Neurobiological Underpinnings to Hypersexual Disorder

Karolinska Institutet42 enrolled

Overview

Hypersexual Disorder (HD), sometimes called "sexual addiction", is a disorder with intense sexual desires and psychological preoccupations that lead to out-of-control sexual activities with severe consequences. HD is related to higher risks of HIV infection and an important risk factor for committing sexual crimes. The prevalence of HD is 3-6% of the general population, thus, a significant burden for society. The neurobiological mechanisms behind HD are still unknown, and there is still a great need for causal treatments. This study is aimed at identifying neurobiological and psychological mechanisms underlying HD as a basis for treatment development. The overall goal is to improve mental health, quality of life, diagnosis and treatment options for affected individuals, and to reduce the impact HD can have on society. Patients with HD will be recruited at Karolinska University Hospital in close collaboration between endocrinologists, psychologists, psychiatrists, and brain researchers at Karolinska Institutet. Cases and healthy controls will undergo brain scans (MRI), psychological and blood tests to quantify neurobiological, cognitive, and behavioral aspects of HD. This study is directly integrated into clinical practice, can identify important targets for interventions and factors predicting treatment outcomes. This study is essential for a better understanding of HD, the improvement of treatments, and can have significant impact on the prevention of HIV infections and sexual crimes.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Hypersexuality Hypersexual Disorder Compulsive Sexual Behavior

Eligibility

Sex: MALEMin age: 18 YearsMax age: 100 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Male * At least 18 years of age, * Fluent in the Swedish language * Patients will meet diagnostic criteria for hypersexual disorder and will not have started with any psychotherapy or psychological treatment. * Controls will be physically and psychologically healthy, and show no indication of clinical hypersexuality Exclusion Criteria: For both patients and controls any reported medical or clinical condition known to affect brain structure and function, test performance, or associated with risks for the MRI environment will be exclusionary. The investigators will exclude for the following: * Severe neurological/psychiatric diseases or conditions (e.g., major depression, bipolar disorder, ADHD, autism, anxiety/panic disorder, obsessive compulsive disorder, personality disorder, Parkinson's disease, epilepsy, PTSD/chronic stress/burnout syndrom, Alzheimer's disease) * Gender identity disorder/gender dysphoria * Chronic pain conditions * Impared vision, or other vision problems that cannot be corrected with MR-safe equipment. * Hearing impairments, or problems with other senses * History of severe brain damage/injuries * Claustrophobia * Having metal implants, a pacemaker, metallic braces or other MRI contra-indications * Alcohol/drug dependence/abuse, eating disorder, pathological gambling, during the past 6 months. * HIV and Hepatitis C/B, if the condition is untreated or virus levels detectable. * Untreated endocrinologic diseases * Medication: bensodiazepine, antipsychotics, mood stabilizers, centrally acting sympathicomimetics, SSRI (if use started less than 3 months ago). Any medication or pharmaceutical drug that interferes with sex hormone production or metabolism, i.e. ketoconazol, cyproteronacetate, spironolactone and similar drugs. Note: There is a potentially higher prevalence of comorbidities and medication use in patients. To facilitate recruitment and study completion, the investigators may include subjects that report specific conditions at the discretion of the principle investigator. In those cases, corresponding information will be recorded in order to control for potential confounders.

Outcomes

Primary Outcomes

Brain activity

Functional brain response (BOLD activity) upon presentation and anticipation of visual sexual stimuli.

Time frame: acquired during brain imaging experiment (MRI scan day)

Anatomical brain measures

Measures for brain morphology (regional cortical volume, thickness, surface area, and subcortical volumes)

Time frame: Acquired during brain imaging experiment (MRI scan day)

Secondary Outcomes

Resting state fMRI

Functional connectivity

Time frame: Acquired during fMRI experiment (MRI scan day)

Diffusion MRI

Structural connectivity

Time frame: Acquired during fMRI experiment (MRI scan day)

Reaction times

Response reaction times during fMRI task

Time frame: Acquired during fMRI experiment (MRI scan day)

Raven Progressive Matrices (cognitive task)

Objective measures for intelligence

Time frame: Acquired at brain MRI assessment day, or as close to this day as possible.

Balloon Analogue Risk Task (cognitive task)

Objective measures for impulsivity/risk-taking

Time frame: Acquired at brain MRI assessment day, or as close to this day as possible.

Stop Signal Task (cognitive task)

Objective measures for inhibitory control

Time frame: Acquired at brain MRI assessment day, or as close to this day as possible.

MADRS-S (questionnaire)

Montgomery Asberg Depression Rating Scale