SEXUAL ADDICTION & COMPULSIVITY

2018, VOL. 25, NO. 2-3, 197–215

https://doi.org/10.1080/10720162.2018.1495586

Operationalization of Excessive Masturbation—

Development of the EMS
Wiebke Driemeyera, Jan Snagowskib, Christian Laierb, Michael Schwarzb, and
Matthias Branda,c
a
Clinic of Psychiatry and Psychotherapy, University Medical Center Essen, Essen, Germany;
b
General Psychology, Cognition University of Duisburg-Essen Germany and Center for Behavioral
Addiction Research (CeBAR), Duisburg, Germany; cErwin L. Hahn Institute for Magnetic
Resonance Imaging, Essen, Germany

ABSTRACT
Research has recently focused on hypersexual behavior and
Internet-pornography-viewing disorder as potential psychopa-
thological conditions, but specific aspects of the phenomena
have been widely neglected. This study aimed to investigate
excessive masturbation as a subset and symptom of hypersex-
ual behaviors. 2 studies with independent samples have been
conducted. In study 1 (n ¼ 146), the Excessive Masturbation
Scale (EMS) was designed and tested via explorative factor
analysis. In study 2 (n ¼ 255), the psychometric properties of
the EMS were evaluated by confirmatory factor analysis. A rep-
licable 2-factor structure (“Coping” and “Loss of Control”) was
identified. The EMS showed good psychometric properties
and provides a promising basis for further research.

Introduction
Although the clinical relevance of excessive sexual behaviors (including
excessive casual sex, viewing of pornography, and/or masturbation) is
undoubted (Duffy, Dawson, & das Nair, 2016; Kraus, Voon, Potenza, 2016;
Reid et al., 2012), these phenomena have not yet been included in the current
version of the Diagnostic and Statistical Manual of Mental Disorders (APA,
2013; Kafka, 2010; Reid & Kafka, 2014). Therefore, their diagnostic criteria
and classification are still under debate. For instance, hypersexual behavior
has also been referred to as sexual addiction (Garcia & Thibaut, 2010), com-
pulsive sexual behavior, or sexual impulsivity (Bancroft & Vukadinovic,
2004). Accordingly, a number of models exist to explain hypersexual behav-
ior on- or offline (Brand, Young, Laier, W€ olfling, & Potenza, 2016; Walton,
Cantor, & Lykins, 2015) and a large body of instruments to measure

CONTACT Matthias Brand matthias.brand@uni-due.de Department of General Psychology, Cognition and

Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Forsthausweg 2, 47057
Duisburg, Germany.
ß 2018 Taylor & Francis Group, LLC
198 W. DRIEMEYER ET AL.

hypersexual behavior has been developed (Hook, Hook, Davis, Worthington,

& Penberthy, 2010). Currently, one of the most common instruments to
measure symptoms of hypersexuality is the Hypersexual Behavior Inventory
(HBI; Reid, Garos, & Carpenter, 2011), which is based on the criteria of the
proposed diagnosis for DSM-5 and consists of three factors, i.e., control, cop-
ing, and consequences. However, it has been criticized, that none of the
models have “yet met with compelling outcome data” (Cantor et al., 2013, p.
883) and that hypersexuality self-report measures do not well predict the
actual frequency of sexual activities a person is involved in (Walton, Lykins,
& Bhullar, 2016). One aspect that has been discussed in this context is that
hypersexual behavior, as opposed to the predominant assumption, might not
hold one underlying feature, but is the expression of several different psycho-
physiological conditions (Cantor et al., 2013; Orford, 1978; Walton, Cantor,
& Lykins, 2015). Walton et al. (2015) concluded from their results that three
different taxa of hypersexual behavior exist: (1) Dysregulated sexual inhibi-
tion/-excitation proneness, (2) greater trait impulsivity than adults with typi-
cal sexual functioning, and (3) maladaptive coping mechanism to relieve
negative mood states. Moreover, some authors described different subtypes
of hypersexual behavior, which are characterized by the specific sexual
behavior acted out, for example paraphilic hypersexual behavior, chronic
adultery, and excessive masturbation (Cantor et al., 2013; Kaplan & Krueger,
2010; Sutton, et al., 2015). It is possible that the above-mentioned models
yield more explanatory power when investigated for each subtype separately
instead of for hypersexual behavior in general. It seems likely that different
motivations underlie different types of hypersexual behavior. First
approaches to identify specific psychosocial characteristics of these subtypes,
for example level and area of impairment, have yielded promising results
(Spenhoff, Kruger, Hartmann, & Kobs, 2013; Sutton et al., 2015). However,
so far, the classification of subtypes is based on clinical observations and a
theoretical conceptualization and operationalization is lacking. Also, current
instruments do not provide the possibility to distinguish hypersexual behav-
ior by type of behavior. Whereas the definition for DSM-5 explicitly requires
a specification what kind of sexual behavior is reported (i.e., masturbation,
pornography, sexual behavior with consenting adults, cybersex, telephone
sex, strip clubs, other), generic expressions are used with regard to the type
of sexual activity in the 19 questions of the HBI (e.g., “sexual behavior,”
“something sexual,” or “sexual activities”).
The present study focuses on the operationalization of masturbation as a
subset and symptom of hypersexuality, which has been referred to as a
strong marker (e.g., Klein, Rettenberger, & Briken, 2014; Reid et al., 2012)
and even as criterion for hypersexual disorder (Långstr€ om & Hanson,
2006), but has not yet been investigated as a separate phenomenon. It was
 SEXUAL ADDICTION & COMPULSIVITY 199

found in high rates among people who report hypersexual behavior

(56%–75%; Kafka & Hennen, 1999; Raymond, Coleman, & Miner, 2003;
Wines, 1997), but the criteria for excessive masturbation in those studies
have been either not specified or simply adopted from the general defini-
tion of hypersexual behavior. Moreover, despite these findings and the
common assumption that excessive masturbation is a crucial component of
hypersexual behavior, knowledge about its interactions with and relevance
to other subsets is limited. Findings of a few studies indicated that solitary
sexual activities (e.g., masturbation, pornography viewing) might be stron-
ger predictors of hypersexual behavior than partnered sexual activities
(with one or more sex partners) (Klein, Rettenberger, & Briken, 2014; Reid
et al., 2012; Walters, Knight, & Langstr€om, 2011). Moreover, excessive mas-
turbation has been found to be highly associated with pornography view-
ing, but not significantly with promiscuity (Griffiths, 2012; Kafka &
Hennen, 1999). Others described that masturbation and the need to mas-
turbate have a reinforcing effect on the consumption of Internet-pornogra-
phy-viewing disorder (Laier et al., 2013; Meerkerk, Van Den Eijnden, &
Garretsen, 2006), while cybersex addiction is not associated with satisfac-
tion by partnered sex and with the number of sexual contacts (Laier, Pekal,
& Brand, 2014). These findings suggest that solitary sexual activities play a
distinct role from partnered sexual activities for hypersexual behavior, but
what exactly those differences are and how they could be explained needs
further investigation. One reason for a stronger connection between solitary
sexual activities and hypersexual behavior might be a higher availability of
solitary activities (comparable to the Triple-A-Engine for online sexual
activity; Cooper, 1998) as well as a higher efficiency with regard to the
experience of orgasm. Schultz et al. (2014) hypothesized, that “isolative sex-
ual activities,” which are more acted out by men than by women, have a
negative influence on distress and thereby motivate to continue engaging in
sexual activities. This notion refers to the hypothesis that sexual behavior
can be used as a dysfunctional coping mechanism to relieve negative mood
states. Indeed, Spenhoff et al. (2013) reported that masturbation and view-
ing pornography were associated with more distress compared to reports of
other types of hypersexual behavior. In a study about subtypes of hypersex-
ual behavior by Cantor et al. (2013), many in the group of “avoidant
masturbators” reported feelings of anxiety and dysthymia. Likewise, Sutton
et al. (2015) found more anxiety problems in this group. These findings
suggest that negative mood states can not only be the cause of solitary
hypersexual behavior but also result from it, for example if a lack of inti-
macy is hereby stabilized. More important, the findings also suggest that
the hypothesis that hypersexual behavior could be a coping mechanism to
sooth unpleasant mood states seems to well apply to excessive
200 W. DRIEMEYER ET AL.

masturbation. However, the association between negative mood states and

excessive masturbation could also be explained by other mechanisms. A
qualitative study (Bancroft et al., 2003) indicated that an increased interest
in masturbation is more connected to anxiety than to depression, while an
increased interest in sex with another person is connected to both mood
states (for contradictory results, see Frohlich & Meston, 2002). Bancroft
et al. (2003) assumed that masturbation would not, as opposed to sex with
another person, work to compensate for feelings of loneliness during
depressed mood states, while during stressed and anxious mood states, on
the other hand, psychophysiological excitation might be transferred to sex-
ual arousal regardless of the type of practice acted out. In this context, the
Dual Control Model (Janssen & Bancroft, 2007) is commonly referred to in
order to explain increased sexual desire and activity during and despite
negative mood states and evidence for its applicability to the concept of
hypersexuality is growing (Rettenberger, Klein, & Briken, 2016). According
to this model and to empirical findings this model is based on (Bancroft
et al., 2003; Bancroft, Janssen, Strong, Carnes, Vukadinovic, & Long, 2003;
Bancroft & Vukadinovic, 2004), individuals suffering from hypersexual
behavior reported a low tendency to inhibit sexual urges (e.g., during dys-
phoric mood states or cognitions) while being easily sexually aroused
and excited.
The empirical basis is yet too weak to draw conclusions and it can only
be speculated which of the supposed theories best explains excessive mas-
turbation, but it seems plausible that different psychopathological mecha-
nisms and predispositions apply to different types of hypersexual behavior.
However, conceptual knowledge about possible subtypes is very limited. It
is unknown whether specific types of sexual behavior hold the same charac-
teristics as the concept of hypersexuality on the whole or if they constitute
distinct phenomena. A separate investigation of subsets should enlighten
specific patterns and predispositions of the behavior and its underlying
phenomena and thereby contribute to a more differentiated understanding
of hypersexuality in general. While different questionnaires for the assess-
ment of excessive cybersex use exist (e.g., the Internet Addiction Test or
the Compulsive Internet Use Scale both modified for sexual behaviors
online (Downing, Antebi, & Schrimshaw, 2014; Laier et al., 2013), excessive
masturbation has not yet been operationalized. In order to address the
question of which characteristics of excessive masturbation are overlapping
or distinct from other subsets of hypersexual behavior (e.g., pornography
viewing) and from hypersexual behavior in general as well as its associated
concepts (e.g., sexual inhibition/excitation, psychopathological states such
as depression etc.), an instrument that investigates excessive masturbation
specifically is needed.
 SEXUAL ADDICTION & COMPULSIVITY 201

Aim
The aim of this study was to operationalize excessive masturbation as a
subset and symptom of hypersexual behavior in order to allow for a sepa-
rate investigation of the phenomenon in future. Therefore, two studies
were conducted: In study 1, a questionnaire for the assessment of excessive
masturbation behavior (EMS) was designed and its factor structure was
investigated using exploratory factor analyses. In study 2, the identified fac-
tor structure was validated using confirmatory factor analyses and psycho-
metric properties of the EMS were evaluated.

Study 1
Participants
A total of 146 male participants took part in the study (Mage ¼ 23.30,
SD ¼ 5.13, Range ¼ 18–54 years). Participants reported masturbating 4.05
(SD ¼ 3.60) times per week with an average duration of 13.81 (SD ¼ 8.44)
minutes. Only adult individuals of legal age (over 18 years old) were asked
to participate in the study and, prior to the investigation, they were
informed that they would be surveyed regarding their sexual behaviors. All
participants gave written informed consent before the investigation and
were fully debriefed at the end of the study. Participants were recruited
through local advertisements at the University ANONYMIZED and online
platforms. Students could collect credit points and non-student participants
received 10e financial reimbursement. A local ethics committee approved
the study.

Methods
The Excessive Masturbation Scale (EMS) was developed to assess problematic
masturbation behavior. For this purpose, 26 items were generated following
the concepts of impulse control disorder, substance abuse, gambling disorder,
Internet-use disorder, and the suggested criteria for hypersexual disorder.
Examples of the items are “How often do you try to masturbate less often and
fail?,” “How often do you masturbate in order to forget your everyday
worries?”). The items were answered on a 5-point Likert-type response format
(1 ¼ never, 2 ¼ rarely, 3 ¼ sometimes, 4 ¼ often, 5 ¼ very often).

Statistical analyses
To explore the factor structure of the developed scale, an exploratory factor
analysis (EFA) with principal component analysis and promax rotation was
calculated. The EFA was conducted with SPSS (v.22). Further, Horn’s parallel
202 W. DRIEMEYER ET AL.

analysis (Horn, 1965) was used to verify the number of extracted factors. It
was argued that this method is more valid compared to others such as the
Kaiser criterion (Pawlikowski, Altst€otter-Gleich, & Brand, 2013). In a second
step, we included a randomly generated unique variable to confirm the num-
ber of extracted factors as suggested by Zwick and Velicer (1986).

Results
The criteria of Horn’s parallel analysis suggested a two-factor solution of the
EMS. Since adding a randomly generated unique variable did not change the
factor loadings, this finding was further ensured using the method suggested by
Zwick and Velicer (1986). The empirical eigenvalue of the first factor (5.84) was
higher than the eigenvalue from parallel analysis (1.72). The empirical eigen-
value of the second factor (2.20) was higher than the eigenvalue from parallel
analysis (1.56) as well. The third factor was not extracted since the empirical
eigenvalue (1.06) was lower than the eigenvalue from parallel analysis (1.45).
The extracted two-factor solution explained 50.23% of the variance in the EMS.
Based on the EFA, 10 items have been excluded because of insufficient factor
loadings (low main loadings and/or high parallel loadings). After the EFA, 16 of
the original 26 items were considered adequate with respect to their factor load-
ings and were therefore kept. Although Ferguson and Cox (1993) suggested
excluding items with low factor loadings (< 0.50) and/or high parallel loadings
(< 0.20), items 9 and 10 were kept because of their contribution to the scale’s
content and because the exclusion criteria by Ferguson and Cox (1993) are
rather conservative, whereas less strict criteria have frequently been proposed
(e.g., Tabachnick & Fidell, 2001). The items of the EMS are listed in Table 1.
In summary, Factor 1 contains 10 items which overall assess the fre-
quency of situations in which masturbation is used to cope with specific
moods or feelings (e.g., stress, anxiety, depression, etc.). Therefore, Factor 1
is referred to as “coping.” Further, Factor 2 consists of 6 items, which
assess indications of losing control over masturbation with regard to time
spent masturbating and masturbation frequency. Hence, Factor 2 is referred
to as “loss of control.” Overall, both factors as well as the sum score of the
EMS provided good reliability in the current sample (EMS coping:
Cronbach’s a ¼ 0.852; EMS loss of control: Cronbach’s a ¼ 0.854; EMS sum
score: Cronbach’s a ¼ 0.879).

Study 2
Participants
A total of 255 participants (102 females) took part in the second study
(Mage ¼ 25.54, SD ¼ 4.86, Range ¼ 18–51 years). Participants reported
 SEXUAL ADDICTION & COMPULSIVITY 203

Table 1. Factor loadings and reliabilities of the two EMS factors.

Factor
Item number Item 1. 2. M (SD)
Factor 1: Coping
1 How often do you masturbate in order to forget 0.810 0.019 1.75 0.97
your everyday worries?
2 How often do you masturbate because you 0.769 0.021 1.57 0.90
are depressed?
3 How often do you masturbate because you 0.669 0.067 1.19 0.49
feel anxious?
4 How often do you masturbate because you are 0.646 0.012 1.53 0.79
irritated or upset?
5 How often do you masturbate because you are 0.645 0.040 2.09 10.00
stressed out?
6 How often do you masturbate to feel better? 0.570 0.040 2.51 10.01
7 How often do you recognize that you masturbate 0.516 0.191 1.74 0.95
more often when being under emo-
tional pressure?
8 How often do you recognize that you have to 0.502 0.057 1.89 0.81
masturbate a longer time or more frequently to
receive the desired gratification?
9 How often do you have problems to fall asleep 0.478 0.069 1.70 0.93
when you have not masturbated?
10 How often do you think about masturbating even 0.454 0.062 2.03 0.95
when you are not able to masturbate?
Factor 2: Loss of control
11 How often do you try to masturbate less often 0.213 0.886 1.67 0.96
and fail?
12 How often do you try omitting masturbation 0.035 0.806 1.62 0.85
and fail?
13 How often do you notice that you masturbate 0.083 0.741 2.09 10.02
more often than you intended to?
14 How often do you perceive that you spend too 0.116 0.737 1.90 0.94
much time on masturbating?
15 How often do you masturbate despite knowing 0.136 0.522 1.54 0.86
that you will regret it afterwards?
16 How often do you experience negative feelings 0.072 0.441 1.60 0.78
after having masturbated?
Main loadings ¼ bold.

masturbating 3.98 (SD ¼ 1.99) times per week with an average duration of
13.81 (SD ¼ 8.44) minutes. The setting of investigation and the age require-
ment for participation remained the same as in study 1.

Methods
In study 2, the extracted factor structure from study 1 was validated. Here,
the reliability of the EMS was excellent (Cronbach’s a ¼ 0.919).
Additionally, actual masturbation behavior was assessed by ad hoc items.
The items assessed the self-reported time spent on masturbation, frequency
of masturbation, subjective feelings during and after masturbation.
Examples are “On average, how often do you masturbate?,” “On average,
how long do you masturbate,” “How would you describe your feelings
while/after masturbating” (scale from 1 ¼ positive to 5 ¼ negative). In order
to be able to investigate psychometric properties and convergent validity of
204 W. DRIEMEYER ET AL.

the EMS, further questionnaires were applied. First, tendencies towards

hypersexuality were measured with a German version (Klein, Rettenberger,
Boom, & Briken, 2014) of the Hypersexual Behavioral Inventory (Reid,
Garos, & Carpenter, 2011). The HBI contains 19 items rated on a scale
from 1 (never) to 5 (very often) that can be separated into three subscales:
Control (e.g., “My sexual cravings and desires feel stronger than my self-
discipline.”), coping (e.g., “I use sex to forget about the worries of daily
life.”), and consequences (e.g., “My sexual behavior controls my life.”). In
this study, the internal consistency of the HBI was excellent
(Cronbach’s a ¼ 0.910).
Second, to assess sensitivity towards sexual excitation, a German version
of the short form of the Sexual Excitation Scale was used (Turner, Briken,
Klein, & Rettenberger, 2014). The SES consists of 6 items (e.g., “When I
see an attractive person, I start fantasizing about having sex with him/
her.”). The internal consistency of the SES was barely acceptable in this
study (Cronbach’s a ¼ 0.675). Compared to the original version from
Carpenter, Janssen, Graham, Vorst, and Wicherts (2010), an inverted scale
from 1 (strongly disagree) to 4 (strongly agree) was used.
Third, in order to measure tendencies towards cybersex addiction, a
German version of the short version of the Internet Addiction Test (s-IAT;
Pawlikowski et al., 2013), modified for cybersex (s-IATsex; Laier et al.,
2013) was used. The s-IATsex consists of 12 items on a scale ranging from
1 (never) to 5 (very often). The internal consistency of the s-IATsex in this
study was good (Cronbach’s a ¼ 0.837). The s-IATsex can be subdivided
into the subscales (each having six items): loss of control/time management
(e.g., “How often do you find that you stay on Internetsex sites longer than
you intended?”) and craving/social problems (e.g., “How often do you feel
preoccupied with online sexual activities when off-line, or fantasize about
being on Internetsex sites?”).
Fourth, to assess psychopathological symptoms, two subscales of the Brief
Symptom Inventory (BSI; Derogatis & Melisaratos, 1983) were used. The
items of the BSI are rated on a scale ranging from 0 (no problem) to 4 (very
serious). In the course of this study, the subscales depression (Cronbach’s
a ¼ 0.870) and interpersonal sensitivity (Cronbach’s a ¼ 0.796) were used.
Interpersonal Sensitivity is defined as feelings of personal inadequacy and
inferiority; people with high levels of interpersonal sensitivity characteristi-
cally experience uneasiness and discomfort during interpersonal interactions.

Statistical analyses
A confirmatory factor analysis (CFA) was used to verify the extracted fac-
tors from study 1. The CFA was conducted via Mplus 6.12 (Muthen &
 SEXUAL ADDICTION & COMPULSIVITY 205

Muthen, 2011). To verify the model fit, the following indices were consid-
ered. As absolute fit-index, the v2 statistic was used. Because of its sensitiv-
ity to sample size, the v2 to degrees of freedom ratio (v2/df) was calculated
to assess the general model fit. Schermelleh-Engel, Moosbrugger, and
M€ uller (2003) suggest a ratio <2 to indicate a good model fit while a ratio
<3 indicates an acceptable model fit. For testing against a baseline model,
the Comparative Fit Index (CFI) and the Tucker Lewis Index (TLI) were
used. A CFI/TLI between 0.95 and 1 indicates a good model fit, whereas a
value between 0.90 and 0.95 resembles an acceptable model fit.
Additionally, the root Mean Square Residual (SRMR) was used as a further
absolute fit-index. Thereby, a SRMR <0.08 indicates a good model fit,
while a SRMR <0.10 indicates an acceptable model fit. Accordingly, models
with a SRMR >0.10 should be rejected (Hu & Bentler, 1999). Furthermore,
the Root Mean Square Error of Approximation (RMSEA) was used as par-
simony fit-index. Thereby, a RMSEA <0.05 indicates a good model fit,
while a RMSEA between 0.05 and 0.08 indicates an acceptable model fit.
Moreover, a RMSEA >0.08 indicates that the model should be rejected
(Hu & Bentler, 1999). To investigate relationships between two variables,
Pearson correlations were used. Effect sizes are reported according to
Cohen (1988) (r  0.10, small; r  0.30, medium; r  0.50, large) on the sig-
nificance level p  0.05.

Results
Confirmatory factor analysis (CFA)
For the two-factor CFA model, the v2 statistic was significant v2
(103) ¼ 315.52, p < 0.001. The value of the v2/df ratio (3.06) was slightly
over 3 but barely acceptable. The fit indices CFI ¼ 0.92 and TLI ¼ 0.90
indicated an acceptable model fit. However, since the SRMR ¼ 0.059 and
the RMSEA ¼ 0.090 did not meet the required criteria, this model had to
be rejected.
Therefore, the second model was calculated. Since two item-pairs—11
and 12 as well as 13 and 14—are overlapping with regard to content, we
allowed inter-correlations between the specific items of each pair (see Table
1 for item descriptions). The v2 statistic for the second model was signifi-
cant v2 (101) ¼ 256.86, p < 0.001 with an acceptable v2/df ratio (2.54).
Moreover, the fit indices CFI ¼ 0.94, TLI ¼ 0.93, and SRMR ¼ 0.57 indi-
cated a good model fit, whereas the RMSEA ¼ 0.078 pointed towards an
acceptable model fit. At last, both factors as well as the sum score of the
EMS provided excellent reliability in the current sample (EMS coping:
Cronbach’s a ¼ 0.902; EMS loss of control: Cronbach’s a ¼ 0.902; EMS sum
score: Cronbach’s a ¼ 0.919).
206 W. DRIEMEYER ET AL.

Table 2. Mean values of the EMS, HBI, SES, s-IATsex and BSI subscales.
Min Max Range M SD
EMSa 16 64 16–80 29.25 10.70
Coping 10 43 10–50 19.37 7.48
Loss of control 6 29 6–30 9.87 4.62
HBIa 19 80 19–95 35.40 11.75
Control 8 31 8–40 13.82 5.43
Coping 7 34 7–35 15.63 5.97
Consequences 4 16 4–20 5.95 2.81
SESb 6 23 6–24 15.80 2.72
s-IATsexa 12 46 12–60 17.77 6.43
BSI-Depressionc 0.00 3.50 0.00–6.00 0.76 0.79
BSI-Interpersonal sensitivityc 0.00 4.00 0.00–4.00 0.86 0.82
a
Scale from 1 ¼ never to 5 ¼ very often. bInverted scale from 1 ¼ strongly disagree to 4 ¼ strongly agree. High
SES-scores represent high sensitivity for sexual excitation. cScale from 0 ¼ no problem to 4 ¼ very serious.

Psychometric properties and convergent validity

Descriptive values of all assessed questionnaires are presented in Table 2.
Relationships between selected variables and the EMS scales are summar-
ized in Table 3. A positive association between the EMS and weekly mas-
turbation frequency (r ¼ 0.562, p < 0.001) as well as average time of one
masturbation session in minutes (r ¼ 0.174, p < 0.001) was found. Although
no significant correlation between the EMS and subjective feelings during
masturbation could be found (r ¼ 0.110, p ¼ 0.079), participants with high
EMS scores reported more often to experience negative feelings after mas-
turbation (r ¼ 0.264, p < 0.001) (results not shown in a table).
To address the predictive value of the two EMS factors, hierarchical regres-
sion analyses were carried out. We focused on the indicators of hypersexuality,
cybersex addiction, depression, interpersonal sensitivity, and sexual excitation.
In a first hierarchical regression analysis, the factor “coping” of the EMS was a
predictor of the HBI, R2 ¼ 0.467, F(1, 253) ¼ 222.106, p < 0.001. Adding the fac-
tor “loss of control” of the EMS, the increase of variance explanation was signif-
icant, DR2 ¼ 0.056, DF(1, 252) ¼ 29.702, p ¼ < 0.001. The whole model was
significant and explained 52.4% of the HBI (R2 ¼ 0.524, F(2, 252) ¼ 138.503,
p < 0.001). In a second hierarchical regression analysis, the factor “coping” of
the EMS was a predictor of the s-IATsex, R2 ¼ 0.270, F(1, 253) ¼ 93.492,
p < 0.001. Adding the factor “loss of control” of the EMS, the increase of var-
iance explanation was significant, DR2 ¼ 0.093, DF(1, 252) ¼ 36.617, p ¼ <
0.001. The whole model was significant and explained 36.2% of the s-IATsex
(R2 ¼ 0.362, F(2, 252) ¼ 71.635, p < 0.001). In a third hierarchical regression
analysis, the factor “loss of control” of the EMS was a predictor of the BSI-
Depression, R2 ¼ 0.087, F(1, 253) ¼ 24.165, p < 0.001. Adding the factor
“coping” of the EMS, the increase of variance explanation was significant,
DR2 ¼ 0.151, DF(1, 252) ¼ 49.996, p ¼ < 0.001. The whole model was signifi-
cant and explained 23.8% of the BSI-Depression (R2 ¼ 0.238, F(2, 252) ¼ 39.42,
p < 0.001). In a fourth hierarchical regression analysis, the factor “loss of
Table 3. Bivariate correlations between the EMS and selected variables.
EMS
1 2 3 4 5 6 7 8 9 10 11
2 EMS coping 0.931
3 EMS loss of control 0.807 0.537
4 HBI 0.723 0.684 0.567
5 HBI control 0.521 0.401 0.557 0.825
6 HBI coping 0.676 0.738 0.368 0.824 0.393
7 HBI consequences 0.580 0.514 0.511 0.836 0.679 0.557
8 SESa 0.358 0.362 0.241 0.383 0.291 0.331 0.335
9 s-IATsex 0.595 0.519 0.536 0.622 0.553 0.419 0.641 0.300
10 BSI-Depression 0.458 0.486 0.295 0.429 0.317 0.406 0.318 0.129 0.247
11 BSI-Interpersonal sensitivity 0.446 0.472 0.269 0.419 0.300 0.418 0.283 0.136 0.173 0.757
a
Inverted scale. High SES-scores represent high sensitivity for sexual excitation.
p < 0.05, p < 0.01.
SEXUAL ADDICTION & COMPULSIVITY
207
208 W. DRIEMEYER ET AL.

Table 4. Further values regarding the hierarchical regression analyses.

b T p
HBI
EMS “Coping” 0.533 10.347 <0.001
EMS “Loss of control” 0.281 5.450 <0.001
s-IATsex
EMS “Coping” 0.326 5.469 <0.001
EMS “Loss of control” 0.361 6.051 <0.001
BSI-Depression
EMS “Loss of control” 0.048 0.379 0.461
EMS “Coping” 0.461 7.071 <0.001
BSI-Interpersonal sensitivity
EMS “Loss of control” 0.022 0.335 0.738
EMS “Coping” 0.460 6.994 <0.001
SES
EMS “Loss of control” 0.066 0.946 0.345
EMS “Coping” 0.327 4.710 <0.001

control” of the EMS was a predictor of the BSI-Interpersonal sensitivity,

R2 ¼ 0.072, F(1, 253) ¼ 19.727, p < 0.001. Adding the factor “Coping” of the
EMS, the increase of variance explanation was significant, DR2 ¼ 0.151, DF(1,
251) ¼ 48.920, p ¼ < 0.001. The whole model was significant and explained
22.3% of the BSI-Interpersonal sensitivity (R2 ¼ 0.223, F(2, 252) ¼ 36.191,
p < 0.001). In a fifth hierarchical regression analysis, the factor “loss of control”
of the EMS was a predictor of the SES, R2 ¼ 0.058, F(1, 253) ¼ 15.628,
p < 0.001. Adding the factor “Coping” of the EMS, the increase of variance
explanation was significant, DR2 ¼ 0.076, DF(1, 251) ¼ 22.186, p ¼ < 0.001. The
whole model was significant and explained 13.4% of the SES (R2 ¼ 0.134, F(2,
252) ¼ 19.561, p < 0.001). For further values of the hierarchical regression analy-
ses see Table 4.

Discussion
The aim of the present study was to operationalize excessive masturbation
behavior and to validate the developed questionnaire. Therefore, the EMS
was developed and its psychometric properties as well as relationships with
selected questionnaires and variables were tested. The main result of the
first study is that an exploratory factor analyses yielded a 16-item question-
naire with two factors: coping and loss of control. The main results of the
second study are that a confirmatory factor analyses approved the factor
structure. The reliability of both factors as well as of the sum score of the
questionnaire were adequate and excessive masturbation was strongly asso-
ciated with indicators of hypersexuality, cybersex addiction, depression,
interpersonal sensitivity, and sexual excitation as well as with masturbation
frequency, duration of masturbation, and the experience of negative feelings
after masturbation. These findings point towards good psychometric prop-
erties of the EMS.
 SEXUAL ADDICTION & COMPULSIVITY 209

In accordance with the literature on hypersexual behavior, higher scores

of the EMS and both of its subscales were also associated with depression,
interpersonal sensitivity, and sexual excitability (Bancroft & Vukadinovic,
2004; Rettenberger, Klein, & Briken, 2016; Schultz et al., 2014; Sutton et al.,
2015; Walton, Cantor, & Lykins, 2015). Associations with questionnaires
that are designed to assess related constructs, i.e., Internet-pornography-
viewing disorder and hypersexual behavior, further provided indications of
a good convergent validity. However, most of the associations were only
moderate, with exception of the sum scores of the HBI and the EMS as
well as the scores of the respective subscales coping of both of the ques-
tionnaires, which correlated substantially. Thus, the EMS seems to measure
a similar, but not the same construct compared to instruments measuring
hypersexuality or Internet-pornography-viewing disorder. Regarding the
subscales of the EMS and of the HBI and s-IATsex respectively, the stron-
gest common characteristic seems to be that sexual practices are acted out
in an attempt to cope with negative mood states and that those activities
cannot or can only hardly be controlled. On the other hand, both the HBI
and the s-IATsex comprise scales referring to negative consequences that
result from sexual behavior, such as the negligence of other activities, tasks,
and needs, whereas a comparable subscale does not exist in the EMS; items
referring to potential negative consequences as a result of masturbation
behavior were rejected during factor analyses. Those items addressed nega-
tive feelings caused by masturbation, physical harm, partnership conflicts,
and negative effects on the sexual life and on the completion of duties. The
statistical elimination of this facet from the questionnaire might hint at a
specific characteristic of excessive masturbation and imply that negative
consequences in terms of social problems and physical impairments are not
as relevant for this behavior. On the one hand, it seems plausible that the
existence of negative consequences is more relevant for other types of
hypersexual behaviors, because it is a rather low or non-risk sexual behav-
ior (Coleman, 2003), e.g., concerning the risk of unwanted pregnancy or
the transmission of infections. Moreover, other activities, such as cybersex
or partnered sexual activities, are potentially more time and money con-
suming and rather in conflict with romantic relationships. Sutton et al.
(2015) described that the group of “avoidant masturbators” had less rela-
tionship experiences altogether, which might be another reason why inter-
ference in this area is unlikely. In contrast to that, Spenhoff et al. (2013)
found that hypersexual masturbation and online pornography viewing were
stronger associated with impairments in the social and relationship situa-
tion than other behaviors. In any case, there might be, on the other hand,
another reason why the dimension of negative consequences seems to be
not as relevant for excessive masturbation: Impulsivity proneness, which
210 W. DRIEMEYER ET AL.

refers to a pleasure-seeking behavior despite negative consequences, might

not be a dominant underlying mechanism of excessive masturbation.
Instead, it might be more compulsivity-driven, which means that the
behavior rather serves to avoid or relieve negative feelings instead of gain-
ing pleasure. Altogether, the results suggest that excessive masturbation
may be considered a feature in hypersexual behavior or Internet-pornogra-
phy-viewing disorder or may be a subtype of hypersexuality with specific
characteristics. Which exactly those characteristics are and whether they
mainly derive from the solitary nature of masturbation as opposed to a
(virtually or non-virtually) partnered sexual activity or from other compo-
nents of the behavior needs further investigation. All those interpretations
are at this point at a speculative level and they only give a hint at what
kind of questions might be investigated using this questionnaire in future
research. In this regard, it would be interesting to use other instruments
that measure different facets of hypersexual behavior for further validation
of this questionnaire. For example, the Sexual Dependency Inventory-
revised comprises ten subscales of sexual addiction (e.g., Fantasy,
Voyeuristic, Intrusive) and therefore represents a questionnaire that seems
promising for further validation (Delmonico, Bubenzer, & West, 1998).
Moreover, it should be investigated whether the EMS is sensitive for assess-
ing excessive masturbation in different groups of gender and sexual orien-
tation (see Carnes, 1991 and Carnes, Green, & Carnes, 2010 for gender
specific research on sexual addiction).
It needs to be mentioned with constraints that this questionnaire was
developed based on surveys in non-clinical samples. Although the investi-
gation of the structure of psychiatric disorders with analog samples offers
many benefits (Abramowitz et al., 2014), our findings cannot be entirely
transferred to a clinical population. Referring to this limitation, it is possi-
ble that excessive masturbation also differs from other subsets of hypersex-
uality by being of less clinical significance. The finding that the facet of
consequences plays a minor role for this behavior leads to the assumption
that transient phases of masturbating excessively are to a certain extent
part of common, non-pathological behavior (as humorously reflected by
the term “procrasturbation”; www.urbandictionary.com). Further limita-
tions of this study result from the lack of distinctness of the measured
behavior. High levels of masturbation are part of other types of hypersexual
behavior as well (Klein, Rettenberger, & Briken, 2014) and people who
exclusively show problematic masturbation behavior only account for a
small part (Sutton et al., 2015). Further research is needed to define mean-
ingful and valid subtypes, which might include more than one type of
behavior, like it has been suggested for masturbation and online pornogra-
phy viewing (Spenhoff et al., 2013). Further weaknesses of the
 SEXUAL ADDICTION & COMPULSIVITY 211

Figure 1. Completely standardized factor loadings and residuals of the measurement model.

questionnaire in its current state exist in its validation process. First, the
fit-indices of the confirmatory factor analysis only met the required criteria
after inter-correlations between two item-pairs were allowed, which could
again be connected to the type of study sample. Secondly, indications for
convergent and divergent validity are only on an approximate level because
questionnaires that measure the same construct as the EMS are lacking.
However, the EMS provides a promising basis for further examination
and conceptualization of excessive masturbation as a subtype of hypersex-
ual behavior. Used in combination with other scales, it should be helpful
for the investigation of more specific research questions that focus on the
differentiated facets and patterns of hypersexual behavior and thereby con-
tribute to the development of more specific and effective treatment and
consultative interventions for people who suffer from hypersexual behavior.
After defining subtypes more precisely, future research should explore pos-
sible differences in predispositions, underlying psychological mechanisms,
and comorbidities between these types. Moreover, it seems necessary to
examine whether a subgroup of people with “general hypersexual behavior”
212 W. DRIEMEYER ET AL.

exists, who show hypersexual behavior in any sexual activity that is acted
out by them, regardless of its type. On the basis of these findings, current
instruments that measure hypersexual behavior should be modified in a
way that allows for the differentiation of subtypes. The two-factor structure
of the EMS, if further validated, can contribute to this.

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