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Neuropsychiatry of Hypersexuality

Published online by Cambridge University Press:  07 November 2014

Dan J. Stein ,
Frans Hugo ,
Piet Oosthuizen ,
Susan M. Hawkridge  and
Ben van Heerden
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Abstract

Relatively few studies of the psychobiology of hypersexuality have been undertaken. Nevertheless, the literature does suggest the possibility of a neurobiology of hypersexuality. Three cases of hypersexual behavior are presented in the context of neuropsychiatric disorders, and the literature on this phenomenon is briefly reviewed. These case studies and the literature provide evidence that different brain systems may play a role in this disorder. Frontal lesions may be accompanied by disinhibition, including impulsive hypersexual response to external cues, while striatal lesions may be accompanied by repetitive triggering of internally generated response patterns. Temporal-limbic lesions may be accompanied by disturbances in sexual appetite itself, including change in the direction of sexual drive. These case studies demonstrate that a neurobiology of hypersexuality may prove of some heuristic value in the clinic. However, further research is required to consolidate the literature in this area.

Type
Feature Articles
Information
CNS Spectrums , Volume 5 , Issue 1: The Epidemiology, Psychopharmacology, and Neurobiology of Compulsive Sexual Behavior , January 2000 , pp. 36 - 46
Copyright
Copyright © Cambridge University Press 2000

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References

REFERENCES

1.Kafka, MP, Prentky, R. A comparative study of nonparaphilic sexual addictions and paraphilias in men. J Clin Psychiatry. 1992;53:345–350.Google ScholarPubMed
2.Black, DW, Kehrberg, LLD, Flumerfelt, DL, Schlosser, SS. Characteristics of 36 subjects reporting compulsive sexual behavior. Am J Psychiatry. 1997;154:243–249.Google ScholarPubMed
3.Diagnostic and Statistical Manual of Mental Disorders. 3rd ed rev. Washington, DC: American Psychiatric Association; 1980.Google Scholar
4.Coleman, E. Sexual compulsivity: definition, etiology, and treatment considerations. Journal of Chemical Dependency and Treatment. 1987;1:189–204.CrossRefGoogle Scholar
5.Barth, RJ, Kinder, BN. The mislabeling of sexual impulsivity. J Sex Marital Ther. 1987;1:15–23.CrossRefGoogle Scholar
6.Stein, DJ, Hollander, E. Stein and Hollander reply [letter; respnse to: Satel SL. The diagnostic limits of “addiction”]. J Clin Psychiatry. 1993;54:237–238.Google Scholar
7.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
8.McDougle, CJ, Goodman, WK, Leckman, JF, et al.Haloperidol addition in fluvoxamine-refractory obsessive-compulsive disorder: a double-blind placebo-controlled study in patients with and without tics. Arch Gen Psychiatry. 1994;51:302–308.CrossRefGoogle ScholarPubMed
9.Hawkridge, S, Stein, DJ, Bouwer, C. Combining neuroleptics with serotonin specific reuptake inhibitors in Tourette's syndrome [letter]. J Am Acad Child Adolesc Psychiatry. 1996;35:703–704.CrossRefGoogle Scholar
10.Stein, DJ, Hollander, E, Anthony, D, et al.Serotonergic medications for sexual obsessions, sexual addictions, and paraphilias. J Clin Psychiatry. 1992;53:267–271.Google ScholarPubMed
11.Miller, BL, Cummings, JL, McIntyre, H, et al.Hypersexuality or altered sexual preference following brain injury. J Neurol Neurosurg Psychiatry. 1986;49:867–873.CrossRefGoogle ScholarPubMed
12.Huws, R, Subsachs, APW, Taylor, PJ. Hypersexuality, fetishism and multiple sclerosis. Br J Psychiatry. 1991;158:280–281.CrossRefGoogle ScholarPubMed
13.Cooper, AJ. Medroxyprogesterone acetate (MPA) treatment of sexual acting out in men suffering from dementia. J Clin Psychiatry. 1987;48:368–370.Google ScholarPubMed
14.Potocnik, F. Successful treatment of hypersexuality in AIDS dementia with cyproterone acetate. S Afr Med J. 1992;81:433–434.Google ScholarPubMed
15.Stein, DJ. The neurobiology of obsessive-compulsive disorder. The Neuroscientist. 1996;2:300–305.CrossRefGoogle Scholar
16.Elridge, R, Sweet, R, Lake, R, et al.Gilles de la Tourette's syndrome: clinical, genetic, psychologic, and biochemical aspects in 21 selected families. Neurology. 1977;27:115–124.CrossRefGoogle Scholar
17.Nee, LE, Caine, Ed, Polinsky, RJ, et al.Gilles de la Tourette syndrome: clinical and family study of 50 cases. Ann Neurol. 1980;7:41–49.CrossRefGoogle ScholarPubMed
18.Comings, DE. A controlled study of Tourette syndrome, VII. Summary: a common genetic disorder causing dis-inhibition of the limbic system. Am J Hum Genet. 1987;41:839–866.Google Scholar
19.Bruun, RD. The natural history of Tourette's syndrome. In: Cohen, DJ, Bruun, RD, Leckman, JF, eds. Tourette's Syndrome and Tic Disorders: Clinical Understanding and Treatment. New York, NY: John Wiley and Sons; 1988:21–39.Google Scholar
20.Comings, DE. Role of genetic factors in human sexual behavior based on studies of Tourette syndrome and ADHD probands and their relatives. Am J Med Genet. 1994;54:227–241.CrossRefGoogle ScholarPubMed
21.Kerbeshian, J, Burd, L. Tourette syndrome and recurrent paraphilic masturbatory fantasy. Can J Psychiatry. 1991;36:155–157.CrossRefGoogle ScholarPubMed
22.Comings, DE, Comings, BG. A case of familial exhibitionism in Tourette's syndrome successfully treated with haloperidol. Am J Psychiatry. 1982;139:913–915.Google ScholarPubMed
23.McDougle, CJ, Southwick, SM, Rohrbaugh, RM. Tourette's disorder and associated complex behaviors: a case report. Yale J Biol Med. 1990;63:209–214.Google ScholarPubMed
24.Monteiro, WO, Noshirvani, HF, Marks, IM, et al.Anorgasmia from clomipramine in obsessive-compulsive disorder: a controlled trial. Br J Psychiatry. 1987;151:107–112.CrossRefGoogle ScholarPubMed
25.Stein, DJ. Sexual obsessions, compulsions and paraphilias. In Greist, JH, Jefferson, JW, eds. Obsessive Compulsive Disorder Casebook. Washington, DC. American Psychiatric Press; 1995.Google Scholar
26.Rosenbaum, D. Psychosis with Huntington's chorea. Psychiatr Q. 1941;15:93–99.CrossRefGoogle Scholar
27.Janati, A. Klüver-Bucy syndrome in Huntington's chorea. J Nerv Ment Dis. 1985;173:632–635.CrossRefGoogle ScholarPubMed
28.Akil, M, Brewer, GJ. Psychiatric and behavioral abnormalities in Wilson's disease. Adv Neurol. 1995;65:171–178.Google ScholarPubMed
29.Fairweather, DS. Psychiatric aspects of the post-encephalitic syndrome. J Ment Sci. 1947;391:200–254.Google Scholar
30.Bowers, MB Jr, van Woert, M, Davis, L. Sexual behavior during L-dopa treatment for Parkinsonism. Am J Psychiatry. 1971;127:1691–1693.CrossRefGoogle ScholarPubMed
31.Brown, E, Brown, GM, Kofman, O, et al.Sexual function and affect in parkinsonian men treated with L-dopa. Am J Psychiatry. 1978;135:1552–1555.Google ScholarPubMed
32.Uitti, RJ, Tanner, CM, Rajput, AH, et al.Hypersexuality with antiparkinsonian therapy. Clin Neuropharmacol. 1989;12:375–383.CrossRefGoogle ScholarPubMed
33.Mas, M. Neurobiological correlates of masculine sexual behavior. Neurosci Biobehav Rev. 1995;19:261–277.CrossRefGoogle ScholarPubMed
34.Pfaus, JG, Everitt, BJ. The psychopharmacology of sexual behavior. In: Bloom, FE, Kupfer, DJ, eds. Psychopharmacology: The Fourth Generation of Progress. New York, NY: Raven Press; 1995: 743–758Google Scholar
35.Allison, JB, Wilson, WP. Sexual behavior of manic patients: a preliminary report. South Med J. 1960;53:870–874.CrossRefGoogle ScholarPubMed
36.Kafka, MRSuccessful antidepressant treatment of nonparaphilic sexual addictions and paraphilias in men. J Clin Psychiatry. 1991;52:60–65.Google ScholarPubMed
37.Stein, SL, Solvason, HB, Biggart, E, Spiegel, D. A 25-year-old woman with hallucinations, hypersexuality, nightmares, and a rash. Am J Psychiatry. 1996;153:545–551.Google ScholarPubMed
38.Angrist, B, Gershon, S. Clinical effects of amphetamines and L-dopa on sexuality and aggression. Compr Psychiatry. 1979;17:715–722.CrossRefGoogle Scholar
39.Bradford, JMW. Pharmacological treatment of the paraphilias. In: Oldham, JM, Riba, MB, eds. American Psychiatric Press Review of Psychiatry. Vol 14. Washington, DC: American Psychiatric Press; 1995.Google Scholar
40.Kafka, MP, Prentky, R. Fluoxetine treatment of nonparaphilic sexual addictions and paraphilias in men. J Clin Psychiatry. 1992;53:351–358.Google ScholarPubMed
41.Kafka, MP. Sertraline pharmacotherapy for paraphilias and paraphilia-related disorders: an open trial. Ann Clin Psychiatry. 1994;6:189–195.CrossRefGoogle ScholarPubMed
42.Bartholomew, AA. A long-acting phenothiazine as a possible agent to control deviant sexual behavior. Am J Psychiatry. 1968;124:917–923.CrossRefGoogle ScholarPubMed
43.Field, LH. Benperidol in the treatment of sexual offenders. Med Sci Law. 1973;13:195–196.CrossRefGoogle ScholarPubMed
44.Tennent, G, Bancroft, J, Cass, J. The control of deviant sexual behavior by drugs: a double-blind controlled study of benperidol, chlorpromazine, and placebo. Arch Sex Behav. 1974;3:261–271.CrossRefGoogle ScholarPubMed
45.Bartova, D. Comparative study of prophylactic lithium and diethylstilbesterol in sexual deviants. Acta Nerv Suppl (Praha). 1979;21:163–164.Google Scholar
46.Snaith, RP. Five exhibitionists and a method of treatment. Br J Psychiatry. 1981;132:126–130.CrossRefGoogle Scholar
47.Kafka, MP. A monoamine hypothesis for the pathophysiology of paraphilic disorders. Arch Sex Behav. 1997;26:343–358.CrossRefGoogle ScholarPubMed
48.Zohar, J, Kaplan, Z, Benjamin, J. Compulsive exhibitionism successfully treated with fluvoxamine: a controlled case study. J Clin Psychiatry. 1994;55:86–88.Google ScholarPubMed
49.Kruesi, MJP, Fine, S, Valladares, L, et al.Paraphilias: a double-blind crossover comparison of clomipramine versus desipramine. Arch Sex Behav. 1992;21:587–593.CrossRefGoogle ScholarPubMed
50.MacLean, PD, Ploog, DW. Cerebral representations of penile erection. J Neurophysiol. 1962;25:29–55.CrossRefGoogle Scholar
51.MacLean, PD, Denniston, RH, Dua, S, Ploog, DW. Further studies on cerebral representation of penile erection: caudal thalamus, midbrain, and pons. J Neurophysiol. 1963;26:273–293.CrossRefGoogle Scholar
52.Persinger, MA. Maintained hypersexuality between male rats following chronically induced limbic seizures: implications for bisexuality in complex partial epileptic seizures. Psychol Rep. 1994;74:647–652.CrossRefGoogle ScholarPubMed
53.Klüver, H, Bucy, P. Preliminary analysis of functions of the temporal lobes in monkeys. Arch Neurol Psychiatry. 1939;42:979–1000.CrossRefGoogle Scholar
54.Wood, CD. Behavioral changes following discrete lesions of temporal lobe structures. Neurology. 1958;8:215–220.CrossRefGoogle ScholarPubMed
55.Rasmussen, EW, Kaada, BR, Bruland, H. Effects of neo-cortical and limbic lesions on the sex drive in rats. Acta Physiol Scand. 1960;S175:126–127.Google Scholar
56.Hagamen, WB, Zitzmann, EK, Ungewitter, LH. Sexual activity of male cats following localized lesions of the frontal lobes. Anat Rec. 1963;56:298–302.Google Scholar
57.Lisk, R. Increased sexual behavior in the male rat following lesions in the mamillary region. J Exp Zool. 1966;161:129–136.CrossRefGoogle Scholar
58.Heath, RG, de Balbain Verster, F. Effects of chemical stimulation to discrete brain areas. Am J Psychiatry. 1961;117:980–990.CrossRefGoogle ScholarPubMed
59.Heath, RB. Pleasure and brain activity in man. J Nerv Ment Dis. 1972;154:3–18.CrossRefGoogle ScholarPubMed
60.Terzian, H, Dall Ore, G. Syndrome of Klüver and Bucy reproduced in man by bilateral removal of the temporal lobes. Neurology. 1955;5:373–386.CrossRefGoogle Scholar
61.Gerstenbrand, F, Poewe, W, Aichner, F, Salturai, L. Klüver-Bucy syndrome in man: experiences with posttraumatic cases. Neurosci Biobehav Rev. 1983;7:413–417.CrossRefGoogle ScholarPubMed
62.Lilly, R, Cummings, JL, Benson, DF, et al.The human Klüver-Bucy syndrome. Neurology. 1983;333:1141–1145.CrossRefGoogle Scholar
63.Ball, JRB. A case of hair fetishism, transvestitism, and organic cerebral disorder. Acta Psychiatr Scand. 1968;44:249–254.CrossRefGoogle ScholarPubMed
64.Blustein, J, Seeman, MV. Brain tumours as functional psychiatric disturbances. Can Psychiatr Assoc J. 1972;17:S59–S63.CrossRefGoogle ScholarPubMed
65.Gorman, DG, Cummings, JL. Hypersexuality following septal injury. Arch Neurol. 1992;49:308–310.CrossRefGoogle ScholarPubMed
66.Monga, TN, Monga, M, Raina, MS, Hardjasudarma, M. Hypersexuality in stroke. Arch Phys Med Rehabil. 1986;67:415–417.Google ScholarPubMed
67.Signer, SS, Cummings, JL. Erotomania and cerebral dys-function. Br J Psychiatry. 1987;151:275.CrossRefGoogle Scholar
68.Morrell, MJ. Sexual dysfunction in epilepsy. Epilepsia. 1991;32:S38–S45.CrossRefGoogle ScholarPubMed
69.Epstein, AW. Relationship of fetishism and transvestism to brain and particularly to temporal lobe dysfunction. J Nerv Ment Dis. 1961;133:247–253.CrossRefGoogle ScholarPubMed
70.Hoenig, J, Kenna, J. EEG abnormalities and transsexualism. Br J Psychiatry. 1979;134:293–300.CrossRefGoogle ScholarPubMed
71.Bear, DM, Fedio, P. Quantitative analysis of interictal behavior in temporal lobe epilepsy. Arch Neurol. 1977;34:454–467.CrossRefGoogle ScholarPubMed
72.Kolarsky, A, Freund, K, Machek, J, et al.Male sexual deviation: association with early temporal lobe damage. Arch Gen Psychiatry. 1967;17:735–743.CrossRefGoogle ScholarPubMed
73.Demerdash, A, Shaalan, M, Midani, A, et al.Sexual behavior of a sample of females with epilepsy. Epilepsia. 1991;32:82–85.CrossRefGoogle ScholarPubMed
74.Remillard, GM, Andermann, F, Testa, GF, et al.Sexual ictal manifestations predominate in women with temporal lobe epilepsy: a finding suggesting sexual dimorphism in the human brain. Neurology. 1983;33:323–330.CrossRefGoogle ScholarPubMed
75.Backman, DS, Rossel, CW. Orgasmic epilepsy. Neurology. 1984;34:559–560.CrossRefGoogle Scholar
76.Blumer, D. Hypersexual episodes in temporal lobe epilepsy. Am J Psychiatry. 1970;126:1099–1106.CrossRefGoogle ScholarPubMed
77.Stewart, JT. Carbamazepine treatment of a patient with Klüver-Bucy syndrome. J Clin Psychiatry. 1985;46:496–497.Google ScholarPubMed
78.Mitchell, W, Falconer, MA. Epilepsy with fetishism relieved by temporal lobectomy. Lancet. 1954;2:626–630.CrossRefGoogle Scholar
79.Hunter, R, Logue, V, McMenemy, WH. Temporal lobe epilepsy supervening on long standing transvestism and fetishism. Epilepsia. 1963;4:60–65.CrossRefGoogle Scholar
80.Walinder, J. Transvestism, definition and evidence in favour of occasional deviation from cerebral dysfunction. Int J Neuropsychiatry. 1965;1:567–573.Google Scholar
81.Hucker, S, Langevin, R, Wortzman, G, et al.Cerebral damage and dysfunction in sexually aggressive men. Annals Sexual Research. 1988;1:33–47.CrossRefGoogle Scholar
82.Wright, P, Nobrega, J, Langevin, R, et al.Brain density and symmetry in pedophilic and sexually aggressive offenders. Annals Sexual Research. 1990;3:319–328.CrossRefGoogle Scholar
83.Langevin, R, Wortzman, G, Wright, P. Studies of brain damage and dysfunction in sex offenders. Annals Sexual Research. 1989;2:163–179.CrossRefGoogle Scholar
84.Langevin, R, Lang, RA, Wortzman, G, et al.An examination of brain damage and dysfunction in genital exhibitionists. Annals Sexual Research. 1989;2:77–94.CrossRefGoogle Scholar
85.Raine, A. The Psychopathology of Crime: Criminal Behavior as a Clinical Disorder. San Diego, Calif: Academic Press; 1993.CrossRefGoogle Scholar
86.Hitchcock, E. Psychosurgery today. Annals Clinical Research. 1971;3:187–198.Google ScholarPubMed
87.Dieckmann, G, Schneider-Jonietz, B, Schneider, H. Psychiatric and neuropsychological findings after stereotactic hypothalamotomy in cases of extreme sexual aggressivity. Acta Neurochir (Wien). 1988;44:S163–S166.Google ScholarPubMed
88.Stein, MB, Koverola, C, Hanna, C, Torchia, MG, McClarty, B. Hippocampal volume in women victimized by child-hood sexual abuse. Psychol Med. 1997;27:951–959.CrossRefGoogle Scholar
89.Mani, SK, Allen, JMC, Clark, JH, et al.Convergent pathways for steroid hormone- and neurotransmitter-induced rat sexual behavior. Science. 1994;265:1246–1248.CrossRefGoogle ScholarPubMed
90.Cryan, EMJ, Butcher, GJ, Webb, MGT. Obsessive-compulsive disorder and paraphilia in a monozygotic twin pair. Br J Psychiatry. 1992;161:694–698.CrossRefGoogle Scholar
91.Gaffney, GR, Lurie, SF, Berlin, SF. Is there familial transmission of pedophilia? J Nerv Ment Dis. 1984;172:546–548.CrossRefGoogle ScholarPubMed
92.Blair, C, Lanyon, RI. Exhibitionism: etiology and treatment. Psychol Bull. 1981;89:439–463.CrossRefGoogle ScholarPubMed
93.Arieff, AJ, Rotman, DB. 100 cases of indecent exposure. J Nerv Ment Dis. 1942;96:523–528.CrossRefGoogle Scholar
94.Henn, FA, Herjanci, M, Vanderpearl, RH. Forensic psychiatry: profiles of two types of sex offenders. Am J Psychiatry. 1976;133:696–699.Google ScholarPubMed