The Emperor Has No Clothes: A Review of the ‘Pornography Addiction’ Model

The paradox of pornography - sexuality and problematic pornography use

The experiences of sexual minority men who report self-perceived problematic pornography use is under theorised and not well understood despite controversial and conflicting research into the phenomena in heterosexual male populations. This study aimed to widen the conversation to consider the experience of sexuality in relation to self-perceived problematic pornography use, rather than contribute to literature that debates the definition and aetiology of problematic pornography use. Semi-structured online qualitative interviews were conducted with three sexual minority men who self-reported problematic pornography use. Interpretive phenomenological analysis was used to develop themes. Five themes pertinent to understanding the participants' experiences with problematic pornography use were developed: problematised sexuality, pornography as liberator, pornography as corrupter, reform, and relapse and restore. The themes highlight three men's relationship with their sexuality as a feature of their self-perceived problematic pornography use. The research suggests that idiographic experiences of self-perceived problematic pornography use are influenced and maintained by an incongruent and conflicting relationship between an individual's own experiences of sexuality and self-perceptions of pornography use. Limitations and future research recommendations are discussed.

A new variation of modern prejudice: young Korean men's anti-feminism and male-victim ideology

In South Korea, anti-feminism is now rapidly spreading online among young men, who have started to identify themselves as a social minority or "victims" of female power. Despite its ramifications, theoretically, anti-feminism is indistinct from the racism and sexism of White men that emerged more than half a century ago. In view of this, it shares the same root as typical modern racism or sexism, although it appears to be a novel phenomenon. Such a hypothesis was buttressed by quantifying the attitudes of anti-feminists toward various outgroups based on the transference of prejudice theory. Moreover, the subtle sexist undertones hidden in their arguments have been discussed using various psychological theories and empirical data/statistics. Additionally, various potential factors that may shape or accelerate their attitudes or behaviors have been discussed on the basis of the threat-defense theory. Through comprehensive literature review based on this theory, this study proposes the features related to Korean anti-feminism, encompassing behavioral/situational (overindulging violent or degrading Internet contents, verbal aggression), relational/epistemic (ostracism, attachment insecurity, pseudo-rationalism), and group-level (provocative interactions, polarization) attributes, some of which may also influence groups other than young men and ingrain or exacerbate the extreme ideologies of other groups, including young women. Scrutinizing Korean online anti-feminism and male-victim ideology may improve our understanding of the psychological origins of various social extremities or radical ideologies beyond cultural barriers.

Effects of a 7-Day Pornography Abstinence Period on Withdrawal-Related Symptoms in Regular Pornography Users: A Randomized Controlled Study

Little is known about whether withdrawal-like symptoms manifest when regular pornography users attempt to abstain from pornography. The present study used a randomized controlled design to examine whether (1) negative abstinence effects that may be potentially reflective of withdrawal-related symptoms manifest when a non-clinical sample of regular pornography users attempt to abstain from pornography for a 7-day period and (2) these negative abstinence effects would only manifest (or manifest more strongly) for those with higher levels of problematic pornography use (PPU). A total of 176 undergraduate students (64.2% female) who were regular pornography users (defined as having used pornography ≥ three times a week in the past 4 weeks) were randomly assigned to an abstinence group (instructed to attempt abstinence from pornography for 7 days, n = 86) or a control group (free to watch pornography as usual, n = 90). Participants completed measures of craving, positive and negative affect, and withdrawal symptoms at baseline and each night of the 7-day period. Contrary to the confirmatory hypotheses, there were no significant main effects of group (abstinence vs. control) or group × PPU interaction effects on any of the outcome measures, controlling for baseline scores. These findings indicate that no evidence of withdrawal-related symptoms was found for abstaining participants, and this was not dependent on level of PPU. However, exploratory analyses showed a significant three-way interaction (group × PPU × past 4-week frequency of pornography use [FPU]) on craving, where an abstinence effect on craving was found at high levels of PPU only once past 4-week FPU reached the threshold of daily use. While these exploratory findings should be interpreted with caution, they suggest that abstinence effects could potentially manifest when there is a combination of high PPU and high FPU-a hypothesis that warrants investigation in future prospective abstinence studies.

Web-Based Relationship Education and Pornography-Related Behaviors: A Single-Group Design During the COVID-19 Pandemic

Research surrounding pornography and its impact on individual and relationship functioning is a frequent and ongoing debate in the current literature. However, recent meta-analyses and aggregated studies suggest that relationship distress is associated with higher levels of general pornography use. This may be a reason why a significant number of men and women view pornography and seek help for their use. In the present study, we explored whether participation in the OurRelationship program, a web-based relationship education program that has been empirically shown to reduce relationship distress but is not tailored to reduce general pornography use, was associated with reliable changes in pornography-related behaviors. In a sample of low-income and diverse couples (N = 314 couples; 628 individuals), we observed high completion rates (64.3%) as well as reliable, small-sized decreases in the frequency and duration of pornography use for the average couple (d = 0.12-0.13). Furthermore, post hoc analyses found that individuals who began the program viewing pornography daily reported reliability-larger decreases in pornography-related behaviors (d = 0.32-0.90) than those who viewed pornography less frequently. However, we did not see reliable changes in couples' arguments about pornography use or perceptions of problematic use. The findings were generally not moderated by gender or lifestyle changes due to the COVID-19 pandemic. Clinicians struggling to reduce their client's general pornography use may consider including a focus on improving general romantic relationship functioning.

The Development and Validation of the Pornography Use in Romantic Relationships Scale

Recent reviews of the pornography literature have called for the development of valid and reliable measures that assess multiple facets of pornography use. Moreover, despite pornography use having important implications for romantic relationships, there are currently no self-report assessments of pornography use specifically within the context of romantic relationships. To address these limitations, the current paper reports on two studies regarding the development and psychometric evaluation of a 38-item multidimensional measure of pornography use within the context of romantic relationships: the Pornography Use in Romantic Relationships Scale (PURRS). Study 1 (n = 739) reports on an Exploratory and Confirmatory Factor Analytic approach to determine the factor structure of the PURRS. Study 2 (n = 765) reports on the cross-validation of the factor structure of the PURRS, before assessing the criterion validity of the measure. The PURRS exhibited good internal consistency, construct validity, and criterion validity. The findings suggest that the PURRS is best modeled by 13 first-order factors, though a higher-order factor structure comprising four broad factors may also be used. The PURRS significantly extends on past assessments of pornography use, and in particular, advances the assessment and study of pornography use within the context of romantic relationships.

Males' Lived Experience with Self-Perceived Pornography Addiction: A Qualitative Study of Problematic Porn Use

The positive impact of pornography use has been demonstrated; however, most research points towards problematic, compulsive, or excessive engagement with pornography and associated adverse effects on well-being. However, results remain inconclusive and qualitative research capturing perspectives of affected people is scarce. This phenomenological study aimed to explore the perspective and lived experience of males with a self-reported addiction to pornography. Semi-structured in-depth interviews with 13 males aged between 21 and 66 years from Australia and the USA were conducted. A thematic analysis of the transcripts was undertaken, resulting in the identification of four themes. The interviews explored the participants' reasoning for determining themselves as porn addicts, investigated patterns of use, examined the perceived multifaceted impacts of pornography use, illustrated applied individual strategies to overcome the addiction, and proposed interventions helping to inform future recommendations. Experiences and perceptions of pornography addiction were consistently depicted as problematic and harmful. Most participants described an inability to stop their consumption despite experiencing adverse effects. Commonly reported was a gradual increase in the use of and consumption of new or more shocking content. Consumption of content was outlined as an escape or coping mechanism for negative emotions or boredom. Participants reported a variety of applied strategies to manage their addiction and suggested recommendations. Investigation into strategies for the identification of problematic pornography use, its conceptualization, associated health outcomes, and effective preventative and interventional strategies are required to provide academic consistency, support those negatively affected by pornography, and achieve increased public awareness of the issue.

The Relation of Sexual Attitudes to Hypersexuality and Problematic Pornography Use

Previous studies have shown that specific attitudes related to moral convictions can have an important role in the development and maintenance of problematic sexual behavior symptoms. However, although other types of attitudes, like sexual attitudes, are potentially highly relevant, they have not yet been studied in this role. We investigated how four dimensions of sexual attitudes: Permissiveness, Birth Control, Communion and Instrumentality, contribute to problematic pornography use (PPU) and hypersexual disorder (HD) symptoms, controlling for religiosity, sex, age and relationship status. The study was administered through an online questionnaire and based on a representative sample of n = 1036 (M_age = 43.28, SD = 14.21; 50.3% women) Polish adult citizens. When adjusting for other variables, higher sexual Permissiveness positively predicted HD and PPU among both men (HD: β = .26, p < .001; PPU: β = .22, p < .001) and women (HD: β = .44, p < .001; PPU: β = .26; p < .001). Sexual Instrumentality positively, although weakly, contributed to HD severity among men (β = .11, p < .05). Attitudes reflecting higher support for responsible sexuality (Birth Control subscale) negatively and weakly predicted HD among women (β = - .11, p < .05). Permissiveness was also the only sexual attitude dimension that consistently predicted a higher frequency of sexual activity among men and women. Based on the cutoff criteria proposed by the authors of the used screening instruments (≥ 53 points for the Hypersexual Behavior Inventory and ≥ 4 points for the Brief Pornography Screen), the prevalence of being at risk for HD was 10.0% (men: 11.4%, women: 8.7%) and for PPU was 17.8% (men: 26.8%, women: 9.1%). Our results point to a significant contribution of sexual attitudes to problematic sexual behavior symptoms, which was not encapsulated by the previously studied influence of religious beliefs, although most of the obtained relationships were relatively weak. Particularly, a consistent link between permissive attitudes and both HD and PPU among men and women may indicate that permissive attitudes can potentially contribute to the development and maintenance of problematic sexual behavior. The prevalence of being at risk for PPU (and to some degree HD) in the current representative sample was high. Such results raise questions about the appropriateness of the proposed cutoff criteria and the risk of overpathologizing normative sexual activity, if the cutoff thresholds are not tailored adequately. The results have implications for the assessment, diagnosis and theory of problematic sexual behavior.

Desire thinking and craving as predictors of problematic Internet pornography use in women and men

INTRODUCTION

According to the recent adaptation of the I-PACE model, desire thinking and craving might be closely related to problematic Internet pornography use. The overall aim of the present study was to investigate the role of two components of desire thinking (imaginal prefiguration and verbal perseveration) and craving in problematic Internet pornography use. Furthermore, we examined gender differences in the underlying mechanism linking desire thinking to problematic Internet pornography use.

METHOD

A total of 414 Italian adults (mean age = 27.55 years, SD = 6.13; age range = 18-58; 53.6 % men) participated in this study. Participants completed an online survey to assess problematic Internet pornography use, pornography craving, desire thinking and problematic Internet use. Path analyses and a multi-group approach were used to test the relationships among variables and to explore gender differences.

RESULTS

Imaginal prefiguration was associated to pornography craving which, in turn, was associated to verbal perseveration as proximal antecedent of problematic Internet pornography use, above and beyond the effect of age, relationship status, and problematic Internet use. Two paths significantly differed between men and women: the path between verbal perseveration and problematic Internet pornography, which for women was weaker and did not reach significance; and the path between problematic Internet use and problematic Internet pornography use that was not significant for women.

CONCLUSIONS

In line with the I-PACE model, the present study provided support for the potential role of desire thinking in problematic Internet pornography use as a specific Internet-use disorder and expanded the literature in the field by testing unexplored gender differences. Preventive and clinical implications are discussed.

Making Sense of Jiese: An Interview Study of Members from a Porn-Free Self-Help Forum in China

About 6 million men in China engage in jiese (abstaining from masturbation and porn) and call themselves jieyou (porn-free self-help community members). In this article, we sought to unpack how the idea of jiese took root in Chinese historical, social, and cultural contexts by interviewing 32 jieyou. Guided by the sensemaking theory, we conducted a critical discourse analysis of participants' responses and ended up identifying four major themes: embodied experiences, jiese as rational and noble, reconstructing the subjectivity of jieyou, and nationalistic sentiments. We found out that jieyou tended to justify their abstinence by seeking sources of legitimacy in traditional Chinese culture, the ideology of healthism, science, and patriotic discourses. We argue that jiese reflects young men's contradictory cultural practices of conservatism, self-medicalization, and neoliberal governmentality.

Criteria for the establishment of a new behavioural addiction •

When does repeated behaviour constitute behavioural addiction? There has been considerable debate about non-substance-related addictions and how to determine when impaired control over a behaviour is addiction. There are public health benefits to identifying new behavioural addictions if intervention can improve outcomes. However, criteria for establishing new behavioural addictions must guard against diagnostic inflation and the pathologizing of normal problems of living. Criteria should include clinical relevance (Criterion 1), alignment with addiction phenomenology (Criterion 2) and theory (Criterion 3), and taxonomic plausibility (Criterion 4). Against such criteria, evidence does not yet support classification of pornography-use and buying-shopping disorders as addictions.

Religiosity, Perceived Effects of Pornography Use on Personal Sex Life, and Moral Incongruence: Insights from the German Health and Sexuality Survey (GeSiD)

Although online pornography use appears to be a mainstream activity, there is little information, particularly outside of the USA, about how consumers perceive its impact on their sexuality. Considering increasing concerns about pornography use, this lack of evidence has sociocultural and clinical ramifications - especially because the recently proposed Moral Incongruence model (MI) suggests that some individuals may see their pornography use as problematic independently of the frequency of use. Using data from 4,177 adults from the 2018-2019 national probability-based German Health and Sexuality Survey, we explored self-perceived impact of pornography use on personal sex life and the role of MI. Most participants (61.7%) reported no impact of pornography. Women were characterized by significantly higher odds of reporting positive relative to no impact, while men had higher odds of reporting mixed/negative compared to no impact. Participants in both the positive and the mixed impact group reported a significantly higher frequency of pornography use than participants in the no impact group. In line with the MI model, we observed a significant relationship between participants' religious upbringing and self-perceived negative (relative to mixed) impact of pornography use. Social relevance and clinical implications of the findings are discussed.

Pornography—Is It Good for Sexual Health? A Systematic Review

Aim:

The topic of pornography use is controversial. It is important to understand how young people use pornography and determine whether pornography use has adverse effects on health and well-being.

Methods:

A comprehensive systematic literature search was conducted in 4 electronic databases (PubMed, Google Scholar, CINAHL plus, and Cochrane library) with appropriate MeSH terms “sexual health” and “pornography” and Boolean operators “AND” and “OR,” using SPIDER search strategy tools (sample, phenomenon of interest, design, evaluation, and research type). 11 articles were proceeded with systematic review after critical appraisal following PRISMA guidelines.

Results:

The major findings of the study imply that traditional and unimaginative activities depicted in some pornography and sexualized media are harmful because they impose restricted and circumscribed concepts of sex and sexuality. As a result, sexism, sexual objectification, neoliberal sexual consumerism, and sexual variety are reproduced and reinforced rather than promoted. FPU is linked to better levels of sexual comfort and self-acceptance and reduced levels of anxiety, shame, and guilt over sexual behavior. Pornography consumption has also been linked to increased arousal and orgasm responses, a greater interest in sex, acceptance of various sexual acts, and more sexual experimentation.

Conclusion:

Watching pornography may be a healthy phenomenon if it is occasional, not impairing the personal and social life; however, it can become pathological if watched excessively and impairs the individual’s functioning.

"Pornography Addiction": Elements for Discussion of a Case Report

Can Internet pornography use (IPU) lead to addiction? "Pornography addiction" is a highly controversial concept within the scientific community. In the absence of consensus, international classifications do not consider that the concept meets the criteria to be recognized as a distinct diagnostic entity. However, the term "pornography addiction" has now become common parlance and is therefore present in the discourse of patients seeking therapy to address what they perceive as problematic pornography consumption. Drawing on a brief case vignette, presenting the case of a man who views himself as a pornography addict, we offer a critical review of this concept. Different diagnostic hypotheses will be considered. Beyond the diagnostic process, we consider the issue of "perceived addiction" and its relationship with "moral incongruence." From a psychotherapeutic view, we suggest that patients who self-identify as "porn addicts" must be supported using a more comprehensive approach that goes beyond their symptomatic behavior or the manner in which they present or perceive themselves. The proposed therapy did not seek or require an end to the behavior. The therapy approach focused on exploring the patient's history in an attempt to understand the construction of his sexuality and morality. In the case analyzed, focusing on the source of moral incongruence led to the disappearance of IPU and all associated suffering.

Associations Between Pornography Consumption, Sexual Flexibility, and Sexual Functioning Among Austrian Adults

To date, only a few studies have examined the associations between pornography consumption and sexual functioning. The Acquisition, Activation, Application Model (₃AM) indicates that the frequency of pornography consumption and the perceived realism of pornography may influence whether sexual scripts are acquired from viewed pornography. Having sexual scripts that are alternative to their preferred sexual behaviors may help people switch to alternative sexual behavior when sexual problems arise. The current study analyzed whether frequent pornography consumption was associated with greater sexual flexibility and greater sexual functioning. Additionally, the perceived realism of pornography consumption was tested as a moderator of those associations. At an Austrian medical university, an online cross-sectional questionnaire study was conducted among 644 medical students (54% women and 46% men; M_age = 24.1 years, SD = 3.8). The participants were asked about their pornography consumption, partnered sexual activity, sexual flexibility, perceived realism of pornography, and sexual functioning. Manifest path analyses revealed direct and indirect associations between frequent pornography consumption and greater sexual functioning through greater sexual flexibility in women but not in men. Perceived realism did not moderate those associations. In conclusion, our study was in line with previous studies that found no significant associations between men's pornography consumption and sexual functioning in men. However, some women may expand their sexual scripts and learn new sexual behaviors from pornography consumption, which may help with their sexual functioning.

Online Sex Addiction: A Qualitative Analysis of Symptoms in Treatment-Seeking Men

BACKGROUND

Problematic sexual internet use has been attracting increasing research attention in recent years. However, there is a paucity of qualitative studies about how this problem manifests on a daily basis in the clinical population and whether the phenomenon should fall within the hypersexual, compulsive-impulsive, or addictive spectrums of disorders.

METHODS

Twenty-three semi-structured interviews, including AICA-C clinical interviews, were conducted with men who were in treatment for problematic internet sex use (aged 22-53; Mage = 35.82). The interview structure focused on the patterns of sexual behavior in question, their development, the manifestation of symptoms, and other associated psychosocial problems. A thematic analysis was applied as the main analytical strategy.

RESULTS

Typical problematic patterns included pornography use and cybersex, together with continuous masturbation for several hours several times a week. This pattern emerged relatively early in young adulthood and became persistent for years. The majority of participants fulfilled the criteria for behavioral addiction (as defined, e.g., by the components model of addiction), with loss of control and preoccupation being the most pronounced and withdrawal symptoms being the least. Together with the onset of erectile dysfunction, negative consequences were reported as being slowly built up over years and typically in the form of deep life dissatisfaction, regret, and feelings of unfulfilled potential.

DISCUSSION AND CONCLUSION

The Addiction model is relevant for describing the difficulties in treatment-seeking men who suffer from problematic sexual internet use. However, the manifestations of the additional criteria are nuanced. In the case of negative consequences, their onset might be very slow and not easily reflected. While there was evidence of several forms of tolerance, potential withdrawal symptoms in online sex addiction need further attention to be verified.

Examining the Problematic Pornography Use Model: A Quantitative Exploration of Dysregulated Pornography Use

BACKGROUND

Questions concerning problematic pornography consumption have been widely discussed, but longitudinal data examining the relationships implicated by problematic pornography use models are rare. To date, two models have been proposed that have sought to elucidate the causal mechanisms involved in a problematic pornography use model, the I-PACE model and the Pornography Problems Due to Moral Incongruence Model.

AIM

We sought to clarify this issue by investigating the prospective association between variables integral to previously proposed addiction models.

METHODS

Using a longitudinal TurkPrime.com sample (N = 317), and a newly developed measure of pornography consumption, we asked participants to answer questions related to their pornography usage, their distress levels, and individual differences over a six-month time frame during 2017.

MAIN OUTCOME

Pornography consumption only led to distress when an individual possessed certain individual differences. Moreover, there was no evidence that pornography use mediated or suppressed the relationship between pornography consumption and distress.

RESULTS

Using a series of mediation/suppression models, we found evidence to support the structure of existing theoretical models; specifically, pornography consumption amplifies the relationship between individual differences (ie, sexual compulsivity and sexual sensation seeking) and distress (ie, depression and sexual esteem) over a six-month time period. However, we failed to observe an association between pornography consumption and distress when sexual compulsivity and sexual sensation seeking were left unaccounted for within the model, suggesting pornography use likely only results in distress in those with certain individual differences. Moreover, there was no evidence that perceptions of problematic pornography use suppressed or mediated the relationship between pornography consumption and distress.

CLINICAL IMPLICATIONS

These findings suggest that targeting specific individual differences -a la Acceptance and Commitment Therapy-rather than pornography consumption attitudes may be a more effective strategy to reduce problematic pornography use.

STRENGTHS & LIMITATIONS

One strength of the current study was that we were able to corroborate previously hypothesized models of problematic pornography consumption. Furthermore, this was done using a newly designed measurement of pornography consumption. However, the study was not without some shortcoming. We were unable to test the pornography problems due to moral incongruence arm of the study, something that previous research has indicated may lead to distress.

CONCLUSION

This paper sought to empirically examine models investigating problematic pornography use. Our findings indicate that pornography consumption will only lead to certain sorts of distress in the presence of specific individual differences ie, sexual compulsivity and sexual sensation seeking.

Subpopulations of Addictive Behaviors in Different Sample Types and Their Relationships with Gender, Personality, and Well-Being: Latent Profile vs. Latent Class Analysis

BACKGROUND

Relatively strong theoretical assumptions and previous studies concerning co-occurring addictive behaviors suggest a subpopulation representing general proclivity to behavioral addictions (BAs), and there are gender-specific subpopulations. This study aimed to compare latent profile analysis (LPA) and latent class analysis (LCA) as the methods of investigating different clusters of BAs in the general student population and among students positively screened for at least one BA. Participants and procedure: Analyses of six BAs (study, shopping, gaming, Facebook, pornography, and food) and their potential antecedents (personality) and consequences (well-being) were conducted on a full sample of Polish undergraduate students (N = 1182) and a subsample (n = 327) of students including individuals fulfilling cutoff for at least one BA.

RESULTS

LPA on the subsample mostly replicated the previous four profiles found in the full sample. However, LCA on a full sample did not replicate previous findings using LPA and showed only two classes: those with relatively high probabilities on all BAs and low probabilities. LCA on the subsample conflated profiles identified with LPA and classes found with LCA in the full sample.

CONCLUSIONS

LCA on dichotomized scores (screened positively vs. negatively) were less effective in identifying clear patterns of interrelationships between BAs based on relatively strong theoretical assumptions and found in previous research. BAs can be investigated on the whole spectrum of behavior, and person-centered analyses might be more useful when they are based on continuous scores. This paper provides more detailed analyses of the four basic clusters of BAs, prevalence, and co-occurrence of particular BAs within and between them, their gender and personality risk factors, relationships to well-being, and their interrelationships as emerging from the results of this and previous studies.

Exploring the Etiological Pathways of Problematic Pornography Use in NoFap/PornFree Rebooting Communities: A Critical Narrative Analysis of Internet Forum Data

Problematic pornography use (PPU) has been extensively studied in terms of its negative implications for various life domains. The empirical literature reveals measured outcomes of interpersonal and intrapersonal dysfunction in participants' everyday living, supporting its classification as a disorder. The increasing number of complaints around PPU opens the door to the creation of online self-help rebooting communities. This qualitative study aimed to provide a better understanding of this behavior by investigating potential etiological pathways contributing to the onset of PPU, as they were expressed by members of the online NoFap/PornFree self-help communities with self-perceived PPU. The critical narrative analysis reveals a complex web of mutually informing causal connections. The dialectical relationship between situational resources, material conditions, and an embodied spectator gives rise to an online persona with motivations of self-exploration, experimentation, and socializing. A sense of vulnerability rendered the use of pornography as a means of escape and validation. Furthermore, commitment to abstinence, framed by the notions of recovery and relapse, was found to be a major factor for maintaining distress. The study highlighted the need for a thorough understanding of the etiological pathways of PPU for a more effective and targeted intervention. Moving beyond biomedical conceptualizations suggests an intervention whereby PPU is placed in a context of a crisis of meaning.

The Structure, Covariates, and Etiology of Hypersexuality: Implications for Sexual Offending

PURPOSE OF REVIEW

A substantial increase in research on the structure, covariates, and etiology of hypersexuality has emerged during the last decade. It is the goal of this review to summarize and integrate this research and to indicate some practical implications for clinical and forensic practice, especially as applied to those who have sexually offended.

RECENT FINDINGS

Studies from the last half-decade converge on the conclusion that hypersexuality has both problematic and high sexual drive components. Both aspects have consistently been found to be distributed dimensionally and not categorically. Each subdimension covaries differentially with specific types of impulsivity. In addition to sexual abuse, psychological or emotional abuse has emerged to be a potent developmental antecedent of hypersexuality. Current research has focused on the problematic dimension of hypersexuality and has neglected to specify the criteria for high sexual drive. Lacking are large-scale representative and clinical samples that provide determination of optimal cutoffs for treatment and dispositional decisions for both dimensions of hypersexuality. Research on the etiology of both aspects of hypersexuality is in its infancy, and more differentiated assessments of developmental abuse histories are required.

Self-Assessed Effects of Pornography Use on Personal Sex Life: Results from a Large-Scale Study of Norwegian Adults

Objectives: The study explored characteristics associated with the self-assessed effects of pornography use on one's personal sex life. Methods: Data were collected in a probability-based sample of Norwegian adults (n = 4,160). Results: Most participants (41.3%) did not believe that pornography affected their sex life. More participants reported positive (33.2%) than mixed/negative (25.5%) effects of pornography use. Sociodemographic and sexual characteristics that predicted these self-assessments were examined. Among participants in a steady relationship, emotional intimacy and relationship satisfaction were unrelated to the self-assessed effects. Conclusions: The current study findings add to scant literature about the self-assessed effects of pornography usage.

Frequency of use, moral incongruence and religiosity and their relationships with self-perceived addiction to pornography, internet use, social networking and online gaming

BACKGROUND AND AIMS

Moral incongruence involves disapproval of a behavior in which people engage despite their moral beliefs. Although considerable research has been conducted on how moral incongruence relates to pornography use, potential roles for moral incongruence in other putative behavioral addictions have not been investigated. The aim of this study was to investigate the role of moral incongruence in self-perceived addiction to: (i) pornography; (ii) internet addiction; (iii) social networking; and (iv) online gaming.

DESIGN

A cross-sectional, preregistered, online survey using multivariable regression.

SETTING

Online study conducted in Poland.

PARTICIPANTS

1036 Polish adults aged between 18 and 69 years.

MEASUREMENTS

Measures included self-perceived behavioral addiction to pornography, internet use, social networking and online gaming and their hypothesized determinants (moral incongruence, frequency of use, time of use, religiosity, age and gender).

FINDINGS

Higher moral incongruence (β = 0.20, P < 0.001) and higher religiosity (β = 0.08, P < 0.05) were independently associated with higher self-perceived addiction to pornography. Additionally, frequency of pornography use was the strongest of the analyzed predictors (β = 0.43, P < 0.001). A similar, positive relationship between high moral incongruence and self-perceived addiction was also present for internet (β = 0.16, P < 0.001), social networking (β = 0.18, P < 0.001) and gaming addictions (β = 0.16, P < 0.001). Religiosity was uniquely, although weakly, connected to pornography addiction, but not to other types of addictive behaviors.

CONCLUSIONS

Moral incongruence may be positively associated with self-perception of behavioral addictions including not only pornography viewing, but also internet use, social networking and online gaming.

Compulsive Conditioned Sexual Responding of Male Japanese Quail in Extinction

Previous experiments showed that following acquisition of an association between a terry-cloth object conditioned stimulus (CS) and a live female unconditioned stimulus (US), male quail increased the frequency of their copulations with the inanimate CS during subsequent CS-alone (extinction) trials. The present experiment was conducted to identify the potential factors responsible for this unexpected increase in conditioned sexual behavior during extinction. A total of 57 naïve male quail were given pairings of a terry-cloth CS with a live female during acquisition. A total of 36 of these quail (the approach responders) showed only conditioned approach response to the CS object, whereas the remaining 21 quail (the consummatory responders) also displayed copulatory or consummatory responses to the CS. In the extinction phase, these two sets of quail were divided into two subgroups: one subgroup received a female in their home cages while the other did not. Consummatory responders that were not exposed to a female quail in the home cage showed a significant increase in conditioned consummatory responding as the extinction trials progressed (i.e., compulsive conditioned sexual responding), whereas the other subgroup showed no change. However, both subgroups showed resistance to extinction in both conditioned approach and consummatory behavior. These findings indicate that the increase in copulation with the terry-cloth CS during extinction is possibly caused by US deprivation. The findings also suggest that conditioned copulation with the terry-cloth CS may lead to partial drive satisfaction, which may contribute to persistence of the behavior. Implications of these findings for paraphilias and compulsive sexual behavior are discussed.

Prevalence of Problematic Pornography Use and Attitude Toward Pornography Among the Undergraduate Medical Students

Background:

There are mixed views on categorizing pornography as addiction or as a sexual compulsivity or a subset of hypersexual behavior. Due to rise in the Internet access and technologies, the possibilities of conduit for sexual interactions, online pornography, and other type of repetitive behaviors have increased.

Aims:

The current study aimed to find the prevalence of problematic pornography use and attitude toward pornography.

Methodology:

A cross-sectional study was carried out among 1,050 undergraduate medical students to assess the prevalence of pornography addiction and attitude toward pornography. A Google document containing structured questionnaire in 3 different parts: (a) demographic details of students, (b) Problematic Pornography Consumption Scale, and (c) attitudes toward pornography scale. This Google document was shared with all the undergraduate students through email address and WhatsApp group. Participants who did not respond to the questionnaire were sent 3 reminders at a gap of 3 days. The responses were recorded in Excel sheet and analyzed using Epi-Info software.

Results:

Prevalence of problematic pornography use among participants was 12.5%. There was statistically high prevalence of problematic pornography use among male participants ( P < .001), nearly daily consumption of pornography per week ( P < .001) and more than 20 min of consumption per day ( P <.001). A statistical significant negative correlation was shown (r = −0.483, P < .001) between age of first exposure to pornography and problematic pornography consumption score. Males, being in a relationship, and those with problematic pornography use had higher score on attitude toward pornography scale.

Conclusion:

It is important to provide education to students about the effects of problematic pornography use because there is negative correlation between exposure to pornographic imagery on the Internet and levels of genital and sexual esteem; pornography use was associated with poor quality of life, and depressive and anxiety symptoms. Gender-specific discussions so as to promote sexual health and participation in media literacy education would be beneficial for young people in changing attitude toward pornography.

Variability of Pornographic Content Consumed and Longest Session of Pornography Use Associated With Treatment Seeking and Problematic Sexual Behavior Symptoms

INTRODUCTION

Most of the previous studies on problematic pornography use and related behavior have focused on such descriptors of pornography use habits as frequency or time devoted to pornography use.

AIM

We argue that this constitutes a narrow view and indicators that characterize other aspects of explicit content consumption, namely (i) longest session of pornography viewing (which may be related to binge behavior), as well as (ii) variability of consumed pornographic content, can also be useful indicators.

METHODS

An online study based on a sample of 132 heterosexual men seeking treatment for problematic pornography use, referred by therapists after their initial visit and 437 non-treatment seekers in the control group.

MAIN OUTCOME MEASURES

The main outcomes of this study are reported longest, non-stop session of viewing pornography, variability in consumed pornographic content (including paraphilic and violent pornography), actual treatment seeking for problematic pornography use and severity of symptoms, and average weekly time devoted to pornography use.

RESULTS

Our analysis showed that longest session of viewing pornographic content as well as the variety of consumed pornography influenced the decision to seek treatment and the severity of symptoms even when the sheer amount of time devoted to pornography use was controlled.

CONCLUSION

This is one of the few studies examining the role of engagement in prolonged sessions of pornography use and the variability of consumed pornographic content in the clinical context of problematic sexual behavior. The study's main limitations are its relatively narrow method of operationalization of variability of pornographic content and longest session of pornography viewing, as well as its cross-sectional, online, and anonymous character. As the described factors have an important influence on treatment seeking and the severity of experienced symptoms, they should be considered in the process of assessing compulsive sexual behavior disorder and related symptoms. Lewczuk K, Leśniak J, Lew-Starowicz M, et al. Variability of Pornographic Content Consumed and Longest Session of Pornography Use Associated With Treatment Seeking and Problematic Sexual Behavior Symptoms. Sex Med 2021;9:100276.

Are sexual functioning problems associated with frequent pornography use and/or problematic pornography use? Results from a large community survey including males and females

There is much debate regarding whether pornography use has positive or negative associations with sexuality-related measures such as sexual functioning problems. The present study aimed to examine differential correlates between quantity (frequency of pornography use-FPU) and severity (problematic pornography use-PPU) of pornography use with respect to sexual functioning problems among both males and females. Multi-group structural equation modeling was conducted to investigate hypothesized associations between PPU, FPU, and sexual functioning problems among males and females (N = 14,581 participants; females = 4,352; 29.8%; M_age=33.6 years, SD_age=11.0), controlling for age, sexual orientation, relationship status, and masturbation frequency. The hypothesized model had excellent fit to the data (CFI = 0.962, TLI = 0.961, RMSEA = 0.057 [95% CI = 0.056-0.057]). Similar associations were identified in both genders, with all pathways being statistically significant (p < .001). PPU had positive, moderate associations (β_males=0.37, β_females=0.38), while FPU had negative, weak associations with sexual functioning problems (β_males=-0.17, β_females=-0.17). Although FPU and PPU had a positive, moderate association, they should be assessed and discussed separately when examining potential associations with sexuality-related outcomes. Given that PPU was positively and moderately and FPU negatively and weakly associated with problems in sexual functioning, it is important to consider both PPU and FPU in relation to sexual functioning problems.

Measuring the Multidimensional Construct of Pornography: A Long and Short Version of the Pornography Usage Measure

With the increase in the availability and usage of pornography, the research on the effects of pornography has also increased. This research has uncovered several controversies in the field regarding how pornography usage influences attitudes, sexual behaviors, and relationships. However, many of the measures of pornography are problematic as there is often little reliability and validity information for them and it is not clear that participants in these research studies are referring to the same types of materials when they answer pornography usage questions. Consequently, many of the research findings are suspect and it is crucial to develop reliable and valid scales to measure general pornography usage. In this study, we present both a 20-item and a 7-item version of the Pornography Usage Measure (PUM) that is based on extensive previous research on what types of materials individuals consider pornographic and that indicates pornography is a multidimensional construct. We evaluated the reliability and validity of both versions by using an MTurk sample of 934 males and 705 females (N =1639 total) to conduct confirmatory factor analyses, item response analyses, and structural equation model analyses. These analyses demonstrated that there were adequate reliability and early evidence for content, construct, concurrent, and predictive validity for both versions of the PUM. This measure could improve the quality of future research on pornography by providing more consistency between different studies about what is being measured when individuals indicate their pornography usage patterns.

Sexual addiction 25 years on: A systematic and methodological review of empirical literature and an agenda for future research

In 1998, Gold and Heffner authored a landmark review in Clinical Psychology Review on the topic of sexual addiction that concluded that sexual addiction, though increasingly popular in mental health settings, was largely based on speculation, with virtually no empirical basis. In the more than two decades since that review, empirical research around compulsive sexual behaviors (which subsumes prior research about sexual addiction) has flourished, ultimately culminating in the inclusion of a novel diagnosis of Compulsive Sexual Behavior Disorder in the eleventh edition of the World Health Organization's International Classification of Diseases. The present work details a systematic review of empirical research published between January 1st, 1995 and August 1st, 2020 related to compulsive sexual behaviors, with a specific focus on evaluating the methodologies of that literature. This review yielded 371 papers detailing 415 individual studies. In general, the present review finds that, although research related to compulsive sexual behaviors has proliferated, much of this work is characterized by simplistic methodological designs, a lack of theoretical integration, and an absence of quality measurement. Moreover, the present review finds a virtual absence of high-quality treatment-related research published within this time frame. Implications of these findings for both clinical practice and future research are discussed.

Three Diagnoses for Problematic Hypersexuality; Which Criteria Predict Help-Seeking Behavior?

This study aimed to assess the best combination of indicators of problematic hypersexuality (PH), in a survey (n = 58,158) targeting individuals wondering if they were sex addicted. The survey allowed for testing of criteria from three theoretical models used to conceptualize PH. Factor analyses for women and men yielded an interpretable grouping of indicators consisting of four factors. In subsequent logistic regressions, these factors were used as predictors for experiencing the need for help for PH. The factors Negative Effects and Extreme positively predicted experiencing the need for help, with Negative Effects as the most important predictor for both women and men. This factor included, among others, withdrawal symptoms and loss of pleasure. The Sexual Desire factor negatively predicted the need for help, suggesting that for the targeted population more sexual desire leads to less PH. The Coping factor did not predict experiencing the need for help. Outcomes show that a combination of indicators from different theoretical models best indicates the presence of PH. Therefore, a measurement instrument to assess existence and severity of PH should consist of such a combination. Theoretically, this study suggests that a more comprehensive model for PH is needed, surpassing existing conceptualizations of PH.

Gender differences in implicit exposure to cyber-pornography

Cyber-pornography consumption has become a widespread behavioral habit, with potential diverse outcomes for the user. Previous studies have repeatedly found that males are exposed to cyber-pornography more than females, when they are asked about it explicitly. However, perceived social acceptance of cyber-pornography consumption may dramatically bias such explicit reports. The current study aimed at better understanding gender differences in exposure to cyber-pornography using both explicit self-report measures and a new measure developed to examine exposure to cyber-pornography indirectly. The findings demonstrated gender differences in exposure to cyber-pornography in both measures. Women tended to understate the extent of their exposure. Interestingly, men showed the opposite tendency. Lastly, perceived social acceptance mediated the relationship between gender and explicit report bias. We discuss the conclusions of the current study in relation to previous theories and findings, as well as the importance of using indirect measures to study socially controversial topics such as cyber-pornography.

Exploring the clinical profile of problematic pornography use

BACKGROUND

Although problematic pornography use (PPU) will soon be diagnosable through the International Classification for Diseases, 11th revision, its clinical profile remains contentious. The current study assessed whether PPU may be characterized by various symptoms sometimes observed among online recovery forums that currently lack empirical assessment, such as heightened cognitive-affective issues following pornography use and sexual dysfunction with partners as a result of escalating use.

METHOD

Cross-sectional surveys were completed by male PPUs (N = 138, mean age = 31.75 years, standard deviation = 10.72) recruited via online recovery communities and Amazon Mechanical Turk. Multiple regression analysis was performed using the Problematic Pornography Use Scale as the dependent variable and variables of interest (Arizona Sexual Experiences Scales modified for partnered sex and pornography use, Brunel Mood Scale, Social Interaction Anxiety Scale, and the Tolerance subscale from the Problematic Pornography Consumption Scale) and potential confounders (eg, comorbid psychopathology) as independent variables.

RESULTS

Current levels of pornography use, indicators of tolerance and escalation, greater sexual functioning with pornography, and psychological distress were uniquely associated with PPU severity, while cognitive-affective issues after pornography use, impulsivity and compulsivity were not. Although sexual dysfunction did not predict PPU severity, nearly half the sample indicated sexual dysfunction with intimate partners.

CONCLUSIONS

The present findings suggest that PPU may be characterized by tolerance and escalation (as per substance addiction models), greater sexual responsivity toward pornography, and psychological distress. Meanwhile, the high rate of partnered sexual dysfunction observed suggests that PPU might be somewhat separable from other forms of compulsive sexual behavior.

Cybersex addiction: an overview of the development and treatment of a newly emerging disorder

Cybersex addiction is a non-substance related addiction that involves online sexual activity on the internet. Nowadays, various kinds of things related to sex or pornography are easily accessible through internet media. In Indonesia, sexuality is usually assumed taboo but most young people have been exposed to pornography. It can lead to an addiction with many negative effects on users, such as relationships, money, and psychiatric problems like major depression and anxiety disorders. A few instruments may be used to detect cybersex behavior. This review was aimed to provide a comprehensive discussion about cybersex addiction in Indonesian society and the importance of its screening for this condition to enable its early detection and subsequent management. 

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.

The Exacerbating Impact of Moral Disapproval on the Relationship Between Pornography Use and Depression, Anxiety, and Relationship Satisfaction

Using an online sample of participants in committed relationships, support was found for a moderated mediation model in which depression mediated the relationship between pornography use and relationship satisfaction, and this indirect effect was moderated by level of moral disapproval. Results indicate that, among consumers of pornography, their level of moral disapproval exacerbates adverse intra- and interpersonal outcomes such as distress and decreased relationship satisfaction. These results extend the empirical literature that examines the conditional effects of moral disapproval of pornography use to relational outcomes.

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.

A Network Approach to Hypersexuality: Insights and Clinical Implications

BACKGROUND

In spite of a growing interest in research on hypersexuality, consensus about its etiology and best treatment strategy has not been achieved.

AIM

To further the empirical and clinical understanding of hypersexuality by exploring the structure of its symptoms using a network analytic approach.

METHODS

In 2014, an online survey advertised as focusing on Internet pornography, sexual health, and relationships was carried out among Croatian men and women aged 18-60 years (M_age = 31.1 years, SD = 9.67). In a sample of 3,028 participants, we applied a network analytic approach to explore the structure of hypersexuality symptoms. In the network, nodes represented hypersexuality symptoms and associated sexual behaviors, while their connections were operationalized as partial correlations. 4 Research questions were addressed: (1) does the hypersexuality network differ between genders; (2) which symptoms are centrally positioned; (3) what is the topological location of pornography use; and (4) are there distinct clusters ("communities") of symptoms in the network?

OUTCOMES

We estimated and plotted hypersexuality networks by gender using items from the Hypersexual Disorder Screening Inventory and the Hypersexual Behavioral Consequences Scale, as well as indicators of sexual desire, pornography use, sexual intercourse, and masturbation frequency.

RESULTS

The structure of the hypersexuality network was surprisingly similar in women and men, both in terms of symptom centrality and the clustering of symptoms. Psychological distress and negative emotions triggered by sexual fantasies and/or behaviors, together with a loss of control over sexual feelings, occupied central positions in the networks. Pornography use was located peripherally in both the men's and women's hypersexuality networks.

CLINICAL TRANSLATION

Psychological distress and negative emotions triggered by sexual fantasies and/or behaviors constituted the core of the hypersexuality network, which makes them potential prime targets for clinical intervention and calls for normalization of (presumably self-stigmatized) sexual expression through affirmative therapy and interventions that enhance self-care, self-compassion, and adaptive coping mechanisms.

STRENGTHS & LIMITATIONS

This is the first network analytic approach to hypersexuality. Apart from its novel insights about the structure of hypersexuality, the study employed several methods to assure reliability and robustness of findings. Considering that networks were estimated in a convenience-based community sample, the findings might not generalize to clinically distressed individuals.

CONCLUSION

Our results demonstrate the usefulness of network analytics to hypersexuality in a non-clinical sample and we encourage future clinical and longitudinal explorations of hypersexuality using this novel approach. Werner M, Štulhofer A, Waldorp L, et al. A Network Approach to Hypersexuality: Insights and Clinical Implications. J Sex Med 2018;15:373-386.

No Sex Difference Found: Cues of Sexual Stimuli Activate the Reward System in both Sexes

Sexually explicit material (SEM) is increasingly used in western societies. One reason for this high usage might be the rewarding property of SEM demonstrated in many brain imaging studies showing an activation of the reward system during the presentation of SEM. It is not yet well understood why women use SEM to a remarkably lesser extent than men. Maybe men react stronger to stimuli - so called SEM cues -, which signal the presentation of SEM and are therefore more vulnerable to use SEM than women. Therefore, the present study aimed at investigating the sex specific neural correlates towards SEM and SEM cues. We were further interested in whether person characteristics as trait sexual motivation, extent of SEM use in the last month, and age at onset of goal-oriented SEM use affect the neural responses to SEM and SEM cues. The trials of the fMRI experiment consisted of an expectation phase with SEM or neutral cues and a presentation phase with SEM or neutral stimuli, respectively. Analyses showed that the reward circuitry was activated by SEM, but also by SEM cues. There were some sex differences in hemodynamic responses to SEM during the presentation phase, but not during the expectation phase to SEM cues in any of the regions of interest. The influence of the investigated person characteristics was only small if existent. The results suggest that sex specific cue processing cannot explain sex differences in the use of SEM.

The contribution of ADHD and attachment difficulties to online pornography use among students

BACKGROUND

There is a high rate of ADHD among individuals with compulsive sexual behavior disorder (CSBD). There is also evidence for an association between compulsive sexual behavior disorder, sensation seeking and attachment difficulties. Problematic pornography use may be considered as a subtype of CSBD hence it merits investigation. The aim of the current study was to investigate the relationships between ADHD, attachment style, sensation seeking and problematic use of pornography online in the general population.

METHODS

The sample was comprised of 85 participants [38 men (44.7%) and 47 women (55.3%)] with mean age 25. 66 (SD = 4.63) and 26.42 (SD = 6.94) years, respectively. There were 30 participants (35%) with ADHD and 55 participants (65%) without ADHD. They were recruited on-line via social network sites. They filled in a demographic questionnaire, Zukerman's Sensation Seeking Scale, Experience in Close Relationship (ECR) questionnaire that assessed anxious and avoidant attachment and the Cyber Pornography Use Inventory (CPUI).

RESULTS

Individuals with self-reported ADHD had higher scores of avoidant attachment on the ECR and CPUI compared with individuals without ADHD. Multivariate linear regression analysis has indicated that male gender, ADHD and anxious attachment on the ECR contributed significantly to the variance of cyber pornography use, and explained 34% of the variance.

CONCLUSIONS

The results indicate that males with ADHD and anxious attachment show an extensive use of pornography online. Males with ADHD who have difficulties in close relationship may use online pornography excessively that in turn may exacerbate their difficulty in forming secure attachment at adult life, a finding that has major clinical implications.

Psychometric Instruments for Problematic Pornography Use: A Systematic Review

Despite a lack of consensus in the field about how best to conceptualize problematic pornography use, psychometric instruments have nonetheless been developed to assess the construct. The present systematic review aimed to (i) identify psychometric tools that have been developed to assess problematic pornography use; (ii) summarize key characteristics, psychometric properties, and strengths and limitations of instruments for problematic pornography use; (iii) compare the instruments' theoretical conceptualizations of problematic pornography use; and (iv) evaluate each instrument on their ability to assess various core components of addiction. In this article, 22 instruments assessing problematic pornography use were reviewed. Results indicated that while the instruments had different conceptualizations of problematic pornography use, addiction still emerged as the most common theoretical framework used by the instruments. Five of the most commonly assessed addiction components across the different instruments were (1) impaired control, (2) salience, (3) mood modification, (4) interpersonal conflict, and (5) general life conflict. Contextual factors that may potentially affect the assessment of problematic pornography use and recommendations for researchers and clinicians are discussed.