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On the current psychotherapeutic situation for persons with pornography use disorder in Germany
(2023)
Background and aims: For the first time, the ICD-11 provides the diagnosis compulsive sexual behavior disorder (CSBD) that can be assigned for pornography use disorder (PUD). This study aimed to estimate the prevalence of PUD and associated consequences in Germany, to identify the psychotherapy demand among likely PUD (lPUD) cases and the treatment supply in different psychotherapeutic settings, to survey psychotherapists' level of expertise regarding PUD, and to identify predictors for psychotherapy demand.
Methods: Four studies were conducted: 1. Online study in the general population (n = 2070; m = 48.9%, f = 50.8%, d = 0.2%), 2. Survey among practicing psychotherapists (n = 983), 3. Survey of psychotherapists in psychotherapeutic outpatient clinics (n = 185), 4. Interviews with psychotherapeutic inpatient clinics (n = 28).
Results: The estimated prevalence of lPUD in the online study was 4.7% and men were 6.3 times more often affected than women. Compared to individuals without PUD, individuals with lPUD more often indicated negative consequences in performance-related areas. Among lPUD cases, 51.2% of men and 64.3% of women were interested in a specialized PUD treatment. Psychotherapists reported 1.2%–2.9% of lPUD cases among their patients. 43.2%–61.5% of psychotherapists stated to be poorly informed about PUD. Only 7% of psychotherapeutic inpatient clinics provided specific treatments to patients with PUD. While, among other factors, negative consequences attributed to lPUD were predictive for psychotherapy demand, weekly pornography consumption, subjective well-being, and religious attachment were not.
Discussion and conclusions: Although PUD occurs quite often in Germany, availability of mental health care services for PUD is poor. Specific PUD treatments are urgently needed.
Until now, the NW Indian Ocean was sparsely covered with coral proxy records, and records from the Maldives Archipelago do not exist. The first such coral proxy record from the central Maldives is presented in this study. It originates from a massive Porites lutea (Quoy and Gaimard, 1833) colony that was sampled March 2007 in the lagoon of Rasdhoo Atoll (4°N/ 73°W), which is located in the central Maldives. The record spans a period of 90 yrs and reaches back to 1917 AD with monthly to bimonthly resolution. This study investigates temporal variations of the skeletal stable oxygen (delta18O) and carbon (delta13C) isotopes, the strontium-to-calcium (Sr/Ca), and the annual extension-rates, and their relationship to historical climate variations 1917-2007. Annual extension-rates show an increase over the 20th century, and are correlated with instrumental sea surface temperatures (SST). The interannual variation of the extension-rates within 2.5-4 years is driven by the El Niño-Southern Oscillation (ENSO). The amount of skeletal extension during the summer months is triggered by variations in the strength of the SW monsoon. Interannual and decadal variability in monsoon current activity (18-19 yrs) and rainfall over India are an expression of the summer monsoon strength. This is the reason why a statistical link between coral extension-rates and precipitation over India can be established. This implies that annual extension-rates in corals can be used as a new proxy for Indian monsoon variability on decadal resolution. The delta18O record exhibits the 20th century warming trend that is influenced by the effect of monsoon-induced cooling. delta18O also reveals interannual ENSO triggered variability, which is due to ENSO-forced variations in SST and sea surface salinity (SSS). A decadal variation at 12-14 yrs cannot be linked to SST variations in the NW Indian Ocean, but with decadal variations of SSS. They could be caused by ENSO- forced variations of the monsoon currents during the mature phase of ENSO teleconnections in the Indian Ocean in boreal winter. The Sr/Ca record does not indicate a significant warming, in spite of the observed SST rise at the sampling site. Changes in seawater Sr/Ca cannot be excluded. Nevertheless, interannual ENSO forcing is still evident. Evidence for the Pacific Decadal Oscillation (PDO) is found during 1917-1955. Afterwards, the Sr/Ca data indicate the disappearance of PDO forcing. By the combination of Sr/Ca and delta18O it is possible to detect ~80% of historical El Niño and La Niña events at the sample site. This study confirms the notion that interannual to multi-decadal climate fluctuations in the Pacific play a crucial role for climate variability in the Indian Ocean.
