Aims and Implications of the International Sex Survey (ISS)

Sexuality is one of the basic needs of humans and an integral part of well-being. However, some sexual behaviors may result in significant psychological distress or functional impairment in different life domains1,2. Compulsive sexual behavior (also known as sex addiction or hypersexuality) is one of the oldest problematic sexual behaviors mentioned in history3. Its systematic scientific examination has started to increase only a few decades ago, but proliferated in the past 25 years4,5. As a result, Compulsive Sexual Behavior Disorder (i.e., persistent patterns of uncontrollable sexual urges and behaviors, resulting in clinically significant distress and functional impairment; CSBD) is now included in the 11th edition of the International Classification of Diseases (ICD-11)2,6. However, some crucial questions are yet to be addressed, as most prior work in the field is characterized by relatively small samples, an absence of quality measurement, a lack of theoretical models and integration, and a lack of large-scale, collaborative studies between research laboratories4. To address these gaps, the aims of the International Sex Survey (ISS) are to (1) validate and provide theory-based screening tools that can reliably and validly assess different sexual behaviors, (2) study mechanisms underlying different sexual behaviors and identify risk and protective factors contributing to the development of maladaptive sexual behaviors, and (3) identify populations at high risk of developing maladaptive sexual behaviors. In the ISS, we use theory-based innovative multi-method approaches and large multi-cultural and diverse samples (e.g., sex and gender diverse individuals) to address the aforementioned gaps, contributing to the identification of empirically-supported prevention and intervention targets.

To date, one of the main issues in sexuality research, and CSBD research, in particular, is the lack of valid and unified measurement, resulting in the incomparability of findings4. To address this issue, we developed the Compulsive Sexual Behavior Disorder Scale (CSBD-19)7, which is currently the only tool assessing CSBD based on the ICD-11 diagnostic guidelines. Although the CSBD-19 was developed in an international setting and demonstrated strong psychometric properties, it was only the first step in a thorough examination that we aim to continue in the ISS. As more than 80% of individuals with CSBD report problematic pornography use (PPU)8,9, PPU may be considered the most prominent manifestation of CSBD. In a series of studies, we developed and validated the Problematic Pornography Consumption Scale (PPCS) and the Brief Pornography Screen (BPS) in diverse populations10–14. However, further examination is needed to establish these scales’ adequacy in other populations (e.g., adolescents, women, older adults). This examination not only consolidates the assessment of CSBD and PPU, but also paves the way for the next part of the ISS.

Prior work15–19 highlighted the need to better understand processes underlying the development and maintenance of CSBD and PPU and identify populations being at risk of developing CSBD and PPU, using solid theoretical frameworks and sophisticated methods in large, diverse samples. The second part of the ISS focuses on these issues by examining risk and protective factors contributing to CSBD and PPU, and identifying populations at high risk of developing CSBD and PPU. Using person-centered statistical approaches, we aim to examine individuals’ sexual and pornography use profiles, explore a wide range of characteristics underlying the development of problematic and non-problematic sexual and pornography use profiles (e.g., impulsivity), and examine the potential outcomes of these profiles (e.g., sexual dysfunction). We believe that results from the current investigation will allow practitioners to easily identify sexual and pornography user profiles with knowledge about the likely outcomes and identify targets of intervention to increase the likelihood of desirable user profiles.

In sum, the ISS is dedicated to understanding a wide range of sexual behaviors, with a focus on CSBD and PPU in diverse populations. Well-validated, publicly available, screening tools (CSBD-19, PPCS, BPS) will be available in the literature, helping to eliminate major issues in the field of compulsive, impulsive, and addictive sexual behaviors research (e.g., incomparability of findings deriving from different measurements) that may eventually lead to a high-quality, unified assessment and a deeper understanding of CSBD and PPU4. Moreover, the ISS lays the foundations for the development of empirically-based theoretical models of CSBD and PPU, provides blueprints for future research in addiction and sexuality research, and introduces empirically supported treatment targets that can be used for the development of new prevention and intervention programs.

References

  1. Bőthe, B. et al. Are sexual functioning problems associated with frequent pornography use and/or problematic pornography use? Results from a large community survey including males and females. Addict. Behav. 112, 1–9 (2021).
  2. Kraus, S. W. et al. Compulsive sexual behaviour disorder in the ICD-11. World Psychiatry 17, 109–110 (2018).
  3. Carnes, P. Out of the Shadows: Understanding Sexual Addiction. (CompCare, 1983).
  4. Grubbs, J. B. et al. Sexual addiction 25 years on: A systematic and methodological review of empirical literature and an agenda for future research. Clin. Psychol. Rev. 1–15 (2020) doi:10.31234/osf.io/r6947.
  5. Kafka, M. P. Hypersexual disorder: A proposed diagnosis for DSM-V. Arch. Sex. Behav. 39, 377–400 (2010).
  6. World Health Organization. International statistical classification of diseases and related health problems (11th ed.). (2019).
  7. Bőthe, B. et al. The development of the Compulsive Sexual Behavior Disorder Scale (CSBD-19): An ICD-11 based screening measure across three languages. J. Behav. Addict. 9, 247–258 (2020).
  8. Reid, R. C. et al. Report of findings in a DSM-5 field trial for hypersexual disorder. J. Sex. Med. 9, 2868–2877 (2012).
  9. Wordecha, M. et al. ‘Pornographic binges’ as a key characteristic of males seeking treatment for compulsive sexual behaviors: Qualitative and quantitative 10-week-long diary assessment. J. Behav. Addict. 7, 433–444 (2018).
  10. Bőthe, B. et al. The development of the Problematic Pornography Consumption Scale (PPCS). J. Sex Res. 55, 395–406 (2018).
  11. Bőthe, B., Lonza, A., Štulhofer, A. & Demetrovics, Z. Symptoms of problematic pornography use in a sample of treatment considering and treatment non-considering men: A network approach. J. Sex. Med. 17, 2016–2028 (2020).
  12. Bőthe, B., Tóth-Király, I., Demetrovics, Z. & Orosz, G. The short version of the Problematic Pornography Consumption Scale (PPCS-6): A reliable and valid measure in general and treatment-seeking populations. J. Sex Res. 58, 342–352 (2021).
  13. Chen, L. et al. Properties of the Problematic Pornography Consumption Scale (PPCS-18) in community and subclinical samples in China and Hungary. Addict. Behav. 112, 106591 (2021).
  14. Kraus, S. W. et al. Validation of a brief pornography screen across multiple samples. J. Behav. Addict. 9, 259–271 (2020).
  15. Bőthe, B., Koós, M., Tóth-Király, I., Orosz, G. & Demetrovics, Z. Investigating the Associations Of Adult ADHD Symptoms, Hypersexuality, and Problematic Pornography Use Among Men and Women on a Largescale, Non-Clinical Sample. J. Sex. Med. 16, (2019).
  16. Bőthe, B. et al. Why do people watch pornography? The motivational basis of pornography use. Psychol. Addict. Behav. 1–10 (2020) doi:10.1037/adb0000603.
  17. Bőthe, B. et al. Revisiting the role of impulsivity and compulsivity in problematic sexual behaviors. J. Sex Res. 56, 166–179 (2019).
  18. Kowalewska, E., Gola, M., Kraus, S. W. & Lew-starowicz, M. Spotlight on compulsive sexual behavior disorder: A systematic review of research on women. Neuropsychiatr. Dis. Treat. 2025–2043 (2020) doi:10.2147/NDT.S221540.
  19. Kraus, S. W., Martino, S. & Potenza, M. N. Clinical characteristics of men interested in seeking treatment for use of pornography. J. Behav. Addict. 5, 169–178 (2016).
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