Diagnosis, Assessment, And Treatment of Hypersexuality (Survey‪)‬

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.