Seager M., Barry J.A. (2019) Cognitive Distortion in Thinking About Gender Issues: Gamma Bias and the Gender Distortion Matrix. In: Barry J., Kingerlee R., Seager M., Sullivan L. (eds) The Palgrave Handbook of Male Psychology and Mental Health. Palgrave Macmillan, Cham. Mar 2 2019. https://doi.org/10.1007/978-3-030-04384-1_5
Abstract: Psychology has identified many examples of cognitive biases and errors. In relation to gender, there are alpha bias (magnifying gender differences) and beta bias (minimising gender differences). In this chapter we identify another gender bias, gamma bias, which simultaneously magnifies and minimises gender differences. An example is domestic violence, where violence against men tends to be overlooked whereas violence against women is often highlighted. It is argued in this chapter that although we live in times where we now rightly talk a lot about conscious and unconscious bias against women, we are not yet conscious of our biases against men. The gender distortion matrix is proposed as a framework for identifying cognitive bias regarding men and boys.
Keywords: Gender Cognitive distortion Minimisation Maximisation Empathy gap
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Introduction
The seed that grew into my (JB) interest in Male Psychology was planted at a seminar on clinical psychology during my undergraduate degree at a respected English university in the mid-1990s. The group had spent a lot of time exploring possible theory-based reasons for female depression (e.g. the female gender role leading to learned helplessness), but then swiftly glossed over the subject of high male suicide rates with a “humorous” remark: “men construct more lethal methods because they are better at DIY”. This raised a few giggles at the sem-inar, and the group quickly moved on to the next topic. However it struck me as odd that my educators—and psychologists in general—appeared to have little serious curiosity about the causes of a fatal issue like suicide. I pre-sumed that this would change, but I heard the same DIY explanation in 2016 at a public talk on gender at LSE, also greeted with giggles from the audience. Clearly this phenomenon—a cognitive distortion involving the minimisation of the importance of male suicide to the point of near-invisibility—was diffi-cult for people to overcome.
Cognitive distortions can be defined as “the result of processing information in ways that predictably result in identifiable errors in thinking” (Yurica etal. 2005). Since the 1960s, a growing number of distortions have been identified. Aaron T. Beck (1967) originally identified cognitive distortions in his work with depressed patients. The six errors he identified were: arbitrary inference; selective abstraction; overgeneralization; magnification and min-imization; personalization; and absolutistic, dichotomous thinking. Since that time others have extended Beck’s list. In this chapter we are postulating a newly identified cognitive distortion, gamma bias.Gamma Bias andthe Gender Distortion MatrixA range of examples of gamma bias are described in the gender distortion matrix, and they fall primarily under two categories: magnification and min-imization. Magnification is defined as “the tendency to exaggerate or magnify either the positive or negative importance or consequence of some personal trait, event, or circumstance” (Yurica etal. 2005). Minimization is defined as “the process of minimizing or discounting the importance of some event, trait, or circumstance” (Yurica etal. 2005).Table 1 describes the gender distortion matrix. It is a 2 × 2 matrix, and in each of the four cells, the experiences, behaviours or characteristics of men and women are either magnified or minimised. The matrix describes how it can be good or harmful to do certain things or receive certain experiences. Unlike either alpha bias (magnification) or beta bias (minimisation), each cell demonstrates that certain gender issues are both magnified and mini-mised. Whether an aspect of the gender issue is magnified or minimised depends upon whether the issue is related to men or women.In this paper we argue that there is much evidence in everyday experience, and some in research, which supports the existence of gamma bias. Note that we do not suggest that gamma bias is eternal and unchangeable. To the degree that it is changeable, we suggest that it is very important that we Table1The gender distortion matrix, describing examples of gamma bias i.e. situ-ations in which aspects of our perceptions of men and women are magnified (upper case/italics) or minimised (lower case)GOODHARMDO (active mode)FEMALE male (celebration)MALE female (perpetration)RECEIVE (passive mode)MALE female (privilege)FEMALE male (victimhood)
Cognitive Distortion in Thinking About Gender Issues ... 89rectify, or at least recognise, these distortions. When discussions of gender are distorted, this misshapes the narrative and warps our public attitudes, policies and conversations about gender. For example, as a result of wide-spread gamma bias we tend to believe that:•men are more harmful than helpful•women are more helpful than harmful•men are more privileged than disadvantaged•women are more disadvantaged than privileged.Examples ofEach Type ofDistortionWe list below some preliminary examples of the very public ways that these distorted attitudes to gender are reinforced continually in the English-speaking or Western world. Examples will at this stage be brief and sche-matic, but hopefully sufficient to demonstrate the face validity of this new hypothesis, which will be subjected to rigorous empirical testing in research over the coming years.Doing Good (Active Mode) (Celebration/Appreciation)Female Magnification•We celebrate women publicly—for their gender alone—in the archetypal realms of beauty, fashion, sexuality and motherhood.•The UN has got four days dedicated to women: International Day of Women and Girls in Science, International Women’s Day, International Day of Rural Women and International Day for the Elimination of Violence against Women.•The Royal Society in the UK and other institutions worldwide have at various times held “Wikipedia Edit-A-Thon” days, when people are encouraged to add the names and achievements of women to Wikipedia, in order to make women in science more visible (Huffington Post 2012).•Suffragettes—female suffrage has been selectively celebrated in writings, films and the media as a gender issue, minimising the lack of suffrage for half of the male population in the same historical period.
90M. •The careers and achievements of women in science, politics, business and education are actively promoted and celebrated as a gender issue.•Women in the military and emergency services are celebrated for their gender and not just their actions.Male Minimisation•We do not celebrate men collectively for their gender alone, only the par-ticular achievements of individual men.•The UN has no special day to celebrate men. In many countries International Men’s Day has been celebrated on November 19th since around 2010, but this is not recognised by the UN.•The heroism within the military and the emergency services is often remarked upon in the news. However, the almost exclusively male gender of the heroes is not marked. In ceremonies to pay tribute to war heroes we acknowledge their brave deeds but not their masculine gender. We also include women when celebrating war sacrifice so that celebrations become gender-neutral rather than gender-specific. Recently, the rescue of a group of boys by male cave divers in Thailand was celebrated, but not marked as a gender issue or as an example of positive masculinity. In the Titanic disaster in 1912 most men were drowned (80%) but most women (75%) were saved. Men were clearly acting heroically to protect the women and children, but this, though a famous story, has not been celebrated as a story of positive masculinity.•Working class sacrifice—the complete physical infrastructure and security of the UK and other nations has been built and maintained almost exclu-sively by working class men. This is reflected in the fact that to this day in the UK men account for 96% of deaths at work. The same picture is found across the world. Clearly men continue to do the heavy, dirty and dangerous jobs in all societies. However, males who are builders, miners, firefighters, quarrymen, road workers, deep sea fishermen, scaffolders, steeplejacks, navvies and who occupy many other dangerous professions are not celebrated for their gender in a positive way. The image of male builders, for example, still tends to be more “wolf whistler” than “DIY SOS” hero.•Male suffrage—the vote for men has never been celebrated as a gender issue even though 44% men also only got the vote for the first time in 1918 and at a time when men had been sacrificed in large numbers in World War One for the protection of society.
Cognitive Distortion in Thinking About Gender Issues ... 91•We do not celebrate fatherhood or male childcare. Indeed in many ways public attitudes towards men as caregivers of children are negative, ambivalent and even suspicious, even amongst politicians (Dench 1996).•Male sexuality is typically viewed in public life and policy as a source of harm, threat, abuse and power. The joy and positivity of male sexuality is rarely celebrated today, except indirectly through the arts.Doing Harm (Active Mode) (Perpetration/Toxicity)Male Magnification•Negative attitudes towards masculinity have become widely accepted in mainstream public discourse in recent years. In contrast to the “women are wonderful” effect (Eagly etal. 1991), contemporary men are subject to a “men are toxic” effect. The notion of “toxic masculinity” has emerged and has even gained widespread credence despite the lack of any empirical testing (see chapter on masculinity by Seager and Barry). In general terms it appears as if attitudes to men have been based on generalisations made from the most damaged and extreme individual males. An example of this is the case from 2016, when a young woman called India Chipchase was raped and murdered. There were two men in her story: the rapist/mur-derer, and her grieving father who movingly stated “I will never get to walk my daughter down the aisle”. However, the media attention follow-ing this tragic event focussed almost exclusively on a sense of urgent need to teach boys and men in general to respect women. This suggests that in terms of public attitudes, the rapist/murderer was being viewed as more representative of masculinity than the victim’s father.•The concept of ‘rape culture’ has also developed and gained credibility, originating in the USA in the 1970s. However, in 2012 figures for the USA as a whole show that 0.6% of adult males had been registered for sexual offences (including rape), meaning that 99.4% were not. Even allowing for some inevitable under-representation, and whilst recognising that one rape is one too many, the evidence suggests that the vast major-ity of adult males are not sexually violent or dangerous. The public per-ception, however, is very different, especially in an age of “#MeToo” and “Enough is enough”.
92M. •In the UK and elsewhere the image of domestic violence and intimate partner violence (IPV) is almost exclusively one of male perpetrators and female victims. This is reflected in “treatment” approaches to IPV such as the “Duluth model” which is aimed exclusively at males (see chap-ter by Powney and Graham-Kevan). It is also reflected in the provision of places in refuges for victims of IPV. In 2010 in the UK, for example, whilst male victims accounted for at least 33% of IPV victims, less than 1% of a total of 7650 refuge places were available for men. Research evidence of equal levels of IPV by females (e.g. Archer 2000) is still not being reflected in public attitudes in this area (Seager 2019, in this vol-ume Chapter 12).Female Minimisation•We have already seen (above) that evidence of equivalent levels of domes-tic and IPV by females (e.g. Archer 2000) is not reflected in public atti-tudes or policies.•There is evidence that women receive less severe sentences for the same crimes (e.g. Starr 2012; Mustard 2001).•The high level of online emotional abuse by women (cyber-bullying) (e.g. Marcum etal. 2012) is not reflected in public attitudes or policies.•52% of men in a sample of high-security prisoners who had committed serious offences against women and had been sexually abused in child-hood were found to have been abused by female abusers acting inde-pendently ofmen (Murphy 2018). However, the picture of sexual abuse portrayed in the media does not reflect this complex gender picture of sexual abuse. Those who propose a social transmission theory of “toxic masculinity” would have to take account of the fact that male children spend significantly more of the developing years in the company of adult females than adult males.•Parental alienation, a diagnosis newly added to the ICD-11, is a form of child abuse involving one parent alienating their child from the other. Evidence has long shown that the father is more often the victim and the mother the perpetrator (e.g. Bala etal. 2010). Briggs, in another chap-ter in this volume, also shows examples of clinical cases in which moth-ers have alienated children from fathers prior to psychotherapeutic intervention.
Cognitive Distortion in Thinking About Gender Issues ... 93Receive Good (Passive Mode) (or Privilege)Male Magnification•The whole sociological concept of “patriarchy” (see also chapter on mas-culinity by Barry and Seager) is predicated on the idea that it is a “man’s world”. Specifically, society is viewed as inherently privileging and advan-tageous for men and organised in ways that empower men and disem-power and exclude women. This bold and sweeping hypothesis has received widespread acceptance despite being subject to relatively lit-tle academic evaluation, let alone being subject to empirical testing as a scientific hypothesis. This uncritical acceptance of a radical theory by mainstream society in itself indicates that gender distortions may be in operation on a large scale. The concept of patriarchy focuses on an elite group of more powerful and wealthy males, whilst minimising the vast majority of men who are working class men, homeless men, parentally alienated men, suicidal men and other relatively disadvantaged male groups. It also minimises the benefits and protections involved in moth-erhood, family and domestic life for many women including the poten-tial joys and rewards of raising children. Also the concept of patriarchy minimises the hardships of the traditional male role, such as fighting in wars, lower life expectancy, higher risk-taking and working in dangerous occupations.•Young women in the UK are now in fact earning more on average than their male counterparts (see below), yet the gender pay gap is misun-derstood and presented as an example of women’s oppression, primarily because of dubious and selective methods of measuring and comparing pay. Even when men are earning more, there are other “trade-offs” and risks that men choose to take on that confer counterbalancing disadvan-tages (Farrell 2005). However, the public perception and emotional out-rage on gender pay are out of proportion to the actual differences that emerge if the matter is analysed more scientifically.Female Minimisation•As we saw above, there is evidence that women receive less severe sen-tences for the same crimes (e.g. Starr 2012; Mustard 2001). Women also enjoy better health and living conditions than men (Carcedo etal. 2008).
94M. Mothers who are prisoners also enjoy better access to their children than fathers who are prisoners (Collins etal. 2011). And yet in terms of public perception there is an image of women being “oppressed in a male-centric prison system” (e.g. Baroness Corston in The Guardian2018).•In OECD countries at the present time significantly more young women than young men graduate from school and college. According to fig-ures supplied by the Guardian newspaper (2017), for every 13 girls who entered university, only 10 boys did so. The education gap has seen boys fall behind girls in the UK since the 1980s, and 30 years later it has become usual for women in their 20s to be earning more than their male peers, and has been for some years (Guardian 2015). There are still more male senior academics and professors than female in academia, but apart from this 0.3% of jobs at the top of the educational hierarchy, the rest of the hierarchy—from primary school onwards—favours females (Brown 2016).•Parental privilege—it is a widespread practice in many countries that in legal cases of parental dispute over child custody, sole custody is awarded to mothers rather than fathers almost by default.•Maternity privilege—when children are born, antenatal, perinatal and postnatal services are highly female-centric and the role of the father is generally not thought about or included. The assumption is that fathers are not as important to children as mothers.•Protection—we have seen (above) that both in times of war and peace women enjoy the protection of men at times of great threat.•Elsewhere in this volume (Chapter 10) Belinda Brown presents evidence indicating that females enjoy power and privileges within the domestic and household domain.Receive Bad (Passive Mode) (or Victimhood)Male Minimisation•Men across the globe have a significantly lower average life expectancy than women. As we have also seen (above) men account for almost all deaths at work both in the UK and other nations. However, in terms of public attitudes and beliefs, these facts are relatively invisible. Certainly, no concept of a “gender death gap” has been proposed.
Cognitive Distortion in Thinking About Gender Issues ... 95•Although there are signs of this changing, for years there has been less investment in prostate cancer than breast cancer, even though the rates of death caused by each are similar (around 10,000 per year for each in the UK).•The vast majority of rough sleepers (85% in the UK) are male but there are no gender policies to address this.•Boys have been falling behind girls in education since the 1980s. Boys are now in the UK around a third less likely to attend university than girls. This however has met with no political action and has never been referred to as the “gender education gap”.•In almost every country across the world men kill themselves at a higher rate than women do. This is now starting to be recognised, but research into suicide and services for those at risk have remained relatively “gender-blind” (Seager, in this volume Chapter 12).•When in distress, women tend to want to talk about their feel-ings whereas men tend to want to fix whatever is causing the distress (Holloway etal. 2018). However our mental health services are delivered in a “gender blind” way, so that treatment options that might suit men better are rarely considered (Liddon etal. 2017).•Issues that impact males more than females such as colour blindness (in 8% of boys and 0.5% girls), tend to be overlooked, despite the signifi-cant impact on QoL (Barry etal. 2017). For example, although coloured graphs are difficult for colour blind students to read, a large educational board in the UK recently declined to make graphs in exam papers more colour blind friendly. •Bedi etal. (2016) found that there are significantly more psychology papers dedicated to women and women’s issues compared to men and men’s issues.•Field experiments of domestic violence show that bystanders intervene if the victim is a woman, but keep walking—or even laugh—when the vic-tim is male and the perpetrator female (e.g. ABC News 2010).•In Nigeria in 2014, 300 female students were kidnapped by the terror group Boko Haram, prompting an international outcry. At the same time, however, and in the same country, as many as 10,000 boys were abducted and many even murdered. However, this even greater outrage went almost completely unnoticed in the media.•Whilst female genital mutilation (FGM) has rightly received widespread condemnation, male genital mutilation (MGM) has been relatively ignored, despite evidence of harm caused to those who are circumcised.
Female Magnification•We have already seen (above) that in the field of domestic violence and IPV, the emphasis is largely on female victims and treatments for male perpetrators, when the reality is that both genders are equally capable of such abuses (Archer 2000; Fiebert 2010).•We have also seen (above) that the concept of “rape culture” exaggerates the perception of men as potential rapists and creates a climate of fear for women. Campaigns such as “#MeToo” can also play into a sense of fear that is based on distorted generalisations from small samples of damaged men to the whole male population.•The Boko Haram example (above) provides strong evidence that there are much greater empathy levels for females than for males. Correspondingly, our sense of female victimhood is magnified and our sense of outrage is increased by virtue of the gender of the victim rather than the crime.Why Do These Gender Distortions Exist?It is challenging to think about the possible adaptive function of biases and errors, but an adaptive value helps us to understand their existence, as well as absolving people of blame for holding them. Haselton etal. (2015) high-light some of the adaptive functions of cognitive biases, and suggest that our evolved adaptive responses can sometimes act against our self-interest when faced with novel modern rules.Why We Favour WomenThe “women are wonderful” effect (Eagly etal. 1991) predicts a type of “halo effect” for women. This effect means that we magnify women in the Do/Good cell. This might involve a certain amount of what Beck (1979) call emotional reasoning, where one’s emotional state guides conclusions about self and others. Such views would be expected if the effect is the result of positive views about women being created from positive early experiences with mothers and other female caregivers.It also makes sense that women are more valuable than men, because of their importance in reproduction. A very basic way of understanding this is to think about the question of which hypothetical village would have the better chance of survival: the one with 100 women and one man or the
Cognitive Distortion in Thinking About Gender Issues ... 97village with 100 men and one woman? The answer to the question demon-strates the unquestionable value of women to human survival.Why We Disfavour MenOn an evolutionary level, males can be seen as the providers of protec-tion, not the recipients of protection (Seager etal. 2016). It makes sense that someone should have the role of protecting offspring, and also pro-tect those who give birth to and nurture the offspring. Thus social attitudes would have been calibrated accordingly over many thousands of years to associate femininity with nurturing and vulnerability and masculinity with protection and strength. Because of this, it would be more difficult—both unconsciously and consciously—to feel the same level of emotional sympa-thy for a male than a female. For the man, it might also therefore be diffi-cult to deviate from the script of the protector and seek help. By the same token, it might also be difficult for society to see men as victims rather than protectors.Another explanation, which is probably an extension to the previ-ous rather than an alternative explanation, is derived from research in social psychology. The phenomenon of ingroup favouritism and outgroup bias is a cornerstone of social psychology. The strength of such biases vary by group e.g. it is well-established that higher-status groups invoke more ingroup bias (e.g. Nosek etal. 2002). Men in general (historically and cross- culturally) have had higher status than women in the public realm (politics, finance etc.), so one might expect that male identity invokes a high level of ingroup bias. However research shows that—uniquely in social identity theory—male identity, unlike female identity, invokes no significant ingroup bias (e.g. Richeson and Ambady 2001).Men support each other effectively when the identity is based on some-thing other than being male (e.g. football teams), but how do we explain the incohesive effect of male identity? There are several possibilities. For exam-ple, it could be that because infant attachment mostly happens with moth-ers, this programmes for greater bias towards women in later life (Rudman 2004). Similarly, it could be that men are stereotypically more associated with violence and aggression and thus invoke less sympathy even from each other (Rudman and Goodwin 2004).It is likely that seeing men as protectors rather than receivers of protection leads to a lack of sympathetic bias in their favour, and leads to male gender blindness (Seager etal. 2014), the phenomenon where men’s problems go
98M. Seager and J. A. Barryrelatively unseen. This in turn facilitates the gender empathy gap, the phe-nomenon where males receive less empathy than females, even when in a similar predicament (Barry 2016).Intersectionality asMale Gender BlindnessAccording to a much-cited paper by Professor of Psychology and Women’s Studies, Stephanie Shields, “Intersectionality, the mutually constitutive rela-tions amongst social identities, is a central tenet of feminist thinking and has transformed how gender is conceptualised in research” (Shields 2008, p. 301). According to this view, men are historically privileged and therefore don’t generally deserve help or attention unless they are also members of another historically oppressed, disempowered and marginalised group (e.g. gay, BAME or disabled men). Intersectionality is therefore sometimes used as a way of criticising or devaluing efforts to understand issues facing men in gen-eral by deflecting attention exclusively onto specific marginalised sub-groups of men, and so minimising the importance of universal issues facing men.On one level, the idea of intersectionality has merit in the same way that interactions in ANOVA help identify interesting differences between sub-groups of the main variable. But there is one major flaw with the intersec-tional level of analysis when it comes to understanding male psychology: there is a main effect of being male that runs through all levels of the varia-ble. For example, when it comes to suicide, not only do men in general kill themselves more frequently than women, but BAME men kill themselves more frequently than BAME women (Oquendo etal. 2001), and gay men attempt to kill themselves more frequently than gay women (Bagley and Tremblay 2000). Similarly, the academic underperformance of boys cuts across all social strata and geographies (Curnock-Cook 2016). We should note that firm statistics are not always available related to demographic groups, but what evidence there is tends to support the idea that men in general, not just specific demographics of men, need our help. “Drilling down” into data can be enlightening, but focusing on a single tree might not tell us much about the forest. Focusing on specific issues facing subgroups is of value to the individuals in these groups, but should not be used to distract attention when we are trying to understand wider issues in male psychology.There are various ways in which male gender blindness is both a cause and effect of the ways we study gender. For example, it can be argued that the concept of “masculinities” is largely based on subjective judgements by
Cognitive Distortion in Thinking About Gender Issues ... 99theorists trying to make the case for alternatives ‘hegemonic’ masculinity. Interestingly, at the same time as magnifying different varieties of masculin-ity, these theorists tend to minimize difference between men and women, an approach which is a type of gamma bias (see chapter on gamma bias by Seager and Barry). Moreover, in attempting to identify multiple versions of masculinity, theorists run the risk of obscuring masculinity as a unitary phe-nomenon. This means that focusing only on a plurality of “masculinities” doesn’t help us address more general issues related to masculinity and may even distract us from doing so.By looking at men only in terms of the other sub-groups that their gen-der intersects with, there is in truth the great danger that we will miss the wider gender issues altogether. By defining men only in terms of their sub-group identities (e.g. by race or sexuality) without honouring their collective group identity as a gender, the needs of men of all kinds are likely to be overlooked. If men across various demographic groups, for example, appear to respond in a similar way to therapy (as suggested by Groth in his chapter on existential therapy), then it is likely that the concept of intersectionality is of much less practical or clinical value than the underlying concept of gen-der itself.Like the blind man who touches the elephant’s tail and then thinks an elephant is like a snake, those who dismiss the idea that men in general need help are committing the cognitive bias of selective abstraction: instead of appreciating the whole picture, they focus on just one part of it. If science is to understand the problems facing men, scientific investigation needs to examine how some discussions about gender tend to distort the issues, mak-ing some parts of the picture invisible and magnifying others as if they were the whole picture.Unconscious Bias RevisitedSome or all of the phenomena described in the cells of the matrix can be considered types of unconscious bias. Distorted narratives that put men perpetually in the role of toxic abuser, risk alienating men from themselves and others, leading to what might be called a state of gender alienation. As pointed out by Damien Ridge in his chapter in this book: “the disconnec-tion between theoretical discussions and the daily reality of men promotes a poverty of understanding of male subjectivity... Masculinity has essentially become what different theorists and their followers say it is”, and something that probably means little to the average man.
100M. Seager and J. A. BarryThe Patriarchy RevisitedEssentially, patriarchy theory (Walby 1990) is a distorted and untested way of explaining the differences we observe in the reproduction-based division of labour. For example, women are seen as oppressed by the role of “housewife”, and men are seen as liberated in the role of “breadwinner”. However this is not the only way of viewing traditional gender roles. For example, Dench (1996) suggests that women can have a much more rewarding role in the private realm, and men can have a much harder time in the dangerous, dirty and soulless world of the workplace. Dench also suggests that the idea of the traditional male role as desirable rather than a burden was a way to encourage men to accept a supporting role in society, one that is ultimately of lesser value. Similarly, Van Creveld in his book The Privileged Sex (van Creveld 2013) hypothesises that women have always had privileges (e.g. ‘women and children first’, less dangerous jobs) and that this is something that most people unquestioningly accept as a good thing.Nobody’s life is without suffering, but the suggestion that women have been oppressed by the patriarchy is at best an untested theory and at worst a damaging distortion. At best, it is like looking at the famous rabbit/duck illusion and claiming that there is only a rabbit and no duck, or that the rab-bit is being oppressed by the duck. Once evolutionary biology is honoured rather than dismissed, it can be seen that the traditional family structure is based primarily on reciprocal and evolved reproductive roles. Thus the great-est influence on the balance of gender relations, is perhaps none other than the great matriarch herself, “mother nature”.Criticism ofthe Preliminary Evidence ofGamma BiasThe evidence that we have presented above might be criticised on the grounds of confirmatory bias i.e. the tendency to select only infor-mation that supports your view. At the time of writing (August 2018), gamma bias is being presented as a hypothesis that promises to explain broad patterns of data in relation to how issues of gender are perceived, expressed and responded to both in academia and elsewhere in life. The examples we have provided are incomplete and inevitably selective, but we are confident that they offer preliminary support for the existence of gamma bias.
Cognitive Distortion in Thinking About Gender Issues ... 101Future ResearchThe gender distortion matrix offers many examples of how the gamma bias hypothesis can be tested. As we write, a new research programme is being organised by the Male Psychology Network, and no doubt our hypothesis will be modified in light of the findings. To enhance ecological validity, real-world examples might be found in newspapers (e.g. the Boka Haram com-parison) or the cinema, and assessed. The same principle might be expanded to academic writing and work. It might even be possible to quantify the degree of distortion within a given news article or academic paper. These are just some very basic ideas which we are happy to see others elaborate upon.ConclusionsIn academia, beta-bias and the gender similarities hypothesis are encouraged to such a degree that the term “sex differences” now has an air of contro-versy, and to point out differences between men and women is considered somewhat distasteful. Perhaps a more acceptable term than “sex differences” is “gender distinctions” (Lemkey etal. 2016) with its connotations that both genders have attributes that are unique and positive.There is a serious risk arising from using terms such as “toxic masculin-ity”. Unlike “male depression”, which helps identify a set of symptoms that can be alleviated with therapy, the term “toxic masculinity” has no clinical value. In fact it is an example of another cognitive distortion called labelling(Yurica etal. 2005). Negative labelling and terminology usually have a nega-tive impact, including self-fulfilling prophecies and alienation of the groups who are being labelled. We wouldn’t use the term “toxic” to describe any other human demographic. Such a term would be unthinkable with refer-ence to age, disability, ethnicity or religion. The same principle of respect must surely apply to the male gender. It is likely therefore that developing a more realistic and positive narrative about masculinity in our culture will be a good thing for everyone.
Tuesday, March 19, 2019
Self‐Focus After Interpersonal and Intergroup Transgressions: Victims show a stronger self‐focus than perpetrators & the higher self‐focus is a predictor of willingness to reconcile
(Not) Thinking About You ‐ Differences in Victims’ and Perpetrators’ Self‐Focus After Interpersonal and Intergroup Transgressions. Birte Siem, Markus Barth. European Journal of Social Psychology, March 18 2019. https://doi.org/10.1002/ejsp.2584
Abstract: We tested the hypothesis that, following a transgression, victims and perpetrators differ in their focus of attention. In three studies (total N = 740), we manipulated participants’ social role (victim vs. perpetrator) in a hypothetical scenario (Studies 1 and 2) and in a perceived real conflict (Study 3) in an interpersonal (Studies 1 and 2) and an intergroup (Study 3) context. Results from all studies confirmed that victims show a stronger self‐focus than perpetrators. Moreover, results suggest victims’ higher self‐focus as a predictor of willingness to reconcile. Participants’ self‐focus mediated the effect of social role on reconciliation intentions as a single mediator (Study 2), or in sequence with their motivation to consider the other party's needs (Study 3). Overall, the present research suggests that victims and perpetrators differ in their focus of attention, and that this difference has important theoretical and practical implications for reconciliation between individuals and between groups.
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Although it is sometimes easier to think of perpetrators as “winners”and victims as “losers”, social psychological research has shown that a conflict is threatening and aversive to both sides(e.g.,Shnabel & Nadler, 2008). Consequently, all involved parties will be motivated to cope with the threat and to protect themselves from the negative consequences of the conflict for their self-esteem. One potent way to do socould be to reconcile with the former adversary. Still, the road to reconciliation often is a rocky one. For instance, only one side might be willing to reconcile and reassume a positive and harmonious relationshipwhile the other side might not be as ready as it is hindered from going forward by lingering threats and unresolvedissues. In this article, we will turn to one such psychological obstacle on the road to reconciliation thathas notreceivedmuchattention in work onconflict and reconciliationso far(for an exception, seeMazziotta, Feuchte, Gausel, & Nadler, 2014): self-focus. Defined as a situationally salient strong attention to self-targeted cognitions and internal feelings(e.g., Hess & Pickett, 2010), self-focus is potentially decreasing willingness to reconcile. This paper aims at investigating this possibility, as we will show that perpetrators and victimsof interpersonal and intergroup transgressionsdiffer in self-focus and this,in turn,affects their willingness to reconcile.Theoretical Framework –The Needs-Based Model of ReconciliationThe theoretical framework of the present research is mainly builton the Needs-Based Model of Reconciliation (NBMR, Shnabel & Nadler, 2008)which sees reconciliation as a process to overcome specific socio-emotional barriers resulting fromconflict. These barriers are related to specific aspects of victims’ and perpetrators’ social identitiesand they are linked to specificsocio-emotionalneeds that must be satisfiedfor reconciliation to occur. Specifically, victims have been violated in their social identity as powerful agents who are in full control of their environment, which leaves them with a need for empowerment, forreclaimingcontrol. On the other hand, perpetrators suffer a threat to their identity as moral actors, as members of a global moral community, and should consequently develop a need for
acceptanceandreassurance that they are still “good”. The NBMRclaims that both parties’ need satisfactionis possible by engaging in a bilateral strategy in which perpetrators empower victims by apologizing and asking for their forgiveness while victims try to empathizeand accept the perpetrators as fellow human beings. The models’ basic tenets have been supported in a number of empirical studiesin the context ofinterpersonaltransgressions (e.g., Shnabel & Nadler, 2008) and ofintergrouptransgressions (e.g., Aydin, Ullrich, Siem, Locke, & Shnabel, 2019; Shnabel, Nadler, Ullrich, Dovidio, & Carmi, 2009; see also Siem, von Oettingen, Mummendey, & Nadler, 2013). Results from these studies converginglyconfirmed the differing needs structure in victims(or members of victimized groups)and perpetrators(or members of perpetrating groups)and how messages of acceptance and empowerment are facilitating reconciliation if they fit the needs of the recipient(group)(for an overview, see Shnabel & Nadler, 2015).Mazziotta et al. (2014) have linked the different socio-emotional needs to potential differences in focus between perpetrators and victims. Theyproposedthat victims’ need for empowerment might direct their focus of attention toward thesuffering of theingroupand its primary goals. Consequently, victimsmight be less willing to approach the former adversaryoutgroup. Perpetrators’ need for acceptance should increase their awareness of others and their motivation to affiliate with them. In other words, their attention shiftstowards those outgroups who can give perpetrators what they need: acceptance. Although they only offered indirect empirical evidence for their claim and did not measure focus in their studies, we agree withMazziotta et al.’s basic idea thatperpetrators and victims differ in their self-focus, with victims focusing moreon the self and perpetrators showing a stronger other-focus.1
Empirical Evidence for aWeakerSelf-Focus of PerpetratorsSome preliminary evidence on perpetrators’ focus comesfrom research on social rejectionand exclusion. Even thoughperpetrators donot necessarily suffer a rejection in the conflict itself, they often fear rejection or exclusion from the moral community as a consequence of their actions (Shnabel & Nadler, 2008), so that their reactions mightbe comparable to those of targetsof true rejection.Social exclusion can be understood as a signal that something is wrong with the self, e.g., that one has undesirable traits. Such a realization is aversive and potentially harmful which explains why an excluded individual is less likely to focus strongly on the self. In line with this reasoning, research has shown that social rejection in fact leadsto a stronger desire to avoid self-awareness or self-focus (for instance, by facing away from a mirror, Twenge, Catanese, & Baumeister, 2003). Research on interoceptive accuracy (i.e. the ability to accurately detect and interpret signalsof one’s own body)–a concept that has been linked to self-focus (Ainley, Tajadura-Jiménez, Fotopoulou, & Tsakiris, 2012)–further supports this perspective by showingthat individuals who experienced social exclusion were less accurate than participants who were socially included (Durlik & Tsakiris, 2015). Similar processesmight lead perpetrators to turn their attention away from the self, as the confrontation with their transgressions represents a strong threat to their social identity as moral actors. A stronger other-focus(and thus a weaker self-focus)can also be understood as part of a strategy to regain social relationships(Hess & Pickett, 2010). Closely observing others’ behaviour and mood can help to adapt more successfully,which will, in turn, lead to more approval by others. Supporting this view, compared to not-rejected individuals,rejected individuals seem to show a better memory for information related to others than to the self (Hess & Pickett, 2010), and a stronger tendency to mimicry others (Lakin, Chartrand, & Arkin, 2008). With regard to the context of interpersonal and intergroup transgressions, these
lines ofresearch suggest thatperpetrators shouldbe motivated to protect their (collective) self from self-threatening information, and should be oriented towards others in order to increase their chance of approval. In the present research, we argue that a strongerother-focus should help to satisfy these motives. Empirical Evidence for aStronger Self-Focus of VictimsThe idea thatvictims should be more concerned with the selfin order to re-establish a sense of personal control (see also Mazziotta et al., 2014; Shnabel & Nadler, 2008)can be linked to research on victims’ feelings of entitlement. Afterexperiencing physical pain (aform ofvictimization), participants were more likely to indulge in guilty pleasures and self-reward, as they felt entitled to this treat after their suffering (Bastian, Jetten, & Stewart, 2013). In fact, some researchers see entitlement as a specific form of self-focus (e.g., O’Brien, Anastasio, & Bushman, 2011). Furtherevidence showsthat victims tend to be less prosocial. Theywere less likely to help another person, demanded more resources for themselves than participants who were not reminded of some past unfair treatment(e.g., Fetchenhauer & Huang, 2004; Zitek, Jordan, Monin, &Leach, 2010), or experienced less empathy (Chaitin & Steinberg, 2008), an emotional response that has been strongly linked to prosocial behaviour (Batson, Chang, Orr,& Rowland, 2002;).In another study, victims of sexual abuse were less likely to think of others than were non-victims(McMullin, Wirth, & White, 2007), and became even more self-focused over time. With their attention focused on themselves, victims might have less resources to spare to consider the well-being of others or basic social rules that are meant to facilitate social relationships(see also Chaitin &Steinberg, 2008).
Self-Focus Decreases Willingness to ReconcileIn the present research, we argue that a stronger self-focus should be related to less willingness to reconcile. Initial evidence supporting this reasoning comes froma study showingthat in the aftermath of a transgression, self-focus was related to avoidance, and a less forgiving stance towards the previous adversary(Strelan, McKee, Calic, Cook, & Shaw, 2013).As we have pointed out above, self-focus diminishes feelings of empathy(Chaitin &Steinberg, 2008). Empathy, in turn, is an important predictor not only of prosocial behaviour but also of forgiveness (McCullough et al., 1998). A related construct, the ability to take the perspective of another person, has also been shown to be related to reconciliation (e.g.,Exline, Baumeister, Zell, Kraft, & Witvliet, 2008; Zebel, Doosje, & Spears, 2009). Ifself-focus decreases empathic reaction and perspective taking, then willingness to reconcile should be reduced, too.In another line of research, McCullough, Bono, and Root(2007)investigated the effects of rumination on forgiveness. Rumination, a passive, repetitive focus on personal suffering andthe negative consequences of a conflict episode, reduced forgiveness and increased anger at the offender. As we have outlined above, victims are very much focusing on their suffering.This strong attention to the events of the conflict and its negative consequences for the self might be similar to a form of rumination. To summarize, we assume that perpetrators and victims in interpersonaland intergroupconflictsdiffer in their focus of attention. Victims should be more focused on the self as they are trying to cope with the painful events. Perpetrators should be more other-focused in order to satisfy their need for acceptance and as a strategy to distance themselves from confronting their personal(or their ingroup’s)violation of moral norms. We further
argue that self-focus should be related to less willingness to reconcile, as it decreases the capability to acknowledge the needs of others and increases avoidance and vengeful thoughts.Study 1The main aim of Study 1 was to test the influence of social role (perpetrator versus victim) on focus of attentionin an interpersonal transgression situation. We expected participants who adopt a victim role to be more self-focused than participants who adopt a perpetrator role. In addition, we aimed at investigating the effect of social role on participants’ sensitivity towards the adversary’s socio-emotional needs. Specifically, we hypothesized that victims, due to their strongerself-focus, would be lesssensitive to the actual socio-emotional needs of the other partythan perpetrators. When given a choicebetween different messages that could be communicated to the other party, they should thus be less likely to selectthemessage that is best suited to satisfy the other party’s need than perpetrators.
General Discussion
Based on the NBMR(Shnabel &Nadler, 2008) the present research tested the hypothesis that, following a transgression, victims and perpetrators differ in their focus of attention such that victims show a strongerself-focus than perpetrators (see also Mazziotta et al., 2014). To our knowledge, this assumption has received only indirect empirical supportin previous research(e.g., in research on social rejection, e.g.,Twenge et al., 2003; or entitlement, e.g., Chaitin & Steinberg, 2008). In three studies, we systematically tested this assumption by manipulating social role (victim vs. perpetrator) in a hypothetical transgression scenario(Studies 1 and 2) and in a perceived real conflict(Study 3),as well as in an interpersonal (Studies 1 and 2) and an intergroup (Study 3) context. Results from all three studies clearly confirmed our hypothesis that victims show a strongerself-focus than perpetrators.This effectheld up when we controlledfor dispositional empathy and perspective taking (Study 1 and 2). The fact that we were able toreplicate this effect in an intergroup context in Study 3further underlines its robustness. First, the effect occurred even though participants in the perpetrator conditionwere not personally responsible for the harm
done to the outgroup. Second, and related, more than in interpersonal contexts, perpetrators in intergroup contexts have several options to distance themselves from the perpetrating members of their ingroup, for instance by disidentifying from the ingroup (Becker & Tausch, 2014), or by treating the perpetratingingroup members as “black sheep” (Marques, Yzerbyt, & Leyens, 1988). Such processes should weaken the effects of social role in the present intergroup context. Still, the observed effect can be classified as strong.Another central aimof the present research was to link people’s social role to their willingness to reconcile with the adversary. Building on the NBMR(Shnabel & Nadler, 2008) and other work on the determinants of reconciliation (e.g., Exline et al., 2008) we assume that, due to their increased self-focus, victims should be less willing to reconcile than perpetrators. Findings from Studies2and 3provided converging support for this assumption suggesting that the effect of participants’(ingroup’s) role on their willingnessto reconcile was mediated by their focus of attention(Study 2),or sequentially mediated bytheirfocus of attention and their motivation to consider the other party’s feelings and needs (Study 3).The present resultshave important theoretical andpractical implications. From a theoretical perspective, our findings help to understand why victims’ capacity for feeling empathy for a perpetrator or, more generally, for others,has been shown to be reduced (e.g., Chaitin & Steinberg, 2008). Specifically, empathy is an other-orientedemotional reaction (e.g., Batson, 2011)and the increased self-focus that has been observed in the present research as a consequence ofvictimhoodmost likely inhibits the development of this emotion. Closely related, our Study 3 data showed that strong-self focus decreased the motivation to actually considerthe other party’s needs and well-being (Study 3). From a practical perspective, it is important to know that victims and perpetratorsdiffer in their focus of attention and that this affects their reconciliation willingness. Specifically, while interventions designed to promote people’s focus on the respective other party (e.g.,
perspective taking interventions, e.g.,Barth & Stürmer, 2016) might effectively increase willingness to reconcile among victims(for evidence, see McCullough, Worthington,& Rachal, 1997), perpetrators’ willingness to reconcile might profit more strongly from other forms of interventions (e.g., interventions focussing on dealing with own feelings of guilt and shame; for related evidence, see Woodyatt & Wenzel, 2014). Designing and evaluatingvictim-and perpetrator-specific interventions that take differences infocusof attention into account is an important field for future research on reconciliation. While we received converging support for our predictions regarding the effects of social role on focus of attention and on reconciliation willingness, results regarding participants’ preferred messages (to be sent to the other party, to be received from the other party)were less consistent. First, we assumed that, due to their strongerself-focus, victimsshould be lesssensitive to the actual socio-emotional needs of the other party. Only one out of six analyses yielded a result in the predicted direction, while the remaining five analyses produced inconsistent results. At this point, we can only speculate about potential reasons for thesemixed findings. For instance, factors other than participants’ social role (e.g., dispositionally pursued communal vs. agentic interaction goals, Locke, 2010) might have had a stronger influence on the messagesparticipants preferred to send than the experimental manipulation, thusleading to an overall unsystematicresult pattern. Future research is needed, consideringtheoretically plausible alternative predictors as well as alternative operationalisations of need sensitivity (e.g., via an open answerformat). Another inconsistency concerns the mediating role of participants’ own socio-emotional needs operationalized via the kind of message they themselves would like to receive from the other party (measured in Studies 1 and 3). Specifically, although in both studies victims showed a (at least marginally significant) strongerdominance ofthe empowerment over the social acceptance need than perpetrators, participants’ own socio-
emotional needs were significantly related to their focus of attention only in Study 1. We assume that additional sources of focus that are specific to group contexts might be anexplanation for why we were not able to replicate thisStudy 1 finding in Study 3. Beyond socio-emotional needs, participants might be motivated to protect their group from threats to its positive image or to cope with potential negative emotions because of one’s membership in a deviant group. Consequently, participants might have turned their attention to the out-group, not because they wish for their acceptance but because this helps them to distance themselves from aversive thoughts and feelings.Similarly, they might have coped with the aversive situation by distancing from the group itself and recategorizing as a simple observer unrelated to the misbehaviour of the ingroup. As we have shown, observers with no relation to the conflict werestrongly other-focused but their motivation probably did not include the needs we investigated in the present work.These alternative factors might explain more variance of focus than the needs we investigated in the present work. Future research will need to consider such group-level specific processes.As a final remark, we have concentrated on focus of attention as one possible explanation for the differences in reconciliation between victims and perpetrator. However, this is not to say that there are no relevant other mediating processes(as indicated by the partial mediations reported inStudies 2 and 3). One such processdiscussed in the literature is perceived severity of the transgression,with victims tending to perceive the very same transgression as more severe than perpetrators (“the magnitude gap”; Baumeister, 1997). Additional analyses witha single-item measureof perceived severity included for exploratory reasons in Study 3 (see supplemental materials)did not yield significant effects. Still,to gain a more comprehensive understanding of the processes underlying the effect of social role on reconciliation, severityand other potential explanations(e.g., victims’ fear of repeated poor treatmentby the perpetrator) need to be more systematically tested in future research.
The present research contributes to a mounting body of work addressing how victims and perpetrators differ in their perceptions of and reactions to a transgression (e.g., Baumeister, 1997; Mazziotta et al., 2014). Using interpersonal and intergroup conflict settings, we found consistent support for our assumption that victims showed a stronger self-focus than perpetrators, and could demonstrate that this stronger self-focus reduced victims’willingness to reconcile with the perpetrator. The present research might thus be another paving stone in the long and winding road to reconciliation.
Abstract: We tested the hypothesis that, following a transgression, victims and perpetrators differ in their focus of attention. In three studies (total N = 740), we manipulated participants’ social role (victim vs. perpetrator) in a hypothetical scenario (Studies 1 and 2) and in a perceived real conflict (Study 3) in an interpersonal (Studies 1 and 2) and an intergroup (Study 3) context. Results from all studies confirmed that victims show a stronger self‐focus than perpetrators. Moreover, results suggest victims’ higher self‐focus as a predictor of willingness to reconcile. Participants’ self‐focus mediated the effect of social role on reconciliation intentions as a single mediator (Study 2), or in sequence with their motivation to consider the other party's needs (Study 3). Overall, the present research suggests that victims and perpetrators differ in their focus of attention, and that this difference has important theoretical and practical implications for reconciliation between individuals and between groups.
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Although it is sometimes easier to think of perpetrators as “winners”and victims as “losers”, social psychological research has shown that a conflict is threatening and aversive to both sides(e.g.,Shnabel & Nadler, 2008). Consequently, all involved parties will be motivated to cope with the threat and to protect themselves from the negative consequences of the conflict for their self-esteem. One potent way to do socould be to reconcile with the former adversary. Still, the road to reconciliation often is a rocky one. For instance, only one side might be willing to reconcile and reassume a positive and harmonious relationshipwhile the other side might not be as ready as it is hindered from going forward by lingering threats and unresolvedissues. In this article, we will turn to one such psychological obstacle on the road to reconciliation thathas notreceivedmuchattention in work onconflict and reconciliationso far(for an exception, seeMazziotta, Feuchte, Gausel, & Nadler, 2014): self-focus. Defined as a situationally salient strong attention to self-targeted cognitions and internal feelings(e.g., Hess & Pickett, 2010), self-focus is potentially decreasing willingness to reconcile. This paper aims at investigating this possibility, as we will show that perpetrators and victimsof interpersonal and intergroup transgressionsdiffer in self-focus and this,in turn,affects their willingness to reconcile.Theoretical Framework –The Needs-Based Model of ReconciliationThe theoretical framework of the present research is mainly builton the Needs-Based Model of Reconciliation (NBMR, Shnabel & Nadler, 2008)which sees reconciliation as a process to overcome specific socio-emotional barriers resulting fromconflict. These barriers are related to specific aspects of victims’ and perpetrators’ social identitiesand they are linked to specificsocio-emotionalneeds that must be satisfiedfor reconciliation to occur. Specifically, victims have been violated in their social identity as powerful agents who are in full control of their environment, which leaves them with a need for empowerment, forreclaimingcontrol. On the other hand, perpetrators suffer a threat to their identity as moral actors, as members of a global moral community, and should consequently develop a need for
acceptanceandreassurance that they are still “good”. The NBMRclaims that both parties’ need satisfactionis possible by engaging in a bilateral strategy in which perpetrators empower victims by apologizing and asking for their forgiveness while victims try to empathizeand accept the perpetrators as fellow human beings. The models’ basic tenets have been supported in a number of empirical studiesin the context ofinterpersonaltransgressions (e.g., Shnabel & Nadler, 2008) and ofintergrouptransgressions (e.g., Aydin, Ullrich, Siem, Locke, & Shnabel, 2019; Shnabel, Nadler, Ullrich, Dovidio, & Carmi, 2009; see also Siem, von Oettingen, Mummendey, & Nadler, 2013). Results from these studies converginglyconfirmed the differing needs structure in victims(or members of victimized groups)and perpetrators(or members of perpetrating groups)and how messages of acceptance and empowerment are facilitating reconciliation if they fit the needs of the recipient(group)(for an overview, see Shnabel & Nadler, 2015).Mazziotta et al. (2014) have linked the different socio-emotional needs to potential differences in focus between perpetrators and victims. Theyproposedthat victims’ need for empowerment might direct their focus of attention toward thesuffering of theingroupand its primary goals. Consequently, victimsmight be less willing to approach the former adversaryoutgroup. Perpetrators’ need for acceptance should increase their awareness of others and their motivation to affiliate with them. In other words, their attention shiftstowards those outgroups who can give perpetrators what they need: acceptance. Although they only offered indirect empirical evidence for their claim and did not measure focus in their studies, we agree withMazziotta et al.’s basic idea thatperpetrators and victims differ in their self-focus, with victims focusing moreon the self and perpetrators showing a stronger other-focus.1
Empirical Evidence for aWeakerSelf-Focus of PerpetratorsSome preliminary evidence on perpetrators’ focus comesfrom research on social rejectionand exclusion. Even thoughperpetrators donot necessarily suffer a rejection in the conflict itself, they often fear rejection or exclusion from the moral community as a consequence of their actions (Shnabel & Nadler, 2008), so that their reactions mightbe comparable to those of targetsof true rejection.Social exclusion can be understood as a signal that something is wrong with the self, e.g., that one has undesirable traits. Such a realization is aversive and potentially harmful which explains why an excluded individual is less likely to focus strongly on the self. In line with this reasoning, research has shown that social rejection in fact leadsto a stronger desire to avoid self-awareness or self-focus (for instance, by facing away from a mirror, Twenge, Catanese, & Baumeister, 2003). Research on interoceptive accuracy (i.e. the ability to accurately detect and interpret signalsof one’s own body)–a concept that has been linked to self-focus (Ainley, Tajadura-Jiménez, Fotopoulou, & Tsakiris, 2012)–further supports this perspective by showingthat individuals who experienced social exclusion were less accurate than participants who were socially included (Durlik & Tsakiris, 2015). Similar processesmight lead perpetrators to turn their attention away from the self, as the confrontation with their transgressions represents a strong threat to their social identity as moral actors. A stronger other-focus(and thus a weaker self-focus)can also be understood as part of a strategy to regain social relationships(Hess & Pickett, 2010). Closely observing others’ behaviour and mood can help to adapt more successfully,which will, in turn, lead to more approval by others. Supporting this view, compared to not-rejected individuals,rejected individuals seem to show a better memory for information related to others than to the self (Hess & Pickett, 2010), and a stronger tendency to mimicry others (Lakin, Chartrand, & Arkin, 2008). With regard to the context of interpersonal and intergroup transgressions, these
lines ofresearch suggest thatperpetrators shouldbe motivated to protect their (collective) self from self-threatening information, and should be oriented towards others in order to increase their chance of approval. In the present research, we argue that a strongerother-focus should help to satisfy these motives. Empirical Evidence for aStronger Self-Focus of VictimsThe idea thatvictims should be more concerned with the selfin order to re-establish a sense of personal control (see also Mazziotta et al., 2014; Shnabel & Nadler, 2008)can be linked to research on victims’ feelings of entitlement. Afterexperiencing physical pain (aform ofvictimization), participants were more likely to indulge in guilty pleasures and self-reward, as they felt entitled to this treat after their suffering (Bastian, Jetten, & Stewart, 2013). In fact, some researchers see entitlement as a specific form of self-focus (e.g., O’Brien, Anastasio, & Bushman, 2011). Furtherevidence showsthat victims tend to be less prosocial. Theywere less likely to help another person, demanded more resources for themselves than participants who were not reminded of some past unfair treatment(e.g., Fetchenhauer & Huang, 2004; Zitek, Jordan, Monin, &Leach, 2010), or experienced less empathy (Chaitin & Steinberg, 2008), an emotional response that has been strongly linked to prosocial behaviour (Batson, Chang, Orr,& Rowland, 2002;).In another study, victims of sexual abuse were less likely to think of others than were non-victims(McMullin, Wirth, & White, 2007), and became even more self-focused over time. With their attention focused on themselves, victims might have less resources to spare to consider the well-being of others or basic social rules that are meant to facilitate social relationships(see also Chaitin &Steinberg, 2008).
Self-Focus Decreases Willingness to ReconcileIn the present research, we argue that a stronger self-focus should be related to less willingness to reconcile. Initial evidence supporting this reasoning comes froma study showingthat in the aftermath of a transgression, self-focus was related to avoidance, and a less forgiving stance towards the previous adversary(Strelan, McKee, Calic, Cook, & Shaw, 2013).As we have pointed out above, self-focus diminishes feelings of empathy(Chaitin &Steinberg, 2008). Empathy, in turn, is an important predictor not only of prosocial behaviour but also of forgiveness (McCullough et al., 1998). A related construct, the ability to take the perspective of another person, has also been shown to be related to reconciliation (e.g.,Exline, Baumeister, Zell, Kraft, & Witvliet, 2008; Zebel, Doosje, & Spears, 2009). Ifself-focus decreases empathic reaction and perspective taking, then willingness to reconcile should be reduced, too.In another line of research, McCullough, Bono, and Root(2007)investigated the effects of rumination on forgiveness. Rumination, a passive, repetitive focus on personal suffering andthe negative consequences of a conflict episode, reduced forgiveness and increased anger at the offender. As we have outlined above, victims are very much focusing on their suffering.This strong attention to the events of the conflict and its negative consequences for the self might be similar to a form of rumination. To summarize, we assume that perpetrators and victims in interpersonaland intergroupconflictsdiffer in their focus of attention. Victims should be more focused on the self as they are trying to cope with the painful events. Perpetrators should be more other-focused in order to satisfy their need for acceptance and as a strategy to distance themselves from confronting their personal(or their ingroup’s)violation of moral norms. We further
argue that self-focus should be related to less willingness to reconcile, as it decreases the capability to acknowledge the needs of others and increases avoidance and vengeful thoughts.Study 1The main aim of Study 1 was to test the influence of social role (perpetrator versus victim) on focus of attentionin an interpersonal transgression situation. We expected participants who adopt a victim role to be more self-focused than participants who adopt a perpetrator role. In addition, we aimed at investigating the effect of social role on participants’ sensitivity towards the adversary’s socio-emotional needs. Specifically, we hypothesized that victims, due to their strongerself-focus, would be lesssensitive to the actual socio-emotional needs of the other partythan perpetrators. When given a choicebetween different messages that could be communicated to the other party, they should thus be less likely to selectthemessage that is best suited to satisfy the other party’s need than perpetrators.
General Discussion
Based on the NBMR(Shnabel &Nadler, 2008) the present research tested the hypothesis that, following a transgression, victims and perpetrators differ in their focus of attention such that victims show a strongerself-focus than perpetrators (see also Mazziotta et al., 2014). To our knowledge, this assumption has received only indirect empirical supportin previous research(e.g., in research on social rejection, e.g.,Twenge et al., 2003; or entitlement, e.g., Chaitin & Steinberg, 2008). In three studies, we systematically tested this assumption by manipulating social role (victim vs. perpetrator) in a hypothetical transgression scenario(Studies 1 and 2) and in a perceived real conflict(Study 3),as well as in an interpersonal (Studies 1 and 2) and an intergroup (Study 3) context. Results from all three studies clearly confirmed our hypothesis that victims show a strongerself-focus than perpetrators.This effectheld up when we controlledfor dispositional empathy and perspective taking (Study 1 and 2). The fact that we were able toreplicate this effect in an intergroup context in Study 3further underlines its robustness. First, the effect occurred even though participants in the perpetrator conditionwere not personally responsible for the harm
done to the outgroup. Second, and related, more than in interpersonal contexts, perpetrators in intergroup contexts have several options to distance themselves from the perpetrating members of their ingroup, for instance by disidentifying from the ingroup (Becker & Tausch, 2014), or by treating the perpetratingingroup members as “black sheep” (Marques, Yzerbyt, & Leyens, 1988). Such processes should weaken the effects of social role in the present intergroup context. Still, the observed effect can be classified as strong.Another central aimof the present research was to link people’s social role to their willingness to reconcile with the adversary. Building on the NBMR(Shnabel & Nadler, 2008) and other work on the determinants of reconciliation (e.g., Exline et al., 2008) we assume that, due to their increased self-focus, victims should be less willing to reconcile than perpetrators. Findings from Studies2and 3provided converging support for this assumption suggesting that the effect of participants’(ingroup’s) role on their willingnessto reconcile was mediated by their focus of attention(Study 2),or sequentially mediated bytheirfocus of attention and their motivation to consider the other party’s feelings and needs (Study 3).The present resultshave important theoretical andpractical implications. From a theoretical perspective, our findings help to understand why victims’ capacity for feeling empathy for a perpetrator or, more generally, for others,has been shown to be reduced (e.g., Chaitin & Steinberg, 2008). Specifically, empathy is an other-orientedemotional reaction (e.g., Batson, 2011)and the increased self-focus that has been observed in the present research as a consequence ofvictimhoodmost likely inhibits the development of this emotion. Closely related, our Study 3 data showed that strong-self focus decreased the motivation to actually considerthe other party’s needs and well-being (Study 3). From a practical perspective, it is important to know that victims and perpetratorsdiffer in their focus of attention and that this affects their reconciliation willingness. Specifically, while interventions designed to promote people’s focus on the respective other party (e.g.,
perspective taking interventions, e.g.,Barth & Stürmer, 2016) might effectively increase willingness to reconcile among victims(for evidence, see McCullough, Worthington,& Rachal, 1997), perpetrators’ willingness to reconcile might profit more strongly from other forms of interventions (e.g., interventions focussing on dealing with own feelings of guilt and shame; for related evidence, see Woodyatt & Wenzel, 2014). Designing and evaluatingvictim-and perpetrator-specific interventions that take differences infocusof attention into account is an important field for future research on reconciliation. While we received converging support for our predictions regarding the effects of social role on focus of attention and on reconciliation willingness, results regarding participants’ preferred messages (to be sent to the other party, to be received from the other party)were less consistent. First, we assumed that, due to their strongerself-focus, victimsshould be lesssensitive to the actual socio-emotional needs of the other party. Only one out of six analyses yielded a result in the predicted direction, while the remaining five analyses produced inconsistent results. At this point, we can only speculate about potential reasons for thesemixed findings. For instance, factors other than participants’ social role (e.g., dispositionally pursued communal vs. agentic interaction goals, Locke, 2010) might have had a stronger influence on the messagesparticipants preferred to send than the experimental manipulation, thusleading to an overall unsystematicresult pattern. Future research is needed, consideringtheoretically plausible alternative predictors as well as alternative operationalisations of need sensitivity (e.g., via an open answerformat). Another inconsistency concerns the mediating role of participants’ own socio-emotional needs operationalized via the kind of message they themselves would like to receive from the other party (measured in Studies 1 and 3). Specifically, although in both studies victims showed a (at least marginally significant) strongerdominance ofthe empowerment over the social acceptance need than perpetrators, participants’ own socio-
emotional needs were significantly related to their focus of attention only in Study 1. We assume that additional sources of focus that are specific to group contexts might be anexplanation for why we were not able to replicate thisStudy 1 finding in Study 3. Beyond socio-emotional needs, participants might be motivated to protect their group from threats to its positive image or to cope with potential negative emotions because of one’s membership in a deviant group. Consequently, participants might have turned their attention to the out-group, not because they wish for their acceptance but because this helps them to distance themselves from aversive thoughts and feelings.Similarly, they might have coped with the aversive situation by distancing from the group itself and recategorizing as a simple observer unrelated to the misbehaviour of the ingroup. As we have shown, observers with no relation to the conflict werestrongly other-focused but their motivation probably did not include the needs we investigated in the present work.These alternative factors might explain more variance of focus than the needs we investigated in the present work. Future research will need to consider such group-level specific processes.As a final remark, we have concentrated on focus of attention as one possible explanation for the differences in reconciliation between victims and perpetrator. However, this is not to say that there are no relevant other mediating processes(as indicated by the partial mediations reported inStudies 2 and 3). One such processdiscussed in the literature is perceived severity of the transgression,with victims tending to perceive the very same transgression as more severe than perpetrators (“the magnitude gap”; Baumeister, 1997). Additional analyses witha single-item measureof perceived severity included for exploratory reasons in Study 3 (see supplemental materials)did not yield significant effects. Still,to gain a more comprehensive understanding of the processes underlying the effect of social role on reconciliation, severityand other potential explanations(e.g., victims’ fear of repeated poor treatmentby the perpetrator) need to be more systematically tested in future research.
The present research contributes to a mounting body of work addressing how victims and perpetrators differ in their perceptions of and reactions to a transgression (e.g., Baumeister, 1997; Mazziotta et al., 2014). Using interpersonal and intergroup conflict settings, we found consistent support for our assumption that victims showed a stronger self-focus than perpetrators, and could demonstrate that this stronger self-focus reduced victims’willingness to reconcile with the perpetrator. The present research might thus be another paving stone in the long and winding road to reconciliation.
Monday, March 18, 2019
Asexuality: Sexual Health Does Not Require Sex
Asexuality: Sexual Health Does Not Require Sex. Brenna Conley-Fonda & Taylor Leisher. Sexual Addiction & Compulsivity, Volume 25, 2018 - Issue 1, Pages 6-11. https://doi.org/10.1080/10720162.2018.1475699
ABSTRACT: The working definition of sexual health published in this issue of Sexual Addiction and Compulsivity promises to advance theory, research, practice, and training. The definition implicitly assumes that desire is a requirement of healthy sexuality. Recent emergence of research and advocacy for the asexual identity challenges the contemporary definition of sexual health and offers questions for reflective practice.
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The concept of “sexual health” is inherently fluid and dynamic, as it is constantly changing and shifting on both micro and macro levels. However difficult the task may be, a definition is necessary to provide a framework to assess client behavior, communicate the needs of clients and partners, and develop best practices to help clients achieve their goals. Further, a definition of sexual health provides a mechanism which prevents clinicians from pathologizing behaviors which may not in fact represent dysfunction or “problematic sexual behavior.” This is necessary given psychology's history of pathologizing what we have now come to understand as normal and healthy expressions of sexuality: BDSM, homosexuality, bisexuality, and polyamory.
Numerous agencies and organizations have attempted to define sexual health. These efforts are attempts to express and qualify this elusive “sexual health” definition. As the Society for the Advancement of Sexual Health stated, it is “…committed to an intentional effort to expand the scope of our work and contribute to an inclusive, contemporary view of sexual health.” (Southern, 2017 Southern, S. (2017). Editorial. Sexual Addiction and Compulsivity, 24(4), 241. doi:10.1080/10720162.2017.1408999, p. 241).
As clinicians and editorial assistants, we believe the definition of sexual health should contain an explicit mention of “asexual orientation.” The absence of asexuality speaks to the lack of understanding currently reported in the sexual health/addiction field. We believe the concept of asexuality and self-identification of an asexual lifestyle should be explored as a facet of sexual health.
Asexuality defined
There isn't a singular definition of “normal” asexuality. There are a range of experiences within the orientation: some asexual individuals engage in partnered sexual activity, solitary sexual activity, or abstain from sex completely (Bogaert, 2004 Bogaert, A. (2004). Asexuality: Prevalence and associated factors in a national probability sample. The Journal of Sex Research, 41(3), 279–287. doi:10.1080/00224490409552235) However, the common thread throughout is that asexuals have never experienced sexual attraction or sexual desire throughout the course of their life (Bogaert, 2015 Bogaert, A. (2015). Asexuality: What it is and why it matters. The Journal of Sex Research, 52(4), 362–379. Retrieved from. doi:10.1080/00224499.2015.1015713). And while sexual interest and desire naturally fit into the definition of sexual health, the absence of desire challenges the concept of sexual orientation being centered around the presence of sexual desire.
Recently, an organization called The Asexual Visibility and Education Network (AVEN), emerged with the goals to create awareness and promote acceptance of asexuality, while building community around the orientation (AVEN, n.d. Asexual Visibility and Education Network (AVEN). (n.d.). Overview. https://www.asexuality.org/?q=overview.html). AVEN defined the asexual orientation as follows,
An asexual is someone who does not experience sexual attraction. Unlike celibacy, which people choose, asexuality is an intrinsic part of who we are. Asexuality does not make our lives any worse or any better, we just face a different set of challenges than most sexual people. There is considerable diversity among the asexual community; each asexual person experiences things like relationships, attraction, and arousal somewhat differently. (AVEN, n.d. Asexual Visibility and Education Network (AVEN). (n.d.). Overview. https://www.asexuality.org/?q=overview.html)
The lack of sexual desire as reported by asexual people, means that these individuals can make meaningful relationships in their lives that are not based on sexual functioning. As a result, asexuality can be distinguished from inhibited or hypoactive sexual desire as they are described by the American Psychiatric Association (2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). (DSM-V). Arlington, VA: Author). The distinction between a sexual desire disorder and an asexual orientation has significant implications for treatment and attitudes towards an asexual person.
Sexual desire disorder
Desire disorders include low sexual desire or interest within an individual or between partners in a sexual relationship. There are many theories or models that account for lack or loss of desire including biological, developmental, intrapsychic, relational, and cultural factors. Two specific diagnoses include Female Sexual Interest/Arousal Disorder (302.72) and Male Hypoactive Sexual Desire Disorder (302.71) (DSM-V; American Psychiatric Association, 2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). (DSM-V). Arlington, VA: Author, p. 433–436; 440–443). It is not uncommon for one partner to report the other has low desire, which typically means less interest in sex than the one who applies the label. Therefore, diagnoses of sexual desire disorders must satisfy certain criteria.
Female Sexual Interest/Arousal Disorder blurs the sexual responses of interest and arousal. Low sexual desire in this context may be presented as lack of interest in sexual activity, absence of erotic or sexual thoughts, reluctance to initiate sex, and inability to respond to a partner's sexual invitations (APA, 2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). (DSM-V). Arlington, VA: Author, p. 433). Female sexual interest/arousal disorder may be lifelong or acquired; generalized or situational; and range from mild to moderate or severe distress. Symptoms must have persisted for at least 6 months, and the symptoms cannot be better explained by a nonsexual medical or mental condition or by severe relationship distress such as partner violence. At least three of the following characteristics are required for diagnosis of the disorder (APA, 2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). (DSM-V). Arlington, VA: Author, p. 433):
1. Absent/reduced interest in sexual activity.
2. Absent/reduced sexual/erotic thoughts or fantasies.
3. No/reduced initiation of sexual activity, and typically unresponsive to a partner's attempts to initiate.
4. Absent/reduced sexual excitement/pleasure during sexual activity in almost all or all (approximately 75–100%) sexual encounters (in identified situational contexts or, if generalized, in all contexts).
5. Absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues (e.g., written, verbal, visual).
6. Absent/reduced genital or nongenital sensations during sexual activity in almost or all (approximately 75–100%) sexual encounters (in identified situational contexts or, if generalized, in all contexts).
Male Hypoactive Sexual Desire Disorder (APA, 2013 Gressgård, R. (2012). Asexuality: From pathology to identity and beyond. Psychology & Sexuality, 4(2), 179–192. doi:10.1080/19419899.2013.774166, pp.440–443) remains distinct from female sexual interest/arousal disorder in arousal/excitement and orgasm/ejaculation in sexual responding. Some of the shared criteria with female sexual interest/arousal disorder include: at least 6 months duration; lifelong vs. acquired; generalized vs. situational; and mild-moderate-severe distress. However, the major diagnostic feature places hypoactive sexual desire in context:
Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity. The judgment of deficiency is made by the clinician, taking into account factors that affect sexual functioning, such as age and general and sociocultural contexts of the individual's life. (APA, 2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). (DSM-V). Arlington, VA: Author, p. 440)
Both male hypoactive sexual desire disorder and female sexual interest/arousal disorder are associated with five conditions in the DSM-V (APA, 2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). (DSM-V). Arlington, VA: Author):
1. Partner factors (e.g., partner's sexual problems, partner's health status);
2. Relationship factors (poor communication, desire discrepancies);
3. Individual vulnerability factors (poor body image, history of sexual or emotional abuse) and/or psychiatric comorbidity (depression, anxiety) or stressors (job loss, bereavement);
4. Cultural/religious factors (attitudes, inhibitions or prohibitions against sexual activity); and
5. Medical factors (including effects of medication).
Sexual desire disorders are, by definition, distressing for the person experiencing them. The lack of desire is experienced as a loss or void for the person, and the ability to ethically and humanely treat the disorder offers the perspective that sexual desire disorders are change-worthy themselves. However, normal or healthy asexuality is not experienced as a problem, loss, or disorder. Brotto and Yule (2017 Brotto, L., & Yule, A. (2017). Asexuality: Sexual orientation, paraphilia, sexual dysfunction, or none of the above? Archives of Sexual Behavior, 46(3), 619–627. doi:10.1007/s10508-016-0802-7) found there is no evidence to suggest that asexuality is a psychiatric disorder, sexual dysfunction, or paraphilia. Rather, their data suggested that asexuality is a recognizable sexual orientation. As the asexuality definition proposed by AVEN (n.d. Asexual Visibility and Education Network (AVEN). (n.d.). Overview. https://www.asexuality.org/?q=overview.html) suggests, asexual people seek to inform clinicians and society-at-large that their sexual orientation is not a sexual desire disorder needing to be treated.
Excluding asexuality from sexual health may harm
The lack of sexual interest or desire that asexual people experience has historically been pathologized as a disorder (Gressgård, 2012 Gressgård, R. (2012). Asexuality: From pathology to identity and beyond. Psychology & Sexuality, 4(2), 179–192. doi:10.1080/19419899.2013.774166). The authors believe that this exclusion furthers the experience of invisibility described by asexuals and contributes to the discrimination which they experience. In a study investigating intergroup bias towards asexuals, asexuals were evaluated more negatively by participants. They were viewed as less human than other sexual minority groups, and contact with asexual people was considered less desirable than contact with homosexual and heterosexual people (MacInnis & Hodson, 2012 MacInnis, C., & Hodson, G. (2012). Intergroup bias toward “Group X”: Evidence of prejudice, dehumanization, avoidance, and discrimination against asexuals. Group Processes & Intergroup Relations, 15(6), 725–743. Retrieved from. doi:10.1177/1368430212442419). This recognizable bias fuels the pathologizing of asexuality and reinforces a need for the inclusion of the orientation in a contemporary definition of sexual health.
The exclusion of asexual people from the working definition of sexual health, presented in this issue by Southern (2018 Southern, S. (2018, in press). Recent perspectives on sexual health. Sexual Addiction and Compulsivity, 25(1), in press), erases any acknowledgement of the sexual experiences of asexuals. This exclusion can influence not only any positive and healthy sexual experiences, but also any negative or clinically significant ones. The result then, is that all data related to the sexual experiences of asexuals are not observed or studied, effectively disabling any definition from gaining a more nuanced understanding of sexual health for this emerging population.
Excluding or pathologizing of asexual experiences, reflects an implicit a disqualification of the subjective experience of persons choosing this lifestyle. Asexuality itself is not considered a “problem” within the asexual community (AVEN, n.d. Asexual Visibility and Education Network (AVEN). (n.d.). Overview. https://www.asexuality.org/?q=overview.html). While other sexual minorities may be validated in their sexual desires, a lack of sexual desire transgresses the social narrative that all people naturally have sexual desire. As such, to maintain the status quo, asexuals are placed into an “other” category and deemed pathologically troubled. It is this mindset, that all people must have sexual desire to be sexually healthy, that leads to the exclusion of asexual people from the current definition of sexual health.
It is important to include asexuality
The authors believe that there can be much learned about the nature of sexuality through the study and inclusion of asexuality. An example being clarity around the role of sexual desire in determining sexual health. The question, “Is someone who has sex for reasons other than sexual desire considered to be sexually healthy?” offers insight into how contemporary thought places sexual desire as a necessary component to sexual activity. Asexual persons do not consider their sexuality to be inherently “the problem.” In addition, they do not want to be seen as having hypoactive sexual desire and experience the shame that may come with psychiatric diagnosis.
It is also noteworthy that asexuals do enter romantic relationships. It has been found in a study done by Bogaert (2004 Bogaert, A. (2004). Asexuality: Prevalence and associated factors in a national probability sample. The Journal of Sex Research, 41(3), 279–287. doi:10.1080/00224490409552235), that up to 44% of identified asexual people in a British survey were currently in a long-term relationship or had been previously. For the asexual person, the major concern for them within the relationship could be the emotional connection, rather than the sexual one. The result, then, is that their engagement in sexual activity could be done to please their sexual partner, and possibly facilitate emotional connection (Bogaert, 2004 Bogaert, A. (2004). Asexuality: Prevalence and associated factors in a national probability sample. The Journal of Sex Research, 41(3), 279–287. doi:10.1080/00224490409552235). This dynamic can offer valuable insight into how emotional intimacy and connectivity can be facilitated with or without sexual desire being present.
By incorporating asexuality into a definition of sexual health, the importance of cultural competence when working with asexuals is stressed, facilitating sexual health professionals to seek out and gain knowledge about the asexual community. A culturally competent professional should recognize the difference between a sexual desire disorder and the asexual orientation. This distinction can be the difference between asexual people feeling comfortable entering therapy for any reason and accepted by the clinician.
Conclusion and recommendations
The inclusion of asexuality in the definition of sexual health can provide numerous benefits and insights into how sexual health is defined for both asexual and sexual people. As previously stated, the exclusion of asexual people from the working definition demonstrates a lack of understanding and consideration for the wide berth of sexualities. Recognizing that asexual people can maintain a healthy sexual life with or without sexual desire being present allows for a more nuanced and inclusive discussion about the role of sexual desire in sexual health. Ultimately, by providing space for asexual people within the sexual health definition, a community far too often overlooked is able to be recognized and respected.
As we continue to address the definition of sexual health, it will be helpful to expand the construct to include diversity in terms of gender, orientation, preference, and identity. The following questions may be helpful to encourage the advancement of sexual health in the association, consulting room, and community. Our goals are reflective practice and equity.
1. How does one define a constantly changing construct such as sexuality?
2. Within the current construct of sexuality, does sexual desire have to exist in order for intimacy and connectedness to be present within a relationship? And if so, does this reflect a personal bias or a necessary component to connection in the context of said relationship?
3. Does the thought that an individual can exist absent of sexual desire while still engaging in meaningful intimate connected relationship pose a threat to the field of sex therapy?
4. What are unique elements of sexual health for asexual people, that may be distinct from sexual people?
5. How can sexual health professionals develop cultural competence to better work with the asexual community?
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). (DSM-V). Arlington, VA: Author.
Asexual Visibility and Education Network (AVEN). (n.d.). Overview. Retrieved from https://www.asexuality.org/?q=overview.html
Bogaert, A. (2004). Asexuality: Prevalence and associated factors in a national probability sample. The Journal of Sex Research, 41(3), 279–287. doi:10.1080/00224490409552235
Bogaert, A. (2015). Asexuality: What it is and why it matters. The Journal of Sex Research, 52(4), 362–379. Retrieved from. doi:10.1080/00224499.2015.1015713
Brotto, L., & Yule, A. (2017). Asexuality: Sexual orientation, paraphilia, sexual dysfunction, or none of the above? Archives of Sexual Behavior, 46(3), 619–627. doi:10.1007/s10508-016-0802-7
Gressgård, R. (2012). Asexuality: From pathology to identity and beyond. Psychology & Sexuality, 4(2), 179–192. doi:10.1080/19419899.2013.774166.[Taylor & Francis Online], ,
MacInnis, C., & Hodson, G. (2012). Intergroup bias toward “Group X”: Evidence of prejudice, dehumanization, avoidance, and discrimination against asexuals. Group Processes & Intergroup Relations, 15(6), 725–743. Retrieved from. doi:10.1177/1368430212442419
Southern, S. (2017). Editorial. Sexual Addiction and Compulsivity, 24(4), 241. doi:10.1080/10720162.2017.1408999
Southern, S. (2018, in press). Recent perspectives on sexual health. Sexual Addiction and Compulsivity, 25(1), in press.
ABSTRACT: The working definition of sexual health published in this issue of Sexual Addiction and Compulsivity promises to advance theory, research, practice, and training. The definition implicitly assumes that desire is a requirement of healthy sexuality. Recent emergence of research and advocacy for the asexual identity challenges the contemporary definition of sexual health and offers questions for reflective practice.
---
The concept of “sexual health” is inherently fluid and dynamic, as it is constantly changing and shifting on both micro and macro levels. However difficult the task may be, a definition is necessary to provide a framework to assess client behavior, communicate the needs of clients and partners, and develop best practices to help clients achieve their goals. Further, a definition of sexual health provides a mechanism which prevents clinicians from pathologizing behaviors which may not in fact represent dysfunction or “problematic sexual behavior.” This is necessary given psychology's history of pathologizing what we have now come to understand as normal and healthy expressions of sexuality: BDSM, homosexuality, bisexuality, and polyamory.
Numerous agencies and organizations have attempted to define sexual health. These efforts are attempts to express and qualify this elusive “sexual health” definition. As the Society for the Advancement of Sexual Health stated, it is “…committed to an intentional effort to expand the scope of our work and contribute to an inclusive, contemporary view of sexual health.” (Southern, 2017 Southern, S. (2017). Editorial. Sexual Addiction and Compulsivity, 24(4), 241. doi:10.1080/10720162.2017.1408999, p. 241).
As clinicians and editorial assistants, we believe the definition of sexual health should contain an explicit mention of “asexual orientation.” The absence of asexuality speaks to the lack of understanding currently reported in the sexual health/addiction field. We believe the concept of asexuality and self-identification of an asexual lifestyle should be explored as a facet of sexual health.
Asexuality defined
There isn't a singular definition of “normal” asexuality. There are a range of experiences within the orientation: some asexual individuals engage in partnered sexual activity, solitary sexual activity, or abstain from sex completely (Bogaert, 2004 Bogaert, A. (2004). Asexuality: Prevalence and associated factors in a national probability sample. The Journal of Sex Research, 41(3), 279–287. doi:10.1080/00224490409552235) However, the common thread throughout is that asexuals have never experienced sexual attraction or sexual desire throughout the course of their life (Bogaert, 2015 Bogaert, A. (2015). Asexuality: What it is and why it matters. The Journal of Sex Research, 52(4), 362–379. Retrieved from. doi:10.1080/00224499.2015.1015713). And while sexual interest and desire naturally fit into the definition of sexual health, the absence of desire challenges the concept of sexual orientation being centered around the presence of sexual desire.
Recently, an organization called The Asexual Visibility and Education Network (AVEN), emerged with the goals to create awareness and promote acceptance of asexuality, while building community around the orientation (AVEN, n.d. Asexual Visibility and Education Network (AVEN). (n.d.). Overview. https://www.asexuality.org/?q=overview.html). AVEN defined the asexual orientation as follows,
An asexual is someone who does not experience sexual attraction. Unlike celibacy, which people choose, asexuality is an intrinsic part of who we are. Asexuality does not make our lives any worse or any better, we just face a different set of challenges than most sexual people. There is considerable diversity among the asexual community; each asexual person experiences things like relationships, attraction, and arousal somewhat differently. (AVEN, n.d. Asexual Visibility and Education Network (AVEN). (n.d.). Overview. https://www.asexuality.org/?q=overview.html)
The lack of sexual desire as reported by asexual people, means that these individuals can make meaningful relationships in their lives that are not based on sexual functioning. As a result, asexuality can be distinguished from inhibited or hypoactive sexual desire as they are described by the American Psychiatric Association (2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). (DSM-V). Arlington, VA: Author). The distinction between a sexual desire disorder and an asexual orientation has significant implications for treatment and attitudes towards an asexual person.
Sexual desire disorder
Desire disorders include low sexual desire or interest within an individual or between partners in a sexual relationship. There are many theories or models that account for lack or loss of desire including biological, developmental, intrapsychic, relational, and cultural factors. Two specific diagnoses include Female Sexual Interest/Arousal Disorder (302.72) and Male Hypoactive Sexual Desire Disorder (302.71) (DSM-V; American Psychiatric Association, 2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). (DSM-V). Arlington, VA: Author, p. 433–436; 440–443). It is not uncommon for one partner to report the other has low desire, which typically means less interest in sex than the one who applies the label. Therefore, diagnoses of sexual desire disorders must satisfy certain criteria.
Female Sexual Interest/Arousal Disorder blurs the sexual responses of interest and arousal. Low sexual desire in this context may be presented as lack of interest in sexual activity, absence of erotic or sexual thoughts, reluctance to initiate sex, and inability to respond to a partner's sexual invitations (APA, 2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). (DSM-V). Arlington, VA: Author, p. 433). Female sexual interest/arousal disorder may be lifelong or acquired; generalized or situational; and range from mild to moderate or severe distress. Symptoms must have persisted for at least 6 months, and the symptoms cannot be better explained by a nonsexual medical or mental condition or by severe relationship distress such as partner violence. At least three of the following characteristics are required for diagnosis of the disorder (APA, 2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). (DSM-V). Arlington, VA: Author, p. 433):
1. Absent/reduced interest in sexual activity.
2. Absent/reduced sexual/erotic thoughts or fantasies.
3. No/reduced initiation of sexual activity, and typically unresponsive to a partner's attempts to initiate.
4. Absent/reduced sexual excitement/pleasure during sexual activity in almost all or all (approximately 75–100%) sexual encounters (in identified situational contexts or, if generalized, in all contexts).
5. Absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues (e.g., written, verbal, visual).
6. Absent/reduced genital or nongenital sensations during sexual activity in almost or all (approximately 75–100%) sexual encounters (in identified situational contexts or, if generalized, in all contexts).
Male Hypoactive Sexual Desire Disorder (APA, 2013 Gressgård, R. (2012). Asexuality: From pathology to identity and beyond. Psychology & Sexuality, 4(2), 179–192. doi:10.1080/19419899.2013.774166, pp.440–443) remains distinct from female sexual interest/arousal disorder in arousal/excitement and orgasm/ejaculation in sexual responding. Some of the shared criteria with female sexual interest/arousal disorder include: at least 6 months duration; lifelong vs. acquired; generalized vs. situational; and mild-moderate-severe distress. However, the major diagnostic feature places hypoactive sexual desire in context:
Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity. The judgment of deficiency is made by the clinician, taking into account factors that affect sexual functioning, such as age and general and sociocultural contexts of the individual's life. (APA, 2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). (DSM-V). Arlington, VA: Author, p. 440)
Both male hypoactive sexual desire disorder and female sexual interest/arousal disorder are associated with five conditions in the DSM-V (APA, 2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). (DSM-V). Arlington, VA: Author):
1. Partner factors (e.g., partner's sexual problems, partner's health status);
2. Relationship factors (poor communication, desire discrepancies);
3. Individual vulnerability factors (poor body image, history of sexual or emotional abuse) and/or psychiatric comorbidity (depression, anxiety) or stressors (job loss, bereavement);
4. Cultural/religious factors (attitudes, inhibitions or prohibitions against sexual activity); and
5. Medical factors (including effects of medication).
Sexual desire disorders are, by definition, distressing for the person experiencing them. The lack of desire is experienced as a loss or void for the person, and the ability to ethically and humanely treat the disorder offers the perspective that sexual desire disorders are change-worthy themselves. However, normal or healthy asexuality is not experienced as a problem, loss, or disorder. Brotto and Yule (2017 Brotto, L., & Yule, A. (2017). Asexuality: Sexual orientation, paraphilia, sexual dysfunction, or none of the above? Archives of Sexual Behavior, 46(3), 619–627. doi:10.1007/s10508-016-0802-7) found there is no evidence to suggest that asexuality is a psychiatric disorder, sexual dysfunction, or paraphilia. Rather, their data suggested that asexuality is a recognizable sexual orientation. As the asexuality definition proposed by AVEN (n.d. Asexual Visibility and Education Network (AVEN). (n.d.). Overview. https://www.asexuality.org/?q=overview.html) suggests, asexual people seek to inform clinicians and society-at-large that their sexual orientation is not a sexual desire disorder needing to be treated.
Excluding asexuality from sexual health may harm
The lack of sexual interest or desire that asexual people experience has historically been pathologized as a disorder (Gressgård, 2012 Gressgård, R. (2012). Asexuality: From pathology to identity and beyond. Psychology & Sexuality, 4(2), 179–192. doi:10.1080/19419899.2013.774166). The authors believe that this exclusion furthers the experience of invisibility described by asexuals and contributes to the discrimination which they experience. In a study investigating intergroup bias towards asexuals, asexuals were evaluated more negatively by participants. They were viewed as less human than other sexual minority groups, and contact with asexual people was considered less desirable than contact with homosexual and heterosexual people (MacInnis & Hodson, 2012 MacInnis, C., & Hodson, G. (2012). Intergroup bias toward “Group X”: Evidence of prejudice, dehumanization, avoidance, and discrimination against asexuals. Group Processes & Intergroup Relations, 15(6), 725–743. Retrieved from. doi:10.1177/1368430212442419). This recognizable bias fuels the pathologizing of asexuality and reinforces a need for the inclusion of the orientation in a contemporary definition of sexual health.
The exclusion of asexual people from the working definition of sexual health, presented in this issue by Southern (2018 Southern, S. (2018, in press). Recent perspectives on sexual health. Sexual Addiction and Compulsivity, 25(1), in press), erases any acknowledgement of the sexual experiences of asexuals. This exclusion can influence not only any positive and healthy sexual experiences, but also any negative or clinically significant ones. The result then, is that all data related to the sexual experiences of asexuals are not observed or studied, effectively disabling any definition from gaining a more nuanced understanding of sexual health for this emerging population.
Excluding or pathologizing of asexual experiences, reflects an implicit a disqualification of the subjective experience of persons choosing this lifestyle. Asexuality itself is not considered a “problem” within the asexual community (AVEN, n.d. Asexual Visibility and Education Network (AVEN). (n.d.). Overview. https://www.asexuality.org/?q=overview.html). While other sexual minorities may be validated in their sexual desires, a lack of sexual desire transgresses the social narrative that all people naturally have sexual desire. As such, to maintain the status quo, asexuals are placed into an “other” category and deemed pathologically troubled. It is this mindset, that all people must have sexual desire to be sexually healthy, that leads to the exclusion of asexual people from the current definition of sexual health.
It is important to include asexuality
The authors believe that there can be much learned about the nature of sexuality through the study and inclusion of asexuality. An example being clarity around the role of sexual desire in determining sexual health. The question, “Is someone who has sex for reasons other than sexual desire considered to be sexually healthy?” offers insight into how contemporary thought places sexual desire as a necessary component to sexual activity. Asexual persons do not consider their sexuality to be inherently “the problem.” In addition, they do not want to be seen as having hypoactive sexual desire and experience the shame that may come with psychiatric diagnosis.
It is also noteworthy that asexuals do enter romantic relationships. It has been found in a study done by Bogaert (2004 Bogaert, A. (2004). Asexuality: Prevalence and associated factors in a national probability sample. The Journal of Sex Research, 41(3), 279–287. doi:10.1080/00224490409552235), that up to 44% of identified asexual people in a British survey were currently in a long-term relationship or had been previously. For the asexual person, the major concern for them within the relationship could be the emotional connection, rather than the sexual one. The result, then, is that their engagement in sexual activity could be done to please their sexual partner, and possibly facilitate emotional connection (Bogaert, 2004 Bogaert, A. (2004). Asexuality: Prevalence and associated factors in a national probability sample. The Journal of Sex Research, 41(3), 279–287. doi:10.1080/00224490409552235). This dynamic can offer valuable insight into how emotional intimacy and connectivity can be facilitated with or without sexual desire being present.
By incorporating asexuality into a definition of sexual health, the importance of cultural competence when working with asexuals is stressed, facilitating sexual health professionals to seek out and gain knowledge about the asexual community. A culturally competent professional should recognize the difference between a sexual desire disorder and the asexual orientation. This distinction can be the difference between asexual people feeling comfortable entering therapy for any reason and accepted by the clinician.
Conclusion and recommendations
The inclusion of asexuality in the definition of sexual health can provide numerous benefits and insights into how sexual health is defined for both asexual and sexual people. As previously stated, the exclusion of asexual people from the working definition demonstrates a lack of understanding and consideration for the wide berth of sexualities. Recognizing that asexual people can maintain a healthy sexual life with or without sexual desire being present allows for a more nuanced and inclusive discussion about the role of sexual desire in sexual health. Ultimately, by providing space for asexual people within the sexual health definition, a community far too often overlooked is able to be recognized and respected.
As we continue to address the definition of sexual health, it will be helpful to expand the construct to include diversity in terms of gender, orientation, preference, and identity. The following questions may be helpful to encourage the advancement of sexual health in the association, consulting room, and community. Our goals are reflective practice and equity.
1. How does one define a constantly changing construct such as sexuality?
2. Within the current construct of sexuality, does sexual desire have to exist in order for intimacy and connectedness to be present within a relationship? And if so, does this reflect a personal bias or a necessary component to connection in the context of said relationship?
3. Does the thought that an individual can exist absent of sexual desire while still engaging in meaningful intimate connected relationship pose a threat to the field of sex therapy?
4. What are unique elements of sexual health for asexual people, that may be distinct from sexual people?
5. How can sexual health professionals develop cultural competence to better work with the asexual community?
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). (DSM-V). Arlington, VA: Author.
Asexual Visibility and Education Network (AVEN). (n.d.). Overview. Retrieved from https://www.asexuality.org/?q=overview.html
Bogaert, A. (2004). Asexuality: Prevalence and associated factors in a national probability sample. The Journal of Sex Research, 41(3), 279–287. doi:10.1080/00224490409552235
Bogaert, A. (2015). Asexuality: What it is and why it matters. The Journal of Sex Research, 52(4), 362–379. Retrieved from. doi:10.1080/00224499.2015.1015713
Brotto, L., & Yule, A. (2017). Asexuality: Sexual orientation, paraphilia, sexual dysfunction, or none of the above? Archives of Sexual Behavior, 46(3), 619–627. doi:10.1007/s10508-016-0802-7
Gressgård, R. (2012). Asexuality: From pathology to identity and beyond. Psychology & Sexuality, 4(2), 179–192. doi:10.1080/19419899.2013.774166.[Taylor & Francis Online], ,
MacInnis, C., & Hodson, G. (2012). Intergroup bias toward “Group X”: Evidence of prejudice, dehumanization, avoidance, and discrimination against asexuals. Group Processes & Intergroup Relations, 15(6), 725–743. Retrieved from. doi:10.1177/1368430212442419
Southern, S. (2017). Editorial. Sexual Addiction and Compulsivity, 24(4), 241. doi:10.1080/10720162.2017.1408999
Southern, S. (2018, in press). Recent perspectives on sexual health. Sexual Addiction and Compulsivity, 25(1), in press.
Fieldwork from Poland suggested that well over 80% of people seeking treatment for sex addiction had a problem with pornography use, rather than issues from acting out with real sexual partners
Darryl Mead & Mary Sharpe (2019): Pornography and sexuality research papers at the 5th International Conference on Behavioral Addictions, Sexual Addiction & Compulsivity, Mar 2019. DOI: 10.1080/10720162.2019.1578312
ABSTRACT: The 5th International Conference on Behavioral Addictions was held in Cologne, Germany, April 23-25, 2018. It featured one of the largest concentrations of papers on pornography and sexual research presented in a single venue to date. Several key themes emerged from the conference. The theoretical basis for developing pornography and sexuality studies as components within the behavioral addiction research landscape is beginning to mature. Core components are the I-PACE theory and the development, validation, and employment in field studies of a steadily growing set of assessment tools including the Problematic Pornography Use Scale, the Brief Pornography Screener, and the Hypersexual Behavior Inventory. The field also benefitted from a keynote speech and a formal pro/con debate. The other principal debate was around the imminent release of ICD-11 by the World Health Organization and the way that Compulsive Sexual Behavior Disorder (CSBD) would be handled. There was a selection of papers looking at the debate from a variety of theoretical and practical points of view. Fieldwork from Poland suggested that well over 80% of people seeking treatment for CSBD had a problem with pornography use, rather than issues from acting out with real sexual partners.
Introduction
The overall message for pornography research from the three days of the 5th International Conference on Behavioral Addictions (ICBA, 2018) was one of positive advances in scientific understanding. Compared to the 4th Conference, 14 months earlier, there were greater aspirations in the scope of the research, significant progress in increasing the sample sizes in many studies, and improvements in sample quality. Underpinning all of these was the success of the Interaction of Person-Affect-Cognition-Execution (I-PACE) theory in providing a unifying framework. I-PACE not only starred in the sexuality papers, but also was referred to in several keynotes and featured in the work presented in several parallel research fields. It has become a common starting point for many behavioral addiction researchers, irrespective of their field of interest.
For sexuality and pornography researchers, the critical background factor was the imminent release of the 11th revision of the International Classification of Diseases (ICD-11) by the World Health Organization. There were a number of papers attempting to predict what it would contain. In some cases, the authors hoped to directly influence what was to be included and how it would be framed or limited. ICD-11 was released on June 18, 2018. It introduced 6C72, Compulsive Sexual Behavior Disorder (CSBD), within the category of Impulse Control Disorders. This differed from what some researchers proposed at ICBA 2018. They indicated that it might best be placed in the realm of addictions, within the category of Disorders Due to Addictive Behaviors, along with 6C50 Gambling Disorder and 6C51 Gaming Disorder. It is anticipated that there will be plenty of scope at upcoming ICBA meetings to develop the arguments to shape future updates of the ICD. All abstracts for the 5th Conference have been published in a supplement to the Journal of Behavioral Addictions (Demetrovics 2018). The 6th International Conference on Behavioral Addictions was announced by the International Society for the Study of Behavioral Addictions for June 17-19, 2019 in Yokohama, Japan.
Keynote lecture
The keynote lecture by Germany’s eminent researcher and clinician Rudolf Stark on “Pathological Pornography Use—What We Know and What We Still Need to Know” was the first time pornography research had been given such a prominent place at the International Conference on Behavioral Addictions.
This keynote was in three parts. First, it considered pornography consumption as a social phenomenon on the Internet, noting the rising prevalence of use, particularly by men. Stark explored the neurobiological correlates of watching pornography as well as experiments covering distractibility and learning. Pornographic stimuli may activate reward systems and capture attention. The anticipation of sexual stimuli may activate reward systems in similar fashions as does anticipation of drugs, although these have not been directly compared.
The second part considered the potential to place problematic pornography use within the Beta draft of ICD-11 under 6C5Y, “Other Specified Disorders Due to Addictive Behaviors.” Two open questions were identified. First, within diagnostic criteria, are withdrawal and tolerance key features of pathological pornography use? Second, are different compulsive sexual behaviors, such as excessive impairing promiscuous dating behavior and pathological pornography use, different or do they constitute the same disorder?
The Keynote concluded by considering the current knowledge of the etiology of problematic pornography use. Stark made reference to the I-PACE model for problematic pornography use, covering data from experimental perspectives of cue reactivity, personality analysis, and co-occurring disorders. He then referred to his own work using the Trait Sexual Motivation Questionnaire (Stark et al, 2015) to consider if there may be subtypes of individuals with problematic porn use. He identified a Gratification group driven mainly by positive reinforcement, that is seeking pleasure, and a Compensation group where the reinforcement was negative, to avoid pain or other negative affect. He reported that around half of a clinical sample was in one group and half in the other.
Stark concluded by suggesting more work is needed to examine the natural course of problematic pornography use where non-problematic pornography use transitions into problematic use. He concluded by suggesting that the case for pornography use disorder in the ICD is strengthened by its foundation in the stimulation of systems relating to the processing of natural rewards. As to why a clinical diagnosis was not yet accepted, at the time of the conference, he suggested that it may be due to individual, socio-cultural, and political reasons.
Pro/Con debate on behavioral addictions
A welcome addition to ICBA 2018 was the introduction of a debate on the fundamental nature of behavioral addiction. The bonus for students of sexual behavioral addiction studies was that both speakers are recognized researchers in the pornography field, so they drew heavily on sexualitybased issues in framing their arguments.
Pro: “Behavioral Addictions: From Over-Pathologizing to Real Clinical Phenomenon” Aviv M. Weinstein, Israel
The arguments identified by Weinstein in favor of considering behavioral
addictions as a real clinical phenomenon were as follows:
Pathological gambling (PG), Internet gaming disorder (IGD), compulsive
sexual behavior (CSB), and compulsive buying (CB) all fit better into the
behavioral model of addiction than in an obsessive-compulsive model. He
argued that the neural mechanisms underlying the four conditions are
similar to those of drug addictions. These conditions and behaviors involve
changes in reward processing, inhibitory mechanisms, impulsivity, and
impaired control.
For example, he reported that video game playing was associated with
dopamine release similar in magnitude to that of drugs of abuse. He stated
that lower dopamine transporter levels and dopamine receptor D2 occupancy
in the striatum suggested poor sensitivity of dopamine
reward mechanisms.
He reported that high rates of co-morbidity between behavioral addictions
and other psychiatric disorders are evident including with respect to
depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), obsessive-
compulsive disorder (OCD), and personality disorders. He stated that
treating co-morbid conditions may not solve addiction problems.
Con: “Conceptualizing Behavioral Addictions without Pathologizing Common Behaviors.” Joel Billieux, Luxembourg
Joel Billieux began with a working hypothesis that “According to the criteria generally used to identify behavioral addictions, it is likely that the elevated involvement of any type of activity can be considered as a psychiatric disorder…”
The aim of this working hypothesis was to clarify possible confusion between “real” disorders and healthy passions and/or dysfunctional coping strategies. In this way, clinicians could avoid imposing inappropriate treatments, and the conference could contribute to the continuing credibility and relevance of (behavioral) addiction research.
After considering the literature generated for a range of potential “fringe” behaviors as test candidates for addiction, which might alternatively be seen as everyday behaviors and leisure activities, such as dancing, studying, taking selfies, fishing, and binge watching, the analysis considered the unhelpful power of the confirmatory approach.
Billieux’s talk ended with three recommendations. First, there is a need to shift from a confirmatory and symptom-based approach to a theoretically grounded and process-based approach, for example, the I-PACE model of problematic Internet use (Brand et al, 2016). Second, there is a need to improve the diagnostic approach of behavioral addiction with stronger clinical relevance and construct validity, with particular reference to the World Health Organization initiative to develop new screening tools (Carragher et al, 2018). Lastly, there is need to acknowledge the differences between high involvement (passion) versus dysfunctional involvement (addiction).
Presentations
Session: Hypersexual disorder: Relationships with transdiagnostic measures and clinically relevant behaviors Chair: Shane W. Kraus
“The Impulsive and Compulsive Aspects of Problematic Pornography Use and Hypersexuality”
Zsolt Demetrovics, Hungary with B. B}othe, I. T oth-Kir aly, and G. Orosz
This study used a Hungarian online sample that provided a useable dataset of 13,778 individuals, 30.1% female. It concluded that impulsivity and compulsivity did not contribute as importantly and directly to problematic pornography use as previously hypothesized, and that impulsivity may have a more prominent role in hypersexuality. This research has now been published as B}othe et al. (2018a) and interested readers are directed to the full paper.
“Sexting among Military Veterans: Prevalence and Correlates with Psychopathology, Suicidal Ideation, Impulsivity, Hypersexuality, and Sexually Transmitted Infections Steven D. Shirk, USA, with J. L. Turban, M. N. Potenza, R. A. Hoff, and S. W. Kraus
This study surveyed 283 male and female veterans via email, recording data across nine mental health, substance use, psychological, and sexual behavior instruments. Within the sample, 68.9% had sent sexually explicit texts, photos, or videos. Sexting rates in the sample were comparable with rates in civilian populations, with men having higher rates. Sexting rates were higher among individuals with less education and employment. Individuals reporting more religious service attendance were less likely to engage in sexting. Sending sexts was significantly linked to measures of depression, impulsivity, sensation seeking, and a lack of perseverance. Individuals who had sexted as compared to those who did not had more lifetime sexual partners and more symptoms of hypersexuality, but there were no group differences in reported sexually transmitted infections.
“Investigating the Psychometric Properties of the Hypersexual Behavior Inventory Using a Large-Scale, Nonclinical Sample across Gender and Sexual Orientation” Beata Bothe, Hungary, with R. Bartok, I. Toth-Kiraly, M. D Griffiths, Z. Demetrovics, and G. Orosz
This study was based on a substantial data set of over 18,000 individuals gathered in Hungary through the January 2017 online survey by Demetrovics et al., referenced above. The sample was one third women and about 6% non-heterosexual. The mean age was 33.6 years, standard deviation (SD) 11.1 years and range 18–76 years. The study measured coping, control, and consequences using the Hypersexual Behavior Inventory (HBI) and employed sexuality-related questions. The focus was on hypersexuality rather than pornography consumption. It concluded that the HBI has initial diagnostic value, but to secure a diagnosis, the patients would also need to undergo a formal clinical interview using defined criteria. Efforts to determine valid threshold values for the HBI were complicated by the presence of possible false positives. The group with the highest risk of developing hypersexual disorder may have been non-heterosexual males, with non-heterosexual females also apparently at high risk. Individuals with hypersexuality had lower levels of mindfulness, self-compassion and selfforgiveness. This research has now been published as Bothe et al. (2018b).
“Hypersexuality and Pornography Consumption in U.S. Military Veterans with Comorbid Pathological Gambling Disorder”
Joshua B. Grubbs, USA, with H. Chapman, L. Milner, and R. C. Reid
This study of 329 U.S. military veterans receiving inpatient treatment for gambling disorder (80% men, mean age 53 years, SD 11.5 years) reported on the prevalence of compulsive sexual behavior disorder (CSBD) in the group. Analysis suggested that gambling disorder was associated with greater levels of CSBD, although less than suggested by prior studies. Veterans with both gambling and sexual behavior problems exhibited greater distress and lower quality of life, as well as a greater severity of gambling-related difficulties.
“Psychological Correlates of Coping with Stressful Life Events among Hypersexual Patients in an Outpatient Setting” Rory C. Reid, USA
The study focused on the types of coping strategies and treatments used with hypersexual patients. The HBI is available in seven languages, including English and Spanish. A short form of the HBI with 8 items may be published soon, employing 5-point scales. Reid reported that in the clinical group he studied, shame, withdrawal, and turning to sex as a way of coping were related to hypersexuality. Patients were given training to reduce shame through self-compassion based on a model developed by Kristen Neff. In the setting of stressful experiences, hypersexuality was positively correlated with stress proneness and tendencies to adopt avoidant strategies and negatively correlated with assertive strategies. The strongest correlation appeared to exist with the tendency to distract oneself in response to a stressful event. Data in this study support the idea of hypersexual patients turning to sex as a way of distracting themselves from stressful events.
Session: The Diversity of Addictive Behaviors Chair: Koby Cohen “On the Relationship between Obsessive-Compulsive Symptoms, Depression, Anxiety and Sexual Addiction among Adults Who Use the Internet to Find Sexual Partners” Koby Cohen, Israel, with G. Levi, K. Cohen, and A. M. Weinstein
This small-scale Israeli study included 145 males of mean age 32.79 years (range 20–65) and 32 females, mean age 30.18 (20–63). The participants were recruited online via social network sites for finding sexual partners. It concluded that the largest contribution to sexual addiction was the presence of obsessive-compulsive symptoms, rather than depression or anxiety.
“Obsessive-Compulsive Disorder in Hypersexual Patients” Magdalena Smas-Myszczyszyn, Poland, with M. Lew-Starowicz
This Polish study considered levels of obsessiveness and compulsiveness
in three patient groups—compulsive masturbators, people who were engaging
in poorly controlled sexual relationships with multiple partners, and a
group doing both activities. The study interviewed 108 patients meeting the
criteria for hypersexual disorder and took measures using the Yale-Brown
Obsessive-Compulsive Scale, the Obsessive-Compulsive Inventory–Revised,
and the State-Trait Anxiety Inventory.
The authors found that the nature of obsessions and compulsions presented
by hypersexual patients is varied and includes non-sexual aspects.
Significant differences were found relating to the intensity of the obsessivecompulsive
symptoms and the level of anxiety between the three groups.
The group of compulsively masturbating patients had a higher level of anxiety
and a greater severity of obsessive-compulsive features than the two
other groups.
The basis for impaired control in the compulsive masturbation group
may relate to high levels of anxiety. Compulsive masturbation may be
obsessive-compulsive in nature, and this relationship should be considered
in planning therapy.
Session: Compulsive Sexual Behavior: Characteristics and Diagnostic Considerations
Chair: Marc N. Potenza
“Findings from the Polish Compulsive Sexual Behavior Disorder Field Trial”
Mateusz Gola, Poland, with E. Kowalewska, M. Wordecha, M. Lew-Starowicz, S. W.
Kraus, and M. N. Potenza
This study examined in a large Polish sample the proposed definition of
Compulsive Sexual Behavior Disorder (6C72) in the draft of ICD-11. In
particular, among those seeking treatment for CSB, the criteria proposed
for ICD-11 CSBD were examined, as were relationships with constructs
such as sex addiction and hypersexual disorder. Screening tests were also
examined, as were characteristics of people seeking treatment for CSB.
Recruitment of test subjects through Polish media resulted in 1,812 treatment
seekers, with 93% being male, 86% reporting problems with pornography,
87% reporting problems with masturbation, 18% having concerns
relating to casual sex, and 12% having concerns relating to paid sexual
activities. The sample had a mean age of 35.69 years (SD¼9.78).
In the sample, 50% to 72% of people interested in treatment for CSB
met criteria proposed for ICD-11 for CSBD. The most common problematic
behaviors included pornography viewing and masturbation. Screening
tools such as the Hypersexual Behavior Inventory, the Sexual Addiction
Screening Test, and the Brief Pornography Screener (BPS) appeared to
perform well. When compared to the group who failed to meet the criteria
for CSBD diagnosis under ICD-11, the individuals meeting the criteria
experienced more primary and secondary negative impacts on their life,
especially in the areas related to relationships.
“The Relationship between Compulsive Sexual Behavior and Sexual Performance and Attitudes among Males and Females” Ewelina Kowalewska, Poland, with K. Sro slak and M. Gola
Following a detailed introduction on the Multidimensional Sexuality Questionnaire (MSQ; Snell et al, 1993), the team described two studies. The first study examined relationships between dimensions on the MSQ and CSB symptoms in a general Polish population. The respondents were 200 males (mean age 25.78 years, SD¼5.75 years, 66.5% heterosexual) and 43 females (26.05 years, SD¼6.88 years, 79.5% heterosexual). The study used Polish versions of the MSQ, the Sexual Addiction Screening Test (SAST-PL) and the Brief Pornography Screener. In the case of women, problematic pornography use was correlated positively with anxiety about sexual aspects of one’s life, the tendency to be aware of the public impression that one’s sexuality makes on others, and the fear of engaging in sexual relations with another individual. Among males, all three of these aspects were strongly and significantly related to scores on the SAST-PL. Individual scores obtained on the SAST-PL for both genders were also strongly related to feelings of depression stemming from sexual behaviors. CSB features (as assessed with SAST) were negatively related to levels of sexual satisfaction in both males and females.
In the second study, the researchers compared the general population to a group of patients seeking treatment for CSB. The male sample from Study 1 and a separate sample of 7 men meeting the criteria of hypersexual disorder (Kafka, 2010) who were seeking treatment for CSB were studied. Instruments employed included the MSQ, SAST (revised), and the BPS. There were significant differences between the clinical group and the males from Study 1 on scores of sexual anxiety, sexual assertiveness, and sexual monitoring and SAST-R scores. There were significant negative correlations between BPS scores and sexual esteem and sexual satisfaction, and significant positive correlations between BPS scores and sexual anxiety and sexual depression.
“Reward Learning in Men with Compulsive Sexual Behavior” Valerie Voon, UK
Taking Kuhn and Gallinat (2014) as a starting point for distinguishing between problematic and non-problematic levels of pornography use, Voon characterized the problematic users as men with CSB. She used the models for the proposed DSM-5 criteria for Hypersexual Behavior Disorder from Kafka (2010) and Reid et al. (2012), as well as the Carnes (2001) model of sexual addiction. This led her to posit a conceptual model which considered the potential overlaps between four factors: behavioral addiction, excessive desire, impulse control disorders, and obsessive-compulsive-spectrum disorder. At this point, the question was asked, “Do addiction theories apply to CSB?” The examination came from experimental perspectives of incentive motivation, the relationship of impulsivity to compulsivity, and the role of negative reinforcement. To explore the question, Voon discussed a selection of cue-reactivity studies, including recent work by Gola et al. on wanting and liking. She then considered how conditioning or novelty-seeking may relate to attentional bias, particularly with respect to habituation. Men with CSB were more likely to prefer novel sexual cues than men without CSB. The CSB group also demonstrated a preference for cues conditioned to sexual and monetary outcomes. Men with CSB were also more likely to demonstrate greater habituation in dorsal cingulate activation to repeated sexual, versus monetary, stimuli. The degree of the habituation correlated with their preference for sexual novelty. Functional connectivity patterns in the dorsal cingulate to the ventral striatum and hippocampus relating to sexual cue outcomes differed over time for the CSB and non-CSB groups, with greater connectivity in later trials by the CSB group (Banca et al., 2016).
“Assessing Problematic Pornography Use in a Nationally Representative Sample ofU.S. Adults” Joshua B. Grubbs, USA, with S. Perry and S. W. Kraus
This study considered four potential predictors of self-reported pornography related problems in a nationally representative sample of 2,000 people. The predictors were pornography use, religious beliefs, moral disapproval and male gender. Test subjects were representative by age, gender, income, race, and U.S. Census Region. Within the sample, 1,061 (67% male) had used pornography in the past year. The tools used included the Cyber Pornography Use Inventory (CPUI-3), single item addiction, BPS, a single item Moral Disapproval of Pornography Use, pornography use by frequency and hours, religiousness (three items), and a DSM-5 measure. A substantial percentage (15.5%) of people reported some problems with pornography use based on a BPS score greater than 4. Overall, 6% of the population identified with the statement, “I am addicted to internet pornography.”
Cross-sectionally, self-reported pornography problems were positively associated with moral disproval, religiousness, pornography use, and the frequency of pornography use. They were associated with male gender but not age.
“A Rose by Any Other Name? Classification Issues Surrounding Compulsive Sexual Behavior for ICD-11” Marc N. Potenza, USA
This presentation summarized developments in the field of CSBD during
the past year and then outlined some issues requiring additional research.
It began with a recent history of CSBD in the context of DSM-5 and the
development of ICD-11. It noted that the Impulse Control Disorder
Workgroup had been the group most actively considering CSB for inclusion
in ICD-11. There has been significant discussion in the literature, particularly
in Kraus et al. (2018) that appeared in World Psychiatry, as to
whether it should be listed as an impulse control or addictive disorder.
Other key contributions included letters in Lancet Psychiatry from Potenza
et al. (2017) and Prause et al. (2017).
Potenza noted that data collection, particularly field testing, was ongoing
to see how the proposed definitions for ICD-11 diagnoses operate (e.g., in
clinical settings). The ICD-11 Beta test site has produced feedback which
led to the removal of the narrower term of “sex addiction.” The presentation
concluded with the suggestion that the inclusion of CSBD in the ICD
would support public health, prevention, program, policy, and treatments
relating to the disorder. It is expected that precise diagnostic criteria will be
developed through an ongoing process supported by additional data.
Session: Hypersexual Behavior in Different Contexts Chair: Yasser Khazaal
“Understanding and Predicting Profiles of Compulsive Sexual Behavior among Adolescents”
Yaniv Efrati, Israel, with M. Gola
This two-part study aimed to provide data on CSB features among adolescents
and hoped to propose a typology of CSB sub-types in this age
group. The first study of 1,182 Israeli school students (42.3% boys, mean
age 16.68 years, SD¼1.54 years) worked with the new Individual-based
Compulsive Sexual Behavior (I-CSB) tool (Efrati & Mikulincer, 2018).
Latent profile analysis was used to examine differences between groups
across four factors: unwanted consequences, negative affect, poor control,
and affect regulation. The study generated characteristic profiles for individuals
with no CSB (low), fantasizing CSB (medium), and CSB (high)
scores. The authors noted that the I-CSB scale showed that individuals
with high sexual desire, but also high fear of performance, generally
escaped to sexual fantasies rather than engaging in explicit sexual behaviors
with other people.
In the second study, participants were 618 Israeli adolescents (341 boys,
mean age 16.69 years, SD¼1.16 years). Instruments/assessments included/
measured the I-CSB, frequency of pornography use, off-line sexual
behaviors, sex-related online activities, Big Five inventory, revised UCLA
Loneliness Scale, and the Levenson feelings of control and attachment styles
through the Experiences in Close Relationships scale. The results were considered
with respect to the same characteristic profiles as in Study 1: no
CSB (low), fantasizing CSB (medium) and CSB (high) scores. Study 2
found that the majority of participants engaged in sexual activity, with
approximately 10% presenting a high level of CSB. Adolescents in the high
CSB group differed in their personality features (higher neuroticism and
lower agreeableness) from adolescents in the non-CSB and fantasizing
groups. The findings suggest possible risk factors of CSB development and
provide some hints for early prevention.
Adolescents with high levels of CSB symptoms may be characterized by
an external locus of control, anxious attachment, greater loneliness, higher
frequency of pornography use, and more sex-related online activities. The
CSB and CSB fantasizing groups were comprised of more boys than the
non-CSB group. In addition, more adolescents in the CSB group had offline
sexual experiences than the fantasizing CSB group, which in turn had
more than the non-CSB group.
“Implicit Associations in Hypersexual Disorder”
Jannis Engel, Germany, with M. Veit, C. Sinke, J. Kneer, C. Laier, U. Hartmann, T.
Hillemacher, and T. H. C. Kru€ger
In Germany, a group of 50 male, heterosexual participants (mean age
36.51 years, SD¼11.47 years) with Hypersexual Disorder (Kafka 2010) were
compared to 40 healthy volunteers (37.92 years, SD¼12.33 years) across a
selection of questionnaires, clinical interviews, neuropsychological tests, and
fMRI. Weekly pornography viewing by the two groups was respectively
87.53 minutes (SD¼125.50) and 18.93 minutes (SD¼19.2). A modified
version of the Implicit Association Test (Snagowski et al, 2015) was
employed. The responses of the hypersexual disorder group were distinct
from those of the healthy volunteers when plotting the Hypersexual
Behavior Inventory-19 scale against the Implicit Association Test. The
researchers concluded that the men classified as having hypersexual behavior
disorder had stronger implicit associations towards pornographic content
than did the healthy volunteers. The results indicate similarities to
findings from research on substance and behavioral addictions.
“Online Sexual Activities (OSAs) in Spain: Similarities and Differences across the Lifespan”
Jesus Castro-Calvo, Spain, with R. Ballester-Arnal, D. Gil-Llario, C. Gimenez-Garcia, & J. Billieux
Aims of this study were to compare the online sexual activities of people
of various ages and to compare the prevalence of problematic use of the
Internet for sexual purposes by different age groups. They recruited 1,000
participants, 200 in each age group of under 18 years, 18–25 years, 26–40,
41–60, and 61 or older. All groups had 50% males and females. Assessment
was on an ad hoc scale assessing online sexual activities and the Internet
Sex Screening Test (ISST).
Overall, nearly all age groups used the Internet for sexual purposes, with
prevalence rates exceeding those from previous national studies in Spain.
Differences between men and women were more evident among people
over 40 years old, and in women, the use of the Internet for sexual purposes
was infrequent in individuals over 40 years of age. There was a progressive
reduction of gender-related differences among younger
respondents.
In both males and females, non-arousal and solitary arousal activities
were most frequent in individuals aged between 18 and 25 years. Partnered
arousal activities were more prevalent in individuals aged between 26 and
40 years old. Age is an important variable in considering potential risks of
problematic Internet use for sexual purposes, particularly in males. The
highest prevalence of participants seemingly at risk of developing symptoms
of problematic Internet sexual use was in the group between 26 and
40 years old. In this group 33% were at risk. Overall, educational and
hedonic motives related to OSAs may lose importance with age, whereas
social motives may be more relevant later in life. However, factors related
to generational impacts as opposed to age per se cannot be excluded.
“Gambling Motives Questionnaire Adapted to Cybersex”
Yasser Khazaal, Switzerland, with E. Franc and S. Rothen
This Swiss project reported on the conversion of the Gambling Motives
Questionnaire, an established tool, into an instrument for investigating the
motives for the use of cybersex. The study also sought to validate the new
tool. The Cybersex Motives Questionnaire adapted a 17-question set from
gambling research into three motivation subscales.
The modification included the removal of several gambling questions
and the inclusion of several new potential cybersex motivations. The result
was a 17-item questionnaire which allows assessment on three sub-scales:
enhancement, coping, and social.
The validity of the new tool was examined for the principal component
analysis using an online sample of 191 adults who used cybersex and for
the confirmatory factor analysis using an online sample of 204 adults.
External validity was judged against the Sexual Desire Inventory. The selfselected
test sample population had a median age of 32 years, was 54.4%
male, with a breakdown of relationship status of 29.4% single, 45.4% in a
relationship, and 24.4% married. The sample reported as 81.3% heterosexual,
13.8% homosexual, and 4.9% bisexual. The researchers concluded that
the motivation factors, enhancement, social and coping were in line with
existing mainstream work in this field.
“Communicating the Science of Cybersex Addiction to Wider Audiences”
Darryl K. Mead, UK, with M. Sharpe
Research suggests that there is considerable potential for internet pornography
consumption to lead to addiction-related brain changes. How can
the emerging science of problematic pornography use be made accessible to
professionals and the wider public in effective ways?
After a brief review of the origins of The Reward Foundation, Mead and
Sharpe looked at the efficacy of some of the public communication initiatives
with which they have experimented in the past three years. Their
efforts fell into two main strands. First, they have concentrated on sharing
their knowledge of the behavioral-addiction-based pornography research
with healthcare professionals such as family doctors and sex therapists. In
2017, their one-day training workshop on the impact of Internet pornography
on mental and physical health was accredited by the Royal College
of General Practitioners in London for Continuing Professional
Development credits. Delivery of this training helps bridge the knowledge
gap between the behavioral addiction research community and the practitioners
who can apply that knowledge in a healthcare context. The authors
also published a summary of the cybersex papers presented at the 4th
ICBA Conference in a peer-reviewed journal for the sexual therapy community
to enhance their understanding of the neuroscience (Mead &
Sharpe, 2017).
Second, The Reward Foundation delivers lessons in secondary schools,
where it also trains teachers and engages with parents. Since 2017, The
Reward Foundation has developed lesson plans for use by a school’s own
teachers to help them unpack different aspects of problematic pornography
use in the classroom context. To date, this work has concentrated on the
government school sector and is now being extended experimentally into
faith-based schools. Religious educators are very cautious about encouraging
any discussion of the influence of pornography. However, using an evidence-
based behavioral addiction model makes access easier. Delivered
sensitively, the science of cybersex addiction can be acceptable to faithbased
communities, where its messages are seen as complementary, not
contradictory, to teachings in religions such as Catholicism and Islam.
Session: Problematic Pornography Use: Assessing Characteristics in a Rapidly Changing
Environment Chair: Joshua B. Grubbs
“Gender Considerations in the Correlates of Problematic Pornography Use”
Gretchen R. Blycker, USA, with S. W. Kraus, B. Bothe, A. Zsila, I. Toth-Kiraly, G.
Orosz, Z. Demetrovics, and M. N. Potenza
Health concerns linked to pornography viewing have been underresearched
within populations of women. The presentation began with an
assessment of the literature. It then utilized a large online sample to understand
how pornography viewing relates to hypersexuality, impulsivity,
childhood sexual abuse, and other factors.
Data from 24,372 pornography viewers (7,486 female) were gathered
through a large Hungarian news portal. Assessment tools included the
Problematic Pornography Consumption Scale (PPCS), the Hypersexual
Behavior Inventory, the Hypersexual Behavior Consequences Scale, the
Sexual Abuse History Questionnaire, the UCLA Loneliness Scale and the
ADHD Self Report Scale. Impulsivity was assessed using the UPPS-P scale.
As hypothesized, more men (97%) than women (78%) reported past year
pornography use. Men also reported greater hypersexuality, more hypersexuality-
related consequences, and more problematic pornography use than
women. Surprisingly, men also reported more childhood and adolescent
sexual abuse than women.
Women were more likely than men to score higher on ADHD measures
and impulsivity, including all except the Sensation-Seeking subscale. The
findings suggest that women who view pornography may be particularly
impulsive and may experience attentional difficulties. Additionally, 6.2% of
men and 4.7% of women recorded behaviors above the threshold for
Problematic Pornography Use.
The correlations between the PPCS and measures of impulsivity, hypersexuality,
loneliness, and ADHD were similar in men and women, suggesting
that common pathways may be operating across gender groups. The
particularly strong correlations in men between PPCS scores and hypersexuality
and its consequences is consistent with existing research and suggests
interventions for hypersexuality in men may need to consider targeting
pornography viewing.
“Binge Pornography Use and Masturbation as a Key Characteristic of Males Seeking Treatment for Compulsive Sexual Behaviors”
Małgorzata I. Wordecha, Poland with M. Wilk, E. Kowalewska, M. Skorko, A.
Łapi nski, and M. Gola
The study reported on nine men who had been referred by sexual health
centers for treatment of CSB. The group was a mix of heterosexual and
homosexual men with a mean age of 31.7 years (SD¼4.85). There was no
control group.
This study considered binge pornography use and masturbation with
respect to self-perceived factors hypothesized to be driving the behavior.
The factors were compared via ten weeks of daily diary data and a onehour
structured clinical interview. Diary records included measures of
sexual arousal, anxiety, stress, mood, and features of CSB, including time
spent viewing pornography and numbers of sessions of masturbation and
intercourse.
The researchers noted that there is a lack of scientific evidence to show
if bingeing is a standard characteristic of CSB. The study defined a binge
as watching pornographic content (and/or masturbating) for a few hours,
or repeating the activity many times during a day. Seven subjects had experienced
binges, ranging from duration of half-an-hour to half-a-day, up to
several times per day, and with frequency ranging from daily to several in
the ten weeks or only one day in their life. In the clinical interview, the
triggers reported were mainly stress and problems in personal life, fear of
failure, anger, loneliness, and rejection.
For processing the diary data, the criteria for bingeing were set at more
than two masturbations per day and a single pornography session lasting
more than one hour. Overall, the researchers reported that binge pornography
use may allow men to feel excitement and pleasure, while “turning
off” thinking and emotions. After the binge, all subjects reportedly experienced
negative emotions and thoughts about themselves. Four possible
explanations were put forward for binges: a stress-reducing mechanism,
increasing reactivity with stronger urges, habituation, and as a delay of climax
(“edging”). This paper has now been published by Wordecha
et al. (2018).
“Delay Discounting and Craving in the Context of Internet-Pornography-Use Disorder”
Stephanie Antons, Germany, with M. Brand
Antons and Brand focused on specific aspects of the I-PACE Model to
consider delay discounting. Delay discounting involves selecting smaller,
more immediate rewards over larger, later rewards. It is considered a form
of impulsivity and of the tendency to have difficulties in delaying gratification.
The researchers studied this aspect of impulsivity component through
the lens of craving in the affective and cognitive responses involved in
Internet-pornography-use disorder. They asked if craving has a mediating
or moderating effect on the link between delay discounting and the symptom
severity of Internet-pornography-use disorder. The sample was comprised
of 145 heterosexual males who use Internet pornography (average
age¼29.92 years).
Participants performed a delay-discounting task. Baseline craving and
symptom severity of Internet-pornography-use disorder were assessed using
questionnaires. While baseline craving was correlated with symptom severity
of Internet-pornography-use disorder on a bivariate level, delay discounting
and symptom severity of Internet-pornography-use disorder
were not.
The moderated regression analysis shows that participants who preferentially
selected immediate rewards rather than delayed rewards and who
showed higher baseline craving also had higher symptom severity of
Internet-pornography-use disorder. This finding suggests that decisionmaking
styles, in conjunction with affective factors such as baseline craving,
explain symptom severity of Internet-pornography-use disorder. Results
were also discussed in the context of potential neural mechanisms.
“Individual Delay-Discounting Rate in a Patient with Hypersexual Disorder”
Magdalena Smas-Myszczyszyn, Poland, with M. Lew-Starowicz
This sample of 108 patients with hypersexual disorder was given the
Monetary Choice questionnaire that assessed delay discounting. They also
completed the Polish version of the Sexual Addiction Screening Test. The
sexological sample was comprised of 66 individuals with compulsive masturbation,
along with 22 individuals who were compulsively “acting out”
sexually with partners and 20 who were compulsive in both categories.
Small amounts of money were discounted, preferred, more than large
amounts by all test groups. Patients in the group who were compulsive in
both masturbation and in pursuing sex with many partners were the most
impulsive. Learning the ability to defer gratification may represent an
important therapeutic goal for this group. Previous experiments confirm
that rewards are more strongly discounted than penalties (Thaler 1991),
suggesting that approaches that place more emphasis on the potential benefits
of the cessation of uncontrolled sexual behaviors, rather than on the
consequences of continuation, could have therapeutic effectiveness.
“Sociodemographic Changes in Pornography Use Between 2002 And 2016: A Study of a Representative Sample of the Polish Population”
Karol Lewczuk, Poland, with M. Gola
In the United States, the General Social Survey has been asking a single
question “Have you seen an X-Rated movie in the last year?” in every decade
since the 1960s. Currently 40% of men and 20% of women answer
“yes.” However, many studies from gaming, gambling, and Facebook use
show a large gap between declared use and a higher level of actual use.
Obtaining new longitudinal, population-level data on pornography use is
rare. This Polish study collaborated with an Internet provider, Gemius,
who could provide technical access and historical data. Participants were
invited to participate in a panel survey through pop-ups on popular websites.
After giving informed consent, basic information about participants’
Internet browsing activities were gathered in an anonymized way using
cookies. The cookies revealed if individuals had visited pornographic websites.
Separately, the team analyzed data from samples of 10,000 plus users
in the month of October every two years from 2004 to 2016. A person was
rated as a pornography user if they visited a pornographic website during
the month—a yes/no variable.
Researchers observed a steady increase in the population using pornography,
from 8% in October 2004 to 25% in October 2016. This growth paralleled
the overall growth of the number of Internet users in the population
during the same period. There is a moderate increase in the proportion of
Internet users using pornography, most notably for males. Gender, age,
and to a small degree the size of the place of residence, seem to influence
the probability of having viewed pornography on the Internet. Age and
gender explained 8% of the variance of online pornography viewing. The
limitations of the study include that data were not gathered if incognito
mode was used for browsing and it was based only on fixed line computers
(no mobiles). The figures were also scaled up to the population level, rather
than being based on raw data. The study does not provide information
regarding the quantity, frequency or type of pornography use.
“Clinical Characteristics of Compulsive Pornography Users: A Military Sample”
Shane W. Kraus, USA, with R. A. Hoff, M. Gola, E. Kowalewska, and M. N. Potenza
In the first part of this presentation, and in reaction to the growing
range of tools to measure problematic pornography use, this team set out
to develop and validate a shorter instrument, the Brief Pornography
Screener (BPS). It is a 5-item screener used to assess compulsive/problematic
use of pornographers in healthcare settings. It is scored each factor
either “never” (0), “sometimes” (1), and “frequently” (2), producing a
cumulative range of scores from 0 to 10. Work with U.S. (n¼223) and
Polish (n¼703) samples indicated excellent reliability and recommended a
cutoff score of 4, above which the subjects are likely to have problematic
pornography viewing issues. A score of 4 has a sensitivity of 80.4% and a
specificity of 80.3%.
The second study evaluated the clinical characteristics of participants
who scored positive on the BPS. The sample was 283 U.S. post-9/11 military
veterans was assessed with tools including sociodemographics, PRIMEMD,
AUDADIS-IV, Insomnia Severity Index, PTSD Symptom Checklist,
BPS, PPUS, HBI, UPPS-P, and the Difficulties in Emotional
Regulation Scale.
In the sample, 27.3% scored on or above the cutoff for the BPS. Over
92% of the veterans in the sample were male and more than a third of
individuals screening positive viewed pornography daily.
Emotional dysregulation was higher among problematic users than
among non-users. It is possible that problematic use may occur within the
context of emotional states related to stress or depression. Positive and
negative urgency forms of impulsivity were higher among individuals with
problematic pornography use. The findings resonate with prior work in
substance use and hypersexuality suggesting that problematic use can occur
in the context of stress or strong emotional states.
Depression was elevated among individuals with problematic pornography
use. Problematic pornography use was also associated with craving
for pornography.
Other presentations on pornography and sexuality
There were five other presentations that we were not able to observe. Readers are directed to the published abstracts for an indication of their content and conclusions (Demetrovics 2018). The session Cue-Reactivity and Craving in Off-Line and Online Behavioral Disorders included two relevant papers:
“Hypersexual Behaviors and Craving Reactions to Pornographic Pictures are Related
to Symptoms of an Internet-Pornography-Use Disorder”
Jaroslaw Pekal, Germany, with M. Brand
“The Influence of Stress on the Processing of Visual Sexual Stimuli in Men”
Jana Strahler, Germany, with O. Kruse and R. Stark
Research presented in the session Binge Behaviors: Conceptualization and Underlying Psychological Processes included:
“Approach and Avoidance Tendencies in Hypersexual Disorder”
Maria Veit, Germany, with J. Engel, C. Sinke, J. Kneer, C. Laier, S. Antons, U. Hartmann, T. Hillemacher, and T. H. C. Kru€ger
“Surveying Self-Identified Sex Addicts Supplies Evidence That Symptoms of Hypersexual Behavior and Internet-Pornography-Use Disorder are Associated with Common, but also Different Personality Characteristics”
Christian Laier, Germany, with J. Engel, M. Veit, S. Antons, M. Brand, and T. H.
C. Kru€ger
Within the Minitalk strand there was a paper titled:
“Excessive Internet Use for Sexual Purposes in Late Life: An Explorative Study of Risk Factors” Anna Sevcıkova, Czech Republic, with L. Blinka and K. Skarupova
...............................................
Discussion
This conference explored many different aspects of current research into the use of pornography by individuals and populations. Importantly, the conference keynote by Rudolf Stark concluded by suggesting that the case for pornography use disorder in the ICD-11 was strengthened by its foundation in the processing of natural rewards. Less than two months later, the new diagnosis of CSBD was ratified by the WHO secretariat for inclusion in ICD-11 (World Health Organization, 2018).
There were also advances in the collective scale and ambition of the reported research. In the past, small sample sizes and variable sample quality have limited some studies in the pornography research field. At the 2018 ICBA, the emergence of some larger samples suggested a growing strength in the field. While heterosexual men still dominate the research reports as test subjects in terms of sheer number, three of the studies reported on samples involving thousands of women and several more involved hundreds of women. Key were studies in Hungary, Poland, and the United States. The major Spanish study controlled its subject sample by both gender and age, but this was at the cost of only having 100 people of each gender and age group. Sexual minorities also appeared in a few studies at levels which support the drawing of statistically valid conclusions.
Several studies focusing on smaller numbers of subjects were able to work
more intensively, administering a wider selection of investigatory tools.
Sexually focused behavioral research is becoming well established with a
wider range of societies around the world now being investigated by
national or multinational research groups. A positive trend is the resulting
translation and validation of research tools into more languages. For
example, the Hypersexual Behavior Inventory has been translated and is
available in seven languages, and several other instruments originally developed
in English now come in Hungarian, Polish, and German versions.
Efforts to make assessment and diagnostic instruments shorter are also
coming to fruition. The Brief Pornography Screener now seems fit for
adoption by frontline practitioners as a tool for initial assessment of individuals
within the context of a short face-to-face consultation.
Work linked to the WHO CSB field trial found that significant numbers
of individuals who use pornography felt they were addicted to pornography
(6% in United States). Within the treatment-seeking Polish group, 86%
self-reported problems with pornography and 87% with masturbation, with
about half of both groups meeting clinical criteria for entering treatment.
In the online Hungarian study, 6.2% of the men and 4.7% of the women
recorded behaviors above the threshold for problematic pornography use.
These studies of self-selected groups begin to give a picture of the extent to
which issues relating to pornography use are appearing in pornographyconsuming
populations.
ABSTRACT: The 5th International Conference on Behavioral Addictions was held in Cologne, Germany, April 23-25, 2018. It featured one of the largest concentrations of papers on pornography and sexual research presented in a single venue to date. Several key themes emerged from the conference. The theoretical basis for developing pornography and sexuality studies as components within the behavioral addiction research landscape is beginning to mature. Core components are the I-PACE theory and the development, validation, and employment in field studies of a steadily growing set of assessment tools including the Problematic Pornography Use Scale, the Brief Pornography Screener, and the Hypersexual Behavior Inventory. The field also benefitted from a keynote speech and a formal pro/con debate. The other principal debate was around the imminent release of ICD-11 by the World Health Organization and the way that Compulsive Sexual Behavior Disorder (CSBD) would be handled. There was a selection of papers looking at the debate from a variety of theoretical and practical points of view. Fieldwork from Poland suggested that well over 80% of people seeking treatment for CSBD had a problem with pornography use, rather than issues from acting out with real sexual partners.
Introduction
The overall message for pornography research from the three days of the 5th International Conference on Behavioral Addictions (ICBA, 2018) was one of positive advances in scientific understanding. Compared to the 4th Conference, 14 months earlier, there were greater aspirations in the scope of the research, significant progress in increasing the sample sizes in many studies, and improvements in sample quality. Underpinning all of these was the success of the Interaction of Person-Affect-Cognition-Execution (I-PACE) theory in providing a unifying framework. I-PACE not only starred in the sexuality papers, but also was referred to in several keynotes and featured in the work presented in several parallel research fields. It has become a common starting point for many behavioral addiction researchers, irrespective of their field of interest.
For sexuality and pornography researchers, the critical background factor was the imminent release of the 11th revision of the International Classification of Diseases (ICD-11) by the World Health Organization. There were a number of papers attempting to predict what it would contain. In some cases, the authors hoped to directly influence what was to be included and how it would be framed or limited. ICD-11 was released on June 18, 2018. It introduced 6C72, Compulsive Sexual Behavior Disorder (CSBD), within the category of Impulse Control Disorders. This differed from what some researchers proposed at ICBA 2018. They indicated that it might best be placed in the realm of addictions, within the category of Disorders Due to Addictive Behaviors, along with 6C50 Gambling Disorder and 6C51 Gaming Disorder. It is anticipated that there will be plenty of scope at upcoming ICBA meetings to develop the arguments to shape future updates of the ICD. All abstracts for the 5th Conference have been published in a supplement to the Journal of Behavioral Addictions (Demetrovics 2018). The 6th International Conference on Behavioral Addictions was announced by the International Society for the Study of Behavioral Addictions for June 17-19, 2019 in Yokohama, Japan.
Keynote lecture
The keynote lecture by Germany’s eminent researcher and clinician Rudolf Stark on “Pathological Pornography Use—What We Know and What We Still Need to Know” was the first time pornography research had been given such a prominent place at the International Conference on Behavioral Addictions.
This keynote was in three parts. First, it considered pornography consumption as a social phenomenon on the Internet, noting the rising prevalence of use, particularly by men. Stark explored the neurobiological correlates of watching pornography as well as experiments covering distractibility and learning. Pornographic stimuli may activate reward systems and capture attention. The anticipation of sexual stimuli may activate reward systems in similar fashions as does anticipation of drugs, although these have not been directly compared.
The second part considered the potential to place problematic pornography use within the Beta draft of ICD-11 under 6C5Y, “Other Specified Disorders Due to Addictive Behaviors.” Two open questions were identified. First, within diagnostic criteria, are withdrawal and tolerance key features of pathological pornography use? Second, are different compulsive sexual behaviors, such as excessive impairing promiscuous dating behavior and pathological pornography use, different or do they constitute the same disorder?
The Keynote concluded by considering the current knowledge of the etiology of problematic pornography use. Stark made reference to the I-PACE model for problematic pornography use, covering data from experimental perspectives of cue reactivity, personality analysis, and co-occurring disorders. He then referred to his own work using the Trait Sexual Motivation Questionnaire (Stark et al, 2015) to consider if there may be subtypes of individuals with problematic porn use. He identified a Gratification group driven mainly by positive reinforcement, that is seeking pleasure, and a Compensation group where the reinforcement was negative, to avoid pain or other negative affect. He reported that around half of a clinical sample was in one group and half in the other.
Stark concluded by suggesting more work is needed to examine the natural course of problematic pornography use where non-problematic pornography use transitions into problematic use. He concluded by suggesting that the case for pornography use disorder in the ICD is strengthened by its foundation in the stimulation of systems relating to the processing of natural rewards. As to why a clinical diagnosis was not yet accepted, at the time of the conference, he suggested that it may be due to individual, socio-cultural, and political reasons.
Pro/Con debate on behavioral addictions
A welcome addition to ICBA 2018 was the introduction of a debate on the fundamental nature of behavioral addiction. The bonus for students of sexual behavioral addiction studies was that both speakers are recognized researchers in the pornography field, so they drew heavily on sexualitybased issues in framing their arguments.
Pro: “Behavioral Addictions: From Over-Pathologizing to Real Clinical Phenomenon” Aviv M. Weinstein, Israel
The arguments identified by Weinstein in favor of considering behavioral
addictions as a real clinical phenomenon were as follows:
Pathological gambling (PG), Internet gaming disorder (IGD), compulsive
sexual behavior (CSB), and compulsive buying (CB) all fit better into the
behavioral model of addiction than in an obsessive-compulsive model. He
argued that the neural mechanisms underlying the four conditions are
similar to those of drug addictions. These conditions and behaviors involve
changes in reward processing, inhibitory mechanisms, impulsivity, and
impaired control.
For example, he reported that video game playing was associated with
dopamine release similar in magnitude to that of drugs of abuse. He stated
that lower dopamine transporter levels and dopamine receptor D2 occupancy
in the striatum suggested poor sensitivity of dopamine
reward mechanisms.
He reported that high rates of co-morbidity between behavioral addictions
and other psychiatric disorders are evident including with respect to
depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), obsessive-
compulsive disorder (OCD), and personality disorders. He stated that
treating co-morbid conditions may not solve addiction problems.
Con: “Conceptualizing Behavioral Addictions without Pathologizing Common Behaviors.” Joel Billieux, Luxembourg
Joel Billieux began with a working hypothesis that “According to the criteria generally used to identify behavioral addictions, it is likely that the elevated involvement of any type of activity can be considered as a psychiatric disorder…”
The aim of this working hypothesis was to clarify possible confusion between “real” disorders and healthy passions and/or dysfunctional coping strategies. In this way, clinicians could avoid imposing inappropriate treatments, and the conference could contribute to the continuing credibility and relevance of (behavioral) addiction research.
After considering the literature generated for a range of potential “fringe” behaviors as test candidates for addiction, which might alternatively be seen as everyday behaviors and leisure activities, such as dancing, studying, taking selfies, fishing, and binge watching, the analysis considered the unhelpful power of the confirmatory approach.
Billieux’s talk ended with three recommendations. First, there is a need to shift from a confirmatory and symptom-based approach to a theoretically grounded and process-based approach, for example, the I-PACE model of problematic Internet use (Brand et al, 2016). Second, there is a need to improve the diagnostic approach of behavioral addiction with stronger clinical relevance and construct validity, with particular reference to the World Health Organization initiative to develop new screening tools (Carragher et al, 2018). Lastly, there is need to acknowledge the differences between high involvement (passion) versus dysfunctional involvement (addiction).
Presentations
Session: Hypersexual disorder: Relationships with transdiagnostic measures and clinically relevant behaviors Chair: Shane W. Kraus
“The Impulsive and Compulsive Aspects of Problematic Pornography Use and Hypersexuality”
Zsolt Demetrovics, Hungary with B. B}othe, I. T oth-Kir aly, and G. Orosz
This study used a Hungarian online sample that provided a useable dataset of 13,778 individuals, 30.1% female. It concluded that impulsivity and compulsivity did not contribute as importantly and directly to problematic pornography use as previously hypothesized, and that impulsivity may have a more prominent role in hypersexuality. This research has now been published as B}othe et al. (2018a) and interested readers are directed to the full paper.
“Sexting among Military Veterans: Prevalence and Correlates with Psychopathology, Suicidal Ideation, Impulsivity, Hypersexuality, and Sexually Transmitted Infections Steven D. Shirk, USA, with J. L. Turban, M. N. Potenza, R. A. Hoff, and S. W. Kraus
This study surveyed 283 male and female veterans via email, recording data across nine mental health, substance use, psychological, and sexual behavior instruments. Within the sample, 68.9% had sent sexually explicit texts, photos, or videos. Sexting rates in the sample were comparable with rates in civilian populations, with men having higher rates. Sexting rates were higher among individuals with less education and employment. Individuals reporting more religious service attendance were less likely to engage in sexting. Sending sexts was significantly linked to measures of depression, impulsivity, sensation seeking, and a lack of perseverance. Individuals who had sexted as compared to those who did not had more lifetime sexual partners and more symptoms of hypersexuality, but there were no group differences in reported sexually transmitted infections.
“Investigating the Psychometric Properties of the Hypersexual Behavior Inventory Using a Large-Scale, Nonclinical Sample across Gender and Sexual Orientation” Beata Bothe, Hungary, with R. Bartok, I. Toth-Kiraly, M. D Griffiths, Z. Demetrovics, and G. Orosz
This study was based on a substantial data set of over 18,000 individuals gathered in Hungary through the January 2017 online survey by Demetrovics et al., referenced above. The sample was one third women and about 6% non-heterosexual. The mean age was 33.6 years, standard deviation (SD) 11.1 years and range 18–76 years. The study measured coping, control, and consequences using the Hypersexual Behavior Inventory (HBI) and employed sexuality-related questions. The focus was on hypersexuality rather than pornography consumption. It concluded that the HBI has initial diagnostic value, but to secure a diagnosis, the patients would also need to undergo a formal clinical interview using defined criteria. Efforts to determine valid threshold values for the HBI were complicated by the presence of possible false positives. The group with the highest risk of developing hypersexual disorder may have been non-heterosexual males, with non-heterosexual females also apparently at high risk. Individuals with hypersexuality had lower levels of mindfulness, self-compassion and selfforgiveness. This research has now been published as Bothe et al. (2018b).
“Hypersexuality and Pornography Consumption in U.S. Military Veterans with Comorbid Pathological Gambling Disorder”
Joshua B. Grubbs, USA, with H. Chapman, L. Milner, and R. C. Reid
This study of 329 U.S. military veterans receiving inpatient treatment for gambling disorder (80% men, mean age 53 years, SD 11.5 years) reported on the prevalence of compulsive sexual behavior disorder (CSBD) in the group. Analysis suggested that gambling disorder was associated with greater levels of CSBD, although less than suggested by prior studies. Veterans with both gambling and sexual behavior problems exhibited greater distress and lower quality of life, as well as a greater severity of gambling-related difficulties.
“Psychological Correlates of Coping with Stressful Life Events among Hypersexual Patients in an Outpatient Setting” Rory C. Reid, USA
The study focused on the types of coping strategies and treatments used with hypersexual patients. The HBI is available in seven languages, including English and Spanish. A short form of the HBI with 8 items may be published soon, employing 5-point scales. Reid reported that in the clinical group he studied, shame, withdrawal, and turning to sex as a way of coping were related to hypersexuality. Patients were given training to reduce shame through self-compassion based on a model developed by Kristen Neff. In the setting of stressful experiences, hypersexuality was positively correlated with stress proneness and tendencies to adopt avoidant strategies and negatively correlated with assertive strategies. The strongest correlation appeared to exist with the tendency to distract oneself in response to a stressful event. Data in this study support the idea of hypersexual patients turning to sex as a way of distracting themselves from stressful events.
Session: The Diversity of Addictive Behaviors Chair: Koby Cohen “On the Relationship between Obsessive-Compulsive Symptoms, Depression, Anxiety and Sexual Addiction among Adults Who Use the Internet to Find Sexual Partners” Koby Cohen, Israel, with G. Levi, K. Cohen, and A. M. Weinstein
This small-scale Israeli study included 145 males of mean age 32.79 years (range 20–65) and 32 females, mean age 30.18 (20–63). The participants were recruited online via social network sites for finding sexual partners. It concluded that the largest contribution to sexual addiction was the presence of obsessive-compulsive symptoms, rather than depression or anxiety.
“Obsessive-Compulsive Disorder in Hypersexual Patients” Magdalena Smas-Myszczyszyn, Poland, with M. Lew-Starowicz
This Polish study considered levels of obsessiveness and compulsiveness
in three patient groups—compulsive masturbators, people who were engaging
in poorly controlled sexual relationships with multiple partners, and a
group doing both activities. The study interviewed 108 patients meeting the
criteria for hypersexual disorder and took measures using the Yale-Brown
Obsessive-Compulsive Scale, the Obsessive-Compulsive Inventory–Revised,
and the State-Trait Anxiety Inventory.
The authors found that the nature of obsessions and compulsions presented
by hypersexual patients is varied and includes non-sexual aspects.
Significant differences were found relating to the intensity of the obsessivecompulsive
symptoms and the level of anxiety between the three groups.
The group of compulsively masturbating patients had a higher level of anxiety
and a greater severity of obsessive-compulsive features than the two
other groups.
The basis for impaired control in the compulsive masturbation group
may relate to high levels of anxiety. Compulsive masturbation may be
obsessive-compulsive in nature, and this relationship should be considered
in planning therapy.
Session: Compulsive Sexual Behavior: Characteristics and Diagnostic Considerations
Chair: Marc N. Potenza
“Findings from the Polish Compulsive Sexual Behavior Disorder Field Trial”
Mateusz Gola, Poland, with E. Kowalewska, M. Wordecha, M. Lew-Starowicz, S. W.
Kraus, and M. N. Potenza
This study examined in a large Polish sample the proposed definition of
Compulsive Sexual Behavior Disorder (6C72) in the draft of ICD-11. In
particular, among those seeking treatment for CSB, the criteria proposed
for ICD-11 CSBD were examined, as were relationships with constructs
such as sex addiction and hypersexual disorder. Screening tests were also
examined, as were characteristics of people seeking treatment for CSB.
Recruitment of test subjects through Polish media resulted in 1,812 treatment
seekers, with 93% being male, 86% reporting problems with pornography,
87% reporting problems with masturbation, 18% having concerns
relating to casual sex, and 12% having concerns relating to paid sexual
activities. The sample had a mean age of 35.69 years (SD¼9.78).
In the sample, 50% to 72% of people interested in treatment for CSB
met criteria proposed for ICD-11 for CSBD. The most common problematic
behaviors included pornography viewing and masturbation. Screening
tools such as the Hypersexual Behavior Inventory, the Sexual Addiction
Screening Test, and the Brief Pornography Screener (BPS) appeared to
perform well. When compared to the group who failed to meet the criteria
for CSBD diagnosis under ICD-11, the individuals meeting the criteria
experienced more primary and secondary negative impacts on their life,
especially in the areas related to relationships.
“The Relationship between Compulsive Sexual Behavior and Sexual Performance and Attitudes among Males and Females” Ewelina Kowalewska, Poland, with K. Sro slak and M. Gola
Following a detailed introduction on the Multidimensional Sexuality Questionnaire (MSQ; Snell et al, 1993), the team described two studies. The first study examined relationships between dimensions on the MSQ and CSB symptoms in a general Polish population. The respondents were 200 males (mean age 25.78 years, SD¼5.75 years, 66.5% heterosexual) and 43 females (26.05 years, SD¼6.88 years, 79.5% heterosexual). The study used Polish versions of the MSQ, the Sexual Addiction Screening Test (SAST-PL) and the Brief Pornography Screener. In the case of women, problematic pornography use was correlated positively with anxiety about sexual aspects of one’s life, the tendency to be aware of the public impression that one’s sexuality makes on others, and the fear of engaging in sexual relations with another individual. Among males, all three of these aspects were strongly and significantly related to scores on the SAST-PL. Individual scores obtained on the SAST-PL for both genders were also strongly related to feelings of depression stemming from sexual behaviors. CSB features (as assessed with SAST) were negatively related to levels of sexual satisfaction in both males and females.
In the second study, the researchers compared the general population to a group of patients seeking treatment for CSB. The male sample from Study 1 and a separate sample of 7 men meeting the criteria of hypersexual disorder (Kafka, 2010) who were seeking treatment for CSB were studied. Instruments employed included the MSQ, SAST (revised), and the BPS. There were significant differences between the clinical group and the males from Study 1 on scores of sexual anxiety, sexual assertiveness, and sexual monitoring and SAST-R scores. There were significant negative correlations between BPS scores and sexual esteem and sexual satisfaction, and significant positive correlations between BPS scores and sexual anxiety and sexual depression.
“Reward Learning in Men with Compulsive Sexual Behavior” Valerie Voon, UK
Taking Kuhn and Gallinat (2014) as a starting point for distinguishing between problematic and non-problematic levels of pornography use, Voon characterized the problematic users as men with CSB. She used the models for the proposed DSM-5 criteria for Hypersexual Behavior Disorder from Kafka (2010) and Reid et al. (2012), as well as the Carnes (2001) model of sexual addiction. This led her to posit a conceptual model which considered the potential overlaps between four factors: behavioral addiction, excessive desire, impulse control disorders, and obsessive-compulsive-spectrum disorder. At this point, the question was asked, “Do addiction theories apply to CSB?” The examination came from experimental perspectives of incentive motivation, the relationship of impulsivity to compulsivity, and the role of negative reinforcement. To explore the question, Voon discussed a selection of cue-reactivity studies, including recent work by Gola et al. on wanting and liking. She then considered how conditioning or novelty-seeking may relate to attentional bias, particularly with respect to habituation. Men with CSB were more likely to prefer novel sexual cues than men without CSB. The CSB group also demonstrated a preference for cues conditioned to sexual and monetary outcomes. Men with CSB were also more likely to demonstrate greater habituation in dorsal cingulate activation to repeated sexual, versus monetary, stimuli. The degree of the habituation correlated with their preference for sexual novelty. Functional connectivity patterns in the dorsal cingulate to the ventral striatum and hippocampus relating to sexual cue outcomes differed over time for the CSB and non-CSB groups, with greater connectivity in later trials by the CSB group (Banca et al., 2016).
“Assessing Problematic Pornography Use in a Nationally Representative Sample ofU.S. Adults” Joshua B. Grubbs, USA, with S. Perry and S. W. Kraus
This study considered four potential predictors of self-reported pornography related problems in a nationally representative sample of 2,000 people. The predictors were pornography use, religious beliefs, moral disapproval and male gender. Test subjects were representative by age, gender, income, race, and U.S. Census Region. Within the sample, 1,061 (67% male) had used pornography in the past year. The tools used included the Cyber Pornography Use Inventory (CPUI-3), single item addiction, BPS, a single item Moral Disapproval of Pornography Use, pornography use by frequency and hours, religiousness (three items), and a DSM-5 measure. A substantial percentage (15.5%) of people reported some problems with pornography use based on a BPS score greater than 4. Overall, 6% of the population identified with the statement, “I am addicted to internet pornography.”
Cross-sectionally, self-reported pornography problems were positively associated with moral disproval, religiousness, pornography use, and the frequency of pornography use. They were associated with male gender but not age.
“A Rose by Any Other Name? Classification Issues Surrounding Compulsive Sexual Behavior for ICD-11” Marc N. Potenza, USA
This presentation summarized developments in the field of CSBD during
the past year and then outlined some issues requiring additional research.
It began with a recent history of CSBD in the context of DSM-5 and the
development of ICD-11. It noted that the Impulse Control Disorder
Workgroup had been the group most actively considering CSB for inclusion
in ICD-11. There has been significant discussion in the literature, particularly
in Kraus et al. (2018) that appeared in World Psychiatry, as to
whether it should be listed as an impulse control or addictive disorder.
Other key contributions included letters in Lancet Psychiatry from Potenza
et al. (2017) and Prause et al. (2017).
Potenza noted that data collection, particularly field testing, was ongoing
to see how the proposed definitions for ICD-11 diagnoses operate (e.g., in
clinical settings). The ICD-11 Beta test site has produced feedback which
led to the removal of the narrower term of “sex addiction.” The presentation
concluded with the suggestion that the inclusion of CSBD in the ICD
would support public health, prevention, program, policy, and treatments
relating to the disorder. It is expected that precise diagnostic criteria will be
developed through an ongoing process supported by additional data.
Session: Hypersexual Behavior in Different Contexts Chair: Yasser Khazaal
“Understanding and Predicting Profiles of Compulsive Sexual Behavior among Adolescents”
Yaniv Efrati, Israel, with M. Gola
This two-part study aimed to provide data on CSB features among adolescents
and hoped to propose a typology of CSB sub-types in this age
group. The first study of 1,182 Israeli school students (42.3% boys, mean
age 16.68 years, SD¼1.54 years) worked with the new Individual-based
Compulsive Sexual Behavior (I-CSB) tool (Efrati & Mikulincer, 2018).
Latent profile analysis was used to examine differences between groups
across four factors: unwanted consequences, negative affect, poor control,
and affect regulation. The study generated characteristic profiles for individuals
with no CSB (low), fantasizing CSB (medium), and CSB (high)
scores. The authors noted that the I-CSB scale showed that individuals
with high sexual desire, but also high fear of performance, generally
escaped to sexual fantasies rather than engaging in explicit sexual behaviors
with other people.
In the second study, participants were 618 Israeli adolescents (341 boys,
mean age 16.69 years, SD¼1.16 years). Instruments/assessments included/
measured the I-CSB, frequency of pornography use, off-line sexual
behaviors, sex-related online activities, Big Five inventory, revised UCLA
Loneliness Scale, and the Levenson feelings of control and attachment styles
through the Experiences in Close Relationships scale. The results were considered
with respect to the same characteristic profiles as in Study 1: no
CSB (low), fantasizing CSB (medium) and CSB (high) scores. Study 2
found that the majority of participants engaged in sexual activity, with
approximately 10% presenting a high level of CSB. Adolescents in the high
CSB group differed in their personality features (higher neuroticism and
lower agreeableness) from adolescents in the non-CSB and fantasizing
groups. The findings suggest possible risk factors of CSB development and
provide some hints for early prevention.
Adolescents with high levels of CSB symptoms may be characterized by
an external locus of control, anxious attachment, greater loneliness, higher
frequency of pornography use, and more sex-related online activities. The
CSB and CSB fantasizing groups were comprised of more boys than the
non-CSB group. In addition, more adolescents in the CSB group had offline
sexual experiences than the fantasizing CSB group, which in turn had
more than the non-CSB group.
“Implicit Associations in Hypersexual Disorder”
Jannis Engel, Germany, with M. Veit, C. Sinke, J. Kneer, C. Laier, U. Hartmann, T.
Hillemacher, and T. H. C. Kru€ger
In Germany, a group of 50 male, heterosexual participants (mean age
36.51 years, SD¼11.47 years) with Hypersexual Disorder (Kafka 2010) were
compared to 40 healthy volunteers (37.92 years, SD¼12.33 years) across a
selection of questionnaires, clinical interviews, neuropsychological tests, and
fMRI. Weekly pornography viewing by the two groups was respectively
87.53 minutes (SD¼125.50) and 18.93 minutes (SD¼19.2). A modified
version of the Implicit Association Test (Snagowski et al, 2015) was
employed. The responses of the hypersexual disorder group were distinct
from those of the healthy volunteers when plotting the Hypersexual
Behavior Inventory-19 scale against the Implicit Association Test. The
researchers concluded that the men classified as having hypersexual behavior
disorder had stronger implicit associations towards pornographic content
than did the healthy volunteers. The results indicate similarities to
findings from research on substance and behavioral addictions.
“Online Sexual Activities (OSAs) in Spain: Similarities and Differences across the Lifespan”
Jesus Castro-Calvo, Spain, with R. Ballester-Arnal, D. Gil-Llario, C. Gimenez-Garcia, & J. Billieux
Aims of this study were to compare the online sexual activities of people
of various ages and to compare the prevalence of problematic use of the
Internet for sexual purposes by different age groups. They recruited 1,000
participants, 200 in each age group of under 18 years, 18–25 years, 26–40,
41–60, and 61 or older. All groups had 50% males and females. Assessment
was on an ad hoc scale assessing online sexual activities and the Internet
Sex Screening Test (ISST).
Overall, nearly all age groups used the Internet for sexual purposes, with
prevalence rates exceeding those from previous national studies in Spain.
Differences between men and women were more evident among people
over 40 years old, and in women, the use of the Internet for sexual purposes
was infrequent in individuals over 40 years of age. There was a progressive
reduction of gender-related differences among younger
respondents.
In both males and females, non-arousal and solitary arousal activities
were most frequent in individuals aged between 18 and 25 years. Partnered
arousal activities were more prevalent in individuals aged between 26 and
40 years old. Age is an important variable in considering potential risks of
problematic Internet use for sexual purposes, particularly in males. The
highest prevalence of participants seemingly at risk of developing symptoms
of problematic Internet sexual use was in the group between 26 and
40 years old. In this group 33% were at risk. Overall, educational and
hedonic motives related to OSAs may lose importance with age, whereas
social motives may be more relevant later in life. However, factors related
to generational impacts as opposed to age per se cannot be excluded.
“Gambling Motives Questionnaire Adapted to Cybersex”
Yasser Khazaal, Switzerland, with E. Franc and S. Rothen
This Swiss project reported on the conversion of the Gambling Motives
Questionnaire, an established tool, into an instrument for investigating the
motives for the use of cybersex. The study also sought to validate the new
tool. The Cybersex Motives Questionnaire adapted a 17-question set from
gambling research into three motivation subscales.
The modification included the removal of several gambling questions
and the inclusion of several new potential cybersex motivations. The result
was a 17-item questionnaire which allows assessment on three sub-scales:
enhancement, coping, and social.
The validity of the new tool was examined for the principal component
analysis using an online sample of 191 adults who used cybersex and for
the confirmatory factor analysis using an online sample of 204 adults.
External validity was judged against the Sexual Desire Inventory. The selfselected
test sample population had a median age of 32 years, was 54.4%
male, with a breakdown of relationship status of 29.4% single, 45.4% in a
relationship, and 24.4% married. The sample reported as 81.3% heterosexual,
13.8% homosexual, and 4.9% bisexual. The researchers concluded that
the motivation factors, enhancement, social and coping were in line with
existing mainstream work in this field.
“Communicating the Science of Cybersex Addiction to Wider Audiences”
Darryl K. Mead, UK, with M. Sharpe
Research suggests that there is considerable potential for internet pornography
consumption to lead to addiction-related brain changes. How can
the emerging science of problematic pornography use be made accessible to
professionals and the wider public in effective ways?
After a brief review of the origins of The Reward Foundation, Mead and
Sharpe looked at the efficacy of some of the public communication initiatives
with which they have experimented in the past three years. Their
efforts fell into two main strands. First, they have concentrated on sharing
their knowledge of the behavioral-addiction-based pornography research
with healthcare professionals such as family doctors and sex therapists. In
2017, their one-day training workshop on the impact of Internet pornography
on mental and physical health was accredited by the Royal College
of General Practitioners in London for Continuing Professional
Development credits. Delivery of this training helps bridge the knowledge
gap between the behavioral addiction research community and the practitioners
who can apply that knowledge in a healthcare context. The authors
also published a summary of the cybersex papers presented at the 4th
ICBA Conference in a peer-reviewed journal for the sexual therapy community
to enhance their understanding of the neuroscience (Mead &
Sharpe, 2017).
Second, The Reward Foundation delivers lessons in secondary schools,
where it also trains teachers and engages with parents. Since 2017, The
Reward Foundation has developed lesson plans for use by a school’s own
teachers to help them unpack different aspects of problematic pornography
use in the classroom context. To date, this work has concentrated on the
government school sector and is now being extended experimentally into
faith-based schools. Religious educators are very cautious about encouraging
any discussion of the influence of pornography. However, using an evidence-
based behavioral addiction model makes access easier. Delivered
sensitively, the science of cybersex addiction can be acceptable to faithbased
communities, where its messages are seen as complementary, not
contradictory, to teachings in religions such as Catholicism and Islam.
Session: Problematic Pornography Use: Assessing Characteristics in a Rapidly Changing
Environment Chair: Joshua B. Grubbs
“Gender Considerations in the Correlates of Problematic Pornography Use”
Gretchen R. Blycker, USA, with S. W. Kraus, B. Bothe, A. Zsila, I. Toth-Kiraly, G.
Orosz, Z. Demetrovics, and M. N. Potenza
Health concerns linked to pornography viewing have been underresearched
within populations of women. The presentation began with an
assessment of the literature. It then utilized a large online sample to understand
how pornography viewing relates to hypersexuality, impulsivity,
childhood sexual abuse, and other factors.
Data from 24,372 pornography viewers (7,486 female) were gathered
through a large Hungarian news portal. Assessment tools included the
Problematic Pornography Consumption Scale (PPCS), the Hypersexual
Behavior Inventory, the Hypersexual Behavior Consequences Scale, the
Sexual Abuse History Questionnaire, the UCLA Loneliness Scale and the
ADHD Self Report Scale. Impulsivity was assessed using the UPPS-P scale.
As hypothesized, more men (97%) than women (78%) reported past year
pornography use. Men also reported greater hypersexuality, more hypersexuality-
related consequences, and more problematic pornography use than
women. Surprisingly, men also reported more childhood and adolescent
sexual abuse than women.
Women were more likely than men to score higher on ADHD measures
and impulsivity, including all except the Sensation-Seeking subscale. The
findings suggest that women who view pornography may be particularly
impulsive and may experience attentional difficulties. Additionally, 6.2% of
men and 4.7% of women recorded behaviors above the threshold for
Problematic Pornography Use.
The correlations between the PPCS and measures of impulsivity, hypersexuality,
loneliness, and ADHD were similar in men and women, suggesting
that common pathways may be operating across gender groups. The
particularly strong correlations in men between PPCS scores and hypersexuality
and its consequences is consistent with existing research and suggests
interventions for hypersexuality in men may need to consider targeting
pornography viewing.
“Binge Pornography Use and Masturbation as a Key Characteristic of Males Seeking Treatment for Compulsive Sexual Behaviors”
Małgorzata I. Wordecha, Poland with M. Wilk, E. Kowalewska, M. Skorko, A.
Łapi nski, and M. Gola
The study reported on nine men who had been referred by sexual health
centers for treatment of CSB. The group was a mix of heterosexual and
homosexual men with a mean age of 31.7 years (SD¼4.85). There was no
control group.
This study considered binge pornography use and masturbation with
respect to self-perceived factors hypothesized to be driving the behavior.
The factors were compared via ten weeks of daily diary data and a onehour
structured clinical interview. Diary records included measures of
sexual arousal, anxiety, stress, mood, and features of CSB, including time
spent viewing pornography and numbers of sessions of masturbation and
intercourse.
The researchers noted that there is a lack of scientific evidence to show
if bingeing is a standard characteristic of CSB. The study defined a binge
as watching pornographic content (and/or masturbating) for a few hours,
or repeating the activity many times during a day. Seven subjects had experienced
binges, ranging from duration of half-an-hour to half-a-day, up to
several times per day, and with frequency ranging from daily to several in
the ten weeks or only one day in their life. In the clinical interview, the
triggers reported were mainly stress and problems in personal life, fear of
failure, anger, loneliness, and rejection.
For processing the diary data, the criteria for bingeing were set at more
than two masturbations per day and a single pornography session lasting
more than one hour. Overall, the researchers reported that binge pornography
use may allow men to feel excitement and pleasure, while “turning
off” thinking and emotions. After the binge, all subjects reportedly experienced
negative emotions and thoughts about themselves. Four possible
explanations were put forward for binges: a stress-reducing mechanism,
increasing reactivity with stronger urges, habituation, and as a delay of climax
(“edging”). This paper has now been published by Wordecha
et al. (2018).
“Delay Discounting and Craving in the Context of Internet-Pornography-Use Disorder”
Stephanie Antons, Germany, with M. Brand
Antons and Brand focused on specific aspects of the I-PACE Model to
consider delay discounting. Delay discounting involves selecting smaller,
more immediate rewards over larger, later rewards. It is considered a form
of impulsivity and of the tendency to have difficulties in delaying gratification.
The researchers studied this aspect of impulsivity component through
the lens of craving in the affective and cognitive responses involved in
Internet-pornography-use disorder. They asked if craving has a mediating
or moderating effect on the link between delay discounting and the symptom
severity of Internet-pornography-use disorder. The sample was comprised
of 145 heterosexual males who use Internet pornography (average
age¼29.92 years).
Participants performed a delay-discounting task. Baseline craving and
symptom severity of Internet-pornography-use disorder were assessed using
questionnaires. While baseline craving was correlated with symptom severity
of Internet-pornography-use disorder on a bivariate level, delay discounting
and symptom severity of Internet-pornography-use disorder
were not.
The moderated regression analysis shows that participants who preferentially
selected immediate rewards rather than delayed rewards and who
showed higher baseline craving also had higher symptom severity of
Internet-pornography-use disorder. This finding suggests that decisionmaking
styles, in conjunction with affective factors such as baseline craving,
explain symptom severity of Internet-pornography-use disorder. Results
were also discussed in the context of potential neural mechanisms.
“Individual Delay-Discounting Rate in a Patient with Hypersexual Disorder”
Magdalena Smas-Myszczyszyn, Poland, with M. Lew-Starowicz
This sample of 108 patients with hypersexual disorder was given the
Monetary Choice questionnaire that assessed delay discounting. They also
completed the Polish version of the Sexual Addiction Screening Test. The
sexological sample was comprised of 66 individuals with compulsive masturbation,
along with 22 individuals who were compulsively “acting out”
sexually with partners and 20 who were compulsive in both categories.
Small amounts of money were discounted, preferred, more than large
amounts by all test groups. Patients in the group who were compulsive in
both masturbation and in pursuing sex with many partners were the most
impulsive. Learning the ability to defer gratification may represent an
important therapeutic goal for this group. Previous experiments confirm
that rewards are more strongly discounted than penalties (Thaler 1991),
suggesting that approaches that place more emphasis on the potential benefits
of the cessation of uncontrolled sexual behaviors, rather than on the
consequences of continuation, could have therapeutic effectiveness.
“Sociodemographic Changes in Pornography Use Between 2002 And 2016: A Study of a Representative Sample of the Polish Population”
Karol Lewczuk, Poland, with M. Gola
In the United States, the General Social Survey has been asking a single
question “Have you seen an X-Rated movie in the last year?” in every decade
since the 1960s. Currently 40% of men and 20% of women answer
“yes.” However, many studies from gaming, gambling, and Facebook use
show a large gap between declared use and a higher level of actual use.
Obtaining new longitudinal, population-level data on pornography use is
rare. This Polish study collaborated with an Internet provider, Gemius,
who could provide technical access and historical data. Participants were
invited to participate in a panel survey through pop-ups on popular websites.
After giving informed consent, basic information about participants’
Internet browsing activities were gathered in an anonymized way using
cookies. The cookies revealed if individuals had visited pornographic websites.
Separately, the team analyzed data from samples of 10,000 plus users
in the month of October every two years from 2004 to 2016. A person was
rated as a pornography user if they visited a pornographic website during
the month—a yes/no variable.
Researchers observed a steady increase in the population using pornography,
from 8% in October 2004 to 25% in October 2016. This growth paralleled
the overall growth of the number of Internet users in the population
during the same period. There is a moderate increase in the proportion of
Internet users using pornography, most notably for males. Gender, age,
and to a small degree the size of the place of residence, seem to influence
the probability of having viewed pornography on the Internet. Age and
gender explained 8% of the variance of online pornography viewing. The
limitations of the study include that data were not gathered if incognito
mode was used for browsing and it was based only on fixed line computers
(no mobiles). The figures were also scaled up to the population level, rather
than being based on raw data. The study does not provide information
regarding the quantity, frequency or type of pornography use.
“Clinical Characteristics of Compulsive Pornography Users: A Military Sample”
Shane W. Kraus, USA, with R. A. Hoff, M. Gola, E. Kowalewska, and M. N. Potenza
In the first part of this presentation, and in reaction to the growing
range of tools to measure problematic pornography use, this team set out
to develop and validate a shorter instrument, the Brief Pornography
Screener (BPS). It is a 5-item screener used to assess compulsive/problematic
use of pornographers in healthcare settings. It is scored each factor
either “never” (0), “sometimes” (1), and “frequently” (2), producing a
cumulative range of scores from 0 to 10. Work with U.S. (n¼223) and
Polish (n¼703) samples indicated excellent reliability and recommended a
cutoff score of 4, above which the subjects are likely to have problematic
pornography viewing issues. A score of 4 has a sensitivity of 80.4% and a
specificity of 80.3%.
The second study evaluated the clinical characteristics of participants
who scored positive on the BPS. The sample was 283 U.S. post-9/11 military
veterans was assessed with tools including sociodemographics, PRIMEMD,
AUDADIS-IV, Insomnia Severity Index, PTSD Symptom Checklist,
BPS, PPUS, HBI, UPPS-P, and the Difficulties in Emotional
Regulation Scale.
In the sample, 27.3% scored on or above the cutoff for the BPS. Over
92% of the veterans in the sample were male and more than a third of
individuals screening positive viewed pornography daily.
Emotional dysregulation was higher among problematic users than
among non-users. It is possible that problematic use may occur within the
context of emotional states related to stress or depression. Positive and
negative urgency forms of impulsivity were higher among individuals with
problematic pornography use. The findings resonate with prior work in
substance use and hypersexuality suggesting that problematic use can occur
in the context of stress or strong emotional states.
Depression was elevated among individuals with problematic pornography
use. Problematic pornography use was also associated with craving
for pornography.
Other presentations on pornography and sexuality
There were five other presentations that we were not able to observe. Readers are directed to the published abstracts for an indication of their content and conclusions (Demetrovics 2018). The session Cue-Reactivity and Craving in Off-Line and Online Behavioral Disorders included two relevant papers:
“Hypersexual Behaviors and Craving Reactions to Pornographic Pictures are Related
to Symptoms of an Internet-Pornography-Use Disorder”
Jaroslaw Pekal, Germany, with M. Brand
“The Influence of Stress on the Processing of Visual Sexual Stimuli in Men”
Jana Strahler, Germany, with O. Kruse and R. Stark
Research presented in the session Binge Behaviors: Conceptualization and Underlying Psychological Processes included:
“Approach and Avoidance Tendencies in Hypersexual Disorder”
Maria Veit, Germany, with J. Engel, C. Sinke, J. Kneer, C. Laier, S. Antons, U. Hartmann, T. Hillemacher, and T. H. C. Kru€ger
“Surveying Self-Identified Sex Addicts Supplies Evidence That Symptoms of Hypersexual Behavior and Internet-Pornography-Use Disorder are Associated with Common, but also Different Personality Characteristics”
Christian Laier, Germany, with J. Engel, M. Veit, S. Antons, M. Brand, and T. H.
C. Kru€ger
Within the Minitalk strand there was a paper titled:
“Excessive Internet Use for Sexual Purposes in Late Life: An Explorative Study of Risk Factors” Anna Sevcıkova, Czech Republic, with L. Blinka and K. Skarupova
...............................................
Discussion
This conference explored many different aspects of current research into the use of pornography by individuals and populations. Importantly, the conference keynote by Rudolf Stark concluded by suggesting that the case for pornography use disorder in the ICD-11 was strengthened by its foundation in the processing of natural rewards. Less than two months later, the new diagnosis of CSBD was ratified by the WHO secretariat for inclusion in ICD-11 (World Health Organization, 2018).
There were also advances in the collective scale and ambition of the reported research. In the past, small sample sizes and variable sample quality have limited some studies in the pornography research field. At the 2018 ICBA, the emergence of some larger samples suggested a growing strength in the field. While heterosexual men still dominate the research reports as test subjects in terms of sheer number, three of the studies reported on samples involving thousands of women and several more involved hundreds of women. Key were studies in Hungary, Poland, and the United States. The major Spanish study controlled its subject sample by both gender and age, but this was at the cost of only having 100 people of each gender and age group. Sexual minorities also appeared in a few studies at levels which support the drawing of statistically valid conclusions.
Several studies focusing on smaller numbers of subjects were able to work
more intensively, administering a wider selection of investigatory tools.
Sexually focused behavioral research is becoming well established with a
wider range of societies around the world now being investigated by
national or multinational research groups. A positive trend is the resulting
translation and validation of research tools into more languages. For
example, the Hypersexual Behavior Inventory has been translated and is
available in seven languages, and several other instruments originally developed
in English now come in Hungarian, Polish, and German versions.
Efforts to make assessment and diagnostic instruments shorter are also
coming to fruition. The Brief Pornography Screener now seems fit for
adoption by frontline practitioners as a tool for initial assessment of individuals
within the context of a short face-to-face consultation.
Work linked to the WHO CSB field trial found that significant numbers
of individuals who use pornography felt they were addicted to pornography
(6% in United States). Within the treatment-seeking Polish group, 86%
self-reported problems with pornography and 87% with masturbation, with
about half of both groups meeting clinical criteria for entering treatment.
In the online Hungarian study, 6.2% of the men and 4.7% of the women
recorded behaviors above the threshold for problematic pornography use.
These studies of self-selected groups begin to give a picture of the extent to
which issues relating to pornography use are appearing in pornographyconsuming
populations.
Experiment in South Africa: Black lecturers receive lower ratings than white lecturers, particularly from black students
Race and Gender biases in Student Evaluations of Teachers. Carolyn Chisadza, Nicky Nicholls„, Eleni Yitbarek. March 4, 2019. https://custom.cvent.com/4E741122FD8B4A1B97E483EC8BB51CC4/files/Event/159bd4dc083941a79dd0211437d5d7dc/b5c289adc7964d92b1ad00c38179a9e6.pdf
Abstract: Student ratings of teaching (SETs) are vital for academic career trajectories of higher education lecturers. Although student bias against female lecturers is noted in previous studies, mostly in the developed world, the extent to which race affects such ratings has received limited attention. To better understand the role of race and gender bias in SETs, we conduct an experiment in South Africa, where racial bias is highly prevalent. Students are randomly assigned to follow video lectures with identical narrated slides and script but given by lecturers of different race and gender. We find that black lecturers receive lower ratings than white lecturers, particularly from black students.
Key words: student evaluations of teaching, gender and race bias, Africa
JEL classification: I23; J15; J16
Abstract: Student ratings of teaching (SETs) are vital for academic career trajectories of higher education lecturers. Although student bias against female lecturers is noted in previous studies, mostly in the developed world, the extent to which race affects such ratings has received limited attention. To better understand the role of race and gender bias in SETs, we conduct an experiment in South Africa, where racial bias is highly prevalent. Students are randomly assigned to follow video lectures with identical narrated slides and script but given by lecturers of different race and gender. We find that black lecturers receive lower ratings than white lecturers, particularly from black students.
Key words: student evaluations of teaching, gender and race bias, Africa
JEL classification: I23; J15; J16
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