What is pornography addiction?

Background

There is no diagnosis of pornography (porn) addiction in the American Psychiatric Association’s
Diagnostic and Statistical Manual of Mental Disorders
(DSM). However, porn addiction was under consideration as a particular variant of hypersexual disorder to be included in the revised DSM-5 (published in May 2013), but hypersexual disorder was ultimately not included because of insufficient conclusive evidence.

In many cases porn addiction may be better understood as overuse or problematic or compulsive use of sexually explicit materials without severe negative consequences, which often accompany other behavioral or drug addictions. Many psychologists who consider porn to be addictive also consider porn that is available online to be more problematic than traditional porn because of its ease of access. Also, online porn can be anonymously acquired, and it is affordable.

Advocates of the diagnosis of porn “addiction” argue that it is a behavioral addiction that activates the underlying neurological circuit involved in addictive drug use. Studies to this end have been conducted at the University of Cambridge and the University of California, Los Angeles (UCLA) that looked at the brain responses of compulsive porn viewers. The University of Cambridge found that the brain responses of these subjects were similar to those of drug addicts, while the UCLA study did not. Proponents also argue that the behavioral patterns of porn addiction are similar to those seen in drug addiction. In a survey by the Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University, it was found that 9 percent of people who watch porn could not curb their viewing habits.

Causes

Given the nature of the human sex drive and the variety of psychological needs that sexual arousal and gratification serve, there is no one root cause for porn addition. Researcher Patrick Carnes has identified four core beliefs of persons struggling with sex or porn addictions: they are essentially bad, unworthy persons; they are unlovable as they currently are; their needs will never be met if they depend upon others to meet them; and satisfaction of their sexual needs is the most important thing in their life.

Several researchers and therapists have proposed stages of porn addiction, but these stages are not necessarily sequential. While there exists no general agreement on these stages, in the most general terms, the stages are early exposure, fixation on pornography, escalation (increased, compulsive use), desensitization, and manifestation (sexually acting out). Reasons for excessive consumption of porn appear to be rooted in a desire for sexual pleasure or sexual variety, an escape from stress, and a way to cope with negative emotions.

Risk Factors

Research indicates that adolescent and young adult men are the primary consumers of sexually explicit materials and are most likely to develop maladaptive patterns of porn consumption. Other factors include early exposure to sexually explicit material, poor emotional attachment styles, and using porn as a masturbatory aid. Generally, the maladaptive pattern of use and sexually acting-out is developed between adolescence and early adulthood; however, it can begin later in adulthood.

Symptoms

Symptoms of porn addiction are wide-ranging, but they generally follow those listed in the DSM for substance abuse (with appropriate modification). These symptoms include combinations of the following: recurrent viewing of pornographic material or images resulting in a failure to fulfill major role obligations at work, school, or home (such as repeated absences or poor work performance, suspensions or expulsion from school, or neglect of children or household); recurrent viewing of pornographic material or images that results in legal (criminal) problems; and continued viewing of pornographic material despite having persistent or recurrent social or interpersonal problems (for example, domestic and family) caused or exacerbated by their effects.

More specifically, the symptoms may include excessive personal (non-work-related) viewing of more than twenty hours per week, neglect or avoidance of previously rewarding personal relationships or interaction with peers, depression (either short- or long-term), underestimation of time spent viewing or searching for material, and pursuit of “highs” that have been experienced while online.

Generally, the porn addict is unable to choose whether or not to perform the behavior (and is addictive or compulsive) and continues to view porn in spite of clear, negative consequences. Some of these consequences are marital or relationship problems (studies have found that porn addicts often become withdrawn from their partners), financial problems, job loss, and sexual dysfunction. Also, the addict’s thoughts center on the sexual content and the pornographic material (such as the next time it can be viewed, how to acquire it, anticipation of orgasm), which takes up a significant amount of the person’s cognitive energy.

Screening and Diagnosis

Several screening tools have been developed to study porn addiction, none of which is considered a gold standard. Two screening tools of note are the pornography consumption inventory (a fifteen-item Likert-scale inventory with four subscales: sexual pleasure, emotional escape, sexual curiosity, and novelty) and the men’s sexual addiction screening test (a twenty-five-item screening tool used in clinical settings that is simple, quick, and easy to score).

Given that porn addiction is not listed in the DSM, it is not considered a clinical diagnosis. Porn addiction, however, remains a popular diagnosis and may fit under the diagnosis of hypersexual disorder or sexual disorder with paraphilia. These paraphilic and hypersexual diagnoses may be the result of an underlying organic pathology relating to a brain lesion (trauma or tumor), the side effect of medication, or a symptom of endocrine abnormality, so these diagnoses should be investigated early in treatment.

Differential diagnosis can be indicated by atypical symptomology, such as onset in middle age or later, dramatic change from previously normal sexual habits or patterns, aggression, or seizure-like symptoms surrounding sexual arousal or behavior. Diagnosis of porn addiction as sexual paraphilia or hypersexuality should consider common addiction criteria such as tolerance, psychological or physiological withdrawal symptoms after extended periods of porn viewing abstinence, progressive viewing of more explicit content, and a cycle of abstinence followed by relapse. A diagnosis of pornography or masturbatory compulsivity or hypersexuality also should be considered.

Treatment and Therapy

Individual psychotherapy and psychoeducation about the effects of porn consumption are the most commonly used treatments. Interpersonal therapy and cognitive-behavior therapy are commonly employed to identify triggers and to treat comorbid psychological issues. In addition, support groups (such as Sexaholics Anonymous) and group therapy can be effective in treating porn addiction, provided these therapeutic approaches consider matters of access, coping skills, relapse prevention, and recovery.

Online communities for recovery also exist, although computer access, availability, and the anonymous nature of the Internet can be problematic for porn recovery. To address these issues, therapists can employ filtering software to monitor use and prevent access to sexually explicit material. Pharmacotherapy for pornography addiction or a related diagnosis (such as an anxiety, mood, or hypersexual disorder) should also be considered, especially in severe cases.

Prevention

Given that the development of porn addiction or compulsive viewing of porn is highly associated with sexually acting-out in response to the sexual arousal that viewing explicit material elicits, prevention is best achieved by avoiding the regular viewing of pornographic material. Refraining from viewing of sexually explicit materials as a regular part of sexual activity also is recommended.

Bibliography

Carnes, Patrick, David Delmonico, and Joseph Moriarity, eds. In the Shadows of the Net: Breaking Free from Compulsive Online Sexual Behavior. 2nd ed. Center City, MN: Hazelden, 2007.

Cooper, Al, ed. Sex and the Internet: A Guidebook for Clinicians. New York: Brunner, 2002.

Maltz, Wendy, and Larry Maltz. The Porn Trap. New York: Collins, 2008.

Mouras, H., et al. “Brain Processing of Visual Sexual Stimuli in Healthy Men: A Functional Magnetic Resonance Imaging Study.” Neuroimage 20 (2003): 855–69. Print.

Reid, Rory C., et al. “Reliability, Validity, and Psychometric Development of the Pornography Consumption Inventory in a Sample of Hypersexual Men.” Journal of Sex and Marital Therapy 37.5 (2011): 359–85. Print.

Štulhofer, Aleksandar, Vesna Buško, and Ivan Landripet. “Pornography, Sexual Socialization, and Satisfaction among Young Men.” Archives of Sexual Behavior 39.1 (2010): 168–78. Print.

Weir, Kirsten. "Is Pornography Addictive?" Monitor on Psychology 45.4 (2014): 46. Print.