Assessment Methods and Management of Hypersexuality and Paraphilic Disorders

Daniel Turner; Daniel Schöttle; John Bradford; Peer Briken


Curr Opin Psychiatry. 2014;27(6):413-422. 

In This Article

Assessment of Hypersexuality and Hypersexual Disorders

All instruments currently in use for the assessment of hypersexual behaviors or hypersexual disorders were developed in the North American or European countries. For an overview of scales in use, we want to recommend the recently conducted reviews by Hook et al. and Womack et al.; however, there is no overlap concerning the included studies between our and their reviews.[39,40]

During the time period considered, cross-validation studies of the following questionnaires were conducted: 'Sexual Compulsivity Scale' (SCS), the 'Hypersexual Behavior Inventory' (HBI), and the 'Hypersexual Disorder Screening Inventory' (HDSI).[41–43] Reliability of measures is usually reported as Cronbach's alpha (internal consistency). An alpha value of at least 0.7 is considered as appropriate if that instrument is used for research purposes, however, an alpha value of 0.9 should be achieved if the instrument should be used in clinical contexts.[44,45]

The Sexual Compulsivity Scale

The SCS consists of 10 items and has shown acceptable validity in various populations, for example, heterosexual and homosexual community men and women, HIV positive men, and college students concerning the assessment of hypersexuality.[41,46] In a sample of 1196 Spanish college students (74.5% women, Mage = 20.2 years, 96% heterosexual), the SCS revealed an internal consistency of α = 0.84, a test–retest reliability of 0.73, and a replication of the scale's two-factor structure (factor 1: interference of sexual behavior and factor 2: failure to control sexual impulses).[24] Furthermore, the SCS positively correlated with sexual sensation seeking, number of sexual partners, and participation in risky sexual behaviors.[24]

The Hypersexual Behavior Inventory

The HBI consists of 19 items and measures hypersexual behaviors on three factors: control, coping, and consequences, showing good psychometric properties in treatment-seeking hypersexual men.[42] The HBI total score (α = 0.90) and the three subscales (α = 0.78 control, α = 0.86 coping, and α = 0.78 consequences) yielded good-to-excellent internal consistency in a large German online community sample (n = 1749, 57% women, Mage = 24.4 years, 90.3% heterosexual).[25] The HBI total score correlated positively with the SCS total score, masturbation frequency, frequency of pornography consumption, number of sexual partners, number of one night stands, and dissatisfaction with the own sexual life.[25]

In another study with young gay and bisexual men, the three-factor structure of the HBI could be replicated.[28] Furthermore, a higher score in the sexual control subscale increased the risk for unprotective receptive anal intercourse, whereas a higher score in the coping subscale decreased the risk.[28]

The Hypersexual Disorder Screening Inventory

The HDSI was developed by the DSM-5 Workgroup committee and includes seven items divided in two sections (section A: recurrent and intense sexual fantasies, urges and behaviors; factor B: distress and impairment as a result of these fantasies, urges, and behaviors). The items were developed based on the proposed DSM-5 diagnostic criteria for hypersexual disorder.[26] Parsons et al.[26] evaluated the factor structure of the HDSI in a sample of 202 highly sexually active gay and bisexual men using item response theory analysis and found that either a one-factor or a three-factor solution with the additional factor 'sex as a coping mechanism' would present a better fit to the data than the initially proposed two-factor structure. Further, internal consistency was found to be α = 0.88.

Assessment of Hypersexual Behaviors in Patients With Neurodegenerative Disorders

Family members as well as clinicians are sometimes confronted with hypersexual behaviors of patients suffering from neurodegenerative disorders like Parkinson disease or dementia, which can pose a challenge for those confronted with it.[47,48] Pereira et al. created a five-item screening version of hypersexual behaviors based on the sexual addiction screening test (SAST) for people with neurodegenerative disorders with scores possibly ranging from 0 to 5 and a cutoff score of 2.[27,49] Compared with clinical hypersexual disorder diagnoses (consensus diagnosis of neurologist and psychiatrist), the instrument revealed a specificity of 92.6% and a sensitivity of 100% in a sample of 159 outpatients diagnosed with Parkinson disease (52 women, Mage = 68.2 years).[27] However, more research about this scale from independent research groups including large samples of patients has to be conducted before the scale can be applied in everyday practice.