Hypersexuality
Encyclopedia
Hypersexuality is extremely frequent or suddenly increased sexual urges or sexual activity. Hypersexuality is typically associated with lowered sexual inhibition
Sexual inhibition
A sexual inhibition is a conscious or unconscious constraint or curtailment by a person of behaviour relating to specific sexual matters or practices or of a discussion of sexual matters....

s. Although hypersexuality can be caused by some medical conditions or medications, in most cases the cause is unknown. Medical conditions such as bipolar disorder
Bipolar disorder
Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...

s can give rise to hypersexuality, and alcohol
Alcohol
In chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....

 and some drugs can affect social and sexual inhibitions in some people. A number of theoretical models have been used to explain or treat hypersexuality. The most common one, especially in the popular media, is the sexual addiction
Sexual addiction
Sexual addiction is a popular model to explain hypersexuality—sexual urges, behaviors, or thoughts that appear extreme in frequency or feel out of one's control...

 approach, but sexologists have not reached any consensus. Alternative explanations for the condition include compulsive
Compulsive behavior
Compulsive behavior is behavior which a person does compulsively—in other words, not because they want to behave that way, but because they feel they have to do so....

 and impulsive
Impulsivity
Impulsivity is a personality trait characterized by the inclination of an individual to initiate behavior without adequate forethought as to the consequences of their actions, acting on the spur of the moment. Eysenck and Eysenck related impulsivity to risk-taking, lack of planning, and making up...

 behavioral models.

The International Classification of Diseases (ICD-10) of the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 includes “Excessive Sexual Drive” (coded F52.8), which is divided into satyriasis for males and nymphomania for females, and “Excessive Masturbation” (coded F98.8).

The American Psychiatric Association
American Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...

 (APA) rejected a proposal to add sexual addiction
Sexual addiction
Sexual addiction is a popular model to explain hypersexuality—sexual urges, behaviors, or thoughts that appear extreme in frequency or feel out of one's control...

 to its official list of psychiatric disorders, the Diagnostic and Statistical Manual of Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

 (DSM). A proposal to include Hypersexual Disorder
Hypersexual disorder
Hypersexual disorder was proposed in 2010 for inclusion in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association . It is currently under consideration for inclusion in the appendix of the DSM, but not in the main list of official diagnoses...

, which is not Hypersexuality, simply describes the symptom without implying any specific theory, is under consideration for inclusion in the appendix of the DSM, but not in the main list of official diagnoses.

Some authors have questioned whether it makes sense to discuss hypersexuality at all, arguing that extreme sexual urges merely stigmatize persons who do not conform to the norms of their culture or peer group.

Epidemiology

The number of people who are hypersexual, or believe that they are hypersexual, is unknown. Although several estimates have been published, it is not clear on what basis they were made. The estimates asserted are usually 3–6%.

Many proposed definitions of hypersexuality are relative to cultural or peer group norms. Surveys of "convenience samples" suggest that 3–5% of high school or college age males masturbate on a daily basis. In the Kinsey studies
Kinsey Reports
The Kinsey Reports are two books on human sexual behavior, Sexual Behavior in the Human Male and Sexual Behavior in the Human Female , by Dr. Alfred Kinsey, Wardell Pomeroy and others and published by Saunders...

, 7.6% of males engaged in some sexual behavior leading to orgasm (masturbation, sexual intercourse, oral sex, etc.) on a daily basis or more. In the Laumann study (a large-scale representative survey of sexual behavior), 1.9% of men ages 18–59 masturbated daily, and 1.2% masturbated more than once per day.

Possible Causes

Research has shown that the behavior of some cases to be linked to biochemical or physiological changes that accompany dementia. Psychological needs also complicate the biological explanation, which identifies the temporal/frontal lobe of the brain as the area for regulating libido. Persons suffering from injuries to this part of the brain often are accounted for aggressive behavior and other behavioral problems including personality changes and socially inappropriate sexual behavior such as hypersexuality.

Models and labels

Sexologists have been describing cases of hypersexuality since the late 1800s. In some cases, the hypersexuality was a symptom of another medical disease, such as Klüver-Bucy syndrome
Klüver-Bucy syndrome
Klüver-Bucy syndrome is a behavioral disorder that occurs when both the right and left medial temporal lobes of the brain malfunction. The amygdala has been a particularly implicated brain region in the pathogenesis of this syndrome. The syndrome is named for Heinrich Klüver and Paul...

 or bipolar disorder
Bipolar disorder
Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...

, or the side effect of a medication, such as the drugs used to treat Parkinson's disease
Parkinson's disease
Parkinson's disease is a degenerative disorder of the central nervous system...

. In other cases, the hypersexuality was reported to be the primary problem.

Sexologists have not reached a consensus over how best to describe when hypersexuality is the primary problem. Some researchers assert that such situations represent a literal addiction; other researchers assert that such situations represent a type of obsessive-compulsive disorder
Obsessive-compulsive disorder
Obsessive–compulsive disorder is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry, by repetitive behaviors aimed at reducing the associated anxiety, or by a combination of such obsessions and compulsions...

 (OCD) or “OCD-spectrum disorder”; and other researchers assert that it is a disorder of impulsivity. Moreover, some authors assert that there is no such thing as hypersexuality at all and that the condition merely reflects a cultural dislike of exceptional sexual behavior.

Consistent with there not being any consensus over what causes hypersexuality, authors have used many different labels to refer to it, sometimes interchangeably, but often depending on which theory they favor or which specific behavior they were studying. Contemporary names include compulsive masturbation, compulsive sexual behavior, cybersex addiction, erotomania
Erotomania
Erotomania is a type of delusion in which the affected person believes that another person, usually a stranger or famous person, is in love with him or her. The illness often occurs during psychosis, especially in patients with schizophrenia or bipolar mania...

, “excessive sexual drive”, hyperphilia, hypersexuality, hypersexual disorder, problematic hypersexuality, sexual addiction, sexual compulsivity, sexual dependency, sexual impulsivity, “out of control sexual behavior”, and paraphilia
Paraphilia
Paraphilia is a biomedical term used to describe sexual arousal to objects, situations, or individuals that are not part of normative stimulation and that may cause distress or serious problems for the paraphiliac or persons associated with him or her...

-related disorder. Other, mostly historical, names include Don Juanism
Don Juanism
Don Juanism is a non-clinical term for the desire, in a man, to have sex with many different female partners; that is: a "seducer of women."The name derives from Don Juan of opera and fiction, who seems in turn to have been patterned after the Spanish noble Don Juan Tenorio. The term satyriasis is...

, the Messalina
Messalina
Valeria Messalina, sometimes spelled Messallina, was a Roman empress as the third wife of the Emperor Claudius. She was also a paternal cousin of the Emperor Nero, second cousin of the Emperor Caligula, and great-grandniece of the Emperor Augustus...

 complex, nymphomania, and satyriasis.

Addiction model of hypersexuality

The most commonly discussed way of understanding hypersexuality is with an addiction model. The concept of hypersexuality as an addiction was started in the 1970s by former members of Alcoholics Anonymous
Alcoholics Anonymous
Alcoholics Anonymous is an international mutual aid movement which says its "primary purpose is to stay sober and help other alcoholics achieve sobriety." Now claiming more than 2 million members, AA was founded in 1935 by Bill Wilson and Dr. Bob Smith in Akron, Ohio...

 who believed that their sexual behaviors meant the same thing as their alcohol use. Multiple 12-step style self-help groups now exist for people who identify as sex addicts, including Sex Addicts Anonymous
Sex Addicts Anonymous
Sex Addicts Anonymous is an organization that describes itself as providing a twelve-step program for recovery from what it calls sex addiction. SAA was founded in 1977 by several men who wanted a greater sense of anonymity than what they perceived in other twelve step programs for sex addicts...

, Sexaholics Anonymous
Sexaholics Anonymous
Sexaholics Anonymous is one of several twelve-step programs for hypersexuality based on the original Twelve Steps of Alcoholics Anonymous. SA takes its place among various 12-step groups that seek recovery from sexual addiction: Sex Addicts Anonymous, Sex and Love Addicts Anonymous, Sexual...

, Sex and Love Addicts Anonymous
Sex and Love Addicts Anonymous
Sex and Love Addicts Anonymous is a twelve-step program for people recovering from what they call sex addiction and love addiction. SLAA was founded in Boston, Massachusetts in 1976, by a member of Alcoholics Anonymous . Though he had been a member of AA for many years, he repeatedly acted out and...

, and Sexual Compulsives Anonymous
Sexual Compulsives Anonymous
Sexual Compulsives Anonymous is an organization that describes itself as providing a twelve-step program for recovery from what it terms sexual compulsion. SCA's founding is attributed variously to 1982 in New York City and to 1973 in Los Angeles...

.

Compulsivity model of hypersexuality

Compulsions
Compulsive behavior
Compulsive behavior is behavior which a person does compulsively—in other words, not because they want to behave that way, but because they feel they have to do so....

 are behaviors a person performs in order to reduce feelings of anxiety or tension. According to this explanation of hypersexuality, persons engage in whatever sexual behavior in order to reduce feelings of tension, instead of to express sexual desire. Because engaging in the behavior can worsen the situation causing the tension, the person experiences a longer-term increase in tension, despite the shorter-term relief, resulting in a self-perpetuating cycle.

Impulsivity model of hypersexuality

Barth and Kinder (1987) argued against classifying hypersexuality as an addiction or as a compulsion, arguing instead for classifying it as an impulsivity
Impulsivity
Impulsivity is a personality trait characterized by the inclination of an individual to initiate behavior without adequate forethought as to the consequences of their actions, acting on the spur of the moment. Eysenck and Eysenck related impulsivity to risk-taking, lack of planning, and making up...

 problem. They argued that an addiction entails a substance and withdrawal states, whereas sexual behavior has neither, and that compulsive behaviors exclude intrinsically enjoyable activities, whereas sexual behavior is intrinsically enjoyable. Hypersexuality does, however, contain the essential elements of an impulsivity problem: (1) It pertains to the failure to resist an impulse, drive, or temptation. (2) There is an increasing sense of tension before the behavior. (3) There is an experience of either pleasure, gratification, or release at the time of committing the behavior.

Medical disorders and drugs causing hypersexuality

People who suffer from bipolar disorder
Bipolar disorder
Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...

 may often display tremendous swings in sex drive depending on their mood. As defined in the DSM-IV-TR, hypersexuality can be a symptom of hypomania
Hypomania
Hypomania is a mood state characterized by persistent and pervasive elevated or irritable mood, as well as thoughts and behaviors that are consistent with such a mood state...

 or mania
Mania
Mania, the presence of which is a criterion for certain psychiatric diagnoses, is a state of abnormally elevated or irritable mood, arousal, and/ or energy levels. In a sense, it is the opposite of depression...

 in bipolar disorder
Bipolar disorder
Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...

 or schizoaffective disorder
Schizoaffective disorder
Schizoaffective disorder is a psychiatric diagnosis that describes a mental disorder characterized by recurring episodes of elevated or depressed mood, or of simultaneously elevated and depressed mood, that alternate with, or occur together with, distortions in perception.Schizoaffective disorder...

. Pick’s Disease cause damage to the temporal/frontal lobe of the brain. People suffering with Pick’s disease show a range of these socially inappropriate behaviors

Several neurological conditions such as Alzheimer's disease
Alzheimer's disease
Alzheimer's disease also known in medical literature as Alzheimer disease is the most common form of dementia. There is no cure for the disease, which worsens as it progresses, and eventually leads to death...

, various types of brain injury, Klüver-Bucy syndrome
Klüver-Bucy syndrome
Klüver-Bucy syndrome is a behavioral disorder that occurs when both the right and left medial temporal lobes of the brain malfunction. The amygdala has been a particularly implicated brain region in the pathogenesis of this syndrome. The syndrome is named for Heinrich Klüver and Paul...

, Kleine-Levin syndrome
Kleine-Levin syndrome
Kleine-Levin Syndrome or KLS is aneurological disorder characterized by recurring periods of excessive amounts of sleeping and eating. At the onset of an episode the patient becomes drowsy and sleeps for most of the day and night , waking only to eat or go to the bathroom...

, and many more neuro-degenerative diseases can cause hypersexual behavior. Hypersexuality has also been reported to result as a side-effect of some medications used to treat Parkinson's disease
Parkinson's disease
Parkinson's disease is a degenerative disorder of the central nervous system...

. Some street drugs, such as methamphetamine
Methamphetamine
Methamphetamine is a psychostimulant of the phenethylamine and amphetamine class of psychoactive drugs...

, may also contribute to hypersexual behavior.

Hypersexuality can be caused by dementia in a number of ways, including disinhibition
Disinhibition
Disinhibition is a term in psychology used to describe a lack of restraint manifested in several ways, including disregard for social conventions, impulsivity, and poor risk assessment. Disinhibition affects motor, instinctual, emotional, cognitive and perceptual aspects with signs and symptoms...

 due to organic disease, misreading of social cues, understimulation, the persistence of learned sexual behaviour after other behaviours have been lost, and the side-effects of the drugs used to treat dementia.

Other possible causes of dementia-related hypersexuality include an inappropriately expressed psychological need for intimacy and forgetfulness of the recent past.

Some patients with autism also exhibit hypersexuality. A variety of treatments have been tried for hypersexuality in autistic patients, with no clear consensus as to their applicability.

Official diagnostic status

The Diagnostic and Statistical Manual of Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

 (DSM) of the American Psychiatric Association
American Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...

 (APA) includes an entry called Sexual Disorder Not Otherwise Specified (Sexual Disorder NOS) to apply to, among other conditions, “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.” A proposal to add Hypersexual Disorder
Hypersexual disorder
Hypersexual disorder was proposed in 2010 for inclusion in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association . It is currently under consideration for inclusion in the appendix of the DSM, but not in the main list of official diagnoses...

to the appendix (but not the main list of official diagnoses) of the DSM is currently under consideration by the APA.

The International Statistical Classification of Diseases and Related Health Problems (ICD-10) of the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 (WHO), includes two relevant entries: One is “Excessive Sexual Drive” (coded F52.8), which is divided into satyriasis for males and nymphomania for females. The other is “Excessive Masturbation” or “Onanism (excessive)” (coded F98.8).

A proposal to add Sexual Addiction
Sexual addiction
Sexual addiction is a popular model to explain hypersexuality—sexual urges, behaviors, or thoughts that appear extreme in frequency or feel out of one's control...

to the DSM system has been rejected by the APA, as not enough evidence suggested to them that the condition is analogous to substance addictions, as that name would imply.

Treatment

There does not yet exist any treatment approach uniformly endorsed by experts and/or community groups. Most clinical authors recommend a multifaceted or multimodal approach that includes a variety of treatments, including certain classes of anti-depressants (selective serotonin reuptake inhibitor
Selective serotonin reuptake inhibitor
Selective serotonin re-uptake inhibitors or serotonin-specific reuptake inhibitor are a class of compounds typically used as antidepressants in the treatment of depression, anxiety disorders, and some personality disorders. The efficacy of SSRIs is disputed...

s, or SSRIs) that reduce sex drive in some people, motivational interviewing, and individual, group, or couples' therapy (including cognitive-behavioral, psychodynamic, and relapse-prevention).

Richard von Krafft-Ebing

Krafft-Ebing described several cases of extreme sexual behaviours in his seminal 1886 book, Psychopathia Sexualis. Although he also used the term "hypersexuality" in that book, he was describing conditions that would now be called premature ejaculation
Premature ejaculation
Premature ejaculation is a condition in which a man ejaculates earlier than he or his partner would like him to. Premature ejaculation is also known as rapid ejaculation, rapid climax, premature climax, or early ejaculation....

.

Nymphomania in the Victorian age

Many Victorian era
Victorian era
The Victorian era of British history was the period of Queen Victoria's reign from 20 June 1837 until her death on 22 January 1901. It was a long period of peace, prosperity, refined sensibilities and national self-confidence...

 mental institutions treated nymphomania as an exclusively female mental illness. Women were classified as mentally ill for nymphomania if they were a victim of sexual assault, bore illegitimate children, "abused themselves" (i.e. masturbated), or were deemed promiscuous. Upon arrival at the asylum, doctors would give the woman a pelvic exam. If doctors felt that the woman had an enlarged clitoris, she would undergo treatments. These treatments included induced vomiting, bloodletting, leeches, restricted diet, douches to the head or breasts, and, at times, clitoridectomies
Clitoridectomy
Clitoridectomy is the surgical removal of the clitoris. It is rarely needed as a therapeutic medical procedure, such as when cancer has developed in or spread to the clitoris...

.

See also

  • Compulsive masturbation
  • Persistent sexual arousal syndrome
    Persistent sexual arousal syndrome
    Persistent Genital Arousal Disorder , originally called Persistent Sexual Arousal Syndrome and also known as Restless Genital Syndrome or Mempin Syndrome , results in a spontaneous, persistent, and uncontrollable genital arousal, with or without orgasm or genital engorgement, unrelated to any...

  • Pornography addiction
    Pornography addiction
    Pornography addiction, or more broadly overuse of pornography, is excessive pornography use that interferes with daily life.There is no diagnosis of pornography addiction in the current Diagnostic and Statistical Manual of Mental Disorders , and as with the broader proposed diagnosis of sexual...

  • Sexual obsessions
    Sexual obsessions
    Sexual obsessions are obsessions with sex, and in the context of obsessive-compulsive disorder these are extremely common . It can become extremely debilitating, making the sufferer ashamed of the symptoms and reluctant to seek help. Preoccupation with sexual matters, however, does not only occur...

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