Cognitive processes related to problematic pornography use (PPU): A systematic review of experimental studies

Spanish Validation of the Long and Short Versions of the Problematic Pornography Consumption Scale (PPCS and PPCS-6) in Adolescents

Although 1-14% of adolescents may experience problematic pornography use (PPU), psychometrically sound instruments for assessing PPU in Spanish-speaking adolescents are scarce. Given the advantages of the different forms of the Problematic Pornography Consumption Scale (PPCS), the aim of the present study was to assess the psychometric properties of the PPCS and PPCS-6, and to examine associations between PPU and age among boys and girls. Two school-based adolescent samples were recruited in Spain (n = 650; Mage = 16.0 [SD = 1.1]; 50% girls and 50% boys) and Mexico (n1, 160; Mage = 15.8 [SD = 1.1]; 68% girls) to assess the psychometric properties of the PPCS and PPCS-6. Confirmatory factor analysis was applied and convergent and discriminant validity with other measures related to PPU was also tested. The results provided empirical support for the six-factor structure of the PPCS and the one-factor structure of the PPCS-6. Boys with older age showed higher levels of tolerance than girls on the PPCS in both countries. Both the PPCS and the PPCS-6 may be considered valid psychometric instruments for the assessment of PPU in Spanish-speaking adolescents from Spain and Mexico.

Female Affective Perception of Mainstream and Paraphilic Pornography: Associations with Sexual and Psychological Intrapersonal Variables

Understanding affective perceptual processes can further contribute to the explanation of motivation and actions, as well as sexual risk behaviors. Pornography can be considered salient emotional content and is popular, also among females. Yet, the female perspective on pornography has often been overlooked and it remains unclear how individual variables may be associated with the affective perception of pornography and could provide a risk profile. Possible associations between several sexual and psychological intrapersonal variables and the affective perception of various forms of pornography were analyzed from the female perspective. A sample of 231 females (M = 21.87 years; SD = 3.9 years) provided ratings of affective valence, arousal, disgust, and moral and ethical acceptance for mainstream pornographic and paraphilic images of dominance, submission, or sexual violence. Paraphilic pornography was perceived as less pleasant, arousing, and moral and ethically acceptable, but more disgusting compared to mainstream pornography. This was more pronounced among females who had never consumed pornography. Results further suggest that the female affective perception of pornography was associated with the following sexual intrapersonal variables: sexual sensation seeking for physical sensations, erotophilia, lack of sexual control, problematic pornography consumption, and sexual disgust sensitivity. Of the assessed psychological intrapersonal variables, only anxiety was negatively associated with disgust for paraphilic pornography. It is important to further analyze the female affective perception of pornography and associated variables to include them in strategies for prevention and for addressing problematic consequences of the acceptance of specific sexual content and behaviors, especially related to sexualized violence.

Distortions in time perception related to videogames, pornography, and TV series exposure: An experimental study in three independent samples

Background and aims

Time perception is a cognitive process involving both the ability to estimate the duration of an event (time estimation, TE) and the subjective perception of its passage (time passage, TP). Studies show that alteration in TE/TP is associated with substance use disorders. However, little is known about the impact of these alterations in potentially problematic online behaviors. We explore TE and TP while participants were exposed to cues related to videogames, pornography, and TV series, and the relationship of TE and TP with scores from instruments that measure problematic gaming (PG), problematic pornography use (PPU), and problematic binge-watching (BW).

Methods

Participants from three independent samples (40 men from Luxembourg; 99 Spanish men, 111 Spanish women) completed an experimental task designed to assess TE and TP while they were exposed to short clips related to videogames, pornography, TV series, and documentaries (control condition). Participants also completed different self-reports.

Results

Whereas men underestimated the time that they were exposed to pornography and TV series, women overestimated it. For videogames, we showed a consistent pattern of overestimation of time duration. Time was systematically perceived as passing faster while participants were presented with TV series and pornography. Regarding the association between time perception and PG, PPU, and BW, TE did not correlate with any of the indicators of problematic engagement assessed; but TP correlated with several of these indicators.

Discussion and conclusions

The present preliminary results showed mixed evidence regarding the involvement of time perception in gaming, pornography use, and binge-watching.

Uncontrolled eating and sensation-seeking partially explain the prediction of future binge drinking from adolescent brain structure

Binge drinking behavior in early adulthood can be predicted from brain structure during early adolescence with an accuracy of above 70%. We investigated whether this accurate prospective prediction of alcohol misuse behavior can be explained by psychometric variables such as personality traits or mental health comorbidities in a data-driven approach. We analyzed a subset of adolescents who did not have any prior binge drinking experience at age 14 (IMAGEN dataset, n = 555, 52.61% female). Participants underwent structural magnetic resonance imaging at age 14, binge drinking assessments at ages 14 and 22, and psychometric questionnaire assessments at ages 14 and 22. We derived structural brain features from T1-weighted magnetic resonance and diffusion tensor imaging. Using Machine Learning (ML), we predicted binge drinking (age 22) from brain structure (age 14) and used counterbalancing with oversampling to systematically control for 110 + variables from a wide range of social, personality, and other psychometric characteristics potentially associated with binge drinking. We evaluated if controlling for any variable resulted in a significant reduction in ML prediction accuracy. Sensation-seeking (-13.98 ± 1.68%), assessed via the Substance Use Risk Profile Scale at age 14, and uncontrolled eating (-13.98 ± 3.28%), assessed via the Three-Factor-Eating-Questionnaire at age 22, led to significant reductions in mean balanced prediction accuracy upon controlling for them. Thus, sensation-seeking and binge eating could partially explain the prediction of future binge drinking from adolescent brain structure. Our findings suggest that binge drinking and binge eating at age 22 share common neurobiological precursors discovered by the ML model. These neurobiological precursors seem to be associated with sensation-seeking at age 14. Our results facilitate early detection of increased risk for binge drinking and inform future clinical research in trans-diagnostic prevention approaches for adolescent alcohol misuse.

Sexual development in ADHD and internet pornography consumption

Development of sexual identity during adolescence is a major process of transition in individual life which in cases of ADHD specifically interacts with other ontogenetic, pathological and psychosocial conditions. According to recent findings growing consumption of internet pornography mainly in male ADHD population is closely related to compulsive sexual behavior and hypersexuality. Recent findings also indicate that consumption of internet pornography in ADHD individuals and other sexual activities may serve as a mood-altering "self-medication" which may help to cope with stressful events and decrease depression and anxiety. Taken together recent findings indicate that internet pornography consumption mainly in ADHD individuals is closely related to stressful experiences, anxiety, depression and identity problems in partnerships which significantly increase their vulnerability to the so-called "problematic pornography use" and other forms of addictive sexual behavior. From this developmental perspective "problematic pornography use" in ADHD individuals represents significant epidemiological problem which requires further research mainly with focus on clinical diagnostics and treatment.

Decision making and executive functions in problematic pornography use

Introduction

Previous research on cognitive functions in Compulsive Sexual Behavior Disorder (CSBD) and problematic pornography use (PPU) reported inconsistent findings and mostly included sexual pictures in the used tasks. The role of general executive functions and cognitive competences (without the presence of appetitive stimuli) in the context of PPU is largely unexplored.

Methods

This study investigated differences between individuals with high versus low problem severity of PPU regarding decision making and executive functions. The sample of the laboratory study consisted of N = 102 male adults. Besides measures of trait impulsivity, we used standard neuropsychological tests (Trail Making Test and three-back working memory task) and an intertemporal risky choice paradigm, the Cards & Lottery Task (CLT).

Results

The results show heightened impulsivity (urgency and deficits in perseverance) in individuals with high PPU, but no differences regarding performance in the CLT and executive function tasks.

Discussion

The findings indicate that PPU might be associated with impulsive behavior when experiencing strong emotions (urgency) and deficient cognitive performance especially in the presence of sexual stimuli but not in general.

Is sexual attraction and place of origin a moderator of sex in pornography consumption? Cross-sectional study on a representative sample of young adults

BACKGROUND

Pornography consumption is higher in men, but we do not know if this association can be modified by different variables, such as sexual attraction and place of origin. Given the impact pornography has on minors, there are limited studies that analyze the use of pornography in representative samples of the adult population. The aim was analyze the prevalence and factors associated with using pornography in young adult men and women, living in Spain, with different sexual attractions and different places of birth.

METHODS

Cross-sectional study with an online survey conducted with 2515 men and women aged between 18 and 35 years of age. The prevalence of pornography consumption is described and analyzed in the total sample and stratified by sex, according to socio-demographic and sexual attraction variables. The association between covariates and pornography consumption at some point in life was estimated with prevalence ratios (PR) obtained with the Poisson models of robust variance.

DEPENDENT VARIABLE

voluntarily using pornography at some point in life. Socio-demographic variables were included in the analysis: age, sex, level of education, place of birth. Sexual attraction was also analyzed.

RESULTS

In Spain, 94.7% of men between 18 and 34 years and 74.6% of women have voluntarily used pornography at some point in their life. The mean age to start using it is earlier in men [Mean:14.2; Standard Deviation (SD):2.3]. Bisexual/homosexual attraction (reference: heterosexual) increases the probability of using pornography in women [(PR (95%CI): 1.30 (1.22; 1.38)]. Yet this is not observed in men. In both sexes, the probability of using pornography increases with age [(PR (95%CI): 1.01(1.00; 1.01)] and coming from abroad (reference: native), being the effect of country of birth significantly higher in women [(PR (95%CI): 1.17 (1.09; 1.26)] than in men [(PR (95%CI): 1.04 (1.01; 1.07).

CONCLUSIONS

Public health programmes aimed at improving affective-sexual health should consider the high use of pornography among young adults in Spain, as well as those variables that increase its use.

Biopsychosocial Determinants of Problematic Pornography Use: A Systematic Review

Background

Although some studies have examined the determinants of problematic pornography use (PPU), few systematic comparisons of risk profiles have been conducted so far. Research on risk profiles can shed a bright light on our knowledge of both the early diagnosis and etiology of such highly prevalent disorders. Accordingly, the present study aimed to provide a comprehensive overview of the determinants of PPU.

Methods

Scopus, Web of Science, PubMed, and PsycINFO databases were systematically searched, and relevant English articles, including longitudinal and cross-sectional studies on risk factors published from January 2000 to February 2022 were reviewed.

Findings

The determinants of PPU extracted from the investigated studies (n=66) were summarized and clustered into biological, psychological, and social categories. The findings indicated that ventral striatum activity is a consistent biological factor which plays a key role in the development of PPU, while there were other psychological factors influencing PPU as mentioned in several studies, including craving, low self-esteem, sexual arousal, coping styles, stress, frequent pornography watching, avoidance, negative beliefs, and emotional deficiency. In addition, the social factors affecting PPU have been reported to be male gender, age, religion, moral incompatibility, and loneliness. According to these results, the identified factors could be considered in preventive treatment.

Conclusion

This systematic review provided a comprehensive overview of the biopsychosocial determinants of PPU by analyzing 66 articles mostly from Europe and North America. Most studies showed that ventral striatum activity, craving, self-esteem, stress, frequent pornography watching, gender, age, and religion are related to PPU.

Self-regulatory Processes in Problematic Pornography Use

Purpose of Review

A core symptom of problematic pornography use (PPU) is the repeated failure to control sexual impulses resulting in pornography use; however, the field of self-regulation research has rarely been applied to PPU.

Recent Findings

Various goals can underly the use of online pornography. These goals can conflict with other self-regulatory goals a person holds, which leads to moments of self-control. The outcome of such self-control moments depends on multiple internal factors, including the strength of the desire to use pornography, whether a person perceives a conflict with their behaviour, and the motivation to resist their desire, as well as external, situational factors. Findings on the contribution of volition towards self-regulation in PPU are inconclusive.

Summary

More research is needed to further explore what influences moments of self-control, specifically in PPU. The proposed model of self-control moments can be used to derive research questions for further studies as well as to develop prevention and intervention approaches.

Compulsive Sexual Behavior Disorder should not be classified by solely relying on component/symptomatic features •

The paper by Sassover and Weinstein (2022) contributes to a timely and complex debate related to the classification of Compulsive Sexual Behavior Disorder (CSBD). The recent inclusion of CSBD as an impulse-control disorder in the ICD-11 has generated debate since a competitive view is that CSBD should rather be classified as an addictive disorder. Sassover and Weinstein (2022) reviewed existing evidence and concluded it does not support the conceptualization of CSBD as an addictive disorder. Although we agree regarding the relevance and timely nature of considering the classification of CSBD, we respectfully disagree with the position that relying on the components model of addiction (Griffiths, 2005) is the optimal approach for determining whether or not CSBD is an addictive disorder. In this commentary, we discuss potential pitfalls of relying on the components model to conceptualize CSBD as an addictive disorder and argue that considering a process-based approach is important for advancing this timely debate.

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.

Reward Responsiveness, Learning, and Valuation Implicated in Problematic Pornography Use — a Research Domain Criteria Perspective

Purpose of Review

Problematic pornography use (PPU) describes a pattern of behavior characterized by excessive time spent using or thinking about pornography and continued use despite negative consequences. To help advance the understanding of transdiagnostic underlying psychological and neurobiological mechanisms in PPU, we aim to review existing evidence on these mechanisms focusing on positive valence systems within the transdiagnostic Research Domain Criteria (RDoC) framework.

Recent Findings

Reward anticipation processes seem to be increased in individuals with PPU symptoms when they anticipate sexual stimuli compared with other rewards. Studies further suggest that the initial neural and attentional responses to sexual rewards compared with different control stimuli are also increased in individuals with PPU symptoms, as are conditioned responses in sexual reward learning paradigms. Sexual reward valuation studies point towards an increased neural value differentiation with increasing PPU symptoms.

Summary

The current state of evidence indicates that positive valence systems are altered in persons with PPU. This framework of organizing evidence may aid in elucidating PPU development and maintenance as well as planning future studies.

Rich Get Richer: Extraversion Statistically Predicts Reduced Internet Addiction through Less Online Anonymity Preference and Extraversion Compensation

Internet addiction may arise from multiple factors and personality tendencies have been previously implicated. Prior studies have found that extraversion may be a protective factor mitigating against internet addiction, yielding a "rich-get-richer" effect. However, few studies have explored how extraversion may influence internet addiction from the perspective of online-offline integration. Drawing on a sample of 428 college students, the current study examined a serial mediation model exploring the underlying mechanisms of how extraversion may statistically predict internet addiction through online-offline integration and antecedent factors. The serial mediation model analyses indicated that extraverted internet users exhibited a weaker preference for online anonymity and less online extraversion compensation, thus formulating a higher level of online-offline integration than introverted individuals, which, in turn, appeared to reduce the risk of internet addiction. In contrast, with regard to specific components of online-offline integration, introverted internet users preferred online anonymity, which reduced their relationship integration and increased their likelihood of internet addiction; similarly, the introverted individuals were also more likely to exhibit an extraversion compensation effect. That is, they were more extraverted on the internet than in general; hence, they had a lower level of self-identity integration, resulting in a greater likelihood of experiencing internet addiction. These results highlight the importance of online-offline integration that may account for personality variations in social and psychological outcomes related to internet use, and suggest a role for online anonymity preference and extraversion compensation in influencing specific components of integration.

Electrophysiological evidence of enhanced early attentional bias toward sexual images in individuals with tendencies toward cybersex addiction

BACKGROUND AND AIMS

Attentional bias is a key factor in addictive behavior maintenance. However, whether attentional bias has a similar effect on cybersex addiction is unclear. We investigated differences in the attentional processing of sexually explicit images between individuals with high tendencies toward cybersex addiction (TCA) versus low tendencies using behavioral and electrophysiological indices.

METHODS

Twenty-eight individuals with high TCA and 29 with low TCA performed an addiction Stroop task comprising sexual and neutral images in colored frames. Participants were asked to respond to the frame color and not the image contents, and behavioral and event-related potentials were recorded.

RESULTS

Behaviorally, an addiction Stroop interference effect was found in the high TCA group, as shown by the longer reaction times to judge the frame colors of sexual images. Electrophysiologically, a P200 (150-220 ms) enhancement was present in response to sexual images compared with neutral ones, which was absent in the low TCA group. The event-related potential correlates with the addiction Stroop interference effect, indicating that the attentional bias underlying the addiction Stroop interference operates at an automatic level. A general, sexually related bias was found in the late positive potential (300-700 ms) amplitude, although between-group differences were insignificant.

DISCUSSION AND CONCLUSIONS

These findings indicate that sexual stimuli grab the attentional resources of individuals with high TCA at early automatic stages of attentional processing. Increased cue reactivity to sexual stimuli may contribute to pornographic consumption and play a crucial role in sustaining problematic excessive use of online pornography.

Problematic Pornography Use: Legal and Health Policy Considerations

Purpose of Review

Reports of sexual violence, especially towards women and children, are rapidly increasing. At the same time, rates of problematic pornography use (PPU) are accelerating across the world too. The purpose of this review is to consider the recent research on PPU and its contribution to sexual violence. The article offers guidance to governments on possible health policy interventions and legal actions to prevent the development of PPU and to reduce the incidence of sexual violence in society.

Recent Findings

Working from the consumer’s point of view, we identify PPU and ask how much pornography is needed to cause PPU. We examine how PPU drives sexual offending in children, adolescents and adults. The impact of PPU on some consumers’ behaviour suggests significant links to domestic violence. Sexual strangulation is highlighted as an example. Artificial intelligence algorithms play a key role in the pornography industry and appear to be driving escalation to more violent material, inducing high levels of sexual dysfunction in consumers and creating appetites for viewing child sexual abuse material (CSAM).

Summary

Easy access to internet pornography has led to an increase in PPU and sexual violence. Diagnoses and treatments for PPU are examined, as are legal transgressions of a civil and criminal nature arising from PPU. Legal remedies and government policy implications are discussed from the point of view of the precautionary principle. Strategies covered include age verification for pornography, public health campaigns and embedded health and legal warnings for users at the start of pornography sessions along with lessons for pupils about pornography’s impact on the brain.

Diagnostic and Classification Considerations Related to Compulsive Sexual Behavior Disorder and Problematic Pornography Use

Purpose of Review

There are ongoing debates about specific features of compulsive sexual behavior disorder (CSBD) relating to classification and diagnoses. We aim to address current discussions relating to potential subtypes of CSBD, the aspect of compulsivity in CSBD, and the aspect of moral incongruence and CSBD.

Recent Findings

CSBD includes multiple specific sexual behaviors that might be related to specific psychological processes. Problematic pornography use may be considered a subtype of CSBD, which may have multiple parallels with addictive behaviors. The feature of compulsivity in CSBD may be different from compulsivity in other disorders and may be differently involved in early versus later stages of CSBD. Moral incongruence is important to consider in the context of CSBD, although moral disapproval is not a general exclusion criterion for diagnosing CSBD.

Summary

Considering the current debates of specific features of CSBD, future research and clinical practice may benefit from a trans-diagnostic approach to contribute to a more fine-grained understanding of the multiple facets of CSBD.