Academic journal article
By Kaplan, Meg S.; Krueger, Richard B.
The Journal of Sex Research , Vol. 47, No. 2-3
Hypersexual behavior has long been described (Allen, 1969; Ellis & Sagarin, 1965; Haire, 1966; Stoller, 1986; Von Krafft-Ebing, 1939), with examples of both men and women with excessive sexual appetites. Different terms have been used to refer to such behavior, including "hyperphilia" (Money, 1980), "hypersexual disorder" (Krueger & Kaplan, 2001; Stein & Black, 2000; Stein, Black, & Pienaar, 2000), "paraphilia-related disorder" (Kafka, 1991, 2007), "compulsive sexual behavior" (Black, 1998, 2000; Kuzma & Black, 2008), "sexual addiction" (Carnes, 1983, 1990, 1991b), "impulsive-compulsive sexual behavior" (Raymond, Coleman, & Miner, 2003), or simply "out-of-control" sexual behavior (Bancroft, 2008). Presently, there is no one clear accepted terminology. In this article, we use the term hypersexuality (unless a different term is used in a study that we describe), as it appears to be the most atheoretical and neutral term.
Sexuality is dependent on many factors, including individual and relationship variables, societal values, cultural mores, and ethnic and religious beliefs. In discussing hypersexuality, these contexts need to be considered. Society has long tried to control the sexual behavior of individuals by stigmatizing sexual practices (Klein, 2008). Levine and Troiden (1988), comparing different societies, stated that individuals who engaged in frequent sexual behavior were often labeled and pathologized because their behaviors did not follow the norms of their society. A sexual behavior that is thought to be excessive by one individual or group may not be seen as excessive by another. For example, nymphomania was a diagnosis for excessive sexual desire in women in the 19th century and was considered a disease. Today, although a woman's desire for sex is considered to be healthy, there is no consensus on exactly what this means. In discussing nymphomania, Groneman (2000) succinctly queried, "How much sex is too much? How much is enough? And who decides?" (p. 151). As Money (1980) wrote, "It hardly needs to be said that there is no fixed standard as to how often is too often in sex" (p. 94). In any discussion of whether a sexual behavior is problematic or not, it is critical to attempt to define what constitutes excessive sexual behavior and whether it is a problem for self or others.
Definition and Diagnosis
There is no current specific, separate, named diagnosis for hypersexuality. In the United States, some clinicians use the category of "sexual disorder not otherwise specified" (NOS) to diagnose hypersexual behavior (American Psychiatric Association [APA], 2000). The Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision; APA, 2000) indicated that, "This category is included for coding a sexual disturbance that does not meet the criteria for any specific Sexual Disorder and is neither a Sexual Dysfunction nor a Paraphilia" and gave an example of "distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used" (p. 582).
Currently, the manual is being revised (i.e., DSM-V [5th ed.] see also Zucker, 2009). The Paraphilias Subworkgroup of the DSM-V Work Group on Sexual and Gender Identity Disorders has considered hypersexual behavior as a problem, and has proposed the term hypersexual disorder as a distinct category with the following diagnostic criteria for consideration to be included in, modified, or rejected for use in the DSM-V (Kafka, 2009):
A. Over a period of at least 6 months, recurrent and intense sexual fantasies, sexual urges, or sexual behaviors in association with 3 or more of the following 5 criteria:
A. 1. Time consumed by sexual fantasies, urges or behaviors repetitively interferes with other important (non-sexual) goals, activities and obligations.
A.2. Repetitively engaging in sexual fantasies, urges or behaviors in response to dysphoric mood states (e. …