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An insight into the empirical research available in regards to Sex Addiction, paying particular
attention to whether Pornography can be deemed a behavioural addiction.
Nicola Falzon
Department of Psychology
University of Malta
(May, 2015)
1
AUTHOR’S NOTE
This paper was presented as an assessment for the study unit PSY3159 entitled ‘Addictive
Behavior’ in part fulfilment of the requirements for the degree of Bachelor of Psychology
March 2015
2
INTRODUCTION
Addiction refers to an individual becoming intensely preoccupied with a behaviour that primarily
is acted upon to achieve a desired satiation effect. As cited from Sussman et al. ‘s (2011) study,
“the appetitive effect generally is equated with changes in firing in the mesolimbic dopaminergic
system, but there are numerous brain neurotransmission and hormonal systems involved,
axis (HPA), among others; associated with subjective reports of arousal, pleasure, or fantasy
(Brewer & Potenza, 2008; Johansson et al. , 2009; Schneider & Irons, 2001; Volkow & Wise,
2005). Continued repetition of the behaviour results in a loss of ability to choose whether to
proceed with the behavior or terminate it, hence, the person experiences a loss of control which
Through their literature research on the meaning of addiction, Sussman and Sussman (2011)
derive five elements of addiction from 52 studies which include: " (a) ‘’engagement in the
behaviour to achieve appetitive effects, (b) preoccupation with the behaviour, (c) temporary
satiation, (d) loss of control, and (e) suffering negative consequences”. These elements are
considered to be the stages of developing an addiction, with ‘loss of control’ being the crucial
While there are a large number of addictions, some located within the Diagnostic and Statistical
Manual of Mental Disorders (DSM-5), and others proposed, Schaef (1987) put forward a
typology to classify these various addictive behaviours. This typology involves substance
addiction, which “involves direct manipulation of pleasure through the use of products that are
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ingested into the body, including drug use disorders and food-related disorders.” The second
category is that of process addiction, in which are collected “a series of potentially pathological
behaviours that expose individuals to ‘mood-altering events’ by which they achieve pleasure and
become dependent” (Robinson & Berridge, 2000; Schaef, 1987). By citing Griffiths (2005a) and
Orford (2001), Sussman et al. (2011) identify several process addictions in the current literature
including gambling, various types of Internet use, love, sex, exercise, work, and compulsive
spending.
Sex Addiction
Using the terminology mentioned above, the concept of sex addiction falls under the category of
biological, sociological and psychological components. Sex addiction has been previously
described using multiple labels including compulsive promiscuity, Don Juan Complex,
partnerism, among others (Orford, 1985). Even though most of these terms are outdated and no
longer used, especially due to the stigmatizing and negative connotations some of them hold,
there still seems to be a dispute regarding the proper terminology to refer to individuals with
disproportionate sexual behaviours that can be considered as sexual addiction (Carnes, 1983),
sexual compulsion (Coleman, 1986), sexual impulsivity (Barth & Kinder, 1987) and non-
paraphilia related disorders (Kafka, 1993), as Griffiths (2004) describes in his study, ‘Sex
Addiction on the Internet’. Carnes (2001), as cited by Griffith (2004), explains “sex addiction as
any sexually-related, compulsive behavior which interferes with normal living and eventually
mood altering experience.” Griffith (2004) defines three basic categories that seem to act as the
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psychological motivation for addiction: “arousal addictions that stimulate and thrill; satiation
addictions that ease tension and discomfort; and fantasy addictions that escape mundane reality.
Sexual behavior has the capacity to span all three of these types of addiction.”
When considering other forms of addictive behaviour, sex addiction has not generally
been viewed or accepted as a viable form of addiction. Having said that, research shows that, just
like an alcoholic or drug addict, hypersexual people are unable to stop their self-destructive
sexual behaviour and hence share similarities with other forms of more well known addictions
(Griffiths, 2004). Research shows that excessive sexual behaviour does have significant
implications, especially since sex addicts tend to ignore the adverse repercussions of their
behaviour due to loss of control; this affects families, relationships and work together with
psychological implications like low self esteem and depression. “Addictive, somatic and
psychiatric disorders coexist with sexual addiction.” (Karila, 2014). In fact, research displays that
what distinguishes a sex addict from a person who only engages in sexual binges is the
implication of that binge on his or her life; sex addicts tend to describe their binges as being
episodic however those binges tend to have effects on all aspects of their life (Carnes, 2001).
support the argument in favour of including sex addiction into a future version of the DSM.
However, sex addiction, as an umbrella term used to include the various types of sexual
behaviours that have been or are being deemed problematic such as excessive masturbation, sex
using technological device, cybersex, pornography use, excessive strip club visitation, and other
behaviours, has existing prevalence rates of sexual addiction-related disorders ranging from 3%
to 6% (Karila, 2014). This number is a significant percentage, so the existence of this compulsive
5
behaviour cannot be denied and hence more research must be done in the area in order to clarify
exactly what sexual behaviours can be identified as an addictive behaviour, and at which point
through videos, magazines or written text; and the reward, gained from looking at nude photos
and sex acts performed by others. Research that has been developed more recently has been
expanded to and focused mainly on internet sex as an addiction. As cited in Kor et al.’s study
(2013), “Internet pornography represents a significant problem for some individuals (Bancroft,
2008) and was the most widely endorsed manifestation of hypersexual behavior in a DSM-5 field
trial (Reid et al., 2012)”. What is important to keep in mind when talking about hypersexual
behaviours, is that they are mostly considered legal and morally acceptable. “It is the
excessiveness of hypersexual behavior [and loss of control], combined with risks and associated
consequences that may lead to functional impairment and distress” (Kor, 2013). When it comes
to pornography however, there is the issue of morality in relation to the cultural experiences of
the person, which is something that needs to be regarded when considering pornography as a
behavioral addiction. Additionally, pornography also tends to often be paired with excessive
masturbation and induces behavioral interactions with multiple partners. It is these behaviours,
among others, being poorly controlled that leads to functional impairment (Kafka,
Based on behavioural perspectives, Carnes introduced the term ‘sexual addiction’ (Carnes,
2001). Hilton (2013) states that “others have supported a behavioral model for sexual
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addiction…[including] Garcia and Thibaut, which stated, “The phenomenology of excessive non
paraphilic sexual disorder favors its conceptualization as an addictive behavior” (Garcia &
Thibaut, 2010). Research has regarded a number of areas while considering pornography and sex
addiction in general, yet has taken a strong behavioural approach, and hence as neuroscience has
emerged and is developing a somewhat parallel, competing paradigm with the introduction of the
and Watts (2011), postulate that “all addictions create, in addition to chemical changes in the
brain, anatomical and pathological changes which result in various manifestations of cerebral
defect, reduced to its simplest description, is damage to the ‘braking system’ of the brain.” In
their study they suggest that addiction could produce measurable, anatomical change in the brain
and hence it is important to regard the neurological perspective in the consideration of sex and
porn addiction as such. Furthermore, evidence for the existence of process addictions has
increased with our knowledge of synaptic and dendritic plasticity, as explained by Hilton (2013)
neuroplasticity”. He argues that it is very difficult to label sex addiction as such when taking a
strict behavioral approach, and maintains that when taking this approach, one ignores “two
decades of research about how learning changes the brain both micro- and macroscopically, and
it does a disservice to both professionals and the public in inconsistently exempting the most
powerful natural dopaminergic reward in the nervous system, sexual orgasm (Georgiadis, 2006),
When talking about addiction, one must also consider the issue of risk, and the various
repercussions that this excessive behavior can lead to. As previously mentioned one can discuss
7
the psychological consequences such as chronic low self-esteem, shame, self-hatred and moral
conflict. This can then cause the person to engage in multiple addictive behaviors such as
combining drinking and drug use to watching pornography to help shadow the guilt and self-
hatred (Sexual Recovery Institute, 2011). Excessive pornography use has also been highly
correlated to a number of issues, such as the deterioration of relationships and marriages; many
times sex addictions create a significant strain on the person’s ability to maintain healthy
relationships and this once again creates esteem problems, moral issues, shame and other
psychological implications (Steurer, n.d). One must also consider the financial strains that such
necessary to consider that it is very likely that addiction to pornography creates or is created by
comorbidity with other sexual behaviours such as excessive visits to strip clubs and prostitutes,
hence coming back to the issue of financial burden. Moreover, as cited in Hilton and Watts
(2011), Bourke and Hernandez (2009) have found a significantly high correlation (85%) between
viewing child pornography and participating in actual sexual relations with children. Finally,
according to Hald et al. (2010) there is also a significant link with regard to violence attitudes
towards women and the viewing of pornography which is strongly supported by data from their
meta-analysis. The above risks are important to consider when it comes to determining whether a
behaviour should be considered an addiction or not, and the benefit or risk of the effects that this
addiction can have. Here one can question whether creating a label such as pornography
addiction would help or hinder the outcomes of these risks; would more research be done and
more solutions found?; can such a label attend to a self fulfilling prophecy leading to an increase
of the behavior?.
Alternative Research
8
With the increasing widespread usage of the internet, even on portable and mobile devices, there
has been a significant increase in the use of online pornography, and hence once cannot discuss
the concept of addiction without regarding Media. In their article “Problematic Online
Pornography Use”, Sirianni and Vishwanath (2015), put forward a model which presents a
explanation for online pornography addiction”. However, their research did not produce any
evidence of pornography use developing into an addiction, with only three of their participants
agreeing that it was affecting their lives negatively and interfering significantly. They claim that
“these findings [were] consistent with prior studies, including those of Caplan (2005) and
LaRose and colleagues (2003) that have reported few severely problematic users among student
samples.” In fact, there have been quite a number of studies arguing against the existence of
being heavily and/or negatively affected by the behaviour. According to Ley et al. (2014)
research “is hindered by poor experimental designs, limited methodological rigor, and lack of
model specification.”
When arguing against the concept of behavioural addictions, some claim that excessive use of
pornography and loss of control is a 'compulsion' not an 'addiction', and hence should fall under
the category of Obsessive Compulsive Disorder. OCD sufferers battle what are called
obsessions which are defined as recurring thoughts in a person's mind. “These thoughts usually
occur throughout the day and often distract the person from the tasks of everyday life. Typical
examples of obsessions are doubt, perfection, a fear of losing things, religion, aggression, and
sexual tension. While many people experience similar feelings and concerns, OCD patients
9
feel controlled by them.” (OCD and the Interner, n.d) Similarly to addiction, and also a
correlation to addiction, OCD patients feel a lack of control, and hence it could very well be
argued that pornography addiction could be a compulsion. There is however, little research done
Taking a reflective and critical approach to reviewing the research compiled for this paper, one
can confidently conclude that there is a lack of significantly valid data, in relation to sex
addiction, and in particular to pornography; both in general and referring to addiction. There are
a variety of studies that follow a behavioural approach, very much based on Carnes’ (2001)
definition of sex addiction, and a lot of research in regard to hypersexual behavior seems to
regard behavior quite holistically in terms of the social and the psychological; however it is
lacking in the biological or medical perspectives. More recently this has been tackled by
neuroscientists such as Hilton (2013), however, just as all other areas, more research must be
According to empirical research findings from nationally representative samples, 0.8% of men
and 0.6% of women report out-of-control sexual behaviors that negatively affect their daily lives
(Skegg et al., 2010). Reports such as these create limited arguments in favor of sex addiction as
an addiction. However, here it is important to keep in mind the element such as shame, guilt and
moral conflict; “The difficulty in objective peer-reviewed discussion of this topic is again
illustrated by the attempted suppression of this data on social grounds” (Hilton and Watts, 2011).
Due to the negative attitudes and the moral issues in regard to excessive sexual behaviours,
studies may be lacking significant percentages due to people not coming forward or not being
10
honest. As discussed in an online article entitled ‘There's No Such Thing as Porn Addiction’
(David Heitz, 2014), in their study Ley et al. (2014) argue that the limited research that exists
tends to be written by people working in the industry. The article quotes Ley who states the
following: “Many of these clinicians are themselves self-identified porn addicts, who are treating
others who self-identify as addicts. They base their writings upon their own clinical experience
and anecdotes.” Statements such as these create doubt in regards to the validity and credibility of
An extensive amount of research has to be done in order to consider hyper sexuality as addiction
research looking into the female perspective, attitudes and use of pornography, other than the
effects of having partners who compulsively use pornography. There is also a lack of qualitative
studies, looking into the subjective personal accounts of battling with loss of control.
issues and the methodology and models used to study them. Griffith (2004) argues that “one of
the objectives of any future research should be to determine the object of Internet sex addiction.”
He also proposes a number of future studies including: the identification of risk factors for those
who might be susceptible to Internet sex addictions; Research that controls for important socio-
demographic variables in the study of the acquisition; development and maintenance of risk
factors; Studies that use adequate and diverse samples (racial or ethnic minorities, females,
rural/urban etc.) rather than the self-selected samples that the current literature is based upon, and
much more. This would aid in determining the best approach to treating the behavior and at what
11
Implications for intervention - is the field well equipped for treatment?
the addictive behaviour in order to avoid any unnecessary stigmatisation of people. According to
Ley et al. (2014), it is evident in existing research that people who self-report as having an
addiction to pornography, tend to be gay or bisexual men with religious conflict, hence such a
model of addiction is “pathologising and stigmatizing the normal, even healthy sexual behaviors
One must also consider the implications on treatment. Some argue that the field is not well
equipped to treat process addictions like pornography addiction, such as Ley (2014) who
according to Heitz (2014) “likened the porn addiction recovery movement to gay conversion
therapy”. While discussing internet sex addiction, Griffiths (2004) states that there are a number
of treatment programs for sexual addiction such as, patient, outpatient, and aftercare support, as
well as self-help groups while also offering family counseling programs, support groups, and
educational workshops. However, he claims that currently there seem to be a lack of treatment
plans directed specifically at online or internet sex addiction. Thus far it seems that pornography
addiction is treated similarly to sex addiction, using methods such as cognitive behavioral
“Unlike recovering alcoholics who must abstain from drinking for life, sexual [and pornography]
addicts are led back into a normal, healthy sex life much in the way those suffering from eating
disorders must relearn healthy eating patterns” (Griffiths, 2004). Hence it is crucial that the
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appropriate treatment plans are instilled for sex addiction and pornography addiction in
particular. It is also important to consider the treatment of excessive pornography use as an OCD
Conclusion
what one accepts or can understand, as evidence, while keeping in mind factors such as bias,
personal education and life experiences. Coming into this assignment I thought my conclusion
would argue in favour of putting forward sex addiction as part of the DSM and having
pornography fall under this category, and hence my perception was swayed based on my
experiences and views. However, now that I have read a significant amount of research, I find
that I cannot properly justify an arguement in favour, or against. My response is simply, that
much more research is needed and that it should be expanded across multiple perspectives,
models and research methods. Caution must also be raised in relation to the negative effects, that
labelling an addiction as such could bring, and the repercussions of these effects.
13
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