Sexual compulsivity among heterosexual college students

Journal of Sex Research, Nov, 2004 by Brian Dodge, Michael Reece, Sara L. Cole, Theo G.M. Sandfort

Recent studies suggest that sexual compulsivity is related to participation in sexual behaviors that are high risk for HIV infection (Benotsch, Kalichman, & Kelly, 1999; Kalichman, Greenberg, & Abel, 1997; Kalichman et al., 1994; Kalichman & Rompa, 1995; Kalichman & Rompa, 2001; Reece, Hate, & Daughtry, 2001). Sexual compulsivity has been defined as "an insistent, repetitive, intrusive, and unwanted urge to perform specific acts often in ritualized or routinized fashions" (Kalichman & Rompa, 1995, p. 587). Recently, some have conceptualized sexual compulsivity as a pattern of participation in sexually oriented activities in a manner that is persistent and escalating and that has the potential to result in negative consequences for self and others, or the drive to participate in such activities (National Council on Sexual Addiction and Compulsivity, 2004; Reece, 2003). Although substantial debate and skepticism surround the nature and existence of sexual compulsivity as a "pathological condition" (Levine & Troiden, 1988), the concept has been widely studied and measured in recent sexological, psychological, and public health research (Carnes & Adams, 2002). As yet, sexual compulsivity and its associations with HIV risk behavior have only been assessed among those at high risk for infection or those who are HIV-positive.

Because the human immunodeficiency virus (HIV) is principally transmitted through sexual and intravenous drug use behaviors, public health researchers have examined factors related to sexual risk including substance use, sexual situations, and relationship features. Few early studies on HIV transmission considered the role of personality traits and their relation to sexual and risk behaviors. Researchers have begun to focus on individual characteristics, including the "propensity to prefer exciting, optimal, and novel stimulation or arousal" known as sensation seeking (Kalichman, et al., 1994, p. 387), and their relation to sexual behaviors that may place individuals at high risk for HIV infection. Recent attention to sexual compulsivity arose from an interest in sensation seeking as the potential cause for the continuation of high risk sexual behaviors despite their potentially harmful and lethal consequences.

In earlier studies, before the dawn of the HIV epidemic, Zuckerman (1979, 1994) found that sensation seeking was associated with participation in a number of behaviors including "potentially risky experiments, sports, vocations, criminal activities, sexual behavior, smoking, heavy drinking, drug use and abuse, reckless driving and driving under the influence of alcohol, and gambling" (Zuckerman & Kuhlman, 2000, p. 1001). At this time, risky sexual behavior was conceptualized as promiscuity, in which an individual did not properly compare, for example, "the possibilities of contracting a sexually transmitted disease against the possibility of a thrilling sexual encounter" (Zuckerman & Kuhlman, 2000, p. 1000). Kalichman et al. (1994) argued that traditional criteria for sensation seeking that were applied to sexual behaviors, including the Sensation Seeking Scale (Zuckerman, Kolin, Price, & Zoob, 1964), contained socioculturally outdated concepts and terminology that were not directly related to the sexual variables of interest.

New scales have subsequently been produced with the intention of measuring both sexual and nonsexual sensation seeking as well as sexual compulsivity as a separate and discrete phenomenon. Although the term sexual compulsivity to some extent overlaps with and has been used interchangeably with popular concepts such as sexual addiction (Carnes & Adams, 2002), sexual impulsivity (Barth & Kinder, 1987), and the established psychiatric diagnosis of hypersexuality (Montaldi, 2002), it has been most widely measured and studied as a distinct concept in relation to HIV risk behavior using the Sexual Compulsivity Scale (SCS: Kalichman & Rompa, 1995).

Originally designed in the mid-1990s to explore high risk sexual behaviors (e.g., unprotected anal intercourse) in samples of men who have sex with men (MSM), the SCS seeks to tap into underlying compulsive personality traits that could be linked to a resistance to sexual behavior change despite exposure to HIV prevention messages and interventions (Kalichman et al., 1994). The instrument asks respondents to indicate the extent of their agreement to 10 statements related to compulsive sexually intrusive thoughts, preoccupations, and behaviors (see Table 1). The statements were largely derived from a contemporary 12-step self-help manual for persons seeking recovery from so-called sexual addiction in clinical settings; specifically, these individuals complained of sexual control issues, problems managing their sexual behaviors and thoughts, or a possible belief that they might be sex addicts (CompCare, 1987; Kalichman & Rompa, 2001). Responses are given on a 4-point scale that ranges from 1 (not at all like me) to 4 (very much like me). Reliability of the SCS was originally found to be high ([alpha] = .89) in a pilot convenience sample of self-identified homosexually active men (Kalichman et al., 1994). Higher levels of compulsivity were found to be positively related to psychological constructs such as loneliness, self-esteem, and sexual self-control. In this initial sample, however, the scale did not demonstrate significant associations with high risk sexual behaviors (in terms of frequency of engaging in these behaviors).