Hypersexual disorder, or HD for short, is a proposed diagnosis for people who have excessive sexual urges or activities that negatively impact their lives. The term hypersexual disorder may be used interchangeably with other terms, including:
- Hypersexuality
- Hypersexuality disorder
- Problematic hypersexuality
- Sex addiction
- Compulsive sexual behavior
- Compulsive sexual behavior disorder
- Hyperactive sexuality
- Excessive sexuality
- Problematic sexual behavior.
However, hypersexual disorder has different diagnostic criteria to sex addiction and compulsive sexual behavior disorder, although some proposed criteria overlaps between these conditions.
What is hypersexual disorder?
Hypersexuality was listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-4) as a "sexual disorder, not otherwise specified." This definition noted that the condition was characterized by “distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things used to be.” In 2010, a team lead by UCLA research psychologist and assistant professor of psychiatry Rory Reid proposed including hypersexual diagnosis in DSM-5. They suggested clear criteria that people should meet before being diagnosed with hypersexual disorder, including:
- Recurrent and intense sexual fantasies, urges, and sexual behavior over at least a six-month period that satisfies at least four of the following criteria:
- Excessive time spent on sexual fantasies and urges and planning and engaging in sexual behavior
- Repeatedly engaging in sexual fantasies, urges, and behaviors in response to mood states such as anxiety, depression, boredom, or irritability
- Repeatedly engaging in sexual fantasies, urges, and behaviors during periods of stress
- Repeated, unsuccessful attempts to control or reduce sexual fantasies, urges, and behaviors
- Repeatedly engaging in sexual behaviors with no regards for physical or emotional harm it could cause oneself or others.
- Significant personal distress or impairment to personal or professional life caused by frequency or intensity of sexual fantasies, urges, and behaviors.
- No connection between sexual fantasies, urges, and behaviors and use of drugs, medications, manic episodes, or other medical conditions.
- At least 18 years old at time of assessment.
The researchers also noted what sexual behaviors the people they assessed engaged in, including:
- Masturbation
- Use of pornography
- Sex with consenting adult partners
- Cyber sex
- Phone sex
- Visiting strip clubs.
While Reid’s team claimed the criteria was reliable and valid for diagnosing hypersexual disorder, this condition was ultimately omitted from the DSM-5. Those who voted against its inclusion claimed there was insufficient evidence to support the diagnosis of hypersexual disorder. Some also worried that diagnosing this condition may pathologize behaviors that fall under the banner of normal human sexuality. While the American Psychiatric Association doesn’t officially recognize hypersexual disorder, it is recognized by other major bodies, including the World Health Organization.
What causes hypersexual disorder?
It’s unclear what causes hypersexual disorder, but experts have several theories. Some believe damage to the brain caused by conditions such as epilepsy may be to blame. Others believe imbalances of chemicals in the brain, such as dopamine, might make someone hypersexual, just as they could diminish someone’s sexual urges. The link between dopamine and hypersexual disorder has also been explored by experts who think dopamine-replacement medication, used to treat Parkinson’s disease, might trigger this condition. Other factors including drug use, sexual trauma, and a familial history of mental health issues might also cause hypersexual disorder.
Diagnosing hypersexual disorder
As there are no approved criteria for diagnosing hypersexual disorder in the United States, identifying this condition can be challenging. Some mental health professionals recognize Reid’s criteria, even though it’s not listed in DSM-5. Others believe hypersexual disorder is a type of behavioral addiction, so they use the criteria for this addiction for diagnosis. Others use a less rigid diagnosis criteria, and instead look for common symptoms including:
- Sexual fantasies, urges, or behaviors that disrupt daily activities
- An inability to stop sexual thoughts or behaviors, even when they have a negative impact
- An increasing tolerance to sexual stimuli, or need to engage in sexual thoughts or behaviors more often
- Withdrawal symptoms when sexual stimuli is removed
- A loss of pleasure related to sexual thoughts or activities.
Some mental health professionals do not believe in diagnosing hypersexual disorder at all. Many point to the link between problematic sexual behaviors and other issues, such as depression and anxiety. They argue that treating underlying issues like mental health problems should resolve the sexual behaviors.
Professionals who support diagnosing hypersexual disorder say recognizing the condition can give anyone struggling with their sexual thoughts or behaviors a starting point from which to work towards feeling better, regardless of what triggered their sexual issues.
“Recognizing hypersexual disorder as a valid diagnosis can have some benefits to treatment approaches,” Dr. Jessica Lamar, a licensed mental health therapist, explained to Kinkly. “It allows for a clearer framework for understanding and treating individuals who experience distressing levels of preoccupation with sexual thoughts, urges, or behaviors that feel out of control. A formal diagnosis can also help individuals get access to treatment. Having a specific diagnosis can validate the experiences and struggles of those affected, reducing stigma and encouraging individuals to seek help. However, having these labels can pathologize what might be normal variations in sexual desire or behavior for some, leading to unnecessary treatment or stigma. It’s crucial that such diagnoses are approached with nuance and a thorough understanding of an individual’s personal, cultural, and psychological context.”
How common is hypersexual disorder?
As hypersexual disorder isn’t universally recognized as a mental health diagnosis, it’s unclear how many people have this condition. A 2018 paper published in the Journal of Psychopathology claims between 2 and 6 percent of the population have this disorder. It’s also most commonly seen in men. A 2022 study also found people with attention deficit/hyperactivity disorder (ADHD) are more likely to act in ways linked to hypersexual disorder, but the reasons why are unclear.
It’s important to note that simply having a high sex drive is not the same as having hypersexual disorder. Many people enjoy pornography, masturbation, and frequent sex, including sex with multiple partners and many different sexual experiences. So long as these experiences don’t cause personal harm or distress, they’re not seen as symptomatic of hypersexual disorder.
Risks associated with hypersexual disorder
Someone with hypersexual disorder may be at greater risk of the following issues:
- Negative emotions, such as guilt, embarrassment, and low self-esteem
- Mental health conditions, including depression, anxiety, and substance abuse
- Relationship breakdowns with intimate partners, family members, friends, and colleagues
- Poor performance at work due to increased focus on sex
- Financial problems from purchasing pornography and sexual services
- Sexually transmitted infections due to risky or increased sexual activity
- Legal charges due to inappropriate sexual conduct.
Treating hypersexual disorder
Self-help is often the first step for people concerned about their sexual urges or behavior. They might identify their own triggers and consider ways to avoid them or minimize their impact. They might also address any underlying issues that could contribute to the condition, such as addiction or depression, and try healthier coping strategies such as exercise.
“Support groups can help by connecting with others who understand your struggles can be incredibly helpful. It also provides the opportunity to learn more effective coping strategies from people who have similar experiences,” Dr. Lamar suggested. “Mindfulness and stress reduction techniques can help individuals gain better control over their impulses and reduce anxiety related to sexual thoughts or behaviors."
People who feel distressed or like they’ve lost control of their sexual urges or behaviors might seek help from a trusted healthcare provider. Early intervention may stop any problems related to sexual behavior from escalating.
Counseling may help people concerned they may have hypersexual disorder. Therapists may help their clients identify triggers for sexual thoughts and behaviors and learn how to manage them better, including giving them strategies for managing destructive sexual habits and alternatives to these behaviours. They may also help them manage stress and negative emotions surrounding hypersexuality, including guilt and embarrassment. Therapists can also help people rebuild relationships damaged by their condition.
“It's important to find a therapist who specializes in treating sexual health concerns,” Dr. Lamar stressed. “They can create a personalized treatment plan that addresses the root of the problem and helps you develop healthier sexual behaviors.” She noted that useful therapy might involve “Cognitive behavioral therapy (CBT) to help identify and change negative or unhelpful thought patterns that contribute to the behavior or acceptance and commitment therapy (ACT) to work towards accepting thoughts and urges and committing to a plan to deal with them. With ACT individuals can learn to choose actions that are in line with their important values.”
Some professionals believe medications, including antidepressants and anti-androgens, may reduce symptoms of hypersexual disorder. However, more research is needed to determine their effectiveness for treating this condition.
Synonyms: Hypersexuality, hypersexuality disorder, problematic hypersexuality, sex addiction, compulsive sexual behavior, compulsive sexual behavior disorder, excessive sexuality, hyperactive sexuality, problematic sexual behavior.
Acronyms: HD
