Skip to main content

Advertisement

Log in

Controversies About Hypersexual Disorder and the DSM-5

  • Variations in Orientation, Identity, Addiction, and Compulsion (E Coleman, Section Editor)
  • Published:
Current Sexual Health Reports Aims and scope Submit manuscript

Abstract

Criteria for hypersexual disorder were proposed for consideration for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), but ultimately rejected by the American Psychiatric Association despite a field trial suggesting the criteria were valid and reliable. This article highlights the vast array of controversial issues surrounding the proposal for hypersexual disorder. While some criticisms covered a broader scope of general concerns about the field of psychiatric mental illness, many of these often extended to the proposal for hypersexual disorder. It is important to discuss both general concerns about psychiatric disorders and those specifically focused on hypersexuality in order to understand the challenges encountered in advancing the criteria for hypersexual disorder. This article attempts to place the controversies, criticisms, and issues about hypersexuality in context from leading experts in the field.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Kafka MP. Hypersexual disorder: a proposed diagnosis for DSM-V. Arch Sex Behav. 2010;39:377–400. This is the first publication to highlight the proposed criteria for HD for the DSM-5 and contains an excellent literature review.

    Article  PubMed  Google Scholar 

  2. Phillips J, Frances A, Cerullo MA, et al. The six most essential questions in psychiatric diagnosis: a pluralogue part 1: conceptual and definitional issues in psychiatric diagnosis. Philos Ethics Humanit Med. 2012;7:3. This is one of a three part series of well written articles that discusses some of the major concerns around defining mental illness in the psychiatric community.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Wakefield JC. The DSM-5’s proposed new categories of sexual disorder: the problem of false positives in sexual diagnosis. Clin Soc Work J. 2012;40:213–23.

    Article  Google Scholar 

  4. Winters J. Hypersexual disorder: a more cautious approach. Arch Sex Behav. 2010;39:594–6.

    Article  PubMed  Google Scholar 

  5. Steele VR, Staley C, Fong T, Prause N. Sexual desire, not hypersexuality, is related to neurophysiological responses elicited by sexual images. Socioaffect Neurosci Psychol. 2013;3:20770.

    PubMed  PubMed Central  Google Scholar 

  6. Halpern AL. The proposed diagnosis of hypersexual disorder for inclusion in DSM-5: unnecessary and harmful. Arch Sex Behav. 2011;40:487–8.

    Article  PubMed  Google Scholar 

  7. Kafka, MP. What happened to hypersexual disorder? Arch Sex Behav. doi:10.1007/s10508-014-0326-y.

  8. Moser C. Hypersexual disorder: just more muddled thinking. Arch Sex Behav. 2011;40(2):227–9. Dr. Moser has been a major opponent of the HD proposal. While some of his viewpoints have been somewhat strident, he does raise important questions to be addressed for HD researchers.

    Article  PubMed  Google Scholar 

  9. Kafka MP, Krueger RB. Response to Moser’s (2010) critique of hypersexual disorder for DSM-5. Arch Sex Behav. 2011;40:231–2.

    Article  Google Scholar 

  10. Scadding J. Diagnosis: the clinician and the computer. Lancet. 1967;2:877–82.

    Article  PubMed  CAS  Google Scholar 

  11. Wakefield JC. The concept of mental disorder: diagnostic implications of the harmful dysfunction analysis. World Psychiatry. 2007;6:149–56.

    PubMed  PubMed Central  Google Scholar 

  12. Varga S. Defining mental disorder. Exploring the ‘natural function’ approach. Philos Ethics Humanit Med. 2011;6:1.

    Article  PubMed  PubMed Central  Google Scholar 

  13. First MB, Wakefield JC. Defining ‘mental disorder’ in DSM-V. Psychol Med. 2010;40:1779–82.

    Article  PubMed  CAS  Google Scholar 

  14. Giles J. No such thing as excessive levels of sexual behavior. Arch Sex Behav. 2006;35(6):641–2.

    Article  PubMed  Google Scholar 

  15. Levine MP, Troiden RR. The myth of sexual compulsivity. J Sex Res. 1988;25(3):347–63.

    Article  Google Scholar 

  16. Van Lankveld J. The road ahead: theoretical models to guide new sex research. J Sex Res. 2012;49(2–3):103–4.

    Article  PubMed  Google Scholar 

  17. Bancroft J, Graham CA, Janssen E, Sanders SA. The dual control model: current status and future directions. J Sex Res. 2009;46(2–3):121–42.

    Article  PubMed  Google Scholar 

  18. Reid RC, Karim R, McCrory E, Carpenter BN. Self-reported differences on measures of executive function and hypersexual behavior in a patient and community sample of men. Int J Neurosci. 2010;120(2):120–7.

    Article  PubMed  Google Scholar 

  19. Reid RC, Garos S, Carpenter BN, Coleman E. A surprising finding related to executive control in a patient sample of hypersexual men. J Sex Med. 2011;8(8):2227–36.

    Article  PubMed  Google Scholar 

  20. Kingston DA, Firestone P. Problematic hypersexuality: a review of conceptualization and diagnosis. Sex Addict Compul. 2008;15:284–310.

    Article  Google Scholar 

  21. Reid RC, Cyders MA, Moghaddam JF, Fong TW. Psychometric properties of the Barratt Impulsiveness Scale in patients with gambling disorders, hypersexuality, and methamphetamine dependence. Addict Behav. 2014;39(11):1640–5.

    Article  PubMed  Google Scholar 

  22. Reid RC, Garos S, Fong T. Psychometric development of the hypersexual behavior consequences scale. J Behav Addict. 2012;1(3):115–22.

    Article  Google Scholar 

  23. Coleman E, Horvath KJ, Miner M, Ross MW, Oakes M, Rosser BRS. Compulsive sexual behavior and risk for unsafe sex among internet using men who have sex with men. Arch Sex Behav. 2010;39:1045–53.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Fry PS, Debats DL. Perfectionism and other related trait measures as predictors of mortality in diabetic older adults: a six-and-a-half-year longitudinal study. J Health Psychol. 2011;16(7):1058–70.

    Article  PubMed  Google Scholar 

  25. Bardone-Cone AM, Wonderlich SA, Frost RO, Bulik CM, Mitchell JE, Uppala S, et al. Perfectionism and eating disorders: current status and future directions. Clin Psychol Rev. 2007;27:384–405.

    Article  PubMed  Google Scholar 

  26. McGrath DS, Sherry SB, Stewart SH, Mushquash AR, Allen SL, Nealis LJ, et al. Reciprocal relations between self-critical perfectionism and depressive symptoms: evidence from a short-term, four-wave longitudinal study. Can J Behav Sci. 2012;44(3):169–81.

    Article  Google Scholar 

  27. Flett GL, Hewitt PL. Treatment interventions for perfectionism—a cognitive perspective: introduction to the special issue. J Ration Emot Cogn Behav Ther. 2008;26:127–33.

    Article  Google Scholar 

  28. Block AD, Adriaens PR. Pathologizing sexual deviance: a history. J Sex Res. 2013;50(3–4):276–98.

    Article  PubMed  Google Scholar 

  29. Skegg K, Nada-Raja S, Dickson N, Paul C. Perceived “out of control” sexual behavior in a cohort of young adults from the Dunedin Multidisciplinary Heath and Development Study. Arch Sex Behav. 2010;39:968–78.

    Article  PubMed  Google Scholar 

  30. Winters J, Christoff K, Gorzalka BB. Dysregulated sexuality and high sexual desire: distinct constructs? Arch Sex Behav. 2010;39:1029–43. This is one of the prominent articles to question whether hypersexuality is just a problem with high sexual desire rather than a pathology.

    Article  PubMed  Google Scholar 

  31. Voon V, Mole TB, Banca P, et al. Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours. PLoS ONE. 2014;9(7):e102419. This is one of the more tightly controlled neuroimaging studies that also used the HD criteria in the assessment of subjects. This study showed significant differences in various brain regions among sexually compulsive subjects paralleling those also found in subjects with substance abuse.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Miner MH, Raymond N, Mueller BA, et al. Preliminary investigation of the impulsive and neuroanatomical characteristics of compulsive sexual behavior. Psychiatry Res. 2009;174:146–51.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kuhn S, Gallinat J. Brain structure and functional connectivity associated with pornography consumption: the brain on porn. JAMA Psychiatry. 2014;71(7):827–34.

    Article  PubMed  Google Scholar 

  34. Ley D, Prause N, Finn P. The emperor has no clothes: a review of the ‘pornography addiction’ model. Curr Sex Health Rep. 2014;6:94–105. While this paper has been very controversial, it highlights the need for theory in guiding the scientific study of HD and offers plausible alternative viewpoints in conceptualizing hypersexual behavior.

    Article  Google Scholar 

  35. Reid RC, Carpenter BN, Hook JN, Garos S, Manning JC, Gilliland R, et al. Report of findings in a DSM-5 field trial for hypersexual disorder. J Sex Med. 2012;9(11):2868–77. This was the UCLA field trial for the DSM-5 proposed criteria for HD wherein the researchers found evidence for the validity and reliability of the HD criteria.

    Article  PubMed  Google Scholar 

  36. Twohig MP, Crosby JM, Cox JM. Viewing internet pornography: for whom is it problematic, how, and why? Sex Addict Compul. 2009;16(4):253–66.

    Article  Google Scholar 

  37. Hook JN, Reid RC, Penberthy JK, Davis DE, Jennings DJ. Methodological review of treatments for nonparaphilic hypersexual behavior. J Sex Marital Ther. 2014;40(4):294–308.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Reid has no formal declarations of conflicts. He was the principal investigator for the DSM-5 field trial on hypersexual disorder conducted by UCLA. Dr. Kafka was a member of the DSM-5 Workgroup on Sexual and Gender Identity Disorders.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rory C. Reid.

Additional information

This article is part of the Topical Collection on Variations in Orientation, Identity, Addiction, and Compulsion

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Reid, R.C., Kafka, M.P. Controversies About Hypersexual Disorder and the DSM-5. Curr Sex Health Rep 6, 259–264 (2014). https://doi.org/10.1007/s11930-014-0031-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11930-014-0031-9

Keywords

Navigation