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

Differences in cross-sectional and daily diary problematic pornography use correlates

Background

Most problematic pornography use (PPU) research relies on cross-sectional designs. Ecological momentary assessment (EMA) studies are needed to better understand PPU correlates. We evaluated how daily PPU and pornography use ratings were correlated with baseline PPU, pornography use frequency (over 12-months), alcohol problems, and depression in a community sample of men living in the United States.

Design

Participants (n = 113, mean age 37.95 [11.09]) completed a baseline survey battery followed by daily EMAs over 14 days (k = 1,240 observations). Data were gathered on the Prolific panel.

Findings

Screener thresholds suggested 32%, 25%, and 24% of sample were at-risk for PPU, depression, and alcohol use problems respectively. Baseline estimates suggested PPU to be weakly correlated with depression (r = 0.29) and past 12-month pornography use (r = 0.27), but not alcohol problems (r = 0.08). Multilevel modeling indicated aggregated pornography use amount as a robust correlate of aggregated pornography control problems over the observation period. Baseline PPU and pornography use indicators were significant predictors of aggregated control problems and pornography use amount respectively. Baseline depression and alcohol problem predictors were non-significant. Past 12-month pornography use frequency and depression scores exacerbated the relationships between daily pornography use amount and aggregated control problems. Sensitivity analyses specific to only those who used pornography across all observations were consistent with full model results (though effect strength changed).

Conclusions

With exception to the PPU and pornography use indicators, cross-sectional baseline estimates (e.g., alcohol problems and depression) were generally not predictive of aggregated pornography use and control problems in the following 14 days.

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.

Magnetoencephalographic correlates of pornography consumption: Associations with indicators of compulsive sexual behaviors

Pornography consumption is highly prevalent but can develop into problematic sexual behavior with severe negative emotional consequences. Neurobiological studies indicate that compulsive sexual behaviors (CSB) are associated with altered brain structure and function in processing pornography. This study investigated the neuroaffective mechanisms underlying exposure to erotic and explicit pornographic images and their relationship to CSB-relevant symptoms. Whole-head magnetoencephalography (MEG) assessed brain activity during passive viewing of opposite- and same-sex erotic and pornographic images in healthy heterosexual and homosexual women and men (N = 50). Correlations of estimated event-related neural activity with indicators of CSB (hypersexuality, sexual sensation seeking, problematic pornography use, and time spent on pornography use), mood and anxiety, as well as with subjective picture ratings of hedonic valence and emotional arousal were analyzed. Responses of brain regions to sexual content revealed hyper- and hypoactivation and were related to problematic pornography consumption, hypersexuality, time spent on pornography use, and perceived subjective arousal. The neural activation towards erotic and pornographic content revealed further significant associations with depression and anxiety scores. The findings suggest an involvement of prefrontal and temporo-parietal cortex regions in the divergent processing of sexual content in relation to indicators of CSBD. Insight into the neurobiological factors underlying CSB can contribute to a more precise clinical conceptualization of this problem and may promote the development of more effective therapeutic interventions.

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.

Co-Occurring Obsessive-Compulsive Disorder and Compulsive Sexual Behavior: Clinical Features and Psychiatric Comorbidities

Obsessive-compulsive disorder (OCD) commonly co-occurs with other psychiatric conditions. Though research is limited, there is preliminary evidence that OCD also co-occurs with compulsive sexual behavior (CSB). Yet, few studies have investigated the demographic, clinical, and psychiatric comorbidities associated with co-occurring OCD and CSB. To address this gap, the current study aimed to evaluate rates of co-occurring OCD and CSB, identify demographic and clinical factors associated with comorbid OCD and CSB, and assess associated psychiatric comorbidity. Participants (N = 950) were patients of a large multisite treatment for OCD. Standardized self-report measures were used to assess demographic and clinical characteristics such as anxiety, depression, and severity and dimensions of OCD. Semi-structured interviews including the SCID were used to assess psychiatric comorbidities. A total of 36 (3.8%) of participants met the criteria for CSB. Binary logistic regression analysis revealed that males were significantly more likely to present with CSB than females and CSB was associated with greater psychiatric comorbidity, particularly impulse control disorders. These findings suggest that individuals with co-occurring OCD and CSB may have more complex treatment needs, and more tailored interventions may be necessary.

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.

Approach-Avoidance pattern of attentional bias in individuals with high tendencies toward problematic Internet pornography use

Attentional bias plays a vital role in the occurrence and development of addictive behaviors. However, little is known about attentional processes in problematic Internet pornography use (PIPU), and previous studies have reported mixed results. The current study examined the components of attentional processing to sexual stimuli using an exogenous cueing task designed to differentiate between attentional engagement and disengagement. Two different stimulus presentation times (100 and 500 ms) were used to present the pornographic and neutral images to differentiate the early and late stages of attentional bias. Individuals with high (n = 40) and low (n = 40) PIPU tendencies were compared. The results demonstrated that individuals with high tendencies toward PIPU showed enhanced attentional engagement with pornographic stimuli in the early stage of attentional processing (100 ms), followed by attentional avoidance in the late stages of attentional processing (500 ms). Moreover, the severity of PIPU symptoms was positively correlated with attentional engagement scores in the short picture-time trials (100 ms) and weakly negatively correlated with attentional disengagement scores in the long picture-time trials (500 ms). This approach-avoidance pattern of attentional biases is in line with a recent theoretical model that emphasizes that appetitive and aversive motivational processes jointly determine attentional bias.