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Is Scrupulosity Behind the Relationship Between Problematic Pornography Viewing and Depression, Anxiety, and Stress?

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This study examined how scrupulosity, depression, anxiety, stress, and neuroticism may statistically predict problematic pornography viewing dimensions. Participants (n = 507 women and n = 250 men) responded to an online survey. Structural equation modeling indicated scrupulosity as a significant positive predictor across all problematic pornography viewing dimensions across genders. Depression was also a significant positive predictor, but only for those who use pornography to escape negative emotions, and for women with functional problems related to pornography use. The relationship between scrupulosity and functional pornography problems was significantly stronger for men. Interaction analyses suggested that low scrupulosity may buffer the relationship between mental health concerns and problematic pornography viewing in men, while high scrupulosity may exacerbate the relationship between anxiety and excessive pornography use in women. The full model accounted for 14 – 34% of the variance of various dimensions of problematic pornography viewing. Clinical implications and areas of further research are discussed.
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Sexual Addiction & Compulsivity
The Journal of Treatment & Prevention
ISSN: 1072-0162 (Print) 1532-5318 (Online) Journal homepage:
Is scrupulosity behind the relationship between
problematic pornography viewing and depression,
anxiety, and stress?
Nicholas C. Borgogna, Jessica Duncan & Ryon C. McDermott
To cite this article: Nicholas C. Borgogna, Jessica Duncan & Ryon C. McDermott (2018)
Is scrupulosity behind the relationship between problematic pornography viewing and
depression, anxiety, and stress?, Sexual Addiction & Compulsivity, 25:4, 293-318, DOI:
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Published online: 18 Feb 2019.
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Is scrupulosity behind the relationship between
problematic pornography viewing and depression,
anxiety, and stress?
Nicholas C. Borgogna , Jessica Duncan, and Ryon C. McDermott,
University of South Alabama, Mobile, Alabama
This study examined how scrupulosity, depression, anxiety,
stress, and neuroticism may statistically predict problematic
pornography viewing dimensions. Participants (n¼507
women and n¼250 men) responded to an online survey.
Structural equation modeling indicated scrupulosity as a sig-
nificant positive predictor across all problematic pornography
viewing dimensions across genders. Depression was also a sig-
nificant positive predictor, but only for those who use pornog-
raphy to escape negative emotions, and for women with
functional problems related to pornography use. The relation-
ship between scrupulosity and functional pornography prob-
lems was significantly stronger for men. Interaction analyses
suggested that low scrupulosity may buffer the relationship
between mental health concerns and problematic pornog-
raphy viewing in men, while high scrupulosity may exacerbate
the relationship between anxiety and excessive pornography
use in women. The full model accounted for 14 34% of the
variance of various dimensions of problematic pornography
viewing. Clinical implications and areas of further research
are discussed.
Over the past two decades researchers and clinicians have become increas-
ingly interested in understanding predictors of problematic pornography
viewing (Borgogna & McDermott, 2018; Brand, Antons, Wegmann, &
Potenza, 2018; Grubbs & Perry, 2018; Grubbs, Perry, Wilt, & Reid, 2018;
Kor et al., 2014; Price, Patterson, Regnerus, & Walley, 2016; Short, Black,
Smith, Wetterneck, & Wells, 2012; Sniewski, Farvid, & Carter, 2018;
Twohig, Crosby, & Cox, 2009). Defined as personal/interpersonal problems
associated with compulsive/addictive pornography use, problematic pornog-
raphy viewing has been conceptualized as a multidimensional construct.
Using Kor et al.s(2014) framework specifically, these dimensions include
functional problems related to pornography viewing; i.e., relationship/work
CONTACT Nicholas C. Borgogna University of South Alabama, Mobile,
Alabama, USA.
Supplemental data for this article can be accessed on the publishers website.
ß2019 Taylor & Francis Group, LLC
2018, VOL. 25, NO. 4, 293318
problems (Kor et al., 2014; Leonhardt, Willoughby, & Young-Petersen,
2017; Manning, 2006; Minarcik, Wetterneck, & Short, 2016; Muusses,
Kerkhof, & Finkenauer, 2015; Perry, 2016; Poulsen, Busby, & Galovan,
2013); problems associated with excessive use and control difficulties
(DOrlando, 2011; Kor et al., 2014; Kraus, Potenza, Martino, & Grant,
2015); and, using pornography as a dysfunctional means of escaping mental
health problems (Kor et al., 2014; Perry, 2017). While multiple studies have
observed significant positive relationships between pornography viewing
and various mental health outcomes (e.g., Butler, Pereyra, Draper,
Leonhardt, & Skinner, 2018; Egan & Parmar, 2013; Levin, Lillis, & Hayes,
2012; Perry, 2017), few have included important cultural and individual dif-
ference factors that may be relevant in determining how general mental
health concerns (i.e., anxiety/depression) are related to problematic pornog-
raphy viewing. Such factors may be helpful for informing clinical
Gender and religiosity constructs have both been offered as avenues that
may moderate frequencies of pornography viewing and subjective feelings
of problematic pornography viewing behaviors (e.g., perceived addiction;
Grubbs, Stauner, Exline, Pargament, & Lindberg, 2015; Grubbs, Wilt,
Exline, Pargament, & Kraus, 2018). Scrupulosity specifically has gained
recent attention as a particular aspect of religiosity that may be strongly
predictive of problematic pornography behaviors (Borgogna & McDermott,
2018; Grubbs et al., 2018; Short, Kasper, & Wetterneck, 2015), although
this view has been debated (Brand et al., 2018). However, to date, no study
has examined mental health and scrupulosity variables simultaneously in
the prediction of problematic pornography viewing. Nor has any study
examined how gender, scrupulosity, and mental health may interact in the
prediction of problematic pornography viewing. We, therefore, sought to
address these gaps in the literature.
Pornography viewing and mental health
While research on problematic pornography viewing is relatively nascent,
multiple studies have indicated concerning outcomes associated with porn-
ography viewing frequency. These include modest positive correlations with
loneliness (Butler et al., 2018; Yoder, Virden, & Amin, 2005), depression
(Kraus et al., 2015; Nelson, Padilla-Walker, & Carroll, 2010; Perry, 2017;
Wolak, Mitchell, & Finkelhor, 2007; Ybarra & Mitchell, 2005), anxiety
(Harper & Hodgins, 2016; Levin et al., 2012), narcissism (Kasper, Short, &
Milam, 2015), headaches (Anand & Dhikav, 2012), and neuroticism (Egan
& Parmar, 2013). Moreover, pornography use has also been modestly nega-
tively associated with general life satisfaction (Harper & Hodgins, 2016;
Wright, Tokunaga, Kraus, & Klann, 2017), relationship satisfaction/relation-
ship problems (Bergner & Bridges, 2002; Bridges, Bergner, & Hesson-
McInnis, 2003; Daspe, Vaillancourt-Morel, Lussier, Sabourin, & Ferron,
2018; Perry, 2018), and sexual satisfaction/desire (Carvalheira, Traeen, &
Stulhofer, 2015; Daspe et al., 2018; Sun, Bridges, Johnson, & Ezzell, 2016;
Wright, Bridges, Sun, Ezzell, & Johnson, 2018; Wright, Sun, Steffen, &
Tokunaga, 2017). While mental health factors are implicated in relation to
pornography viewing (both as a statistical predictor and as an outcome;
Butler et al., 2018; Perry, 2017), cultural and individual factors have also
been reported to be important in determining who may develop problem-
atic pornography viewing behaviors. Religiosity and gender have both been
identified has variables important to this consideration (e.g., Nelson et al.,
2010; Perry, 2017; Twohig et al., 2009).
Pornography and religiosity
Multiple studies have noted that the negative outcomes related to pornog-
raphy viewing are pronounced in religious populations (Borgogna &
McDermott, 2018; Bradley, Grubbs, Uzdavines, Exline, & Pargament, 2016;
Grubbs, Exline, Pargament, Volk, & Lindberg, 2017; Grubbs & Perry, 2018;
Grubbs, Stauner, et al., 2015; Nelson et al., 2010; Patterson & Price, 2012;
Perry, 2017; Perry & Snawder, 2017; Short et al., 2015; Whitehead & Perry,
2018), and more specifically religious men (e.g., Perry, 2017). Prior reports
have demonstrated that religious individuals may perceive their pornog-
raphy use as addictive even if it may not follow an addictive paradigm
(termed perceived addiction; Grubbs, Exline, Pargament, Hook, & Carlisle,
2015; Wilt, Cooper, Grubbs, Exline, & Pargament, 2016; however, see
Brand et al., 2018). Perceived addiction is statistically predictive of psycho-
logical distress even when pornography viewing frequency is controlled
(Grubbs, Stauner, et al., 2015; Grubbs, Volk, Exline, & Pargament, 2015;
Wilt et al., 2016). While these finding broadly suggest that religious indi-
viduals may be at-risk for developing problems related to pornography use,
other researchers have suggested religiosity may act a potential protective
factor (e.g., Hardy, Steelman, Coyne, & Ridge, 2013). Moreover, religiosity
as a broad-construct may have dimensions that function as both protective
and risk-factors. Scrupulous-religiosity (scrupulosity) has been suggested as
a potential religious dimension that may serve as a risk-factor for problem-
atic pornography viewing (N.C. Borgogna & McDermott, 2018).
Characterized as a psychological condition defined by pathological guilt
and/or obsession associated with moral or religious issues (Abramowitz,
Huppert, Cohen, Tolin, & Cahill, 2002; Miller & Hedges, 2008), scrupulos-
ity was suggested as a potential risk factor in the role between religiosity
and problematic pornography viewing by Short et al. (2015). Grubbs et al.
(2018) similarly identified religious scruplesas relevant to the develop-
ment of perceived addiction to pornography viewing. Most recently, scru-
pulosity was reported as a significant statistical predictor of problematic
pornography viewing in men and women across all dimensions in Kor
et al.s(2014) framework (Borgogna & McDermott, 2018).
While these studies indicate scrupulosity may be relevant to the develop-
ment of problematic pornography viewing, no studies have examined how
mental health issues and scrupulosity may interact to exacerbate and/or
buffer problematic pornography viewing tendencies. Similarly, there is a
need to further examine how gender may influence such possible interac-
tions. This is important as men typically report more problematic tenden-
cies associated with their viewing and higher viewing frequencies than
women (e.g. Albright, 2008; Carroll et al., 2008; Harper & Hodgins, 2016;
Price, Patterson, Regnerus, & Walley, 2016;W
ery & Billieux, 2017). Thus,
there is need to examine the suggested moderating roles of scrupulosity
and gender on the relationships between general mental issues and prob-
lematic pornography viewing.
The current study
We addressed these considerations by conducting a study examining how
depression, anxiety, and stress may statistically predict the problematic
dimensions suggested in Kor et al.s(2014) framework, while simultan-
eously examining the contribution of scrupulosity and gender. Four
hypotheses guided our analyses: First, consistent with Borgogna and
McDermott (2018), we hypothesized that scrupulosity would emerge as a
strong significant statistical positive predictor across all problematic porn-
ography viewing constructs. Second, consistent with examinations of men-
tal health in relation to problematic pornography viewing (e.g., Kor et al.,
2014; Kraus et al., 2015; Levin et al., 2012), we hypothesized that anxiety,
depression, and stress would modestly and positively statistically predict all
dimensions as well. Third, because men view pornography more often than
women (Albright, 2008; Carroll et al., 2008; Paul, 2009; Price et al., 2016),
we hypothesized that gender would moderate these relationships, such that
the relationship between scrupulosity and mental health as positive statis-
tical predictors of problematic pornography viewing would be significantly
stronger for men. Fourth, as a means of further exploration, and consistent
with research indicating religious populations experience worse mental
health outcomes associating with pornography viewing in general (Grubbs,
Stauner, et al., 2015; Nelson et al., 2010; Patterson & Price, 2012; Perry,
2017; Perry & Whitehead, 2018; Volk, Thomas, Sosin, Jacob, & Moen,
2016), we also examined how scrupulosity may interact with anxiety,
depression, and stress. Specifically, we hypothesized that an exacerbation
effect would occur at high levels of scrupulosity, with the interactions being
significantly predictive of all dimensions of problematic pornography view-
ing. We further hypothesized that gender would additionally moderate the
interaction effect of scrupulosity, such that the interaction paths would be
significantly stronger for men.
After review board approval, participants were gathered online via a subject
pool located at a university in the southeastern United States, with add-
itional snowball sampling through professional research social media for-
mats (such as the Psychology on the Net web service), and postings on
craigslist and Reddit. Data were gathered from January 2017 to January
2018. The study was advertised as a social survey exploring mental health
and sexuality. Participants gathered through the subject pool were offered
extra-credit, and those participating through the snowball procedure could
optionally enter a raffle for one $100 Visa-gift card. We only included par-
ticipants who completed at least 80% of all measures and passed a random
response check in the survey. Since gender as a binary variable was critical,
16 non-cisgender participants were removed from analyses, yielding a final
sample of 757 (507 women and 250 men). Demographics are available in
Table 1.
Problematic pornography viewing
We used the Problematic Pornography Use Scale (PPUS; Kor et al., 2014)
as our measure of problematic pornography viewing. The PPUS is a 12-
item measure with four, three-item factors. The factors are: distress and
functional problems (FP, I risked or put in jeopardy a significant relation-
ship, place of employment, educational or career opportunity because of
the use of pornographic materials), excessive use (EU, I spend too much
time being involved in thoughts about pornography), control difficulties
(CD, I feel I cannot stop watching pornography), and use for escape/
avoidance negative emotions (ANE, I watch pornographic materials when
am feeling despondent). Items are scored on a Likert scale (1-never true to
6-almost always true). The four-factor model has been validated across gen-
ders via confirmatory factor analyses, though some research has indicated
questionable reliability for the functional problems scale in women
(Borgogna, Lathan, & Mitchell, 2018). The measure has further been shown
to have appropriate convergent and construct validity (Kor et al., 2014).
Internal consistencies were adequate on all four subscales: FP a¼.70, EU
a¼.89, CD a¼.88, and ANE a¼.90. Pornography was defined as view-
ing materials that depict sexual activity, organs, and/or experiences for the
purpose of sexual arousal (Kalman, 2008).
We used the 12-item Fear of Sinsubscale of the Penn Inventory of
Scrupulosity (PIOS; Abramowitz et al., 2002) as our measure of scrupulos-
ity (I feel guilty about immoral thoughts I have had). Items are scored on
a Likert-Scale (1-never to 4-constantly). The PIOS has demonstrated good
internal consistency and adequate convergent and discriminant validity
(Abramowitz et al., 2002; Olatunji, Abramowitz, Williams, Connolly, &
Table 1. Demographic Information.
Men (n¼250) Women (n¼507)
White or Caucasian 72.40% 65.30%
Black/African American 12.40% 18.30%
Hispanic/Latino(a) 5.20% 5.10%
Asian American/Middle Eastern 6.80% 7.10%
Native American/Pacific Islander 0.40% 1.00%
Other/Multiracial 2.80% 3.20%
Sexual Orientation
Heterosexual 86.00% 83.20%
Homosexual 5.20% 3.20%
Bisexual 5.60% 9.70%
Questioning 1.60% 2.40%
Other Sexual Minority 1.60% 1.60%
Relationship Status
Single 46.80% 37.10%
Casually Dating 8.40% 13.00%
Seriously Dating 30.40% 36.10%
Engaged/Married 11.60% 9.30%
Separated/Divorced 2.00% 2.60%
Widow 0.40% 1.20%
Other 0.40% 0.80%
Highest Level of Education
High School 70.40% 73.60%
Associates/Technical 12.00% 11.80%
Bachelors 12.00% 9.50%
Masters 4.00% 3.90%
Doctorate/Professional 1.60% 1.20%
Christian 62.00% 72.80%
Agnostic/Atheist 24.00% 15.00%
Hindu 0.80% 0.00%
Muslim 4.80% 1.00%
Jewish 1.20% 1.80%
Buddhist 1.20% 2.40%
Other 6.00% 6.90%
Missing/Did Not Respond 0.00% 0.20%
Mean (SD) Mean (SD)
Age 24.2 (9.9) 24.1 (10.7)
Age of First Pornography Viewing 13.2 (2.4) 15.2 (4.3)
Lohr, 2007). The Fear of Sin subscale alone has been shown to be an effi-
cient way of measuring scrupulosity (Borgogna & McDermott, 2018;
Olatunji, 2008). Internal consistency for the current sample was excellent: a
General mental health
We used the Depression, Anxiety and Stress Scale (DASS; Lovibond &
Lovibond, 1995) as our measure of general mental health. The DASS is a
21-item measure with three, seven-item factors: Depression (DASS-D,
Over the past week, I couldnt seem to experience any positive feeling at
all), anxiety (DASS-A, Over the past week, I felt I was close to panic),
and stress (DASS-S, Over the past week, I found it hard to wind down).
Items are presented using a Likert scale (1-did not apply to me at all to 4-
applied to me very much, or most of the time). The DASS has been vali-
dated across genders, races, and cultures, and has demonstrated adequate
construct, convergent, and discriminate validity (Crawford & Henry, 2003;
Norton, 2007). Internal consistencies were excellent on all three subscales:
DASS-D a¼.90, DASS-A a¼.81, and DASS-S a¼.84.
We used the 8-item Neuroticism scale from the Big Five Inventory (BFI-N;
John, Donahue, & Kentle, 1991) as our measure of neuroticism (I see
myself as someone who worries a lot). Items are presented using a Likert
scale (1-disagree strongly to 5-agree strongly). The BFI has been validated
across genders, races, and cultures via exploratory and confirmatory factor
analyses and has demonstrated adequate convergent and discriminant val-
idity (John, Naumann, & Soto, 2008). Internal consistency was good: a
Primary analysis plan
We used multi-group structural equation modeling (SEM) to examine the
hypothesized relationships between depression, anxiety, stress, and scrupu-
losity on problematic pornography viewing dimensions (i.e., functional
problems, excessive use, control difficulties, and avoidance of negative emo-
tions), while controlling for neuroticism (as it has been shown to be a stat-
istical predictor of general mental health problems (Lahey, 2009) and
problematic pornography viewing tendencies (Egan & Parmar, 2013)).
Figure 1 depicts the basic conceptual model that was examined across gen-
ders. Following best practices for SEM (Kline, 2016), we first tested a meas-
urement model to ensure that all latent variables were adequately
represented by their manifest indicators. We then examined a structural
model with paths included to test the hypothesized relationships. For evalu-
ating model-fit, we used the following indices and cutoffs (Hu & Bentler,
1999; Kline, 2016): comparative fit index (CFI) and the Tucker-Lewis index
(TLI; values above .90 indicate acceptable fit for both the CFI and TLI), the
root-mean-square error of approximation (RMSEA) with 90% confidence
intervals (CIs; low values of .06 or less and high values less than .10 indi-
cate a good fit), and the standardized root-mean-square residual (SRMR;
values of .08 or less indicate a good fit). The chi-square test statistic was
also reported (a non-significant value indicates a good fit to the data); how-
ever, it was interpreted with caution, given its sensitivity to sample size.
Figure 1. Conceptual Model.
Note: Error and disturbance terms are not shown for readability.
Because the present study also examined the potential moderating effect
of gender, we tested measurement and structural invariance between groups
(Kline, 2016). Three forms of invariance were examined: configural invari-
ance (determining whether the same basic pattern of factor loadings was
evidenced across genders), metric invariance (testing the equivalence of fac-
tor loadings for each latent variable between genders), and direct-effects
invariance (determining whether the direct effects between depression, anx-
iety, stress, neuroticism, and scrupulosity on the problematic pornography
viewing factors were equivalent between genders). Configural and metric
invariance are necessary to ensure that any moderation effects are not due
to underlying differences in the measurement of the constructs between
groups. Direct-effects invariance is the final step of the analysis, and if sig-
nificant differences in the strength of the direct relationships are found,
then moderation is evident (Kline, 2016).
To evaluate measurement invariance in each model, we used a scaled
chi-square difference test in which a more parsimonious model was tested
against a less parsimonious model. A non-significant chi-square difference
provides support for invariance (Kline, 2016). However, the chi-square dif-
ference test is sensitive to sample size; thus, even small changes in the chi-
square can be statistically significant (Kline, 2016). Therefore, we also used
two alternative approaches to measurement invariance testing: examining
the change in CFI (Cheung & Rensvold, 2002) and calculating the bias-cor-
rected bootstrapped confidence intervals (CIs) of the difference between
groups on parameters of interest (Cheung & Lau, 2012). A change of CFI
less than or equal to .01 (Cheung & Rensvold, 2002) and a CI containing
zero for the between-groups difference on a particular unstandardized par-
ameter suggest invariance (Cheung & Lau, 2012).
Because we also examined the potential interaction effect of scrupulosity
with anxiety, depression, and stress, we constructed several latent variable
interaction models. Our interactions were created using the latent moder-
ated structural equations method suggested by Klein and Moosbrugger
(2000). In these models, mental health variables were examined in predic-
tion of dimensions of problematic pornography viewing at high (1 SD
above the mean) and low (1 SD below the mean) levels of scrupulosity.
Preliminary analyses
Of the 757 participants, few had missing responses (no more than four on
any item). A small number of participants were identified as univariate out-
liers (<2.8% on the PPUS scales). Some (<4.1%) multivariate outliers
were also identified by examining the Mahalanobis distances in the total
sample. Most of the predictor variables were distributed normally, with
exception to depression (positively skewed). Additionally, each of the PPUS
subscales showed a positive skew. Thus, we used a maximum likelihood
estimator with robust standard errors in our primary analyses to fit the
model, while taking into account potential normality violations. Table 2
displays the bivariate correlations, means, and standard deviations across
men and women.
Primary analysis
After our preliminary analyses, we tested the specified SEM measurement
and structural models. These analyses were conducted in Mplus version 8
en & Muth
en, 2017). Item parcels were generated for the DASS-D,
DASS-A, DASS-S, PIOS, and BFI-N scales. Our parceling procedure
involved conducting an exploratory factor analysis for items in each scale
fitted to a one-factor solution. Items were then assigned to three parcels in
an iterative fashion to ensure that all loadings were balanced (Russell,
Kahn, Spoth, & Altmaier, 1998). Since each of the PPUS subscales consists
of three items, we used the individual items to form the PPUS subscale
latent variables. All analyses (except bootstraps) used a maximum likeli-
hood estimator with robust standard errors.
Measurement model
The measurement model provided a good fit for men, (n¼250) v
(288) ¼
441.89, p<.001, CFI ¼.96, TLI ¼.95, RMSEA ¼.046 (90% CI ¼.037,
.055), and SRMR ¼.046; and an acceptable fit for women, (n¼507) v
(288) ¼655.49, p<.001, CFI ¼.94, TLI ¼.93, RMSEA ¼.05 (90% CI ¼
Table 2. Correlations, Means, and Standard Deviations.
Men Women
Variable 1 2 3 4 5 6 7 8 9 MSDMSD
1. PPUS-FP - .51 .48 .43 .24 .25 .25 .39 .23 1.71 .99 1.27 .59
2. PPUS-EU .52 - .72 .59 .16-.11.24 .31.21 2.01 1.16 1.41 .88
3. PPUS-CD .49 .66 - .58 .13 .15.25 .36 .161.28 1.36 1.27 .74
4. PPUS-ANE .39 .69 .63 - .37 .23 .32 .36 .25 2.37 1.43 1.59 1.16
5. DASS-D .19 .17 .15 .31 - .62 .70 .26 -.15 1.81 .76 1.74 .74
6. DASS-A .14 .21 .19 .24 .64 - -.23 .29 .58 1.63 .59 1.74 .62
7. DASS-S .15 .20 .13 .28 .73 .72 - .40 .59 1.88 .64 2.02 .65
8. PIOS .20 .28 .25 .26 .29 .31 .35 - .29 2.07 .85 1.98 1.00
9. BFI-N .04 .11.08 .22 .55 .51 .62 .29 - 2.82 .88 3.25 .85
Note: Men above the midline, women below. PPUS-FP ¼Problematic Pornography Use Scale - Functional
Problems, PPUS-EU ¼Excessive Use, PPUS-CD ¼Control Difficulties, PPUS-ANE ¼Avoidance of Negative
Emotions, Depression, Anxiety, and Stress Scale - D ¼Depression, DASS-A ¼Anxiety, DASS-S ¼Stress,
PIOS ¼Penn Inventory of Scrupulosity, BFI-N ¼Big Five Inventory - Neuroticism.
.045, .055), and SRMR ¼.043. A configural invariance model, in which all
paths were freely estimated between men and women, provided an accept-
able fit overall, v
(576) ¼1117.88, p<.001, CFI ¼.95, TLI ¼.94,
RMSEA ¼.05 (90% CI ¼.045, .054), and SRMR ¼.044. Thus, the meas-
urement model appeared to be capturing the same general pattern of factor
loadings between men and women.
We then tested a metric invariance measurement model by constraining
the factor loadings to be equal across genders. The constrained model pro-
vided acceptable fit, v
(594) ¼1166.50, p<.001, CFI ¼.94, TLI ¼.93,
RMSEA ¼.05 (90% CI ¼.046, .055), and SRMR ¼.051. The scaled chi-
square difference test indicated that the metric invariance model was sig-
nificantly worse than the configural model, v
(18) ¼44.73, p<.001; how-
ever, the change in CFI was within appropriate limits (DCFI ¼-.003).
Furthermore, bias-corrected bootstrap confidence intervals of the differen-
ces between factor loadings (Cheung & Lau, 2012) were all non-significant,
with exception to the items on the excessive use scale. Supplementary
Table 1 displays the factor loadings in the measurement model.
Structural model
We then examined a structural model with paths specified between men and
women. The configural invariance structural model provided acceptable fit,
(612) ¼1210.52, p<.001, CFI ¼.94, TLI ¼.93, RMSEA ¼.051 (90%
CI ¼.047, .055), and SRMR ¼.053. Bias-corrected bootstrap samples
(n¼1000) were then used to estimate the confidence intervals of each path
from depression, anxiety, stress, and scrupulosity to the problematic pornog-
raphy viewing variables. Table 3 displays the unstandardized and standar-
dized coefficients for each path and the 95% confidence intervals. Results
indicated several significant paths for both men and women. Specifically,
scrupulosity significantly predicted functional problems, excessive use, con-
trol difficulties, and avoidance of negative emotions, while depression signifi-
cantly predicted avoidance of negative emotions in the sample of men. For
women, nearly the same relationships were found across scales, with scrupu-
losity predicting functional problems, excessive use, control difficulties, and
avoidance of negative emotions, and depression significantly predicting func-
tional problems and avoidance of negative emotions. All other relationships
between mental health constructs and problematic pornography viewing
dimensions were non-significant (see Table 3 for specific coefficients).
Moderation analyses
To examine the potential moderation effect of gender in the structural
model, we constrained the direct effects between each latent variable to be
difference test indicated that the direct effect invariance model was a sig-
nificantly worse fit compared to a model in which direct effects were
freely estimated, v
(18) ¼41,46, p<.001, though the CFI did not
change. The bootstrap procedure only suggested significant differences on
the relationship between scrupulosity and functional problems, with the
relationship being significantly stronger for men than women. For men,
the structural model accounted for 27% of the variance for functional
control difficulties, and 25% of the variance for avoidance of negative
emotions. For women, the structural model accounted for 13% of the
variance for functional problems, 12% of the variance for excessive use,
12% of the variance for control difficulties, and 15% of the variance for
avoidance of negative emotions.
Table 3. Standardized and Unstandardized Structural Model Results.
Variables !
Effect BSE
Direct Effect b95% CI
Men Scrupulosity !FP .53 .14 .46 (.244, .792)
Women Scrupulosity !FP .13 .05 .21(.042, .251)
Men Scrupulosity !EU .42 .14 .30 (.133, .549)
Women Scrupulosity !EU .28 .07 .26 (.147, .447)
Men Scrupulosity !CD .48 .14 .32 (.198, .744)
Women Scrupulosity !CD .22 .06 .26 (.100, .341)
Men Scrupulosity !ANE .50 .15 .31 (.226, .811)
Women Scrupulosity !ANE .25 .09 .19 (.092, .432)
Men Depression !FP .16 .15 .12 (-.082, .478)
Women Depression !FP .16.08 .23(.022, .386)
Men Depression !EU -.11 .21 -.07 (-.435, .225)
Women Depression !EU .04 .16 .03 (-.305, .383)
Men Depression !CD -.22 .21 -.12 (-.645, .239)
Women Depression !CD .18 .14 .18 (-.074, .488)
Men Depression !ANE .69 .24 .36 (.188, 1.159)
Women Depression !ANE .52 .20 .33(.147, .927)
Men Anxiety !FP .15 .42 .07 (-.466, .961)
Women Anxiety !FP -.03 .18 -.03 (-.501, .301)
Men Anxiety !EU -.02 .45 -.01 (-.601, .690)
Women Anxiety !EU .20 .34 .11 (-.557, .958)
Men Anxiety !CD -.28 .45 -.10 (-1.136, .615)
Women Anxiety !CD .46 .34 .34 (-.183, 1.128)
Men Anxiety !ANE -.67 .54 -.23 (-1.719, .187)
Women Anxiety !ANE .15 .43 .07 (-.679, .999)
Men Stress !FP -.15 .32 -.09 (-.848, .307)
Women Stress !FP .15 .23 .18 (-.303, .731)
Men Stress !EU .28 .31 .15 (-.317, .678)
Women Stress !EU .12 .44 .08 (-.725, 1.153)
Men Stress !CD .66 .37 .33 (-.032, 1.454)
Women Stress !CD -.40 .41 -.36 (-1.323, .287)
Men Stress !ANE .38 .41 .17 (-.386, 1.219)
Women Stress !ANE -.22 .54 -.12 (-1.300, .788)
FP ¼Functional Problems, EU ¼Excessive Use, CD ¼Control Difficulties, ANE ¼Avoidance of Negative Emotions.
Contact first author for non-significant neuroticism path coefficients.
Interaction analyses
We then examined interactions between scrupulosity and depression, anx-
iety, and stress for each dimension of problematic pornography viewing
(see Table 4 for all significant interactions, with a value approaching sig-
nificance at p<0.05 (p¼0.051) also included). We chose to examine gen-
der samples separately since Mplus is currently unable to consider
categorical grouping variables within latent variable interaction models. For
men, a significant interaction occurred between depression and scrupulosity
on excessive use, control difficulties, and avoidance of negative emotions.
Figure 2 demonstrates these relationships. For men, anxiety also interacted
with scrupulosity to statistically predict control difficulties (see Figure 2).
Interactions also occurred between stress and problematic pornography
viewing across excessive use, control difficulties, and avoidance of negative
emotions (see Table 4 and Figure 3). In each case, low levels of scrupulosity
buffered the relationship between mental health problems and problematic
pornography use; however, the buffering effect is non-significant for those
high in scrupulosity, and becomes somewhat exacerbating for those strug-
gling with depression who are also high in scrupulosity (see Figure 2).
Unlike men, no interactions occurred between depression or stress with
scrupulosity across any of the dimensions of problematic pornography use
in the sample of women. However, anxiety and scrupulosity interacted with
an exacerbation effect on excessive use in women (see Figure 3). For men,
the depression X scrupulosity interaction model increased variance
accounted for to 31% for functional problems, 22% for excessive use, 22%
of the variance for control difficulties, and 32% of the variance for avoid-
ance of negative emotions. The anxiety X scrupulosity interaction model
increased variance accounted for to 31% for functional problems, 20% for
excessive use, 22% for control difficulties, and 31% for avoidance of nega-
tive emotions. The stress X scrupulosity interaction model increased
Table 4. Latent Variable Interactions Reaching or Approaching Significance at p <0.05.
Gender Interaction !
Effect BSE
Direct Effect bpValue
Men SCRUPXDEP !EU -.27 .11 -.17p¼.018
Men SCRUPXDEP !CD -.32 .16 -.14p¼.040
Men SCRUPXDEP !ANE -.44 .19 -.19p¼.021
Men SCRUPXANX !CD -.41 .21 -.13 p¼.051
Men SCRUPXSTRESS !EU -.33 .11 -.12 p¼.003
Men SCRUPXSTRESS !CD -.35 .17 -.18p¼.035
Men SCRUPXSTRESS !ANE -.48 .19 -.18 p¼.010
Women SCRUPXANX !EU .36 .18 .16p¼.041
Note: FP ¼Functional Problems, EU ¼Excessive Use, CD ¼Control Difficulties, ANE ¼Avoidance of Negative
Emotions, SCRUPXDEP ¼Scrupulosity X Depression Interaction, SCRUPXANX ¼Scrupulosity X Anxiety
Interaction, SCRUPXSTRESS ¼Scrupulosity X Stress Interaction. Contact first author for other non-significant
interaction coefficients.
variance accounted for to 33% for functional problems, 23% for excessive
use, 21% for control difficulties, and 34% for avoidance of negative emo-
tions. For women, the depression X scrupulosity and anxiety X scrupulosity
interaction models did not account for any additional variance. The stress
X scrupulosity interaction model increased variance accounted for to 14%
Figure 2. Unstandardized simple slope coefficients are given for high (1 SD above) and low (1
SD below) levels of scrupulosity.
Figure 3. Unstandardized simple slope coefficients are given for high (1 SD above) and low (1
SD below) levels of scrupulosity.
for functional problems but did not account for additional variance across
the other problematic pornography viewing dimensions.
This study advanced prior work by examining how scrupulosity and gender
moderate the relationships across a range of mental health concerns
(depression, anxiety, and stress) and multiple dimensions of problematic
pornography viewing (functional problems, excessive use, control difficul-
ties, and avoidance of negative emotions). Broadly, results were consistent
with our hypotheses, with a few notable exceptions. Consistent fully with
our first hypothesis, scrupulosity emerged as a strong significant positive
statistical predictor across all measures of problematic pornography viewing
in both men and women. These results are consistent with Borgogna and
McDermott (2018), and further suggest scrupulosity as a construct within
the broader domain of religiosity, that may be relevant to the construct,
impact and potential treatment of problematic pornography use.
Partially consistent with our second hypothesis, depression was a strong
significant positive statistical predictor of pornography use to avoid nega-
tive emotions across men and women. This is logical, as those using porn-
ography in a dysfunctional manner to escape unpleasant emotions must
first be experiencing unpleasant emotions. Furthermore, depression was a
significant moderate positive statistical predictor of functional problems
only in the sample of women. This could be indicative of the relationship
problems some women experience as the result of pornography use with a
partner. Recent findings have indicated that women who hold traditionally
masculine conceptualizations of what men should be may be more likely to
experience functional problems associated with their pornography use
(Borgogna, McDermott, Browning, Beach, & Aita, 2018). However, these
results could also be related to findings that indicate viewing pornography
in relationships is associated with more positive outcomes for men than for
women (Poulsen et al., 2013). This would be especially relevant for scrupu-
lous women who may be opposed to pornography use but view it at their
partners behest. Future qualitative studies examining the context in which
functional problems develop for both men and women and how they are
associated with depression and scrupulosity would be beneficial for under-
standing these findings further. Interestingly, stress, anxiety, and neuroti-
cism were not significant statistical predictors of any dimensions of
problematic pornography viewing across men or women within the full
model, despite being significantly related to many of the variables at the
bivariate level.
Inconsistent with our third hypothesis, the gender moderation analyses
(via direct effects invariance) were broadly non-significant with one excep-
tion: the relationship between scrupulosity and functional problems was
moderated by gender, with men reporting a significantly stronger relation-
ship. This is consistent with literature indicating that men may be more at-
risk than women for having pornography effect their relationships in a
negative way (e.g., Willoughby, Carroll, Busby, & Brown, 2016; Wright,
Bridges, et al., 2018; Zitzman & Butler, 2009), have pornography jeopardize
their employment (Kor et al., 2014; Maltz & Maltz, 2009), or jeopardize
their respect (such as work examining the role of pornography use among
clergy; Ahmad et al., 2015; Ferree, 2002). More importantly, these findings
suggest a stronger need to examine gender-related differences across mental
health issues and problematic pornography viewing in future studies, espe-
cially as many of the studies suggesting a relationship between mental
health issues and pornography viewing have used male-exclusive samples
(see Egan & Parmar, 2013; Kraus et al., 2015; Levin et al., 2012; Nelson
et al., 2010; Twohig et al., 2009 for examples).
The interaction analyses were partially consistent with our fourth
hypothesis. For men, high scrupulosity was related to more problematic
pornography viewing compared to low scrupulosity across depression, anx-
iety, and stress. However, only in a few cases was there an exacerbation
effect in the sample of men. Rather, low scrupulosity acted as a buffer
across most of the interactions in the sample. Additionally, for most of the
significant interactions, high levels of mental health concerns lowered prob-
lematic pornography viewing in highly scrupulous men (see Figures 2 and
3), while increasing problematic pornography viewing for those low in
The interaction analyses were largely non-significant across the sample of
women. However, consistent with our fourth hypothesis, a single inter-
action occurred with anxiety and scrupulosity exacerbating problems
related to perceptions of excessive pornography use. Interestingly, anxiety
was non-significant in the direct effects model for women, suggesting scru-
pulosity as a key contributor to the excessive use problems. This is the first
study to identify such a nuanced finding and suggests that women who are
highly anxious and scrupulous may perceive their pornography use as
excessive. Despite neuroticism being controlled, this may indicate add-
itional personality dimensions worth examining in future studies. For
instance, scrupulosity has been shown to partially mediate the relationship
between perfectionism and mental health concerns (Allen & Wang, 2014).
Thus, researchers may want to consider perfectionism as a variable in
future examinations, given that excessive use problems may be based on
subjective perceptions that behaviors are excessive or interfering (see
discussions on perceived addiction; e.g., Brand et al., 2018 and Grubbs,
Stauner, et al., 2015).
While this study contributes novel findings, it is not without limitations.
Namely, the cross-sectional nature of the data precludes causal inferences.
Furthermore, we only explored general mental health problems. Past
research has implicated severe mental health issues, such as bipolar dis-
order, as being associated with problematic internet use (W
olfling, Beutel,
Dreier, & M
uller, 2015). Thus, a potential area of further research would
be examining how problematic pornography use relates too other (and pos-
sibly more severe) psychopathologies. The self-report nature of this study
places the data at risk of participant biases. The study also used a relatively
liberal threshold for setting statistical significance, as multiple comparisons
were not controlled. The generalizability of these results is also limited to a
primarily white population from the United States. While the majority of
the extant research has been conducted on American and European sam-
ples, recent data have indicated that black Americans may view more porn-
ography than white Americans, with religiosity only moderating the
relationship for white Americans (Perry & Schleifer, 2019). Thus, further
research across different ethnic and cultural groups appears to be an
important area of study.
The interaction between scrupulosity and anxiety on control difficulties
in men should also be examined carefully in future studies. The standard
error of .21 is slightly larger than half the unstandardized coefficient of
-.41. Indeed, the p-value of .051 is technically outside of the domain for
assigning statistical significance by traditional methods. Thus, we emphasize
a need for replication of this interaction, as well as our findings
more broadly.
Additionally, future studies should consider examining these variables
with alternative measures of problematic pornography use. Specifically, the
problematic pornography consumption scale (PPCS; B}
othe et al., 2018) has
recently been published which contains additional measurements for toler-
ance and withdrawal factors. This scale was not available when the current
study began data collection, but has strong theoretical and psychometric
support. Additional nuanced measures such as compulsive pornography
consumption scale (CPC; Noor, Rosser, & Erickson, 2014) and the cyber
pornography use inventory (CPUI; Grubbs, Sessoms, Wheeler, & Volk,
2010) may also provide nuanced information about relationship between
problematic pornography use, scrupulosity, and mental health problems,
and should thus be considered in future studies.
The results provide considerable implications for researchers and clinicians.
For researchers, these findings highlight the importance of considering
multiple potentially related constructs when examining variables related to
problematic pornography use. For instance, several researchers report sig-
nificant bivariate relationships between problematic pornography viewing
and anxiety (e.g., Kor et al., 2014). However, in the current study, this rela-
tionship disappears when accounting for the role of depression, stress,
neuroticism, and scrupulosity in a structural model. Interestingly, anxiety
then reemerges as a significant statistical predictor but only in interaction
with scrupulosity for control difficulties in men and excessive use problems
in women. Similarly, unlike Egan and Parmar (2013), neuroticism was not
related to any dimensions of problematic pornography use in our analyses
for men or women when controlling for the additional roles of mental
health and scrupulosity, despite being significantly related at the bivariate
level. Thus, continued nuanced approaches utilizing sophisticated analyses
while controlling for multiple co-varying factors across studies of problem-
atic pornography use are recommended.
For clinicians, these findings contribute to a growing literature (e.g.,
Bradley et al., 2016; Grubbs, Stauner, et al., 2015; Grubbs et al., 2018;
Perry, 2017; Wilt et al., 2016) implicating religiosity, and particularly scru-
pulosity (Borgogna & McDermott, 2018; Grubbs et al., 2018; Short et al.,
2015), as a variable relevant to the problematic pornography use. Multiple
nationwide analyses have indicated that internet searches for pornographic
material are highest in regions of the United States that are more religious
and traditionally conservative (Edelman, 2009; Macinnis & Hodson, 2015;
Whitehead & Perry, 2018). Thus, exploring religious factors in the context
of treatment of problematic pornography use should be considered an inte-
gral part of assessment and conceptualization (Kraus and Sweeney, 2018).
Clinicians may consider investigating dysfunctional methods clients may
have used to control their pornography viewing. For instance, Borgogna
and McDermott (2018) suggest avoidant-based mechanisms, such as
thought suppression techniques (as examined in scrupulous populations),
may serve to increase pornography-related thoughts. Therefore, approaches
that emphasize mindful awareness techniques paired with values-based
behavioral goals may provide more meaningful results (Crosby &
Twohig, 2016; Twohig & Crosby, 2010).
Clinicians should also assess what particularly about the clients pornog-
raphy use is problematic. Measures such as the PPUS (Kor et al., 2014),
othe, T
aly, Zsila, et al., 2018), CPUI (Grubbs et al., 2010);
and CPC (Noor et al., 2014) can be helpful in this process. Importantly,
many individuals in treatment may refer to their pornography use as
addictive;however, clinicians should not assume and/or treat the use as a
traditional addiction without proper assessment. Indeed, there is a consid-
erable debate as to whether problematic pornography viewing should be
conceptualized as an addiction (B}
othe, T
aly, Potenza, et al., 2018;
Kowalewska et al., 2018; Ley, Prause, & Finn, 2014; Stark, Klucken,
Potenza, Brand, & Strahler, 2018; Potenza et al., 2017; Prause et al., 2017).
Moreover, formal categorization of compulsive/addictive pornography use
is not included in the Diagnostic and Statistical Manual of Mental
Disorders (American Psychiatric Association, 2013).
Grubbs and colleagues (2015; 2018) have reported that religious individ-
uals may perceive their viewing as addictive, and may describe their prob-
lems using such terminology, even if their behavior may not follow an
addictive pattern (i.e., with features such as withdrawal and tolerance).
Thus, some individuals in treatment may not be viewing pornography very
frequently, yet may find it highly distressing when it occurs. Moreover,
exploring values and perceptions on a case-by-case basis may be beneficial
in establishing achievable goals for therapeutic work. Clinical trials investi-
gating the treatment of problematic pornography viewing (Crosby &
Twohig, 2016; Twohig & Crosby, 2010) are consistent with these recom-
mendations, and may be used as additional sources for recommendations
and guides for therapists.
In conclusion, problematic pornography viewing is likely going to continue
being a clinical concern (Brand et al., 2018; Cooper, Delmonico, & Burg,
2000; Grubbs & Perry, 2018; Sniewski et al., 2018). Our findings extend
prior research implicating scrupulosity as a primary factor relevant to prob-
lematic pornography use (Borgogna & McDermott, 2018). We extended
prior work by examining the potential contributions of scrupulosity, anx-
iety, depression, and stress, while also controlling for neuroticism, as pre-
dictors of functional problems related to pornography viewing, perceived
excessive pornography use and control difficulties, as well as the use of
pornography to avoid uncomfortable emotions. Scrupulosity was the stron-
gest factor in relation to all dimensions of problematic pornography use
across genders. Multiple interactions were noted in the sample of men with
a single interaction in the sample of women between scrupulosity and men-
tal health constructs (see figures 2 and 3). Low scrupulosity broadly buf-
fered the relationship between mental health issues and problematic
pornography viewing in men, though high scrupulosity exacerbated exces-
sive use problems in anxious women. Our models broadly accounted for a
moderate portion of the variance across all problematic pornography
viewing dimensions for both men and women. We recommend examining
scrupulosity as a potentially relevant factor in clinical interventions
designed to reduce problems associated with pornography use. Given the
novelty of our findings, as well as the high degree of nuance, we addition-
ally recommend continued research across these variables, with an
emphasis on replication.
The authors declare that they have no conflicts of interest. The data used
for this study has not been presented elsewhere.
Author Note
Nicholas C. Borgogna and Jessica Duncan: Department of Psychology, University of South
Alabama; Ryon C. McDermott: Counseling and Instructional Sciences, University of South
Alabama. We thank two additional members of the Culture and Individual Differences
(CID) research team within the undergraduate Psychology program at the University of
South Alabama for their help collecting data: Katelyn Baker and Davidson Meador.
Correspondence may be directed to Nicholas C. Borgogna, Department of Psychology, 75 S.
University Blvd., Mobile, AL 36608,
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... However, while the literature shows that problematic sexual behaviors are often comorbid to other psychopathological disorders (Ballester-Arnal et al., 2020;Wéry et al., (2016a2016b), to our knowledge, their influence on the development of PPU has been under-explored. In this sense, among these disorders, few existing cross-sectional studies have focused on the influence of anxiodepressive disorder (Borgogna et al., 2018;Shirk et al., 2021;Whitfield et al, 2018), attention deficit hyperactivity disorder (ADHD) (Bőthe et al., 2019(Bőthe et al., , 2020Hernández-Mora and Varescon, 2022;Kraus et al., 2015;Niazof et al., 2019) and obsessive-compulsive disorder (OCD) (Kraus et al., 2015;Hernández-Mora and Varescon, 2022). ...
... These studies have explored psychological aspects, personality dimensions and sexual factors related to PPU, but only one of them has considered psychiatric features such as ADHD and depressive symptomatology (Bőthe et al., 2020). This study showed, unexpectedly because contrary to previous results (Borgogna et al., 2018;Niazof et al., 2019), that these symptomatologies did not differentiate problematic and non-problematic profiles. Therefore, it is necessary to further explore the psychopathological characteristics of different profiles of pornography users. ...
... However, studies show that many variables can mediate the shift from pornography use to PPU, such as psychopathological ones. In this sense, it is interesting to note that the three profiles varied significantly in their depression and ADHD scores (Table 2), which contradicts the findings of Bőthe et al. (2020), but in contrast is consistent with other studies (Borgogna et al., 2018;Niazof et al., 2019). ...
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Studies using person-centered approaches to further explore the profiles of pornography users throw their psychiatric features are lacking. This study was designed to examine the different profiles of pornography users based on the addictive dimensions of Problematic Pornography Use (PPU) and to characterize these profiles according to psychopathological variables such as depression, anxiety, attention deficit hyperactivity disorder (ADHD) and obsessive–compulsive disorder (OCD). A sample of 1001 French adults participated to a survey containing scales related to psychopathological variables, cybersexual addiction and PPU. PPU was assessed with the French Version of Problematic Pornography Consumption Scale (Fr-PPCS-18). An Agglomerative Hierarchical Classification was performed on the basis of FR-PPCS-18. A student's t-test was used to observe PPU and psychopathological differences between profiles. Findings revealed three profiles of users: non-problematic users (66.5%), at-risk users (29.9%), and problematic users (3.6%). There were significant differences between the three profiles concerning levels of global PPU, PPU mechanisms, cybersexual addiction symptoms, ADHD symptomatology and depressive symptomatology. Results confirmed the existence of different levels of severity of pornography use corresponding to three different profiles. Also, findings revealed the influence of ADHD symptoms, obsessive–compulsive symptoms and depressive symptoms on PPU.
... Over 80% of individuals with CSBD have reported PPU (Reid et al., 2012), suggesting that PPU is a common aspect of the disorder (Kraus et al., 2015;Reid et al., 2012;Short et al., 2016). PPU has consistently been shown to be a significant correlate of psychological distress (e.g., depression, anxiety, and stress) in cross-sectional (e.g., Borgogna et al., 2018;Grubbs, Kraus, et al., 2019;Guidry et al., 2020;Hermand et al., 2020;Perry, 2018) and longitudinal studies (e.g., Grubbs, Stauner, et al., 2015;Maddock et al., 2019). ...
... However, when PPU was included, the association between pornography use frequency and mental health problems became non-significant; that is, PPU completely mediated their association. According to these findings, PPU may be a more reliable predictor of mental health than pornography use frequency, which is consistent with previous research (e.g., Borgogna et al., 2018). This also echoes the result of a meta-analysis on the association between online media consumption (internet, smartphone, social media, and gaming) and depression, which indicated that the severity of online media use (i.e., the subjective experience of problematic use) was more closely linked to psychological symptoms than the quantity of online media use (Shin et al., 2022). ...
... In path a of the mediation process (the relationship between pornography use frequency and PPU), our results confirm that pornography use frequency could be a robust predictor for PPU (β = 0.41 in the mediation model and β = 0.47 in the moderated mediation model), which is consistent with a recent meta-analysis (Chen, Jiang, Wang, et al., 2022). Our finding in path b of the mediation process (the relationship between PPU and mental health problems) is also consistent with the definition and empirical studies of PPU, which claim that watching pornography in a problematic pattern causes psychological distress (e.g., Borgogna et al., 2018;Grubbs, Stauner, et al., 2015;Sniewski & Farvid, 2020). ...
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Pornography has become increasingly prevalent worldwide with the development of the Internet, and considerable research on the effects of pornography use has emerged. Based on existing research and the Pornography Problems Due to Moral Incongruence (PPMI) model, we examined problematic pornography use (PPU) as a mediator and moral disapproval of pornography use as a moderator in the links between pornography use frequency and mental health problems in a Chinese sample (N = 833). Our results support the completely mediated effect of PPU (ab = 0.16) and the moderated effect of moral disapproval of pornography use on the association between pornography use frequency and PPU. Pornography use frequency was strongly associated with PPU when participants experienced high moral incongruence (MI), and the indirect effect of PPU was weaker (ab = 0.13) at the lower level of moderator (-1 SD), and stronger (ab = 0.23) at the higher level of moderator (+1 SD). However, the direct effect of MI on mental health problems was not supported. This study advances our understanding of the internal mechanism between pornography use and mental health and extends the PPMI model to the Chinese cultural context (characterized as low religiosity and sexually conservative). The findings confirm the cross-cultural consistency of the PPMI model in China and highlight another important source of MI besides religiosity: cultural characteristics.
... The majority of studies have assessed religiosity using religious participation and belief salience as proxy measures (Jennings et al., 2021). However, it has been shown that religiosity is multifaceted and extends beyond religious participation and belief salience (Borgogna, Duncan, & McDermott, 2018;Borgogna, Isacco, & McDermott, 2020;Krauss & Hood, 2013). For instance, a study by Rosmarin and Pirutinsky (2019) found that among a sample of Orthodox Jews, there was a positive association between spiritual struggles and problematic sexual behavior for participants with a religious Jewish upbringing, but not for participants without such an upbringing. ...
... In terms of religious commitment, several studies have found associations between greater religiosity, as measured by salience and participation, and CSB (Grubbs et al., 2015(Grubbs et al., , 2019, suggesting that religious orientations capturing aspects of religious commitment will exhibit stronger associations with CSB. While the present literature does not provide as much insight into the connection between unreflective religious orientations (the lack of questioning of one's faith) and CSB, some research has examined religiosity constructs akin to unreflective religious orientations, such as scrupulosity (Borgogna et al., 2018(Borgogna et al., , 2020. These findings suggest that religious individuals who are heavily committed to their beliefs and exhibit a rigid adherence to those beliefs may be most likely to report greater CSB. ...
Compulsive sexual behavior (CSB) is associated with religiosity and moral disapproval for sexual behaviors, and religiosity and moral disapproval are often used interchangeably in understanding moral incongruence. The present study expands prior research by examining relationships between several religious orientations and CSB and testing how moral disapproval contributes to these relationships via mediation analysis. Results indicated that religious orientations reflecting commitment to beliefs and rigidity in adhering to beliefs predicted greater CSB. Additionally, moral disapproval mediated relationships between several religiosity orientations and CSB. Overall, findings suggest that religiosity and moral disapproval are related constructs that aid in understanding CSB presentations.
... Correlations presented below the diagonal represent the correlations for men, and correlations presented above the diagonal represent the correlations for women * Perry, 2017;Svedin et al., 2022). Self-perceived PPU and depressive and anxiety symptoms were also positively associated with PPU measured by the BPS in the present study, supporting prior findings (Borgogna et al., 2018;Kor et al., 2014;Levin et al., 2012;Potenza, 2018). We consider these findings as supportive of the adapted scale, but recognize further work examining PPU among Bangladesh adults and other non-WEIRD samples are needed for replication. ...
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With the growth of Internet pornography and the impacts of problematic pornography use (PPU), the validation of short and psychometrically sound screening instruments in different cultures is needed to identify individuals with PPU who may benefit from intervention. This study sought to validate the Bangla version of the Brief Pornography Screen (BPS) and examine its psychometric properties in a large adult sample of men and women. Using an online platform in Bangladesh, we recruited 6023 participants (39.9% women, M age = 22.7 years; SD = 5.0) with lifetime pornography use for the study. To examine the psychometric properties of the BPS, confirmatory factor analysis and gender-based measurement invariance testing were conducted. We assessed theoretically relevant correlates (i.e., self-perceived PPU, depressive and anxiety symptoms) as elements of validity for the scale. The findings suggested that the Bangla BPS version demonstrated strong psy-chometric properties in terms of factor structure, reliability (i.e., Cronbach's alpha = .86, composite reliability = .93), and measurement invariance (i.e., men vs. women). The BPS score positively correlated with self-perceived PPU, and anxiety and depressive symptoms, supporting elements of discriminant validity. The Bangla BPS is a reliable and valid self-report scale to assess PPU in the Bangladeshi cultural context.
... Correlations presented below the diagonal represent the correlations for men, and correlations presented above the diagonal represent the correlations for women * Perry, 2017;Svedin et al., 2022). Self-perceived PPU and depressive and anxiety symptoms were also positively associated with PPU measured by the BPS in the present study, supporting prior findings (Borgogna et al., 2018;Kor et al., 2014;Levin et al., 2012;Potenza, 2018). We consider these findings as supportive of the adapted scale, but recognize further work examining PPU among Bangladesh adults and other non-WEIRD samples are needed for replication. ...
Full-text available
With the growth of Internet pornography and the impacts of problematic pornography use (PPU), the validation of short and psychometrically sound screening instruments in different cultures is needed to identify individuals with PPU who may benefit from intervention. This study sought to validate the Bangla version of the Brief Pornography Screen (BPS) and examine its psychometric properties in a large adult sample of men and women. Using an online platform in Bangladesh, we recruited 6023 participants (39.9% women, M age = 22.7 years; SD = 5.0) with lifetime pornography use for the study. To examine the psychometric properties of the BPS, confirmatory factor analysis and gender-based measurement invariance testing were conducted. We assessed theoretically relevant correlates (i.e., self-perceived PPU, depressive and anxiety symptoms) as elements of validity for the scale. The findings suggested that the Bangla BPS version demonstrated strong psy-chometric properties in terms of factor structure, reliability (i.e., Cronbach's alpha = .86, composite reliability = .93), and measurement invariance (i.e., men vs. women). The BPS score positively correlated with self-perceived PPU, and anxiety and depressive symptoms, supporting elements of discriminant validity. The Bangla BPS is a reliable and valid self-report scale to assess PPU in the Bangladeshi cultural context.
... Therefore, risk factors for PPU could be distinct from those for HD or CSBD and merit targeted studies. Furthermore, with regard to PPU specifically, few studies have shown the impact of anxiety and depressive symptomatology on PPU (Bőthe, Tóth-Király, Potenza, Orosz, & Demetrovics, 2020;Kraus, Potenza, Martino, & Grant, 2015;Perry, 2018;Shirk et al., 2021;Whitfield, Rendina, Grov, & Parsons, 2018) mediated by other factors such as scrupulosity or emotional avoidance (Borgogna, Duncan, & McDermott, 2018). Further, the effect of ADHD symptoms on PPU is still under debate, as studies have shown contradictory results. ...
Background and aims: Risk factors for problematic pornography use (PPU) need targeted studies. This study aims to examine sociodemographic and psychopathological factors that may predict PPU. Methods: 1,001 French adults (Mage = 25.56) were assessed via an online survey. Results and discussion: Male gender, attention-deficit/hyperactivity (ADHD) and obsessivecompulsive (OCD) symptoms are significant predictors of PPU. The tendency toward impulsivity of people with ADHD symptoms and the tendency toward compulsivity of people with OCD symptoms could explain their link with PPU. Conclusions: As sexual addiction, PPU lies on the impulsive–compulsive scale and could be classified as a behavioral addiction.
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The pornography problems due to moral incongruence (PPMI) model is a premier framework for understanding problematic pornography use (PPU). However, past studies have generally examined men or entered gender as a covariate in primary analyses. Such approaches mask between-gender differences. Additionally, dysregulation constructs are also thought to be relevant to PPU, yet it is unclear the degree to which they incrementally predict PPU beyond moral incongruence constructs in non-pathological populations. We addressed these gaps by gathering a large sample of college students (n = 295 men, n = 838 women). Analyses with pornography users (n = 251 men, n = 407 women) were consistent with the PPMI model, adjusted for pornography use frequency. Findings did not change when dysregulation constructs of impulsivity and emotional resilience were added to the model. No paths significantly differed between genders. Altogether, among college student pornography users, religiosity was strongly positively correlated with moral disapproval (β = .65 men, β = .62 women), moral disapproval was moderately positively correlated with PPU (β = .41 men, β = .29 women), religiosity was initially moderately positively correlated with PPU (r = .21 men, r = .22 women), but became non-significant in the full model (β = − .21 men, β = − .04 women), and indirect effects of religiosity to PPU through moral disapproval were significant (indirect β = .27 men, β = .18 women). None of the dysregulation constructs significantly predicted PPU. The full model accounted for 23-22% of the PPU variance in men and women, respectively. Implications, future directions, and limitations are discussed.
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Previous work regarding Problematic Pornography Use (PPU) has been limited due to scales with weak statistical constructions, few female participants, reliance on an English-language-only sample, and/or the omission of potentially important co-variates. We tested the inter-relationships between adults’ PPU, scrupulosity, six subdimensions of experiential avoidance (EA), and Dark Tetrad personality traits (Machiavellianism, narcissism, psychopathy, subclinical sadism). Previous research, to our knowledge, has not yet considered subclinical sadism in this context. An online survey was completed by 672 volunteers (MAge=26.14 years, SDAge=8.33) in either the English or Spanish language. Reliable measures were used to evaluate co-variates. Analyses determined that total and sub-dimensional PPU was predicted by scrupulosity. Furthermore, PPU was predicted by certain sub-dimensions of EA (Behavioral Avoidance, Distress Aversion). Mediation analysis suggested four sub-dimensions of EA (Distress Aversion, Procrastination, Distraction/Suppression, and Repression/Denial) as mediators in the relationship between scrupulosity and PPU. Our research builds upon limited literature examining the impact of aversive personality traits on PPU. Our finding that PPU is positively predicted by vicarious sadism has implications for identification of at-risk individuals and can inform the development of interventions to mitigate PPU.
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Purpose of Review In the recently released eleventh edition of the International Classification of Diseases (ICD-11), compulsive sexual behavior disorder (CSBD) was for the first time included and classified as an impulse control disorder. The present report aims at summarizing the empirical results concerning the neurobiological underpinnings of CSBD, including problematic pornography use. Insight into mechanistic factors underlying CSBD may promote the development of more effective therapeutic interventions for people affected. Recent Findings Recent neurobiological studies have revealed that compulsive sexual behaviors are associated with altered processing of sexual material and differences in brain structure and function. Summary Although few neurobiological studies of CSBD have been conducted to date, existing data suggest neurobiological abnormalities share communalities with other additions such as substance use and gambling disorders. Thus, existing data suggest that its classification may be better suited as a behavioral addiction rather than an impulse-control disorder.
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Pornography viewing is a growing practice that has been understudied in samples of women. As an answer to calls within the literature, we explored the role of problematic pornography viewing constructs, body image, and relationship satisfaction in a sample of women (n = 949). Structural equation modeling indicated pornography viewing frequency, perceptions of excessive use, and control difficulties were unrelated to body image or relationship satisfaction. However, problematic pornography use to escape negative emotions significantly predicted participants’ body image and relationship dissatisfaction. Future directions, limitations, and clinical implications are discussed.
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Purpose of Review The current review summarizes the latest findings concerning neurobiological mechanisms of compulsive sexual behavior disorder (CSBD) and provides recommendations for future research specific to the diagnostic classification of the condition. Recent Findings To date, most neuroimaging research on compulsive sexual behavior has provided evidence of overlapping mechanisms underlying compulsive sexual behavior and non-sexual addictions. Compulsive sexual behavior is associated with altered functioning in brain regions and networks implicated in sensitization, habituation, impulse dyscontrol, and reward processing in patterns like substance, gambling, and gaming addictions. Key brain regions linked to compulsive sexual behavior features include the frontal and temporal cortices, amygdala, and striatum, including the nucleus accumbens. Summary Despite much neuroscience research finding many similarities between CSBD and substance and behavioral addictions, the World Health Organization included CSBD in the ICD-11 as an impulse-control disorder. Although previous research has helped to highlight some underlying mechanisms of the condition, additional investigations are needed to fully understand this phenomenon and resolve classification issues surrounding CSBD.
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Problematic pornography viewing (PPV) is a growing concern. Based on a masculine gender role strain framework, individuals endorsing traditional masculinity ideology (TMI) may be especially drawn to pornography. However, relatively few studies have explored how TMI is related to PPV. Furthermore, no known studies have explored how these connections differ in men and women. To address these gaps, we conducted a large survey of 310 men and 469 women in the United States assessing multiple PPV and TMI dimensions. A bifactor structural equation model was used to regress PPV domains onto global and specific TMI factors. Invariance testing further examined the moderating effects of participants’ gender in the model. Results indicated that global TMI was unrelated to men’s PPV. However, men’s dominance ideologies predicted greater functional problems and excessive pornography use. Men’s restrictive emotionality and heterosexist ideologies predicted control difficulties with pornography use and using pornography to escape negative emotions. Additionally, men’s avoidance of femininity ideology predicted excessive pornography use and control difficulties. For women, only global TMI was associated with functional problems. Invariance testing suggested the observed gender differences were not due to underlying discrepancies in the measurement of TMI or PPV. Clinical interventions for PPV that incorporate gender role themes are recommended.
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Impulsivity and compulsivity are transdiagnostic features associated with clinically relevant aspects of psychiatric disorders, including addictions. However, little research has investigated how impulsivity and compulsivity relate to hypersexuality and problematic pornography use. Thus, the aims of the present study were to investigate (a) self-reported impulsivity and compulsivity with respect to hypersexuality and problematic pornography use and (b) the similarities and possible differences between hypersexuality and problematic pornography use in these domains. Utilizing structural equation modeling (SEM) in a large community sample (N = 13,778 participants; female = 4,151, 30.1%), results indicated that impulsivity (β = .28, β = .26) and compulsivity (β = .23, β = .14) were weakly related to problematic pornography use among males and females, respectively. Impulsivity had a stronger relationship (β = .41, β = .42) with hypersexuality than did compulsivity (β = .21, β = .16) among males and females, respectively. Consequently, impulsivity and compulsivity may not contribute as substantially to problematic pornography use as some scholars have proposed. On the other hand, impulsivity might have a more prominent role in hypersexuality than in problematic pornography use. Future research should examine further social and situational factors associated with problematic pornography use.
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Internet pornography use (IPU) remains a controversial topic within sexual behavior research fields. Whereas some people report feeling dysregulated in their use of pornography, mental health and medical communities are divided as to whether or not IPU can be addictive. The present review seeks to examine this issue more closely, with a focus on how variables other than pornography use, such as moral disapproval and moral incongruence (i.e., feeling as if one’s behaviors and one’s values about those behaviors are misaligned) might specifically contribute to self-perceived problems around pornography use. Through an examination of recent literature, the present work reviews evidence that moral incongruence about IPU is a common phenomenon and that it is associated with outcomes relevant to current debates about pornography addiction. Specifically, moral incongruence regarding IPU appears to be associated with greater distress about IPU, greater psychological distress in general, greater reports of problems related to IPU, and greater reports of perceived addiction to IPU. The implications of this body of evidence for both clinical and research communities are discussed, and future directions for research are considered.
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There is an understudied, meaningful distinction between high frequency of pornography use and the subjective feeling that this behavior is out of control. We examined whether the quality of a couple's relationship and sex life can strengthen or weaken the association between frequency of Internet pornography use and perceived lack of control over this behavior. In a sample of 1036 participants, results showed that frequency of pornography use was more strongly associated with feeling out of control when relationship and sexual satisfaction were lower. Findings suggest that couple dissatisfaction puts the individual at risk of reporting out-of-control pornography use.
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Research has often demonstrated a negative association between pornography use and various intrapersonal and relationship outcomes, particularly for men. Several recent studies, however, have suggested that the negative association between pornography use and these indicators is stronger among more religious Americans, suggesting that moral incongruence (engaging in an activity that violates one's sacred values) and the attendant shame or cognitive dissonance, rather than the pornography use per se, may be the primary factor at work. The current study tested and extended this theory by examining how religion potentially moderates the link between pornography use and sexual satisfaction in a national random sample of American adults (N=1,501). Analyses demonstrated that, while pornography use was negatively associated with sexual satisfaction for American men (not women), among men who rarely attended religious services or held a low opinion of the Bible, this negative association essentially disappeared. Conversely, the negative association between frequency of pornography consumption and sexual satisfaction was more pronounced for men with stronger ties to conventional religion. These findings suggest that the connection between pornography use and sexual satisfaction, especially for men, depends largely on what viewing pornography means to the consumer and their moral community, and less so on the practice itself.
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Marc Potenza and colleagues1 advocated classifying “excessive sexual behaviour” as an addictive disorder in ICD-11. Sex has components of liking and wanting that share neural systems with many other motivated behaviours.2 However, experimental studies do not support key elements of addiction such as escalation of use, difficulty regulating urges, negative effects, reward deficiency syndrome, withdrawal syndrome with cessation, tolerance, or enhanced late positive potentials. A key neurobiological feature of addiction is the increased responsiveness of glutamate neurons that synapse on the nucleus accumbens. These changes might affect long-term sensitisation of the mesocorticolimbic dopamine pathway, as manifested by a range of symptoms including cue-induced craving and compulsive drug use.3 To date, research on the effects of sex on glutamate function and its modulation of dopamine pathways is scarce. Sex is a primary reward, with unique peripheral representation. Engagement in sex is positively associated with health and life satisfaction. Sex does not allow for supraphysiological stimulation. Research in this area has yet to investigate actual partnered sexual behaviours. Experimental work has been limited to sexual cues, or secondary rewards, using images. More research is needed, but data concerning frequent or excessive sex do not support its inclusion as an addiction. Also, data are not sufficient to differentiate between compulsive and impulsive models. Many other approaches exist, including well-supported non-pathological models.4 Potenza and colleagues5 also stated that addiction criteria were not met for sexual behaviours: we agree with this earlier conclusion.
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While some research has uncovered racial differences in patterns of pornography viewership, no studies to date have considered how these patterns may be changing over time or how these trends may be moderated by other key predictors of pornography viewership, specifically, gender and religion. Using nationally representative data from the 1973-2016 General Social Surveys (N = 20,620), and taking into account different ethno-religious histories with pornography as a moral issue, we examine how race, gender, and religion intersect to influence trends in pornography viewership over 43 years. Analyses reveal that black Americans in general are more likely to view pornography than whites, and they are increasing in their pornography viewership at a higher rate than whites. Moreover, black men are more likely to consume pornography than all other race-gender combinations, but only differ from white women in their increasing rate of pornography viewership. Lastly, frequent worship attendance only moderates trends in pornography viewership for white men. By contrast, regardless of attendance frequency, black men and women show increasing rates of pornography use while white women show flat rates. We conclude by discussing the implications of these findings for research on the intersections of race, gender, religion, and sexuality.