Skip to main content
NCBI home page
International Journal of Sexual Health logoLink to International Journal of Sexual Health
. 2025 Aug 22;37(4):695–710. doi: 10.1080/19317611.2025.2548010

The Role of Attachment, Childhood Traumatic Experiences and Gender in Men and Women with Compulsive Sexual Behavior Symptoms

Laura I Kürbitz a,✉, Johanna Schröder b,*, Peer Briken a,*
PMCID: PMC12867395  PMID: 41641060

Abstract

Objectives

Research on the association of childhood traumatic experiences and attachment styles with symptoms of Compulsive Sexual Behavior Disorder (CSBD) so far showed inhomogeneous results. This study aims to investigate the associations of these factors and their interaction with gender.

Methods

Within a cross-sectional study design, we collected a German convenience sample (n = 154, 73.4% women) online and tested the association of attachment style (Experiences in Close Relationships Revised, ECR-R), childhood traumatic experiences (Childhood Trauma Questionnaire, CTQ), gender as predictor variables and CSBD symptoms (CSBD-19) as outcome in a linear regression analysis.

Results

Attachment anxiety and attachment avoidance were associated with CSBD symptoms in both genders. Women, but not men, who reported more pronounced childhood traumatic experiences, especially for the subscale of physical neglect in childhood, also reported more severe CSBD symptoms.

Conclusions

The results have implications for psychotherapy with individuals presenting with CSBD symptoms.

Keywords: Compulsive sexual behavior disorder, gender, attachment, childhood trauma, childhood traumatic experiences

1. Introduction

Compulsive Sexual Behavior Disorder (CSBD) has been described as a diagnostic category for the first time in the International Classification of Diseases 11th edition (ICD-11) (World Health Organization, 2018). While the diagnostic category is relatively new, CSBD is not a new phenomenon, as excessive sexual behavior has been described for well over 100 years (Briken, 2020).

Different perspectives in diagnostic manuals and ongoing debates in the field have resulted in various conceptualizations over time (Briken et al., 2024). While Compulsive Sexual Behavior Disorder (CSBD) is included as an impulse control disorder in the ICD-11 (World Health Organization, 2018), a comparable concept is absent from the 5th edition of the Diagnostic and Statistical Manual of Mental disorders (DSM-5, American Psychiatric Association, 2013). Additionally, similar syndromes have been discussed under the term “sex addiction” (Carnes, 1991; Grubbs et al., 2020), especially by treatment centers and self-help groups (Briken et al., 2024). Although, “excessive sexual drive” was included in the ICD-10 (World Health Organization, 1992), it lacked specific diagnostic criteria. Considering these differing conceptualizations, various psychometric instruments have been developed, complicating the comparability of research results (for an overview see Kürbitz & Briken, 2021).

Given these differences, we will use the term “CSBD”, whenever CSBD was measured according to ICD-11 guidelines. For older studies which used differing criteria and concepts (e.g., hypersexual disorder, sex addiction), we will use compulsive sexual behavior (CSB) as an umbrella term. Regardless the conceptualization, all approaches share the commonality of describing difficulties in controlling sexual behavior that results in impairment or distress (Grubbs et al., 2020).

In the ICD-11, CSBD is described with the following symptoms: recurrent and intense sexual fantasies and urges, failure to control these sexual urges in the past, and the repetition of the behavior despite adverse consequences (Briken, 2020; Grubbs et al., 2020; Kraus et al., 2018). It is important to note that a high sex drive per se is not pathological if the individual does not suffer from their sexual behavior. Thus, individuals with a mere high sex drive should not be pathologized (Briken, 2020; Briken et al., 2022, 2024). Additionally, if the suffering is solely a result of sex-negative social norms (e.g., restrictive or religious norms), it is not considered CSBD (Kraus et al., 2018).

Despite the growing body of research on correlates of CSB in men, women were often not recruited in samples (Kowalewska et al., 2020) in the past. This could be due to the different prevalence of CSB for men and women, with men reporting CSB more often throughout different samples and methods (Kürbitz & Briken, 2021).

Consequently, CSB was predominantly regarded as a ‘male problem’ by clinicians, as men with CSB symptoms may be more likely to seek treatment (Dhuffar & Griffiths, 2016). Thus, research on women was predominantly focused on “female sexual dysfunctions”, such as pain during intercourse and low libido (Basson et al., 2004), which led to the status quo that the specifics of CSBD in women are still not well understood (Kowalewska et al., 2020).

Despite this focus on men, epidemiological data have demonstrated that up to 7% of women report that they have experienced out-of-control sexual behavior in the past [7.0% (Dickenson et al., 2018), 7.0% (Långström & Hanson, 2006), 6.7% (Skegg et al., 2010)]. In a recent representative, probability-based German national sample (Briken et al., 2022); however, 4.9% of men and 3.0% of women reported CSBD symptoms consistent with the ICD-11 guidelines. Even though prevalence could be lower than initially expected, women seem to be affected by CSBD as well, which is probably why more recent research has included women in their samples (e.g. Briken et al., 2022; Graham et al., 2016; Koós et al., 2022; Levi et al., 2020; Shimoni et al., 2018).

Regarding the expression of CSBD as well as correlated variables, gender differences have been described in the past. For example, men report CSBD more often than women throughout different samples and methods (Kürbitz & Briken, 2021). Furthermore, gender differences in covariates have been reported in samples with CSB, e.g., neuroticism (inconclusive results, Carvalho et al., 2015; Shimoni et al., 2018), ADHD (moderate association with CSB in men, but weak association in women, Bőthe et al., 2019), OCD, depression and anxiety (more relevant factor for men, Grant Weinandy et al., 2023; Levi et al., 2020), consumption of pornography (a stronger association in men; Bőthe et al., 2019; Castro-Calvo et al., 2020) and child sexual abuse (a correlation for women only, Långström & Hanson, 2006; a correlation only for men, Skegg et al., 2010).

One model used to describe individuals with CSBD is the Integrated Model of CSBD (Briken, 2020; Briken et al., 2024). This model is based on the Dual Control Model of Sexuality (Bancroft et al., 2009) and combines it with the Sexual Tipping Point Model® (Perera, 2009) to explain the emergence of CSBD symptoms. According to the Dual Control Model of Sexuality, two independent systems—Inhibition and Excitation—regulate sexual arousal in humans (Bancroft et al., 2009). In those with CSBD symptoms, this balance is skewed toward increased excitability, while the capacity for inhibition is decreased. In addition, factors such as habituation and the use of sex as a coping mechanism for dysphoric mood states, further shift the balance toward excitatory influences. In the Integrated Model, genetic vulnerability, sexual, physical, and psychological abuse, as well as environmental factors (e.g., the availability of pornography), are considered background factors influencing the development of CSBD symptoms (for a thorough discussion, see Briken, 2020).

2. Attachment and CSB

An additional factor frequently associated with CSB is an insecure attachment style. This concept, based on the work of Bowlby (1969, 2008), suggests that early interactions with caregivers influence how we establish emotional connections in adulthood. According to this, adult relationships may reflect attachment styles similar to those initially observed in children (Hazan & Shaver, 1987). Attachment styles can be conceptualized as secure or insecure, and while they can change over the lifespan, they are generally considered relatively stable (Mikulincer et al., 2003; Mikulincer & Shaver, 2007).

Secure attachment is characterized by a heightened sense of self-worth and the belief that one’s partner is trustworthy, which, in turn, facilitates comfort with intimacy, closeness and reliance on others for support (Hazan & Shaver, 1987). When individuals do not experience needs-adjusted relational exchanges with their caregivers, they may develop insecure attachment.

Insecure attachment styles can be high in avoidance, high in anxiety or high in both (Fraley et al., 2000; Hazan & Shaver, 1987). Avoidant attachment is characterized as forming emotionally distant relationships, having difficulty trusting others, and being uncomfortable with intimacy (Bogaert & Sadava, 2002). Individuals who exhibit high levels of attachment avoidance have internalized others as unavailable, emotionally distant or unresponsive. As a result, individuals tend to avoid intimacy and dependence on others. They often restrict their expression of affection, seek emotional distance and try to be self-reliant (Mikulincer, 2008).

Individuals with anxious attachment styles often fear abandonment and may perceive others as reluctant to be intimate with them (Bogaert & Sadava, 2002). These individuals frequently express a fear of rejection and hold negative self-representations, which can lead to reassurance-seeking behaviors to cope with stress. This may sometimes manifest as high demands for attention, clinging, or controlling behaviors (Mikulincer, 2008; Thibodeau et al., 2017).

In their early research on attachment, Hazan and Shaver suggested that attachment insecurities might influence the nature of sexual experiences (Hazan & Shaver, 1987). This has since been empirically validated (Birnbaum et al., 2014; Brassard et al., 2015; Rajkumar, 2015). For example, avoidant attachment has been linked to lower sexual desire in women (Favez & Tissot, 2017), while some research suggests that individuals with high attachment anxiety may rely on sex for reassurance (Birnbaum, 2010) and as a form of self-affirmation (Schachner & Shaver, 2004). However, individuals with a strong tendency toward avoidance may try to disconnect from their partner during sex (Birnbaum, 2010) and use sex in an emotionally detached way to cope with negative emotions, essentially employing it as a coping strategy (Favez & Tissot, 2017).

As sexual behavior is often partnered behavior, it has been suggested that relationship attachment styles play a part in the formation of CSB(D). There is growing interest in the link between CSB and attachment styles (Benfield, 2018; Faisandier et al., 2012), with a significant percentage of individuals with CSB also reporting insecure attachment styles (Benfield, 2018).

Two pathways are plausible: Individuals with high attachment anxiety (i.e., fear of losing the partner) may use excessive sexual activity to reassure themselves of relationship stability [cf. (Birnbaum, 2010)], or they might use sexual activity without commitment to alleviate fears of separation and abandonment (Weinstein et al., 2015). On the other hand, individuals with high attachment avoidance (i.e., fear of being absorbed by the partner) might engage in excessive sexual activities (e.g., outside of partnered sexuality) to reassure themselves of their independence (Beaulieu-Pelletier et al., 2011). Alternatively, CSB could serve as a coping mechanism, used to manage the stress associated with fears of abandonment or intimacy and to deal with the difficulty of bonding with others (Beaulieu-Pelletier et al., 2011). In line with these hypotheses, CSB has been connected to insecure attachment styles in the past (Bogaert & Sadava, 2002; Ciocca et al., 2021; Crocker, 2015; Efrati & Gola, 2018; Weinstein et al., 2015; Zapf et al., 2008).

For instance, Crocker and colleagues investigated attachment styles and CSB in a case–control study in a sample of men. In their multivariate analysis, high scores on avoidance and anxiety predicted CSB, with attachment avoidance predicting CSB better than attachment anxiety (Crocker, 2015). Similarly, in their study on 52 men, Zapf and colleagues found that men with CSB were more likely to report an insecure attachment style, as well as higher avoidance and anxiety in romantic relationships (Zapf et al., 2008). Interestingly, Bogaert and Sadava (2002) found a more pronounced association of insecure attachment and sexuality in women. In a more recent study, Ciocca et al. (2021) assessed traumatization, CSB and attachment styles. In their sample, CSB was associated with insecure attachment, especially fearful and preoccupied attachment (=highly anxious and avoidant attachment) (Ciocca et al., 2021). In their online study, Coleman and colleagues found a moderation effect of attachment anxiety on the relationship between boredom proneness and CSB. Individuals with high attachment anxiety were more likely to react to boredom with CSB, whereas this effect was absent for individuals with high attachment avoidance (Coleman et al., 2023).

3. CSB and childhood traumatic experiences

Childhood traumatic experiences are frequently discussed as a possible etiological factor for CSBD (e.g., Castellini et al., 2018; Diehl et al., 2019; Fontanesi et al., 2021; Perera et al., 2009; Slavin et al., 2020). Childhood traumatic experiences can take different forms: physical and emotional neglect and sexual, physical and emotional abuse (Diehl et al., 2019), of which not all have been thoroughly studied as covariates of CSB.

Slavin et al. (2020) reported an association between sexual abuse and CSB for both men and women, albeit a stronger connection for men. Similarly, in their online convenience sample, Fontanesi et al. (2021) found a direct effect of symptoms of post-traumatic stress disorder (PTSD) on CSB, with male gender being a relevant covariate. In their systematic review, Slavin and colleagues investigated the connection of childhood sexual abuse (CSA) and CSB (Slavin et al., 2020). Concerning gender differences, they reported two studies with contradicting findings: In their national health survey, Långström and Hanson found that CSA was associated with CSB in women, but not in men (Långström & Hanson, 2006). In contrast, Skegg and colleagues reported an association of CSA and CSB in men only (Skegg et al., 2010). In their review, Slavin and colleagues concluded that CSA could lead to different behaviors in men and women, due in part to varying gender roles and socially accepted behaviors (Slavin et al., 2020). Furthermore, the type of abuse may be significant, as women are more likely to report abuse by a family member and/or experiences of penetrative abuse (Slavin et al., 2020).

Moreover, evidence suggests a general link between CSA and more dysregulated sexual behavior in adulthood (Noll et al., 2003; Wilson & Widom, 2008). In their prospective longitudinal study, Noll and colleagues examined women who had experienced sexual abuse (Noll et al., 2003). Ten years after disclosure, they found that anxiety predicted sexual preoccupation, while childhood sexual behavior problems predicted sexual aversion (Noll et al., 2003). Thus, they conclude that a history of CSA may have a key role in determining subsequent CSB, functioning as a maladaptive coping strategy for emotional dysregulation (Messman-Moore et al., 2010).

There is empirical evidence linking several forms of childhood traumatic experiences to CSB. For example, in a sample of women with eating disorders, Castellini and colleagues found that childhood traumatic experiences moderated the effect of emotional dysregulation and psychopathology on CSB (Castellini et al., 2020). In their sample, only individuals who reported childhood traumatic experiences demonstrated a link between emotional dysregulation and compulsive sexual behavior. These traumatic experiences, associated with CSB, were not limited to childhood sexual abuse (CSA) but also included neglect and absent fathers (Castellini et al., 2020). Comparably, in another study on female patients with eating disorders, D’Anna and colleagues found a significant correlation of CSB and childhood traumatic experiences in general (D’Anna et al., 2021). Likewise, Efrati and colleagues reported elevated CSB symptoms and tendencies for risky sexual behavior in young women with substance abuse disorders. These behaviors were associated exclusively with emotional abuse in childhood, but no other forms of abuse (Efrati et al., 2022). Chatzitoffis and colleagues found that men with CSB reported more childhood traumatic experiences, particularly exposure to violence, compared to a group of healthy controls (Chatzittofis et al., 2017).

In conclusion, extensive literature exists on childhood traumatic experiences as a risk factor for developing mental health problems in general [for a review, see (Panagou & MacBeth, 2022)]. Although research explored the connection between childhood trauma and compulsive sexual behavior, it has not been sufficiently aligned with the ICD-11 guidelines for CSBD. Moreover, research on gender differences in the association between childhood traumatic experiences and CSBD symptoms based on ICD-11 guidelines remains limited. Studies suggest that various forms of childhood trauma may have different associations with the development of CSBD symptoms, potentially affecting men and women in unique ways.

Finally, CSB(D) has been associated with childhood traumatic experiences as well as insecure attachment styles in the past. However, since the concept of CSBD has changed considerably with the introduction of the ICD-11, these associations have not yet been demonstrated for the current conceptualization. Furthermore, the literature on attachment styles, childhood traumatic experiences and CSBD is still inconclusive. As gender differences have been reported but not yet comprehensively studied, the possible moderating effect of gender on the effects of childhood traumatic experiences and attachment on CSBD symptoms is still unknown.

This leads to the following research questions:

  1. Do traumatic childhood experiences and attachment style contribute to symptoms of CSBD and does gender moderate this influence? We hypothesize that more pronounced childhood traumatic experiences, as well as more pronounced anxious and avoidant attachment styles, are associated with more severe CSBD symptoms. Furthermore, we hypothesize that gender moderates the influence of attachment styles and childhood traumatic experiences on CSBD symptom severity.

  2. Are different forms of childhood traumatic experiences associated with CSBD symptoms in different ways and does gender moderate these associations? We will explore which kind of traumatic experiences contribute to the sum score of CSBD symptoms and if gender moderates this influence.

4. Methods

4.1. Participants and recruitment

To recruit women and men with CSBD symptoms, we used the following recruitment strategy: We asked the question, “Is your sexuality too much for you? According to recent studies, approximately 7% of respondents report that they have experienced their behavior as insufficiently controllable in the past. The survey is anonymous and takes approximately 20–30 min” and provided the link leading to our survey. We spread this introduction and the link via social media (e.g., comments on relevant YouTube videos, a Tinder profile leading to the survey, comments on relevant Instagram posts and Facebook ads). Additionally, with a second link, we asked individuals if they wanted to participate in a study about sexuality to find individuals without CSBD symptoms. Inclusion criteria were being 18 years of age and providing informed consent. No incentive was offered for participation. There were no exclusion criteria.

4.2. Study design and procedure

We examined participants via an anonymous cross-sectional online survey with Qualtrics© in Germany. Data collection was between May 2020 and May 2021. After giving informed consent, 187 participants completed an online questionnaire. The online survey consisted of demographic questions and the following questionnaires: Compulsive Sexual Behavior Disorder Scale (CSBD-19 scale; Bőthe et al., 2020), Experiences in Close Relationships Revised (ECR-R; Ehrenthal et al., 2009), Childhood Trauma Questionnaire (CTQ; Klinitzke et al., 2012). Completion of this study took 20 min on average. As only five individuals reported non-binary gender, they were excluded from analysis. Only complete cases were included in this study, thus resulting in a final sample size of n = 154. Participants were excluded if they did not fill out any of the relevant questionnaires completely (incomplete cases). This study has been approved by the local psychological ethics committee of the University Medical Center Hamburg-Eppendorf (reference: LPEK-0147). This study was preregistered on Open Science Framework https://osf.io/7fxj5 (accessed on 16/07/2024) prior to data analysis.

4.3. Measures

The Compulsive Sexual Behavior Disorder Scale (CSBD-19; Bőthe et al., 2019) assesses CSBD symptoms according to ICD-11 guidelines on a 4-point Likert scale (ranging from ‘do not agree at all’ to ‘do totally agree’, sample item: “Even though my sexual behavior was irresponsible or reckless, I found it difficult to stop”). A total score of 50 or higher is indicative of CSBD. The CSBD-19 Scale has been tested with satisfactory validity and reliability (α = .91) in a German sample (Bőthe et al., 2020). Cronbach’s Alpha in our sample was α = .97.

The Childhood Trauma Questionnaire (CTQ; Bernstein et al., 2003) is a questionnaire assessing childhood traumatic experiences on a 5-point Likert scale (ranging from ‘not at all” to “very frequently”, sample item: “In my childhood and youth, my parents were too drunk or ‘high’ to take care of the family”) with 5 dimensions: emotional abuse, physical abuse, sexual abuse, emotional neglect and physical neglect. We used the German translation of the CTQ, which has sufficient internal consistency in the validation study (all α ≥ .80), with the exception of the subscale “physical neglect” (α = .55) (Klinitzke et al., 2012). The low reliability of the physical neglect scale may be attributable to age cohort effects in postwar Germany. For example, items such as “When I was young, I had to wear torn or dirty clothes” could reflect generally limited family resources of the time rather than true neglect (Klinitzke et al., 2012). A recent study with adolescents found similar validity issues with this scale, particularly among younger participants, but demonstrated higher reliability in a clinical sample (Hagborg et al., 2022). Despite these difficulties, the questionnaire remains a widely accepted and frequently used instrument (Hagborg et al., 2022). In our data, the internal consistency was comparable to the validation study (CTQtotal: α = .94, emotional abuse: α = .89, physical abuse: α = .88, sexual abuse: α = .87, emotional neglect: α = .94 and physical neglect: α = .56).

The Experience in Close Relationships-Revised (ECR-R) (Fraley et al., 2000) is a measurement of attachment styles in relationships on two dimensions: anxious attachment and avoidant attachment. The measurement can be used by individuals with and without a romantic relationship, as it assesses how relationships are experienced in general. While some research in the past reported four attachment types (fearful, preoccupied, avoidant, secure), the author of the ECR-R questionnaire suggests using the two subscales (anxiety and avoidance) in a continuous manner (Shaver & Fraley, 2004). We used the translated and validated German version of the questionnaire (Ehrenthal et al., 2009), which has good psychometric properties (α = .92) and uses a 7-point Likert Scale (ranging from ‘do not agree at all’ to ‘do totally agree’, sample item: “I prefer to not show my partner how I am feeling inside”). In our sample, Cronbach’s Alpha was α = .93 for the Anxiety Scale and α = .94 for the Avoidance Scale.

4.4. Statistical analysis

We aimed to analyze associations between childhood trauma, attachment styles and CSBD symptoms as well as the moderating effects of gender. Deviating from the planned statistical models in the preregistration, we decided to analyze two of the delineated research questions in one statistical model to eliminate redundancies. The outcome variable was the CSBD-19 total score. Predictors were CTQtotal, attachment anxiety, attachment avoidance and gender. Differences in the association of these predictor variables between men and women were examined by including interaction terms with the “gender” variable. Gender was coded in a binary manner (0: women, 1: men). Regarding the second research question, we calculated a regression analysis, using all five CTQ subscales (emotional neglect, emotional abuse, physical neglect, physical abuse and sexual abuse) as well as their interaction terms with gender as predictors for the CSBD-19 score. For all analyses, we used a significance level of α = .05 and included only cases with complete data for all variables (n = 154). All computations were performed with IBM SPSS Statistics (Version 26). Moderation analysis was conducted using the PROCESS macro for SPSS (Hayes, 2018).

Additionally, we calculated post-hoc power analyses. For our first model, we used the detected effect of f2 = .56, an .05 α error probability in a linear multiple regression (Fixed model, R2 deviation from zero) with a sample size of n = 154 and 7 predictors. Here, we obtained a power of .95. For our second model, we used the detected effect of f2 = .39, an .05 α error probability in an F Test (Linear multiple Regression: Fixed Model; R2 deviation from zero) with our sample size of n = 154 and 10 predictors. Here, we obtained a power of .95. The effects were larger than expected, therefore we were able to achieve good test power, even though the sample size was smaller than initially anticipated.

5. Results

5.1. Sample characteristics

The final sample consisted of n = 154 individuals. Most individuals reported a high level of education, and many indicated university attendance (Table 1). Most individuals reported being in a relationship or married. Employment rates were high.

Table 1.

Sample characteristics (n = 154).

Sociodemographic Characteristics  
Women, n (%) 113 (73.4)
Age, Mean (SD) 29.24 (8.19)
Education, n (%)  
No secondary education 1 (0.6)
Lower secondary education 5 (3.2)
Intermediate secondary education 19 (12.3)
High School Diploma 63 (40.9)
Bachelor Degree 27 (17.5)
Master Degree 29 (18.8)
Other 10 (6.5)
Relationship status, n (%)  
Single 45 (29.2)
In a relationship 76 (49.4)
Married 18 (11.7)
Divorced 6 (3.9)
Other 6 (3.9)
Employment, n (%)  
Full-time 47 (30.5)
Part-time 22 (14.3)
Not regularly employed 16 (10.4)
In School 59 (38.3)
No Employment/Retired 3 (1.9)
Predictor Statistics, M (SD)  
Attachment Anxiety 3.54 (1.39)
Attachment Avoidance 2.79 (1.27)
Childhood Traumatic Experiences 41.55 (15.97)
CSBD Symptoms 45.84 (20.43)
Open in a new tab

Note. Attachment anxiety and attachment avoidance were measured with the ECR-R. Childhood traumatic experiences were measured with the CTQ. CSBD symptoms were measured with the CSBD-19 scale.

5.2. Association of attachment styles, childhood traumatic experiences and gender with CSBD symptoms

We conducted a regression analysis using attachment anxiety, attachment avoidance, childhood traumatic experiences and their interaction with gender as predictors of CSBD symptoms.

We report the findings of a multiple regression analysis on the association of several predictor variables and the CSBD-19 score in Table 2. A significant regression equation was found, F (7, 146) = 13.22, p ≤ .001), with an adjusted R2 of .359. The effect size of the model is f2 = .56 (large effect). In the regression model, attachment anxiety and attachment avoidance were associated with more severe CSBD symptoms. There was no significant interaction effect of attachment anxiety or attachment avoidance and gender in the association with CSBD symptoms.

Table 2.

Multiple linear regression analysis of childhood traumatic experiences, attachment styles and gender on CSBD (n = 154).

  B SE β 95% CI p
Constant .13 5.56      
Gender 3.88 3.11 .08 (-2.26 ; 10.02) .21
Attachment Anxiety 3.72 1.54 .21 (.69 ; 6.76) .02*
Attachment Avoidance 2.77 1.35 .17 (−.11 ; 5.43) .042*
Childhood Traumatic Experiences .56 .11 .44 (.35 ; .77) <.001**
Attachment Anxiety x Gender 5.09 3.58 .13 (−1.98 ; 12.17) .16
Attachment Avoidance x Gender 4.27 5.54 .06 (−6.67 ; 15.22) .44
Childhood Traumatic Experiences x Gender −1.02 .24 −.35 (−1.48 ; −.55) <.001**
Open in a new tab

Note. CSBD: Compulsive Sexual Behavior Disorder. CSBD was measured using the CSBD-19 Scale. Relationship anxiety and relationship avoidance were measured using the Experiences in Close Relationships questionnaire (ECR-R); Childhood traumatic experiences were measured using the Childhood Trauma Questionnaire (CTQ). ‘x’ is indicating an interaction term.

*

p < 0.05.

**

p < 0.01.

Gender moderated the effect of childhood traumatic experiences on CSBD symptoms significantly. A post-hoc probe of the interaction effect with PROCESS (Hayes, 2018) showed that childhood trauma experiences were positively associated with CSBD symptoms in women (b = .54, SE = .10, p < .001, 95% CI [.34, .75]), but not in men (b = −.33, SE = .19, p = .09, 95% CI [-.71, .05]).

5.3. Regression analysis with CTQ subscales

We investigated the association of the CTQ subscales and their interaction with gender in an additional regression analysis. We report the findings of a multiple regression analysis on the association of several predictor variables and CSBD-19 scores in Table 3. A significant regression equation was found, F (11, 142) = 6.39, p < .001), with an adjusted R2 of .279. The effect size of the model was f 2 = .39 (large effect). In the regression model, only gender and the interaction of gender and physical neglect showed a significant effect, indicating that women with higher scores in CTQphysicalneglect also reported more CSBD symptoms.

Table 3.

Explorative regression analysis of types of childhood traumatic experiences and gender on CSBD symptoms (n = 154).

  B SE β 95% CI p
Constant 12.918 4.83      
Gender 28.779 12.69 .63 (3.695 ; 53.863) .025*
CTQ Emotional Abuse .64 .55 .159 (−.451 ; 1.730) .248
CTQ Physical Abuse .083 .677 .13 (−1.255 ; 1.420) .903
CTQ Sexual Abuse .974 .577 .141 (−.166 ; 2.114) .094
CTQ Emotional Neglect .912 .575 .235 (−.224; 2.049) .115
CTQ Physical Neglect 1.158 .781 .179 (-.386 ; 2.703) .140
CTQ Emotional Abuse x Gender .287 1.409 .063 (−2.497 ; 3.072) .839
CTQ Physical Abuse x Gender 1.013 1.418 .161 (−1.790 ; 3.815) .476
CTQ Sexual Abuse x Gender 1.672 1.612 .224 (−1.515 ; 4.859) .302
CTQ Emotional Neglect x Gender −1.370 1.058 −.337 (−3.462 ; 0.722) .198
CTQ Physical Neglect x Gender −3.946 1.805 −.724 (−7.515 ; −0.378) .030*
Open in a new tab

Note. Regression model with inclusion of all subscales of the Childhood Trauma Questionnaire (CTQ Subscales) and their interactions with gender. Emotional neglect, emotional abuse, sexual abuse, physical neglect and physical abuse were measured with the CTQ. ‘x’ is indicating an interaction term. CSBD: Compulsive Sexual Behavior Disorder.

*

p < 0.05.

6. Discussion

We investigated the association of attachment style and childhood traumatic experiences with CSBD symptoms with gender as a moderator in a cross-sectional online study. Additionally, we explored how different types of childhood trauma, in interaction with gender, contribute to the relationship between childhood traumatic experiences and CSBD symptoms.

6.1. The association of attachment style and gender with CSBD symptoms

In our sample, we found an association of attachment anxiety and avoidance with CSBD symptoms, but no gender interaction effect. As expected, the results indicate an association of anxious attachment, avoidant attachment, childhood traumatic experiences and CSBD scores. Gender did not moderate the effect of attachment styles on CSBD symptom severity. As CSBD has been connected to insecure attachment in other studies (Ciocca et al., 2021; Crocker, 2015; Efrati & Gola, 2018; Weinstein et al., 2015; Zapf et al., 2008), our results align with these previous findings. Zapf et al. (2008) as well as Weinstein et al. (2015) reported a connection of CSB to both, attachment anxiety and avoidance, which is in line with our findings. Despite this, some authors, e.g. Coleman an colleagues (2023) reported an association of CSBD and attachment anxiety only, not attachment avoidance, in a mixed-gender sample.

In the context of the Integrated Model of CSBD (Briken, 2020), an insecure attachment style could be interpreted as a background factor, heightening the vulnerability to develop CSBD symptoms. Given that insecure attachment styles have been linked to intimacy problems (Schwartz & Southern, 1999), some researchers propose that individuals with CSBD may yearn for close attachment and intimacy. However, their expectations of how others will respond to them may hinder the formation of close attachments (Leedes, 2001; Weinstein et al., 2015). This may lead them to fantasize about unattainable substitutes (Weinstein et al., 2015; Zapf et al., 2008), making those without secure attachments more susceptible to CSBD symptoms. It could also be plausible that individuals who feel insecure about their connection to others could use sex to reassure themselves of the connection. Another pathway could be the attempt to reduce general anxiety with sexual behavior as a coping strategy (Beaulieu-Pelletier et al., 2011). Additionally, some individuals may employ both strategies, either alternately or simultaneously.

Moreover, it cannot be ruled out that other covariates play a crucial role in explaining the association between insecure attachment styles and CSBD symptoms. In a recent online convenience sample, Ciocca and colleagues identified an association between fearful and preoccupied attachment – characterized by high anxiety and low avoidance - and CSB. Additionally, depressive and post-traumatic symptoms played a mediating role in the relationship between insecure attachment and hypersexual behavior (Ciocca et al., 2021). In the study of Ciocca and colleagues, these associations were influenced by depressive and post-traumatic symptoms, which were not assessed in our study. Future research could benefit from exploring further associations among psychological burden, attachment, gender and CSBD, along with their interactions.

Possibly, additional underlying covariates (e.g., emotion regulation skills, the type of compulsive sexual behavior) moderate the association of insecure attachment with CSBD. Therefore, our findings strengthen the assumption that anxious and avoidant attachment are associated with CSBD symptoms for men and women alike, but more research on other covariates would be advisable in the future.

6.2. The association of general childhood traumatic experiences and gender with CSBD symptoms

In our sample, we observed an interaction effect between gender and general childhood traumatic experiences on CSBD symptoms, suggesting that these experiences were positively associated with CSBD symptoms among women.

These findings are consistent with other research that reports an association between childhood traumatic experiences and CSBD in women (Castellini et al., 2020; D’Anna et al., 2021; Efrati et al., 2022). For example, Castellini and colleagues investigated women with eating disorders and found a positive association of the CTQ and CSB (measured with Hypersexual Behavior Inventory; HBI Reid et al., 2011). In their sample, patients who reported childhood traumatic experiences also reported more emotional dysregulation and CSB. As Slavin and Scoglio (2020) propose, childhood traumatic experiences might be associated with different behaviors in men and women (e.g., engaging in risky sexual behavior, masturbation, consumption of pornography, retreat from relationships or asexual behavior), as there are differing socially accepted norms and rules for men and women (England & Bearak, 2014; Slavin et al., 2020). Efrati et al. (2022) found that emotional abuse during childhood was strongly associated with greater severity of CSBD symptoms in their sample of women with substance abuse disorders. This suggests that CSBD symptoms and substance use disorders may share similar underlying mechanisms – such as compulsivity, deprivation and avoidance strategies – as well as comparable biographical antecedents (Efrati et al., 2022; Jepsen et al., 2024). Moreover, since men and women are also differently burdened by abuse (Witt et al., 2017), it follows that their responses may also differ. As women face more restrictive socio-sexual norms and gender stereotypes (England & Bearak, 2014; Yost & Zurbriggen, 2006), it is possible that CSB may be considered inadequate for women, compared to men. It is therefore plausible that women use other coping strategies more often (e.g., retreat from sexual behaviors or asexual behavior, Ullman & Filipas, 2005). Conversely, socio-sexual norms tend to be more permissive for men (e.g., consuming pornography and masturbation, Yost & Zurbriggen, 2006), thereby facilitating the use of compulsive sexual behaviors as a coping mechanism. Given that emotion dysregulation is frequently observed in individuals with CSB (Lew-Starowicz et al., 2020), and that gender differences in emotion regulation have been documented (Nolen-Hoeksema, 2012), it is reasonable to suggest that the capacity to regulate emotions may play a significant role in contributing to the observed gender disparity.

Beyond these psychological and social factors, the timing of abuse may also play an important role in the development of CSBD symptoms. In a recent large (n = 82,233) international study, the association between sexual abuse and CSBD symptoms was examined across different countries (Vaillancourt-Morel et al., 2025). Findings indicate that individuals who had experienced childhood sexual abuse (CSA), as well as adolescent or adult unwanted sexual experiences (AASA), were more likely to report symptoms of CSBD. The relationship between all forms of sexual abuse (CSA, AASA, CSA + AASA) and CSB symptoms was especially pronounced among younger participants and cisgender men. Moreover, these associations varied across countries. For instance, in Germany, CSA alone was positively associated with CSBD symptoms, whereas AASA or the combination of CSA and AASA were not. In contrast, in the United States, both CSA only and the combination of CSA and AASA were positively linked to CSBD symptoms (Vaillancourt-Morel et al., 2025). Given the considerably larger sample size of this international study, it is plausible that a potential association between CSA and CSBD in our sample may not have been detected due to limited statistical power. These findings underscore the need for further research on the relationship between CSBD symptoms and their antecedents, preferably in large samples, as they may differ substantially across demographic groups and cultural contexts.

Even though we did find that childhood traumatic experiences were positively associated with CSBD symptoms in women only, there is some evidence that childhood traumatic experiences are associated with CSB in men as well (Chatzittofis et al., 2017). For example, in their case–control study, Chatzitoffis and colleagues investigated men undergoing treatment for CSB compared to healthy controls. In their sample, the individuals with CSB reported more exposure to violence in childhood as well as sexual abuse (Chatzittofis et al., 2017). One possible explanation of the different findings in our sample may be attributed to the sampling method. While Chatzitoffis and colleagues included participants diagnosed with CSB through a face-to-face assessment based on Kafka’s concept of hypersexual disorder (Kafka, 2010), we utilized an online questionnaire aligned with the CSBD concept. It is possible that individuals in their study were more affected by symptoms due to seeking treatment, or that the concept of hypersexual disorder differs too greatly from CSBD to make a direct comparison of the results.

With our second regression analysis, we wanted to explore if these differences could be due to different forms of childhood traumatic experiences being associated with CSBD for men and women distinctly. The interaction of gender and childhood physical neglect (CPN) was the only significant factor in the association of childhood traumatic experiences and CSBD symptoms, indicating that CPN is a relevant factor for women, but not men. Similar findings were previously reported by Ashkenazi et al. (2023), who also identified an association between physical neglect and CSB in their predominantly female sample. Our results should be interpreted with caution however, because of the low reliability of the CTQ subscale “physical neglect”, both in the validation of the questionnaire (Klinitzke et al., 2012) and our sample. Interestingly, the CTQ subscale "sexual abuse" was not a relevant predictor of CSBD symptoms in our sample. This contrasts with the findings of Skegg and colleagues, who reported an association between CSA and CSB, but only in men (Skegg et al., 2010). Conversely, Långström and Hanson, in their study of a representative, non-clinical population, found an association between CSB with CSA in women, but not in men (Långström & Hanson, 2006). In a large international sample, sexual abuse (both CSA and AASA) was associated with higher CSBD scores, with particularly stronger effects observed in cisgender men (Vaillancourt-Morel et al., 2025).

Since childhood traumatic experiences appear to be a significant factor for both men and women, yet CPN was primarily associated with CSBD symptoms in women in our sample, it would be valuable to explore which specific types of childhood trauma serve as more relevant covariates for men with CSBD symptoms. As there were no other gender interactions in our analysis, there might be other underlying factors (e.g., emotional regulation skills) mediating the association.

As our sample size was small and included only a small number of men, these results can only be interpreted with caution. It would be advisable to conduct further studies with larger sample sizes, to be able to also detect potential small effects.

Childhood traumatic experiences are known to have a deleterious impact on well-being and functioning in general (Carr et al., 2013) as well as sexual well-being and sexual functioning specifically (Bigras et al., 2017; Hughes et al., 2017; Kinzl et al., 1996). Since various forms of childhood traumatic experiences are observed in individuals with CSBD symptoms, but not all traumatized individuals develop these symptoms, there may be underlying factors that mediate the relationship between childhood traumatic experiences and CSBD symptoms. Promising covariates could include emotional dysregulation, a lack of emotion regulation skills, or learning to use sexual behavior as a self-soothing behavior and coping strategy (Noll et al., 2003). As these concepts are most likely interconnected (Brereton & McGlinchey, 2020; Brumariu, 2015) more research is needed to further explore these relations. In the Integrated Model of CSBD, childhood traumatic experiences can be considered a background factor (Briken, 2020), but more specific models on the connection of CSBD and childhood traumatic experiences are still lacking.

6.3. Limitations

A first limitation of the study is the limited generalizability, as the sample is not representative of the general population or the population of individuals with CSBD. In future studies, it would be interesting to see if these findings are also existent in representative samples. Another limitation is the small sample size. By specifically targeting women in our recruitment efforts, we successfully gathered a sample where the majority were women, resulting in only 26.3% male participants. Since CSBD research has traditionally focused on male subjects, this approach might be useful for recruiting more women with CSBD symptoms and achieving a more gender-balanced dataset in the future. However, the strategy led to an unequal gender distribution in our sample, reducing the statistical power of our tests, possibly causing smaller effects to go undetected. Furthermore, we were not able to report data for the whole gender spectrum or for different sexual minorities, which would also be important to include in future studies.

Another limitation is the low internal consistency of the subscale ‘physical neglect’ of the CTQ, also noted in the validation study (Klinitzke et al., 2012). This limits the reliability of the findings regarding this dimension due to possible measurement error or attenuation bias. Excluding items did not improve the internal consistency of this dimension in our sample. Given the CTQ’s widespread use and validation, we retained this subscale, but results should be interpreted with caution. Additionally, even though some individuals reported high levels of CSBD symptoms, we cannot guarantee that they would be diagnosed with CSBD in a clinical sense, as no clinical interviews were conducted.

As we used liberal inclusion criteria, we accommodated a broader range of participants, potentially enhancing the generalizability of our findings. However, this approach may have introduced greater variability and potential confounding factors. As we did not assess geographic data, we also cannot rule out the possibility that German-speaking individuals from other countries also participated in the study.

7. Conclusions

The results of this study suggest that both anxious and avoidant attachment are contributing factors to the development of CSBD symptoms in men and women. Furthermore, childhood traumatic experiences, particularly physical neglect, appear to be significant factors for women. This emphasizes the importance of addressing childhood traumatic experiences and attachment styles in therapy for individuals with CSBD, especially women. Clinicians should comprehensively assess childhood traumatic experiences and examine the interaction between CSBD symptoms and current relationships, placing focus on these areas during treatment.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Acknowledgments

We want to thank the participants of this study. Furthermore, we want to thank Dr. Christian Wiessner for his methodological insights and helpful comments. We would like to acknowledge the use of ChatGPT (OpenAI’s language model) for grammar and spelling corrections.

Institutional review board statement

The study has been approved by the local psychological ethics committee of the University Medical Center Hamburg-Eppendorf (reference: LPEK-0147).

Informed consent statement

All participants provided online informed consent prior to participation.

Author Contributions

Study concept and design: Conceptualization, L.I.K., J.S. and P.B.; Data curation, L.I.K.; Formal analysis, L.I.K.; Methodology, L.I.K., J.S. and P.B.; Resources, P.B.; Supervision, J.S. and P.B.; Writing—original draft, L.I.K.; Writing—review and editing, J.S. and P.B. All authors had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors have read and agreed to the published version of the manuscript.

Conflicts of Interest

The authors declare no conflicts of interest.

Data availability statement

As it includes data around sensitive topics, the raw data supporting the conclusion of this article will be made available by the authors on request.

Funding

This research received no external funding.

References

  1. American Psychiatric Association . (2013). Diagnostic and statistical manual of mental disorders: DSM-5. [Google Scholar]
  2. Ashkenazi, S., Anaki, L., Nahum, Y., & Weinstein, A. (2023). A study on the relationship between child abuse and neglect and sexual addiction in a predominantly female population seeking partners for sex. Current Psychology, 42(34), 29831–29837. 10.1007/s12144-022-03925-y [DOI] [Google Scholar]
  3. Bancroft, J., Graham, C. A., Janssen, E., & Sanders, S. A. (2009). The dual control model: Current status and future directions. Journal of Sex Research, 46(2-3), 121–142. 10.1080/00224490902747222 [DOI] [PubMed] [Google Scholar]
  4. Basson, R., Leiblum, S., Brotto, L., Derogatis, L., Fourcroy, J., Fugl‐Meyer, K., Graziottin, A., Heiman, J. R., Laan, E., Meston, C., Schover, L., Van Lankveld, J., & Schultz, W. W. (2004). Revised definitions of women’s sexual dysfunction. The Journal of Sexual Medicine, 1(1), 40–48. 10.1111/j.1743-6109.2004.10107.x [DOI] [PubMed] [Google Scholar]
  5. Beaulieu-Pelletier, G., Philippe, F. L., Lecours, S., & Couture, S. (2011). The role of attachment avoidance in extradyadic sex. Attachment & Human Development, 13(3), 293–313. 10.1080/14616734.2011.562419 [DOI] [PubMed] [Google Scholar]
  6. Benfield, J. (2018). Secure attachment: an antidote to sex addiction? A thematic analysis of therapists’ experiences of utilizing attachment-informed treatment strategies to address sexual compulsivity. Sexual Addiction & Compulsivity, 25(1), 12–27. 10.1080/10720162.2018.1462746 [DOI] [Google Scholar]
  7. Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T., Stokes, J., Handelsman, L., Medrano, M., Desmond, D., & Zule, W. (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse & Neglect, 27(2), 169–190. 10.1016/S0145-2134(02)00541-0 [DOI] [PubMed] [Google Scholar]
  8. Bigras, N., Godbout, N., Hébert, M., & Sabourin, S. (2017). Cumulative adverse childhood experiences and sexual satisfaction in sex therapy patients: What role for symptom complexity? The Journal of Sexual Medicine, 14(3), 444–454. 10.1016/j.jsxm.2017.01.013 [DOI] [PubMed] [Google Scholar]
  9. Birnbaum, G. E. (2010). Bound to interact: The divergent goals and complex interplay of attachment and sex within romantic relationships. Journal of Social and Personal Relationships, 27(2), 245–252. 10.1177/0265407509360902 [DOI] [Google Scholar]
  10. Birnbaum, G. E., Mikulincer, M., Szepsenwol, O., Shaver, P. R., & Mizrahi, M. (2014). When sex goes wrong: A behavioral systems perspective on individual differences in sexual attitudes, motives, feelings, and behaviors. Journal of Personality and Social Psychology, 106(5), 822–842. 10.1037/a0036021 [DOI] [PubMed] [Google Scholar]
  11. Bogaert, A. F., & Sadava, S. (2002). Adult attachment and sexual behavior. Personal Relationships, 9(2), 191–204. 10.1111/1475-6811.00012 [DOI] [Google Scholar]
  12. Bőthe, B., Koós, M., Tóth-Király, I., Orosz, G., & Demetrovics, Z. (2019). Investigating the associations of adult ADHD symptoms, hypersexuality, and problematic pornography use among men and women on a largescale, non-clinical sample. The Journal of Sexual Medicine, 16(4), 489–499. 10.1016/j.jsxm.2019.01.312 [DOI] [PubMed] [Google Scholar]
  13. Bőthe, B., Kovács, M., Tóth-Király, I., Reid, R. C., Griffiths, M. D., Orosz, G., & Demetrovics, Z. (2019). The psychometric properties of the hypersexual behavior inventory using a large-scale nonclinical sample. Journal of Sex Research, 56(2), 180–190. 10.1080/00224499.2018.1494262 [DOI] [PubMed] [Google Scholar]
  14. Bőthe, B., Potenza, M. N., Griffiths, M. D., Kraus, S. W., Klein, V., Fuss, J., & Demetrovics, Z. (2020). The development of the Compulsive Sexual Behavior Disorder Scale (CSBD-19): An ICD-11 based screening measure across three languages. Journal of Behavioral Addictions, 9(2), 247–258. 10.1556/2006.2020.00034 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Bowlby, E. J. M. (2008). Attachment: Volume one of the attachment and loss trilogy. Random House. [Google Scholar]
  16. Bowlby, J. (1969). Attachment and loss. Basic Books. [Google Scholar]
  17. Brassard, A., Dupuy, E., Bergeron, S., & Shaver, P. R. (2015). Attachment insecurities and women’s sexual function and satisfaction: The mediating roles of sexual self-esteem, sexual anxiety, and sexual assertiveness. Journal of Sex Research, 52(1), 110–119. 10.1080/00224499.2013.838744 [DOI] [PubMed] [Google Scholar]
  18. Brereton, A., & McGlinchey, E. (2020). Self-harm, emotion regulation, and experiential avoidance: A systematic review. Archives of Suicide Research: Official Journal of the International Academy for Suicide Research, 24(sup1), 1–24. 10.1080/13811118.2018.1563575 [DOI] [PubMed] [Google Scholar]
  19. Briken, P. (2020). An integrated model to assess and treat compulsive sexual behaviour disorder. Nature Reviews. Urology, 17(7), 391–406. 10.1038/s41585-020-0343-7 [DOI] [PubMed] [Google Scholar]
  20. 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]
  21. 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]
  22. Brumariu, L. E. (2015). Parent-child attachment and emotion regulation: Parent-child attachment and emotion regulation. New Directions for Child and Adolescent Development, 2015(148), 31–45. 10.1002/cad.20098 [DOI] [PubMed] [Google Scholar]
  23. Carnes, P. (1991). Don’t call it love: Recovery from sexual addiction. Bantam Books. [Google Scholar]
  24. Carr, C. P., Martins, C. M. S., Stingel, A. M., Lemgruber, V. B., & Juruena, M. F. (2013). The role of early life stress in adult psychiatric disorders: A systematic review according to childhood trauma subtypes. The Journal of Nervous and Mental Disease, 201(12), 1007–1020. 10.1097/NMD.0000000000000049 [DOI] [PubMed] [Google Scholar]
  25. Carvalho, J., Štulhofer, A., Vieira, A. L., & Jurin, T. (2015). Hypersexuality and high sexual desire: Exploring the structure of problematic sexuality. The Journal of Sexual Medicine, 12(6), 1356–1367. 10.1111/jsm.12865 [DOI] [PubMed] [Google Scholar]
  26. Castellini, G., D’Anna, G., Rossi, E., Cassioli, E., Appignanesi, C., Monteleone, A. M., Rellini, A. H., & Ricca, V. (2020). Dysregulated sexuality in women with eating disorders: The role of childhood traumatic experiences. Journal of Sex & Marital Therapy, 46(8), 793–806. 10.1080/0092623X.2020.1822484 [DOI] [PubMed] [Google Scholar]
  27. Castellini, G., Rellini, A. H., Appignanesi, C., Pinucci, I., Fattorini, M., Grano, E., Fisher, A. D., Cassioli, E., Lelli, L., Maggi, M., & Ricca, V. (2018). Deviance or normalcy? The relationship among paraphilic thoughts and behaviors, hypersexuality, and psychopathology in a sample of university students. The Journal of Sexual Medicine, 15(9), 1322–1335. 10.1016/j.jsxm.2018.07.015 [DOI] [PubMed] [Google Scholar]
  28. Castro-Calvo, J., Gil-Llario, M. D., Giménez-García, C., Gil-Juliá, B., & Ballester-Arnal, R. (2020). Occurrence and clinical characteristics of Compulsive Sexual Behavior Disorder (CSBD): A cluster analysis in two independent community samples. Journal of Behavioral Addictions, 9(2), 446–468. 10.1556/2006.2020.00025 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Chatzittofis, A., Savard, J., Arver, S., Öberg, K. G., Hallberg, J., Nordström, P., & Jokinen, J. (2017). Interpersonal violence, early life adversity, and suicidal behavior in hypersexual men. Journal of Behavioral Addictions, 6(2), 187–193. 10.1556/2006.6.2017.027 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Ciocca, G., Pelligrini, F., Mollaioli, D., Limoncin, E., Sansone, A., Colonnello, E., Jannini, E. A., & Fontanesi, L. (2021). Hypersexual behavior and attachment styles in a non-clinical sample: The mediation role of depression and post-traumatic stress symptoms. Journal of Affective Disorders, 293, 399–405. 10.1016/j.jad.2021.06.064 [DOI] [PubMed] [Google Scholar]
  31. Coleman, E., Rahm-Knigge, R. L., Danielson, S., Nielsen, K. H., Gleason, N., Jennings, T., & Miner, M. H. (2023). The relationship between boredom proneness, attachment styles and compulsive sexual behavior. Journal of Sex & Marital Therapy, 49(2), 172–188. 10.1080/0092623X.2022.2086511 [DOI] [PubMed] [Google Scholar]
  32. Crocker, M. M. (2015). Out-of-control sexual behavior as a symptom of insecure attachment in men. Journal of Social Work Practice in the Addictions, 15(4), 373–393. 10.1080/1533256X.2015.1091000 [DOI] [Google Scholar]
  33. D’Anna, G., Castellini, G., Rossi, E., Cassioli, E., Appignanesi, C., Monteleone, A. M., Rellini, A. H., & Ricca, V. (2021). Dysregulated sexuality and childhood trauma in eating disorders: Psychopathological, biological and behavioural correlates. European Psychiatry, 64(S1), S112–S113. 10.1192/j.eurpsy.2021.321 [DOI] [Google Scholar]
  34. Dhuffar, M. K., & Griffiths, M. D. (2016). Barriers to female sex addiction treatment in the UK. Journal of Behavioral Addictions, 5(4), 562–567. 10.1556/2006.5.2016.072 [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Dickenson, J. A., Gleason, N., Coleman, E., & 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]
  36. Diehl, A., Clemente, J., Pillon, S. C., Santana, P. R. H., da Silva, C. J., & Mari, J. D J. (2019). Early childhood maltreatment experience and later sexual behavior in Brazilian adults undergoing treatment for substance dependence. Revista Brasileira de Psiquiatria (Sao Paulo, Brazil: 1999), 41(3), 199–207. 10.1590/1516-4446-2017-0020 [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. 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]
  38. Efrati, Y., Goldman, K., Levin, K., & Rosca, P. (2022). Early-life trauma, negative and positive life events, compulsive sexual behavior disorder and risky sexual action tendencies among young women with substance use disorder. Addictive Behaviors, 133, 107379. 10.1016/j.addbeh.2022.107379 [DOI] [PubMed] [Google Scholar]
  39. Ehrenthal, J., Dinger, U., Lamla, A., Funken, B., & Schauenburg, H. (2009). Evaluation der deutschsprachigen Version des Bindungsfragebogens „Experiences in Close Relationships – Revised” (ECR-RD). PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie, 59(06), 215–223. 10.1055/s-2008-1067425 [DOI] [PubMed] [Google Scholar]
  40. England, P., & Bearak, J. (2014). The sexual double standard and gender differences in attitudes toward casual sex among U.S. university students. Demographic Research, 30, 1327–1338. 10.4054/DemRes.2014.30.46 [DOI] [Google Scholar]
  41. Faisandier, K. M., Taylor, J. E., & Salisbury, R. M. (2012). What does attachment have to do with out-of-control sexual behaviour? New Zealand Journal of Psychology, 41(1), 19–29. https://mro.massey.ac.nz/items/18c30735-1697-4384-8e2b-b4eec822f9b7 [Google Scholar]
  42. Favez, N., & Tissot, H. (2017). Attachment tendencies and sexual activities: The mediating role of representations of sex. Journal of Social and Personal Relationships, 34(5), 732–752. 10.1177/0265407516658361 [DOI] [Google Scholar]
  43. Fontanesi, L., Marchetti, D., Limoncin, E., Rossi, R., Nimbi, F. M., Mollaioli, D., Sansone, A., Colonnello, E., Simonelli, C., Di Lorenzo, G., Jannini, E. A., & Ciocca, G. (2021). Hypersexuality and trauma: A mediation and moderation model from psychopathology to problematic sexual behavior. Journal of Affective Disorders, 281, 631–637. 10.1016/j.jad.2020.11.100 [DOI] [PubMed] [Google Scholar]
  44. Fraley, R. C., Waller, N. G., & Brennan, K. A. (2000). An item response theory analysis of self-report measures of adult attachment. Journal of Personality and Social Psychology, 78(2), 350–365. 10.1037/0022-3514.78.2.350 [DOI] [PubMed] [Google Scholar]
  45. Graham, F., Walters, G. D., Harris, D. A., & Knight, R. A. (2016). Is hypersexuality dimensional or categorical? Evidence from male and female college samples. Journal of Sex Research, 53(2), 224–238. 10.1080/00224499.2014.1003524 [DOI] [PubMed] [Google Scholar]
  46. Grant Weinandy, J. T., Lee, B., Hoagland, K. C., Grubbs, J. B., & Bőthe, B. (2023). Anxiety and compulsive sexual behavior disorder: A systematic review. Journal of Sex Research, 60(4), 545–557. 10.1080/00224499.2022.2066616 [DOI] [PubMed] [Google Scholar]
  47. Grubbs, J. B., Hoagland, K. C., Lee, B. N., Grant, J. T., Davison, P., Reid, R. C., & Kraus, S. W. (2020). Sexual addiction 25 years on: A systematic and methodological review of empirical literature and an agenda for future research. Clinical Psychology Review, 82, 101925. 10.1016/j.cpr.2020.101925 [DOI] [PubMed] [Google Scholar]
  48. Hagborg, J. M., Kalin, T., & Gerdner, A. (2022). The Childhood Trauma Questionnaire—Short Form (CTQ-SF) used with adolescents – methodological report from clinical and community samples. Journal of Child & Adolescent Trauma, 15(4), 1199–1213. 10.1007/s40653-022-00443-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Hayes, A. F. (2018).). The PROCESS macro for SPSS and SAS (Version 5)[Software]retrieved from: https://www.processmacro.org/download.html
  50. Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52(3), 511–524. 10.1037/0022-3514.52.3.511 [DOI] [PubMed] [Google Scholar]
  51. Hughes, K., Bellis, M. A., Hardcastle, K. A., Sethi, D., Butchart, A., Mikton, C., Jones, L., & Dunne, M. P. (2017). The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. The Lancet Public Health, 2(8), e356–e366. 10.1016/S2468-2667(17)30118-4 [DOI] [PubMed] [Google Scholar]
  52. Jepsen, D., Luck, T., Heckel, C., Niemann, J., Winter, K., & Watzke, S. (2024). Compulsive sexual behavior, sexual functioning problems, and their linkages to substance use among German medical students: Exploring the role of sex and trauma exposure. Frontiers in Psychology, 15, 1423690. 10.3389/fpsyg.2024.1423690 [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Kafka, M. P. (2010). Hypersexual disorder: A proposed diagnosis for DSM-V. Archives of Sexual Behavior, 39(2), 377–400. 10.1007/s10508-009-9574-7 [DOI] [PubMed] [Google Scholar]
  54. Kinzl, J. F., Mangweth, B., Traweger, C., & Biebl, W. (1996). Sexual dysfunction in males: Significance of adverse childhood experiences. Child Abuse & Neglect, 20(8), 759–766. 10.1016/0145-2134(96)00063-4 [DOI] [PubMed] [Google Scholar]
  55. Klinitzke, G., Romppel, M., Häuser, W., Brähler, E., & Glaesmer, H. (2012). Die deutsche Version des Childhood Trauma Questionnaire (CTQ) – psychometrische Eigenschaften in einer bevölkerungsrepräsentativen Stichprobe. PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie, 62(02), 47–51. 10.1055/s-0031-1295495 [DOI] [PubMed] [Google Scholar]
  56. Koós, M., Fuss, J., Klein, V., Demetrovics, Z., & Bőthe, B. (2022). Sexual motivations underlying compulsive sexual behavior in women and men from Germany and Hungary. The Journal of Sexual Medicine, 19(2), 170–181. 10.1016/j.jsxm.2021.11.005 [DOI] [PubMed] [Google Scholar]
  57. Kowalewska, E., Gola, M., Kraus, S. W., & Lew-Starowicz, M. (2020). Spotlight on compulsive sexual behavior disorder: A systematic review of research on women. Neuropsychiatric Disease and Treatment, Volume 16, 2025–2043. 10.2147/NDT.S221540 [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. 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: Official Journal of the World Psychiatric Association (WPA), 17(1), 109–110. 10.1002/wps.20499 [DOI] [PMC free article] [PubMed] [Google Scholar]
  59. Kürbitz, L. I., & Briken, P. (2021). Is compulsive sexual behavior different in women compared to men? Journal of Clinical Medicine, 10(15), 3205. 10.3390/jcm10153205 [DOI] [PMC free article] [PubMed] [Google Scholar]
  60. Långström, N., & Hanson, R. K. (2006). High rates of sexual behavior in the general population: Correlates and predictors. Archives of Sexual Behavior, 35(1), 37–52. 10.1007/s10508-006-8993-y [DOI] [PubMed] [Google Scholar]
  61. Leedes, R. (2001). The three most important criteria in diagnosing sexual addictions: Obsession, obsession, and obsession. Sexual Addiction & Compulsivity, 8(3-4), 215–226. 10.1080/107201601753459928 [DOI] [Google Scholar]
  62. Levi, G., Cohen, C., Kaliche, S., Sharaabi, S., Cohen, K., Tzur-Bitan, D., & Weinstein, A. (2020). Sexual addiction, compulsivity, and impulsivity among a predominantly female sample of adults who use the internet for sex. Journal of Behavioral Addictions, 9(1), 83–92. 10.1556/2006.2020.00007 [DOI] [PMC free article] [PubMed] [Google Scholar]
  63. Lew-Starowicz, M., Lewczuk, K., Nowakowska, I., Kraus, S., & Gola, M. (2020). Compulsive Sexual Behavior and Dysregulation of Emotion. Sexual Medicine Reviews, 8(2), 191–205. 10.1016/j.sxmr.2019.10.003 [DOI] [PubMed] [Google Scholar]
  64. Messman-Moore, T. L., Walsh, K. L., & DiLillo, D. (2010). Emotion dysregulation and risky sexual behavior in revictimization. Child Abuse & Neglect, 34(12), 967–976. 10.1016/j.chiabu.2010.06.004 [DOI] [PubMed] [Google Scholar]
  65. Mikulincer, M. (2008). Adult attachment and affect regulation. Handbook of attachment: theory, research, and clinical applications/Guilford. [Google Scholar]
  66. Mikulincer, M., & Shaver, P. R. (2007). Boosting Attachment Security to Promote Mental Health, Prosocial Values, and Inter-Group Tolerance. Psychological Inquiry, 18(3), 139–156. 10.1080/10478400701512646 [DOI] [Google Scholar]
  67. Mikulincer, M., Shaver, P. R., & Pereg, D. (2003). Attachment theory and affect regulation: The dynamics, development, and cognitive consequences of attachment-related strategies. Motivation and Emotion, 27(2), 77–102. 10.1023/A:1024515519160 [DOI] [Google Scholar]
  68. Nolen-Hoeksema, S. (2012). Emotion regulation and psychopathology: The role of gender. Annual Review of Clinical Psychology, 8(1), 161–187. 10.1146/annurev-clinpsy-032511-143109 [DOI] [PubMed] [Google Scholar]
  69. Noll, J. G., Trickett, P. K., & Putnam, F. W. (2003). A prospective investigation of the impact of childhood sexual abuse on the development of sexuality. Journal of Consulting and Clinical Psychology, 71(3), 575–586. 10.1037/0022-006X.71.3.575 [DOI] [PMC free article] [PubMed] [Google Scholar]
  70. Panagou, C., & MacBeth, A. (2022). Deconstructing pathways to resilience: A systematic review of associations between psychosocial mechanisms and transdiagnostic adult mental health outcomes in the context of adverse childhood experiences. Clinical Psychology & Psychotherapy, 29(5), 1626–1654. 10.1002/cpp.2732 [DOI] [PMC free article] [PubMed] [Google Scholar]
  71. Perera, B., Reece, M., Monahan, P., Billingham, R., & Finn, P. (2009). Childhood characteristics and personal dispositions to sexually compulsive behavior among young adults. Sexual Addiction & Compulsivity, 16(2), 131–145. 10.1080/10720160902905421 [DOI] [Google Scholar]
  72. Rajkumar, R. P. (2015). The impact of disrupted childhood attachment on the presentation of psychogenic erectile dysfunction: An exploratory study. The Journal of Sexual Medicine, 12(3), 798–803. 10.1111/jsm.12815 [DOI] [PubMed] [Google Scholar]
  73. Reid, R. C., Garos, S., & Carpenter, B. N. (2011). Reliability, validity, and psychometric development of the hypersexual behavior inventory in an outpatient sample of men. Sexual Addiction & Compulsivity, 18(1), 30–51. 10.1080/10720162.2011.555709 [DOI] [Google Scholar]
  74. Schachner, D. A., & Shaver, P. R. (2004). Attachment dimensions and sexual motives. Personal Relationships, 11(2), 179–195. 10.1111/j.1475-6811.2004.00077.x [DOI] [Google Scholar]
  75. Schwartz, M. F., & , Southern, S. (1999). Manifestations of damaged development of the human affectional systems and developmentally based psychotherapies. Sexual Addiction & Compulsivity, 6(3), 163–175. 10.1080/10720169908400190 [DOI] [Google Scholar]
  76. Shaver, P. R., & Fraley, R. C. (2004). Self-Report Measures of Adult Attachment. http://labs.psychology.illinois.edu/∼rcfraley/measures/newmeasures.html
  77. Shimoni, L., Dayan, M., Cohen, K., & Weinstein, A. (2018). The contribution of personality factors and gender to ratings of sex addiction among men and women who use the Internet for sex purpose. Journal of Behavioral Addictions, 7(4), 1015–1021. 10.1556/2006.7.2018.101 [DOI] [PMC free article] [PubMed] [Google Scholar]
  78. Skegg, K., Nada-Raja, S., Dickson, N., & Paul, C. (2010). Perceived “Out of Control” sexual behavior in a cohort of young adults from the dunedin multidisciplinary health and development study. Archives of Sexual Behavior, 39(4), 968–978. 10.1007/s10508-009-9504-8 [DOI] [PubMed] [Google Scholar]
  79. Slavin, M. N., Blycker, G. R., Potenza, M. N., Bőthe, B., Demetrovics, Z., & Kraus, S. W. (2020). Gender-related differences in associations between sexual abuse and hypersexuality. The Journal of Sexual Medicine, 17(10), 2029–2038. 10.1016/j.jsxm.2020.07.008 [DOI] [PMC free article] [PubMed] [Google Scholar]
  80. Slavin, M. N., Scoglio, A. A. J., Blycker, G. R., Potenza, M. N., & Kraus, S. W. (2020). Child sexual abuse and compulsive sexual behavior: a systematic literature review. Current Addiction Reports, 7(1), 76–88. 10.1007/s40429-020-00298-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  81. Thibodeau, M.-E., Lavoie, F., Hébert, M., & Blais, M. (2017). Pathways linking childhood maltreatment and adolescent sexual risk behaviors: The role of attachment security. Journal of Sex Research, 54(8), 994–1005. 10.1080/00224499.2017.1316816 [DOI] [PMC free article] [PubMed] [Google Scholar]
  82. Ullman, S. E., & Filipas, H. H. (2005). Gender differences in social reactions to abuse disclosures, post-abuse coping, and PTSD of child sexual abuse survivors. Child Abuse & Neglect, 29(7), 767–782. 10.1016/j.chiabu.2005.01.005 [DOI] [PubMed] [Google Scholar]
  83. Vaillancourt-Morel, M.-P., Bergeron, S., Gewirtz-Meydan, A., Zippan, N., Nagy, L., Koós, M., Kraus, S. W., Demetrovics, Z., Potenza, M. N., & Bőthe, B, International Sex Survey (ISS) Consortium, & Bőthe, B . (2025). For whom is sexual abuse related to compulsive sexual behaviors? timing of abuse and sociodemographic characteristics as potential moderators across 42 countries. Archives of Sexual Behavior, 54(6), 2249–2268. 10.1007/s10508-025-03162-x [DOI] [PubMed] [Google Scholar]
  84. Weinstein, A., Katz, L., Eberhardt, H., Cohen, K., & Lejoyeux, M. (2015). Sexual compulsion—Relationship with sex, attachment and sexual orientation. Journal of Behavioral Addictions, 4(1), 22–26. 10.1556/JBA.4.2015.1.6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  85. Wilson, H. W., & Widom, C. S. (2008). An examination of risky sexual behavior and HIV in victims of child abuse and neglect: A 30-year follow-up. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 27(2), 149–158. 10.1037/0278-6133.27.2.149 [DOI] [PubMed] [Google Scholar]
  86. Witt, A., Brown, R. C., Plener, P. L., Brähler, E., & Fegert, J. M. (2017). Child maltreatment in Germany: Prevalence rates in the general population. Child and Adolescent Psychiatry and Mental Health, 11(1), 47. 10.1186/s13034-017-0185-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  87. World Health Organisation . (2018). ICD-11—ICD-11 for Mortality and Morbidity Statistics. https://icd.who.int/browse11/l-m/en#/http%3a//id.who.int/icd/entity/1630268048
  88. World Health Organization . (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines (Bd. 1). [Google Scholar]
  89. Yost, M. R., & Zurbriggen, E. L. (2006). Gender differences in the enactment of sociosexuality: An examination of implicit social motives, sexual fantasies, coercive sexual attitudes, and aggressive sexual behavior. Journal of Sex Research, 43(2), 163–173. 10.1080/00224490609552311 [DOI] [PubMed] [Google Scholar]
  90. Zapf, J. L., Greiner, J., & Carroll, J. (2008). Attachment styles and male sex addiction. Sexual Addiction & Compulsivity, 15(2), 158–175. 10.1080/10720160802035832 [DOI] [Google Scholar]

Associated Data

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

Data Availability Statement

As it includes data around sensitive topics, the raw data supporting the conclusion of this article will be made available by the authors on request.

Articles from International Journal of Sexual Health are provided here courtesy of Taylor & Francis

RESOURCES