Enhanced conditioning and disrupted extinction processes in men struggling with compulsive sexual behaviors

Background and aims: Despite a previously reported connection between compulsive sexual behaviors (CSB), such as problematic pornography use, and heightened cue-reactivity, empirical evidence of the alteration of processes responsible for increased salience attribution to erotic cues remains sparse. Drawing on similarities with addiction models, this study explores the neuronal mechanisms of CSB through the use of appetitive conditioning and extinction with erotic and monetary rewards. Methods: Thirty-two heterosexual males struggling with CSB (age: 28.9 +/- 7.1), and 31 healthy matched participants (age: 27.8 +/- 5.6) underwent active appetitive conditioning and extinction tasks in fMRI. The effects of conditioning and extinction towards cues of erotic and monetary rewards were measured via self-assessment (valence and arousal rating towards cues), behavior (reaction times), and brain reactivity. Results: In conditioning, subjective ratings increased, and reaction times were faster for both erotic and monetary cues among participants with CSB, along with altered activity in ventral striatum (vStr), dorsal anterior cingulate cortex (dACC), and anterior orbitofrontal cortex (aOFC). In extinction, self-assessment ratings remained elevated in the CSB group for both cues in a non-reward-specific fashion, accompanied by altered activity of dACC and vStr. Discussion and conclusions: These findings suggest enhanced incentive salience attribution to conditioned cues, highlighting a generalized motivational and value-related transfer from rewards to the cues in participants with CSB. Additionally, despite the absence of rewards, the persistence of arousal and valence towards cues underscored the maladaptive extinction process. These insights advance the understanding of CSB's neurobiological underpinnings and its relation to addiction frameworks.