From Don Juanism and nymphomania to hypersexual disorders

Hypersexual Disorder is proposed as a new psychiatric disorder for consideration in the sexual disorders section of the DSM-V. Historically, excessive sexual behaviors were clinically documented by diverse clinicians such as the 19th century Western European pioneer sexologists Richard von Krafft-Ebing (1840–1902), Havelock Ellis (1859–1939), and Magnus Hirshfeld (1868–1935). Benjamin Rush(1745–1813), a physician and founding father of the United States (Rush, 1746-1813) also studied the same subject. These clinicians and investigators described a frame of persistent socially deviant sexual behaviors as well as clinical examples of males and females whose nonparaphilic (i.e., normophilic) sexual appetite was excessive and maladaptive. The clinical examples of such appetitive behaviors described by these investigators were precursors to the 20th century characterization of protracted promiscuity as Don Juanism (Stoller, 1975) or satyriasis (Allen, 1969) in males and nymphomania (Ellis & Sagarin, 1965) in females. The DSM-II (American Psychiatric Association, 1968) recognized sexual deviations as personality disorders but there was no mention of excessive or maladaptive nonparaphilic sexual behavior disorders. By 1980, the DSM-III (American Psychiatric Association, 1980) classified paraphilic disorders as distinct pathologies (Psychosexual Disorders) and a residual diagnostic category, Psychosexual Disorder Not Otherwise Specified included ''distress about a pattern of repeated sexual conquests with a succession of individuals who exist only as things to be used (Don Juanism and nymphomania)''. In the DSM-IV (American Psychiatric Association, 1994) and its text revision, DSM-IV-TR (American Psychiatric Association, 2000), the original DSM-III characterization of these behaviors was reestablished. Sexual Disorders Not Otherwise Specified (302.9) included a condition characterized by: ''distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used''. Until recently, authors have used different terms for hypersexual disorders, such as "sexual addiction" (Carnes), "paraphilia-related disorders and non-paraphilic hypersexuality" (Kafka), "excessive sexual desire disorders" (Marshal), "problematic hypersexuality" (Finlayson) and "compulsive sexual bahavior" (Cooper and Coleman). These disorders were described as markedly increased expressions of culturally normative sexual desire (fantasies, urges, and behaviors) persisting for a minimum duration of 6 months and associated with clinically significant personal distress, impairment in reciprocal romantic relationships or other adverse psychosocial consequences. Thera are several form of hypersexual disorders such as compulsive masturbation, pornography dependence, telephone sex dependence, cybersex, severe sexual desire incompatibility, anonymous sex and multiple sexual partners (Coleman 1995, Carnes 2007, Kafka 2000, Kafka 2007, Cooper 2002, Cooper 2003).

There are significant gaps in the current scientific knowledge base regarding the clinical course, developmental risk factors, family history, neurobiology, and neuropsychology of hypersexual disorder. As is true of so many psychiatric disorders, the comment that ''more research is needed'' is certainly applicable to these conditions. Although there are significant shortcomings in the state of our current empirical knowledge, there is little doubt that patients with such conditions commonly present to clinicians as well as to specialized treatment programs.