How does the conceptualization of out-of-control sexual behavior shape the social, clinical, and legal reactions?

• Applicant: Professor Dr. Johannes Fuß
• Subject Area: Clinical Psychiatry, Psychotherapy, Child and Adolescent Psychiatry
• Term: since 2021
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 466178460

There is an ongoing debate how to conceptualize sexual behaviors that are out-of-control and associated with personal distress and problems in functioning. Some clinicians, scientists and public stakeholders see it as an impulse control disorder, others as an addiction, a sexual disorder or an expression of normal behavior. Often neuroscientific evidence plays a central role in the debate to underline arguments for or against a certain concept. Out-of-control sexual behavior is also defined as a typically male mental disorder and previous research indicates that beliefs about gender and biological causation also influence the perception of out-of-control sexual behavior. Although out-of-control sexual behavior will be included in the ICD-11 as an impulse control disorder, the debate about conceptualization is ongoing. However, the consequences for those affected are rarely considered in this debate. This is surprising since undesired social, clinical, and legal consequences were cited as main reasons for rejecting inclusion of out-of-control sexual behavior in the DSM-5. Still, little is known about how these undesired consequences may be influenced by the proposed concepts in affected men and women. The present proposal aims to close this gap of knowledge by examining social, clinical, and legal consequences of different conceptualizations. The project will focus on the most discussed conceptualizations of out-of-control sexual behaviors (impulse control disorder vs. addiction vs. sexual disorder vs. neither) and will scrutinize the effect of conceptualizing it as a neurobiological disorder by emphasizing altered brain structure and function. It will also investigate if concepts are perceived differently in men and women. To reach the objective, the work has been broken down into three studies assessing the social (study 1), clinical (study 2) and legal (study 3) consequences using randomly-assigned web-based case vignettes: Study 1 will investigate how different concepts impact on stigmatization in men and women. Study 2 examines clinical decisions and empathy towards men and women with out-of-control sexual behaviors in a population of mental health professionals. Again, the impact of different conceptualizations will be evaluated. Study 3 will study sentencing of men and women with out-of-control sexual behavior in a population of judges. Study 3 aims to scrutinize how men and women with out-of-control sexual behavior are evaluated by judges if they have committed a sexual offense. The main aim is to investigate the influence of conceptualization on the sentencing and the assessment of legal responsibility in a hypothetical criminal case.Thus, this proposal aims to close the gap in knowledge about social, clinical, and legal consequences of conceptualizations of out-of-control sexual behavior. The data obtained should make an important contribution in future considerations regarding the conceptualization of out-of-control sexual behavior.

• DFG Programme: Research Grants
• International Connection: South Africa
• Cooperation Partner: Professor Dr. Dan Stein