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Hypersexuality

Hypersexuality is a term used for a presumed mental disorder


Hypersexuality
causing people to engage in or think about sexual activity to a
point of distress or impairment.[1] It is controversial whether it Specialty Psychiatry
should be included as a clinical diagnosis [1] used by mental
healthcare professionals. Nymphomania and satyriasis were terms previously used for the condition in
women and men, respectively.

Hypersexuality may be a primary condition, or the symptom of other medical conditions or disorders such
as Klüver–Bucy syndrome and bipolar disorder. Hypersexuality may also present as a side effect of
medication such as dopaminergic drugs used to treat Parkinson's disease.[2] Frontal lesions caused by brain
injury, strokes, and frontal lobotomy are thought to cause hypersexuality in individuals who have had these
conditions.[3] Clinicians have yet to reach a consensus over how best to describe hypersexuality as a
primary condition,[4][5][6] or to determine the appropriateness of describing such behaviors and impulses as
a separate pathology.

Hypersexual behaviors are viewed variously by clinicians and therapists as a type of obsessive-compulsive
disorder (OCD) or "OCD-spectrum disorder", an addiction,[7][8][9] or a disorder of impulsivity. A number
of authors do not acknowledge such a pathology[10] and instead assert that the condition merely reflects a
cultural dislike of exceptional sexual behavior.[11][12]

Consistent with there not being any consensus over what causes hypersexuality,[13] authors have used
many different labels to refer to it, sometimes interchangeably, but often depending on which theory they
favor or which specific behavior they have studied or have done research on; related or obsolete terms
include compulsive masturbation, compulsive sexual behavior,[14][15] cybersex addiction, erotomania,
"excessive sexual drive",[16] hyperphilia,[17] hypersexuality,[18][19] hypersexual disorder,[20] problematic
hypersexuality,[21] sexual addiction, sexual compulsivity,[22] sexual dependency,[12] sexual impulsivity,[23]
"out of control sexual behavior",[24] and paraphilia-related disorder.[25][26][27]

Due to the controversy surrounding the diagnosis of hypersexuality, there is not one generally accepted
definition and measurement for hypersexuality, making it difficult to truly determine the prevalence. Thus,
the prevalence can vary depending on how it is defined and measured. Overall, hypersexuality is estimated
to affect 2–6% of the population, and may be higher in certain populations like men, the LGBTQ+
community, and sex offenders.[28][29][30]

Causes
There is little consensus among experts as to the causes of hypersexuality. Some research suggests that
some cases can be linked to biochemical or physiological changes that accompany dementia, as dementia
can lead to disinhibition.[31] Psychological needs also complicate the biological explanation, which
identifies the temporal/frontal lobe of the brain as the area for regulating libido. Injuries to this part of the
brain increase the risk of aggressive behavior and other behavioral problems including personality changes
and "socially inappropriate" sexual behavior such as hypersexuality.[32] The same symptom can occur after
unilateral temporal lobotomy.[33] There are other biological factors that are associated with hypersexuality
such as premenstrual changes, and the exposure to virilising hormones in childhood or in utero.[34]

Physiology

In research involving the use of antiandrogens to reduce undesirable sexual behaviour such as
hypersexuality, testosterone has been found to be necessary, but not sufficient, for sexual drive.[34] A lack
of physical closeness and forgetfulness of the recent past were proposed as other potential factors
(specifically in the context of hypersexual behavior exhibited by people suffering from dementia).[35]

Pathogenic overactivity of the dopaminergic mesolimbic pathway in the brain—forming either


psychiatrically, during mania,[36] or pharmacologically, as a side effect of dopamine agonists, specifically
D3 -preferring agonists[37][38]—is associated with various addictions[39][40] and has been shown to result
among some in overindulgent, sometimes hypersexual, behavior.[36][37][38] HPA axis dysregulation has
been associated with hypersexual disorder.[41]

The American Association for Sex Addiction Therapy acknowledges biological factors as contributing
causes of sex addiction. Other associated factors include psychological components (which affect mood
and motivation as well as psychomotor and cognitive functions[42]), spiritual control, mood disorders,
sexual trauma, and intimacy anorexia as causes or type of sex addiction.[43]

As a symptom
Hypersexuality is known to present itself as a symptom in connection to a number of mental and
neurological disorders. Some people with borderline personality disorder (sometimes referred to as BPD)
can be markedly impulsive, seductive, and extremely sexual. Sexual promiscuity, sexual obsessions, and
hypersexuality are very common symptoms for both men and women with BPD. On occasion for some
there can be extreme forms of paraphilic drives and desires. "Borderline" patients, due in the opinion of
some to the use of splitting, experience love and sexuality in unstable ways.[44]

People with bipolar disorder may often display tremendous swings in sex drive depending on their mood.
As defined in the DSM-IV-TR, hypersexuality can be a symptom of hypomania or mania in bipolar
disorder or schizoaffective disorder. Pick's disease causes damage to the temporal/frontal lobe of the brain;
people with Pick's disease show a range of socially inappropriate behaviors.[45]

Several neurological conditions such as Alzheimer's disease, autism,[46][47] various types of brain
injury,[48] Klüver–Bucy syndrome,[49] Kleine–Levin syndrome,[50] and many neurodegenerative diseases
can cause hypersexual behavior. Sexually inappropriate behavior has been shown to occur in 7–8% of
Alzheimer's patients living at home, at a care facility or in a hospital setting. Hypersexuality has also been
reported to result as a side-effect of some medications used to treat Parkinson's disease.[51][52] Some
recreationally used drugs, such as methamphetamine, may also contribute to hypersexual behavior.[53]

A positive link between the severity of dementia and occurrence of inappropriate behavior has also been
found.[54] Hypersexuality can be caused by dementia in a number of ways, including disinhibition due to
organic disease, misreading of social cues, understimulation, the persistence of learned sexual behavior after
other behaviours have been lost, and the side-effects of the drugs used to treat dementia.[55] Other possible
causes of dementia-related hypersexuality include an inappropriately expressed psychological need for
intimacy and forgetfulness of the recent past.[35] As this illness progresses, increasing hypersexuality has
been theorized to sometimes compensate for declining self-esteem and cognitive function.[35]
Symptoms of hypersexuality are also similar to those of sexual addiction in that they embody similar traits.
These symptoms include the inability to be intimate (intimacy anorexia), depression and bipolar
disorders.[56] The resulting hypersexuality may have an impact in the person's social and occupational
domains if the underlying symptoms have a large enough systemic influence.[57][58]

As a disorder
In 2010, a proposal to add Sexual Addiction to the Diagnostic and Statistical Manual of Mental Disorders
(DSM) system has failed to get support of the American Psychiatric Association (APA).[59][60][61] The
DSM does include an entry called Sexual Disorder Not Otherwise Specified (Sexual Disorder NOS) to
apply to, among other conditions, "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".[62] As of March
2022 the DSM-5-TR, does not recognize a diagnosis of sexual addiction.[63]

The International Statistical Classification of Diseases and Related Health Problems (ICD-10) of the World
Health Organization (WHO), includes two relevant entries. One is "Excessive Sexual Drive" (coded
F52.7),[64] which is divided into satyriasis for males and nymphomania for females. The other is
"Excessive Masturbation" or "Onanism (excessive)" (coded F98.8).[65]

In 1988, Levine and Troiden questioned whether it makes sense to discuss hypersexuality at all, arguing
that labeling sexual urges "extreme" merely stigmatizes people who do not conform to the norms of their
culture or peer group, and that sexual compulsivity be a myth.[11] However, and in contrast to this view, 30
years later in 2018, the ICD-11 created a new condition classification, compulsive sexual behavior, to
cover "a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in
repetitive sexual behaviour". It classifies this "failure to control" as an abnormal mental health
condition.[66][67]

Risks
Individuals with hypersexuality are at a higher risk for various negative consequences, such as contracting
STIs, damaging relationships, and developing other addictions. 27.5% of affected individuals contracted an
STI on at least one occasion as a result of their hypersexual behavior, and 12% of affected individuals
engage in excessive, unprotected sex with multiple anonymous partners.[68] Additionally, an overwhelming
89% affected individuals admit to engaging in sexual activities outside of their primary relationship.[68]
This can negatively affect one's interpersonal and sexual relationships. In fact, 22.8% of sex addicts have
had a relationship end due to their behaviors. [69]

Furthermore, those with hypersexuality are more likely to have had or acquire another addiction. Multiple
addictions are also prevalent amongst affected individuals. Common co-occurring disorders and addictions
hypersexual individuals include eating disorders, compulsive spending, chemical dependency, and
uncontrollable gambling.[70]

Assessment
Those seeking treatment for hypersexual behavior are a heterogeneous group, thus a thorough assessment is
required to evaluate what kinds of behaviors and conditions need to be addressed and treated. It is essential
for clinicians to conduct a comprehensive clinical interview with the patient, in which they address the
history of their presenting problems, psychological history, sexual history, psychiatric history, mental health
history, substance use history, and medical history.[71] Understanding these facets of an individual
exhibiting hypersexual behavior is crucial due to the diverse array of comorbid conditions potentially linked
to hypersexuality. The presence of ongoing treatment for any coexisting conditions in the individual can
also have an impact on their symptoms and subsequent therapeutic interventions. Supplemental information
from a spouse or family member could also be used during assessments.

In addition to this, various questionnaires and instruments may be used to further assess various aspects of
an individual's behaviors and symptoms. Some common questionnaires that are used in assessments are the
Sexual Inhibition/Sexual Excitation Scale,[72] Intensity of Sexual Desire and Symptoms Scale,[73]
Compulsive Sexual Behavior Inventory,[74] Sexual Compulsivity Scale,[75] and the Sexual Addiction
Screening Test[76] amongst others. Different instruments can also be used in assessments, including but not
limited to the Clinical Global Impression Scale,[77] Timeline Followback,[78] Minnesota Multiphase
Personality Inventory II,[79] and the Millon Inventory.[80]

Treatment
The first step to treat hypersexual behavior is to help the individual stop or control their urges. There are a
multitude of different treatment options for those experiencing hypersexual behaviors, and many clinicians
recommend a multifaceted approach. Treatment plans are created after assessing the individual, so treatment
methods can vary depending on an individual's history, current symptoms, and any comorbid conditions
they may have. Common treatment methods include cognitive-behavioral therapy, relapse-prevention
therapy, psychodynamic psychosocial therapy, and psychopharmacological treatment, which can be
implemented through individual therapy, couple's therapy, and/or group therapy. [81]

The concept of hypersexuality as an addiction was started in the 1970s by former members of Alcoholics
Anonymous who felt they experienced a similar lack of control and compulsivity with sexual behaviors as
with alcohol.[11][82] Multiple 12-step style self-help groups now exist for people who identify as sex
addicts, including Sex Addicts Anonymous, Sexaholics Anonymous, Sex and Love Addicts Anonymous,
and Sexual Compulsives Anonymous. Some hypersexual men may treat their condition with the usage of
medication (such as Cyproterone acetate) or consuming foods considered to be anaphrodisiacs.[83] Other
hypersexuals may choose a route of consultation, such as psychotherapy, self-help groups or
counselling.[84]

Terminology
Sexologists have been using the term hypersexuality since the late 1800s, when Krafft-Ebing described
several cases of extreme sexual behaviours in his seminal 1886 book, Psychopathia Sexualis.[85][13] The
author used the term "hypersexuality" to describe conditions that would now be termed premature
ejaculation. Terms to describe males with the condition include donjuanist,[86] satyromaniac,[87]
satyriac[88] and satyriasist,[89] for women clitoromaniac,[90] nympho and nymphomaniac,[91] for
teleiophilic (attracted to adults) heterosexual women andromaniac,[92] while hypersexualist, sexaholic,[93]
onanist, hyperphiliac and erotomaniac[94] are gender neutral terms.[95]

Other, mostly historical, names include Don Juanism, the Messalina complex,[96] sexaholism,[97]
hyperlibido[98] and furor uterinus.[99] John Wilmot, 2nd Earl of Rochester described hypersexuality in
some of his literature.[100]

See also
Psychology portal
Human sexuality
portal

Compulsive sexual behaviour disorder


Erotophilia
Persistent genital arousal disorder
Pornography addiction
Sexual Compulsivity Scale

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