Effects of emotions on sexual behavior in men with and without hypersexuality: Findings lend support to conceptualizing HS behavior as a coping strategy for affective arousal

Effects of emotions on sexual behavior in men with and without hypersexuality. Michael H. Miner, Janna Dickenson & Eli Coleman. Sexual Addiction & Compulsivity, https://doi.org/10.1080/10720162.2018.1564408

Abstract: The association between positive and negative affect and sexual behavior in 39 MSM with and without hypersexuality (HS) was explored using ecological momentary assessment. Participants reported their current positive and negative affect three times per day and their sexual behavior each morning and evening. The relationship between affect and sexual behavior differed between men with or without HS. In those with HS, the timing of and interactions between experienced affect differentially predicted types of sexual behavior, indicating differing mechanisms driving partnered sexual behavior and masturbation. These findings lend support to conceptualizing HS behavior as a coping strategy for affective arousal.

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Hypersexual behavior is characterized by intense, distressing, and recurrentsexual urges and fantasies that significantly interfere with a person’s dailyfunctioning (e.g., with personal, interpersonal, and occupational responsi-bilities). Hypersexual behavior is widely disputed with regard to conceptualization, etiology, and nomenclature, and has been dubbed such terms as “sexual addiction” (Carnes, 1983),“compulsive sexual behavior” (Coleman, 1991), “paraphilia related disorder” (Kafka & Prentky, 1997),“hypersexual disorder” (Kafka, 2010), and “out of control sexual behavior” (Braun-Harvey & Vigorito, 2015). Despite such disagreement, one of the hallmarksof all conceptualizations of hypersexuality (Carnes,1983,1991; Coleman, 1991, 2003; Kafka, 1997, 2010) is distress resulting from obsessive, compulsive, impulsive, and/or out of control sexual behavior (Black, Kehrberg, Flumerfelt, & Schlosser, 1997; Coleman et al., 2010; Dickenson, Gleason, Coleman, & Miner, 2018). Moreover, several theoretical models of hyper-sexual behavior indicate that engaging in sexual behavior functions as astrategy to cope with, escape from, or avoid unwanted emotions (Kafka, 2010; Reid & Kafka, 2014). Yet, to date, our understanding of how day-to-day changes in negative and positive affect are related to day-to-day changes in sexual behavior among men who exhibit hypersexual behavior remains limited.

Negative affect (e.g., sadness, fear) and mood (e.g., depressed, anxious) typically impede sexual interest and arousal (Bancroft et al., 2003a, 2003b), although some men have shown increases in sexual interest and arousalafter experiencing negative affect. Moreover, the link between negativeaffect and sexual behavior appears to vary across individuals. For example, men who have sex with men (MSM) show increased sexual risk behavior following anxious affective states, but only if they have low trait anxiety (Mustanski, 2007). Thus, negative affect can either augment or impede sexual interest, arousal, and behavior depending on additional traits of the individual. Perhaps the degree to which negative affect motivates sexual behavior is also different for men who vary in their tendency to exhibit hypersexual behavior.

Research has consistently demonstrated that men with hypersexual behav-ior exhibit emotion regulation difficulties. Many men with hypersexualbehavior exhibit high negative emotionality (Miner et al.,2016); negative emotional states related to their sexual behavior, such as shame, guilt, and hostility toward themselves (Reid, 2010); are more vulnerable to general lifestressors (Laier & Brand,2017); and have greater deficits in their ability to regulate emotions (Leppink, Chamberlain, Redden, & Grant, 2016; Rizor, Callands, Desrosiers, & Kershaw, 2017). Various theoretical models indicatethat hypersexual behavior serves to reduce unwanted emotions (Bancroft & Vukadinovic, 2004; Coleman, 1991). Such behavior initially provides relief, but this relief is temporary and ultimately leads to guilt and shame about engaging in problematic sexual behavior, thus, reentering the cycle.

Yet, the notion that the cycle of hypersexual behavior begins with negative emotionality has proven inconsistent. On one hand, research examining reports of reasons for engaging in sexual behavior has corroborated thehypothesized link between negative emotionality and sexual behavior. Some research has indicated that sexual behavior may be related to difficulties with negative affect regulation among hypersexual men, and hypersexualmen self-report that negative affect motivates sexual behavior (Parsonset al., 2008). Individuals who compulsively view pornography exhibited higher general stress levels, reported viewing sexual imagery for the purposes of sensation seeking or emotional avoidance, and showed an increasein positive affect immediately after viewing sexual imagery (Laier & Brand, 2017). Moreover, hypersexual MSM have reported that they engage in sexual behavior to cope with negative affect and gain a sense of affirmation and validation that they could not obtain from non-sexual social relationships,  whereas  MSM  without  hypersexual  behavior  did  not  (Parsonset al., 2008)

Other research has not substantiated the link between negative affect andsexual activity. Grov, Golub, Mustanski, and Parsons (2010) found that among MSM, daily negative affect was associated with decreased likelihood of partnered sexual activity that same day. Contrary to expectations and the above mentioned studies, men with and without HS did not differ in thedegree to which negative affect was associated with partnered sexual activity. Such inconsistent findings indicate that the role of affective regulation in pre-dicting sexual behavior is not clear and may involve the interaction of positive and negative affective changes.

Such contradictory results may be explained by differences in method-ology. Studies varied in their assessment of state versus trait levels of affect,the valence of the affective state (positive versus negative), assessment oftemporal versus concurrent effects (i.e., does affect lead to sexual behavior?), and assessment of whether the relationship between affective states(or traits) and sexual behavior differ between men with and without HS.To date, no study has examined whether the ways in which negative orpositive affect leads to a greater or lower likelihood of engaging in sexualbehavior differs among men with and without HS.

The current study aims to address this gap by examining the day-to-dayrelation between positive and negative affect and various types of sexualbehavior (viewing sexual imagery, engaging in masturbation and engagingin partnered sexual activity) using a sample of MSM with and without hypersexuality. By using Ecological Momentary Assessment (EMA: Dunton,Liao, Intille, Spruijt-Metz, & Pentz,2011; Shiffman, Stone, & Hufford,2008), we examined  temporal ordering of affect and sexual behavior. Thisstudy extends existing research by focusing on positive affect, as well asnegative affect, and by assessing masturbation and partnered sexual activity. Given prior research and proposed theoretical conceptualizations thathypersexual behavior serves as a coping strategy, we expected that negativeaffect will be associated with greater likelihood of engaging in all threetypes of sexual behavior among hypersexual men. Further, we expected thatpositive affect, but not negative affect, will be associated with greater likeli-hood of engaging in all three types of sexual behavior among MSM without hypersexuality.