A Current Understanding of the Behavioral Neuroscience of Compulsive Sexual Behavior Disorder and Problematic Pornography Use
Purpose of Review
In the recently released eleventh edition of the International Classification of Diseases (ICD-11), compulsive sexual behavior disorder (CSBD) was for the first time included and classified as an impulse control disorder. The present report aims at summarizing the empirical results concerning the neurobiological underpinnings of CSBD, including problematic pornography use. Insight into mechanistic factors underlying CSBD may promote the development of more effective therapeutic interventions for people affected.
Recent neurobiological studies have revealed that compulsive sexual behaviors are associated with altered processing of sexual material and differences in brain structure and function.
Although few neurobiological studies of CSBD have been conducted to date, existing data suggest neurobiological abnormalities share communalities with other additions such as substance use and gambling disorders. Thus, existing data suggest that its classification may be better suited as a behavioral addiction rather than an impulse-control disorder.
KeywordsCompulsive sexual behavior disorder Problematic pornography use fMRI Hypersexuality Sexual addiction
Dr. Stark receives support from the German Research Foundation for his research in this research area. Dr. Potenza receives support from the Connecticut State Department of Mental Health and Addiction Services, Hartford, CT; the Connecticut Council on Problem Gambling, Wethersfield, CT; and, a Center of Excellence in Gambling Research Award from the National Center for Responsible Gaming.
The funding agencies did not provide input or comment on the content of the manuscript, and the content of the manuscript reflects the contributions and thoughts of the authors and do not necessarily reflect the views of any funding agencies.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest with respect to the content of this manuscript. Dr. Marc Potenza has received financial support or compensation for the following: Dr. Potenza has consulted for and advised Shire, INSYS, RiverMend Health, Opiant/Lakelight Therapeutics, and Jazz Pharmaceuticals; has received unrestricted research support from Mohegan Sun Casino and grant support (to Yale) from the National Center for Responsible Gaming and Pfizer pharmaceuticals; has participated in surveys, mailings or telephone consultations related to drug addiction, impulse control disorders or other health topics; has consulted for legal and gambling entities on issues related to impulse control disorders and addictions including with respect to dopaminergic drugs; has provided clinical care in the Connecticut Department of Mental Health and Addiction Services Problem Gambling Services Program; has performed grant reviews for the National Institutes of Health and other agencies; has edited journals and journal sections; has given academic lectures in grand rounds, CME events and other clinical or scientific venues; and has generated books or book chapters for publishers of mental health texts. Dr. Rudolf Stark, Dr. Tim Klucken, Dr. Matthias Brand, and Dr. Jana Strahler report no disclosures.
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
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