Compulsive Sexual Behavior Disorder Research Articles

Development and Validation of the Metacognitions about Sex Scale: Exploring its Role as a Mediator between Negative Affect, Emotion Dysregulation Strategies, and Compulsive Sexual Behavior Disorder

Metacognitions about sex are theorized to shape cognitive appraisal, coping mechanisms, and regulation or dysregulation before, during, and/or after exposure to sexual stimuli. In our study, we examined the construct structure and validity of the Metacognitions about Sex Scale (MSS) among a sample of adolescents. We estimated the convergent validity of the MSS by factors: negative affect, dysregulated thoughts, and impulsivity, and compulsive sexual behavior (CSB). We also ran a structural equation model in which we examined the possibility that metacognitions about sex would mediate the association between negative affect, dysregulated thoughts, and impulsivity on the one hand, and CSB on the other. The study population included 662 adolescents (252 boys and 410 girls, M = 16.70, SD = 1.32) between 13–18 years of age. The analyses indicated that the factorial structure of the MSS comprised the two expected factors. We also found that positive and negative metacognitions about sex significantly mediated the effect of negative affect, dysregulated thoughts, and impulsivity on CSB. The findings provide evidence that MSS among Israeli adolescents are psychometrically appropriate for use by researchers and practitioners in the prevention and treatment of CSB.

Compulsive Sexual Behavior Disorder and Problematic Pornography Use in Cisgender Sexual Minority Individuals: The Associations with Minority Stress, Social Support, and Sexualized Drug Use

ABSTRACT Compulsive Sexual Behavior Disorder (CSBD), recently recognized in the ICD-11 as an independent disorder, has been shown to be more prevalent in sexual minorities. However, we still lack studies investigating which factors contribute to CSBD and related behaviors in this group. In our cross-sectional study, we investigated the relationships between characteristics potentially contributing to CSBD and problematic pornography use (PPU) in sexual minority individuals: sexual minority stress (internalized sexual stigma, discrimination experiences, and openness about one’s sexual orientation), perceived social support, and sexualized drug use (also more prevalent in sexual minorities). We adjusted for gender, age, sexual orientation, and the frequency of sexual behaviors. Cisgender sexual minority participants (n = 198, 72.7% men, 27.3% women; Mage = 27.13, SD = 7.78) completed an online survey. We conducted a two-step linear regression. In the first step, we introduced sociodemographic variables and the frequency of sexual activities. In the second step, we placed the predictors of main interest: perceived social support, minority stress measures, and the frequency of sexualized drug use. Our results showed that social support was negatively related to CSBD, while experiences of discrimination due to sexual orientation and engagement in sexualized drug use were associated with higher CSBD symptom severity. Internalized sexual stigma related to greater PPU severity. The discussed relationships were weak to moderate in strength. Implications of current results for therapy and diagnosis of CSBD in sexual minorities are discussed. The role of minority stressors and other factors specific to sexual minorities requires further exploration to design well-suited therapeutic interventions.

Identifying Relationships Between Difficulties with Emotion Regulation and Compulsive Sexual Behavior.

Emotion dysregulation is an associated feature of compulsive sexual behavior disorder (CSBD), now recognized by the World Health Organization. Previous studies have identified associations between trait emotion dysregulation and CSBD. Given that difficulties with emotion regulation (DERS) is comprised of several facets (e.g., difficulty with impulse control and lacking awareness of one's feelings when upset), and that these facets differentially relate to other mental health concerns, the present study aimed to examine how DERS facets relate to compulsive sexual behavior (CSB). The present study also considered interpersonal emotion regulation via attachment avoidance and attachment anxiety. Hierarchical regression was conducted, first accounting for demographic covariates, then adding attachment styles, and finally all DERS subscales. Results indicated that, among a large, diverse, online U.S. sample (N = 915; Mage = 39.21, SD = 0.81; 54.3% men), difficulty controlling impulses when upset, difficulty with clarity of emotions, and non-acceptance of emotions were significantly positively associated with CSB (small to moderate effects). Attachment anxiety and avoidance were also significantly positively associated with CSB, although their effects were minimal when adding DERS facets. Overall, this study supports the theorized impact of emotion dysregulation on CSB. Assessment of individual differences in DERS and intervening on these concerns are important for treating CSB.

Management of Concurrent Bipolar I Disorder and Compulsive Sexual Behavior Disorder: A Case Report

Pornography addiction is not currently recognized in the Diagnostic and Statistical Manual of Mental Disorders Five (DSM-V), but can be broadly classified under Compulsive Sexual Behavior Disorder (CSBD) in the International Classification for Diseases (ICD). An increased incidence of CSBD has been reported in patients with ipolar I Disorder (BPI) as an independent compulsion, not secondary to mania. Due to the ambiguity of identifying pornography addiction in the DSM-V, approved treatment for patients with a concurrent diagnosis of CSBD in the context of BPI is limited. The following article presents a patient with CSBD with concurrent BPI, and investigates the treatment strategy taken in an inpatient setting.

Decision making and executive functions in problematic pornography use.

Previous research on cognitive functions in Compulsive Sexual Behavior Disorder (CSBD) and problematic pornography use (PPU) reported inconsistent findings and mostly included sexual pictures in the used tasks. The role of general executive functions and cognitive competences (without the presence of appetitive stimuli) in the context of PPU is largely unexplored. This study investigated differences between individuals with high versus low problem severity of PPU regarding decision making and executive functions. The sample of the laboratory study consisted of N = 102 male adults. Besides measures of trait impulsivity, we used standard neuropsychological tests (Trail Making Test and three-back working memory task) and an intertemporal risky choice paradigm, the Cards & Lottery Task (CLT). The results show heightened impulsivity (urgency and deficits in perseverance) in individuals with high PPU, but no differences regarding performance in the CLT and executive function tasks. The findings indicate that PPU might be associated with impulsive behavior when experiencing strong emotions (urgency) and deficient cognitive performance especially in the presence of sexual stimuli but not in general.

Defining a Framework for Those with Compulsive Sexual Behavior Disorder: A Narrative Synthesis

Defining a Framework for Those with Compulsive Sexual Behavior Disorder: A Narrative Synthesis

Compulsive sexual behavior disorder in 42 countries: Insights from the International Sex Survey and introduction of standardized assessment tools.

Despite its inclusion in the 11th revision of the International Classification of Diseases, there is a virtual paucity of high-quality scientific evidence about compulsive sexual behavior disorder (CSBD), especially in underrepresented and underserved populations. Therefore, we comprehensively examined CSBD across 42 countries, genders, and sexual orientations, and validated the original (CSBD-19) and short (CSBD-7) versions of the Compulsive Sexual Behavior Disorder Scale to provide standardized, state-of-the-art screening tools for research and clinical practice. Using data from the International Sex Survey (N= 82,243; Mage = 32.39 years, SD = 12.52), we evaluated the psychometric properties of the CSBD-19 and CSBD-7 and compared CSBD across 42 countries, three genders, eight sexual orientations, and individuals with low vs. high risk of experiencing CSBD. A total of 4.8% of the participants were at high risk of experiencing CSBD. Country- and gender-based differences were observed, while no sexual-orientation-based differences were present in CSBD levels. Only 14% of individuals with CSBD have ever sought treatment for this disorder, with an additional 33% not having sought treatment because of various reasons. Both versions of the scale demonstrated excellent validity and reliability. This study contributes to a better understanding of CSBD in underrepresented and underserved populations and facilitates its identification in diverse populations by providing freely accessible ICD-11-based screening tools in 26 languages. The findings may also serve as a crucial building block to stimulate research into evidence-based, culturally sensitive prevention and intervention strategies for CSBD that are currently missing from the literature.

On the current psychotherapeutic situation for persons with pornography use disorder in Germany

For the first time, the ICD-11 provides the diagnosis compulsive sexual behavior disorder (CSBD) that can be assigned for pornography use disorder (PUD). This study aimed to estimate the prevalence of PUD and associated consequences in Germany, to identify the psychotherapy demand among likely PUD (lPUD) cases and the treatment supply in different psychotherapeutic settings, to survey psychotherapists' level of expertise regarding PUD, and to identify predictors for psychotherapy demand. Four studies were conducted: 1. Online study in the general population(n = 2070; m = 48.9%, f = 50.8%, d = 0.2%), 2. Survey among practicing psychotherapists (n = 983), 3. Survey of psychotherapists in psychotherapeutic outpatient clinics (n = 185), 4. Interviews with psychotherapeutic inpatient clinics (n = 28). The estimated prevalence of lPUD in theonline study was 4.7% and men were 6.3 times more often affected than women. Compared to individuals without PUD, individuals with lPUD more often indicated negative consequences in performance-related areas. Among lPUD cases, 51.2% of men and 64.3% of women were interested in a specialized PUD treatment. Psychotherapists reported 1.2%-2.9% of lPUD cases among their patients. 43.2%-61.5% of psychotherapists stated to be poorly informed about PUD. Only 7% of psychotherapeutic inpatient clinics provided specific treatments to patients with PUD. While, among other factors, negative consequences attributed to lPUD were predictive for psychotherapy demand, weekly pornography consumption, subjective well-being, and religious attachment were not. Although PUD occurs quite often in Germany, availability of mental health care services for PUD is poor. Specific PUD treatments are urgently needed.

Stress Susceptibility, Affective Responses toward Acute Stressors and Emotion Regulation Strategies in the Context of Problematic Pornography Use

The problematic use of pornography (PPU) is one phenotype of compulsive sexual behavior disorder. Stress has been identified as central factor involved in dysregulated behaviors, acting both as cause and consequence. Overall, 99 heterosexual males participated in an experimental study. Experience of early childhood trauma, chronic stress, acute responses toward a stressor, emotion regulation strategies, and coping were associated with symptoms of PPU. Alterations within neural stress circuits due to childhood trauma and chronic stress may interact with neural circuits of reward and executive control. Coping with acute, chronic and past stressors should be an essential component in treatment approaches.

(024) Cognitive Behavioral Therapy for Compulsive Sexual Behavior Disorder

Abstract Introduction Cognitive Behavioral Therapy (CBT) is often used in the treatment for Compulsive Sexual Behavior Disorder (CSBD). However, no review of the evidence on the clinical efficacy of CBT for CSBD has been conducted. Compulsive Sexual Behavior Disorder (CSBD) is characterized by a lack of control over sexual impulses, thought, phantasies and urges and may have serious negative consequences of a person well-being, families, and functioning in work and education (Kraus et al., 2018). The prevalence of CSBD in the general population ranges from 3% to 6% (Derbyshire & Grant, 2015) with a near 4:1 ratio of male to female (Kuzma & Black, 2008). Due to the negative consequences of CSBD people often seek professional help. Objective To provide a systematic review of published studies on the efficacy of CBT for Compulsive Sexual Behavior Disorder. Methods The material for the analysis was obtained by searching 4 internet databases: Scopus, PubMed, ResearchGate and the Cochrane Library. Articles describing Cognitive Behavioral Therapy and their efficiency in reducing symptoms of CSBD were required. The search in the selected databased using the keywords identified in 203 records. Screening of abstract excluded 174 records and 29 records were assessed for eligibility. Four studies fulfilled the criteria for eligibility and were included in the study (see table 1). The selection process and reasons for exclusion of studies are shown in the Prisma flowchart (see Figure 1). Results 4 original research articles were included to the review (Hallberg et al., 2017; Hallberg et al., 2019; Hallberg et al., 2020; Nwokeoma et al., 2019). Articles were devoted to the analysis of the efficiency of Cognitive Behavioral Therapy in reducing symptoms of hypersexual behavior. Studies show that CBT led to a significant reduction in hypersexual as well as symptoms of CSBD. Both RCT and non-controlled studies showed decrease in symptoms of CSBD after CBT. RCTs showed significant intermediate effects between treatment groups and control groups. Means (s.d.) on pre- and post-treatment scores of selected measures from included RCTs are shown in table (see table 2). Result indicate that CBT is a promising treatment for CSBD. However, studies included in the current review suffer from several methodological bias. Conclusions CBT show promise as treatment of CSBD. However, future studies should evaluate the treatment program with a larger sample in randomized controlled procedures and investigate the long-term effects; include women and comprise dismantling analysis of the constituting interventions. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Clinic for Sexology and Psychotherapy

Properties of the Compulsive Sexual Behavior Disorder Scale-19 among Nationally Representative Sample in Japan

Properties of the Compulsive Sexual Behavior Disorder Scale-19 among Nationally Representative Sample in Japan

Between pleasure, guilt, and dissociation: How trauma unfolds in the sexuality of childhood sexual abuse survivors

BackgroundChildhood sexual abuse (CSA) is a significant risk factor for sexual difficulties in adulthood. ObjectiveIn the current study we aimed to expand the understanding of the association between CSA and sexual difficulties by examining the moderating role of traumatic sexuality in the association between CSA and sexual difficulties among a sample of CSA survivors. Participants and settingThe hypothesized moderation model was examined among a sample of 393 CSA survivors. MethodsSignificant interactions were probed using simple slopes tests using the interactions R package. ResultsThe results indicated main effects of traumatic sexuality on survivors' sexual difficulties: Greater severity of dissociation during sex was linked with greater sexual dysfunction and higher compulsive sexual behavior disorder (CSBD), and greater intrusiveness during sex and pleasing the other during sex were linked with higher CSBD. Experiencing higher sex-related guilt and/or shame and hypervigilance with regard to sex were associated with greater sexual dysfunction. As for the moderations, intrusiveness during sex and pleasing the other during sex moderated the association between CSA and sexual dysfunction. Intrusiveness during sex and sex-related guilt and/or shame moderated the association between CSA and CSBD. Intrusiveness during sex, pleasing the other during sex, and/or hypervigilance with regard to sex moderated the association between CSA and problematic pornography use. ConclusionThis study points to the potential contribution of traumatic sexuality symptoms to sexual difficulties among survivors of CSA and lends support to the idea of offering trauma-focused therapy when treating the sexual difficulties of CSA survivors.

Psychometric Properties of the Persian version of the Compulsive Sexual Behavior Disorder Scale (CSBD-19)

Conducting studies in the field of Compulsive Sexual Behavior Disorder (CSBD) has mostly been limited to Western cultures, and disagreements regarding the definition and assessment of this disorder are still debated. This study aims to examine the validity and Reliability of the Persian version of the Compulsive Sexual Behavior Disorder Scale (CSBD-19). We conducted this cross-sectional online study from April to July 2022 among 200 Iranian women and men (100 women, Mage (SD)* = 38.5 years(12/79), 100 males, Mage (SD) = 48.5 years (16/26)). After back-to-back translations, we examined the Face, Content, and Construct Validity, Reliability, and Confirmatory Factor Analysis. The results indicated excellent Face validity (impact score >1.5 for all items), Content validity (CVI > 0.79), Reliability (Cronbach’s alpha ≥ 0.95, CI = 95% (0.92-0.98)). The pre-established five-factor model of the CSBD-19 (i.e., control, salience, relapse, dissatisfaction, and negative consequences) had an excellent fit to the data and demonstrated appropriate associations with the correlates. The Persian version of the CSBD-19 is a valid and reliable scale based on the ICD-11 definition of CSBD that may identify people at high risk for CSBD. This tool can apply in large sample size studies, and in a traditional context, such as Islamic countries. Mean (Standard Deviation)*

Structural brain differences related to compulsive sexual behavior disorder.

Compulsive sexual behavior disorder (CSBD) has been included as an impulse control disorder in the International Classification of Diseases (ICD-11). However, the neurobiological mechanisms underlying CSBD remain largely unknown, and given previous indications of addiction-like mechanisms at play, the aim of the present study was to investigate if CSBD is associated with structural brain differences in regions involved in reward processing. We analyzed structural MRI data of 22 male CSBD patients (mean = 38.7 years, SD = 11.7) and 20 matched healthy controls (HC; mean = 37.6 years, SD = 8.5). Main outcome measures were regional cortical thickness and surface area. We also tested for case-control differences in subcortical structures and the effects of demographic and clinical variables, such as CSBD symptom severity, on neuroimaging outcomes. Moreover, we explored case-control differences in regions outside our hypothesis including white matter. CSBD patients had significantly lower cortical surface area in right posterior cingulate cortex than HC. We found negative correlations between right posterior cingulate area and CSBD symptoms scores. There were no group differences in subcortical volume. Our findings suggest that CSBD is associated with structural brain differences, which contributes to a better understanding of CSBD and encourages further clarifications of the neurobiological mechanisms underlying the disorder.

Assessing compulsive sexual behavior disorder: The development and international validation of the compulsive sexual behavior disorder-diagnostic inventory (CSBD-DI).

The World Health Organization's International Classification of Diseases (ICD-11) includes Compulsive Sexual Behavior Disorder (CSBD), a new diagnosis that is both controversial and groundbreaking, as it is the first diagnosis to codify a disorder related to excessive, compulsive, and out-of-control sexual behavior. The inclusion of this novel diagnosis demonstrates a clear need for valid assessments of this disorder that may be quickly administered in both clinical and research settings. The present work details the development of the Compulsive Sexual Behavior Disorder Diagnostic Inventory (CSBD-DI) across seven samples, four languages, and five countries. In the first study, data were collected in community samples drawn from Malaysia (N = 375), the U.S. (N = 877), Hungary (N = 7,279), and Germany (N = 449). In the second study, data were collected from nationally representative samples in the U.S. (N = 1,601), Poland (N = 1,036), and Hungary (N = 473). Across both studies and all samples, results revealed strong psychometric qualities for the 7-item CSBD-DI, demonstrating evidence of validity via correlations with key behavioral indicators and longer measures of compulsive sexual behavior. Analyses from nationally representative samples revealed residual metric invariance across languages, scalar invariance across gender, strong evidence of validity, and utility in classifying individuals who self-identified as having problematic andexcessive sexual behavior, as evidenced by ROC analyses revealing suitable cutoffs for a screening instrument. Collectively, these findings demonstrate the cross-cultural utility ofthe CSBD-DI as a novel measure for CSBD and provide a brief,easily administrable instrument for screening for this novel disorder.

Adult ADHD Diagnosis, Symptoms of Impulsivity, and Emotional Dysregulation in a Clinical Sample of Outpatients Consulting for a Behavioral Addiction

Objective: This study aimed to investigate ADHD in adult outpatients seeking treatment for a behavioral addiction and to identify the specificity of psychopathological features if the behavioral addiction cooccurs with adult ADHD. Method: Sixty-five outpatients consulting for a behavioral addiction were assessed for ADHD (DIVA-5), addictive disorder (alcohol, tobacco, cannabis, gambling, gaming, food, and sex), impulsivity (UPPS-P), and emotion dysregulation (DERS-36). Results: In our sample of outpatients seeking treatment for a behavioral addiction, adult ADHD was independently associated with higher compulsive sexual behavior disorder severity, “sensation seeking,” “positive urgency,” difficulties in “goal-directed behavior,” “impulse control,” and use of “emotion regulation strategies” in the context of intense emotions. A 29% of the sample was diagnosed for adult ADHD. Conclusion: The association of adult ADHD with specific dimensions of impulsivity and emotion dysregulation, pave the way for future clinical and research perspectives.

Time Goes Back—Time Perspective in Polish Men with Compulsive Sexual Behavior Disorder and Risky Sexual Behavior

Many relationships between time perspective and a propensity to engage in risky behaviors or developing addictions have been demonstrated. The aim of our study was to determine the differences in intensity of individual time perspectives in people with compulsive sexual behavior disorder (CSBD) and risky sexual behavior (RSB). The analysis includes 425 men: 98 CSBD (age M = 37.99 years), 63 RSB (age M = 35.70 years), 264 without CSBD and RSB features constituting the control group (age M = 35.08 years). We used the Zimbardo Time Perspective Inventory, the Sexual Addiction Screening Test-Revised, the Risky Sexual Behavior Scale and a self-constructed survey. The comparative analysis showed a higher intensity of past-negative (p = 0.040), a lower of past-positive (p < 0.001) and a present-fatalistic (p = 0.040) outlook in the CSBD group compared to the control group. Compared to the participants with RSB, the CSBD group was characterized by a higher intensity of past-negative (p = 0.010), a lower of past-positive (p = 0.004) and a present-hedonistic perspective (p = 0.014). The RSB group also achieved higher results from the present-hedonistic perspective (p = 0.046) compared to the control group. The CSBD patients indicate a stronger tendency to focus on negative past compared to non-CSBD men, both taking and not taking RSB. The time perspective profiles of RSB men are similar to those who do not engage in RSB. The distinguishing feature of men with RSB without CSBD is a greater ability to enjoy current experiences.

Hypo- or hyperfunction? Differential relationships between compulsive sexual behavior disorder facets and sexual health.

Previous studies linking compulsive sexual behavior disorder (CSBD) and sexual health have shown mixed results, which could be due to the fact that different CSBD facets may have differential relationships with sexual functioning. As CSBD is a multidimensional disorder, we wanted to investigate whether distinct CSBD domains are differentially related to sexual health. Two online studies were conducted-the first on a convenience sample (812 Polish participants; mean [SD] age,22.07[5.91] years) and a replication study on a representative sample of Polish adults (n = 1526;43.02 [14.37]). Hierarchical regression was employed with sexual functioning as a predicted variable and CSBD symptoms as predictors. The Compulsive Sexual Behavior Disorder Scale was used to assess CSBD symptoms, and the Arizona Sexual Experience Scale was used to measure sexual dysfunction. In study 1, CSBD salience (β = -.20, P < .001) predicted hyperfunction (ie, stronger sex drive, easier sexual arousal, easier vaginal lubrication/penile erection, easier ability to reach an orgasm, and more satisfying orgasms). Yet, CSBD negative consequences (β = .15, P = .001) and dissatisfaction (β = .22, P < .001) predicted hypofunction (ie, weaker sex drive, more difficulties in sexual arousal, greater difficulties in vaginal lubrication/penile erection, less ability to reach an orgasm, and less satisfying orgasms). Similar results were found in study 2: salience (β = -.26, P < .001) and relapse (β = -.11, P = .004) predicted hyperfunction, while negative consequences (β = .12, P < .001) and dissatisfaction (β = .12, P < .001) predicted hypofunction. Our results stress the importance of assessing the severity of each group of symptoms in patients with CSBD to better understand possible difficulties in their sexual functioning. Our studies are the first to evaluate the effects of each CSBD domain on sexual health. We also replicated results obtained from a convenience sample on a representative sample. The cross-sectional design of the current studies does not allow causal relations to be tested, so future longitudinal research should be carried out. We also gathered data from a general population-thus, it is important to replicate these results on patients diagnosed with CSBD. Our research points out the differential impact of CSBD domains on sexual health: salience and relapse are related to sexual hyperfunction, while negative consequences and dissatisfaction to hypofunction.

Mindfulness-Based Intervention and Sexuality: A Systematic Review.

Mindfulness has generated considerable interest in the last two decades in clinical and research settings. The efficacy of mindfulness has been evaluated for the sexual dysfunctions recognized by the DSM-5 and other sexual problems, such as compulsive sexual behavior disorder (CSBD), also known as sex addiction or hypersexuality. Here, we review the evidence for various mindfulness-based treatments as mindfulness-based cognitive-behavioral treatment or mindfulness-based relapse prevention for different problems related to sexuality to respond our question: "Are Mindfulness-Based Treatments (MBT) effective in reducing the symptomatology of sexuality-related disorders?". Through a systematic search conducted following the PRISMA guidelines, we found 11 studies that met the inclusion criteria: (I) articles using MBT for sexuality-related problems, (II) clinical population, (III) no date range limits were applied, (IV) only empirical studies were included, (V) language and (VI) quality of studies. Evidence shows that mindfulness practice could be effective for some sexual disorders, such as female sexual arousal/desire disorder. However, due to scarcity of studies on other sexual problems such as situational erectile dysfunction, genitopelvic pain/penetration disorder, childhood sexual abuse or compulsive sexual behavior disorder, the findings cannot be generalized. Mindfulness-based therapies provides evidence to reduce the symptomatology associated with various sexual problems. However more studies are needed for these sexual problems. By last, future directions and implications are discussed.

Management of concurrent bipolar i disorder and compulsive sexual behavior disorder: A case report

Management of concurrent bipolar i disorder and compulsive sexual behavior disorder: A case report