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Vera Cruz G, Aboujaoude E, Liberacka-Dwojak M, Wiłkość-Dębczyńska M, Rochat L, Khan R, Khazaal Y. How much online pornography is too much? A comparison of two theoretically distinct assessment scales. Arch Public Health 2024; 82:79. [PMID: 38816773 PMCID: PMC11137999 DOI: 10.1186/s13690-024-01294-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 04/15/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Online pornography use, an ever more common activity, has raised myriad psychosocial and clinical concerns. While there is a need to screen for and measure its problematic dimension, there is a debate about the adequacy of existing assessment tools. OBJECTIVE The study compares two instruments for measuring pathological online pornography use (POPU) that are based on different theoretical frameworks-one in line with DSM-5 criteria and the six-component addiction model and one in line with ICD-11 criteria. METHODS An international sample of 1,823 adults (Mean age = 31.66, SD = 6.74) answered an online questionnaire that included the Short Version of the Problematic Pornography Consumption Scale (PPCS-6) and the Assessment of Criteria for Specific Internet-Use Disorders (ACSID-11). Factorial, correlational, and network analyses were conducted on the data. RESULTS Both tools adequately screened for online "addictive" behavior, but the ACSID-11 was superior in assessing the degree of clinical risk. CONCLUSION Depending on the specific aim of the assessment (screening vs. clinical diagnostics), both online pornography measurement tools may be useful.
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Affiliation(s)
- Germano Vera Cruz
- Department of Psychology, CRP-CPO, University of Picardie Jules Verne, Amiens, France.
| | - Elias Aboujaoude
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
- Program in Internet, Health and Society, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | | | | | - Lucien Rochat
- Department of Mental Health and Psychiatry, Specialized Facility in Behavioral Addiction ReConnecte, University Hospitals of Geneva, Geneva, Switzerland
| | - Riaz Khan
- Department of Mental Health and Psychiatry, Frontier Medical College Abbottabad, Bahria University Islamabad, Islamabad, Pakistan
| | - Yasser Khazaal
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.
- Research Centre, University Institute of Mental Health at Montreal and Department of Psychiatry and Addiction Montreal University, Montreal, Canada.
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Fournier L, Schimmenti A, Musetti A, Boursier V, Flayelle M, Cataldo I, Starcevic V, Billieux J. Deconstructing the components model of addiction: an illustration through "addictive" use of social media. Addict Behav 2023; 143:107694. [PMID: 36940658 DOI: 10.1016/j.addbeh.2023.107694] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/31/2023] [Accepted: 03/03/2023] [Indexed: 03/17/2023]
Abstract
The components model of addiction posits that all addictions share six components, namely salience, tolerance, mood modification, relapse, withdrawal, and conflict. This highly influential model has resulted in the development of numerous psychometric instruments that measure addictive behaviors according to these criteria. However, recent research suggests that, in the context of behavioral addictions, certain components constitute peripheral features that do not distinguish non-pathological from pathological behavior. Using "addictive" use of social media as a representative example, we examined this perspective by testing whether these six components actually assess central features of addiction, or whether some of them constitute peripheral features that are not indicative of a disorder. Four independent samples totaling 4,256 participants from the general population completed the Bergen Social Media Addiction Scale, a six-item psychometric instrument derived from the components model of addiction to assess social media "addiction". By performing structural equation modeling and network analyses, we showed that the six components did not form a unitary construct and, crucially, that some components (i.e., salience, tolerance) were not associated with measures assessing psychopathological symptoms. Taken together, these results suggest that psychometric instruments based on the components model conflate central and peripheral features of addiction when applied to behavioral addictions. This implies that such instruments pathologize involvement in appetitive behaviors. Our findings thus call for renewing the conceptualization and assessment of behavioral addictions.
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Affiliation(s)
- Loïs Fournier
- Institute of Psychology, University of Lausanne, CH-1015 Lausanne, Switzerland.
| | - Adriano Schimmenti
- Faculty of Human and Social Sciences, UKE - Kore University of Enna, Cittadella Universitaria, 94100 Enna, Italy.
| | - Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, 43121 Parma, Italy.
| | - Valentina Boursier
- Department of Humanities, University of Naples "Federico II", 80133 Naples, Italy.
| | - Maèva Flayelle
- Institute of Psychology, University of Lausanne, CH-1015 Lausanne, Switzerland.
| | - Ilaria Cataldo
- Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Trento, Italy.
| | - Vladan Starcevic
- Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, University of Sydney, Penrith, NSW 2751, Australia.
| | - Joël Billieux
- Institute of Psychology, University of Lausanne, CH-1015 Lausanne, Switzerland; Center for Excessive Gambling, Addiction Medicine, Lausanne University Hospital (CHUV), CH-1011 Lausanne, Switzerland.
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Castro-Calvo J, Flayelle M, Perales JC, Brand M, Potenza MN, Billieux J. Compulsive Sexual Behavior Disorder should not be classified by solely relying on component/symptomatic features •. J Behav Addict 2022; 11:210-215. [PMID: 35895452 PMCID: PMC9295252 DOI: 10.1556/2006.2022.00029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/14/2022] [Accepted: 04/15/2022] [Indexed: 01/02/2023] Open
Abstract
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.
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Affiliation(s)
- Jesús Castro-Calvo
- Department of Personality, Assessment, and Psychological Treatments, University of Valencia, Spain
- Corresponding authors. E-mail: ,
| | - Maèva Flayelle
- Institute of Psychology, University of Lausanne (UNIL), Lausanne, Switzerland
| | - José C. Perales
- Department of Experimental Psychology, Mind, Brain and Behavior Research Center (CIMCYC), Universidad de Granada, Spain
| | - Matthias Brand
- General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Germany
| | - Marc N. Potenza
- Department of Psychiatry and the Child Study Center, Yale School of Medicine, New Haven, CT, USA
- Department of Neuroscience and the Wu Tsai Institute, Yale University, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
- The Connecticut Council on Problem Gambling, Wethersfield, CT 06109, USA
| | - Joël Billieux
- Institute of Psychology, University of Lausanne (UNIL), Lausanne, Switzerland
- Centre for Excessive Gambling, Addiction Medicine, Lausanne University Hospitals (CHUV), Lausanne, Switzerland
- Corresponding authors. E-mail: ,
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Chen L, Jiang X, Wang Q, Bőthe B, Potenza MN, Wu H. The Association between the Quantity and Severity of Pornography Use: A Meta-analysis. JOURNAL OF SEX RESEARCH 2022; 59:704-719. [PMID: 34723731 DOI: 10.1080/00224499.2021.1988500] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
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.
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Affiliation(s)
- Lijun Chen
- School of Humanities and Social Sciences, Fuzhou University
| | - Xiaoliu Jiang
- School of Humanities and Social Sciences, Fuzhou University
| | - Qiqi Wang
- School of Humanities and Social Sciences, Fuzhou University
| | - Beáta Bőthe
- Département de Psychologie, Université de Montréal
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine
- Department of Neuroscience, Yale University School of Medicine
- Department of Child Study Center, Yale University School of Medicine
- Connecticut Mental Health Center
- Connecticut Council on Problem Gambling
| | - Huijuan Wu
- School of Humanities and Social Sciences, Fuzhou University
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Bőthe B, Lonza A, Štulhofer A, Demetrovics Z. 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. [PMID: 32675049 DOI: 10.1016/j.jsxm.2020.05.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/24/2020] [Accepted: 05/26/2020] [Indexed: 12/14/2022]
Abstract
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 (Mage = 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.
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Affiliation(s)
- Beáta Bőthe
- Département de Psychologie, Université de Montréal, Montréal, Canada; Institute of Psychology, ELTE EötvösLoránd University, Budapest, Hungary.
| | - Anamarija Lonza
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
| | - Aleksandar Štulhofer
- Department of Sociology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE EötvösLoránd University, Budapest, Hungary
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Bőthe B, Tóth-Király I, Potenza MN, Orosz G, Demetrovics Z. High-Frequency Pornography Use May Not Always Be Problematic. J Sex Med 2020; 17:793-811. [PMID: 32033863 DOI: 10.1016/j.jsxm.2020.01.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/18/2019] [Accepted: 01/07/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Previously, variable-centered analytic approaches showed positive, weak-to-moderate associations between frequency of pornography use (FPU) and problematic pornography use (PPU). However, person-centered studies are sparse in the literature, and these could provide insight into whether there are individuals who use pornography frequently and do not experience problems or whether there are individuals with comparable high-frequency use who differ on reported experiencing of negative consequences. AIM The aims of the present study were (i) to identify profiles of pornography use based on FPU and PPU by applying a person-centered analytic approach and (ii) to examine whether the identified profiles could be distinguished based on theoretically relevant demographic and psychological constructs. METHODS Latent profile analyses were conducted on 3 nonclinical samples recruited from general websites and a pornography site (study 1: N = 14,006; study 2: N = 483; study 3: N = 672). RESULTS Results were consistent across all studies. 3 distinct pornography-use profiles emerged: nonproblematic low-frequency pornography use (68-73% of individuals), nonproblematic high-frequency pornography use (19-29% of individuals), and problematic high-frequency use (3-8% of individuals). Nonproblematic and problematic high-frequency-use groups showed differences in several constructs (ie, hypersexuality, depressive symptoms, boredom susceptibility, self-esteem, uncomfortable feelings regarding pornography, and basic psychological needs). CLINICAL TRANSLATION FPU should not be considered as a sufficient or reliable indicator of PPU because the number of people with nonproblematic high-frequency use was 3-6 times higher than that with problematic high-frequency use. These results suggest that individuals with PPU use pornography frequently; however, FPU may not always be problematic. STRENGTHS & LIMITATIONS Self-report cross-sectional methods have possible biases that should be considered when interpreting findings (eg, underreporting or overreporting). However, the present research included 3 studies and involved large community samples and visitors of a pornography website. The present study is the first that empirically investigated pornography-use profiles with a wide range of correlates using both severity of PPU and FPU as profile indicators on specific and general samples. CONCLUSION The present study is a first step in the differentiated examination of pornography-use profiles, taking into consideration both PPU and FPU, and it provides a foundation for further clinical and large-scale studies. Different psychological mechanisms may underlie the development and maintenance of FPU with or without PPU, suggesting different treatment approaches. Therefore, the present results may guide clinical work when considering reasons for seeking treatment for PPU. Bőthe B, Tóth-Király I, Potenza MN, et al. High-Frequency Pornography Use May Not Always Be Problematic. J Sex Med 2020;17:793-811.
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Affiliation(s)
- Beáta Bőthe
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Département de Psychologie, Université de Montréal, Montreal, Canada.
| | | | - Marc N Potenza
- Departments of Psychiatry and Neuroscience, Child Study Center, Yale University School of Medicine, New Haven, CT, USA; Substance Abuse Center, Connecticut Mental Health Center, New Haven, CT, USA
| | - Gábor Orosz
- Department of Psychology, Stanford University, Stanford, CA, USA; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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Problematic and Non-Problematic Pornography Use Among LGBTQ Adolescents: a Systematic Literature Review. CURRENT ADDICTION REPORTS 2019. [DOI: 10.1007/s40429-019-00289-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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