Hypersexuality

What Causes Hypersexuality?

The cause of hypersexuality is unknown, but different factors likely trigger it in different cases. Scientists believe that physical, medical, and psychological factors may all play a role in producing the disorder’s behavior.

Some possible risk factors that could play a role in producing hypersexual behavior include:

• Anxiety or depression
• Trauma or abuse
• Other disorders involving compulsive behavior, such as gambling addiction
• Substance abuse
• Neurological disorders such as dementia
• Reactions to medications, including those used to treat Parkinson’s disease

Is Hypersexuality Hereditary?

Some scientists believe that hypersexuality is related to disorders of compulsive behavior or impulse control, such as gambling addiction, and these disorders appear to have a genetic component. Studies have found that people with a first-degree relative (a parent or sibling) with a gambling problem are as much as eight times more likely than the general population to develop a gambling addiction. Close relatives of people with gambling problems are also significantly more likely to suffer from a range of other psychiatric disorders, including major depression, bipolar disorder, social anxiety disorder, substance use disorders, post-traumatic stress disorder (PTSD), and antisocial personality disorder.

Research has not yet discovered a specific gene that appears to be associated with hypersexuality.

How Is Hypersexuality Detected?

Sexual behavior, even frequent and intense behavior, is normal unless it causes distress or harm to you or another person. Warning signs that sexual behavior or thoughts may be disordered include:

• Feeling unable to control your sexual behavior, urges, fantasies, or thoughts
• Feeling guilt, remorse, shame, or distress because of your sexual behavior
• Feeling the need to hide your sexual behavior
• Your sexual behavior causes relationship difficulties, legal problems, trouble at work, or financial consequences.

How Is Hypersexuality Diagnosed?

Diagnosis of hypersexuality is challenging because the disorder is not recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM). When a patient presents with sexual behavior that causes distress or impairment, doctors may follow a diagnostic process to identify medical or psychological disorders that could be causing the symptoms.

Diagnostic steps may include:

• A physical exam. This exam will be aimed at ruling out physical conditions that could be causing the symptoms.
• Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Hypersexuality Treated?

In most cases, hypersexuality does not require treatment. Treatment is usually only required if the person experiencing the behavior is troubled by it and requests treatment. Doctors may also recommend treatment if a person’s urges or activities put them at risk of real physical harm or death.

Treatment of hypersexuality may include both psychotherapy and medications. Common treatment options include:

• Cognitive-behavioral therapy, which teaches a person to recognize the situations that trigger their sexual behaviors and develop new, healthy ways to cope with those situations.
• Group therapy or support groups
• Antidepressant medications, typically serotonin reuptake inhibitors (SSRIs)
• Antiandrogen drugs such as gonadotropin-releasing hormone (GnRH) agonists and depot medroxyprogesterone acetate, which work to lower testosterone levels and decrease sexual urges

How Does Hypersexuality Progress?

Hypersexual behavior often changes in intensity over a person’s lifetime. In some cases, the urges may lessen with age as the person’s sex drive naturally decreases.

When hypersexuality rises to the level of a disorder, it can produce emotional and social consequences, such as:

• Guilt or shame
• Anxiety or depression
• Relationship difficulties
• Employment problems
• Legal problems
• Financial problems
• Substance abuse

How Is Hypersexuality Prevented?

There is no known way to prevent hypersexuality. However, treatment may relieve the effects of the disorder and make it less likely that the sufferer will experience severe complications over time.

Hypersexuality Caregiver Tips

Some people with hypersexuality also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the issues commonly associated with the disorder:

• Some people with the disorder also suffer from depression.
• Some people with the disorder have a co-existing anxiety disorder.
• Hypersexuality is sometimes associated with other sexual disorders, such as fetishistic disorder.
• Hypersexuality is sometimes associated with attention-deficit/hyperactivity disorder (ADHD).
• People with dementia sometimes experience hypersexuality.
• Hypersexuality is sometimes a feature of personality disorders such as borderline personality disorder.

Hypersexuality Brain Science

Under normal circumstances, pleasurable activities (eating good food, exercising, sex, positive social interactions, etc.) trigger the release of a brain chemical called dopamine. Reactions to the presence of dopamine in our brains produce feelings of satisfaction, contentment, and happiness. This pleasure-reward cycle serves an essential biological function in that it encourages us to seek out positive, beneficial situations.

Some drugs alter the normal pleasure-reward system by triggering the release of large amounts of dopamine. The result is an intense good feeling (a “high”) that can only be reproduced by taking the drug. In some cases, the elevated level of dopamine eventually causes the brain to lose sensitivity to the chemical. As a result, the drug user must take higher and higher doses of the drug to achieve the same good feeling. Some scientists believe that the same process is at work in the brains of people who experience hypersexuality.

The link between dopamine and hypersexuality is illustrated by studies of patients who have Parkinson’s disease. Parkinson’s is caused by a deficiency of dopamine activity, and some Parkinson’s medications (levodopa and others) increase dopamine levels. Studies have shown that Parkinson’s patients have a significantly higher rate of hypersexuality than the general population, suggesting that dopamine-boosting medications could be to blame.

Hypersexuality Research

Title: Clinical Response of Impulsivity After Brain Stimulation in Parkinson’s Disease (CRIPS)

Stage: Not Yet Recruiting

King’s College London

London, UK

The study will record outcomes related to Impulse Control Behaviors (ICBs) for PD patients who have already been selected for Deep Brain Stimulation (DBS) therapy as a routine clinical treatment in participating in DBS operating center.

It is routine practice to assess ICBs before DBS decisions are made, but the manner varies across DBS operating centers. The only additional factor to the routine DBS clinical pathway in this study is that the centers involved will uniformly perform assessments to allow data to be combined. A unified set of clinical assessment scales for Impulsive Control Disorders (ICDs) and ICBs, as well as other relevant neuropsychiatric symptom assessments, will be added to routine pre- and post-operational clinical assessments for participants.

The primary endpoint of the study is the change in the severity of ICBs. If subjects score above 1 in any of the given questions on QUIP-RS, or if subjects had a disagreement with carers regarding scores, The Parkinson’s Impulse-Control Scale (PICs) will be triggered. PICs then will be administered by a trained research fellow (AA) over the phone or in the clinic.

Other scales to be administered are listed below:

• Neuropsychiatric Inventory (NPI)
• General anxiety disorder-7 (GAD-7)
• Patient Health Questionnaire-9 (PHQ9)
• Parkinson’s disease questionnaire-39 (PDQ-39)
• EuroQol 5 Dimension (EQ-5D)
• Clinical Global Impression – Severity scale (CGI-S) at baseline and Clinician’s Global Impression – Improvement scale (GGI-I) post-operatively.
• Zarit Caregiver Burden Scale
• Work and Social Adjustment Scale
• UPPS-P Impulsive Behaviour Scale

Assessments will be performed at baseline, 3, 6, and 12 months post-operatively.

Results will be analyzed to ascertain potential predictive measures for ICBS development/change.

Title: Naltrexone for Impulse Control Disorders in Parkinson’s Disease

Stage: Completed

Principal investigator: Daniel Weintraub, MD

University of Pennsylvania

Philadelphia, PA 

Impulse control disorders (ICDs), including compulsive gambling, sexual behavior, buying, and eating, are increasingly recognized as a significant clinical problem in Parkinson’s disease (PD), occurring in up to 15% of patients. Dopamine agonist (DA) treatment is thought to be the primary risk factor for developing ICDs in PD. ICDs often lead to significant impairments in psychosocial functioning, interpersonal relationships, and quality of life. The management of ICDs in the context of PD can be complex. Patients may be reluctant to discontinue DA treatment due to the motor benefits derived from treatment, so patients often have chronic symptoms. Thus, additional treatment approaches are needed.

A medication shown to be efficacious for the treatment of ICDs with minimal impact on parkinsonism would allow many ICD patients to continue on full-dose DA treatment. Naltrexone, a long-acting opioid receptor antagonist, helps treat alcohol and opioid dependence. In addition, placebo-controlled studies have demonstrated that it helps treat pathological gambling in the general population. Opioids regulate dopamine pathways in areas of the brain linked with impulse control disorders, and opioid antagonists block opioid receptors in these regions. In this study, 48 PD patients with an ICD will be treated either with naltrexone (50-100 mg/day) or placebo for 8 weeks. The study will assess if naltrexone improves ICD symptoms in PD and is well tolerated. To the investigator’s knowledge, the proposed study is the first controlled trial of an agent to treat ICDs in PD.

Title: Prevalence of Sexual Addiction in an Inmate Population at the Muret Detention Center in Haute-Garonne (PAS-CD) (PAS-CD)

Stage: Not Yet Recruiting

Principal Investigator: Julien JD Da Costa, MD

Federation Regionale de Recherche en Psychiatrie et Sante Mentale Occitanie

Toulouse, France 

Sexual addiction, also known as hypersexuality or compulsive sexuality, is a human sexual behavior that results in a continuous and persistent search for sexual pleasure. Replacing the former terms satyriasis and nymphomania, the World Health Organization (WHO) ICD-11 has referred to this disorder as “compulsive sexual behavior disorders.”

From multiple causes (iatrogeny, neurological causes, psychiatric causes, psychopathological hypotheses), but still only partially known, the inclusion of this disorder among impulsivity-related disorders, obsessive-compulsive disorders, or addiction-related disorders is still debated in the scientific literature. Thus, in the absence of sufficiently robust scientific data, DSM-5 refused to include this disorder in its classification.

However, the consequences of this disorder on the psychosocial functioning of individuals are not negligible, which can go as far as the precipitation of a transition to an heteroaggressive act which can thus lead to incarceration.

The prevalence of this disorder in the general population is estimated between 2 and 6% based on current literature data. This rate appears to be higher among men and, more specifically, among sex offenders.

However, some authors have noted that the difficulty in determining a clear prevalence of sexual addiction may be related to the still poorly defined diagnostic criteria for this disorder as well as the choice of measurement tools.

To the investigator’s knowledge, there are no French prevalence studies of this disorder in the inmate population. In addition, no studies have been conducted comparing the prevalence of sexual addiction among sex offenders (SASO) with that among non-sex offenders (SANSO).

Researchers hope that better screening for addiction would enable better management of patients with this disorder, promoting their psychosocial rehabilitation and well-being to prevent the recurrence of a transition to sexual arousal.