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

The standardization of a new Explicit Pornographic Picture Set (EPPS)

Pictures with affective content have been extensively used in scientific studies of emotion and sexuality. However, only a few standardized picture sets have been developed that offer explicit images, with most lacking pornographic pictures depicting diverse sexual practices. This study aimed to fill this gap through developing a standardized affective set of diverse pornographic pictures (masturbation, oral sex, vaginal sex, anal sex, group sex, paraphilia) of same-sex and opposite-sex content, offering dimensional affective ratings of valence, arousal, and dominance, as well as co-elicited discrete emotions (disgust, moral and ethical acceptance). In total, 192 pornographic pictures acquired from online pornography platforms and 24 control IAPS images have been rated by 319 participants (Mage = 22.66, SDage = 4.66) with self-reported same- and opposite-sex sexual attraction. Stimuli were representative of the entire affective space, including positively and negatively perceived pictures. Participants showed differential affective perception of pornographic pictures according to gender and sexual attraction. Differences in affective ratings related to participants' gender and sexual attraction, as well as stimuli content (depicted sexual practices and sexes). From the stimuli set, researchers can select explicit pornographic pictures based on the obtained affective ratings and technical parameters (i.e., pixel size, luminosity, color space, contrast, chromatic complexity, spatial frequency, entropy). The stimuli set may be considered a valid tool of diverse explicit pornographic pictures covering the affective space, in particular, for women and men with same- and opposite-sex sexual attraction. This new explicit pornographic picture set (EPPS) is available to the scientific community for non-commercial use.

Problematic pornography use across countries, genders, and sexual orientations: Insights from the International Sex Survey and comparison of different assessment tools

BACKGROUND AND AIMS

Problematic pornography use (PPU) is a common manifestation of the newly introduced Compulsive Sexual Behavior Disorder diagnosis in the 11th edition of the International Statistical Classification of Diseases and Related Health Problems. Although cultural, gender- and sexual orientation-related differences in sexual behaviors are well documented, there is a relative absence of data on PPU outside Western countries and among women as well as gender- and sexually-diverse individuals. We addressed these gaps by (a) validating the long and short versions of the Problematic Pornography Consumption Scale (PPCS and PPCS-6, respectively) and the Brief Pornography Screen (BPS) and (b) measuring PPU risk across diverse populations.

METHODS

Using data from the pre-registered International Sex Survey [n = 82 243; mean age (Mage) = 32.4 years, standard deviation = 12.5], a study across 42 countries from five continents, we evaluated the psychometric properties (i.e. factor structure, measurement invariance, and reliability) of the PPCS, PPCS-6, and BPS and examined their associations with relevant correlates (e.g. treatment-seeking). We also compared PPU risk among diverse groups (e.g. three genders).

RESULTS

The PPCS, PPCS-6, and BPS demonstrated excellent psychometric properties [for example, comparative fit index = 0.985, Tucker-Lewis Index = 0.981, root mean square error of approximation = 0.060 (90% confidence interval = 0.059-0.060)] in the confirmatory factor analysis, with all PPCS' inter-factor correlations positive and strong (rs = 0.72-0.96). A total of 3.2% of participants were at risk of experiencing PPU (PPU+) based on the PPCS, with significant country- and gender-based differences (e.g. men reported the highest levels of PPU). No sexual orientation-based differences were observed. Only 4-10% of individuals in the PPU+ group had ever sought treatment for PPU, while an additional 21-37% wanted to, but did not do so for specific reasons (e.g. unaffordability).

CONCLUSIONS

This study validated three measures to assess the severity of problematic pornography use across languages, countries, genders, and sexual orientations in 26 languages: the Problematic Pornography Consumption Scale (PPCS, and PPCS-6, respectively), and the Brief Pornography Screen (BPS). The problematic pornography use risk is estimated to be 3.2-16.6% of the population of 42 countries, and varies among different groups (e.g. genders) and based on the measure used.

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.

Women Reporting on Their Use of Pornography: A Qualitative Study Exploring Women's Perceived Precursors and Perceived Outcomes

The aim of this study was to explore motivations women describe for using pornography. A qualitative online interview study was conducted with 30 women (Mean age 30.23, range 20-47; residing in the UK and in Greece; of varied sexual orientations and relationship status) about their pornography use, motivations for use, and preferences. Reflexive thematic analysis was used. Results were organized into four themes: Sexual Precursors, Non-sexual Precursors, Intended Outcomes, and Unintended Outcomes. The findings highlight that pornography use for women can have both positive and negative ramifications for women's sexual lives. Implications for clinical practice and education are discussed.

Associations Between Pornography Use Frequency and Intimate Partner Violence Perpetration Among Young Adult Couples: A 2-Year Longitudinal Study

Pornography use is a common sexual activity for many individuals including those in a romantic relationship. Some studies have shown that violent content depicted in pornography is a risk factor for perpetration of violence in real life. Even if most of these studies examined perpetration of violent behaviors in general, not specifically toward the intimate partner, some studies have shown that pornography use frequency is related to a greater perpetration of intimate partner violence (IPV), while other studies have found that it is not significantly related. However, most previous studies were cross-sectional, sampled individuals rather than couples, and did not include separately forms of IPV (e.g., physical, psychological, and sexual). The present study examined the associations between pornography use frequency and the perpetration of physical and psychological IPV, and sexual coercion among young adult couples. A convenience sample of 113 couples aged between 16 and 29 years old completed self-reported online questionnaires two times over a 2-year period. The results of autoregressive cross-lagged models showed that a person's pornography use frequency at Time 1 was related to their own higher sexual coercion perpetration 2 years later and that a person's sexual coercion perpetration was related to their partner's lower pornography use frequency 2 years later. However, no significant association between pornography use frequency and physical and psychological IPV emerged. In line with previous studies, our results suggest that pornography use represents an important risk factor for the perpetration of sexual coercion. Findings support the need to include education around pornography use in sexual violence prevention programs to avoid that young adults reproduce pornographic scripts in their sexuality.

Associations Between Contents of Pornography and Sexual Satisfaction and Function Among Young Adults

Pornography offers a wide variety of sexual contents and has documented potential positive (e.g., higher sexual satisfaction) and negative associations (e.g., lower sexual function) with sexuality. The aims of this study were to describe the proportion of use of five different contents of pornography (i.e. group sex, passion and romance, gender-bending, taboo transgression and forbidden sex, power, control, and rough sex pornography), to examine gender-based differences in the frequency of use of these contents, and to examine the associations between the frequency of use of these contents and sexual satisfaction and function, considering potential differences among genders and individuals with and without a romantic or sexual partner, and controlling for frequency of masturbation. A sample of 827 young adults (503 women; Mage = 23.44) completed online self-report questionnaires. Results of path analysis indicated that, controlling for frequency of masturbation, the use of passion and romance pornography was associated with higher sexual satisfaction, whereas the use of power, control, and rough sex pornography was associated with lower sexual satisfaction. Cisgender men's use of power, control, and rough sex pornography was also associated with lower sexual function. These findings suggest different associations between pornography use and sexual satisfaction and function depending on the pornographic contents used.

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.

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

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

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.

Parental practices as predictors of adolescents' compulsive sexual behavior: a 6-month prospective study

Compulsive sexual behavior (CSB) is a prevalent disorder among adolescents. To date, most studies focused on the self-report assessment of individuals without assessing possible parental practices that might alleviate or exacerbate adolescents' CSB. In the present research, I adopted the family systematic approach, which considers the effects of family context on children's and adolescents' development and examined whether and how parental (fathers' and mothers') support giving, communication, and restrictive mediation relate to children's current and future severity of CSB. The sample comprised 300 Israeli families [triad of mothers, fathers, and one adolescent (39% boys, 61% girls; age 14-18)]. Results indicate that maternal support and paternal quality of communication with children significantly predicted lower severity of current and future CSB, respectively. These findings highlight an important and understudied topic in the hope of motivating additional researchers and practitioners to adopt a familial, microsystem perspective on healthy sexual development-a perspective that holds great promise in promoting normal sexual development and in decreasing risky sexual behaviors.

Withdrawal-like Symptoms in Problematic Pornography Use: A Scoping Review

OBJECTIVES

There is still debate whether problematic pornography use (PPU) can be understood as an addictive disorder, and little is known about withdrawal-like symptoms in these patients. Therefore, our aim was to summarize the existing scientific literature about this topic in the format of a scoping review.

METHODS

Potentially eligible references were retrieved from 6 databases (MEDLINE/PubMed, Web of Science, Embase, PsycINFO, LILACS, and SciELO) up to February 7, 2023. Studies were included if they reported original data about withdrawal-like symptoms in individuals with PPU. Studies investigating child pornography use, or in which it was not possible to extract data of interest were excluded. Data extracted from included studies and their quality assessment were described narratively.

RESULTS

A total of 937 references were retrieved, and 14 studies were included (n = 31,009 participants). According to our results, cravings were intense in most cases and frequent reasons for relapse. The proportion of participants experiencing other withdrawal-like symptoms (mental, sexual, and physical symptoms) reached up to 72.2% in the cross-sectional studies with this information available. Severity of withdrawal symptoms was associated with severity of PPU and frequency of pornography use. In some studies, measures of withdrawal symptoms were considered central symptoms of PPU and were significantly higher in individuals considering treatment. Masturbation was reported to alleviate withdrawal-like symptoms in some cases.

CONCLUSIONS

There is preliminary evidence for the existence of withdrawal-like symptoms in PPU. Future studies should investigate onset, characteristics, duration, and proportion of withdrawal-like symptoms in PPU with robust methodology, also investigating potential confounding variables.

Distress and Satisfaction in Women Who Perceive that Their Male Partners Use Pornography: The Roles of Attitude, Religious Commitment and Conservative Religiosity

Qualitative studies suggest that women's attitudes and religiosity have an important role in their experience of their male partners' pornography use, but these factors have not been adequately studied. The present study examined the contributions of perceived frequency of male partners' solitary pornography use (PFREQ), women's attitudes toward their partners' pornography use, conservative religiosity, and religious commitment to women's pornography-related distress, relationship satisfaction, and sexual satisfaction in women who reported they were married to or cohabitating with men who had used pornography in the prior 3 months (median frequency = 1-2 times/week). Participants were online research panel participants (n = 625), age mean = 44[SD = 13], diverse SES, 86% White. Partial correlations and multiple regressions, controlling for demographic variables and COVID-19-related stress, indicated that higher PFREQ and negative attitudes toward pornography were significantly associated with women's higher pornography-related distress, lower relationship satisfaction, and lower sexual satisfaction. Moderation analyses found that negative attitude amplified the negative association between PFREQ and relationship satisfaction, and conservative religiosity amplified the positive association between PFREQ and pornography-related distress. Neither attitude nor religious factors moderated the negative association between PFREQ and sexual satisfaction. Findings suggest that attitude, religious factors, and PFREQ are each important to consider in research and clinical contexts.

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

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

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.

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.

Identifying Relationships Between Difficulties with Emotion Regulation and Compulsive Sexual Behavior

Emotion dysregulation is an associated feature of compulsive sexual behavior disorder (CSBD), now recognized by the World Health Organization. Previous studies have identified associations between trait emotion dysregulation and CSBD. Given that difficulties with emotion regulation (DERS) is comprised of several facets (e.g., difficulty with impulse control and lacking awareness of one's feelings when upset), and that these facets differentially relate to other mental health concerns, the present study aimed to examine how DERS facets relate to compulsive sexual behavior (CSB). The present study also considered interpersonal emotion regulation via attachment avoidance and attachment anxiety. Hierarchical regression was conducted, first accounting for demographic covariates, then adding attachment styles, and finally all DERS subscales. Results indicated that, among a large, diverse, online U.S. sample (N = 915; Mage = 39.21, SD = 0.81; 54.3% men), difficulty controlling impulses when upset, difficulty with clarity of emotions, and non-acceptance of emotions were significantly positively associated with CSB (small to moderate effects). Attachment anxiety and avoidance were also significantly positively associated with CSB, although their effects were minimal when adding DERS facets. Overall, this study supports the theorized impact of emotion dysregulation on CSB. Assessment of individual differences in DERS and intervening on these concerns are important for treating CSB.

Development and Validation of the Metacognitions about Sex Scale: Exploring its Role as a Mediator between Negative Affect, Emotion Dysregulation Strategies, and Compulsive Sexual Behavior Disorder

Metacognitions about sex are theorized to shape cognitive appraisal, coping mechanisms, and regulation or dysregulation before, during, and/or after exposure to sexual stimuli. In our study, we examined the construct structure and validity of the Metacognitions about Sex Scale (MSS) among a sample of adolescents. We estimated the convergent validity of the MSS by factors: negative affect, dysregulated thoughts, and impulsivity, and compulsive sexual behavior (CSB). We also ran a structural equation model in which we examined the possibility that metacognitions about sex would mediate the association between negative affect, dysregulated thoughts, and impulsivity on the one hand, and CSB on the other. The study population included 662 adolescents (252 boys and 410 girls, M = 16.70, SD = 1.32) between 13-18 years of age. The analyses indicated that the factorial structure of the MSS comprised the two expected factors. We also found that positive and negative metacognitions about sex significantly mediated the effect of negative affect, dysregulated thoughts, and impulsivity on CSB. The findings provide evidence that MSS among Israeli adolescents are psychometrically appropriate for use by researchers and practitioners in the prevention and treatment of CSB.

"We Felt Emotionally Closer:" A Qualitative Study of Couples' Communication about Pornography Use

Despite much empirical study of the complex association between pornography use and relationship health, little research has been conducted on the quality of communication about pornography use within relationships, which may meaningfully impact its association with relationship health. We used reflexive thematic analysis and behavioral intimacy theory to analyze responses to an online survey in which 146 individuals (77.3% women) in committed relationships described their communication with their partner about pornography use. Themes drawn from participants' responses included: 1) Discussing pornography use is not vulnerable (anymore); (2) Asymmetrical vulnerability within the couple; (3) Disappointment and divergent values present in suppressive events; (4) Sharing the struggle of navigating unwanted pornography use; and (5) Selective reinforcement: encouraging some, but not all, vulnerable behavior, which included two subthemes: (a) Your pornography use is not okay, but I'm glad you told me; and (b) You can use pornography; I just don't need to hear about it. Findings provide guidance to help couples navigate conversations about pornography use in ways that enhance relationship health.

How Much Pornography Use Do Americans Think Is "Average" for a Man and Woman? Findings from a National Survey

Though research has examined pornography viewing frequency and its correlates in national samples, researchers have yet to assess how much pornography use the general population thinks is "average" for men and women. Drawing on data from a nationally representative sample of American adults (Men: N = 1,127; Women = 1,382; total mean age = 50.0, SD = 17.4), it was hypothesized that Americans' estimations of how much pornography use is average for men and women would be shaped by perceptual mechanisms as well as the influence of religious subculture. Results show that age, personal pornography use, self-reported addiction to pornography, and religiosity (for men), were associated with Americans' perceptions of what is average for others. The association with personal pornography use was amplified for same-gender estimations, and Americans estimated the average man views pornography more frequently than the average woman. Americans rarely reported viewing pornography at higher rates than what they estimated for others. This study provides initial steps toward understanding gendered impressions of average pornography use and provides recommendations for how future research could explore differing mechanisms of same-gender and cross-gender perceptions.

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.

Anxiety and Compulsive Sexual Behavior Disorder: A Systematic Review

The inclusion of the novel diagnosis of Compulsive Sexual Behavior Disorder in the forthcoming 11^th edition of the International Classification of Diseases has spurred increasing interest in the clinical profile of the disorder. Such attention has included a focus on potential comorbidities, risk factors, or symptoms resulting from such behaviors, including anxiety. Anxiety disorders have long been noted as comorbid with many other diagnoses, such as posttraumatic stress disorder, obsessive compulsive disorder, and substance use disorders. This review aims to understand the relationship between anxiety and compulsive sexual behavior in adults and adolescents, based on available quantitative studies. A search of PsycInfo and PubMed revealed 40 studies which quantitatively assessed a relationship between an anxiety measure and a Compulsive Sexual Behavior Disorder measure, including dissertations and published articles using clinical and community samples. A qualitative synthesis and risk of bias analysis of the studies was conducted, rather than a meta-analysis, due to the variety of methods. Overall, studies were primarily cross-sectional and the relationship between these two constructs was unclear, likely due to several factors, including inconsistent measurement of Compulsive Sexual Behavior Disorder, lack of gender diversity, and very little longitudinal data. Directions for future research are discussed.

Web-Based Relationship Education and Pornography-Related Behaviors: A Single-Group Design During the COVID-19 Pandemic

Research surrounding pornography and its impact on individual and relationship functioning is a frequent and ongoing debate in the current literature. However, recent meta-analyses and aggregated studies suggest that relationship distress is associated with higher levels of general pornography use. This may be a reason why a significant number of men and women view pornography and seek help for their use. In the present study, we explored whether participation in the OurRelationship program, a web-based relationship education program that has been empirically shown to reduce relationship distress but is not tailored to reduce general pornography use, was associated with reliable changes in pornography-related behaviors. In a sample of low-income and diverse couples (N = 314 couples; 628 individuals), we observed high completion rates (64.3%) as well as reliable, small-sized decreases in the frequency and duration of pornography use for the average couple (d = 0.12-0.13). Furthermore, post hoc analyses found that individuals who began the program viewing pornography daily reported reliability-larger decreases in pornography-related behaviors (d = 0.32-0.90) than those who viewed pornography less frequently. However, we did not see reliable changes in couples' arguments about pornography use or perceptions of problematic use. The findings were generally not moderated by gender or lifestyle changes due to the COVID-19 pandemic. Clinicians struggling to reduce their client's general pornography use may consider including a focus on improving general romantic relationship functioning.

Porn use and men's and women's sexual performance: evidence from a large longitudinal sample

BACKGROUND

We examined whether young men and women differ in the relation between porn use and sexual performance (sexual self-competence, sexual functioning, and partner-reported sexual satisfaction).

METHODS

We conducted a three-wave longitudinal study (spanning 2015-16-17) that involved a very large number of men and women in their early 20s (100 000 + French-speaking individuals; 4000 + heterosexual couples).

RESULTS

The results revealed a twofold phenomenon. Among men, a higher frequency of porn use (wave 1) and increased porn use over time (waves 1-3) were associated with lower levels of sexual self-competence, impaired sexual functioning, and decreased partner-reported sexual satisfaction. In contrast, among women, higher and increasing frequencies of porn use were associated with higher levels of sexual self-competence, improved sexual functioning, and enhanced partner-reported sexual satisfaction (for some aspects).

CONCLUSIONS

The findings reveal the irony that porn - a male-dominated industry that targets a male-dominated audience - is associated with the erosion of the quality of men's sex lives and the improvement of women's sex lives.

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.

Associations Between Pornography Consumption Patterns, Pornography Consumption Motives, and Social Wellbeing among U.S. College Students: A Latent Profile Analysis with a Primarily Female Sample

This study identified profiles of pornography motivations and outcomes and assessed differences between profiles on three measures of social well-being: social support, fear of intimacy, and loneliness. Latent profile analysis and group comparisons were conducted using cross-sectional data from college students (N = 389). Results indicated four profiles: low motivation/average distress, porn for enjoyment, high motivation/average guilt, low motivation/high distress. Those in the high motivation/average guilt profile reported more social well-being difficulties relative to the other profiles and non-pornography consumers. Results suggest that individuals who report varying pornography use motivations and negative outcomes may report difficulties with social well-being, with implications for intimate relationships.

Reasons for Moral-Based Opposition to Pornography in a U.S. Nationally Representative Sample

Pornography use is a common-but-controversial activity that many people object to or morally disapprove of. Despite this, there is a limited understanding of the reasons for such moral opposition. Although some prior research has assessed characteristics that influence moral opposition to pornography, most research has done so using various forced-choice methods. The present study aimed to better understand the reasoning behind moral-based opposition to pornography by using open-ended questioning and exploring the relationship between these reasons and pornography use habits. To achieve these aims, we analyzed data from a nationally representative U.S. sample, specifically studying individuals who reported moral beliefs opposing pornography (N = 1,020). Results revealed 14 general themes (e.g., religion/spirituality; concerns about abuse; disgust) in the reasons participants reported for their moral disapproval of pornography, many of which were related to individual difference variables such as gender, age, religiousness, and political preferences. Implications, limitations, and directions for future research are also discussed.

The Relationship Between Alcohol and Drug Use, Compulsive Sexual Behavior, and Condomless Anal Sex in Men Who have Sex with Men: Analysis of Retrospectively-Reported Sexual Behavior

Men who have sex with men (MSM) are disproportionately impacted by HIV in the United States, and substance use and compulsive sexual behavior (CSB) are contributors to HIV risk behavior. This study sought to examine the direct and interactive effects of concurrent substance use and CSB on condomless anal sex (CAS) in a community sample of MSM (N = 200) utilizing a 90-day timeline follow-back assessment. Results indicated CSB did not directly increase risk for CAS when controlling for substance use and age. There was limited evidence for a direct effect of concurrent alcohol use on CAS, and no evidence for an interaction effect with CSB. The relationship between concurrent drug use and CAS was moderated by CSB, such that concurrent drug use was positively associated with CAS for those who screened positive for CSB, while the association was non-significant for those who screened negative. Implications and limitations of these findings are discussed.

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.

Religiousness and Sexual Values Predict Sexual Incongruence: Results from a U.S. Nationally Representative Study

The present work aimed to clarify commonly endorsed sexual values in the general U.S. population as well as the association between sexual values and incongruence. Study 1 recruited adults (N = 923; 51.8% women; M_age = 35.5, SD = 10.8) to answer a free response question about sexual values via Amazon's Mechanical Turk, while Study 2 posed the same question to a weighted, nationally representative U.S. sample (N = 2,519; 51.4% women; M_age = 48.2, SD = 17.8). Data collection was completed in 2017 and 2019, respectively. Results from these cross-sectional studies demonstrated that, although religiousness predicted sexual incongruence, conservative sexual values predicted variance in sexual incongruence, over and above the effects of religiousness.

Another failure of the latent disease model? The case of compulsive sexual behavior disorder •

Recent debates have evolved regarding the classification/conceptualization of compulsive sexual behavior disorder (CSBD). Conclusions regarding an agreed upon CSBD model are hindered by reliance on the latent disease model. Competing biological-based frameworks are moving forward to replace latent disease classification more broadly but have been met with limited success. We suggest that CSBD researchers move towards developing dimensional, transtheoretical, process-based models. We further suggest additional research, particularly mixed methods and longitudinal studies. Finally, we request that federal funding bodies take a more active role in supporting CSBD research.

The Relationship between Compulsive Sexual Behavior, Religiosity, and Moral Disapproval

Compulsive sexual behavior (CSB) is associated with religiosity and moral disapproval for sexual behaviors, and religiosity and moral disapproval are often used interchangeably in understanding moral incongruence. The present study expands prior research by examining relationships between several religious orientations and CSB and testing how moral disapproval contributes to these relationships via mediation analysis. Results indicated that religious orientations reflecting commitment to beliefs and rigidity in adhering to beliefs predicted greater CSB. Additionally, moral disapproval mediated relationships between several religiosity orientations and CSB. Overall, findings suggest that religiosity and moral disapproval are related constructs that aid in understanding CSB presentations.

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.

Who feels affected by "out of control" sexual behavior? Prevalence and correlates of indicators for ICD-11 Compulsive Sexual Behavior Disorder in the German Health and Sexuality Survey (GeSiD)

BACKGROUND AND AIMS

The purpose of this study was to examine the prevalence and correlates of indicators consistent with Compulsive Sexual Behavior Disorder (CSBD)-defined and operationalized according to the ICD-11 guidelines-in a large (n = 4,633; 50.5% male; 49,5% female) probability-based German national sample.

METHODS

Participants were asked if they had ever experienced "intense and recurring sexual impulses or sexual urges that I had difficulty controlling and resulted in sexual behavior" over a period of several months. Those who reported this experience were queried about the associated distress.

RESULTS

Overall, 4.9% of men [95% CI = 3.9-6.1] and 3.0% of women [95% CI = 2.3-3.9] reported experiences consistent with ICD-11 diagnostic requirements for lifetime diagnosis. In the 12 months preceding the study, 3.2% of men [95% CI = 2.4-4.2] and 1.8% of women [95% CI = 1.2-2.5] reported experiences consistent with CSBD requirements. Compared to controls and participants who reported elements of compulsive sexuality but without accompanying distress, strict religious upbringing was most prevalent in the CSBD group. The CSBD group was more likely to view sexual practices like men having sex with men as unacceptable and to report the belief that pornography has negative impacts on their sex life and life in general. Compared to the other two groups, the CSBD group was significantly more likely to have received psychiatric treatment for depression or another mental health problem during the past 12 months.

DISCUSSION AND CONCLUSIONS

The current study provides novel and important insights into the prevalence and characteristics of CSBD in the general population.

Assessment of compulsive sexual behavior disorder among lesbian, gay, bisexual, transgender, and queer clients •

Numerous debates surround the recent inclusion of compulsive sexual behavior disorder (CSBD) in the International Classification of Diseases (11th ed.), such as the appropriate classification of this construct and what symptom criteria best capture this syndrome. Although controversy surrounding CSBD abounds, there is general agreement that researchers should examine this syndrome in diverse groups, such as lesbian, gay, bisexual, and transgender populations. However, there have been few investigations into how diverse sociocultural contexts may influence the assessment and treatment of CSBD. Therefore, we propose several differential diagnosis considerations when working with sexual and gender diverse clients to avoid CSBD misdiagnosis.

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.

What is Normal Pornography Use in a Highly Religious Area? Exploring Patterns of Pornography Use in Utah

BACKGROUND

Pornography has become mainstream in society, including in the state of Utah, which is a highly religious, conservative state.

AIM

The purpose of this study is to gather basic descriptive norms for pornography use in the state of Utah (given its unique religious profile), establish clinical cutoffs based on frequency and duration of pornography consumption, and begin to establish a clinical picture of problematic pornography use in a regionally representative sample.

METHODS

We recruited a representative sample of 892 Utahns via CloudResearch.com. Participants completed the following measures: Consumption of Pornography - General (COPS); Problematic Pornography Use Scale; Clear Lake Addiction to Pornography Scale; The Inventory of Depression and Anxiety Symptoms (Second Version).

OUTCOME

Documentation of pornography use norms among Utahns.

RESULTS

In our sample, 79% reported viewing pornography in their lifetime (85% of men, 75% of women). The most common frequency of pornography viewing was weekly or monthly among men, and monthly or every 6 months among women, which is comparable to national averages. Men and women showed significantly different pornography use frequencies. We demonstrate a relationship between higher levels of pornography use and higher perceived levels of pornography use as a problem or "addiction" and depression scores and explore the typical demographics of our highest pornography users.

CLINICAL TRANSLATION

This study will aid clinicians in using the COPS to derive normal pornography use compared to above average pornography use among pornography users from a religious background, especially for clinicians who seek to provide normative data to clients presenting with problematic pornography use like in motivational interviewing interventions.

STRENGTHS AND LIMITATIONS

Strengths include our measures generally demonstrated strong validity, we provide the beginnings of sound clinical implementation of the COPS for benchmarking pornography use in a clinical setting in Utah, and that our sample was representative of the state of Utah according to current census data. Limitations include those commonly seen in survey-based data collection methods, and that findings from our unique Utah sample may not be as relevant among other religious or cultural samples.

CONCLUSION

Our findings provide an updated picture of pornography use in the state of Utah and suggest that even those high in religiosity continue to use pornography. Our results can provide a spectrum of pornography use, aiding a pornography user in treatment to be able to compare his or her use to this norm. Esplin CR, Hatch SG, Ogles BM, et al. What is Normal Pornography Use in a Highly Religious Area? Exploring Patterns of Pornography Use in Utah. J Sex Med 2022;19:823-833.

No Significant Changes in Addictive and Problematic Behaviors During the COVID-19 Pandemic and Related Lockdowns: A Three-Wave Longitudinal Study

Introduction

The COVID-19 outbreak and related lockdowns brought substantial changes in people's lives and led to concerns about possible increases of addictive behaviors at the initial stages of the pandemic. To examine these concerns, the aim of the present study was to assess longitudinal changes in addictive and problematic behaviors (i.e., problematic social media use, Internet gaming disorder, gambling disorder, problematic pornography use, and compulsive sexual behavior disorder) over time during the COVID-19 pandemic.

Methods

Three waves of data collection took place in different stages of the COVID-19 outbreak in Hungary in a general population, from the first wave of lockdowns to the second and third waves of restrictions (May, 2020; N T1 = 1747; June-August, 2020; N T2 = 656; January, 2021; N T3 = 411). Latent growth curve models were calculated to assess the potential changes in addictive and problematic behaviors over time.

Results

Latent growth curve models showed that the sample varied in their initial scores, but there were no significant changes over time in any of the examined behaviors, except for compulsive sexual behavior disorder, which demonstrated a small but significant increase (i.e., positive and significant slope factor). However, the rate of this change was negligible. Overall, there were no noteworthy changes over time regarding any of the examined addictive and problematic behaviors.

Conclusion

Contrary to initial concerns, no substantial changes over time were observed regarding the examined addictive behaviors during the COVID-19 pandemic and related lockdowns. These findings indicate that those who had no previous problem with these addictive behaviors, might have not developed a problem, and those who had problem with either of the behaviors previously, might have not experienced a significant increase in their symptoms.

"Pornography Addiction": Elements for Discussion of a Case Report

Can Internet pornography use (IPU) lead to addiction? "Pornography addiction" is a highly controversial concept within the scientific community. In the absence of consensus, international classifications do not consider that the concept meets the criteria to be recognized as a distinct diagnostic entity. However, the term "pornography addiction" has now become common parlance and is therefore present in the discourse of patients seeking therapy to address what they perceive as problematic pornography consumption. Drawing on a brief case vignette, presenting the case of a man who views himself as a pornography addict, we offer a critical review of this concept. Different diagnostic hypotheses will be considered. Beyond the diagnostic process, we consider the issue of "perceived addiction" and its relationship with "moral incongruence." From a psychotherapeutic view, we suggest that patients who self-identify as "porn addicts" must be supported using a more comprehensive approach that goes beyond their symptomatic behavior or the manner in which they present or perceive themselves. The proposed therapy did not seek or require an end to the behavior. The therapy approach focused on exploring the patient's history in an attempt to understand the construction of his sexuality and morality. In the case analyzed, focusing on the source of moral incongruence led to the disappearance of IPU and all associated suffering.