Abstract
BackgroundsThe classification of addictions and impulse control disorders is changing as reflected in the 11th version of International Classification of Disorders (WHO, 2018). However, studies focusing on direct comparison of structural brain differences in behavioral and substance addictions are limited. AimHere, we contrast gray matter volumes (GMVs) across groups of individuals with compulsive sexual behavior disorder (CSBD), gambling disorder (GD), and alcohol use disorder (AUD) with those with none of these disorders (healthy controls participants; HCs). MethodsVoxel-based morphometry was used to study brain structure, and severities of addiction symptoms were assessed with questionnaires. To identify brain regions related to severities of addictions, correlations between questionnaire scores and GMVs were computed. Main OutcomeWe collected magnetic resonance imaging (GMVs) data from 26 patients with CSBD, 26 patients with GD, 21 patients with AUD, and 25 HC participants (all heterosexual males; age: 24-60; mean = 34.5, standard deviation = 6.48). ResultsAffected individuals (CSBD, GD, AUD) compared with HC participants showed smaller GMVs in the left frontal pole, specifically in the orbitofrontal cortex. The most pronounced differences were observed in the GD and AUD groups, and the least in the CSBD group. In addition, a negative correlation was found between GMVs and disorder severity in the CSBD group. Higher severity of CSBD symptoms was correlated with decreased GMVs in the right anterior cingulate gyrus. Clinical ImplicationsOur findings suggest similarities between CSBD and addictions. Strenghs and LimitiationsThis study is the first showing smaller GMVs in 3 clinical groups of CSBD, GD, and AUD. But the study was limited only to heterosexual men. Longitudinal studies should examine the extent to which ventral prefrontal decrements in volume may represent preexisting vulnerability factors or whether they may develop with disorder progression. ConclusionsOur research extends prior findings in substance use disorders of lower GMVs in prefrontal cortical volumes among 3 clinical groups of patients with specific impulse control (CSBD) and behavioral (GD) and substance (AUD) addictive disorders. The negative correlation between CSBD symptoms and GMV of right anterior cingulate gyrus suggests a link with clinical symptomatology.Draps M, Sescousse G, Potenza MN, et al. Gray Matter Volume Differences in Impulse Control and Addictive Disorders—An Evidence From a Sample of Heterosexual Males. J Sex Med 2020;17:1761–1769.
Highlights
The most pronounced results were observed in gambling disorder (GD) (T-stat 1⁄4 5.20, peak coordinates: x 1⁄4 -32, y 1⁄4 65, z 1⁄4 -14) and alcohol use disorder (AUD) groups (T-stat 1⁄4 4.43, peak coordinates: x 1⁄4 -27, y 1⁄4 60, z 1⁄4 -11), and the least pronounced in the compulsive sexual behavior disorder (CSBD) group (T-stat 1⁄4 3.8, peak coordinates: x 1⁄4 -20, y 1⁄4 71, z 1⁄4 -9)
Our results suggest that a common feature of CSBD and behavioral (GD) and substance (AUD) addictions is that they lower gray matter volumes (GMVs) in frontal pole—a subregion of prefrontal cortex (PFC) implicated in cognitive control,[35,51,52] and cognitive processing.53e55 Reduction of GMVs in the frontopolar cortex was previously found in AUD and GD.[15,18,21,27]
Our results suggest that CSBD resembles GD and AUD from the perspective of GMV reduction in the frontopolar cortex
Summary
Compulsive Sexual Behavior Disorder—State of KnowledgeRecently compulsive sexual behavior disorder (CSBD) was included in the 11th version of International Classification of Disorders (ICD-11) and was classified as an impulse control disorder (Code 6C72 in the ICD-111) characterized by “repeated failure to resist an impulse, drive, or urge to perform an act that is rewarding to the person, at least in the short term, despite consequences such as long-term harm either to the individual or to others, marked distress about the behavior pattern, or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning”.1Such characteristics of CSBD resemble features of behavioral (eg, gambling) or substance (eg, alcohol use disorder [AUD]) addictions, raising questions regarding neural similarities.[2]Addictions are associated with impaired control and continuing behaviors despite adverse consequences involving substance use (such as alcohol, heroin, or cocaine) or specific behaviors (such as gambling or gaming)3e7 taking increasing precedence over other life activities and leading to functional impairment in one or more domains of functioning. Compulsive sexual behavior disorder (CSBD) was included in the 11th version of International Classification of Disorders (ICD-11) and was classified as an impulse control disorder (Code 6C72 in the ICD-111) characterized by “repeated failure to resist an impulse, drive, or urge to perform an act that is rewarding to the person, at least in the short term, despite consequences such as long-term harm either to the individual or to others, marked distress about the behavior pattern, or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning”.1 Such characteristics of CSBD resemble features of behavioral (eg, gambling) or substance (eg, alcohol use disorder [AUD]) addictions, raising questions regarding neural similarities.[2]. During ICD-11 deliberations, GD, gaming disorder, and CSBD were considered
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