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.

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.

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 psychometric properties of the Bergen-Yale sex addiction scale for the Iranian population.

BACKGROUND: The assessment of sex addiction among different populations requires a valid and reliable tool. Since the Bergen-Yale Sex Addiction Scale (BYSAS) was not available in Iran, this study aimed to evaluate the validity and reliability of the Persian version of the BYSAS. METHODS: After translation/back-translation procedure, a total of 756 Iranian men and women completed the BYSAS. The structural validity of this tool was evaluated by exploratory and confirmatory factor analyses. An expert panel review also examined content validity of the items. Psychometric properties of the scale including validity, reliability (internal consistency [Cronbach's alpha]) and test-retest) and factor structure were assessed. RESULTS: Content Validity Index (CVI) and Content Validity Ratio (CVR) scores for the BYSAS were 0.75 and 0.62, respectively. In the measure's structural validity, the results of exploratory and confirmatory factor analysis supported the One-factor structure. Data analysis demonstrated satisfactory internal consistency (Cronbach's alpha ranging from 0.88 to 0.89). DISCUSSION: Study findings suggest that the BYSAS is a valid and reliable instrument for assessing sex addiction among Persian speaking adults. Replication of research findings is needed to expand the BYSAS for clinical and non-clinical Iranian populations.

Naltrexone Use in Treating Hypersexuality Induced by Dopamine Replacement Therapy: Impact of OPRM1 A/G Polymorphism on Its Effectiveness.

Hypersexuality is a well-known adverse side effect of dopamine replacement therapy (DRT), and anti-craving drugs could be an effective therapeutic option. Our aim was to update the knowledge on this issue, particularly on the influence of an Opioid Receptor Mu 1 (OPRM1) genetic polymorphism. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We also analyzed a case of iatrogenic hypersexuality that occurred in a patient treated with DRT. An analysis of the OPRM1 gene was performed on said patient. Our search identified 597 publications, of which only 7 were included in the final data synthesis. All seven publications involved naltrexone use. Five of them were case reports. None of the publications mentioned DRT side effects, nor did they report genetic data. Regarding our case report, the introduction of naltrexone corresponded with the resolution of the patient's hypersexuality. Moreover, the patient carried the A/G genotype, which has been reported to be associated with a stronger response to naltrexone for patients with an alcohol use disorder. Although studies are inconclusive so far, naltrexone could be an interesting therapeutic option for resistant hypersexuality due to DRT. Carrying the A/G genotype could help explain a good response to treatment.

Does experiential avoidance explain the relationships between shame, PTSD symptoms, and compulsive sexual behaviour among women in substance use treatment?

OBJECTIVE: Untreated compulsive sexual behaviour (CSB) poses a risk to efficacious substance use disorder (SUD) treatment. Yet the ways in which CSB manifests in women with SUDs remains poorly understood. Shame and trauma exposure are well-documented correlates for women's CSB. Prior theory suggested women with shame and trauma-related symptoms may engage in CSB in an effort to escape aversive internal experiences. Thus, the present study examined experiential avoidance as a mediator of the relationship between defectiveness/shame beliefs, post-traumatic stress disorder symptoms, and CSB in a sample of women with SUDs. METHOD: Cross-sectional, self-report data were collected from 446 women (M age = 37.40) in residential treatment for SUDs. RESULTS: Experiential avoidance partially mediated the relationship between both post-traumatic stress disorder symptoms and defectiveness/shame beliefs and CSB. CONCLUSIONS: These results extend theoretical conceptualizations of women's CSB to a treatment population. CSB intervention efforts may benefit from targeting women's avoidance of painful experiences.

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.

Depression, anxiety, and compulsive sexual behaviour among men in residential treatment for substance use disorders: The role of experiential avoidance.

Nearly one-third of individuals in treatment for substance use disorders endorse at-risk levels of compulsive sexual behaviours (CSBs). Untreated sexual compulsivity may facilitate relapse for treatment-seeking men. Previous research and theory suggest that CSBs are maintained by efforts to escape or alter negative affect (e.g., depression and anxiety). However, this hypothesis has not been examined within a sample of men in treatment for substance use disorders. In an effort to better understand CSBs within a population of men with substance use disorders, the present study is the first to examine experiential avoidance as one potential mechanism underlying the relation between men's symptoms of depression and anxiety and their use of CSBs. The present study reviewed medical records of 150 men in residential treatment for substance use disorders. Structural equation modelling was used to examine pathways from men's depression and anxiety symptoms to CSBs directly and indirectly through experiential avoidance while controlling for alcohol/drug problems and use. Results revealed significant indirect effects of both depression and anxiety symptoms on CSB through experiential avoidance. These results support and extend existing research on CSB in a treatment population. Findings suggest that intervention efforts for CSB may benefit by targeting men's avoidance of painful internal events. KEY PRACTITIONER MESSAGE: Compulsive sexual behaviour is related to symptoms of depression and anxiety amongst men in residential treatment for substance use disorders. Experiential avoidance is positively related to compulsive sexual behaviour amongst men with substance use disorders. For men in treatment for substance use disorders, the relation between symptoms of depression and anxiety and compulsive sexual behaviour is explained, in part, by experiential avoidance. Helping men with substance use disorders develop more adaptive methods of processing aversive experiences, as opposed to escaping them, may reduce their use of compulsive sexual behaviours when faced with aversive affect.

Clinicians' Beliefs, Observations, and Treatment Effectiveness Regarding Clients' Sexual Addiction and Internet Pornography Use.

This study addressed how sex addiction and problematic IP use present to mental health professionals (MHPs), and how MHPs conceptualize and treat these issues. MHPs (N = 183) reported on beliefs about, experiences with, and treatment of problematic sexual behaviors (PBS). Most MHPs saw clients with PBS, but most do not feel competent to treat PBS. Specialized MHPs endorsed seeing more clients with PBS and feeling more effective than nonspecialists. Sexual addiction and problematic IP use share similarities, but differ in etiology and co-occurring problems. Diagnostic ambiguity, insufficient knowledge, and limited dissemination may hinder MHPs ability to assess and treat PBSs.

Mindfulness, emotional dysregulation, impulsivity, and stress proneness among hypersexual patients.

OBJECTIVE: The current study explores relationships between mindfulness, emotional regulation, impulsivity, and stress proneness in a sample of participants recruited in a Diagnostic and Statistical Manual of Mental Disorder Fifth Edition Field Trial for Hypersexual Disorder and healthy controls to assess whether mindfulness attenuates symptoms of hypersexuality. METHOD: Hierarchal regression analysis was used to assess whether significant relationships between mindfulness and hypersexuality exist beyond associations commonly found with emotional dysregulation, impulsivity, and stress proneness in a sample of male hypersexual patients (n = 40) and control subjects (n = 30). RESULTS: Our results show a robust inverse relationship of mindfulness to hypersexuality over and above associations with emotional regulation, impulsivity, and stress proneness. CONCLUSIONS: These results suggest that mindfulness may be a meaningful component of successful therapy among patients seeking help for hypersexual behavior in attenuating hypersexuality, improving affect regulation, stress coping, and increasing tolerance for desires to act on maladaptive sexual urges and impulses.

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.

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.

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.

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.

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.

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.

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).