Revisiting the Role of Impulsivity and Compulsivity in Problematic Sexual Behaviors (2018)

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In this new paper, top researchers ask whether internet porn problems should be categorized differently from other problematic sexual behaviors based on study results. They also suggest that porn problems may be better categorized as "addictions" rather than "impulse control disorders," given the evidence supports both - but porn problems don't fit in well with the other "impulse control disorders," such as intermittent explosive disorder, pyromania, and kleptomania.

June 2018, The Journal of Sex Research 

https://doi.org/10.1080/00224499.2018.1480744

Abstract

Impulsivity and compulsivity are transdiagnostic features associated with clinically relevant aspects of psychiatric disorders, including addictions. However, little research has investigated how impulsivity and compulsivity relate to hypersexuality and problematic pornography use. Thus, the aims of the present study were to investigate (a) self-reported impulsivity and compulsivity with respect to hypersexuality and problematic pornography use and (b) the similarities and possible differences between hypersexuality and problematic pornography use in these domains. Utilizing structural equation modeling (SEM) in a large community sample (N = 13,778 participants; female = 4,151, 30.1%), results indicated that impulsivity (β = .28, β = .26) and compulsivity (β = .23, β = .14) were weakly related to problematic pornography use among men and women, respectively. Impulsivity had a stronger relationship (β = .41, β = .42) with hypersexuality than did compulsivity (β = .21, β = .16) among men and women, respectively. Consequently, impulsivity and compulsivity may not contribute as substantially to problematic pornography use as some scholars have proposed. On the other hand, impulsivity might have a more prominent role in hypersexuality than in problematic pornography use. Future research should examine further social and situational factors associated with problematic pornography use.

Online pornography has become more anonymous, accessible, and affordable over time. One popular pornography Web site’s statistics reported approximately 81 million visitors per day and approximately 28.5 billion visits in 2017 (Pornhub.com, 2018). In most cases, pornography viewing is not problematic. However, for some viewers, pornography use may become problematic (estimated at approximately 3.6% of pornography users; Bőthe et al., 2018 Bőthe, B., Tóth-Király, I., Zsila, Á., Griffiths, M. D., Demetrovics, Z., & Orosz, G. (2018). The development of the problematic pornography consumption scale (PPCS). Journal of Sex Research, 55, 395–406. doi:10.1080/00224499.2017.1291798[Taylor & Francis Online], [Web of Science ®][Google Scholar]) and negatively impact functioning by generating impairments in romantic relationships, meeting obligations, and/or achieving other goals (Kraus, Meshberg-Cohen, Martino, Quinones, & Potenza, 2015 Kraus, S. W., Meshberg-Cohen, S., Martino, S., Quinones, L. J., & Potenza, M. N. (2015). Treatment of compulsive pornography use with naltrexone: A case report. American Journal of Psychiatry, 172, 1260–1261. doi:10.1176/appi.ajp.2015.15060843[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Twohig, Crosby, & Cox, 2009 Twohig, M. P., Crosby, J. M., & Cox, J. M. (2009). Viewing internet pornography: For whom is it problematic, how, and why? Sexual Addiction & Compulsivity, 16, 253–266. doi:10.1080/10720160903300788[Taylor & Francis Online][Google Scholar]). According to recent case studies (Bostwick & Bucci, 2008 Bostwick, J. M., & Bucci, J. A. (2008). Internet sex addiction treated with naltrexone. Mayo Clinic Proceedings, 83, 226–230.[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Kraus, Meshberg-Cohen et al., 2015 Kraus, S. W., Meshberg-Cohen, S., Martino, S., Quinones, L. J., & Potenza, M. N. (2015). Treatment of compulsive pornography use with naltrexone: A case report. American Journal of Psychiatry, 172, 1260–1261. doi:10.1176/appi.ajp.2015.15060843[Crossref], [PubMed], [Web of Science ®][Google Scholar]), difficulties in controlling urges to engage in pornography use, a feature which may involve impulsive and compulsive tendencies, may represent a strong obstacle for people to overcome when attempting to reduce problematic pornography use. Problematic pornography use may represent a prominent manifestation of hypersexuality (also referred to as sexual compulsivity, sexual addiction, or excessive sexual behavior in the literature; Kafka, 2010 Kafka, M. P. (2010). Hypersexual disorder: A proposed diagnosis for DSM-V. Archives of Sexual Behavior, 39, 377–400. doi:10.1007/s10508-009-9574-7[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Karila et al., 2014 Karila, L., Wéry, A., Weinstein, A., Cottencin, O., Petit, A., Reynaud, M., & Billieux, J. (2014). Sexual addiction or hypersexual disorder: Different terms for the same problem? A review of the literature. Current Pharmaceutical Design, 20, 4012–4020.[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Wéry & Billieux, 2017 Wéry, A., & Billieux, J. (2017). Problematic cybersex: Conceptualization, assessment, and treatment. Addictive Behaviors, 64, 238–246. doi:10.1016/j.addbeh.2015.11.007[Crossref], [PubMed], [Web of Science ®][Google Scholar]) because in several studies more than 80% of people with hypersexuality have reported excessive/problematic pornography use (Kafka, 2010 Kafka, M. P. (2010). Hypersexual disorder: A proposed diagnosis for DSM-V. Archives of Sexual Behavior, 39, 377–400. doi:10.1007/s10508-009-9574-7[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Reid et al., 2012 Reid, R. C., Carpenter, B. N., Hook, J. N., Garos, S., Manning, J. C., Gilliland, R., … Fong, T. (2012). Report of findings in a DSM‐5 field trial for hypersexual disorder. The Journal of Sexual Medicine, 9, 2868–2877. doi:10.1111/j.1743-6109.2012.02936.x[Crossref], [PubMed], [Web of Science ®][Google Scholar]). An improved understanding of the similarities and possible differences between problematic pornography use and hypersexuality may help with respect to developing improved interventions. Because both impulsivity and compulsivity have been highly associated with non-substance-related addictive behaviors such as gambling (American Psychiatric Association, 2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.[Crossref][Google Scholar]; el-Guebaly, Mudry, Zohar, Tavares, & Potenza, 2012; Leeman & Potenza, 2012 Leeman, R. F., & Potenza, M. N. (2012). Similarities and differences between pathological gambling and substance use disorders: A focus on impulsivity and compulsivity. Psychopharmacology, 219, 469–490. doi:10.1007/s00213-011-2550-7[Crossref], [PubMed], [Web of Science ®][Google Scholar]; World Health Organization, 2017 World Health Organization. (2017). International statistical classification of diseases and related health problems. (11th ed. beta version). Retrieved December 8, 2017, from https://icd.who.int/dev11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1630268048 [Google Scholar]), questions have arisen regarding the extent to which these features may be associated with problematic pornography use and hypersexuality. The aim of the present study was, for the first time, to simultaneously examine the relationships between the two transdiagnostic measures of self-reported impulsivity and compulsivity and specific forms of problematic sexual behaviors (i.e., problematic pornography consumption and hypersexuality).

The Proposed Obsessive-Compulsive Spectrum Model as Related to Problematic Sexual Behaviors

Over two decades ago, an obsessive-compulsive spectrum model was proposed (Hollander, 1993 Hollander, E. (1993). Obsessive-compulsive spectrum disorders: An overview. Psychiatric Annals, 23, 255–358.[Crossref], [Web of Science ®][Google Scholar]; Hollander & Wong, 1995 Hollander, E., & Wong, C. M. (1995). Obsessive-compulsive spectrum disorders. Journal of Clinical Psychiatry, 56(Suppl 4), 3–6.[PubMed][Google Scholar]) with the conceptualization that different addictions could be juxtaposed on a continuum or spectrum. Disorders were proposed to lie along this spectrum with underestimation of harm being on the impulsive end and overestimation of harm being on the compulsive end (American Psychiatric Association, 2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.[Crossref][Google Scholar]; Hollander & Benzaquen, 1997 Hollander, E., & Benzaquen, S. D. (1997). The obsessive-compulsive spectrum disorders. International Review of Psychiatry, 9, 99–110. doi:10.1080/09540269775628[Taylor & Francis Online], [Web of Science ®][Google Scholar]). According to the metatheory of Hollander and Wong (1995 Hollander, E., & Wong, C. M. (1995). Obsessive-compulsive spectrum disorders. Journal of Clinical Psychiatry, 56(Suppl 4), 3–6.[PubMed][Google Scholar]), sexuality-related compulsions or addictions are closer to the impulsive end of the spectrum. Just over a decade later, Mick and Hollander (2006 Mick, T. M., & Hollander, E. (2006). Impulsive-compulsive sexual behavior. CNS Spectrums, 11, 944–955. doi:10.1017/S1092852900015133[Crossref], [PubMed], [Web of Science ®][Google Scholar]) proposed that problematic sexual behaviors had both impulsive and compulsive characteristics. However, these models were proposed largely in the absence of empirical data supporting this continuum of impulsivity and compulsivity lying along extreme ends of a continuous spectrum. When examining gambling and substance use disorders, both impulsive and compulsive features have been observed, and individuals with gambling disorders score high on measures of both impulsivity and compulsivity (Leeman & Potenza, 2012 Leeman, R. F., & Potenza, M. N. (2012). Similarities and differences between pathological gambling and substance use disorders: A focus on impulsivity and compulsivity. Psychopharmacology, 219, 469–490. doi:10.1007/s00213-011-2550-7[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Potenza, 2007 Potenza, M. N. (2007). Impulsivity and compulsivity in pathological gambling and obsessive-compulsive disorder. Revista Brasileira De Psiquiatria, 29, 105–106. doi:10.1590/S1516-44462007000200004[Crossref], [PubMed], [Web of Science ®][Google Scholar]). Consequently, questions exist regarding empirically derived relationships between problematic sexual behaviors and impulsivity and compulsivity.

According to Lochner et al.’s (2005) study, hypersexual disorder may belong to the reward-deficiency cluster rather than impulsive or somatic clusters on the basis of complex clinical interviews with patients with obsessive-compulsive spectrum disorders. However, the ICD-11 (beta version of the eleventh version of the International Statistical Classification of Diseases and Related Health Problems) Working Group on obsessive-compulsive and related disorders suggested that compulsive sexual behavior disorder (hypersexual disorder) should be included under the classification of impulse control disorders in the ICD-11 (Grant et al., 2014 Grant, J. E., Atmaca, M., Fineberg, N. A., Fontenelle, L. F., Matsunaga, H., Janardhan Reddy, Y. C., … Woods, D. W. (2014). Impulse control disorders and “behavioural addictions” in the ICD11. World Psychiatry, 13, 125–127. doi:10.1002/wps.20115[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Kraus et al., 2018 Kraus, S. W., Krueger, R. B., Briken, P., First, M. B., Stein, D. J., Kaplan, M. S., … Reed, G. M. (2018). Compulsive sexual behaviour disorder in the ICD‐11. World Psychiatry, 17, 109–110. doi:10.1002/wps.20499[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Stein et al., 2016 Stein, D. J., Kogan, C. S., Atmaca, M., Fineberg, N. A., Fontenelle, L. F., Grant, J. E., … Van Den Heuvel, O. A. (2016). The classification of obsessive–compulsive and related disorders in the ICD-11. Journal of Affective Disorders, 190, 663–674. doi:10.1016/j.jad.2015.10.061[Crossref], [PubMed], [Web of Science ®][Google Scholar]; World Health Organization, 2017 World Health Organization. (2017). International statistical classification of diseases and related health problems. (11th ed. beta version). Retrieved December 8, 2017, from https://icd.who.int/dev11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1630268048 [Google Scholar]) due to its conceptualization and symptomatology (e.g., repeated failure to resist the impulse to engage in sexual behavior despite its long-term negative consequences). However, such a classification has been questioned because compulsive sexual behavior has similar neurobiological features to substance use disorders, indicating that compulsive sexual behavior could be considered an addictive disorder (Potenza, Gola, Voon, Kor, & Kraus, 2017 Potenza, M. N., Gola, M., Voon, V., Kor, A., & Kraus, S. W. (2017). Is excessive sexual behaviour an addictive disorder? The Lancet Psychiatry, 4, 663–664. doi:10.1016/S2215-0366(17)30316-4[Crossref], [PubMed], [Web of Science ®][Google Scholar]). Thus, there is currently no consensus whether sexuality-related disorders or problems (such as problematic pornography use or hypersexuality) relate to impulsive or compulsive features or whether they should be considered behavioral addictions (e.g., Griffiths, 2016 Griffiths, M. D. (2016). Compulsive sexual behaviour as a behavioural addiction: The impact of the internet and other issues. Addiction, 111, 2107–2108. doi:10.1111/add.13315[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Kraus, Voon, & Potenza, 2016 Kraus, S. W., Voon, V., & Potenza, M. N. (2016). Should compulsive sexual behavior be considered an addiction? Addiction, 111, 2097– 2106. doi:10.1111/add.13297[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Potenza et al., 2017 Potenza, M. N., Gola, M., Voon, V., Kor, A., & Kraus, S. W. (2017). Is excessive sexual behaviour an addictive disorder? The Lancet Psychiatry, 4, 663–664. doi:10.1016/S2215-0366(17)30316-4[Crossref], [PubMed], [Web of Science ®][Google Scholar]), while noting that these possibilities are not mutually exclusive. Given that no prior studies have simultaneously examined impulsivity and compulsivity as related to hypersexuality and problematic pornography use, there is currently a knowledge gap in this area.

One study investigated compulsivity and impulsivity together as related to pornography use (Wetterneck, Burgess, Short, Smith, & Cervantes, 2012 Wetterneck, C. T., Burgess, A. J., Short, M. B., Smith, A. H., & Cervantes, M. E. (2012). The role of sexual compulsivity, impulsivity, and experiential avoidance in internet pornography use. Psychological Record, 62, 3–18.[Crossref], [Web of Science ®][Google Scholar]). However, in this study, sexual compulsivity, as opposed to general compulsivity, was assessed. According to that study’s results, impulsivity-related features (risk taking and sensation seeking) were positively and weakly correlated with self-reported positive and negative effects of pornography use and the frequency of pornography use. However, after dividing the sample into problematic and nonproblematic users, there were no significant differences between the groups regarding their level of impulsivity. With respect to sexual compulsivity, the positive and negative effects of pornography use and the frequency of pornography use were positively and moderately associated with sexual compulsivity, and there was a significant difference between the problematic and nonproblematic user groups, because individuals in the problematic groups reported 1.5-fold higher levels of sexual compulsivity than the nonproblematic group. This study is the only one that has assessed both impulsivity and (sexual) compulsivity in one model, with few studies having separately examined impulsivity or compulsivity as related to problematic sexual behaviors, such as hypersexuality and problematic pornography consumption, as discussed in the next section.

Impulsivity, Hypersexuality, and Pornography Consumption

Impulsivity has been related to multiple behaviors relevant to psychiatric problems and disorders (alcohol drinking, Anestis, Selby, & Joiner, 2007 Anestis, M. D., Selby, E. A., & Joiner, T. E. (2007). The role of urgency in maladaptive behaviors. Behaviour Research and Therapy, 45, 3018– 3029. doi:10.1016/j.brat.2007.08.012[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Fischer, Anderson, & Smith, 2004 Fischer, S., Anderson, K. G., & Smith, G. T. (2004). Coping with distress by eating or drinking: Role of trait urgency and expectancies. Psychology of Addictive Behaviors, 18, 269–274. doi:10.1037/0893-164X.18.3.269[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Fischer & Smith, 2008 Fischer, S., & Smith, G. T. (2008). Binge eating, problem drinking, and pathological gambling: Linking behavior to shared traits and social learning. Personality and Individual Differences, 44, 789–800. doi:10.1016/j.paid.2007.10.008[Crossref], [Web of Science ®][Google Scholar]; compulsive buying, Billieux, Rochat, Rebetez, & Van Der Linden, 2008 Billieux, J., Rochat, L., Rebetez, M. M. L., & Van Der Linden, M. (2008). Are all facets of impulsivity related to self-reported compulsive buying behavior? Personality and Individual Differences, 44, 1432–1442. doi:10.1016/j.paid.2007.12.011[Crossref], [Web of Science ®][Google Scholar]; eating disorders, Claes, Vandereycken, & Vertommen, 2005 Claes, L., Vandereycken, W., & Vertommen, H. (2005). Impulsivity-related traits in eating disorder patients. Personality and Individual Differences, 39, 739–749. doi:10.1016/j.paid.2005.02.022[Crossref], [Web of Science ®][Google Scholar]; Fischer et al., 2004 Fischer, S., Anderson, K. G., & Smith, G. T. (2004). Coping with distress by eating or drinking: Role of trait urgency and expectancies. Psychology of Addictive Behaviors, 18, 269–274. doi:10.1037/0893-164X.18.3.269[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Fischer & Smith, 2008 Fischer, S., & Smith, G. T. (2008). Binge eating, problem drinking, and pathological gambling: Linking behavior to shared traits and social learning. Personality and Individual Differences, 44, 789–800. doi:10.1016/j.paid.2007.10.008[Crossref], [Web of Science ®][Google Scholar]) and specific problematic online behaviors or online addictions (such as Internet addiction, Burnay, Billieux, Blairy, & Larøi, 2015 Burnay, J., Billieux, J., Blairy, S., & Larøi, F. (2015). Which psychological factors influence internet addiction? Evidence through an integrative model. Computers in Human Behavior, 43, 28–34. doi:10.1016/j.chb.2014.10.039[Crossref], [Web of Science ®][Google Scholar]; problematic online gaming, Billieux et al., 2011 Billieux, J., Chanal, J., Khazaal, Y., Rochat, L., Gay, P., Zullino, D., & Van Der Linden, M. (2011). Psychological predictors of problematic involvement in massively multiplayer online role-playing games: Illustration in a sample of male cybercafe players. Psychopathology, 44, 165–171. doi:10.1159/000322525[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Zsila et al., 2017 Zsila, Á., Orosz, G., Bőthe, B., Tóth-Király, I., Király, O., Griffiths, M., & Demetrovics, Z. (2017). An empirical study on the motivations underlying augmented reality games: The case of Pokémon go during and after Pokémon fever. Personality and Individual Differences. doi:10.1016/j.paid.2017.06.024[Crossref][Google Scholar]; Facebook overuse and problematic series watching, Orosz, Vallerand, Bőthe, Tóth-Király, & Paskuj, 2016 Orosz, G., Vallerand, R. J., Bőthe, B., Tóth-Király, I., & Paskuj, B. (2016). On the correlates of passion for screen-based behaviors: The case of impulsivity and the problematic and non-problematic Facebook use and TV series watching. Personality and Individual Differences, 101, 167–176. doi:10.1016/j.paid.2016.05.368[Crossref], [Web of Science ®][Google Scholar]). According to Whiteside and Lynam (2001 Whiteside, S. P., & Lynam, D. R. (2001). The five factor model and impulsivity: Using a structural model of personality to understand impulsivity. Personality and Individual Differences, 30, 669–689. doi:10.1016/S0191-8869(00)00064-7[Crossref], [Web of Science ®][Google Scholar]), impulsivity is defined via four dimensions: sensation seeking (openness to experiences that might be dangerous and enjoyment of exciting activities), negative urgency (the tendency to engage in impulsive behaviors in order to diminish negative emotions and affects, despite the potentially harmful long-term consequences), lack of perseverance (difficulties with staying focused on tasks that might be boring and with finishing projects or tasks if distracting stimuli are present), and lack of premeditation (acting before thinking about the possible consequences). This original four-dimensional impulsivity model was later complemented with a fifth dimension, namely, positive urgency (Billieux et al., 2012 Billieux, J., Rochat, L., Ceschi, G., Carré, A., Offerlin-Meyer, I., Defeldre, A. C., … Van Der Linden, M. (2012). Validation of a short French version of the UPPS-P impulsive behavior scale. Comprehensive Psychiatry, 53, 609–615. doi:10.1016/j.comppsych.2011.09.001[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Lynam, Smith, Whiteside, & Cyders, 2006 Lynam, D. R., Smith, G. T., Whiteside, S. P., & Cyders, M. A. (2006). The UPPS-P: Assessing five personality pathways to impulsive behavior. Technical report. West Lafayette, IN: Purdue University. [Google Scholar]). Positive urgency refers to the tendency to act rashly when experiencing intensive positive emotions. Most research examining the relationships between pornography use and impulsivity or hypersexuality and impulsivity have either applied a unidimensional impulsivity concept or emphasized the role of sensation seeking.

Within the field of hypersexuality, previous research on heterosexual, bisexual, and homosexual men and women has identified a positive but weak association between self-reported impulsive tendencies and hypersexuality. This suggests that people with higher impulsivity are more likely to engage in hypersexual behaviors (Walton, Cantor, & Lykins, 2017 Walton, M. T., Cantor, J. M., & Lykins, A. D. (2017). An online assessment of personality, psychological, and sexuality trait variables associated with self-reported hypersexual behavior. Archives of Sexual Behavior, 46, 721–733. doi:10.1007/s10508-015-0606-1[Crossref], [PubMed], [Web of Science ®][Google Scholar]). However, in a study examining a combined sample of hypersexual males and healthy community controls, a moderate positive association was found between impulsivity and the level of hypersexuality, a relationship persisting when anxiety, depression, vulnerability, and mindfulness were taken into consideration (Reid, Bramen, Anderson, & Cohen, 2014 Reid, R. C., Bramen, J. E., Anderson, A., & Cohen, M. S. (2014). Mindfulness, emotional dysregulation, impulsivity, and stress proneness among hypersexual patients. Journal of Clinical Psychology, 70, 313–321. doi:10.1002/jclp.22027[Crossref], [PubMed], [Web of Science ®][Google Scholar]). In the case of highly sexually active gay and bisexual males, a similar positive, moderate association has been observed between self-reported impulsivity and levels of hypersexuality (Pachankis, Rendina, Ventuneac, Grov, & Parsons, 2014 Pachankis, J. E., Rendina, H. J., Ventuneac, A., Grov, C., & Parsons, J. T. (2014). The role of maladaptive cognitions in hypersexuality among highly sexually active gay and bisexual men. Archives of Sexual Behavior, 43, 669–683. doi:10.1007/s10508-014-0261-y[Crossref], [PubMed], [Web of Science ®][Google Scholar]).

However, when hypersexual and nonhypersexual males were compared regarding their level of impulsivity, only a trend toward significance was found in relation to impulsivity (Mulhauser et al., 2014 Mulhauser, K. R., Struthers, W. M., Hook, J. N., Pyykkonen, B. A., Womack, S. D., & MacDonald, M. (2014). Performance on the Iowa gambling task in a sample of hypersexual men. Sexual Addiction & Compulsivity, 21, 170–183. doi:10.1080/10720162.2014.908333[Taylor & Francis Online][Google Scholar]). In another study comparing impulsivity between hypersexual gay men and nonhypersexual gay men (Miner et al., 2016 Miner, M. H., Romine, R. S., Raymond, N., Janssen, E., MacDonald, A., & Coleman, E. (2016). Understanding the personality and behavioral mechanisms defining hypersexuality in men who have sex with men. Journal of Sexual Medicine, 13, 1323–1331. doi:10.1016/j.jsxm.2016.06.015[Crossref], [PubMed], [Web of Science ®][Google Scholar]), only one significant difference was observed. Hypersexual gay men showed elevated levels of nonplanning impulsivity compared to non-hypersexual gay men. There were no significant differences between the two groups in their levels of attentional and motor impulsivity. The aforementioned findings suggest that hypersexuality is related to generalized impulsivity and that hypersexual males are not a homogenous group regarding impulsivity levels (Miner et al., 2016 Miner, M. H., Romine, R. S., Raymond, N., Janssen, E., MacDonald, A., & Coleman, E. (2016). Understanding the personality and behavioral mechanisms defining hypersexuality in men who have sex with men. Journal of Sexual Medicine, 13, 1323–1331. doi:10.1016/j.jsxm.2016.06.015[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Mulhauser et al., 2014 Mulhauser, K. R., Struthers, W. M., Hook, J. N., Pyykkonen, B. A., Womack, S. D., & MacDonald, M. (2014). Performance on the Iowa gambling task in a sample of hypersexual men. Sexual Addiction & Compulsivity, 21, 170–183. doi:10.1080/10720162.2014.908333[Taylor & Francis Online][Google Scholar]). However, the findings suggest that impulsivity importantly relates to hypersexuality (Pachankis et al., 2014 Pachankis, J. E., Rendina, H. J., Ventuneac, A., Grov, C., & Parsons, J. T. (2014). The role of maladaptive cognitions in hypersexuality among highly sexually active gay and bisexual men. Archives of Sexual Behavior, 43, 669–683. doi:10.1007/s10508-014-0261-y[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Reid et al., 2014 Reid, R. C., Bramen, J. E., Anderson, A., & Cohen, M. S. (2014). Mindfulness, emotional dysregulation, impulsivity, and stress proneness among hypersexual patients. Journal of Clinical Psychology, 70, 313–321. doi:10.1002/jclp.22027[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Walton et al., 2017 Walton, M. T., Cantor, J. M., & Lykins, A. D. (2017). An online assessment of personality, psychological, and sexuality trait variables associated with self-reported hypersexual behavior. Archives of Sexual Behavior, 46, 721–733. doi:10.1007/s10508-015-0606-1[Crossref], [PubMed], [Web of Science ®][Google Scholar]).

Regarding pornography use, sensation seeking is arguably the most prevalently examined impulsivity-related characteristic studied to date. Sensation seeking has been found to be positively related to the frequency of pornography consumption (Beyens, Vandenbosch, & Eggermont, 2015 Beyens, I., Vandenbosch, L., & Eggermont, S. (2015). Early adolescent boys’ exposure to internet pornography relationships to pubertal timing, sensation seeking, and academic performance. Journal of Early Adolescence, 35, 1045–1068. doi:10.1177/0272431614548069[Crossref], [Web of Science ®][Google Scholar]; Peter & Valkenburg, 2010 Peter, J., & Valkenburg, P. M. (2010). Processes underlying the effects of adolescents’ use of sexually explicit internet material: The role of perceived realism. Communication Research, 37, 375–399. doi:10.1177/0093650210362464[Crossref], [Web of Science ®][Google Scholar]). For men, experience seeking has also been found to be positively related to online pornography use (Paul, 2009 Paul, B. (2009). Predicting Internet pornography use and arousal: The role of individual difference variables. Journal of Sex Research, 46, 344– 357. doi:10.1080/00224490902754152[Taylor & Francis Online], [Web of Science ®][Google Scholar]). According to Cooper, Delmonico, and Burg’s (2000) research, sexually compulsive people and individuals with cybersex addictions score higher on sexual and nonsexual sensation-seeking scales than do non–sexually compulsive and moderately sexually compulsive people. In sum, people with higher levels of sensation seeking may use pornography more intensively as manifested by either an increased amount of time spent with online pornography or the development of problematic online pornography use. Regarding the four other proposed dimensions of impulsivity (negative urgency, positive urgency, lack of perseverance, and lack of premeditation), no previous research has ever examined associations between these variables and online pornography use.

With respect to general impulsivity, the frequency of pornography use has been found to be negatively related to impulsivity among men (i.e., losing one’s temper or easily getting irritated), but this was not the case for women (Carroll et al., 2008 Carroll, J. S., Padilla-Walker, L. M., Nelson, L. J., Olson, C. D., Barry, C. M., & Madsen, S. D. (2008). Generation XXX pornography acceptance and use among emerging adults. Journal of Adolescent Research, 23, 6–30. doi:10.1177/0743558407306348[Crossref], [Web of Science ®][Google Scholar]). In a separate study, low self-control (including impulsivity) explained only a small amount of the variance concerning the frequency of visiting pornography Web sites and downloading pornographic material after controlling for gender and age (Buzzell, Foss, & Middleton, 2006 Buzzell, T., Foss, D., & Middleton, Z. (2006). Explaining use of online pornography: A test of self-control theory and opportunities for deviance. Journal of Criminal Justice and Popular Culture, 13, 96–116. [Google Scholar]). Other research has found that motivations for using pornography positively and moderately relate to impulsivity across all motivational dimensions investigated (Reid, Li, Gilliland, Stein, & Fong, 2011 Reid, R. C., Li, D. S., Gilliland, R., Stein, J. A., & Fong, T. (2011). Reliability, validity, and psychometric development of the pornography consumption inventory in a sample of hypersexual men. Journal of Sex & Marital Therapy, 37, 359–385. doi:10.1080/0092623X.2011.607047[Taylor & Francis Online], [Web of Science ®][Google Scholar]). Consequently, these data suggest weak but complex relationships between pornography use and impulsivity that do not appear entirely consistent across studies.

In sum, the empirical evidence shows that impulsivity is weakly or moderately related to several aspects of pornography use, such as frequency of pornography use or motivation for pornography viewing (e.g., Beyens et al., 2015 Beyens, I., Vandenbosch, L., & Eggermont, S. (2015). Early adolescent boys’ exposure to internet pornography relationships to pubertal timing, sensation seeking, and academic performance. Journal of Early Adolescence, 35, 1045–1068. doi:10.1177/0272431614548069[Crossref], [Web of Science ®][Google Scholar]; Carroll et al., 2008 Carroll, J. S., Padilla-Walker, L. M., Nelson, L. J., Olson, C. D., Barry, C. M., & Madsen, S. D. (2008). Generation XXX pornography acceptance and use among emerging adults. Journal of Adolescent Research, 23, 6–30. doi:10.1177/0743558407306348[Crossref], [Web of Science ®][Google Scholar]; Peter & Valkenburg, 2010 Peter, J., & Valkenburg, P. M. (2010). Processes underlying the effects of adolescents’ use of sexually explicit internet material: The role of perceived realism. Communication Research, 37, 375–399. doi:10.1177/0093650210362464[Crossref], [Web of Science ®][Google Scholar]; Reid et al., 2011 Reid, R. C., Li, D. S., Gilliland, R., Stein, J. A., & Fong, T. (2011). Reliability, validity, and psychometric development of the pornography consumption inventory in a sample of hypersexual men. Journal of Sex & Marital Therapy, 37, 359–385. doi:10.1080/0092623X.2011.607047[Taylor & Francis Online], [Web of Science ®][Google Scholar]). However, little research has focused on the relationship between impulsivity and problematic pornography use. On the other hand, data suggest that impulsivity relates to hypersexuality, with other personality-related measures also showing relationships (Miner et al., 2016 Miner, M. H., Romine, R. S., Raymond, N., Janssen, E., MacDonald, A., & Coleman, E. (2016). Understanding the personality and behavioral mechanisms defining hypersexuality in men who have sex with men. Journal of Sexual Medicine, 13, 1323–1331. doi:10.1016/j.jsxm.2016.06.015[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Mulhauser et al., 2014 Mulhauser, K. R., Struthers, W. M., Hook, J. N., Pyykkonen, B. A., Womack, S. D., & MacDonald, M. (2014). Performance on the Iowa gambling task in a sample of hypersexual men. Sexual Addiction & Compulsivity, 21, 170–183. doi:10.1080/10720162.2014.908333[Taylor & Francis Online][Google Scholar]; Pachankis et al., 2014 Pachankis, J. E., Rendina, H. J., Ventuneac, A., Grov, C., & Parsons, J. T. (2014). The role of maladaptive cognitions in hypersexuality among highly sexually active gay and bisexual men. Archives of Sexual Behavior, 43, 669–683. doi:10.1007/s10508-014-0261-y[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Reid et al., 2014 Reid, R. C., Bramen, J. E., Anderson, A., & Cohen, M. S. (2014). Mindfulness, emotional dysregulation, impulsivity, and stress proneness among hypersexual patients. Journal of Clinical Psychology, 70, 313–321. doi:10.1002/jclp.22027[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Walton et al., 2017 Walton, M. T., Cantor, J. M., & Lykins, A. D. (2017). An online assessment of personality, psychological, and sexuality trait variables associated with self-reported hypersexual behavior. Archives of Sexual Behavior, 46, 721–733. doi:10.1007/s10508-015-0606-1[Crossref], [PubMed], [Web of Science ®][Google Scholar]).

Compulsivity, Hypersexuality, and Pornography Consumption

Compulsivity is another personality-related characteristic that has been associated with psychiatric disorders and behaviors (e.g., substance use and gambling disorders, Leeman & Potenza, 2012 Leeman, R. F., & Potenza, M. N. (2012). Similarities and differences between pathological gambling and substance use disorders: A focus on impulsivity and compulsivity. Psychopharmacology, 219, 469–490. doi:10.1007/s00213-011-2550-7[Crossref], [PubMed], [Web of Science ®][Google Scholar]; compulsive overeating, Davis & Carter, 2009 Davis, C., & Carter, J. C. (2009). Compulsive overeating as an addiction disorder. A review of theory and evidence. Appetite, 53, 1–8. doi:10.1016/j.appet.2009.05.018[Crossref], [PubMed], [Web of Science ®][Google Scholar]; alcohol abuse and dependence, Modell, Glaser, Mountz, Schmaltz, & Cyr, 1992 Modell, J. G., Glaser, F. B., Mountz, J. M., Schmaltz, S., & Cyr, L. (1992). Obsessive and compulsive characteristics of alcohol abuse and dependence: Quantification by a newly developed questionnaire. Alcoholism: Clinical and Experimental Research, 16, 266–271. doi:10.1111/j.1530-0277.1992.tb01374.x[Crossref], [PubMed], [Web of Science ®][Google Scholar]; bulimia nervosa, Engel et al., 2005 Engel, S. G., Corneliussen, S. J., Wonderlich, S. A., Crosby, R. D., Le Grange, D., Crow, S., … Mitchell, J. E. (2005). Impulsivity and compulsivity in bulimia nervosa. International Journal of Eating Disorders, 38, 244–251. doi:10.1002/eat.20169[Crossref], [PubMed], [Web of Science ®][Google Scholar]). Compulsivity is characterized by the “performance of repetitive and functionally impairing overt or covert behavior without adaptive function, performed in a habitual or stereotyped fashion, either according to rigid rules or as a means of avoiding perceived negative consequences” (Fineberg et al., 2014 Fineberg, N. A., Chamberlain, S. R., Goudriaan, A. E., Stein, D. J., Vanderschuren, L. J., Gillan, C. M., … Denys, D. (2014). New developments in human neurocognition: Clinical, genetic, and brain imaging correlates of impulsivity and compulsivity. CNS Spectrums, 19, 69–89. doi:10.1017/S1092852913000801[Crossref], [PubMed], [Web of Science ®][Google Scholar], p. 70). Therefore, compulsivity may refer to the engagement in ritualistic, repetitive behaviors and actions to prevent or reduce distress or eliminate feared consequences of an individual’s behaviors. However, this feeling of alleviation may be temporary, leading to a vicious cycle where the individual regularly engages in ritualistic actions (Deacon & Abramowitz, 2005 Deacon, B. J., & Abramowitz, J. S. (2005). The Yale-Brown Obsessive-Compulsive Scale: Factor analysis, construct validity, and suggestions for refinement. Journal of Anxiety Disorders, 19, 573–585. doi:10.1016/j.janxdis.2004.04.009[Crossref], [PubMed], [Web of Science ®][Google Scholar]).

Few studies have examined associations between compulsivity and hypersexuality. Among males with nonparaphilic hypersexual disorder, the lifetime prevalence of obsessive-compulsive disorder—a psychiatric disorder characterized by compulsivity—ranges from 0% to 14% (Kafka, 2015 Kafka, M. P. (2015). DSM-IV Axis I psychopathology in males with non-paraphilic hypersexual disorder. Current Addiction Reports, 2, 202– 206. doi:10.1007/s40429-015-0060-0[Crossref][Google Scholar]). Obsessiveness—which may be associated with compulsive behavior (Minnesota Multiphasic Personality Inventory 2 (MMPI-2); Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989 Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A., & Kaemmer, B. (1989). MMPI-2: Manual for administration and scoring. Minneapolis, MN: University of Minnesota Press. [Google Scholar])—in treatment-seeking men with hypersexuality has been found to be elevated relative to a comparison group, but the effect size of this difference was weak (Reid & Carpenter, 2009 Reid, R. C., & Carpenter, B. N. (2009). Exploring relationships of psychopathology in hypersexual patients using the MMPI-2. Journal of Sex & Marital Therapy, 35, 294–310. doi:10.1080/00926230902851298[Taylor & Francis Online], [Web of Science ®][Google Scholar]). When the association between the level of obsessive-compulsive behavior—assessed by a subscale of the Structured Clinical Interview for DSM-IV (SCID-II) (First, Gibbon, Spitzer, Williams, & Benjamin, 1997 First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin, L. S. (1997). SCID-II personality questionnaire. Washington, DC: American Psychiatry Press. [Google Scholar])—and the level of hypersexuality was examined among treatment-seeking males with hypersexual disorder, a trend toward a positive, weak association was found (Carpenter, Reid, Garos, & Najavits, 2013 Carpenter, B. N., Reid, R. C., Garos, S., & Najavits, L. M. (2013). Personality disorder comorbidity in treatment-seeking men with hypersexual disorder. Sexual Addiction & Compulsivity, 20, 79–90. doi:10.1080/10720162.2013.772873[Taylor & Francis Online][Google Scholar]). On the basis of the aforementioned results, compulsivity appears to contribute in a relatively small manner to hypersexuality.

Sexual compulsivity (more so than general compulsivity) has been associated with pornography use. Among male students, pornography viewing has been found to be positively and moderately associated with sexual compulsivity, with sexual compulsivity mediating the positive association between pornography viewing and problematic behavioral outcomes (Twohig et al., 2009 Twohig, M. P., Crosby, J. M., & Cox, J. M. (2009). Viewing internet pornography: For whom is it problematic, how, and why? Sexual Addiction & Compulsivity, 16, 253–266. doi:10.1080/10720160903300788[Taylor & Francis Online][Google Scholar]). In line with the effects of thought suppression observed in obsessive-compulsive disorder (e.g., Abramowitz, Tolin, & Street, 2001 Abramowitz, J. S., Tolin, D. F., & Street, G. P. (2001). Paradoxical effects of thought suppression: A meta-analysis of controlled studies. Clinical Psychology Review, 21, 683–703. doi:10.1016/S0272-7358(00)00057-X[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Tolin, Abramowitz, Przeworski, & Foa, 2002 Tolin, D. F., Abramowitz, J. S., Przeworski, A., & Foa, E. B. (2002). Thought suppression in obsessive-compulsive disorder. Behaviour Research and Therapy, 40, 1255–1274. doi:10.1016/S0005-7967(01)00095-X[Crossref], [PubMed], [Web of Science ®][Google Scholar]), these results suggest that the unwanted urges to use pornography may influence pornography use, leading to ego-dystonic viewing (i.e., pornography viewing in conflict with an individual’s personality and beliefs), which in turn could lead to negative outcomes (i.e., problematic viewing). A moderate positive association between sexual compulsivity and problematic pornography use was reported in a separate convenience sample of males and females (Grubbs, Exline, Pargament, Hook, & Carlisle, 2015 Grubbs, J. B., Exline, J. J., Pargament, K. I., Hook, J. N., & Carlisle, R. D. (2015). Transgression as addiction: Religiosity and moral disapproval as predictors of perceived addiction to pornography. Archives of Sexual Behavior, 44, 125–136. doi:10.1007/s10508-013-0257-z[Crossref], [PubMed], [Web of Science ®][Google Scholar]). Other research has found that craving for pornography was also positively and moderately related to sexual compulsivity (Kraus & Rosenberg, 2014 Kraus, S. W., & Rosenberg, H. (2014). The pornography craving questionnaire: Psychometric properties. Archives of Sexual Behavior, 43, 451–462. doi:10.1007/s10508-013-0229-3[Crossref], [PubMed], [Web of Science ®][Google Scholar]). These results are consistent with the notion that hypersexuality includes elements of sexual compulsivity (e.g., Kafka, 2010 Kafka, M. P. (2010). Hypersexual disorder: A proposed diagnosis for DSM-V. Archives of Sexual Behavior, 39, 377–400. doi:10.1007/s10508-009-9574-7[Crossref], [PubMed], [Web of Science ®][Google Scholar]).

In one study, general compulsivity was examined in relation to problematic pornography use among men, showing positive but weak associations (Egan & Parmar, 2013 Egan, V., & Parmar, R. (2013). Dirty habits? online pornography use, personality, obsessionality, and compulsivity. Journal of Sex & Marital Therapy, 39, 394–409. doi:10.1080/0092623X.2012.710182[Taylor & Francis Online], [Web of Science ®][Google Scholar]). When investigated in a more complex model, the relationship between general compulsivity and problematic pornography use was mediated by sexual addiction and Internet addiction, as well as an addiction more generally (Egan & Parmar, 2013 Egan, V., & Parmar, R. (2013). Dirty habits? online pornography use, personality, obsessionality, and compulsivity. Journal of Sex & Marital Therapy, 39, 394–409. doi:10.1080/0092623X.2012.710182[Taylor & Francis Online], [Web of Science ®][Google Scholar]). Taken together, the associations between compulsivity and hypersexuality and compulsivity and problematic use appear relatively weak (Carpenter et al., 2013 Carpenter, B. N., Reid, R. C., Garos, S., & Najavits, L. M. (2013). Personality disorder comorbidity in treatment-seeking men with hypersexual disorder. Sexual Addiction & Compulsivity, 20, 79–90. doi:10.1080/10720162.2013.772873[Taylor & Francis Online][Google Scholar]; Egan & Parmar, 2013 Egan, V., & Parmar, R. (2013). Dirty habits? online pornography use, personality, obsessionality, and compulsivity. Journal of Sex & Marital Therapy, 39, 394–409. doi:10.1080/0092623X.2012.710182[Taylor & Francis Online], [Web of Science ®][Google Scholar]).

Examining Impulsivity and Compulsivity With Respect to Hypersexuality and Problematic Pornography Consumption

Building on prior work (Wetterneck et al., 2012 Wetterneck, C. T., Burgess, A. J., Short, M. B., Smith, A. H., & Cervantes, M. E. (2012). The role of sexual compulsivity, impulsivity, and experiential avoidance in internet pornography use. Psychological Record, 62, 3–18.[Crossref], [Web of Science ®][Google Scholar]), a subsequent step is the simultaneous examination of general compulsivity and impulsivity and how each of the constructs may relate to problematic pornography use and hypersexuality in the case of men and women. The aims of the present study were to examine impulsivity and compulsivity relative to hypersexuality and problematic pornography use to identify possible similarities and differences in relationships with hypersexuality and problematic pornography use in a large, nonclinical sample and using validated and well-established measures. It was hypothesized that impulsivity and compulsivity would each positively correlate with problematic pornography use and hypersexuality, and that these relationships would be relatively weak but stronger for hypersexuality.

Method

Participants and Procedure

The present study was conducted in accordance with the approval of the institutional review board (IRB) of the related university and following the Declaration of Helsinki. Informed consent was obtained from all participants. Data collection was conducted in January 2017 via an online questionnaire that was advertised on one of the largest Hungarian news portals as a research study examining sexual activities. Only individuals aged 18 years old or older were invited to participate in the present study. Participants received detailed information about the aims of the study (i.e., investigation of sexual habits and behaviors of people), and they were assured of anonymity and confidentiality. Subsequently, the participants read and provided informed consent. Completing the questionnaire took approximately 30 minutes.

Overall, 24,372 individuals agreed to participate. However, 7,282 participants quit before completing the scales used in these analyses. Four requirements were established for being included in the present analysis: (1) having watched pornography at least once in the past year, (2) completing the hypersexuality-related scale, (3) completing the compulsivity-related scale, and (4) completing the impulsivity-related scale. Out of 17,090 participants, 1,602 had not watched pornography at least once in the past year; 469 did not complete the hypersexuality-related scale; 899 did not complete the compulsivity-related scale, and 342 did not complete the impulsivity-related scale. Therefore, 13,778 participants met the aforementioned criteria (female = 4,151, 30.1%; did not indicate gender = 72, 0.5%) and were aged between 18 and 76 years (Mage = 33.52, SDage = 10.93). Regarding residency, 7,505 (54.5%) lived in the capital city, 2,133 (15.5%) in county towns, 2,881 (20.9%) in towns, and 1,259 (9.1%) in villages. Regarding level of education, 350 (2.5%) had primary school degrees or less, 541 (3.9%) had vocational degrees, 4,383 (31.8%) had high school degrees, and 8,504 (61.7%) had higher education degrees (bachelor’s, master’s, or doctoral). Regarding relationship status, 3,198 were single (23.2%), 5,932 were in a relationship (43.1%), 556 were engaged (4.0%), 3,430 were married (24.9%), 384 were divorced (2.8%), 67 were widows/widowers (0.5%), and 211 indicated the “other” option (1.5%). A previously established question was asked to assess the sexual orientation of the participants (Træen, Nilsen, & Stigum, 2006 Træen, B., Nilsen, T. S. R., & Stigum, H. (2006). Use of pornography in traditional media and on the internet in norway. Journal of Sex Research, 43, 245–254.[Taylor & Francis Online], [Web of Science ®][Google Scholar]). Based on responses to this question, 11,388 were heterosexual (82.7%), 1,401 were heterosexual with same-sex orientation to some extent (10.2%), 380 were bisexual (2.8%), 99 were homosexual with heterosexuality to some extent (0.7%), 384 were same-sex orientation (2.8%), 16 were asexual (0.1%), 73 were unsure about their sexual orientation (0.5%), and 37 indicated the “other” option (0.3%). Regarding past-year pornography use, participants watched online pornography weekly, and reported spending 26.4 minutes per session (SD = 20.5).

Measures

UPPS-P Impulsive Behavior Scale (UPPS-P)

The Short UPPS-P Impulsive Behavior Scale (Zsila, Bőthe, Demetrovics, Billieux, & Orosz, 2017 Zsila, Á., Bőthe, B., Demetrovics, Z., Billieux, J., & Orosz, G. (2017). Further exploration of the SUPPS-P impulsive behavior scale’s factor structure: Evidence from a large Hungarian sample. Current Psychology, 1–11. doi:10.1007/s12144-017-9773-7[Crossref][Google Scholar]) was developed by Billieux et al. (2012 Billieux, J., Rochat, L., Ceschi, G., Carré, A., Offerlin-Meyer, I., Defeldre, A. C., … Van Der Linden, M. (2012). Validation of a short French version of the UPPS-P impulsive behavior scale. Comprehensive Psychiatry, 53, 609–615. doi:10.1016/j.comppsych.2011.09.001[Crossref], [PubMed], [Web of Science ®][Google Scholar]) from the original 59-item UPPS-P (Lynam et al., 2006 Lynam, D. R., Smith, G. T., Whiteside, S. P., & Cyders, M. A. (2006). The UPPS-P: Assessing five personality pathways to impulsive behavior. Technical report. West Lafayette, IN: Purdue University. [Google Scholar]). The Short UPPS-P is a 20-item scale comprising five different impulsivity aspects with four items per dimension: negative urgency (e.g., “When I am upset I often act without thinking”), positive urgency (e.g., “When I am really excited, I tend not to think about the consequences of my actions”), sensation seeking (e.g., “I sometimes like doing things that are a bit frightening”), lack of premeditation (e.g., “I usually think carefully before doing anything”), and lack of perseverance (e.g., “I generally like to see things through to the end”). All items were scored on a four-point Likert scale (from 1 = I agree strongly to 4 = I disagree strongly). The facets negative urgency, positive urgency, and sensation seeking include reversed items. Descriptive statistics and the internal consistencies of the scale are shown in Table 1.

Table 1. Descriptive Statistics, Reliability Indices and Correlations Between the Aspects of Impulsivity, Compulsivity, Hypersexuality and Problematic Pornography Use

CSVDisplay Table

Structured Clinical Interview for DSM Disorders

The SCID-II (First et al., 1997 First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin, L. S. (1997). SCID-II personality questionnaire. Washington, DC: American Psychiatry Press. [Google Scholar]; Szádóczky, Unoka, & Rózsa, 2004 Szádóczky, E., Unoka, Z., & Rózsa, S. (2004). User’s guide for the structured clinical interview for DSM-IV axis II personality disorders (SCID-II), Hungarian version. Budapest, Hungary: OS Hungary Kft. [Google Scholar]) comprises 140 items covering 10 personality disorders included in TheDiagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), Axis II and two personality disorders listed in the appendix for diagnoses requiring further studies. In the present research, only the compulsivity subscale was used, which assesses compulsive behavior, utilizing nine true (1) or false (0) items (e.g., “Do you have trouble throwing things out because they might come in handy someday?”). Descriptive statistics and the internal consistency of the scale are shown in Table 1.

Hypersexual Behavior Inventory (HBI)

The HBI (Bőthe, Bartók et al., 2018 Bőthe, B., Bartók, R., Tóth-Király, I., Reid, R. C., Griiths, M. D., Demetrovics, Z., & Orosz, G. (2018). Hypersexuality, gender, and sexual orientation: A large-scale psychometric survey study. Archives of Sexual Behavior. doi:10.1007/s10508-018-1201-z[Crossref][Google Scholar]; Reid et al., 2011 Reid, R. C., Li, D. S., Gilliland, R., Stein, J. A., & Fong, T. (2011). Reliability, validity, and psychometric development of the pornography consumption inventory in a sample of hypersexual men. Journal of Sex & Marital Therapy, 37, 359–385. doi:10.1080/0092623X.2011.607047[Taylor & Francis Online], [Web of Science ®][Google Scholar]) comprises 19 items assessing the level of hypersexual behavior across three dimensions. The control factor (eight items; e.g., “I engage in sexual activities that I know I will later regret”) assesses the lack of self-control in sexuality-related behaviors, such as an individual’s failed attempts to change his or her sexual behavior. The coping factor (seven items; e.g., “Doing something sexual helps me cope with stress”) refers to sexual behaviors as a response to emotional distress, such as frustration, sadness, or daily life worries. The consequences factor (four items; e.g., “My sexual thoughts and fantasies distract me from accomplishing important tasks”) refers to perceived consequences of sexual urges, thoughts, and behaviors, such as sexual activities interfering with important tasks, studies, or work. This scale was translated on the basis of the protocol outlined by Beaton, Bombardier, Guillemin, and Ferraz (2000 Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25, 3186–3191.[Crossref], [PubMed], [Web of Science ®][Google Scholar]). All items are scored on a five-point Likert scale (from 1 = Never to 5 = Very often). Descriptive statistics and the internal consistency of the scale are shown in Table 1.

Problematic Pornography Consumption Scale (PPCS)

The PPCS (Bőthe, Tóth-Király et al., 2018 Bőthe, B., Tóth-Király, I., Zsila, Á., Griffiths, M. D., Demetrovics, Z., & Orosz, G. (2018). The development of the problematic pornography consumption scale (PPCS). Journal of Sex Research, 55, 395–406. doi:10.1080/00224499.2017.1291798[Taylor & Francis Online], [Web of Science ®][Google Scholar]) is based on a proposed six-component addictions model (Griffiths, 2005 Griffiths, M. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191–197. doi:10.1080/14659890500114359[Taylor & Francis Online][Google Scholar]). The PPCS is an 18-item scale that assesses problematic pornography consumption using six factors, with three items relating to each factor. Tolerance captures when increasing amounts of the activity are required to achieve the same mood-modifying effects (e.g., “I felt that I had to watch more and more porn for satisfaction”). Salience refers to the relevance of pornography in an individual’s life (e.g., “I felt that porn is an important part of my life”). Mood modification is an either arousing or relaxing subjective experience that users report as a consequence of viewing pornography (e.g., “I released my tension by watching porn”). Conflict includes interpersonal conflicts between problematic users and their significant others, intrapsychic conflicts (e.g., knowing the activity is generating problems but finding difficulties consuming less or quitting), and occupational or educational concerns (e.g., “I felt porn caused problems in my sexual life”). Relapse is the tendency for returning to pornography quickly after abstinence or control (e.g., “I unsuccessfully tried to reduce the amount of porn I watch”). Last, withdrawal refers to the unpleasant feelings and emotional states that occur when the particular activity is decreased or ceased (e.g., “I became stressed when something prevented me from watching porn”). All items are scored on a 7-point Likert scale (from 1 = Never to 7 = Very often). Descriptive statistics and the internal consistency of the scale are shown in Table 1.

Statistical Analyses

For the statistical analysis, SPSS 21 and Mplus 7.3 (Muthén & Muthén, 1998 Muthén, L. K., & Muthén, B. O. (1998-2012). Mplus user’s guide (7th ed.). Los Angeles, CA: Muthén & Muthén. [Google Scholar]–2015) were used. Normality was assessed by the investigation of skewness and kurtosis. Reliability was assessed using Cronbach’s alpha (Nunnally, 1978 Nunnally, J. C. (1978). Psychometric theory. In McGraw-Hill series in psychology (2nd ed.). New York, NY: McGraw-Hill. [Google Scholar]) in the case of continuous scales. For the one dichotomous scale used (i.e., compulsivity subscale of SCID-II), internal consistency was examined with Kuder–Richardson formula 20 (KR-20, Kuder & Richardson, 1937 Kuder, G. F., & Richardson, M. W. (1937). The theory of the estimation of test reliability. Psychometrika, 2, 151–160. doi:10.1007/BF02288391[Crossref], [Web of Science ®][Google Scholar]). Structural equation modeling (SEM) was used to explore the associations between impulsivity, compulsivity, hypersexuality, and problematic pornography use. Items were treated as categorical indicators, because they had significant floor effects (on the basis of kurtosis and skewness). Consequently, the mean- and variance-adjusted weighted least squares estimator (WLSMV) was applied (Finney & DiStefano, 2006 Finney, S. J., & DiStefano, C. (2006). Non-normal and categorical data in structural equation modeling. In G. R. Hancock & R. D. Mueller (Eds.), Structural equation modeling: A second course (pp. 269–314). Charlotte, NC: Information Age Publishing. [Google Scholar]). Commonly used goodness-of-fit indices (Brown, 2015 Brown, T. A. (2015). Confirmatory factor analysis for applied research (2nd ed.). New York, NY: Guilford Press. [Google Scholar]; Kline, 2011 Kline, R. B. (2011). Principles and practice of structural equation modeling (3rd ed.). New York, NY: Guilford Press. [Google Scholar]) were observed (Bentler, 1990 Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107, 238–246. doi:10.1037/0033-2909.107.2.238[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Brown, 2015 Brown, T. A. (2015). Confirmatory factor analysis for applied research (2nd ed.). New York, NY: Guilford Press. [Google Scholar]; Browne & Cudeck, 1993 Browne, M. V., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing structural equation models (pp. 136–162). Newbury Park, CA: Sage.[Crossref][Google Scholar]; Hu & Bentler, 1999 Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55. doi:10.1080/10705519909540118[Taylor & Francis Online], [Web of Science ®][Google Scholar]; Schermelleh-Engel, Moosbrugger, & Müller, 2003 Schermelleh-Engel, K., Moosbrugger, H., & Müller, H. (2003). Evaluating the fit of structural equation models: Tests of significance and descriptive goodness-of-fit measures. Methods of Psychological Research Online, 8, 23–74. [Google Scholar]; Tabachnick & Fidell, 2001 Tabachnick, B. G., & Fidell, L. S. (2001). Using multivariate statistics (4th ed.). Boston, MA: Allyn and Bacon. [Google Scholar]) to assess the acceptability of the proposed model. The analyses examined the comparative fit index (CFI; ≥ .95 for good, ≥ .90 for acceptable), the Tucker–Lewis index (TLI; ≥ .95 for good, ≥ .90 for acceptable), and the root mean square error of approximation (RMSEA; ≤ .06 for good, ≤. 08 for acceptable) with a 90% confidence interval (CI).

In the case of the SCID-II compulsivity subscale and the HBI items, a parceling approach was conducted due to the fact that these latent variables were assessed using many items. Parcels are aggregated items that were used in the present model as assessed variables. This approach is acceptable in the case of theoretically unidimensional scales (e.g., Bandalos & Finney, 2001 Bandalos, D. L., & Finney, S. J. (2001). Item parceling issues in structural equation modeling. In G. A. Marcoulides & R. E. Schumacker (Eds.), New developments and techniques in structural equation modeling (pp. 269–296). London, UK: Lawrence Erlbaum. [Google Scholar]; Little, Cunningham, Shahar, & Widaman, 2002 Little, T. D., Cunningham, W. A., Shahar, G., & Widaman, K. F. (2002). To parcel or not to parcel: Exploring the question, weighing the merits. Structural Equation Modeling, 9, 151–173. doi:10.1207/S15328007SEM0902_1[Taylor & Francis Online], [Web of Science ®][Google Scholar]; Orosz et al., 2016 Orosz, G., Vallerand, R. J., Bőthe, B., Tóth-Király, I., & Paskuj, B. (2016). On the correlates of passion for screen-based behaviors: The case of impulsivity and the problematic and non-problematic Facebook use and TV series watching. Personality and Individual Differences, 101, 167–176. doi:10.1016/j.paid.2016.05.368[Crossref], [Web of Science ®][Google Scholar]), and it can minimize the issues related to non–normally distributed data (Bandalos, 2002 Bandalos, D. L. (2002). The effects of item parceling on goodness-of-fit and parameter estimate bias in structural equation modeling. Structural Equation Modeling, 9, 78–102. doi:10.1207/S15328007SEM0901_5[Taylor & Francis Online], [Web of Science ®][Google Scholar]; Matsunaga, 2008 Matsunaga, M. (2008). Item parceling in structural equation modeling: A primer. Communication Methods and Measures, 2, 260–293. doi:10.1080/19312450802458935[Taylor & Francis Online][Google Scholar]). In the case of the SCID-II compulsivity subscale, Rogers and Schmitt’s (2004 Rogers, W. M., & Schmitt, N. (2004). Parameter recovery and model fit using multidimensional composites: A comparison of four empirical parceling algorithms. Multivariate Behavioral Research, 39, 379– 412. doi:10.1207/S15327906MBR3903_1[Taylor & Francis Online], [Web of Science ®][Google Scholar]) exploratory factor analysis–based algorithm was applied in the parcel construction. For the HBI, a facet-representative approach was employed (Little, Rhemtulla, Gibson, & Schoemann, 2013 Little, T. D., Rhemtulla, M., Gibson, K., & Schoemann, A. M. (2013). Why the items versus parcels controversy needn’t be one. Psychological Methods, 18, 285–300. doi:10.1037/a0033266[Crossref], [PubMed], [Web of Science ®][Google Scholar]) and each subscale (namely, coping, control, and consequences) was averaged. Consequently, three indicators were constructed.

Results

Descriptive data, reliability indices, and correlations between the aspects of impulsivity, compulsivity, hypersexuality, and problematic pornography use are shown in Table 1. According to the correlations, there were only small differences between the correlations of problematic pornography use, hypersexuality, and the specific aspects of impulsivity. Therefore, for the sake of simplicity, the total score of impulsivity was used in further analyses.

By using SEM, the associations between impulsivity, compulsivity, hypersexuality, and problematic pornography use were investigated in the total sample and in the case of men and women in separate models as well. The models with standardized estimates are shown in Figure 1.

Figure 1. The impulsivity and compulsivity background of hypersexuality and problematic pornography use (Ntotal = 13,778; Nmales = 9,555; Nfemales = 4,151). All variables presented in ellipses are latent variables. For the sake of clarity, indicator variables related to them are not depicted in this figure. One-headed arrows represent standardized regression weights and two-headed arrows represent correlations. The first numbers on the arrows indicate the path coefficients of the total sample, the second numbers indicate the path coefficients of the male sample, and the third numbers indicate the path coefficients of the female sample. All pathways were significant at level < .01.

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In the total sample model, the fit indices were acceptable (CFI = .941, TLI = .937, RMSEA = .055 [90% CI = .054–.055]). Both impulsivity and compulsivity were related positively but weakly to problematic pornography use (β = .17, p < .01, and β = .19, p < .01, respectively). The proportion of explained variance of problematic pornography use was 6.6%. In the case of hypersexuality, compulsivity was also positively but weakly related to hypersexuality (β = .19, p < .01). However, impulsivity was positively but moderately related to hypersexuality (β = .37, p < .01). The proportion of explained variance of hypersexuality was 18.1%.

In the male sample model, the fit indices were acceptable (CFI = .929, TLI = .924, RMSEA = .059 [90% CI = .058–.059]). Both impulsivity and compulsivity were related positively but weakly to problematic pornography use (β = .28, p < .01, and β = .23, p < .01, respectively). The proportion of explained variance of problematic pornography use was 13.2%. In the case of hypersexuality, compulsivity was also positively but weakly related to hypersexuality (β = .21, p < .01). However, impulsivity was positively but moderately related to hypersexuality (β = .41, p < .01). The proportion of explained variance of hypersexuality was 21.7%.

In the female sample model, the fit indices were acceptable (CFI = .914, TLI = .908, RMSEA = .055 [90% CI = .054–.056]). Both impulsivity and compulsivity were related positively but weakly to problematic pornography use (β = .26, p < .01, and β = .14, p < .01, respectively). The proportion of explained variance of problematic pornography use was 9.1%. In the case of hypersexuality, compulsivity was also positively but weakly related to hypersexuality (β = .16, p < .01). However, impulsivity was positively but moderately related to hypersexuality (β = .42, p < .01). The proportion of explained variance of hypersexuality was 21.0%.

In sum, the associations between problematic pornography use and impulsivity and compulsivity, respectively, were weak, and the explained variance of problematic pornography use by impulsivity and compulsivity was relatively low (6.6% to 13.2%) in the total sample, as well as among men and women. In the case of hypersexuality, impulsivity had a stronger effect on hypersexual behavior than compulsivity, with hypersexuality having an explained variance of approximately 20% by impulsivity and compulsivity in the total sample, as well as among men and women.

Discussion

There is a current debate regarding how best to consider problematic sexual behaviors (such as hypersexuality and problematic pornography use), with competing models proposing classifications as impulse-control disorders, obsessive-compulsive spectrum disorders, or behavioral addictions (e.g., Griffiths, 2016 Griffiths, M. D. (2016). Compulsive sexual behaviour as a behavioural addiction: The impact of the internet and other issues. Addiction, 111, 2107–2108. doi:10.1111/add.13315[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Kraus et al., 2016 Kraus, S. W., Voon, V., & Potenza, M. N. (2016). Should compulsive sexual behavior be considered an addiction? Addiction, 111, 2097– 2106. doi:10.1111/add.13297[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Potenza et al., 2017 Potenza, M. N., Gola, M., Voon, V., Kor, A., & Kraus, S. W. (2017). Is excessive sexual behaviour an addictive disorder? The Lancet Psychiatry, 4, 663–664. doi:10.1016/S2215-0366(17)30316-4[Crossref], [PubMed], [Web of Science ®][Google Scholar]). Relationships between transdiagnostic features of impulsivity and compulsivity and problematic sexual behaviors should inform such considerations, although both impulsivity and compulsivity have been implicated in addictions (Fineberg et al., 2014 Fineberg, N. A., Chamberlain, S. R., Goudriaan, A. E., Stein, D. J., Vanderschuren, L. J., Gillan, C. M., … Denys, D. (2014). New developments in human neurocognition: Clinical, genetic, and brain imaging correlates of impulsivity and compulsivity. CNS Spectrums, 19, 69–89. doi:10.1017/S1092852913000801[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Leeman & Potenza, 2012 Leeman, R. F., & Potenza, M. N. (2012). Similarities and differences between pathological gambling and substance use disorders: A focus on impulsivity and compulsivity. Psychopharmacology, 219, 469–490. doi:10.1007/s00213-011-2550-7[Crossref], [PubMed], [Web of Science ®][Google Scholar]). The present study contributes to the ongoing debate by examining and identifying differences in the relationships between measures of self-reported impulsivity, compulsivity, hypersexuality, and problematic pornography consumption.

The findings of the present study showed that impulsivity was moderately and positively related to hypersexual behavior, while compulsivity was only weakly related, suggesting that impulsivity contributes more strongly to hypersexuality than compulsivity in both men and women. However, impulsivity and compulsivity related only weakly to problematic pornography use among both genders. From a statistical perspective, impulsivity and compulsivity both positively predicted problematic pornography use, but the effect sizes were small in both cases and the proportion of explained variance of problematic pornography use did not reach 15%, suggesting that more emphasis should be put on other factors (e.g., social and society related) in research and clinical interventions in the case of problematic pornography use. On the other hand, the finding that impulsivity related moderately to hypersexuality provides support both for the classification of compulsive sexual behavior disorder (as proposed for ICD-11; World Health Organization, 2017 World Health Organization. (2017). International statistical classification of diseases and related health problems. (11th ed. beta version). Retrieved December 8, 2017, from https://icd.who.int/dev11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1630268048 [Google Scholar]) as an impulse-control disorder or as a behavioral addiction. In considering the other disorders currently being proposed as impulse-control disorders (e.g., intermittent explosive disorder, pyromania, and kleptomania) and the central elements of compulsive sexual behavior disorder and proposed disorders due to addictive behaviors (e.g., gambling and gaming disorders), the classification of compulsive sexual behavior disorder in the latter category appears better supported.

The findings of the present study suggest that problematic pornography use may differ from hypersexuality more generally. As such, considering specific forms of excessive or problematic sexual behaviors will be important because different individuals with different temperamental features may be vulnerable to, and experience problems with, different types of sexual behavior.

The Role of the Impulsivity and Compulsivity in Hypersexuality and Problematic Pornography Consumption

Impulsivity and compulsivity are among the most frequently examined personality-related factors in the case of problematic behaviors with addictive potential (e.g., Billieux et al., 2008 Billieux, J., Rochat, L., Rebetez, M. M. L., & Van Der Linden, M. (2008). Are all facets of impulsivity related to self-reported compulsive buying behavior? Personality and Individual Differences, 44, 1432–1442. doi:10.1016/j.paid.2007.12.011[Crossref], [Web of Science ®][Google Scholar]; Davis & Carter, 2009 Davis, C., & Carter, J. C. (2009). Compulsive overeating as an addiction disorder. A review of theory and evidence. Appetite, 53, 1–8. doi:10.1016/j.appet.2009.05.018[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Deckman & DeWall, 2011 Deckman, T., & DeWall, C. N. (2011). Negative urgency and risky sexual behaviors: A clarification of the relationship between impulsivity and risky sexual behavior. Personality and Individual Differences, 51, 674–678. doi:10.1016/j.paid.2011.06.004[Crossref], [Web of Science ®][Google Scholar]; Engel et al., 2005 Engel, S. G., Corneliussen, S. J., Wonderlich, S. A., Crosby, R. D., Le Grange, D., Crow, S., … Mitchell, J. E. (2005). Impulsivity and compulsivity in bulimia nervosa. International Journal of Eating Disorders, 38, 244–251. doi:10.1002/eat.20169[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Leeman & Potenza, 2012 Leeman, R. F., & Potenza, M. N. (2012). Similarities and differences between pathological gambling and substance use disorders: A focus on impulsivity and compulsivity. Psychopharmacology, 219, 469–490. doi:10.1007/s00213-011-2550-7[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Mottram & Fleming, 2009 Mottram, A. J., & Fleming, M. J. (2009). Extraversion, impulsivity, and online group membership as predictors of problematic internet use. CyberPsychology & Behavior, 12, 319–321. doi:10.1089/cpb.2007.0170[Crossref], [PubMed][Google Scholar]). However, little research has examined the associations of impulsivity, compulsivity, and problematic sexual behaviors (such as hypersexuality and problematic pornography use). This small body of work reports relatively small effect sizes and inconsistent results. However, no prior study to this one has ever simultaneously investigated the relationships of impulsivity and compulsivity with hypersexuality and problematic pornography use.

Regarding pornography use motivations (Reid et al., 2011 Reid, R. C., Li, D. S., Gilliland, R., Stein, J. A., & Fong, T. (2011). Reliability, validity, and psychometric development of the pornography consumption inventory in a sample of hypersexual men. Journal of Sex & Marital Therapy, 37, 359–385. doi:10.1080/0092623X.2011.607047[Taylor & Francis Online], [Web of Science ®][Google Scholar]), impulsivity was positively and moderately related to almost all motivational factors, whereas, in the case of frequency of pornography use, a less consistent pattern was observed, from positive associations to no association (e.g., Beyens et al., 2015 Beyens, I., Vandenbosch, L., & Eggermont, S. (2015). Early adolescent boys’ exposure to internet pornography relationships to pubertal timing, sensation seeking, and academic performance. Journal of Early Adolescence, 35, 1045–1068. doi:10.1177/0272431614548069[Crossref], [Web of Science ®][Google Scholar]; Carroll et al., 2008 Carroll, J. S., Padilla-Walker, L. M., Nelson, L. J., Olson, C. D., Barry, C. M., & Madsen, S. D. (2008). Generation XXX pornography acceptance and use among emerging adults. Journal of Adolescent Research, 23, 6–30. doi:10.1177/0743558407306348[Crossref], [Web of Science ®][Google Scholar]; Peter & Valkenburg, 2011 Peter, J., & Valkenburg, P. M. (2011). The use of sexually explicit internet material and its antecedents: a longitudinal comparison of adolescents and adults. Archives Of Sexual Behavior, 40, 1015–1025. doi: 10.1007/s10508-010-9644-x[Crossref], [PubMed], [Web of Science ®][Google Scholar]). Only one study (i.e., Wetterneck et al., 2012 Wetterneck, C. T., Burgess, A. J., Short, M. B., Smith, A. H., & Cervantes, M. E. (2012). The role of sexual compulsivity, impulsivity, and experiential avoidance in internet pornography use. Psychological Record, 62, 3–18.[Crossref], [Web of Science ®][Google Scholar]) has investigated the associations between impulsivity, compulsivity, and problematic pornography use simultaneously. Similar to the results of the present study, positive but weak associations between the variables were observed, and after dividing the sample into problematic and nonproblematic users, no significant differences were found between the groups regarding levels of impulsivity. Therefore, impulsivity may not be as relevant to problematic pornography use as previously proposed (e.g., Hollander & Wong, 1995 Hollander, E., & Wong, C. M. (1995). Obsessive-compulsive spectrum disorders. Journal of Clinical Psychiatry, 56(Suppl 4), 3–6.[PubMed][Google Scholar]; Mick & Hollander, 2006 Mick, T. M., & Hollander, E. (2006). Impulsive-compulsive sexual behavior. CNS Spectrums, 11, 944–955. doi:10.1017/S1092852900015133[Crossref], [PubMed], [Web of Science ®][Google Scholar]).

In the case of hypersexuality, research has shown that impulsivity is weakly or moderately associated with hypersexual behaviors, fantasies, and urges (Pachankis et al., 2014 Pachankis, J. E., Rendina, H. J., Ventuneac, A., Grov, C., & Parsons, J. T. (2014). The role of maladaptive cognitions in hypersexuality among highly sexually active gay and bisexual men. Archives of Sexual Behavior, 43, 669–683. doi:10.1007/s10508-014-0261-y[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Reid et al., 2014 Reid, R. C., Bramen, J. E., Anderson, A., & Cohen, M. S. (2014). Mindfulness, emotional dysregulation, impulsivity, and stress proneness among hypersexual patients. Journal of Clinical Psychology, 70, 313–321. doi:10.1002/jclp.22027[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Walton et al., 2017 Walton, M. T., Cantor, J. M., & Lykins, A. D. (2017). An online assessment of personality, psychological, and sexuality trait variables associated with self-reported hypersexual behavior. Archives of Sexual Behavior, 46, 721–733. doi:10.1007/s10508-015-0606-1[Crossref], [PubMed], [Web of Science ®][Google Scholar]). However, comparisons of hypersexual and nonhypersexual individuals have not shown consistent results (Miner et al., 2016 Miner, M. H., Romine, R. S., Raymond, N., Janssen, E., MacDonald, A., & Coleman, E. (2016). Understanding the personality and behavioral mechanisms defining hypersexuality in men who have sex with men. Journal of Sexual Medicine, 13, 1323–1331. doi:10.1016/j.jsxm.2016.06.015[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Mulhauser et al., 2014 Mulhauser, K. R., Struthers, W. M., Hook, J. N., Pyykkonen, B. A., Womack, S. D., & MacDonald, M. (2014). Performance on the Iowa gambling task in a sample of hypersexual men. Sexual Addiction & Compulsivity, 21, 170–183. doi:10.1080/10720162.2014.908333[Taylor & Francis Online][Google Scholar]). The results of the present study corroborate the findings of Pachankis et al. (2014 Pachankis, J. E., Rendina, H. J., Ventuneac, A., Grov, C., & Parsons, J. T. (2014). The role of maladaptive cognitions in hypersexuality among highly sexually active gay and bisexual men. Archives of Sexual Behavior, 43, 669–683. doi:10.1007/s10508-014-0261-y[Crossref], [PubMed], [Web of Science ®][Google Scholar]) and Reid et al. (2014 Reid, R. C., Bramen, J. E., Anderson, A., & Cohen, M. S. (2014). Mindfulness, emotional dysregulation, impulsivity, and stress proneness among hypersexual patients. Journal of Clinical Psychology, 70, 313–321. doi:10.1002/jclp.22027[Crossref], [PubMed], [Web of Science ®][Google Scholar]) because the associations between impulsivity and hypersexuality are positive and moderate, suggesting that impulsivity may contribute importantly to the development and maintenance of hypersexuality.

Regarding compulsivity, associations between pornography use and sexual compulsivity have been more widely investigated than those between pornography use and general compulsivity. Not surprisingly, when sexual compulsivity was assessed in relation to pornography viewing (e.g., Grubbs, Exline et al., 2015 Grubbs, J. B., Exline, J. J., Pargament, K. I., Hook, J. N., & Carlisle, R. D. (2015). Transgression as addiction: Religiosity and moral disapproval as predictors of perceived addiction to pornography. Archives of Sexual Behavior, 44, 125–136. doi:10.1007/s10508-013-0257-z[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Twohig et al., 2009 Twohig, M. P., Crosby, J. M., & Cox, J. M. (2009). Viewing internet pornography: For whom is it problematic, how, and why? Sexual Addiction & Compulsivity, 16, 253–266. doi:10.1080/10720160903300788[Taylor & Francis Online][Google Scholar]; Wetterneck et al., 2012 Wetterneck, C. T., Burgess, A. J., Short, M. B., Smith, A. H., & Cervantes, M. E. (2012). The role of sexual compulsivity, impulsivity, and experiential avoidance in internet pornography use. Psychological Record, 62, 3–18.[Crossref], [Web of Science ®][Google Scholar]), the association was moderate and positive. Several possible reasons for this relationship have been proposed. First, context-specific compulsivity may be expected to be more strongly related to problematic pornography use than context-free (i.e., general) compulsivity. Second, hypersexuality by definition may include sexual compulsivity (e.g., Kafka, 2010 Kafka, M. P. (2010). Hypersexual disorder: A proposed diagnosis for DSM-V. Archives of Sexual Behavior, 39, 377–400. doi:10.1007/s10508-009-9574-7[Crossref], [PubMed], [Web of Science ®][Google Scholar]). However, when general compulsivity has been assessed as an antecedent of problematic pornography use, similar to the results of the present study, positive but weak associations were observed (Egan & Parmar, 2013 Egan, V., & Parmar, R. (2013). Dirty habits? online pornography use, personality, obsessionality, and compulsivity. Journal of Sex & Marital Therapy, 39, 394–409. doi:10.1080/0092623X.2012.710182[Taylor & Francis Online], [Web of Science ®][Google Scholar]). Previously, general compulsivity or obsessiveness was only weakly related or unrelated to hypersexuality (e.g., Carpenter et al., 2013 Carpenter, B. N., Reid, R. C., Garos, S., & Najavits, L. M. (2013). Personality disorder comorbidity in treatment-seeking men with hypersexual disorder. Sexual Addiction & Compulsivity, 20, 79–90. doi:10.1080/10720162.2013.772873[Taylor & Francis Online][Google Scholar]; Reid & Carpenter, 2009 Reid, R. C., & Carpenter, B. N. (2009). Exploring relationships of psychopathology in hypersexual patients using the MMPI-2. Journal of Sex & Marital Therapy, 35, 294–310. doi:10.1080/00926230902851298[Taylor & Francis Online], [Web of Science ®][Google Scholar]). In the present study, similar relationships were observed because general compulsivity (from a statistical perspective) significantly predicted hypersexuality, but the effect size was low.

In the present study, the five-facet model of impulsivity (Billieux et al., 2012 Billieux, J., Rochat, L., Ceschi, G., Carré, A., Offerlin-Meyer, I., Defeldre, A. C., … Van Der Linden, M. (2012). Validation of a short French version of the UPPS-P impulsive behavior scale. Comprehensive Psychiatry, 53, 609–615. doi:10.1016/j.comppsych.2011.09.001[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Lynam et al., 2006 Lynam, D. R., Smith, G. T., Whiteside, S. P., & Cyders, M. A. (2006). The UPPS-P: Assessing five personality pathways to impulsive behavior. Technical report. West Lafayette, IN: Purdue University. [Google Scholar]) was examined in relation to problematic pornography use and hypersexuality. The five facets—namely, negative urgency, positive urgency, lack of premeditation, lack of perseverance, and sensation seeking—were generally positively but weakly related to problematic pornography use and positively and moderately to hypersexuality, demonstrating a consistent relationship pattern between the aspects of impulsivity and problematic pornography use and hypersexuality. Therefore, the total score of impulsivity was used as a statistical predictor of problematic pornography use and hypersexuality. As expected, impulsivity was positively associated with problematic pornography use and hypersexuality. However, the extent of the association between impulsivity and problematic pornography use was rather small.

Possible Explanations for the Weak Associations Between Impulsivity, Compulsivity, and Problematic Pornography Use

Several factors may explain why impulsivity and compulsivity only weakly statistically predicted the level of problematic pornography use while hypersexuality was moderately statistically predicted by impulsivity. It is possible that impulsivity and compulsivity do not have a strong direct impact on problematic pornography use but have stronger effects via mediating variables. In the case of impulsivity, Reid et al. (2011 Reid, R. C., Li, D. S., Gilliland, R., Stein, J. A., & Fong, T. (2011). Reliability, validity, and psychometric development of the pornography consumption inventory in a sample of hypersexual men. Journal of Sex & Marital Therapy, 37, 359–385. doi:10.1080/0092623X.2011.607047[Taylor & Francis Online], [Web of Science ®][Google Scholar]) found that impulsivity had positive moderate associations with all four motivations of pornography use. From their four motivational factors, emotional avoidance had the strongest relationship with impulsivity, with excitement seeking being the second strongest and sexual pleasure being the third strongest, whereas sexual curiosity had the weakest relationship with impulsivity. Based on these results, emotional avoidance motivation may represent a mediator between impulsivity and problematic pornography use, although direct investigation of this possibility is needed to confirm the hypothesis.

Moreover, the frequency of pornography use may also serve as a potential mediator between impulsivity and problematic pornography use. For men, impulsivity has been found to be positively related to the frequency of pornography viewing; for females, it was not related (Carroll et al., 2008 Carroll, J. S., Padilla-Walker, L. M., Nelson, L. J., Olson, C. D., Barry, C. M., & Madsen, S. D. (2008). Generation XXX pornography acceptance and use among emerging adults. Journal of Adolescent Research, 23, 6–30. doi:10.1177/0743558407306348[Crossref], [Web of Science ®][Google Scholar]). As men tend to have higher levels of impulsivity (e.g., Chapple & Johnson, 2007 Chapple, C. L., & Johnson, K. A. (2007). Gender differences in impulsivity. Youth Violence and Juvenile Justice, 5, 221–234. doi:10.1177/1541204007301286[Crossref][Google Scholar]; Cross, Copping, & Campbell, 2011 Cross, C. P., Copping, L. T., & Campbell, A. (2011). Sex differences in impulsivity: A meta-analysis. Psychological Bulletin, 137, 97–130.[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Waldeck & Miller, 1997 Waldeck, T. L., & Miller, L. S. (1997). Gender and impulsivity differences in licit substance use. Journal of Substance Abuse, 9, 269–275. doi:10.1016/S0899-3289(97)90021-3[Crossref], [PubMed][Google Scholar]), it could be hypothesized that this elevated level of impulsivity may lead to an increased frequency of pornography use, which in turn may lead to problematic pornography use (e.g., Brand et al., 2011 Brand, M., Laier, C., Pawlikowski, M., Schächtle, U., Schöler, T., & Altstötter-Gleich, C. (2011). Watching pornographic pictures on the internet: Role of sexual arousal ratings and psychological–Psychiatric symptoms for using internet sex sites excessively. Cyberpsychology, Behavior, and Social Networking, 14, 371–377. doi:10.1089/cyber.2010.0222[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Grubbs, Exline et al., 2015 Grubbs, J. B., Exline, J. J., Pargament, K. I., Hook, J. N., & Carlisle, R. D. (2015). Transgression as addiction: Religiosity and moral disapproval as predictors of perceived addiction to pornography. Archives of Sexual Behavior, 44, 125–136. doi:10.1007/s10508-013-0257-z[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Grubbs , Volk et al., 2015 Grubbs, J. B., Volk, F., Exline, J. J., & Pargament, K. I. (2015). Internet pornography use: Perceived addiction, psychological distress, and the validation of a brief measure. Journal of Sex & Marital Therapy, 41, 83–106. doi:10.1080/0092623X.2013.842192[Taylor & Francis Online], [Web of Science ®][Google Scholar]; Twohig et al., 2009 Twohig, M. P., Crosby, J. M., & Cox, J. M. (2009). Viewing internet pornography: For whom is it problematic, how, and why? Sexual Addiction & Compulsivity, 16, 253–266. doi:10.1080/10720160903300788[Taylor & Francis Online][Google Scholar]). For women, impulsivity was not related to the frequency of pornography use (Carroll et al., 2008 Carroll, J. S., Padilla-Walker, L. M., Nelson, L. J., Olson, C. D., Barry, C. M., & Madsen, S. D. (2008). Generation XXX pornography acceptance and use among emerging adults. Journal of Adolescent Research, 23, 6–30. doi:10.1177/0743558407306348[Crossref], [Web of Science ®][Google Scholar]); therefore, it could be assumed that their impulsivity may not reflect in the frequency of pornography leading to problematic pornography use, but problematic pornography use could develop via different pathways (e.g., Lewczuk, Szmyd, Skorko, & Gola, 2017 Lewczuk, K., Szmyd, J., Skorko, M., & Gola, M. (2017). Treatment seeking for problematic pornography use among women. Journal of Behavioral Addictions, 6, 445–456. doi:10.1556/2006.6.2017.063[Crossref], [PubMed][Google Scholar]). In Egan and Parmar’s (2013 Egan, V., & Parmar, R. (2013). Dirty habits? online pornography use, personality, obsessionality, and compulsivity. Journal of Sex & Marital Therapy, 39, 394–409. doi:10.1080/0092623X.2012.710182[Taylor & Francis Online], [Web of Science ®][Google Scholar]) study, the association between compulsivity and problematic pornography use was mediated by sexual addiction, Internet addiction, and addiction more generally. Therefore, a similar mediational pattern could be hypothesized regarding the association between compulsivity and hypersexuality.

Likewise, self-efficacy may also mediate possible relationships between impulsivity, compulsivity, and problematic pornography use. In previous studies (e.g., Kraus, Rosenberg, Martino, Nich, & Potenza, 2017; Kraus, Rosenberg, & Tompsett, 2015), self-efficacy in reducing pornography use and self-efficacy in avoiding possibly tempting situations were identified as important factors in reducing problematic pornography use. Therefore, one might hypothesize that people with high levels of impulsivity or compulsivity may control their urges because of their high level of self-efficacy to avoid tempting situations, which in turn may result in lower levels of problematic pornography use.

Nevertheless, it is possible that levels of impulsivity and compulsivity in relationships with problematic sexual behaviors (such as problematic pornography use and hypersexuality) have been overestimated. According to a number of scholars (e.g., Conway, Kane, Ball, Poling, & Rounsaville, 2003 Conway, K. P., Kane, R. J., Ball, S. A., Poling, J. C., & Rounsaville, B. J. (2003). Personality, substance of choice, and polysubstance involvement among substance dependent patients. Drug and Alcohol Dependence, 71, 65–75. doi:10.1016/S0376-8716(03)00068-1[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Griffiths, 2017 Griffiths, M. D. (2017). The myth of ‘addictive personality’. Global Journal of Addiction & Rehabilitation Medicine, 3, 555610. doi:10.19080/GJARM.2017.03.555610[Crossref][Google Scholar]; Kerr, 1996 Kerr, J. S. (1996). Two myths of addiction: The addictive personality and the issue of free choice. Human Psychopharmacology, 11, S9–S14.[Crossref], [Web of Science ®][Google Scholar]; Szalavitz, 2016 Szalavitz, M. (2016). Unbroken brain: A revolutionary new way of understanding addiction. New York, NY: St. Martin’s Press. [Google Scholar]), no single personality trait or set of traits may lead to problematic behaviors or addictions. The three cornerstones of online pornography use (anonymity, affordability, and accessibility; Cooper, 1998 Cooper, A. (1998). Sexuality and the internet: Surfing into the new millennium. CyberPsychology & Behavior, 1, 187–193. doi:10.1089/cpb.1998.1.187[Crossref][Google Scholar]) may create situations that facilitate the increased use of pornography, and these may also contribute to the development of problematic pornography use. The careful, experimental examination of these cornerstones may significantly contribute to the understanding of problematic pornography use. Furthermore, situation-related factors that may affect individuals in a given life stage, such as loneliness (e.g., Bozoglan, Demirer, & Sahin, 2013 Bozoglan, B., Demirer, V., & Sahin, I. (2013). Loneliness, self‐esteem, and life satisfaction as predictors of internet addiction: A cross‐sectional study among Turkish university students. Scandinavian Journal of Psychology, 54(4), 313–319. doi:10.1111/sjop.12049[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Ceyhan & Ceyhan, 2008 Ceyhan, A. A., & Ceyhan, E. (2008). Loneliness, depression, and computer self-efficacy as predictors of problematic internet use. CyberPsychology & Behavior, 11, 699–701. doi:10.1089/cpb.2007.0255[Crossref], [PubMed][Google Scholar]) or perceived stress (e.g., Grubbs, Volk, et al., 2015 Grubbs, J. B., Volk, F., Exline, J. J., & Pargament, K. I. (2015). Internet pornography use: Perceived addiction, psychological distress, and the validation of a brief measure. Journal of Sex & Marital Therapy, 41, 83–106. doi:10.1080/0092623X.2013.842192[Taylor & Francis Online], [Web of Science ®][Google Scholar]; Levin, Lillis, & Hayes, 2012 Levin, M. E., Lillis, J., & Hayes, S. C. (2012). When is online pornography viewing problematic among college males? Examining the moderating role of experiential avoidance. Sexual Addiction & Compulsivity, 19, 168–180. doi:10.1080/10720162.2012.657150[Taylor & Francis Online][Google Scholar]; Paul & Shim, 2008 Paul, B., & Shim, J. W. (2008). Gender, sexual affect, and motivations for internet pornography use. International Journal Of Sexual Health, 20, 187–199. doi: 10.1080/19317610802240154[Taylor & Francis Online], [Web of Science ®][Google Scholar]; Reid et al., 2011 Reid, R. C., Li, D. S., Gilliland, R., Stein, J. A., & Fong, T. (2011). Reliability, validity, and psychometric development of the pornography consumption inventory in a sample of hypersexual men. Journal of Sex & Marital Therapy, 37, 359–385. doi:10.1080/0092623X.2011.607047[Taylor & Francis Online], [Web of Science ®][Google Scholar]), may also influence the level of addictive online behaviors such as problematic pornography use. Finally, it should also be noted that societal factors such as regulations and policies that influence the accessibility, affordability, and anonymity of pornography may in turn promote or hinder the emergence of those specific situations in which (problematic or nonproblematic) pornography use may have significant psychosocial impacts.

Future Studies and Limitations

Further measures are needed in future studies that may directly assess respondents’ behaviors while respecting individuals’ privacy. The extent of problematic pornography consumption and the level of hypersexuality may be temporally stable or it may change over time. It is possible that an individual may temporarily use pornography more intensively or in a more problematic manner, but this behavior may change. Therefore, longitudinal studies are needed to answer the question of stability. Future experimental studies with well-established designs are needed to determine a potentially causal role of individual differences and situational factors in the development and maintenance of hypersexuality and problematic pornography use, such as sex mind-set beliefs (Bőthe, Tóth-Király, Demetrovics, & Orosz, 2017 Bőthe, B., Tóth-Király, I., Demetrovics, Z., & Orosz, G. (2017). The pervasive role of sex mindset: Beliefs about the malleability of sexual life is linked to higher levels of relationship satisfaction and sexual satisfaction and lower levels of problematic pornography use. Personality and Individual Differences, 117, 15–22. doi:10.1016/j.paid.2017.05.030[Crossref], [Web of Science ®][Google Scholar]), reward deficiency syndrome (Comings & Blum, 2000 Comings, D. E., & Blum, K. (2000). Reward deficiency syndrome: Genetic aspects of behavioral disorders. Progress in Brain Research, 126, 325–341. doi:10.1016/S0079-6123(00)26022-6[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Lochner et al., 2005 Lochner, C., Hemmings, S. M., Kinnear, C. J., Niehaus, D. J., Nel, D. G., Corfield, V. A., … Stein, D. J. (2005). Cluster analysis of obsessive-compulsive spectrum disorders in patients with obsessive-compulsive disorder: Clinical and genetic correlates. Comprehensive Psychiatry, 46, 14–19. doi:10.1016/j.comppsych.2004.07.020[Crossref], [PubMed], [Web of Science ®][Google Scholar]), perceived stress (Grubbs, Volk, Exline, & Pargament, 2015 Grubbs, J. B., Volk, F., Exline, J. J., & Pargament, K. I. (2015). Internet pornography use: Perceived addiction, psychological distress, and the validation of a brief measure. Journal of Sex & Marital Therapy, 41, 83–106. doi:10.1080/0092623X.2013.842192[Taylor & Francis Online], [Web of Science ®][Google Scholar]), or basic psychological needs (Tóth-Király, Morin, Bőthe, Orosz, & Rigó, 2018 Tóth-Király, I., Morin, A. J., Bőthe, B., Orosz, G., & Rigó, A. (2018). Investigating the multidimensionality of need fulfillment: A bifactor exploratory structural equation modeling representation. Structural Equation Modeling: A Multidisciplinary Journal, 25, 267–286. doi:10.1080/10705511.2017.1374867[Taylor & Francis Online], [Web of Science ®][Google Scholar]). Finally, it should be kept in mind that the outcomes studied in the present study pertain only to specific problematic aspects of sexuality (i.e., problematic online pornography use and hypersexuality). Developing measures that can assess nonproblematic aspects of pornography use may be useful in further research. Stronger cooperation between pornography Web sites—which may provide behavioral data—and the scientific community may be beneficial in providing predictive validity of related measures. Future studies should focus on preventions and interventions that emphasize not only self-reported individual differences but also social and situational factors related to the development and maintenance of problematic sexual behaviors.

Some limitations of the present study should be noted. The use of self-report cross-sectional methods have possible biases that need be considered when interpreting the findings. Moreover, causality cannot be inferred from the present cross-sectional findings. The internal consistency of the compulsivity subscale of the SCID-II was not adequate; therefore, it is possible that the low level of internal consistency may have distorted the findings. In addition, self-reported compulsivity was assessed via SCID-II methods. Other assessments of compulsivity (e.g., via the Padua Inventory or other assessments; Andrews et al., 2011 Andrews, M. M., Meda, S. A., Thomas, A. D., Potenza, M. N., Krystal, J. H., Worhunsky, P., … Pearlson, G. D. (2011). Individuals family history positive for alcoholism show functional magnetic resonance imaging differences in reward sensitivity that are related to impulsivity factors. Biological Psychiatry, 69, 675–683. doi:10.1016/j.biopsych.2010.09.049[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Scherrer, Xian, Slutske, Eisen, & Potenza, 2015 Scherrer, J. F., Xian, H., Slutske, W. S., Eisen, S. A., & Potenza, M. N. (2015). Associations between obsessive-compulsive classes and pathological gambling in a national cohort of male twins. JAMA Psychiatry, 72, 342–349. doi:10.1001/jamapsychiatry.2014.2497[Crossref], [PubMed], [Web of Science ®][Google Scholar]) may have yielded different results. Similar concerns exist regarding the UPPS-P and other self-report measures of impulsivity. In addition, because self-report measures differ with behavioral measures of constructs (e.g., Krishnan-Sarin et al., 2007 Krishnan-Sarin, S., Reynolds, B., Duhig, A. M., Smith, A., Liss, T., McFetridge, A., … Potenza, M. N. (2007). Behavioral impulsivity predicts treatment outcome in a smoking cessation program for adolescent smokers. Drug and Alcohol Dependence, 88, 79–82. doi:10.1016/j.drugalcdep.2006.09.006[Crossref], [PubMed], [Web of Science ®][Google Scholar]), it is important for future studies to investigate both behavioral and self-report measures related to hypothesized predictors of the given behavior (e.g., using the cued go/no-go task [Fillmore, 2003 Fillmore, M. T. (2003). Drug abuse as a problem of impaired control: Current approaches and findings. Behavioral and Cognitive Neuroscience Reviews, 2, 179–197. doi:10.1177/1534582303257007[Crossref], [PubMed][Google Scholar]] or the stop signal task [Logan, 1994 Logan, G. D. (1994). On the ability to inhibit thought and action: A users’ guide to the stop signal paradigm. In D. Dagenbach & T. H. Carr (Eds.), Inhibitory processes in attention, memory, and language (pp. 189–239). San Diego, CA: Academic Press. [Google Scholar]] with a self-reported measure in the case of impulsivity [Ding et al., 2014 Ding, W. N., Sun, J. H., Sun, Y. W., Chen, X., Zhou, Y., Zhuang, Z. G., … Du, Y. S. (2014). Trait impulsivity and impaired prefrontal impulse inhibition function in adolescents with internet gaming addiction revealed by a Go/No-Go fMRI study. Behavioral and Brain Functions, 10(1), 20. doi:10.1186/1744-9081-10-20[Crossref], [PubMed][Google Scholar]]). It will also be important to concurrently assess the behavior itself (e.g., actual amount of pornography use employing tracking-data approaches in collaboration with pornography Web site operators as has been done in other fields such as gambling; Griffiths, 2014 Griffiths, M. D. (2014). The use of behavioural tracking methodologies in the study of online gambling. SAGE Research Methods Cases. doi:10.4135/978144627305013517480[Crossref][Google Scholar]).

Conclusion and Implications

In sum, impulsivity and compulsivity did not contribute as importantly and directly to problematic pornography use as previously proposed in the literature, and impulsivity may have a more prominent role in hypersexuality. Furthermore, these results have several conceptual and research implications. First, several issues arise regarding the categorization of problematic pornography use. One issue is whether problematic pornography use may be considered a subcategory of hypersexuality if relationships with impulsivity and compulsivity are not as strong as previously hypothesized. A second issue—which may be related to the categorization of problematic pornography use under the umbrella of hypersexuality—is how problematic pornography use (and especially problematic online pornography use) may best be categorized (Griffiths, 2016 Griffiths, M. D. (2016). Compulsive sexual behaviour as a behavioural addiction: The impact of the internet and other issues. Addiction, 111, 2107–2108. doi:10.1111/add.13315[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Kraus et al., 2016 Kraus, S. W., Voon, V., & Potenza, M. N. (2016). Should compulsive sexual behavior be considered an addiction? Addiction, 111, 2097– 2106. doi:10.1111/add.13297[Crossref], [PubMed], [Web of Science ®][Google Scholar]; Potenza et al., 2017 Potenza, M. N., Gola, M., Voon, V., Kor, A., & Kraus, S. W. (2017). Is excessive sexual behaviour an addictive disorder? The Lancet Psychiatry, 4, 663–664. doi:10.1016/S2215-0366(17)30316-4[Crossref], [PubMed], [Web of Science ®][Google Scholar]).

From a research perspective, self-reported tendencies may have a stronger impact on problematic sexual behaviors via mediating variables such as motivations, frequency and time spent with the activity, frustration relating to psychological needs, beliefs about the malleability of the given activities, topic-relevant self-efficacy beliefs, and/or other factors. All of these possibilities warrant direct examination. Moreover, it is important to consider the complex etiologies of addictions. More specifically, it is likely that a complex set of personality factors, other individual difference factors, and social and situational factors lead to the development and maintenance of problematic sexual behaviors and that these may vary according to the type of problematic sexual behavior. Additional research is needed to understand factors related to specific problematic sexual behaviors and translate the factors into improved prevention, treatment, and policy initiatives.

Conflict of Interest

The authors declare no conflict of interest with respect to the content of this manuscript. Dr. Potenza has consulted for and advised Rivermend Health, Opiant/Lightlake Therapeutics, and Jazz Pharmaceuticals; received research support (to Yale) from the Mohegan Sun Casino and the National Center for Responsible Gaming; consulted for legal and gambling entities on issues related to impulse control and addictive behaviors. The other authors report no financial relationships with commercial interests.

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