Industrial Psychiatry Journal

LETTER TO EDITOR
Year
: 2022  |  Volume : 31  |  Issue : 2  |  Page : 380--381

Nymphomania with intellectual disability


Mini Sharma1, Manoj Kumar2, Sneha Gupta2,  
1 Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India
2 Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, New Delhi, India

Correspondence Address:
Dr. Mini Sharma
Department of Psychiatry, Lady Hardinge Medical College, New Delhi - 110 001
India




How to cite this article:
Sharma M, Kumar M, Gupta S. Nymphomania with intellectual disability.Ind Psychiatry J 2022;31:380-381


How to cite this URL:
Sharma M, Kumar M, Gupta S. Nymphomania with intellectual disability. Ind Psychiatry J [serial online] 2022 [cited 2023 Feb 9 ];31:380-381
Available from: https://www.industrialpsychiatry.org/text.asp?2022/31/2/380/349954


Full Text



A 30-year-old female married homemaker from an urban background of lower socio-economic status presented to the psychiatry outpatient department with the complaint of excessive sexual activity for the past 15 years which has led to significant dysfunction over the past 2–3 years. The patient attained menarche at age of 13 years, sexual knowledge at age of around 14 years from her peer group and became sexually active at age of 15 years. Over a year, she started having an increased desire to have sexual activity and would find it difficult to resist these desires which she acknowledges to be her desire. Failure to avail sexual gratification would lead to heaviness in the head and would experience immense pleasure after attaining orgasm, and has increased sexual desire which gradually had worsened over the years. Earlier she would require one orgasm per sexual intercourse at a frequency of 3–4 times per day to the level of the current frequency of 4–5 orgasms per sexual intercourse about 8–9 times a day. The patient would either be involved in masturbatory practices or would reach out to stranger males or would get involved with sex workers for fulfilling her sexual needs. She also had three medically assisted abortions as well due to a lack of ability to follow contraceptive practice by herself. Due to this, she started having frequent altercations with her spouse leading to significant social and interpersonal dysfunction, to an extend of legal proceedings of divorce with the spouse. There has been no history suggestive of other sexual perversions/paraphilias, obsessive–compulsive and related disorder, mood symptoms, psychotic symptoms, substance use, seizure disorder, hyperphagia, hypersomnia or emotional lability, or any other medical comorbidity in the patient.

The patient's mother had a history of exposure to anti-tubercular medications and related radiological testing during her pregnancy. The patient had a global delayed developmental milestone, poor scholastic performances, socially immature behavior; although, she was able to manage her activity of daily living and other gross household work on her own.

Her general physical examination was unremarkable. Her routine blood investigations including hormone profile-thyroid functions, Prolactin levels were found to be within the normal limits. Her urine drug screening was found to be negative for any substance. The patient was also found negative for sexually transmitted diseases (HIV, venereal disease research laboratory, Hepatitis B and C). Her neuroimaging studies (computed tomography head and magnetic resonance imaging brain) and electroencephalogram did not reveal any abnormality. On clinical assessment, a provisional impression of mild mental retardation with nymphomania was made and hence, formal testing was planned. On assessment using Vineland's social maturity scale, the patient had an social quotient score of 62 indicating mild intellectual impairment. While a score of 77 was noted on hypersexual behavior inventory (HBI)[1] (having a cut-off score of >59 for hypersexual behavior) suggestive of hypersexuality. The patient was diagnosed as per the International Classification of Diseases-10 (World Health Organization, 2007) to have mild mental retardation with no, or minimal, impairment of behavior (F70.0) with “excessive sexual drive” (nymphomania) (F52.7).

Nymphomania occurs as a part of an impulsive–compulsive behavior[2] that implicates reward systems similar to those of substance addictions, involving dopaminergic and endogenous opiate circuits.[2],[3] The behavioral problems in intellectual disability, are attributed to the neuronal dysmaturation in the frontal region.[4] In the index case, the sexual problem suggests that hypersexuality is a separate identity that needs evaluation apart from just being considered as a part of intellectual disability as evident from high scores on the HBI.

Ethics/consent

A shared decision of the patient and her family members was taken. An informed consent was taken from patient's family members (elder sister and mother; spouse (husband) didn't follow up due to conflict with the patient).

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Acknowledgment

Thankful to the patient.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Kühn S, Gallinat J. Neurobiological basis of hypersexuality. Int Rev Neurobiol 2016;129:67-83.
2Derbyshire KL, Grant JE. Compulsive sexual behavior: A review of the literature. J Behav Addict 2015;4:37-43.
3Zapf JL, Greiner J, Carroll J. Attachment styles and male sex addiction. Sex Addict Compulsivity 2008;15:158-75.
4Briken P, Habermann N, Berner W, Hill A. Diagnosis and treatment of sexual addiction: A survey among German sex therapists. Sex Addict Compulsivity J Treatment Prevention 2007;14:131-43.