Psychophysiology has been described as a “hub” science, where neuroscience, psychology, and physiology are joined to understand phenomena. Multiple levels of analysis are especially important in sexuality, where the sexual arousal that someone reports differs from the sexual arousal suggested by responses in the brain and genitals. These discrepancies are at the center of controversies regarding sex and masturbation/pornography as “addictions”. Clients often report feeling they are too sexually interested or responsive, yet the few assessments of genital response find evidence against these claims. Brain patterns consistent with high sex sensitivity do not discriminate for those with shame concerning a higher sex incentive motivation. The negative effects reported reflect stigma and partner conflict that remain uncontrolled/ignored in clinical trials. These oversights have resulted in literature that is completely at odds regarding clients who are distressed about the frequency of their sexual urges: addictions researchers on one side, sexuality researchers on the other side. I will clarify the different origins of behaviors driven by sexual control versus sexual dysregulation, which underlies why persons with sex offenses should not be in the “treatments” developed for those who are hypersexual. Further, the pretty brain pictures of supposed “hypersexuals” are not very convincing to a neuroscientist, especially with respect to their discriminate validity. The evidence required to make neuroimaging a compelling argument for a distinct disorder will be covered, including why I believe the likelihood of such evidence is rapidly approaching zero. The consequences of selecting the wrong model for these behaviors is not simply a nomenclature issue: it determines whether we help or harm our clients.