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Perrotta G. The Concept of "Hypersexuality" in the Boundary between Physiological and Pathological Sexuality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105844. [PMID: 37239570 DOI: 10.3390/ijerph20105844] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
INTRODUCTION The concept of hypersexuality belongs to modern parlance, according to a predominantly clinical meaning, and is understood as a psychological and behavioural alteration as a result of which sexually motivated stimuli are sought in inappropriate ways and often experienced in a way that is not completely satisfactory. METHODS Literature up to February 2023 was reviewed, with 25 searches selected. RESULTS Forty-two articles were included in the review. CONCLUSION Hypersexuality is a potentially clinically relevant condition consisting of one or more dysfunctional and pathological behaviours of one's sexual sphere and graded according to the severity of impairment of subjective acting out; for this reason, the Perrotta Hypersexuality Global Spectrum of Gradation (PH-GSS) is suggested, which distinguishes high-functioning forms (pro-active and dynamic hypersexuality) from those of attenuated and corrupted functioning (dysfunctional and pathological hypersexuality of grades I and II). Future research is hoped to address the practical needs of this condition, such as the exact etiopathology, the role of oxytocin in dopaminergic hypotheses (and its ability to attenuate the symptomatology suffered by the patient in terms of manic drive), the best structural and functional personality framing of the subject, and the appropriate therapy to pursue.
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Affiliation(s)
- Giulio Perrotta
- Istituto per lo Studio delle Psicoterapie-ISP, Via San Martino Della Battaglia n. 31, 00185 Rome, Italy
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2
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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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3
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Boström ADE, Andersson P, Chatzittofis A, Savard J, Rask-Andersen M, Öberg KG, Arver S, Jokinen J. HPA-axis dysregulation is not associated with accelerated epigenetic aging in patients with hypersexual disorder. Psychoneuroendocrinology 2022; 141:105765. [PMID: 35452872 DOI: 10.1016/j.psyneuen.2022.105765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/15/2022] [Accepted: 04/10/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hypersexual disorder (HD) - a nonparaphilic sexual desire disorder with impulsivity component - was evaluated for inclusion as a diagnosis in the DSM-5 and the diagnosis compulsive sexual behavior disorder is included as an impulse control disorder in the ICD-11. Hypothalamic-pituitary-adrenal (HPA)-axis hyperactivity is believed to affect cellular senescence and has been implicated in HD. No previous study investigated HD or HPA-axis dysregulation in relation to measures of epigenetic age (EA) acceleration. METHODS This study reports on a case-control study set-up from a well-characterized cohort, contrasting EA predictors in relation to 60 HD patients and 33 healthy volunteers (HV) and 19 mixed HD/HV exhibiting dexamethasone suppression test (DST) non-suppression to 73 mixed HD/HV DST controls. The genome-wide methylation pattern was measured in whole blood from 94 subjects using the Illumina Infinium Methylation EPIC BeadChip and preprocessed according to specialized protocols suitable for epigenetic age estimation. The online DNAm Age Calculator (https://dnamage. GENETICS ucla.edu/) was implemented to retrieve various EA predictors, which were compared between the in-silico generated subgroups. RESULTS Quality control analyses indicated strong correlations between the EA measure DNA methylation GrimAge (DNAm GrimAge - the EA clock most reliably associated with mortality risk) and chronological age in all sub-groups. The study was adequately powered to detect differences of 2.5 and 3.0 years in DNAm GrimAge minus age in relation to both HD and HPA-axis dysregulation, respectively. Baseline DNAm GrimAge exceeded chronological age by 2.8 years on average across all samples. No EA acceleration marker was associated with HD or DST suppression status (p > 0.05). CONCLUSION EA acceleration markers shown to be strongly predictive of physiological dysregulation and mortality-risk, are not related to HD or DST non-suppression status (measured after 0.5 mg dexamethasone). The independency of HPA-axis dysregulation to EA acceleration does not support the biological relevance of this dosage-regimen when applied to patients with HD. These findings do not support the notion of accelerated cellular senescence in HD. Studies stratifying DST non-suppressors according to established dosage-regimens in somatic settings are needed to fully elucidate the putative contribution of HPA-axis dysregulation to EA.
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Affiliation(s)
- Adrian Desai E Boström
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden; Department of Women's and Children's Health/Neuropediatrics, Karolinska Institutet, Stockholm, Sweden.
| | - Peter Andersson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden
| | - Andreas Chatzittofis
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden; Medical School, University of Cyprus, Nicosia, Cyprus
| | - Josephine Savard
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
| | - Mathias Rask-Andersen
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Katarina G Öberg
- Anova, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Arver
- Anova, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jussi Jokinen
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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4
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Kürbitz LI, Wiessner C, Schoon W, Briken P, Schöttle D, Schröder J. Gender differences in the association of psychological distress and sexual compulsivity before and during the COVID-19 pandemic. J Behav Addict 2022; 11:533-543. [PMID: 35895475 PMCID: PMC9295247 DOI: 10.1556/2006.2022.00046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/20/2022] [Accepted: 05/31/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic had numerous consequences for general, mental and sexual health. As gender differences in sexual compulsivity (SC) have been reported in the past and SC has been connected to adverse events and psychological distress, the current study aims at investigating associations between these factors in the context of contact restrictions in the course of the COVID-19 pandemic in Germany. METHODS We collected data for five time points in four retrospective measurement points in an online convenience sample (n T0 = 399, n T4 = 77). We investigated the influence of gender, several pandemic-related psychosocial circumstances, sensation seeking (Brief Sensation Seeking Scale), and psychological distress (Patient-Health-Questionnaire-4) on the change of SC (measured with an adapted version of the Yale-Brown Obsessive Compulsive Scale) between T0 and T1 (n = 292) in a linear regression analysis. Additionally, the course of SC over the time of the pandemic was explored with a linear mixed model. RESULTS Male gender was associated with higher SC compared to female gender over all measurement points. An older age, being in a relationship, having a place to retreat was associated with a change to lower SC during the first time of the pandemic. Psychological distress was associated with SC in men, but not in women. Men, who reported an increase of psychological distress were also more likely to report an increase of SC. DISCUSSION The results demonstrate that psychological distress seems to correlate with SC differently for men and women. This could be due to different excitatory and inhibitory influences on men and women during the pandemic. Furthermore, the results demonstrate the impact of pandemic related psychosocial circumstances in the times of contact restrictions.
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Affiliation(s)
- Laura I. Kürbitz
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,Corresponding author. E-mail:
| | - Christian Wiessner
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wiebke Schoon
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Schöttle
- Department of Psychiatry and Psychotherapy, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johanna Schröder
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,Department of Psychology, Medical School Hamburg, Hamburg, Germany
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5
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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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6
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Stark R, Markert C, Kruse O, Walter B, Strahler J, Klein S. Individual cortisol response to acute stress influences neural processing of sexual cues. J Behav Addict 2022; 11:506-519. [PMID: 35895611 PMCID: PMC9295234 DOI: 10.1556/2006.2022.00037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/28/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND AIMS Problematic pornography use can be conceptualized as an impulse control disorder or alternatively as a behavioral addiction. Stress is an important trigger in addiction, but less is known about the neural effect of stress in problematic pornography use. Therefore, we aimed at investigating the effect of stress during the anticipation and viewing of sexually explicit material while considering person characteristics related to potentially being at risk for developing problematic pornography use. METHODS In an fMRI study (n = 157 men, age: mean = 25.46, SD = 4.11) we used a sexual incentive delay task. A social stress test was used to induce stress in half of the participants. Salivary cortisol was repeatedly measured and person characteristics were considered moderating the effects of cortisol response. RESULTS We found no group differences in the neural responses during the anticipation phase, but a higher reactivity to sexual stimuli in the dACC in the stress group. Acute stress activated a pronounced cortisol response, which positively correlated with neural activations in the reward system (NAcc, dACC) to sexual cues. Further, the individual time spent on pornography use moderated the effect of cortisol in some regions of the reward system (dACC, mOFC). DISCUSSION AND CONCLUSIONS Our results suggest that acute stress related increases in cortisol can enhance the incentive value of cues announcing sexual stimuli. This might explain why acute stress is considered a trigger of pornography use and relapse and why individual stress response might be a risk factor for developing a problematic pornography use.
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Affiliation(s)
- Rudolf Stark
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University of Giessen, Germany,Bender Institute of Neuroimaging, Justus Liebig University of Giessen, Germany,Center of Mind, Brain and Behavior, Universities of Marburg and Giessen, Germany,Corresponding author. E-mail:
| | - Charlotte Markert
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University of Giessen, Germany,Bender Institute of Neuroimaging, Justus Liebig University of Giessen, Germany,Center of Mind, Brain and Behavior, Universities of Marburg and Giessen, Germany
| | - Onno Kruse
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University of Giessen, Germany,Bender Institute of Neuroimaging, Justus Liebig University of Giessen, Germany
| | - Bertram Walter
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University of Giessen, Germany,Center of Mind, Brain and Behavior, Universities of Marburg and Giessen, Germany
| | - Jana Strahler
- Sportpsychology, Institute of Sport and Sport Sciences, University of Freiburg, Germany
| | - Sanja Klein
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University of Giessen, Germany,Bender Institute of Neuroimaging, Justus Liebig University of Giessen, Germany,Center of Mind, Brain and Behavior, Universities of Marburg and Giessen, Germany
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7
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Efrati Y, Goldman K, Levin K, Rosca P. Early-life trauma, negative and positive life events, compulsive sexual behavior disorder and risky sexual action tendencies among young women with substance use disorder. Addict Behav 2022; 133:107379. [PMID: 35659693 DOI: 10.1016/j.addbeh.2022.107379] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/25/2022] [Accepted: 05/25/2022] [Indexed: 11/01/2022]
Abstract
Although significant advances have been made in the field to date, gender-based issues for women remain a neglected area in much of substance abuse research. In the current study we examined two gaps in the literature: the co-occurrence of compulsive sexual behavior disorder (CSBD) and risky sexual action tendencies among women with substance use disorders (SUDs), and their shared antecedents in the form of early life adversity and negative life events. The sample comprised 132 women of whom 62 had substance use disorder (drug and alcohol) and 70 were healthy controls. Each participant completed self-report measures of drug abuse and alcoholism, compulsive sexual behavior disorder and risky sexual action tendencies as well as early-life trauma and negative and positive life events. Results indicate that young women with substance use disorder have higher compulsive sexual behavior disorder symptoms and more prevalent risky sexual action tendencies than controls. Compulsive sexual behavior was also found to mediate the association between substance use and risky sexual action tendencies. In addition, all addictive behaviors were linked with emotional abuse at childhood but not with other types of abuse. Conversely, negative life events in adulthood were only linked with CSBD and not with substance use. The findings provide deeper insights into the comorbidity of addictive behaviors and an opportunity for developing more effective treatments for women who suffer from these addictions.
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Flanagan J, Chatzittofis A, Boström ADE, Hallberg J, Öberg KG, Arver S, Jokinen J. High Plasma Oxytocin Levels in Men With Hypersexual Disorder. J Clin Endocrinol Metab 2022; 107:e1816-e1822. [PMID: 35108393 PMCID: PMC9016473 DOI: 10.1210/clinem/dgac015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Indexed: 01/23/2023]
Abstract
CONTEXT Hypersexual disorder (HD) involves excessive, persistent sexual behaviors related to various mood states and the diagnosis compulsive sexual behavior disorder is included as an impulse control disorder in the 11th revision of the International Classification of Diseases. Although the neurobiology behind the disorder is not clear, some studies suggest dysregulated hypothalamic-pituitary-adrenal axis. Oxytocin acts as counterregulatory neuroendocrine hormone to cortisol and is also involved in sexual behavior. OBJECTIVE We hypothesized that oxytocin may play a role in the pathophysiology of HD with compensatory actions to cortisol. DESIGN Longitudinal. SETTING ANOVA clinic (Karolinska University Hospital). PATIENTS OR OTHER PARTICIPANTS 64 males with HD and 38 age-matched healthy volunteers. MAIN OUTCOME MEASURES Plasma oxytocin levels, measured with radioimmunoassay; Hypersexual Disorder Screening Inventory; and Hypersexual Disorder: Current Assessment Scale for assessing hypersexual symptoms. INTERVENTIONS A patient subgroup (n = 30) completed the manual-based group-administered cognitive-behavioral therapy (CBT) program for HD, and posttreatment oxytocin levels were measured. RESULTS Hypersexual men (n = 64) exhibited significantly higher oxytocin plasma levels (mean ± SD: 31.0 ± 9.9 pM) compared with healthy volunteers (16.9 ± 3.9 pM; P < 0.001). There were significant positive correlations between oxytocin levels and the rating scales measuring hypersexual behavior. Patients who completed CBT treatment (n = 30) had a significant reduction of oxytocin plasma levels from pretreatment (30.5 ± 10.1 pM) to posttreatment (20.2 ± 8.0 pM; P < 0.001). CONCLUSIONS The results suggest that the hyperactive oxytocinergic system in hypersexual men may be a compensatory mechanism to attenuate hyperactive stress.
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Affiliation(s)
- John Flanagan
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Chatzittofis
- Medical School, University of Cyprus, Nicosia, Cyprus
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå,Sweden
- Correspondence: Andreas Chatzittofis, MD, PhD, University of Cyprus, Medical School, Palaios dromos Lefkosias Lemesou No.215/6 2029 Aglantzia, Nicosia, Cyprus.
| | - Adrian Desai E Boström
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå,Sweden
- Neuropaediatric Unit, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Hallberg
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Katarina Görts Öberg
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Stefan Arver
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jussi Jokinen
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå,Sweden
- Department of Clinical Neuroscience/Psychiatry, Karolinska Institutet, Stockholm, Sweden
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9
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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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10
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Chatzittofis A, Boström ADE, Ciuculete DM, Öberg KG, Arver S, Schiöth HB, Jokinen J. HPA axis dysregulation is associated with differential methylation of CpG-sites in related genes. Sci Rep 2021; 11:20134. [PMID: 34635736 PMCID: PMC8505644 DOI: 10.1038/s41598-021-99714-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/27/2021] [Indexed: 11/01/2022] Open
Abstract
DNA methylation shifts in Hypothalamic-pituitary-adrenal (HPA) axis related genes is reported in psychiatric disorders including hypersexual disorder. This study, comprising 20 dexamethasone suppression test (DST) non-suppressors and 73 controls, examined the association between the HPA axis dysregulation, shifts in DNA methylation of HPA axis related genes and importantly, gene expression. Individuals with cortisol level ≥ 138 nmol/l, after the low dose (0.5 mg) dexamethasone suppression test (DST) were classified as non-suppressors. Genome-wide methylation pattern, measured in whole blood using the EPIC BeadChip, investigated CpG sites located within 2000 bp of the transcriptional start site of key HPA axis genes, i.e.: CRH, CRHBP, CRHR-1, CRHR-2, FKBP5 and NR3C1. Regression models including DNA methylation M-values and the binary outcome (DST non-suppression status) were performed. Gene transcripts with an abundance of differentially methylated CpG sites were identified with binomial tests. Pearson correlations and robust linear regressions were performed between CpG methylation and gene expression in two independent cohorts. Six of 76 CpG sites were significantly hypermethylated in DST non-suppressors (nominal P < 0.05), associated with genes CRH, CRHR1, CRHR2, FKBP5 and NR3C1. NR3C1 transcript AJ877169 showed statistically significant abundance of probes differentially methylated by DST non-suppression status and correlated with DST cortisol levels. Further, methylation levels of cg07733851 and cg27122725 were positively correlated with gene expression levels of the NR3C1 gene. Methylation levels of cg08636224 (FKBP5) correlated with baseline cortisol and gene expression. Our findings revealed that DNA methylation shifts are involved in the altered mechanism of the HPA axis suggesting that new epigenetic targets should be considered behind psychiatric disorders.
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Affiliation(s)
- Andreas Chatzittofis
- Medical School, University of Cyprus, 1678, Nicosia, Cyprus. .,Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden.
| | - Adrian Desai E Boström
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden.,Neuropaediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Katarina Görts Öberg
- Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Stefan Arver
- Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Helgi B Schiöth
- Department of Neuroscience, 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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11
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Soraci P, Melchiori FM, Del Fante E, Melchiori R, Guaitoli E, Lagattolla F, Parente G, Bonanno E, Norbiato L, Cimaglia R, Campedelli L, Abbiati FA, Ferrari A, Griffiths MD. Validation and Psychometric Evaluation of the Italian Version of the Bergen-Yale Sex Addiction Scale. Int J Ment Health Addict 2021; 21:1-27. [PMID: 34393683 PMCID: PMC8351585 DOI: 10.1007/s11469-021-00597-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 11/06/2022] Open
Abstract
Excessive problematic sexual behavior in the form of compulsive sexual behavior disorder (CSBD), hypersexuality (HS), and sex addiction has gained increasing credibility in recent years and has led to the development of various psychometric instruments to assess such behavior. However, there is still considerable controversy over the operational definition of such concepts and whether they can be used interchangeably to describe the behavior. One recently developed tool is the Bergen-Yale Sex Addiction Scale (BYSAS) based on the "components model of addiction." The present study validated the Italian version of the BYSAS. The BYSAS was administered to a large Italian-speaking sample of Italian adults [N = 1230, aged 18 to 67 years] along with psychometric instruments assessing the "Big Five" personality traits, self-esteem, depression, and two other measures of addictive sexual behavior (i.e., PATHOS and Shorter PROMIS Questionnaire-Sex Subscale). Confirmatory factorial analysis supported a one-factor solution. Furthermore, the scale had good internal consistency (Cronbach's α = 0.787). The BYSAS was positively associated with extroversion, openness to experience, depression, and problematic sexual behavior, and negatively associated with self-esteem, conscientiousness, emotional stability, agreeableness, and age. Based on the findings, the BYSAS is a brief, psychometrically reliable and valid measure for assessing sex addiction among Italian adults.
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Affiliation(s)
- Paolo Soraci
- Associazione Psicoterapia Cognitivo Comportamentale Di Gruppo, Rome, Italy
| | | | - Elena Del Fante
- Department of Psychology, Università degli Studi di Torino–UNITO, Turin, Italy
| | - Roberto Melchiori
- Faculty of Educational Sciences, University Niccolò Cusano, Rome, Italy
| | - Eleonora Guaitoli
- Department of General Surgery, Perrino Hospital Brindisi, Brindisi, Italy
| | - Fulvia Lagattolla
- Servizio Di Psiconcologia, IRCCS Istituto Tumori “Giovanni Paolo II” Di Bari, Bari, Italy
| | - Grazia Parente
- Associazione Matrice Orientamento E Formazione Onlus, Bari, Italy
| | - Enrico Bonanno
- Department of Environmental Research and Innovation, Luxembourg Institute of Science and Technology, Belvaux, Luxembourg
| | | | - Roberta Cimaglia
- Istituto Romano Di Psicoterapia Psicodinamica Integrata, Rome, Italy
| | | | | | - Ambra Ferrari
- Department of Human Science for Education, Università Degli Studi Di Milano, Bicocca, Milan Italy
| | - Mark D. Griffiths
- International Gaming Unit, Psychology Department, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ UK
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12
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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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13
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Efrati Y, Amichai-Hamburger Y. Adolescents who solely engage in online sexual experiences are at higher risk for compulsive sexual behavior. Addict Behav 2021; 118:106874. [PMID: 33647708 DOI: 10.1016/j.addbeh.2021.106874] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/07/2021] [Accepted: 02/07/2021] [Indexed: 01/20/2023]
Abstract
In addition to its expression offline, sexual behavior is frequently expressed online. Some adolescents solely engage in online sexual activities, whereas others in offline and online activities, or have no sexual experience at all. In the current research, we examined whether those who solely engage in online sexual activities are at greater risk for compulsive sexual behavior. In Study 1 (n = 164), we examined differences in compulsive sexual behavior (CSB) and risky sexual action tendencies between study groups. In Study 2 (n = 713), we statistically replicated the classification into different sexual behaviors and examined differences between the clusters in CSB, social tendencies and socio-demographic measures. Results indicated that adolescents who only engaged in online sexual activities had significantly higher percentage of clinical CSB, were less likely boys and more likely to be religious. There were not more prone to risky sexual behavior, however. The current research expands the knowledge about offline or online sexually related activities among adolescence.
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Affiliation(s)
| | - Yair Amichai-Hamburger
- The Research Center for Internet Psychology (CIP), Sammy Ofer School of Communication, The Interdisciplinary Center (IDC) Herzliya, Herzliya 46150, Israel
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14
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Campana G, Loizzo S, Fortuna A, Rimondini R, Maroccia Z, Scillitani A, Falchetti A, Spampinato SM, Persani L, Chiodini I. Early post-natal life stress induces permanent adrenocorticotropin-dependent hypercortisolism in male mice. Endocrine 2021; 73:186-195. [PMID: 33630246 DOI: 10.1007/s12020-021-02659-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/10/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE It has been hypothesized that specific early-life stress (ES) procedures on CD-1 male mice produce diabetes-like alterations due to the failure of negative feedback of glucocorticoid hormone in the pituitary. The aim of this study is to investigate the possible mechanism that leads to this pathological model, framing it in a more specific clinical condition. METHODS Metabolic and hypothalamic-pituitary-adrenal-related hormones of stressed mice (SM) have been analyzed immediately after stress procedures (21 postnatal days, PND) and after 70 days of a peaceful (unstressed) period (90 PND). These data have been compared to parameters from age-matched controls (CTR), and mice treated during ES procedures with oligonucleotide antisense for pro-opiomelanocortin (AS-POMC). RESULTS At 21 PND, SM presented an increased secretion of hypothalamic CRH and pituitary POMC-derived peptides, as well as higher plasmatic levels of ACTH and corticosterone vs. CTR. At 90 PND, SM showed hyperglycemia, with suppression of hypothalamic CRH, while pituitary and plasmatic ACTH levels, as well as plasma corticosterone, were constantly higher than in CTR. These values are accompanied by a progressive acceleration in gaining total body weight, which became significant vs. CTR at 90 PND together with a higher pituitary weight. Treatment with AS-POMC prevented all hormonal and metabolic alterations observed in SM, both at 21 and 90 PND. CONCLUSIONS These findings show that these specific ES procedures affect the negative glucocorticoid feedback in the pituitary, but not in the hypothalamus, suggesting a novel model of ACTH-dependent hypercortisolism that can be prevented by silencing the POMC gene.
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Affiliation(s)
- Gabriele Campana
- Department of Pharmacy and Biotechnology, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Stefano Loizzo
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
| | - Andrea Fortuna
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Roberto Rimondini
- Department of Medical and Clinical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Zaira Maroccia
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Alfredo Scillitani
- Endocrinology and Diabetology, Ospedale "Casa Sollievo della sofferenza" IRCCS, Viale Cappuccini 1, 71013, San Giovanni Rotondo, Foggia, Italy
| | - Alberto Falchetti
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122, Milan, Italy
| | - Santi Mario Spampinato
- Department of Pharmacy and Biotechnology, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Luca Persani
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122, Milan, Italy
- Division of Endocrine and Metabolic Diseases & Laboratory of Endocrine and Metabolic Research, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
| | - Iacopo Chiodini
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122, Milan, Italy
- Division of Endocrine and Metabolic Diseases & Laboratory of Endocrine and Metabolic Research, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
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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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The Addictive Nature of Compulsive Sexual Behaviours and Problematic Online Pornography Consumption: A Review. CANADIAN JOURNAL OF ADDICTION 2020. [DOI: 10.1097/cxa.0000000000000091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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17
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Li Z, Gao C, Peng J, Liu M, Cong B. Multi-omics analysis of pathological changes in the amygdala of rats subjected to chronic restraint stress. Behav Brain Res 2020; 392:112735. [PMID: 32502515 DOI: 10.1016/j.bbr.2020.112735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Overwhelming stress potentially results in the occurrence of many mental diseases. The amygdala is one region in the brain targeted by stress. Recent studies have shown that changes in the amygdala of subjects under stress are related to depression, anxiety and post-traumatic stress disorder (PTSD). However, researchers have not clearly elucidated the changes in the amygdala in response to stress and the underlying mechanism. We conducted several experiments to understand this mechanism. METHODS In this study, we first established a rat model of chronic restraint stress (CRS) and observed the changes in behavior and neurons in the amygdala. Second, an integrated metabolomics and proteomics experiment was conducted to identify potential stress-related biomarkers. Finally, we validated two molecules of interest and detected four apoptosis-related proteins using Western blotting to further determine the related mechanisms. RESULTS Our study revealed the presence of anxiety-like behaviors and pathological changes in amygdalar neurons in the rat model. In the multi-omics analysis, 19 potential molecules were identified. Western blotting confirmed consistent changes in the levels of Cry1 and Brcc36 obtained in previous results. The levels of proteins in the ataxia telangiectasia mutated (ATM) pathway were increased in the CRS group. CONCLUSIONS CRS causes anxiety-like behaviors that are potentially related to decreased levels of GABA in the amygdala. Moreover, CRS potentially alters the levels of Cry1 and Brcc36 and results in circadian rhythm disorder and impairments in DNA repair and apoptosis in the amygdala through a mechanism mediated by the ATM pathway.
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Affiliation(s)
- Zhonghua Li
- West China School of Basic Medical Sciences & Forensic Science, Sichuan University, Chengdu, 610041 China; Procuratorial Technology Department of the People's Procuratorate of Sichuan Province, Chengdu, 610041 China
| | - Chong Gao
- Procuratorial Technology Information Center of the Supreme People's Procuratorate, Beijing, 100726 China
| | - Jin Peng
- West China School of Basic Medical Sciences & Forensic Science, Sichuan University, Chengdu, 610041 China
| | - Min Liu
- West China School of Basic Medical Sciences & Forensic Science, Sichuan University, Chengdu, 610041 China
| | - Bin Cong
- West China School of Basic Medical Sciences & Forensic Science, Sichuan University, Chengdu, 610041 China; Department of Forensic Medicine, Hebei Medical University, Shijiazhuang, 050017 China.
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18
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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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19
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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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20
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Abstract
PURPOSE OF REVIEW We reviewed recent data on sexual addiction and its treatment. We examined the different definitions of this disorder, related to the pathophysiological mechanisms. We addressed the pharmacological treatment of sexual addiction. RECENT FINDINGS Hypersexual behavior can be considered an addictive disorder. Sexual addiction is accompanied by significant psychiatric and addictive comorbidities and is responsible for life impairment. A comprehensive and efficient treatment must be proposed. Selective serotonin reuptake inhibitors seem the first-line pharmacological treatment for sexual addiction. Naltrexone could be another therapeutic option. Psychotherapy and preferentially cognitive-behavioral therapy should be used in association with pharmacotherapy and treatments of comorbidities.
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Affiliation(s)
- Leo Malandain
- Department of Adult Psychiatry and Medical Psychology, Saint-Antoine Hospital, Sorbonne Université, AP-HP, Paris, France.
| | - Jean-Victor Blanc
- Department of Adult Psychiatry and Medical Psychology, Saint-Antoine Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Florian Ferreri
- Department of Adult Psychiatry and Medical Psychology, Saint-Antoine Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Florence Thibaut
- University Hospital Cochin (site Tarnier), Paris University, AP-HP, Paris, France
- INSERM U1266, Institute of Psychiatry and Neurosciences, Paris, France
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21
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Chatzittofis A, Boström AE, Öberg KG, Flanagan JN, Schiöth HB, Arver S, Jokinen J. Normal Testosterone but Higher Luteinizing Hormone Plasma Levels in Men With Hypersexual Disorder. Sex Med 2020; 8:243-250. [PMID: 32173350 PMCID: PMC7261685 DOI: 10.1016/j.esxm.2020.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/22/2020] [Accepted: 02/05/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Hypersexual disorder as suggested to be included in the Diagnostic and Statistical Manual of Mental Disorders-5 integrates aspects of sexual desire deregulation, impulsivity, and compulsivity. However, it is unknown how it affects gonadal activity and the function of the hypothalamus-pituitary-gonadal (HPG) axis. AIM The aim of this study was to investigate testosterone and luteinizing hormone (LH) levels in hypersexual men compared with healthy controls. Furthermore, we investigated associations between epigenetic markers and hormone levels. METHODS Basal morning plasma levels of testosterone, LH, and sex hormone-binding globulin (SHBG) were assessed in 67 hypersexual men (mean age: 39.2 years) compared with 39 age-matched healthy controls (mean age: 37.5 years). The Sexual Compulsivity Scale and the Hypersexual Disorder: Current Assessment Scale were used for assessing hypersexual behavior, the Montgomery-Åsberg Depression Scale-self rating was used for depression severity, and the Childhood Trauma Questionnaire (CTQ) was used for assessing history of childhood adversity. The genome-wide methylation pattern of more than 850 K CpG sites was measured in whole blood using the Illumina Infinium Methylation EPIC BeadChip. CpG sites located within 2,000 bp of the transcriptional start site of hypothalamus pituitary adrenal (HPA) and HPG axis-coupled genes were included. MAIN OUTCOME MEASURES Testosterone and LH plasma levels in association with clinical rating and a secondary outcome was the epigenetic profile of HPA and HPG axis-coupled CpG sites with testosterone and LH levels. RESULTS LH plasma levels were significantly higher in patients with hypersexual disorder than in healthy volunteers. No significant differences in plasma testosterone, follicle stimulating hormone, prolactin, and SHBG levels were found between the groups. There were no significant associations between DNA methylation of HPA and HPG axis-coupled genes and plasma testosterone or LH levels after multiple testing corrections. CONCLUSIONS Subtle dysregulation of the HPG axis, with increased LH plasma levels but no difference in testosterone levels may be present in hypersexual men. Chatzittofis A, Boström AE, Öberg KG, et al. Normal Testosterone but Higher Luteinizing Hormone Plasma Levels in Men With Hypersexual Disorder. Sex Med 2020;8:243-250.
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Affiliation(s)
- Andreas Chatzittofis
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden; Medical School, University of Cyprus, Nicosia, Cyprus.
| | | | - Katarina Görts Öberg
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Sweden
| | - John N Flanagan
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Sweden
| | - Helgi B Schiöth
- Department of Neuroscience, Uppsala University, Uppsala, Sweden; Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Stefan Arver
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Sweden
| | - Jussi Jokinen
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden; Department of Clinical Neuroscience/Psychiatry, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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22
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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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23
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Cowie ME, Kim HS, Hodgins DC, McGrath DS, Scanavino MDT, Tavares H. Demographic and psychiatric correlates of compulsive sexual behaviors in gambling disorder. J Behav Addict 2019; 8:451-462. [PMID: 31416337 PMCID: PMC7044634 DOI: 10.1556/2006.8.2019.35] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND AIMS Gambling disorder (GD) and compulsive sexual behavior (CSB) may commonly co-occur. Yet, the psychiatric correlates of these co-occurring disorders are an untapped area of empirical scrutiny, limiting our understanding of appropriate treatment modalities for this dual-diagnosed population. This study examined the demographic and clinical correlates of CSB in a sample of treatment-seeking individuals with GD (N = 368) in São Paulo, Brazil. METHODS Psychiatrists and psychologists conducted semi-structured clinical interviews to identify rates of CSB and other comorbid psychiatric disorders. The Shorter PROMIS Questionnaire was administered to assess additional addictive behaviors. The TCI and BIS-11 were used to assess facets of personality. Demographic and gambling variables were also assessed. RESULTS Of the total sample, 24 (6.5%) met diagnostic criteria for comorbid CSB (GD + CSB). Compared to those without compulsive sexual behaviors (GD - CSB), individuals with GD + CSB were more likely to be younger and male. No differences in gambling involvement emerged. Individuals with GD + CSB tended to have higher rates of psychiatric disorders (depression, post-traumatic stress disorder, and bulimia nervosa) and engage in more addictive behaviors (problematic alcohol use, drug use, and exercise) compared to GD - CSB. Those with GD + CSB evidenced less self-directedness, cooperativeness, self-transcendence, and greater motor impulsivity. Logistic regression showed that the predictors of GD + CSB, which remained in the final model, were being male, a diagnosis of bulimia, greater gambling severity, and less self-transcendence. DISCUSSION AND CONCLUSION Given those with GD + CSB evidence greater psychopathology, greater attention should be allocated to this often under studied comorbid condition to ensure adequate treatment opportunities.
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Affiliation(s)
- Megan E. Cowie
- Addictive Behaviours Laboratory, Department of Psychology, University of Calgary, Calgary, AB, Canada,Corresponding author: Megan E. Cowie; Addictive Behaviours Laboratory, Department of Psychology, University of Calgary, Room AD 240, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; Phone: +1 403 210 9580; E-mail:
| | - Hyoun S. Kim
- Addictive Behaviours Laboratory, Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - David C. Hodgins
- Addictive Behaviours Laboratory, Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Daniel S. McGrath
- Addictive Behaviours Laboratory, Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Marco D. T. Scanavino
- Outpatient Unit for Excessive Sexual Drive and Prevention of Negative Outcomes Associated with Sexual Behavior, Institute of Psychiatry, Clinicas’ Hospital, University of São Paulo Medical School, São Paulo, Brazil,Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil,Experimental Pathophysiology, Post-Graduation Program, Medical School, University of São Paulo, São Paulo, Brazil
| | - Hermano Tavares
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil,Impulse Control Disorders and Behavioral Addictions Outpatient Unit, Institute and Department of Psychiatry, University of São Paulo, São Paulo, Brazil
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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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Hallberg J, Kaldo V, Arver S, Dhejne C, Jokinen J, Öberg KG. A Randomized Controlled Study of Group-Administered Cognitive Behavioral Therapy for Hypersexual Disorder in Men. J Sex Med 2019; 16:733-745. [DOI: 10.1016/j.jsxm.2019.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 02/26/2019] [Accepted: 03/02/2019] [Indexed: 10/27/2022]
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Brown A, Fiori LM, Turecki G. Bridging Basic and Clinical Research in Early Life Adversity, DNA Methylation, and Major Depressive Disorder. Front Genet 2019; 10:229. [PMID: 30984237 PMCID: PMC6448008 DOI: 10.3389/fgene.2019.00229] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 03/01/2019] [Indexed: 12/13/2022] Open
Abstract
Early life adversity (ELA)- including childhood physical, emotional, and sexual abuse, as well as childhood neglect- is an important predictive factor for negative psychopathology, including Major Depressive Disorder (MDD). ELA can epigenetically regulate key emotional and behavioral systems in ways that can stably persist into adulthood and contribute to the development of MDD and other psychopathology. DNA methylation has been one of the most investigated forms of epigenetic regulation in ELA to MDD pathway. From these studies, genes and sites associated with ELA/MDD have been identified and should be further investigated in order to identify potential avenues for intervention.
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Affiliation(s)
- Amanda Brown
- McGill Group for Suicide Studies, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Laura M Fiori
- McGill Group for Suicide Studies, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Department of Psychiatry, McGill University, Montreal, QC, Canada
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Fisher WA, Montgomery-Graham S, Kohut T. Pornography Problems Due to Moral Incongruence. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:425-429. [PMID: 30128983 DOI: 10.1007/s10508-018-1291-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/06/2018] [Indexed: 05/25/2023]
Affiliation(s)
- William A Fisher
- Department of Psychology, Western University, London, ON, N6G 2 V4, Canada
| | | | - Taylor Kohut
- Department of Psychology, Western University, London, ON, N6G 2 V4, Canada
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de Alarcón R, de la Iglesia JI, Casado NM, Montejo AL. Online Porn Addiction: What We Know and What We Don't-A Systematic Review. J Clin Med 2019; 8:E91. [PMID: 30650522 PMCID: PMC6352245 DOI: 10.3390/jcm8010091] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/27/2018] [Accepted: 01/10/2019] [Indexed: 01/09/2023] Open
Abstract
In the last few years, there has been a wave of articles related to behavioral addictions; some of them have a focus on online pornography addiction. However, despite all efforts, we are still unable to profile when engaging in this behavior becomes pathological. Common problems include: sample bias, the search for diagnostic instrumentals, opposing approximations to the matter, and the fact that this entity may be encompassed inside a greater pathology (i.e., sex addiction) that may present itself with very diverse symptomatology. Behavioral addictions form a largely unexplored field of study, and usually exhibit a problematic consumption model: loss of control, impairment, and risky use. Hypersexual disorder fits this model and may be composed of several sexual behaviors, like problematic use of online pornography (POPU). Online pornography use is on the rise, with a potential for addiction considering the "triple A" influence (accessibility, affordability, anonymity). This problematic use might have adverse effects in sexual development and sexual functioning, especially among the young population. We aim to gather existing knowledge on problematic online pornography use as a pathological entity. Here we try to summarize what we know about this entity and outline some areas worthy of further research.
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Affiliation(s)
- Rubén de Alarcón
- Psychiatry Service, Hospital Clínico Universitario de Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain.
| | - Javier I de la Iglesia
- Psychiatry Service, Hospital Clínico Universitario de Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain.
| | - Nerea M Casado
- Psychiatry Service, Hospital Clínico Universitario de Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain.
| | - Angel L Montejo
- Psychiatry Service, Hospital Clínico Universitario de Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain.
- University of Salamanca, EUEF, 37007 Salamanca, Spain.
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Coleman E, Dickenson JA, Girard A, Rider GN, Candelario-Pérez LE, Becker-Warner R, Kovic AG, Munns R. An Integrative Biopsychosocial and Sex Positive Model of Understanding and Treatment of Impulsive/Compulsive Sexual Behavior. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/10720162.2018.1515050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Eli Coleman
- University of Minnesota, Minneapolis, Minnesota
| | | | - Abby Girard
- University of Minnesota, Minneapolis, Minnesota
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30
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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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Scanavino MD, Ventuneac A, Abdo CH, Tavares H, Amaral ML, Messina B, Reis SC, Martins JP, Parsons JT. Sexual compulsivity, anxiety, depression, and sexual risk behavior among treatment-seeking men in São Paulo, Brazil. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2018; 40:424-431. [PMID: 29898197 PMCID: PMC6899385 DOI: 10.1590/1516-4446-2017-2476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 12/07/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE There is a lack of studies on negative mood states and sexual risk behavior in men of all sexual orientations who seek treatment for excessive sexual behavior (ESB). We aim to examine sexual compulsivity (SC), anxiety, depression, and sexual risk behavior in a treatment-seeking sample of men and controls. METHODS We enrolled 88 (37 [42%] gay or bisexual and 51 [58%] heterosexual) ESB outpatients and 64 controls. Assessments included the Sexual Compulsivity Scale (SCS), the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI), and sexual risk behaviors. RESULTS Compared to controls, ESB outpatients showed increased SC, anxiety, and depression, which were correlated. Regarding sex with casual partners, ESB outpatients reported more sexual intercourse, a greater number of partners, more anal intercourse, and unprotected anal intercourse. Anxiety, depression, and SC were associated with protected vaginal intercourse with a main partner, whereas they were associated with unprotected anal intercourse with a casual partner. Depression was associated with unprotected vaginal intercourse with a casual partner. Condomless anal intercourse was predicted by SC and was also reported by the heterosexual ESB outpatients (36%). CONCLUSION The data contribute to the field by providing information on men of all sexual orientations who are searching for mental healthcare. The connections among these psychopathological factors and sexual risk behavior have implications for public health, clinicians, and research.
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Affiliation(s)
- Marco D.T. Scanavino
- Ambulatório de Impulso Sexual Excessivo e Prevenção de Desfechos Negativos Associados ao Comportamento Sexual (AISEP), Instituto de Psiquiatria (IPq), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
- Departamento de Psiquiatria, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Ana Ventuneac
- Center for HIV Educational Studies & Training (CHEST), New York, NY, USA
| | - Carmita H.N. Abdo
- Departamento de Psiquiatria, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Hermano Tavares
- Departamento de Psiquiatria, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Maria L.S. Amaral
- Ambulatório de Impulso Sexual Excessivo e Prevenção de Desfechos Negativos Associados ao Comportamento Sexual (AISEP), Instituto de Psiquiatria (IPq), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Bruna Messina
- Ambulatório de Impulso Sexual Excessivo e Prevenção de Desfechos Negativos Associados ao Comportamento Sexual (AISEP), Instituto de Psiquiatria (IPq), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Sirlene C. Reis
- Ambulatório de Impulso Sexual Excessivo e Prevenção de Desfechos Negativos Associados ao Comportamento Sexual (AISEP), Instituto de Psiquiatria (IPq), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
- Departamento de Psiquiatria, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - João P.L.B. Martins
- Ambulatório de Impulso Sexual Excessivo e Prevenção de Desfechos Negativos Associados ao Comportamento Sexual (AISEP), Instituto de Psiquiatria (IPq), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Jeffrey T. Parsons
- Center for HIV Educational Studies & Training (CHEST), New York, NY, USA
- Department of Psychology, Hunter College, City University of New York (CUNY), New York, NY, USA
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center, CUNY, New York, NY, USA
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32
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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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Walton MT, Cantor JM, Bhullar N, Lykins AD. Hypersexuality: A Critical Review and Introduction to the "Sexhavior Cycle". ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:2231-2251. [PMID: 28687897 DOI: 10.1007/s10508-017-0991-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 04/03/2017] [Accepted: 04/12/2017] [Indexed: 05/03/2023]
Abstract
An empirical review of hypersexuality is timely as "compulsive sexual behavior" is being considered as an impulse control disorder for inclusion in the forthcoming International Classification of Diseases, 11th ed. Specifically, hypersexuality has been conceptualized in the literature as the inability to regulate one's sexual behavior that is a source of significant personal distress. Various theoretical models have been posited in an attempt to understand the occurrence of hypersexuality, although disagreement about these divergent conceptualizations of the condition has made assessment and treatment of hypersexual clients more challenging. Theories of sexual compulsivity, sexual impulsivity, dual control (sexual inhibition/excitation), and sex addiction are critically examined, as are the diagnostic criteria for clinically assessing hypersexuality as a sexual disorder. Our discussion of hypersexuality covers a diversity of research and clinical perspectives. We also address various challenges associated with reliably defining, psychometrically measuring, and diagnosing hypersexuality. Furthermore, literature is reviewed that expresses concerns regarding whether hypersexuality (conceptualized as a disorder) exists, whether it is simply normophilic behavior at the extreme end of sexual functioning, or alternatively is a presenting problem that requires treatment rather than a clinical diagnosis. Following our literature review, we developed the "sexhavior cycle of hypersexuality" to potentially explain the neuropsychology and maintenance cycle of hypersexuality. The sexhavior cycle suggests that, for some hypersexual persons, high sexual arousal may temporarily and adversely impact cognitive processing (cognitive abeyance) and explain a repeated pattern of psychological distress when interpreting one's sexual behavior (sexual incongruence). We also suggest that further research is required to validate whether hypersexuality is a behavioral disorder (such as gambling), although some presentations of the condition appear to be symptomatic of a heterogeneous psychological problem that requires treatment.
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Affiliation(s)
- Michael T Walton
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW, 2351, Australia
| | - James M Cantor
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Navjot Bhullar
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW, 2351, Australia
| | - Amy D Lykins
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW, 2351, Australia.
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Chatzittofis A, Savard J, Arver S, Öberg KG, Hallberg J, Nordström P, Jokinen J. Interpersonal violence, early life adversity, and suicidal behavior in hypersexual men. J Behav Addict 2017; 6:187-193. [PMID: 28467102 PMCID: PMC5520124 DOI: 10.1556/2006.6.2017.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background and aims There are significant gaps in knowledge regarding the role of childhood adversity, interpersonal violence, and suicidal behavior in hypersexual disorder (HD). The aim of this study was to investigate interpersonal violence in hypersexual men compared with healthy volunteers and the experience of violence in relation to suicidal behavior. Methods This case-control study includes 67 male patients with HD and 40 healthy male volunteers. The Childhood Trauma Questionnaire - Short Form (CTQ-SF) and the Karolinska Interpersonal Violence Scale (KIVS) were used for assessing early life adversity and interpersonal violence in childhood and in adult life. Suicidal behavior (attempts and ideation) was assessed with the Mini-International Neuropsychiatric Interview (version 6.0) and the Montgomery-Åsberg Depression Rating Scale - Self-rating. Results Hypersexual men reported more exposure to violence in childhood and more violent behavior as adults compared with healthy volunteers. Suicide attempters (n = 8, 12%) reported higher KIVS total score, more used violence as a child, more exposure to violence as an adult as well as higher score on CTQ-SF subscale measuring sexual abuse (SA) compared with hypersexual men without suicide attempt. Discussion Hypersexuality was associated with interpersonal violence with higher total scores in patients with a history of suicide attempt. The KIVS subscale exposure to interpersonal violence as a child was validated using the CTQ-SF but can be complemented with questions focusing on SA for full assessment of early life adversity. Conclusion Childhood adversity is an important factor in HD and interpersonal violence might be related to suicidal behavior in hypersexual men.
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Affiliation(s)
- Andreas Chatzittofis
- Department of Clinical Neuroscience/Psychiatry, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden,Medical School, University of Cyprus, Nicosia, Cyprus,Corresponding author: Andreas Chatzittofis; Department of Clinical Neuroscience/Psychiatry, Karolinska Institutet, Karolinska University Hospital, Solna, SE-171 76 Stockholm, Sweden; Phone: +46 7 00289786; Fax: +46 8 303706; E-mail:
| | - Josephine Savard
- Department of Clinical Neuroscience/Psychiatry, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Stefan Arver
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Katarina Görts Öberg
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Hallberg
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Nordström
- Department of Clinical Neuroscience/Psychiatry, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jussi Jokinen
- Department of Clinical Neuroscience/Psychiatry, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden,Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
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Jokinen J, Boström AE, Chatzittofis A, Ciuculete DM, Öberg KG, Flanagan JN, Arver S, Schiöth HB. Methylation of HPA axis related genes in men with hypersexual disorder. Psychoneuroendocrinology 2017; 80:67-73. [PMID: 28319850 DOI: 10.1016/j.psyneuen.2017.03.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/26/2017] [Accepted: 03/03/2017] [Indexed: 12/21/2022]
Abstract
Hypersexual Disorder (HD) defined as non-paraphilic sexual desire disorder with components of compulsivity, impulsivity and behavioral addiction, and proposed as a diagnosis in the DSM 5, shares some overlapping features with substance use disorder including common neurotransmitter systems and dysregulated hypothalamic-pituitary-adrenal (HPA) axis function. In this study, comprising 67 HD male patients and 39 male healthy volunteers, we aimed to identify HPA-axis coupled CpG-sites, in which modifications of the epigenetic profile are associated with hypersexuality. The genome-wide methylation pattern was measured in whole blood using the Illumina Infinium Methylation EPIC BeadChip, measuring the methylation state of over 850K CpG sites. Prior to analysis, the global DNA methylation pattern was pre-processed according to standard protocols and adjusted for white blood cell type heterogeneity. We included CpG sites located within 2000bp of the transcriptional start site of the following HPA-axis coupled genes: Corticotropin releasing hormone (CRH), corticotropin releasing hormone binding protein (CRHBP), corticotropin releasing hormone receptor 1 (CRHR1), corticotropin releasing hormone receptor 2 (CRHR2), FKBP5 and the glucocorticoid receptor (NR3C1). We performed multiple linear regression models of methylation M-values to a categorical variable of hypersexuality, adjusting for depression, dexamethasone non-suppression status, Childhood Trauma Questionnaire total score and plasma levels of TNF-alpha and IL-6. Of 76 tested individual CpG sites, four were nominally significant (p<0.05), associated with the genes CRH, CRHR2 and NR3C1. Cg23409074-located 48bp upstream of the transcription start site of the CRH gene - was significantly hypomethylated in hypersexual patients after corrections for multiple testing using the FDR-method. Methylation levels of cg23409074 were positively correlated with gene expression of the CRH gene in an independent cohort of 11 healthy male subjects. The methylation levels at the identified CRH site, cg23409074, were significantly correlated between blood and four different brain regions. CRH is an important integrator of neuroendocrine stress responses in the brain, with a key role in the addiction processes. Our results show epigenetic changes in the CRH gene related to hypersexual disorder in men.
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Affiliation(s)
- Jussi Jokinen
- Department of Clinical Neuroscience/Psychiatry, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden.
| | | | - Andreas Chatzittofis
- Department of Clinical Neuroscience/Psychiatry, Karolinska Institutet, Stockholm, Sweden; Medical School, University of Cyprus, Nicosia, Cyprus
| | | | | | - John N Flanagan
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Arver
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Helgi B Schiöth
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
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Kraus SW, Voon V, Potenza MN. Should compulsive sexual behavior be considered an addiction? Addiction 2016; 111:2097-2106. [PMID: 26893127 PMCID: PMC4990495 DOI: 10.1111/add.13297] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/30/2015] [Accepted: 01/04/2016] [Indexed: 12/16/2022]
Abstract
AIMS To review the evidence base for classifying compulsive sexual behavior (CSB) as a non-substance or 'behavioral' addiction. METHODS Data from multiple domains (e.g. epidemiological, phenomenological, clinical, biological) are reviewed and considered with respect to data from substance and gambling addictions. RESULTS Overlapping features exist between CSB and substance use disorders. Common neurotransmitter systems may contribute to CSB and substance use disorders, and recent neuroimaging studies highlight similarities relating to craving and attentional biases. Similar pharmacological and psychotherapeutic treatments may be applicable to CSB and substance addictions, although considerable gaps in knowledge currently exist. CONCLUSIONS Despite the growing body of research linking compulsive sexual behavior (CSB) to substance addictions, significant gaps in understanding continue to complicate classification of CSB as an addiction.
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Affiliation(s)
- Shane W. Kraus
- VISN 1 Mental Illness Research Education and Clinical Centers, VA Connecticut Healthcare System, West Haven, CT USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Valerie Voon
- University of Cambridge, Cambridge, United Kingdom
| | - Marc N. Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
- Department of Neurobiology, Child Study Center and CASAColumbia, Yale University School of Medicine, New Haven, CT 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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