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Measuring Hypersexual Behavior

a a a
Stephanie D. Womack , Joshua N. Hook , Marciana Ramos , Don
b c
E. Davis & J. Kim Penberthy
a
University of North Texas , Denton , Texas
b
Georgia State University , Atlanta , Georgia
c
University of Virginia , Charlottesville , Virginia
Published online: 09 Apr 2013.

To cite this article: Stephanie D. Womack , Joshua N. Hook , Marciana Ramos , Don E. Davis & J. Kim
Penberthy (2013) Measuring Hypersexual Behavior, Sexual Addiction & Compulsivity: The Journal of
Treatment & Prevention, 20:1-2, 65-78

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 Sexual Addiction & Compulsivity, 20:65–78, 2013
Copyright © Taylor & Francis Group, LLC
ISSN: 1072-0162 print / 1532-5318 online
DOI: 10.1080/10720162.2013.768126

Measuring Hypersexual Behavior

STEPHANIE D. WOMACK, JOSHUA N. HOOK,

and MARCIANA RAMOS
University of North Texas, Denton, Texas
DON E. DAVIS
Georgia State University, Atlanta, Georgia
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J. KIM PENBERTHY
University of Virginia, Charlottesville, Virginia

Research on hypersexual behavior consisting of excessive and un-

controllable sexual fantasies, urges, and behavior has increased
in recent years. Although no formal diagnosis for hypersexual be-
havior exists, criteria were proposed for Hypersexual Disorder (HD)
for possible inclusion in the DSM-5 (Kafka, 2010). The present ar-
ticle aims to (a) review extant measures of hypersexual behavior,
(b) compare the items on the existing measures to the proposed
criteria of HD, and (c) evaluate which measures best reflect the
proposed criteria. We present and review 32 measures, which fall
into 3 categories: (a) clinical interviews, (b) self-report measures
of general symptoms, and (c) self-report measures of consequences
associated with hypersexual behavior. We conclude by providing
recommendations for researchers and clinicians regarding use of
these assessments.

The term hypersexual behavior (also referred to as sexual addiction, com-

pulsive sexual behavior, or sexual impulsivity) refers to excessive and un-
controllable sexual fantasies, urges, and behaviors (Garcia & Thibaut, 2010;
Kafka, 2010). Although there is currently no specific diagnosis relating to
hypersexual behavior (Kaplan & Krueger, 2010), the Work Group on Sexual
and Gender Identity Disorders has proposed diagnostic criteria for Hyper-
sexual Disorder (HD; Kafka, 2010) to be considered for inclusion in the
Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).

Address correspondence to Joshua N. Hook, Department of Psychology, University of

North Texas, 1155 Union Circle #311280, Denton, TX 76203. E-mail: joshua.hook@unt.edu

65
 66 S. D. Womack et al.

HD has been characterized as a repetitive and intense preoccupation

with non-paraphilic sexual fantasies, urges, and behaviors, which lead to ad-
verse consequences and significant impairment in important areas of func-
tioning. Patients meeting criteria for HD often use sexual fantasies, urges,
and behaviors in response to dysphoric mood states or to cope with stress.
Also, patients meeting criteria for HD have experienced multiple unsuccess-
ful attempts to cut down or control the sexual fantasies, urges, and behaviors
that have been problematic. Symptoms must last for a period of at least 6
months and occur independent of drug use, a general medical condition, or
mania (see Table 1 for the proposed criteria).
Empirical research on hypersexual behavior has increased in recent
years (for recent reviews, see Kafka, 2010; Kaplan & Krueger, 2010; Levine,
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2012; Marshall & Briken, 2010) leading to considerable interest in developing

measures that assess problematic hypersexual behavior (Hook, Hook, Davis,

TABLE 1 Proposed Diagnostic Criteria for Hypersexual Disorder

A. Over a period of at least 6 months, recurrent and intense sexual

fantasies, sexual urges, or sexual behaviors in association with
3 or more of the following 5 criteria:
A1. Time consumed by sexual fantasies, urges or behaviors
repetitively interferes with other important (non-sexual) goals,
activities, and obligations.
A2. Repetitively engaging in sexual fantasies, urges or behaviors in
response to dysphoric mood states (e.g., anxiety, depression,
boredom, irritability).
A3. Repetitively engaging in sexual fantasies, urges or behaviors in
response to stressful life events.
A4. Repetitive but unsuccessful efforts to control or significantly
reduce these sexual fantasies, urges or behaviors.
A5. Repetitively engaging in sexual behaviors while disregarding the
risk for physical or emotional harm to self or others.
B. There is clinically significant personal distress or impairment in
social, occupational or other important areas of functioning
associated with the frequency and intensity of these sexual
fantasies, urges or behaviors.
C. These sexual fantasies, urges or behaviors are not due to the
direct physiological effect of an exogenous substance (e.g., a
drug of abuse or a medication).
D. The individual is at least 18 years of age.
Specify if:
Masturbation
Pornography
Sexual Behavior
with Consenting
Adults
Cybersex
Telephone Sex
Strip Clubs
Other:
Note. http://www.dsm5.org
 Measuring Hypersexual Behavior 67

Worthington, & Penberthy, 2010). For example, a recent review of mea-

sures examining problematic hypersexual behavior revealed a wide variety
of instruments assessing this construct (Hook et al., 2010). The instruments
varied widely in their psychometric properties. Many instruments were re-
cently created, and thus the evidence supporting their reliability and validity
were limited. Also, some instruments were studied only in specific popula-
tions, which may limit their generalizability for use in research and clinical
settings. Overall, the review reflected the fact that research on hypersexual
behavior is an emerging field, with many new instruments being developed
in response to the demand for research on this construct.
One significant limitation of the previous review of measures (and of the
field of hypersexual behavior in general) is that definitions of hypersexual
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behavior have not yet been consolidated. Although there are many similar-
ities in how researchers define and operationalize problematic hypersexual
behavior, there are also some differences reflected across studies. This is
evident in the considerable debate regarding the best term or language used
to describe problematic hypersexual behavior (e.g., Bancroft & Vukadinovic,
2004; Gold & Heffner, 1998), which has made measurement of hypersexual
behavior a moving target. Not surprisingly, researchers have tended to use
measures that align with their preferred and sometimes idiosyncratic defini-
tions and conceptualizations. For example, some measures focused primarily
on level of sexual activity (e.g., number of orgasms per week), whereas other
measures focused on perceptions that the sexual behavior was out of con-
trol. Others attained information on the consequences of the hypersexual
behavior.
As the field of hypersexual behavior develops, it is likely that defini-
tions will begin to converge. The proposed diagnostic criteria of HD for the
DSM-5 may provide a catalyst for the convergence of definitions. Indeed,
the proposed diagnostic criteria have already generated ample debate (e.g.,
Halpern, 2011; Moser, 2011; Winters, 2010). As the definitions of hypersexual
behavior begin to converge, it is likely that the measurement of hypersexual
behavior will become more precise. However, given the variability of defini-
tions, conceptualizations, and measurement of hypersexual behavior at this
time, the purpose of the current review was to evaluate the extent to which
existing measures of hypersexual behavior aligned with the proposed diag-
nostic criteria for HD. We have also updated the list of measures to include
instruments not available at the time of the Hook et al. (2010) review.

METHOD

We reviewed empirical studies that utilized or described a measure of hyper-

sexual behavior, sexual addiction, sexual compulsivity, or sexual impulsivity.
Since symptoms must occur independently of a general medical condition
 68 S. D. Womack et al.

for HD to be diagnosed (Kafka, 2010), we excluded studies that assessed

hypersexual behavior solely within the context of another condition (e.g.,
some measures assessing Parkinson’s disease include sub-sections that assess
hypersexual behavior).
We conducted the literature search through August 25, 2012, and used
three strategies. First, we consulted prior reviews of the literature (e.g., Hook
et al., 2010) to identify existing measures. Second, we searched the PsycINFO
and ProQuest databases using the following terms: sexual addiction, sexual
compulsivity, sexual impulsivity, and hypersexual to identify empirical stud-
ies examining hypersexual behavior. We reviewed the method sections of
these articles to identify any additional measures. Third, we examined the
reference sections of the empirical articles in order to identify additional
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empirical articles. We again reviewed the method sections of these articles

to identify any additional measures. Overall, we found 32 separate measures
that examined hypersexual behavior.
After identifying the measures of hypersexual behavior that met inclu-
sion criteria, we coded each item from each of the measures according to
the proposed criteria for HD (see Table 1). Each item was coded as either
assessing (or not) seven of the eight proposed diagnostic criteria (e.g., A3.
Repetitively engaging in sexual fantasies, urges, or behaviors in response to
stressful life events). Criterion D (i.e., the individual is at least 18 years old)
was excluded from the analysis because no measure included any items as-
sessing age. Two independent coders rated each item. A third independent
coder resolved any discrepancies.

RESULTS

We identified three main types of measures, including (a) clinical inter-

views (4 instruments), (b) self-report measures that provided an overview
of symptoms associated with hypersexual behavior (24 instruments), and
(c) self-report measures that focused on the consequences associated with
hypersexual behavior (4 instruments). Data describing the number of items
that assessed the diagnostic criteria for HD are summarized in Table 2. We
also report descriptive information for the number of diagnostic criteria as-
sessed by each type of measure (see Table 3), as well as the number of items
assessing each diagnostic criterion (see Table 4). We organize our review of
instruments based on type of measure.

Clinical Interviews
Clinical interviews assessing hypersexual behavior are typically adminis-
tered by trained professionals, and assess symptoms and consequences of
 Measuring Hypersexual Behavior 69

TABLE 2 Analysis of Measures: Items per Proposed Hypersexual Disorder Criteria

Criterion
Measure Items A1 A2 A3 A4 A5 B C D

Clinical Interviews
Diagnostic Interview for Sexual Compulsivity (DISC; 53 4 0 1 3 3 16 0 0
Morgenstern et al., 2009)
Hypersexual Disorder Diagnostic Clinical Interview 8 1 1 1 1 1 2 1 0
(HDDCI; Reid, Carpenter et al., 2012)
Hypersexual Disorder Screening Inventory (HDSI; 8 1 1 1 1 1 3 0 0
APA, 2012)
Yale Brown Obsessive Compulsive Scale – 8 2 0 0 2 0 4 0 0
Compulsive Sexual Behavior (YBOCS-CSB;
Morgenstern et al., 2009)
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Self-Report General
Compulsive Sexual Behavior Inventory (CSBI; 28 1 1 1 4 7 6 0 0
Coleman et al., 2001)
Cyberporn Compulsivity Scale (CCS; Abell et al., 4 0 0 0 0 0 3 0 0
2006)
Cyber-Pornography Use Inventory (CPUI; Grubbs 39 5 0 1 5 1 12 0 0
et al., 2010)
Disorders Screening Inventory – Sexual Addiction 5 0 1 1 1 0 2 0 0
Scale (DSI-SAS; Carter & Ruiz, 1996)
Garos Sexual Behavior Inventory (GSBI; Garos & 72 2 0 0 8 0 13 0 0
Stock, 1998)
Hypersexual Behavior Inventory (HBI; Reid et al., 19 0 4 3 4 2 3 0 0
2011)
Hypersexual Disorder Questionnaire (HDQ; Reid, 10 2 1 1 1 2 2 1 0
Carpenter et al., 2012)
Internet Addiction Test – Sex (IAT-Sex; Brand et al., 20 3 2 0 1 0 8 0 0
2011)
Internet Sex Screening Test (ISST; Delmonico & 25 2 0 1 2 1 2 0 0
Carnes, 1999)
Minnesota Impulse Control Inventory Questionnaire 33 7 1 0 6 0 3 0 0
– Sexual Behavior Module (MICQ-S; Raymond
et al., 2003)
Multidimensional Sexuality Questionnaire (MSQ; 61 6 0 0 2 0 9 0 0
Snell et al., 1993)
Perceived Sexual Control Scale (PSCS; Exner et al., 20 0 0 0 9 8 0 0 0
1992)
Pornography Consumption Effects Scale (PCES; Hald 47 0 0 0 0 0 14 0 0
& Malamuth, 2008)
Sex Addicts Anonymous Questionnaire (SAAQ; 16 0 0 0 0 2 9 0 0
Mercer, 1998)
Sexual Addiction Screening Test (SAST; Carnes, 25 1 0 1 8 2 7 0 0
1989)
Sexual Addiction Screening Test for Gay Men 25 1 0 0 2 5 10 0 0
(G-SAST; Corley, 1999)
Sexual Addiction Screening Test for Women 25 1 0 1 5 3 6 0 0
(W-SAST; O’Hara, 1999)
Sexual Addiction Screening Test – Revised (SAST-R; 45 5 0 1 5 6 9 0 0
Carnes et al., 2010)
Sexual Compulsivity Scale (SCS; Kalichman et al., 10 1 0 0 0 3 0 0 0
1994)
(Continued on next page)
 70 S. D. Womack et al.

TABLE 2 Analysis of Measures: Items per Proposed Hypersexual Disorder Criteria

(Continued)

Criterion
Measure Items A1 A2 A3 A4 A5 B C D

Sexual Dependency Inventory – Revised (SDI-R; 170 5 0 0 61 0 4 0 0

Delmonico et al., 1998)
The Sexuality Scale (SS; Snell & Papini, 1998) 30 9 0 0 0 0 0 0 0
Sexual Outlet Inventory (SOI; Kafka, 1991) 6 2 0 0 0 0 0 0 0
Sexual Sensation Seeking Scale (SSSS; Kalichman 9 0 0 0 3 0 0 0 0
et al., 1994)
Sexual Symptom Assessment Scale (SSAS; Raymond 12 5 0 0 0 2 0 0 0
et al., 2007)
Self-Report Consequences
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Cognitive and Behavioral Outcomes of Sexual 36 0 0 0 0 13 23 0 0

Behavior Scale (CBOSB; McBride et al., 2007)
Compulsive Sexual Behavior Consequences Scale 21 0 0 0 0 3 18 0 0
(CSBCS; Muench et al., 2007)
Hypersexual Behavior Consequences Scale (HBCS; 22 0 0 0 0 2 20 0 0
Reid, Garos et al., 2012)
Primary Appraisal Measure – Compulsive Sexual 7 0 0 0 0 1 6 0 0
Behavior (PAM-CSB; Muench et al., 2007)

problem thoughts, urges, and behaviors. The format of the clinical interview,
which allows communication between the administrator and the participant,
has several strengths. Administrators can probe for more detailed answers
or more thorough explanations of symptoms, and participants can ask for
clarification on items that might be confusing or otherwise misunderstood.
Clinical interviews may be less subjective than self-report measures, and of-
ten include open-ended questions that allow for additional information to be
gathered. However, clinical interviews often require more time and energy
to administer than self-report measures, and participants might feel uncom-
fortable discussing distressing sexual thoughts and behaviors verbally with
another individual in certain settings.
The clinical interviews included in the present review varied in length
(i.e., three instruments contained eight questions and one instrument con-
tained 17 multi-part questions). Overall, the clinical interviews assessed a
greater number of the proposed diagnostic criteria for HD than the self-
report measures (M = 5.25 criteria per instrument), but did not provide

TABLE 3 Number of Proposed Hypersexual Disorder Criteria

Group Mean Standard Deviation Minimum Maximum

Clinical Interview 5.25 1.71 3.00 7.00

Self-Report General 3.58 1.72 1.00 7.00
Self-Report Consequences 2.00 0.00 2.00 2.00
 Measuring Hypersexual Behavior 71

TABLE 4 Number of Items per Hypersexual Disorder Criterion

Group Mean Standard Deviation Minimum Maximum

Clinical Interview 1.82 3.02 0.00 16.00

Self-Report General 2.35 5.43 0.00 61.00
Self-Report Consequences 3.07 6.69 0.00 23.00

much in-depth information for each criterion (M = 1.82 items per HD crite-
rion). Thus, the clinical interviews may be useful for assessing the breadth
of the proposed HD criteria, but may not provide detailed information about
each criterion.
Examining the four instruments, the Hypersexual Disorder Diagnostic
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Clinical Interview (HDDCI; Reid et al., 2012) included items that fit all seven
of the proposed HD diagnostic criteria we analyzed, and the Hypersexual
Disorder Screening Inventory (HDSI; American Psychiatric Association, 2012)
addressed six, but each measure only included one or two items per criterion.
The Diagnostic Interview for Sexual Compulsivity (DISC; Morgenstern et al.,
2009) assessed five of the seven criteria we analyzed, but included more
items per criterion than the HDDCI. The Yale Brown Obsessive Compulsive
Scale—Compulsive Sexual Behavior (YBOCS-CSB; Morgenstern et al., 2009)
only included items that fit three of the criteria, but included at least two
items per criterion.

Self-Report Measures of General Symptoms

Self-report measures of general symptoms provided an overview of hy-
persexual behavior or general symptoms associated with hypersexuality.
The self-report measures generally used rating scales or yes/no answers,
and tended to be more subjective than the other types of measures included
in the present review (e.g., they often focused on the subjective perception
of experiences and feelings). These self-report measures of general symp-
toms have several important strengths. The questions on these measures are
usually quick and easy to answer, and considering the personal nature of
the topic, participants may feel more comfortable completing a questionnaire
than a face-to-face interview. Despite these advantages, self-report measures
present several challenges for researchers and clinicians. Participants might
misunderstand items or instructions and therefore provide inaccurate reports,
or they may answer in a socially desirable way. There is also the potential for
over-endorsing symptoms to exaggerate or for underreporting hypersexual
behavior due to the stigma and shame associated with such activities.
There was a great deal of variability in the length of the self-report
measures of general symptoms (M = 31.5 items, SD = 34.2), as well as
in the focus and content. Some measures were very broad in scope (e.g.,
 72 S. D. Womack et al.

Hypersexual Behavior Inventory; Reid, Garos, & Carpenter, 2011), while

others were more specific (e.g., Cyber-Pornography Use Inventory; Grubbs,
Sessoms, Wheeler, & Volk, 2010).
Overall, this general type of measure assessed fewer diagnostic criteria
than clinical interviews but more than the self-report measures of conse-
quences associated with hypersexual behavior (M = 3.07). Similar to the
other measures, self-report measures of general symptoms included rela-
tively few items that assessed each criterion (M = 2.35 items per criterion).
Self-report measures of general symptoms focused primarily on criteria A1
(i.e., excessive time), A4 (i.e., attempts to control or reduce behavior), and
B (i.e., subjective distress), although there was a high degree of variability
among the measures.
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This group of measures also had the highest variability in terms of

utility in assessing the diagnostic criteria of HD. The Hypersexual Disorder
Questionnaire (HDQ; Reid et al., 2012) provided the most comprehensive
assessment of the proposed criteria for HD (i.e., it assessed all seven criteria
we analyzed) but only included one or two items per criterion, whereas the
Compulsive Sexual Behavior Inventory (CSBI; Coleman, Miner, Ohlerking,
& Raymond, 2001) also provided a thorough assessment of the diagnostic
criteria (i.e., six out of seven criteria we analyzed) and included multiple
items per criterion. Other measures included only one or two items within
one criterion, and therefore would be less useful in establishing a broad
picture of problematic hypersexual behaviors.

Self-Report Measures of Consequences

The third type of measure included in this review primarily assessed the
consequences associated with hypersexual behaviors. The advantages and
disadvantages of this type of measure are similar to those discussed for self-
report measures of general symptoms, although the self-report measures of
consequences included more objective items than the self-report measures
of general symptoms.
The majority of self-report measures of consequences associated with
hypersexual behavior were moderate in length (M = 21.5 items, SD = 11.9).
In general, this group of measures did not address a majority of the proposed
HD criteria (i.e., all measures addressed 2 out of 7 criteria we analyzed), but
were thorough in their assessment of two of the seven criteria (M = 10.6
items each for criteria A5 and B). This type of self-report measure might
be useful for providing a more in-depth assessment of subjective distress
(criterion B) or the potential for harm (criterion A5) associated with problem
hypersexual behaviors.
The Cognitive and Behavioral Outcomes of Sexual Behavior Scale
(CBOSB; McBride, Reece, & Sanders, 2007) provided the most complete
 Measuring Hypersexual Behavior 73

assessment of the proposed HD criteria (13 questions for criterion A5, 22

questions for criterion B), in that it had the highest number of items for
each criteria, though the Compulsive Sexual Behavior Consequences Scale
(CSBCS; Muench et al., 2007) and the Hypersexual Behavior Consequences
Scale (HBCS; Reid, Garos, & Fong, 2012) would also be useful in thoroughly
assessing the A5 and B proposed criteria of HD.

DISCUSSION

Research on hypersexuality is in a formative stage, and the possibility that

HD may be included in the DSM-5 has provided a catalyst for consolidat-
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ing definitions and measurement strategies. Should HD get adopted into the
DSM-5, the criteria may remain more stable. In the present review, we exam-
ined and summarized how well existing measures of hypersexuality relate
to the proposed criteria for HD.
Several measures of hypersexual behavior address the proposed diag-
nostic criteria for HD and could therefore be useful assessment tools for re-
searchers or clinicians interested in providing an accurate diagnosis of these
criteria. Most notably, all items on both the HDDCI (clinical interview) and
the HDQ (self-report of general symptoms) assess aspects of the proposed
criteria, and both measures assess seven out of eight criteria for HD. Other
measures such as the DISC and HDSI (clinical interviews), the HBI, ISST, and
all versions of the SAST (self-reports of general symptoms) would also be
useful for assessing HD because they include a multi-item assessment of at
least five of the proposed criteria. Several measures (CBOSB, CSBCS, HBCS,
DSI-SAS; SCS; CPUI) provide a thorough evaluation of one or two criteria
and might be useful for assessing specific issues (e.g., subjective distress,
risk of physical or emotional harm).
Although several measures fit exactly with the proposed criteria for
HD, the majority of instruments examined in the present review did not. For
example, one item on the CSBI (Coleman et al., 2001) asked participants how
often they promised to change their sexual behavior. This item is similar to
criterion A4 (i.e., repetitive and unsuccessful attempts to control or reduce
sexual behaviors), but does not align with the criterion exactly. Similarly,
one item on the SCS asked participants to rate a statement about feeling out
of control when aroused (Kalichman et al., 1994). This item also relates to
control of sexual behavior (criterion A4). However, neither item from the
CSBI nor the SCS fit the criterion as well as one item from the HDQ, which
specifically asked whether the participant had made unsuccessful attempts
to reduce or control sexual behaviors (Reid et al., 2012). Therefore, some
caution should be exercised in choosing measures to assess HD, because
the majority of instruments were designed before the proposed diagnostic
criteria were developed.
 74 S. D. Womack et al.

Criterion B (i.e., subjective distress) was the most thoroughly examined

criterion among the measures (i.e., 29 out of 32 studies included at least one
item addressing it). By contrast, criterion A3 (i.e., engaging in hypersexual
behaviors in response to stress) was addressed by 12 measures, criterion
A2 (i.e., engaging in hypersexual behaviors in response to dysphoric mood)
was assessed by 8 measures, and criterion C (i.e., hypersexual behaviors not
due to substances or medical conditions) was assessed by 4 measures. These
three criteria were underrepresented among the measures included in this
review.
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Limitations
There are several limitations to the present review of measures. First, the
proposed criteria for HD were developed relatively recently, and even the
definition of “hypersexual behavior” has changed over time. Kafka (2010)
outlined a more detailed list of criteria for possible inclusion in the DSM-
5. Twenty-three of the measures included in this review (71.9%) pre-date
Kafka’s criteria for HD. Only nine of the measures included in the present
review (28.1%) were written after the proposed criteria for HD were es-
tablished. Given the short existence of formal criteria for HD, most of the
measures included in this review were not specifically designed to align
with the proposed criteria. Of the 12 measures that addressed five or more
criteria of HD, 7 were written after Kafka’s criteria were published (58.3%).
It is likely that the measures that fit well with the proposed criteria did so
because they were written after the criteria were proposed. In fact, four of
the measures in this review were specifically tailored for HD as outlined by
Kafka. Therefore, the poor fit of many measures to the proposed diagnostic
criteria may be a product of the time at which they were written and the
shifting nature of the definition of HD more so than a lack of utility.
Second, most of the measures only provide a partial picture of HD as
outlined by its diagnostic criteria. Twenty out of thirty-two measures (62.5%)
assessed four or fewer proposed criteria, making them less useful for a
comprehensive diagnosis of HD than measures such as the HDQ that assess
seven out of eight criteria.
Third, most of the instruments reviewed were self-report measures and
subjective in nature. They relied on the participant to define “excessive” hy-
persexual thoughts, urges, and behaviors, and therefore may not accurately
reflect the level of hypersexual behavior. It is possible that some partici-
pants might report higher levels of hypersexual behavior because they feel
that any “unsuitable” thoughts or behaviors are “excessive” (e.g., individu-
als from conservative religious groups; Kwee, Dominguez, & Ferrell, 2007).
On the other hand, some participants may fail to report significant levels
 Measuring Hypersexual Behavior 75

of hypersexual behavior due to stigma and shame surrounding “unsuitable”

sexual thoughts, urges, and actions.
Finally, some of the proposed criteria for HD, such as A2 (i.e., engaging
in behaviors due to dysphoric mood) and A3 (i.e., engaging in behaviors due
to stressful life events) are somewhat similar to one another, and therefore
are often addressed by the same item in a measure. For example, one item
on the CSBI asks participants how often they use sex to cope with “worries
or problems in your life” (Coleman et al., 2001). For items such as these,
it may be difficult to differentiate between whether the participant is using
hypersexual behavior in response to dysphoric mood states, stressful life
events, or both. This lack of specificity makes it difficult to assess accurately
each criterion.
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Recommendations for Researchers and Clinicians

Based on the results from the present review, we provide several recom-
mendations for researchers and clinicians wanting to assess HD as defined
by the proposed diagnostic criteria. First, there are several instruments that
have been created specifically to assess the proposed diagnostic criteria for
HD. These measures provide a broad overview of the diagnostic criteria and
are likely to be the best choice of measures if the researcher or clinician is
looking for a brief instrument.
Second, if possible, we recommend that researchers and clinicians
combine instruments and especially measurement methods to provide a
more complete picture of a client’s problematic hypersexual behavior. For
example, a self-report measure could be combined with a clinical interview.
The self-report measure assesses the client’s subjective experience, whereas
the clinical interview might generate more detailed information and clarify
discrepancies or misunderstandings. Also, a measure of general symptoms
could be combined with a measure of consequences associated with HD.
The measure of symptoms could give a broad overview of HD, whereas
the measure of consequences could clarify the extent to which a person’s
hypersexual behavior is actually causing problems in one’s life. Finally, a
subjective measure of general symptoms could be combined with an objec-
tive measure of sexual behavior (e.g., number of orgasms per week, number
of hours spent viewing pornography; either self-report or via a clinical inter-
view). Again, the measure of symptoms could give a broad overview of HD,
whereas the objective measure of sexual behavior could clarify the extent
to which a client’s views about his or her sexual behavior are normative.
Ideally, a thorough assessment of hypersexual behavior would include (a) a
self-report measure of general symptoms, (b) a self-report measure of con-
sequences, (c) a clinical interview, and (d) an objective assessment of sexual
behavior.
 76 S. D. Womack et al.

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