores. Depression, anxiety, post-traumatic stress disorder (PTSD), insomnia, and impulsivity were positively associated with higher PPUS scores. There was no statistically significant association between PPU with suicidal ideation or alcohol use disorder. In the multivariable hierarchical
regression, depression, frequency of use, and higher PCQ scores were associated with higher PPUS scores, although on the latter two remained significant in the final model. Understanding the risk factors via more frequent screening for PPU will help with the development of treatment protocols for this problematic behavior.
... Among them, the impact of certain sociodemographic and psychopathological factors is still under debate (Alarcon, De la Iglesia, Casado, & Montejo, 2019). Regarding sociodemographic factors, while the literature has shown that the male gender is the main sociodemographic factor of vulnerability to PPU (Alarcon et al., 2019;Grubbs, Kraus, & Perry, 2019;Mamun, Yasir Arafat, Ambiatunnahar, & Griffiths, 2019;Niazof, Weizman, & Weinstein, 2019;Shirk, Saxena, Park, & Kraus, 2021), these studies have not reached a consensus on the impact of marital status and sexual orientation on the development of PPU. For example, while some studies have shown that being single is a risk factor (Kraus, Martino, & Potenza, 2016;Studer, Marmet, Wicki, & Gmel, 2019), others have contradicted this finding (Daneback, Cooper, & Månsson, 2005). ...
... Therefore, risk factors for PPU could be distinct from those for HD or CSBD and merit targeted studies. Furthermore, with regard to PPU specifically, few studies have shown the impact of anxiety and depressive symptomatology on PPU (Bőthe, Tóth-Király, Potenza, Orosz, & Demetrovics, 2020;Kraus, Potenza, Martino, & Grant, 2015;Perry, 2018;Shirk et al., 2021;Whitfield, Rendina, Grov, & Parsons, 2018) mediated by other factors such as scrupulosity or emotional avoidance (Borgogna, Duncan, & McDermott, 2018). Further, the effect of ADHD symptoms on PPU is still under debate, as studies have shown contradictory results. ...
... This model, which included anxio-depressive symptoms, ADHD, OCD, and gender, explained 26.4% of the variance in PPU scores, and only ADHD and OCD remained predictors. While the literature has shown an association between anxio-depressive symptoms and PPU Shirk et al., 2021), our results seem surprising and could be explained as follows: Firstly, women have more pronounced anxio-depressive tendencies than men (Schuch, Roest, Nolen, Penninx, & de Jonge, 2014), which could explain why, in this model, because of the strong influence of the male gender on the prediction, anxiety and depression did not predict PPU. In addition, participants with anxious and depressive symptomatology did not have a significantly different PPU score than those without this symptomatology (Table 2). ...
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.
... However, it is not clear whether these participants experienced PPU specifically. These results are inconsistent with another study where no statistically significant association was found between PPU and suicidal ideation among US veteran men [66]. As highlighted by Sharpe and Mead [67], it is uncertain whether depression experienced by people who have PPU may lead to suicidality. ...
... Thus, it is not easy to generalize our findings or compare them with the previous literature. As mentioned previously, Shirk et al. [66] could not find any association between PPU and suicidal thoughts. Although their study focused only on male veterans, this would confirm the results of our study. ...
The relationship between suicidality and problematic pornography use (PPU) is not clear, and the limited research data that exists show contradictory results. The present study aims to explore the associations between these two variables in a sample of young adults, taking into account gender differences and the role of loneliness, emotional states, and well-being. A total of 332 national and international students (60% female) at an Italian University with a mean age of 23 years (SD = 2.84) completed an anonymous online survey during the period from March 2023 to May 2023. The results show that PPU was associated with higher levels of anxiety, depression, stress, loneliness, and suicide ideation, as well as lower life satisfaction. Gender comparison analysis revealed significantly higher scores for PPU and loneliness among men, while women scored higher in stress, anxiety, and life satisfaction. Significant correlations between PPU and suicidal ideation and having a suicide plan were established for female participants despite their lower scores in PPU. Multiple regression analysis revealed that PPU and its interaction with gender were both significant predictors of suicidal ideation. Future attention should be paid to how young women may be influenced by exposure to sexually explicit materials, while always considering the role of loneliness.
... Additionally, CSBs are often linked to various psychiatric diagnoses, such as depression, substance use disorders, and behavioral addictions, such as gambling disorder (Ballester-Arnal et al., 2020;Derbyshire & Grant, 2015;Kraus et al., 2017Kraus et al., , 2021Nelson & Oehlert, 2008). PPU similarly appears to be associated with a number of psychiatric comorbidities (Shirk et al., 2021). In short, the simple association between components of CSBD and psychological distress and other psychiatric comorbidities gives reasonable evidence to suspect a potential relationship with SI. ...
... Research has shown that PPU is related to psychological distress (Grubbs et al., 2015;Volk et al., 2019). Nevertheless, few studies have looked specifically at the relationship between pornography use and suicide (Shirk et al., 2021). As such, this work aimed to understand the relationships between frequency of pornography use, moral incongruence regarding pornography use, PPU, and SI, both cross-sectionally and longitudinally. ...
Objective: There is a growing consensus that problematic pornography use (PPU), one of the most commonly reported compulsive sexual behaviors, is related to a number of internalizing psychiatric symptoms (e.g., anxiety, depression). However, little is known about the potential comorbidity of PPU and suicidal thoughts. Given known links between PPU and higher levels of guilt, shame, and moral disapproval, it may be that PPU may be related to suicidal thoughts. Method: Using two independent samples, we cross-sectionally (Sample 1: undergraduates, n = 422) and longitudinally (Sample 2: nationally representative sample of U.S. adults, n = 1,455) tested for associations between PPU and past-month suicidal ideation and perceived likelihood of suicidal behaviors, while controlling for frequency of pornography use, moral disapproval, moral incongruence, and religiousness. Results: Cross-sectionally, PPU was related to higher levels of self-perceived likelihood of suicidal behaviors, but not past-month suicidal thoughts. Longitudinally, PPU was related to higher initial levels (i.e., intercept) of past-month suicidal thoughts and self-perceived likelihood of suicidal behaviors, but not changes in either (i.e., slope). The frequency of pornography use was statistically unrelated to each outcome for both samples, while moral beliefs about pornography use showed mixed relationships. Conclusions: Clinicians working with patients reporting PPU may consider ways it may contribute to suicidal thinking.
... 27 articles were excluded after applying eligibility criteria. Therefore, a final set of 5 studies were retained after the full-search procedure [36][37][38][39][40]. The backward and forward citation analysis added 3 items to the previous search [41][42][43]. ...
... Table 1 shows the characteristics of the 10 initial studies. Of these, 6 were initially classified into Level 1 category [36,37,[40][41][42][43], 2 as Level 2 [38,39], and 2 as Level 3 [33, 34•, 37, 41, 42]; three others performed correlation analyses between the variables of interest for us and shared their results [36,40,43]; and the remaining 3 other studies belong to our own team [33, 34•, 39], so we had direct access to all data. As noted earlier, the necessary data or analyses never became available for one of the studies, so it is not included in further analyses. ...
Purpose of Review
Here, we systematically review all available evidence on the triadic relationship between positive and negative urgency, craving, and severity of symptoms of candidate behavioral addictions.
Recent Findings
Current theoretical models attribute a central importance to craving in the chronification and prognosis of behavioral addictions and other problematic non-substance-related behavioral patterns. Craving, in turn, has been convincingly shown to be an affect-laden state, and its control can be conceptualized as partially resulting from emotion regulation mechanisms. However, some gaps remain: first, there is no consensus on the predominantly appetitive or aversive nature of craving; and, second, although positive and negative urgency have been proposed as proxies to incidental emotion regulation mechanisms, their direct or indirect role in craving regulation and severity of problematic behaviors is still poorly known.
Summary
According to our results, craving emerges as a central construct, partially resulting from emotion dysregulation as assessed by urgency. The preponderance of positive urgency shown by most studies in this review also reinforces the view of positive emotions as a ‘trojan horse’ in addictive processes. Negative urgency, in turn, seems to be a complication factor that could underlie gambling addiction and other related mental health conditions. Most studies, however, are about gambling behavior, with the few studies in other domains precluding firm conclusions about the differences or similarities between them.
... Further analysis ) demonstrated a positive association between symptom severity of unregulated IP use and IP use that was partially mediated by craving. Finally, among male US military veterans, the severity of craving and the frequency of engagement in the behavior, were strong predictors of problematic pornography use (Shirk et al., 2021). ...
... In addition, the items "repeated failures to resist sexual impulses", "engaged more or longer than intended", "failure to quit despite desire or attempts", "excessive time obtaining/recovering from sex" were also highly prevalent and appeared thereby as a key feature of problematic sexual behavior. Impaired control (Chen et al., 2021) and severity of craving (Shirk, 2021) were also found to be strongly predictive of problematic sexual behavior. These symptoms may thereby constitute a core symptom for CSBD screening as suggested by Böthe et al. , helping to determine whether pornography use is a problem, and to differential problematic to non-problematic users. ...
Despite similarities between compulsive sexual disorder and substance use disorder, the issue whether problematic sexual behavior should be viewed within an addiction framework continues to be a subject of debate with no consensus regarding its conceptualization and diagnosis criteria. Examining the presence of addiction criteria among clinical and no clinical samples in the existing literature could permit to ascertain clinical validity of sex addiction diagnosis and support its overlapping feature with other addictive disorders. The aim of this systematic review was to examine this issue by assessing DSM-5 criteria of substance use disorder among individuals engaged in problematic sexual activity. Methods: Using PRISMA criteria, three databases were comprehensively searched up to April 2022, in order to identify all candidate studies based on broad key words. Resulting studies were then selected if they examined problematic sexual behavior within the framework of DSM-5 addiction criteria. Results: Twenty articles matched the selection criteria and were included in this review. DSM-5 criteria of addictive disorders were found to be highly prevalent among problematic sex users, particularly craving, loss of control over sex use, and negative consequences related to sexual behavior. Exposition to sexual cues was also shown to trigger craving, with an association to problematic use and symptom severity. Conclusions: More studies should been done to assess homogeneously according to the DSM-5 criteria the addiction-like features of problematic sexual behaviors in clinical and no-clinical populations. Furthermore, this work argues for the need of further research to examine the extent to which anti-craving interventions could be effective in improving clinical outcomes.
... The shift from recreational to problematic use, engaging the development of addictive mechanisms, has sparked the interest of international researchers who explore vulnerability factors that facilitate the development of PPU. Most of the studies conducted have been cross-sectional and have focused on the influence of several factors such as sociodemographic characteristics (i.e., Hernández-Mora and Varescon, 2022;Shirk et al., 2021), psychological and personality constructs (i.e., Antons et al., 2019;Antons & Brand, 2020;Bőthe et al., 2019;Wetterneck et al., 2012;Zilberman et al., 2018) and moral incongruence (Grubbs et al., 2019). ...
... However, while the literature shows that problematic sexual behaviors are often comorbid to other psychopathological disorders (Ballester-Arnal et al., 2020;Wéry et al., (2016a2016b), to our knowledge, their influence on the development of PPU has been under-explored. In this sense, among these disorders, few existing cross-sectional studies have focused on the influence of anxiodepressive disorder (Borgogna et al., 2018;Shirk et al., 2021;Whitfield et al, 2018), attention deficit hyperactivity disorder (ADHD) (Bőthe et al., 2019(Bőthe et al., , 2020Hernández-Mora and Varescon, 2022;Kraus et al., 2015;Niazof et al., 2019) and obsessive-compulsive disorder (OCD) (Kraus et al., 2015;Hernández-Mora and Varescon, 2022). ...
Studies using person-centered approaches to further explore the profiles of pornography users throw their psychiatric features are lacking. This study was designed to examine the different profiles of pornography users based on the addictive dimensions of Problematic Pornography Use (PPU) and to characterize these profiles according to psychopathological variables such as depression, anxiety, attention deficit hyperactivity disorder (ADHD) and obsessive–compulsive disorder (OCD). A sample of 1001 French adults participated to a survey containing scales related to psychopathological variables, cybersexual addiction and PPU. PPU was assessed with the French Version of Problematic Pornography Consumption Scale (Fr-PPCS-18). An Agglomerative Hierarchical Classification was performed on the basis of FR-PPCS-18. A student's t-test was used to observe PPU and psychopathological differences between profiles. Findings revealed three profiles of users: non-problematic users (66.5%), at-risk users (29.9%), and problematic users (3.6%). There were significant differences between the three profiles concerning levels of global PPU, PPU mechanisms, cybersexual addiction symptoms, ADHD symptomatology and depressive symptomatology. Results confirmed the existence of different levels of severity of pornography use corresponding to three different profiles. Also, findings revealed the influence of ADHD symptoms, obsessive–compulsive symptoms and depressive symptoms on PPU.
... Several studies found positive small-to-moderate correlations between anxiety and the Hypersexual Behavior Consequences Scale (HBCS; Reid et al., 2016;Reid, Garos et al., 2012), HBI (Reid et al., 2016;Reid, Garos et al., 2011), Problematic Pornography Use Scale (Shirk et al., 2021), SCS (Lackups-Fuentes, 2018;Reid et al., 2008;Scanavino et al., 2018), SAST (Levi et al., 2020), Compulsive Sexual Behavior Inventory (CSBI; Blain et al., 2012), Sexual Thoughts, Urges, and Behavior (STUB;Gilliland, 2015), the hypersexuality subscale of the Recognizing Addictive Disorders Scale (RAD; Carr, 2018), IATsex (Brand et al., 2011;Lackups-Fuentes, 2018), and the PCBS, ISST, and CPUI-9 (Lackups-Fuentes, 2018). Four studies found positive correlations between stress and the HBI (Reid, Garos et al., 2011), SCS (Lackups-Fuentes, 2018Reid et al., 2008), and the PCBS, ISST, CPUI-9, and IATsex (Lackups-Fuentes, 2018). ...
... Four studies found at least one non-significant correlation between CSB and anxiety (Blain et al., 2012;Gilliland, 2015;Grov, 2007;Lackups-Fuentes, 2018), ranging from negligible to moderate in strength (r = .04-.49; Lackups-Fuentes, 2018). Furthermore, using regression analyses, six studies found that anxiety did not significantly predict CSB (Blain et al., 2012;Grov, 2007;Kraus, Martino et al., 2017;Lackups-Fuentes, 2018;Levi et al., 2020;Shirk et al., 2021), and two studies found that stress did not predict CSB (Gilliland, 2015;Lackups-Fuentes, 2018). Conversely, Efrati and Dannon (2018) found that CSB did not predict anxiety. ...
The inclusion of the novel diagnosis of Compulsive Sexual Behavior Disorder in the forthcoming 11th edition of the International Classification of Diseases has spurred increasing interest in the clinical profile of the disorder. Such attention has included a focus on potential comorbidities, risk factors, or symptoms resulting from such behaviors, including anxiety. Anxiety disorders have long been noted as comorbid with many other diagnoses, such as posttraumatic stress disorder, obsessive compulsive disorder, and substance use disorders. This review aims to understand the relationship between anxiety and compulsive sexual behavior in adults and adolescents, based on available quantitative studies. A search of PsycInfo and PubMed revealed 40 studies which quantitatively assessed a relationship between an anxiety measure and a Compulsive Sexual Behavior Disorder measure, including dissertations and published articles using clinical and community samples. A qualitative synthesis and risk of bias analysis of the studies was conducted, rather than a meta-analysis, due to the variety of methods. Overall, studies were primarily cross-sectional and the relationship between these two constructs was unclear, likely due to several factors, including inconsistent measurement of Compulsive Sexual Behavior Disorder, lack of gender diversity, and very little longitudinal data. Directions for future research are discussed.
... Keyword: gaming, pornography, problematic internet use, personality characteristics use behaviors (Lee & Stapinski, 2012). Specifically, several studies found that anxiety is positively associated with IGD (Adams et al., 2019;Bargeron & Hormes, 2017;Bonnaire & Baptista, 2019;Marino et al., 2020;Wang et al., 2017) as well as PPU (Niazof et al., 2019;Shirk et al., 2021). Trait anxiety is defined as a relatively stable state of proneness to experiencing anxiety (Julian, 2011). ...
... Regarding pornography use in hypothesis one, we confirmed previous research in that those with more impulsivity, narcissism, and sexual narcissism were more likely to engage in pornography consumption (Antons & Brand, 2018;Kasper et al., 2015). Interestingly, we did not find a direct relationship between anxiety and an individual's pornography use, contrary to previous research (Niazof et al., 2019;Shirk et al., 2021). It appears that engaging in more pornography did not correspond with more anxiety in our sample. ...
The purpose of the present study was to examine the relationships among appreciation, gratitude, and happiness - particularly the emotional components of positive affect, negative affect, and life satisfaction. Several hypotheses were posed.
... use behaviors (Lee & Stapinski, 2012). Specifically, several studies found that anxiety is positively associated with IGD (Adams et al., 2019;Bargeron & Hormes, 2017;Bonnaire & Baptista, 2019;Marino et al., 2020;Wang et al., 2017) as well as PPU (Niazof et al., 2019;Shirk et al., 2021). Trait anxiety is defined as a relatively stable state of proneness to experiencing anxiety (Julian, 2011). ...
... Regarding pornography use in hypothesis one, we confirmed previous research in that those with more impulsivity, narcissism, and sexual narcissism were more likely to engage in pornography consumption (Antons & Brand, 2018;Kasper et al., 2015). Interestingly, we did not find a direct relationship between anxiety and an individual's pornography use, contrary to previous research (Niazof et al., 2019;Shirk et al., 2021). It appears that engaging in more pornography did not correspond with more anxiety in our sample. ...
Internet use has become a prominent part of everyday life, with some individuals using the internet as a tool and others for entertainment. The purpose of this study was to investigate whether individuals with certain personality traits are more likely to engage in excessive internet use behaviors.
... Several studies found positive small-to-moderate correlations between anxiety and the Hypersexual Behavior Consequences Scale (HBCS; Reid et al., 2016;Reid, Garos et al., 2012), HBI (Reid et al., 2016;Reid, Garos et al., 2011), Problematic Pornography Use Scale (Shirk et al., 2021), SCS (Lackups-Fuentes, 2018;Reid et al., 2008;Scanavino et al., 2018), SAST (Levi et al., 2020), Compulsive Sexual Behavior Inventory (CSBI; Blain et al., 2012), Sexual Thoughts, Urges, and Behavior (STUB;Gilliland, 2015), the hypersexuality subscale of the Recognizing Addictive Disorders Scale (RAD; Carr, 2018), IATsex (Brand et al., 2011;Lackups-Fuentes, 2018), and the PCBS, ISST, and CPUI-9 (Lackups-Fuentes, 2018). Four studies found positive correlations between stress and the HBI (Reid, Garos et al., 2011), SCS (Lackups-Fuentes, 2018Reid et al., 2008), and the PCBS, ISST, CPUI-9, and IATsex (Lackups-Fuentes, 2018). ...
... Four studies found at least one non-significant correlation between CSB and anxiety (Blain et al., 2012;Gilliland, 2015;Grov, 2007;Lackups-Fuentes, 2018), ranging from negligible to moderate in strength (r = .04-.49; Lackups-Fuentes, 2018). Furthermore, using regression analyses, six studies found that anxiety did not significantly predict CSB (Blain et al., 2012;Grov, 2007;Kraus, Martino et al., 2017;Lackups-Fuentes, 2018;Levi et al., 2020;Shirk et al., 2021), and two studies found that stress did not predict CSB (Gilliland, 2015;Lackups-Fuentes, 2018). Conversely, Efrati and Dannon (2018) found that CSB did not predict anxiety. ...
The inclusion of the novel diagnosis of Compulsive Sexual Behaviour Disorder in the forthcoming 11th edition of the International Classification of Diseases has spurred increasing interest in the clinical profile of the disorder. Such attention has included a focus on potential comorbidities, risk factors, or symptoms resulting from such behaviours, including anxiety. Anxiety disorders have long been noted as comorbid with many other diagnoses, such as posttraumatic stress disorder, obsessive compulsive disorder, and substance use disorders. This review aims to understand the relationship between anxiety and compulsive sexual behaviour in adults and adolescents, based on available quantitative studies. A search of PsycInfo and PubMed revealed 36 studies which quantitatively assessed a relationship between an anxiety measure and a Compulsive Sexual Behaviour Disorder measure, including dissertations and published articles using clinical and community samples. A qualitative synthesis of the studies was conducted, rather than a meta-analysis, due to the variety of methods. Overall, studies were primarily cross-sectional and the relationship between these two constructs was unclear, likely due to several factors, including inconsistent measurement of Compulsive Sexual Behaviour Disorder, lack of gender diversity, and very little longitudinal data. Directions for future research are discussed.
... Higher BPS values were associated with more severe psychopathology, consistent with previous findings linking PPU to psychopathology or poor mental health (Bibi et al., 2022;Borgogna et al., 2018;Hernández et al., 2023;Hernandez-Mora & Varescon, 2022;Shirk et al., 2021;Whitfield et al., 2018). Correlations between the BPS and measures of depression and anxiety were also reported in the validation study of BPS in a general population (Islam et al., 2024). ...
Problematic pornography use (PPU) shares characteristics with behavioral addictions, such as gambling disorder (GD), and PPU and GD may frequently co-occur. In order to fill existing gaps in screening instruments for PPU validated in GD, the study examined the psychometric properties of the Spanish version of the Brief Pornography Screen (BPS) within a clinical sample of individuals with GD. A total of 200 individuals seeking treatment for GD were consecutively recruited. The psychometric properties of the BPS were examined by performing confirmatory factor analysis (CFA) and testing for evidence of convergent and discriminant validity. The CFA supported a one-factor solution showing high internal consistency (α = 0.81). The BPS showed convergent validity and correlated with psychological distress, general psychopathology, impulsive tendencies, and low self-directedness. The BPS demonstrated adequate psychometric properties and is therefore recommended as a brief screening tool for identifying probable PPU in individuals seeking treatment for GD.
... Other studies have linked PPU to psychological distress and psychiatric symptomatology involving impulsivity, anxiety, post-traumatic stress disorder, and SUDs, particularly to alcohol (Borgogna et al., 2018;Borgogna, Kraus, & Grubbs, 2021;Moisson et al., 2019;Shirk, Saxena, Park, & Kraus, 2021). Pornography use has been associated with depression and anxiety (Guidry, Floyd, Volk, & Moen, 2020;Perry, 2018;Willoughby, Busby, & Young-Petersen, 2019), although the precise nature of the relationship remains incompletely understood. ...
Background and Aims
Many jurisdictions are experiencing opioid epidemics. Opioid use disorder (OUD) often co-occurs with other psychiatric disorders including behavioral addictions like gambling disorder. However, little is known regarding the frequency and correlates of problematic pornography use (PPU) among people seeking treatment for OUD. Here we aimed to investigate PPU and its correlates in people seeking OUD treatment.
Method
From October 2018 to March 2020, 1,272 individuals seeking OUD treatment were screened for PPU by completing the Brief Pornography Screen (BPS), a 5-item instrument validated for assessing PPU. Self-reported data were used.
Results
Among the sample there were 707 (60%) males and 565 (40%) females. The mean age of participants was 37.9 ± 10.5 years (range 18–73), there were 707 (60%) males and 565 (40%) females, 14.4% ( n = 183) exhibited low positive BPS scores (1 ≤ score ≤4), and 4.5% of the sample ( n = 57) screened positive for PPU (BPS score ≥4). Individuals screening positive for PPU versus negative were mostly male (77%), scored higher on measures of impulsivity in the domains of positive urgency, negative urgency, and sensation-seeking and demonstrated more psychopathology on measures of substance use, psychotic symptoms, emotional lability, depression/functioning and self-harm.
Discussion and Conclusion
A minority of individuals seeking treatment for OUD screened positive for PPU. Among individuals with OUD, those screening positive (versus negative) for PPU were more impulsive and experienced more psychiatric symptoms, suggesting the need for additional investigation and screening for and addressing PPU in people with OUD.
... On the other hand, CSBDþ women may violate society's norms and they might be socially isolated which leads to psychological problems such as depression (Ballester-Arnal et al., 2020). It should be noted that although some studies reported the relationship between depression with CSBD (Kraus et al., 2017), this relationship was not observed in some other studies (Shirk, Saxena, Park, & Kraus, 2021). Regarding the relationship between CSBD and OCS, it seems plausible that disturbing and repetitive thoughts caused by OCS can also be focused on sexual issues and cause unwanted sexual behaviours. ...
Background and Aims
This study addresses the scarcity of research on Compulsive Sexual Behavior Disorder (CSBD) in non-Western cultures and women, exploring its prevalence, sociodemographic, sexual history characteristics, and sexual and psychological health factors in Iranian married women.
Methods
A cross-sectional study involving 772 heterosexual married women was conducted between 2022 and 2023, covering all 31 provinces of Iran. Participants were categorized as CSBD+ (at-risk individuals) and CSBD− (low-risk individuals) based on a pre-established cut-off point of ≥18 by the Compulsive Sexual Behavior Disorder Scale −7. Depression, anxiety, obsessive-compulsive disorder, self-esteem, sexual distress, sexual satisfaction, relationship satisfaction, and sexual dysfunction were assessed as psychological and sexual health variables by standardized scales.
Results
The prevalence of CSBD was 3.8% in women. Linear regression analysis showed that lower education, being jobless, substance use, pornography use, paraphilic behaviors, conflict on sex frequency, relationship, orgasm and sexual dissatisfaction, higher sexual arousal, depression, and obsessive-compulsive symptoms were positively associated with CSBD. The univariate analysis, at a stringent significance level of 0.005, mirrored the regression findings. Additionally, women with CSBD+ exhibited lower religiousness and higher anxiety compared to those without CSBD−.
Discussion and Conclusions
Raising awareness of CSBD is crucial for health systems and individuals for better policy-making and help-seeking behavior. Identifying risk factors like substance use presents opportunities for prevention, and the association of CSBD with sexual and mental health variables suggests addressing co-occurring issues for improved treatment outcomes. Recognizing culture and gender-specific sexual and psychological correlates enables targeted and effective treatment approaches.
... (15, 106,107) and these anxiety symptoms are related to pornography consumption (6, [108][109][110][111][112][113][114]. In this context, other studies documenting PPU epidemiology indicate that PPU is mainly related to symptoms of anxiety and depression (41,76,89,(115)(116)(117)(118)(119)(120), and also to obsessivecompulsive symptoms (6, 47, 121). This severity of PPU as a mental health problem is documented by recent research which indicates that more than 80% of people seeking treatment for a compulsive sexual behavior disorder reported an inability to control their use of pornography, despite negative consequences (41, 78, 122-126). ...
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.
... Suicidal ideation was not associated with problem pornography viewing in a survey of 283 men (Shirk et al., 2021). Yet, in a qualitative analysis of 104 journals from a Reboot website (Fernandez et al., 2021), three followers spontaneously expressed suicidal ideation as a response to their Reboot. ...
"Reboot," especially NoFap, promotes abstinence from masturbation and/or pornography to treat "pornography addiction," an unrecognized diagnosis. While the intention of Reboot/NoFap is to decrease distress, qualitative studies have consistently suggested that "Reboots" paradoxically cause more distress. The distress appears to occur in response to (1) the abstinence goal, which recasts common sexual behaviors as personal "failures," and (2) problematic and inaccurate Reboot/NoFap forum messaging regarding sexuality and addiction. This preregistered survey asked men about their experience with perceived "relapse" and NoFap forums. Participants reported that their most recent relapse was followed by feeling shameful, worthless, sad, a desire to commit suicide, and other negative emotions. A novel predictor of identifying as a pornography addict in this lower religiosity sample was higher narcissism. Participants reported that NoFap forums contained posts that were misogynist (73.7% of participants), bullying (49.1%), anti-LGBT (42.9%), antisemitic (32.0%), instructing followers to harm or kill themselves (23.5%), or threats to hurt someone else (21.1%). More engagement in NoFap online forums was associated with worse symptoms of erectile dysfunction, depression, anxiety, and more sex negativity. Results support and expand previously documented harms and problems with Reboot/NoFap claims of treating pornography addiction from qualitative research.
... Affective disorders are some of the main mental health effects related to childhood abuse and trauma (Gardner et al., 2019). In addition, both anxiety and depression are significantly associated with sexual dysfunction (Barata, 2017), CSBD , and pornography use (Shirk et al., 2021). Based on the association between affective disorders and sexual behaviors, studies have suggested that anxiety and depression mediate the relationship between childhood abuse and sexual dysfunction (Pulverman et al., 2018) and between childhood abuse and hypersexual behaviors (Blain et al., 2012). ...
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.
... As a result of the performed correlation analysis, a significant positive association was found between POPU and insomnia symptoms. This echoes previous evidence, 18 and is also in line with research into the broader dimension of problematic Internet use. 59 However, mediation analyses also highlighted that the relationship between POPU and insomnia symptoms occurs mainly through an indirect way, with the total mediation by psychological stress and emotion dysregulation. ...
Purpose
Although a link between problematic online pornographic use (POPU) and insomnia symptoms has been established, psychological and psychopathological mechanisms underlying this relationship are still not clear. Psychological stress and emotion dysregulation have been pointed out as relevant in the development and maintenance of insomnia. This study aims to explore the associations between POPU, psychological stress, emotion dysregulation and insomnia symptoms and to understand the mediating role of psychological stress and emotion dysregulation in the relationship between POPU and insomnia symptoms.
Participants and Methods
A sample of 776 Italian adults aged 19–48 years (51.4% female; M age = 28.49; SD = 7.33) completed questionnaires regarding demographics, COVID-19-related variables, POPU, psychological stress, emotion dysregulation, and insomnia symptoms.
Results
After controlling for demographic covariates and COVID-19-related variables, multiple mediation model showed that higher psychological stress and emotion dysregulation fully mediated the link between POPU and insomnia.
Conclusion
The findings underscore the significance of the negative consequences of POPU and underline the importance of working on this and its effects on psychological stress and emotion dysregulation to limit insomnia.
... The PPUS has four factors based on the core features of the addiction framework: (1) excessive or compulsive behavioral engagement with pornographic material; (2) repetitive engagement to attain/maintain a positive emotional state or to escape or avoid a negative emotional state; (3) diminished self-control over behavioral engagement; and (4) continued engagement despite adverse consequences, which, in turn, leads to significant personal distress and functional impairment (Kor et al., 2014). To date, the PPUS has been used to determine the associations of PPU with other psychological variables and among various populations (e.g., Borgogna et al., 2018;Pepping et al., 2018;Shirk et al., 2021). It has been used in several countries, including China and Korea (e.g., Chen et al., 2018aChen et al., , 2018b. ...
Problematic pornography use (PPU) is the inability to control the use of pornography and is considered a form of compulsive sexual behavior. It can have a negative effect on one’s life and is an important clinical and social issue. In Japan, there is no assessment tool to measure PPU and very little research has been done. The Problematic Pornography Use Scale is one of the scales assessing the severity of PPU. This study validated a Japanese version of the Problematic Pornography Use Scale (PPUS-J) and examined its psychometric properties in a sample of 1011 individuals through an online survey (502 men, 509 women; Mage = 35.9 years, SD = 13.75). The results of the confirmatory factor analysis indicated that the four factors in the original scale were consistent with the factors in the PPUS-J, and strict invariance could be assumed for male and female participants. With regard to reliability, internal consistency indices were appropriate both at the overall and subscale levels for male and female participants. The PPUS-J showed good convergent and divergent validity due to the relationship between the subscales and other measures such as the Sexual Compulsivity Scale. These results demonstrate the validity of the PPUS-J for assessing problematic pornography use in a Japanese sample. Given the paucity of studies conducted in non-Western cultures and on women, this study will be useful in advancing research on PPU across different cultures. Future studies should examine test–retest reliability of the PPUS-J and its use with clinical groups.
... Individuals in sexually conservative cultures [e.g., traditional Asian cultures that stress sexual conservatism (Kim, 2009)] may feel more conflict and negative emotions about their use given that it may be in opposition to their sexual moral values, and may be more likely to label themselves as being addicted to pornography. For example, associations between QPU and PPU were stronger in a Chinese sample, compared to a US sample using the same PPU scale (r = 0.60 vs 0.39, respectively) (Chen, Yang et al., 2018;Shirk et al., 2021). Furthermore, although conservative cultures stipulate sexual restriction for both men and women, female sexuality is typically more restricted, especially for girls and unmarried women (Browning et al., 2006;Kim, 2009;Okazaki, 2002). ...
Although the quantity of pornography use (QPU, i.e., frequency/time spent on pornography use) has been positively associated with the severity of pornography use (i.e., problematic pornography use, PPU), the magnitudes of relationships have varied across studies. This meta-analysis aimed to assess the overall relationships and identify potential moderating variables to explain the variation in these associations between QPU and PPU. We performed a literature search for all published and unpublished studies from 1995 to 2020 in major online scientific databases up until December 2020. Sixty-one studies were
identified with 82 independent samples involving 74,880 participants. Results indicated that there was a positive, moderate relationship between QPU and PPU (r = 0.34, p < .001). The strength of relationship significantly varied across measures of PPU based on different theoretical frameworks, indicators of QPU, and sexual cultural contexts (conservative vs. permissive sexual values). Frequency was a more robust quantitative indicator of PPU than time spent on pornography use. In conservative countries, QPU showed more robust association with self-perceived PPU. Future studies are encouraged to select the measurement of PPU according to research aims and use multi-item measures with demonstrated content validity to assess pornography use. Cross-cultural (conservative/permissive) comparisons also warrant further research.
... In another study, the authors posited that non-paraphilic problematic sexual behavior was associated with impulsivity, emotion dysregulation, problematic use of the internet, current suicidal behavior, anxiety and depression symptomatology, and low self-esteem [48]. However, Shirk et al. did not find a significant association between problematic pornography use and suicidal ideation [49]. ...
Addictive disorders are characterized by severe consequences, including suicidal events, but most studies investigating the association between addiction and suicidal risk have focused on substance use disorders and gambling disorder at the expense of the rest of behavioral addictions. This study examined the prevalence and the associated clinical correlates of suicidal ideation and suicide attempts in a sample of patients with a diagnosis of behavioral addiction. The total sample consisted of 4404 individuals: 4103 of these patients with gambling disorder, 99 with gaming disorder, 44 with sex addiction, and 158 with buying–shopping disorder. All of them were assessed consecutively at a specialized hospital unit for the treatment of behavioral addictions. Participants attended two clinical interviews and completed self-reported questionnaires to explore clinical features of behavioral addictions, personality traits, psychopathological symptomatology, suicidal behavior, and sociodemographic variables. The highest prevalence of suicidal ideation was found in patients with gambling disorder (22.9%), followed by buying–shopping disorder (18.4%), sex addiction (18.2%), and gaming disorder (6.1%). The highest prevalence of suicide attempts was registered for sex addiction (9.1%), followed by buying–shopping disorder (7.6%), gambling disorder (6.7%), and gaming disorder (3.0%). Female gender and unemployment constituted two relevant sociodemographic factors associated with suicidal risk in gambling disorder, gaming disorder, and buying–shopping disorder. Lack of family support appeared as a relevant risk factor, except for gaming disorder. These results pointed out that suicide is a prevalent behavior in behavioral addictions, and clinicians and researchers need to pay particular attention to the specificities of each behavioral addiction when assessing suicidal risk.
... In a recent published narrative review, Hook et al., (2021) found that UPPS-P is one of the most used selfreport measures of impulsivity. Furthermore, UPPS-P model has been useful to elucidate the impulsivity subtypes concerning both clinical and nonclinical outcomes as procrastination ( Wypych et al., 2018 ), traffic risk behavior ( Luk et al., 2017 ), gender differences ( Cyders, 2013 ), pathological gambling behavior ( Aragay et al., 2018 ), eating disorders ( Mallorquí-Bagué et al., 2020 ), alcohol problematic consumption ( Tran et al., 2018 ), problematic phornography use ( Shirk et al., 2021 ), suicide behavior ( Millner et al., 2020 ) and personality disorders (Fossati et al., 2020). ...
The aime was to examine the factor structure, reliability and to obtain preliminary parameters of the Brazilian adaptation of the UPPS-P Impulsive Behavior Scale, a widely self-report measure used to assess impulsive behavior, in research and clinical setting. The scale is composed of 59 items assessing five factors of impulsivity: (1) positive urgency, (2) negative urgency, (3) lack of premeditation; (4) lack of perseverance; (5) sensation seeking. In the present study 718 participants (504 women and 214 men), with mean age 38.5 (SD = 12.4) who were recruited online fulfilled the UPPS-P scale. A Confirmatory Factor Analysis (CFA) presented appropriate goodness of fit for the five-factor model, and a Multi-Group Confirmatory Factor Analysis (MGCFA) revealed evidence of invariance of its psychometric parameters as a function of gender. Our results showed that the Brazilian Portuguese version of UPPS-P presents good psychometric properties and the same five-factor structure of the original version of UPPS-P.
Purpose of Review
Research has demonstrated that craving is a salient aspect of behavioral and substance use addictions. In 2014, the Pornography Craving Questionnaire (PCQ) was published as the first comprehensive scale to assess craving for pornography. This review was undertaken to understand conceptualizations of craving in behavioral addictions and identify all research studies assessing the subjective experience of craving for pornography using the PCQ.
Recent Findings
Craving has been conceptualized as a passionate attachment, ambivalence, and desire thinking. The PCQ has been administered in multiple studies in various countries. These investigations have indicated that the PCQ is positively related to desire thinking, passionate attachment (i.e., obsessive and harmonious passion), future pornography use (e.g., duration and frequency), mental health concerns (e.g., anger, anxiety, depression, behavioral and substance use addictions), dysfunctional coping (i.e., the tendency to use sex in response to negative mood states and stressors), and problematic pornography use.
Summary
Craving is a salient dimension of pornography use. Additionally, the PCQ appears of value to measure craving for diagnostic and outcome evaluation purposes. We recommend further evaluation of the PCQ in clinical settings to predict the course and prognosis among help-seeking patients for problematic pornography use.
Objectives:
The purpose of the current study was to estimate prevalence of pornography use and addiction in Rhode Island young adults, identify sociodemographic disparities, and determine if use and addiction were associated with mental illness.
Methods:
Data from n=1022 participants of the Rhode Island Young Adult Survey were used. Pornography use and addiction, depression, anxiety, and suicide ideation were assessed. Multivariable logistic regressions controlled for age, social status, sex, gender, sexual orientation, and race/ethnicity.
Results:
54% indicated pornography use; 6.2% met the criteria for addiction. Odds of pornography use were 5 times higher (95%CI=3.18,7.71), and addiction 13.4 times higher (95%CI=5.71,31.4) among heterosexual cis-males. Pornography addiction was associated with increased odds of depression (OR=1.92, 95%CI=1.04,3.49) and suicide ideation (OR=2.34, 95%CI=1.24,4.43).
Conclusions:
Pornography use is highly prevalent, and addiction may be associated with mental illness. New screenings, media literacy training, and developing new therapeutic interventions should be considered.
Background:
Previously, variable-centered analytic approaches showed positive, weak-to-moderate associations between frequency of pornography use (FPU) and problematic pornography use (PPU). However, person-centered studies are sparse in the literature, and these could provide insight into whether there are individuals who use pornography frequently and do not experience problems or whether there are individuals with comparable high-frequency use who differ on reported experiencing of negative consequences.
Aim:
The aims of the present study were (i) to identify profiles of pornography use based on FPU and PPU by applying a person-centered analytic approach and (ii) to examine whether the identified profiles could be distinguished based on theoretically relevant demographic and psychological constructs.
Methods:
Latent profile analyses were conducted on 3 nonclinical samples recruited from general websites and a pornography site (study 1: N = 14,006; study 2: N = 483; study 3: N = 672).
Results:
Results were consistent across all studies. 3 distinct pornography-use profiles emerged: nonproblematic low-frequency pornography use (68-73% of individuals), nonproblematic high-frequency pornography use (19-29% of individuals), and problematic high-frequency use (3-8% of individuals). Nonproblematic and problematic high-frequency-use groups showed differences in several constructs (ie, hypersexuality, depressive symptoms, boredom susceptibility, self-esteem, uncomfortable feelings regarding pornography, and basic psychological needs).
Clinical translation:
FPU should not be considered as a sufficient or reliable indicator of PPU because the number of people with nonproblematic high-frequency use was 3-6 times higher than that with problematic high-frequency use. These results suggest that individuals with PPU use pornography frequently; however, FPU may not always be problematic.
Strengths & limitations:
Self-report cross-sectional methods have possible biases that should be considered when interpreting findings (eg, underreporting or overreporting). However, the present research included 3 studies and involved large community samples and visitors of a pornography website. The present study is the first that empirically investigated pornography-use profiles with a wide range of correlates using both severity of PPU and FPU as profile indicators on specific and general samples.
Conclusion:
The present study is a first step in the differentiated examination of pornography-use profiles, taking into consideration both PPU and FPU, and it provides a foundation for further clinical and large-scale studies. Different psychological mechanisms may underlie the development and maintenance of FPU with or without PPU, suggesting different treatment approaches. Therefore, the present results may guide clinical work when considering reasons for seeking treatment for PPU. Bőthe B, Tóth-Király I, Potenza MN, et al. High-Frequency Pornography Use May Not Always Be Problematic. J Sex Med 2020;XX:XXX-XXX.
Introduction:
Sending sexually explicit text messages ("sexting") is prevalent among US adults; however, the mental health correlates of this behavior among adults have not been studied adequately. Furthermore, there are few studies examining the related but distinct behavior of posting sexually explicit photos or videos of oneself online (posting sexual images [PSI]) and the mental health correlates of this behavior.
Aim:
To examine associations between sexting, PSI, impulsivity, hypersexuality, and measures of psychopathology.
Methods:
Using a national convenience sample of 283 US post-deployment, post-9/11 military veterans, we evaluated the prevalence of 2 behaviors: sexting and PSI and the associations of these behaviors with psychopathology, suicidal ideation, sexual behaviors, hypersexuality, sexually transmitted infections, trauma history, and measures of impulsivity.
Main outcome measure:
Measures of psychopathology including depression, anxiety, post-traumatic stress disorder, insomnia, substance dependence, hypersexuality, and suicidal ideation, as well as measures of impulsivity, sexual behavior, and trauma.
Results:
Sexting was found to be common among post-9/11 veterans (68.9%). A smaller number of veterans engaged in PSI (16.3%). PSI veterans were more likely to be younger, male, less educated, and unemployed. After adjusting for covariates, no associations were detected between PSI or sexting and the examined measures of psychopathology. However, PSI was associated with higher levels of impulsivity and hypersexuality, whereas sexting was not associated with these measures.
Clinical implications:
Results from this study suggest that not all digital sexual behaviors are associated with psychopathology. However, PSI was associated with hypersexuality and impulsivity. Those who engage with PSI may benefit from guidance on how to manage their impulsivity to prevent ego-dystonic sexual behaviors.
Strengths & limitations:
The strengths of this study include differentiating PSI from sexting broadly, highlighting that digital sexual behaviors are heterogeneous. Limitations include the study's cross-sectional design, which limits causal interpretations. More research is also needed in civilian populations.
Conclusion:
PSI was less prevalent than sexting in our sample. This behavior was associated with impulsivity and hypersexuality but not with elevated levels of psychopathology. Sexting was not associated with any of these measures. Turban JL, Shirk SD, Potenza MN, et al. Posting Sexually Explicit Images or Videos of Oneself Online Is Associated with Impulsivity and Hypersexuality but Not Measures of Psychopathology in a Sample of US Veterans. J Sex Med 2019; XX:XXX-XXX.
Introduction:
Early life trauma is at the core of many psychopathologies, including compulsive sexual behavior (CSB). The intermediate processes linking early life trauma and CSB have been less well studied.
Aims:
To investigate whether impulsiveness, internalizing symptoms, sensation-seeking, and self-criticism mediate the links between early life trauma and CSB.
Methods:
The sample comprised 65 Sexaholics Anonymous members and 47 healthy volunteers who completed self-report measures assessing CSB, early life trauma, and the mediating variables.
Main Outcomes Measures:
The main outcome measures were severity of CSB symptoms, impulsiveness, internalizing symptoms, sensation-seeking, self-criticism, and early life trauma.
Results:
The analysis indicated that the total effect of early life trauma on CSB was significant, with more prevalent and severe trauma relating to higher CSB. The analysis also revealed that this effect was significantly mediated by 3 mediation paths—greater sensation-seeking, internalizing symptoms, and self-criticism—and that these measures in turn were associated with higher CSB.
Conclusion:
Our findings provide an opportunity for researchers to gain a better insight into the effect of early life trauma on CSB.
Questions remain regarding how best to define problematic online sexual activities (OSAs) and about paths that may lead to problematic use of OSAs and their consequences. Although frequency and duration of use and motivational drive, as expressed through craving, to view pornography have been implicated in problematic OSAs, their inter-relationships warrant direct examination. We propose and test a model by which pornography craving may promote more frequent engagement in OSAs and more time spent engaging in OSAs, and this may lead to problematic OSAs and subsequent negative consequences like negative emotions. Data from 1070 college students suggested that 20.63% of students were at risk of problematic OSAs use, and this group had greater frequency of OSAs, more usage time, higher pornography craving and more negative academic emotions. Our proposed path model was partially supported. Pornography craving was associated with problematic OSAs use more, so through frequency than quantity of OSAs, and OSAs were related to negative academic emotions. Future studies of problematic OSAs use should consider the complexity of relationships between craving, use of OSAs and negative health measures in college students and other groups.
Importance
The veracity, nomenclature, and conceptualizations of sex addiction, out-of-control sexual behavior, hypersexual behavior, and impulsive or compulsive sexual behavior are widely debated. Despite such variation in conceptualization, all models concur on the prominent feature: failing to control one’s sexual feelings and behaviors in a way that causes substantial distress and/or impairment in functioning. However, the prevalence of the issue in the United States is unknown.
Objective
To assess the prevalence of distress and impairment associated with difficulty controlling sexual feelings, urges, and behaviors among a nationally representative sample in the United States.
Design, Setting, and Participants
This survey study used National Survey of Sexual Health and Behavior data to assess the prevalence of distress and impairment associated with difficulty controlling sexual feelings, urges, and behaviors and determined how prevalence varied across sociodemographic variables. Participants between the ages of 18 and 50 years were randomly sampled from all 50 US states in November 2016.
Main Outcomes and Measures
Distress and impairment associated with difficulty controlling sexual feelings, urges, and behavior were measured using the Compulsive Sexual Behavior Inventory–13. A score of 35 or higher on a scale of 0 to 65 indicated clinically relevant levels of distress and/or impairment.
Results
Of 2325 adults (1174 [50.5%] female; mean [SD] age, 34.0 [9.3] years), 201 [8.6%] met the clinical screen cut point of a score of 35 or higher on the Compulsive Sexual Behavior Inventory. Gender differences were smaller than previously theorized, with 10.3% of men and 7.0% of women endorsing clinically relevant levels of distress and/or impairment associated with difficulty controlling sexual feelings, urges, and behavior.
Conclusions and Relevance
The high prevalence of this prominent feature associated with compulsive sexual behavior disorder has important implications for health care professionals and society. Health care professionals should be alert to the high number of people who are distressed about their sexual behavior, carefully assess the nature of the problem within its sociocultural context, and find appropriate treatments for both men and women.
Background and aims
Compulsive sexual behaviors (CSBs) are an important clinical and social issue. Despite the increasing number of studies, some of CSB’s aspects remain under-investigated. Here, we explore the nature of CSB, such as binge pornography use and masturbation (PuM), and verify the correspondence between self-perceived factors leading to such behavior with its measures obtained in a diary assessment.
Methods
Semi-structuralized interviews with nine treatment-seeking males aged 22–37 years (M = 31.7, SD = 4.85) were followed by a questionnaire and a 10-week-long diary assessment, allowing us to acquire real-life daily patterns of CSB.
Results
Six out of nine subjects experienced binge (multiple hours or times a day) PuM. All subjects presented a high level of anxiety and perceived PuM as a way to regulate mood and stress. Data collected in the diary assessment uncovered a high diversity in the patterns of sexual behaviors (such as frequency of regular and binge PuM) and its correlates. Binge PuM was related to decreased mood and/or increased stress or anxiety. The causal relation between these correlates remains undetermined.
Discussion and conclusions
Binge PuM seems to be one of the most characteristic behavior among males who are seeking treatment for CSB and is related to the feeling of losing control over one’s sexual activity. CSB individuals indicate a variety of binge triggers. Also, diary assessment data indicate that specific correlates of binge PuM (decreased mood, increased stress, and anxiety) differ between subjects. It suggests the existence of significant individual differences in binge PuM behaviors, and a need to study these differences, as it may help guide personalized treatment.
Impulsivity and compulsivity are transdiagnostic features associated with clinically relevant aspects of psychiatric disorders, including addictions. However, little research has investigated how impulsivity and compulsivity relate to hypersexuality and problematic pornography use. Thus, the aims of the present study were to investigate (a) self-reported impulsivity and compulsivity with respect to hypersexuality and problematic pornography use and (b) the similarities and possible differences between hypersexuality and problematic pornography use in these domains. Utilizing structural equation modeling (SEM) in a large community sample (N = 13,778 participants; female = 4,151, 30.1%), results indicated that impulsivity (β = .28, β = .26) and compulsivity (β = .23, β = .14) were weakly related to problematic pornography use among males and females, respectively. Impulsivity had a stronger relationship (β = .41, β = .42) with hypersexuality than did compulsivity (β = .21, β = .16) among males and females, respectively. Consequently, impulsivity and compulsivity may not contribute as substantially to problematic pornography use as some scholars have proposed. On the other hand, impulsivity might have a more prominent role in hypersexuality than in problematic pornography use. Future research should examine further social and situational factors associated with problematic pornography use.
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.
Introduction:
Population-based data on the prevalence, correlates, and treatment utilization of post-traumatic stress disorder by gender and veteran status are limited. With changes in post-traumatic stress disorder diagnostic criteria in 2013, current information from a uniform data source is needed.
Methods:
This was a secondary analysis of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, which consisted of in-person interviews that were conducted with a representative sample of U.S. adults. The Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-5 Version was used to assess past-year and lifetime post-traumatic stress disorder among veterans (n=3,119) and civilians (n=32,982). Data were analyzed from January to March 2017.
Results:
Adjusting for age and race/ethnicity, women veterans reported the highest rates of lifetime and past-year post-traumatic stress disorder (13.4%, 95% CI=8.8%, 17.9%, and 11.7%, 95% CI=7.1%, 16.4%) compared with women civilians (8.0%, 95% CI=7.4%, 8.6%, and 6.0%, 95% CI=5.5%, 6.6%); men veterans (7.7%, 95% CI=6.5%, 8.8%, and 6.7%, 95% CI=5.7%, 7.8%); and men civilians (3.4%, 95% CI=3.0%, 3.9%, and 2.6%, 95% CI=2.2%, 2.9%). Traumatic event exposure, correlates of lifetime post-traumatic stress disorder, and treatment seeking varied across subgroups. Men and women veterans were more likely than civilians to use a variety of treatment sources, with men civilians being least likely to seek treatment and men veterans exhibiting the longest delay in seeking treatment.
Conclusions:
Post-traumatic stress disorder is a common mental health disorder that varies by gender and veteran status. Women veterans' high rates of post-traumatic stress disorder highlight a critical target for prevention and intervention, whereas understanding treatment barriers for men veterans and civilians is necessary.
Compulsive sexual behavior comprises individual-based (e.g., sexual fantasies, compulsive sexual thoughts, masturbation) and partnered (e.g., interpersonal sexual conquests, repeated infidelity) facets. Most instruments for assessing compulsive sexual behavior, however, focus less on the individual-based facet and specifically on fantasies and compulsive thoughts. In the current research, we developed and validated an individual-based compulsive sexual behavior scale (I-CSB). In Study 1 (N = 492), the factorial structure of the I-CSB was examined. In Study 2 (N = 406), we assessed I-CSB's convergent validity. In Study 3 (N = 112), we examined whether the I-CSB differentiates between individuals who suffer from compulsive sexual behavior and those who do not. Results revealed a 4-factor structure for individual-based compulsive sexual behavior that is associated with an intense inner conflict regarding sexuality (high arousal contrasting with high sexual anxiety), and that account for approximately 75% of the differences between people with compulsive sexual behavior and controls. Results are discussed in light of the need for a broader understanding of compulsive sexual behavior.
Background and aims
There are significant gaps in knowledge regarding the role of childhood adversity, interpersonal violence, and suicidal behavior in hypersexual disorder (HD). The aim of this study was to investigate interpersonal violence in hypersexual men compared with healthy volunteers and the experience of violence in relation to suicidal behavior.
Methods
This case–control study includes 67 male patients with HD and 40 healthy male volunteers. The Childhood Trauma Questionnaire – Short Form (CTQ-SF) and the Karolinska Interpersonal Violence Scale (KIVS) were used for assessing early life adversity and interpersonal violence in childhood and in adult life. Suicidal behavior (attempts and ideation) was assessed with the Mini-International Neuropsychiatric Interview (version 6.0) and the Montgomery–Åsberg Depression Rating Scale – Self-rating.
Results
Hypersexual men reported more exposure to violence in childhood and more violent behavior as adults compared with healthy volunteers. Suicide attempters (n = 8, 12%) reported higher KIVS total score, more used violence as a child, more exposure to violence as an adult as well as higher score on CTQ-SF subscale measuring sexual abuse (SA) compared with hypersexual men without suicide attempt.
Discussion
Hypersexuality was associated with interpersonal violence with higher total scores in patients with a history of suicide attempt. The KIVS subscale exposure to interpersonal violence as a child was validated using the CTQ-SF but can be complemented with questions focusing on SA for full assessment of early life adversity.
Conclusion
Childhood adversity is an important factor in HD and interpersonal violence might be related to suicidal behavior in hypersexual men.
Compulsive sexual behavior (CSB) is defined as difficulties in controlling inappropriate or excessive sexual fantasies, urges, or behaviors that cause subjective distress or impairment in important areas of daily functioning. Using data from a baseline telephone interview, we examined the prevalence of CSB in a convenience sample of 820 post-deployed US military male and female veterans and investigated correlates of CSB with sociodemographics and other mental health and sexual history characteristics. More men (13.8%) than women (4.3%) endorsed CSB-related symptoms. Given the limited sample size of women reporting CSB, correlational analyses were conducted only with men. After adjusting for significant sociodemographics, results indicated that gambling, suicidality, and sexually transmitted infections were significantly associated with male CSB. Current results suggest that CSB may be prevalent among US military veterans post deployment and associated with significant negative health indices in men. CSB warrants attention regarding screening and intervention.
Background and aims
This study examined the prevalence of, and factors associated with, men’s interest in seeking treatment for use of pornography.
Methods
Using an Internet-based data-collection procedure, we recruited 1,298 male pornography users to complete questionnaires assessing demographic and sexual behaviors, hypersexuality, pornography-use characteristics, and current interest in seeking treatment for use of pornography.
Results
Approximately 14% of men reported an interest in seeking treatment for use of pornography, whereas only 6.4% of men had previously sought treatment for use of pornography. Treatment-interested men were 9.5 times more likely to report clinically significant levels of hypersexuality compared with treatment-disinterested men (OR = 9.52, 95% CI = 6.72–13.49). Bivariate analyses indicated that interest-in-seeking-treatment status was associated with being single/unmarried, viewing more pornography per week, engaging in more solitary masturbation in the past month, having had less dyadic oral sex in the past month, reporting a history of seeking treatment for use of pornography, and having had more past attempts to either “cut back” or quit using pornography completely. Results from a binary logistic regression analysis indicated that more frequent cut back/quit attempts with pornography and scores on the Hypersexual Behavior Inventory – Control subscale were significant predictors of interest-in-seeking-treatment status.
Discussion and conclusions
Study findings could be used to inform current screening practices aimed at identifying specific aspects of sexual self-control, impulsivity, and/or compulsivity associated with problematic use of pornography among treatment-seeking individuals.
For individuals with sexual addiction, sexual behaviors often are the primary means of regulating distressing or undesirable emotion. In this study, we sought to examine differences in aspects of emotion regulation between students in the clinical range of sexual addiction and those in the nonclinical range. Among a sample of 337 college students, 57 (16.9 %) scored in the clinical range of sexual addiction and students in the clinical range differed significantly from students in the nonclinical range on three aspects of emotion regulation: (a) nonacceptance of emotional responses, (b) limited engagement in goal-directed behaviors in response to negative affect, and (c) minimal emotion regulation strategies. Implications for interventions on college campuses are provided.
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.
Background and aims: Compulsive sexual behavior (CSB) is highly prevalent among men, often co-occurring with psychiatric disorders and traumatic experiences. Psychiatric disorders and trauma are highly prevalent among military veterans, yet there is a paucity of research on CSB among military samples. The aim of this study was to examine the prevalence of and factors associated with CSB among male military veterans. Methods: Surveys were administered to veterans of Operations Iraqi Freedom, Enduring Freedom, or New Dawn at baseline (n = 258), 3 months (n = 194), and 6 months (n = 136). Bivariate analyses and Generalized Estimating Equations were utilized to estimate associations between CSB and the following variables: psychiatric co-morbidity, childhood physical or sexual trauma, pre- and post-deployment experiences, TV/ Internet usage, and sociodemographics. Associations between CSB and specific PTSD symptom clusters were also examined. Results: CSB was reported by 16.7% of the sample at baseline. Several variables were associated with CSB in bivariate analyses; however, only PTSD severity, childhood sexual trauma, and age remained significant in multivariable GEE models. The PTSD symptom cluster re-experiencing was most strongly associated with CSB. Discussion: This exploratory study suggests that CSB is prevalent amongst veterans returning from combat and is associated with childhood trauma and PTSD, particularly re-experiencing. Conclusions: Further study is needed to identify the mechanisms linking PTSD and CSB, define the context and severity of CSB in veterans, and examine the best ways to assess and treat CSB in VA clinical settings.
Despite the prevalence of pornography use, and recent conceptualization of problematic use as an addiction, we could find no published scale to measure craving for pornography. Therefore, we conducted three studies employing young male pornography users to develop and evaluate such a questionnaire. In Study 1, we had participants rate their agreement with 20 potential craving items after reading a control script or a script designed to induce craving to watch pornography. We dropped eight items because of low endorsement. In Study 2, we revised both the questionnaire and cue exposure stimuli and then evaluated several psychometric properties of the modified questionnaire. Item loadings from a principal components analysis, a high internal consistency reliability coefficient, and a moderate mean inter-item correlation supported interpreting the 12 revised items as a single scale. Correlations of craving scores with preoccupation with pornography, sexual history, compulsive internet use, and sensation seeking provided support for convergent validity, criterion validity, and discriminant validity, respectively. The enhanced imagery script did not impact reported craving; however, more frequent users of pornography reported higher craving than less frequent users regardless of script condition. In Study 3, craving scores demonstrated good one-week test-retest reliability and predicted the number of times participants used pornography during the following week. This questionnaire could be applied in clinical settings to plan and evaluate therapy for problematic users of pornography and as a research tool to assess the prevalence and contextual triggers of craving among different types of pornography users.
Hypersexual behavior has been documented within clinical and research settings over the past decade. Despite recent research on hypersexuality and its associated features, many questions remain how best to define and classify hypersexual behavior. Proposed diagnostic criteria for Hypersexual Disorder (HD) have been proposed for the DSM-5 and a preliminary field trial has lent some support to the reliability and validity of the HD diagnosis. However, debate exists with respect to the extent to which the disorder might be categorized as a non-substance or behavioral addiction. In this article, we will discuss this debate in the context of data citing similarities and differences between hypersexual disorder, drug addictions, and pathological gambling. The authors of this paper conclude that despite many similarities between the features of hypersexual behavior and substance-related disorders, the research on HD at this time is in its infancy and much remains to be learned before definitively characterizing HD as an addiction at this time.
The current study explores relationships between mindfulness, emotional regulation, impulsivity, and stress proneness in a sample of participants recruited in a Diagnostic and Statistical Manual of Mental Disorder Fifth Edition Field Trial for Hypersexual Disorder and healthy controls to assess whether mindfulness attenuates symptoms of hypersexuality.
Hierarchal regression analysis was used to assess whether significant relationships between mindfulness and hypersexuality exist beyond associations commonly found with emotional dysregulation, impulsivity, and stress proneness in a sample of male hypersexual patients (n = 40) and control subjects (n = 30).
Our results show a robust inverse relationship of mindfulness to hypersexuality over and above associations with emotional regulation, impulsivity, and stress proneness.
These results suggest that mindfulness may be a meaningful component of successful therapy among patients seeking help for hypersexual behavior in attenuating hypersexuality, improving affect regulation, stress coping, and increasing tolerance for desires to act on maladaptive sexual urges and impulses.
Arnau RC, Meagher MW, Norris MP, Bramson R. Psychometric evaluation of the Beck Depression Inventory-II with primary care medical patients. Health Psychol. 2001 Mar;20(2):112-9.
This study evaluated the psychometric characteristics of the Beck Depression Inventory-II (BDI-II; A. T. Beck, R. A. Steer, & G. K. Brown, 1996) in a primary care medical setting. A principal-components analysis with Promax rotation indicated the presence of 2 correlated factors, Somatic-Affective and Cognitive, which explained 53.5% of the variance. A hierarchical, second-order analysis indicated that all items tap into a second-order construct of depression. Evidence for convergent validity was provided by predicted relationships with
subscales from the Short-Form General Health Survey (SF-20; A. L. Stewart, R. D. Hayes, & J. E. Ware, 1988). A receiver operating characteristic analysis demonstrated criterion-related validity: BDI-II scores predicted a diagnosis of major depressive disorder (MDD), as determined by the Primary Care Evaluation of Mental Disorders (PRIME-MD) Patient Health Questionnaire (PHQ). This study
demonstrated that the BDI-II yields reliable, internally consistent, and valid scores in a primary care medical setting, suggesting that use of the BDI-II in this setting may improve detection and treatment of depression in these medical patients.
PMID: 11315728
Context
The Primary Care Evaluation of Mental Disorders (PRIME-MD) was developed
as a screening instrument but its administration time has limited its clinical
usefulness.Objective
To determine if the self-administered PRIME-MD Patient Health Questionnaire
(PHQ) has validity and utility for diagnosing mental disorders in primary
care comparable to the original clinician-administered PRIME-MD.Design
Criterion standard study undertaken between May 1997 and November 1998.Setting
Eight primary care clinics in the United States.Participants
Of a total of 3000 adult patients (selected by site-specific methods
to avoid sampling bias) assessed by 62 primary care physicians (21 general
internal medicine, 41 family practice), 585 patients had an interview with
a mental health professional within 48 hours of completing the PHQ.Main Outcome Measures
Patient Health Questionnaire diagnoses compared with independent diagnoses
made by mental health professionals; functional status measures; disability
days; health care use; and treatment/referral decisions.Results
A total of 825 (28%) of the 3000 individuals and 170 (29%) of the 585
had a PHQ diagnosis. There was good agreement between PHQ diagnoses and those
of independent mental health professionals (for the diagnosis of any 1 or
more PHQ disorder, κ = 0.65; overall accuracy, 85%; sensitivity, 75%;
specificity, 90%), similar to the original PRIME-MD. Patients with PHQ diagnoses
had more functional impairment, disability days, and health care use than
did patients without PHQ diagnoses (for all group main effects, P<.001). The average time required of the physician to review the
PHQ was far less than to administer the original PRIME-MD (<3 minutes for
85% vs 16% of the cases). Although 80% of the physicians reported that routine
use of the PHQ would be useful, new management actions were initiated or planned
for only 117 (32%) of the 363 patients with 1 or more PHQ diagnoses not previously
recognized.Conclusion
Our study suggests that the PHQ has diagnostic validity comparable to
the original clinician-administered PRIME-MD, and is more efficient to use.
Figures in this Article
Mental disorders in primary care are common, disabling, costly, and
treatable.1- 5
However, they are frequently unrecognized and therefore not treated.2- 6
Although there have been many screening instruments developed,7- 8
PRIME-MD (Primary Care Evaluation of Mental Disorders)5
was the first instrument designed for use in primary care that actually diagnoses
specific disorders using diagnostic criteria from the Diagnostic
and Statistical Manual of Mental Disorders, Revised Third Edition9(DSM-III-R) and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition10(DSM-IV).
PRIME-MD is a 2-stage system in which the patient first completes a
26-item self-administered questionnaire that screens for 5 of the most common
groups of disorders in primary care: depressive, anxiety, alcohol, somatoform,
and eating disorders. In the original study,5
the average amount of time spent by the physician to administer the clinician
evaluation guide to patients who scored positively on the patient questionnaire
was 8.4 minutes. However, this is still a considerable amount of time in the
primary care setting, where most visits are 15 minutes or less.11
Therefore, although PRIME-MD has been widely used in clinical research,12- 28
its use in clinical settings has apparently been limited. This article describes
the development, validation, and utility of a fully self-administered version
of the original PRIME-MD, called the PRIME-MD Patient Health Questionnaire
(henceforth referred to as the PHQ).
DESCRIPTION OF PRIME-MD PHQ
ABSTRACT
|
DESCRIPTION OF PRIME-MD PHQ
|
STUDY PURPOSE
|
METHODS
|
RESULTS
|
COMMENT
|
REFERENCES
The 2 components of the original PRIME-MD, the patient questionnaire
and the clinician evaluation guide, were combined into a single, 3-page questionnaire
that can be entirely self-administered by the patient (it can also be read
to the patient, if necessary). The clinician scans the completed questionnaire,
verifies positive responses, and applies diagnostic algorithms that are abbreviated
at the bottom of each page. In this study, the data from the questionnaire
were entered into a computer program that applied the diagnostic algorithms
(written in SPSS 8.0 for Windows [SPSS Inc, Chicago, Ill]). The computer program
does not include the diagnosis of somatoform disorder, because this diagnosis
requires a clinical judgment regarding the adequacy of a biological explanation
for physical symptoms that the patient has noted.
A fourth page has been added to the PHQ that includes questions about
menstruation, pregnancy and childbirth, and recent psychosocial stressors.
This report covers only data from the diagnostic portion (first 3 pages) of
the PHQ. Users of the PHQ have the choice of using the entire 4-page instrument,
just the 3-page diagnostic portion, a 2-page version (Brief PHQ) that covers
mood and panic disorders and the nondiagnostic information described above,
or only the first page of the 2-page version (covering only mood and panic
disorders) (Figure 1).
Figure 1. First Page of Primary Care Evaluation
of Mental Disorders Brief Patient Health QuestionnaireGrahic Jump Location+View Large |
Save Figure |
Download Slide (.ppt)
|
View in Article ContextCopyright held by Pfizer Inc, but may be photocopied ad libitum.
For office coding, see the end of the article.
The original PRIME-MD assessed 18 current mental disorders. By grouping
several specific mood, anxiety, and somatoform categories into larger rubrics,
the PHQ greatly simplifies the differential diagnosis by assessing only 8
disorders. Like the original PRIME-MD, these disorders are divided into threshold
disorders (corresponding to specific DSM-IV diagnoses,
such as major depressive disorder, panic disorder, other anxiety disorder,
and bulimia nervosa) and subthreshold disorders (in which the criteria for
disorders encompass fewer symptoms than are required for any specific DSM-IV diagnoses: other depressive disorder, probable alcohol
abuse or dependence, and somatoform and binge eating disorders).
One important modification was made in the response categories for depressive
and somatoform symptoms that, in the original PRIME-MD, were dichotomous (yes/no).
In the PHQ, response categories are expanded. Patients indicate for each of
the 9 depressive symptoms whether, during the previous 2 weeks, the symptom
has bothered them "not at all," "several days," "more than half the days,"
or "nearly every day." This change allows the PHQ to be not only a diagnostic
instrument but also to yield a measure of depression severity that can be
of aid in initial treatment decisions as well as in monitoring outcomes over
time. Patients indicate for each of the 13 physical symptoms whether, during
the previous month, they have been "not bothered," "bothered a little," or
"bothered a lot" by the symptom. Because physical symptoms are so common in
primary care, the original PRIME-MD dichotomous-response categories often
led patients to endorse physical symptoms that were not clinically significant.
An item was added to the end of the diagnostic portion of the PHQ asking
the patient if he or she had checked off any problems on the questionnaire:
"How difficult have these problems made it for you to do your work, take care
of things at home, or get along with other people?" As with the original PRIME-MD,
before making a final diagnosis, the clinician is expected to rule out physical
causes of depression, anxiety and physical symptoms, and, in the case of depression,
normal bereavement and history of a manic episode.
STUDY PURPOSE
ABSTRACT
|
DESCRIPTION OF PRIME-MD PHQ
|
STUDY PURPOSE
|
METHODS
|
RESULTS
|
COMMENT
|
REFERENCES
Our major purpose was to test the validity and utility of the PHQ in
a multisite sample of family practice and general internal medicine patients
by answering the following questions:
Are diagnoses made by the PHQ as accurate as diagnoses
made by the original PRIME-MD, using independent diagnoses made by mental
health professionals (MHPs) as the criterion standard?Are the frequencies of mental disorders found by
the PHQ comparable to those obtained in other primary care studies?Is the construct validity of the PHQ comparable
to the original PRIME-MD in terms of functional impairment and health care
use?Is the PHQ as effective as the original PRIME-MD
in increasing the recognition of mental disorders in primary care patients?How valuable do primary care physicians find the
diagnostic information in the PHQ?How comfortable are patients in answering the questions
on the PHQ, and how often do they believe that their answers will be helpful
to their physicians in understanding and treating their problems?
This study addresses the adult romantic attachment styles of sexually addicted men. The Sexual Addiction Screening Test and the Experiences in Close Relationships Revised were used to determine the presence of a sexual addiction and the participants' style of romantic attachment. ANOVA revealed that sexually addicted men are more likely to relate with insecure attachment styles. Specifically, sexually addicted men were found to have higher anxiety F(1, 38) = 6.122, p < .05 and avoidance F(1, 37) = 4.685, p < .05 in their romantic relationships. Treatment for male sexual addicts should address both addiction and relationship insecurity.
The Internet has substantially changed the way society consumes pornographic material and as become the most popular venue for this sexual purpose. However, researchers have paid little attention to why people use pornographic material online. Arguing that the use of Internet pornography is a motivated behavior meant to obtain what one wants to see, this study attempts to identify specific motivations for Internet pornography use. In addition, this study analyzes how gender and sexual affect—positive or negative—are associated with motivations for Internet pornography use. Overall, 321 undergraduate students including males and females responded to an online questionnaire. Findings show that motivations behind Internet pornography use can be broken down into four factors—relationship, mood management, habitual use, and fantasy. Males revealed far stronger motivations than females; and those with more erotophilic tendencies were more likely than those with more erotophobic tendencies to be motivated to use Internet pornography for all four motivational factors. The implications of the findings are discussed.
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.
This study evaluated the psychometric characteristics of the Beck Depression Inventory-II (BDI-II; A. T. Beck, R. A. Steer, & G. K. Brown, 1996) in a primary care medical setting. A principal-components analysis with Promax rotation indicated the presence of 2 correlated factors, Somatic-Affective and Cognitive, which explained 53.5% of the variance. A hierarchical, second-order analysis indicated that all items tap into a second-order construct of depression. Evidence for convergent validity was provided by predicted relationships with subscales from the Short-Form General Health Survey (SF-20; A. L. Stewart, R. D. Hayes, & J. E. Ware, 1988). A receiver operating characteristic analysis demonstrated criterion-related validity: BDI-II scores predicted a diagnosis of major depressive disorder (MDD), as determined by the Primary Care Evaluation of Mental Disorders (PRIME-MD) Patient Health Questionnaire (PHQ). This study demonstrated that the BDI-II yields reliable, internally consistent, and valid scores in a primary care medical setting, suggesting that use of the BDI-II in this setting may improve detection and treatment of depression in these medical patients.
This article reports the findings of a study investigating psy-chopathology, personality traits, and marital distress among a sample of women married to hypersexual men (n = 85) com-pared with a control group (n = 85) drawn from a combined college and community sample. Psychopathology and personality traits were measured using the NEO Personality Inventory—Revised (NEO–PI–R), and martial satisfaction was measured using the Re-vised Dyadic Adjustment Scale (RDAS). A multivariate analysis of variance (MANOVA) of between-group differences was significant. However, although there were a few minor differences with mod-est effect sizes, examination of post-hoc univariate tests revealed that generally, the wives did not show any more psychopathol-ogy or problematic personality traits than would be found within a community sample. In contrast, wives were significantly more distressed about their marriages compared with the controls. Over-all, these findings contradict much of the existing research that characterizes wives of hypersexual men as being more depressed, anxious, and chemically dependent, as well as emotionally needy.
Psychometric properties of the Hypersexual Behavior Inventory (HBI) are reported using treatment-seeking samples of hypersexual men. Study 1 details item reduction and exploratory factor analysis of the HBI. Study 2 provides results of a confirmatory factor anal-ysis yielding a 3-factor model measuring Control, Consequences, and Coping associated with sexual thoughts, feelings, and behav-iors. Concurrent and discriminant validity was established with measures of theoretically related and dissimilar constructs. The psychometric properties of the HBI suggest it reflects the proposed DSM-V classification criteria for hypersexual disorder and has both the clinical and research utility to advance a more comprehensive understanding of hypersexuality. The proposed diagnostic criteria for Hypersexual Disorder (HD) in the DSM-V characterize this phenomenon as a repetitive and intense preoccupation with sexual fantasies, urges, and behaviors, leading to adverse consequences and clinically significant distress or impairment in social, occupational, or other important areas of functioning (Kafka, 2010; Kaplan & Krueger, 2010; Address correspondence to Rory C. Reid, Ph.D.
BACKGROUND: When gambling opportunities are made available to the public in a given jurisdiction, some individuals participate occasionally and others more frequently. Among frequent gamblers, some individuals develop problematic involvement and some do not. This study addresses the association among demographic and social risk factors, frequency of gambling and gambling disorders.Method
Data from an adult community sample (n=1372) were used to identify risk factors for higher-frequency gambling and disordered gambling involvement. RESULTS: Individuals with higher intelligence, older individuals and more religious individuals were less frequent gamblers. Males, single individuals and those exposed to gambling environments (friends and family who gamble) and those who started to gamble at a younger age were more frequent gamblers. Excitement-seeking personality traits were also higher among more frequent gamblers. A different set of risk factors was associated with the likelihood of gambling disorder among these higher-frequency gamblers. These variables included mental health indicators, childhood maltreatment and parental gambling involvement. Among higher-frequency gamblers, individuals who smoke cigarettes, those with a diagnosis of alcohol or drug dependence or obsessive-compulsive disorder, those with higher anxiety or depression and those with higher impulsivity and antisocial personality traits were more likely to report gambling-related problems. These individuals were also more likely to report gambling on electronic gambling machines (e.g. slot machines). CONCLUSIONS: These data suggest a model in which higher-frequency gambling, particularly with electronic gambling machines, when combined with any type of emotional vulnerability increased the likelihood of gambling disorder.
The present project utilized the Five Factor Model of personality (FFM; McCrae & Costa, 1990) to clarify the multi-faceted nature of impulsivity. The NEO-PI-R and a number of commonly used impulsivity measures were administered to over 400 young adults. Exploratory factor analyses identified four distinct personality facets associated with impulsive-like behavior which were labeled urgency, (lack of) premeditation, (lack of) perseverance, and sensation seeking. Each of these traits was marked by a different facet of the FFM. Following the initial factor identification, scales to measure each of the personality facets were created and combined to form the UPPS Impulsive Behavior scale. Implications for the understanding of impulsive behavior and the FFM are discussed, as are future applications of the UPPS impulsive behavior scale.
This study compared male and female university students' experiences with online sexual activity (OSA) and tested a model explaining gender differences in OSA. OSAs were categorized as non-arousal (e.g., seeking sexuality information), solitary-arousal (e.g., viewing sexually explicit materials), or partnered-arousal (e.g., sharing sexual fantasies). Participants (N = 217) completed measures of OSA experience, sexual attitudes, and sexual experience. Significantly more men than women reported engaging in solitary-arousal and partnered-arousal OSA and doing so more often. However, the men and women who reported having engaged in partnered-arousal activities reported equal frequencies of experience. There were no significant gender differences for engaging in non-arousal OSA experience. These results support the importance of grouping OSAs in terms of the proposed non-arousal, solitary-arousal, and partnered-arousal categories. Attitude toward OSA but not general attitudes toward or experiences with sexuality partially mediated the relationship between gender and frequency of engaging in arousal-oriented OSA (solitary and partnered OSA). This suggests that attitude toward OSA specifically and not gender socialization more generally account for gender differences in OSA experience.
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.
Background: Insomnia is a prevalent health complaint that is often difficult to evaluate reliably. There is an important need for brief and valid assessment tools to assist practitioners in the clinical evaluation of insomnia complaints.Objective: This paper reports on the clinical validation of the Insomnia Severity Index (ISI) as a brief screening measure of insomnia and as an outcome measure in treatment research. The psychometric properties (internal consistency, concurrent validity, factor structure) of the ISI were evaluated in two samples of insomnia patients.Methods: The first study examined the internal consistency and concurrent validity of the ISI in 145 patients evaluated for insomnia at a sleep disorders clinic. Data from the ISI were compared to those of a sleep diary measure. In the second study, the concurrent validity of the ISI was evaluated in a sample of 78 older patients who participated in a randomized-controlled trial of behavioral and pharmacological therapies for insomnia. Change scores on the ISI over time were compared with those obtained from sleep diaries and polysomnography. Comparisons were also made between ISI scores obtained from patients, significant others, and clinicians.Results: The results of Study 1 showed that the ISI has adequate internal consistency and is a reliable self-report measure to evaluate perceived sleep difficulties. The results from Study 2 also indicated that the ISI is a valid and sensitive measure to detect changes in perceived sleep difficulties with treatment. In addition, there is a close convergence between scores obtained from the ISI patient's version and those from the clinician's and significant other's versions.Conclusions: The present findings indicate that the ISI is a reliable and valid instrument to quantify perceived insomnia severity. The ISI is likely to be a clinically useful tool as a screening device or as an outcome measure in insomnia treatment research.
We critically review the concepts of sexual addiction, sexual compulsivity, and sexual impulsivity and discuss their theoretical bases. A sample of 31 self-defined sex addicts were assessed by means of interview and questionnaires and compared with a large age-matched control group. A tendency to experience increased sexual interest in states of depression or anxiety was strongly characteristic of the sex addict group. Dissociative experiences were described by 45% of sex addicts and may have some explanatory relevance. Obsessive-compulsive mechanisms may be relevant in some cases, and the addiction concept may prove to be relevant with further research. Overall, results suggested that out of control sexual behavior results from a variety of mechanisms. We propose an alternative theoretical approach to investigating these mechanisms based on the dual control model and recent research on the relation between mood and sexuality.
Background and objectives:
Little research has examined the clinical characteristics of U.S. post-9/11 military veterans coping with alcohol problems. Specifically, we examined psychopathology and hypersexuality among male and female post-9/11 veterans with and without a lifetime history of alcohol-use disorders (AUDs).
Methods:
Using data from a baseline telephone interview and follow-up web-based survey, we examined frequencies of AUDs, mental health and addictive disorders, sexual behaviors, hypersexuality, and problematic use of pornography in a national convenience sample of 283 U.S. veterans.
Results:
Many (39.1%) veterans met lifetime criteria for AUDs. Bivariate associations revealed that veterans with lifetime AUDs met clinically significant levels of posttraumatic stress disorder and criteria for drug-use disorders (lifetime). Veterans with lifetime AUDs also attended religious services less often, engaged in more solitary masturbation in the past month, and reported more issues with problematic use of pornography and hypersexuality compared with veterans without AUDs. Results from a logistic regression found that lifetime drug-use disorders (odds ratio [OR] = 4.22) and posttraumatic stress disorder symptoms (OR = 1.98) were significant predictors of veterans with lifetime AUD status.
Discussion and conclusions:
We found differences among veterans with lifetime AUDs compared with those without on select measures of psychopathology, sexual behavior, and hypersexuality.
Scientific significance:
Further screening for substance-use disorders and hypersexuality in Veterans Affairs is strongly encouraged while veterans are transitioning back into civilian life (Am J Addict 2019;00:00-00).
Despite a lack of consensus in the field about how best to conceptualize problematic pornography use, psychometric instruments have nonetheless been developed to assess the construct. The present systematic review aimed to (i) identify psychometric tools that have been developed to assess problematic pornography use; (ii) summarize key characteristics, psychometric properties, and strengths and limitations of instruments for problematic pornography use; (iii) compare the instruments’ theoretical conceptualizations of problematic pornography use; and (iv) evaluate each instrument on their ability to assess various core components of addiction. In this article, 22 instruments assessing problematic pornography use were reviewed. Results indicated that while the instruments had different conceptualizations of problematic pornography use, addiction still emerged as the most common theoretical framework used by the instruments. Five of the most commonly assessed addiction components across the different instruments were (1) impaired control, (2) salience, (3) mood modification, (4) interpersonal conflict, and (5) general life conflict. Contextual factors that may potentially affect the assessment of problematic pornography use and recommendations for researchers and clinicians are discussed.
Introduction:
Impulsivity has been identified to be involved in the development and maintenance of specific Internet-use disorders (IUD). It can be differentiated between relatively stable trait impulsivity and state impulsivity which is dependent on environmental and affective factors such as craving. Following the I-PACE (Interaction of Person-Affect-Cognition-Execution) model, both trait and state impulsivity may play an interactive role in IUD. The present study aimed to investigate the relationship between trait and state impulsivity and symptom severity of Internet-pornography-use disorder (IPD) as one form of IUD.
Methods:
Fifty heterosexual males participated in this study. State impulsivity was measured with reaction times in a modified stop-signal task. Each participant conducted two blocks of this task which included neutral and pornographic pictures. Moreover, current subjective craving, trait impulsivity, and symptom severity of IPD were assessed using several questionnaires.
Results:
Results indicate that trait impulsivity was associated with higher symptom severity of IPD. Especially those males with higher trait impulsivity and state impulsivity in the pornographic condition of the stop-signal task as well as those with high craving reactions showed severe symptoms of IPD.
Conclusion:
The results indicate that both trait and state impulsivity play a crucial role in the development of IPD. In accordance with dual-process models of addiction, the results may be indicative of an imbalance between the impulsive and reflective systems which might be triggered by pornographic material. This may result in loss of control over the Internet-pornography use albeit experiencing negative consequences.
Defined as sexually explicit material that elicits erotic thoughts, feelings, and behaviours, internet pornography is a prevalent form of media that may facilitate problematic use and craving for engagement. Research suggests that superordinate cognitions and information processing, such as desire thinking and metacognition, are central to the activation and escalation of craving in addictive behaviours. The current study aimed to contribute to the literature by testing the proposed metacognitive model of desire thinking and craving in a sample of problematic pornography users, while revising the model by incorporating negative affect. From a theoretical perspective, environmental cues trigger positive metacognitions about desire thinking that directly influence desire thinking, resulting in the escalation of craving, negative metacognitions, and negative affect. Participants were recruited via an online survey and screened for problematic internet pornography use. Path analyses were used to investigate relationships among the aforementioned constructs in a final sample of 191 participants. Consistent with previous research, results of this study validated the existence of metacognitive processes in the activation of desire thinking and escalation of craving, while indicating that desire thinking has the potential to influence negative affect. Additionally, results supported the role of significant indirect relationships between constructs within the revised model of metacognition, desire thinking, and psychopathology. Collectively, the findings demonstrate the clinical value of a metacognitive conceptualisation of problematic pornography use. Exploring the metacognitive mechanisms that underpin problematic internet pornography use may give rise to the development of new treatment and relapse prevention strategies.
Introduction: Digital social media platforms represent outlets through which individuals may find partners for sexual encounters. Using a sample of US post-deployment military veterans, the current study evaluated the prevalence of digital sex seeking with clinical correlates of psychopathology, suicidal ideation, and sexually transmitted infections (STIs).
Methods: Using data from a baseline telephone interview and follow-up internet-based survey, we examined the prevalence of sexual partnering via digital social-media platforms in a national sample of 283 US combat veterans.
Results: Among veterans, 35.5% of men and 8.5% of women reported having used digital social media to meet someone for sex. Individuals who reported having used digital social media to find sexual partners (DSMSP+) as compared to those who did not (DSMSP-) were more likely to be young, male, and in the Marine Corps. After adjusting for sociodemographic variables, DSMSP+ status was associated with post-traumatic stress disorder (OR=2.26, p=0.01), insomnia (OR=1.99, p=0.02), depression (OR=1.95, p=0.03), hypersexuality (OR=6.16, p<0.001), suicidal ideation (OR=3.24, p=0.04), and treatment for an STI (OR=1.98, p=0.04).
Conclusion: Among US post-deployment military veterans, DSMSP+ behaviors were prevalent, particularly amongst men. The association between DSMSP+ behaviors and PTSD, insomnia, depression, hypersexuality, suicidal ideation, and STIs suggest that veterans who engage in DSMSP+ behaviors should be particularly thoroughly screened and evaluated for these psychiatric concerns and counseled on the benefits of safe sexual practices.
Introduction:
Pornography has become popular with Internet technology. For most people, pornography use (PU) is entertainment; for some, it can result in seeking treatment for out-of-control behavior. Previous studies have suggested that PU can influence sexual behaviors, but the direct relation between frequency of PU and treatment-seeking behaviors has not been examined.
Aims:
To investigate whether individuals seeking treatment as a consequence of their problematic PU do so because of their quantity of pornography consumption or because of more complex psychological and behavioral factors related to PU, such as the severity of negative symptoms associated with PU and/or subjective feeling of loss of control over one's behavior.
Methods:
A survey study was conducted of 569 heterosexual Caucasian men 18 to 68 years old, including 132 seeking treatment for problematic PU (referred by psychotherapists after their initial visit).
Main outcomes measures:
The main outcome measures were self-reported PU, its negative symptoms, and actual treatment-seeking behavior.
Results:
We tested models explaining sources of seeking treatment for problematic PU with negative symptoms associated with PU and additional factors (eg, onset and number of years of PU, religiosity, age, dyadic sexual activity, and relationship status). Seeking treatment was significantly, yet weakly, correlated solely with the frequency of PU (r = 0.21, P < .05) and this relation was significantly mediated by negative symptoms associated with PU (strong, nearly full mediation effect size; k(2) = 0.266). The relation between PU and negative symptoms was significant and mediated by self-reported subjective religiosity (weak, partial mediation; k(2) = 0.066) in those not seeking treatment. Onset of PU and age appeared to be insignificant. Our model was fairly fitted (comparative fit index = 0.989; root mean square error of approximation = 0.06; standardized root mean square residual = 0.035) and explained 43% of the variance in treatment-seeking behavior (1% was explained by frequency of PU and 42% was explained by negative symptoms associated with PU).
Conclusion:
Negative symptoms associated with PU more strongly predict seeking treatment than mere quantity of pornography consumption. Thus, treatment of problematic PU should address qualitative factors, rather than merely mitigating the frequency of the behavior, because frequency of PU might not be a core issue for all patients. Future diagnostic criteria for problematic PU should consider the complexity of this issue.
Abstract In the context of Internet addiction, cybersex is considered to be an Internet application in which users are at risk for developing addictive usage behavior. Regarding males, experimental research has shown that indicators of sexual arousal and craving in response to Internet pornographic cues are related to severity of cybersex addiction in Internet pornography users (IPU). Since comparable investigations on females do not exist, the aim of this study is to investigate predictors of cybersex addiction in heterosexual women. We examined 51 female IPU and 51 female non-Internet pornography users (NIPU). Using questionnaires, we assessed the severity of cybersex addiction in general, as well as propensity for sexual excitation, general problematic sexual behavior, and severity of psychological symptoms. Additionally, an experimental paradigm, including a subjective arousal rating of 100 pornographic pictures, as well as indicators of craving, was conducted. Results indicated that IPU rated pornographic pictures as more arousing and reported greater craving due to pornographic picture presentation compared with NIPU. Moreover, craving, sexual arousal rating of pictures, sensitivity to sexual excitation, problematic sexual behavior, and severity of psychological symptoms predicted tendencies toward cybersex addiction in IPU. Being in a relationship, number of sexual contacts, satisfaction with sexual contacts, and use of interactive cybersex were not associated with cybersex addiction. These results are in line with those reported for heterosexual males in previous studies. Findings regarding the reinforcing nature of sexual arousal, the mechanisms of learning, and the role of cue reactivity and craving in the development of cybersex addiction in IPU need to be discussed.
Despite the increased social acceptance and widespread use of pornography over the past few decades, reliable and valid instruments assessing problematic use of pornography are lacking. This paper reports the findings of three studies aimed at developing and validating a new scale measuring problematic pornography use. The Problematic Pornography Use Scale (PPUS) items showed high internal consistency, convergent validity, and construct validity. Exploratory and confirmatory factor analyses revealed four core factors relating to proposed domains of problematic pornography use. High PPUS scores were positively correlated with measures of psychopathology, low self-esteem and poor attachment. Although PPUS scores were related to other behavioral addictions, problematic pornography use as operationalized in the current paper appears to be uniquely distinguished from features of behavioral addictions relating to gambling and Internet use. Findings highlight the potential use of the PPUS for future research and possible clinical applications by defining problematic pornography use as a behavioral addiction.
Patrick Carnes (1989)6.
Carnes , P. J. 1989 . Contrary to love: Helping the sexual addict , Minneapolis, MN : CompCare Publishers . View all references developed the Sexual Addiction Screening Test (SAST) to identify individuals at risk for sexual addiction. Using two groups of veterans from an addictions treatment program (N = 313, N = 316), this research explored the psychometric properties of the SAST and explored the feasibility of reducing the length of the SAST. Results suggested that the SAST measured a single construct with excellent reliability and acceptable convergent and divergent validity. Examination of the shortened SAST provided some initial support for a six-item SAST version. Finally, a wide-ranging pattern of significant correlations between personality disorders and sexual addiction emerged.
The posttraumatic stress disorder checklist is a commonly used measure, with military (PCL-M), civilian (PCL-C), and specific trauma (PCL-S) versions. This synthesis of the psychometric properties of all three versions found the PCL to be a well-validated measure. The PCL shows good temporal stability, internal consistency, test-retest reliability, and convergent validity. The majority of structural validity studies support four factor models. Little is available on discriminant validity and sensitivity to change. Strengths, limitations, and future research directions are discussed. Understanding the PCL's psychometric properties, strengths (e.g., items map on to DSM-IV diagnostic criteria), and limitations (e.g., may overestimate PTSD prevalence) will help clinicians and researchers make educated decisions regarding the appropriate use of this measure in their particular setting.
The authors describe the sociodemographic features, phenomenology, and psychiatric comorbidity of 36 subjects reporting compulsive sexual behavior.
Twenty-eight men and eight women who responded to advertisements for "persons ... who have a problem with compulsive sexual behavior" completed structured and semistructured assessments, including the Diagnostic Interview Schedule for DSM-III-R disorders (axis I) and the Structured Interview for DSM-III-R Personality Disorders, Revised (axis II).
The typical subject was a 27-year-old man who reported experiencing compulsive sexual behavior for nearly 9 years. Sexual behavior was described as excessive and poorly controlled and was associated with either subjective distress or impairment in interpersonal or occupational functioning or as overly time-consuming. Fourteen subjects (39%) reported a history of major depression or dysthymia, 15 (42%) a history of phobic disorder, and 23 (64%) a history of substance use disorder. Personality disorders were quite frequent, particularly the paranoid, histrionic, obsessive-compulsive, and passive-aggressive subtypes. The compulsive sexual behavior was quite varied and included both paraphilic (e.g., cross-dressing) and nonparaphilic (e.g., compulsive masturbation) types.
Compulsive sexual behavior may be a clinically useful concept, but it describes a heterogeneous group of individuals with substantial psychiatric comorbidity and diverse behavioral problems.
the purpose of this study was to assess the test-retest reliability of newly introduced or revised modules of the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV), including alcohol consumption, tobacco use, family history of depression, and selected DSM-IV axis I and II psychiatric disorders.
kappa and intraclass correlation coefficients were calculated for the AUDADIS-IV modules using a test-retest design among a total of 2657 respondents, in subsets of approximately 400, randomly drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).
reliabilities for alcohol consumption, tobacco use and family history of major depression measures were good to excellent, while reliabilities for selected DSM-IV axis I and II disorders were fair to good. The reliabilities of dimensional symptom scales of DSM-IV axis I and axis II disorders exceeded those of their dichotomous diagnostic counterparts and were generally in the good to excellent range.
the high reliability of alcohol consumption, tobacco use, family history of depression and psychiatric disorder modules found in this study suggests that the AUDADIS-IV can be a useful tool in various research settings, particularly in studies of the general population, the target population for which it was designed.