Can Pornography be Addictive? An fMRI Study of Men Seeking Treatment for Problematic Pornography Use

Pornography Use and Associated Factors in Adolescents: A Cross-Jurisdictional Approach (Spain vs. Mexico)

Pornography use is common among adolescents. However, there has been limited in-depth examination of cross-country differences in adolescent pornography use. Therefore, the main aim of the present study was to understand cross-jurisdictional differences in problematic pornography use (PPU) in 1810 adolescents from Spain and Mexico. The relationship between sociodemographic variables, loneliness, sexual risk behaviors, and religiosity with PPU and cross-jurisdictional differences between the two Spanish-speaking populations was assessed. In the Spanish sample, pornography use was a mediator of risky sexual behaviors, with this association being greater in males, older individuals, and those with a non-heterosexual orientation. In the Mexican sample, non-use of condoms was directly statistically predicted by older age, poor familial relationships, low religiosity, and more frequent pornography use. Jurisdictional differences in relationships between variables were observed in the two samples (Spanish and Mexican). Clinical implications and potential sociocultural factors that may underlie observed differences in the two Spanish-speaking cultures are considered and warrant additional investigation.

Investigating mood-modification, withdrawal, and sensitization in compulsive sexual behaviour

Background and aims

Compulsive Sexual Behaviour (CSB), defined as a persistent failure to control repetitive sexual impulses, has been discussed as a pathological phenomenon for centuries. Various terms, such as excessive sexual behaviour, hyper-sexuality, compulsive sexual behaviour disorder (CSBD), or sexual addiction (SA), have been used to describe it, contributing to ongoing debates about its theoretical framework. The following three studies aim to empirically assess whether CSB exhibits key elements of behavioural addiction (mood-modification, sensitization/tolerance, and withdrawal).

Method

Three studies, involving participants with and without CSB, were conducted. The mood-modification hypothesis was tested by exposing participants to short films inducing positive, negative, and emotionally neutral moods, followed by an evaluation of their craving for pornography. To test the sensitization hypothesis, participants viewed short films with varying levels of explicit sexual stimuli, and their level of actual wanting and liking were assessed through self-reports. For the withdrawal hypothesis, participants underwent a 10-day sexual abstinence, with self-reports of various symptoms, collected on pre-intervention, 3rd, 7th, and 10th days.

Results

Contrary to previous studies of addiction, CSB participants didn't show increased craving to mood induction and negative mood actually decreased craving for pornography. Secondly, they showed wanting to explicit sexual stimuli although it was not increased with explicitness. Finally, they demonstrated reduced withdrawal symptom during abstinence.

Conclusion

The results of this study provide conflicting results concerning the model of behavioural addiction. There is supporting evidence for wanting in response to explicit pornography stimuli although it was not associated with increased explicitness. There is also evidence for reduced withdrawal during abstinence. Finally, there was no evidence that mood modification increases craving for pornography, negative mood actually decreased craving. Further research is needed to test the various models of CSB.

Blunted sensitivity to expected value during risky decision making in individuals with problematic pornography use

Background and aims

Neurobiological models of addiction posit that addiction manifests through an amplified salience towards addiction-associated stimuli and a diminished responsiveness to non-addiction-related incentives. However, existing research on reward processing in individuals with problematic pornography use (PPU) has primarily been limited to sexual cue reactivity.

Methods

In this event-related potential (ERP) study, we employed a risky decision-making task involving 30 individuals with PPU and 33 healthy controls (HCs) to examine the effects of PPU on non-pornographic (money) reward valuation.

Results

Compared to HCs, individuals with PPU exhibited compromised sensitivity to monetary rewards. Specifically, while the HC group demonstrated a differential response in late positive potential (LPP) amplitude to various expected value (EV) levels, this pattern was absent in the PPU group. This impairment was associated with poorer adaptive decision-making, as evidenced by PPU participants' inability to adjust risk choices based on changes in EV, leading to a propensity for riskier decisions in disadvantageous situations.

Discussion and conclusions

The findings of impaired monetary evaluation in individuals with PPU may potentially explain why they continually pursue pornographic rewards while showing insensitivity to other rewards in daily life. Consequently, treatment development strategies may prioritize improving sensitivity to non-pornographic rewards within this population.

Spanish Validation of the Brief Pornography Screen Within a Clinical Sample of Individuals with Gambling Disorder

Problematic pornography use (PPU) shares characteristics with behavioral addictions, such as gambling disorder (GD), and PPU and GD may frequently co-occur. In order to fill existing gaps in screening instruments for PPU validated in GD, the study examined the psychometric properties of the Spanish version of the Brief Pornography Screen (BPS) within a clinical sample of individuals with GD. A total of 200 individuals seeking treatment for GD were consecutively recruited. The psychometric properties of the BPS were examined by performing confirmatory factor analysis (CFA) and testing for evidence of convergent and discriminant validity. The CFA supported a one-factor solution showing high internal consistency (α = 0.81). The BPS showed convergent validity and correlated with psychological distress, general psychopathology, impulsive tendencies, and low self-directedness. The BPS demonstrated adequate psychometric properties and is therefore recommended as a brief screening tool for identifying probable PPU in individuals seeking treatment for GD.

Pornography use, problematic pornography use, impulsivity, and sensation seeking: a meta-analysis

BACKGROUND

While some individuals engage in recreational pornography use (PU), others may develop an uncontrolled pattern of use termed problematic pornography use (PPU). PPU is characterized by persistent, excessive, or compulsive engagement with pornographic content, despite distress and adverse consequences. Impulsivity has been identified as a factor associated with PU and PPU.

AIM

The present meta-analysis aims to sum up the existing research on the relationship between impulsivity and PU/PPU and investigate whether age and gender could moderate this relationship.

METHODS

A keyword-based systematic literature search was performed to identify articles that assessed PU/PPU and impulsivity. Extracted correlations were converted into Fisher's Z. Meta-regression analyses were also performed. Publication bias was assessed by Egger's regression intercept.

OUTCOMES

Outcomes included general impulsivity and its dimensions (ie, negative and positive urgency, lack of premeditation and perseverance), sensation seeking, PU, and PPU.

RESULTS

Meta-analytic results of the random effects model showed a significant positive correlation between impulsivity as total score and PU (n = 1504, k = 4, Fisher's Z = 0.21, P < .001) and PPU (n = 20174, k = 13, Fisher's Z = 0.17, P < .001). Significant and positive associations were also found between sensation seeking and PU (n = 11707, k = 11, Fisher's Z = 0.14, P < .001) and PPU (n = 20152, k = 9, Fisher's Z = 0.06, P < .001). Concerning the relationship between PPU and different dimensions of impulsivity, almost all the associations were significant and positive. The dimension of positive urgency and attentional and nonplanning impulsivity showed the strongest association. Age (β = -0.50, Q = 101.26, df = 11, P < .001) and gender (female = 1; β = -0.46, Q = 102.54, df = 12, P < .001) moderated the association between general impulsivity and PPU. No risk of publication bias emerged.

CLINICAL IMPLICATIONS

Prevention programs of PPU should focus on impulsivity and certain key dimensions (eg, positive urgency, attentional and nonplanning impulsivity) and be tailored to individual impulsivity profiles, considering age and gender differences.

STRENGTHS AND LIMITATIONS

The primary strength of this meta-analysis is that it considers various conceptualizations of impulsivity. However, the results are to be interpreted with caution since >30% of relevant studies had to be excluded because information could not be gathered from the study authors.

CONCLUSION

These results suggest that general impulsivity is linked to PU and PPU and that specific dimensions of impulsivity (ie, attentional impulsivity, nonplanning impulsivity, and positive urgency) can serve as risk factors for PPU.

Problematic Pornography Use, Mental Health, and Suicidality among Young Adults

The relationship between suicidality and problematic pornography use (PPU) is not clear, and the limited research data that exists show contradictory results. The present study aims to explore the associations between these two variables in a sample of young adults, taking into account gender differences and the role of loneliness, emotional states, and well-being. A total of 332 national and international students (60% female) at an Italian University with a mean age of 23 years (SD = 2.84) completed an anonymous online survey during the period from March 2023 to May 2023. The results show that PPU was associated with higher levels of anxiety, depression, stress, loneliness, and suicide ideation, as well as lower life satisfaction. Gender comparison analysis revealed significantly higher scores for PPU and loneliness among men, while women scored higher in stress, anxiety, and life satisfaction. Significant correlations between PPU and suicidal ideation and having a suicide plan were established for female participants despite their lower scores in PPU. Multiple regression analysis revealed that PPU and its interaction with gender were both significant predictors of suicidal ideation. Future attention should be paid to how young women may be influenced by exposure to sexually explicit materials, while always considering the role of loneliness.

Problematic pornography use and novel patterns of escalating use: A cross-sectional network analysis with two independent samples

Modern internet pornography allows users to harness sexual novelty in numerous ways, which can be used to overcome desensitisation through increasing volume of use (quantitative tolerance), progressing to more stimulating genres (qualitative escalation), skipping between stimuli (tab-jumping), delaying orgasm ('edging'), and engaging in pornographic binges. However, existing research has not yet evaluated how these potentially reciprocal consumption patterns relate to problematic pornography use (PPU). To this end, we recruited two independent samples of male pornography users (N1 = 1,356, Mage = 36.86, SD = 11.26; N2 = 944, Mage = 38.69, SD = 12.26) and examined the relationships between these behavioural dimensions and self-reported difficulties in controlling one's pornography use. Data were analysed through the network analysis approach (using Gaussian graphical models). As hypothesised, i) quantitative tolerance was centrally placed within the overall network, and ii) acted as a statistical bridge node between other patterns of pornography use (e.g., pornographic binges), and all measured facets of PPU. Our results are consistent with other emerging literature suggesting that tolerance, pornographic binges, tab-jumping, and edging behaviours as relevant features ofPPU, and that upscaling overall usage may connect broader patterns of use with problematic engagement. Clinical and theoretical implications, as well as future research directions, are discussed.

Understanding the Co-occurrence of Gambling Disorder and Problematic Pornography Use: Exploring Sociodemographic and Clinical Factors

The co-occurrence between gambling disorder (GD) and problematic pornography use (PPU) has not yet been explored. Therefore, the present study compared (a) sociodemographic variables, (b) GD-related factors, (c) substance use, (d) psychopathology, (e) personality features, (f) impulsivity, and (g) emotion regulation between individuals with GD (GD group) and those with co-occurring GD and PPU (GD+PPU group). The sample consisted of 359 treatment-seeking individuals with GD: n = 332 individuals had GD only (GD group) and n = 37 individuals had GD and co-occurring PPU (GD+PPU group). GD severity, impulsivity, psychopathology, personality, emotion regulation, and other sociodemographic and clinical variables were assessed. No between-group differences in sociodemographic measures were observed. The GD+PPU group demonstrated greater GD severity and a higher likelihood of substance use compared to those without PPU. Furthermore, the presence of PPU was associated with worse psychopathology, higher impulsivity (except for lack of premeditation and positive urgency), more difficulties in emotion regulation (except for non-acceptance of emotions and limited access to emotions), and a personality profile characterized by lower levels of self-directedness and cooperativeness. The co-occurrence of GD and PPU seems associated with a more dysfunctional clinical profile.

Learning and memory processes in behavioural addiction: A systematic review

Similar to addictive substances, addictive behaviours such as gambling and gaming are associated with maladaptive modulation of key brain areas and functional networks implicated in learning and memory. Therefore, this review sought to understand how different learning and memory processes relate to behavioural addictions and to unravel their underlying neural mechanisms. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched four databases - PsycINFO, PubMed, Scopus, and Web of Science using the agreed-upon search string. Findings suggest altered executive function-dependent learning processes and enhanced habit learning in behavioural addiction. Whereas the relationship between working memory and behavioural addiction is influenced by addiction type, working memory aspect, and task nature. Additionally, long-term memory is incoherent in individuals with addictive behaviours. Consistently, neurophysiological evidence indicates alterations in brain areas and networks implicated in learning and memory processes in behavioural addictions. Overall, the present review argues that, like substance use disorders, alteration in learning and memory processes may underlie the development and maintenance of behavioural addictions.

A review of published studies on virtual reality in sexuality research

INTRODUCTION

Virtual reality (VR) technology contributes to greater approach of methodological safety to make ecological validity more feasible and a growing interest in sexuality behaviors.

OBJECTIVES

The aim of this study was to show VR in the sexuality area by a comprehensive review of outcomes, offer a synthesis of the studies, and make a methodological quality assessment of finding results. A secondary goal was to investigate the effect of immersion on diverse sexual responses outcomes.

METHODS

We designed a review based on a systematic review strategy describing types of studies, participants, data collection and outcomes; searched in 4 electronic databases (PubMed, EMBASE, PsycINFO, and SciELO), and made a full-text screening process.

RESULTS

The study found 18 articles that met research criteria synthesized within 3 outcome groups: erection measures, level of immersion, and biomarker studies. Synthesis shows a lack of methodological aspects that impair results, such as description of methods from bias protection, randomization, or concealment. The literature still needs to improve its methodology, even though it already shows relevant data for intervention in sexual dysfunction, forensic psychiatry, sexual attraction, orientation, and use of pornography.

CONCLUSION

Current methodological issues need better design to highlight relevant issues in sexuality with stronger quality of design, opening boundaries to new diagnostic or interventional technologies to sexual health.

Appetitive conditioning with pornographic stimuli elicits stronger activation in reward regions than monetary and gaming-related stimuli

Appetitive conditioning plays an important role in the development and maintenance of pornography-use and gaming disorders. It is assumed that primary and secondary reinforcers are involved in these processes. Despite the common use of pornography and gaming in the general population appetitive conditioning processes in this context are still not well studied. This study aims to compare appetitive conditioning processes using primary (pornographic) and secondary (monetary and gaming-related) rewards as unconditioned stimuli (UCS) in the general population. Additionally, it investigates the conditioning processes with gaming-related stimuli as this type of UCS was not used in previous studies. Thirty-one subjects participated in a differential conditioning procedure in which four geometric symbols were paired with either pornographic, monetary, or gaming-related rewards or with nothing to become conditioned stimuli (CS + porn, CS + game, CS + money, and CS-) in an functional magnetic resonance imaging study. We observed elevated arousal and valence ratings as well as skin conductance responses for each CS+ condition compared to the CS-. On the neural level, we found activations during the presentation of the CS + porn in the bilateral nucleus accumbens, right medial orbitofrontal cortex, and the right ventral anterior cingulate cortex compared to the CS-, but no significant activations during CS + money and CS + game compared to the CS-. These results indicate that different processes emerge depending on whether primary and secondary rewards are presented separately or together in the same experimental paradigm. Additionally, monetary and gaming-related stimuli seem to have a lower appetitive value than pornographic rewards.

Increased sensitivity for negative emotional images in individuals with problematic pornography use

Background

Despite the frequent comorbidity of affective and addictive disorders, the significance of affective dysregulation in problematic pornography use (PPU) is commonly disregarded. The objective of this study is to investigate whether individuals with PPU demonstrate increased sensitivity to negative emotional stimuli in comparison to healthy controls (HCs).

Methods

Electrophysiological responses were captured via event-related potentials (ERPs) from 27 individuals with PPU and 29 HCs. They completed an oddball task involving the presentation of deviant stimuli in the form of highly negative (HN), moderately negative (MN), and neutral images, with a standard stimulus being a neutral kettle image. To evaluate participants' subjective feelings of valence and arousal, the Self-Assessment Manikin (SAM) was employed.

Results

Regarding subjective evaluations, individuals with PPU indicated diminished valence ratings for HN images as opposed to HCs. Concerning electrophysiological assessments, those with PPU manifested elevated N2 amplitudes in response to both HN and MN images when contrasted against neutral images. Additionally, PPU participants displayed an intensified P3 response to HN images in contrast to MN images, a distinction not evident within the HCs.

Discussion

These outcomes suggest that individuals with PPU exhibited heightened reactivity toward negative stimuli. This increased sensitivity to negative cues could potentially play a role in the propensity of PPU individuals to resort to pornography as a coping mechanism for managing stress regulation.

Compulsive sexual behavior disorder: The importance of research on women

The current understanding of compulsive sexual behavior disorder (CSBD) is primarily based on studies involving non-clinical samples of heterosexual men, resulting in significant gaps in knowledge regarding women with CSBD. The commentary highlights the domains where further research is necessary, including incidence and prevalence, etiology, diagnostic criteria, comorbidities, sexual patterns, personality profiles, and barriers to help-seeking among women with CSBD. Bridging this research gap is essential for improving clinical care, developing tailored interventions, and increasing awareness about CSBD in women among healthcare providers, policymakers, and the general public.

Spanish Validation of the Long and Short Versions of the Problematic Pornography Consumption Scale (PPCS and PPCS-6) in Adolescents

Although 1-14% of adolescents may experience problematic pornography use (PPU), psychometrically sound instruments for assessing PPU in Spanish-speaking adolescents are scarce. Given the advantages of the different forms of the Problematic Pornography Consumption Scale (PPCS), the aim of the present study was to assess the psychometric properties of the PPCS and PPCS-6, and to examine associations between PPU and age among boys and girls. Two school-based adolescent samples were recruited in Spain (n = 650; Mage = 16.0 [SD = 1.1]; 50% girls and 50% boys) and Mexico (n1, 160; Mage = 15.8 [SD = 1.1]; 68% girls) to assess the psychometric properties of the PPCS and PPCS-6. Confirmatory factor analysis was applied and convergent and discriminant validity with other measures related to PPU was also tested. The results provided empirical support for the six-factor structure of the PPCS and the one-factor structure of the PPCS-6. Boys with older age showed higher levels of tolerance than girls on the PPCS in both countries. Both the PPCS and the PPCS-6 may be considered valid psychometric instruments for the assessment of PPU in Spanish-speaking adolescents from Spain and Mexico.

Emotional processing deficits in individuals with problematic pornography use: Unpleasant bias and pleasant blunting

Background and aims

A growing body of evidence indicates a connection between emotional processes and the emergence and progression of addiction. However, scant research has examined the involvement of emotional processing within the framework of problematic pornography use (PPU). This study aimed to examine the electrophysiological and subjective differences in emotional processing between male individuals with PPU and healthy controls (HCs) following exposure to everyday affective images.

Methods

Event-related potentials (ERPs) were recorded from 42 PPU participants (mean age = 20.14 years, SD = 1.35) and 45 HCs (mean age = 20.04 years, SD = 1.45) during an oddball task, in which unpleasant, pleasant, and neutral images were presented as deviant stimuli, while a neutral kettle image served as the standard stimulus. The Self-Assessment Manikin (SAM) was employed to assess participants' subjective experience on the dimensions of valence and arousal.

Results

Regarding subjective measures of emotion, individuals with PPU reported lower valence ratings for unpleasant images compared to HCs. In terms of electrophysiological measures of emotion, PPU participants reported larger P2 amplitudes for unpleasant pictures compared to both pleasant and neutral pictures. Moreover, HCs showed enhanced P3 amplitudes in response to pleasant images compared to neutral images, whereas this effect was not observed in PPU participants.

Discussion and Conclusion

These findings indicate that individuals with PPU may display deficits in emotional processing characterized by enhanced responsiveness to negative stimuli and attenuated responsiveness to positive stimuli. The heightened sensitivity to negative stimuli may contribute to the inclination of individuals with PPU to engage in pornography as a coping mechanism for stress regulation. Conversely, their diminished sensitivity to positive stimuli presents a challenge in seeking alternative natural rewards to counter potentially addictive behaviors.

Should problematic sexual behavior be viewed under the scope of addiction? A systematic review based on DSM-5 substance use disorder criteria

Despite similarities between compulsive sexual disorder and substance use disorder, the issue whether problematic sexual behavior should be viewed within an addiction framework continues to be a subject of debate with no consensus regarding its conceptualization and diagnosis criteria. Examining the presence of addiction criteria among clinical and no clinical samples in the existing literature could permit to ascertain clinical validity of sex addiction diagnosis and support its overlapping feature with other addictive disorders. The aim of this systematic review was to examine this issue by assessing DSM-5 criteria of substance use disorder among individuals engaged in problematic sexual activity. Methods: Using PRISMA criteria, three databases were comprehensively searched up to April 2022, in order to identify all candidate studies based on broad key words. Resulting studies were then selected if they examined problematic sexual behavior within the framework of DSM-5 addiction criteria. Results: Twenty articles matched the selection criteria and were included in this review. DSM-5 criteria of addictive disorders were found to be highly prevalent among problematic sex users, particularly craving, loss of control over sex use, and negative consequences related to sexual behavior. Exposition to sexual cues was also shown to trigger craving, with an association to problematic use and symptom severity. Conclusions: More studies should been done to assess homogeneously according to the DSM-5 criteria the addiction-like features of problematic sexual behaviors in clinical and no-clinical populations. Furthermore, this work argues for the need of further research to examine the extent to which anti-craving interventions could be effective in improving clinical outcomes.

Moderating Role of Sexual Attitudes in the Association between Online Sexual Activity and Problematic Pornography Use: Evidence from the Chinese Community and Help-Seeking Men

Objectives

This study aimed to investigate the moderating role of sexual attitudes in the association between online sexual activity (OSA) and problematic pornography use (PPU) in the Chinese context. Specifically, we examined whether incongruence stemming from attitudes (i.e., disapproval of nonmarital and casual sex but engaging in OSA) amplifies the perception of PPU.

Methods

We recruited two samples of Chinese men, one from the community (N1 = 525) and the other comprising help-seeking individuals (N2 = 578).

Results

Sexual attitudes moderate the relationship between OSA and PPU in both samples, with the predictive influence of OSA on PPU weakening among individuals with a relatively permissive attitude (scored one SD above the mean of sexual attitudes), and strengthened among individuals with a relatively conservative attitude (scored one SD below the mean of sexual attitudes).

Conclusions

In the conservative sexual cultural context of China, a relatively conservative sexual attitude might strengthen the association between OSA and PPU.

Altered reward processing in patients with lifelong premature ejaculation

Given that sexual behavior is usually pleasurable and highly rewarding, it is surprising that there is as yet no known research to empirically assess how premature ejaculation (PE) patients respond to the rewarding aspect of sexual behavior. This study was designed to address this issue by evaluating how these men respond to the anticipation and hedonic experience of sexual rewards in comparison to non-sexual rewards. Thirty lifelong PE patients and thirty healthy controls (HCs) performed the incentive delay task manipulating both erotic and monetary rewards. Compared to HCs, lifelong PE patients exhibited significantly faster RTs to erotic cues than to monetary cues during reward anticipation. Meanwhile, hedonic experience ratings after obtaining the actual reward showed that erotic rewards were rated as more pleasant than monetary rewards only by lifelong PE patients, which was driven by a decreased sensitivity to experienced monetary rewards in lifelong PE patients compared to HCs. These findings indicate the existence of dysfunctional reward processing in lifelong PE patients, which is characterized by increased incentive motivation elicited by sexual cues and reduced hedonic impact of nonsexual rewards. This study may offer an insightful clue regarding how PE is related to the abnormal regulation of the rewarding aspect of sexual behavior.

Separating desire from prediction of outcome value

Individuals typically want what they expect to like, often based on memories of previous positive experiences. However, in some situations desire can decouple completely from memories and from learned predictions of outcome value. The potential for desire to separate from prediction arises from independent operating rules that control motivational incentive salience. Incentive salience, or 'wanting', is a type of mesolimbic desire that evolved for adaptive goals, but can also generate maladaptive addictions. Two proof-of-principle examples are presented here to show how motivational 'wanting' can soar above memory-based predictions of outcome value: (i) 'wanting what is remembered to be disgusting', and (ii) 'wanting what is predicted to hurt'. Consequently, even outcomes remembered and predicted to be negatively aversive can become positively 'wanted'. Similarly, in human addictions, people may experience powerful cue-triggered cravings for outcomes that are not predicted to be enjoyable.

Neural fingerprints of gambling disorder using diffusion tensor imaging

Gambling disorder (GD) is a behavioral addiction associated with personal, social and occupational consequences. Thus, examining GD's clinical relationship with its neural substrates is critical. We compared neural fingerprints using diffusion tensor imaging (DTI) in GD subjects undergoing treatment relative to healthy volunteers (HV). Fifty-three (25 GD, 28 age-matched HV) males were scanned with structural magnetic resonance imaging (MRI) and DTI. We applied probabilistic tractography based on DTI scanning data, preprocessed and analyzed using permutation testing of individual connectivity weights between regions for group comparison. Permutation-based comparisons between group-averaged connectomes highlighted significant structural differences. The GD group demonstrated increased connectivity, and striatal network reorganisation, contrasted by reduced connectivity within and to frontal lobe nodes. Modularity analysis revealed that the GD group had fewer hubs integrating information across the brain. We highlight GD neural changes involved in controlling risk-seeking behaviors. The observed striatal restructuring converges with previous research, and the increased connectivity affects subnetworks highly active in gambling situations, although these findings are not significant when correcting for multiple comparisons. Modularity analysis underlines that, despite connectivity increases, the GD connectome loses hubs, impeding its neuronal network coherence. Together, these results demonstrate the feasibility of using whole-brain computational modeling in assessing GD.

Decision making and executive functions in problematic pornography use

Introduction

Previous research on cognitive functions in Compulsive Sexual Behavior Disorder (CSBD) and problematic pornography use (PPU) reported inconsistent findings and mostly included sexual pictures in the used tasks. The role of general executive functions and cognitive competences (without the presence of appetitive stimuli) in the context of PPU is largely unexplored.

Methods

This study investigated differences between individuals with high versus low problem severity of PPU regarding decision making and executive functions. The sample of the laboratory study consisted of N = 102 male adults. Besides measures of trait impulsivity, we used standard neuropsychological tests (Trail Making Test and three-back working memory task) and an intertemporal risky choice paradigm, the Cards & Lottery Task (CLT).

Results

The results show heightened impulsivity (urgency and deficits in perseverance) in individuals with high PPU, but no differences regarding performance in the CLT and executive function tasks.

Discussion

The findings indicate that PPU might be associated with impulsive behavior when experiencing strong emotions (urgency) and deficient cognitive performance especially in the presence of sexual stimuli but not in general.

Biopsychosocial Determinants of Problematic Pornography Use: A Systematic Review

Background

Although some studies have examined the determinants of problematic pornography use (PPU), few systematic comparisons of risk profiles have been conducted so far. Research on risk profiles can shed a bright light on our knowledge of both the early diagnosis and etiology of such highly prevalent disorders. Accordingly, the present study aimed to provide a comprehensive overview of the determinants of PPU.

Methods

Scopus, Web of Science, PubMed, and PsycINFO databases were systematically searched, and relevant English articles, including longitudinal and cross-sectional studies on risk factors published from January 2000 to February 2022 were reviewed.

Findings

The determinants of PPU extracted from the investigated studies (n=66) were summarized and clustered into biological, psychological, and social categories. The findings indicated that ventral striatum activity is a consistent biological factor which plays a key role in the development of PPU, while there were other psychological factors influencing PPU as mentioned in several studies, including craving, low self-esteem, sexual arousal, coping styles, stress, frequent pornography watching, avoidance, negative beliefs, and emotional deficiency. In addition, the social factors affecting PPU have been reported to be male gender, age, religion, moral incompatibility, and loneliness. According to these results, the identified factors could be considered in preventive treatment.

Conclusion

This systematic review provided a comprehensive overview of the biopsychosocial determinants of PPU by analyzing 66 articles mostly from Europe and North America. Most studies showed that ventral striatum activity, craving, self-esteem, stress, frequent pornography watching, gender, age, and religion are related to PPU.

Effects of a 7-Day Pornography Abstinence Period on Withdrawal-Related Symptoms in Regular Pornography Users: A Randomized Controlled Study

Little is known about whether withdrawal-like symptoms manifest when regular pornography users attempt to abstain from pornography. The present study used a randomized controlled design to examine whether (1) negative abstinence effects that may be potentially reflective of withdrawal-related symptoms manifest when a non-clinical sample of regular pornography users attempt to abstain from pornography for a 7-day period and (2) these negative abstinence effects would only manifest (or manifest more strongly) for those with higher levels of problematic pornography use (PPU). A total of 176 undergraduate students (64.2% female) who were regular pornography users (defined as having used pornography ≥ three times a week in the past 4 weeks) were randomly assigned to an abstinence group (instructed to attempt abstinence from pornography for 7 days, n = 86) or a control group (free to watch pornography as usual, n = 90). Participants completed measures of craving, positive and negative affect, and withdrawal symptoms at baseline and each night of the 7-day period. Contrary to the confirmatory hypotheses, there were no significant main effects of group (abstinence vs. control) or group × PPU interaction effects on any of the outcome measures, controlling for baseline scores. These findings indicate that no evidence of withdrawal-related symptoms was found for abstaining participants, and this was not dependent on level of PPU. However, exploratory analyses showed a significant three-way interaction (group × PPU × past 4-week frequency of pornography use [FPU]) on craving, where an abstinence effect on craving was found at high levels of PPU only once past 4-week FPU reached the threshold of daily use. While these exploratory findings should be interpreted with caution, they suggest that abstinence effects could potentially manifest when there is a combination of high PPU and high FPU-a hypothesis that warrants investigation in future prospective abstinence studies.

Computational models of behavioral addictions: State of the art and future directions

Non-pharmacological behavioral addictions, such as pathological gambling, videogaming, social networking, or internet use, are becoming major public health concerns. It is not yet clear how behavioral addictions could share many major neurobiological and behavioral characteristics with substance use disorders, despite the absence of direct pharmacological influences. A deeper understanding of the neurocognitive mechanisms of addictive behavior is needed, and computational modeling could be one promising approach to explain intricately entwined cognitive and neural dynamics. This review describes computational models of addiction based on reinforcement learning algorithms, Bayesian inference, and biophysical neural simulations. We discuss whether computational frameworks originally conceived to explain maladaptive behavior in substance use disorders can be effectively extended to non-substance-related behavioral addictions. Moreover, we introduce recent studies on behavioral addictions that exemplify the possibility of such extension and propose future directions.

Time Goes Back-Time Perspective in Polish Men with Compulsive Sexual Behavior Disorder and Risky Sexual Behavior

Many relationships between time perspective and a propensity to engage in risky behaviors or developing addictions have been demonstrated. The aim of our study was to determine the differences in intensity of individual time perspectives in people with compulsive sexual behavior disorder (CSBD) and risky sexual behavior (RSB). The analysis includes 425 men: 98 CSBD (age M = 37.99 years), 63 RSB (age M = 35.70 years), 264 without CSBD and RSB features constituting the control group (age M = 35.08 years). We used the Zimbardo Time Perspective Inventory, the Sexual Addiction Screening Test-Revised, the Risky Sexual Behavior Scale and a self-constructed survey. The comparative analysis showed a higher intensity of past-negative (p = 0.040), a lower of past-positive (p < 0.001) and a present-fatalistic (p = 0.040) outlook in the CSBD group compared to the control group. Compared to the participants with RSB, the CSBD group was characterized by a higher intensity of past-negative (p = 0.010), a lower of past-positive (p = 0.004) and a present-hedonistic perspective (p = 0.014). The RSB group also achieved higher results from the present-hedonistic perspective (p = 0.046) compared to the control group. The CSBD patients indicate a stronger tendency to focus on negative past compared to non-CSBD men, both taking and not taking RSB. The time perspective profiles of RSB men are similar to those who do not engage in RSB. The distinguishing feature of men with RSB without CSBD is a greater ability to enjoy current experiences.

Hypo- or hyperfunction? Differential relationships between compulsive sexual behavior disorder facets and sexual health

BACKGROUND

Previous studies linking compulsive sexual behavior disorder (CSBD) and sexual health have shown mixed results, which could be due to the fact that different CSBD facets may have differential relationships with sexual functioning.

AIM

As CSBD is a multidimensional disorder, we wanted to investigate whether distinct CSBD domains are differentially related to sexual health.

METHODS

Two online studies were conducted-the first on a convenience sample (812 Polish participants; mean [SD] age, 22.07 [5.91] years) and a replication study on a representative sample of Polish adults (n = 1526; 43.02 [14.37]). Hierarchical regression was employed with sexual functioning as a predicted variable and CSBD symptoms as predictors.

OUTCOMES

The Compulsive Sexual Behavior Disorder Scale was used to assess CSBD symptoms, and the Arizona Sexual Experience Scale was used to measure sexual dysfunction.

RESULTS

In study 1, CSBD salience (β = -.20, P < .001) predicted hyperfunction (ie, stronger sex drive, easier sexual arousal, easier vaginal lubrication/penile erection, easier ability to reach an orgasm, and more satisfying orgasms). Yet, CSBD negative consequences (β = .15, P = .001) and dissatisfaction (β = .22, P < .001) predicted hypofunction (ie, weaker sex drive, more difficulties in sexual arousal, greater difficulties in vaginal lubrication/penile erection, less ability to reach an orgasm, and less satisfying orgasms). Similar results were found in study 2: salience (β = -.26, P < .001) and relapse (β = -.11, P = .004) predicted hyperfunction, while negative consequences (β = .12, P < .001) and dissatisfaction (β = .12, P < .001) predicted hypofunction.

CLINICAL IMPLICATIONS

Our results stress the importance of assessing the severity of each group of symptoms in patients with CSBD to better understand possible difficulties in their sexual functioning.

STRENGTHS AND LIMITATIONS

Our studies are the first to evaluate the effects of each CSBD domain on sexual health. We also replicated results obtained from a convenience sample on a representative sample. The cross-sectional design of the current studies does not allow causal relations to be tested, so future longitudinal research should be carried out. We also gathered data from a general population-thus, it is important to replicate these results on patients diagnosed with CSBD.

CONCLUSION

Our research points out the differential impact of CSBD domains on sexual health: salience and relapse are related to sexual hyperfunction, while negative consequences and dissatisfaction to hypofunction.

Psychometric Network Analysis of the Problematic Pornography Use Scale (PPUS) in Peruvian Adults

Objective

The aim of this research was to analyze the psychometric properties of the Problematic Pornography Use Scale (PPUS).

Methods

A sample of 704 Peruvian youth and adults aged 18 to 62 years (M = 26, SD = 6.0) was considered, of which 56% were female and 43% male. The participants were from various cities in Peru: Lima (84%), Trujillo (2.6%), Arequipa (1.8%), and Huancayo (1.6%). The validity of the theoretical structure of the PPUS was carried out by means of two techniques: Confirmatory factor analysis (CFA) and Exploratory Graphical Analysis (EGA), a new effective and efficient dimension evaluation technique, whose measure consists of verifying the fit of the dimension structure.

Results

Using the bifactor model, the hypothesis that PPUS has a unifactorial behavior was corroborated. These approximations of unidimensionality are also corroborated by the EGA method, where the centrality parameters and network loadings are found to have acceptable estimates.

Conclusion

The results demonstrate the validity of the PPUS, contrasting with the factor model and verifying the unidimensionality of the construct, which provide useful directions for future studies on the instrumentalization of problematic pornography use scale.

The World Federation of Societies of Biological Psychiatry guidelines on the assessment and pharmacological treatment of compulsive sexual behaviour disorder

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.

Self-regulatory Processes in Problematic Pornography Use

Purpose of Review

A core symptom of problematic pornography use (PPU) is the repeated failure to control sexual impulses resulting in pornography use; however, the field of self-regulation research has rarely been applied to PPU.

Recent Findings

Various goals can underly the use of online pornography. These goals can conflict with other self-regulatory goals a person holds, which leads to moments of self-control. The outcome of such self-control moments depends on multiple internal factors, including the strength of the desire to use pornography, whether a person perceives a conflict with their behaviour, and the motivation to resist their desire, as well as external, situational factors. Findings on the contribution of volition towards self-regulation in PPU are inconclusive.

Summary

More research is needed to further explore what influences moments of self-control, specifically in PPU. The proposed model of self-control moments can be used to derive research questions for further studies as well as to develop prevention and intervention approaches.

A motivation model of sex addiction - Relevance to the controversy over the concept

An integrative model of sexual addiction is presented, involving a combination of models based upon (i) incentive motivation theory and (ii) the dual organisation of the control of behavior. The model is related to ongoing arguments about the validity of the notion of addiction when applied to sexual behavior. It is suggested that the evidence strongly favors the viability of an addiction model of sex. Strong similarities to the classical addiction to hard drugs are observed and features can be better understood with the help of the model. These include tolerance, escalation and withdrawal symptoms. It is argued that other candidates for accounting for the phenomena, such as obsessive-compulsive behavior, faulty impulse control, high drive and hypersexuality do not fit the evidence. The role of dopamine is central to the model. The model's relevance to stress, abuse, development, psychopathy, fantasy, sex differences, evolutionary psychology and the interaction with drug-taking is shown.

Functional Connectivity in Compulsive Sexual Behavior Disorder - Systematic Review of Literature and Study on Heterosexual Males

BACKGROUND

Compulsive Sexual Behavior Disorder (CSBD) was recently included in ICD-11 as a new impulse control disorder. While this certainly improved the diagnosis of CSBD, the underlying brain mechanisms of the disorder are still poorly understood. Better description of brain functional deficits is required.

AIM

Here we investigate patterns of resting-state brain functional connectivity (fc) in a group of CSBD patients compared to a group of healthy controls (HC).

METHODS

A MATLAB toolbox named CONN functional connectivity toolbox was employed to study patterns of brain connectivity. Also correlation between fc and severity of CSBD symptoms and other psychological characteristics, assessed with questionnaires, were examined.

OUTCOMES

We collected resting-state functional magnetic resonance imaging data from 81 heterosexual males: 52 CSBD patients and 29 HC.

RESULTS

We found increased fc between left inferior frontal gyrus and right planum temporale and polare, right and left insula, right Supplementary Motor Cortex (SMA), right parietal operculum, and also between left supramarginal gyrus and right planum polare, and between left orbitofrontal cortex and left insula when compared CSBD and HC. The decreased fc was observed between left middle temporal gyrus and bilateral insula and right parietal operculum. No significant correlations between psychological questionnaires assessing CSBD symptoms and resting-state functional connectivity were observed.

CLINICAL IMPLICATIONS

Results from our study extend the knowledge of brain mechanisms differentiating CSBD from HC.

STRENGTHS & LIMITATIONS

The study was the first large sample study showing 5 distinct functional brain networks differentiating CSBD patients and HC. However, the sample was limited only to heterosexual men, in the future a greater diversity in studied sample and longitudinal studies are needed. Also, the present study examined functional connectivity at the level of regions of interest (ROIs). Future studies could verify these results by examining functional connectivity at the voxel level.

CONCLUSION

The identified functional brain networks differentiate CSBD from HC and provide some support for incentive sensitization as mechanism underlying CSBD symptoms. The correlation between psychological assessment (ie, severity of CSBD, depression and anxiety symptoms, level of impulsivity and compulsivity) and resting-state functional connectivity need further examination. Draps M, Adamus S, Wierzba M, et al. Functional Connectivity in Compulsive Sexual Behavior Disorder - Systematic Review of Literature and Study on Heterosexual Males. J Sex Med 2022;19:1463-1471.

HIV-related drivers of sexual compulsivity and sexuality in sexual minority men who use methamphetamine

Although co-occurring methamphetamine (meth) use and HIV amplify the risk for neuropsychiatric comorbidities, the underlying neuroimmune mechanisms are not well characterized. We examined whether a detectable viral load and dysregulated metabolism of amino acid precursors for neurotransmitters predicted subsequent levels of sexual compulsivity and sexual sensation seeking. This 15-month longitudinal study enrolled 110 sexual minority men (SMM) living with HIV who had biologically confirmed meth use (i.e., reactive urine or hair toxicology results). Peripheral venous blood samples collected at baseline, 6 months, 12 months, and 15 months were used to measure a detectable viral load (> 40 copies/mL), the kynurenine/tryptophan (K/T) ratio, and the phenylalanine/tyrosine (P/T) ratio. The K/T and P/T ratios index dysregulated serotonin and catecholamine (e.g., dopamine) synthesis, respectively. In a cross-lagged panel model, a detectable viral load at 6 months predicted greater sexual compulsivity at 12 months after adjusting for prior levels of sexual compulsivity and recent stimulant use (β = 0.26, p = 0.046). A greater P/T ratio at baseline predicted decreased sexual sensation seeking at 6 months (β = - 0.25, p = 0.004) after adjusting for baseline sexual sensation seeking and recent stimulant use. Taken together, HIV replication and dysregulated catecholamine synthesis could potentiate sexual compulsivity while decreasing sexual pleasure in SMM who use meth.

Reward Responsiveness, Learning, and Valuation Implicated in Problematic Pornography Use — a Research Domain Criteria Perspective

Purpose of Review

Problematic pornography use (PPU) describes a pattern of behavior characterized by excessive time spent using or thinking about pornography and continued use despite negative consequences. To help advance the understanding of transdiagnostic underlying psychological and neurobiological mechanisms in PPU, we aim to review existing evidence on these mechanisms focusing on positive valence systems within the transdiagnostic Research Domain Criteria (RDoC) framework.

Recent Findings

Reward anticipation processes seem to be increased in individuals with PPU symptoms when they anticipate sexual stimuli compared with other rewards. Studies further suggest that the initial neural and attentional responses to sexual rewards compared with different control stimuli are also increased in individuals with PPU symptoms, as are conditioned responses in sexual reward learning paradigms. Sexual reward valuation studies point towards an increased neural value differentiation with increasing PPU symptoms.

Summary

The current state of evidence indicates that positive valence systems are altered in persons with PPU. This framework of organizing evidence may aid in elucidating PPU development and maintenance as well as planning future studies.

The Association between the Quantity and Severity of Pornography Use: A Meta-analysis

Although the quantity of pornography use (QPU, i.e., frequency/time spent on pornography use) has been positively associated with the severity of pornography use (i.e., problematic pornography use, PPU), the magnitudes of relationships have varied across studies. This meta-analysis aimed to assess the overall relationships and identify potential moderating variables to explain the variation in these associations between QPU and PPU. We performed a literature search for all published and unpublished studies from 1995 to 2020 in major online scientific databases up until December 2020. Sixty-one studies were identified with 82 independent samples involving 74,880 participants. Results indicated that there was a positive, moderate relationship between QPU and PPU (r = 0.34, p < .001). The strength of relationship significantly varied across measures of PPU based on different theoretical frameworks, indicators of QPU, and sexual cultural contexts (conservative vs. permissive sexual values). Frequency was a more robust quantitative indicator of PPU than time spent on pornography use. In conservative countries, QPU showed more robust association with self-perceived PPU. Future studies are encouraged to select the measurement of PPU according to research aims and use multi-item measures with demonstrated content validity to assess pornography use. Cross-cultural (conservative/permissive) comparisons also warrant further research.

Analyzing University Students' Perceptions Regarding Mainstream Pornography and Its Link to SDG5

BACKGROUND

Violence against women and girls continues to be a widespread problem, and its elimination is one of the targets of the Sustainable Development Goal 5 toward achieving gender equality. One of the main causes of this violence is the structural sexism present in societies that continues to be perpetuated through pornography, especially among young people. Therefore, the main objective of this research is to analyze the consumption of pornography among young people, studying its effects and relationship with affective-sexual education.

METHODS

This study was carried out with a sample of 280 students in the north of Spain. The ages of the entire sample ranged from 18 to 37 years (M = 20.3, SD = 2.6). From the sample, 78.9% (n = 221) define their gender identity as women and 21.1% (n = 59) define their gender identity as men; no person within this research self-identify as non-binary. The instrument used was the Survey on Affective-sexual Education and Pornography (Ballester et al., 2019). The sample was recruited by snowball sampling.

RESULTS

The results of the present study show that the average age at which people start watching pornography is 10.4 years. The majority of young people consume it to satisfy their curiosity. In addition, with regard to gender, boys consume more pornography, especially for masturbation. Finally, 20.5% of the participants believe that the sexual education they have received has not been adequate, and most of them solve their sexual doubts by asking friends.

CONCLUSIONS

The results indicate that it is necessary to improve the affective-sexual education provided in schools, since students consume pornography at a very early age, and young people have normalized its consumption to address their curiosity and satisfy their sexual needs. Finally, the impact of pornography consumption on SDG5 was reflected on.

Emerging experience with selected new categories in the ICD-11: complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder

Among the important changes in the ICD-11 is the addition of 21 new mental disorders. New categories are typically proposed to: a) improve the usefulness of morbidity statistics; b) facilitate recognition of a clinically important but poorly classified mental disorder in order to provide appropriate management; and c) stimulate research into more effective treatments. Given the major implications for the field and for World Health Organization (WHO) member states, it is important to examine the impact of these new categories during the early phase of the ICD-11 implementation. This paper focuses on four disorders: complex post-traumatic stress disorder, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. These categories were selected because they have been the focus of considerable activity and/or controversy and because their inclusion in the ICD-11 represents a different decision than was made for the DSM-5. The lead authors invited experts on each of these disorders to provide insight into why it was considered important to add it to the ICD-11, implications for care of not having that diagnostic category, important controversies about adding the disorder, and a review of the evidence generated and other developments related to the category since the WHO signaled its intention to include it in the ICD-11. Each of the four diagnostic categories appears to describe a population with clinically important and distinctive features that had previously gone unrecognized as well as specific treatment needs that would otherwise likely go unmet. The introduction of these categories in the ICD-11 has been followed by a substantial expansion of research in each area, which has generally supported their validity and utility, and by a significant increase in the availability of appropriate services.

Neural and behavioral correlates of sexual stimuli anticipation point to addiction-like mechanisms in compulsive sexual behavior disorder

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.

Predictors of Compulsive Sexual Behavior Among Treatment-Seeking Women

Background

Compulsive Sexual Behavior Disorder is currently included in the forthcoming eleventh revision of the International Classification of Diseases (ICD-11); however, prior studies have been conducted mostly on heterosexual, White/European male samples.

Aim

To examine the correlates of compulsive sexual behaviors (CSB) with sociodemographic and sexual history characteristics, as well as predictors of CSB in a sample of treatment-seeking Polish women.

Methods

Six hundred seventy-four (674) Polish women aged 18–66 completed an online-based survey.

Outcomes

Polish adaptation of the Sexual Addiction Screening Test-Revised (SAST-PL) was used to assess the severity of CSB symptoms. Brief Pornography Screen was used to measure problematic pornography use. The bivariate associations between SAST-PL scores and demographic and sexual history characteristics were also examined. A linear regression analysis was performed to identify variables related to the severity of CSB symptoms.

Results

Thirty one percent (31.8%) of women in the studied sample reported treatment seeking for CSB in the past. Problematic pornography use was the strongest predictor of CSB symptoms. Higher severity of CSB symptoms were observed among divorced/separated and single women compared to those who were married or in informal relation. Severity of CSB was positively related to the number of sexual partners during the last year, number of dyadic sexual intercourse during the last 7 days, and negatively associated with age of first sexual intercourse.

Clinical Implications

Our results suggest that CSB is a significant concern among women and more research is needed to identify protective (eg, relationship status) and risk (eg, problematic pornography use, number of past year sexual partners, frequency of past week masturbation) factors associated with CSB symptom severity among treatment-seeking women.

Strengths & Limitations

Our study is one of very few investigating predictors of CSB among women. Given the lack of precise estimates of the prevalence, as well as lack of psychometrically validated instruments measuring CSB in women, present findings should not be considered indicative of CSB prevalence among Polish women.

Conclusion

The lack of clinical data on women reporting issues with CSB remains an important target for future clinical research exploration.

Kowalewska E, Gola M, Lew-Starowicz M, et al. Predictors of Compulsive Sexual Behavior Among Treatment-Seeking Women. Sex Med 2022;10:100525.

Individual cortisol response to acute stress influences neural processing of sexual cues

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.

Assessment of Criteria for Specific Internet-use Disorders (ACSID-11): Introduction of a new screening instrument capturing ICD-11 criteria for gaming disorder and other potential Internet-use disorders

Background and aims

With the inclusion of gaming disorder in the ICD-11, diagnostic criteria were introduced for this relatively new disorder. These criteria may also be applied to other potential specific Internet-use disorders, which may be classified in ICD-11 as other disorders due to addictive behaviors, such as online buying-shopping disorder, online pornography-use disorder, social-networks-use disorder, and online gambling disorder. Due to the heterogeneity in existing instruments, we aimed to develop a consistent and economic measure of major types of (potential) specific Internet-use disorders based on ICD-11 criteria for gaming disorder.

Methods

The new 11-item Assessment of Criteria for Specific Internet-use Disorders (ACSID-11) measures five behavioral addictions with the same set of items by following the principles of WHO's ASSIST. The ACSID-11 was administered to active Internet users (N = 985) together with an adaptation of the Ten-Item Internet Gaming Disorder Test (IGDT-10) and screeners for mental health. We used Confirmatory Factor Analyses to analyze the factor structure of ACSID-11.

Results

The assumed four-factorial structure was confirmed and was superior to the unidimensional solution. This applied to gaming disorder and to the other specific Internet-use disorders. ACSID-11 scores correlated with IGDT-10 as well as with the measures of psychological distress.

Discussion and Conclusions

The ACSID-11 seems to be suitable for the consistent assessment of (potential) specific Internet-use disorders based on ICD-11 diagnostic criteria for gaming disorder. The ACSID-11 may be a useful and economic instrument for studying various behavioral addictions with the same items and improving comparability.

Do Pornography Use and Masturbation Frequency Play a Role in Delayed/Inhibited Ejaculation during Partnered Sex? A Comprehensive and Detailed Analysis

The role of masturbation frequency and pornography use on sexual response during partnered sex has been controversial, the result of mixed and inconsistent findings. However, studies investigating this relationship have often suffered from methodological shortcomings. We investigated the role of masturbation frequency and pornography use on both the occurrence and severity of delayed/inhibited ejaculation (DE), an increasingly common sexual problem among men. We did so in a large (nonclinical) multinational sample of cisgender men (N = 2332; mean age = 40.3, SE = 0.31) within a multivariate context that relied on multiple (and, when possible, standardized) assessments of sexual dysfunctions while controlling for possible confounding variables. Results indicated a weak, inconsistent, and sometimes absent association between the frequency of pornography use and DE symptomology and/or severity. In contrast, both poorer erectile functioning and anxiety/depression represented consistent and strong predictors of DE and, to a lesser extent, DE severity. Other factors, including relationship satisfaction, sexual interest, and masturbation frequency, were significantly though moderately to weakly associated with DE. In conclusion, associations (or sometimes lack thereof) between masturbation frequency, pornography use, and delayed ejaculation are more clearly understood when analyzed in a multivariate context that controls for possible confounding effects.

Increase in the Prevalence of Online Pornography Use: Objective Data Analysis from the Period Between 2004 and 2016 in Poland

Despite the considerable amount of attention presently devoted to the high accessibility of online pornography, very little formal analyses have been carried out to show how the advent and proliferation of Internet technology has changed the prevalence of pornography use in populations. We conducted a preliminary analysis based on objective website traffic data, representing the changes in the number of (1) Internet users generally and (2) online pornography users specifically, between 2004 and 2016 in Poland. We observed a clear increase in the estimated number of people using online pornography in the analyzed period. The estimated number of general population members viewing pornography on the Internet increased over three times (310%) between October 2004 and October 2016-starting from an estimated 2.76 million in the first period to 8.54 million in the last. At the same time, we did not observe a clear increase in the percentage of Internet users who viewed online pornography in the same time period. Additionally, pornography viewership on the Internet was almost 2 times more prevalent among male (47%) than female Internet users (27%), and most popular in the 18-27 age group. Since our analysis is based on objective data, it does not share the limitations inherent in self-reports. However, our approach also has several important limitations (e.g., the analysis does not include online activity generated on mobile devices and under a private browsing mode); thus, the results should be interpreted with caution.

Sexual Shame as a Unique Distress Outcome of Morally Incongruent Pornography Use: Modifications and Methodological Considerations

Researchers focused on the model of pornography problems due to moral incongruence (PPMI) have suggested that perceptions of addiction, stemming from a misalignment between one's moral values and online sexual behavior, may lead to heightened sexual shame. Even so, it has been suggested that the associations found in previous models of PPMI may have been inflated by the inclusion of the emotional distress subscale in the widely used Cyber Pornography Use Inventory (CPUI-9), leading many to use the abridged 4-item version (i.e., the CPUI-4), which excludes emotional distress. Prior models assessing sexual shame have yet to fully address this potential methodological limitation. Considering advances in the conceptualization of PPMI and recommendations concerning best practices, a sample of participants (N = 296) that reported using pornography in the last six months was utilized to compare findings from two moderated mediation models. The first model assessed the differential strength of effects when the subscales of the CPUI-9 were assessed as separate mediators of the associations between moral incongruence and sexual shame, while the second model examined whether such associations persisted when using the recommended CPUI-4. Model results provide further justification for previous findings, indicating that associations between constructs were not the sole result of emotional distress, which supports the utility of the CPUI-4 in models that include sexual shame. Findings provide added support for sexual shame as a unique outcome among those who, due to moral incongruence, perceive that they are addicted to Internet pornography.

Multi-band FMRI compromises detection of mesolimbic reward responses

Recent innovations in Functional Magnetic Resonance Imaging (FMRI) have sped data collection by enabling simultaneous scans of neural activity in multiple brain locations, but have these innovations come at a cost? In a meta-analysis and preregistered direct comparison of original data, we examined whether acquiring FMRI data with multi-band versus single-band scanning protocols might compromise detection of mesolimbic activity during reward processing. Meta-analytic results (n = 44 studies; cumulative n = 5005 subjects) indicated that relative to single-band scans, multi-band scans showed significantly decreased effect sizes for reward anticipation in the Nucleus Accumbens (NAcc) by more than half. Direct within-subject comparison of single-band versus multi-band scanning data (multi-band factors = 4 and 8; n = 12 subjects) acquired during repeated administration of the Monetary Incentive Delay task indicated that reductions in temporal signal-to-noise ratio could account for compromised detection of task-related responses in mesolimbic regions (i.e., the NAcc). Together, these findings imply that researchers should opt for single-band over multi-band scanning protocols when probing mesolimbic responses with FMRI. The findings also have implications for inferring mesolimbic activity during related tasks and rest, for summarizing historical results, and for using neuroimaging data to track individual differences in reward-related brain activity.

An empirical study of affective and cognitive functions in Compulsive Sexual Behavior Disorder

BACKGROUND AND AIMS

Despite the inclusion of the Compulsive Sexual Behavior Disorder (CSBD) in the International Classification of Diseases, very little is known about the underlying affective and cognitive processes. To fill this gap, we compared CSBD subjects and Healthy-Controls (HC) across negative/positive valence, cognitive and sensorimotor systems, as proposed by the Research Domain Criteria framework.

METHODS

74 heterosexual CSBD and 66 matched HC males were studied with 10 questionnaires and 8 behavioral tasks. Analyses were conducted with frequent and Bayesian statistics.

RESULTS

CSBD individuals showed significantly higher (than HC) punishment sensitivity, anxiety, depression, compulsivity, and impulsivity symptoms. Frequentist statistical analysis revealed significant interaction between subject group and condition in Incentive Delay Task, concerning the strength of motivation and hedonic value of erotic rewards. Bayesian analysis produced evidence for the absence of group differences in Facial Discrimination Task, Risk-Ambiguity Task, and Learning Task. Also, Bayesian methods provided evidence for group differences in the Emotional Stroop Task and the Incentive Delay Task. Sexual Discounting Task, Attentional Network Task, and Stop Signal Task produced mixed results.

CONCLUSIONS

Higher punishment sensitivity and impulsivity among CSBD subjects, along with significant interaction between these groups and erotic vs. non-erotic reward processing is in line with previous findings on negative/positive valence alterations in CSBD patients. This result shows that there are similarities to substance and behavioral addictions. The absence of group differences and mixed results related to cognitive and sensorimotor systems raise concerns to what extent CSBD resembles a wide spectrum of impairments observed in disorders, and demand further research.

Aberrant orbitofrontal cortex reactivity to erotic cues in Compulsive Sexual Behavior Disorder

BACKGROUND AND AIMS

Compulsive Sexual Behavior Disorder (CSBD) is characterized by increased reactivity to erotic reward cues. Cue-encoded reward parameters, such as type (e.g. erotic or monetary) or probability of anticipated reward, shape reward-related motivational processes, increase the attractiveness of cues and therefore might enhance maladaptive behavioral patterns in CSBD. Studies on the neural patterns of cue processing in individuals with CSBD have been limited mainly to ventral striatal responses. Therefore, here we aimed to examine the cue reactivity of multiple key structures in the brain's reward system, taking into account not only the type of predicted reward but also its probability.

METHODS

Twenty Nine men seeking professional help due to CSBD and 24 healthy volunteers took part in an fMRI study with a modified Incentive Delay Task with erotic and monetary rewards preceded by cues indicating a 25%, 50%, or 75% chance of reward. Analyses of functional patterns of activity related to cue type and probability were conducted on the whole-brain and ROI levels.

RESULTS

Increased anticipatory response to cues predictive of erotic rewards was observed among CSBD participants when compared to controls, in the ventral striatum and anterior orbitofrontal cortex (aOFC). The activity in aOFC was modulated by reward probability.

DISCUSSION AND CONCLUSIONS

Type of anticipated reward (erotic vs monetary) affects reward-related behavioral motivation in CSBD more strongly than reward probability. We present evidence of abnormal aOFC function in CSBD by demonstrating the recruitment of additional subsections of this region by erotic reward cues.

Impulsivity in Compulsive Sexual Behavior Disorder and Pedophilic Disorder

BACKGROUND AND AIMS

Impulsivity is regarded as a risk factor for sexual crime reoffending, and a suggested core feature in Compulsive Sexual Behavior Disorder. The aim of this study was to explore clinical (e.g. neurodevelopmental disorders), behavioral and neurocognitive dimensions of impulsivity in disorders of problematic sexuality, and the possible correlation between sexual compulsivity and impulsivity.

METHODS

Men with Compulsive Sexual Behavior Disorder (n = 20), and Pedophilic Disorder (n = 55), enrolled in two separate drug trials in a specialized Swedish sexual medicine outpatient clinic, as well as healthy male controls (n = 57) were assessed with the Hypersexual Behavior Inventory (HBI) for sexual compulsivity, and with the Barratt Impulsiveness Scale (BIS) and Connors' Continuous Performance Test-II (CPT-II) for impulsivity. Psychiatric comorbidity information was extracted from interviews and patient case files.

RESULTS

Approximately a quarter of the clinical groups had Attention-Deficit/Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder. Both clinical groups reported more compulsive sexuality (r = 0.73-0.75) and attentional impulsivity (r = 0.36-0.38) than controls (P < 0.05). Based on results on univariate correlation analysis, BIS attentional score, ADHD, and Commissions T-score from CPT-II were entered in a multiple linear regression model, which accounted for 15% of the variance in HBI score (P < 0.0001). BIS attentional score was the only independent positive predictor of HBI (P = 0.001).

DISCUSSION

Self-rated attentional impulsivity is an important associated factor of compulsive sexuality, even after controlling for ADHD. Psychiatric comorbidity and compulsive sexuality are common in Pedophilic Disorder.

CONCLUSION

Neurodevelopmental disorders and attentional impulsivity - including suitable interventions - should be further investigated in both disorders.