Skip to main content
Log in

The Role of Maladaptive Cognitions in Hypersexuality Among Highly Sexually Active Gay and Bisexual Men

Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

Cognitive appraisals about sex may represent an important component of the maintenance and treatment of hypersexuality, but they are not currently represented in conceptual models of hypersexuality. Therefore, we validated a measure of maladaptive cognitions about sex and examined its unique ability to predict hypersexuality. Qualitative interviews with a pilot sample of 60 highly sexually active gay and bisexual men and expert review of items yielded a pool of 17 items regarding maladaptive cognitions about sex. A separate sample of 202 highly sexually active gay and bisexual men completed measures of sexual inhibition and excitation, impulsivity, emotional dysregulation, depression and anxiety, sexual compulsivity, and a measure of problematic hypersexuality. Factor analysis confirmed the presence of three subscales: perceived sexual needs, sexual costs, and sexual control efficacy. Structural equation modeling results were consistent with a cognitive model of hypersexuality whereby magnifying the necessity of sex and disqualifying the benefits of sex partially predicted minimized self-efficacy for controlling one’s sexual behavior, all of which predicted problematic hypersexuality. In multivariate logistic regression, disqualifying the benefits of sex predicted unique variance in hypersexuality, even after adjusting for the role of core constructs of existing research on hypersexuality, AOR = 1.78, 95 % CI 1.02, 3.10. Results suggest the utility of a cognitive approach for better understanding hypersexuality and the importance of developing treatment approaches that encourage adaptive appraisals regarding the outcomes of sex and one’s ability to control his sexual behavior.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  • American Psychiatric Association’s DSM-5 Workgroup on Sexual and Gender Identity Disorders. (2010). Hypersexual disorder screening inventory.

  • Amtmann, D., Bamer, A. M., Cook, K. F., Askew, R. L., Noonan, V. K., & Brockway, J. A. (2012). University of Washington self-efficacy scale: A new self-efficacy scale for people with disabilities. Archives of Physical Medicine and Rehabilitation, 93, 1757–1765. doi:10.1016/j.apmr.2012.05.001.

    Article  PubMed  Google Scholar 

  • Amtmann, D., Cook, K. F., Jensen, M. P., Chen, W. H., Choi, S., Revicki, D., … Callahan, L. (2010). Development of a PROMIS item bank to measure pain interference. Pain, 150, 173–182. doi:10.1016/j.pain.2010.04.025.

  • Bancroft, J., Graham, C. A., Janssen, E., & Sanders, S. A. (2009). The dual control model: Current status and future directions. Journal of Sex Research, 46, 121–142. doi:10.1080/00224490902747222.

    Article  PubMed  Google Scholar 

  • Bancroft, J., & Janssen, E. (2000). The dual control model of male sexual response: A theoretical approach to centrally mediated erectile dysfunction. Neuroscience and Biobehavioral Reviews, 24, 571–579. doi:10.1016/S0149-7634(00)00024-5.

    Article  PubMed  Google Scholar 

  • Bancroft, J., & Vukadinovic, Z. (2004). Sexual addiction, sexual compulsivity, sexual impulsivity, or what? Toward a theoretical model. Journal of Sex Research, 41, 225–234. doi:10.1080/00224490409552230.

    Article  PubMed  Google Scholar 

  • Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191–215. doi:10.1037/0033-295X.84.2.191.

    Article  PubMed  Google Scholar 

  • Baum, M. D., & Fishman, J. M. (1994). AIDS, sexual compulsivity, and gay men: A group treatment approach. In S. A. Caldwell, R. A. Burnham, & M. Forstein (Eds.), Therapists on the front line: Psychotherapy with gay men in the age of AIDS (pp. 255–274). Washington, DC: American Psychiatric Press.

    Google Scholar 

  • Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1987). Cognitive therapy of depression. New York: Guilford Press.

    Google Scholar 

  • Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107, 238–246. doi:10.1037/0033-2909.107.2.238.

    Article  PubMed  Google Scholar 

  • Briere, J., & Elliott, D. M. (2003). Prevalence and psychological sequelae of self-reported childhood physical and sexual abuse in a general population sample of men and women. Child Abuse and Neglect, 27, 1205–1222. doi:10.1016/j.chiabu.2003.09.008.

    Article  PubMed  Google Scholar 

  • Carnes, P. (1983). The sexual addiction. Minneapolis, MN: CompCare Publications.

    Google Scholar 

  • Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. Journal of Consulting and Clinical Psychology, 56, 251–260.

    Google Scholar 

  • Coleman, E. (1987). Sexual compulsivity. Journal of Chemical Dependency Treatment, 1, 189–204. doi:10.1300/J034v01n01_11.

    Article  Google Scholar 

  • Coleman, E. (1990). The obsessive-compulsive model for describing compulsive sexual behavior. American Journal of Preventive Psychiatry Neurology, 2, 9–14.

    Google Scholar 

  • D’Augelli, A. R. (2002). Mental health problems among lesbian, gay, and bisexual youths ages 14 to 21. Clinical Child Psychology and Psychiatry, 7, 433–456. doi:10.1177/1359104502007003010.

    Article  Google Scholar 

  • Derogatis, L. R. (1975). Brief Symptom Inventory. Baltimore: Clinical Psychometric Research.

    Google Scholar 

  • Dilley, J. W., Woods, W. J., Loeb, L., Nelson, K., Sheon, N., Mullan, J., … McFarland, W. (2007). Brief cognitive counseling with HIV testing to reduce sexual risk among men who have sex with men: Results from a randomized controlled trial using paraprofessional counselors. Journal of Acquired Immune Deficiency Syndromes, 44, 569–577. doi:10.1097/QAI.0b013e318033ffbd.

  • Dodge, B., Reece, M., Herbenick, D., Fisher, C., Satinsky, S., & Stupiansky, N. (2008). Relations between sexually transmitted infection diagnosis and sexual compulsivity in a community-based sample of men who have sex with men. Sexually Transmitted Infections, 84, 324–327. doi:10.1136/sti.2007.028696.

    Article  PubMed  Google Scholar 

  • First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, research version, patient edition with psychotic screen (SCID-I/PW/PSY Screen). New York State Psychiatric Institute: Biometrics Research.

    Google Scholar 

  • Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.

    Article  PubMed  Google Scholar 

  • Gallup. (2012). Morality of gay/lesbian relations: 20012012 (Graph). http://www.gallup.com/poll/154634/Acceptance-Gay-Lesbian-Relations-New-Normal.aspx?utm_source=alert&utm_medium=email&utm_campaign=syndication&utm_content=morelink&utm_term=Politics%20-%20Social%20Issues.

  • Gold, S. N., & Heffner, C. L. (1998). Sexual addiction: Many conceptions, minimal data. Clinical Psychology Review, 18, 367–381.

    Article  PubMed  Google Scholar 

  • Goodman, A. (1997). Sexual addiction: Diagnosis, etiology, and treatment. In J. H. Lowenstein, R. B. Millman, & P. Ruiz (Eds.), Substance abuse: A comprehensive textbook (3rd ed., pp. 340–354). Baltimore, MD: Williams & Wilkins.

    Google Scholar 

  • Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54. doi:10.1007/s10862-008-9102-4.

    Article  Google Scholar 

  • Grov, C., Parsons, J. T., & Bimbi, D. S. (2010). Sexual compulsivity and sexual risk in gay and bisexual men. Archives of Sexual Behavior, 39, 940–949. doi:10.1007/s10508-009-9483-9.

    Article  PubMed Central  PubMed  Google Scholar 

  • Hatzenbuehler, M. L. (2009). How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychological Bulletin, 135, 707–730. doi:10.1037/a0016441.

    Article  PubMed Central  PubMed  Google Scholar 

  • Hatzenbuehler, M. L., McLaughlin, K. A., & Nolen-Hoeksema, S. (2008). Emotion regulation and internalizing symptoms in a longitudinal study of sexual minority and heterosexual adolescents. Journal of Child Psychology and Psychiatry, 49, 1270–1278. doi:10.1111/j.1469-7610.2008.01924.x.

    Article  PubMed Central  PubMed  Google Scholar 

  • Hofmann, W., Baumeister, R. F., Förster, G., & Vohs, K. D. (2012). Everyday temptations: An experience sampling study of desire, conflict, and self-control. Journal of Personality and Social Psychology, 102, 1318–1335. doi:10.1037/a0026545.

    Article  PubMed  Google Scholar 

  • Hofmann, W., Deutsch, R., Lancaster, K., & Banaji, M. R. (2010). Cooling the heat of temptation: Mental self-control and the automatic evaluation of tempting stimuli. European Journal of Social Psychology, 40, 17–25. doi:10.1002/ejsp.708.

    Google Scholar 

  • Hook, J. N., Hook, J. P., Davis, D. E., Worthington, E. L., & Penberthy, J. K. (2010). Measuring sexual addiction and compulsivity: A critical review of instruments. Journal of Sex and Marital Therapy, 36, 227–260. doi:10.1080/00926231003719673.

    Article  PubMed  Google Scholar 

  • Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6, 1–55. doi:10.1080/10705519909540118.

    Article  Google Scholar 

  • Joormann, J., & Siemer, M. (2011). Affective processing and emotion regulation in dysphoria and depression: Cognitive biases and deficits in cognitive control. Social and Personality Psychology Compass, 5, 13–28. doi:10.1111/j.1751-9004.2010.00335.x.

    Article  Google Scholar 

  • Kafka, M. P. (2010). Hypersexual disorder: A proposed diagnosis for DSM-V. Archives of Sexual Behavior, 39, 377–400. doi:10.1007/s10508-009-9574-7.

    Article  PubMed  Google Scholar 

  • Kafka, M. P., & Prentky, R. (1992). Fluoxetine treatment of nonparaphilic sexual addictions and paraphilias in men. Journal of Clinical Psychiatry, 53, 351–358.

    PubMed  Google Scholar 

  • Kalichman, S. C., Adair, V., Rompa, D., Multhauf, K., Johnson, J., & Kelly, J. (1994). Sexual sensation-seeking: Scale development and predicting AIDS-risk behavior among homosexually active men. Journal of Personality Assessment, 62, 385–387. doi:10.1207/s15327752jpa6203_1.

    Article  PubMed  Google Scholar 

  • Kalichman, S. C., & Rompa, D. (1995). Sexual sensation seeking and sexual compulsivity scales: Validity, and predicting HIV risk behavior. Journal of Personality Assessment, 65, 586–601. doi:10.1207/s15327752jpa6503_16.

    Article  PubMed  Google Scholar 

  • Kalichman, S. C., & Rompa, D. (2001). The sexual compulsivity scale: Further development and use with HIV-positive persons. Journal of Personality Assessment, 76, 379–395. doi:10.1207/S15327752JPA7603_02.

    Article  PubMed  Google Scholar 

  • Kingston, D. A., & Firestone, P. (2008). Problematic hypersexuality: A review of conceptualization and diagnosis. Sexual Addiction & Compulsivity, 15, 284–310. doi:10.1080/10720160802289249.

    Article  Google Scholar 

  • Kline, R. B. (2010). Principles and practice of structural equation modeling. New York: Guilford Press.

    Google Scholar 

  • Kohn, C. S. (2006). Conceptualization and treatment of kleptomania behaviors using cognitive and behavioral strategies. International Journal of Behavioral Consultation and Therapy, 2, 105–111.

    Article  Google Scholar 

  • Lelutiu-Weinberger, C., Pachankis, J. E., Golub, S. A., Walker, J. N. J., Bamonte, A. J., & Parsons, J. T. (2011). Age cohort differences in the effects of gay-related stigma, anxiety and identification with the gay community on sexual risk and substance use. AIDS and Behavior, 1–10. doi:10.1007/s10461-011-0070-4.

  • Logue, A. W. (1988). Research on self-control: An integrating framework. Behavioral and Brain Sciences, 11, 665–679. doi:10.1017/S0140525X00053978.

    Article  Google Scholar 

  • Marlatt, G. A., & Gordon, J. R. (Eds.). (1985). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York: Guilford.

    Google Scholar 

  • Mischel, W., & Baker, N. (1975). Cognitive appraisals and transformations in delay behavior. Journal of Personality and Social Psychology, 31, 254. doi:10.1037/h0076272.

    Article  Google Scholar 

  • Missildine, W., Feldstein, G., Punzalan, J. C., & Parsons, J. T. (2005). S/he loves me, s/he loves me not: Questioning heterosexist assumptions of gender differences and romantic attractions. Sexual Addiction & Compulsivity, 12, 65–74. doi:10.1080/10720160590933662.

    Google Scholar 

  • Muench, F., & Parsons, J. T. (2004). Sexual compulsivity and HIV: Identification and treatment. Focus: A Guide to AIDS Research and Counseling, 19, 1–5.

  • Murphy, W. D., & Page, I. J. (2008). Exhibitionism: Assessment and treatment. In D. R. Laws & W. T. O’Donohue (Eds.), Sexual deviance: Theory, assessment, and treatment (pp. 61–75). New York: Guilford Press.

    Google Scholar 

  • Pachankis, J. E., & Bernstein, L. B. (2012). An etiological model of anxiety in young gay men: From early stress to public self-consciousness. Psychology of Men & Masculinity, 13, 107–122. doi:10.1037/a0024594.

    Article  Google Scholar 

  • Pachankis, J. E., & Hatzenbuehler, M. L. (2013). The social development of contingent self-worth among sexual minority young men: An empirical test of the “Best Little Boy in the World” hypothesis. Basic and Applied Social Psychology, 35, 176–190.

    Article  Google Scholar 

  • Parsons, J. T., Bimbi, D. S., & Halkitis, P. N. (2001). Sexual compulsivity among gay/bisexual male escorts who advertise on the Internet. Sexual Addiction & Compulsivity, 8, 101–112. doi:10.1080/10720160127562.

    Article  Google Scholar 

  • Parsons, J. T., Grov, C., & Golub, S. A. (2012). Sexual compulsivity, co-occurring psychosocial health problems, and HIV risk among gay and bisexual men: Further evidence of a syndemic. American Journal of Public Health, 102, 156–162. doi:10.2105/AJPH.2011.300284.

    Article  PubMed Central  PubMed  Google Scholar 

  • Parsons, J. T., Kelly, B. C., Bimbi, D. S., DiMaria, L., Wainberg, M. L., & Morgenstern, J. (2008). Explanations for the origins of sexual compulsivity among gay and bisexual men. Archives of Sexual Behavior, 37, 817–826. doi:10.1007/s10508-007-9218-8.

    Article  PubMed  Google Scholar 

  • Parsons, J. T., Rendina, H. J., Ventuneac, A., Cook, K. F., Grov, C., & Mustanski, B. (2013). A psychometric investigation of the hypersexual disorder screening inventory among highly sexually active gay and bisexual men: An item response theory analysis. Journal of Sexual Medicine, 10, 3088–3101. doi:10.1111/jsm.12117.

    Article  PubMed  Google Scholar 

  • Patton, J. H., Stanford, M. S., & Barratt, E. S. (1995). Factor structure of the Barratt impulsiveness scale. Journal of Clinical Psychology, 51, 768–774. doi:10.1002/1097-4679(199511)51:6<768:AID-JCLP2270510607>3.0.CO;2-1.

    Article  PubMed  Google Scholar 

  • Pincu, L. (1989). Sexual compulsivity in gay men: Controversy and treatment. Journal of Counseling & Development, 68, 63–66. doi:10.1002/j.1556-6676.1989.tb02495.x.

    Article  Google Scholar 

  • Purcell, D. W., Patterson, J. D., Spikes, P. S., Wolitski, R. J., Stall, R., & Valdiserri, R. O. (2007). Childhood sexual abuse experienced by gay and bisexual men: Understanding the disparities and interventions to help eliminate them. In R. J. Wolitski, R. Stall, & R. O. Valdiserri (Eds.), Unequal opportunity: Health disparities affecting gay and bisexual men in the United States (pp. 72–96). New York: Oxford University Press Inc.

    Chapter  Google Scholar 

  • Raymond, N. C., Coleman, E., & Miner, M. H. (2003). Psychiatric comorbidity and compulsive/impulsive traits in compulsive sexual behavior. Comprehensive Psychiatry, 44, 370–380. doi:10.1016/S0010-440X(03)00110-X.

    Article  PubMed  Google Scholar 

  • Reise, S. P., & Haviland, M. G. (2005). Item response theory and the measurement of clinical change. Journal of Personality Assessment, 84, 228–238. doi:10.1207/s15327752jpa8403_02.

    Article  PubMed  Google Scholar 

  • Safren, S. A., & Heimberg, R. G. (1999). Depression, hopelessness, suicidality, and related factors in sexual minority and heterosexual adolescents. Journal of Consulting and Clinical Psychology, 67, 859–866.

    Article  PubMed  Google Scholar 

  • Sarin, S., & Nolen-Hoeksema, S. (2010). The dangers of dwelling: An examination of the relationship between rumination and consumptive coping in survivors of childhood sexual abuse. Cognition and Emotion, 24, 71–85. doi:10.1080/02699930802563668.

    Article  Google Scholar 

  • Schwartz, S. A., & Abramowitz, J. S. (2003). Are nonparaphilic sexual addictions a variant of obsessive-compulsive disorder? A pilot study. Cognitive and Behavioral Practice, 10, 372–377. doi:10.1016/S1077-7229(03)80054-8.

    Article  Google Scholar 

  • Sharpe, L., & Tarrier, N. (1993). Towards a cognitive-behavioural theory of problem gambling. British Journal of Psychiatry, 162, 407–412. doi:10.1192/bjp.162.3.407.

    Article  PubMed  Google Scholar 

  • Shepherd, L. (2010). Cognitive behavior therapy for sexually addictive behavior. Clinical Case Studies, 9, 18–27.

    Article  Google Scholar 

  • Shrier, L. A., Shih, M. C., Hacker, L., & de Moor, C. (2007). A momentary sampling study of the affective experience following coital events in adolescents. Journal of Adolescent Health, 40, 357.e351–357e358. doi:10.1016/j.jadohealth.2006.10.014.

  • Smith, A., Miles, I., Finlayson, T., Oster, A., DiNenno, E., & Centers for Disease Control and Prevention. (2010). Prevalence and awareness of HIV infection among men who have sex with men—21 cities, United States, 2008. Morbidity and Mortality Weekly Report (Vol. 59, pp. 1201–1207). Atlanta, GA: Centers for Disease Control and Prevention.

  • Sobell, M. B., & Sobell, L. C. (1992). Problem drinkers: Guided self-change treatment. New York: Guilford Press.

    Google Scholar 

  • Stall, R., Mills, T. C., Williamson, J., Hart, T., Greenwood, G., Paul, J., … Catania, J. A. (2003). Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. American Journal of Public Health, 93, 939–942. doi:10.2105/AJPH.93.6.939.

  • Stall, R., Paul, J. P., Greenwood, G., Pollack, L. M., Bein, E., Crosby, G. M., … Catania, J. A. (2002). Alcohol use, drug use and alcohol‐related problems among men who have sex with men: the Urban Men’s Health Study. Addiction, 96, 1589–1601. doi:10.1046/j.1360-0443.2001.961115896.x.

  • Weiss, R. (2004). Treating sex addiction. In R. H. Coombs (Ed.), Handbook of addictive disorders: A practical guide to diagnosis and treatment (pp. 233–274). New York: John Wiley.

    Google Scholar 

  • Wells, A. (1999). A cognitive model of generalized anxiety disorder. Behavior Modification, 23, 526–555. doi:10.1177/0145445599234002.

    Article  PubMed  Google Scholar 

  • West, S. G., Finch, J. F., & Curran, P. J. (1995). Structural equation models with nonnormal variables: Problems and remedies. In R. H. Hoyle (Ed.), Structural equation modeling: Concepts, issues, and applications (pp. 56–75). Thousand Oaks, CA: Sage.

    Google Scholar 

  • Wiers, R. W., Rinck, M., Kordts, R., Houben, K., & Strack, F. (2010). Retraining automatic action-tendencies to approach alcohol in hazardous drinkers. Addiction, 105, 279–287. doi:10.1111/j.1360-0443.2009.02775.x.

    Article  PubMed  Google Scholar 

  • Williams, D. M. (2010). Outcome expectancy and self-efficacy: Theoretical implications of an unresolved contradiction. Personality and Social Psychology Review, 14, 417–425. doi:10.1177/1088868310368802.

    Article  PubMed  Google Scholar 

  • Wincze, J. P. (2000). Assessment and treatment of atypical sexual behavior. In S. R. Leiblum & R. C. Rosen (Eds.), Principles and practice of sex therapy (2nd ed., pp. 449–470). New York: Guilford Press.

    Google Scholar 

  • Witkiewitz, K., & Marlatt, G. A. (2004). Relapse prevention for alcohol and drug problems: that was Zen, this is Tao. American Psychologist, 59, 224. doi:10.1037/0003-066X.59.4.224.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This project was supported by a Research Grant from the National Institute of Mental Health (R01-MH087714; Jeffrey T. Parsons, Principal Investigator). H. Jonathon Rendina was supported, in part, by a National Institute of Mental Health Ruth L. Kirchstein Individual Predoctoral Fellowship (F31-MH095622). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors would like to acknowledge the contributions of the Pillow Talk Research Team: Ruben Jimenez, Joshua Guthals, and Brian Mustanski. We would also like to thank CHEST staff who played important roles in the implementation of the project: Chris Cruz, Fran Ferayorni, Sitaji Gurung, and Chris Hietikko, as well as our team of research assistants, recruiters, and interns. Finally, we thank Chris Ryan, Daniel Nardicio, and Stephan Adelson and the participants who volunteered their time for this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jeffrey T. Parsons.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pachankis, J.E., Rendina, H.J., Ventuneac, A. et al. The Role of Maladaptive Cognitions in Hypersexuality Among Highly Sexually Active Gay and Bisexual Men. Arch Sex Behav 43, 669–683 (2014). https://doi.org/10.1007/s10508-014-0261-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-014-0261-y

Keywords

Navigation