MUNICH — Audiences mostly find the sex-obsessed protagonists of Steve McQueen’s movie Shame and Lars von Trier’s Nymphomaniac bizarre and alien, or at the very least irritating. But there really are people like that in real life.

Take, for example, this 58-year-old man somewhere in the eastern part of Germany sitting by his phone. He’s only seen the Nymphomaniac trailer. “It’s disturbing,” he says. And, no, he doesn’t think he could sit through the whole movie. “A reformed alcoholic doesn’t go to wine tastings,” is the way he puts it. His obsession started after the reunification of Germany, in the early 1990s, when he began looking at porn videos and frequently visiting prostitutes. Or phoning. Daily, and always the same woman. Eight hundred euros, 900, 1,000: That’s the kind of money he was spending on phone sex. It represented more than his monthly rent. At some point, he had to tell his wife he’d phoned their life savings away.

Men like him are proof that the Steve McQueen and Lars von Trier movies are not just fiction. There are people whose overwhelming need for sex becomes a torment. Psychiatrists call it hypersexuality, and the phenomenon isn’t as rare as people might think. According to American studies, 3% to 6% of the population suffers from hypersexuality at some point in their life, and for every three men one woman is afflicted. How reliable these figures are is hard to say, however, because defining how much sex is too much is subjective.

“It’s also the wrong question,” says psychiatrist Peer Briken, director of the Institute for Sex Research and Forensic Psychiatry in Hamburg. It’s not about quantity but about inner pain, he says. “If the patient isn’t suffering from his or her condition, then the doctor shouldn’t make a diagnosis,” assuming the case involved isn’t a forensic one where crime is involved, he says. Critics fear that clinical diagnosis of the disorder could lead those who have more sex than average being classed as pathological. Which is why hypersexual disturbance has not yet been included in the new version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

In one common definition of hypersexuality, the person suffering from the disorder has to have experienced intense sexual fantasies for over six months, along with such exaggerated sexual desire or behavior that it is damaging his or her life — in the sense that it is detrimental to social life and that the sleepless nights spent watching porn are making them ineffective at work. The reaction to stress, boredom or anxiety is to turn to sex. Crucial to determining if someone is suffering from hypersexuality is whether their condition makes them suffer. If the word alcohol were used to replace sex in this description, we would very quickly recognize the same patterns.

Men vs. women

There are differences between how men and women suffer. Most hypersexual women act out their desire. “They go out at night, get drunk or take drugs, but the one-night stands sometimes get them into situations that overstep the bounds,” Briken explains. For example, they may seek contact with men with sadistic tendencies who won’t respect signals to stop, or consciously risk getting infected with a STD.

A typical male patient, on the other hand, will sit for hours in front of his computer and masturbate. Briken tells of one man who said that when he was with his girlfriend he didn’t feel like having sex with her. He preferred looking for new porn films on the Internet.

Hypersexual behavior does not bring lasting satisfaction. After sexual acts patients often feel shame. But soon the fires of desire are lit anew, leading to further sexual escapades. It’s a vicious circle that is particularly difficult to break. Both men and women suffering from hypersexuality perceive their sexual behavior as sick but can’t seem to control it.

In the next edition of the World Health Organization’s International Classification of Diseases, at least one obsessive sexual disturbance will be included, Briken believes. In the current edition, only heightened sexual desire — satyriasis for men and nymphomania for women — are mentioned, without more precise definitions. “If a disturbance is not included in the manual, what that means is that it isn’t taken seriously scientifically,” says Briken. “Then it can be difficult getting health insurers to pay for treatment.” So for the time being, psychiatrists are choosing other categories for their diagnoses, such as “disturbance of impulse control” or “non-specific sexual disturbance.”

Confusion about terms and criteria is typical. Even the term “sex addiction” is controversial, though many patients themselves use it. Briken says it doesn’t stand up medically since only some of the criteria of physical addiction are met with hypersexuality. The word “nymphomania” is one that doctors stopped using in the 1990s, even if it still appears in medical literature.

Causes are therapies

The reasons why hypersexuality develops have yet to be conclusively explained. Experiences in childhood and adolescence presumably play a role, for example in cases of sexual abuse or an over-sexualized atmosphere in the family home. Briken relates that some patients had a mother or father who frequently changed sexual partners. These patients sometimes report that their parents invited them to watch porn movies with them.

But the opposite — when sexual desire and behavior is taboo — can be just as problematic, Briken says. In this case, sexuality can come to be dissociated from daily life and associated with everything that can’t be discussed openly. Hypersexuality sufferers are often afflicted by depression, anxiety, boredom and inner emptiness. For them, sex seems to be the only way to mitigate negative feelings.

Additionally, neurobiological mechanisms may play a role when the brain’s reward system reacts more strongly than average to sexual stimulation. Some doctors treat the few patients this applies to with medication such as antidepressants. These diminish not only depression and anxiety but also libido, making patients better able to control themselves.

Psychotherapists have so far had the greatest success rate with hypersexual patients. In a first phase, the therapists explore how patients could better control their behavior, for example by equipping their computer with filter software or putting it in a room where they are observed and cannot spend hours masturbating. They also teach patients how to deal with negative feelings with other means than sex — for example, sports, relaxation and mindfulness exercises.

In a second phase, the patients are asked to look at how their hypersexuality could be explained in the context of their life story, their experiences and conflicts. Therapies of this sort can sometimes go on for years, Briken says, but chances of success are good just as they are for patients who suffer from the opposite problem — too little desire or sex — who far outnumber those suffering from hypersexuality.