Elsevier

Journal of Psychiatric Research

Volume 55, August 2014, Pages 117-125
Journal of Psychiatric Research

Gender-related differences in the associations between sexual impulsivity and psychiatric disorders

https://doi.org/10.1016/j.jpsychires.2014.04.009Get rights and content

Abstract

Objective

Sexual impulsivity (SI) has been associated with conditions that have substantial public health costs, such as sexually transmitted infections and unintended pregnancies. However, SI has not been examined systematically with respect to its relationships to psychopathology. We aimed to investigate associations between SI and psychopathology, including gender-related differences.

Method

We performed a secondary data analysis of Wave-2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a national sample of 34,653 adults in the United States. DSM-IV-based diagnoses of mood, anxiety, drug and personality disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Scheduled DSM-IV Version.

Results

The prevalence of SI was considerable (14.7%), with greater acknowledgment by men than women (18.9% versus 10.9%; p < 0.0001). For both women and men, SI was positively associated with most Axis-I and Axis-II psychiatric disorders (OR range: Women, Axis-I:1.89–6.14, Axis-II:2.10–10.02; Men, Axis-I:1.92–6.21, Axis-II:1.63–6.05). Significant gender-related differences were observed. Among women as compared to men, SI was more strongly associated with social phobia, alcohol abuse/dependence, and paranoid, schizotypal, antisocial, borderline, narcissistic, avoidant and obsessive-compulsive personality disorders.

Conclusion

The robust associations between SI and psychopathology across genders suggest the need for screening and interventions related to SI for individuals with psychiatric concerns. The stronger associations between SI and psychopathology among women as compared to men emphasize the importance of a gender-oriented perspective in targeting SI. Longitudinal studies are needed to determine the extent to SI predates, postdates or co-occurs with specific psychiatric conditions.

Section snippets

Background

Impulsivity has been defined as ‘a predisposition toward rapid, unplanned reactions to internal or external stimuli with diminished regard to the negative consequences of these reactions to the impulsive individual or to others’ (Moeller et al., 2001, Potenza and de Wit, 2010). Given that general impulsivity has been associated with multiple adverse consequences, it has been proposed and investigated as an important intermediate phenotype (Fineberg et al., 2014). Impulsivity has been associated

NESARC sample

The NESARC, sponsored by the National Institute on Alcohol Abuse and Alcoholism (Grant et al., 2001), is a nationally representative survey of US adults that was conducted in two waves. The study surveyed individuals aged ≥18 years (at Wave 1, conducted in 2001–2002) in the civilian non-institutionalized population living in households and group quarters. Black and Hispanic households were over-sampled as well as surveyees aged 18–24 years. Face-to-face personal interviews were conducted with

Bivariate associations between SI and socio-demographic characteristics, by gender

Among both women and men, SI was associated with marital status, employment, and age (Table 1). Specifically, SI was positively associated with being unmarried, full-time work, and younger age.

Gender-related differences in the prevalence of SI

The prevalence estimate of SI in the total sample was 14.7%. Men were more likely than women to acknowledge SI (18.9% vs. 10.9%; χ2 = 104.8, p < 0.0001).

SI and the prevalence of Axis I and Axis II disorders, overall and by gender

Sixty-one percent (N = 3157) of individuals with SI had one or more Axis-I disorder, and 46.2% had one or more Axis-II disorder (Table 2). Among women

Discussion

The present study represents the first to our knowledge to investigate systematically the prevalence of SI in a nationally representative sample of adults, the relationships between SI and psychopathology in women and men, and gender-related differences in the associations between psychiatric disorders and SI. The findings largely support our a priori hypotheses that men would be more likely than women to report SI, psychiatric disorders would be found in association with SI in women and men,

Disclosures

Dr. Potenza has consulted for Lundbeck and Ironwood pharmaceuticals; has had financial interests in Somaxon pharmaceuticals; received research support from Mohegan Sun Casino, Psyadon pharmaceuticals, the National Center for Responsible Gambling, the National Institutes of Health (NIH), Veterans Administration; has participated in surveys, mailings, or telephone consultations related to drug addiction, impulse-control disorders, or other health topics; has consulted for gambling, legal and

Role of the funding source

The findings do not necessarily reflect those of the funding agencies and the funding agencies did not review or provide input into the content of this manuscript.

Contributors

Dr. Erez and Prof. Potenza designed the study. Dr. Erez wrote the first draft of the manuscript. Dr. Pilver conducted the statistical analyses. All authors contributed to the manuscript and approved the final version.

Conflicts of interest

The authors report no conflicts of interests.

Acknowledgments

Dr. Erez would like to thank Dr. Shmuel Kron, Prof. Alan Apter and Dr. Gidi Ratzoni for enabling collaborative work between Shalvata Mental Health Center and Yale University in this study.

References (89)

  • M.H. Miner et al.

    Preliminary investigation of the impulsive and neuroanatomical characteristics of compulsive sexual behavior

    Psychiatry Res Neuroimaging

    (2009)
  • N.C. Raymond et al.

    Psychiatric comorbidity and compulsive/impulsive traits in compulsive sexual behavior

    Compr Psychiatry

    (2003)
  • R.C. Reid et al.

    Report of findings in a DSM-5 field trial for hypersexual disorder

    J Sex Med

    (2012)
  • T. Rinne et al.

    Serotonergic blunting to meta-chlorophenylpiperazine (m-CPP) highly correlates with sustained childhood abuse in impulsive and autoaggressive female borderline patients

    Biol Psychiatry

    (2000)
  • S.A. Schwartz et al.

    Are nonparaphilic sexual addictions a variant of obsessive-compulsive disorder? A pilot study

    Cogn Behav Pract

    (2003)
  • D.J. Stein

    Classifying hypersexual disorders: compulsive, impulsive, and addictive models

    Psychiatr Clin North Am

    (2008)
  • S.F. Stoltenberg et al.

    Does gender moderate associations among impulsivity and health-risk behaviors?

    Addict Behav

    (2008)
  • R.I. Wood

    Reinforcing aspects of androgens

    Physiol Behav

    (2004)
  • A. Abbey et al.

    The cumulative effects of acute alcohol consumption, individual differences and situational perceptions on sexual decision making

    J Stud Alcohol

    (2005)
  • R.J. Barth et al.

    The mislabeling of sexual impulsivity

    J Sex Marital Ther

    (1987)
  • M.M. Bersamin et al.

    Risky business: is there an association between casual sex and mental health among emerging adults?

    J Sex Res

    (2014)
  • D.W. Black et al.

    Characteristics of 36 subjects reporting compulsive sexual behavior

    Am J Psychiatry

    (1997)
  • R.A. Black et al.

    Association between impulsivity and high risk sexual behaviors in dually diagnosed outpatients

    Am J Drug Alcohol Abuse

    (2009)
  • C. Blanco et al.

    Sex differences in subclinical and DSM-IV pathological gambling: results from the National Epidemiologic Survey on Alcohol and Related Conditions

    Psychol Med

    (2006)
  • E. Calvete et al.

    Gender differences in cognitive vulnerability to depression and behavior problems in adolescents

    J Abnorm Child Psychol

    (2005)
  • P. Carnes

    Don't call it love: Recovery from sexual addiction

    (1991)
  • P.J. Carnes et al.

    PATHOS: a brief screening application for assessing sexual addiction

    J Addict Med

    (2012)
  • B.N. Carpenter et al.

    Personality disorder comorbidity in treatment-seeking men with hypersexual disorder

    Sex Addict Compulsivity

    (2013)
  • K.L. Chou et al.

    Binge drinking and Axis I psychiatric disorders in community-dwelling middle-aged and older adults: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

    J Clin Psychiatry

    (2011)
  • E. Coleman

    Is your patient suffering from compulsive sexual behavior?

    Psychiatr Ann

    (1992)
  • W.M. Compton et al.

    Prevalence, correlates, and comorbidity of DSM-IV antisocial personality syndromes and alcohol and specific drug use disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions

    J Clin Psychiatry

    (2005)
  • C.P. Cross et al.

    Sex differences in impulsivity: a meta-analysis

    Psychol Bull

    (2011)
  • R.A. Desai et al.

    Gender differences in the associations between past-year gambling problems and psychiatric disorders

    Soc Psychiatry Psychiatr Epidemiol

    (2008)
  • M.E. Eisenberg et al.

    Casual sex and psychological health among young adults: is having “friends with benefits” emotionally damaging?

    Perspect Sex Reprod Health

    (2009)
  • R. Fierros-Gonzalez et al.

    High risk behaviors in a sample of Mexican American college students

    Psychol Rep

    (2002)
  • N.A. Fineberg et al.

    New developments in human neurocognition: clinical, genetic, and brain imaging correlates of impulsivity and compulsivity

    CNS Spectrums

    (2014)
  • W.F. Flack et al.

    Risk factors and consequences of unwanted sex among university students: hooking up, alcohol, and stress response

    J Interpers Violence

    (2007)
  • F.D. Garcia et al.

    Sexual addictions

    Am J Drug Alcohol Abuse

    (2010)
  • J.R. Garcia et al.

    Sexual Hookup Culture: a review

    Rev General Psychol

    (2012)
  • J.R. Garcia et al.

    Hook-up behavior: a biopsychosocia perspective

    J Soc Evol Cult Psychol

    (2008)
  • A. Goodman

    What's in a name? Terminology for designating a syndrome of driven sexual behavior

    Sex Addict Compulsivity

    (2001)
  • B. Grant et al.

    The alcohol use disorder and associated disabilities interview schedule DSM-IV version

    Inst Alcohol Abuse Alcohol

    (2001)
  • B.F. Grant et al.

    Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions

    J Clin Psychiatry

    (2004)
  • B.F. Grant et al.

    The epidemiology of social anxiety disorder in the United States: results from the national epidemiologic survey on alcohol and related conditions

    J Clin Psychiatry

    (2005)
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