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Porn Addiction

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PORNOGRAPHY ADDICTION

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

Bachelor of Psychology (Hons)

Department of Psychology

Faculty of Social Wellbeing

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

(Honours) at the University of Malta.

March 2015

2
INTRODUCTION

The construct of addiction

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,

including mu opioid, serotonin, nor epinephrine, anandamide, and the hypothalamic-pituitary-

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

leads to an experience of behavior-related adverse consequences (Schneider & Irons, 2001).

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

element in considering an addiction as such.

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

3
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

‘Process Addictions’, also referred to as behavioural addictions; which are composed of

biological, sociological and psychological components. Sex addiction has been previously

described using multiple labels including compulsive promiscuity, Don Juan Complex,

erotomania, hypererotocism, hypersensuality, nymphomania, oversexuality and pathologic multi-

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

becomes unmanageable, although he has also described it as a pathological relationship with a

mood altering experience.” Griffith (2004) defines three basic categories that seem to act as the

4
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).

As a proposed behavioural addiction, there does not seem to be enough research to

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

these behaviours are no longer considered ordinary.

Considering pornography as a behavioural addiction

Alternative to sex addiction, pornography addiction is based entirely on visual stimulation,

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,

2010; Bancroft, 2008).

Based on behavioural perspectives, Carnes introduced the term ‘sexual addiction’ (Carnes,

2001). Hilton (2013) states that “others have supported a behavioral model for sexual

6
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

concept of behavioral or process addictions. Neuroscience perspectives, such as those by Hilton

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

dysfunction collectively labeled hypofrontal syndromes. In these syndromes, the underlying

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)

in his study, “Pornography addiction – a supranormal stimulus considered in the context of

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),

from neuroplastic learning.”

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

an addiction can cause, related to excessive spending on pornography. Furthermore, it is

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

framework of “habitual online pornography use and deficient self-regulation as an alternative

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

pornography addiction because of a lack of individuals who actually consider themselves as

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

in the area and once again inconclusive evidence.

Tentative conclusions, limitations & future research – is the research valid?

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

done in the field.

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

some of the research presented.

An extensive amount of research has to be done in order to consider hyper sexuality as addiction

and excessive pornography use as a behavioural addiction. Moreover, there is practically no

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.

Furthermore, there needs to be a more widespread approach to research, in terms of relevant

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

point intervention is necessary.

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Implications for intervention - is the field well equipped for treatment?

There are a number of implications that have to be considered in regards to determining

excessive pornography use as a behavioural addiction. Primarily, it is important to regard the

consequences of labelling pornography addiction as such, while determining the parameters of

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

and desires of some groups, because of cultural biases.”

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

therapy or support groups.

“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

12
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

rather than an addiction, if it deemed as such.

Conclusion

The question remains: is there evidence supporting the existence of pornography as a

behavioural addiction? As an operation of perspective and education, the answer depends on

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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