Masked liking of pornography: implicit associations in men with compulsive sexual behavior

Background Compulsive Sexual Behavior Disorder is a new category in the 11th version of the International Classification of Diseases and is showing neuropsychological similarities to substance dependencies and behavioral addictions. Aims This experimental study aims to further our knowledge on implicit associations in Compulsive Sexual Behavior (CSB) with a clinical sample. Methods Participants completed an Implicit Association Test modified with pornographic pictures. In addition, problematic sexual behavior and sensitivity toward sexual excitation were assessed. Outcomes We collected data on implicit associations from 47 heterosexual men with CSB (age, M = 36.51, SD = 11.47) and a control group of 38 men without the condition (age: M = 37.92, SD = 12.33). Results Results show significantly more positive relationships between implicit associations of pornographic pictures with positive emotions, as well as with problematic sexual behavior and sensitivity toward sexual excitation, in men with CSB vs. men without CSB. Furthermore, implicit associations, sexual excitation, and sexual inhibition due to threat of performance consequences differentiated significantly between groups using a binary stepwise logistic regression analysis. The findings are in line with those of previous subclinical investigations and support the assumption of pronounced positive implicit associations in CSB. Moreover, as suggested by the I-PACE model of addictive behaviors, implicit associations may be crucial to the maintenance of behavioral addictions. Clinical implications Implicit associations could be addressed in therapy to illustrate cognitive processes of those affected and as an outcome measure in research on treatment efficiency. Strengths & limitations The present study is the first to investigate implicit associations in CSB in a clinical sample. Findings are limited to heterosexual men. Conclusion Findings can be seen in accordance with a proposed classification of CSB as a behavioral addiction

Hypersexual behavior in a large online sample: Individual characteristics and signs of coercive sexual behavior

Background and aims Despite the high prevalence of perceived problems relating to symptoms of hypersexual disorder (HD), important aspects remain underinvestigated. This study examines symptoms of depression, symptoms of problematic cybersex, and coercive sexual behavior in a large online sample from a German-speaking population. Methods In an online survey, N = 1,194 (n = 564 women) participated in this study and completed measures including self-report questionnaires to assess depressive symptoms (PHQ-9), HD (HBI-19), symptoms of problematic cybersex (s-IATsex), as well as questions characterizing participants sexually, including fantasies and actual sexual coercive behaviors. Results Men reported increased levels of HD symptom severity, pornography consumption, masturbation, and partnered sexual activity. Moreover, 59% of men and 18% of women reported fantasies of sexual coercion, whereas 21% of men and 4% of women reported acts of sexual coercion. Moderated regression analyses showed that symptoms of depression as well as sexual coercive fantasies and behaviors were associated with levels of HD symptom severity. Problematic cybersex, total sexual outlet (TSO), pornography consumption, and number of sexual partners were also associated with HD symptom severity. Interaction effects indicated that, in women, the connection of TSO as well as pornography was more strongly associated with levels of HD symptom severity than in men. Conclusions This survey indicated that levels of HD symptom severity are often associated with severe intra- and interpersonal difficulties. Furthermore, the amount of sexual activity seems to be more strongly connected to levels of HD symptom severity in women than in men

Two Sides of One Coin: A Comparison of Clinical and Neurobiological Characteristics of Convicted and Non-Convicted Pedophilic Child Sexual Offenders

High prevalence of child sexual offending stand in contradiction to low conviction rates (one-tenth at most) of child sexual offenders (CSOs). Little is known about possible differences between convicted and non-convicted pedophilic CSOs and why only some become known to the judicial system. This investigation takes a closer look at the two sides of "child sexual offending" by focusing on clinical and neurobiological characteristics of convicted and non-convicted pedophilic CSOs as presented in the Neural Mechanisms Underlying Pedophilia and sexual offending against children (NeMUP)*-study. Seventy-nine male pedophilic CSOs were examined, 48 of them convicted. All participants received a thorough clinical examination including the structured clinical interview (SCID), intelligence, empathy, impulsivity, and criminal history. Sixty-one participants (38 convicted) underwent an inhibition performance task (Go/No-go paradigm) combined with functional magnetic resonance imaging (fMRI). Convicted and non-convicted pedophilic CSOs revealed similar clinical characteristics, inhibition performances, and neuronal activation. However, convicted subjects' age preference was lower (i.e., higher interest in prepubescent children) and they had committed a significantly higher number of sexual offenses against children compared to non-convicted subjects. In conclusion, sexual age preference may represent one of the major driving forces for elevated rates of sexual offenses against children in this sample, and careful clinical assessment thereof should be incorporated in every preventive approach

The German COVID-19 Survey on Mental Health: Primary Results

First cases of COVID-19 were reported in Wuhan, China in early December 2019. Preliminary data from China indicated that the pandemic and its associated lockdown measures may have a substantial impact on mental health and well-being, with evidence of increased levels of psychological distress, anxiety, depressive symptoms and insomnia.1,2 In March 2020, the German government agreed upon a substantial catalogue of measures including contact bans that came into effect on 22 March. Such measures are unprecedented for the majority of people and may affect their lives tremendously. Thus, the current survey was immediately developed to systematically assess mental health in response to these measures. Methods The survey was approved by the local ethics committee at Hannover Medical School, Germany and included web-based self-report measures as outlined below. First wave data were taken during the height of lockdown measures in Germany from 1 April to 15 April 2020. Results Demographics A total of 3,545 volunteers took part in this cross-sectional survey. Mean age was 40.36 years (SD = 11.70; 83.1% female, 15.2% male), mean educational years 15.87 (SD = 4.19), 9.9% were unemployed and 23.9% reported living alone. Acute or chronic disease was reported by 36.7% (physical) and 24.7% (mental) of subjects. Distress, Anxiety and Depression Psychosocial distress as measured with the PHQ stress module (items 12a-12j of PHQ-D) was at M = 6.36 (SD = 0.89), implying mild psychosocial distress (range 5-9). Depression and anxiety as assessed by PHQ-4 was at M = 3.80 (SD = 3.03) and significantly higher than in a reference sample (t(6008) = 32.78, p = 0.00).3 The mean well-being score (WHO-5) was 50.7 (SD = 23.8) (range 0-100), with normal individuals having a mean score of 75 and subjects with major depression 37.5.4 The majority of subjects (60%) indicated very good or fair, 26.9% poor or very poor subjective coping with the pandemic and corresponding measures. Calculation of gender differences revealed higher scores for depression and anxiety (t(3459) = 4.93, p = 0.00) and poorer coping in women (U = 678156, p = 0.00). Sleep, irritability &amp; violence Using comparative questions on a 5-point Likert scale 45.3% of participants reported worsened sleep compared to pre-pandemic times. Of all participants 50.9% reported being more easily irritated (compared to 12.2% feeling less easily irritated) and 29% reported experiencing more anger and aggression (compared to 12.8% experiencing less). Of these 65.5% directed their anger and aggression at others, while 32.6% directed it at themselves. Most importantly, 5% of all participants reported experiencing interpersonal violence (IPV) on a verbal (98.4%), physical (41.9%) or sexual (30.2%) level. In case of verbal violence, 77.3% reported experiencing more verbal violence lately (compared to 3.4% experiencing less). Regarding physical violence, 19.5% reported experiencing increased levels (compared to 2.8% experiencing less) and in case of sexual violence more people reported experiencing increased sexual violence lately (11.1%) compared to 1.7% that experienced less. Discussion This is one of the first and largest surveys on mental health during COVID pandemic in a European society. Although the cohort reflects a relatively well educated and financially secure sample, there is evidence of substantial mental burden with increased levels of stress, anxiety, depressive symptoms, sleep disturbance and irritability. Most importantly and also most concerning is the finding of a one-month prevalence of 5% IPV, which is already close to one-year prevalence rates5 and for which there were indices that this has currently increased. We think it is of vital importance to continuously monitor the mental health of the general public during this pandemic and its aftermath and to carefully screen for IPV and its risk factors such as stress, sleep problems and anger.6 </jats:sec

Mental Health, Sense of Coherence, and Interpersonal Violence during the COVID-19 Pandemic Lockdown in Germany

Preliminary data indicates that the Coronavirus SARS-CoV-2 disease (COVID-19) pandemic may have a substantial impact on mental health and well-being. We assessed mental health in response to the lockdown in Germany between 1 April 2020 and 15 April 2020 using a cross-sectional online survey (n = 3545) with a mixed-methods approach. We found increased levels of psychosocial distress (Patient Health Questionnaire (PHQ) stress module), anxiety, depressive symptoms (PHQ-4), irritability, and a decrease in overall well-being (WHO-Five Well-Being Index (WHO-5)), sense of coherence (Short Form of the Sense of Coherence Scale (SOC-L9)), sexual contentment, and sleep quality. The four-week-prevalence of interpersonal violence was yet at 5% and included verbal, physical, and sexual violence. Participants reported finding comfort in family, friends, conversation, exercise, and activity. Findings are also in line with research showing that women seem to have more trouble coping with the pandemic and lockdown measures. Our observations demonstrate that the COVID-19 pandemic and related measures lead to a mental health burden even in a highly developed Western country and should, therefore, be taken seriously. The findings for interpersonal violence are alarming. Thus, we should sharpen our focus on the matter and activate and enhance supporting systems to help protect those affected.</jats:p

Mental Health, Sense of Coherence, and Interpersonal Violence during the COVID-19 Pandemic Lockdown in Germany

Preliminary data indicates that the Coronavirus SARS-CoV-2 disease (COVID-19) pandemic may have a substantial impact on mental health and well-being. We assessed mental health in response to the lockdown in Germany between 1 April 2020 and 15 April 2020 using a cross-sectional online survey (n = 3545) with a mixed-methods approach. We found increased levels of psychosocial distress (Patient Health Questionnaire (PHQ) stress module), anxiety, depressive symptoms (PHQ-4), irritability, and a decrease in overall well-being (WHO-Five Well-Being Index (WHO-5)), sense of coherence (Short Form of the Sense of Coherence Scale (SOC-L9)), sexual contentment, and sleep quality. The four-week-prevalence of interpersonal violence was yet at 5% and included verbal, physical, and sexual violence. Participants reported finding comfort in family, friends, conversation, exercise, and activity. Findings are also in line with research showing that women seem to have more trouble coping with the pandemic and lockdown measures. Our observations demonstrate that the COVID-19 pandemic and related measures lead to a mental health burden even in a highly developed Western country and should, therefore, be taken seriously. The findings for interpersonal violence are alarming. Thus, we should sharpen our focus on the matter and activate and enhance supporting systems to help protect those affected

Alterations in voxel based morphometry and resting state functional connectivity in men with compulsive sexual behavior disorder in the Sex@Brain study

Aim: Compulsive Sexual Behavior Disorder (CSBD) is a new category in ICD-11. Research examining underlying brain mechanisms is sparse. Research into neurobiological differences can be helpful in advancing the possibilities of new diagnostic approaches and therapeutic methods. The present study aimed to examine brain matter volume and resting state functional connectivity (rs-FC) in CSBD. Methods: Structural and rs-FC magnetic resonance imaging and data from questionnaires were collected in 30 men with CSBD and 32 age- and education-matched controls. Whole brain voxel based morphometry (VBM) and seed based rs-FC in a-priori defined seeds were analyzed. Results: Structural analyses showed that men with CSBD had significantly increased gray matter volume in the right cerebellum, middle occipital and superior frontal lobe. No differences in rs-FC could be detected when using these brain structures as seed regions in rs-FC. In contrast, literature based rs-FC analysis revealed decreased rs-FC between the right orbital middle frontal cortex (mOFC) and the right gyrus rectus, as well as between left pallidum and right post/precentral gyrus in men with CSBD. In the left amygdala we observed increased rs-FC with precuneus in this group. In addition, most of these measures correlated with symptom severity. Conclusion: Structural findings may underscore the idea that the cerebellum plays an important role in sexual arousal and CSBD. Perhaps, a simultaneous activation of the left amygdala and the precuneus reflects a constant sexual occupation of men with CSBD. Furthermore, lower connectivity between mOFC and gyrus rectus in CSBD may support the assumption that sexual stimuli are evaluated more positively because inhibition is decreased