Hyposexual Desire Disorder: Understanding a Common but Often Overlooked Issue
Monday, September 2, 2024.
Hyposexual Desire Disorder (HSDD) might sound like a mouthful, but at its core, it's about something many people can relate to—a persistent lack of interest in sex.
It’s not just about having an “off week” or feeling stressed; it’s when this lack of desire becomes a pattern that causes personal distress or strains a relationship.
HSDD can affect anyone, though it’s more often reported by women. Unlike its antithesis, hypersexuality, It’s recognized as a legitimate medical condition and is something worth talking about openly.
What Exactly is Hyposexual Desire Disorder?
HSDD is a type of sexual dysfunction that specifically relates to a low or absent sexual desire. Unlike other sexual issues that might involve problems with arousal, orgasm, or physical discomfort during sex, HSDD is purely about a lack of interest in sexual activity.
For it to be considered a disorder, this low desire has to be ongoing and causing real distress for the person experiencing it. It’s not about avoiding sex because of a rough patch in a relationship or due to other life stressors—HSDD runs deeper than that.
Related Terms You Might Hear
Female Sexual Interest/Arousal Disorder (FSIAD): This is a diagnosis that combines what we used to call HSDD and female arousal disorder. It reflects how closely desire and arousal are linked, especially for women.
Sexual Dysfunction: This is a broad term for various issues that prevent people from enjoying sex the way they want to. HSDD is one specific type of sexual dysfunction.
Sexual Inhibition: Some people are naturally more inhibited when it comes to sex, and this can play a role in conditions like HSDD.
Psychogenic vs. Organic Causes: HSDD can have roots in psychological factors (like stress or anxiety) or organic factors (like hormone imbalances). Figuring out the cause is key to finding the right treatment.
What Does the Research Say?
There’s a lot of research out there about HSDD, and it’s clear that this isn’t just about someone “not being in the mood.” Here’s a look at some of the key findings:
The Role of Mental Health: Studies have shown that mental health issues like anxiety, depression, and past trauma can play a big role in sexual desire.
For example, Derogatis and Burnett (2008) found that these psychological factors can not only contribute to HSDD but sometimes even be the main cause. This tells us that treating HSDD often requires looking at the whole person, not just their sex life.
Cultural and Social Influences: Society and culture have a big impact on how we feel about sex and, by extension, our sexual desire. Brotto et al. (2016) explored how cultural norms and media portrayals of sexuality can shape our desires.
In some cultures, there’s a lot of pressure to conform to specific sexual expectations, which can create internal conflict and contribute to HSDD.
Relationships Matter: Unsurprisingly, the quality of a person’s relationship can have a big impact on their sexual desire.
Research by McCabe and Goldhammer (2012) found that couples who struggle with communication or who are experiencing emotional distance are more likely to have issues with desire. HSDD isn’t just about the individual; it’s often about the relationship too.
Hormonal and Biological Factors: While social and psychological factors are crucial, hormones also play a big part.
Kingsberg and Woodard (2015) highlighted how changes in hormone levels, like those that occur during menopause or due to certain medical conditions, can lead to a decrease in sexual desire. For some people, hormone therapy or other medical treatments might be necessary to address the biological aspects of HSDD.
How is HSDD Treated?
Treating HSDD usually involves a combination of approaches. Cognitive-behavioral therapy (CBT) can be really effective in helping people change negative thought patterns and improve their sexual relationships.
In some cases, medications like flibanserin (often called “female Viagra”) might be prescribed, especially for premenopausal women. It’s important to remember that treatment is very individual—what works for one person might not work for another.
Hypo Sexual Desire Disorder: The Deep Connection with Childhood Sexual Abuse and Developmental Trauma
Hypo Sexual Desire Disorder (HSDD) isn’t just about a lack of interest in sex; it’s often a window into deeper, more complex issues rooted in a person’s past.
One of the most significant and painful connections to HSDD is the history of childhood sexual abuse and developmental trauma. Understanding this connection is crucial for those working through HSDD, as it often reveals underlying emotional and psychological wounds that need to be addressed.
Understanding the Impact of Childhood Sexual Abuse on Adult Sexual Desire
Childhood sexual abuse can have profound and long-lasting effects on an individual's emotional and psychological well-being.
Survivors often carry the scars of their trauma into adulthood, which can manifest in various ways, including in their sexual lives. Research shows that survivors of childhood sexual abuse are at a higher risk of developing sexual dysfunctions, including HSDD.
The Trauma Response and Sexual Desire
When a child experiences sexual abuse, their developing brain is overwhelmed with stress and fear. This trauma can alter the way the brain processes emotions, relationships, and physical sensations, leading to what is often referred to as a "trauma response."
This response is the body's way of protecting itself from further harm but can result in long-term consequences like HSDD.
Avoidance and Emotional Numbing: Survivors of childhood sexual abuse may develop avoidance behaviors as a coping mechanism. This can include avoiding sexual activity altogether, as it may trigger memories or feelings related to the abuse. Over time, this avoidance can become ingrained, leading to a chronic lack of sexual desire.
Emotional numbing, another common trauma response, can also contribute to a reduced ability to feel pleasure or desire in any aspect of life, including sex.
Dissociation: Dissociation is another common response to trauma, where individuals mentally “check out” during stressful situations. For survivors of childhood sexual abuse, dissociation can become a way of coping during sexual activity, which can severely impact their ability to engage fully and enjoy sex. This disconnection can lead to a decrease in sexual desire over time, contributing to HSDD.
Shame and Guilt: Many survivors of childhood sexual abuse carry intense feelings of shame and guilt, often feeling responsible for what happened to them.
These feelings can become deeply embedded and affect their self-worth and view of sexuality. For some, the idea of sex becomes associated with these negative emotions, leading to a desire to avoid sexual activity, which can develop into HSDD.
Developmental Trauma and Its Role in HSDD
Developmental trauma refers to chronic, prolonged exposure to stress or abuse during the formative years of a child’s life. Unlike single-event trauma, developmental trauma can be pervasive and impact multiple areas of functioning, including emotional regulation, attachment, and identity formation.
Attachment Issues: Children who experience developmental trauma often have disrupted attachment patterns, particularly if the trauma involved a caregiver.
These attachment issues can persist into adulthood, making it difficult for individuals to form healthy, secure relationships. In the context of HSDD, insecure attachment can manifest as a fear of intimacy, difficulty trusting partners, or a tendency to withdraw from close relationships—all of which can diminish sexual desire.
Emotional Dysregulation: Developmental trauma can impair a person’s ability to manage their emotions effectively.
Survivors may struggle with anxiety, depression, or mood swings, all of which can negatively impact sexual desire. For instance, chronic anxiety might make it difficult for someone to relax and feel aroused, while depression can drain the energy and motivation needed for sexual activity.
Identity and Self-Worth: Developmental trauma can also interfere with the formation of a positive self-identity.
Survivors may struggle with feelings of inadequacy, worthlessness, or self-loathing, which can manifest in a negative relationship with their own body and sexuality. These feelings can lead to a disinterest in sex or a belief that they are not worthy of a fulfilling sexual relationship, contributing to HSDD.
Research Findings on the Connection Between Childhood Trauma and HSDD
Numerous studies have explored the link between childhood sexual abuse, developmental trauma, and sexual desire in adulthood.
A comprehensive review by Najman et al. (2005) found that women who reported a history of childhood sexual abuse were significantly more likely to experience sexual dysfunctions, including low sexual desire, compared to those without such a history.
This research emphasizes the lasting impact of childhood trauma on adult sexual health.
In another study, Rellini (2008) highlighted how women with a history of sexual abuse often experience lower sexual desire due to their struggles with emotional regulation and intimacy.
The study also noted that these women are more likely to report difficulties in their sexual relationships, further complicating their sexual desire.
Therapeutic Approaches to Addressing HSDD Linked to Trauma
When HSDD is connected to a history of childhood sexual abuse or developmental trauma, treatment needs to be sensitive to these underlying issues. Trauma-informed therapy, which prioritizes the safety, empowerment, and healing of the trauma survivor, is often recommended.
Cognitive-Behavioral Therapy (CBT): CBT can help folks reframe negative thoughts related to their trauma and sexuality, gradually reducing avoidance behaviors and increasing sexual desire.
Eye Movement Desensitization and Reprocessing (EMDR): EMDR is a therapeutic approach specifically designed to help individuals process and integrate traumatic memories, which can reduce the emotional charge of these memories and help restore healthy sexual desire.
However, research by Bessel van der Kolk suggests that 66% of patients with Developmental Trauma either fail to improve, or actually get worse. I find it frankly astonishing how casually the EMDR community of practice has engaged with this research.
Frankly, much of the research on EMDR is sloppy. It would not considered to be a first line intervention for Hyposexual Desire Disorder.
Somatic Experiencing: This therapy focuses on helping folks reconnect with their bodies and physical sensations in a safe and controlled way. It can be particularly helpful for those who experience dissociation or numbing as part of their trauma response.
Science-based Couples Therapy: For those in relationships, couples therapy can be an effective way to address the impact of trauma on the relationship and work on rebuilding intimacy and sexual desire.
Final thoughts
Hypo Sexual Desire Disorder is often more than just a lack of interest in sex—it can be a manifestation of deeper, unresolved trauma from childhood sexual abuse or developmental trauma.
There is a profound impact from these early experiences.
It can have on adult sexual desire, therapists and folks alike can approach HSDD with greater empathy and effectiveness.
Healing from HSDD often involves addressing these root causes and working through the trauma that underlies the disorder.
Be Well, Stay Kind, and Godspeed.
REFERENCES:
Brotto, L. A., Krychman, M., & Katz, A. (2016). Sexual desire and arousal disorders in women. BMJ, 352, i385. https://doi.org/10.1136/bmj.i385
Derogatis, L. R., & Burnett, A. L. (2008). The epidemiology of sexual dysfunctions. Journal of Sexual Medicine, 5(2), 289-300. https://doi.org/10.1111/j.1743-6109.2007.00668.x
Kingsberg, S. A., & Woodard, T. (2015). Female sexual dysfunction: Focus on hypoactive sexual desire disorder. Therapeutic Advances in Urology, 7(2), 45-60. https://doi.org/10.1177/1756287214566421
McCabe, M. P., & Goldhammer, D. L. (2012). Relationship factors in women with hypoactive sexual desire disorder. Sexual and Relationship Therapy, 27(3), 225-236. https://doi.org/10.1080/14681994.2012.719826
Najman, J. M., Dunne, M. P., Purdie, D. M., Boyle, F. M., & Coxeter, P. D. (2005). Sexual abuse in childhood and sexual dysfunction in adulthood: An Australian population-based study. Archives of Sexual Behavior, 34(5), 517-526. https://doi.org/10.1007/s10508-005-6277-6
Rellini, A. H. (2008). Sexual desire and sexual arousal problems in women reporting a history of childhood sexual abuse. Journal of Sexual Medicine, 5(4), 1017-1028. https://doi.org/10.1111/j.1743-6109.2008.00768.x
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