Hypersexual disorder (HD) is not defined in a uniform way in the psychiatric literature. In the absence of solid evidence on prevalence, causes, empirically validated diagnostic criteria, instruments for diagnosis, consistent guidelines on treatment options, medical and psychosocial consequences, and type of caregivers that need to be involved, HD remains a controversial and relatively poorly understood chronic disease construct. The role of family medicine in the detection, treatment, and followup of HD is not well studied. The purpose of this paper is to describe the complexity of HD as a multidimensional chronic disease construct and its relevance to family medicine and primary care. 1. Introduction Hypersexual disorder (HD) [1], also previously known as out-of-control sexual behavior, impulse control disorders [2], sexual addiction, sexual compulsivity, and sexual desire dysregulation [3], is not defined in a uniform way in the psychiatric literature. Although the clinical presentation of the disorder is varied, HD is characterized by an increased frequency and intensity of sexually motivated fantasies, arousal, urges, and enacted behavior in association with an impulsivity component over a period of ≥6 months [4]. It is estimated that 6% of the general population in the USA is afflicted [5], whereas to our knowledge no reliable estimates on the prevalence of HD in Europe are available. The usefulness of the term HD depends upon the degree to which it can be defined, measured, and distinguished from other psychiatric disorders and nonpathological sexual behaviour [6]. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), criteria for HD have been proposed by the Work Group on Sexual and Gender Identity Disorders to capture symptoms reported by patients seeking help for out-of-control sexual behavior [7, 8]. HD is nowadays not included in DSM-V as a distinct disorder as it requires more research and evidence to illuminate the cause, diagnosis, and treatment. In the absence of solid evidence on prevalence, causes, empirically validated diagnostic criteria, instruments for diagnosis, consistent guidelines on treatment options, medical and psychosocial consequences, and type of caregivers that need to be involved, HD remains a controversial and relatively poorly understood chronic disease construct. Whether or not HD will be considered as a distinct disorder in the next Diagnostic and Statistical Manual of Mental Disorders, we think it is important to outline its inherent complexity. In the light of the growing number of chronic
References
[1]
M. P. Kafka and J. Hennen, “Hypersexual desire in males: are males with paraphilias different from males with paraphilia-related disorders?” Sexual Abuse, vol. 15, no. 4, pp. 307–321, 2003.
[2]
J. Bancroft, “Sexual behavior that is “Out of Control”: a theoretical conceptual approach,” Psychiatric Clinics of North America, vol. 31, no. 4, pp. 593–601, 2008.
[3]
J. Bancroft, “Central inhibition of sexual response in the male: a theoretical perspective,” Neuroscience and Biobehavioral Reviews, vol. 23, no. 6, pp. 763–784, 1999.
[4]
E. Echeburua, “Does really sex addiction exist?” Adicciones, vol. 24, no. 4, pp. 281–285, 2012.
[5]
D. W. Black, “The epidemiology and phenomenology of compulsive sexual behavior,” CNS Spectrums, vol. 5, no. 1, pp. 26–72, 2000.
[6]
A. Baumelou, F. Marcelli, G. Robin, and J. M. Rigot, “Normal sexuality and sexual disorders,” Revue du Praticien, vol. 63, no. 2, pp. 245–251, 2013.
[7]
M. P. Kafka, “Hypersexual disorder: a proposed diagnosis for DSM-V,” Archives of Sexual Behavior, vol. 39, no. 2, pp. 377–400, 2010.
[8]
R. C. Reid, B. N. Carpenter, J. N. Hook, et al., “Report of findings in a DSM-5 field trial for hypersexual disorder,” Journal of Sexual Medicine, vol. 9, no. 11, pp. 2868–2877, 2012.
[9]
World Health Organisation, The Global Burden of Disease: 2004 Update, World Health Organisation, Geneva, Switzerland, 2008.
[10]
L. Borgermans, J. de Maeseneer, H. Wollersheim, B. Vrijhoef, and D. A. Devroey, “theoretical lens for revealing the complexity of chronic care,” Perspectives in Biology and Medicine. In press.
[11]
J. de Maeseneer, R. G. Roberts, M. Demarzo et al., “Tackling NCDs: a different approach is needed,” The Lancet, vol. 379, no. 9829, pp. 1860–1861, 2011.
[12]
J. de Maeseneer and P. Boeckxstaens, “James Mackenzie Lecture 2011: multimorbidity, goal-oriented care, and equity,” British Journal of General Practice, vol. 62, no. 600, pp. e522–e524, 2012.
[13]
J. de Maeseneer and P. Boeckxstaens, “Care for noncommunicable diseases (NCDs): time for a paradigm-shift,” World Hospitals and Health Services, vol. 47, no. 4, pp. 30–33, 2011.
[14]
S. Gress, C. A. Baan, M. Clanan et al., “Co-ordination and management of chronic conditions in Europe: the role of primary care—position paper of the European forum for primary care,” Quality in Primary Care, vol. 17, no. 1, pp. 75–86, 2009.
[15]
J. M. de Maeseneer, M. L. van Driel, L. A. Green, and C. van Weel, “The need for research in primary care,” The Lancet, vol. 362, no. 9392, pp. 1314–1319, 2003.
[16]
C. van Weel, J. de Maeseneer, and R. Roberts, “Integration of personal and community health care,” The Lancet, vol. 372, no. 9642, pp. 871–872, 2008.
[17]
World Health Organization, “Noncommunicable diseases country profiles 2011,” WHO Global Report, 2013.
[18]
A. Warsi, P. S. Wang, M. P. LaValley, J. Avorn, and D. H. Solomon, “Self-management education programs in chronic disease: a systematic review and methodological critique of the literature,” Archives of Internal Medicine, vol. 164, no. 15, pp. 1641–1649, 2004.
[19]
M. M. Safford, J. J. Allison, and C. I. Kiefe, “Patient complexity: more than comorbidity. The vector model of complexity,” Journal of General Internal Medicine, vol. 22, no. 3, supplement, pp. 382–390, 2007.
[20]
N. L？ngstr？m and R. K. Hanson, “High rates of sexual behavior in the general population: correlates and predictors,” Archives of Sexual Behavior, vol. 35, no. 1, pp. 37–52, 2006.
[21]
M. D. Scanavino, A. Ventuneac, C. H. Abdo, et al., “Compulsive sexual behavior and psychopathology among treatment-seeking men in Sao Paulo, Brazil,” Psychiatric Research, vol. 1781, no. 13, pp. 42–45, 2013.
[22]
F. D. Garcia and F. Thibaut, “Sexual addictions,” American Journal of Drug and Alcohol Abuse, vol. 36, no. 5, pp. 254–260, 2010.
[23]
C. Cui, A. Noronha, H. Morikawa, et al., “New insights on neurobiological mechanisms underlying alcohol addiction,” Neuropharmacology, vol. 67, pp. 223–232, 2013.
[24]
K. Blum, E. R. Braverman, J. M. Holder et al., “Reward deficiency syndrome: a biogenetic model for the diagnosis and treatment of impulsive, addictive, and compulsive behaviors,” Journal of Psychoactive Drugs, vol. 32, supplement, pp. 1–112, 2000.
[25]
K. Blum, M. Oscar-Berman, D. Barh, J. Giordano, and M. Gold, “Dopamine genetics and function in food and substance abuse,” Journal of Genetic Syndromes & Gene Therapy, vol. 4, no. 121, 2013.
[26]
K. S. Kendler, “What psychiatric genetics has taught us about the nature of psychiatric illness and what is left to learn,” Molecular Psychiatry, 2013.
[27]
K. Blum, A. L. Chen, J. Giordano, et al., “The addictive brain: all roads lead to dopamine,” Journal of Psychoactive Drugs, vol. 44, no. 2, pp. 134–143, 2012.
[28]
G. M. Slavich and S. W. Cole, “The emerging field of human social genomics,” Clinical Psychological Science, vol. 1, no. 3, pp. 331–348, 2013.
[29]
F. Ducci and D. Goldman, “The genetic basis of addictive disorders,” Psychiatric Clinics of North America, vol. 35, no. 2, pp. 495–519, 2012.
[30]
T. Otowa, C. O. Gardner, K. S. Kendler, and J. M. Hettema, “Parenting and risk for mood, anxiety and substance use disorders: a study in population-based male twins,” Social Psychiatry and Psychiatric Epidemiology. In press.
[31]
D. A. Brent and M. Silverstein, “Shedding light on the long shadow of childhood adversity,” Journal of the American Medical Association, vol. 309, no. 17, pp. 1777–1778, 2013.
[32]
Y. Nomura, Y. L. Hurd, and D. J. Pilowsky, “Life-time risk for substance use among offspring of abusive family environment from the community,” Substance Use & Misuse, vol. 47, no. 12, pp. 1281–1292, 2012.
[33]
G. Sirvinskiene, N. Zemaitiene, A. Zaborskis, E. Markuniene, and R. Jusiene, “Infant difficult behaviors in the context of perinatal biomedical conditions and early child environment,” BMC Pediatrics, vol. 12, article 44, 2012.
[34]
T. Fryers and T. Brugha, “Childhood determinants of adult psychiatric disorder,” Clinical Practice and Epidemiology in Mental Health, vol. 9, pp. 1–50, 2013.
[35]
A. Elton, S. P. Tripathi, T. Mletzko, et al., “Childhood maltreatment is associated with a sex-dependent functional reorganization of a brain inhibitory control network,” Human Brain Mapping, 2013.
[36]
E. G. Flaherty, R. Thompson, H. Dubowitz, et al., “Adverse childhood experiences and child health in early adolescenceJAMA Pediatrics,” vol. 167, no. 7, pp. 622–629, 2013.
[37]
M. Spenhoff, T. H. Kruger, U. Hartmann, and J. Kobs, “Hypersexual behavior in an online sample of males: associations with personal distress and functional impairment,” The Journal of Sexual Medicine, 2013.
[38]
Mental Health Care Services By Family Physicians (Position Paper), American Association of Family Physicians, 2000.
[39]
J. de Lepeleire, M. Oud, and M. Buszewicz, “Mental health problems in family medicine/general practice,” International Journal of Family Medicine, vol. 2012, Article ID 794845, 2 pages, 2012.
[40]
G. N. Dawson and D. E. Warren, “Evaluating and treating sexual addiction,” American Family Physician, vol. 86, no. 1, pp. 74–76, 2012.
[41]
M. S. Kaplan and R. B. Krueger, “Diagnosis, assessment, and treatment of hypersexuality,” Journal of Sex Research, vol. 47, no. 2-3, pp. 181–198, 2010.
[42]
M. Chinman, R. S. Oberman, B. H. Hanusa, et al., “A Cluster randomized trial of adding peer specialists to intensive case management teams in the veterans health administration,” Journal of Behavioral Health Services and Research. In press.
[43]
T. Kotter, F. A. Schaefer, M. Scherer, and E. Blozik, “Involving patients in quality indicator development—a systematic review,” Patient Preference and Adherence, vol. 7, pp. 259–268, 2013.
[44]
E. Tierens, J. Vandevoorde, and D. Devroey, “Diagnosis and treatment of participants of support groups for hypersexual disorder in Belgium,” Unpublished report, 2013.
[45]
S. A. Chong, E. Abdin, C. Sherbourne, et al., “Treatment gap in common mental disorders: the Singapore perspective,” Epidemiology and Psychiatric Sciences, vol. 21, no. 2, pp. 195–202, 2012.
[46]
A. Koski-J？nnes, T. Hirschovits-Gerz, and M. Pennonen, “Population, professional, and client support for different models of managing addictive behaviors,” Substance Use and Misuse, vol. 47, no. 3, pp. 296–308, 2012.
[47]
J. A. Schmittdiel, S. M. Shortell, T. G. Rundall, T. Bodenheimer, and J. V. Selby, “Effect of primary health care orientation on chronic care management,” Annals of Family Medicine, vol. 4, no. 2, pp. 117–123, 2006.
[48]
M. Codony, J. Alonso, J. Almansa et al., “Perceived need for mental health care and service use among adults in Western Europe: results of the ESEMeD project,” Psychiatric Services, vol. 60, no. 8, pp. 1051–1058, 2009.
[49]
M. S. Donaldson and N. A. Vanselow, “The nature of primary care,” Journal of Family Practice, vol. 42, no. 2, pp. 113–116, 1996.
[50]
E. Brohan, S. Clement, D. Rose, N. Sartorius, M. Slade, and G. Thornicroft, “Development and psychometric evaluation of the Discrimination and Stigma Scale (DISC),” Psychiatry Research, vol. 208, no. 1, pp. 33–40, 2013.
[51]
E. Corker, S. Hamilton, C. Henderson, et al., “Experiences of discrimination among people using mental health services in England 2008–2011,” The British Journal of Psychiatry, vol. 202, pp. s58–s63, 2013.
[52]
http://www.aafp.org/.
[53]
F. J. Crosson, “21st-Century health care—the case for integrated delivery systems,” The New England Journal of Medicine, vol. 361, no. 14, pp. 1324–1325, 2009.
[54]
S. Adelson, R. Bell, A. Graff, et al., “Toward a definition of, “hypersexuality” in children and adolescents,” Psychodynamic Psychiatry, vol. 40, no. 3, pp. 481–503, 2012.
[55]
M. Turner, “Female sexual compulsivity: a new syndrome,” Psychiatric Clinics of North America, vol. 31, no. 4, pp. 713–727, 2008.
[56]
D. M. Fergusson, G. F. McLeod, and L. J. Horwood, “Childhood sexual abuse and adult developmental outcomes: findings from a 30-year longitudinal study in New Zealand,” Child Abuse and Neglect, vol. 2134, no. 13, pp. 85–89, 2013.
[57]
J. T. Parsons, C. Grov, and S. A. Golub, “Sexual compulsivity, co-occurring psychosocial health problems, and HIV risk among gay and bisexual men: further evidence of a syndemic,” American Journal of Public Health, vol. 102, no. 1, pp. 156–162, 2012.
