Kafka (2010) defines paraphilia related disorders as recurring, intense sexually arousing fantasies, urges, or behaviors involving essentially normative aspects of sexual expression that cause distress or significant psychosocial impairment. These include compulsive masturbation, protracted promiscuity, dependence on pornography, cybersex, or telephone sex, and severe sexual desire incompatibility. Kafka described the major distinction between paraphilias and paraphilia – related disorders is that the former behaviors are considered socially unconventional or deviant in their object of sexual arousal while the latter are not.

Non-paraphilic hypersexuality disorders are disinhibited or exaggerated expressions of human sexual arousal. Kinsey Institute researchers have outlined a theoretical model for sexual appetite and have illustrated its applicability to nonparaphilic “out of control” sexual behaviors (Bancroft &Vukadinovic, 2004). The following questions would help to identify and diagnose conditions during the early part of treatment in provide a complete understanding of the cause for a person’s suffering.

Have you ever had recurrent trouble controlling your sexual behaviors?
Has your sexual behavior ever caused you persistent personal distress or caused significant consequences to you such as loss of the relationship, legal problems, job related problems, or medical conditions including a sexually transmitted disease or unwanted pregnancy?
Have you ever had repetitive sexual activities that you felt needed to be kept secret or that you felt very ashamed of?
Have you ever been troubled by feeling that you spend too much time engaging in sexual fantasy, masturbation, or other sexual behaviors?
Have you ever felt that you have a high sex drive? For example, if we include both partners sex and masturbation, have you ever been sexual seven or more times/week during a have at least six months. Since adolescence? When was that? Did it last longer than six months?

If a person answers “yes” to one or more of these questions, it would be recommended asking specifically about the presence of a “paraphilia – related disorder”. In the studies that have evaluated axis one diagnosis in “sexually compulsive” males and females (Black et al., 1997), one of the major findings is that most subjects with these disorders have multiple lifetime co-morbid moods, psychoactive substance abuse, anxiety, and or other impulse disorder diagnoses. These co-morbid psychiatric conditions may be risk factors that substantially contribute to the onset, severity, and social deviance of hyper sexual behaviors (Kafka & Prentky, 1998).