ArticlePDF Available

The Emperor Has No Clothes: A Review of the ‘Pornography Addiction’ Model

Authors:

Abstract

The addiction model is rarely used to describe high frequency use of Visual Sexual Stimulus (VSS) in research, yet it is commonly used in media and clinical practice. The theory and research behind “pornography addiction” is hindered by poor experimental designs, limited methodological rigor, and lack of model specification. The history and limitations of addiction models are reviewed, including how VSS fail to meet standards of addiction. These include how VSS use can reduce health risk behaviors. Proposed negative effects, including erectile problems, difficulty regulating sexual feelings, and neuroadaptations are discussed as non-pathological evidence of learning. Individuals reporting “addictive” use of VSS could be better conceptualized by considering issues such as gender, sexual orientation, libido, desire for sensation, with internal and external conflicts influenced by religiosity and desire discrepancy. Since a large, lucrative industry has promised treatments of pornography addiction despite this poor evidence, scientific psychologists are called to declare the emperor (treatment industry) has no clothes (supporting evidence). When faced with such complaints, clinicians are encouraged to address behaviors without conjuring addiction labels.
CURRENT CONTROVERSIES (PJ KLEINPLATZ AND C MOSER, SECTION EDITORS)
The Emperor Has No Clothes: A Review of the Pornography
AddictionModel
David Ley &Nicole Prause &Peter Finn
#Springer Science+Business Media, LLC 2014
Abstract The addiction model is rarely used to describe high-
frequency use of visual sexual stimuli (VSS) in research, yet
common in media and clinical practice. The theory and re-
search behind pornography addictionis hindered by poor
experimental designs, limited methodological rigor, and lack
of model specification. The history and limitations of addic-
tion models are reviewed, including how VSS fails to meet
standards of addiction. These include how VSS use can reduce
health-risk behaviors. Proposed negative effects, including
erectile problems, difficulty regulating sexual feelings, and
neuroadaptations are discussed as non-pathological evidence
of learning. Individuals reporting addictiveuse of VSS could
be better conceptualized by considering issues such as gender,
sexual orientation, libido, desire for sensation, with internal
and external conflicts influenced by religiosity and desire
discrepancy. Since a large, lucrative industry has promised
treatments for pornography addiction despite this poor evi-
dence, scientific psychologists are called to declare the emper-
or (treatment industry) has no clothes (supporting evidence).
When faced with such complaints, clinicians are encouraged
to address behaviors without conjuring addiction labels.
Keywords Pornography addiction .Pornography addiction
model .Visual sexual stimulus (VSS) .Libido .
Sensation-seeking .Erectile dysfunction .Addiction model .
Impulsivity .Compulsivity
Introduction
Pornography addictionis one label that has been used spe-
cifically to describe the high-frequency viewing of sexual
images. Related concepts, such as sex addictionor internet
addictionrefer to broader constellations of behaviors. These
address problem sexual (e.g., financial loss with high involve-
ment with sex workers) or internet (e.g., web browsing in lieu
of any family time) behaviors broadly. Competing models of
high-frequency viewing of sexual images also have been
offered, such as sexual compulsivity [1]. Some have claimed
to abdicate models by using terms like hypersexual disorder,
but these authors are still using a model of pathology. In this
manuscript, we specifically critique the addiction model of
high use of visual sexual stimuli.
Scientists investigating high-frequency sexual behaviors
rarely describe these behaviors as an addiction (37 % of
articles) [2••]. In fact, most scientists have overtly rejected
the addiction model [3,4]. The recent revision of the
Diagnostic and Statistical Manual (DSM) similarly did not
include sex addiction, citing To include this as an addiction
would require published scientific research that does not exist
at this time(Charles OBrien, personal communication,
September 19, 2013). Widely cited critiques of addiction
models have been leveled against other behaviors as well,
including food [5,6], internet use [7], and gambling [8]. The
perseverance of this term in the popular press and by some
treatment providers is puzzling. The pseudoscientific practices
surrounding the treatment of porn addictioncompel us to
reveal that the emperor is not wearing any clothes [9].
The overwhelming majority of patients seeking help for
high-frequency sexual problems report that frequency of
viewing sexual stimuli is their main, or primary, problem
[10]. The addiction model of visual sexual stimuli (VSS)
viewing continues to be popular in the media and appears in
the journal name of a clinical society focused on treatment
issues (Sexual Addiction and Compulsivity). The current
This article is part of the Topical Collection on Current Controversies
D. Ley (*)
New Mexico Solutions, 707 Broadway NE #500, Albuquerque,
NM 87102, USA
e-mail: nmpsychologist@yahoo.com
N. Prause
University of California, Los Angeles, CA, USA
P. Finn
Indiana University, Bloomington, IN, USA
Curr Sex Health Rep
DOI 10.1007/s11930-014-0016-8
review is specifically critical of addiction as an appropriate
model for the high-frequency viewing of VSS, sometimes
referred to as pornography addiction. (Studies of addic-
tionto sexual imagery overwhelmingly use the biased term
pornography[11]. Since many benefits of sexual stimuli
also have been identified (see below), we follow the APA
recommendation to use less biased language [12••]. The
empirically accurate term visual sexual stimuli(VSS is
used instead of pornography. Other models for high-
frequency VSS viewing are suggested, including non-
pathology models.
Some have suggested that easier access to sexual films
online is responsible for creating an epidemic of porn addic-
tion [13]. Emotional images with movement significantly
increase arousal over still images across a variety of domains
[14]. Moreover, motion may be important for generating
motivated states, such as generating actual fear to phobic
objectsratherthanmereunpleasantaffect[15]. Greater com-
plexity (e.g., number of scene changes) in the films is known
to impact posterior, but not anterior, cortical sites on the brain
[16]. The more interest a person reports in a film, the greater
their frontal alpha suppression during the film [16]. This
finding was recently extended in response to sexual films
[17]. In summary, sexual films, like other emotional films,
engage the brain in ways consistent with high arousal, moti-
vated states. The brain appears to respond similarly with
sexual and other emotional films.
VSS use does not appear to be increasing despite increased
availability. Fluctuations in VSS formats and legislation in
recent decades helps to clarify this issue. VSS viewing in the
USA has remained remarkably steady (near 22 %) since 1973,
showing the greatest changewith the introduction of the VCR
after a period of legal prohibition [18]. Of those over age 18,
75 % now have regular internet access with 60 % reporting
broadband athome and 55 % accessing the internetwirelessly
[19]. In contrast to frequent claims in the popular media about
an epidemic of porn use, no change in the last 4 decades has
been noted in more detailed longitudinal data since internet
access increased [20]. Further, searches for sex(Google
Analytics) appear stable since data collection started in
2004. It is possible that something about the films has changed
over time, altering its effect. For example, those studying
video games investigate changing realismas predictors of
the changing effects of video games [21]. Given that visual
erotica has long appeared in film, realism is probably not the
best parallel for VSS changes over time. No data have yet
been offered to suggest how the VSS format or content may
have changed over decades.VSS viewing appears very stable,
with a larger change in viewing with the introduction of the
VCR, not internet availability.
The prevalence of VSS problems reported is inconsistent.
Clinicians frequently cite up to 6 %of the US population is
sexually addicted. This estimate comes from clinical speculation
in a popular book [22] in which the clinician/authors focusing
their practice on these issues do not clearly define the bound-
aries of this diagnosis. Empirical estimates from nationally
representative samples are that 0.8 % of men and 0.6 % of
women report out of control sexual behaviors that interfere with
their daily lives [23]. If one assumes these individuals might
seek treatment, 82 % of treatment seekers report problems with
VSS, and clinicians agree that they have a clinical problem in
about 88 % of cases [10]. Thus, VSS problems might affect
0.58 % of men and 0.43 % of women in the USA.
Positive Effects of VSS Use
While much has been written about the potential negative
effects of VSS, a number of positive effects also have been
suggested [24]. Most people who view VSS believe that it
improves their attitudes towards sexuality [25] and improves
their quality of life [26]. More VSS viewing has been related
to greater likelihood of anal and oral sex [27]andagreater
variety of sexual behaviors [28]. This increased breadth of
sexual behaviors could arise by increasing a personsfeeling
of empowerment to suggest new sexual behaviors or by
normalizing the behaviors [29]. In any case, sexual novelty
can increase pleasure in long-term partners. VSS can also
promote pleasant feelings in the moment, such as happiness
and joy [30,31]. Additionally, VSS may provide a legal outlet
for illegal sexual behaviors or desires. Increased VSS con-
sumption or availability has been associated with a decrease in
sex offenses [32], especially child molestation [33,34]and
inhibition of aggression [35]. On the other hand, a large
longitudinal study controlling for baseline attitudes and be-
haviors identified that VSS use accounted for only 01%of
the variance in gender role attitudes, permissive sexual norms,
andsexualharassmentinboysorgirls[12••]. While much has
been written about negative aspects of VSS for the general
population, the many possible benefits suggest that VSS use is
not problematic de facto.
Addiction Model
What is Addiction?
What should be labeled an addiction in the first place [36]?
Addictionis a term that is often reified, when it really is
being used as a theoretical construct or a model to describe a
cluster of behaviors. The question raised in this review is
whether VSS viewing could be described using an addiction
construct or model, so it may be helpful to consider how the
term addictionis being used with substances.
DSM-5 introduced the term addictionwithin the broad
category Substance-Related and Addictive Disordersover
Curr Sex Health Rep
the objections of the working group [37]. However, the term
addictionwas specifically rejected to describe gambling [38]
or substance use despite the section title. This suggests some
tension over the utility of the addiction framework even for
substances and gambling. Presumably, if addictionpos-
sessed diagnostic or prognostic value, it would be defined
and would distinguish clinical cases. Of course, the DSM is
hardly the only consensus rejecting the utility of addictions.
Increased modern understanding of the effects of various
substances such as cannabis has raised questions about the
scientific and clinical applicability of the concept as it has
historically been defined. As with many other clinical con-
cepts, addiction has seen significant bleedas the term has
been broadened to describe a wide range of problematic
behaviors. While there seems to be a consensus that addiction
is a useful construct to describe opiate dependence [39], the
usefulness of addictionto describe the excessive use of any
drug [40], compulsive gambling [41], and excessive video
game playing [42] has raised many concerns.
While we generally reject the usefulness of the term, if one
is pressed, some commonalities have been suggested by ad-
dictions research. A key feature of addiction is the shift from
using the drug for pleasure (liking) to using the drug due to
need (wanting) [43,44]. This transition is characterized by the
shift from substance use associated with reward and pleasur-
able effects to cue-elicited compulsive use associated with
cue-elicited craving. In other words, motivation shifts towards
relieving craving or withdrawal, while the pleasure once as-
sociated with the substance recedes [4345]. Finally, this
pattern is associated with long-term changes in the neural
circuits involving dopamine, glutamate, and GABA in the
fronto-limbic system involving the interconnectedness of the
ventral tegmental area, nucleus accumbens, amygdala, and
prefrontal cortex [43,44,46]. Such a transition and long-
term neural changes have yet to be demonstrated in any
studies of porn addiction.
Porn Addiction?
Many have attempted to generalize the patterns related to
problem substance use to explain other behavior problems,
including use of VSS [47]. Surprisingly, a clear, falsifiable
theoretical model of porn addictionhas yet to be described.
Some use addiction interchangeably with other labels such as
hypersexual disorder (HD) also known as sexual addiction
[48]. Others define addiction broadly to refer to any substance
or behavior with evidence of excessive appetite: appetitive
behaviour is excessive, at least in the statistical sense[49].
Simply because a behavior is appetitive and frequently en-
gaged does not mean the behavior is a problem, let alone an
addiction. Even when consequences, distress, or dysfunction
follow such behaviors, interaction with third variables, such as
relationship status or culture, must first be examined.
Research concerning VSS use problems is also unusually
weak, making any support for an addiction model necessarily
weak. For example, studies usually fail to define the term
pornography, either for participants or operationalized in
the manuscript, and do not use psychometrically tested ques-
tionnaires to assess the types of VSS consumed [50]. Döring
[51••] summarized research on VSS as one seldom encoun-
ters more sophisticated research designswhere one-shot
studies are the rule, positive effects are rarely assessed, and
cross-sectional data cannot establish causality (p. 1098). A
review by Mudry et al. [2••] identified that a mere 27 % (13 of
49) of articles concerning high-frequency sexual behaviors
contained actual data. In 2013, only a single psychophysio-
logical study on the topic appeared [52]. In other words, most
publications that might be relevant for VSS addiction models
contain no data, and those that contain data generally are weak
scientifically.
Given the absence of a clear model, a substance addiction
model is used in this review as a basis to evaluate the sex
addiction model. Using a substance addiction model means
comparing the extent to which VSS addictionsresemble
features of substance addictions. No doubt some will object
to this framework, but no falsifiable alternative has been
specified. For example, Griffiths [53] describes behavioural
addictions feature the core components of addiction (i.e.,
salience, mood modification, tolerance, withdrawal, conflict
and relapse). Others go so far as to recommend treatment
parallel to 12-step interventions [54]. Clearly, the substance
addictions model is being applied in pornography addiction.
We specifically review the appropriateness of porn addic-
tionwith respect to its possible negative consequences, lack of
control reported in viewing behaviors, and any neural evidence
supporting a shift to wanting/craving rather than liking. Not
every aspect of substance addiction models can be discussed.
After these comparisons with substance addictions, possible
alternative models of high-frequency VSS use are reviewed,
including the possibility that no pathology exists.
Negative Consequences of High Use of VSS
High levels of VSS use alone are often alleged to cause
negative life consequences, increased health-risk behaviors,
as well as social and relational difficulties. These negative
consequences are commonly identified as hallmark dysfunc-
tioncriteria to support the diagnosis of porn addiction.
However, these negative consequences are not well
established, and the causal link with VSS use is not clear.
High VSS Use Associations with Health-Risk Behaviors?
Cross-sectional studies have identified relationships between
sex addiction and more unprotected anal sex [55], having
Curr Sex Health Rep
more previously unknown partners [56], and a greater likeli-
hood of having ever paid for sex [57]. However, none of these
address VSS use. In fact, some have argued that VSS use and
masturbation may red u ce health-risk behaviors by managing
sex drive effectively and safely [58,59]. Using data from the
very large, representative longitudinal General Social Survey,
Wright [60] similarly found VSS use and engagement in
casual sex were related only in those who reported unhappi-
ness and low life satisfaction. Similarly, political ideology
moderated the apparent relationship between VSS use and
casual sex partners [20]. No study has demonstrated a direct,
causal link between VSS use and health-risk behaviors.
Erectile Dysfunction and High VSS Use?
While no empirical claims tying erectile function and porn
addictionwere identified, this is a frequent media claim. Two
research groups studied erectile dysfunction (ED) specifically
in young men. In one study, 26 % of men seeking treatment
for first-onset ED were under age 40 [61]. The main predic-
tors of ED specific to the younger men were smoking and
illicit drug use. Another study of men age 1825 found 30 %
reported ED [62]. Again, ED appeared primarily related to
illicit drug use, but also depression and poor physical health.
Neither study measured or conjectured about VSS use.
Considering another study showed no differences during
VSS viewing in the brains of men with and without ED
[63], it is difficult to find evidence for a rise in ED in young
men attributable to VSS use.
VSS viewing is almost always accompanied by masturbation
[10], suggesting several mechanisms by which high-frequency
VSS viewing could contribute to difficulties getting or sustain-
ing an erection. However, both reflect basic physiology and
learning principles, not pathology. First, men exhibit refractory
periods. Refractory periods refer to the latency after an orgasm
during which subsequent erection and orgasm are more difficult
(for review, see Levin [64]). Sperm factors are affected posi-
tively by the latency since last ejaculation [65,66], leading to
speculation that refractory periods function to pace reproductive
copulation. Increased VSS use means more recent orgasms,
thus a male who views VSS more frequently is more likely to
be within a refractory period when partnered sex is attempted.
The other non-pathological mechanism by which VSS
viewing might contribute to decreased erections is learning.
Sexual response can be conditioned to images of a penny jar
[67], to specific sexual images using vibratory stimuli [68],
and using sexual films as the unconditioned stimulus [69].
Even rodents appear unable to behave sexually in the absence
of a conditioned jacket [70]. Sexual responses also habituate
[7174]. In fact, habituation to sexual stimuli is faster than
habituation to negative stimuli [75]. Physiology and learning,
not addiction, can explain any links between VSS use and
erections. In other words, increasing VSS use could lead to
ED, but the causal mechanism is most parsimoniously ex-
plained by processes other than addiction.
Failure to Inhibit VSS Use
Anecdotal reports of addiction often describe individuals
reporting difficulty controlling their use of VSS. To parallel
substance addictions, VSS use should also be difficult to
inhibit. However, a laboratory study did not identify any
relationship between the ability to self-regulate sexual arous-
al to VSS and measures of hypersexual problems [76]. This
finding was recently extended to demonstrate that sexual
desire levels, not hypersexual problems, predict how well a
person up- and down-regulates their sexual responses to
VSS [77]. Similarly, sex addiction patients report
dysexecutive problems [78], but do not actually exhibit them
when tested [79]. If there is not actually any evidence for
dysregulation, what might explain their reports of problems
regulating VSS use?
Some have cited personal religious values as providing a
conflict between their VSS use and feeling unable to stop.
Religious conflict was the main reason cited for problems
viewing VSS in one study [80]. Those who want treatment
for sex addiction are also more likely to be members of orga-
nized religion and hold strong religious values [81,82].
However, the reverse was not true: religiosity explained little
variance (3 %) in the decision to use VSS [83]. Far more people
report a feeling of inability to control their VSS use, than
actually report life difficulties resulting from their use [23].
Feeling unable to stop may reflect personal value conflicts with
normal VSS use. No data currently support the notion that
porn addictshave difficulty inhibiting their VSS use.
Neuroadaptations to VSS Use
Data consistently demonstrate the ability of substances to shift
brain response to craving, rather than liking, states. The same
cannot be said of VSS. Sexual images are known to evoke
stronger motivation than other pleasant images, manifesting in
a variety of physiological indicators [84,85]. Sexual images
and films increase blood flow to many areas of the brain,
including those associated with reward, relative to neutral
films (for review, see Kühn and Gallinat [86]). VSS also
provoke increases in dopamine-tagged ligands in PET [87,
88]. Also, VSS appear pleasant and rewarding to both men
and women in fMRI studies [89]. This appears to fulfill the
initial liking present in the development of substance addic-
tions [90] and offers some commonalities with substance
reinforcement [91], but in no case has a shift away from liking
to wanting or craving been demonstrated.
In fact, no data have demonstrated that VSS are different
from any other likedactivity or object [92]. This is
Curr Sex Health Rep
important, because pathology should be conceptually distinct,
not merely those on the high end of a construct like sexual
desire [93]. For example, Florida students respond with in-
creased late positive brain potentials to images of their adored
Gator team over images of other sports [94]. Similarly, those
who have no problems with their eating still exhibit greater
frontal alpha asymmetry to images of delicious desserts
(EEG [95]) and striatal activity specifically increases to
preferred chocolate brands (fMRI [96]). Also, activity in
the left nucleus accumbens to delicious foods positively
predicts BMI change prospectively [97] in those without
any known eating pathology. Those who enjoy extreme
sports also show differential modulation of the brain re-
sponse (P300) not associated with pathology [98]. In sum-
mary, stronger neural responses occur to any enjoyed activ-
ity that is not pathological [99]. Thus, stronger activation to
VSS in those reporting liking VSS more are both expected
and non-pathological.
VSS processing can further be associated with state and
trait differences, which would be necessary to associate ad-
dictsresponses. Activation of entorhinal cortex activity is
lesser in those who report hypoactive sexual desire problems
[100]. Left insula and right thalamus activity is lesser to VSS
in those with lower levels of sexual desire [101]. Further,
frontal alpha asymmetry to sexual films are also related to
reported sexual arousal, particularly in women [17]. However,
no shift in neural response in porn addictshas been
demonstrated.
Substance use problems appear heritable, suggesting a
biological susceptibility. For example, those with higher ge-
netic risk for alcoholism similarly are more reactive to alcohol
cues [102]. Sexual debut and risk behaviors are heritable (for
review, see Harden [103]). Sexual sensitivity also appears
heritable, such as with orgasm capacity in women [104,
105]. However, heritable components of VSS use have not
been demonstrated.
ΔFosB has recently drawn increased interest in substance
addictions. This transcription factor is implicated in epige-
netic effects in the nucleus accumbens, via direct D1 path-
ways, that occur in both normal reward learning and drug
taking [106]. This is being interpreted as a mechanism by
which drugs may chronically decrease dopamine signaling
[107]. Similar changes have been demonstrated to food
following the administration of high fat diets to rodents
[108]. Increased latency to mount and intromission, though
notejaculation,havebeenobservedinsexuallyexperienced
male rodents [109]. This was interpreted as evidence of
ΔFosB as a critical mediator for reward reinforcement
and natural reward memory, although sex addiction was
not discussed (p. 837). There are serious challenges to mea-
suring ΔFosB in humans, and null results have been report-
ed in humans to date (e.g., in alcoholics in Watanabe et al.
[110]). Even more problematic is that the rodent model of
hypersexuality is male on male mounting behaviors [111]. It
appears that pathologizing homosexual behaviors would be
necessary to test ΔFosB as a mediator in a rodent model of
sex addiction. Porn addictionlanguishes without any clear
animal model.
Alternative Models
If high-frequency VSS viewing is not usefully described as an
addiction, is there a better model to describe those who report
problems regulating their VSS viewing and experience nega-
tive consequences from it? Several alternative models have
been suggested. Before describing the possible pathology
models, it is important to note that high-frequency viewing
of VSS may not be pathological at all.First, we review several
correlates of VSS use that are inconsistent with pathology.
Next, we review compulsivity and impulsivity models of
these behaviors.
Secondary Gain
The treatment of pornography and sex addiction is a lucrative,
largely unregulated industry. The industry makes many claims
for treatment and success, with little (to no) published data.
Many treatment centers in the USA have emerged claiming to
treat sex addiction. The first 20 inpatient facilities advertising
on the internet to treat sex and/or porn addiction in the USA
were contacted. They averaged a cost of US$677 (SD =$403)
per day. They required or recommended between 9 days to
9 months minimum of inpatient stay. For example, one center
claims their sex addiction treatment is clinically shown to
produce results that are up to 3 times faster and 11 times more
effective than traditional treatment methods, although none
of the articles on their website (nor in the literature) actually
test sex addiction [112]. The use of medications off-labelto
treat pornography addictionalso appears common. Drugs
originally designed to treat alcoholism, depression, and ED
have all been suggested [113,114]. This therapeutic oppor-
tunism is well characterized [115]. Some have advocated for
transparency, requiring therapists to inform patients that such
therapies are experimental, and have not been tested for sex
addiction [116].
Many of the treatment centers and providers also claim
religious affiliations, raising questions about the nature of
supposed pathology if it is rooted in a particular religion.
Some of the most outspoken advocates for an addiction pa-
thology model have publications making explicitly religious
arguments against VSS viewing [117119]. Religiosity is one
of the strongest (negative) predictors of problems with internet
VSS use [82]. The risk of conflating profit motive and diag-
nosis in a population vulnerable due to their strong religious
beliefs appears high.
Curr Sex Health Rep
VSS Use and Mental Health Problems
VSS use might be elevated due to mental health problems
that are not explicitly sexual, such as depression [120].
Those with more frequent use of VSS reported more depres-
sive symptoms, poorer quality of life, lower health status and
more days that were diminished due to mental and physical
health [121] in addition to more drug and alcohol use [122].
The number of hours one spends viewing VSS also is related
(r=.24) to the severity of psychological symptoms [123].
These negative relationships appear more common in males.
Similarly, those who specifically report problems with VSS
were significantly more likely to report current or past
psychiatric treatment, mental health therapy, and suicide
ideation [124].
Given that positive effects also are common (reviewed
above) and the positive and negative effects of VSS use often
are even correlated, data are needed to address causality
between VSS use and mental health problems. Causality
could be supported by demonstrating that(i) the mental health
problems occur after the VSS use (or increase with greater
VSS use), (ii) third variables do not account for the apparent
relationship between mental health problems and VSS use,
and (iii) problems increase in a dose-response fashion with
greater VSS use. Limited data to date refute each requirement.
When examined over time, mental health problems do not
follow VSS use. In a large sample of Dutch adolescents, lower
life satisfaction predicted greater VSS use at time 2 [125]. This
is the reverse of what would be expected if VSS use were
causing life dissatisfaction.
VSS use also may be related to a number of other variables
that better account for a VSSmental health relationship. For
example, even when loneliness was strongly predicted by
overall Internet use, researchers failed to appropriately statis-
tically control for general Internet use and attributed loneliness
to VSS use [126]. It is rare that investigators even collect data
on such third variables, however, so this study represents a
positive step.
Others have reached similar conclusions: the high comor-
bidity rates in the present sample call into question the extent
to which it is possible to speak of Internet sex addiction as a
primary disorder or whether it is more appropriate to view it as
a symptom of another underlying mental health problem
[127]. In summary, it is baffling that VSS use is described as
comorbidwith mental health issues (e.g., comordbid hy-
persexual behavior and ADHDin Reid et al. [128]). This
language elevates VSS use to disorder status and should be
avoided.
VSS Use Explained by Sex Drive
More VSS use is related to higher levels of libido/sexual
arousal. Individuals who report being more aroused by VSS
also use VSS more and report higher levels of sexual desire
[122,123,129,130]. Two studies directly investigating
high desire models found support for these models. In one
study, those who desired help regulating their sexual behav-
iors were only distinguished by a high sexual desire level
[81]. In the second study, neural responses to sexual stim-
uli were related to sexual desire levels, but not any (of
three) measures of sexual addiction [52]. Indirect evidence
also comes from a study in which single women looked
longer than women in relationships at images of men [131].
Desire discrepancy, rather than low sexual desire, appears
central to couples reporting a mismatch of desire [132].
VSS may be blamed for problems really due to a mismatch
of sexual needs.
VSS Use Explained by Sensation Seeking
Higher need or desire for sensation is predictive of more
frequent use of VSS, in both adolescents and adults [12••,
133,134]. A higher need for sensation seeking may drive
individuals towards forbidden or taboo experiences, may be
connected to higher libido, may result from increased VSS
use, or may dispose individuals to use exciting sexual stimuli
or experiences as a form of emotional coping. Little informa-
tion exists as to whether sensation seeking acts as a disposing
characteristic, is a result of use of VSS and other sexually
adventurous behaviors, or is bidirectional. Future research
may further elucidate the connections between this variable
and problems related to VSS.
VSS Use as Effective Affect Regulation
Individuals report using VSS to cope with negative emotions,
and such use is frequently identified as a core symptom of sex
addiction. Although this strategy may contribute to relation-
ship conflict [124,135], VSS are likely effective for regulating
emotion. Like other emotional images, VSS capture cognitive
resources effectively [136]. Distraction is an effective method
for reducing negative affect [137]. Although distraction is
relatively less effective for regulating emotions than other
strategies [138], distraction also requires less effort than other
strategies [139]. Thus, VSS appear likely to be effective in
improving mood, possibly in similar ways to pleasant car-
toons [55]. Recent experimental evidence suggested that peo-
ple with problems regulating their viewing of VSS respond
with similarly positive emotions while viewing VSS to people
without problems [140]. Those with higher sexual compulsiv-
ity also appear more prone to respond with increased interest
(assessed by attractiveness ratings and gaze direction) to flir-
tatious faces after a shame induction than those with lower
sexual compulsivity [141]. Data have not yet demonstrated
that using VSS to regulate mood is ineffective or leads to
specific problems.
Curr Sex Health Rep
VSS Use and Sexual Orientation
Studies that examine rates of VSS use consistently find high
rates of use in men who self-identify as gay or bisexual.
Cooper et al. [142] described overrepresentation of men who
have sex with men (MSM) in groups reporting the highest
rates of use of VSS. Studies examining rates of VSS use in
nationally representative samples find higher rates of VSS use
in both adolescents and adults who identify as other than
heterosexual [133], as do studies of clinical samples [143].
Trials of DSM-5 hypersexual disorder criteria found that
MSM were more than three times as likely to be in such
treatment settings, compared with rates of MSM in compara-
ble substance abuse or mental health facilities [144].
Increased use of VSS in these populations may reflect
adaptive strategies. MSM may be more likely to seek informa-
tion and stimuli consistent with their sexual orientation. This
may reflect a common component of the coming-out process
of forming a stable sexual identity [145]. In other words, VSS
use could reflect the behaviors of a disenfranchised group
seeking safe, anonymous venues to explore their sexual needs,
or may reflect unique aspects of homosexual culture. It also
may simply reflect the higher sexual drive of men (see above).
Studies that examine use of VSS in MSM find that these men
overwhelmingly endorse these positive benefits from VSS use
[146]. Rates of VSS use in MSM may reflect unique aspects of
homosexuality, aspects of male sexuality, or both.
Impulsivity
Impulsivity broadly refers to a sudden urge to respond to a
(internal orexternal) cue with less executive mediation than is
probably appropriate. In VSS use, this might mean noticing a
sexual cue and beginning to use VSS with little consideration
for other immediate time demands. Measures of impulsivity
correlate moderately with measures of sexual compulsivity
and experiential avoidance [147] and sexual arousal reported
to VSS [148]. A pilot study (N=16) suggested that patients
made more errors on a task indicative of impulsivity than
controls [149]. A recent evoked response potential study
further supported this model, identifying that those reporting
problems regulating their VSS use exhibited decreased neural
motivation to sexual images [150]. New fMRI models suggest
impulsivity might reflect a greater isolation of prefrontal brain
areas from appetitive-associated subcortical structures [151].
A larger body of experimental work appears available to guide
future investigations testing an impulsivity model of high-
frequency VSS use.
Compulsivity
Compulsivity broadly refers to the perseveration ofbehaviors,
which could characterize repeatedly returning to VSS. Some
have argued that compulsive behaviors are best viewed as a
type of impulsivity [114]. However, perseveration is distin-
guishable from impulsive problems in the brain. Orbitofrontal
lesions in rodent models specifically provoke perseveration,
separating these from discrimination errors affected by dorsal
anterior cingulate cortex lesions [54]. Differences between
impulsive and compulsive behaviors also have strong charac-
terization in humans [116]. Dissociations between impulsiv-
ity and compulsivity also have been used to meaningfully
differentiate clinical profiles, such as in hair-pulling [152].
Compulsivity has become a very popular term to refer to
high-frequency sexual behaviors, although little research ex-
ists to clearly support differentiating sexual behaviors as com-
pulsive. Cooper (1998) appears one of the first to use this
term. His widely-cited Triple-A Engine(Accessibility,
Affordability and Anonymity) is cited as driving VSS com-
pulsions, especially to relieve negative affect by positive
reinforcement[124]. However, no one has directly tested
whether compulsivity is a reasonable model for characterizing
high-frequency VSS use.
Conclusions
VSS may have a number of links to positive health outcomes,
especially through its connection to orgasm. For example,
VSS could reduce sexual risk behaviors. In a longitudinal
study, those who reported higher sexual sensation seeking
engage in more risky sexual behaviors, and sexual sensation
seeking is inversely related to VSS viewing [153]. One pos-
sibility is that those with higher sexual sensation seeking use
VSS at younger ages and broaden the content of their VSS
when sexual partners are not available to them to engage in
actual sexual risk behaviors [154]. This is consistent with
suggestions that masturbation, which almost always accom-
panies VSS viewing, could reduce risky partnered sexual
behaviors [59]. The potential risk in labeling VSS as only
addictive, and the role of VSS in regulating emotions as
inherently problematic, misses opportunities to take advan-
tage of the positive features of VSS (cp., cognitive retraining
in gaming as in Bavelier and Davidson [155]).
Based upon the empirical data reviewed herein, the tenacity
and popularity of the porn addiction concept to describe high
rates of VSS use appears to be driven by non-empirical forces.
Based upon this review, the authors suggest that this popular-
ity reflectsseveral factors. First, the concept of addiction itself
is broadly used in the media to describe any high-frequency
behavior that can be associated with problems for the individ-
ual or society. The lack of specificity makes the term nearly
useless to scientists or clinicians. Secondly, the strong desire
of most clinicians to be helpful to those in pain has been
leveraged into a large, lucrative treatment industry benefitting
from the perception that these behaviors are addictive and
Curr Sex Health Rep
require (paid) assistance to change. Finally, the ability to label
VSS use as addictive appears to serve sociocultural functions.
The label supports moralistic judgments, the stigmatization of
sexual minorities, and the suppression of certain sexual ex-
pressions and behaviors. The concept of porn addiction is one
mechanism to exert social control over sexuality as expressed
or experienced through modern technological means. Mere
conflict between a persons preferences and social standards
should not be used to characterize pathology [156]. Moreover,
this label may distract attention from the more likely causes of
the negative consequences spuriously correlated with VSS
use.
Individuals reporting addictiveuse of VSS could be
conceptualized using the approach outlined here. These indi-
viduals may be likely to be male, have a non-heterosexual
orientation, have a high libido, tend towards sensation seek-
ing, and have religious values that conflict with their sexual
behaviors and desires. They may be using VSS as a means of
coping with negative emotional states or decreased life satis-
faction. When faced with such complaints, clinicians are
encouraged to address these factors without conjuring addic-
tion labels. As better models for high-frequency VSS use are
tested, we may yet be able to spin fine cloth as an effective
method for assisting these individuals without pathologizing
them or their use of VSS.
Compliance with Ethics Guidelines
Conflict of Interest David Ley has received royalties from Rowman &
Littlefield Publishers, is a paid blogger/writer for Psychology Today,and
has had travel expenses covered by various media outlets for appearances
on television shows.
Nicole Prause and Peter Finn declare that they have no conflict of
interest.
Human and Animal Rights and Informed Consent This article does
not contain any studies with human or animal subjects performed by any
of the authors.
References
Papers of particular interest, published recently, have been
highlighted as:
Of importance
•• Of major importance
1. Coleman E. Sexual compulsivity: definition, etiology, and
treatment considerations. J Chem Depend Treat. 1987;1(1):
189204.
2.•• Mudry TE, Hodgins DC, el-Guebaly N, Wild TC, Colman I,
Patten SB, et al. Conceptualizing excessive behaviour syndromes:
a systematic review. Curr Psychiatr Rev. 2011;7(2):13851. doi:
10.2174/157340011796391201.An extensive review of numerous
attempts to classify excessive behaviors as disorders. Highlights
the many methodological problems and limited data in these areas.
3. Stein DJ, Black DW, Pienaar W. Sexual disorders not otherwise
specified: compulsive, addictive, or impulsive? CNS Spectr.
2000;5(1):604.
4. Kor A, Fogel YA, Reid RC, Potenza MN. Should hypersexual
disorder be classified as an addiction? Sex Addict Comp.
2013;20(12):2747. doi:10.1080/10720162.2013.768132.
5. Benton D. The plausibility of sugar addiction and its role in
obesity and eating disorders. Clin Nutr. 2010;29(3):288303.
doi:10.1016/j.clnu.2009.12.001.
6. Ziauddeen H, Farooqi IS, Fletcher PC. Obesity and the brain: how
convincing is the addiction model? Nat Rev Neurosci. 2012;13(4):
27986.
7. Davis RA. A cognitive-behavioral model of pathological Internet
use. Comput Hum Behav. 2001;17(2):18795. doi:10.1016/
S0747-5632(00)00041-8.
8. Walker M. Some problems with the concept of gambling addic-
tion: should theories of addiction be generalized to include ex-
cessive gambling? J Gambl Stud. 1989;5(3):179200. doi:10.
1007/bf01024386.
9. McFall RM. Manifesto for a science of clinical psychology. Clin
Psychol. 1991;44:7588.
10. Reid RC, Carpenter BN, Hook JN, Garos S, Manning JC,
Gilliland R, et al. Report of findings in a DSM-5 field trial for
hypersexual disorder. J Sex Med. 2012;9(11):286877. doi:10.
1111/j.1743-6109.2012.02936.x.
11. Gewirtz P. On I know it when I see it. Yale Law J. 1996;105(4):
102347.
12.•• Brown JD, LEngle KL. X-rated: sexual attitudes and behaviors
associated with U.S. early adolescentsexposure to sexually ex-
plicit media. Commun Res. 2009;36(1):12951. doi:10.1177/
0093650208326465.In a rare longitudinal data set, the authors
try to separate the effects of VSS viewing from individual
differences. Sensation seeking in children may drive them to seek
VSS that further increase sexual behaviors associated with high
sensation seeking.
13. Carnes P, Schneider JP. Recognition and management of addictive
sexual disorders: guide for the primary care clinician. Lippincotts
Prim Care Pract. 2000;4(3):30218.
14. Simons RF, Detenber BH, Roedema TM, Reiss JE. Emotion
processing in three systems: the medium and the message.
Psychophysiology. 1999;36(5):61927. doi:10.1111/1469-8986.
3650619.
15. Courtney CG, Dawson ME, Schell AM, Iyer A, Parsons TD.
Better than the real thing: eliciting fear with moving and static
computer-generated stimuli. Int J Psychophysiol. 2010;78(2):
10714. doi:10.1016/j.ijpsycho.2010.06.028.
16. Smith ME, Gevins A. Attention and brain activity while watching
television: components of viewer engagement. Media Psychol.
2004;6(3):285305. doi:10.1207/s1532785xmep0603_3.
17. Prause N, Staley C, Roberts V. Frontal alpha asymmetry and
sexually motivated states. Psychophysiology. 2014. doi:10.1111/
psyp.12173.
18. Buzzell T. Demographic characteristics of persons using pornog-
raphy in three technological contexts. Sex Cult. 2005;9(1):2848.
doi:10.1007/bf02908761.
19. Rainie L, Pew Research Center. Internet, broadband, and cell
phone statistics: Pew Internet & American Life Project. 2010.
http://pewinternet.org/Reports/2010/Internet-broadband-and-cell-
phone-statistics.aspx.
20. Wright P, Bae S, Funk M. United States women and pornography
through four decades: exposure, attitudes, behaviors, individual
differences. Arch Sex Behav. 2013;42(7):113144. doi:10.1007/
s10508-013-0116-y.
21. Krcmar M, Farrar K, McGloin R. The effects of video game
realism on attention, retention and aggressive outcomes. Comput
Hum Behav. 2011;27(1):4329. doi:10.1016/j.chb.2010.09.005.
Curr Sex Health Rep
22. Carnes P. Dont call it love: recovery from sexual addiction. New
York: Bantam; 1991.
23. Skegg K, Nada-Raja S, Dickson N, Paul C. Perceived out of
controlsexual behavior in a cohort of young adults from the
Dunedin Multidisciplinary Health and Development Study. Arch
Sex Behav. 2010;39(4):96878. doi:10.1007/s10508-009-9504-8.
24. Watson MA, Smith RD. Positive porn: educational, medical, and
clinical uses. Am J Sex Educ. 2012;7(2):12245. doi:10.1080/
15546128.2012.680861.
25. McKee A. The positive and negative effects of pornography as
attributed by consumers. Aust J Commun. 2007;34(1):87104.
26. Hald GM, Malamuth NM. Self-perceived effects of pornography
consumption. Arch Sex Behav. 2008;37(4):61425.
27. Häggström-Nordin E, Hanson U, Tydén T. Associations between
pornography consumption and sexual practices among adoles-
cents in Sweden. Int J STD AIDS. 2005;16(2):1027.
28. Štulhofer A, Buško V, Landripet I. Pornography, sexual socializa-
tion, and satisfaction among young men. Arch Sex Behav.
2010;39(1):16878. doi:10.1007/s10508-008-9387-0.
29. Weinberg MS, Williams CJ, Kleiner S, Irizarry Y. Pornography,
normalization, and empowerment. Arch Sex Behav. 2010;39(6):
1389401. doi:10.1007/s10508-009-9592-5.
30. PetersonZ, Janssen E. Ambivalent affect and sexual response: the
impact of co-occurring positive and negative emotions on subjec-
tive and physiological sexual responses to erotic stimuli. Arch Sex
Behav. 2007;36:793807.
31. Prause N, Staley C, Fong T. No evidence of emotion dysregulation
in hypersexualsreporting their emotions to a sexual film. Sex
Addict Comp. 2013;20:10626. doi:10.1080/10720162.2013.
772874.
32.Diamond M. Pornography, public acceptance and sex related
crime: a review. Int J Law Psychiatry. 2009;32(5):30414. doi:
10.1016/j.ijlp.2009.06.004.Review which challenges many
assumptions regarding pornography use and sexual crime.
33. Brannigan A, Kapardis A. The controversy over pornography and
sex crimes: the criminological evidence and beyond.
Aust N Z J Criminol. 1986;19(4):25984. doi:10.1177/
000486588601900406.
34. Kutchinsky B. The effect of easy availability of pornography on
the incidence of sex crimes: the Danish experience. J Soc Issues.
1973;29(3):16381. doi:10.1111/j.1540-4560.1973.tb00094.x.
35. Baron RA, Bell PA. Sexual arousal and aggression by males:
effects of type of erotic stimuli and prior provocation. J Pers Soc
Psychol. 1977;35(2):7987. doi:10.1037/0022-3514.35.2.79.
36.OBrien CP, Volkow N, Li TK. Whats In a word? Addiction
versus dependence in DSM-V. Am J Psychiatry. 2006;163(5):
7645. doi:10.1176/appi.ajp.163.5.764.Useful exploration of the
use and misuse of the word addiction.
37. Hasin DS, OBrien CP, Auriacombe M, Borges G, Bucholz K,
Budney A, et al. DSM-5 criteria for substance use disorders:
recommendations and rationale. Am J Psychiatry. 2013;170(8):
83451. doi:10.1176/appi.ajp.2013.12060782.
38. Petry NM, Blanco C, Auriacombe M, Borges G, Bucholz K,
Crowley TJ, et al. An overview of and rationale for changes
proposed for pathological gambling in DSM-5. J Gambl Stud.
2013. doi:10.1007/s10899-013-9370-0.
39. Stepney R. The concept of addiction: its use and abuse in the
media and science. Hum Psychopharmacol Clin Exp.
1996;11(S1):S1520.
40. Drew LR. Beyond the disease concept of addiction: drug use as a
way of life leading to predicaments. J Drug Issues. 1986;16(2):
26374.
41. Walker MB. Some problems with the concept of gambling ad-
diction: should theories of addiction be generalized to include
excessive gambling? J Gambl Stud. 1989;5(3):179200. doi:10.
1007/bf01024386.
42. Wood R. Problems with the concept of video game addiction:
some case study examples. Int J Ment Health Addict. 2008;6(2):
16978. doi:10.1007/s11469-007-9118-0.
43. Koob GF, Le Moal M. Drug addiction, dysregulation of reward,
and allostasis. Neuropsychopharmacology. 2001;24(2):97129.
doi:10.1016/s0893-133x(00)00195-0.
44. Robinson TE, Berridge KC. The psychology and neurobiology of
addiction: an incentivesensitization view. Addiction.
2000;95(8s2):91117. doi:10.1046/j.1360-0443.95.8s2.19.x.
45. Goldstein RZ, Volkow ND. Drug addiction and its underlying
neurobiological basis: neuroimaging evidence for the involvement
of the frontal cortex. Am J Psychiatry. 2002;159(10):164252.
46. Kalivas PW, OBrien C. Drug addiction as a pathology of staged
neuroplasticity. Neuropsychopharmacology. 2008;33(1):16680.
doi:10.1038/sj.npp.1301564.
47. Smith DE. Editors note: the process addictions and the new
ASAM definition of addiction. J Psychoactive Drugs.
2012;44(1):14. doi:10.1080/02791072.2012.662105.
48. Fong TW, Reid RC, Parhami I. Behavioral addictions: where to
draw the lines? Psychiatr Clin N Am. 2012;35(2):27996. doi:10.
1002/cpp.609.
49. Orford J. Addiction as excessive appetite. Addiction. 2001;96(1):
1531. doi:10.1046/j.1360-0443.2001.961152.x.
50. Short MB, Black L, Smith AH, Wetterneck CT, Wells DE. A
review of Internet pornography use research: methodology and
content from the past 10 years. Cyberpsychol Behav Soc Netw.
2012;15(1):1323. doi:10.1089/cyber.2010.0477.
51.•• Döring NM. The Internets impact on sexuality: a critical review of
15 years of research. Comput Hum Behav. 2009;25(5):1089101.
doi:10.1016/j.chb.2009.04.003.Review of research on Internet
and sexuality, underscoring methodological issues inherent in
these studies.
52. Steele V, Staley C, Fong T, Prause N. Sexual desire, not hyper-
sexuality, is related to neurophysiological responses elicited by
sexual images. Socioaffect Neurosci Psychol. 2013. http://www.
socioaffectiveneuroscipsychol.net/index.php/snp/article/view/
20770.Accessed7Feb2014.
53. Griffiths M. Does internet and computer addictionexist? Some
case study evidence. CyberPsychol Behav. 2000;3(2):2118. doi:
10.1089/109493100316067.
54. Chudasama Y, Passetti F, Rhodes SEV, Lopian D, Desai A,
Robbins TW. Dissociable aspects of performance on the 5-
choice serial reaction time task following lesions of the dorsal
anterior cingulate, infralimbic and orbitofrontal cortex in the rat:
differential effects on selectivity, impulsivity and compulsivity.
Behav Brain Res. 2003;146(12):10519. doi:10.1016/j.bbr.
2003.09.020.
55. Moran CC. Short-term mood change,perceived funniness, and the
effect of humor stimuli. Behav Med. 1996;22(1):328. doi:10.
1080/08964289.1996.9933763.
56. Schnarrs PW, Rosenberger JG, Satinsky S, Brinegar E, Stowers
J, Dodge B, et al. Sexual compulsivity, the Internet, and sexual
behaviors among men in a rural area of the United States.
AIDS Patient Care STDS. 2010;24(9):5639. doi:10.1089/apc.
2010.0117.
57. Storholm E, Fisher D, Napper L, Reynolds G, Halkitis P.
Proposing a tentative cut point for the compulsive sexual behavior
inventory. Arch Sex Behav. 2011;40(6):13018. doi:10.1007/
s10508-010-9712-2.
58. Coleman E. Masturbation as a means of achieving sexual health. J
Psychol Hum Sex. 2003;14(23):516. doi:10.1300/
J056v14n02_02.
59. Elders MJ.Sex for health and pleasure throughout a lifetime. J Sex
Med. 2010;7 Suppl 5:2489.
60.Wright PJ. U.S. Males and pornography, 19732010: consump-
tion, predictors, correlates. J Sex Res. 2013;50(1):6071. One of
Curr Sex Health Rep
the few longitudinal studies examining VSS use, showing unhap-
piness and lower life satisfaction as moderating variables.
61.Capogrosso P, Colicchia M, Ventimiglia E, Castagna G, Clementi
MC, Suardi N, et al. One patient out of four with newly diagnosed
erectile dysfunction is a young manworrisome picture from the
everyday clinical practice. J Sex Med. 2013;10(7):183341. doi:
10.1111/jsm.12179.Examination of rates of E.D. in young men,
explained by health and life variables.
62. Mialon A, Berchtold A, Michaud PA, Gmel G, Suris JC. Sexual
dysfunctions among young men: prevalence and associated fac-
tors. J Adolesc Health Off Publ Soc Adolesc Med. 2012;51(1):25
31. doi:10.1016/j.jadohealth.2012.01.008.
63. Hagemann JH, Berding G, Bergh S, Sleep DJ, Knapp WH, Jonas
U, et al. Effects of visual sexual stimuli and apomorphine SL on
cerebral activity in men with erectile dysfunction. Eur Urol.
2003;43(4):41220.
64. Levin RJ. Revisiting post-ejaculation refractory timewhat we
know and what we do not know in males and in females. J Sex
Med. 2009;6(9):237689. doi:10.1111/j.1743-6109.2009.01350.x.
65. Freund M. Effect of frequency of emission on semen output and
an estimate of daily sperm production in man. J Reprod Fertil.
1963;6(2):26986. doi:10.1530/jrf.0.0060269.
66. Magnus Ø, Tollefsrud A, Árbyholm T, Purvis K. Effects of vary-
ing the abstinence period in the same individuals on sperm quality.
Syst Biol Reprod Med. 1991;26(3):199203. doi:10.3109/
01485019108987644.
67. Plaud JJ, Martini JR. The respondent conditioning of male sexual
arousal. Behav Modif. 1999;23(2):25468.
68. Both S, Laan E, Spiering M, Nilsson T, Oomens S, Everaerd W.
Appetitive and aversive classical conditioning of female sexual
response. J Sex Med. 2008;5(6):1386401.
69. Hoffmann H, Janssen E, Turner SL. Classical conditioning of
sexual arousal in women and men: effects of varying awareness
and biological relevance of the conditioned stimulus. Arch Sex
Behav. 2004;33(1):4353.
70.Pfaus JG, Erickson KA, Talianakis S. Somatosensory conditioning
of sexual arousal and copulatory behavior in the male rat: A model
of fetish development. Physiol Behav. 2013;122:17. A model for
the development of sexual preferences is described. The possible
relevance to humans shaped by sexual experiencesis outlined.
71. Both S, Laan E, Everaerd W. Focusing hotor focusing cool:
attentional mechanisms in sexual arousal in men and women. J Sex
Med. 2011;8(1):16779. doi:10.1111/j.1743-6109.2010.02051.x.
72. Conaglen H, Evans I. Pictorial cues and sexual desire: an exper-
imental approach. Arch Sex Behav. 2006;35(2):197212.
73. Koukounas E, Over R. Changes in the magnitude of the eyeblink
startle response during habituation of sexual arousal. Behav Res
Ther. 2000;38(6):57384.
74. Laan E, Everaerd W. Habituation of female sexualarousal to slides
and film. Arch Sex Behav. 1995;24(5):51741.
75. Carretiè L, Hinojosa JA, Mercado F. Cerebral patterns of atten-
tional habituation to emotional visual stimuli. Psychophysiology.
2003;40(3):3818.
76. Winters J, Christoff K, Gorzalka BB. Conscious regulation of
sexual arousal in men. J Sex Res. 2009;46(4):33043.
77. Moholy M, Staley C, Prause N. Experimental and first functional
neuro studies of the sex addiction model. International Academy
of Sex Research Annual Meeting. Chicago: IL; 2013.
78. Reid RC, Karim R, McCrory E, Carpenter BN. Self-reported
differences on measures of executive function and hypersexual
behavior in a patient and community sample of men. Int J
Neurosci. 2010;120(2):1207. doi:10.3109/00207450903165577.
79. Reid RC, Garos S, Carpenter BN, Coleman E. A surprising
finding related to executive control in a patient sample of hyper-
sexual men. J Sex Med. 2011;8(8):222736. doi:10.1111/j.1743-
6109.2011.02314.x.
80. Twohig MP, Crosby JM, Cox JM. Viewing internet pornography:
for whom is it problematic, how, and why? Sex Addict Compul.
2009;16(4):25366. doi:10.1080/10720160903300788.
81.Winters J, Christoff K, Gorzalka BB. Dysregulated sexuality and
high sexual desire: distinct constructs? Arch Sex Behav.
2010;39(5):102943. doi:10.1007/s10508-009-9591-6.
Empirical study with self-identified sex addicts, underscoring role
of religious values and sexual desire in the identification of prob-
lematic sexual behaviors.
82. Ross M, Månsson S-A, Daneback K. Prevalence, severity, and
correlates of problematic sexual internet use in Swedish men and
women. Arch Sex Behav. 2012;41(2):45966. doi:10.1007/
s10508-011-9762-0.
83. Wright PJ. U.S. males and pornography, 1973-2010: consump-
tion, predictors, correlates. J Sex Res. 2013;50(1):6071.
84. Vrana SR, Spence EL, Lang PJ. The startle probe response: a new
measure of emotion? J Abnorm Psychol. 1988;97(4):48791.
85. Weinberg A, Hajcak G. Beyond good and evil: the time-course of
neural activity elicited by specific picture content. Emotion.
2010;10(6):76782. doi:10.1037/a0020242.
86. Kühn S, Gallinat J. A quantitative meta-analysis on cue-induced
male sexual arousal. J Sex Med. 2011;8(8):226975. doi:10.1111/
j.1743-6109.2011.02322.x.
87. Bocher M, Chisin R, Parag Y, Freedman N, Meir Weil Y, Lester H,
et al. Cerebral activation associated with sexual arousal in re-
sponse to a pornographic clip: A 15O-H2O PET study in hetero-
sexual men. Neuroimage. 2001;14(1 Pt 1):10517.
88. Georgiadis JR, Kortekaas R, Kuipers R, Nieuwenburg A, Pruim J,
Reinders AATS, et al. Regional cerebral blood flow changes
associated with clitorally induced orgasm in healthy women. Eur
J Neurosci. 2006;24(11):330516. doi:10.1111/j.1460-9568.2006.
05206.x.
89. Wehrum S, Klucken T, Kagerer S, Walter B, Hermann A, Vaitl D,
et al. Gender commonalities and differences in the neural process-
ing of visual sexual stimuli. J Sex Med. 2013;10(5):132842. doi:
10.1111/jsm.12096.
90. Robinson TE, Berridge KC. The neural basis of drug craving: an
incentive-sensitization theory of addiction. Brain Res Rev.
1993;18(3):24791. doi:10.1016/0165-0173(93)90013-P.
91. Blum K, Braverman ER, Holder JM, Lubar JF, Monastra VJ,
Miller D, et al. Reward deficicency syndrome: a biogenetic model
for the diagnosis and treatment of impulsive, addictive, and
compulsive behaviors. J Psychoactive Drugs. 2000;32(Suppl):
168.
92.Georgiadis JR, Kringelbach ML. The human sexual response
cycle: brain imaging evidence linking sex to other pleasures.
Prog Neurobiol. 2012;98(1):4981. doi:10.1016/j.pneurobio.
2012.05.004.Review of neurobiological research, indicating that
sexual response and desires are not neurologically distinct from
other nonsexual likes and desires.
93. Moser C. Hypersexualdisorder: just more muddled thinking. Arch
Sex Behav. 2011;40(2):2279. doi:10.1007/s10508-010-9690-4.
94.Hillman CH, Cuthbert BN, Cauraugh J, Schupp HT, Bradley MM,
Lang PJ. Psychophysiological responses of sport fans. Motivation
& Emotion. 2000;24(1):1328. Study demonstrating neurological
effects of interest and prefernces for nonsexual stimuli.
95. Gable PA, Harmon-Jones E. Relative left frontal activation to
appetitive stimuli: considering the role of individual differences.
Psychophysiology. 2008;45(2):2758.
96. Schaefer M, Knuth M, Rumpel F. Striatal response to favorite
brands as a function of neuroticism and extraversion. Brain Res.
2011;1425:839. doi:10.1016/j.brainres.2011.09.055.
97. Demos KE, Heatherton TF, Kelley WM. Individual differences in
nucleus accumbens activity to food and sexual images predict
weight gain and sexual behavior. J Neurosci. 2012;32(16):5549
52. doi:10.1523/jneurosci.5958-11.2012.
Curr Sex Health Rep
98. Fjell AM, Aker M, Bang KH, Bardal J, Frogner H, Gangås OS,
et al. Habituation of P3a and P3b brain potentials in men engaged
in extreme sports. Biol Psychol. 2007;75(1):8794. doi:10.1016/j.
biopsycho.2006.12.004.
99. Salamone JD, Correa M. Dopamine and food addiction: Lexicon
Badly Needed. Biol Psychiatry. 2013;73(9):e1524. doi:10.1016/
j.biopsych.2012.09.027.
100. Arnow BA, Millheiser L, Garrett A, Lake Polan M, Glover GH,
Hill KR, et al. Women with hypoactive sexual desire disorder
compared to normal females: a functional magnetic resonance
imaging study. Neuroscience. 2009;158(2):484502. doi:10.
1016/j.neuroscience.2008.09.044.
101. Fonteille V, Stoléru S. The cerebral correlates of sexual desire:
functional neuroimaging approach. Sexologies. 2011;20(3):142
8. doi:10.1016/j.sexol.2010.03.011.
102. Pihl RO, Peterson J, Finn PR. Inherited predisposition to alcohol-
ism: characteristics of sons of male alcoholics. J Abnorm Psychol.
1990;99(3):291301. doi:10.1037/0021-843x.99.3.291.
103. Harden KP. Genetic influences on adolescent sexual behavior:
why genes matter for environmentally oriented researchers.
Psychol Bull. 2013. doi:10.1037/a0033564.
104. Dawood K, Kirk KM, Bailey JM, Andrews PW, Martin NG.
Genetic and environmental influences on the frequency of orgasm
in women. Twin Res Hum Genet. 2005;8(1):2733. doi:10.1375/
1832427053435427.
105. Dunn KM, Cherkas LF, Spector TD. Genetic influences on vari-
ationinfemaleorgasmicfunction: a twin study. Biol Lett.
2005;1(3):2603. doi:10.1098/rsbl.2005.0308.
106. Grueter BA, Robison AJ, Neve RL, Nestler EJ, Malenka RC.
ΔFosB differentially modulates nucleus accumbens direct and
indirect pathway function. Proc Natl Acad Sci. 2013;110(5):
19238. doi:10.1073/pnas.1221742110.
107. Wong CCY, Mill J, Fernandes C. Drugs and addiction: an intro-
duction to epigenetics. Addiction. 2011;106(3):4809. doi:10.
1111/j.1360-0443.2010.03321.x.
108. Teegarden SL,Scott AN, Bale TL. Early life exposure to a high fat
diet promotes long-term changes in dietary preferences and central
reward signaling. Neuroscience. 2009;162(4):92432. doi:10.
1016/j.neuroscience.2009.05.029.
109. Pitchers KK, Frohmader KS, Vialou V, Mouzon E, Nestler EJ,
Lehman MN, et al. ΔFosB in the nucleus accumbens is critical for
reinforcing effects of sexual reward. Genes Brain Behav.
2010;9(7):83140. doi:10.1111/j.1601-183X.2010.00621.x.
110. Watanabe H, Henriksson R, Ohnishi YN, Ohnishi YH, Harper C,
Sheedy D, et al. HUMAN STUDY: FOSB proteins in the
orbitofrontal and dorsolateral prefrontal cortices of human alco-
holics. Addict Biol. 2009;14(3):2947. doi:10.1111/j.1369-1600.
2009.00155.x.
111. Pettit M. The queer life of a lab rat. Hist Psychol. 2012;15(3):217
27. doi:10.1037/a0027269.
112. Theta Wellness Centers. Theta Advanced Technology Menu.
2013. http://www.thetawellnesscenter.com/medical-research/
theta-medical-research-studies-drug-abuse-in-utah.html.
Accessed 9 Jan 2013.
113. Bostwick JM, Bucci JA. Internet sex addiction treated with
naltrexone. Mayo Clin Proc. 2008;83(2):22630. doi:10.4065/
83.2.226.
114. Dalley Jeffrey W, Everitt Barry J, Robbins TW. Impulsivity,
compulsivity, and top-down cognitive control. Neuron.
2011;69(4):68094. doi:10.1016/j.neuron.2011.01.020.
115. Reay B, Attwood N, Gooder C. Inventing sex: the short history of
sex addiction. Sex Cult. 2013;17(1):119. doi:10.1007/s12119-
012-9136-3.
116.Grant JE, Kim SW. Brain circuitry of compulsivity and impulsiv-
ity. CNS Spectr. 2013;17. doi:10.1017/S109285291300028X.
The differences between compulsivity and impulsivity models are
reviewed. The relevance of these concepts to addiction models is
discussed.
117. Reid R. No more disposition to do evil [Audio CD]: Cedar
Fort. 2008.
118. Hilton DL. He restoreth my soul: understanding and breaking
the chemical and spiritual chains of pornography through the
atonement of Jesus Christ. 3rd ed. LLC: Forward Press
Publishing; 2011.
119. Weiss R. 101 Freedom exercises: a Christian guide for sex addic-
tion recovery. Los Angeles, CA: Discovery Press; 2009.
120. Cantor J, Klein C, Lykins A, Rullo J, Thaler L, Walling B. A
treatment-oriented typology of self-identified hypersexuality re-
ferrals. Arch Sex Behav. 2013;42(5):88393. doi:10.1007/
s10508-013-0085-1.
121. Dabbs Jr JM, Bassett JF, Dyomina NV. The palm IAT: a portable
version of the implicit association task. Behav Res Methods
Instrum Comp J Psychon Soc Inc. 2003;35(1):905.
122. Svedin CG, Akerman I, Priebe G. Frequent users of pornography.
A population based epidemiological study of Swedish male ado-
lescents. J Adolesc. 2011;34(4):77988. doi:10.1016/j.
adolescence.2010.04.010.
123. Brand M, Laier C, Pawlikowski M, Schächtle U, Schöler T,
Altstötter-Gleich C. Watching pornographic pictures on the internet:
role of sexual arousal ratings and psychologicalpsychiatric symp-
toms for using internet sex sites excessively. Cyberpsychol Behav
Soc Netw. 2011;14(6):3717. doi:10.1089/cyber.2010.0222.
124. Cooper A, Griffin-Shelley E, Delmonico DL, Mathy RM. Online
sexual problems: assessment and predictive variables. Sex Addict
Compul Spec Issue Prepar DSM-V. 2001;8(3):26785.
125. Peter J, Valkenburg PM. The use of sexually explicit material and
its antecedents: a longitudinal comparison of adolescents and
adults. Arch Sex Behav. 2011;40(5):101525. doi:10.1007/
s10508-010-9644-x.
126. Yoder KK, Morris ED, Constantinescu CC, Cheng T-E,
Normandin MD, OConnor SJ, et al. When what you see isnt
what you get: alcohol cues, alcohol administration, prediction
error, and human Striatal dopamine. Alcohol Clin Exp Res.
2009;33(1):13949. doi:10.1111/j.1530-0277.2008.00821.x.
127. Griffiths MD. Internet sex addiction: a review of empirical re-
search. Addict Res Theory. 2012;20(2):11124. doi:10.1037/
0893-164x.18.3.223.
128. Reid RC, Carpenter BN, Gilliland R, Karim R. Problems of self-
concept in a patient sample of hypersexual men with attention-
deficit disorder. J Addict Med. 2011;5(2):13440. doi:10.1097/
ADM.0b013e3181e6ad32.
129. Gable PA, Adams DL. Nonaffective motivation modulates the
sustained LPP (1,0002,000 ms). Psychophysiology.
2013;50(12):12514. doi:10.1111/psyp.12135.
130. Pripfl J, Neumann R, Köhler U, Lamm C. Effects of transcranial
direct current stimulation on risky decision making are mediated
by hotand colddecisions, personality, and hemisphere. Eur J
Neurosci. 2013:n/a-n/a. doi:10.1111/ejn.12375.
131. Rupp H, Librach G, Feipel N, Ketterson E, Sengelaub D, Heiman
J. Partner status influences womens interest in the opposite sex.
Hum Nat. 2009;20(1):93104. doi:10.1007/s12110-009-9056-6.
132. Davies S, Katz J, Jackson JL. Sexual desire discrepancies: effects
on sexual and relationship satisfaction in heterosexual dating
couples. Arch Sex Behav. 1999;28(6):55367.
133. Nongpiur A, Sinha VK, Praharaj SK, Goyal N. Theta-patterned,
frequency-modulated priming stimulation enhances low-
frequency, right prefrontal cortex repetitive transcranial magnetic
stimulation (rTMS) in depression: a randomized, sham-controlled
study. J Neuropsychiatry Clin Neurosci. 2011;23(3):34857. doi:
10.1176/appi.neuropsych.23.3.348.
134. Izzo AA, Piscitelli F, Capasso R, Aviello G, Romano B, Borrelli F,
et al. Peripheral endocannabinoid dysregulation in obesity:
Curr Sex Health Rep
relation to intestinal motility and energy processing induced by
food deprivation and re-feeding. Br J Pharmacol. 2009;158(2):
45161. doi:10.1111/j.1476-5381.2009.00183.x.
135. Cooper A, Galbreath N, Becker MA. Sex on the internet: further-
ing our understanding of men with online sexual problems.
Psychol Addict Behav. 2004;18(3):22330. doi:10.1037/0893-
164X.18.3.223.
136. Laier C, Schulte FP, Brand M. Pornographic picture processing
interferes with working memory performance. J Sex Res. 2012;
doi:10.1080/00224499.2012.716873.
137. Kalisch R, Wiech K, Herrmann K, Dolan RJ. Neural correlates of
self-distraction from anxiety and a process model of cognitive
emotion regulation. J Cogn Neurosci. 2006;18(8):126676. doi:
10.1162/jocn.2006.18.8.1266.
138. McRae K, Hughes B, Chopra S, Gabrieli JDE, Gross JJ, Ochsner
KN. The neural bases of distraction and reappraisal. J Cogn
Neurosci. 2010;22(2):24862. doi:10.1162/jocn.2009.21243.
139. Sheppes G, Catran E, Meiran N. Reappraisal (but not distraction)
is going to make you sweat: physiological evidence for self-
control effort. Int J Psychophysiol. 2009;71(2):916. doi:10.
1016/j.ijpsycho.2008.06.006.
140. Steele V, Prause N, Staley C, Fong GW. Sexual desire, not hyper-
sexuality, is related to neurophysiological responses elicited by
sexual images. Socioaffect Neurosci Psychol. 2013;3:20770. doi:
10.3402/snp.v3i0.20770.
141. Petrican R, Burris CT, Moscovitch M. Shame, sexual compulsiv-
ity, and eroticizing flirtatious others: an experimental study. J Sex
Res. 2013:1-12. doi:10.1080/00224499.2013.829796.
142. CooperA,DelmonicoDL,BurgR.Cybersexusers,abusers,and
compulsives: New findings and implications. Sexual Addiction &
Compulsivity 2000;7(12):529. doi:10.1080/10720160008400205.
143. Thomsen R, Soltis J. Male masturbation in free-ranging japanese
macaques. Int J Primatol. 2004;25(5):103341. doi:10.1023/
b:ijop.0000043350.75897.89.
144. Borbély AA, Baumann F, Brandeis D, Strauch I, Lehmann D.
Sleep deprivation: effect on sleep stages and EEG power density
in man. Electroencephalogr Clin Neurophysiol. 1981;51(5):483
93. doi:10.1016/0013-4694(81)90225-X.
145. Polivy J, Herman CP. Dieting and binging: a causal analysis. Am
Psychol. 1985;40(2):193201. doi:10.1037/0003-066x.40.2.193.
146. Raffaelli M, Crockett LJ. Sexual risk taking in adolescence: the
role of self-regulation and attraction to risk. Dev Psychol.
2003;39(6):103646. doi:10.1037/0012-1649.39.6.1036.
147. Wetterneck CT, Burgess AJ, Short MB, Smith AH, Cervantes ME.
The role of sexual compulsivity, impulsivity, and experiential avoid-
ance in internet pornography use. Psychol Rec. 2012;62(1):317.
148. Paul B. Predicting internet pornography use and arousal: the role
of individual difference variables. J Sex Res. 2009;46(4):34457.
doi:10.1080/00224490902754152.
149. Miner MH, Raymond N, Mueller BA, Lloyd M, Lim KO.
Preliminary investigation of the impulsive and neuroanatomical
characteristics of compulsive sexual behavior. Psychiatry Res
Neuroimaging. 2009;174(2):14651.
150. Prause N, Steele VR, Staley C, Sabatinelli D, Hajcak G, Fong T.
Neural evidence of underreactivity to sexual stimuli in those
reporting problems regulating their viewing of visual sexual stim-
uli. 2013. manuscript under review.
151. Davis FC, Knodt AR, Sporns O, Lahey BB, Zald DH, Brigidi BD,
et al. Impulsivity and the modular organization of resting-state
neural networks. Cereb Cortex. 2013;23(6):144452. doi:10.
1093/cercor/bhs126.
152. Odlaug BL, Chamberlain SR, Schreiber LRN, Grant JE. Where on
the obsessive impulsivecompulsive spectrum does hair-pulling
sisorder belong? Int J Psychiatry Clin Pract. 2013;17(4):27985.
doi:10.3109/13651501.2013.828079.
153. SinkovićM, Štulhofer A, BožićJ. Revisiting the association
between pornography use and risky sexual behaviors: the role of
early exposure to pornography and sexual sensation seeking. J Sex
Res. 2012;50(7):63341. doi:10.1080/00224499.2012.681403.
154. Seigfried-Spellar KC, Rogers MK. Does deviant pornography use
follow a Guttman-like progression? Comput Hum Behav.
2013;29(5):19972003. doi:10.1016/j.chb.2013.04.018.
155. Bavelier D, Davidson RJ. Brain training: games to do you good.
Nature. 2013;494(7438):4256.
156. Moser C. Hypersexual disorder: searching for clarity. Sex Addict
Comp. 2013;20:4858.
Curr Sex Health Rep
... Despite these self-reports, researchers still disagree about whether habitual pornography users can develop genuine addictions to pornography and manifest addiction-related symptomatology akin to substance addictions. Some have argued that pornography is inherently addictive due to it being a particularly novel and rewarding stimulus (Hilton Jr., 2013) and that symptoms of dysregulated pornography use fit within an addiction framework, sharing similar neurobiological mechanisms with substance addictions and other behavioral addictions Love et al., 2015), while others hold the view that pornography addiction is not a valid clinical entity and can instead be explained by non-pathological learning (Ley et al., 2014). One model (Grubbs et al., 2019b) has posited that while some users may experience genuine dysregulation in their pornography use, other users may inaccurately pathologize their use even in the absence of genuine dysregulation due to moral incongruence (i.e., using pornography while morally disapproving of it)-suggesting that self-diagnoses of "pornography addiction" should be regarded with caution. ...
Article
Full-text available
Little is known about whether withdrawal-like symptoms manifest when regular pornography users attempt to abstain from pornography. The present study used a randomized controlled design to examine whether (1) negative abstinence effects that may be potentially reflective of withdrawal-related symptoms manifest when a non-clinical sample of regular pornography users attempt to abstain from pornography for a 7-day period and (2) these negative abstinence effects would only manifest (or manifest more strongly) for those with higher levels of problematic pornography use (PPU). A total of 176 undergraduate students (64.2% female) who were regular pornography users (defined as having used pornography ≥ three times a week in the past 4 weeks) were randomly assigned to an abstinence group (instructed to attempt abstinence from pornography for 7 days, n = 86) or a control group (free to watch pornography as usual, n = 90). Participants completed measures of craving, positive and negative affect, and withdrawal symptoms at baseline and each night of the 7-day period. Contrary to the confirmatory hypotheses, there were no significant main effects of group (abstinence vs. control) or group × PPU interaction effects on any of the outcome measures, controlling for baseline scores. These findings indicate that no evidence of withdrawal-related symptoms was found for abstaining participants, and this was not dependent on level of PPU. However, exploratory analyses showed a significant three-way interaction (group × PPU × past 4-week frequency of pornography use [FPU]) on craving, where an abstinence effect on craving was found at high levels of PPU only once past 4-week FPU reached the threshold of daily use. While these exploratory findings should be interpreted with caution, they suggest that abstinence effects could potentially manifest when there is a combination of high PPU and high FPU-a hypothesis that warrants investigation in future prospective abstinence studies.
... The ongoing controversy about the most accurate conceptualization of this phenomenon-as compulsive disorder or addiction-remains, due to a lack of scientific research and inconsistencies of applied definitions and classifications [10,21,27,30,31]. Particularly, the measurement of what is considered problematic pornography use has turned out to be challenging [5,23]. ...
Article
Full-text available
The positive impact of pornography use has been demonstrated; however, most research points towards problematic, compulsive, or excessive engagement with pornography and associated adverse effects on well-being. However, results remain inconclusive and qualitative research capturing perspectives of affected people is scarce. This phenomenological study aimed to explore the perspective and lived experience of males with a self-reported addiction to pornography. Semi-structured in-depth interviews with 13 males aged between 21 and 66 years from Australia and the USA were conducted. A thematic analysis of the transcripts was undertaken, resulting in the identification of four themes. The interviews explored the participants’ reasoning for determining themselves as porn addicts, investigated patterns of use, examined the perceived multifaceted impacts of pornography use, illustrated applied individual strategies to overcome the addiction, and proposed interventions helping to inform future recommendations. Experiences and perceptions of pornography addiction were consistently depicted as problematic and harmful. Most participants described an inability to stop their consumption despite experiencing adverse effects. Commonly reported was a gradual increase in the use of and consumption of new or more shocking content. Consumption of content was outlined as an escape or coping mechanism for negative emotions or boredom. Participants reported a variety of applied strategies to manage their addiction and suggested recommendations. Investigation into strategies for the identification of problematic pornography use, its conceptualization, associated health outcomes, and effective preventative and interventional strategies are required to provide academic consistency, support those negatively affected by pornography, and achieve increased public awareness of the issue.
... Pornography has created considerable debate in scientific, legal, and public spheres-with some even arguing that it is among the most contested moral issues of our time (Burger, 1987;Hatch et al., 2020a, b;Segal, 1990). Among these debates is: (1) whether pornography consumption should be considered an addictive or problematic behavior worthy of behavioral intervention, and (2) whether pornography consumption is negatively associated, positively associated, or uncorrelated with relationship functioning (Ley et al., 2014;Love et al., 2015;Montgomery-Graham et al., 2015;Wright, 2019). Approximately 4-6% of men and 1-2% of women report having felt addicted to pornography, which may lead them to seek help for their use (Grubbs et al., 2019). ...
Article
Full-text available
Research surrounding pornography and its impact on individual and relationship functioning is a frequent and ongoing debate in the current literature. However, recent meta-analyses and aggregated studies suggest that relationship distress is associated with higher levels of general pornography use. This may be a reason why a significant number of men and women view pornography and seek help for their use. In the present study, we explored whether participation in the OurRelationship program, a web-based relationship education program that has been empirically shown to reduce relationship distress but is not tailored to reduce general pornography use, was associated with reliable changes in pornography-related behaviors. In a sample of low-income and diverse couples (N = 314 couples; 628 individuals), we observed high completion rates (64.3%) as well as reliable, small-sized decreases in the frequency and duration of pornography use for the average couple (d = 0.12–0.13). Furthermore, post hoc analyses found that individuals who began the program viewing pornography daily reported reliability-larger decreases in pornography-related behaviors (d = 0.32–0.90) than those who viewed pornography less frequently. However, we did not see reliable changes in couples’ arguments about pornography use or perceptions of problematic use. The findings were generally not moderated by gender or lifestyle changes due to the COVID-19 pandemic. Clinicians struggling to reduce their client’s general pornography use may consider including a focus on improving general romantic relationship functioning.
... Research suggests that religiosity is associated with significantly lower PU (Bridges & Morokoff, 2011;Patterson & Price, 2012;Perry & Schleifer, 2018b), which authors attribute to the influence of moral prohibitions against PU associated with religiosity, particularly religious conservatism (Ley, Prause, & Finn, 2014;Perry, 2018;Perry & Whitehead, 2019;Thomas, 2016). However, a significant number of religious and conservatively religious individuals still use pornography despite these prohibitions (Perry & Schleifer, 2018a;Whitehead & Perry, 2017), perhaps with greater relational consequences. ...
Thesis
Full-text available
Approximately 40% of U.S. women in married or cohabitating heterosexual relationships have a partner who uses pornography more than once a month. Some studies demonstrate a negative association between the frequency of male partners’ pornography use (PU) and women’s sexual satisfaction and relationship satisfaction, while others find no association. These mixed findings may be due to moderating influences of women’s religiosity, attitudes, and diverse meanings given to PU (e.g. addiction, gendered norm, inspiration), which have not been adequately studied. The current study included a sample of 625 women (mean age=44, diverse SES, 86% White), recruited through a Qualtrics research panel, who were married or cohabitating with a man who had used pornography in the prior 3 months. Study aims were to investigate (1) pornography-related distress, attitudes and meanings given to a partner’s PU, (2) the relationship between perceived frequency of partners’ solitary PU (PFREQ) and women’s pornography-related distress, relationship satisfaction and sexual satisfaction, (3) contributions of attitude and religiosity (commitment and conservatism) to distress and satisfaction, and (4) associations among attitudes, religiosity and meanings, and among meanings, distress and satisfaction. Self-report measures included the Partner’s Pornography Use Scale, Pornography Distress Scale, Couples Satisfaction Index, Global Measure of Sexual Satisfaction, Multidimensional Religious Ideology Scale, Religious Commitment Inventory, Biblical Literalism Measure, Pornography Meaning Scales, and an item measuring attitudes towards pornography. Participants endorsed a range of PFREQ (median frequency=1-2 times/week) and attitudes (28% negative, 34% neutral, 38% positive). Partial correlations and multiple regressions, controlling for demographic variables and COVID-19-related stress, indicated that higher PFREQ was significantly associated with women’s higher pornography-related distress, lower relationship satisfaction, and lower sexual satisfaction. Attitude and PFREQ made independent contributions to distress and satisfaction. Negative attitude amplified the negative association between PFREQ and relationship satisfaction, and religious conservatism amplified the positive association between PFREQ and pornography-related distress. Findings support and extend previous research regarding the associations of higher PFREQ and negative attitude with greater distress and lower relationship and sexual satisfaction, the contribution of religiosity to greater distress, and the role of meanings of infidelity, sin, addiction and inadequacy in predicting greater distress and lower satisfaction.
... Some studies indicate that Internet pornography addiction fits into the general addiction model (e.g., substance addiction) (Love et al., 2015). However, others argue that there is little evidence that suggests that porn use is addictive (Ley et al., 2014). Owens et al. (2012) conducted a systematic literature review on the effects of internet pornography on adolescents and concluded that there was no obvious association between the consumption of online pornography and health problems. ...
Article
Full-text available
About 6 million men in China engage in jiese (abstaining from masturbation and porn) and call themselves jieyou (porn-free self-help community members). In this article, we sought to unpack how the idea of jiese took root in Chinese historical, social, and cultural contexts by interviewing 32 jieyou. Guided by the sensemaking theory, we conducted a critical discourse analysis of participants’ responses and ended up identifying four major themes: embodied experiences, jiese as rational and noble, reconstructing the subjectivity of jieyou, and nationalistic sentiments. We found out that jieyou tended to justify their abstinence by seeking sources of legitimacy in traditional Chinese culture, the ideology of healthism, science, and patriotic discourses. We argue that jiese reflects young men’s contradictory cultural practices of conservatism, self-medicalization, and neoliberal governmentality.
... Nonetheless, there is growing concern (e.g., Duffy, Dawson, & Das Nair, 2016;Keane, 2016) about the negative consequences of problematic Internet pornography use for daily life, including financial, legal, occupational, and relational issues as well as psychological problems (e.g., irresponsible search for gratification, blame). Given the lack of a formal definition, different terms have been used in pornography research, leading to several inconsistencies in the methodology and assessment tools (Ley, Prause, & Finn, 2014;de Alarcón, de la Iglesia, Casado, & Montejo, 2019). ...
Article
Introduction According to the recent adaptation of the I-PACE model, desire thinking and craving might be closely related to problematic Internet pornography use. The overall aim of the present study was to investigate the role of two components of desire thinking (imaginal prefiguration and verbal perseveration) and craving in problematic Internet pornography use. Furthermore, we examined gender differences in the underlying mechanism linking desire thinking to problematic Internet pornography use. Method A total of 414 Italian adults (mean age = 27.55 years, SD = 6.13; age range= 18 – 58; 53.6% men) participated in this study. Participants completed an online survey to assess problematic Internet pornography use, pornography craving, desire thinking and problematic Internet use. Path analyses and a multi-group approach were used to test the relationships among variables and to explore gender differences. Results Imaginal prefiguration was associated to pornography craving which, in turn, was associated to verbal perseveration as proximal antecedent of problematic Internet pornography use, above and beyond the effect of age, relationship status, and problematic Internet use. Two paths significantly differed between men and women: the path between verbal perseveration and problematic Internet pornography, which for women was weaker and did not reach significance; and the path between problematic Internet use and problematic Internet pornography use that was not significant for women. Conclusions In line with the I-PACE model, the present study provided support for the potential role of desire thinking in problematic Internet pornography use as a specific Internet-use disorder and expanded the literature in the field by testing unexplored gender differences. Preventive and clinical implications are discussed.
... There are different opinions regarding the impact of pornography use. Some claim that it is having adverse effects (Hilton, 2013), some claim to be having positive results (Ley et al., 2014), whereas some people think that it is likely to possess mixed effects (Hald & Malamuth, 2008). There are significant harmful impacts of pornography on young people's sexual and emotional development, but there is a lack of scientific evidence to explore the effect (Bulot et al., 2015). ...
Article
Este trabalho, através de revisão bibliográfica, investiga a associação entre o uso de pornografia e o crescente aumento nas taxas de disfunção erétil, em um contexto onde fatores tradicionais não sofreram variações suficientes para justificar a grandeza dessa elevação.As alterações relacionadas ao sistema de recompensa se apresentam como fator chave na elucidação do aumento da taxa de disfunções sexuais, por meio da diminuição da sensibilidade do indivíduo frente aos prazeres reais e da formação de mecanismos que levam ao vício e a compulsão. A partir da análise e reflexões sobre a bibliografia é possível considerar que existe uma estreita relação de causa e consequência entre pornografia e disfunção erétil em homens com idade inferior a 40 anos. A elevação da incidência do distúrbio tem, como uma das razões de seu agravamento,a proliferação de grandes sites da indústria pornográfica, que busca atender as demandas específicas dos usuários. Relatórios clínicos tem apontado a superação do vício por meio da reinicialização, onde o sujeito se abstém da pornografia por um dado período de tempo. Entretanto, mais estudos se fazem necessários na elaboração de eficazes métodos diagnósticos e de tratamentos farmacológicos.
Chapter
In this chapter, the authors critically review the body of research on adolescents’ and emerging adults’ pornography use and its consequences. We start with a number of theoretical concepts—including social learning and comparison theories, sexual scripting, self-objectification theory, the confluence model, the value congruence model, cultivation and media practice models developed in communication science, and the differential susceptibility to media model—that have been employed in the field, mainly with the goal of understanding possible effects of youth pornography use. Next, we explore the prevalence (both pre- and post-internet), the dynamics (i.e., change over time), and correlates of pornography exposure and use. Associations between pornography use on the one hand and sexual risk taking and sexual aggression on the other hand are explored in separate sections. The role of pornography use in young people’s psychological and sexual well-being is also explored, focusing on possible negative, but also positive outcomes. Acknowledging rising societal concerns, we also reviewed the research on the role of parents in their children’s experience with pornography, as well as the potential contribution of emerging pornography literacy programs. In the final section, we present some recommendations for future research. In particular, much needed measurement (for pornography use and its specific content) and research design improvements are suggested, and practical implications are briefly discussed.KeywordsPornography useAdolescents and emerging adultsSexual risk takingSexual aggressionPsychological and sexual well-being
Article
La pornografía en internet se presenta como un fenómeno sin precedentes en la historia de la humanidad. Este trabajo expone una revisión teórico-histórica que da cuenta de las transformaciones culturales y sociojurídicas que permitieron su conformación, y al mismo tiempo destaca los rasgos distintivos que la separan cualitativamente de formas similares de material erotizante. En un movimiento dialéctico, caracterizado inicialmente por la unión entre sexualidad y divinidad, posteriormente por una era oscura de censura y opresión y, finalmente, por una nueva liberación como mercancía y entretenimiento en la era de la información, la pornografía ha sufrido transformaciones vertiginosas que adelantan con creces el estudio de la academia, particularmente en nuestra realidad latinoamericana.
Article
Full-text available
The conceptualization of Hypersexual Disorder that was proposed for DSM-5 is reviewed and found to be inconsistent with the existing data. Any proposal for adding a new psychiatric disorder should demonstrate the need for a new diagnosis, describe individuals with only that psychiatric disorder, and explain why existing diagnoses are inadequate to describe the new entity. The conceptualization and diagnostic criteria should distinguish between those with the disorder from those without it, as well as demonstrate that the disorder is not a symptom or result of another psychiatric disorder. The current proposal falls short of all these goals. The problems and dangers of adding Hypersexual Disorder to our diagnostic classification system are discussed.
Article
Full-text available
Objective: Hair-pulling disorder (HPD) is a putative obsessive-compulsive spectrum disorder, but proper categorization is challenging. Distinct subgroups of HPD may exist, depending on the primary motivation in the act of pulling. Two notable proposed subgroups are "relief pullers" (pulling primarily to reduce anxiety- a "compulsive" subgroup) and "pleasure/gratification pullers" (pulling primarily for reward- an "impulsive" subgroup) which we sought to examine in order to contribute to conversations on the categorization of HPD. Methods: A total of 111 HPD subjects (mean age 33.7 ± 10.7 [range 18-61] years; 87.4% female) were included. Demographic and clinical characteristics were compared between subgroups (pleasure: n = 51; relief: n = 60); and cognitive performance where data were available (n = 29 per group) and 32 matched healthy controls. Results: No significant demographic differences were noted between groups. Pleasure pullers were significantly more conscious of their pulling. Response inhibition and set shifting deficits were noted in HPD versus controls; however, pleasure and relief pullers did not differ significantly from each other on neurocognitive measures. Conclusions: The results suggest common clinical features and associated neural dysfunction between relief and pleasure/gratification pullers, rather than supporting their existence as discrete clinical entities. Selection of appropriate treatment may focus on other aspects of hair pulling, including family history and comorbidity.
Article
85 undergraduate males participated in an experiment designed to investigate the impact of various types of erotic stimuli on aggression. On the basis of previous research, it was hypothesized that exposure to mild erotic stimuli would tend to inhibit subsequent aggression, while exposure to more arousing stimuli of this type would facilitate such behavior. In order to examine this hypothesis, Ss were first angered or treated in a more neutral manner by a confederate of the E and then provided with an opportunity to aggress against this person by means of electric shock. Before aggressing, Ss were exposed to 1 of 5 different types of stimuli: nonerotic pictures of furniture, scenery, and abstract art; pictures of seminude females; pictures of nude females; pictures of couples engaged in various acts of lovemaking; or explicit erotic passages. Results offer partial support for the major hypothesis. Exposure to mild erotic stimuli inhibited later aggression, while exposure to more arousing sexual materials neither facilitated nor inhibited such behavior. (22 ref) (PsycINFO Database Record (c) 2006 APA, all rights reserved).
Article
This paper presents a biopsychological theory of drug addiction, the 'Incentive-Sensitization Theory'. The theory addresses three fundamental questions. The first is: why do addicts crave drugs? That is, what is the psychological and neurobiological basis of drug craving? The second is: why does drug craving persist even after long periods of abstinence? The third is whether 'wanting' drugs (drug craving) is attributable to 'liking' drugs (to the subjective pleasurable effects of drugs)? The theory posits the following. (1) Addictive drugs share the ability to enhance mesotelencephalic dopamine neurotransmission. (2) One psychological function of this neural system is to attribute 'incentive salience' to the perception and mental representation of events associated with activation of the system. Incentive salience is a psychological process that transforms the perception of stimuli, imbuing them with salience, making them attractive, 'wanted', incentive stimuli. (3) In some individuals the repeated use of addictive drugs produces incremental neuroadaptations in this neural system, rendering it increasingly and perhaps permanently, hypersensitive ('sensitized') to drugs and drug-associated stimuli. The sensitization of dopamine systems is gated by associative learning, which causes excessive incentive salience to be attributed to the act of drug taking and to stimuli associated with drug taking. It is specifically the sensitization of incentive salience, therefore, that transforms ordinary 'wanting' into excessive drug craving. (4) It is further proposed that sensitization of the neural systems responsible for incentive salience ('for wanting') can occur independently of changes in neural systems that mediate the subjective pleasurable effects of drugs (drug 'liking') and of neural systems that mediate withdrawal. Thus, sensitization of incentive salience can produce addictive behavior (compulsive drug seeking and drug taking) even if the expectation of drug pleasure or the aversive properties of withdrawal are diminished and even in the face of strong disincentives, including the loss of reputation, job, home and family. We review evidence for this view of addiction and discuss its implications for understanding the psychology and neurobiology of addiction.