Recent research from functional MRI scans appear to show hypersexuality and “sex addicts” just have high desire.
This is something I’ve expected. They may not even have a lot of sex, but a lot of desire, which keeps them preoccupied with sexual thoughts. This seems a valuable piece of research and I hope to read the original paper to find out more.
My own experience over 30 years working with gay and bisexual men who present for help with “sexual addiction” is that they client’s are generally low on education and information about normative sexual behaviour and drives and very sex negative, or feel shame about their thoughts or behaviours or others tell them they are obsessed or ‘addicted’ then they may internalise this ‘diagnosis’ and consider themselves negatively. These people often come from religions which take a highly moralising view of what is healthy and what is sinful
One of the reasons why group work is a positive approach to sexual compulsivity is that it can show the range of ideas and sex negativity and people can realise there is a spectrum of behaviour and obtain some information about what is healthy and understand more about themselves.
Where sexual behaviour gets out of control, this is usually a symptom of some other distress and focussing solely on the sexual behaviour can deflect attention away from responding to the underlying trauma or more serious mental health difficulties.