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DESCRIPTION: Phases of intense desire and phases devoid of any desire: in AuDHS, both are often found in the same person. What research on ADHD and autism reveals, and what is missing from it.

AuDHS and Sexuality

One moment, sexuality, masturbation or pornography provide daily relief. Then, often for no apparent reason, the opposite takes hold: touch feels overwhelming, desire is absent, and sexuality seems alien. Many people with AuDHS – the combination of autism and ADHD – describe this back-and-forth. Hardly anyone talks about it, because both extremes are stigmatised: one as ‘too much’, the other as ‘broken’.

Hypersexuality and sexual withdrawal are often two phases in AuDHS. Anyone who labels them separately – as a disorder on the one hand and as an orientation on the other – loses sight of the connection. This connection is the pendulum.

The pendulum is an observation. No study has yet examined it as a developmental trajectory in AuDHS. It is based on the self-reports of many affected individuals and on research into ADHD and autism, each of which highlights one pole.

What research on ADHD, autism and sexuality shows

ADHD: increased sexual desire, rarely clinical

A systematic review of sexuality in ADHD found greater sexual desire, more frequent masturbation, lower sexual satisfaction and more sexual dysfunction than in the general population (Soldati et al., 2020, Journal of Sexual Medicine).

When broken down by severity, the picture becomes clearer. In a German online survey (Hertz et al., 2022) involving 139 people with ADHD (89 women, 44 men, 6 non-binary) and 67 control participants, the total score on the Hypersexual Behaviour Inventory (HBI-19) was significantly higher in the ADHD group (mean 40.4 versus 32.5). 24.5% of the ADHD group and 14.9% of the control group scored above the clinical cut-off (≥ 53). This difference was not statistically significant (Hertz et al., 2022, Frontiers in Psychiatry). The authors refer to this as increased hypersexuality at a subclinical level. The study is based on self-report data and recruitment via forums and social media; the control group comprised only 21 men; and medication use was not analysed in a differentiated manner.

One finding relating to women is particularly revealing. Among women with ADHD, affective lability, irritability and impulsivity were associated with the total HBI score (r ≈ 0.33) and with the subscale ‘Sexuality as a means of coping with unwanted feelings and stress’ (r ≈ 0.27). This was not observed in men (Hertz et al., 2022). Here, sexuality appears to function as a means of regulation rather than as an independent drive.

Conversely, ADHD is overrepresented among people diagnosed with hypersexuality. A meta-analysis of seven studies involving a total of 730 patients estimated the prevalence of ADHD in this group at 22.6 per cent (95 per cent confidence interval 17 to 29.4, high heterogeneity) (Korchia et al., 2022, European Archives of Psychiatry and Clinical Neuroscience). By contrast, an older systematic review found no clear evidence that hypersexuality occurs more frequently in ADHD groups, citing small sample sizes and inconsistent measurement tools (Soldati et al., 2021, Psychiatry Research).

A narrative review from 2025 notes that sexual dysfunction in ADHD is inconsistent and encompasses both hypersexuality and hyposexuality (Puszcz et al., 2025, Cureus). It does not investigate whether the same individuals fluctuate between these two extremes.

Autism: less interest, more non-heterosexuality

A systematic review of 17 autism and 19 ADHD studies reports ‘sexual ambivalence’ amongst autistic people, as well as more frequent homo-, bi- and asexual interest. In one of the included studies, 29.4 per cent of autistic participants, compared with 9.6 per cent of neurotypical participants, reported thinking about sex ‘never or rarely’ (Young & Cocallis, 2023, Neuropsychiatric Disease and Treatment). Sensory hypersensitivity and hyposensitivity are considered possible contributing factors: touch can become unpleasant, and arousal and orgasm can be more difficult to achieve. The review itself did not investigate this.

George and Stokes surveyed 309 autistic and 310 non-autistic adults online. In the autistic group, 69.7 per cent identified as non-heterosexual, compared with 30.3 per cent in the control group, with higher rates of homosexuality, bisexuality and asexuality (George & Stokes, 2018, Autism Research).

The gap

There is literature on the individual phenomena. It is missing in three areas:

AuDHS as a distinct group. Young and Cocallis report on ADHD and autism studies separately. None of the 36 included studies specifically examines this combination (Young & Cocallis, 2023).
The course of an individual’s condition. Cross-sectional studies show whether, on average, a group experiences more or less craving. Whether an individual shifts between phases remains unclear. The authors themselves call for longitudinal and qualitative research.
Opposing averages. ADHD traits tend to increase craving, whilst autistic traits tend to reduce it. In an AuDHS group, this may cancel each other out statistically. An average of ‘normal’ can mask this seesaw effect.

The pendulum

The pendulum describes a continuum with two poles.

Pole 1: Sexuality as dopamine-seeking and relief

· Stimulus seeking: Sexual arousal provides intense, reliable and readily available stimulation. During periods of understimulation, it becomes one of the most effective remedies for inner emptiness and restlessness (more on this under ‘Stimulus seeking and stimulus openness in AuDHS’).

· Emotional regulation: The link between affective lability and the coping subscale in Hertz et al. is consistent with a function of relieving tension following overload.

· Hyperfocus: Sexuality can temporarily become a special interest, with the typical exclusivity and subsequent waning. Puszcz et al. cite hyperfocus and shifting interests as possible influences.

Pole 2: Withdrawal as protection from stimuli

· Sensory saturation: Following periods of sensory overload – whether work-related, social or sexual – physical contact becomes an additional stimulus.

· Masking exhaustion: Intimacy requires constant attunement to a partner. Those who wear a mask constantly in everyday life lack the capacity for this during periods of exhaustion (more on this under ‘Masking in AuDHS’).

· Shift in interests: Once hyperfocus subsides, the subject can abruptly lose all meaning. The capacity to desire remains intact.

Why dopamine alone is not enough

Popular accounts often explain ADHD hypersexuality as a ‘dopamine craving’. Puszcz et al. review this hypothesis and the related self-medication hypothesis, and consider the evidence to be patchy: small sample sizes, inconsistent measures, and a lack of gender-disaggregated analyses. Furthermore, a single neurotransmitter does not account for the opposite extreme. The pendulum requires three dimensions: the need for stimulation, the processing of stimulation, and the capacity a person currently has to regulate it.

Two labels

1: Compulsive sexual behaviour disorder (ICD-11 6C72)

The ICD-11 classifies compulsive sexual behaviour disorder under impulse control disorders. The criteria require a persistent pattern of lack of control over intense sexual impulses over an extended period (for example, six months or more), as well as significant distress or impairment in daily life. Distress arising solely from moral disapproval is not sufficient (WHO, ICD-11, 6C72).

This raises two questions in the context of AuDHS. The first concerns duration: a course of the condition involving long periods of withdrawal may not fulfil the criterion of a persistent pattern, and focusing solely on the hypersexual phase amounts to a snapshot diagnosis. The second concerns the better explanation: if the behaviour can be understood as a regulatory strategy in AuDHS, the focus should be on stimulus regulation and affect control rather than on sexuality itself. People with AuDHS may have a compulsive sexual behaviour disorder . The diagnosis must then take the timeline into account.

2: Orientation label for withdrawal

Asexuality is a sexual orientation. It is more common amongst autistic people (George & Stokes, 2018).

The problem arises when a state is interpreted as an orientation. An orientation describes a relatively stable pattern of sexual attraction. Withdrawal during a phase of exhaustion, on the other hand, usually concerns desire and behaviour. The distinction between attraction, desire and behaviour is crucial here (more on this under ‘Sexual Attraction’).

Labels such as ‘nebulasexual’, which describe an elusive experience of attraction linked to neurodiversity, can provide relief and give voice to these experiences. It becomes difficult, however, when a label fixes a particular phase in place and the next phase is experienced as a betrayal of one’s own identity.

The common problem

Both labels isolate a specific part of a continuum: one turns it into a disorder, the other into an identity. Both reinforce shame as soon as the opposite pole emerges.

Shame as an amplifier

Shame has two faces in AuDHS.

· Hypersexual phase: shame about loss of control, the time spent and the nature of the behaviour, plus keeping it secret from partners and doctors.

· Withdrawal phase: Shame about ‘failure’ in the relationship, about a lack of intimacy and fear of jeopardising the partnership.

Concealment prevents the connection from becoming apparent. In medical histories, two separate complaints then emerge, or none at all. In relationships, it is easy to confuse this pendulum effect with attachment patterns: shifts between closeness and distance, which depend on stimuli, are then regarded as an avoidant attachment style. Both may be present. It is worth making the distinction.

Stimulants: Does methylphenidate affect sexuality?

Medication alters sexuality in both directions. Puszcz et al. report adverse effects associated with methylphenidate and, in one study, increased subjective arousal; for atomoxetine, they report primarily reduced libido and erectile dysfunction. They describe the available data as limited. The assumption that hypersexuality is merely a side effect of stimulants does not explain the cases observed in untreated individuals (ibid.).

The start of medication, dose adjustments and drug levels throughout the day should form part of every observation of the pendulum and be discussed with the prescribing doctor.

Monitoring the pendulum

Anyone who suspects they are experiencing the ‘pendulum’ effect can make it visible. Over a period of several months, sexual desire, exposure to sexual stimuli, sleep, social exhaustion and medication can be recorded; the menstrual cycle can also be noted if necessary. The notes reveal whether there is a connection between these phases. It helps to ask whether there has been a change in who one finds attractive, or simply whether one currently has the capacity for it. And to ask what purpose sexuality serves at the moment: pleasure, the release of tension, or the intake of stimulation.

A label may be provisional. If you lose control or if it affects your relationships, work or health, it is worth seeking support through sex therapy, couples therapy or psychotherapy from practitioners with experience of neurodiversity.

Conclusion

Research into ADHD and sexuality, and into autism and sexuality, is limited but does exist. What is lacking is a focus on people who have both conditions, and on how these develop over weeks and months. As long as this perspective is missing, the pendulum remains split between two categories: disorder and identity. The pendulum shows that these two poles belong together and helps to alleviate some of the stigma associated with them.

Key points in brief

• Many people with AuDHS experience phases of intense desire and phases without desire. Both are part of the same continuum.

• ADHD is associated with greater sexual desire, usually at a subclinical level. Autism is associated with less interest in sex and a higher prevalence of non-heterosexuality.

• No study has examined AuDHS as a distinct group or the course of an individual’s condition. Opposing mean values may mask a pendulum effect on average.

• Pole 1 is sexuality as a source of stimulation and release; Pole 2 is withdrawal as a means of protection from stimulation.

• The diagnosis of compulsive sexual behaviour disorder requires a persistent pattern. An orientation label describes attraction, not a state of exhaustion.

• Shame obscures the connection. Medication influences sexuality in both directions.

Sources

· George, R. & Stokes, M. A. (2018): Sexual orientation in autism spectrum disorder. Autism Research, 11(1), 133–141. doi.org/10.1002/aur.1892

· Hertz, P. G., Turner, D., Barra, S., Biedermann, L., Retz-Junginger, P., Schöttle, D. & Retz, W. (2022): Sexuality in adults with ADHD: Results of an online survey. Frontiers in Psychiatry, 13, 868278. doi.org/10.3389/fpsyt.2022.868278

· Korchia, T., Boyer, L., Deneuville, M., Etchecopar-Etchart, D., Lancon, C. & Fond, G. (2022): ADHD prevalence in patients with hypersexuality and paraphilic disorders: A systematic review and meta-analysis. European Archives of Psychiatry and Clinical Neuroscience, 272(8), 1413–1420. doi.org/10.1007/s00406-022-01421-9

· Puszcz, A., Platnikow, M., Antos, Z., Czech, M. & Kipka, A. (2025): Sexual functioning in individuals with attention-deficit hyperactivity disorder: A narrative review. Cureus, 17(11), e97194. doi.org/10.7759/cureus.97194

· Soldati, L., Bianchi-Demicheli, F., Schockaert, P., Koehl, J. C., Bolmont, M., Hasler, R. & Perroud, N. A. (2020): Sexual function, sexual dysfunctions, and ADHD: A systematic literature review. Journal of Sexual Medicine, 17(9), 1653–1664. doi.org/10.1016/j.jsxm.2020.03.019

· Soldati, L., Bianchi-Demicheli, F., Schockaert, P., Koehl, J. C., Bolmont, M., Hasler, R. & Perroud, N. A. (2021): Association of ADHD with hypersexuality and paraphilias. Psychiatry Research, 295, 113638. doi.org/10.1016/j.psychres.2020.113638

· World Health Organisation (2019/2022): ICD-11, 6C72 Compulsive sexual behaviour disorder. icd.who.int

· Young, S. & Cocallis, K. (2023): A systematic review of the relationship between neurodiversity and psychosexual functioning in individuals with autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD). Neuropsychiatric Disease and Treatment, 19, 1379–1395. doi.org/10.2147/NDT.S319980

AuDHS and Sexuality

One moment, sexuality, masturbation or pornography provide daily relief. Then, often for no apparent reason, the opposite takes hold: touch feels overwhelming, desire is absent, and sexuality seems alien. Many people with AuDHS – the combination of autism and ADHD – describe this back-and-forth. Hardly anyone talks about it, because both extremes are stigmatised: one as ‘too much’, the other as ‘broken’.

Hypersexuality and sexual withdrawal are often two phases in AuDHS. Anyone who labels them separately – as a disorder on the one hand and as an orientation on the other – loses sight of the connection. This connection is the pendulum.

The pendulum is an observation. No study has yet examined it as a developmental trajectory in AuDHS. It is based on the self-reports of many affected individuals and on research into ADHD and autism, each of which highlights one pole.

What research on ADHD, autism and sexuality shows

ADHD: increased sexual desire, rarely clinical

A systematic review of sexuality in ADHD found greater sexual desire, more frequent masturbation, lower sexual satisfaction and more sexual dysfunction than in the general population (Soldati et al., 2020, Journal of Sexual Medicine).

When broken down by severity, the picture becomes clearer. In a German online survey (Hertz et al., 2022) involving 139 people with ADHD (89 women, 44 men, 6 non-binary) and 67 control participants, the total score on the Hypersexual Behaviour Inventory (HBI-19) was significantly higher in the ADHD group (mean 40.4 versus 32.5). 24.5% of the ADHD group and 14.9% of the control group scored above the clinical cut-off (≥ 53). This difference was not statistically significant (Hertz et al., 2022, Frontiers in Psychiatry). The authors refer to this as increased hypersexuality at a subclinical level. The study is based on self-report data and recruitment via forums and social media; the control group comprised only 21 men; and medication use was not analysed in a differentiated manner.

One finding relating to women is particularly revealing. Among women with ADHD, affective lability, irritability and impulsivity were associated with the total HBI score (r ≈ 0.33) and with the subscale ‘Sexuality as a means of coping with unwanted feelings and stress’ (r ≈ 0.27). This was not observed in men (Hertz et al., 2022). Here, sexuality appears to function as a means of regulation rather than as an independent drive.

Conversely, ADHD is overrepresented among people diagnosed with hypersexuality. A meta-analysis of seven studies involving a total of 730 patients estimated the prevalence of ADHD in this group at 22.6 per cent (95 per cent confidence interval 17 to 29.4, high heterogeneity) (Korchia et al., 2022, European Archives of Psychiatry and Clinical Neuroscience). By contrast, an older systematic review found no clear evidence that hypersexuality occurs more frequently in ADHD groups, citing small sample sizes and inconsistent measurement tools (Soldati et al., 2021, Psychiatry Research).

A narrative review from 2025 notes that sexual dysfunction in ADHD is inconsistent and encompasses both hypersexuality and hyposexuality (Puszcz et al., 2025, Cureus). It does not investigate whether the same individuals fluctuate between these two extremes.

Autism: less interest, more non-heterosexuality

A systematic review of 17 autism and 19 ADHD studies reports ‘sexual ambivalence’ amongst autistic people, as well as more frequent homo-, bi- and asexual interest. In one of the included studies, 29.4 per cent of autistic participants, compared with 9.6 per cent of neurotypical participants, reported thinking about sex ‘never or rarely’ (Young & Cocallis, 2023, Neuropsychiatric Disease and Treatment). Sensory hypersensitivity and hyposensitivity are considered possible contributing factors: touch can become unpleasant, and arousal and orgasm can be more difficult to achieve. The review itself did not investigate this.

George and Stokes surveyed 309 autistic and 310 non-autistic adults online. In the autistic group, 69.7 per cent identified as non-heterosexual, compared with 30.3 per cent in the control group, with higher rates of homosexuality, bisexuality and asexuality (George & Stokes, 2018, Autism Research).

The gap

There is literature on the individual phenomena. It is missing in three areas:

AuDHS as a distinct group. Young and Cocallis report on ADHD and autism studies separately. None of the 36 included studies specifically examines this combination (Young & Cocallis, 2023).
The course of an individual’s condition. Cross-sectional studies show whether, on average, a group experiences more or less craving. Whether an individual shifts between phases remains unclear. The authors themselves call for longitudinal and qualitative research.
Opposing averages. ADHD traits tend to increase craving, whilst autistic traits tend to reduce it. In an AuDHS group, this may cancel each other out statistically. An average of ‘normal’ can mask this seesaw effect.