Abstract
Hypersexuality has been defined as abnormally increased sexual activity. Epidemiological and clinical studies have shown that this non-paraphilic condition consists of "excessive" sexual behaviors and disorders accompanied by personal distress and social and medical morbidity. It is a very controversial and political topic in terms of how best to categorize it as similar or not similar to addictive behaviors including substance abuse. Hypersexual disorder is conceptualized as a non-paraphilic sexual desire disorder with impulsivity. Pathophysiological perspectives include dysregulation of sexual arousal and desire, sexual impulsivity, and sexual compulsivity. The nucleus accumbens, situated within the ventral striatum, mediates the reinforcing effects of drugs of abuse, such as cocaine, alcohol, nicotine, and food as well as music. Indeed, it is believed that this structure mandates behaviors elicited by incentive stimuli. These behaviors include natural rewards like feeding, drinking, sexual behavior, and exploratory locomotion. An essential rule of positive reinforcement is that motor responses will increase in magnitude and vigor if followed by a rewarding event. Here, we are hypothesizing that there is a common mechanism of action (MOA) for the powerful effects drugs, music, food, and sex have on human motivation. The human drive for the three necessary motivational behaviors "hunger, thirst, and sex" may all have common molecular genetic antecedents that, if impaired, lead to aberrant behaviors. We hypothesize that based on a plethora of scientific support hypersexual activity is indeed like drugs, food, and music that activate brain mesolimbic reward circuitry. Moreover, dopaminergic gene and possibly other candidate neurotransmitter-related gene polymorphisms affect both hedonic and anhedonic behavioral outcomes. There is little known about both the genetics and epigenetics of hypersexuality in the current literature. However, we anticipate that future studies based on assessments with clinical instruments combined with genotyping of sex addicts will provide evidence for specific clustering of sexual typologies with polymorphic associations. There have been some studies using electrophysiological techniques that do not support the view that hypersexuality is indeed similar to substance abuse and other behavioral addictions. The authors are also encouraging both clinical and academic scientists to embark on research using neuroimaging tools to examine natural dopaminergic agonistic agents targeting specific gene polymorphisms to "normalize" hypersexual behavior.
Highlights
BackgroundCertainly, hypersexual behavior has been documented within clinical and research settings over the past decade [1]
We argue that there is ample evidence to propose that sexual addiction does exist and studies involving neuroimaging, neurogenetics and even epigenetics support the notion that compulsive sex addiction as well as hypersexuality could be considered as an addictive disorder
In spite of some disagreement, we are proposing hypersexuality disorder as a subtype of reward deficiency syndrome (RDS) sharing characteristics with substance and non-substance addictive behaviors with its clinical expression being partly affected by both genetics and epigenetics. Untested at this time, we propose short-term FDA-approved medication-assisted treatments (MAT) favoring blocking dopamine function followed by gentle activation of dopaminergic pathways leading to long-term dopamine homeostasis
Summary
Hypersexual behavior has been documented within clinical and research settings over the past decade [1]. Benjamin Rush, a physician one of the founding father of the United States clinically documented excessive sexual behaviors [2] Richard von Krafft-Ebing, a 19th-century Western European pioneer sexologist, and Hirshfeld in 1948 both continued the work [3,4]. The basic tenant of these investigators suggested that hypersexuality constituted persistent socially deviant sexual behavior(s) in both males and females with excessive sexual appetite being maladaptive. Even though hypersexuality is not included as a psychiatric diagnosis in DSM, work of a number of contemporary investigators including Kafka, Reid, Bancroft, their colleagues and the inclination of the World Health organization could lead to inclusion of this condition as a separate diagnostic entity [8,9,10,11]
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