Latent profile analysis identified four distinct psychological profiles among men who have sex with men associated with differential chemsex engagement and mental/sexual health risks, with profile membership generally stationary over 12 months except for the Insecure and Withdrawn profiles, who significantly transitioned to the Impulsive and Self-Centered profiles respectively.
Key Findings
Results
Four distinct psychological profiles were identified among MSM using latent profile analysis based on personality traits, identity resilience, and homonegativity.
Study 1 used a sample of N = 503 men who self-identify as men who have sex with men (MSM)
The four profiles were labeled: Impulsive, Insecure, Self-Centered, and Withdrawn
Latent profile analysis mapped individual differences in personality traits, identity resilience, and internalized homonegativity
Profiles were associated with differential patterns of chemsex engagement and mental and sexual health risks
Results
The Impulsive profile was characterized by high disinhibition and risky chemsex engagement.
This profile showed high levels of disinhibition as a personality trait
Members of this profile were associated with risky chemsex behaviors
The Impulsive profile represented one of the highest-risk groups for adverse sexual health outcomes
Both the Insecure and Withdrawn profiles showed significant transitions toward the Impulsive profile over 12 months
Results
The Insecure profile was characterized by low identity continuity, high internalized homonegativity, and internalizing distress.
Members showed low identity continuity as a defining characteristic
High internalized homonegativity was a key feature distinguishing this profile
The Insecure profile was associated with internalizing distress, including mental health difficulties
Over 12 months, the Insecure profile showed significant transitions to the Impulsive profile, as assessed by McNemar-Bowker's test
Results
The Self-Centered profile was characterized by high identity resilience, wellbeing, and predominantly recreational chemsex.
This profile showed high identity resilience as a defining trait
Members reported higher wellbeing compared to other profiles
Chemsex engagement in this profile was predominantly recreational rather than compulsive or risk-driven
The Withdrawn profile significantly transitioned to the Self-Centered profile over 12 months
Results
The Withdrawn profile was characterized by emotional detachment, low externalized risk, and reduced wellbeing.
Emotional detachment was a defining characteristic of this profile
Members showed low externalized behavioral risk despite reduced wellbeing
This profile transitioned significantly to the Self-Centered profile over the 12-month follow-up period
Withdrawn individuals who transitioned to the Self-Centered profile showed improved sleep quality
Results
Profile membership was generally stationary over 12 months, with significant transitions occurring only for the Insecure and Withdrawn profiles.
Study 2 examined 12-month profile transitions in the same N = 503 participants from Study 1
Transitions were assessed using McNemar-Bowker's test
The Impulsive and Self-Centered profiles showed generally stable membership over time
Only the Insecure (transitioning to Impulsive) and Withdrawn (transitioning to Self-Centered) showed statistically significant profile transitions
Results
Withdrawn individuals who transitioned to the Self-Centered profile showed improved sleep quality over 12 months.
Sleep quality improvement was specifically observed in the subgroup transitioning from Withdrawn to Self-Centered
This finding represents a positive outcome associated with profile transition
The transition was associated with moving from reduced wellbeing and emotional detachment toward higher identity resilience and wellbeing
Sleep quality was one of the mental health outcomes tracked over the 12-month period
Discussion
The study findings suggest the need for person-centered harm reduction strategies tailored to specific psychological profiles.
Different profiles showed distinct patterns of vulnerability, risk behavior, and mental health outcomes
The authors argue that uniform harm reduction approaches may be insufficient given the heterogeneity of chemsex users
Profile-based differentiation could help identify when vulnerability is greatest and why some chemsex users experience poorer outcomes
The research spans two studies over a 12-month longitudinal window with the same sample of 503 participants
What This Means
This research suggests that men who have sex with men (MSM) who engage in chemsex — the intentional use of drugs in sexual contexts — are not a uniform group. By analyzing data from 503 participants, researchers identified four distinct psychological profiles: the 'Impulsive' group (characterized by poor impulse control and risky sexual behavior), the 'Insecure' group (marked by low self-continuity and internalized shame about sexual identity), the 'Self-Centered' group (with strong resilience and predominantly recreational drug-sex behavior), and the 'Withdrawn' group (emotionally detached with lower risk behavior but also lower wellbeing). These profiles were associated with meaningfully different mental and sexual health outcomes, suggesting that the same behavior — chemsex — carries very different risks depending on a person's psychological makeup.
When the same participants were followed over 12 months, most people stayed in their original profile. However, two groups showed significant change: those in the Insecure profile tended to move toward the higher-risk Impulsive profile, while those in the Withdrawn profile tended to shift toward the more resilient Self-Centered profile. Those who made the Withdrawn-to-Self-Centered transition also showed improved sleep quality, suggesting this shift may have broader mental health benefits.
This research suggests that one-size-fits-all approaches to chemsex harm reduction may miss important differences in why and how people engage in these behaviors. Individuals with high internalized homonegativity or poor impulse control may need more targeted psychological support, while others engaging in chemsex more recreationally may face fewer harms. Identifying which profile a person belongs to — and tracking how that may change over time — could help health providers offer more effective, individualized support.
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Emanuele Fino, Nadia Badran, P. Farah, Ismael Maatouk, M. Robinson, Kostas Papageorgiou, et al.. (2026). Chemsex-Related Risk Among Men Who Have Sex with Men: Profiling and Mapping Psychological Vulnerability Over Time.. Journal of Sex Research. https://doi.org/10.1080/00224499.2026.2656774