Pornography addiction - a supranormal stimulus considered in the context of neuroplasticity

Blunted sensitivity to expected value during risky decision making in individuals with problematic pornography use

Background and aims

Neurobiological models of addiction posit that addiction manifests through an amplified salience towards addiction-associated stimuli and a diminished responsiveness to non-addiction-related incentives. However, existing research on reward processing in individuals with problematic pornography use (PPU) has primarily been limited to sexual cue reactivity.

Methods

In this event-related potential (ERP) study, we employed a risky decision-making task involving 30 individuals with PPU and 33 healthy controls (HCs) to examine the effects of PPU on non-pornographic (money) reward valuation.

Results

Compared to HCs, individuals with PPU exhibited compromised sensitivity to monetary rewards. Specifically, while the HC group demonstrated a differential response in late positive potential (LPP) amplitude to various expected value (EV) levels, this pattern was absent in the PPU group. This impairment was associated with poorer adaptive decision-making, as evidenced by PPU participants' inability to adjust risk choices based on changes in EV, leading to a propensity for riskier decisions in disadvantageous situations.

Discussion and conclusions

The findings of impaired monetary evaluation in individuals with PPU may potentially explain why they continually pursue pornographic rewards while showing insensitivity to other rewards in daily life. Consequently, treatment development strategies may prioritize improving sensitivity to non-pornographic rewards within this population.

Problematic pornography use and novel patterns of escalating use: A cross-sectional network analysis with two independent samples

Modern internet pornography allows users to harness sexual novelty in numerous ways, which can be used to overcome desensitisation through increasing volume of use (quantitative tolerance), progressing to more stimulating genres (qualitative escalation), skipping between stimuli (tab-jumping), delaying orgasm ('edging'), and engaging in pornographic binges. However, existing research has not yet evaluated how these potentially reciprocal consumption patterns relate to problematic pornography use (PPU). To this end, we recruited two independent samples of male pornography users (N1 = 1,356, Mage = 36.86, SD = 11.26; N2 = 944, Mage = 38.69, SD = 12.26) and examined the relationships between these behavioural dimensions and self-reported difficulties in controlling one's pornography use. Data were analysed through the network analysis approach (using Gaussian graphical models). As hypothesised, i) quantitative tolerance was centrally placed within the overall network, and ii) acted as a statistical bridge node between other patterns of pornography use (e.g., pornographic binges), and all measured facets of PPU. Our results are consistent with other emerging literature suggesting that tolerance, pornographic binges, tab-jumping, and edging behaviours as relevant features ofPPU, and that upscaling overall usage may connect broader patterns of use with problematic engagement. Clinical and theoretical implications, as well as future research directions, are discussed.

Emotional processing deficits in individuals with problematic pornography use: Unpleasant bias and pleasant blunting

Background and aims

A growing body of evidence indicates a connection between emotional processes and the emergence and progression of addiction. However, scant research has examined the involvement of emotional processing within the framework of problematic pornography use (PPU). This study aimed to examine the electrophysiological and subjective differences in emotional processing between male individuals with PPU and healthy controls (HCs) following exposure to everyday affective images.

Methods

Event-related potentials (ERPs) were recorded from 42 PPU participants (mean age = 20.14 years, SD = 1.35) and 45 HCs (mean age = 20.04 years, SD = 1.45) during an oddball task, in which unpleasant, pleasant, and neutral images were presented as deviant stimuli, while a neutral kettle image served as the standard stimulus. The Self-Assessment Manikin (SAM) was employed to assess participants' subjective experience on the dimensions of valence and arousal.

Results

Regarding subjective measures of emotion, individuals with PPU reported lower valence ratings for unpleasant images compared to HCs. In terms of electrophysiological measures of emotion, PPU participants reported larger P2 amplitudes for unpleasant pictures compared to both pleasant and neutral pictures. Moreover, HCs showed enhanced P3 amplitudes in response to pleasant images compared to neutral images, whereas this effect was not observed in PPU participants.

Discussion and Conclusion

These findings indicate that individuals with PPU may display deficits in emotional processing characterized by enhanced responsiveness to negative stimuli and attenuated responsiveness to positive stimuli. The heightened sensitivity to negative stimuli may contribute to the inclination of individuals with PPU to engage in pornography as a coping mechanism for stress regulation. Conversely, their diminished sensitivity to positive stimuli presents a challenge in seeking alternative natural rewards to counter potentially addictive behaviors.

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.

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.

Computational models of behavioral addictions: State of the art and future directions

Non-pharmacological behavioral addictions, such as pathological gambling, videogaming, social networking, or internet use, are becoming major public health concerns. It is not yet clear how behavioral addictions could share many major neurobiological and behavioral characteristics with substance use disorders, despite the absence of direct pharmacological influences. A deeper understanding of the neurocognitive mechanisms of addictive behavior is needed, and computational modeling could be one promising approach to explain intricately entwined cognitive and neural dynamics. This review describes computational models of addiction based on reinforcement learning algorithms, Bayesian inference, and biophysical neural simulations. We discuss whether computational frameworks originally conceived to explain maladaptive behavior in substance use disorders can be effectively extended to non-substance-related behavioral addictions. Moreover, we introduce recent studies on behavioral addictions that exemplify the possibility of such extension and propose future directions.

Impact of COVID-19 on adolescent sexual life and attitudes: have we considered all the possible secondary effects of the pandemic?

A significant increase in pornography use has been reported in the adolescent population worldwide over the past few years, with intensification of the phenomenon during the COVID-19 pandemic. The aim of the present review is to provide data on the frequency of pornography consumption among adolescents during the pandemic and raise awareness about its potential impact on personal beliefs and sexual attitudes in the long term. A comprehensive literature review was performed in two scientific databases using the crossmatch of the terms "pornography", "adolescents" and "COVID-19". A significant increase in pornography consumption in adolescents was documented during the COVID-19 pandemic as a result of social detachment. Fulfilment of sexual desires in the context of social distancing, alleviation of COVID-19-related boredom and psychological strain, and coping with negative emotions are some of the reported reasons for increased pornography use during the pandemic. However, concerns have been raised in the literature regarding potentially negative effects of excessive pornography use from an early age, including the development of pornography addiction, sexual dissatisfaction and aggressive sexual attitudes reinforced by gender preoccupations and sexual inequality beliefs.

CONCLUSION

The extent to which increased pornography consumption from an early age during the COVID-19 pandemic may have affected adolescents' mental well-being, personality construction and sexual behaviour is yet to be seen. Vigilance from the society as a whole is required so that potential negative adverse effects of adolescent pornography use and potential social implications are recognized early and managed. Further research is needed so that the full impact of the COVID-19-related pornography use in the adolescent population is revealed.

WHAT IS KNOWN

•A significant increase in pornography consumption has been documented in the adolescent population worldwide over the past decades due to its quick, affordable and easy access from electronic devices and the possibility of anonymous and private participation. •During the COVID-19 pandemic, this phenomenon was intensified as a coping mechanism to social isolation and increased psychosocial strain.

WHAT IS NEW

•Concerns have been raised regarding the risk of pornography addiction in adolescents during the COVID-19 pandemic, making the post-pandemic adaptation challenging. •Awareness is raised in parents, health care providers and policy makers about the potential negative impacts of pornography consumption from an early, vulnerable age, such as sexual dissatisfaction and development of aggressive sexual attitudes and sex inequality beliefs.

Some Considerations about Pornography Watching in Early Adolescence

Adolescence is a time of significant transition because of the rapid acceleration of bodily changes [...].

mHealth Technologies for Managing Problematic Pornography Use: A Content Analysis (Preprint)

Background

Several mobile apps are currently available that purportedly help with managing pornography addiction. However, the utility of these apps is unclear, given the lack of literature on the effectiveness of mobile health solutions for problematic pornography use. Little is also known about the content, structure, and features of these apps.

Objective

This study aims to characterize the purpose, content, and popularity of mobile apps that claim to manage pornography addiction.

Methods

The phrase “pornography addiction” was entered as a search term in the app stores of the two major mobile phone platforms (Android and iOS). App features were categorized according to a coding scheme that contained 16 categories. Apps were included in the analysis if they were described as helpful for reducing pornography use, and data were extracted from the store descriptions of the apps. Metrics such as number of user ratings, mean rating score, and number of installations were analyzed on a per-feature basis.

Results

In total, 170 apps from both app stores met the inclusion criteria. The five most common and popular features, both in terms of number of apps with each feature and minimum possible number of installations, were the ability to track the time since last relapse (apps with feature=72/170, 42.4%; minimum possible number of installations=6,388,000), tutorials and coaching (apps with feature=63/170, 37.1%; minimum possible number of installations=9,286,505), access to accountability partners or communities (apps with feature=51/170, 30%; minimum possible number of installations=5,544,500), content blocking or content monitoring (apps with feature=46/170, 27.1%; minimum possible number of installations=17,883,000), and a reward system for progress (apps with feature=34/170, 20%; minimum possible number of installations=4,425,300). Of these features, content-blocking apps had the highest minimum possible number of installations. Content blocking was also the most detected feature combination in a combinatorial analysis (with 28 apps having only this feature), but it also had the lowest mean consumer satisfaction rating (4.04) and second-lowest median rating (4.00) out of 5 stars. None of the apps reviewed contained references to literature that provided direct evidence for the app’s efficacy or safety.

Conclusions

There are several apps with the potential to provide low- or zero-cost real-time interventions for people struggling to manage problematic pornography use. Popular app features include blockers of pornographic content, behavior monitoring, and tutorials that instruct users how to eliminate pornography use. However, there is currently no empirical evidence to support the effectiveness and safety of these apps. Further research is required to be able to provide recommendations about which apps (and app features) are safe for public consumption.

A Network Comparison of Motives behind Online Sexual Activities and Problematic Pornography Use during the COVID-19 Outbreak and the Post-Pandemic Period

Many researchers have considered whether online sexual activities (OSAs) increased over the course of the COVID-19 pandemic and whether these have led to an increase in problematic pornography use (PPU). This study investigated the impact of COVID-19 on PPU through pornography use motivations (PUMs) and OSAs to develop a better understanding of the mechanism and changes affecting PPU. Two groups of Chinese adults were recruited during the initial months of the pandemic (April 2020, n₁ = 496) and the post-pandemic period (October 2021, n₂ = 504). A network analysis was conducted to compare the structures of PPU symptoms among the two groups. The results showed that PUMs and OSAs were stronger predictors of PPU during the pandemic than post-pandemic (R²_pandemic = 57.6% vs. R²_{post-pandemic} = 28.7%). The motives of fantasy, sexual pleasure, stress reduction, and self-exploration were the prominent motivations during these two periods, but we found distinct PPU-related communities. PPU, sexual pleasure, and viewing sexually explicit materials (a type of OSAs) constituted a community during the pandemic but not in the post-pandemic’s network. The present study indicated that the pandemic may not have been the only factor impacting the higher rate of PPU. Instead, the higher frequency of OSAs during the pandemic may have been a strategy to cope with stress and to safely satisfy sexual desire.

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

Aim:

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

Methods:

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

Results:

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

Conclusion:

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

Psychometric Properties of the Youth Pornography Addiction Screening Tool

BACKGROUND

Addiction to pornography in the virtual world can seriously affect the mental, psychological, social, and family health of individuals and easy access to the Internet and cyberspace has intensified addiction to virtual pornography. Knowledge of the status of phenomena requires an accurate and scientific measurement tool with appropriate validity and reliability, so this study was conducted with the aim to study the Youth Pornography Addiction Screening Tool (YPAST).

METHODS

This study was carried out using the descriptive-exploratory method. The statistical population of the study included all students aged 18 to 30 years studying in the universities of Hamadan, Iran, in the academic year 2020-2021. Using stratified random sampling method, 480 individuals were selected from Bu-Ali Sina University, Islamic Azad University, and Payame Noor University of Hamadan Province. To collect data, the YPAST was utilized. The Cronbach's alpha coefficient, exploratory factor analysis (EFA) with Varimax rotation, and confirmatory factor analysis (CFA) were used to analyze the data.

FINDINGS

The YPAST consists of the 3 components of lack of control over pornographic behavior, regret after pornography use, and pornography for sexual arousal. These 3 factors together explained 61.16% of the total variance of pornography addiction in cyberspace, with the first, second, and third factors explaining 22.98%, 21.79%, and 16.39% of the variance, respectively. The CFA results showed that the scale items were of appropriate factor loads and higher than 0.40 on each factor, and the study measurement model in the first and second order factor analysis was of an acceptable fit. Therefore, the YPAST had an appropriate and acceptable structural validity among young people. The total validity coefficient of the YPAST was 0.88 and that of the first, second, and third factors were 0.94, 0.93 and 0.88, respectively. The YPAST has 3 factors.

CONCLUSION

The YPAST can be a powerful and accurate tool for measuring youth pornography addiction and it can be used with confidence in various situations to measure youth virtual pornography addiction. In addition, it seems that the scale items have a proper coherence and fluency, which, as a unified and integrated set of different aspects, can measure virtual pornography addiction among young people with high accuracy.

Understanding the Role of Incentive Salience in Sexual Decision-Making

In the search for understanding female sexual decision-making, progress has been made in uncovering a variety of perceptual biases and most of these concern the animal's sensory biology and cognitive processes. We are now poised to dig deeper into the female's decision-making and ask if incentive salience, which plays a role in all types of appetitive behaviors, also influences a female's "taste for the beautiful." The incentive salience hypothesis suggests that dopamine assigns value or salience to objects or actions. After value is assigned to all potential actions, an action selection system then chooses among potential options to select the most valuable action. In this view, dopamine stimulates reward-seeking behavior by assigning incentive salience to specific behavioral actions, which in turn, increases pursuit and focus on objects or stimuli that represent the valuable action. Here, we apply this framework to understand why females are compelled to respond maximally to some male courtship signals over others and how this process may reveal a female's hidden mate preferences. We examine studies of dopamine and the mesolimbic reward system because these may play a role in expanding the female's perceptual landscape for novelty in male courtship signals and establishing novel hidden preferences. We review three avenues of research that may identify signatures of incentive salience in females during sexual decision-making. This review includes studies of dopamine agonist or antagonist administration in females during mate choice or partner preference tests, measures of neural activity in dopaminergic neural circuits during mate choice or partner preference tests, and social regulation of dopamine in females when entering reproductive contexts and/or exposure to mate signals. By applying the incentive salience hypothesis to female reproductive decision-making, it redefines how we see the female's role in sexual encounters. Females cannot be considered passive during reproductive encounters; rather they are seeking sexual encounters, particularly with males that tap into their perceptual biases and initiate a reward-seeking response. Incentive salience applied to reproductive behavior requires considering females as viewing sexual stimuli as rewarding and initiating action to seek out this reward, all of which indicates females are driving sexual encounters.

Internet and Pornography Use During the COVID-19 Pandemic: Presumed Impact and What Can Be Done

The COVID-19 pandemic continues to cause an immense psychosocial strain worldwide. Excessive use of the internet during these psychologically trying times, fueled by physical isolation as a result of lockdowns, has translated into dysfunctional behaviors. A growing body of evidence suggests an unprecedented increase in internet use and consumption of online pornography during the pandemic, and possibly even directly caused by it. In this review, the authors report data from relevant sources to show the rise in pornography use during lockdowns in different countries worldwide. In addition to a brief overview of the neurobiology of internet addiction broadly and problematic online pornography use specifically, similarities with substance use disorders are explained. Further, the current status of the debate about defining diagnostic criteria is discussed. Finally, the review sheds light on the potential detrimental outcomes during the future post-pandemic "re-adaptation," while simultaneously offering preventative and management strategies for harm reduction. The authors conclude that foresightedness with utilizing existing tools and therapies and exercising appropriate amounts of caution could go a long way in addressing the challenges that lie ahead in the post-pandemic era.

Decision-Making in Gambling Disorder, Problematic Pornography Use, and Binge-Eating Disorder: Similarities and Differences

Purpose of Review

The present review attempts to provide a comprehensive and critical overview of the neurocognitive mechanisms of gambling disorder (GD), problematic pornography use (PPU) and binge-eating disorder (BED), focusing specifically on decision-making processes.

Recent findings

GD, PPU and BED have been associated with decision-making impairments both under risk and ambiguity. Features such as intelligence, emotions, social variables, cognitive distortions, comorbidities, or arousal may condition decision-making processes in these individuals.

Summary

Impairments in decision-making seem to be a shared transdiagnostic feature of these disorders We also hypothesized the EG relative to the NEG group would demonstrate weaker relationships between problem-gambling severity and health/functioning measures (e.g., substance use) and gambling behaviors (e.g., more time spent gambling) given that EG would account for some of the variance in the relationships between ARPG and these measures. However, there is varying support for the degree to which different features may affect decision-making. Therefore, the study of decision-making processes can provide crucial evidence for understanding addictions and other disorders with addiction-like symptomatology.

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

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

Brain Structure Alterations in Poly-Drug Use: Reduced Cortical Thickness and White Matter Impairments in Regions Associated With Affective, Cognitive, and Motor Functions

Substance use disorders (SUDs) are defined by obsessive and uncontrolled consumption, which is related to neurobiological changes. Based on previous work, this study investigated potential alterations in brain structure in poly-drug use disordered (PUD) patients in comparison to controls from the normal population. This study involved a sample of 153 right-handed men aged between 18 and 41 years, comprising a clinical group of 78 PUD and a group of 75 healthy controls. Group differences in gray matter (GM) and white matter (WM), as well as cortical thickness (CT), were investigated by means of diffusion tensor imaging using automated fiber quantification (AFQ) and voxel-based morphometry. We observed significant WM impairments in PUD, especially in the bilateral corticospinal tracts and the inferior longitudinal fasciculi. Furthermore, we found reduced CT in the PUD group especially in the left insular and left lateral orbitofrontal cortex. There were no group differences in GM. In addition, PUD exhibited a higher amount of psychiatric symptoms (Brief Symptom Inventory) and impairments in cognitive functions (Wonderlic Personnel Test). In line with previous research, this study revealed substantial impairments in brain structure in the PUD group in areas linked with affective, cognitive, and motor functions. We therefore hypothesize a neurologically informed treatment approach for SUD. Future studies should consequently explore a potential positive neuroplasticity in relation to a better therapeutic outcome.

Psychometric Instruments for Problematic Pornography Use: A Systematic Review

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

Compulsive Pornography Use in Late Life: A Case Report

Compulsive pornography use is on the rise and is a common compulsive sexual behavior being seen in the younger age groups between 18 and 30 years of age. The treatment of the same involves a combination of medical and behavioral management. We present herewith a case of a 69-year-old male who developed compulsive pornography usage for the first time and that responded well to psychotherapy and medication.

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

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

Survey of Sexual Function and Pornography

Introduction

We aimed to explore and describe the pornography habits of young men and women. Given recent upward trends in pornography use and erectile dysfunction, along with a plausible pathophysiology, we hypothesized that pornography use would correlate with sexual dysfunction.

Materials and Methods

Institutional Review Board approval was obtained. Surveys were distributed to 20–40 year old men and women presenting to a urology clinic. Information was collected on demographics and medical history. Sexual function was evaluated with the International Index of Erectile Function (IIEF) in men and the Female Sexual Function Index in women. Extent of potential addiction to pornography was measured with the pornography craving questionnaire and the obsessive passion scale. Pornography use was measured based on both frequency and duration, and analyzed relative to sexual dysfunction.

Results

Men used pornography significantly more frequently than women (81.1% vs. 39%). Computer and cellular phone image viewing were the most popular modalities in both sexes. There was no association between IIEF and craving for, or obsessive passion for, pornography. Preference for pornography with masturbation was found to be significantly associated with erectile dysfunction (p = 0.001). Rates of erectile dysfunction were lowest in those preferring partnered sex without pornography (22.3%) and increased significantly when pornography was preferred over partnered sex (78%). No correlation was found between any variables and female sexual dysfunction.

Conclusions

Pornography and sexual dysfunction are common among young people. No clear relationship exists between extent of addiction to pornography and sexual dysfunction in either gender. However, men who prefer masturbation with pornography to partnered sex have a significantly increased risk of sexual dysfunction. Given sexual dysfunction may be associated with mental health concerns, further evaluation of its causes and impact on military operational readiness are warranted.

Self-reported addiction to pornography in a nationally representative sample: The roles of use habits, religiousness, and moral incongruence

BACKGROUND AND AIMS

Despite controversies regarding its existence as a legitimate mental health condition, self-reports of pornography addiction seem to occur regularly. In the United States, prior works using various sampling techniques, such as undergraduate samples and online convenience samples, have consistently demonstrated that some pornography users report feeling dysregulated or out of control in their use. Even so, there has been very little work in US nationally representative samples to examine self-reported pornography addiction.

METHODS

This study sought to examine self-reported pornography addiction in a US nationally representative sample of adult Internet users (N = 2,075).

RESULTS

The results indicated that most participants had viewed pornography within their lifetimes (n = 1,461), with just over half reporting some use in the past year (n = 1,056). Moreover, roughly 11% of men and 3% of women reported some agreement with the statement "I am addicted to pornography." Across all participants, such feelings were most strongly associated with male gender, younger age, greater religiousness, greater moral incongruence regarding pornography use, and greater use of pornography.

DISCUSSION AND CONCLUSION

Collectively, these findings are consistent with prior works that have noted that self-reported pornography addiction is a complex phenomenon that is predicted by both objective behavior and subjective moral evaluations of that behavior.

The components of the adolescent brain and its unique sensitivity to sexually explicit material

INTRODUCTION

The focus of this brief literature review is to explore whether there is a relationship between the unique anatomical and physiological paradigms of the adolescent brain and an increased sensitivity to sexually explicit material.

METHODS

The EBSCO Research Data bases were searched using the following key terms: adolescence, adolescent brain development, neuroplasticity, sexually explicit material, sexualization, and pornography.

RESULTS

The literature highlighted several components of the adolescent brain that are different than the mature brain. These include: an immature prefrontal cortex and over-responsive limbic and striatal circuits, heightened period for neuroplasticity, overactive dopamine system, a pronounced HPA axis, augmented levels of testosterone, and the unique impact of steroid hormones. The physiological response to sexually explicit material is delineated. The overlap of key areas associated with the unique adolescent brain development and sexually explicit material is noteworthy. A working model summary that compares the response of the adult and adolescent brain to the same sexually explicit stimulus is outlined.

CONCLUSIONS

The literature suggests that the adolescent brain may indeed be more sensitive to sexually explicit material, but due to a lack of empirical studies this question cannot be answered definitively. Suggestions for future research are given to further advance the work in this applicable field of today.

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

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

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

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

Atitudes de Jovens frente à Pornografia e suas Consequências

Resumo Esta pesquisa qualitativa objetiva identificar e compreender as atitudes que homens e mulheres têm em relação à pornografia, bem como verificar as vantagens e desvantagens percebidas do consumo desse tipo de material no comportamento sexual e nos relacionamentos amorosos. Foram entrevistados dez homens e dez mulheres nascidos no Brasil, entre 20 e 30 anos de idade. Da análise de conteúdo emergiram quatro eixos temáticos: definição de pornografia, finalidade do uso, mudanças na forma de uso, e impactos do uso no comportamento sexual e no relacionamento amoroso. Os entrevistados, tanto homens quanto mulheres, elencaram prejuízos e benefícios do uso de forma semelhante, e sugeriram que características pessoais possam ser elementos importantes nessa avaliação.

Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports

Traditional factors that once explained men's sexual difficulties appear insufficient to account for the sharp rise in erectile dysfunction, delayed ejaculation, decreased sexual satisfaction, and diminished libido during partnered sex in men under 40. This review (1) considers data from multiple domains, e.g., clinical, biological (addiction/urology), psychological (sexual conditioning), sociological; and (2) presents a series of clinical reports, all with the aim of proposing a possible direction for future research of this phenomenon. Alterations to the brain's motivational system are explored as a possible etiology underlying pornography-related sexual dysfunctions. This review also considers evidence that Internet pornography's unique properties (limitless novelty, potential for easy escalation to more extreme material, video format, etc.) may be potent enough to condition sexual arousal to aspects of Internet pornography use that do not readily transition to real-life partners, such that sex with desired partners may not register as meeting expectations and arousal declines. Clinical reports suggest that terminating Internet pornography use is sometimes sufficient to reverse negative effects, underscoring the need for extensive investigation using methodologies that have subjects remove the variable of Internet pornography use. In the interim, a simple diagnostic protocol for assessing patients with porn-induced sexual dysfunction is put forth.

Trading Later Rewards for Current Pleasure: Pornography Consumption and Delay Discounting

Internet pornography is a multi-billion-dollar industry that has grown increasingly accessible. Delay discounting involves devaluing larger, later rewards in favor of smaller, more immediate rewards. The constant novelty and primacy of sexual stimuli as particularly strong natural rewards make Internet pornography a unique activator of the brain's reward system, thereby having implications for decision-making processes. Based on theoretical studies of evolutionary psychology and neuroeconomics, two studies tested the hypothesis that consuming Internet pornography would relate to higher rates of delay discounting. Study 1 used a longitudinal design. Participants completed a pornography use questionnaire and a delay discounting task at Time 1 and then again four weeks later. Participants reporting higher initial pornography use demonstrated a higher delay discounting rate at Time 2, controlling for initial delay discounting. Study 2 tested for causality with an experimental design. Participants were randomly assigned to abstain from either their favorite food or pornography for three weeks. Participants who abstained from pornography use demonstrated lower delay discounting than participants who abstained from their favorite food. The finding suggests that Internet pornography is a sexual reward that contributes to delay discounting differently than other natural rewards. Theoretical and clinical implications of these studies are highlighted.

Sex Trafficking: Policies, Programs, and Services

Sex trafficking (ST), a contemporary form of female slavery, is a human rights issue of critical concern to social work. The global response to ST has been substantial, and 166 countries have adopted anti-ST legislation. Despite considerable efforts to combat ST, the magnitude is increasing. To date, the majority of anti-ST efforts have focused on criminalization policies that target traffickers or purchasers of sexual services, who are predominantly male; prevention programming and services for predominantly female victims have received less support. Therapeutic services to assist pornography addicts and purchasers of sexual services are also necessary. In this article, authors examine current anti-ST policies, programs, and services, both domestically and globally, and present an innovative paradigm that addresses social inequities and emphasizes prevention programming. They conclude with a discussion of the paradigm's implications for social work policies, practices, and services.

Neuroscience of Internet Pornography Addiction: A Review and Update

Many recognize that several behaviors potentially affecting the reward circuitry in human brains lead to a loss of control and other symptoms of addiction in at least some individuals. Regarding Internet addiction, neuroscientific research supports the assumption that underlying neural processes are similar to substance addiction. The American Psychiatric Association (APA) has recognized one such Internet related behavior, Internet gaming, as a potential addictive disorder warranting further study, in the 2013 revision of their Diagnostic and Statistical Manual. Other Internet related behaviors, e.g., Internet pornography use, were not covered. Within this review, we give a summary of the concepts proposed underlying addiction and give an overview about neuroscientific studies on Internet addiction and Internet gaming disorder. Moreover, we reviewed available neuroscientific literature on Internet pornography addiction and connect the results to the addiction model. The review leads to the conclusion that Internet pornography addiction fits into the addiction framework and shares similar basic mechanisms with substance addiction. Together with studies on Internet addiction and Internet Gaming Disorder we see strong evidence for considering addictive Internet behaviors as behavioral addiction. Future research needs to address whether or not there are specific differences between substance and behavioral addiction.