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Sexual Addiction & Compulsivity
The Journal of Treatment & Prevention
ISSN: 1072-0162 (Print) 1532-5318 (Online) Journal homepage: https://www.tandfonline.com/loi/usac20
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:
10.1080/10720162.2019.1567410
To link to this article: https://doi.org/10.1080/10720162.2019.1567410
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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
ABSTRACT
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 nicholascborgogna@gmail.com University of South Alabama, Mobile,
Alabama, USA.
Supplemental data for this article can be accessed on the publisher’s website.
ß2019 Taylor & Francis Group, LLC
SEXUAL ADDICTION & COMPULSIVITY
2018, VOL. 25, NO. 4, 293–318
https://doi.org/10.1080/10720162.2019.1567410
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
(D’Orlando, 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
interventions.
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;
294 N. C. BORGOGNA ET AL.
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
SEXUAL ADDICTION & COMPULSIVITY 295
and problematic pornography viewing by Short et al. (2015). Grubbs et al.
(2018) similarly identified “religious scruples”as 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,
296 N. C. BORGOGNA ET AL.
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.
Method
Participants/Procedure
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.
Measures
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
SEXUAL ADDICTION & COMPULSIVITY 297
(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).
Scrupulosity
We used the 12-item “Fear of Sin”subscale 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)
Race
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%
Religion
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)
298 N. C. BORGOGNA ET AL.
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
¼.93.
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 couldn’t 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.
Neuroticism
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
¼.85.
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
SEXUAL ADDICTION & COMPULSIVITY 299
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.
300 N. C. BORGOGNA ET AL.
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.
Results
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
SEXUAL ADDICTION & COMPULSIVITY 301
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
(Muth
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
2
(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
2
(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.
p<.05.
p<.01.
p<.001.
302 N. C. BORGOGNA ET AL.
.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
2
(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
2
(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
2
(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,
v
2
(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
SEXUAL ADDICTION & COMPULSIVITY 303
equalacrossgroups(i.e.,directeffectsinvariance).Thescaledchi-square
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
2
(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
problems,15%ofthevarianceforexcessiveuse,16%ofthevariancefor
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.
Gender
Predictor
Variables !
Criterion
Variables
Direct
Effect BSE
Standardized
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.
p<.05.
p<.01.
p<.001.
304 N. C. BORGOGNA ET AL.
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 !
Criterion
Variables
Direct
Effect BSE
Standardized
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.
p<.05.
p<.01.
p<.001.
SEXUAL ADDICTION & COMPULSIVITY 305
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.
306 N. C. BORGOGNA ET AL.
for functional problems but did not account for additional variance across
the other problematic pornography viewing dimensions.
Discussion
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
partner’s 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.
SEXUAL ADDICTION & COMPULSIVITY 307
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
scrupulosity.
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
308 N. C. BORGOGNA ET AL.
discussions on perceived addiction; e.g., Brand et al., 2018 and Grubbs,
Stauner, et al., 2015).
Limitations
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.
SEXUAL ADDICTION & COMPULSIVITY 309
Implications
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 client’s pornog-
raphy use is problematic. Measures such as the PPUS (Kor et al., 2014),
PPCS (B}
othe, T
oth-Kir
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
310 N. C. BORGOGNA ET AL.
“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
oth-Kir
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.
Conclusion
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
SEXUAL ADDICTION & COMPULSIVITY 311
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, nicholascborgogna@gmail.com.
ORCID
Nicholas C. Borgogna http://orcid.org/0000-0002-5085-3656
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