Exploring Hypersexuality Pathways From Eye Movements: The Role of (Sexual) Impulsivity.

BACKGROUND: Impulsivity is regarded as a key factor underpinning hypersexuality like-conditions. However, impulsivity is a multifaceted construct, and existing research has not been capturing such complexity, which includes the effects of domain-general and domain-specific impulsivity in hypersexuality. AIM: The aim of this study was to test the predictive role of specific impulsivity domains, ie, domain-general and domain-specific, in hypersexuality and its associated consequences. METHODS: Fifty-five men and 58 women went through an emotional Go/-no-Go task (including sexual, high-valence positive, and neutral pictures), aimed at capturing domain-general and domain-specific impulsivity. Ocular metrics were further considered in order to increase the validity of the experimental task, and provide a metric of attention capturing. The study was carried out in a community sample. OUTCOMES: Self-reported (general)impulsivity and commission errors toward high-valence positive and sexual pictures (signaling domain-general and domain-specific impulsivity, respectively) were settled as independent variables, along with Time to First Fixation to stimuli, capturing early/uncontrolled attention. Scores on hypersexuality and negative consequences emerging from hypersexual behavior were settled as outcome variables. RESULTS: Self-reported (general)impulsivity was the only predictor of hypersexuality scores, while negative consequences were best accounted by higher fixation time to sexual pictures. In all, findings did not support the role of domain-specific impulsivity (ie, sexual impulsivity) in hypersexuality. CLINICAL TRANSLATION: Findings tentatively suggest that hypersexuality, as captured at the community level, may be best positioned within the general spectrum of psychopathology, thus influencing educational and clinical intervention protocols aimed at addressing hypersexuality related complaints. Protocols would be expected to primarily target general psychopathology phenomena, rather than specific sexual aspects. STRENGTHS & LIMITATIONS: This study implemented an innovative approach to capture different impulsivity domains, thus adding to previous literature in the field. However, the current study precludes the generalization of findings to clinical samples, where psychological comorbidities are expected to impact results. Further, findings must be read with caution given to limited effect sizes. CONCLUSION: While hypersexuality was related to self-reported (general) impulsivity, findings on the negative consequences associated with hypersexual behavior mirrored response patterns found in depression. Such evidence aligns with the assumption that hypersexuality related phenomena might be better positioned in the psychopathology domain, rather than simply framed as a specific sexual problem. Carvalho J, Rosa PJ, Stulhofer A. Exploring Hypersexuality Pathways From Eye Movements: The Role of (Sexual) Impulsivity. J Sex Med 2021;18:1607-1614.

An Online Assessment of Personality, Psychological, and Sexuality Trait Variables Associated with Self-Reported Hypersexual Behavior.

"Hypersexual" behavior represents a perceived inability to control one's sexual behavior. To investigate hypersexual behavior, an international sample of 510 self-identified heterosexual, bisexual, and homosexual men and women completed an anonymous online self-report questionnaire battery. In addition to age and sex (male), hypersexual behavior was related to higher scores on measures of sexual excitation, sexual inhibition due to the threat of performance failure, trait impulsivity, and both depressed mood and anxiety. In contrast, hypersexual behavior was related to lower scores on sexual inhibition due to the threat of performance consequences. Higher neuroticism and extraversion, as well as lower agreeableness and conscientiousness, also predicted hypersexual behavior. Interestingly, interactions among the variables assessed did not significantly predict hypersexual behavior, suggesting the possible existence of multiple and predominantly independent taxa for various persons reporting hypersexual behavior. Core personality features may also be present in persons with hypersexual behavior. Clinical implications and future research directions are discussed.

Hypersexuality: A Critical Review and Introduction to the "Sexhavior Cycle".

An empirical review of hypersexuality is timely as "compulsive sexual behavior" is being considered as an impulse control disorder for inclusion in the forthcoming International Classification of Diseases, 11th ed. Specifically, hypersexuality has been conceptualized in the literature as the inability to regulate one's sexual behavior that is a source of significant personal distress. Various theoretical models have been posited in an attempt to understand the occurrence of hypersexuality, although disagreement about these divergent conceptualizations of the condition has made assessment and treatment of hypersexual clients more challenging. Theories of sexual compulsivity, sexual impulsivity, dual control (sexual inhibition/excitation), and sex addiction are critically examined, as are the diagnostic criteria for clinically assessing hypersexuality as a sexual disorder. Our discussion of hypersexuality covers a diversity of research and clinical perspectives. We also address various challenges associated with reliably defining, psychometrically measuring, and diagnosing hypersexuality. Furthermore, literature is reviewed that expresses concerns regarding whether hypersexuality (conceptualized as a disorder) exists, whether it is simply normophilic behavior at the extreme end of sexual functioning, or alternatively is a presenting problem that requires treatment rather than a clinical diagnosis. Following our literature review, we developed the "sexhavior cycle of hypersexuality" to potentially explain the neuropsychology and maintenance cycle of hypersexuality. The sexhavior cycle suggests that, for some hypersexual persons, high sexual arousal may temporarily and adversely impact cognitive processing (cognitive abeyance) and explain a repeated pattern of psychological distress when interpreting one's sexual behavior (sexual incongruence). We also suggest that further research is required to validate whether hypersexuality is a behavioral disorder (such as gambling), although some presentations of the condition appear to be symptomatic of a heterogeneous psychological problem that requires treatment.

Delay discounting of protected sex and compulsive sexual behavior in women with borderline personality disorder.

Background and aims: Borderline personality disorder (BPD) is a complex mental health condition characterized by emotional dysregulation, impulsivity, and unstable interpersonal relationships. Some individuals with BPD regularly engage in sexual risk behavior such as unprotected sex and are at higher risk of contracting sexually transmitted infections. This study investigates discounting of condom- or dental dam-protected sex in women with BPD compared with a control group. Methods: Data were collected from 40 women diagnosed with BPD and 40 healthy controls with an average age of 27.28 years (SD = 6.14) using the Sexual Delay Discounting Task (SDT), the Borderline Symptom List-23 (BSL-23), and the Compulsive Sexual Behavior Disorder Scale-19 (CSBD-19). Results: Women with BPD were less likely to use an immediately available condom or dental dam and more likely to discount safer sex than controls. Partner desirability and the perceived STI risk influenced the participants' likelihood of having protected sex. Women with BPD showed more symptoms of compulsive sexual behavior (CSB) than controls. However, sexual delay discounting was not significantly correlated with borderline symptoms or CSB in the BPD group. Discussion and conclusions: These findings contribute to our understanding of sexual impulsivity in women with BPD and highlight the omission and delayed availability of safety measures as important contributors to sexual risk behavior and STI risk in women. Impulsive sexual behavior, as well as the accompanying sexual health concerns, should receive special attention in the treatment of women with BPD.

Hypersexual behavior in an online sample of males: associations with personal distress and functional impairment.

INTRODUCTION: The population of individuals reporting hypersexual behavior is heterogeneous. Prior research has implicated the importance of personal distress and functional impairment, as both may serve as indicators of problem severity and relevance. Still, little is known about associations with distress and impairment following hypersexuality. AIM: The purpose of this study was to investigate personal distress and functional impairment in a community sample of male self-identified "sex addicts" and to explore the associations with related variables. METHODS: Three hundred forty-nine men completed an online survey that included questions about personal distress, functional impairment, motivation for behavior change, type of hypersexual behaviors, time spent on sexual behavior, and progression of sexual urges. The survey included the Sexual Addiction Screening Test-Revised (SAST-R) core. MAIN OUTCOME MEASURE: Specific survey questions about personal distress and functional impairment in six life areas were used to assess these variables. Chi-square and P-values were calculated to explore the interrelations among them. RESULTS: There were 75.3% (N = 253) who reported feeling distressed due to hypersexual behavior. Functional impairment in at least one life area was specified by 77.4% (N = 270), and most participants (56.2%) reported impairment regarding partner relationships. Personal distress and functional impairment in three areas were associated with a strong motivation for behavior change. Distress was associated with online pornography use, masturbation, and/or sexual contact with changing partners. The progression of sexual urges was related to distress, while time spent on sexual behavior was not. There were 92.9% of the distressed participants who scored above the SAST-R core scale cut-off, but also 59.0% of the participants with little or no distress scored in this range. CONCLUSIONS: Results underline the particular role of problems in social or intimate relationships in association with hypersexuality. Clustering individuals with regard to their specific sexual behavior and impairment pattern seems to be promising for further research.

How should severity be determined for the DSM-5 proposed classification of Hypersexual Disorder?

BACKGROUND AND AIMS: The concept of severity among providers working with hypersexual behavior is frequently used despite a lack of consensus about how severity should be operationalized. The paucity of dialogue about severity for hypersexual behavior is disconcerting given its relevance in determining level of care, risk, allocation of resources, and measuring treatment outcomes in clinical practice and research trials. The aim of the current article is to highlight several considerations for assessing severity based on the proposed DSM-5 criteria for hypersexual disorder. METHODS: A review of current conceptualizations for severity among substance-use disorders and gambling disorder in the DSM-5 were considered and challenged as lacking applicability or clinical utility for hypersexual behavior. RESULTS AND CONCLUSIONS: The current research in the field of hypersexual behavior is in its infancy. No concrete approach currently exists to assess severity in hypersexual populations. Several factors in operationalizing severity are discussed and alternative approaches to defining severity are offered for readers to consider.

Which Techniques Are Used in Psychotherapeutic Interventions for Nonparaphilic Hypersexual Behavior?

INTRODUCTION: Attempts to draw a distinction between excessive and so-called normal sexual behavior are discussed controversially. Although no consensus has been reached so far on how to label the phenomenon of clinical relevant excessive sexual behavior, Kafka proposed the term hypersexual disorder. There are only a few empirical studies on the effectiveness of treatment. In the recent systematic review by Hook and colleagues, the total number of subject-related studies amounts to only 14 studies. However, it might be difficult for mental health professionals to fully comprehend the intervention techniques used in the different studies. AIM: The present article aims at reviewing the psychotherapeutic interventions for nonparaphilic hypersexual behavior use. METHOD: Each study mentioned in the recent review by Hook et al. was analyzed with regard to the psychotherapeutic interventions that had been applied. Only studies with positive treatment outcomes were considered. From among those studies, only the interventions which seemed to be sufficiently detailed and which are related to the obvious therapeutic results in the treatment of hypersexual symptoms were chosen. Furthermore, the interventions were assigned to the proposed diagnostic criteria of the hypersexual disorder. RESULTS: The hypothesized mechanisms how certain treatment techniques could change and influence hypersexual symptoms were mostly described in an unsatisfactory way. Interventions were targeted on impairment in social, occupational, or other important areas of functioning, negative mood states, stressful life events, and lack of behavioral control. No specific interventions were included for the risk for physical or emotional harm to self or others. CONCLUSION: Future treatment approaches should explicitly formulate the etiological mechanism and contain interventions for the neglected areas. In addition, a more flexible approach in the treatment of different subgroups with hypersexual behavior might be promising. von Franqué F, Klein V, and Briken P. Which techniques are used in psychotherapeutic interventions for nonparaphilic hypersexual behavior? Sex Med Rev 2015;3:3-10.

Gender-related differences in the associations between sexual impulsivity and psychiatric disorders.

OBJECTIVE: Sexual impulsivity (SI) has been associated with conditions that have substantial public health costs, such as sexually transmitted infections and unintended pregnancies. However, SI has not been examined systematically with respect to its relationships to psychopathology. We aimed to investigate associations between SI and psychopathology, including gender-related differences. METHOD: We performed a secondary data analysis of Wave-2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a national sample of 34,653 adults in the United States. DSM-IV-based diagnoses of mood, anxiety, drug and personality disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Scheduled DSM-IV Version. RESULTS: The prevalence of SI was considerable (14.7%), with greater acknowledgment by men than women (18.9% versus 10.9%; p < 0.0001). For both women and men, SI was positively associated with most Axis-I and Axis-II psychiatric disorders (OR range: Women, Axis-I:1.89-6.14, Axis-II:2.10-10.02; Men, Axis-I:1.92-6.21, Axis-II:1.63-6.05). Significant gender-related differences were observed. Among women as compared to men, SI was more strongly associated with social phobia, alcohol abuse/dependence, and paranoid, schizotypal, antisocial, borderline, narcissistic, avoidant and obsessive-compulsive personality disorders. CONCLUSION: The robust associations between SI and psychopathology across genders suggest the need for screening and interventions related to SI for individuals with psychiatric concerns. The stronger associations between SI and psychopathology among women as compared to men emphasize the importance of a gender-oriented perspective in targeting SI. Longitudinal studies are needed to determine the extent to SI predates, postdates or co-occurs with specific psychiatric conditions.

Borderline personality symptomatology, casual sexual relationships, and promiscuity.

In this study, we compiled 12 previous databases to examine, among a large sample (N=972) of psychiatric and nonpsychiatric patients, the relationship, if any, between borderline personality symptomatology and sexual impulsivity. Two types of sexual impulsivity were assessed through two self-report items that queried participants about (1) having sex with individuals whom respondents hardly knew (i.e., casual sexual relationships) and (2) promiscuity. Across the entire sample, those with borderline personality symptomatology evidenced at least twice the rate of endorsement of these items compared to those without such symptomatology. This proportion was also closely approximated in the various subsamples (i.e., psychiatric, internal medicine, and other medical subsamples). These findings indicate that a substantial minority of patients with borderline personality symptomatology exhibit sexual impulsivity in the form of casual sexual relationships as well as promiscuity.

Indicadores de deseo, autoerotismo e impulsividad sexual en mujeres de la Ciudad de México / Desire, Autoerotic and Sexual Impulsivity Indicators in Women from Mexico City

El propósito de este trabajo fue describir indicadores de deseo sexual, impulsividad sexual y autoerotismo en 402 mujeres entre 17 y 35 años de edad residentes de la Ciudad de México. Se encontraron relaciones positivas entre los factores de autoeficacia sexual y cuatro de los seis factores de deseo sexual (atracción, excitación, romanticismo y entrega) y sólo una relación negativa entre autoeficacia y culpabilidad sexual. La impulsividad sexual correlacionó positivamente con culpabilidad sexual. El deseo de autoerotismo se vinculó negativamente con los factores de autoeficacia y culpabilidad sexual. Tanto en los grupos divididos por edad como en los grupos divididos por haber o no iniciado una vida sexual activa; se encontraron algunas diferencias significativas siendo las mujeres con más edad y las que habían ya iniciado su vida sexual, las que obtuvieron las medias más altas en los factores de deseo sexual (entrega y excitación).

The purpose of this study was to describe indicators of sexual desire, sexual impulsivity and auto-eroticism in 402 women aged between 17 and 35 years living in Mexico City. Positive relationships were found between the factors sexual self-efficacy and four of the six factors of sexual desire ('attraction', 'excitement', 'romance' and 'sexual surrender') and only one negative relationship between 'self-efficacy' and 'sexual guilt'. 'Sexual impulsivity' correlated positively with sexual guilt. 'Autoerotic desire' correlated negatively with the factors 'self-efficacy' and 'sexual guilt'. Some significant differences were found between age groups and between those classified as being or not sexually active. The group of elder women and of those who had already started their sexual life obtained the highest averages in the factors 'sexual surrender' and 'excitement'.