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Review

Common Features in Compulsive Sexual Behavior, Substance Use Disorders, Personality, Temperament, and Attachment—A Narrative Review

by
Yaniv Efrati
1,*,
Shane W. Kraus
2 and
Gal Kaplan
3
1
Faculty of Education, Bar-Ilan University, Ramat Gan 5290002, Israel
2
Psychology Department, University of Nevada, Las Vegas, NV 89154, USA
3
Baruch Ivcher School of Psychology, Reichman University, Herzliya 4610101, Israel
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2022, 19(1), 296; https://doi.org/10.3390/ijerph19010296
Submission received: 10 November 2021 / Revised: 24 December 2021 / Accepted: 25 December 2021 / Published: 28 December 2021
(This article belongs to the Special Issue Advances in Sexual Health and Sexual Rights)
Browse Figure
Review Reports Versions Notes

Abstract

:
Do addictions share common traits of an “addictive personality” or do different addictions have distinct personality profiles? This narrative review examines the differences in the associations between substance use disorder (SUD) and compulsive sexual behavior disorder (CSBD), on the one hand, and personality traits, attachment dispositions, and temperament, on the other hand. We found that both people with a SUD and people with CSBD tended to be more spontaneous, careless, and less reliable, to place self-interest above getting along with others, to show emotional instability and experience negative emotions such as anger, anxiety, and/or depression, to be less able to control their attention and/or behavior, and to be engulfed with a constant sensation of “wanting”. Only people with CSBD, but not SUD, noted concerns with their social ties, fear of losing close others, and/or trusting others around them. Results also suggested that people with a SUD and people with CSBD share high commonalities in personality traits and temperament, yet there are noted differences in their social tendencies, especially with close others. People with CSBD reported more concerns with possible relationship losses compared to people with SUD issues, who may be more worried about losing their source of escapism.

1. Introduction

Laypeople often relate the definition of addiction to substance use disorder (SUD). Research, however, has indicated that addictions do not only comprise the consumption of exogenous psychoactive substances such as drugs or alcohol, but also include behaviors. Non-substance behavioral addictions include internet addiction, internet gaming disorder, gambling disorder (formerly known as pathological gambling), compulsive buying, exercise dependence, food addiction, work addiction, and compulsive sexual behavior (often referred in the academic and popular culture as “sexual addiction”) [1,2]. Prior work has already examined whether there is an “addictive personality” that predisposes people to various forms of addictions [3,4], or whether there are different personality dispositions that predispose people to different forms of addictions. In the current review, we will draw similarities between SUD and one common behavioral addiction—compulsive sexual behavior disorder (CSBD)—in various trait-like dispositions—the big-five personality traits, attachment styles, and temperament. To date, most studies examined SUD and behavioral addiction separately [5,6] with only a few studies contrasting SUD and CSBD directly [4,7].

SUD and Compulsive Sexual Behavior

SUD is a psychiatric disorder characterized by a pathological and compulsive pattern of substance-seeking and substance-taking behaviors that occupy most of a person’s time and efforts, leading to significant functional impairments at work, school, and/or home [8]. Persistent use of psychoactive drugs may lead to long-term changes in the brain (i.e., the development of new reward pathways), leading to multiple symptoms and features of addictions, including craving, withdrawal, and tolerance [9,10]. The disruptive pattern of substance-seeking behaviors persists despite the negative consequences of addiction (e.g., relationship, legal, health), with many individuals struggling to reduce or abstain from substance use [11,12]. Definitions of behavioral addictions, such as CSBD, share many commonalities with the definition of SUD, though this area still remains largely unexplored as new research continues to elucidate the etiology of this condition [13].
CSBD is defined as an impulse control disorder [14] characterized by a repetitive and intense preoccupation with sexual fantasies, urges, and behaviors, as well as an extensive pornography use and masturbation, use of paid sexual services, and risky sexual behaviors leading to clinically significant distress or impairment in social and occupational functioning and to other adverse consequences [14,15,16,17]. Although CSBD is officially classified as an impulse control disorder, the psychiatric classification of CSBD is still hotly debated [13,18]. In addition, most therapeutic interventions treat CSBD as an addiction [19], because it shares many addiction-like neurocognitive mechanisms and clinical characteristics [20]; however, despite some evidence of shared similarities, clinical studies examining the neurobiology of CSBD remain scarce.
Thus far, research on SUD and CSBD indicates that compulsive behavior, craving, and extensive preoccupation with the condition, which leads to impaired psychosocial functioning, are central characteristics in both addictions [21,22]. Do these disorders share commonalities in personality dispositions because they are all a result of an “addictive personality” that confers an inclination to addiction [23], or is the reason that one person is addicted to drugs (i.e., has SUD) and another to a sexual behavior a different personality profile of the affected person? To answer this question, we conducted a review on the correlation between SUD and CSBD, on the one hand, and three common personality-like dispositions—big five personality traits, attachment orientations, and temperament, on the other.
One of the most used personality classifications is known as the Five Factor Model (FFM) [24]. This classification emerged out of a series of attempts to understand the organization of trait descriptors in natural language [25,26,27]. Structural analyses of these descriptors consistently revealed five broad factors: extraversion (outgoing/energetic vs. solitary/reserved), agreeableness (friendly/compassionate vs. challenging/detached), conscientiousness (efficient/organized vs. easy-going/careless), neuroticism (sensitive/nervous vs. secure/confident), and openness to experience (inventive/curious vs. consistent/cautious). This structure has proven to be remarkably robust, with the same five factors observed in both self- and peer-ratings [28], in analyses of both children and adults [29], and across a wide variety of languages and cultures [30,31]. The big five personality traits have been extensively studied in relation with various addictions including SUD, though less literature is available on its relationship with CSBD.
Another domain in which people with SUD and people with CSBD might share commonalities is their temperament—individual differences in behavior that unlike personality are believed to be innate and relatively independent of learning, systems of values, and attitudes. One common classification of temperament perceives it as a 4-facet construct: negative affect including the inborn tendency for fear, sadness, discomfort, and frustration; effortful control comprising the innate ability for attentional, inhibitory and/or activation control; extraversion/surgency consisting of the inborn tendency for sociability, positive affect, and high-intensity pleasure; and orienting sensitivity comprising the innate neural and affective perceptual sensitivity. The dimension of “effortful control” received much attention in the etiology of psychopathology [32] and specifically of addictive behavior [33]. High effortful control includes the abilities to voluntarily manage attention (attentional regulation) and inhibit (inhibitory control) or activate (activational control) behavior as needed to adapt. For example, the abilities to focus attention when there are distractions, to not interrupt others and sit still in class or a movie theater, and to force oneself to do a tedious task are aspects of effortful control.
A second common classification of temperament relates to Cloninger’s biosocial model of personality [34] which emphasizes the biological background of personality. According to the model, personality could be assessed by four heritable, temperament dimensions of personality, and three additional character dimensions. The four temperament dimensions are: novelty seeking, comprising the innate tendency to respond actively to novel stimuli (a tendency supported by a correlation between novelty seeking and heighten functioning of the dopaminergic system); harm avoidance, consisting of the innate tendency towards an inhibitory response to signals of aversive stimuli leading to avoidance of punishment (often related to the functioning of the serotonergic system); reward dependence, comprising the inborn tendency for positive responses to signals of rewards in maintaining behaviors (often associated with the functioning of noradrenergic system); and, lastly, persistence, consisting of the inborn ability to maintain behaviors despite frustration and fatigue.
The three character dimensions are: self-directedness, comprising the ability of an individual to control, regulate and adapt one’s behavior in accordance with chosen goals and values; cooperativeness, consisting of the tendency towards social tolerance, empathy, helpfulness, and compassion; and self-transcendence, comprising the tendency for spirituality.
A final domain in which people with SUD and people with CSBD might share commonalities is people’s attachment orientations—trait-like dispositions that relate to social tendencies and emotion and stress regulation.
Attachment orientations are shaped during infancy via intimate interactions with caregivers in times of need [35]. When caregivers lend support and care, and the needs for comfort and security are consistently satisfied, the infant develops a secure bond towards the attachment figure (i.e., attachment security), which is characterized by a view of the self as lovable and of others as dependable. Secure people are generally more social and tend to develop healthy ties with family members, friends, and romantic partners.
At times, however, parental support is insufficient, and, as a result, infants might develop insecure attachment orientations that are classified along two dimensions, referred to as attachment anxiety and avoidance [36,37]. If infants’ needs are not sufficiently met by caregivers and the availability of support and care is uncertain, fear of abandonment can develop alongside an internalized anxiety of being rejected. Individuals with this attachment orientation are called anxiously attached and are characterized by an unfulfilled need for affection regardless of the amount of affection they receive [38]. If infants’ needs are not fulfilled and met with cold and distancing caregiving, infants will view others as untrustworthy and undependable and develop an attachment avoidance orientation. These individuals do not trust the goodwill of others and prefer to emotionally distance themselves from intimate relationships [39].
Research has indicated that attachment insecurities (both anxiety and avoidance) are associated with a general vulnerability to mental disorders [40,41]. For example, attachment insecurities are correlated with depression [42], generalized anxiety disorder [43], obsessive–compulsive disorder [44], posttraumatic stress disorder (PTSD) [45], eating disorders [46], and suicide ideation [47]. Therefore, attachment insecurities have transdiagnostic characteristics [48,49] and should be explored as they relate to behavioral disorders such as CSBD. Therefore, the goal of the current review is to examine the commonalities and differences in the big five personality traits, temperament, and attachment orientations between people who have a SUD and those with CSBD.

2. Methodology

Search Strategy

The current review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The process is presented in Figure 1. We conducted an electronic search for literature updated from 1 January 2000 to 30 November 2020. To identify relevant studies, we conducted two separate searches in the following six online databases: PsycINFO, PsychARTICLES, Open Grey, PubMed, Web of Science, and Psychiatric Abstracts (PubPsych, which includes PSYNDEX; PASCAL; ISOC-Psicologa; MEDLINE®; ERIC; NARCIS; NORART; PsychOpen; and PsychData). The first search was conducted on the association between CSB and personality-related aspects (i.e., attachment styles, the big five personality model, and temperament), and the second between SUD and personality-related aspects. In the first search, we used the following searching terms: (“Sex addiction” or “Hypersexual” or “Compulsive sexual behavior” or “Compulsive sexual behavior disorder” or “Compulsive sexual behaviour” or “Compulsive sexual behaviour disorder” or “CSBD” or “CSB”) AND (“big five Personality” or “five factor model” or “Temperament” or “Attachment Style” or “Attachment Orientation”). In the second search, we used the following searching terms: (“Drug addiction” or “Drug abuse” or “drug dependence” or “substance use disorder” or “substance dependence”) AND (“big five Personality” or “five factor model” or “Temperament” or “Attachment Style” or “Attachment Orientation”). Additionally, a snowball search was also conducted within Google Scholar to identify further studies which did not appear in the initial search.
After combining the two sets of database searches and the snowball search, and after removing duplicates, we were left with 739 articles. We then screened articles by abstract and title and screened by full-text evaluation according to the inclusion criteria. We included studies: (1) addressing the association between CSBD and personality-related aspects (i.e., attachment styles, the big five personality model, and temperament), or the association between SUD and personality-related aspects; (2) including 27 subjects or more for a clinical sample and 150 or more for a non-clinical sample; (3) based on a quantitative research design; and (4) published in the English language. Next, we excluded results that were derived from: (1) conferences or not a published article or chapters; (2) individuals younger than 16 years of age; (3) sex offenders; (4) individuals with psychiatric disorders other than CSBD and SUD; (5) animal models (i.e., non-human participants); (6) addictions that are not substance related; and/or (7) participants with comorbid psychiatric disorders. This screening process led to 88 potentially eligible papers. After reviewing the articles’ full text, 19 additional papers were excluded (see Figure 1) for a total of 69 papers in the final review. Methodology reported based on Orilisi et al. [50].

3. Results

3.1. Commonalities and Differences in Big Five Personality Dispositions

To date, a few dozen studies have been published on the correlation between SUD and the big five personality traits [6,51,52]. In contrast, only 9 studies correlated compulsive sexual behavior and the big five personality traits [1,2,5,53,54,55,56,57], and only one study compared SUD and people with compulsive sexual behavior directly [4]. Table 1 summarizes the main findings.
Zilberman and colleagues [4] revealed that the “addictive personality” of people with compulsive sexual behavior and those with SUD is remarkedly similar with respect to the five major facets of personality. Both groups score low on agreeableness and conscientiousness and high on neuroticism. Research that has separately examined the big five traits among people with a SUD and people with compulsive sexual behavior shows high agreement with Zilberman and colleagues’ [4] findings. Specifically, in 8 out of 9 studies on compulsive sexual behavior and personality dispositions, compulsive sexual behavior was correlated with higher neuroticism; 7 out of 9 studies correlated it with lower conscientiousness, and 4 out of 9 with lower agreeableness. These seemingly robust results share high commonality with studies on the correlation between SUD and personality dispositions such that all studies show that SUD is correlated with higher neuroticism and lower conscientiousness; most studies (but not all) related SUD with lower agreeableness.
This pattern of results also indicates that people with a SUD and people with compulsive sexual behavior tend to be more spontaneous, careless, and less reliable (i.e., low conscientiousness), to place self-interest above getting along with others (i.e., low agreeableness), and to show greater emotional instability and experience negative emotions, such as anger, anxiety, and/or depression (i.e., high neuroticism).
The final two personality dispositions—openness to experience and extraversion—were only sporadically correlated with addictive behavior. Whereas openness to experience was not reliably correlated with addictive behavior, there are inconsistencies regarding extraversion in both groups (i.e., compulsive sexual behavior and SUD). A meta-analysis covering 175 studies (published until 2007) on SUD and the big five personality traits indicated that people with a SUD are lower on extraversion—i.e., are more solitary and reserved. However, studies that were published since then did not reveal significant associations between SUD and extraversion. Similarly, the findings on people with compulsive sexual behavior are also equivocal such that some do not find any association [4,5,53,55,56,63], one found lower extraversion [61], and two, higher [54,57]. Thus, a meta-analysis regarding the correlation with extraversion is warranted to examine the role of extraversion in addictions. Here, we would like to suggest one possible moderator that might explain the inconsistent correlation between CSBD and extraversion—the type of CSBD in question.

3.2. Commonalities and Differences in Temperament

Research on the association between the 4 facets of temperament (negative affect, effortful control, extraversion/surgency, and orienting sensitivity) and addictive behavior highlighted effortful control as a key player in addictions. The current reviewed studies agree with this finding (see Table 2 and Table 3). Specifically, studies examining the role of effortful control in SUD found that low effortful control (i.e., lower ability to regulate or control behaviors) reliably relates to SUD at all stages of addiction [33,74,75,76,77,78,79]. High effortful control was correlated with less SUD [80] and a lower drinking frequency [81]. For example, Santens and colleagues [82] conducted a study on 712 SUD adult patients and found that high effortful control was characteristic of the “resilient” group, whereas low effortful control was typical with the “anxious” and “reward-sensitive” groups. This review did not reveal any other associations between the remaining temperament clusters (e.g., negative affect, extraversion/surgency, and orienting sensitivity) and SUD.
To date, only a single study on 310 adolescents has examined the associations between temperament (i.e., negative affect, effortful control, extraversion/surgency, and orienting sensitivity) and CSBD [107] using the current classification of temperament. In accordance with the correlation between SUD and low effortful control, lower effortful control was found to be related to more severe symptoms of CSBD [107]. Furthermore, this study also noted positive associations between higher orienting sensitivity and CSBD. Because only a single study examined the association between temperament and CSBD, it is premature to draw conclusions regarding the role of orienting sensitivity.
Research on the association between Cloninger’s biosocial clusters of personality and SUD revealed one reliable heritable, temperament cluster—novelty seeking. People with an SUD seem to have an overly active dopaminergic system and thus a greater innate tendency to actively explore novel stimulation, while exhibiting impulsive decision making. The dopaminergic system is part of the reward system and relates to the sensation of “wanting” [108], which correlated perfectly with SUD. The single study that examined the association between CSBD and Cloninger’s biosocial clusters of personality [104] revealed a similar positive association with novelty seeking, which also correlated the compulsive engagement of people with CSBD with sexuality and the “wanting” sensation of sexual-related behaviors and/or cognitions [109].
The review also revealed two additional (somewhat) consistent associations between SUD: self-directedness (53% consistency) [84,86,87,88,90,91,94,98,102] and cooperativeness (53% consistency) [84,86,87,89,90,91,94,96,102]. People with an SUD are less able to control and/or regulate their behavior following chosen goals and values, or to demonstrate social tolerance, empathy, helpfulness, and compassion towards others. CSBD was also found to be related with lower self-directedness [104], which fits well with the inability to control one’s behavior (i.e., impaired control) and maintain a goal-directed path in one’s life. This tendency is also consistent with the association of SUD, CSBD, and low effortful control (i.e., less ability to control one’s attention and goal directed behavior).

3.3. Commonalities and Differences in Attachment Orientations

The associations between attachment orientations and SUD have been extensively examined in cross-sectional and longitudinal studies [110]. In a meta-analysis summarizing 34 longitudinal samples and comprising 56,721 participants, a significant correlation was noted between attachment insecurity (both anxiety and avoidance) and SUD such that the higher people’s attachment anxiety and/or avoidance, the higher the likelihood for SUD. In addition, researchers found that, whereas earlier attachment insecurity predicts later SUD, earlier SUD does not predict later attachment insecurity—a finding supporting attachment insecurity as a predisposition for SUD and not an outcome of it. Of note, however, the correlations between insecure attachment orientations and SUD are generally weak to negligible, with a shared variance of approximately 2%. Recently, Estévez and colleagues [111] directly compared the associations between attachment orientations, SUD, and several behavioral addictions (problematic internet use, video game addictions, and gambling disorders; but did not include compulsive sexual behavior) and found that, whereas attachment insecurity reliably correlated with higher likelihood for all behavioral addictions, it was not, however, correlated with SUD.
In contrast to SUD, the associations between attachment orientations and CSBD are more indicated [5,105,112,113,114,115,116,117,118,119]. Specifically, attachment insecurity (both anxiety and avoidance) relates to greater likelihood of CSBD and higher symptom severity of CSBD, with a shared variance ranging from 5% to 21%. Thus, it seems possible that attachment insecurity that relates to various social dysfunctions, greater distress, and emotion dysregulation is a predisposition for addictions, but this could be particularly salient for development of CSBD.

4. Discussion

In sum, people with an SUD and people with compulsive sexual behavior tend to be more spontaneous, careless, and less reliable (i.e., low conscientiousness), to place self-interest above getting along with others (i.e., low agreeableness), to show emotional instability and experience negative emotions such as anger, anxiety, and/or depression (i.e., high neuroticism), to be less able to control their attention and/or behavior (i.e., low effortful control and self- directedness), and to be engulfed with a constant sensation of “wanting” (i.e., high novelty seeking). These correlational clusters may shed further light on our understanding of the psychology of addictive behaviors, particularly as it relates to possible differences between clinical and non-clinical populations. However, only people with compulsive sexual behavior, but not SUD, are especially concerned with their social ties, fear of losing close others, and/or trusting others around them. These latter differences seem to fit well with the differences in addiction type—addiction to a substance versus addiction to a behavior. Acknowledging these commonalities and differences may allow a better detection of risk factors attributed to the development of addictive behaviors and possibly offer better-suited therapies for people reporting issues with addictions. Further research is particularly needed to examine personality classification among individuals seeking treatment for CSBD given the considerable absence of clinical data. Moreover, additional research is needed to examine possible gender differences in personality classification, particularly as it relates to the clinical manifestation of CSBD, which remains still understudied. Moreover, examining personality classification within subtypes of CSBD (e.g., exclusive problematic pornography use, engagement in anonymous/casual sex with strangers or paid sex workers) could also elucidate possible personality differences between solitary and dyadic sexual behavior, which in turn could inform treatment strategies for help seeking individuals. In a similar vein, further research is also needed to examine the specific relationships between CSBD, personality dispositions, attachment style, and temperament as a function of substance use (e.g., stimulant, sedative, alcohol, cannabis) since such information could possibly help to identify possible symptoms and personality clusters in clinical and non-clinical populations.

5. Conclusions

In conclusion, we view this research as important in studying the personality classification (personality traits, temperament, and attachment dispositions) related to people with SUD or CSBD. These findings add to the body of data that may help to better understand the personality underpinnings of people with SUD or CSBD even when their symptoms are below the clinical threshold. In addition, the current research may help to better tailor interventions aimed at reducing SUD or CSBD and its negative outcomes by targeting specific personality classification considered highly indicative of SUD or CSBD.

Author Contributions

Y.E. conducted the study and wrote, with S.W.K., the introduction section of the article. G.K. analyzed the results and wrote the Methods and Results section of the article. All authors contributed to the Discussion section of the article and edited the final draft of the article. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Griffiths, M. Behavioural Addiction: An Issue for Everybody? Emil. Couns. Today 1996, 8, 19–25. [Google Scholar] [CrossRef]
  2. Karim, R.; Chaudhri, P. Behavioral Addictions: An Overview. J. Psychoact. Drugs 2012, 44, 5–17. [Google Scholar] [CrossRef] [PubMed]
  3. Kornør, H.; Nordvik, H. Five-Factor Model Personality Traits in Opioid Dependence. BMC Psychiatry 2007, 7, 37. [Google Scholar] [CrossRef] [Green Version]
  4. Zilberman, N.; Yadid, G.; Efrati, Y.; Neumark, Y.; Rassovsky, Y. Personality Profiles of Substance and Behavioral Addictions. Addict. Behav. 2018, 82, 174–181. [Google Scholar] [CrossRef]
  5. Efrati, Y.; Gola, M. Understanding and Predicting Profiles of Compulsive Sexual Behavior among Adolescents. J. Behav. Addict. 2018, 7, 1004–1014. [Google Scholar] [CrossRef]
  6. Fehrman, E.; Egan, V.; Gorban, A.N.; Levesley, J.; Mirkes, E.M.; Muhammad, A.K. Personality Traits and Drug Consumption: A Story Told by Data; Springer International Publishing: Cham, Switzerland, 2019. [Google Scholar] [CrossRef] [Green Version]
  7. Efrati, Y.; Gerber, Z.; Tolmacz, R. The Relation of Intra-Psychic and Relational Aspects of the Self to Compulsive Sexual Behavior. J. Sex Marital Ther. 2019, 45, 618–631. [Google Scholar] [CrossRef]
  8. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed.; American Psychiatric Association: Arlington, VA, USA, 2013. [Google Scholar] [CrossRef]
  9. Alvarez-Monjaras, M.; Mayes, L.C.; Potenza, M.N.; Rutherford, H.J. A Developmental Model of Addictions: Integrating Neurobiological and Psychodynamic Theories through the Lens of Attachment. Attach. Hum. Dev. 2019, 21, 616–637. [Google Scholar] [CrossRef]
  10. Volkow, N.D.; Wang, G.-J.; Fowler, J.S.; Tomasi, D.; Telang, F. Addiction: Beyond Dopamine Reward Circuitry. Proc. Natl. Acad. Sci. USA 2011, 108, 15037–15042. [Google Scholar] [CrossRef] [Green Version]
  11. Johnson, B. Addiction and Will. Front. Hum. Neurosci. 2013, 7, 545. [Google Scholar] [CrossRef] [Green Version]
  12. Robinson, T.E.; Berridge, K.C. The Incentive Sensitization Theory of Addiction: Some Current Issues. Philos. Trans. R. Soc. B Biol. Sci. 2008, 363, 3137–3146. [Google Scholar] [CrossRef]
  13. Grubbs, J.B.; Hoagland, K.C.; Lee, B.N.; Grant, J.T.; Davison, P.; Reid, R.C.; Kraus, S.W. Sexual Addiction 25 Years on: A Systematic and Methodological Review of Empirical Literature and an Agenda for Future Research. Clin. Psychol. Rev. 2020, 82, 101925. [Google Scholar] [CrossRef]
  14. International Classification of Diseases (ICD). Available online: https://www.who.int/standards/classifications/classification-of-diseases (accessed on 9 November 2021).
  15. Kraus, S.W.; Krueger, R.B.; Briken, P.; First, M.B.; Stein, D.J.; Kaplan, M.S.; Voon, V.; Abdo, C.H.N.; Grant, J.E.; Atalla, E.; et al. Compulsive Sexual Behaviour Disorder in the ICD-11. World Psychiatry 2018, 17, 109–110. [Google Scholar] [CrossRef] [Green Version]
  16. Kafka, M.P. Hypersexual Disorder: A Proposed Diagnosis for DSM-V. Arch. Sex. Behav. 2010, 39, 377–400. [Google Scholar] [CrossRef]
  17. ICD-11 for Mortality and Morbidity Statistics. Available online: https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/1630268048 (accessed on 9 November 2021).
  18. Gola, M.; Lewczuk, K.; Potenza, M.N.; Kingston, D.A.; Grubbs, J.B.; Stark, R.; Reid, R.C. What Should Be Included in the Criteria for Compulsive Sexual Behavior Disorder? J. Behav. Addict. 2020, 1. [Google Scholar] [CrossRef] [PubMed]
  19. Efrati, Y.; Gola, M. Treating Compulsive Sexual Behavior. Curr. Sex. Health Rep. 2018, 10, 57–64. [Google Scholar] [CrossRef]
  20. Kowalewska, E.; Grubbs, J.B.; Potenza, M.N.; Gola, M.; Draps, M.; Kraus, S.W. Neurocognitive Mechanisms in Compulsive Sexual Behavior Disorder. Curr. Sex. Health Rep. 2018, 10, 255–264. [Google Scholar] [CrossRef]
  21. Ballester-Arnal, R.; Castro-Calvo, J.; Giménez-García, C.; Gil-Juliá, B.; Gil-Llario, M.D. Psychiatric Comorbidity in Compulsive Sexual Behavior Disorder (CSBD). Addict. Behav. 2020, 107, 106384. [Google Scholar] [CrossRef] [PubMed]
  22. Kraus, S.W.; Popat-Jain, A.; Potenza, M.N. Compulsive Sexual Behavior and Substance Use Disorders. In Compulsive Sexual Behavior Disorder Understanding, Assessment, and Treatment; American Psychiatric Association Publishing: Washington, DC, USA, 2021; pp. 21–34. [Google Scholar]
  23. Davis, C. Addictive Personality. In Encyclopedia of Personality and Individual Differences; Zeigler-Hill, V., Shackelford, T.K., Eds.; Springer International Publishing: Cham, Switzerland, 2016; pp. 1–5. [Google Scholar] [CrossRef]
  24. McCrae, R.R.; Costa, P.T. The Stability of Personality: Observation and Evaluations. Curr. Dir. Psychol. Sci. 1994, 3, 173–175. [Google Scholar] [CrossRef]
  25. Goldberg, L.R. The Structure of Phenotypic Personality Traits. Am. Psychol. 1993, 48, 26–34. [Google Scholar] [CrossRef]
  26. John, O.P.; Srivastava, S. The Big Five Trait Taxonomy: History, Measurement, and Theoretical Perspectives. In Handbook of Personality: Theory and Research, 2nd ed.; Guilford Press: New York, NY, USA, 1999; pp. 102–138. [Google Scholar]
  27. McCrae, R.R.; Costa, P.T.; Ostendorf, F.; Angleitner, A.; Hrebícková, M.; Avia, M.D.; Sanz, J.; Sánchez-Bernardos, M.L.; Kusdil, M.E.; Woodfield, R.; et al. Nature over Nurture: Temperament, Personality, and Life Span Development. J. Pers. Soc. Psychol. 2000, 78, 173–186. [Google Scholar] [CrossRef]
  28. McCrae, R.R.; Costa, P.T. Validation of the Five-Factor Model of Personality across Instruments and Observers. J. Pers. Soc. Psychol. 1987, 52, 81–90. [Google Scholar] [CrossRef] [PubMed]
  29. Digman, J.M. Higher-Order Factors of the Big Five. J. Pers. Soc. Psychol. 1997, 73, 1246–1256. [Google Scholar] [CrossRef]
  30. Allik, J. Personality Dimensions across Cultures. J. Personal. Disord. 2005, 19, 212–232. [Google Scholar] [CrossRef]
  31. McCrae, R.R.; Costa, P.T. Personality Trait Structure as a Human Universal. Am. Psychol. 1997, 52, 509–516. [Google Scholar] [CrossRef]
  32. Rothbart, M.K.; Sheese, B.E.; Posner, M.I. Executive Attention and Effortful Control: Linking Temperament, Brain Networks, and Genes. Child Dev. Perspect. 2007, 1, 2–7. [Google Scholar] [CrossRef]
  33. Mun, C.J.; Dishion, T.J.; Tein, J.-Y.; Otten, R. Adolescence Effortful Control as a Mediator between Family Ecology and Problematic Substance Use in Early Adulthood: A 16-Year Prospective Study. Dev. Psychopathol. 2018, 30, 1355–1369. [Google Scholar] [CrossRef]
  34. Cloninger, C.R.; Svrakic, D.M.; Przybeck, T.R. A Psychobiological Model of Temperament and Character. Arch. Gen. Psychiatry 1993, 50, 975–990. [Google Scholar] [CrossRef]
  35. Mikulincer, M.; Shaver, P.R. Adult Attachment and Emotion Regulation. In Handbook of Attachment: Theory, Research, and Clinical Applications; Guilford Publications: New York, NY, USA, 2016; pp. 507–533. [Google Scholar]
  36. Brennan, K.A.; Clark, C.L.; Shaver, P.R. Self-Report Measurement of Adult Attachment: An Integrative Overview. In Attachment Theory and Close Relationships; The Guilford Press: New York, NY, USA, 1998; pp. 46–76. [Google Scholar]
  37. Collins, N.L.; Allard, L.M. Cognitive Representations of Attachment: The Content and Function of Working Models. In Social Cognition, Perspectives on Social Psychology; Blackwell Publishing: Malden, MA, USA, 2004; pp. 75–101. [Google Scholar]
  38. Birnbaum, G.E.; Reis, H.T.; Mikulincer, M.; Gillath, O.; Orpaz, A. When Sex Is More than Just Sex: Attachment Orientations, Sexual Experience, and Relationship Quality. J. Pers. Soc. Psychol. 2006, 91, 929–943. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  39. Smith, E.R.; Murphy, J.; Coats, S. Attachment to Groups: Theory and Measurement. J. Pers. Soc. Psychol. 1999, 77, 94–110. [Google Scholar] [CrossRef] [PubMed]
  40. Mikulincer, M.; Shaver, P.R. An Attachment Perspective on Psychopathology. World Psychiatry Off. J. World Psychiatr. Assoc. WPA 2012, 11, 11–15. [Google Scholar] [CrossRef]
  41. Sroufe, L.A.; Duggal, S.; Weinfield, N.; Carlson, E. Relationships, Development, and Psychopathology. In Handbook of Developmental Psychopathology; Sameroff, A.J., Lewis, M., Miller, S.M., Eds.; Springer: Boston, MA, USA, 2000; pp. 75–91. [Google Scholar] [CrossRef]
  42. Cantazaro, A.; Wei, M. Adult Attachment, Dependence, Self-Criticism, and Depressive Symptoms: A Test of a Mediational Model. J. Pers. 2010, 78, 1135–1162. [Google Scholar] [CrossRef] [PubMed]
  43. Marganska, A.; Gallagher, M.; Miranda, R. Adult Attachment, Emotion Dysregulation, and Symptoms of Depression and Generalized Anxiety Disorder. Am. J. Orthopsychiatry 2013, 83, 131–141. [Google Scholar] [CrossRef] [Green Version]
  44. Doron, G.; Moulding, R.; Kyrios, M.; Nedeljkovic, M.; Mikulincer, M. Adult Attachment Insecurities Are Related to Obsessive Compulsive Phenomena. J. Soc. Clin. Psychol. 2009, 28, 1022–1049. [Google Scholar] [CrossRef]
  45. Ein-Dor, T.; Doron, G.; Solomon, Z.; Mikulincer, M.; Shaver, P.R. Together in Pain: Attachment-Related Dyadic Processes and Posttraumatic Stress Disorder. J. Couns. Psychol. 2010, 57, 317–327. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  46. Illing, V.; Tasca, G.A.; Balfour, L.; Bissada, H. Attachment Insecurity Predicts Eating Disorder Symptoms and Treatment Outcomes in a Clinical Sample of Women. J. Nerv. Ment. Dis. 2010, 198, 653–659. [Google Scholar] [CrossRef]
  47. Davaji, R.B.O.; Valizadeh, S.; Nikamal, M. The Relationship between Attachment Styles and Suicide Ideation: The Study of Turkmen Students, Iran. Procedia-Soc. Behav. Sci. 2010, 5, 1190–1194. [Google Scholar] [CrossRef] [Green Version]
  48. Ein-Dor, T.; Doron, G. Psychopathology and Attachment. In Attachment Theory and Research: New Directions and Emerging Themes; The Guilford Press: New York, NY, USA, 2015; pp. 346–373. [Google Scholar]
  49. Ein-Dor, T.; Viglin, D.; Doron, G. Extending the Transdiagnostic Model of Attachment and Psychopathology. Front. Psychol. 2016, 7, 484. [Google Scholar] [CrossRef] [Green Version]
  50. Orilisi, G.; Mascitti, M.; Togni, L.; Monterubbianesi, R.; Tosco, V.; Vitiello, F.; Santarelli, A.; Putignano, A.; Orsini, G. Oral Manifestations of COVID-19 in Hospitalized Patients: A Systematic Review. Int. J. Environ. Res. Public Health 2021, 18, 12511. [Google Scholar] [CrossRef] [PubMed]
  51. Kotov, R.; Gamez, W.; Schmidt, F.; Watson, D. Linking “Big” Personality Traits to Anxiety, Depressive, and Substance Use Disorders: A Meta-Analysis. Psychol. Bull. 2010, 136, 768–821. [Google Scholar] [CrossRef]
  52. Dash, G.F.; Slutske, W.S.; Martin, N.G.; Statham, D.J.; Agrawal, A.; Lynskey, M.T. Big Five Personality Traits and Alcohol, Nicotine, Cannabis, and Gambling Disorder Comorbidity. Psychol. Addict. Behav. 2019, 33, 420–429. [Google Scholar] [CrossRef] [Green Version]
  53. Pinto, J.; Carvalho, J.; Nobre, P.J. The Relationship between the FFM Personality Traits, State Psychopathology, and Sexual Compulsivity in a Sample of Male College Students. J. Sex. Med. 2013, 10, 1773–1782. [Google Scholar] [CrossRef]
  54. Walton, M.T.; Cantor, J.M.; Lykins, A.D. An Online Assessment of Personality, Psychological, and Sexuality Trait Variables Associated with Self-Reported Hypersexual Behavior. Arch. Sex. Behav. 2017, 46, 721–733. [Google Scholar] [CrossRef]
  55. Amamou, B.; Missaoui, C.; Haouala, A.B.; Mhalla, A.; Zaafrane, F.; Gaha, L. Sexual Addiction, Self-Esteem and Personality Dimensions. J. Addict. Ther. Res. 2020, 4, 006–012. [Google Scholar] [CrossRef] [Green Version]
  56. Paz, G.; Griffiths, M.D.; Demetrovics, Z.; Szabo, A. Role of Personality Characteristics and Sexual Orientation in the Risk for Sexual Addiction Among Israeli Men: Validation of a Hebrew Sex Addiction Scale. Int. J. Ment. Health Addict. 2021, 19, 32–46. [Google Scholar] [CrossRef] [Green Version]
  57. Soraci, P.; Melchiori, F.M.; Del Fante, E.; Melchiori, R.; Guaitoli, E.; Lagattolla, F.; Parente, G.; Bonanno, E.; Norbiato, L.; Cimaglia, R.; et al. Validation and Psychometric Evaluation of the Italian Version of the Bergen–Yale Sex Addiction Scale. Int. J. Ment. Health Addict. 2021, 1–27. [Google Scholar] [CrossRef] [PubMed]
  58. Skinner, H.A. The Drug Abuse Screening Test. Addict. Behav. 1982, 7, 363–371. [Google Scholar] [CrossRef]
  59. Efrati, Y.; Mikulincer, M. Individual-Based Compulsive Sexual Behavior Scale: Its Development and Importance in Examining Compulsive Sexual Behavior. J. Sex Marital Ther. 2018, 44, 249–259. [Google Scholar] [CrossRef]
  60. Coleman, E.; Miner, M.; Ohlerking, F.; Raymond, N. Compulsive Sexual Behavior Inventory: A Preliminary Study of Reliability and Validity. J. Sex Marital Ther. 2001, 27, 325–332. [Google Scholar] [CrossRef] [PubMed]
  61. Rettenberger, M.; Klein, V.; Briken, P. The Relationship Between Hypersexual Behavior, Sexual Excitation, Sexual Inhibition, and Personality Traits. Arch. Sex. Behav. 2016, 45, 219–233. [Google Scholar] [CrossRef]
  62. Reid, R.C.; Garos, S.; Carpenter, B.N. Reliability, Validity, and Psychometric Development of the Hypersexual Behavior Inventory in an Outpatient Sample of Men. Sex. Addict. Compulsivity 2011, 18, 30–51. [Google Scholar] [CrossRef]
  63. Shimoni, L.; Dayan, M.; Cohen, K.; Weinstein, A. The Contribution of Personality Factors and Gender to Ratings of Sex Addiction among Men and Women Who Use the Internet for Sex Purpose. J. Behav. Addict. 2018, 7, 1015–1021. [Google Scholar] [CrossRef] [PubMed]
  64. Carnes, P. Sexual Addiction Screening Test. Tenn. Nurse 1991, 54, 29. [Google Scholar] [PubMed]
  65. Andreassen, C.S.; Pallesen, S.; Griffiths, M.D.; Torsheim, T.; Sinha, R. The Development and Validation of the Bergen–Yale Sex Addiction Scale with a Large National Sample. Front. Psychol. 2018, 9, 144. [Google Scholar] [CrossRef] [Green Version]
  66. Bucholz, K.K.; Cadoret, R.; Cloninger, C.R.; Dinwiddie, S.H.; Hesselbrock, V.M.; Nurnberger, J.I.; Reich, T.; Schmidt, I.; Schuckit, M.A. A New, Semi-Structured Psychiatric Interview for Use in Genetic Linkage Studies: A Report on the Reliability of the SSAGA. J. Stud. Alcohol 1994, 55, 149–158. [Google Scholar] [CrossRef] [PubMed]
  67. Heath, A.C.; Bucholz, K.K.; Madden, P.A.; Dinwiddie, S.H.; Slutske, W.S.; Bierut, L.J.; Statham, D.J.; Dunne, M.P.; Whitfield, J.B.; Martin, N.G. Genetic and Environmental Contributions to Alcohol Dependence Risk in a National Twin Sample: Consistency of Findings in Women and Men. Psychol. Med. 1997, 27, 1381–1396. [Google Scholar] [CrossRef] [Green Version]
  68. Spitzer, R.L.; Endicott, J.; Robins, E. Clinical Criteria for Psychiatric Diagnosis and DSM-III. Am. J. Psychiatry 1975, 132, 1187–1192. [Google Scholar] [CrossRef] [PubMed]
  69. Sattler, S.; Schunck, R. Associations Between the Big Five Personality Traits and the Non-Medical Use of Prescription Drugs for Cognitive Enhancement. Front. Psychol. 2016, 6, 1971. [Google Scholar] [CrossRef] [Green Version]
  70. Terracciano, A.; Löckenhoff, C.E.; Crum, R.M.; Bienvenu, O.J.; Costa, P.T. Five-Factor Model Personality Profiles of Drug Users. BMC Psychiatry 2008, 8, 22. [Google Scholar] [CrossRef] [Green Version]
  71. Lackner, N.; Unterrainer, H.-F.; Neubauer, A.C. Differences in Big Five Personality Traits between Alcohol and Polydrug Abusers: Implications for Treatment in the Therapeutic Community. Int. J. Ment. Health Addict. 2013, 11, 682–692. [Google Scholar] [CrossRef]
  72. Raketic, D.; Barisic, J.V.; Svetozarevic, S.M.; Gazibara, T.; Tepavcevic, D.K.; Milovanovic, S.D. Five-Factor Model Personality Profiles: The Differences between Alcohol and Opiate Addiction among Females. Psychiatr. Danub. 2017, 29, 74–80. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  73. Hwang, J.Y.; Choi, J.-S.; Gwak, A.R.; Jung, D.; Choi, S.-W.; Lee, J.; Lee, J.-Y.; Jung, H.Y.; Kim, D.J. Shared Psychological Characteristics That Are Linked to Aggression between Patients with Internet Addiction and Those with Alcohol Dependence. Ann. Gen. Psychiatry 2014, 13, 6. [Google Scholar] [CrossRef] [Green Version]
  74. Cheetham, A.; Allen, N.B.; Yücel, M.; Lubman, D.I. The Role of Affective Dysregulation in Drug Addiction. Clin. Psychol. Rev. 2010, 30, 621–634. [Google Scholar] [CrossRef]
  75. Peeters, M.; Oldehinkel, T.; Vollebergh, W. Behavioral Control and Reward Sensitivity in Adolescents’ Risk Taking Behavior: A Longitudinal TRAILS Study. Front. Psychol. 2017, 8, 231. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  76. Novak, S.P.; Clayton, R.R. The Influence of School Environment and Self-Regulation on Transitions between Stages of Cigarette Smoking: A Multilevel Analysis. Health Psychol. Off. J. Div. Health Psychol. Am. Psychol. Assoc. 2001, 20, 196–207. [Google Scholar] [CrossRef]
  77. Patock-Peckham, J.A.; Cheong, J.; Balhorn, M.E.; Nagoshi, C.T. A Social Learning Perspective: A Model of Parenting Styles, Self-Regulation, Perceived Drinking Control, and Alcohol Use and Problems. Alcohol. Clin. Exp. Res. 2001, 25, 1284–1292. [Google Scholar] [CrossRef]
  78. Wills, T.A.; DuHamel, K.; Vaccaro, D. Activity and Mood Temperament as Predictors of Adolescent Substance Use: Test of a Self-Regulation Mediational Model. J. Pers. Soc. Psychol. 1995, 68, 901–916. [Google Scholar] [CrossRef] [PubMed]
  79. Lyvers, M. “Loss of Control” in Alcoholism and Drug Addiction: A Neuroscientific Interpretation. Exp. Clin. Psychopharmacol. 2000, 8, 225–249. [Google Scholar] [CrossRef]
  80. Nigg, J.T.; Glass, J.M.; Wong, M.M.; Poon, E.; Jester, J.M.; Fitzgerald, H.E.; Puttler, L.I.; Adams, K.M.; Zucker, R.A. Neuropsychological Executive Functioning in Children at Elevated Risk for Alcoholism: Findings in Early Adolescence. J. Abnorm. Psychol. 2004, 113, 302–314. [Google Scholar] [CrossRef]
  81. Wong, M.M.; Rowland, S.E. Self-Determination and Substance Use: Is Effortful Control a Mediator? Alcohol. Clin. Exp. Res. 2013, 37, 1040–1047. [Google Scholar] [CrossRef]
  82. Santens, E.; Claes, L.; Dierckx, E.; Luyckx, K.; Peuskens, H.; Dom, G. Personality Profiles in Substance Use Disorders: Do They Differ in Clinical Symptomatology, Personality Disorders and Coping? Personal. Individ. Differ. 2018, 131, 61–66. [Google Scholar] [CrossRef]
  83. Bozkurt, M.; Evren, C.; Can, Y.; Evren, B.; Cetingok, S.; Yilmaz, A. Relationships of Personality Dimensions with Impulsivity in Alcohol-Dependent Inpatient Men. Nord. J. Psychiatry 2014, 68, 316–322. [Google Scholar] [CrossRef] [PubMed]
  84. First, M.B. User’s Guide for the Structured Clinical Interview for DSM-IV Axis I Disorders SCID-I: Clinician Version; American Psychiatric Press: Washington, DC, USA, 1997. [Google Scholar]
  85. Tomassini, A.; Struglia, F.; Spaziani, D.; Pacifico, R.; Stratta, P.; Rossi, A. Decision Making, Impulsivity, and Personality Traits in Alcohol-Dependent Subjects. Am. J. Addict. 2012, 21, 263–267. [Google Scholar] [CrossRef]
  86. Abassi, M.; Abolghasemi, A. Temperament and Character Dimensions: Correlates of Impulsivity in Morphine Addicts. Int. J. High Risk Behav. Addict. 2015, 4, e21142. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  87. Can, S.S.; Ünlütürk, S. Personality Traits of Substance Abusers in Turkish Military Population. J. Subst. Use 2014, 19, 440–443. [Google Scholar] [CrossRef]
  88. Seyed Hashemi, S.G.; Merghati Khoei, E.; Hosseinnezhad, S.; Mousavi, M.; Dadashzadeh, S.; Mostafaloo, T.; Mahmoudi, S.; Yousefi, H. Personality Traits and Substance Use Disorders: Comparative Study with Drug User and Non-Drug User Population. Personal. Individ. Differ. 2019, 148, 50–56. [Google Scholar] [CrossRef]
  89. Amirabadi, B.; Nikbakht, M.; Nokani, M.; Alibeygi, N.; Safari, H. Role of Temperament, Personality Traits and Onset Age of Smoking in Predicting Opiate Dependence. Int. J. High Risk Behav. Addict. 2015, 4, e24585. [Google Scholar] [CrossRef] [Green Version]
  90. Fassino, S.; Daga, G.A.; Delsedime, N.; Rogna, L.; Boggio, S. Quality of Life and Personality Disorders in Heroin Abusers. Drug Alcohol Depend. 2004, 76, 73–80. [Google Scholar] [CrossRef]
  91. Hosák, L.; Preiss, M.; Halír, M.; Cermáková, E.; Csémy, L. Temperament and Character Inventory (TCI) Personality Profile in Metamphetamine Abusers: A Controlled Study. Eur. Psychiatry J. Assoc. Eur. Psychiatr. 2004, 19, 193–195. [Google Scholar] [CrossRef]
  92. Steingrimsson, S.; Carlsen, H.K.; Lundström, E.; Lundström, S.; Nilsson, T. Problematic Alcohol and Drug Use Is Associated with Low Self-Directedness and Cooperativeness. Eur. Addict. Res. 2020, 26, 326–334. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  93. World Health Organization. AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Health Care; WHO/MSD/MSB/01.6a; World Health Organization: Geneva, Switzerland, 2001. [Google Scholar]
  94. Hildebrand, M. The Psychometric Properties of the Drug Use Disorders Identification Test (DUDIT): A Review of Recent Research. J. Subst. Abuse Treat. 2015, 53, 52–59. [Google Scholar] [CrossRef] [PubMed]
  95. Chang, H.-L.; Chen, S.-H.; Huang, C. Temperament of Juvenile Delinquents with History of Substance Abuse. Chang Gung Med. J. 2007, 30, 47–52. [Google Scholar]
  96. Sarra, A.; Fontanella, L.; D’Egidio, F.; Frattone, P. The Dimensional Assessment of Personality in Drug Addicts: A Mixed-Effects Rasch Model Approach. Qual. Quant. 2014, 48, 3025–3036. [Google Scholar] [CrossRef]
  97. Lukasiewicz, M.; Neveu, X.; Blecha, L.; Falissard, B.; Reynaud, M.; Gasquet, I. Pathways to Substance-Related Disorder: A Structural Model Approach Exploring the Influence of Temperament, Character, and Childhood Adversity in a National Cohort of Prisoners. Alcohol Alcohol. 2008, 43, 287–295. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  98. Watanabe, J.; Lu, X.; Liu, Q.; Uji, M.; Shono, M.; Chen, Z.; Kitamura, T. The Effects of Perceived Childhood Rearing on Substance and Behaviour Addiction among Japanese University Students: Mediation through Personality Traits. In Family Life, Roles, Bonds and Impact; Goossens, C.L., Ed.; Nova Science Publishers, Inc.: New York, NY, USA, 2011. [Google Scholar]
  99. Milivojevic, D.; Milovanovic, S.D.; Jovanovic, M.; Svrakic, D.M.; Svrakic, N.M.; Svrakic, S.M.; Cloninger, C.R. Temperament and Character Modify Risk of Drug Addiction and Influence Choice of Drugs. Am. J. Addict. 2012, 21, 462–467. [Google Scholar] [CrossRef] [PubMed]
  100. Conway, K.P.; Kane, R.J.; Ball, S.A.; Poling, J.C.; Rounsaville, B.J. Personality, Substance of Choice, and Polysubstance Involvement among Substance Dependent Patients. Drug Alcohol Depend. 2003, 71, 65–75. [Google Scholar] [CrossRef]
  101. Herrero, M.J.; Domingo-Salvany, A.; Torrens, M.; Brugal, M.T.; Gutiérrez, F.; The ITINERE investigators. Personality Profile in Young Current Regular Users of Cocaine. Subst. Use Misuse 2008, 43, 1378–1394. [Google Scholar] [CrossRef]
  102. Torrens, M.; Serrano, D.; Astals, M.; Pérez-Domínguez, G.; Martín-Santos, R. Diagnosing Comorbid Psychiatric Disorders in Substance Abusers: Validity of the Spanish Versions of the Psychiatric Research Interview for Substance and Mental Disorders and the Structured Clinical Interview for DSM-IV. Am. J. Psychiatry 2004, 161, 1231–1237. [Google Scholar] [CrossRef] [Green Version]
  103. Do Amaral, M.L.S.; Abdo, C.H.N.; Tavares, H.; de Tubino Scanavino, M. Personality among Sexually Compulsive Men Who Practice Intentional Unsafe Sex in São Paulo, Brazil. J. Sex. Med. 2015, 12, 557–566. [Google Scholar] [CrossRef]
  104. Kalichman, S.C.; Rompa, D. The Sexual Compulsivity Scale: Further Development and Use with HIV-Positive Persons. J. Pers. Assess. 2001, 76, 379–395. [Google Scholar] [CrossRef]
  105. Andrews, G.; Peters, L. The Psychometric Properties of the Composite International Diagnostic Interview. Soc. Psychiatry Psychiatr. Epidemiol. 1998, 33, 80–88. [Google Scholar] [CrossRef] [PubMed]
  106. Zucker, R.A.; Fitzgerald, H.E. Family Study of Risk for Alcoholism over the Life Course. Appendix 9.3 Assessment Protocol: Description of Instruments and Copies of Contact Schedules; Department of Psychiatry, University of Michigan: Ann Arbor, MI, USA, 2002. [Google Scholar]
  107. Efrati, Y. Adolescent Compulsive Sexual Behavior: Is It a Unique Psychological Phenomenon? J. Sex Marital Ther. 2018, 44, 687–700. [Google Scholar] [CrossRef]
  108. Berridge, K.C.; Robinson, T.E.; Aldridge, J.W. Dissecting Components of Reward: “Liking”, “Wanting”, and Learning. Curr. Opin. Pharmacol. 2009, 9, 65–73. [Google Scholar] [CrossRef] [Green Version]
  109. Mechelmans, D.J.; Irvine, M.; Banca, P.; Porter, L.; Mitchell, S.; Mole, T.B.; Lapa, T.R.; Harrison, N.A.; Potenza, M.N.; Voon, V. Enhanced Attentional Bias towards Sexually Explicit Cues in Individuals with and without Compulsive Sexual Behaviours. PLoS ONE 2014, 9, e105476. [Google Scholar] [CrossRef]
  110. Fairbairn, C.E.; Briley, D.A.; Kang, D.; Fraley, R.C.; Hankin, B.L.; Ariss, T. A Meta-Analysis of Longitudinal Associations between Substance Use and Interpersonal Attachment Security. Psychol. Bull. 2018, 144, 532–555. [Google Scholar] [CrossRef]
  111. Estévez, A.; Jáuregui, P.; Sánchez-Marcos, I.; López-González, H.; Griffiths, M.D. Attachment and Emotion Regulation in Substance Addictions and Behavioral Addictions. J. Behav. Addict. 2017, 6, 534–544. [Google Scholar] [CrossRef]
  112. Weinstein, A.; Katz, L.; Eberhardt, H.; Cohen, K.; Lejoyeux, M. Sexual Compulsion—Relationship with Sex, Attachment and Sexual Orientation. J. Behav. Addict. 2015, 4, 22–26. [Google Scholar] [CrossRef] [Green Version]
  113. Zapf, J.; Greiner, J.; Carroll, J. Attachment Styles and Male Sex Addiction. Sch. Psychol. Publ. 2008, 15, 158–175. [Google Scholar] [CrossRef]
  114. Gilliland, R.; Blue Star, J.; Hansen, B.; Carpenter, B. Relationship Attachment Styles in a Sample of Hypersexual Patients. J. Sex Marital Ther. 2015, 41, 581–592. [Google Scholar] [CrossRef]
  115. Crocker, M.M. Out-of-Control Sexual Behavior as a Symptom of Insecure Attachment in Men. J. Soc. Work Pract. Addict. 2015, 15, 373–393. [Google Scholar] [CrossRef]
  116. Giordano, A.L.; Cashwell, C.S.; Lankford, C.; King, K.; Henson, R.K. Collegiate Sexual Addiction: Exploring Religious Coping and Attachment. J. Couns. Dev. 2017, 95, 135–144. [Google Scholar] [CrossRef]
  117. Ciocca, G.; Pelligrini, F.; Mollaioli, D.; Limoncin, E.; Sansone, A.; Colonnello, E.; Jannini, E.A.; Fontanesi, L. Hypersexual Behavior and Attachment Styles in a Non-Clinical Sample: The Mediation Role of Depression and Post-Traumatic Stress Symptoms. J. Affect. Disord. 2021, 293, 399–405. [Google Scholar] [CrossRef] [PubMed]
  118. Kircaburun, K.; Ünübol, H.; Sayar, G.H.; Çarkçı, J.; Griffiths, M.D. Sex Addiction in Turkey: A Large-Scale Survey with a National Community Sample. Curr. Psychol. 2021, 1–9. [Google Scholar] [CrossRef]
  119. Efrati, Y.; Amichai-Hamburger, Y. Adolescents Who Solely Engage in Online Sexual Experiences Are at Higher Risk for Compulsive Sexual Behavior. Addict. Behav. 2021, 118, 106874. [Google Scholar] [CrossRef] [PubMed]
Ijerph 19 00296 g001 550
Figure 1. PRISMA flow chart regarding paper selection process (n= 1022).
Figure 1. PRISMA flow chart regarding paper selection process (n= 1022).
Ijerph 19 00296 g001
Table
Table 1. Personality traits on CSBD and SUD.
Table 1. Personality traits on CSBD and SUD.
StudyDesignSample
(n, Sex)		Mean Age
(Year)		MeasureCSBDSubstance Abuse
ACONEACONE
Zilberman et al., 2018 [4]CSSDrugs (n = 58): 45 male and 13 Female.
CSBD (n = 65): 57 male and 4 Female.		Age (mean rank):
Drug- 149
CSBD- 132		Drug- DAST [58].
CSBD: Individual-based compulsive sexual behavior scale [59] 		-
29.44 (5.74)		-
28.62 (6.078)		+
36.89 (6.54)		 -
28.67 (7)		-
29.88 (6.725)		 +
26.97 (5.68)
Efrati & Gola [5]CSS618 Israeli adolescents (341 boys and 277 girls)Aged 14–18 years (M = 16.69, SD = 1.16),Individual-based compulsive sexual behavior scale [59]-
3.37
[0.54]		 +
3.13
[0.62]
Pinto et al., 2013 [53]CSS152 male college students recruited in a Portuguese university22 years (standard deviation [SD] = 2.63)
raging from 18 to 33		Compulsive Sexual Behavior Inventory; CSBI-22 [60]-
B = −0.35		 +
B = 0.21
Rettenberger et al., 2016 [61]CSS1749 German students, 56.5% (n = 988) were female, 42.9% (n = 750) male, and 0.6% (n = 11) described themselves as neither male nor female (e.g., transgender).M = 24.42 (SD = 4.37, range 18–62).Hypersexual Behavior Inventory; HBI [62]-
r = −0.05		+
r = −0.22		 -
r = 0.07
Walton et al., 2017 [54]CSS510 Australian participants (267 males and 243 females)The respective mean age of male and female participants was 36.52 years (SD = 12.66) and 30.38 years (SD = 12.12).Hypersexual Behavior Inventory; HBI [62]-
b = −0.44		-
b = −0.16		 +
b =
0.44		+
b = 0.25
Shimoni et al., 2018 [63]CSS 267 Israeli participants (186 males and 81 females)mean age of 30.2 years (SD = 9.8) and age range of 18–68.Sexual Addiction Screening Test; SAST [64] -
β = −0.21		+
β = 0.18		+
β = 0.15
Amamou et al., 2020 [55]CSS510 Tunisian volunteers. 360 women (60%) and 204 men (40%)The average age was 31.5 +/− 9.3 yearsSexual Addiction Screening Test; SAST [64] -
3.30
[0.64]		 +
3.61
[0.94]
Paz et al., 2021 [56]CSSIsraeli participants. The sample comprised solely of men. Of these, 113 identified themselves as heterosexuals (63.8%), 48 as gay men (27.1%), and the remaining 16 as bisexuals (9%).The participants’ mean age was 32.44 years (SD = 8.41), ranging from 19 to 70 years.Bergen–Yale Sex Addiction Scale; BYSAS [65] -
r = −0.152		 +
r = 0.173
Soraci et al., 2021 [57]CSS1230 Italian participants. (26.7% males, 73.1% females, other 0.2%) Mean age 24.9 years [SD ± 5.60];Bergen–Yale Sex Addiction Scale; BYSAS [65] +
7.01
[1.83]		 +
5.72
[2.43]
Fehrman et al., 2019 [6]CSS1885 participants (male/female = 943/942)18–24 years (643; 34.1%), 25–34 years (481; 25.5%), 35–44 years (356; 18.9%), 45–54 years (294; 15.6%), 55–64 (93; 4.9%), and over 65 (18; 1%).Participants were questioned concerning their use of 18 legal and illegal drugs. -
≤44–49		-
≤44–49		+
≥51–56		+
≥51–56
Dash et al., 2019 [52]CSSParticipants were 3785 twins and siblings from Australian Twin Registry (1365 men, 2420 women).Age: M = 32 years, range 21–46 yearsAustralian version of the Semi-Structured
Assessment of the Genetics of Alcoholism [66,67]		 -
3.6
SE-0.01		-
3.7
SE-0.02		 +
2.47
SE-0.02
Kotov et al., 2010 [51] based on studies up to 2007CSS +LSThe review included 175 studies published from 1980 to 2007, which yielded 851 effect sizes. For a given analysis, the number of studies ranged from three to 63 (total sample size ranged from 1076 to 75,229).N/ADiagnoses were made by a trained rater according to one of the modern classification systems, namely the
DSM–III, DSM–III–R, DSM–IV, ICD–9, ICD–10, or Research
Diagnostic Criteria [68] 		-
d = −0.75
-
d = −1.02
 +
d =
1.13
-
d = 0.33
Sattler & Schunck, 2016 [69]CSSGerman employees: n = 6454 (Male: 0.53)Age: M = 40.63, SD = 8.64.Cognitive Enhancement for drug use -
OR = 0.774		 +
OR = 1.352
Terracciano et al., 2008 [70]CSS1102 Participants from the East Baltimore (About 62% of the sample was female; 63%)age ranged from 30 to 94 years (M = 56.6; SD = 12.4)Classified: “never use”; “former use” (as those who use but not in the last seven days), and ‘current use’ as those who use in the last seven days -
40.3 (1.77)		 +
57.6 (1.77)
Lackner et al., 2013 [71]CSS63 Austrian male substance dependents (30 alcohol abusers, 33 polydrug abusers)The alcohol abusers mean age was 42 years (SD = 8.54), whereas the polydrug abusers mean age was 31 years (SD = 8.39Expert assessment (not further specified) -
d =
−0.42		-
d =
−0.64		-
d =
−1.10		+
d =
0.64
Raketic et al., 2017 [72]CSS62 woman outpatients from Serbia +30 control group.
30 women who had alcohol use disorder and 32 women who had opioid use disorder.		Opiate dependent (M = 35.4, SD = ±5.2); Alcohol dependent (M = 39.9, SD = ±5.1); Control group (M = 36.1, SD = ±5.6). Expert assessment (not further specified) -
165.0
[±16.4]		 +
148.0
[±21.6]
Hwang et al., 2014 [73]CSS30 patients from Korea, diagnosed with alcohol dependence (mean age, 30.03 ± 5.89 years), and 30 healthy controls Alcohol Dependence:
(M = 30.03, SD = ±5.89 years); healthy controls (M = 25.33, SD = ±2.77 years).		Expert assessment (not further specified) -
37.33
[6.09]		-
36.43
[9.93]		 +
39.07
[8.37]		-
36.37
[8.50]
Note. A = Agreeableness, C = Conscientiousness, O = Openness, n = Neuroticism, E = Extraversion, + = positive correlation, - = negative correlation; CSS = cross-sectional study; LS = longitudinal study; OR = Odds Ratios.
Table
Table 2. Temperament traits (TCI; Temperament and Character Inventory) on CSBD and substance abuse.
Table 2. Temperament traits (TCI; Temperament and Character Inventory) on CSBD and substance abuse.
Substance Abuse
StudyDesignSample
(n, Sex)		Mean Age
(Year)		MeasureNSHARDPSSDCOST
Bozkurt et al., 2014 [83]; AlcoholCSSn = 94 male alcohol-dependent inpatients and A healthy control group (n = 63).male alcohol-dependent (M = 44.04), A healthy control group (M = 35.24)The substance dependence section of the SCID-I [84] ++----
r = 0.46r = 0.45r = −0.29r = −0.36r = −0.49r = −0.48
Tomassini et al., 2012 [85]; AlcoholCSSTwenty-seven abstinent alcohol-dependent subjects (21 males and 6 femalesAge (M = 46.15, SD = ±7.67)Expert assessment (not further specified)-
r = −0.34
Abassi et al., 2015 [86]; MorphineCSS120 Iranians with morphine (opioid) use disorderAge of addicts was M = 36.45, SD = 4.37 year, with a range of 20–40 years old.Expert assessment (not further specified)++----
r = 0.54r = 0.33r = −0.44r = −0.41r = −0.57r = −0.52
Can et al., 2014 [87]; Substance abuseCSS 87 male substance abusers from Turkish and 50 healthy male volunteers Age (M = 21.3, SD = ±2.3)Expert assessment (not further specified)++ ---
21.51.63.718.917.9
[4.2][5.7][1.9][5.5][7.9]
Hashemi et al., 2019 [88]; DrugCSS58 men and 52 women from addiction treatment clinics-Iran.Men: (M = 36.00, SD = 7.66)Expert assessment (not further specified)++---
Control group,Woman: (M = 30.94)8.748.045.612.58.79
58 men and 52 womenSD = 6.94.[2.12][1.97][1.72][0.94][3.25]
from the general population
Amirabadi et al., 2015 [89]; OpiateCSS45 male nicotine use disorder and 45 male opioid use disorder individualsOpiate addicts M = 35.97, SD = 7.24) Nicotine addicts M = 39.02, SD = 6.22Expert assessment (not further specified)+ -
86.08 (8.51)87.46 (6.52)
Fassino et al., 2004 [90]; HeroinCSS180 heroin abusers. (83.3% of these were men, 16.7% were women)Man: 31.38 years (SD = 6.06).The Structured Clinical Interview; SCID II [83]++- --+
Woman: 28.78 years (SD = 6.30).20.92 (4.73)14.98 (6.31)15.05 (4.21)30.29 (4.03)29.07 (6.18)14.56 (6.40)
Hosák et al., 2004 [91]; Methamphetamine CSS 41 inpatients dependent on methamphetamine, and 35 controls. Age (M = 24.0, SD = ±3.9) years. Range: 19–32. Women (n = 12). Expert assessment (not further specified)++ ---+
26.8 [4.7]18.0 [6.5]3.9 [1.8]20.226.0 [7.1]18.2
[6.2] [6.7]
Steingrimsson et al., 2020 [92]; Drug CSS 6917 individuals from Sweden (58% women)N/AThe alcohol use disorders identification test; AUDIT [93]. --
Drug Use Disorders Identification Test; DUDIT [94]r = −0.11r = −0.09
Chang et al., 2007 [95]; Substance abuseCSS60 males with history of substance abuseAge: M = 17.68, SD = 1.45 years (range, 14−20 years)Substance abuse index (SAI)+
19.0 [3.4]
Sarra et al., 2014 [96]; Substance abuseCSS 84 participants from drug treatment services in Italy, 74 (88.1%) are males and 10 (11.9%) females. M = 30 Expert assessment (not further specified)+ + +-
(minimum = 17, maximum = 47, SD = 7.5) years. E = 0.319 [0.141]E = 0.410 [0.168]E = 0.853 [0.153]E = −0.330 [0.165]
Lukasiewicz et al., 2008 [97]; Substance abuseCSSAlcohol abuse and dependence: n = 167 (95.2% Male), Drug abuse and dependence: n= 270 (93.0% Male).Age: M = 39, SD = ± 13Expert assessment (not further specified)+
General population-N = 998 (90.1% Male).Years.11.2
[2.6]
Watanabe et al., 2011 [98]; Substance abuseCSS3802 Japanese university students. 1109 men and 2693 women. Age: M = 20.2, SD = 1.5.Prevalence of smoking and alcohol use+-+--
r = 0.18r = −0.13r = 0.06r = −0.09r = −0.10
Milivojevic et al., 2012 [99]; Opiate and AlcoholCSSOpiate addicts: 312 subjects from Serbia, 66 females and 246 males. Alcoholics: 100 subjects, 36 females and 64 males. Control group: 346 volunteers (177 females and 169 males).Alcohol addicts: 39.21 years (SD 11.1), Opiate addicts 26.32 years (SD 5.99), and Normal controls 23.33 years (SD 6.79).Clinical interview by a psychiatrist and DSM IV TR criteria.+ - - +
OR = 3.61 (2.68–4.86)OR0 = 0.76 (0.60–0.96)OR= 0.64 (0.46–0.88)OR = 1.37 (1.08–1.71)
Conway et al., 2003 [100]; Substance abuseCSS326 addiction treatment from USA was 44.2% male, 54.9%Age: 32.9 (SD = 7.9)Lifetime history of most serious substance of dependence.+
23.67−24.44
Herrero et al., 2008 [101]; CocaineCSS120 individuals from Spain, 38.3% were women.Age: 23.8 years (SD = 3.4; range 18–31)Preferred Reporting Items for Systematic Reviews and Meta-Analyses [102] --+
41.9 (10.4)42.3 (9.4)53.8 (10.5)
Compulsive sexual behavior disorder
STCOSDPSRDHANS
do Amaral et al., 2015 [103]CSS69 sexually compulsive MSM from BrazilAge: M = 35.2, SD = 8.2.Sexual Compulsivity Scale; SCS [104]+ -
25.92 (5.22)15.72 (6.36)
Note. NS = Novelty Seeking, HA = Harm Avoidance, RD = Reward Dependence, PS = Persistence, SD = Self-Directedness, CO = Cooperativeness, ST = Self-Transcendence, + = positive correlation, - = negative correlation, CSS = cross-sectional study, E = Estimate.
Table
Table 3. Temperament traits (ATQ; Adult Temperament Questionnaire) on substance abuse and CSBD.
Table 3. Temperament traits (ATQ; Adult Temperament Questionnaire) on substance abuse and CSBD.
Substance Abuse
StudiesDesignSample
(n, Sex)		Mean Age
(Year)		MeasureNAECE/SOS
Mun et al., 2018 [33]; Tobacco, alcohol, and marijuanaLS311 adolescents with parents from USA. LS-from 16 to 27Composite International Diagnostic Interview [105] -
r = −0.05
Cheetham et al., 2010 [74]; Substance useReviewN/AN/AN/A+-
N/AN/A
Nigg et al., 2004 [80]; AlcoholLSboys from 198 families LS- followed between 3 and 14 yearsAlcoholism subtype groups -
N/A
Wong et al., 2013 [81]; Alcohol and drugCSS644 undergraduate students (67.2% female)23.58 (SD = 6.861)Drinking and other Drug Use History Questionnaire; DDHQ [106] - +
R = −0.86 OR = 0.42r = 0.03 OR = 1.03
Santens et al., 2018 [82]; Substance useCSS700 adult Caucasian patients on treatment program for SUDs. (68.1% males and 31.9% females).45.7 years (SD = 11.25).Addicted group -
M ≥ −0.500000
CSBD
NAECE/SOS
Efrati, 2018 [107]CSS310 high-school students (183 male, 127 female)age 16 to 18 years (M = 16.94, SD = 0.65),Individual-based compulsive sexual behavior scale [59] - +
r = −0.11r = 0.11
Note. NA = Negative affect, EC = Effortful control, E/S = Extraversion/Surgency, OS = Orienting sensitivity, + = positive correlation, − = negative correlation, CSS = Cross-sectional study; LS = Longitudinal study.
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Efrati, Y.; Kraus, S.W.; Kaplan, G. Common Features in Compulsive Sexual Behavior, Substance Use Disorders, Personality, Temperament, and Attachment—A Narrative Review. Int. J. Environ. Res. Public Health 2022, 19, 296. https://doi.org/10.3390/ijerph19010296

AMA Style

Efrati Y, Kraus SW, Kaplan G. Common Features in Compulsive Sexual Behavior, Substance Use Disorders, Personality, Temperament, and Attachment—A Narrative Review. International Journal of Environmental Research and Public Health. 2022; 19(1):296. https://doi.org/10.3390/ijerph19010296

Chicago/Turabian Style

Efrati, Yaniv, Shane W. Kraus, and Gal Kaplan. 2022. "Common Features in Compulsive Sexual Behavior, Substance Use Disorders, Personality, Temperament, and Attachment—A Narrative Review" International Journal of Environmental Research and Public Health 19, no. 1: 296. https://doi.org/10.3390/ijerph19010296

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