Sheila Garos

Reliability, Validity, and Psychometric Development of the Hypersexual Behavior Inventory in an Outpatient Sample of Men

Psychometric properties of the Hypersexual Behavior Inventory (HBI) are reported using treatment-seeking samples of hypersexual men. Study 1 details item reduction and exploratory factor analysis of the HBI. Study 2 provides results of a confirmatory factor analysis yielding a 3-factor model measuring Control, Consequences, and Coping associated with sexual thoughts, feelings, and behaviors. Concurrent and discriminant validity was established with measures of theoretically related and dissimilar constructs. The psychometric properties of the HBI suggest it reflects the proposed DSM-V classification criteria for hypersexual disorder and has both the clinical and research utility to advance a more comprehensive understanding of hypersexuality.

Report of Findings in a DSM‐5 Field Trial for Hypersexual Disorder

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.

Psychometric development of the hypersexual behavior consequences scale

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.

A Surprising Finding Related to Executive Control in a Patient Sample of Hypersexual Men

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. .

Inmate Thinking Patterns: An Empirical Investigation

This study investigated patterns of maladaptive thinking in 435 offenders and sought to develop and preliminarily validate a measure of criminal thinking patterns. An exploratory factor analysis of 77 thinking errors derived from four theories of cognitive distortions that influence behavior yielded a three-factor model of dysfunctional thinking among offenders. Interpretations of these three factors were provided (i.e., Control, Cognitive Immaturity, and Egocentrism). Implications for treatment and future research with offenders, using the conceptualization of erroneous thinking posited by the three-factor model, are discussed.

The Effectiveness of Brief Multimodal Experiential Therapy in the Treatment of Sexual Addiction

The authors assessed treatment outcomes in 38 self-identified sex addicts who participated in a brief residential, multimodal experiential group therapy treatment program. Participants completed psychological and sexual symptom measures prior to treatment, immediately following treatment, and six months after treatment. Significant reductions in overall psychological distress, depression, obsessive-compulsive symptoms, and preoccupation with sex and sexual stimuli were reported by participants immediately following treatment and were stable at 6-month follow-up. Significant reductions in anxiety, intrapsychic conflict regarding sexual desire, and shame felt as a result of acting out on sexual desires were reported by participants from posttreatment to 6-month follow-up. The clinical implications of the present study, limitations of the study, and directions for further research in this area are discussed.

Measuring disorders of sexual frequency and control: The garos sexual behavior index

Abstract The Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) provides diagnostic criteria for sexual disorders and dysfunctions. However, debates continue regarding the conceptualization and classification of excessive sexual behavior. The Garos Sexual Behavior Index was developed to measure constructs associated with disorders of sexual frequency and control. Factor analyses resulted in four clearly defined factors: Discordance, Sexual Obsession, Permissiveness, and Sexual Stimulation. Methods and results of item selection, factor analysis, reliability analyses, and establishment of factorial validity are presented and discussed. Though additional studies are needed to evaluate the full utility and validity of the measure, its viability for use in future research has clearly been established.

Sexism and Pornography Use: Toward Explaining Past (Null) Results

Abstract Empirical research has failed to provide a clear understanding of the relationship between pornography use and sexism. Study 1 showed an inverse correlation between modern sexism and pornography use, such that participants who used pornography more frequently displayed less sexist attitudes. Study 2 found a positive correlation between pornography use and benevolent sexism, such that participants who used pornography more frequently displayed more benevolent sexism. Our studies provide insight into the largely inconclusive findings of previous research on pornography use and sexist attitudes toward women.

Investigating the discriminant validity and differentiating capability of the garos sexual behavior index

Abstract The Garos Sexual Behavior Index (GSBI) was developed to measure constructs associated with disorders of sexual frequency and control. The scale consists of 70 items representing four clearly defined factors: Discordance, Sexual Obsession, Permissiveness, and Sexual Stimulation. The present study indicates that the measure shows acceptable degrees of discriminate validity, and it correlated as expected with constructs such as impulsivity, sensation seeking, self-esteem, and depression. The authors present results of two discriminant functions (to determine the measures differentiating capability) and of MANOVA analysis (to determine whether significant differences existed between various groups responding to items on the Index). Results from each of these studies are reported and discussed.

Personality Disorder Comorbidity in Treatment-Seeking Men with Hypersexual Disorder

Consideration of Hypersexual Disorder as a diagnosable condition has led to recognition that various aspects of its psychopathology, including comorbidity, are largely unknown. Comorbidity with personality disorders (PDs) has been hypothesized, but the few studies assessing PD comorbidity are limited by sample size, recruitment methods, and varying definitions of hypersexuality. This study examines the presence of confirmed PD diagnoses among 132 men seeking treatment for Hypersexual Disorder, as diagnosed by the criteria proposed for DSM-5. The SCID-II Personality Questionnaire, a screening measure for DSM-IV-TR PDs, suggested potential disorders in 92% of the sample. However, only 17% of the sample met full criteria for a PD based on the SCID-II interview. Thus, whereas personality-based difficulty appears commonplace in these men, the broad, severe dysfunction required for a PD diagnosis does not. This prevalence is higher than expected for community samples, but lower than for either general clinic samples or that found in previous studies. The differences between this and previous studies may arise largely out of different sampling methods, suggesting that PD comorbidity among hypersexuals may be strongly influenced by other factors. Implications for clinicians and researchers are discussed.