Hypersexuality: A Critical Review and Introduction to the “Sexhavior Cycle”

Abstract

An empirical review of hypersexuality is timely as "compulsive sexual behavior" is being considered as an impulse control disorder for inclusion in the forthcoming International Classification of Diseases, 11th ed. Specifically, hypersexuality has been conceptualized in the literature as the inability to regulate one's sexual behavior that is a source of significant personal distress. Various theoretical models have been posited in an attempt to understand the occurrence of hypersexuality, although disagreement about these divergent conceptualizations of the condition has made assessment and treatment of hypersexual clients more challenging. Theories of sexual compulsivity, sexual impulsivity, dual control (sexual inhibition/excitation), and sex addiction are critically examined, as are the diagnostic criteria for clinically assessing hypersexuality as a sexual disorder. Our discussion of hypersexuality covers a diversity of research and clinical perspectives. We also address various challenges associated with reliably defining, psychometrically measuring, and diagnosing hypersexuality. Furthermore, literature is reviewed that expresses concerns regarding whether hypersexuality (conceptualized as a disorder) exists, whether it is simply normophilic behavior at the extreme end of sexual functioning, or alternatively is a presenting problem that requires treatment rather than a clinical diagnosis. Following our literature review, we developed the "sexhavior cycle of hypersexuality" to potentially explain the neuropsychology and maintenance cycle of hypersexuality. The sexhavior cycle suggests that, for some hypersexual persons, high sexual arousal may temporarily and adversely impact cognitive processing (cognitive abeyance) and explain a repeated pattern of psychological distress when interpreting one's sexual behavior (sexual incongruence). We also suggest that further research is required to validate whether hypersexuality is a behavioral disorder (such as gambling), although some presentations of the condition appear to be symptomatic of a heterogeneous psychological problem that requires treatment.

Social exclusion and human rights at the intersection of HIV and severe mental illness

“…Many other approaches exist, including well-supported non-pathological models. 4 Potenza and colleagues 5 also stated that addiction criteria were not met for sexual behaviours: we agree with this earlier conclusion.…”

“…Addressing abuse and empowering women to make sexual and reproductive decisions reduces transmission rates in a way that promotes human rights. 4 Similarly, the intersection of HIV and mental illness is not a static phenomenon, but probably amenable to human rightsbased interventions.…”

A Randomized Controlled Study of Group-Administered Cognitive Behavioral Therapy for Hypersexual Disorder in Men

“…As presented above, there is a plethora of research on hypersexual behavior, and a wide range of factors that may predict and contribute to the development and maintenance of hypersexuality has been identified. However, these conceptualizations may not individually provide a comprehensive and exhaustive understanding of the heterogenic clinical presentations of the condition (Montgomery-Graham, 2016; Walton, Cantor, Bhullar, & Lykins, 2017). Predispositions for hypersexuality are diverse and complex, and a wide range of risk factors may contribute to the condition and its varying manifestation in individuals (Walton, Lykins, & Bhullar, 2016).…”

“…Predispositions for hypersexuality are diverse and complex, and a wide range of risk factors may contribute to the condition and its varying manifestation in individuals (Walton, Lykins, & Bhullar, 2016). The identified predictive factors are not exclusively specific for hypersexuality and most individuals do not use sexual activities to alleviate dysphoric mood states, even though it is likely that the experience of such emotions at some point in life is universal (Walton, Cantor, Bhullar, et al, 2017). Some hypersexual individuals may perceive their sexual behaviors as excessive and uncontrollable, even when they are considered to be functioning normally (Walton et al, 2016).…”

Normative and Clinical Self-Perceptions of Sexuality and Their Links to Psychopathology among Adolescents

“…Specifically, CSB includes the following 4 facets: (1) unwanted consequences because of sexual fantasies – how sexual fantasies carry harm to oneself by causing physical, mental, and spiritual distress [17] and to one’s close others such as family members [18], colleagues, and peers [19]; (2) lack of behavioral control – constant engagement with sexual fantasies without control of thoughts and exposure to pornography; (3) negative affect – a negative feeling accompanied by guilt and shame because of sexual fantasies that feed feelings of unworthiness; and (4) affect regulation – escape to sexual fantasies and pornography because of pain, stress, and distress. Research has supported this definition [20, 21]. …”