Introduction Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for hypersexual disorder (HD) have been proposed to capture symptoms reported by patients seeking help for out-of-control sexual behavior. The proposed criteria created by the DSM-5 Work Group on Sexual and Gender Identity Disorders require evaluation in a formal field trial. Aim This DSM-5 Field Trial was designed to assess the reliability and validity of the criteria for HD in a sample of patients seeking treatment for hypersexual behavior, a general psychiatric condition, or a substance-related disorder. Method Patients (N = 207) were assessed for psychopathology and HD by blinded raters to determine inter-rater reliability of the HD criteria and following a 2-week interval by a third rater to evaluate the stability of the HD criteria over time. Patients also completed a number of self-report measures to assess the validity of the HD criteria. Main Outcome Measures HD and psychopathology were measured by structured diagnostic interviews, the Hypersexual Behavior Inventory, Sexual Compulsivity Scale, and Hypersexual Behavior Consequences Scale. Emotional dysregulation and stress proneness were measured by facets on the NEO Personality Inventory—Revised. Results Inter-rater reliability was high and the HD criteria showed good stability over time. Sensitivity and specificity indices showed that the criteria for HD accurately reflected the presenting problem among patients. The diagnostic criteria for HD showed good validity with theoretically related measures of hypersexuality, impulsivity, emotional dysregulation, and stress proneness, as well as good internal consistency. Patients assessed for HD also reported a vast array of consequences for hypersexual behavior that were significantly greater than those diagnosed with a general psychiatric condition or substance-related disorder. Conclusions The HD criteria proposed by the DSM-5 Work Group on Sexual and Gender Identity Disorders appear to demonstrate high reliability and validity when applied to patients in a clinical setting among a group of raters with modest training on assessing HD.
Introduction Prostate cancer is the most common type of cancer found in American men. Patient adjustment to prostate cancer is not limited to attempts to restore sexual function, a process that can pose significant challenges to couples following most surgical and nonsurgical treatments. Patients often struggle with depression and other relational stressors. Partners also undergo psychosocial, relational, sexual, and quality-of-life changes and their responses to these changes may relate to patient adjustment. Aim To evaluate to what extent partners' psychosocial and relational adjustment relates to prostate cancer patient adjustment. Main Outcome Measures Partner and patient general and sexual depression; patient relationship satisfaction, quality of sexual communication, sexual satisfaction, and life satisfaction. Method A total of 77 patients and 57 partners responded to a mail survey that included demographic information, the Beck Depression Inventory, Life Satisfaction Index, Index of Sexual Satisfaction, Relationship Assessment Scale, Dyadic Sexual Communication Scale, Sexuality Scale, and Client Satisfaction Questionnaire. Results Patients and their partners differed in their sexual self-esteem, sexual depression, sexual preoccupation, and life satisfaction. Both had greater levels of depression, poorer quality of sexual communication, and more sexual dissatisfaction than the general population. Partners' level of general depression and depression concerning their sex lives were significant predictors of patients' relationship satisfaction, perceived quality of communication about the sexual relationship, and sexual satisfaction after controlling for patients' general and sexual depression. Conclusions Partners often serve as primary caregivers, thus partner adjustment can be critical to the health of the patient and to his primary relationship. Results suggest the importance of including partners' adjustment in assessing patient adjustment post-treatment. We suggest that physicians working with these patients partner with mental health professionals who can help couples address the challenges they encounter and extend the continuity of care when the need for medical intervention has passed.
Background and aims:The past decade has seen an increased interest in understanding hypersexual behavior and its associated features. Beyond the obvious risks for sexually transmitted infections, there is a paucity of literature examining specific challenges encountered by hypersexual individuals. This study investigated and developed a new scale, the Hypersexual Behavior Consequences Scale (HBCS), to assess the various consequences reported among hypersexual patients. Methods: Participants were drawn from a sample of patients recruited in a DSM-5 Field Trial for Hypersexual Disorder (HD). Participants completed the Hypersexual Behavior Inventory, a structured diagnostic interview to assess for psychopathology and HD, and self-report measures of personality, life satisfaction, and the initial item pool for the HBCS. Results: Factor analysis reduced the HBCS items to a single factor solution which showed high internal consistency and stability over time. Higher HBCS scores were positively correlated with higher levels of emotional dysregulation, impulsivity, and stress proneness and lower levels of satisfaction with life and happiness. HBCS scores among the hypersexual patients were significantly higher than non-hypersexual patients. Conclusions:The HBCS possesses good psychometric properties and appears to capture various consequences associated with the DSM-5 proposed criteria for HD. The HBCS can be used to aid clinicians and researchers in identifying consequences associated with hypersexual behavior. The HBCS may also prove a useful tool to guide treatment interventions aimed at reducing the negative impact of hypersexuality in patient populations.
Introduction Patients seeking help for hypersexual behavior often exhibit features of impulsivity, cognitive rigidity, and poor judgment as well as deficits in emotion regulation and excessive preoccupation with sex. Some of these characteristics are also common among patients presenting with neurological pathology associated with executive dysfunction. Exploring relationships between dysregulated sexual behavior and executive deficits will enhance our understanding of hypersexuality. Aim This study sought to assess whether patients seeking help for hypersexual behavior exhibit executive deficits as measured by standardized neuropsychological tests of executive functioning when compared with healthy controls. Methods Executive deficits were assessed in a sample of male patients (N = 30) seeking help for hypersexual behavior compared with a nonhypersexual community sample of men (N = 30) using neuropsychological tests of executive functioning. Using multivariate statistics, differences between the groups were examined. Main Outcome Measures Sexual activity measured by the Hypersexual Behavior Inventory and the Compulsive Sexual Behavior Inventory. Executive functions measured through neuropsychological testing using several subtests of Delis–Kaplan Executive Function System: Color–Word Interference Test, the Tower Test, the Trail Making Test, the Verbal Fluency Test, as well as the Wisconsin Card Sorting Test. Psychopathology was assessed using the Mini International Neuropsychiatric Interview, and cognitive ability was assessed using the Wechsler Adult Intelligence Scale. Results Significant differences on measures of hypersexuality were observed. However, the groups failed to exhibit significant differences across neuropsychological tests of executive functioning even after controlling for cognitive ability. Conclusions These results contradict a previous finding of executive deficits among hypersexual men measured by self-report. The lack of executive deficits suggests that this population may exhibit domain-specific aspects of impulsivity, poor judgment, and risky behavior that are not generalizable to other domains of life. Furthermore, our findings fail to support a conceptualization of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, proposed hypersexual disorder based on models of executive dysfunction.
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