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

Abstract

Background and aimsCompulsive 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.MethodsTwenty 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.ResultsIncreased 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 conclusionsType 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.

Neural cue-reactivity in pathological gambling as evidence for behavioral addiction: a systematic review

“…Furthermore, in opioids addiction, functional connectivity between the OFC and dorsal striatum could predict the force of craving after a period of a voluntary abstinence (Fredriksson et al, 2021 ). Interestingly, these variations in OFC were also observed in other BAs, such as the Compulsive Sexual Behavior Disorder (Golec et al, 2021 ). Finally, a shared neurofunctional alteration has been observed both in frontal and ACC in BAs such as IGD along with all SUDs (Klugah-Brown et al, 2021 ).…”

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

“…Individuals who report compulsive sexual behaviour, as compared to individuals who do not, exhibit increased blood flow in the reward system of the brain in response to erotic cues 268‐270 , greater responsivity and attention to erotic cues 271‐273 , increased gray matter volume in the left amygdala 274 , and decreased right caudate nucleus volume 275 . Men with compulsive sexual behaviour disorder, relative to controls without the disorder, also show increased anticipatory response to cues predictive of erotic rewards in the ventral striatum and anterior orbitofrontal cortex 276 . Current findings suggest that compulsive sexual behaviour disorder shares similar brain region abnormalities with both obsessive‐compulsive disorder and substance addiction, although further work is needed to elucidate the underlying brain mechanisms 277 .…”

“…Since the inclusion of compulsive sexual behaviour disorder in the ICD‐11 was proposed, there has been a major expansion of research in this area 227 . A good deal of the early research was based on a conceptualization of “sex addiction” 242 , that later began to shift to a discussion of compulsive sexual behaviour, that does not entirely map to ICD‐11 compulsive sexual behaviour disorder 291,258‐297 , or simply “problematic sexual behaviours” 298 or “problematic pornography use” 299 . A good deal of the research in the past several years has focused on “hypersexuality” e.g., 301,302 , although this has only occasionally been operationalized as hypersexual disorder as it had been proposed for DSM‐5.…”

Another failure of the latent disease model? The case of compulsive sexual behavior disorder •

“…More basic neuroscientific studies are also cautiously recommended. While the neuroscience of CSBD is burgeoning ( Draps, Kowalczyk-Grębska, Marchewka, Shi, & Gola, 2021 ; Golec, Draps, Stark, Pluta, & Gola, 2021 ; Kowalewska et al., 2018 , 2020 ), and will likely be aided by RDoC, funding for imaging studies should not necessarily be prioritized over well designed longitudinal and mixed methods approaches, at least until imaging technologies improve. This “cautious” recommendation is a direct result of the current methodological/reproducibility crisis ongoing within the neuroimaging community ( Eklund, Nichols, & Knutsson, 2016 ; Marek et al., 2022 ; Mueller, Lepsien, Möller, & Lohmann, 2017 ; Turner, Paul, Miller, & Barbey, 2018 ).…”