Archives of Sexual Behavior

, Volume 46, Issue 8, pp 2279–2287 | Cite as

Response to Commentaries: Recognizing Hypersexuality as a Psychosexual Behavioral Problem and Advancing the Sexhavior Cycle of Hypersexuality

  • Michael T. WaltonEmail author
  • James M. Cantor
  • Navjot Bhullar
  • Amy D. Lykins

We acknowledge the authors of the six commentaries on our Target Article, “Hypersexuality: A Critical Review and Introduction to the Sexhavior Cycle” (Walton, Cantor, Bhullar, & Lykins, 2017a), and value their contribution to advancing the clinical discussion on hypersexuality. As with many published literature reviews, there are likely to be areas of consensus and recognition, disagreement and criticism, and several observed limitations among colleagues.

We hope that discussion on the current Target Article may (1) inform readers, health professionals, and researchers about the diverse understanding, complexity, and heterogeneity of hypersexuality; (2) assist professionals to evaluate when presentations indicate either clinically relevant hypersexuality or normophilic behavior at the higher end of sexual functioning and arousal; (3) provide an update about advances in the research on hypersexuality as a distinct disorder, condition, or psychological problem and highlight mechanisms by...



The authors report no conflicts of interest and received no financial support directly related to the research, authorship, and/or publication of this Target Article. Specifically, the authors received no financial support from parties associated either directly or indirectly with the addiction, sex or pornography industry.


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Press.CrossRefGoogle Scholar
  2. American Society of Addiction Medicine. (2011). Public policy statement: Definition of addiction. Retrieved from
  3. Balt, S. (2011). Is the criticism of DSM-5 misguided? Retrieved from
  4. Bancroft, J., Janssen, E., Carnes, L., Goodrich, D., Strong, D., & Long, J. S. (2004). Sexual activity and risk-taking in young heterosexual men: The relevance of sexual arousability, mood, and sensation seeking. Journal of Sex Research, 41, 181–192. Scholar
  5. Bancroft, J., Janssen, E., Strong, D., Carnes, L., Vukadinovic, Z., & Long, J. S. (2003). Sexual risk-taking in gay men: The relevance of sexual arousability, mood, and sensation seeking. Archives of Sexual Behavior, 32, 555–572. Scholar
  6. Bancroft, J., & Vukadinovic, Z. (2004). Sexual addiction, sexual compulsivity, sexual impulsivity or what? Toward a theoretical model. Journal of Sex Research, 41, 225–234. Scholar
  7. Black, D. W., Kehrberg, L. L. D., Flumerfelt, D. L., & Schlosser, S. S. (1997). Characteristics of 36 subjects reporting compulsive sexual behavior. American Journal of Psychiatry, 154, 243–249.CrossRefPubMedGoogle Scholar
  8. Blum, K., Badgaiyan, R. D., & Gold, M. S. (2015). Hypersexuality addiction and withdrawal: Phenomenology, neurogenetics and epigenetics. Cureus. Scholar
  9. Braun-Harvey, D., & Vigorito, M. A. (2016). Treating out of control sexual behavior: Rethinking sex addiction. New York: Springer.Google Scholar
  10. Cantor, J. M., Klein, C., Lykins, A. D., Rullo, J. E., Thaler, L., & Walling, B. R. (2013). A treatment-orientated typology of self-identified hypersexuality referrals. Archives of Sexual Behavior, 42, 883–893. Scholar
  11. Carnes, P. J. (1991). Don’t call it love: Recovery from sexual addiction. New York: Bantam Books.Google Scholar
  12. Carnes, P. J. (2001). Out of the shadows: Understanding sexual addiction (3rd ed.). Center City, MN: Hazelden Publishing. (Originally published 1983)Google Scholar
  13. Carnes, S., & Love, T. (2017). Separating models obscures the scientific underpinnings of addiction as a disorder [Commentary]. Archives of Sexual Behavior. Scholar
  14. Coleman, E. (1992). Is your patient suffering from compulsive sexual behavior? Psychiatric Annals, 22, 320–325.CrossRefGoogle Scholar
  15. Dhuffar, M. K., & Griffiths, M. D. (2016). Barriers to female sex addiction treatment in the UK. Journal of Behavioral Addictions, 5, 562–567. Scholar
  16. Finlayson, R. A. J., Sealy, J., & Martin, P. R. (2001). The differential diagnosis of problematic hypersexuality. Sexual Addiction & Compulsivity, 8, 241–251. Scholar
  17. Grabowska-Grzyb, A., Naganska, E., & Wolanczyk, T. (2006). Hypersexuality in two patients with epilepsy treated with lamotrigine. Epilepsy & Behavior, 8, 663–665. Scholar
  18. Grant, J. E., Atmaca, M., Fineberg, N. A., Fontenelle, L. F., Matsunaga, H., Janardhan Reddy, Y. C., & Stein, D. J. (2014). Impulse control disorders and “behavioural addictions” in the ICD-11. World Psychiatry, 13, 125–127. Scholar
  19. Griffee, K., O’Keefe, S. L., Stroebel, S. S., Beard, K. W., Swindell, S., & Young, D. H. (2012). On the brink of paradigm change? Evidence for unexpected predictive relationships among sexual addiction, masturbation, sexual experimentation, and revictimization, child sexual abuse, and adult sexual risk. Sexual Addiction & Compulsivity, 19, 225–264.Google Scholar
  20. Grubbs, J. B., Stauner, N., Exline, J. J., Pargament, K. I., & Lindberg, M. J. (2015). Perceived addiction to internet pornography and psychological distress: Examining relationships concurrently over time. Psychology of Addictive Behaviors, 29, 1056–1067. Scholar
  21. Kafka, M. P. (2003). Sex offending and sexual appetite: The clinical and theoretical relevance of hypersexual desire. International Journal of Offender Therapy and Comparative Criminology, 47, 439–451. Scholar
  22. Kafka, M. P. (2010). Hypersexual disorder: A proposed diagnosis for DSM-V. Archives of Sexual Behavior, 39, 377–400. Scholar
  23. Kafka, M. P., & Hennen, J. (2002). A DSM-IV Axis I comorbidity study of males (n = 120) with paraphilias and paraphilia-related disorders. Sexual Abuse: A Journal of Research and Treatment, 14, 349–366. Scholar
  24. Kaplan, M. S., & Krueger, R. B. (2010). Diagnosis, assessment, and treatment of hypersexuality. Journal of Sex Research, 47, 181–198. Scholar
  25. Kataoka, H., Shinkai, T., Inoue, M., & Satoski, U. (2009). Increased medial temporal blood flow in Parkinson’s disease with pathological hypersexuality. Movement Disorders, 24, 471–473. Scholar
  26. Kingston, D. A. (2017). Moving forward on hypersexuality [Commentary]. Archives of Sexual Behavior. Scholar
  27. Kingston, D. A., & Firestone, P. (2008). Problematic hypersexuality: A review of conceptualization and diagnosis. Sexual Addiction & Compulsivity, 15, 284–310. Scholar
  28. Klein, V., Rettenberger, M., & Briken, P. (2014). Self-reported indicators of hypersexuality and its correlates in a female online sample. Journal of Sexual Medicine, 11, 1974–1981. Scholar
  29. Knight, R. A., & Graham, F. J. (2017). Hypersexuality: Equifinal, cohesive, clinical presentation, or symptom cluster with multiple underlying mechanisms? [Commentary]. Archives of Sexual Behavior. Scholar
  30. Kuzma, J. M., & Black, D. W. (2008). Epidemiology, prevalence, and natural history of compulsive sexual behavior. Psychiatric Clinics of North America, 31, 603–611. Scholar
  31. Ley, D. J., & Grubbs, J. B. (2017). The sexhavior cycle: Good review, but still not enough data to support a new theory [Commentary]. Archives of Sexual Behavior. Scholar
  32. Masters, W. H., & Johnson, V. E. (2010). Human sexual response. New York: Ishi Press. (Originally published 1966)Google Scholar
  33. Metin, S. Z., Ozmen, M., Ozkara, C., & Ozmen, E. (2013). Hypersexuality in a patient with epilepsy during treatment of levetiracetam. Seizure, 22, 151–152. Scholar
  34. Munhoz, R. P., Fabiani, G., Becker, N., Helio, A. G., & Teive, H. A. G. (2009). Increased frequency and range of sexual behavior in a patient with Parkinson’s disease after use of pramipexole: A case report. Journal of Sexual Medicine, 6, 1177–1180. Scholar
  35. Nair, D., Pawar, A., Kalra, G., & Shah, N. (2013). An Indian study of hypersexual disorder in patients with anxiety and mood disorders. Sexual Addiction & Compulsivity, 20, 292–305. Scholar
  36. Odlaug, B. L., Lust, K., Schrelber, L. R. N., Christenson, G., Derbyshire, K., Harvanko, A., & Grant, J. E. (2013). Compulsive sexual behavior in young adults. Annals of Clinical Psychiatry, 25, 193–200.PubMedGoogle Scholar
  37. Oxford University Press. (2017). Babble. Retrieved from
  38. Pachankis, J. E., Redina, H. J., Ventuneac, A., Grov, C., & Parsons, J. T. (2014). The role of maladaptive cognitions in hypersexuality among highly sexually active gay and bisexual men. Archives of Sexual Behavior, 43, 669–683. Scholar
  39. Phillips, B., Hajela, R., & Hilton, D. L., Jr. (2015). Sex addiction as a disease: Evidence for assessment, diagnosis, and response to critics. Sexual Addiction & Compulsivity, 22, 167–192. Scholar
  40. Politis, M., Loane, C., Wu, K., O’Sullivan, S. S., Woodhead, Z., Kiferie, L., & Piccini, P. (2013). Neural response to visual sexual cues in dopamine treatment-linked hypersexuality in Parkinson’s disease. Brain, 136, 400–411. Scholar
  41. Prause, N. (2017). Evaluate models of high-frequency sexual behaviors already [Commentary]. Archives of Sexual Behavior. Scholar
  42. Raymond, N. C., Coleman, E., & Miner, M. H. (2003). Psychiatric comorbidity and compulsive/impulsive traits in compulsive sexual behavior. Comprehensive Psychiatry, 44, 370–380. Scholar
  43. Reid, R. C., Berlin, H. A., & Kingston, D. A. (2015). Sexual impulsivity in hypersexual men. Current Behavioral Neuroscience Reports, 2, 1–8. Scholar
  44. Reid, R. C., Carpenter, B. N., Hook, J. N., Garos, S., Manning, J. C., Gilliland, R., & Fong, T. (2012). Report of findings in a DSM-5 field trial for hypersexual disorder. Journal of Sexual Medicine, 9, 2868–2877. Scholar
  45. Reid, R. C., Garos, S., & Carpenter, B. N. (2011). Reliability, validity, and psychometric development of the Hypersexual Behavior Inventory in an outpatient sample of men. Sexual Addiction & Compulsivity, 18, 30–51. Scholar
  46. Reid, R. C., & Grant, J. F. (2017). In search of a parsimonious model to explain hypersexual behavior [Commentary]. Archives of Sexual Behavior. Scholar
  47. Rettenberger, M., Klein, V., & Briken, P. (2016). The relationship between hypersexual behavior, sexual excitation, sexual inhibition, and personality traits. Archives of Sexual Behavior, 45, 219–233. Scholar
  48. Rooney, B. M., Tulloch, T. G., & Blashill, A. J. (2017). Psychosocial syndemic correlates of sexual compulsivity among men who have sex with men: A meta-analysis. Archives of Sexual Behavior. Scholar
  49. Schultz, K., Hook, J. N., Davis, D. E., Penberthy, J. K., & Reid, R. C. (2014). Nonparaphilic hypersexual behavior and depressive symptoms: A meta-analytic review of the literature. Journal of Sex and Marital Therapy, 40, 477–487. Scholar
  50. Shapiro, M. A., Chang, Y. L., Munson, S. K., Okun, M. S., & Fernandez, H. H. (2006). Hypersexuality and paraphilia induced by selegiline in Parkinson’s disease: Report of 2 cases. Parkinsonism and Related Disorders, 12, 392–395. Scholar
  51. Starks, T. J., Grov, C., & Parsons, J. T. (2013). Sexual compulsivity and interpersonal functioning: Sexual relationship quality and sexual health in gay relationships. Health Psychology, 32, 1047–1056. Scholar
  52. Walton, M. T. (2017). Sexhavior cycle of hypersexuality [Theoretical model]. Armidale: School of Psychology, University of New England.Google Scholar
  53. Walton, M. T., Cantor, J. M., Bhullar, N., & Lykins, A. D. (2017a). Hypersexuality: A critical review and introduction to the “sexhavior cycle”. Archives of Sexual Behavior. Scholar
  54. Walton, M. T., Cantor, J. M., Bhullar, N., & Lykins, A. D. (2017b). A latent profile analysis of self-reported hypersexuality. Manuscript submitted for publication.Google Scholar
  55. Walton, M. T., Cantor, J. M., Bhullar, N., & Lykins, A. D. (2017c). An online assessment of self-reported non-paraphilic and paraphilic hypersexuality. Manuscript submitted for publication.Google Scholar
  56. Walton, M. T., Cantor, J. M., Bhullar, N., & Lykins, A. D. (2017d). Sexhavior cycle of hypersexuality: A 1-month daily diary study of self-reported “sex addicts.” Manuscript in preparation.Google Scholar
  57. Walton, M. T., Cantor, J. M., & Lykins, A. D. (2017e). An online assessment of personality, psychological, and sexuality variables associated with self-reported hypersexual behavior. Archives of Sexual Behavior, 46, 721–733. Scholar
  58. Walton, M. T., Lykins, A. D., & Bhullar, N. (2016). Sexual arousal and sexual activity frequency: Implications for understanding hypersexuality [Letter to the Editor]. Archives of Sexual Behavior, 45, 777–782. Scholar
  59. Weintraub, D., Koester, J., Potenza, M. N., Siderowf, A. D., Stacy, M., Voon, V., … Lang, A. E. (2010). Impulse control disorders in Parkinson disease: A cross-sectional study of 3090 patients. Archives of Neurology, 67, 589–595.
  60. Weintraub, D., Siderowf, A. D., Potenza, M. N., Goveas, J., Morales, K. H., Duda, J. E., … Stern, M. B. (2006). Dopamine agonist use is associated with impulse control disorders in Parkinson’s disease. Archives of Neurology, 63, 969–973.
  61. Winters, J., Christoff, K., & Gorzalka, B. B. (2010). Dysregulated sexuality and high sexual desire: Distinct constructs? Archives of Sexual Behavior, 39, 1029–1043. Scholar
  62. World Health Organization. (1992). International statistical classification of diseases and related health problems (ICD-10). Geneva: Author.Google Scholar
  63. World Health Organization. (2016). Classifications: ICD-11 revision. Retrieved from

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Michael T. Walton
    • 1
    Email author
  • James M. Cantor
    • 2
    • 3
  • Navjot Bhullar
    • 1
  • Amy D. Lykins
    • 1
  1. 1.School of PsychologyUniversity of New EnglandArmidaleAustralia
  2. 2.Campbell Family Mental Health Research InstituteCentre for Addiction and Mental HealthTorontoCanada
  3. 3.Department of Psychiatry, Faculty of MedicineUniversity of TorontoTorontoCanada

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