What is Hypersexuality Disorder?
Hypersexuality Disorder, also known as Compulsive Sexual Behavior Disorder (CSBD), is characterized by repetitive, persistent, intense, and uncontrollable sexual thoughts, urges, or behaviors that often interfere with daily functioning, relationships, and well-being and cause significant clinical distress and impairment. Another defining feature includes multiple, unsuccessful attempts to control or diminish the amount of time an individual engages in sexual fantasies, urges, and behavior in response to dysphoric mood states or stressful life events. Although Hypersexuality Disorder is not formally recognized as a distinct disorder in the DSM-5-TR, it is increasingly discussed in both clinical and research settings as a problematic condition. In 2019, the World Health Organization added the novel diagnosis, CSBD, to the International Classification of Diseases – 11th edition (ICD-11).
What are the Key Features of Hypersexuality Disorder?
- Excessive Preoccupation with Sexual Thoughts: Individuals often experience an overwhelming focus on sexual fantasies, desires, or behaviors, consuming a significant portion of their time and attention.
- Lack of Control: Individuals may attempt to stop or reduce their sexual activity but find themselves unable to do so. They may engage in sexual behaviors even when it leads to negative consequences, such as harm to relationships, work performance, or emotional well-being.
- Escalation of Sexual Activities: The frequency or intensity of sexual behaviors may increase over time and involve seeking riskier or more frequent sexual encounters.
- Interference with Daily Life: The compulsive nature of these sexual behaviors often interferes with personal, social, and professional life. For example, individuals may neglect responsibilities or engage in risky sexual behaviors that lead to health or legal issues.
- Feelings of Guilt or Shame: Individuals with hypersexuality often feel guilt, shame, or distress about their behaviors, which can lead to emotional turmoil and further isolation.
What are the Causes and Risk Factors?
Similar to other mental health conditions, hypersexuality disorder does not have a definitive cause. Individuals are usually heavily influenced by the environment and/or childhood trauma. Since hypersexuality disorder can be categorized as an addiction disorder, some of the etiology may be similar.
Although individuals who are addicted to sex partially engage in these behaviors for the euphoric physical sensations, the act provides an escape to their unpleasant thoughts or emotions, which is similar to drug addiction. Higher levels of androgenic, or male hormones, can play a role since these hormones influence libido. Genetics may also play a role in hypersexuality disorder, as addictive tendencies and personalities can be passed down.
- Psychological factors: Some individuals may use sex as a coping mechanism for stress, anxiety, depression, or trauma.
- Neurological factors: Hypersexuality may be linked to changes in brain chemistry, particularly in regions associated with impulse control, reward systems, and decision-making.
- Co-occurring disorders: Hypersexuality disorder often coexists with other mental health conditions, such as substance use disorders, mood disorders, or personality disorders.
How is Hypersexuality Disorder Treated?
Treatment for hypersexuality typically involves a combination of therapeutic approaches, including:
- Cognitive Behavioral Therapy (CBT): CBT helps individuals identify and modify unhealthy thought patterns and behaviors.
- Psychotherapy: Talk therapy, particularly when addressing underlying trauma or emotional difficulties, can be effective in managing the disorder.
- Support Groups: Programs like Sex Addicts Anonymous (SAA) offer peer support for individuals struggling with compulsive sexual behaviors.
- Medication: In some cases, medications such as antidepressants or mood stabilizers may be prescribed to help regulate mood and reduce impulsivity.
Hypersexuality Disorder, or CSBD, is a condition marked by an inability to control sexual impulses, often leading to significant personal and social distress. Proper diagnosis and treatment are essential for helping individuals regain control over their behaviors and improve their quality of life.
Understanding the nuances and challenges surrounding hypersexuality can help reduce stigma and encourage those affected to seek help.
Concomitant Disorders
Kleine-Levin syndrome is a rare disease with hypersexuality as one of its hallmark symptoms. Approximately half of males and one-third of females have hypersexuality during at least one episode.
Hypersexuality can also be induced by substances of abuse, mania, medications (e.g., dopamine agonists), or even other medical conditions (e.g., frontal-lobe tumors). However, once those primary conditions are treated, the individual’s sexual behaviors return to their normal frequency and intensity.
Most commonly, hypersexuality is a symptom of other mental disorders. In individuals with Bipolar I disorder, hypersexuality can be a key symptom in the manic state. If the clinician is able to detect an increase in hypersexual activities, one may be able to appropriately treat the individual for their manic state in a swifter fashion.
More research needs to be conducted focusing solely on hypersexuality disorder as its own entity instead of a byproduct of another disease. Clear guidelines, such as those in the World Health Organization’s ICD-11 for CSBD, are needed to assist clinicians with appropriate diagnosis of Hypersexuality Disorder. Until then, there is a lack of information or research for its definition, causes, and treatment. It is important for clinicians to include and expand on an individual’s history of sexual activities during their initial visit in order to potentially diagnose and treat the disorder appropriately.
Resources
American Psychiatric Association. (n.d.). DSM–5: Frequently Asked Questions. Retrieved from:
American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed, text revision). American Psychiatric Publishing, Inc. https://doi.org/10.1176/appi.books.9780890425596.
Reid R. C. (2015). How should severity be determined for the DSM-5 proposed classification of Hypersexual Disorder?. Journal of behavioral addictions, 4(4), 221–225. https://doi.org/10.1556/2006.4.2015.041
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712755/
Codling, D., Shaw, P., & David, A. S. (2015). Hypersexuality in Parkinson’s Disease: Systematic Review and Report of 7 New Cases. Movement disorders clinical practice, 2(2), 116–126. https://doi.org/10.1002/mdc3.12155 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6183311/
Fong T. W. (2006). Understanding and managing compulsive sexual behaviors. Psychiatry (Edgmont (Pa. : Township)), 3(11), 51–58. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945841/
Derbyshire, K. L., & Grant, J. E. (2015). Compulsive sexual behavior: a review of the literature. Journal of behavioral addictions, 4(2), 37–43. https://doi.org/10.1556/2006.4.2015.003 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500883/
Aran, A., Mignot, E., Arnulf, I., & Chervin, R. D. (2019). Kleine-Levin syndrome (recurrent hypersomnia). Retrieved from:
Marchetti I. (2023). The Structure of Compulsive Sexual Behavior: A Network Analysis Study. Archives of sexual behavior, 52(3), 1271–1284. https://doi.org/10.1007/s10508-023-02549-y
Grubbs, J. B., Reid, R. C., Böthe, B., Demetrovics, Z., Coleman, E., Gleason, N., Miner, M. H., Fuss, J., Klein, V., Lewczuk, K., & Gola, M. (2023). Assessing compulsive sexual behavior disorder: The development and international validation of the compulsive sexual behavior disorder-diagnostic inventory (CSBD-DI). Journal of Behavioral Addictions, 12(1), 242–260. https://doi.org/10.1556/2006.2023.00005
Beth A. Pratt earned a Doctor of Philosophy in nursing and Master of Science in nursing education from Florida Atlantic University, a Master of Science in forensic science from Florida International University, a Bachelor of Science in nursing from Johns Hopkins University, a Bachelor of Arts in biology from St. Olaf College and a Second Major in Spanish from St. Catherine University. Dr. Pratt began her career in labor and delivery and had the opportunity to nurse in other areas, including public health, infertility, antepartum home health, and nursing education. Dr. Pratt is passionate about holistic health and conducts research on complementary interventions to enhance wellness.
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