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Problematic sexual behaviours, dissociation, and adult attachment: A path

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DOI: 10.1016/j.jadr.2024.100786

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Research Paper

Problematic sexual behaviours, dissociation, and adult attachment: A path

analysis model
Alessio Gori a, b, *, Eleonora Topino c
a
Department of Health Sciences, University of Florence, Via di San Salvi 12, Pad. 26, 50135, Florence, Italy
b
Integrated Psychodynamic Psychotherapy Institute (IPPI), via Ricasoli 32, 50122, Florence, Italy
c
Department of Human Sciences, LUMSA University of Rome, Via della Traspontina 21, 00193 Rome, Italy

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Problematic sexual behaviours are controversial phenomena, lacking diagnostic consensus, yet they
Behavioural addiction are significant and warrant in-depth scientific research due to their clinically significant consequences. There­
Cyberpornography addiction fore, this study aimed to explore the association between potential risk factors of sex addiction and problematic
Hypersexuality
online pornography use, with a specific focus on the role of attachment and dissociation.
Pornography addiction
Method: A sample of 375 participants (Mage = 30 years; SD = 12.441) was involved in the research. The collected
Sex addiction
Sexual compulsivity data were analysed by implementing a path analysis model.
Results: Significant and positive total effects in the relationships between fearful/preoccupied attachment pat­
terns and both sex addiction and problematic online pornography use were shown. Furthermore, these associ­
ations were significantly mediated by dissociation. Finally, sex addiction and problematic online pornography
use were significantly associated with daily thoughts about sex and weekly online pornography use, respectively.
Limitations: The cross-sectional design and the use of only self-report measures in an online survey should be kept
in mind while interpreting the results.
Conclusions: Such data provide useful insight into the complex interplay of attachment, dissociation, and prob­
lematic sexual behaviours, providing information that may inform and guide targeted clinical interventions.

1. Introduction with problematic online pornography use (Bőthe et al., 2018), which, in
turn, is associated with interpersonal problems and psychological
In light of research emphasizing the addictive potential of sex based distress (see De Alarcón et al., 2019 for a review). While there is no
on brain circuitry and neurotransmitters involved in the experience of consensus on the diagnostic classification of these phenomena, their
reward and gratification, the existing scientific narrative increasingly clinical significance has been consistently emphasized (see Antons and
describes hypersexuality as a behavioural addiction (see Jha, and Brand, 2021 for a review), stimulating a line of research on risk factors
Banerjee, 2022 for a review). Specifically, sex addiction is defined as a for these conditions. Within this framework, the present study aimed at
problematic and persistent pattern of dysfunctional and excessive sexual exploring the associations between some potential risk factors of sex
behaviours that can compromise several important areas in the in­ addiction and problematic online pornography use, by specifically
dividual’s life, for example resulting in financial and interpersonal dif­ exploring the role of attachment and dissociation.
ficulties, emotional distress, and physical problems (see Rosenberg et al.,
2014a, 2014b for a review). Furthermore, within the vast array of sexual 1.1. The association of attachment with sex addiction and problematic
behaviours, online pornography (also known as cyberpornography) is online pornography use
increasingly emerging as an easily accessible, anonymous,
cost-effective, and continuously renewed source of sexual gratification Problematic sexual behaviours may be rooted in insecure attachment
(see Duffy, Dawson, and Das Nair, 2016 for a review). Although this relationships (Weinstein et al., 2015). In this regard, attachment theory
activity does not always result in harmful consequences, prior evidence posits that early childhood interactions play a crucial role in shaping
indicates that elevated levels of sex addiction are positively correlated regulatory abilities and serve as a blueprint for intimate relationships in

* Corresponding author at: Alessio Gori, Department of Health Sciences, University of Florence, Via di San Salvi 12, Pad. 26, 50135, Firenze, Italy.
E-mail address: [email protected] (A. Gori).

https://doi.org/10.1016/j.jadr.2024.100786
Received 2 January 2024; Received in revised form 27 March 2024; Accepted 14 April 2024
Available online 19 April 2024
2666-9153/© 2024 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
A. Gori and E. Topino Journal of Affective Disorders Reports 17 (2024) 100786

adulthood (Bowlby, 1969; Giannini et al., 2011; Mikulincer and Shaver, 2. Method
2016). According to this perspective, addictive behaviours, including
those related to sexuality and cyberponography, can be conceptualized 2.1. Participants, procedure, and ethics
as dysfunctional strategies to manage internal emotional experiences
(Gori et al., 2023a). These patterns arise from the inadequate develop­ A sample of 375 participants (70 % females and 30 % males) was
ment of regulatory capacities in early caregiver relationships and the involved in the research. Their mean age was 30 years (SD = 12.441). As
persistence of insecure attachment into adulthood (Craparo, 2014; Gori shown in Table 1, the majority were single (70 %), with a substantial
et al., 2023b). In line with such theorization, previous evidence showed portion being students (38 %) or employees (28 %). Furthermore, most
significant associations of anxious attachment with sexually compulsive of them reported having obtained a high school diploma (43 %) or a
behaviours (Timberlake et al., 2016) and problematic pornography use university degree (35 %). They were recruited using a snowball pro­
(Cardoso et al., 2022). Additionally, other research (Kotera and Rhodes, cedure, and the survey was administered online through the Google
2019) has delved into these findings, emphasizing the association be­ Form platform. Before beginning, each participant electronically pro­
tween problematic sexual behaviours and fearful and preoccupied pat­ vided informed consent. Anonymity and privacy were guaranteed. The
terns (both adult attachment styles characterized by elevated levels of study protocol was approved by the first author’s institutional Ethical
anxiety). Committee.

1.2. The mediating role of dissociation

2.2. Measures

Previous research has often conceptualized addiction as a defensive

Demographic questionnaire. Some information about the participants
mechanism associated with dissociative strategies aimed at coping with
was requested including questions concerning gender, age, marital sta­
negative emotional experiences within a context of deficient regulatory
tus, education, professional condition, weekly online pornography use
skills linked to insecure attachment (Gori et al., 2022a, 2023). Not
(0–1 times a week, 2–4 times a week, 5–7 times a week, 8–10 times a
surprisingly, dissociation has been frequently linked to adult anxious
week, 11–14 times a week, 15–20 times a week, more than 20), and
attachment in its relationship with addiction (e.g., Topino, Griffiths, and
daily thoughts about sex (from 0 = “never” to 10 = “always”).
Gori, 2023). In line with this perspective, sexual addiction can be
Bergen–Yale Sex Addiction Scale (BYSAS). The BYSAS (Andreassen
interpreted as a dissociative attempt to regulate emotions in people who,
et al., 2018; Italian version: Soraci et al., 2023) is a 6-item self-report
due to the poor dyadic regulation with caregivers, have not fully
scale used to evaluate the levels of Problematic Sex Behaviour, based on
developed the ability to regulate and mentalize negative affects in a
the components model of addiction (Griffiths, 2005). Items are scored on
more adaptive way (Craparo, 2014a, 2014b; Schimmenti, 2018).
a 6-point Likert scale (from 0 = “completely disagree” to 5 = “completely
Research evidence has further proven and enriched these in­
terpretations, delving into data related to online sexual behaviours.
Table 1
More specifically, a significant and positive association was identified
Demographic characteristics of the sample (N = 375).
between the time participants spent online engaging in sexual activities
and the levels of dissociation (Chaney and Burns-Wortham, 2014). Characteristics M ± SD n %

Age (years) 30.03 ±

12.441
1.3. The present research
Sex
Females 263 70.1
Based on the aforementioned theoretical and empirical framework, Males 112 29.9
the present study aimed to explore the relationships between factors that Marital Status
Single 262 69.9
may influence the levels of problematic sexual behaviours. Although the
Married 63 16.8
scientific community has frequently demonstrated the role of anxiety Cohabiting 44 11.7
levels in attachment and dissociation contributing to addictions (e.g., Separated/Divorced 6 1.6
Gori et al., 2023a), to the best of the author’s knowledge, no research Education
has yet tested the associations of these variables specifically for sex Middle School 16 4.3
diploma
addiction and problematic online pornography use in a unified model.
High School diploma 162 43.2
Therefore, a path analysis model was implemented, by hypothesizing University degree 131 34.9
that: Master’s degree 54 14.4
Post-lauream 12 3.2
H1. Fearful and preoccupied attachment patterns would be signifi­ specialization
cantly and positively associated with sex addiction and problematic Occupation
online pornography use; Student 142 37.9
Working student 71 18.9
Artisan 10 2.7
H2. Fearful and preoccupied attachment patterns would be signifi­ Employee 106 28.3
cantly and positively associated with dissociation; Entrepreneur 13 3.5
Manager 6 1.6
H3. Dissociation would be significantly and positively associated with Trader 5 1.3
Unemployed 11 2.9
sex addiction and problematic online pornography use; Retired 11 2.9
Daily thoughts about sex 5.06 ±
H4. Sex addiction would be significantly and positively associated (from 0 to 10) 2.257
with problematic online pornography use; Weekly online pornography
use
0–1 times a week 258 68.8
H5. Sex addiction would be significantly and positively associated 2–4 times a week 91 24.3
with daily thoughts about sex; 5–7 times a week 19 5.1
8–10 times a week 3 0.8
H6. Problematic online pornography use would be significantly and 11–14 times a week 2 0.5
15–20 times a week 2 0.5
positively associated with weekly online pornography use.

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A. Gori and E. Topino Journal of Affective Disorders Reports 17 (2024) 100786

agree”). The Italian version used in this research showed good internal [Boot LLCI] to Upper Limit Confidence Interval [Boot ULCI]) did not
consistency in the present sample (α = 0.79). include zero (Preacher and Hayes, 2008).
Cyber Pornography Addiction Test (CYPAT). The CYPAT (Cacioppo
et al., 2018a,b) is an 11-item self-report scale used to evaluate the levels 3. Results
of Problematic Online Pornography Use. Items are rated on a 5-point
Likert scale (from 1 = “never” to 5 = “always”). The original (Italian) Concerning daily thoughts about sex (see Table 1), participants,
version used in this research showed good internal consistency in the using a Likert scale from 0 = "never" to 10 = "always," responded with an
present sample (α = 0.86). average of 5.06 (SD = 2.257). Regarding weekly online pornography use
Dissociative Experiences Scale-II (DES-II). The DESS-II (Carlson and (see Table 1), the majority reported a frequency of 0–1 times a week
Putnam, 1993; Italian version: Schimmenti, 2016) is a 28-item self-­ (68.8 %), followed by 2–4 times a week (24.3 %) and 5–7 times a week
report scale used to evaluate the levels of dissociative experiences. Items (5.1 %). A smaller percentage mentioned 8–10 times a week (0.8 %),
are rated on an 11-point scale (from 0 % = “never,” to 100 % = “always”), 11–14 times a week (0.5 %), and 15–20 times a week (0.5 %).
and may be grouped in both a total score and three subfactors (disso­ Pearson r analysis showed significant associations among the vari­
ciative amnesia, absorption, depersonalization-derealization). The total ables of interest (see Table 2). By specifically focusing on attachment
score of the Italian version used in this research showed excellent in­ patterns, Preoccupied Attachment showed significant and positive cor­
ternal consistency in the present sample (α = 0.95). relations with both Problematic Online Pornography use (r = 0.154, p <
Relationship Questionnaire (RQ). The RQ (Bartholomew and Hor­ 001) and Sex Addiction (r = 0.187, p < 001). Similarly, Fearful
owitz, 1991; Italian version: Carli et al., 1995) is a 4-item self-report Attachment was significantly and positively related to both Problematic
scale used to evaluate attachment patterns. Items are rated on a Online Pornography use (r = 0.189, p < 001) and Sex Addiction (r =
7-point Likert scale (from 1 = “It does not describe me at all” to 7 = “It very 0.227, p < 001). Neither Secure nor Dismissing attachment showed a
much describes me”), and explore four styles: Secure, Dismissing, Preoc­ significant association with Problematic Online Pornography use (p <
cupied, and Fearful. The Italian version was used in this research, and .05) and Sex Addiction (p < .05). Dissociation was significantly and
due to the assessment of the four attachment styles using a single item positively related to Problematic Online Pornography use (r = 0.325, p
each, the alpha coefficient cannot be calculated. < 001) and Sex Addiction (r = 0.339, p < 001). Problematic Online
Pornography use and Sex Addiction were significantly and positively
associated with each other (r = 0.509, p < .001). Finally, Problematic
2.3. Data analysis
Online Pornography use was significantly and positively related to
Weekly online pornography use (r = 0.476, p < .001), and Sex Addiction
Data were implemented using the SPSS (version 27.0; IBM, New
showed a significant and positive correlation with Daily thoughts about
York, USA) and AMOS (Version 24.0; IBM, New York, USA) software for
sex (r = 0.279, p < .001).
Windows. First, descriptive statistics and Pearson r analyses were per­
The path analysis model was constructed to test the mediation role of
formed. Then, the hypothesized path analysis model was implemented.
dissociation in the relation of Preoccupied and Fearful Attachment
Specifically, the mediation role of dissociation in the relationship be­
patterns with Problematic Online Pornography use and Sex Addiction,
tween preoccupied and fearful attachment patterns and Problematic
also exploring the effects on weekly online pornography use and daily
Online Pornography use and Sex Addiction was tested, also exploring
thoughts about sex. The emerging parallel mediation model showed an
the effects on weekly online pornography use and daily thoughts about
excellent fit to the data: CMIN/DF = 2.419; GFI = 0.986; NFI = 0.962;
sex. The statistical goodness of fit of the model was assessed based on the
TLI = 0.939; CFI = 0.977; RMSEA = 0.062; SRMR = 0.038 (see Fig. 1).
following indices: the discrepancy divided by degree of freedom (CMIN/
Specifically, both Fearful and Preoccupied attachment patterns
DF), suggesting a reasonable fit for values less than 5 (Marsh and
showed a significant and positive total effect in their relationship with
Hocevar, 1985); the Goodness of Fit (GFI), Normed-Fit Index (NFI),
Sex Addiction (β = 0.41, p < .001 and β = 0.29, p < .01, respectively)
Tucker Lewis index (TLI), and Comparative Fit Index (CFI) suggesting a
and Problematic Online Pornography use (β = 0.34, p < .001 and β =
good fit when the values are above 0.90 (Hu and Bentler, 1999; Kline,
0.24, p < .001, respectively). Furthermore, both Fearful and Preoccu­
2015); the Root Mean Square Error Of Approximation (RMSEA) and
pied attachment patterns were significantly and positively associated
Standardized Root Mean Square Residual (SRMR) suggesting a reason­
with dissociation (β = 0.20, p < .001 and β = 0.22, p < .001, respec­
able fit when the values are below 0.08 (Hooper, Coughlan, and Mullen,
tively), which, in turn, was significantly and positively related to Sex
2008; Marsh, Hau, and Wen, 2004; Fabrigar et al., 1999). The R2 index
Addiction (β = 0.28, p < .001) and Problematic Online Pornography use
was also computed, with classifications as follows: R2 < 0.02 = very
(β = 0.16, p < .001). Sex Addiction was significantly and positively
weak effect; 0.02–0.12 = weak effect; 0.13–0.26 = moderate effect; R2
associated with daily thoughts about sex (β = 0.53, p < .001) and
> 0.26 = substantial effect (Cohen, 1988). Finally, the statistical sta­
Problematic Online Pornography use (β = 0.44, p < .001), which, in
bility of the model paths was assessed using the bootstrap technique
turn, was significantly and positively related to weekly online pornog­
(5000 bootstrapped samples with 95 % bias-corrected bootstrap confi­
raphy use (β = 0.48, p < .001). When all these variables were included in
dence intervals): the significance of the effects was confirmed when the
the model, the relationship between Fearful Attachment and Sex
bootstrap confidence intervals (from Lower Limit Confidence Interval

Table 2
Correlation matrix.
1 2 3 4 5 6 7 8 9

1. Problematic Online Pornography use 1

2. Sex Addiction 0.509** 1
3. Dissociation 0.325** 0.339** 1
4. Secure Attachment − 0.079 − 0.079 ¡0.134** 1
5. Preoccupied Attachment 0.154** 0.187** 0.270** ¡0.219** 1
6. Fearful Attachment 0.189** 0.227** 0.260** ¡0.202** 0.259** 1
7. Dismissing Attachment 0.095 0.064 0.160** ¡0.108* − 0.030 − 0.084 1
8. Daily thoughts about sex 0.279** 0.545** 0.276** − 0.025 0.138** 0.128* 0.066 1
9. Weekly online porn use 0.476** 0.382** 0.219** − 0.014 0.075 0.102* 0.140** 0.308** 1

Note: Bold values indicates significant p values. **. Correlation is significant at the 0.01 level (2-tailed). *. Correlation is significant at the 0.05 level (2-tailed).

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A. Gori and E. Topino Journal of Affective Disorders Reports 17 (2024) 100786

Fig. 1. Path analysis exploring the association between Fearful and Preoccupied Attachment patterns, Dissociation, Problematic Online Pornography use, Sex
Addiction, Weekly Online Porn Use, and Daily thoughts about Sex.
Note: *** p < .001; ** p < .01; * p < .05. Standardized regression coefficients are presented.

Addiction remained significant, albeit diminishing (β = 0.13, p < .05; attachment styles were also positively related to dissociation (H2), and
partial mediation), while that with Problematic Online Pornography use higher levels of dissociation were associated with higher levels of sex
became non-significant (β = 0.04, p = .354; total mediation). On the addiction and problematic online pornography use (H3). The scientific
other hand, when all these variables were included in the model, the literature has consistently demonstrated the role of dissociation in
relationships of Preoccupied Attachment with Sex Addiction and Prob­ addiction, often conceptualizing the use of substances or compulsive
lematic Online Pornography use became non-significant (β = 0.08, p = behaviours as maladaptive dissociative strategies (e.g., Craparo, 2014b;
.107 and β = 0.02, p = .672, respectively; total mediation). Gori et al., 2022b; Schimmenti, 2018; Topino, Gori, and Cacioppo,
The examined model’s relationship accounted for 15 % of the total 2021). This perspective is reinforced by the findings of this study, which
variance in Sex Addiction (0.13 > R2 < 0.026 = moderate effect), 29 % elucidates the existing evidence in the realm of problematic sexual be­
of the total variance in Problematic Online Pornography use (R2 > 0.26 haviours (Chasioti and Binnie, 2021). These behaviours may be inter­
= substantial effect), 28 % of the total variance in daily thoughts about preted as dissociative strategies to manage the fear of intimacy
sex (R2 > 0.26 = substantial effect), and 23 % of the total variance in (associated with worried attachment) and the fear of abandonment
weekly online pornography use (0.13 > R2 < 0.26 = moderate effect). (associated with fearful attachment), in the absence of more functional
Finally, the bias-corrected bootstrap procedure confirmed the sta­ regulatory skills (Ciocca et al., 2021; Gori et al., 2023a). Additionally,
tistical stability of the multiple mediation model (see Table 3). sex addiction also showed a significant and positive association with
problematic online pornography use (H4). This result is consistent with
4. Discussion prior research that has identified the excessive use of pornography as
one of the most pertinent and widespread issues among individuals with
Recent scientific research consistently emphasizes the significant hypersexuality (Reid et al., 2012). Finally, sex addiction and problem­
adverse consequences of problematic sexual behaviours in various atic online pornography use were found to be significantly associated
crucial areas of the lives of those affected (see Mauer-Vakil and Bahji, with daily thoughts about sex and weekly online pornography use,
2020 for a review) and, consequently, there is an agreement on the need respectively (H5 and H6). This is in line with the existing evidence
for further investigation into the risk and protective factors associated (Bőthe et al., 2021) and theorizations that identify salience (over-­
with this condition. In line with this, the present study aimed at preoccupation with or intense desire for sex) as one of the key symptoms
exploring the relationship between the factors that may be associated of addiction (Andreassen et al., 2018; Griffiths, 2005).
with sex addiction and problematic online pornography use, by specif­ This research presents some limitations that should be acknowl­
ically exploring the role of attachment and dissociation. edged. First, the cross-sectional design hinders the establishment of
The results supported all the formulated hypotheses (from H1 to H6). causal relationships between the variables. Future research could
Primarily, fearful and preoccupied attachment patterns were signifi­ employ longitudinal designs to better understand the temporal re­
cantly and positively associated with both sex addiction and problematic lationships between the explored variables, providing a more robust
online pornography use (H1). Such findings align with previous evi­ basis for causal inferences. Furthermore, participants were predomi­
dence (Cardoso et al., 2022; Kotera and Rhodes, 2019) and confirm the nantly females, and this gender imbalance may limit generalization to
utility of exploring various forms of addiction in relation to attachment the male population. Future research could employ targeted recruitment
patterns (see Alvarez-Monjaras et al., 2019 for a review). In line with strategies or implement diverse outreach methods to ensure a more
this view, attachment insecurity can interfere with the development of representative and balanced sample, fostering a more comprehensive
healthy emotional intimacy and its connection to sexuality. Conse­ understanding of the phenomenon across genders. Finally, the reliance
quently, engaging in sexual activities can be perceived as one of the on self-report measures introduces the potential for response bias and
limited avenues to attain a tolerable sense of connection with others social desirability, impacting the accuracy of reported behaviours and
(Gold and Seifer, 2002). Consistently, fearful and preoccupied emotions. Future studies could incorporate multi-method approaches,

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A. Gori and E. Topino Journal of Affective Disorders Reports 17 (2024) 100786

Table 3 Table 3 (continued )

Unstandardized coefficients of the path analysis. Estimate SE p BootLLCI* BootULCI*
Estimate SE p BootLLCI* BootULCI*
Dissociation → Sex
Total effects Addiction → Daily
Fearful Attachment → 0.340 0.114 0.001 0.131 0.652 thoughts about sex
Problematic Online Preoccupied 0.201 0.068 < 0.084 0.354
Pornography use Attachment → 0.001
Fearful Attachment → 0.410 0.118 < 0.189 0.575 Dissociation → Sex
Sex Addiction 0.001 Addiction →
Preoccupied 0.239 0.094 0.008 0.064 0.436 Problematic Online
Attachment → Pornography use
Problematic Online Preoccupied 0.023 0.011 0.008 0.005 0.048
Pornography use Attachment →
Preoccupied 0.291 0.107 0.007 0.076 0.500 Dissociation → Sex
Attachment → Sex Addiction →
Addiction Problematic Online
Direct effects Pornography use →
Fearful Attachment → 0.090 0.101 0.354 − 0.104 0.292 Weekly online porn
Problematic Online use
Pornography use
Note: *5000 bootstrapped samples with 95 % biascorrected bootstrap confi­
Fearful Attachment → 0.287 0.120 0.011 0.063 0.535
Sex Addiction dence intervals.
Preoccupied 0.037 0.090 0.672 − 0.141 0.213
Attachment → combining self-report measures with behavioural observations or
Problematic Online
physiological assessments, to enhance the reliability and validity of data
Pornography use
Preoccupied 0.161 0.104 0.107 − 0.033 0.366 collection.
Attachment → Sex
Addiction 5. Conclusions
Indirect effects
Fearful Attachment → 0.561 0.159 < 0.272 0.902
Dissociation → 0.001
This research contributes to the expanding body of scientific litera­
Problematic Online ture on problematic sexual behaviours by shedding light on the associ­
Pornography use ations among fearful and preoccupied attachment patterns, dissociation,
Fearful Attachment → 0.658 0.161 < 0.357 0.995 sex addiction, problematic online pornography use, daily thoughts
Dissociation → 0.001
about sex, and weekly online pornography use. The obtained findings
Problematic Online
Pornography use → may have valuable clinical implications. Indeed, the data support the
Weekly online porn potential application of attachment theory in clinical practice for the
use treatment of problematic sexual behaviours. Therapeutic approaches
Fearful Attachment → 0.123 0.044 < 0.054 0.229 that focus on relational depth moments would be beneficial for in­
Dissociation → Sex 0.001
Addiction
dividuals dealing with sex issues. Consistently, the results also under­
Fearful Attachment → 0.133 0.039 < 0.063 0.217 score the necessity for enhanced regulatory skills that prove more
Dissociation → Sex 0.001 functional than relying on dissociative strategies. This highlights the
Addiction → Daily opportunity to focus therapeutic interventions on cultivating healthier
thoughts about sex
coping mechanisms. Furthermore, the link between Sex Addiction and
Fearful Attachment → 0.250 0.073 < 0.130 0.418
Dissociation → Sex 0.001 Problematic Online Pornography use was highlighted, suggesting that
Addiction → compulsive behaviours may be significantly associated with the prob­
Problematic Online lematic use of online platforms. Hence, it could be useful to address
Pornography use problematic sexual behavior in clinical practice not only in its tradi­
Fearful Attachment → 0.033 0.012 0.001 0.012 0.059
Dissociation → Sex
tional offline context but also concerning its manifestation in cyber­
Addiction → space. These insights can therefore guide clinicians and researchers in
Problematic Online developing targeted interventions that address the core issues associated
Pornography use → with attachment patterns, dissociation, and problematic sexual behav­
Weekly online porn
iours, promoting more effective and sustainable treatment outcomes.
use
Preoccupied 0.864 0.158 < 0.565 1187
Attachment → 0.001 Role of funding sources
Dissociation →
Problematic Online This research did not receive any specific grant from funding
Pornography use
Preoccupied 1189 0.158 < 0.885 1508
agencies in the public, commercial, or not-for-profit sectors.
Attachment → 0.001
Dissociation → Consent to participate
Problematic Online
Pornography use →
Informed consent was obtained from all individual participants
Weekly online porn
use included in the study.
Preoccupied 0.130 0.042 < 0.063 0.229
Attachment → 0.001 Data statement
Dissociation → Sex
Addiction
Preoccupied 0.094 0.036 0.006 0.026 0.167
The data presented in this study are available on request from the
Attachment → corresponding author.

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A. Gori and E. Topino Journal of Affective Disorders Reports 17 (2024) 100786

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