ORIGINAL RESEARCH-PSYCHOLOGYA Surprising Finding Related to Executive Control in a Patient Sample of Hypersexual Men
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
References (83)
Epilepsy and sexuality
Seizure
(2008)Psychoneuroendocrine aspects of temporolimbic epilepsy. Part I. Brain, reproductive steroids, and emotions
Psychosomatics
(1999)Classifying hypersexual disorders: Compulsive, impulsive, and addictive models
Psychiatr Clin North Am
(2008)- et al.
Preliminary investigation of the impulsive and neuroanatomical characteristics of compulsive sexual behavior
Psychiatry Res
(2009) - et al.
Focusing “hot” or focusing “cool”: Attentional mechanisms in sexual arousal in men and women
J Sex Med
(2011) - et al.
The impact of frontal and non‐frontal brain tumor lesions on Wisconsin Card Sorting Test performance
Brain Cogn
(2004) - et al.
Inhibition of action, thought, and emotion: A selective neurobiological review
Appl Prev Psychol
(2007) - et al.
Validity of the executive function theory of attention‐deficit/hyperactivity disorder: A meta‐analytic review
Biol Psychiatry
(2005) - et al.
Impairment of fronto‐striatal and parietal cerebral networks correlates with attention deficit hyperactivity disorder (ADHD) psychopathology in adults—A functional magnetic resonance imaging (fMRI) study
Psychiatry Res
(2010) - et al.
Biopsychosocial determinants of men's sexual desire: Testing an integrative model
J Sex Med
(2011)
Psychiatric comorbidity and compulsive/impulsive traits in compulsive sexual behavior
Compr Psychiatry
Sexual compulsivity and substance use in HIV‐seropositive men who have sex with men: Prevalence and predictors of high‐risk behaviors
Addict Behav
Problematic Internet experiences: Primary or secondary presenting problems in persons seeking mental health care?
Soc Sci Med
An event‐level analysis of the sexual characteristics and composition among adults ages 18 to 59: Results from a national probability sample in the United States
J Sex Med
Medroxyprogesterone in the treatment of aggressive hypersexual behavior in traumatic brain injury
Brain Inj
Effect of haloperidol on a patient with hypersexuality following frontal lobe injury
Psychogeriatrics
Hypersexuality and dysexecutive syndrome after a thalamic infarct
Int J Neurosci
Hypersexuality and dementia: Dealing with inappropriate sexual expression
Br J Nurs
Understanding hypersexuality: A behavioral disorder of dementia
Home Healthc Nurse
Kluver‐Bucy syndrome in Huntington's chorea
J Nerv Ment Dis
Effects of donepezil on compulsive hypersexual behavior in Parkinson disease: A single case study
Am J Ther
Medication‐related impulse control and repetitive behaviors in Parkinson disease
Arch Neurol
Sexual compulsivity: Definition, etiology, and treatment considerations
J Chem Dependency Treat
Compulsive sexual behavior: New concepts and treatments
J Psychol Hum Sex
Hypersexual disorder: A proposed diagnosis for DSM‐V
Arch Sex Behav
Diagnosis, assessment, and treatment of hypersexuality
J Sex Res
Differentiating emotions in sample of men in treatment for hypersexual behavior
J Soc Work Pract Addict
Psychopathia sexualis
Diagnostic and statistical manual of mental disorders
Paraphilias
Hypersexual desire in males: An operational definition and clinical implications for males with paraphilias and paraphilia‐related disorders
Arch Sex Behav
The paraphilia‐related disorders: A proposal for a unified classification of nonparaphilic hypersexuality disorders
Sex Addict Compul
What is sexual addiction? A response to Stephen Levine
J Sex Marital Ther
Alexithymia, emotional instability, and vulnerability to stress proneness in patients seeking help for hypersexual behavior
J Sex Marital Ther
Test review: Delis–Kaplan Executive Function System
Child Neuropsychol
Assessing the elusive cognitive deficits associated with ventromedial prefrontal damage: A case of a modern‐day Phineas Gage
J Int Neuropsychol Soc
Neuropsychological assessment
Self‐rated executive function: Development of the Executive Function Index
Int J Neurosci
Adult clinical neuropsychology: Lessons from studies of the frontal lobes
Annu Rev Psychol
Self‐reported differences on measures of executive function and hypersexual behavior in a patient and community sample of men
Int J Neurosci
Cited by (59)
Cognitive inflexibility and heightened error monitoring are related to lower sexual functioning
2024, International Journal of PsychophysiologyRate of dilution and redox ratio influence the refolding efficiency of recombinant fungal dehydrogenases
2023, International Journal of Biological MacromoleculesA motivation model of sex addiction – Relevance to the controversy over the concept
2022, Neuroscience and Biobehavioral ReviewsSexual Disorders and Quality of Life in Parkinson's Disease
2021, Sexual MedicineCompulsive Sexual Behavior and Dysregulation of Emotion
2020, Sexual Medicine ReviewsCitation Excerpt :However, it is still unclear whether, and to what degree, CSB is associated with general deficits in impulse control, or rather with more specific deficits limited to the domain of sexuality (eg, impulsivity in the presence of sexual stimuli). Previous studies on this subject led to conflicting findings, both confirming and contradicting the assertion about broad impulse control deficits among participants high in CSB symptoms severity.63–67 The lifetime comorbidity of impulse control disorders among patients with CSB varies between specific conditions and was reported to be 2–14% for kleptomania, 0–3% for trichotillomania, 3–13% for intermittent explosive disorder, and 0–8% for pyromania.40,68
Trait and state impulsivity in males with tendency towards Internet-pornography-use disorder
2018, Addictive BehaviorsCitation Excerpt :To the best of our knowledge, there is no study which investigated trait and state impulsivity in individuals with tendency towards IPD. Studies which investigated impulsivity in hypersexual individuals reported higher trait impulsivity compared to controls (Raymond, Coleman, & Miner, 2003; Rettenberger, Klein, & Briken, 2016) and, similarly to specific IUDs, mixed results were found for state impulsivity (Miner, Raymond, Mueller, Lloyd, & Lim, 2009; Reid, Garos, Carpenter, & Coleman, 2011). Few studies examined the effects of Internet-pornographic-cues on individuals with IPD tendencies.