High-Frequency Pornography Use May Not Always Be Problematic

The Associations Between Attachment Insecurity and Compulsive Sexual Behavior Disorder or Problematic Pornography Use: The Mediating Role of Emotion Regulation Difficulties

Compulsive sexual behavior disorder (CSBD) was previously considered an attachment disorder, while emotion dysregulation was thought to potentially be a key characteristic of it. However, this theoretical model was not tested in previous empirical research. In our cross-sectional study, we tested whether emotional regulation (ER) difficulties can be adopted as an explanatory mechanism for the relationships between attachment avoidance and anxiety, as well as CSBD and its most prevalent behavioral presentation-problematic pornography use (PPU). Participants (n = 1002; Mage = 50.49 years, SD = 13.32; men: 50.2%) completed an online survey regarding the investigated variables. In mediation analyses, attachment avoidance and anxiety were treated as simultaneous predictors, ER difficulties as a mediating variable, with CSBD/PPU severity as dependent variables. Emotion regulation difficulties and attachment anxiety had a direct positive effect on both CSBD and PPU. The direct effect of attachment avoidance on PPU was non-significant, and significant for CSBD depending on the measure used. Moreover, all the relationships between both insecure attachment dimensions and CSBD/PPU symptom severity were at least partially mediated by ER difficulties. Our results corroborate the theoretical claim that ER difficulties may be a useful framework for explaining the impact of attachment insecurity on CSBD/PPU. Theoretical and practical implications of the findings are discussed.

Who Finds Pornography Stressful? A Latent Profile Analysis

This study explores the connection between pornography use, sexual functioning, and mental health using latent profile analysis (LPA) to identify distinct profiles among pornography users and assess variations in mental health, including anxiety, depression, and emotion regulation. The aim of this study was to identify profiles among pornography users, specifically distinguishing those with sexual distress and sexual function problems, characterize these profiles, and assess variations in mental health. Data were collected from 463 participants through an anonymous online survey. Three distinct pornography user profiles were identified based on their consumption and sexual problems: high-frequency problematic pornography use (PPU, which is defined as uncontrollable patterns of pornography use resulting in adverse consequences and significant distress) with sexual problems, high-frequency non-PPU without/with low sexual problems, and no/low-frequency non-PPU without sexual problems. Differences among the profiles emerged in anxiety and depressive symptoms as well as emotion regulation capabilities. The high-frequency PPU with sexual problems group exhibited lower emotion regulation capabilities, while the no/low-frequency non-PPU without sexual problems group reported significantly lower depressive symptoms. This study emphasizes the multifaceted nature of pornography use, revealing that certain patterns may be more problematic. The findings highlight the interplay between emotional dysregulation, anxiety, depression, problematic pornography use, and sexual problems and distress. Recognizing these distinct profiles is crucial for understanding the relationship between pornography use and sexual and mental well-being, ultimately contributing to more targeted interventions and improved outcomes for all populations.

Compulsive Sexual Behavior Disorder and Problematic Pornography Use in Cisgender Sexual Minority Individuals: The Associations with Minority Stress, Social Support, and Sexualized Drug Use

Compulsive Sexual Behavior Disorder (CSBD), recently recognized in the ICD-11 as an independent disorder, has been shown to be more prevalent in sexual minorities. However, we still lack studies investigating which factors contribute to CSBD and related behaviors in this group. In our cross-sectional study, we investigated the relationships between characteristics potentially contributing to CSBD and problematic pornography use (PPU) in sexual minority individuals: sexual minority stress (internalized sexual stigma, discrimination experiences, and openness about one's sexual orientation), perceived social support, and sexualized drug use (also more prevalent in sexual minorities). We adjusted for gender, age, sexual orientation, and the frequency of sexual behaviors. Cisgender sexual minority participants (n = 198, 72.7% men, 27.3% women; Mage = 27.13, SD = 7.78) completed an online survey. We conducted a two-step linear regression. In the first step, we introduced sociodemographic variables and the frequency of sexual activities. In the second step, we placed the predictors of main interest: perceived social support, minority stress measures, and the frequency of sexualized drug use. Our results showed that social support was negatively related to CSBD, while experiences of discrimination due to sexual orientation and engagement in sexualized drug use were associated with higher CSBD symptom severity. Internalized sexual stigma related to greater PPU severity. The discussed relationships were weak to moderate in strength. Implications of current results for therapy and diagnosis of CSBD in sexual minorities are discussed. The role of minority stressors and other factors specific to sexual minorities requires further exploration to design well-suited therapeutic interventions.

The Associations of Pornography Use and Body Image Among Heterosexual and Sexual Minority Men

This study investigated the relationship between pornography use and men's body image, utilizing the social comparison theory as the theoretical framework. The research focused on a moderated mediation model, examining the role of social body comparison as a mediator between pornography use (frequency and problematic use) and men's body image. The sample consisted of 726 men aged 18-68, with 223 (30.7%) identifying as sexual minorities. Sexual minority men reported higher levels of pornography use frequency, problematic use, perceived realism, social body comparison, negative body image, and psychological distress compared to heterosexual men. Findings revealed that problematic pornography use (but not frequency of use) was related to higher levels of social body comparison, which, in turn, were related to higher levels of negative body image. The perceived realism in pornography did not moderate the examined associations. Clinicians should consider the impact of the relationship between pornography and body image among men.

Pornography Use and Mental Health Problems in the Chinese Population: Examining the Pornography Problems Due to Moral Incongruence Model

Pornography has become increasingly prevalent worldwide with the development of the Internet, and considerable research on the effects of pornography use has emerged. Based on existing research and the Pornography Problems Due to Moral Incongruence (PPMI) model, we examined problematic pornography use (PPU) as a mediator and moral disapproval of pornography use as a moderator in the links between pornography use frequency and mental health problems in a Chinese sample (N = 833). Our results support the completely mediated effect of PPU (ab = 0.16) and the moderated effect of moral disapproval of pornography use on the association between pornography use frequency and PPU. Pornography use frequency was strongly associated with PPU when participants experienced high moral incongruence (MI), and the indirect effect of PPU was weaker (ab = 0.13) at the lower level of moderator (-1 SD), and stronger (ab = 0.23) at the higher level of moderator (+1 SD). However, the direct effect of MI on mental health problems was not supported. This study advances our understanding of the internal mechanism between pornography use and mental health and extends the PPMI model to the Chinese cultural context (characterized as low religiosity and sexually conservative). The findings confirm the cross-cultural consistency of the PPMI model in China and highlight another important source of MI besides religiosity: cultural characteristics.

Pornography use, problematic pornography use, impulsivity, and sensation seeking: a meta-analysis

BACKGROUND

While some individuals engage in recreational pornography use (PU), others may develop an uncontrolled pattern of use termed problematic pornography use (PPU). PPU is characterized by persistent, excessive, or compulsive engagement with pornographic content, despite distress and adverse consequences. Impulsivity has been identified as a factor associated with PU and PPU.

AIM

The present meta-analysis aims to sum up the existing research on the relationship between impulsivity and PU/PPU and investigate whether age and gender could moderate this relationship.

METHODS

A keyword-based systematic literature search was performed to identify articles that assessed PU/PPU and impulsivity. Extracted correlations were converted into Fisher's Z. Meta-regression analyses were also performed. Publication bias was assessed by Egger's regression intercept.

OUTCOMES

Outcomes included general impulsivity and its dimensions (ie, negative and positive urgency, lack of premeditation and perseverance), sensation seeking, PU, and PPU.

RESULTS

Meta-analytic results of the random effects model showed a significant positive correlation between impulsivity as total score and PU (n = 1504, k = 4, Fisher's Z = 0.21, P < .001) and PPU (n = 20174, k = 13, Fisher's Z = 0.17, P < .001). Significant and positive associations were also found between sensation seeking and PU (n = 11707, k = 11, Fisher's Z = 0.14, P < .001) and PPU (n = 20152, k = 9, Fisher's Z = 0.06, P < .001). Concerning the relationship between PPU and different dimensions of impulsivity, almost all the associations were significant and positive. The dimension of positive urgency and attentional and nonplanning impulsivity showed the strongest association. Age (β = -0.50, Q = 101.26, df = 11, P < .001) and gender (female = 1; β = -0.46, Q = 102.54, df = 12, P < .001) moderated the association between general impulsivity and PPU. No risk of publication bias emerged.

CLINICAL IMPLICATIONS

Prevention programs of PPU should focus on impulsivity and certain key dimensions (eg, positive urgency, attentional and nonplanning impulsivity) and be tailored to individual impulsivity profiles, considering age and gender differences.

STRENGTHS AND LIMITATIONS

The primary strength of this meta-analysis is that it considers various conceptualizations of impulsivity. However, the results are to be interpreted with caution since >30% of relevant studies had to be excluded because information could not be gathered from the study authors.

CONCLUSION

These results suggest that general impulsivity is linked to PU and PPU and that specific dimensions of impulsivity (ie, attentional impulsivity, nonplanning impulsivity, and positive urgency) can serve as risk factors for PPU.

U.S. Males and Pornography: Replication and Experimental Extension

Communication scientists have published pornography research in the communication discipline's central journals for decades. Health communication scholars have become particularly interested in pornography in recent years, given increasing evidence of its likely impact on critical sexual health outcomes. An important resource for scholarship on pornography use is the General Social Survey (GSS). The first major article on pornography use and potential effects using the GSS was published only a decade ago and in a sexological journal, however. The present study provides a replication of this original article within the context of a GSS methodological experiment designed to provide pornography scholars with the first opportunity in 50 years to test a potential new pornography use measure. Results are interpreted in terms of their implications for the GSS, the pornography literature in general, and multiple theories of media use, processes, and effects.

Exploring the Interplay of problematic pornography use, sexism, and rape myth acceptance: An Italian cross-sectional study

The relationships among pornography use, sexist ideology and false or stereotypical ideas about rape are controversial. This study specifically examines the associations of problematic pornography use (PPU) with sexism and rape myth acceptance among both male and female participants within the Italian context utilizing a cross-sectional methodology. Based on data from 815 participants collected through an online questionnaire, the study identifies significant gender-based differences, with men typically exhibiting higher scores on sexism, rape myth acceptance, and token resistance beliefs. Correlation analysis revealed that in men, there was a positive relationship between pornography cravings and sexist beliefs but not between pornography cravings and minimizing rape or accusations of lying (rape myth). Women showed significant positive correlations across all problematic pornography use dimensions with sexist ideology, although the relationship with rape myth acceptance varied. These findings underscore the critical need for acknowledging these relationships to enhance strategies for preventing gender-based violence.

Assessment and treatment of compulsive sexual behavior disorder: a sexual medicine perspective

INTRODUCTION

The addition of compulsive sexual behavior disorder (CSBD) into the ICD-11 chapter on mental, behavioral, or neurodevelopmental disorders has greatly stimulated research and controversy around compulsive sexual behavior, or what has been termed "hypersexual disorder," "sexual addiction," "porn addiction," "sexual compulsivity," and "out-of-control sexual behavior."

OBJECTIVES

To identify where concerns exist from the perspective of sexual medicine and what can be done to resolve them.

METHODS

A scientific review committee convened by the International Society for Sexual Medicine reviewed pertinent literature and discussed clinical research and experience related to CSBD diagnoses and misdiagnoses, pathologizing nonheteronormative sexual behavior, basic research on potential underlying causes of CSBD, its relationship to paraphilic disorder, and its potential sexual health consequences. The panel used a modified Delphi method to reach consensus on these issues.

RESULTS

CSBD was differentiated from other sexual activity on the basis of the ICD-11 diagnostic criteria, and issues regarding sexual medicine and sexual health were identified. Concerns were raised about self-labeling processes, attitudes hostile to sexual pleasure, pathologizing of nonheteronormative sexual behavior and high sexual desire, mixing of normative attitudes with clinical distress, and the belief that masturbation and pornography use represent "unhealthy" sexual behavior. A guide to CSBD case formulation and care/treatment recommendations was proposed.

CONCLUSIONS

Clinical sexologic and sexual medicine expertise for the diagnosis and treatment of CSBD in the psychiatric-psychotherapeutic context is imperative to differentiate and understand the determinants and impact of CSBD and related "out-of-control sexual behaviors" on mental and sexual well-being, to detect forensically relevant and nonrelevant forms, and to refine best practices in care and treatment. Evidence-based, sexual medicine-informed therapies should be offered to achieve a positive and respectful approach to sexuality and the possibility of having pleasurable and safe sexual experiences.

Multicultural Considerations for the Psychometrics of the Brief Pornography Screen

Problematic pornography use (PPU) is a burgeoning area of clinical interest. The Brief Pornography Screen (BPS) is a new PPU measure. The BPS has not been psychometrically studied within specific race/cultural groups. We sought to broaden the PPU literature by examining the confirmatory factor analysis (CFA) fit, measurement invariance, and structural invariance of the BPS across eight identity groups. Participants came from a survey administered at three U.S. universities. In total, n = 2,475 participants were analyzed, with the following identity group breakdowns: Asian American/Pacific Islander (AAPI) male = 268, AAPI female = 303, Black male = 101, Black female = 189, Latin male = 208, Latin female = 372, White male = 432, and White female = 602. BPS CFA fit was good across all groups. Measurement invariance analyses suggested metric, but not scalar invariance across all groups. We then split participants by sex assignment, full residual invariance was evident across groups for male participants and partial residual invariance was evident for female participants. Structural invariance analyses indicated anxiety as a weak positive BPS correlate in AAPI, Latin, and White male participants (β's = 0.25-0.27), but not meaningfully related in the other groups. Pornography viewing frequency was positively correlated with BPS scores across most groups with a wide range (β's = 0.29-0.52), except for Black male participants (β = 0.15). Our results suggest that the BPS is an appropriate PPU measure across the tested identity groups. While between-group measurement is relatively accurate within sex assignment groups, correlates differed in strength, meaning different variables likely predict PPU for different groups of people.

Taking Another Look at the Pornography Problems Due to Moral Incongruence Model: Does Gender Play a Role?

The pornography problems due to moral incongruence (PPMI) model is a premier framework for understanding problematic pornography use (PPU). However, past studies have generally examined men or entered gender as a covariate in primary analyses. Such approaches mask between-gender differences. Additionally, dysregulation constructs are also thought to be relevant to PPU, yet it is unclear the degree to which they incrementally predict PPU beyond moral incongruence constructs in non-pathological populations. We addressed these gaps by gathering a large sample of college students (n = 295 men, n = 838 women). Analyses with pornography users (n = 251 men, n = 407 women) were consistent with the PPMI model, adjusted for pornography use frequency. Findings did not change when dysregulation constructs of impulsivity and emotional resilience were added to the model. No paths significantly differed between genders. Altogether, among college student pornography users, religiosity was strongly positively correlated with moral disapproval (β = .65 men, β = .62 women), moral disapproval was moderately positively correlated with PPU (β = .41 men, β = .29 women), religiosity was initially moderately positively correlated with PPU (r = .21 men, r = .22 women), but became non-significant in the full model (β = - .21 men, β = - .04 women), and indirect effects of religiosity to PPU through moral disapproval were significant (indirect β = .27 men, β = .18 women). None of the dysregulation constructs significantly predicted PPU. The full model accounted for 23-22% of the PPU variance in men and women, respectively. Implications, future directions, and limitations are discussed.

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.

Compulsive sexual behavior disorder in an inpatient sample with substance use disorder

Background

Several studies indicate that compulsive sexual behavior disorder (CSBD) shares core elements with substance use disorder (SUD). These findings support the assumption of common mechanisms in addiction, which may lead to a higher tendency in patients with SUD to have comorbid CSBD. Nevertheless, this relationship between CSBD and SUD is poorly understood to date.

Aim

This study aimed to compare the prevalence of CSBD and its subtype pornography use disorder (PUD) between a SUD group and a matched control group. Herein, we aimed to test whether patients with SUD are more likely to have a comorbid CSBD/PUD. We further hypothesized that a higher CSBD/PUD prevalence in patients with SUD is accompanied by more pronounced CSBD- and PUD-related personal characteristics.

Methods

We assessed CSBD, PUD, and related personal characteristics in an inpatient SUD sample (N = 92) and a healthy control sample matched by age, gender, and educational level.

Outcomes

Primary outcomes were the diagnoses of CSBD/PUD as assessed by questionnaires. CSBD/PUD-related personal characteristics were the early onset of problematic pornography consumption, relationship status as a single person, a high sexual motivation, a high level of time spent watching pornography, and a high degree of problematic pornography consumption (Problematic Pornography Consumption Scale, short version).

Results

There was no significant difference between groups regarding CSBD prevalence (SUD sample, 3.3%; control sample, 7.6%) and PUD prevalence (SUD sample, 2.2%; control sample, 6.5%). We found relationship status as a single person and the sexual motivation dimension of importance of sex to be the only CSBD-related personal characteristics that were more pronounced in the SUD sample than the matched control group.

Clinical Implications

Results indicate no higher tendency for patients with SUD to develop comorbid CSBD/PUD, yet important vulnerabilities (eg, emotional dysregulation) should be considered when treating addictive disorder to prevent possible symptom displacement.

Strengths and Limitations

A strength of the study is that we compared a sample of patients with SUD with a matched control sample and used an instrument based on ICD-11 criteria for CSBD. Possible limitations are significant differences between the groups because of the restrictions in an inpatient clinic that may have influenced responses (eg, roommates) and that the control group was not screened for SUD. Therefore, the results should be interpreted with some caution.

Conclusion

We found no evidence of an overcomorbidity of SUD and CSBD/PUD. However, a higher rate of vulnerability factors for CSBD/PUD in the SUD sample might suggest some similarities between SUD and CSBD/PUD.

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.

The Effect of Time Spent on Online Gaming on Problematic Game Use in Male: Moderating Effects of Loneliness, Living Alone, and Household Size

OBJECTIVE

This study aimed to investigate the association between gaming time and problematic game use (PGU) within a large sample of Korean male gamers and to examine the potential moderating effects of loneliness, living alone, and household size.

METHODS

This study employed data from 743 male gamers from the National Mental Health Survey 2021, a nationally representative survey of mental illness conducted in South Korea. Self-reported data on the average gaming time per day, severity of PGU, loneliness, living alone, and household size were used.

RESULTS

Gaming time was positively associated with PGU and this relationship was significantly moderated by loneliness such that the positive effect of gaming time on PGU was greater when the levels of loneliness were high. The three-way interaction effect of gaming time, loneliness, and living alone was also significant, in that the moderating effect of loneliness on the relationship between gaming time and PGU was significant only in the living alone group. However, household size (i.e., number of housemates) did not moderate the interaction between gaming time and loneliness among gamers living with housemates.

CONCLUSION

These results suggest the importance of considering loneliness and living arrangements of male gamers, in addition to gaming time, in identifying and intervening with individuals at heightened risk of PGU.

Is Sex Cam Use a Substitute for "Real Sex?" Attitudes and Experiences of Consumers Using Adult Cam Platforms

Adult webcam sites with live performers who provide viewer interactive experiences are a rapidly increasing form of sexual entertainment or "sextech." The opportunity to engage with performers during synchronous contact without health risks represents a novel form of transactional sex. This study sought to understand viewer preferences in performers, and how viewers perceive webcam use is affecting their sex lives and their mood. Participants (N = 10,570) responded to a link on the adult webcam platform Chaturbate.com and completed a 93-item survey. Simple frequencies and descriptive statistics were used to characterize responses. Most viewers identified as heterosexual (75.1%) men (94.2%). Two-fifths (40.3%) had no sexual partners over the past 12 months. Exploratory factor analysis showed that respondents' preferred qualities in performers clustered around an ideal sexual partner, an emotional connection, power dynamics, and compliance with viewers' wishes. Respondents generally agreed that webcam use made them better educated about sex (66.0%) and feel better about their sex lives (54.6%), though about one-fourth reported less positive experiences. The majority (72.2%) felt watching cams was less satisfying than sex away from screen and only 19.1% defined watching cams as "real sex." Over half (64.0%) perceived their webcam use as having positive effects on their mood, while a moderate proportion perceived negative emotional consequences. Findings suggest that a majority of viewers experience their webcam activities as a means of obtaining sexual release, but that this is not considered actual sex. Future research should explore additional consequences of long-term use of transactional webcam sex.

Moderating Role of Sexual Attitudes in the Association between Online Sexual Activity and Problematic Pornography Use: Evidence from the Chinese Community and Help-Seeking Men

Objectives

This study aimed to investigate the moderating role of sexual attitudes in the association between online sexual activity (OSA) and problematic pornography use (PPU) in the Chinese context. Specifically, we examined whether incongruence stemming from attitudes (i.e., disapproval of nonmarital and casual sex but engaging in OSA) amplifies the perception of PPU.

Methods

We recruited two samples of Chinese men, one from the community (N1 = 525) and the other comprising help-seeking individuals (N2 = 578).

Results

Sexual attitudes moderate the relationship between OSA and PPU in both samples, with the predictive influence of OSA on PPU weakening among individuals with a relatively permissive attitude (scored one SD above the mean of sexual attitudes), and strengthened among individuals with a relatively conservative attitude (scored one SD below the mean of sexual attitudes).

Conclusions

In the conservative sexual cultural context of China, a relatively conservative sexual attitude might strengthen the association between OSA and PPU.

Understanding Perceived Problematic Pornography Use with the Differential Susceptibility to Media Effects Model

Problematic pornography use and its adverse consequences are prevalent, but little is known about its psychosocial contributors. Drawing on the Differential Susceptibility to Media Effects Model (DSMM), this study explores whether and how perceived problematic Internet pornography use is associated with psychological factors from three domains: social (i.e., family adaptability), dispositional (i.e., self-acceptance), and development factors (i.e., impulse control difficulties). Analysis of an anonymous survey of 1,483 Chinese emerging adults showed that family adaptability and self-acceptance were negatively correlated with perceived problematic pornography use, whereas impulse control difficulties were positively correlated with perceived problematic pornography use. Self-acceptance mediated the association between family adaptability and perceived problematic pornography use. Impulse control difficulties moderated such mediation effect, in which the protective effect of family adaptability on self-acceptance and that of self-acceptance on perceived problematic pornography use were attenuated by impulse control difficulties. These findings advance understanding of the complex underlying psychosocial mechanisms of perceived problematic pornography use by providing evidence to the applicability of DSMM on such problematic use and clarifying the direct, indirect, and/or moderating role(s) of family adaptability, self-acceptance, and impulse control difficulties in those mechanisms. They also provide insights for targeted approaches in future intervention programs among emerging adults.

Confirming and Expanding the Moral Incongruence Model of Compulsive Sexual Behavior

Compulsive sexual behavior (CSB) is a clinical syndrome in which repetitive sexual behaviors, urges, or thoughts cause significant distress and impairment. Moral incongruence (MI), or conflict between an individual's sexual behaviors and moral beliefs, is highly associated with self-reported problematic pornography use, a common behavioral manifestation of CSB. However, it is currently unknown whether MI is associated with other self-reported compulsive sexual behaviors, such as masturbation, sexual fantasy, and sex with multiple partners. Additionally, research on MI has not explored whether emotional responses to sexual cues (i.e., erotophilia-erotophobia) may serve as a moderating variable in the MI model. To address these gaps in the literature, this study administered an online survey to a sample of 804 American participants. Results confirmed previous research on MI indicating frequency of pornography use is more strongly associated with self-reported CSB at high levels of moral disapproval. This moderation was also replicated with frequency of sexual fantasy and number of sex partners, but not with frequency of masturbation. Results also indicated that self-reported CSB was modestly associated with positive emotional response to sexual cues (i.e., erotophilia) but offered limited support for erotophilia as a moderator in the MI model. Collectively, these findings suggest the MI model can be expanded to several behavioral manifestations of CSB, but that emotional responses to sexual cues may play a limited or more nuanced role in MI.

Investigating mental representations of psychoactive substance use and other potentially addictive behaviors using a data driven network-based clustering method

BACKGROUND AND AIMS

The aim of the present study was to examine the mental representations of the use of different substances and other potentially addictive behaviors in order to explore meaningful similarities and differences that may contribute to a better understanding of behavioral addictions' representations and diagnostic criteria.

METHODS

The authors mapped the mental and emotional representations of 661 participants (70.5% women; Mage = 35.2 years, SD = 11.7) to the concept "your most disturbing excessive activity" using free-word associations combined with a network-based clustering method.

RESULTS

The network analyses identified four distinct mental representations, three implicating dominantly negative (Guilt/Shame/Relief, Addiction/Health, and Procrastination/Boredom) and one dominantly positive emotion (Stress/Relaxation). The distribution of Addiction/Health and Procrastination/Boredom representations were different across substance use and problem behaviors, indicating meaningful differences in the underlying cognitive evaluation processes. The Addiction/Health representation was more frequent for substances, while for other addictive behaviors, the Procrastination/Boredom representation was more frequent, and its frequency increased with the self-reported intensity of the behavior. Guilt/Shame/Relief was equally common for both substances and behaviors, but importantly, for substances its' likelihood increased with the intensity of use.

CONCLUSION

The common part of representations for substance use and other potentially addictive behaviors supports the scientific viewpoint, that real addictions can exist even in the absence of psychoactive drugs. Based on the results, a novel proposition is posited, that a more appropriate indicator of tolerance for problem behaviors might be the perceived amount of time wasted on the activity rather than the actual time spent.

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.

Family functioning and problematic internet pornography use among adolescents: a moderated mediation model

Background

In recent years, the issue of problematic Internet pornography use (PIPU) among adolescents has become increasingly prominent, attracting widespread attention from society. Family functioning has been recognized as a protective factor for PIPU, but the underlying mediating and moderating mechanisms remain unclear. The purpose of this study is (a) to investigate the mediating role of self-esteem in the relationship between family functioning and PIPU, and (b) to examine the moderating role of the need to belong in this mediating pathway.

Methods

A total of 771 high school students (Mage = 16.19, SD = 0.90) were surveyed using the Problematic Internet Pornography Use Scale, Family Assessment Device, Rosenberg Self-Esteem Scale, and the Need to Belong Scale.

Results

Correlation analysis showed a significant negative correlation between family functioning and PIPU (r = -0.25, p < 0.001), a significant positive correlation between self-esteem and family functioning (r = 0.38, p < 0.001), a significant negative correlation between self-esteem and PIPU (r = -0.24, p < 0.001), and a significant positive correlation between need to belong and PIPU (r = 0.16, p < 0.01). Mediation analysis showed that self-esteem partially mediated the relationship between family functioning and PIPU, with a mediation effect of -0.06. Further moderated mediation analysis showed that for adolescents with higher need to belong, the mediating effect of self-esteem was stronger.

Conclusions

For adolescents with high belonging needs who are at high risk for PIPU, good family functioning may have a protective effect by boosting self-esteem.

Profiles of Pornography Use Based on Addictive Mechanisms and Psychopathological Features

Studies using person-centered approaches to further explore the profiles of pornography users throw their psychiatric features are lacking. This study was designed to examine the different profiles of pornography users based on the addictive dimensions of Problematic Pornography Use (PPU) and to characterize these profiles according to psychopathological variables such as depression, anxiety, attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). A sample of 1001 French adults participated to a survey containing scales related to psychopathological variables, cybersexual addiction and PPU. PPU was assessed with the French Version of Problematic Pornography Consumption Scale (Fr-PPCS-18). An Agglomerative Hierarchical Classification was performed on the basis of FR-PPCS-18. A student's t-test was used to observe PPU and psychopathological differences between profiles. Findings revealed three profiles of users: non-problematic users (66.5%), at-risk users (29.9%), and problematic users (3.6%). There were significant differences between the three profiles concerning levels of global PPU, PPU mechanisms, cybersexual addiction symptoms, ADHD symptomatology and depressive symptomatology. Results confirmed the existence of different levels of severity of pornography use corresponding to three different profiles. Also, findings revealed the influence of ADHD symptoms, obsessive-compulsive symptoms and depressive symptoms on PPU.

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.

The association between problematic pornography use and eating disorder symptoms among heterosexual and sexual minority men

In this study, we investigated the link between problematic pornography use and eating disorder symptoms in men, with body comparison and body image as mediators, and perceived realism and anxiety and depression as moderators. We also analyzed the model for both heterosexual and sexual minority men to detect any differences. The current study included 705 Israeli men, 479 of whom identified as heterosexual and 226 as sexual minority. The majority of the sample (90.6%) identified as Jewish with a mean age of 32.5. Results showed that problematic pornography use was linked to more upward body comparison, which in turn was related to negative body image, and ultimately, increased severity of eating disorder symptoms. Anxiety and depression moderated the association between male body image and eating disorder symptoms. However, perceived realism did not moderate the link between problematic pornography use and upward body comparison. Whereas there were significant differences in the mean rank values between heterosexual and sexual minority men in all measures, the processes linking these measures were virtually the same. To reduce the risk of developing or worsening eating disorder symptoms, clinicians working with male clients should assess for problematic pornography use and body image concerns during therapy.

Atypical Sexual Interests in Compulsive Sexual Behavior: Results From a Phallometric Study

The link between Compulsive Sexual Behavior (CSB) and atypical sexual interests is elusive. This study aimed to provide preliminary insights into the relationship between both aspects. The study sample comprised 61 self-identified straight men. CSB was measured through a composite self-report index assessing symptoms of CSB, whereas sexual interests -atypical and normophilic- were assessed objectively through penile plethysmography. The CSB index had small, non-significant correlation with greater sexual response to different sexual stimuli (r_{general sexual responsiveness}=.127 [95% CI: -.137, .384]). In terms of overall sexual interest, increased scores on the CSB index had small, non-significant correlation with a higher preference for younger sexual stimuli (r = -.098 [95% CI: -.499, .215]) and persuasive sex (r = .10 [95% CI: -.168, .316]). Finally, CSB had a moderate correlation with sexual response when presented with stimuli depicting "female toddler coercive" (r = .27 [95% CI: -.083, .544]). We conclude that our findings do not support the hypotheses that CSB is significantly related to an increased arousability across sexual stimuli. The study findings also suggest that CSB may be, to a small degree, predisposed to experience sexual attraction toward children. Given the preliminary nature of the study, these conclusions warrant further research. Alternative explanations for the study findings related to the particular components of CSB that may be related to typical and atypical sexual interests are also considered.

Pornography, Sexual Insecurity, and Orgasm Difficulty

While recent meta-analyses have provided answers to a number of historically contentious debates about correlates of pornography use, several questions remain unanswered. Whether pornography is associated with sexual functioning is one such question. Informed by theorizing on sexual scripting, social comparisons, and sexual objectification, the present study examined the possibility that pornography is related to orgasm difficulty through sexual insecurity (i.e., insecurity about one's sexual performance and sexual attractiveness). Data were from the National Survey of Porn Use, Relationships, and Sexual Socialization (NSPRSS), a U.S. population-based probability study. There was an indirect effect of pornography consumption frequency on orgasm difficulty through sexual insecurity. Participants who used pornography more frequently reported higher levels of sexual insecurity, and higher levels of sexual insecurity predicted orgasm difficulty. There was also an indirect effect of partner pressure to view pornography on orgasm difficulty. Higher levels of partner pressure to view pornography were associated with higher levels of sexual insecurity, which in turn predicted orgasm difficulty. Results were indistinguishable by gender and maintained after controlling for a number of potential confounds. These findings suggest that some men and women's personal and (pressured) partnered pornography consumption have the potential to increase orgasm difficulty through bodily and performance insecurity.

Hypo- or hyperfunction? Differential relationships between compulsive sexual behavior disorder facets and sexual health

BACKGROUND

Previous studies linking compulsive sexual behavior disorder (CSBD) and sexual health have shown mixed results, which could be due to the fact that different CSBD facets may have differential relationships with sexual functioning.

AIM

As CSBD is a multidimensional disorder, we wanted to investigate whether distinct CSBD domains are differentially related to sexual health.

METHODS

Two online studies were conducted-the first on a convenience sample (812 Polish participants; mean [SD] age, 22.07 [5.91] years) and a replication study on a representative sample of Polish adults (n = 1526; 43.02 [14.37]). Hierarchical regression was employed with sexual functioning as a predicted variable and CSBD symptoms as predictors.

OUTCOMES

The Compulsive Sexual Behavior Disorder Scale was used to assess CSBD symptoms, and the Arizona Sexual Experience Scale was used to measure sexual dysfunction.

RESULTS

In study 1, CSBD salience (β = -.20, P < .001) predicted hyperfunction (ie, stronger sex drive, easier sexual arousal, easier vaginal lubrication/penile erection, easier ability to reach an orgasm, and more satisfying orgasms). Yet, CSBD negative consequences (β = .15, P = .001) and dissatisfaction (β = .22, P < .001) predicted hypofunction (ie, weaker sex drive, more difficulties in sexual arousal, greater difficulties in vaginal lubrication/penile erection, less ability to reach an orgasm, and less satisfying orgasms). Similar results were found in study 2: salience (β = -.26, P < .001) and relapse (β = -.11, P = .004) predicted hyperfunction, while negative consequences (β = .12, P < .001) and dissatisfaction (β = .12, P < .001) predicted hypofunction.

CLINICAL IMPLICATIONS

Our results stress the importance of assessing the severity of each group of symptoms in patients with CSBD to better understand possible difficulties in their sexual functioning.

STRENGTHS AND LIMITATIONS

Our studies are the first to evaluate the effects of each CSBD domain on sexual health. We also replicated results obtained from a convenience sample on a representative sample. The cross-sectional design of the current studies does not allow causal relations to be tested, so future longitudinal research should be carried out. We also gathered data from a general population-thus, it is important to replicate these results on patients diagnosed with CSBD.

CONCLUSION

Our research points out the differential impact of CSBD domains on sexual health: salience and relapse are related to sexual hyperfunction, while negative consequences and dissatisfaction to hypofunction.

Engagement with Emerging Forms of Sextech: Demographic Correlates from a National Sample of Adults in the United States

Social technology is ever-evolving, and increasingly offers novel domains for sexual experiences. In the current study, we investigated demographic correlates of engagement with emerging forms of sextech, defined here as internet-based applications, platforms, or devices used for sexual pleasure. Our web-based, demographically representative sample included 7,512 American adults aged 18-65 years, with a near-even gender split of men/women and moderate racial diversity (63% White). Participants indicated their engagement with eight forms of sextech, including six emerging forms of sexual technology (visiting erotic camming sites, participating in camming streams, teledildonic use, accessing virtual reality pornography, playing sexually explicit video games, and sexual messaging with chatbots or artificially intelligent entities) as well as two more common domains (online pornography and sexting). Participants who were younger, were men, had higher income, and were sexual minorities reported more frequent engagement with all forms of sextech assessed. Unlike prior work on pornography, religious individuals were more likely to engage with emerging sextech. Beyond online pornography (50%) and sexting (29%), visiting camming sites (18%) and playing sexually explicit video games (13%) were relatively common. Findings may contribute to the destigmatization of sextech engagement and forecast future norms in technologically-facilitated sexual behavior.

Teen Pornography: An Emerging Mental Health Challenge

Exposure to pornography is not an uncommon and unusual phenomenon in the digital era, with teens being no exception. Exposure to pornography among teens may happen accidentally, out of curiosity, or intentionally to derive sexual excitement. Many individuals exposed to pornography may later develop pornography addiction. Most parents who are aware that their children view pornography are often worried about such behavior and sometimes seek help from mental health professionals. So, it can be certainly said that exposure to pornography among teens may cause significant distress in them and their parents. As pornography is a major source of sex education for a large number of teens, lots of myth and misguided information are harbored from watching pornography. This article focuses on the mental health aspects of pornography exposure among teens and the possible remedial measures.

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.

Withdrawal and tolerance as related to compulsive sexual behavior disorder and problematic pornography use - Preregistered study based on a nationally representative sample in Poland

Background

The addiction model of compulsive sexual behavior disorder (CSBD) and problematic pornography use (PPU) predicts the presence of withdrawal symptoms and increased tolerance for sexual stimuli in the disorder phenotype. However, clear empirical evidence supporting this claim has largely been lacking.

Methods

In the preregistered, nationally representative survey (n = 1,541, 51.2% women, age: M = 42.99, SD = 14.38), we investigated the role of self-reported withdrawal symptoms and tolerance with respect to CSBD and PPU severity.

Results

Both withdrawal and tolerance were significantly associated with the severities of CSBD (β = 0.34; P < 0.001 and β = 0.38; P < 0.001, respectively) and PPU (β = 0.24; P < 0.001 and β = 0.27; P < 0.001, respectively). Of the 21 withdrawal symptom types investigated, the most often reported symptoms were frequent sexual thoughts that were difficult to stop (for participants with CSBD: 65.2% and with PPU: 43.3%), increased overall arousal (37.9%; 29.2%), difficult to control level of sexual desire (57.6%; 31.0%), irritability (37.9%; 25.4%), frequent mood changes (33.3%; 22.6%), and sleep problems (36.4%; 24.5%).

Conclusions

Changes related to mood and general arousal noted in the current study were similar to the cluster of symptoms in a withdrawal syndrome proposed for gambling disorder and internet gaming disorder in DSM-5. The study provides preliminary evidence on an understudied topic, and present findings can have significant implications for understanding the etiology and classification of CSBD and PPU. Simultaneously, drawing conclusions about clinical importance, diagnostic utility and detailed characteristics of withdrawal symptoms and tolerance as a part of CSBD and PPU, as well as other behavioral addictions, requires further research efforts.

Investigating the Associations of ADHD Symptoms, Impulsivity, Physical Exercise, and Problematic Pornography Use in a Chinese Sample

Investigating the relationship between attention-deficit/hyperactivity disorder (ADHD) symptoms and impulsivity will benefit our understanding of the concept of problematic pornography use (PPU), and revealing predisposing and malleable moderators of PPU will be beneficial for its prevention and intervention. The current study not only aimed to observe these relationships, but also explored the potential moderating role of physical exercise in the general population. A total of 600 Chinese adults (M_age = 32.31, SD_age = 12.40, 39.8% women) were recruited and completed an online survey. The results showed that participants with regular exercise scored lower than those without exercise on ADHD, impulsivity, and PPU (all ps < 0.001). Using latent moderated structural equations (LMS), the findings revealed that the relationship between ADHD symptoms and PPU was mediated by impulsivity, and physical exercise moderated this relationship (B = -0.14, p = 0.048). Specifically, when individuals' physical exercise was higher than 0.84 standard deviations above the mean, the positive predictive effect of impulsivity on PPU was not significant. These findings indicate the important role of impulsivity in the relationship between ADHD and PPU, and physical exercise could be a meaningful component of interventions among individuals experiencing PPU.

The Role of Pornography Use in Intimate Partner Violence in Different-Sex Couples: A Prospective Longitudinal Study

Pornography use and intimate partner violence (IPV) are both prevalent in romantic relationships. However, information is lacking about whether pornography use predicts IPV. This study examined the relation between frequency of pornography use (FPU) and IPV across a span of 4 months in a sample of 132 different-sex couple dyads. At least one partner in each couple was attending a Canadian university. Participants (N = 264) completed online measures of pornography use, IPV, and social desirability at baseline and at a 4-month follow-up. Two longitudinal actor-partner interdependence models using a structural equation framework to conduct path analyses demonstrated that (a) higher FPU among men at baseline predicted increases in IPV perpetration and victimization from baseline to 4-month follow-up for both men and women and (b) women's baseline FPU did not predict change in IPV over time for themselves or their partners. These findings suggest that frequent pornography use among male partners in different-sex romantic relationships may represent an under-recognized risk factor for IPV, and further research is needed to identify latent factors that may be contributing to this relation. Although women's baseline FPU did not predict changes in IPV over time, this may be because women used pornography less frequently than men.

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.

Symptoms of problematic pornography use among help-seeking male adolescents: Latent profile and network analysis

BACKGROUND AND AIMS

Little data exist on exploring the subgroups and characteristics of problematic pornography use (PPU) in help-seeking adolescents. The aims of the study were to classify the subgroups among help-seeking male adolescents, explore their similarities and differences, and uncover their core symptoms.

METHODS

A total of 3,468 Chinese male adolescents (Mage = 16.64 years, SD = 1.24) who were distressed about their pornography use were recruited. The Problematic Pornography Consumption Scale, the Brief Pornography Screen Scale, and Moral Disapproval of Pornography Use were used to classify them. The General Health Questionnaire, the Pornography Craving Questionnaire, and the Sexual Compulsivity Scale were used to investigate participants' negative consequence related to their pornography use; and the Online Sexual Activity Questionnaire (OSAs) and time spent on pornography use every week were considered as quantitative indicators.

RESULTS

Help-seeking male adolescents could be divided into 3 profiles, namely, self-perceived problematic (SP, n = 755), impaired control (IC, n = 1,656), and problematic use groups (PPU, n = 1,057). Frequency of OSAs was important for the identification of SP individuals, while negative consequences were more effective in identifying individuals with objective dysregulated behavior. Salience and mood modification were shared by all groups; however, in addition to this, the SP and PPU groups also showed withdrawal symptoms.

DISCUSSION AND CONCLUSION

This study's results provide support for the presence of different profiles of help-seeking individuals and information on potential intervention targets among adolescents which is lacking in the literature.

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.

Contradicting classification, nomenclature, and diagnostic criteria of Compulsive Sexual Behavior Disorder (CSBD) and future directions •

Building on the conclusions of the debate papers by Gola et al. (2022) and Sassover and Weinstein (2022), the present commentary further addressed the contradictions between the current classification, nomenclature, and diagnostic criteria of Compulsive Sexual Behavior Disorder (CSBD) with elaborating on the potential roles impulsivity and compulsivity may play in CSBD, and how these characteristics may relate to addictive behaviors in particular. Moreover, it briefly discussed how the classification of CSBD might impact research and clinical practice and proposed potential future research directions that may help to reach a consensus on the classification and core symptoms of CSBD.

The Association between the Quantity and Severity of Pornography Use: A Meta-analysis

Although the quantity of pornography use (QPU, i.e., frequency/time spent on pornography use) has been positively associated with the severity of pornography use (i.e., problematic pornography use, PPU), the magnitudes of relationships have varied across studies. This meta-analysis aimed to assess the overall relationships and identify potential moderating variables to explain the variation in these associations between QPU and PPU. We performed a literature search for all published and unpublished studies from 1995 to 2020 in major online scientific databases up until December 2020. Sixty-one studies were identified with 82 independent samples involving 74,880 participants. Results indicated that there was a positive, moderate relationship between QPU and PPU (r = 0.34, p < .001). The strength of relationship significantly varied across measures of PPU based on different theoretical frameworks, indicators of QPU, and sexual cultural contexts (conservative vs. permissive sexual values). Frequency was a more robust quantitative indicator of PPU than time spent on pornography use. In conservative countries, QPU showed more robust association with self-perceived PPU. Future studies are encouraged to select the measurement of PPU according to research aims and use multi-item measures with demonstrated content validity to assess pornography use. Cross-cultural (conservative/permissive) comparisons also warrant further research.

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.

Cyber pornography use and masturbation outburst. Considerations on 150 italian patients complaining erectile dysfunction and trying to solve it

OBJECTIVE

We aimed to verify the rate of masturbation (Mst) in a group of 150 Italian patients complaining Erectile Dysfunction (ED).

MATERIALS AND METHODS

Our diagnostic protocol for penile and sexual problems included the collection of the patient's history, general and local clinical examination, and metabolic and hormonal analyses. Selected patients were also submitted to nocturnal penile tumescence test (Rigiscan), Duplex ultrasound of the penis, Magnetic Resonance Imaging, neurological tests and cardiological examination. A group of 150 Italian males (aged between 20 and 86 years) who complained ED and who presented to our Andrological Center to research the possibility of correcting their ED and being able to recover adequate sexual erectile activity were included in this study. In this group of patients suffering from ED we decided to evaluate the practice of Mst by asking specific questions: 1. Do you sometimes practice Mst? 2. How often in a week? 3. Is Mst hidden or known by the partner? 4. What do you use as a masturbatory sexual stimulus? The frequency of Mst was assessed according to a Likert scale as follow: a: No Mst; b:1-2/week; c: 2-3/week; d: > 3/week; e: daily or more. We also asked if it was possible to have penetrative marital intercourse on the same day as Mst (1-10 hours). We also asked what they used as a triggering sexual stimulus: press magazines, TV movies, the WEB.

RESULTS

Only 5/150 patients did not report Mst while 27/145 pts (aged 20-30 years) reported it more than 3 times a week; 44/145 (aged 31-50 years) 1-3 times a week and 27/145 (51-86 years) 1-2 times a week. Almost all patients used WebPorn as a stimulus for Mst. A group of patients over the age of 50 said they were quite satisfied with the physical results of Mst even though they would prefer to have sex as part of a couple relationship.

CONCLUSIONS

The outburst of Mst in this web-dominated era could affect the sexual activity of individual males and couples.