Background and aimsFor the first time, the ICD-11 provides the diagnosis compulsive sexual behavior disorder (CSBD) that can be assigned for pornography use disorder (PUD). This study aimed to estimate the prevalence of PUD and associated consequences in Germany, to identify the psychotherapy demand among likely PUD (lPUD) cases and the treatment supply in different psychotherapeutic settings, to survey psychotherapists' level of expertise regarding PUD, and to identify predictors for psychotherapy demand.MethodsFour studies were conducted: 1. Online study in the general population (n = 2070; m = 48.9%, f = 50.8%, d = 0.2%), 2. Survey among practicing psychotherapists (n = 983), 3. Survey of psychotherapists in psychotherapeutic outpatient clinics (n = 185), 4. Interviews with psychotherapeutic inpatient clinics (n = 28).ResultsThe estimated prevalence of lPUD in the online study was 4.7% and men were 6.3 times more often affected than women. Compared to individuals without PUD, individuals with lPUD more often indicated negative consequences in performance-related areas. Among lPUD cases, 51.2% of men and 64.3% of women were interested in a specialized PUD treatment. Psychotherapists reported 1.2%–2.9% of lPUD cases among their patients. 43.2%–61.5% of psychotherapists stated to be poorly informed about PUD. Only 7% of psychotherapeutic inpatient clinics provided specific treatments to patients with PUD. While, among other factors, negative consequences attributed to lPUD were predictive for psychotherapy demand, weekly pornography consumption, subjective well-being, and religious attachment were not.Discussion and conclusionsAlthough PUD occurs quite often in Germany, availability of mental health care services for PUD is poor. Specific PUD treatments are urgently needed.

No abstract

Background Sexual dysfunctions are commonly associated with depression by which women are particularly affected. Aim In the following study, we looked at which stage–early attention-related processes or later evaluation-related processes–of the processing of sexual stimuli deviations occur in depressed individuals. Methods We examined 96 women who either suffered from a major depressive disorder, or had recovered from it, and a healthy control group. The early level of attention processes was represented by reaction time tasks (dot probe, line orientation, picture categorization). In addition, implicit approach and avoidance behavior was tested by the Approach-Avoidance Task. Later evaluation of the visual material was determined with the help of a questionnaire for recording automatic negative thoughts regarding sexuality. Outcomes Reaction times and explicit ratings as well as the Becks Depression Inventory (BDI II), the Trait Sexual Motivation Questionnaire (TSMQ), the Sexual Modes Questionnaire (SMQ) and a screening for sexual dysfunction were used. Results Depressed women did not differ significantly from healthy women in their attention processes and approach-avoidance behavior. However, there were clear differences in explicit assessment and automatic thoughts about sexual stimuli. Women who had recovered from depression lay between the 2 groups. Clinical Implications The results indicated that the therapy of sexual dysfunction in depressed patients should focus more on automatic thoughts than on attention processes. Strengths & Limitations This study is the first to experimentally research the attention processes of depression towards sexual stimuli. However, participants were only tested on one occasion so that change of attention processes and evaluation of sexual stimuli over the course of a depression could not be assessed. Conclusion Our novel findings demonstrate the role of attention processes in sexual dysfunctions of depressed women and suggest potential mechanisms that may underlie the observed correlation between depression and sexual dysfunction.