Sexual addiction, sexual compulsivity, sexual impulsivity, or what? Toward a theoretical model

Journal of Sex Research, August, 2004 by John Bancroft, Zoran Vukadinovic

Paraphilics versus nonparaphilics. This comparison is shown in Table 5. None of the comparisons of the two subgroups was significant, although there was a trend for paraphilics to score higher on SES than controls (p = .06), a difference which was not found for nonparaphilics.

Dissociators. Those who described a dissociative mental state during acting out (n = 13) were compared to the rest (n = 16) and these comparisons are shown in Table 6. There were no significant differences between the two groups. However, the dissociators scored higher than controls on SES (p = .02).

History of sexual abuse when a child. To explore the possibility that a history of child sexual abuse may have accounted for the high MSQ scores, we compared those with such a history (n = 9) to those without (n = 17) and controls. None of the comparisons was significant.

DISCUSSION

What Can We Learn From This Study?

This sample of self-defined sex addicts is too small to draw conclusions about etiology, but it does allow us to explore our theoretical ideas and develop them further. We discuss our four preliminary hypotheses first, followed by some other aspects of the results.

Hypotheses. Hypothesis 1 (a tendency to increased sexual interest and responsiveness during negative mood states is more common in men with out of control sexual behavior) was strongly supported by both our questionnaire and interview data. The two subscales of the MSQ that we examined, MS-1 and MS-3, indicated that increased sexual interest in states of both depression and anxiety were characteristics of the sex addict group. Even though our sample was small, the differences with the controls for both measures were highly significant. Furthermore, the subgroup who completed the ZDPR (the trait measure of depression) had significantly higher scores than the controls, indicating that in addition to displaying this paradoxical relationship between negative mood and sexual interest, they were also more prone to experiencing depression than were controls. With the interview data, all but 4 of the 29 men and both women reported an increased likelihood of acting out in states of either depression or anxiety or both.

Hypothesis 2 (increased sexual interest associated with anxiety rather than depression is more associated with out of control masturbation than with sexual behavior involving another person) and Hypothesis 3 (increased sexual interest associated with depression is associated with out of control interaction with sexual partners) were not supported by our results. We did, however, find depression to have a clearer role than anxiety. MS-1 scores (sexual interest when depressed) were significantly higher in the depression regulators than the rest and the controls. MS-3 (sexual interest when anxious) was higher in the anxiety regulators but not significantly so, and in fact MS-3 was slightly higher in the depression regulators than in the anxiety regulators. This raises the possibility, which we have discussed elsewhere (Bancroft, Janssen, Strong, Carnes, et al., 2003b), that some of the sexual enhancing effect of depression may result from concurrent anxiety, a pattern which our simple MSQ trait measure does not identify. The relevance of such an association was shown by Nofzinger et al. (1993), who found that depressed men who did not respond to cognitive behavioral therapy had higher anxiety levels as well as higher sexual interest than those who did respond and the nondepressed controls. A mixture of depression and anxiety is not uncommon in affective disorders and needs to be carefully assessed in further studies of sex addicts.