Alexithymia and problematic sexual behaviour: the mediation of dissociative patterns

Autor

Słowa kluczowe:

alexithymia, behavioural addiction, compulsive sexual behaviour, dissociation, problematic sexual behaviour

Abstrakt

Background

Sex addiction is a behavioural addiction that has received increasing scientific attention in recent years. Indeed, problematic sexual behaviours represent a growing clinical concern, often associated with significant emotional distress and interpersonal difficulties. In light of this, the present study aimed to investigate its psychological antecedents by exploring the role of alexithymia and dissociation, and by examining the effect of gender as a covariate.

Participants and procedure

A sample of 326 participants completed validated selfreport measures assessing alexithymia, dissociative experiences, and problematic sexual behaviour. Data analysis included ANOVAs, regression models, and a path analysis.

Results

The results showed that two subdimensions of alexithymia (difficulty in identifying feelings and difficulty in describing feelings) were significantly associated with higher levels of sex addiction. Moreover, the dissociation subdimension of absorption significantly mediated both relationships, while dissociative amnesia and depersonalization/derealization did not show significant mediation effects. Gender also played a role, with male participants reporting higher levels of problematic sexual behaviour.

Conclusions

These findings offer novel insight into the emotional and dissociative processes underlying sex addiction. The results emphasize the central role of absorption (a form of dissociation involving deep immersion in internal experience) as a potential emotional avoidance strategy that may sustain compulsive sexual behaviours. Understanding these mechanisms can guide future research and inform the development of targeted clinical interventions. Additionally, the relevance of gender differences suggests the importance of considering sex-specific pathways in assessment and treatment planning.

Downloads

Download data is not yet available.

Bibliografia

Aaron, M. (2012). The pathways of problematic sexual behavior: a literature review of factors affecting adult sexual behavior in survivors of childhood sexual abuse. Sexual Addiction & Compulsivity, 19, 199–218. https://doi.org/10.1080/10720162.2012.690678

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). APA Publishing. https://doi.org/10.1176/appi.books.9780890425596

Andreassen, C. S., Pallesen, S., Griffiths, M. D., Torsheim, T., & Sinha, R. (2018). The development and validation of the Bergen-Yale Sex Addiction Scale with a large national sample. Frontiers in Psychology, 9, 144. https://doi.org/10.3389/fpsyg.2018.00144

Bagby, R. M., Parker, J. D., & Taylor, G. J. (1994a). The twenty-item Toronto Alexithymia Scale-I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38, 23–32. https://doi.org/10.1016/0022-3999(94)90005-1

Bagby, R. M., Taylor, G. J., & Parker, J. D. (1994b). The twenty-item Toronto Alexithymia Scale-II. Convergent, discriminant, and concurrent validity. Journal of Psychosomatic Research, 38, 33–40. https://doi.org/10.1016/0022-3999(94)90006-X

Bőthe, 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., Csako, R., … 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, 393–407. https://doi.org/10.1556/2006.2023.00028

Bressi, C., Taylor, G., Parker, J., Bressi, S., Brambilla, V., Aguglia, E., Allegranti, I., Bongiorno, A., Giberti, F., Bucca, M., Todarello, O., Callegari, C., Vender, S., Gala, C., & Invernizzi, G. (1996). Cross validation of the factor structure of the 20-item Toronto Alexithymia Scale: an Italian multicenter study. Journal of Psychosomatic Research, 41, 551–559. https://doi.org/10.1016/S0022-3999(96)00228-0

Carlson, E. B., & Putnam, F. W. (1993). An update on the Dissociative Experiences Scale. Dissociation: Progress in the Dissociative Disorders, 6, 16–27.

Carnes, P. (2001). Out of the shadows: Understanding sexual addiction. Hazelden Publishing.

Cavicchioli, M., Scalabrini, A., Northoff, G., Mucci, C., Ogliari, A., & Maffei, C. (2021). Dissociation and emotion regulation strategies: a meta-analytic review. Journal of Psychiatric Research, 143, 370–387. https://doi.org/10.1016/j.jpsychires.2021.09.011

Craparo, G. (2011). Internet addiction, dissociation, and alexithymia. Procedia – Social and Behavioral Sciences, 30, 1051–1056. https://doi.org/10.1016/j.sbspro.2011.10.205

Craparo, G. (2014). The role of dissociation, affect dysregulation, and developmental trauma in sexual addiction. Clinical Neuropsychiatry, 11, 86–90.

Craparo, G., & Gori, A. (2015). Can we consider sexual addiction as an addictive disorder? Clinical Neuropsychiatry, 12, 46–47.

Craparo, G., Ardino, V., Gori, A., & Caretti, V. (2014). The relationships between early trauma, dissociation, and alexithymia in alcohol addiction. Psychiatry Investigation, 11, 330. https://doi.org/10.4306%2Fpi.2014.11.3.330

Derbyshire, K. L., & Grant, J. E. (2015). Compulsive sexual behavior: a review of the literature. Journal of Behavioral Addictions, 4, 37-43. https://doi.org/10.1556/2006.4.2015.003

Dhuffar, M. K., & Griffiths, M. D. (2016). Barriers to female sex addiction treatment in the UK. Journal of Behavioral Addictions, 5, 562–567. https://doi.org/10.1556/2006.5.2016.072

Elrafei, H., & Jamali, Q. (2022). Assessment and treatment of hypersexuality: a review. BJPsych Advances, 28, 198–205. https://doi.org/10.1192/bja.2021.68

Gori, A., & Topino, E. (2024a). Problematic sexual behaviours, dissociation, and adult attachment: a path analysis model. Journal of Affective Disorders Reports, 17, 100786. https://doi.org/10.1016/j.jadr.2024.100786

Gori, A., & Topino, E. (2024b). Problematic gambling behavior in a sample of gamblers: The role of alexithymia, dissociation features, and external locus of control. Journal of Gambling Studies, 40, 2077–2091. https://doi.org/10.1007/s10899-024-10322-6

Gori, A., Topino, E., Cacioppo, M., Craparo, G., Schimmenti, A., & Caretti, V. (2023). An integrated approach to addictive behaviors: a study on vulnerability and maintenance factors. European Journal of Investigation in Health, Psychology and Education, 13, 512–524. https://doi.org/10.3390/ejihpe13030039

Gori, A., Topino, E., Craparo, G., Bagnoli, I., Caretti, V., & Schimmenti, A. (2022). A comprehensive model for gambling behaviors: Assessment of the factors that can contribute to the vulnerability and maintenance of gambling disorder. Journal of Gambling Studies, 38, 235–251. https://doi.org/10.1007/s10899-021-10024-3

Griffin-Shelley, E., Benjamin, L., & Benjamin, R. (1995). Sex addiction and dissociation. Sexual Addiction & Compulsivity: The Journal of Treatment and Prevention, 2, 295–306. https://doi.org/10.1080/10720169508400090

Griffiths, M. D. (2005). A components model of addiction within a biopsychological framework. Journal of Substance Use, 10, 191–197. https://doi.org/10.1080/14659890500114359

Hegbe, K. G., Reveillere, C., Brunault, P., & Barrault, S. (2022). Sexual addiction: a maladaptive strategy to regulate mood and anxiety symptoms? Journal of Behavioral Addictions, 11, 297–297.

Hooper, D., Coughlan, J., & Mullen, M. R. (2008). Structural equation modeling: Guidelines for determining model fit. Electronic Journal of Business Research Methods, 6, 53–59.

Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55. https://doi.org/10.1080/10705519909540118

Kafka, M. P. (2010). Hypersexual disorder: a proposed diagnosis for DSM-V. Archives of Sexual Behavior, 39, 377–400. https://doi.org/10.1007/s10508-009-9574-7

Kaplan, M. S., & Krueger, R. B. (2010). Diagnosis, assessment, and treatment of hypersexuality. Journal of Sex Research, 47, 181–198. https://doi.org/10.1080/00224491003592863

Karila, L., Wery, A., Weinstein, A., Cottencin, O., Petit, A., Reynaud, M., & Billieux, J. (2014). Sexual addiction or hypersexual disorder: Different terms for the same problem? A review of the literature. Current Pharmaceutical Design, 20, 4012–4020. https://doi.org/10.2174/13816128113199990619

Kline, R. B. (2015). Principles and practice of structural equation modeling. Guilford Publications.

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, 16, 2025–2043. https://doi.org/10.2147/NDT.S221540

Kürbitz, L. I., & Briken, P. (2021). Is compulsive sexual behavior different in women compared to men? Journal of Clinical Medicine, 10, 3205. https://doi.org/10.3390/jcm10153205

Levine, S. B. (2010). What is sexual addiction? Journal of Sex & Marital Therapy, 36, 261–275. https://doi.org/10.1080/00926231003719681

Lew-Starowicz, M., Lewczuk, K., Nowakowska, I., Kraus, S., & Gola, M. (2020). Compulsive sexual behavior and dysregulation of emotion. Sexual Medicine Reviews, 8, 191–205. https://doi.org/10.1016/j.sxmr.2019.10.003

Liu, Y., Qiu, Z., & van den Wildenberg, W. P. (2024). Alexithymia and internet gaming disorder: The mediating role of internalizing and externalizing problems. Current Psychology, 43, 10567–10577. https://doi.org/10.1007/s12144-023-05113-y

Madioni, F., & Mammana, L. A. (2001). Toronto Alexithymia Scale in outpatients with sexual disorders. Psychopathology, 34, 95–98. https://doi.org/10.1159/000049287

Mahapatra, A., & Sharma, P. (2018). Association of Internet addiction and alexithymia – a scoping review. Addictive Behaviors, 81, 175–182. https://doi.org/10.1016/j.addbeh.2018.02.004

Marsh, H. W., Hau, K. T., & Wen, Z. (2004). In search of golden rules: Comment on hypothesis‐testing approaches to setting cutoff values for fit indexes and dangers in overgeneralizing Hu and Bentler’s (1999) findings. Structural Equation Modeling, 11, 320–341. https://doi.org/10.1207/s15328007sem1103_2

Morie, K. P., Yip, S. W., Nich, C., Hunkele, K., Carroll, K. M., & Potenza, M. N. (2016). Alexithymia and addiction: a review and preliminary data suggesting neurobiological links to reward/loss processing. Current Addiction Reports, 3, 239–248. https://doi.org/10.1007/s40429-016-0097-8

Orford, J. (1978). Hypersexuality: Implications for a theory of dependence. British Journal of Addiction to Alcohol & Other Drugs, 73, 299–310. https://doi.org/10.1111/j.1360-0443.1978.tb00157.x

Petersen, J. L., & Hyde, J. S. (2011). Gender differences in sexual attitudes and behaviors: a review of meta-analytic results and large datasets. Journal of Sex Research, 48, 149–165. https://doi.org/10.1080/00224499.2011.551851

Pistre, N., Schreck, B., Grall-Bronnec, M., & Fatseas, M. (2023). Should problematic sexual behavior be viewed under the scope of addiction? A systematic review based on DSM-5 substance use disorder criteria. Addictive Behaviors Reports, 18, 100510. https://doi.org/10.1016/j.abrep.2023.100510

Pocknell, V., & King, A. R. (2019). Personality inventory for the DSM-5 (brief form) predictors of sexual addiction. Sexual Addiction & Compulsivity, 26, 315–332. https://doi.org/10.1080/10720162.2019.1645059

Porcelli, P., Affatati, V., Bellomo, A., De Carne, M., Todarello, O., & Taylor, G. J. (2004). Alexithymia and psychopathology in patients with psychiatric and functional gastrointestinal disorders. Psychotherapy and Psychosomatics, 73, 84–91. https://doi.org/10.1159/000075539

Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891. https://doi.org/10.3758/BRM.40.3.879

Quayle, E., Vaughan, M., & Taylor, M. (2006). Sex offenders, Internet child abuse images and emotional avoidance: The importance of values. Aggression and Violent Behavior, 11, 1–11. https://doi.org/10.1016/j.avb.2005.02.005

Reid, R. C., Carpenter, B. N., Spackman, M., & Willes, D. L. (2008). Alexithymia, emotional instability, and vulnerability to stress proneness in patients seeking help for hypersexual behavior. Journal of Sex & Marital Therapy, 34, 133–149. https://doi.org/10.1080/00926230701636197

Renner, E., Wimmer, R., Zipper, Z., Brössler, H., Brouschek, J., Fuchshuber, J., Beiglböck, W., & Unterrainer, H. F. (2025). Affects, dissociative symptoms and addictive behaviours: Insights from clinical and non-clinical samples. Journal of Affective Disorders, 370, 481–488. https://doi.org/10.1016/j.jad.2024.11.031

Reyno, S. M., Simmons, M., & Kinley, J. (2020). A metaanalytic study examining the relationship between alexithymia and dissociation in psychiatric and nonclinical populations. Research in Psychotherapy: Psychopathology, Process, and Outcome, 23, 439. https://doi.org/10.4081/ripppo.2020.439

Rosenberg, K. P., O’Connor, S., & Carnes, P. (2014). Sex addiction: An overview. Behavioral Addictions, 2014, 215–236. https://doi.org/10.1016/B978-0-12-407724-9.00009-4

Sahithya, B. R., & Kashyap, R. S. (2022). Sexual addiction disorder – a review with recent updates. Journal of Psychosexual Health, 4, 95–101. https://doi.org/10.1177/26318318221081080

Schimmenti, A. (2016). Dissociative experiences and dissociative minds: Exploring a nomological network of dissociative functioning. Journal of Trau ma & Dissociation, 17, 338–361. https://doi.org/10.1080/15299732.2015.1108948

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, 1015–1021. https://doi.org/10.1556/2006.7.2018.101

Sifneos, P. E. (1973). The prevalence of ‘alexithymic’ characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22, 255–262. https://doi.org/10.1159/000286529

Soraci, P., Melchiori, F. M., Del Fante, E., Melchiori, R., Guaitoli, E., Lagattolla, F., Parente, G., Bonanno, E., Norbiato, L., Cimaglia, R., Campedelli, L., Abbiati, F. A., Ferrari, A., & Griffiths, M. D. (2023). Validation and psychometric evaluation of the Italian version of the Bergen-Yale Sex Addiction Scale. International Journal of Mental Health and Addiction, 21, 1636–1662. https://doi.org/10.1007/s11469-021-00597-w

Speranza, M., Corcos, M., Stéphan, P., Loas, G., Pérez-Diaz, F., Lang, F., Venisse, J. L., Bizouard, P., Flament, M., Halfon, O., & Jeammet, P. (2004). Alexithymia, depressive experiences, and dependency in addictive disorders. Substance Use & Misuse, 39, 551–579. https://doi.org/10.1081/ja-120030058

Testa, G., Villena-Moya, A., & Chiclana-Actis, C. (2024). Emotional dysregulation and coping strategies in the context of problematic pornography use: a narrative review. Current Addiction Reports, 11, 229–241. https://doi.org/10.1007/s40429-024-00548-0

Topino, E., Gori, A., & Cacioppo, M. (2021). Alexithymia, dissociation, and family functioning in a sample of online gamblers: a moderated mediation study. International Journal of Environmental Research and Public Health, 18, 13291. https://doi.org/10.3390/ijerph182413291

Weil, A. (2018). Integrative sexual health. Oxford University Press.

Wise, T. N., Osborne, C., Strand, J., Fagan, P. J., & Schmidt, C. W., Jr. (2002). Alexithymia in patients attending a sexual disorders clinic. Journal of Sex &Marital Therapy, 28, 445–450. https://doi.org/10.1080/00926230290001556

Woody, J. D. (2011). Sexual addiction/hypersexuality and the DSM: Update and practice guidance for social workers. Journal of Social Work Practice in the Addictions, 11, 301–320. https://doi.org/10.1080/1533256X.2011.619926

World Health Organization (2022). ICD-11: International classification of diseases (11th revision). Retrieved from https://icd.who.int/en/

Opublikowane

2025-10-10

Jak cytować

Topino, E., Fioravanti, G., Fabiani, D., Musetti, A., & Gori, A. (2025). Alexithymia and problematic sexual behaviour: the mediation of dissociative patterns. Health Psychology Report, 13(4), 317–326. Pobrano z https://czasopisma.bg.ug.edu.pl/index.php/HPR/article/view/12890

Numer

Dział

Artykuły