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Reward processing – related orbitofrontal reactivity alterations in patients suffering from problematic pornography use

Lew-Starowicz, M1; Wordecha, M2; Sescousse, G3; Potenza, MN4; Wypych, M2; Marchewka, A2; Gola, M5

1: Institute of Psychiatry and Neurology, Warsaw, Poland; 2: Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology of Polish Academy of Science, Warsaw, Poland; 3: Radboud University, Donders Institute for Brain, Cognition and Behavior, Nijmegen, Netherlands; 4: Departments of Psychiatry and Neurobiology, Child Study Center and CASAColumbia, Yale School of Medicine, New Haven, CT, USA and Connecticut Mental Health Center, New Haven, CT, USA; 5: Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California San Diego, San Diego, USA and Institute of Psychology, Polish Academy of Science, Warsaw, Poland


Objectives: Problematic pornography use (PPU) usually accompanied by compulsive masturbation is the most common manifestation of compulsive sexual behavior (CSB). Given the highly prevalent pornography consumption in non-clinical population, it remains largely unknown why for some individuals this activity leads to loss of control and negative psychosocial consequences. Determining neuronal mechanisms of CSB may play an important role in the development of more effective treatment strategies. In our previous studies (Gola et al., 2017) we have found that PPU subjects showed increased activation of brain reward circuits (ventral striatum) specifically for cues predicting erotic pictures but not for cues predicting monetary gains. The same pattern but with an opposite preference towards rewarding cues (monetary over erotic) was found in individuals with gambling disorder. Our current research focused on the activation patterns of posterior and anterior orbitofrontal cortex (pOFC and aOFC) which are another regions of interest, the first being engaged in processing of primary (such as food and sexual activity) and the latter in secondary (such as money and social reinforces) rewards.

Material and Methods: 28 heterosexual males seeking treatment because of PPU who met diagnostic criteria of hypersexual disorder (HD) by Kafka et al. (2010) and 24 matched controls were examined using fMRI procedure utilizing erotic and monetary gains.

Results: Control subjects, as previously showed (Sescousse et al., 2013), indicated higher activations of aOFC in response to monetary than to erotic rewards. In the PPU subjects, we found no difference in pOFC activations during processing erotic rewards and a significantly higher response of aOFC to erotic rewards as compared with controls. Our results indicate an alteration of aOFC: while among healthy controls this region is reactive for monetary rewards, among PPU subjects it becomes responsive also for erotic stimuli. This response was related to the severity measures of CSB.

Conclusions: Our findings suggest that PPU subjects may experience difficulties in differentiating between value of erotic and non-erotic rewards. Similar outcomes related to monetary and non-monetary rewards were found for pathological gamblers which adds another argument that PPU resembles neural and behavioral patterns of this well-described behavioral addiction.


Work supported by industry: no.

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