Hypersexuality

Hypersexual disorder is a proposed diagnosis for people who have an "excessive" amount of sex and feel distress as a result. There is debate, however, over whether sex addiction exists in the same way as other addictions.

Definition

In Western psychiatry, "excessive" sexual behaviors have been documented since the 1700s and have been referred to as Don Juanism, satyriasis, nymphomania, excessive sexual drive, sexual addiction, and hypersexuality, among other things. These terms all refer to sexual behavior that includes limited control of excessive and problematic sexual fantasies, urges, and behaviors.

Hypersexual disorder is a controversial diagnosis and is not included in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In the previous version of the DSM (DSM-IV-TR), a diagnosis referred to as Sexual Disorder - Not Otherwise Specified was applied to situations in which a person experienced "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."

Specific criteria for hypersexual disorder were proposed for the DSM-5 in 2010 to capture symptoms reported by people seeking help for out-of-control sexual behavior. Many clinicians and researchers support the existence of this diagnosis because it may be used to help people who engage in "excessive" sexual behavior and simultaneously, and as a direct result, experience a great deal of personal distress. In the proposed criteria for the DSM-5, hypersexual disorder was conceptualized as a nonparaphilic sexual desire disorder that had an impulsivity component.

Although this criteria was tested and found to be valid when used with patients in a clinical setting, the proposed diagnosis was not added to the DSM because of the controversy that surrounds it. A diagnosis of "sex addiction" has also not been added to the DSM because clinicians and researchers agree there is not enough empirical evidence to support this diagnosis. The term "sex addict" is commonly used, however, and refers to a person who compulsively seeks out sexual acts despite negative consequences to self or others. This may be limited to compulsive masturbation or viewing of pornography, or it may extend as far as engaging in illegal sexual behavior such as exhibitionism or rape.

It is not yet clear to clinicians whether compulsive sexual behavior should be viewed as an addiction similar to drug addictions, and many people feel that such a diagnosis is shaming to people who enjoy having a lot of sex with multiple partners. Many people believe strongly that hypersexuality as a concept is real but should not use addiction language and should be described using non-moral terms.

Symptoms

The following criteria for hypersexual disorder was proposed as an addition to the DSM-5. While hypersexual disorder was ultimately not included in the DSM-5, research has shown that this criteria is a valid and reliable way of identifying hypersexuality.

For a period of at least six months:

  • An individual experiences recurrent and intense sexual fantasies, sexual urges, or sexual behaviors
  • The time spent engaging in sexual fantasies, urges, or behaviors consistently interferes with other important activities and obligations
  • Sexual fantasies, urges, or behaviors occur in response to dysphoric mood states (anxiety, depression, boredom, irritability) or stressful life events
  • An individual engages in consistent but unsuccessful efforts to control or reduce their sexual fantasies, urges, or behaviors
  • An individual engages 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 personal distress or impairment

Some research has shown a link between hypersexuality and depressive symptoms. Several theories offer explanations for this link. For example, people 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.

Causes

The causes of hypersexual behavior are not well understood. 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.

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 sociodemographic 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."

Treatments

While sexual addiction and hypersexual disorder are not included in the DSM-5. 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

Find a Treatment Program here.

References

  • Adelson, S., Bell, R., Graff, A., Goldenberg, D., Haase, E., Downey, J. I., & Friedman, R. C. (2012). Toward a definition of “hypersexuality” in children and adolescents. Psychodynamic psychiatry, 40(3), 481-503.

  • American Psychiatric Association, Diagnostic and Statistical Manual, Fourth Edition, Revised

  • Kafka, M. P. (2010). Hypersexual disorder: A proposed diagnosis for DSM-V. Archives of sexual behavior, 39(2), 377-400.

  • Reid, R. C., Carpenter, B. N., Hook, J. N., Garos, S., Manning, J. C., Gilliland, R., ... & Fong, T. (2012). Report of findings in a DSM‐5 field trial for hypersexual disorder. The journal of sexual medicine, 9(11), 2868-2877.

  • Schultz, K., Hook, J. N., Davis, D. E., Penberthy, J. K., & Reid, R. C. (2014). Nonparaphilic hypersexual behavior and depressive symptoms: a meta-analytic review of the literature. Journal of sex & marital therapy, 40(6), 477-487.

Last reviewed 05/04/2017