Pornography addiction

Addiction and dependence glossary[1][2][3][4]
• addiction – a medical condition 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 or as something to be approached
• 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. Universally accepted diagnostic criteria do not exist for pornography addiction or problematic pornography viewing.[5] 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.[6]

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.[7] 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.[8]

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.[9] 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,[10] and there is evidence that such changes can occur in internet porn addicts.[11][12]

Diagnostic status

The status of pornography addiction as an addictive disorder, rather than simply a compulsivity, has been hotly contested.[13][14] 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.[15] One other behavioral addiction, Internet gaming disorder, appears in the conditions proposed for further study in DSM-5.[15] Psychiatrists cited a lack of research support for refusing to include other behavioral disorders at this time,[15] 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.[16]

Porn addiction is not a diagnosis in DSM-5 (or any previous version).[17][18][19] "Viewing pornography online" is mentioned verbatim inside DSM-5,[15] but it is not considered a mental disorder either.[17][18][19]

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.[17]
— 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,[20][21] though he also suggested that "most people would do it and it won’t become a problem."[20]

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.[22] 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.,[11][23][24] which is consistent with a large body of research finding similar markers in other kinds of problematic internet users.[23] 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."[25]

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.[26] 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.[27][28][29]

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.[27] Cognitive therapist Mary Anne Layden suggested that filters may be useful in maintaining environmental control.[29] Internet behavior researcher David Delmonico stated that, despite their limitations, filters may serve as a "frontline of protection."[28]

Support groups

Further information: NoFap

NoFap is an online community founded in 2011.[30] It serves as a support group for those who wish to avoid the use of pornography, masturbation, and/or sexual intercourse.[31][32]

Medications

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.[33] 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.[34] Research on Internet addiction disorder indicates rates may range from 1.5 to 8.2% in Europeans and Americans.[35] 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.[36]

Religion effect

A 2014 released study identified a connection between a subjects religious beliefs and their self perception of pornography addiction.[37][38][39][40][41] 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.[40] 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.[41][42]

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.[43][44] 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.[45][46][47][48]

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 the sexologists.[49]

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 3898681Freely accessible. PMID 24459410.
  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.
  5. 1 2 3 4 5 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. ↑ 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.
  7. ↑ 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.
  8. ↑ 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 3164585Freely accessible. PMID 20560821.
  9. ↑ 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.
  10. ↑ "ASAM Definition of Addiction". 19 April 2011. Retrieved 7 November 2016.
  11. 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 4677151Freely accessible. PMID 26657963.
  12. ↑ 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.
  13. ↑ 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. doi:10.3402/snp.v3i0.20770.
  14. ↑ http://www.socioaffectiveneuroscipsychol.net/index.php/snp/article/view/23833/32589 "‘High desire’, or ‘merely’ an addiction? A response to Steele et al."
  15. 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.
  16. ↑ 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. PMID 26393658.
  17. 1 2 3 Weir, Kirsten (April 2014). "Is pornography addictive?". Monitor on Psychology. Washington, D.C. 45 (4): 46. ISSN 1529-4978. OCLC 612512821.
  18. 1 2 Hall, Paula (2014). "Chapter Ten. The pleasure, the power, and the perils of Internet pornography". In Hudson Allez, Glyn. Sexual Diversity and Sexual Offending: Research, Assessment, and Clinical Treatment in Psychosexual Therapy. Karnac Books. p. 161. ISBN 9781781813683.
  19. 1 2 Since it is none of two behavioral addictions mentioned above.
  20. 1 2 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".
  21. ↑ 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: 59–71. doi:10.1089/cyber.2014.0343. PMID 25587721.
  22. ↑ "DEFINITION OF ADDICTION: FREQUENTLY ASKED QUESTIONS" (PDF). American Society of Addiction Medicine. 2011. Archived from the original (PDF) on November 5, 2015. Retrieved November 5, 2015.
  23. 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.
  24. ↑ 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.
  25. ↑ http://www.washingtontimes.com, The Washington Times. "Internet porn addicts behave like drug abusers as enjoyment turns into compulsion". The Washington Times. Retrieved 2016-11-07.
  26. ↑ Laier, Christian. Cybersex addiction: Craving and cognitive processes. Diss. Universität Duisburg-Essen, Fakultät für Ingenieurwissenschaften» Ingenieurwissenschaften-Campus Duisburg» Abteilung Informatik und Angewandte Kognitionswissenschaft, 2012.
  27. 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.
  28. 1 2 Delmonico, David L. (1997). "Cybersex: High tech sex addiction". Sexual Addiction & Compulsivity. 4 (2): 159–167. doi:10.1080/10720169708400139.
  29. 1 2 Layden, Mary Anne (September 2005). "Cyber Sex Addiction" (PDF). Advances in Cognitive Therapy: 1–2, 4–5.
  30. ↑ "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.
  31. ↑ Cowell, Tom (17 September 2013). "No fapping, please, it's making us ill". The Telegraph. London, England: Telegraph Media Group. Retrieved 22 May 2015.
  32. ↑ 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.
  33. ↑ Cooper A.; Delmonico D. L.; Burg R. (2000). "Cybersex user, abusers, and compulsives". Sexual Addiction and Compulsivity. 7: 5–29. doi:10.1080/10720160008400205.
  34. ↑ 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.
  35. ↑ 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.
  36. ↑ 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.
  37. ↑ Grubbs, Joshua B.; Exline, Julie J.; Pargament, Kenneth I.; Hook, Joshua N.; Carlisle, Robert D. (12 February 2014). "Transgression as Addiction: Religiosity and Moral Disapproval as Predictors of Perceived Addiction to Pornography". Archives of Sexual Behavior. 44 (1): 125–136. doi:10.1007/s10508-013-0257-z. ISSN 0004-0002. Retrieved 1 May 2014.
  38. ↑ David J Ley (15 September 2015). "Your Belief in Porn Addiction Makes Things Worse: The label of "porn addict" causes depression but porn watching doesn't.". Retrieved 20 October 2015.
  39. ↑ "Religious People More Likely To Feel They're Addicted To Porn, New Study Shows". Retrieved 20 October 2015.
  40. 1 2 Staff. "Christians fear porn addiction: A psychology study found that people who regard themselves as very religious may regard themselves as addicts – even if they watch internet porn only once.". Health24.com. Retrieved 4 April 2014.
  41. ↑ Abel, Jennifer. "Researchers: pornography addiction isn't real: Though self-identified porn addicts are probably sincere". Consumer Affairs. Retrieved 1 May 2014.
  42. ↑ http://www.newrepublic.com/article/119119/secular-sociologist-studies-evangelical-virgin-men-who-got-married
  43. ↑ https://theconversation.com/what-happens-to-men-who-stay-abstinent-until-marriage-47898
  44. ↑ Dagmar Herzog (2008). Sex in Crisis: The New Sexual Revolution and the Future of American Politics. Basic Books. ISBN 978-0-465-00214-6.
  45. ↑ http://www.marketwired.com/press-release/christianet-poll-finds-that-evangelicals-are-addicted-to-porn-703951.htm
  46. ↑ http://www.washingtontimes.com/news/2014/aug/24/more-than-half-of-christian-men-admit-to-watching-/?page=all
  47. ↑ Paul Olaf Chelsen (2011). "An Examination of Internet Pornography Usage Among Male Students at Evangelical Christian Colleges". Loyola University Chicago. 79.3 percent of male undergraduate students at Evangelical colleges reported accessing Internet pornography at some point in the previous year, with 61.1 percent reported accessing Internet pornography at least some amount of time each week
  48. ↑ Casper van der Veen (17 August 2016). "'Erectieproblemen bij jongeren door porno op internet' - NRC". Retrieved 20 September 2016.

Further reading

External links

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