Preliminary investigation of the impulsive and neuroanatomical characteristics of compulsive sexual behavior

https://doi.org/10.1016/j.pscychresns.2009.04.008Get rights and content

Abstract

In recent years, there has been increased interest in a clinical syndrome characterized by excessive sexual thoughts, sexual urges, and/or sexual behaviors that has many aspects in common with impulse control disorders. This study provides a preliminary examination of the impulsive aspects of this syndrome, compulsive sexual behavior (CSB). Sixteen male subjects, eight CSB patients and eight non-patient controls, completed psychometric measures of impulsivity and compulsive sexual behavior, performed a behavioral task designed to assess impulse control (Go–No Go task), and underwent diffusion tensor imaging (DTI) procedures. The results indicated that CSB patients were significantly more impulsive; whether measured by psychometric testing or the Go-No Go procedure, than controls. The results also indicate that CSB patients showed significantly higher superior frontal region mean diffusivity (MD) than controls. A correlational analysis indicated significant associations between impulsivity measures and inferior frontal region fractional anisotropy (FA) and MD, but no associations with superior frontal region measures. Similar analyses indicated a significant negative association between superior frontal lobe MD and the Compulsive Sexual Behavior Inventory. Thus, while CSB patients were more impulsive than controls, the DTI results were not consistent with impulse control disorders.

Introduction

Over the course of the last several decades, an increasing number of clinicians and researchers have become interested in a clinical syndrome involving excessive sexual thoughts, sexual urges, or sexual activity which cause distress or impairment. This phenomenon has been called compulsive sexual behavior (CSB; Quadland, 1985, Coleman, 1991), paraphilia-related disorder (Kafka, 1994), sexual impulsivity (Barth and Kinder, 1987), and sexual addiction (Carnes, 1983, Goodman, 1993). Coleman and colleagues (Coleman et al., 2000) proposed criteria for CSB that require the presence of recurrent and intense sexually arousing fantasies, sexual urges, or behaviors over a period of at least 6 months that cause distress or impairment. While there are some disagreements over the nature and the etiology of compulsive sexual behavior, all of the researchers listed above agree that the syndrome includes intense, intrusive sexual urges and fantasies, along with excessive problematic sexual behavior. In this manner, CSB resembles impulse control disorders such as kleptomania, pathological gambling, and eating disorders such as bulimia nervosa and binge eating disorder.

Although there have been no brain-imaging studies of CSB, it has been suggested that damage to the frontal lobes can result in disinhibition of sexual behavior, and thus, hypersexual, or CSB (Coleman, 2005). Diffusion tensor imaging (DTI) is an MRI technique that measures the self-diffusion of water in brain tissue. DTI has been used to provide quantitative information about white matter organization and integrity. The DTI data can be represented in a number of ways, including fractional anisotropy (FA), a measure of the extent to which water diffusion is directionally restricted, and mean diffusivity (MD), a measure of overall diffusivity in the tissue. Grant et al. (2006) used DTI to examine white matter in kleptomania. These investigators found that FA was significantly lower in the inferior frontal regions of individuals with kleptomania, indicating altered white matter organization in this region of the brain, which influences executive function and inhibitory control (Hoptman et al., 2002).

The purpose of this study is to explore white matter micro-structure with DTI in men with CSB. Given the results for kleptomania and the presence of impulsivity in CSB, we hypothesized that we would find greater disorganization of white matter on DTI in the frontal lobes of men with CSB and that this white matter disorganization would be associated with greater impulsivity in CSB patients than non-CSB controls.

Section snippets

Subjects

Eight men who met the proposed research criteria for CSB described above were recruited from a treatment program for individuals seeking treatment for sexual problems. CSB patients all reported non-paraphilic CSB. Five of the eight (62%) had a history of major depression, almost all (7 of 8) had a history of alcohol abuse or dependence, and four (50%) had a history of other substance abuse or dependence. One subject had a history of obsessive–compulsive disorder, and another subject reported

Results

The data presented in Table 1 show that the CSB group differs from the controls on multiple measures of impulsivity. Significant CSB vs. control differences were found for overall impulsivity, t14 =  2.64, P < 0.019, and constraint, t14 = 2.50, P < 0.026. Additionally, CSB participants showed significantly higher negative emotionality, t14 =  3.16, P < 0.007. The CSB participants also showed significantly higher scores on the CSBI, t14 = 9.57, P < 0.001.

The results of a Go–No Go procedure, which is a

Discussion

The data presented herein are consistent with the assumption that CSB has much in common with impulse control disorders, such as kleptomania, compulsive gambling, and eating disorders. Specifically, we found that individuals who meet diagnostic criteria for compulsive sexual behavior score higher on self-report measures of impulsivity, including measures of overall impulsivity and the personality factor, constraint. However, although there was a significant difference between scores on the

Acknowledgments

This project was supported in part by a Grant-in-Aid of Research, Artistry and Scholarship from the University of Minnesota to Michael H. Miner, R01MH060662 and P20DA024196 to Kelvin O. Lim and by P41 R008079, P30 NS057091, M01-RR00400 and the MIND Institute.

References (36)

  • BarthJ. et al.

    The mislabeling of sexual impulsivity

    Journal of Sexual and Marital Therapy

    (1987)
  • BasserP.J.

    Inferring microstructural features and the physiological state of tissues from diffusion-weighted images

    NMR in Biomedicine

    (1995)
  • BraverT.S. et al.

    Anterior cingulated cortex and response conflict: effects of frequency, inhibition and errors

    Cerebral Cortex

    (2001)
  • CannistraroP.A. et al.

    A diffusion tensor imaging study of white matter in obsessive–compulsive disorder

    Depression and Anxiety

    (2007)
  • CarnesP.

    Out of the Shadows: Understanding Sexual Addiction

    (1983)
  • CheungA.M. et al.

    The relationship of behavioral inhibition to executive functions in young adults

    Journal of Clinical and Experimental Neurophyshcology

    (2004)
  • CohenJ.

    Statistical Power for the Behavioral Sciences (2nd Ed.)

    (1988)
  • ColemanE.

    Compulsive sexual behavior. New concepts and treatments

    Journal of Psychology and Human Sexuality

    (1991)
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      Strong impulses or compulsions are distinctive from addictions in that addiction is typically associated with additional features caused by the substance or behavior, including tolerance and withdrawal, whereas in impulse control disorders (e.g., kleptomania and pyromania) or compulsive disorders (e.g., obsessive compulsive disorder) the assumption is that the pathology lies primarily within the individual. Some evidence suggests that persons with CSB exhibit significantly higher levels of impulsiveness than healthy controls (Antons et al., 2019; Mechelmans et al., 2014; Miner, Raymond, Mueller, Lloyd, & Lim, 2009; Reid, Berlin, & Kingston, 2015), however, similar associations have been observed in people with other addictive disorders, such as gambling (Specker, Carlson, Christenson, & Marcotte, 1995), alcohol (Lejoyeux, Feuché, Loi, Solomon, & Adès, 1999), or cocaine (Li et al., 2008) use disorders. In short, impulsivity is a feature of most addictive disorders, which suggests that distinguishing between impulse control disorder and addiction is not a straightforward endeavor.

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