ORIGINAL RESEARCH-PSYCHOLOGY
A Surprising Finding Related to Executive Control in a Patient Sample of Hypersexual Men

https://doi.org/10.1111/j.1743-6109.2011.02314.xGet rights and content

ABSTRACT

Introduction

Patients seeking help for hypersexual behavior often exhibit features of impulsivity, cognitive rigidity, and poor judgment as well as deficits in emotion regulation and excessive preoccupation with sex. Some of these characteristics are also common among patients presenting with neurological pathology associated with executive dysfunction. Exploring relationships between dysregulated sexual behavior and executive deficits will enhance our understanding of hypersexuality.

Aim

This study sought to assess whether patients seeking help for hypersexual behavior exhibit executive deficits as measured by standardized neuropsychological tests of executive functioning when compared with healthy controls.

Methods

Executive deficits were assessed in a sample of male patients (N = 30) seeking help for hypersexual behavior compared with a nonhypersexual community sample of men (N = 30) using neuropsychological tests of executive functioning. Using multivariate statistics, differences between the groups were examined.

Main Outcome Measures

Sexual activity measured by the Hypersexual Behavior Inventory and the Compulsive Sexual Behavior Inventory. Executive functions measured through neuropsychological testing using several subtests of Delis–Kaplan Executive Function System: Color–Word Interference Test, the Tower Test, the Trail Making Test, the Verbal Fluency Test, as well as the Wisconsin Card Sorting Test. Psychopathology was assessed using the Mini International Neuropsychiatric Interview, and cognitive ability was assessed using the Wechsler Adult Intelligence Scale.

Results

Significant differences on measures of hypersexuality were observed. However, the groups failed to exhibit significant differences across neuropsychological tests of executive functioning even after controlling for cognitive ability.

Conclusions

These results contradict a previous finding of executive deficits among hypersexual men measured by self‐report. The lack of executive deficits suggests that this population may exhibit domain‐specific aspects of impulsivity, poor judgment, and risky behavior that are not generalizable to other domains of life. Furthermore, our findings fail to support a conceptualization of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, proposed hypersexual disorder based on models of executive dysfunction. Reid RC, Garos S, Carpenter BN, and Coleman E. A surprising finding related to executive control in a patient sample of hypersexual men. J Sex Med 2011;8:2227–2236.

Introduction

Hypersexuality is frequently discussed as a sequela of other medical conditions such as brain injury 1, 2, 3, degenerative disorders 4, 5, or temporal lope deficits such as epilepsy and Kluver–Bucy syndrome 6, 7. Medication effects 8, 9 and endocrinological factors [10] have also been implicated in the etiology of some manifestations of hypersexuality. However, there is mounting evidence suggesting that hypersexual behavior can exist as a primary condition independent of any apparent medical etiology with consequences warranting both medical and psychological interventions 11, 12, 13, 14, 15, 16.

The notion of excessive or uncontrolled sexual behavior has its historical roots in medicine, dating back to the early references to “hyperesthesia,” a condition characterized by Richard von Krafft‐Ebing that involved abuse of one's self and an abnormally increased and intense libido [17]. Krafft‐Ebing coined the terms “satyriasis” and “nymphomania,” which remain in the sexual taxonomy of behavior in the International Classification of Diseases, 10th edition, under “sexual dysfunction, not caused by organic disorder or disease.” Although previous versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) included references to “sexual addiction” in the category of a nonparaphilic Sexual Disorder Not Otherwise Specified (DSM‐III‐R [18]), it was discontinued in subsequent manuals largely due to a lack of empirical research validating the phenomenon [19]. Over the past decade, however, a growing body of research about hypersexual behavior has emerged, leading to a renewed interest and proposed classification criteria for patterns of hypersexuality in the forthcoming DSM‐V 13, 14, 20, 21, 22.

The proposed diagnostic criteria for the DSM‐V characterize hypersexual disorder (HD) as a repetitive and intense preoccupation with sexual fantasies, urges, and behaviors, leading to adverse consequences and clinically significant distress or impairment in social, occupational, or other important areas of functioning 13, 22. One defining feature of this proposed disorder includes multiple unsuccessful attempts to control or diminish the amount of time the individual engages in sexual fantasies, urges, and behavior in response to dysphoric mood states or stressful life events 13, 14, 23, 24. Despite a constellation of studies investigating characteristics of HD (usually defined in the literature as sexual addiction, sexual compulsivity, or hypersexual behavior), little is known about the neuropsychological correlates of this phenomenon, including possible associations with executive functioning.

Section snippets

Hypersexuality and Executive Function

Executive functions refer to a variety of mental processes necessary for adaptive behavior. Cognitive processes linked to executive functions include inhibition of behavior, impulse control, nonverbal and verbal working memory, emotion regulation, motivation and arousal, planning, organization, decision making, judgment, task monitoring, attention, problem solving, hypothesis generation, abstract thinking, and cognitive flexibility 25, 26, 27, 28, 29. Interestingly, there is evidence to suggest

Participants

The patient sample in this study consisted of men seeking treatment for hypersexual behavior at outpatient clinics predominantly located in Los Angeles, California. Patients were primarily recruited through referrals from their primary provider from clinics that specialized in the treatment of sexual issues including sexual addiction. Sexually active subjects for the community‐based control group were recruited from Utah and California via advertisements placed online, on community bulletin

Results

To examine whether there were differences between subjects in the hypersexual and control groups on hypersexuality and executive function, two multivariate analyses of variance (MANOVAs) were conducted. The two groups were approximately equal in education and income and showed a modest but significant difference in age and FSIQ. When age and FSIQ were entered as covariates in our analysis, the overall results reported below were unaltered.

Discussion

The current investigation examined differences across scores on objective neuropsychological tests of executive functioning in a group of hypersexual male patients compared with a nonhypersexual community sample of men. Subjects were matched on age, years of education, income, and cognitive ability as measured by FSIQ. Group comparisons were examined yielding significant differences on measures of hypersexuality. Surprisingly, and in contrast to previous research using self‐report measures [30]

Conclusions and Directions for Future Research

Given the limitations of objective neuropsychological assessments, more definitive indices of cognitive function should be considered in future investigations of cortical structures that may be associated with hypersexuality. For example, neuroimaging studies highlighting neuroanatomical characteristics of hypersexuality or biophysiological data generated from brain maps using quantitative electroencephalography should be pursued to elucidate possible etiological factors associated with

Conflict of Interest

None declared.

Category 1

  • (a)

    Conception and Design

    Rory C. Reid; Eli Coleman; Bruce N. Carpenter; Sheila Garos

  • (b)

    Acquisition of Data

    Rory C. Reid

  • (c)

    Analysis and Interpretation of Data

    Rory C. Reid; Bruce N. Carpenter

Category 2

  • (a)

    Drafting the Article

    Rory C. Reid; Sheila Garos; Bruce N. Carpenter; Eli Coleman

  • (b)

    Revising It for Intellectual Content

    Rory C. Reid; Bruce N. Carpenter; Sheila Garos

Category 3

  • (a)

    Final Approval of the Completed Article

    Rory C. Reid; Sheila Garos; Bruce N. Carpenter; Eli Coleman

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