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High Rates of Sexual Behavior in the General Population: Correlates and Predictors

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We studied 2450, 18-60-year-old men and women from a 1996 national survey of sexuality and health in Sweden to identify risk factors and correlates of elevated rates of sexual behavior (hypersexuality) in a representative, non-clinical population. Interviews and questionnaires measured various sexual behaviors, developmental risk factors, behavioral problems, and health indicators. The results suggested that correlates of high rates of intercourse were mostly positive, whereas the correlates of high rates of masturbation and impersonal sex were typically undesirable. For both men and women, high rates of impersonal sex were related to separation from parents during childhood, relationship instability, sexually transmitted disease, tobacco smoking, substance abuse, and dissatisfaction with life in general. The association between hypersexuality and paraphilic sexual interests (exhibitionism, voyeurism, masochism/sadism) was particularly and equally strong for both genders (odds ratios of 4.6-25.6). The results held, with a few exceptions, when controlling for age, being in a stable relationship, living in a major city, and same-sex sexual orientation. We conclude that elevated rates of impersonal sex are associated with a range of negative health indicators in the general population.
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Archives of Sexual Behavior, Vol. 35, No. 1, February 2006, pp. 37–52 (
C
2006)
DOI: 10.1007/s10508-006-8993-y
High Rates of Sexual Behavior in the General Population:
Correlates and Predictors
Niklas L
˚
angstr
¨
om, M.D., Ph.D.
1,3
and R. Karl Hanson, Ph.D.
2
Received April 20, 2004; revision received September 14, 2004; accepted November 16, 2004
We studied 2450, 18–60-year-old men and women from a 1996 national survey of sexuality
and health in Sweden to identify risk factors and correlates of elevated rates of sexual behavior
(hypersexuality) in a representative, non-clinical population. Interviews and questionnaires measured
various sexual behaviors, developmental risk factors, behavioral problems, and health indicators.
The results suggested that correlates of high rates of intercourse were mostly positive, whereas
the correlates of high rates of masturbation and impersonal sex were typically undesirable. For
both men and women, high rates of impersonal sex were related to separation from parents during
childhood, relationship instability, sexually transmitted disease, tobacco smoking, substance abuse,
and dissatisfaction with life in general. The association between hypersexuality and paraphilic sexual
interests (exhibitionism, voyeurism, masochism/sadism) was particularly and equally strong for both
genders (odds ratios of 4.6–25.6). The results held, with a few exceptions, when controlling for age,
being in a stable relationship, living in a major city, and same-sex sexual orientation. We conclude
that elevated rates of impersonal sex are associated with a range of negative health indicators in the
general population.
KEY WORDS: sexual behavior; population survey; paraphilias.
INTRODUCTION
One of the most salient dimensions of sexual
behavior is frequency. Historically, excessive sexual
behavior was considered important (e.g., Hagenbach,
2002), whereas recent research and medical attention
has focused on disorders that inhibit or block sexual
expression, such as hypoactive sexual desire disorder,
male erectile disorder, and dyspareunia (American Psy-
chiatric Association, 2000). The DSM-IV-TR does not
address problems associated with excessive sexuality,
and such problems were only briefly mentioned as “non-
paraphilic sexual addictions” in the DSM-III-R (American
1
Centre for Violence Prevention, Karolinska Institutet, Stockholm,
Sweden.
2
Corrections Policy, Public Safety and EmergencyPreparednessCanada,
Ottawa, Ontario, Canada.
3
To whom correspondence should be addressed at The Centre for
Violence Prevention, Karolinska Institutet, P.O. Box 23000, S-104 35
Stockholm, Sweden; e-mail: niklas.langstrom@cvp.se.
Psychiatric Association, 1987), as an example under
sexual disorders not otherwise specified.
The attention to inhibitory sexual problems has been
justified by large scale community surveys in which
such sexual difficulties are associated with dissatisfaction
with sexual life (Fugl-Meyer & Sj
¨
ogren Fugl-Meyer,
1999), decreased quality of life (Ventegodt, 1998), and
low general happiness (Laumann, Paik, & Rosen, 1999).
Laumann, Gagnon, Michael, and Michaels (1994), for
example, found that individuals who have intercourse less
than three times per month were less happy than average.
Although sexual experience is highly valued in
Western cultures, there is some evidence that high rates
of sexual behavior can be problematic. It is easy to find
individuals whose high frequency sexual behavior appears
to interfere with their personal happiness and social
adjustment; in fact, an entire journal, Sexual Addiction
and Compulsivity, is devoted to this topic. It has even been
suggested that compulsive sexuality may be common,
possibly affecting up to 6% of the general population
in the United States (Black, 2000; Coleman, 1992). The
37
0004-0002/06/0200-0037/0
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2006 Springer Science+Business Media, Inc.
38 L
˚
angstr
¨
om and Hanson
question motivating the current research is whether it
makes sense to consider an upper limit on the amount
of sexual behavior, beyond which the behavior could
reasonably be described as excessive. In other words, is it
possible to determine how much sex is “too much”?
Correlates of High Frequency Sexual Behavior
In medical practice, high rates of sexual behavior
have occasionally been noted secondary to brain injury,
particularly insults to the right temporal cortex (Braun,
Dumont, Duval, Hamel, & Godbout, 2003), including
stroke (Stein, Hugo, Oosthuizen, Hawkridge, & van
Heerden, 2000) and multiple sclerosis (Gondim Fde &
Thomas, 2001; Huws, Shubsachs, & Taylor, 1991). More
often though, it is encountered as a symptom in general
impulse control disorders, mania (Perugi et al., 1998),
substance use, and personality disorders. Clinical studies
of adults (predominantly men) recruited for research on,
or seeking help for, compulsive or excessive sexuality
suggest substantial (>30%) co-morbidity with anxiety
and mood disorders and substance abuse (Bancroft
& Vukadinovic, 2004; Black, Kehrberg, Flumerfeldt,
& Schlosser, 1997; Kafka & Hennen, 2002; Kafka &
Prentky, 1994; Raymond, Coleman, & Miner, 2003),
pathological gambling (Black et al., 1997), attention
deficit hyperactivity disorder (Kafka & Hennen, 2002;
Kafka & Prentky, 1998), and personality disorder (Black
et al., 1997; Raymond et al., 2003).
The public health hazard associated with excessive
or risky sexual behavior that has attracted the most
attention has been the increased risk for acquiring STD,
in particular HIV infection (Johnson et al., 2001). A less
well-known but troubling feature associated with high
rates of sexual behavior is paraphilia—deviant sexual
interests involving pain or suffering or that preclude a
consenting adult partner (Black et al., 1997; Kafka &
Hennen, 1999, 2002). Sexual preoccupations are common
among identified sexual offenders (Marshall & Marshall,
2001) and, when present, increase their risk of sexual
recidivism (Quinsey, Khanna, & Malcolm, 1998). The
association between paraphilias and high rates of sexual
behavior is sufficiently strong to prompt Kafka (1997)
to propose that excessive sexual desire be classified as a
paraphilia-related disorder.
High Rates of Sexual Behavior as a Distinct
Disorder (Hypersexuality)
Although clinical studies have found an association
between high rates of sexual behavior and a variety of
mental and physical problems, there is less agreement on
whether excessive sexual behavior should be a distinct
disorder. Among those who propose a distinct disorder,
the nosology remains controversial (Goodman, 2001).
The term “compulsive sexual behavior” is often used to
describe high rates of masturbation, pornography use, and
protracted promiscuity, but there is little evidence for a
connection to obsessive-compulsive disorder (Jaisoorya,
Janardhan Reddy, & Srinath, 2003). Some researchers
(e.g., Coleman, 1992; Raymond et al., 2003) have used
broader definitions of sexual preoccupation, including not
only impersonal sex acts, but also preoccupation with
unobtainable partners and multiple love relationships. The
latter factors, however, would better be understood as
relationship problems, which fall outside a core definition
of excessive sexual behavior.
Kafka (1997) proposed a definition of hypersexuality
based on the total frequency of sexual outlets. Using data
from Kinsey, Pomeroy, and Martin (1948) and others
(Atwood & Gagnon, 1987), Kafka recommended that the
minimum criteria for hypersexual disorder would be daily
orgasms for six consecutive months, which would identify
the top 5–10% of the male population. Kafka’s definition
included all sexual outlets: intercourse with a regular
partner, along with masturbation, protracted promiscuity,
and paying for sex. Daily orgasm was necessary but not
sufficient for Kafka’s definition of hypersexuality; to be
problematic, the high frequency of total sexual outlets also
required significant sexual pre-occupation and adverse
psychosocial consequences (Kafka, 1997, 2003).
Kafka’s (1997, 2003) definition is promising, but
it is always difficult to define unusual behavior (in the
statistical sense) as pathological. Even if the behavior
is rare, and the people engaging in the behavior show
distress or impairment, the behavior could still be simply
“different. The experience of distress or impairment isnot
solely a function of the individual’s characteristics; it will
also be related to others’ reactions to these characteristics
(consider, for example, homosexuality in a homophobic
culture). Nevertheless, the observation that a particular
behavior is rare and that it is associated with negative or
positive attributes and outcomes is an important reference
point in judging whether that behavior is a potential asset
or a liability.
Total sexual outlet is a face valid and easily quan-
tified index of the rate of sexual activity, but there are
problems with using it as a marker for excess. In a large
survey of sexual behavior in the United States, Laumann
et al. (1994) found that the frequency of intercourse
was positively associated with happiness whereas an
elevated masturbation frequency was related to decreased
happiness. Furthermore, individuals who had only one sex
High Rates of Sexual Behavior 39
partner during the past 12 months were happier than those
who had multiple sex partners (or those who had none).
Consequently, a definition of excessive sexuality that only
counts orgasms is likely to miss important distinctions in
the expression of sexuality.
One hypothesis is that definitions of excessive
sexuality should be based on high rates of impersonal
sex, and not on high rates of intercourse within romantic
relationships. “Impersonal sex” could be defined as sexual
behavior that is primarily concerned with and focused
upon the sex act itself. In contrast, “personal sex” is
sexual behavior that is concerned with and focused upon a
particular person. The psychological attitude determines
whether sex is personal or impersonal. It is possible, for
example, to treat a long-term stable sex partner as a sex
object. Similarly, it is possible to have a deep, human
connection with the partner involved in a one-night stand.
There are, however, some sexual behaviors that are more
likely motivated by the sex acts themselves rather than by
attraction to a particular person. Examples of impersonal
sex would include masturbation (no partner), paying for
sex, and multiple changes in partners.
Overview of Current Study
The objective of the current study was to explore
the correlates and risk factors of high rates of sexual
behavior in a large, representative epidemiological
sample. Most of what we know about hypersexuality
comes from clinical studies or from individuals who
self-identify problems with excessive sexuality. Although
recently there have been a number of large, population-
based studies of high frequency sexual behavior, these
surveys excluded masturbation because their focus
has been on the risk of sexually transmitted diseases
(e.g., Johnson, Wadsworth, Wellings & Field, 1994;
Ramrakha, Caspi, Dickson, Moffitt, & Paul, 2000).
Among the few recent surveys that included questions
concerning masturbation (e.g., Laumann et al., 1994),
none, to our knowledge, has considered the physical
and mental health correlates of high frequency sexual
behavior (including masturbation). The neglect of
masturbation is significant because masturbation is the
primary sexual outlet of hypersexual males (Kinsey et al.,
1948).
The Swedish Sexuality and Health Project provided
a unique opportunity to study hypersexuality because it
yielded information on a wide range of sexual behaviors
(intimate, impersonal, and solitary) in the general popu-
lation along with measures of physical and psychological
health, subjective well-being, and paraphilic interests.
Using the available data, personal sex was measured by
intercourse within stable relationships and impersonal sex
was indexed by a variety of indicators (e.g., masturbation,
paying for sex, group sex, frequent changes in sex
partners). We hypothesized that personal sex would be
associated with positive factors (e.g., satisfaction with
sexual life and life in general), but that high rates of
impersonal sex would be associated with undesirable
features (e.g., paraphilia, substance abuse, dissatisfaction
with life in general).
METHOD
Participants
We analyzed data collected for the Sexuality and
Health Project (Lewin, Fugl-Meyer, Helmius, Lalos, &
M
˚
ansson, 1998), sponsored by the Swedish Public Health
Institute and approved by the research ethics commit-
tee of the Swedish Research Council for Humanistic
and Social Sciences. The Sexuality and Health Project
contacted by mail a random selection of 5250 18–74-
year-olds from the general population of Sweden in 1995
(6,200,000 individuals). Of these, 469 were considered
ineligible due to language problems, severe visual or
hearing impairment, long-term illness, or emigration. The
remaining 4781 subjects were invited to participate, and
2810 consented when the study was conducted during
the spring of 1996 (59% response rate). A comparison
of responders and non-responders did not find gender
differences or differences on social or geographic char-
acteristics; however, older persons (particularly older
women) were less likely to participate (Lewin et al., 1998).
Consequently, all respondents over age 60 were elimi-
nated to minimize the effects of age-related attrition. The
final sample included 1279 men and 1171 women aged
18–60.
Procedure
Before data collection, participants signed informed
consent forms. Trained research assistants collected in-
formation concerning sociodemographic variables, work,
and leisure activities during face-to-face interviews, typ-
ically in the respondent’s home. Information about sexu-
ality and sexual health was obtained from questionnaires
completed in private. The efforts to obtain confidentiality
appeared successful because previous analyses revealed
no general social desirability bias or obvious deception,
not even for the sensitive sex-related questions (Lewin
et al., 1998).
40 L
˚
angstr
¨
om and Hanson
Table I. Indicators of Hypersexuality Among 18–60-Year-Old Subjects in a Representative National Sample
Men (n = 1244) Women (n = 1142)
Indicator of Indicator of
Variable MSDhypersexuality MSDhypersexuality
Masturbation during last month (times) 4.96.9 15 (11.4%) 1.63.3 5(10.6%)
Pornography use last year (times) 14.036.8 31 (9.8%) 1.44.5 4(10.5%)
Number of sexual partners
Last year 1.41.6 3(10.0%) 1.21.8 2(12.3%)
Per active year 0.91.4 3(6.4%) 0.61.2 2(5.5%)
Ever sex with another person while
married/cohabiting Yes (38.2%) Yes (24.4%)
Currently more than one stable
sex partner
a
Yes (2.2%)
Prefers casual sex lifestyle to
one (or no) stable partner Yes (20.1%) Yes (6.8%)
Ever group sex Yes (10.4%) Yes (4.4%)
a
An insufficient number of women (n = 5) responded affirmatively to provide a reliable estimate.
Measures
Indicators of High Rates of Impersonal Sex
Table I presents the indicators of impersonal sexual
behavior used in the current study: masturbation, pornog-
raphy use, number of sex partners in last year, number
of sex partners per active year, ever sex with another
person while married/cohabiting, currently more than one
stable sex partner, attitudes supportive of casual sex, and
group sex. For continuous measures, a high level of
impersonal sex was determined by selecting an integer
cut-point near the 90th percentile separately for men
and women (identifying the top 5–10% of male and
female samples, respectively). For example, a high rate
of masturbation for men was defined as 15 times or more
during the last month, which identified 11.4% of the men.
For women, a rate of masturbation of five times or more
during the last month identified the top 10.6% of the
women. The same items (with different cut-points) were
used for both genders with the exception that, for women,
the item “currently more than one stable sex partner” was
not used because only five women endorsed this item.
Dichotomous variables were based on the presence or
absence of each characteristic (cf. Table I)
The indicators of impersonal sex were positively
correlated with each other and crude overall comparisons
showed similar relationships to studied risk factors and
correlates (data not shown). For men, principal compo-
nents factor analysis indicated that the eight items in
Table I could be subsumed under one factor, accounting
for 26.3% of the variance. A one-factor solution seemed
most appropriate judging from Cattell’s (1966) scree test
and visual inspection of two- and three-factor solutions.
The average correlations among the items were small to
moderate (Cronbach’s α = .58).
For women, factor analysis indicated that the seven
items in Table I could be subsumed under one factor,
accounting for 25.6% of the variance. Again, a one-factor
solution seemed most appropriate judging from Cattell’s
scree test and visual inspection of two- and three-factor
solutions. The average correlations between the items
were small to moderate (Cronbach’s α = .51).
If the items listed in Table I are valid indicators of
hypersexuality, then individuals with more of them should
be more representative of persons with hypersexuality
than those with few or none of the items. Consequently,
the eight items in Table I were given unit weights and
summed. The resulting scores were used to classify the
men into three groups: low (0, n = 554), moderate (1,
2, n = 539), or high hypersexuality (3 indicators, n =
151). The seven items in Table I were similarly summed
and used to classify women into low (0, n = 635), mod-
erate (1, 2, n = 427), or high hypersexuality groups (3
indicators, n = 80). The cutoff for “high” hypersexuality
was set at three or more indicators to identify as closely
as possible the 90th percentile separately for each gender.
Subjects with one or two indicators were assigned to an
in-between “moderate” group. Thirty-five men and 29
women were not classified because they did not respond
to two or more of the items.
Risk Factors and Correlates
The risk factors and correlates examined in this
study are displayed in Tables II, III, and IV (32 variables
High Rates of Sexual Behavior 41
Table II. Selected Correlates to Frequency of Sexual Intercourse Among 18–60 Year-Old
Subjects That Were in Stable Relationships with One Partner
Frequency of intercourse (last 30 days)
Variable Men (n = 826) Women (n = 823)
Satisfaction
a
...With sexual life
a
.415
∗∗∗
.417
∗∗∗
...With life in general
a
.084
.090
...With physical health
a
.080
.033
...With psychological health
a
.048 .069
Separation from parents .039 .062
during childhood
Age 1st vaginal intercourse .118
∗∗
.082
n 801 806
Ever STD infection .003 .005
n 807 810
Ever sexually aroused by
...Exposing genitals to a stranger .105
∗∗
.050
...Spying on what others are .063 .017
doing sexually
...Deliberately using pain .107
∗∗
.071
Ever illegal drug use
b
.085
.087
Ever substantially drunk .198
∗∗∗
.143
∗∗∗
last month
Current tobacco smoker
c
.018 .014
Note. Sample size is given for variables with missing data for more than 10 cases.
a
Self-reported on a six-point Likert-type scale from very unsatisfying (1) to very
satisfying (6).
b
Use of narcotics not prescribed to subject by physician.
c
Smoked five or more cigarettes per day during last year.
p<.05.
∗∗
p<.01.
∗∗∗
p<.001, two-tailed.
for each of the latter two). Most of the items are self-
explanatory, with the exception of the following items
(all translated from Swedish by the first author). Sexual
abuse history was assessed with the question, “Were
you ever involved in a sexual activity without wanting
it yourself?” A separate variable was created if any
abuse happened before age 18. The measure of sexual
intercourse included both vaginal and anal intercourse.
The subjects were not specifically asked if they self-
identified as hetero-, bi- or homosexual. However, they did
report whether they had been sexually attracted to women,
men or both on a five-step Likert-type scale ranging from
exclusively women to exclusively men. An individual was
considered to have a homosexual attraction when he/she
felt sexually attracted to individuals of the same sex
as much as (or more) than with the opposite sex. STD
infection history was based on the question, “Have you
ever been afflicted with gonorrhea, chlamydia, syphilis,
genital herpes, condyloma (genital warts), HIV/AIDS or
any other sexually transmitted disease?” The English
descriptions of all variables correspond closely to the
intent of the original Swedish questions. For example,
“Separation from parents during childhood” was based on
the question “Did you grow up with both your parents?”
Self-reported sexual arousal was used to create proxy
measures of DSM-IV paraphilias: “Have you ever exposed
your genitals to a stranger and become sexually aroused by
this?” (exhibitionism),“Haveyou ever spied on what other
people are doing sexually and become sexually aroused
by this?” (voyeurism), and “Have you ever deliberately
used physical pain and become sexually aroused by this?”
(masochism or sadism).
Self-reported satisfaction with sexual life, life in
general, physical health, and psychological health was
rated on a six-point Likert scale from very unsatisfying
(1) to very satisfying (6).
Statistical Analysis
Differences among hypersexuality groups were
tested with one-way ANOVAs for continuous variables
and the χ
2
-test for dichotomous variables. Given large
samples sizes, even small effects would be statistically
significant. Consequently, unadjusted odds ratios (OR)
42 L
˚
angstr
¨
om and Hanson
Table III. Correlates of Hypersexuality Among 18–60-Year-Old Men in a Representative National Sample (N = 1244)
Level of hypersexuality
Unadjusted OR
a
Adjusted OR
b
Low (0) Moderate (1, 2) High (3+) F or χ
2
(95% CI) (95% CI)
Variable (n = 554, 44.5%) (n = 539, 43.3%) (n = 151, 12.1%) (overall) (high vs. low) (high vs. low)
Sociodemographic characteristics
Age (years) 38.21 (11.81) 36.31 (12.26) 34.03 (10.93) 8.41
∗∗∗
.97 (.95–.98)
Born and raised abroad (%) 6.07.89.93.20 1.74 (.92–3.29)
Separation from parents during childhood (%) 12.115.225.215.90
∗∗∗
2.44 (1.56–3.82) 2.33 (1.45–3.74)
Currently living in major city area
c
(%) 17.628.537.732.90
∗∗∗
2.84 (1.91–4.21)
Current socioeconomic position
d
1.65 (.70) 1.75 (.73) 1.69 (.72) 2.64 1.08 (.83–1.41)
n 519 490 137
Currently not studying or working (%) 8.56.512.15.09 1.48 (.83–2.64)
n 543 523 149
Sexuality and relationships
Positive parental attitudes to sex
e
3.30 (.72) 3.31 (.74) 3.44 (.86) 1.79 1.26 (.98–1.63)
n 469 466 132
Age 1st vaginal intercourse (years) 17.80 (3.69) 16.54 (2.45) 15.79 (2.23) 35.28
∗∗∗
.77 (.71–.84) .76 (.70–.84)
n 516 507 148
Frequency of intercourse last month 5.28 (5.19) 5.26 (6.65) 7.38 (7.60) 7.27
∗∗
1.06 (1.03–1.09) 1.08 (1.05–1.12)
n 492 491 143
Ever victim of sexual abuse (%) 9.414.713.27.25
1.47 (.85–2.55)
Ever victim of sexual abuse before age 18 (%) 1.94.23.54.42 1.83 (.62–5.45)
n 516 499 143
Ever stable sexual relationship (%) 94.092.996.01.96 1.53 (.63–3.71)
Current stable sexual relationship (%) 83.771.866.031.61
∗∗∗
.38 (.25–.57)
Serious discussion concerning separation
from stable relation last year (%)
5.39.121.427.07
∗∗∗
4.88 (2.59–9.19) 4.30 (2.21–8.38)
n 453 385 98
Ever same sex sexual partner (%) 1.63.07.313.30
∗∗
4.70 (1.91–11.56) 4.12 (1.59–10.69)
n 547 536 151
Equally or more often sexually attracted to
men as compared to women (%)
0.70.90.7 .18 .91 (.10–8.17)
Ever paid for sexual contact (%) 6.217.024.045.69
∗∗∗
4.78 (2.86–7.99) 5.69 (3.24–9.97)
n 549 534 146
More easily sexually aroused than others (%) 23.238.063.690.10
∗∗∗
5.77 (3.92–8.49) 5.49 (3.66–8.23)
Ever sexually aroused by
...Exposing genitals to a stranger (%) 1.45.29.322.20
∗∗∗
6.96 (2.86–16.93) 4.66 (1.83–11.89)
...Spying on what others are doing
sexually (%)
5.613.527.256.84
∗∗∗
6.29 (3.78–10.47) 7.12 (4.15–12.22)
...Deliberately using pain (%) 0.43.37.929.48
∗∗∗
23.83 (5.27–107.69) 14.16 (3.02–66.31)
Ever STD infection (%) 9.920.038.668.01
∗∗∗
5.71 (3.69–8.84) 5.11 (3.23–8.08)
n 544 529 145
Ever consulted with professional for advice
on sexuality (%)
7.412.814.711.13
∗∗
2.14 (1.23–3.72) 2.01 (1.12–3.58)
Satisfaction with sexual life
f
4.67 (1.24) 4.16 (1.38) 4.42 (1.29) 20.64
∗∗∗
.86 (.75–.99) .99 (.84–1.16)
High Rates of Sexual Behavior 43
General health and substance use
Current tobacco smoker
g
(%) 18.221.230.510.73
∗∗
1.96 (1.31–2.96) 2.01 (1.30–3.09)
Ever substantially drunk last month (%) 23.237.153.055.26
∗∗∗
3.72 (2.56–5.42) 3.14 (2.03–4.87)
Ever illegal drug use
h
(%) 3.813.936.4 120.16
∗∗∗
14.38 (8.31–24.86) 11.62 (6.54–20.63)
n 548 533 151
Problematic gambling behavior
i
(%) 8.611.015.97.00
2.02 (1.19–3.42) 2.18 (1.24–3.84)
Current psychiatric morbidity
j
(%) 0.71.50.03.34 0.00 0.00
Satisfaction with life in general
f
4.94 (.90) 4.70 (.93) 4.55 (1.04) 14.26
∗∗∗
.67 (.56–.80) .71 (.58–.86)
Satisfaction with physical health
f
5.19 (.88) 5.02 (.96) 4.97 (.93) 5.71
∗∗
.77 (.64–.94) .76 (.63–.93)
Satisfaction with psychological health
f
5.33 (.85) 5.12 (.98) 5.15 (1.02) 7.57
∗∗
.81 (.67–.98) .83 (.68–1.01)
Note. Sample sizes are given for specific variables when missing data resulted in the loss of 10 or more men.
a
Unadjusted ORs express the association between each variable and the likelihood for high as compared to low level of hypersexuality.
b
Adjusted ORs were derived from multivariate logistic regression models and express the relationship between variable and high vs. low level of hypersexuality controlling for age, currently
living in major city area, and current stable relationship. Adjusted ORs were only calculated for variables that had a significant unadjusted association with hypersexuality (reflected in 95% CIs
not including 1.00).
c
Larger Stockholm, Gothenburg, and Malm
¨
o areas.
d
Rated on a three-step ordinal scale based on current or latest occupation; the higher socioeconomic position the higher score.
e
Self-reported on a five-point Likert-type scale from very negative (1) to very positive (5).
f
Self-reported on a six-point Likert-type scale from very unsatisfying (1) to very satisfying (6).
g
Smoked five or more cigarettes per day during last year.
h
Use of narcotics not prescribed to subject by physician.
i
Spent 500 Swedish Crowns ($US 65) or more on gambling in last month.
j
Consulted physician and was diagnosed with a psychiatric disorder during the last year.
p<.05.
∗∗
p<.01.
∗∗∗
p<.001.
44 L
˚
angstr
¨
om and Hanson
Table IV. Correlates of Hypersexuality Among 18–60-Year-Old Women in a Representative National Sample (N = 1142)
Level of hypersexuality
Unadjusted OR
a
Adjusted OR
b
Low (0) Moderate (1, 2) High (3+) F or χ
2
(95% CI) (95% CI)
Variable (n = 635, 55.6%) (n = 427, 37.4%) (n = 80, 7.0%) (overall) (high vs. low) (high vs. low)
Sociodemographic characteristics
Age (years) 39.11 (11.89) 36.21 (11.82) 30.10 (8.80) 24.69
∗∗∗
.93 (.91–.95)
Born and raised abroad (%) 7.65.48.82.44 1.17 (.51–2.67)
Separation from parents during childhood (%) 13.719.730.016.58
∗∗∗
2.70 (1.59–4.58) 2.25 (1.28–3.96)
Currently living in major city area
c
(%) 27.128.132.51.07 1.30 (.79–2.14)
Current socioeconomic position
d
1.67 (.65) 1.71 (.66) 1.63 (.70) .76 .91 (.62–1.35)
n 594 382 65
Currently not studying or working (%) 8.28.911.4 .92 1.44 (.68–3.05)
n 609 406 79
Sexuality and relationships
Positive parental attitudes to sex
e
3.25 (.82) 3.30 (.90) 3.37 (.94) .75 1.18 (.87–1.60)
n 533 369 68
Age 1st vaginal intercourse (years) 17.35 (2.67) 16.47 (2.36) 15.78 (2.48) 22.96
∗∗∗
.71 (.62–.82) .78 (.68–.89)
n 598 412 76
Frequency of intercourse last month 4.27 (4.20) 5.79 (6.31) 7.86 (7.11) 20.19
∗∗∗
1.13 (1.08–1.18) 1.19 (1.12–1.25)
n 561 389 76
Ever victim of sexual abuse (%) 20.234.039.231.98
∗∗∗
2.56 (1.56–4.18) 2.53 (1.50–4.28)
Ever victim of sexual abuse before age 18 (%) 5.811.710.811.10
∗∗
1.95 (.87–4.40)
n 582 393 74
Ever stable sexual relationship (%) 97.999.195.06.50
.40 (.13–1.23)
Current stable sexual relationship (%) 85.478.665.821.44
∗∗∗
.33 (.20–.55)
Serious discussion concerning separation
from stable relation last year (%)
3.611.126.945.49
∗∗
9.93 (4.62–21.33) 7.38 (3.28–16.60)
n 531 333 52
Ever same sex sexual partner (%) 0.52.613.858.36
∗∗∗
33.16 (9.03–121.74) 30.35 (7.68–119.96)
Equally or more often sexually attracted to
women as compared to men (%)
0.31.21.33.03 3.95 (.35–44.05)
Ever paid for sexual contact (%) 0.00.00.0—
n 629 419 78
More easily sexually aroused than others (%) 7.715.233.849.71
∗∗∗
6.13 (3.54–10.62) 5.35 (2.97–9.63)
n 626 422 80
Ever sexually aroused by
...Exposing genitals to a stranger (%) 0.33.77.526.80
∗∗∗
25.66 (5.09–129.46) 27.81 (4.84–159.75)
...Spying on what others are doing sexually
(%)
2.74.411.314.26
∗∗
4.61 (1.98–10.72) 4.45 (1.76–11.30)
...Deliberately using pain (%) 0.81.412.554.65
∗∗∗
18.00 (5.98–54.16) 13.36 (4.12–43.32)
High Rates of Sexual Behavior 45
Table IV. Continued
Ever STD infection (%) 15.124.932.923.92
∗∗∗
2.76 (1.64–4.63) 2.68 (1.55–4.63)
n 623 413 79
Ever consulted with professional for advice
on sexuality (%)
22.031.238.817.44
∗∗∗
2.24 (1.38–3.65) 1.67 (.98–2.82)
Satisfaction with sexual life
f
4.47 (1.37) 4.36 (1.39) 4.39 (1.50) .89 .96 (.81–1.13) 1.12 (.92–1.37)
n 625 422 80
General health and substance use
Current tobacco smoker
g
(%) 23.631.748.124.62
∗∗∗
3.00 (1.86–4.85) 3.42 (2.03–5.75)
Ever substantially drunk last month (%) 6.316.737.575.09
∗∗∗
8.88 (5.10–15.46) 5.13 (2.82–9.35)
Ever illegal drug use
h
(%) 1.15.919.061.64
∗∗∗
20.86 (8.20–53.04) 11.01 (4.15–29.17)
Problematic gambling behavior
i
(%) 3.02.30.02.68 0.00 0.00
Current psychiatric morbidity
j
(%) 1.32.36.39.34
∗∗
5.22 (1.67–16.38) 5.77 (1.53–21.76)
Satisfaction with life in general
f
4.95 (.97) 4.78 (.98) 4.55 (1.04) 8.11
∗∗∗
.70 (.56–.86) .77 (.61–.97)
Satisfaction with physical health
f
5.00 (1.07) 4.95 (1.11) 5.18 (.95) 1.48 1.19 (.93–1.52)
Satisfaction with psychological health
f
5.22 (.95) 4.96 (1.08) 4.97 (1.08) 8.87
∗∗∗
.79 (.64–.98) .89 (.70–1.13)
Note. Sample sizes are given for specific variables when missing data resulted in the loss of 10 or more women.
a
Unadjusted ORs express the association between each variable and the likelihood for high as compared to low level of hypersexuality.
b
Adjusted ORs were derived from multivariate logistic regression models and express the relationship between variable and high versus low level of hypersexuality controlling for age, currently
living in major city area, and current stable relationship. Adjusted ORs were only calculated for those variables that had a significant unadjusted association with hypersexuality (reflected in 95%
CIs not including 1.00).
c
Larger Stockholm, Gothenburg, and Malm
¨
o areas.
d
Rated on a three-step ordinal scale based on current or latest occupation; the higher socioeconomic position the higher score.
e
Self-reported on a five-point Likert-type scale from very negative (1) to very positive (5).
f
Self-reported on a six-point Likert-type scale from very unsatisfying (1) to very satisfying (6).
g
Smoked five or more cigarettes per day during last year.
h
Use of narcotics not prescribed to subject by physician.
i
Spent 500 Swedish Crowns ($US 65) or more on gambling in last month.
j
Consulted physician and was diagnosed with a psychiatric disorder during the last year.
p<.05.
∗∗
p<.01.
∗∗∗
p<.001.
46 L
˚
angstr
¨
om and Hanson
with 95% confidence intervals were calculated to express
the strength of the association between risk factors or
correlates and hypersexuality. These effect size indicators
compared the high hypersexual group to the low hypersex-
ual group (medium levels were not taken into account for
the OR calculations). To control statistically for the most
likely confounding variables, the comparisons between
high and low hypersexual groups were also calculated
from multivariate logistic regression models, controlling
for the respondents’ age, whether they were currently in
a stable relationship, and whether they lived in a major
urban center.
RESULTS
The first stage of the data analysis explored potential
indicators of hypersexuality. The two most obvious
indicators were the rates of intercourse and masturbation.
On average, the mean frequency of sexual intercourse per
month was 5.5 times for men (n = 1130, SD = 6.2, range,
0–63) and 5.1 for women (n = 1028, SD = 5.4, range, 0–
50), a non-significant difference (t = 1.61, df = 2156,
p = .11). Men reported more masturbation per month
(M = 4.9, n = 1,180, SD = 6.9, range, 0–50) than did
women (M = 1.6, n = 1,065, SD = 3.3, range, 0–30)(t =
14.45, df = 2243, p<.001). Thirty-five percent of men
and 61% of women reported no masturbation during the
previous month. Although both correlations were small,
the rate of intercourse and the rate of masturbation were
negatively correlated for men (r =−.11, p<.001) and
positively correlated for women (r = .14, p<.001).
Intercourse and masturbation were both significantly
related to quality of life indicators, but in opposite direc-
tions. As can be seen in Fig. 1, high rates of intercourse
were associated with increased satisfaction with sexual
life, life in general, and physical and psychological health.
In contrast, high rates of masturbation were associated
with decreased satisfaction with sexual life and with life
in general. Masturbation was not significantly associated
with subjective ratings of satisfaction with physical
and psychological health. When analyzed separately by
gender, the same overall pattern of results was found for
both men and women (data not shown).
It is likely that the associations between frequency
of sexual intercourse or masturbation and quality of life
measures could be confounded by relationship status.
Looking only at men currently in a stable relationship
with one partner (n = 826), the frequency of sexual
intercourse was strongly associated with satisfaction with
their sexual life (r = .42, p<.001), and showed weaker,
although still positive, correlations with satisfaction with
life in general (r = .08, p = .016), physical health (r =
.08, p = .022), and psychological health (r = .05, p =
.164). A similar pattern was found for women in stable
relationships (see Table II). The correlation coefficient
was only an approximate indicator of the association
because, as shown by Fig. 1, the patterns tended to be
non-linear. Very low levels of intercourse were associated
with low satisfaction whereas there was relatively little
change in sexual and life satisfaction once the rate of
intercourse increased to 3–5 times a month.
Contrary to expectation, intercourse frequency
within stable relationships tended to show positive re-
lationships with indicators of substance abuse and para-
philias (see Table II). The associations, however, were
small and often non-significant (particularly for females).
Much stronger associations were found between these
problematic variables and high rates of impersonal sex
(see below).
Hypersexuality in Men
Table III presents 32 potential correlates of hypersex-
uality in men. An OR of, for example, .77 per year for age
at first sexual intercourse could be interpreted to mean that
the odds of being classified as high hypersexuality versus
low hypersexuality decreased by 23% for each year delay
in the onset of sexual intercourse. A 5-year delay would
decrease the odds by 73% (.77
5
= .27).
For three out of six tested sociodemographic char-
acteristics, men with high levels of hypersexuality were
different from less hypersexual or non-hypersexual men.
Hypersexual men were more likely to be young, having
experienced separation from parents during childhood,
and to live in major urban areas. With respect to the
17 sexuality and relationship variables, hypersexuality
was significantly related to 12. The sexual experiences
of high hypersexual men started early and were fre-
quent and diverse, including increased frequencies of
same-sex sexual behavior, paying for sex, exhibitionism,
voyeurism, and masochism/sadism. The association be-
tween hypersexuality and paraphilic interests was strong,
with ORs ranging from 6.3 to 23.8. Despite being highly
sexually active, hypersexual men were less satisfied
with their sexual life than were non-hypersexual men.
Hypersexual men were also more likely to have had
problems in current adult romantic relationships, have had
an STD infection, and to have consulted a professional for
advice about sexuality. In total, only 10 men (0.8%) had a
homosexualsexual attraction pattern defined as having felt
sexually attracted by individuals of the same sex at least
as much as by persons of the opposite sex. No difference
High Rates of Sexual Behavior 47
in sexual orientation was found across the three levels of
hypersexuality.
Hypersexuality in men was associated with seven
out of eight general health and substance use variables.
Hypersexual men engaged in a variety of risk behaviors,
including smoking tobacco, heavy drinking, using illegal
drugs, and gambling. They also reported relatively less
satisfaction with physical health, psychological health,
and with life in general.
The results were essentially unchanged when con-
trolling for age, urban living, and current stable partner.
For only two variables did the OR comparing the high
Fig. 1. Satisfaction with sexual life, life in general, and health by frequency of sexual intercourse or masturbation. Self-reports addressed
sexual activity during the last month and current satisfaction with sexual life, life in general, physical, and psychological health in 2450, 18–
60-year-old subjects from the general population. The dependent variables were rated on six-point Likert-type scales from very unsatisfying
(1) to very satisfying (6). Error bars represent means for each activity group with 95% confidence intervals.
48 L
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angstr
¨
om and Hanson
Fig. 1. Continued.
and low hypersexual groups change from statistically
significant to non-significant: satisfaction with sexual life
and satisfaction with psychological health.
Hypersexuality in Women
As can be seen in Table IV, the correlates of
hypersexuality in women were substantially the same as
those found in men. With respect to sociodemographic
characteristics, hypersexuality in women was associated
with two out of six tested variables: younger age and
separation from parents during childhood. Early onset
of intercourse, relationship instability, diverse sexual ex-
periences including same-sex sexual partners, paraphilic
interests, and STD infections were among the 12 out of
17 tested sexuality and relationship variables associated
with female hypersexuality. Eight women (0.7%) had
a predominantly homosexual sexual attraction pattern.
Sexual orientation was not significantly related to the level
of hypersexuality. Six out of eight general health and
High Rates of Sexual Behavior 49
substance use variables were related to hypersexuality in
women, among them tobacco smoking, substance abuse,
and dissatisfaction with psychological health and with life
in general.
The most notable difference from the findings for
men was the substantial association between hyper-
sexuality and a history of sexual abuse for women.
Hypersexuality in women was also related to an increase
in psychiatric co-morbidity, whereas no such relationship
was found for men. Finally, hypersexuality in women,
in contrast to men, was neither associated with a lower
satisfaction with sexual life nor with physical health.
The results were essentially unchanged when con-
trolling for age, urban living, and current stable partner.
Only for two variables (ever consulted with professional
for advice with sexuality and satisfaction with psycho-
logical health) did the control procedure wash out the
significant associations with high versus low hypersexual
groups.
DISCUSSION
The main question guiding this study was whether it
is possible to identify a level of sexual activity that could
be considered excessive (Rinehart & McCabe, 1997).
The results indicated that any definition of excessive sex
should distinguish between intercourse within a stable
relationship and impersonal sexual behavior. High rates
of intercourse were associated with mostly desirable
features (e.g., high satisfaction with sex life, life in
general) and a few undesirable features (e.g., substance
abuse). In comparison, the correlates of high rates of
impersonal sex were undesirable (or neutral). For both
men and women, high rates of impersonal sex were
associated with adverse family backgrounds, a variety of
negative health indicators, and dissatisfaction with life in
general. High rates of impersonal sex were not associated
with an increase in any desirable characteristic, except
young age. Not all of the associations with undesirable
features were strong, and a few (e.g., satisfaction with
psychological health) were no longer significant after
controlling for age, urban living, and a current stable
partner. The direction of causation is difficult to infer from
cross-sectional data. Nevertheless, the overall pattern of
results suggest that problems with “excessive” sexuality
are more likely to be connected with impersonal sex than
with high rates of intercourse within stable relationships.
The strong association between high rates of impersonal
sex and paraphilic interests (exhibitionism, voyeurism,
masochism/sadism) suggested that sexually preoccupied
individuals are not only at risk for personal distress, but
also pose a risk to others.
Previous clinical research has noted associations
between high rates of sexual activity and anxiety and
depression (Raymond et al., 2003) and paraphilias (Kafka,
1997). In addition, a study of a birth cohort (Ramrakha
et al., 1998) found young adults diagnosed with depres-
sion, antisocial personality, and substance use disorder
to be more than twice as likely to exhibit risky sexual
behavior (defined as three or more partners during the
last year combined with low frequency condom use). The
present findings from a general population survey suggest
that the problems found in clinical groups of individuals
with high rates of sexual activity are not exclusively
attributable to self-selection biases.
Associations with negative attributes are not suffi-
cient to determine whether unusual behavior should be
considered pathological, but it is one element to consider.
Impersonal sex was common (most men masturbated)
and, in low frequencies, impersonal sex was not associated
with negative characteristics in the current data set. It was
only among individuals reporting high rates of imper-
sonal sexual behavior that the negative correlates were
observed.
The indicators of hypersexuality used in the current
study had face validity, and our summary measures
showed expected relationships with sexuality and health
risk variables, typically in a dose response fashion. The
gender-specific measures, however, are not proposed as
full definitions of excessive sexual behavior. The internal
consistency of the measures was marginal and the avail-
able data did not include indicators of some prototypical
features of hypersexuality such as the amount of time
devoted to sexual activities. Researchers and clinicians
constructing a definition of excessive sexual activity
should consider other potential indicators, such as sexual
rumination, difficulty managing sexual impulses, a high
sex drive, and interference with social or occupational
functioning (e.g., sexual harassment, surfing the Internet
for porn rather than working) (Kafka, 1997; Stein, Black,
Shapira, & Spitzer, 2001).
The rates of impersonal sex were higher for men
than for women. Nevertheless, a high rate of impersonal
sex was associated with essentially the same negative
correlates for both genders. The major gender difference
was that sexual victimization emerged more clearly as
a risk factor for excessive sexuality in women. Previous
population-based studies have found that sexual abuse is
linked to promiscuous or risky sexual behavior (Bensley,
Van Eenwyk, & Simmons, 2000; Shrier, Pierce, Emans, &
DuRant, 1998) as well as to decreased sexual arousal and
desire (Laumann et al., 1999) in both men and women (see
50 L
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angstr
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om and Hanson
also Merrill, Guimond, Thomsen & Milner, 2003). Further
research is required to determine whether women are more
likely than men to respond to sexual victimization with
increased sexual activity. It is also possible, however, that
sexual victimization among women who engage in high
rates of impersonal sex is a consequence (not a cause) of
a risky lifestyle.
The current study did not identify the causes of hy-
persexuality or whether it is a distinct disorder. Research
has yet to identify possible genetic or neuroendocrine
features associated with excessive sexual behavior (e.g.,
Haake et al., 2003) but it is likely that hypersexuality
has biological as well as psychological determinants.
Hypersexuality would be expected, for example, among
individuals who overvalue sex in the pursuit of happiness
or use sex to compensate for other unfulfilled needs
(Bancroft & Vukadinovic, 2004; Cortoni & Marshall,
2001). Bancroft and Vukadinovic (2004), for example,
found that most individuals (84%) seeking treatment for
“out of control” sexual behavior reported that their sexual
responses increased when anxious or depressed, a pattern
found only in a minority of the general population (15–
25%).
There are several research traditions that may inform
the interpretation of our findings. For example, it has long
been noted that individuals with an antisocial, criminal
orientation are likely to begin sexual intercourse early and
to have many sexual partners (Glueck & Glueck, 1950).
Donovan, Jessor, and Costa (1988; Costa, Jessor, Dono-
van, & Fortenberry, 1995) found that early onset of sexual
intercourse correlated with other indicators of “psychoso-
cial unconventionality, including substance abuse, law
breaking, and poor school attendance. Gottfredson and
Hirschi (1990) proposed that these associations could be
explained through individual differences in self-control.
Substance abuse, school dropout, sexual promiscuity, and
crime are all behaviors that have short-term benefits and
long-term costs.
From an evolutionary perspective, Belsky, Steinberg,
and Draper (1991) proposed that early maturation and
high rates of impersonal sex could be an adaptive re-
productive strategy when faced with harsh environments.
Rather than delaying gratification, establishing stable
relationships and conforming to the demands of society,
children who have been rejected and neglected obtain
sexual maturity early, adopt an opportunistic approach
to relationships and, as adults, invest little in parenting.
Such behaviors have high costs in stable societies, but
could promote reproductive success when social norms
are weak and life expectancy short. They went on to
suggest that the propensity for risk taking (or low self-
control according to Gottfredson & Hirschi, 1990) could
actually be an adaptive trait in dangerous environments
(Steinberg & Belsky, 1996).
To our knowledge, this study was the first to examine
the correlates of high rates of sexual activity in a represen-
tative population sample. It is important to note, however,
the inherent limitations of examining a construct using a
data set that was not specifically collected for the purpose.
Although many of the questions were relevant, further
precision would have been desirable to help disentangle
alternate explanations.
The response rate was adequate, but it is possible
that non-participants systematically differed from partic-
ipants. Previous analyses of the present cohort found no
major sexual, social, or geographic differences between
responders and non-responders (Lewin et al., 1998).
Although effect sizes were generally small, participants
in earlier studies of sexual attitudes have been found to be
somewhat more liberal, more sexually novelty-seeking,
and more likely to have behavior problems than non-
participants (Dunne et al., 1997; Purdie, Dunne, Boyle,
Cook, & Najman, 2002).
A further limitation is that the study focused on one
relatively homogenous Nordic country, and the results
may not generalize fully to other populations. The rates
of sexual behavior were, however, similar to those found
in other countries: masturbation and intercourse in the
United States (Laumann et al., 1994), intercourse in the
United Kingdom (Johnson et al., 2001), and homosexu-
ality in the United Kingdom (Wellings, Wadsworth, &
Johnson, 1994) and Switzerland (Narring, Huwiler, &
Michaud, 2003).
In conclusion, men and women who engage in high
rates of impersonal sex report adverse backgrounds and
a variety of concurrent life problems and negative health
indicators. Consequently, professionals addressing sexual
disorders should not only be concerned with barriers to
sexual expression, but also with high levels of sexual
interest and behavior, particularly when it is not directed
toward a particular intimate partner. In many cases,
excessive sexual behavior may be secondary to other
disorders, but it is possible that hypersexuality could
be a distinct disorder, worthy of its own classification,
assessment, and treatment.
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... Studies on the prevalence of clinically relevant indications of compulsive sexual behavior in the general population are still rare. The Swedish study by Långström and Hanson (2006), which investigated correlates of compulsive sexual behavior in a Swedish sample, was, to our knowledge, the first to assess a prevalence estimation in the general population. More recently (Dickenson, Gleason, Coleman, & Miner, 2018), a study on prevalence using a screen cut point of a score of 35 or higher on the Compulsive Sexual Behavior Inventory (CSBI) -13 was carried out in the US American population, which produced very high prevalence estimates (10.3% in men; 7.0% in women). ...
... The sum score of the CSBI-13 is likely to be related to the presence or absence of CSBD, but it is unclear how sensitive and specific it is in relation to the ICD-11 diagnostic requirements. Operationalization in studies has varied widely (Böthe et al., 2018;Dickenson et al., 2018;Långström & Hanson, 2006), which makes the range of figures not comparable. Prior to the publication of ICD-11, measures used in studies focusing on CSBD were not based on specific clinical guidelines. ...
... Both estimates are markedly lower than those reported by Dickenson et al. (2018), who used a different conceptualization and measurement. Gender differences observed in our study are in line with previous reports (Böthe et al., 2018;Dickenson et al., 2018;Långström & Hanson, 2006). We found no difference in educational status, unlike in other healthrelated problems (Autorengruppe Bildungsberichterstattung, 2014). ...
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Background and aims The purpose of this study was to examine the prevalence and correlates of indicators consistent with Compulsive Sexual Behavior Disorder (CSBD)—defined and operationalized according to the ICD-11 guidelines—in a large ( n = 4,633; 50.5% male; 49,5% female) probability-based German national sample. Methods Participants were asked if they had ever experienced “intense and recurring sexual impulses or sexual urges that I had difficulty controlling and resulted in sexual behavior” over a period of several months. Those who reported this experience were queried about the associated distress. Results Overall, 4.9% of men [95% CI = 3.9–6.1] and 3.0% of women [95% CI = 2.3–3.9] reported experiences consistent with ICD-11 diagnostic requirements for lifetime diagnosis. In the 12 months preceding the study, 3.2% of men [95% CI = 2.4–4.2] and 1.8% of women [95% CI = 1.2–2.5] reported experiences consistent with CSBD requirements. Compared to controls and participants who reported elements of compulsive sexuality but without accompanying distress, strict religious upbringing was most prevalent in the CSBD group. The CSBD group was more likely to view sexual practices like men having sex with men as unacceptable and to report the belief that pornography has negative impacts on their sex life and life in general. Compared to the other two groups, the CSBD group was significantly more likely to have received psychiatric treatment for depression or another mental health problem during the past 12 months. Discussion and conclusions The current study provides novel and important insights into the prevalence and characteristics of CSBD in the general population.
... While the inclusion of hypersexuality in the DSM-5 is still under investigation (Kingston, Graham, & Knight, 2017;, its location within developmental models of sexual violence is supported by empirical evidence (e.g., Kingston et al., 2017;Knight & Sims-Knight, 2006;Långström & Hanson, 2006). Hypersexuality has been associated with higher sex rate and unconventional sex activities in a sample of men with paraphilias and paraphilia-related disorder. ...
... Therefore, both appear to be two important manifestations of hypersexuality. Additionally, Långström and Hanson (2006) found a relationship between hypersexuality and exhibitionism, voyeurism, masochism and sadismsuggesting a link between hypersexuality and paraphilias. One implication of the association between hypersexuality and paraphilia is that high rates of sexual activity can lead individuals to develop sexual inclinations and desires to explore outside the realm of normophilic behaviours. ...
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Purpose: Paraphilia can be defined as a condition in which the sexual excitement rely on fantasizing and/or participating in unusual sexual behaviour. The last decades have been rich with new studies investigating the prevalence of paraphilic desires and behaviours among the general population as well as clarifying the boundary between paraphilic and normophilic. However, few studies have focused on paraphilic interests' nomological network. Methods: The project aimed to assess the prevalence of paraphilias among the general population, including a subgroup of people with self-reported atypical sexual interests. Furthermore, the relationship between Childhood Traumatic Experiences, Personality Traits, Hypersexuality, Pornography Consumption and Paraphilic Arousal was examined through mediation analysis. Analyses were conducted on a sample of N = 372 participants. Results: Analyses revealed a difference in the prevalence between sexual fantasy and sexual arousal, with a majority of self-reported arousal being lower than fantasy. Furthermore, mediation analyses revealed that the relationship between trauma and arousal is mediated by hypersexuality, problematic pornography consumption and personality traits. Conclusions: Abuses during childhood are the starting point of an over-involvement in sexuality, which increase the likelihood of developing atypical sexual interest or behaviour. Implications will be discussed.
... Some patients show problematic use of sex and drugs/ alcohol, either at different times or in combination (Black et al., 1997;Braun-Harvey and Vigorito, 2015;Kasl, 1989;Långström and Hanson, 2006;Raymond et al., 2003;Schneider, 1991Schneider, , 1994Timms and Connors, 1992). Some use alcohol to relax, overcome inhibitions and give the courage to 'act out' (Kasl, 1989). ...
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An integrative model of sexual addiction is presented, involving a combination of models based upon (i) incentive motivation theory and (ii) the dual organisation of the control of behavior. The model is related to ongoing arguments about the validity of the notion of addiction when applied to sexual behavior. It is suggested that the evidence strongly favors the viability of an addiction model of sex. Strong similarities to the classical addiction to hard drugs are observed and features can be better understood with the help of the model. These include tolerance, escalation and withdrawal symptoms. It is argued that other candidates for accounting for the phenomena, such as obsessive-compulsive behavior, faulty impulse control, high drive and hypersexuality do not fit the evidence. The role of dopamine is central to the model. The model’s relevance to stress, abuse, development, psychopathy, fantasy, sex differences, evolutionary psychology and the interaction with drug-taking is shown.
... Higher incidence of sexual addiction disorder has been observed among individuals with substance use disorders. 7 Sexual addiction disorder has also been linked to adverse childhood events which include sexual, physical, and emotional abuse. 8 However, systematic data regarding the risk factors associated with the disorder, weather genetic, personality, early life experience, and so on, as well as associated sociocultural and sociodemographic factors are lacking. ...
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Sexual addiction, hypersexuality, sexual compulsivity, and sexual impulsivity are all terms that describe a psychological disorder that is characterized by a person's inability to control his or her sexual behavior. This spectrum of symptoms are often referred to as sexual addiction disorder. Whether excessive sexual behavior should be regarded as an addiction, or a compulsion, or an impulse control disorder is arguable, as each label indicates a specific etiological model and treatment plan. Sexual addiction disorder has been largely ignored by the clinicians, although it causes significant emotional and behavioral problems among the patients. Fortunately, in the recent years, this disorder is gaining recognition, and attempts have been made to understand it through research. The present article aims to systematically review and summarize the recent understanding and research on phenomenology, clinical characteristics, etiology, assessment, and management of sexual addiction disorder.
... Individuals with paraphilic interests represent a diverse group with both positive and negative adjustment patterns (Connolly, 2006;Lodi-Smith et al., 2014). Paraphilias have been linked with a range of psychosexual and criminogenic outcomes, including sexual violence, antisociality, and mental health conditions (e.g., depression, anxiety) (Baur et al., 2016;Bradford & Ahmed, 2014;Chan et al., 2015;Fedora et al., 1992;Långström & Hanson, 2006;Lodi-Smith et al., 2014). In contrast, individuals with paraphilias, such as sadism or masochism, have been found to report increased life and sexual satisfaction relative to individuals without such paraphilias (Joyal & Carpentier, 2017;Pascoal et al., 2015;Shindel & Moser, 2011;Wismeijer & van Assen, 2013). ...
Article
Little is known about distinct factors linked with acting on paraphilic interests or refraining from engaging in paraphilic behaviors. Participants from Canada and the United States ( N = 744), aged 19–42 years ( M = 29.2; SD = 3.18), were recruited through Amazon’s Mechanical Turk. Participants completed questionnaires about their paraphilic interests and behaviors, as well as potential key factors linked to behavioral engagement (i.e., perceptions of consent, sexual excitation/inhibition, impulsivity, moral disengagement, empathy). Results indicated that higher moral disengagement and impulsivity, lower sexual control (i.e., high sexual excitation, low sexual inhibition), and maladaptive understandings of consent were best able to differentiate individuals who reported highly stigmatized (e.g., hebephilia, pedophilia, coprophilia) or Bondage and Dicipline, Dominance and Submission, Sadism and Masochism(BDSM)/Fetish paraphilic interests and engagement in the paraphilic behaviours associated with these interests relative to individuals who did not report such paraphilic interests or behaviors. Moreover, higher moral disengagement, impulsivity, and maladaptive perceptions of consent were best able to differentiate non-consensual paraphilic interests and behaviours (e.g., voyeurism, exhibitionism) compared to individuals who did not report these paraphilic interests or behaviours. These results provide future directions for the exploration of mechanisms that may contribute to engagement in paraphilic behaviors and may be targets for intervention aimed at preventing engagement in potentially harmful paraphilias.
... Even so, considering our findings, the higher percentage of males consulting for any type of CSB were heterosexual. This result is in line with previous studies, suggesting that CSB is more prevalent among men than women, but differs from those authors finding in general population, more prevalence among LGBTQ men than heterosexual men (60,(62)(63)(64). It is possible that the stigmatization associated with homosexuality and that the more liberal sexual behaviors that are usually associated with this sexual orientation, lead these people to seek less treatment for this problem, consulting for other comorbid symptoms (i.e., anxiety). ...
Article
Full-text available
Background and Aims Compulsive sexual behavior (CSB) is characterized by a persistent pattern of failure to control sexual impulses, resulting in repetitive sexual behavior over a prolonged period that causes marked discomfort in personal, family, social, school, work or in other functional areas. The evolution of the worldwide incidence of this disorder warrants further studies focused on examining the characteristics of the affected people. The purpose of this study was to compare online compulsive sexual behavior (when the problematic sexual practices were online) and non-online compulsive sexual behavior (when the problematic sexual practices were in-person) patients (OCSB and non-OCSB, respectively), and healthy controls in terms of sexual behavior, sociodemographic variables and psychopathology and personality characteristics. Method A sample of 80 CSB male patients consecutively admitted to our Behavioral Addictions Unit and 25 healthy male controls, participated in the study. The CSB group was comprised by 36 online CSB patients (mean age 42.25, SD: 10.0) and 44 non-online CSB patients (mean age 43.5, SD: 11.9). Scores on the Sexual Compulsivity Scale, Temperament and Character Inventory-Revised, Symptom CheckList-90 Items-Revised, State-Trait Anxiety Index, and additional demographic, clinical, and social/family variables related to sexual behaviors between the three groups were compared. Results When compared with healthy controls, both clinical groups showed higher psychopathology in all measures as well as higher harm avoidance and self-transcendence and lower self-directness and cooperativeness. When comparing OCSB and non-OCSB patients, results showed that non-OCSB patients exhibited higher prevalence of sexually transmitted diseases, higher percentage of homosexual and bisexual orientation and higher scores in anxiety and in sexual impulse control failure. Conclusion Both online and non-online CSB patients may experience a variety of comorbid psychological and medical problems. Patients with non-OCSB may suffer more consequences that are negative. Therefore, these results should be considered when designing the most convenient therapeutic approach. Whether sexual orientation plays a role in treatment needs and treatment response in CSB, should be further explored in future studies.
... Of these factors, arguably, the propensity for cannabis to elevate sexual arousal is most concerning since sexual preoccupation appears to be a prominent risk factor for sexual recidivism (Hanson & Morton-Bourgon, 2005;Mann et al., 2010). Although compulsive sexual behavior is controversial and difficult to precisely define (Derbyshire & Grant, 2015), there is a significant, albeit complex association between elevated sexual interest and paraphilic interests, including exhibitionism, pedophilia, voyeurism and sadism (Långström & Hanson, 2006;Wittström et al., 2020). This risk, however, is eventually attenuated by advancing age which is associated with declining androgen levels (Travison et al., 2007) and general desistance from offending behavior, including sexual offenses (Barbaree et al., 2006;Hanson et al., 2018). ...
Article
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Substance abuse is an established risk factor for crime and violence, including sexual violence. Nevertheless, the link between cannabis use and sexual offenses remains poorly understood. Cannabis use has a broad effect on sexual functioning and can have both acute and lasting adverse effects on psychological functioning, which in turn can elevate the risk of sexual offending behavior. Yet there is a scarcity of studies that have examined the link between cannabis use and sexual offending. To help fill the gap, this perspective review investigates the link between substance use and crime with a particular emphasis on cannabis use and its effects on sexual and psychological functioning. It then explores how these mechanisms may contribute to sexual offenses and recidivism, with a final discussion on how cannabis use should be conceptualized as a risk factor for sexual violence.
Chapter
Although empirical literature into sex addiction has flourished in the last two decades, the lack of universal agreement, and diagnostic criteria within such studies was reflected in the paucity of treatment provisions for those experiencing compulsive sexual behaviors. Since its ultimate inclusion in the International Classification of Diseases-11 (ICD-11), Compulsive Sexual Behavior Disorder (CSBD) provides a solid foundation in which gold-standard treatment interventions can be designed and implemented. This chapter will provide a theoretical overview of this issue, its biological basis, co-morbidities, prevalence rates, assessment approaches and treatment approaches reported in the literature. While research in CSBD has accelerated and there is evidence that examines the lasting consequences of the disorder, the field has been has subjected to a number of treatment barriers. The implications of these are further discussed.KeywordsCompulsive sexual behavior disorderCompulsive sexual behaviorHypersexualitySex addiction treatmentTreatment interventionsBehavioral addictions
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Although there is growing clinical interest in problematic pornography use (PPU), few studies focus on differences between men and women. The purpose of this study was to examine gender differences in the effects of pornographic media and personality traits on the PPU. Participants were a community sample of 502 men and 509 women, who completed an online questionnaire. Pornographic video, low self-control, and Fun Seeking affected the PPU for men and women. For women, Reward Responsiveness and Drive are also related to the severity of PPU. Gender differences should be considered when considering treatment and prevention of problematic pornography use.
Article
Phallometric assessment is used to assess men’s sexual interest in children and to assist in risk assessment and treatment planning. A common response pattern, especially when the assessment is conducted in a forensic context, is an indiscriminate pattern of penile responses: No sexual stimulus seems to produce a substantially higher response than another. This indiscriminate response profile could be the result of (1) faking good (in particular, reducing the responses to child stimuli); (2) floor or ceiling effects caused by low or high arousability, or (3) non-exclusivity (the individual is similarly sexually interested in both children and adults). In this study of 2,858 adult male patients who underwent volumetric phallometric assessment for sexual interest in children between 1995 and 2011, we tested these three possible explanations. Results showed support for each of the explanations, but the variance accounted for in response discrimination was quite small when considering each explanation (separately or when considered together). We discuss avenues for future research to better discern the causes of indiscriminate responding in phallometric assessment.
Article
The current research examined the hypothesis that sexual activity functions as a coping strategy for sexual offenders. A 16-item scale, the Coping Using Sex Inventory (CUSI), was developed to assess the presence of and the degree to which sex was used to deal with problematic situations. Sexual offenders consistently reported using sexual activities, both consenting and nonconsenting, as a coping strategy to deal with stressful and problematic situations. In the first study, when compared to nonsexual violent offenders, sexual offenders showed evidence of sexual preoccupation during adolescence, and this preoccupation was related to the latter use of sex as a coping strategy. In the second study, intimacy deficits and loneliness were related to greater use of sexual activity as a coping mechanism. The third study examined the psychometric properties of the CUSI. A factor analysis revealed 3 factors in the CUSI corresponding to consenting sexual themes, rape themes, and child sexual abuse themes. Sexual offenders reported higher use of each type of sexual activity to cope with stressful and difficult situations as compared to nonsexual offenders. Theoretical and clinical implications are discussed here.
Article
Sexual behaviour is a major determinant of sexual and reproductive health. We did a National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) in 1999-2001 to provide population estimates of behaviour patterns and to compare them with estimates from 1990-91 (Natsal 1990). Methods We did a probability sample survey of men and women aged 16-44 years who were resident in Britain, using computer-assisted interviews. Results were compared with data from respondents in Natsal 1990. Findings We interviewed 11 161 respondents (4762 men, 6399 women). Patterns of heterosexual and homosexual partnership varied substantially by age, residence in Greater London, and marital status. In the past 5 years, mean numbers of heterosexual partners were 3.8 (SD 8.2) for men, and 2.4 (SD 4.6) for women; 2.6% (95% CI 2.2-3.1) of both men and women reported homosexual partnerships; and 4.3% (95% CI 3.7-5.0) of men reported paying for sex. In the past year, mean number of new partners varied from 2.04 (SD 8.4) for single men aged 25- 34 years to 0.05 (SD 0.3) for married women aged 35-44 years. Prevalence of many reported behaviours had risen compared with data from Natsal 1990. Benefits of greater condom use were offset by increases in reported partners. Changes between surveys were generally greater for women than men and for respondents outside London. Interpretation Our study provides updated estimates of sexual behaviour patterns. The increased reporting of risky sexual behaviours is consistent with changing cohabitation patterns and rising incidence of sexually transmitted infections. Observed differences between Natsal 1990 and Natsal 2000 are likely to result from a combination of true change and greater willingness to report sensitive behaviours in Natsal 2000 due to Improved survey methodology and more tolerant social attitudes.
Article
Study objective: To assess the representativeness of survey participants by systematically comparing volunteers in a national health and sexuality survey with the Australian population in terms of self reported health status (including the SF-36) and a wide range of demographic characteristics. Design: A cross sectional sample of Australian residents were compared with demographic data from the 1996 Australian census and health data from the 1995 National Health Survey. Setting: The Australian population. Participants: A stratified random sample of adults aged 18–59 years drawn from the Australian electoral roll, a compulsory register of voters. Interviews were completed with 1784 people, representing 40% of those initially selected (58% of those for whom a valid telephone number could be located). Main results: Participants were of similar age and sex to the national population. Consistent with prior research, respondents had higher socioeconomic status, more education, were more likely to be employed, and less likely to be immigrants. The prevalence estimates, means, and variances of self reported mental and physical health measures (for example, SF-36 subscales, women’s health indicators, current smoking status) were similar to population norms. Conclusions: These findings considerably strengthen inferences about the representativeness of data on health status from volunteer samples used in health and sexuality surveys.
Article
Objective: To determine if risky sexual intercourse, sexually transmitted diseases, and sexual intercourse at an early age are associated with psychiatric disorder. Design: Cross sectional study of a birth cohort at age 21 years with assessments presented by computer (for sexual behaviour) and by trained interviewers (for psychiatric disorder). Setting: New Zealand in 1993-4. Participants: 992 study members (487 women) from the Dunedin multidisciplinary health and development study. Complete data were available on both measures for 930 study members. Main outcome measures: Psychiatric disorders (anxiety, depression, eating disorder, substance dependence, antisocial disorder, mania, schizophrenia spectrum) and measures of sexual behaviour. Results: Young people diagnosed with substance dependence, schizophrenia spectrum, and antisocial disorders were more likely to engage in risky sexual intercourse, contract sexually transmitted diseases, and have sexual intercourse at an early age (before 16 years). Unexpectedly, so were young people with depressive disorders. Young people with mania were more likely to report risky sexual intercourse and have sexually transmitted diseases. The likelihood of risky behaviour was increased by psychiatric comorbidity. Conclusions: There is a clear association between risky sexual behaviour and common psychiatric disorders. Although the temporal relation is uncertain, the results indicate the need to coordinate sexual medicine with mental health services in the treatment of young people.