Hypersexuality ("Sex Addiction")

Hypersexual disorder is a proposed diagnosis for people who engage in sex or think about sex through fantasies and urges more than normal. These individuals may engage in activities such as porn, masturbation, sex for pay, and multiple partners, among others. As a result, these people may feel distress in areas of life including work and relationships

The existence of "sex addiction" is under heated debate. However, in a controversial decision, compulsive sexual behavior disorder was added to the World Health Organization's International Classification of Diseases. Some researchers see this tendency as a problem of regulating behavior, while other experts wonder whether this behavior derives from a higher sex drive or if it stems from impulse control problems. Because of such disagreement over the validity of this behavior, the number of those affected is also under scrutiny—some say it is 3 percent to 10 percent of adults.

Other experts believe that the real causes of the behavior include emotional states, namely anxiety, depression, or relationship conflict. For some individuals, shame and morality may also be involved. Whether the condition exists or not, psychotherapy may be useful for individuals seeking to regulate emotions and gain insight into their sexuality.

Hypersexuality is not included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. It was previously listed in the DSM-4 as a Sexual Disorder, Not Otherwise Specified with the definition "distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used."

The 2010 proposal for the addition of hypersexual disorder into the DSM-5 included the criteria of uncontrollable sexual behavior. Supporters of the behavior's inclusion argued that people who engage in this excessiveness suffer from great distress. In the proposed criteria, hypersexual disorder was conceived as a nonparaphilic sexual desire disorder with an impulsivity component.

The proposed diagnosis was not added to the DSM-5. Experts note that there isn’t enough empirical evidence to support the diagnosis. Many do not view it as an addiction and believe it has no similarities to other addictions. 

Symptoms

It is important to note that sexual behavior is a normal, healthy part of life and many people enjoy being active with multiple sexual partners or seeking out many different kinds of sexual experiences. Hypersexuality becomes problematic when it causes significant distress to an individual, or puts them at risk of harming themselves or someone else.

While the behavior was not included in the DSM-5, the following criteria may be a way of identifying hypersexuality. For a period of at least six months:

  • Have recurrent, intense sexual fantasies, urges, and/or behaviors
  • The behaviors consistently interfere with other activities and obligations
  • Behaviors occur in response to dysphoric mood states (anxiety, depression, boredom, irritability) or stressful life events
  • Engage in consistent but unsuccessful efforts to control or reduce sexual fantasies, urges, or behaviors
  • Engage in sexual behaviors while disregarding the potential for physical or emotional harm to self or others
  • The frequency or intensity of sexual fantasies, urges, or behaviors cause significant distress or impairment

As mentioned, hypersexuality may also be linked to depression and anxiety. Some individuals may avoid difficult emotions, such as sadness or shame, and seek temporary relief by engaging in sexual behavior. Sexual cravings, therefore, can mask other issues such as depression, anxiety, and stress.

Causes

The causes of hypersexual behavior are not well understood. Some children or adolescents may engage in increased or developmentally inappropriate sexual behavior as a result of traumatic experiences, stressors, or mental illness. While there is no standard definition of hypersexuality in children, it is known that sexually abused children may display increased sexual behaviors and high-risk sexual behavior is associated with socio-demographic factors such as family dysfunction and social stress.

It's also important to consider the role culture plays in the concept of hypersexuality. Cultures that view sexuality in a more positive light may have values that don't judge sexual behavior as being "excessive."

Treatment

Sexual addiction and hypersexual disorder are not included in the DSM-5, but if a person engages in sexual behaviors that causes distress, specialized counseling is available.

Treatment may involve the following:

  • Rebuilding relationships
  • Managing stress
  • Identifying triggers for sexual thoughts or compulsive sexual behaviors
  • Finding alternative behaviors that are less destructive

Find a Treatment Program here.

References

  • Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
  • Adelson, S., Bell, R., Graff, A., Goldenberg, D., Haase, E., Downey, J. I., & Friedman, R. C. (2012). Toward a definition of “hypersexuality” in children and adolescents. Psychodynamic psychiatry, 40(3), 481-503.
  • American Psychiatric Association, Diagnostic and Statistical Manual, Fifth Edition, Revised
  • Kafka, M. P. (2010). Hypersexual disorder: A proposed diagnosis for DSM-V. Archives of sexual behavior, 39(2), 377-400.
  • Reid, R. C., Carpenter, B. N., Hook, J. N., Garos, S., Manning, J. C., Gilliland, R., ... & Fong, T. (2012). Report of findings in a DSM‐5 field trial for hypersexual disorder. The journal of sexual medicine, 9(11), 2868-2877.  
  • Schultz, K., Hook, J. N., Davis, D. E., Penberthy, J. K., & Reid, R. C. (2014). Nonparaphilic hypersexual behavior and depressive symptoms: a meta-analytic review of the literature. Journal of sex & marital therapy, 40(6), 477-487.

Last reviewed 02/07/2019