SCIENTIFIC LETTER Primary hypersexuality: Nosological status, pathogenesis, and treatment

Hypersexuality is a psychopathological alteration frequently associated with various psychiatric and neurological symptoms.1,2 It sometimes becomes the main symptom that the patient presents, consequently acquiring the level of mental disorder. We present the case of a 16-year-old female adolescent referred to the Child and Adolescent Mental Health Centre in Mataró for assessment for sexual promiscuity. The patient reported fantasies and constant hypersexual activity since she was 15, with compulsive masturbation (3--4/day) and multiple sexual encounters (1--2/week) using prophylactics. Throughout this period, there was intermittent school absenteeism (she went to the park to run and voluntarily bumped into men). Likewise, she was incapable of maintaining a stable romantic relationship, with infidelities when she had a partner. She reported exacerbation of the hypersexual behaviour in the context of stress, indicating that there was a transitory relief from discomfort when an organism was reached. She stated that her selfesteem increased by feeling desired by many men. For several months, there has been a sensation of lack of control over these impulses, which motivated the application for treatment. Her birth and puerperium were without any incidences; standard development through the growth landmarks, with no delay in learning. Premature menarche (9 years old). She was described from infancy as a child who was ‘‘insecure and with low self-esteem’’. She indicated that, when she was 12, she suffered a sexual aggression with a penetration attempt from an unknown adult, which she did not tell anyone about because she felt ashamed. She reported that, after that, she exhibited symptomatology compatible with compatible PTSD until 14 years of age (nightmares, fear of the dark, flashbacks, situational avoidance, separation anxiety),