Altered Appetitive Conditioning and Neural Connectivity in Subjects with Compulsive Sexual Behavior

Abstract

Introduction There has been growing interest in a better understanding of the etiology of compulsive sexual behavior (CSB). It is assumed that facilitated appetitive conditioning might be an important mechanism for the development and maintenance of CSB, but no study thus far has investigated these processes. Aim To explore group differences in neural activity associated with appetitive conditioning and connectivity in subjects with CSB and a healthy control group. Methods Two groups (20 subjects with CSB and 20 controls) were exposed to an appetitive conditioning paradigm during a functional magnetic resonance imaging experiment, in which a neutral stimulus (CS+) predicted visual sexual stimuli and a second stimulus (CS-) did not. Main Outcome Measures Blood oxygen level-dependent responses and psychophysiologic interaction. Results As a main result, we found increased amygdala activity during appetitive conditioning for the CS+ vs the CS- and decreased coupling between the ventral striatum and prefrontal cortex in the CSB vs control group. Conclusion The findings show that neural correlates of appetitive conditioning and neural connectivity are altered in patients with CSB. The increased amygdala activation might reflect facilitated conditioning processes in patients with CSB. In addition, the observed decreased coupling could be interpreted as a marker for impaired emotion regulation success in this group.

Neural correlates of subjective CS/UCS association in appetitive conditioning

“…Previous studies observed decreased coupling between the vmPFC and the ventral striatum as well as with the amygdala to be associated with facilitated appetitive conditioning (Klucken, Wehrum‐Osinsky, Schweckendiek, Kruse, & Stark, ; Klucken et al, ). For instance, subjects with compulsive sexual behavior showed increased task‐specific (CS+–CS−) amygdala activation as well as decreased coupling between the ventral striatum and vmPFC during appetitive acquisition compared to the controls (Klucken et al, ). Similarly, facilitated conditioning processes and decreased coupling between the amygdala and vmPFC were also found in an appetitive conditioning study investigating the effect of a dopaminergic genotype on learning (Klucken et al, ).…”

“…Thus, higher subjective CS/UCS association corresponds to less task‐specific (CS+–CS−) coupling between V1 and the vmPFC and between the ventral striatum and the vmPFC throughout the acquisition phase. A previous study found a similar pattern of decoupling between the ventral striatum and the vmPFC in an appetitive conditioning paradigm with sexual stimuli as the UCS in subjects with sexual compulsive behavior compared to that of the controls (Klucken et al, ). However, our findings also showed this pattern of decoupling in healthy subjects.…”

“…This supports neurocircuitry models proposing that hypoactivity in the vmPFC gives rise to disinhibited increased amygdala activity, a process which is referred to as disinhibition. Previous studies observed decreased coupling between the vmPFC and the ventral striatum as well as with the amygdala to be associated with facilitated appetitive conditioning (Klucken, Wehrum‐Osinsky, Schweckendiek, Kruse, & Stark, ; Klucken et al, ). For instance, subjects with compulsive sexual behavior showed increased task‐specific (CS+–CS−) amygdala activation as well as decreased coupling between the ventral striatum and vmPFC during appetitive acquisition compared to the controls (Klucken et al, ).…”

Neuroticism and extraversion moderate neural responses and effective connectivity during appetitive conditioning

“…Since contingency awareness may significantly impact CRs [Hamm and Weike, 2005;Lovibond and Shanks, 2002], subjects were instructed to look at the stimuli and to pay attention to possible relationships between the monetary reward (UCS) and the stimuli (CS) during the experiment to ensure that all participants acquired contingency awareness [Klucken et al, 2012[Klucken et al, , 2016Phelps et al, 2004;Schiller et al, 2008]. Since contingency awareness may significantly impact CRs [Hamm and Weike, 2005;Lovibond and Shanks, 2002], subjects were instructed to look at the stimuli and to pay attention to possible relationships between the monetary reward (UCS) and the stimuli (CS) during the experiment to ensure that all participants acquired contingency awareness [Klucken et al, 2012[Klucken et al, , 2016Phelps et al, 2004;Schiller et al, 2008].…”

The Risks Young People Face as Porn Consumers

“…Historically, levels of impotence among young men have been 2% to 5% (Park et al, 2016). A range of recent studies are finding that 27% to 33% of young men age 18-40 years are having erectile difficulties and low libido rates with a real partner (Bronner & Ben-Zion, 2014;Klucken, Wehrum-Osinsky, Schweckendiek, Kruse, & Stark, 2016;Kühn & Gallinat, 2014;Mialon, Berchtold, Michaud, Gmel, & Suris, 2012;Pizzol, Bertoldo, & Foresta, 2015;Sutton, Stratton, Pytyck, Kolla, & Cantor, 2015), though not with internet pornography (Landripet & Štulhofer, 2015). Essentially, they have conditioned their brains to respond to images on a screen and not to real partners.…”