Could Anthony Weiner Ace the Stroop Test?

Former U.S. Representative Anthony Weiner served New York's 9th congressional district for 12 years until his online sexual indiscretions forced him to resign on June 16, 2011. We've all been overexposed [so to speak] to the "Weinergate" scandal, so no need to recount all the lurid details. Boxer briefly, he sent lewd photos of himself to young women and underaged girls following him on Twitter. This occurred despite the fact that Huma Abedin, Deputy Chief of Staff for Hillary Rodham Clinton and his wife of 2 years less than a year, was newly pregnant. Why would a high profile politician engage in such outrageous behavior?

What a silly question! Because he could! Because of his political power and a giant ego that needed massaging from pretty girls less than half his age. And because he thought he could get away with it. Ask Bill, Arnold, John, and Eliot. For more on this phenomenon, I recommend On the biology of sexting, a monograph at the blog Neurological Correlates.

Like many other public male figures who have fallen from grace due to their sexual activities, Weiner claimed to have checked into a treatment center to seek professional help for his ill-defined problems:

"Congressman Weiner departed this morning to seek professional treatment to focus on becoming a better husband and healthier person," Weiner's spokeswoman, Risa Heller, tells Us Weekly in a statement. "In light of that, he will request a short leave of absence from the House of Representatives so that he can get evaluated and map out a course of treatment to make himself well.

This was, of course, before his resignation. The New York Times went on to state:

Ms. Heller would not identify the facility or the precise kind of counseling Mr. Weiner, who has admitted having explicit communications with six women he met online, would receive...

. . .

Ms. Pelosi had hoped that the congressman would reach the decision on his own to go. In addition to her concerns about the political distraction Mr. Weiner had become, Ms. Pelosi concluded that his behavior required medical intervention.

“When you are this self-destructive, there is obviously something deeper going on with you,” said a Pelosi adviser who spoke on condition of anonymity for fear of being seen as betraying her confidence.

This brings us to the issue of "sexual addiction", or compulsive sexuality, or hypersexuality. Establishing an agreed-upon definition and proper diagnostic critieria for this condition is a minefield (compare Kafka 2010a, 2010b and Levine, 2010). For the present blog post, I will present the view of Reid et al. (2011) from their paper on A Surprising Finding Related to Executive Control in a Patient Sample of Hypersexual Men:

The proposed diagnostic criteria for the DSM-V characterize hypersexual disorder (HD) as a repetitive and intense preoccupation with sexual fantasies, urges, and behaviors, leading to adverse consequences and clinically significant distress or impairment in social, occupational, or other important areas of functioning. One defining feature of this proposed disorder includes multiple unsuccessful attempts to control or diminish the amount of time the individual engages in sexual fantasies, urges, and behavior in response to dysphoric mood states or stressful life events. Despite a constellation of studies investigating characteristics of HD (usually defined in the literature as sexual addiction, sexual compulsivity, or hypersexual behavior), little is known about the neuropsychological correlates of this phenomenon, including possible associations with executive functioning.

Executive functions are a series of high-level cognitive processes that allow for the flexible control of thought and adaptive behavior. They include processes such as planning, decision making, multitasking, task switching, and impulse control. One might expect that executive functions (or at least some of them) would be impaired in those who show problematic hypersexual behavior. For example, although Weiner may be witty and reasonably intelligent, his apparent narcissism, poor impulse control, and terrible decision making abilities in the sexting realm proved to be his downfall.

Anthony Weiner's comedy routine at the Congressional Correspondent's Dinner, March 30, 2011.

Highlights:

• Ambitions to run for mayor of NY
• Weiner jokes
• Praises his lovely wife - "opposites attract"
• Outlines his use of social media, including Twitter
• Follow me @RepWeiner! (18,000 followers at that time, now over 83,000)
• Named to Time's 140 Best Twitter Feeds
  

To jump to the conclusion, the study of Reid et al. (2011) was surprising because the executive function scores of 30 men diagnosed with HD were the same as a group of 30 male volunteers without HD. All participants were administered a series of standardized neuropsychological tests that included the Stroop Color-Word Interference Test (shown above in Weiner's thought bubble), the Wisconsin Card Sorting Test (WCST), the Trail Making Test, and the Verbal Fluency Test. All of these tasks involve planning or overcoming automatic responses.

In the Stroop task, the participant is instructed to say the font color and ignore the word. It's much more automatic to read the word than to say the font color, so people are slower to respond when the two dimensions are in conflict:

BLUE
PURPLE
RED
GREEN

Trail Making version B is an attention switching task where the participant connects the dots on the sheet below by alternating between letters and numbers: 1-A-2-B-3-C, etc.



Before we examine the authors' interpretation of this interesting null effect, let's take a closer look at some of the defining characteristics of the HD group. The majority of the patients were men seeking treatment for hypersexual behavior at clinics in Los Angeles (a few were from Utah). All participants were carefully screened to exclude those with history of a head injury, stroke, alcohol or drug abuse, and any other neurological or psychiatric condition (including ADHD).

In the clinical interview, participants were asked about the degree to which they use sex to cope with stress or uncomfortable emotions, consequences they have experienced as a result of their sexual choices, and ways in which they may have felt unable to control their sexual behavior. For patients referred for the hypersexual group, classification as such was verified based on elevated scores on the hypersexuality measures and (i) a reported pattern of hypersexual behavior that persisted for at least 6 months; (ii) reported preoccupation with sexual thoughts, urges, and the pursuit of sexual activities that interfered with at least two aspects of their daily life (e.g., academic or scholastic goals, work, parenting); and (iii) reported experiencing at least one significant consequence (e.g., contraction of a sexually transmitted disease [STD], loss of employment, debt, arrest, relational discord) as a result of their sexual behavior.

The controls were fairly well-matched to the patient group on all variables except their sexual behavior. Why were there no differences in neuropsychological test performance between the two groups? One of the most plausible reasons was context. The patients did not have to demonstrate restraint in tests involving pornographic images, internet use, or access to sex partners.

There are a number of potential explanations as to why executive deficits did not emerge among the patient sample in this study despite a pattern of impulsive and risky sexual behavior. First, difficulties in executive functioning of a magnitude that would show up on performance-based measures may be present in only a subset of hypersexual patients... Second, it is possible that the neuropsychological tests of executive functions were not sensitive to detect subtle deficits that may have existed in the patient sample. Third, it may be that hypersexual men may exhibit impaired judgment, difficulty with impulse control, and cognitive rigidity but only in situations where they encounter opportunities for sex. ... In other words, hypersexual men may indeed exhibit impaired judgment, difficulty with impulse control, cognitive rigidity, and so forth only in situations where they encounter opportunities for sex or are exposed to specific cues that have been paired with sex.

In other words, the hypersexual participants might have had more difficulty on the Sex Stroop task:

TITS
DICK
ASS
FUCK

Perhaps I can go into the business of designing customized neuropsychological tests of executive functions for use on VH1 reality shows like Sex Rehab with Dr. Drew...


References

Kafka MP. (2010a). Hypersexual disorder: a proposed diagnosis for DSM-V. Arch Sex Behav. 39:377-400.

Kafka MP. (2010b). "What is sexual addiction?" A response to Stephen Levine. J Sex Marital Ther. 36:276-81.

Levine SB. (2010). What is sexual addiction? J Sex Marital Ther. 36:261-75.

Reid, R., Garos, S., Carpenter, B., & Coleman, E. (2011). A Surprising Finding Related to Executive Control in a Patient Sample of Hypersexual Men. The Journal of Sexual Medicine DOI: 10.1111/j.1743-6109.2011.02314.x



Anthony Weiner's resignation speech.