Can YOU be addicted to sex???

Is Pornography Addiction a True Addiction?

The debate surrounding whether or not pornography addiction can be classified as a true addiction is still fraught. As of the making of this document, November 2022, there is no section within the DSM-5 that classifies pornography addiction as a psychological disorder. Further, there is not even a definition of hypersexual (a broader umbrella term) within the DSM-5, though it has been proposed. Further, the American Association of Sexualtiy Educators, Counselors, and Therapists (AASECT) stated that porn and sex addiction did not have enough empirical evidence to accept the sex addition model. And even went on to claim that both treatment and training were not informed by accurate human sexuality knowledge.

However, the American Society of Addiction Medicine (ASAM) updated their definition of addiction in 2011 to include behavioral additions like food, gambling, and sex. Which kept the conversation open to behavioral addictions, including sex and porn addictions. In 2019, the World Health Organization (WHO) accepted Compulsive Sexual Behavior Disorder (CSBD) into ICD11. However, it defined CSBD as an ‘impulse control disorder’ rather than an ‘addictive disorder’ further pushing the narrative that ‘addiction’ to pornography is more of an impluse control issue rather than a true addiction.

Refer to this table from De Alarcón et al. (2019) for a summary:

What We Know

As we enter an age where everyone has the internet at their fingertips, unsurprisingly pornography consumption and masturbation to pornography has increased dramatically over the past few decades, specifically in men. While some of these statistics may be startling on their face it is important to note that masturbation and pornography consumption can actually be a positive source for sexual health. Further, it is important to understand that cultural expectations surrounding sexuality can impact standards of what someone thinks to be an ‘addiciton’ to pornography or sex. Differing sex drives within a couple or network of sexual partners can also be a reason why someone may be accused of having a pornography or sex addiction, making it a relational issue. So, it is also very important to ensure that it is the client themselves that is feeling like their consumption is addictive and not their partner pushing them to think so.

Most of the research surrounding porn addiction tries to classify pornography as a ‘supranormal stimulus’ which is similar to an addictive substance like a drug, and can cause an addictive disorder. The definition of addiction from the DSM-5 includes cravings, inability to cut down use even if there is a will to do so, consuming more of the substance for longer, neglecting other parts of the subject’s life, using even if it’s damaging to relationships, and using even if it puts the subject in danger. There is still a large debate surrounding whether or not pornography can meet all of these criteria. However, while it is not recognized by the DSM-5, there are many models that have been created and implemented to quantify and treat this ‘addiction’. Two that I would like to highlight here are the Internet Sex Screening test (ISST) and the Out of Control Sexual Behavior (OCSB) framework.

The ISST is the most used screening tool to assess online pornography use. It contains 25 yes or no questions that examines five dimensions: online sexual compulsivity, online sexual behavior-social, online sexual behavior-isolated, online sexual spending, and interest in online sexual behavior. The OCSB is a framework used to treat many types of sexual dysfunction but has been useful in addressing pornography consumption issues. This integrative model is very flexible and client-focused. It looks to treat the issue as simply that, a problem, rather than some sort of dysfunction. Attempting to normalize sexual variation and integrating sociocultural context into its treatment.

Biological Effects

Addiction disorders are at the intersection of compulsive disorders (anxiety reduction) and impulse disorders (gratification). With symptoms being thought to influence dopaminergic, serotonergic, noradrenergic, and opioid systems. ‘Addiction’ to pornography can indeed alter your brain chemistry. But this occurs in the same way that an ‘addiction’ to chocolate or scratching your head can change your brain. Since pornography is an outside stimulus, there can be rushes of pleasure (through the systems listed above) from consuming it which someone can develop a maladaptive preference for. Overall, there have been little to no correlations found between porn addiction and significant neurophysiological changes. But the area is still very understudied.

What We Don’t Know

There is some debate on whether or not some of the clinical features of pornography addiction are due to consumption itself or due to clients perceiving themselves as addicts and increasing their reported problems. Further, as mentioned above, increased pornography consumption could simply be a form of compensation for mismatched sex drives between partners. Overall, while the concept of hypersexuality and porn addiction have been talked about for decades now, there is still very little research that can conclusively confirm and define it, both in a behavioral sense and biologically. Thus, while the DSM-5 does not accept porn addiction it is still important to validate client’s experiences and use what information is available to help them correct maladaptive behaviors.

References

Recommended Readings: Hall (2021) & De Alarcón (2019)

De Alarcón, R., de la Iglesia, J. I., Casado, N. M., & Montejo, A. L. (2019). Online porn addiction: What we know and what we don’t—A systematic review. Journal of clinical medicine, 8(1), 91.

Hall, P. (2021). The moral maze of sex & porn addiction. Addictive Behaviors, 123, 107054.

Levith, J. (2021). Translating the Out of Control Sexual Behavior Treatment Model for Work with Cisgender Women. Available at SSRN 3758348.

Prause, N., Steele, V. R., Staley, C., Sabatinelli, D., & Hajcak, G. (2015). Modulation of late positive potentials by sexual images in problem users and controls inconsistent with “porn addiction”. Biological psychology, 109, 192-199.

Razi, N. I. M., Rahman, A. W. A., & Kamaruddin, N. (2018, July). Neurophysiological analysis of porn addiction to learning disabilities. In 2018 International Conference on Information and Communication Technology for the Muslim World (ICT4M) (pp. 272-277). IEEE.