Assessment and treatment of hypersexuality: a review

SUMMARY Hypersexuality is defined under various terms in the DSM and ICD diagnostic classifications. However, it can be challenging to differentiate between hypersexuality as one of the symptoms of a mental disorder and hypersexual disorder as a primary diagnosis. In this article, we explore the physiology, assessment and treatment of hypersexual disorder, and consider its aetiology and epidemiology. In addition, we highlight the paucity of evidence in the literature about licensed or specific pharmacological recommendations for its treatment and the poor awareness of hypersexuality in clinical and research practice. Further research is recommended to identify more precise guidance for the pharmacological management of hypersexuality.

Non-Paraphilic Hypersexual Disorder – Compulsive Sexual Behavior Disorder or Sexual Addiction

The conceptualization of excessive sexual behavior has been intensely debated over the years, and the concept of hypersexuality is still controversial. After long debates, the indexation in ICD-11 (International Classification of Diseases, 11th Revision, World Health Organization, 2018) of excessive and problematic sexual behavior as a compulsive sexual behavior disorder (CSBD) is welcome. There are still debates about the category of the disorder. In ICD-11, CSBD is classified as an impulse control disorder, but this classification is controversial, as there is evidence that CSBD has many addictive features (Kraus et al., 2016). Although the diagnosis of hypersexual disorder, proposed by Kafka, was not included in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition, American Psychiatric Association, 2013), this diagnosis was supported by both clinical contexts as well as by some research that indicates that excessive sexual behavior can have serious consequences in an individual’s life (Kafka, 2010; Kaplan & Krueger, 2010, Reid et al., 2012). Understanding, defining and correctly diagnosing this disorder are important prerequisites for proper treatment, and allow also warning of certain risk factors for the development of this disorder.

Hypersexual Behaviors and Personality Traits in Men with Substance Use Disorders in Iran

The present study was conducted aiming to compare the five-factor model of personality in addicted men with and without hypersexual disorder (HD). The research method was causal-comparative, and the study population included all addicted men who were residents of addiction treatment centers in Tabriz city. 216 male addicts with HD and without HD were compared in 2 groups of 108 members through the Big Five Inventory (BFI-44). Data were analyzed using independent t test, chi-square, multivariate analysis of variance, and SPSS 22 version software for Windows (IBM Corporation, Armonk, NY, USA). The results showed that 2 groups were significantly different in the five-factor model of personality. Addicted men with HD obtained lower scores in agreeableness, conscientiousness, and openness to experience; and obtained higher scores in neuroticism personality dimension in comparison to addicted men without HD. There was no significant difference between the 2 groups in extraversion dimension. These findings indicated that there is a significant difference between the 2 groups in the five-factor model of personality, and addicted men with HD scored higher in neuroticism dimension. Therefore, this study illustrates the need to pay attention to the personality dimension of neuroticism (or emotional instability) as a variable comorbid with HD and substance-related disorders.

Same Same but Different: A Clinical Characterization of Men with Hypersexual Disorder in the Sex@Brain Study

Problems arising from hypersexual behavior are often seen in clinical settings. We aimed to extend the knowledge about the clinical characteristics of individuals with hypersexual disorder (HD). A group of people who fulfilled the proposed diagnostic criteria for HD (men with HD, n = 50) was compared to a group of healthy controls (n = 40). We investigated differences in sociodemographic, neurodevelopmental, and family factors based on self-report questionnaires and clinical interviews. Men with HD reported elevated rates of sexual activity, paraphilias, consumption of child abusive images, and sexual coercive behavior compared to healthy controls. Moreover, rates of affective disorders, attachment difficulties, impulsivity, and dysfunctional emotion regulation strategies were higher in men with HD. Men with HD seem to have experienced various forms of adverse childhood experiences, but there were no further differences in sociodemographic, neurodevelopmental factors, and family factors. Regression analyses indicated that attachment-related avoidance and early onset of masturbation differentiated between men with HD and healthy controls. In conclusion, men with HD appear to have the same neurodevelopment, intelligence levels, sociodemographic background, and family factors compared to healthy controls, but they report different and adverse experiences in childhood, problematic sexual behavior, and psychological difficulties.