"Pornography Addiction" in 2017

You can diagnose yourself, but professionals can’t.

Posted Oct 07, 2017

An increasing number of men have been self-referring to psychologists and counselors for ‘pornography addiction.’  While voluntarily seeking help for a mental health issue is praiseworthy, there is one serious challenge: Porn addiction as a mental health disorder does not officially exist.  In formulating the 2013 update of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the standard classification of mental disorders used by mental health professionals in the U.S., the diagnosis of 'hypersexual disorder' was considered for insertion, including a specific subtype for pornography use.  Still, in spite of a heated, contentious, and highly public debate, hypersexual disorder was relegated to a list of conditions requiring further study.  Quality supporting research did not exist at the time, and thus ‘porn addiction’ as a diagnosis does not exist today.  This explains whey we find recent studies using terminology such as 'self-perceived pornography addiction' and 'self-diagnosed porn addiction.'

Even though four years have elapsed since the release of the most recent DSM, there are still continued debate and confusion as to the fundamental aspects of this hypothesized condition.  For example, in reviewing literature on the topic, Duffy et al. (2016) found lack of a consistent definition.  Half of the studies reviewed simply relied on participants’ self-assessments to determine if their pornography use was problematic or excessive (e.g., “Do you think your pornography use is excessive?”).  As a result, the researchers concluded our current understanding of porn addiction is “not grounded in robust evidence.”[i] 

Other studies of porn addiction utilize an arbitrary measurement of “problematic” or “excessive” porn use (e.g., ten or more times in the past three months) in spite of there being any known demarcation point at which porn use becomes extreme.  While there is a common belief that more porn use equates with more problems, even this putative truism is questionable.  As early as 1999, Cooper et al. found that almost half of individuals engaging in eleven or more hours of on-line sexual activity reported it did not interfere with their everyday lives.[ii]  Similarly, Gola et al. (2016) sought to determine if men sought treatment for their porn use because of the amount of time they spent engaging in this activity or due to the consequences of this use.  In their study of 569 heterosexual Caucasian men 18 to 68 years old, including 132 seeking treatment for problematic porn use, the researchers found that frequency of porn use has far less bearing as to whether one seeks treatment in comparison to its consequences.[iii]

Finally, Landripet and Štulhofer (2015) challenged the common assertion that pornography use is harmful to sexual functioning.  Using a large cross-section of men living in three countries, the authors found little evidence for an association between pornography use and male sexual health disturbances. They concluded public concern about pornography use and sexual dysfunctions are misplaced and instead surmised more likely factors are substance abuse, stress, depression, intimacy deficit, and misinformation about sexuality.[iv]

At present we have an unclear and inconsistent definition of pornography addiction.  As a result, no standardized protocol for its treatment exists.  Still, as stated at the beginning of this posting, more and more men are seeking therapeutic help for self-diagnosed porn addiction. This post does not claim porn addiction does not exist, and every aforementioned study acknowledged that some individuals might develop an unhealthy relationship with internet pornography.  How to diagnostically separate these individuals from other males with non-problematic porn use (which, quite frankly, is the majority of males) remains as unclear as it did five years ago.

References

[i] Duffy, Athena, David L. Dawson, and Roshan Das Nair. "Pornography Addiction in Adults: A Systematic Review of Definitions and Reported Impact." The Journal of Sexual Medicine 13, no. 5 (2016): 760-777.

[ii] Cooper, Alvin, Coralie R. Scherer, Sylvain C. Boies, and Barry L. Gordon. "Sexuality on the Internet: From Sexual Exploration to Pathological Expression." Professional Psychology: Research and Practice 30, no. 2 (1999): 154-164.

 [iii] Gola, Mateusz, Karol Lewczuk, and Maciej Skorko. "What Matters: Quantity or Quality of Pornography Use? Psychological and Behavioral Factors of Seeking Treatment for Problematic Pornography Use." The Journal of Sexual Medicine 13, no. 5 (2016): 815-824. 

[iv] Landripet, Ivan, and Aleksandar Štulhofer. “Is Pornography Use Associated with Sexual Difficulties and Dysfunctions Among Younger Heterosexual Men?” The Journal of Sexual Medicine, 12, no. 5 (2015) 1136-1139.