|Addiction and dependence glossary|
Pornography addiction is an addiction model of compulsive sexual activity with concurrent use of pornographic material, despite negative consequences to one's physical, mental, social, or financial well-being. Neither the DSM-5 nor the ICD-11 classify pornography as a mental disorder or 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 their social life.
Symptoms and diagnosis
Universally accepted diagnostic criteria do not exist for pornography addiction or problematic pornography viewing. Pornography addiction is often defined operationally by the frequency of pornography viewing and negative consequences. 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 subtype 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.
According to the American Society of Addiction Medicine, some psychological and behavioral changes characteristic of addiction brain changes include addictive cravings, impulsiveness, weakened executive function, desensitization, and dysphoria. BOLD fMRI results have shown that individuals diagnosed with compulsive sexual behavior (CSB) show enhanced cue reactivity in brain regions associated traditionally with drug-cue reactivity. These regions include the amygdala and the ventral striatum. Men without CSB who had a long history of viewing pornography exhibited a less intense response to pornographic images in the left ventral putamen, possibly suggestive of desensitization. ASAMs position is inconsistent with the American Association of Sex Educators, Counselors, and Therapists, who cite strong evidence against such classification, describing ASAM as not informed by "by accurate human sexuality knowledge".
The status of pornography addiction as an addictive disorder, rather than simply a compulsivity, has been hotly contested.[unreliable medical source?][unreliable medical source?] Furthermore, research suggests that the use of a pornography addiction label may indicate a socially (as opposed to clinically) driven nosology 
It is worth considering whether the apparent epidemic of self-diagnosed pornography addicts seeking help today perhaps represents the ready uptake of a relatively new way to describe one’s problematic behaviour, and not the development of a modern disease entity whose description should dictate its treatment.— Kris Taylor, Nosology and metaphor: How pornography viewers make sense of pornography addiction
In November 2016, the American Association of Sexuality Educators, Counselors and Therapists (AASECT) issued a position statement on sex/porn addiction which states that AASECT "does not find sufficient empirical evidence to support the classification of sex addiction or porn addiction as a mental health disorder, and does not find the sexual addiction training and treatment methods and educational pedagogies to be adequately informed by accurate human sexuality knowledge. Therefore, it is the position of AASECT that linking problems related to sexual urges, thoughts or behaviors to a porn/sexual addiction process cannot be advanced by AASECT as a standard of practice for sexuality education delivery, counseling or therapy."
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes a new section for behavioral addictions, but includes only one disorder: pathological gambling. One other behavioral addiction, internet gaming disorder, appears in 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.
Porn addiction is not a diagnosis in DSM-5 (or any previous version). "Viewing pornography online" is mentioned verbatim in the DSM-5, but it is not considered a mental disorder either.
When the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was being drafted, experts considered a proposed diagnostic addiction called hypersexual disorder, which also included a pornography subtype. But in the end, reviewers determined that there wasn't enough evidence to include hypersexual disorder or its subtypes in the 2013 edition.— Kirsten Weir, Is pornography addictive?
A number of studies have found neurological markers of addiction in internet porn users, which is consistent with a large body of research finding similar markers in other kinds of problematic internet users. Yet other studies found that critical biomarkers of addiction were missing, and most addiction biomarkers have never been demonstrated for pornography.
The International Classification of Disorders 11 (ICD-11) rejected "pornography addiction". Specifically, the World Health Organization (WHO) wrote: "Based on the limited current data, it would therefore seem premature to include [pornography viewing] in ICD-11."
Introductory psychology textbook authors Coon, Mitterer and Martini, passingly mentioning NoFap, speak of pornography as a "supernormal stimulus" but use the model of compulsion rather than 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.
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."
Studies of those with non-paraphilic expressions of hypersexuality have hypothesized that various mood disorders, as defined in the DSM, may occur more frequently in sexually compulsive men.
Compulsive sexual behavior has been treated with antidepressants including SSRIs and serotonin-norepinephrine reuptake inhibitors, naltrexone, a medication used to inhibit reward mechanisms in opiate or alcohol addictions, other mood-stabilizers, and anti-androgens.
There is only one representative sample to date concerning distress about sex video use. They found that of 10,131 women surveyed, 0.5% of women agreed with the statement that they were "addicted" to pornography; 1.2% (of 4,218 who viewed) when limited to women who say they viewed sex films. The comparable figure limiting to men who view sex films was 4.4%. This was without any clinical screening that should eliminate primary disorders (e.g., depression) or religious-based concerns, so these should be considered high-end estimates for potential disorders, if any exist.
Most studies of rates use a convenience sample. One study of a convenience sample of 9,265 people found that 1% of Internet users have concerns about their Internet use and 17% of users meet criteria for problematic sexual compulsivity, meaning they score above one standard deviation of the mean on the Kalichman Sexual Compulsivity Scale.[full citation needed] A survey of 84 college-age males 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.
Society and culture
Twelve-step programs such as Sex Addicts Anonymous (SAA), Sexaholics Anonymous (SA), Sex and Love Addicts Anonymous (SLAA), Sexual Recovery Anonymous (SRA) and Sexual Compulsives Anonymous (SCA) are fellowships of men and women who share their experience, strength and hope with each other so they may overcome their common problem and help others recover from addiction or dependency, by using the 12 steps of AA and other recovery tools.
NoFap is an online community founded in 2011. It serves as a support group for those who wish to avoid the use of pornography, masturbation, and/or sexual intercourse. Recent peer-reviewed data highlighted considerable misogyny and poor understanding of sexual relationships in this online community.
Additionally, Fight the New Drug, a Salt Lake City based non-profit, is a non-religious and non-legislative organization, which seeks to inform and educate individuals regarding pornography usage with science and personal stories. It is aimed at the youth demographic to raise awareness of potential problems with pornography
Celebrate Recovery (CR) is a Christian inter-denominational 12 step program with about 35,000 available groups and is open to any person who is struggling with life's bad habits, hurts, and hang-ups. CR was started in 1991 at Saddleback Church in CA, and the CR program is based on the 8 Beatitudes from Christ's sermon on the Mountain, and Twelve-step programs from Alcoholics Anonymous.
Political and religious motivation
According to professor E.T.M. Laan, a sexologist working for the Academic Medical Center, it is usually the American religious right which claims the existence of pornography addiction and such claims are rare among sexologists.
A meta-analysis showed a correlation between a person being religious and perceiving themself as having a pornography addiction, possibly due to people using pornography despite their religion prohibiting it.
In 2013, American actor Joseph Gordon-Levitt wrote, directed, and starred in the comedy-drama film Don Jon, in which the protagonist is addicted to pornography. In an interview to promote the film, Gordon-Levitt discussed what he referred to as the "fundamental difference between a human being and an image on a screen".
In his 2014 autobiography, American actor Terry Crews talked about his long-standing pornography addiction, which he said had seriously affected his marriage and life and which he was only able to overcome after entering rehab in 2009. He now takes an active role in speaking out about pornography addiction and its impact.
In 2015, English comedian Russell Brand appeared in videos by American anti-pornography group Fight the New Drug, in which he discussed pornography and its harmful effects. Later that year, American actress Rashida Jones produced the documentary Hot Girls Wanted, which gave an in-depth look into the exploitation of women in the pornography industry.
In 2016, American comedian Chris Rock and his wife Malaak Compton divorced after 20 years of marriage, which Rock attributed to his infidelity and pornography addiction. He later discussed the details of his pornography addiction in his 2018 stand-up comedy special Tamborine.
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Despite the importance of numerous psychosocial factors, at its core, drug addiction involves a biological process: the ability of repeated exposure to a drug of abuse to induce changes in a vulnerable brain that drive the compulsive seeking and taking of drugs, and loss of control over drug use, that define a state of addiction. ... A large body of literature has demonstrated that such ΔFosB induction in D1-type [nucleus accumbens] neurons increases an animal's sensitivity to drug as well as natural rewards and promotes drug self-administration, presumably through a process of positive reinforcement ... Another ΔFosB target is cFos: as ΔFosB accumulates with repeated drug exposure it represses c-Fos and contributes to the molecular switch whereby ΔFosB is selectively induced in the chronic drug-treated state.41. ... Moreover, there is increasing evidence that, despite a range of genetic risks for addiction across the population, exposure to sufficiently high doses of a drug for long periods of time can transform someone who has relatively lower genetic loading into an addict.
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Substance-use disorder: A diagnostic term in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) referring to recurrent use of alcohol or other drugs that causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. Depending on the level of severity, this disorder is classified as mild, moderate, or severe.
Addiction: A term used to indicate the most severe, chronic stage of substance-use disorder, in which there is a substantial loss of self-control, as indicated by compulsive drug taking despite the desire to stop taking the drug. In the DSM-5, the term addiction is synonymous with the classification of severe substance-use disorder.
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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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