Introduction Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for hypersexual disorder (HD) have been proposed to capture symptoms reported by patients seeking help for out-of-control sexual behavior. The proposed criteria created by the DSM-5 Work Group on Sexual and Gender Identity Disorders require evaluation in a formal field trial. Aim This DSM-5 Field Trial was designed to assess the reliability and validity of the criteria for HD in a sample of patients seeking treatment for hypersexual behavior, a general psychiatric condition, or a substance-related disorder. Method Patients (N = 207) were assessed for psychopathology and HD by blinded raters to determine inter-rater reliability of the HD criteria and following a 2-week interval by a third rater to evaluate the stability of the HD criteria over time. Patients also completed a number of self-report measures to assess the validity of the HD criteria. Main Outcome Measures HD and psychopathology were measured by structured diagnostic interviews, the Hypersexual Behavior Inventory, Sexual Compulsivity Scale, and Hypersexual Behavior Consequences Scale. Emotional dysregulation and stress proneness were measured by facets on the NEO Personality Inventory—Revised. Results Inter-rater reliability was high and the HD criteria showed good stability over time. Sensitivity and specificity indices showed that the criteria for HD accurately reflected the presenting problem among patients. The diagnostic criteria for HD showed good validity with theoretically related measures of hypersexuality, impulsivity, emotional dysregulation, and stress proneness, as well as good internal consistency. Patients assessed for HD also reported a vast array of consequences for hypersexual behavior that were significantly greater than those diagnosed with a general psychiatric condition or substance-related disorder. Conclusions The HD criteria proposed by the DSM-5 Work Group on Sexual and Gender Identity Disorders appear to demonstrate high reliability and validity when applied to patients in a clinical setting among a group of raters with modest training on assessing HD.

This article reports the psychometric evaluation of the Pornography Consumption Inventory (PCI), which was developed to assess motivations for pornography use among hypersexual men. Initial factor structure and item analysis were conducted in a sample of men (N = 105) seeking to reduce their pornography consumption (Study 1), yielding a 4-factor solution. In a second sample of treatment-seeking hypersexual men (N = 107), the authors further investigated the properties of the PCI using confirmatory factor analytic procedures, reliability indices, and explored PCI associations with several other constructs to establish convergent and discriminant validity. These studies demonstrate psychometric evidence for the PCI items that measure tendencies of hypersexual men to use pornography (a) for sexual pleasure; (b) to escape, cope, or avoid uncomfortable emotional experiences or stress; (c) to satisfy sexual curiosity; and (d) to satisfy desires for excitement, novelty, and variety.

Studies among people struggling with hypersexual behavior commonly report that shame needs to be addressed when treating this population. These studies theoretically distinguish that it is shame and not guilt that exacerbates hypersexual behavior, yet no study to date has demonstrated this difference empirically. This observation led to the current investigation in which a sample (N = 177) of people seeking treatment for pornography use anonymously filled out measures of hypersexuality, shame-proneness, guilt-proneness, and motivation to change unwanted behavior. A hypothetical path model of the constructs was analyzed yielding significant positive relationships between shame-proneness and hypersexuality as well as guiltproneness and motivation to change. The data support previous findings that shame is active among people seeking treatment for hypersexual behavior. This study adds an additional element to the story by empirically demonstrating that shame and guilt have opposing relationships with hypersexuality and motivation for change.

Studies among people struggling with hypersexual behavior commonly report that shame needs to be addressed when treating this population. These studies theoretically distinguish that it is shame and not guilt that exacerbates hypersexual behavior, yet no study to date has demonstrated this difference empirically. This observation led to the current investigation in which a sample (N = 177) of people seeking treatment for pornography use anonymously filled out measures of hypersexuality, shame-proneness, guilt-proneness, and motivation to change unwanted behavior. A hypothetical path model of the constructs was analyzed yielding significant positive relationships between shame-proneness and hypersexuality as well as guiltproneness and motivation to change. The data support previous findings that shame is active among people seeking treatment for hypersexual behavior. This study adds an additional element to the story by empirically demonstrating that shame and guilt have opposing relationships with hypersexuality and motivation for change.

The results of these findings suggest that clinicians should exercise caution in assuming that common characteristics of ADHD, such as impulsivity and hyperactivity, exert the strongest influence on hypersexual behavior. Rather, our results provide evidence that the associated features of ADHD, such as problems with low self-esteem, might be more salient factors in influencing hypersexuality severity among patients with comorbid hypersexual behavior and ADHD.