Pornography addiction

Addiction and dependence glossary[1][2][3][4]
  • addiction – a brain disorder characterized by compulsive engagement in rewarding stimuli despite adverse consequences
  • addictive behavior – a behavior that is both rewarding and reinforcing
  • addictive drug – a drug that is both rewarding and reinforcing
  • dependence – an adaptive state associated with a withdrawal syndrome upon cessation of repeated exposure to a stimulus (e.g., drug intake)
  • drug sensitization or reverse tolerance – the escalating effect of a drug resulting from repeated administration at a given dose
  • drug withdrawal – symptoms that occur upon cessation of repeated drug use
  • physical dependence – dependence that involves persistent physical–somatic withdrawal symptoms (e.g., fatigue and delirium tremens)
  • psychological dependence – dependence that involves emotional–motivational withdrawal symptoms (e.g., dysphoria and anhedonia)
  • reinforcing stimuli – stimuli that increase the probability of repeating behaviors paired with them
  • rewarding stimuli – stimuli that the brain interprets as intrinsically positive and desirable or as something to approach
  • sensitization – an amplified response to a stimulus resulting from repeated exposure to it
  • substance use disorder – a condition in which the use of substances leads to clinically and functionally significant impairment or distress
  • tolerance – the diminishing effect of a drug resulting from repeated administration at a given dose

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.

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.[5]

Symptoms and diagnosis

Universally accepted diagnostic criteria do not exist for pornography addiction or problematic pornography viewing.[5] Pornography addiction is often defined operationally by the frequency of pornography viewing and negative consequences.[6] 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.[7]

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.[8] 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.[5]

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,[9] and there is evidence that such changes can occur in internet porn addicts.[10][11]

Diagnostic status

The status of pornography addiction as an addictive disorder, rather than simply a compulsivity, has been hotly contested.[12][13]

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.[14] One other behavioral addiction, internet gaming disorder, appears in the conditions proposed for further study in DSM-5.[14] Psychiatrists cited a lack of research support for refusing to include other behavioral disorders at this time.[14]

Porn addiction is not a diagnosis in DSM-5 (or any previous version).[15][16][17] "Viewing pornography online" is mentioned verbatim inside DSM-5,[14] but it is not considered a mental disorder either.[15][16][17]

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.[15]

— Kirsten Weir, Is pornography addictive?

A number of studies have found neurological markers of addiction in internet porn users,[10][18][19] which is consistent with a large body of research finding similar markers in other kinds of problematic internet users.[18]

The International Classification of Disorders 11 (ICD-11) rejected "pornography addiction". Specifically, the World Health Organization wrote "Based on the limited current data, it would therfore seem premature to include [pornography viewing] in ICD-11." [20]

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.[21] Acceptance and commitment therapy has also been shown to be a potentially effective treatment for problematic internet pornography viewing.[5]

Online pornography

Some clinicians and support organizations recommend voluntary use of Internet content-control software, internet monitoring, or both, to manage online pornography use.[22][23][24]

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.[22] Cognitive therapist Mary Anne Layden suggested that filters may be useful in maintaining environmental control.[24] Internet behavior researcher David Delmonico stated that, despite their limitations, filters may serve as a "frontline of protection."[23]

Medications

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.[25][26][27]

Epidemiology

There is only one representative sample to date concerning distress about sex video use.[28] 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.[29] 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.[30] Research on internet addiction disorder indicates rates may range from 1.5 to 8.2% in Europeans and Americans.[31]

Society and culture

Support groups

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.[32] It serves as a support group for those who wish to avoid the use of pornography, masturbation, and/or sexual intercourse.[33][34] There is also a PornFree group which focuses on giving up porn rather than masturbation.[35] Recent peer-reviewed data highlighted considerable misogyny and poor understanding of sexual relationships in this online community.[36]

Covenant Eyes is a Christian company founded in 2000 whose accountability software is designed to help users overcome porn addiction by monitoring their online activity and sending a report to a trusted friend who holds them accountable for their online choices.

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 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.[37]

Mainstream media

In 2014, American actor Terry Crews talked about his long-standing pornography addiction,[38] which he said had seriously affected his marriage and life, and which he was only able to overcome after entering rehab around 2009 and 2010; he now takes an active role in speaking out about pornography addiction and its impact.[39][40][41]

In 2016, American comedian Chris Rock and his wife divorced,[42] which he attributed to his infidelity and pornography addiction.[43][44] He later discussed the details of his pornography addiction in his 2018 standup comedy special Tamborine.

See also

References

  1. ↑ Malenka RC, Nestler EJ, Hyman SE (2009). "Chapter 15: Reinforcement and Addictive Disorders". In Sydor A, Brown RY. Molecular Neuropharmacology: A Foundation for Clinical Neuroscience (2nd ed.). New York: McGraw-Hill Medical. pp. 364–375. ISBN 9780071481274.
  2. ↑ Nestler EJ (December 2013). "Cellular basis of memory for addiction". Dialogues Clin. Neurosci. 15 (4): 431–443. PMC 3898681. PMID 24459410. 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.
  3. ↑ "Glossary of Terms". Mount Sinai School of Medicine. Department of Neuroscience. Retrieved 9 February 2015.
  4. ↑ Volkow ND, Koob GF, McLellan AT (January 2016). "Neurobiologic Advances from the Brain Disease Model of Addiction". N. Engl. J. Med. 374 (4): 363–371. doi:10.1056/NEJMra1511480. PMID 26816013. 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.
  5. 1 2 3 4 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.
  6. ↑ Duffy, A; Dawson, DL; das Nair, R (May 2016). "Pornography Addiction in Adults: A Systematic Review of Definitions and Reported Impact". The Journal of Sexual Medicine. 13 (5): 760–77. doi:10.1016/j.jsxm.2016.03.002. PMID 27114191.
  7. ↑ 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.
  8. ↑ Kafka, M. P. (2009). "Hypersexual Disorder: A Proposed Diagnosis for DSM-V" (PDF). Archives of Sexual Behavior. 39 (2): 377–400. doi:10.1007/s10508-009-9574-7. PMID 19937105.
  9. ↑ "ASAM Definition of Addiction". 19 April 2011. Retrieved 7 November 2016.
  10. 1 2 Kraus, Shane W; Voon, Valerie; Potenza, Marc N (2015-09-22). "Neurobiology of Compulsive Sexual Behavior: Emerging Science". Neuropsychopharmacology. 41 (1): 385–386. doi:10.1038/npp.2015.300. ISSN 0893-133X. PMC 4677151. PMID 26657963.
  11. ↑ Chatzittofis, Andreas; Arver, Stefan; Öberg, Katarina; Hallberg, Jonas; Nordström, Peter; Jokinen, Jussi (2016-01-01). "HPA axis dysregulation in men with hypersexual disorder". Psychoneuroendocrinology. 63: 247–253. doi:10.1016/j.psyneuen.2015.10.002. ISSN 1873-3360. PMID 26519779.
  12. ↑ 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: 20770. doi:10.3402/snp.v3i0.20770.
  13. ↑ Hilton, Donald L. (21 February 2014). "'High desire', or 'merely' an addiction? A response to Steele et al". Socioaffective Neuroscience & Psychology. 4 (1): 23833. doi:10.3402/snp.v4.23833.
  14. 1 2 3 4 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.
  15. 1 2 3 Weir, Kirsten (April 2014). "Is pornography addictive?". Monitor on Psychology. Washington, D.C. 45 (4): 46. ISSN 1529-4978. OCLC 612512821. Archived from the original on 2014-04-05.
  16. 1 2 Glyn Hudson Allez, ed. (4 June 2014). "Chapter Ten. The pleasure, the power, and the perils of Internet pornography". Sexual Diversity and Sexual Offending: Research, Assessment, and Clinical Treatment in Psychosexual Therapy. Karnac Books. p. 161. ISBN 978-1-78181-368-3.
  17. 1 2 Since it is none of two behavioral addictions mentioned above.
  18. 1 2 Brand, Matthias; Young, Kimberly S.; Laier, Christian; Wölfling, Klaus; Potenza, Marc N. (2016-12-01). "Integrating psychological and neurobiological considerations regarding the development and maintenance of specific Internet-use disorders: An Interaction of Person-Affect-Cognition-Execution (I-PACE) model". Neuroscience & Biobehavioral Reviews. 71: 252–266. doi:10.1016/j.neubiorev.2016.08.033.
  19. ↑ Kühn, S.; Gallinat, J. (2016-01-01). Peterson, Natalie M. Zahr and Eric T., ed. International Review of Neurobiology. Imaging the Addicted Brain. 129. Academic Press. pp. 67–83.
  20. ↑ Grant, J. (2014). "Impulse control disorders and "behavioural addictions" in the ICD‐11". World Psychiatry. 13: 125–127.
  21. ↑ Laier, Christian. Cybersex addiction: Craving and cognitive processes. Diss. Universität Duisburg-Essen, Fakultät für Ingenieurwissenschaften» Ingenieurwissenschaften-Campus Duisburg» Abteilung Informatik und Angewandte Kognitionswissenschaft, 2012.
  22. 1 2 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): 79–104. doi:10.1080/10720169908400182.
  23. 1 2 Delmonico, David L. (1997). "Cybersex: High tech sex addiction". Sexual Addiction & Compulsivity. 4 (2): 159–167. doi:10.1080/10720169708400139.
  24. 1 2 Layden, Mary Anne (September 2005). "Cyber Sex Addiction" (PDF). Advances in Cognitive Therapy: 1–2, 4–5.
  25. ↑ Kafka, M.P., & Hennen, J. (2002). A DSM IV axis I comorbidity study of males (n¼120) with paraphilias and paraphilia-related disorders. Sexual Abuse: A Journal of Research and Treatment. 14. 349–366.
  26. ↑ Kafka, M.P., & Prentky, R.A. (1994). Preliminary observations of DSM III-R axis I comorbidity in men with paraphilias and paraphilia-related disorders. Journal of Clinical Psychiatry. 55. 481–487.
  27. ↑ Kafka, M.P., & Prentky, R.A. (1998). Attention deficit hyperactivity disorder in males with paraphilias and paraphilia-related disorders: a comorbidity study. Journal of Clinical Psychiatry. 1998; 59:388–396.
  28. ↑ Rissel, C; Richters, J.; de Visser, R.; McKee, A.; Yeung, A. (2017). "A profile of pornography users in australia: Findings from the second australian study of health and relationships". he journal of sex research. 54: 227–240. doi:10.1080/00224499.2016.1191597.
  29. ↑ Cooper A.; Delmonico D. L.; Burg R. (2000). "Cybersex user, abusers, and compulsives". Sexual Addiction and Compulsivity. 7: 5–29. doi:10.1080/10720160008400205.
  30. ↑ 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): 253–266. doi:10.1080/10720160903300788.
  31. ↑ 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.
  32. ↑ "NoFap » About". NoFap LLC. Retrieved 22 May 2015. NoFap was originally founded by Alexander Rhodes on June 20, 2011 as a forum on the social media platform 'Reddit' and has since grown to become much more .
  33. ↑ Cowell, Tom (17 September 2013). "No fapping, please, it's making us ill". The Telegraph. London, England: Telegraph Media Group. Retrieved 22 May 2015.
  34. ↑ McMahon, Tamsin (20 January 2014). "Will quitting porn improve your life?: A growing 'NoFap' movement of young men are saying no to porn and masturbation". Maclean's. Toronto, Canada: Rogers Media. Retrieved 22 May 2015.
  35. ↑ Hosie, Rachel (3 May 2017). "INSIDE THE COMMUNITY OF MEN WHO HAVE GIVEN UP PORN". The Independent. Retrieved 2 July 2018.
  36. ↑ Taylor, K.; Jackson, S. (2018). "'I want that power back': Discourses of masculinity within an online pornography abstinence forum". Sexualities. doi:10.1177/1363460717740248.
  37. ↑ Casper van der Veen (17 August 2016). "'Erectieproblemen bij jongeren door porno op internet' - NRC". Retrieved 20 September 2016.
  38. ↑ "No One Wants To Be With The Marlboro Man: Terry Crews On 'Manhood'". NPR.org. May 17, 2014.
  39. ↑ "Terry Crews' New Book Details Struggle With Porn Addiction - Black America Web". Black America Web. May 27, 2014. Archived from the original on May 28, 2014.
  40. ↑ ABC News. "Terry Crews Says Porn Addiction Nearly Ruined His Life". ABC News.
  41. ↑ Brandon Griggs, CNN (February 24, 2016). "Terry Crews: Porn addiction 'messed up my life'". CNN.
  42. ↑ Corriston, Michele (December 28, 2014). "Chris Rock & Wife Malaak Compton-Rock Split". People. Retrieved December 28, 2014.
  43. ↑ Sharf, Zach (February 14, 2018). "Chris Rock Gets Brutally Honest About Porn Addiction and Cheating on His Wife: 'I Wasn't a Good Husband'". Indiewire.com. Retrieved February 14, 2018.
  44. ↑ Bitette, Nicole (August 23, 2016). "Chris Rock, Malaak Compton finalize divorce after 20 years of marriage". NewYork Daily News. Retrieved November 13, 2016.

Further reading

  • Klein, M. (2017). His Porn, Her Pain: Confronting America’s PornPanic With Honest Talk About Sex ( ISBN 1440842868) Praeger
  • Cooper, Al (2002). Sex and the Internet: A Guidebook for Clinicians ( ISBN 1-58391-355-6) Routledge
  • 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 (2001). Out of the Shadows: Understanding Sexual Addiction ( ISBN 978-1-56838-621-8) Hazelden
  • Sex Addicts Anonymous ( ISBN 0-9768313-1-7)
  • Rosenberg, Matthew (1999). “Understanding, Assessing, and Treating Sexual Offenders: Tools for the Therapist, downloadable version on stopoffending.com
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