Personality among Sexually Compulsive Men Who Practice Intentional Unsafe Sex in São Paulo, Brazil
Corresponding Author
Maria Luiza S. do Amaral MS
Department and Institute of Psychiatry, Clinicas' Hospital (HC), University of São Paulo Medical School (FMUSP), São Paulo, Brazil
Corresponding Author: Maria Luiza S. do Amaral, MS, Department and Institute of Psychiatry, Clinicas' Hospital (HC), University of São Paulo Medical School (FMUSP), Rua Dr. Ovídio Pires de Campos, 785. Cerqueira Cesar, São Paulo CEP 05403-010, Brazil. Tel: 5511993330610; Fax: 55-11-29712630; E-mail: [email protected]Search for more papers by this authorCarmita H.N. Abdo MD, PhD
Department and Institute of Psychiatry, Clinicas' Hospital (HC), University of São Paulo Medical School (FMUSP), São Paulo, Brazil
Search for more papers by this authorHermano Tavares MD, PhD
Department and Institute of Psychiatry, Clinicas' Hospital (HC), University of São Paulo Medical School (FMUSP), São Paulo, Brazil
Search for more papers by this authorMarco de Tubino Scanavino MD, PhD
Department and Institute of Psychiatry, Clinicas' Hospital (HC), University of São Paulo Medical School (FMUSP), São Paulo, Brazil
Search for more papers by this authorCorresponding Author
Maria Luiza S. do Amaral MS
Department and Institute of Psychiatry, Clinicas' Hospital (HC), University of São Paulo Medical School (FMUSP), São Paulo, Brazil
Corresponding Author: Maria Luiza S. do Amaral, MS, Department and Institute of Psychiatry, Clinicas' Hospital (HC), University of São Paulo Medical School (FMUSP), Rua Dr. Ovídio Pires de Campos, 785. Cerqueira Cesar, São Paulo CEP 05403-010, Brazil. Tel: 5511993330610; Fax: 55-11-29712630; E-mail: [email protected]Search for more papers by this authorCarmita H.N. Abdo MD, PhD
Department and Institute of Psychiatry, Clinicas' Hospital (HC), University of São Paulo Medical School (FMUSP), São Paulo, Brazil
Search for more papers by this authorHermano Tavares MD, PhD
Department and Institute of Psychiatry, Clinicas' Hospital (HC), University of São Paulo Medical School (FMUSP), São Paulo, Brazil
Search for more papers by this authorMarco de Tubino Scanavino MD, PhD
Department and Institute of Psychiatry, Clinicas' Hospital (HC), University of São Paulo Medical School (FMUSP), São Paulo, Brazil
Search for more papers by this authorAbstract
Introduction
There is evidence of an association between the practice of intentional unsafe sex among men who have sex with men (MSM) and sensation seeking and impulsivity. However, other aspects of personality have been less frequently investigated.
Aims
This study aims to investigate the association between the practice of intentional unsafe sex and personality traits in individuals who sought treatment and met the criteria for compulsive sexual behavior in São Paulo, Brazil.
Methods
The sample consisted of 69 sexually compulsive MSM. The participants underwent psychiatric evaluation and an interview to define intentional condomless sex and completed self-report instruments.
Main Outcome Measures
The participants completed the following measures: the Temperament and Character Inventory and the Sexual Compulsivity Scale.
Results
Twenty-five participants (36%) reported intentional unsafe sex with casual partners, of whom 84% were gay and 16% bisexual (P < 0.05). Fifteen (22%) individuals reported being HIV positive, and 11 (73%) of them practiced intentional unprotected anal intercourse (P < 0.05). The mean of sexual compulsivity was associated with men who engaged in intentional unsafe sex (P = 0.01). Men who reported intentional unsafe sex scored significantly higher on the novelty seeking temperament dimension (P < 0.05) and scored significantly lower on the self-directedness character dimension (P < 0.001). However, self-directedness predicted intentional unsafe sex in the multiple logistic regression (P = 0.001).
Conclusions
Sexually compulsive individuals who practiced intentional unsafe sex presented lower self-directedness than the group who did not engage in intentional unsafe sex, which suggests less autonomy regarding life itself. To the best of our knowledge, this is the first study to consider intentional unsafe sex in sexually compulsive men. Amaral MLS, Abdo CHN, Tavares H, and Scanavino MdeT. Personality among sexually compulsive men who practice intentional unsafe sex in São Paulo, Brazil. J Sex Med 2015;12:557–566.
References
- 1Parsons JT, Bimbi DS. Intentional unprotected anal intercourse among sex who have sex with men: Barebacking—From behavior to identity. AIDS Behav 2007; 11: 277–287.
- 2Carballo-Dieguez A, Ventuneac A, Bauermeister J, Dowsett GW, Dolezal C, Remien RH, Balan I, Rowe M. Is “bareback” a useful construct in primary HIV-prevention? Definitions, identity and research. Cul Health Sex 2009; 11: 51–65.
- 3Halkitis PN. Behavioral patterns, identity, and health characteristics of self-identified barebackers: Implications for HIV prevention and intervention. J LGBT Health Res 2007; 3: 37–48.
- 4Bancroft J. Sexual behavior that is “out of control”: A theoretical conceptual approach. Psychiatr Clin North Am 2008; 31: 593–601.
- 5Kafka MP, Prentky RA. Preliminary observations of DSM-III-R Axis I comorbidity in men with paraphilias and paraphilia-related disorders. J Clin Psychiatry 1994; 55: 481–487.
- 6Parsons JT, Kelly BC, Bimbi DS, Muench F, Morgenstern J. Accounting for the social triggers of sexual compulsivity. J Addict Dis 2007; 26: 5–16.
- 7Reisner S, Mimiaga M, Mayer K, Tinsley J, Safren S. Tricks of the trade: Sexual health behaviors, the context of HIV risk, and potential prevention intervention strategies for male sex workers. J LGBT Health Res 2008; 4: 195–209.
- 8Coleman E, Raymond N, McBean A. Assessment and treatment of compulsive sexual behavior. Minn Med 2003; 86: 42–47.
- 9Coleman E, Miner M, Ohlerking F, Raymond N. Compulsive sexual behavior inventory: A preliminary study of reliability and validity. J Sex Marital Ther 2001; 27: 325–332.
- 10Kafka MP. Successful antidepressant treatment of nonparaphilic sexual addictions and paraphilias in men. J Clin Psychiatry 1991; 52: 60–65.
- 11Carnes P. Sexual addiction screening test. Tenn Nurse 1991; 54: 29.
- 12Coleman E. Is your patient suffering from compulsive sexual behavior? Psychiatr Ann 1992; 22: 320–325.
- 13Kalichman SC, Greenberg J, Abel GG. HIV-seropositive men who engage in high-risk sexual behaviour: Psychological characteristics and implications for prevention. AIDS Care 1997; 9: 441–450.
- 14Kalichman SC, Rompa D. Sexual sensation seeking and Sexual Compulsivity Scales: Reliability, validity, and predicting HIV risk behavior. J Pers Assess 1995; 65: 586–601.
- 15Dodge B, Reece M, Cole SL, Sandfort TG. Sexual compulsivity among heterosexual college students. J Sex Res 2004; 41: 343–350.
- 16Benotsch EG, Kalichman SC, Pinkerton SD. Sexual compulsivity in HIV-positive men and women: Prevalence, predictors and consequences of high risk sexual behaviors. Sex Addict Compuls 2001; 8: 83–89.
10.1080/10720160127561 Google Scholar
- 17Blain LM, Muench F, Morgenstern J, Parsons JT. Exploring the role of child sexual abuse and posttraumatic stress disorder symptoms in gay and bisexual men reporting compulsive sexual behavior. Child Abuse Negl 2012; 36: 413–422.
- 18Benotsch EG, Kalichman SC, Kelly JA. Sexual compulsivity and substance use in HIV-seropositive men who have sex with men: Prevalence and predictors of high-risk behaviors. Addict Behav 1999; 24: 857–868.
- 19Grov C, Parsons JT, Bimbi DS. Sexual compulsivity and sexual risk in gay and bisexual men. Arch Sex Behav 2010; 39: 940–949.
- 20Parsons JT, Bimbi DS, Halkitis PN. Sexual compulsivity among gay/bisexual male escorts who advertise on the Internet. Sex Addict Compuls 2001; 8: 101–112.
10.1080/10720160127562 Google Scholar
- 21Reece M. HIV-related mental health care: Factors influencing dropout among low-income, HIV-positive individuals. AIDS Care 2003; 15: 707–716.
- 22Coleman E, Horvath KJ, Miner M, Ross MW, Oakes M, Rosser BRS. Men's ISM-IIT. Compulsive sexual behavior and risk for unsafe sex among internet using men who have sex with men. Arch Sex Behav 2010; 39: 1045–1053.
- 23Semple SJ, Zians J, Strathdee SA, Patterson TL. Sexual marathons and methamphetamine use among HIV-positive men who have sex with men. Arch Sex Behav 2009; 38: 583–590.
- 24Dilley JW, Loeb L, Marson K, Chen S, Schwarcz S, Paul J, McFarland W. Sexual compulsiveness and change in unprotected anal intercourse—Unexpected results from a randomized controlled HIV counseling intervention study. J Acquir Immune Defic Syndr 2008; 48: 113–114.
- 25Grov C, Golub SA, Mustanski B, Parsons JT. Sexual compulsivity, state affect, and sexual risk behavior in a daily diary study of gay and bisexual men. Psychol Addict Behav 2010; 24: 487–497.
- 26Dodge B, Reece M, Herbenick D, Fisher C, Satinsky S, Stupiansky N. Relations between sexually transmitted infection diagnosis and sexual compulsivity in a community-based sample of men who have sex with men. Sex Transm Infect 2008; 84: 324–327.
- 27Stall R, Mills TC, Williamson J, Hart T, Greenwood G, Paul J, Pollack L, Binson D, Osmond D, Catania JA. Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. Am J Public Health 2003; 93: 939–942.
- 28Mustanski BS. Are sexual partners met online associated with HIV/STI risk behaviours? Retrospective and daily diary data in conflict. AIDS Care 2007; 19: 822–827.
- 29Mustanski B, Garofalo R, Herrick A, Donenberg G. Psychosocial health problems increase risk for HIV among urban young men who have sex with men: Preliminary evidence of a syndemic in need of attention. Ann Behav Med 2007; 34: 37–45.
- 30Cloninger CR, Svrakic DM, Przybeck TR. A psychobiological model of temperament and character. Arch Gen Psychiatry 1993; 50: 975–990.
- 31Svrakic DM, Draganic S, Hill K, Bayon C, Przybeck TR, Cloninger CR. Temperament, character, and personality disorders: Etiologic, diagnostic, treatment issues. Acta Psychiatr Scand 2002; 106: 189–195.
- 32Shuper PA, Joharchi N, Rehm J. Personality as a predictor of unprotected sexual behavior among people living with HIV/AIDS: A systematic review. AIDS Behav 2014; 18: 398–410.
- 33Cooper ML, Agocha VB, Sheldon MS. A motivational perspective on risky behaviors: The role of personality and affect regulatory processes. J Pers 2000; 68: 1059–1088.
- 34Trobst KK, Herbst JH, Masters HL III, Costa PT Jr. Personality pathways to unsafe sex: Personality, condom use, and HIV risk behaviors. J Res Pers 2002; 36: 117–133.
- 35Pinto J, Carvalho J, Nobre PJ. The relationship between the FFM personality traits, state psychopathology, and sexual compulsivity in a sample of male college students. J Sex Med 2013; 10: 1773–1782.
- 36 World Health Organization. The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 1992.
- 37Goodman A. What's in a name? Terminology for designating a syndrome of driven sexual behavior. Sex Addict Compuls 2001; 8: 191–213.
10.1080/107201601753459919 Google Scholar
- 38Kalichman SC, Johnson JR, Adair V, Rompa D, Multhauf K, Kelly JA. Sexual sensation seeking: Scale development and predicting AIDS-risk behavior among homosexually active men. J Pers Assess 1994; 62: 385–397.
- 39Scanavino MdT, Ventuneac A, Rendina HJ, Abdo CHN, Tavares H, Amaral MLS, Messina B, Reis SC, Vieira JC, Martins JPLB, Parsons JT. Sexual compulsivity scale, compulsive sexual behavior inventory, hypersexual disorder screening inventory: Translation, adaptation, and validation for use in Brazil. Arch Sex Behav 2014. doi: 10.1007/s10508-014-0356-5.
- 40Amorim P. Mini International Neuropsychiatric Interview (MINI):Validation of a short structured diagnostic interview. Rev Bras Psiquiatr 2000; 22: 106–115.
10.1590/S1516-44462000000300003 Google Scholar
- 41Fuentes D, Tavares H, Camargo CHP, Gorenstein C. Inventário de Temperamento e Caráter de Cloninger: Validação da Versão em Português [Temperament and Character Inventory of Cloninger: Validation of the Portuguese Version]. In: C Gorenstein, LHSG Andrade, AW Zuardi (Org.), eds. Escalas de Avaliação Clínica em Psiquiatria e Psicofarmacologia [Scales for Clinical Assessment in Psychiatry and Psychopharmacology]. São Paulo: Lemos; 2000: 363–369.
- 42Halkitis PN, Wilton L, Wolitski RJ, Parsons JT, Hoff CC, Bimbi DS. Barebacking identity among HIV-positive gay and bisexual men: Demographic, psychological, and behavioral correlates. AIDS 2005; 19: S27–35.
- 43Leobon A, Velter A, Engler K, Drouin MC, Otis J. A relative profile of HIV-negative users of French websites for men seeking men and predictors of their regular risk taking: A comparison with HIV-positive users. AIDS Care 2011; 23: 25–34.
- 44Berg RC. Barebacking among MSM internet users. AIDS Behav 2008; 12: 822–833.
- 45Mansergh G, Marks G, Colfax G, Guzman R, Rader M, Buchbinder S. “Barebacking” in a diverse sample of men who have sex with men. AIDS 2002; 16: 653–659.
- 46Grov C, DeBusk JA, Bimbi DS, Golub SA, Nanin JE, Parsons JT. Barebacking, the Internet, and harm reduction: An intercept survey with gay and bisexual men in Los Angeles and New York City. AIDS Behav 2007; 11: 527–536.
- 47Scanavino MdT, Ventuneac A, Abdo CHN, Tavares H, Amaral MLS, Messina B, Reis SC, Martins JPLB, Parsons JT. Compulsive sexual behavior and psychopathology among treatment-seeking men in São Paulo, Brazil. Psychiatry Res 2013; 209: 518–524.
- 48Elford J, Bolding G, Davis M, Sherr L, Hart G. Barebacking among HIV-positive gay men in London. Sex Transm Dis 2007; 34: 93–98.
- 49Grov C, Bamonte A, Fuentes A, Parsons JT, Bimbi DS, Morgenstern J. Exploring the internet's role in sexual compulsivity and out of control sexual thoughts/behaviour: A qualitative study of gay and bisexual men in New York City. Cult Health Sex 2008; 10: 107–125.
- 50Starks TJ, Parsons JT. Adult attachment among partnered gay men: Patterns and associations with sexual relationship quality. Arch Sex Behav 2014; 43: 107–117.
- 51Cloninger CR, Svrakic NM, Svrakic DM. Role of personality self-organization in development of mental order and disorder. Dev Psychopathol 1997; 9: 881–906.
- 52 APA. American Psychiatric Association: Diagnostic and statistical manual of mental disorders. Fifth. Aufl. Washington, DC: American Psychiatric Association; 2013.
- 53Black DW, Kehrberg LLD, Flumerfelt DL, Schlosser SS. Characteristics of 36 subjects reporting compulsive sexual behavior. Am J Psychiatry 1997; 154: 243–249.
- 54Raymond NC, Coleman E, Miner MH. Psychiatric comorbidity and compulsive/impulsive traits in compulsive sexual behavior. Compr Psychiatry 2003; 44: 370–380.
- 55Montaldi D. Understanding hypersexuality with an Axis II model. J Psychol Human Sex 2003; 14: 1–23.
10.1300/J056v14n04_01 Google Scholar
- 56Veras MAdSM. Comportamentos e práticas sexuais, acesso à prevenção, prevalência de HIV e outras infecções de transmissão sexual entre gays, travestis e homens que fazem sexo com homens (HSH) na região central de São Paulo [Sexual behavior and practices, access to prevention, prevalence of HIV and other infections of sexual transmission among gay men, transvestites and men who have sex with men (MSM) in the central region of the São Paulo.]. In. 200 ed. Revista Pesquisa Fapesp; 2012:Outubro 2012.
