Upcoming Studies From 3rd & 4th International Conference on Behavioral Addictions

The following abstracts related to porn use and sex addiction were taken from the 3rd International Conference on Behavioral Addictions March 14–16, 2016, and 4th International Conference on Behavioral Addictions February 20-22, 2017. Most abstracts presented are eventually published in peer-reviewed journals.

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

MATTHIAS BRAND

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

VALERIE VOON

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

RONIT ARGAMAN

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

ERIN B. COOPER, RORY C. REID

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?

MATEUSZ GOLA

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

FARSHAD HASHEMIAN, ELNAZ ROOHI

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

JUSSI JOKINEN, ANDREAS CHATZITTOFIS, JONAS HALLBERG, PETER NORDSTRÖM,

KATARINA ÖBERG, STEFAN ARVER

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

SHANE W. KRAUS, STEVE MARTINO, MARC POTENZA

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

SHANE W. KRAUS, STEVE MARTINO, JOHN ANDREW STURGEON, ARIEL KOR, MARC N. POTENZA

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

CHRISTIAN LAIER, MARCO BÄUMER, MATTHIAS BRAND

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

MICHAEL H. MINER1, ANGUS MACDONALD, III2, ERICK JANSSEN3, REBECCA SWINBURNE ROMINE4,

ELI COLEMAN AND NANCY RAYMOND5

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

JARO PEKAL, CHRISTIAN LAIER, MATTHIAS BRAND

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

RORY C. REID, JON GRANT, MARC POTENZA

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

JAN SNAGOWSKI, JARO PEKAL, LYDIA HARBARTH, CHRISTIAN LAIER, MATTHIAS BRAND

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

RUDOLF STARK, TIM KLUCKEN, JAN SNAGOWSKI, SINA WEHRUM-OSINSKY

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

AVIV WEINSTEIN, RINAT ZOLEK, ANA BABKIN, MICHEL LEJOYEUX

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

AVIV WEINSTEIN, YONI ZLOT, MAYA GOLDSTEIN

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

ALINE WÉRY, KIM VOGELAERE, GAËLLE CHALLET-BOUJU, FRANÇOIS-XAVIER POUDAT, MARTHYLLE

LAGADEC, CHARLOTTE BRÉGEAU, JOËL BILLIEUX, MARIE GRALL-BRONNEC

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.

BELOW ARE THE ABSTRACTS FROM THE 2017 CONFERENCE

Internet addiction: Current theoretical considerations and future directions

MATTHIAS BRAND

1General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Germany 2Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg, Germany; E-mail: [email protected]

Background and aims: Internet-gaming disorder has been included in the appendix of the DSM-5 indicating that it is likely a relevant clinical phenomenon, which deserves fur­ther attention. Beyond the addictive use of Internet games, other types of Internet applications are also discussed as being used addictively, for example communication appli­cations, pornography, gambling, and shopping applications. Based on previous research from both the substance and the behavioral addiction area, theoretical considerations of the development and maintenance of specific types of Inter­net-use disorders are suggested.

Methods: The theoretical model of Internet addiction by Brand et al. (2014) and that by Dong and Potenza (2014) have been integrated into a new theoretical framework. In addition, very recent articles on Internet-gaming disorder and other types of an addictive use of specific Internet applications have been considered.

Results: The Interaction of Person˗Affect˗Cognition˗Execution (I-PACE) model of specific Internet-use disorders has been suggested (Brand et al., 2016). The I-PACE model is considered a process model, which specifies several predis­posing factors (e.g., neurobiological and psychological constitutions), moderating variables (e.g., coping style, In­ternet-use expectancies, and implicit associations), and me­diating variables (e.g., affective and cognitive responses to internal and external triggers), which act in concert with reduced inhibitory control and executive functioning. On the brain level, a dysfunctional interaction of limbic and para-limbic structures, e.g. the ventral striatum, and pre­frontal areas, particularly the dorsolateral prefrontal cortex, is considered a main neural correlate of specific Internet-use disorders. These neural correlates of Internet-use disor­ders are consistent with what is known about other types of behavioral addictions.

Conclusions: The I-PACE model summarizes the mechanisms potentially underlying the de­velopment and maintenance of specific Internet-use disor­ders and also reflects the temporal dynamics of the addic­tion process. The hypotheses summarized in this model should be specified for the specific types of Internet-use disorders, such as Internet-gaming, gambling, pornogra­phy-viewing, shopping, and communication.

Attentional bias and inhibition in males with tendency to Internet-pornography-viewing disorder

STEPHANIE ANTONS1*, JAN SNAGOWSKI1 and MATTHIAS BRAND1, 2

1General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Germany 2Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany *E-mail: [email protected]

Background and aims: Recent studies investigated the in­terference of addiction-related cues with cognitive process­es in Internet-pornography-viewing disorder (IPD) and found comparable results to those reported for substance-use disorders (SUD). In the I-PACE (Interaction of Person˗ Affect˗Cognition˗Execution) model of specific Internet-use disorders, it has been suggested that craving, attentional bias, and dysfunctional inhibitory control are main process­es underlying the development and maintenance of Inter­net-use disorders (Brand et al., 2016). In the current study, we investigated particularly the association of attentional bias, inhibitory control, and symptoms of IPD.

Methods: To investigate these relationships, two experimental studies comparing male participants with high and low tendencies towards IPD were conducted. Tendencies towards IPD were assessed with the short version of the Internet Addic­tion Test modified for Internet sex sites (Laier et al., 2013). In the first study, 61 participants completed a Visual Probe Task (Mogg et al., 2003) which was modified with porno­graphic stimuli. In the second study, 12 participants were investigated so far with two modified Stop-Signal Tasks (Logan et al., 1984) which included task-irrelevant neutral and pornographic stimuli.

Results: Participants with high tendencies towards IPD showed higher attentional bias to pornographic stimuli in comparison to participants with low tendencies towards IPD. The first analyses from the second study revealed that males with high tendencies to­wards IPD had longer inhibition times and more errors in stop trials especially when confronted with pornographic pictures.

Conclusions: Results provide further evidence for similarities between IPD and SUD. Clinical implications are discussed.

Mindfulness-based interventions in the assessment, treatment and relapse prevention of compulsive sexual behaviors: Experiences from clinical practice

GRETCHEN R. BLYCKER1 and MARC N. POTENZA2

1Halsosam Therapy, Jamestown, RI and University of Rhode Island, Kingston, RI, USA 2Connecticut Mental Health Center and Yale University School of Medicine, New Haven, CT, USA *E-mail: [email protected]

Background and aims: Compulsive sexual behaviors in­clude a range of sexual activities including excessive and problematic pornography use, disordered hypersexuality and sexual infidelity. Although many individuals and cou­ples suffer from compulsive sexual behaviors, relatively few seek treatment and empirically validated treatments are largely lacking. Tenets of Eastern philosophy have been incorporated into empirically validated treatments for stress reduction and other psychiatric and psychologi­cal concerns. However, their application to sexual health is less well investigated.

Methods: Through an Eastern-influenced Hakomi clinical training, a mindfulness-based approach to therapeutic interventions aimed at improving sexual, intimacy-oriented and relationship health has been developed and explored in clinical practice. Cases from clinical practice will be presented as a means to provide a basis for future direct clinical investigation into therapeu­tic approaches to help people suffering from the impact of compulsive sexual behaviors.

Results: Cases from men, women and couples will be presented. Examples of how mindfulness-based interventions have helped individuals reduce compulsive and addictive sexual behaviors and move towards and attain healthy sexual relationship func­tioning will be discussed. Conclusions: In clinical prac­tice, mindfulness-based approaches resonate with a broad range of individuals and help people develop skills that assist in creating more connected and healthy patterns of sexual functioning. Future studies should examine direct­ly in randomized clinical trials the efficacy and tolerabili­ty of mindfulness-based approaches for individuals and couples suffering from the impact of compulsive sexual behaviors.

Cue-reactivity and craving in Internet-pornography-viewing disorder: Behavioral and neuroimaging findings

MATTHIAS BRAND1,2*

1General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Germany2Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Germany*E-mail: [email protected]

Background and aims: Internet-pornography-viewing dis­order (IPD) is considered one type of specific Internet-use disorders, but potentially shares some mechanisms with general hypersexual behavior. Cue-reactivity and craving are crucial concepts in both substance and behavioral ad­diction research.

Methods: These concepts have been re­cently investigated in subjects with hypersexual behavior and in individuals with IPD. Studies addressing behavioral correlates of cue-reactivity and craving as well as results from neuroimaging investigations are summarized.

Results: Behavioral data support the theoretical hypothesis that cue-reactivity and craving are mechanisms underlying IPD. Be­havioral data are complemented by functional neuroimag­ing findings, which suggest a contribution of the ventral striatum to the subjective feeling of craving. Cue-induced hypersensitivity of the ventral striatum and further brain areas, which are involved in reward anticipation and re­ward processing, can be considered an important brain cor­relate of IPD.

Conclusions: The findings on cue-reactivity and craving in IPD are consistent with the recently suggest­ed Interaction of Person–Affect–Cognition–Execution (I-PACE) model of specific Internet-use disorders. This model suggests that gratification and reinforcement learn­ing contribute to the development of cue-reactivity and craving when being confronted with specific stimuli, which makes it more likely that individuals develop a diminished control over their behavior. Specifications of the I-PACE model for IPD and hypersexual behavior are discussed.

Adolescent hypersexuality: Is it a distinct disorder?

YANIV EFRATI1 and MARIO MIKULINCER1

1Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel E-mail: [email protected]

Background and aims: Adolescent hypersexuality, and its position within personality dispositions, is the subject of this presentation. The personality dispositions examined were attachment style, temperament, gender, religiosity, and psychopathology.

Methods: To do so, 311 high-school adolescents (184 boys, 127 girls) between the ages 16–18 (M = 16.94, SD = .65), enrolled in the eleventh (n = 135, 43.4%) and twelfth (n = 176, 56.6%) grades, most of whom (95.8%) were native Israelis. By religiosity, 22.2% defined themselves as secular, 77.8% reported various degrees of religiosity. Five possible empirical models were examined, all based on current theory and research on hypersexuality.

Results and Conclusions: The fourth model was found to be compatible with the data, indicating that psychopatholo­gy and hypersexuality are independent disorders and are not related by a mediating process. In addition, religiosity and gender are predictors, but the relationship between temperament and attachment is independent of them – the process is identical in religious and non-religious adoles­cents, both boy and girl. Additionally, the hormone oxy­tocin may be related to hypersexuality, with implications that could affect the therapeutic meaning of understanding the location of adolescent hypersexuality as a disorder in and of itself.

Altered orbitofrontal reactivity during reward processing among problematic pornography users and pathological gamblers

MATEUSZ GOLA1,2 *PHD, MAŁGORZATA WORDECHA3, MICHAŁ LEW-STAROWICZ5 MD, PHD, MARC N. POTENZA6,7 MD, PHD, ARTUR MARCHEWKA3 PHD and GUILLAUME SESCOUSSE4 PHD

1 Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California San Diego, San Diego, USA 2 Institute of Psychology, Polish Academy of Science, Warsaw, Poland 3 Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology of Polish Academy of Science, Warsaw, Poland 4 Radboud University, Donders Institute for Brain, Cognition and Behavior, Nijmegen, Netherlands 5 III Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland 6 Departments of Psychiatry and Neurobiology, Child Study Center and CASAColumbia, Yale School of Medicine, New Haven, CT, USA 7 Connecticut Mental Health Center, New Haven, CT, USA *E-mail: [email protected]

Background and aims: Frequent pornography use is highly relevant among young males (Hald, 2006). For majority, pornography viewing is a form of entertainment, but for some individuals problematic pornography use (PPU) ac­companied by excessive masturbation is a reason for treat­ment seeking (Gola et al., 2016). What differentiate prob­lematic and regular pornography users? And how does it mimic other problematic behaviors, such as e.g. pathologi­cal gambling?

Methods: Using fMRI methodology we examined brain reactivity towards erotic and monetary stimuli, disentangling cue-related ‘wanting’ from reward-related ‘liking’ among 28 heterosexual males seeking treat­ment for PPU and 24 matched controls (Gola et al., 2016). The same procedure had been used previously in studies on pathological gambling (Sescousse et al., 2013).

Results: As we showed before (Gola et al., 2016) compared with control subjects, PPU subjects showed increased activation of brain reward circuits (ventral striatum) specifically for cues predicting erotic pictures but not for cues predicting monetary gains, which exactly mimics results of previous study with the same method on individuals with gambling disorder (Sescousse, et al., 2013). Here we focused on oth­er brain region involved in reward processing – orbitofron­tal cortex (OFC). As it had been shown, evolutionally old­er posterior OFC in healthy subjects is involved in processing of primary rewards (food and sex), while ante­rior OFC process secondary rewards (such as money or so­cial reinforces). According to this state of art aOFC is in our study it was the only ROI expressing higher activa­tions for monetary gains than erotic rewards in control subjects. But interestingly, for PPU subjects the aOFC was more active for erotic pictures than monetary rewards, while pOFC remained unchanged. The amount of this shift in aOFC was related to PPU severity measures. Among subjects with pathological gambling opposite pattern of changes was observed: pOFC was activated more for mon­etary rewards, while aOFC activations remained un­changed when compared to controls (Sescousse et al., 2013).

Conclusions: Our results suggest that PPU subjects may experience difficulties in differentiating between val­ue of erotic and non-erotic rewards similarly to pathologi­cal gamblers in case of monetary and non-monetary re­wards. Our results show also that PPU resembles neural and behavioral patterns well-described in gambling disor­der although functional changes.

Interpersonal violence, early life adversity and suicidal behavior in men with hypersexual disorder

JUSSI JOKINENa, b*, ANDREAS CHATZITTOFISa, JOSEPHINE SAVARDa, PETER NORDSTRÖMa, JONAS HALLBERGc, KATARINA ÖBERGc and STEFAN ARVERc

a Department of Clinical Neuroscience/Psychiatry, Karolinska Institutet, Karolinska University Hospital, Solna, SE-171 76 Stockholm, Swedenb Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Swedenc Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Sweden*E-mail: [email protected]

Background and aims: Few studies have investigated childhood adversity, interpersonal violence and suicidal behavior in hypersexual disorder. The aim of this study was to assess self-reported interpersonal violence in men with hypersexuality compared to healthy volunteers and to study association between the experience of interpersonal violence and suicidal behavior.

Methods: The study in­cludes 67 male patients with hypersexual disorder (HD) and 40 male healthy volunteers. The Childhood trauma questionnaire-Short Form (CTQ-SF) and the Karolinska Interpersonal Violence Scales (KIVS) were used for as­sessing early life adversity and interpersonal violence as a child and in adult life. Suicidal behavior (attempts and ide­ation) was assessed with the Mini-International Neuropsy­chiatric Interview (MINI 6.0) and the Montgomery-Åsberg Depression Rating Scale-Self rating (MADRS-S).

Results: Men with HD reported more exposure to violence in child­hood and more violent behavior as adults compared to healthy volunteers. Suicide attempters (n = 8, 12%) report­ed higher KIVS total score, more used violence as a child, more exposure to violence as an adult as well as higher score on CTQ-SF subscale measuring sexual abuse com­pared to hypersexual men without suicide attempt.

Conclu­sions: Hypersexuality was associated with interpersonal violence with highest total scores in patients with suicide attempt.

Methylation of the HPA axis related genes in men with hypersexual disorder

JUSSI JOKINENa, b*, ADRIAN BOSTRÖMc, ANDREAS CHATZITTOFISa, KATARINA GÖRTS ÖBERGd, JOHN N. FLANAGANd, STEFAN ARVERd and HELGI SCHIÖTHc

a Department of Clinical Neuroscience/Psychiatry, Karolinska Institutet, Stockholm, Swedenb Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Swedenc Department of Neuroscience, Uppsala University , Uppsala, Swedend Department of Medicine, Karolinska Institutet, Stockholm, Sweden*E-mail: [email protected]; [email protected]

Background and aims: Hypersexual Disorder (HD) defined as non-paraphilic sexual desire disorder with components of compulsivity, impulsivity and behavioral addiction, was proposed as a diagnosis in the DSM 5. Some overlapping features between HD and substance use disorder including common neurotransmitter systems and dysregulated hypo­thalamic-pituitary-adrenal (HPA) axis function have been reported. In this study, comprising 67 male patients diag­nosed with HD and 39 healthy male volunteers, we aimed to identify HPA-axis coupled CpG-sites, in which modifi­cations of the epigenetic profile are associated with hyper­sexuality.

Methods: The genome-wide methylation pattern was measured in whole blood using the Illumina Infinium Methylation EPIC BeadChip, measuring the methylation state of over 850 K CpG sites. Prior to analysis, the global DNA methylation pattern was pre-processed according to standard protocols and adjusted for white blood cell type heterogeneity. We included CpG sites located within 2000 bp of the transcriptional start site of the following HPA-axis coupled genes: Corticotropin releasing hormone (CRH), corticotropin releasing hormone binding protein (CRHBP), corticotropin releasing hormone receptor 1 (CRHR1), corticotropin releasing hormone receptor 2 (CRHR2), FKBP5 and the glucocorticoid receptor (NR3C1). We performed multiple linear regression models of methylation M-values to a categorical variable of hyper­sexuality, adjusting for depression, DST non-suppression status, Childhood Trauma Questionnaire total score and plasma levels of TNF-alpha and IL-6.

Results: 76 individ­ual CpG sites were tested, and four of these were nomi­nally significant (p < 0.05), associated with the genes CRH, CRHR2 and NR3C1. Cg23409074 – located 48 bp upstream of the TSS of the CRH gene – was significantly hypomethylated in hypersexual patients after corrections for multiple testing using the FDR-method. Methylation levels of cg23409074 were positively correlated with gene expression of the CRH gene in an independent cohort of 11 healthy male subjects.

Conclusions: CRH is an impor­tant integrator of neuroendocrine stress responses in the brain, modulating behavior and the autonomic nervous system. Our results show epigenetic changes in CRH gene related to hypersexual disorder in men.

Psychometrics properties of a problematic pornography use scale and associations with psychological and clinical characteristics in US military veterans

ARIEL KOR1, MARC. N. POTENZA, M.D., PhD.2,3, RANI A. HOFF, PhD.2, 4, ELIZABETH PORTER, MBA4 and SHANE W. KRAUS, PhD.,5

1Teachers College, Columbia University, Department of Counseling & Clinical Psychology, Teachers College, Columbia University, USA2Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA3Department of Neuroscience, Child Study Center and the National Center on Addiction and Substance Abuse, Yale School of Medicine, New Haven, CT, USA4VISN 1 MIRECC, VA CT Healthcare System, West Haven, CT, USA5VISN 1 New England MIRECC, Edith Nourse Rogers Memorial Veterans Hospital, Bedford MA, USA*E-mail: [email protected]

Background and aims: Although most individuals viewing pornography experience few problems with pornography, a subset of individuals report significant problems managing their use. The Problematic Pornography Use Scale (PPUS) was developed to assess for problematic use of pornogra­phy among adults living in Israel. Despite its initial prom­ising psychometric properties, the PPUS has not been vali­dated among US adult pornography users. To investigate further, the current study evaluated the psychometric prop­erties of the PPUS in a sample of males and females re­porting pornography use.

Methods: A sample of 223 US military veterans completed measures assessing demo­graphics, psychopathology, frequency of pornography use, craving for pornography, problematic use of pornography, hypersexuality, and impulsivity.

Results: Findings found that the PPUS demonstrated high internal consistency, convergent, discriminant, and construct validity. Higher PPUS scores were associated with higher frequency of weekly pornography use, male gender, craving for pornog­raphy, and affective disorders.

Conclusions: The PPUS showed promising psychometric properties among a sam­ple of US veterans reporting pornography use, although additional research is needed to examine its factor struc­ture and determine the appropriate threshold to accurately detect problematic use.

How impulsivity is related to problematic pornography use? Longitudinal study among participants of 12-steps sexual addiction treatment program

EWELINA KOWALEWSKA1*, JAROSLAW SADOWSKI2, MALGORZATA WORDECHA3, KAROLINA GOLEC4, MIKOLAJ CZAJKOWSKI, PhD2 and MATEUSZ GOLA, PhD3, 5

1Department of Psychology, University of Social Sciences and Humanities, Warsaw, Poland 2 Department of Economy, University of Warsaw, Warsaw, Poland 3 Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland 4 Department of Psychology, University of Warsaw, Warsaw, Poland 5 Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California San Diego, San Diego, USA *E-mail: [email protected]

Background and aims: Some research show relation be­tween impulsivity and pornography use (Mainer et al., 2009; Mick & Hollander, 2006; Davis et al., 2002; Shapira et al., 2000). One aspect of impulsivity is the ability of de­laying gratification and discounting. It remains unknown whether deferment of gratification is the cause or the result of frequent pornography use.

Methods: We measured dis­counting by MCQ questionnaire (Monetary Choice Ques­tionnaire; Kirby & Marakovic, 1996) in two studies. In Study 1, data were collected from surveys conducted on a members of 12-steps groups for sexual addiction (N = 77, mean age 34.4, SD = 8.3) and control individuals (N = 171, mean age 25.6, SD = 6.4). In Study 2, we conducted re­peated measurement after 3 months on a 17 members of 12-steps group for sexual addiction from Study 1 (N = 17, mean age 34.8, SD = 2.2). The average time of sexual ab­stinence in clinical group was 243.4 days (SD = 347.4, Min. = 2, Max. = 1216; Study 1) and 308.5 days (SD = 372.9, Min. = 1, Max. = 1281; Study 2). Both studies were performed via the Internet.

Results: In Study 1 time spent on pornography and masturbation was correlated pos­itively with the discounting parameter. Correlations be­tween these variables were stronger in among sex addicts (masturbation frequency, r = 0.30, p < 0.05; pornography use, r = 0.28, p < 0.05) than the control group (masturba­tion frequency, r = 0.23, p < 0.05; pornography use, r = 0.19, p < 0.05) The strongest correlation (r = −0.39) occurs between the discounting parameter and sobriety among sex addicts. Contrary to our hypothesis average discounting function parameters were higher in control group than in group of sex addicts. In Study 2, results didn’t show signifi­cant relation between discounting and time of sexual absti­nence. However, groups did not significantly differ in dis­counting between measurements and gain in sobriety during 3 months was not accompanied by decrease of dis­counting. Changes in sobriety could be better explained by number of mentee on 12-step program (r = 0.92, p < 0.05) or current step in 12-steps therapy (r = 0,68; p < 0,001) than by discounting.

Conclusions: The ability of delaying gratification is rather not modified by the pornography use. Probably it is a constant feature that can determine the fre­quency of pornography use in the general population. Among the members of the 12-steps groups for sex addicts the ability of delaying gratification, paradoxically, is higher than in the general population and is not modified during 3 months of working on a 12-steps program. Moreover, dis­counting does not change with the time of abstinence. This result may suggest that individuals with low discounting may be more prone to benefit form 12-step program, than those with high discounting.

Pornography avoidance self-efficacy scale: Psychometric properties

SHANE W. KRAUSa, b, *, HAROLD ROSENBERGb, CHARLA NICHc STEVE MARTINOc, d and MARC N. POTENZAc

a Department of Psychology, Bowling Green State University, Bowling Green, OH, 43403, USA b VISN 1 New England MIRECC, Edith Nourse Rogers Memorial Veterans Hospital, 200 Spring Road, Bedford MA, USA c Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA d VISN 1 New England MIRECC, VA Connecticut Healthcare System, West Haven, CT USA *E-mail: [email protected]

Background and aims: The presented study examined whether participants’ self-efficacy to avoid using pornog­raphy in each of 18 emotional, social, and sexually arous­ing contexts was associated with their typical frequency of pornography use.

Methods: Using a web-based data collection procedure, 229 male pornography users who had sought or had considered seeking professional help for their use of pornography completed questionnaires as­sessing their context-specific self-efficacy, history of por­nography use, self-efficacy to employ specific pornogra­phy-reduction strategies, clinical hypersexuality, and demographic characteristics.

Results: A series of ANO­VAs showed that frequency of pornography use was sig­nificantly and negatively associated with level of confi­dence in 12 of the 18 contexts. Similarly, we found that lower hypersexuality and higher confidence to employ pornography-use-reduction strategies were associated with higher confidence to avoid using pornography in each of the 18 situations. An exploratory factor analysis also revealed three clusters of situations: (a) Sexual arous­al/Boredom/Opportunity, (b) Intoxication/Locations/Easy access, and (c) Negative Emotions; the two remaining sit­uations did not load on any of three clusters. Because only one of the three clusters reflected a consistent theme, we do not recommend averaging self-efficacy within clusters comprised of different types of situations.

Conclusions: Mental health clinicians could use the questionnaire to identify specific higher risk situations for relapse in indi­viduals seeking to reduce or stop using pornography prob­lematically.

Brief Pornography Screener: A comparison of US and Polish pornography users

SHANE W. KRAUS, PhD.,1 MATEUSZ GOLA, PhD.,2 EWELINA KOWALEWSKA,3 MICHAL LEW-STAROWICZ , M.D., PhD.4 RANI A. HOFF, PhD.,5, 6 ELIZABETH PORTER, MBA,6 and MARC. N. POTENZA, M.D., PhD.5,7

1VISN 1 New England MIRECC, Edith Nourse Rogers Memorial Veterans Hospital, Bedford MA, USA2Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California San Diego, San Diego, USA3Department of Psychology, University of Social Sciences and Humanities, Warsaw, Poland4Institute of Psychiatry and Neurology, 3rd Psychiatric Clinic, Warsaw, Poland5Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA6VISN 1 MIRECC, VA CT Healthcare System, West Haven CT, USA7Department of Neuroscience, Child Study Center and the National Center on Addiction and Substance Abuse, Yale School of Medicine, New Haven, CT, USA*E-mail: [email protected]

Background and aims: The current study evaluated the psychometric properties of a newly developed six-item questionnaire designed to identify behaviors, thoughts, and experiences associated with problematic use of pornogra­phy. Methods: In Studies 1 and 2, 223 US military veter­ans and 703 Polish community members were adminis­tered the Brief Pornography Screener (BPS) and measures assessing frequency of pornography use, craving for por­nography, problematic use of pornography, clinical hyper­sexuality, and impulsivity. In Study 3, 26 Polish male clin­ical patients were administered the BPS and measures of psychopathology.

Results: In Study 1, findings supported dropping one item from the questionnaire; the five remain­ing items were subjected to an exploratory factor analysis which yielded a one-factor solution with an eigenvalue of 3.75 that accounted for 62.5% of the total variance. The BPS also demonstrated high internal reliability (α = 0.89). Next, we found that BPS scores were significantly and positively associated with craving for pornography, prob­lematic use of pornography, and hypersexuality, but weak­ly related to impulsivity. In Study 2, findings were similar in that BPS scores were positively associated with a meas­ure of hypersexuality but weakly associated with scores on measures assessing obsessive-compulsive symptoms and impulsivity. Results also indicated that the one-factor solu­tion yielded an excellent fit: χ2/df = 5.86, p = 0.00, RM­SEA = 0.08, SRMR = 0.02, CFI = 0.99, and TLI = 0.97. In Study 3, we assessed the classification quality of BPS us­ing an a priori selected group of patients against a control group. The ROC analysis indicated that the AUC value was 0.863 (SE = 0.024; p < 0.001; 95% CI: 81.5−91.1).

Conclusions: The BPS demonstrated promising psycho­metric properties across both US and Polish samples and could be used by clinicians in mental health settings to identify individuals.

Sexual arousal reaction to pornographic stimuli mediates the relationship between predisposing personal characteristics and symptoms of Internet-pornography-viewing disorder

CHRISTIAN LAIER1 and MATTHIAS BRAND1,2

1 General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Duisburg-Essen, Germany2 Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany*E-mail: [email protected]

Background and aims: Main factors underlying Internet-pornography-viewing in general are seeking sexual excita­tion and sexual pleasure, satisfying sexual curiosity, or avoiding aversive emotions (Reid et al., 2011). The I-PACE (Interaction of Person−Affect−Cognition−Execution) model of specific Internet-use disorders (Brand et al., 2016) postu­lates an interaction of user’s personal characteristics, affec­tive responses, cognitive processes, and executive functions with the gratification gained by viewing Internet-pornogra­phy. The aim of the study was to investigate the relationship between the personal characteristics such as pornography-viewing motivation, psychological symptoms, and per­ceived stress with sexual arousal as reaction to pornographic material and tendencies towards Internet-pornography-viewing disorder (IPD).

Methods: Male participants (N = 88) were investigated in a laboratory setting. Questionnaires assessed tendencies towards IPD, pornography-viewing mo­tivation, psychological symptoms, and perceived stress. Moreover, participants viewed pornographic pictures and indicated their sexual arousal and their need to masturbate before and after cue presentation.

Results: The results showed that tendencies towards IPD were strongly associat­ed to all factors of pornography-viewing motivation, psy­chological symptoms, perceived stress, and indicators of sexual arousal reactions. Moreover, the need to masturbate partially mediated the relationship between the motivation to view pornography and the relationship between psycho­logical symptoms and stress with symptoms of IPD.

Con­clusions: The findings showed that tendencies towards IPD were associated to the postulated personal characteristics and that this relation was partially mediated by an indicator of sexual arousal. Thus, the results are in line with the I-PACE model and strengthen the assumption that future re­search should focus on the interaction of specific variables beyond bivariate correlations to give further insights into the psychological mechanisms underlying IPD.

Compulsivity and impulsivity in sexual addiction

ERIC LEPPINK

University of Chicago, Chicago, USA E-mail: [email protected]

Sexual addiction has frequently been characterized as a dis­order of impulsivity, suggesting that the initiation and/or persistence of the problematic behavior may be due to an inability to suppress impulses to engage in the rewarding behavior. Current findings related to this disorder, however, have suggested that in addition to impulsivity, compulsivity may play a notable role in the presentation and perpetua­tion of sexual addiction. This presentation will present new neurocognitive and neuroimaging data regarding the broad­er clinical domains of compulsivity and impulsivity in sex­ual addiction. Particular emphasis will be placed on current understanding of neurobiology and neurocognition in pa­tients with sexual addiction and how these data may im­prove treatment approaches.

Treatment seeking for problematic pornography use among women

KAROL LEWCZUK1, JOANNA SZMYD2 and MATEUSZ GOLA3,4*

1 Department of Psychology, University of Warsaw, Warsaw, Poland2Department of Cognitive Psychology, University of Finance and Management, Warsaw, Poland3 Institute of Psychology, Polish Academy of Sciences, Warsaw , Poland4 Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California San Diego, San Diego, USA*E-mail: [email protected]

Backgrounds and aims: Previous studies examined psycho­logical factors related to treatment-seeking for problematic pornography use (PU) among males. In this study we fo­cused on females who seek treatment for problematic PU and examined the differences with regards to variables re­lated to problematic PU between this group and the group of women that did not seek such treatment. Secondly, we in­vestigated the relationships between critical constructs re­lated to problematic PU with path analysis method, empha­sizing the predictors for treatment-seeking among women. We also compared our results to previous studies on males.

Methods: A survey study was conducted on 719 Caucasian females 14 to 63 years old, including 39 treatment-seekers for problematic PU (referred by psychotherapists after their initial visit)

Results: Treatment-seeking among females is related to negative symptoms associated with PU, but also to the mere amount of PU. This stands in opposition to pre­viously published analyses on males. Additionally, in the case of females, religiosity is a strong, significant predictor of treatment seeking.

Discussion: Differently from previous studies that focused on male samples, our analysis showed that in case of women mere amount of PU may be related with treatment-seeking behavior even after accounting for negative symptoms associated with PU. Moreover, reli­giousness is a significant predictor of treatment seeking among women, what may indicate that in case of women, treatment seeking for problematic PU is motivated not only by experienced negative symptoms of PU, but also personal beliefs about PU and social norms. Those factors should be taken into account in treatment.

Conclusions: Negative symptoms associated with pornography use, frequency of pornography use and religiousness are associated with treat­ment-seeking among women – this pattern is different than the results obtained in previous studies on males.

Behavioral Indications of Cognitive Disruption in Hypersexuality

MICHAEL H. MINER1*, ANGUS MACDONALD, III2 and EDWARD PATZALT3

1Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN. USA2Department of Psychology, University of Minnesota, Minneapolis, MN. USA3Department of Psychology, Harvard University, Cambridge, MA. USA*E-mail: [email protected]

Background and aims: Addictive processes are thought to be the result of a number of underlying cognitive disrup­tions that influence decision-making. Specifically, it has been suggested that addiction accesses the same neuro­physiological mechanisms used by normal reinforcement learning systems. Our aim is to examine the involvement of disruptions in three areas of cognitive control, (1) Shift­ing reinforcement contingencies, (2) delaying gratification and risk-taking, and (3) stimulus interference.

Methods: We examined a sample of 242 adult men who had a sexual in­terest or had engaged in sexual behavior with men. Ninety-three met criteria for hypersexuality. Participants complet­ed three cognitive tasks: a reversal learning task, a delayed discounting task, and a single-trial Stroop.

Results: We ex­plored both group differences and correlations with the Compulsive Sexual Behavior Inventory obtained by vari­ous computational models characterizing responses to these three measures of cognitive control. We found few indica­tions that hypersexuality, either defined by group assign­ment or by score on the CSBI, was associated with meas­ures of cognitive disruptions that have characterized other forms of addiction. We did find a significant interaction be­tween a Grattan effect on the Stroop and CSBI score in pre­dicting number of sexual encounters over a 90-day period.

Conclusions: Hypersexuality, at least in MSM, does not ap­pear to be related to the cognitive disruptions found in oth­er addictions, such as cocaine abuse. However, in the pres­ence of high levels of hypersexuality, at least as measured by the CSBI, a failure to moderate behavior due to immedi­ate previous experience does appear related to increased sexual behavior. Thus, the mechanism by which hypersexu­ality leads to high levels of partnered sex may be through this disruption in moment to moment modification of be­havior. Our findings are influenced by sampling in that hy­persexuality manifests itself differently in MSM. Addition­ally, hypersexuality is multi-dimensional, and it may be that different behaviors result from multiple sources of dis­ruption,

Craving responses to watching pornographic clips are related to symptoms of Internet-pornography-viewing disorder

JARO PEKAL1* and MATTHIAS BRAND1,2

1General Psychology: Cognition, University of Duisburg-Essen and Center for Behavioral Addiction Research (CeBAR), Germany 2Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany *E-mail: [email protected]

Background and aims: Cue-Reactivity and craving reac­tions are important aspects in the development of sub­stance-use disorders. Since it has been suggested that both processes are also involved in Internet-pornography-view­ing disorder (IPD), it is important to investigate them in more detail. Some authors consider the anticipation of grat­ification as key factor in the development and maintenance of an IPD. In the I-PACE (Interaction of Person-Affect- Cognition-Execution) model for specific Internet-use disor­ders (Brand et al., 2016), cue reactivity and craving as well as reward-learning mechanisms are assumed to be crucial mechanisms of an IPD. In former cue-reactivity studies mostly pornographic pictures were used for induction of sexual arousal and craving. The aim of the current study was to investigate the effects of pornographic clips on sub­jective craving and relationships with specific cognitions about Internet-pornography-viewing and tendencies to­wards IPD.

Methods: An experimental study with a sample of 51 male participants was conducted. All participants viewed 60 pornographic clips, rated them with respect to sexual arousal and indicated their current sexual arousal and their need to masturbate before and after the cue pres­entation. Furthermore, questionnaires were used to assess motives for viewing pornography, Internet-pornography-use expectancies and tendencies towards IPD.

Results: The pornographic clips were rated as sexually arousing and lead to an increase of sexual arousal and the need to masturbate. Moreover, sexual arousal reactions were moderately to strongly associated with expectancies and motives to view Internet-pornography as well as with symptoms of IPD.

Conclusions: The results are consistent with former studies on IPD and emphasize the involvement of cue-reactivity and craving in IPD as suggested in the I-PACE model for specific Internet-use disorders. From a methodically view, the observed effects of the cue-reactivity paradigm with pornographic clips are comparable to those reported when pictures were used as cues.

How might compulsive sexual behaviors be considered in ICD-11 and what are the clinical implications?

MARC N. POTENZA1

1Connecticut Mental Health Center and Yale University School of Medicine, USA *E-mail: [email protected]

Background and aims: Although prevalence estimates are largely lacking, a considerable number of individuals may encounter problems with various forms of problematic sexual behaviors related to hypersexuality, problematic pornography viewing or compulsive sexual behaviors. In preparation for the fifth edition of the Diagnostic and Sta­tistical Manual (DSM-5), hypersexual disorder was field-tested and considered for inclusion but was ultimately ex­cluded from the manual. In preparation for the eleventh edition of the International Classification of Diseases (ICD-11), non-substance or behavioral addictions are be­ing considered for inclusion, with questions regarding defi­nitions and classifications being discussed.

Methods: The obsessive-compulsive and related disorders group and the substance use disorders group have considered behavioral addictions including those relating to sex. Three work­group meetings organized by the World Health Organiza­tion have considered Internet-related behaviors and disor­ders, with consideration of both online and offline behaviors with addictive potential. In these meetings, in­ternational participation from the majority of the World Health Organization’s global zones participated to help en­sure that global jurisdictions were well represented and involved in the process of considering how best to concep­tualize and define behavioral addictions and related sub­syndromal behaviors.

Results: The obsessive-compulsive and related disorders group has reported an opinion that compulsive sexual behaviors be recognized as a specific diagnostic entity in the impulse control disorder section. The addictive disorders group in ICD-11 has proposed cri­teria for gambling disorder and gaming disorder, with both online and offline specifiers. Related definitions for haz­ardous gambling and gaming have been proposed, with these definitions being mutually exclusive from the corre­sponding disorder conditions. While no specific behavioral addiction related to sexual behaviors has been proposed, a category for “Disorders Due to Addictive Behaviors” has been proposed, and this designation may be used to diag­nose behavioral addictions related to sex.

Conclusions: Al­though the ICD-11 process is not yet finalized, problemat­ic, compulsive, excessive and/or hypersexual behaviors relating to sex are being discussed with respect to inclu­sion in ICD-11. A currently proposed diagnostic category by the addictive disorders group would permit clinicians to have a diagnosis for a broad range of addictive behaviors relating to sex. Given the use of the ICD by a large num­ber of groups including many clinicians and insurance companies, the existence of a diagnostic entity capturing addictive behaviors relating to sex may have significant clinical and public health impacts.

Out-of-control use of the internet for sexual purposes as behavioural addiction?

ANNA ŠEVČÍKOVÁ1*, LUKAS BLINKA1 and VERONIKA SOUKALOVÁ1

1Masaryk University, Brno, Czech Republic*E-mail: [email protected]

Background and aims: There is an ongoing debate wheth­er excessive sexual behaviour should be understood as a form of behavioural addiction (Karila, Wéry, Weistein et al., 2014). The present qualitative study aimed at analys­ing the extent to which out-of-control use of the internet for sexual purposes (OUISP) may be framed by the con­cept of behavioural addiction among those individuals who were in treatment due to their OUISP.

Methods: We conducted in-depth interviews with 21 participants aged 22–54 years (Mage = 34.24 years). Using a thematic anal­ysis, the clinical symptoms of OUISP were analysed with the criteria of behavioural addiction, with the special fo­cus on tolerance and withdrawal symptoms (Griffiths, 2001).

Results: The dominant problematic behaviour was out-of-control online pornography use (OOPU). Building up tolerance to OOPU manifested itself as an increasing amount of time spent on pornographic websites as well as searching for new and more sexually explicit stimuli with­in the non-deviant spectrum. Withdrawal symptoms mani­fested themselves on a psychosomatic level and took the form of searching for alternative sexual objects. Fifteen participants fulfilled all of the addiction criteria.

Conclu­sions: The study indicates a usefulness for the behavioural addiction framework.

The contribution of personality factors and gender to ratings of sex addiction among men and women who use the internet for sex purposes

LI SHIMONI L.1, MORIAH DAYAN1 and AVIV WEINSTEIN*1

1Department of Behavioral Science, Ariel University, Science Park, Ariel, Israel. *E-mail: [email protected]

Background and aims: Sex addiction otherwise known as hypersexual disorder is characterized by excessive sexual activity which includes watching pornography, using chat rooms and cybersex on the internet. In this study we have investigated the contribution of the big five personality fac­tors and sex to sex addiction.

Methods: 267 participants (186 males and 81 females) were recruited from internet sites that are used for finding sexual partners. Participants filled in the Sexual Addiction Screening Test (SAST) the Big Five Index and a demographic questionnaire.

Results: Men have shown higher scores on the SAST than women [t (1,265) = 4.1; p < 0.001]. Regression analysis showed that conscientiousness contributed negatively (F(5,261) = 8.12; R = 0.36, p < 0.01, β = –0.24) and openness contrib­uted positively (F(5,261) = 8.12, R = 0.36, p < 0.01, β = 0.1) to the variance of sex addiction scores. Neuroticism only marginally contributed to sex addiction scores (F(5,261) = 8.12, R = 0.36, p = 0.085, β = 0.12) . Finally, there was an interaction between sex and openness (R2change = 0.013, F2(1,263) = 3.782, p = 0.05) which indicated that openness contributed to sex addiction among women (β = 0.283, p = 0.01).

Discussion and conclusions: this study showed that personality factors such as (lack of) conscientiousness and openness contributed to sex addiction. The study also con­firmed previous evidence for higher scores of sex addiction among males compared with females. Among women, openness was associated with greater propensity for sex ad­diction. These personality factors predict who has the pro­pensity to develop sex addiction.

Distractibility by sexual stimuli – a biological marker of hypersexuality?

RUDOLF STARK1*, ONNO KRUSE1, TIM KLUCKEN2, JANA STRAHLER1 and SINA WEHRUM-OSINSKY1

1 Justus Liebig University Giessen, Germany 2 University of Siegen, Germany *E-mail: [email protected]

Background and aims: A high distractibility by sexual stim­uli could be a possible vulnerability factor for the develop­ment of sexual addiction. The first hypothesis of the present study was that subjects with high trait sexual motivation are more attracted by sexual cues than subjects with low trait sexual motivation. The second hypothesis was that this distractibility by sexual stimuli can result in addictive sexu­al behaviour, e.g. problematic use of pornography. Assum­ing this to be true then the distractibility should be greater in sexual addicts than in healthy control subjects.

Methods: We conducted two experiments with the same experimental functional magnetic resonance imaging (fMRI) paradigm. In the first experiment we examined 100 healthy subjects (50 females). In the second experiment we compared the responses of 20 male sexual addicts to those of 20 control subjects. The experimental task required the decision whether two lines, which were located left and right from a picture with either neutral or sexual content, were equally aligned or not.

Results: First results show that the reaction times in the line alignment task were indeed greater in case of a sexual distractor than in case of a neutral distractor. However, the trait sexual motivation and the presence of sexual addiction had only small if any effects on reaction times and the neural activation pattern.

Conclusions: Against our hypothesis, the distractibility by sexual stimuli is obviously not a prominent vulnerability factor for the de­velopment of a sexual addiction. Maybe this result can be traced back to a ceiling effect: Sexual cues strongly attract attention independent of trait sexual motivation or sexual compulsive behaviour.

Clinical characteristics associated with digital hookups, psychopathology, and clinical hypersexuality among US military veterans

JACK L. TURBAN B.A.a, MARC N. POTENZA M.D., PhD.a, b, c, RANI A. HOFF PhD., MPHa, d, STEVE MARTINO PhD.a, d, and SHANE W. KRAUS, PhD.d

a Department of Psychiatry, Yale School of Medicine, New Haven, CT, USAb Department of Neuroscience, Child Study Center and the National Center on Addiction and Substance Abuse, Yale School of Medicine, New Haven, CT, USAc Connecticut Mental Health Center, New Haven, CT, USAd VISN1 New England MIRECC, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA*E-mail: [email protected]

Background and aims: Digital social media platforms (e.g., Match, Manhunt, Grindr, Tinder) provide outlets through which individuals can find partners for consensual sexual encounters.

Methods: Using a sample of US post-deploy­ment military returning war veterans, we evaluated the prevalence of digital sex seeking with clinical correlates of psychopathology, suicidal ideation, and sexually transmit­ted infections (STIs). Specifically, using data from a base­line telephone interview and follow-up internet-based sur­vey, we assessed the prevalence of sexual partnering via digital social-media platforms in a national sample of 283 US combat veterans.

Results: Among veterans, 35.5% of men and 8.5% of women reported having used digital so­cial media to meet someone for sex in their lifetime. Veter­ans who reported having used digital social media to find sexual partners (DSMSP+) as compared to those who did not (DSMSP-) were more likely to be young, male, and in the Marine Corps. After adjusting for sociodemographic variables, DSMSP+ status was significantly associated with post-traumatic stress disorder (OR = 2.26, p = 0.01), in­somnia (OR = 1.99, p = 0.02), depression (OR = 1.95, p = 0.03), clinical hypersexuality (OR = 6.16, p < 0.001), sui­cidal ideation (OR = 3.24, p = 0.04), and treatment for an STI (OR = 1.98, p = 0.04).

Conclusions: Among a national sample of US post-deployment military veterans, DSMSP+ behaviors were prevalent, particularly among male veter­ans. Findings also suggest that in particular veterans who engage in DSMSP+ behaviors should be thoroughly screened during routine mental health appointments and counseled on the benefits of safe sexual practices.

Compulsive sexual behaviour: prefrontal and limbic volume and interactions

VALERIE VOON1, CASPER SCHMIDT1, LAUREL MORRIS1, TIMO KVAMME1, PAULA HALL2 and THADDEUS BIRCHARD1

1 Department of Psychiatry, University of Cambridge, Cambridge, UK2 United Kingdom Council for PsychotherapyE-mail: [email protected]

Background and aims: Compulsive sexual behaviors (CSB) are relatively common and associated with signifi­cant personal and social dysfunction. The underlying neu­robiology is still poorly understood. The present study ex­amines brain volumes and resting state functional connectivity in CSB compared with matched healthy vol­unteers (HV).

Methods: Structural MRI (MPRAGE) data were collected in 92 subjects (23 CSB males and 69 age-matched male HV) and analyzed using voxel-based mor­phometry. Resting state functional MRI data using multi-echo planar sequence and independent components analysis (ME-ICA) were collected in 68 subjects (23 CSB subjects and 45 age-matched HV).

Results: CSB subjects showed greater left amygdala gray matter volumes (small volume corrected, Bonferroni adjusted P < 0.01) and re­duced resting state functional connectivity between the left amygdala seed and bilateral dorsolateral prefrontal cortex (whole brain, cluster corrected FWE P < 0.05) compared with HV.

Conclusions: CSB is associated with elevated volumes in limbic regions relevant to motivational sali­ence and emotion processing, and impaired functional con­nectivity between prefrontal control regulatory and limbic regions. Future studies should aim to assess longitudinal measures to investigate whether these findings are risk fac­tors that predate the onset of the behaviors or are conse­quences of the behaviors.

Clinical diversity among males seeking treatment for compulsive sexual behaviors. Qualitative study followed by 10-week diary assessment

MAŁGORZATA WORDECHA*1, MATEUSZ WILK1, EWELINA KOWALEWSKA2, MACIEJ SKORKO1 and MATEUSZ GOLA1,3

1Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland 2University of Social Sciences and Humanities, Warsaw, Poland 3Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California San Diego, San Diego, CA, USA *E-mail: [email protected]

Background and aims: We wanted to assess similarities and diversity among males seeking treatment for compulsive sexual behaviors and verify a correspondence of perceived reasons of pornography use with real-life data.

Methods: We conducted semi-structuralized interviews with 9 males in age of 22–37 years (M= 31.7; SD = 4.85) followed by 10-week long diary assessment. During interviews we cov­ered characteristic of CSB symptoms, underlying psycho­logical mechanisms, and role of social relations. Using questioners’ methods, we verified qualitative data and in addition we conducted10-week long diary assessment to examine real-life patterns of CSB.

Results: All subjects ex­pressed high level of severity of pornography use and mas­turbation. They also presented increased level of anxiety and declared that pornography use and masturbation serves for mood and stress regulation. There was high diversity in terms of impulsivity, social competence and other psycho­logical mechanism underlying CSB. Data collected in diary assessment uncovered high diversity in patterns of sexual behaviors (such as frequency or binge pornography use, dyadic sexual activity) and triggers. It was impossible to fit one regression model for all subjects. Instead each subject had his own model of predictors of CSB mostly not related to decelerated triggers.

Discussion and conclusions: De­spite similar scheme of problematic sexual behavior and accompanied emotions and thoughts CSB seems to have homogeneous psychological mechanisms. Individual analy­sis of longitudinal diary assessment uncovered high varia­bility in individual predictors of pornography use and mas­turbation. Therefore, those individual patters have to be carefully studied in clinical settings to provide effective treatment.

The six-component problematic pornography consumption scale

BEÁTA BŐTHE1,2*, ISTVÁN TÓTH-KIRÁLY1,2, ÁGNES ZSILA1,2, MARK D. GRIFFITHS3, ZSOLT DEMETROVICS2 AND GÁBOR OROSZ2,4

1Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary 2Institute of Psychology, Eötvös Loránd University, Budapest, Hungary 3Psychology Department, Nottingham Trent University, Nottingham, United Kingdom 4Institute of Cognitive Neuroscience and Psychology, Hungarian Research Centre for Natural Sciences, Budapest, Hungary *E-mail: [email protected]

Background and aims: To our best knowledge, no scale ex­ists with strong psychometric properties assessing problem­atic pornography consumption which is based on an over­arching theoretical background. The goal of the present study was to develop a short scale (Problematic Pornogra­phy Consumption Scale; PPCS) on the basis of Griffiths` (2005) six-component addiction model that can assess problematic pornography consumption.

Methods: The sam­ple comprised 772 respondents (390 females; Mage = 22.56, SD = 4.98 years). Items creation was based on the definitions of the components of Griffiths’ model.

Results: A confirmatory factor analysis was carried out leading to an 18-item second-order factor structure. The reliability of the PPCS was good and measurement invariance was estab­lished. Considering the sensitivity and specificity values, we identified an optimal cut-off to distinguish between problematic and non-problematic pornography users. In the present sample, 3.6% of the pornography consumers be­longed to the at-risk group.

Discussion and Conclusion: The PPCS is a multidimensional scale of problematic por­nography consumption with strong theoretical background that also has strong psychometric properties.

Sex mindset beliefs can diminish the negative association between relationship satisfaction and problematic pornography consumption

BEÁTA BŐTHE1,2†*, ISTVÁN TÓTH-KIRÁLY1,2, ZSOLT DEMETROVICS2 AND GÁBOR OROSZ2,3†

1Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary 2Institute of Psychology, Eötvös Loránd University, Budapest, Hungary 3Institute of Cognitive Neuroscience and Psychology, Hungarian Research Centre for Natural Sciences, Budapest, Hungary † Authors contributed equally to this research. *E-mail: [email protected]

Background and aims: The present research investigated the associations between relationship satisfaction and prob­lematic pornography consumption considering beliefs about the changeability of sexual life.

Methods: In Study 1 (N1 = 769), the Sex Mindset Scale was created which measures beliefs about the malleability of sexual life. In Study 2 and Study 3 (N2 = 315, N3 = 378), structural equa­tion modeling (SEM) was used to identify the relationship patterns between problematic pornography consumption, relationship satisfaction and sex mindset beliefs.

Results: Confirmatory factor analyses (Study 1) demonstrated strong psychometric properties. Each examined model (Study 2 and Study 3) showed that sex mindset beliefs are positively and directly related to relationship satisfaction, while negatively and directly related to problematic pornography consumption. Additionally, Problematic pornography con­sumption and relationship satisfaction were not related. Thus, problematic pornography use did not mediate the re­lationship between sex mindset beliefs and relationship sat­isfaction.

Discussion and Conclusions: In the light of our results, the negative relationship between problematic por­nography consumption and relationship satisfaction disap­pears by considering sex mindset as a common denominator.

Hypersexuality and its association with pedophilic sexual interests and criminal behaviors in a German male community sample

DR. DANIEL TURNER1, 2 *, DR. VERENA KLEIN2, PROF. DR. ALEXANDER SCHMIDT3 and PROF. DR.PEER BRIKEN2

1Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Germany 2Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Germany 3Department of Psychology, Legal Psychology, Medical School Hamburg, Germany *E-mail: [email protected]

Background and aims: Hypersexuality, sexual addiction or hypersexual disorder describes recurrent and intense sexual fantasies, sexual urges, or sexual behaviors that in­terfere with other important (non-sexual) goals or obliga­tions (Kafka, 2010). Although hypersexuality has recently received much consideration in the sexual offender litera­ture and is seen as one important risk factor for sexual of­fending, still not much is known about the prevalence of hypersexuality and its relationship to pedophilic sexual interests and criminal behaviors in the general population.

Methods: In a large community sample consisting of 8,718 German men who participated in an online study, we assessed self-reported hypersexual behaviors using the total sexual outlets (TSO) questionnaire and evaluated its association with self-reported pedophilic sexual interests and antisocial behaviors.

Results: Overall, the mean TSO per week was 3.46 (SD = 2.29) and participants spent on average 45.2 minutes per day (SD = 38.1) with sexual fantasies and urges. Altogether, 12.1% of the participants (n = 1,011) could be classified as hypersexual according to the classical cut-off value of TSO ≥ 7 (Kafka, 1991). Hypersexuality (TSO ≥ 7) as well as the TSO absolute values were positively correlated with sexual fantasies in­volving children, the consumption of child pornography, self-reported previous property and violent offences but not with contact sexual offending.

Conclusions: Although hypersexuality is seen as an important risk factor for sex­ual offending in sexual offender samples, this relationship could not be replicated in a community sample at least for contact sexual offending. Nevertheless, in clinical practice an assessment of criminal behaviors and pedophilic fanta­sies in hypersexual individuals and vice versa hypersexu­ality in men showing antisocial or pedophilic behaviors should be considered.