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The first region in which the variations in BOLD signal were correlated to those of genital response was the left frontal operculum. In the functional context of sexual affiliation, two interpretations are possible regarding the role of this neural system: On the other hand, the behavioral response was also recorded by physiological the erectile response and some of the efferences of the frontal operculum to the insula could be the corresponding anatomical support. Therefore, these results place the physiological response at the center of the processes involved in social relations with a strong motivational component.
These results are in accordance with those showing a possible anticipatory activation of this network, that is, before the observation of motor scenes Kilner et al. For somatosensory areas, important results have been obtained. Everything happens as if the observation of sexual explicit scenes induced activation only in motor areas corresponding to the hand, but also in areas of the somatosensory cortex corresponding to the representation of the hand. Such processes may play a role in recognizing emotions in others by the observer Adolphs et al. The exploration of the neural networks involved in healthy human sexual behavior through modern neuroimaging techniques remains recent, centered on healthy human male sexual motivation.
Even if the number of studies on this topic is growing exponentially, there are still a lot of scientific questions to solve. As shown by this article, the question of the neural circuits involved in addiction is an important topic. In the field of sexual addiction, different kinds of data are now available. Today, modern neuroimaging techniques such as MRI allow using different modalities to record during the same experimental session either data regarding the anatomical properties of the brain or its functional properties through neural activations recorded in any kind of behavior.
However, from one study to another, the evaluation method to assess and evaluate compulsive sexual behavior have been different. Recently, Miner et al. To recruit patients with a certain homogeneity, authors used as inclusion criterion the CSB syndrome. In , Coleman et al. As explained by authors, this syndrome shares criteria with other addictions such as bulimic behavior and pathological gambling.
Although this study was the first to present data on patients with a CSB, important hypotheses have been proposed through the report of single cases. The first one is the disruption of frontal brain areas that usually have an inhibitory effect on sexual behavior and that could induce an hypersexuality. Here, the recorded informations were only anatomical. With highly specific settings, diffusion tensor imaging DTI gives very precise information on cerebral white matter organization and integrity.
Therefore using DTI, authors compared cerebral microarchitecture in a group of patients with CSB and a group of appealed control participants. In parallel, informations were recorded from both groups through standardized questionnaires dealing with 1 intensity of symptoms of the CSB; 2 intensity of different traits related to impulsivity; and 3 skills regarding emotional regulation.
In this task, they were asked to push a button when a given letter appeared on a screen, hereafter called the target letter. This first version of the task was dedicated to evaluate the intensity of impulsivity. This second version of the task was dedicated to measure inattention of participants by measuring omission errors when they omit to left click on the mouse for a target letter occurrence. The results of this study were very interesting. Regarding impulsivity, patients with higher impulsivity scores as measured by standardized questionnaires were more sensitive to negative emotions.
Regarding anatomical data, two different types of analyses have been performed. These results were changing a little bit when correlational analyses were performed between anatomical and cerebral data: How to interpret these results? Firstly, these results demonstrate that CSB shares a lot of properties with other impulsivity control disorders such as kleptomania, pathological gambling, and alimentation disorders.
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Thanks to the Go-noGo behavioral task, a higher level of impulsivity was reported in patients with CSB than in control participants. These results are in accordance with those demonstrated in patients with compulsive obsessional troubles as reported in a recent study using the same behavioral task in a group of patients depicting trichotillomania as compared to controlled participants Chamberlain et al.
The cerebral side was also explored in terms of anatomy and processes. The anatomical data did not support the first hypotheses of the authors. These results were different than those of previous studies reporting a disorganization of the inferior frontal cortex in other categories of impulsivity disorders Grant et al. Although no significant results were reported, some preliminary tendencies regarding anatomical data appeared. DTI indexes variations were reported for the superior frontal lobe between patients and control participants that supports an alteration of axons within this region.
For neuroimaging, a very interesting approach is to perform correlational analyses between neuroimaging and behavioral data. For this specific study, authors demonstrated a correlation between impulsivity measures and white matter troubles for the inferior frontal gyrus. Similar results were demonstrated in studies dealing with compulsive obsessional disorders.
As explained above and as postulated by Eli Coleman , CSB would be a partial response to negative affects such as depression or anxiety. Such an hypothesis is in accordance with responses reported in patients with higher ratings on a negative emotional scale and with behavioral and anatomical data recorded more generally in anxious troubles. As mentioned above, anatomical data would support CSB more as an obsessional compulsive behavior than an impulsivity control disorder. Clinically, this type of addiction raises the problem of its screening.
Indeed, to consult a therapist because of a too intense sexual like is not trivial. Moreover, the denial of the problems related to this kind of behavior, avoidance of suffering of depressive symptoms associated with a personal questioning do not help much these patients to consult a therapist. When a therapeutic process begins, it will promote a flexible but robust therapeutic setting so that the patient gradually learns to keep a rhythm that is to say, also invest in the therapeutic relationship rather than to go from on therapist to zap from one therapist to another one as soon as frustration is felt.
Emotional reactions on edge, acts, or acting out often make it difficult to develop a good psychic elaboration. Carnes a , b was the first to develop a behavioral method based on the 12 steps of Anonymous Alcoholics that aims to rehabilitate these individuals. The method is quite simple: Other authors such as Earl developed care programs in the same direction. Schneider highlighted the difficulty of these individuals to stop their behavior: This simple idea has some merit to attract patients, who, desperate and alone, then have a new challenge to overcome.
Indeed, abstinence will be able to afford to give, eventually, relief to a later love affair, which would — before — not resist to the temptation to change automatically because the other, that is, the partner, did not exist as such , but is the internal psychic structure really modified by this conditional abstinence? The challenge for an analytical therapy is not to focus on the symptom. This type of care in the sense that such treatment will involve to be confronted to difficult life episodes, scarrying when it comes to open conflict and painful memories for consciousness. Moreover, as for some borderline states, the analytical cure for sex-addicts often reveals a great difficulty in remembering the past, which does not facilitate the elaboration processes.
Behaviorally, which is implicitly aimed in the cure is learning a relationship with the other. Within the model of the therapeutic relationship stable, rhythmic, challenging , the subject will learn a relational kind of consistency that he will be able to appreciate and incorporate the side of his emotional and sexual life. These psychotherapies may, depending on the intensity of pain experienced, be coupled with a medical care. On the pharmacological side, treatments are various and depend largely on their effect on the patient: Inhibitory hormonal therapy often designed as castrating is usually reserved for a forensic use.
A recent study by Gulsun et al.
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On the neurobiological side, as shown by the data discussed in this article, the investigation of the role of the brain in emotions and motivations remained for a long time out of the range of cognitive neuroscience. A fortiori, it took a decade after the discovery of an imaging technique such as functional MRI to see the first studies on male sexual behavior appear. Although developing exponentially, the field remains largely unexplored for healthy sexual behavior.
For sexual addiction, neuroscientists still have little data. However, these data are encouraging and suggest that the disorder observed on the behavioral side resonates with that observed on the neural side. The sexual affiliation model and its associated troubles could become one of the most second working model for the convergence and the dialog between psychoanalysis and neuroscience. Clinical and scientific advances in this topic are of great interest for other fields sociology, anthropology, epidemiology, and public health in terms of their impact in reducing risk for HIV prevention.
The authors have not received any funding or benefits from industry or elsewhere to write this review. Europe PMC requires Javascript to function effectively. In this article - reflecting the collaboration of a clinical psychologist and a neuroscientist - we show that in the current period, sexual affiliation is one of the most promising affiliation context to articulate a debate, a dialog and convergence points between psychoanalysis and neuroscience.
The snippet could not be located in the article text. This may be because the snippet appears in a figure legend, contains special characters or spans different sections of the article. Published online Jan Accepted Nov 4. This article has been cited by other articles in PMC. Abstract Sexual motivation is a fundamental behavior in human.
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In , the North American psychiatrists Reed and Blaine proposed a nosological description of addictive sexuality and described a process in four phases in which both compulsive and impulsive aspects can be found: Elements of psychopathology Phenomenological psychopathology of addictive sexuality From the phase of searching up until the actual sexual activity, the subjects concerned may feel some benefits: Time immobilized by the repetition compulsion From the point of view of temporality, the sex-addict suffers from a repetition compulsion, often giving him an impression of a stagnant temporality that is not open toward the future.
How to live without belief? The space of the backrooms If addictive sexuality is a disorder that is easier to live with in big cities than in the countryside, this is in part due to the strong urban implantation of various venues dedicated to sexual encounters: Personality traits, defense mechanisms According to different authors Carnes, Earle, Estellon, Goodman, and Poudat one finds certain common personality traits in sex-addicts such as: Denial Complementary to splitting and shored up by it, denial permits the exclusion of the field of consciousness and facilitates the isolation of those representations or affects that are not in keeping with the ideal self-image.
Idealization, omnipotence, and devalorization The mechanism of idealization functions in a way that is complementary to splitting. Anaclitic anxieties and their avoidance From a relationship point of view, addictive sexuality can be understood as a phobic strategy that allows one to avoid any real encounter with others. Comorbid disorders and risk taking Other dependencies During sexual activity, drugs may be used by the more dependent subjects: Masked depression Depression often constitutes the backdrop on which sexually addictive behavior is constituted and chronicized.
Research in neurobiology In this chapter, it is interesting to summarize some recent studies issued from cognitive neuroscience that investigated human male sexual behavior in general and, for some of them, its compulsive practice. Recent advances from neuroimaging studies From now several decades, the growing development of neuroimaging techniques shed light on brain processes with a new angle. Two emerging fields within cognitive neuroscience: Contemporary data on healthy human male sexual function To understand the present assumptions of neuroscience on the neural networks that could be involved in sexual addiction, it is necessary to present some interesting recent results on the role of the brain on healthy human male sexual motivation.
Open in a separate window. Exploratory data on CSB The exploration of the neural networks involved in healthy human sexual behavior through modern neuroimaging techniques remains recent, centered on healthy human male sexual motivation. Therapeutic Clinical and therapeutic difficulties Clinically, this type of addiction raises the problem of its screening.
Behavioral individual or group SAA therapies Carnes a , b was the first to develop a behavioral method based on the 12 steps of Anonymous Alcoholics that aims to rehabilitate these individuals. Issues of psychodynamic therapies The challenge for an analytical therapy is not to focus on the symptom. Pharmacological aspects On the pharmacological side, treatments are various and depend largely on their effect on the patient: Conclusion On the neurobiological side, as shown by the data discussed in this article, the investigation of the role of the brain in emotions and motivations remained for a long time out of the range of cognitive neuroscience.
Conflict of interest and funding The authors have not received any funding or benefits from industry or elsewhere to write this review. A role for somatosensory cortices in the visual recognition of emotion as revealed by three-dimensional lesion mapping. Sexual addiction, sexual compulsivity, sexual impulsivity, or what? Toward a theoretical model. Journal of Sex Research. The mislabeling of sexual impulsivity.
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