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Draps M, Kulesza M, Glica A, Szymanowska J, Lewińska K, Żukrowska W, Gola M. Emotional interference and attentional bias in compulsive sexual behaviors disorder - An fMRI study on heterosexual males. J Behav Addict 2024. [PMID: 38967992 DOI: 10.1556/2006.2024.00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/06/2024] [Accepted: 05/18/2024] [Indexed: 07/07/2024] Open
Abstract
Background and aims Despite the inclusion of the Compulsive Sexual Behavior Disorder (CSBD) in the 11th edition of the International Classification of Diseases, emotional and cognitive impairments related to CSBD remains unclear. This study aimed to investigate the behavioral and neuronal effects of emotional interference on cognition among CSBD patients. Methods Thirty heterosexual males with CSBD and matched healthy controls (HC) were studied with the Emotional Stroop Task using 5 categories of emotionally arousing words (sex-related, positive, fear-related, negative, neutral) during functional magnetic imaging. Results At the behavioral level, we found the main effect of the condition: sex-related words evoked a stronger Stroop effect than other conditions. At the neural level, we found a significant group effect. Among CSBD patients processing of sex-related words was related to increased activity in the right putamen, right thalamus, hippocampi, and left pulvinar, when compared to HC. We also found a negative correlation between neuronal activation and time spent on sexual activity during the week preceding study and numerous group differences in brain regions connected to the emotional and motivational processing of sexually explicit material, correlating with CSBD symptoms. Conclusions Behavioral results indicate a specific attentional bias toward sex-related stimuli in both groups, while neural data uncovered stronger reactivity to sex-related words in CSBD compared to HC. This reactivity is related to CSBD symptoms and provides evidence for the interference of sex-related stimuli with cognition. Such results are firmly in line with the Incentive Salience Theory and conceptualizing CSBD as a behavioral addiction.
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Affiliation(s)
- Małgorzata Draps
- 1Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Maria Kulesza
- 2Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Agnieszka Glica
- 3Laboratory of Language Neurobiology, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Julia Szymanowska
- 4Department of Psychology, University of Social Sciences and Humanities, Warsaw, Poland
| | - Katarzyna Lewińska
- 4Department of Psychology, University of Social Sciences and Humanities, Warsaw, Poland
| | | | - Mateusz Gola
- 1Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
- 5Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California San Diego, San Diego, USA
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Briken P, Bőthe B, Carvalho J, Coleman E, Giraldi A, Kraus SW, Lew-Starowicz M, Pfaus JG. Assessment and treatment of compulsive sexual behavior disorder: a sexual medicine perspective. Sex Med Rev 2024; 12:355-370. [PMID: 38529667 PMCID: PMC11214846 DOI: 10.1093/sxmrev/qeae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION The addition of compulsive sexual behavior disorder (CSBD) into the ICD-11 chapter on mental, behavioral, or neurodevelopmental disorders has greatly stimulated research and controversy around compulsive sexual behavior, or what has been termed "hypersexual disorder," "sexual addiction," "porn addiction," "sexual compulsivity," and "out-of-control sexual behavior." OBJECTIVES To identify where concerns exist from the perspective of sexual medicine and what can be done to resolve them. METHODS A scientific review committee convened by the International Society for Sexual Medicine reviewed pertinent literature and discussed clinical research and experience related to CSBD diagnoses and misdiagnoses, pathologizing nonheteronormative sexual behavior, basic research on potential underlying causes of CSBD, its relationship to paraphilic disorder, and its potential sexual health consequences. The panel used a modified Delphi method to reach consensus on these issues. RESULTS CSBD was differentiated from other sexual activity on the basis of the ICD-11 diagnostic criteria, and issues regarding sexual medicine and sexual health were identified. Concerns were raised about self-labeling processes, attitudes hostile to sexual pleasure, pathologizing of nonheteronormative sexual behavior and high sexual desire, mixing of normative attitudes with clinical distress, and the belief that masturbation and pornography use represent "unhealthy" sexual behavior. A guide to CSBD case formulation and care/treatment recommendations was proposed. CONCLUSIONS Clinical sexologic and sexual medicine expertise for the diagnosis and treatment of CSBD in the psychiatric-psychotherapeutic context is imperative to differentiate and understand the determinants and impact of CSBD and related "out-of-control sexual behaviors" on mental and sexual well-being, to detect forensically relevant and nonrelevant forms, and to refine best practices in care and treatment. Evidence-based, sexual medicine-informed therapies should be offered to achieve a positive and respectful approach to sexuality and the possibility of having pleasurable and safe sexual experiences.
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Affiliation(s)
- Peer Briken
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center, Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Beáta Bőthe
- Department of Psychology, Université de Montréal, Montréal, QC H3C 3J7, Canada
- Centre de Recherche Interdisciplinaire Sur Les Problèmes Conjugaux Et Les Agressions Sexuelles, Montréal, QC H3C 3J7, Canada
| | - Joana Carvalho
- William James Center for Research, Department of Education and Psychology, University of Aveiro, Aveiro 3810-193, Portugal
| | - Eli Coleman
- Eli Coleman Institute for Sexual and Gender Health, University of Minnesota, Minneapolis, MN 55454, United States
| | - Annamaria Giraldi
- Sexological Clinic, Mental Health Center, Copenhagen University Hospital, Mental Health Services, Copenhagen CPH 2200, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Shane W Kraus
- Department of Psychology, University of Nevada Las Vegas, Las Vegas, NV 5030, United States
| | - Michał Lew-Starowicz
- Department of Psychiatry, Centre of Postgraduate Medical Education, Warsaw 01-809, Poland
| | - James G Pfaus
- Center for Sexual Health and Intervention, Czech National Institute of Mental Health, Klecany 25067, Czech Republic
- Department of Psychology and Life Sciences, Faculty of Humanities, Charles University, Prague 18200, Czech Republic
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3
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Schmidt NM, Hennig J, Munk AJL. Interplay between sexual excitation and inhibition: impact on sexual function and neural correlates of erotic stimulus processing in women. Front Behav Neurosci 2024; 18:1386006. [PMID: 38813468 PMCID: PMC11133591 DOI: 10.3389/fnbeh.2024.1386006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/26/2024] [Indexed: 05/31/2024] Open
Abstract
Background As outlined by the dual control model (DCM), individual differences in the regulation of sexual arousal following sexual stimulation depend on two distinct neurophysiological processes: sexual excitation (SE) and sexual inhibition (SI). Although associations with sexual function, behavior, and cue processing have been demonstrated in previous research, underlying neural correlates remain insufficiently explored. Moreover, interactive effects of SE/SI as proposed by the DCM, as well as factors impacting SE/SI properties, such as the use of oral contraceptives (OCs), have not received adequate attention in existing research. Methods 90 healthy, sexually active women (n = 51 using OCs, n = 39 naturally cycling) completed an Emotional-Picture-Stroop-Paradigm (EPSP) while a 64-channel EEG was recorded. LPP amplitudes toward erotic and neutral stimuli were consecutively computed as a marker of motivational salience and approach motivation. Additionally, women provided self-reports of SE/SI and sexual function. Moderation analyses were performed to assess interactive effects of SE/SI in predicting LPP amplitudes and sexual function. Results Sexual function was negatively associated with SI levels but unrelated to SE. Higher SI was associated with reduced LPP amplitudes in response to erotic stimuli. This negative association was, however, attenuated for women high in SE, suggesting interactive effects of SE/SI. Furthermore, women using OCs reported lower SE compared to naturally cycling women. Conclusion The observed findings provide additional psychophysiological evidence supporting the DCM and underscore the relevance of interactive SE/SI effects in stimulus processing and approach motivation. They also highlight the possible impact of OCs on psychosexual variables that warrants further research.
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Affiliation(s)
- Norina M. Schmidt
- Department of Differential and Biological Psychology, Justus-Liebig-University Giessen, Giessen, Germany
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4
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Görts P, Savard J, Görts-Öberg K, Dhejne C, Arver S, Jokinen J, Ingvar M, Abé C. Structural brain differences related to compulsive sexual behavior disorder. J Behav Addict 2023; 12:278-287. [PMID: 36943775 DOI: 10.1556/2006.2023.00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/16/2023] [Accepted: 02/25/2023] [Indexed: 03/23/2023] Open
Abstract
Background and aims Compulsive sexual behavior disorder (CSBD) has been included as an impulse control disorder in the International Classification of Diseases (ICD-11). However, the neurobiological mechanisms underlying CSBD remain largely unknown, and given previous indications of addiction-like mechanisms at play, the aim of the present study was to investigate if CSBD is associated with structural brain differences in regions involved in reward processing. Methods We analyzed structural MRI data of 22 male CSBD patients (mean = 38.7 years, SD = 11.7) and 20 matched healthy controls (HC; mean = 37.6 years, SD = 8.5). Main outcome measures were regional cortical thickness and surface area. We also tested for case-control differences in subcortical structures and the effects of demographic and clinical variables, such as CSBD symptom severity, on neuroimaging outcomes. Moreover, we explored case-control differences in regions outside our hypothesis including white matter. Results CSBD patients had significantly lower cortical surface area in right posterior cingulate cortex than HC. We found negative correlations between right posterior cingulate area and CSBD symptoms scores. There were no group differences in subcortical volume. Conclusions Our findings suggest that CSBD is associated with structural brain differences, which contributes to a better understanding of CSBD and encourages further clarifications of the neurobiological mechanisms underlying the disorder.
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Affiliation(s)
- Per Görts
- 1Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
| | - Josephine Savard
- 1Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
- 2ANOVA Clinic, Karolinska University Hospital, Stockholm, Sweden
- 3Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Görts-Öberg
- 2ANOVA Clinic, Karolinska University Hospital, Stockholm, Sweden
- 3Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Dhejne
- 2ANOVA Clinic, Karolinska University Hospital, Stockholm, Sweden
- 3Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Arver
- 2ANOVA Clinic, Karolinska University Hospital, Stockholm, Sweden
- 3Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Jussi Jokinen
- 1Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
- 4Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Martin Ingvar
- 4Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Christoph Abé
- 4Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- 5Quantify Research, Stockholm, Sweden
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Turner D, Briken P, Grubbs J, Malandain L, Mestre-Bach G, Potenza MN, Thibaut F. The World Federation of Societies of Biological Psychiatry guidelines on the assessment and pharmacological treatment of compulsive sexual behaviour disorder. DIALOGUES IN CLINICAL NEUROSCIENCE 2022; 24:10-69. [PMID: 37522807 PMCID: PMC10408697 DOI: 10.1080/19585969.2022.2134739] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/18/2022] [Accepted: 10/03/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The current guidelines aim to evaluate the role of pharmacological agents in the treatment of patients with compulsive sexual behaviour disorder (CSBD). They are intended for use in clinical practice by clinicians who treat patients with CSBD. METHODS An extensive literature search was conducted using the English-language-literature indexed on PubMed and Google Scholar without time limit, supplemented by other sources, including published reviews. RESULTS Each treatment recommendation was evaluated with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. Psychoeducation and psychotherapy are first-choice treatments and should always be conducted. The type of medication recommended depended mainly on the intensity of CSBD and comorbid sexual and psychiatric disorders. There are few randomised controlled trials. Although no medications carry formal indications for CSBD, selective-serotonin-reuptake-inhibitors and naltrexone currently constitute the most relevant pharmacological treatments for the treatment of CSBD. In cases of CSBD with comorbid paraphilic disorders, hormonal agents may be indicated, and one should refer to previously published guidelines on the treatment of adults with paraphilic disorders. Specific recommendations are also proposed in case of chemsex behaviour associated with CSBD. CONCLUSIONS An algorithm is proposed with different levels of treatment for different categories of patients with CSBD.
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Affiliation(s)
- Daniel Turner
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joshua Grubbs
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
| | - Leo Malandain
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin (site Tarnier) AP-HP, Paris, France
| | - Gemma Mestre-Bach
- Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, La Rioja, Spain
| | - Marc N. Potenza
- Departments of Psychiatry and Neuroscience and Child Study Center, Yale School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Florence Thibaut
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin (site Tarnier) AP-HP, Paris, France
- INSERM U1266, Institute of Psychiatry and Neurosciences, University of Paris Cité, Paris, France
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Ekmekçi Ertek İ, Bozdağ MÇ, Ünler M, Yurtseven ÇH, Candansayar S. Clinical Presentations of Female Hypersexuality on a Psychiatry Outpatient Clinic in Turkey: A Retrospective Analysis of Patients in the Concept of Diagnosis and Trauma. SEXUAL HEALTH & COMPULSIVITY 2022. [DOI: 10.1080/26929953.2022.2143460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- İrem Ekmekçi Ertek
- Gazi University Faculty of Medicine, Department of Psychiatry, Ankara, Turkey
| | - Meltem Çınar Bozdağ
- Gazi University Faculty of Medicine, Department of Psychiatry, Ankara, Turkey
| | - Mehmet Ünler
- Gaziantep 25 Aralık State Hospital, Psychiatry Clinic, Gaziantep, Turkey
| | | | - Selçuk Candansayar
- Gazi University Faculty of Medicine, Department of Psychiatry, Ankara, Turkey
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Limoncin E, Ciocca G, Castellini G, Sansone A, Cavalieri F, Cavallo F, Cocchiaro T, Ricca V, di Lorenzo G, Rossi A, Fisher AD, Rochira V, Corona G, Jannini EA. Hypersexuality as a tip of the iceberg of a primary psychopathology: a joined position statement of the Italian Society of Andrology and Sexual Medicine (SIAMS) and of the Italian Society of Psychopathology (SOPSI). J Endocrinol Invest 2022; 45:1787-1799. [PMID: 35527295 DOI: 10.1007/s40618-022-01798-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
In the last years, hypersexual behavior has been broadly scientifically studied. The interest in this topic, belonging to psycho-sexology and sexual medicine, has been due to its still unclear aetiology, nature, and its manifestation in relationship with several organic and psychopathological conditions. So, the specialist (the psychologist, psychiatrist, endocrinologist, neurologist) may encounter some difficulties in diagnosing and managing this symptom. The first main objective of this position statement, which has been developed in collaboration between the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Psychopathology (SOPSI) is to give to the reader evidence about the necessity to consider hypersexuality as a symptom related to another underlying condition. Following this consideration, the second main objective is to give specific statements, for the biopsychosocial assessment and the diagnosis of hypersexual behavior, developed on the basis of the most recent literature evidence. To develop a psycho-pharmacological treatment tailored on patients' needs, our suggestion is to assess the presence of specific comorbid psychopathological and organic conditions, and the impact of pharmacological treatments on the presence of an excess of sexual behavior. Finally, a suggestion of a standardized psychometric evaluation of hypersexuality will be given.
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Affiliation(s)
- E Limoncin
- Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University Tor Vergata, E Tower South. Floor 4, Room E413, Via Montpellier 1, 00133, Rome, Italy
- Department of Dynamic, Clinical Psychology and Health, University Sapienza, Rome, Italy
| | - G Ciocca
- Department of Dynamic, Clinical Psychology and Health, University Sapienza, Rome, Italy
| | - G Castellini
- Psychiatric Unit, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - A Sansone
- Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University Tor Vergata, E Tower South. Floor 4, Room E413, Via Montpellier 1, 00133, Rome, Italy
| | - F Cavalieri
- Department of Medicine, Unit of Andrology and Reproduction Medicine, University of Padova, Padua, Italy
| | - F Cavallo
- Spinal Unit, San Raffaele Institute of Sulmona, Sulmona, Italy
| | - T Cocchiaro
- Department of Gender, Parenting, Child and Adolescent Medicine, Unit of Reproductive Pathophysiology and Andrology, "Sandro Pertini" Hospital, Rome, Italy
| | - V Ricca
- Psychiatric Unit, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - G di Lorenzo
- Laboratory of Psychophysiology and Cognitive Neuroscience, Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Psychiatry and Clinical Psychology Unit, Section of Psychiatry, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - A Rossi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - A D Fisher
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - V Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - G Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Bologna, Italy
| | - E A Jannini
- Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University Tor Vergata, E Tower South. Floor 4, Room E413, Via Montpellier 1, 00133, Rome, Italy.
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8
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Sharma M, Kumar M, Gupta S. Nymphomania with intellectual disability. Ind Psychiatry J 2022; 31:380-381. [PMID: 36419678 PMCID: PMC9678153 DOI: 10.4103/ipj.ipj_151_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/29/2021] [Accepted: 10/25/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mini Sharma
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India
| | - Manoj Kumar
- Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Sneha Gupta
- Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, New Delhi, India
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9
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Liberg B, Görts-Öberg K, Jokinen J, Savard J, Dhejne C, Arver S, Fuss J, Ingvar M, Abé C. Neural and behavioral correlates of sexual stimuli anticipation point to addiction-like mechanisms in compulsive sexual behavior disorder. J Behav Addict 2022; 11:520-532. [PMID: 35895609 PMCID: PMC9295238 DOI: 10.1556/2006.2022.00035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/25/2022] [Accepted: 04/21/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Compulsive sexual behavior disorder (CSBD) is characterized by persistent patterns of failure to control sexual impulses resulting in repetitive sexual behavior, pursued despite adverse consequences. Despite previous indications of addiction-like mechanisms and the recent impulse-control disorder classification in the International Classification of Diseases (ICD-11), the neurobiological processes underlying CSBD are unknown. METHODS We designed and applied a behavioral paradigm aimed at disentangling processes related to anticipation and viewing of erotic stimuli. In 22 male CSBD patients (age: M = 38.7, SD = 11.7) and 20 healthy male controls (HC, age: M = 37.6, SD = 8.5), we measured behavioral responses and neural activity during functional magnetic resonance imaging (fMRI). The main outcomes were response time differences between erotic and non-erotic trials and ventral striatum (VS) activity during anticipation of visual stimuli. We related these outcomes with each other, to CSBD diagnosis, and symptom severity. RESULTS We found robust case-control differences on behavioral level, where CSBD patients showed larger response time differences between erotic and non-erotic trials than HC. The task induced reliable main activations within each group. While we did not observe significant group differences in VS activity, VS activity during anticipation correlated with response time differences and self-ratings for anticipation of erotic stimuli. DISCUSSION AND CONCLUSIONS Our results support the validity and applicability of the developed task and suggest that CSBD is associated with altered behavioral correlates of anticipation, which were associated with ventral striatum activity during anticipation of erotic stimuli. This supports the idea that addiction-like mechanisms play a role in CSBD.
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Affiliation(s)
- Benny Liberg
- Department of Clinical Neuroscience, Osher Center, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Görts-Öberg
- ANOVA Clinic, Karolinska University Hospital, Stockholm, Sweden,Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Jussi Jokinen
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Josephine Savard
- ANOVA Clinic, Karolinska University Hospital, Stockholm, Sweden,Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
| | - Cecilia Dhejne
- ANOVA Clinic, Karolinska University Hospital, Stockholm, Sweden,Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Arver
- ANOVA Clinic, Karolinska University Hospital, Stockholm, Sweden,Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Johannes Fuss
- Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Martin Ingvar
- Department of Clinical Neuroscience, Osher Center, Karolinska Institutet, Stockholm, Sweden
| | - Christoph Abé
- Department of Clinical Neuroscience, Osher Center, Karolinska Institutet, Stockholm, Sweden,Quantify Research, Stockholm, Sweden,Corresponding author. Tel.: +468 52483265. E-mail:
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10
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Neurochemical and Hormonal Contributors to Compulsive Sexual Behavior Disorder. CURRENT ADDICTION REPORTS 2022. [DOI: 10.1007/s40429-021-00403-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Purpose of Review
Compulsive sexual behavior disorder has been recently included in the 11th revision of the International Classification of Diseases (ICD-11), and the possible contribution of neurochemical and hormonal factors have been reported. However, relatively little is known concerning the neurobiology underlying this disorder. The aim of this article is to review and discuss published findings in the area.
Recent Findings
Evidence suggests that the neuroendocrine systems are involved in the pathophysiology of compulsive sexual behavior. The hypothalamus-pituitary adrenal axis, the hypothalamus-pituitary–gonadal axis, and the oxytocinergic system have been implicated.
Summary
Further studies are needed to elucidate the exact involvement of neuroendocrine and hormonal systems in compulsive sexual behavior disorder. Prospective longitudinal studies are particularly needed, especially those considering co-occurring psychiatric disorders and obtaining hormonal assessments in experimental circumstances with appropriate control groups.
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11
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Rodríguez-Nieto G, Dewitte M, Sack AT, Schuhmann T. Individual Differences in Testosterone and Self-Control Predict Compulsive Sexual Behavior Proneness in Young Males. Front Psychol 2021; 12:723449. [PMID: 34925132 PMCID: PMC8677662 DOI: 10.3389/fpsyg.2021.723449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
The ability to control sexual urges and impulses is essential to achieve individual and social harmony. Failing to regulate sexual behavior can lead to the interference with daily life goals, sexual diseases transmission and moral violations, among others. The dual control model of sexual response proposes that an imbalance between sexual excitation and sexual inhibition mechanisms may lead to sexual dysregulation, thereby explaining problematic sexual behavior. Interindividual differences in self-control and testosterone levels are likely to modulate sexual regulation mechanisms, but these individual features have scarcely been studied in the context of compulsive sexual behavior. This study investigated the role of sexual excitation and inhibition, self-control and testosterone levels in predicting individuals' proneness to display compulsive sexual behavior. Seventy healthy young males provided a saliva sample for testosterone measurements and filled in questionnaires on self-control, sexual excitation, sexual inhibition, sexual compulsivity and sexual behavior. High testosterone levels and low self-control were associated with higher sexual compulsivity scores. Additionally, testosterone levels and sexual inhibition negatively predicted the frequency of sexual behavior with a partner. The results of our study highlight the joint role of psychological traits and testosterone levels in compulsive sexual behavior proneness, providing implications regarding the prevention and treatment of this condition in young males.
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Affiliation(s)
- Geraldine Rodríguez-Nieto
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Department of Movement Sciences, KU Leuven, Heverlee, Belgium
| | - Marieke Dewitte
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Alexander T. Sack
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Teresa Schuhmann
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
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12
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Golec K, Draps M, Stark R, Pluta A, Gola M. Aberrant orbitofrontal cortex reactivity to erotic cues in Compulsive Sexual Behavior Disorder. J Behav Addict 2021; 10:646-656. [PMID: 34437297 PMCID: PMC8997235 DOI: 10.1556/2006.2021.00051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/28/2021] [Accepted: 07/10/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIMS Compulsive Sexual Behavior Disorder (CSBD) is characterized by increased reactivity to erotic reward cues. Cue-encoded reward parameters, such as type (e.g. erotic or monetary) or probability of anticipated reward, shape reward-related motivational processes, increase the attractiveness of cues and therefore might enhance maladaptive behavioral patterns in CSBD. Studies on the neural patterns of cue processing in individuals with CSBD have been limited mainly to ventral striatal responses. Therefore, here we aimed to examine the cue reactivity of multiple key structures in the brain's reward system, taking into account not only the type of predicted reward but also its probability. METHODS Twenty Nine men seeking professional help due to CSBD and 24 healthy volunteers took part in an fMRI study with a modified Incentive Delay Task with erotic and monetary rewards preceded by cues indicating a 25%, 50%, or 75% chance of reward. Analyses of functional patterns of activity related to cue type and probability were conducted on the whole-brain and ROI levels. RESULTS Increased anticipatory response to cues predictive of erotic rewards was observed among CSBD participants when compared to controls, in the ventral striatum and anterior orbitofrontal cortex (aOFC). The activity in aOFC was modulated by reward probability. DISCUSSION AND CONCLUSIONS Type of anticipated reward (erotic vs monetary) affects reward-related behavioral motivation in CSBD more strongly than reward probability. We present evidence of abnormal aOFC function in CSBD by demonstrating the recruitment of additional subsections of this region by erotic reward cues.
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Affiliation(s)
- Karolina Golec
- Faculty of Psychology, University of Warsaw, Warsaw, Poland,Corresponding author. E-mail:
| | - Małgorzata Draps
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Rudolf Stark
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University of Giessen, Giessen, Germany,Bender Institute of Neuroimaging, Justus Liebig University of Giessen, Giessen, Germany
| | | | - Mateusz Gola
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland,Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California, San Diego, CA, USA
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13
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Markert C, Baranowski AM, Koch S, Stark R, Strahler J. The Impact of Negative Mood on Event-Related Potentials When Viewing Pornographic Pictures. Front Psychol 2021; 12:673023. [PMID: 34290650 PMCID: PMC8288192 DOI: 10.3389/fpsyg.2021.673023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Negative affective states may increase the risk for problematic pornography use. Underlying neurophysiological mechanisms are, however, not completely understood. Previous research suggests that the participants' emotional state may affect neural processing of sexual stimuli. The aim of this study was to investigate neural correlates of negative affect-induced alterations in sexual cue reactivity in healthy men. The moderating effects of habitual porn consumption, trait sexual motivation, and symptoms of cybersex addiction were also considered. Method: Sixty-four healthy men engaged in a sexual cue reactivity task (passive viewing of explicit sexual pictures and neutral pictures depicting scenes of social interaction) during negative (n = 32) vs. neutral affect (n = 32), induced via tailored feedback on a performance task. Self-reported sexual arousal and event-related brain potentials indicated cue reactivity and motivated attention. Symptoms of cybersex addiction and trait sexual motivation were assessed with the help of the short Internet Addiction Test, adapted to online sexual activities, and the Trait Sexual Motivation Questionnaire. Results: Negative feedback increased negative affect after the performance task. While sexual pictures compared to neutral pictures elicited significantly larger P300 and late positive potential (LPP) amplitudes, there was no general effect of negative feedback on sexual stimuli-related P300 and LPP amplitudes. In the negative feedback group, men with higher solitary sexual motivation levels showed higher P300/LPP difference amplitudes for sexual stimuli compared to men with lower levels of solitary sexual motivation. The opposite effect was found in the group with neutral feedback. There was no link to other aspects of trait sexual motivation and symptoms of cybersex addiction. Conclusions: Results suggest that higher levels of solitary sexual motivation may enhance motivated attention toward sexual stimuli among men receiving negative performance feedback. Other characteristics of sexual behaviors and traits provided no exploratory value. Future studies extending onto men suffering from compulsive sexual behavior disorder will have to closer look at the neurophysiological bases of why and when some men develop an addictive pornography consumption.
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Affiliation(s)
- Charlotte Markert
- Department of Psychotherapy and Systems Neuroscience, Psychology and Sport Science, University of Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, University of Giessen, Giessen, Germany
- Center for Mind, Brain and Behavior, Universities of Marburg and Giessen, Giessen, Germany
| | - Andreas M. Baranowski
- Department of Psychotherapy and Systems Neuroscience, Psychology and Sport Science, University of Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, University of Giessen, Giessen, Germany
- Center for Mind, Brain and Behavior, Universities of Marburg and Giessen, Giessen, Germany
| | - Simon Koch
- Department of Psychotherapy and Systems Neuroscience, Psychology and Sport Science, University of Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, University of Giessen, Giessen, Germany
| | - Rudolf Stark
- Department of Psychotherapy and Systems Neuroscience, Psychology and Sport Science, University of Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, University of Giessen, Giessen, Germany
- Center for Mind, Brain and Behavior, Universities of Marburg and Giessen, Giessen, Germany
| | - Jana Strahler
- Department of Psychotherapy and Systems Neuroscience, Psychology and Sport Science, University of Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, University of Giessen, Giessen, Germany
- Center for Mind, Brain and Behavior, Universities of Marburg and Giessen, Giessen, Germany
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14
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Hurel E, Grall-Bronnec M, Thiabaud E, Saillard A, Hardouin JB, Challet-Bouju G. A Case-Control Study on Behavioral Addictions and Neurocognition: Description of the BANCO and BANCO2 Protocols. Neuropsychiatr Dis Treat 2021; 17:2369-2386. [PMID: 34321880 PMCID: PMC8312511 DOI: 10.2147/ndt.s292490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/19/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Only two behavioral addictions (BAs) are currently recognized in international classifications (gambling disorder: GbD; gaming disorder: GmD), while some of them await further investigation (food addiction: FA; sexual addiction: SA). Neurocognitive functioning is considered a risk factor for BAs. Research is quite abundant for GbD and highlights specific deficits in several cognitive functions. Nevertheless, grey areas still exist. The aim of this research programme is to investigate the neurocognitive profiles of patients presenting with various BAs and to establish parallels between different forms of BA to achieve a common addiction concept. METHODS AND ANALYSIS This research program is composed of two studies sharing the same methodology but focusing on different samples: the BANCO study aims to include 30 individuals with a GbD, whereas the BANCO2 study aims to include 30 individuals with a GmD, 30 with a SA, and 30 with a FA. Moreover, for each BA group, 30 healthy controls will be recruited, matched by sex, age and education level. Several cognitive tasks will be completed by participants. Cue reactivity and physiological responses, as well as clinical data regarding addiction characteristics and personality, will also be investigated. A composite score based on the cognitive tasks will be computed using principal component analysis (PCA). Overall cognitive performance and detailed performance on the different cognitive tasks will be compared between individuals with BAs and their matched healthy controls using linear models with random effects. Comparisons will also be made between BA groups to investigate specific alterations associated with each disorder. DISCUSSION The results of this research programme will impact both research and clinical areas by (i) providing new knowledge for discussions regarding the inclusion of BAs under the spectrum of addictive disorders; (ii) improving understanding of addiction mechanisms in general; (iii) providing clarity in the grey areas in neurocognitive research on BAs and improving the understanding of less studied BAs, (iv) guiding clinicians to propose therapeutic alternatives and complementary programmes. TRIAL REGISTRATION BANCO study (ClinicalTrials.gov NCT03202290); BANCO2 study (ClinicalTrials.gov NCT03967418).
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Affiliation(s)
- Elodie Hurel
- CHU Nantes, Addictology and Psychiatry Department, Nantes, France.,INSERM U1246 SPHERE (methodS in Patient-centered outcomes & HEalth ResEarch), University of Nantes, University of Tours, Nantes, France
| | - Marie Grall-Bronnec
- CHU Nantes, Addictology and Psychiatry Department, Nantes, France.,INSERM U1246 SPHERE (methodS in Patient-centered outcomes & HEalth ResEarch), University of Nantes, University of Tours, Nantes, France
| | - Elsa Thiabaud
- CHU Nantes, Addictology and Psychiatry Department, Nantes, France
| | - Anaïs Saillard
- CHU Nantes, Addictology and Psychiatry Department, Nantes, France
| | - Jean-Benoît Hardouin
- INSERM U1246 SPHERE (methodS in Patient-centered outcomes & HEalth ResEarch), University of Nantes, University of Tours, Nantes, France
| | - Gaëlle Challet-Bouju
- CHU Nantes, Addictology and Psychiatry Department, Nantes, France.,INSERM U1246 SPHERE (methodS in Patient-centered outcomes & HEalth ResEarch), University of Nantes, University of Tours, Nantes, France
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15
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Rodríguez-Nieto G, Sack AT, Dewitte M, Emmerling F, Schuhmann T. The Modulatory Role of Cortisol in the Regulation of Sexual Behavior in Young Males. Front Behav Neurosci 2020; 14:552567. [PMID: 33250723 PMCID: PMC7674834 DOI: 10.3389/fnbeh.2020.552567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/07/2020] [Indexed: 11/13/2022] Open
Abstract
The proneness to be sexually aroused, to perform sexual acts, or to be sexually disinhibited during a particular mood varies across individuals. However, the physiological mechanisms underlying this specific and variable relationship between mood and sex-related processes are poorly understood. We propose that cortisol may act as an important moderator in this as it has shown to influence sexual arousal and to play a neuromodulatory role during emotion regulation. Here, we conducted a functional magnetic resonance imaging study in a sample of young males to investigate whether cortisol modulates the neural response during the approach of sexual stimuli in an approach-avoidance task and whether this potential relationship explains the individual differences in sexual inhibition and in mood-related sexual interest and activity. We revealed that cortisol associates with the anteromedial prefrontal cortex activation during the approach towards sexual stimuli. Moreover, this anteromedial prefrontal cortex response was dependent on individual differences in sexual inhibition and the improvements of negative mood as a result of sexual activity. The anteromedial prefrontal cortex is already known to process bottom-up information, reward, and risk estimation. The neuromodulatory role of cortisol within this region during sexual approach may represent a previously unknown yet key element in the regulation of sexual behavior in young males.
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Affiliation(s)
- Geraldine Rodríguez-Nieto
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Department of Movement Sciences, Catholic University of Leuven, Leuven, Belgium
| | - Alexander T Sack
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Marieke Dewitte
- Department of Clinical Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Franziska Emmerling
- Chair of Research and Science Management, Technical University of Munich, Munich, Gemany
| | - Teresa Schuhmann
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
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16
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Naltrexone in Compulsive Sexual Behavior Disorder: A Feasibility Study of Twenty Men. J Sex Med 2020; 17:1544-1552. [DOI: 10.1016/j.jsxm.2020.04.318] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 11/18/2022]
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17
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Briken P. An integrated model to assess and treat compulsive sexual behaviour disorder. Nat Rev Urol 2020; 17:391-406. [DOI: 10.1038/s41585-020-0343-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2020] [Indexed: 12/12/2022]
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18
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Arafat SMY, Kar SK. Hypersexuality in a Bangladeshi Female: A Case Report. JOURNAL OF PSYCHOSEXUAL HEALTH 2020. [DOI: 10.1177/2631831819898933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hypersexuality has been a debated disorder, which has not been able to secure its place into the classificatory systems. This article was aimed to report a female with hypersexuality in Bangladesh. Mrs X, a 20-year-old married lady, presented with the complaints of irritability, low mood, sleep disturbances for last one month. As per Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria and mental state examination findings, she was labeled as a case of major depressive disorder and borderline personality disorder. Her early childhood was uneventful, and she got married 2 years back after having a love relationship with the person. Immediately after her marriage, she was used to enjoy sex for 5 to 6 hours daily as she used to enjoy 5 to 6 orgasms per day. The couple enjoyed their sex daily, even the in the days of menstruation. For last one year her husband stopped daily intercourses as well as the duration of the intercourses was also decreased below 1 hour. Subsequently, the lady felt disturbances and used to demand sex more time as well as orgasms daily. She used to consume pornography, masturbate, and started extramarital relationship for sexual activity. She enjoys her persistent thoughts, fantasies regarding sex; however, she became frustrated when she was not getting expected duration and expected number of orgasms. She asked her husband to divorce her as he was not being able to have intercourses for 5 to 6 hours daily. This is the first reported case of hypersexuality in a sexually conservative country like Bangladesh which may open the whole hidden problem.
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Affiliation(s)
| | - Sujita Kumar Kar
- Department of Psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh, India
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19
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Balodis IM, Potenza MN. Common neurobiological and psychological underpinnings of gambling and substance-use disorders. Prog Neuropsychopharmacol Biol Psychiatry 2020; 99:109847. [PMID: 31862419 DOI: 10.1016/j.pnpbp.2019.109847] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 12/20/2022]
Abstract
Both psychological and neurobiological studies in gambling disorder have increased in the past 10-15 years. This review examines the current state of the literature, with a focus on recent magnetic resonance imaging (MRI) studies in gambling disorder. The review compares and contrasts findings across gambling and substance-use disorders. Additionally, features with arguably particular relevance to gambling disorder (e.g., "near-miss" processing) are described, as well as their relationship to choice behaviors. More broadly, the review informs on how these studies advance our understanding of brain-behavior relationships relating to decision-making and key features of addictive disorders.
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Affiliation(s)
- Iris M Balodis
- Peter Boris Centre for Addictions Research, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Marc N Potenza
- Departments of Psychiatry, Neuroscience and Child Study, Yale University School of Medicine, New Haven, CT, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, USA; Connecticut Mental Health Center, New Haven, CT, USA
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20
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Stefanou MI, Vittore D, Wolz I, Klingberg S, Wildgruber D. Recurrent Episodes of Paraphilic Behavior Possibly Associated With Olanzapine and Aripiprazole Treatment in a Patient With Schizophrenia. Front Psychiatry 2020; 11:318. [PMID: 32425825 PMCID: PMC7212450 DOI: 10.3389/fpsyt.2020.00318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/31/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Hypersexual and paraphilic disorders have been frequently associated with concomitant psychiatric disorders, including schizophrenia. A growing number of published cases has recently indicated that hypersexual behavior may also arise in conjunction with treatment with second-generation antipsychotics. Although hypersexuality has been acknowledged as a possible side effect of antipsychotic treatment with partial dopamine agonists, including aripiprazole, only very few cases of olanzapine-associated hypersexuality have been reported in the literature. CASE PRESENTATION A 29-year-old man presented with delusions of persecution and reference, auditory hallucinations, and negative symptoms, and was diagnosed with paranoid-hallucinatory schizophrenia. One and a half months after initiation of antipsychotic treatment with olanzapine, he developed compulsive sexual behavior and paraphilia, without signs of akathisia. After olanzapine discontinuation, a full remission of the hypersexual behavior was noted within one week, and treatment was switched to risperidone. Due to hyperprolactinemia, adjunct treatment with low-dose aripiprazole was initiated and a severe recurrence of identical hypersexual behavior occurred. The hypersexual behavior resolved completely within a week after aripiprazole discontinuation. CONCLUSION This case illustrates that hypersexuality may be a rare adverse effect of treatment with second-generation antipsychotics. Although aripiprazole is a drug with a well-established risk for hypersexuality, the question of whether a causal association between hypersexuality and olanzapine exists remains currently unresolved. As the currently limited amount of available evidence precludes any definitive conclusions, additional research is warranted to delineate the possible neurobiological substrates of hypersexual and paraphilic disorders in patients treated with second-generation antipsychotics.
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Affiliation(s)
- Maria-Ioanna Stefanou
- Department of Neurology & Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Debora Vittore
- Department of Psychiatry and Psychotherapy, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Ines Wolz
- Department of Psychiatry and Psychotherapy, Eberhard-Karls University of Tübingen, Tübingen, Germany.,Department of Clinical Psychology and Psychotherapy, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Dirk Wildgruber
- Department of Psychiatry and Psychotherapy, Eberhard-Karls University of Tübingen, Tübingen, Germany
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21
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Chen J, Yang J, Huang X, Ni L, Fan Q, Liu T, Yao Z, Chen Y. Reduced segregation and integration of structural brain network associated with sympathetic and dorsal penile nerve activity in anejaculation patients: a graph‐based connectome study. Andrology 2019; 8:392-399. [PMID: 31610095 DOI: 10.1111/andr.12715] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/11/2019] [Accepted: 10/08/2019] [Indexed: 12/14/2022]
Affiliation(s)
- J. Chen
- Department of Andrology Jiangsu Province Hospital of Chinese Medicine Affiliated Hospital of Nanjing University of Chinese Medicine Nanjing China
| | - J. Yang
- Department of Urology Jiangsu Provincial People's Hospital First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - X. Huang
- Department of Andrology Jiangsu Province Hospital of Chinese Medicine Affiliated Hospital of Nanjing University of Chinese Medicine Nanjing China
| | - L. Ni
- Department of Andrology Jiangsu Province Hospital of Chinese Medicine Affiliated Hospital of Nanjing University of Chinese Medicine Nanjing China
| | - Q. Fan
- Department of Andrology Jiangsu Province Hospital of Chinese Medicine Affiliated Hospital of Nanjing University of Chinese Medicine Nanjing China
| | - T. Liu
- Department of Andrology Jiangsu Province Hospital of Chinese Medicine Affiliated Hospital of Nanjing University of Chinese Medicine Nanjing China
| | - Z. Yao
- Department of Psychiatry Nanjing Brain Hospital Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Y. Chen
- Department of Andrology Jiangsu Province Hospital of Chinese Medicine Affiliated Hospital of Nanjing University of Chinese Medicine Nanjing China
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22
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Calabrò RS, Cacciola A, Bruschetta D, Milardi D, Quattrini F, Sciarrone F, la Rosa G, Bramanti P, Anastasi G. Neuroanatomy and function of human sexual behavior: A neglected or unknown issue? Brain Behav 2019; 9:e01389. [PMID: 31568703 PMCID: PMC6908863 DOI: 10.1002/brb3.1389] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/03/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Sexual desire, arousal, and orgasm are mediated by complex, yet still not fully understood, interactions of the somatic and autonomic nervous systems operating at the central and peripheral levels. Disruption of endocrine, neural, or vascular response, caused by aging, medical illness, neurological diseases, surgery, or drugs, can lead to sexual dysfunctions, thus significantly affecting patients' quality of life. PURPOSE This narrative review aims at characterizing the involvement of the central nervous system in human sexual behavior. METHODS A literature search was conducted using PubMed in its entirety up to June 2018, analyzing the studies dealing with the neurobiological and neurophysiological basis of human sexuality. RESULTS Sexual behavior is regulated by both subcortical structures, such as the hypothalamus, brainstem, and spinal cord, and several cortical brain areas acting as an orchestra to finely adjust this primitive, complex, and versatile behavior. At the central level, dopaminergic and serotonergic systems appear to play a significant role in various factors of sexual response, although adrenergic, cholinergic, and other neuropeptide transmitter systems may contribute as well. CONCLUSIONS Providing healthcare professionals with information concerning sexual behavior may overcome useless and sometimes dangerous barriers and improve patient management, since sexual well-being is considered one of the most important aspects of one's quality of life.
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Affiliation(s)
| | | | - Daniele Bruschetta
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Demetrio Milardi
- IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy.,Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | | | | | | | | | - Giuseppe Anastasi
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
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23
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Boström AE, Chatzittofis A, Ciuculete DM, Flanagan JN, Krattinger R, Bandstein M, Mwinyi J, Kullak-Ublick GA, Öberg KG, Arver S, Schiöth HB, Jokinen J. Hypermethylation-associated downregulation of microRNA-4456 in hypersexual disorder with putative influence on oxytocin signalling: A DNA methylation analysis of miRNA genes. Epigenetics 2019; 15:145-160. [PMID: 31542994 PMCID: PMC6961682 DOI: 10.1080/15592294.2019.1656157] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Hypersexual disorder (HD) was proposed as a diagnosis in the DSM-5 and the classification ‘Compulsive Sexual Behavior Disorder’ is now presented as an impulse-control disorder in ICD-11. HD incorporates several pathophysiological mechanisms; including impulsivity, compulsivity, sexual desire dysregulation and sexual addiction. No previous study investigated HD in a methylation analysis limited to microRNA (miRNA) associated CpG-sites. The genome wide methylation pattern was measured in whole blood from 60 subjects with HD and 33 healthy volunteers using the Illumina EPIC BeadChip. 8,852 miRNA associated CpG-sites were investigated in multiple linear regression analyses of methylation M-values to a binary independent variable of disease state (HD or healthy volunteer), adjusting for optimally determined covariates. Expression levels of candidate miRNAs were investigated in the same individuals for differential expression analysis. Candidate methylation loci were further studied for an association with alcohol dependence in an independent cohort of 107 subjects. Two CpG-sites were borderline significant in HD – cg18222192 (MIR708)(p < 10E-05,pFDR = 5.81E-02) and cg01299774 (MIR4456)(p < 10E-06, pFDR = 5.81E-02). MIR4456 was significantly lower expressed in HD in both univariate (p < 0.0001) and multivariate (p < 0.05) analyses. Cg01299774 methylation levels were inversely correlated with expression levels of MIR4456 (p < 0.01) and were also differentially methylated in alcohol dependence (p = 0.026). Gene target prediction and pathway analysis revealed that MIR4456 putatively targets genes preferentially expressed in brain and that are involved in major neuronal molecular mechanisms thought to be relevant for HD, e.g., the oxytocin signalling pathway. In summary, our study implicates a potential contribution of MIR4456 in the pathophysiology of HD by putatively influencing oxytocin signalling.
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Affiliation(s)
- Adrian E Boström
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | | | - Diana-Maria Ciuculete
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - John N Flanagan
- Andrology/Sexual Medicine Group (ANOVA), Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Regina Krattinger
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Marcus Bandstein
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Jessica Mwinyi
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Gerd A Kullak-Ublick
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Katarina Görts Öberg
- Andrology/Sexual Medicine Group (ANOVA), Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Arver
- Andrology/Sexual Medicine Group (ANOVA), Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Helgi B Schiöth
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden.,Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Jussi Jokinen
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden.,Department of Clinical Neuroscience/Psychiatry, Karolinska Institutet, Stockholm, Sweden
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24
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Efrati Y, Gola M. The Effect of Early Life Trauma on Compulsive Sexual Behavior among Members of a 12-Step Group. J Sex Med 2019; 16:803-811. [DOI: 10.1016/j.jsxm.2019.03.272] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/07/2019] [Accepted: 03/21/2019] [Indexed: 11/26/2022]
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25
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Rodriguez-Nieto G, Sack AT, Dewitte M, Emmerling F, Schuhmann T. Putting out the blaze: The neural mechanisms underlying sexual inhibition. PLoS One 2019; 14:e0208809. [PMID: 30601828 PMCID: PMC6314635 DOI: 10.1371/journal.pone.0208809] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 11/25/2018] [Indexed: 11/29/2022] Open
Abstract
The successful inhibition of sexual thoughts, desires, and behaviors represents an essential ability for adequate functioning in our daily life. Evidence derived from lesion studies indicates a link between sexual inhibition and the general ability for behavioral and cognitive control. This is further supported by the high comorbidity of sexual compulsivity with other inhibition-related disorders. Here, we aimed at investigating whether sexual and general inhibition recruit overlapping or distinct neural correlates in the brain. Furthermore, we investigated the specificity of two different kinds of sexual inhibition: inhibition of sexually driven motor responses and inhibition of sexual incoming information. To this end, 22 healthy participants underwent functional Magnetic Resonance Imaging (fMRI) while performing a task requiring general response inhibition (Go/No-go), as well as cognitive and motivational sexual inhibition (Negative Affective Priming and Approach-Avoidance task). Our within-subject within-session design enabled the direct statistical comparison between general and sexual inhibitory mechanisms. The general inhibition task recruited mainly prefrontal and insular regions, replicating previous findings. In contrast, the two types of sexual inhibition activated both common and distinct neural networks. Whereas cognitive sexual inhibition engaged the inferior frontal gyrus, the orbitofrontal cortex and the fusiform gyrus, motivational sexual inhibition was characterized by a hypoactivation in the anterolateral prefrontal cortex. Both types of sexual inhibition recruited the inferior frontal gyrus and the inferotemporal cortex. However, the activity of the inferior frontal gyrus did not correlate with behavioral inhibitory scores. These results support the hypothesis of inhibitory processing being an emergent property of a functional network.
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Affiliation(s)
- Geraldine Rodriguez-Nieto
- Brain Stimulation and Cognition Lab, Department of Cognitive Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Alexander T. Sack
- Brain Stimulation and Cognition Lab, Department of Cognitive Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Marieke Dewitte
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
| | | | - Teresa Schuhmann
- Brain Stimulation and Cognition Lab, Department of Cognitive Neuroscience, Maastricht University, Maastricht, Netherlands
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Efrati Y, Gola M. Understanding and predicting profiles of compulsive sexual behavior among adolescents. J Behav Addict 2018; 7:1004-1014. [PMID: 30378458 PMCID: PMC6376392 DOI: 10.1556/2006.7.2018.100] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/16/2018] [Accepted: 09/07/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND AIMS This two-study research was designed to define and predict profiles of compulsive sexual behavior (CSB) among non-clinical population of adolescents, and aimed to fill gaps in the current research. METHODS In Study 1 (N = 1,182), we examined the profiles of CSB among adolescents using latent profile analysis. Results revealed the following three clusters: abstainers, sexual fantasizers, and individuals with CSB. In Study 2 (N = 618), we replicated this classification and examined differences between the clusters in Big Five personality traits, locus of control, attachment orientations, loneliness, age, gender, socioeconomic status (SES), residence quality, use of pornography, and sex-related online activities. RESULTS Adolescents classified into different clusters significantly differed in personality traits, loneliness, age, SES, use of pornography, and sex-related online activities. Specifically, individuals with CSB had external locus of control, anxious attachment, greater loneliness, higher frequency of pornography use, and more sex-related online activities than the other groups. DISCUSSION The current research expands the knowledge about CSB by providing a more individualized approach to understanding CSB among adolescence.
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Affiliation(s)
- Yaniv Efrati
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
- Faculty of Education and Society and Culture, Beit-Berl Collage, Kfar Saba, Israel
| | - Mateusz Gola
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
- Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California San Diego, San Diego, CA, USA
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Stark R, Klucken T, Potenza MN, Brand M, Strahler J. A Current Understanding of the Behavioral Neuroscience of Compulsive Sexual Behavior Disorder and Problematic Pornography Use. Curr Behav Neurosci Rep 2018. [DOI: 10.1007/s40473-018-0162-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Kuiper LB, Coolen LM. Compulsive Sexual Behavior in Humans and Preclinical Models. CURRENT SEXUAL HEALTH REPORTS 2018. [DOI: 10.1007/s11930-018-0157-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Novati A, Yu-Taeger L, Gonzalez Menendez I, Quintanilla Martinez L, Nguyen HP. Sexual behavior and testis morphology in the BACHD rat model. PLoS One 2018; 13:e0198338. [PMID: 29883458 PMCID: PMC5993248 DOI: 10.1371/journal.pone.0198338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/17/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Huntington disease (HD) is an autosomal dominant neurodegenerative disorder caused by a mutation in the huntingtin (HTT) gene, which results in brain neurodegeneration and peripheral pathology affecting different organs including testis. Patients with HD suffer from motor and cognitive impairment, and multiple psychiatric symptoms. Among behavioral abnormalities in HD, sexual disturbances have often been reported, but scarcely investigated in animal models. The BACHD rat model of HD carries the human full-length mutated HTT (mHTT) genomic sequence with 97 CAG-CAA repeats and displays HD-like alterations at neuropathological and behavioral level. OBJECTIVE This study aims to phenotype the BACHD rats' sexual behavior and performance as well as testis morphology because alterations in these aspects have been associated to HD. METHODS Two rat cohorts at the age of 3 and 7 months were subjected to mating tests to assess different parameters of sexual behavior. Histological analyses for testis morphology were performed in different rat cohorts at 1.5, 7 and 12 months of age whereas immunohistochemical analyses were carried out at 7 and 12 months of age to visualize the presence of mHTT in testicular tissue. Furthermore, western blot analyses were used to assess HTT and mHTT expression levels in striatum and testis at three months of age. RESULTS At 3 months, BACHD rats showed a decreased time exploring the female anogenital area (AGA), decreased latency to mount, increased number of intromissions and ejaculations and enhanced hit rate. At 7 months, all sexual parameters were comparable between genotypes with the exception that BACHD rats explored the AGA less than wild type rats. Testis analyses did not reveal any morphological alteration at any of the examined ages, but showed presence of mHTT limited to Sertoli cells in transgenic rats at both 7 and 12 months. BACHD rat HTT and mHTT expression levels in testis were lower than striatum at 3 months of age. CONCLUSIONS The testis phenotype in the BACHD rat model does not mimic the changes observed in human HD testis. The altered sexual behavior in BACHD rats at three months of age could be to a certain extent representative of and share common underlying pathways with some of the sexual disturbances in HD patients. Further investigating the biological causes of the sexual phenotype in BACHD rats may therefore contribute to clarifying the mechanisms at the base of sexual behavior changes in HD.
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Affiliation(s)
- Arianna Novati
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- Centre for Rare Diseases, University of Tübingen, Tübingen, Germany
| | - Libo Yu-Taeger
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- Centre for Rare Diseases, University of Tübingen, Tübingen, Germany
| | - Irene Gonzalez Menendez
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center, University of Tübingen, Tübingen, Germany
| | - Leticia Quintanilla Martinez
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center, University of Tübingen, Tübingen, Germany
| | - Huu Phuc Nguyen
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- Centre for Rare Diseases, University of Tübingen, Tübingen, Germany
- Department of Human Genetics, University of Bochum, Bochum, Germany
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Abstract
Background and aims Sexuality is natural to human life and inseparable from it, yet some individuals develop compulsive sexual behavior (CSB). Many individuals with CSB seek treatment in free self-support groups based on the twelve-step program. This program was extensively studied in substance abuse disorders (e.g., Alcoholics Anonymous), but little is known about its efficiency in CSB. Methods We "assesed" questionnaire data on sociodemographical-, psychological-, and recovery-related factors from 97 male participants of Sexaholics Anonymous (SA) programs in Israel. Results Our results indicated that advancement in the SA program, measured as a current step of the program, is significantly related to lower levels of sexual-related overall sense of helplessness, avoidant help-seeking, self-control, overall CSB, and sexual suppression. It is also related to the higher well-being. Discussion This is the first study to examine psychological factors of CSB recovery process in twelve-step groups, and future research is needed to replicate our results within a longitudinal study.
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Affiliation(s)
- Yaniv Efrati
- Faculty of Education and Society and Culture, Beit-Berl College, Kfar Saba, Israel,Corresponding author: Yaniv Efrati, PhD; Faculty of Education and Society and Culture, Beit-Berl College, Kfar Saba 4490500, Israel; Phone: +972 545 800 094; E-mail:
| | - Mateusz Gola
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland,Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California San Diego, San Diego, CA, USA
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Efrati Y. Adolescents with a Disposition toward Compulsive Sexual Behavior: The Role of Shame in Willingness to Seek Help and Treatment. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/10720162.2018.1454371] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Efrati Y, Dannon P. Normative and Clinical Self-Perceptions of Sexuality and Their Links to Psychopathology among Adolescents. Psychopathology 2018; 51:380-389. [PMID: 30673673 DOI: 10.1159/000495842] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 11/25/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Compulsive sexual behavior (CSB) has been linked to psychopathology among adults. Only preliminary research has been conducted on adolescents. In our study, we examined whether CSB is linked to psychopathology among adolescents or whether it is a part of normal sexual development. We also, examined potential risk and resiliency factors that might influence this link. METHODS The study population included 311 high school students (184 males and 127 females) aged 16-18 years who completed self-report measures regarding CSB, psychopathology, temperament, and attachment orientations. RESULTS Adolescents with clinical CSB had more severe psychopathologies than nonclinical ones (with moderate and low levels of CSB) and were unable to utilize resilience factors (i.e., low negative affectivity, high effortful control, and/or attachment security). CONCLUSIONS Low and moderate levels of CSB seem to be part of the normal development of sexuality among adolescents. Clinical CSB seems to be a deviation from this normal development.
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Affiliation(s)
| | - Pinhas Dannon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Carnes S, Love T. Separating Models Obscures the Scientific Underpinnings of Sex Addiction as a Disorder. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:2253-2256. [PMID: 28948394 DOI: 10.1007/s10508-017-1072-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 08/30/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Stefanie Carnes
- American Foundation for Addiction Research, PO Box 3172, Carefree, AZ, 85377, USA.
| | - Todd Love
- Society for the Advancement of Sexual Health, Ardmore, PA, 19003, USA
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Park BY, Wilson G, Berger J, Christman M, Reina B, Bishop F, Klam WP, Doan AP. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports. Behav Sci (Basel) 2016; 6:E17. [PMID: 27527226 PMCID: PMC5039517 DOI: 10.3390/bs6030017] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/29/2016] [Accepted: 08/02/2016] [Indexed: 01/07/2023] Open
Abstract
Traditional factors that once explained men's sexual difficulties appear insufficient to account for the sharp rise in erectile dysfunction, delayed ejaculation, decreased sexual satisfaction, and diminished libido during partnered sex in men under 40. This review (1) considers data from multiple domains, e.g., clinical, biological (addiction/urology), psychological (sexual conditioning), sociological; and (2) presents a series of clinical reports, all with the aim of proposing a possible direction for future research of this phenomenon. Alterations to the brain's motivational system are explored as a possible etiology underlying pornography-related sexual dysfunctions. This review also considers evidence that Internet pornography's unique properties (limitless novelty, potential for easy escalation to more extreme material, video format, etc.) may be potent enough to condition sexual arousal to aspects of Internet pornography use that do not readily transition to real-life partners, such that sex with desired partners may not register as meeting expectations and arousal declines. Clinical reports suggest that terminating Internet pornography use is sometimes sufficient to reverse negative effects, underscoring the need for extensive investigation using methodologies that have subjects remove the variable of Internet pornography use. In the interim, a simple diagnostic protocol for assessing patients with porn-induced sexual dysfunction is put forth.
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Affiliation(s)
- Brian Y Park
- Flight Surgeon, Fleet Logistics Support Squadron 40, Norfolk, VA 34800 Bob Wilson Drive, San Diego, CA 92592, USA.
| | - Gary Wilson
- The Reward Foundation, 5 Rose Street, Edinburgh EH2 2PR, Scotland, UK.
| | - Jonathan Berger
- Department of Urology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92592, USA.
| | - Matthew Christman
- Department of Urology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92592, USA.
| | - Bryn Reina
- Department of Mental Health, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92592, USA.
| | - Frank Bishop
- Department of Ophthalmology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92592, USA.
| | - Warren P Klam
- Department of Mental Health, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92592, USA.
| | - Andrew P Doan
- Department of Mental Health, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92592, USA.
- Department of Ophthalmology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92592, USA.
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