Neurobiological Underpinnings to Hypersexual Disorder
Condition: Hypersexuality; Hypersexual Disorder; Compulsive Sexual Behavior
Study type: Observational

Summary: 
      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.
    


Intervention name(s): Brain Imaging; Cognitive testing; Psychometric; Blood test
Intervention type(s): Other; Other; Other; Other
Intervention description(s): Structural MRI (T1 weighted)
Diffusion Tensor Imaging (DTI)
resting state functional MRI (rs-fMRI)
functional MRI (fMRI): Brain activity will be measured in response to sexual images (visually evoked sexual arousal; processing of sexual stimuli), and importantly during a phase when these stimuli are anticipated (neural correlates of wanting and desire; reward anticipation).; We will administer neuropsychological tests assessing objective measures for
intelligence (Ravens Matrices)
impulsivity and risk-taking behavior (Balloon Analogue Risk Task)
inhibitory control (Stop Signal Task).; Administered questionnaires include anxiety and depression symptoms (MADRS, HADS, GAD), drug use (AUDIT, DUDIT), attention deficits (ASRS), impulsivity (BIS-11), reward seeking behavior (BIS/BAS), sexual orientation, (hyper)sexual behavior, desire and compulsivity aspects (HDSI, HBI, SCS, SDI, SIS/SES).; Blood samples will be taken for routine health assessment, measurement of sex hormonal levels, HPA-axis function test (dexamethasone suppression), and potential DNA extraction and (epi)genetic profiling.
Observational model: Case-Control
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        Patients will be recruited through an ongoing CBT study (KAFKA_IT) at Karolinska University
        Hospital (ANOVA). Initial contact between patients and study coordinators will primarily be
        made through the phone helpline PrevenTell, designed to prevent sexual offences by
        targeting persons at risk. At the clinical visit patients will be evaluated in a face to
        face interview by trained psychologists/psychiatrists to establish psychiatric diagnoses,
        including the diagnosis of HD. If criteria for HD are met, patients will be informed about
        the present imaging study. Healthy controls from the Stockholm catchment area will be
        recruited through Karolinska Trial Alliance, and/or public advertisement in form of
        posters, online job postings and/or social media.
      
Biospecimen description: 
      DNA extraction is planned for potential epigenetic profiling for analysis of genes related to
      regulation of the HPA-axis and other relevant epigenomes.