Response to Commentaries

If you want to read the PDF, try requesting it from the authors.
1 3
Archives of Sexual Behavior (2019) 48:461–468
Response toCommentaries
JoshuaB.Grubbs1 · SamuelPerry2· JoshuaA.Wilt3· RoryC.Reid4
Received: 31 December 2018 / Accepted: 18 January 2019 / Published online: 28 January 2019
© Springer Science+Business Media, LLC, part of Springer Nature 2019
With the inclusion of Compulsive Sexual Behavior Disorder
(CSBD) in the forthcoming ICD-11, research into the compul-
sive or addictive use of sexual media will likely greatly expand
in coming years. Similarly, behavioral science debates about
the best way to conceptualize pornography use—particularly
problematic pornography use—are likely to continue for the
foreseeable future. In tandem with these trends, there is also
an increasing need for nuanced discussions of these topics that
enhance taxonomical, diagnostic, and etiological understand-
ings of such problematic sexual behavior. In service of this
goal, we described a model by which pornography use might
lead to problems in users’ lives, even in the absence of dys-
regulation, compulsivity, or addiction (Grubbs, Perry, Wilt,
& Reid, 2018a).
In our Target Article, we posited a model of pornography
problems due to moral incongruence (PPMI) wherein some
users experience problems related to their pornography use that
arise due to a misalignment between moral values and actual
behavior. As theorists have speculated for over half a century
(Bem, 1967; Festinger, 1962) and as addictions researchers have
noted for several decades (Hettema, Steele, & Miller, 2005;
Miller & Rollnick, 1991), the relationships between behaviors
and self-perceptions of those behaviors are often misaligned.
In that same tradition, we set forth a model that accounts for the
documented tendency of a substantive percentage of pornogra-
phy users to describe moral disapproval of their own behaviors.
Simply put, many users of pornography—particularly in the
U.S.—find that behavior to be morally problematic (Grubbs,
Kraus, & Perry, 2019b).
Building on the fact that many users of pornography morally
disapprove of their own use habits, we constructed our model
of PPMI. Across a number of studies, we found support for
this model. Religiousness is consistently related to moral dis-
approval of pornography use. Self-reported feelings of addic-
tion to pornography are consistently linked to feelings of moral
incongruence. And, in non-clinical populations, meta-analytic
results strongly support the notion that moral incongruence is
the strongest correlate of self-reported problems associated with
pornography use. In sum, moral incongruence, which appears to
often (but not always) be a by-product of conservative religious
ideals, is clearly a key component of self-reported problematic
pornography use.
Across all commentaries and feedback (both praise and cri-
tique), we are grateful for the evaluations and careful considera-
tions provided. The opportunity to have one’s work critiqued
and debated in such a public and rigorous forum is an honor
and privilege. Across all commentaries, we noted both com-
mendations and insightful critiques. Chiefly, most responses
commended the nature of the review and the utility of the model
for some specific cases. Moreover, at least two commentaries
directly applied the model to either case studies in problematic
pornography use (Kraus & Sweeney, 2018) or empirical analy-
ses of hypersexuality more generally (Walton, 2018). Impor-
tantly, in both of these cases, the model was well supported by
available data. Rather than expand further on the commenda-
tions received, however, it is our aim to specifically summarize
and address the critiques raised and future directions posited.
Ultimately, we believe that the two most substantive cri-
tiques fall into one of two primary categories. Chiefly, a num-
ber of critiques noted that the model was quite narrow in its
scope, focus, and implications (Fisher, Montgomery-Graham,
& Kohut, 2018; Vaillancourt-Morel & Bergeron, 2018; Wil-
loughby, 2018), while others noted that the work may inap-
propriately distinguish between pathways to problematic use
(Brand, Antons, Wegmann, & Potenza, 2018; Wright, 2018).
Below, we consider these critiques broadly.
* Joshua B. Grubbs
1 Department ofPsychology, Bowling Green State University,
BowlingGreen, OH43403, USA
2 Department ofSociology, University ofOklahoma, Norman,
3 Department ofPsychological Sciences, Case Western Reserve
University, Cleveland, OH, USA
4 Department ofPsychiatry andBiobehavioral Sciences,
University ofCalifornia Los Angeles, LosAngeles, CA, USA
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... However, critics of the CPUI-9 have suggested against the inclusion of the emotional distress subscale, based on the notion that its inclusion may have inflated previous associations found between moral incongruence and perceived addiction (Fernandez et al., 2017). Such claims were promptly met with significant evidence to the contrary; particularly evidence that this measurement confound has been noted and accounted for in prior works (Grubbs & Gola, 2019;Grubbs et al., 2019aGrubbs et al., , 2019bGrubbs et al., , 2019c dating back to the preliminary assessment of PPMI (Grubbs et al., 2015a). Much of the research has utilized the 4-item abridged version of the CPUI-9, the CPUI-4 (Grubbs & Gola, 2019;Grubbs et al., 2015c), in which the emotional distress subscale is excluded. ...
... As such, excluding emotional distress may eliminate a distinguishing factor in the proposed pathways of PPMI: those whose perceived problems resulting from moral incongruence are thought to be a function of negative emotions rather than mere perceptions of dysregulated use. Thus, scores on the CPUI-4, with its exclusion of emotional distress, may represent users' perceptions of uncontrollable use, but without consideration of the subjective distress users' experience, these scores may be mere reflections of a perceived lack of control that individuals do not find distressing (Grubbs et al., 2019a(Grubbs et al., , 2019b(Grubbs et al., , 2019c. Considering this, scores on the CPUI-4 may be interpreted not as a measure of perceived addiction, as indicated by total scores on the CPUI-9, but rather as a measure of a specific element of perceived addiction, self-reported compulsivity, or uncontrollable use (See Grubbs et al., 2020b). ...
... Given the potential issues associated with the CPUI-9's emotional distress subscale, a need exists for a re-examination of previous model configurations in which moral incongruence is measured in a manner more consistent with its current conceptualization and perceived addiction is measured using the recommended CPUI-4 (Grubbs & Gola, 2019;Grubbs et al., 2015aGrubbs et al., , 2019aGrubbs et al., , 2019bGrubbs et al., , 2019c. Doing so will provide insight into whether previous findings persist when excluding emotional distress, which is especially relevant to the research assessing sexual shame as a unique outcome of moral incongruence. ...
Full-text available
Researchers focused on the model of pornography problems due to moral incongruence (PPMI) have suggested that perceptions of addiction, stemming from a misalignment between one's moral values and online sexual behavior, may lead to heightened sexual shame. Even so, it has been suggested that the associations found in previous models of PPMI may have been inflated by the inclusion of the emotional distress subscale in the widely used Cyber Pornography Use Inventory (CPUI-9), leading many to use the abridged 4-item version (i.e., the CPUI-4), which excludes emotional distress. Prior models assessing sexual shame have yet to fully address this potential methodological limitation. Considering advances in the conceptualization of PPMI and recommendations concerning best practices, a sample of participants (N = 296) that reported using pornography in the last six months was utilized to compare findings from two moderated mediation models. The first model assessed the differential strength of effects when the subscales of the CPUI-9 were assessed as separate mediators of the associations between moral incongruence and sexual shame, while the second model examined whether such associations persisted when using the recommended CPUI-4. Model results provide further justification for previous findings, indicating that associations between constructs were not the sole result of emotional distress, which supports the utility of the CPUI-4 in models that include sexual shame. Findings provide added support for sexual shame as a unique outcome among those who, due to moral incongruence, perceive that they are addicted to Internet pornography.
... Moreover, the model was designed to describe the factors contributing to self-perceived pornography addiction 3 and is also based on research predicting self-perceived addiction. 3,25,31 However, as the authors of the model suggest that the PPMI model can be a suitable framework for investigating the factors influencing a broader set of behavioral, cognitive, and affective symptoms connected with problematic pornography use and should be examined in this role. ...
... However, such self-labels are important as they may lead to self-stigmatization, 32 distress, or treatment seeking. 3,25 As the way in which "self-perceived addiction" is operationalized has generated some controversy (for a discussion, refer to the study by Brand et al, 16 Grubbs et al, 26,31 and Fernandez et al 33 ), we propose that it is most clearly operationalized as we have described previously. That is, selfperceived addiction is best described as a mental act of self-inclusion within a group of addicts, the measurement of which is not necessarily based on quantitative self-description of behavioral symptoms (such as frequency of use, difficulty abstaining, emotional distress, using pornography as a coping mechanism, or craving). ...
... 33,45,46 Validating the model in another cultural context is one of the most important research directions, which was demarked by the authors of the model themselves. 3,31 ...
Full-text available
Introduction To date, multiple models of problematic pornography use have been proposed, but attempts to validate them have been scarce. Aim In our study, we aimed to evaluate the Pornography Problems due to Moral Incongruence model proposing that self-appraisals of pornography addiction stem from (i) general dysregulation, (ii) habits of use, and (iii) moral incongruence between internalized norms and behavior. We investigated whether the model can be used to adequately explain the self-perceptions of addiction to pornography (model 1) and a broader phenomenon of problematic pornography use (model 2). Methods An online, nationally representative study was conducted on a sample of 1036 Polish adult participants, of whom, 880 declared a lifetime history of viewing pornography. Main Outcome Measure The outcomes were self-perceived pornography addiction, problematic pornography use, avoidant coping, frequency of pornography use, religiosity, moral disapproval of pornography, and related variables. Results Our results indicated that avoidant coping (an indicator of general dysregulation), frequency of pornography use (indicator of habits of use), and the distress connected with incongruence between own sexual behavior and internalized norms, attitudes and beliefs positively contributed to self-perceived addiction (model 1) as well as problematic pornography use (model 2). This broadly confirms the basic shape of the PPMI model. There were, however, notable differences between the models. Moral incongruence related distress was only weakly related to self-perceived addiction (β = 0.15, P < .001), with a stronger relation for problematic pornography use (β = 0.31, P < .001). When controlling for other factors, religiosity weakly predicted problematic pornography use (β = 0.13, P < .001), but not self-perceived addiction to pornography (β = 0.03, P = .368). Frequency of pornography use was the strongest predictor of both self-perceived addiction (β = 0.52, P < .001) and problematic pornography use (β = 0.43, P < .001). Clinical Implications Factors proposed within the PPMI model are distinctly relevant intervention targets, and they should be considered in the process of diagnosis and treatment. Strengths & Limitations The presented study is the first to evaluate PPMI model. Its main limitation is that it has a cross-sectional design. Conclusion The PPMI model is a promising framework for investigating the factors related to self-perceived addiction and problematic pornography use. Despite the differences between the models and in the strength of specific predictors, (i) dysregulation, (ii) habits of use, and (iii) moral incongruence all uniquely contribute to self-perceived addiction and problematic pornography use.
... Moreover, the model was designed to describe the factors contributing to self-perceived pornography addiction 3 and is also based on research predicting self-perceived addiction. 3,25,31 However, as the authors of the model suggest that the PPMI model can be a suitable framework for investigating the factors influencing a broader set of behavioral, cognitive, and affective symptoms connected with problematic pornography use and should be examined in this role. ...
... However, such self-labels are important as they may lead to self-stigmatization, 32 distress, or treatment seeking. 3,25 As the way in which "self-perceived addiction" is operationalized has generated some controversy (for a discussion, refer to the study by Brand et al, 16 Grubbs et al, 26,31 and Fernandez et al 33 ), we propose that it is most clearly operationalized as we have described previously. That is, selfperceived addiction is best described as a mental act of self-inclusion within a group of addicts, the measurement of which is not necessarily based on quantitative self-description of behavioral symptoms (such as frequency of use, difficulty abstaining, emotional distress, using pornography as a coping mechanism, or craving). ...
... 33,45,46 Validating the model in another cultural context is one of the most important research directions, which was demarked by the authors of the model themselves. 3,31 ...
Introduction Dysregulation of emotion (DE) is commonly seen in individuals suffering from compulsive sexual behavior (CSB), as well as represents a crucial element of its common comorbidities like mood, anxiety, and substance use disorders. Aim To investigate the links between CSB and DE. Methods A review of pertinent literature on CSB and DE was performed using EBSCO, PubMed, and Google Scholar databases. Main Outcome Measure Patterns of DE were evaluated as a common clinical feature, underlying mechanisms, as well as a target for psychological and pharmacological interventions in CSB. Results Across different conceptualizations of CSB, DE represents the core element of a failure to cope with sexual impulses, thoughts, urges, or resulting uncontrolled sexual behaviors. DE may contribute to the occurrence of CSB while for individuals affected by this condition, sexual arousal and release act as an easier/learned (yet uncontrolled and leading to negative consequences) way of coping with negative mood states. CSB may represent a delusive form of self-regulation. Experience of child sexual abuse and insecure attachment patterns are considered risk factors for CSB (likely to be mediated by DE) but require further investigation. DE is also positively associated with CSB symptom severity. Pharmacological treatments affecting mood regulation, anxiety, impulsivity, and regulation within the brain reward system have been reported to help people with CSB achieve better control over their sexual urges and behavior. However, the available data are scarce and well-powered randomized controlled trials are needed to support these observations. Although improvement in one's emotional self-regulation is considered as an important healing factor in treatment, its benefit in psychological therapies specific to CSB requires further investigation. Conclusion DE represents a core symptom of compulsive sexual behavior disorder and related comorbidities as well as a predisposing factor to the development of compulsive sexual behavior disorder. Addressing DE may facilitate better treatment outcomes for patients with CSB.
... Several studies have now indicated that self-reported feelings of compulsivity in or perceived addiction to pornography use are often better accounted for by personal morality and conservative beliefs, rather than actual pornography use Grubbs, Perry, Wilt, & Reid, 2019a). In several samples, both in the United States and abroad, religiousness and moral disapproval of pornography use are known to be associated with greater reports of perceived addiction to pornography or compulsivity in use, which suggests that perceptions of problems with pornography use are likely influenced by personal beliefs (for a review, see Grubbs et al., 2019a;Grubbs, Perry, Wilt, & Reid, 2019b). ...
... The first way that we examined this was via the interaction of pornography use and moral disapproval of pornography. Whereas earlier works examined how moral disapproval of pornography use and pornography use itself each directly predict self-reported feelings of addiction to pornography (for reviews, see Grubbs et al., 2019aGrubbs et al., , 2019b, we sought to extend such works by testing the interaction of pornography use and moral disapproval. That is, rather than inferring moral incongruence (i.e., moral disapproval among users), we defined incongruence as the interaction of use and disapproval, because this interaction is more consistent with previous definitions of moral incongruence (Grubbs et al., 2019a). ...
Despite controversies about the diagnosis, the World Health Organization recently elected to include compulsive sexual behavior disorder in the 11th edition of the International Classification of Diseases. Both recent and remote works have suggested that various cultural factors such as personal religiousness and morality can influence both the experience and expression of compulsive sexual behaviors. Because prior works have indicated that pornography use is likely to be the most common expression of compulsive sexual behavior, the present work sought to examine whether moral incongruence about pornography use may account for a substantive part of self-reports of compulsive sexual behavior. In 2 studies involving 4 samples, the present work tested the hypothesis that moral incongruence would positively predict self-reported compulsivity in pornography use. In Study 1, across 3 samples (Sample 1, N = 467; Sample 2, N = 739; Sample 3, N = 1,461), including 2 matched to U.S. nationally representative norms (Samples 2 and 3), results indicated that moral incongruence was a substantive and robust predictor of self-reported compulsivity. In Study 2 (baseline N = 850), parallel process latent growth curve analyses over the course of 1 year revealed that the trajectories of pornography use, self-reported compulsivity, and moral disapproval of such use covaried together over time. Collectively, these results underscore the contention that personal morality may influence individuals' self-perceptions of their sexual behaviors, which, in turn, may complicate efforts to accurately diagnose compulsive sexual behavior disorder. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
... Such findings have led to the proposal of a model of pornography problems due to moral incongruence (PPMI model [27]). Despite supporting evidence, the model has been criticized in that (1) other factors may relate more strongly to problematic pornography use than moral incongruence, (2) that moral incongruence may not represent an independent pathway to problematic pornography use, and (3) that other addictive behaviours may share similar relationships with moral incongruence [41][42][43][44][45][46][47][48]. ...
Background and Aims Moral incongruence involves disapproval of a behaviour in which people engage despite their moral beliefs. Although considerable research has been conducted on how moral incongruence relates to pornography use, potential roles for moral incongruence in other putative behavioural addictions have not been investigated. The aim of this study was to investigate the role of moral incongruence in self‐perceived addiction to: (1) pornography, (2) internet addiction, (3) social networking, and (4) online gaming. Design A cross‐sectional, preregistered, online survey using multivariable regression. Setting Online study conducted in Poland. Participants 1036 Polish adults aged between 18 and 69 years. Measurements Measures included self‐perceived behavioural addiction to pornography, internet use, social networking and online gaming) and their hypothesized determinants (moral incongruence, frequency of use, time of use, religiosity, age, gender). Findings Higher moral incongruence (β=0.20, p<.001) and higher religiosity (β=0.08, p<.05) were independently associated with higher self‐perceived addiction to pornography. Additionally, frequency of pornography use was the strongest of the analyzed predictors (β=0.43, p<.001). A similar, positive relationship between high moral incongruence and self‐perceived addiction was also present for internet (β=0.16, p<.001), social networking (β=0.18, p<.001) and gaming addictions (β=0.16, p<.001). Religiosity was uniquely, although weakly, connected to pornography addiction, but not to other types of addictive behaviours. Conclusions Moral incongruence may be positively associated with self‐perception of behavioural addictions including not only pornography viewing, but also internet use, social networking and online gaming.
... Some items from the "Guilt" subscale of the CPUI were retained to form the Emotional Distress subscale of the CPUI-9 but with an intended focus on "negative affect associated with pornography use rather than feelings of guilt or shame directly" (Grubbs et al., 2015, p. 9). It is important to highlight that questions surrounding the Emotional Distress subscale have nonetheless been raised in the literature, mainly about the possibility of the subscale inflating full scale scores of individuals who morally disapprove of pornography (Brand, Antons, Wegmann, & Potenza, 2019;Fernandez, Tee, & Fernandez, 2017), which the leading author of the CPUI-9 has since responded to at length (see Grubbs, Perry, Wilt, & Reid, 2019b). ...
Despite a lack of consensus in the field about how best to conceptualize problematic pornography use, psychometric instruments have nonetheless been developed to assess the construct. The present systematic review aimed to (i) identify psychometric tools that have been developed to assess problematic pornography use; (ii) summarize key characteristics, psychometric properties, and strengths and limitations of instruments for problematic pornography use; (iii) compare the instruments’ theoretical conceptualizations of problematic pornography use; and (iv) evaluate each instrument on their ability to assess various core components of addiction. In this article, 22 instruments assessing problematic pornography use were reviewed. Results indicated that while the instruments had different conceptualizations of problematic pornography use, addiction still emerged as the most common theoretical framework used by the instruments. Five of the most commonly assessed addiction components across the different instruments were (1) impaired control, (2) salience, (3) mood modification, (4) interpersonal conflict, and (5) general life conflict. Contextual factors that may potentially affect the assessment of problematic pornography use and recommendations for researchers and clinicians are discussed.
Full-text available
Background and aims: Despite controversies regarding its existence as a legitimate mental health condition, self reports of pornography addiction seem to occur regularly. In the United States, prior works using various sampling techniques, such as undergraduate samples and online convenience samples, have consistently demonstrated that some pornography users report feeling dysregulated or out of control in their use. Even so, there has been very little work in US nationally representative samples to examine self-reported pornography addiction. Methods: This study sought to examine self-reported pornography addiction in a US nationally representative sample of adult Internet users (N = 2,075). Results: The results indicated that most participants had viewed pornography within their lifetimes (n = 1,461), with just over half reporting some use in the past year (n = 1,056). Moreover, roughly 11% of men and 3% of women reported some agreement with the statement “I am addicted to pornography.” Across all participants, such feelings were most strongly associated with male gender, younger age, greater religiousness, greater moral incongruence regarding pornography use, and greater use of pornography. Discussion and conclusion: Collectively, these findings are consistent with prior works that have noted that self-reported pornography addiction is a complex phenomenon that is predicted by both objective behavior and subjective moral evaluations of that behavior.
Full-text available
Pornography has become an increasingly salient topic in public discourse. We sought to better understand the role of religiosity in shaping people’s support of policy stances against pornography, in the form of censorship, using nationally representative data from the 2014 General Social Survey (n = 1676). Results from logistic regression indicate that high religiosity significantly increases odds of supporting censorship. Holding control variables at their sample means, the least religious persons had a predicted probability of 0.09 of supporting censorship, compared to 0.57 for the most religious respondents. We discuss these findings within the context of the current public health debate.
Full-text available
Commentary on Grubbs et al.'s (2018) Target Article - Pornography Problems Due to Moral Incongruence: An Integrative Model with a Systematic Review and Meta-Analysis.
At present, the scientific community has not reached a consensus regarding whether or not people may be become addicted to or compulsive in use of pornography. Even so, a substantial number of people report feeling that their use of pornography is dysregulated or out of control. Whereas prior works considered self-reported feelings of addiction via indirect scales or dimensional measures, the present work examined what might lead someone to specifically identify as a pornography addict. Consistent with prior research, pre-registered hypotheses predicted that religiousness, moral disapproval, and average daily pornography use would emerge as consistent predictors of self-identification as a pornography addict. Four samples, involving adult pornography users (Sample 1, N = 829, Mage = 33.3; SD = 9.4; Sample 2, N = 424, Mage = 33.6; SD = 9.1; Sample 4, N = 736, Mage = 48.0; SD = 15.8) and undergraduates (Sample 3, N = 231, Mage = 19.3; SD = 1.8), were collected. Across all three samples, male gender, moral incongruence, and average daily pornography use consistently emerged as predictors of self-identification as a pornography addict. In contrast to prior literature indicating that moral incongruence and religiousness are the best predictors of self-reported feelings of addiction (measured dimensionally), results from all four samples indicated that male gender and average daily pornography use were the most strongly associated with self-identification as a pornography addict, although moral incongruence consistently emerged as a robust and unique predictors of such self-identification.
Introduction: Despite evidence to the contrary, a number of advocacy and self-help groups persist in claiming that internet pornography use is driving an epidemic of erectile dysfunction (ED). Aim: The present work sought to explore whether mere pornography use itself and self-reported problematic use of pornography are related to ED, both cross-sectionally and longitudinally. Methods: A series of 3 samples of sexually active men who also used pornography were collected: a cross-sectional sample of undergraduate men in the United States (n = 147), an online sample of men derived from a larger sample that was matched to U.S. nationally representative norms (n = 297), and a 1-year, 4-wave longitudinal sample of adult men derived from an online convenience sample (Mechanical Turk: time 1, n = 433; time 2, n = 223; time 3, n = 202; time 4, n = 196). Pearson correlations and cross-sectional structural equation models were conducted in each sample. Latent growth curve analyses were conducted in the longitudinal sample. Main outcome measure: The primary outcomes of interest were cross-sectional and longitudinal reports of erectile functioning as measured by the International Index of Erectile Functioning 5. Results: Across all 3 samples, there was evidence of a positive, cross-sectional association between self-reported problematic use and ED, but no consistent association between mere use itself and ED. In our longitudinal sample, there were correlations among baseline pornography use, baseline self-reported problematic use, and prospective ED at times 2-4; however, latent growth curve analyses demonstrated no significant relationships between any pornography-related variables and trajectories of ED. Clinical implications: These results suggest that among non-treatment-seeking pornography users, self-reported problematic use likely is associated with concurrent reports of ED, but that the links between these variables are not directional or causal in nature. Strength & limitations: This work is the first work to systematically examine the links between self-reported problematic use of pornography and ED, and it did so in a variety of samples, using both cross-sectional and longitudinal methods. Even so, the work relied exclusively on self-report methods, and did not control for medical covariates that may be related to the experience of ED. Conclusion: In conjunction with prior literature, we conclude that there is little or no evidence of an association between mere pornography use and ED, consistent evidence of an association between self-reported problematic use and ED cross-sectionally, and no evidence of causal links between any pornography variables and ED. Grubbs JB, Gola M. Is Pornography Use Related to Erectile Functioning? Results From Cross-Sectional and Latent Growth Curve Analyses. J Sex Med 2019;16:111-125.