Pornography addiction is a conceptual model assessing behavioral addiction characterized by compulsive, repeated use of pornographic material until it causes serious negative consequences to one's physical, mental, social, or financial well-being. However, the existence of pornography addiction has been hotly contested by scientists and clinicians. Addiction to Internet pornography is also a form of cybersex addiction.
Problematic Internet pornography viewing is viewing of Internet pornography that is problematic for an individual due to personal or social reasons, including excessive time spent viewing pornography instead of interacting with others. Individuals may report depression, social isolation, career loss, decreased productivity, or financial consequences as a result of their excessive Internet pornography viewing impeding on their social life.
Most studies of prevalence use a convenience sample. One of the studies of a convenience sample suggested that 17% of people who viewed pornography on the Internet met criteria for problematic[clarification needed] sexual compulsivity. A survey found that 20–60% of a sample of college-age males who use pornography found it to be problematic. Research on Internet addiction disorder indicates rates may range from 1.5 to 8.2% in Europeans and Americans. Internet pornography users are included in Internet users, and Internet pornography has been shown to be the Internet activity most likely to lead to compulsive disorders.
Status as addiction
Current models of addiction from natural rewards and chronic drug use involve alterations in gene expression in the mesocorticolimbic projection. ΔFosB is the most significant gene transcription factor involved in altered gene expression, since its overexpression in the nucleus accumbens is necessary and sufficient for most of the neural adaptations seen in drug addiction; it has been implicated in addictions to alcohol, cannabinoids, cocaine, nicotine, phenylcyclidine, and substituted amphetamines. ΔJunD is the transcription factor which directly opposes ΔFosB. Increases in nucleus accumbens ΔJunD expression can reduce or, with a large increase, even block most of the neural alterations seen in chronic drug abuse (i.e., the alterations mediated by ΔFosB).
ΔFosB also plays an important role in regulating behavioral responses to natural rewards, such as palatable food, sex, and exercise. Natural rewards, like drugs of abuse, induce ΔFosB in the nucleus accumbens, and chronic acquisition of these rewards can result in a similar pathological addictive state. Thus, ΔFosB is also the key transcription factor involved in addictions to natural rewards as well, and sex addictions in particular, since ΔFosB in the nucleus accumbens is critical for the reinforcing effects of sexual reward. Research on the interaction between natural and drug rewards suggests that psychostimulants and sexual reward act on similar biomolecular mechanisms to induce ΔFosB in the nucleus accumbens and possess cross-sensitization effects that are mediated through ΔFosB.
The current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes a new section for behavioral addictions, but includes only one disorder: pathological gambling, while only one other behavioral addiction, Internet gaming disorder, belongs to the conditions proposed for further study in DSM-5. Psychiatrists cited a lack of research support for refusing to include other behavioral disorders at this time.
While pornography is mentioned inside DSM-5 when discussing several paraphilias, there is no such thing as pornography addiction or health hazard due to porn consumption, according to DSM-5. DSM-5 does not consider pornography to be a mental health problem.
In 2011, the American Society of Addiction Medicine published a definition of addiction that for the first time stated that addiction includes pathological pursuit of all kinds of external rewards and not just substance dependence. This definition does not explicitly include porn addiction. Instead ASAM uses the phrase, "sexual behavior addiction".
The status of pornography addiction as an addictive disorder, rather than simply a compulsivity, has been hotly contested, particularly by a small group of researchers.[unreliable medical source?] However, their work has been challenged in the peer-reviewed literature.[unreliable medical source?]
However, Dr. Richard Krueger, DSM-5 work-group member (Sexual and Gender Identity Disorders) and associate clinical professor of psychiatry at Columbia University’s College of Physicians and Surgeons, has said that he "has little doubt porn addiction is real and will eventually garner enough attention to be recognized as a mental illness" by the DSM.[unreliable medical source?] Krueger also stated "most people would do it and it won’t become a problem" and recognized that there is yet no academic evidence for considering it a mental disorder.[unreliable medical source?]
Symptoms and diagnosis
Accepted diagnostic criteria do not exist for pornography addiction or problematic pornography viewing. The only diagnostic criteria for a behavioral addiction in the current Diagnostic and Statistical Manual of Mental Disorders are for pathological gambling, and they are similar to those for substance abuse and dependence, such as preoccupation with the behavior, diminished ability to control the behavior, tolerance, withdrawal, and adverse psychosocial consequences. Diagnostic criteria have been proposed for other behavioral addictions, and these are usually also based on established diagnoses for substance abuse and dependence.
A proposed diagnosis for hypersexual disorder includes pornography as a sub-type of this disorder. It included such criteria as time consumed by sexual activity interfering with obligations, repetitive engagement in sexual activity in response to stress, repeated failed attempts to reduce these behaviors, and distress or impairment of life functioning. A study on problematic Internet pornography viewing used the criteria of viewing Internet pornography more than three times a week during some weeks, and viewing causing difficulty in general life functioning.
A 2014 released study identified a connection between a subjects religious beliefs and their self perception of pornography addiction. The study's lead author is Case Western Reserve University psychology doctoral student Joshua Grubbs; the study is titled "Transgression as Addiction: Religiosity and Moral Disapproval as Predictors of Perceived Addiction to Pornography" and was published in the journal Archives of Sexual Behaviour. One of the findings of the study is that the results strongly indicate a predilection in religious people to believe they are addicted to pornography regardless of how much they watch or whether it negatively impacts their lives.
Cognitive-behavioral therapy has been suggested as a possible effective treatment for pornography addiction based on its success with Internet addicts, though no clinical trials have been performed to assess effectiveness among pornography addicts as of 2012. Acceptance and commitment therapy has also been shown to be a potentially effective treatment for problematic Internet pornography viewing.
Sex researcher Alvin Cooper and colleagues suggested several reasons for using filters as a therapeutic measure, including curbing accessibility that facilitates problematic behavior and encouraging clients to develop coping and relapse prevention strategies. Cognitive therapist Mary Anne Layden suggested that filters may be useful in maintaining environmental control. Internet behavior researcher David Delmonico stated that, despite their limitations, filters may serve as a "frontline of protection."
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- American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 481, 797–798. ISBN 978-0-89042-555-8. "In addition to the substance-related disorders, this chapter also includes gambling disorder, reflecting evidence that gambling behaviors activate reward systems similar to those activated by drugs of abuse and produce some behavioral symptoms that appear comparable to those produced by the substance use disorders. Other excessive behavioral patterns, such as Internet gaming, have also been described, but the research on these and other behavioral syndromes is less clear. Thus, groups of repetitive behaviors, which some term behavioral addictions, with such subcategories as "sex addiction," "exercise addiction," or "shopping addiction," are not included because at this time there is insufficient peer-reviewed evidence to establish the diagnostic criteria and course descriptions needed to identify these behaviors as mental disorders. ... Excessive use of the Internet not involving playing of online games (e.g., excessive use of social media, such as Facebook; viewing pornography online) is not considered analogous to Internet gaming disorder, and future research on other excessive uses of the Internet would need to follow similar guidelines as suggested herein. Excessive gambling online may qualify for a separate diagnosis of gambling disorder."
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- Since it is none of two behavioral addictions mentioned above.
- All mentions of pornography inside DSM-5: p. 694 pornography mentioned in sexual masochism disorder; p. 696 pornography mentioned in sexual sadism disorder; p. 698, 699 pornography mentioned in pedophile disorder; p. 797 pornography disqualified as a possible internet use disorder, in the context of internet gaming disorder, which does not amount to a recognized disorder, but to a condition for further study.
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