TY - JOUR
T1 - Symptom-level associations between attention-deficit hyperactivity disorder (ADHD) and compulsive sexual behaviour
T2 - undirected and Bayesian network analysis across multiple sociodemographic characteristics
AU - International Sex Survey Consortium
AU - Jannini, Tommaso B.
AU - Ciocca, Giacomo
AU - Giannini, Tessa
AU - Nagy, Léna
AU - Koós, Mónika
AU - Kraus, Shane W.
AU - Potenza, Marc N.
AU - Demetrovics, Zsolt
AU - Bothe, Beáta
AU - Aksen, Damla E.
AU - Ballester-Arnal, Rafael
AU - Batthyány, Dominik
AU - Bergeron, Sophie
AU - Billieux, Joël
AU - Briken, Peer
AU - Burkauskas, Julius
AU - Cárdenas-López, Georgina
AU - Carvalho, Joana
AU - Calvo, Jesús Castro
AU - Chen, Lijun
AU - Corazza, Ornella
AU - Csako, Rita I.
AU - Czakó, Andrea
AU - Fernandez, David P.
AU - Fernandez, Elaine F.
AU - Fujiwara, Hironobu
AU - Fuss, Johannes
AU - Gabrhelík, Roman
AU - Gewirtz-Meydan, Ateret
AU - Gjoneska, Biljana
AU - Gola, Mateusz
AU - Grubbs, Joshua B.
AU - Hashim, Hashim T.
AU - Islam, Md Saiful
AU - Jiménez-Martínez, Martha C.
AU - Jurin, Tanja
AU - Kalina, Ondrej
AU - Klein, Verena
AU - Költo, András
AU - Lee, Chih Ting
AU - Lee, Sang Kyu
AU - Lewczuk, Karol
AU - Lin, Chung Ying
AU - Lochner, Christine
AU - López-Alvarado, Silvia
AU - Lukavská, Katerina
AU - Mayta-Tristán, Percy
AU - Miller, Dan J.
AU - Orosová, Oľga
AU - Orosz, Gábor
N1 - Publisher Copyright:
© The Author(s), 2026. Published by Cambridge University Press on behalf of Royal College of Psychiatrists.
PY - 2026
Y1 - 2026
N2 - Background Attention-deficit hyperactivity disorder (ADHD) has been associated with compulsive sexual behaviours, including problematic pornography use. However, symptom-level mechanisms underlying this relationship remain poorly characterised, particularly across diverse demographic groups. Aims To identify key ADHD symptoms that bridge to compulsive sexual behaviour phenotypes (compulsive sexual behaviours and problematic pornography use) and examine whether symptom-level associations differ across sex, gender identity and age groups. Method This cross-sectional study analysed data from the International Sex Survey (2021-2022). Participants completed the Adult ADHD Self-Report Screening Scale, Compulsive Sexual Behaviour Disorder Scale and Problematic Pornography Consumption Scale. Gaussian graphical models and Bayesian networks were used to assess symptom-level relationships. Centrality and bridging indices were computed. Network comparison tests were also used to assess for any differences in network invariance and global strength across multiple demographic subgroups. Directed acyclic graphs were constructed to consider potential causal pathways. Results Among 82 243 participants (48 987 men (59.6%), 33 245 women (40.4%), mean age 33.1 years), ADHD symptoms of inattention and hyperactivity-impulsivity emerged as central, bridging and directionally plausible nodes. Network comparisons revealed demographic differences in overall network strength, with men and cisgender individuals exhibiting higher frequencies of association. Nonetheless, items relating to both inattention and hyperactivity-impulsivity consistently emerged as central across all population subgroups. Conclusions The finding suggesting that ADHD symptoms of inattention and hyperactivity-impulsivity are key drivers of compulsive sexual behaviours across global populations and multiple sociodemographic characteristics underscores the relevance of transdiagnostic mechanisms and suggests use of targeted interventions addressing executive dysfunction and reward dysregulation in ADHD.
AB - Background Attention-deficit hyperactivity disorder (ADHD) has been associated with compulsive sexual behaviours, including problematic pornography use. However, symptom-level mechanisms underlying this relationship remain poorly characterised, particularly across diverse demographic groups. Aims To identify key ADHD symptoms that bridge to compulsive sexual behaviour phenotypes (compulsive sexual behaviours and problematic pornography use) and examine whether symptom-level associations differ across sex, gender identity and age groups. Method This cross-sectional study analysed data from the International Sex Survey (2021-2022). Participants completed the Adult ADHD Self-Report Screening Scale, Compulsive Sexual Behaviour Disorder Scale and Problematic Pornography Consumption Scale. Gaussian graphical models and Bayesian networks were used to assess symptom-level relationships. Centrality and bridging indices were computed. Network comparison tests were also used to assess for any differences in network invariance and global strength across multiple demographic subgroups. Directed acyclic graphs were constructed to consider potential causal pathways. Results Among 82 243 participants (48 987 men (59.6%), 33 245 women (40.4%), mean age 33.1 years), ADHD symptoms of inattention and hyperactivity-impulsivity emerged as central, bridging and directionally plausible nodes. Network comparisons revealed demographic differences in overall network strength, with men and cisgender individuals exhibiting higher frequencies of association. Nonetheless, items relating to both inattention and hyperactivity-impulsivity consistently emerged as central across all population subgroups. Conclusions The finding suggesting that ADHD symptoms of inattention and hyperactivity-impulsivity are key drivers of compulsive sexual behaviours across global populations and multiple sociodemographic characteristics underscores the relevance of transdiagnostic mechanisms and suggests use of targeted interventions addressing executive dysfunction and reward dysregulation in ADHD.
KW - ADHD
KW - compulsive sexual behaviour
KW - directed acyclic graph
KW - Gaussian graphical model
KW - network analysis
UR - https://www.scopus.com/pages/publications/105045561055
U2 - 10.1192/bjp.2026.10691
DO - 10.1192/bjp.2026.10691
M3 - Artículo
AN - SCOPUS:105045561055
SN - 0007-1250
JO - British Journal of Psychiatry
JF - British Journal of Psychiatry
ER -