Hypersexuality (Sex Addiction)
Hypersexual disorder is a proposed diagnosis for people who engage in sex or think about sex through fantasies and urges to the point of distress or impairment. These individuals may engage in activities such as porn, masturbation, sex for pay, and multiple partners, among others. They may feel distress in areas of life including work, school, and relationships.
The concept of "sex addiction" is under heated debate. However, in a controversial decision, compulsive sexual behavior disorder was added to the World Health Organization's International Classification of Diseases. Some researchers see this tendency as a problem of regulating behavior, while other experts wonder whether this behavior derives from a higher sex drive or if it stems from impulse control problems.
Other experts believe that the real causes of the behavior include emotional states, namely anxiety, depression, or relationship conflict. For some individuals, shame and morality may also be involved. Whether the condition exists or not, psychotherapy may be useful for individuals seeking to regulate their emotions and gain insight into their sexuality.
Hypersexuality is not included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. It was previously listed in the DSM-4 as a Sexual Disorder, Not Otherwise Specified with the definition "distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used."
The 2010 proposal for the addition of hypersexual disorder into the DSM-5 included the criteria of uncontrollable sexual behavior. Supporters of the behavior's inclusion argued that people who engage in this excessiveness suffer from great distress. In the proposed criteria, hypersexual disorder was conceived as a non-paraphilic sexual desire disorder with an impulsivity component.
The proposed diagnosis was not added to the DSM-5. Experts note that there isn’t enough empirical evidence to support the diagnosis. Many do not view it as an addiction and believe it has no similarities to other addictions. Some also fear that the diagnosis would pathologize normal aspects of human sexuality.
It is important to note that sexual behavior is a normal, healthy part of life and many people enjoy being active with multiple sexual partners or seeking out many different kinds of sexual experiences. Hypersexuality becomes problematic when it causes significant distress to an individual, or puts them at risk of harming themselves or someone else.
While the behavior was not included in the DSM-5, the following criteria may be a way of identifying hypersexuality. For a period of at least six months:
- Have recurrent, intense sexual fantasies, urges, and or behaviors that consistently interfere with other activities and obligations
- Behaviors occur in response to dysphoric mood states (anxiety, depression, boredom, irritability) or stressful life events
- Engage in consistent but unsuccessful efforts to control or reduce sexual fantasies, urges, or behaviors
- Engage in sexual behaviors while disregarding the potential for physical or emotional harm to self or others
- The frequency or intensity of sexual fantasies, urges, or behaviors cause significant distress or impairment
As mentioned, hypersexuality may also be linked to depression and anxiety. Some individuals may avoid difficult emotions, such as sadness or shame, and seek temporary relief by engaging in sexual behavior. Sexual cravings, therefore, can mask other issues such as depression, anxiety, and stress.
Due to the disagreement over the validity of sex addiction, the number of individuals affected is also a topic of debate. Recent research suggests that around 8 percent of American adults reported distress and impairment associated with trouble controlling their sexual urges and behaviors. Other studies have arrived at lower estimates, between 1 and 6 percent.
The causes of hypersexual behavior are not well understood. Some children or adolescents may engage in increased or developmentally inappropriate sexual behavior as a result of traumatic experiences, stressors, or mental illness. While there is no standard definition of hypersexuality in children, it is known that sexually abused children may display increased sexual behaviors and high-risk sexual behavior is associated with socio-demographic factors such as family dysfunction and social stress.
It's also important to consider the role culture plays in the concept of hypersexuality. Cultures that view sexuality in a more positive light may have values that don't judge sexual behavior as being "excessive."
People who believe they are "addicted" to sex often have feelings of shame around sex; they may believe that sexual thoughts, fantasies, masturbation, and porn are wrong, harmful, or evil. Many of these individuals were raised in a deeply religious household, which may have contributed to their beliefs about sex and sex addiction.
Hypersexuality may develop at any point, as research suggests that about 50 percent of those with hypersexuality report that they experienced dysregulated sexual fantasies, urges, and behaviors in childhood and adolescence. About 80 percent report that their symptoms progressed gradually over months or years.
"Sexual addiction" and hypersexuality are not included in the DSM-5, but if a person engages in sexual behaviors that causes distress, specialized counseling is available.
Treatment may involve the following:
- Rebuilding relationships
- Managing stress
- Identifying triggers for sexual thoughts or compulsive sexual behaviors
- Finding alternative behaviors that are less destructive
Common antidepressants may also reduce symptoms of hypersexuality in some cases, although more clinical trials are needed.
Therapy can help people better understand their sexual beliefs and behaviors, identify and address sources of distress, and treat any coexisting mental health conditions such as anxiety or depression. For people who have harmful beliefs about sex—that masturbation is sinful, for example—cognitive behavioral therapy can be particularly helpful for correcting false beliefs and alleviating distress.