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The Science and Politics of Sex Addiction Research
Abstract
This chapter explores the science and controversy around sex addiction. While some medical and counseling professionals emphasize an addiction model for grappling with compulsive use of pornography. Nicole Prause and Timothy Fong explain that the research does not support an addiction framework. Although sex addiction was rejected as a psychiatric diagnostic category in the most recent
edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) based on lack of credible scientific evidence, rejecting the addiction model has political ramifications. including. in this
instance. attacks on the authors by what they call "proaddiction antipornography stakeholders.“
Readers will note that the “pornography" is replaced in this chapter with the phrase “visual sexual stimuli" (VSS). This is based on the view that “pornography” is biased to suggest that sexual images are inherently negative. For example, the classification of visual representations as “pornography" has been used to restrict information about homosexuality in some countries, or even to prosecute gay businesses. Therefore. rather than using the term “pornography,” the authors follow others by using visual sexual stimuli to refer to visual representations likely to provoke a sexual responses.
... Intrapersonal and relational costs of pornography viewing are much higher for those who hold personal or religious convictions against pornography (Perry, 2016), and religious households appear to experience the greatest negative consequences of pornography use when evaluating levels of sexual satisfaction and the presence of relationship challenges (Perry, 2016;Perry & Whitehead, 2019). Religious background appears to influence individual perceptions of what is normal and acceptable sexuality and sexual behavior (Prause & Fong, 2015), and those with stronger religious values are more likely to seek treatment for what they consider to be problematic pornography use (Grubbs et al., 2015a, b). ...
Introduction
The impacts of the World Health Organization’s new compulsive sexual behavior disorder diagnosis on sexual minority populations are unclear. This study’s aim was to better understand the relationship between sexual orientation and self-perceived pornography addiction. We hypothesized that sexual minority respondents would score higher than heterosexual respondents on self-perceived addiction and this relationship would be moderated by homophobic attitudes.
Methods
Surveys were administered online in 2019 to US adults (n = 540). Four OLS regression models were constructed, with three subscales of self-perceived addiction and the total score acting as outcome variables. Moderation was assessed via a sexual orientation x homophobic attitudes interaction term.
Results
As hypothesized, sexual minority participants scored higher on self-perceived addiction than their heterosexual counterparts overall. At low levels of homophobic attitudes, there was no significant difference, while at high levels, sexual minority respondents were much more likely to endorse self-perceived addiction. Ancillary analyses comprising the subsample of sexual minority respondents (n = 116) suggested that religiosity is a key variable of interest and has a multifaceted relationship with homophobic attitudes and self-perceived addiction.
Conclusions
The sexual orientation x homophobic attitudes interaction term might be seen as a proxy for internalized homophobia among sexual minority respondents, suggesting such sexual stigma is associated with individuals feeling their behavior is dysregulated.
Policy Implications
These findings raise concern that the World Health Organization diagnosis might disproportionally pathologize sexual minority persons, particularly those from religious backgrounds who hold internalized homophobia. Uncritical diagnosis and treatment might act as a covert avenue of conversion therapy. Any future debates around diagnostic classification of “sex addiction” need to consider potential iatrogenic harms.
... Over the last 30 years, there has been a slow but growing acceptance among some academics, professionals, policymakers, media, and members of the public regarding the popular concept of addiction to sex and/or pornography (Irvine, 1993(Irvine, , 1995Reay, Attwood, & Gooder, 2013;Ley, Prause, & Finn, 2014;Voros, 2009). Although some academic and professional reports have supported the application of an addiction model to frequent sexual behavior and/or pornography viewing (i.e., Hilton & Watts, 2011;Kafka, 2010), others point out serious potential or actual problems with applying an addiction model to sexual behavior and pornography viewing (Ley, 2012;Ley, Prause, & Finn, 2014;Reid & Kafka, 2014;Giugliano, 2009;Hall, 2014;Karila et al., 2014;Moser, 2013;Kor, Fogel, Reid, & Potenza, 2013;Ley et al., 2014;Prause & Fong, 2015;Prause, Steele, Staley, Sabatinelli, & Hajcak, 2015). Despite serious disagreement among scholars, the concept of sex/porn addiction frequently is applied across multiple professional contexts, including various legal settings (Ley, Brovko, & Reid, 2015). ...
... Consistent with other reviews (i.e., Ley, 2012Ley, , 2018Ley, Prause, & Finn, 2014;Prause & Fong, 2015;Williams et al., 2017;Voros, 2009), we find that the addiction model as applied to sex and VSS viewing fails to meet scientific criteria for model support. Although only one hypothesis generated by the addiction model would need to be falsified to reject the model, many hypotheses generated by the addiction model have been falsified. ...
Laws and legal systems can have a constraining effect on scientific research and harm the public interest. The overt use of the law against research often has a smaller impact than the indirect effects of laws. Examples from three areas – defamation, euthanasia, and intellectual property – illustrate how laws can hinder research. When researchers are threatened with legal action for defamation, this can discourage research in their topic area. Laws against voluntary euthanasia have an indirect effect on research, such as by making it difficult to study euthanasia where it is illegal and hindering research into methods of do-it-yourself euthanasia. Copyright protection is so excessive that it inhibits creative work building on previous ideas, while patents of pharmaceutical drugs enable such huge profits that research into nonpatentable alternatives is neglected. Options for responding to legal constraints on research include acquiescence, law reform, and resistance.
... Yet, in contrast to these kinds of claims, Prause and Fong (2015) found that although pornography viewing does activate "brain areas associated with reward" (p. 433), "the areas of the brain that become more active strongly resemble other nonsexual rewards" (p.436)-whether those be the use of illegal substances or simply the consumption of "a preferred brand of chocolate." ...
Over the last 30 years, there has been a growing trend among both professionals and nonprofessionals in applying an addiction framework to understand frequent sexual behavior and pornography viewing. However, sexual scientists have identified serious methodological problems in applying an addiction model to such behavior and have noted that this movement appears to be largely morally, ideologically, and politically motivated. The scientific establishment of a valid mental health condition requires a thorough process of attempting (and subsequently failing) to disprove a condition, rather than primarily focusing on generating support for it. While there remains fierce professional contention surrounding how to interpret frequent sexual behavior and pornography viewing, perhaps surprisingly, the possibility that sexual behavior and pornography viewing may function as leisure has received little scholarly consideration to date. This article summarizes the current scientific critique of sex and pornography addiction before critically applying a leisure perspective to the issue.
... Consistent with other reviews (i.e., Ley, 2012Ley, Prause, & Finn, 2014;Prause & Fong, 2015;Williams, et al., 2017;Voros, 2009), we find that the addiction model as applied to sex and VSS viewing fails to meet scientific criteria for model support. Although only one hypothesis generated by the addiction model would need to be falsified to reject the model, many hypotheses generated by the addiction model have been falsified. ...
The widespread application of an addiction model to pornography viewing and sexual behavior (henceforth “sex addiction”) is inaccurate, misleading, and likely harmful to patients. Although it has become increasingly popular for academics, professionals, and lay people to describe sexual behaviors as “addictive”, basic science has falsified core predictions of the “sex addiction” model. Better models for understanding sexual shame, including socio-historical and cultural contexts, are discussed. Various socially-unacceptable sexualities, including homosexuality, followed a similar sociological trajectory attempting to reframe personal and religious values as a public health threat. Mental health practitioners perpetuate these myths due to a longstanding resistance to use research-supported treatments that challenge their current profit model. Finally, the intentional adoption of neuroscience jargon for widespread political manipulation and social control is characterized.
... Whereas sexologists and behavioural scientists are still researching and debating the effects of pornography as well as the applicability of the addiction model (Prause and Fong 2015), resolutions are already being passed, screening tests made, therapies prescribed, pills swallowed, porn-blocking software installed, support groups formed, and many other measures taken. On top of alarmed parents, partners, and wives, a tendency towards self-pathologization has already been observed (Voros 2009, 245), with men selfidentifying as porn addicts and consulting doctors in panic over their habit of bimonthly masturbation (Prause and Fong 2015, 432). ...
... Over the last 30 years, Americans have increasingly embraced the idea of sexual addiction (Irvine, 1993(Irvine, , 1995Reay, Attwood, & Gooder, 2013) and especially that of pornography addiction Voros, 2009). Although there is substantial academic disagreement about what constitute these addictions Hall, 2014;Karila et al., 2014;Moser, 2013) or whether these addictions even really exist Prause & Fong, 2015;Prause, Steele, Staley, Sabatinelli, & Hajcak, 2015), the popular use of these ideas has become increasingly widespread (Reay et al., 2013). ...
Emerging adulthood is a period of development characterized by the maturation of more complex sexual and religious/spiritual (r/s) identities. In some cases, r/s may enhance positive sexual experiences; however, r/s may also exacerbate problems that result from sexual difficulties. In the current study, a cross-sectional survey was administered to university students (N = 295) to test whether the associations of hypersexual behavior with spiritual struggle and with sexual self-concept would differ based on sexual congruence. We found that the associations of hypersexual behavior with sexual anxiety and with some facets of spiritual struggle were more strongly positive among participants who perceived their sexual values and behaviors as incongruent. Also, the association between hypersexual behavior and sexual esteem was more strongly negative among those who perceived their sexual values and behaviors as incongruent. We discuss implications for future examinations of the intersectionality of sexuality, religiousness, and spirituality.
... Over the last 30 years, Americans have increasingly embraced the idea of sexual addiction (Irvine, 1993(Irvine, , 1995Reay, Attwood, & Gooder, 2013) and especially that of pornography addiction (Ley, Prause, & Finn, 2014;Voros, 2009). Although there is substantial academic disagreement about what constitute these addictions (Giugliano, 2009;Hall, 2014;Karila et al., 2014;Moser, 2013) or whether these addictions even really exist (Kor, Fogel, Reid, & Potenza, 2013;Ley et al., 2014;Prause & Fong, 2015;Prause, Steele, Staley, Sabatinelli, & Hajcak, 2015), the popular use of these ideas has become increasingly widespread (Reay et al., 2013). ...
Based on an archival analysis of the popular evangelical magazine Christianity Today, the story of evangelical thinking about pornography during the course of the magazine's history from 1956 to 2014 is traced. This article shows how evangelicals have developed and deployed the idea of pornography addiction, and in doing so, have communicated messages about pornography that have made it more likely for evangelicals to perceive themselves as being addicted to pornography. This article investigates the motivations behind these messages, and suggests that these messages may, in fact, tell us less about individual pornography users and more about those who are developing and deploying such messages.
... Over the last 30 years, Americans have increasingly embraced the idea of sexual addiction (Irvine, 1993(Irvine, , 1995Reay, Attwood, & Gooder, 2013) and especially that of pornography addiction Voros, 2009). Although there is substantial academic disagreement about what constitute these addictions Hall, 2014;Karila et al., 2014;Moser, 2013) or whether these addictions even really exist Prause & Fong, 2015;Prause, Steele, Staley, Sabatinelli, & Hajcak, 2015), the popular use of these ideas has become increasingly widespread (Reay et al., 2013). ...
The current issue of Sexual Addiction & Compulsivity is a foray into the intersection between the psychology of religion and spirituality and the psychology of human sexual behavior. Religiousness and sexual behavior are intricately related domains of human functioning, but, prior to the present issue, relatively little work had been done examining how religiousness and spirituality were related to the experience of sexual addiction. The present issue seeks to address this paucity of research. Nine articles featuring a variety of methods (e.g., qualitative, experimental, survey) and sampling techniques (e.g., undergraduates, community samples of adults, clinical samples of treatment-seeking adults) delve into the nuances of the relationships between religiousness/spirituality and sexual addiction. Collectively, these works expand current understandings of sexual addiction and provide a valuable foundation for much needed future research.
Sexual responses are some of the strongest, primary rewards used in
research and, arguably, in nature. Sexual response often is considered only in isolation as a reflection of good general health or relevant solely for reproduction. Yet, altered responsiveness to sexual rewards is evident in a number of affective disorders not limited to sexual difficulties. The chapter reviews how sexual responses are affected in general emotional disorders, then attempts to distinguish these, often unsuccessfully, from related sexual difficulties.
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