Hypersexual Disorder: A Proposed Diagnosis for DSM-V

Abstract

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.

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Acknowledgments

The author is a member of the DSM-V Workgroup on Sexual and Gender Identity Disorders (Chair, Kenneth J. Zucker, Ph.D.). I wish to acknowledge the valuable input I received from members of my Paraphilias subworkgroup (Ray Blanchard, Richard Krueger, and Niklas Långström), Kenneth J. Zucker, and two Workgroup Advisors, David Delmonico and Michael Miner. Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders V Workgroup Reports (Copyright 2009), American Psychiatric Association.

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Kafka, M.P. Hypersexual Disorder: A Proposed Diagnosis for DSM-V. Arch Sex Behav 39, 377–400 (2010). https://doi.org/10.1007/s10508-009-9574-7

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Keywords

  • Hypersexuality
  • Sexual desire
  • Sexual addiction
  • Sexual compulsivity
  • Paraphilia-related disorder
  • DSM-V