Hypersexual Behavior Inventory Research Articles

Early traumatic experiences are linked to hypersexual behavior and erectile dysfunction in men through the mediation of body uneasiness and general psychopathology.

Childhood traumatic experiences have been associated with hypersexuality and sexual dysfunctions. However, the mediators of the interactions between these variables should be clarified in men. This study aimed to investigate the interaction of early traumatic experiences, psychopathology, and sexuality with respect to erectile dysfunction (ED) and hypersexual behavior. The hypothesized model expected that traumatic experiences would be associated with hypersexual behavior and reduced sexual functioning through the mediation of body uneasiness and psychological distress. The study was cross-sectional and observational. A total of 317 men were enrolled. Male patients with a primary complaint of ED and an indication for psychiatry referral represented the clinical sample (n = 116; mean ± SD age,42.82 ± 16.89years). Clinical classification was assessed with the Structured Interview on Erectile Dysfunction. The second sample (n = 201, 30.82 ± 11.94years) was recruited from the general population. All participants were administered the following questionnaires: Brief Symptom Inventory, Childhood Trauma Questionnaire-Short Form, Hypersexual Behavior Inventory, Body Uneasiness Test-A, and 5-item International Index of Erectile Function. Psychopathology and sexual functioning were assessed by a dimensional approach, and a multivariate model was computed by structural equation model analysis. When compared with the sample from the general population, the clinical sample exhibited a higher prevalence of early traumatic experiences, as measured by scores on the Childhood Trauma Questionnaire-Short Form (45.08 ± 14.25 vs 39.03 ± 10.22, F = 17.63, P < .001), and a higher tendency to engage in hypersexual behaviors (34.63 ± 13.55 vs 30.79 ± 12.44, F = 6.97, P < .01). Structural equation model analysis showed excellent fit indices indicating that early traumatic experiences predicted hypersexual behaviors and ED through the exacerbating mediating effect of body uneasiness and psychopathology. Clinicians should not limit their attention to the behavioral level when assessing sexual dysfunction in men; rather, they should also consider the complex psychopathologic consequences of childhood trauma. Integrated treatments that address the potential presence of childhood trauma with its wider psychological correlates (eg, emotion dysregulation, body uneasiness) might improve treatment response. The study reports novel data on the relationship among childhood maltreatment, male sexuality, and psychopathologic mediators with a dimensional assessment. However, the assessment was cross-sectional, and causality was mainly derived from previous studies. The present study enriches the current literature, strengthening the hypothesis that childhood traumatic experiences significantly shape development and sexuality. Body uneasiness and psychopathology can both tax sexual functioning, as assessed by erectile functioning or hypersexuality.

Capacity to love and problematic sexuality: the role of defense mechanisms and psychopathological suffering.

Limitation to the capacity to love is often a feature of a suffering personality. We aimed to investigate the role of the capacity to love in hypersexual behavior, considering both distress and defense mechanisms as possible psychological mediators. Through an online platform, we recruited a convenience sample of 521 subjects (390 [74.9%] females and 131 [25.1%] males; mean [SD] age, 26.46 [5.89] years). Recruited subjects completed a psychometric protocol that included completion of the following measurement tools: (1) the Capacity to Love Inventory (CTL-I), (2) the Hypersexual Behavior Inventory (HBI), (3) the 30-item self-report Defense Mechanisms Rating Scale, and (4) the Brief Symptom Inventory. We then performed correlation and regression analyses and used a mediation model for data analysis. A significant negative relationship between the capacity to love and hypersexual behavior was found. Furthermore, indirect effects were also statistically significant, supporting the hypothesis that limitation to the capacity to love is related to hypersexuality through the paths of psychological distress and immature defense mechanisms. Finally, compared to the other subjects, those with pathological scores for the HBI showed significantly lower scores on the CTL-I, which suggested limitations to the capacity to love. The relationship between limitation to the capacity to love and hypersexuality is fundamental to the diagnostic process in persons with problematic sexuality and psychopathological distress. This study is the first, to our knowledge, to highlight the role of the capacity to love in sexual behavior, although future studies in specific clinical sample groups would be suitable for further investigation of the relationships among the considered variables. The etiology of limitation in the capacity to love is related to dysfunctional aspects of psychological functioning, such as psychological distress and immature defense mechanisms, and these factors together generate problematic sexuality such as hypersexual behavior. Our results highlight the central role in mental and sexual health of the capacity to love. Based on these findings, clinicians should take these aspects into consideration for diagnosis and treatment of patients presenting with problematic sexuality.

(016) Pharmacological Treatment of Men with Compulsive Sexual Behaviour Disorder - Randomized, Double-blind, Placebo-controlled Trial of Paroxetine and Naltrexone

Abstract Introduction Psychotherapy is considered as first-line therapy for compulsive sexual behaviour disorder (CSBD). “Off-label” use of selective serotonin reuptake inhibitors and opioid antagonists was reported as effective but the evidence-based data on pharmacological interventions remains very scarce. Objective The purpose of the study was to compare safety and efficacy of naltrexone and paroxetine in the treatment of CSBD. Methods Double-blind, randomized study comparing naltrexone, paroxetine and placebo was performed in a group of 73 treatment-seeking, heterosexual males meeting the ICD-11 criteria of CSBD. During 5 months treatment, the safety and efficacy of the medication was assessed by clinical examinations and clinical scales including Sexual Addiction Screening Test (SAST), Hypersexual Behavior Inventory (HBI), the Brief Pornography Screen (BPS), as well as in the Ecological Momentary Assessment. Results Symptoms of CSBD significantly improved in all three treatment arms but receiving active treatment was related to better satisfaction with the therapy and self-reported decrease of problematic sexual behavior. Sexual and porn craving decrease was pronounced the most in the paroxetine group. Adverse effects were relatively seldom and mild. All-cause discontinuation rate was 15.1%. Conclusions The study has shown that paroxetine and naltrexone represent safe treatment options for CSBD male patients. However, due to mixed results, their clinical efficacy should be confirmed in future trials that should also include women and non-heterosexual groups of patients. Disclosure No

Examining the Psychometric Properties of the HBI-19 Scale in a Sample of Women with Persistent Genital Arousal Symptoms

ABSTRACT Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD) is a highly distressing, yet poorly understood health concern characterized by persistent, unwanted, and unpleasant genital arousal sensations in the absence of psychological arousal and desire. PGAD/GPD symptoms can be reduced by engaging in frequent sexual behaviors, meaning that hypersexual behavior may be present as a feature of PGAD/GPD in some cases. Given this association and the current lack of measures designed for assessment of PGAD/GPD specifically, the present study aimed to investigate the psychometric properties of the Hypersexual Behavior Inventory (HBI-19) in a sample of women with PGAD/GPD symptoms. Specifically, the factor structure of the HBI-19 was explored via Exploratory Factor Analysis (EFA) as well as evaluation of model fit indices and reliability indices (Cronbach’s alpha). EFA revealed a two-factor structure for the HBI-19 in the sample of women with PGAD/GPD symptoms, differing from the originally validated three-factor structure. RMSEA as well as TLI values suggested poor fit for all three models examined, including the two-factor model, while SRMR suggested good fit for the two-factor and three-factor model and suggested poor fit for the one-factor models. These findings suggest measurement non-invariance at the configural level and indicate that hypersexual behavior is best understood as a possible feature of PGAD/GPD as opposed to a core element of PGAD/GPD.

Cross-Sectional and Longitudinal Associations Between Posttraumatic Stress Symptoms and Hypersexual Behaviors Among Individuals Who have Gambled in Their Lifetimes

Exposure to traumatic experiences represent one factor that may contribute to the development of hypersexual behaviors. We investigated the associations between posttraumatic stress symptoms and hypersexual behaviors by analyzing survey data from 2 samples. The first sample consisted of n=585 college students, and the second consisted of n = 786 adults recruited via Amazon's Mechanical Turk (MTurk), n=337 of whom completed a 6-month follow-up survey. We conducted 3 hierarchical regression analyses adjusting for age, gender, sexual orientation, impulsivity, drug use, alcohol use, and gambling. The primary outcomes for this investigation were associations between posttraumatic stress symptoms, measured using the PTSD Checklist for DSM-IV and DSM-5 (PCL-C and PCL-5), and hypersexual behaviors, measured using the Hypersexual Behavior Inventory (HBI). A significant regression, R2=0.230, R2adjusted=0.211, F (14,570)=12.17, P < .001, revealed posttraumatic stress symptoms were associated with hypersexual behaviors in the university student sample (β=0.154). A significant regression using the MTurk sample, R2=0.403, R2adjusted=0.392, F (14,771)=37.13, P < .001, confirmed this finding (β=0.259). In addition, a significant regression, R2=0.562, R2adjusted=0.541, F (15,321)=27.42, P < .001, indicated that posttraumatic stress symptoms were longitudinally associated with increased hypersexual behaviors (β=.190) after adjusting for all variables, including baseline hypersexuality. Results suggest that individuals experiencing posttraumatic stress symptoms are at increased risk for current and future hypersexual behaviors. This investigation involved secondary analyses of adults who had gambled at least once in their lives and findings may not generalize to those who have never gambled. Furthermore, longitudinal findings may be impacted by selection bias (42% completion rate) and may not generalize to follow up periods longer than 6-months. This study provides support for the hypothesis that posttraumatic stress symptoms are associated with increased hypersexual behavior, and further research is indicated to explore the etiology and directionality of this relationship.

The Relation of Sexual Attitudes to Hypersexuality and Problematic Pornography Use.

Previous studies have shown that specific attitudes related to moral convictions can have an important role in the development and maintenance of problematic sexual behavior symptoms. However, although other types of attitudes, like sexual attitudes, are potentially highly relevant, they have not yet been studied in this role. We investigated how four dimensions of sexual attitudes: Permissiveness, Birth Control, Communion and Instrumentality, contribute to problematic pornography use (PPU) and hypersexual disorder (HD) symptoms, controlling for religiosity, sex, age and relationship status. The study was administered through an online questionnaire and based on a representative sample of n = 1036 (Mage = 43.28, SD = 14.21; 50.3% women) Polish adult citizens. When adjusting for other variables, higher sexual Permissiveness positively predicted HD and PPU among both men (HD: β = .26, p < .001; PPU: β = .22, p < .001) and women (HD: β = .44, p < .001; PPU: β = .26; p < .001). Sexual Instrumentality positively, although weakly, contributed to HD severity among men (β = .11, p < .05). Attitudes reflecting higher support for responsible sexuality (Birth Control subscale) negatively and weakly predicted HD among women (β = – .11, p < .05). Permissiveness was also the only sexual attitude dimension that consistently predicted a higher frequency of sexual activity among men and women. Based on the cutoff criteria proposed by the authors of the used screening instruments (≥ 53 points for the Hypersexual Behavior Inventory and ≥ 4 points for the Brief Pornography Screen), the prevalence of being at risk for HD was 10.0% (men: 11.4%, women: 8.7%) and for PPU was 17.8% (men: 26.8%, women: 9.1%). Our results point to a significant contribution of sexual attitudes to problematic sexual behavior symptoms, which was not encapsulated by the previously studied influence of religious beliefs, although most of the obtained relationships were relatively weak. Particularly, a consistent link between permissive attitudes and both HD and PPU among men and women may indicate that permissive attitudes can potentially contribute to the development and maintenance of problematic sexual behavior. The prevalence of being at risk for PPU (and to some degree HD) in the current representative sample was high. Such results raise questions about the appropriateness of the proposed cutoff criteria and the risk of overpathologizing normative sexual activity, if the cutoff thresholds are not tailored adequately. The results have implications for the assessment, diagnosis and theory of problematic sexual behavior.

Evaluating the Effectiveness of Short-term Clinical Guideline to Treat Sexual Addiction Disorder in People With Sexual Addiction: A Clinical Trial

Objectives Sex addiction is one type of behavioral addiction that is characterized by extreme fantasies and hard-to-control sexual behaviors. This disorder causes problems in the lives of affected people and their victims. The treatment is non-pharmacological and psychological, which are time-consuming and expensive. Short-term interventions are one of the ways to help these people. This study aims to evaluate the effectiveness of short-term clinical guidelines to treat sexual addiction disorder in affected individuals. Methods This was a randomized clinical trial study with pre-test-post-test and follow-up. The studied population in this research included all people with sexual addiction disorder who live in Isfahan City, Iran. The statistical population was those who had the chance to be included in the study. These were individuals who were referred to outpatient and residential drug abuse treatment centers, psychiatric treatment centers, and sexual disorders treatment clinics. Using the balance block randomization method, 30 male subjects who were diagnosed with sex addiction disorder based on the cut-off point of the hypersexual behavior inventory (HBI) with a score of 53 and above were randomly divided into 2 intervention and comparison groups. The intervention group received ten 120-min therapy sessions held weekly. Because of the coronavirus pandemic, the treatment sessions had to be held virtually (Skype). The comparison group was put on hold so that they could benefit from the treatment if the guide was effective. Both groups completed the HBI three times. The first time was immediately before the treatment, the second time immediately after the intervention, and the third time 3 months later in the follow-up phase. The results were analyzed via repeated measures analysis of variance (RM-ANOVA) in the SPSS software, v. 22. Results In the present study, there were 30 patients with a sexual addiction disorder, of which 15 were in the intervention group and 15 were in the comparison group (the Mean age of the participants was 26.4 years). The Mean scores of HBI in the intervention group in the pretest, post-test, and follow-up stages were 67, 49, and 57, respectively, while the mean scores of HBI in the comparison group were 64, 60, and 59 for the pretest, post-test, and the follow-up, respectively. Repeated measurement findings showed that this clinical guideline is effective in reducing participants’ sexual addiction symptoms (P‌&lt;‌0.01). Conclusion Clinical guideline for short-term treatment of sexual addiction disorder is effective in reducing the symptoms of sexual addiction disorder. Using this method, which can be held online, and considering its short time and reduced cost of treatment, allows more people to benefit from it.

Hypersexual Behavior and Depression Symptoms among Dating App Users

The use of Dating Applications (DAs) is widespread, and in some cases could be associated with psychosexological issues. Hence, we decided to investigate hypersexual behavior and depression symptoms among DA users and non-users. We recruited a snowball convenience sample of 1000 subjects through an online platform in 2020 for a cross-sectional study. One hundred and nineteen (11.9%) were classified as DA users and 881 as non-users. All subjects completed a sociodemographic questionnaire, the Hypersexual Behavior Inventory (HBI), to assess hypersexuality, and the Patient Health Questionnaire (PHQ-9) to evaluate depression symptoms. We primarily found higher levels of hypersexual behavior and depression symptoms in DA users compared to non-users. In particular, HBI Total (users = 42.27 ± 16.37 vs. non-users = 31.85 ± 12.06; p &lt; 0.0001), HBI Coping (users = 17.92 ± 8.01 vs. non-users = 13.52 ± 6.03; p &lt; 0.0001), HBI Control (users = 14.73 ± 6.68 vs. non-users = 10.71 ± 4.95; p &lt; 0.0001), HBI Consequences (users = 9.62 ± 4.33 vs. non-users = 7.60 ± 3.37; p &lt; 0.0001), PHQ-9 Depression (users = 12.82 ± 6.64 vs. nonusers = 10.05 ± 5.84; p &lt; 0.0001). On the whole, we found that hypersexual behavior and depression symptoms strongly characterize DAs users; this evidence could represent an important associated factor in DA use for sexual purposes.

Sexuality in ADHD: empirical data concerning hypersexual and paraphilic fantasies and behaviors in adults with ADHD

IntroductionADHD is a neurodevelopmental disorder displaying inattention, hyperactivity, and impulsivity as core symptoms. It can affect several areas of life including sexual health. Clinicians have often made assumptions concerning the bound of specific ADHD symptoms affecting sexual desire by increasing its frequency and intensity. Yet, there is still a lack of knowledge about the comorbidity between ADHD, hypersexuality, and paraphilias. A recent literature review could show that some individuals who suffer from ADHD report about hypersexual and paraphilic fantasies and behaviors, but as far as we know, no clear empirical data has emerged supporting the idea that hypersexuality and paraphilias are more frequent in individuals with ADHD.ObjectivesThe present investigation aimed to compare several sexuality related aspects between individuals with and without ADHD.MethodsTherefore, we designed an extensive online survey based on established questionnaires, such as the Hypersexual Behavior Inventory (HBI). The survey was implemented in a outpatient sample, ADHD specific fora as well as other general online channels.ResultsIn total, N = 238 individuals participated in the survey (n = 160 with ADHD). Thereby, individuals with ADHD reported significantly more often about a wide range of hypersexual fantasies and behaviors in comparison to individuals without ADHD. Furthermore, individuals with ADHD reported significantly more often about paraphilic fantasies and behaviors including fetishistic and sadistic sexual fantasies. No differences were found concerning other paraphilias. Further results regarding other facets of sexuality, such as sexual orientation, are to be presented and discussed.ConclusionsThe present study contributes to closing the knowledge gap regarding sexuality in individuals with an ADHD.DisclosureNo significant relationships.

Psychometric Properties of Common Measures of Hypersexuality in an Online Canadian Sample

BackgroundHypersexuality has been posited as the central defining feature of Compulsive Sexual Behavior Disorder, and although the acceptance and inclusion of this construct in psychiatric nosologies provides some legitimacy, concerns surrounding terminology, assessment, and diagnosis remain. AimThe present study was an independent psychometric examination of 2 of the most commonly used measures of Compulsive Sexual Behavior Disorder; specifically, the gender invariance of the latent structure, reliability (test retest, internal consistency), and external correlates (concurrent validity) of these measures. MethodsThe Sexual Compulsivity Scale and the Hypersexual Behavior Inventory were completed by 2 nonclinical online community samples of cisgender women (ns = 525 and 359), cisgender men (ns = 419 and 364), and transgender or non-binary individuals (ns = 38 and 11). OutcomesCriterion based measures of sexual history and total sexual outlet (number of orgasms per week) were gathered to validate Sexual Compulsivity Scale and Hypersexual Behavior Inventory total and factor scores. ResultsResults supported the factorial validity of both assessment measures: correlated 3 factor solutions were established through exploratory factor analysis of 1 sample, and confirmatory factor analysis in the second sample. Multiple group confirmatory factor analysis, conducted on the 2 combined samples, also supported the gender invariance of the 3-factor solutions. Additional basic psychometric indices of test-retest and internal consistency reliability and criterion-related (concurrent) validity conducted across the 2 online samples were supported. Clinical ImplicationsCommon measures of hypersexuality have potential for use in its assessment, treatment, and management. Strengths & LimitationsStudy strengths include: the inclusion of 2 fairly large and diverse online samples, thorough checks for insufficient effort/validity of responding, validity and reliability methodology (ie, measurement at multiple time points, obtaining behavioral indicators of sexual health), and a comprehensive set of psychometric analyses to inform conclusions regarding the external validity, reliability, and latent structure of hypersexuality measures across gender groups. Study limitations include: potential concerns related to validity and accuracy of responding owing to a reliance on self-report, the potential for selection bias, and limiting the examination of the latent structure of hypersexuality to cisgender men and women such that the results may not generalize to gender diverse populations. ConclusionHypersexuality is a multidimensional construct, with a common latent structure among cisgender men and women, consistency in measurement over time, and meaningful concurrent associations with behavioral criteria that have relevance for sexual health.Olver ME, Kingston DA, Laverty EK, et al. Psychometric Properties of Common Measures of Hypersexuality in an Online Canadian Sample. J Sex Med 2022;19:331–346.

Impulsivity in Compulsive Sexual Behavior Disorder and Pedophilic Disorder.

Background and aimsImpulsivity is regarded as a risk factor for sexual crime reoffending, and a suggested core feature in Compulsive Sexual Behavior Disorder. The aim of this study was to explore clinical (e.g. neurodevelopmental disorders), behavioral and neurocognitive dimensions of impulsivity in disorders of problematic sexuality, and the possible correlation between sexual compulsivity and impulsivity.MethodsMen with Compulsive Sexual Behavior Disorder (n = 20), and Pedophilic Disorder (n = 55), enrolled in two separate drug trials in a specialized Swedish sexual medicine outpatient clinic, as well as healthy male controls (n = 57) were assessed with the Hypersexual Behavior Inventory (HBI) for sexual compulsivity, and with the Barratt Impulsiveness Scale (BIS) and Connors’ Continuous Performance Test-II (CPT-II) for impulsivity. Psychiatric comorbidity information was extracted from interviews and patient case files.ResultsApproximately a quarter of the clinical groups had Attention-Deficit/Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder. Both clinical groups reported more compulsive sexuality (r = 0.73−0.75) and attentional impulsivity (r = 0.36−0.38) than controls (P < 0.05). Based on results on univariate correlation analysis, BIS attentional score, ADHD, and Commissions T-score from CPT-II were entered in a multiple linear regression model, which accounted for 15% of the variance in HBI score (P < 0.0001). BIS attentional score was the only independent positive predictor of HBI (P = 0.001).DiscussionSelf-rated attentional impulsivity is an important associated factor of compulsive sexuality, even after controlling for ADHD. Psychiatric comorbidity and compulsive sexuality are common in Pedophilic Disorder.ConclusionNeurodevelopmental disorders and attentional impulsivity – including suitable interventions – should be further investigated in both disorders.

Hypersexual behavior and attachment styles in a non-clinical sample: The mediation role of depression and post-traumatic stress symptoms.

IntroductionHypersexuality is a complex behavioral dysfunction concerning the excess of sexual activities. In this study, we aim to investigate the role of attachment styles, post-traumatic and depression symptoms in hypersexual behavior. MethodsWe recruited through an online platform a snowball convenience sample of 1025 subjects (females: n=731; 71.3%; males: 294; 28.7%; age: 29.62±10.90) and we administered them a sociodemographic questionnaire, with a psychometric protocol composed by the Hypersexual Behavior Inventory (HBI) to assess hypersexuality, the Relationship Questionnaire (RQ) for the attachment styles, the International Trauma Questionnaire (ITQ) to evaluate the trauma and Patient Health Questionnaire (PHQ) for depression. ResultsWe found a significant and predictive impact of preoccupied and fearful attachment styles on hypersexual behavior (β=.116; p<.0001 and β=.121p<.0001, respectively). The categorical analysis of RQ confirmed also statistically significant differences between secure attachment style with fearful and preoccupied ones in terms of HBI levels (secure=30.01±10.79; preoccupied=35.50±14.46; fearful=36.57±13.50). Moreover, we found that depression symptoms and the total score of ITQ also resulted predictive for hypersexuality (β=.323; p<.0001 and β=.063; p<.04). However, in our model, depression and post-traumatic symptoms played a mediation role between insecure attachment and hypersexual behavior. ConclusionThis study found a fundamental role of insecure attachment styles, post-traumatic and depression symptoms in the development of problematic sexuality. Hypersexual behavior is related in a causal manner with an insecure attachment style, fearful and preoccupied attachment, particularly. Nevertheless, the traumatic core of personality together with depression symptoms could play a mediation role towards the hypersexual behavior.

The negative consequences of hypersexuality: Revisiting the factor structure of the Hypersexual Behavior Consequences Scale and its correlates in a large, non-clinical sample

IntroductionDespite the growing literature about hypersexuality and its negative consequences, most studies have focused on the risk of sexually transmitted infections (STI’s), resulting in relatively few studies about the nature and the measurement of a broader spectrum of adverse consequences. MethodsThe aim of the present study was to examine the validity and reliability of the Hypersexual Behavior Consequence Scale (HBCS) in a large, non-clinical population (N = 16,935 participants; females = 5854, 34.6%; Mage = 33.6, SDage = 11.1) and identify its factor structure across genders. The dataset was divided into three independent samples, taking into consideration gender ratio. The validity of the HBCS was investigated in relation to sexuality-related questions (e.g., frequency of pornography use) and the Hypersexual Behavior Inventory (Sample 3). ResultsBoth the exploratory (Sample 1) and confirmatory (Sample 2) factor analyses (CFI = 0.954, TLI = 0.948, RMSEA = 0.061 [90% CI = 0.059–0.062]) suggested a first-order, four-factor structure that included work-related problems, personal problems, relationship problems, and risky behavior as a result of hypersexuality. The HBCS showed adequate reliability and demonstrated reasonable associations with the examined theoretically relevant correlates, corroborating the validity of the HBCS. ConclusionFindings suggest that the HBCS may be used to assess consequences of hypersexuality. It may also be used in clinical settings to assess the severity of hypersexuality and to map potential areas of impairment, and such information may help guide therapeutic interventions.

Hypersexuality and Trauma: a mediation and moderation model from psychopathology to problematic sexual behavior

Introduction. Hypersexuality is a clinical condition regarding the psychopathology of sexual behavior. In this study, we aimed to investigate the role of trauma, through the post-traumatic stress-disorder (PTSD), depression, shame and guilt on the hypersexual behavior. Methods. Through an online platform, a convenience sample of 1025 subjects was recruited (females: n=731; 71.3%; males: 294; 28.7%; age: 29.62±10.90). Recruited subjects compiled a psychometric protocol composed by the Hypersexual Behavior Inventory (HBI) to assess hypersexuality, the International Trauma Questionnaire (ITQ) for PTSD, the Patient Health Questionnaire (PHQ-9) to evaluate depression and the State Shame and Guilt Scale (SSGS) for shame and guilt. Then a mediation/moderation model was performed for the data analysis. Results. There was a statistically significant direct effect of post-traumatic symptoms (ITQTotal) on hypersexual behavior (HBTotal). Furthermore, indirect effects were also statistically significant, providing support to the hypothesis that depression and guilt would be serial mediators of trauma-hypersexual behavior relations. The paths through depression and guilt have been found to be the most significant with moderate and high indirect effects on hypersexuality. Moreover, male gender, as covariate variable, is a relevant risk factor for hypersexual behavior. Conclusion. We found the relationship between hypersexuality and trauma describing a possible etiological pathway mainly involving depression, shame and guilt. Hypersexuality can be considered as a reactive form of a major affective psychopathology representing a tip of the iceberg hiding the real issues of a suffering personality. Clinicians and researchers should therefore consider hypersexual behavior in the light of a symptomatic manifestation of a major psychopathology involving the affective aspects of personality.

Dysregulated Sexuality in Women with Eating Disorders: The Role of Childhood Traumatic Experiences

The present study explored the psychopathological, behavioral, and putative biological underpinnings of dysregulated sexuality in eating disorders (EDs), focusing on the role of childhood trauma – evaluated with the Childhood Trauma Questionnaire (CTQ). The comparison between Binge-Purging and Restricting patients outlined the predominance of markers of dysregulated sexuality in the first subgroup. In the clinical sample, hypersexuality – measured through the Hypersexual Behavior Inventory (HBI) – was associated with severe psychopathology, emotion dysregulation, childhood trauma, adverse consequences, and higher ghrelin levels. Moderation analyses showed that hypersexuality was associated with emotion dysregulation and psychopathology only in those patients reporting childhood traumatic experiences.

Internet-Administered Cognitive Behavioral Therapy for Hypersexual Disorder, With or Without Paraphilia(s) or Paraphilic Disorder(s) in Men: A Pilot Study

BackgroundHypersexual disorder (HD) is a condition in which the individual experiences loss of control over engagement in sexual behaviors, leading to negative effects on various areas of life. Paraphilias often present concomitantly with HD, and although cognitive behavioral therapy (CBT) has been proven to reduce engagement in hypersexual behavior, no studies have investigated the effects of Internet-administered CBT (ICBT) on HD, with or without paraphilia(s) or paraphilic disorder(s). AimTo investigate the effects of Internet-administered CBT on HD, with or without paraphilia(s) or paraphilic disorder(s). MethodsMale participants (n = 36) evaluated positive according to the proposed diagnostic HD criteria, with or without paraphilia(s) or paraphilic disorder(s), received 12 weeks of ICBT. Measures were administered weekly over the treatment period, with an additional follow-up measurement 3 months after completion of treatment. An assessment interview was performed 2 weeks after treatment. OutcomesThe primary outcome was the Hypersexual Behavior Inventory (HBI-19), and secondary outcomes were the Hypersexual Disorder: Current Assessment Scale (HD:CAS), the Sexual Compulsivity Scale (SCS), as well as a tentative composite of 6 Severity Self-rating Measures, for Paraphilic Disorders and depression (Montgomery-Åsberg Depression Rating Scale [MADRS-S]), psychological distress (Clinical Outcomes in Routine Evaluation Outcome Measure [CORE-OM]), and treatment satisfaction (CSQ-8). ResultsLarge, significant decreases in HD symptoms and sexual compulsivity were found, as well as moderate improvements in psychiatric well-being and paraphilic symptoms. These effects remained stable 3 months after treatment. Clinical ImplicationsICBT can ameliorate HD symptoms, psychiatric distress, and paraphilic symptoms, which suggests that the ICBT for HD, with or without paraphilia(s) or paraphilic disorder(s), may constitute a valuable addition of treatment options in clinical settings. Strengths and LimitationsThis is the first study evaluating the efficacy of ICBT on a sample of men suffering from HD. In addition, a proportion of the sample reported concomitant paraphilic interests and disorders, thus mirroring an everyday clinical practice in the field of sexual medicine. No control group was assigned, and some of the outcome measures are still to be validated. The long-term effects of ICBT and its efficacy in hypersexual women are unknown. ConclusionsThis study gives support for ICBT as an effective treatment option for HD. Future evaluations of the treatment program should include women and larger samples in randomized controlled procedures and investigate the long-term effects.Hallberg J, Kaldo V, Arver S, et al. Internet-Administered Cognitive Behavioral Therapy for Hypersexual Disorder, With or Without Paraphilia(s) or Paraphilic Disorder(s) in Men: A Pilot Study. J Sex Med 2020;17:2039–2054.

Naltrexone in Compulsive Sexual Behavior Disorder: A Feasibility Study of Twenty Men

BackgroundCompulsive sexual behavior disorder (CSBD) is a common disorder affecting different areas of life, although studies focusing on pharmacological treatment are sparse. AimTo investigate whether the opioid receptor antagonist naltrexone is feasible and tolerable and can provide symptom reduction in CSBD. MethodsTwenty men aged 27–60 years (mean = 38.8 years, standard deviation = 10.3) with CSBD seeking treatment in an outpatient nonforensic clinic received four weeks of naltrexone 25–50 mg. Measurements were made before, during, and four weeks after treatment. OutcomesThe self-assessment Hypersexual Disorder: Current Assessment Scale (HD: CAS) score was the primary outcome measure, and secondary outcomes were the Hypersexual Behavior Inventory (HBI) score, reported adverse effects, adherence to treatment, and dropouts. ResultsThere was significant decrease on both HD: CAS and HBI scores during treatment with naltrexone. Even though some of the effects remained after treatment, the increased scores on HD: CAS indicated worsening of CSBD symptoms. The most reported side effects were fatigue (55%), nausea (30%), vertigo (30%), and abdominal pain (30%). However, there were no serious adverse effects leading to discontinuation of naltrexone. Clinical ImplicationsDespite side effects being common, naltrexone seems to be feasible in the treatment of CSBD. Strengths & LimitationsBeing the first nonforensic prospective trial on naltrexone in CSBD, this study provides novel insights on a pharmacological intervention. However, owing to the small sample size and the lack of a control group, conclusions of effectiveness should be interpreted with caution. ConclusionNaltrexone is feasible and tolerable and may reduce symptoms of CSBD; nevertheless, future studies should ensure a randomized controlled procedure to evaluate possible effectiveness.Savard J, Öberg KG, Chatzittofis A, et al. Naltrexone in Compulsive Sexual Behavior Disorder: A Feasibility Study of Twenty Men. J Sex Med 2020;17:1544–1552.

Impulse Control Disorders in Dopamine Agonist-Treated Hyperprolactinemia: Prevalence and Risk Factors.

There are growing reports of dopamine agonist (DA)-induced impulse control disorders (ICDs) in hyperprolactinemic patients. However, the magnitude of this risk and predictive factors remain uncertain. To determine ICD prevalence and risk factors in DA-treated hyperprolactinemic patients compared to community controls. Multicenter cross-sectional analysis of 113 patients and 99 healthy controls. Participants completed a neuropsychological questionnaire consisting of the Depression Anxiety Stress Scale (DASS21), Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP-S), Hypersexual Behavior Inventory (HBI), Hypersexual Behavior Consequences Scale and Social Desirability Response Set Scale. Demographic and clinical data were collated to determine ICD risk factors. Patients testing positive for an ICD were offered a semistructured psychological interview. Patients were more likely than controls to test positive by QUIP-S for any ICD (61.1 vs 42.4%, P = .01), hypersexuality (22.1 vs 8.1%, P = .009), compulsive buying (15.9 vs 6.1%, P = .041) and punding (18.6 vs 6.1%, P = 0.012), and by HBI for hypersexuality (8.0 vs 0.0%, P = 0.004). Independent risk factors were male sex (odds ratio [OR] 13.85), eugonadism (OR 7.85), Hardy's tumor score and psychiatric comorbidity (OR 6.86) for hypersexuality, and age (OR 0.95) for compulsive buying. DASS21 subset scores were higher in patients vs controls and in patients with vs without different ICDs. Only 19/51 (37.3%) interviewed patients were aware of the relationship between DAs and ICDs before the study. DA therapy poses a high, previously underestimated risk of ICDs, especially in the form of hypersexuality in eugonadal men.

Efficacy of prison-based cognitive behavioral rehabilitation intervention on violent sexual behaviors among sex offenders in Nigerian prisons.

Background/Objective:Evidence showed that reoffending habits are increasing among offenders with violent sexual behaviors. Given the recidivism rates, a psychotherapeutic intervention becomes imperative. This study examined the efficacy of prison-based cognitive behavioral rehabilitation intervention (PCBRI) on violent sexual behaviors among sex offenders in Nigerian prisons.Method:A total of45 participants were the sample size. Compulsive Sexual Behavior Inventory and Hypersexual Behavior Inventory were employed in assessing the participants at 3 points. Using a simple random allocation sequence, 23 participants were exposed to PCBRI programme and 22 participants allocated to control condition. The data obtained were analyzed using repeated measures 2-way analysis of variance.Results:Results indicated a significant effect of the treatment on violent sexual behaviors among sex offenders in Nigerian prisons exposed to the PCBRI programme when compared to the no-intervention group. Result also showed a significant interaction effect of time and group on sex offenders with violent sexual behaviors. Follow-up tests showed significant decrease in violent sexual behaviors after 6 months for the PCBRI group in comparison to the control group.Conclusion:This study concluded that PCBRI approach is a type of psychotherapy that reduces violent sexual behaviors among sex offenders in Southeast Nigeria.

A Validation Study of the Spanish Version of the Hypersexual Behavior Inventory (HBI): Paper-and-Pencil Versus Online Administration

Hypersexuality is a problematic behavior characterized by the combination of an excessive sexual desire and the pathological inability to control it. This study presents the psychometric properties of the Spanish paper-and-pencil and online versions of the Hypersexual Behavior Inventory (HBI), one of the most popular scales to assess this issue. A total of 2,250 participants (1,070 men) completed a translated version of the HBI (1,450 in paper-and-pencil; 800 online). The exploratory factor analysis yielded three factors that explained 67.53% of total variance for the HBI paper-and-pencil version. This factor structure was confirmed in the HBI online version through confirmatory factor analysis (CFA). Factorial, structural, scalar and error variance-invariance according to gender was also confirmed through multigroup CFA. Reliability of the total score and subscales ranged between .89 and .96. Likewise, correlations with other related scales were positive and significant (r between .511 and .743). Temporal stability one year after the first application was .77 (paper-and-pencil format) and .68 (online version). These results support the reliability and validity of the HBI and justify its use in the assessment of hypersexuality in Spanish-speaking countries.