Abstract
Hypersexual behavior is a construct that is well recognized yet vaguely conceptualized, leading to some arguments that it may be comprised of multiple etiologies. Childhood sexual abuse is often acknowledged as a common experience among those with sexually addictive behaviors, yet the intersection between PTSD and sexual addiction has not been fully explored. This case illustrates the use of Cognitive Processing Therapy, an empirically supported treatment for PTSD, as a means to treat both PTSD symptoms and hypersexual behaviors in a veteran who had experienced military sexual trauma. Treatment led to a meaningful decrease in both types of symptoms, even in the absence of a structured treatment approach for sexual addiction. It is argued that differential diagnosis, including functional analysis of hypersexual behaviors, is crucial in treatment planning. Further, attention to trauma and PTSD is important in veterans and others for whom PTSD is part of the etiology of hypersexual behavior; trauma-focused CBT therapies can provide a useful treatment approach in these cases.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Adams, M., Donald, W., & Robinson, K. (2001). Shame reduction, affect regulation, and sexual boundary development: Essential building blocks of sexual addiction treatment. Sexual Addiction & Compulsivity, 8(1), 23–44.
American Psychological Association. (2017). Clinical practice guideline for the treatment of PTSD. http://www.apa.org/ptsd-guideline/ptsd.pdf. Accessed 11 December 2018.
Blain, L. M., Muench, F., Morgenstern, J., & Parsons, J. T. (2012). Exploring the role of child sexual abuse and posttraumatic stress disorder symptoms in gay and bisexual men reporting compulsive sexual behavior. Child Abuse and Neglect, 36(5), 413–422.
Carnes, P. (1983). The sexual addiction. Minneapolis, MN: CompCare Publications.
Carnes, P. J., & Adams, K. M. (2002). Clinical management of sex addiction. New York: Brunner-Routledge.
Carnes, P., Green, B., & Carnes, S. (2010). The same yet different: Refocusing the Sexual Addiction Screen Test (SAST) to reflect orientation and gender. Sexual Addiction & Compulsivity, 17, 7–30.
Carnes, S., & Love, T. (2017). Separating models obscures the scientific underpinnings of sex addiction as a disorder [Commentary]. Archives of Sexual Behavior, 46(8), 2253–2256.
Courtois, C. A., & Weiss, R. (2017). Early-life sexual trauma and adult-life hypersexual behavior (sex addiction) in males. In R. B. Gartner (Ed.), Understanding the sexual betrayal of boys and men: The trauma of sexual abuse (pp. 158–178). London: Routledge.
Cox, R. P., & Howard, M. D. (2007). Utilization of EMDR in the treatment of sexual addiction: A case study. Sexual Addiction & Compulsivity, 14(1), 1–20.
Foa, E. B., & Rothbaum, B. O. (2001). Treating the trauma of rape: Cognitive-behavioral therapy for PTSD. New York: Guilford Press.
Gilliland, R., South, M., Carpenter, B. N., & Hardy, S. A. (2011). The roles of shame and guilt in hypersexual behavior. Sexual Addiction & Compulsivity, 18(1), 12–29.
Gold, S. N., & Heffner, C. L. (1998). Sexual addiction: Many conceptions, minimal data. Clinical Psychology Review, 18, 367–381.
Hall, P. (2012). Understanding and treating sex addiction: A comprehensive guide for people who struggle with sex addiction and those who want to help them. London: Routledge.
Hall, P. (2014). Sex addiction—An extraordinarily contentious problem. Sexual and Relationship Therapy, 29(1), 68–75.
Kafka, M. P. (2010). Hypersexual disorder: A proposed diagnosis for DSM-V. Archives of Sexual Behavior, 39, 377–400.
Knight, R. A., & Graham, F. J. (2017). Hypersexuality: Equifinal, cohesive, clinical presentation or symptom cluster with multiple underlying mechanisms? [Commentary]. Archives of Sexual Behavior, 46(8), 2261–2264.
Kort, J. (2017). Sexual aftereffects in male survivors of childhood sexual abuse: Orientation confusion, compulsions, kinky sexual interests, and dysfunctions. In R. B. Gartner (Ed.), Understanding the sexual betrayal of boys and men: The trauma of sexual abuse (pp. 311–335). London: Routledge.
Kraus, S. W., Martino, S., Potenza, M. N., Park, C., Merrel, J. D., & Hoff, R. A. (2017). Examining compulsive sexual behavior and psychopathology among a sample of postdeployment US male and female military veterans. Military Psychology, 29(2), 143–156.
Kraus, S. W., Voon, V., & Potenza, M. N. (2016). Should compulsive sexual behavior be considered an addiction? Addiction, 111(12), 2097–2106.
Morris, E. E., Smith, J. C., Farooqui, S. Y., & Surís, A. M. (2014). Unseen battles: The recognition, assessment, and treatment issues of men with military sexual trauma (MST). Trauma, Violence, & Abuse, 15(2), 94–101.
Petri-Kelvasa, M., & Schulte-Herbrüggen, O. (2017). Disinhibited exposing behavior, hypersexuality, and erectile dysfunction as a consequence of posttraumatic stress in a 42-year-old male patient. Archives of Sexual Behavior, 46, 2197–2205.
Raymond, N. C., Lloyd, M. D., Miner, M. H., & Kim, S. W. (2007). Preliminary report on the development and validation of the Sexual Symptom Assessment Scale. Sexual Addiction & Compulsivity, 14, 119–129.
Resick, P. A., Nishith, P., Weaver, T. L., Astin, M. C., & Feuer, C. A. (2002). A comparison of cognitive processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Consulting and Clinical Psychology, 70, 867–879.
Resick, P. A., & Schnicke, M. K. (1993). Cognitive processing therapy for rape victims: A treatment manual. Newbury Park, CA: Sage.
Rosenberg, K. P., O’Connor, S., & Carnes, P. (2014). Sex addiction: An overview. In K. P. Rosenberg & L. Curtiss Feder (Eds.), Behavioral addictions: Criteria, evidence, and treatment (pp. 215–236). Waltham, MA: Academic Press.
Smith, P., Potenza, M., Mazure, C., McKee, S., Park, C., & Hoff, R. (2014). Compulsive sexual behavior among male military veterans: Prevalence and associated clinical factors. Journal of Behavioral Addictions, 3(4), 214–222.
Walton, M. T., Cantor, J. M., Bhullar, N., & Lykins, A. D. (2017). Hypersexuality: A critical review and introduction to the “sexhavior cycle”. Archives of Sexual Behavior, 46(8), 2231–2251.
Weathers, F., Litz, B., Herman, D., Huska, J., & Keane, T. (October, 1993). The PTSD checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the meeting of the International Society for Traumatic Stress Studies, San Antonio, TX.
Acknowledgements
This manuscript is the result of work supported with resources and the use of facilities at the Clement J. Zablocki VAMC, Milwaukee, WI.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The author declares no conflict of interest.
Ethical Approval
The manuscript was reviewed by the Institutional Review Board and determined to constitute operations rather than research.
Informed Consent
The patient described has given written consent for this case study to be written, with the understanding that identifying information has been changed.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Larsen, S.E. Hypersexual Behavior as a Symptom of PTSD: Using Cognitive Processing Therapy in a Veteran with Military Sexual Trauma-Related PTSD. Arch Sex Behav 48, 987–993 (2019). https://doi.org/10.1007/s10508-018-1378-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10508-018-1378-1