Self-reported addiction to pornography in a nationally representative sample: The roles of use habits, religiousness, and moral incongruence

Occurrence and clinical characteristics of Compulsive Sexual Behavior Disorder (CSBD): A cluster analysis in two independent community samples

BACKGROUND AND AIMS

Compulsive Sexual Behavior Disorder (CSBD) is characterized by a persistent failure to control intense and recurrent sexual impulses, urges, and/or thoughts, resulting in repetitive sexual behavior that causes a marked impairment in important areas of functioning. Despite its recent inclusion in the forthcoming ICD-11, concerns regarding its assessment, diagnosis, prevalence or clinical characteristics remain. The purpose of this study was to identify participants displaying CSBD through a novel data-driven approach in two independent samples and outline their sociodemographic, sexual, and clinical profile.

METHODS

Sample 1 included 1,581 university students (females = 56.9%; Mage = 20.58) whereas sample 2 comprised 1,318 community members (females = 43.6%; Mage = 32.37). First, we developed a new composite index to assess the whole range of CSBD symptoms based on three previously validated scales. Based on this new composite index, we subsequently identified individuals with CSBD through a cluster analytic approach.

RESULTS

The estimated occurrence of CSBD was 10.12% in sample 1 and 7.81% in sample 2. Participants with CSBD were mostly heterosexual males, younger than respondents without CSBD, reported higher levels of sexual sensation seeking and erotophilia, an increased offline and especially online sexual activity, more depressive and anxious symptoms, and poorer self-esteem.

CONCLUSIONS

This research provides further evidence on the occurrence of CSBD based on an alternative data-driven approach, as well as a detailed and nuanced description of the sociodemographic, sexual, and clinical profile of adults with this condition. Clinical implications derived from these findings are discussed in detail.

Hands-off: Study protocol of a two-armed randomized controlled trial of a web-based self-help tool to reduce problematic pornography use

BACKGROUND AND AIMS

The past-year prevalence of problematic pornography use (PPU) was 1-6% in adult populations. As a result of treatment obstacles and barriers, such as unaffordable treatments, only a minority of problematic pornography users may seek treatment. Having a free, online, self-help program may overcome treatment barriers and may help those individuals who cannot receive traditional or offline treatment for PPU. Although the effectiveness of such online programs reducing substance use and problematic gambling have been reported, no prior study has examined the efficacy of an online self-help intervention aiming to reduce PPU.

METHODS

This two-armed randomized controlled trial (RCT) will examine the effectiveness of an online self-help program (Hands-off) to reduce PPU, while also considering psychopathological comorbidities. The six-week intervention condition includes six core modules developed to reduce PPU based on motivational interviewing, cognitive behavioral therapy, mindfulness, and wise social-psychological intervention techniques. The target sample size is 242 participants. Self-report questionnaires will be administered at baseline, right after the end of the intervention, at one-month, and three-month follow-ups after the end of the intervention. The primary outcome will be the level of PPU. Secondary outcomes will include pornography use frequency, pornography craving, pornography use-avoidance self-efficacy, sex mindset, sexual satisfaction, negative and positive emotions, and life satisfaction. Data will be analyzed on an intention-to-treat basis using linear mixed models.

RESULTS

Results will be reported at conferences and published in a scientific peer-reviewed journal. The participants will be sent a lay-person-friendly summary of the results via e-mail.

Treatments for internet addiction, sex addiction and compulsive buying: A meta-analysis

BACKGROUND AND AIMS

Internet addiction, sex addiction and compulsive buying are common behavioral problems, which share similarities with gambling disorder and substance use disorders. However, little is known about the efficacy of their treatments. The objective of this meta-analysis was to examine the efficacy of the treatments of such problem behaviors, and to draw parallels to gambling disorder and substance use disorders in terms of treatment response.

METHODS

Literature search yielded 91 studies totaling 3,531 participants to provide a comprehensive evaluation of the short-term and long-term efficacy of psychological, pharmacological and combined treatments for internet addiction, sex addiction, and compulsive buying.

RESULTS

Psychological, pharmacological, and combined treatments were associated with robust pre-post improvements in the global severity of internet addiction (Hedges's g: 1.51, 1.13, and 2.51, respectively) and sex addiction (Hedges's g: 1.09, 1.21, and 1.91, respectively). For compulsive buying, psychological and pharmacological treatments were also associated with a large-sized pre-post reduction in global severity (Hedges's g: 1.00 and 1.52, respectively). The controlled pre-post and within-group pre-follow-up effect sizes were in the similar range, with few exceptions. Moderator analyses suggest that psychological interventions are effective for reducing compulsive behaviors, especially when delivered face-to-face and conducted over extended periods of time. Combinations of cognitive-behavioral approaches with medications showed an advantage over monotherapies.

DISCUSSION AND CONCLUSIONS

The results suggest that treatments for common behavioral addictions are effective in the short term, similar to those implemented for gambling disorder and substance use disorders, but more rigorous clinical trials are needed.

A Large-Scale Comparison of Canadian Sexual/Gender Minority and Heterosexual, Cisgender Adolescents' Pornography Use Characteristics

BACKGROUND

The ease of access to pornography has made its use common among adolescents. Although sexual and gender minority (SGM) (eg, gay, transgender) adolescents may be more prone to use pornography owing to sexual orientation-related information seeking and/or scarcity of potential romantic or sexual partners, relatively little attention has been paid to their pornography use and to the quantitative examination of the similarities and differences between heterosexual, cisgender (HC) and SGM adolescents' pornography use characteristics.

AIM

The aim of the present study was to compare SGM and HC adolescents' pornography use considering potential sex differences.

METHODS

We used a sample of 2,846 adolescents (52.5% girls; M_age = 14.5 years, SD = 0.6), which was collected as part of an ongoing longitudinal study on adolescents' sexual health. Data were analyzed with 5 groups: HC boys; HC girls; SGM boys; SGM girls; and SGM non-binary individuals.

OUTCOMES

Adolescents completed a self-report questionnaire about sexual and gender minority status and pornography use (ie, lifetime use, age at first exposure, and frequency of use in the past 3 months.) RESULTS: Results indicated significant differences between all groups: 88.2% of HC boys, 78.2% of SGM boys, 54.2% of SGM girls, 39.4% of HC girls, and 29.4% of SGM non-binary individuals reported having ever viewed pornography by the age of 14 years. SGM girls indicated a significantly younger age at first pornography use than HC girls, but this difference was not significant among boys. SGM boys reported the highest (median: many times per week), whereas HC girls reported the lowest (median: less than once a month) frequency of pornography use.

CLINICAL TRANSLATION

Results suggest that SGM and HC boys' pornography use characteristics are rather similar, whereas SGM and HC girls' pornography use patterns may be considered different presumably because of the varying underlying motivations (eg, using pornography to confirm sexual orientation).

STRENGTHS & LIMITATIONS

Self-report measures and cross-sectional designs have potential biases that should be considered. However, the present study involved a large sample of adolescents including SGM adolescents, a population group that is understudied.

CONCLUSION

Approximately two-thirds of teenagers had gained their first experience with pornography in the present sample, and 52.2% reported using it once a week or more often in the past 3 months, indicating that pornography use may play an important role in both HC and SGM adolescents' sexual development. Gender-based differences concerning pornography use seem to be robust regardless of SGM status. Bőthe B, Vaillancourt-Morel, MP, Girouard A, et al. A Large-Scale Comparison of Canadian Sexual/Gender Minority and Heterosexual, Cisgender Adolescents' Pornography Use Characteristics. J Sex Med 2020;17:1156-1167.

High-Frequency Pornography Use May Not Always Be Problematic

BACKGROUND

Previously, variable-centered analytic approaches showed positive, weak-to-moderate associations between frequency of pornography use (FPU) and problematic pornography use (PPU). However, person-centered studies are sparse in the literature, and these could provide insight into whether there are individuals who use pornography frequently and do not experience problems or whether there are individuals with comparable high-frequency use who differ on reported experiencing of negative consequences.

AIM

The aims of the present study were (i) to identify profiles of pornography use based on FPU and PPU by applying a person-centered analytic approach and (ii) to examine whether the identified profiles could be distinguished based on theoretically relevant demographic and psychological constructs.

METHODS

Latent profile analyses were conducted on 3 nonclinical samples recruited from general websites and a pornography site (study 1: N = 14,006; study 2: N = 483; study 3: N = 672).

RESULTS

Results were consistent across all studies. 3 distinct pornography-use profiles emerged: nonproblematic low-frequency pornography use (68-73% of individuals), nonproblematic high-frequency pornography use (19-29% of individuals), and problematic high-frequency use (3-8% of individuals). Nonproblematic and problematic high-frequency-use groups showed differences in several constructs (ie, hypersexuality, depressive symptoms, boredom susceptibility, self-esteem, uncomfortable feelings regarding pornography, and basic psychological needs).

CLINICAL TRANSLATION

FPU should not be considered as a sufficient or reliable indicator of PPU because the number of people with nonproblematic high-frequency use was 3-6 times higher than that with problematic high-frequency use. These results suggest that individuals with PPU use pornography frequently; however, FPU may not always be problematic.

STRENGTHS & LIMITATIONS

Self-report cross-sectional methods have possible biases that should be considered when interpreting findings (eg, underreporting or overreporting). However, the present research included 3 studies and involved large community samples and visitors of a pornography website. The present study is the first that empirically investigated pornography-use profiles with a wide range of correlates using both severity of PPU and FPU as profile indicators on specific and general samples.

CONCLUSION

The present study is a first step in the differentiated examination of pornography-use profiles, taking into consideration both PPU and FPU, and it provides a foundation for further clinical and large-scale studies. Different psychological mechanisms may underlie the development and maintenance of FPU with or without PPU, suggesting different treatment approaches. Therefore, the present results may guide clinical work when considering reasons for seeking treatment for PPU. Bőthe B, Tóth-Király I, Potenza MN, et al. High-Frequency Pornography Use May Not Always Be Problematic. J Sex Med 2020;17:793-811.

The Assessment of Problematic Internet Pornography Use: A Comparison of Three Scales with Mixed Methods

The primary aim of this study was to compare different screening tools for problematic internet pornography use (IPU) and identify the most accurate measure. The reliability and validity of three scales, namely, the Problematic Pornography Consumption Scale (PPCS), Problematic Pornography Use Scale (PPUS), and Short Internet Addiction Test Adapted to Online Sexual Activities(s-IAT-sex), were examined using three homogeneous groups, respectively. A total of 972 adults (mean age = 24.8) from 28 provinces/regions in China participated in the quantitative part (QUAN). The Brief Pornography Screener served as the reference standard. The PPCS demonstrated stronger reliability and validity, including criterion validity, as well as greater sensitivity and acceptable specificity; therefore, it was considered to be the more accurate screening instrument. In the qualitative part (QUAL), we interviewed 22 volunteers and 11 therapists (who had worked with individuals with problematic IPU) to examine their perspectives on the core features of problematic IPU and dimensions of the PPCS. Almost all the interviewees endorsed the structure of the PPCS. These findings encourage the use of the PPCS in future research studies and underscore its screening applications because of its ability to classify IPU as problematic or nonproblematic.

Sexual Desire and Subjective Distress among Pornography Consumers

Clients are increasingly seeking professional help related to pornography viewing in the digital age. Given distress is a key reason clients seek help, the purpose of this study was to identify variables associated with it. Drawing from recent literature, we examined the roles of solitary sexual desire, moral incongruence, feelings of dysregulation, and shame-proneness in predicting subjective distress among consumers. Surveys were administered through Amazon Mechanical Turk to US adults (n = 559). Structural equation models supported moderated mediation, where the positive relationship between sexual desire and subjective distress was fully mediated by feelings of dysregulation, and the relationship between sexual desire and feelings of dysregulation was moderated by moral incongruence. Moral incongruence was the largest direct predictor of subjective distress, while shame-proneness was not significantly associated with it. This study points to targets for intervention research, reinforces findings that values play an integral role in how individuals interpret their viewing and whether they feel distressed, and suggests that values may impact how individuals interpret their sexual desire. Implications for practitioners are discussed, including the need for person-in-environment assessment and more holistic care than has traditionally been proposed in the sex addiction field.

Evaluating Pornography Problems Due to Moral Incongruence Model

INTRODUCTION

To date, multiple models of problematic pornography use have been proposed, but attempts to validate them have been scarce.

AIM

In our study, we aimed to evaluate the Pornography Problems due to Moral Incongruence model proposing that self-appraisals of pornography addiction stem from (i) general dysregulation, (ii) habits of use, and (iii) moral incongruence between internalized norms and behavior. We investigated whether the model can be used to adequately explain the self-perceptions of addiction to pornography (model 1) and a broader phenomenon of problematic pornography use (model 2).

METHODS

An online, nationally representative study was conducted on a sample of 1036 Polish adult participants, of whom, 880 declared a lifetime history of viewing pornography.

MAIN OUTCOME MEASURE

The outcomes were self-perceived pornography addiction, problematic pornography use, avoidant coping, frequency of pornography use, religiosity, moral disapproval of pornography, and related variables.

RESULTS

Our results indicated that avoidant coping (an indicator of general dysregulation), frequency of pornography use (indicator of habits of use), and the distress connected with incongruence between own sexual behavior and internalized norms, attitudes and beliefs positively contributed to self-perceived addiction (model 1) as well as problematic pornography use (model 2). This broadly confirms the basic shape of the PPMI model. There were, however, notable differences between the models. Moral incongruence related distress was only weakly related to self-perceived addiction (β = 0.15, P < .001), with a stronger relation for problematic pornography use (β = 0.31, P < .001). When controlling for other factors, religiosity weakly predicted problematic pornography use (β = 0.13, P < .001), but not self-perceived addiction to pornography (β = 0.03, P = .368). Frequency of pornography use was the strongest predictor of both self-perceived addiction (β = 0.52, P < .001) and problematic pornography use (β = 0.43, P < .001).

CLINICAL IMPLICATIONS

Factors proposed within the PPMI model are distinctly relevant intervention targets, and they should be considered in the process of diagnosis and treatment.

STRENGTHS & LIMITATIONS

The presented study is the first to evaluate PPMI model. Its main limitation is that it has a cross-sectional design.

CONCLUSION

The PPMI model is a promising framework for investigating the factors related to self-perceived addiction and problematic pornography use. Despite the differences between the models and in the strength of specific predictors, (i) dysregulation, (ii) habits of use, and (iii) moral incongruence all uniquely contribute to self-perceived addiction and problematic pornography use. Lewczuk, K., Glica, A., Nowakowska, I., et al. Evaluating Pornography Problems Due to Moral Incongruence Model. J Sex Med 2020;17:300-311.

Cybersex use and problematic cybersex use among young Swiss men: Associations with sociodemographic, sexual, and psychological factors

BACKGROUND AND AIMS

Cybersex use (CU) is highly prevalent in Switzerland's population, particularly among young men. CU may have negative consequences if it gets out of control. This study estimated prevalence of CU, frequency of CU (FCU), and problematic CU (PCU) and their correlates.

METHODS

A non-selective sample of young Swiss men (N = 5,332, mean age = 25.45) completed a questionnaire assessing FCU and PCU, sociodemographics (age, linguistic region, and education), sexuality (being in a relationship, number of sexual partners, and sexual orientation), dysfunctional coping (denial, self-distraction, behavioral disengagement, and self-blame), and personality traits (aggression/hostility, sociability, anxiety/neuroticism, and sensation seeking). Associations were tested using hurdle and negative binomial regression models.

RESULTS

At least monthly CU was reported by 78.6% of participants. CU was associated positively with post-secondary schooling (vs. primary schooling), German-speaking (vs. French-speaking), homosexuality, bisexuality (vs. heterosexuality), more than one sexual partner (vs. one), dysfunctional coping (except denial), and all personality traits except sociability, but negatively with being in a relationship (vs. not), age, and sociability. FCU was associated positively with homosexuality, bisexuality, no or more than one sexual partner, dysfunctional coping (except denial), and all personality traits except sociability, but negatively with age, being in a relationship, and sociability. PCU was associated positively with bisexuality, four or more sexual partners, dysfunctional coping, and all personality traits except sociability, but negatively with German-speaking and sociability.

DISCUSSION AND CONCLUSIONS

CU should be viewed in light of its associations with sociodemographic, sexual, and psychological factors. Healthcare professionals should consider these aspects to adapt their interventions to patients' needs.

The Potential Associations of Pornography Use with Sexual Dysfunctions: An Integrative Literature Review of Observational Studies

This paper reviews the associations between pornography use and sexual dysfunction based on evidence from observational studies. The existing data in this regard mostly derive from cross-sectional investigations and case reports. There is little if no evidence that pornography use may induce delayed ejaculation and erectile dysfunction, although longitudinal studies that control for confounding variables are required for a full assessment. The associations between pornography use and sexual desire may differ between women and men although the existing data is contradictory and causal relationships cannot be established. The strongest evidence is available for the relation of pornography use with decreased sexual satisfaction, although the results of prospective studies are inconsistent. The paper outlines future research prospects beneficial in understanding the nature of associations between pornography use and sexual dysfunctions in men and women.

Which Dimensions of Human Sexuality Are Related to Compulsive Sexual Behavior Disorder (CSBD)? Study Using a Multidimensional Sexuality Questionnaire on a Sample of Polish Males

INTRODUCTION

Human sexuality is a multidimensional phenomenon related to several factors, such as self-esteem, awareness of sexual needs, and ability to communicate them to others.

AIM

To examine the sexual characteristics of patients seeking treatment for compulsive sexual behavior disorder (CSBD)-a clinical diagnosis recently included in the 11th edition of the International Classification of Diseases classification.

METHODS

We have investigated the sexual characteristics of 72 Polish men seeking treatment for CSBD compared with 208 men from the Polish general population.

MAIN OUTCOME MEASURES

The Multidimensional Sexual Questionnaire-PL was used to examine 12 sexual aspects of human sexuality. The severity of CSBD symptoms was assessed using Sexual Addiction Screening Test-PL, and the severity of problematic pornography use was measured by Brief Pornography Screener.

RESULTS

Results show that CSBD patients (when compared with the general population) exhibit higher sexual anxiety, sexual depression, external sexual control, and fear of sexual relationship. Furthermore, CSBD severity is negatively related to sexual esteem, internal sexual control, sexual consciousness, sexual assertiveness, and sexual satisfaction.

CLINICAL IMPLICATIONS

Our findings suggest that the impairment of the abovementioned dimensions warrant attention during clinical work and future studies on CSBD.

STRENGTHS & LIMITATIONS

This study was limited to men, most of whom self-identified as heterosexual. Future research should include women and non-heterosexual identified individuals.

CONCLUSION

Sexual esteem, consciousness, assertiveness, satisfaction and internal sexual control are commonly affected among CSBD individuals and should be properly addressed during the clinical interview and treatment intervention. Kowalewska E, Kraus SW, Lew-Starowicz M, et al. Which Dimensions of Human Sexuality Are Related to Compulsive Sexual Behavior Disorder (CSBD)? Study Using a Multidimensional Sexuality Questionnaire on a Sample of Polish Males. J Sex Med 2019;16:1264-1273.

Hypersexual behavior in a large online sample: Individual characteristics and signs of coercive sexual behavior

BACKGROUND AND AIMS

Despite the high prevalence of perceived problems relating to symptoms of hypersexual disorder (HD), important aspects remain underinvestigated. This study examines symptoms of depression, symptoms of problematic cybersex, and coercive sexual behavior in a large online sample from a German-speaking population.

METHODS

In an online survey, N = 1,194 (n = 564 women) participated in this study and completed measures including self-report questionnaires to assess depressive symptoms (PHQ-9), HD (HBI-19), symptoms of problematic cybersex (s-IATsex), as well as questions characterizing participants sexually, including fantasies and actual sexual coercive behaviors.

RESULTS

Men reported increased levels of HD symptom severity, pornography consumption, masturbation, and partnered sexual activity. Moreover, 59% of men and 18% of women reported fantasies of sexual coercion, whereas 21% of men and 4% of women reported acts of sexual coercion. Moderated regression analyses showed that symptoms of depression as well as sexual coercive fantasies and behaviors were associated with levels of HD symptom severity. Problematic cybersex, total sexual outlet (TSO), pornography consumption, and number of sexual partners were also associated with HD symptom severity. Interaction effects indicated that, in women, the connection of TSO as well as pornography was more strongly associated with levels of HD symptom severity than in men.

CONCLUSIONS

This survey indicated that levels of HD symptom severity are often associated with severe intra- and interpersonal difficulties. Furthermore, the amount of sexual activity seems to be more strongly connected to levels of HD symptom severity in women than in men.