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PATHOS: A Brief Screening Application for Assessing Sexual Addiction

Carnes, Patrick J. PhD; Green, Bradley A. PhD; Merlo, Lisa J. PhD, MPE; Polles, Alexis MD; Carnes, Stefanie PhD; Gold, Mark S. MD

Journal of Addiction Medicine: March 2012 - Volume 6 - Issue 1 - p 29–34
doi: 10.1097/ADM.0b013e3182251a28
Original Research

Sexual addiction is estimated to afflict up to 3% to 6% of the population. However, many clinicians lack clear criteria for detecting potential cases.

Objectives: The present studies were conducted to assess the effectiveness of a brief sexual addiction screening instrument (ie, PATHOS Questionnaire) to correctly classify patients being treated for sex addiction and healthy volunteers.

Methods: In study 1, a 6-item questionnaire, which utilizes the mnemonic “PATHOS,” was examined in regard to sensitivity and specificity using a sample combining patients being treated for sex addiction and healthy volunteers (970 men/80.2% patients; 938 women/63.8% patients). In study 2, a cross-validation sample of 672 men (93% patients) and 241 women (35.3% patients) completed the PATHOS screener.

Results: Results of receiver operating characteristics analyses in study 1 demonstrated that the PATHOS captured 92.6% of the area under the curve and achieved 88.3% sensitivity and 81.6% specificity for classifying the male sample (n = 963) as patients and healthy subjects using a cutoff score of 3. Similarly, the PATHOS captured 90.2% of the area under the curve and, with a cutoff of 3, achieved 80.9% sensitivity and 87.2% specificity for the female sample (n = 808). In study 2, results of receiver operating characteristics analyses indicated that the PATHOS captured 85.1% of the area under the curve, with sensitivity of 70.7% and specificity of 86.9% for men (cutoff of 3). For women, the PATHOS captured 80.9% of the area under the curve and achieved 69.7% sensitivity and 85.1% specificity with the cutoff of 3.

Conclusions: These studies provide support for the use of the PATHOS as a screening instrument to detect potential sexual addiction cases in clinical settings.

From the Pine Grove Behavioral Health Services (PJC) and Department of Psychology, University of Southern Mississippi (BAG), Hattiesburg, MS; Department of Psychiatry, University of Florida, Gainesville, FL (LJM, MSG); Washington University, Department of Psychiatry, St Louis, MO (LJM); COPAC Addiction Treatment Services, Brandon, MS (AP); and IITAP, LLC, Carefree, AZ (SC).

Send correspondence and reprint requests to Stefanie Carnes, PhD, IITAP, LLC, PO Box 2112, Carefree, AZ 85377. E-mail:

No conflicts of interest to report.

The third author was supported in part by National Institute on Drug Abuse (NIDA) training grant T32-DA-07313-10 (PI: Linda B. Cottler). NIDA had no further role in study design; in the collection, analysis, and interpretation of the data; in the writing of the report; or in the decision to submit the paper for publication.

Received July 20, 2010

Accepted May 18, 2011

© 2012 American Society of Addiction Medicine