Objective: Diagnostic guidelines for compulsive sexual behavior disorder note that moral distress related to sexual behavior is not sufficient to receive the diagnosis. Recent work has questioned the uniqueness of moral distress in predicting self-reported feelings of sexual addiction, demonstrating that other so-called addictive behaviors (e.g., gaming and internet use) are well-predicted by moral disapproval of those behaviors. The present work tested if moral incongruence (the interaction of behavioral frequency and moral disapproval of a behavior) is uniquely related to sexual behavior, or if it generalizes to other addictions as well. Method: This work used a large sample (N = 4,363) involving a representative sample of the U.S. population (n = 2,806) and a sample of sports-wagering individuals in the U.S. (n = 1,557). Interactions between moral disapproval and behavioral frequency were tested for several behaviors (i.e., pornography use, gambling, and several substances). Results: The interaction of behavioral frequency and behavioral disapproval (i.e., moral incongruence) predicted self-reported feelings of addiction to pornography and gambling. Moral incongruence was consistently unrelated to self-reported feelings of addiction to tobacco, illicit substances, and prescription drugs. Results regarding alcohol and marijuana were inconclusive. Conclusions: Moral incongruence is clearly a salient factor in understanding compulsive sexual behavior, and it appears to also be salient to gambling disorder. Though moral incongruence does not seem relevant to some substances (i.e., nicotine, prescription drug misuse, or illicit drug use), further research is needed regarding the effect of moral incongruence on self-reported feelings of addiction to alcohol and marijuana.
Background While preliminary research suggests non-heterosexual men and women view more pornography than their heterosexual counterparts, few studies have examined how problematic use differs across sexual and gender identity groups. Aim We sought to test measurement invariance across popular measures of problematic pornography use (PPU) and examine mean PPU differences across heterosexual men, non-heterosexual men, heterosexual women, and non-heterosexual women. Methods We used 3 large archival datasets to examine psychometrics/group differences on the Brief Pornography Screen (BPS; N = 1,439), Problematic Pornography Use Scale (PPUS; N = 5,859), and Cyber Pornography Use Inventory-4 (CPUI-4; N = 893). Outcomes Most PPU scales/subscales demonstrated acceptable fit, and non-heterosexual men and women tended to report more PPU than heterosexual men and women (though exceptions were evident). Results Confirmatory factor analyses revealed good fit across each group and instrument, with exception to sexual minority women on the CPUI-4. Each instrument demonstrated at least metric invariance between groups, with exception to one item between heterosexual and sexual minority men on the CPUI-4. Mean differences suggested that sexual minority men and women tend to report more PPU than heterosexual men and women, though several exceptions were evident depending on the PPU dimension. Men tended to report more PPU than women, though exceptions were also evident. Effect sizes ranged from large-to-non-significant depending on PPU dimension. Clinical Implications Researchers and clinicians should consider sexual orientation, gender, and PPU dimension when addressing PPU concerns. Strengths & Limitations A primary strength of this study is the use of multiple large samples, meaning our results are likely highly generalizable. However, this study is limited in that it only examined sexual orientation groups broadly and did not account for non-cisgender identities. Conclusions The BPS, PPUS, and CPUI-4 are all appropriate tools to measure PPU depending on researcher and clinician needs.
Introduction Erectile dysfunction (ED) is one of the most prevalent sexual dysfunctions in men and often co-occurs with physical and mental health issues. Military veterans are at elevated risk for many comorbid physical and mental health issues, including ED, although little research has examined the prevalence and health burden of ED in the general U.S. veteran population. The present study calculated the weighted lifetime prevalence of ED and its association with physical and mental health conditions in a nationally representative sample of U.S. veterans. Materials and Methods Using data from a nationally representative sample of 921 male U.S. veterans, self-report assessments assessed major depressive disorder (MDD), generalized anxiety disorder, probable post-traumatic stress disorder (PTSD), at-risk/problem gambling, and past two-week suicidal ideation and attempts, as well as 22 physical health conditions. Results The weighted lifetime prevalence of ED among veterans was 14.2% (95% CI = 12.0%-16.0%). Veterans with ED were more likely to be older than 60, unemployed, to have served less than four years in the military, and to have served in combat roles and in the Vietnam War. Relative to veterans without ED, veterans with ED had higher rates of sleep disorders (adjusted odds ratio [aOR] = 3.23), arthritis (aOR = 2.60), high cholesterol (aOR = 2.30), diabetes (aOR = 2.29), high blood pressure (aOR = 2.14), obesity (aOR = 2.12), heart disease (aOR = 2.10), cancer (aOR = 2.07), respiratory illness (aOR = 2.02), and chronic pain (aOR = 1.86). After adjusting for sociodemographic characteristics and physical health conditions, ED was associated with increased odds of MDD (aOR = 2.88), at-risk/problem gambling (aOR = 2.45), and suicidal ideation (aOR = 1.91) but not for generalized anxiety disorder (aOR = 1.69) or probable PTSD (aOR = 1.63). When considered in the context of all mental health variables, MDD was independently associated with ED (aOR = 3.39). Conclusion This study examined both mental and physical health conditions associated with ED in a U.S. nationally representative sample of veterans. ED is prevalent in veterans and associated with elevated physical and mental health burden. Results highlight the importance of considering ED in disease prevention and treatment efforts in this population. These findings may help inform prevention approaches as well as clinical targets for early screening and treatment in vulnerable subgroups of this population. Notably, data collected relied on self-report assessments; data on race and socioeconomic status were not collected.
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