Symptom-level associations between attention-deficit hyperactivity disorder (ADHD) and compulsive sexual behaviour: undirected and Bayesian network analysis across multiple sociodemographic characteristics.

Abstract

Attention-deficit hyperactivity disorder (ADHD) has been associated with compulsive sexual behaviours, including problematic pornography use. However, symptom-level mechanisms underlying this relationship remain poorly characterised, particularly across diverse demographic groups. To identify key ADHD symptoms that bridge to compulsive sexual behaviour phenotypes (compulsive sexual behaviours and problematic pornography use) and examine whether symptom-level associations differ across sex, gender identity and age groups. This cross-sectional study analysed data from the International Sex Survey (2021-2022). Participants completed the Adult ADHD Self-Report Screening Scale, Compulsive Sexual Behaviour Disorder Scale and Problematic Pornography Consumption Scale. Gaussian graphical models and Bayesian networks were used to assess symptom-level relationships. Centrality and bridging indices were computed. Network comparison tests were also used to assess for any differences in network invariance and global strength across multiple demographic subgroups. Directed acyclic graphs were constructed to consider potential causal pathways. Among 82 243 participants (48 987 men (59.6%), 33 245 women (40.4%), mean age 33.1 years), ADHD symptoms of inattention and hyperactivity-impulsivity emerged as central, bridging and directionally plausible nodes. Network comparisons revealed demographic differences in overall network strength, with men and cisgender individuals exhibiting higher frequencies of association. Nonetheless, items relating to both inattention and hyperactivity-impulsivity consistently emerged as central across all population subgroups. The finding suggesting that ADHD symptoms of inattention and hyperactivity-impulsivity are key drivers of compulsive sexual behaviours across global populations and multiple sociodemographic characteristics underscores the relevance of transdiagnostic mechanisms and suggests use of targeted interventions addressing executive dysfunction and reward dysregulation in ADHD.