What Is Hypersexuality Disorder?

Hypersexuality Disorder, Compulsive Sexual Behavior, and Sex Addiction

By Geralyn Dexter, LMHC

Hypersexuality is defined by an intense urge or desire to engage in various kinds of sexual activity. The terms “sex addiction” and “compulsive sexual behavior” are often used interchangeably with hypersexuality disorder. While sexual desire and activity are part of human nature, it can become problematic when the behavior results in adverse consequences or is used as an escape mechanism.

Read on to learn about symptoms, diagnosis, treatment, and coping with hypersexuality disorder.

Hypersexuality Disorder

Research estimates that between 3%-6% of the population deals with hypersexuality, compulsive sexual behavior, or sex addiction. This may include activities such as:1

• Excessive masturbation
• Consensual sexual activity with multiple partners 
• Pornography use
• Phone or cyber sex
• Frequenting strip clubs

Sexual thoughts, urges, or behaviors can have negative consequences when a person is preoccupied with them, and they begin to take up more space in their minds and lives.

Fantasies and urges may feel intrusive, intense, and challenging to change or manage. These compulsions or actions can significantly affect a person’s quality of life and create problems at home, work, school, and relationships.< Additionally, a person with hypersexuality disorder may experience emotional distress, find themselves in financial or legal trouble, or need evaluation or treatment for sexually transmitted infections (STIs).

Symptoms

Compulsive sexual behavior can present differently, as there are different types of sexual behaviors.

Symptoms of hypersexuality disorder or sex addiction may include:

• Repetitive thoughts, urges, or behaviors that feel unmanageable
• Strong emotions such as depression, anxiety, shame, guilt, remorse related to behavior
• Unsuccessful attempts to change, control, or reduce fantasies or behaviors
• Using sexual behavior as a coping mechanism
• Continuing to participate in behaviors that have caused significant repercussions
• Engaging in risky behavior
• Being untruthful about or trying to hide behavior
• Trouble establishing or maintaining healthy relationships

Hypersexuality disorder is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the American Psychiatric Association’s handbook for diagnosing mental health conditions. Because of this, mental health professionals go back and forth on how to classify compulsive sexual behavior.

Currently, hypersexuality disorder is characterized similarly to impulse control disorders and behavioral addictions.

Compulsive sexual behavior disorder (CSBD) is classified under the International Classification of Disease, 11th revision (ICD-11), as an impulse control disorder.2 It defines CSBD as a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behavior. Symptoms include:

• Repetitive sexual activities become a central focus of the person’s life, to the point of neglecting health and personal care or other interests, activities, and responsibilities.
• Numerous unsuccessful efforts to significantly reduce repetitive sexual behavior
• Continued repetitive sexual behavior despite adverse consequences or deriving little or no satisfaction from it
• A person enters a pattern of failure to control intense sexual impulses or urges, resulting in repetitive sexual behavior that manifests over an extended period (e.g., six months or more). This causes marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. It’s important to note that distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviors is insufficient to meet this requirement.

Causes

More research is needed on the cause of hypersexuality. However, a review of the literature on hypersexual behavior has identified several factors that may lead to hypersexual behavior, including:

• Medication side effects, specifically those that target dopamine, like those used for treating Parkinson’s disease
• Medical conditions such as dementia, Alzheimer’s disease, Kleine-Levin syndrome, and other neurological conditions
• Disruption or imbalance in neurotransmitters (brain chemicals) like dopamine, serotonin, and norepinephrine have been associated with hypersexuality
• Presents as a symptom or a means of coping with trauma

Individuals with easy access to sexual content or material may have a higher risk of developing compulsive sexual behavior. Additionally, mental health conditions such as anxiety, depression, or addiction may also be risk factors.3

Risk of Sexually Transmitted Infections

Excessive and unsafe sexual behavior puts a person at greater risk of contracting STIs. Therefore, those with hypersexual behavior should discuss screening for STIs with their healthcare provider and possibly starting pre-exposure prophylaxis (PrEP) to prevent HIV infection.

Diagnosis

Though hypersexuality disorder is not included in the DSM-5 as a formal diagnosis, clinicians assess patients similarly to how they would for a mental health condition. They may also use the criteria for compulsive sexual behavior disorder in the ICD-11.

Consultation with a medical healthcare provider may be recommended to rule out other conditions before conducting a mental health examination. A healthcare provider will explore a patient’s thought content and behavior related to sex, especially those that feel difficult to control.

To get a complete picture of a patient’s health and how they are impacted by compulsive sexual behavior, a healthcare provider may ask about relationships, substance use, and financial or legal consequences.

Additionally, your provider may ask about significant or stressful life events, feelings of guilt, shame, or remorse, low self-esteem, or use a screening tool to gauge symptoms.4

Treatment

Treatment for compulsive sexual behavior can vary based on the underlying issues. For example, one study revealed that 72% of patients with hypersexual behavior were diagnosed with a mood disorder, 38% had an anxiety disorder, and 40% had substance use issues.5

If a mood disorder, anxiety disorder, or substance use disorder is the cause, a healthcare provider may recommend the following medications:

• Mood stabilizers: For patients with mood disorders such as bipolar disorder. Hypersexual behavior may occur particularly during a manic episode.
• Antidepressants: Can reduce urges in individuals with anxiety and depression
• Naltrexone: Used to manage impulses with alcohol and opioids (sometimes coupled with antidepressants)

Individual, family, or group therapy can occur in inpatient or outpatient settings based on a patient’s needs.

Psychodynamic therapy may help patients identify triggers and examine feelings of guilt, shame, and self-esteem that may contribute to hypersexuality.

In cognitive behavioral therapy, patients learn to recognize unhealthy beliefs about themselves and their sexual behavior, develop tools to manage complex thoughts and emotions, and sustain healthy behaviors. A therapist may introduce techniques from acceptance and commitment therapy to support patients with practicing mindfulness.

Seeking support through a self-help group is another option that a mental health professional may suggest in conjunction with therapy. Based on the 12-step theory, groups like Sex Addicts Anonymous can help people with compulsive sexual behavior find a sense of community in recovery.

When to Call Your Doctor

It may be time to contact your healthcare provider if you:

• Are worried or distressed about sexual fantasies, urges, or behaviors
• Have difficulty changing or controlling your actions
• Experience negative consequences in other areas of your life such as relationships, work, or your health
• Attempt to hide your behavior
• Believe your urges or desires may lead you to cause harm to yourself or others

If you are experiencing suicidal thoughts, you can call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text ‘HOME’ to 741-741 to reach a crisis counselor at the Crisis Text Line.

Coping

Learning to cope with hypersexuality and its impact on your life is essential to recovery. Strategies that may be useful include:

• Seeking treatment and being consistent with treatment by keeping appointments and communicating concerns and problems with a therapist.
• Connect with an established support system or join a support group.
• Engage in activities that promote relaxation, mindfulness, and stress management.
• Be compassionate with yourself.
• Have honest conversations with your partner or family members.
• Explore and set boundaries in your relationships.

Summary

Hypersexuality disorder is characterized by an intense desire to engage in sexual activity. This kind of compulsive sexual behavior can negatively affect your relationships. Treatment and coping options are available to help you live with or recover from hypersexuality disorder.

A Word From Verywell

Feelings of guilt and shame are often associated with compulsive sexual behavior. If you struggle to control sexual fantasies, urges, and behaviors, you are not alone. Seeking help from a mental health professional, finding support and treatment, and being compassionate with yourself can aid you in recovery.

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