Compulsive Sexual Behavior Disorder and Pedophilic Disorder-neurobiological correlates and novel treatments

Compulsive Sexual Behavior Disorder (CSBD), a new diagnosis in the ICD-11 affecting 3-6% of the population, includes intense preoccupation and loss of control of sexual behavior, resulting in significant impairment/distress. Very few studies have investigated neuroendocrine markers, epigenetics, or reward anticipation processes in CSBD.

Whether naltrexone is efficacious in CSBD is not known.Pedophilic disorder (PeD) is characterized by persistent sexual attraction to prepubertal children.

We will recruit clinically well characterized patients with CSBD and PeD at ANOVA, for two randomized clinical trials. 1) Eighty adult participants with CSBD will be randomized to receive either Naltrexone 25-50 mg or Fluoxetine 20-40 mg for eight weeks, followed by six weeks without treatment. We perform a functional MRI experiment.

The genome wide methylation pattern is measured in whole blood using the Illumina EPIC BeadChip.

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

Study 2 is a randomized controlled trial comparing the efficacy of two active treatments for problematic sexual behaviors in self-referred male participants with PeD.

The participants (n = 111) will be randomized to receive either 1) only internet-administered Psychoeducational Program iPP (the control group), 2) SSRI (Fluoxetine 20-40 mg) in addition to iPP or 3) a 12-week iCBT in addition to iPP.