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      “Pornographic binges” as a key characteristic of males seeking treatment for compulsive sexual behaviors: Qualitative and quantitative 10-week-long diary assessment

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          Abstract

          Background and aims

          Compulsive sexual behaviors (CSBs) are an important clinical and social issue. Despite the increasing number of studies, some of CSB’s aspects remain under-investigated. Here, we explore the nature of CSB, such as binge pornography use and masturbation (PuM), and verify the correspondence between self-perceived factors leading to such behavior with its measures obtained in a diary assessment.

          Methods

          Semi-structuralized interviews with nine treatment-seeking males aged 22–37 years ( M = 31.7, SD = 4.85) were followed by a questionnaire and a 10-week-long diary assessment, allowing us to acquire real-life daily patterns of CSB.

          Results

          Six out of nine subjects experienced binge (multiple hours or times a day) PuM. All subjects presented a high level of anxiety and perceived PuM as a way to regulate mood and stress. Data collected in the diary assessment uncovered a high diversity in the patterns of sexual behaviors (such as frequency of regular and binge PuM) and its correlates. Binge PuM was related to decreased mood and/or increased stress or anxiety. The causal relation between these correlates remains undetermined.

          Discussion and conclusions

          Binge PuM seems to be one of the most characteristic behavior among males who are seeking treatment for CSB and is related to the feeling of losing control over one’s sexual activity. CSB individuals indicate a variety of binge triggers. Also, diary assessment data indicate that specific correlates of binge PuM (decreased mood, increased stress, and anxiety) differ between subjects. It suggests the existence of significant individual differences in binge PuM behaviors, and a need to study these differences, as it may help guide personalized treatment.

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          Most cited references 40

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          Hypersexual disorder: a proposed diagnosis for DSM-V.

           M Kafka (2010)
          Hypersexual Disorder is proposed as a new psychiatric disorder for consideration in the Sexual Disorders section for DSM-V. Historical precedents describing hypersexual behaviors as well as the antecedent representations and proposals for inclusion of such a condition in the previous DSM manuals are reviewed. Epidemiological as well as clinical evidence is presented suggesting that non-paraphilic "excesses" of sexual behavior (i.e., hypersexual behaviors and disorders) can be accompanied by both clinically significant personal distress and social and medical morbidity. The research literature describing comorbid Axis I and Axis II psychiatric disorders and a purported relationship between Axis I disorders and Hypersexual Disorder is discussed. Based on an extensive review of the literature, Hypersexual Disorder is conceptualized as primarily a nonparaphilic sexual desire disorder with an impulsivity component. Specific polythetic diagnostic criteria, as well as behavioral specifiers, are proposed, intended to integrate empirically based contributions from various putative pathophysiological perspectives, including dysregulation of sexual arousal and desire, sexual impulsivity, sexual addiction, and sexual compulsivity.
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            Delay-discounting probabilistic rewards: Rates decrease as amounts increase.

            The independence of delay-discounting rate and monetary reward size was tested by offering subjects (N = 621) a series of choices between immediate rewards and larger, delayed rewards. In contrast to previous studies, in which hypothetical rewards have typically been employed, subjects in the present study were entered into a lottery in which they had a chance of actually receiving one of their choices. The delayed rewards were grouped into small ($30-$35), medium ($55-$65), and large amounts ($70-$85). Using a novel parameter estimation procedure, we estimated discounting rates for all three reward sizes for each subject on the basis of his/her pattern of choices. The data indicated that the discounting rate is a decreasing function of the size of the delayed reward (p < .0001), whether hyperbolic or exponential discounting functions are assumed. In addition, a reliable gender difference was found (p = .005), with males discounting at higher rates than females, on average.
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              Addiction: decreased reward sensitivity and increased expectation sensitivity conspire to overwhelm the brain's control circuit.

              Based on brain imaging findings, we present a model according to which addiction emerges as an imbalance in the information processing and integration among various brain circuits and functions. The dysfunctions reflect (a) decreased sensitivity of reward circuits, (b) enhanced sensitivity of memory circuits to conditioned expectations to drugs and drug cues, stress reactivity, and (c) negative mood, and a weakened control circuit. Although initial experimentation with a drug of abuse is largely a voluntary behavior, continued drug use can eventually impair neuronal circuits in the brain that are involved in free will, turning drug use into an automatic compulsive behavior. The ability of addictive drugs to co-opt neurotransmitter signals between neurons (including dopamine, glutamate, and GABA) modifies the function of different neuronal circuits, which begin to falter at different stages of an addiction trajectory. Upon exposure to the drug, drug cues or stress this results in unrestrained hyperactivation of the motivation/drive circuit that results in the compulsive drug intake that characterizes addiction.
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                Author and article information

                Journal
                jba
                JBA
                Journal of Behavioral Addictions
                J Behav Addict
                Akadémiai Kiadó (Budapest )
                2062-5871
                2063-5303
                05 June 2018
                June 2018
                : 7
                : 2
                : 433-444
                Affiliations
                [ 1 ]Clinical Neuroscience Laboratory, Institute of Psychology, Polish Academy of Sciences , Warsaw, Poland
                [ 2 ]Faculty of Mathematics and Computer Science, Nicolaus Copernicus University , Torun, Poland
                [ 3 ]Department of Psychology, University of Social Sciences and Humanities , Warsaw, Poland
                [ 4 ]Predict Watch, Bialystok, Poland
                [ 5 ]Swartz Center for Computational Neuroscience, Institute for Neural Computation, University of California San Diego , San Diego, CA, USA
                Author notes
                [* ]Corresponding author: Mateusz Gola; Clinical Neuroscience Laboratory, Institute of Psychology, Polish Academy of Sciences, 1 Jaracza St. 00-378 Warsaw, Poland; Phone: +48 22 583 13 80; Fax: +48 22 583 13 81; E-mail: mgola@ 123456psych.pan.pl
                Article
                10.1556/2006.7.2018.33
                6174597
                29865868
                © 2018 The Author(s)

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated.

                Page count
                Figures: 4, Tables: 5, Equations: 0, References: 39, Pages: 12
                Funding
                Funding sources: This study was supported by the Polish National Science Centre, by two grants OPUS grant (2014/15/B/HS6/03792) (MG, MWi, MWo, and EK) and PRELUDIUM grant (2016/23/N/HS6/02906) (MWo). MG is additionally supported by scholarships of the Polish Ministry of Science scholarships (469/STYP/10/2015) and the Kosciuszko Foundation.
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