Pornography addiction

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 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.

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, and there is evidence that such changes can occur in internet porn addicts.

Diagnostic status

The status of pornography addiction as an addictive disorder, rather than simply a compulsivity, has been hotly contested. 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. 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, however, an extensive 2015 review of the neuroscience/neuropsych studies on pornography users now calls for internet addiction to be included in the DSM with internet pornography addiction as a subtype.

Porn addiction is not a diagnosis in DSM-5 (or any previous version). "Viewing pornography online" is mentioned verbatim inside 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.

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, though he also suggested that "most people would do it and it won’t become a 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. However, this definition does not explicitly include porn addiction. Instead ASAM uses the phrase, "sexual behavior addiction".

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. According to addiction researcher Todd Love: "“There’s a growing consensus among the top addiction neuroscientists worldwide that internet porn use alters some users’ brains in some of the same ways substance abuse does, and that these brain changes are consistent with the established addiction model."

Treatment

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.

Online pornography

Some clinicians and support organizations recommend voluntary use of Internet content-control software, Internet monitoring, or both, to manage online pornography use.

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."

Support groups

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.

Epidemiology

Most studies of rates use a convenience sample. One study of a convenience sample of 9,265 people found that 1% of Internet users are clearly addicted to cybersex 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. 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. 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.

Religion effect

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 Behavior. 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.

Sarah Diefendorf, a sociologist at the University of Washington, found that Evangelical men who took an abstinence pledge before marriage "still struggle with issues like excessive pornography viewing, masturbation" when married. In one study, half of Christian pastors said they used porn in the last year, and in another, roughly 50% of Christian men and 20% of Christian women self-report being addicted to porn.

Political motivation

According to E.T.M. Laan, a sexologist working for the Academic Medical Center, it is usually the religious right which claims the existence of pornography addiction and such claims are rare among sexologists.