Compulsive Sexual Behavior in Humans and Preclinical Models
Purpose of Review
Compulsive sexual behavior (CSB) is widely regarded as a “behavioral addiction,” and is a major threat to quality of life and both physical and mental health. However, CSB has been slow to be recognized clinically as a diagnosable disorder. CSB is co-morbid with affective disorders as well as substance use disorders, and recent neuroimaging studies have demonstrated shared or overlapping neural pathologies disorders, especially in brain regions controlling motivational salience and inhibitory control.
Clinical neuroimaging studies are reviewed that have identified structural and/or function changes in prefrontal cortex, amygdala, striatum, and thalamus in individuals suffering from CSB. A preclinical model to study the neural underpinnings of CSB in male rats is discussed consisting of a conditioned aversion procedure to examine seeking of sexual behavior despite known negative consequences. Using this preclinical model, a role of the medial prefrontal cortex was identified, including neural plasticity during comorbidity of CSB and psychostimulant abuse.
This review summarizes recent human behavioral and neuroimaging studies, in addition to preclinical models that can be used to study the underlying neurobiology of CSB.
KeywordsCompulsive sexual behavior Hypersexuality Addiction Prefrontal cortex Limbic system Sexual behavior
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance
- 8.Lee K, Hutton HE, Lesko CR, Monroe AK, Alvanzo A, McCaul ME, et al. Associations of drug use, violence, and depressive symptoms with sexual risk behaviors among women with alcohol misuse. Womens Health Issues. 2018;Google Scholar
- 11.K. Romer Thomsen et al. Impulsivity traits and addiction-related behaviors in youth. J Behav Addict. 2018;1–14.Google Scholar
- 14.•• Krueger RB. Diagnosis of hypersexual or compulsive sexual behavior can be made using ICD-10 and DSM-5 despite rejection of this diagnosis by the American Psychiatric Association. Addiction. 2016;111:2110–1. This commentary supports the clinical diagnosis of compulsive sexual behavior based on the ICD-10 and ICD-11, if not based on DSM-V. CrossRefPubMedGoogle Scholar
- 17.• Gola M, Potenza MN. The proof of the pudding is in the tasting: data are needed to test models and hypotheses related to compulsive sexual behaviors. Arch Sex Behav. 2018). This letter highlights the importance of empirically-defined definitions of compulsive sexual behavior, and calls for more neuroscientific studies of the disorder.;47:1323–5.CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Weiss NH, Tull MT, Sullivan TP, Dixon-Gordon KL, Gratz KL. Posttraumatic stress disorder symptoms and risky behaviors among trauma-exposed inpatients with substance dependence: the influence of negative and positive urgency. Drug Alcohol Depend. 2015;155:147–53.CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Weiss NH, Tull MT, Dixon-Gordon K, Gratz KL. Assessing the negative and positive emotion-dependent nature of risky behaviors among substance dependent patients. Assessment. 2016:107319111666590.Google Scholar
- 27.Weiss NH, Tull MT, Viana AG, Anestis MD, Gratz KL. Impulsive behaviors as an emotion regulation strategy: examining associations between PTSD, emotion dysregulation, and impulsive behaviors among substance dependent inpatients. J Anxiety Disord. 2012;26:453–8.CrossRefPubMedPubMedCentralGoogle Scholar
- 35.M. R. Lo Monaco et al., Prevalence of impulsive-compulsive symptoms in elderly Parkinson's disease patients: a case-control study. J Clin Psychiatry. 2018;79.Google Scholar
- 41.•• M. S. Berry, M. W. Johnson, Does being drunk or high cause HIV sexual risk behavior? A systematic review of drug administration studies. Pharmacol Biochem Behav 164, 125–138 (2018). This systematic review summarizes the recent links within the published literature, in both men and women, between substance use and compulsive sexual behavior. Google Scholar
- 54.• M. W. Johnson, P. S. Johnson, E. S. Herrmann, M. M. Sweeney, Delay and probability discounting of sexual and monetary outcomes in individuals with cocaine use disorders and matched controls. PLoS One 10, e0128641 (2015). This study demonstrates that individuals with cocaine use disorders make impulsive choices for less-favorable outcomes, such as risky sexual behavior without a condom, in both sexual and monetary hypothetical delay discounting tasks. Google Scholar
- 70.Fisher DG, Reynolds GL, Ware MR, Napper LE. Methamphetamine and Viagra use: relationship to sexual risk behaviors. Arch Sex Behav. 2009;Google Scholar
- 74.•• Johnson MW, Herrmann ES, Sweeney MM, LeComte RS, Johnson PS. Cocaine administration dose-dependently increases sexual desire and decreases condom use likelihood: the role of delay and probability discounting in connecting cocaine with HIV. Psychopharmacology. 2017;234:599–612. This study demonstrates that accute cocaine intoxication directly increases sexual desire and impulsive choice (delay discounting) in hypothetical behavioral economics tasks. CrossRefPubMedGoogle Scholar
- 77.•• Koffarnus MN, Johnson MW, Thompson-Lake DGY, Wesley MJ, Lohrenz T, Montague PR, et al. Cocaine-dependent adults and recreational cocaine users are more likely than controls to choose immediate unsafe sex over delayed safer sex. Exp Clin Psychopharmacol. 2016;24:297–304. This study confirms that in addition to individuals with cocaine use disorders (see Johnson et al. 2015 PLoS One ), recreational cocaine users also demonstrate impulsive, risky sexual decision making compared to controls in a hypothetical delay-discounting task. CrossRefPubMedPubMedCentralGoogle Scholar
- 84.•• J. W. Seok, J. H. Sohn, Neural Substrates of Sexual Desire in Individuals with Problematic Hypersexual Behavior. Front Behav Neurosci 9, 321 (2015). This study measures fMRI activity correlating with viewing sexual stimuli, and observed greater activation in the caudate nucleus, inferior parietal lobe, dorsal anterior cingulate gyrus, thalamus, and dorsolateral prefrontal cortex, i.e. areas that are also activated in drug-users when exposed to drug cues. Google Scholar
- 86.•• Schmidt C, Morris LS, Kvamme TL, Hall P, Birchard T, Voon V. Compulsive sexual behavior: prefrontal and limbic volume and interactions. Hum Brain Mapp. 2017;38:1182–90. This study is a first step in identifying functional brain connectivity in compulsive sexual behavior subjects at resting state, and demonstrates a decrease in resting state functional connectivity between prefrontal cortex and amygdala which correlated with greater left amygdala gray matter volume. CrossRefPubMedGoogle Scholar
- 97.Le Moene O, Agmo A. The neuroendocrinology of sexual attraction. Front Neuroendocrinol. 2017;Google Scholar
- 101.•• Davis JF, Loos M, di Sebastiano AR, Brown JL, Lehman MN, Coolen LM. Lesions of the medial prefrontal cortex cause maladaptive sexual behavior in male rats. Biol Psychiatry. 2010;67:1199–204. This study is the first description of conditioned sex aversion as a model for compulsive sexual behavior, in male rats, and demonstrates a critical role of the medial prefrontal cortex. CrossRefPubMedPubMedCentralGoogle Scholar
- 104.Kwok DWS, Boakes RA. Situational relevance: context as a factor in serial overshadowing of taste aversion learning. Q J Exp Psychol (Hove). 2017:1–35.Google Scholar
- 107.•• Frohmader KS, Lehman MN, Laviolette SR, Coolen LM. Concurrent exposure to methamphetamine and sexual behavior enhances subsequent drug reward and causes compulsive sexual behavior in male rats. J Neurosci. 2011;31:16473–82. This study demonstrates the experience with methamphetamine concurrently with sexual behavior results in compulsive sexual behavior in male rats. CrossRefPubMedGoogle Scholar
- 108.•• Kuiper LB, Frohmader KS, Coolen LM. Maladaptive sexual behavior following concurrent methamphetamine and sexual experience in male rats is associated with altered neural activity in frontal cortex. Neuropsychopharmacology. 2017). This study is a first preclinical study showing the neural correlates of conditioned sex aversion, and compulsive sexual behavior, in male rats.;42:2011–20.CrossRefPubMedGoogle Scholar