Hypersexuality, also named as sexual addiction, sexual compulsivity or sexual impulsivity, is a phenomenon generally characterized by excessive and intense sexual drives, sexual fantasies, sexual cognitions, or sexual activities. It is related closely to the clinical distress and the impaired functioning in individuals’ life domains such as the social, study, occupational, physical, or emotional areas [1, 2]. Kafka proposed diagnostic criteria for hypersexual disorder , but it was not included in the main diagnostic criteria systems such as the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria .
The hypersexual behaviors were linked with the compulsive masturbation (56%), pornography use (51%) and extramarital sex (21%) in one study . It has been calculated that the prevalence of hypersexuality is approximately 2% among university students , 5% among American adults (a rough estimation) , 3.3% among adult outpatients , and 4.4% among adult psychiatric inpatients . On the other hand, there was a male preponderance (more than 60%) in people with hypersexuality [6, 8, 10]. Meanwhile, men reported more masturbation, sexual partners, and problematic cybersex than women did , while the hypersexual women were involved in more sexual risk behaviors, and more worries about physical pain and harm .
The exact etiology of hypersexuality is not fully known up to present. Some clinical-based models such as the neurobiological etiology [13, 14], addiction model , psychodynamic theory , and so on, have been proposed, but none of them presents a clear explanation for hypersexuality. Hypersexuality is also a common syndrome in other mental disorders such as bipolar disorder [17, 18], and hypersexual patients have more psychiatric comorbidity, including anxiety, substance use, mood and personality disorders [19, 20]. A recent study also revealed that compared to healthy individuals, hypersexual men had higher rates of impulsivity, attachment difficulties, affective disorders, and maladaptive emotion regulation strategies . Moreover, hypersexuality increased the risk of infectious diseases, such as the sexually transmitted diseases and the acquired immunodeficiency syndrome [22, 23].
There are many questionnaires targeting the measurement of hypersexuality from different angles . However, in these questionnaires, except for the Mood Disorder Questionnaire  and the Revised Mood and Sexuality Questionnaire , the number of items measuring hypersexuality responding to dysphoric mood and stress is either just one or none. The Internet Sex Screening Test  is a highly specialized one but it is just applied to evaluate problematic sexual behavior on the Internet. The Revised Mood and Sexuality Questionnaire  is also a highly content-specific one, which aims to assess the sex-related emotions and mood states. On the other aspect, the Sexual Addiction Screening Test [28, 29] is limited in a specific scope in heterosexual men, and it has a lower internal consistency in women . Overall, no single questionnaire offers a comprehensive measure of hypersexuality.
Based on the previous literature, we believe that the measure of hypersexuality includes the following aspects, and we have developed an item-matrix measuring hypersexuality of these aspects. Firstly, the negative impact of hypersexuality on individual’s life domain, for example the item that “My self-esteem has been negatively impacted by my sexual activities” is a simplification of the item “My self-respect, self-esteem, or self-confidence, has been negatively impacted by my sexual activities” in Hypersexual Behavior Consequences Scale . Secondly, the sex-related communication, for example that “I have used sexual jokes or implications when communicating with others”, which is similar with the item that “I use sexual humor and innuendo with others while online” in Internet Sex Screening Test . Thirdly, the abnormal sexual behavior, for example that “I have beat and kicked, or restrained my sexual partners”, which is included in Compulsive Sexual Behavior Inventory . Fourthly, the increased sexual interest and pornography consumption, for example that “I’m more interested in sex than usual”, which is included in Mood Disorder Questionnaire . Fifthly, the hypersexual behavior in response to stress and mood, for example that “I often use sex to cope with difficult feelings (e.g., worry, sadness, boredom, frustration, guilt, or shame)”, which is also included in Hypersexual Disorder Screening Inventory . Sixthly, cognition of hypersexuality, for example that “I feel that my sexual behaviors are not normal”, which is similar to the item “Do you ever feel your sexual behavior is not normal?” in Sexual Addiction Screening Test [28, 29]. Seventhly, the regret after the impulsive sexual behavior, for example that “When I feel anxious or stressed, I am likely to do something sexual that I regret later”, which is also included in Revised Mood and Sexuality Questionnaire .
For the development of a measure of hypersexuality in our study, we would like to use the exploratory factor analysis and the exploratory structural equation modeling (ESEM) procedures. The ESEM, as a confirmatory tool that integrates the best features of exploratory and confirmatory factor analysis, has more potential advantages than the confirmatory factor analysis, with more remarkable flexibility, better goodness of fit, and more accurate factor correlation, and it also has a wide applicability to clinical measure-research . In addition, the ESEM has been considered as more viable for plenty of items with a modest sample size . In the current study, we have hypothesized that: 1) the hypersexuality includes several aspects: awareness of hypersexual activity, increased sexual interest, increased pornography consumption, increased emotional-coping with sex, abnormal sexual behavior, negative consequences of hypersexual activity, and regret after impulsive sexual activity, and 2) male participants (university students) express higher levels of hypersexuality than their female counterparts.