Purpose of the Review
This systematic review explores comorbidities related to the problematic use of online sexual activities (OSAs) in the absence of any published synthesis on the subject. These comorbidities are commonly confused with problems associated with offline addictive sexual disorders, even though it is not clear whether they are strictly similar.
This is the first systematic review of the literature synthesizing data on the comorbidities of problematic OSA use. The pattern of comorbidities that was evidenced supports the hypothesis that problematic OSA use is part of a spectrum of related (yet distinct) disorders, Internet-related disorders.
A total of 23 studies were selected and analyzed. The systematic literature review conducted showed that various comorbidities occur with problematic OSA use as follows: (1) addictive behaviors (internet addiction, online gaming problem, substance use disorders), (2) other psychiatric disorders or psychopathological symptoms (mood disorders and suicidality, anxiety, post-traumatic stress disorder, borderline personality disorder, eating disorder, online dissociation), (3) psychological dimensions (insecure peer attachment, specific personality traits), and (4) sexual problems (sexual dysfunction, paraphilia, offline addictive sexual disorders).
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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
•• Castro Calvo. Motives to engage in online sexual activities and their links to excessive and problematic use: a systematic review - dimensions. https://app.dimensions.ai/details/publication/pub.1108057364?and_facet_journal=jour.103401. This is important study documenting the motives behind OSAs. Authors noted that important motive related to the pathological use of OSAs was emotional coping and fantasizing motives.
•• Wery A, Billieux J. Online sexual activities: an exploratory study of problematic and non-problematic usage patterns in a sample of men. Comput. Hum. Behav. 2016;56:257–66 This study aimed to investigate the characteristics, usage patterns and motives for men to engage in OSAs. Results showed that sexual dysfunction, anonymous fantasying and mood regulation are associated with problematic OSA use.
Albright JM. Sex in America online: an exploration of sex, marital status, and sexual identity in internet sex seeking and its impacts. J Sex Res. 2008;45:175–86.
Cooper A, Morahan-Martin J, Mathy RM, Maheu M. Toward an increased understanding of user demographics in online sexual activities. J. Sex Marital Ther. 2002;28:105–29.
Shaughnessy K, Byers ES, Walsh L. Online sexual activity experience of heterosexual students: gender similarities and differences. Arch Sex Behav. 2011;40:419–27.
Cooper A, Putnam DE, Planchon LA, Boies SC. Online sexual compulsivity: getting tangled in the net. Sex. Addict. Compulsivity. 1999;6:79–104.
Cooper A, Delmonico DL, Griffin-Shelley E, Mathy RM. Online sexual activity: an examination of potentially problematic behaviors. Sex Addict Compulsivity. 2004;11:129–43.
Potenza MN. Obesity, food, and addiction: emerging neuroscience and clinical and public health implications. Neuropsychopharmacol Off Publ Am Coll Neuropsychopharmacol. 2014;39:249–50.
Kafka MP. Hypersexual disorder: a proposed diagnosis for DSM-V. Arch Sex Behav. 2010;39:377–400.
Kraus SW, et al. Compulsive sexual behaviour disorder in the ICD-11. World Psychiatry Off J World Psychiatr Assoc WPA. 2018;17:109–10.
Moser C. Hypersexual disorder: searching for clarity. Sex. Addict. Compulsivity. 2013;20:48–58.
Orzack MH, Voluse AC, Wolf D, Hennen J. An ongoing study of group treatment for men involved in problematic internet-enabled sexual behavior. CyberPsychol Behav. 2006;9:348–60.
Berberovic D. Sexual compulsivity comorbidity with depression, anxiety, and substance use in students from Serbia and Bosnia and Herzegovina. Eur. J. Psychol. 2013;9:517–30.
Garcia C. Conceptualization and measurement of coping during adolescence: a review of the literature. J Nurs Scholarsh. 2010;42:166–85.
Mick TM, Hollander E. Impulsive-compulsive sexual behavior. CNS Spectr. 2006;11:944–55.
Ferree MC. Women and the web: cybersex activity and implications. Sex Relatsh Ther. 2003;18:385–93.
Giugliano J. Out of control sexual behavior: a qualitative investigation: Ingenta Connect. https://www-ingentaconnect-com.docelec.univ-lyon1.fr/content/routledg/usac/2006/00000013/00000004/art00003.
Carroll JJ. For lack of wanting: discourses of desire in Ukrainian opiate substitution therapy programs. Transcult Psychiatry. 2016;53:198–216.
Häggström-Nordin E, Hanson U, Tydén T. Associations between pornography consumption and sexual practices among adolescents in Sweden. Int J STD AIDS. 2005;16:102–7.
Kalichman SC, Cain D. The relationship between indicators of sexual compulsivity and high risk sexual practices among men and women receiving services from a sexually transmitted infection clinic. J. Sex Res. 2004;41:235–41.
Moher D, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1.
Ballester-Arnal R, Castro Calvo J, Gil-Llario MD, Gil-Julia B. Cybersex addiction: a study on Spanish college students. J Sex Marital Ther. 2017;43:567–85.
Barrault S, Hegbe KG, Bertsch I, Courtois R. Relationship between traumatic life events of childhood, borderline personality disorder and problematic cybersexual behavior. Psychotr Belg. 2017;22:65–81.
Beutel ME, et al. Prevalence and determinants of online-sex use in the German population. PLoS One. 2017;12:e0176449.
Blais-Lecours S, Vaillancourt-Morel M-P, Sabourin S, Godbout N. Cyberpornography: time use, perceived addiction, sexual functioning, and sexual satisfaction. Cyberpsychology Behav. Soc. Netw. 2016;19:649–55.
Bothe B, Tóth-Király I, Orosz G. Clarifying the links among online gaming, internet use, drinking motives, and online pornography use. Games Health J. 2015;4:107–12.
Chaney, D. Online experiences of sexually compulsive men who have sex with men: sexual addiction & compulsivity: Vol 10, No 4. https://www-tandfonline-com.docelec.univ-lyon1.fr/doi/abs/https://doi.org/10.1080/713775414.
Deborah Corley M, Hook J. Women, female sex and love addicts, and use of the internet. Sex. Addict. Compulsivity. 2012;19:53–76.
Daneback K, Ross MW, Månsson S-A. Characteristics and behaviors of sexual compulsives who use the internet for sexual purposes. Sex. Addict. Compulsivity. 2006;13:53–67.
Egan V, Parmar R. Dirty habits? Online pornography use, personality, obsessionality, and compulsivity. J. Sex Marital Ther. 2013;39:394–409.
Greenfield DN. Psychological characteristics of compulsive internet use: a preliminary analysis. Cyberpsychology Behav Impact Internet Multimed Virtual Real Behav Soc. 1999;2:403–12.
Grov C, et al. Exploring the internet’s role in sexual compulsivity and out of control sexual thoughts/behaviour: a qualitative study of gay and bisexual men in New York City. Cult Health Sex. 2008;10:107–25.
Grubbs JB, Wilt JA, Exline JJ, Pargament KI, Kraus SW. Moral disapproval and perceived addiction to internet pornography: a longitudinal examination. Addiction. 2018;113:496–506.
Levin ME, Lillis J, Hayes SC. When is online pornography viewing problematic among college males? Examining the Moderating Role of Experiential Avoidance. Sex Addict Compulsivity. 2012;19:168–80.
Meerkerk G-J, Van Den Eijnden RJJM, Garretsen HFL. Predicting compulsive internet use: it’s all about sex! CyberPsychol Behav. 2006;9:95–103.
Mitchell K, Becker-Blease K, Finkelhor D. Inventory of problematic internet experiences encountered in clinical practice. Prof Psychol-Res Pract. 2005;36:498–509.
Morelli M, Bianchi D, Baiocco R, Pezzuti L, Chirumbolo A. Sexting behaviors and cyber pornography addiction among adolescents: the moderating role of alcohol consumption. Sex Res Soc Policy. 2017;14:113–21.
Reiner I, Tibubos AN, Hardt J, Müller K, Wölfling K, Beutel ME. Peer attachment, specific patterns of internet use and problematic internet use in male and female adolescents. Eur Child Adolesc Psychiatry. 2017;26:1257–68.
Schneider, J. P. Effects of cybersex addiction on the family: results of a survey: Sexual Addiction & Compulsivity: Vol 7, No 1–2. https://www-tandfonline-com.docelec.univ-lyon1.fr/doi/abs/https://doi.org/10.1080/10720160008400206.
Schneider JP. A qualitative study of cybersex participants: gender differences, recovery issues, and implications for therapists. Sex. Addict. Compulsivity. 2000;7:249–78.
Schwartz M. Compulsive cybersex: the new tea room. Sex. Addict. Compulsivity. 2000;7:127–44.
Stockdale, L. Video game addiction in emerging adulthood: cross-sectional evidence of pathology in video game addicts as compared to matched healthy controls. - PubMed - NCBI. https://www-ncbi-nlm-nih-gov.docelec.univ-lyon1.fr/pubmed/28841491.
Wéry A, Karila L, De Sutter P, Billieux J. Conceptualisation, évaluation et traitement de la dépendance cybersexuelle : une revue de la littérature. Can Psychol. 2014;55:266.
Griffiths MD. The use of online methodologies in studying paraphilias - a review. J Behav Addict. 2012;1:143–50.
Cooper A, McLoughlin IP, Campbell KM. Sexuality in cyberspace: update for the 21st century. CyberPsychol Behav. 2000;3:521–36.
Hayes. Experimental avoidance and behavioral disorders: a functional dimensional approach to diagnosis and treatment. - PubMed - NCBI. https://www-ncbi-nlm-nih-gov.docelec.univ-lyon1.fr/pubmed/8991302.
Adams RE, Urosevich TG, Hoffman SN, Kirchner HL, Hyacinthe JC, Figley CR, et al. Social support, help-seeking, and mental health outcomes among veterans in non-VA facilities: results from the veterans’ health study. Mil Behav Health. 2017;5:393–405.
Schimmenti A, Passanisi A, Caretti V, la Marca L, Granieri A, Iacolino C, et al. Traumatic experiences, alexithymia, and internet addiction symptoms among late adolescents: a moderated mediation analysis. Addict Behav. 2017;64:314–20.
Dervaux A, Laqueille X. Troubles de personnalité borderline et addictions. Inf Psychiatr. 2016;92:38–44.
Carnes, P. Out of the shadows: understanding sexual addiction. (Hazelden Publishing, 2001).
•• Wéry A, Billieux J. Problematic cybersex: conceptualization, assessment, and treatment. Addict. Behav. 2017;64:238–46 This systematic examination of the literature showed that problematic OSA use is an umbrella construct that regroups various types of distinct dysfunctional online behaviors. The authors summarized data on epidemiology, profiles, risks factors, assessment and treatment of problematic OSA users.
Brand M, et al. Watching pornographic pictures on the internet: role of sexual arousal ratings and psychological-psychiatric symptoms for using internet sex sites excessively. Cyberpsychology Behav Soc Netw. 2011;14:371–7.
Laier C, Pekal J, Brand M. Sexual excitability and dysfunctional coping determine cybersex addiction in homosexual males. Cyberpsychology Behav. Soc. Netw. 2015;18:575–80.
Ross MW, Månsson S-A, Daneback K. Prevalence, severity, and correlates of problematic sexual internet use in Swedish men and women. Arch Sex Behav. 2012;41:459–66.
Abramowitz JS, Tolin DF, Street GP. Paradoxical effects of thought suppression: a meta-analysis of controlled studies. Clin Psychol Rev. 2001;21:683–703.
Birchard, T. Sexual addiction and the paraphilias: sexual addiction & compulsivity, 18:3, 157-187DOI: https://doi.org/10.1080/10720162.2011.606674. https://www.tandfonline.com/doi/abs/10.1080/10720162.2011.606674.
Davis JL, Petretic-Jackson PA, Ting L. Intimacy dysfunction and trauma symptomatology: long-term correlates of different types of child abuse. J Trauma Stress. 2001;14:63–79.
Maniglio R. The impact of child sexual abuse on health: A systematic review. Clinical Psychology Review. 2009;29:647–57. https://doi.org/10.1016/j.epr.2009.08.003. https://www.sciencedirect.com/science/article/pii/S0272735809001093.
• Wéry, A., Schimmenti, A., Karila, L. & Billieux, J. Where the mind cannot dare: a case of addictive use of online pornography and its relationship with childhood trauma. J. Sex Marital Ther. 1–14 (2018) doi:https://doi.org/10.1080/0092623X.2018.1488324. This case report aimed to identify psychological processes and risk factors that may foster thedevelopment of addictive use of online pornography and critically consider the clinical utility of current diagnostic criteria proposed in the literature. In particular, this study documenting the impact of trauma-related dissociation.
Compas BE, Jaser SS, Bettis AH, Watson KH, Gruhn MA, Dunbar JP, et al. Coping, emotion regulation, and psychopathology in childhood and adolescence: a meta-analysis and narrative review. Psychol Bull. 2017;143:939–91.
Dalal PK, Basu D. Twenty years of internet addiction … quo Vadis? Indian J Psychiatry. 2016;58:6–11.
Cash H, Rae CD, Steel AH, Winkler A. Internet addiction: a brief summary of research and practice. Curr Psychiatr Rev. 2012;8:292–8.
Rehbein F, Mößle T, Arnaud N, Rumpf H-J. Video game and internet addiction. The current state of research. Nervenarzt. 2013;84:569–75.
• Baggio S, et al. Technology-mediated addictive behaviors constitute a spectrum of related yet distinct conditions: a network perspective. Psychol. Addict. Behav. J. Soc. Psychol. Addict. Behav. 2018;32:564–72 This article supports the notion that Internet addiction is a spectrum of Internet-related disorders, which pertain to addictive online behaviours, such as gaming and sexual activities.
Pawlikowski M, Nader IW, Burger C, Stieger S, Brand M. Pathological internet use - it is a multidimensional and not a unidimensional construct. Addict Res Theory. 2014;22:166–75.
Pontes HM, Szabo A, Griffiths MD. The impact of internet-based specific activities on the perceptions of internet addiction, quality of life, and excessive usage: a cross-sectional study. Addict Behav Rep. 2015;1:19–25.
Griffiths MD, Szabo A. Is excessive online usage a function of medium or activity? An empirical pilot study. J Behav Addict. 2014;3:74–7.
Weinstein AM, Zolek R, Babkin A, Cohen K, Lejoyeux M. Factors predicting cybersex use and difficulties in forming intimate relationships among male and female users of cybersex. Front Psychiatry. 2015;6:54.
Wang C-W, Ho RTH, Chan CLW, Tse S. Exploring personality characteristics of Chinese adolescents with internet-related addictive behaviors: trait differences for gaming addiction and social networking addiction. Addict Behav. 2015;42:32–5.
Conflict of Interest
Dr. Laurent Karila has received consulting fees from Gillead, Recordati, indivior, Ethypharm Pharmaceuticals.
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Hermand, M., Benyamina, A., Donnadieu-Rigole, H. et al. Addictive Use of Online Sexual Activities and its Comorbidities: a Systematic Review. Curr Addict Rep 7, 194–209 (2020). https://doi.org/10.1007/s40429-020-00301-3
- Online sexual activities.
- Systematic review