hypersexual disorder

Looking For Love in All the Wrong Places



Hypersexual Disorder (Kafka, 2009). Kafka’s proposal includes the following diagnostic criteria: (1) Over a period of at least six months, recurrent and intense sexual fantasies, sexual urges, or sexual behaviors in association with three or more of the following five criteria: a. Time consumed by repeatedly indulging in sexual fantasies, urges or behaviors which interferes with other important (non-sexual) goals, activities and obligations. b. Repetitively engaging in sexual fantasies, urges or behaviors in response to dysphoric mood states (e.g., anxiety, depression, boredom, irritability). c. Repetitively engaging in sexual fantasies, urges or behaviors in response to stressful life events. d. Repetitive but unsuccessful efforts to control or significantly reduce these sexual fantasies, urges, or behaviors. e. Repetitively engaging in sexual behaviors while disregarding the risk for physical or emotional harm to self or others. (2) There is a clinically significant personal distress or impairment in social, occupational, or other important areas of functioning associated with the frequency and intensity of these sexual fantasies, urges, or behaviors. (3) These sexual fantasies, urges, or behaviors are not due to the direct physiological effect of an exogenous substance (e.g., a drug of abuse or a medicine). (p. 3)

This study (1) resulted in findings that showed the relationship of high levels of attachment anxiety and avoidance to hypersexual behavior and in those with Hypersexual Disorder (HD) or Out-of-Control Sexual Behavior (OCSB).


“OCSB as an Attachment Disorder

OCSB has been related to insecure attachment styles and their impact on affect regulation (Katehakis, 2009). According to Katehakis, affect regulation is directly related to attachment issues, and these affect-regulation difficulties are, in turn, related to OCSB. Using anecdotal case reviews, Katehakis examined attachment experiences and their relation to brain function and affect regulation and saw a direct connection between OCSB and affect regulation. Only one study to date (Zaph et al., 2008) has directly examined OCSB and attachment. This quantitative study indicated that men who display OCSB tend to have an insecure attachment style. It should be noted, however, that Zaph et al. did not control for men who have been in therapy.


OCSB as an Addiction

Wines (1997) studied the connection between the seven criteria in the DSM-IV for substance dependency and OCSB using a purposive sample of 183 men recruited through 12-step groups and a snowball sampling process. He developed a survey that assessed OCSB using the criteria of substance dependence. The criteria included increased tolerance of the behavior, withdrawal effects, unsuccessful efforts at stopping the behavior, and consequences of the behavior. The percentage of respondents who related their sexual behavior to each criterion was between 74% and 98%, which validated the relevance of these descriptors to OCSB.

Nakken (1988) developed the concept of behavioral addictions and theorized that addiction to an activity could substitute for actual relationships. Nakken believed that the activity or the process can become the individual’s primary emotional relationship due to its ability to change the way the individual feels. Nakken provides a model in which certain behaviors have affect-regulating effects. He proposed that certain individuals use activities, rather than turning to another person, as the primary method to change the way they feel.


Attachment, Affect Regulation, and OCSB

In a study by Feeney and Noller (1990), university students who were classified as insecure-avoidant were found to have a tendency toward multiple relationships and a use of sex for enjoyment rather than a deepening of emotional relationships.

Tracey, Shaver, Albino, and Cooper (2003), found that insecurely-attached adolescents tended to use sex as a way to ward off feelings of rejection. Tracey et al. also found that insecure-avoidantly-attached adolescents had less of a tendency to connect sex with love and affection. Davis, Shaver, and Vernon (2004) found that insecurely-attached individuals tended to use sex for more manipulative, self-serving purposes.

Schachner and Shaver (2004) found that insecure avoidantly-attached individuals tended to use sexual relations for more narcissistic, self enhancing, rather than intimacy-enhancing, motives, while anxiously-attached individuals tended to use sex to feel loved and avoid rejection.


As hypothesized (1), men who were assessed as having high levels of hypersexual behavior on the assessments for hypersexual behavior (HBI) also were assessed as having insecure attachment based on high scores on the attachment style scale (ECR-S). High levels of attachment anxiety and avoidance are indicators of insecure attachment.

Those with more attachment anxiety tend to have an excessive need for the social approval from others as well as a tendency toward emotional reactivity and interpersonal distress.

Those with more attachment avoidance tend to display an excessive need for self-reliance and are more emotionally cut-off and fearful of intimacy (Mallinkodt & Wang, 2004, Mikulincer & Shaver, 2007).

Attachment avoidance is based in the defense against fears of attachment as the primary manifestation of insecure attachment. It is this defense against attachment that seems most related to (Out-of-Control Sexual Behavior) OCSB. In this sense, OCSB is the manifestation of the defense. Stated differently, OCSB is the strategy that an individual uses to defend against his fears of attachment.


Discussion – This study resulted in findings that linked higher levels of attachment avoidance to a stronger predictor of hypersexual behavior than were high levels of attachment anxiety. It appears that those with high levels of attachment anxiety seek out relationships but that their constant need for reassurance and approval may leave them with high levels of interpersonal distress.

Thus, those with higher levels of attachment anxiety may experience distress in their connections, but they connect, nonetheless. Individuals with higher levels of attachment avoidance may have well-developed defenses that leave them less capable and consciously desirous of connection.

These individuals experience emotional shut-down and excessive self reliance, yet these defenses are not assuaging their distress in life. Like those with high levels of attachment anxiety, individuals with attachment avoidance are often depressed, anxious, and lonely.

One strategy that those with high levels of attachment avoidance may use to address these difficulties is to sexually act out their emotional needs. These sexual behaviors may provide the opportunity for connection while disavowing the actual emotional need. This strategy creates more safety; they have the need for connection but they never have to acknowledge it.

This approach is similar to what is seen in infants in Main’s Infant Strange Situation experiments. The infants seem unaffected by their mothers’ absence, but the heart-rate monitor tells a different story. Slade (2000) stated that, for those with avoidant styles of attachment, “sexual feelings are unintegrated and may function as split-off ways of obtaining care and/or expressing aggression” (p. 1161).

Estellon and Mouras (2012) stated that men with OCSB have difficulty trusting others and that this distrust affects their worldview. They noted that these men question whether they will have a responsive, reliable other in their lives. This also is a description of the underlying fears of individuals with an insecure attachment styles.

Fonagy (2001) noted that individuals with higher levels of avoidant attachment suffer from “introjective pathology,” which he described as an intensified need for autonomous identity rather than relatedness.”




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