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Assessment Instruments and Basic Personality Underpinnings of Hypersexuality

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Assessment Instruments and Basic Personality Underpinnings of Hypersexuality Western University Scholarship@Western Electronic Thesis and Dissertation Repository 8-17-2020 10:30 AM Assessment Instruments and Basic Personality Underpinnings of Hypersexuality Stephanie L. Montgomery-Graham, The University of Western Ontario Supervisor: Fisher, William A., The University of Western Ontario A thesis submitted in partial fulfillment of the equirr ements for the Doctor of Philosophy degree in Psychology © Stephanie L. Montgomery-Graham 2020 Follow this and additional works at: https://ir.lib.uwo.ca/etd Part of the Clinical Psychology Commons Recommended Citation Montgomery-Graham, Stephanie L., "Assessment Instruments and Basic Personality Underpinnings of Hypersexuality" (2020). Electronic Thesis and Dissertation Repository. 7216. https://ir.lib.uwo.ca/etd/7216 This Dissertation/Thesis is brought to you for free and open access by Scholarship@Western. It has been accepted for inclusion in Electronic Thesis and Dissertation Repository by an authorized administrator of Scholarship@Western. For more information, please contact [email protected]. Abstract Despite rejection of the Hypersexual Disorder (HD) diagnosis from DSM-5, individuals continue to present clinically with feelings of out-of-control sexual behaviour, clinicians continue to treat “sexual addiction,” and researchers continue to study HD-type symptomology. To further investigation of the HD construct, Levaque and colleagues (2016) used common HD assessment measures and found that between 16.7% and 37.8% of young adult males met clinically significant scores for HD. Phase one of this dissertation replicated the surprising finding in a North American community sample and furthered the research by testing the assessment tool used in DSM-5 HD field trials, and the first sex addiction screening tool. Study One findings were largely as expected, with as many as 27.6% of the youngest males flagged as problematically hypersexual by commonly used HD scales. Study Two queried whether HD scale cut scores predicted age-relevant negative life outcomes in younger adults (i.e., risky sexual behaviour, sexually transmitted infections [STIs], pregnancy), or in middle and older adults (i.e., long-term relationship distress/instability, contraceptive/STI risk, employment or legal sanctions for sex-related acts). Predicted negative outcomes were based on an expanded novel model synthesizing existing HD research (Montgomery-Graham, 2016). While the scales themselves seem to unexpectedly over-select too many of the youngest males between ages 18 to 24, and the oldest males ages 36 to 45 as HD, the scales are indeed related to the negative life outcomes associated with out-of-control sexual behavior as reflected in the literature, and demonstrate strong criterion validity. Finally, Study Three assessed whether conceptually relevant personality variables are conceptually and statistically superior predictors of clinically significant outcomes associated with hypersexuality in adult males than the current HD scales. Variables investigated included: sex drive, erotophilia, emotion regulation, sexual excitation, sexual inhibition, and religiosity. Together these variables did not account for much of the variance in negative HD behavioural outcomes when competitively tested against existing HD scales. Emotion dysregulation and sociosexuality remained important yet distinct constructs from HD. Study Three findings suggest that the various theoretically and empirically relevant variables do not better account for negative behavioural outcomes associated with hypersexuality than the current HD scales. ii Keywords hypersexual disorder, sex addiction, sexual compulsivity, psychometrics, construct validity, criterion validity Summary for Lay Audience “Sex addiction” is a label used commonly in the popular media when people are accused of sex crimes, or sexually inappropriate behaviour. Although “sex addiction” is commonly used, it is not a formal psychological diagnosis supported by scientific research. Yet individuals are treated for “sex addiction” by clinicians who believe that “sex addiction” is a diagnosable condition. Researchers have suggested that a person’s religious values, their partner’s or family’s negative judgments about their sexual practices, or a lack of good sexual education about what is healthy sexuality may be causing some of the confusion. Three studies were designed to examine whether sex addiction or Hypersexual Disorder (HD) is a valid psychological disorder that warrants its own diagnosis. Study One used a community sample of North American males aged 18 to 45 years and replicated research conducted with Canadian undergraduate males in which between 16.7% and 37.8% had been diagnosed a “sex addicted”. Study One found up to 27.6% of the youngest males were flagged as HD by commonly used HD scales. Study Two examined whether reaching the HD cut off score on an instrument was related to age-relevant negative life outcomes (i.e., risky sexual behaviour, sexually transmitted infections, pregnancy, long-term relationship distress, employment or legal sanctions for sexual behaviour). While the scales themselves seem to over-select too many of the youngest males (ages 18 to 24), and the oldest males (ages 36 to 45) as HD, the scales are indeed related to the negative life outcomes associated with hypersexual behavior. Finally, Study Three assessed whether certain personality variables are better predictors of clinically significant outcomes associated with hypersexuality in adult males than the current HD scales. Variables investigated included: sex drive, erotophilia (i.e., negative to positive feelings about sex), emotion regulation, sexual excitation/inhibition, and religiosity. Together these variables did not explain negative HD behavioural outcomes when they were compared to how well the existing HD scales could predict negative HD behavioural outcomes. Study Three findings suggest that the various theoretically and empirically relevant variables do not iii better explain the negative behavioural outcomes associated with hypersexuality than the current HD scales. iv Acknowledgments First and foremost, I would like to express my profound sense of gratitude to Dr. William Fisher for agreeing to supervise my doctoral scholarship. Bill is an entertaining, generous, intellectually rigorous world class scholar to whom I will always be grateful for his mentorship. Dr. Fisher is both a scholar and a gentleman and I am truly fortunate to have matured scholastically under his tutelage. I would like to thank Dr. Taylor Kohut and Erin Shumlich who provided a rich and collaborative intellectual climate in our lab, as well as being great human beings to work with. Thank you to my dissertation preparation committee members, Drs. David Dozois and Paul Tremblay, for giving of their time and effort over the course of my doctoral work, as well as serving as important mentors and teachers throughout my PhD training. Finally, I would like to express my gratitude to Drs. David Dozois, Louis Charland, Erin Kaufman, and Mark Olver for giving of their time to review and lend their combined expertise to examine my doctoral dissertation. v Table of Contents Abstract ............................................................................................................................... ii Summary for Lay Audience ............................................................................................... iii Acknowledgments............................................................................................................... v Table of Contents ............................................................................................................... vi List of Tables ...................................................................................................................... x List of Figures .................................................................................................................. xiv List of Appendices ............................................................................................................ xv Chapter 1 ............................................................................................................................. 1 1 Background .................................................................................................................... 1 1.1 Theoretical approaches used to explain hypersexuality .......................................... 2 1.2 Epidemiology of hypersexuality ............................................................................. 6 1.3 Psychometric Assessment Measures of Hypersexuality ....................................... 12 Chapter 2 ........................................................................................................................... 17 2 Study One – Replication and Extension of Recent Research Findings: Most Commonly Used HD Measures Appear to Pathologize Young Males ........................ 17 2.1 Hypotheses ............................................................................................................ 19 2.1.1 Hypothesis 1. Replication Hypotheses: Hypersexuality Scales ................ 19 2.1.2 Hypothesis 2. Replication Hypotheses: Impersonal Sexual Behaviour Variables ................................................................................................... 19 2.1.3 Hypothesis 3. Extension Hypotheses: DSM-5 HD Scale and Sex Addiction Scale .........................................................................................................
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