Hypersexuality

Hypersexuality means extremely frequent or suddenly increased sexual urges or sexual activity.

Although hypersexuality can sometimes be linked to medical conditions or medication, in many cases the exact cause is unclear. Mental health problems such as Bipolar disorder can be associated with it, and Alcohol or some drugs can lower inhibitions and push sexual behavior further than normal. Different models have been used to explain or treat hypersexuality. The one most often mentioned in popular media is the Sex addiction approach, but there is no real consensus. Other explanations focus on compulsive behavior or impulsive behavior.

The ICD system of the World Health Organization has included categories such as excessive sexual drive and excessive masturbation. Older medical language also divided excessive sexual drive into satyriasis for men and nymphomania for women. A proposed diagnosis called Hypersexual disorder was discussed for psychiatric classification, but it did not become a main official diagnosis.

The American Psychiatric Association rejected adding sexual addiction as an official psychiatric disorder in the DSM. Some writers have also questioned whether the whole idea of hypersexuality is too broad, arguing that calling sexual urges "extreme" can sometimes just reflect cultural discomfort with people who do not fit local norms.

Epidemiology

The real number of people who are hypersexual, or who think they are, is unknown. Estimates are often repeated, but the basis for them is not always clear. Figures often quoted are around 3 to 6 percent of the United States population.

A big problem is that definitions are relative. What looks excessive in one culture or peer group may not look unusual in another. Surveys of younger males have suggested that daily masturbation is not especially rare in some age groups. Older sex studies also reported a noticeable minority of men having orgasm through masturbation or sex on a daily basis or more.

Etiology

There is no agreement among experts on one single cause of hypersexuality. Some cases appear to be linked to biochemical or physiological changes, especially in people with dementia or other neurological problems. Injuries involving the temporal or frontal parts of the brain can affect behavior, impulse control, social judgment, and sexual conduct. In some people this can show up as aggressive behavior, personality change, or inappropriate sexual behavior.

Hormonal and developmental factors have also been discussed. In other cases the cause appears more psychological. Some people may be seeking intimacy, validation, stress relief, or escape, but that need gets expressed through repetitive sexual behavior instead. In dementia, a loss of self-esteem or cognitive decline may also play a role.

Overactivity in dopamine-related reward pathways has also been linked to hypersexual behavior. This can happen during Mania or as a side effect of certain medications, especially dopamine-related drugs. In some people this can lead to overindulgent or clearly out-of-control sexual behavior.

Models and labels

Sexologists have been describing cases of unusually intense sexual behavior since the late 1800s. In some cases it was treated as a symptom of another disease, such as Bipolar disorder or certain neurological syndromes. In other cases it was treated as the main problem itself.

There is still no agreement on the best way to describe hypersexuality when it appears as a primary problem. Some writers describe it as an addiction. Others see it as a compulsive disorder or an impulsivity disorder. Some reject the idea completely and say it is often just a moral or cultural judgment placed on strong sexual behavior.

Because of that, many different labels have been used, sometimes interchangeably. These include compulsive masturbation, compulsive sexual behavior, cybersex addiction, erotomania, excessive sexual drive, hyperphilia, hypersexuality, hypersexual disorder, problematic hypersexuality, sexual addiction, sexual compulsivity, sexual dependency, sexual impulsivity, out of control sexual behavior, and paraphilia-related disorder. Older terms include Don Juan, the Messalina complex, and nymphomania.

Addiction model of hypersexuality

The most commonly discussed model in public discussion is the addiction model. The basic idea is that some people experience sexual behavior the same way others experience alcohol or drug addiction, with repeated behavior, loss of control, compulsivity, and damage to daily life. This idea became especially popular through 12-step style self-help groups such as Sex Addicts Anonymous, Sexaholics Anonymous, Sex and Love Addicts Anonymous, and Sexual Compulsives Anonymous.

Compulsivity model of hypersexuality

Another explanation is the compulsivity model. In this view, the person is not mainly chasing pleasure but trying to reduce inner tension, anxiety, or distress. Sexual behavior becomes a ritual used to calm down or escape difficult emotions. The relief may be short-term, but the longer-term result can be more shame, more stress, and more repetition.

Impulsivity model of hypersexuality

A third model treats hypersexuality mainly as an impulsivity problem. In this version, the central issue is failing to resist urges, temptations, or drives. There is often tension before the behavior and pleasure, release, or gratification during it. This model focuses less on addiction language and more on poor impulse control.

Medical disorders and drugs causing hypersexuality

People with Bipolar disorder can show major swings in sex drive depending on mood. Hypersexuality can appear during hypomania or mania. Pick's disease and other degenerative brain conditions can also cause socially inappropriate sexual behavior.

Neurological conditions that have been linked to hypersexuality include Alzheimer's disease, brain injury, Klüver-Bucy syndrome, and Kleine-Levin syndrome. Hypersexuality has also been reported as a side effect of medication used for Parkinson's disease. Some street drugs, especially stimulants such as methamphetamine, may also increase hypersexual behavior.

In dementia, hypersexuality can develop through disinhibition, misreading social signals, boredom, persistence of old sexual habits after other behaviors fade, or side effects from medication. Some patients may also show it because of a confused or badly expressed need for intimacy.

Some patients with autism have also been described as showing hypersexual behavior, although there is no clear consensus on treatment or how broadly the label should be used.

Official diagnostic status

The DSM has included a category called Sexual Disorder Not Otherwise Specified, which could be used in some cases involving distressing repeated sexual relationships or patterns of sexual behavior that feel impersonal, compulsive, or out of control.

The ICD has included entries for excessive sexual drive and excessive masturbation. Hypersexual disorder was considered for newer psychiatric classification work, but it was not adopted as a standard official diagnosis.

Sexual addiction as a formal DSM diagnosis was also rejected, mainly because there was not enough evidence to prove it should be treated in the same category as substance addictions.

Treatment

There is no single treatment method accepted by everybody. Most clinicians who deal with hypersexuality use a mixed approach. This can include antidepressants such as SSRIs, motivational interviewing, and individual, group, or couples therapy. Cognitive-behavioral methods and relapse-prevention strategies are also commonly used, especially when the behavior is repetitive and damaging to work, relationships, or mental health.

Historical uses

Richard von Krafft-Ebing

Richard von Krafft-Ebing described extreme sexual behavior in his well known 1886 work Psychopathia Sexualis. He used the term hypersexuality in ways that do not always match modern usage, and some of what he described would today fall closer to conditions such as premature ejaculation.

Nymphomania in the Victorian age

In the Victorian period, mental institutions often classified nymphomania as a female mental illness. Women could be labeled mentally ill for sexual behavior outside accepted social norms, for being victims of sexual assault, for having children outside marriage, or for masturbating. Once placed in institutions, some women were subjected to invasive and abusive treatments including cold-water therapies, bloodletting, restricted diets, and even clitoridectomy.

See Also

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