Hypersexual Disorder: A Proposed Diagnosis for DSM-V

Abstract

Hypersexual Disorder is proposed as a new psychiatric disorder for consideration in the Sexual Disorders section for DSM-V. Historical precedents describing hypersexual behaviors as well as the antecedent representations and proposals for inclusion of such a condition in the previous DSM manuals are reviewed. Epidemiological as well as clinical evidence is presented suggesting that non-paraphilic "excesses" of sexual behavior (i.e., hypersexual behaviors and disorders) can be accompanied by both clinically significant personal distress and social and medical morbidity. The research literature describing comorbid Axis I and Axis II psychiatric disorders and a purported relationship between Axis I disorders and Hypersexual Disorder is discussed. Based on an extensive review of the literature, Hypersexual Disorder is conceptualized as primarily a nonparaphilic sexual desire disorder with an impulsivity component. Specific polythetic diagnostic criteria, as well as behavioral specifiers, are proposed, intended to integrate empirically based contributions from various putative pathophysiological perspectives, including dysregulation of sexual arousal and desire, sexual impulsivity, sexual addiction, and sexual compulsivity.

Compulsive sexual behavior: Prefrontal and limbic volume and interactions

“…Age‐matched male HV were recruited from community‐based advertisements in the East Anglia area. All CSB subjects were interviewed by a psychiatrist to confirm they fulfilled diagnostic criteria for CSB (met proposed diagnostic criteria for both hypersexual disorder [Kafka, 2010; Reid et al, 2012] and sexual addiction [Carnes et al, 2007]), focusing on compulsive use of online sexually explicit material. This was assessed using a modified version of the Arizona Sexual Experiences Scale (ASES) [Mcgahuey et al, 2011], in which questions were answered on a scale of 1–8, with higher scores representing greater subjective impairment.…”

DSM-5 and the Decision Not to Include Sex, Shopping or Stealing as Addictions

“…It can be hard to draw limits between hypersexual disorder and normal sexual behavior, which depends on partner's behavior, societal and moral values, and ethics and religious beliefs [20]. However, hypersexual disorder has been reported to be associated with unwanted outcomes, such as unplanned pregnancy, marital separation and divorce, and sexually transmitted diseases, including HIV infection [21,22].…”

“…These include an early onset with a chronic-relapsing course that comprises pursuit of short-term reward (i.e., orgasm in hypersexual disorder or a "high" in substance use disorders), despite potential long-term negative consequences (e.g., physical or emotional harm to self or others), and frustrated attempts to inhibit or control the behavior [21]. Some have argued that, like addiction, hypersexual disorder patients may develop tolerance to increasing levels of sexual stimulation, and even withdrawal-like syndromes in the absence of sexual activities, although there are no high quality data available to prove or disprove this observation.…”

“…Some have argued that, like addiction, hypersexual disorder patients may develop tolerance to increasing levels of sexual stimulation, and even withdrawal-like syndromes in the absence of sexual activities, although there are no high quality data available to prove or disprove this observation. Thus, if hypersexual disorder exists as a discrete psychiatric disorder that is independent from other existing nosological entities, phenomenological data suggests that it could be classified as a behavioral addiction [21].…”

“…For instance, it could be also classified as a non-paraphilic sexual desire disorder, as an obsessivecompulsive related disorder, or as a disruptive, impulse control, or conduct-related disorder [21]. The identification of neurobiological links between hypersexual disorder and the conditions listed under these headings could help to establish its place in the current nosological scenario.…”