In 1998, Gold and Heffner authored a landmark review in Clinical Psychology Review on the topic of sexual addiction that concluded that sexual addiction, though increasingly popular in mental health ...settings, was largely based on speculation, with virtually no empirical basis. In the more than two decades since that review, empirical research around compulsive sexual behaviors (which subsumes prior research about sexual addiction) has flourished, ultimately culminating in the inclusion of a novel diagnosis of Compulsive Sexual Behavior Disorder in the eleventh edition of the World Health Organization's International Classification of Diseases. The present work details a systematic review of empirical research published between January 1st, 1995 and August 1st, 2020 related to compulsive sexual behaviors, with a specific focus on evaluating the methodologies of that literature. This review yielded 371 papers detailing 415 individual studies. In general, the present review finds that, although research related to compulsive sexual behaviors has proliferated, much of this work is characterized by simplistic methodological designs, a lack of theoretical integration, and an absence of quality measurement. Moreover, the present review finds a virtual absence of high-quality treatment-related research published within this time frame. Implications of these findings for both clinical practice and future research are discussed.
•Research related to sexual addiction and compulsive sexual behaviors has proliferated in recent years.•The ICD-11 has elected to include a novel diagnosis of Compulsive Sexual behavior Disorder.•A systematic review revealed 415 empirical studies of compulsive sexual behavior in the past 25 years.•The majority of studies made use of cross-sectional designs in non-clinical populations.•At present, there is almost no empirical basis for the treatment of compulsive sexual behaviors.
Reward based learning is broadly acknowledged to underpin the development and maintenance of addictive behaviour although the mechanism in sexual compulsivity is less understood. Using a ...Pavlovian-to-Instrumental Transfer (PIT) task we tested whether the motivational aspect of conditioned Pavlovian conditioned stimulus invigorated instrumental responding in relation to specific compatible monetary rewards. Performance on the task was analysed between two groups of males based on Low (N = 38) and High (N = 41) self-report online sexual behaviour (OSB). Psychometric tests including sexual compulsivity scale and behavioural activation/behavioural inhibition (BIS/BAS) were also administered to determine the relationship between OSB and general reward sensitivity. We show clear evidence of acquisition in the Pavlovian and instrumental conditioning phases. Specific transfer effect was greater in the High-OSB group although the difference compared to the Low-OSB group was non-significant. OSB negatively correlated with both BIS and BAS indicative of introversion and low reward sensitivity. OSB positively correlated with sexual compulsivity although it is unclear whether individuals in the High-OSB group considered their behaviour either excessive or problematic. These findings contribute to the ongoing debate regarding the nature of problematic OSB. Fundamental differences in motivational characteristics and mechanism contributing to compulsive behaviour in relation to high-OSB might indicate incompatibility with behavioural addiction models. PIT was not enhanced in high-OSB by appetitive conditioning, although problematic OSB could stem from failure to inhibit actions. Further research should investigate whether aversive conditioning differentially affects responding in high-OSB individuals, potentially explaining perseverant behaviour despite negative consequences.
This study is about the role of the addiction discourse in the self-identity of Israeli men who pay women for sex (MPWS). Using the theoretical framework of
we identified two main contradictory ...themes regarding the role of the addict identity in the self-narratives of the participants: one presenting the addict identity as contributing to the participants' positive self-perception and the second as challenging it. Within a social context that often portrays MPWS as perpetrators and abusers, the addiction discourse was a useful source in helping the participants negotiate the dilemma of how to engage in "deviant" acts and still appear to be decent men. While not dismissing the reality of addiction or the distress experienced by some of the participants, we suggest that being "sick" and "having no control over one's actions" might be considered by some MPWS as preferable explanations to being an outlaw, or villain. However, the inconclusive nature of the sex addiction discourse intimidated some of the participants' self-identity, thus stressing the need for a clear definition and further theorization of sex addiction, particularly in the context of sex for pay. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
An integrative model of sexual addiction is presented, involving a combination of models based upon (i) incentive motivation theory and (ii) the dual organisation of the control of behavior. The ...model is related to ongoing arguments about the validity of the notion of addiction when applied to sexual behavior. It is suggested that the evidence strongly favors the viability of an addiction model of sex. Strong similarities to the classical addiction to hard drugs are observed and features can be better understood with the help of the model. These include tolerance, escalation and withdrawal symptoms. It is argued that other candidates for accounting for the phenomena, such as obsessive-compulsive behavior, faulty impulse control, high drive and hypersexuality do not fit the evidence. The role of dopamine is central to the model. The model’s relevance to stress, abuse, development, psychopathy, fantasy, sex differences, evolutionary psychology and the interaction with drug-taking is shown.
•A combination of (i) an incentive motivation model of sex and (ii) dual control theory is presented.•By the criteria of (i) suffering and (ii) a shift in weight of control from goal-based to stimulus-based, sex can become addictive.•Scrutiny of the criticisms of the notion of sex as addiction reveals them to be invalid.•Similarities between sex addiction and drug addiction are noted.•Out-of-control sexual behavior is not best characterized as hypersexuality, high drive or an impulse control disorder.
Background and Objectives:Sexual addiction is known as a disorder that afflicts a person with difficulty in controlling or delaying sexual behaviors. In order to prevent social, physical, and ...psychological consequences, validated screening tests are needed to diagnose this disorder. One of these tests is established by Carnes with the name of “Sexual Addiction Screening Test-Revised” (SAST-R). In this study, Sexual Addiction Screening Test-Revised has been translated and verified in the Persian language. Methods: To this purpose, the original screening test was translated to the Persian language and also back translated for matching by two different expert teams. Data was collected through online survey from 1268 participants who were between 18 to 65 years old (M=29.44 and SD=6.90) that 56.1% and 43.9% of them where women and men respectively. Three questionnaires including sexual addiction screening test–revised (SAST-R), hypersexual behavior consequences scale, and Connor-Davidson Resilience Scale as the principal, convergent and divergent tests were administered to the participants. Results: The reliability of the test's internal consistency (Cronbach's alpha = 0.883), Split-Half (Cronbach's alpha = 0.779), and Guttman (lambda coefficients were between 0.773 to 0.883) tests were used. In addition, four methods of content validity (sexual hyperactivity specialist approved), convergent structure validity (P<0.001, R =0.731), the validity of divergent structure (P<0.09, R = -0.132), and factor validity (CFI=0.884, GFI=0.873, RMSEA=0.047) were measured and confirmed the validity of the test. Conclusion: The Persian version of the sexual addiction screening test–revised (SAST-R) seems to be a reliable pre-clinical tool to assess the severity of sexual desire of patients.
Although compulsive sexual behaviour (CSB) has been conceptualized as a "behavioural" addiction and common or overlapping neural circuits may govern the processing of natural and drug rewards, little ...is known regarding the responses to sexually explicit materials in individuals with and without CSB. Here, the processing of cues of varying sexual content was assessed in individuals with and without CSB, focusing on neural regions identified in prior studies of drug-cue reactivity. 19 CSB subjects and 19 healthy volunteers were assessed using functional MRI comparing sexually explicit videos with non-sexual exciting videos. Ratings of sexual desire and liking were obtained. Relative to healthy volunteers, CSB subjects had greater desire but similar liking scores in response to the sexually explicit videos. Exposure to sexually explicit cues in CSB compared to non-CSB subjects was associated with activation of the dorsal anterior cingulate, ventral striatum and amygdala. Functional connectivity of the dorsal anterior cingulate-ventral striatum-amygdala network was associated with subjective sexual desire (but not liking) to a greater degree in CSB relative to non-CSB subjects. The dissociation between desire or wanting and liking is consistent with theories of incentive motivation underlying CSB as in drug addictions. Neural differences in the processing of sexual-cue reactivity were identified in CSB subjects in regions previously implicated in drug-cue reactivity studies. The greater engagement of corticostriatal limbic circuitry in CSB following exposure to sexual cues suggests neural mechanisms underlying CSB and potential biological targets for interventions.
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