Upcoming Studies From 3rd International Conference on Behavioral Addictions (March 14–16, 2016)

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The following abstracts were taken from the 3rd International Conference on Behavioral Addictions March 14–16, 2016


Internet pornography addiction: Theoretical models, behavioral data, and neuroimaging findings


University of Duisburg-Essen, Duisburg, Germany

Background and aims: Internet pornography addiction (IPA) is considered one specific type of Internet addiction. From substance dependence research, it is well known that addiction can be viewed as a transition from voluntary, recreational drug use to compulsive drug-seeking habits, neurally underpinned by a transition from prefrontal cortical to striatal control over drug seeking and taking (Everitt & Robbins, 2015).

Methods: These concepts have been recently transferred to Internet addiction in general, and IPA in specific. For example, in two recently published theoretical models on Internet addiction (Brand et al., 2014) and specifically on Internet Gaming Disorder (Dong & Potenza, 2014), cognitive processes and emotional responses to specific Internet-related cues are considered crucial in the development and maintenance of the addictive behavior. These models are investigated in the context of PA.

Results: Behavioral data support the theoretical assumption showing that cue-reactivity and craving can be demonstrated in individuals with IPA. Also, executive reductions and reduced inhibitory control when being confronted with pornographic material increase the probability of experiencing a loss of control over the consumption of pornography. Functional neuroimaging findings suggest specific brain correlates of IPA, which are comparable with those reported in individuals with Internet Gaming Disorder and other behavioral addictions as well as substance dependence. Particularly the ventral striatum, a region associated with reward anticipation, responds to the confrontation with explicit pornographic material in subjects with IPA.

Conclusions: Existing findings suggest that IPA is a specific type of Internet addiction, which is comparable with Internet Gaming Disorder and other types of behavioral addictions.


Incentive salience and novelty in compulsive sexual behaviors


University of Cambridge, Cambridge, United Kingdom

Compulsive sexual behaviors (CSB) or sexual addiction are commonly hidden and can be associated with marked distress. The behaviors occur commonly in the general population at 2–4% and can be associated with dopaminergic medications used in the treatment of Parkinson’s disease at a similar frequency of 3.5%. In preclinical studies, sexual motivation is associated with dopaminergic mechanisms. This talk will focus on evidence supporting a role for incentive motivation theories. CSB is associated with enhanced reactivity to sexual cues of a neural network implicated in drug cue reactivity studies with greater subjective ‘wanting’ associated with enhanced connectivity of this network. The sexual cues are associated with enhanced early attentional bias which link with a greater preference for cues conditioned to sexual rewards. Functional connectivity of this saliency network is decreased at rest and influenced by depression scores. CSB is also associated with greater preference for novel sexual imagery linked to enhanced dorsal cingulate habituation to sexual outcomes. These findings highlight a relationship with incentive motivation and negative emotionality theories of addiction and emphasize a role for habituation and preference for sexual novelty that might be unique to online sexual materials


Gender differences between males and females in sex addiction – Psychological and social Characteristics and implications in treatment


MSW Argaman Institute Tel Aviv, Israel

Background and aims: According to researchers and therapists around the world, the prevalence of sex addiction in the United States ranges from 3–8%. Social awareness to the problem in the 70s and 80s, focused primarily on men sex addicts and myths in relation to sex addiction present it as a masculine phenomenon. In recent years, there is a growing recognition that women also suffer from sex and love addiction, and there is a growing need for treatment adjustments. However, social perceptions related to the sexual behavior of men and women in general and hyper-sexuality in particular (double standard) stops many women from turning to help. Although we can find similarities in sex addiction among men and women there are also significant differences that may affect the unique therapeutic needs of women. Differences in the perception of the romantic and sexual relationship between men and women. Difficulty in defining the problem by the woman herself or by therapists. Different types of sexual behaviors and their etiology – with men sexual behavior focuses mainly on objectifying and emotional detachment (sexual stimulation), while in women the focus is on attachment and self-objectification (sexually stimulating relationship). Severe consequences of sexual behavior on women, medical (STI / STD, unwanted pregnancy), psychological (humiliation, shame), rape and sexual abuse. The presentation will focus on gender differences both in personal and social perspectives and therapeutic perspective.


Exploring the Pathways Model for Problem Gamblers in Hypersexual Patients


University of California Los Angeles, Los Angeles, CA, US

Background and aims: While there has been an increase in the amount of research linked to hypersexual behavior over the past decade, there is a paucity of work highlighting the etiology, risk factors, or possible pathways through which hypersexuality may arise.

Methods: We examined NEO-Personality Inventory data from the DSM-5 Field Trial for Hypersexual Disorder among men (N = 254) who were classified as meeting the threshold.

Results: We hypothesized 3 latent classes of hypersexual patients based on the pathways model commonly applied to those with gambling disorder. The data was explored using Latent Class Analysis (LCA) with alternative models compared to the hypothesized latent classes. The 3 classes model was supported with facets of personality paralleling the pathways model among problem gamblers.

Conclusion: This is the first study to compare the pathways model common to gamblers with hypersexual patients. The parallel in data between hypersexual behavior and gambling disorder suggests these two patterns of de-regulated behaviors may share common pathways in their development.


One or Multiple Neural Mechanisms of Problematic Pornography Use?


University of California San Diego, San Diego, USA Polish Academy of Science, Warsaw, Poland

Background and aims: Clinicians and researchers often hesitate how to conceptualize problematic pornography use (PPU). The two most discussed frameworks are behavioral addiction and compulsion. Neuroscientific studies on pornography use and compulsive sexual behaviors (CSB) indicate a significant involvement of brain reward circuits in such conditions and the similarities with other addiction-related behaviors. However, clinical observations and recent studies on risky sexual behaviors and problematic alcohol use show that reward circuitry disruption is not the only possible neural mechanism of problematic behaviors. Due to recent findings, addictive behaviors may be underlined either by increased reward system reactivity for appetitive cues or increased amygdala threat-reactivity.

Methods: Here we present our studies on paroxetine treatment of PPU and role of amygdale threat-reactivity in this condition.

Results and Conclusions: We will discuss the meaning of these findings for PPU and CSB treatment as well as for directions of future neuroscience research.


A Review on Pharmacotherapy and Management of Hypersexual Behavior


Islamic Azad University, Tehran, Tehran, Iran

Background and aims: There has been a growing interest in the area of pharmacotherapy of sexual disorders in the recent years. Different hormonal levels, neurotransmitters, receptors, and brain areas involved in sexual desire have been yet identified. However, there is still incomplete understanding of neurobiology of hypersexual behavior. Various pharmacological agents have been reported to decrease sexual behavior. The aim of the present article was to review pharmacological treatments available for patients with hypersexual behavior. Moreover, mechanism of action, dosages and algorithm of use of the available treatments were discussed. Optional new treatments undergoing clinical trials were also mentioned.

Methods: Studies were identified by searching electronic databases of Medline, PsycINFO, Cochrane Library, and Clinical Trial Registers. All eligible studies investigating efficacy and safety of the pharmacological treatments for patients with hypersexual disorder conducted between 2000 and 2015 were included in the present article.

Results: Current pharmacotherapies include Selective Serotonin Reuptake Inhibitors (SSRIs), Antiandrogens, and Gonadotropin-releasing hormone agonists. The most commonly used pharmacotherapy is reported to be SSRIs. However, Anti-androgen therapy has been reported to decrease sexual desire and have an effect size comparable to cognitive behavioral therapy. Gonadotropin-releasing hormone agonists were reported to be treatment options for patients with severe hypersexual disorder.

Conclusions: The use of pharmacotherapy integrated with behavioral and cognitive therapies is recommended. There are still gaps in the knowledge regarding pharmacotherapy of hypersexual disorder. Development of agents with more efficacy and better safety profiles are needed


Overactive Stress System Linked to Hypersexual Disorder in Men



Karolinska Institute, Stockholm, Sweden

Background and aims: Hypersexual disorder integrates pathophysiological aspects such as sexual desire deregulation, sexual addiction, impulsivity and compulsivity. However, little is known about the neurobiology behind this disorder. A dysregulation of the hypothalamic pituitary adrenal (HPA) axis has been shown in psychiatric disorders but has not been investigated in hypersexual disorder. The aim of this study was to investigate the function of the HPA axis in men with hypersexual disorder.

Methods: The study includes 67 male patients with hypersexual disorder and 39 healthy male volunteers. The Sexual Compulsive scale (SCS), Hypersexual Disorder Current Assessment Scale (HD:CAS), Montgomery-Åsberg Depression Scale-Self Rating (MADRS-S) and Childhood Trauma Questionnaire (CTQ), were used in assessing hypersexual behavior, depression severity, and early life adversity. Basal morning plasma levels of cortisol and ACTH were assessed and low dose (0.5mg) dexamethasone suppression test was performed with cortisol and ACTH measured post dexamethasone administration. Non-suppression status was defined with DST-cortisol levels _138nmol/l.

Results: Patients with hypersexual disorder were significantly more often DST non-suppressors and had significantly higher DST-ACTH levels compared to healthy volunteers. The patients reported significantly more childhood trauma and depression symptoms compared to healthy volunteers. CTQ scores showed a significant negative correlation with DST-ACTH whereas SCS and HD: CAS scores showed a negative correlation with baseline cortisol in patients. The diagnosis of hypersexual disorder was significantly associated DST non-suppression and higher plasma DST-ACTH even when adjusted for childhood trauma. Sensitivity analysis omitting patients with comorbid depression diagnosis did not change the results.

Conclusions: The results suggest HPA axis dysregulation in male patients with hypersexual disorder. We will discuss these findings and future research on neurobiological markers of hypersexual disorder.


Losing Control: Clinical characteristics of men interested in treatment for use of pornography


VA Connecticut Healthcare System, West Haven, Connecticut, USA

Background and aims: The current study investigated the prevalence of, and factors associated with, men’s interest in seeking treatment for use of pornography.

Methods: Using the Internet, we recruited 1298 male pornography users to complete questionnaires assessing demographic and sexual behaviors, hypersexuality, pornography-use characteristics, and current interest in seeking treatment for use of pornography.

Results: Approximately 14% of men expressed an interest in seeking treatment for use of pornography. Treatment-interested men had 9.5 higher odds of reporting clinically significant levels of hypersexuality compared to treatment-disinterested men. Bivariate analyses also found that treatment-interested men were less likely to be married/partnered, but consumed more pornography weekly, masturbated more often, and had more past attempts to cut back or quit using pornography compared to treatment-disinterested men. Regression analysis found that daily pornography use, frequent past attempts to cut back or quit using pornography and scores on the Hypersexual Behavior Inventory Control subscale were predictors of interest-in-seeking-treatment status.

Conclusions: Current study findings could help develop screening practices aimed at identifying specific aspects of sexual self-control (i.e., “loss of control”), impulsivity, and/or compulsivity associated with excessive/problematic use of pornography among treatment-seeking individuals.


Specific Forms of Passionate Attachment Differentially Mediate Relationships between Pornography Use and Sexual Compulsivity


Connecticut Healthcare System, West Haven, Connecticut USA

Background and aims: The current study examined the mediational role of two types of “passionate attachment” in the relationship of pornography use and sexual compulsivity. Harmonious passion refers to when a person’s sexual behavior is in harmony with other areas of his or her life. Obsessive passion refers to an “uncontrollable urge” to engage in sexual activity that creates conflict with other areas of a person’s life and contributes to personal distress.

Methods: Using the Internet, we recruited 265 university men to complete questionnaires assessing demographics, pornography-use characteristics, passionate attachment for pornography and sexual compulsivity (non-specific to pornography). Relationships between study variables were examined using structural path modeling analysis.

Results: Harmonious passion ratings were found to significantly, though partially, mediate the relationship between weekly pornography use and sexual compulsivity ratings. Obsessive passion ratings were found to fully mediate the relationship between weekly pornography use and sexual compulsivity ratings. When a fully specified two-mediator model was employed, only obsessive passion remained a significant predictor of sexual compulsivity. The relationship between weekly pornography use and sexual compulsivity was fully explained by obsessive passion ratings, while harmonious passion was not found to contribute to sexual compulsivity scores, above and beyond the effect of obsessive passion.

Conclusions: The findings that obsessive passion, but not harmonious passion, links pornography use and sexual compulsivity suggests that obsessive forms of passionate attachment may represent a target for treatment development for reducing and eliminating problematic pornography use or other compulsive sexual behaviors.


In the mood to watch pornography? The role of general versus situational mood for Internet pornography addiction


University of Duisburg-Essen, Duisburg, Germany

Background and aims: Pathological Internet pornography use is considered a specific Internet addiction (Young, 2008). In a recent cognitive-behavioral model of Internet pornography addiction (IPA), positive and negative reinforcement resulting from Internet pornography use were hypothesized to be important mechanisms in the development of IPA (Laier & Brand, 2014). This study investigates mood changes due to Internet pornography use in relationship with tendencies toward IPA.

Methods: Male participants (N = 39) were investigated using an online survey with two parts: In the first assessment, demographic information, tendencies towards IPA, Internet pornography use motivation, and general mood were assessed. In the second assessment, participants were asked to indicate their sexual arousal and their actual mood before and after a voluntarily, self-determined use of Internet pornography at home.

Results: The results showed that tendencies toward IPA correlated with emotional avoidance and excitement seeking due to Internet pornography use, but not with general mood. Furthermore, tendencies toward IPA correlated with nervousness before Internet pornography use. Internet pornography consumption led to a decrease of sexual arousal, better mood, and less nervousness.

Conclusions: The findings demonstrated that tendencies toward IPA were related to the Internet pornography use motivation to find gratification and to cope with aversive emotional states. Moreover, IPA was associated with aversive mood prior to voluntary Internet pornography use. Together with the observation that Internet pornography use changed mood, the results support theoretical assumptions that besides gratification also negative reinforcement plays an important role in the development of IPA.


What is Hypersexuality? An Investigation of Psychological Mechanisms in Men who have Sex with Men



1University of Minnesota Medical School, Duluth, MN, USA

2University of Minnesota, Minneapolis, MN, USA

3KU Leuven, Leuven, Flanders, Belgium

4University of Kansas, Lawrence, KS, USA

5University of Minnesota Medical School, Minneapolis, MN, USA

Background and Aims: The major criticism of hypersexuality has been the lack of empirical support for any of the conceptualizations put forward to explain it. This study is designed to investigate personality, cognitive, and psychophysiological factors that have been hypothesized to characterize hypersexuality by numerous authors.

Methods: Participants were 243 men who have sex with men recruited using both on-line and community-based venues, programs, and word of mouth. Participants must have had sex with a man in the last 90-days, have no indications of major thought disorder or cognitive dysfunction, and be at least 18 years of age. Participants were assigned to a hypersexual disorder or comparison group based on a SCID-type interview. Data included three cognitive tasks, a self-report computer administered questionnaire, and a psychophysiological assessment of sexual arousal following mood induction.

Results: Results showed group differences in personality factors, sexual behavioral control, and experiences of sexual urges and fantasies. Sexual behavior control was related to sexual excitation and sexual inhibition, but not to more general behavioral arousal or behavior inhibition. Hypersexual participants showed lower levels of physiological arousal during the laboratory procedure, but did not show differences in inhibition of arousal by negative affect.

Conclusions: We found that while hypersexuality is related to broad personality factors, the lack of sexual behavioral control appears to be related to arousal and inhibitory factors specific to sexual behavior and not general behavioral arousal and inhibitory systems. Further, our data is contradictory with respect to whether hypersexuality can be explained by higher levels of sexual arousal/excitation.


Differences between problematic and non-problematic Internet pornography users: The role of sexual excitability and hypersexual behaviors


University of Duisburg-Essen, Duisburg, Germany

Background and aims: The classification of Internet pornography addiction (IPA) is still discussed controversially. Some authors consider IPA as one specific type of Internet addiction (Brand et al., 2014). Theoretically, habitual sexual excitability and hypersexual behavior are specific predispositions for the development and maintenance of IPA. In the current study, problematic and healthy Internet pornography users were compared regarding sexual excitability and hypersexuality.

Methods: Out of a sample of overall N = 274 male participants, two groups (both n = 25) consisting of healthy and problematic IP users were extracted ex post facto by using the short Internet Addiction Test modified for cybersex that measures tendencies towards IPA. These groups were compared regarding their self-reports on general sexual excitability (Sexual Excitation Scale) and hypersexual behavior (Hypersexual Behavior Inventory).

Results: The results showed significant differences between problematic and non-problematic IP users regarding sexual excitability and hypersexual behavior. Further, problematic IP users reported significantly higher scores on both scales. No differences were found for sexual inhibition.

Discussion and Conclusions: Overall, the results underline the importance of specific predispositions for the development and maintenance of IPA and strengthen the theoretical model developed for specific Internet addiction. Moreover, results support the gratification hypothesis (Young, 2004), whereby the anticipation and the reception of sexual arousal can be seen as a major factor in developing IPA. To further evaluate the theoretical model by Brand and colleagues, other crucial factors like dysfunctional coping strategies and psychological symptom severity need to be tested for problematic and non-problematic IP users.


Advancing Understanding of DSM-5 Non-Substance-Related Disorders: Comparing Hypersexuality and Gambling Disorder


University of California Los Angeles, Los Angeles, CA, USA

Background and Aims: The past decade has seen an increase in research investigating de-regulated hypersexual behavior and gambling disorder. Collectively classified as behavioral addictions, little has been done to explore commonalities between different manifestations of de-regulated behavior. The current study reports findings comparing characteristics of gambling disorder with the proposed classification criteria for hypersexual disorder for the DSM-5.

Methods: Self-report questionnaires measuring common indices reflecting stress proneness, emotional dysregulation, and impulsivity were administered to separate groups of treatment seeking patients with gambling disorder (n = 77) or individuals meeting criteria for the DSM-5 hypersexual disorder (n = 74).

Results: Multivariate statistics were used to explore group differences across study variables. Both groups showed comparable scores across measures and both groups had scores significantly higher than those observed in norming groups for the psychometric properties of each scale. Examination of effect sizes also supported the lack of significant differences between groups.

Conclusions: While understanding about the etiology of these disorders continues to evolve, the underlying issues that precipitate and perpetuate these patterns of de-regulated behavior may be similar. These results suggest that problem gamblers and hypersexual patients may engage in dysfunctional behavior for similar reasons and that interventions targeting stress coping, impulsivity, and emotional regulation may generalize to both populations.


Internet pornography addiction and attentional bias towards pornographic pictures in a sample of regular male and female cybersex users


University of Duisburg-Essen, Duisburg, Germany

Background and aims: Research on Internet pornography addiction (IPA) as a form of specific Internet addiction has received growing attention in the past years. Recent studies indicated analogies to substance dependencies, for which attentional bias is considered a crucial mechanism in the addiction process. The underlying study investigated relationships between attentional bias and tendencies toward IPA in a sample of regular male and female cybersex users.

Methods: In this study male (n = 60) and female (n = 60) regular cybersex users completed an Addiction Stroop (Bruce & Jones, 2004) and a Visual Probe Task (Mogg et al., 2003), which were modified with pornographic pictures. Sexual sensation seeking and tendencies toward IPA were assessed with questionnaires.

Results: The results show that male participants had significantly higher scores regarding attentional bias, sexual sensation seeking, and tendencies toward IPA. However, moderated regression analyses did not reveal any significant interactions of sex and attentional bias on tendencies toward IPA.

Conclusions: Overall, results suggest differences in male and female cybersex users regarding the relative strength of attentional bias towards pornographic pictures as well as tendencies towards IPA. This strengthens the assumption that IPA might be more prevalent in men, while higher attentional bias scores could be referred to a higher pornography consumption of men. However, our findings suggest that an attentional bias towards pornographic pictures might be a crucial mechanism in both men and women for developing and maintaining an IPA.


Approach bias towards explicit sexual stimuli and sexual motivation


Justus Liebig University, Gießen, Germany

Background and aims: Explicit sexual material attracts attention. However, the question whether trait sexual motivation modulates this attentional bias is still under debate.

Methods: In the present study we use a joystick taskto measure biases in approach and avoidance behavior in females and males. The subjects had to pull or push a joystick to shrink or enlarge positive, negative or explicit sexual pictures. It was assumed that the reaction times differ with regard to the direction of movement (approach or withdrawal) and the emotional value of the pictures, resulting in specific biases. Further we measured trait sexual motivation, a psychological construct related to sexual drive, using a questionnaire.

Results: The first analyses revealed that the biases towards sexual stimuli measured by the applied experimental approach were minimal and the relation to trait sexual motivation was not statistically significant.

Discussion: The results will be presented in detail at the conference and the implications will be discussed


Gender differences in sex addiction


Ariel University, Ari’el, Israel

Background and aims: sexual addiction – otherwise known as compulsive sexual behavior – is associated with serious psycho-social problems and risk-taking behavior. The aim of this study was to investigate sex differences among men and women who use sites on the Internet dedicated to pornography and cybersex.

Methods: the study used the Cybersex addiction test, Craving for pornography questionnaire, and a Questionnaire on intimacy among 267 participants (192 males and 75 females). Participants’ mean age for males was 28.16 (SD = 6.8) and for females 25.5 (SD = 5.13). They used sites that are dedicated to pornography and cybersex on the Internet.

Results of regression analysis indicated that pornography, gender, and cybersex significantly predicted difficulties in intimacy and it accounted for 66.1% of the variance of rating on the intimacy questionnaire. Second, regression analysis also indicated that craving for pornography, gender, and difficulties in forming intimate relationships significantly predicted frequency of cybersex use and it accounted for 83.7% of the variance in ratings of cybersex use. Third, men had higher scores of frequency of using cybersex than women [t(2,224) = 1.97, p < 0.05] and higher scores of craving for pornography than women [t(2,265) = 3.26, p < 0.01] and no higher scores on the questionnaire measuring difficulties in forming intimate relationship than women [t(2,224) = 1, p = 0.32].

Conclusions: These findings support previous evidence for sex differences in compulsive sexual behavior. We will also describe the psycho-biological evidence for gender differences in sex addiction


Social anxiety contributes to sex addiction among individuals who use a dating application on the Internet


Ariel University, Ari’el, Israel

Background and Aims: there is an increasing trend in the use of the Internet for dating and sexual purposes (“Tinder”). The aim of this study was to investigate the effects of social anxiety, sensation seeking and gender on sex addiction among those who use Internet sites for dating.

Methods: 279 participants (128 males and 151 females) age range: 18–38 years answered questionnaires on the Internet (Google drive). Questionnaires included demographic information, the Leibowitz social anxiety scale, Sensation seeking scale, and Sexual addiction screening test (SAST).

Results: users of Internet dating applications showed higher scores on the SAST than non-users [(t(2,277) = 2.09; p < 0.05)]. Secondly, regression analysis showed that social anxiety accounted significantly to the variance of sexual addiction (Beta = .245; p < .001). Gender or scores on the sensation seeking questionnaire did not contribute significantly to the variance of sexual addiction scores.

Discussion and conclusions: results of this study indicate that users of dating applications on the internet have higher levels of sex addiction. Sex addiction can also predict levels of social anxiety. The study improves our understanding on the factors that influence sex addiction. The results indicate that social anxiety rather than sensation seeking is a major factor affecting the use of Internet dating applications for sexual purposes


Characteristics of self-identified patients with sexual addiction in an outpatient clinic



Catholic University of Louvain, Louvain-la-Neuve, Belgium

Background and aims: Research on sexual addiction (SA) has flourished during the last decade, supported by the development of Internet and online sexual activities (e.g., sex chat and webcam, free access pornography). However, despite the increasing number of SA researches, few empirical data are available on the characteristics of treatment seeking self-defined “sex addicts”. The purpose of this study is to describe the characteristics, habits, and comorbidities in a sample of people seeking-treatment in a specialized outpatient program.

Methods: This study included 72 patients who consulted the Department of Addictology and Psychiatry in the University Hospital of Nantes (France) from April 2010 to December 2014. Measures included self-reports and hetero-questionnaires completed by a psychologist of the outpatient program.

Results: The majority of the 72 patients were middle-aged (M: 40.33; SD: 10.93) men consulting mainly for hypersexuality, risky sexual behaviors, and overuse of cybersex. Some patients presented paraphilia and sexual dysfunctions. The majority of the sample presented comorbid psychiatric or addictive diagnosis, low self-esteem, and a history of trauma.

Conclusions: The current study highlighted that SA is related to heterogeneous risk factors (e.g., traumatic events, comorbid states, psychosocial variables) often characterized by multiple SA-related behaviors, whose interrelations are complex. Treatment programs should take into account this heterogeneity and favor tailored rather than standardized.