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

Mateusz Gola,Scott Makeig,Małgorzata Wordecha,Marek Wypych,Guillaume Sescousse,Michał Lew-Starowicz,Bartosz Kossowski,Marc N Potenza,Artur Marchewka

doi:10.1038/npp.2017.78

Abstract

Pornography consumption is highly prevalent, particularly among young adult males. For some individuals, problematic pornography use (PPU) is a reason for seeking treatment. Despite the pervasiveness of pornography, PPU appears under-investigated, including with respect to the underlying neural mechanisms. Using functional magnetic resonance imaging (fMRI), we examined ventral striatal responses to erotic and monetary stimuli, disentangling cue-related 'wanting' from reward-related 'liking' among 28 heterosexual males seeking treatment for PPU and 24 heterosexual males without PPU. Subjects engaged in an incentive delay task in the scanner, in which they received erotic or monetary rewards preceded by predictive cues. Blood-oxygen-level-dependent responses to erotic and monetary cues were analyzed and examined with respect to self-reported data on sexual activity collected over the 2 preceding months. Men with and without PPU differed in their striatal responses to cues predicting erotic pictures but not in their responses to erotic pictures. PPU subjects when compared with control subjects showed increased activation of ventral striatum specifically for cues predicting erotic pictures but not for cues predicting monetary gains. Relative sensitivity to cues predicting erotic pictures vs monetary gains was significantly related to the increased behavioral motivation to view erotic images (suggestive of higher 'wanting'), severity of PPU, amount of pornography use per week, and number of weekly masturbations. Our findings suggest that, similar to what is observed in substance and gambling addictions, the neural and behavioral mechanisms associated with the anticipatory processing of cues specifically predicting erotic rewards relate importantly to clinically relevant features of PPU. These findings suggest that PPU may represent a behavioral addiction and that interventions helpful in targeting behavioral and substance addictions warrant consideration for adaptation and use in helping men with PPU.

Highlights

Pornography consumption has become highly prevalent, in part given Internet availability (Luscombe, 2016)
As there were no interactions of probability and group both in RTs (F(2,50) = 1.132; p = 0.331) and BOLD response (F(2,50) = 2.046; p = 0.135), we present these results in Supplementary Material (Supplementary Figure S1)
No group-by-reward-type interaction (F(1,50) = 0.2.054; p = 0.158) was observed. These results indicate that pornography use (PPU) men and CSubs differ during the cue phase but demonstrate similar ventral striatal reactivity in the reward phase, with results showing a significant three-way group-by-cue-type-by-processing-phase interaction (F(1,50) = 5.438; p = 0.024)

Summary

Introduction

Pornography consumption has become highly prevalent, in part given Internet availability (Luscombe, 2016). Men with CSB (meeting criteria for hypersexual disorder; Kafka, 2010) as compared with those without (comparison subjects (CSubs)) demonstrated increased striatal reactivity for sexually explicit videos (Voon et al, 2014) and decreased functional connectivity between the ventral striatum and prefrontal cortex (Klucken et al, 2016). These findings suggest similarities between CSB and addictions

Methods

Results

Discussion

Conclusion