The assessment and treatment of adult heterosexual men with self-perceived problematic pornography use: A review

No Magic Pill: A Systematic Review of the Pharmacological Treatments for Compulsive Sexual Behavior Disorder

Compulsive sexual behavior disorder (CSBD) is a burgeoning diagnostic construct. No systematic reviews of CSBD pharmacotherapy interventions have been conducted. We addressed this gap using a three-aim approach. We reviewed researchers' theoretical arguments for various pharmacotherapies, outcomes from pharmacotherapy trials, and the generalizability of the extant findings. Our review included k = 13 studies, with n = 141 participants. An opioid model of reward seeking was the most popular framework, though inconsistently specified. A serotonin model was also documented, though with few details. Naltrexone was the most prominently examined pharmacotherapy and the only medication that reliably demonstrated a therapeutic effect for some (but not all) indicators compared to placebo. Paroxetine and citalopram were also documented in placebo-controlled trials, though their incremental benefit compared to placebo is suspect. Several additional pharmacotherapies have been documented in case series contexts. Across studies, only one female participant was identified. All trials were conducted in developed nations, and race was rarely assessed. We conclude that the case for pharmacotherapy for CSBD is limited and should preferably not occur outside of clinical trial contexts. Naltrexone offers the best evidence for a potential research program, though new theoretically informed approaches are welcome. Finally, we call for additional pharmacotherapy research in women and non-White populations.

The effect of therapeutic and deterrent messages on Internet users attempting to access 'barely legal' pornography

Online child sexual abuse material (CSAM) is a growing problem. Prevention charities, such as Stop It Now! UK, use online messaging to dissuade users from viewing CSAM and to encourage them to consider anonymous therapeutic interventions. This experiment used a honeypot website that purported to contain barely legal pornography, which we treated as a proxy for CSAM. We examined whether warnings would dissuade males (18-30 years) from visiting the website. Participants (n = 474) who attempted to access the site were randomly allocated to one of four conditions. The control group went straight to the landing page (control; n = 100). The experimental groups encountered different warning messages: deterrence-themed with an image (D3; n = 117); therapeutic-themed (T1; n = 120); and therapeutic-themed with an image (T3; n = 137). We measured the click through to the site. Three quarters of the control group attempted to enter the pornography site, compared with 35 % to 47 % of the experimental groups. All messages were effective: D3 (odds ratio [OR] = 5.02), T1 (OR = 4.06) and T2 (OR = 3.05). Images did not enhance warning effectiveness. We argue that therapeutic and deterrent warnings are useful for CSAM-prevention.

Understanding How Religiousness Shapes Perceptions of Compulsive Sexual Behavior

In the present study, we test the model of moral incongruence by examining whether moral disapproval of pornography mediates the relationship between organizational religious activity and self-reported CSB and whether the frequency of viewing pornography moderates the relationship between moral disapproval and self-reported CSB in two samples: a general population sample and a sample of members of the Church of Jesus Christ of Latter-day Saints ("Mormons"). Analyses revealed that, among both samples, frequency of pornography viewing moderated the indirect effect of organizational religious activity on perceived CSB via morally disapproving of pornography. Specifically, moral disapproval of pornography mediated the relationship between organizational religious activity and compulsive sexual behavior when participants viewed pornography approximately monthly or more (mean and +1 SD among the general population sample, +1 SD among the Latter-day Saint sample). Findings suggest that individuals who attend worship services more frequently are more likely to perceive their pornography viewing as compulsive at higher frequencies of usage - even when their frequency of pornography viewing is unlikely to be associated with actual functional impairment - and that this distress is better understood in relation to experiences of moral incongruence.

Current Understanding of Compulsive Sexual Behavior Disorder and Co-occurring Conditions: What Clinicians Should Know about Pharmacological Options

Compulsive sexual behavior disorder (CSBD) has recently been recognized as a psychiatric disorder. Pharmacological treatments for CSBD have received little study and thus have limited empirical support. The main objective of the present work is to review existing literature on the efficacy of different drugs on the symptomatology of CSBD, including the subtype of problematic pornography use (PPU). The main pharmacological approaches to treating CSBD have included opioid antagonists (naltrexone and nalmefene), selective serotonin reuptake inhibitors (paroxetine, citalopram, fluoxetine, and sertraline), mood stabilizers (topiramate), tricyclic antidepressants (clomipramine), serotonin antagonist and reuptake inhibitors (nefazodone), and N-acetylcysteine. Since people with CSBD may experience different co-occurring disorders, these should be considered when choosing the best pharmacological treatment. Pharmacological therapy for CSBD/PPU has been suggested as an adjunct to psychological therapies, which, for the moment, have the most empirical evidence. However, to evaluate the efficacy of most of the drugs presented in this narrative review, data to date have only been available from case studies. Thus, empirical support is scant and generalizability of results is limited, highlighting the need for more research in this area.

Treatment Approaches for Problematic Pornography Use: A Systematic Review

Problematic pornography use (PPU) is an emerging condition associated with several negative psychological and sexual outcomes. This study aimed to systematically review treatment approaches for PPU. Potentially eligible studies were searched for in PubMed/MEDLINE, Embase, PsycINFO, and Web of Science up to April 1, 2023. The quality of the evidence was assessed with the use of the Joanna Briggs Institute's checklists, the Cochrane risk-of-bias tools, and the GRADE approach. A total of 8936 references were retrieved, and 28 studies were included in the systematic review (n = 500 participants). Included studies were case reports (k = 16), case series (k = 1), quasi-experimental investigations (k = 7), and randomized clinical trials (k = 4). The majority of included studies presented overall low quality and significant risk of bias, with all interventions receiving a low or very low rating according to the GRADE approach. Most studies investigated psychological interventions, with the predominance of second and third wave cognitive behavioral therapy interventions. Pharmacological treatments included opioid antagonists (naltrexone in most cases) and antidepressants, while one study investigated a protocol that included rTMS. Several investigations described the combination of psychological and pharmacological approaches. Most studies did not report on side effects, with online and self-help interventions presenting significant issues in terms of treatment adherence. Even though there are promising options that may have efficacy for the treatment of patients with PPU, the literature in the topic still presents significant limitations that compromise the reaching of more definitive conclusions.

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.

Pornography Consumption and Cognitive-Affective Distress

ABSTRACT

According to recent studies, the growing consumption of Internet pornography mainly in male population becomes an increasing problem, which is closely linked to compulsive sexual behavior. Some findings also suggest that Internet pornography consumption might represent a defense mechanism against excessive stress, which enables to cope with stressful events, helps in mood regulation, and decreases depression and anxiety. Users of online pornography involved in these activities also reported that their self-exposition to pornographic material may create guilty feelings and internal conflict in themselves with respect to their own "involuntary" sexual behavior, which suggest that psychosocial stress and possibly traumatic experiences may play a significant role in Internet pornography addiction. Taken together, these findings show that stressful experiences, anxiety, and depression are strongly related to pornography consumption. In addition, conflicting emotional experiences as well as identity problems significantly increase vulnerability to addictive sexual behavior and pornography consumption.

Difficulties in Emotion Regulation and Problematic Pornography Use: The Mediating Role of Loneliness

Objectives

To analyze the association between difficulties in emotion regulation and problematic pornography use (PPU) and test the mediating effect of loneliness.

Methods

All 339 participants (M = 28.53 years, SD = 10.32) completed online self-report scales assessing difficulties in emotion regulation, PPU, and loneliness.

Results

Difficulties in emotion regulation are positively correlated with PPU. Loneliness partially mediates the relationship between difficulties in emotion regulation and PPU. Gender and intimate relationship status had moderating effects on the tested mediation model.

Conclusions

Greater difficulties in emotion regulation have a significant indirect effect on PPU through loneliness.

Treatments and interventions for compulsive sexual behavior disorder with a focus on problematic pornography use: A preregistered systematic review

Background and aims

Compulsive sexual behavior disorder (CSBD) which includes problematic pornography use (PPU) is a clinically relevant syndrome that has been included in the ICD-11 as impulse control disorder. The number of studies on treatments in CSBD and PPU increased in the last years. The current preregistered systematic review aimed for identifying treatment studies on CSBD and PPU as well as treatment effects on symptom severity and behavior enactment.

Methods

The study was preregistered at Prospero International Prospective Register of Systematic Reviews (CRD42021252329). The literature search done in February 2022 at PubMed, Scopus, Web of Science, and PsycInfo, included original research published in peer-reviewed journals between 2000 to end 2021. The risk of bias was assessed with the CONSORT criteria. A quantitative synthesis based on effect sizes was done.

Results

Overall 24 studies were identified. Four of these studies were randomized controlled trials. Treatment approaches included settings with cognitive behavior therapy components, psychotherapy methods, and psychopharmacological therapy. Receiving treatment seems to improve symptoms of CSBD and PPU. Especially, evidence for the efficacy of cognitive behavior therapy is present.

Discussion and conclusions

There is first evidence for the effectiveness of treatment approaches such as cognitive behavior therapy. However, strong conclusions on the specificity of treatments should be drawn with caution. More rigorous and systematic methodological approaches are needed for future studies. Results may be informative for future research and the development of specific treatment programs for CSBD and PPU.

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.

Associations Between Pornography Use Frequency, Pornography Use Motivations, and Sexual Wellbeing in Couples

Pornography use is prevalent, even among partnered individuals. Although pornography use motivations represent key predictors of sexual behaviors, prior studies only assessed the associations between pornography use frequency and sexual wellbeing, with mixed results. This cross-sectional dyadic study examined the associations between partners' individual and partnered pornography use frequency, motivations, and sexual wellbeing. Self-report data from 265 couples (M_{age_men} = 31.49 years, SD = 8.26; M_{age_women} = 29.36 years, SD = 6.74) were analyzed using an actor-partner interdependence model. Men's greater emotional avoidance motivation was related to their own lower sexual function (β = -.24, p = .004) and greater sexual distress (β = .19, p = .012), while their higher sexual curiosity motivation was related to higher partnered sexual frequency (β = .15, p = .031), their own greater sexual satisfaction (β = .13, p = .022), sexual function (β = .16, p = .009), and lower sexual distress (β = -.13, p = .043). Women's higher partnered pornography use frequency was associated with their own greater sexual function (β = .15, p = .034) and lower sexual distress (β = -.14, p = .012). Additionally, women's higher individual pornography use frequency (β = .33, p < .001) and lower sexual pleasure motivation (β = -.35, p = .002) were associated with higher partnered sexual frequency. No partner effects were observed. Findings highlight that women's pornography use frequency and each partner's motivations might play crucial roles in couples' sexual wellbeing.

Psychometric Properties of the Problematic Pornography Use Scale in a Japanese Sample

Problematic pornography use (PPU) is the inability to control the use of pornography and is considered a form of compulsive sexual behavior. It can have a negative effect on one's life and is an important clinical and social issue. In Japan, there is no assessment tool to measure PPU and very little research has been done. The Problematic Pornography Use Scale is one of the scales assessing the severity of PPU. This study validated a Japanese version of the Problematic Pornography Use Scale (PPUS-J) and examined its psychometric properties in a sample of 1011 individuals through an online survey (502 men, 509 women; M_age = 35.9 years, SD = 13.75). The results of the confirmatory factor analysis indicated that the four factors in the original scale were consistent with the factors in the PPUS-J, and strict invariance could be assumed for male and female participants. With regard to reliability, internal consistency indices were appropriate both at the overall and subscale levels for male and female participants. The PPUS-J showed good convergent and divergent validity due to the relationship between the subscales and other measures such as the Sexual Compulsivity Scale. These results demonstrate the validity of the PPUS-J for assessing problematic pornography use in a Japanese sample. Given the paucity of studies conducted in non-Western cultures and on women, this study will be useful in advancing research on PPU across different cultures. Future studies should examine test-retest reliability of the PPUS-J and its use with clinical groups.

Sexual Shame as a Unique Distress Outcome of Morally Incongruent Pornography Use: Modifications and Methodological Considerations

Researchers focused on the model of pornography problems due to moral incongruence (PPMI) have suggested that perceptions of addiction, stemming from a misalignment between one's moral values and online sexual behavior, may lead to heightened sexual shame. Even so, it has been suggested that the associations found in previous models of PPMI may have been inflated by the inclusion of the emotional distress subscale in the widely used Cyber Pornography Use Inventory (CPUI-9), leading many to use the abridged 4-item version (i.e., the CPUI-4), which excludes emotional distress. Prior models assessing sexual shame have yet to fully address this potential methodological limitation. Considering advances in the conceptualization of PPMI and recommendations concerning best practices, a sample of participants (N = 296) that reported using pornography in the last six months was utilized to compare findings from two moderated mediation models. The first model assessed the differential strength of effects when the subscales of the CPUI-9 were assessed as separate mediators of the associations between moral incongruence and sexual shame, while the second model examined whether such associations persisted when using the recommended CPUI-4. Model results provide further justification for previous findings, indicating that associations between constructs were not the sole result of emotional distress, which supports the utility of the CPUI-4 in models that include sexual shame. Findings provide added support for sexual shame as a unique outcome among those who, due to moral incongruence, perceive that they are addicted to Internet pornography.

Self-Perceived Problematic Use of Online Pornography Is Linked to Clinically Relevant Levels of Psychological Distress and Psychopathological Symptoms

Online pornography is a widespread Internet application. As with other Internet applications, in some cases its use can become problematic. First indications point to a link between problematic use of online pornography and psychological distress and general functional impairment. However, to date, there are no standardized criteria for assessing problematic use of online pornography. In this study, we used the Online Pornography Disorder Questionnaire (OPDQ)-an instrument which adapted the official criteria for Internet Gaming Disorder to online pornography-to measure problematic use and investigated to what extent consumers with a self-perceived problematic use of online pornography differed from casual users with regard to their psychological distress. An online sample of German adult visitors to a popular casual dating site completed the OPDQ, the Brief Symptom Inventory (BSI), and provided information on their online pornography use (n = 1539; 72.6% male; 31.43 ± 11.96 years). T-scores for the BSI were calculated and independent t-tests were conducted to compare casual users with consumers with a self-perceived problematic use of online pornography. Of the users, 5.9% fulfilled the criteria for problematic use. This group consumed online pornography for longer amounts of time and showed higher levels of psychological distress (Hedges' g from 0.75 to 1.21). The T-scores of users with self-perceived problematic online pornography use reached clinically relevant levels on all subscales. Overall, the results of the study indicate that self-perceived problematic use of online pornography seems to be linked to severe psychological distress that may warrant clinical attention.

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.

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.

The effectiveness of intervention with cognitive behavioral therapy on pornography: A systematic review protocol of randomized clinical trial studies

BACKGROUND

The increasing rate of problematic pornography use (PPU) among the general population has risen. There are limited data on the efficacy of Cognitive Behavioral Therapy (CBT) on online pornographic addiction; therefore, this study aimed at investigating the issue.

METHODS

SCOPUS, PubMed, PubPsych, WOS (Web of Science), Cochrane Central Register of Controlled Trials, Google Scholar, Scientific Information Database (SID) & Iranmedex, and other databases (for gray literature) (eg, conference papers, key journals) will be systematically reviewed. Preliminary search strategies were started on March 2, 2019, and will be updated in April 2021. Eligibility criteria were having PPU, with designs of interest including randomized trials with three or more months of follow-up with CBT intervention. Two authors will independently conduct data extraction and quality assessment. A modified Verhagen checklist for clinical trial studies will be used for quality assessment. Pooled measures of association will be computed using random-effects model meta-analyses. Between-study heterogeneity will be assessed using the I2 statistic and the Cochrane χ2 statistic. Minor study effects will be evaluated for meta-analyses with sufficient studies using funnel plots and Egger's test. If a meta-analysis is appropriate, quantitative data will be pooled using the comprehensive meta-analysis software.

DISCUSSION

The evidence obtained in this meta-analysis will help to determine whether CBT can decrease PPU severity, anxiety, depression, and compulsive sexual behavior. In addition, due to the comprehensive view on CBT effects on PPU patients, which was not clarified before, we can expect that the results of this study will benefit psychiatrists.

Managing Problematic Usage of the Internet and Related Disorders in an Era of Diagnostic Transition: An Updated Review

INTRODUCTION

Problematic Usage of the Internet (PUI) refers to a broad and likely heterogeneous group of Internet-related conditions associated with behavioural disturbances and functional impairment.

METHODS

Within PUI several conditions have been reported, including Gaming Disorder, Shopping Addiction, Cyberchondria, Gambling Disorder, Cyberpornography Addiction and Cyberbullying. While increasing reports in the field try to define the epidemiologic and clinical boundaries of these conditions, the rapid and continuous evolution of Internet related behaviours as well as their problematic/pathological expressions are often difficult to diagnose, assess, approach with treatment interventions and follow-up.

RESULTS

In addition, some of the PUI-related conditions show characteristics of addiction to the Internet as a preferential tool to engage in specific behaviours, while some others exclusively manifest on the Internet, making it necessary to find distinct assessment and treatment pathways.

CONCLUSION

The inclusion of Internet Gaming Disorder in Section III by the DSM-5 and the recognition of Gaming Disorder by the ICD-11 opened the way for a systematic clinical investigation of this and other PUI-related conditions, particularly in terms of preventive and therapeutic strategies. The present article is aimed at offering an updated clinical overview on the main expressions of PUI, focussing on the latest acquisitions in this evolving field.

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.

Theoretical Antecedents of Male Adolescents' Problematic Pornography Use: A Longitudinal Assessment

Although considerable research has examined the antecedents of adolescents' pornography use (PU), little data exist on the underlying mechanisms of problematic pornography use (PPU) in adolescence. To bridge this gap, the current longitudinal study examined the long-term associations between adolescent boys' PU frequency, PPU, and theory-based predictors of PPU. Testing three conceptual models (the moral incongruence, out of control, and mood management models), we examined the relative contributions of impulsivity, depression/anxiety symptoms, and religiosity to PPU, controlling for PU over time. The analysis was conducted using a panel sample of 337 Croatian men (M_age = 15.9 years, SD = 0.52). Latent growth curve modeling showed that baseline levels of, and subsequent growth in PU predicted later higher levels of PPU, irrespective of participants' religiosity, negative emotions, and impulsivity. Baseline higher levels of negative emotions and impulsivity predicted higher levels of PPU three years later, even after controlling for the growth in PU over time. Religiosity moderated the association between changes in PU and PPU. Growth in PU resulted in higher PPU among more religious adolescents, compared to their less religious peers. This study's findings support all three conceptual models explaining PPU in adults and may guide clinical work with adolescents seeking help for PPU.

Women in Relationships and Their Pornography Use: A Systematic Review and Thematic Synthesis

A systematic review and thematic synthesis were conducted on the motivations, purposes, and influence of pornography use among women who are in committed relationships. Pornography use was identified as having both positive and negative outcomes for women's sexual and relationship lives. Women watched pornography for diverse reasons: to feel sexually empowered, to enhance sexual arousal, and for masturbation purposes. Shared use of pornography with partners provided variety in sexual activities, could aid communication about sexual issues and helped improve intimacy. Pornography use can help some women feel sexually empowered, relaxed and better able to enjoy their sexual lives.

The Neurosciences of Health Communication: An fNIRS Analysis of Prefrontal Cortex and Porn Consumption in Young Women for the Development of Prevention Health Programs

This work explores the use of fNIRS neuroimaging technique using young female college students with different levels of consumption of pornography, and the activation of the prefrontal cortex (cue reactivity) when viewing a pornographic clip (cue exposure) versus a control clip. The results indicate that the viewing of the pornographic clip (vs. control clip) causes an activation of Brodmann's area 45 of the right hemisphere (BA 45, pars triangularis) (p < 0.01). An effect also appears between the level of self-reported consumption and the activation of right BA 45: the higher the level of self-reported consumption, the greater the activation (p < 0.01). On the other hand, those participants who have never consumed pornographic material do not show activity of the right BA 45 compared to the control clip (p < 0.01) indicating a qualitative difference between non-consumers and consumers. These results are consistent with other research made in the field of addictions. It is hypothesized that the mirror neuron system may be involved, through the mechanism of empathy, which could provoke vicarious eroticism. Finally, we suggest the applications that these results may have for primary and secondary prevention programs in the field of problematic consumption of pornography.

Symptoms of Problematic Pornography Use in a Sample of Treatment Considering and Treatment Non-Considering Men: A Network Approach

BACKGROUND

Pornography use may become problematic for 1-6% of the people and may be associated with adverse consequences leading to treatment-seeking behavior. Although the identification of the central symptoms of problematic pornography use (PPU) may inform treatment strategies, no prior study has applied the network approach to examine the symptoms of PPU.

AIM

To explore the network structure of PPU symptoms, identify the topological location of pornography use frequency in this network, and examine whether the structure of this network of symptoms differs between participants who considered and those who did not consider treatment.

METHODS

A large-scale online sample of 4,253 men (M_age = 38.33 years, SD = 12.40) was used to explore the structure of PPU symptoms in 2 distinct groups: considered treatment group (n = 509) and not-considered treatment group (n = 3,684).

OUTCOMES

Participants completed a self-report questionnaire about their past-year pornography use frequency and PPU measured by the short version of the Problematic Pornography Consumption Scale.

RESULTS

The global structure of symptoms did not differ significantly between the considered treatment and the not-considered treatment groups. 2 clusters of symptoms were identified in both groups, with the first cluster including salience, mood modification, and pornography use frequency and the second cluster including conflict, withdrawal, relapse, and tolerance. In the networks of both groups, salience, tolerance, withdrawal, and conflict appeared as central symptoms, whereas pornography use frequency was the most peripheral symptom. However, mood modification had a more central place in the considered treatment group's network and a more peripheral position in the not-considered treatment group's network.

CLINICAL IMPLICATIONS

Based on the results of the centrality analysis in the considered treatment group, targeting salience, mood modification, and withdrawal symptoms first in the treatment may be an effective way of reducing PPU.

STRENGTHS & LIMITATIONS

The present study appears to be the first to analyze the symptoms of PPU using a network analytic approach. Self-reported measures of PPU and pornography use frequency might have introduced some biases.

CONCLUSION

The network of PPU symptoms was similar in participants who did and those who did not consider treatment because of their pornography use, with the exception of the mood modification symptom. Targeting the central symptoms in the treatments of PPU seems to be more effective than focusing on reducing pornography use. Bőthe B, Lonza A, Štulhofer A, et al. Symptoms of Problematic Pornography Use in a Sample of Treatment Considering and Treatment Non-Considering Men: A Network Approach. J Sex Med 2020;17:2016-2028.

Internet Pornography: Some Medical and Spiritual Perspectives

The Internet has made pornography available on a massive scale. Data released by "Pornhub" the world's most popular Internet porn site, reveal that in 2019 alone, there were over 42 billion visits to its website, which in itself is an incredible waste of time and energy, which could be more fruitfully employed. Pornography viewing is poisonous for the conscience and commodifies the human body, reducing it to an object of abusive pleasure. Its negative effects can be broadly seen in three overlapping categories: personal, psychological, and social. The antidote is a renewed call to chastity, that self-mastery that can help direct one's passions in a more fruitful way. Without prayer, we cannot live chastely as "the spirit is willing but the flesh is weak" (Matthew 26:41). There is an urgency for the new evangelization to help recapture the dignity of the body and counter the lie of pornography, and to ensure that in the digital world, the face of Christ needs to be seen and his voice heard.

Summary

The first part of this essay outlines some personal, psychological, and social dangers of pornography. Viewing of pornography is harmful, as it objectifies the human body and distorts one's vision of sexuality. The second part of the essay gives some practical advice concerning how to ideally halt or reverse the epidemic of porn viewing, emphasizing the dignity of each person as subject, and reminding us of how a chaste gaze helps one rediscover the real beauty and value of the human body.

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

BACKGROUND AND AIMS

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

METHODS

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

RESULTS

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

Aligning the "Manifesto for a European Research Network into Problematic Usage of the Internet" with the Diverse Needs of the Professional and Consumer Communities Affected by Problematic Usage of Pornography

The Manifesto for a European research network into Problematic Usage of the Internet was published in May 2018. It was written from the perspective of the COST Action Network, a programme of the European Cooperation in Science and Technology CA16207 and is expected to have significant influence on research funding priorities over the next decade. The Manifesto identified nine key research priorities to advance understanding in the field. Our analysis shows that while at the most general level it identified problematic usage of pornography (PUP) as a key research priority, it then barely mentioned it again within the body of the report. This paper uses the Manifesto's framework to suggest research areas into the problematic usage of pornography which are of particular relevance to clinicians and other professionals working in the field who want to develop approaches to assist individuals and target groups affected by PUP. It also looks at potential research opportunities inspired by the lived-experience of users withdrawing from PUP. A large number of opportunities are identified for new work on PUP across all nine key research areas of the Manifesto.

Are Playboy (and girl) Norms Behind the Relationship Problems Associated with Pornography Viewing in Men and Women?

Research has indicated that pornography viewing is related to romantic relationship problems. However, the correlations across past studies have been small. We tested a model in which playboy norm conformity (i.e. desires to have frequent sex with multiple partners) functions as a confound between pornography viewing constructs on three romantic relationship wellbeing indicators: Relationship satisfaction, relationship commitment, and infidelity proclivity. Results from men (n = 286) and women (n = 717) indicated that the significant inverse correlations between relationship satisfaction and relationship commitment with pornography viewing constructs becomes non-significant when playboy norm conformity is accounted. Further, the positive relationship between pornography viewing and infidelity proclivity also becomes non-significant in women (no initial connection between pornography viewing and infidelity proclivity was found in men). Though conformity to playboy norms was more strongly related to all romantic relationship wellbeing indicators across genders, pornography viewing frequency was still significantly inversely correlated with relationship satisfaction for women; though the effect size was small. Moderation analyses suggested that pornography viewing frequency was more strongly inversely correlated with relationship satisfaction for women than men. Cumulatively, our results suggest conformity to playboy norms is a significant confounding variable between pornography viewing and romantic relationship wellbeing.

Nalmefene in the Treatment of Internet Pornography Addiction - A Case Report and Review of Literature

: The mu-opioid antagonist nalmefene (18 mg per day) was administered in the treatment of a heterosexual male with internet pornography addiction. The patient had no other co-addictions or psychiatric comorbidities, allowing a direct measurement for the effectiveness of nalmefene on internet pornography addiction. Over a period of 72 weeks and an assessment frequency between 1 and 18 weeks, self-monitoring assessments of craving and pornography consumption were collected on different craving and obsessive-compulsive scales. Results indicate that nalmefene impressively decreased addictive symptoms. Importantly, the patient-induced discontinuation of nalmefene led to an immediate increase of craving scores and addictive behavior, which dropped again after restarting the medication. The patient has been in complete remission of symptoms for over a year under our supervision, and for further 2 years after that according to his account. Therefore, nalmefene seems to be a useful adjunction for patients with internet pornography addiction.

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

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

Prevalence, Patterns and Self-Perceived Effects of Pornography Consumption in Polish University Students: A Cross-Sectional Study

This cross-sectional online survey of Polish students (n = 6463) assessed the frequency and patterns of pornography consumption, its self-perceived effects, the prevalence of self-perceived pornography addiction, and opinions on the potential effects of pornography and its legal status. Nearly 80% of students have been exposed to pornography (median age of first exposure: 14 years). Streaming videos were decidedly the most frequent form of use. In the subset of current users (n = 4260), daily use and self-perceived addiction was reported by 10.7% and 15.5%, respectively. The majority of those surveyed did not report any negative effects of pornography use on their sexual function, sexual, and relationship satisfaction. Instead, over one-quarter of students in relationships reported beneficial effects on its quality. The most common self-perceived adverse effects of pornography use included: the need for longer stimulation (12.0%) and more sexual stimuli (17.6%) to reach orgasm, and a decrease in sexual satisfaction (24.5%). Females and males with a Body Mass Index >25 kg/m2 more often reported a self-perceived decrease in relationship quality associated with pornography use. Age of first exposure was significantly associated with reported need for longer stimulation and more sexual stimuli to reach orgasm when using pornography, decrease in sexual satisfaction, and quality of romantic relationship, neglect of basic needs and duties due to pornography use, and self-perceived addiction in both females and males. The highest odds ratios were always observed for age <12 years in reference to exposure at >16 years. In the opinion of most of the surveyed students, pornography may have adverse effects on human health, although access restrictions should not be implemented. The study gives a broad insight into the pornography consumption in young Polish adults.

Pornography Problems Due to Moral Incongruence: An Integrative Model with a Systematic Review and Meta-Analysis

The notion of problematic pornography use remains contentious in both academic and popular literature. Although the mental health community at large is divided as to the addictive versus non-addictive nature of Internet pornography, substantial numbers of individuals report "feeling" as if their use of Internet pornography is problematic. The present work seeks to construct a model related to problematic pornography use that is clearly derived from empirical literature and that provides directions to be tested in future research. The focus of the present work is on those perceptions as they relate to the overarching experience of moral incongruence in pornography use, which is generally thought of as the experience of having one's behaviors be inconsistent with one's beliefs. To this end, we put forth a model of pornography problems due to moral incongruence. Within this model, we describe how pornography-related problems-particularly feelings of addiction to pornography-may be, in many cases, better construed as functions of discrepancies-moral incongruence-between pornography-related beliefs and pornography-related behaviors. A systematic review of literature and meta-analysis is conducted in order to evaluate support for this model, and the implications of this model for research and clinical practice are discussed.

Online Porn Addiction: What We Know and What We Don't-A Systematic Review

In the last few years, there has been a wave of articles related to behavioral addictions; some of them have a focus on online pornography addiction. However, despite all efforts, we are still unable to profile when engaging in this behavior becomes pathological. Common problems include: sample bias, the search for diagnostic instrumentals, opposing approximations to the matter, and the fact that this entity may be encompassed inside a greater pathology (i.e., sex addiction) that may present itself with very diverse symptomatology. Behavioral addictions form a largely unexplored field of study, and usually exhibit a problematic consumption model: loss of control, impairment, and risky use. Hypersexual disorder fits this model and may be composed of several sexual behaviors, like problematic use of online pornography (POPU). Online pornography use is on the rise, with a potential for addiction considering the "triple A" influence (accessibility, affordability, anonymity). This problematic use might have adverse effects in sexual development and sexual functioning, especially among the young population. We aim to gather existing knowledge on problematic online pornography use as a pathological entity. Here we try to summarize what we know about this entity and outline some areas worthy of further research.