Psychology
2014. Vol.5, No.2, 151-159
Published Online February 2014 in SciRes (http://www.scirp.org/journal/psych) http://dx.doi.org/10.4236/psych.2014.52024
151
Conceptualization of Hypersexual Disorder with the
Behavioral-Cognitive Inhibition Theory
Nenad Paunović, Jonas Hallberg
Center for Andrology and Sexual Medicine, Karolinska University Hospital, Stockholm, Sweden
Received December 20th, 2013; revised January 17th, 2014; accepted February 16th, 2014
Copyright © 2014 Nenad Paunović, Jonas Hallberg. This is an open access article dis tributed un der the Creative
Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited. In accordance of the Creative Commons Attribution License all
Copyrights © 2014 are reserved for SCIRP and the owner of the intellectual property Nenad Paunović, Jonas
Hallberg. All Copyright © 2014 are guarded by law and by SCIRP as a guardian.
Hypersexual disorder is conceptualized with the behavioral-cognitive inhibition (BCI) theory. The current
article focuses on the following aspects: (a) triggers of dysfunctional sexual behaviors and fantasies, (b)
dysfunctional beliefs of excessive sexual behaviors and fantasies, (c) negative interpretations of triggers
of sexual behaviors and fantasies, (d) excessive sexual behaviors and fantasies as avoidance behaviors, (e)
consequences of excessive sexual behaviors and fantasies vs. healthy coping strategies, (f) sexual behav-
iors as inhibitors of distressing memories associated with negative beliefs, (g) sexual fantasies and other
valued memories as inhibitors of dysfunctional memories associated with negative beliefs, and (h) behav-
ioral activation of valued activities as inhibitors of sexual behaviors and distressing memories. Some im-
portant issues are discussed.
Keywords: Behavioral-Cognitive Inhibition Theory; Hypersexual Disorder; Negative Beli ef s ; Avoidance
Behaviors; Inhibition; Valued Memories; Dysfunctional Memories
Introduction
The aim of this article is to conceptualize hypersexual dis-
order, in accordance with the proposed criteria for the DSM-V,
with the behavioral-cognitive inhibition theory. An initial at-
tempt to such a conceptualization has been made (Paunovic,
2010a). The behavioral-cognitive inhibition theory was first
introduced in order to conceptualize posttraumatic stress dis-
order (PTSD) and other psychopathology disorders (Paunovic,
2010b). The current conceptualization has been developed by
taking into consideration (a) important factors in current con-
ceptualizations and treatments of hypersexual-related disorders
(Adams & Robinson, 2001; Gilliland, South, Carpenter, &
Hardy, 2011; Giugliano, 2006; Hardy, Ruchty, Hull, & Hyde,
2010; Howard, 2007; Kingston & Firestone, 2008; Klontz,
Garos, & Klontz, 2005; Putnam, 2000; Robinson, 1999; Same-
nov, 2011; Yoder, Virden, & Amin, 2011), and (b) the authors
clinical experience with hypersexual disorders in the context of
a current research project. The aim of this project is to develop
an effective cognitive-behavioral treatment for hypersexual dis-
order. The current article focuses on the development of a
theoretical model whose aim is to pinpoint proposed maintain-
ing factors in hypersexual disorder (see Figure 1). These fac-
tors include:
(a) Negative beliefs and interpretations of hypersexual beha-
viors, fantasies, urges, triggers and consequences;
(b) Avoidance and escape functions of sexual behaviors and
fantasies;
(c) Dysfunctional inhibition of valued memories by negative
memories associated with dysfunctional beliefs or by current
contingencies, and;
(d) Correction of dysfunctional respondent-functional-beliefs
memories that maintain dysfunctional sexual behaviors and fan-
tasies.
Triggers of Excessive Sexual Beha viors,
Fantasies and Urges
Four different categories of triggers that may set of hyper-
sexual behaviors, fantasies and urges. Triggers include sexual
and non-sexual related stimuli, and they can be external vs.
internal (i.e., env ironm ental vs. cognitions and memory).
External Sexual-Related Triggers to Hypersexual
Behaviors, Fantasies and Urges
External sexual-related stimuli that trigger sexual behaviours,
fantasies and/or urges include, but may not be limited to (a)
individuals that are perceived in one’s everyday life, (b) be-
haviours of others, (c) non-personal stimuli such as pictures
(e.g. commercials), magazines or movies of sexually attractive
individuals or behaviours.
External Non-Sexual-Related Triggers to
Hypersexual Behaviors, Fantasies and Urges
External non-sexual-related triggers include (a) individuals,
situations or events that elicit negative emotions, (b) current
distress, stress or crisis, or (c) stimuli that elicit positive emo-
tions and sexual feelings or interest.

N. PAUNOVIĆ, J. HALLB ERG
152
Figure 1.
Behavioral-cognitive inhib itio n th eo ry for hypersexual disorder: (1) A. Sexual and non-sexual stimuli function as triggers to starting to en g age in
excessive sexual behav iors and fantasies; B. Different t ypes of sexual behaviors and fantasies can be utilized as dysf unctional coping strategies;
C. Consequences of sexual behaviors and fantasies; and D. Negative or dysfunctional interpretations and beliefs about triggers, sexual beha-
viors/fantasies and their consequences; (2) A. Behavior-memory inhibition: excessive sexual behaviors and fantasies may shut-down (i.e., pre-
vents new learning) distressing memories associated with negative beliefs (sexual and/or non-sexual) or therapeutically inhibit such memories
(i.e., leads to n ew learning); B. Dysfunction al memories associated with negative beliefs may inhibit v alued and meaningful memories; C. Va-
lued and meaningful memories may therapeutically inhibit distressing memories associated with negative beliefs; D. Current valued activities
and functional coping may inhibit distressing memories associated with negative beliefs, and E. Reinforce plus expand valued memories.
Negative emotions, that constitute emotional responses to
current environmental stimuli, such as loneliness, boredom, sadness, anxiety or anger, can start to function as triggers to excessive sexual activities.
Sex with others (e.g., infidelity)
Pleasurable sexual emotions-positively reinforcing
activity-dysfunctional or negative beliefs
Negatively reinforcing sexual behaviors (e,g, cybersex)
Sexual arousal-negative reinforcement-dysfunctional or
negative beliefs
Negative sexual and personal experiences with partner
Distressing emotional responses-positively punishing
experiences-negative beliefs of self/partner
Negative event (e.g., trauma, abandonment, social, loss)
Negative distressing emotions-e.g. negative
re inforcement-negative beliefs of self and others
Relationship and sexual experiences with partner
Pleasurable emotions-positively reinforcing activities-
positive beliefs of self/partner
Valued relationships
Valued positive emotions-positively reinforcing
activities-positively valued people and relationships
Other valued life areas (job, sexual, achievements,
activities)
Valued positive emotions-positively reinforcing
activities-meaningful beliefs of life area, self, others
Current meaningful sexual fantasies
Pleasurable sexual emotions-positively reinforcing
sexual activity-positive personal meaning
MEMORY-MEMORY INHIBITION
A
BEHAVIOR- MEMORY INHIBITION
Current excessive sexual behaviors
2
B
C
E
Current valued activities and functional coping
BEHAVIORS
Sexual-related stimuli
•Attractive persons or other sexual stimuli
•Distressing reminders of painful
sexual experiences
•Reminders of positive sexual experiences
•Sexual interest, desire, urges
Non-sexual-related stimuli
•Negative and distressing emotions
•Memories of negative events and beliefs
•Stressful/distressing stimuli and emotions
•Mast urbat ion
•Pornography
•Adult consenting sex
•Cybersex
•Telephone Sex
•Strip Clubs
Topography
•Frequency, intensity,
duration
D. Currentnegative or dysfunctional beliefs and interpretations
BELIEFS
•Negative reinforcement
•Negative consequences in valued
life areas (relationships, job,
monetary etc.)
•Shut-down or retrieval prevention
of negative emotions, beliefs,
memori es
•Sexual positive reinforcement
•Sexual satiation
•De-inhibition of valued emotions,
beliefs, memories (functional)
•Inhibition of negative emotions,
beliefs, memories (functional)
1
A. Sexual behavior triggersB. Sexual behaviors/fantasiesC. Consequences
Distressing/dysfunctional memories (respondent-
funct iona l-beliefs memory elements)
Valued memories (responde nt -func t ional -
beliefs memory elements)

N. PAUNOVIĆ, J. HALLB ERG
153
Sexual-Related Memories as Triggers to Hypersexual
Behaviors, Fantasies and Urges
Memories of negative sexual experiences may function as
triggers to start engaging in current sexual behaviours and fan-
tasies. Negative sexual experiences may include sexual assault
or other types of negative sexual experiences. Negative sexual
experiences, distressing emotional and physiological responses,
and negative meanings and behaviours become encoded (per-
ceived) and stored in memory. The activated negative sexual
memories include memories of the event, distressing emotions
and physiological responses, negative meanings, and behav-
iours. Such distressing memories may become further nega-
tively elaborated by post-event sexual and non-sexual distress-
ing experiences. Activated negative sexual-related memories
may start to function as a trigger to hypersexual behaviours, fan-
tasies and urges.
Pleasurable sexual experiences with consenting adults or
other types of pleasurable sexual activities become encoded and
stored in memory. Such memories consist of the sexual-arous-
ing stimuli, the sexual activities and behaviours, the sexual
emotional and physiological responses and the meanings at-
tached to the activity. The activation of pleasurable sexual
memories may act as a trigger to start to engage in positively
reinforcing sexual activities or behaviours in the current situa-
tion. Additional pleasurable sexual activities reinforce the sex-
ual memory triggers. The pleasurable sexual memories may
expand in terms of additional stimuli and responses that be-
come associated with sexual pleasure. Some individuals feel so
compelled by the urge to satisfy one’s sexual pleasure in the
short-term, that the potential negative consequences are not cur-
rently considered.
Non-Sexual-Related Memories That Act as Triggers
to Hypersexual Behaviors, Fantasies and Urges
Various types of negative life experiences are associated with
distressing emotions, physiological responses, dysfunctional
coping behaviors and negative meanings that become encoded
and stored in memory. The activation of unprocessed negative
memories , or memories with excessively negative meanings
(e.g., trauma, distressing interpersonal events e.g. bullying or
conflicts, distressing medical conditions of self or others, loss
of significant others etc.), leads to psychological distress. The
activation of negative memories that lead to emotional distress
may act as a trigger to start engaging in hypersexual behaviors,
fantasies and/or urges.
Negative or Dysf unctional Beliefs about
Excessive Sexu al Behaviors
It is proposed that negative interpretations of hypersexual
behaviors, fantasies and urges contribute to the maintenance of
the disorder.
Hypersexual behaviors and fantasies, that lead to distress
and negative consequences in ones functioning in important life
areas (job, interpersonal, leisure etc.), may be interpreted as
uncontrollable and as indications of that one is an incompetent
individual. Entrenched beliefs that one cannot control one’s
hypersexual behaviors, fantasies or urges contribute to the
maintenance of hypersexual disorder. In addition, beliefs that
one cannot cope adequately with negative emotions and dis-
tress associated with daily endeavors, contribute indirectly to
the maintenance of hypersexual disorder. This is because hy-
persexual behaviors and fantasies are utilized as dysfunctional
alternatives to adequate coping.
An entrenched belief that an exposure to triggers of sexual
fantasies or urges will inevitably lead to sexual behaviors, in-
creases the risk to engage in the latter. If sexual behaviors lead
to an increased risk to negative consequences (e.g. relationship,
job, economic), and if such beliefs are correct, it may be im-
portant to avoid such triggers for the time being, while devel-
oping adequate coping strategies.
The belief that excessive sexual behaviors, fantasies and
urges are addictions is dysfunctional. Healthy sexual needs and
behaviors are not disorders that people need to control and ab-
stain from. Sexuality is a biological necessity (survival of the
species) and a pleasurable activity at its best. The view that
troubled couples must abstain from sexual activities with each
other may lead to negative consequences for the relationship.
The view that a couple must abstain from sex in a shaky rela-
tionship because such an activity is viewed as an addiction may
lead to a deterioration in the relationship, especially if it is the
most pleasurable activity for the couple. Also, if a dysfunc tion-
al sexual activity that is a bad habit is conceptualized as an
addiction, the problematic sexual behavior may be attributed to
a “disorder”, and not to the individuals own responsibility.
Different types of negative interpretations of excessive sex-
ual behaviors, urges and fantasies are usually associated with
different types of concomitant emotional responses. Here are a
couple of examples. The belief that hypersexual behaviours are
dangerous (e.g., that they may lead to feared negative cones-
quences) leads to anxiety and fear. The belief that sexual be-
haviours, fantasies or urges are indications of that oneself is a
bad person leads to shame. The belief that sexual behaviours,
fantasies and urges are actions that harm others emotionally
may lead to feelings of guilt. The belief that one’s sexual be-
haviours has led to interpersonal loss (e.g., abandonment by
partner) may lead to emot ions of sadness and grief. Sometimes
such beliefs may be functional (if one abstains from engaging
in sexual activities with negative consequences), and sometimes
they are non-functional (only adding to a person’s emotional
distress).
Some individuals hold the belief that they must engage in
sexual behaviors, fantasies or urges in order to feel good about
themselves. Sexual behaviors are viewed as a means of coping
(e.g. soothing oneself). Distressing situations or activated me-
mories may trigger the belief that “I must engage in sexual
activities in order to feel better”. That is, some individuals hold
the belief that sexual behaviors and fantasies have an important
soothing function when negative emotions are experienced. For
example, boredom and loneliness may trigger such a belief.
Boredom may trigger specific thoughts that sexual behaviors
and fantasies are the only means to become stimulated in one’s
otherwise dull and boring everyday life. Feelings of loneliness
may trig ger specifi c thoughts that the only means to escape the
loneliness in the present moment is to engage in sexual beha-
viors, fantasies and urges.
Some people hold the belief that sexual behaviors and fanta-
sies is the most effective way to reduce stress (e.g., engage in
cybersex during job time) or to reduce the negative emotional
consequences of stress (e.g., go to a striptease club after work).
The maintenance of such beliefs increases the risk that sexual
behaviors and fantasies will continue to be used as effective
stress-reducing coping strategies in the short-run. However,

N. PAUNOVIĆ, J. HALLB ERG
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such sexual behaviors and fantasies may also lead to harsh neg-
ative consequences (e.g., job loss or relationship strains).
Non-sexual related shame may trigger a belief that sexual
behaviors or fantasies may effectively shut down the feelings of
shame. Also, sexual behaviors and fantasies may be believed to
be an indication of that oneself is a bad person, which leads to
further shame. The urges to engage in sexual behaviors and
fantasies may be stronger than shame-related beliefs and emo-
tions. Shame-related beliefs about sexual behaviors and fanta-
sies may express themselves in shame-attacks directed to one-
self. It usually may consist of an internal repeating self-punish-
ing dialogue with the content that oneself is a very bad person.
The engagement in sexual behaviors and fantasies may trigger
beliefs such as “I am filthy and despicable” and elicit feelings
of shame. Shame may lead to a concealing response so that the
individual hides his/her sexual behaviors and fantasies to others.
There is a fear that being exposed to an engagement in sexual
behaviors and fantasies will lead to verbal condemnation in line
with the shame-related attacks on oneself.
An individual may feel guilty for engaging in sexual beha-
viors and fantasies (Gilliland, South, Carpenter, & Hardy,
2011). The guilt may be about the consequences of the sexual
behaviors and fantasies, or about the sexual behaviors and fan-
tasies themselves. To what extent does sexual-related guilt
make sense? And to what extent does it constitute cognitive
distortions? The answers to these questions are probably con-
text-related. On the one hand, some sexual behaviors and fanta-
sies may hurt other people emotionally (e.g., guilt is a logical
response). On the other hand, engaging in some sexual beha-
viors and fantasies may sometimes only be about one’s values.
For example, watching porn may to one person be a normal
activity. However, when one’s partner doesn’t approve or views
such behaviors as infidelity, then there is a clash in values re-
garding the specific sexual activity. Another negative belief is
to deem such sexual activities as morally wrong. Such beliefs
may cause distress in individuals for sexual behaviors that may
be considered acceptable, or within the limits of normal sexual
behavior for most people.
Excessive sexual behaviors, fantasies and urges may be in-
terpreted as indications of a psychological disturbance, i. e., that
there is something seriously defective about oneself. Sexual
behaviors and fantasies are behaviors that can be enacted on a
continuum in terms of frequency, intensity and duration. Nega-
tive beliefs about sexual behaviors and fantasies that are within
the limits of acceptable sexual behavior for most people can
lead to psychological distress and other negative consequences
in important life areas. The belief that sexual behaviors, fanta -
sies and urges are symptoms of a psychological disturbance,
behaviors and reactions acceptable in society, may be dysfunc-
tional. If an elevated frequency, intensity and duration of ac-
ceptable sexual behaviors leads to psychological distress and
decreased functioning in important life areas, then such beha-
viors may be viewed as elevated normal sexual behaviors that
need to be better controlled or decreased.
The belief that pleasurable sexual behaviors and fantasies are
positive, despite negative consequences to oneself and others
(relationship, job, emotional, economic etc.), should be consi-
dered dysfunctional. Infidelity may constitute excessively pleas-
urable activities that are viewed very positively. However, if it
hurts one’s partner and leads to disruptions in a significant rela-
tionship, then positive beliefs about infidel sexual activities are
dysfunctional. Also, pleasurable sexual behaviors and fantasies
that take up too much time (e.g., cyberporn) may compromise
other important engagements. If other important engagements
become seriously compromised because time is wasted on sex-
ual activities, then the positive beliefs about such activities
should be considered dysfunctional in relation to the compro-
mised engagements.
Negative Interpretations of Stimuli That
Function as Triggers to Excessive Sexual
Behaviors
Negative Beliefs and Interpretations of Negative
Emotions Related to Current Situations as Triggers
Unwanted negative emotional experiences may function as
triggers to hypersexual behaviours. The content of negative
beliefs and interpretations of current situations or stimuli are
logically tied to specific emotional responses. Specific beliefs
and interpretations and their emotional consequences may start
to function as triggers to excessive sexual behaviors and fanta-
sies. Situations that are interpreted as indications of that one has
been violated in personal ways, or that one has been seriously
hampered in achieving a personally important goal, often lead
to emotions of anger. Situations that are interpreted as that one
has no stimulating or meaningful activities to engage in may
lead to emotions of boredom. Beliefs that oneself as inadequate,
that other people are non-helpful or untrustworthy, and that the
future is full of unattainable obstacles often lead to low mood,
depressive-like emotions and sadness. The belief that specific
situations or stimuli are dangerous leads to emotions of anxiety
and fear. Stressful situations that are interpreted as too de-
manding may lead to emotional stress responses. Negative un-
wanted emotions such as anger, boredom, anxiety , fear, sadness
and low mood may start to function as triggers to excessive
sexual fantasies and behaviors.
Negative Beliefs and Interpretations of
Relationship-Related Situations and Problems as
Triggers
A partner that is believed to be too demanding may result in
emotional distress. Such distress may act as a trigger to exces-
sive sexual behaviors and fantasies. The belief that a partner is
too demanding may relate to non-sexual or sexual issues. Be-
liefs and interpretations of the partner as excessively demand-
ing are subjective. They may reflect behaviors that may be
viewed as more or less “objectively demanding” by outside
observers. Subjective experiences of demanding partners may
differ extensively with regard to what is deemed to be demand-
ing, and the subjective threshold of what needs to happen for
this subjective experience to be felt. Other contributing factors
should be taken into consideration. Does the client have deficits
in coping capabilities with regard to handling demanding situa-
tions? Is the frequency, intensity and/or duration of a partners
demands extensive (i.e., is a client’s experience realistic?)?
Does the client give in to a partner’s demands due to a fear of
being negatively evaluated? Do sexual behaviors and fantasies
temporarily alleviate short-term sexual or non-sexual perceived
demands from a partner?
If a partner has less sexual interest or need than a client who
wants to engage in sexual activities more often, this may result
in a belief that one cannot meet one’s sexual needs with the
partner. The client may start to engage in sexual behaviors and

N. PAUNOVIĆ, J. HALLB ERG
155
fantasies without the partner (e.g., internet porn or sexual ac-
tivities with other people). The partner may hold the belief that
the client is a sex addict, or is inadequate in other ways (e.g.,
doesn’t care, isn’t interested in oneself, doesn’t listen etc.).
Thus, negative responses from the partner with regard to sexual
activities may trigger a belief that the partner is sexually in-
adequate and lead to the exacerbation of sexual behaviors and
fantasies without the partner.
Entrenched beliefs that oneself is lonely and the emotional
experience of loneliness may trigger an excessive engagement
in sexual behaviors and fantasies. Entrenched beliefs of loneli-
ness may be triggered by unprocessed memories of earlier neg-
ative interpersonal experiences (e.g., abandonment or separa-
tion experiences). Intimacy with others may be viewed as
threatening because it may trigger beliefs of repeated aban-
donment. A current partner may be viewed as non-trustworthy
due to a fear that he/she is going to abandon oneself. In order to
suppress such beliefs and fears, a client may start to engage in
excessive sexual behaviors and fantasies. Consequently, the
belief is maintained due to a lack of adequate cognitive and
emotional processing. Since such sexual behaviors and fanta-
sies suppress one’s fear of intimacy and abandonment tempora-
rily, the dysfunctional beliefs of abandonment are maintained.
However, a partner’s responses to dysfunctional sexual beha-
viors and fantasies may lead to real abandonment in the long
run if the partner finds such behaviors excessively distressing.
Negative Interpretations of One’s Sexual Func tioning
as Triggers
The theme “porn impotence” has to do with the belief that
oneself is sexually impotent with one’s partner. If a client is
able to react sexually by other means (e.g., cybersex, sexual
activities with others), then “I am porn impotent” is a faulty
assumption. “Inability” to sexually react towards one’s partner
may be due to alternative explanations. A couple of possible
alternative explanations are presented next. First, a lack of sex-
ual responses towards one’s partner may be due to sexual satia-
tion as a result of other sexual behaviors and fantasies, sexual
stimulation (e.g., masturbation), and resulting ejaculation or
orgasm. Second, a lack of sexual responses towards one’s part-
ner may be due to the fear that one’s partner sees oneself as
sexually unattractive or inadequate. Third, a lack of sexual res-
ponses towards one’s partner may be due to the client per-
ceiving the partner’s physical appearance as unattractive or
behaviors as sexually non-appealing. Fourth, relationship con-
flicts and intimacy problems with the partner may lead to a
diminished sexual interest towards the partner.
Negative Beliefs and Interpretations of Sexual- and
Non-Sexual Related Memories as Triggers
Sexual pleasurable memories may be viewed as desirable and
function as triggers to plan and engage in excessive sexual be-
haviours and fantasies. By dysfunctional is meant any behav-
iors and fantasies that lead to negative consequences to oneself
and/or others (e.g., emotionally, legally, health-related, mone-
tary etc.). Distressing sexual memories (negative sexual ex-
periences, sexual assault etc.) may be interpreted neg atively and
motivate an engagement in excessive sexual behaviors and
fantasies. The function is to shut down the negative meaning
and emotions associated with non-processed distressing sexual-
relate d memories.
Distressing non-sexual memories associated with excessively
negative beliefs and interpretations may, when triggered, gen-
erate psychopathology symptoms. Psychopathology symptoms
may be negatively interpreted and lead to negative or dysfunc-
tional beliefs about oneself, other people and the world. Nega-
tive beliefs that are associated with negative or distressing non-
sexual memories, contribute to the maintenance of psychopa-
thology symptoms. The strategies that are used in order to get
rid of these symptoms, in the form of sexual behaviors and
fantasies, contribute in the maintenance of negative beliefs and
interpretations. If excessive sexual behaviors and fantasies are
continuously utilized in order to shut down psychopathology
symptoms, then the individual doesn’t learn new alternative
beliefs associated with one’s personal negative memories, and
the role of sexual behaviors and fantasies in one’s psychopa-
thology symptoms.
Negative Interpretations of Inhibited Valued
Memories as Triggers
Distressing memories associated with negative beliefs and
current distressing circumstances may inhibit valued memories
associated with significant relationships, sexual experiences,
job careers, leisure activities etc. Valued memories may be-
come inhibited and more or less non-accessible. Such an inhibi-
tion may lead to depressive symptoms such as an increased
sense of meaninglessness, diminished interest in previously
appreciated activities, decreased ability to feel positive emo-
tions and diminished motivation to relate to other people. Such
reactions may be negatively interpreted and lead to the devel-
opment of dysfunctional beliefs such as (a) that one is unable to
experience positive activities and emotions, or (b) negative
beliefs about oneself, other people or the world. Such negative
beliefs may become triggers of excessive sexual behaviors and
fantasies.
Minimization of Consequences of Excessive Sexual
Behaviors and Fantasies as a Tr ig ger
One kind of negative belief that can function as a trigger to
excessive sexual behaviors and fantasies is the faulty thought
pattern minimization. Minimization is defined as some people’s
tendency to downplay the role of negative consequences of
engaging in dysfunctional sexual behaviors and fantasies. The
more distress or harm that is a consequence of sexual beha-
viors and fantasies, the more dysfunctional minimization of
these sexual behaviors and fantasies becomes. For example, if
an individual ignores the risk of engaging in cybersex during
work-time, and one’s employer finds out about such activities,
job loss may follow. Or, if a spouse harbors excessively nega-
tive beliefs about cybersex, relationship strains may follow
when such activities are discovered. Precautionary measures
may be initiated in order to minimize the risk of becoming dis-
covered. However, if such negatively valued sexual behaviors
and fantasies become discovered, negative consequences may
follow. A client needs to learn in advance how it would feel to
be faced with interpersonal, job or other significant negative
consequences in one’s life as a direct result of one’s engage-
ment in dysfunctional sexual behaviors.
Excessive Sexu al Behaviors and Fantasies as
Avoidance Behaviors
Sexual behaviors and fantasies can have the following psy-

N. PAUNOVIĆ, J. HALLB ERG
156
chological functions: (a) to inhibit distressing sexual and non-
sexual memories and associated beliefs and interpretations, (b)
to avoid current distressing sexual and non-sexual stimuli and
associated beliefs and interpretations, and (c) to provide sexual
pleasure and intimacy. Sexual behaviors and fantasies with
such psychological functions may lead to the following: (a)
prevent new corrective experiences during the retrieval of dis-
tressing sexual and non-sexual-related memories and associated
beliefs and interpretations, (b) prevent new corrective expe-
riences related to coping with current distressing situations and
associated beliefs and interpretations, and (c) lead to negative
long-term consequences (e.g., relationships, monetary, health-
related, job loss etc .).
Avoiding Negative Memories Associated with
Negative Beliefs and Interpretations by Engaging in
Sexual Behaviors and Fanta si e s
Grief due to the loss of a significant other may be avoided by
an engagement in sexual behaviors and fantasies. This leads to
a temporary relief from the grief. However, when the sexual
behaviors and fantasies are halted the un-processed grief will
re-emerge. This motivates the individual to continually re-en-
gage in sexual behaviors and fantasies in order to shut down the
grief. The long-term consequence may be a maintenance of
non-processed grief. This may have a negative impact on cur-
rent relationships and one’s sexual functioning due to depres-
sive-related mood.
Sexual behaviors and fantasies may have the function of
avoiding or escaping from traumatic memories as part of PTSD
symptoms (Howard, 2007; Robinson, 1999). The function of
sexual behaviors and fantasies may be to prevent the activation
of traumatic memories (i.e., avoidance responses), or to shut
down activated traumatic memories (i.e., escape responses).
Current trauma memory triggers function as signals to start to
engage in sexual behaviors and fantasies in order to prevent the
activation of traumatic memories or to shut down activated
trauma memories.
People who have been severely bullied earlier in life may
suffer severe psychological consequences (e.g., depression,
negative self-view etc. ). The activation of unprocessed bullying
memories that are related to excessively negative beliefs may
be avoided by an engagement in sexual behaviors and fantasies.
If distressing bullying memories are activated they may be shut
down by an excessive engagement in sexual behaviors and
fantasies.
Avoiding Negative Emotions Triggered by Current
Circumstances with Sexual Beha viours and Fantasies
Current circumstances may be such that an individual l ives a
lonely life. Sometimes this may be due to a job loss, relation-
ship break-up or other reasons. Feelings of loneliness may be
avoided by engaging in hypersexual behaviors and fantasies. In
order to hold feelings of loneliness at bay in the short-term one
has to constantly engage in hypersexual behaviors and fantasies.
If the circumstances don’t change, the function of the sexual
behaviors and fantasies may be maintained.
Sexual behaviors and fantasies may be utilized as relaxation
strategies in response to stress behaviors. This means that sex-
ual behaviors and fantasies may indirectly maintain stress be-
haviors by reducing the short-term negative stress-related con-
sequences. Furthermore, sexual behaviors and fantasies may be
an avoidance strategy to perceived or real demands, contribut-
ing to the procrastination of important activities (e.g., job, in-
terpersonal, other endeavours).
Sexual behaviors and fantasies may constitute functional
responses to relationship-related dissatisfaction. Dissatisfac-
tions may stem from an impoverished sexual life with the part-
ner, verbal conflicts, distressing demands from the partner, loss
of sexual interest from the partner or other types of relationship
problems. Sexual behaviors and fantasies as coping strategies
don’t learn the individual to cope with the real problems in the
relationship. It only leads to a temporary relief from the emo-
tional consequences of the relationship issues.
Some individuals harbor an irrational fear of intimacy with
other people (e.g., one’s partner). An engagement in certain
sexual behaviors and fantasies may keep such fear at bay.
Sexual behaviors or fantasies may have the function of
soothing physical pain caused by physical injuries.
People who have irrational fears of being abandoned may
handle this fear by temporarily engaging in certain sexual be-
haviors and fantasies. This temporarily soothes or decreases the
fear of abandonment.
Emotions of sadness and depressive-like sy mptoms m ay be a
response to current circumstances or due to the activation of
unprocessed distressing memories associated with negative
beliefs. Such emotions may be undesirable and coped with by
an engagement in sexual behaviors and fantasies that tempora-
rily inhibit feelings of sadness and depressive-like symptoms.
Loss of significant others due to e.g. terminal medical condi-
tions or traffic accidents leads ordinarily to acute grief reactions,
and sometimes to posttraumatic stress symptoms. The natural
grief process may be halted if the individual starts to engage
excessive sexual behaviors and fantasies in order to avoid ex-
periencing the grief. In order to keep acute grief out of one’s
immediate consciousness and experience, one must constantly
engage in sexual behaviors and fantasies.
Anger may constitute a response to a perceived threat (e.g.,
phys i c a l, social, psyc hological etc.), a means to cope with neg-
ative events or emotions, or a consequence of negative inter-
pretations of other people’s or one’s own behavior as unfair etc.
Anger may be an undesirable emotion that can be temporarily
suppressed by an engagement in sexual behaviors and fantasies.
Guilt involves interpretations of one’s own behaviors or lack
of actions that is thought to have led to the occurrence of nega-
tive events. Shame consists of beliefs about one’s character as
completely bad (i.e., an excessively negatively characterologi-
cal view of oneself). Guilt and shame may be so distressing and
undesirable that an individual starts to engage in excessive
sexual behaviors and fantasies. This is done in order to shut
down emotions and cognitions associated with guilt or shame.
However, this is a temporary solution since the guilt and shame
is not adequately processed. Consequently, it will re-emerge
back when the sexual behaviors and fantasies are halted. In
addition, sexual behaviors and fantasies may generate addition-
al guilt and shame if these actions are deemed to be a wrong-
doing. Such beliefs further exacerbate the guilt and shame.
Pleasurable Sexual A ctivities That Lead to Negative
Consequences
Sometimes the dysfunctionality of sexual behaviors and fan-
tasies are solely determined by the negative consequences asso-

N. PAUNOVIĆ, J. HALLB ERG
157
ciated with such behaviors. Negative consequences may be
related to one’s own beliefs about the specific sexual behaviors
and fantasies (e.g., guilt or shame). Or negative consequences
may be related to negative responses from significant others,
monetary loss or negative job consequences. The short-term
pleasurable sexual engagements may hinder an individual from
reflecting upon the possible real-life damaging consequences as
a result of such behaviors.
Consequences of E xcessive Sexual B ehaviors vs.
Developing Healthy Coping Strategies
The Shut-Down of Distressing Memories Associated
with Negative Beliefs
Excessive sexual behaviours and fantasies may maintain dis-
tressing memories associated with negative beliefs if the former
are functionally related to the latter. This may be due to the
following reasons. First, there is a lack of adequate cognitive
and emotional processing of issues that the distressing memo-
ries and associated beliefs represent. Second, there is no focus
on to solving real life problems, i.e. functional coping behaviors
have not been developed or are not applied to primary trouble-
some situations. When excessive sexual behaviours and fanta-
sies are halted the avoided psychological or real life problems
have the opportunity to become available in one’s conscious-
ness. Alternative healthy coping strategies must be utilized in
relation to one’s non-processed distressing memories. If this is
not done, the individual may re-engage in the only coping be-
havior that has seemed to work in shutting down distressing
memories associated with negative beliefs: sexual behaviours
and fantasies. Hence, the underlying psychological problems
and life issues will be maintained as well as the dysfunctional
sexual behaviors and fantasies.
Coping with Stress
Excessive sexual behaviours and fantasies may have two
primary functions with regard to coping with stress: (a) to pro-
crastinate from important engagements, activities or duties, or
(b) to handle the consequences of primary stress behaviors (i.e.,
a soothing function). Unless the individual develops healthy
strategies on how to deal with primary stress situations it their
consequences, there is a risk that the excessive sexual behav-
iors and fantasies will be maintained.
Coping with Negative Emotions in Gen eral
When excessive sexual behaviors and fantasies fulfil an avoi-
dance function in relation to negative emotions, the individual
must develop alternative coping strategies in order to handle
negative emotions and the associated beliefs and life problems.
If alternative coping strategies are developed, or existing cop-
ing abilities are applied, the function of excessive sexual be-
haviors and fantasies cease to hold their sole grip on the indi-
vidual. This is so because other more healthier coping alterna-
tives become possible.
Coping with the Aftermath of Interpersonal Distress
When excessive sexual behaviours and fantasies fulfil a
soothing function that decreases interpersonal-related emotional
distress (e.g., conflicts with a partner), it is important to develop
more functional coping strategies in order to handle the specific
interpersonal problems. If this is not accomplished, the client
will continue to engage in excessive sexual behaviours and
fantasies in order to sooth the aftermath of interpersonal prob-
lems.
Experiencing Dysfunctional Sexual Pleasure
When sexual pleasurable activities lead to negative cones-
quences (e.g., interpersonal strain with a partner, job or finan-
cial difficulties etc.), the sexual activities are considered to be
dysfunctional due to their negative consequences. Here it is
crucial to develop consequential thinking that can inhibit im-
pulses related to engagements in dysfunctional sexual behaviors
and fantasies. Learning to reflect upon realistic negative con-
sequences as a result of an engagement in dysfunctional sexual
behaviours and fantasies is essential in order to be motivated to
abstain from such destructive behaviours.
Behavior-Memory Inhibition: Sexual Behaviors
as Inhibitors o f ( A) Distressing Memor ies
Associated with Negative Beliefs, and (B)
Current Distressing Stimuli
It is argued that sexual behaviors, associated with positive or
functional beliefs that are in opposite to dysfunctional or nega-
tive beliefs, may be able to inhibit the latter.
Inhibition of Distressing Sexual-Related Memories
Distressing or dysfunctional sexual-related memories may
constitute emotionally non-processed memories. In the last
section the view was put forward that sexual behaviors may
function as avoidance behaviours. That is, those sexual behav-
iors may hinder adequate emotional and cognitive processing of
distressing sexual-related memories associated with negative
beliefs. On the other hand, sexual behaviors may in some cir-
cumstances fulfil the opposite function. That is, sexual behav-
iors may in some circumstances therapeutically inhibit emo-
tions associated with distressing sexual-related memories and
lead to an increased psychological and sexual well-being.
The Inhibition of Distressing Relationship-Related
Memories Associated with Negative Beliefs
Sexual behaviors may in some circumstances function as in-
hibitors to distressing relationship memories associated with
negative beliefs. In the previous section the view was presented
that sexual behaviors may constitute dysfunctional avoidance
behaviors to problematic relationship issues that need to be
resolved. However, sometimes sexual behaviors may have a
positive function in some relationships, and may inhibit some
strains associated with some types of relationship difficulties.
Inhibition of Distressing Non-Sexual Memories
Associated with Negative Beliefs
Sexual behaviors can likewise function as inhibitors to dis-
tressing non-sexual related memories associated with negative
beliefs. Once again, in this context sexual behaviours may have
a positive function insofar as they may therapeutically inhibit
distressing memories associated with negative beliefs.

N. PAUNOVIĆ, J. HALLB ERG
158
Inhibition of Emotional Responses to Current
Distressing Stimuli
Sexual behaviors may in some circumstances be viewed as
positive coping strategies. If such behaviors have a soothing or
relaxing function, and if they don’t lead to negative cones-
quences in important life areas, then it is up to the individual
who engages in such behaviors to decide whether to engage in
them or not.
Memory-Memory Inhibition: Sexual Fantasies
and Other Valued Memories as Inhibitors of
Dysfunctional Memories Associated with
Negative Beliefs
Pleasurable sexual fantasies and other valued memories may
function as inhibitors to distressing dysfunctional memories
associated with negative beliefs. The distressing memories as-
sociated with negative beliefs may constitute distressing sex-
ual memories, negative relationship-related memories or other
distressing non-sexual related memories associated with nega-
tive beliefs. If the pleasurable sexual or other valued memories
are associated with positive or functional beliefs, and if the
latter constitute strong evidence against dysfunctional or nega-
tive beliefs generated by activated negative or distressing
memories , then a healthy psychological functioning will de-
velop.
Behavioral Activ ation of Valued Activities as
Inhibitors of Sexual Behaviors and Distressing
Memories
An increased engagement in valued behavioral activities that
are related to meaningful relationships, jobs, leisure activities
can acquire inhibiting functions. That is, valued behavioral
activities may inhibit dysfunctional sexual behaviors, fantasies
and urges. Such activities may also function as inhibitors to
distressing sexual and non-sexual memories associated with
negative beliefs. For this to occur, it is important that the ex-
periences of valued behavioral activities constitute strong evi-
dence that support positive or functional beliefs about oneself,
other people and the world. It is also important that the positive
or functional beliefs are relevant and strong enough so that they
can inhibit the negative or dysfunctional sexual- and non-sexual
related beliefs.
Discussion
In the present article hypersexual disorder is conceptualized
with the behavioral-cognitive inhibition theory. It is argued that
excessive sexual behaviors and fantasies may become asso-
ciated with dysfunctional negative or positive beliefs. Next, it is
argued that excessive sexual behaviors and fantasies have dys-
functional psychological functions. First, their function is to
help the individual to cope with distressing situations or memo-
ries that are associated with negative or dysfunctional beliefs.
Second, sexual behaviors may sometimes only be dysfunctional
due to their negative consequences for oneself or other people.
Next, it is also argued that sexual behaviors and fantasies in
some circumstances may constitute functional behaviors that
may inhibit distressing memories associated with negative be-
liefs, and also current distressing situations.
The article has not focused on biologically related contribut-
ing factors such as sexual deprivation and satiation. Excessive
sexual behaviors and fantasies are more effective in suppressing
or inhibiting negative or distressing emotions and memories
when an individual is in a state of sexual deprivation. That is, if
an individual has not engaged in sexual activities for a long
enough time, one’s natural biological sexual urges become
stronger. Hence, when an individual uses sexual activities in a
sexually deprived state, he or she will respond emotionally
stronger to the sexual activity. Consequently, the stronger the
sexual emotional response, the more effectively it will be able
to inhibit distressing emotional responses. Conversely, if the
individual has engaged excessively in sexual activities and
fantasies, and ejaculated or had multiple orgasms for a short
period of time, one’s natural sexual biological satiation will
lead to decreasingly pleasurable sexual emotional responses. In
the latter case, an engagement in sexual behaviors and fantasies
when an individual is in a state of sexual satiation, will result in
a diminished capacity to suppress negative emotional responses
associated with distressing sexual and non-sexual problematic
life issues.
A cognitive-behavioral treatment for hypersexual disorder,
based on the behavioral-cognitive inhibition theory, should in-
clude the following components:
• The identification of triggers that set of excessive sexual
behaviours and fantasies (whether sexual or non-sexual
current stimuli or distressing memories associated with ne-
gative beliefs);
• The topography of specific excessive sexual behaviours and
fantasies; their frequencies, duration and intensity;
• The context in which excessive sexual behaviors and fanta-
sies occur: where, with whom, other important aspects of
the situation;
• The psychological function of excessive sexual behaviors
and fantasies: to handle distress (negative reinforcement)
and/or to get pleasure (positive reinforcement);
• The consequences (both short- and long-term) that follow
due to the engagement in excessive sexual behaviours and
fantasies;
• The idiosyncratic interpretations and beliefs of triggers,
hypersexual behaviours and fantasies, and consequences;
• The inhibition of valued memories and how to through be-
havioral and cognitive techniques de-inhibit the valued
memories ;
• The maintenance of dysfunctional respondent-functional-
beliefs memories.
The behavioral-cognitive inhibition theory provides a broad
and focused conceptualization that can target relevant main-
taining factors in hypersexual disorder. The behavioral-cogni-
tive inhibition theory is able to tie together all these problem
areas into a coherent framework.
Cognitive therapy that has been developed for the treatment
of depression and anxiety disorders (Beck, Emery, & Green-
berg, 1985; Beck , Rush, Shaw, & Emery, 1979) may be adapt-
ed and utilized in the treatment of excessive sexual behaviors
and fantasies. Interpretations and negative beliefs about exces-
sive sexual behaviours and fantasies, and sexual and non-sexual
triggers, may be crucial to target in treatment when they con-
tribute to the maintenance of the hypersexual disorder. The
focus on beliefs associated with triggers of excessive sexual
behaviors and fantasies is important in order to defuse the im-
pact that triggers have on the urge to engage in excessive sexual
behaviors and fantasies. The focus on beliefs about excessive

N. PAUNOVIĆ, J. HALLB ERG
159
sexual behaviors and fantasies themselves may include both
thoughts about the function they serve as well as negative be-
liefs that may contribute to the maintenance of hypersexual
behaviors and fantasies.
Behavioral techniques should focus on two important aspects.
First, on the function of the excessive sexual behaviors and
fantasies. Second, on behavioral activation and developing com-
petencies that will defuse the impact of triggers that set of ex-
cessive sexual behaviors and fantasies.
Imagery techniques can be utilized in order to strengthen
memories that are incompatible to negative or dysfunctional
memories (Holmes, 2007; Paunovic, 2011). Imagery techniques
may be more effective in changing negative cognitions that
maintain excessive sexual behaviors and fantasies than cogni-
tive techniques. Imagery may be more effective in eliciting
emotions that provide corrective experiences than verbal tech-
niques.
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