Hypersexuality

What is hypersexuality?

The terms hypersexuality and sex addiction are used to describe people who have an 'excessive' or 'out of control' amount of sexual behaviour and feel distressed as a result. These terms refer to sexual behaviour that includes limited control of excessive sexual fantasies, urges, and behaviour that may cause personal distress.

Hypersexual disorder has been used to describe a person who experiences distress about a pattern of repeated sexual relationships involving a succession of lovers, who are experienced by the person only as things to be used.

The term 'sex addict' is often used to refer to a person who compulsively seeks out sexual acts despite bad consequences to themself or to others.

It is not yet clear whether compulsive sexual behaviour should be viewed as an addiction similar to drug addictions. Many experts feel that such a diagnosis is inappropriate for people who just enjoy having a lot of sex with multiple partners. Many people believe that hypersexuality can be a problem but not an addiction. In ICD-11, a commonly used list of medical diagnoses, compulsive sexual behaviour disorder is the term used to describe hypersexuality and it is listed as an impulse control disorder.

Culture also plays a part in defining hypersexuality. Cultures that think of sexuality in a more positive way may have values that don't judge sexual behaviour as being 'excessive'.

Therefore a main point in thinking of it as a problem or an addiction is if the behaviour causes any harm to the person themself or to others.

What are the symptoms of hypersexuality?

ICD-11 gives a list of symptoms for compulsive sexual behaviour disorder, which have to be present for at least 6 months. It is made clear that if the distress is entirely related to moral judgments or disapproval, then the diagnosis cannot be made.

There is clearly a wide variation in the nature of the behaviours that come under this diagnosis, and there may be some overlap with normality, but the distress caused, and the inability to stop the behaviour despite the distress and possibly the lack of pleasure from the behaviour, are key to making the diagnosis.

Essential features:

• A persistent pattern of failure to control intense, repetitive sexual impulses or urges which results in repetitive sexual behaviour - this is shown by one of the following:

  • Repetitive sexual behaviour is a central focus of life such that health or personal care or other responsibilities or interests are neglected.

  • The person has tried many times to control this behaviour, without success.

  • The behaviour continues despite it causing problems, for example within a marriage or relationship, financial or health problems.

  • The behaviour continues even when the person gets little or no pleasure from it.

• There is no other condition which better accounts for the behaviour (eg, bipolar disorder) and it is not caused by drugs or medicines.

• The behaviour causes marked distress or significant problems in at least one important area of life, eg, work, family or social life, education.

Additional features

• The disorder may be expressed in a variety of behaviours including sex with others masturbation, use of pornography or sex at a distance (online or on the phone).

• Sex may be a response to depression, anxiety, boredom or loneliness.

What are the causes of hypersexuality?

The causes of hypersexual behaviour are not well understood, though the behaviour may occur as part of other illnesses such as bipolar disorder or Parkinson's disease. As mentioned above, if another diagnosis can explain the behaviour, then it is not compulsive sexual behaviour disorder.

Adults who have been sexually abused as children may display increased sexual behaviour. High-risk sexual behaviour may also be associated with family problems and social stress.

What are the treatments for hypersexuality and sex addiction?

The possible treatments for hypersexuality and sex addiction include a combination of self-help, psychological treatment and sometimes medication. The aim of treatment is to help you manage sexual urges and reduce excessive behaviours while maintaining healthy sexual activities. Some people also need treatment for another mental health condition, such as an alcohol or drug abuse problem, anxiety or depression.

Self-help

• Learn about compulsive sexual behaviour so that you can better understand its causes and treatment.

• Identify situations, thoughts and feelings that may trigger sexual compulsions so that you can take steps to avoid and manage them.

• Get treatment for any other mental health problems, such as addictions, depression, anxiety or stress.

• If you use sexual behaviour as a way to cope with negative emotions, explore healthier ways to cope, such as through exercise and recreational activities.

• Practise relaxation and stress management.

Psychotherapy

Psychotherapy can help you learn how to manage your compulsive sexual behaviour. Psychotherapies can be provided on an individual basis or with a group, with family or with your partner. Types of psychotherapy include:

• Cognitive behavioural therapy (CBT). Helps you identify unhealthy, negative beliefs and behaviours and replace them with more beneficial ways of coping.

• Acceptance and commitment therapy. This is a form of CBT that emphasises acceptance of thoughts and urges and a commitment to choose actions that are more consistent with important values.

• Psychodynamic psychotherapy. Focuses on increasing your awareness of unconscious thoughts and behaviours, developing new insights into your motivations, and helping you to resolve conflicts.

Medications

Certain medications may help by reducing obsessive thoughts and behaviours or by reducing sexual urges. Medications used to treat compulsive sexual behaviour are often also prescribed for other conditions. Examples include:

• Antidepressants. Certain types of antidepressants used to treat depression, anxiety or obsessive-compulsive disorder may help with compulsive sexual behaviour.

• Naltrexone. Naltrexone is generally used to treat alcohol and opiate dependence and blocks the part of your brain that feels pleasure with certain addictive behaviours. It may help with behavioural addictions such as compulsive sexual behaviour or gambling disorder.

• Mood stabilisers. These medications are generally used to treat bipolar disorder, but may reduce compulsive sexual urges.

• Anti-androgens - eg, cyproterone. These medications reduce the biological effects of sex hormones (androgens) in men. Because they reduce sexual urges, anti-androgens are often used in men whose compulsive sexual behaviour is dangerous to others.

Complications of hypersexuality

Medical complications include sexually transmitted infections. Other complications include damage to your social life, work, education or relationship, and financial hardship if you spend money pursuing sex.