Enhanced attentional bias towards sexually explicit cues in individuals with and without compulsive sexual behaviours.

Compulsive sexual behaviour (CSB) is relatively common and has been associated with significant distress and psychosocial impairments. CSB has been conceptualized as either an impulse control disorder or a non-substance 'behavioural' addiction. Substance use disorders are commonly associated with attentional biases to drug cues which are believed to reflect processes of incentive salience. Here we assess male CSB subjects compared to age-matched male healthy controls using a dot probe task to assess attentional bias to sexually explicit cues. We show that compared to healthy volunteers, CSB subjects have enhanced attentional bias to explicit cues but not neutral cues particularly for early stimuli latency. Our findings suggest enhanced attentional bias to explicit cues possibly related to an early orienting attentional response. This finding dovetails with our recent observation that sexually explicit videos were associated with greater activity in a neural network similar to that observed in drug-cue-reactivity studies. Greater desire or wanting rather than liking was further associated with activity in this neural network. These studies together provide support for an incentive motivation theory of addiction underlying the aberrant response towards sexual cues in CSB.This is the published version of the manuscript. It is originally published by PLoS in PLoS ONE here: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0105476

Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours

Although compulsive sexual behaviour (CSB) has been conceptualized as a "behavioural" addiction and common or overlapping neural circuits may govern the processing of natural and drug rewards, little is known regarding the responses to sexually explicit materials in individuals with and without CSB. Here, the processing of cues of varying sexual content was assessed in individuals with and without CSB, focusing on neural regions identified in prior studies of drug-cue reactivity. 19 CSB subjects and 19 healthy volunteers were assessed using functional MRI comparing sexually explicit videos with non-sexual exciting videos. Ratings of sexual desire and liking were obtained. Relative to healthy volunteers, CSB subjects had greater desire but similar liking scores in response to the sexually explicit videos. Exposure to sexually explicit cues in CSB compared to non-CSB subjects was associated with activation of the dorsal anterior cingulate, ventral striatum and amygdala. Functional connectivity of the dorsal anterior cingulate-ventral striatum-amygdala network was associated with subjective sexual desire (but not liking) to a greater degree in CSB relative to non-CSB subjects. The dissociation between desire or wanting and liking is consistent with theories of incentive motivation underlying CSB as in drug addictions. Neural differences in the processing of sexual-cue reactivity were identified in CSB subjects in regions previously implicated in drug-cue reactivity studies. The greater engagement of corticostriatal limbic circuitry in CSB following exposure to sexual cues suggests neural mechanisms underlying CSB and potential biological targets for interventions

Dot probe task and attentional bias.

<p>Dot probe task. The cues (A, B) represent either a sexually explicit, erotic or neutral woman cue paired with a neutral furniture cue randomly presented on either side. Subjects are required to indicate the side in which the green target appears using one of two key presses. The graph represents attentional bias ((Reaction time (RT) for control – RT test cue)/(RT control + RT test cue)) for the early stimulus latency compared between subjects with compulsive sexual behavior (CSB) and healthy volunteers (HV). The error bars represent standard error of the mean.</p

Subject characteristics.

<p>Abbreviations: CSB = subjects with compulsive sexual behavior; HV = healthy volunteers; BES = Binge Eating Scale; AUDIT = Alcohol Use Disorders Identification Test; BDI = Beck Depression Inventory; SSAI/STAI = Speilberger State and Trait Anxiety Inventory; OCI-R = Obsessive Compulsive Inventory; UPPS-P = UPPS Impulsive Behaviour Scale.</p

Stimulus latency and raw reaction time scores.

<p>A. Stimulus latency. The attentional bias score is shown for subjects with compulsive sexual behavior (CSB) and healthy volunteers (HV) as a function of stimulus latency (Early: 250–350 msec; Late 350–450 msec). B. Raw reaction time for cues and control stimuli for CSB and HV subjects. The error bars represent standard error of the mean.</p

Sexual desire.

<p>A. Subjective desire and liking scores to video types in subjects with compulsive sexual behaviours (CSB) and healthy volunteer (HV) participants. There was a significant group-by-video-type-by-desire/liking interaction. Error bars represent SEM. *p<0.05. B. Desire covariate for explicit videos in both CSB and HV subjects with the corresponding regression analysis graph for dorsal cingulate parameter estimates (P.E.) and desire scores. C. Psychophysiological interaction analysis with desire covariate for explicit-exciting contrast with dorsal cingulate seed. The coronal images and graphs show CSB subjects with an HV exclusive mask and corresponding regression analyses for ventral striatum and amygdala parameter estimates and desire scores. The images are shown as regions of interest at P<0.005.</p

Condition contrasts.

<p>The glass brains and coronal images show the effects across groups of the following contrasts: explicit – exciting (left, top row), erotic – exciting (middle, middle row) and money – exciting (right, bottom row). The images are shown at whole-brain FWE-corrected P<0.05. The axial view (top right) shows the contrast across groups of explicit – exciting videos focusing on the substantia nigra. The image is shown with a substantia nigra region of interest mask overlaid on a magnetization transfer sequence.</p

Age.

<p>The coronal view shows the age covariate for explicit videos in subjects with Compulsive Sexual Behaviours (CSB) with a healthy volunteer (HV) exclusive mask. The graph shows the corresponding regression analysis for the ventral striatal parameter estimate (PE) and age in years. The image is shown as a region of interest at P<0.005.</p

Explicit versus exciting cues.

<p>The coronal views represent the group-byvideo-type interaction of subjects with compulsive sexual behaviour (CSB)>healthy volunteers (HV) contrasting explicit>exciting cues. The images are shown as regions of interest at P<0.005. The time course analyses represent the % signal change to explicit videos (top) and exciting videos (bottom) with CSB subjects in red and healthy volunteers in black. Error bars represent SEM.</p