Hypersexuality refers to abnormally increased or extreme involvement in any sexual activity.
It is clinically challenging, presents trans-diagnostically and there is extensive medical literature addressing
the nosology, pathogenesis and neuropsychiatric aspects in this clinical syndrome. Classification includes
deviant behaviours, diagnosable entities related to impulsivity, and obsessional phenomena. Some
clinicians view an increase in sexual desire as ‘normal’ i.e. psychodynamic theorists consider it as egodefensive
at times alleviating unconscious anxiety rooted in intrapsychic conflicts. We highlight hypersexuality
as multi-dimensional involving an increase in sexual activity that is associated with distress and
functional impairment. The aetiology of hypersexuality is multi-factorial with differential diagnoses that
include major psychiatric disorders (e.g. bipolar disorder), adverse effects of treatments (e.g. levodopatreatment),
substance-induced disorders (e.g. amphetamine substance use), neuropathological disorders
(e.g. frontal lobe syndrome), among others. Numerous neurotransmitters are implicated in its pathogenesis,
with dopamine and noradrenaline playing a crucial role in the neural reward pathways and emotionally-
regulated limbic system neural circuits. The management of hypersexuality is determined by the
principle of de causa effectu evanescent, if the causes are treated, the effect may disappear. We aim to review
the role of pharmacological agents causing hypersexuality and centrally acting agents treating the
associated underlying medical conditions. Bio-psycho-social determinants are pivotal in embracing the
understanding and guiding management of this complex and multi-determined clinical syndrome.
Keywords: Hypersexuality, normality, neuropsychiatry, bio psychological treatment, neurobiology, libido.
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