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Monday, March 18, 2019

Asexuality: Sexual Health Does Not Require Sex

Asexuality: Sexual Health Does Not Require Sex. Brenna Conley-Fonda & Taylor Leisher. Sexual Addiction & Compulsivity, Volume 25, 2018 - Issue 1, Pages 6-11. https://doi.org/10.1080/10720162.2018.1475699

ABSTRACT: The working definition of sexual health published in this issue of Sexual Addiction and Compulsivity promises to advance theory, research, practice, and training. The definition implicitly assumes that desire is a requirement of healthy sexuality. Recent emergence of research and advocacy for the asexual identity challenges the contemporary definition of sexual health and offers questions for reflective practice.

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The concept of “sexual health” is inherently fluid and dynamic, as it is constantly changing and shifting on both micro and macro levels. However difficult the task may be, a definition is necessary to provide a framework to assess client behavior, communicate the needs of clients and partners, and develop best practices to help clients achieve their goals. Further, a definition of sexual health provides a mechanism which prevents clinicians from pathologizing behaviors which may not in fact represent dysfunction or “problematic sexual behavior.” This is necessary given psychology's history of pathologizing what we have now come to understand as normal and healthy expressions of sexuality: BDSM, homosexuality, bisexuality, and polyamory.

Numerous agencies and organizations have attempted to define sexual health. These efforts are attempts to express and qualify this elusive “sexual health” definition. As the Society for the Advancement of Sexual Health stated, it is “…committed to an intentional effort to expand the scope of our work and contribute to an inclusive, contemporary view of sexual health.” (Southern, 2017 Southern, S. (2017). Editorial. Sexual Addiction and Compulsivity, 24(4), 241. doi:10.1080/10720162.2017.1408999, p. 241).

As clinicians and editorial assistants, we believe the definition of sexual health should contain an explicit mention of “asexual orientation.” The absence of asexuality speaks to the lack of understanding currently reported in the sexual health/addiction field. We believe the concept of asexuality and self-identification of an asexual lifestyle should be explored as a facet of sexual health.

Asexuality defined
There isn't a singular definition of “normal” asexuality. There are a range of experiences within the orientation: some asexual individuals engage in partnered sexual activity, solitary sexual activity, or abstain from sex completely (Bogaert, 2004 Bogaert, A. (2004). Asexuality: Prevalence and associated factors in a national probability sample. The Journal of Sex Research, 41(3), 279–287. doi:10.1080/00224490409552235) However, the common thread throughout is that asexuals have never experienced sexual attraction or sexual desire throughout the course of their life (Bogaert, 2015 Bogaert, A. (2015). Asexuality: What it is and why it matters. The Journal of Sex Research, 52(4), 362–379. Retrieved from. doi:10.1080/00224499.2015.1015713). And while sexual interest and desire naturally fit into the definition of sexual health, the absence of desire challenges the concept of sexual orientation being centered around the presence of sexual desire.

Recently, an organization called The Asexual Visibility and Education Network (AVEN), emerged with the goals to create awareness and promote acceptance of asexuality, while building community around the orientation (AVEN, n.d. Asexual Visibility and Education Network (AVEN). (n.d.). Overview. https://www.asexuality.org/?q=overview.html). AVEN defined the asexual orientation as follows,

An asexual is someone who does not experience sexual attraction. Unlike celibacy, which people choose, asexuality is an intrinsic part of who we are. Asexuality does not make our lives any worse or any better, we just face a different set of challenges than most sexual people. There is considerable diversity among the asexual community; each asexual person experiences things like relationships, attraction, and arousal somewhat differently. (AVEN, n.d. Asexual Visibility and Education Network (AVEN). (n.d.). Overview. https://www.asexuality.org/?q=overview.html)

The lack of sexual desire as reported by asexual people, means that these individuals can make meaningful relationships in their lives that are not based on sexual functioning. As a result, asexuality can be distinguished from inhibited or hypoactive sexual desire as they are described by the American Psychiatric Association (2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). (DSM-V). Arlington, VA: Author). The distinction between a sexual desire disorder and an asexual orientation has significant implications for treatment and attitudes towards an asexual person.

Sexual desire disorder
Desire disorders include low sexual desire or interest within an individual or between partners in a sexual relationship. There are many theories or models that account for lack or loss of desire including biological, developmental, intrapsychic, relational, and cultural factors. Two specific diagnoses include Female Sexual Interest/Arousal Disorder (302.72) and Male Hypoactive Sexual Desire Disorder (302.71) (DSM-V; American Psychiatric Association, 2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). (DSM-V). Arlington, VA: Author, p. 433–436; 440–443). It is not uncommon for one partner to report the other has low desire, which typically means less interest in sex than the one who applies the label. Therefore, diagnoses of sexual desire disorders must satisfy certain criteria.

Female Sexual Interest/Arousal Disorder blurs the sexual responses of interest and arousal. Low sexual desire in this context may be presented as lack of interest in sexual activity, absence of erotic or sexual thoughts, reluctance to initiate sex, and inability to respond to a partner's sexual invitations (APA, 2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). (DSM-V). Arlington, VA: Author, p. 433). Female sexual interest/arousal disorder may be lifelong or acquired; generalized or situational; and range from mild to moderate or severe distress. Symptoms must have persisted for at least 6 months, and the symptoms cannot be better explained by a nonsexual medical or mental condition or by severe relationship distress such as partner violence. At least three of the following characteristics are required for diagnosis of the disorder (APA, 2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). (DSM-V). Arlington, VA: Author, p. 433):

1. Absent/reduced interest in sexual activity.

2. Absent/reduced sexual/erotic thoughts or fantasies.

3. No/reduced initiation of sexual activity, and typically unresponsive to a partner's attempts to initiate.

4. Absent/reduced sexual excitement/pleasure during sexual activity in almost all or all (approximately 75–100%) sexual encounters (in identified situational contexts or, if generalized, in all contexts).

5. Absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues (e.g., written, verbal, visual).

6. Absent/reduced genital or nongenital sensations during sexual activity in almost or all (approximately 75–100%) sexual encounters (in identified situational contexts or, if generalized, in all contexts).

Male Hypoactive Sexual Desire Disorder (APA, 2013 Gressgård, R. (2012). Asexuality: From pathology to identity and beyond. Psychology & Sexuality, 4(2), 179–192. doi:10.1080/19419899.2013.774166, pp.440–443) remains distinct from female sexual interest/arousal disorder in arousal/excitement and orgasm/ejaculation in sexual responding. Some of the shared criteria with female sexual interest/arousal disorder include: at least 6 months duration; lifelong vs. acquired; generalized vs. situational; and mild-moderate-severe distress. However, the major diagnostic feature places hypoactive sexual desire in context:

Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity. The judgment of deficiency is made by the clinician, taking into account factors that affect sexual functioning, such as age and general and sociocultural contexts of the individual's life. (APA, 2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). (DSM-V). Arlington, VA: Author, p. 440)

Both male hypoactive sexual desire disorder and female sexual interest/arousal disorder are associated with five conditions in the DSM-V (APA, 2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). (DSM-V). Arlington, VA: Author):

1. Partner factors (e.g., partner's sexual problems, partner's health status);

2. Relationship factors (poor communication, desire discrepancies);

3. Individual vulnerability factors (poor body image, history of sexual or emotional abuse) and/or psychiatric comorbidity (depression, anxiety) or stressors (job loss, bereavement);

4. Cultural/religious factors (attitudes, inhibitions or prohibitions against sexual activity); and

5. Medical factors (including effects of medication).

Sexual desire disorders are, by definition, distressing for the person experiencing them. The lack of desire is experienced as a loss or void for the person, and the ability to ethically and humanely treat the disorder offers the perspective that sexual desire disorders are change-worthy themselves. However, normal or healthy asexuality is not experienced as a problem, loss, or disorder. Brotto and Yule (2017 Brotto, L., & Yule, A. (2017). Asexuality: Sexual orientation, paraphilia, sexual dysfunction, or none of the above? Archives of Sexual Behavior, 46(3), 619–627. doi:10.1007/s10508-016-0802-7) found there is no evidence to suggest that asexuality is a psychiatric disorder, sexual dysfunction, or paraphilia. Rather, their data suggested that asexuality is a recognizable sexual orientation. As the asexuality definition proposed by AVEN (n.d. Asexual Visibility and Education Network (AVEN). (n.d.). Overview. https://www.asexuality.org/?q=overview.html) suggests, asexual people seek to inform clinicians and society-at-large that their sexual orientation is not a sexual desire disorder needing to be treated.

Excluding asexuality from sexual health may harm
The lack of sexual interest or desire that asexual people experience has historically been pathologized as a disorder (Gressgård, 2012 Gressgård, R. (2012). Asexuality: From pathology to identity and beyond. Psychology & Sexuality, 4(2), 179–192. doi:10.1080/19419899.2013.774166). The authors believe that this exclusion furthers the experience of invisibility described by asexuals and contributes to the discrimination which they experience. In a study investigating intergroup bias towards asexuals, asexuals were evaluated more negatively by participants. They were viewed as less human than other sexual minority groups, and contact with asexual people was considered less desirable than contact with homosexual and heterosexual people (MacInnis & Hodson, 2012 MacInnis, C., & Hodson, G. (2012). Intergroup bias toward “Group X”: Evidence of prejudice, dehumanization, avoidance, and discrimination against asexuals. Group Processes & Intergroup Relations, 15(6), 725–743. Retrieved from. doi:10.1177/1368430212442419). This recognizable bias fuels the pathologizing of asexuality and reinforces a need for the inclusion of the orientation in a contemporary definition of sexual health.

The exclusion of asexual people from the working definition of sexual health, presented in this issue by Southern (2018 Southern, S. (2018, in press). Recent perspectives on sexual health. Sexual Addiction and Compulsivity, 25(1), in press), erases any acknowledgement of the sexual experiences of asexuals. This exclusion can influence not only any positive and healthy sexual experiences, but also any negative or clinically significant ones. The result then, is that all data related to the sexual experiences of asexuals are not observed or studied, effectively disabling any definition from gaining a more nuanced understanding of sexual health for this emerging population.

Excluding or pathologizing of asexual experiences, reflects an implicit a disqualification of the subjective experience of persons choosing this lifestyle. Asexuality itself is not considered a “problem” within the asexual community (AVEN, n.d. Asexual Visibility and Education Network (AVEN). (n.d.). Overview. https://www.asexuality.org/?q=overview.html). While other sexual minorities may be validated in their sexual desires, a lack of sexual desire transgresses the social narrative that all people naturally have sexual desire. As such, to maintain the status quo, asexuals are placed into an “other” category and deemed pathologically troubled. It is this mindset, that all people must have sexual desire to be sexually healthy, that leads to the exclusion of asexual people from the current definition of sexual health.


It is important to include asexuality

The authors believe that there can be much learned about the nature of sexuality through the study and inclusion of asexuality. An example being clarity around the role of sexual desire in determining sexual health. The question, “Is someone who has sex for reasons other than sexual desire considered to be sexually healthy?” offers insight into how contemporary thought places sexual desire as a necessary component to sexual activity. Asexual persons do not consider their sexuality to be inherently “the problem.” In addition, they do not want to be seen as having hypoactive sexual desire and experience the shame that may come with psychiatric diagnosis.

It is also noteworthy that asexuals do enter romantic relationships. It has been found in a study done by Bogaert (2004 Bogaert, A. (2004). Asexuality: Prevalence and associated factors in a national probability sample. The Journal of Sex Research, 41(3), 279–287. doi:10.1080/00224490409552235), that up to 44% of identified asexual people in a British survey were currently in a long-term relationship or had been previously. For the asexual person, the major concern for them within the relationship could be the emotional connection, rather than the sexual one. The result, then, is that their engagement in sexual activity could be done to please their sexual partner, and possibly facilitate emotional connection (Bogaert, 2004 Bogaert, A. (2004). Asexuality: Prevalence and associated factors in a national probability sample. The Journal of Sex Research, 41(3), 279–287. doi:10.1080/00224490409552235). This dynamic can offer valuable insight into how emotional intimacy and connectivity can be facilitated with or without sexual desire being present.

By incorporating asexuality into a definition of sexual health, the importance of cultural competence when working with asexuals is stressed, facilitating sexual health professionals to seek out and gain knowledge about the asexual community. A culturally competent professional should recognize the difference between a sexual desire disorder and the asexual orientation. This distinction can be the difference between asexual people feeling comfortable entering therapy for any reason and accepted by the clinician.

Conclusion and recommendations
The inclusion of asexuality in the definition of sexual health can provide numerous benefits and insights into how sexual health is defined for both asexual and sexual people. As previously stated, the exclusion of asexual people from the working definition demonstrates a lack of understanding and consideration for the wide berth of sexualities. Recognizing that asexual people can maintain a healthy sexual life with or without sexual desire being present allows for a more nuanced and inclusive discussion about the role of sexual desire in sexual health. Ultimately, by providing space for asexual people within the sexual health definition, a community far too often overlooked is able to be recognized and respected.

As we continue to address the definition of sexual health, it will be helpful to expand the construct to include diversity in terms of gender, orientation, preference, and identity. The following questions may be helpful to encourage the advancement of sexual health in the association, consulting room, and community. Our goals are reflective practice and equity.

1. How does one define a constantly changing construct such as sexuality?

2. Within the current construct of sexuality, does sexual desire have to exist in order for intimacy and connectedness to be present within a relationship? And if so, does this reflect a personal bias or a necessary component to connection in the context of said relationship?

3. Does the thought that an individual can exist absent of sexual desire while still engaging in meaningful intimate connected relationship pose a threat to the field of sex therapy?

4. What are unique elements of sexual health for asexual people, that may be distinct from sexual people?

5. How can sexual health professionals develop cultural competence to better work with the asexual community?


References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). (DSM-V). Arlington, VA: Author.
Asexual Visibility and Education Network (AVEN). (n.d.). Overview. Retrieved from https://www.asexuality.org/?q=overview.html
Bogaert, A. (2004). Asexuality: Prevalence and associated factors in a national probability sample. The Journal of Sex Research, 41(3), 279–287. doi:10.1080/00224490409552235
Bogaert, A. (2015). Asexuality: What it is and why it matters. The Journal of Sex Research, 52(4), 362–379. Retrieved from. doi:10.1080/00224499.2015.1015713
Brotto, L., & Yule, A. (2017). Asexuality: Sexual orientation, paraphilia, sexual dysfunction, or none of the above? Archives of Sexual Behavior, 46(3), 619–627. doi:10.1007/s10508-016-0802-7
Gressgård, R. (2012). Asexuality: From pathology to identity and beyond. Psychology & Sexuality, 4(2), 179–192. doi:10.1080/19419899.2013.774166.[Taylor & Francis Online], ,
MacInnis, C., & Hodson, G. (2012). Intergroup bias toward “Group X”: Evidence of prejudice, dehumanization, avoidance, and discrimination against asexuals. Group Processes & Intergroup Relations, 15(6), 725–743. Retrieved from. doi:10.1177/1368430212442419
Southern, S. (2017). Editorial. Sexual Addiction and Compulsivity, 24(4), 241. doi:10.1080/10720162.2017.1408999
Southern, S. (2018, in press). Recent perspectives on sexual health. Sexual Addiction and Compulsivity, 25(1), in press.

Fieldwork from Poland suggested that well over 80% of people seeking treatment for sex addiction had a problem with pornography use, rather than issues from acting out with real sexual partners

Darryl Mead & Mary Sharpe (2019): Pornography and sexuality research papers at the 5th International Conference on Behavioral Addictions, Sexual Addiction & Compulsivity, Mar 2019. DOI: 10.1080/10720162.2019.1578312

ABSTRACT: The 5th International Conference on Behavioral Addictions was held in Cologne, Germany, April 23-25, 2018. It featured one of the largest concentrations of papers on pornography and sexual research presented in a single venue to date. Several key themes emerged from the conference. The theoretical basis for developing pornography and sexuality studies as components within the behavioral addiction research landscape is beginning to mature. Core components are the I-PACE theory and the development, validation, and employment in field studies of a steadily growing set of assessment tools including the Problematic Pornography Use Scale, the Brief Pornography Screener, and the Hypersexual Behavior Inventory. The field also benefitted from a keynote speech and a formal pro/con debate. The other principal debate was around the imminent release of ICD-11 by the World Health Organization and the way that Compulsive Sexual Behavior Disorder (CSBD) would be handled. There was a selection of papers looking at the debate from a variety of theoretical and practical points of view. Fieldwork from Poland suggested that well over 80% of people seeking treatment for CSBD had a problem with pornography use, rather than issues from acting out with real sexual partners.

Introduction

The overall message for pornography research from the three days of the 5th International Conference on Behavioral Addictions (ICBA, 2018) was one of positive advances in scientific understanding. Compared to the 4th Conference, 14 months earlier, there were greater aspirations in the scope of the research, significant progress in increasing the sample sizes in many studies, and improvements in sample quality. Underpinning all of these was the success of the Interaction of Person-Affect-Cognition-Execution (I-PACE) theory in providing a unifying framework. I-PACE not only starred in the sexuality papers, but also was referred to in several keynotes and featured in the work presented in several parallel research fields. It has become a common starting point for many behavioral addiction researchers, irrespective of their field of interest.

For sexuality and pornography researchers, the critical background factor was the imminent release of the 11th revision of the International Classification of Diseases (ICD-11) by the World Health Organization.  There were a number of papers attempting to predict what it would contain.  In some cases, the authors hoped to directly influence what was to be included and how it would be framed or limited. ICD-11 was released on June 18, 2018. It introduced 6C72, Compulsive Sexual Behavior Disorder (CSBD), within the category of Impulse Control Disorders. This differed from what some researchers proposed at ICBA 2018. They indicated that it might best be placed in the realm of addictions, within the category of Disorders Due to Addictive Behaviors, along with 6C50 Gambling Disorder and 6C51 Gaming Disorder. It is anticipated that there will be plenty of scope at upcoming ICBA meetings to develop the arguments to shape future updates of the ICD.  All abstracts for the 5th Conference have been published in a supplement to the Journal of Behavioral Addictions (Demetrovics 2018). The 6th International Conference on Behavioral Addictions was announced by the International Society for the Study of Behavioral Addictions for June 17-19, 2019 in Yokohama, Japan.

Keynote lecture
The keynote lecture by Germany’s eminent researcher and clinician Rudolf Stark on “Pathological Pornography Use—What We Know and What We Still Need to Know” was the first time pornography research had been given such a prominent place at the International Conference on Behavioral Addictions.

This keynote was in three parts. First, it considered pornography consumption as a social phenomenon on the Internet, noting the rising prevalence of use, particularly by men. Stark explored the neurobiological correlates of watching pornography as well as experiments covering distractibility and learning. Pornographic stimuli may activate reward systems and capture attention. The anticipation of sexual stimuli may activate reward systems in similar fashions as does anticipation of drugs, although these have not been directly compared.

The second part considered the potential to place problematic pornography use within the Beta draft of ICD-11 under 6C5Y, “Other Specified Disorders Due to Addictive Behaviors.” Two open questions were identified. First, within diagnostic criteria, are withdrawal and tolerance key features of pathological pornography use? Second, are different compulsive sexual behaviors, such as excessive impairing promiscuous dating behavior and pathological pornography use, different or do they constitute the same disorder?

The Keynote concluded by considering the current knowledge of the etiology of problematic pornography use. Stark made reference to the I-PACE model for problematic pornography use, covering data from experimental perspectives of cue reactivity, personality analysis, and co-occurring disorders. He then referred to his own work using the Trait Sexual Motivation Questionnaire (Stark et al, 2015) to consider if there may be subtypes of individuals with problematic porn use. He identified a Gratification group driven mainly by positive reinforcement, that is seeking pleasure, and a Compensation group where the reinforcement was negative, to avoid pain or other negative affect. He reported that around half of a clinical sample was in one group and half in the other.

Stark concluded by suggesting more work is needed to examine the natural course of problematic pornography use where non-problematic pornography use transitions into problematic use. He concluded by suggesting that the case for pornography use disorder in the ICD is strengthened by its foundation in the stimulation of systems relating to the processing of natural rewards. As to why a clinical diagnosis was not yet accepted, at the time of the conference, he suggested that it may be due to individual, socio-cultural, and political reasons.


Pro/Con debate on behavioral addictions

A welcome addition to ICBA 2018 was the introduction of a debate on the fundamental nature of behavioral addiction. The bonus for students of sexual behavioral addiction studies was that both speakers are recognized researchers in the pornography field, so they drew heavily on sexualitybased issues in framing their arguments.

Pro: “Behavioral Addictions: From Over-Pathologizing to Real Clinical Phenomenon” Aviv M. Weinstein, Israel
The arguments identified by Weinstein in favor of considering behavioral
addictions as a real clinical phenomenon were as follows:
Pathological gambling (PG), Internet gaming disorder (IGD), compulsive
sexual behavior (CSB), and compulsive buying (CB) all fit better into the
behavioral model of addiction than in an obsessive-compulsive model. He
argued that the neural mechanisms underlying the four conditions are
similar to those of drug addictions. These conditions and behaviors involve
changes in reward processing, inhibitory mechanisms, impulsivity, and
impaired control.
For example, he reported that video game playing was associated with
dopamine release similar in magnitude to that of drugs of abuse. He stated
that lower dopamine transporter levels and dopamine receptor D2 occupancy
in the striatum suggested poor sensitivity of dopamine
reward mechanisms.
He reported that high rates of co-morbidity between behavioral addictions
and other psychiatric disorders are evident including with respect to
depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), obsessive-
compulsive disorder (OCD), and personality disorders. He stated that
treating co-morbid conditions may not solve addiction problems.

Con: “Conceptualizing Behavioral Addictions without Pathologizing Common Behaviors.” Joel Billieux, Luxembourg

Joel Billieux began with a working hypothesis that “According to the criteria generally used to identify behavioral addictions, it is likely that the elevated involvement of any type of activity can be considered as a psychiatric disorder…”
The aim of this working hypothesis was to clarify possible confusion between “real” disorders and healthy passions and/or dysfunctional coping strategies. In this way, clinicians could avoid imposing inappropriate treatments, and the conference could contribute to the continuing credibility and relevance of (behavioral) addiction research.
After considering the literature generated for a range of potential “fringe” behaviors as test candidates for addiction, which might alternatively be seen as everyday behaviors and leisure activities, such as dancing, studying, taking selfies, fishing, and binge watching, the analysis considered the unhelpful power of the confirmatory approach.
Billieux’s talk ended with three recommendations. First, there is a need to shift from a confirmatory and symptom-based approach to a theoretically grounded and process-based approach, for example, the I-PACE model of problematic Internet use (Brand et al, 2016). Second, there is a need to improve the diagnostic approach of behavioral addiction with stronger clinical relevance and construct validity, with particular reference to the World Health Organization initiative to develop new screening tools (Carragher et al, 2018). Lastly, there is need to acknowledge the differences between high involvement (passion) versus dysfunctional involvement (addiction).


Presentations

Session: Hypersexual disorder: Relationships with transdiagnostic measures and clinically relevant behaviors Chair: Shane W. Kraus

“The Impulsive and Compulsive Aspects of Problematic Pornography Use and Hypersexuality”
Zsolt Demetrovics, Hungary with B. B}othe, I. T oth-Kir aly, and G. Orosz
This study used a Hungarian online sample that provided a useable dataset of 13,778 individuals, 30.1% female. It concluded that impulsivity and compulsivity did not contribute as importantly and directly to problematic pornography use as previously hypothesized, and that impulsivity may have a more prominent role in hypersexuality. This research has now been published as B}othe et al. (2018a) and interested readers are directed to the full paper.

“Sexting among Military Veterans: Prevalence and Correlates with Psychopathology, Suicidal Ideation, Impulsivity, Hypersexuality, and Sexually Transmitted Infections Steven D. Shirk, USA, with J. L. Turban, M. N. Potenza, R. A. Hoff, and S. W. Kraus
This study surveyed 283 male and female veterans via email, recording data across nine mental health, substance use, psychological, and sexual behavior instruments. Within the sample, 68.9% had sent sexually explicit texts, photos, or videos. Sexting rates in the sample were comparable with rates in civilian populations, with men having higher rates. Sexting rates were higher among individuals with less education and employment. Individuals reporting more religious service attendance were less likely to engage in sexting. Sending sexts was significantly linked to measures of depression, impulsivity, sensation seeking, and a lack of perseverance. Individuals who had sexted as compared to those who did not had more lifetime sexual partners and more symptoms of hypersexuality, but there were no group differences in reported sexually transmitted infections.

“Investigating the Psychometric Properties of the Hypersexual Behavior Inventory Using a Large-Scale, Nonclinical Sample across Gender and Sexual Orientation” Beata Bothe, Hungary, with R. Bartok, I. Toth-Kiraly, M. D Griffiths, Z. Demetrovics, and G. Orosz
This study was based on a substantial data set of over 18,000 individuals gathered in Hungary through the January 2017 online survey by Demetrovics et al., referenced above. The sample was one third women and about 6% non-heterosexual. The mean age was 33.6 years, standard deviation (SD) 11.1 years and range 18–76 years. The study measured coping, control, and consequences using the Hypersexual Behavior Inventory (HBI) and employed sexuality-related questions. The focus was on hypersexuality rather than pornography consumption. It concluded that the HBI has initial diagnostic value, but to secure a diagnosis, the patients would also need to undergo a formal clinical interview using defined criteria. Efforts to determine valid threshold values for the HBI were complicated by the presence of possible false positives. The group with the highest risk of developing hypersexual disorder may have been non-heterosexual males, with non-heterosexual females also apparently at high risk. Individuals with hypersexuality had lower levels of mindfulness, self-compassion and selfforgiveness. This research has now been published as Bothe et al. (2018b).

“Hypersexuality and Pornography Consumption in U.S. Military Veterans with Comorbid Pathological Gambling Disorder”
Joshua B. Grubbs, USA, with H. Chapman, L. Milner, and R. C. Reid
This study of 329 U.S. military veterans receiving inpatient treatment for gambling disorder (80% men, mean age 53 years, SD 11.5 years) reported on the prevalence of compulsive sexual behavior disorder (CSBD) in the group. Analysis suggested that gambling disorder was associated with greater levels of CSBD, although less than suggested by prior studies. Veterans with both gambling and sexual behavior problems exhibited greater distress and lower quality of life, as well as a greater severity of gambling-related difficulties.

“Psychological Correlates of Coping with Stressful Life Events among Hypersexual Patients in an Outpatient Setting” Rory C. Reid, USA
The study focused on the types of coping strategies and treatments used with hypersexual patients. The HBI is available in seven languages, including English and Spanish. A short form of the HBI with 8 items may be published soon, employing 5-point scales. Reid reported that in the clinical group he studied, shame, withdrawal, and turning to sex as a way of coping were related to hypersexuality. Patients were given training to reduce shame through self-compassion based on a model developed by Kristen Neff. In the setting of stressful experiences, hypersexuality was positively correlated with stress proneness and tendencies to adopt avoidant strategies and negatively correlated with assertive strategies. The strongest correlation appeared to exist with the tendency to distract oneself in response to a stressful event. Data in this study support the idea of hypersexual patients turning to sex as a way of distracting themselves from stressful events.

Session: The Diversity of Addictive Behaviors Chair: Koby Cohen “On the Relationship between Obsessive-Compulsive Symptoms, Depression, Anxiety and Sexual Addiction among Adults Who Use the Internet to Find Sexual Partners” Koby Cohen, Israel, with G. Levi, K. Cohen, and A. M. Weinstein
This small-scale Israeli study included 145 males of mean age 32.79 years (range 20–65) and 32 females, mean age 30.18 (20–63). The participants were recruited online via social network sites for finding sexual partners. It concluded that the largest contribution to sexual addiction was the presence of obsessive-compulsive symptoms, rather than depression or anxiety.

“Obsessive-Compulsive Disorder in Hypersexual Patients” Magdalena Smas-Myszczyszyn, Poland, with M. Lew-Starowicz
This Polish study considered levels of obsessiveness and compulsiveness
in three patient groups—compulsive masturbators, people who were engaging
in poorly controlled sexual relationships with multiple partners, and a
group doing both activities. The study interviewed 108 patients meeting the
criteria for hypersexual disorder and took measures using the Yale-Brown
Obsessive-Compulsive Scale, the Obsessive-Compulsive Inventory–Revised,
and the State-Trait Anxiety Inventory.
The authors found that the nature of obsessions and compulsions presented
by hypersexual patients is varied and includes non-sexual aspects.
Significant differences were found relating to the intensity of the obsessivecompulsive
symptoms and the level of anxiety between the three groups.
The group of compulsively masturbating patients had a higher level of anxiety
and a greater severity of obsessive-compulsive features than the two
other groups.
The basis for impaired control in the compulsive masturbation group
may relate to high levels of anxiety. Compulsive masturbation may be
obsessive-compulsive in nature, and this relationship should be considered
in planning therapy.


Session: Compulsive Sexual Behavior: Characteristics and Diagnostic Considerations
Chair: Marc N. Potenza

“Findings from the Polish Compulsive Sexual Behavior Disorder Field Trial”
Mateusz Gola, Poland, with E. Kowalewska, M. Wordecha, M. Lew-Starowicz, S. W.
Kraus, and M. N. Potenza
This study examined in a large Polish sample the proposed definition of
Compulsive Sexual Behavior Disorder (6C72) in the draft of ICD-11. In
particular, among those seeking treatment for CSB, the criteria proposed
for ICD-11 CSBD were examined, as were relationships with constructs
such as sex addiction and hypersexual disorder. Screening tests were also
examined, as were characteristics of people seeking treatment for CSB.
Recruitment of test subjects through Polish media resulted in 1,812 treatment
seekers, with 93% being male, 86% reporting problems with pornography,
87% reporting problems with masturbation, 18% having concerns
relating to casual sex, and 12% having concerns relating to paid sexual
activities. The sample had a mean age of 35.69 years (SD¼9.78).
In the sample, 50% to 72% of people interested in treatment for CSB
met criteria proposed for ICD-11 for CSBD. The most common problematic
behaviors included pornography viewing and masturbation. Screening
tools such as the Hypersexual Behavior Inventory, the Sexual Addiction
Screening Test, and the Brief Pornography Screener (BPS) appeared to
perform well. When compared to the group who failed to meet the criteria
for CSBD diagnosis under ICD-11, the individuals meeting the criteria
experienced more primary and secondary negative impacts on their life,
especially in the areas related to relationships.

“The Relationship between Compulsive Sexual Behavior and Sexual Performance and Attitudes among Males and Females” Ewelina Kowalewska, Poland, with K. Sro slak and M. Gola
Following a detailed introduction on the Multidimensional Sexuality Questionnaire (MSQ; Snell et al, 1993), the team described two studies. The first study examined relationships between dimensions on the MSQ and CSB symptoms in a general Polish population. The respondents were 200 males (mean age 25.78 years, SD¼5.75 years, 66.5% heterosexual) and 43 females (26.05 years, SD¼6.88 years, 79.5% heterosexual). The study used Polish versions of the MSQ, the Sexual Addiction Screening Test (SAST-PL) and the Brief Pornography Screener. In the case of women, problematic pornography use was correlated positively with anxiety about sexual aspects of one’s life, the tendency to be aware of the public impression that one’s sexuality makes on others, and the fear of engaging in sexual relations with another individual. Among males, all three of these aspects were strongly and significantly related to scores on the SAST-PL. Individual scores obtained on the SAST-PL for both genders were also strongly related to feelings of depression stemming from sexual behaviors. CSB features (as assessed with SAST) were negatively related to levels of  sexual satisfaction in both males and females.
In the second study, the researchers compared the general population to a group of patients seeking treatment for CSB. The male sample from Study 1 and a separate sample of 7 men meeting the criteria of hypersexual disorder (Kafka, 2010) who were seeking treatment for CSB were studied. Instruments employed included the MSQ, SAST (revised), and the BPS. There were significant differences between the clinical group and the males from Study 1 on scores of sexual anxiety, sexual assertiveness, and sexual monitoring and SAST-R scores. There were significant negative correlations between BPS scores and sexual esteem and sexual satisfaction, and significant positive correlations between BPS scores and sexual anxiety and sexual depression.

“Reward Learning in Men with Compulsive Sexual Behavior” Valerie Voon, UK
Taking Kuhn and Gallinat (2014) as a starting point for distinguishing between problematic and non-problematic levels of pornography use, Voon characterized the problematic users as men with CSB. She used the models for the proposed DSM-5 criteria for Hypersexual Behavior Disorder from Kafka (2010) and Reid et al. (2012), as well as the Carnes (2001) model of sexual addiction. This led her to posit a conceptual model which considered the potential overlaps between four factors: behavioral addiction, excessive desire, impulse control disorders, and obsessive-compulsive-spectrum disorder. At this point, the question was asked, “Do addiction theories apply to CSB?” The examination came from experimental perspectives of incentive motivation, the relationship of impulsivity to  compulsivity, and the role of negative reinforcement. To explore the question, Voon discussed a selection of cue-reactivity studies, including recent work by Gola et al. on wanting and liking. She then considered how conditioning or novelty-seeking may relate to attentional bias, particularly with respect to habituation. Men with CSB were more likely to prefer novel sexual cues than men without CSB. The CSB group also demonstrated a preference for cues conditioned to sexual and monetary outcomes. Men with CSB were also more likely to demonstrate greater habituation in dorsal cingulate activation to repeated sexual, versus monetary, stimuli. The degree of the habituation correlated with their preference for sexual novelty. Functional connectivity patterns in the dorsal cingulate to the ventral striatum and hippocampus relating to sexual cue outcomes differed over time for the CSB and non-CSB groups, with greater connectivity in later trials by the CSB group (Banca et al., 2016).

“Assessing Problematic Pornography Use in a Nationally Representative Sample ofU.S. Adults” Joshua B. Grubbs, USA, with S. Perry and S. W. Kraus
This study considered four potential predictors of self-reported pornography related problems in a nationally representative sample of 2,000 people. The predictors were pornography use, religious beliefs, moral disapproval and male gender. Test subjects were representative by age, gender, income, race, and U.S. Census Region. Within the sample, 1,061 (67% male) had used pornography in the past year. The tools used included the Cyber Pornography Use Inventory (CPUI-3), single item addiction, BPS, a single item Moral Disapproval of Pornography Use, pornography use by frequency and hours, religiousness (three items), and a DSM-5 measure. A substantial percentage (15.5%) of people reported some problems with pornography use based on a BPS score greater than 4. Overall, 6% of the population identified with the statement, “I am addicted to internet pornography.”

Cross-sectionally, self-reported pornography problems were positively associated with moral disproval, religiousness, pornography use, and the frequency of pornography use. They were associated with male gender but not age.

“A Rose by Any Other Name? Classification Issues Surrounding Compulsive Sexual Behavior for ICD-11” Marc N. Potenza, USA
This presentation summarized developments in the field of CSBD during
the past year and then outlined some issues requiring additional research.
It began with a recent history of CSBD in the context of DSM-5 and the
development of ICD-11. It noted that the Impulse Control Disorder
Workgroup had been the group most actively considering CSB for inclusion
in ICD-11. There has been significant discussion in the literature, particularly
in Kraus et al. (2018) that appeared in World Psychiatry, as to
whether it should be listed as an impulse control or addictive disorder.
Other key contributions included letters in Lancet Psychiatry from Potenza
et al. (2017) and Prause et al. (2017).
Potenza noted that data collection, particularly field testing, was ongoing
to see how the proposed definitions for ICD-11 diagnoses operate (e.g., in
clinical settings). The ICD-11 Beta test site has produced feedback which
led to the removal of the narrower term of “sex addiction.” The presentation
concluded with the suggestion that the inclusion of CSBD in the ICD
would support public health, prevention, program, policy, and treatments
relating to the disorder. It is expected that precise diagnostic criteria will be
developed through an ongoing process supported by additional data.

Session: Hypersexual Behavior in Different Contexts Chair: Yasser Khazaal

“Understanding and Predicting Profiles of Compulsive Sexual Behavior among Adolescents”
Yaniv Efrati, Israel, with M. Gola
This two-part study aimed to provide data on CSB features among adolescents
and hoped to propose a typology of CSB sub-types in this age
group. The first study of 1,182 Israeli school students (42.3% boys, mean
age 16.68 years, SD¼1.54 years) worked with the new Individual-based
Compulsive Sexual Behavior (I-CSB) tool (Efrati & Mikulincer, 2018).
Latent profile analysis was used to examine differences between groups
across four factors: unwanted consequences, negative affect, poor control,
and affect regulation. The study generated characteristic profiles for individuals
with no CSB (low), fantasizing CSB (medium), and CSB (high)
scores. The authors noted that the I-CSB scale showed that individuals
with high sexual desire, but also high fear of performance, generally
escaped to sexual fantasies rather than engaging in explicit sexual behaviors
with other people.
In the second study, participants were 618 Israeli adolescents (341 boys,
mean age 16.69 years, SD¼1.16 years). Instruments/assessments included/
measured the I-CSB, frequency of pornography use, off-line sexual
behaviors, sex-related online activities, Big Five inventory, revised UCLA
Loneliness Scale, and the Levenson feelings of control and attachment styles
through the Experiences in Close Relationships scale. The results were considered
with respect to the same characteristic profiles as in Study 1: no
CSB (low), fantasizing CSB (medium) and CSB (high) scores. Study 2
found that the majority of participants engaged in sexual activity, with
approximately 10% presenting a high level of CSB. Adolescents in the high
CSB group differed in their personality features (higher neuroticism and
lower agreeableness) from adolescents in the non-CSB and fantasizing
groups. The findings suggest possible risk factors of CSB development and
provide some hints for early prevention.
Adolescents with high levels of CSB symptoms may be characterized by
an external locus of control, anxious attachment, greater loneliness, higher
frequency of pornography use, and more sex-related online activities. The
CSB and CSB fantasizing groups were comprised of more boys than the
non-CSB group. In addition, more adolescents in the CSB group had offline
sexual experiences than the fantasizing CSB group, which in turn had
more than the non-CSB group.

“Implicit Associations in Hypersexual Disorder”
Jannis Engel, Germany, with M. Veit, C. Sinke, J. Kneer, C. Laier, U. Hartmann, T.
Hillemacher, and T. H. C. Kru€ger
In Germany, a group of 50 male, heterosexual participants (mean age
36.51 years, SD¼11.47 years) with Hypersexual Disorder (Kafka 2010) were
compared to 40 healthy volunteers (37.92 years, SD¼12.33 years) across a
selection of questionnaires, clinical interviews, neuropsychological tests, and
fMRI. Weekly pornography viewing by the two groups was respectively
87.53 minutes (SD¼125.50) and 18.93 minutes (SD¼19.2). A modified
version of the Implicit Association Test (Snagowski et al, 2015) was
employed. The responses of the hypersexual disorder group were distinct
from those of the healthy volunteers when plotting the Hypersexual
Behavior Inventory-19 scale against the Implicit Association Test. The
researchers concluded that the men classified as having hypersexual behavior
disorder had stronger implicit associations towards pornographic content
than did the healthy volunteers. The results indicate similarities to
findings from research on substance and behavioral addictions.

“Online Sexual Activities (OSAs) in Spain: Similarities and Differences across the Lifespan”
Jesus Castro-Calvo, Spain, with R. Ballester-Arnal, D. Gil-Llario, C. Gimenez-Garcia, & J. Billieux
Aims of this study were to compare the online sexual activities of people
of various ages and to compare the prevalence of problematic use of the
Internet for sexual purposes by different age groups. They recruited 1,000
participants, 200 in each age group of under 18 years, 18–25 years, 26–40,
41–60, and 61 or older. All groups had 50% males and females. Assessment
was on an ad hoc scale assessing online sexual activities and the Internet
Sex Screening Test (ISST).
Overall, nearly all age groups used the Internet for sexual purposes, with
prevalence rates exceeding those from previous national studies in Spain.
Differences between men and women were more evident among people
over 40 years old, and in women, the use of the Internet for sexual purposes
was infrequent in individuals over 40 years of age. There was a progressive
reduction of gender-related differences among younger
respondents.
In both males and females, non-arousal and solitary arousal activities
were most frequent in individuals aged between 18 and 25 years. Partnered
arousal activities were more prevalent in individuals aged between 26 and
40 years old. Age is an important variable in considering potential risks of
problematic Internet use for sexual purposes, particularly in males. The
highest prevalence of participants seemingly at risk of developing symptoms
of problematic Internet sexual use was in the group between 26 and
40 years old. In this group 33% were at risk. Overall, educational and
hedonic motives related to OSAs may lose importance with age, whereas
social motives may be more relevant later in life. However, factors related
to generational impacts as opposed to age per se cannot be excluded.

“Gambling Motives Questionnaire Adapted to Cybersex”
Yasser Khazaal, Switzerland, with E. Franc and S. Rothen
This Swiss project reported on the conversion of the Gambling Motives
Questionnaire, an established tool, into an instrument for investigating the
motives for the use of cybersex. The study also sought to validate the new
tool. The Cybersex Motives Questionnaire adapted a 17-question set from
gambling research into three motivation subscales.
The modification included the removal of several gambling questions
and the inclusion of several new potential cybersex motivations. The result
was a 17-item questionnaire which allows assessment on three sub-scales:
enhancement, coping, and social.
The validity of the new tool was examined for the principal component
analysis using an online sample of 191 adults who used cybersex and for
the confirmatory factor analysis using an online sample of 204 adults.
External validity was judged against the Sexual Desire Inventory. The selfselected
test sample population had a median age of 32 years, was 54.4%
male, with a breakdown of relationship status of 29.4% single, 45.4% in a
relationship, and 24.4% married. The sample reported as 81.3% heterosexual,
13.8% homosexual, and 4.9% bisexual. The researchers concluded that
the motivation factors, enhancement, social and coping were in line with
existing mainstream work in this field.

“Communicating the Science of Cybersex Addiction to Wider Audiences”
Darryl K. Mead, UK, with M. Sharpe
Research suggests that there is considerable potential for internet pornography
consumption to lead to addiction-related brain changes. How can
the emerging science of problematic pornography use be made accessible to
professionals and the wider public in effective ways?
After a brief review of the origins of The Reward Foundation, Mead and
Sharpe looked at the efficacy of some of the public communication initiatives
with which they have experimented in the past three years. Their
efforts fell into two main strands. First, they have concentrated on sharing
their knowledge of the behavioral-addiction-based pornography research
with healthcare professionals such as family doctors and sex therapists. In
2017, their one-day training workshop on the impact of Internet pornography
on mental and physical health was accredited by the Royal College
of General Practitioners in London for Continuing Professional
Development credits. Delivery of this training helps bridge the knowledge
gap between the behavioral addiction research community and the practitioners
who can apply that knowledge in a healthcare context. The authors
also published a summary of the cybersex papers presented at the 4th
ICBA Conference in a peer-reviewed journal for the sexual therapy community
to enhance their understanding of the neuroscience (Mead &
Sharpe, 2017).
Second, The Reward Foundation delivers lessons in secondary schools,
where it also trains teachers and engages with parents. Since 2017, The
Reward Foundation has developed lesson plans for use by a school’s own
teachers to help them unpack different aspects of problematic pornography
use in the classroom context. To date, this work has concentrated on the
government school sector and is now being extended experimentally into
faith-based schools. Religious educators are very cautious about encouraging
any discussion of the influence of pornography. However, using an evidence-
based behavioral addiction model makes access easier. Delivered
sensitively, the science of cybersex addiction can be acceptable to faithbased
communities, where its messages are seen as complementary, not
contradictory, to teachings in religions such as Catholicism and Islam.
Session: Problematic Pornography Use: Assessing Characteristics in a Rapidly Changing
Environment Chair: Joshua B. Grubbs

“Gender Considerations in the Correlates of Problematic Pornography Use”
Gretchen R. Blycker, USA, with S. W. Kraus, B. Bothe, A. Zsila, I. Toth-Kiraly, G.
Orosz, Z. Demetrovics, and M. N. Potenza
Health concerns linked to pornography viewing have been underresearched
within populations of women. The presentation began with an
assessment of the literature. It then utilized a large online sample to understand
how pornography viewing relates to hypersexuality, impulsivity,
childhood sexual abuse, and other factors.
Data from 24,372 pornography viewers (7,486 female) were gathered
through a large Hungarian news portal. Assessment tools included the
Problematic Pornography Consumption Scale (PPCS), the Hypersexual
Behavior Inventory, the Hypersexual Behavior Consequences Scale, the
Sexual Abuse History Questionnaire, the UCLA Loneliness Scale and the
ADHD Self Report Scale. Impulsivity was assessed using the UPPS-P scale.
As hypothesized, more men (97%) than women (78%) reported past year
pornography use. Men also reported greater hypersexuality, more hypersexuality-
related consequences, and more problematic pornography use than
women. Surprisingly, men also reported more childhood and adolescent
sexual abuse than women.
Women were more likely than men to score higher on ADHD measures
and impulsivity, including all except the Sensation-Seeking subscale. The
findings suggest that women who view pornography may be particularly
impulsive and may experience attentional difficulties. Additionally, 6.2% of
men and 4.7% of women recorded behaviors above the threshold for
Problematic Pornography Use.
The correlations between the PPCS and measures of impulsivity, hypersexuality,
loneliness, and ADHD were similar in men and women, suggesting
that common pathways may be operating across gender groups. The
particularly strong correlations in men between PPCS scores and hypersexuality
and its consequences is consistent with existing research and suggests
interventions for hypersexuality in men may need to consider targeting
pornography viewing.

“Binge Pornography Use and Masturbation as a Key Characteristic of Males Seeking Treatment for Compulsive Sexual Behaviors”
Małgorzata I. Wordecha, Poland with M. Wilk, E. Kowalewska, M. Skorko, A.
Łapi nski, and M. Gola
The study reported on nine men who had been referred by sexual health
centers for treatment of CSB. The group was a mix of heterosexual and
homosexual men with a mean age of 31.7 years (SD¼4.85). There was no
control group.
This study considered binge pornography use and masturbation with
respect to self-perceived factors hypothesized to be driving the behavior.
The factors were compared via ten weeks of daily diary data and a onehour
structured clinical interview. Diary records included measures of
sexual arousal, anxiety, stress, mood, and features of CSB, including time
spent viewing pornography and numbers of sessions of masturbation and
intercourse.
The researchers noted that there is a lack of scientific evidence to show
if bingeing is a standard characteristic of CSB. The study defined a binge
as watching pornographic content (and/or masturbating) for a few hours,
or repeating the activity many times during a day. Seven subjects had experienced
binges, ranging from duration of half-an-hour to half-a-day, up to
several times per day, and with frequency ranging from daily to several in
the ten weeks or only one day in their life. In the clinical interview, the
triggers reported were mainly stress and problems in personal life, fear of
failure, anger, loneliness, and rejection.
For processing the diary data, the criteria for bingeing were set at more
than two masturbations per day and a single pornography session lasting
more than one hour. Overall, the researchers reported that binge pornography
use may allow men to feel excitement and pleasure, while “turning
off” thinking and emotions. After the binge, all subjects reportedly experienced
negative emotions and thoughts about themselves. Four possible
explanations were put forward for binges: a stress-reducing mechanism,
increasing reactivity with stronger urges, habituation, and as a delay of climax
(“edging”). This paper has now been published by Wordecha
et al. (2018).

“Delay Discounting and Craving in the Context of Internet-Pornography-Use Disorder”
Stephanie Antons, Germany, with M. Brand
Antons and Brand focused on specific aspects of the I-PACE Model to
consider delay discounting. Delay discounting involves selecting smaller,
more immediate rewards over larger, later rewards. It is considered a form
of impulsivity and of the tendency to have difficulties in delaying gratification.
The researchers studied this aspect of impulsivity component through
the lens of craving in the affective and cognitive responses involved in
Internet-pornography-use disorder. They asked if craving has a mediating
or moderating effect on the link between delay discounting and the symptom
severity of Internet-pornography-use disorder. The sample was comprised
of 145 heterosexual males who use Internet pornography (average
age¼29.92 years).
Participants performed a delay-discounting task. Baseline craving and
symptom severity of Internet-pornography-use disorder were assessed using
questionnaires. While baseline craving was correlated with symptom severity
of Internet-pornography-use disorder on a bivariate level, delay discounting
and symptom severity of Internet-pornography-use disorder
were not.
The moderated regression analysis shows that participants who preferentially
selected immediate rewards rather than delayed rewards and who
showed higher baseline craving also had higher symptom severity of
Internet-pornography-use disorder. This finding suggests that decisionmaking
styles, in conjunction with affective factors such as baseline craving,
explain symptom severity of Internet-pornography-use disorder. Results
were also discussed in the context of potential neural mechanisms.

“Individual Delay-Discounting Rate in a Patient with Hypersexual Disorder”
Magdalena Smas-Myszczyszyn, Poland, with M. Lew-Starowicz
This sample of 108 patients with hypersexual disorder was given the
Monetary Choice questionnaire that assessed delay discounting. They also
completed the Polish version of the Sexual Addiction Screening Test. The
sexological sample was comprised of 66 individuals with compulsive masturbation,
along with 22 individuals who were compulsively “acting out”
sexually with partners and 20 who were compulsive in both categories.
Small amounts of money were discounted, preferred, more than large
amounts by all test groups. Patients in the group who were compulsive in
both masturbation and in pursuing sex with many partners were the most
impulsive. Learning the ability to defer gratification may represent an
important therapeutic goal for this group. Previous experiments confirm
that rewards are more strongly discounted than penalties (Thaler 1991),
suggesting that approaches that place more emphasis on the potential benefits
of the cessation of uncontrolled sexual behaviors, rather than on the
consequences of continuation, could have therapeutic effectiveness.

“Sociodemographic Changes in Pornography Use Between 2002 And 2016: A Study of a Representative Sample of the Polish Population”
Karol Lewczuk, Poland, with M. Gola
In the United States, the General Social Survey has been asking a single
question “Have you seen an X-Rated movie in the last year?” in every decade
since the 1960s. Currently 40% of men and 20% of women answer
“yes.” However, many studies from gaming, gambling, and Facebook use
show a large gap between declared use and a higher level of actual use.
Obtaining new longitudinal, population-level data on pornography use is
rare. This Polish study collaborated with an Internet provider, Gemius,
who could provide technical access and historical data. Participants were
invited to participate in a panel survey through pop-ups on popular websites.
After giving informed consent, basic information about participants’
Internet browsing activities were gathered in an anonymized way using
cookies. The cookies revealed if individuals had visited pornographic websites.
Separately, the team analyzed data from samples of 10,000 plus users
in the month of October every two years from 2004 to 2016. A person was
rated as a pornography user if they visited a pornographic website during
the month—a yes/no variable.
Researchers observed a steady increase in the population using pornography,
from 8% in October 2004 to 25% in October 2016. This growth paralleled
the overall growth of the number of Internet users in the population
during the same period. There is a moderate increase in the proportion of
Internet users using pornography, most notably for males. Gender, age,
and to a small degree the size of the place of residence, seem to influence
the probability of having viewed pornography on the Internet. Age and
gender explained 8% of the variance of online pornography viewing. The
limitations of the study include that data were not gathered if incognito
mode was used for browsing and it was based only on fixed line computers
(no mobiles). The figures were also scaled up to the population level, rather
than being based on raw data. The study does not provide information
regarding the quantity, frequency or type of pornography use.

“Clinical Characteristics of Compulsive Pornography Users: A Military Sample”
Shane W. Kraus, USA, with R. A. Hoff, M. Gola, E. Kowalewska, and M. N. Potenza
In the first part of this presentation, and in reaction to the growing
range of tools to measure problematic pornography use, this team set out
to develop and validate a shorter instrument, the Brief Pornography
Screener (BPS). It is a 5-item screener used to assess compulsive/problematic
use of pornographers in healthcare settings. It is scored each factor
either “never” (0), “sometimes” (1), and “frequently” (2), producing a
cumulative range of scores from 0 to 10. Work with U.S. (n¼223) and
Polish (n¼703) samples indicated excellent reliability and recommended a
cutoff score of 4, above which the subjects are likely to have problematic
pornography viewing issues. A score of 4 has a sensitivity of 80.4% and a
specificity of 80.3%.
The second study evaluated the clinical characteristics of participants
who scored positive on the BPS. The sample was 283 U.S. post-9/11 military
veterans was assessed with tools including sociodemographics, PRIMEMD,
AUDADIS-IV, Insomnia Severity Index, PTSD Symptom Checklist,
BPS, PPUS, HBI, UPPS-P, and the Difficulties in Emotional
Regulation Scale.
In the sample, 27.3% scored on or above the cutoff for the BPS. Over
92% of the veterans in the sample were male and more than a third of
individuals screening positive viewed pornography daily.
Emotional dysregulation was higher among problematic users than
among non-users. It is possible that problematic use may occur within the
context of emotional states related to stress or depression. Positive and
negative urgency forms of impulsivity were higher among individuals with
problematic pornography use. The findings resonate with prior work in
substance use and hypersexuality suggesting that problematic use can occur
in the context of stress or strong emotional states.
Depression was elevated among individuals with problematic pornography
use. Problematic pornography use was also associated with craving
for pornography.


Other presentations on pornography and sexuality

There were five other presentations that we were not able to observe. Readers are directed to the published abstracts for an indication of their content and conclusions (Demetrovics 2018). The session Cue-Reactivity and Craving in Off-Line and Online Behavioral Disorders included two relevant papers:

“Hypersexual Behaviors and Craving Reactions to Pornographic Pictures are Related
to Symptoms of an Internet-Pornography-Use Disorder”
Jaroslaw Pekal, Germany, with M. Brand

“The Influence of Stress on the Processing of Visual Sexual Stimuli in Men”
Jana Strahler, Germany, with O. Kruse and R. Stark


Research presented in the session Binge Behaviors: Conceptualization and Underlying Psychological Processes included:

“Approach and Avoidance Tendencies in Hypersexual Disorder”
Maria Veit, Germany, with J. Engel, C. Sinke, J. Kneer, C. Laier, S. Antons, U. Hartmann, T. Hillemacher, and T. H. C. Kru€ger

“Surveying Self-Identified Sex Addicts Supplies Evidence That Symptoms of Hypersexual Behavior and Internet-Pornography-Use Disorder are Associated with Common, but also Different Personality Characteristics”
Christian Laier, Germany, with J. Engel, M. Veit, S. Antons, M. Brand, and T. H.
C. Kru€ger


Within the Minitalk strand there was a paper titled:

“Excessive Internet Use for Sexual Purposes in Late Life: An Explorative Study of Risk Factors” Anna Sevcıkova, Czech Republic, with L. Blinka and K. Skarupova

...............................................
Discussion

This conference explored many different aspects of current research into the use of pornography by individuals and populations. Importantly, the conference keynote by Rudolf Stark concluded by suggesting that the case for pornography use disorder in the ICD-11 was strengthened by its foundation in the processing of natural rewards. Less than two months later, the new diagnosis of CSBD was ratified by the WHO secretariat for inclusion in ICD-11 (World Health Organization, 2018).

There were also advances in the collective scale and ambition of the reported research. In the past, small sample sizes and variable sample quality have limited some studies in the pornography research field. At the 2018 ICBA, the emergence of some larger samples suggested a growing strength in the field. While heterosexual men still dominate the research reports as test subjects in terms of sheer number, three of the studies reported on samples involving thousands of women and several more involved hundreds of women. Key were studies in Hungary, Poland, and the United States. The major Spanish study controlled its subject sample by both gender and age, but this was at the cost of only having 100 people of each gender and age group. Sexual minorities also appeared in a few studies at levels which support the drawing of statistically valid conclusions.
Several studies focusing on smaller numbers of subjects were able to work
more intensively, administering a wider selection of investigatory tools.
Sexually focused behavioral research is becoming well established with a
wider range of societies around the world now being investigated by
national or multinational research groups. A positive trend is the resulting
translation and validation of research tools into more languages. For
example, the Hypersexual Behavior Inventory has been translated and is
available in seven languages, and several other instruments originally developed
in English now come in Hungarian, Polish, and German versions.
Efforts to make assessment and diagnostic instruments shorter are also
coming to fruition. The Brief Pornography Screener now seems fit for
adoption by frontline practitioners as a tool for initial assessment of individuals
within the context of a short face-to-face consultation.
Work linked to the WHO CSB field trial found that significant numbers
of individuals who use pornography felt they were addicted to pornography
(6% in United States). Within the treatment-seeking Polish group, 86%
self-reported problems with pornography and 87% with masturbation, with
about half of both groups meeting clinical criteria for entering treatment.
In the online Hungarian study, 6.2% of the men and 4.7% of the women
recorded behaviors above the threshold for problematic pornography use.
These studies of self-selected groups begin to give a picture of the extent to
which issues relating to pornography use are appearing in pornographyconsuming
populations.

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Experiment in South Africa: Black lecturers receive lower ratings than white lecturers, particularly from black students

Race and Gender biases in Student Evaluations of Teachers. Carolyn Chisadza, Nicky Nicholls„, Eleni Yitbarek. March 4, 2019. https://custom.cvent.com/4E741122FD8B4A1B97E483EC8BB51CC4/files/Event/159bd4dc083941a79dd0211437d5d7dc/b5c289adc7964d92b1ad00c38179a9e6.pdf

Abstract: Student ratings of teaching (SETs) are vital for academic career trajectories of higher education lecturers. Although student bias against female lecturers is noted in previous studies, mostly in the developed world, the extent to which race affects such ratings has received limited attention. To better understand the role of race and gender bias in SETs, we conduct an experiment in South Africa, where racial bias is highly prevalent. Students are randomly assigned to follow video lectures with identical narrated slides and script but given by lecturers of different race and gender. We find that black lecturers receive lower ratings than white lecturers, particularly from black students.

Key words: student evaluations of teaching, gender and race bias, Africa
JEL classification: I23; J15; J16

Sunday, March 17, 2019

Thinking about Karma decreased selfishness among karmic believers across religious affiliations & non-religious Americans; about God also decreased selfishness among believers, but not with others

Supernatural norm enforcement: Thinking about karma and God reduces selfishness among believers. Cindel J.M. White et al. Journal of Experimental Social Psychology, https://doi.org/10.1016/j.jesp.2019.03.008

Abstract: Four experiments (total N = 3591) examined how thinking about Karma and God increases adherence to social norms that prescribe fairness in anonymous dictator games. We found that (1) thinking about Karma decreased selfishness among karmic believers across religious affiliations, including Hindus, Buddhists, Christians, and non-religious Americans; (2) thinking about God also decreased selfishness among believers in God (but not among non-believers), replicating previous findings; and (3) thinking about both karma and God shifted participants' initially-selfish offers towards fairness (the normatively prosocial response), but had no effect on already fair offers. These supernatural framing effects were obtained and replicated in high-powered, pre-registered experiments and remained robust to several methodological checks, including hypothesis guessing, game familiarity, demographic variables, between- and within-subjects designs, and variation in data exclusion criteria. These results support the role of culturally-elaborated beliefs about supernatural justice as a motivator of believer's adherence to prosocial norms.

Was Europe losing to the US its most talented workers, 1850–1913? Irish data shows the contrary: the sons of farmers & illiterate men were more likely to emigrate than their literate & skilled counterparts

Connor, Dylan Shane. 2019. «The Cream of the Crop? Geography, Networks, and Irish Migrant Selection in the Age of Mass Migration». The Journal of Economic History 79 (1): 139–175. doi:10.1017/S0022050718000682.

Abstract: With more than 30 million people moving to North America during the Age of Mass Migration (1850–1913), governments feared that Europe was losing its most talented workers. Using new data from Ireland in the early twentieth century, I provide evidence to the contrary, showing that the sons of farmers and illiterate men were more likely to emigrate than their literate and skilled counterparts. Emigration rates were highest in poorer farming communities with stronger migrant networks. I constructed these data using new name-based techniques to follow people over time and to measure chain migration from origin communities to the United States.

Gendered marketing is a pervasive trend, despite the public controversy; consumers who own gender-typical products are mentally pictured as more physically attractive, sexier, & more desirable partners

Gendered products act as the extended phenotype of human sexual dimorphism: They increase physical attractiveness and desirability. Sylvie Borau, Jean-François Bonnefon. Journal of Business Research, Mar 16 2019, https://doi.org/10.1016/j.jbusres.2019.03.007

Abstract: Gendered marketing is a pervasive trend, despite the public controversies it generates. Most of research so far has focused on the socialization-based perspectives of gendered marketing to explain this phenomenon. In this research, we ask the following instrumental question: which benefits can men and women derive from owning gender-typical variants of consumer goods? We propose that gender-typical products can act as the extended phenotype of human sexual dimorphism, broadcasting a cultural equivalent to the signals issued by biological, secondary sexual characteristics. Based on evidence showing that secondary sexual characteristics increase attractiveness and desirability, we predict that gender-typical products increase the attractiveness and desirability of their owners by acting as supernormal stimuli of sexual dimorphism. An internal meta-analysis across three studies confirms that consumers who own gender-typical products are mentally pictured as more physically attractive. We also find that owners of gender-typical products can be perceived as sexier, and more desirable partners.

Dramatic shortening of careers of scientists: The time over which half of the cohort has left the field has shortened from 35 y in the 1960s to only 5 y in the 2010s

Changing demographics of scientific careers: The rise of the temporary workforce. Staša Milojević, Filippo Radicchi, and John P. Walsh. Proceedings of the National Academy of Sciences, December 11, 2018 115 (50) 12616-12623. https://doi.org/10.1073/pnas.1800

Abstract: Contemporary science has been characterized by an exponential growth in publications and a rise of team science. At the same time, there has been an increase in the number of awarded PhD degrees, which has not been accompanied by a similar expansion in the number of academic positions. In such a competitive environment, an important measure of academic success is the ability to maintain a long active career in science. In this paper, we study workforce trends in three scientific disciplines over half a century. We find dramatic shortening of careers of scientists across all three disciplines. The time over which half of the cohort has left the field has shortened from 35 y in the 1960s to only 5 y in the 2010s. In addition, we find a rapid rise (from 25 to 60% since the 1960s) of a group of scientists who spend their entire career only as supporting authors without having led a publication. Altogether, the fraction of entering researchers who achieve full careers has diminished, while the class of temporary scientists has escalated. We provide an interpretation of our empirical results in terms of a survival model from which we infer potential factors of success in scientific career survivability. Cohort attrition can be successfully modeled by a relatively simple hazard probability function. Although we find statistically significant trends between survivability and an author’s early productivity, neither productivity nor the citation impact of early work or the level of initial collaboration can serve as a reliable predictor of ultimate survivability.

Keywords: scientific workforcescientific careerscareer success

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Discussion

Recent work on the organization of science has focused on theinternal structures of research teams and has argued that onelikely outcome of this shift in the nature of scientific work hasbeen the growth of supporting scientists, whose careers dependon being members of such teams (6, 13). Less obviously, therehas also been a concomitant increase in high-stakes evaluationand competition for funding, increasing the emphasis on pro-ductivity (43–46). One solution to this new emphasis on pro-ductivity is increasing the division of labor (47, 48). The growthof scientific team sizes is being accompanied by a transition inthe organization of scientific work from craft to bureaucraticindustrial principles, with increased division of labor and standardi-zation of tasks (13, 49, 50). The result is a growth of scientists whosefunction is to support the projects that others are leading. Ourresults confirm this scenario, showing that an increasing frac-tion of entering authors never transition from a supportingauthor to lead author role. We also show that such a trend isnot an inevitable outcome of the increasing sizes of teams, perse, but arises due to the different roles that some authors nowhave in large teams compared with the roles that members ofsmaller teams have (team members vs. collaborators). In somefields, such as ecology and robotics, lead and supporting au-thors have similar half-lives, while in others, such as astronomy,the half-lives of supporting authors is significantly shorter.Of course, there are well-known productivity advantages fromorganizing teams with a division of labor, and with having someteam members specializing in supporting roles (47). Hence, it isperhaps not surprising that science is shifting to larger teams,with more specialization, and that, increasingly, some scientistsare specializing in supporting roles. Note that we are not as-suming status or skill distinctions in our classification of leadand supporting authors (49). We are arguing that such sup-porting scientists are critical tothe production of contemporaryscience (6). However, it is also the case that institutions, such asuniversities and funding agencies, build around these traditionalstatus distinctions, for example, between postdoctoral scientists andtenure track professors (6). However, our survival analyses suggestthat the criteria predicting longevity for supporting scientists are quitedistinct from those for lead researchers and it may not be appropriateto impose similar criteria on bothgroupswhenmakingdecisionsabout who to hire or whose contract to renew. We argue there is aneed to reform career structuresin universities to account for thechanging nature of the population composition and reproductioncycles in team science, with social insect colonies rather than parent-child reproduction as a more appropriate model.While we cannot address this with our current data, we pointto a tension between the research production and teachingfunctions that academic laboratories provide (5, 12, 43, 49, 51).These two trends are bringing fundamental changes to scientificcareers, with decreasing opportunities for lead researcher po-sitions and increasing production of, and demand for, a scientificworkforce to fill positions as permanent supporting scientists.Together, these trends suggest downward pressure on careerlongevity (as more people exit the academic science labor force)and the growth of dependent supporting scientist positions tosupport the relatively shrinking share of lead researchers. How-ever, one concern is that such supporting scientist positions do notfit well with the employment system in most universities, which arestructured around a graduate apprenticeship, a short period ofpostdoctoral training, and then movement into a tenure track (andeventually tenured) professor position (5). Instead, these supportworkers may be relegated to a series of short-term postdoctoralcontracts or other forms of contingent academic work. While thetraditional model implies an up-or-out academic pipeline (withsignificant shares of the research workforce dropping out ofresearch-active academic positions at each stage), the growth ofpermanent supporting scientists may suggest an alternative careerpath that, while perhaps with shorter survival than the traditionallead researcher path, may be a growing share of the academiclabor force. Furthermore, such careers may be premised on adifferent set of criteria than is typically predictive of the careersurvival of lead researchers.Our findings show that the shift in the mode of knowledgeproduction from solo authors and small core teams (2) has co-incided with a differentiation in the scientific workforce in termsof their roles. The increased need for both the specializationand possession of specialized technical knowledge to manipulateincreasingly complex instrumentation and data has created an es-sential group of supporting contributors to knowledge. Unfortu-nately, the existing job roles and educational structures may not beresponding to these changes. Our results suggest that, while essen-tial, these supporting researchers are suffering from greater careerinstability and worse long-term career prospects in some fields.

Identification with fictional characters in computerised fictional narrative material: Females identify more strongly with their own gender whereas males identify equally with either gender

Hook N. (2019) May the force of gender be with you: Identity, Identification and “Own-Gender Bias”. In: Barry J., Kingerlee R., Seager M., Sullivan L. (eds) The Palgrave Handbook of Male Psychology and Mental Health. Palgrave Macmillan, Cham. https://link.springer.com/chapter/10.1007/978-3-030-04384-1_9

Abstract: In this chapter an innovative experimental methodology is described for studying identity by using identification with fictional characters in computerised fictional narrative material (hypertext). This methodology reveals an unpredicted finding that females identify more strongly with their own gender whereas males identify equally with either gender. This echoes other research findings from quite different domains, suggesting a general phenomenon. Implications for further research and how these findings might inform creative communication and mental health practice in relation to gender are discussed.


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Someone suggests that this means than men are more compassive... But in many species, the female is more helping, even of members of other species, like in those videos of cows feeding kittens or dogs... the girls work better as nurses, school teachers, etc., than men do... They oppose the death penalty in greater numbers than men, and support more gov't expenditures, and in the US vote more Democratic than Republican than men do. So no, in their own magical way, they are more compassive... just it seems they are too feminine, more than we are too masculine (?). Maybe the guys who say they have a greater percentage of gay members than men are right, too leaning to their own conspecifics. Or as they say recently, their sexual orientation is more fluid.

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Text:
In 1890 one of the founders of experimental psychology William James referred to ‘multiple selves,’ meaning that the ‘self’ contains multiple identities. In simple terms an identity is an answer to the question ‘who am I?’ All of us have many ways to answer that question in different times and contexts. Identity is an under-researched topic primarily because it is difficult to access and hard to measure in quantifiable terms, yet at the same time identity goes to the very heart of what psychology is about, being literally the study of the ‘psyche’ or ‘mind’. For a more formal definition of identity, Stryker (1980) refers to an ‘internalised positional designation’ for each of the roles one plays in society; someone ‘is a student’, not ‘playing the role of a student.’ More recently Burke and Stets (2009) suggest that an identity could either relate to a role in society (as Stryker describes), group membership (as Social Identity Theory (SIT) presents) or particular identifying characteristics. Burke and Stets also note that this third category of identity, based on particular characteristics, is a particularly under-researched area. Identity theory is a generic term that encompasses a range of specific theories that seek to explain the mechanisms of identities, how identities relate to each other and how they influence behaviour, thoughts and emotions along with their wider social impact. Successfully fulfilling a sense of identity generates self-esteem, while a lack of self-esteem creates vulnerability to mental health conditions such as depression—a failure to satisfactorily answer the question ‘who am I?’ and thus a failure to construct oneself or one’s possible future. However, because identity theory consists of ideas developed across different disciplines, it does not yield a coherent unified model. Furthermore, because different disciplines use the same terms to mean different things, there is also a lack of consistent terminology. Identity theory recognises that identities do change, but usually over time in a gradual and developmental sense. This fits with our everyday experience that a person is unlikely to say that they are a different person from a week ago, but more likely to perceive a change over a decade or more. Identity theory generally recognises gender as a core aspect of identity for most human beings. It is accepted that gender identity is usually formed very early and usually remains in place for life. While other identities such as an occupational role identity can depend on physical resources and/or social position, gender identity is broadly much less dependent on context.
 

Experimental Approaches to Identity
Psychology is not the only discipline interested in identity, but unlike other disciplines it has sought to apply the experimental method. One strand of this has been a series of experiments that led to SIT developed by Tajfel (1970). By assigning participants to random groups and asking them to assign points to other participants, it was found that people demonstrated a bias in favour of their own group over another group, implying that group identity is very easily formed and that group conflict is inevitable. There is now a large body of research on SIT and while there is still much debate about what conclusions can be drawn, this is perhaps the most well- established way of applying the experimental method to researching identity based on group membership. However, gender is not merely a group identity. An individual cut off from other people would still retain some sense of their gender. Gender can also be considered to be an embodied and personal characteristic, and yet previously there have been few attempts to explore gender identity in this holistic way experimentally. This chapter describes a new approach developed by the author to tackle this issue by using identification as a proxy for identity. Rather than testing how strongly a person self-identifies, this method tests how strongly a person identifies with a fictional character in a game or story. This lends itself to the experimental method because a controlled stimulus consisting of a fictional character can be presented precisely and consistently. This then allows participants to report on the strength of identification with characters in a concise and highly measurable fashion. This methodology based upon identification with fictional characters in a game or story can therefore help to expand the findings, value and scope of identity theory by offering insight into the mechanisms by which identities connect or detach. The methodology offers an opportunity to measure the divergence and the boundary between possible mechanisms of identification and dis-identification:
• One possibility is that identifying with a character who shares one or more identities with the player globally activates these shared identities, generating a sense of connection and self-esteem. In this first model, a character activating shared identities would generate stronger identification than one that does not. • A second possibility is that although there are some shared identities, the character is construed as a separate identity with its own set of sub-identities. 


 In the second model any shared identities would be much less likely to lead to identification.
This chapter describes an experiment using this new methodology to examine gender identity and to explore potential gender differences in how players/readers identify with characters of a particular gender, both in their own right and as a proxy for their own sense of self-identity. The initial hypothesis under investigation was that both (self-identifying) men and women would identify more strongly with characters of their own gender than those of the other gender. The null hypothesis correspondingly was that the strength with which players identify with characters is unaffected by the gender of the character.
A Brief Review of Literature on Identification in Science and the Humanities
For the purposes of this review, the Oxford dictionary definition of identification as ‘a person’s sense of identity with someone or something’ is being followed. In the field of sociology, the concept of identification has been used to refer to identifying with a group (Holt 1950) while in the field of psychoanalytic theory Freud (2010) discusses identification with a real person or object. Neither theorist however addresses identification with fictional characters in stories, even though fiction is a substantial part of human life and culture.
 

In the humanities, Igartua (2010) found that strong identification with film characters is associated with enjoyment, cognitive elaboration, dramatic impact and attitude change. Identification is also a core topic within literary and film studies (Oatley 1994) and McCloud (1993) writing about characters in comics suggests that shallow iconic characters pull readers in. Cohen (2001) discusses the lack of empirical testing or conceptualisation in these fields. At an applied level, a better understanding of this topic would be useful to inform science, media and the arts in terms of how best to communicate and connect with fellow human beings. From the turn of the millennium, a new academic discipline called Game Studies has emerged. Game studies draws on both humanities and social sciences and involves studying games as text, gaming as an activity and gamer culture. This relatively new discipline inevitably focuses on computer games but is not limited to these. Within the field of game studies, Klimmt et al. (2009) argue that identification with a character occurs when the player self-perceives some of the character’s attributes as part of themselves. These authors also claim that everyday life self-perception can be altered by this fictional identification process. Follow-up empirical research by Blake et al. (2012) does provide some support for this theory although because of some design flaws, alternative explanations of these results may be possible. Shaw (2011) interviewed players qualitatively and found that greater control over a character’s actions increases identification. There is a reasonable body of research within game studies on identification with an avatar, including Martin (2005), Bessiere et al. (2007), and Kafai et al. (2007), Kujanpää et al. (2007), Ducheneaut et al. (2009), Jorgensen (2009) and Shaw (2011). Kromand (2007) offers an axis model for categorising the design of avatars involving “archetypes”. However avatar play differs from playing a character in the literary sense. An avatar is a digital object manipulated by the player like a chess piece rather than a character-person treated as having their own agency and an internal mind. In summary, identification with fictional characters is an under-researched topic in psychology and sociology, and lacks robust empirical investigation within the field of literary, media and film studies. Game studies has focused on exploring avatar play and not investigated identifying with an active character in the literary sense. The present study described here therefore may be said to address all of these gaps in the literature by using an experimental methodology rooted in the social psychology tradition using technology to precisely measure identification with fictional characters.
 

Since the focus of the present study was not just identification in general but gender identification in particular, it is also important to summarise briefly the literature on own-gender bias. Wright and Sladden (2003) investigated gender differences in face recognition and found an own-gender bias for both genders: males are better at recognising male faces and females are better at identifying female faces. In contrast, Herlitz and Loven (2013) used a meta-analysis to review research on the same topic and found that females remember more faces generally and remember more female faces than male faces but that males do not remember more faces of one gender than the other. In other words, they found a female own-gender bias but not a male own-gender bias. These researchers explain their findings in terms of facial and visual processes with the implication that this gender difference would not necessarily generalise to other situations. In relation to SIT, Rudman and Goodwin (2004) report four experiments relating to gender differences in in-group bias and found that women‘s automatic in-group bias was stronger than men‘s. However they did not use gender itself as the basis of group membership in this research. In game studies Yee’s (2017) quantitative research reported that 75% of female gamers rated the presence of female protagonists as ‘very or extremely important,’ three times higher than the male gamers who tended to rate the presence of female protagonists as ‘somewhat important.’
 

Methodology
My own experiment used as a stimulus a Hypertext Fiction (HF) story-game, a type of Interactive Fiction (IF), as discussed in Montfort (2005). HF might be more commonly referred to in everyday language as a ‘choose-your-ownadventure’ story. Such texts are intended to be read in a non-linear sequence (Aarseth 1997). When reading a HF the reader-player reads a passage of text (usually written in the second person) and selects from a number of options to continue. This decision points the reader to the next passage to read until the next decision point. The term HF refers to this hyperlink mechanism which might be implemented as a physical page number in a hardcopy book to turn to or as a digital link. Interactive Fiction can also use other interfaces such as free text entry. Famous HF texts include the computer game Depression Quest (Quinn 2013) and the Fighting Fantasy physical book series that started with The Warlock of Firetop Mountain (Jackson and Livingstone 1982). Aarseth (1997) has claimed that the reader of an IF is a player in a game-world whereas the reader of a traditional linear text is a spectator. HF is used as a form of minimal role-playing game with a single player-participant thus enabling strong experimental controls. A game with more players would have been too unpredictable and varied to serve as a controlled stimulus. For a further discussion of digital games as experimental stimulus, see Järvelä et al. (2012). At a higher conceptual level this ‘minimal ludic roleplay experiment’ was inspired in part by the ‘minimal group experiments’ of Tajfel (1970). One design challenge was the need to avoid identification based on other shared player-character traits, such as a student player identifying with a student character. For this reason a modern day setting was avoided and the diegetic setting of Star Wars was used, since it was unlikely that players would share other identities such as occupation roles with such characters. It also provided an easily relatable fictional world that many participants would have some level of awareness of, while it could still be understood as a generic space adventure setting. Use of this setting also could be said to increase ecological validity because it is already used for many commercial games and other texts in different media. At a practical level this popular setting also helped attract participants to take part in the research, making the pool of participants larger. Original characters previously unknown to the participants were used as protagonists in the HF to avoid any bias for pre-existing characters. The text of the game was also original, being developed by the research team whose qualifications include creative writing. This ensured that no player had any prior exposure to the narrative stimulus. While the use of original material as opposed to a published game is unusual in game studies and literary research, it is not unusual practice in psychology to create the experimental stimulus. The stimulus was a short HF with two separate stories each about a different character, referred to here as J (in the Star Wars setting, a Jedi) and S (in the Star Wars setting, a Sith). After reading an introduction screen, the participant would be presented with a character briefing screen followed by the first page of the story, ending with a binary decision point as hypertext links. These links would then lead to the next page depending on which option was chosen, which then would in turn link to the next page with another binary decision point. In total each story was made up of five binary decision points for each participant playing each character. After this the character briefing screen for the next character would be presented and a different story with another five binary decision points would be presented. The sequence of the two stories/characters was randomised independently of group allocation to counteract any influence this might have. The participants were blindly and randomly split by the software into one of two groups, referred to here as JMSF and JFSM. The stimulus for each group differs in that:
• For group JMSF, character J is male and character S is female. • For group JFSM, character J is female and character S is male.
Every text page in the game included one reference to the character’s gender, such as another character addressing them in dialogue with a gendered term. Aside from these minor text changes and the randomised sequence of characters the story-game itself was exactly the same for all participants. The experiment could have functioned with a single character and story, but this double design enabled a built in replication to be conducted at the same time. In practical terms the HF was developed with the free development software Twine version 2.1.3 (http://twinery.org/) and uploaded to the web. It could be played on any web browser and the participants used their own devices in their natural surroundings. While this varied between participants this was controlled for by the independent group randomisation. This unusual experimental design makes the hardware and physical surroundings the same as when the participants play digital games or read web-based texts in everyday life.
 

Data Collection
Twine does not record user inputs and so a link to an online form for data collection was shown after the participants played both stories, with the data downloaded after the experiment was completed. After playing through the HF for each character, participants are asked two questions for each character:
• ‘How strongly did you identify with < character name > ?’ • ‘How strongly were you able to take on the role of < character name > ?’
 

Responses were recorded on a scale from 1 to 7, and the pair of responses for each character then averaged. This use of two questions with combined results was intended to lessen any quirk of the particular wording or the participant’s understanding. Together this produced quantitative data for appropriate statistical analysis. The three dimensions were:
• The player’s gender (M or F). Participants could also state their own gender as either ‘other/non-binary’ or ‘prefer not to say’, but their data was then excluded from the primary analysis. • The character’s gender (M or F). • The character (J or S).
All participants provided two data points: how strongly they identified with character J and character S, in the dimensions for their own gender and the character’s gender (which depended on their assigned group). Information about the participant’s age bracket, gender identity, national identity, educational background, familiarity with the setting, level of HF and roleplay experience, device used, whether the surroundings were distracting and self-declared play-style was also gathered for secondary analysis. Participant names and other identifying data were not requested so data was automatically anonymous.
 

Participants
Participants were recruited by posting a request to take part with a link to various Star Wars, gaming and roleplay social media communities online. The first page explained that the game was for academic research and that their consent for their data to be used could be given by taking part, filling in the form and clicking “submit”. No reward was offered for taking part and participants had the option to leave the page or to play the game but then not complete the research questions at the end. It is unknown how many potential participants opted out in this way. The experiment ran online for two weeks during May 2017. In total 386 responses were received. Based on the responses to secondary questions, it is possible to make some descriptive statements about the participant pool:
• 73% identified as male, 24% identified as female, 2% as other/non- binary, 1% declined to answer.
May the force of gender be with you: Identity, Identification …     173 • 47% identified with a European nationality, 45% with North American nationality, 2% with an Asian nationality, 1% with a Middle East nationality and 1% with a South American nationality. 4% identified with an ‘other’ nationality, and 1 single participant left this blank. • 45% completed the experiment on a computer, 47% on a phone, and 8% on a tablet. Two participants used an ‘other’ device. • 30% of participants had no degree, 33% had one or more science degrees and 30% had one or more arts/humanities degrees, 7% had degrees in both sciences and arts/humanities. Three participants left this blank. • 2% had no knowledge of the Star Wars setting, 34% knew only the main films and 65% reported that they knew the wider expanded universe from other media. • 15% reporting their surroundings were distracting while playing the game. Two participants left this blank.
Some questions were asked for the participant’s role-play game experience:
• 5% had no experience with IF games, 18% had played less than three games, 25% had played between three and ten games, 51% had played more than ten games. Two participants left this question blank. • 21% had ‘none / very little’ experience of tabletop RPGs, 18% had ‘some, up to a year’ of experience, 61% had ‘many years’ of experience. One participant left this question blank. • 72% had ‘none / very little’ experience of ‘larps’ (live action role-play games), 12% had ‘some, up to a year’ of experience, 16% had ‘many years’ of experience.
Participants were asked a single question about their play-style/creative agenda, based on the GNS model from Forge theory (Boss 2008). A full discussion of this theory is beyond the scope of this chapter. The question was ‘When role-playing, which of these is most important to you?’ The possible answers were:
• ‘Your character achieving their goals / winning’ (gamism), • ‘Experiencing a good story with strong narrative / drama’ (narrativism) • ‘Becoming the character, feeling their emotions and acting accurately for the character’ (simulationism).
The results were 8% gamist, 61% narrativist and 30% simulationist for these participants. Three participants left this blank.
 

Analysis
Once the data was gathered, it was analysed using paired T tests which reveal whether two groups of data are significantly different or not. There were four T tests for participants of the same gender playing the same character, between those who played the character as male and those who played the character as female. There were a further four T tests comparing participants of different genders playing the same character with the same gender. Hence all tests were between different participants. It would have been possible to compare the two data points from the same participants but this would be data from different characters and different stories so any differences this might produce could be due to these differences in stimulus. The eight mean identification scores are shown in Table 1. The range of possible scores is from 1 to 7 and the means fall roughly in the middle of that range. For the four comparisons between those who played the character as male and those who played the character as female (for each character and each player gender group) the results for the male participants showed no significant differences for either character. However for female participants a
Table 1 Mean identification scores, split by participant group and character Male participants Character Character gender J S M 4.725352 4.431655 F 4.776978 4.31338 Female participants Character Character gender J S M 4.117021 4.095745 F 4.787234 4.361702 Jedi character Participant Character gender M F M 4.725352 4.117021 F 4.776978 4.787234 Sith character Participant Character gender M F M 4.431655 4.095745 F 4.31338 4.361702
 

highly statistically significant difference was found. Female participants more strongly identified with character J if that character were female (p = 0.005). While not quite significant with this sample size, results for female participants with character S were also in support of this trend (p= 0.1655). This provides some evidence that the gender of a character does not affect how strongly males identify with the character, but that females do identify more strongly with female character than a male character. For the comparisons between male and female participants (for the same character with the same character gender) these results give one strongly significant result (p = 0.0035) that women identify less strongly than men with character J as male. The result for character S as male was also in this direction and approaching significance (p = 0.074). For either character as female there was no significant difference for how strongly male or female participants identified with them. Putting this all together, it seems that males and females identify equally with a female character, but that females identify less strongly than males with a male character. The pattern generated by all of these results is presented visually in Table 2. Looking at the results together, this experiment has found significant evidence that character gender has no significant effect on how strongly males identify with a character, but that female players identify more strongly with female characters than male characters and also identify less strongly than male players with male characters. This means that this experiment has found clear evidence of a female own-gender bias alongside clear evidence that males lack an own-gender bias. Six responses from participants who identified either as ‘other / non- binary’ and five who replied ‘prefer not to say’ (including one who left this blank) were not included in the primary analysis. No other data were excluded. The data from the six ‘other / non-binary’ participants (3 from each group) indicated that they identified much more strongly with characters as male rather than as female, implying that there may be a distinct
Table 2 Significant differences, shown visually Player M Is there evidence of  significant differences?
Player F
Character M Significant Differences Is there evidence of significant differences? No evidence Significant Differences Character F No evidence

third group. While constituting too small a sample for statistical analysis, this does add an interesting additional twist to these findings.
 

Secondary Analysis
Beyond testing the primary hypothesis some observations can also be made from the responses to the secondary questions. These may provide additional insights for planning future experiments.
• Participants using a phone device generally reported lower identification (mean 4.41) than tablet users (4.58) and computer users (4.61). This might reflect the comfort of the surroundings, ease of use and lack of distraction. Two participants used an ‘other’ device and reported much lower identification (3.75). • Participants who knew the wider expanded Star Wars universe from other media reported higher identification (4.62) than those who knew only the main films (4.30). • Simulationists reported stronger identification (4.77) than narrativists (4.44) and gamists (4.26) This may reflect aiming for and mentally seeking stronger character identification, an underlying personality difference or a positive reporting bias (participants reporting they do well at something they consider important).
Group assignment was random and independent of these other factors, so these should not have impacted on the primary analysis. These are included as an additional insight unrelated to the hypothesis to raise further questions and suggest areas for further research. While it would be technically possible to carry out further statistical tests with this data, testing every possible combination after the fact would dramatically increase the possibility of false positive “type I” errors.
 

Relating Back to Theory
The initial hypothesis being tested was that both males and females would identify more strongly with characters of their own gender. However the results instead provide evidence for a more nuanced two-fold finding:

• Males identify equally strongly with characters regardless of their gender. • Females identify more strongly with a female character than a male character.
If we accept the validity of these findings this may be new evidence of an important gender difference that males lack an own-gender bias, at least in certain domains. The statistics strongly indicate that this gender difference is present but they cannot tell us the reason for it, whether it has an underlying biological cause or results from life experience or cultural exposure. However it is possible to speculate in an educated way on the reasons for this gender difference based on existing theories. Considering these results through the lens of SIT, these findings might be understood as providing insight into the implicit construction of ‘in-groups’ and ‘out-groups.’ Women see gender as a characteristic to determine group membership, which leads to displaying in-group bias. Men are more ‘gender blind’ and tend not to construct in- and out-groups by gender and so don’t display this form of in-group bias. This is a feature that would likely not have been captured by traditional experiments in the SIT tradition where the relevant group membership would be implicitly or explicitly stated to the participants. As noted in the literature review (above), Herlitz and Loven (2013) and Rudman and Goodwin (2004) who researched very different topics did similarly find a female only own-gender bias. These authors had suggested domain-specific explanations, but taking their work and the findings of this experiment together implies that a cross-domain generalised mechanism may be the source of a much broader gender difference. The literature review noted two possible ways of adapting identity theory to the topic of identification and the results of this experiment can perhaps help determine which model best fits reality: either playing a character activates the player’s own gender identity (and other identities shared by both player and character) or the character is related to as a separate and distinct identity. One way to interpret these more nuanced results is to conclude that the first approach is a better model for understanding typical female character role-playing and the second approach is a better model for understanding typical male character role-playing. Further research could explore this by looking at other identities that a player and character share and investigating if sharing more identities increases identification. For example, would a male player and a female player identify more strongly with a character that shares the same occupation or national identity as them? Given the findings of this experiment, it might be predicted that generally male players will not but female players will. An alternative hypothesis would be that there is something inherently special about gender identity, being stable for most people, that functions differently from other identities. In this experiment the story-game was exactly the same for participants apart from the minor text change on every page to indicate the character’s gender, to maintain strong experimental controls. It might be speculated that the results would have been even more pronounced if the fictional characters had engaged in behaviour appropriate to their gender (either as defined by the reader-player’s worldview or by the character’s diegetic culture). This may be more relevant if the diegesis (the fictional world) has strongly defined gender roles. The Star Wars setting lacks strongly differentiated gender roles which made it easier to write a consistent story regardless of character gender. We might also reflect on how players would have responded to a gender neutral character such as a droid or an alien species without gendered biology or culture.
 

Reflection on the Method
Aside from the particular hypothesis tested by this experiment, it is also worth reflecting on the method. The experimental approach is unusual in both the topic of identity and the varied disciplines of literary studies and game studies. This experiment demonstrates how by using identification as a proxy for identity it is possible to construct and administer an experiment in the psychological tradition within this field of enquiry. The digital nature of many ludic media lends itself to the experimental method and freely available tools make it practical to create or modify games to produce stimulus material for experimental purposes. There may well be other topics in psychology where games offer a way to conduct experiments. Applying the self-reflexivity of the British critical psychology tradition, it occurs to me that had the results supported the original hypothesis of an own-gender bias for both genders, speculation would have followed that this would be likely to generalise to other identities that a reader/player shares with their character, an example of over-generalisation of findings. This was the primary reason why the design used a fictional setting as a precaution against such global self-reference. As it turned out the findings obtained are counter-intuitive to simple generalisations, and therefore more robust and more striking.
 


Practical Implications and Applications
One direct implication of this finding is that it can inform artistic creation, potentially across a wide range of media. Given that strong identification increases reader-players’ involvement, it suggests a game or other work of fiction intended for a mixed audience would be better received with a female protagonist since it would increase identification for female players and not affect male players. This might also generalise to other fields seeking to build popular identification with someone, such as a brand choosing a celebrity to promote itself. The mirror side of this is that when creating art to appeal to men, depicting a male protagonist does not in itself build identification. Other identities and techniques need to be used in artistic creation to achieve this. For example, previous experiments that used a similar design to the one described here found that richly defined characters with many identities build stronger identification than one-dimensional characters. On a wider scale, these results might suggest one possible and important explanation for why men are more prone to suicide. Identity theory suggests that people have many identities and that fulfilling those identities produces self-esteem. For most people gender might be thought of as a core identity that can usually be fulfilled for self-esteem. However, if men do not as strongly invest in their gender identity, they have one less easy source of self-esteem than women, which leaves them more vulnerable when other identities (e.g. occupational) are not able to be fulfilled. For example, a female teacher who loses their job can still derive self-esteem from their gender during a difficult time of unemployment, but a male teacher could be less equipped to do so. One way to tackle this at a personal level might be to encourage men at risk of depression to cultivate a richer and more varied set of identities, to have many ways of defining who they are, so that if some become blocked they still have others. This is healthy for everyone but may be particularly important to males. Practically speaking, identities that are less dependent upon physical resources or social position are also less likely to be disrupted. At a wider social level, challenging negative constructions of males and masculinity and recognising the positive contributions that exceptional men and men collectively make to the world may help to support boys and young men in viewing their gender in a more positive way that could boost self-esteem. Celebrating masculine psychology as having the clarity and strength to avoid own-gender bias and to display less in-group bias generally could form one facet of that.
 

From a wider social justice perspective, assuming the validity of these findings, the presence of greater in-group bias in one gender has potential implications for social policy. Making this issue more explicit could help prevent unnecessary bias or inequality in hitherto hidden contexts.
 


Conclusion
This experiment has produced strong evidence (with extremely low p values) that females have an own-gender bias in character identification but males do not. We might explain this finding using several different theories, but the strong implication is that gender is a less important group identity for men than it is for women. This has implications for how we communicate with men and women across varied domains of life such as health, politics and culture. It also has implications for how we might need to design differently nuanced health messages and approaches to connect with and help vulnerable men in comparison with vulnerable women. These findings also raise the question as to whether this is a universal finding or culture-dependent.
 

 Further research will be required to answer these important questions more fully. Whatever the reason for the difference and however global it might be, it is hoped that this chapter has revealed important evidence of potentially critical gender differences, along with an important new experimental method for researching identity






176N. Hookthird group. While constituting too small a sample for statistical analysis, this does add an interesting additional twist to these findings.Secondary AnalysisBeyond testing the primary hypothesis some observations can also be made from the responses to the secondary questions. These may provide additional insights for planning future experiments.Participants using a phone device generally reported lower identification (mean 4.41) than tablet users (4.58) and computer users (4.61). This might reflect the comfort of the surroundings, ease of use and lack of dis-traction. Two participants used an ‘other’ device and reported much lower identification (3.75).Participants who knew the wider expanded Star Wars universe from other media reported higher identification (4.62) than those who knew only the main films (4.30).Simulationists reported stronger identification (4.77) than narrativists (4.44) and gamists (4.26) This may reflect aiming for and mentally seek-ing stronger character identification, an underlying personality difference or a positive reporting bias (participants reporting they do well at some-thing they consider important).Group assignment was random and independent of these other factors, so these should not have impacted on the primary analysis. These are included as an additional insight unrelated to the hypothesis to raise further questions and suggest areas for further research. While it would be technically possi-ble to carry out further statistical tests with this data, testing every possible combination after the fact would dramatically increase the possibility of false positive “type I” errors.Relating Back toTheoryThe initial hypothesis being tested was that both males and females would identify more strongly with characters of their own gender. However the results instead provide evidence for a more nuanced two-fold finding:178N. Hookthe same occupation or national identity as them? Given the findings of this experiment, it might be predicted that generally male players will not but female players will. An alternative hypothesis would be that there is some-thing inherently special about gender identity, being stable for most people, that functions differently from other identities.In this experiment the story-game was exactly the same for participants apart from the minor text change on every page to indicate the character’s gender, to maintain strong experimental controls. It might be speculated that the results would have been even more pronounced if the fictional characters had engaged in behaviour appropriate to their gender (either as defined by the reader-player’s worldview or by the character’s diegetic cul-ture). This may be more relevant if the diegesis (the fictional world) has strongly defined gender roles. The Star Wars setting lacks strongly differen-tiated gender roles which made it easier to write a consistent story regard-less of character gender. We might also reflect on how players would have responded to a gender neutral character such as a droid or an alien species without gendered biology or culture.Reflection onthe MethodAside from the particular hypothesis tested by this experiment, it is also worth reflecting on the method. The experimental approach is unusual in both the topic of identity and the varied disciplines of literary studies and game studies. This experiment demonstrates how by using identification as a proxy for identity it is possible to construct and administer an experiment in the psychological tradition within this field of enquiry. The digital nature of many ludic media lends itself to the experimental method and freely avail-able tools make it practical to create or modify games to produce stimulus material for experimental purposes. There may well be other topics in psy-chology where games offer a way to conduct experiments.Applying the self-reflexivity of the British critical psychology tradition, it occurs to me that had the results supported the original hypothesis of an own-gender bias for both genders, speculation would have followed that this would be likely to generalise to other identities that a reader/player shares with their character, an example of over-generalisation of findings. This was the primary reason why the design used a fictional setting as a precaution against such global self-reference. As it turned out the findings obtained are counter-intuitive to simple generalisations, and therefore more robust and more striking.May the force of gender be with you: Identity, Identification ... 179Practical Implications andApplicationsOne direct implication of this finding is that it can inform artistic creation, potentially across a wide range of media. Given that strong identification increases reader-players’ involvement, it suggests a game or other work of fic-tion intended for a mixed audience would be better received with a female protagonist since it would increase identification for female players and not affect male players. This might also generalise to other fields seeking to build popular identification with someone, such as a brand choosing a celebrity to promote itself.The mirror side of this is that when creating art to appeal to men, depict-ing a male protagonist does not in itself build identification. Other identities and techniques need to be used in artistic creation to achieve this. For exam-ple, previous experiments that used a similar design to the one described here found that richly defined characters with many identities build stronger identification than one-dimensional characters.On a wider scale, these results might suggest one possible and impor-tant explanation for why men are more prone to suicide. Identity theory suggests that people have many identities and that fulfilling those identi-ties produces self-esteem. For most people gender might be thought of as a core identity that can usually be fulfilled for self-esteem. However, if men do not as strongly invest in their gender identity, they have one less easy source of self-esteem than women, which leaves them more vulnerable when other identities (e.g. occupational) are not able to be fulfilled. For example, a female teacher who loses their job can still derive self-esteem from their gender during a difficult time of unemployment, but a male teacher could be less equipped to do so.One way to tackle this at a personal level might be to encourage men at risk of depression to cultivate a richer and more varied set of identities, to have many ways of defining who they are, so that if some become blocked they still have others. This is healthy for everyone but may be particularly important to males. Practically speaking, identities that are less dependent upon physical resources or social position are also less likely to be disrupted.At a wider social level, challenging negative constructions of males and masculinity and recognising the positive contributions that exceptional men and men collectively make to the world may help to support boys and young men in viewing their gender in a more positive way that could boost self-esteem. Celebrating masculine psychology as having the clarity and strength to avoid own-gender bias and to display less in-group bias generally could form one facet of that.180N. HookFrom a wider social justice perspective, assuming the validity of these findings, the presence of greater in-group bias in one gender has potential implications for social policy. Making this issue more explicit could help prevent unnecessary bias or inequality in hitherto hidden contexts.ConclusionThis experiment has produced strong evidence (with extremely low p values) that females have an own-gender bias in character identification but males do not. We might explain this finding using several different theories, but the strong implication is that gender is a less important group identity for men than it is for women. This has implications for how we communicate with men and women across varied domains of life such as health, politics and culture. It also has implications for how we might need to design differ-ently nuanced health messages and approaches to connect with and help vul-nerable men in comparison with vulnerable women. These findings also raise the question as to whether this is a universal finding or culture-dependent. Further research will be required to answer these important questions more fully. Whatever the reason for the difference and however global it might be, it is hoped that this chapter has revealed important evidence of poten-tially critical gender differences, along with an important new experimental method for researching identity.ReferencesThe experimental stimulus material (in web page or source code format) is available from the author on request.Aarseth, E. (1997). Cybertext: Perspectives on ergodic literature. Baltimore, MD: John Hopkins University Press. http://www.autzones.com/din6000/textes/semaine09/Aarseth(1997).pdf.Bessiere, K., Seay, A., & Kiesler, S. (2007). The ideal self: Identity exploration in World of Warcraft. Cyber Psychology and Behavior, 10, 530–535. http://online.liebertpub.com/doi/abs/10.1089/cpb.2007.9994.Blake C., Hefner D., Roth C., Klimmt C., & Vorderer, P. (2012). Cognitive pro-cesses involved in video game identification. In M. Herrlich, R. Malaka, & M. Masuch (Eds.), Entertainment computing—ICEC 2012. Lecture Notes in Computer Science (Vol. 7522). Berlin, Heidelberg: Springer. https://doi.org/10.1007/978-3-642-33542-6_7.






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