Striato-limbic and frontoparietal dysfunction underlying imbalance of reward-motivation and cognitive control in compulsive sexual behaviour disorder: A neuroimaging meta-analysis.

Abstract

Background: Compulsive sexual behavior disorder (CSBD) involves uncontrollable sexual urges and behaviors that cause distress or functional impairment. Although classified as an impulse control disorder in ICD-11, its neurobiological basis and cognitive deficits remain poorly understood. Advances in large language models (LLMs) enable scalable literature parsing and multimodal neuroimaging synthesis. This study applied an LLM-based framework for coordinate-based meta-analysis and functional decoding to generate a brain-cognition mapping of CSBD that links neurobiological alterations with cognitive dysfunctions.

Methods: Relevant structural and functional neuroimaging studies of CSBD were identified through semantic screening in Neurosynth Compose. Coordinates were extracted and synthesized using Multi-level Kernel Density Analysis (MKDA-χ2), with subgroup analyses conducted by study characteristics. The resulting brain maps were then functionally annotated in NeuroVault to identify associated cognitive, emotional, motivational, and behavioral dimensions.

Results: Meta-analysis revealed consistent abnormalities in the left hippocampus, inferior parietal lobule, precentral gyrus, putamen, and angular gyrus, and in the right globus pallidus and supramarginal gyrus. Task-based studies mainly implicated the inferior parietal lobule, hippocampus, and globus pallidus, whereas resting-state studies indicated cerebellar involvement. In European samples, abnormalities appeared in the globus pallidus, precentral gyrus, and hippocampus, while East Asian samples showed alterations in the inferior parietal lobule and precuneus. Functional decoding linked these patterns to motivational delay, anxiety, social interaction, and response inhibition.

Conclusion: CSBD may reflect a dual dysregulation mechanism involving hyperactivation of the striato-limbic reward-motivation circuitry and impaired top-down control within the frontoparietal network, together promoting persistent and compulsive sexual behaviors.