Hypersexual Behavior Due to Premature Psychosexual Development: Clinical Examples

The article contains 3 clinical examples, which demonstrate possible appearance of hypersexuality, caused by premature psychosexual development. The first case (observed by the author) deals with a 13-year-old teenager, who was adopted at the age of 9. His birth mother (BM), who was deprived of parental rights, abused alcoholic beverages. BM had sexual intercourses with men, while her son was with her in the same bed. Besides approximately from the age of 6–7 years she sucked his penis. Soon after his adoption the boy climbed up on his lying adoptive mother (AM), with whom he lived together in one flat, and began pressing his lips to hers (“he lied like a male on a female”). Once, when they were visited by AM relatives and it was necessary to distribute, who would sleep with whom, a decision was made that the adopted son (AS) would sleep with a 7-year-old adopted grandson (AG) of AM. Then AS was 12 and he, as it was found out later, made an attempt to insert his erected penis into the anus of AG, but the latter managed to writhe himself free. At the same age of 12 he attempted a sexual intercourse with a native granddaughter of AM (a little girl), who told her grandmother about it. Then they found a significant amount of blood on her panties and genitals, and decided that he deflowered her. But as a result of forensic examination it was revealed that the blood on the granddaughter’s panties and genitals was not hers, but belonged to AS, whose attempt to insert his penis into her vagina resulted in a rupture of his penile frenulum, that made him stop any further sexual actions. AM informed that AS constantly peeped at her when she was naked or scantly dressed. He did the same with her granddaughter, after what she refused to visit them. Now, in order not “to be in the cross hairs”, AM takes a bath only after he leaves for school. As a result of his talk with AM and examination of AS the author has concluded that the patient has sexual disinhibition associated with his premature psychosexual development, the latter being caused by sexually molesting behaviour on the part of the child’s BM. The second and third cases (observations by other authors) also deal with hypersexual behaviour, caused by premature psychosexual development.

Response inhibition during processing of sexual stimuli in males with problematic hypersexual behavior

Background and aims Individuals with problematic hypersexual behavior (PHB) are unable to control their sexual cravings, regardless of other situational factors. This inability to control cravings is a common trait in patients with neurological pathologies related to response inhibition. Until recently, however, it was unclear whether individuals with PHB have decreased inhibition and altered neural responses in the brain regions associated with inhibition compared to healthy control individuals, especially in the presence of distracting sexual stimuli. In this study, we examined the neural and psychological underpinnings of inhibition in individuals with PHB. Methods Thirty individuals with PHB and 30 healthy subjects underwent functional magnetic resonance imaging while performing a modified go/no-go task with neutral or sexual backgrounds used as distractors. Results Individuals with PHB showed poorer response inhibition than healthy subjects, especially when sexual distractors were present. Further, compared to healthy control subjects, individuals with PHB showed decreased activation in the right inferior frontal gyrus (IFG) and reduced functional connectivity between the IFG and the pre-supplementary motor area (preSMA) when response inhibition was required. Finally, the reduced activation and connectivity were more pronounced in the presence of sexual distractors than in the presence of neutral distractors. Discussion These findings suggest that individuals with PHB show reduced ability to inhibit responses that might be related to lower IFG activation and IFG-preSMA connectivity during response inhibition. Our results provide insights into the neurobiological underpinnings of poor response inhibition in individuals with PHB.

Impulse Control Disorders in Dopamine Agonist-Treated Hyperprolactinemia: Prevalence and Risk Factors

Context There are growing reports of dopamine agonist (DA)-induced impulse control disorders (ICDs) in hyperprolactinemic patients. However, the magnitude of this risk and predictive factors remain uncertain. Objective To determine ICD prevalence and risk factors in DA-treated hyperprolactinemic patients compared to community controls. Design, Setting and Participants Multicenter cross-sectional analysis of 113 patients and 99 healthy controls. Main Outcome Measures Participants completed a neuropsychological questionnaire consisting of the Depression Anxiety Stress Scale (DASS21), Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease (QUIP-S), Hypersexual Behavior Inventory (HBI), Hypersexual Behavior Consequences Scale and Social Desirability Response Set Scale. Demographic and clinical data were collated to determine ICD risk factors. Patients testing positive for an ICD were offered a semistructured psychological interview. Results Patients were more likely than controls to test positive by QUIP-S for any ICD (61.1 vs 42.4%, P = .01), hypersexuality (22.1 vs 8.1%, P = .009), compulsive buying (15.9 vs 6.1%, P = .041) and punding (18.6 vs 6.1%, P = 0.012), and by HBI for hypersexuality (8.0 vs 0.0%, P = 0.004). Independent risk factors were male sex (odds ratio [OR] 13.85), eugonadism (OR 7.85), Hardy’s tumor score and psychiatric comorbidity (OR 6.86) for hypersexuality, and age (OR 0.95) for compulsive buying. DASS21 subset scores were higher in patients vs controls and in patients with vs without different ICDs. Only 19/51 (37.3%) interviewed patients were aware of the relationship between DAs and ICDs before the study. Conclusions DA therapy poses a high, previously underestimated risk of ICDs, especially in the form of hypersexuality in eugonadal men.