Hypersexual Behavior Research Articles

Differentiating Emotions in a Sample of Men in Treatment for Hypersexual Behavior

This study investigated distinct emotions in a sample of men (n = 103) seeking help for hypersexual behavior compared to a control group of college students (n = 100) using the Hypersexual Behavior Inventory and the Differential Emotions Scale. Significant differences between groups emerged on several domains of emotion and hypersexual behavior. Self-hostility was the most significant predictor of hypersexual behavior. These findings suggest that self-critical affect, such as shame, might exert an influence in precipitating or perpetuating hypersexual behavior.

Impulsive smoking in a patient with Parkinson’s disease treated with dopamine agonists

Impulse control disorders, including pathological gambling, binge eating, compulsive shopping and hypersexual behaviors, have frequently been reported as a side effect of dopaminergic medications for Parkinson’s disease (PD). Here we describe a patient with PD who developed an unusual manifestation of impulsive behaviors, including cigarette smoking, associated with an increase in dopamine agonist medication. We postulate this to be related to an overstimulation of mesolimbic dopamine receptors responsible for reward-seeking behaviors. Further research is needed to examine impulsive cigarette smoking in PD.

Hypersexual Disorder: A More Cautious Approach

Kafka (2009) has done an exemplary job of synthesizing disparate perspectives on dysregulated sexuality, and distilling the common elements into Hypersexual Disorder, a proposed new diagnosis for the fifth edition of the Diagnostic and Statistical ManualofMentalDisorders.Thereappears tobesubstantialclinical support for this disorder; however, strong empirical evidence demonstrating its validity is currently lacking. Further, previous criticisms of the theoretical assumptions underlying a dysregulated sexuality disorder, regardless of how it is conceptualized and labeled, have not yet been adequately addressed (e.g., Giles, 2006;LevineTMoser,1993;RinehartM Winters, Christoff, & Gorzalka, 2010). For these reasons, the addition of Hypersexual Disorder to the DSM may be premature. To meet the DSM definition for a mental disorder, it must be shown that Hypersexual Disorder represents a psychological or behavioral syndrome that is the manifestation of a dysfunction (American Psychiatric Association, 2000). In the case of Hypersexual Disorder, there is no clear explanation of the dysfunction. Kafka’s description indicates that the dysfunction is manifest as recurrent and excessive sexual thoughts, feelings, and behaviors. Basedonthisassertion,wearetoassumethat thereisnormalsexual expression and too much sexual expression (i.e., the dysfunction), and that there is a distinct and agreed upon boundary between the two. This is not the case. Kafka (1997)previouslyproposed that excessive sexuality (i.e., hypersexuality) was best operationalized as a weekly average of seven of more orgasms, the intention being that only a small proportion of the population would be identified as hypersexual (5–10%). This diagnostic marker has not been widely adopted by the academic and clinical communities, perhaps because there is a dearth of independent empirical support. Also, recent data suggest that a larger proportion of the population may meet this criterion, calling into question its specificity. For example, in our study utilizing an internet based convenience sample, 43.9% (2559/5824) of men and 21.5% (1538/7166) of women would have met this criterion for hypersexuality (Winters et al., 2010). These subjects reported a total weekly average sexual outlet of seven or more orgasms on Kafka’s (1997) Sexual Outlet Inventory. The other way in which increased or excessive sexual behavior has been operationalized is by its qualitative nature. Examples of sexual behaviors that are thought to be symptomatic of Hypersexual Disorder include: compulsive masturbation, protracted promiscuity, and pornography, sex chatroom, and phone sex addiction (e.g., Cooper, Scherer, Boies, & Gordon, 1999; Kafka & Hennen, 1999; Raymond, Coleman, & Miner, 2003). Yet, within the literature, there is no explanation provided as to how these are operationalized and measured. It is not clear when masturbation becomes compulsive, when promiscuity becomes protracted, and when the pursuit of sexual stimuli becomes a so-called addiction. Anonymous sex, onenight stands, and multiple partners are also considered hypersexual behaviors (e.g., Coleman, Raymond, & McBean, 2003; Kalichman & Rompa, 1995), but it seems that these behaviors are considered pathological only because of an ongoing, if not overtly stated, bias that sexual expression outside a traditional monogamous marital dyad is unhealthy. The criteria indicate that the sexual fantasies, urges or behaviors characteristic of Hypersexual Disorder may interfere with day-to-day responsibilities and activities. As has been noted previously, these types of experiences can be typical of healthy sexually active individuals, especially those in new sexual relationships (Gold & Heffner, 1998; Moser, 1993). Additionally, people often will repeatedly eschew activities and J. Winters (&) Forensic Psychiatric Services Commission, British Columbia Provincial Health Services Authority, #300–307 West Broadway, Vancouver, BC V5Y 1P9, Canada e-mail: jasonwinters@telus.net

Self-Reported Differences on Measures of Executive Function and Hypersexual Behavior in a Patient and Community Sample of Men

ABSTRACTPatients seeking help for hypersexual behavior often exhibit features of impulsivity, cognitive rigidity, poor judgment, deficits in emotion regulation, and excessive preoccupation with sex. Some of these characteristics are also common among patients presenting with neurological pathology associated with executive dysfunction. These observations led to the current investigation of differences between a group of hypersexual patients (n == 87) and a non-hypersexual community sample (n == 92) of men using the Behavior Rating Inventory of Executive Function—Adult Version (BRIEF-A) and the Hypersexual Behavior Inventory (HBI). Significant differences between the groups emerged on eight subscales and all of the general indices of executive functioning with the most dramatic differences on BRIEF-A's Shift, Emotional Control, Initiate, and Plan/Organize subscales. Hypersexual behavior was positively correlated (r == .37, p < .01) with global indices of executive dysfunction and several subscales of the BRIEF-A. These findings provide preliminary evidence supporting the hypothesis that executive dysfunction may be implicated in hypersexual behavior.

P01-279 - Hypersexuality following traumatic brain injury (TBI) and neurosurgery: case analysis with literature review

IntroductionHypersexuality is an uncommon behavioral complication associated with traumatic brain injury (TBI) involving lesions to frontal basal, temporal, or diencephalic structures. Experimental brain injury in animals has produced hypersexual behaviors; however, there is comparative paucity of knowledge in humans. TBI with hypersexuality offers insights into neurological basis of aberrant sexual behaviors as well as potential treatments. This case report describes social/sexual disinhibition in a patient following neurosurgery for self-inflicted TBI.MethodCase analysis with literature review.Results32-year-old male was admitted with TBI following an unsuccessful suicide attempt, self-inflicted nail gun injury to the occiput. CT scan revealed 6.5cm nail that had entered the skull in right occiput, right parasagittal location with nail head right of vein of Galen, coursing through splenium of corpus callosum, right thalamus-hypothalamus-midbrain, with its tip at the suprasellar cistern. Occipital craniotomy with retrieval of foreign body was performed eleven days after admission. From post-operative day eight through twenty-seven, patient made inappropriate sexual comments to female medical student: asking her out repetitively, describing her physical appearance, enquiring about her suitors, and requesting her to call him upon his discharge. Prior psychiatric history was pertinent for major depression and social anxiety (especially women) with psychotropic noncompliance. During admission, patient was diagnosed with recurrent major depression, social anxiety by history, and impulse control disorder nos. On sertraline titrated to 100mg qhs, depression resolved with increased control over newly acquired sexual/social disinhibition noted.ConclusionTBI can lead to social disinhibition and hypersexuality. Sertraline may be a beneficial treatment.

Hypersexual Disorder: A Proposed Diagnosis for DSM-V

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.

Hypersexuality from resection of left occipital arteriovenous malformation

The authors report their experience on one patient with hypersexuality from resection of left occipital arteriovenous malformation. To the best of our knowledge, this is the first case reported in the literature. A 35-year-old right-handed female farmer suffered a sudden left occipital hemorrhage with subarachnoid and subdural hemorrhages of the left hemisphere. Transient left uncal herniation occurred at the onset and was released by conservative treatment. Digital subtraction angiography showed a brain left occipital arteriovenous malformation. After microsurgical resection of the arteriovenous malformation, the patient developed hypersexual behavior. Positron emission tomography showed hypermetabolism in the left frontal region and left posterior hippocampal gyrus and hypometabolism in the left anterior hippocampal gyrus and the left occipital surgical area. Theories concerning normal pressure perfusion breakthrough and specific areas in the brain responsible for the human sexual response are discussed.

Forced spousal intercourse after seizures

Hypersexuality, a feature of Klüver–Bucy syndrome, is a rare but dramatic postictal symptom of temporal lobe epilepsy. We describe a 39-year-old patient with uncontrolled partial epilepsy who developed postictal periods of hypersexual aggression toward his wife after nocturnal convulsions. Following these seizures, he would have forced intercourse with his wife, followed by tremendous guilt and remorse when informed of his actions in the morning. Nocturnal convulsions and postictal hypersexuality resolved with a combination of lamotrigine and levetiracetam, more sleep, and stress management. The temporal features of the hypersexual behavior with respect to convulsions and the resolution of the behavior with seizure control support that aggressive hypersexuality can occur as a transient postictal behavioral change. The more intense nature of his symptoms compared with previously reported cases may reflect the occurrence of symptoms after tonic–clonic rather than partial seizures.

Demoralization, Hypomanic Activation, and Disconstraint Scores on MMPI-2 Scales as Significant Predictors of Hypersexual Behavior

This article reports the findings of a study investigating which facets of psychopathology are most strongly associated with hypersexual behavior among a patient sample (N = 151). Psychopathology was measured using the Restructured Clinical scales and the PSY-5 scales of the MMPI-2, and hypersexual behavior was measured using the Sexual Compulsivity Scale. Regression analysis revealed that Demoralization was the strongest predictor of scores on a measure of hypersexuality, with Hypomanic Activation on the RC scales and Disconstraint on the PSY-5 scales making additional modest, but statistically significant, contributions. Although some MMPI-2 scales were significantly elevated, an important finding of the current investigation is the lack of elevations across many MMPI-2 scales. The results of these findings are addressed and recommendations for future research are discussed.

Exploring Relationships of Psychopathology in Hypersexual Patients Using the MMPI-2

This article reports the findings of a study investigating relationships among Minnesota Multiphasic Personality Inventory-2 (MMPI-2) scales as they pertain to a group of individuals seeking help for hypersexual behavior (N = 152). A number of MMPI-2 scale elevations were prevalent with this group, suggesting that some of these patients experience symptoms associated with psychopathology and interference or impairment in important areas of personal and interpersonal functioning. We failed to find any evidence in our data supporting the notion that hypersexual patients experience addictive tendencies. For a significant portion of the group, however, there were few-to-minimal elevations, reflecting normal psychological profiles. An overall important finding in our data suggests that patients presenting with hypersexual behavior are a diverse group, sufficiently so that studying subsamples of this group may lead to a clearer understanding of this behavior. Models that promote a homogenous conceptualization and treatment of hypersexuality likely miss important differences that provide valuable insight when working with this population.

The so-called hypersexual behaviors in dementia

Real hypersexuality is rare in demented subjects. Most inappropriate sexual behaviors are related to disinhibition or lack of taking into account contextual environment and feelings of others. Four dimensions should be taken into account for their analysis: research of intimacy, libido enhancement, disinhibition, and cognitive factors. An integrative model is proposed to adequately adapt their management, using both psychocomportemental and pharmacological approaches.

Hypersexuality among Cognitively Impaired Older Adults

Hypersexuality, also referred to in the literature as sexually inappropriate behavior and sexual disinhibition, involves persistent, uninhibited sexual behaviors directed at oneself or at others. For older adults, the literature generally attributes the behavior to biochemical or physiological changes that accompany cognitive impairment-specifically, dementia. Although less common than other behavioral issues, such as aggression and agitation, hypersexuality presents complex logistical and ethical problems for caregivers. This article reviews the current literature on hypersexual behavior. Assessment essentials as well as nonpharmacological and pharmacological treatment approaches are discussed, identifying the need for standardization as well as caregiver education and training.

Behavioural phenotype in Börjeson‐Forssman‐Lehmann syndrome

Börjeson-Forssman-Lehmann syndrome (BFLs) is an X-linked inherited disorder characterised by unusual facial features, abnormal fat distribution and intellectual disability. As many genetically determined disorders are characterised not only by physical features but also by specific behaviour, we studied whether a specific behavioural phenotype exists in BFLs. We studied in detail the behaviour of four molecularly proven BFLs patients, and reviewed available literature on BFLs specifically for behavioural characteristics. Behaviour in persons with BFLs is in general friendly, but can be challenging with externalising and thrill-seeking features. Social skills are good. However, variation among patients is wide. Three patients from a single family showed expressed hypersexual behaviour. This was not present in other patients. In BFLs a specific behavioural phenotype exists and in behaviour general is challenging besides a friendly habit. Within single families more problematic behaviour may occur. Further behavioural and molecular analysis of a larger group of patients is warranted to determine whether a genotype-behavioural phenotype correlation exists.

Prevalence of hypersexual behavior in Parkinson&amp;rsquo;s disease patients: Not restricted to males and dopamine agonist use

This study investigates the prevalence and demographic characteristics of hypersexuality in Parkinson's disease (PD). Impulse control disorders in PD patients have been associated with dopamine agonist therapy. Moreover, hypersexuality and pathological gambling have been associated with males, while females may be inherently thought to be more likely to participate in compulsive shopping and binge-eating behaviors. In this study, a screening mail-in survey was sent to all PD patients at a single Movement Disorders Center. One hundred forty one of 400 (35.3%) research packets were returned completed. Fifteen of 141 patients met initial screening criteria for hypersexual behavior. After detailed interview, only 6/141 (4.3%) of PD patients met criteria for pathologic hypersexual behavior. These behaviors included: compulsive masturbation, prostitution, and paraphilias. Patients with a younger age of PD onset were more likely to exhibit hypersexual behavior. Unlike previous report, no significant association was found between hypersexuality and gender or dopamine agonist use. Rather, this study suggests that physicians should be vigilant for hypersexual behavior in all PD patients, regardless of gender and PD medication regimen. Ultimately, given the innate sensitivity of the topic and survey limitations, it is very likely that hypersexual behavior in our cohort, as it is in the general PD population, has been under-reported.

Coping strategies used by hypersexual patients to defend against the painful effects of shame

This article reports the findings of a study investigating coping strategies used by hypersexual patients (n = 71), compared with a control group (n = 73), in their attempts to defend against shame. Coping strategies were measured using the Compass of Shame Scale (CoSS) and hypersexual behaviour was measured by the Hypersexual Behavior Inventory (HBI). A multivariate analysis of variance of between-group differences was significant, and examination of post hoc univariate tests revealed that the sample of hypersexual patients defended against shame with higher levels of withdrawal and higher tendencies to attack self and others when compared with the control group. The effect sizes of these differences were moderate to large. A categorical analysis of the patient group indicated that the greatest percentages of elevated shame scores were clustered on the Withdrawal and Attack Self subscales of the CoSS. Between-group differences on the Avoidance subscale of the CoSS were not significant. The results of this study are discussed as they pertain to clinical practice, and future recommendations for research are offered.

Assessing psychological symptom patterns of patients seeking help for hypersexual behavior

This study used the Symptom Checklist to examine the psychological symptom patterns among hypersexual patients (n = 59) at intake compared to a control group of non-hypersexual individuals (n = 55). Group membership for the hypersexual group was assigned based on the individual's chief complaint at intake and on elevated scores on the Hypersexual Behavior Inventory. A discriminant function analysis of between-group differences was statistically significant and post-hoc univariate tests revealed several distinct features associated with the hypersexual group compared to the controls. These findings are discussed in the context of treatment implications for clinicians working with patients seeking help for hypersexual behavior.

Effect of citalopram in treating hypersexuality in an Alzheimer’s Disease case

Hypersexuality in Alzheimer's disease (AD) has been rarely investigated. Hypersexual behaviours should be classified as a sexual obsession and included in the "obsessive-compulsive disorder-like" spectrum. Hypersexuality has no proven treatment, although reports have described reductions of this behaviour using antiandrogen treatment, H2-receptor antagonists and antipsychotic drugs. Serotonin reuptake blockers seem to be effective in the treatment of sexual obsessions or compulsions and less on paraphilic disturbances. We present the case of a 54-year-old male patient with Alzheimer's disease with compulsive sexual behaviour as reported by his wife. A 18-FDG PET scan evidenced prevalent hypometabolism of the right hemisphere, congruent with neuropsychological evaluation. Donepezil, 10 mg per day, produced cognitive improvement but no effects on sexual behaviour. Therapy with SSRI was subsequently started (citalopram): after 60 days, the patient showed improvement in both the compulsive pursuit of sex acts and the level of frustration when refused.

Treatment of Hypersexual Behavior with Oral Estrogen in an Autistic Male

Hypersexual behavior can be exhibited by patients with autism. Several medications have been used in hypersexual paraphiliac male and elderly patient populations, including antiandrogens, estrogen, gonadotropin-releasing hormone analogues, and selective serotonin reuptake inhibitors. Due to limited research in autistic patients exhibiting hypersexuality, physicians must base their medication selection on outcomes seen in patients with other conditions.

Klüver Bucy syndrome, unusual consequence of excessively rapid correction of severe hyponatremia

Features of Klüver-Bucy syndrome (KBS) include hypersexuality, hyperorality, placidity, visual agnosia, amnesia, hypermetamorphosis, and emotional and nutritional behavior changes. It is a clinical presentation of bitemporal disorders with limbic system abnormalities. The most common cause of KBS is herpes encephalitis. An otherwise healthy 61-year-old woman presented with mental status changes (MMSE-0) after 6 days of severe vomiting. Extracellular dehydration, hyponatremia (107 mmol/L), low levels of natriuresis, and mild hypokalemia were noted. The initial computed tomography (CT) of the brain was normal. Over 36 hours of hospitalization in a district hospital she developed unusual neuropsychiatric disorders: hypersexuality, hyperorality, absence, visual agnosia, sensory aphasia, amnesia, and depression typical of KBS. She was then transferred to a neurology department. Clear improvement was visible 3 months later: MMSE-22, moderation of hypersexuality and hyperorality, partial correction of amnesia and aphasia, regression of visual agnosia. But the prosopagnosia (face blindness) persisted, and the patient remained unable to differentiate positive and negative facial expressions. Intracranial mass, epilepsy, neuromeningeal infection and head trauma were all ruled out. Antiepileptic and antiherpetic agents were tested without success. There was no evidence of adrenal insufficiency or inappropriate vasopressin secretion. Only severe vomiting, corrected by water intake, could explain the hyponatremia. The first MRI showed bitemporal edema; 3 months later it showed large bitemporal lesions, both internal and external, with atrophy of the hippocampus and limbic system. These MRI findings are characteristic of KBS. To our knowledge, this is the only the second case of KBS with bitemporal myelinolysis reported related to excessively rapid correction of hyponatremia (increase of 30 mmol/L over 36 h), which leads more usually to central pontine myelinolysis.

Alexithymia, Emotional Instability, and Vulnerability to Stress Proneness in Patients Seeking Help for Hypersexual Behavior

This article reports the findings of a study investigating alexithymia, emotional instability, and vulnerability to stress proneness among individuals (N = 120) seeking help for hypersexual behavior. At the onset of treatment at an outpatient community clinic, subjects completed the Sexual Compulsivity Scale (SCS), the 20-item Toronto Alexithymia Scale (TAS-20), and the NEO Personality Inventory Revised (NEO-PI-R). The results of a hierarchical regression analysis revealed the best model in predicting severity of hypersexual behavior included the facets of depression and vulnerability to stress from the NEO and the Difficulty Identifying Feelings (DIF) factor of the TAS-20. Although the NEO domain of neuroticism appeared to capture the majority of variance in hypersexual behavior, the difficulty identifying feelings factor of the TAS-20 did make some modest, but significant, contribution to the severity of hypersexual behavior after controlling for depression and vulnerability to stress. These data provide evidence for the hypothesis that individuals who manifest symptoms of hypersexual behavior are more likely to experience deficits in affect regulation and negative affect (including alexithymia, depression, and vulnerability to stress). Possible reasons for these results are suggested and future recommendations for research are offered.