How much online pornography is too much? A comparison of two theoretically distinct assessment scales.

BACKGROUND: Online pornography use, an ever more common activity, has raised myriad psychosocial and clinical concerns. While there is a need to screen for and measure its problematic dimension, there is a debate about the adequacy of existing assessment tools. OBJECTIVE: The study compares two instruments for measuring pathological online pornography use (POPU) that are based on different theoretical frameworks-one in line with DSM-5 criteria and the six-component addiction model and one in line with ICD-11 criteria. METHODS: An international sample of 1,823 adults (Mean age = 31.66, SD = 6.74) answered an online questionnaire that included the Short Version of the Problematic Pornography Consumption Scale (PPCS-6) and the Assessment of Criteria for Specific Internet-Use Disorders (ACSID-11). Factorial, correlational, and network analyses were conducted on the data. RESULTS: Both tools adequately screened for online "addictive" behavior, but the ACSID-11 was superior in assessing the degree of clinical risk. CONCLUSION: Depending on the specific aim of the assessment (screening vs. clinical diagnostics), both online pornography measurement tools may be useful.

Comparison of Maslow's hierarchy of needs, decision-making, and attention control in individuals with sex addiction and normal people.

BACKGROUND AND PURPOSE: Sexual addiction as a neglected disorder requires investigation and exploration as it affects various aspects of individual's personal and social lives. Therefore, the current research purpose was to examine the afflicted individuals from the standpoints of Maslow's hierarchy of needs, decision-making styles, and the function of attention. MATERIALS AND METHODS: The research population of this study included all students of Isfahan University during the academic year January 2020 to February 2021, and after the screening, a total of 200 individuals were selected as a research sample and divided into two groups: the group with sexual addiction and the healthy group. Subsequently, both groups completed questionnaires related to Maslow's Hierarchy of Needs Questionnaire (MHNQ), General Decision-Making Style Questionnaire, and Attention Control Scale (ACS). FINDINGS: The results of multivariate analysis of variance showed significant differences between two groups, normal and abnormal, in the needs for safety and the need for respect from Maslow's hierarchy of needs, decision-making styles (intuitive, dependent, and spontaneous), and the focus maintenance of attention in attentional functioning (P < 0/001). The variables of physiological needs, belongingness, and self-actualization in Maslow groups, normal and abnormal, decision-making styles, and the subscale of attention switching in attentional functioning did not show any significant difference in the two groups. CONCLUSION: Overall, it appears that fixing (stabilization) in one category and returning (regression) in the stages of Maslow's hierarchy of needs, attention deficits including excessive or hyper-focused attention, malfunctioning in the decision-making process, and an impulsive, desire-driven approach, may significantly account for the difference observed between the two groups in these variables.

Prevalence and clinical phenotypes of adult patients with attention deficit hyperactivity disorder and comorbid behavioral addictions.

Background: Although the correlation between substance use disorder and attention deficit hyperactivity disorder (ADHD) has been largely studied, less is known about the correlation between behavioral addictions and ADHD. Thus, the aim of the present study was to investigate the prevalence of behavioral addictions in a large sample of adult patients with a primary diagnosis of ADHD and to compare the clinical profile of ADHD patients with and without behavioral addictions comorbidity. Methods: 248 consecutive adults newly diagnosed as ADHD patients were assessed through a series of validated scales for gambling disorder, internet, sex, shopping and food addictions. ADHD patients with at least one comorbid behavioral addiction were compared to non-comorbid patients on ADHD symptoms, impulsivity, mood and anxiety symptoms and functional impairment. Results: 58.9% of patients had at least one behavioral addiction comorbidity. Of the whole sample, 31.9% of the patients had a comorbidity with one behavioral addiction while the 27% showed a comorbidity with two or more behavioral addictions. Internet addiction was the most common comorbidity (33.9%) followed by food addiction (28.6%), shopping addiction (19%), sex addiction (12.9%) and gambling disorder (3.6%). ADHD patients with comorbid behavioral addictions showed higher ADHD current and childhood symptoms, higher cognitive and motor impulsivity, higher mood and anxiety symptoms and higher functional impairment. Conclusions: Behavioral addictions are highly frequent in adult ADHD patients. Comorbid patients seem to have a more complex phenotype characterized by more severe ADHD, mood and anxiety symptoms, higher impulsivity levels and greater functional impairment.

Betrayal Trauma Anger: Clinical Implications for Therapeutic Treatment based on the Sexually Betrayed Partner's Experience Related to Anger after Intimate Betrayal.

This article provides insight into the complex anger often following the discovery of broken trust and attachment in a relationship as a result of sexual betrayal. In the past, the helping profession viewed angry betrayed partners from a pathological lens. Through research and progression in the mental health field, betrayed partners are now viewed from a trauma lens as traumatized individuals, and a greater understanding exists of why partners will most likely experience complex anger after betrayal. This article aims to add to the existing literature on the topic of betrayal trauma and provide clinical considerations for assessment and treatment of those seeking therapeutic help to manage and reduce anger. 297 sexually betrayed partners participated in a Betrayal Trauma Anger Survey. Results revealed 83.5% of participants remain in the relationships with their betrayers. 39% of betrayed partners reported not being provided specific help to manage anger from their helping professional. 87% reported self-blame and 43% considered harming themselves. Results clearly indicate that betrayed partners are significantly impacted physiologically, psychologically, behaviorally, and spiritually, and they experience feelings of intense anger with 84% reporting their experienced anger is more intense than at any other time they experienced anger prior to discovering betrayal.

Impulsivity and sexual addiction: factor structure and criterion-related validity of the sexual addiction screening test in Mexican adults.

Sexual addiction is associated with serious health problems. Due to that fact, it is quite important to perform a comprehensive assessment. The Sex Addiction Screening Test (SAST-R) is a self-administered questionnaire with good psychometric properties used in several countries. Our study conducts a cross-cultural adaptation of the SAST-R on the Mexican population. The original version of the SAST-R was translated into Mexican Spanish, and we performed a pilot with 23 participants to be sure that the participants understood the meaning of the items. The final version was administered to 370 adults who completed the SAST-R, and measures of impulsivity (the Kirby questionnaire), reward/punishment responsivity (BIS-BAS scale), personality (BIG-Five), and psychological distress (SCL-90). The confirmatory factor analysis (CFA) with a five-factor model with one second-order factor model had the best fit. Reliability analysis suggests acceptable internal consistency (α = 0.80). The SAST-R scores exhibited significant correlations with several variables. Specifically, they showed a positive correlation with the neuroticism scale (r = 0.11, p < 0.05), a negative correlation with the conscientiousness scale (r = -0.21, p < 0.01), a negative correlation with the BIS scale (r = -0.11, p < 0.05), and a positive correlation with psychological distress (r = 0.34, p < 0.01). Notably, there were no significant correlations observed with variables that we initially expected to have a substantial association, such as impulsivity (r = -0.004, p > 0.05) and the three BAS subscales (p > 0.05). We found with an algorithm that psychological distress, impulsivity, neuroticism, and agreeableness were the good predictors to identify high scores of hypersexuality. Our results confirmed that the Mexican Spanish version of the SAST-R has good psychometric properties to be used in future research.

The Prevalence of Domestic Violence in the Lives of Female Heterosexual Partners of Sex Addicts.

This study provides evidence that rates of domestic violence (DV) run considerably higher in the lives of heterosexual women who identify as partners of sex addicts (PSAs) than in the general population. Data collected from 558 survey participants, from a variety of high-income nations, revealed that 92.1% had ever experienced any form of DV perpetrated by their partner and 57.7% had experienced physical and/or sexual intimate partner violence with their partner. The study also tests several hypotheses about sex addiction behaviors and PSA intimate partner violence (IPV), to help those working with these populations understand what factors may be contributing to, or mitigating, these women's experiences of violence.

Decision making and executive functions in problematic pornography use.

Introduction: 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. Methods: 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). Results: 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. Discussion: 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.

Adicción al sexo, trastorno hipersexual o desorden del comportamiento sexual compulsivo

Introducción: El trastorno hipersexual fue propuesto y desestimado como diagnóstico, con el argumento de escasa evidencia científica y uso indebido en asuntos legales, pero fue reconocido en 2018 como desorden del comportamiento sexual compulsivo. Es una entidad clínica que aún carece de reconocimiento diagnóstico, pero constituye un importante problema de salud mental, sexual y general. Objetivo: Presentar una paciente con un desorden del comportamiento sexual compulsivo y el procedimiento terapéutico empleado. Caso clínico: Paciente femenina de 21 años de edad, con antecedentes de abuso sexual en la infancia. Es traída por la madre porque no lograba controlar sus impulsos sexuales con repetidas búsquedas compulsivas de encuentros sexuales, uso frecuente de pornografía, con malestar clínico significativo y problemas en el área social, estudiantil y otras. Conclusiones: Al diagnosticar el desorden del comportamiento sexual compulsivo, es esencial la entrevista clínica, confeccionar la historia psiquiátrica completa, alcanzar el control de la conducta sexual, las comorbilidades y obtener una mejor calidad de vida del paciente.

Introduction: The hypersexual disorder was proposed and underrated as diagnostic with the argument of scarce scientific evidence and undue use in legal matters, but recognized in 2018 as disorder of compulsive sexual behavior. It is a clinical entity, that still lacks diagnostic recognition, but it constitutes an important problem of mental, sexual and general health. Objective: To present a patient with a disorder of the compulsive sexual behavior and the procedure therapeutic used. Clinical case: 21-year-old female patient, with antecedents of sexual abuse in the childhood. The mother brings her because was not able to control their sexual impulses with repeated compulsive searches of sexual encounters, frequent use of pornography with significant clinical malfunction, and problems in social, student and other important areas. Conclusions: When diagnosing compulsive sexual behavior disorder the essential is the clinical interview, to perform a complete psychiatric history, later to reach the control of the sexual behavior, comorbidity, and to obtain a better quality of the patients' life.

Frequency of and Factors Associated with the Presence of a History of Probable Attention-Deficit Hyperactivity Disorder in a Population of Patients with Sex Addiction.

INTRODUCTION: Since the first description of sex addiction (SA) by Carnes, research on this problematic behaviour has continued to grow, and the association with attention-deficit hyperactivity disorder (ADHD) appears to be frequent. This study aimed to estimate the frequency of a history of probable ADHD in a population of patients with SA and to explore the factors associated with it. METHODS: One hundred 85 patients referred to the Nantes University Hospital for SA between 2011 and 2020 were included. Patients completed the Sexual Addiction Screening Test (SAST) or its revised version (SAST-R) to establish the presence of SA. As the SAST-R was not validated in French, we conducted a validation study for the French version. ADHD was screened using the Wender-Utah Rating Scale in childhood and the Adult ADHD Self-Report Scale in adulthood. A multivariate logistic regression model was used to identify factors associated with the presence of a history of probable ADHD. RESULTS: Childhood ADHD was identified in 36% of patients with SA. Factors associated with the presence of a history of probable ADHD were a low education level, an earlier age of onset of problematic sexual behaviour, another addictive disorder, an anxiety disorder, impulsivity (high negative urgency score), and high scores on harm avoidance and novelty-seeking temperament scales. Furthermore, the French version of the SAST-R displayed good psychometric properties, especially excellent sensitivity. CONCLUSION: The frequency of a history of probable ADHD among patients with SA is consistent with the literature and close to the highest range. Specific personality traits in patients with both SA and a history of probable ADHD could induce lasting problems of adaptation, which may precipitate the development of SA or maintain it.

Hypersexual behaviour among young adults in Germany: characteristics and personality correlates.

BACKGROUND: Hypersexual behaviour (HB) is characterized by recurring unsuccessful efforts to control intense, repetitive sexual impulses that result in sexual activities and manifest in the behaviour of the concerning individual over an extended period. This study aims to describe the characterization of HB among the target group, identify personality correlates, and associations between HB and a lack of sexual education and reflection during school time. METHODS: A cross-sectional design was used to survey the participants (age 18-27; n = 609) online who were recruited via a web forum for addiction selfcare, a website for casual sex dating, Facebook and the mail distribution of the University of Applied Science Nordhausen (Germany). Standardised questionnaires were used to measure the key variables in the study. The sexual behaviour (masturbation, pornography consumption, promiscuity), several personality tendencies, and retrospective information about sexual education of the participants during school time were investigated. Correlation and binomial logistic regression were used to analyse the data with HB as the outcome variable. RESULTS: 10.5% (n = 64) of the participants were identified as hypersexual. The assignment to male sex, a problematic pornography consumption, and impulsive tendencies were determined as predictors of HB. Strong correlates were identified between HB and promiscuity, and impairments in important areas of life. Weak to moderate correlates comprise between HB and all investigated personality traits, and several aspects of sexual risk behaviour. No association was found between HB and a lacking sexual education during school time. The descriptive analysis revealed further sexual problems within the sample (e.g. feelings of shame and guilt, sexual risk behaviour, sexual dysfunction). CONCLUSION: Young adults should get more attention as a vulnerable group for the development of hypersexuality in sexual education, prevention and therapy. Regarding to its treatment, HB therefore should be considered together with its associations with sociodemographic information, personality traits, and psychosocial factors.

Estimación de las propiedades psicométricas del instrumento de medición de adicción al sexo (MAS)

Introducción: El instrumento MAS, una prueba para evaluar adicción al sexo, ha presentado inconvenientes en el nivel factorial. Por esto, esta investigación buscó estimar las propiedades psicométricas de dicho instrumento, en población colombiana. Método: Inicialmente, se realizó un juicio de expertos para establecer la validez de contenido, a través de la V de Aiken; luego se aplicó el MAS y la escala de inhibición/excitación sexual (SIS/ SES) a 337 participantes, por medio de un formulario web (Google forms), de los cuales 312 cumplieron con los criterios de inclusión (221 mujeres y 91 hombres) con edades en el rango 18-65 años (x_ = 28.49, DE = 9.77). Mediante SPSS, se calculó el alfa de Cronbach, la correlación de Pearson y se hizo un análisis factorial con rotación Varimax. Resultados: Los análisis reflejaron una buena confiabilidad, una correlación ajustada a lo esperado, en relación con la prueba SIS/SES y el análisis factorial arrojó seis factores que presentan diferencias en comparación con la prueba planteada inicialmente. Conclusión: La prueba MAS presenta un adecuado nivel de confiabilidad, pero no cuenta con una validez de constructo adecuada.

Introduction: The MAS instrument, a test to assess sex addiction, has presented drawbacks at the factorial level. For this reason, this research sought to estimate the psychometric properties of the sex addiction measurement instrument (MAS) in Colombian population. Method: Initially, an expert judgment was carried out to establish the validity of content through Aiken's V, then the MAS and the sexual inhibition/arousal scale (SIS/SES) were applied to 337 participants through a form web (Google forms) of which 312 met the inclusion criteria (221 women and 91 men) aged between 18 and 65 years (x_ = 28.49, SD = 9.77). Using SPSS, Cronbach's alpha, Pearson's correlation, and a factorial analysis with Varimax rotation were calculated. Results: The analyzes showed a good reliability, a correlation adjusted to what was expected in relation to the SIS/SES test and the factorial analysis showed six factors that present differences in comparison with the initially proposed test. Conclusion: The sex addiction measurement test (MAS) has an adequate level of reliability, but does not have adequate construct validity.

Use of Fluoxetine in Treating Compulsive Sexual Behavior: A Case Report.

Compulsive sexual behavior (CSB) disorder is generally characterized by recurrent and intense sexually arousing fantasies, sexual urges, and behaviors that cause individual distress or impair daily functioning. CSB has significant consequences, including but not limited to personal distress, depression, anxiety, and a high risk of sexually transmitted diseases. CSB is often seen along with other psychiatric disorders, most commonly with major depressive and substance use disorders.  A primary goal of treatment for CSB is to help manage the uncontrollable impulses and urges a patient endures by reducing excessive sexual behavior with the use of psychotherapy, self-help groups, and medications such as selective serotonin reuptake inhibitors (SSRIs). SSRIs are well-known for their pharmacotherapeutic role in many psychiatric and medical conditions; however, symptoms of hyposexuality are notable side effects.  Here we report our findings on a patient, a 36-year-old male who classified himself as a sex addict since late adolescence, participating in various forms of sexual-related activities at high frequency. He presented to the outpatient clinic for treatment for depression alongside his CSB. He was successfully treated with an SSRI, fluoxetine.

Disorders due to addictive behaviors: Further issues, debates, and controversies •.

Two recent papers in the Journal of Behavioral Addictions by Brand et al. (2022), and Sassover and Weinstein (2022) both make interesting additions to the place of behavioral addictions in the more general addictive behaviors field. This commentary discusses some of the further nuances in the debates surrounding whether problematic engagement in social networking, pornography, and buying/shopping should be considered as possible 'disorders due to addictive behaviors' in the ICD-11. Particular emphasis in this commentary is placed on social network use disorder and its delineation. While there is growing evidence that addictions to sex, pornography, social network sites, exercise, work, and buying/shopping may be genuine disorders among a minority of individuals, none of these behaviors is likely to be included in formal psychiatric manuals in the near future until there is more high-quality data on all research fronts (e.g., epidemiological, neurobiological, psychological, and clinical).

Neural and behavioral correlates of sexual stimuli anticipation point to addiction-like mechanisms in compulsive sexual behavior disorder.

Background and aims: Compulsive sexual behavior disorder (CSBD) is characterized by persistent patterns of failure to control sexual impulses resulting in repetitive sexual behavior, pursued despite adverse consequences. Despite previous indications of addiction-like mechanisms and the recent impulse-control disorder classification in the International Classification of Diseases (ICD-11), the neurobiological processes underlying CSBD are unknown. Methods: We designed and applied a behavioral paradigm aimed at disentangling processes related to anticipation and viewing of erotic stimuli. In 22 male CSBD patients (age: M = 38.7, SD = 11.7) and 20 healthy male controls (HC, age: M = 37.6, SD = 8.5), we measured behavioral responses and neural activity during functional magnetic resonance imaging (fMRI). The main outcomes were response time differences between erotic and non-erotic trials and ventral striatum (VS) activity during anticipation of visual stimuli. We related these outcomes with each other, to CSBD diagnosis, and symptom severity. Results: We found robust case-control differences on behavioral level, where CSBD patients showed larger response time differences between erotic and non-erotic trials than HC. The task induced reliable main activations within each group. While we did not observe significant group differences in VS activity, VS activity during anticipation correlated with response time differences and self-ratings for anticipation of erotic stimuli. Discussion and Conclusions: Our results support the validity and applicability of the developed task and suggest that CSBD is associated with altered behavioral correlates of anticipation, which were associated with ventral striatum activity during anticipation of erotic stimuli. This supports the idea that addiction-like mechanisms play a role in CSBD.

Compulsive sexual behavior, religiosity, and spirituality: A systematic review.

BACKGROUND AND AIMS: In recent years, increasing attention has been given to the relationship between compulsive sexual behavior (CSB), religiosity, and spirituality. This review summarizes research examining the relationship CSB has with religiosity and spirituality, clarifying how these constructs inform the assessment and treatment of this syndrome. METHODS: The present paper reviews research published through August 1, 2021, using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Only studies providing quantitative analyses were included. RESULTS: This review identified 46 articles, subsuming 59 studies, analyzing the relationship between CSB and religiosity or spirituality. Most studies used cross-sectional designs with samples primarily composed of heterosexual White men and women. Generally, the studies found small to moderate positive relationships between religiosity and CSB. Studies considering the mediating or moderating role of moral incongruence identified stronger, indirect relationships between religiosity and problematic pornography use (PPU), a manifestation of CSB. Few studies examined the association between spirituality and CSB, but those that did either reported negative relationships between indicators of spiritual well-being and CSB or positive relationships between CSB and aspects of spiritual struggles. DISCUSSION AND CONCLUSIONS: Although research examining CSB and religiosity has flourished, such growth is hampered by cross-sectional samples lacking in diversity. Moral incongruence assists in explaining the relationship between religiosity and PPU, but future research should consider other manifestations of CSB beyond PPU. Attention should also be given to examining other religiosity and spirituality constructs and obtaining more diverse samples in research on CSB, religiosity, and spirituality.

Global scientific production regarding behavioral addictions: An analysis of the literature from 1995 to 2019.

AIMS: The increase in scientific interest in so-called behavioral addictions has been growing in recent years. For this reason, the aim of our study is to use bibliometric techniques to identify where and with what intensity these behaviors are being studied. METHODS: In October 2020, we conducted a search in the Web of Science Core Collection using a search equation designed to retrieve the articles that combine the general keywords of addiction with specific terms of the 7 groups of behavioral addictions analyzed (gambling; gaming; information and communication related disorders; and the so-called somatic addictions related to sex, shopping, food and sports). Articles published from 1995 to 2019 were included. RESULTS: We found 9199 distinct articles. Gambling was the most studied addiction, but Information and Technology Communication-related disorders (ITC) had the highest growth rate over the span of five five-year periods, followed by gaming and food addiction. In general, there was a growth rate of 130.46% in the research on behavioral addiction issues. By geographical region, the United States was the most productive country regarding all addictions, but Oceania had the highest proportion of publications per million population. There was a clear interest among Asian countries in studying problems related to ITC and gaming problems. CONCLUSIONS: The importance of the seven behavioral addictions analyzed according to their growth rate in scientific research fields over the last 25 years was confirmed in our study. In addition, the differences in interest by geographical region show us that it is important to delve deeper into cultural particularities to better understand this phenomenon.

Is Compulsive Sexual Behavior Different in Women Compared to Men?

The inclusion of Compulsive Sexual Behavior Disorder (CSBD) in the ICD-11 has sparked research interest on this topic in recent years. This review aims to investigate gender differences in Compulsive Sexual Behavior (CBD) and persons with CSBD. While impulsivity and psychiatric comorbidity play a role in persons with CSBD regardless of gender, some gender differences can be identified. CSBD is more prevalent in men, with a higher rate of reported sexual behaviors and higher scores on questionnaires measuring CSBD related symptoms. Neuroticism and stress vulnerability seem to play a more important role in the symptomatology of CSBD in women. While it seems plausible that childhood adversities play a role in the development of CSB, the manner with respect to how these adversities affect men and women differently is still to be explored. More clinical studies including the female CSBD population are required to infer clinical implications.

Validation and Psychometric Evaluation of the Italian Version of the Bergen-Yale Sex Addiction Scale.

Excessive problematic sexual behavior in the form of compulsive sexual behavior disorder (CSBD), hypersexuality (HS), and sex addiction has gained increasing credibility in recent years and has led to the development of various psychometric instruments to assess such behavior. However, there is still considerable controversy over the operational definition of such concepts and whether they can be used interchangeably to describe the behavior. One recently developed tool is the Bergen-Yale Sex Addiction Scale (BYSAS) based on the "components model of addiction." The present study validated the Italian version of the BYSAS. The BYSAS was administered to a large Italian-speaking sample of Italian adults [N = 1230, aged 18 to 67 years] along with psychometric instruments assessing the "Big Five" personality traits, self-esteem, depression, and two other measures of addictive sexual behavior (i.e., PATHOS and Shorter PROMIS Questionnaire-Sex Subscale). Confirmatory factorial analysis supported a one-factor solution. Furthermore, the scale had good internal consistency (Cronbach's α = 0.787). The BYSAS was positively associated with extroversion, openness to experience, depression, and problematic sexual behavior, and negatively associated with self-esteem, conscientiousness, emotional stability, agreeableness, and age. Based on the findings, the BYSAS is a brief, psychometrically reliable and valid measure for assessing sex addiction among Italian adults.

Estimated Prevalence and Demographic Correlates of Compulsive Sexual Behavior Among Gay Men in the United States.

BACKGROUND: Compulsive sexual behavior (CSB) is a clinical syndrome that causes significant distress and impairment for many individuals in the United States. Gay men are thought to have a higher prevalence of CSB, and it is associated with many relevant health outcomes including HIV risk behavior. AIM: To estimate the prevalence and examine demographic correlates of CSB among gay men in the United States. METHODS: A U.S. national probability sample of 227 gay-identified men were collected as part of the 2015 National Survey of Sexual Health and Behavior (NSSHB). OUTCOMES: Participants completed the Compulsive Sexual Behavior Inventory (CSBI-13) and demographic measures. RESULTS: Eighteen participants (7.93%) scored above the CSBI-13 clinical cut point, indicating they would likely meet criteria for clinically significant compulsive sexual behavior. To assess demographic correlates of CSB, demographic variables were entered into a logistic regression. Results of the logistic regression indicated that participant age, education, and religious affiliation were significant predictors of CSB status. Individuals scoring above the cut point were younger on average (M = 39.17; SD = 14.84) than those scoring below the cut point (M = 47.52; SD = 14.62; P = .02). Odds of scoring above the cut point were about six times greater for religiously affiliated participants compared to non-religiously affiliated participants (P = .005), and four times greater for those who had attended college compared to those who had not (P = .03). CLINICAL IMPLICATIONS: These results indicate the prevalence of CSB in gay men is more modest than previously estimated, and is similar to the general population prevalence estimated in a previous study. The strongest predictor of CSB in this sample was religious affiliation, which underscores the importance of evaluating the role of religiosity in the etiology and/or identification of this clinical syndrome. STRENGTHS AND LIMITATIONS: These findings are strengthened by the national probability sampling methodology and the use of the empirically validated CSBI-13 cut point. However, this sample was also older and had higher income and educational attainment than the larger population of gay men in the U.S. CONCLUSION: These results indicate gay men may have a CSB prevalence rate similar to the general population, which contradicts previous research suggesting they are at greater risk for CSB. Gleason N, Finotelli I, Miner MH, et al. Estimated Prevalence and Demographic Correlates of Compulsive Sexual Behavior Among Gay Men in the United States. J Sex Med 2021;18:1545-1554.

The moral maze of sex & porn addiction.

Sex addiction, a term first coined in the early 80s, has always been met with controversy. Some say the label of addiction is an excuse used by those who have lost their moral compass or refuse to accept responsibility for their sexual choices. Others claim the label is used to pass moral judgement on those whose sex lives or internet viewing habits do not fit societally prescribed norms. The acceptance by WHO of CSBD (Compulsive Sexual Behaviour Disorder) into ICD11 was heralded as a moral victory by the sex addiction naysayers who claimed WHO's position 'proved' it wasn't an addiction; conversely sex addiction professionals claimed victory saying that finally this was a step in the right direction. This paper will explore the divide and provide insight on how using a pure medical model of addiction has contributed and fueled the debate. An alternative model for conceptualization from a biopsychosocial perspective will be provided to suggest ways of moving forward that could ease the controversies as well as opening new areas for research and most importantly, greater understanding and empathy for clients.