Hypersexuality

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Hypersexuality
Specialty Psychiatry

Hypersexuality is extremely frequent or suddenly increased libido. It is currently controversial whether it should be included as a clinical diagnosis [1] used by mental healthcare professionals. Nymphomania and Satyriasis were terms previously used for the condition in women and men, respectively.

Contents

Hypersexuality may be a primary condition, or the symptom of another medical disease or condition; for example, Klüver-Bucy syndrome or bipolar disorder. Hypersexuality may also present as a side effect of medication such as drugs used to treat Parkinson's disease. Clinicians have yet to reach a consensus over how best to describe hypersexuality as a primary condition, [2] [3] [4] or to determine the appropriateness of describing such behaviors and impulses as a separate pathology.

Hypersexual behaviours are viewed variously by clinicians and therapists as a type of obsessive-compulsive disorder (OCD) or "OCD-spectrum disorder", an addiction, [5] [6] [7] or a disorder of impulsivity. A number of authors do not acknowledge such a pathology [8] and instead assert that the condition merely reflects a cultural dislike of exceptional sexual behavior. [9] [10]

Consistent with there not being any consensus over what causes hypersexuality, [11] 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, [12] [13] cybersex addiction, erotomania, "excessive sexual drive", [14] hyperphilia, [15] hypersexuality, [16] [17] hypersexual disorder, [18] problematic hypersexuality, [19] sexual addiction, sexual compulsivity, [20] sexual dependency, [10] sexual impulsivity, [21] "out of control sexual behavior", [22] and paraphilia-related disorder. [23] [24] [25]

Causes

There is little consensus among experts as to the causes of hypersexuality. Some research suggests that some cases can 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 are at increased risk for aggressive behavior and other behavioral problems including personality changes and socially inappropriate sexual behavior such as hypersexuality. [26] The same symptom can occur after unilateral temporal lobotomy. [27] There are other biological factors that are associated with hypersexuality such as premenstrual changes, and the exposure to virilising hormones in childhood or in utero. [28]

In research involving the use of antiandrogens to reduce undesirable sexual behaviour such as hypersexuality, testosterone has been found to be necessary, but not sufficient, for sexual drive. [28] Other proposed factors include a lack of physical closeness and forgetfulness of the recent past. [29]

Pathogenic overactivity of the dopaminergic mesolimbic pathway in the brain—forming either psychiatrically, during mania, [30] or pharmacologically, as a side effect of dopamine agonists, specifically D3-preferring agonists [31] [32] —is associated with various addictions [33] [34] and has been shown to result among some in overindulgent, sometimes hypersexual, behavior. [30] [31] [32] HPA axis dysregulation has been associated with hypersexual disorder. [35]

The American Association for Sex Addiction Therapy acknowledges biological factors as contributing causes of sex addiction. Other associated factors include psychological components (which affect mood and motivation as well as psychomotor and cognitive functions [36] ), spiritual control, mood disorders, sexual trauma, and intimacy anorexia as causes or type of sex addiction. [37]

As a symptom

Hypersexuality is known to present itself as a symptom in connection to a number of mental and neurological disorders. Some people with borderline personality disorder (sometimes referred to as BPD) can be markedly impulsive, seductive, and extremely sexual. Sexual promiscuity, sexual obsessions, and hypersexuality are very common symptoms for both men and women with BPD. On occasion for some there can be extreme forms of paraphilic drives and desires. "Borderline" patients, due in the opinion of some to the use of splitting, experience love and sexuality in unstable ways. [38]

People with bipolar disorder 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 or mania in bipolar disorder or schizoaffective disorder. Pick's disease causes damage to the temporal/frontal lobe of the brain; people with Pick's disease show a range of socially inappropriate behaviors. [39]

Several neurological conditions such as Alzheimer's disease, autism, [40] [41] various types of brain injury, [42] Klüver–Bucy syndrome, [43] Kleine–Levin syndrome, [44] and many more neurodegenerative diseases can cause hypersexual behavior. Sexually inappropriate behavior has been shown to occur in 7–8% of Alzheimer's patients living at home, at a care facility or in a hospital setting. Hypersexuality has also been reported to result as a side-effect of some medications used to treat Parkinson's disease. [45] [46] Some street drugs, such as methamphetamine, may also contribute to hypersexual behavior. [47]

A positive link between the severity of dementia and occurrence of inappropriate behavior has also been found. [48] Hypersexuality can be caused by dementia in a number of ways, including disinhibition 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. [49] Other possible causes of dementia-related hypersexuality include an inappropriately expressed psychological need for intimacy and forgetfulness of the recent past. [50] As this illness progresses, increasing hypersexuality has been theorized to sometimes compensate for declining self-esteem and cognitive function. [29]

Symptoms of hypersexuality are also similar to those of sexual addiction in that they embody similar traits. These symptoms include the inability to be intimate (intimacy anorexia), depression and bipolar disorders. [51] The resulting hypersexuality may have an impact in the person's social and occupational domains if the underlying symptoms have a large enough systemic influence. [52] [53]

As a disorder

As of 2010, a proposal to add Sexual Addiction to the Diagnostic and Statistical Manual of Mental Disorders (DSM) system has failed to get support of the American Psychiatric Association (APA). [54] [55] [56] The DSM does include 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". [57]

The International Statistical Classification of Diseases and Related Health Problems (ICD-10) of the World Health Organization (WHO), includes two relevant entries. One is "Excessive Sexual Drive" (coded F52.7), [58] which is divided into satyriasis for males and nymphomania for females. The other is "Excessive Masturbation" or "Onanism (excessive)" (coded F98.8). [59]

In 1988, Levine and Troiden questioned whether it makes sense to discuss hypersexuality at all, arguing that labeling sexual urges "extreme" merely stigmatizes people who do not conform to the norms of their culture or peer group, and that sexual compulsivity be a myth. [9] However, and in contrast to this view, 30 years later in 2018, the ICD-11 created a new condition classification, compulsive sexual behavior, to cover "a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour". It classifies this "failure to control" as an abnormal mental health condition. [60] [61]

Treatment

Hypersexuality may negatively impact an individual. The concept of hypersexuality as an addiction was started in the 1970s by former members of Alcoholics Anonymous who felt they experienced a similar lack of control and compulsivity with sexual behaviors as with alcohol. [9] [62] Multiple 12-step style self-help groups now exist for people who identify as sex addicts, including Sex Addicts Anonymous, Sexaholics Anonymous, Sex and Love Addicts Anonymous, and Sexual Compulsives Anonymous. Some hypersexuals may treat their condition with the usage of medication (such as Cyproterone acetate) or consuming foods considered to be anaphrodisiacs. [63] Other hypersexuals may choose a route of consultation, such as psychotherapy, self-help groups or counselling. [64]

Terminology

The Merriam-Webster Dictionary defines hypersexual as "exhibiting unusual or excessive concern with or indulgence in sexual activity". [65] Sexologists have been using the term hypersexuality since the late 1800s, when Krafft-Ebing described several cases of extreme sexual behaviours in his seminal 1886 book, Psychopathia Sexualis. [66] [11] The author used the term "hypersexuality" to describe conditions that would now be termed premature ejaculation. Terms to describe males with the condition include donjuanist, [67] satyromaniac, [68] satyriac [69] and satyriasist, [70] for women clitoromaniac, [71] nympho and nymphomaniac, [72] for teleiophilic (attracted to adults) heterosexual women andromaniac, [73] while hypersexualist, sexaholic, [74] onanist, hyperphiliac and erotomaniac [75] are gender neutral terms. [76]

Other, mostly historical, names include Don Juanism, the Messalina complex, [77] sexaholism, [78] hyperlibido [79] and furor uterinus. [80]

See also

Related Research Articles

Paraphilia is the experience of intense sexual arousal to atypical objects, situations, fantasies, behaviors, or individuals.

Borderline personality disorder Personality disorder characterized by unstable relationships, impulsivity, and strong emotional reactions

Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a mental illness characterized by a long-term pattern of unstable relationships, distorted sense of self, and strong emotional reactions. Those affected often engage in self-harm and other dangerous behavior. They may also struggle with a feeling of emptiness, fear of abandonment, and detachment from reality. Symptoms of BPD may be triggered by events considered normal to others. The behavior in BPD typically begins by early adulthood and occurs across a variety of situations. Substance abuse, depression, and eating disorders are commonly associated with BPD. Approximately 10% of people affected with the disorder die by suicide. The disorder is often stigmatized in both the media and the psychiatric field.

Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. An old concept, the meaning of hypochondria has repeatedly changed. It has been claimed that this debilitating condition results from an inaccurate perception of the condition of body or mind despite the absence of an actual medical diagnosis. An individual with hypochondriasis is known as a hypochondriac. Hypochondriacs become unduly alarmed about any physical or psychological symptoms they detect, no matter how minor the symptom may be, and are convinced that they have, or are about to be diagnosed with, a serious illness.

Obsessive–compulsive personality disorder Personality disorder involving orderliness

Obsessive–compulsive personality disorder (OCPD) is a cluster C personality disorder marked by an excessive need for orderliness, neatness, and perfectionism. Symptoms are usually present by the time a person reaches adulthood, and are visible in a variety of situations.

Pornography addiction is an addiction model of compulsive sexual activity with concurrent use of pornographic material, despite negative consequences to one's physical, mental, social, or financial well-being. Neither the DSM-5 nor the ICD-11 classify pornography as a mental disorder or addiction.

Compulsive hoarding

Compulsive hoarding, also known as hoarding disorder, is a behavioral pattern characterized by excessive acquisition of and an inability or unwillingness to discard large quantities of objects that cover the living areas of the home and cause significant distress or impairment. Compulsive hoarding behavior has been associated with health risks, impaired functioning, workplace impairment, economic burden, and adverse effects on friends and family members. When clinically significant enough to impair functioning, hoarding can prevent typical uses of space, enough so that it can limit activities such as cooking, cleaning, moving through the house, and sleeping. It can also put the individual and others at risk of fires, falling, poor sanitation, and other health concerns.

Kleptomania Inability to resist the urge to steal

Kleptomania is the inability to resist the urge to steal items, usually for reasons other than personal use or financial gain. First described in 1816, kleptomania is classified in psychiatry as an impulse control disorder. Some of the main characteristics of the disorder suggest that kleptomania could be an obsessive-compulsive spectrum disorder, but also share similarities with addictive and mood disorders.

Generalized anxiety disorder (GAD) is an anxiety disorder characterized by excessive, uncontrollable and often irrational worry about events or activities. Worry often interferes with daily functioning, and sufferers are overly concerned about everyday matters such as health, finances, death, family, relationship concerns, or work difficulties. Symptoms may include excessive worry, restlessness, trouble sleeping, exhaustion, irritability, sweating, and trembling.

Disorganized schizophrenia, or hebephrenia, was a subtype of schizophrenia prior to 2013. Subtypes of schizophrenia were no longer recognized as separate conditions in DSM 5 published in 2013. The disorder is no longer listed in the 11th revision of the International Statistical Classification of Diseases and Related Health Problems, or ICD-11

Impulse-control disorder (ICD) is a class of psychiatric disorders characterized by impulsivity – failure to resist a temptation, an urge, or an impulse; or having the inability to not speak on a thought. Many psychiatric disorders feature impulsivity, including substance-related disorders, behavioral addictions, attention deficit hyperactivity disorder, fetal alcohol spectrum disorders, antisocial personality disorder, borderline personality disorder, conduct disorder and some mood disorders.

Sexual addiction, also known as sex addiction, is a state characterized by compulsive participation or engagement in sexual activity, particularly sexual intercourse, despite negative consequences.

Organic brain syndrome Disorder of mental function whose cause is alleged to be known as physiological

Organic brain syndrome, also known as organic brain disease, organic brain disorder, organic mental syndrome, or organic mental disorder, refers to any syndrome or disorder of mental function whose cause is alleged to be known as organic (physiologic) rather than purely of the mind. These names are older and nearly obsolete general terms from psychiatry, referring to many physical disorders that cause impaired mental function. They are meant to exclude psychiatric disorders. Originally, the term was created to distinguish physical causes of mental impairment from psychiatric disorders, but during the era when this distinction was drawn, not enough was known about brain science for this cause-based classification to be more than educated guesswork labeled with misplaced certainty, which is why it has been deemphasized in current medicine. While mental or behavioural abnormalities related to the dysfunction can be permanent, treating the disease early may prevent permanent damage in addition to fully restoring mental functions. An organic cause to brain dysfunction is suspected when there is no indication of a clearly defined psychiatric or "inorganic" cause, such as a mood disorder.

The obsessive–compulsive spectrum is a model of medical classification where various psychiatric, neurological and/or medical conditions are described as existing on a spectrum of conditions related to obsessive–compulsive disorder (OCD). "The disorders are thought to lie on a spectrum from impulsive to compulsive where impulsivity is said to persist due to deficits in the ability to inhibit repetitive behavior with known negative consequences, while compulsivity persists as a consequence of deficits in recognizing completion of tasks." OCD is a mental disorder characterized by obsessions and/or compulsions. An obsession is defined as "a recurring thought, image, or urge that the individual cannot control". Compulsion can be described as a "ritualistic behavior that the person feels compelled to perform". The model suggests that many conditions overlap with OCD in symptomatic profile, demographics, family history, neurobiology, comorbidity, clinical course and response to various pharmacotherapies. Conditions described as being on the spectrum are sometimes referred to as obsessive–compulsive spectrum disorders.

Compulsive buying disorder (CBD), or oniomania, is characterized by an obsession with shopping and buying behavior that causes adverse consequences. According to Kellett and Bolton, compulsive buying "is experienced as an irresistible–uncontrollable urge, resulting in excessive, expensive and time-consuming retail activity [that is] typically prompted by negative affectivity" and results in "gross social, personal and/or financial difficulties". Most people with CBD meet the criteria for a personality disorder. Compulsive shopping is classified by ICD-10 (F63.8) as an "impulse control disorder, not otherwise classified." Several authors consider compulsive shopping rather as a variety of dependence disorder.

The effects of pornography on individuals or their sexual relationships depend on the type of pornography used and differ from person to person. Pornographic material has been studied particularly for associations with addiction as well as effects on the brain over time. Some literature reviews suggest that pornographic images and films can be addictive, particularly when combined with masturbation, while others maintain that data remains inconclusive. Other research has looked at pornographic material's relation to sexual violence, with varying results.

Behavioral addiction is a form of addiction that involves a compulsion to engage in a rewarding non-substance-related behavior – sometimes called a natural reward – despite any negative consequences to the person's physical, mental, social or financial well-being. Addiction canonically refers to substance abuse; however, the term connotation has been expanded to include behaviors that may lead to a reward since the 1990s. A gene transcription factor known as ΔFosB has been identified as a necessary common factor involved in both behavioral and drug addictions, which are associated with the same set of neural adaptations in the reward system.

Dopamine dysregulation syndrome

Dopamine dysregulation syndrome (DDS) is a dysfunction of the reward system observed in some individuals taking dopaminergic medications for an extended length of time. It typically occurs in people with Parkinson's disease (PD) who have taken dopamine agonist medications for an extended period of time. It is characterized by self-control problems such as addiction to medication, gambling, or sexual behavior.

Addiction Compulsive engagement in rewarding stimuli despite adverse consequences

Addiction is a brain disorder characterized by compulsive engagement in rewarding stimuli despite adverse consequences. Despite the involvement of a number of psychosocial factors, a biological process—one that is induced by repeated exposure to an addictive stimulus—is the core pathology that drives the development and maintenance of an addiction, according to the "brain disease model" of addiction. However, many scholars who study addiction argue that the brain disease model is incomplete and misleading.

James Cantor

James M. Cantor is a Canadian clinical psychologist and sexologist, specializing in hypersexuality and atypical sexual interests. He is a former editor of the journal Sexual Abuse and an expert on paraphilias. His neuroscience research on brain differences in pedophiles has been cited as evidence that pedophilia is something unchangeable and that people are likely born with it.

Hypersexual disorder is a pattern of behavior involving intense preoccupation with sexual fantasies, urges and activities, leading to adverse consequences and clinically significant distress or impairment in social, occupational or other important functions. It was proposed in 2010 for inclusion in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) of the American Psychiatric Association (APA).

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