The present article develops sex-specific profiles for pure exhibitionists, pure voyeurs/covert intruders, and those engaging in both behaviors, using a clinical sample. Specific sexual behavior patterns (as measured by the SDI), general areas of disturbance (as measured by the SAST-R), and sexual addiction diagnostic criteria were considered in developing the profiles. Results suggested that men and women display unique clinical profiles related to exhibitionism and voyeurism/covert intrusion. Additionally, exhibitionists evidenced the least sexual pathology, followed by voyeurs/covert intruders, with the greatest disturbance demonstrated by the group elevated on both exhibitionism and voyeurism/covert intrusion. Particular attention was paid to relationships with rape, pedophilia, and legal consequences in the three groups. Implications for treatment and diagnosis are discussed.

The current exploratory study investigated associations between personality and psychopathology, as measured by the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), and engagement in sadomasochistic (S&M) behaviors in a sample of individuals presenting for treatment of problematic sexual behavior and/or sexual addiction. Profiles were established by sex for both low-risk (e.g., seeking out humiliation and loss of power during sexual experiences) and high-risk (e.g., engagement in sexual asphyxiation) presentations. A series of correlation and multiple regression analyses were conducted to establish associations. Results indicated that a scale measuring trauma-related symptoms (PK) predicted both high-risk and low-risk S&M behaviors, across sexes. Among men, schizoptypal characteristics, hypomanic activation, disconstraint, and negative emotionality predicted both risk levels. Low-risk behaviors in men were also predicted by self-deprecation, familial alienation, low positive emotions, and anxiety. Conversely, high-risk S&M behaviors inmen were predicted by antisocial behavior, trait psychoticism, and generalized fearfulness. High-risk S&M behaviors in women were predicted by self-deprecation, disconstraint, competitiveness, anger, antisocial behaviors, and aberrant experiences, among others. History of sexual abuse was a predictor of low-risk and high-risk S&M behavior in women only. Findings are discussed in terms of implications for treatment and further research.

Despite what some write off as phenomenological, hypothesis seeking is as important as hypothesis proving. When we notice something important clinically, we at best can report it as a case example....

Little research has focused on the risk of sexual addiction within an inpatient drug and alcohol treatment facility. The present study compared the rate and severity of sexual addiction in three chemical dependency units (30-day primary, 30-day relapse, and 90-day extended). A total of 485 participants completed the Sexual Addiction Screening Test-Revised (SAST-R). Demographic variables and substance and psychiatric diagnoses were gathered through patient chart review. Prevalence rates by unit were Primary Care 18%, Relapse 18.6%, and Extended Care 29.0%. Participants in Extended Care had a significantly higher prevalence of being identified as at risk for sexual addiction than either Relapse or Primary Care. Results showed significant differences in scores on the SAST-R in individuals in Extended Care as compared to individuals in either the Primary or Relapse units. Significant gender differences also emerged overall and by unit. Higher rates of diagnoses of certain chemical substances and psychiatric disorders emerged between the individuals at risk for sexual addiction versus those not at risk. This study is the first to explore risk for sexual addiction in inpatient substance use disorder treatment at different levels of care, and it demonstrates the need for further research that can differentiate between substance use disorders and sexual addiction in order to provide early intervention to improve treatment outcomes and prevent relapse.

The purpose of the current study was to establish the replicability of the component structure of the Sexual Dependency Inventory (SDI), a broadband, multidimensional measure of problematic sexual behaviors and preoccupations associated with sexual addiction or other sexual disorders, such as the paraphilias. The internal structure of the SDI was previously evaluated in a sexual addiction clinical sample of 626 men and 85 women, but the replicability of the component structure was not evaluated. The present study examined the internal structure of SDI responses in a very large (N > 1,000) clinical sample, and evaluated the replicability of the structure in a second sample of similar size. The structure of the SDI derived was consistent with the previous version ( SDI-3.0), was coherent and psychometrically sound, and replicated well in a second sample. Based upon these results, recommendations were made for revisions to establish the Sexual Dependency Inventory-4th Edition (SDI-4.0) Behavior and Preoccupation scales to better match the component structure identified and improved psychometric performance of the measure. Psychometric properties of scores from the revised scales were reported, including estimates of internal consistency reliability from both samples. Clinical implications and suggestions for future research are discussed.

We know the brain works to simplify decisions. Thus, when we label something, the brain's goal is to work at a higher level of efficiency. This higher order thinking of classification, while facili...

The present article examines and compares the various diagnostic rubrics proposed to codify symptoms of sexual addiction, and then briefly summarizes the ongoing controversy on whether sexual addiction is a valid construct. Using the diagnostic criteria proposed by Carnes (2005), the prevalence rate of each criterion is examined in terms of scores on the Sexual Addiction Screening Test-Revised scales (Carnes et al., 2010). Differences in diagnostic criteria endorsement associated with sex, sexual orientation, and setting were also explored. Results from a clinical sample of men and women seeking treatment for sexual addiction demonstrated clinical relevance of the criteria, in that all but 3 criteria are endorsed at more than 50% of participants screening positive for sexual addiction on the Sexual Addiction Screening Test-Revised. Sex differences were also noted for endorsement rates of several of the criteria. Finally, several proposed criteria may pose a higher clinical threshold and thus be utilized by clinicians to identify patients with increased pathology. Results are discussed in the context of existing diagnostic frameworks across etiological perspectives.

&NA;Sexual addiction is estimated to afflict up to 3% to 6% of the population. However, many clinicians lack clear criteria for detecting potential cases. Objectives:The present studies were conducted to assess the effectiveness of a brief sexual addiction screening instrument (ie, PATHOS Questionnaire) to correctly classify patients being treated for sex addiction and healthy volunteers. Methods:In study 1, a 6-item questionnaire, which utilizes the mnemonic “PATHOS,” was examined in regard to sensitivity and specificity using a sample combining patients being treated for sex addiction and healthy volunteers (970 men/80.2% patients; 938 women/63.8% patients). In study 2, a cross-validation sample of 672 men (93% patients) and 241 women (35.3% patients) completed the PATHOS screener. Results:Results of receiver operating characteristics analyses in study 1 demonstrated that the PATHOS captured 92.6% of the area under the curve and achieved 88.3% sensitivity and 81.6% specificity for classifying the male sample (n = 963) as patients and healthy subjects using a cutoff score of 3. Similarly, the PATHOS captured 90.2% of the area under the curve and, with a cutoff of 3, achieved 80.9% sensitivity and 87.2% specificity for the female sample (n = 808). In study 2, results of receiver operating characteristics analyses indicated that the PATHOS captured 85.1% of the area under the curve, with sensitivity of 70.7% and specificity of 86.9% for men (cutoff of 3). For women, the PATHOS captured 80.9% of the area under the curve and achieved 69.7% sensitivity and 85.1% specificity with the cutoff of 3. Conclusions:These studies provide support for the use of the PATHOS as a screening instrument to detect potential sexual addiction cases in clinical settings.

The present study examines differences in cybersex behavior related to gender and sexual orientation. Data were from 4,492 individuals being treated for sexual addiction, including 3,561 heterosexual men, 164 homosexual men, 131 bisexual men, 429 heterosexual women,18 homosexual women, and 61 bisexual women. Measures included the Sexual Dependency Inventor –Revised (SDI-R; Carnes & Delmonico, 1996) and the Sexual Addiction Screening Test-Revised (SAST-R; Carnes, Green & Carnes, 2010). Similarities and differences across genders and sexual orientations are reported. Multiple regression results demonstrated a general pattern in which isolative sex behaviors predicted more Internet use and relational sex behaviors predicted less use.

Sexual addiction is estimated to afflict up to 3% to 6% of the population. However, many clinicians lack clear criteria for detecting potential cases. Objectives: The present studies were conducted to assess the effectiveness of a brief sexual addiction screening instrument (ie, PATHOS Questionnaire) to correctly classify patients being treated for sex addiction and healthy volunteers. Methods: In study 1, a 6-item questionnaire, which utilizes the mnemonic "PATHOS," was examined in regard to sensitivity and specificity using a sample combining patients being treated for sex addiction and healthy volunteers (970 men/80.2% patients; 938 women/63.8% patients). In study 2, a cross-validation sample of 672 men (93% patients) and 241 women (35.3% patients) completed the PATHOS screener. Results: Results of receiver operating characteristics analyses in study 1 demonstrated that the PATHOS captured 92.6% of the area under the curve and achieved 88.3% sensitivity and 81.6% specificity for classifying the male sample (n = 963) as patients and healthy subjects using a cutoff score of 3. Similarly, the PATHOS captured 90.2% of the area under the curve and, with a cutoff of 3, achieved 80.9% sensitivity and 87.2% specificity for the female sample (n = 808). In study 2, results of receiver operating characteristics analyses indicated that the PATHOS captured 85.1% of the area under the curve, with sensitivity of 70.7% and specificity of 86.9% for men (cutoff of 3). For women, the PATHOS captured 80.9% of the area under the curve and achieved 69.7% sensitivity and 85.1% specificity with the cutoff of 3. Conclusions: These studies provide support for the use of the PATHOS as a screening instrument to detect potential sexual addiction cases in clinical settings.

The American Journal on AddictionsVolume 17, Issue 3 p. 247-248 Response to “Comorbid Psychiatric Diagnoses and Their Association with Cocaine-Induced Psychosis in Cocaine-Dependent Subjects” Lisa J. Merlo PhD, Corresponding Author Lisa J. Merlo PhD Department of Psychiatry, Division of Addiction Medicine, University of Florida, Gainesville, FloridaMcKnight Brain Institute, P.O. Box 100183, Gainesville, FL, 32610-0183. E-mail: [email protected]Search for more papers by this authorPatrick J. Carnes PhD, Patrick J. Carnes PhD Sexual Disorders Services, Meadows Institute, Wickenburg, ArizonaSearch for more papers by this authorMark S. Gold MD, Mark S. Gold MD Departments of Psychiatry, Neuroscience, Anesthesiology, Community Health & Family Medicine, Division of Addiction Medicine, University of Florida, Gainesville, FloridaSearch for more papers by this author Lisa J. Merlo PhD, Corresponding Author Lisa J. Merlo PhD Department of Psychiatry, Division of Addiction Medicine, University of Florida, Gainesville, FloridaMcKnight Brain Institute, P.O. Box 100183, Gainesville, FL, 32610-0183. E-mail: [email protected]Search for more papers by this authorPatrick J. Carnes PhD, Patrick J. Carnes PhD Sexual Disorders Services, Meadows Institute, Wickenburg, ArizonaSearch for more papers by this authorMark S. Gold MD, Mark S. Gold MD Departments of Psychiatry, Neuroscience, Anesthesiology, Community Health & Family Medicine, Division of Addiction Medicine, University of Florida, Gainesville, FloridaSearch for more papers by this author First published: 18 February 2010 https://doi.org/10.1080/10550490802019857Citations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1 Tang Y, Kranzler HR, Gelernter J, Farrer LA, Cubells JF. Comorbid psychiatric diagnoses and their association with cocaine-induced psychosis in cocaine-dependent subjects. The American Journal on Addictions. 2007; 16: 343–351. 2 Miller NS, Summers GL, Gold MS. Cocaine dependence: alcohol and other drug dependence and withdrawal characteristics. Journal of Addictive Diseases. 1993; 12: 25–35. 3 Gold MS. Cocaine Plenum Publishing Corp. New York. 1993. 4 Washton AM. Cocaine abuse and compulsive sexuality. Medical Aspects of Human Sexuality. 1989 32–40. 5 Goldstein RZ, Tomasi D, Alia-Klein N et al. Subjective sensitivity to monetary gradients is associated with frontolimbic activation to reward in cocaine abusers. Drug and Alcohol Dependence. 2007; 87: 233–240. 6 Hall GW, Carriero NJ, Takushi RY, Montoya ID, Preston KL, Gorelick DA. Pathological gambling among cocaine-dependent outpatients. American Journal of Psychiatry. 2000; 157: 1127–1133. 7 Shapira NA, Goldsmith TD, Keck PE Jr, Khosla UM, McElroy SL. Psychiatric features of individuals with problematic internet use. Journal of Affective Disorders. 2000; 57: 267–272. Citing Literature Volume17, Issue3May‐June 2008Pages 247-248 ReferencesRelatedInformation

Back to table of contents Previous article Next article Letters to the EditorFull AccessDepression-Related Improvement With Vardenafil for Erectile ResponseMARK S. GOLD M.D.KIMBERLY FROST-PINEDA M.P.H.,PATRICK J. CARNES Ph.D.,MARK S. GOLD M.D.KIMBERLY FROST-PINEDA M.P.H.,PATRICK J. CARNES Ph.D.,Published Online:1 Aug 2006AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: It is with great interest that we read the article in the January 2006 issue of the Journal by Raymond Rosen, Ph.D, and colleagues on depression-related improvement with vardenafil for erectile response (1) . While we agree with the authors' conclusions related to improved treatment outcomes and quality of life when physical symptoms associated with depression are managed, we argue that there are a number of issues that are not adequately addressed in their study. Based upon our clinical experience and review of the literature and initial data, we feel that there are some populations that should be screened for nonprescription use of erectile dysfunction drugs (2 , 3) . In the study by Dr. Rosen and colleagues, no mention is made regarding the screening of participants for sexual compulsivity. In addition, the authors do not address the issue of medication diversion, which is a considerable matter for erectile dysfunction treatment. Patients with a history of 3,4-methylenedioxymethamphetamine or methamphetamine abuse commonly use diverted prescription drugs for erectile dysfunction, and prescription misuse is increasing. However, no national survey or surveillance system tracks the misuse of any erectile dysfunction medication. Patients with a history of internet sex or sexual compulsivity are also in need of further evaluation. An increased number of patients are reporting a decline in their sexual performance co-occurring with problematic, compulsive online sexual behavior.We feel that future studies should address the diversion and abuse potential of erectile dysfunction treatment and screen for sexual compulsivity problems in study populations.Gainesville, Fla.Hattiesburg, Miss.References1. Rosen R, Shabsigh R, Berber M, Assalian P, Menza M, Rodriguez-Vela L, Porto R, Bangerter K, Seger M, Montorsi F: Efficacy and tolerability of vardenafil in men with mild depression and erectile dysfunction: the depression-related improvement with vardenafil for erectile response study. Am J Psychiatry 2006; 163:79–87Google Scholar2. Graham NA, Gold MS: Performance enhancing, non-prescription use of erectile dysfunction medications. J Addict Dis 2006 (in press)Google Scholar3. Carnes PJ: Sexual addiction, in Kaplan and Sadock's Comprehensive Textbook of Psychiatry. Sadock BJ, Sadock VA (eds). Philadelphia, Lippincott, Williams, and Wilkins, 2004Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 163Issue 8 August, 2006Pages 1449-1449THE AMERICAN JOURNAL OF PSYCHIATRY August 2006 Volume 163 Number 8 Metrics PDF download History Published online 1 August 2006 Published in print 1 August 2006

This paper proposes a theoretical framework by way of exploring addiction interaction in terms of addressing the following key questions: What happens when a patient population of sex addicts is assessed for other comorbid disorders? What conceptual foundations might we look to in terms of possible etiology and clinical intervention? Are there ways these addictions interact making the whole more than just the “sum” of the addictions themselves? Can we explain these interactions from what is known from neurobiology? Finally, are these interactions comprehensible to patients? In order for the paradigm to be useful to patients, they have to be able to recognize them. Clinicians who achieve a basic understanding of addiction interactions and relevant neurobiological background will be in a better position to serve the needs of their client.

(2002). Richard Irons, M.D. (1948-2002) Sexual Addiction & Compulsivity: Vol. 9, No. 2-3, pp. 185-187.

Three clinical constructs are proposed: (1) Human beings have an arousal template that is sexually dynamic and critical for understanding sexually addictive behavior; (2) Courtship disorders are a framework for making explicit arousal dynamics in compulsive behavior; and (3) Cybersex, by escalating behavior rapidly, can help us to understand the arousal template, the role of courtship distortions, and the nature of compulsive sex. This paper approaches escalating arousal from the perspective of affective content, especially rage, courtship distortions, and our increasing knowledge of neurochemistry. Each of the above constructs provides essential understandings necessary for both client and therapist. The arousal template emerges as a functional framework to understand and teach about key roles arousal plays in sexually compulsive behavior. Clinical interventions and implications are discussed.