Despite a limited amount of outcome research, there have been a number of recent studies that have enhanced current understandings of hypersexual behavior in ways that may inform treatment. At the forefront of these advances were the diagnostic criteria and etiological considerations that were put forth for consideration in the DSM-5. Although hypersexual behavior was ultimately excluded from the publication, the consolidation of diagnostic criteria [3, 32], the development of rigorous and comprehensive assessment instruments related to those criteria (e.g., Hypersexual Behavior Inventory, [7]), and a field trial assessing the reliability and validity of the diagnostic criteria [8] provide a consolidated structure that may allow for future advances in the field. Although such advances are still relatively recent, it is likely that they will prove fruitful in guiding future outcome research. Numerous other advances have also been achieved in recent years, with many bearing clear treatment implications.

Advances in Psychosocial Understanding

Research examining the psychosocial correlates of hypersexual behavior has expanded greatly within the past 3 years. A number of recent works on the correlates of hypersexual behavior have highlighted several common threads [10, 19, 33–36]. Specifically, hypersexual tendencies correlate with a propensity to experience negative emotion [33–39] and poor impulse regulation [19, 40]. Collectively, these findings point toward more global symptoms of dysregulation and distress within hypersexual individuals.

Building on findings linking hypersexual behavior and a propensity toward negative emotion, many works have highlighted deficits in adaptive coping techniques in hypersexual individuals. For example, recent work [41] found that hypersexual tendencies were associated with lower levels of self-forgiveness. Additionally, self-compassion was also lower among those expressing hypersexual tendencies [37]. Mindfulness was also found to be a negative predictor of hypersexual behavior, above and beyond general propensities toward negative emotion [38]. In short, hypersexual individuals seem to have a range of deficiencies in adaptive coping mechanisms, particularly those that involve dealing with negative emotions. These findings are particularly relevant for future treatment research. Mindfulness-based techniques and interventions have demonstrated efficacy in treating addictive disorders such as substance abuse [42] and pathological gambling [43–45], and a wide range of mindfulness-enhancing interventions exist [46]. Similarly, interventions designed to enhance self-compassion [47] are effective in enhancing adaptive coping mechanisms, and interventions based on self-forgiveness [48] have been found to be effective in treating other addictive patterns of behavior and could be tailored for the treatment of hypersexual behavior.

A third advance in the understanding of hypersexual behavior has been the focus of recent works on how many people may identify as struggling with hypersexual behavior (or “sexual addition”), even if their sexual behavior is within normal limits. Indeed, the field has conflated perceived hypersexual behavior with behaviors consistent with problematic hypersexual tendencies, as documented by many theoretical works [1], empirical articles [12, 40], narrative reviews [49] and case studies [15]. A noted shortcoming of research about hypersexual behavior in general is that a number of the inventories designed to measure hypersexual tendencies rely fully on self-reported impressions of one’s own behavior, with little attention paid to actual behavior [50]. Even some previously published studies of hypersexual behavior treatment have only relied upon self-reported feelings as inclusion criteria [13••, 14••].

Collectively, a body of evidence indicates that there has often been a failure to distinguish between perceived feelings of hypersexuality and actual hypersexual behavior. This shortcoming has hampered the interpretability and general utility of much hypersexual behavior research. Although some have postulated that this weakness is evidence of the faulty nature of hypersexual behavior as a construct [49], we are hesitant to make such a claim. Recent advances in the diagnosis and assessment of hypersexual behavior will likely provide greater structure for future treatment studies. Even so, there is also a body of evidence that suggests that for many people, the perception of hypersexual behavior or sexual addiction is, within itself, problematic [15, 40]. In essence, for some individuals, perceived hypersexual behavior may be the problem, even though their behavior is not inherently problematic. Individuals may have more or less stringent sexual values. For individuals who have very strict values, the threshold for feeling potentially very high levels of distress associated with sexual thoughts or behaviors is likely to be very low [12]. Even if a sexual behavior is infrequent, a person with strict sexual values may ruminate heavily on past sexual behaviors in a way that promotes feelings of distress, perceptions of hypersexuality, and behaviors that perpetuate those feelings. Although the notion of perceived addiction is relatively novel in the realm of hypersexual behavior, it has been studied for several years in substance abuse research [51, 52] and process addiction research [53], often predicting future recurrences of problematic behaviors and a wide range of psychological distress indicators.

Given the emergence of perceived hypersexual behavior as a construct and the associations of such a perception with truly problematic mental health symptoms [40], there is a need for research addressing perceived hypersexual behavior, in addition to further research related to the treatment of hypersexual behavior itself. This need is most apparent in two domains. Primarily, there is a need for research that objectively distinguishes between (or at least clearly relates) perceived hypersexual behavior and actual hypersexual tendencies. Secondarily, there is a need for research into the development, etiology, progression, and treatment of perceived hypersexual behavior, particularly in the absence of objective hypersexual tendencies. Indeed, the modification of negative self-perceptions is a hallmark of most modern psychotherapies. For at least some individuals, there is evidence to suggest that the maladaptive self-view associated with perceived hypersexual behavior is of greater consequence than their sexual behaviors themselves. As such, there is a need for studies in which perceived hypersexual behavior is effectively controlled for.

Advances in Neurological Understanding of Hypersexuality

Moving beyond psychosocial associates of hypersexual behavior, recent studies have also suggested that neurological factors may be related to hypersexual behavior [54, 55]. In particular, functional magnetic resonance imaging (fMRI) has revealed similarities between the way that hypersexual individuals respond to sexual stimuli and the way that substance abusers respond to substances on which they are dependent [54]. Similarly, in a sample of 64 adult males, Kühn and Gallant [55] found that gray matter volume within the reward system structures of the brain (i.e., the right caudate) was inversely correlated with the number of hours an individual reported viewing pornography. Collectively, both of these studies suggest similar neurological structures between hypersexual behavior and other addictive processes. Furthermore, in addition to these studies, recent editorials [56] and theoretical reviews [57] pointed to the importance of understanding neurobiological underpinnings of certain forms of hypersexual behavior. Although some of these opinions have been subject to debate, general consensus exists that implicates neurobiological underpinnings in the experience of hypersexual behavior and associated conditions [58].

Collectively, these recent works point toward an understanding of neurological factors as related to the experience of hypersexual behavior and also highlight the possibility of enhanced pharmacological management of hypersexual behavior. Although prior reviews [14••] have highlighted that poor etiological understanding of hypersexual behavior has limited pharmacological management of the disorder, this emerging body of research is enhancing present understandings of the potential etiology and neurobiology of hypersexual behavior. By extension of this enhanced understanding, it is plausible that more efficacious pharmacological treatments might be tested, and it is likely that this is an area in which productive research might be conducted.