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. Universally accepted diagnostic criteria do not exist for pornography addiction or problematic pornography viewing. The rewarding and reinforcing (i.e., addictive) properties of cybersex have been evidenced using cue reactivity experiments with pornographic cues in humans, which supports the classification of cybersex addiction as a true behavioral addiction.
|Addiction and dependence glossary|
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.
Symptoms and diagnosisEdit
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.
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 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, a 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.[unreliable medical source?]
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.— Kirsten Weir, Is pornography addictive?
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."
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-paraphillic expressions of hypersexuality have hypothesized that various mood disorders, as defined in the DSM, may occur more frequently in sexually compulsive men. 
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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.[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. 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.
Society and cultureEdit
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. There is also a PornFree group which focuses on giving up porn rather than masturbation.
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.
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.
- 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.
- Nestler EJ (December 2013). "Cellular basis of memory for addiction". Dialogues Clin. Neurosci. 15 (4): 431–443. PMC . 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.
- "Glossary of Terms". Mount Sinai School of Medicine. Department of Neuroscience. Retrieved 9 February 2015.
- 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.
- 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.
- 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" (PDF). Journal of Behavioral Addictions. 2 (2): 100–107. doi:10.1556/JBA.2.2013.002. PMID 26165929.
- 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.
- 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 . PMID 20560821.
- 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.
- "ASAM Definition of Addiction". 19 April 2011. Retrieved 7 November 2016.
- 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 . PMID 26657963.
- 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.
- 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.
- 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.
- 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.
- Love T, Laier C, Brand M, Hatch L, Hajela R (2015). "Neuroscience of Internet Pornography Addiction: A Review and Update". Behav Sci (Basel). 5 (3): 388–433. doi:10.3390/bs5030388. PMC . PMID 26393658.
- 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.
- 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.
- Since it is none of two behavioral addictions mentioned above.
- 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. See the paragraph beginning with the words "He has little doubt".
- Harkness EL, Mullan B, Mullan BM, Blaszczynski A (2015). "Association between pornography use and sexual risk behaviors in adult consumers: a systematic review". Cyberpsychol Behav Soc Netw. 18 (2): 59–71. doi:10.1089/cyber.2014.0343. PMID 25587721.
- "DEFINITION OF ADDICTION: FREQUENTLY ASKED QUESTIONS" (PDF). American Society of Addiction Medicine. 2011. Retrieved November 5, 2015.
- 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.
- 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.
- Richardson, Bradford (August 10, 2016). "Internet porn addicts behave like drug abusers as enjoyment turns into compulsion". The Washington Times. Retrieved 2016-11-07.
- Laier, Christian. Cybersex addiction: Craving and cognitive processes. Diss. Universität Duisburg-Essen, Fakultät für Ingenieurwissenschaften» Ingenieurwissenschaften-Campus Duisburg» Abteilung Informatik und Angewandte Kognitionswissenschaft, 2012.
- 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.
- Delmonico, David L. (1997). "Cybersex: High tech sex addiction". Sexual Addiction & Compulsivity. 4 (2): 159–167. doi:10.1080/10720169708400139.
- Layden, Mary Anne (September 2005). "Cyber Sex Addiction" (PDF). Advances in Cognitive Therapy: 1–2, 4–5.[permanent dead link]
- 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.
- 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.
- 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.
- Cooper A.; Delmonico D. L.; Burg R. (2000). "Cybersex user, abusers, and compulsives". Sexual Addiction and Compulsivity. 7: 5–29. doi:10.1080/10720160008400205.
- 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.
- 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.
- "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.
- Cowell, Tom (17 September 2013). "No fapping, please, it's making us ill". The Telegraph. London, England: Telegraph Media Group. Retrieved 22 May 2015.
- 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.
- Casper van der Veen (17 August 2016). "'Erectieproblemen bij jongeren door porno op internet' - NRC". Retrieved 20 September 2016.
- 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)
- Rosenberg, Matthew (1999). “Understanding, Assessing, and Treating Sexual Offenders: Tools for the Therapist, downloadable version on stopoffending.com