COMMENTS: Most of the subjects appear to be sex addicts, not “porn addicts”: Older, male, all in treatment, higher % of gay/bisexual, etc. The study assessed executive functioning at baseline, and again at least 6 months later, right after the subjects viewed a porn film of their choice. Results: At baseline, controls and sex addicts scored the same on executive functioning. Right after porn viewing, controls performed much better than their earlier test scores (due to learning). Sex addicts did not improve on their scores. Researchers interpret this as cues/triggers interfering with executive functioning and learning. This is because the sex addicts should (also) have scored better than their first round had their executive function not been impaired. I think the wording should have been more straightforward in this study. In short, this study is evidence of hypofrontality in sex addicts.
Curiously, the editors of the journal in which this appeared seem to have done their best to obscure the bottom line finding about the relevance for the field of sex addiction, including highlighting the results about the controls instead of the subjects. Most peculiar.
The Journal of Sexual Medicine, Available online 20 January 2017.
Bruna Messina, MS, , Daniel Fuentes, MD, PhD, Hermano Tavares, MD, PhD, Carmita H.N. Abdo, MD, PhD, Marco de T. Scanavino, MD, PhD
Department and Institute of Psychiatry, Clinical Hospital, University of São Paulo Medical School (FMUSP), São Paulo, Brazil
http://dx.doi.org/10.1016/j.jsxm.2016.12.235
Abstract
Introduction
Despite the serious behavioral consequences faced by individuals with sexual compulsivity, related neuropsychological studies are sparse.
Aim
To compare decision making and cognitive flexibility at baseline and after exposure to an erotic video in sexually compulsive participants and non-sexually compulsive controls.
Methods
The sample consisted of 30 sexually compulsive men and 30 controls. Cognitive flexibility was investigated through the Wisconsin Card Sorting Test and decision making was examined through the Iowa Gambling Task.
Main Outcome Measures
Wisconsin Card Sorting Test categories, correct responses, and perseverative errors and Iowa Gambling Task general trends and blocks.
Results
Sexually compulsive subjects and controls performed similarly at baseline. After watching an erotic video, controls performed better in block 1 of the Iowa Gambling Task (P = .01) and had more correct responses on the Wisconsin Card Sorting Test (P = .01).
Conclusions
The controls presented fewer impulsive initial choices and better cognitive flexibility after exposure to erotic stimuli.
Key Words: Impulse Control Disorders; Decision Making; Executive Function; Sexual Behavior
Conflicts of Interest: The authors report no conflicts of interest.
Funding: Foundation for Research Support of the State of São Paulo (FAPESP; process number 2010/15921-6).
Corresponding Author: Bruna Messina, MS, Rua Dr, Ovódio Pires de Campos, 785, Cerqueira Cesar, São Paulo, SP, CEP 05403-010 Brazil. Tel: 55-11-97189-4059; Fax: 55 11 26803750
Excerpts from discussion:
We hypothesized that sexually compulsive participants would present worse cognitive flexibility and decision making on neuropsychological tasks after exposure to sexual stimulation than at baseline and that after stimulus their neuropsychological functioning would be worse than that of controls.
In the baseline assessments, we found no differences in cognitive flexibility, except for the number of correct answers; sexually compulsive men presented more correct responses than the controls. For the decision-making process, we did not observe a tendency toward more impulsive decision making in sexually compulsive men compared with controls
Therefore, our results conflict with studies of individuals with substance addiction and related disorders25,26 and pathologic gamblers27,28 and previous studies of individuals with CSB3,9 who presented impairment in the decision-making process, favoring immediate rewards without considering the medium- and long-term results.
For the evaluation after exposure to visual sexual stimulation (erotic video), between times 0 and 1, we observed an improvement in cognitive flexibility at time 1 by the controls on the correct response variable on the test that evaluated cognitive flexibility.
This finding indicates better cognitive flexibility after sexual stimulation by controls compared with sexually compulsive participants, which seemed to be supported by the finding of greater average differences in sexually compulsive men on the number of perseverative errors compared with controls These data support the idea that sexually compulsive men do not to take advantage of the possible learning effect from experience, which could result in better behavior modification. A larger proportion of errors in cognitive tests of sexually compulsive individuals has been observed and attributed to similarities in the functioning of obsessive-compulsion disorder, in which the presence of perseverations could decrease the ability to respond at the moment responses are required3 and which could explain the worse cognitive performance of sexual compulsive participants after erotic stimulation in our study
Studies investigating the reliability across time of neurocognitive tasks have observed an effect of learning when reapplication occurs early.18 However, what at first seemed to be a limitation provided an opportunity to formulate a clinical inference on the conceptualization of the “cycle of sexual addiction.” We noticed that after watching the erotic video, the controls improved their performance in block 1 of the IGT,16 whereas sexually compulsive participants maintained the same performance as at the time 0 assessments. This also could be understood as a lack of a learning effect by the sexually compulsive group when they were sexually stimulated, similar to what happens in the cycle of sexual addiction, which starts with an increasing amount of sexual cognition, followed by the activation of sexual scripts and then orgasm, very often involving exposure to risky situations.29 The highest sexual arousal at the beginning of the cycle of sexual addiction might be one of the factors related to the difficulty of learning or behavior modification, leading to more impulsive decision making by sexually compulsive men.
For desire, excitement, and sexual compulsivity, the scores of sexually compulsive participants and controls on the SADI17 indicated they were sexually excited after watching the video. However, sexually compulsive participants had higher mean scores on the SADI17 subdomains, which also showed a good correlation with the SCS.14 These results corroborate the difference in sexual response between sexually compulsive and nonsexually compulsive individuals, adding greater internal validity. These findings are in agreement with a recent neuroimaging study of 23 individuals with CSB and 22 matched healthy controls who were exposed to visual sexual stimulation.6
Our findings support the hypothesis that the difficulties in decision making and cognitive flexibility of sexually compulsive men are more evident in the context of sexual stimulation, thus opening a door to future research in this area.
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