Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours

Abstract

Although compulsive sexual behaviour (CSB) has been conceptualized as a “behavioural” addiction and common or overlapping neural circuits may govern the processing of natural and drug rewards, little is known regarding the responses to sexually explicit materials in individuals with and without CSB. Here, the processing of cues of varying sexual content was assessed in individuals with and without CSB, focusing on neural regions identified in prior studies of drug-cue reactivity. 19 CSB subjects and 19 healthy volunteers were assessed using functional MRI comparing sexually explicit videos with non-sexual exciting videos. Ratings of sexual desire and liking were obtained. Relative to healthy volunteers, CSB subjects had greater desire but similar liking scores in response to the sexually explicit videos. Exposure to sexually explicit cues in CSB compared to non-CSB subjects was associated with activation of the dorsal anterior cingulate, ventral striatum and amygdala. Functional connectivity of the dorsal anterior cingulate-ventral striatum-amygdala network was associated with subjective sexual desire (but not liking) to a greater degree in CSB relative to non-CSB subjects. The dissociation between desire or wanting and liking is consistent with theories of incentive motivation underlying CSB as in drug addictions. Neural differences in the processing of sexual-cue reactivity were identified in CSB subjects in regions previously implicated in drug-cue reactivity studies. The greater engagement of corticostriatal limbic circuitry in CSB following exposure to sexual cues suggests neural mechanisms underlying CSB and potential biological targets for interventions.

Compulsive sexual behavior: Prefrontal and limbic volume and interactions

“…CSB subjects had higher BDI ( P  = 0.006) and UPPS‐P ( P  < 0.001) scores compared with HV. Other behavioral scores including pattern and severity of pornography and internet use have been reported elsewhere [Mechelmans et al, 2014; Voon et al, 2014]. …”

“…Such drug‐related neurotoxicity is likely a highly relevant issue in SUD but less of an issue in behavioral addictions. In a recent CSB study using fMRI, exposure to sexually explicit cues in CSB compared with non‐CSB subjects was associated with activation of the amygdala [Voon et al, 2014]. Whether the difference in amygdala volume is a pre‐existing trait predisposing individuals to CSB or related to excessive exposure remains to be established.…”

“…All HV were age‐matched (±5 years of age) with CSB subjects. Subjects were also screened for compatibility with the MRI environment as we have done previously [Banca et al, 2016; Mechelmans et al, 2014; Voon et al, 2014]. Exclusionary criteria included being under 18 years of age, having a history of SUD, being a current regular user of illicit substances (including cannabis), and having a serious psychiatric disorder, including current moderate‐severe major depression or obsessive‐compulsive disorder, or history of bipolar disorder or schizophrenia (screened using the Mini International Neuropsychiatric Inventory) [Sheehan et al, 1998].…”

“…Group comparisons were adjusted for both age and depression scores as covariates. We focused on a priori hypothesized regions of interest identified in our previous study [Voon et al, 2014] and in meta‐analyses of drug cue reactivity studies [Kühn and Gallinat, 2011], namely left and right VS, left and right amygdala, and dorsal ACC using small volume corrected (SVC) family‐wise error (FWE) corrected P  < 0.01 (Bonferroni corrected for multiple comparisons). For these SVC analyses, we used a VS anatomical ROI, previously described [Murray et al, 2008] which was hand drawn using MRIcro based on the definition of VS by Martinez et al [2003].…”

“…With respect to functional activity, male HV show enhanced habituation processes with lower left putaminal BOLD activity to static erotic images [Kühn and Gallinat, 2014] and lower late positive potential to explicit images [Prause et al, 2015]. In contrast, in a task‐based fMRI study comparing CSB with HV, explicit sexual videos elicited higher VS, amygdala and dorsal ACC BOLD responses in CSB [Voon et al, 2014]. Functional connectivity between these regions correlated with an index of sexual desire or “wanting” but not “liking” in CSB subjects suggesting the role of incentive motivation, paralleling substance addiction.…”