This study aims to examine the indirect effect of problematic pornography consumption on the relationship between difficulties in emotion regulation and loneliness while also considering the effects of frequency of pornography use. Specifically, the hypothesized moderated mediation model includes problematic pornography consumption as mediator and frequency of pornography use as moderator of the association between difficulties in emotion regulation and problematic pornography consumption. A total of 768 individuals from Romania (aged 18-49 years; M = 28.31, SD = 8.52; 57.3% women) participated in the study. The moderated mediation model was tested using regression-based conditional process analysis. Results indicated that difficulties in emotion regulation were indirectly associated with loneliness via problematic pornography consumption, and that this indirect association was conditional on the frequency of pornography use. Specifically, frequency of pornography use moderated the path linking difficulties in emotion regulation to problematic pornography consumption. The frequency of pornography use may play an important contextual role in understanding the dynamics between difficulties in emotion regulation, problematic pornography consumption, and loneliness.
This article introduces a novel approach to group therapy for individuals who have repeatedly engaged in sexual behavior that conflicts with their commitments, values, sense of self-control, and/or responsibility to others. Its central organizing construct is the Problematic Sexual Behavior (PSB) Framework, a simple, adaptable, theory-flexible, non-pathologizing and description-based method for assessing sexual behavior patterns for the presence of problematic attributes. After briefly outlining the structure and advantages of the PSB Framework, this article describes its application to group therapy by listing the major distinguishing features and benefits of "PSB groups."
Compulsive sexual behaviors (CSB) deeply impact the family system in diverse ways. This study aimed to explore the experiences of self-perceived adult children of parents with compulsive sexual behaviors (ACPCSBs) in childhood and adulthood, and the lasting impacts of having a parent they perceived as struggling with CSB. Due to the novelty of researching the experiences of self-perceived ACPCSBs, a qualitative approach was utilized to provide a deeper understanding of the ACPCSB experience. Participants (n = 10) completed semi-structured interviews via Zoom. Interviews were transcribed and analyzed using an interpretive phenomenological analysis. The themes (1) experiences and impacts of self-perceived ACPCSBs and (2) recontextualizing and unraveling their story emerged with numerous subthemes. Participants described their parents' self-perceived CSB as impacting the sexual messages, images, and behaviors modeled to them, as well as lasting impacts to their sexuality, emotional well-being, identity, and relationships. Participants also described recontextualizing past childhood experiences and emotions in adulthood and unraveling the impacts of their parents' self-perceived CSB throughout life. This study highlights the challenges and lasting impacts that self-perceived ACPCSBs experience after growing up in a family system with perceived CSB, as well as the need for greater research documenting ACPCSBs experiences.
Previous literature suggests that higher subjective sexual responsivity may increase the risk of problematic pornography use (PPU), although this assumption remains debated. Empirical studies are scarce, and the methodology used could be improved. We examined individuals' subjective sexual arousal responses and their association with PPU. A total of 219 men and women completed an experimental task in which they self-reported subjective sexual arousal every 20 s during a pornographic film. Profiles were identified using time-series clustering techniques. Participants also reported their online and offline sexual behavior, PPU, other out-of-control sexual behaviors, and dispositional variables (sexual sensation-seeking, impulsivity, affect). Three response patterns emerged: "non-responsive" (36.5%), "low-responsive" (38.8%), and "moderate-responsive" (24.7%). Most participants experienced sexual responsivity during pornography exposure, but a significant proportion did not (non-responsive profile). Those with a non-responsive profile displayed a lower lifetime pornography use (81.25%) than responsive profiles (low-responsive: 95.3%; moderate-responsive: 98.1%; p<.01) and reported less weekly time on the internet for sexual purposes (1.10 h) than the moderate-responsive profile (2.20 h; p<.05), suggesting a possible relationship between arousal responsivity and non-problematic use. No significant differences emerged between profiles in PPU indicators, suggesting that subjective sexual arousal during pornography use is not related to risk of PPU.
Researchers are increasingly interested in the types of pornography individuals view and how these patterns relate to sexual behavior and problematic pornography use (PPU). However, few studies evaluate the psychometric properties of scales assessing the use of different types of pornography. The Nonmainstream Pornography Use Extent Scale (NPUES) was initially proposed to examine the extent of use across five types of nonmainstream pornography. Since the release of the NPUES, the scale has not been psychometrically evaluated. In the present study, we examined the psychometric properties of the NPUES in a diverse sample of American adults (N = 791) who reported viewing pornography at least monthly. Confirmatory factor analysis revealed a one-factor, five-item scale best fit the data. Measurement invariance results supported the strictest level of invariance for gender and PPU status. The NPUES is an adequate measure to assess the extent of nonmainstream pornography use. Men reported viewing pornography more frequently and for longer durations of time than women. Women reported viewing all types of nonmainstream pornography use more than men. Those with PPU viewed pornography more frequently, for longer duration, and endorsed viewing all types of nonmainstream pornography more than those without PPU.
While existing research often emphasizes women's sexual experiences or men's reproductive roles, limited attention has been paid to how societal and cultural expectations of manhood shape men's experiences of intimacy. This study explored the cultural and social factors influencing sexual behavior and perceived sexual ability among young men in Taraba State, Nigeria. Thirty men aged 18-35 years, from diverse socio-economic backgrounds including students, artisans, and traders, participated in in-depth interviews and focus group discussions. Using frameworks of hegemonic masculinity and social constructionism, the analysis identified four primary themes: (1) anxiety and shame related to sexual performance; (2) influence of peers and digital media on masculine ideals; (3) the use of sexual enhancement products as markers of male power; and (4) tension between private difficulties and public claims of sexual competence. Findings reveal that pressures to demonstrate sexual prowess are deeply entrenched in local cultural norms, and are amplified by peer networks and online platforms. These pressures contribute to risky behaviors, including reliance on unregulated enhancement products, and create a private-public divide marked by stress and concealment. The study recommends culturally sensitive sexual health interventions that will address performance pressures, promote open communication, and reconceptualize masculinity beyond sexual prowess.
This study examined the relations between therapist perceptions of psychodynamic therapy (PDT) process, adherence to PDT principles, and interaction structures formed between therapist and patient. A graduate student therapist treated a 28-year-old man diagnosed with compulsive sexual behavior disorder and borderline personality disorder with PDT (N = 52 sessions). Following each session, the therapist completed the Psychotherapy Process Q-Set (PQS) to capture his perceptions of session process. Independent coders completed the PQS from session audio-recordings. Preceding each session, the patient completed the Outcome Questionnaire to measure psychological distress. The therapist was most discrepant on items pertaining to his own attitudes and behavior (including interventions), indicating countertransference. Therapist agreement with the independent coders was positively correlated with PDT session adherence and negatively correlated with untherapeutic interaction structures (i.e. reciprocal patterns of interaction) identified in a previous study. Simulation modeling analysis revealed that increased therapist agreement and psychological distress independently preceded increases in a potentially therapeutic interaction structure observed one session later. Therapist agreement was associated with PDT session adherence and interaction structures, suggesting routine monitoring to protect treatment fidelity and therapeutic interaction structures.
The internet plays a essential role in modern life, but its problematic use, especially involving sexual content, can lead to serious psychosocial issues. Violent pornography is particularly concerning for its potential to desensitize users to aggression and reinforce antisocial behaviors. This study investigated the relationship between violent pornography consumption, problematic sexual internet use, and Dark Tetrad personality traits (Machiavellianism, narcissism, psychopathy, and sadism). A total of 795 participants, mostly female and recruited via social media, completed an online survey measuring these variables. The findings revealed significant associations, with psychopathy and sadism showing the strongest links to problematic sexual use of the internet. Structural equation modeling, controlling for the sex of the participants, confirmed that time spent viewing violent pornography and problematic sexual internet use are associated to the Dark Tetrad traits. These results suggest a reinforcing cycle, where individuals high in psychopathy and sadism are drawn to violent sexual content, which may further entrench these traits and normalize aggressive or antisocial behaviors. The study underscores the importance of addressing the psychological factors behind problematic sexual internet use.
There is strong evidence suggesting that addiction is highly stigmatized. However, less research has examined stigma associated with compulsive sexual behavior (CSB; i.e. sex addiction), and findings yield mixed results. Further, few studies have explored the role of gender in stigma associated with CSB, particularly within the context of problem pornography use (PPU). Therefore, we examined stigma associated with CSB - specifically PPU - compared to other addictions and mental health conditions, and determined if gender had an effect. Participants (N = 750, 53% women) were randomly assigned to read one of several vignettes each depicting a different addictive behavior (CSB, gambling, alcohol), mental health condition (depression) or health condition (cancer). There were two gendered versions (man vs. woman) of each vignette. Participants answered a series of questions to assess various types of stigma (e.g. general attitudes, affective reactions, social distance) associated with each condition. Results suggested that CSB was often more stigmatized than other conditions. Stigma toward men with CSB was greater than toward women with CSB. These findings suggest that gender may play a role in how individuals with CSB are perceived. Understanding stigma associated with CSB is essential given the associated negative consequences, including barriers to seeking treatment.
This study examined the relationships between pornography consumption, sexual compulsivity, and problematic pornography use (PPU) among Italian adults. Data were collected online through standardized and self-report questionnaires from 2,460 participants (63% female, 37% male). Results showed that there was a positive and significant correlation between pornography consumption and both sexual compulsivity and problematic use (r = .44 to r = .64). Regression and mediation analyses using the PROCESS macro revealed that sexual compulsivity partially mediated the relationship between pornography consumption and problematic pornography use, controlling for age group and gender. Additionally, ANOVA tests showed that single and polyamorous individuals had higher means on the COPS, SCS, and PPCS variables compared to married individuals (eta 2 ranged from .01 to .04). These findings support six-factor models of behavioral addiction and emphasize the key role of sexual compulsivity as an important psychological factor in the development of PPU. Overall, the results of this study highlight the need for culturally based interventions and further research on the individual and social factors influencing problematic pornography use.
This study investigated the efficacy of a palette of Addiction Focused Eye Movement Desensitization and Reprocessing (AF-EMDR) therapy interventions in patients struggling with sexual addiction, including those with a history of sexual offenses. Using a single case multiple baseline design, we aimed to determine if AF-EMDR therapy reduced craving for explicit content and other symptoms of sexual addiction. Data were collected using the Empatica E4 wristband, passively monitoring indirect measures of autonomic nervous system activity during cravings, alongside self-reports of sexual craving, online sexual addiction and online sexual behavior. Measurements were taken before, during, and post-desensitization, both at rest and during exposure to questions about online pornography use. A follow-up interview was conducted to assess the lasting effects of the treatment. During exposure to sexual addiction related questions, more sympathetic nervous system activity was measured than in the resting condition. In both conditions clinically desirable changes occurred following the initiation of desensitization in AF-EMDR treatment. Follow-up measurements and the interview suggested that the behavioral changes were maintained a year post-treatment. This study indicates that AF-EMDR therapy is a viable treatment option for patients who are struggling with sexual addiction.
Compulsive Sexual Behavior Disorder (CSBD) was recently included in the 11th edition of the International Classification of Diseases (ICD-11). However, there is a notable lack of valid and concise measures for assessing CSBD in non-WEIRD contexts, such as Iran. This study aimed to validate a culturally sensitive and succinct inventory for CSBD within Iranian society. A convenience sample of 1,058 participants (78.3% female, 21.7% male) was recruited, all of whom were married and provided informed consent. The research employed the Compulsive Sexual Behavior Disorder-Diagnostic Inventory (CSBD-DI) in both 9-item and 7-item formats. Psychometric evaluations included descriptive statistics, exploratory factor analyses, bootstrap analyses for factor stability, and confirmatory factor analyses to establish construct validity. Reliability was assessed using Kuder-Richardson 20 (KR-20) and Coefficients Omega metrics. Findings indicated a single-factor structure with strong fit indices, particularly for the 7-item version. The 9-item version exhibited superior reliability and IRT test information. Notably, gender differences were observed. Men showed higher mean scores (9-item version) and greater construct variance (both versions) compared to women. Additionally, significant gender differences emerged in error variances for items 1, 2 (both versions) and item 9 (9-item version). Overall, the CSBD-DI demonstrated robust construct validity and reliability for measuring CSBD in Iranian society while highlighting significant gender considerations.
Moral incongruence, the conflict between an individual's beliefs and behaviors, has been identified as a significant contributor to psychological distress among pornography users. However, little research has focused specifically on how this dynamic affects single men. Thus, the objective of this cross-sectional study was to investigate the relationship between morally incongruent pornography use and sexual shame, loneliness, and depression in a sample of 167 single men, with particular attention to the moderating role of secure friendships. Participants completed self-report measures assessing pornography use, moral disapproval, sexual shame, friendship attachment, loneliness, and depression. Results of mediation and moderation analyses indicated that morally incongruent pornography use was significantly associated with increased sexual shame which was linked to greater loneliness and depressive symptoms. Importantly, the presence of secure friendships was protective, attenuating the effects of morally incongruent pornography use. These findings suggest that for single men who experience moral conflict over their pornography use sexual shame and loneliness may function as a pathway through which morally incongruent pornography use contributes to depression. However, cultivating secure friendships may mitigate the development of sexual shame and its effects. This study highlights the importance of relational support in addressing the psychological impacts of moral incongruence and suggests potential avenues for intervention and future research.
Hypersexuality is defined by the presence of excessive sexual fantasies, urges, and behaviors. Several authors suggest that extensive use of sexuality might represent a coping strategy for negative affect, in the context of emotion regulation difficulties and insecure attachment styles. The current study focuses on identifying different profiles, based on attachment dimensions and on the tendency to use sexual activity as a coping mechanism, examining differences in self-criticism and pathological personality traits. A total of 562 participants from the general Italian population, with an average age of 30.81 years (SD = 12.54), completed the self-report questionnaires: Hypersexual Behavior Inventory, Attachment Style Questionnaire, Personality Inventory for DSM-5 Short Form, and Forms of Self-Criticizing/Attacking and Self-Reassuring Scale. Latent profile analysis and multivariate analyses of variance between profiles were performed. Three profiles, Secure without Sexual Coping, Insecure with Sexual Coping and Insecure without Sexual Coping, were identified, based on scores on the sex use subscale and in the insecure attachment dimensions. Significant differences emerged between the profiles: the Insecure with Sexual Coping profile was characterized by the highest levels in the Antagonism and Disinhibition domains of pathological personality, while the Insecure without Sexual Coping showed the highest levels in the dimensions of Inadequate Self, Reassured Self, and Negative Affect.
Comorbidity rates between Compulsive Sexual Behavior (CSB) Disorder and addictive disorders range from 14% to 44%. However, it remains unclear whether individuals who report concern about CSB are more likely to engage in, and experience problems with, other addictive behaviors. This study aimed to examine whether those who report concern about CSB engage in and experience problems with other addictive behaviors more than those who do not report concern about CSB. Adults (N = 4,072) from a census-matched U.S. sample reported their frequency of engagement with several substances/behaviors. Those who reported past-year engagement also completed measures assessing the number of problems they experienced. Correlations and independent-sample t-tests showed higher engagement and problems with all substances/behaviors in those who reported concern about their CSB compared to those who did not report concern about CSB. This suggests distress across multiple addictive areas in those who are concerned about their CSB, regardless of diagnosis, highlighting a need for prevention and screening across addictive domains in this population.
This study examined the relationships between symptoms of post-traumatic stress (PTS), compulsive sexual behavior (CSB), and problematic pornography use (PPU) while investigating the moderating roles of two types of lifetime trauma experiences (sexual, physical injury-related, and their combination) and gender. Using data from 2,900 American adults (52.5% men, 45.2% women, and 2.3% gender-diverse individuals), we conducted moderated linear regressions to test whether the PTS-CSB and PTS-PPU relationships varied by trauma type and gender. Findings indicated that PTS significantly and positively predicted both CSB and PPU. Originally, trauma type did not significantly moderate the PTS-CSB relationship, only the PTS-PPU relationship. However, a sensitivity analysis revealed a significant moderating effect of sexual trauma on both associations. Contrary to our hypothesis, individuals with sexual-only trauma and higher PTS indicated lower CSB/PPU scores than those with physical injury-related trauma, combined trauma, or no trauma, suggesting that sexual-only trauma may also be linked with sexual avoidance in some individuals. Gender moderated the associations, with men exhibiting higher CSB and PPU scores than women in the presence of higher levels of PTS. Implications and recommendations for future research are discussed.
This study explored the crucial yet overlooked topic of healthy sexuality in individuals who struggle with compulsive sexual behavior disorder (CSBD). This study used interpretive phenomenological analysis to examine the lived experiences of eight straight married men recovering from CSBD. Analysis revealed six themes: (a) a holistic practice fostering fulfillment, joy, and freedom; (b) the journey of self-discovery encompassing self-esteem, self-confidence and self-love; (c) resilience against limiting beliefs and shame; (d) mindful, purposeful engagement with life; (e) honoring personal boundaries; and (f) expressing values with integrity. This study offers insights that can enhance clinical practice by understanding how this population experiences healthy sexuality while in recovery.
