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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.
VARIATIONS IN ORIENTATION, IDENTITY, ADDICTION, AND COMPULSION (E COLEMAN, SECTION EDITOR)
Controversies About Hypersexual Disorder and the DSM-5
Rory C. Reid &Martin P. Kafka
Published online: 16 September 2014
#Springer Science+Business Media, LLC 2014
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 sur-
rounding 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 impor-
tant to discuss both general concerns about psychiatric disor-
ders 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.
Keywords Hypersexual disorder .Sex addiction .DSM-5 .
Hypersexual behavior .Sexualcompulsivity .Mentaldisorders
Introduction
A constellation of debates have arisen over the proposed [1••]
diagnostic criteria for hypersexual disorder (HD) considered
for inclusion in the recently published Diagnostic and Statis-
tical Manual of Mental Disorders, Fifth Edition (DSM-5), by
the American Psychiatric Association (but ultimately it was
excluded). Moreover, researchers and clinicians seeking to
understand hypersexual behavior have also had controversies
arise among their groups about the legitimacy of this phenom-
enon and what labels might be most conceptually appropriate.
This article highlights some of the critical issues and offers
suggestions for future directions in the field of hypersexual
behavior.
Politics, False Positives, and High Sexual Desire
The cultural climate in psychiatry in which HD was consid-
ered as a possible new diagnosis was particularly scrupulous
making its candidacy for the DSM an arduous endeavor from
its inception. Prior to publication, the DSM-5 Task Force and
Workgroups were already being heavily scrutinized by indi-
viduals such as previous DSM Editors Robert Spitzer (DSM-
III) and Allen Frances (DSM-IV) who used the Psychiatric
Times and other forums as a platform to openly publish their
criticisms. A number of criticisms were raised across all
psychiatric disorders, not just the HD proposal. Concerns
were raised about adding new diagnoses to the DSM-5 with-
out sufficient scientific research including anatomical and
functional imaging, molecular genetics, pathophysiology, ep-
idemiology, and neuropsychological testing. The adequacy of
literature reviews for changes to various diagnoses were crit-
icized. Ramifications for public policy and concerns about
potential misuse in the legal community were raised, particu-
larly for sexual disorders. The need to clarify definitional
issues across psychiatric mental disorders also surfaced with
concern about the trend in expanding the population of the
mentally ill, increasing the number of false-positive diagnoses
and potential for unnecessarily exposing individuals to potent
This article is part of the Topical Collection on Variations in Orientation,
Identity, Addiction, and Compulsion
R. C. Reid (*)
Department of Psychiatry and Biobehavioral Sciences, Semel
Institute for Neuroscience and Human Behavior, University of
California, Los Angeles, 760 Westwood Boulevard, Suite 38-153,
Los Angeles, CA 90024, USA
e-mail: rreid@mednet.ucla.edu
R. C. Reid :M. P. Kafka
Harvard Medical School, Harvard University, Boston, MA, USA
Curr Sex Health Rep (2014) 6:259264
DOI 10.1007/s11930-014-0031-9
psychotropic medications [2]. The potential for false posi-
tives (i.e., erroneously diagnosing an individual with a mental
disorder that is a normal variant of human behavior) were
specifically raised with respect to HD wherein the proposal
was purported to confuse social disapproval and morality
with issues of health and disorder [3].Moreover, it was stated
that the “…criteria do not adequately distinguish normal-
range high levels of sexual desire and activity from patholog-
ical levels of sexual desire and activity [3].This latter con-
cern has also been raised by researchers who concur that high
sexual desire has not been differentiated from a dysfunction of
a biological mechanism with some supporting data suggesting
this maybe a legitimate criticism in need of further clarifica-
tion [4,5]. As part of the process of development of DSM-5,
proposed changes for psychiatric disorders and diagnostic
criteria were subject to commentary by both the general public
and various special interest groups. Direct attacks were even
launched in the media against specific members of the Sexual
and Gender Identity Disorders DSM-5 Task Force Committee
(Kenneth Zucker and Ray Blanchard) with efforts to petition
removing them for some alleged controversial viewpoints on
sex research. The panoply of issues on the table before the
field trials inferred that the best case scenario, if the criteria
were found to be valid and reliable, was that HD might be
considered for Section III: Emerging Measures and Models in
the DSM-5 (a section reserved for conditions which appear to
have some scientific merit but need further research before
they might be considered as formal disorders).
Potential for Forensic Abuse of Hypersexual Disorder
The misapplication or abuse of HD as a diagnosis in forensic
settings was raised as a concern purporting the legal commu-
nity would advance HD as a mitigating factorin the defense of
hypersexual criminal defendants being prosecuted for felonies
such as child sex abuse [6,7]. Interestingly, these challenges
did not advance any data indicating that sex offenders suffer-
ing from a paraphilia such as pedophilia, for example, secured
for themselves reduced sentences. Conversely, criminals who
use a mental disorder as a defense sometimes receive longer
incarceration sentences. Moreover, the US Supreme Court has
even ruled it is constitutional to involuntarily commit an
individual with a mental disorder after they have served full
prison terms for their crimes as a form of preventative institu-
tionalization. Furthermore, a recent summary of the field trials
for HD among sex offenders found that a very small number
of these individuals would actually receive a current diagnosis
of HD [7]. Even if an individual met criteria for HD, providers
failing to also diagnose a comorbid sexual disorder (such as a
paraphilia disorder) constitutes a problem with comprehensive
assessment by clinicians, not a problem with the HD criteria
itself.
Discounting by Dissecting the Diagnosis
Several individuals have attempted to criticize the HD pro-
posal by systematically discounting the high likelihood of
erroneous assessment of individual criterion for the condition.
One author, minimizing the A4 criterion Repetitive but un-
successful efforts to control or significantly reduce these sex-
ual fantasies, urges, and behaviorstated that engaging in
highly desired and pleasurable activities despite potential risks
for harm is normal and by such reasoning scuba diving,
mountain climbing, and freeway driving can be indications
of a psychiatric disorder [8].Such rationale is flawed and
could be similarly used to distort other well-established diag-
noses. For example, most parents of a newborn baby report
sleep disturbance nearly every day for a period of at least
2 weeks but they are not diagnosed with a major depressive
disorder because an alternative explanation for their lack of
sleep exists and they would likely deny experiencing the
required number of additional symptoms necessary for such
a diagnosis. However, in a few cases, it should be noted this
could be a possible sign of the onset of postpartum depression
but such is usually the exception, not the rule. As another
example, rarely do clinicians ask how much sadness is too
much sadness needed to assess for depressed mood states but
many have curiously (and in some cases cynically) asked how
much sex is too much sex indicative of hypersexuality. Thus,
systematically dissecting each criterion independent of the
broader scope of signs and symptoms ignores the high thresh-
old set for an HD diagnosis requiring four of the five behav-
ioral criteria to persist for a minimum of 6 months [9]. Like
many other disorders, a minimum set number of signs and
symptoms must converge and persist over time in order for the
diagnosis to be considered. This approach is intended to
safeguard against potential false positives.
Mental Illness and Pathologizing Sexuality
Across the debate about conceptualizing HD as a mental
disorder is the larger controversy in the psychiatric communi-
ty about what actually constitutes a mental illness. Some
suggest abnormality should be both statistically deviant and
biologically disadvantageous [10]. Others have sought a com-
promise by suggesting values can be considered in defining
harmassociated with a disorder while maintaining dys-
functionshould be defined by evolutionary biology as a
failure of an internal mechanism to perform its natural func-
tion [11].In response to the various challenges of defining
mental disorders, some have suggested a psychopharmaco-
logical taxonomy of classifying disorders as any condition
that is alleviated by psychopharmacological products. How-
ever, this taxonomy only succeeds in categorizing a class of
disorders and fails to define the concept of a mental disorder.
260 Curr Sex Health Rep (2014) 6:259264
Moreover, this approach is unreliable given the high number
of non-responders to medication across a broad range of
psychiatric disorders [12]. Collectively, how a mental disorder
should be defined was a topic of passionate debate prior to
DSM-5 and continues to elicit ongoing controversial discus-
sion [13]. By extension, this debate has been generalized to
whether HD should be classified as a mental disorder.
The concept of mental disorders has also been
condemned by some who suggest it is a value-laden
socially constructed phenomena used to impose confor-
mity to cultural norms. Not surprisingly, similar argu-
ments have been launched against the HD proposal with
allegations that HD pathologizes normal variants of
healthy sexual behavior, and hence, it does not meet
the requirements for deviance [14,15].Another fre-
quent criticism is that HD could be an extension or
manifestationofanexisting mental disorder [6,8].
This latter critique should not be quickly dismissed
given high comorbidity rates of other mental illness
commonly reported among treatment-seeking samples
of hypersexual patients. Further, it is widely believed
among clinicians working with hypersexual patients that
sex is used to copewith challenging situations or as a
way of copinginthewakeofemotionaldistress.
Such assertions might imply that hypersexuality is an
attempt to compensate for maladaptive systems designed
to regulate emotion. Subsequently, wouldntthemore
parsimonious conceptualization of hypersexuality be
some type of an emotional dysfunction disorder or an
adjustment disorder rather than an independent patholo-
gy? If one argues for HD as an independent disorder,
they must also identify which internal functions are
failing to operate and advance some theory implicating
what mechanisms of action are purported to cause the
dysfunction. Sadly, sex researchers investigating hyper-
sexuality have often failed in this endeavor [16]witha
few notable exceptions. For example, neurobiological
mechanisms linked to sexual excitation and sexual inhi-
bition has been advanced as a plausible explanation for
hypersexuality [17]. A broader hypothesis about execu-
tive deficits in frontal lobe functioning reported mixed
findings where hypersexual patients self-reported execu-
tive deficits but did not exhibit executive dysfunctions
when tested [18,19]. Many have suggested addiction,
impulsivity, and compulsivity models [20], although its
questionable whether these conceptualizations really
constitute theoretical models given their lack of speci-
ficity, falsifiable testability, or explanatory power for the
construct of hypersexuality. Moreover, proponents of
these approaches have yet to clearly operationalize and
delineate the respective distinct contributions of addic-
tion, impulsivity, or compulsivity as they relate to hy-
persexual behavior. Instead, it is argued there is overlap
between these paradigms which further diminishes how
each is purported to exert its effect on hypersexuality.
As an illustration, advocates of sex addictionwill
integrate components of impulsivity or compulsivity in
their rhetoric claiming that all addicts are impulsive
despite published research data that contradicts this as-
sertion [21].
While significant consequences such as personal distress or
impairment are common denominators across many DSM
disorders, evidence linking excessive sexual thoughts, urges,
and behaviors to such consequences [22,23] is insufficient to
classify a phenomenon as a psychiatric disorder. There are
many issues in life resulting in significant negative outcomes
that do not rise to the level of pathology or constitute a mental
illness. For example, negative aspects of perfectionism can
interfere with relationships, contribute to job loss, predict
earlier mortality [24],andhavebeenassociatedwithmental
illness such as eating disorders [25] and depression [26].
Perfectionism, however, has been characterized as a multidi-
mensional personality trait not a pathological condition. Nev-
ertheless, treatment approaches have been developed for at-
tenuating the distress associated with negative aspects of
perfectionism [27]. Subsequently, perfectionism is taken seri-
ously by researchers and clinicians, can result in negative
consequences and personal distress, has been studied exten-
sively by the scientific community, and is the focus of treat-
ment by health care providersall of this without having
perfectionism classified as a disease or mental illness. By
extension of this analogy, the pertinent question is whether
hypersexuality constitutes a problem in living, an internal
conflict around sexual values, a culturally bound construct,
or a personality trait or does this phenomenon adhere to the
more stringent standard required for a mental disorder?
Amidst the landscape of the various controversies
noted above, it is important to put criticisms about the
HD proposal in context. There has been a long history of
resistance to pathologizing sexuality more broadly across
multiple domains [28], and so, resistance to classifying
HD as a psychiatric disorder was to be expected. Per-
haps, the greater obstacle given current advances in
science is that any new diagnostic proposal faces an
enormously strict standard requiring rigorous research
and empirical evidence. Indeed, given the heated debate
about HD, one wonders whether male hypoactive sexual
desire disorder could meet the strict standard of mental
illness required for the DSM-5 if the criteria for hypo
had to start from scratch. Yet, if individuals can have a
hyposexual desire disorder it seems reasonable that a
hypersexual disorder is also plausible. Nevertheless,
there is wisdom in exercising caution with respect to
pathologizing any phenomenon given the significant
ramifications for health care providers, the corporate
sector (e.g., insurance and pharmacological companies),
Curr Sex Health Rep (2014) 6:259264 261
the scientific field, the legal community, the allocation of
public funding, the social policies, and the obvious im-
plications for patients having the stigma of a diagnosis.
Epidemiological Studies and Hypersexuality
Currently, there is a paucity of literature examining hypersex-
uality in non-clinical samples. A few studies have assessed
some limited facets of hypersexual behavior noting preva-
lence rates from 0.6 to 1.8 % in the general population [29,
30]. However, epidemiological studies specifically applying
the diagnostic criteria for HD in representative community
samples is needed to clarify whether the proposed criteria
demonstrate validity and reliability in distinguishing a patho-
logical condition associated with hypersexual behavior. The
lack of such epidemiological research was a major concern of
the DSM-5 committees and the APA in considering the HD
proposal. One challenge associated with these types of studies
and the psychiatric conceptualization of a mental disorder is
that a standard of normality is established through a reference
group and the bandwidth of sexual behaviors among humans
appears to be quite broad. Therefore, care will need to be taken
to determine what reference group should be used as a com-
parison to evaluate deviance and, by extension, abnormality
indicative of a mental disorder among hypersexual subjects.
Some dialogue is also needed to help clarify how severity
should be defined.
Collectively, the scientific evidence for HD to be consi-
dered a mental illness is incomplete at the present time based
on the current psychiatric definitions for a mental disorder.
Primarily, objective data identifying internal biological dys-
function (e.g., genetic abnormality, deficits in brain function,
etc.) are lacking. This, of course, assumes that natural func-
tions are objectively discoverable, and therefore, dysfunctions
are subsequently measurable.
Neuroimaging and Hypersexual Behavior
While there are some neuroimaging studies [31,32,33]
beginning toemerge investigating brain function and response
to sexual stimuli among hypersexual subjects, these pilot
studies are in their infancy use correlational cross-sectional
designs, and fall short of controlling for a host of potential
confounds that might offer alternative explanations for the
findings. Moreover, visual sexual stimuli used in neuroimag-
ing studies are emotionally salient and increase blood flow to
multiple brain regions also implicated in reward processing,
motivation, vigilance, and attention [34••]. Subsequently, al-
ternative hypothesis neglected in these studies might offer
more parsimonious explanations for the findings. Despite
these shortcomings, neuroimaging can play an important role
in helping illuminate possible underlying neurobiological
mechanisms that might be implicated in hypersexuality and
have the potential to provide evidence of dysfunction.
Conclusion
The issues that led to the exclusion of HD from the DSM-5 are
complex. This article has attempted to identify some of the
more prominent issues raised in response to the HD proposal.
As outlined above, many of these issues extend beyond the
scope of the HD proposal and constitute more general chal-
lenges to the broader field of psychiatric diagnosis and partic-
ularly focus on how mental illness is conceptualized. Whether
or not the HD proposal will end up in subsequent updates to
the DSM has yet to be determined.
The DSM-5 field trial conducted through UCLA found
evidence in support of the validity and reliability of the HD
criteria [35••]. Yet, this article highlights the need for more
research if HD is to be classified as a mental disorder. Scien-
tists should also explore alternative non-pathological models
to help clarify the phenomenon of hypersexuality. For exam-
ple, models examining reward processing and reward sensi-
tivity might offer new insights and directions for the field.
Care must be taken by clinicians to avoid misdiagnosing
individuals. In the case of HD, cultural values, sexual orien-
tation, and religiosity [36] should be considered in working
with those seeking help for hypersexual behavior as these
factors may play an important role in case conceptualization
(e.g., hypersexuality reframed as internal conflict with reli-
gious values as opposed to a disordered pattern of behavior).
Given that relationship discord is often a catalyst for
treatment-seeking individuals, distress related to hypersexual
behavior might be more parsimoniously explained by rela-
tionship incompatibility. As one critic has accurately noted,
If sexual desires or activities cause distress, this may be
because of the attitude of the individual towards the sexual
desires or activities, not because the desires or activities are
inherently pathological [3].Patients receiving treatment for
hypersexuality should be given adequate informed consent
regarding their treatment. For example, clinicians should dis-
close to patients the status of mental health illness if a diag-
nosis is warranted and converselyindicate when a patient does
not meet the criteria for a mental disorder. While sex addic-
tionis not a sanctioned disorder by the American Psychiatric
Association, patients should be told that hypersexual behavior
often cooccurs with other mental disorders. Regardless of the
presence or absence of a mental disorder, patients should be
reassured that their issues can be the focus of treatment, with
the caveat that treatment specifically focused on hypersexual-
ity may not be covered by insurance providers.
Clinicians should understand there is no current gold stan-
dard of care for treating hypersexuality and empirical outcome
262 Curr Sex Health Rep (2014) 6:259264
studies in the field have been found to have significant meth-
odological limitations [37]. Some providers have reported the
quandary of how to classify patients who might have previ-
ously been categorized under DSM-IV by the designation
Sexual Disorder Not Otherwise Specified. In the new DSM-
5 classification system, hypersexuality is not considered a
variant of paraphilia, a sexual dysfunction, or an unspecified
sexual disorder. However, since there is evidence that many
patients seeking help for hypersexual behavior exhibit prob-
lems with impulse control, [21] it may be appropriate in those
cases to use a designation of Unspecified disruptive, im-
pulse-control, and conduct disorder(ICD 312.9) [William
Narrow, M.D., Research Director for DSM-5 Task Force,
personal communication 9/5/13]. As research continues to
elucidate the phenomenon of hypersexual behavior, providers
should be encouraged to continue to develop empirically
supported treatments and best practice guidelines, as has been
applied to other constructs like perfectionism.
Finally, even among opponents of the HD proposal, there is
an acknowledgment that some patients genuinely struggle to
regulate their sexual behavior in a way that causes significant
problems and negative consequences. Thus, it is imperative
that mental health professionals, researchers, and scientists
collaborate when possible to find ways to help alleviate the
suffering and distress encountered by those experiencing hy-
persexual behavior.
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.
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Papers of particular interest, published recently, have been
highlighted as:
Of importance
•• Of major importance
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264 Curr Sex Health Rep (2014) 6:259264
... Individuals with CSB also experience negative emotions to a greater extent than individuals without CSB symptoms (Janssen et al., 2020;Miner, Dickenson, & Coleman, 2019;Miner et al., 2016). From an etiological standpoint, CSB may develop as a coping mechanism to manage these negative affective states (Coleman et al., 2018;Kafka, 2010;Reid, Carpenter, Spackman, & Willes, 2008;Reid & Kafka, 2014). For example, a daily diary study found that men with CSB were more likely to regulate affective arousal through sexual behavior than controls (Miner et al., 2019). ...
... Conversely, if individuals high in boredom proneness are more securely attached, suggesting sufficient emotional self-monitoring and affect regulation, they may be less likely to engage in CSB to cope externally with negative affective states. Given the previously proposed importance of affect regulation in CSB (Coleman et al., 2018;Kafka, 2010;Reid et al., 2008;Reid & Kafka, 2014), understanding how correlates of affect regulation relate to CSB and interact with one another may contribute to the conceptual understanding of CSB and inform areas of intervention. ...
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Affect regulation is associated with compulsive sexual behavior (CSB) despite ongoing debate about its inclusion in diagnostic criteria. Previous studies on two specific affect regulation constructs - boredom proneness and attachment styles - suggest that affect regulation is associated with CSB. We tested a moderation model of the effects of attachment anxiety and attachment avoidance on the relationship between boredom proneness and CSB. Results indicate that the relationship between boredom proneness and CSB is stronger at higher levels of attachment anxiety, with no interaction between boredom proneness and attachment avoidance. Overall findings support the importance of affect regulation in conceptualizing and treating CSB.
... Its recent inclusion as an impulse-control disorder in the ICD-11 has been debated (Gola & Potenza, 2018a;Potenza, Gola, Voon, Kor, & Kraus, 2017), since a competitive view is that CSBD should rather be classified as an addictive disorder. The conceptualization of CSBD within an addiction framework has been discussed for decades (Orford, 1978), and this debate intensified with the release of the DSM-5, when CSBDoperationalized as "Hypersexual Disorder"was not included (Reid & Kafka, 2014). Since then, and given emerging data, there has been increasing consideration of conceptualizing CSBD as an addictive disorder (Kor, Fogel, Reid, & Potenza, 2013;Kowalewska et al., 2018;Kraus, Voon, & Potenza, 2016;Stark, Klucken, Potenza, Brand, & Strahler, 2018). ...
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The paper by Sassover and Weinstein (2022) contributes to a timely and complex debate related to the classification of Compulsive Sexual Behavior Disorder (CSBD). The recent inclusion of CSBD as an impulse control disorder in the ICD-11 has generated debate since a competitive view is that CSBD should rather be classified as an addictive disorder. Sassover and Weinstein (2022) reviewed existing evidence and concluded it does not support the conceptualization of CSBD as an addictive disorder. Although we agree regarding the relevance and timely nature of considering the classification of CSBD, we respectfully disagree with the position that relying on the components model of addiction (Griffiths, 2005) is the optimal approach for determining whether or not CSBD is an addictive disorder. In this commentary, we discuss potential pitfalls of relying on the components model to conceptualize CSBD as an addictive disorder and argue that considering a process-based approach is important for advancing this timely debate.
... Hypersexual Disorder (HD) en tant que nouveau diagnostic spécifique. Comme l'expliquent Reid et Kafka (Reid & Kafka, 2014 ;Kafka, 2014), au cours du processus d'élaboration du DSM-5 de fortes critiques ont été émises quant au risque d'introduire un diagnostic susceptible de pathologiser à tort le comportement sexuel « normal » (Frances, 2010 ;Wakefield, 2012 ;Winters, 2010), ce qui pouvait fournir une excuse médicalisée pour des conduites jugées immorales (Halpern, 2011), était insuffisamment fondé scientifiquement (Wakefield, 2012) et s'expliquait déjà par d'autres troubles (Halpern, 2011 27 Compulsive sexual behaviour disorder is characterised by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour. Symptoms may include repetitive sexual activities becoming 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 behaviour; and continued repetitive sexual behaviour despite adverse consequences or deriving little or no satisfaction from it. ...
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Jeux de hasard et d’argent, gaming, sexualité, achats, réseaux sociaux, Internet : des conduites addictives sans substance ? État des lieux sur les évidences scientifiques, la terminologie, les échelles de mesure et les prévalences. Rapport de recherche. Lausanne : Addiction Suisse & GREA.
... This suggested diagnosis included experiencing repetitive, impairing, and time-consuming sexual urges, fantasies, or behaviors that are uncontrollable, despite trying to reduce the symptoms, in response to negative emotions or stress and which neglect self or others' well-being and safety. However, the DSM-5, published in 2013, did not include Hypersexual Disorder due to concerns about social and moral confounds, accuracy of the diagnosis, and more general skepticism in the medical community (Kafka, 2014;Reid & Kafka, 2014). ...
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There has been a surge of research articles in the last two decades about sexual addiction (SA) and compulsive sexual behavior (CSB). In the literature, SA/CSB is mostly presented as being comparable to other behavioral addictions and similarly involves a problematic consumption model: loss of control, psycho-social impairments, and risky sexual activities. Despite a recent rise in research interest in this area, only a small number of studies have focused on the partners’ lived experiences and wellbeing following the discovery or disclosure of compulsive sexual activities. This literature review addresses this knowledge gap by examining existing research on the female partners of those who have engaged in CSBs. The focus of this study is intentionally heteronormative, meaning that it expressly analyses the literature in relation to females who find themselves in a relationship with a male partner who experiences SA/CSBs. This research paper converges around the synthesis that female partners may endure a range of emotional, relational, physical, sexual, and/or spiritual effects following the discovery or disclosure of SA/CSB. In consequence, this review points to opportunities for future research whereby prospective studies may examine partner wellbeing through in-depth qualitative empirical research. This article charts pertinent perspectives and prospects. Supplemental data for this article is available online at https://doi.org/10.1080/26929953.2022.2050862 . HighlightsThe last two decades have seen a surge in research interest in sexual addiction (SA) and compulsive sexual behavior (CSB).Despite growing interest in this area, only a small number of studies have focused on the partners’ lived experiences and wellbeing following the discovery or disclosure of compulsive sexual activities.Applying a heteronormative analytical lens, this literary study addresses this knowledge gap by examining existing research on female partners of males experiencing SA/CSBs.The findings converge around the synthesis that female partners may endure a range of negative emotional, relational, physical, sexual, and/or spiritual effects following the discovery or disclosure of SA/CSB.The analysis points to opportunities for future studies to examine partner wellbeing through in-depth qualitative empirical research.
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Hypersexual Disorder (HD) was a proposed diagnosis for inclusion in DSM-5 and was conceptualized as a sexual behavior disorder with an impulsivity component (Kafka, 2010).Despite what was, arguably, a substantial body of clinical information, an independent field trial in outpatients (Reid et al., 2012) as well as field trials in sex offenders (see below), HD was rejected for placement in Section 3 (Appendix: Emerging Measures and Models) of the DSM-5 by the Board of Trustees of the American Psychiatric Association. Why?During the process of the development of DSM-5, there were persisting general criticisms that the proposed revision potentially would add many new diagnoses that pathologize normal behaviors, including sexual behavior (Frances, 2010; Wakefield, 2012; Winters, 2010) or provide a medicalized excuse for immoral conduct (Halpern, 2011; Moser, 2010). Any new diagnostic entity would require rigorous scientific and epidemiological testing to reduce the risk of unintended conse
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The addiction model is rarely used to describe high frequency use of Visual Sexual Stimulus (VSS) in research, yet it is commonly used in media and clinical practice. The theory and research behind “pornography addiction” is hindered by poor experimental designs, limited methodological rigor, and lack of model specification. The history and limitations of addiction models are reviewed, including how VSS fail to meet standards of addiction. These include how VSS use can reduce health risk behaviors. Proposed negative effects, including erectile problems, difficulty regulating sexual feelings, and neuroadaptations are discussed as non-pathological evidence of learning. Individuals reporting “addictive” use of VSS could be better conceptualized by considering issues such as gender, sexual orientation, libido, desire for sensation, with internal and external conflicts influenced by religiosity and desire discrepancy. Since a large, lucrative industry has promised treatments of pornography addiction despite this poor evidence, scientific psychologists are called to declare the emperor (treatment industry) has no clothes (supporting evidence). When faced with such complaints, clinicians are encouraged to address behaviors without conjuring addiction labels.
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Research on nonparaphilic hypersexual behavior has increased in recent years. In the present article, the authors conducted a methodological review of empirical studies that evaluated a treatment for nonparaphilic hypersexual behavior. The authors reviewed several characteristics of the extant studies, including the participants, research designs, treatments evaluated, assessment of nonparaphilic hypersexual behavior, and outcomes. Despite several attempts to explore treatments aimed at attenuating the symptoms of nonparaphilic hypersexual behavior, the findings from this review indicate that much of the outcome research in the field contains significant methodological limitations. The authors conclude by offering recommendations to enhance future outcome research among investigators working with hypersexual populations.
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