Pornography addiction

Template:Short description Pornography addiction is the scientifically controversial<ref name="contro">Sources for 'controversial':Template:Bulleted list</ref> application of an addiction model to the use of pornography.<ref name=":1">Template:Cite encyclopedia</ref> Pornography use may be part of compulsive behavior, with negative consequences to one's physical, mental, social, or financial well-being. While the World Health Organization's ICD-11 (2022) has recognized compulsive sexual behaviour disorder (CSBD) as an impulse-control disorder,<ref>Template:Cite web</ref> CSBD is not an addiction,<ref name="Martinez-Gilliard 2023 p. 113">Template:Cite book</ref><ref name="Pontes 2022 p. 163">Sources for 'not an addiction':Template:Bulleted list</ref> and the American Psychiatric Association's DSM-5 and the DSM-5-TR do not classify compulsive pornography consumption as a mental disorder or a behavioral addiction.<ref name="Martinez-Gilliard 2023 p. 113"/><ref name=weir/><ref name="allez"/>

Problematic Internet pornography viewing, also known as Problematic Pornography Use (PPU) is the viewing of Internet pornography that is problematic for an individual due to personal or social reasons, including the excessive time spent viewing pornography instead of interacting with others and the facilitation of procrastination. 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 lives.<ref name="Taylor"/>

Diagnosis

Pornography addiction is often defined operationally by the frequency of pornography viewing and negative consequences.<ref name="Duffy">Template:Cite journal</ref> The only diagnostic criteria for a behavioral addiction in the DSM-5 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.<ref name="r942">Template:Cite journal</ref>

A proposed diagnosis for hypersexual disorder includes pornography as a subtype of this disorder. It includes criteria such 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.<ref>Template:Cite journal</ref>

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.<ref>Template:Cite web</ref> 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.<ref name="Kraus 2097–2106">Template:Cite journal</ref><ref name="Neuropsychopharmacology">Template:Cite journal</ref> These regions include the amygdala and the ventral striatum.<ref name="Kraus 2097–2106"/><ref name="Neuropsychopharmacology"/> 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.<ref name="Kraus 2097–2106"/>

The position of the American Society of Addiction Medicine is that sexual addiction is not a recognized diagnosis.Template:Sfn

Neuropsychopharmacological and psychological research on pornography addiction conducted between 2015 and 2021 have concluded that most studies have been focused entirely or almost exclusively on men in anonymous settings, and the findings are contradictory.<ref name="Neuropsychopharmacology"/> Some researchers support the idea that pornography addiction qualifies as a form of behavioral addiction under the umbrella construct of hypersexual behavior or a subset of compulsive sexual behavior (CSB),<ref name="Hilton1">Template:Cite journal</ref> and should be treated as such, whereas others have detected the increased activation of ventral striatal reactivity in men for cues predicting erotic but not monetary rewards and cues signaling erotic pictures, therefore suggesting similarities between pornography addiction and conventional addiction disorders.<ref name="Neuropsychopharmacology"/>

Despite the fact that pornography is being spuriouslyTemplate:Sfn indicted as a public health crisis in the United States and elsewhere,<ref name="nelroth2020">Template:Cite journal</ref><ref name="auto">Template:Cite book</ref> with problematic Internet and online pornography use reported to constitute an increasing burden on public mental health since the 2000s, psychopathological models and diagnostic criteria have lacked consensus, and the body of evidence on the effectiveness of therapeutic approaches is still scarce.Template:Citation needed

Paula Hall supports the use of an addiction framework to understand and treat problematic pornography use, and she advocates for recognizing porn addiction as a legitimate clinical issue.<ref name="v923">Template:Cite book</ref>

A 2016 systemic review found that studies have linked self-perceived pornography addiction (SPPA) to increased isolation and relationship breakdowns for both users and their partners, though the researchers never say that it constitutes an official psychiatric disorder.<ref>Template:Cite journal</ref>

Hunt (2021) stated that porn is part of culture, and therefore hard to tell what produces harm.<ref>Template:Cite book</ref>

A 2024 review supports a diagnosis of pornography addiction as a public health crisis, but it is based upon a page published by the American Psychiatric Association, which in its turn is based upon an MDPI paper, rather than upon the statistical processing of empirical data by the reviewers.<ref name="q743">Template:Cite journal</ref>

A 2025 systematic review about pornography use by adolescents says that further research is needed. That is, the existing evidence is of limited use for psychiatry (rather inconclusive for a diagnosis). The review described the evidence as heterogeneous and limited.<ref name="n039">Template:Cite journal</ref>

A 2025 public policy research, including about teenagers using pornographic media, says "The evidence to substantiate these assertions remains preliminary" (causality cannot be shown). That is, the existing evidence does not support public policy stances about how teenagers use media. However, the review did not concentrate upon pornography use, and just mentioned it passingly.<ref name="w455">Template:Cite journal</ref>

Diagnostic status

Pornography addiction is a controversial concept, since it appears to be "largely morally, ideologically, and politically motivated."Template:Sfn Although it is a "nice theory", empirical support for it is largely missing,<ref name="z537"/> and the "industry of porn/sex addiction is based on conservative moral values around sexuality that intrude into clinical practice".<ref name="z537">Template:Cite book</ref> Julie Sale stated "No-one refutes that clients access therapy for help with sexual behaviours that they feel they have no control over. The issue is how these client experiences are conceptualised and how the clinical formulation informs treatment."<ref>Sale, Julie "Preface" in Template:Harvnb</ref>

The status of pornography addiction as an addictive disorder, rather than simply a compulsivity, has been hotly contested.<ref name=Steeleetal2013>Template:Cite journal</ref>Template:Medrs<ref name="Hilton2">Template:Cite journal</ref>Template:Medrs Furthermore, research suggests that the use of a pornography addiction label may indicate a socially (as opposed to clinically) driven nosology.<ref name="Taylor">Template:Cite journal</ref>

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."<ref>Template:Cite web</ref>

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) includes a new section for behavioral addictions, but includes only one disorder: pathological gambling.<ref name="dsm-5">Template:Cite book</ref> One other behavioral addiction, internet gaming disorder, appears in the conditions proposed for further study in DSM-5.<ref name="dsm-5" /> Psychiatrists cited a lack of research support for refusing to include other behavioral disorders, such as pornography, at the time.<ref name="dsm-5" />

Porn addiction is not a diagnosis in DSM-5 (or any previous version).<ref name=weir>Template:Cite journal</ref><ref name="allez">Template:Cite book</ref><ref name=othertwo>Since it is neither of two behavioral addictions mentioned above.</ref> "Viewing pornography online" is mentioned verbatim in the DSM-5,<ref name=dsm-5/> but it is not considered a mental disorder either.<ref name=weir/><ref name=allez/><ref name=othertwo/>

A number of studies have found neurological markers of addiction in internet porn users,<ref name="Kraus 385–386">Template:Cite journal</ref><ref name=":0">Template:Cite journal</ref><ref>Template:Cite journal</ref> which is consistent with a large body of research finding similar markers in other kinds of problematic internet users.<ref name=":0" /> Yet other studies found that critical biomarkers of addiction were missing.<ref name="Steele2">Template:Cite journal</ref>

The International Classification of Disorders 11 (ICD-11) rejected "pornography addiction".<ref name="Martinez-Gilliard 2023 p. 113"/><ref>Sources for 'rejected':Template:Bulleted list</ref><ref name="Prause Binnie 2023"/> Specifically, the World Health Organization (WHO) wrote: "Based on the limited current data, it would therefore seem premature to include [problematic Internet use] in ICD-11."<ref name="h760">Template:Cite journal</ref>

However, ICD-11 does include the "Compulsive sexual behaviour disorder" (CSBD)<ref>Template:Cite book</ref> in the "impulse control disorders" section. It is defined as "a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour." David J. Ley argued that that is not an endorsement of the concept of pornography addiction.Template:Sfn ICD also specifically excludes anyone from this diagnosis whose distress is due to moral conflict alone, yet moral incongruence is the strongest predictor of believing one is addicted to porn.<ref name="Grubbs Perry Wilt Reid 2018 pp. 397–415">Template:Cite journal</ref> Note that two studies now contradict this, finding that narcissism,<ref name="Prause Binnie 2023">Template:Cite journal</ref> especially antagonistic narcissism,<ref name="Grubbs Tahk Fernandez Fernandez 2023 p. 104419">Template:Cite journal</ref> predicts identification as a pornography addict.

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.<ref name="CoonMitterer2016">Template:Cite book</ref> Addiction and compulsion are models of mental disorders that cancel each other out,<ref name="Heather 2017 pp. 15–38">Template:Cite journal</ref><ref name="Go Ask Alice!">Template:Cite web</ref><ref name="Munson Knauer 2014 p. 54">Template:Cite book</ref> the term "addiction" being deprecated,<ref>Template:Cite book</ref> but ICD-11 does not support the existence of "porn addiction"/"sex addiction".Template:Sfn<ref name="DPB">Sources for 'ICD-11':Template:Bulleted list</ref><ref name="kru">Template:Cite book</ref>

DSM-5-TR, published in March 2022, does not recognize a diagnosis of sexual addiction/compulsion (which would include internet pornography viewing).<ref name="Martinez-Gilliard 2023 p. 113"/><ref name="American Psychiatric Association 2022 ch. 29">Template:Cite book</ref><ref name="American Psychiatric Association 2022 ch. 19">Template:Cite book</ref>

ICD-11 has added pornography to CSBD.<ref name="ICD-11 2022">Template:Cite web</ref> However, this is categorized as an impulse control disorder, not an addictive disorder.Template:Sfn<ref name="DPB" /><ref name="ICD-11 2022"/> It has been argued that the CSBD diagnosis is not based upon sex research.<ref name="Briken Turner pp. 222–225">Template:Cite journal</ref>

Neither DSM-5, nor DSM-5-TR, nor ICD-10, nor ICD-11 recognize sex addiction or porn addiction as a valid diagnosis.<ref name="Martinez-Gilliard 2023 p. 113"/><ref name="Prause Binnie 2023"/><ref name="DPB" /> Rothman has stated "pornography is not yet clearly established as a risk factor for multiple health outcomes".Template:Sfn

The 2020 view about problematic pornography use (PPU) is that addiction is the wrong model for it.<ref name="d127">Template:Cite book</ref>

A 2022 book by McKee, Litsou, Byron, and Ingham casts serious doubts upon the model of "porn addiction", suggesting that sexual shame should be blamed, instead of pornography.Template:Sfn They note that much of the research on the effects of pornography often confuses correlation with causation,<ref name="McKee">Template:Cite book</ref> and that much pornography research has been normative (i.e. moralistic) instead of descriptive.<ref name="McKee"/>

Even scientists who find a problem with excessive pornography consumption state that moderate pornography consumption is healthy.<ref name="i579">Template:Cite journal</ref>

According to a 2024 book, "The truth is most sex therapists and educators do not prescribe to the idea of sex addiction."<ref name="a863">Template:Cite book</ref>

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.<ref>Laier, Christian. Cybersex addiction: Craving and cognitive processes Template:Webarchive. Diss. Universität Duisburg-Essen, Fakultät für Ingenieurwissenschaften» Ingenieurwissenschaften-Campus Duisburg» Abteilung Informatik und Angewandte Kognitionswissenschaft, 2012.</ref>

Online pornography

Template:See also Some clinicians and support organizations recommend voluntary use of Internet content-control software, internet monitoring, or both, to manage online pornography use.<ref name="cooper1999">Template:Cite journal</ref><ref name="delmonico1997">Template:Cite journal</ref><ref name="layden2005">Template:Cite journalTemplate:Dead link</ref> 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.<ref name=cooper1999/> Cognitive therapist Mary Anne Layden suggested that filters may be useful in maintaining environmental control.<ref name=layden2005/> Internet behavior researcher David Delmonico stated that, despite their limitations, filters may serve as a "frontline of protection."<ref name=delmonico1997/>

Medications

Template:See also 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.<ref name="c674">Template:Cite journal</ref><ref name="p360">Template:Cite journal</ref><ref name="u917">Template:Cite journal</ref>

Compulsive sexual behavior has been treated with antidepressants including selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs), naltrexone (a medication used to inhibit reward mechanisms in opioid or alcohol addictions), mood stabilizers, and antiandrogens.

Prevalence

The prevalence rate of problematic pornography consumption ranges from 0.20% to 57.40%, with the overall prevalence rate being 13.00% and the prevalence rate with taking publication bias into account being 8%. The prevalence rate varies by region. Asia has the highest prevalence rate (19.00%), followed by Europe (11.00%), North America (7.00%) and Australia (5.00%). Gender, age and user type had no influence on the prevalence rate, but the instruments used to assess problematic pornography consumption did have an influence: BPS had the highest prevalence rate (21.00%), followed by PPCS-6 (16.00%), other psychometric instruments (14.00%), PPCS (12.00%) and ad hoc scales (6.00%), which could be explained by the lack of official diagnostic criteria for PPU as a distinct disorder and the methodology of the instrument. The higher prevalence rate in the Asian region could be explained by the relatively conservative cultures in which pornography is often considered taboo or even illegal (e.g. Malaysia). Specifically, this could be explained by the 'forbidden fruit effect,' in which the frequency of a behaviour increases because it is prohibited.<ref>Template:Cite journal</ref>

Society and culture

Support groups

Several support groups exist for people who wish to quit pornography use and/or believe themselves to be addicted to pornography. 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 twelve-step program borrowed from Alcoholics Anonymous (AA) and other recovery tools.<ref>Template:Cite journal</ref>

NoFap is a website and community forum founded in 2011 that serves as a support group for those who wish to give up pornography and masturbation.<ref name="Burnett 2021">Template:Cite journal</ref> It serves as a support group for those who wish to avoid the use of pornography, masturbation, and/or sexual intercourse.<ref name="Burnett 2021"/><ref>Template:Cite newsTemplate:Cbignore</ref><ref>Template:Cite news</ref> Recent peer-reviewed data highlighted considerable levels of misogyny along with a poor understanding of human sexuality and relationships within this online community.<ref>Template:Cite journal</ref> Sociologist Kelsy Burke, author of The Pornography Wars, believes that this misogyny arises from blaming the female-dominated profession of pornography for men's personal problems.<ref name="Hagen">Template:Cite news</ref> The Daily Dot and Der Spiegel linked NoFap to recent gender-based murders and breeding domestic terrorism.<ref name="The Daily Dot 2021">Template:Cite web</ref><ref name="Rosenbach Müller Höfner Baumgärtner 2021">Template:Cite web</ref>

Fight the New Drug, a Salt Lake City-based non-profit organization founded by members of the Church of Jesus Christ of Latter-day Saints,<ref name="LaPlante 2018">Template:Cite news</ref><ref name="beast">Template:Cite news</ref> is a non-legislative organization which claims to seek to inform and educate individuals regarding pornography usage with science and personal stories. It is aimed at the youth demographic. There is also a PornFree reddit group that focuses on giving up porn rather than masturbation.<ref>Template:Cite news</ref><ref>Template:Cite web</ref>

Celebrate Recovery is a Christian interdenominational twelve-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.<ref>Template:Cite web</ref> Celebrate Recovery was started in 1991 at Saddleback Church in California, and their program is based on the Beatitudes from the biblical Sermon on the Plain and the twelve-step program from Alcoholics Anonymous.<ref>Template:Cite web</ref>

Religious and political factors

According to professor Template:Ill, 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 (scarce) among sexologists.<ref>Template:Cite news</ref> A 2018 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.<ref name="Grubbs Perry Wilt Reid 2018 pp. 397–415"/><ref name="stopped">Template:Cite web</ref><ref>Template:Citation</ref>

According to Addicted to Lust: Pornography in the Lives of Conservative Protestants (2019) written by Samuel L. Perry, professor of sociology at the University of Oklahoma, conservative Protestants in the United States are characterized by a "sexual exceptionalism" related to their consumption of pornography due to certain pervasive beliefs within the Conservative Protestant subculture, which entails cognitive dissonance associated with the unfounded conviction to be addicted to pornography, psychological distress, and intense feelings of guilt, shame, self-loathing, depression, and sometimes withdrawal from faith altogether.<ref>Template:Cite book</ref><ref name="Chotiner 2019">Template:Cite magazine</ref>

Perry's book received widespread media coverage<ref name="Chotiner 2019"/><ref name="Stone 2019">Template:Cite magazine</ref> and his findings were criticized by Lyman Stone of the Evangelical magazine Christianity Today, which asserted that both the quantitative and qualitative statistical data collected by Perry demonstrate that the consumption of pornography in the United States is significantly lower among church-attending Protestant Christians compared to other religious groups, and declared that "Protestant men today who attend church regularly are basically the only men in America still resisting the cultural norm of regularized pornography use".<ref name="Stone 2019"/>

The overwhelming majority of all websites and YouTube channels devoted to anti-masturbation and anti-porn addiction propaganda, channels and websites supporting NoFap included, are, according to various sources, owned by far-right Christian fundamentalists and conservative biblical inerrantists, and are also entirely political in nature.<ref name="Burnett 2021"/><ref name="DLey 2018">Template:Cite web</ref> Various psychologists, medical doctors, and social scientists have contended that traditional Christian concerns over combating sexual thoughts, desires, and activities, including masturbation,<ref>Template:Cite book</ref><ref>Template:Cite journal</ref><ref>Template:Cite book</ref><ref>Template:Cite book</ref><ref>Template:Cite book</ref> can be seen as unhealthy and unwholesome. This may also apply to secular advocacy of anti-pornography and anti-masturbation,<ref name="nelroth2020"/><ref name="auto"/> including 16 U.S. states' legislatures which have declared that pornography is a "public health crisis".<ref name="nelroth2020"/><ref name="Governing 2019">Template:Cite web</ref>

The American Psychiatric Association had by then already dismissed such moral panic ("political stunt")<ref name="nelroth2020"/> in DSM-5 (published in 2013),<ref name=weir/> and DSM-5-TR, published in March 2022, does not recognize a diagnosis of sexual addiction (which would include internet pornography viewing).<ref name="American Psychiatric Association 2022 ch. 29"/><ref name="American Psychiatric Association 2022 ch. 19"/>

Emily F. Rothman, professor of Community Health Sciences at the Boston University School of Public Health, stated in 2021 that "the professional public health community is not behind the recent push to declare pornography a public health crisis".Template:Sfn The ideas supporting the "crisis" have been described as pseudoscientific.<ref name="de Jong Faulkenberry Konda Joyner 2022 p.">Template:Cite book</ref>

In many cases, sexual addiction therapy applied to gay men is akin to conversion therapy.<ref>Sources for 'conversion therapy':Template:Bulleted list</ref>

According to a book published by the evangelical<ref name="u873">Template:Cite web</ref><ref name="t849">Template:Cite web</ref> publisher Thomas Nelson, pornography addiction does exist.<ref name="a455">Template:Cite book</ref>

Conservative Protestant men often claim to be porn addicts, even if their usage of pornography is very modest,<ref name="i969">Template:Cite book</ref> while Christian nationalists are more likely than others to see themselves as pornography addicts.<ref name="c063">Template:Cite book</ref>

Mainstream media

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.<ref>Template:Cite web</ref> 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".<ref name="Minow">Template:Cite web</ref>

In 2014, 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 able to overcome only after entering rehab in 2009.<ref>Template:Cite web</ref> He now takes an active role in speaking out about pornography addiction and its impact.<ref>Template:Cite web</ref><ref>Template:Cite web</ref><ref>Template:Cite web</ref>

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.<ref name="y843">Template:Cite web</ref>

In 2016, American comedian Chris Rock and his wife, Malaak Compton, divorced after 20 years of marriage,<ref>Template:Cite news</ref> which Rock attributed to his infidelity and pornography addiction.<ref>Template:Cite news</ref> He later discussed the details of his pornography addiction in his 2018 stand-up comedy special Tamborine.<ref>Template:Cite web</ref>

See also

• Accountability software
• Anti-pornography movement
• Content-control software
• National Center on Sexual Exploitation
• Rational Recovery
• Sexaholics Anonymous
• Sex Addicts Anonymous
• Sexual ethics
• Sexual addiction

Further reading

• Klein, M. (2017). His Porn, Her Pain: Confronting America's Porn Panic With Honest Talk About Sex (Template:ISBN) Praeger
• Cooper, Al (2002). Sex and the Internet: A Guidebook for Clinicians (Template:ISBN) Routledge
• P. Williamson, S. Kisser (1989). Answers In the Heart: Daily Meditations for Men and Women Recovering from Sex Addiction (Template:ISBN) Hazelden
• Patrick Carnes (2001). Out of the Shadows: Understanding Sexual Addiction (Template:ISBN) Hazelden
• Sex Addicts Anonymous (Template:ISBN)
• Rosenberg, Matthew (1999). "Understanding, Assessing, and Treating Sexual Offenders: Tools for the Therapist, downloadable version on stopoffending.com
• Template:Cite web

External links

• Pornography addiction at Medical News Today