SEXUAL ADDICTION & COMPULSIVITY

2019, VOL. 26, NOS. 3–4, 315–332

https://doi.org/10.1080/10720162.2019.1645059

Personality Inventory for the DSM-5 (Brief Form)

Predictors of Sexual Addiction
Victoria Pocknell and Alan R. King
University of North Dakota, Grand Forks, North Dakota, USA

ABSTRACT
Sexual addiction risk may be elevated by personality mal-
adjustment. The Personality Inventory for the DSM-5 (PID) was
identified in the DSM-5 as an exemplar for future personality
research. The brief form (DSM-5-BF) canvases the same
domains, with concerns raised that it may underestimate lev-
els of maladjustment. PID-5-BF associations were found in this
national sample (N ¼ 428) with all five subscales of the Sexual
Addiction Screening Test (preoccupation with sex, loss of con-
trol, relationship disturbance, affective disturbance, and
Internet addiction). PID-5-BF personality maladjustment in this
national survey sample appeared to increase the relative risks
of elevated sexual addiction symptomatology.

Introduction
The DSM-5 (American Psychiatric Association, 2013) provided impetus for
accelerated research into links between “big five” personality traits and clin-
ically relevant maladjustment indicators as a prelude to adoption of a
dimensional diagnostic system. The Personality Inventory for the DSM-5
(PID-5; Krueger, Derringer, Markon, Watson, & Skodol, 2013; Quilty,
Ayearst, Chmielewski, Pollock, & Bagby, 2013) was cited as an exemplar as
a dimensional measurement strategy in the conceptualization and assess-
ment of personality disturbance. While predisposed by heritance (Plomin,
DeFries, Knopik, & Neiderhiser, 2016), these generalized trait penchants
(antagonism, disinhibition, negative affect, detachment, and psychoticism)
appear to be differentiated during development into more specialized sec-
ondary and tertiary traits with distinctive situational and ideational triggers.
Maladaptive sexual interests and practices may constitute a clinically rele-
vant outgrowth of generalized “big five” trait maladjustment.
Significant relationships have been found between personality traits and
addictive behavior, including risky sexual and hypersexual behavior (Pinto,
Carvalho, & Nobre, 2013). One early speculation (Cloninger, Bayon, &

CONTACT Alan R. King alan.king@und.edu Psychology Department, University of North Dakota, P.O. Box
8380, Grand Forks, ND 58202-8380.
ß 2019 Taylor & Francis Group, LLC
316 V. POCKNELL AND A. R. KING

Svrakic, 1998) was that the acquisition and maintenance of sexually addict-
ive behavior was related to personality-modulated harm avoidance, novelty
seeking, reward dependency, persistence strategies, and social interaction
dynamics. Personality dysfunctions were thought to magnify inner conflicts
and distort the implications of compulsive coping through mechanisms
such as denial, repression, dissociation, or other auxiliary defenses.
Inhibitory and decision-making processes may be compromised among
personality disordered individuals, leading to heightened sensation seeking
and risk taking (Pinkerton & Abramson, 1995). The interaction of person-
ality and sexual addiction may be highlighted in the elevated risk for
comorbid personality disorders amongst those seeking treatment for hyper-
sexuality (Carpenter, Reid, Garos, & Najavits, 2013). Cluster B personality
disorder traits, especially antisocial, borderline, histrionic, and dependent
traits, are common among those with compulsive sexual behavior as meas-
ured by the Minnesota Multiphasic Personality Inventory (MMPI-2;
Hathaway et al., 1989) and Restructured Form and Structured Interview for
DSM-III-R (Black, Kehrberg, Flumerfelt, & Schlosser, 1997; Carnes, 1991;
Kastner & Sellbom, 2012).
A popular and most commonly used approach is to identify personality
dimensions underlying sexual addiction using the big-five model operation-
alized as the Big Five Inventory (BFI) or Revised NEO Personality
Inventory (NEO PI-R; Elliot & Thrash, 2002; Larsen & Augustine, 2008).
Researchers posit that high neuroticism and extroversion and low agree-
ableness and conscientiousness are commonly associated with increased
sexual activity (Reid, Carpenter, Spackman, & Willes, 2008; Walton,
Cantor, & Lykins, 2017; Zilberman, Yadid, Efrati, Neumark, & Rassovsky,
2018). Neuroticism is the most predictive big-five personality domain, most
likely due to the overlap it has with the impulsivity, anxiety, and dysphoric
mood associated with the proposed sexual addiction criteria (Walton et al.,
2017). Eysenck (1976) found that extroversion was associated with younger
sexual experiences, risky sexual behavior, less stable intimate relationships,
and a higher number of sexual partners. Later research suggests this may
be due to a greater tendency to focus on approach goals and higher sensi-
tivity to reward cues (Cooper, Talley, Sheldon, Levitt, & Barber, 2008; Reid,
Garos, & Carpenter, 2011; Smillie, 2008). Conscientiousness and agreeable-
ness were associated with lower sexual satisfaction, perceived sexual pro-
cess, and sexual inhibition (Heaven, Fitzpatrick, Craig, Kelly, & Sebar,
2000; Hoyle, Fejfar, & Miller, 2000; Miller et al., 2004; Nettle, 2005).
Openness to experience has not been found to be significantly related to
increased sexual activity.
Personality research in the area of sexual addictions could be of value in
a number of ways. Personality traits have been associated with
 SEXUAL ADDICTION & COMPULSIVITY 317

hypersexuality as a predisposition for many different psychosocial concerns

(Walton et al., 2017). Personality differences may inform the treatment pro-
cess for sexual addiction. For example, neurotics and clients low in agreeable-
ness have been found to be poorly motivated, challenging to engage, and less
likely to acknowledge their sexual behavior as a problem (Cantor et al., 2013;
Kaplan & Krueger, 2010; Reid, 2007). While PID-5’s domain-level structure
closely resembles the Five Factor Model (Griffin & Samuel, 2014), Fowler
et al. (2018) found that the PID-5 was more accurate than the Big Five
Inventory at screening for maladaptive personality traits. Unfortunately, there
is little to no research utilizing the PID-5 as the primary tool to investigate
sexual addiction. The DSM-6 personality disorders task force could benefit
from evidence extending the concurrent validity of the PID-5 trait domains
to a clinical problem domain as specialized as sexual addiction.

Sexual addiction
The concept of sexual addiction was first introduced by Orford (1978) and
subsequently popularized by Carnes’ systematic research on the disorder
(Carnes, 1983, 1991, 2000, 2001, 2005; Carnes, Green, & Carnes, 2010;
Carnes & Schneider, 2000). Clinicians have accepted the validity of the
diagnosis in increasing numbers (Kafka, 2010; Krueger & Kaplan, 2001;
Levine, 2010; Womack, Hook, Ramos, Davis, & Penberthy, 2013).
Compulsive Sexual Behavior Disorder has now been recognized in the
ICD-11 (International Classification of Diseases), with Non-Substance-
Related Addictive Disorders under further consideration in the DSM-5.
Carnes (2005) estimated that 6% of the general population meets criteria
for sexual addiction, and men had more than twice as many symptoms as
the women in one college sample (Cashwell, Giordano, King, Lankford, &
Henson, 2017). The prevalence rate may be higher among (European)
Caucasians within the upper socioeconomic strata (Kraus, Voon, &
Potenza, 2016). Sexual compulsivity tends to emerge relatively early in life
with a broader range and higher frequency of acts (Karila et al., 2014).
Sequalae of compulsive sexual behavior include sexually transmitted dis-
eases, unintended pregnancies, legal charges, financial and relationship
losses, social ostracization, and other adverse consequences (Coleman,
1992; Coleman et al., 2010; Schnarrs et al., 2010; Storholm, Fisher, Napper,
Reynolds, & Halkitis, 2011). Effortful long-term strategies are typically
required to manage the condition and circumvent the moral and social
inhibitors of its free expression (Levine & Troiden, 1988).
Sexual addiction behaviors include masturbation, pornography consump-
tion, and intimate acts with others that elicit clinically significant emotional
distress and/or impairment in psychosocial functioning. The diagnosis is not
318 V. POCKNELL AND A. R. KING

restricted to acts that are illegal, involve nonconsenting partners, or paraphilic

ideational content. Sexual compulsivity is often expressed in normative acts
that are distinguished by their frequency and/or intensity, prompting feelings
of distress and/or loss of control despite substantial hardships (Goodman,
1993). Sex addicts appear to rely on these ritualistic acts to temporarily relieve
negative emotional states such as low self-esteem, dysphoria, anxiety, empti-
ness, and/or anger (Bancroft, 2009; Bancroft, Janssen, Strong, Carnes et al.,
2003; Bancroft, Janssen, Strong, & Vukadinovic, 2003; Goodman, 1993;
Guigliamo, 2006; Reid, 2010; Schwartz, 2008). Sexually addictive behavior typ-
ically elicits both pleasure (positive reward) and provides escape (negative
reinforcement) from internal discomfort. This behavioral pattern interestingly
produces symptoms of tolerance and/or withdrawal such as insomnia, ner-
vousness, sweating, and fatigue as might be seen in physical addiction
(Carnes & Schneider, 2000; Coleman-Kennedy & Pendley, 2002; Nakken,
2009). In fact, neurological studies have suggested that sexually addictive
behavior alters the reward circuitry of the brain in a manner similar to that
of dopaminergic drugs that trigger limbic and/or paralimbic activation (Blum
et al., 2012; Hamann, Herman, Nolan, & Wallen, 2004). Perceptions of
reward size, contingencies, and contiguities may all be affected and comprom-
ise self-control competencies over time (Coleman, 1990; Logue, 1988; Mischel
& Baker, 1975; Sharpe & Tarrier, 1993; Witkiewitz & Marlatt, 2004).

Study hypotheses
Five hypotheses were examined involving anticipated associations between
maladaptive personality attributes and sexual addiction symptomatology: (1)
Personality Inventory for the DSM-5–Brief Form (PID-5-BF) domain attrib-
utes will all be significantly associated with core and subscale Sexual Addiction
Screening Test–Revised (SAST-R) scores; (2) Selected PID-5-BF domains will
account for unshared variance in core and subscale SAST-R scores; (3) PID-5-
BF dimensional scores will significantly differentiate addicted from normative
respondents as defined by SAST-R cutoff scores; (4) Relative risks of sexual
addiction will be raised by PID-5-BF domain score elevations; and (5) Gender
differences will be found in relationships between PID-5-BF and SAST-R
symptomatology.

Method
Participants and procedure
Pocknell (2017) sampled the self-reported sexual fantasies of national sur-
vey respondents using Amazon’s Mechanical Turk (MTurk). Respondents
were told that the purpose of the survey was to explore associations
 SEXUAL ADDICTION & COMPULSIVITY 319

between early sexual experiences and present sexual interests and concerns.
A central purpose of this analysis was to determine if the PID-5-BF domain
scores could identify respondents who would be classified at high risk for
sexual addiction on the basis of the definitional thresholds established in
SAST-R validation studies (Carnes et al., 2010; Hook, Hook, Davis,
Worthington, & Penberthy, 2010; Nelson & Oehlert, 2008; Hanson &
Harris, 2000). A subset of respondents from this earlier sample who
exceeded the specified criterion for “sexual addiction” (n ¼ 214) were
selected for further analysis in this study along with a randomly selected
comparison cohort (n ¼ 214) of non-addicted counterparts. This final sam-
ple (N ¼ 428) included an equal number of sexually addicted and non-
addicted survey respondents.
Survey respondents in this study were all at least 18 years of age and from
the United States. MTurk workers have been found to attend to instructions,
respond reliably, and exhibit levels of motivation that are comparable to par-
ticipants in face-to-face survey sampling (Berinsky, Huber, & Lenz, 2012;
Buhrmester, Kwang, & Gosling, 2011; Gosling, Vazire, Srivastava, & John,
2004). Repeat sampling is prevented through account-specific identification
and verification from payment information. MTurk has been characterized as
a valid and representative crowdsourcing research platform (Buhrmester
et al., 2011; Paolacci, Chandler, & Ipeirotis, 2010). Validity items were used in
the protocol to exclude inattentive respondents.

Materials
Personality Inventory for DSM-5–Brief Form
The PID-5 is comprised of 220 four-point items that canvas five broad
domains and 25 facet trait dimensions. Empirical analyses of the PID-5
appear to have accelerated after the publication of the DSM-5 in 2013.
Links between PID-5 trait scores and sexual addiction have not been estab-
lished to date, and the length of the PID-5 restricts its application in many
research protocols. The 25-item short form (PID-5-BF; Krueger et al.,
2013) has been found to provide domain scores that appear comparable to
the original version (Bach, Maples-Keller, Bo, & Simonsen, 2016). The effi-
ciency of the PID-5-BF makes it optimal for incorporation into protocols
that explore five-factor trait involvement in previously unexplored forms of
psychological maladjustment. The PID-5-BF measures the five trait
domains of the original inventory (antagonism, disinhibition, negative
affect, detachment, and psychoticism). Items are scaled using the same
four-point metric which generates scores that range from 0–15. Scores are
left uncalculated if more than 25% of the contributing items were left
blank, and missing scores were prorated as specified by the test developers.
320 V. POCKNELL AND A. R. KING

PID-5-BF psychometric properties have been established in various sources

(Anderson, Sellbom, & Salekin, 2016; Debast, Rossi, & van Alphen, 2017;
Fossati, Somma, Borroni, Markon, & Krueger, 2015; G ongora & Solano,
2017; Hopwood, Schade, Krueger, Wright, & Markon, 2013).
Watters (2018) recognized the growing popularity of the PID-5-BF but
warned in her analysis that these domain scores may underestimate symp-
tomatology, relative to the PID-5, in clinical applications. It seems prudent
for future PID-5-BF researchers to rely on relatively high “elevation”
thresholds when intending to trigger diagnostic concern in clinical or sub-
clinical applications. This study tested a threshold of roughly þ1.7 standard
deviations above the mean as a cause for concern regarding sexual addic-
tion. This standard translated into an average raw score of 10 (or higher)
in the PID-5-BF distributions of a recent national MTurk sample (Matson,
Russell, & King, 2018). Reliance on a raw, as opposed to z-score, threshold,
has appeal in assuring uniformity in future research or applied uses of the
PID-5-BF.

Sexual Addiction Screening Test–Revised

The SAST-R (Carnes et al., 2010) represents the most widely used self-report
inventory for identifying compulsive sexual behavior. The SAST-R is a 45-
item, dichotomous-scaled self-report inventory developed to measure various
aspects of maladaptive sexual behavior. The SAST-R provides a core score of
20 items with four subscale dimensions including preoccupation with sex,
loss of control, relationship disturbance, affective disturbance, and Internet
addiction. While the prevalence of sexual addiction is higher among men
than women (Carnes, 1991; Cooper, Delmonico, Griffin-Shelley, & Mathy,
2004), the SAST-R developers emphasized sexual addiction similarities in
manifestations and consequences across demographic subgroups.
Interpretation thresholds have not emerged to differentiate SAST-R elevation
risks. A receiver operating characteristic (ROC) analysis established optimal
raw score thresholds (Core ¼ > 6; ¼ > 2 for subscale dimensions) for differ-
entiating between clinical (sexually addicted inpatients) and normative (non-
addicted) group cohorts in the standardization analyses (86.0% and 83.8%
accuracy for the men and women, respectively). Additional evidence of
SAST-R concurrent validity has been provided in multiple sources (Hook
et al., 2010; Nelson & Oehlert, 2008; Hanson & Harris, 2000).

Analytic strategy
Analyses were conducted to establish the extent to which dimensional and
high-risk SAST-R classification scores could be predicted by the PID-5-BF
personality domains. Dimensional score analyses served to advance current
 SEXUAL ADDICTION & COMPULSIVITY 321

understanding of nexuses between maladaptive personality attributes and

sexual addiction symptomatology. Analyses of covariance and nonparamet-
ric relative risk analyses were used to estimate the extent to which PID-5-
BF domain scores could predict clinically relevant elevations in the SAST-R
scores. SAST-R core and subscale diagnostic thresholds for sexual addiction
derived from previous ROC work (Carnes et al., 2010) were relied upon in
these nonparametric analyses. Sexual addiction was defined by SAST-R
Core scores in excess of five. This study relied on a PID-5-BF operational
score threshold of þ1.7 standard deviations above the mean to define
heightened risk from personality pathology.

Results
Descriptive statistics
This sample (N ¼ 428) varied in gender (52.5% men, 47.5% women), age
(M ¼ 36.30, SD ¼ 11.38, range ¼ 18–84), and ethnicity (Caucasian, n ¼ 310,
72.4%; African American, n ¼ 31, 7.2%; Asian, n ¼ 22, 5.1%; Hispanic,
n ¼ 22, 5.1%; American Indian/Alaskan Native, n ¼ 8, 1.9%; and multiracial,
n ¼ 9, 2.1%). SAST-R and PID-5-BF score differences between the sexually
addicted and nonaddicted respondents are presented in Table 1. An SAST-
R core scale score of six or higher was used to identify respondents who
were likely to meet criteria for sexual addiction. A PID-5-BF raw score of
10 or higher was used to define domain elevations.

Gender differences
Men scored significantly higher than the women in their SAST-R core
(p ¼ .002, d ¼ .31), preoccupation with sex (p < .001, d ¼ .50), loss of con-
trol (p < .001, d ¼ .49), and Internet addiction (p < .001, d ¼ .71). Men also

Table 1. SAST-R and PID-5-BF Differences Between the Addicted and Nonaddictive Cohorts.
Sexually Addicted Respondents Normative Respondents Group Difference
Measures a M SD Range M SD Range p d
SAST-R Scores
SAST-R Core .83 8.80 2.67 6–20 1.85 1.65 0–5 <.001 1.69
Preoccupation with Sex .60 2.14 1.08 0–4 .61 .77 0–3 <.001 1.27
Loss of Control .70 1.93 1.22 0–4 .17 .46 0–3 <.001 1.38
Relationship Disturbance .64 1.24 1.15 0–4 .14 .43 0–2 <.001 1.07
Affective Disturbance .63 2.74 1.25 0–5 .74 .90 0–4 <.001 1.35
Internet Addiction .70 2.23 1.73 0–6 .59 1.00 0–5 <.001 1.17
PID-5-BF Scores
Negative Affect .85 6.89 3.74 0–15 4.71 3.70 0–14 <.001 .56
Detachment .80 5.64 3.43 0–15 3.67 3.55 0–15 <.001 .54
Antagonism .78 4.06 3.26 0–14 2.26 2.64 0–14 <.001 .58
Disinhibition .86 5.17 3.62 0–15 2.47 3.04 0–15 <.001 .75
Psychoticism .83 5.07 3.55 0–14 2.79 3.14 0–14 <.001 .64
Note. The sexually addicted and normative cohorts were equal in cell size (n ¼ 214).
322 V. POCKNELL AND A. R. KING

Table 2. SAST-R and PID-5-BF Bivariate Associations Differentiated by Gender.

Measure Negative Affect Detachment Antagonism Disinhibition Psychoticism
Men (n ¼ 197)
SAST-R Core .27 .24 .22 .23 .25
Preoccupation with Sex .27 .08 .21 .15 .22
Loss of Control .21 .15 .17 .13 .21
Relationship Concerns .12 .19 .16 .11 .10
Affective Disturbance 30 .30 .12 .28 .28
Internet Addiction .30 .18 .17 .08 .19
Women (n ¼ 217)
SAST-R Core .41 .38 .38 .47 .43
Preoccupation with Sex .32 .28 .38 .35 .37
Loss of Control .30 .29 .31 .40 .33
Relationship Concerns .23 .20 .33 .36 .28
Affective Disturbance .38 .36 .28 .39 .36
Internet Addiction .24 .26 .31 .38 .35
Note. Significant gender differences (p < .05) in correlation strengths indicated by shaded blocks.

scored significantly higher than women on PID-5-BF negative affect

(p ¼ .001, d ¼ .33), and antagonism (p ¼ .005, d ¼ .28) scales. Gender differ-
ences were not found for the remaining SAST-R (relationship and affective
disturbances) and PID-5-BF (detachment, disinhibition, and psychoticism)
subscales. Men were disproportionately represented in the addicted versus
normative cohorts, v2 ¼ 6.85, p ¼ .009.

Correlation analyses
Table 2 presents SAST-R bivariate correlates with the PID-5-BF domain
scores. The shaded coefficients differ significantly in strength between the
men and women.

Regression analyses
Table 3 presents the results of linear regression predictions of scores for the
SAST-R core and its constituent symptom subscales. These six regression
models were all significant: SAST-R core, F (7, 394) ¼ 13.81, p < .001, adjusted
R2 ¼ 18.3%, preoccupation with sex, F (7, 394) ¼ 13.19, p < .001, adjusted
R2 ¼ 17.5%, loss of control, F (7, 394) ¼ 10.30, p < .001, adjusted R2 ¼ 14.0%,
relationship concerns, F (7, 394) ¼ 5.68, p < .001, adjusted R2 ¼ 7.6%, affective
disturbance, F (7, 394) ¼ 11.62, p < .001, adjusted R2 ¼ 15.6%, and Internet
addiction, F (7, 394) ¼ 14.67, p < .001, adjusted R2 ¼ 19.3%.

ROC analyses
ROC curve analyses found that each of the five domains were able to sig-
nificantly differentiate the sexually addicted from nonaddicted respondents
for both the women (disinhibition, AUC ¼ .740, SE ¼ .035, p < .001;
 SEXUAL ADDICTION & COMPULSIVITY 323

Table 3. Regression Model PID-5-BF Predictions of Sexual Addiction Symptoms.

Unstandardized
Standardized
Trait Domain B SE Beta t p
SAST-R Core
Negative Affect .174 .066 .163 2.64 .009
Detachment .049 .071 .043 0.69 .492
Antagonism .139 .075 .104 1.85 .065
Disinhibition .168 .072 .147 2.33 .020
Psychoticism .099 .081 .085 1.21 .226
Preoccupation with Sex
Negative Affect .063 .019 .201 3.23 .001
Detachment .038 .021 .114 1.82 .069
Antagonism .066 .022 .170 3.01 .003
Disinhibition .015 .021 .044 0.69 .491
Psychoticism .045 .024 .130 1.86 .063
Loss of Control
Negative Affect .046 .021 .139 2.19 .029
Detachment .002 .022 .005 0.79 .937
Antagonism .036 .024 .088 1.53 .127
Disinhibition .031 .023 .087 1.35 .178
Psychoticism .028 .026 .076 1.07 .285
Relationship Concerns
Negative Affect .010 .018 .039 0.59 .554
Detachment .014 .019 .049 0.74 .458
Antagonism .055 .020 .164 2.75 .006
Disinhibition .039 .019 .137 2.04 .042
Psychoticism .000 .022 .018 0.24 .812
Affective Disturbance
Negative Affect .064 .024 .169 2.68 .008
Detachment .051 .026 .126 1.99 .048
Antagonism .041 .027 .086 1.50 .134
Disinhibition .070 .026 .171 2.68 .008
Psychoticism .035 .030 .083 1.18 .241
Internet Addiction
Negative Affect .063 .026 .151 2.45 .015
Detachment .008 .028 .018 0.30 .769
Antagonism .038 .029 .072 1.28 .200
Disinhibition .007 .028 .016 0.26 .793
Psychoticism .040 .032 .087 1.26 .210
Note. Respondent age and gender controlled in each model.

psychoticism, AUC ¼ .709, SE ¼ .036, p < .001; antagonism, AUC ¼ .640,

SE ¼ .039, p ¼ .001; detachment, AUC ¼ .691, SE ¼ .037, p < .001; negative
affect, AUC ¼ .684, SE ¼ .038, p < .001) and the men (disinhibition,
AUC ¼ .704, SE ¼ .039, p < .001; psychoticism, AUC ¼ .687, SE ¼ .040,
p < .001; antagonism, AUC ¼ .684, SE ¼ .040, p < .001; detachment,
AUC ¼ .645, SE ¼ .042, p ¼ .001; negative affect, AUC ¼ .642, SE ¼ .041,
p ¼ .001) in the sample.

Analyses of covariance
A series of five independent 2  2 (gender; PID-5-BF Risk Group)
ANCOVAs were conducted using the SAST-R subscale dimensions as the
dependent measure and respondent age as the covariate in each analysis
(see Table 4). Gender by group interactions were observed for four
324 V. POCKNELL AND A. R. KING

Table 4. Gender by PID-5-BF Risk Group Analyses of Covariance for SAST-R Scores.
Gender Risk Group Gender x Risk Age
Sexual Addiction Screening Test Dimension F gp2 F gp 2 F gp 2 F gp 2
Disinhibition Trait Domain
SAST-R Core .39 10.32 .025 7.06 .017 2.28
Preoccupation with Sex .41 5.47 .014 6.48 .016 1.75
Loss of Control 1.54 6.39 .016 2.91 3.91 .010
Relationship Disturbance .86 7.60 .019 5.65 .014 .06
Affect Disturbance 1.33 5.36 .013 2.70 3.40
Internet Addiction 1.36 7.98 .020 12.07 .029 4.03 .010
Psychoticism Trait Domain
SAST-R Core 1.27 15.62 .037 .75 .52
Preoccupation with Sex 5.34 .013 7.13 .017 .69 .31
Loss of Control 10.45 .025 10.30 .025 .07 1.40
Relationship Disturbance 1.39 11.70 .027 .00 .30
Affect Disturbance .33 10.38 .025 1.38 2.01
Internet Addiction 14.02 .034 7.52 .018 .51 2.69
Antagonism Trait Domain
SAST-R Core .20 14.01 .034 2.78 .78
Preoccupation with Sex 1.91 4.52 .011 .41 .44
Loss of Control 2.50 6.31 .016 .17 1.77
Relationship Disturbance 1.07 17.43 0.42 3.29 .25
Affect Disturbance .97 2.81 1.53 2.96
Internet Addiction 4.93 .012 8.71 .021 .71 2.84
Detachment Trait Domain
SAST-R Core .04 10.23 .025 7.05 .017 2.82
Preoccupation with Sex .83 .39 8.01 .020 1.83
Loss of Control .38 4.99 .01 10.74 .026 4.26 .011
Relationship Disturbance 1.11 5.42 .01 .05 .01
Affect Disturbance 1.15 15.72 .04 2.76 3.86 .010
Internet Addiction 7.08 .018 8.06 .020 6.87 .017 5.48 .014
Negative Affect Trait Domain
SAST-R Core 5.19 .013 30.54 .070 1.07 .56
Preoccupation with Sex 20.76 .049 27.20 .063 .019 .17
Loss of Control 16.73 .040 17.30 .041 .087 1.50
Relationship Disturbance .35 7.68 .019 3.54 .20
Affect Disturbance .58 28.91 .067 .111 .17
Internet Addiction 52.10 .114 20.04 .047 2.18 2.46
Note. Respondent age used as a covariate. PID-5-BF Risk group defined by extreme (raw domain score ¼ > 10)
versus normative (remaining sample) scores on respective dimension.

disinhibition (core, preoccupation, relationship disturbance, and Internet

addiction) and four detachment (core, preoccupation, loss of control, &
Internet addiction) indicators. Women showed relatively stronger connec-
tions than men between the respective PID-5-BF and SAST-R indicators
each of these interactions.

Relative risk analyses

Table 5 findings provide estimates of the relative increase in risk of being
assigned to the sexual addiction cell on the basis of an elevated (raw score-
> 9,  þ1.7 SD) rather than normative (raw score < 10) PID-5-BF score
on the respective dimension. The high-risk sexual addiction thresholds for
the SAST-R were derived from prior ROC analyses (Carnes et al., 2010)
that relied upon a clinical diagnostic group. Significant relative risk
 SEXUAL ADDICTION & COMPULSIVITY 325

Table 5. PID-5-BF Domain Elevations and Relative Risks of Sexual Addiction Symptomatology.
Negative Affect Detachment Antagonism Disinhibition Psychoticism
Sexual Addiction At Low At Low At Low At Low At Low
Dimension Risk Risk Risk Risk Risk Risk Risk Risk Risk Risk
Core Addiction 59 151 27 81 15 196 26 181 28 182
Normative Group 22 188 15 292 4 201 6 203 8 203
Relative Risk (RR) 1.63 2.96 1.60 1.72 1.65
Sex Preoccupation 50 133 20 163 13 169 19 162 20 161
Normative Group 31 206 22 210 6 228 13 222 16 224
Relative Risk (RR) 1.57 1.09 1.61 1.40 1.33
Loss of Control 39 97 20 115 11 123 19 115 18 117
Normative Group 42 242 22 258 8 274 13 269 18 268
Relative Risk (RR) 1.68 1.54 1.87 1.98 1.65
Relationship Issues 25 59 12 69 9 73 12 72 14 71
Normative Group 56 280 30 304 10 324 20 312 22 314
Relative Risk (RR) 1.77 1.54 2.58 2.00 2.11
Affect Disturbance 59 153 30 181 12 199 23 187 27 185
Normative Group 22 186 12 192 7 198 9 197 27 200
Relative Risk (RR) 1.61 1.47 1.26 1.47 1.04
Internet Addiction 42 128 25 142 12 156 19 149 20 148
Normative Group 39 211 17 231 7 241 13 235 16 237
Relative Risk (RR) 1.37 1.56 1.61 1.53 1.45
Note. High risk predictor groups defined as follows: PID-5-BF (raw domain score ¼ > 10). Sexual Addiction
groups defined as follows: SAST-R Core (¼ > 6); SAST-R subscale (¼ > 2). RR estimates quantify the increased
risk of sexual addiction accompanying an elevated (raw score > 9,  þ1.7 SD) versus normative (raw score <
10) PID-5-BF score on the respective dimension.

elevations were found for all but two of the predictor-criterion pairings
(Detachment–Preoccupation and Psychoticism–Preoccupation).
Gender by PID-5-BF group interactions (see Table 4) prompted some
additional gender-specific relative risk analyses for those respective pairings.
In all of these cases, the relative risk of the PID-5-BF elevation was height-
ened for the women. Extreme disinhibition raised clinical concerns regard-
ing the core, RR ¼ 2.21, 95% CI [1.73, 2.81], p < .0001, preoccupation,
RR ¼ 1.99, 95% CI [1.27, 3.13], p ¼ .003, relationship disturbance,
RR ¼ 3.31, 95% CI [1.91, 5.73], p < .0001, and Internet addiction,
RR ¼ 2.94, 95% CI [1.90, 4.56], p < .0001, scales for the women in the sam-
ple. Men showed elevated relative risk of clinical concerns regarding only
core scores, RR ¼ 2.21, 95% CI [1.73, 2.81], p < .0001. Extreme detachment
raised clinical concerns regarding the core, RR ¼ 1.66, 95% CI [1.17, 2.35],
p ¼ .004, preoccupation, RR ¼ 1.54, 95% CI [0.92, 2.59], p ¼ .010, loss of
control, RR ¼ 3.08, 95% CI [1.82, 5.21], p < .0001, and Internet addiction,
RR ¼ 1.68, 95% CI [1.68, 4.27], p < .0001, scales for the women in the sam-
ple. Men showed elevated relative risk of clinical concerns regarding only
loss of control scores, RR ¼ 2.72, 95% CI [1.93, 3.84], p < .0001.

Discussion
The PID-5 and other dimensional trait measures will be relied upon
increasingly in the future by both researchers and practitioners given the
326 V. POCKNELL AND A. R. KING

anticipated paradigm shift in DSM-5 away from categorical conceptualiza-

tions of personality disturbance. Normative data for both the PID-5 and
PID-5-BF are important to for both theoretical (research) and practical
(applied) reasons. Theoretical models regarding the role of personality traits
in later maladjustment rely on measures that can be administered widely
and interpreted consistently in the field. Personality inventories are also
used extensively for applied reasons to assess attributes that may reflect
present or future behavior in work, school, or clinical settings. Trait score
elevations do not constitute prima facie concerns but instead alert practi-
tioners to potential risks in functioning that warrants closer attention.
Significant associations between trait scores and indicators of maladaptive
functioning provide the necessary evidentiary base for their continued
usage in both theoretical and applied settings. These results also supple-
ment the paucity of available empirical data establishing nexuses between
personality traits and this highly specialized form of maladjustment.
Support was found for all five hypotheses in this study. Bivariate correl-
ation coefficients between the PID-5-BF and SAST-R were statistically sig-
nificant in 100% (30/30) and 76.7% (23/30) of the associations for the
women and men respectively (see Table 2). All five PID-5-BF domains
were associated with all five facets of sexual addiction measured by the
SAST-R (Hypothesis 1). The trait domains of negative affect, antagonism,
and disinhibition also accounted for unshared variance in SAST-R subscale
scores (Hypothesis 2). Both dimensional and high-risk categorical PID-5-
BF scores differentiated between the sexually addicted and normative
cohorts (Hypothesis 3). The relative risks of PID-5-BF elevations to sexual
addiction were established (Hypothesis 4). Significant gender differences
also were established. The diagnostic risks examined in this study were
often magnified for women who showed roughly triple the probabilities of
internet addiction and relationship disturbances secondary to elevated dis-
inhibition and negative affect were most closely linked to sexual addiction
among the women. Disinhibition posed a unitary concern of relative
importance among the men (Hypothesis 5). While the PID-5 domain and
facet traits continue to accrue an evidentiary base supporting their concur-
rent validity, the merits of the PID-5-BF as a screening inventory remain
to be determined. It seems unlikely the PID-5 or PID-5-BF would assume
a central role in the diagnosis of sexual addiction, but it is worth note that
this study did generate evidence that elevated PID-5-BF domain scores
(raw score > 9,  þ1.7 SD) do constitute a risk of sexual addiction. The
clinical relevance of these PID-5-BF risk estimates was enhanced by the
ROC work of Carnes and colleagues (Carnes et al., 2010) in their establish-
ment of core and subscale cutoffs for accurately predicting diagnosable sex-
ual addiction problems. While PID-5-BF elevations posed risks that were
 SEXUAL ADDICTION & COMPULSIVITY 327

moderate in size, they were pervasive in scope and often highly significant.
The high-risk group main effects were significant in 28 of 30 contrasts (see
Table 3).

Design limitations, generality, and future directions

The “sexually addicted” cohort in this analysis would most appropriately be
described as a “subclinical” group given the absence of a diagnostic inter-
view or formal DSM-5 criteria to guide the evaluative process. The SAST-R
items are also dichotomous, which limits information regarding the severity
of particular symptomatic behaviors. Studies such as this will expand the
evidentiary base for future DSM task forces during deliberations regarding
the possible inclusion of behavioral addictions to the diagnostic manual.
Data analyzed in this cross-sectional study are all self-report and retrospect-
ive in nature without verification of the accuracy of respondent recollec-
tions. The directionality of these correlation findings cannot be established.
These MTurk findings may not generalize well to clinical samples, the col-
lege population, ethnic cohorts, or other subgroups. Future studies should
focus on the role of disinhibition and negative affect as developmental sources
of sexual addiction. These theoretical factors would optimally be included in
more comprehensive etiologic models with a focus on differentiating diagnos-
able from normative forms of sexual behavior. The PID-5 and PID-5-BF liter-
atures have attended disproportionately to generalized indicators of
psychological distress in their concurrent validation efforts. Future researchers
should be encouraged to canvas broader areas of maladjustment, including
disorders that are as specialized as sexual addiction.

Conclusions
The PID-5 continues to expand its usage in both research and applied areas
of psychology. The length of the PID-5 does limit its usage, and the PID-5-
BF offers a suitable alternative for screening the core trait domains referred to
in five-factor theory. Early research on the comparability of the two invento-
ries has been promising, but the evidentiary base for the concurrent validity
of the brief forms remains incompletely established. This study provided evi-
dence of significant and pervasive associations between the five domains of
the PID-5-BF and clinically significant indicators of sexual addiction. These
results support the concurrent validity of the brief form of the PID-5.

Disclosure statement
This was an unfunded project with no authorship conflicts of interest.
328 V. POCKNELL AND A. R. KING

Ethics assurance
This project was approved by our university Institutional Review Board
with informed consent required for all respondents.

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