Emotional interference and attentional bias in compulsive sexual behaviors disorder - An fMRI study on heterosexual males.

Background and aims: Despite the inclusion of the Compulsive Sexual Behavior Disorder (CSBD) in the 11th edition of the International Classification of Diseases, emotional and cognitive impairments related to CSBD remains unclear. This study aimed to investigate the behavioral and neuronal effects of emotional interference on cognition among CSBD patients. Methods: Thirty heterosexual males with CSBD and matched healthy controls (HC) were studied with the Emotional Stroop Task using 5 categories of emotionally arousing words (sex-related, positive, fear-related, negative, neutral) during functional magnetic imaging. Results: At the behavioral level, we found the main effect of the condition: sex-related words evoked a stronger Stroop effect than other conditions. At the neural level, we found a significant group effect. Among CSBD patients processing of sex-related words was related to increased activity in the right putamen, right thalamus, hippocampi, and left pulvinar, when compared to HC. We also found a negative correlation between neuronal activation and time spent on sexual activity during the week preceding study and numerous group differences in brain regions connected to the emotional and motivational processing of sexually explicit material, correlating with CSBD symptoms. Conclusions: Behavioral results indicate a specific attentional bias toward sex-related stimuli in both groups, while neural data uncovered stronger reactivity to sex-related words in CSBD compared to HC. This reactivity is related to CSBD symptoms and provides evidence for the interference of sex-related stimuli with cognition. Such results are firmly in line with the Incentive Salience Theory and conceptualizing CSBD as a behavioral addiction.

Sex Differences in Low-Level Multisensory Integration in Developmental Dyslexia.

Reading acquisition involves the integration of auditory and visual stimuli. Thus, low-level audiovisual multisensory integration might contribute to disrupted reading in developmental dyslexia. Although dyslexia is more frequently diagnosed in males and emerging evidence indicates that the neural basis of dyslexia might differ between sexes, previous studies examining multisensory integration did not evaluate potential sex differences nor tested its neural correlates. In the current study on 88 adolescents and young adults, we found that only males with dyslexia showed a deficit in multisensory integration of simple nonlinguistic stimuli. At the neural level, both females and males with dyslexia presented smaller differences in response to multisensory compared to those in response to unisensory conditions in the N1 and N2 components (early components of event-related potentials associated with sensory processing) than the control group. Additionally, in a subsample of 80 participants matched for nonverbal IQ, only males with dyslexia exhibited smaller differences in the left hemisphere in response to multisensory compared to those in response to unisensory conditions in the N1 component. Our study indicates that deficits of multisensory integration seem to be more severe in males than females with dyslexia. This provides important insights into sex-modulated cognitive processes that might confer vulnerability to reading difficulties.

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

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.

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

BACKGROUND: 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. AIM: As CSBD is a multidimensional disorder, we wanted to investigate whether distinct CSBD domains are differentially related to sexual health. METHODS: 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. OUTCOMES: The Compulsive Sexual Behavior Disorder Scale was used to assess CSBD symptoms, and the Arizona Sexual Experience Scale was used to measure sexual dysfunction. RESULTS: In study 1, CSBD salience (ß = -.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 (ß = .15, P = .001) and dissatisfaction (ß = .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 (ß = -.26, P < .001) and relapse (ß = -.11, P = .004) predicted hyperfunction, while negative consequences (ß = .12, P < .001) and dissatisfaction (ß = .12, P < .001) predicted hypofunction. CLINICAL IMPLICATIONS: 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. STRENGTHS AND LIMITATIONS: 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. CONCLUSION: 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.

The relation of perceived social support to compulsive sexual behavior.

We conducted two studies to investigate the links between perceived social support, problematic pornography use (PPU) and compulsive sexual behavior disorder (CSBD). In Study 1 (n=807, convenience sample recruited via social media) we collected preliminary data and in Study 2 (n=1526) we checked whether the results replicate in a sample representative of the Polish adult population. In both studies participants completed the Brief Pornography Screen, Compulsive Sexual Behavior Disorder Scale and Multidimensional Scale of Perceived Social Support. In Study 1 and 2, general social support was a weak protective factor against CSBD (ß = -0.15 and ß = -0.10) and PPU (ß = -0.12 and ß = -0.09 respectively, all p values ≤ .001) adjusting for gender, age, sexual orientation and relationship status. The results for three domains of social support (from friends, significant other and family), however, largely differed between the two studies. In Study 1, perceived friends' support weakly protected against PPU and CSBD symptoms. In Study 2 higher support from friends weakly predicted lower CSBD symptoms among men; and stronger family support predicted lower PPU. Support from a significant other was weakly related to lower CSBD for women in Study 1. The conducted studies provided evidence that perceived social support is a protective factor against problematic sexual behavior; however, its predictive power is limited and further studies are needed to assess the importance of various domains of social support in the development of CSBD and PPU symptoms.

Withdrawal and tolerance as related to compulsive sexual behavior disorder and problematic pornography use - Preregistered study based on a nationally representative sample in Poland.

Background: The addiction model of compulsive sexual behavior disorder (CSBD) and problematic pornography use (PPU) predicts the presence of withdrawal symptoms and increased tolerance for sexual stimuli in the disorder phenotype. However, clear empirical evidence supporting this claim has largely been lacking. Methods: In the preregistered, nationally representative survey (n = 1,541, 51.2% women, age: M = 42.99, SD = 14.38), we investigated the role of self-reported withdrawal symptoms and tolerance with respect to CSBD and PPU severity. Results: Both withdrawal and tolerance were significantly associated with the severities of CSBD (ß = 0.34; P < 0.001 and ß = 0.38; P < 0.001, respectively) and PPU (ß = 0.24; P < 0.001 and ß = 0.27; P < 0.001, respectively). Of the 21 withdrawal symptom types investigated, the most often reported symptoms were frequent sexual thoughts that were difficult to stop (for participants with CSBD: 65.2% and with PPU: 43.3%), increased overall arousal (37.9%; 29.2%), difficult to control level of sexual desire (57.6%; 31.0%), irritability (37.9%; 25.4%), frequent mood changes (33.3%; 22.6%), and sleep problems (36.4%; 24.5%). Conclusions: Changes related to mood and general arousal noted in the current study were similar to the cluster of symptoms in a withdrawal syndrome proposed for gambling disorder and internet gaming disorder in DSM-5. The study provides preliminary evidence on an understudied topic, and present findings can have significant implications for understanding the etiology and classification of CSBD and PPU. Simultaneously, drawing conclusions about clinical importance, diagnostic utility and detailed characteristics of withdrawal symptoms and tolerance as a part of CSBD and PPU, as well as other behavioral addictions, requires further research efforts.

Evaluating Pornography Problems Due to Moral Incongruence Model.

INTRODUCTION: To date, multiple models of problematic pornography use have been proposed, but attempts to validate them have been scarce. AIM: In our study, we aimed to evaluate the Pornography Problems due to Moral Incongruence model proposing that self-appraisals of pornography addiction stem from (i) general dysregulation, (ii) habits of use, and (iii) moral incongruence between internalized norms and behavior. We investigated whether the model can be used to adequately explain the self-perceptions of addiction to pornography (model 1) and a broader phenomenon of problematic pornography use (model 2). METHODS: An online, nationally representative study was conducted on a sample of 1036 Polish adult participants, of whom, 880 declared a lifetime history of viewing pornography. MAIN OUTCOME MEASURE: The outcomes were self-perceived pornography addiction, problematic pornography use, avoidant coping, frequency of pornography use, religiosity, moral disapproval of pornography, and related variables. RESULTS: Our results indicated that avoidant coping (an indicator of general dysregulation), frequency of pornography use (indicator of habits of use), and the distress connected with incongruence between own sexual behavior and internalized norms, attitudes and beliefs positively contributed to self-perceived addiction (model 1) as well as problematic pornography use (model 2). This broadly confirms the basic shape of the PPMI model. There were, however, notable differences between the models. Moral incongruence related distress was only weakly related to self-perceived addiction (ß = 0.15, P < .001), with a stronger relation for problematic pornography use (ß = 0.31, P < .001). When controlling for other factors, religiosity weakly predicted problematic pornography use (ß = 0.13, P < .001), but not self-perceived addiction to pornography (ß = 0.03, P = .368). Frequency of pornography use was the strongest predictor of both self-perceived addiction (ß = 0.52, P < .001) and problematic pornography use (ß = 0.43, P < .001). CLINICAL IMPLICATIONS: Factors proposed within the PPMI model are distinctly relevant intervention targets, and they should be considered in the process of diagnosis and treatment. STRENGTHS & LIMITATIONS: The presented study is the first to evaluate PPMI model. Its main limitation is that it has a cross-sectional design. CONCLUSION: The PPMI model is a promising framework for investigating the factors related to self-perceived addiction and problematic pornography use. Despite the differences between the models and in the strength of specific predictors, (i) dysregulation, (ii) habits of use, and (iii) moral incongruence all uniquely contribute to self-perceived addiction and problematic pornography use. Lewczuk, K., Glica, A., Nowakowska, I., et al. Evaluating Pornography Problems Due to Moral Incongruence Model. J Sex Med 2020;17:300-311.