This article reports the findings of a study investigating coping strategies used by hypersexual patients (n = 71), compared with a control group (n = 73), in their attempts to defend against shame. Coping strategies were measured using the Compass of Shame Scale (CoSS) and hypersexual behaviour was measured by the Hypersexual Behavior Inventory (HBI). A multivariate analysis of variance of between-group differences was significant, and examination of post hoc univariate tests revealed that the sample of hypersexual patients defended against shame with higher levels of withdrawal and higher tendencies to attack self and others when compared with the control group. The effect sizes of these differences were moderate to large. A categorical analysis of the patient group indicated that the greatest percentages of elevated shame scores were clustered on the Withdrawal and Attack Self subscales of the CoSS. Between-group differences on the Avoidance subscale of the CoSS were not significant. The results of this study are discussed as they pertain to clinical practice, and future recommendations for research are offered.