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  • 1 Department of Behavioral Science, Ariel University, , Science Park, Ariel, , Israel
  • | 2 Department of Behavioral Science and Integrative Brain and Cognition Center, Ariel University, Ariel, , Israel
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Abstract

Background and aims

Compulsive sexual behavior disorder (CSBD) has been a long debated issue. While formerly the discussion was about whether to regard CSBD as a distinctive disorder, the current debate is dealing with the classification of this phenomenon. One of the prominent voices in this field considers CSBD as a behavioral addiction and proposes CSBD to be called and diagnosed as sexual addiction (SA). This present debate paper will review the existing evidence supporting this view and it will argue against it.

Results

We have found that a great deal of the current literature is anecdotal while empirical evidence is insufficient. First, the reports about the prevalence of CSBD are contradictory. Additionally, the field mainly suffers from inconsistent defining criteria of CSBD and a consensus which symptoms should be included. As a result, the empirical evidence that does exist is mostly about some symptoms individually and not on the disorder as a whole construct.

Conclusions

We conclude that currently, there is not enough data supporting CSBD as a behavioral addiction. Further research has to be done, examining CSBD phenomenology as a whole construct and based on a homogeneous criterion.

Abstract

Background and aims

Compulsive sexual behavior disorder (CSBD) has been a long debated issue. While formerly the discussion was about whether to regard CSBD as a distinctive disorder, the current debate is dealing with the classification of this phenomenon. One of the prominent voices in this field considers CSBD as a behavioral addiction and proposes CSBD to be called and diagnosed as sexual addiction (SA). This present debate paper will review the existing evidence supporting this view and it will argue against it.

Results

We have found that a great deal of the current literature is anecdotal while empirical evidence is insufficient. First, the reports about the prevalence of CSBD are contradictory. Additionally, the field mainly suffers from inconsistent defining criteria of CSBD and a consensus which symptoms should be included. As a result, the empirical evidence that does exist is mostly about some symptoms individually and not on the disorder as a whole construct.

Conclusions

We conclude that currently, there is not enough data supporting CSBD as a behavioral addiction. Further research has to be done, examining CSBD phenomenology as a whole construct and based on a homogeneous criterion.

Introduction

Excessive sexual behavior, hypersexuality, compulsive sexual behavior disorder (CSBD) or sexual addiction (SA), are all different labels referring the same phenomena, but those different names reflect different theoretical frameworks for the understanding of excessive sexual behavior. The behavior those concepts represent, is a maladaptive sexual behavior, taking a lot of time daily, persisting despite adverse consequences and despite efforts to stop them (Levine, 2010). The literature is still inconclusive regarding the prevalence and the classification of CSBD. The main goal of this paper is to review the current data regarding those topics and specifically addressing the issue if there is enough data to justify seeing CSBD as a behavioral addiction. We will review the prevalence of CSBD and some of the findings regarding comorbidity with CSBD. We will then address the classification of CSBD by briefly reviewing impulsivity and compulsivity, and then we will discuss in detail the phenomenology of addiction and whether CSBD corresponds with it. We will also review some of the findings from the neurobiology aspect and finally we will discuss some recommendations for further research.

Epidemiology

The Prevalence of CSBD is unknown due to very few population-based studies been made. Data about prevalence of CSBD is limited and sparse. Most of reviews show that the prevalence range of CSBD is between 3 and 6% although some studies extend the range to even above 16% (Yoon, Houang, Hirshfield, & Downing, 2016). Reviewing other studies even broadens the range from as high as 18% (American Psychiatric Association, 2000; Walton, Cantor, & Lykins, 2017) to as low as 1% (Dickenson, Gleason, Coleman & Miner, 2018). Further exploration of the existing data raises the hypothesis that part of the discrepancy between studies is explained by gender, age and the sexual orientation of the participants. For example, sexual impulsivity, which might be a facet of CSBD, in the US was found to be higher amongst men than in women, 18.9% versus 10.9% accordingly (Erez, Pilver, & Potenza, 2014). A large survey study conducted by Dickenson et al. (2018) found that above 10% of men and 7% of women are distressed with issues regarding their sexual behavior and feel that their sexual habits are excessive and uncontrollable. Bőthe et al. (2018) have reported a study on CSBD conducted in a large scale diverse non-clinical sample (N =  18,034 participants) across both gender and sexual orientation. The results have indicated that Lesbian Gay Bisexual, Transgender and Queer (LGBTQ) males may be a group most at risk of engaging in hypersexual behavior, and LGBTQ females are at a higher risk of engaging in hypersexual activities due to coping problems. For more detailed review of differences between research populations see Yoon et al. (2016). Additionally, as suggested by Stewart and Fedoroff (2014) and by Yoon et al. (2016) it is obvious that the lack of consensus about the prevalence rates stems also from the disagreement about the core perspective of the disorder and as a result, the use of different tools with different emphasis of the observed behavior.

Comorbidity

Reviewing the literature regarding CSBD reveals a significant occurrence of comorbidity between CSBD and other psychiatric disorders. Mood disorders, especially depression, is the most common disorder that appear to comorbid with CSBD (e.g. Kopeykina et al., 2016; Kor, Fogel, Reid, & Potenza, 2013; Schultz, Hook, Davis, Penberthy, & Reid, 2014; Wéry et al., 2016). Anxiety disorders also found to be highly co-occur with CSBD, particularly generalized anxiety disorder and social anxiety (33–46%; e.g. Kafka, 2015; Karila et al., 2014; Wéry et al., 2016). Additionally, Wéry et al. (2016) found individuals with CSBD to be highly subjected (41.7%) to suicidal risk. Also frequently reported is the comorbidity between CSBD and Substance Use Disorder, mainly alcohol abuse (13–64%; e.g. Ballester-Arnal, Castro-Calvo, Giménez-García, Gil-Juliá, & Gil-Llario, 2020; Hartman, Ho, Arbour, Hambley, & Lawson, 2012; Reid & Meyer, 2016). Research focused on individuals with SUD as opposed to CSBD, have also found positive associations with hypersexuality (25%; Stavro, Rizkallah, Dinh-Williams, Chiasson, & Potvin, 2013). Another disorder frequently found to be associated with CSBD is Attention Deficit Hyperactivity Disorder (ADHD) (23–27%; e.g. Karaca, Saleh, Canan, & Potenza, 2017; Niazof, Weizman, & Weinstein, 2019). A recent large-scale study done by Bőthe, Koós, Tóth-Király, Orosz, and Demetrovics (2019) has found that ADHD symptoms had positive and moderate associations with CSBD in both men (β = 0.5) and women (β = 0.43). Studies also report for comorbidity between CSBD and personality disorders. The most common personality types associated with CSBD are histrionic, paranoid, avoidant, obsessive-compulsive, narcissistic, and passive aggressive (14–28%; e.g. Black, Kehrberg, Flumerfelt, & Schlosser, 1997; Kaplan & Krueger, 2010; Raymond, Coleman, & Miner, 2003). Carpenter, Reid, Garos, and Najavits (2013) have found that although personality disorders are more prevalent among individuals with CSBD than in the general population, most of the cases do not meet the full criteria of personality disorder and rather represent a mere personality trait. Similarly, the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) scores of individuals with CSBD reveals this group is not characterized by other pathology or even addictive tendency. In fact, evidence support the idea that hypersexual patients are a diverse group with an array of causes that might lead to the hypersexual behavior (Reid & Carpenter, 2009). There are different personal traits that lead to different form of CSBD. For example, individuals with anxiety use masturbation as an avoidant strategy while individuals with novelty-seeking might constantly cruise for occasional partner along with substances use to satisfy the urge for new stimulus (Sutton, Stratton, Pytyck, Kolla, & Cantor, 2015). To conclude, we think further research should be done to isolate the possible subtypes of CSBD, to determine whether they comprise a cohesive disorder and whether it is a behavioral addiction.

Typology

Different authors have reviewed CSBD from different perspectives. For example, Gold & Heffner (1998) reviewed CSBD as a sexual addiction, sexual compulsivity or sexual impulsivity. They assumed that each one of the viewpoints they reviewed accounts for a subgroup of cases rather than for the whole phenomena. They have argued that the field will not benefit by further debates rather by well-controlled empirical research. Bancroft (2008) reviewed CSBD as an addiction, failure of self-regulation or Obsessive Compulsive Disorder (OCD), and concluded that any overriding definition will be premature due to the lack of clinically empirical research.

CSBD as impulsive or obsessive–compulsive disorder

The most predominant frameworks of conceptualization are the addiction model, compulsivity model and the impulsivity model (Kingston & Firestone, 2008). Looking at the definitions of the International Classification of Diseases for Mortality and Morbidity Statistics (11th ed., ICD-11; World Health Organization, 2018) to those three categories reveals main similarity which is performing an act that is being experienced as irresistible. While those three classes share some features, they defer in profound others. Addiction is characterized by withdrawal and tolerance phenomena which are not featured by impulsivity and compulsivity (American Psychiatric Association, 2013). Impulsivity and compulsivity are sometimes being used interchangeably (Hollander & Rosen, 2002), but they mainly differ in the motivational mechanisms behind behavior. While impulsive individuals seek to maximize pleasure and gratification, compulsive individuals often desire to avoid harm or reduce anxiety (Claes, Vandereycken, & Vertommen, 2002). Obsessive-compulsive behavior, unlike addiction and impulsivity, is also defined by intrusive distressful thoughts or images (American Psychiatric Association, 2013). Black et al. (1997) found intrusive and repetitive sexual fantasies to be a common experience among individuals with CSBD and that argues in favor of describing CSBD as a particular instance of OCD. Contrariwise, in CSBD, although the urge is experienced as irresistible, the individual purposefully acts out the prior sexual fantasy and the behavior is an emulation of the prior cognition. In OCD, on the other hand, the compulsive rituals are initially resisted and typically are not behavioral representations of the prior though but representing acts of the wish to neutralize those thoughts (Schwartz & Abramowitz, 2005). Recent studies still portray an inconclusive picture. For example, Fuss, Briken, Stein and Lochner (2019) found that CSBD in OCD was more likely comorbid with other impulsive, compulsive, and mood disorders, but not with behavioral- or substance-related addictions. This finding supports the conceptualization of CSBD as a compulsive–impulsive disorder. On the contrary, Bőthe, Tóth-Király et al. (2019) have investigated impulsivity and compulsivity with respect to hypersexuality and problematic pornography in a large community sample (N = 13,778 participants). The results have indicated that impulsivity had a stronger relationship with hypersexuality than did compulsivity among men and women, respectively.

In Table 1 we have summarized some of the main findings that have been discussed in the review papers. We have utilized PubMed Central® search engine using the terms: “hypersexuality,” “excessive sex,” “sexual addiction,” “sex addiction,” “addiction to sex,” “impulsive sex,” “impulsive sexual,” “compulsive sexual,” “compulsive sex,” allowing any or all of them to appear anywhere in the article. We have sorted the result by “best match” and we have looked for articles that include a review on CSBD. We have realized there is no additional data beyond the first 40 results, and as a precaution from missing relevant data, we have explored further the next 60 results without finding any other relevant data. Identical search sorted by “most recent” and “publication date,” has revealed no additional relevant papers either. In Table 1 we have detailed the range of prevalence, assessment tools, conceptual perspectives, psychological and pharmacological treatment as well as comorbidities with CSBD that are reviewed and discussed broadly.

Table 1.

Summary of CSBD reviews

AuthorPrevalenceAssessmentConceptual perspectivesPsychological treatmentPharmacological treatmentComorbidities
Derbyshire and Grant (2015)2–27.9% (among LGBTQ)Psychodynamic therapyCitalopram
CBTNaltrexone with or without SSRI
Group therapy
Couple therapy
Montgomery-Graham (2017)CSBIDual-control model,
HBIThe addiction model,
SASTObsessive – compulsive model,
SAST-RDeficient impulse control,
SCSAttachment Theory,
HDSIExecutive Cognitive Functioning
Kafka (2010)3–12.1%TSODual-control modelDepression
Sexual AddictionAnxiety
Sexual CompulsivitySUD
Sexual DesireSocial avoidance
DysregulationImpulse behavior
Impulsivity DisordersADHD
Paranoid PD
Narcissistic PD
Avoidant PD
Histrionic PD
Obsessive-compulsive PD
2–6%Dual-control modeNarcissistic PD
Sexual AddictionAntisocial PD
Sexual Compulsivity
Sexual Impulsivity
Cognition biases
Attachment style
Mick and Hollander (2006)‏5–6%TSOBrain abnormalityCBTCitalopramMood disorders
Behavioral addictionGroup therapySertralineSUD
Couple therapyFluoxetineSocial phobia
NefazodoneADHD
Impulse control
Kingston and Firestone (2008)3–10%TSOSexual Addiction
Compulsive Sexual Behavior
Impulsive Sexual Behavior
Sexual Desire Disorders Model
Gold and Heffner (1998)Sexual Addiction12-step programFluoxetine
Sexual CompulsivityGroup therapyOther SSRIs
Sexual impulsivity
Karila et al. (2014)3–16.8%SASTCBTSSRIs
SAST-RCouples therapy
SCSMotivational interviewing
PATHOSFamily therapy
SOI
Garcia and Thibaut (2010)3–6%Dual-control modelCBTAntiandrogen
Obsessive-Compulsive12-Step programSSRIs
Impulse-Control Disorder
Sexual Addiction
Kraus, Voon, and Potenza (2016)CBTSSRIsMood disorders
ACTOpioid antagonistsAnxiety
SUD
Impulse-control disorders
Social phobia
Paranoid PD
Schizotypal PD
Antisocial PD
Borderline PD
Narcissistic PD
Avoidant PD
Obsessive-compulsive PD

Note. LGBTQ = lesbians, gays, bisexuals, transsexuals and queers; CSBI = compulsive sexual behavior inventory; HBI = hypersexual behavioral inventory; SAST = sexual addiction screening test; SAST-R = sexual addiction screening test – revised; SCS = sexual compulsivity scale; HDSI = hypersexual disorder screening inventory; TSO = total sexual outlet; SOI = sexual outlet inventory; CBT = cognitive behavioral therapy; ACT = acceptance and commitment therapy; SSRI = selective serotonin reuptake inhibitor; SUD = substance abuse disorder; ADHD = attention deficit/hyperactivity disorder; PD = personality disorder.

CSBD as a behavioral addiction

As mentioned above, one of the three most dominant frameworks of CSBD is the “addiction model” and in this current debate paper, we will examine whether CSBD fits this model. Specifically, we will examine whether CSBD meets the core elements of “behavioral addiction,” namely; salience, mood modification, tolerance, withdrawal, conflict and relapse (Griffiths, 2005). Biological studies that might have shed some light on this issue are also very few and will be discussed below as well.

Traditionally, the concept of addiction used to involve taking drugs (e.g. Rachlin, 1990; Walker, 1989). The release of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) broadens the definition of addiction and includes Gambling Disorder (GD) as a behavioral addiction along with drugs under the category “Substance-Related and Addictive Disorders” (American Psychiatric Association, 2013; Kraus, Voon, & Potenza, 2016).

In this paper we have used GD as compass to deduce from GD to CSBD, whether it should be defined as an addiction. Griffiths' (2005) components (salience, mood modification, tolerance, withdrawal, conflict and relapse) overlap with the DSM-5 American Psychiatric Association (2013) criteria for GA. It is important to note that the ICD-11 (World Health Organization, 2018) classified CSBD under impulse control disorders and the phenomenology described seems to combine those of addiction, impulse control disorders as well as compulsive characteristics. Amongst Griffiths' six components of addiction, the ICD-11 requires for diagnosis of CSBD, only “salience” (“repetitive sexual activities becoming a central focus of the person's life”), conflict (“Neglecting health and personal care or other interests, activities, responsibilities and continued repetitive sexual behavior despite adverse consequences”) and relapse (“Numerous unsuccessful efforts to significantly reduce repetitive sexual behavior”), while “mood-modification,” “tolerance” and “withdrawal” are absent. For detailed comparison between DSM-5 criteria for GD, ICD-11 for CSBD and Griffiths' (2005) criteria for addiction, see Table 2.

Table 2.

Comparison of criteria for Compulsive Sexual Behavior (CSBD): Griffiths (2005), DSM-5 and ICD-11

CriterionGriffiths (2005)DSM-5 for GDICD-11 for CSBD
SalienceWhen the particular activity becomes the most important activity in the person's life and dominates their thinking, feelings and behaviorIs often preoccupied with gamblingRepetitive sexual activities becoming a central focus of the person's life
Mood modificationThe subjective experience that people report as a consequence of engaging in the particular activityOften gambles when feeling distressed
ToleranceThe process whereby increasing amounts of the particular activity are required to achieve the former effectsNeeds to gamble with increasing amounts of money in order to achieve the desired excitement
WithdrawalThe unpleasant feeling states and/or physical effects which occur when the particular activity is discontinued or suddenly reducedIs restless or irritable when attempting to cut down or stop gambling
ConflictConflicts between the addict and those around them (interpersonal conflict) or from within the individual themselves (intrapsychic conflict) which are concerned with the particular activityHas jeopardized or lost a significant relationship, job, or educational or career opportunity because of gamblingNeglecting health and personal care or other interests, activities, responsibilities and continued repetitive sexual behavior despite adverse consequences.
RelapseThe tendency for repeated reversions to earlier patterns of the particular activity to recur and for even the most extreme patterns typical of the height of the addiction to be quickly restored after many years of abstinence or controlHas made repeated unsuccessful efforts to control, cut back, or stop gamblingNumerous unsuccessful efforts to significantly reduce repetitive sexual behavior
Chasing lossesAfter losing money gambling, often returns another day to get even
Lack of controlPattern of failure to control intense, sexual impulses or urges and resulting repetitive sexual behavior
Diminished satisfactionDeriving little or no satisfaction from it

Note. GD, Gambling disorder; CSBD, compulsive sexual behavior disorder; DSM-5, Diagnostic and Statistical Manual, 5th ed.; ICD-11, International Classification of Diseases, 11th.

Anecdotal reports based on clinical experience with CSBD patients support the idea of seeing CSBD as an addiction, but the field suffers from a lack of systematic empirical evidence supporting the endorsement of those six components mentioned above, by CSBD patients. Below we will review and discuss some of the relevant literature discussing each of the six addiction components and their relevance to CSBD.

Salience

Salience or preoccupation is when certain activity or content becomes predominant through action and thinking (Griffiths, 2005). Some authors claim for endorsement of the “preoccupation” criteria by CSBD patients, but they rely on general reports of patients rather than on empirical evidence (e.g. Schneider, 2004). Rosenberg, O'Connor, & Carnes (2014) quote Carnes's report (1991) that 77% of CSBD patients endorsed preoccupation criteria. Looking more deeply into Carnes's (1991) findings raise some questions about the meaning of this finding, whether it relies on a self-report tool he administrated or based on interviews he made as well. Looking for more empirical studies requires a more precise definition of “preoccupation.” Back in the DSM-IV-TR (4th ed., text rev.; American Psychiatric Association, 2000), the GD was defined as “pathological gambling” classified under “impulse control disorders - Not Otherwise Specified.” With moving GD to “addictive disorder” in the DSM-5, the change was accompanied with some “lenience” in diagnosing GD. For example, reducing the required criteria from five to four, or omitting the illegal facet of the behavior. Another reflection is the change from "Is preoccupied with gambling” to, “Is often preoccupied with gambling” to clarify that one needs not be obsessed with gambling all the time to meet this diagnostic symptom (Reilly, 2017). This change suggests that in order to define preoccupation in behavioral addiction, constant preoccupation is not needed and rather often preoccupation is preferred. This new definition opens the diagnosis to subjective interpretation of the assessor and might be biased particularly in self-report measures. The literature that is based on empirical evidence leans mostly on self-report inventories. The four tools most commonly used in English-language literature are the “Sexual Compulsivity Scale,” the “Compulsive Sexual Behavior Inventory,” the “Sexual Addiction Screening Test,” and “The Hypersexual Behavior Inventory” (Stewart & Fedoroff, 2014). Amongst those four only the “Sexual Addiction Screening Test” (SAST) addresses the preoccupation issue directly. The SAST includes dichotomous items such as “Do you often find yourself preoccupied with sexual thoughts.” Using the SAST, Carnes, Hopkins, and Green (2014) have found a significant relationship between preoccupation with sex and diagnostic criteria of CSBD. Also using the SAST, Carnes, Green, and Carnes (2010) found preoccupation with sex is a core component of CSBD across women and men. There are two significant interrelated drawbacks using the SAST; the one deals with the patient as the assessor and other deals with the lack of a continuum scale to assess the endorsement of the preoccupation criteria. To conclude, although based on the SAST there is some evidence that CSBD patients subjectively report being preoccupied with sex, more methodological research is required to ensure objective observation whether and how often the “salience” symptom occurs.

Mood modification

Different writers address the link between addiction and mood from different angles. Brown (1993) refers to any change of mood that is being experienced following engaging a certain activity. Carnes (1991) requires using the behavior as a coping strategy. Griffiths (2005) defines it as “Mood modification,” and like Carnes (1991) denotes the aspect of using the certain behavior as a reliable and consistent coping strategy to deal with unpleasant emotions or feelings. The DSM-5 requires for Gambling Disorder: that the gambler “often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed)” which implies the idea of a coping strategy as Griffiths (2005) has elaborated. The SAST questionnaire has one factor “affect disturbance” but involves different items that mainly deal with negative emotions caused by the sexual activity. The Hypersexual Behavior Inventory (HBI) questionnaire has one factor called “coping” and has specific items that describe using sex as a coping strategy. Results from studies using the HBI show significant differences between patients groups and control groups on this scale (Reid, Carpenter, & Lloyd, 2009; Reid, Harper, & Anderson, 2009) and a substantive body of research shows that CSBD patients use sex to deal with unwanted experiences or situations (Gilliland, South, Carpenter, & Hardy, 2011). It is important to note that in a large-scale study using non-clinical sample, Bőthe, Bartók, et al. (2018) have found that LGBTQ participants are more at risk of using sex related behavior as “mood modification” than heterosexual participants. In conclusion, relying on the HBI, we can see how sex is being used as a coping strategy and to avoid inconvenient mood. However, since this symptom was not tested under the framework of an addiction paradigm together with other necessary symptoms such as tolerance and withdrawal, we think it is not enough to deduce the presence of “addiction” by definition and further research is needed.

Tolerance

The DSM-5 defines Tolerance, by either of the following: (a) a need for markedly increased amounts of a substance to achieve intoxication or a desired effect, (b) markedly diminished effect with continued use of the same amount of a substance. Karila et al. (2014) describe few features of CSBD that could suggest tolerance. Among other behavioral symptoms, they mention pursuit of new sexual partners as well as engagement in sexual activity without physiological arousal. They have based their assertion on few resources which do not include empirical evidence or even specifically exclude tolerance and withdrawal from required elements of CSBD. Similarly to Karila et al. (2014), Coleman-Kennedy and Pendley (2002) specifically refer to the term “tolerance” and to its origin in substance use addiction. They claim that just as in substance addiction, individuals with sex addiction experience the continual need to expand the time spent in sexual activity to ease the emotional pain. In addition, they claim that in the attempt to feel the emotional relief, individuals with sexual addiction tend to choose partners and sexual practices carelessly.

Again, no empirical evidence has been shown to support those tolerance symptoms. Furthermore, choosing partners or practices injudiciously, might be a core element of CSBD patients without escalating or increasing amount of sex, meaning, regardless the tolerance phenomenon. Coleman-Kennedy and Pendley (2002) continue and claim that individuals with CSBD report having sex without truly choosing or wanting it. This element suggests that there is a compulsive quality of CSBD rather than an addiction to a satisfactory activity and the increasing need for more of it. Kalichman and Rompa (1995) have made a distinction between two types of what we would define as CSBD. The first is the “sensation seeking” type. Sensation seeking is described by Zuckerman (1983) as the propensity to change, to diversify and to expand the array of sensations and experiences, as well as the tendency to take risks for the sake of that purpose. Sexual compulsivity on the other hand, is characterized by repetitive and intrusive thoughts and urges to act usually in a ritualized or meticulous way (Barth & Kinder, 1987). Although those acts are experienced as uncontrollable just as impulsive acts, at the core of sexual compulsivity lay the obsessive patterns of cognition and behavior (Kalichman & Rompa, 1995). Those descriptions suggest that first, seeking new partners or practices is not necessarily a feature of CSBD patients. Secondly, seeking new partners or practices does not stem from habituation to old patterns or amount of sensual stimulation, but it is a predominant character of detesting the known, the usual and the banal. Neither the SAST nor the HBI include items assessing the tolerance phenomenon. In conclusion, we could not find methodological evidence for the existence of “tolerance” among CSBD patients.

Withdrawal

Karila et al. (2014) claim that more than 70% of individuals with CSBD report withdrawal symptoms. They base their claim on Carnes (1991) statement that CSBD patients report withdrawal symptoms that utterly alike symptoms reported by individuals with cocaine addiction following cessation or diminishing of using the drug. Those symptoms include a variety of body aches, dizziness, restlessness and sleeping problems. It appears that this report is based on a general impression rather than on methodological research. Similarly, Nakken (1996) claims that some behavioral activities such as gambling, spending or sex, can become an actual addiction with physical symptoms upon withdrawal. He argues that individuals with behavioral addiction report physical symptoms when they stop acting out. As argued before, it appears that a general description is given but it is not necessarily based on methodological research. Furthermore, Nakken (1996) deliberates with the question whether those symptoms are entitled to be called “withdrawal symptoms.” He wonders if those symptoms are actual withdrawal symptoms or they might be considered a mere part of a grief process that occurs upon ending an addictive relationship. Moreover, Carnes and Schneider (2000) do not see tolerance and withdrawal as an essential feature to diagnose an addiction. When suggesting the addiction model, they emphasize that tolerance and withdrawal are not part their model, as many drugs of abuse are also not associated with tolerance and do not have specific withdrawal symptoms. Garcia and Thibaut (2010) bring a general report of CSBD patients about intense feeling of dysphoria and depressive thoughts when they attempt to cease inappropriate sexual behaviors. The authors compare it to the withdrawal symptoms after abrupt cessation of consuming drugs. As with “tolerance” neither the SAST nor the HBI include items assessing the “withdrawal” phenomenon. Thus, to conclude, we did not find methodological evidence for the existence of “tolerance” among CSBD patients. It is worth emphasizing that the DSM-5 requires that the withdrawal symptoms (for substance addiction) are not better explained by another mental disorder, if so, those withdrawal symptoms are defined as such only if they are not explained by – for example – a prior state that may lead to the “addiction” at the first place as a coping strategy.

Conflict

Regarding Gambling Disorder, the DSM-5 defines the criterion that reflects the maladaptive facet of the behavior as, “Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling.” Regarding CSBD, Carnes et al. (2010), in their revised version of the SAST, the SAST-R, narrow the definition to “Relationship Disturbance” which described by them as significant problems caused by a sexual behavior. Consequently, in the “Relationship Disturbance” section of their questionnaire, they included only items referring to relationship problems.1 One item (16) does include other domains of life but they have combined it together with relationship so there is no information specifically regarding those other domains. Naturally, any irregular sexual behavior might adversely affect close relationships even if not caused by clinically significant pathology, so we want to broaden the disturbance effect to different domains of life such as work or education. Additionally, in order to diagnose an addiction, we need to verify that the adverse consequences are caused by the frequency of the behavior and not by any other characteristics such as bizarre or disloyal sexual activity. Indeed, Reid et al. (2012) did find adverse consequences caused by the frequency of sexual thoughts and acts and specifically excluded relationship difficulties caused for example by extra dyadic affairs. In summary, those findings from studies using the HBI questionnaire do suggest “adverse consequences” as described by the DSM-5 regarding Gambling Disorder, but as we wrote before, those “adverse consequences” are supposed to be tested under the framework of addiction paradigm together with other necessary symptoms such as tolerance and withdrawal.

Repeated unsuccessful attempts to quit – Relapse

One of the core elements of any addiction is the loss-of-control experience. This is reflected in the DSM-5 criteria for substance use disorder by requiring that “the Substance is taken in larger amounts or over a longer period than was intended” and “There is a persistent desire or unsuccessful efforts to cut down or control substance use.” Interestingly, the aspect of lack-of-control appears different in the Gambling Disorder where the relevant criterion is “has made repeated unsuccessful efforts to control, cut back, or stop gambling.” Theoretical writing attributes the uncontrollable facet to CSBD (Carnes, 1996). Individuals with CSBD experience their sexuality as excessive and out of control (Winters, Christoff, & Gorzalka, 2010). Kraus, Rosenberg, and Tompsett (2015) found CSBD to be negatively correlated with self-efficacy to initiate taking measures to reduce pornography use.‏‏ Carvalho, Štulhofer, Vieira, and Jurin (2015), as well as Pachankis, Rendina, Ventuneac, Grov, and Parsons (2014) found that individuals with CSBD perceive an inability to control their sexuality. Regarding the assessment tools discussed above; The SAST has a “loss of control” component that includes items such as: “Have you made efforts to quit a type of sexual activity and failed?” or, “do you feel controlled by your sexual desire.” The HBI has also “control” factor that includes also items such as “I engage in sexual activities that I know I will later regret.” Different studies using the SAST and the HBI showed constantly and repeatedly that losing control over the sexual behavior and failing the attempts to restrain it are a key feature of CSBD (e.g. Carnes et al., 2014; Kingston et al., 2018; Reid, Garos, & Carpenter, 2011). In summary, as argued before, further research needs to assess this criterion alongside the other addiction criterions. Additionally, since the current questionnaires add more exhibitions of lack-of-control than the DSM's definition, a refinement of this criterion as it appears in assessment tools, should be considered.

Neurobiology

Another domain that determines the classification of CSBD is the neurobiological mechanism of CSBD and its similarities to other disorders. A sexual pleasure is involved with neural reward system such as the mesolimbic dopamine pathway (Balfour, Yu, & Coolen, 2004). According to “salience incentive theory of addiction” (Robinson & Berridge, 2008), this neural activity is linked to “wanting” hedonic stimuli rather than “liking,” and pathological activity of the dopamine-”wanting” system is behind addictive behavior. Neuroimaging Studies comparing non-CSBD and CSBD patients showed – like substances addiction – augmented reactivity in the mesolimbic (wanting) area. For example, Voon et al. (2014) showed how sexual cues lead to greater cortico-striatal activity by CSBD patients compared with healthy control participants. Specifically, the greater activity was found in the dorsal anterior cingulate, ventral striatum and amygdala. This pathway suggests for more wanting (as opposed to liking) arousal by CSBD patients as a reaction to sexual cues. Gola et al. (2017) showed that compared to control participants, individuals with problematic pornography use showed greater neural activation in response to cues predicting sexual stimuli. This difference was not shown in reaction to the actual sexual stimuli which suggests for differences in “wanting” rather than in “liking.” Furthermore, Brand, Snagowski, Laier, & Maderwald (2016) found that CSBD patients showed stronger ventral striatum activity for preferred compared to non-preferred pornographic stimuli and not only when comparing pornographic with non-pornographic material. Similarly, Seok and Sohn (2015) showed that compared to the control group, CSBD patients had more intense and more frequent – due to sensitization – activity in reaction to pornographic stimuli. Those findings suggest advocating for the addiction model of CSBD. Based upon the mentioned studies in addition to other studies, Stark, Klucken, Potenza, Brand, & Strahler (2018), as well as Kowalewska et al. (2018) concluded in their review that CSBD should be classified as an addiction. Slightly different results found by Klucken, Wehrum-Osinsky, Schweckendiek, Kruse, & Stark (2016) showed greater activity – by CSBD patients compared to control participants in the amygdala in reaction to conditioned stimuli but found no differences between CSBD and control participants in the ventral striatum.

In addition to differences in cue activation between CSBD and control participants, there is also evidence of differences in brain structure. Time spent watching pornography was negatively corelated with gray matter volume in the striatum. Volumetric differences in the striatum have previously been associated with substance use disorder but with mixed results. While some studies reporting a decrease, others reported an increase of grey matter volume. Consuming pornography was found also to be related to poorer connectivity between the striatum and the left dorsolateral prefrontal cortex (Kühn & Gallinat, 2014) and the superior temporal gyrus (Seok & Sohn, 2018). Seok and Sohn (2018) also found gray matter enlargement in the right cerebellar tonsil amongst CSBD patients and they pointed out the role of this area in OCD and that similar findings were observed in OCD patients. Schmidt et al. (2017) have found increased volume in the amygdala that is relevant to motivational salience and emotional processing. They argued the fact that opposite findings were shown regarding alcohol addiction and raise the assumption that it is a result of alcohol neurotoxicity.

More possible relevant information comes from Diffusion Tensor Imaging (DTI). DTI is an MRI technique that examines white matter integrity by measuring self-diffusion of water in the brain tissue. Kor et al. (2013) have found differences in the inferior frontal region between patients with pathological gambling and healthy participants. Regarding CSBD, Miner, Raymond, Mueller, Lloyd, and Lim (2009) have found no differences between CSBD patients and control participants. In fact, some differences were shown in the superior frontal region, suggesting similarities to patterns found by OCD patients, which might also imply that CSBD fits better to an OCD model. Thus, while according to Stark et al. (2018), Kowalewska et al., (2018), Kraus et al. (2016) and Kor et al. (2013) neuroimaging data supports the addiction model it seems that other neuroimaging studies require in order to examine also the OCD model.

CSBD and neurochemical interplay can also shed some light on the relatedness of CSBD and addiction. Naltrexone, an opioid antagonist that is primarily used to manage alcohol or opioid dependence, was found as effective at reducing urges and behaviors associated with CSBD (Raymond, Grant, & Coleman, 2010). This is consistent with its role in gambling disorder and it supports the addiction model of CSBD. A literature review conducted by Nakum and Cavanna (2016) shows higher prevalence of CSBD among patients with Parkinson's disease who were treated with dopamine replacement therapy (TRP), especially with dopamine agonists. Kraus et al. (2016) argued that the association between TRP and CSBD can resolve the classification issue, but to our opinion the findings about TRP is not a decisive evidence regarding this puzzle since TRP has been found to cause a variety of impulse–control problems and not necessarily addictive behaviors (see Potenza, Voon, & Weintraub, 2007; Seeman, 2015).

Discussion

The scientific interest in hypersexuality or CSBD has considerably elevated since the publication of Carnes's book The Sexual Addiction (1983). Since then, a debate was conducted whether considering CSBD as a distinct clinical disorder and under which groups of disorders it should be classified. Three possible categories of mental disorders are being suggested as a framework of CSBD, namely: impulse control, OCD and a behavioral addiction. The evidence that is needed to answer these questions should come from the fields of: epidemiology, phenomenology, mental health and neurobiology.

In the early review by Kor et al. (2013) the authors have discussed the similarities and differences between hypersexual disorder, drug addiction, and pathological gambling. They have concluded that despite many similarities between the features of hypersexual behavior and substance-related disorders, the research on CSBD disorder at this time is in its infancy and much remains to be learned before definitively characterizing CSBD disorder as an addiction at this time.

Later on, Kraus et al. (2016) have reviewed the evidence for regarding CSBD as a behavioral addiction from epidemiological, phenomenological, clinical and biological domains with respect to data from substance addiction and gambling disorder. They have found overlapping features between CSBD and substance-use disorders such as common neurotransmitter systems and similar craving and attention biases that were shown by recent neuroimaging studies. Also, similar pharmacological and psychotherapeutic treatments may be applicable to CSBD and substance addictions, although there is little evidence at the moment to support that. The authors have concluded that despite the growing body of research linking compulsive sexual behavior to substance addictions, significant gaps in understanding continue to complicate classification of compulsive sexual behavior as an addiction. Finally, Bőthe, Koós, et al. (2019) have used self-report data from a very large community sample and they have rejected the OCD model and they have concluded that compulsivity is a negligible component of CSBD while impulsivity has a major role in it.

In this paper we have reviewed the evidence in view of the theories that see compulsive sexual behavior as a behavioral addiction. We have used Griffiths (2005) six components model of addiction to evaluate the existing literature about CSBD. The components are: Salience, Mood modification, Tolerance, Withdrawal, adverse consequences and relapse. In addition, we have reviewed the recent data about the neurological and neurochemical nature of CSBD as well as a short review of the prevalence of this phenomenon. Our review reveals that in the phenomenology aspect most of the studies did not include all the six components of behavioral addiction in their definition of CSBD. As a result, for the most part, those components have not been investigated as a whole construct so that the little empirical evidence we do have, gives us only a fragmented picture of the phenomenology of CSBD. Additionally, looking at the neuroscience field, as opposed to the conclusive view of Stark et al. (2018) and Kowalewska et al. (2018) that see CSBD as addiction, we think the data suggesting that there is a compulsive component in CSBD should be given more attention and further research.

Recommendations for future research

We think the main field that suffers from stagnation is the phenomenology research of CSBD. In order to assess properly the nature of this phenomenon and decide whether it fits the addiction model, we recommend using a comprehensive assessment that includes all the addiction components. Recently, three assessment tools were developed, one corresponds with the ICD-11 criteria for CSBD and two that correspond with the six components of addiction. The Compulsive Sexual Behavior Disorder Scale (CSBD-19; Bőthe et al., 2020) is a 19-item self-report measuring tool that aims to assess CSBD based on ICD-11 diagnostic guidelines. The authors recognized in the ICD-11 criteria, five domains (i.e., control, salience, relapse, dissatisfaction, and negative consequences) and the CSBD-19 is loaded with five factors reflecting these domains. The CSBD-19 show good psychometric properties in terms of factor structure, reliability, measurement invariance, and associations with theoretically relevant constructs (Bőthe et al., 2020). The Bergen–Yale Sex Addiction Scale (BYSAS; Andreassen, Pallesen, Griffiths, Torsheim, & Sinha, 2018) and the Problematic Pornography Consumption Scale (PPCS; Bőthe, Tóth-Király et al., 2018) both reflect the six components of addiction. The BYSAS comprises of six items simply depict the six components of addiction as discussed above. The psychometric properties support one factor model consists of the six items and show good internal consistency (Cronbach's α = 0.83) of the six components. We believe clinical population-based research is needed to determine through the BYSAS whether CSBD consists of the six-component addiction and whether a single item is enough to encompass each of the addiction components. The PPCS is more elaborate and includes 18 items with three items dedicated to each of the six components. As we wrote before, some components such as “salience” might suffer from subjective bias when they are self-reported. Thus, we suggest using clinician administrated inventories that also specify the frequency of the sexual acts and thoughts such as the Sexual Outlet Inventory (SOI) as recommended by Hook, Hook, Davis, Worthington, and Penberthy (2010) or interviews by trained clinician (Reid et al., 2012). Regarding the PPCS, it is important to note that Bőthe, Tóth-Király et al. (2018) differentiate between CSBD and “problematic pornography consumption.” According to Bőthe, Koós, et al. (2019), problematic pornography use is not necessary considered a manifestation of CSBD. For example, they differ in the extent of impulsivity involved (Bőthe, Tóth-Király et al., 2019) and their association with attention deficit hyperactivity disorder (Bőthe, Koós, et al., 2019). These findings support Derbyshire and Grant (2015) claim that CSBD does not reflect just one type of problematic sexual behavior and that there is a substantial heterogeneity within the disorder.

Additionally, since researchers define and interpret differently some of the mentioned components of addiction, we recommend using and interpreting those components homogeneously according to the DSM-5 criteria for “Gambling Disorder.” Regarding epidemiology data, after defining a consistent construct of the disorder, more population-based studies should be done to asses better the prevalence of CSBD among different populations. Mapping the prevalence of CSBD amongst different groups might shed more light on the essence and nature of CSBD.

To summarize, it seems that the conclusion of previous reviews by Kor et al. (2013), Derbyshire and Grant (2015) and Kraus et al. (2016) supports our conclusion that although the evidence may support the view of CSBD as a behavioral addiction there is insufficient data to determine this conclusion. We agree with Derbyshire and Grant (2015) who argued that the categorization of CSBD is still a challenge that requires further research and understanding.

Funding sources

The study was done as part of an academic course in behavioral addiction at the Ariel University, Ariel, Israel.

Authors' contribution

All individuals included as authors of the paper have contributed substantially to the scientific process leading up to the writing of the paper. The authors have contributed to the conception and design of the project, performance of the experiments, analysis and interpretation of the results and preparing the manuscript for publication.

Conflict of interest

The authors have no interests or activities that might be seen as influencing the research (e.g., financial interests in a test or procedure, funding by pharmaceutical companies for research).

References

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

    • Search Google Scholar
    • Export Citation
  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

  • Andreassen, C. S., Pallesen, S., Griffiths, M. D., Torsheim, T., & Sinha, R. (2018). The development and validation of the Bergen–Yale sex addiction scale with a large national sample. Frontiers in Psychology, 9, 115. https://doi.org/10.3389/fpsyg.2018.00144.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Balfour, M. E., Yu, L., & Coolen, L. M. (2004). Sexual behavior and sex-associated environmental cues activate the mesolimbic system in male rats. Neuropsychopharmacology, 29, 718730.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ballester-Arnal, R., Castro-Calvo, J., Giménez-García, C., Gil-Juliá, B., & Gil-Llario, M. D. (2020). Psychiatric comorbidity in compulsive sexual behavior disorder (CSBD). Addictive Behaviors, 107, 17. https://doi.org/10.1016/j.addbeh.2020.106384.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bancroft, J. (2008). Sexual behavior that is “out of control”: A theoretical conceptual approach. Psychiatric Clinics of North America, 31, 593601.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Barth, R. J., & Kinder, B. N. (1987). The mislabeling of sexual impulsivity. Journal of Sex & Marital Therapy, 13, 1523.

  • Black, D. W., Kehrberg, L. L. D., Flumerfelt, D. L., & Schlosser, S. S. (1997). Characteristics of 36 subjects reporting compulsive sexual behavior. The American Journal of Psychiatry, 154, 243249.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Brand, M., Snagowski, J., Laier, C., & Maderwald, S. (2016). Ventral striatum activity when watching preferred pornographic pictures is correlated with symptoms of Internet pornography addiction. NeuroImage, 129, 224232.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Brown, R. I. F. (1993). Some contributions of the study of gambling to the study of other addictions. In Gambling behavior and problem gambling(pp. 241272). Reno, NV: University of Nevada Press.

    • Search Google Scholar
    • Export Citation
  • Butcher, N. J., Dahlstrom, W. G., Graham, J. R., Tellegen, A., & Kaemmer, B. (1989). MMPI-2 (Minnesota Multiphasic Personality Inventory-2): Manual for administration and scoring. Minneapolis, MN: University of Minnesota Press.

    • Search Google Scholar
    • Export Citation
  • Bőthe, B., Bartók, R., Tóth-Király, I., Reid, R. C., Griffiths, M. D., Demetrovics, Z., et al. (2018). Hypersexuality, gender, and sexual orientation: A large-scale psychometric survey study. Archives of Sexual Behavior, 47, 22652276.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bőthe, B., Koós, M., Tóth-Király, I., Orosz, G., & Demetrovics, Z. (2019). Investigating the associations of adult ADHD symptoms, hypersexuality, and problematic pornography use among men and women on a largescale, non-clinical sample. The Journal of Sexual Medicine, 16, 489499.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bőthe, B., Potenza, M. N., Griffiths, M. D., Kraus, S. W., Klein, V., Fuss, J., et al. (2020). The development of the Compulsive Sexual Behavior Disorder Scale (CSBD-19): An ICD-11 based screening measure across three languages. Journal of Behavioral Addictions, 9(2), 247258.‏

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bőthe, B., Tóth-Király, I., Potenza, M. N., Griffiths, M. D., Orosz, G., & Demetrovics, Z. (2019). Revisiting the role of impulsivity and compulsivity in problematic sexual behaviors. The Journal of Sex Research, 56, 166179.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bőthe, B., Tóth-Király, I., Zsila Á., Griffiths, M. D., Demetrovics, Z., & Orosz, G. (2018). The Development of the problematic pornography consumption scale (PPCS). The Journal of Sex Research, 55, 395406. https://doi.org/10.1080/00224499.2017.1291798.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Carnes, P. J. (1983). The sexual addiction. Minneapolis, MN: CompCare Publications.

  • Carnes, P. J. (1991). Don't call it love: Recovering from sexual addiction. New York, NY: Bantam Books.

  • Carnes, P. J. (1996). Addiction or compulsion: Politics or illness?. Sexual Addiction & Compulsivity, 3, 127150.

  • Carnes, P. J., Green, B., & Carnes, S. (2010). The same yet different: Refocusing the Sexual Addiction Screening Test (SAST) to reflect orientation and gender. Sexual Addiction & Compulsivity, 17, 730.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Carnes, P. J., Hopkins, T. A., & Green, B. A. (2014). Clinical relevance of the proposed sexual addiction diagnostic criteria: Relation to the sexual addiction screening test-revised. Journal of Addiction Medicine, 8, 450461.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Carnes, P. J., & Schneider, J. P. (2000). Recognition and management of addictive sexual disorders: Guide for the primary care clinician. Lippincott's Primary Care Practice, 4, 302318.

    • Search Google Scholar
    • Export Citation
  • Carpenter, B. N., Reid, R. C., Garos, S., & Najavits, L. M. (2013). Personality disorder comorbidity in treatment-seeking men with hypersexual disorder. Sexual Addiction & Compulsivity, 20, 7990. https://doi.org/10.1080/10720162.2013.772873.

    • Search Google Scholar
    • Export Citation
  • Carvalho, J., Štulhofer, A., Vieira, A. L., & Jurin, T. (2015). CSBD and high sexual desire: Exploring the structure of problematic sexuality. The Journal of Sexual Medicine, 12, 13561367.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Claes, L., Vandereycken, W., & Vertommen, H. (2002). Impulsive and compulsive traits in eating disordered patients compared with controls. Personality and Individual Differences, 32, 707714. https://doi.org/10.1016/S0191-8869(01)00071-X.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Coleman-Kennedy, C., & Pendley, A. (2002). Assessment and diagnosis of sexual addiction. Journal of the American Psychiatric Nurses Association, 8, 143151.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Derbyshire, K. L., & Grant, J. E. (2015). Compulsive sexual behavior: A review of the literature. Journal of Behavioral Addictions, 4, 3743.

  • Dickenson, J. A., Gleason, N., Coleman, E., & Miner, M. H. (2018). Prevalence of distress associated with difficulty controlling sexual urges, feelings, and behaviors in the United States. JAMA Network Open, 1, 110. https://doi.org/10.1001/jamanetworkopen.2018.4468.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Erez, G., Pilver, C. E., & Potenza, M. N. (2014). Gender-related differences in the associations between sexual impulsivity and psychiatric disorders. Journal of Psychiatric Research, 55, 117125.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Fuss, J., Briken, P., Stein, D. J., & Lochner, C. (2019). Compulsive sexual behavior disorder in obsessive–compulsive disorder: Prevalence and associated comorbidity. Journal of Behavioral Addictions, 8, 242248. https://doi.org/10.1556/2006.8.2019.23.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Garcia, F. D., & Thibaut, F. (2010). Sexual addictions. The American Journal of Drug and Alcohol Abuse, 36, 254260.

  • Gilliland, R., South, M., Carpenter, B. N., & Hardy, S. A. (2011). The roles of shame and guilt in hypersexual behavior. Sexual Addiction & Compulsivity, 18, 1229.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gola, M., Wordecha, M., Sescousse, G., Lew-Starowicz, M., Kossowski, B., Wypych, M., et al. (2017). Can pornography be addictive? An fMRI study of men seeking treatment for problematic pornography use. Neuropsychopharmacology, 42, 20212031.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gold, S. N., & Heffner, C. L. (1998). Sexual addiction: Many conceptions, minimal data. Clinical Psychology Review, 18, 367381.

  • Griffiths, M. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191197.

  • Hartman, L. I., Ho, V., Arbour, S., Hambley, J. M., & Lawson, P. (2012). Sexual addiction and substance addiction: Comparing sexual addiction treatment outcomes among clients with and without comorbid substance use disorders. Sexual Addiction & Compulsivity, 19, 284309.

    • Search Google Scholar
    • Export Citation
  • Hollander, E., & Rosen, J. (2002). Obsessive-compulsive spectrum disorders: A review. In M. Maj, N. Sartorius, A. Okasha, & J. Zohar (Eds.), Obsessive-compulsive disorder (2nd ed., pp. 203252). Chichester: John Wiley & Sons, Ltd.

    • Search Google Scholar
    • Export Citation
  • Hook, J. N., Hook, J. P., Davis, D. E., Worthington, E. L., & Penberthy, J. K. (2010). Measuring sexual addiction and compulsivity: A critical review of instruments. Journal of Sex & Marital Therapy, 36, 227260. https://doi.org/10.1080/00926231003719673.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kafka, M. P. (2010). Hypersexual disorder: A proposed siagnosis for DSM-V. Archives of Sexual Behavior, 39, 377400. https://doi.org/10.1007/s10508-009-9574-7.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kafka, M. P. (2015). DSM-IV Axis I psychopathology in males with non-paraphilic hypersexual disorder. Current Addiction Reports, 2, 202206. https://doi.org/10.1007/s40429-015-0060-0.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kalichman, S. C., & Rompa, D. (1995). Sexual sensation seeking and sexual compulsivity scales: Validity and predicting HIV risk behavior. Journal of Personality Assessment, 65, 586601.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kaplan, M. S., & Krueger, R. B. (2010). Diagnosis, assessment, and treatment of hypersexuality. The Journal of Sex Research, 47, 181198. https://doi.org/10.1080/00224491003592863.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Karaca, S., Saleh, A., Canan, F., & Potenza, M. N. (2017). Comorbidity between behavioral addictions and attention deficit/hyperactivity disorder: A systematic review. International Journal of Mental Health and Addiction, 15, 701724. https://doi.org/10.1007/s11469-016-9660-8.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Karila, L., Wéry, A., Weinstein, A., Cottencin, O., Petit, A., Reynaud, M., et al. (2014). Sexual addiction or hypersexual disorder: Different terms for the same problem? A review of the literature. Current Pharmaceutical Design, 20, 40124020.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kingston, D. A., & Firestone, P. (2008). Problematic hypersexuality: A review of conceptualization and diagnosis. Sexual Addiction & Compulsivity, 15, 284310. https://doi.org/10.1080/10720160802289249.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kingston, D. A., Walters, G. D., Olver, M. E., Levaque, E., Sawatsky, M., & Lalumière, M. L. (2018). Understanding the latent structure of hypersexuality: A taxometric investigation. Archives of Sexual Behavior, 47, 22072221.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Klucken, T., Wehrum-Osinsky, S., Schweckendiek, J., Kruse, O., & Stark, R. (2016). Altered appetitive conditioning and neural connectivity in subjects with compulsive sexual behavior. The Journal of Sexual Medicine, 13, 627636.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kopeykina, I., Kim, H. J., Khatun, T., Boland, J., Haeri, S., Cohen, L. J., et al. (2016). Hypersexuality and couple relationships in bipolar disorder: A review. Journal of Affective Disorders, 195, 114. https://doi.org/10.1016/j.jad.2016.01.035.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kor, A., Fogel, Y. A., Reid, R. C., & Potenza, M. N. (2013). Should hypersexual disorder be classified as an addiction? Sexual Addiction & Compulsivity, 20, 2747.

    • Search Google Scholar
    • Export Citation
  • Kowalewska, E., Grubbs, J. B., Potenza, M. N., Gola, M., Draps, M., & Kraus, S. W. (2018). Neurocognitive mechanisms in compulsive sexual behavior disorder. Current Sexual Health Reports, 10, 255264.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kraus, S. W., Rosenberg, H., & Tompsett, C. J. (2015). Assessment of self-efficacy to employ self-initiated pornography use-reduction strategies. Addictive Behaviors, 40, 115118. https://doi.org/10.1016/j.addbeh.2014.09.012.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kraus, S. W., Voon, V., & Potenza, M. N. (2016). Should compulsive sexual behavior be considered an addiction? Addiction, 111, 20972106.

  • Kühn, S., & Gallinat, J. (2014). Brain structure and functional connectivity associated with pornography consumption: The brain on porn. JAMA Psychiatry, 71, 827834.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Levine, S. B. (2010). What is sexual addiction? Journal of Sex & Marital Therapy, 36, 261275.

  • Mick, T. M., & Hollander, E. (2006). Impulsive-compulsive sexual behavior. CNS Spectrums, 11, 944955. https://doi.org/10.1017/S1092852900015133.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Miner, M. H., Raymond, N., Mueller, B. A., Lloyd, M., & Lim, K. O. (2009). Preliminary investigation of the impulsive and neuroanatomical characteristics of compulsive sexual behavior. Psychiatry Research: Neuroimaging, 174, 146151.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Montgomery-Graham, S. (2017). Conceptualization and assessment of hypersexual disorder: A systematic review of the literature. Sexual Medicine Reviews, 5, 146162.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nakken, C. (1996). The addictive personality: Understanding the addictive process and compulsive behavior (2nd ed.). Center City, MN: Hazelden Publishing.

    • Search Google Scholar
    • Export Citation
  • Nakum, S., & Cavanna, A. E. (2016). The prevalence and clinical characteristics of hypersexuality in patients with Parkinson's disease following dopaminergic therapy: A systematic literature review. Parkinsonism & Related Disorders, 25, 1016.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Niazof, D., Weizman, A., & Weinstein, A. (2019). The contribution of ADHD and attachment difficulties to online pornography use among students. Comprehensive Psychiatry, 93, 5660. https://doi.org/10.1016/j.comppsych.2019.07.002.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Pachankis, J. E., Rendina, H. J., Ventuneac, A., Grov, C., & Parsons, J. T. (2014). The role of maladaptive cognitions in CSBD among highly sexually active gay and bisexual men. Archives of Sexual Behavior, 43, 669683.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Potenza, M. N., Voon, V., & Weintraub, D. (2007). Drug Insight: Impulse control disorders and dopamine therapies in Parkinson's disease. Nature Reviews Neurology, 3, 664.

    • Search Google Scholar
    • Export Citation
  • Rachlin, H. (1990). Why do people gamble and keep gambling despite heavy losses? Psychological Science, 1, 294297.

  • Raymond, N. C., Coleman, E., & Miner, M. H. (2003). Psychiatric comorbidity and compulsive/impulsive traits in compulsive sexual behavior. Comprehensive Psychiatry, 44(5), 370380. https://doi.org/10.1016/S0010-440X(03)00110-X.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Raymond, N. C., Grant, J. E., & Coleman, E. (2010). Augmentation with naltrexone to treat compulsive sexual behavior: A case series. Annals of Clinical Psychiatry, 22, 5662.

    • Search Google Scholar
    • Export Citation
  • Reid, R. C., & Carpenter, B. N. (2009). Exploring relationships of psychopathology in hypersexual patients using the MMPI-2. Journal of Sex & Marital Therapy, 35, 294310. https://doi.org/10.1080/00926230902851298.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reid, R. C., Carpenter, B. N., Hook, J. N., Garos, S., Manning, J. C., Gilliland, R., et al. (2012). Report of findings in a DSM‐5 field trial for hypersexual disorder. The Journal of Sexual Medicine, 9, 28682877.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reid, R. C., Carpenter, B. N., & Lloyd, T. Q. (2009). Assessing psychological symptom patterns of patients seeking help for hypersexual behavior. Sexual and Relationship Therapy, 24, 4763. https://doi.org/10.1080/14681990802702141.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reid, R. C., Garos, S., & Carpenter, B. N. (2011). Reliability, validity, and psychometric development of the Hypersexual Behavior Inventory in an outpatient sample of men. Sexual Addiction & Compulsivity, 18, 3051.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reid, R. C., Harper, J. M., & Anderson, E. H. (2009). Coping strategies used by hypersexual patients to defend against the painful effects of shame. Clinical Psychology & Psychotherapy, 16, 125138.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reid, R. C., & Meyer, M. D. (2016). Substance use disorders in hypersexual adults. Current Addiction Reports, 3, 400405. https://doi.org/10.1007/s40429-016-0124-9.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reilly, C. (Ed.). (2017). Identifying a gambling disorder. In Gambling and public health: A guide for policy makers (pp. 717). Retrieved from http://www.ncrg.org/sites/default/files/uploads/gambling_and_public_health_-_a_guide_for_policymakers_web.pdf#page=15.

    • Search Google Scholar
    • Export Citation
  • Robinson, T. E., & Berridge, K. C. (2008). The incentive sensitization theory of addiction: Some current issues. Philosophical Transactions of the Royal Society B: Biological Sciences, 363(1507), 31373146.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rosenberg, K. P., O'Connor, S., & Carnes, P. (2014). Sex addiction: An overview. In K. P. Rosenberg & L. C. Feder (Eds.), Behavioral addictions (pp. 215236). https://doi.org/10.1016/B978-0-12-407724-9.00009-4.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Schmidt, C., Morris, L. S., Kvamme, T. L., Hall, P., Birchard, T., & Voon, V. (2017). Compulsive sexual behavior: Prefrontal and limbic volume and interactions. Human Brain Mapping, 38, 11821190.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Schneider, J. P. (2004). Understanding and diagnosing sex addiction. In R. H. Coombs (Ed.), Handbook of addictive disorders: A practical guide to diagnosis and treatment (pp. 197232). Hoboken, NJ: John Wiley & Sons, Inc.

    • Search Google Scholar
    • Export Citation
  • Schultz, K., Hook, J. N., Davis, D. E., Penberthy, J. K., & Reid, R. C. (2014). Nonparaphilic hypersexual behavior and depressive symptoms: A meta-analytic review of the literature. Journal of Sex & Marital Therapy, 40, 477487. https://doi.org/10.1080/0092623X.2013.772551.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Schwartz, S. A., & Abramowitz, J. S. (2005). Contrasting nonparaphilic sexual addictions and OCD. In J. S. Abramowitz & A. C. Houts (Eds.), Concepts and controversies in obsessive-compulsive disorder (pp. 177184). https://doi.org/10.1007/0-387-23370-9_9.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Seeman, P. (2015). Parkinson's disease treatment may cause impulse–control disorder via dopamine D3 receptors. Synapse, 69, 183189.

  • Seok, J. W., & Sohn, J. H. (2015). Neural substrates of sexual desire in individuals with problematic hypersexual behavior. Frontiers in Behavioral Neuroscience, 9, 111. https://doi.org/10.3389/fnbeh.2015.00321.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Seok, J. W., & Sohn, J. H. (2018). Gray matter deficits and altered resting-state connectivity in the superior temporal gyrus among individuals with problematic hypersexual behavior. Brain Research, 1684, 3039.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Stark, R., Klucken, T., Potenza, M. N., Brand, M., & Strahler, J. (2018). A current understanding of the behavioral neuroscience of compulsive sexual behavior disorder and problematic pornography use. Current Behavioral Neuroscience Reports, 5, 218231.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Stavro, K., Rizkallah, E., Dinh-Williams, L., Chiasson, J.-P., & Potvin, S. (2013). Hypersexuality among a substance use disorder population. Sexual Addiction & Compulsivity, 20, 210216. https://doi.org/10.1080/10720162.2013.787379.

    • Search Google Scholar
    • Export Citation
  • Stewart, H., & Fedoroff, J. P. (2014). Assessment and treatment of sexual people with complaints of hypersexuality. Current Sexual Health Reports, 6, 136144.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sutton, K. S., Stratton, N., Pytyck, J., Kolla, N. J., & Cantor, J. M. (2015). Patient characteristics by type of hypersexuality referral: A quantitative chart review of 115 consecutive male cases. Journal of Sex & Marital Therapy, 41, 563580. https://doi.org/10.1080/0092623X.2014.935539.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Voon, V., Mole, T. B., Banca, P., Porter, L., Morris, L., Mitchell, S., et al. (2014). Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours. PloS One, 9, 110. https://doi.org/10.1371/journal.pone.0102419.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Walker, M. B. (1989). Some problems with the concept of “gambling addiction”: Should theories of addiction be generalized to include excessive gambling? Journal of Gambling Behavior, 5, 179200.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Walton, M. T., Cantor, J. M., & Lykins, A. D. (2017). An online assessment of personality, psychological, and sexuality trait variables associated with self-reported hypersexual behavior. Archives of Sexual Behavior, 46, 721733.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wéry, A., Vogelaere, K., Challet-Bouju, G., Poudat, F.-X., Caillon, J., Lever, D., et al. (2016). Characteristics of self-identified sexual addicts in a behavioral addiction outpatient clinic. Journal of Behavioral Addictions, 5, 623630. https://doi.org/10.1556/2006.5.2016.071.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Winters, J., Christoff, K., & Gorzalka, B. B. (2010). Dysregulated sexuality and high sexual desire: Distinct constructs? Archives of Sexual Behavior, 39, 10291043. https://doi.org/10.1007/s10508-009-9591-6.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • World Health Organization. (2018). International classification of diseases for mortality and morbidity statistics (11th ed.). Retrieved from https://icd.who.int/browse11/l-m/en.

    • Search Google Scholar
    • Export Citation
  • Yoon, I. S., Houang, S. T., Hirshfield, S., & Downing, M. J. (2016). Compulsive sexual behavior and HIV/STI risk: A review of current literature. Current Addiction Reports, 3, 387399.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Zuckerman, M. (1983). A biological theory of sensation seeking. In M. Zuckerman (Ed.), Biological buses of sensation: Seeking, impulsivity, and anxiety (pp. 3776). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.

    • Search Google Scholar
    • Export Citation
1

6. Has your sexual behavior ever created problems for you and your family? 7. Has anyone been hurt emotionally because of your sexual behavior? 16. Have important parts of your life (such as job, family, friends, leisure activities) been neglected because you were spending too much time on sex? 26. People in my life have been upset about my sexual activities online

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

    • Search Google Scholar
    • Export Citation
  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

  • Andreassen, C. S., Pallesen, S., Griffiths, M. D., Torsheim, T., & Sinha, R. (2018). The development and validation of the Bergen–Yale sex addiction scale with a large national sample. Frontiers in Psychology, 9, 115. https://doi.org/10.3389/fpsyg.2018.00144.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Balfour, M. E., Yu, L., & Coolen, L. M. (2004). Sexual behavior and sex-associated environmental cues activate the mesolimbic system in male rats. Neuropsychopharmacology, 29, 718730.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ballester-Arnal, R., Castro-Calvo, J., Giménez-García, C., Gil-Juliá, B., & Gil-Llario, M. D. (2020). Psychiatric comorbidity in compulsive sexual behavior disorder (CSBD). Addictive Behaviors, 107, 17. https://doi.org/10.1016/j.addbeh.2020.106384.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bancroft, J. (2008). Sexual behavior that is “out of control”: A theoretical conceptual approach. Psychiatric Clinics of North America, 31, 593601.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Barth, R. J., & Kinder, B. N. (1987). The mislabeling of sexual impulsivity. Journal of Sex & Marital Therapy, 13, 1523.

  • Black, D. W., Kehrberg, L. L. D., Flumerfelt, D. L., & Schlosser, S. S. (1997). Characteristics of 36 subjects reporting compulsive sexual behavior. The American Journal of Psychiatry, 154, 243249.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Brand, M., Snagowski, J., Laier, C., & Maderwald, S. (2016). Ventral striatum activity when watching preferred pornographic pictures is correlated with symptoms of Internet pornography addiction. NeuroImage, 129, 224232.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Brown, R. I. F. (1993). Some contributions of the study of gambling to the study of other addictions. In Gambling behavior and problem gambling(pp. 241272). Reno, NV: University of Nevada Press.

    • Search Google Scholar
    • Export Citation
  • Butcher, N. J., Dahlstrom, W. G., Graham, J. R., Tellegen, A., & Kaemmer, B. (1989). MMPI-2 (Minnesota Multiphasic Personality Inventory-2): Manual for administration and scoring. Minneapolis, MN: University of Minnesota Press.

    • Search Google Scholar
    • Export Citation
  • Bőthe, B., Bartók, R., Tóth-Király, I., Reid, R. C., Griffiths, M. D., Demetrovics, Z., et al. (2018). Hypersexuality, gender, and sexual orientation: A large-scale psychometric survey study. Archives of Sexual Behavior, 47, 22652276.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bőthe, B., Koós, M., Tóth-Király, I., Orosz, G., & Demetrovics, Z. (2019). Investigating the associations of adult ADHD symptoms, hypersexuality, and problematic pornography use among men and women on a largescale, non-clinical sample. The Journal of Sexual Medicine, 16, 489499.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bőthe, B., Potenza, M. N., Griffiths, M. D., Kraus, S. W., Klein, V., Fuss, J., et al. (2020). The development of the Compulsive Sexual Behavior Disorder Scale (CSBD-19): An ICD-11 based screening measure across three languages. Journal of Behavioral Addictions, 9(2), 247258.‏

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bőthe, B., Tóth-Király, I., Potenza, M. N., Griffiths, M. D., Orosz, G., & Demetrovics, Z. (2019). Revisiting the role of impulsivity and compulsivity in problematic sexual behaviors. The Journal of Sex Research, 56, 166179.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bőthe, B., Tóth-Király, I., Zsila Á., Griffiths, M. D., Demetrovics, Z., & Orosz, G. (2018). The Development of the problematic pornography consumption scale (PPCS). The Journal of Sex Research, 55, 395406. https://doi.org/10.1080/00224499.2017.1291798.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Carnes, P. J. (1983). The sexual addiction. Minneapolis, MN: CompCare Publications.

  • Carnes, P. J. (1991). Don't call it love: Recovering from sexual addiction. New York, NY: Bantam Books.

  • Carnes, P. J. (1996). Addiction or compulsion: Politics or illness?. Sexual Addiction & Compulsivity, 3, 127150.

  • Carnes, P. J., Green, B., & Carnes, S. (2010). The same yet different: Refocusing the Sexual Addiction Screening Test (SAST) to reflect orientation and gender. Sexual Addiction & Compulsivity, 17, 730.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Carnes, P. J., Hopkins, T. A., & Green, B. A. (2014). Clinical relevance of the proposed sexual addiction diagnostic criteria: Relation to the sexual addiction screening test-revised. Journal of Addiction Medicine, 8, 450461.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Carnes, P. J., & Schneider, J. P. (2000). Recognition and management of addictive sexual disorders: Guide for the primary care clinician. Lippincott's Primary Care Practice, 4, 302318.

    • Search Google Scholar
    • Export Citation
  • Carpenter, B. N., Reid, R. C., Garos, S., & Najavits, L. M. (2013). Personality disorder comorbidity in treatment-seeking men with hypersexual disorder. Sexual Addiction & Compulsivity, 20, 7990. https://doi.org/10.1080/10720162.2013.772873.

    • Search Google Scholar
    • Export Citation
  • Carvalho, J., Štulhofer, A., Vieira, A. L., & Jurin, T. (2015). CSBD and high sexual desire: Exploring the structure of problematic sexuality. The Journal of Sexual Medicine, 12, 13561367.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Claes, L., Vandereycken, W., & Vertommen, H. (2002). Impulsive and compulsive traits in eating disordered patients compared with controls. Personality and Individual Differences, 32, 707714. https://doi.org/10.1016/S0191-8869(01)00071-X.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Coleman-Kennedy, C., & Pendley, A. (2002). Assessment and diagnosis of sexual addiction. Journal of the American Psychiatric Nurses Association, 8, 143151.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Derbyshire, K. L., & Grant, J. E. (2015). Compulsive sexual behavior: A review of the literature. Journal of Behavioral Addictions, 4, 3743.

  • Dickenson, J. A., Gleason, N., Coleman, E., & Miner, M. H. (2018). Prevalence of distress associated with difficulty controlling sexual urges, feelings, and behaviors in the United States. JAMA Network Open, 1, 110. https://doi.org/10.1001/jamanetworkopen.2018.4468.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Erez, G., Pilver, C. E., & Potenza, M. N. (2014). Gender-related differences in the associations between sexual impulsivity and psychiatric disorders. Journal of Psychiatric Research, 55, 117125.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Fuss, J., Briken, P., Stein, D. J., & Lochner, C. (2019). Compulsive sexual behavior disorder in obsessive–compulsive disorder: Prevalence and associated comorbidity. Journal of Behavioral Addictions, 8, 242248. https://doi.org/10.1556/2006.8.2019.23.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Garcia, F. D., & Thibaut, F. (2010). Sexual addictions. The American Journal of Drug and Alcohol Abuse, 36, 254260.

  • Gilliland, R., South, M., Carpenter, B. N., & Hardy, S. A. (2011). The roles of shame and guilt in hypersexual behavior. Sexual Addiction & Compulsivity, 18, 1229.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gola, M., Wordecha, M., Sescousse, G., Lew-Starowicz, M., Kossowski, B., Wypych, M., et al. (2017). Can pornography be addictive? An fMRI study of men seeking treatment for problematic pornography use. Neuropsychopharmacology, 42, 20212031.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gold, S. N., & Heffner, C. L. (1998). Sexual addiction: Many conceptions, minimal data. Clinical Psychology Review, 18, 367381.

  • Griffiths, M. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191197.

  • Hartman, L. I., Ho, V., Arbour, S., Hambley, J. M., & Lawson, P. (2012). Sexual addiction and substance addiction: Comparing sexual addiction treatment outcomes among clients with and without comorbid substance use disorders. Sexual Addiction & Compulsivity, 19, 284309.

    • Search Google Scholar
    • Export Citation
  • Hollander, E., & Rosen, J. (2002). Obsessive-compulsive spectrum disorders: A review. In M. Maj, N. Sartorius, A. Okasha, & J. Zohar (Eds.), Obsessive-compulsive disorder (2nd ed., pp. 203252). Chichester: John Wiley & Sons, Ltd.

    • Search Google Scholar
    • Export Citation
  • Hook, J. N., Hook, J. P., Davis, D. E., Worthington, E. L., & Penberthy, J. K. (2010). Measuring sexual addiction and compulsivity: A critical review of instruments. Journal of Sex & Marital Therapy, 36, 227260. https://doi.org/10.1080/00926231003719673.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kafka, M. P. (2010). Hypersexual disorder: A proposed siagnosis for DSM-V. Archives of Sexual Behavior, 39, 377400. https://doi.org/10.1007/s10508-009-9574-7.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kafka, M. P. (2015). DSM-IV Axis I psychopathology in males with non-paraphilic hypersexual disorder. Current Addiction Reports, 2, 202206. https://doi.org/10.1007/s40429-015-0060-0.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kalichman, S. C., & Rompa, D. (1995). Sexual sensation seeking and sexual compulsivity scales: Validity and predicting HIV risk behavior. Journal of Personality Assessment, 65, 586601.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kaplan, M. S., & Krueger, R. B. (2010). Diagnosis, assessment, and treatment of hypersexuality. The Journal of Sex Research, 47, 181198. https://doi.org/10.1080/00224491003592863.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Karaca, S., Saleh, A., Canan, F., & Potenza, M. N. (2017). Comorbidity between behavioral addictions and attention deficit/hyperactivity disorder: A systematic review. International Journal of Mental Health and Addiction, 15, 701724. https://doi.org/10.1007/s11469-016-9660-8.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Karila, L., Wéry, A., Weinstein, A., Cottencin, O., Petit, A., Reynaud, M., et al. (2014). Sexual addiction or hypersexual disorder: Different terms for the same problem? A review of the literature. Current Pharmaceutical Design, 20, 40124020.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kingston, D. A., & Firestone, P. (2008). Problematic hypersexuality: A review of conceptualization and diagnosis. Sexual Addiction & Compulsivity, 15, 284310. https://doi.org/10.1080/10720160802289249.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kingston, D. A., Walters, G. D., Olver, M. E., Levaque, E., Sawatsky, M., & Lalumière, M. L. (2018). Understanding the latent structure of hypersexuality: A taxometric investigation. Archives of Sexual Behavior, 47, 22072221.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Klucken, T., Wehrum-Osinsky, S., Schweckendiek, J., Kruse, O., & Stark, R. (2016). Altered appetitive conditioning and neural connectivity in subjects with compulsive sexual behavior. The Journal of Sexual Medicine, 13, 627636.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kopeykina, I., Kim, H. J., Khatun, T., Boland, J., Haeri, S., Cohen, L. J., et al. (2016). Hypersexuality and couple relationships in bipolar disorder: A review. Journal of Affective Disorders, 195, 114. https://doi.org/10.1016/j.jad.2016.01.035.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kor, A., Fogel, Y. A., Reid, R. C., & Potenza, M. N. (2013). Should hypersexual disorder be classified as an addiction? Sexual Addiction & Compulsivity, 20, 2747.

    • Search Google Scholar
    • Export Citation
  • Kowalewska, E., Grubbs, J. B., Potenza, M. N., Gola, M., Draps, M., & Kraus, S. W. (2018). Neurocognitive mechanisms in compulsive sexual behavior disorder. Current Sexual Health Reports, 10, 255264.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kraus, S. W., Rosenberg, H., & Tompsett, C. J. (2015). Assessment of self-efficacy to employ self-initiated pornography use-reduction strategies. Addictive Behaviors, 40, 115118. https://doi.org/10.1016/j.addbeh.2014.09.012.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kraus, S. W., Voon, V., & Potenza, M. N. (2016). Should compulsive sexual behavior be considered an addiction? Addiction, 111, 20972106.

  • Kühn, S., & Gallinat, J. (2014). Brain structure and functional connectivity associated with pornography consumption: The brain on porn. JAMA Psychiatry, 71, 827834.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Levine, S. B. (2010). What is sexual addiction? Journal of Sex & Marital Therapy, 36, 261275.

  • Mick, T. M., & Hollander, E. (2006). Impulsive-compulsive sexual behavior. CNS Spectrums, 11, 944955. https://doi.org/10.1017/S1092852900015133.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Miner, M. H., Raymond, N., Mueller, B. A., Lloyd, M., & Lim, K. O. (2009). Preliminary investigation of the impulsive and neuroanatomical characteristics of compulsive sexual behavior. Psychiatry Research: Neuroimaging, 174, 146151.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Montgomery-Graham, S. (2017). Conceptualization and assessment of hypersexual disorder: A systematic review of the literature. Sexual Medicine Reviews, 5, 146162.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nakken, C. (1996). The addictive personality: Understanding the addictive process and compulsive behavior (2nd ed.). Center City, MN: Hazelden Publishing.

    • Search Google Scholar
    • Export Citation
  • Nakum, S., & Cavanna, A. E. (2016). The prevalence and clinical characteristics of hypersexuality in patients with Parkinson's disease following dopaminergic therapy: A systematic literature review. Parkinsonism & Related Disorders, 25, 1016.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Niazof, D., Weizman, A., & Weinstein, A. (2019). The contribution of ADHD and attachment difficulties to online pornography use among students. Comprehensive Psychiatry, 93, 5660. https://doi.org/10.1016/j.comppsych.2019.07.002.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Pachankis, J. E., Rendina, H. J., Ventuneac, A., Grov, C., & Parsons, J. T. (2014). The role of maladaptive cognitions in CSBD among highly sexually active gay and bisexual men. Archives of Sexual Behavior, 43, 669683.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Potenza, M. N., Voon, V., & Weintraub, D. (2007). Drug Insight: Impulse control disorders and dopamine therapies in Parkinson's disease. Nature Reviews Neurology, 3, 664.

    • Search Google Scholar
    • Export Citation
  • Rachlin, H. (1990). Why do people gamble and keep gambling despite heavy losses? Psychological Science, 1, 294297.

  • Raymond, N. C., Coleman, E., & Miner, M. H. (2003). Psychiatric comorbidity and compulsive/impulsive traits in compulsive sexual behavior. Comprehensive Psychiatry, 44(5), 370380. https://doi.org/10.1016/S0010-440X(03)00110-X.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Raymond, N. C., Grant, J. E., & Coleman, E. (2010). Augmentation with naltrexone to treat compulsive sexual behavior: A case series. Annals of Clinical Psychiatry, 22, 5662.

    • Search Google Scholar
    • Export Citation
  • Reid, R. C., & Carpenter, B. N. (2009). Exploring relationships of psychopathology in hypersexual patients using the MMPI-2. Journal of Sex & Marital Therapy, 35, 294310. https://doi.org/10.1080/00926230902851298.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reid, R. C., Carpenter, B. N., Hook, J. N., Garos, S., Manning, J. C., Gilliland, R., et al. (2012). Report of findings in a DSM‐5 field trial for hypersexual disorder. The Journal of Sexual Medicine, 9, 28682877.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reid, R. C., Carpenter, B. N., & Lloyd, T. Q. (2009). Assessing psychological symptom patterns of patients seeking help for hypersexual behavior. Sexual and Relationship Therapy, 24, 4763. https://doi.org/10.1080/14681990802702141.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reid, R. C., Garos, S., & Carpenter, B. N. (2011). Reliability, validity, and psychometric development of the Hypersexual Behavior Inventory in an outpatient sample of men. Sexual Addiction & Compulsivity, 18, 3051.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reid, R. C., Harper, J. M., & Anderson, E. H. (2009). Coping strategies used by hypersexual patients to defend against the painful effects of shame. Clinical Psychology & Psychotherapy, 16, 125138.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reid, R. C., & Meyer, M. D. (2016). Substance use disorders in hypersexual adults. Current Addiction Reports, 3, 400405. https://doi.org/10.1007/s40429-016-0124-9.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reilly, C. (Ed.). (2017). Identifying a gambling disorder. In Gambling and public health: A guide for policy makers (pp. 717). Retrieved from http://www.ncrg.org/sites/default/files/uploads/gambling_and_public_health_-_a_guide_for_policymakers_web.pdf#page=15.

    • Search Google Scholar
    • Export Citation
  • Robinson, T. E., & Berridge, K. C. (2008). The incentive sensitization theory of addiction: Some current issues. Philosophical Transactions of the Royal Society B: Biological Sciences, 363(1507), 31373146.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rosenberg, K. P., O'Connor, S., & Carnes, P. (2014). Sex addiction: An overview. In K. P. Rosenberg & L. C. Feder (Eds.), Behavioral addictions (pp. 215236). https://doi.org/10.1016/B978-0-12-407724-9.00009-4.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Schmidt, C., Morris, L. S., Kvamme, T. L., Hall, P., Birchard, T., & Voon, V. (2017). Compulsive sexual behavior: Prefrontal and limbic volume and interactions. Human Brain Mapping, 38, 11821190.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Schneider, J. P. (2004). Understanding and diagnosing sex addiction. In R. H. Coombs (Ed.), Handbook of addictive disorders: A practical guide to diagnosis and treatment (pp. 197232). Hoboken, NJ: John Wiley & Sons, Inc.

    • Search Google Scholar
    • Export Citation
  • Schultz, K., Hook, J. N., Davis, D. E., Penberthy, J. K., & Reid, R. C. (2014). Nonparaphilic hypersexual behavior and depressive symptoms: A meta-analytic review of the literature. Journal of Sex & Marital Therapy, 40, 477487. https://doi.org/10.1080/0092623X.2013.772551.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Schwartz, S. A., & Abramowitz, J. S. (2005). Contrasting nonparaphilic sexual addictions and OCD. In J. S. Abramowitz & A. C. Houts (Eds.), Concepts and controversies in obsessive-compulsive disorder (pp. 177184). https://doi.org/10.1007/0-387-23370-9_9.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Seeman, P. (2015). Parkinson's disease treatment may cause impulse–control disorder via dopamine D3 receptors. Synapse, 69, 183189.

  • Seok, J. W., & Sohn, J. H. (2015). Neural substrates of sexual desire in individuals with problematic hypersexual behavior. Frontiers in Behavioral Neuroscience, 9, 111. https://doi.org/10.3389/fnbeh.2015.00321.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Seok, J. W., & Sohn, J. H. (2018). Gray matter deficits and altered resting-state connectivity in the superior temporal gyrus among individuals with problematic hypersexual behavior. Brain Research, 1684, 3039.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Stark, R., Klucken, T., Potenza, M. N., Brand, M., & Strahler, J. (2018). A current understanding of the behavioral neuroscience of compulsive sexual behavior disorder and problematic pornography use. Current Behavioral Neuroscience Reports, 5, 218231.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Stavro, K., Rizkallah, E., Dinh-Williams, L., Chiasson, J.-P., & Potvin, S. (2013). Hypersexuality among a substance use disorder population. Sexual Addiction & Compulsivity, 20, 210216. https://doi.org/10.1080/10720162.2013.787379.

    • Search Google Scholar
    • Export Citation
  • Stewart, H., & Fedoroff, J. P. (2014). Assessment and treatment of sexual people with complaints of hypersexuality. Current Sexual Health Reports, 6, 136144.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sutton, K. S., Stratton, N., Pytyck, J., Kolla, N. J., & Cantor, J. M. (2015). Patient characteristics by type of hypersexuality referral: A quantitative chart review of 115 consecutive male cases. Journal of Sex & Marital Therapy, 41, 563580. https://doi.org/10.1080/0092623X.2014.935539.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Voon, V., Mole, T. B., Banca, P., Porter, L., Morris, L., Mitchell, S., et al. (2014). Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours. PloS One, 9, 110. https://doi.org/10.1371/journal.pone.0102419.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Walker, M. B. (1989). Some problems with the concept of “gambling addiction”: Should theories of addiction be generalized to include excessive gambling? Journal of Gambling Behavior, 5, 179200.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Walton, M. T., Cantor, J. M., & Lykins, A. D. (2017). An online assessment of personality, psychological, and sexuality trait variables associated with self-reported hypersexual behavior. Archives of Sexual Behavior, 46, 721733.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wéry, A., Vogelaere, K., Challet-Bouju, G., Poudat, F.-X., Caillon, J., Lever, D., et al. (2016). Characteristics of self-identified sexual addicts in a behavioral addiction outpatient clinic. Journal of Behavioral Addictions, 5, 623630. https://doi.org/10.1556/2006.5.2016.071.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Winters, J., Christoff, K., & Gorzalka, B. B. (2010). Dysregulated sexuality and high sexual desire: Distinct constructs? Archives of Sexual Behavior, 39, 10291043. https://doi.org/10.1007/s10508-009-9591-6.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • World Health Organization. (2018). International classification of diseases for mortality and morbidity statistics (11th ed.). Retrieved from https://icd.who.int/browse11/l-m/en.

    • Search Google Scholar
    • Export Citation
  • Yoon, I. S., Houang, S. T., Hirshfield, S., & Downing, M. J. (2016). Compulsive sexual behavior and HIV/STI risk: A review of current literature. Current Addiction Reports, 3, 387399.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Zuckerman, M. (1983). A biological theory of sensation seeking. In M. Zuckerman (Ed.), Biological buses of sensation: Seeking, impulsivity, and anxiety (pp. 3776). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.

    • Search Google Scholar
    • Export Citation
The author instruction is available in PDF.
Please, download the file from HERE

Dr. Zsolt Demetrovics
Institute of Psychology, ELTE Eötvös Loránd University
Address: Izabella u. 46. H-1064 Budapest, Hungary
Phone: +36-1-461-2681
E-mail: jba@ppk.elte.hu

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2020  
Total Cites 4024
WoS
Journal
Impact Factor
6,756
Rank by Psychiatry (SSCI) 12/143 (Q1)
Impact Factor Psychiatry 19/156 (Q1)
Impact Factor 6,052
without
Journal Self Cites
5 Year 8,735
Impact Factor
Journal  1,48
Citation Indicator  
Rank by Journal  Psychiatry 24/250 (Q1)
Citation Indicator   
Citable 86
Items
Total 74
Articles
Total 12
Reviews
Scimago 47
H-index
Scimago 2,265
Journal Rank
Scimago Clinical Psychology Q1
Quartile Score Psychiatry and Mental Health Q1
  Medicine (miscellaneous) Q1
Scopus 3593/367=9,8
Scite Score  
Scopus Clinical Psychology 7/283 (Q1)
Scite Score Rank Psychiatry and Mental Health 22/502 (Q1)
Scopus 2,026
SNIP  
Days from  38
submission  
to 1st decision  
Days from  37
acceptance  
to publication  
Acceptance 31%
Rate  

2019  
Total Cites
WoS
2 184
Impact Factor 5,143
Impact Factor
without
Journal Self Cites
4,346
5 Year
Impact Factor
5,758
Immediacy
Index
0,587
Citable
Items
75
Total
Articles
67
Total
Reviews
8
Cited
Half-Life
3,3
Citing
Half-Life
6,8
Eigenfactor
Score
0,00597
Article Influence
Score
1,447
% Articles
in
Citable Items
89,33
Normalized
Eigenfactor
0,7294
Average
IF
Percentile
87,923
Scimago
H-index
37
Scimago
Journal Rank
1,767
Scopus
Scite Score
2540/376=6,8
Scopus
Scite Score Rank
Cllinical Psychology 16/275 (Q1)
Medicine (miscellenous) 31/219 (Q1)
Psychiatry and Mental Health 47/506 (Q1)
Scopus
SNIP
1,441
Acceptance
Rate
32%

 

Journal of Behavioral Addictions
Publication Model Gold Open Access
Submission Fee none
Article Processing Charge 850 EUR/article
Printed Color Illustrations 40 EUR (or 10 000 HUF) + VAT / piece
Regional discounts on country of the funding agency World Bank Lower-middle-income economies: 50%
World Bank Low-income economies: 100%
Further Discounts Editorial Board / Advisory Board members: 50%
Corresponding authors, affiliated to an EISZ member institution subscribing to the journal package of Akadémiai Kiadó: 100%
Subscription Information Gold Open Access
Purchase per Title  

Journal of Behavioral Addictions
Language English
Size A4
Year of
Foundation
2011
Publication
Programme
2021 Volume 10
Volumes
per Year
1
Issues
per Year
4
Founder Eötvös Loránd Tudományegyetem
Founder's
Address
H-1053 Budapest, Hungary Egyetem tér 1-3.
Publisher Akadémiai Kiadó
Publisher's
Address
H-1117 Budapest, Hungary 1516 Budapest, PO Box 245.
Responsible
Publisher
Chief Executive Officer, Akadémiai Kiadó
ISSN 2062-5871 (Print)
ISSN 2063-5303 (Online)

Senior editors

Editor(s)-in-Chief: Zsolt DEMETROVICS

Assistant Editor(s): Csilla ÁGOSTON

Associate Editors

  • Judit BALÁZS (ELTE Eötvös Loránd University, Hungary)
  • Joel BILLIEUX (University of Lausanne, Switzerland)
  • Matthias BRAND (University of Duisburg-Essen, Germany)
  • Anneke GOUDRIAAN (University of Amsterdam, The Netherlands)
  • Daniel KING (Flinders University, Australia)
  • Ludwig KRAUS (IFT Institute for Therapy Research, Germany)
  • H. N. Alexander LOGEMANN (ELTE Eötvös Loránd University, Hungary)
  • Anikó MARÁZ (Humboldt University of Berlin, Germany)
  • Astrid MÜLLER (Hannover Medical School, Germany)
  • Marc N. POTENZA (Yale University, USA)
  • Hans-Jurgen RUMPF (University of Lübeck, Germany)
  • Attila SZABÓ (ELTE Eötvös Loránd University, Hungary)
  • Róbert URBÁN (ELTE Eötvös Loránd University, Hungary)
  • Aviv M. WEINSTEIN (Ariel University, Israel)

Editorial Board

  • Max W. ABBOTT (Auckland University of Technology, New Zealand)
  • Elias N. ABOUJAOUDE (Stanford University School of Medicine, USA)
  • Hojjat ADELI (Ohio State University, USA)
  • Alex BALDACCHINO (University of Dundee, United Kingdom)
  • Alex BLASZCZYNSKI (University of Sidney, Australia)
  • Kenneth BLUM (University of Florida, USA)
  • Henrietta BOWDEN-JONES (Imperial College, United Kingdom)
  • Beáta BÖTHE (University of Montreal, Canada)
  • Wim VAN DEN BRINK (University of Amsterdam, The Netherlands)
  • Gerhard BÜHRINGER (Technische Universität Dresden, Germany)
  • Sam-Wook CHOI (Eulji University, Republic of Korea)
  • Damiaan DENYS (University of Amsterdam, The Netherlands)
  • Jeffrey L. DEREVENSKY (McGill University, Canada)
  • Naomi FINEBERG (University of Hertfordshire, United Kingdom)
  • Marie GRALL-BRONNEC (University Hospital of Nantes, France)
  • Jon E. GRANT (University of Minnesota, USA)
  • Mark GRIFFITHS (Nottingham Trent University, United Kingdom)
  • Heather HAUSENBLAS (Jacksonville University, USA)
  • Tobias HAYER (University of Bremen, Germany)
  • Susumu HIGUCHI (National Hospital Organization Kurihama Medical and Addiction Center, Japan)
  • David HODGINS (University of Calgary, Canada)
  • Eric HOLLANDER (Albert Einstein College of Medicine, USA)
  • Jaeseung JEONG (Korea Advanced Institute of Science and Technology, Republic of Korea)
  • Yasser KHAZAAL (Geneva University Hospital, Switzerland)
  • Orsolya KIRÁLY (Eötvös Loránd University, Hungary)
  • Emmanuel KUNTSCHE (La Trobe University, Australia)
  • Hae Kook LEE (The Catholic University of Korea, Republic of Korea)
  • Michel LEJOXEUX (Paris University, France)
  • Anikó MARÁZ (Eötvös Loránd University, Hungary)
  • Giovanni MARTINOTTI (‘Gabriele d’Annunzio’ University of Chieti-Pescara, Italy)
  • Frederick GERARD MOELLER (University of Texas, USA)
  • Daniel Thor OLASON (University of Iceland, Iceland)
  • Nancy PETRY (University of Connecticut, USA)
  • Bettina PIKÓ (University of Szeged, Hungary)
  • Afarin RAHIMI-MOVAGHAR (Teheran University of Medical Sciences, Iran)
  • József RÁCZ (Hungarian Academy of Sciences, Hungary)
  • Rory C. REID (University of California Los Angeles, USA)
  • Marcantanio M. SPADA (London South Bank University, United Kingdom)
  • Daniel SPRITZER (Study Group on Technological Addictions, Brazil)
  • Dan J. STEIN (University of Cape Town, South Africa)
  • Sherry H. STEWART (Dalhousie University, Canada)
  • Attila SZABÓ (Eötvös Loránd University, Hungary)
  • Ferenc TÚRY (Semmelweis University, Hungary)
  • Alfred UHL (Austrian Federal Health Institute, Austria)
  • Johan VANDERLINDEN (University Psychiatric Center K.U.Leuven, Belgium)
  • Alexander E. VOISKOUNSKY (Moscow State University, Russia)
  • Kimberly YOUNG (Center for Internet Addiction, USA)

 

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