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Original Investigation |

Brain Structure and Functional Connectivity Associated With Pornography Consumption:  The Brain on Porn

Simone Kühn, PhD1; Jürgen Gallinat, PhD2,3
[+] Author Affiliations
1Max Planck Institute for Human Development, Center for Lifespan Psychology, Berlin, Germany
2Clinic for Psychiatry and Psychotherapy, Charité University Medicine, St Hedwig-Krankenhaus, Berlin, Germany
3University Clinic Hamburg-Eppendorf, Clinic and Policlinic for Psychiatry and Psychotherapy, Hamburg, Germany
JAMA Psychiatry. 2014;71(7):827-834. doi:10.1001/jamapsychiatry.2014.93.
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Importance  Since pornography appeared on the Internet, the accessibility, affordability, and anonymity of consuming visual sexual stimuli have increased and attracted millions of users. Based on the assumption that pornography consumption bears resemblance with reward-seeking behavior, novelty-seeking behavior, and addictive behavior, we hypothesized alterations of the frontostriatal network in frequent users.

Objective  To determine whether frequent pornography consumption is associated with the frontostriatal network.

Design, Setting, and Participants  In a study conducted at the Max Planck Institute for Human Development in Berlin, Germany, 64 healthy male adults covering a wide range of pornography consumption reported hours of pornography consumption per week. Pornography consumption was associated with neural structure, task-related activation, and functional resting-state connectivity.

Main Outcomes and Measures  Gray matter volume of the brain was measured by voxel-based morphometry and resting state functional connectivity was measured on 3-T magnetic resonance imaging scans.

Results  We found a significant negative association between reported pornography hours per week and gray matter volume in the right caudate (P < .001, corrected for multiple comparisons) as well as with functional activity during a sexual cue–reactivity paradigm in the left putamen (P < .001). Functional connectivity of the right caudate to the left dorsolateral prefrontal cortex was negatively associated with hours of pornography consumption.

Conclusions and Relevance  The negative association of self-reported pornography consumption with the right striatum (caudate) volume, left striatum (putamen) activation during cue reactivity, and lower functional connectivity of the right caudate to the left dorsolateral prefrontal cortex could reflect change in neural plasticity as a consequence of an intense stimulation of the reward system, together with a lower top-down modulation of prefrontal cortical areas. Alternatively, it could be a precondition that makes pornography consumption more rewarding.

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Figure 1.
Brain Regions and Pornography Consumption

A, Brain region showing a significant negative correlation (r64 = −0.432, P < .001) between hours of pornography consumption per week (square rooted) and gray matter volume (Montreal Neurological Institute coordinates: x = 11, y = 5, z = 3) and the scatterplot illustrating the correlation. B, Negative correlation between hours of pornography consumption per week and blood oxygenation level–dependent signal during sexual cue–reactivity paradigm (sex cue > fixation) (Montreal Neurological Institute coordinates: x = −24, y = 2, z = 4). C, Negative correlation between hours of pornography consumption per week and functional-connectivity map of the right striatum in the left dorsolateral prefrontal cortex.

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Figure 2.
Mediation Analysis

The negative association between gray matter (X) in the right striatum identified in the voxel-based morphometry analysis and pornography consumption (Y) is not strongly mediated by the functional task-related activity in the left striatum (M), showing that structural, as well as functional, effects contribute independently to the prediction of pornography consumption. a, b, ab, and c/c′ indicate path coefficients.aP < .05.bP < .001.

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