Hypersexuality: A Critical Review and Introduction to the “Sexhavior Cycle”
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An empirical review of hypersexuality is timely as “compulsive sexual behavior” is being considered as an impulse control disorder for inclusion in the forthcoming International Classification of Diseases, 11th ed. Specifically, hypersexuality has been conceptualized in the literature as the inability to regulate one’s sexual behavior that is a source of significant personal distress. Various theoretical models have been posited in an attempt to understand the occurrence of hypersexuality, although disagreement about these divergent conceptualizations of the condition has made assessment and treatment of hypersexual clients more challenging. Theories of sexual compulsivity, sexual impulsivity, dual control (sexual inhibition/excitation), and sex addiction are critically examined, as are the diagnostic criteria for clinically assessing hypersexuality as a sexual disorder. Our discussion of hypersexuality covers a diversity of research and clinical perspectives. We also address various challenges associated with reliably defining, psychometrically measuring, and diagnosing hypersexuality. Furthermore, literature is reviewed that expresses concerns regarding whether hypersexuality (conceptualized as a disorder) exists, whether it is simply normophilic behavior at the extreme end of sexual functioning, or alternatively is a presenting problem that requires treatment rather than a clinical diagnosis. Following our literature review, we developed the “sexhavior cycle of hypersexuality” to potentially explain the neuropsychology and maintenance cycle of hypersexuality. The sexhavior cycle suggests that, for some hypersexual persons, high sexual arousal may temporarily and adversely impact cognitive processing (cognitive abeyance) and explain a repeated pattern of psychological distress when interpreting one’s sexual behavior (sexual incongruence). We also suggest that further research is required to validate whether hypersexuality is a behavioral disorder (such as gambling), although some presentations of the condition appear to be symptomatic of a heterogeneous psychological problem that requires treatment.
KeywordsDual control model Hypersexuality Sex addiction Sexhavior cycle Sexual compulsivity Sexual impulsivity DSM-5 ICD-11
The authors report no conflicts of interest and received no financial support directly related to the research, authorship, and/or publication of this target article. Additionally, the authors thank the reviewers and Professor Paul Vasey for their valuable feedback that contributed to the organization and writing of the published article.
- American Psychological Association. (2016). What do practicing psychologists do? Retrieved from http://www.apa.org/helpcenter/about-psychologists.aspx.
- Bancroft, J., Janssen, E., Carnes, L., Goodrich, D., Strong, D., & Long, J. S. (2004). Sexual activity and risk-taking in young heterosexual men: The relevance of sexual arousability, mood, and sensation seeking. Journal of Sex Research, 41, 181–192. doi: 10.1080/00224490409552226.PubMedCrossRefGoogle Scholar
- Baptie, C. A. (2012). The relationship between online sexual compulsivity and shame, guilt, internalized homonegativity, depression, and perceived social support in men who have sex with men (Doctoral dissertation). Available from ProQuest Dissertations and Theses Databases (UMI No. 3537114).Google Scholar
- Baumeister, R. F., Cantanese, K. R., & Vohs, K. D. (2001). Is there a gender difference in strength of sex drive? Theoretical views, conceptual distinctions, and a review of relevant evidence. Personality and Social Psychology Review, 5, 242–273. doi: 10.1207/S15327957PSPR0503_5.CrossRefGoogle Scholar
- 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, 413–422. doi: 10.1016/j.chiabu.2012.03.003.PubMedCrossRefGoogle Scholar
- Bowlby, J. (1973). Attachment and loss: Separation anxiety and anger (Vol. 2). New York, NY: Basic Books.Google Scholar
- Brunk, D. (2014). Axis I ailments common in men with hypersexual disorder. Clinical Psychiatry News, 42, 1.Google Scholar
- Cantor, J. M., Blanchard, R., & Barbaree, H. (2009). Sexual disorders. In P. H. Blaney & T. Millon (Eds.), Oxford textbook of psychopathology (2nd ed., pp. 527–548). New York: Oxford.Google Scholar
- Carnes, P. J. (1991). Don’t call it love: Recovery from sexual addiction. New York, NY: Bantam Books.Google Scholar
- Carnes, P. J. (1993). When the issue is sex addiction with Dr. Patrick Carnes/Interviewer: Richard L. Peck. Addiction and Recovery, 13, 14.Google Scholar
- Carnes, P. J. (2001). Out of the shadows: Understanding sexual addiction (3rd ed.). Center City, MN: Hazelden Publishing. (Originally published 1983)Google Scholar
- Carnes, P. J. (2003). Understanding sexual addiction. Siecus Report, 31, 5–7.Google Scholar
- Carpenter, B. N., Reid, R. C., Garos, S., & Najavits, L. M. (2013). Personality disorder comorbidity in treatment-seeking men with hypersexual disorder. Sexual Addiction & Compulsivity, 20, 79–90.Google Scholar
- Coleman, E. (1990). The obsessive–compulsive model for describing compulsive sexual behavior. American Journal of Preventive Psychiatry and Neurology, 2, 9–14.Google Scholar
- Cooper, C. A., Jadidian, A., Paggi, M., Romrell, J., Okun, M. S., Rodriguez, R. L., & Fernandez, H. H. (2009). Prevalence of hypersexual behavior in Parkinson’s disease patients. Not restricted to males and dopamine agonist use. International Journal of General Medicine, 2, 57–61. doi: 10.2147/IJGM.S4674.PubMedPubMedCentralCrossRefGoogle Scholar
- Dhuffar, M. K., Pontes, H. M., & Griffiths, M. D. (2015). The role of negative mood states and consequences of hypersexual behaviours in predicting hypersexuality among university students. Journal of Behavioral Addictions, 4, 181–188. doi: 10.1556/2006.4.2015.030.PubMedPubMedCentralCrossRefGoogle Scholar
- Downing, M. J., Jr., Antebi, N., & Schrimshaw, E. W. (2014). Compulsive use of internet-based sexually explicit media: Adaptation and validation of the compulsive internet use scale (CIUS). Addictive Behaviors, 39, 1126–1130. doi: 10.1016/j.addbeh.2014.03.007.PubMedPubMedCentralCrossRefGoogle Scholar
- Fagan, P. J., Wise, T. N., Schmidt, C. W., Jr., Ponticas, Y., Marshall, R. D., & Costa, P. T., Jr. (1991). A comparison of five-factor personality dimensions in males with sexual dysfunction and males with paraphilia. Journal of Personality Assessment, 57, 434–448. doi: 10.1207/s15327752jpa5703_4.PubMedCrossRefGoogle Scholar
- Faisandier, K. M., Taylor, J. E., & Salisbury, R. M. (2012). What does attachment have to do with out-of-control sexual behavior? New Zealand Journal of Psychology, 41, 19–29.Google Scholar
- Ferreira, V., Carvalho, E., Santos, R., Peralta, P., & Carvalho, M. (2008). Attachment and sexual compulsivity in sexually active adults: Associations with age of first intercourse, number of partners and short term relations. Sexologies, 17, S99. doi: 10.1016/S1158-1360(08)72787-7.CrossRefGoogle Scholar
- Fuste, R. J., Garcia, E., & Saldana, C. (2015). Hypersexuality, sexual impulsivity, sexual compulsivity or sexual addiction? Which is right? Poster session presented at the fourth International Consultation of Sexual Medicine, Madrid, Spain.Google Scholar
- Grant, J. E., Atmaca, M., Fineberg, N. A., Fontenelle L. F., Matsunaga, H., Janardhan Reddy, Y. C., … Stein, D. J. (2014). Impulse control disorders and “behavioural addictions” in the ICD-11. World Psychiatry, 13, 125–127. doi: 10.1002/wps.20115.
- Griffin, B. J., Worthington, E. L., Jr., Leach, J. D., Hook, J. N., Grubbs, J. B., Exline, J. J., & Davis, D. E. (2016). Sexual congruence moderates the associations of hypersexual behavior with spiritual struggle and sexual self-concept. Sexual Addiction & Compulsivity, 23, 279–295. doi: 10.1080/10720162.2016.1150924.CrossRefGoogle Scholar
- Grubbs, J. B., Exline, J. J., Pargament, K. I., Hook, J. N., & Carlisle, R. D. (2015a). Transgression as addiction: Religiosity and moral disapproval as predictors of perceived addiction to pornography. Archives of Sexual Behavior, 44, 125–136. doi: 10.1007/s10508-013-0257-z.PubMedCrossRefGoogle Scholar
- Grubbs, J. B., Stauner, N., Exline, J. J., Pargament, K. I., & Lindberg, M. J. (2015b). Perceived addiction to internet pornography and psychological distress: Examining relationships concurrently over time. Psychology of Addictive Behaviors, 29, 1056–1067. doi: 10.1037/adb0000114.PubMedCrossRefGoogle Scholar
- Hall, P. (2013). Understanding and treating sex addiction: A comprehensive guide for people who struggle with sex addiction and those who want to help them. New York, NY: Routledge.Google Scholar
- Hollander, E., Poskar, S., & Gerard, A. (2012). Subtypes and spectrum issues. In J. Zohar (Ed.), Obsessive-compulsive disorder: Current science and clinical practice (pp. 135–157). Chichester: Wiley.Google Scholar
- Hook, J. N., Farrell, J. E., Davis, D. E., Van Tongeren, D. R., Griffin, B. J., Grubbs, J. B., … Bedics, J. D. (2015). Self-forgiveness and hypersexual behavior. Sexual Addiction & Compulsivity, 22, 59–70. doi: 10.1080/10720162.2014.1001542.
- HuffPost Sports. (2011). Tiger Woods had sex with 121 women: ‘National Enquirer’. HuffingtonPost.com. Retrieved from http://www.huffingtonpost.com/2010/04/29/tiger-woods-had-sex-with_n_556948.html.
- Hughes, B. (2011). ‘Sexual addiction’: Diagnosis and treatment in clinical practice. Poster session presented at the International Conference for Healthcare and Medical Students, Dublin, Ireland.Google Scholar
- Janssen, E., & Bancroft, J. (2007). The dual control model: The role of sexual inhibition and excitation in sexual arousal and behavior. In E. Janssen (Ed.), The psychophysiology of sex (pp. 197–222). Bloomington, IN: Indiana University Press.Google Scholar
- Kafka, M. P. (2013). The development and evolution of the criteria for a newly proposed diagnosis for DSM-5: Hypersexual disorder. Archives of Sexual Behavior, 20, 19–26.Google Scholar
- Kalichman, S. C., & Cain, D. (2004). The relationship between indicators of sexual compulsivity and high risk sexual practices among men and women receiving services from a sexually transmitted infection clinic. Journal of Sex Research, 41, 235–241. doi: 10.1080/00224490409552231.PubMedCrossRefGoogle Scholar
- Kalichman, S. C., Johnson, J. R., Adair, V., Rompa, D., Multhauf, K., & Kelly, J. A. (1994). Sexual sensation seeking: Scale development and predicting AIDS-risk behavior among homosexually active men. Journal of Personality Assessment, 62, 385–397. doi: 10.1207/s15327752jpa6203_1.PubMedCrossRefGoogle Scholar
- Kaplan, H. S. (1995). The sexual desire disorders: Dysfunctional regulation of sexual motivation. New York, NY: Brunner/Mazel Publishers.Google Scholar
- Klein, M. (2003). Sex addiction: A dangerous clinical concept. Siecus report, 31, 8–11.Google Scholar
- Kor, A., Fogel, Y. A., Reid, R. C., & Potenza, M. N. (2013). Should hypersexual disorder be classified as an addiction. Sexual Addiction & Compulsivity, 20, 27–47.Google Scholar
- Kwee, A. W., Dominguez, A. W., & Ferrell, D. (2007). Sexual addiction and Christian college men: Conceptual, assessment, and treatment challenges. Journal of Psychology and Christianity, 26, 3–13.Google Scholar
- Laumann, E. O., Gagnon, J. H., Michael, R. T., & Michaels, S. (1994). The social organization of sexuality: Sexual practices in the United States. Chicago, IL: University of Chicago Press.Google Scholar
- McVinney, L. D. (1998). Social work practice with gay male couples. In G. P. Mallon (Ed.), Foundations of social work practice with lesbian and gay persons (pp. 209–228). Binghamton, NY: Harrington Park Press.Google Scholar
- Mechelmans, D. J., Irvine, M., Banca, P., Porter, L., Mitchell, S., Mole, T. B., … Voon, V. (2014). Enhanced attentional bias towards sexually explicit cues in individuals with and without compulsive sexual behaviours. PLoS ONE, 9, 1–7. doi: 10.1371/journal.pone.0105476.
- Miltenberger, R. G. (2008). Behavior modification: Principles and procedures (4th ed.). Belmont, CA: Thomson.Google Scholar
- Morgenstern, J., Muench, F., O’Leary, A., Wainberg, M., Parsons, J. T., Hollander, E., … Irwin, T. (2011). Non-paraphilic compulsive sexual behavior and psychiatric comorbidities in gay and bisexual men. Sexual Addiction & Compulsivity, 18, 114–134. doi: 10.1080/10720162.2011.593420.
- Moser, C. (2013). Hypersexual disorder: Searching for clarity. Sexual Addiction & Compulsivity, 20, 48–58.Google Scholar
- Muise, A., Milhausen, R. R., Cole, S. L., & Graham, C. (2013). Sexual compulsivity in heterosexual married adults: The role of sexual excitation and sexual inhibition in individuals not considered “high risk”. Sexual Addiction & Compulsivity, 20, 192–209. doi: 10.1080/10720162.2013.786661.Google Scholar
- Munhoz, R. P., Fabiani, G., Becker, N., Helio, A. G., & Teive, H. A. G. (2009). Increased frequency and range of sexual behavior in a patient with Parkinson’s disease after use of pramipexole. A case report. Journal of Sexual Medicine, 6, 1177–1180. doi: 10.1111/j.1743-6109.2008.00861.x.PubMedCrossRefGoogle Scholar
- Odlaug, B. L., Lust, K., Schrelber, L. R. N., Christenson, G., Derbyshire, K., Harvanko, A., … Grant, J. E. (2013). Compulsive sexual behavior in young adults. Annals of Clinical Psychiatry, 25, 193–200.Google Scholar
- Ogas, O., & Gaddam, S. (2011). A billion wicked thoughts: What the world’s largest experiment reveals about human desire. New York, NY: Dutton.Google Scholar
- Pachankis, J. E., Redina, H. J., Ventuneac, A., Grov, C., & Parsons, J. T. (2014). The role of maladaptive cognitions in hypersexuality among highly sexually active gay and bisexual men. Archives of Sexual Behavior, 43, 669–683. doi: 10.1007/s10508-014-0261-y.PubMedPubMedCentralCrossRefGoogle Scholar
- Parsons, J. T., Grov, C., & Golub, S. A. (2012). Sexual compulsivity, co-occurring psychosocial health problems, and HIV risk among gay and bisexual men: Further evidence of a syndemic. American Journal of Public Health, 102, 156–162. doi: 10.2105/AJPH.2011.300284.PubMedPubMedCentralCrossRefGoogle Scholar
- Politis, M., Loane, C., Wu, K., O’Sullivan, S. S., Woodhead, Z., Kiferie, L., … Piccini, P. (2013). Neural response to visual sexual cues in dopamine treatment-linked hypersexuality in Parkinson’s disease. Brain, 136, 400–411. doi: 10.1093/brain/aws326.
- Reid, R. C., Carpenter, B. N., Hook, J. N., Garos, S., Manning, J. C., Gilliland, R., … Fong, T. (2012a). Report of findings in a DSM-5 field trial for hypersexual disorder. Journal of Sexual Medicine, 9, 2868–2877. doi: 10.1111/j.1743-6109.2012.02936.x.
- Reid, R. C., Carpenter, B. N., Spackman, M., & Willes, D. L. (2008). Alexithymia, emotional instability, and vulnerability to stress proneness in patients seeking help for hypersexual behavior. Journal of Sex and Marital Therapy, 34, 133–149. doi: 10.1080/00926230701636197.PubMedCrossRefGoogle Scholar
- Schneider, J. P. (2005). Guidelines for psychiatrists working with patients with sexual addiction. Psychiatric Times, 22, 64–71.Google Scholar
- Stein, D. J., Silvera, R. J., Hagerty, R., & Marmor, M. (2012). Viewing pornography depicting unprotected anal intercourse: Are there implications for HIV prevention among men who have sex with men? Archives of Sexual Behavior, 41, 411–419. doi: 10.1007/s10508-011-9789-2.PubMedCrossRefGoogle Scholar
- Vitale, C., Santangelo, G., Trojano, L., Verde, F., Rocco, M., Grossi, D., & Barone, P. (2011). Comparative neuropsychological profile of pathological gambling, hypersexuality, and compulsive eating in Parkinson’s Disease. Movement Disorders, 26, 830–836. doi: 10.1002/mds.23567.PubMedCrossRefGoogle Scholar
- Voon, V., Mole, T. B., Banca, P., Porter, L., Morris, L., Mitchell, S., … Irvine, M. (2014). Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours. PLoS ONE, 7, 1–10. doi: 10.1371/journal.pone.0102419.
- Walton, M. T. (2017). Sexhavior cycle of hypersexuality [Theoretical model]. School of Psychology, University of New England, Armidale, Australia.Google Scholar
- Walton, M. T., Cantor, J. M., Bhullar, N., & Lykins, A. D. (2017a). A latent profile analysis of self-reported hypersexuality. Manuscript submitted for publication.Google Scholar
- Walton, M. T., Cantor, J. M., Bhullar, N., & Lykins, A. D. (2017b). A participant’s written response in an online study that pre-screens individuals for hypersexuality and explores the validity of the Sexhavior Cycle. Unpublished raw data related to the PhD Candidature of M. T. Walton at the School of Psychology, University of New England, Armidale, Australia.Google Scholar
- Weintraub, D., Koester, J., Potenza, M. N., Siderowf, A. D., Stacy, M., Voon, V., … Lang, A. E. (2010). Impulse control disorders in Parkinson disease: A cross-sectional study of 3090 patients. Archives of Neurology, 67, 589–595. doi: 10.1001/archneurol.2010.65.
- Weintraub, D., Siderowf, A. D., Potenza, M. N., Goveas, J., Morales, K. H., Duda, J. E., … Stern, M. B. (2006). Dopamine agonist use is associated with impulse control disorders in Parkinson’s disease. Archives of Neurology, 63, 969–973. doi: 10.1001/archneur.63.7.969.
- White, M. A., & Kimball, T. G. (2009). Attributes of Christian couples with a sexual addiction to internet pornography. Journal of Psychology and Christianity, 28, 350–359.Google Scholar
- Wilson, C. (2010). Sex legends: How many women have these celebs slept with, and who has bedded 35,000? Mirror Online. Retrieved from http://www.mirror.co.uk/3am/celebrity-news/sex-legends-how-many-women-221059.
- Wilt, J. A., Cooper, E. B., Grubbs, J. B., Exline, J. J., & Pargament, K. I. (2016). Associations of perceived addiction to internet pornography with religious/spiritual and psychological functioning. Sexual Addiction & Compulsivity, 23, 260–278. doi: 10.1080/10720162.2016.1140604.CrossRefGoogle Scholar
- Winder, B., Lievesley, R., Kaul, A., Elliott, H. J., Thorne, K., & Hocken, K. (2014). Preliminary evaluation of the use of pharmacological treatment with convicted sexual offenders experiencing high levels of sexual preoccupation, hypersexuality and/or sexual compulsivity. Journal of Forensic Psychiatry & Psychology, 25, 176–194. doi: 10.1080/14789949.2014.903504.CrossRefGoogle Scholar
- Womack, S. D., Hook, J. N., Ramos, M., Davis, D. E., & Penberthy, J. K. (2013). Measuring hypersexual behavior. Sexual Addiction & Compulsivity, 20, 65–78.Google Scholar
- World Health Organization. (1992). International statistical classification of diseases and related health problems (ICD-10). Geneva: Author.Google Scholar
- World Health Organization. (2016). Classifications: ICD-11 revision. Retrieved from http://www.who.int/classifications/icd/en/.