Dark Tetrad personality traits, paraphilic interests, and the role of impulsivity: an EEG-study using a Go/No-Go paradigm.

Maladaptive personality traits, such as 'dark personalities' are found to result in a diverse set of negative outcomes, including paraphilic interests and associated (illegal) behaviors. It is however unclear how these are exactly related, and if related, if then only those individuals higher on dark personality traits and higher impulsivity engage in paraphilic behaviors. In the current study, 50 participants were recruited to investigate the relationship between Dark Tetrad personality traits (i.e., narcissism, psychopathy, Machiavellianism and everyday sadism), paraphilic interests (arousal and behavior) and the moderating role of impulsivity. Personality and paraphilic interests were investigated through self-report questionnaires. Impulsivity was measured both through self-reported dysfunctional impulsivity and the P3 event related potential using electroencephalography during the Go/No-Go task (i.e. response inhibition). The results showed that there was a positive association between psychopathy, sadism and paraphilic interests. Whereas everyday sadism was associated with paraphilic (self-reported) arousal, psychopathy was associated with paraphilic behavior. Although P3 amplitude was not associated with paraphilic interests, self-reported dysfunctional impulsivity was associated with paraphilic behavior specifically. However, there was no moderating role of dysfunctional impulsivity and response inhibition (P3) in the relationship between psychopathy and paraphilic behavior. Findings indicate that the relation between specific dark personalities and paraphilic interests may be more complex than initially thought. Nevertheless, risk assessment and intervention approaches for paraphilia and related behavior both may benefit from incorporating Dark Tetrad and impulsivity measurements.

An Evolutionary Psychological Approach Toward BDSM Interest and Behavior.

Bondage/discipline, Dominance/submission, and Sadism/Masochism (BDSM) have gained increased attention and discussion in recent years. This prevalence is accompanied by a shift in perceptions of BDSM, including the declassification of sadomasochism as a paraphilic disorder. Evolutionary psychology offers a unique perspective of why some individuals are interested in BDSM and why some prefer certain elements of BDSM over others (e.g., dominance versus submission). In this paper, we examine BDSM from an evolutionary standpoint, examining biopsychosocial factors that underlie the BDSM interests and practice. We articulate this perspective via an exploration of: proximate processes, such as the role of childhood experiences, sexual conditioning, and physiological factors; as well as ultimate explanations for power play and pain play dimensions of BDSM, highlighting the potential adaptive advantages of each. While BDSM may not be adaptive in itself, we examine the literature of sex differences in BDSM role preferences and argue that these preferences may stem from the extreme forms of behaviors which enhance reproductive success. In the realm of pain play, we explore the intersection of pain and pleasure from both physiological and psychological perspectives, highlighting the crucial role of psychological and play partner factors in modulating the experience of pain. Finally, we encourage future research in social sciences to utilize evolutionary frameworks to further explore the subject and help alleviate the mystification surrounding BDSM. This multifaceted exploration of BDSM provides valuable insights for clinicians, kink-identified individuals, and scholars seeking to understand the evolutionary perspectives of human sexual behavior and preferences.

[Chemsex - drug use primarily orientated around a sexual experience - Patients that fall through the gaps].

INTRODUCTION: Drug use in a sexualised context provides unique challenges both in specialised clinics (psychiatric and sexual health clinics) as well as general practice. Layered onto this leads some inequalities in health care to poorer outcomes in specific groups. This article aims to provide evidence based harm reduction strategies that can easily be applied in primary care to reduce complications, identify those at higher risk and deploy appropriate treatments.

Assessment and treatment of compulsive sexual behavior disorder: a sexual medicine perspective.

INTRODUCTION: The addition of compulsive sexual behavior disorder (CSBD) into the ICD-11 chapter on mental, behavioral, or neurodevelopmental disorders has greatly stimulated research and controversy around compulsive sexual behavior, or what has been termed "hypersexual disorder," "sexual addiction," "porn addiction," "sexual compulsivity," and "out-of-control sexual behavior." OBJECTIVES: To identify where concerns exist from the perspective of sexual medicine and what can be done to resolve them. METHODS: A scientific review committee convened by the International Society for Sexual Medicine reviewed pertinent literature and discussed clinical research and experience related to CSBD diagnoses and misdiagnoses, pathologizing nonheteronormative sexual behavior, basic research on potential underlying causes of CSBD, its relationship to paraphilic disorder, and its potential sexual health consequences. The panel used a modified Delphi method to reach consensus on these issues. RESULTS: CSBD was differentiated from other sexual activity on the basis of the ICD-11 diagnostic criteria, and issues regarding sexual medicine and sexual health were identified. Concerns were raised about self-labeling processes, attitudes hostile to sexual pleasure, pathologizing of nonheteronormative sexual behavior and high sexual desire, mixing of normative attitudes with clinical distress, and the belief that masturbation and pornography use represent "unhealthy" sexual behavior. A guide to CSBD case formulation and care/treatment recommendations was proposed. CONCLUSIONS: Clinical sexologic and sexual medicine expertise for the diagnosis and treatment of CSBD in the psychiatric-psychotherapeutic context is imperative to differentiate and understand the determinants and impact of CSBD and related "out-of-control sexual behaviors" on mental and sexual well-being, to detect forensically relevant and nonrelevant forms, and to refine best practices in care and treatment. Evidence-based, sexual medicine-informed therapies should be offered to achieve a positive and respectful approach to sexuality and the possibility of having pleasurable and safe sexual experiences.

Childhood Adversity and Offense-Supportive Cognitions Among Czech Adults with a Sexual Interest in Violence or Children.

Individuals with paraphilic interests in sexual violence or children may be more likely to sexually offend if they possess offense-supportive cognitions. These cognitions may develop in response to childhood adversity. However, this idea is largely based on research in men convicted of sexual offenses and may not generalize to non-incarcerated adults with paraphilic interests. In a sample of 178 adults screened for paraphilic interests in violence or children (from the general Czech population), we hypothesized that childhood sexual abuse and emotional neglect would be associated with offense-supportive cognitions about rape and child molestation. Participants came from a nationally representative sample of Czech adults and were selected if they self-reported high levels of sexual interest in violence and/or children. Participants completed an online survey with self-report measures of sexual orientation, offense-supportive cognitions (Bumby RAPE and MOLEST scales), and childhood sexual abuse and emotional neglect (Childhood Trauma Questionnaire). Controlling for gender, age, and sexual orientation, we found that both rape-supportive cognitions and child molestation-supportive cognitions were significantly associated with higher levels of childhood sexual abuse, but not emotional neglect. These findings indicate that childhood sexual abuse may lead to offense-supportive cognitions among men and women with paraphilia.

Reexamining predictors of trial outcomes in New York State's sex offender civil management process.

OBJECTIVE: In 2007, New York enacted the Sex Offender Management and Treatment Act, empowering the state to civilly manage individuals who have committed sexual offenses (respondents) and are deemed to have a mental abnormality (MA) that predisposes them to sexually recidivate after serving their criminal sentences. We sought to replicate and extend a previous study (Lu et al., 2015) to identify factors predicting legal decisions. HYPOTHESES: We predicted, on the basis of previous research, that clinical information (e.g., diagnosis) as well as empirically supported risk factors (e.g., sexual deviance) would predict trial outcomes. METHOD: We analyzed multiple pieces of demographic, criminogenic, and clinical data on three nested subsamples of respondents on the basis of the legal process: MA consent (n = 713), MA trial (n = 316), and disposition hearing (n = 643). The binary outcomes of interest were as follows: For the MA consent subsample, it was whether the respondent waived their MA trial; for the MA trial subsample, it was whether the respondent was found at trial to have an MA; and for the disposition hearing, it was whether the respondent was ordered to inpatient or outpatient civil management. RESULTS: The strongest predictor of waiving the trial was geographic location; respondents outside New York City and Long Island were more likely to waive their trials (ORs = 2.38-3.37). The strongest predictors of MA trial and disposition hearing outcomes were Diagnostic and Statistical Manual of Mental Disorders diagnoses; pedophilia (ORs = 4.05-7.22) and sexual sadism (ORs = 2.68-7.03) diagnoses increased the likelihood of an MA finding and confinement order. CONCLUSIONS: Judges and juries give significant weight to clinical information, particularly pedophilia diagnoses, when making civil management legal decisions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Viewing Reaction Time as a Diagnostic Tool of Pedohebephilia in the Dunkelfeld.

Diagnosing pedohebephilia is fraught with obstacles given the tabooed nature of this sexual preference. The viewing reaction time effect (VRT) provides a non-intrusive indirect measure of sexual interest in minors. In forensic populations, the ability of the difference between the latencies while viewing child and adult sexual stimuli (VRT index) to discern child sexual offenders from a range of control groups has been ascertained meta-analytically. Given that the effect has been studied almost exclusively in forensic samples, its dependence or independence on prior overt (deviant) sexual behavior remains unclear. The present study sought to examine the relationship of prior sexual and non-sexual behaviors with the VRT in a sample of 282 self-referring, help-seeking men with and without pedohebephilia with and without a history of prior child sexual offenses (CSO) or a use of child sexual abuse materials (CSAM) recruited outside a forensic context. We found that (1) the clinical diagnosis of pedohebephilia but not prior CSO or CSAM showed a significant association with the VRT index; (2) the discriminatory ability of the VRT index did not differ significantly between samples with and without a history of prior overt sexual behavior with children; (3) the VRT index correlated positively with a behavioral marker of pedohebephilia in a subsample of individuals with prior judicially detected or undetected overt sexual behavior with children; and (4) in the same subsample, the VRT index correlated positively with markers of sexual interests in minors or hypersexuality but not of antisociality. Equivalence testing failed to refute a potential effect of prior sexual behavior on the VRT index. Our study showed that the VRT may provide an unintrusive diagnostic tool for pedohebephilia. The effect of prior overt sexual behavior with children needs further examination.

Coprophilia and Coprophagia: A Literature Review.

BACKGROUND: Coprophilia and coprophagia are distinct paraphilias that fall under the category of other specified paraphilic disorders in the current edition of the Diagnostic and Statistical Manual of Mental Disorders. Coprophilia refers to sexual excitement from viewing, smelling, or handling feces, as well as fantasizing about another person engaging in these activities. Coprophagia, or eating one's own or another person's excrement, has also been observed in some patients with coprophilia. AIMS: The purposes of this review are to examine the current literature on the etiology, symptoms, interviewing techniques, pharmacotherapy, and psychotherapy used for each disorder and to elicit best practice guidelines in the treatment of patients with coprophila and coprophagia. METHODS: Electronic and hand searches were initiated using CINAHL, EBSCOhost, SAGEpub, and MEDLINE databases between 1990 and 2022 using the terms "coprophilia," "coprophagia," "paraphilia NOS," and "other specified paraphilic disorder" restricted to English. RESULTS: Individual case reports and limited studies were found in this literature. Reported treatment protocols included individual and tandem use of pharmacotherapy and psychotherapy, with mixed outcomes. Future studies are needed to explore the factors that mitigate the paraphilias, therapeutic management, and treatment outcomes, to produce evidence-based practice treatment guidelines. CONCLUSIONS: Understanding the psychological and biological factors that may contribute to these disorders' manifestations may portend a greater understanding and insight into the genesis of the paraphilias. Having specific evidence-based treatment protocols will afford the psychiatric nurse practitioner to render patient-centered, safe, and culturally competent care and effect better patient outcomes among this understudied population.

Paraphilias, Sociodemographic and Forensic Profiles of Men Convicted of Sexual Offenses in Turkey.

This study investigated the psychiatric, paraphilic, and forensic profiles of men who were convicted of sexual offenses. It also examined childhood trauma exposure in the group with potential paraphilia. The study was performed in the closed prison located in the Istanbul Silivri Penal Institutions Campus. The interview data of 100 men convicted of sexual offenses were obtained from the psychiatric interview notes based on the DSM-5 criteria, the results of the 28-item Childhood Trauma Questionnaire administered to the participants with paraphilia, and the forensic profiles from examination files. It was found that 39% of individuals were drug users and 36% were alcohol users. Considering the crime scenes, 42% of men convicted of sexual offenses committed the offense in their own house. Pedophilia was the most common among men with paraphilia (59%). The victim age was significantly lower (p < .001), and the male victim ratio was higher (p < .05) in the group with paraphilia than in the group without paraphilia. Sexual offenses against children aged 10 years and below and against males may be suggestive of paraphilia and an increased risk of recidivism.

Sex-biased gene regulation varies across human populations as a result of adaptive evolution.

OBJECTIVES: Studies of human sexual dimorphism and gender disparities in health focus on ostensibly universal molecular sex differences, such as sex chromosomes and circulating hormone levels, while ignoring the extraordinary diversity in biology, behavior, and culture acquired by different human populations over their unique evolutionary histories. MATERIALS AND METHODS: Using RNA-Seq data and whole genome sequences from 1000G and HGDP, we investigate variation in sex-biased gene expression across 11 human populations and test whether population-level variation in sex-biased expression may have resulted from adaptive evolution in regions containing sex-specific regulatory variants. RESULTS: We find that sex-biased gene expression in humans is highly variable, mostly population-specific, and demonstrates between population reversals. Expression quantitative trait locus mapping reveals sex-specific regulatory regions with evidence of recent positive natural selection, suggesting that variation in sex-biased expression may have evolved as an adaptive response to ancestral environments experienced by human populations. DISCUSSION: These results indicate that sex-biased gene expression is more flexible than previously thought and is not generally shared among human populations. Instead, molecular phenotypes associated with sex depend on complex interactions between population-specific molecular evolution and physiological responses to contemporary socioecologies.

Identifying Relationships Between Difficulties with Emotion Regulation and Compulsive Sexual Behavior.

Emotion dysregulation is an associated feature of compulsive sexual behavior disorder (CSBD), now recognized by the World Health Organization. Previous studies have identified associations between trait emotion dysregulation and CSBD. Given that difficulties with emotion regulation (DERS) is comprised of several facets (e.g., difficulty with impulse control and lacking awareness of one's feelings when upset), and that these facets differentially relate to other mental health concerns, the present study aimed to examine how DERS facets relate to compulsive sexual behavior (CSB). The present study also considered interpersonal emotion regulation via attachment avoidance and attachment anxiety. Hierarchical regression was conducted, first accounting for demographic covariates, then adding attachment styles, and finally all DERS subscales. Results indicated that, among a large, diverse, online U.S. sample (N = 915; Mage = 39.21, SD = 0.81; 54.3% men), difficulty controlling impulses when upset, difficulty with clarity of emotions, and non-acceptance of emotions were significantly positively associated with CSB (small to moderate effects). Attachment anxiety and avoidance were also significantly positively associated with CSB, although their effects were minimal when adding DERS facets. Overall, this study supports the theorized impact of emotion dysregulation on CSB. Assessment of individual differences in DERS and intervening on these concerns are important for treating CSB.

Salivary testosterone levels are associated with Compulsive Sexual Behavior (CSB) in men but not in women in a community sample.

Background and aims: Despite the inclusion of Compulsive Sexual Behavior (CSB) as a diagnostic entity in the ICD-11 and the increasing number of studies addressing psychological factors leading to its onset and maintenance, little is known about the role of hormonal factors when accounting for this clinical condition (especially in women). This study aimed to provide insights into the association between testosterone levels (i.e., the androgen more intimately linked to sexual desire and arousability) and CSB in both men and women. Methods: A total of 80 participants (40 men [Mage = 22.31; SD = 2.93] and 40 women [Mage = 21.79; SD = 2.06]) provided a saliva sample for the estimation of the level of free testosterone and completed a battery of measures assessing CSB and other related sexual domains (sexual sensation seeking and online/offline sexual behavior). Results: In men, salivary testosterone had a positive and significant correlation with three scales assessing CSB (r between 0.316 and 0.334). In women, these correlations were small and non-significant (r between 0.011 and 0.079). In both men and women, the level of salivary testosterone had small non-significant correlations with the other domains of sexual behavior assessed. Discussion and conclusions: Individuals' level of testosterone may contribute to the etiopathogenesis of CSB, but only in men. In women, alternative psychological -i.e., motivational, behavioral, or cognitive- processes may be playing a more central role in the expression of this condition.

Compulsive sexual behavior disorder in 42 countries: Insights from the International Sex Survey and introduction of standardized assessment tools.

Background and aims: Despite its inclusion in the 11th revision of the International Classification of Diseases, there is a virtual paucity of high-quality scientific evidence about compulsive sexual behavior disorder (CSBD), especially in underrepresented and underserved populations. Therefore, we comprehensively examined CSBD across 42 countries, genders, and sexual orientations, and validated the original (CSBD-19) and short (CSBD-7) versions of the Compulsive Sexual Behavior Disorder Scale to provide standardized, state-of-the-art screening tools for research and clinical practice. Method: Using data from the International Sex Survey (N = 82,243; Mage = 32.39 years, SD = 12.52), we evaluated the psychometric properties of the CSBD-19 and CSBD-7 and compared CSBD across 42 countries, three genders, eight sexual orientations, and individuals with low vs. high risk of experiencing CSBD. Results: A total of 4.8% of the participants were at high risk of experiencing CSBD. Country- and gender-based differences were observed, while no sexual-orientation-based differences were present in CSBD levels. Only 14% of individuals with CSBD have ever sought treatment for this disorder, with an additional 33% not having sought treatment because of various reasons. Both versions of the scale demonstrated excellent validity and reliability. Discussion and conclusions: This study contributes to a better understanding of CSBD in underrepresented and underserved populations and facilitates its identification in diverse populations by providing freely accessible ICD-11-based screening tools in 26 languages. The findings may also serve as a crucial building block to stimulate research into evidence-based, culturally sensitive prevention and intervention strategies for CSBD that are currently missing from the literature.

Between submission and pain. Shades of BDSM practices. / Miedzy zaleznoscia a bólem. Odcienie praktyk BDSM.

Many people are interested in BDSM practices. Some people practice and others fantasize about participating in these practices. Several elements are related to BDSM practices that are usually unaccepted in a close relationship, such as a strong dependence of one partner on the other or inflicting pain. BDSM practitioners create various relationships, and in a broader context, their communities. From a clinical perspective, an important issue is whether BDSM relation is consensual and serves the personal and relationship development or it can be a premise for the diagnosis of a paraphilic disorder, or recognizing abuse or mechanism of trauma repetition Adequate understanding of the behaviors that may be described by a patient practicing BDSM requires, however, getting to know the specifics of such relationships. The mental and sexual health professional would be able then to evaluate them adequately, without referring to a subjective norm or bias on stereotype or prejudice.

Discrimination, stigma and mental health: what's next?

Stigma and discrimination are a major ongoing problem in the field of mental health as these impact on patient outcomes, access to and acceptability of therapeutic interventions, their quality of life, general wellbeing, social inclusion and opportunities. Social stereotypes, culture and prejudices all contribute to continuing discrimination in mental health. Different settings where people function may also be sources of discrimination such as work and educational environments. The lack of knowledge and understanding of mental health/illness by individuals, their families, carers and policymakers as well as the social media reporting also impact on social attitudes to discrimination. It has been also described a relevant impact of stigma among specific social minorities reporting poor mental health such as elderly people, youths, sexual variants, persons with disability. Educational programs, raising awareness trainings and proper public policies may be developed in order to reduce stigma at social level with favourable outcomes for people with mental illness.

The Dual Control Model of Sexual Response: A Scoping Review, 2009-2022.

The Dual Control Model proposes that sexual arousal and related processes are dependent on the balance between sexual excitation and sexual inhibition, and that individuals vary in their propensity for these processes. This scoping review provides an overview and discussion of the questionnaires used to measure the propensities for sexual excitation and inhibition, their translation and validation in other languages, and their application in empirical research on topics ranging from sexual desire and arousal, sexual (dys)function, sexual risk taking, asexuality, hypersexuality, and sexual aggression. A total of 152 papers, published between 2009 and 2022 and identified using online databases, were included in this review. The findings, consistent with those reviewed by Bancroft et al. (2009), suggest that sexual excitation is particularly relevant to sexual desire and responsivity and predictive of asexuality and hypersexuality. Sexual inhibition plays a role in sexual dysfunction. sexual risk taking, and sexual aggression, although often in interaction with sexual excitation. Suggestions for the further development of the model and for future studies are discussed.

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

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