The connections among childhood abuse, sexual compulsivity, and violent sexual behavior.

Background: Violent sexual behaviors (VSB) are rarely investigated in the clinical context of Compulsive Sexual Behavior (CSB). There is evidence that childhood traumas likely generate more emotional dysregulation, which seems to be associated with greater impulsivity and sexual compulsivity activation.

Aim: We delineated a cross-sectional study with individuals with and without CSB to investigate if symptoms of impulsivity, sexual compulsivity, anxiety, and depression are associated with childhood abuse (CA) and VSB.

Methods: We enrolled 364 (247 CSB and 117 controls) cisgender men who underwent psychiatric structured interview and answered self-responsive standardized measures. We built the Sexual Violence Factor (SVF) after a factorial analysis of the sexual violence subscale of the Compulsive Sexual Behavior Inventory-22, and used it as the outcome variable of VSB. We conducted a structural equation model (SEM).

Outcomes: The evaluation of both direct and indirect effects of the construct Abuse on Violence, as well as the strength of associations between variables within a model demonstrating best-fit to the data.

Results: The SEM analysis showed moderate association between CA and impulsivity (coef. = 0.37, P < 0.001), anxiety and depression (coef. = 0.61, P < 0.001), sexual compulsivity (coef. = 0.58, P < 0.001), and SVF in adulthood (coef. = 0.41, P = 0.01). However, sexual compulsivity was not associated with SVF.

Implications: Impulsivity potentially associates with both CA and SVF, potentially implicating in more intensive clinical care for impulsive changes when a history of CA is present.

Strengths and limitations: few women sought to the service, resulting in a sample comprised solely of men. Due to some missing data, the SEM analysis could not have all the participants. Additionally, the data should not be generalized once it is a convenience sample. Regarding the strengths, this study starts filling a gap of investigations of VSB in clinic samples of CSB individuals outside of a criminal setting. The use of the SEM allowed for a comprehensive examination of the relationships among key psychopathological factors (emotional dysregulation, impulsivity, sexual compulsivity), and trauma experiences with the VSB, helping to identify confounding factors.

Conclusion: The SEM analysis provided a detailed assessment of our initial hypothesis, revealing that impulsivity seems to be a significant associating factor of VSB in individuals with CSB that suffered childhood maltreatment.