Characteristics of HB among young adults

All in all, many of the findings regarding characteristics of HB among young adults in Germany match closely with the results of previous research on hypersexuality in general. Consistent with prior studies [5], in this study, HB seems to occur far more often in male than in female young adults. To the best of our knowledge, so far these gender-based differences have not yet been addressed in research and need further investigation, particularly when considering that the symptom structure of HB in men and women is similar [40]. Focussing on biological (e.g., endocrinal system, neurological processes), and social aspects of gender (e.g., role expectations, attachment experiences), it seems beneficial to explore this relationship in greater detail.

Furthermore, earlier first sexual experiences (earlier firstpornography use, and intercourse) seem to be related to the presence of HB (consistent with Engel et al. 2019, [27]). Adolescents are considered particularly vulnerable to developing sexual problems because sexual experiences within a too early stage of sexual development can lead to difficulties in processing sexual cues and thus to the development of sexual problems like HB [41]. In combination with that, the found strong association between HB and problematic pornography consumption suggests a prominent role of digital sexual media in the manifestation of HB. This association underlines the importance to consider pornography consumption when reflecting on hypersexual behaviours. One possible explanation for the mentioned difficulties in the sexual life of young adults is the strong relation between sexuality and digitalization, and the assumed influences on intimate relationships [41]. These phenomena should get more space in further research of clinically relevant sexual behaviour. No matter how diverse the investigated sample of young adults in Germany might be, they do have one thing in common: they all grew up during a peak of digitalization and individualization. Sexuality and the creation of a sexual identity constitute important areas of life and development [42], which are closely connected to these dominating cultural phenomena [5, 11].

We also found another characteristic of HB among young adults in Germany, i.e., several compulsive reasons for masturbation, which can describe the expression of HB in more detail, regarding to the symptom of the loss of control included in the diagnosis of compulsive sexual behaviour disorder.

Furthermore, the strong associations between HB and risky sexual behaviour seem to be particularly interesting since it has not yet been addressed in previous research. According to this, the results further reveal indications of delinquent behaviour tendencies, as associations between HB and the performance of sexual actions that are not legally permissible or which harmed other people mentally and/ or physically were identified. However, we did not assess in detail what was understood of delinquent behaviour tendencies concretely. Further research is needed to investigate which role this kind of behaviour play in the forensic perspective on HB, as well as in connection with legal problems as consequences of HB, building on previous research [15, 43]. In addition, the revealed association between HB and sex under influence of illegal drugs support results within chemsex research, which outline potential risks for health, like infection with sexually transmitted diseases, and the development of depression, substance addiction, and drug-induced psychosis [44]. Consequently, illegal sexual behaviour and sexual risk behaviour are accompanied by HB and can lead to several consequences for health and existential problems.

Correlates between HB and personality

Particularly strong effects were found between HB and impulsive tendencies, as has been already stated in previous research [15, 18, 29]. Although not all analyses of the relation between stresses in primary socialisation and the presence of HB were significant, the associations were strong and support previous findings of a dysfunctional family structure as an important risk factor for the development of HB [24, 45]. Interestingly seem the associations between narcissistic and histrionic tendencies, which should be considered in the psychotherapeutic treatment of HB as well as appropriate personality disorders.

Associations between HB and a lack of sexual education during school

Although no association was found between HB and a lack of sexual education during school time, sexual education seems scarce among young adults in Germany. Sexual risk behaviour in the form of sex under the influence of illegal drugs and sexual activities that harm other people physically or mentally were stated by many participants, as well as feelings of guilt and shame in relation to sexuality, no matter whether they were classified as hypersexual or not. Further indications of current and former psychosocial impairments within the general population (e.g., harassment, sexual abuse) were identified in a serious proportion of participants. These results of the descriptive analysis portray a sobering balance concerning the distribution of demand and supply addressing the reflection of individual sexuality for young adults in Germany. Regarding the consequences of HB, the development of preventive measures addressing these problems seem beneficial. Therefore, schools especially represent an important setting where sexual education programmes should be included, because the earlier maladaptive patterns of sexual behaviour are identified, the better they can be worked on and realigned in a beneficial manner [46]. Therefore, skilled personnel should create spaces for reflection in the form of project days or workshops for students in which different facets of sexuality are discussed – not just biological basics and safer sex (as is currently operated in Germany). Discretion should play an important role, thus, an opportunity for bilateral conversations with school psychologists, school social workers, or appropriate externals should be established.

Limitations and strengths

The HBI is an instrument for self-assessment. However, the diagnosis of compulsive sexual disorder cannot be made without an evaluation by medical specialists and/or psychotherapists [29]. Consequently, whether hypersexuality is prevalent within the population according to a clinical understanding is not clear. Furthermore, shortened versions of personality inventories were used, meaning that information about their validity and reliability cannot be transmitted from relevant literature. Although the male to female ratio in the participants is nearly balanced, very few women were classified as hypersexual, so concrete assertions about HB in women specifically are not fully possible and results of gender comparisons cannot be conducted with the expectation of valid results. For the description of HB especially in women, publications by Klein et al. [47], Kowalewska et al. [18], and Montgomery-Graham [48] should be considered. Moreover, it is questionable whether the construct of HB pursued in HBI can be operationalized for women and men equally. While interpreting the results, it should be considered that the participants were approached on a website for self-identified addicted persons and a dating website for casual sex contacts, which could bias the selection of the sample. Moreover, we do not have any information how many participants were approached via which online platform, so we cannot estimate the extent of the suspected bias. Although HBI is validated for the German [49], Italian [50], and Spanish population [51], it is questionable whether the results of this study are generalizable for other countries as well, considering the cultural differences regarding definitions of sexual health. Hence, further research with randomized and larger samples is necessary to reach external validity and enable international comparability.

One clear strength of the study is the diversity regarding the distribution of gender and sexual orientation within the sample. The gender ratio is nearly balanced, while the proportion of queer people (25.4%) is high in comparison to results of a current survey of sexual orientation in Germany [52]. Furthermore, the inventories used for measuring hypersexuality (HBI; [28]) and a problematic pornography consumption (PPCS; [31]) show high reliability and validity and are well established within hypersexuality research. The self-generated scale for promiscuity shows a very good reliability. Because HBI and Kafka’s diagnosis criteria were used to measure HB, the results of this study can be compared to the many other studies that have used these instruments as well. In addition, various data were collected that, to this date, had not been subjects of previous research on HB (e.g. associations with, sexual education, reasons for masturbation, or sexual functioning problems). To the best of our knowledge, associations between HB and narcissistic and histrionic tendencies were surveyed last over twenty years ago with smaller sample sizes [53, 54]. Further, in this study we could survey more facets of sexual risk behaviour in relation with HB, while the focus of previous research was on unprotected sexual intercourse and intercourse with multiple sexual partners [55]. Thus, the results of this study are an important tile which can elucidate and supplement the mosaic of hypersexuality research.