Sex Addiction including Hypersexuality
Sexual behaviour is a normal, healthy part of life and many people enjoy being active with multiple sexual partners or seeking out many different kinds of sexual experiences. Hypersexuality becomes a problem when it causes significant distress for a person, or puts them at risk of harming themself or someone else.
What are the symptoms of sex addiction and hypersexuality?
The symptoms should continue for at least six months before hypersexuality is used to describe the symptoms. The symptoms may include:
- Recurrent and intense sexual fantasies, sexual urges, or sexual behaviours.
- The time spent engaging in sexual fantasies, urges, or behaviours consistently interferes with other important life activities.
- Sexual fantasies, urges, or behaviours occur in response to various moods (such as anxiety, depression, boredom, irritability) or to stressful life events.
- There may be consistent but unsuccessful efforts to control or reduce sexual fantasies, urges, or behaviours.
- The person engages in sexual behaviours while disregarding the potential for physical or emotional harm to themself or to others.
- The frequency or intensity of the sexual fantasies, urges, or behaviours causes significant personal distress or impairment.
People may avoid difficult emotions such as sadness or shame and seek temporary relief by engaging in sexual behaviour. Therefore sexual cravings may mask other issues such as depression, anxiety, or stress.
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What is sex addiction and hypersexuality?
There are various definitions used for sex addiction and hypersexuality:
- The terms sex addiction and hypersexuality are used to describe people who have an 'excessive' or 'out of control' amount of sexual behaviour and feel distressed as a result. These terms refer to sexual behaviour that includes limited control of excessive sexual fantasies, urges, and behaviour that may cause personal distress.
- Hypersexual disorder has been used to describe a person who experiences distress about a pattern of repeated sexual relationships involving a succession of lovers, who are experienced by the person only as things to be used.
- The term 'sex addict' is often used to refer to a person who compulsively seeks out sexual acts despite bad consequences to themself or to others.
It is not yet clear whether compulsive sexual behaviour should be viewed as an addiction similar to drug addictions. Many experts feel that such a diagnosis is inappropriate for people who just enjoy having a lot of sex with multiple partners. Many people believe that hypersexuality can be a problem but not an addiction.
Culture also plays a part in defining hypersexuality. Cultures that think of sexuality in a more positive way may have values that don't judge sexual behaviour as being 'excessive'.
Therefore a main point in thinking of it as a problem or an addiction is if the behaviour causes any harm to the person themself or to others.
What are the causes of sex addiction and hypersexuality?
The causes of hypersexual behaviour are not well understood. However, sex addiction and hypersexuality may sometimes be caused by traumatic experiences, distress, or by mental illness, such as bipolar disorder.
Adults who have been sexually abused as children may display increased sexual behaviour. High-risk sexual behaviour may also be associated with family problems and social stress.
How is hypersexuality diagnosed?
There is some debate and controversy about the diagnosis of hypersexual disorder. The features for diagnosis proposed in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), published by the American Psychiatric Association, are:
- Over a period of at least six months, recurrent and intense sexual fantasies, sexual urges and sexual behaviour in association with four or more of the following:
- Excessive time is taken up by sexual fantasies and urges, and by planning for and engaging in sexual behaviour.
- Repetitively engaging in these sexual fantasies, urges and behaviour in response to mood states such as anxiety, depression, boredom or irritability.
- Repetitively engaging in sexual fantasies, urges and behaviour in response to stressful life events.
- Repetitive but unsuccessful efforts to control or significantly reduce these sexual fantasies, urges and behaviour.
- Repetitively engaging in sexual behaviour while disregarding the risk for physical or emotional harm to self or others.
- There is significant personal distress or impairment in social, occupational or other important areas of functioning associated with the frequency and intensity of these sexual fantasies, urges and behaviour. These sexual fantasies, urges and behaviour are not due to the effects of substances such as drugs of abuse or medications, any medical condition or manic episodes.
- The person is at least 18 years old.
What are the treatments for sex addiction and hypersexuality?
The possible treatments for sex addiction and hypersexuality include a combination of self-help, psychological treatment and sometimes medication. The aim of treatment is to help you manage sexual urges and reduce excessive behaviours while maintaining healthy sexual activities. Some people also need treatment for another mental health condition, such as an alcohol or drug abuse problem, anxiety or depression.
- Learn about compulsive sexual behaviour so that you can better understand its causes and treatment.
- Identify situations, thoughts and feelings that may trigger sexual compulsions so that you can take steps to avoid and manage them.
- Get treatment for any other mental health problems, such as addictions, depression, anxiety or stress.
- If you use sexual behaviour as a way to cope with negative emotions, explore healthier ways to cope, such as through exercise and recreational activities.
- Practise relaxation and stress management.
Psychotherapy can help you learn how to manage your compulsive sexual behaviour. Psychotherapies can be provided on an individual basis or with a group, with family or with your partner. Types of psychotherapy include:
- Cognitive behavioural therapy (CBT). Helps you identify unhealthy, negative beliefs and behaviours and replace them with more beneficial ways of coping.
- Acceptance and commitment therapy. This is a form of CBT that emphasises acceptance of thoughts and urges and a commitment to choose actions that are more consistent with important values.
- Psychodynamic psychotherapy. Focuses on increasing your awareness of unconscious thoughts and behaviours, developing new insights into your motivations, and helping you to resolve conflicts.
Certain medications may help by reducing obsessive thoughts and behaviours or by reducing sexual urges. Medications used to treat compulsive sexual behaviour are often also prescribed for other conditions. Examples include:
- Antidepressants. Certain types of antidepressants used to treat depression, anxiety or obsessive-compulsive disorder may help with compulsive sexual behaviour.
- Naltrexone. Naltrexone is generally used to treat alcohol and opiate dependence and blocks the part of your brain that feels pleasure with certain addictive behaviours. It may help with behavioural addictions such as compulsive sexual behaviour or gambling disorder.
- Mood stabilisers. These medications are generally used to treat bipolar disorder, but may reduce compulsive sexual urges.
- Anti-androgens - eg, cyproterone. These medications reduce the biological effects of sex hormones (androgens) in men. Because they reduce sexual urges, anti-androgens are often used in men whose compulsive sexual behaviour is dangerous to others.
Further reading and references
Kraus SW, Voon V, Potenza MN; Should compulsive sexual behavior be considered an addiction? Addiction. 2016 Dec111(12):2097-2106. doi: 10.1111/add.13297. Epub 2016 Feb 18.
Miner MH, Romine RS, Raymond N, et al; Understanding the Personality and Behavioral Mechanisms Defining Hypersexuality in Men Who Have Sex With Men. J Sex Med. 2016 Sep13(9):1323-1331. doi: 10.1016/j.jsxm.2016.06.015. Epub 2016 Jul 30.
Dhuffar MK, Pontes HM, Griffiths MD; The role of negative mood states and consequences of hypersexual behaviours in predicting hypersexuality among university students. J Behav Addict. 2015 Sep4(3):181-8. doi: 10.1556/2006.4.2015.030.
Bothe B, Bartok R, Toth-Kiraly I, et al; Hypersexuality, Gender, and Sexual Orientation: A Large-Scale Psychometric Survey Study. Arch Sex Behav. 2018 Jun 20. pii: 10.1007/s10508-018-1201-z. doi: 10.1007/s10508-018-1201-z.
Reid RC; How should severity be determined for the DSM-5 proposed classification of Hypersexual Disorder? J Behav Addict. 2015 Dec4(4):221-5. doi: 10.1556/2006.4.2015.041.
Werner M, Stulhofer A, Waldorp L, et al; A Network Approach to Hypersexuality: Insights and Clinical Implications. J Sex Med. 2018 Mar15(3):373-386. doi: 10.1016/j.jsxm.2018.01.009.