Hypersexuality: Terms, Diagnostic Approaches, Conceptualization, Prevalence
Abstract: Харьковская медицинская академия последипломного образования в статье представлены некоторые аспекты проблемы гиперсексуальности: используемые термины, отражение ее в современных классификациях (мКБ-10, DSM-5, проекте мКБ-11), различные модели патологической гиперсексуальности: обсессивно-компульсивная, аддиктивная, обусловленная нарушением контроля импульсов, а также связанная с расстройством в форме постоянного генитального возбуждения и синдромом раздраженных половых органов. высказывается мнение, что гипер… Show more
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The article reports on the categories, which are related to hypersexuality and contained in the International Classification of Diseases, 10th Revision (ICD-10) (1994), the American Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (2013) and the ICD-11 project (Kraus Shane W. et al., 2018). Also, 4 conceptualizations of hypersexuality are named: obsessive-compulsive (Bancroft J., Vukadinovic Z., 2004), addictive (Carnes P., 1983), due to an impaired control of impulses (Kraus Shane W. et al., 2016) as well as associated with the persistent sexual arousal syndrome / the persistent genital arousal disorder and the restless genital syndrome (Kocharyan G.S., 2019). A clinical observation, made by the author, is presented; in his opinion, it corresponds with the model of hypersexuality as sexual addiction (porn addiction), though when comparing criteria of sexual addiction and compulsive disorder of sexual behaviour, which was included into the ICD-11 project (Kraus Shane W. et al., 2018), a conclusion can be drawn about their correspondence. During his first visit a 32-year-old man complained of continuously disturbing thoughts about sex and a difficult control of sex impulses, which were realized during masturbation, 80% of its cases occurring with use of Internet porn. He masturbated every day or on alternative days mostly at work, as he was alone at his place of work. He watched clips with different heterosexual plots (vaginal and oral sexual intercourses), sadomasochist and lesbian subject matters as well as clips where a woman copulated with a dog. Due to his problem, which appeared when he was 18, the patient felt constant depression since the age of 22. Interestingly, it was difficult for the patient to connect with females. His last sexual intercourse was at the age of 25. Hypnosuggestive therapy in the variant of programming was the basic method of treatment of the patient. Suggestions were made, they being focused on: reduction/elimination of the compulsion for masturbation and porn (particularly its non-normative variants); increase of the sexual drive to real women in real life; increase of a possible control over sexual addictive impulses; easiness in communication with women; mood improvement. All in all, 7 hypnosis sessions were conducted, as the patient could not continue his treatment due to objective reasons. It is noted that the patient had porn addiction, which was supported by his difficulty in connecting females. The above addiction was well controlled with help of hypnosuggestive therapy (the basic method of treatment) supplemented with reading of religious and philosophic literature, which made it possible to weaken addictive drives by distraction (an auxiliary therapeutic effect). The patient’s set that it was necessary to keep almost complete sexual abstinence which, in his opinion, was useful for his organism, resulted in the situation that sexual drives and their realization, which appeared much less often that before the treatment and were even more than “within the normative line”, were perceived by him as addictive, though really they were not any more. Due to an insufficient duration of the treatment one cannot exclude a possibility of the patient’s gradual “sliding” into sexual addiction (porn addiction), this fact necessitating the control of his state.
The article reports on the categories, which are related to hypersexuality and contained in the International Classification of Diseases, 10th Revision (ICD-10) (1994), the American Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (2013) and the ICD-11 project (Kraus Shane W. et al., 2018). Also, 4 conceptualizations of hypersexuality are named: obsessive-compulsive (Bancroft J., Vukadinovic Z., 2004), addictive (Carnes P., 1983), due to an impaired control of impulses (Kraus Shane W. et al., 2016) as well as associated with the persistent sexual arousal syndrome / the persistent genital arousal disorder and the restless genital syndrome (Kocharyan G.S., 2019). A clinical observation, made by the author, is presented; in his opinion, it corresponds with the model of hypersexuality as sexual addiction (porn addiction), though when comparing criteria of sexual addiction and compulsive disorder of sexual behaviour, which was included into the ICD-11 project (Kraus Shane W. et al., 2018), a conclusion can be drawn about their correspondence. During his first visit a 32-year-old man complained of continuously disturbing thoughts about sex and a difficult control of sex impulses, which were realized during masturbation, 80% of its cases occurring with use of Internet porn. He masturbated every day or on alternative days mostly at work, as he was alone at his place of work. He watched clips with different heterosexual plots (vaginal and oral sexual intercourses), sadomasochist and lesbian subject matters as well as clips where a woman copulated with a dog. Due to his problem, which appeared when he was 18, the patient felt constant depression since the age of 22. Interestingly, it was difficult for the patient to connect with females. His last sexual intercourse was at the age of 25. Hypnosuggestive therapy in the variant of programming was the basic method of treatment of the patient. Suggestions were made, they being focused on: reduction/elimination of the compulsion for masturbation and porn (particularly its non-normative variants); increase of the sexual drive to real women in real life; increase of a possible control over sexual addictive impulses; easiness in communication with women; mood improvement. All in all, 7 hypnosis sessions were conducted, as the patient could not continue his treatment due to objective reasons. It is noted that the patient had porn addiction, which was supported by his difficulty in connecting females. The above addiction was well controlled with help of hypnosuggestive therapy (the basic method of treatment) supplemented with reading of religious and philosophic literature, which made it possible to weaken addictive drives by distraction (an auxiliary therapeutic effect). The patient’s set that it was necessary to keep almost complete sexual abstinence which, in his opinion, was useful for his organism, resulted in the situation that sexual drives and their realization, which appeared much less often that before the treatment and were even more than “within the normative line”, were perceived by him as addictive, though really they were not any more. Due to an insufficient duration of the treatment one cannot exclude a possibility of the patient’s gradual “sliding” into sexual addiction (porn addiction), this fact necessitating the control of his state.
A case history is presented, where hypersexuality could be conceptualized as a manifestation of persistent genital arousal disorder / restless genital syndrome [PGAD/ReGS]. Female patient Sh., 75, who sought our medical advice on April 16, 2015, presented complaints about a feeling of a “sexual drive in my pubic region”, burning in her legs (along the inner surface of her thighs), in her pubis and on her abdomen over the pubis in a small area. “I need intimacy, but I understand with my head that it is not necessary for me”. The above burning and sexual desire were felt, but not always. The appearance of the desire coincided with the appearance of the burning. At first, the burning developed and was followed by the desire, or on the contrary. The burning and desire could begin in the morning and trouble her all day long, but when she was engaged into some activity, she changed over and forgot about it. The appearance of the disorder was preceded with the death of her elder brother, who some time before was actually a substitute for her father. He always supported her both morally and financially. He was a rather valued personality for her, she loved him very much. Therefore, she took his death, which happened in the beginning of December in 2013, very hard. The disorder, concerning which the patient consulted me, appeared on February 14, 2014. She woke up in the night because of her heavy jittering, she felt a terrible sexual drive and a bad burning in her lower abdomen over the pubis and on the inner surface of her thighs. She could not sleep any more. The arousal, which appeared in the night, did not leave her till the morning and remained during the whole day, but then became weakening. She was treated by different medical specialists. Though some weakening of her symptoms was achieved, she failed to get rid of the disorder, which developed in her. As a result of our analysis we supposed its cerebrovascular genesis, which impacted on functions of the brain. As a weighty contributing factor we regarded her long-term distress caused by a manifested psychological trauma (the death of the person who was extremely significant for the patient). Our treatment (hypnosuggestive therapy, Sonapax, Hydazepam, irrigation of the pubis with 10% Lidocaine aerosol), where hypnosis was the main component (its 10 sessions were performed), resulted in complete disappearance of the symptoms. The interview performed 5 years after the end of the treatment demonstrated persistence and duration of the obtained results. The presented clinical case is not very bright, but this fact can be explained to a great extent by the patient’s age that excluded appearance of a number of phenomena typical for PGAD/ReGS.
Харьковская медицинская академия последипломного образования В статье сообщается о рубриках, имеющих отношение к гиперсексуальности, содержащихся в международной классификации болезней 10-го пересмотра (мКБ-10), американском диагностическом и статистическом руководстве по психическим расстройствам 5-го пересмотра (2013) и проекте мКБ-11. Также названы четыре концептуализации гиперсексуальности: обсессивно-компульсивная, аддиктивная, обусловленная нарушением контроля импульсов, а также связанная с синдромом постоянного сексуального возбуждения / расстройством в форме постоянного генитального возбуждения и синдромом раздраженных половых органов. Приведено клиническое наблюдение автора, которое, по его мнению, корреспондируется с моделью гиперсексуальности как сексуальной аддикции (порноаддикции), хотя при сравнении критериев сексуальной аддикции и компульсивного расстройства сексуального поведения, вошедшего в проект мКБ-11, можно сделать вывод об их соответствии. При первичном обращении мужчина 32 лет предъявлял жалобы на беспокоящие его постоянные мысли о сексе, трудность контроля сексуальных импульсов, которые реализуются при мастурбации, в 80% случаев осуществляемой с использованием интернет-порно. мастурбирует ежедневно или через день в основном на работе, так как на рабочем месте находится один. Смотрит ролики с различными гетеросексуальными сюжетами (вагинальные и оральные половые акты), садомазохистской и лейсбийской тематикой, а также ролики, где женщина осуществляет половой акт с собакой. В связи со своей проблемой, которая возникла в 18 лет, с 22 лет отмечает постоянное чувство депрессии. Обращает на себя внимание то, что больному трудно устанавливать контакты с лицами женского пола. Последний половой акт был в 25 лет. Основным методом лечения этого пациента была гипносуггестивная терапия, которая проводилась в варианте программирования. делались внушения, направленные на уменьшение / ликвидацию тяги к мастурбации и порно (особенно к его ненормативным вариантам); усиление сексуального влечения к реальным женщинам в реальной жизни; усиление возможности контроля сексуальных аддиктивных импульсов; легкость общения с женщинами; улучшение настроения. Всего было проведено 7 сеансов гипноза, так как по объективным причинам больной не смог продолжить лечение. Отмечается, что у пациента имела место порноаддикция, которая поддерживалась трудностью установления им контактов с лицами женского пола. данная аддикция хорошо купировалась с помощью гипносуггестивной терапии (основной метод лечения), что дополнялось чтением литературы религиозно-философского содержания, позволявшей ослаблять аддиктивные побуждения путем переключения внимания (вспомогательное терапевтическое воздействие). Установка пациента на необходимость соблюдения практически полного сексуального воздержания, которое, по его мнению, является полезным для организма, привела к тому, что сексуальные побуждения и их реализация, которые стали возникать у него гораздо реже, чем до лечения, и более чем «укладывались в нормативный ряд», воспринимались им как а...
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