The number of people in the US who have difficulty controlling sexual feelings and urges may be greater than realised, researchers say. The study found that 7% of women and more than 10% of men said they were distressed due to difficulty controlling sexual urges, feelings and behaviours.
“It’s a lot more people than we expected to be having difficulty controlling sexual urges and behaviours and who are feeling distressed and impaired,” said the study’s lead author, Janna Dickenson, of the University of Minnesota Medical School in Minneapolis.
“The differences between the sexes are a lot less than we would have expected, raising concerns that the difficulty in controlling sexual behavior affects more than just men,” she added.
Dickenson and colleagues surveyed 2,235 people, ages 18 to 50, across all 50 states. Questions covered household income, personal details and 13 other items specifically addressing sexual urges, feelings and behaviours. Among these 13 were: “How often have you had trouble controlling your sexual urges?”, “How often have you felt unable to control sexual behaviour?”, “How often have you felt guilty or shameful about sexual behaviour?”, “How often have you made pledges or promises to alter your sexual behaviour?” and “How often have your sexual activities caused financial problems for you?”
Study volunteers were told to answer by rating each question using a 5-point scale ranging from 1 (never) to 5 (very frequently). Other research has shown that a score of 35 or more indicates that the person is likely to have “compulsive sexual behaviour disorder,” a newly designated diagnosis listed in the International Classification of Diseases, Dickenson said. The diagnosis is not one that is recognized in the reference used by US psychiatrists and psychologists, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Overall, 10.3% of men and 7.0% of women scored 35 or more. That number is higher than previous research has found, Dickenson said.
Dr Robert Hudak isn’t sure exactly what the new study is telling us. “They kind of mix things up, for example, using ‘impulsive’ and ‘compulsive’ interchangeably,” said Hudak, an associate professor of psychiatry at the University of Pittsburgh School of Medicine in Pennsylvania and medical director of the Obsessive Compulsive Disorders Outpatient Programme at the at Western Psychiatric Hospital at the University of Pittsburgh Medical Centre who wasn’t involved in the study.
Still, Hudak allowed, “they do find a high rate of people with some sort of distress with their sexuality. But is it impulsive, compulsive, addictive? Is it something else? You can’t tell from what they did.”
“What you can take from this research is that there is a pretty decent percentage of people who are complaining about some sort of negative feelings about their sexuality,” Hudak said. “And those negative feelings are leading to some distress.” But that wouldn’t earn them any kind of diagnosis in the US, Hudak noted.
Based on his experiences as a therapist, Thomas Plante wasn’t surprised by the large numbers of people distressed by their sexuality. “There are a lot of people in my patient population – regular folks – who really struggle with their sexual impulses,” said Plante, a professor of psychology at Santa Clara University in California and an adjunct clinical professor of psychiatry at the Stanford University School of Medicine who also wasn’t involved in the new research. “There are folks who are engaging with sex workers when they travel. Others struggle with pornography or the temptation to step away from marital fidelity. Many take risks even when it can impact their lives.”
Plante suspects that more and more people are having trouble these days because so much temptation is at their fingertips. Just a few taps on the smart phone and pornography pops up, or an assignation that might later lead to guilt, can be arranged, he said.
“I’ve had a lot of patients like that,” Plante said. “They start out just poking around on the internet. Then they’re doing it more and more. And then it becomes a problem for them. Their spouse gets all upset, or someone walks in on them. Then they come looking for help.”
Importance: The veracity, nomenclature, and conceptualizations of sex addiction, out-of-control sexual behavior, hypersexual behavior, and impulsive or compulsive sexual behavior are widely debated. Despite such variation in conceptualization, all models concur on the prominent feature: failing to control one’s sexual feelings and behaviors in a way that causes substantial distress and/or impairment in functioning. However, the prevalence of the issue in the United States is unknown.
Objective: To assess the prevalence of distress and impairment associated with difficulty controlling sexual feelings, urges, and behaviors among a nationally representative sample in the United States.
Design, Setting, and Participants: This survey study used National Survey of Sexual Health and Behavior data to assess the prevalence of distress and impairment associated with difficulty controlling sexual feelings, urges, and behaviors and determined how prevalence varied across sociodemographic variables. Participants between the ages of 18 and 50 years were randomly sampled from all 50 US states in November 2016.
Main Outcomes and Measures: Distress and impairment associated with difficulty controlling sexual feelings, urges, and behavior were measured using the Compulsive Sexual Behavior Inventory–13. A score of 35 or higher on a scale of 0 to 65 indicated clinically relevant levels of distress and/or impairment.
Results: Of 2325 adults (1174 [50.5%] female; mean [SD] age, 34.0 [9.3] years), 201 [8.6%] met the clinical screen cut point of a score of 35 or higher on the Compulsive Sexual Behavior Inventory. Gender differences were smaller than previously theorized, with 10.3% of men and 7.0% of women endorsing clinically relevant levels of distress and/or impairment associated with difficulty controlling sexual feelings, urges, and behavior.
Conclusions and Relevance: The high prevalence of this prominent feature associated with compulsive sexual behavior disorder has important implications for health care professionals and society. Health care professionals should be alert to the high number of people who are distressed about their sexual behavior, carefully assess the nature of the problem within its sociocultural context, and find appropriate treatments for both men and women.
Janna A Dickenson; Neil Gleason; Eli Coleman; Michael H Miner