Garos Sexual Behavior Inventory

1. Abstract

The Garos Sexual Behavior Inventory (GSBI; Garos, 2009; Garos & Stock, 1998a, 1998b) is a comprehensive, multidimensional psychometric instrument designed to evaluate the cognitive, affective, and behavioral dimensions of human sexuality, with specialized utility in forensic, clinical, and couples counseling settings. Comprising 70 self-report items administered at a sixth-grade reading level, the GSBI assesses both general sexual adjustment and clinical patterns of sexual dysregulation, including hypersexuality, paraphilic interests, and compulsive sexual behavior patterns. The instrument is structurally organized into four primary clinical scales—Discordance (intrapsychic conflict, shame, and sexual maladjustment), Sexual Obsession (intrusive sexual preoccupation and loss of control over sexual behaviors), Permissiveness (sociosexual attitudes ranging from conservative to unconventional), and Sexual Stimulation (comfort with sexual arousal and erotic cues)—alongside three non-clinical masking scales (Sexual Control Difficulties, Sexual Excitability, and Sexual Insecurity) engineered to mitigate test-taking defensiveness, and an Inconsistent Responding index to identify random or invalid response sets.

Scored via normalized T-scores derived from a broad nonclinical standardization sample spanning ages 17 to 104, the GSBI eschews a global composite score in favor of an ipsative profile analysis, reflecting the statistical independence of its subscales. Psychometric evaluations demonstrate strong internal consistency (Cronbach’s alpha ranging from .70 to .85 across diverse clinical and nonclinical cohorts) and adequate test-retest stability across a 19-day interval (.62 to .84). Factorial validity was established through exploratory and maximum likelihood confirmatory factor analytic procedures. Criterion and predictive validity have been substantiated through robust discriminant function analyses, where the GSBI successfully distinguished incarcerated sex offenders from non-sex offenders with an overall classification accuracy of 84.2%, with the Discordance subscale operating as the primary predictor. Furthermore, the instrument displays sensitivity to therapeutic change in clinical trials evaluating multimodal experiential interventions for compulsive sexual behaviors. The GSBI provides clinicians and psychometricians with an empirically grounded methodology for mapping intrapsychic sexual conflict, sexual preoccupation, and behavioral control deficits.

2. Keywords

Garos Sexual Behavior Inventory, GSBI, sexual discordance, sexual obsession, compulsive sexual behavior disorder, hypersexuality, forensic risk assessment, psychometrics, sex offender assessment, sexual permissiveness, sexual stimulation, intrapsychic conflict.

3. Authors

The Garos Sexual Behavior Inventory was developed by Sheila Garos, Ph.D., in collaboration with psychometrician William A. Stock, Ph.D.

• Sheila Garos, Ph.D.: Associate Professor Emerita and former Director of the Counseling Psychology Program in the Department of Psychological Sciences at Texas Tech University (Lubbock, Texas, USA). Dr. Garos is an authority in counseling psychology, human sexuality, forensic psychological assessment, and the diagnosis and treatment of compulsive sexual behavior disorders. Her empirical research has focused on the intersection of intrapsychic conflict, sex offender rehabilitation, and the psychometric measurement of sexual behaviors. Direct correspondence: Department of Psychological Sciences, Texas Tech University, Lubbock, TX 79409-2051; Email: [email protected].
• William A. Stock, Ph.D.: Professor Emeritus of Psychology in the Division of Psychology in Education at Arizona State University. Dr. Stock is a specialist in quantitative methodology, psychometrics, multivariate statistics, and structural equation modeling, providing the foundational psychometric design, factor analytic frameworks, and item-reduction methodologies utilized in the standardization of the GSBI.

4. Purpose

The assessment of human sexual behavior within clinical, forensic, and therapeutic environments presents unique methodological challenges, primarily stemming from social desirability bias, impression management, pathologization of unconventional yet non-harmful sexual preferences, and the complex interplay between moral incongruence and behavioral dyscontrol. The Garos Sexual Behavior Inventory (GSBI) was developed to address these limitations by providing an objective, standardized, and theoretically grounded instrument capable of evaluating both normative sociosexual dimensions and clinically significant sexual pathology.

From a diagnostic and clinical perspective, the GSBI serves as a specialized assessment tool designed to assist forensic specialists, clinical psychologists, psychiatrists, and licensed marriage and family therapists in formulating differential diagnoses, structuring risk evaluations, and designing targeted treatment regimens. The scale is particularly indicated for individuals presenting with patterns of compulsive sexual behavior, hypersexuality, paraphilic interests, sexual offending histories, substance use disorders co-occurring with sexual acting out, and histories of sexual trauma or victimization. Rather than merely tabulating the sheer frequency of sexual acts—which can conflate high libido with psychological distress—the GSBI focuses heavily on the cognitive appraisals, affective responses, and behavioral regulation strategies surrounding sexuality.

In forensic psychology, the GSBI fulfills a vital function in evaluating incarcerated sex offenders, individuals undergoing pre-sentencing evaluations, and clients mandated to community-based sexual offense treatment programs. Traditional actuarial risk tools focus largely on static historical variables (e.g., age at first offense, victim demographics, prior criminal history) that cannot capture dynamic psychological mechanisms or therapeutic change. The GSBI provides insight into dynamic psychological constructs such as intrapsychic sexual discordance, internal conflict, and pervasive sexual preoccupation. Research demonstrates that high levels of sexual discordance—marked by intense feelings of shame, anxiety, and internal conflict regarding one’s sexual impulses—are strongly correlated with sexual deviance and distinguish sex offenders from non-sex offenders within correctional populations (Garos et al., 2004).

In clinical and couples therapy contexts, the GSBI is frequently utilized to uncover discrepancies between romantic partners regarding sexual values, ideological permissiveness, desire discrepancies, and comfort with sexual arousal. Because the instrument disaggregates attitudinal permissiveness from clinical obsession and intrapsychic discordance, therapists can determine whether relational sexual distress stems from divergent sociocultural values, personal sexual insecurities, or severe individual pathology such as out-of-control sexual behavior. Furthermore, the inclusion of three masking scales and an Inconsistent Responding index enables clinicians to detect defensive distortion, dissimulation, or erratic response patterns commonly observed when individuals are mandated to undergo psychological evaluations.

5. Psychological Construct

The GSBI conceptualizes sexual functioning and sexual behavioral disorders through a multidimensional matrix incorporating cognitive, affective, and behavioral domains. Rather than viewing sexual pathology as a unitary construct (such as a generic “sex addiction” or high libido), the instrument delineates four distinct primary clinical dimensions and three auxiliary masking dimensions:

Primary Clinical Dimensions

• Discordance: This dimension measures the extent of overall sexual maladjustment, characterized by profound intrapsychic conflict, guilt, shame, and fear regarding one’s sexual thoughts, feelings, and behaviors. High scorers on this scale experience their sexual desires and practices as ego-dystonic; they harbor severe internal conflict, fear of exposure, self-loathing, and perceived inadequacy regarding their sexual attractiveness or performance. In contrast, low scorers exhibit harmonious sexual adjustment, experiencing minimal guilt, anxiety, or internal dissonance regarding their sexual identity and behaviors. Discordance represents the most clinically sensitive scale for identifying psychological suffering and differentiating forensic sexual offenders from non-offending populations.
• Sexual Obsession: This subscale assesses the cognitive and behavioral manifestations of sexual preoccupation, intrusive sexual thoughts, and perceived loss of control over sexual urges. It reflects the behavioral criteria traditionally associated with compulsive sexual behavior disorder (CSBD) and out-of-control sexual behavior, such as feeling compelled to engage in masturbation or sexual acts, experiencing an inability to stop sexual behaviors once aroused, and allowing sexual thoughts to displace vocational, educational, or relational responsibilities. Elevated scores indicate significant psychological distress resulting from unmanageable sexual cravings and behavioral compulsivity.
• Permissiveness: This scale captures sociosexual attitudes, moral frameworks, and ideological values regarding sexuality. The continuum ranges from highly conservative, traditional, and restrictive sexual values to liberal, open, and unconventional sexual attitudes. Items query perspectives on non-marital sexual behavior, contraception access, nontraditional gender roles in sexual initiation, and tolerance for diverse sexual practices. This scale is vital for distinguishing between individuals who have unconventional sexual values without psychological distress and those whose behaviors violate their own internal moral standards.
• Sexual Stimulation: This subscale measures an individual’s subjective comfort with sexual arousal, physical sensuality, and exposure to erotic cues. High scorers demonstrate a comfortable, non-defensive acceptance of physiological arousal, sensory erotophilia, and bodily pleasure, finding sexual fantasies and feelings intrinsically enjoyable. Low scorers often demonstrate erotophobia, inhibitory responses to physical stimulation, or discomfort with visceral erotic sensations.

Masking Dimensions

The three masking scales embedded within the GSBI were rationally developed to dilute the transparency of the primary clinical items, thereby reducing social desirability bias and defensive posturing, while capturing secondary psychological constructs relevant to sexual dysregulation:

• Sexual Control Difficulties: Comprising 8 items, this scale explores perceived disruptions in behavioral inhibition, such as sexual impulses overriding logical decision-making or the immediate urge to masturbate upon waking from erotic dreams.
• Sexual Excitability: Consisting of 7 items, this scale evaluates sensory and historical arousability, including an early developmental interest in sexuality relative to peers and acute sensory reactivity to erotic environmental cues (e.g., fragrances or visual stimuli).
• Sexual Insecurity: Comprising 6 items, this scale targets performance anxiety, interpersonal passivity, and fear of failing to satisfy romantic or sexual partners (e.g., feeling like a personal failure if a partner is not maintained in an excited state).

6. Theoretical Framework

The conceptual architecture of the GSBI is grounded in multi-factorial models of human sexuality, contemporary psychopathology, and cognitive-behavioral theories of intrapsychic conflict. During its development in the late 1990s, the conceptualization of out-of-control sexual behavior was sharply divided between the addiction paradigm—championed by clinicians such as Patrick Carnes (1992)—and impulse-control or obsessive-compulsive models of sexual behavior. Dr. Sheila Garos and William A. Stock sought to construct a non-pejorative, empirically testable model that moved beyond moralistic assumptions while rigorously quantifying constructs underlying disorders of sexual frequency, regulation, and intrapsychic suffering.

A central theoretical pillar of the GSBI is the concept of intrapsychic conflict and cognitive dissonance theory, originally formulated by Leon Festinger and later applied to human sexuality. Garos posited that the psychological harm associated with sexual behaviors often arises not strictly from the behaviors themselves, but from the severe psychological dissonance between an individual’s behaviors and their core moral beliefs, cultural expectations, or social self-concept. When an individual engages in sexual acts that induce acute shame, terror of discovery, and moral condemnation, a state of chronic intrapsychic discordance is established. In forensic populations, this internal discordance can fuel defensive psychological adaptations, compartmentalization, cognitive distortions, and maladaptive sexual offending behaviors (Garos et al., 2004).

Furthermore, the GSBI integrates the dual-process and erotophobia-erotophilia frameworks articulated by Fisher, Byrne, White, and Kelley (1988). According to this perspective, individuals possess enduring personality dispositions that dictate emotional and evaluative responses to sexual stimuli, ranging from negative emotional responses and avoidance (erotophobia) to positive emotional responses and approach behaviors (erotophilia). By assessing Permissiveness and Sexual Stimulation independently of Sexual Obsession and Discordance, the GSBI avoids the conflation of high erotophilia (unconventional or highly active sexual engagement) with psychological pathology, aligning with modern nosological systems such as the World Health Organization’s ICD-11 criteria for Compulsive Sexual Behaviour Disorder, which explicitly mandate that distress related solely to moral judgment or religious disapproval is insufficient for a psychiatric diagnosis.

7. Validity

The empirical validity of the GSBI has been substantiated through extensive psychometric testing across diverse clinical, nonclinical, and correctional cohorts, confirming robust construct, convergent, discriminant, and criterion-related validity.

Factorial and Construct Validity

Initial construct validity was established through equivalence of factor structures across independent exploratory and confirmatory investigations (Garos & Stock, 1998a, 1998b). The factor structure derived from the initial 500-participant standardization study was replicated across male and female subgroups, as well as across a subsequent large-scale sample of 1,000 individuals, demonstrating structural invariance across biological sex.

Convergent and Discriminant Validity

Garos and Stock (1998a) systematically investigated the convergent and discriminant validity of the GSBI by correlating its subscales with a battery of established psychological and sexological instruments:

• Sexual Addiction Screening Test (SAST; Carnes, 1992): The Sexual Obsession subscale exhibited strong, statistically significant convergent correlations with the SAST, confirming its sensitivity to compulsive sexual behaviors and perceived behavioral dyscontrol.
• The Sexuality Scale (Snell & Papini, 1989): The GSBI subscales demonstrated theoretical convergence with measures of sexual preoccupation and sexual depression, while maintaining discriminant independence from generalized sexual esteem.
• Sexual Opinion Survey (SOS; Fisher et al., 1988): The Permissiveness and Sexual Stimulation scales exhibited moderate-to-strong positive correlations with the erotophilia spectrum of the SOS, validating their capacity to measure sociosexual attitudes and arousal comfort.
• Beck Depression Inventory (BDI; Beck et al., 1961) and Rosenberg Self-Esteem Scale (RSES; Rosenberg, 1962): The Discordance subscale exhibited significant positive correlations with depressive symptomatology on the BDI and significant inverse correlations with global self-esteem on the RSES. Coefficients across the validation battery ranged from .05 to .52, demonstrating that while the GSBI subscales converge logically with relevant affective and sexual traits, they share minimal variance with generalized psychopathology, thereby confirming discriminant validity.

Criterion and Predictive Forensic Validity

The diagnostic and predictive utility of the GSBI in forensic environments was rigorously examined in a seminal study by Garos, Bleckley, Beggan, and Frizzell (2004). The study investigated whether affective and cognitive intrapsychic conflict could accurately classify incarcerated male sex offenders ($n = 93$) versus incarcerated non-sex offenders ($n = 93$). A discriminant function analysis demonstrated that the GSBI significantly differentiated between the two groups (Wilks’ $lambda = .553$, $F(1, 184) = 148.63$, $p < .001$). The Discordance subscale emerged as the single strongest predictor of sex offender status.

In the primary sample, the GSBI correctly classified 80.6% of sex offenders and 88.3% of non-sex offenders, yielding an overall correct classification rate of 84.2%. When applied to an independent cross-validation sample, classification accuracy remained remarkably stable, correctly identifying 80.6% of sex offenders and 87.2% of non-sex offenders (overall accuracy of 83.7%). Logistic regression analyses further supported these findings, yielding a positive predictive value of 82.8%—a marked improvement over the sample base rate of 53%. When the Discordance scale was omitted from the regression equation, the predictive power of the remaining three subscales dropped significantly, though it still achieved a positive predictive value of 68.4%, demonstrating that intrapsychic conflict is the pivotal cognitive-affective marker distinguishing sex offenders from general criminal offenders.

Treatment Sensitivity

Klontz, Garos, and Klontz (2005) evaluated the clinical sensitivity of the GSBI to therapeutic interventions in a longitudinal study of residential inpatients undergoing multimodal experiential therapy for compulsive sexual behaviors. Repeated-measures multivariate analysis of variance revealed significant main effects for time across the GSBI profiles. Specifically, both male and female patients demonstrated marked, statistically significant reductions on both the Sexual Obsession and Discordance subscales from pre-treatment to post-treatment. Crucially, these clinical gains remained stable and statistically significant at a 6-month post-discharge follow-up, verifying the GSBI’s sensitivity as an outcome measurement tool for psychological and behavioral interventions.

8. Reliability

The GSBI possesses robust internal consistency and temporal stability across diverse community, clinical, and forensic samples. Reliability analyses conducted across initial development and subsequent standardization phases confirm the psychometric integrity of both the primary and masking scales.

Internal Consistency

In the initial standardization cohort (Study 1, $N = 500$; Garos & Stock, 1998b), internal consistency coefficients (Cronbach’s $\alpha$) demonstrated adequate to strong reliability across biological sexes:

• Females ($n = 250$):
  • Discordance: $\alpha = .80$
  • Sexual Obsession: $\alpha = .75$
  • Sexual Stimulation: $\alpha = .74$
  • Permissiveness: $\alpha = .73$
• Males ($n = 250$):
  • Discordance: $\alpha = .85$
  • Sexual Obsession: $\alpha = .72$
  • Sexual Stimulation: $\alpha = .67$
  • Permissiveness: $\alpha = .66$

In the cross-validation study (Study 2, $N = 1,000$; Garos & Stock, 1998a), internal consistency coefficients for the combined normative sample showed enhanced stability:

• Discordance: $\alpha = .82$
• Sexual Obsession: $\alpha = .80$
• Sexual Stimulation: $\alpha = .72$
• Permissiveness: $\alpha = .70$

The three masking scales, standardized on a clinical and nonclinical composite cohort (Garos, 2009), also exhibited strong internal consistency:

• Sexual Control Difficulties (8 items): $\alpha = .85$
• Sexual Excitability (7 items): $\alpha = .82$
• Sexual Insecurity (6 items): $\alpha = .74$

Test-Retest Stability

Temporal stability of the GSBI was evaluated in a sub-sample of participants from Study 2 ($N = 1,000$) re-tested across a 19-day administration window (Garos & Stock, 1998b). Test-retest reliability coefficients demonstrated high temporal stability for cognitive and compulsive dimensions, with moderate stability for value-based dimensions:

• Sexual Obsession: $r_{tt} = .84$ ($n = 53$, $p < .001$)
• Sexual Stimulation: $r_{tt} = .79$ ($n = 52$, $p < .001$)
• Discordance: $r_{tt} = .72$ ($n = 54$, $p < .001$)
• Permissiveness: $r_{tt} = .62$ ($n = 53$, $p < .001$)

The slightly lower coefficient observed for Permissiveness is consistent with social-attitude constructs, which are subject to subtle contextual and conversational priming effects over short intervals. Overall, the coefficients indicate that the GSBI measures stable trait-like behavioral dimensions rather than transient affective states.

9. Factor Analysis

The internal latent structure of the GSBI was determined and refined through a rigorous two-stage exploratory and confirmatory factor analytic sequence, ensuring both statistical parsimony and theoretical coherence.

Stage 1: Exploratory Factor Analysis and Rational Item Reduction

Item generation commenced with a comprehensive theoretical framework mapping potential cognitive, affective, and behavioral expressions of sexual dysregulation and sociosexual orientation. Subject matter experts in sexology, forensic psychology, and psychometrics reviewed an initial pool of over 120 candidate items. Rationally derived item-elimination procedures were applied to remove ambiguous, culturally biased, or conceptually redundant statements.

The retained items were subsequently administered to a diverse sample of 500 adult participants (Study 1; Garos & Stock, 1998b) and subjected to a principal components factor analysis (PCA) followed by an orthogonal Varimax rotation. Examination of the scree plot and eigenvalues greater than 1.0 supported a clean four-factor solution accounting for the primary variance. Items loading substantially ($ge .40$) onto their primary theoretical dimension without exhibiting severe cross-loadings ($ge .30$ on alternate factors) were retained, yielding the core clinical scales: Discordance, Sexual Obsession, Permissiveness, and Sexual Stimulation.

Stage 2: Maximum Likelihood Factor Analysis

In the second validation investigation (Study 2, $N = 1,000$; Garos & Stock, 1998a), the 70-item GSBI was evaluated using a maximum likelihood factor analysis with oblique (Promax/Oblimin) rotation. Oblique rotation was selected based on the theoretical recognition that latent dimensions of human sexuality, while conceptually distinct, share real-world psychological correlations.

The maximum likelihood extraction replicated the four-factor structural solution identified in Study 1 with exceptional stability across the total sample and within discrete male and female subsamples. Factor intercorrelations were low to moderate (ranging from $r = .08$ to $r = .38$), confirming that the subscales represent independent latent constructs rather than facets of a singular, monolithic global dimension. For this reason, Dr. Garos explicitly advised against the calculation of a single composite “total score,” as aggregating uncorrelated or inversely correlated dimensions (such as high Permissiveness and high Discordance) obscures the idiographic clinical profile of the examinee.

10. Instrument / Measurement Tool

• Instrument Name: Garos Sexual Behavior Inventory (GSBI)
• Author: Sheila Garos, Ph.D.
• Publisher: Western Psychological Services (WPS)
• Publication Date: 2009 (Manual); foundational developmental studies published in 1998
• Assessment Format: Standardized self-report inventory
• Item Count: 70 items total
  • Primary Scales: Discordance, Sexual Obsession, Permissiveness, Sexual Stimulation
  • Masking Scales: Sexual Control Difficulties (8 items), Sexual Excitability (7 items), Sexual Insecurity (6 items)
  • Validity Indicator: Inconsistent Responding index (evaluates pairs of highly correlated items to detect careless, random, or contradictory responding)
• Reading Level: 6th-grade reading level (Flesch-Kincaid formula)
• Administration Time: Approximately 20 to 30 minutes
• Response Modality: 5-point Likert-type agreement scale
  • 1 = Strongly Disagree
  • 2 = Disagree
  • 3 = Neither Agree nor Disagree / Undecided
  • 4 = Agree
  • 5 = Strongly Agree
• Administration Materials: Dual-component AutoScore format designed for confidentiality and privacy protection. Test statements are printed on a reusable Administration Card, while responses are recorded on a separate carbonized AutoScore Answer Sheet that conceals item content from casual observation during scoring.
• Scoring and Standardization:
  • Raw scores for each subscale are converted to standardized, normalized $T$-scores ($M = 50$, $SD = 10$).
  • Normative data are based on a large nonclinical community sample ($N > 1,000$) aged 17 to 104 with balanced male/female representation.
  • Supplemental reference profiles and normative means are provided for clinical and correctional subgroups, including incarcerated sex offenders, substance-dependent populations, and self-identified sexual addicts.
  • Total Score: No overall composite score is computed; interpretation is strictly profile-based across independent dimensions.

11. Permissions & Fee and Test Year

The Garos Sexual Behavior Inventory was formally published in manual form in 2009 by Western Psychological Services (WPS), following a decade of clinical validation that originated with Garos and Stock’s initial 1998 publications.

The GSBI is a proprietary, copyrighted psychological assessment. All test items, administrative cards, scoring sheets, and manual materials are legally protected under United States and international copyright law. The complete instrument is not in the public domain and cannot be reproduced, digitized, distributed, or administered without purchasing the authorized test materials or securing formal written permission from Western Psychological Services:

• Publisher Contact: Western Psychological Services (WPS), 12031 Wilshire Blvd., Los Angeles, CA 90025-1251, USA
• Telephone: (800) 648-8857 / (310) 478-2061
• Website: www.wpspublish.com
• Licensing and Inquiries: [email protected]

Professional Qualification Level: In alignment with APA guidelines for psychological assessments, purchase and clinical administration of the GSBI are restricted to qualified individuals meeting Qualification Level B or Level C standards (e.g., master’s or doctoral-level training in psychology, psychiatry, forensic evaluation, or related mental health disciplines with documented coursework in psychometric assessment and statistical interpretation).

12. References

Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4(6), 561–571. https://doi.org/10.1001/archpsyc.1961.01710120031004

Carnes, P. (1992). Out of the shadows: Understanding sexual addiction (2nd ed.). Hazelden Publishing.

Fisher, W. A., Byrne, D., White, L. A., & Kelley, K. (1988). Erotophobia-erotophilia as a dimension of personality. The Journal of Sex Research, 25(1), 123–151. https://doi.org/10.1080/00224498809551448

Garos, S. (2009). Garos Sexual Behavior Inventory test manual. Western Psychological Services.

Garos, S., Bleckley, K. M., Beggan, J. K., & Frizzell, J. (2004). The relationship between intrapsychic conflict and deviant sexual behavior in sex offenders. Journal of Offender Rehabilitation, 40(1–2), 23–38. https://doi.org/10.1300/J076v40n01_02

Garos, S., & Stock, W. A. (1998a). Investigating the discriminant validity and differentiating capability of the Garos Sexual Behavior Index. Sexual Addiction & Compulsivity: The Journal of Treatment & Prevention, 5(4), 251–267. https://doi.org/10.1080/10720169808402327

Garos, S., & Stock, W. A. (1998b). Measuring disorders of sexual frequency and control: The Garos Sexual Behavior Index. Sexual Addiction & Compulsivity: The Journal of Treatment & Prevention, 5(3), 159–177. https://doi.org/10.1080/10720169808400164

Klontz, B., Garos, S., & Klontz, P. (2005). The effectiveness of multimodal experiential therapy in the treatment of sexual addiction. Sexual Addiction & Compulsivity: The Journal of Treatment & Prevention, 12(4), 275–294. https://doi.org/10.1080/10720160500366885

Rosenberg, M. (1962). The association between self-esteem and anxiety. Journal of Psychiatric Research, 1(2), 135–152. https://doi.org/10.1016/0022-3956(62)90004-3

Snell, W. E., & Papini, D. R. (1989). The Sexuality Scale: An instrument to measure sexual-esteem, sexual-depression, and sexual-preoccupation. The Journal of Sex Research, 26(2), 256–263. https://doi.org/10.1080/00224498909551510

World Health Organization. (2019). International statistical classification of diseases and related health problems (11th ed.). https://icd.who.int/

Zuckerman, M., Kuhlman, D. M., Joireman, J., Teta, P., & Kraft, M. (1993). A comparison of three structural models for personality: The Big Three, the Big Five, and the Alternative Five. Journal of Personality and Social Psychology, 65(4), 757–768. https://doi.org/10.1037/0022-3514.65.4.757

13. Items of the Scale