Abstract
The literature on hypersexual behavior following acquired brain injury consists of single or small case series with findings often difficult to reconcile, due to non-systematic, clinical descriptions of the behavior and its associated neurocognitive factors across authors. The objective of this study was to advance an understanding of the behavioral manifestations and neuropathology of acquired hypersexual behavior via literature review with an illustrative case study including pre- and post-onset neuropsychological test results. The case involved acquired hypersexual behavior with an increased ease of arousal manifested as constant verbal demands upon his wife, sexually explicit talk, and insatiable performance followed bithalamic strokes in a 44-year-old male. Neuropsychological testing showed a dense anterograde amnesia and less severe executive impairment. Co-occurring compulsive eating and anosognosia were also observed. The hypersexual behavior and compulsive eating were interpreted as resulting from a disconnection syndrome that separated mesiotemporal limbic structures from orbitofrontal control. It was not part of a generalized disinhibition, as the behaviors that showed a post-injury increase were highly specific. This is consistent with dual control theoretical models of human sexuality whereby the human sexual response involves an interaction between independent sexual excitatory and inhibitory processes. Many questions about acquired hypersexual behavior remain, especially why it so rarely occurs even in cases of bilateral orbitofrontal and temporal injury. A large-scale, multi-site, prospective study to measure prevalence within the overall context of acute frontotemporal injury, although practically difficult to organize, would be informative.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ahmed, R. M., Irish, M., Kam, J., van Keizerwaard, J., Bartley, L., Samaras, K., … Piquet, O. (2014). Quantifying the eating abnormalities in frontotemporal dementia. Journal of the American Medical Association: Neurology, 71(12), 1540–1546. https://doi.org/10.1001/jamaneurol.2014.1931.
Aichner, F. (1984). Phenomenology of the Klüver-Bucy syndrome in man. Fortschritte der Neurologie Psychiatrie, 52(11), 375–397. https://doi.org/10.1055/s-2007-1002207.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Anson, J. A., & Kuhlman, D. T. (1993). Post-ictal Klüver-Bucy syndrome after temporal lobectomy. Journal of Neurology, Neurosurgery, and Psychiatry, 56(3), 311–313. https://doi.org/10.1136/jnnp.56.3.311.
Army Individual Test Battery. (1944). Manual of directions and scoring. Washington, DC: War Department, Adjutant General’s Office.
Baird, A. D., Wilson, S. J., Bladin, P. F., Saling, M. M., & Reutens, D. C. (2007). Neurological control of human sexual behavior: insights from lesion studies. Journal of Neurology, Neurosurgery, and Psychiatry, 78(10), 1042–1049. https://doi.org/10.1136/jnnp.2006.107193.
Bakchine, S., Chain, F., & Lhermitte, F. (1983). Syndrome de Klüver-Bucy human complet après une encéphalite a herpes simplex tipe 2. Revue Neurologique, 142(2), 126–132.
Bancroft, J., Graham, C. A., Janssen, E., & Sanders, S. A. (2009). The dual control model: current status and future directions. Journal of Sex Research, 46(2–3), 121–142. https://doi.org/10.1080/00224490902747222.
Berlin, F. S. (2008). Basic science and neurobiological research: potential relevance to sexual compulsivity. Psychiatric Clinics of North America, 31(4), 623–642. https://doi.org/10.1016/j.psc.2008.07.003.
Black, B., Muralee, S., & Tampi, R. (2005). Inappropriate sexual behaviors in dementia. Journal of Geriatric Psychiatry and Neurobiology, 18(3), 155–162. https://doi.org/10.1177/0891988705277541.
Burns, J. M., & Swerdlow, R. H. (2003). Right orbitofrontal tumor with pedophilia and constructional apraxia sign. Archives of Neurology, 60(3), 437–440. https://doi.org/10.1001/archneur.60.3.437.
Cao, Y., Zhu, Z., Wang, R., Wang, S., & Zhao, J. (2010). Hypersexuality from resection of left occipital arteriovenous malformation. Neurosurgical Review, 33(1), 107–114. https://doi.org/10.1007/s10143-009-0232-2.
Caro, M. A., & Jimenez, X. F. (2016). Mesiotemporal disconnection and hypoactivity in Klüver- Bucy syndrome: case series and literature review. Journal of Clinical Psychiatry, 77(8), e982–e988. https://doi.org/10.4088/JCP.14r09497.
Chen, X. Y., Wang, Q., Wang, X., & Wong, K. S. (2017). Clinical features of thalamic stroke. Current Treatment Options in Neurology, 19(1), 1–10. https://doi.org/10.1007/s11940-017-0438-5.
Cipriani, G., Ulivi, M., Danti, S., Lucetti, C., & Nuti, A. (2016). Sexual disinhibition and dementia. Psychogeriatrics, 16(2), 145–153. https://doi.org/10.1111/psyg.12143.
Corkin, S. (1984). Lasting consequences of bilateral medial temporal lobectomy: clinical course and experimental findings in H.M. Seminars in Neurology, 4(2), 249–259. https://doi.org/10.1055/s-2008-1041556.
De Giorgi, R., & Series, H. (2016). Treatment of inappropriate sexual behavior in dementia. Current Treatment Options in Neurology, 18(9), 41. https://doi.org/10.1007/s11940-016-0425-2.
Delis, D. C., Kramer, J. H., Kaplan, E., & Ober, B. A. (2017). California verbal learning test –third edition. San Antonio: Pearson.
Devinsky, J., Sacks, O., & Devinsky, O. (2010). Klüver-Bucy syndrome, hypersexuality, and the law. Neurocase, 16(2), 140–145. https://doi.org/10.1080/13554790903329182.
Eghwrudjakpor, P. O., & Essien, A. A. (2008). Hypersexual behavior following craniocerebral trauma: an experience with five cases. Libyan Journal of Medicine, 3(4), 192–194. https://doi.org/10.3402/ljm.v3i4.4792.
Gasquoine, P. G. (2011). Cognitive impairment in common, non-central nervous system medical conditions of adults and the elderly. Journal of Clinical and Experimental Neuropsychology, 33(4), 486–496. https://doi.org/10.1080/13803395.2010.536759.
Gentilini, M., Renzi, E., & Crisi, G. (1987). Bilateral paramedian thalamic artery infarcts: report of eight cases. Journal of Neurology, Neurosurgery, and Psychiatry, 50(7), 900–909. https://doi.org/10.1136/jnnp.50.7.900.
Gerstenbrand, F., Poewe, W., Aichner, F., & Saltuari, L. (1983). Klüver-Bucy syndrome in man: experiences with posttraumatic cases. Neuroscience & Biobehavioral Reviews, 7(3), 413–417. https://doi.org/10.1016/0149-7634(83)90047-7.
Ghika-Schmid, F., Assal, G., De Tribolet, N., & Regli, F. (1995). Klüver-Bucy syndrome after left anterior temporal resection. Neuropsychologia, 33(1), 101–113. https://doi.org/10.1016/0028-3932(94)00097-9.
Gorman, D. G., & Cummings, J. L. (1992). Hypersexuality following septal injury. Archives of Neurology, 49(3), 308–310. https://doi.org/10.1001/archneur.1992.00530270128029.
Gościński, I., Kwiatkowski, S., Polak, J., & Orlowiejska, M. (1997). The Kluver-Bucy syndrome. Acta Neurochirurgica, 139(4), 303–306. https://doi.org/10.1007/BF01808825.
Guidotti, T. L., Charness, M. E., & Lamon, J. M. (1979). Acute intermittent porphyria and the Klüver-Bucy syndrome. Johns Hopkins Medical Journal, 145(6), 233–235.
Hayman, L. A., Dexer, J. L., Pavol, M. A., Strite, D., & Meyers, C. A. (1998). Klüver-Bucy syndrome after bilateral selective damage of amygdala and its cortical connections. Journal of Neuropsychiatry and Clinical Neurosciences, 10(3), 354–358. https://doi.org/10.1176/jnp.10.3.354.
Janati, A. (1985). Klüver-Bucy syndrome in Huntington’s chorea. Journal of Nervous and Mental Disease, 173(10), 632–635. https://doi.org/10.1097/00005053-198510000-00010.
Juliá-Palacious, N., Boronat, S., Delgado, I., Felipe, A., & Macaya, A. (2018). Pediatric Klüver- Bucy syndrome: report of two cases and review of the literature. Neuropediatrics, 49(2), 104–111. https://doi.org/10.1055/s-0037-1609036.
Kafka, M. P. (2014). What happened to hypersexual disorder? Archives of Sexual Behavior, 43(7), 1259–1261. https://doi.org/10.1007/s10508-014-0326-y.
Kaplan, M. S., & Krueger, R. B. (2010). Diagnosis, assessment, and treatment of hypersexuality. Journal of Sex Research, 47(2–3), 181–198. https://doi.org/10.1080/00224491003592863.
Kløve, H. (1963). Clinical neuropsychology. In F. M. Forster (Ed.), The medical clinics of North America (pp. 1647–1658). NY: Saunders.
Klüver, H., & Bucy, P. C. (1939). Preliminary analysis of functions of the temporal lobes in monkeys. Archives of Neurology and Psychiatry, 42(6), 979–1000. https://doi.org/10.1001/archneurpsyc.1939.02270240017001.
Lilly, R., Cummings, J. L., Benson, F., & Frankel, M. (1983). The human Klüver-Bucy syndrome. Neurology, 33(9), 1141–1145. https://doi.org/10.1212/WNL.33.9.1141.
Lin, H.-F., Yeh, Y.-C., Chen, C.-F., Chang, W.-C., & Chen, C.-S. (2011). Kluver-Bucy syndrome in one case with systemic lupus erythematosus. Kaohsiung Journal of Medical Sciences, 27(4), 159–162. https://doi.org/10.1016/j.kjms.2010.12.011.
Marlowe, W. B., Mancall, E. L., & Thomas, J. J. (1975). Complete Klüver-Bucy syndrome in man. Cortex, 11(1), 53–59. https://doi.org/10.1016/S0010-9452(75)80020-7.
Mendez, M., & Shapira, J. S. (2011). Pedophilic behavior from brain disease. Journal of Sexual Medicine, 8(4), 1092–1100. https://doi.org/10.1111/j.1743-6109.2010.02172.x.
Mendez, M., & Shapira, J. S. (2013). Hypersexual behavior in frontotemporal dementia: a comparison with early-onset Alzhemier’s disease. Archives of Sexual Behavior, 42(3), 501–509. https://doi.org/10.1007/s10508-012-0042-4.
Miller, B. L., Cummings, J. L., McIntyre, H., Ebers, G., & Grode, M. (1986). Hypersexuality or altered sexual preference following brain injury. Journal of Neurology, Neurosurgery, and Psychiatry, 49(8), 867–873. https://doi.org/10.1136/jnnp.49.8.867.
Mitrushina, M., Boone, K. B., Razani, J., & D’Elia, L. F. (2005). Handbook of normative data for neuropsychological assessment (2nd ed.). NY: Oxford University Press.
Monga, T. N., Monga, M., Raina, M. S., & Hardjasudarma, M. (1986). Hypersexuality in stroke. Archives of Physical Medicine and Rehabilitation, 67(6), 415–417.
Müller, A., Baumgartner, R. W., Röhrenback, C., & Regard, M. (1999). Persistent Klüver-Bucy syndrome after bilateral thalamic infarctions. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 12(1), 136–139.
Mutarelli, E. G., Omuro, A. M. P., & Adoni, T. (2006). Hypersexuality following bilateral thalamic infarctions: case report. Arquivos de Neuro-Psiquiatria, 64(1), 146–148. https://doi.org/10.1590/S0004-282X2006000100032.
Nielssen, O. B., Cook, R. J., Joffe, R., Meagher, L. J., & Silberstein, P. (2009). Paraphilia and other disturbed behavior associated with dopamimetic treatment for Parkinson’s disease. Movement Disorders, 24(7), 1091–1092. https://doi.org/10.1002/mds.22388.
Obrador, S. (1947). Temporal lobectomy. Journal of Neuropathology & Experimental Neurology, 6(2), 185–193. https://doi.org/10.1097/00005072-194704000-00008.
Oliveira, V., Ferro, J. M., Foreid, J. P., Costa, T., & Levy, A. (1989). Klüver-Bucy syndrome in systemic lupus erythematosus. Journal of Neurology, 236(1), 55–56. https://doi.org/10.1007/BF00314220.
Papez, W. J. (1937). A proposed mechanism of emotion. Archives of Neurology and Psychiatry, 38(4), 725–743. https://doi.org/10.1001/archneurpsyc.1937.02260220069003.
Powers, J. M., Schaumburg, H. H., & Gaffney, C. L. (1980). Klüver-Bucy syndrome caused by adreno-leukodystrophy. Neurology, 30(11), 1131–1132. https://doi.org/10.1212/WNL.30.11.1231.
Reid, R. C., Carpenter, B. N., Hook, J. N., Garos, S., Manning, J. C., Gilliland, R., et al. (2012). Report of findings in a DSM-5 field trial for hypersexual disorder. Journal of Sexual Medicine, 9(11), 2868–2877. https://doi.org/10.1111/j.1743-6109.2012.02936.x.
Sandson, T. A., Lilly, R. B., & Sodkol, M. (1988). Klüver-Bucy syndrome associated with delayed post-anoxic leucoencephalopathy following carbon monoxide poisoning. Journal of Neurology, Neurosurgery, and Psychiatry, 51(1), 156–157. https://doi.org/10.1136/jnnp.51.1.156.
Schmahmann, J. D. (2003). Vascular syndromes of the thalamus. Stroke, 34(9), 2264–2278. https://doi.org/10.1161/01.STR.0000087786.38997.9E.
Scoville, W. B., Dunsmore, R. H., Liberson, W. T., Henry, C. E., & Pepe, A. (1953). Observations on medial temporal lobectomy and uncotomy in the treatment of psychotic states. Research Publications of the Association for Research in Nervous and Mental Disease, 31, 347–369.
Shraberg, D., & Weisberg, L. (1978). The Klüver-Bucy syndrome in man. Journal of Nervous and Mental Disease, 166(2), 130–134. https://doi.org/10.1097/00005053-197802000-00008.
Skegg, K., Nada-Raja, S., Dickson, N., & Paul, C. (2010). Perceived “out of control” sexual behavior in a cohort of young adults from the Dunedin Multidisciplinary Health and Development Study. Archives of Sexual Behavior, 39(4), 968–978. https://doi.org/10.1007/s10508-009-9504-8.
Spreen, O., & Benton, A. L. (1977). Neurosensory center comprehensive examination for aphasia. Victoria: Neuropsychology Laboratory, University of Victoria.
Terzian, H., & Dalle Ore, G. (1955). Syndrome of Klüver and Bucy: reproduced in man by bilateral removal of the temporal lobes. Neurology, 5(6), 373–380. https://doi.org/10.1212/WNL.5.6.373.
Torrisi, M., Caccciola, A., Marra, A., De Luca, R., Bramanti, P., & Calabro, R. S. (2017). Inappropriate behaviors and hypersexuality in individuals with dementia: an overview of a neglected issue. Geriatrics & Gerontology International, 17(6), 865–874. https://doi.org/10.1111/ggi.12854.
Vitale, C., Santangelo, G., Trojano, L., Verde, F., Rocco, M., Grossi, D., & Barone, P. (2011). Comparative neuropsychological profile if pathological gambling, hypersexuality, and compulsive eating in Parkinson’s disease. Movement Disorders, 26(5), 830–836. https://doi.org/10.1002/mds.23567.
Voon, V., Hassan, K., Zurowski, M., de Souza, M., Thomson, T., Fox, S., et al. (2006). Prevalence of repetitive and reward-seeking behaviors in Parkinson disease. Neurology, 67(7), 1254–1257. https://doi.org/10.1212/01.wnl.0000238503.20816.13.
Wallace, M., & Safer, M. (2009). Hypersexuality among cognitively impaired older adults. Geriatric Nursing, 30(4), 230–237. https://doi.org/10.1016/j.gerinurse.2008.09.001.
Walton, M. T., Cantor, J. M., Bhullar, N., & Lykins, A. D. (2017). Hypersexuality: a critical review and introduction to the “sexhavior cycle”. Archives of Sexual Behavior, 46(8), 2231–2251. https://doi.org/10.1007/s10508-017-0991-8.
Wechsler, D. (1987). Wechsler memory scale-revised. San Antonio: Psychological Corporation.
Wechsler, D. (1999). Wechsler abbreviated scale of intelligence. San Antonio: Psychological Corporation.
Womack, S. D., Hook, J. N., Ramos, M., Davis, D. E., & Penberty, J. K. (2013). Measuring hypersexual behavior. Sexual Addiction & Compulsivity, 20(1–2), 65–78. https://doi.org/10.1080/10720162.2013.768126.
World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: Author.
World Health Organization. (2018). International statistical classification of diseases and related health problems (11th Revision). Retrieved from https://icd.who.int/browse11/l-m/en
Zuckerman, M., & Lubin, B. (1985). Manual for the MAACL-R: the Multiple Affect Adjective Checklist – Revised. San Diego: Educational and Industrial Testing Service.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The patient’s guardian consented to the use of all the data included in this manuscript that is reported in compliance with the Helsinki Declaration.
Conflict of Interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Gasquoine, P.G. Case Study on the Neuropsychology of Hypersexual Behavior. Act Nerv Super 62, 88–95 (2020). https://doi.org/10.1007/s41470-020-00068-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s41470-020-00068-y