J Sex Med. 2019 May;16(5):733-745. doi: 10.1016/j.jsxm.2019.03.005.
Hallberg J1, Kaldo V2, Arver S1, Dhejne C3, Jokinen J4, Öberg KG5.
Abstract
BACKGROUND:
Hypersexual disorder (HD) is defined as a condition in which the individual loses control over engagement in sexual behaviors, leading to distress and negative effects on key life areas. Cognitive behavioral therapy (CBT) has been proven to reduce symptoms of hypersexual behavior; however, no randomized controlled study of CBT interventions for HD has been reported previously.
AIM:
To investigate the efficacy of group-administered CBT for HD.
METHODS:
Male participants (n = 137) diagnosed with HD, were randomized between 7 weeks of group-administered CBT (n = 70) and a waitlist control receiving the intervention after 8 weeks (n = 67). Measurements were administered at pre-, mid-, and posttreatment, with follow-up after 3 and 6 months.
OUTCOMES:
The primary outcome was the Hypersexual Disorder: Current Assessment Scale (HD:CAS), and secondary outcomes were the Sexual Compulsivity Scale (SCS) and measures of depression (Montgomery-Åsberg Depression Rating Scale (MADRS-S), psychological distress (Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), and treatment satisfaction (CSQ-8).
RESULTS:
A significantly greater decrease in HD symptoms and sexual compulsivity, as well as significantly greater improvements in psychiatric well-being, were found for the treatment condition compared with the waitlist. These effects remained stable at 3 and 6 months after treatment.
CLINICAL IMPLICATIONS:
CBT can ameliorate HD symptoms and psychiatric distress, suggesting that the CBT program may serve as a first-line treatment in clinical settings.
STRENGTHS & LIMITATIONS:
This is the first randomized controlled study evaluating the efficacy of a CBT program in a rather large sample of HD-specific diagnosed men. The long-term treatment effects are vague due to the low response rate on follow-up measurements, and the efficacy of this program for hypersexual women remains unknown.
CONCLUSION:
This study supports the efficacy of a group-administered CBT program as a treatment option for HD; however, future studies should include women, comprise dismantling analysis of the constituting interventions, and evaluate other treatment formats, for example, administration via the Internet.
KEYWORDS: Basic science male behavioral; Male Sexual Desire Disorders; Mental Health and Male Sexuality
PMID: 30956109
DOI: 10.1016/j.jsxm.2019.03.005
In a review on therapeutic interventions, this was supported by the conclusion that a more “flexible approach” in the treatment of different subgroups of hypersexual behavior could be “promising.”54 In the revision of the ICD-11,3 the diagnostic category compulsive sexual behavior disorder is included in the section for impulse control disorders. The criteria bear many similarities to those of HD and a more nuanced research on possible social, psychological, and biological causes can now be performed. This may in turn enable research on accurately constructed and efficacious treatment options.
Although Rettenberger et al23 identified sexual excitation as the most important predictor of hypersexual behavior, it is reasonable to assume that there are differences between those engaging in interpersonal sexual behaviors (ie, sexual behaviors with consenting adults) and those engaging in solitary sexual behaviors (eg, pornography consumption, masturbation). It has long been argued that HD can be subclassified into sexual behaviors used as a strategy for coping with anxiety and negative mood states on the one hand1,53 and a sexually motivated condition, with emphasis on loss of impulse control and sexual sensation-seeking, on the other hand. Sexual behaviors with consenting adults may be further subdivided based on, for example, repeated purchases of sexual services orrepeated establishment of short-term sexual relations.
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