Hypersexual Desire in Males: Are Males With Paraphilias Different From Males With Paraphilia-Related Disorders?

Abstract

The assessment of current sexual behavior (fantasies, urges, and activities) and sexual preoccupation (measured in minlday) associated with both conventional (i.e., adult relationship-associated) or unconventional (paraphilia and paraphilia-related) sexual behavior were ascertained from a sample of 120 consecutively evaluated males with paraphilias (PA; n = 88, including sex offender paraphiliacs ; n = 60) and paraphilia-related disorders (PRD; n = 32). In addition, an assessment of hypersexual desire, defined as the highest sustained period (at least 6 months minimum duration) ofpersistently enacted sexual behavior (total sexual outlet/week [TSO] after age 15) was assessed. In almost all measures, the PA and PRD groups were not statistically significantly different. The average PA or PRD reported a mean hypersexual TSO of 11.7 ± 7.3, a mean age of 21.6 ± 7.1 years at onset of peak hypersexual behavior, and a mean duration of 6.2 ± 7.6 years of hypersexual TSO. When the sample was stratified into three subgroups on the basis of the lifetime number of PAs+PRDs as a proxy measure of the severity of sexual impulsivity, the "high" group, with at least 5 lifetime PAs and PRDs, consisted of all paraphilic males, predominantly sex offenders, who self-reported the highest hypersexual desire (14.3 ± 7.9), the highest current TSO/week (9.9 ± 8.1), the most current sexual preoccupation (2-4 hr/day), and the highest likelihood of incarceration secondary to paraphilic sex-offending behavior. Although hypersexual desire, a quantitative measure of enacted sexual behaviors, may be a meaningful construct for clinically derived samples, the incidence and prevalence of hypersexual desire in community samples of males with paraphilias and paraphilia-related disorders is unknown.

Keywords

hypersexual paraphilia paraphilia-related disorder sexual desire sexual preoccupation total sexual outlet sex offender sexual addiction.

References

Alexander, M.A. (1999). Sexual offender treatment efficacy revisited. Sexual Abuse: A Journal of Treatment and Research, 11, 101-116.

American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders. (3rd ed.). Washington, DC: Author .

American Psychiatric Association. (1987). Diagnostic and statistical manual (3rd ed. res.). Washington, DC: Author.

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed., pp. 493-538). Washington, DC: Author.

Atwood, J.D. , & Gagnon, J. (1987). Masturbatory behavior in college youth. Journal of Sex Education and Therapy, 13, 35-42.

Berlin, F.S. , Malin, H.M. , & Thomas, K. (1995). Nonpedophilic and nontransvestic paraphilias. In G. O. Gabbard (Ed.), Treatments of psychiatric disorders (Vol. 2, pp. 1941-1958). Washington, DC: American Psychiatric Press.

Billy, J.O.G. , Tanfer, K. , Grady, W.R. , & Klepinger, D.H. (1993). The sexual behavior of men in the United States. Family Planning Perspectives, 25, 52-60.

Black, D.W. (1998). Compulsive sexual behavior: A review. Journal of Practical Psychiatry and Behavior, 4, 217-229.

Black, D.W. , Kehrberg, L.L.D. , Flumerfelt, D.L. , & Schlosser, S.S. (1997). Characteristics of 36 subjects reporting compulsive sexual behavior. American Journal of Psychiatry, 154, 243-249.

10.

Bradburn, N.M. , Sudman, S. , Blair, E. , & Stocking, C. (1978). Question threat and response bias. Public Opinion Quarterly, 42, 221-234.

11.

Brotherton, J. (1974). Effect of oral cyproterone acetate on urinary and serum FSH and LH levels in adult males being treated for hypersexuality . Journal of Reproductive Fertility, 36, 177- 187.

12.

Carnes, P. (1983). Out of the shadows: Understanding sexual Addiction . Minneapolis, MN: CompCare.

13.

Carnes, P. (1991). Don't call it love; Recovery from Sexual Addiction . New York: Bantam Books.

14.

Catania, J.A. , McDermott, L. , & Pollack, L. (1986). Questionnaire response bias and face-to-face interview sample bias in sexuality research. Journal of Sex Research , 22, 52-72.

15.

Coleman, E. (1987). Sexual compulsivity: Definition, etiology, and treatment considerations. Journal of Chemical Dependency Treatment , 1, 189-204.

16.

Cooper, A.J. (1981). A placebo-controlled trial of the antiandrogen cyproterone acetate in deviant hypersexuality. Comprehensive Psychiatry, 22, 458-465.

17.

Cooper, A. , Delmonico, D.D. , & Burg, R. (2000). Cybersex users, abusers, and compulsives: New findings and implications. Sexual Addiction and Compulsivity , 7, 5-29.

18.

Everitt, B.J. , & Bancroft, J. (1991). Of rats and men: The comparative approach to male sexuality. In J. Bancroft , C. M. Davis , & H. J. Ruppel Jr. (Eds.), Annual review of sex research (Vol. 2, pp. 77-118). Mt. Vernon, IO: Society for the Scientific Study of Sex.

19.

Jones, J.C. , & Barlow, D.H. (1990). Self-reported frequency of sexual urges, fantasies, and masturbatory fantasies in heterosexual males and females. Archives of Sexual Behavior, 19, 269-279.

20.

Kafka, M.P. (1994a). Paraphilia-related disorders: Common, neglected, and misunderstood. Harvard Review of Psychiatry, 2, 39-40.

21.

Kafka, M.P. (1994b). Sertraline pharmacotherapy for paraphilias and paraphilia-related disorders; an open trial. Annals of Clinical Psychiatry, 6, 189-195.

22.

Kafka, M.P. (1997). Hypersexual desire in males: An operational definition and clinical implications for men with paraphilias and paraphilia-related disorders. Archives of Sexual Behavior, 26, 505-526.

23.

Kafka, M.P. (2000). The paraphilia-related disorders: Nonparaphilic hypersexuality and sexual compulsivity/addiction. In S. R. Lieblum & R. C. Rosen (Eds.), Principles and practice of sex therapy (3rd ed., pp. 471-503). New York: Guilford .

24.

Kafka, M.P. , & Hennen, J. (1999). The paraphilia-related disorders: An empirical investigation of nonparaphilic hypersexuality disorders in 206 outpatient males. Journal of Sex and Marital Therapy, 25, 305-319.

25.

Kafka, M.P. , & Hennen, J. (2000). Psychostimulant augmentation during treatment with selective serotonin reuptake inhibitors in males with paraphilias and paraphilia-related disorders: A case series. Journal of Clinical Psychiatry, 61, 664-670.

26.

Kafka, M. , & Hennen, J. (2002). A DSM IV Axis I comorbidity study of males (n = 120) with paraphilias and paraphilia-related disorders. Sexual Abuses, 14, 349-366.

27.

Kafka, M.P. , & Prentky, R. (1992a). A comparative study of nonparaphilic sexual addictions and paraphilias in men. Journal of Clinical Psychiatry, 53, 345-350.

28.

Kafka, M.P. , & Prentky, R. (1992b). Fluoxetine treatment of nonparaphilic sexual addictions and paraphilias in men. Journal of Clinical Psychiatry , 52, 351-358.

29.

Kaplan, H.S. (1995). The Sexual desire disorders: Dysfunctional regulation of sexual motivation. New York: Brunner/Mazel .

30.

Kinsey, A.C. , Pomeroy, W.B. , & Martin, C.E. (1948a). Homosexual outlet. In A. C. Kinsey , W. B. Pomeroy , & C. E. Martin (Eds.), Sexual behavior in the human male (pp. 636-359). Philadelphia: Saunders.

31.

Kinsey, A.C. , Pomeroy, W.B. , & Martin, C.E. (1948b). Sexual behavior in the human male. Philadelphia: Saunders.

32.

Kinsey, A.C. , Pomeroy, W.B. , & Martin, C.E. (1948c). Total Sexual Outlet, Sexual behavior in the human male (pp. 193-217). Philadelphia: Saunders .

33.

Knight, R. , & Cerce, D. (1999). Validation and revision of the Multidimensional Assessment of Sex and Aggression. Psycholigica Belgica, 39, 135-161.

34.

Knight, R.A. , Prentky, R.A. , & Cerce, D.D. (1994). The development, reliability, and validity of an inventory for the multidimensional assessment of sex and aggression. Criminal Justice and Behavior, 21, 72-94.

35.

Laumann, E.O. , Gagnon, J.H. , Michael, R.T. , & Michaels, S. (1994). The social organization of sexuality: Sexual practices in the United States. Chicago: University of Chicago Press.

36.

Liu, D. , Ng, M. , Zhou, L.P. , & Haeberle, E. (1997). Sexual behavior in modern China. New York: Continuum.

37.

Malamuth, N. , Knight, R. , & Prentky, R. (1995, October 11-14). A unified developmental theory of sexual aggression: Models in the making. Paper presented at the The Fourteenth Annual Research and Treatment Conference of the Association for the Treatment of Sexual Abusers (ATSA), October 11-14, New Orleans.

38.

Malamuth, N.M. , Sockloskie, R.J. , Koss, M.P. , & Tanaka, J.S. (1991). Characteristics of aggressors against women: Testing a model using a national sample of college students. Journal of Consulting and Clinical Psychology, 59, 670-681.

39.

Marshall, W.L. (1979). Satiation therapy. Journal of Applied Behavioral Analysis, 12, 377-389.

40.

Orford, J. (1978). Hypersexuality: Implications for a theory of dependence . British Journal ofAddiction, 73,299-310.

41.

Wellings, K. , Field, J. , Johnson, A. , & Wadsworth, J. (1994). Sexual behavior in Britain: The national survey of sexual attitiudes and lifestyles. London: Penguin Books.