The hypersexual disorder: deciphering

6 min read

Sexual addiction, often referred to as hypersexuality or hypersexual disorder, is a contentious subject in psychiatry and psychology (Pistre and al., 2023). While not officially recognized as a distinct clinical diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), many professionals acknowledge compulsive sexual behaviors as a genuine problem affecting mental health and individuals' well-being.

Identified behaviors

Sexual addiction is characterized by excessive preoccupation and uncontrollable impulses to engage in sexual activities despite negative consequences. In 1990, psychiatrist Aviel Goodman defined it as "the increasing, especially uncontrolled, frequency of sexual behavior that persists despite potential negative consequences and personal suffering. Sex becomes an absolute priority in the subject's life, for which they are willing to sacrifice anything" (An integrated approach).

The most common sexual practices among individuals suffering from this disorder include:
  • Compulsive masturbation
  • Multiple sexual relationships
  • Consumption of pornography via the internet, phone, strip clubs, etc.
  • Engagement in paraphilias or atypical sexual behaviors: fetishism, voyeurism, sadomasochism, exhibitionism, cross-dressing, non-consensual sexual acts, sexual harassment, and relations with minors.

Consequences for the individual

Affected individuals may feel trapped by their sexual impulses, experiencing difficulties in establishing or maintaining healthy relationships. 

Hypersexual behaviors can coexist with other mental health issues such as anxiety, depression, or personality disorders. The complexity of these comorbid conditions often necessitates a multidisciplinary therapeutic approach for effective management.

This situation can have emotional repercussions: feelings of shame and guilt, impacts on the family sphere (neglect of the partner, divorce). Physically, it may manifest in sexually transmitted diseases (HIV).

Apart from the emotional and social repercussions mentioned, this addiction can also affect an individual's professional and financial functioning. Excessive spending associated with these behaviors can lead to serious financial difficulties (cybersex services, prostitution, phone lines, etc.).

These behaviors can also trigger the onset of other addictions such as excessive alcohol or drug consumption, leading the individual into a legal spiral, social marginalization, and ultimately culminating in suicide.

Affected population

Hypersexuality can affect individuals of any age, gender, ethnic origin, or socioeconomic background. However, studies suggest that the disorder is more common among men (Karila and al., 2014) and young adults (Benhaiem, Accro, Flammarion, 2009). This disorder can affect both singles and people in relationships, often disrupting relationships and leading to behaviors such as chronic infidelity or seeking sexual services.

Possible causes

The causes of sexual addiction are diverse and may include biological, psychological, and social factors. Among biological factors are abnormalities in neurotransmitter levels or hormonal imbalances. Psychological factors may include a history of trauma or sexual abuse, attachment disorders, personality disorders, or concurrent substance addictions. Socially, influences such as easy and anonymous access to online pornography and the sexualization of culture could contribute to the development of hypersexual behaviors.

State of research

Research is ongoing to understand hypersexuality, its causes, and implications.

Research focuses on the neuroscience dimension to better understand the underlying brain mechanisms of this addiction. Neuroscientific studies explore correlations between addictive sexual behaviors and brain structures involved in the reward system.

Studies on the psychological aspect evaluate how stress factors, associated mental disorders, and life experiences influence compulsive sexual behavior.

Ongoing studies also aim to assess the long-term efficacy of different therapies for better management.

Therapies under evaluation

Treating sexual addiction often relies on multidisciplinary strategies. Cognitive-behavioral therapy (CBT) has proven particularly effective, as it helps individuals identify and modify thought patterns and behaviors fueling their addiction. Interventions such as group therapy, especially Twelve-Step-based support groups, and individual therapy can also be beneficial.

Other approaches, like psychodynamic therapy, may be used to explore the emotional and relational roots of the disorder. Some professionals may also prescribe medication to treat concurrent disorders like depression or anxiety or as a means to decrease sexual impulsivity. However, it should be noted that medication use in this context must be personalized and closely monitored.

It is crucial for individuals suffering from hypersexuality to consult competent mental health professionals to obtain an accurate diagnosis and a treatment plan tailored to their situation. It is also important to consider the support of partners and family in the healing process. Involving loved ones in the therapeutic process can improve treatment efficacy and the well-being of affected individuals.

Research continues to evaluate the effectiveness of different therapies and their long-term impact. Professionals are encouraged to keep an open mind and adapt to scientific discoveries, as well as the needs and personal experiences of their patients.