Hypersexuality disorder: In a world where sex can be easily found on the phone, television, and computer screens that dominate our lives, the line becomes blurrier for what is acceptable to society. People are more open to talking about sexual relations with each other, and sexual content is readily available on many movies and websites. However, when sexual behaviors create a negative quality of life for a person or to others, this is when the line has been crossed and psychotherapy and other treatments should be considered.

What is Hypersexuality Disorder?

There is still an ongoing debate on how to define hypersexuality disorder. Hypersexuality is not currently listed with formal criteria by the DSM-5-TR, which is a manual by the American Psychiatric Association that assesses and diagnoses mental disorders. It can most closely be defined as repetitive, continued, sexual behaviors that cause 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 event.

Clinical Features

One of the hallmarks for diagnosing Hypersexuality disorder is the continued participation in sexual activities despite the negative outcomes. Further, the disorder can be categorized by impulsive versus compulsive and addictive categories. In the compulsive category, sexual acts are continued as a way of dealing with life stressors and become the primary way of coping which evolves into a different negative cycle. Compulsive behavior can be differentiated between paraphilic and non-paraphilic categories.

Paraphilic behaviors refer to behaviors that are considered to be outside of the conventional range of sexual behaviors, such as pedophilia, sexual sadism, sexual masochism, etc.

Non-paraphilic behaviors represent engagement in commonly available sexual practices, such as attending strip clubs, compulsive masturbation, paying for sex through prostitution, excessive use of pornography, and repeated engagement in extramarital affairs.

Causes of Hypersexuality Disorder

There is not a definitive cause of hypersexuality disorder, just like there is not a definite cause for anxiety, depression, and many other mental illnesses. Similarly, they 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 sex addicts are partially engaging in these behaviors for the euphoric physical sensations, the act provides an escape to the patient’s unpleasant thoughts or emotions, which is similar to drug addiction. Higher levels of androgenic, or male hormones, can play a role since these hormones can dictate a person’s libido. Genetics is a strong influence, as addictive tendencies and personalities can be passed down.

In addition, imbalances in the neurotransmitters, serotonin, dopamine, and norepinephrine, have been proposed but mainly as a conclusion of decreased sexual urges on selective serotonin reuptake inhibitor medications. Cases of hypersexual behavior have also been shown to be induced by medications for Parkinson’s disease, implicating dopamine systems in compulsive sexual behaviors

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 present in states of hypersexuality 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 sexual behaviors return to normalcy in terms of frequency and intensity.

Most commonly, hypersexuality can be concomitant with other mental disorders such as mania, bipolar disease; where hypersexuality is considered a symptom of their mental disorder. Hypersexuality can be a key symptom found in Bipolar I manic state. If the clinician is able to detect an increase in hypersexual activities, one may be able to appropriately treat the patient for their manic state in a swifter fashion.

There is much more research that needs to be conducted solely focusing on hypersexuality disorder as its own entity instead of a byproduct of another disease. If the DSM-5-TR defines sexuality disorder as its own disease, then there would be better guidelines for clinicians to diagnose. Until then, there will be a lack of information or research for its definition, causes, and ultimately treatment. It is important for clinicians to begin to include and expand on the sexual state of activities in the intake of a patient’s history of presenting illness, in order to potentially diagnose and treat the correct disorder appropriately.