Abstract
Compulsive Sexual Behaviors (CSB) are a reason to seek treatment. Given this reality, the number of studies on CSB has increased substantially in the last decade and the World Health Organization (WHO) included CSB in its proposal for the upcoming ICD-11. Sixty percent of the neuroimaging studies on CSB published since 2014 aimed to examine similarities and differences between brain mechanisms underlying CSB, gambling disorder, and substance use disorders. One of the crucial brain circuits involved in addiction is the reward system involving the ventral striatum (including nucleus accumbens). There are two distinct theories describing ventral striatal activity in addictions: Incentive Salience Theory (IST) and Reward Deficiency Syndrome (RDS). IST describes increased ventral striatal activations during the anticipation of addiction-related reward, while RDS describes decreased ventral striatal reactivity both during the anticipation of the reward and during the reward processing. Here, we aim to investigate how the findings on ventral striatal reactivity in CSB support each of these two addiction frameworks. For this purpose, we conducted a systematic review of neuroimaging studies on CSB available in Pubmed, EBSCO, and Google Scholar between 2005 and 2018. We found nine relevant research papers. Only four of these studies directly investigated processing of erotic cues and/or rewards and reported findings related to ventral striatum activations. Three of these studies indicate increased ventral striatal reactivity for erotic stimuli, which is consistent with IST and does not support predictions based on RDS. Therefore, the current state of this data suggest that CSB is related to increased ventral striatal reactivity during the anticipation of erotic stimuli.
Highlights
Compulsive Sexual Behaviors (CSB) are a reason to seek treatment for both males [1,2,3] and females [4]
Data provided by Kühn and Gallinat [38] and collected from a non-clinical sample suggest decreased ventral striatum volumetry among healthy individuals who use more pornography; recent findings [47] do not confirm this difference in ventral striatum volume between individuals meeting CSB criteria and controls
There is no study on a population meeting CSB criteria, testing BOLD responses for erotic stimuli, and examining volumetric changes at the same time, so any speculation on the relations between striatal volumetry and reactivity would be premature at this point
Summary
Compulsive Sexual Behaviors (CSB) are a reason to seek treatment for both males [1,2,3] and females [4]. 1. Excessive time spent on sexual fantasies, urges, or behaviors repeatedly interferes with other important (non-sexual) goals, activities, and obligations, i.e., pornography viewing has become a central interest in one’s life, so that family duties or work obligations are neglected; 2. The subject fails to control or significantly reduce these sexual activities, i.e., the subject makes numerous unsuccessful attempts to limit problematic activities, but invariably loses control over them after a couple of days; 5. The subject continues these sexual activities despite the risk of physical or emotional harm to self or to others, i.e., engaging in frequent sexual behavior despite serious consequences for relationships (e.g., break-up) or threat of job loss
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