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International Journal of Sexual Health logoLink to International Journal of Sexual Health
. 2025 Jul 23;37(3):486–502. doi: 10.1080/19317611.2025.2530511

The Sacred, the Sinful, and the Shamed: The Association Between Compulsive Sexual Behavior, Moral Disapproval, and Sexual Shame Among Jewish Religious Adolescents

Maor Kaplan a, Yael Lazter a,b, Beáta Bőthe c,d, Ateret Gewirtz Meydan a,✉
PMCID: PMC12366806  PMID: 40843156

Abstract

Objectives

Compulsive sexual behavior (CSB) has recently been recognized as a possible disorder (CSBD) by the World Health Organization (ICD-11) and may affect a significant portion of adolescents. Yet the relationship between CSB, religious values, and sexual shame remains underexplored in this population. This study investigated how CSB, moral disapproval, and sexual shame intersect among Orthodox Jewish adolescents.

Methods

Drawing on a sample of 1,050 adolescents (63% boys and 37% girls, Mage = 17.39, SD = 1.36), the study examined the role of moral disapproval, which arises when sexual behaviors conflict with religious beliefs, in amplifying sexual shame.

Results

CSB was positively correlated with moral disapproval (particularly of masturbation, pornography, and non-pornographic sexual content) and with sexual shame, suggesting a potential reinforcing cycle between religious guilt and compulsive sexual behaviors. Network analysis revealed that more religious adolescents experienced distinct clusters of moral disapproval, with masturbation emerging as a central concern.

Conclusions

Findings suggested that adolescents in religious communities might face heightened sexual shame due to the internal conflict between their sexual behaviors and religious ideals, emphasizing the importance of addressing both moral disapproval and CSB in therapeutic and educational settings. By fostering open dialogue around these topics, interventions can help mitigate shame and promote healthier sexual development within religious contexts.

Keywords: Compulsive Sexual Behavior (CSB), moral disapproval, sexual shame, religious adolescents, Orthodox Judaism

Introduction

Compulsive sexual behavior (CSB) has gained increasing attention as a mental health concern among adolescents (Bőthe et al., 2021; Efrati, 2020), particularly due to its repetitive and uncontrollable nature (Kraus et al., 2018; Reed et al., 2022). CSB includes behaviors such as excessive pornography use or masturbation that may cause distress or interfere with functioning. In the 11th revision of the International Classification of Diseases (ICD-11), the World Health Organization formally recognized Compulsive Sexual Behavior Disorder (CSBD) as a clinical condition (Kraus et al., 2018; Reed et al., 2022; World Health Organization, 2022).

Importantly, current research distinguishes between two theorized pathways to self-reported compulsive sexual behavior. One involves actual dysregulated behavior that is difficult to control. The other reflects individuals’ beliefs that their behavior is excessive or out of control, even when it is not, due to feelings of moral incongruence or shame (Grubbs et al., 2019, 2020; Grubbs & Floyd, 2025). This distinction is particularly relevant in religious contexts, where normative sexual behaviors may be perceived as deviant or sinful (Lefevor et al., 2024). The current study does not aim to diagnose CSBD, but rather examines subjective, self-reported compulsive tendencies that may reflect either, or both, pathways.

Research has shown that adolescents, especially in religious communities, might experience a unique interplay between CSB, moral disapproval, and sexual shame (Floyd et al., 2022). This study aimed to investigate these connections, focusing on Modern-Orthodox1 Jewish adolescents and how their religious beliefs might have shaped their experiences of sexual shame and compulsive sexual behaviors.

CSB among adolescents

Despite its recognition, the prevalence and understanding of CSB remain limited. Existing studies have primarily focused on nationally representative samples from Western countries, including the United States, Germany, Hungary, and Poland. These studies suggest that 3–10% of men and 2–7% of women might report CSB (Briken et al., 2022; Bőthe et al., 2020; Dickenson et al., 2018; Grubbs et al., 2023; Lewczuk et al., 2022). There is limited research on CSB among adolescents, especially religious ones. Studies conducted in Israel (Efrati, 2018, 2019) offer valuable insights into adolescent populations. The findings showed that 12% of the adolescent boys and girls were classified as potentially exhibiting CSB. Individual-based compulsive sexual behaviors, such as excessive sexual fantasies and masturbation, were found to be more common than partnered sexual behaviors. Additionally, adolescents reporting higher levels of CSB also reported greater psychological distress and appeared less able to utilize resilience factors, such as effortful control and secure attachment (Efrati and Dannon, 2018). Further research conducted in Israel highlighted that those adolescents who were at risk of CSB were predominantly male and religious (Efrati, 2018; Efrati & Amichai-Hamburger, 2019). These adolescents more likely to engage thought suppression (Efrati, 2019), as well as specific psychological traits like attachment anxiety, and temperamental factors such as lower effortful control and heightened sensitivity to internal and external stimuli (Efrati & Gola, 2018).

CSB and sexual shame

Sexual shame is considered a specific subset of shame and is defined as a deeply ingrained sense of humiliation or disgust related to one’s sexuality, often resulting from societal, cultural, or personal experiences and attitudes (Clark, 2017; Lim, 2019; Seebeck, 2020). Sexual shame can be triggered by others or by oneself. It may manifest as feelings of helplessness, inadequacy, defectiveness, and inferiority, affecting both personal health and interpersonal relationships. Thus, it is often divided into three aspects: (1) intrapersonal sexual shame, (2) interpersonal sexual shame, and (3) sexual inferiority (Seebeck, 2020).

Intrapersonal sexual shame includes feelings of humiliation, disgust, abnormality, and inferiority, often leading to shame about one’s body. Interpersonal sexual shame involves interactions with others and focuses on feelings experienced in those interactions. Sexual inferiority is the feeling of not meeting personal expectations, which are frequently influenced by societal norms and cultural expectations. Sexual shame has been associated with sexual dysfunction (Pulverman & Meston, 2020), sexual dissatisfaction (Marcinechová & Záhorcová, 2020), and moral disapproval of pornography use (Floyd & Grubbs, 2022; Volk et al., 2016). It may result in heightened self-consciousness, fostering maladaptive thoughts, attitudes, beliefs, and behaviors during sex.

People who report high levels of CSB often feel intense shame and negativity about their sexuality (Cienfuegos-Szalay et al., 2022; Gilliland et al., 2011; Sassover et al., 2021). This shame can present itself in various ways, often not seeking help for this problem because individuals feel deeply embarrassed or ashamed to discuss sexual experiences with others, including therapists (Bothe et al., 2023). The stigma surrounding CSB can lead to isolation, as individuals fear judgment and rejection from society, friends, and family (Sassover et al., 2021). This reluctance to seek help or talk about their issues can further entrench compulsive behavior, creating a vicious cycle where shame and compulsivity reinforce each other.

The role of moral disapproval

The relationship between CSB and sexual shame can be direct, but it is often mediated by moral incongruence, a framework that highlights the conflict between an individual’s sexual behaviors (e.g., pornography use) and their personal or societal moral standards. This dissonance, also referred to as moral disapproval, occurs when behaviors are inconsistent with deeply held moral beliefs, leading to heightened psychological distress and shame (Grubbs, Kraus, et al., 2019; Grubbs, Perry, et al., 2019). This conflict can lead to a heightened sense of being out of control and compulsive, exacerbating feelings of sexual shame (Floyd et al., 2022). Individuals feel guilt and self-condemnation for engaging in behaviors they perceive as morally wrong (Floyd & Grubbs, 2022).

Studies have highlighted that sexual shame among individuals who reported high levels of CSB is often linked to religious and cultural beliefs that emphasize sexual purity and moral conduct (Grubbs et al., 2019). For example, individuals from conservative or religious backgrounds may experience more intense sexual shame due to stricter sexual norms and the significant moral weight placed on sexual behavior (Volk et al., 2016). The internalized stigma from these beliefs can lead to a cycle of shame and secrecy, preventing individuals from seeking help and further entrenching their distress (Grubbs et al., 2022).

Moral disapproval may result in sexual shame through several mechanisms. Engaging in behaviors that contradict moral beliefs can trigger intense feelings of guilt and self-condemnation, which may conflict with individual’s moral beliefs, leading to an internal struggle that exacerbates feelings of inadequacy. This dynamic is particularly pronounced in religious communities, where concerns about social disapproval can intensify shame, as seen in the relationship between compulsive sexual behavior and religiosity (Coleman et al., 2023). Furthermore, teachings that label certain sexual behaviors as sinful reinforce these feelings, creating a cycle of shame that discourages individuals from seeking help, potentially worsening their shame (Thomason, 2022).

Previous studies have extensively utilized the concept of moral disapproval/incongruence to understand the conflict between moral attitudes and compulsive sexual behaviors, particularly in relation to pornography use (Floyd & Grubbs, 2022; Jennings et al., 2021). This concept has proven to be a robust predictor of self-reported feelings of addiction to (Bőthe et al., 2024; Grubbs et al., 2018). However, research indicates that moral disapproval extends beyond issues related to pornography (Gola et al., 2020; Lewczuk et al., 2021). In this study, we apply the moral incongruence framework to examine the emotional and psychological challenges faced by Orthodox Jewish adolescents as they reconcile their sexual desires with their religious beliefs, focusing on the association between these struggles and sexual shame. We have expanded the understanding of moral disapproval to include adolescents’ conflicts regarding various sexual prohibitions in Jewish law (i.e., premarital sex, masturbation, pornography use, viewing suggestive sexual non-pornographic content, and same-sex sexual activity).

Judaism, similar to other monotheistic religions, imposes strict guidelines on sexual behavior, emphasizing purity and modesty. These guidelines prohibit physical contact between unmarried individuals of the opposite sex, masturbation, the use of pornography, and viewing sexual non-pornographic content. Same-sex sexual activity is also forbidden (Farmer et al., 2009). According to Jewish law, premarital sex and any form of erotic touch are forbidden before marriage, as physical contact between unmarried individuals is believed to potentially lead to inappropriate behavior and violations of religious law. Despite these prohibitions, studies have found that many Orthodox youths engage in such activities and often suppress their sexual thoughts and fantasies, experiencing feelings of guilt and distress as a result (Efrati & Amichai-Hamburger, 2019, 2020).

Masturbation is another prohibited act, with the Talmud stating that “one who wastes seed is as if he has killed a person” (Niddah 13a). Research has shown that many religious adolescents engage in masturbation but feel significant guilt, viewing it as sinful and unhealthy (Kaestle & Allen, 2011). Qualitative studies have revealed that young Orthodox men (Ariav, 2016; Ross, 2018) and adolescent girls (Kaplan, 2018), experience guilt, shame, and self-hatred following masturbation.

Jewish law also forbids the viewing of explicit sexual content (i.e., pornography), believing it can lead to inappropriate behavior and damage spiritual well-being, as derived from the biblical verse “And you may not stray after your hearts and your eyes” (Numbers 15:39). This commandment is interpreted as a warning against succumbing to visual temptations, particularly those related to improper sexual behavior, thus prohibiting the use of pornography and suggestive sexual non-pornographic content. The adaptation made to the moral incongruence model in this study is crucial for capturing the unique experiences of Jewish adolescents, who face stringent religious guidelines regarding sexual behavior.

The current study

The current study aimed to investigate the association between SBD, moral disapproval, sexual shame, and religiousness among Orthodox Jewish adolescents. Given the complex nature of these variables and their potential interplay, our study investigates moderation effects, as well as potential differences in network structures between more and less religious individuals. Specifically, we hypothesized that: (1) Adolescents who report higher levels of CSB would also report higher levels of sexual shame and various forms of moral disapproval; (2) the association between self-reported CSB and sexual shame would be moderated by distinct clusters of moral disapproval, with higher levels of disapproval strengthening this relationship; and (3) the network structures linking CSB, moral disapproval, and sexual shame would differ between more religious and less religious adolescents. Specifically, we expected that moral disapproval clusters would have higher centrality scores among more religious individuals, indicating a more pivotal role in the network. This aspect of the study aimed to uncover how varying degrees of religious adherence were associated with the interplay between these variables.

Method

Participants

Eligibility criteria for the youth sample included: (a) being able to read Hebrew and (b) being 16 to18 years old. Table 1 presents the demographics of the study’s sample. The sample was comprised of 1,050 youth participants. Most participants are boys (63%), with an average age of 17.39 years. The majority identified as Modern-orthodox religious (89%). Most participants (87%) identified as heterosexual, and 66% observed religious modesty practices.

Table 1.

Demographic and social characteristics of study participants.

Characteristic Value N
Gender Boys 658 (63%)
  Girls 379 (37%)
  Unknown 13
Age Mean (SD) 17.39 (1.36)
Religious affiliation Secular 32 (3.1%)
  Religious 927 (89%)
  Traditional 52 (5.0%)
  Ultra-Orthodox 35 (3.3%)
  Unknown 4
Number of siblings Mean (SD) 4.88 (1.97)
Parents’ marital status Married 976 (93%)
  Divorced 47 (4.5%)
  Widowed 2 (0.2%)
  Separated 15 (1.4%)
  Other 1 (<0.1%)
  Unknown 3
Sexual orientation Heterosexual 907 (87%)
  Homosexual 37 (3.5%)
  Bisexual 9 (0.9%)
  Asexual 45 (4.3%)
  Other 12 (1.1%)
  Unknown 6
Observing religious modesty Yes 690 (66%)
  No 235 (22%)
  Sometimes 124 (12%)
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Procedure

To capitalize on the reach of technology, we recruited participants across Israel online through Facebook and Instagram. Youth who met the ad targets and were interested in participating clicked on the ad, which linked them to the secure survey website. The first page provided a study description and contact information for the project coordinator. The subsequent pages asked screener questions to determine eligibility. Youth who were unsure about participating had the option to return later. Contact numbers for the principal investigator were provided to youth who had questions during the consent process. Those who read and gave their consent were then linked to the online survey. Youth could pause and complete the survey later if they wished.

The study received ethics approval from the University of Haifa [number 184/23]. A waiver of parental consent was requested for adolescents ages 16 to18. This was necessary because requiring parental consent could potentially place religious youth in situations where their sexual experiences and sexual attraction could be unintentionally disclosed to their parents, posing physical or emotional danger. A waiver also avoided sampling bias that would occur by only including youth who were out to their parents or came from very liberal religious households. Indeed, research has suggested that a substantial portion of sexual and gender minority youth (37.6% in one study) said they would not have participated in the research if parental or guardian consent was required (Cwinn et al., 2021). It was reasonable to assume that such a waiver of parental permission might be approved, given that this procedure had been conducted in several past and current studies using similar methodology (Cwinn et al., 2021; Flores et al., 2018; Sims & Nolen, 2021; Ybarra et al., 2016). Youth who participated in the survey were not required to leave any personal or contact information and were not compensated.

Measures

Religiousness

Religiousness was assessed with three items used by Grubbs et al. (2019) (“I consider myself religious,” “Being religious is important to me,” and “I attend religious services regularly”). The response scale ranges from 1 (strongly disagree) to 7 (strongly agree). The sum of the scores obtained for these three items is taken into account for the purpose of the analyses. Previous studies report excellent reliability for this scale (α = .92; Grubbs, Kraus, et al., 2019). This questionnaire was translated and validated to Hebrew in the International Sex Survey (https://osf.io/jcz96/). This measure showed good internal consistency in the present sample (α = .86).

Moral disapproval

Moral disapproval was measured using a well-established scale that measures moral incongruence regarding pornography use using four items (e.g., “I believe pornography use is morally wrong”) on a scale of 1 (strongly disagree) to 7 (strongly agree) (Grubbs et al., 2018). In addition to pornography use, this item has been adapted to evaluate the moral disapproval in relation to offline sexual activities (touch), masturbation, same-sex touch, and viewing suggestive sexual non-pornographic content (theses referred to mainstream movies and series that, while not classified as explicit pornography, include themes, scenes, or imagery considered suggestive or sexually provocative, and as such, are generally prohibited under strict religious guidelines emphasizing modesty). All four questions were asked for each of these behaviors to ensure a comprehensive assessment. This comprehensive approach allowed for capturing a broader spectrum of moral incongruence experiences among Jewish adolescents. This item was translated and validated to Hebrew in the International Sex Survey (https://osf.io/jcz96/). This measure demonstrated excellent internal consistency across the various factors, with moral disapproval (MD) related to using pornography (MD_Porn; α = .90), viewing (MD_View; α = .87), romantic touch (MD_Touch; α = .93), same-sex touch (MD_Same_Sex; α = .93), and masturbation (MD_Masturbation; α = .94).

Compulsive sexual behavior disorder

Compulsive sexual behavior disorder was assessed using the Compulsive Sexual Behavior Disorder Scale-7 (CSBD-7; Bothe et al., 2023). This scale includes five dimensions following the diagnostic guidelines of the ICD-11: control (i.e., failure to control CSB), salience (i.e., CSB being the central focus of one’s life), relapse (i.e., unsuccessful efforts to reduce CSB), dissatisfaction (i.e., experiencing less or no satisfaction from sexual behaviors), and negative consequences (i.e., CSB generating clinically significant distress or impairment). All dimensions were assessed by one item except for negative consequences, which was measured with three items to cover different negative consequences. To ensure that the language used was culturally sensitive to this specific population and to ensure relevance for adolescents who may not be sexually active (in terms of intercourse) but still engage in other sexual behaviors, items 4, 5, and 6 were adapted to refer to “sexual activities” (e.g., masturbation or pornography) rather than engaging in sex (intercourse). For example, “although sex was not as satisfying for me as before, I engaged in it” was revised to “although engaging in sexual activities were not as satisfying as before, I engaged in them.” These changes were made to reflect cultural sensitivity and to ensure the items were inclusive of the unique experiences of this population. Each item was answered on a four-point Likert scale (1 = completely disagree to 4 = completely agree). The overall score of the scale ranged between 7 and 28. This questionnaire was translated and validated to Hebrew in the International Sex Survey (https://osf.io/jcz96/; (Bőthe et al., 2021). The reliability of the scale in the current sample was excellent (α = .85).

Sexual shame was assessed using the Sexual Shame Inventory (SSI; Seebeck, 2020), designed to measure internalized sexual shame. The original version of the Sexual SSI consisted of 10 items. However, for the purposes of this study, three items that assumed sexual relationships occurred with partners were removed, resulting in a seven-item inventory. The remaining items assess feelings of shame and discomfort related to one’s sexuality and sexual experiences. Participants rated their agreement with each statement using a six-point scale ranging from strongly disagree to strongly agree. “There are sexual experiences or thoughts I’ve had that would be difficult for me to talk about with others,” and feel the need to bathe, wash myself, or immerse in a ritual bath after sexual experiences or thoughts.” Participants also rated their agreement with statements like, “I feel ashamed to talk to others about my sexual experiences or thoughts,” and “There are sexual experiences or thoughts that I am ashamed of, and I replay them over and over in my mind.” Scores from all items were averaged to produce a total score, with higher scores indicating greater sexual shame. The questionnaire was translated using a forward-backward translation approach to ensure accuracy and cultural relevance of the inventory (Beaton et al., 2000). This measure showed excellent internal consistency in the present sample (α = .91).

Demographic variables

Demographic variables included gender (boy, girl, prefer not to say), age (numeric response), religiosity (religious, traditional, ultra-Orthodox, secular, prefer not to say), and sexual orientation (heterosexual, homosexual, bisexual, asexual, other, prefer not to say). Additional variables included number of siblings, parents’ marital status (married, divorced, widowed, separated, other, unknown), and observance of clothing modesty laws (yes, no, sometimes).

Data analysis

The analyses were conducted among 1050 participants. Before the primary analyses, we examined the normal distribution of all main study measures using a series of Anderson-Darling normality tests. We also assessed the presence of multivariate outliers using the minimum covariance determinant approach (performed with the Routliers R package). We found that all measures significantly deviated from normality (all p < 3.70–14 or lower). In addition, 139 observations were identified as multivariate outliers. Accordingly, we used robust statistics to examine the study’s hypotheses.

Participants with no exposure to any sexual behaviors were excluded, and full information maximum likelihood (FIML) was used to estimate missing data for those engaging in some but not all behaviors. A total of 19.62% of the data was missing, with 148 different patterns of missingness. Jamshidian and Jalal’s nonparametric missing completely at random (MCAR) test was conducted to examine the type of missingness. The test indicated that the data were missing completely at random (MCAR), χ2(42) = 50.95, p = .162. Accordingly, we used multiple imputation (MI; Rubin, 2009) with 50 datasets to handle missing data.

We began by examining the pattern of associations between moral disapproval, sexual shame, CSB, and religiousness by a series of Winsorized Pearson analyses. Next, we examined the hypothesis that the association between CSB and sexual shame would be moderated by moral disapproval clusters (assessed with four items for each behavior: MD_View, MD_Porn, MD_Touch, MD_Same_Sex, MD_Masturbation). To do so, we conducted a hierarchical robust regression analysis using the lmrob function of the robustbase R package. It utilized the MM-estimator to account for nonnormal and heteroscedastic residuals. In the first step of the analysis, sexual shame was predicted by the moral disapproval clusters and CSB. Gender (dichotomous) and religiousness (continuous) were also added as covariates to adjust the effects of their contribution. In the second step of the analysis, we added the 2-way interactions between moral disapproval clusters and CSB. To avoid multicollinearity, measures were centered around their sample means. Tolerance scores were calculated to ensure that multicollinearity was not present, and all scores were indeed above 0.35.

Finally, we separately estimated two networks between all main study measures for the less religious participants (below the sample mean; n = 366) and more religious participants (above the sample mean; n = 684). We specifically employed the extended Bayesian information criterion (EBIC) with a graphical lasso followed by refitting without the lasso penalty to get more accurate (non-shrunken) estimates of the partial correlations. The correlations employed in this process were based on polychoric and polyserial correlations. In this context, “edges” represent partial correlations between variables (referred to as nodes), and “edges invariance tests” evaluate whether these associations significantly differ across groups. The estimation process was performed using the estimateNetwork function of the bootnet R package. Following the estimation of the networks, we employed edges invariance tests with an FDR of 5% to control for the multiple analyses and centrality invariance tests. Edges in network analysis were equivalent to partial correlations between two variables (known as nodes in network analysis). Centrality refers to a series of measures to evaluate the function of each node (i.e., variable) within the network, and centrality invariance tests allow distinguishing nodes of different networks using the centrality scores. We focused on the following scores: (i) Closeness— a centrality measures how fast information can spread from a given node to other reachable nodes in the network. It was calculated as the inverse of the sum of distances from a node to all other nodes. (ii) Betweenness quantifies the number of times a node acts as a bridge along the shortest path between two other nodes. It can highlight nodes significantly influencing the network, even if they are not directly connected to many other nodes. (iii) Strength: In the context of network analysis, strength centrality is the sum of the weights of a node’s edges, often used in weighted networks to assess the influence or importance of a node. And (iv) Expected Influence is a measure used in weighted, directed networks that calculates the expected influence of a node by summing the weights of outgoing edges and subtracting the weights of incoming edges. It provides a nuanced view of a node’s centrality, considering the direction of relationships. The invariance tests were performed with the NetworkComparisonTest R package.

Results

The pattern of associations between study variables

The results depicted in the heatmap (Figure 1) highlight the associations of CSB with various study measures related to moral disapproval and sexual behaviors. CSB demonstrated a significant, positive, and moderate correlation with sexual shame (r = .45), indicating that individuals with higher levels of CSB also tend to experience higher levels of sexual shame. Additionally, CSB showed significant, positive, and weak correlations with moral disapproval related to pornography use (r = .20), moral disapproval related to viewing sexual, non-pornographic content (r = .17), and moral disapproval related to masturbation (r = .25). These correlations suggested that individuals who reported higher levels of CSB, whether reflecting actual behavioral dysregulation or a perceived loss of control influenced by moral disapproval, were more likely to experience moral disapproval related to intra-personal sexual activities and sensations, such as pornography use, viewing sexual content, and masturbation. Conversely, CSB did not exhibit significant correlations with moral disapproval related to same-sex touch.

Figure 1.

Figure 1.

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Heatmap of Winsorized Pearson correlations between all study measures.

The findings also revealed strong associations among various forms of moral disapproval, particularly between moral disapproval related to pornography use and moral disapproval related to viewing sexual content (r = .72), underscoring the interconnected nature of moral disapproval across different sexual behaviors. Religiousness was positively and moderately correlated with several forms of moral disapproval, such as moral disapproval related to pornography use (r = .46) and moral disapproval related to viewing sexual content (r = .49), highlighting the interconnectedness of religious beliefs with perceptions of moral disapproval in sexual matters.

Predicting sexual shame by CSB as a function of moral disapproval clusters

The analysis presented in Table 2 indicates that, after controlling for gender, religiousness, and CSB, the variables of moral disapproval regarding masturbation, pornography use, viewing non-pornographic content, and moral disapproval related to same-sex touch were uniquely associated with greater sexual shame. Likewise, CSB was linked with higher sexual shame after controlling for the contribution of gender, religiousness, and moral disapproval clusters. In contrast to our hypothesis, moral disapproval clusters did not moderate the association between CSB and sexual shame. The model explained 44.2% of the variance in sexual shame.

Table 2.

Robust hierarchical regression for predicting sexual shame by CSB as a function of moral incongruence clusters.

  Sexual Shame (Step 1)
 Sexual Shame (Step 2)
Predictors Estimates CI P Estimates CI p
(Intercept) 3.78 3.51 – 4.04 <.001 3.80 3.53 – 4.07 <.001
MD masturbation .17 .12 – .22 <.001 .17 .12 – .22 <.001
MD porn .08 .01 – .15 .036 .07 −.00 – .15 .062
MD view .09 .03 – .15 .006 .09 .03 – .16 .004
MD touch .03 −.02 – .09 .236 .03 −.02 – .09 .237
MD same sex .09 .05 – .13 <.001 .10 .06 – .14 <.001
CSB .11 .10 – .13 <.001 .12 .10 – .13 <.001
Gender −.37 −.55 – −.20 <.001 −.38 −.55 – −.20 <.001
Religiousness −.00 −.02 – .02 .899 −.00 −.02 – .02 .900
MD masturbation × CSB       −.01 −.02 – .00 .154
MD porn × CSB       −.00 −.02 – .01 .584
MD view × CSB       .00 −.01 – .02 .582
MD touch × CSB       .00 −.01 – .01 .814
MD same sex × CSB       −.01 −.01 – .00 .194
Observations 1050 1050
R2/R2 adjusted 0.437/0.433 0.442/0.435
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Network analysis

Sub-networks

As shown in Figure 2, the analysis revealed that whereas less religious individuals had a single network, indicating that all variables are positively linked and loaded on a single latent factor, the network among more religious individuals was more complex. The latter is composed of three sub-networks: a network comprised of CSB and sexual shame, a network consisting of intrapersonal moral disapproval (masturbation, pornography use, and viewing non-pornographic content), and a network containing interpersonal moral disapproval (touching and same-sex touch).

Figure 2.

Figure 2.

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Network analysis among less and more religious individuals.Note. Different node colors represent significant sub-networks. Blue edges (i.e., paths) reflect positive associations, whereas red edges reflect negative associations. The edges’ distance, width, and color intensity represent their relative strength.

Centrality invariance

As noted in Table 3 and Figure 3, moral disapproval related to masturbation exhibits higher closeness, strength, and expected influence centrality scores for more religious individuals compared to less religious individuals. Closeness centrality indicates that moral disapproval related to masturbation was more proximally located to all other nodes within the network, suggesting it was a central point of interaction and influence among the studied variables. Strength centrality, which measures the sum of the weights of connections, revealed that moral disapproval related to masturbation had stronger direct connections to other nodes, underscoring its significant role in the network dynamics. Expected influence centrality, which accounts for both direct and indirect influences, further highlighted the potentially pervasive nature of moral disapproval related to masturbation across the network.

Table 3.

Centrality invariance test results comparing the networks of less and more religious individuals.

  Closeness Betweenness Strength Expected Influence
CSB .165 1.000 .018 .528
MD porn .606 1.000 .988 .038
MD view .665 .363 .963 .068
MD masturbation .003 .191 .002 .021
MD touch .158 .850 .106 .154
MD same sex .094 1.000 .106 .665
Sexual shame .236 .380 .695 .696
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Note. All values are p-values. Significant values are in bold, and marginally significant values are italicized.

Figure 3.

Figure 3.

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Centrality scores of the network analysis among less and more religious individuals.Note. A = Less religious individuals; B = More religious individuals.

In addition, the analysis revealed that moral disapproval related to pornography use also demonstrated greater expected influence centrality among more religious individuals compared to their less religious counterparts. This elevated expected influence among more religious individuals suggested that moral disapproval related to pornography use is not only a prominent issue within this group but also exerted substantial influence over other related moral and psychological constructs.

Edges invariance

As noted in Table 4, we found two edges (i.e., associations between nodes) that significantly differed between more and less religious individuals. Specifically, the association between moral disapproval related to pornography use and viewing non-pornographic sexual content was stronger among more religious individuals, as well as the association between CSB and moral disapproval related to masturbation. These results underscore the stronger role of moral disapproval related to masturbation not only within the network as a whole but specifically in the manifestation of CSB. It also showed that, unlike among less religious individuals, pornography consumption is more tightly tied to the consumption of non-pornographic sexual content among more religious individuals.

Table 4.

Edges invariance test results comparing the networks of less and more religious individuals.

Variable 1 Variable 2 p a q b , c
MD porn MD view .047 1.000
CSB MD masturbation .049 1.000
CSB MD touch .104 1.000
MD masturbation Sexual shame .106 1.000
MD masturbation MD same sex .113 1.000
MD masturbation MD touch .166 1.000
CSB MD porn .201 1.000
MD touch MD same sex .212 1.000
MD view Sexual shame .219 1.000
CSB MD same sex .240 1.000
MD porn Sexual shame .258 1.000
MD view MD touch .407 1.000
MD porn MD masturbation .498 1.000
CSB MD view .500 1.000
MD view MD same sex .501 1.000
MD porn MD same sex .503 1.000
MD same sex Sexual shame .571 1.000
MD touch Sexual shame .602 1.000
MD view MD masturbation .805 1.000
MD porn MD touch .893 1.000
CSB Sexual shame .910 1.000
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a

Bolded p-values are nominally significant at p < .05.

b

Bolded variable names reflect significance after FDR correction.

c

q refers to q-values (i.e., false discovery rate of 10%).

Discussion

This study examined the relationships between CSB, moral disapproval, sexual shame, and religiousness among Orthodox Jewish adolescents. The significant positive correlation between CSB and sexual shame aligned with previous research on adult populations (Cienfuegos-Szalay et al., 2022). This finding was expected, as it supports the notion that individuals who reported higher levels of CSB, whether reflecting actual behavioral dysregulation or a perceived loss of control influenced by moral disapproval, often struggle with intense feelings of shame (Bothe et al., 2023; Briken et al., 2024; Gilliland et al., 2011; Sassover et al., 2021; Whelan et al., 2023). In the context of Orthodox Jewish adolescents, this relationship may be particularly pronounced due to the strict religious guidelines surrounding sexual behavior. The shame may be amplified by perceived violations of deeply held religious values, contributing to a cycle of distress and CSB (Jennings et al., 2021).

Furthermore, significant, positive associations were observed between CSB and moral disapproval related to pornography use, viewing non-pornographic sexual content, and masturbation. These findings aligned with existing research on adult populations, which has demonstrated similar links between moral disapproval related to pornography and CSB (Coleman et al., 2023; Grubbs et al., 2020). However, the lack of significant correlations between CSB and moral disapproval related to touching and same-sex touch others was unexpected. For Orthodox Jewish adolescents, CSB seems more strongly linked to intrapersonal sexual activities like masturbation and pornography, which are more private and accessible, making them more likely to conflict with internalized religious values. In contrast, interpersonal sexual behaviors, such as touching or same-sex touch, may involve social dynamics that help justify or normalize the behavior, reducing shame. Additionally, in religious communities within the Western cultural sphere, while sexual contact may be prohibited, it is sometimes more socially understood, lessening the shame attached to interpersonal sexual acts. In contrast, solitary acts like masturbation or viewing explicit content may generate more moral conflict and shame (Fernandez et al., 2017). These findings highlight the tension between religious values and personal behavior, with adolescents facing heightened moral conflict and distress due to the private nature of their actions and religious expectations.

The finding that CSB and various forms of moral disapproval predicted sexual shame, explaining 44.2% of its variance, was notable. This substantial explanatory power underscores the importance of these factors in understanding sexual shame among religious adolescents and aligns with studies that associate CSB with sexual shame (Cienfuegos-Szalay et al., 2022) and moral disapproval with sexual shame (Floyd et al., 2022; Volk et al., 2016). Contrary to our hypothesis, the moral disapproval clusters did not moderate the association of CSB with sexual shame. This suggested that moral disapproval might not change the strength of the relationship between CSB and sexual shame. This finding aligns with previous research on moral disapproval (Floyd et al., 2022; Grubbs et al., 2020) but extends it to an adolescent, Orthodox Jewish population.

In the final set of analyses of this study, we conducted a network analysis to examine the interrelationships between CSB, moral disapproval, sexual shame, and religiousness among Orthodox Jewish adolescents. By employing network analysis, we aimed to uncover potential differences in the network structures between more and less religious individuals, and to identify key variables that played central roles in these networks. Our analysis revealed distinct network structures for more and less religious individuals. Less religious adolescents exhibited a single, interconnected network where all variables were positively linked. In contrast, more religious adolescents showed a more complex structure composed of three distinct sub-networks: (1) CSB and sexual shame, (2) intrapersonal moral disapproval (masturbation, pornography use, and viewing non-pornographic content), and (3) interpersonal moral disapproval (touching and same-sex touch). This complexity in the network structure of more religious adolescents suggests that CSB, sexual shame, and different types of moral disapproval may operate in more nuanced and compartmentalized ways for this group. This could reflect a more conflicted and multifaceted relationship with sexuality among highly religious individuals, possibly due to stricter religious teachings and expectations (Rosmarin & Pirutinsky, 2019).

A key finding of our analysis was the central role of moral disapproval related to masturbation among more religious adolescents. This variable exhibited higher closeness, strength, and expected influence centrality scores compared to less religious individuals. The high centrality of masturbation-related moral disapproval aligns with the strict prohibitions against masturbation in Orthodox Judaism and highlights its potential as a crucial point of intervention in addressing sexual shame and CSB in this population (Ribner & Rosenbaum, 2005). These centrality measures collectively suggest that moral disapproval related to masturbation played a crucial role in the moral and psychological framework of more religious individuals, serving as a key node that affects and is affected by other related constructs. The higher closeness centrality of moral disapproval related to masturbation implied that changes in moral disapproval related to masturbation could rapidly affect other areas within the network, making it a strategic focal point for addressing moral disapproval issues. The higher strength centrality underscored the robust and direct interactions moral disapproval related to masturbation had with other variables, indicating it might be a critical element in the experience of moral incongruence among religious individuals. Lastly, the elevated expected influence centrality score suggests that moral disapproval related to masturbation has a far-reaching impact, both directly and indirectly, on the network, highlighting its significant and pervasive role in shaping moral and psychological outcomes in this population.

Furthermore, we found that the association between moral disapproval related to pornography use and viewing non-pornographic sexual content was stronger among more religious individuals. This suggests that for these adolescents, any form of sexual content, whether pornographic or not, is more likely to be viewed as problematic and cause moral distress. This finding underscores the broader contribution of religious beliefs to attitudes toward various forms of sexual media among Orthodox Jewish adolescents (Efrati, 2019). Additionally, the analysis revealed a stronger association between CSB and moral disapproval related to masturbation among more religious individuals. This indicates that for highly religious adolescents, feelings of moral disapproval about masturbation are more tightly linked to CSB, potentially exacerbating psychological distress (Grubbs et al., 2019).

Overall, the lack of control is a key characteristic in CSB and also directly clashes with religious ideals that value self-mastery. This contrast is captured in a traditional Jewish teaching which asks, “Who is strong? He who conquers his evil inclination.” This saying highlights the high value placed in Judaism on resisting internal impulses, particularly in the moral and sexual domains. For religious adolescents, this struggle for control starkly contrasts with the religious hero, who is seen as mastering their desires. This internal conflict is intensified by the profound dissonance between CSB and religious values, often leading adolescents to attempt to suppress their sexual urges. However, these efforts at suppression can paradoxically heighten sexual desires, and may contribute to a cycle where compulsive behaviors escalate. This possible escalating cycle reinforces moral disapproval, further amplifying feelings of compulsion and intensifying sexual shame (Carboneau, 2018; Floyd et al., 2022). Additionally, intrapersonal sexual behaviors can deepen this dissonance, as adolescents often perceive themselves as devout or righteous within their community while internally grappling with actions they view as sinful or deviant. This disparity between their outward image and internal reality exacerbates moral disapproval and sexual shame, heightening their sense of internal conflict and distress. Together, these dynamics might create a powerful feedback loop, where attempts to reconcile religious values with personal behaviors may serve to increase feelings of shame and conflict. Although this study focuses on Jewish adolescents, the findings may resonate with youth from other monotheistic traditions, such as Christianity and Islam, which also impose strict sexual norms (Lefevor et al., 2024). Across these religions, teachings emphasize chastity, discourage or forbid masturbation and same-sex behavior, and equate sexuality outside marriage with moral failure. Adolescents raised in these traditions similarly experience internal conflict, moral disapproval, and sexual shame (Lefevor et al., 2024). These parallels underscore the broader applicability of the moral incongruence framework and suggest that the psychological toll of navigating sexuality within religious environments may transcend specific cultural or denominational contexts.

Limitations and future research directions

While this study provides valuable insights into the relationships between CSB, moral disapproval, and sexual shame among Orthodox Jewish adolescents, several limitations should be noted. The cross-sectional nature of the study precludes causal inferences. Longitudinal research is needed to establish the temporal order of these relationships and to understand how they evolve over time, particularly during the transition from adolescence to adulthood. Our sample was limited to Orthodox Jewish adolescents in Israel. While this focus allowed for an in-depth examination of this specific population, it limits the generalizability of our findings to other religious or cultural contexts. Our reliance on self-report measures may have introduced bias, particularly given the sensitive nature of the topics studied. Future research could benefit from incorporating behavioral measures or observational data to complement self-report measures. While our study examined various forms of moral disapproval, there may be other relevant aspects of moral incongruence or religious beliefs that we did not capture. Future studies could explore a broader range of moral and religious constructs to provide a more comprehensive understanding of these relationships. In addition, although we controlled for gender in all analyses, gendered dynamics likely play a critical role in shaping how moral disapproval and sexual shame are experienced, particularly in religious contexts. Prior research indicates that boys and girls are subject to different religious teachings and expectations regarding sexual behavior, especially masturbation (Efrati & Amichai-Hamburger, 2019; Kaplan, 2018). For example, boys may receive more direct prohibitions against masturbation and pornography use, which may intensify moral incongruence and sexual shame (Ariav, 2016; Gilliland et al., 2011). These differences suggest that gender-specific pathways to compulsive sexual behavior and internalized shame may exist and warrant future investigation.

Finally, this study did not examine potential protective factors that might mitigate the development of CSB or sexual shame in religious adolescents. Future research should investigate factors such as religious coping strategies, social support, or specific religious teachings that may serve as buffers against negative outcomes.

Implications and future directions in clinical practice

These findings have important implications for clinical practice. CSB, sexual shame, and moral disapproval are topics often surrounded by limited discussion, leading to heightened moral dissonance and, consequently, stronger feelings of sexual shame. For clinicians and educators, this highlights the need to foster more open, normalizing conversations specifically around these topics. The literature shows that educators and therapists tend to avoid discussing issues related to sexuality, particularly those linked to shame and guilt (Byers et al., 2008; Ollis, 2016). These findings emphasize the importance of raising these issues proactively, even if adolescents do not bring them up themselves. Addressing these topics can possibly reduce both the dissonance and the associated sexual shame, ultimately promoting better sexual health and well-being.

In religious educational institutions, there is often an assumption that adolescents are not sexually active, and as a result, discussions around sexuality are frequently absent (Burke & Greteman, 2021). This silence, however, exacerbates the moral dissonance and intensifies feelings of sexual shame. Introducing open discussions does not imply abandoning religious values; rather, it allows for a nuanced conversation that acknowledges the complexity of balancing different values, religious commitments, and sexual needs. By engaging in such dialogue, educators and therapists can provide a safe space where adolescents can navigate the tensions between their religious beliefs and sexual development, reducing feelings of shame and promoting healthier sexual attitudes. This approach encourages a deeper understanding of their own sexual needs without compromising their religious values, ultimately contributing to their overall well-being.

Conclusions

This study highlighted the complex relationships between CSB, moral disapproval, sexual shame, and religiousness among Orthodox Jewish adolescents. Network analysis unveiled distinct structures for more and less religious individuals, with moral disapproval in relation to masturbation emerging as a central node for more religious adolescents. These insights suggest that interventions addressing CSB and sexual shame in this population should focus on specific areas of moral disapproval, especially concerning masturbation and pornography use. By highlighting the nuanced interplay of these factors in Orthodox Jewish adolescents, this study paves the way for more targeted and effective interventions in this unique population.

Note

1

Modern Orthodoxy is a movement within Orthodox Judaism that integrates adherence to Jewish law and tradition with engagement in modern secular society.

Funding Statement

The author(s) reported there is no funding associated with the work featured in this article.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are not publicly available due to ethical considerations and the sensitive nature of the content, which involves minors and topics related to sexuality and religious identity. To protect participant anonymity and in accordance with the ethics approval granted by the Ethics Committee of the University of Haifa (Protocol #184/23), access to the dataset is restricted. However, de-identified aggregated data or specific data elements may be made available upon reasonable request to the corresponding author, contingent upon approval by the institutional ethics committee and a signed data use agreement.

References

  1. Ariav, M. (2016). Coping with sexual prohibitions: An examination of experiences and challenges of older singles in the Israeli Religious- Zionist community. Bar-Ilan University Ramat. https://cris.biu.ac.il/en/studentTheses/coping-eith-sexual-prohibitions-an-examination-of-experiences-and. [Google Scholar]
  2. Beaton, D. E., Bombardier, C., Guillemin, F., &Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25(24), 3186–3191. 10.1097/00007632-200012150-00014 [DOI] [PubMed] [Google Scholar]
  3. Bothe, B., Koós, M., Nagy, L., Kraus, S. W., Demetrovics, Z., Potenza, M. N., Michaud, A., Ballester-Arnal, R., Batthyány, D., Bergeron, S., Billieux, J., Briken, P., Burkauskas, J., Cárdenas-López, G., Carvalho, J., Castro-Calvo, J., Chen, L., Ciocca, G., Corazza, O., … Vaillancourt-Morel, M. P. (2023). Compulsive sexual behavior disorder in 42 countries: Insights from the International Sex Survey and introduction of standardized assessment tools. Journal of Behavioral Addictions, 12(2), 393–407. 10.1556/2006.2023.00028 [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bőthe, B., Koós, M., Nagy, L., Kraus, S. W., Potenza, M. N., & Demetrovics, Z. (2021). International sex survey: Study protocol of a large, cross-cultural collaborative study in 45 countries. Journal of Behavioral Addictions, 10(3), 632–645. 10.1556/2006.2021.00063 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bőthe, B., Vaillancourt-Morel, M. P., Bergeron, S., Hermann, Z., Ivaskevics, K., Kraus, S. W., & Grubbs, J. B. (2024). Uncovering the most robust predictors of problematic pornography use: A large-scale machine learning study across 16 countries. Journal of Psychopathology and Clinical Science, 133(6), 489–502. 10.1037/abn0000913 [DOI] [PubMed] [Google Scholar]
  6. Bőthe, B., Vaillancourt-Morel, M. P., Dion, J., Štulhofer, A., & Bergeron, S. (2021). Validity and reliability of the short version of the problematic pornography consumption scale (PPCS-6-A) in adolescents. Psychology of Addictive Behaviors, 35(4), 486–500. 10.1037/adb0000722.supp [DOI] [PubMed] [Google Scholar]
  7. Briken, P., Bőthe, B., Carvalho, J., Coleman, E., Giraldi, A., Kraus, S. W., Lew-Starowicz, M., & Pfaus, J. G. (2024). Assessment and treatment of compulsive sexual behavior disorder: A sexual medicine perspective. Sexual Medicine Reviews, 12(3), 355–370. 10.1093/sxmrev/qeae014 [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Briken, P., Wiessner, C., Štulhofer, A., Klein, V., Fuß, J., Reed, G. M., & Dekker, A. (2022). Who feels affected by “out of control” sexual behavior? Prevalence and correlates of indicators for ICD-11 Compulsive Sexual Behavior Disorder in the German Health and Sexuality Survey (GeSiD). Journal of Behavioral Addictions, 11(3), 900–911. 10.1556/2006.2022.00060 [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Burke, K. J., & Greteman, A. J. (2021). Educating tensions between religious and sexuality discourses: On resentment and hospitality. Review of Education, Pedagogy, and Cultural Studies, 43(1), 49–68. 10.1080/10714413.2020.1837608 [DOI] [Google Scholar]
  10. Byers, E. S., Sears, H. A., & Weaver, A. D. (2008). Parents’ reports of sexual communication with children in kindergarten to grade 8. Journal of Marriage and Family, 70(1), 86–96. 10.1111/j.1741-3737.2007.00463.x [DOI] [Google Scholar]
  11. Carboneau, R. A. (2018). Religiosity, moral disapproval, shame and pornography use: Assessing the relationship between shame and sexual behaviors. Liberty University. https://digitalcommons.liberty.edu/doctoral/1781/ [Google Scholar]
  12. Cienfuegos-Szalay, J., Moody, R. L., Talan, A., Grov, C., & Rendina, H. J. (2022). Sexual shame and emotion dysregulation: Key roles in the association between internalized homonegativity and sexual compulsivity. Journal of Sex Research, 59(5), 610–620. 10.1080/00224499.2021.1963649 [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Clark, N. (2017). The etiology and phenomenology of sexual shame: A grounded theory study. Seattle Pacific University. https://digitalcommons.spu.edu/cpy_etd/25/ [Google Scholar]
  14. Coleman, E., Jennings, T., Gleason, N., Danielson, S., Nielsen, K. H., Miner, M. H., & Rahm-Knigge, R. L. (2023). The relationship between compulsive sexual behavior, religiosity, and moral disapproval. Journal of Sex & Marital Therapy, 49(3), 314–330. 10.1080/0092623X.2022.2117746 [DOI] [PubMed] [Google Scholar]
  15. Cwinn, E., Cadieux, C., & Crooks, C. V. (2021). Who are we missing? The impact of requiring parental or guardian consent on research with lesbian, gay, bisexual, trans, two-spirit, queer/questioning youth. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 68(6), 1204–1206. 10.1016/j.jadohealth.2020.07.037 [DOI] [PubMed] [Google Scholar]
  16. Dickenson, J. A., Gleason, N., Coleman, ELI., &Miner, M. H. (2018). Prevalence of Distress Associated With Difficulty Controlling Sexual Urges, Feelings, and Behaviors in the United States. JAMA Network Open, 1(7), e184468 10.1001/jamanetworkopen.2018.4468 [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Efrati, Y. (2018). Adolescent compulsive sexual behavior: Is it a unique psychological phenomenon? Journal of Sex & Marital Therapy, 44(7), 687–700. 10.1080/0092623X.2018.1452088 [DOI] [PubMed] [Google Scholar]
  18. Efrati, Y. (2019). God, I Can’t Stop Thinking About Sex! The rebound effect in unsuccessful suppression of sexual thoughts among religious adolescents. Journal of Sex Research, 56(2), 146–155. 10.1080/00224499.2018.1461796 [DOI] [PubMed] [Google Scholar]
  19. Efrati, Y. (2020). Problematic and non-problematic pornography use and compulsive sexual behaviors among understudied populations: Children and adolescents. In Current addiction reports (Vol. 7, Issue 1, pp.68–75). Springer. 10.1007/s40429-020-00300-4 [DOI] [Google Scholar]
  20. Efrati, Y., & Amichai-Hamburger, Y. (2019). The use of online pornography as compensation for loneliness and lack of social ties among Israeli adolescents. Psychological Reports, 122(5), 1865–1882. 10.1177/0033294118797580 [DOI] [PubMed] [Google Scholar]
  21. Efrati, Y., & Amichai-Hamburger, Y. (2020). Are adolescents who consume pornography different from those who engaged in online sexual activities? Children and Youth Services Review, 111, 104843. 10.1016/j.childyouth.2020.104843 [DOI] [Google Scholar]
  22. Efrati, Y., &, Dannon, P. (2018). Normative and Clinical Self-Perceptions of Sexuality and Their Links to Psychopathology among Adolescents. Psychopathology, 51(6), 380–389. 10.1159/000495842 [DOI] [PubMed] [Google Scholar]
  23. Efrati, Y., & Gola, M. (2018). Understanding and predicting profiles of compulsive sexual behavior among adolescents. Journal of Behavioral Addictions, 7(4), 1004–1014. 10.1556/2006.7.2018.100 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Farmer, M. A., Trapnell, P. D., & Meston, C. M. (2009). The relation between sexual behavior and religiosity subtypes: A test of the secularization hypothesis. Archives of Sexual Behavior, 38(5), 852–865. 10.1007/S10508-008-9407-0/TABLES/5 [DOI] [PubMed] [Google Scholar]
  25. Fernandez, D. P., Tee, E. Y. J., & Fernandez, E. F. (2017). Do cyber pornography use inventory-9 scores reflect actual compulsivity in internet pornography use? Exploring the role of abstinence effort. Sexual Addiction & Compulsivity, 24(3), 156–179. 10.1080/10720162.2017.1344166 [DOI] [Google Scholar]
  26. Flores, D., McKinney, R., Arscott, J., & Barroso, J. (2018). Obtaining waivers of parental consent: A strategy endorsed by gay, bisexual, and queer adolescent males for health prevention research. Nursing Outlook, 66(2), 138–148. 10.1016/j.outlook.2017.09.001 [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Floyd, C. G., & Grubbs, J. B. (2022). Context matters: How religion and morality shape pornography use effects. Current Sexual Health Reports, 14(3), 82–98. 10.1007/s11930-022-00329-8 [DOI] [Google Scholar]
  28. Floyd, C. G., Volk, F., Flory, D., Harden, K., Peters, C. E., & Taylor, A. (2022). Sexual shame as a unique distress outcome of morally incongruent pornography use: Modifications and methodological considerations. Archives of Sexual Behavior, 51(2), 1293–1311. 10.1007/s10508-021-02104-7 [DOI] [PubMed] [Google Scholar]
  29. Gilliland, R., South, M., Carpenter, B. N., & Hardy, S. A. (2011). The roles of shame and guilt in hypersexual behavior. Sexual Addiction & Compulsivity, 18(1), 12–29. 10.1080/10720162.2011.551182 [DOI] [Google Scholar]
  30. Gola, M., Lewczuk, K., Potenza, M. N., Kingston, D. A., Grubbs, J. B., Stark, R., &Reid, R. C. (2020). What should be included in the criteria for compulsive sexual behavior disorder?. Journal of Behavioral Addictions, 11(2), 160–165. 10.1556/2006.2020.00090 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Grubbs, J. B., & Floyd, C. G. (2025). Moral incongruence after 10 years: A developmental and narrative review. Current Addiction Reports, 12(1), 1–9. 10.1007/s40429-025-00675-2 [DOI] [Google Scholar]
  32. Grubbs, J. B., Floyd, C. G., Griffin, K. R., Jennings, T. L., &Kraus, S. W. (2022). Moral incongruence and addiction: A registered report. Psychology of Addictive Behaviors : journal of the Society of Psychologists in Addictive Behaviors, 36(7), 749–761. 10.1037/adb0000876 [DOI] [PubMed] [Google Scholar]
  33. Grubbs, J. B., Kraus, S. W., & Perry, S. L. (2019). Self-reported addiction to pornography in a nationally representative sample: The roles of use habits, religiousness, and moral incongruence. Journal of Behavioral Addictions, 8(1), 88–93. 10.1556/2006.7.2018.134 [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Grubbs, J. B., Kraus, S. W., Perry, S. L., Lewczuk, K., & Gola, M. (2020). Moral incongruence and compulsive sexual behavior: Results from cross-sectional interactions and parallel growth curve analyses. Journal of Abnormal Psychology, 129(3), 266–278. 10.1037/abn0000501.supp [DOI] [PubMed] [Google Scholar]
  35. Grubbs, J. B., Perry, S. L., Wilt, J. A., & Reid, R. C. (2019). Pornography problems due to moral incongruence: An integrative model with a systematic review and meta-analysis. In Archives of sexual behavior (Vol. 48, Issue, pp. 397–415). Springer. 10.1007/s10508-018-1248-x [DOI] [PubMed] [Google Scholar]
  36. Grubbs, J. B., Reid, R. C., Bőthe, B., Demetrovics, Z., Coleman, ELI., Gleason, N., Miner, M. H., Fuss, J., Klein, V., Lewczuk, K., Gola, M., Fernandez, D. P., Fernandez, E. F., Carnes, S., Lew-Starowicz, M., Kingston, D., &Kraus, S. W. (2023). Assessing compulsive sexual behavior disorder: The development and international validation of the compulsive sexual behavior disorder-diagnostic inventory (CSBD-DI). Journal of Behavioral Addictions, 12(1), 242–260. 10.1556/2006.2023.00005 [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Grubbs, J. B., Wilt, J. A., Exline, J. J., & Pargament, K. I. (2018). Predicting pornography use over time: Does self-reported “addiction” matter? Addictive Behaviors, 82, 57–64. 10.1016/j.addbeh.2018.02.028 [DOI] [PubMed] [Google Scholar]
  38. Grubbs, J. B., Wilt, J. A., Exline, J. J., Pargament, K. I., & Kraus, S. W. (2018). Moral disapproval and perceived addiction to internet pornography: A longitudinal examination. Addiction, 113(3), 496–506. 10.1111/add.14007 [DOI] [PubMed] [Google Scholar]
  39. Jennings, T. L., Lyng, T., Gleason, N., Finotelli, I., & Coleman, E. (2021). Compulsive sexual behavior, religiosity, and spirituality: A systematic review. In Journal of Behavioral Addictions (Vol. 10, Issue 4, pp.854–878). 10.1556/2006.2021.00084 [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Kaestle, C. E., & Allen, K. R. (2011). The role of masturbation in healthy sexual development: Perceptions of young adults. Archives of Sexual Behavior, 40(5), 983–994. 10.1007/s10508-010-9722-0 [DOI] [PubMed] [Google Scholar]
  41. Kaplan, M. (2018). The preceptions of young adult religious women on sexuality and sexual assault (in Hebrew) [brew University in Jerusalem].
  42. 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., & Reed, G. M. (2018). Compulsive sexual behaviour disorder in the ICD-11. World Psychiatry, 17(1), 109–110. 10.1002/wps.20464 [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Lefevor, G. T., Sorrell, S. A., & Skidmore, S. J. (2024). How and why religiousness influences sexual health: A review. Current Sexual Health Reports, 16(3), 185–194. 10.1007/s11930-024-00390-5 [DOI] [Google Scholar]
  44. Lewczuk, K., Nowakowska, I., Lewandowska, K., Potenza, M. N., &Gola, M. (2021). Frequency of use, moral incongruence and religiosity and their relationships with self-perceived addiction to pornography, internet use, social networking and online gaming. Addiction (Abingdon, England), 116(4), 889–899. 10.1111/add.15272 [DOI] [PubMed] [Google Scholar]
  45. Lewczuk, K., Wizła, M., Glica, A., Potenza, M. N., Lew-Starowicz, M., &Kraus, S. W. (2022). Withdrawal and tolerance as related to compulsive sexual behavior disorder and problematic pornography use- Preregistered study based on a nationally representative sample in Poland. Journal of Behavioral Addictions, 11(4), 979–993. 10.1556/2006.2022.00076 [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Lim, J. S. (2019). Developing the Refined Sexual Shame Inventory: Validation Study of the Kyle Inventory of Sexual Shame. Liberty University. https://digitalcommons.liberty.edu/doctoral/2108/ [Google Scholar]
  47. Marcinechová, D., & Záhorcová, L. (2020). Sexual Satisfaction, Sexual Attitudes, and Shame in Relation to Religiosity. Sexuality & Culture, 24(6), 1913–1928. 10.1007/s12119-020-09727-3 [DOI] [Google Scholar]
  48. Ollis, D. (2016). The challenges, contradictions and possibilities of teaching about pornography in Sex and Relationships Education (SRE): The Australian Context. In Vanita S. (Ed.), Global perspectives and key debates in sex and relationships education: Addressing issues of gender, sexuality, plurality and power. Palgrave Macmillan. 10.1057/9781137500229.0008 [DOI] [Google Scholar]
  49. Pulverman, C. S., & Meston, C. M. (2020). Sexual dysfunction in women with a history of childhood sexual abuse: The role of sexual shame. Psychological Trauma: Theory, Research, Practice and Policy, 12(3), 291–299. 10.1037/tra0000506 [DOI] [PubMed] [Google Scholar]
  50. Reed, G. M., First, M. B., Billieux, J., Cloitre, M., Briken, P., Achab, S., Brewin, C. R., King, D. L., Kraus, S. W., & Bryant, R. A. (2022). Emerging experience with selected new categories in the ICD-11: Complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 21(2), 189–213. 10.1002/wps.20960 [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Ribner, D. S., &, Rosenbaum, T. Y. (2005). Evaluation and treatment of unconsummated marriages among Orthodox Jewish couples. Journal of Sex & Marital Therapy, 31(4), 341–353. 10.1080/00926230590950244 [DOI] [PubMed] [Google Scholar]
  52. Rosmarin, D. H., & Pirutinsky, S. (2019). Problematic sexual behavior and religion among adult Jewish males: An initial study. American Journal of Men’s Health, 13(1), 10.1177/1557988318823586 [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Ross, H. (2018). Emotions, aspirations, and meanings given by adult religious men about their sexuality (in Hebrew). Hebrew University of Jerusalem. [Google Scholar]
  54. Rubin, D. B. (2009). Multiple imputation for nonresponse in surveys (Vol. 81). John Wiley & Sons. [Google Scholar]
  55. Sassover, E., Abrahamovitch, Z., Amsel, Y., Halle, D., Mishan, Y., Efrati, Y., & Weinstein, A. (2021). A study on the relationship between shame, guilt, self-criticism and compulsive sexual behaviour disorder. Current Psychology. 10.1007/s12144-021-02188-3 [DOI] [Google Scholar]
  56. Seebeck, J. (2020). Development of the Sexual Shame Inventory. Available from ProQuest Dissertations & Theses Global. (2507118910). Retrieved from https://www.proquest.com/dissertations-theses/development-sexual-shame-inventory/docview/2507118910/se-2
  57. Sims, J. P., & Nolen, C. (2021). “I wouldn’t trust the parents to ‘do no harm’ to a queer kid”: Rethinking parental permission requirements for youth participation in social science research. Journal of Empirical Research on Human Research Ethics, 16(1-2), 35–45. 10.1177/1556264620983134 [DOI] [PubMed] [Google Scholar]
  58. Thomason, K. K. (2022). Religion and sexual shame. In B. D. Earp, C. Chambers, & L. Watson (Eds.), The Routledge handbook of philosophy of sex and sexuality (1st ed.). Routledge. [Google Scholar]
  59. Volk, F., Thomas, J., Sosin, L., Jacob, V., & Moen, C. (2016). Religiosity, developmental context, and sexual shame in pornography users: A serial mediation model. Sexual Addiction & Compulsivity, 23(2-3), 244–259. 10.1080/10720162.2016.1151391 [DOI] [Google Scholar]
  60. Whelan, T., Cunnane, E., Clifford, D., & Davoren, M. P. (2023). Defining a framework for those with compulsive sexual behavior disorder: A narrative synthesis. Sexual Health & Compulsivity, 30(3), 273–294. 10.1080/26929953.2023.2236607 [DOI] [Google Scholar]
  61. World Health Organization . (2022). International statistical classification of diseases and related health problems (11th ed.). Author: https://icd.who.int/
  62. Ybarra, M. L., Prescott, T. L., Phillips, G. L., Parsons, J. T., Bull, S. S., & Mustanski, B. (2016). Ethical considerations in recruiting online and implementing a text messaging–based HIV prevention program with gay, bisexual, and queer adolescent males. The Journal of Adolescent Health, 59(1), 44–49. 10.1016/j.jadohealth.2016.03.020 [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are not publicly available due to ethical considerations and the sensitive nature of the content, which involves minors and topics related to sexuality and religious identity. To protect participant anonymity and in accordance with the ethics approval granted by the Ethics Committee of the University of Haifa (Protocol #184/23), access to the dataset is restricted. However, de-identified aggregated data or specific data elements may be made available upon reasonable request to the corresponding author, contingent upon approval by the institutional ethics committee and a signed data use agreement.

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