Pornography addiction has been described as a behavioral addiction characterized by compulsive, repeated use of pornographic material until it causes serious negative consequences to one's physical, mental, social, and/or financial well-being. However, the existence of porn addiction has been hotly contested by scientists and clinicians. Addiction to Internet pornography is also a form of cybersex addiction. There is no diagnosis of pornography addiction in the current Diagnostic and Statistical Manual of Mental Disorders (DSM).
Problematic Internet pornography viewing is viewing of Internet pornography that is problematic for an individual for personal, or social reasons, or reasons such as time spent viewing or viewing in problematic situations. Individuals may report depression, social isolation, career loss or decreased productivity, and financial consequences as a result of their problematic Internet pornography viewing.
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. Some have suggested that use can lead to erectile dysfunction, but this has never been demonstrated by any research.
Most studies of prevalence use a convenience sample. The only estimates based on a nationally-representative sample place problems with this behavior around .5% of the population. 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
|Nicole Prause, Ph.D. (sexual physiologist).  CBS (July 18, 2013)|
|Debra Herbenick, Ph.D. (sexuality educator).  Katie Couric Show|
The status of addiction to visual sexual stimuli is strongly contested. The current Diagnostic and Statistical Manual of Mental Disorders (DSM-V) includes a new section for behavioral addictions, but includes only one disorder: pathological gambling. Other behavioral addictions were included in "Conditions for further study". Porn addiction is not currently a diagnosis and was specifically rejected from the most recent revision of the DSM. Psychiatrists cited a lack of research support for refusing to include it at this time.
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 is very controversial, as it is thought to represent overly broad descriptions. It does not explicitly include porn addiction.
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 that porn addiction is real and will eventually garner enough attention to be recognized as a mental illness by the DSM. 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.
Although no brain studies of "porn addiction" existed at the time, a 2011 paper by Donald Hilton and Clark Watts argued that studies demonstrating the effect of sexual experiences on neuroplasticity indicate the existence of process addiction, and specifically focused on pornography addiction as an area requiring further study. In a letter to the editor, Rory Reid, Bruce Carpenter, and Timothy Fong responded by arguing that the studies on neuroplasticity used correlational data, and thus could not be used to establish causation. In a commentary included with the letter to the editor, Hilton and Watts pointed to research connecting ∆FosB, a proposed marker of substance addictions, to sexual experience, and claimed that researchers who reject the research they cite are biased against research which connects neuromodulation to behavioral addictions. A later paper demonstrated that ∆FosB actually has never been tied to sex, and the animal model necessary to test it does not exist.
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 noted that, despite their limitations, filters may serve as a "frontline of protection."
DSM-5 explicitly rejects qualifying online pornography consumption as an addiction.
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.
- Stein, Dan J.; Hollander, Eric; Rothbaum, Barbara Olasov (31 August 2009). Textbook of Anxiety Disorders. American Psychiatric Pub. pp. 359–. ISBN 978-1-58562-254-2. Retrieved 24 April 2010.
- Parashar A, Varma A (April 2007). "Behavior and substance addictions: is the world ready for a new category in the DSM-V?". CNS Spectr 12 (4): 257; author reply 258–9. PMID 17503551.
- Ley, D., Prause, N., & Finn, P. (April 2014). "The Emperor Has No Clothes: A Review of the ‘Pornography Addiction’ Model". Current Sexual Health Reports 1 (1). doi:10.1007/s11930-014-0016-8.
- Laier, C.; Pawlikowski, M.; Pekal, J.; Schulte, F. P.; Brand, M. (2013). "Cybersex addiction: Experienced sexual arousal when watching pornography and not real-life sexual contacts makes the difference". Journal of Behavioral Addictions 2 (2): 100. doi:10.1556/JBA.2.2013.002.
- Downs, Martin F.; Chang, Louise (August 30, 2005). "Is Pornography Addictive? Psychologists debate whether people can have an addiction to pornography.". WebMD. Retrieved 2007-03-22.
- American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 797–798. ISBN 978-0-89042-555-8.
- Twohig, M. P.; Crosby, J. M. (2010). "Acceptance and Commitment Therapy as a Treatment for Problematic Internet Pornography Viewing". Behavior Therapy 41 (3): 285–295. doi:10.1016/j.beth.2009.06.002. PMID 20569778.
- Grant, J. E.; Potenza, M. N.; Weinstein, A.; Gorelick, D. A. (2010). "Introduction to Behavioral Addictions". The American Journal of Drug and Alcohol Abuse 36 (5): 233–241. doi:10.3109/00952990.2010.491884. PMC 3164585. PMID 20560821.
- Kafka, M. P. (2009). "Hypersexual Disorder: A Proposed Diagnosis for DSM-V". Archives of Sexual Behavior 39 (2): 377–400. doi:10.1007/s10508-009-9574-7. PMID 19937105.
- Cooper, A., Delmonico, D. L., & Burg, R. (2000). Cybersex user, abusers, and compulsives. Sexual Addiction and Compulsivity, 7, 5–29.
- Twohig, M. P.; Crosby, J. M.; Cox, J. M. (2009). "Viewing Internet Pornography: For Whom is it Problematic, How, and Why?". Sexual Addiction & Compulsivity 16 (4): 253. doi:10.1080/10720160903300788.
- Weinstein, A.; Lejoyeux, M. (2010). "Internet Addiction or Excessive Internet Use". The American Journal of Drug and Alcohol Abuse 36 (5): 277–283. doi:10.3109/00952990.2010.491880. PMID 20545603.
- Meerkerk, G. J.; Eijnden, R. J. J. M. V. D.; Garretsen, H. F. L. (2006). "Predicting Compulsive Internet Use: It's All about Sex!". CyberPsychology & Behavior 9 (1): 95–103. doi:10.1089/cpb.2006.9.95. PMID 16497122.
- Hilton, D. L. (2013). "Pornography addiction – a supranormal stimulus considered in the context of neuroplasticity". Socioaffective Neuroscience & Psychology 3. doi:10.3402/snp.v3i0.20767.
- American Society of Addiction Medicine. (2011). DEFINITION OF ADDICTION: FREQUENTLY ASKED QUESTIONS. http://www.asam.org/pdf/Advocacy/20110816_DefofAddiction-FAQs.pdf
- Steele, V., Prause, N., Staley, C., & Fong, G. W. (2013). "Sexual Desire, not Hypersexuality, is Related to Neurophysiological Responses Elicited by Sexual Images". Socioaffective Neuroscience of Psychology 3. doi:10.3402/snp.v3i0.20770.
- Tamsin McMahon Will quitting porn improve your life? A growing ‘NoFap’ movement of young men are saying no to porn and masturbation Maclean's, January 20, 2014.
- Watts, C.; Hilton, D. (2011). "Pornography addiction: A neuroscience perspective". Surgical Neurology International 2: 19. doi:10.4103/2152-7806.76977. PMC 3050060. PMID 21427788.
- Reid, R.; Carpenter, B.; Fong, T. (2011). "Neuroscience research fails to support claims that excessive pornography consumption causes brain damage". Surgical Neurology International 2: 64. doi:10.4103/2152-7806.81427. PMC 3115160. PMID 21697978.
- Cooper, Alvin; Putnam, Dana E.; Planchon, Lynn A.; Boies, Sylvain C. (1999). "Online sexual compulsivity: Getting tangled in the net". Sexual Addiction & Compulsivity 6 (2): 79. doi:10.1080/10720169908400182.
- Delmonico, David L. (1997). "Cybersex: High tech sex addiction". Sexual Addiction & Compulsivity 4 (2): 159. doi:10.1080/10720169708400139.
- Layden, Mary Anne, Ph.D. (September 2005). "Cyber Sex Addiction" (PDF). Advances in Cognitive Therapy: 1–2, 4–5.
- Laier, Christian. Cybersex addiction: Craving and cognitive processes. Diss. Universität Duisburg-Essen, Fakultät für Ingenieurwissenschaften» Ingenieurwissenschaften-Campus Duisburg» Abteilung Informatik und Angewandte Kognitionswissenschaft, 2012.
- Stafford, Duncan E (2010). Turned On: Intimacy in a Pornized Society (ISBN 978-0-9564987-1-7). Witting Press, Cambridge
- Cooper, Al (2002). Sex and the Internet: A Guidebook for Clinicians (ISBN 1-58391-355-6) Routledge
- Patrick Carnes (1991). Don't Call It Love: Recovery from Sexual Addiction (ISBN 978-0-553-35138-5) Bantam
- P. Williamson, S. Kisser (1989). Answers In the Heart: Daily Meditations for Men and Women Recovering from Sex Addiction (ISBN 978-0-89486-568-8) Hazelden
- Patrick Carnes (2007). In the Shadows of the Net: Breaking Free of Compulsive Online Sexual Behavior (ISBN 978-1-59285-478-3) Hazelden
- Patrick Carnes (2001). Out of the Shadows: Understanding Sexual Addiction (ISBN 978-1-56838-621-8) Hazelden
- Sex Addicts Anonymous (ISBN 0-9768313-1-7)