Compulsive Sexual Behavior Disorder- neurobiological underpinnings and pharmacological treatment with Naltrexone

Compulsive Sexual Behavior Disorder (CSBD) is a new diagnosis in the ICD-11.

CSBD affecting 3-6% of the population, includes repetitive and intense preoccupation and loss of control of sexual urges and behavior, resulting in significant impairment and/ordistress.

Very few studies have investigated neuroendocrine markers, epigenetics, transcriptomics or reward anticipation processes in CSBD. Whether naltrexone is efficacious in CSBD is not known.

We will recruit clinically well characterized patients with CSBD at ANOVA, Karolinska University Hospital and healthy volunteers through Karolinska Trial Alliance.

Low dose dexamethasone suppression test is performed in all participants and the genome wide methylation pattern is measured in whole blood using the Illumina EPIC BeadChip.

We perform a functional MRI experiment, targeting reward anticipation and arousal processes, to test the hypothesis that CSBD is related to dysfunctional processing of reward anticipation and sexual stimuli.

Brain activity will be measured in response to sexual images (visually evoked sexual arousal; processing of sexual stimuli), and when these stimuli are anticipated.

We will perform a double- blind placebo-controlled evaluation of the efficacy of Naltrexone in the treatment of CSBD with 50 participants in each arm.

A secondary aim is to investigate if neuroendocrine and epigenetic changes or reward-related brain activity in relation to outcome of CBT or naltrexone treatment in patients with CSBD.