Abstract
BACKGROUND AND AIMS: Most men consume pornography, with a small but significant percentage losing control over their use. Since ICD-11, problematic pornography use can be diagnosed as "compulsive sexual behavior disorder." Debate persists on whether problematic pornography use is an impulse-control disorder or a behavioral addiction. Mechanisms of learning and memory play a central role in addictive disorders but are presumably less relevant for impulse control disorders. METHODS: One hundred thirty-nine heterosexual male users of pornography and gaming participated in our study which was part of a multi-center research project on internet use disorders in Germany. We focus on a subsample of fifty-eight non-problematic (n = 35) and problematic pornography users (n = 23, labeled pathological). FMRI data were collected during appetitive conditioning, extinction and recall. Pornographic, game, and money images served as unconditioned stimuli, geometric shapes as conditioned stimuli (CS). RESULTS: During appetitive conditioning pathological pornography users showed a generally stronger response in ventral striatum to all CSs, whereas altered activations in extinction and recall were specific to the porn-associated CS. Greater activations in the dorsal anterior cingulate cortex during extinction and in the medial orbitofrontal cortex during recall suggest persistence of appetitive memory for pornography in pathological users, supported by valence ratings and skin conductance responses (SCR). Sensitization to the monetary cue also emerged in SCR. DISCUSSION AND CONCLUSIONS: Based on these new neurobiological findings, which are consistent with current addiction theories about stimulus-specific altered reward sensitivity and appetitive memory, we argue that problematic pornography use should be considered a behavioral addiction.