Studies linking porn use to “un-egalitarian attitudes” toward women

This page collects findings that falsify the popular sexology claim that porn use promotes egalitarian attitudes toward women.

Let’s begin with the 2016 study that inspired the creation of this page -“Is Pornography Really about “Making Hate to Women”? Pornography Users Hold More Gender Egalitarian Attitudes Than Nonusers in a Representative American Sample“. It has been heavily cited as strong evidence that porn use leads to greater egalitarianism and less sexist attitudes. Actually, this Taylor Kohut study (like a second 2016 Kohut paper) provides an instructive example of how to twist methodology to achieve a desired result. Namely, that porn use is only beneficial.

The authors of this study framed egalitarianism as support for the following: Feminist identification, Women holding positions of power, Women working outside home, Abortion.

Secular populations, which tend to be more liberal, have far higher rates of porn use than religious populations. By choosing these criteria and ignoring endless other relevant variables, lead author Taylor Kohut knew he would end up with porn users scoring higher on his study’s carefully chosen selection of what constitutes “egalitarianism.” Then he chose a title that spun it all.

Kohut has a history of publishing ‘creative’ studies designed to find little or no problems arising from the use of porn. In this 2016 study, Kohut appears to have skewed the sample to produce the results he was seeking. Whereas most studies show that a tiny minority of porn users’ female partners use porn, in this study 95% of the women used porn on their own (85% of the women had used porn since the beginning of the relationship)! Reality: Cross-sectional data from the largest US survey (General Social Survey) reported that only 2.6% of women had visited a “pornographic website” in the last month (data from 2000, 2002, 2004: Pornography and Marriage, 2014)

Kohut’s new website and his attempt at fundraising suggest that he just may have an agenda. By the way, over 50 studies report links between porn use and poorer sexual and relationship satisfaction.

The reality is that nearly every study assessing porn use and egalitarianism (sexual attitudes) has reported that porn use is associated with attitudes toward women that both liberals and conservatives regard as extremely problematic. (Please note that these studies all reported findings about attitude. Studies that did not report attitude correlations are not included, even if they did report a link between porn consumption and actual aggression.) Some examples:

Pornography and Attitudes Supporting Violence Against Women: Revisiting the Relationship in Nonexperimental Studies (2010)A review of the literature. An excerpt:

A meta-analysis was conducted to determine whether nonexperimental studies revealed an association between men’s pornography consumption and their attitudes supporting violence against women. The meta-analysis corrected problems with a previously published meta-analysis and added more recent findings. In contrast to the earlier meta-analysis, the current results showed an overall significant positive association between pornography use and attitudes supporting violence against women in nonexperimental studies. In addition, such attitudes were found to correlate significantly higher with the use of sexually violent pornography than with the use of nonviolent pornography, although the latter relationship was also found to be significant.

Pornography and Sexual Callousness and the Trivialization of Rape (1982) – Excerpt:

Explored the consequences of continued exposure to pornography on beliefs about sexuality in general and on dispositions toward women in particular. Found that massive exposure to pornography resulted in a loss of compassion toward women as rape victims and toward women in general.

Exposure to pornography and attitudes about women and rape: A correlational study (1986) – Excerpt:

Compared to a group that had watched a control film, male subjects who were shown the violent film agreed more with items endorsing interpersonal violence against women than did the control subjects. However, contrary to predictions, there was no statistically significant difference between the two groups in their acceptance of rape myths, although there was a trend in the predicted direction.

Use of pornography and self-reported engagement in sexual violence among adolescents (2005)

This cross-sectional study examined 804 adolescents, boys and girls, aged from 14 to 19 years, attending different types of high schools in the northwest of Italy. The main goals were: (i) to investigate the relationship between active and passive forms of sexual harassment and violence and the relationship between pornography (reading magazines and viewing films or videos) and unwanted sex among adolescents; (ii) to explore the differences in these relationships with respect to gender and age; and (iii) to investigate the factors (pornography, gender and age) that are most likely to promote unwanted sex. The findings showed that active and passive sexual violence and unwanted sex and pornography were correlated.

Relationships among cybersex addiction, gender egalitarianism, sexual attitude and the allowance of sexual violence in adolescents (2007)

This study was done to investigate cybersex addiction, gender egalitarianism, sexual attitude and the allowance of sexual violence in adolescents, and to identify the relationships among these variables. The participants were 690 students from two middle schools and three high schools in Seoul. Cybersex addiction, gender egalitarianism, sexual attitude and the allowance of sexual violence in adolescents were different according to general characteristics. Gender egalitarianism, sexual attitude and the allowance of sexual violence in adolescents were influenced by cybersex addiction.

Adolescents’ Exposure to a Sexualized Media Environment and Their Notions of Women as Sex Objects (2007) – Excerpt:

This study was designed to investigate whether adolescents’ exposure to a sexualized media environment is associated with stronger beliefs that women are sex objects [on-line survey of 745 Dutch adolescents aged 13 to 18]. More specifically, we studied whether the association between notions of women as sex objects and exposure to sexual content of varied explicitness (i.e., sexually non-explicit, semi-explicit, or explicit) and in different formats (i.e., visual and audio-visual) can be better described as cumulative or as hierarchical. Exposure to sexually explicit material in on-line movies was the only exposure measure significantly related to beliefs that women are sex objects in the final regression model, in which exposure to other forms of sexual content was controlled. The relationship between exposure to a sexualized media environment and notions of women as sex objects did not differ for girls and boys

The use of cyberpornography by young men in Hong Kong some psychosocial correlates (2007) – Excerpt:

This study examined the prevalence of online pornography viewing and its psychosocial correlates among a sample of young Chinese men in Hong Kong. Moreover, participants who reported to have more online pornography viewing were found to score higher on measures of premarital sexual permissiveness and proclivities toward sexual harassment.

X-Rated: Sexual attitudes and behaviors associated with U.S. early adolescents’ exposure to sexually explicit media (2009) – Excerpt:

Correlates of use and subsequent sexual attitudes and behaviors predicted by exposure to sexually explicit content in adult magazines, X-rated movies, and the Internet were examined in a prospective survey of a diverse sample of early adolescents (average age at baseline = 13.6 years; N = 967).

Longitudinal analyses showed that early exposure for males predicted less progressive gender role attitudes, more permissive sexual norms, sexual harassment perpetration, and having oral sex and sexual intercourse two years later. Early exposure for females predicted subsequently less progressive gender role attitudes, and having oral sex and sexual intercourse.

Adolescents’ Exposure to Sexually Explicit Internet Material and Notions of Women as Sex Objects: Assessing Causality and Underlying Processes (2009) – Excerpt:

The aim of this study was to clarify causality in the previously established link between adolescents’ exposure to sexually explicit Internet material (SEIM) and notions of women as sex objects. On the basis of data from a three-wave panel survey among 962 Dutch adolescents, structural equation modeling initially showed that exposure to SEIM and notions of women as sex objects had a reciprocal direct influence on each other. The direct impact of SEIM on notions of women as sex objects did not vary by gender. However, the direct influence of notions of women as sex objects on exposure to SEIM was only significant for male adolescents. Further analyses showed that, regardless of adolescents’ gender, liking of SEIM mediated the influence of exposure to SEIM on their beliefs that women are sex objects, as well as the impact of these beliefs on exposure to SEIM.

Japanese College Students’ Media Exposure to Sexually Explicit Materials, Perceptions of Women, and Sexually Permissive Attitudes (2011) – Excerpt:

The present study examined Japanese college students’ (N  = 476) use of sexually explicit material (SEM) and associations with perceptions of women as sex objects and sexually permissive attitudes. Results indicate that Japanese college students used print media most frequently as a source for SEM followed by the Internet and the television/video/DVD. Male participants used SEM significantly more than females. In addition, sexual preoccupancy mediated the relationship between exposure to SEM and perceptions of women as sex objects, whereas exposure to SEM in mass media had a direct association with Japanese participants’ sexually permissive attitudes.

The influence of sexually explicit Internet material and peers on stereotypical beliefs about women’s sexual roles: similarities and differences between adolescents and adults (2011) – Excerpt:

We used data from two nationally representative two-wave panel surveys among 1,445 Dutch adolescents and 833 Dutch adults, focusing on the stereotypical belief that women engage in token resistance to sex (i.e., the notion that women say “no” when they actually intend to have sex). Finally, adults, but not adolescents, were susceptible to the impact of SEIM on beliefs that women engage in token resistance to sex.

Pornography Viewing among Fraternity Men: Effects on Bystander Intervention, Rape Myth Acceptance and Behavioral Intent to Commit Sexual Assault (2011) – Excerpt:

The present study surveyed 62% of the fraternity population at a Midwestern public university on their pornography viewing habits, bystander efficacy, and bystander willingness to help in potential rape situations. Results showed that men who view pornography are significantly less likely to intervene as a bystander, report an increased behavioral intent to rape, and are more likely to believe rape myths.

Pornography and Sexist Attitudes Among Heterosexuals (2013) – Excerpt:

Using a probability-based sample of young Danish adults and a randomized experimental design, this study investigated effects of past pornography consumption, experimental exposure to nonviolent pornography, perceived realism of pornography, and personality (i.e., agreeableness) on sexist attitudes (i.e., attitudes toward women, hostile and benevolent sexism). Further, sexual arousal mediation was assessed. Results showed that, among men, an increased past pornography consumption was significantly associated with less egalitarian attitudes toward women and more hostile sexism. Further, lower agreeableness was found to significantly predict higher sexist attitudes. Significant effects of experimental exposure to pornography were found for hostile sexism among low in agreeableness participants and for benevolent sexism among women.

Activating the Centerfold Syndrome: Recency of Exposure, Sexual Explicitness, Past Exposure to Objectifying Media (2013) – Excerpt:

This experimental study tested whether exposure to female centerfold images causes young adult males to believe more strongly in a set of beliefs clinical psychologist Gary Brooks terms “the centerfold syndrome.” The centerfold syndrome consists of five beliefs: voyeurism, sexual reductionism, masculinity validation, trophyism, and nonrelational sex. Past exposure to objectifying media was positively correlated with all five centerfold syndrome beliefs. Recent exposure to centerfolds had immediate strengthening effects on the sexual reductionism, masculinity validation, and nonrelational sex beliefs of males who view objectifying media less frequently. These effects persisted for approximately 48 hours.

Pornography Consumption and Opposition to Affirmative Action for Women: A Prospective Study (2013) – Excerpt:

Our study investigated a potential source of social influence that has often been hypothesized to reduce compassion and sympathy for women: pornography. National panel data were employed. Data were gathered in 2006, 2008, and 2010 from 190 adults ranging in age from 19 to 88 at baseline. Pornography viewing was indexed via reported consumption of pornographic movies. Attitudes toward affirmative action were indexed via opposition to hiring and promotion practices that favor women. Consistent with a social learning perspective on media effects, prior pornography viewing predicted subsequent opposition to affirmative action even after controlling for prior affirmative action attitudes and a number of other potential confounds. Gender did not moderate this association. Practically, these results suggest that pornography may be a social influence that undermines support for affirmative action programs for women.

Psychological, Relational, and Sexual Correlates of Pornography Use on Young Adult Heterosexual Men in Romantic Relationships (2014) – Excerpt:

The purpose of this study was to examine theorized antecedents (i.e., gender role conflict and attachment styles) and consequences (i.e., poorer relationship quality and sexual satisfaction) of men’s pornography use among 373 young adult heterosexual men. Findings revealed that both frequency of pornography use and problematic pornography use were related to greater gender role conflict, more avoidant and anxious attachment styles, poorer relationship quality, and less sexual satisfaction. In addition, the findings provided support for a theorized mediated model in which gender role conflict was linked to relational outcomes both directly and indirectly via attachment styles and pornography use.

A National Prospective Study of Pornography Consumption and Gendered Attitudes Toward Women (2015) – Excerpt:

The present study explored associations between pornography consumption and nonsexual gender-role attitudes in a national, two-wave panel sample of US adults. Pornography consumption interacted with age to predict gender-role attitudes. Specifically, pornography consumption at wave one predicted more gendered attitudes at wave two for older—but not for younger—adults.

Antecedents of adolescents’ exposure to different types of sexually explicit Internet material: A longitudinal study (2015) – Shows correlation between violent porn use and assessment of hyper-masculine and hyper-feminine attitudes. An Excerpt:

The present two-wave panel survey among 1557 Dutch adolescents addressed these lacunae by studying exposure to affection-themed, dominance-themed and violence-themed SEIM. Younger adolescents were more often exposed to affection-themed SEIM, while older adolescents and adolescents with higher levels of academic achievement were more frequently exposed to dominance-themed SEIM. Hyper masculine boys and hyper feminine girls were more frequently exposed to violence-themed SEIM.

‘It’s always just there in your face’: young people’s views on porn (2015) – Excerpt:

Findings highlight that many young people are exposed to porn both intentionally and unintentionally. Furthermore, they are concerned about gendered norms that reinforce men’s power and subordination over women. A link between porn exposure, young men’s sexual expectations and young women’s pressure to conform to what is being viewed, has been exposed.

What Is the Attraction? Pornography Use Motives in Relation to Bystander Intervention (2015) – Excerpt:

We found that several motivations to view pornography were associated with suppression of willingness to intervene as a bystander, even after controlling for frequency of pornography use. This study joins others in suggesting an association between pornography use and callousness toward sexual violence.

An experimental analysis of young women’s attitude toward the male gaze following exposure to centerfold images of varying explicitness (2015) – Women exposed to explicit centerfolds had greater acceptance of men staring at them sexually.

This study measured young women’s attitude toward the male gaze following exposure to centerfolds of varying explicitness. Explicitness was operationalized as degree of undress. Women exposed to more explicit centerfolds expressed greater acceptance of the male gaze than women exposed to less explicit centerfolds immediately after exposure and at a 48 hour follow-up. These results support the view that the more media depictions of women display women’s bodies, the stronger the message they send that women are sights to be observed by others. They also suggest that even brief exposure to explicit centerfolds can have a nontransitory effect on women’s sociosexual attitudes.

Men’s Objectifying Media Consumption, Objectification of Women, and Attitudes Supportive of Violence Against Women (2016) – Excerpt:

Guided by the concepts of specific and abstract sexual scripting in Wright’s sexual script acquisition, activation, application model of sexual media socialization, this study proposed that the more men are exposed to objectifying depictions, the more they will think of women as entities that exist for men’s sexual gratification (specific sexual scripting), and that this dehumanized perspective on women may then be used to inform attitudes regarding sexual violence against women (abstract sexual scripting).

Data were gathered from collegiate men sexually attracted to women (N = 187). Consistent with expectations, associations between men’s exposure to objectifying media and attitudes supportive of violence against women were mediated by their notions of women as sex objects. Specifically, frequency of exposure to men’s lifestyle magazines that objectify women, reality TV programs that objectify women, and pornography predicted more objectified cognitions about women, which, in turn, predicted stronger attitudes supportive of violence against women.

Soft-core pornography viewers ‘unlikely to hold positive attitudes towards women’ (2016) – Excerpt:

Frequent viewers of soft-core pornography, such as photographs of naked and semi-naked female models, are unlikely to think positively about women and are likely to have become desensitised to soft-core pornography common in newspapers, advertising and the media. The results indicated that people who frequently viewed soft-core pornographic images were less likely to describe these as pornographic than people who had low levels of exposure to these images.  People who were desensitised to these images were more likely than others to endorse rape myths. Furthermore, people who frequently viewed these images were less likely to have positive attitudes to women.

Pornography, Sexual Coercion and Abuse and Sexting in Young People’s Intimate Relationships: A European Study (2016) – Excerpt:

New technology has made pornography increasingly accessible to young people, and a growing evidence base has identified a relationship between viewing pornography and violent or abusive behavior in young men. This article reports findings from a large survey of 4,564 young people aged 14 to 17 in five European countries which illuminate the relationship between regular viewing of online pornography, sexual coercion and abuse and the sending and receiving of sexual images and messages, known as “sexting.” In addition to the survey, which was completed in schools, 91 interviews were undertaken with young people who had direct experience of interpersonal violence and abuse in their own relationships.

Rates for regularly viewing online pornography were very much higher among boys and most had chosen to watch pornography. Boys’ perpetration of sexual coercion and abuse was significantly associated with regular viewing of online pornography. In addition, boys who regularly watched online pornography were significantly more likely to hold negative gender attitudes. The qualitative interviews illustrated that, although sexting is normalized and perceived positively by most young people, it has the potential to reproduce sexist features of pornography such as control and humiliation.

Age of first exposure to pornography shapes men’s attitudes toward women (2017) – Excerpt:

Participants (N = 330) were undergraduate men at a large, Midwestern university, ranging in age from 17-54 years (M = 20.65, SD = 3.06). Participants predominantly identified as White (84.9%) and heterosexual (92.6). After providing informed consent, participants completed the study online.

Results indicated that lower age of first exposure to pornography predicted higher adherence to both the Power over Women and the Playboy masculine norms. Additionally, regardless of the nature of the men’s first exposure to pornography (i.e., intentional, accidental, or forced), participants adhered equally to the Power over Women and the Playboy masculine norm. Various explanations may exist to understand these relationships, but the results show the importance of discussing age of exposure in clinical settings with men.

Studies linking porn use to poorer mental-emotional health & poorer cognitive outcomes

Many individuals who cease using porn for an extended period of time report mental and cognitive benefits, such as improved concentration and focus, better grades, increased energy and motivation, social anxiety improved or gone, increased confidence, improved mood, depression reduced or gone, greater desire to be social, more intense or vibrant emotions, and increased desire to be in a loving relationship.

Here are relevant FAQs with hundreds of first-person accounts:

Some studies have looked at (1) porn use and mental health, and (2) porn use and cognitive functioning. Below are the two lists of these studies.


Studies finding links between porn use and poorer mental and emotional health:

Variations in internet-related problems and psychosocial functioning in online sexual activities: implications for social and sexual development of young adults (2004) – Excerpts:

Students who did not participate in either online sexual activity were more satisfied with their offline life and more connected to friends and family. Those who engaged in both online sexual activities were more dependent on the Internet and reported lower offline functioning.

Despite students’ common participation in online sexual activities (OSA) as a venue for social and sexual development, those relying on the Internet and the affiliations it provides appear at risk of decreased social integration.

Internet Pornography and Loneliness: An Association? (2005) – Excerpt:

Results showed a significant association between Internet pornography usage and loneliness as evidenced by the data analysis.

Use of Internet Pornography and Men’s Well-Being (2005) – Excerpt:

Although most individuals utilize the Internet for occupational, educational, recreational, and shopping purposes, a sizable male minority exists, known as Cybersex compulsives and at-risk users, who invest an inordinate amount of their time, money, and energy in the pursuit of Cybersex experiences with negative intrapersonal ramifications in terms of depression, anxiety, and problems with felt intimacy with their real-life partners.

Adolescent pornographic internet site use: a multivariate regression analysis of the predictive factors of use and psychosocial implications (2009) – Excerpt:

Compared to non-pornographic Internet site users, infrequent pornographic Internet site users users were twice as likely to have abnormal conduct problems; frequent pornographic Internet site users were significantly more likely to have abnormal conduct problems. Thus, both infrequent and frequent pornographic Internet site use are prevalent and significantly associated with social maladjustment among Greek adolescents.

Social bonds and Internet pornographic exposure among adolescents (2009) – A summary from a review:

The study found that adolescents with higher degrees of social interaction and bonding were not as likely to consume sexually explicit material as were their less social peers (Mesch, 2009). Additionally, Mesch found that greater quantities of pornography consumption were significantly correlated with lower degrees of social integration, specifically related to religion, school, society, and family. The study also found a statistically significant relationship between pornography consumption and aggressiveness in school, with higher degrees

Frequent users of pornography. A population based epidemiological study of Swedish male adolescents (2010) – Excerpts

Frequent use was also associated with many problem behaviours. High frequent viewing of pornography may be seen as a problematic behaviour that needs more attention from both parents and teachers and also to be addressed in clinical interviews.

Mental-and physical-health indicators and sexually explicit media use behavior by adults (2011) – Excerpt:

After adjusting for demographics, Pornography (SEMB) users, compared to nonusers, reported greater depressive symptoms, poorer quality of life, more mental- and physical-health diminished days, and lower health status.

Watching Pornographic Pictures on the Internet: Role of Sexual Arousal Ratings and Psychological-Psychiatric Symptoms for Using Internet Sex Sites Excessively (2011)Scores on a porn addiction questionnaire (IATsex) correlated with higher levels of psychological problems such as: interpersonal sensitivity, depression, paranoid thinking and psychoticism. Excerpts:

We found a positive relationship between subjective sexual arousal when watching Internet pornographic pictures and the self-reported problems in daily life due to the excessiveness of cybersex as measured by the IATsex. Subjective arousal ratings, the global severity of psychological symptoms, and the number of sex applications used were significant predictors of the IATsex score, while the time spent on Internet sex sites did not significantly contribute to explanation of variance in the IATsex score.

In our sample, the global symptom severity (SCL GSI), as well as interpersonal sensitivity, depression, paranoid thinking and psychoticism, were correlated particularly with the IATsex score.

When is Online Pornography Viewing Problematic Among College Males? Examining the Moderating Role of Experiential Avoidance (2012) – Excerpt:

The current study examined the relationship of Internet pornography viewing and experiential avoidance to a range of psychosocial problems (depression, anxiety, stress, social functioning, and problems related to viewing) through a cross-sectional online survey conducted with a non-clinical sample of 157 undergraduate college males. Results indicated that frequency of viewing was significantly related to each psychosocial variable, such that more viewing was related to greater problems.

Women, Female Sex and Love Addicts, and Use of the Internet (2012) – This study compared female cybersex addicts to female sex addicts, and female non-addicts. The cybersex addicts experienced higher levels of depression. An excerpt:

For each of these variables, the pattern was that participants in the cybersex group and participants in the addicted/no cybersex group were more likely to experience depression, attempt suicide, or have withdrawal symptoms than participants in the non-addicted/no cybersex group. Participants in the cybersex group were more likely to report being depressed than participants in the addicted/no cybersex group.

Consumption of Pornographic Materials among Hong Kong Early Adolescents: A Replication (2012) – Excerpts:

In general, higher levels of positive youth development and better family functioning were related to a lower level of pornography consumption. The relative contribution of positive youth development and family factors to consumption of pornographic materials was also explored.

The present study attempted to explore the linkage between family functioning and pornography consumption.Three features of family functioning, mutuality, communication and harmony were negatively related to pornography consumption.

Emerging Adult Sexual Attitudes and Behaviors: Does Shyness Matter? (2013) – Excerpt:

Shyness was positively associated with solitary sexual behaviors of masturbation and pornography use for men.

Narcissism & Internet Pornography Use (2014) – Excerpt:

The hours spent viewing Internet pornography use was positively correlated to participant’s narcissism level. Additionally, those who have ever used Internet pornography endorsed higher levels of all three measures of narcissism than those who have never used Internet pornography.

Pornography and Marriage (2014) – Porn use correlated with less overall happiness. An excerpt:

We found that adults who had watched an X-rated movie in the past year were more likely to be divorced, more likely to have had an extramarital affair, and less likely to report being happy with their marriage or happy overall. We also found that, for men, pornography use reduced the positive relationship between frequency of sex and happiness.

Use of Pornography and its Associations with Sexual Experiences, Lifestyles and Health among Adolescents (2014) – Excerpts:

In the longitudinal analyses frequent use of pornography was more associated to psychosomatic symptoms compared with depressive symptoms.

Male frequent users of pornography more often reported peer-relationship problems than their peers.

Psychological, Relational, and Sexual Correlates of Pornography Use on Young Adult Heterosexual Men in Romantic Relationships (2014) – Higher porn use and problematic porn use was linked to more avoidant and anxious attachment styles. Excerpt:

Thus, the purpose of this study was to examine theorized antecedents (i.e., gender role conflict and attachment styles) and consequences (i.e., poorer relationship quality and sexual satisfaction) of men’s pornography use among 373 young adult heterosexual men. Findings revealed that both frequency of pornography use and problematic pornography use were related to greater gender role conflict, more avoidant and anxious attachment styles, poorer relationship quality, and less sexual satisfaction.

Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours (2014) – Even though Voon et al., 2014 excluded individuals with major psychiatric conditions, the porn addicted subjects scores higher on depression and anxiety assessments. Excerpt:

CSB subjects [porn addicts] had higher depression and anxiety scores (Table S2 in File S1) but no current diagnoses of major depression

No Harm in Looking, Right? Men’s Pornography Consumption, Body Image, and Well-Being (2014) – Excerpt:

Path analyses revealed that men’s frequency of pornography use was (a) positively linked to muscularity and body fat dissatisfaction indirectly through internalization of the mesomorphic ideal, (b) negatively linked to body appreciation directly and indirectly through body monitoring, (c) positively linked to negative affect indirectly through romantic attachment anxiety and avoidance, and (d) negatively linked to positive affect indirectly through relationship attachment anxiety and avoidance.

Patient Characteristics by Type of Hypersexuality Referral: A Quantitative Chart Review of 115 Consecutive Male Cases (2015) – Study placed “hypersexuals” into 2 categories: “chronic adulterers” and “avoidant masturbators” (who were chronic porn users).

The avoidant masturbator subtype was operationalized as those cases who reported more than 1 hr (or one episode) of masturbation per day or more than 1 hr of pornography viewing per day, or more than 7 hr (or episodes) per week.

With respect to the mental health and sexological variables, the avoidant masturbator subtype [compulsive porn users] was significantly more likely to report a history of anxiety problems and of sexual functioning problems (71% vs. 31%) with delayed ejaculation being the most commonly reported sexual functioning problem.

Perceived Addiction to Internet Pornography and Psychological Distress: Examining Relationships Concurrently and Over Time (2015) – Ignore the phrase “perceived addiction, as it really means the total score on the Grubbs’s CPUI-9, which is an actual porn addiction questionnaire (see YBOP full critique of the perceived porn addiction nonsense). Put simply, porn addiction is correlated with psychological distress (anger, depression, anxiety, stress). An excerpt:

At the outset of this study, we hypothesized that “perceived addiction” to Internet pornography would be positively associated with psychological distress. Using a large cross-sectional sample of adult web users and a large cross-sectional sample of undergraduate web users, we found consistent support for this hypothesis. Additionally, in a 1-year longitudinal analysis of undergraduate pornography users, we found links between perceived addiction and psychological distress over time. Collectively, these findings strongly underscore the claim that “perceived addiction” to Internet pornography likely contributes to the experience of psychological distress for some individuals.

An Online Assessment of Personality, Psychological, and Sexuality Trait Variables Associated with Self-Reported Hypersexual Behavior (2015) Porn/sex addiction was not only related to fear of experiencing erectile dysfunction, it was also linked to depression and anxiety. An excerpt:

Hypersexual” behavior represents a perceived inability to control one’s sexual behavior. To investigate hypersexual behavior, an international sample of 510 self-identified heterosexual, bisexual, and homosexual men and women completed an anonymous online self-report questionnaire battery. In addition to age and sex (male), hypersexual behavior was related to higher scores on measures of sexual excitation, sexual inhibition due to the threat of performance failure, trait impulsivity, and both depressed mood and anxiety.

Lower Psychological Well-Being and Excessive Sexual Interest Predict Symptoms of Compulsive Use of Sexually Explicit Internet Material Among Adolescent Boys (2015) – Excerpt:

This study investigated whether factors from three distinct psychosocial domains (i.e., psychological well-being, sexual interests/behaviors, and impulsive-psychopathic personality) predicted symptoms of compulsive use of sexually explicit Internet material among adolescent boys. Longitudinally, higher levels of depressive feelings and, again, excessive sexual interest predicted relative increases in compulsive use symptoms 6 months later.

Psychological, Relational, and Biological Correlates of Ego-Dystonic Masturbation in a Clinical Setting (2016) – The original paper (here) used the phrase “Compulsive Masturbation” to describe the subject’s activity. The paper’s publisher (Sexual Medicine Open) changed “Compulsive Masturbation” to “Ego-Dystonic Masturbation”. In 2016 compulsive masturbation, in a clinical setting, is synonymous with compulsive porn use. An excerpt:

Our data confirm previous observations that psychiatric comorbidities, especially mood, anxiety, and personality disorders, are the rule rather the exception for people with compulsive sexual behaviors. 21, 22, 23, 24 However, EM could be associated with a non-specific anxious activation.

Men’s pornography consumption in the UK: prevalence and associated problem behaviour (2016) – Excerpt:

Those who reported pornography addiction were much more likely to engage in a variety of risky antisocial behaviours, including heavy drinking, fighting, and weapon use, using illegal drugs gambling and viewing illegal images to name but a few. They also reported poorer physical and psychological health.

Mood changes after watching pornography on the Internet are linked to symptoms of Internet-pornography-viewing disorder (2016) – Excerpt:

Internet-pornography-viewing disorder (IPD) is considered one type of Internet-use disorder. For IPD’s development, it was assumed theoretically that a dysfunctional use of Internet pornography to cope with depressive mood or stress might be considered as a risk factor. Data showed that tendencies towards IPD were associated negatively with feeling generally good, awake, and calm and positively with perceived stress in daily life and using Internet pornography for excitation seeking and emotional avoidance. Moreover, tendencies towards IPD were negatively related to mood before and after Internet-pornography use.

Problematic sexual behavior in young adults: Associations across clinical, behavioral, and neurocognitive variables (2016) – Individuals with Problematic Sexual Behaviors (PSB) exhibited several neuro-cognitive deficits and psychological problems. A few excerpts:

This analysis also indicated that PSB was associated with worse quality of life, lower self-esteem, and higher rates of comorbidities across several disorders. Furthermore, the PSB group showed deficits across several neurocognitive domains, including motor inhibition, spatial working memory, and an aspect of decision making. Thus, it is possible that PSB gives rise to a host of secondary problems, ranging from alcohol dependence and depression to deteriorations in quality of life and self-esteem.

Problematic internet pornography use: The role of craving, desire thinking, and metacognition (2017) – While not so clear in the text, this study found correlations between cravings for pornography and scores on depression & anxiety questionnaires (negative affect). An excerpt:

The present study tested the metacognitive model of desire thinking and craving for problematic pornography use, and expanded upon the same model to include negative affect related to desire thinking.

Effect of internet on the psychosomatic health of adolescent school children in Rourkela – A cross-sectional study (2017) – Excerpts:

Visiting porn sites were associated with interest in sex, low mood, lack of concentration, and unexplained anxiety.

Pornography was significantly associated with several psychological problems in adolescents. Due to the structural immaturity of the adolescent brain and relative inexperience, they are unable to process the myriad nature of sexual content online which may lead to attention problems, anxiety, and depression.

Pornography Use and Loneliness: A Bi-Directional Recursive Model and Pilot Investigation (2017) – Excerpt:

Theoretically and empirically, we examine loneliness as it relates to pornography use in terms of pornography’s relational scripting and its addictive potential. Results from our analyses revealed significant and positive associations between pornography use and loneliness for all three models. Findings provide grounds for possible future bidirectional, recursive modeling of the relation between pornography use and loneliness.

How Abstinence Affects Preferences (2016) [preliminary results] – Excerpts from the article:

Results of the First Wave – Main Findings

  1. The length of the longest streak participants performed before taking part in the survey correlates with time preferences. The second survey will answer the question if longer periods of abstinence render participants more able to delay rewards, or if more patient participants are more likely to perform longer streaks.
  2. Longer periods of abstinence most likely cause less risk aversion (which is good). The second survey will provide the final proof.
  3. Personality correlates with length of streaks. The second wave will reveal if abstinence influences personality or if personality can explain variation in the length of streaks.

Results of the Second Wave – Main Findings

  1. Abstaining from pornography and masturbation increases the ability to delay rewards
  2. Participating in a period of abstinence renders people more willing to take risks
  3. Abstinence renders people more altruistic
  4. Abstinence renders people more extroverted, more conscientious, and less neurotic

Studies finding links between porn use and poorer cognitive outcomes:

Exposure to Sexual Stimuli Induces Greater Discounting Leading to Increased Involvement in Cyber Delinquency Among Men (2017) – In two studies exposure to visual sexual stimuli resulted in: 1) greater delayed discounting (inability to delay gratification), 2) greater inclination to engage in cyber-deliquency, 3) greater inclination to purchase counterfeit goods & hack someone’s Facebook account. Taken together this indicates that porn use increases impulsivity and may reduce certain executive functions (self-control, judgment, foreseeing consequences, impulse control). Excerpt:

These findings provide insight into a strategy for reducing men’s involvement in cyber delinquency; that is, through less exposure to sexual stimuli and promotion of delayed gratification. The current results suggest that the high availability of sexual stimuli in cyberspace may be more closely associated with men’s cyber-delinquent behavior than previously thought.

Trading Later Rewards for Current Pleasure: Pornography Consumption and Delay Discounting (2015) The more pornography that participants consumed, the less able they were to delay gratification. This unique study also had porn users reduce porn use for 3 weeks. The study found that continued porn use was causally related to greater inability to delay gratification (note that the ability to delay gratification is a function of the prefrontal cortex). Excerpt from the first study (median subject age 20) correlated subjects’ pornography use with their scores on a delayed gratification task:

“The more pornography that participants consumed, the more they saw the future rewards as worth less than the immediate rewards, even though the future rewards were objectively worth more.”

Put simply, more porn use correlated with less ability to delay gratification for larger future rewards. In the second part of this study researchers assessed the subjects’ delayed discounting 4 weeks later and correlated with their porn use.

“These results indicate that continued exposure to the immediate gratification of pornography is related to higher delay discounting over time.”

A second study (median age 19) was performed to assess if porn use causes delayed discounting, or the inability to delay gratification. Researchers divided current porn users into two groups:

  1. One group abstained from porn use for 3 weeks,
  2. A second group abstained from their favorite food for 3 weeks.

All participants were told the study was about self-control, and they were randomly chosen to abstain from their assigned activity. The clever part was that the researchers had the second group of porn users abstain from eating their favorite food. This ensured that 1) all subjects engaged in a self-control task, and 2) the second group’s porn use was unaffected. At the end of the 3 weeks, participants were involved in a task to assess delay discounting. Important note: While the “porn abstinence group” viewed significantly less porn than the “favorite food abstainers,” most did not completely abstain from porn viewing. The results:

“As predicted, participants who exerted self-control over their desire to consume pornography chose a higher percentage of larger, later rewards compared to participants who exerted self-control over their food consumption but continued consuming pornography.”

The group that cut back on their porn viewing for 3 weeks displayed less delay discounting than the group that simply abstained from their favorite food. Put simply, abstaining from internet porn increases porn users’ ability to delay gratification. From the study:

Thus, building on the longitudinal findings of Study 1, we demonstrated that continued pornography consumption was causally related to a higher rate of delay discounting. Exercising self-control in the sexual domain had a stronger effect on delay discounting than exercising self-control over another rewarding physical appetite (e.g., eating one’s favorite food).

The take-aways:

  1. It wasn’t exercising self-control that increased the ability to delay gratification. Reducing porn use was the key factor.
  2. Internet porn is a unique stimulus.
  3. Internet porn use, even in non-addicts, has long-term effects.

[This one also appears above in first section of this page, and is repeated here due to its “delayed discounting” finding.] How Abstinence Affects Preferences (2016) [preliminary results] – Excerpts from the article:

Results of the First Wave – Main Findings

  1. The length of the longest streak participants performed before taking part in the survey correlates with time preferences. The second survey will answer the question if longer periods of abstinence render participants more able to delay rewards, or if more patient participants are more likely to perform longer streaks.
  2. Longer periods of abstinence most likely cause less risk aversion (which is good). The second survey will provide the final proof.
  3. Personality correlates with length of streaks. The second wave will reveal if abstinence influences personality or if personality can explain variation in the length of streaks.

Results of the Second Wave – Main Findings

  1. Abstaining from pornography and masturbation increases the ability to delay rewards
  2. Participating in a period of abstinence renders people more willing to take risks
  3. Abstinence renders people more altruistic
  4. Abstinence renders people more extroverted, more conscientious, and less neurotic

Self-reported differences on measures of executive function and hypersexual behavior in a patient and community sample of men (2010) – “Hypersexual behavior” was correlated with poorer executive function (arisng primarily from the prefrontal cortex). An excerpt:

Patients seeking help for hypersexual behavior often exhibit features of impulsivity, cognitive rigidity, poor judgment, deficits in emotion regulation, and excessive preoccupation with sex. Some of these characteristics are also common among patients presenting with neurological pathology associated with executive dysfunction. These observations led to the current investigation of differences between a group of hypersexual patients (n = 87) and a non-hypersexual community sample (n = 92) of men using the Behavior Rating Inventory of Executive Function-Adult Version  Hypersexual behavior was positively correlated with global indices of executive dysfunction and several subscales of the BRIEF-A. These findings provide preliminary evidence supporting the hypothesis that executive dysfunction may be implicated in hypersexual behavior.

Pornographic picture processing interferes with working memory performance (2013) – German scientists have discovered that Internet erotica can diminish working memory. In this porn-imagery experiment, 28 healthy individuals performed working-memory tasks using 4 different sets of pictures, one of which was pornographic. Participants also rated the pornographic pictures with respect to sexual arousal and masturbation urges prior to, and after, pornographic picture presentation. Results showed that working memory was worst during the porn viewing and that greater arousal augmented the drop. An excerpt:

Results contribute to the view that indicators of sexual arousal due to pornographic picture processing interfere with working memory performance. Findings are discussed with respect to Internet sex addiction because working memory interference by addiction-related cues is well known from substance dependencies.

Working memory is the ability to keep information in mind while using it to complete a task or deal with a challenge. It helps people hold their goals in mind, resist distractions and inhibit impulsive choices, so it’s critical to learning and planning. A consistent research finding is that addiction-related cues hinder working memory, which is a function of the prefrontal cortex.

Sexual Picture Processing Interferes with Decision-Making Under Ambiguity (2013) – Study found that viewing pornographic imagery interfered with decision making during a standardized cognitive test. This suggests porn use might affect executive functioning, which is a set of mental skills that help with meeting goals. These skills are controlled by an area of the brain called the prefrontal cortex.

Decision-making performance was worse when sexual pictures were associated with disadvantageous card decks compared to performance when the sexual pictures were linked to the advantageous decks. Subjective sexual arousal moderated the relationship between task condition and decision-making performance. This study emphasized that sexual arousal interfered with decision-making, which may explain why some individuals experience negative consequences in the context of cybersex use.

Arousal, working memory capacity, and sexual decision-making in men (2014) – Excerpts:

This study investigated whether working memory capacity (WMC) moderated the relationship between physiological arousal and sexual decision making. A total of 59 men viewed 20 consensual and 20 non-consensual images of heterosexual interaction while their physiological arousal levels were recorded using skin conductance response. Participants also completed an assessment of WMC and a date-rape analogue task for which they had to identify the point at which an average Australian male would cease all sexual advances in response to verbal and/or physical resistance from a female partner. Participants who were more physiologically aroused by and spent more time viewing the non-consensual sexual imagery nominated significantly later stopping points on the date-rape analogue task. Consistent with our predictions, the relationship between physiological arousal and nominated stopping point was strongest for participants with lower levels of WMC. For participants with high WMC, physiological arousal was unrelated to nominated stopping point. Thus, executive functioning ability (and WMC in particular) appears to play an important role in moderating men’s decision making with regard to sexually aggressive behavior.

Early Adolescent Boys’ exposure to Internet pornography: Relationships to pubertal timing, sensation seeking, and academic performance (2015) – This rare longitudinal study (over a six-month period) suggests that porn use decreases academic performance. Excerpt:

Moreover, an increased use of Internet pornography decreased boys’ academic performance six months later.

Getting stuck with pornography? Overuse or neglect of cybersex cues in a multitasking situation is related to symptoms of cybersex addiction (2015) – Subjects with a higher tendency towards porn addiction performed more poorly of executive functioning tasks (which are under the auspices of the prefrontal cortex). A few excerpts:

We investigated whether a tendency towards cybersex addiction is associated with problems in exerting cognitive control over a multitasking situation that involves pornographic pictures. We used a multitasking paradigm in which the participants had the explicit goal to work to equal amounts on neutral and pornographic material. We found that participants who reported tendencies towards cybersex addiction deviated stronger from this goal.

The results of the current study point towards a role of executive control functions, i.e. functions mediated by the prefrontal cortex, for the development and maintenance of problematic cybersex use (as suggested by Brand et al., 2014). Particularly a reduced ability to monitor consumption and to switch between pornographic material and other contents in a goal adequate manner may be one mechanism in the development and maintenance of cybersex addiction

Problematic sexual behavior in young adults: Associations across clinical, behavioral, and neurocognitive variables (2016) – Individuals with Problematic Sexual Behaviors (PSB) exhibited several neuro-cognitive deficits. These findings indicate poorer executive functioning (hypofrontality) which is a key brain feature occurring in drug addicts. A few excerpts:

From this characterization, it is be possible to trace the problems evident in PSB and additional clinical features, such as emotional dysregulation, to particular cognitive deficits…. If the cognitive problems identified in this analysis are actually the core feature of PSB, this may have notable clinical implications.

Effects of Pornography on Senior High School Students, Ghana. (2016) – Excerpt:

The study revealed that majority of the students admitted to watching pornography before. Furthermore, it was observed that majority of them agreed that pornography affects students’ academic performance negatively…

Executive Functioning of Sexually Compulsive and Non-Sexually Compulsive Men Before and After Watching an Erotic Video (2017) – Exposure to porn affected executive functioning in men with “compulsive sexual behaviors,” but not healthy controls. Poorer executive functioning when exposed to addiction-related cues is a hallmark of substance disorders (indicating both altered prefrontal circuits and sensitization). Excerpts:

This finding indicates better cognitive flexibility after sexual stimulation by controls compared with sexually compulsive participants. These data support the idea that sexually compulsive men do not to take advantage of the possible learning effect from experience, which could result in better behavior modification. This also could be understood as a lack of a learning effect by the sexually compulsive group when they were sexually stimulated, similar to what happens in the cycle of sexual addiction, which starts with an increasing amount of sexual cognition, followed by the activation of sexual scripts and then orgasm, very often involving exposure to risky situations.

“Conscious and Non-Conscious Measures of Emotion: Do They Vary with Frequency of Pornography Use?” – Excerpts analyzing Steele et al., 2013

Comments: This 2017 EEG study on porn users cited 3 Nicole Prause EEG studies. The authors believe that all 3 Prause EEG studies actually found desensitization or habituation in frequent porn users (which often occurs with addiction). This is exactly what YBOP has always claimed (explained in this critique: Critique of: Letter to the editor “Prause et al. (2015) the latest falsification of addiction predictions” 2016). Steele et al., 2013 was touted in the media  by spokesperson Nicole Prause as evidence against the existence of porn/sex addiction. Contrary to claims, this study actually lends support to the existence of both porn addiction and porn use down-regulating sexual desire. How so? The study reported higher EEG readings (relative to neutral pictures) when subjects were briefly exposed to pornographic photos. Studies consistently show that an elevated P300 occurs when addicts are exposed to cues (such as images) related to their addiction. In line with the Cambridge University brain scan studies, this EEG study also reported greater cue-reactivity to porn correlating with less desire for partnered sex. To put another way – individuals with greater brain activation to porn would rather masturbate to porn than have sex with a real person. Shockingly, study spokesman Nicole Prause claimed that porn users merely had “high libido”, yet the results of the study say something quite different – as this new study points out in the excerpts. Four peer-reviewed papers expose the truth: 1, 2, 3, 4. (Read an extensive critique here)

In the excerpts below these 3 citations indicate the following Nicole Prause EEG studies (#14 is Steele et al., 2013):

  • 7 Prause, N.; Steele, V.R.; Staley, C.; Sabatinelli, D. Late positive potential to explicit sexual images associated with the number of sexual intercourse partners. Soc. Cogn. Affect. Neurosc. 2015, 10, 93–100.
  • 8 Prause, N.; Steele, V.R.; Staley, C.; Sabatinelli, D.; Hajcak, G. Modulation of late positive potentials by sexual images in problem users and controls inconsistent with “porn addiction”. Biol. Psychol. 2015, 109, 192–199.
  • 14 – Steele, V.R.; Staley, C.; Fong, T.; Prause, N. Sexual desire, not hypersexuality, is related to neurophysiological responses elicited by sexual images. Socioaffect. Neurosci. Psychol. 2013, 3, 20770

Excerpts describing Steele et al., 2013:


Event-related potentials (ERPs) have often been used as a physiological measure of reactions to emotional cues, e.g., [24]. Studies utilizing ERP data tend to focus on later ERP effects such as the P300 [14] and Late-Positive Potential (LPP) [7, 8] when investigating individuals who view pornography. These later aspects of the ERP waveform have been attributed to cognitive processes such as attention and working memory (P300) [25] as well as sustained processing of emotionally-relevant stimuli (LPP) [26]. Steele et al. [14] showed that the large P300 differences seen between viewing of sexually explicit images relative to neutral images was negatively related to measures of sexual desire, and had no effect on participants’ hypersexuality. The authors suggested that this negative finding was most probably due to the images shown not having any novel significance to the participant pool, as participants all reported viewing high volumes of pornographic material, consequently leading to the suppression of the P300 component. The authors went on to suggest that perhaps looking at the later occurring LPP may provide a more useful tool, as it has been shown to index motivation processes. Studies investigating the effect pornography use has on the LPP have shown the LPP amplitude to be generally smaller in participants who report having higher sexual desire and problems regulating their viewing of pornographic material [7, 8]. This result is unexpected, as numerous other addiction-related studies have shown that when presented with a cue-related emotion task, individuals who report having problems negotiating their addictions commonly exhibit larger LPP waveforms when presented images of their specific addiction-inducing substance [27]. Prause et al. [7, 8] offer suggestions as to why the use of pornography may result in smaller LPP effects by suggesting that it may be due to a habituation effect, as those participants in the study reporting overuse of pornographic material scored significantly higher in the amount of hours spent viewing pornographic material.

———–

Studies have consistently shown a physiological downregulation in processing of appetitive content due to habituation effects in individuals who frequently seek out pornographic material [3, 7, 8]. It is the authors’ contention that this effect may account for the results observed.

————

Future studies may need to utilise a more up-to-date standardised image database to account for changing cultures. Also, maybe high porn users downregulated their sexual responses during the study. This explanation was at least used by [7, 8] to describe their results which showed a weaker approach motivation indexed by smaller LPP (late positive potential) amplitude to erotic images by individuals reporting uncontrollable pornography use. LPP amplitudes have been shown to decrease upon intentional downregulation [62, 63]. Therefore, an inhibited LPP to erotic images may account for lack of significant effects found in the present study across groups for the “erotic” condition.

———–

 

“Conscious and Non-Conscious Measures of Emotion: Do They Vary with Frequency of Pornography Use?” – Excerpts analyzing Prause et al., 2015

Comments: This EEG study on porn users cited 3 Nicole Prause EEG studies. The authors believe that all 3 Prause EEG studies actually found desensitization or habituation in frequent porn users (which often occurs with addiction). This is exactly what YBOP has always claimed (explained in this critique: Critique of: Letter to the editor “Prause et al. (2015) the latest falsification of addiction predictions” 2016). Five other peer-reviewed papers agree that Prause et al., 2015 actually found desensitization/habituation in frequent porn users: 1, 2, 3, 4. 5.

In the following excerpts these 3 citations indicate the following Nicole Prause EEG studies:

  • 7 – Prause, N.; Steele, V.R.; Staley, C.; Sabatinelli, D. Late positive potential to explicit sexual images associated with the number of sexual intercourse partners. Soc. Cogn. Affect. Neurosc. 2015, 10, 93–100.
  • 8 – Prause, N.; Steele, V.R.; Staley, C.; Sabatinelli, D.; Hajcak, G. Modulation of late positive potentials by sexual images in problem users and controls inconsistent with “porn addiction”. Biol. Psychol. 2015, 109, 192–199.
  • 14 – Steele, V.R.; Staley, C.; Fong, T.; Prause, N. Sexual desire, not hypersexuality, is related to neurophysiological responses elicited by sexual images. Socioaffect. Neurosci. Psychol. 2013, 3, 20770

Excerpts describing Prause et al., 2015:


Event-related potentials (ERPs) have often been used as a physiological measure of reactions to emotional cues, e.g., [24]. Studies utilizing ERP data tend to focus on later ERP effects such as the P300 [14] and Late-Positive Potential (LPP) [7, 8] when investigating individuals who view pornography. These later aspects of the ERP waveform have been attributed to cognitive processes such as attention and working memory (P300) [25] as well as sustained processing of emotionally-relevant stimuli (LPP) [26]. Steele et al. [14] showed that the large P300 differences seen between viewing of sexually explicit images relative to neutral images was negatively related to measures of sexual desire, and had no effect on participants’ hypersexuality. The authors suggested that this negative finding was most probably due to the images shown not having any novel significance to the participant pool, as participants all reported viewing high volumes of pornographic material, consequently leading to the suppression of the P300 component. The authors went on to suggest that perhaps looking at the later occurring LPP may provide a more useful tool, as it has been shown to index motivation processes. Studies investigating the effect pornography use has on the LPP have shown the LPP amplitude to be generally smaller in participants who report having higher sexual desire and problems regulating their viewing of pornographic material [7, 8]. This result is unexpected, as numerous other addiction-related studies have shown that when presented with a cue-related emotion task, individuals who report having problems negotiating their addictions commonly exhibit larger LPP waveforms when presented images of their specific addiction-inducing substance [27]. Prause et al. [7, 8] offer suggestions as to why the use of pornography may result in smaller LPP effects by suggesting that it may be due to a habituation effect, as those participants in the study reporting overuse of pornographic material scored significantly higher in the amount of hours spent viewing pornographic material.

———–

Studies have consistently shown a physiological downregulation in processing of appetitive content due to habituation effects in individuals who frequently seek out pornographic material [3, 7, 8]. It is the authors’ contention that this effect may account for the results observed.

————

Future studies may need to utilise a more up-to-date standardised image database to account for changing cultures. Also, maybe high porn users downregulated their sexual responses during the study. This explanation was at least used by [7, 8] to describe their results which showed a weaker approach motivation indexed by smaller LPP (late positive potential) amplitude to erotic images by individuals reporting uncontrollable pornography use. LPP amplitudes have been shown to decrease upon intentional downregulation [62, 63]. Therefore, an inhibited LPP to erotic images may account for lack of significant effects found in the present study across groups for the “erotic” condition.

———–

Studies falsify the claim that sex & porn addicts “just have high sexual desire”

Porn addiction naysayers often claim that individuals with either sex addiction or porn addiction do not have addiction, they simply have high libidos. David Ley (author of The Myth of Sex Addiction), is one of the most vocal critics of porn addiction, and often claims that “high sexual desire” explains away porn addiction.

You may have seen Ley’s Psychology Today blog post with the catchy title: “Your Brain on Porn – It’s NOT Addictive”. The Ley blog post is not about the science behind YBOP. Instead, it’s about a single EEG study, whose lead author is Nicole Prause. Both Ley and Prause claim that the study’s (Steele et al., 2013) findings support the premise that porn/sex addiction is nothing more than “high sexual desire.”

Contrary to claims by Ley and study author Nicole Prause, Steele et al., 2013 reported greater cue-reactivity to porn correlating with LESS desire for sex with a partner (but not lower desire to masturbate to porn). To put it another way – individuals with more brain activation and cravings for porn would rather masturbate to porn than have sex with a real person.

Greater cue-reactivity to porn coupled with lower desire for sex with real partners aligns with the 2014 Cambridge University brain study on porn addicts. The actual findings of Steele et al., 2013  in no way match the concocted headlines or Ley’s blog post assertions. Five subsequent peer-reviewed papers say that the Steele et al. findings actually lend support to the porn addiction model (as opposed to the “high sexual desire” hypothesis): 1, 2, 3, 4, 5. For more this extensive critique exposes unsupported claims put forth in the press and the study’s methodological flaws.

In 2015, Nicole Prause published a second EEG study (Prause et al., 2015), which found LESS neural response (with brief exposure to still images) for frequent porn users when compared to controls. This is evidence of abnormally reduced sexual desire in compulsive porn users. Put simply, chronic porn users were bored by static images of ho-hum porn (its findings parallel Kuhn & Gallinat., 2014). These findings are consistent with tolerance, a sign of addiction. Tolerance is defined as a person’s diminished response to a drug or stimulus that is the result of repeated use. Six peer-reviewed papers agree that this study actually found desensitization/habituation in frequent porn users (a sign of addiction): 1, 2, 3, 4, 5, 6. The results of Prause’s second EEG study indicate LESS sexual arousal – not higher desire. In fact, Nicole Prause stated in this Quora post she no longer ascribes to the “high libido as sex addiction” hypothesis:

“I was partial to the high sex drive explanation, but this LPP study we just published is persuading me to be more open to sexual compulsivity.”

Since Prause has flip-flopped, where is Ley’s and others continued support for the “porn/sex addiction = high libido” claim? Below are several recent studies that tested and falsified the “high libido = sex/porn addiction” claim:

1) “Is High Sexual Desire a Facet of Male Hypersexuality? Results from an Online Study.” (2015) – Researchers found virtually no overlap between the men with hypersexuality and the men with “High Sexual Desire”. Excerpt from the paper:

“The study findings point to a distinct phenomenology of High Sexual Desire and Hypersexuality in men.

2) “Hypersexuality and High Sexual Desire: Exploring the Structure of Problematic Sexuality” (2015) – The study found little overlap between high sexual desire and hypersexuality. Excerpt from the paper:

“Our study supports the distinctiveness of hypersexuality and high sexual desire/activity.”

3) “Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours” (2014) – A Cambridge University fMRI study comparing porn addicts to healthy controls. The study found that porn addicts had lower sexual desire and greater difficulty achieving erections, yet had greater cue-reactivity to porn (similar to Steele et al. above). Excerpts from the paper:

“On an adapted version of the Arizona Sexual Experiences Scale [43], CSB subjects compared to healthy volunteers had significantly more difficulty with sexual arousal and experienced more erectile difficulties in intimate sexual relationships but not to sexually explicit material (Table S3 in File S1).”

CSB subjects reported that as a result of excessive use of sexually explicit materials….. experienced diminished libido or erectile function specifically in physical relationships with women (although not in relationship to the sexually explicit material)…

4) “Patient Characteristics by Type of Hypersexuality Referral: A Quantitative Chart Review of 115 Consecutive Male Cases” (2015) – Study on men with hypersexuality disorders. 27 were classified as “avoidant masturbators,” meaning they masturbated to porn one or more hours per day or more than 7 hours per week. 71% of the compulsive porn users reported sexual functioning problems, with 33% reporting delayed ejaculation.

5) “Erectile Dysfunction, Boredom, and Hypersexuality among Coupled Men from Two European Countries” (2015) – This survey reported a strong correlation between erectile dysfunction and measures of hypersexuality. Excerpt:

Hypersexuality was significantly correlated with proneness to sexual boredom and more problems with erectile function.”

6) “Adolescents and web porn: a new era of sexuality (2015) – This Italian study analyzed the effects of Internet porn on high school seniors, co-authored by urology professor Carlo Foresta, president of the Italian Society of Reproductive Pathophysiology. The most interesting finding is that 16% of those who consume porn more than once a week report abnormally low sexual desire compared with 0% in non-consumers (and 6% for those who consume less than once a week). From the study:

“21.9% define it as habitual, 10% report that it reduces sexual interest towards potential real-life partners, and the remaining, 9.1% report a kind of addiction. In addition, 19% of overall pornography consumers report an abnormal sexual response, while the percentage rose to 25.1% among regular consumers.”

7) Brain Structure and Functional Connectivity Associated With Pornography Consumption: The Brain on Porn” (2014) – A Max Planck study which found 3 significant addiction-related brain changes correlating with the amount of porn consumed. It also found that the more porn consumed the less reward circuit activity in response to brief exposure (.530 second) to vanilla porn. In a 2014 article lead author Simone Kühn said:

We assume that subjects with a high porn consumption need increasing stimulation to receive the same amount of reward. That could mean that regular consumption of pornography more or less wears out your reward system. That would fit perfectly the hypothesis that their reward systems need growing stimulation.”

A more technical description of this study from a review of the literature by Kuhn & Gallinat – Neurobiological Basis of Hypersexuality (2016).

“The more hours participants reported consuming pornography, the smaller the BOLD response in left putamen in response to sexual images. Moreover, we found that more hours spent watching pornography was associated with smaller gray matter volume in the striatum, more precisely in the right caudate reaching into the ventral putamen. We speculate that the brain structural volume deficit may reflect the results of tolerance after desensitization to sexual stimuli.”

8) “Unusual masturbatory practice as an etiological factor in the diagnosis and treatment of sexual dysfunction in young men” (2014) – One of the 4 case studies in this paper reports on a man with porn-induced sexual problems (low libido, fetishes, anorgasmia). The sexual intervention called for a 6-week abstinence from porn and masturbation. After 8 months the man reported increased sexual desire, successful sex and orgasm, and enjoying “good sexual practices.”

9) Pornography use: who uses it and how it is associated with couple outcomes” (2012) – While not a study on “hypersexuals”, it reported that 1) porn use was consistently correlated with low scores on sexual satisfaction, and 2) that there was no differences in sexual desire between the porn users and the non-users.

10) Sexual Desire, not Hypersexuality, is Related to Neurophysiological Responses Elicited by Sexual Images (2013) – This EEG study was touted in the media as evidence against the existence of porn addiction. Not so. In line with the Cambridge University brain scan studies, this EEG study reported greater cue-reactivity to porn correlated with less desire for partnered sex. To put another way – individuals with more brain activation and cravings for porn would rather masturbate to porn than have sex with a real person. Study spokesman Nicole Prause claimed that porn users merely had high libido, yet the results of the study say something quite different. Four peer-reviewed papers expose the truth: 1, 2, 3, 4. Also see the extensive YBOP critique.

11) Modulation of Late Positive Potentials by Sexual Images in Problem Users and Controls Inconsistent with “Porn Addiction” (2015) – Another SPAN Lab EEG (brain-wave) study comparing the 2013 subjects from the above study to an actual control group (yet it suffered from the same methodological flaws named above). The results: compared to controls “individuals experiencing problems regulating their porn viewing” had lower brain responses to one-second exposure to photos of vanilla porn. The lead author, Nicole Prause, claims these results “debunk porn addiction”. What legitimate scientist would claim that their lone anomalous study has debunked an entire field of study? In reality, the findings of Prause et al. 2015 align perfectly with Kühn & Gallinat (2014), which found that more porn use correlated with less brain activation in response to pictures of vanilla porn. Prause’s findings also align with Banca et al. 2015 which is #4 in this list. Lower EEG readings mean that subjects are paying less attention to the pictures. Put simply, frequent porn users were desensitized to static images of vanilla porn. They were bored (habituated or desensitized). See this extensive YBOP critique. Five peer-reviewed papers agree with YBOP: 1, 2, 3, 4. 5.

12) Use of pornography in a random sample of Norwegian heterosexual couples (2009) – Porn use was correlated with more sexual dysfunctions in the man and negative self perception in the female. The couples who did not use porn had no sexual dysfunctions. A few excerpts from the study:

In couples where only one partner used pornography, we found more problems related to arousal (male) and negative (female) self-perception.

The couples who did not use pornography... may be considered more traditional in relation to the theory of sexual scripts. At the same time, they did not seem to have any dysfunctions.

13) Masturbation and Pornography Use Among Coupled Heterosexual Men With Decreased Sexual Desire: How Many Roles of Masturbation? (2015) – Masturbating to porn was related with decreased sexual desire and low relationship intimacy. Excerpts:

“Among men who masturbated frequently, 70% used pornography at least once a week. A multivariate assessment showed that sexual boredom, frequent pornography use, and low relationship intimacy significantly increased the odds of reporting frequent masturbation among coupled men with decreased sexual desire.”

“Among men [with decreased sexual desire] who used pornography at least once a week [in 2011], 26.1% reported that they were unable to control their pornography use. In addition, 26.7% of men reported that their use of pornography negatively affected their partnered sex and 21.1% claimed to have attempted to stop using pornography.”

14) Men’s Sexual Life and Repeated Exposure to Pornography. A New Issue? (2015) – Excerpts:

Mental health specialists should take in consideration the possible effects of pornography consumption on men sexual behaviors, men sexual difficulties and other attitudes related to sexuality. In the long term pornography seems to create sexual dysfunctions, especially the individual’s inability to reach an orgasm with his partner. Someone who spends most of his sexual life masturbating while watching porn engages his brain in rewiring its natural sexual sets so that it will soon need visual stimulation to achieve an orgasm.

Many different symptoms of porn consumption, such as the need to involve a partner in watching porn, the difficulty in reaching orgasm, the need for porn images in order to ejaculate turn into sexual problems. These sexual behaviors may go on for months or years and it may be mentally and bodily associated with the erectile dysfunction, although it is not an organic dysfunction. Because of this confusion, which generates embarrassment, shame and denial, lots of men refuse to encounter a specialist

Pornography offers a very simple alternative to obtain pleasure without implying other factors that were involved in human’s sexuality along the history of mankind. The brain develops an alternative path for sexuality which excludes “the other real person” from the equation. Furthermore, pornography consumption in a long term makes men more prone to difficulties in obtaining an erection in a presence of their partners.

15) Understanding the Personality and Behavioral Mechanisms Defining Hypersexuality in Men Who Have Sex With Men (2016)

Further, we found no associations between the CSBI Control scale and the BIS-BAS. This would indicate that lack of sexual behavior control is related to specific sexual excitation and inhibitory mechanisms and not to more general behavioral activation and inhibitory mechanisms. This would seem to support conceptualizing hypersexuality as a dysfunction of sexuality as proposed by Kafka. Further, it does not appear that hypersexuality is a manifestation of high sex drive, but that it involves high excitation and a lack of inhibitory control, at least with respect to inhibition owing to expected negative outcomes.

16) Hypersexual, Sexually Compulsive, or Just Highly Sexually Active? Investigating Three Distinct Groups of Gay and Bisexual Men and Their Profiles of HIV-Related Sexual Risk (2016) – If high sexual desire and sex addiction were the same, there would only be one group of individuals per population. This study, like the ones above, reported several distinct sub-groups, yet all groups reported similar rates of sexual activity.

Emerging research supports the notion that sexual compulsivity (SC) and hypersexual disorder (HD) among gay and bisexual men (GBM) might be conceptualized as comprising three groups—Neither SC nor HD; SC only, and Both SC and HD—that capture distinct levels of severity across the SC/HD continuum.

Nearly half (48.9 %) of this highly sexually active sample was classified as Neither SC nor HD, 30 % as SC Only, and 21.1 % as Both SC and HD. While we found no significant differences between the three groups on reported number of male partners, anal sex acts, or anal sex acts

17) The effects of sexually explicit material use on romantic relationship dynamics (2016) – As with many other studies, solitary porn users report poorer relationship and sexual satisfaction. Employing the Pornography Consumption Effect Scale (PCES), the study found that higher porn use was related to poorer sexual function, more sexual problems, and a “worse sex life”. An excerpt describing the correlation between the PCES “Negative Effects” on “Sex Life” questions and frequency of porn use:

There were no significant differences for the Negative Effect Dimension PCES across the frequency of sexually explicit material use; however, there were significant differences on the Sex Life subscale where High Frequency Porn Users reported greater negative effects than Low Frequency Porn Users.

18) Male masturbation habits and sexual dysfunctions (2016)It’s by a French psychiatrist who is the current president of the European Federation of Sexology. While the abstract shifts back and forth between Internet pornography use and masturbation, it’s clear that he’s mostly referring to porn-induced sexual dysfunctions (erectile dysfunction and anorgasmia). The paper revolves around his clinical experience with 35 men who developed erectile dysfunction and/or anorgasmia, and his therapeutic approaches to help them. The author states that most of his patients used porn, with several being addicted to porn. The abstract points to internet porn as the primary cause of the problems (keep in mind that masturbation does not cause chronic ED, and it is never given as a cause of ED). Excerpts:

Intro: Harmless and even helpful in his usual form widely practiced, masturbation in its excessive and pre-eminent form, generally associated today to pornographic addiction, is too often overlooked in the clinical assessment of sexual dysfunction it can induce.

Results: Initial results for these patients, after treatment to “unlearn” their masturbatory habits and their often associated addiction to pornography, are encouraging and promising. A reduction in symptoms was obtained in 19 patients out of 35. The dysfunctions regressed and these patients were able to enjoy satisfactory sexual activity.

Conclusion: Addictive masturbation, often accompanied by a dependency on cyber-pornography, has been seen to play a role in the etiology of certain types of erectile dysfunction or coital anejaculation. It is important to systematically identify the presence of these habits rather than conduct a diagnosis by elimination, in order to include habit-breaking deconditioning techniques in managing these dysfunctions.

19) The Dual Control Model – The Role Of Sexual Inhibition & Excitation In Sexual Arousal And Behavior (2007) – Newly rediscovered and very convincing. In an experiment employing video porn, 50% of the young men couldn’t become aroused or achieve erections with porn (average age was 29). The shocked researchers discovered that the men’s erectile dysfunction was,

related to high levels of exposure to and experience with sexually explicit materials.

The men experiencing erectile dysfunction had spent a considerable amount of time in bars and bathhouses where porn was “omnipresent,” and “continuously playing“. The researchers stated:

“Conversations with the subjects reinforced our idea that in some of them a high exposure to erotica seemed to have resulted in a lower responsivity to “vanilla sex” erotica and an increased need for novelty and variation, in some cases combined with a need for very specific types of stimuli in order to get aroused.”

20) Online sexual activities: An exploratory study of problematic and non-problematic usage patterns in a sample of men (2016) – This Belgian study from a leading research university found problematic Internet porn use was associated with reduced erectile function and reduced overall sexual satisfaction. Yet problematic porn users experienced greater cravings. The study appears to report escalation, as 49% of the men viewed porn that “was not previously interesting to them or that they considered disgusting.” (See studies reporting habituation/desensitization to porn and escalation of porn use) Excerpts:

This study is the first to directly investigate the relationships between sexual dysfunctions and problematic involvement in OSAs. Results indicated that higher sexual desire, lower overall sexual satisfaction, and lower erectile function were associated with problematic OSAs (online sexual activities). These results can be linked to those of previous studies reporting a high level of arousability in association with sexual addiction symptoms (Bancroft & Vukadinovic, 2004; Laier et al., 2013; Muise et al., 2013).”

In addition, we finally have a study that asks porn users about possible escalation to new or disturbing porn genres. Guess what it found?

Forty-nine percent mentioned at least sometimes searching for sexual content or being involved in OSAs that were not previously interesting to them or that they considered disgusting, and 61.7% reported that at least sometimes OSAs were associated with shame or guilty feelings.”

Note – This is the first study to directly investigate the relationships between sexual dysfunctions and problematic porn use. Two other studies claiming to have investigated correlations between porn use and erectile functioning cobbled together data from earlier studies in an unsuccessful attempt to debunk porn-induced ED. Both were criticized in the peer-reviewed literature: paper 1 was not an authentic study, and has been thoroughly discredited; paper 2 actually found correlations that support porn-induced ED. Moreover, paper 2 was only a “brief communication” that did not report important data.

21) Altered Appetitive Conditioning and Neural Connectivity in Subjects With Compulsive Sexual Behavior (2016) – “Compulsive Sexual Behaviors” (CSB) means the men were porn addicts, because CSB subjects averaged nearly 20 hours of porn use per week. The controls averaged 29 minutes per week. Interestingly, 3 of the 20 CSB subjects mentioned to interviewers that they suffered from “orgasmic-erection disorder,” while none of the control subjects reported sexual problems.

22) Study sees link between porn and sexual dysfunction (2017) – The findings of an upcoming study presented at the American Urological Association’s annual meeting. A few excerpts:

Young men who prefer pornography to real-world sexual encounters might find themselves caught in a trap, unable to perform sexually with other people when the opportunity presents itself, a new study reports. Porn-addicted men are more likely to suffer from erectile dysfunction and are less likely to be satisfied with sexual intercourse, according to survey findings presented Friday at the American Urological Association’s annual meeting, in Boston.

23) “I think it has been a negative influence in many ways but at the same time I can’t stop using it”: Self-identified problematic pornography use among a sample of young Australians (2017) – Online survey of Australians, aged 15-29.  Those who had ever viewed pornography (n=856) were asked in an open-ended question: ‘How has pornography influenced your life?’.

Among participants who responded to the open-ended question (n=718), problematic usage was self-identified by 88 respondents. Male participants who reported problematic usage of pornography highlighted effects in three areas: on sexual function, arousal and relationships. Responses included “I think it has been a negative influence in many ways but at the same time I can’t stop using it” (Male, Aged 18–19).

In short, the evidence is piling up that internet porn erodes normal sexual desire, leaving users less responsive to pleasure. They may crave porn, but that is more likely evidence of an addiction-related brain change known as “sensitization” (hyper-reactivity to addiction-related cues). Cravings certainly cannot be assumed to be evidence of greater libido.

Critique of: “Damaged Goods: Perception of Pornography Addiction as a Mediator Between Religiosity and Relationship Anxiety Surrounding Pornography Use” (Leonhardt, Willoughby, & Young-Petersen, 2017)

The “perceived pornography addiction” meme continues to infect the peer-reviewed literature, this time in a new study: “Damaged Goods: Perception of Pornography Addiction as a Mediator Between Religiosity and Relationship Anxiety Surrounding Pornography Use“, 2017 (Leonhardt, et al.). The phrase “perceived pornography addiction” was promoted by Joshua Grubbs, and first used in his 2013 study. It’s abundantly clear that the present study’s support for invoking “perceived porn addiction” or “belief in porn addiction” rests upon Joshua Grubbs’s continued promotion of the concept. Leonhardt, et al. cites 3 Grubbs studies a whopping 36 times in the body of the paper.

Before we examine the Leonhardt, et al. 5-item “perceived pornography addiction” questionnaire, let’s briefly revisit the Grubbs studies. Here is an extensive critique of the claims made in the Grubbs “perceived addiction” studies and in related misleading press.)


Section 1: The reality behind Joshua Grubbs’s phrase “perceived pornography addiction

Reality Check #1: When the Grubbs studies use the phrase “perceived pornography addiction,” it actually denotes the total score on the Grubbs “Cyber Pornography Use Inventory” (CPUI-9) – a questionnaire that cannot, and was never validated for, sorting “perceived” from actual addiction. That’s right, “perceived pornography addiction” indicates nothing more than a number: the total score on 9-item porn addiction questionnaire. This fact is lost in translation in the Grubbs studies due to the frequent repetition of the misleading descriptor “perceived addiction” instead of the accurate, spin-free label: “the Cyber Pornography Use Inventory score.”

Reality Check #2: The Grubbs CPUI-9 assesses actual porn addiction, not belief in porn addiction. It was developed using substance addiction tests. Don’t take our word for it. Here is the CPUI-9. (Each question is scored using a Likert scale of 1 to 7, with 1 being “not at all,” and 7 being “extremely.”)

Compulsivity Section

  1. I believe I am addicted to Internet pornography.
  2. I feel unable to stop my use of online pornography.
  3. Even when I do not want to view pornography online, I feel drawn to it

Access Efforts Section

  1. At times, I try to arrange my schedule so that I will be able to be alone in order to view pornography.
  2. I have refused to go out with friends or attend certain social functions to have the opportunity to view pornography.
  3. I have put off important priorities to view pornography.

Emotional Distress Section

  1. I feel ashamed after viewing pornography online.
  2. I feel depressed after viewing pornography online.
  3. I feel sick after viewing pornography online.

Upon closer examination, questions 1-6 of the CPUI-9 assess the signs and symptoms common to all addictions, while questions 7-9 (Emotional Distress) assess guilt, shame and remorse. As a result, “actual addiction” closely aligns with questions 1-6 (Compulsivity & Access Efforts). Removing the 3 “Emotional Distress” questions (which assess shame and guilt) leads to very different results for the Grubbs studies: 1) A much weaker relationship between religiosity and actual porn addiction. 2) A much stronger relationship between “[Porn] Use In Hours” and actual porn addiction. In other words hours of porn use strongly predict porn addiction, while religiosity’s relationship to porn addiction is far weaker. If we drill down we find that religiosity has virtually no relationship to the core addiction behaviors as assessed by questions 4-6.

Put simply – actual porn addiction has very little correlation to religiosity. One may well ask if it is sound methodology to blend apples and oranges in an assessment instrument, thereby confounding correlations with addiction on the one hand and correlations with shame guilt on the other. One may also ask whether it is appropriate to then choose a descriptor (“perceived”) that implies, wrongly, that an assessment instrument can sort genuine from perceived addiction.

Reality Check #3: You can also take Joshua Grubbs’s word that the CPUI is an actual pornography addiction questionnaire. In Grubbs’s initial 2010 paper he validated the Cyber-Pornography Use Inventory (CPUI) as a questionnaire assessing actual porn addiction (see this section for more). The phrases “perceived addiction” and “perceived porn addiction” do not appear in his 2010 paper. To the contrary, Grubbs et al., 2010 clearly states in several places that the CPUI assesses genuine porn addiction:

“The CPUI design was based on the principle that addictive behavior is characterized by an inability to stop the behavior, significant negative effects as a result of the behavior, and a generalized obsession with the behavior (Delmonico & Miller, 2003)…. The CPUI does indeed show promise as an instrument assessing Internet pornography addiction.”

Reality Check #4: Later, in a 2013 study, Grubbs reduced the number of CPUI questions from 32 (or 39 or 41) to the current 9, and (astonishingly) re-labeled his actual, validated porn addiction test as a questionnaire assessing “perceived pornography addiction.” While Grubbs himself didn’t claim his test could sort perceived from actual addiction, his employment of the misleading term (“perceived addiction”) for scores on his CPUI-9 instrument have led others to assume his instrument has the magical property of being able to discriminate between “perceived” and “real” addiction. This has done enormous damage to the field of porn addiction assessment because others rely on his papers as evidence of something they do not, and cannot, deliver. No test exists that can distinguish “real” from “perceived” addiction. Merely labeling it as such cannot make it so.

Why did Joshua Grubbs re-label the CPUI a “perceived” porn addiction test?

While Grubbs himself didn’t claim his test could sort perceived from actual addiction, his employment of the misleading term (“perceived addiction”) for scores on his CPUI-9 instrument have led others to assume his instrument has the magical property of being able to discriminate between “perceived” and “real” addiction. This has done enormous damage to the field of porn addiction assessment because others rely on his papers as evidence of something they do not, and cannot, deliver. No test exists that can distinguish “real” from “perceived” addiction. Merely labeling it as such cannot make it so.

Joshua Grubbs said in an email that a reviewer of his second CPUI-9 study caused him and his co-authors of the 2013 study to alter the “porn addiction” terminology of the CPUI-9 (because the reviewer sneered at the “construct” of porn addiction). This is why Grubbs changed his description of the test to a “perceived pornography addiction” questionnaire. In essence an anonymous reviewer/editor at this single journal initiated the unsupported, misleading label of “perceived pornography addiction.” The CPUI has never been validated as an assessment test differentiating actual porn addiction from “perceived porn addiction.” Here’s Grubbs tweeting about this process, including the reviewer’s comments:

Josh Grubbs‏ @JoshuaGrubbsPhD

On my 1st paper on compulsive porn use: “This construct [porn addiction] is as meaningful to measure as experiences of alien abduction: it’s meaningless.”

Nicole R Prause, PhD‏ @NicoleRPrause

You or reviewer?

Josh Grubbs‏ @JoshuaGrubbsPhD

Reviewer said it to me

Josh Grubbs‏ @JoshuaGrubbsPhD  Jul 14

Actually what led to my perceived addiction work, I thought about the comments as revised the focus.

Even though Grubbs used the phrase “perceived addiction” 80 times in his 2013 paper, he hinted at the true natiure of the CPUI-9 in this excerpt:

“Last, we found that the CPUI-9 was strongly positively associated with general hypersexual tendencies, as measured by the Kalichman Sexual Compulsivity Scale. This points to the high degree of interrelatedness between compulsive pornography use and hypersexuality more generally.”

Notice how the above excerpt states that the CPUI-9 assesses “compulsive pornography use.”

Reality Check #5: There is no questionnaire that assesses “perceived addiction” to anything – substance or behavior – including pornography use. This why a ‘Google Scholar’ search returns zero results for the following “perceived addictions”:

Reality Check #6: There is no set of questions that can differentiate between “belief in porn addiction” and the signs and symptoms of actual porn addiction. Like other addiction tests, the CPUI assesses behaviors and symptoms common to all addictions (and all addiction tests), such as the inability to control use, compulsion to use, cravings to use, negative psychological, social and emotional effects, and preoccupation with using. In fact, only question #1 of the CPUI-9 even hints at “perceived” addiction: I believe I am addicted to Internet pornography.

In summary, the phrase “perceived pornography addiction” means nothing more than the total score on the CPUI-9, an adaptation of a questionnaire originally validated in 2010 as an actual porn addiction test. Three years later, Grubbs was strongly “encouraged” by the publishing journal to re-label the CPUI-9 a “perceived” pornography addiction test – with no scientific basis, or formal validation whatsoever. That 2013 paper, and all subsequent Grubbs studies, replaced “total score on the CPUI-9” with the phrase “perceived pornography addiction.” If you ever see articles saying things such as:

  • “its your belief in porn addiction that causes psychological distress”

or a study saying that:

  • subjects’ anxiety was related to their perception of porn addiction

Know that the more accurate way to read them is as follows:

  • “porn addiction causes psychological distress”
  • subjects’ anxiety was related to scores on a porn addiction test

Not only did the Grubbs studies strongly, and misleadingly, imply that they assessed “the perception of porn addiction,” two other claims in the study also fall apart:

  • Claim #1) “Porn addiction is strongly related to religiosity.”

Not really. This section reveals that religiosity is only weakly related to actual porn addiction; while this section unravels the religiosity and porn addiction claims.

  • Claim #2) “Porn addiction is unrelated to hours of porn use.”

Not true. This section debunks this claim.

Reality Check #7: Studies recognize that amount of porn use is not linearly related to porn addiction (more below in section 5)

Where’s the evidence on which Leonhardt, et al. and the Grubbs papers are built, namely that amount of porn use is a reliable proxy for genuine addiction – with those using more being more “addicted” than those using less? Leonhardt, et al. asked about frequency, while Grubbs used hours of use, but the point is that neither test is synonymous with “degree of genuine addiction.” The fact is, established addiction assessment tools never use “amount of use” as the sole proxy for addiction.

Given that the amount of porn use is an unreliable measure of addiction, any suggestion that porn addiction is a “religious problem” based on slight discrepancies (between hours of use and scores on the 5-item test) when comparing religious and nonreligious users is thus far unsupportable, and certainly premature.

Moreover, last time I checked neither religious shame or guilt induces brain changes that mirror those found in drug addicts. Yet there are some 32 neurological studies reporting addiction-related brain changes in compulsive porn users/sex addicts. These furnish strong evidence of genuine addiction in some porn users.


Section 2: The Leonhardt, et al. 5-item questionnaire assesses only actual porn addiction

Now, back to the current BYU study: Leonhardt, Willoughby, & Young-Petersen, 2017 (Leonhardt, et al.). To assess “perceived pornography addiction” the authors adapted 5 questions taken from the 10-question “Sexual Compulsivity Scale.” The “Sexual Compulsivity Scale” was created in 1995 and designed with uncontrolled sexual relations in mind (in connection with investigating the AIDS epidemic).

By replacing “sex” or “sexual” with “pornography,” the Leonhardt, et al. authors created a questionnaire they labeled as assessing “perception of pornography addiction.” They used both that phrase and “belief in pornography addiction” throughout their study, as opposed to the more accurate “total score on our 5-item questionnaire.”

Ask yourself, do the following 5 questions measure the “belief in pornography addiction or do they assess signs, symptoms and behaviors fairly common in most addictions?

  1. “My thoughts about pornography are causing problems in my life,”
  2. ”My desires to view pornography disrupt my daily life,”
  3. “I sometimes fail to meet my commitments and responsibilities because of my pornography use,”
  4. “Sometimes my desire to view pornography is so great I lose control,”
  5. “I have to struggle to not view pornography.”

Still not sure? How about we adapt these five questions to create a substance addiction questionnaire:

  1. “My thoughts about using alcohol are causing problems in my life,”
  2. ”My desire to use alcohol disrupts my daily life,”
  3. “I sometimes fail to meet my commitments and responsibilities because of my alcohol use,”
  4. “Sometimes my desire to drink alcohol is so great I lose control,”
  5. “I have to struggle to not use alcohol.”

So, do the above 5 questions assess a “belief in alcohol addiction” or do they assess “actual alcohol addiction?” As anyone can see, these 5 questions assess actual alcohol addiction, just as they assessed actual porn addiction in Leonhardt, et al.

Yet we are told that a person’s total score for all 5 questions is synonymous with “belief in addiction” rather than addiction itself! Very misleading, and without any scientific basis, as these 5 questions were not validated as distinguishing an individual’s “belief in pornography addiction” from an actual addiction.

Note that decades of established addiction assessment tests for both chemical and behavioral addictions rely on similar questions as those above to assess actual, not “merely perceived,” addiction. For example, the Leonhardt, et al. questions assess the core addiction behaviors as outlined by the commonly used assessment tool known as the “4 Cs.” Let’s compare them. Here’s how the Leonhardt, et al questions correlate with the four Cs:

  • Compulsion to use (2, 3)
  • Inability to Control use (2, 3, 4)
  • Cravings to use (1, 2, 3, 4 )
  • Continued use despite negative consequences (2, 3)

In short, Leonhardt, et al. assessed the signs, symptoms and behaviors of an actual porn addiction, not belief in addiction. There is nothing in these 5 questions that hints at “mere belief in addiction.” Not only did the Leonhardt, et al. authors improperly apply the phrase “perceived pornography addiction” throughout their paper, they took it a step further by insinuating that both the Grubbs CPUI-9 and their 5-item questionnaire can actually assess a person’s mere “belief in porn addiction.” It should be noted that Grubbs himself never used the phrase “belief in addiction.”

If these authors were correct that their 5 items assess “perceived addiction,” then no existing addiction test could ever assess true addiction. This would be groundbreaking news indeed to the thousands of addiction experts worldwide who use such tests to assess a wide range of addicts every day.

Bottom line: Every time you read an article or a study using the phase “perceived pornography addiction” or “belief in porn addiction,” just know that all such misleading terms mean only one thing: “the total score on some porn addiction test.” To reveal the true significance of the findings in such articles and studies, simply omit words such as “perceived” or “belief,” and replace them with “porn addiction.” Let’s do this with few of the over 100 instances where Leonhardt, et al. inserted either “perceived” or “belief” into their paper:

Leonhardt, et al. said:

However, it appears that pornography users feel relationship anxiety surrounding their use only insofar as they believe themselves to have a compulsive, distressing pattern of use.

Without the inaccurate terms:

Pornography users who score high on our 5-item porn addiction questionnaire experience relationship anxiety surrounding their compulsive porn use.

Leonhardt, et al. said:

According to these results, those who use pornography are unlikely to feel anxious in their relationships because of their use, unless they believe themselves to have a compulsive, distressing pattern of use.

Without the inaccurate terms:

According to these results those who are addicted to pornography feel anxious in their relationships.

Leonhardt, et al. said:

Considering that dating discomfort was a subsidiary construct to relationship anxiety surrounding pornography use, individuals who believe themselves to have compulsive, distressing pornography use may be particularly reluctant to seek out dating partners.

Without the inaccurate terms:

Considering that dating discomfort was a subsidiary construct to relationship anxiety surrounding pornography use, individuals who are addicted to pornography may be particularly reluctant to seek out dating partners.

In essence the study found that porn addicts experienced anxiety surrounding their compulsive pornography use and its resulting negative consequences, such as inability control use, the disruption of their daily lives, and their inability to meet social and work commitments and responsibilities. Unsurprisingly, their porn addiction affected various aspects of romantic relationships as well.

While it is helpful for caregivers to be aware that some porn users may need to work on their self-esteem as well as any problematic porn use, it is not helpful for the public to be misled that tests can distinguish between “perceived” and actual addiction. And it is particularly unhelpful to confuse the two concepts and make unfounded claims based on such confusion.

UPDATE: On her podcast, Natasha Helfer Parker interviews Dr. Brian Willoughby about this study. In the interview Willoughby makes a startling claim that:

“We saw about 10-15% of our sample fitting into that category (actual porn addiction)…but when we looked at just the perception it was about 2-3 times larger than that number. So we saw this larger of people who self-labeling themselves as having a pornography addiction. The behavioral piece of that seemed that it didn’t line up.”

There is nothing in his study that hints at the above data. Let’s be clear: The only questions related to “perceived porn addiction” or “actual porn addiction” were the 5 questions listed above. These 5 questions cannot provide the information that Willoughby claims he possesses: the ability to distinguish who was actually addicted to porn and who only believed they were addicted to porn (but in fact were not).

These statements by Willoughby are entirely unsupported. Addiction can only be ascertained via a combination of client history taking, interviewing, and possibly assessment questionnaires (such as Cambridge University used with its subjects). No researcher is justified in simply labeling any subject as being “truly addicted” or “falsely believing they are addicted” by using a 5-item questionnaire filled out on Amazon M-turk.

Willoughby not only repeatedly uses the phrases “perceived addiction” and “internal perception of addiction”, he claims that subjects “labeled themselves as addicted”. I’ll repeat: the subject’s answered the 5-item questionnaire. The study and now Willoughby have re-labeled the total score on the 5 questions as all of the following: “perceived porn addiction”, “belief in porn addiction”, “internal perception of porn addiction”. “labeling themselves as addicted”.

Finally, both the study and Willoughby suggest that the relationship between religiosity and scores on the 5-item questionnaire must indicate that most religious porn users only experience shame and do not experience the signs and symptoms of an addiction. That’s quite a leap considering that their study did not assess shame, or any other emotion.


Section 3: Rewriting & reinterpreting the Leonhardt, et al. abstract

What would the Leonhardt, et al. abstract look like if belief and perception were eliminated? First, here’s the abstract as published:

Recent research on pornography suggests that perception of addiction predicts negative outcomes above and beyond pornography use. Research has also suggested that religious individuals are more likely to perceive themselves to be addicted to pornography, regardless of how often they are actually using pornography. Using a sample of 686 unmarried adults, this study reconciles and expands on previous research by testing perceived addiction to pornography as a mediator between religiosity and relationship anxiety surrounding pornography. Results revealed that pornography use and religiosity were weakly associated with higher relationship anxiety surrounding pornography use, whereas perception of pornography addiction was highly associated with relationship anxiety surrounding pornography use. However, when perception of pornography addiction was inserted as a mediator in a structural equation model, pornography use had a small indirect effect on relationship anxiety surrounding pornography use, and perception of pornography addiction partially mediated the association between religiosity and relationship anxiety surrounding pornography use. By understanding how pornography use, religiosity, and perceived pornography addiction connect to relationship anxiety surrounding pornography use in the early relationship formation stages, we hope to improve the chances of couples successfully addressing the subject of pornography and mitigate difficulties in romantic relationships.

Be honest, wouldn’t any reader assume from the above that the mere belief in porn addiction is the sole cause of all porn-related problems examined?

Now, here’s the Leonhardt, et al. abstract written as we think it should have based on its findings, without inaccurate phrases such as “belief in,” “perception of,” and with added context relating to the Grubbs research the Leonhardt, et al. authors relied on:

Recent research on pornography suggests that pornography addiction predicts negative outcomes above and beyond pornography use. A few studies by the Grubbs team have found that “religious porn users” score slightly higher than non-religious porn users on the “Cyber Pornography Use Inventory” (CPUI-9). This finding must be viewed in the context that all cross-sectional studies report far lower rates of porn use in religious individuals. This means that fewer religious persons regularly use porn and thus there are lower rates of “actual porn addiction” among religious populations. Several possible factors have been suggested as to why a population of religious porn users might score higher on porn addiction questionnaires than the population of secular porn users.

Using a sample of 686 unmarried adults, this study expands on previous research by testing compulsive pornography use as a mediator between religiosity and relationship anxiety surrounding pornography. Results revealed that pornography use and religiosity were weakly associated with higher relationship anxiety surrounding pornography use, whereas pornography addiction was highly associated with relationship anxiety surrounding pornography use.

However, when pornography addiction was inserted as a mediator in a structural equation model, pornography use had a small indirect effect on relationship anxiety surrounding pornography use, and pornography addiction partially mediated the association between religiosity and relationship anxiety surrounding pornography use. By understanding how pornography use, religiosity, and pornography addiction connect to relationship anxiety surrounding pornography use in the early relationship formation stages, we hope to improve the chances of couples successfully addressing the subject of pornography and mitigate difficulties in romantic relationships.

THE TAKE-AWAY: Being religious was only “weakly associated” with relationship anxiety surrounding one’s pornography use. On the other hand, pornography addiction (as assessed by the 5 questions) “was highly associated” with relationship anxiety surrounding one’s pornography use. In sum, being religious added a bit anxiety to the relationship and porn use mix – which makes sense. But it was being addicted to porn (whether religious or not) that played the major role in promoting anxiety surrounding porn use. And how did the relationship anxiety manifest in the compulsive pornography users? As study said:

“This relationship anxiety surrounding pornography use was manifest in greater reluctance seeking out dating partners and greater difficulty disclosing pornography use.”

The study’s two major revelations:

  1. Porn addicts don’t want to talk about their porn addiction…especially on the first few dates.
  2. Being addicted to porn has detrimental effects on your love life. Alternately, a porn addict might prefer porn to a real-life sexual partner.

Are these findings a surprise to anyone?


Section 4: Is religiosity really related to actual porn addiction?

Introduction: Anecdotal evidence from sex therapists suggests there are clients who feel addicted to porn, yet view it only occasionally. It’s possible that some of these clients are religious and experience guilt and shame surrounding their occasional porn use. Are these individuals suffering only from “perceived addiction” and not real porn addiction? Perhaps. That said, these individuals want to stop yet they continue to use porn. Whether or not these “occasional porn users” are truly addicted or just feeling guilt and shame, one thing is for sure: neither the Grubbs CPUI-9, nor the Leonhardt, et al. 5-item questionnaire can distinguish “perceived addiction” from actual addiction in these individuals or anyone else.

Religiosity does not correlate with porn use or porn addiction

Religiosity does not predict porn addiction. Quite the opposite. Religious individuals are less likely to use porn and thus less likely to become porn addicts.

Leonhardt, et al. and the Joshua Grubbs studies did not use a cross-section of religious individuals. Instead, only current porn users (religious or nonreligious) were questioned. Pretty much every study published reports far lower rates of porn use in religious individuals as compared with non-religious individuals (study 1, study 2, study 3, study 4, study 5, study 6, study 7, study 8, study 9, study 10, study 11, study 12, study 13, study 14, study 15, study 16, study 17, study 18, study 19)

Studies examining religious porn users end up with a much smaller percentage of all religious persons when compared to secular porn users (among whom porn use is fairly universal in young males). The two take-aways: 1) religiosity is protective against porn addiction; 2) the sample of religious porn users is skewed toward atypical religious people.

As an example, this 2011 study (The Cyber Pornography Use Inventory: Comparing a Religious and Secular Sample) reported the percentage of religious and secular college men who used porn at least once a week:

  • Secular: 54%
  • Religious: 19%

Another study on college aged religious men (I believe it is wrong but I still do it – A comparison of religious young men who do versus do not use pornography, 2010) revealed that:

  • 65% of religious young men reported viewing no pornography in the past 12 months
  • 8.6% reported viewing two or three days per month
  • 8.6% reported viewing daily or every other day

In contrast, cross-sectional studies of college-age men report relatively high rates of porn viewing (US – 2008: 87%, China – 2012: 86%, Netherlands – 2013 (age 16): 73%).

Leonhardt, et al. disregards all other studies ever published on rates of porn use among religious users

In an astounding move the Leonhardt, et al. authors claim that all surveys and studies on rates of porn use among religious users are flat out wrong. In other words, Leonhardt, et al. suggests that a very large and consistent percentage of religious individuals have lied about their porn use on every anonymous survey on porn-use rates ever done. In fact, Leonhardt, et al go so far as to imply that religious individuals instead use porn at higher rates than non-religious individuals! The following excerpt offers their justification for this audacious assertion:

Likely due to these conservative sexual values, and possible anxiety surrounding the use of pornography, religious individuals consistently report lower levels of pornography use than secular populations (Carroll et al., 2008; Poulsen, Busby, & Galovan, 2013; Wright, 2013). However, other studies assessing search engines (MacInnis & Hodson, 2015) and online subscriptions (Edelman, 2009) suggest that individuals from religious, conservative populations may be more likely to search out pornography than their secular counterparts. This discrepancy between self-report data and objective measures hints at the stigma against pornography use in religious cultures, as religious individuals may be more likely to conceal their pornography use due to feelings of shame surrounding such use.

So, support for this Leonhardt, et al. claim comes from 2 studies on state-wide data: 1) MacInnis & Hodson, 2015 (Google searches for certain sex-related terms), and 2) Edelman, 2009 (Subscriptions to a single paid porn site in 2007).

The often-repeated meme that Utah has the highest level of porn use arose from Benjamin Edelman’s 2009 economics paper “Red Light States: Who Buys Online Adult Entertainment?” He relied entirely on subscription data from a single top-ten provider of pay-to-view content when he ranked states on porn consumption – ignoring hundreds of other such websites. Why did he choose that one to analyze?

We do know that Edelman’s analysis was conducted circa 2007, after free, streaming “tube sites” were operational, and porn viewers were increasingly turning to them. So, Edelman’s single data point out of thousands (of free and subscription sites) cannot be presumed to be representative of all US porn users. Turns out  his paper is misleading. (For more see – Is Utah #1 in Porn Use?) In fact, other studies and available data rank Utah porn use between 40th and 50th among the states. See:

  1. This peer-reviewed paper: “A review of pornography use research: Methodology and results from four sources (2015).Cyberpsychology: Journal of Psychosocial Research on Cyberspace (2015).
  2. Or this easier to read 2014 article: Rethinking Mormons and Porn: Utah 40th in US in New Porn Data.
  3. Per capita page views, taken from Pornhub in 2014 (graph on YBOP).

The paper “A review of pornography use research: Methodology and results from four sources (2015)” also analyzes MacInnis & Hodson, 2015. An excerpt explaining what MacInnis & Hodson did:

MacInnis & Hodson, (2014) use Google Trends search term data as a proxy for pornography use and examine the relationship between state-level pornography use and measures of religiosity and conservatism. They find that states with more right-leaning ideological attitudes have higher rates of pornography-related Google searches.

The first problem with MacInnis & Hodson: Google Trend searches are not a proxy for pornography use. For example, self-reports suggest regular porn users visit their favorite tube sites via bookmarks or by typing the tube site’s name into the browser’s address field (while in incognito mode). Once on their favorite tube site, regular porn users often reach a new porn site via hyperlinks and ads, thus bypassing Google searches entirely.

The second weakness in MacInnis & Hodson: Google searches tells us nothing about the amount of time any particular user spends watching porn. For example, a state could have a high rate of first time porn seekers (young people, for instance) who only glance at a a few pictures, while other states could have higher rates of chronic porn users who never use Google, yet spend several hours watching porn.

A third weakness: MacInnis & Hodson failed to consider other possible reasons for higher rates of Google searches for sex and porn related words. It’s quite likely that young people searching for info about sex or sexual practices would use Google, while seasoned porn users would bypass search engines and go directly to porn sites. Moreover, surveys show that the highest rates of porn viewing occur in teen and young adult populations. As a result, we would expect states with higher populations of young people to have higher rates of Google searches for sexual content.

Check out the state by state population demographics. The 16 states with highest percentages of teen populations are considered “Red States” (more religious and politically conservative). On the other hand, all but one of the states with the lowest percentage of teens is a “Blue State” (less religious, more liberal). This one variable alone could explain the MacInnis & Hodson‘s findings.

And this is just one of many variables that must be factored in when affixing significance to correlations between state-level rankings in religiosity and a single highly questionable “proxy for porn use.” Especially when all surveys and studies report less porn use among religious populations.

The paper “A review of pornography use research: Methodology and results from four sources (2015).” says the following about MacInnis & Hodson:

The results in the first row of Table 3 show that we also find a statistically significant relationship between religiosity and conservatism in most cases when we use the Google Trends data. However, the other rows in Table 3 show that we get a much weaker statistical relationship when using any of the other three data sources. These results suggest that if MacInnis and Hodson (2014) had used any of the other three data sources, they probably would have come to a different conclusion in their paper about the strength of the relationship they were examining.

The fact that MacInnis and Hodson (2014) find a statistically significant relationship between state-level religiosity and state-level pornography use is interesting considering that past studies using individual level data find that individuals who regularly attend church are much less likely to use pornography.

Bottom line: We have Leonhardt, et al. disregarding multiple studies and cross-sectional surveys on religious individuals in favor of the conclusions of a methodologically questionable study correlating religious trends of state populations, with a very narrow representation of internet searches for sexual content. Unbelievable.

Internal inconsistency: The Leonhardt, et al. assertion is that a very large percentage of religious individuals lie about their use porn on anonymous surveys. And that they have lied in every survey ever published. If this is true, we must disregard Leonhardt, et al.’s own findings based on self-reports of religious porn users, just as Leonhardt, et al. repeatedly discounted and disregarded all other porn use surveys before theirs.

If Leonhardt, et al.’s religious subjects are consistently under-reporting their porn use (as they claim religious users have in other surveys), this means that the numerical value for “frequency of porn use” in their religious subjects needs to be adjusted upward. Raising (“correcting”) the religious group’s frequency of use brings their use into alignment with their scores on the 5-item questionnaire. Put simply, higher levels of porn use in religious subjects correlate nicely with higher scores on the porn addiction questionnaire. Or simpler yet: the amount of porn used = the levels of porn addiction – in both religious and nonreligious users. If this is so, there’s really nothing for Leonhardt, et al. to report. Null finding.

So, I ask the authors of Leonhardt, et al., which of the following 3 is accurate?

  1. All anonymous surveys on religious subjects are to be disregarded because a very large percentage of religious individuals consistently underreport their porn use. This must include all the Grubbs studies and Leonhardt, et al. 2017
  2. All anonymous surveys on religious subjects should be taken at face value, as all report similar findings: consistently lower rates of porn use among religious populations.
  3. Only the survey by Leonhardt, et al. is to be trusted. All other anonymous surveys on religious subjects are to be disregarded. This is the Leonhardt, et al., authors’ current stance.

Religious porn users are likely to have higher rates of pre-existing conditions

Given that a large majority of college-age, religious men rarely views porn, the Grubbs and Leonhardt, et al. targeted samples of “religious porn users” represented a small minority of the religious population. In contrast, samples of “secular porn users” tend to represent the majority of the non-religious population.

Most young religious porn users say they would rather not watch porn (100% in this study). So why do these particular users watch? It’s extremely likely that the non-representative sample of “religious porn users” contains a far higher percentage of the slice of the entire population that struggles with the pre-existing conditions or comorbidities. These conditions are often present in addicts (i.e. OCD, depression, anxiety, social anxiety disorder, ADHD, family histories of addiction, childhood trauma or sexual abuse, other addictions, etc.).

This factor alone could explain why religious porn users, as a group, score slightly higher on the Grubbs and Leonhardt, et al. porn addiction questionnaires. This hypothesis is supported by studies on treatment seeking porn /sex addicts (whom we could expect to hail disproportionately from that same disadvantaged slice). Treatment seekers reveal no relationship between religiosity and measurements of addiction and religiosity (2016 study 1, 2016 study 2). If Leonhardt, et al.‘s conclusions were valid, we’d surely see a disproportionate number of religious porn users seeking treatment.

At high levels of porn use religious individuals return to religious practices and religion becomes more important

This 2016 study on religious porn users reported an interesting finding that alone could explain a slight correlation between actual porn addiction and religiosity. The relationship between porn use and religiosity is curvilinear. As porn use increases, religious practice and the importance of religion decrease – up to point. Yet when a religious individual begins using porn once or twice a week this pattern reverses itself: The porn user starts attending church more often and the importance of religion in his life increases. An excerpt from the study:

“However, the effect of earlier pornography use on later religious service attendance and prayer was curvilinear: Religious service attendance and prayer decline to a point and then increase at higher levels of pornography viewing.”

This graph, taken from this study, compares religious service attendance with the amount of porn used:

It seems likely that as religious individuals’ porn use grows increasingly out of control, they return to religion as a tactic to address their problematic behavior. This is no surprise, as many addiction recovery groups based on the 12-steps include a spiritual or religious component. The author of the paper suggested this as a possible explanation:

…studies of addiction suggest that those who feel helpless in their addiction often elicit supernatural help. Indeed, twelve-step programs that seek to help persons struggling with addictions ubiquitously include teachings about surrendering to a higher power, and a rising number of conservative Christian twelve-step programs make this connection even more explicit.  It could very well be that persons who use pornography at the most extreme levels (i.e., use levels that might be characteristic of a compulsion or addiction) are actually pushed toward religion over time rather than pulled away from it.

This phenomenon of religious porn users returning to their faiths as addiction worsens could easily explain any correlation between actual porn addiction and religiosity.

In contrast to religious subjects, secular porn using subjects may not recognize porn’s effects because they never try to quit

Is it possible that religious porn users score higher on porn addiction questionnaires because they’ve actually tried to quit, unlike their secular brethren? In doing so they would be more likely to recognize the signs and symptoms of porn addiction as assessed by the Leonhardt, et al. 5-item questionnaire.

Based on years of monitoring porn recovery forums online, we suggest that researchers should segregate users who have experimented with quitting porn from those who haven’t, when asking them about porn’s self-perceived effects. It is generally the case that today’s porn users (both religious and nonreligious) have little understanding of internet porn’s effects on them until after they attempt to quit (and pass through any withdrawal symptoms).

In general, agnostic porn users believe porn use is harmless, so they have no motivation to quit…until they run into intolerable symptoms (perhaps, debilitating social anxiety, inability to have sex with a real partner or escalation to content they find confusing/disturbing or too risky). Prior to that turning point, if you ask them about their porn use, they will report that all is well. They naturally assume they are “casual users,” who could quit anytime, and that symptoms they have, if any, are due to something else. Shame? Nope.

In contrast, most religious porn users have been warned that porn use is risky. They are therefore more likely to have used less porn and to have experimented with giving it up, perhaps more than once. Such experiments with quitting internet porn are very enlightening, as that is when porn users (religious or not) discover:

  1. How difficult it is to quit (if they’re addicted)
  2. How porn use has affected them adversely, emotionally, sexually and otherwise (often because symptoms begin to recede after quitting)
  3. [In the case of such symptoms] How withdrawal can make symptoms worse for a while, before the brain returns to balance
  4. How bad it feels when they want to give something up and can’t (This is shame, but not necessarily “religious/sexual shame” – as researchers sometimes assume because religious users report it more often. Most all addicts unfortunately feel shame when they feel powerless to quit, whether or not they are religious.)
  5. That they experience strong cravings to use porn. Cravings often increase in severity with a week or longer break from using porn.

Such experiences make those who have tried quitting far more wary about porn use. Since more religious users will more frequently have made such experiments, psychological instruments will show that they are more concerned about their porn use than non-religious users – even though they are likely using less porn!

In other words, shouldn’t researchers also be investigating whether secular porn users sometimes misperceive porn use as harmless, rather than assuming it’s the religious people who are misperceiving the existence of porn-related problems even though they’re using less? Addiction, after all, is not assessed based on quantity or frequency of use, but rather debilitating effects.

In any case, the failure to segregate those who have experimented with quitting from those who have not, is a huge confound in research attempting to draw conclusions about the implications of the relationship between religiosity, shame and porn use. It’s easy to misinterpret data as evidence that “religion makes people concerned about porn even if they’re using less than others, and that if they weren’t religious they wouldn’t be concerned.”

The more valid conclusion may be that those who have tried to quit, and realized the points above are more concerned, and that religion is merely the cause of their making such experiments (and otherwise largely irrelevant). It’s disheartening to see psychologists make simplistic correlations with religion/spirituality and draw “shaming” conclusions, without realizing that they are comparing “apples” with “oranges” when they compare users who have tried to quit with users who haven’t. Again, only the former tend to see the risks and harms of porn use clearly, whether or not they are religious.

This confound is too often exploited by those who want to draw attention away from the severe symptoms that non-religious users frequently experience. Agnostic users tend to have more severe symptoms by the time they do quit, simply because they tend to quit at a lower point in the downward spiral of symptoms than religious porn users do. Why aren’t researchers studying this phenomenon?

In fact, we would wager that the lion’s share of those with porn-induced sexual dysfunctions are agnostics. Why? Because the non-religious tend to be so persuaded of the harmlessness of internet porn use that they continue using it well past the warning signs, such as increasing social anxiety, escalation to extreme material, apathy, difficulty achieving an erection without porn, difficulty using condoms or climaxing with a partner, and so forth.

The fact is, even casual, or relatively infrequent, porn use can condition some users’ sexuality such that it interferes with their sexual and relationship satisfaction. Here’s one man’s account. Escalation to porn content that was once uninteresting or repelling is common in half of internet porn users. In short, as discussed above, infrequent use is no panacea. Those who do not use frequently but are anxious about their porn use may have good reason to be concerned based on their own experiments, quite apart from what they hear about porn during religious services.

Might it be better to construct research that asks porn users (both religious and otherwise) to quit porn for a time and compare their experiences with controls? See Eliminate Chronic Internet Pornography Use to Reveal Its Effects for a possible study design.

The biological reasons why intermittent porn users might score higher on porn addiction questionnaires

Very frequent internet porn use has familiar risks for many of today’s users. These include escalation to more extreme material, poorer sexual and relationship satisfaction, addiction, and/or the gradual loss of attraction to real partners (as well as anorgasmia and unreliable erections).

Less well known is the fact that intermittent use (for example, 2 hours of porn bingeing followed by a few weeks of abstinence before another porn session) poses a substantial risk of addiction. The reasons are biological, and there is an entire body of addiction research on intermittent use in animals and humans elucidating the brain events responsible.

For example, both drug and junk food studies reveal that intermittent use can lead more quickly to addiction-related brain changes (whether or not the user slips into full blown addiction). The primary change is sensitization which blasts the brain’s reward center with signals that produce hard to ignore cravings. With sensitization, brain circuits involved in motivation and reward seeking become hyper-sensitive to memories or cues related to the addictive behavior. This deep pavlovian conditioning results in increased “wanting” or craving while liking or pleasure from the activity diminishes. Cues, such as turning on the computer, seeing a pop-up, or being alone, trigger intense cravings for porn. (Studies reporting sensitization or cue-reactivity in porn users: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18.)

Even more remarkable is that periods of abstinence (2-4 weeks) lead to neuroplastic changes that don’t occur in a user that doesn’t take such long breaks. These alterations in the brain increase cravings to use in response to triggers. Furthermore, the stress system changes such that even minor stress can cause cause cravings to use.

Intermittent consumption (especially in the form of a binge) can also produce severe withdrawal symptoms, such as lethargy, depression and cravings. In other words, when someone uses after an interim of abstinence, and binges, it can hit the user harder – perhaps because of the heightened intensity of the experience.

Based on this research, scientists have concluded that everyday consumption of say cocaine, alcohol, cigarettes, or junk food is not necessary to generate addiction-related brain changes. Intermittent bingeing can do the same thing as continuous use, and in some cases do more.

Now, let’s return to a comparison of religious and nonreligious porn users. Which group is likely to include more intermittent users? Given research showing that religious porn users prefer not to be using porn, there are probably more religious than secular users stuck in a binge-abstinence cycle. Religious users would tend to be “intermittent users.” Secular users generally report that they seldom take breaks of more than a few days – unless they become intermittent users because they are trying to quit porn use.

Another important effect of the binge-abstinence cycle is that intermittent porn users experience extended gaps (and often improvements). They can clearly see how their porn use has affected them, in contrast with frequent users. This alone might lead to higher scores on a porn addiction questionnaire. A second, more important result is that intermittent porn users will experience more frequent episodes of strong cravings. Third, when intermittent users do cave in, the science mentioned above predicts that they will often feel more out of control, and experience more of a letdown after the binge. In short, intermittent users can be quite addicted and score surprisingly high on porn addiction tests, even though they are using with less frequency than their secular brethren.

Under the circumstances, it is premature to conclude that shame accounts for the difference between religious and nonreligious users. Researchers must control for the impact of intermittent use. Said differently, if more of Leonhardt et al’s religious subjects included a higher percentage of intermittent users than their nonreligious subjects, one would expect the religious users to score higher on addiction tests despite using significantly less frequently.

Of course, the intermittent use addiction risk is not confined to religious porn users. This phenomenon shows up in animal models and secular porn users who are trying to quit but still bingeing occasionally. The point is that the phenomenon of intermittent use and porn addiction needs to be studied independently prior to drawing and publicizing assumptions about shame (or “perceived” pornography addiction) as the only possible explanation for why religious porn users report higher addiction scores in concert with less frequent use.

Summary of Religiosity and Porn Use:

  1. Religiosity does not predict porn addiction (perceived or otherwise). A far larger percentage of secular individuals use porn.
  2. Since a much smaller percentage of religious people use porn, religiosity is evidently protective against porn addiction.
  3. Grubbs and Leonhardt, et al. samples taken from the minority of “religious porn users” is skewed with respect to religious users, likely resulting in a much higher percentage of the religious sample having comorbidities. As a result religious porn users have slightly higher overall scores on porn-addiction instruments and report more difficulty controlling use.
  4. As porn use becomes frequent or compulsive, religious porn users return to their faiths. This means that those scoring highest on porn addiction tests will also score higher on religiosity.
  5. Most religious porn users have been warned that porn use is risky. They are therefore more likely to have used less porn and to have experimented with giving it up. In doing so they are more likely to recognize the signs and symptoms of porn addiction as assessed by the Leonhardt, et al. 5-item (and similar) questionnaire(s) – regardless of amount of porn use.
  6. Intermittent porn users can be quite addicted and score surprisingly high on porn addiction tests, even though they are using with less frequency than their secular brethren.

Section 5: Studies recognize that “levels of current porn use” is not linearly related to porn addiction

In the Grubbs studies and Leonhardt, et al. an insinuation pervades that hours of porn use is synonymous with “real porn addiction.” That is, that the extent of a “genuine porn addiction” is best indicated simply by “current hours of use” or “frequency of use,” rather than by standard porn addiction tests or by porn-induced symptoms. Addiction experts disagree.

The hole in these author’s underpinnings, which you could drive a truck through, is that research on internet porn and internet addictions (1, 2, 3, 4, 5, 6, 7, 8, 9) has reported that internet addiction sub-types do not correlate linearly with hours of use. In fact, the variable ‘hours of use’ is an unreliable measure of addiction. Established addiction assessment tools evaluate addiction using multiple other, more reliable factors (such as those listed in the first two sections of the CPUI-9 or the Leonhardt, et al. questions). The following cybersex addiction studies report little relationship between hours and indications of addiction:

1) Watching Pornographic Pictures on the Internet: Role of Sexual Arousal Ratings and Psychological-Psychiatric Symptoms for Using Internet Sex Sites Excessively (2011)

“Results indicate that self-reported problems in daily life linked to online sexual activities were predicted by subjective sexual arousal ratings of the pornographic material, global severity of psychological symptoms, and the number of sex applications used when being on Internet sex sites in daily life, while the time spent on Internet sex sites (minutes per day) did not significantly contribute to explanation of variance in Internet Addiction Test sex score (IATsex). We see some parallels between cognitive and brain mechanisms potentially contributing to the maintenance of excessive cybersex and those described for individuals with substance dependence.”

2) Sexual Excitability and Dysfunctional Coping Determine Cybersex Addiction in Homosexual Males (2015)

“Recent findings have demonstrated an association between CyberSex Addiction (CA) severity and indicators of sexual excitability, and that coping by sexual behaviors mediated the relationship between sexual excitability and CA symptoms. Results showed strong correlations between CA symptoms and indicators of sexual arousal and sexual excitability, coping by sexual behaviors, and psychological symptoms. CyberSex Addiction was not associated with offline sexual behaviors and weekly cybersex use time.”

3) What Matters: Quantity or Quality of Pornography Use? Psychological and Behavioral Factors of Seeking Treatment for Problematic Pornography Use (2016)

According to our best knowledge this study is the first direct examination of associations between the frequency of porn use and actual behavior of treatment-seeking for problematic porn use (measured as visiting the psychologist, psychiatrist or sexologist for this purpose). Our results indicate that the future studies, and treatment, in this field should focus more on impact of porn use on the life of an individual (quality) rather than its mere frequency (quantity), as the negative symptoms associated with porn use (rather than porn use frequency ) are the most significant predictor of treatment-seeking behavior.

Relation between PU and negative symptoms was significant and mediated by self-reported, subjective religiosity (weak, partial mediation) among non-treatment seekers. Among treatment-seekers religiosity is not related to negative symptoms.

4) Examining Correlates of Problematic Internet Pornography Use Among University Student (2016)

Higher scores on addictive measures of internet porn use were correlated with daily or more frequent use of internet porn. However, the results indicate that there was no direct link between the amount and frequency of an individual’s pornography use and struggles with anxiety, depression, and life and relationship satisfaction. Significant correlations to high internet porn addiction scores included an early first exposure to internet porn, addiction to video games, and being male. While some positive effects of internet porn use have been documented in previous literature our results do not indicate that psychosocial functioning improves with moderate or casual use of internet porn.

5) Viewing Internet Pornography: For Whom is it Problematic, How, and Why? (2009)

This study investigated the prevalence of problematic Internet pornography viewing, how it is problematic, and the psychological processes that underlie the problem in a sample of 84 college-age males using an anonymous online survey. It was found that approximately 20%–60% of the sample who view pornography find it to be problematic depending on the domain of interest. In this study, the amount of viewing did not predict the level of problems experienced.

Imagine trying to assess the presence of addiction by simply asking, “How many hours do you currently spend eating (food addiction)?” or “How many hours do you spend gambling (gambling addition)?” or “How many hours do you spend drinking (alcoholism)?” You could get very misleading results. More important, “current porn use” questions fail to ask about key variables of porn use: age use began, years of use, whether the user escalated to novel genres of porn or developed unexpected porn fetishes, the ratio of ejaculation with porn to ejaculation without it, amount of sex with a real partner, and so forth. A combination of such questions would likely enlighten us more about who really has a problem with porn use than simply “current frequency/hours of use.”


Abstract

Damaged Goods: Perception of Pornography Addiction as a Mediator Between Religiosity and Relationship Anxiety Surrounding Pornography Use.

J Sex Res. 2017 Mar 13:1-12. doi: 10.1080/00224499.2017.1295013.

Leonhardt ND1, Willoughby BJ1, Young-Petersen B1.

Recent research on pornography suggests that perception of addiction predicts negative outcomes above and beyond pornography use. Research has also suggested that religious individuals are more likely to perceive themselves to be addicted to pornography, regardless of how often they are actually using pornography. Using a sample of 686 unmarried adults, this study reconciles and expands on previous research by testing perceived addiction to pornography as a mediator between religiosity and relationship anxiety surrounding pornography. Results revealed that pornography use and religiosity were weakly associated with higher relationship anxiety surrounding pornography use, whereas perception of pornography addiction was highly associated with relationship anxiety surrounding pornography use. However, when perception of pornography addiction was inserted as a mediator in a structural equation model, pornography use had a small indirect effect on relationship anxiety surrounding pornography use, and perception of pornography addiction partially mediated the association between religiosity and relationship anxiety surrounding pornography use. By understanding how pornography use, religiosity, and perceived pornography addiction connect to relationship anxiety surrounding pornography use in the early relationship formation stages, we hope to improve the chances of couples successfully addressing the subject of pornography and mitigate difficulties in romantic relationships.

PMID: 28287845

DOI: 10.1080/00224499.2017.1295013

Studies Report Escalation (and Habituation) in Porn Users

Compulsive porn users often describe escalation in their porn use that takes the form of greater time viewing or seeking out new genres of porn. New genres that induce shock, surprise, violation of expectations or even anxiety can function to increase sexual arousal, and in porn users whose response to stimuli is growing blunted due to overuse, this phenomenon is extremely common.

Norman Doidge MD wrote about this in his book The Brain That Changes Itself:

The current porn epidemic gives a graphic demonstration that sexual tastes can be acquired. Pornography, delivered by high-speed Internet connections, satisfies every one of the prerequisites for neuroplastic change…. When pornographers boast that they are pushing the envelope by introducing new, harder themes, what they don’t say is that they must, because their customers are building up a tolerance to the content. The back pages of men’s risque magazines and Internet porn sites are filled with ads for Viagra-type drugs—medicine developed for older men with erectile problems related to aging and blocked blood vessels in the penis. Today young men who surf porn are tremendously fearful of impotence, or “erectile dysfunction” as it is euphemistically called. The misleading term implies that these men have a problem in their penises, but the problem is in their heads, in their sexual brain maps. The penis works fine when they use pornography. It rarely occurs to them that there may be a relationship between the pornography they are consuming and their impotence.

And here’s the 2017 evidence from PornHub that real sex is decreasingly interesting to porn users. Porn isn’t enabling people to find their “real” tastes; it’s driving them beyond normal into extreme novelty and “unreal” genres:

It appears that the trend is moving more toward fantasy than reality. ‘Generic’ porn is being replaced with fantasy specific or scenario specific scenes.  Is this as a result of boredom or curiosity? One thing is certain; the typical ‘in-out, in-out’ no longer satisfies the masses, who are clearly looking for  something different” notes Dr Laurie Betito.

Employing various methodologies and approaches various studies have reported habituation to “regular porn” along with escalation into more extreme and unusual genres:


FIRST STUDY: To date only one study has directly asked problematic porn users about escalation: “Online sexual activities: An exploratory study of problematic and non-problematic usage patterns in a sample of men” (2016). The study reports escalation, as 49% of the men reported viewing porn that was not previously interesting to them or that they once considered disgusting. An excerpt:

Forty-nine percent mentioned at least sometimes searching for sexual content or being involved in OSAs that were not previously interesting to them or that they considered disgusting.

This Belgian study also found problematic Internet porn use was associated with reduced erectile function and reduced overall sexual satisfaction. Yet problematic porn users experienced greater cravings (OSA’s = online sexual activity, which was porn for 99% of subjects). Interestingly, 20.3% of participants said that one motive for their porn use was “to maintain arousal with my partner.” An excerpt:

This study is the first to directly investigate the relationships between sexual dysfunctions and problematic involvement in OSAs. Results indicated that higher sexual desire, lower overall sexual satisfaction, and lower erectile function were associated with problematic OSAs (online sexual activities). These results can be linked to those of previous studies reporting a high level of arousability in association with sexual addiction symptoms (Bancroft & Vukadinovic, 2004; Laier et al., 2013; Muise et al., 2013).


SECOND STUDY: The Dual Control Model: The Role Of Sexual Inhibition & Excitation In Sexual Arousal And Behavior,” 2007. Indiana University Press, Editor: Erick Janssen, pp.197-222.  In an experiment employing video porn, 50% of the young men couldn’t become aroused or achieve erections with porn (average age was 29). The shocked researchers discovered that the men’s erectile dysfunction was,

 related to high levels of exposure to and experience with sexually explicit materials.

The men experiencing erectile dysfunction had spent a considerable amount of time in bars and bathhouses where porn was “omnipresent,” and “continuously playing.” The researchers stated:

Conversations with the subjects reinforced our idea that in some of them a high exposure to erotica seemed to have resulted in a lower responsivity to “vanilla sex” erotica and an increased need for novelty and variation, in some cases combined with a need for very specific types of stimuli in order to get aroused.


THIRD & FOURTH STUDIES: Both found that deviant (i.e., bestiality or minor) pornography users reported a significantly younger onset of adult pornography use. These studies confirm that early porn use is related to escalation to more extreme material.

1) “Does deviant pornography use follow a Guttman-like progression?” (2013). An excerpt:

Results suggested deviant pornography use followed a Guttman-like progression in that individuals with a younger “age of onset” for adult pornography use were more likely to engage in deviant pornography (bestiality or child) compared to those with a later “age of onset”.

2) “Deviant Pornography Use: The Role of Early-Onset Adult Pornography Use and Individual Differences” (2016). An excerpt:

Results indicated that adult + deviant pornography users scored significantly higher on openness to experience and reported a significantly younger age of onset for adult pornography use compared to adult-only pornography users.


FIFTH STUDY: “Brain Structure and Functional Connectivity Associated With Pornography Consumption: The Brain on Porn” (Kuhn & Gallinat, 2014) – This Max Planck Institute fMRI study found less grey matter in the reward system (dorsal striatum) correlating with the amount of porn consumed. It also found that more porn use correlated with less reward circuit activation while briefly viewing sexual photos. Researchers believe their findings indicated desensitization, and possibly tolerance, which is the need for greater stimulation to achieve the same level of arousal. Lead author Simone Kühn said the following about her study:

That could mean that regular consumption of pornography more or less wears out your reward system. We assume that subjects with a high porn consumption need increasing stimulation to receive the same amount of reward. That would fit perfectly the hypothesis that their reward systems need growing stimulation.

Furthermore, in May, 2016. Kuhn & Gallinat published this review – Neurobiological Basis of Hypersexuality. In the review Kuhn & Gallinat describe their 2014 fMRI study:

In a recent study by our group, we recruited healthy male participants and associated their self-reported hours spent with pornographic material with their fMRI response to sexual pictures as well as with their brain morphology (Kuhn & Gallinat, 2014). The more hours participants reported consuming pornography, the smaller the BOLD response in left putamen in response to sexual images. Moreover, we found that more hours spent watching pornography was associated with smaller gray matter volume in the striatum, more precisely in the right caudate reaching into the ventral putamen. We speculate that the brain structural volume deficit may reflect the results of tolerance after desensitization to sexual stimuli.


SIXTH STUDY:Novelty, conditioning and attentional bias to sexual rewards” (2015). Cambridge University fMRI study reporting greater habituation to sexual stimuli in compulsive porn users. An excerpt:

Online explicit stimuli are vast and expanding, and this feature may promote escalation of use in some individuals. For instance, healthy males viewing repeatedly the same explicit film have been found to habituate to the stimulus and find the explicit stimulus as progressively less sexually arousing, less appetitive and less absorbing (Koukounas and Over, 2000). … We show experimentally what is observed clinically that Compulsive Sexual Behavior is characterized by novelty-seeking, conditioning and habituation to sexual stimuli in males.

FROM THE RELATED PRESS RELEASE:

The researchers found that sex addicts were more likely to choose the novel over the familiar choice for sexual images relative to neutral object images, whereas healthy volunteers were more likely to choose the novel choice for neutral human female images relative to neutral object images.

“We can all relate in some way to searching for novel stimuli online – it could be flitting from one news website to another, or jumping from Facebook to Amazon to YouTube and on,” explains Dr Voon. “For people who show compulsive sexual behaviour, though, this becomes a pattern of behaviour beyond their control, focused on pornographic images.”

In a second task, volunteers were shown pairs of images – an undressed woman and a neutral grey box – both of which were overlaid on different abstract patterns. They learned to associate these abstract images with the images, similar to how the dogs in Pavlov’s famous experiment learnt to associate a ringing bell with food. They were then asked to select between these abstract images and a new abstract image.

This time, the researchers showed that sex addicts where more likely to choose cues (in this case the abstract patterns) associated with sexual and monetary rewards. This supports the notion that apparently innocuous cues in an addict’s environment can ‘trigger’ them to seek out sexual images.

“Cues can be as simple as just opening up their internet browser,” explains Dr Voon. “They can trigger a chain of actions and before they know it, the addict is browsing through pornographic images. Breaking the link between these cues and the behaviour can be extremely challenging.”

The researchers carried out a further test where 20 sex addicts and 20 matched healthy volunteers underwent brain scans while being shown a series of repeated images – an undressed woman, a £1 coin or a neutral grey box.

They found that when the sex addicts viewed the same sexual image repeatedly, compared to the healthy volunteers they experienced a greater decrease of activity in the region of the brain known as the dorsal anterior cingulate cortex, known to be involved in anticipating rewards and responding to new events. This is consistent with ‘habituation’, where the addict finds the same stimulus less and less rewarding – for example, a coffee drinker may get a caffeine ‘buzz’ from their first cup, but over time the more they drink coffee, the smaller the buzz becomes.

This same habituation effect occurs in healthy males who are repeatedly shown the same porn video. But when they then view a new video, the level of interest and arousal goes back to the original level. This implies that, to prevent habituation, the sex addict would need to seek out a constant supply of new images. In other words, habituation could drive the search for novel images.

“Our findings are particularly relevant in the context of online pornography,” adds Dr Voon. “It’s not clear what triggers sex addiction in the first place and it is likely that some people are more pre-disposed to the addiction than others, but the seemingly endless supply of novel sexual images available online helps feed their addiction, making it more and more difficult to escape.” [emphasis added]


SEVENTH STUDY: Exploring the effect of sexually explicit material on the sexual beliefs, understanding and practices of young men: A qualitative survey. An excerpt:

Findings suggest that the key themes are: increased levels of availability of SEM, including an escalation in extreme content (Everywhere You Look) which are seen by young men in this study as having negative effects on sexual attitudes and behaviours (That’s Not Good). Family or sex education may offer some ‘protection’ (Buffers) to the norms young people see in SEM. Data suggests confused views (Real verses Fantasy) around adolescents’ expectations of a healthy sex life (Healthy Sex Life) and appropriate beliefs and behaviours (Knowing Right from Wrong). A potential causal  pathway is described and areas of intervention highlighted.


EIGHTH STUDY: Modulation of Late Positive Potentials by Sexual Images in Problem Users and Controls Inconsistent with “Porn Addiction” (2015)  (Prause et al., 2015.)

The results: compared to controls “individuals experiencing problems regulating their porn viewing” had lower brain responses to one-second exposure to photos of vanilla porn. The lead author, Nicole Prause, claims these results “debunk porn addiction.” If porn use had no effect on Prause et al’s. subjects, we would expect controls and the frequent porn users to have the same LPP amplitude in response to sexual photos. Instead, the more frequent porn users had less brain activation (lower LPP). In reality, the findings of Prause et al. 2015 align perfectly with Kühn & Gallinat (2014), which found that more porn use correlated with less brain activation in response to pictures of vanilla porn.

Prause’s findings also align with Banca et al. 2015 which is #6 above. Moreover, another EEG study found that greater porn use in women correlated with less brain activation to porn. Lower EEG readings mean that subjects are paying less attention to the pictures. Put simply, frequent porn users were desensitized to static images of vanilla porn. They were bored (habituated or desensitized). Five peer-reviewed papers agree with this extensive critique that this study actually found desensitization/habituation in frequent porn users: 1, 2, 3, 4, 5.


NINTH STUDY: Unusual masturbatory practice as an etiological factor in the diagnosis and treatment of sexual dysfunction in young men (2014). One of the 4 case studies in this paper reports on a man with porn-induced sexual problems (low libido, multiple porn fetishes, anorgasmia). The sexual intervention called for a 6-week abstinence from porn and masturbation. After 8 months the man reported increased sexual desire, successful sex and orgasm, and enjoying “good sexual practices. Excerpts from the paper documenting the patient’s habituation and escalation into what he described as more extreme porn genres:

When asked about masturbatory practices, he reported that in the past he had been masturbating vigorously and rapidly while watching pornography since adolescence. The pornography originally consisted mainly of zoophilia, and bondage, domination, sadism, and masochism, but he eventually got habituated to these materials and needed more hardcore pornography scenes, including transgender sex, orgies, and violent sex. He used to buy illegal pornographic movies on violent sex acts and rape and visualized those scenes in his imagination to function sexually with women. He gradually lost his desire and his ability to fantasize and decreased his masturbation frequency.

An excerpt from the paper documents the patient’s recovery from porn-induced sexual problems and fetishes:

In conjunction with weekly sessions with a sex therapist, the patient was instructed to avoid any exposure to sexually explicit material, including videos, newspapers, books, and internet pornography. After 8 months, the patient reported experiencing successful orgasm and ejaculation. He renewed his relationship with that woman, and they gradually succeeded in enjoying good sexual practices.


TENTH STUDY: Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports (2016) is an extensive review of the literature related to porn-induced sexual problems. Authored by US Navy doctors, the review provides the latest data revealing a tremendous rise in youthful sexual problems. It also reviews the neurological studies related to porn addiction and sexual conditioning via Internet porn. The doctors include 3 clinical reports of servicemen who developed porn-induced sexual dysfunctions. Two of the three servicemen healed their sexual dysfunctions by eliminating porn use while the third man experienced little improvement as he was unable to abstain from porn use. Two of the three servicemen reported habituation to current porn and escalation of porn use. The first servicemen describes his habituation to “soft porn” followed by escalation into more graphic and fetish porn:

A 20-year old active duty enlisted Caucasian serviceman presented with difficulties achieving orgasm during intercourse for the previous six months. It first happened while he was deployed overseas. He was masturbating for about an hour without an orgasm, and his penis went flaccid. His difficulties maintaining erection and achieving orgasm continued throughout his deployment. Since his return, he had not been able to ejaculate during intercourse with his fiancée. He could achieve an erection but could not orgasm, and after 10–15 min he would lose his erection, which was not the case prior to his having ED issues.

Patient endorsed masturbating frequently for “years”, and once or twice almost daily for the past couple of years. He endorsed viewing Internet pornography for stimulation. Since he gained access to high-speed Internet, he relied solely on Internet pornography. Initially, “soft porn”, where the content does not necessarily involve actual intercourse, “did the trick”. However, gradually he needed more graphic or fetish material to orgasm. He reported opening multiple videos simultaneously and watching the most stimulating parts. [emphasis added]

The second servicemen describes increased porn use and escalation into more graphic porn. Soon thereafter sex with his wife “not as stimulating as before”:

A 40-year old African American enlisted serviceman with 17 years of continuous active duty presented with difficulty achieving erections for the previous three months. He reported that when he attempted to have sexual intercourse with his wife, he had difficulty achieving an erection and difficulty maintaining it long enough to orgasm. Ever since their youngest child left for college, six months earlier, he had found himself masturbating more often due to increased privacy. He formerly masturbated every other week on average, but that increased to two to three times per week. He had always used Internet pornography, but the more often he used it, the longer it took to orgasm with his usual material. This led to him using more graphic material. Soon thereafter, sex with his wife was “not as stimulating” as before and at times he found his wife “not as attractive”. He denied ever having these issues earlier in the seven years of their marriage. He was having marital issues because his wife suspected he was having an affair, which he adamantly denied. [emphasis added]


ELEVENTH STUDY: Shifting Preferences In Pornography Consumption (1986)  Six weeks of exposure to nonviolent pornography resulted in subjects having little interest in vanilla porn, electing to almost exclusively watch “uncommon pornography” (bondage, sadomasochism, bestiality). An excerpt:

Male and female students and nonstudents were exposed to one hour of common, nonviolent pornography or to sexually and aggressively innocuous materials in each of six consecutive weeks. Two weeks after this treatment, they were provided with an opportunity to watch videotapes in a private situation. G-rated, R-rated, and X-rated programs were available. Subjects with considerable prior exposure to common, nonviolent pornography showed little interest in common, nonviolent pornography, electing to watch uncommon pornography (bondage, sadomasochism, bestiality) instead. Male nonstudents with prior exposure to common, nonviolent pornography consumed uncommon pornography almost exclusively. Male students exhibited the same pattern, although somewhat less extreme. This consumption preference was also in evidence in females, but was far less pronounced, especially among female students. [emphasis added]


TWELFTH STUDY: Examining Correlates of Problematic Internet Pornography Use Among University Students (2016) Addictive use of internet porn, which is associated with poorer psychosocial functioning, emerges when people begin to use IP daily.

Age of first exposure to IP was found to be significantly correlated with frequent and addictive IP use (see Table 2). Participants who were exposed to IP at an earlier age were more likely to use IP more frequently, have longer IP sessions,and more likely to score higher on Adapted DSM-5 Internet Pornography Addiction Criteria and CPUI-COMP measures. Finally, total IP exposure was found to be significantly correlated with higher frequency of IP use. Participants who had longer total exposure to IP were also more likely to have more IP sessions per month.


THIRTEENTH STUDY: The Relationship between Frequent Pornography Consumption, Behaviors, and Sexual Preoccupancy among Male Adolescents in Sweden Porn use in 18-year old males was universal, and frequent porn users preferred hard-core porn. Does this indicate escalation of porn use?

Among frequent users, the most common type of pornography consumed was hard core pornography (71%) followed by lesbian pornography (64%), while soft core pornography was the most commonly selected genre for average (73%) and infrequent users (36%). There was also a difference between the groups in the proportion who watched hard core pornography (71%, 48%, 10%) and violent pornography (14%, 9%, 0%).

The authors suggest that frequent porn may ultimately lead to a preference for hard-core or violent pornography:

It is also noteworthy that a statistically significant relationship was found between fantasizing about pornography several times a week and watching hard core pornography. Since verbal and physical sexual aggression is so commonplace in pornography, what most adolescents considered hard core pornography could likely be defined as violent pornography. If this is the case, and in light of the suggested cyclical nature of sexual preoccupancy in Peter and Valkenburg,it may be that rather than ‘purging’ individuals of their fantasies and inclinations of sexual aggression, watching hard core pornography perpetuates them, thereby increasing the likelihood of manifested sexual aggression


FOURTEENTH STUDY: The Development of the Problematic Pornography Consumption Scale (PPCS) (2017) – This paper developed and tested a problematic porn use questionnaire that was modeled after substance addiction questionnaires. Unlike previous porn addiction tests, this 18-item questionnaire assessed tolerance and withdrawal with the following 6 questions:

———-

Each question was scored from one to seven on a likert scale: 1- Never, 2- Rarely, 3- Occasionally, 4- Sometimes, 5- Often, 6- Very Often, 7- All the Time. The graph below grouped porn users into 3 categories based on their total scores:  “Nonprobelmatic,” “Low risk,” and “At risk.” The yellow line indicates no problems, which means that the “Low risk” and “At risk” porn users reported both tolerance and withdrawal. Put simply, this study actually asked about escalation (tolerance) and withdrawal – and both are reported by some porn users. End of debate.


STUDY FIFTEEN: Out-of-control use of the internet for sexual purposes as behavioural addiction? An upcoming study (presented at the 4th International Conference on Behavioral Addictions February 20–22, 2017) which asked about tolerance and withdrawal. It found both in “porn addicts”.

Anna Ševčíková1, Lukas Blinka1 and Veronika Soukalová1

1Masaryk University, Brno, Czech Republic

Background and aims:

There is an ongoing debate whether excessive sexual behaviour should be understood as a form of behavioural addiction (Karila, Wéry, Weistein et al., 2014). The present qualitative study aimed at analysing the extent to which out-of-control use of the internet for sexual purposes (OUISP) may be framed by the concept of behavioural addiction among those individuals who were in treatment due to their OUISP.

Methods:

We conducted in-depth interviews with 21 participants aged 22–54 years (Mage = 34.24 years). Using a thematic analysis, the clinical symptoms of OUISP were analysed with the criteria of behavioural addiction, with the special focus on tolerance and withdrawal symptoms (Griffiths, 2001).

Results:

The dominant problematic behaviour was out-of-control online pornography use (OOPU). Building up tolerance to OOPU manifested itself as an increasing amount of time spent on pornographic websites as well as searching for new and more sexually explicit stimuli within the non-deviant spectrum. Withdrawal symptoms manifested themselves on a psychosomatic level and took the form of searching for alternative sexual objects. Fifteen participants fulfilled all of the addiction criteria.

Conclusions:

The study indicates a usefulness for the behavioural addiction framework


 

Interesting 2016 study, which apparently did not ask whether tastes changed over time (escalation):

Some of you may remember A Billion Wicked Thoughts and the claim of co-author Ogas that sexual tastes are stable. Here’s an excerpt from an Ogas blog post on Psychology Today:

“There is no evidence that viewing porn activates some kind of neural mechanism leading one down a slippery slope of seeking more and more deviant material, and plenty of evidence suggesting that adult men’s sexual interests are stable.”

However, this new study casts doubt on that assumption with respect to today’s (streaming) internet pornography. Sexually Explicit Media Use by Sexual Identity: A Comparative Analysis of Gay, Bisexual, and Heterosexual Men in the United States. Excerpt from this new study:

The findings also indicated that many men viewed SEM content inconsistent with their stated sexual identity. It was not uncommon for heterosexual-identified men to report viewing SEM containing  male same-sex behavior (20.7%) and for gay-identified men to report viewing heterosexual behavior in SEM (55.0%). It was also not uncommon for gay men to report that they viewed vaginal sex with  13.9%) and without a condom (22.7%) during the past 6 months.

This study, taken together with others mentioned above, debunks the meme that today’s porn users eventually “discover their true sexuality” by surfing tube sites, and then stick to only one genre of porn for the rest of time.

Is Joshua Grubbs pulling the wool over our eyes with his “perceived porn addiction” research?

INTRODUCTION

A new concept has recently appeared in a rash of papers and articles: “perceived porn addiction.” It was cooked up by Joshua Grubbs and thoroughly examined in the YBOP analysis: Critique of “Perceived Addiction to Internet Pornography and Psychological Distress: Examining Relationships Concurrently and Over Time” (2015). Here are a few of the headlines birthed from that study:

  • Watching Porn Is OK. Believing In Porn Addiction Is Not
  • Perceived Addiction To Porn Is More Harmful Than Porn Use Itself
  • Believing You Have Porn Addiction Is the Cause of Your Porn Problem, Study Finds

Here we revisit Joshua Grubbs’s work as he continues to publish “perceived porn addiction” papers. In this 2015 press release Grubbs suggests that pornography use itself doesn’t cause any problems:

It doesn’t seem to be the pornography itself that is causing folks problems, it’s how they feel about it,

“Perceived addiction involves a negative interpretation of your own behavior, thinking about yourself, like, ‘I have no power over this’ or ‘I’m an addict, and I can’t control this.’

Grubbs sums up his views in this extraordinary 2016 Psychology Today article, claiming that porn addiction is nothing more than religious shame.

Being labeled “porn addict” by a partner, or even by oneself, has nothing to do with the amount of porn a man views, says Joshua Grubbs, assistant professor of psychology at Bowling Green University. Instead, it has everything to do with religiosity and moral attitudes toward sex. In short, he says, “It’s shame-motivated.”…

….Grubbs calls it “perceived pornography addiction.” “It functions very differently from other addictions.”

If Josuha Grubbs was accurately quoted, the above claims border on propaganda  as we will show that:

  1. Grubbs’s questionnaire assesses only actual porn addiction, not “perceived porn addiction.” That porn addiction doesn’t “function differently from other addictions,” and that Grubbs has not shown that it does. In fact, Grubbs based his questionnaire on (standard) drug addiction questionnaires.
  2. Contrary to his statement above, the amount of porn used is strongly related to scores on Grubbs’s porn addiction questionnaire (CPUI). In fact, Grubbs’s studies reveal that porn addiction (CPUI sections 2 & 3) is far more related to the amount of porn viewed than it is to religiosity.
  3. Moreover, “hours of use” are not a reliable measure of (proxy for) addiction. Previous studies have established that “hours of porn viewed” aren’t linearly correlated with porn addiction scores or symptoms. Many additional variables of use also contribute to the development of a porn addiction.

Beyond these evident challenges to Grubbs’s “porn addiction is only religious shame” claim, his model crumbles when we consider that:

  1. Religious shame doesn’t induce brain changes that mirror those found in drug addicts. Yet there are now 33 neurological studies reporting addiction-related brain changes in compulsive porn users/sex addicts.
  2. The preponderance of studies report lower rates of compulsive sexual behavior and porn use in religious individuals (study 1, study 2, study 3, study 4, study 5, study 6, study 7, study 8, study 9, study 10, study 11, study 12, study 13, study 14, study 15, study 16, study 17, study 18, study 19). This means Grubbs’s sample of religious porn users is inevitably skewed (see below). It also means that “religiosity” does not predict porn addiction.
  3. Many atheists and agnostics develop porn addiction. Two 2016 studies on men who had used porn in the last the last 6 months, or in the last 3 months, reported extraordinarily high rates of compulsive porn use (28% for both studies).
  4. “Perceived addiction” obviously couldn’t induce chronic erectile dysfunction, low libido and anorgasmia in healthy young men. Yet numerous studies link porn use to sexual dysfunctions and lower sexual satisfaction, and ED rates have inexplicably skyrocketed by 1000% in men under 40 since “tube” porn arrived in porn users’ lives.
  5. This 2016 study on treatment-seeking porn addicts found that religiosity did not correlate with negative symptoms or scores on a sex addiction questionnaire.
  6. This 2016 study on treatment-seeking hypersexuals found no relationship between religious commitment and self-reported levels of hypersexual behavior and related consequences.

In the following sections we will address Grubbs’s major claims, look deeper into his data and methodology, and suggest alternative explanations for his claim that religiosity is related to porn addiction. But first let’s start with the 3 pillars upon which Grubbs builds his assorted papers.

For Grubbs’s claims to be valid ALL of these 3 must be true and supported by actual research:

1) The Grubbs Cyber Pornography Use Inventory (CPUI) must assess “perceived porn addiction” rather than actual porn addiction.

  • It does not. The CPUI assesses actual porn addiction, as Grubbs himself stated in his original 2010 paper validating the CPUI (more below). In fact, the CPUI was only validated as an actual porn addiction test, and never as a “perceived addiction” test. With no supporting scientific justification, in 2013, Grubbs unaccountably re-labeled his porn addiction test a “perceived porn addiction” test.
  • Note: In Grubbs’s studies he uses the phrase “perceived addiction” or “perceived porn addiction” to denote the total score on his CPUI test (an actual porn addiction test). This is lost in translation due to the frequent repetition of “perceived addiction,” instead of the accurate, spin-free label: “the Cyber Pornography Use Inventory score.”

2) Grubbs must have found little to no correlation between hours of use and CPUI scores (porn addiction).

  • No again. For example, Grubbs et al. 2015 reveals a strong correlation between hours of use and CPUI scores. From p. 6 of the study:

“Additionally, average daily pornography use in hours was significantly and positively associated with depression, anxiety, and anger, as well as with perceived addiction [total CPUI score].

  • Grubbs’s second 2015 study reported a stronger correlation between CPUI scores and “hours of porn use” than it did between CPUI scores and religiosity.

How could Grubbs claim in Psychology Today that porn addiction “has nothing to do with the amount of porn a man views,” when his studies reveal that quantity of use was “significantly and positively” correlated with CPUI scores?

3) Other studies must have reported that the amount porn used is linearly correlated with symptoms of porn addiction or scores on porn addiction tests.

  • They did not. Other research teams have found that the variable “hours of use” is not linearly correlated with cybersex addiction (or video-gaming addiction). That is, addiction is more reliably predicted by other variables than “hours of use” anyway, so the materiality of Grubbs’s claims is questionable even if his methodology were sound and his claims were accurate. (Not the case.) “Hours of use” is not a reliable proxy for “porn addiction,” so neither correlations with it nor lack of correlations with it can have the vast significance Grubbs presumes.

Most of the Grubbs-generated headlines and claims depend upon all 3 of the above points being true. They are not. We now examine these 3 pillars and the details surrounding Grubbs’s studies and claims.


SECTION 1: The Myth of “Perceived” Porn Addiction:

The Cyber Pornography Use Inventory (CPUI): It’s an actual addiction test.

Important to note:

  • Whenever Grubbs uses the phrase “perceived addiction” he really means the total score on his CPUI.
  • The CPUI is divided into 3 sections, which becomes very important later on as we examine how scores on each section correlate with other variables such as “hours of use” and “religiosity.”
  • Each question is scored using a Likert scale of 1 to 7, with 1 being “not at all,” and 7 being “extremely.”

COMPULSIVITY:

1. I believe I am addicted to Internet pornography.

2. I feel unable to stop my use of online pornography.

3. Even when I do not want to view pornography online, I feel drawn to it

ACCESS EFFORTS:

4. At times, I try to arrange my schedule so that I will be able to be alone in order to view pornography.

5. I have refused to go out with friends or attend certain social functions to have the opportunity to view pornography.

6. I have put off important priorities to view pornography.

EMOTIONAL DISTRESS:

7. I feel ashamed after viewing pornography online.

8. I feel depressed after viewing pornography online.

9. I feel sick after viewing pornography online.

In reality, Grubbs’s Cyber Pornography Use Inventory (CPUI) questionnaire is very similar to many other drug and behavioral addiction questionnaires. Like other addiction tests, the CPUI assesses behaviors and symptoms common to all addictions, such as: the inability to control use; compulsion to use, cravings to use, negative psychological, social and emotional effects; and preoccupation with using. In fact, only 1 of the 9 CPUI questions above even hints at “perceived addiction.”

Yet we are told that a person’s total score for all 9 questions is synonymous with “perceived addiction” rather than addiction itself. Very misleading, very clever, and without any scientific basis. Agnotology fodder, anyone? (Agnotology is the study of culturally induced ignorance or doubt, particularly the publication of inaccurate or misleading scientific data designed to confuse the public about the state of research in a particular field. Big Tobacco is credited with inventing the field of agnotology.)

Note that decades of established addiction assessment tests for both chemical and behavioral addictions rely on similar questions as the CPUI to assess actual, not merely perceived, addiction. CPUI questions 1-6 assess core addiction behaviors as outlined by the 4 Cs, while questions 7-9 evaluate negative emotional states after using porn. Let’s compare the CPUI to a commonly used addiction assessment tool known as the “4 Cs.” The CPUI questions that correlate with the four Cs are noted as well.

  • Compulsion to use (2, 3)
  • Inability to Control use (2, 3, maybe 4-6)
  • Cravings to use (3 especially, but 1-6 could be interpreted as cravings)
  • Continued use despite negative consequences (4-6, perhaps 7-9)

Addiction experts rely on assessment tools like the 4Cs as indicating addiction because neuroscientists have correlated the symptoms those questions with underlying addiction-related brain changes in decades of basic-research studies. See the public policy statement of the American Society of Addiction Medicine. In short, the Grubb’s CPUI is an actual porn addiction test; it was never validated for “perceived addiction.”

The initial 2010 Grubbs study said the CPUI assessed actual porn addiction

In Grubbs’s initial 2010 paper he validated the Cyber-Pornography Use Inventory (CPUI) as a questionnaire assessing actual porn addiction. The phrases “perceived addiction” and “perceived porn addiction” do not appear in his 2010 paper. To the contrary, Grubbs et al., 2010 clearly states in several places that the CPUI assesses genuine porn addiction:

The previously described models proposed for understanding behavioral addictions were the primary theoretical assumptions used to derive the instrument for this study, the Cyber-Pornography Use Inventory (CPUI), patterned after the Internet Sex Screening Test developed by Delmonico (Delmonico & Griffin, 2008). The CPUI design was based on the principle that addictive behavior is characterized by an inability to stop the behavior, significant negative effects as a result of the behavior, and a generalized obsession with the behavior (Delmonico & Miller, 2003).

The CPUI does indeed show promise as an instrument assessing Internet pornography addiction. Whereas previous instruments, such as the ISST, had assessed only broad-spectrum online sexual addiction, this scale did demonstrate promise in specifically assessing Internet pornography addiction. Furthermore, the items on the previously explained Addictive Patterns scale seem to find some level of theoretical support and potential construct validity when compared with the diagnostic criteria for both Substance Dependence and Pathological Gambling, an ICD.

Finally, five of the items on the Addictive Patterns scale from the original Compulsivity scale seem to directly tap into the individual’s perceived or actual inability to stop the behavior in which they are engaging. Inability to stop a problematic behavior under any circumstances is not only an important diagnostic criterion for both SD and PG, but it can also can be thought of as one of the core elements of both addiction, as manifested in SD, and ICDs (Dixon et al., 2007; Potenza, 2006). It seems that it is this inability that creates the disorder.

In a 2013 study Grubbs reduced the number of CPUI questions from 32 (or 39 or 41) to the current 9, and re-labeled his actual, validated porn addiction test as a “perceived porn addiction” test (here’s a 41-question version of the CPUI). He did so without any explanation or justification and proceeded to use the phrase “perceived addiction” 80 times in his 2013 paper. That said, Grubbs hinted at the true nature of the CPUI-9 in this excerpt from the 2013 paper:

“Last, we found that the CPUI-9 was strongly positively associated with general hypersexual tendencies, as measured by the Kalichman Sexual Compulsivity Scale. This points to the high degree of interrelatedness between compulsive pornography use and hypersexuality more generally.”

Let’s be very clear – the CPUI was never validated as an assessment test differentiating actual porn addiction from “perceived porn addiction.” This means the public is relying only on Grubbs’s word that his revised test can differentiate between “perceived porn addiction” and the “actual porn addiction” the CPUI was originally validated to assess. How scientific is it to re-label a validated test as something altogether different without validating the radically altered use of the test?

Why did Joshua Grubbs re-label the CPUI a “perceived” porn addiction test?

While Grubbs himself didn’t claim his test could sort perceived from actual addiction, his employment of the misleading term (“perceived addiction”) for scores on his CPUI-9 instrument have led others to assume his instrument has the magical property of being able to discriminate between “perceived” and “real” addiction. This has done enormous damage to the field of porn addiction assessment because others rely on his papers as evidence of something they do not, and cannot, deliver. No test exists that can distinguish “real” from “perceived” addiction. Merely labeling it as such cannot make it so.

Joshua Grubbs said in an email that a reviewer of his second CPUI-9 study caused him and his co-authors of the 2013 study to alter the “porn addiction” terminology of the CPUI-9 (because the reviewer sneered at the “construct” of porn addiction). This is why Grubbs changed his description of the test to a “perceived pornography addiction” questionnaire. In essence an anonymous reviewer/editor at this single journal initiated the unsupported, misleading label of “perceived pornography addiction.” The CPUI has never been validated as an assessment test differentiating actual porn addiction from “perceived porn addiction.” Here’s Grubbs tweeting about this process, including the reviewer’s comments:

Josh Grubbs‏ @JoshuaGrubbsPhD

On my 1st paper on compulsive porn use: “This construct [porn addiction] is as meaningful to measure as experiences of alien abduction: it’s meaningless.”

Nicole R Prause, PhD‏ @NicoleRPrause

You or reviewer?

Josh Grubbs‏ @JoshuaGrubbsPhD

Reviewer said it to me

Josh Grubbs‏ @JoshuaGrubbsPhD  Jul 14

Actually what led to my perceived addiction work, I thought about the comments as revised the focus.

There’s no historical precedent for a “perceived addiction” assessment test

The two studies Grubbs consistently cites (1, 2) to imply that his concept of “perceived addiction” is established/legitimate were done on smokers, and neither supports the concept of “perceived addiction” as Grubbs uses it. First, neither study suggests, as Grubbs does with porn, that actual cigarette addiction doesn’t exist. Nor did either of those studies claim to have developed a questionnaire that could distinguish or isolate “perceived addiction” from actual addiction. Both studies focused instead on assessing how future success in quitting smoking related to earlier self-reports of addiction.

There is no questionnaire for “perceived addiction” to anything – substance or behavior – including pornography use (regardless of Grubbs’s claims). There’s a good reason ‘Google Scholar’ returns zero results for the following “perceived addictions”:

Other researchers predictably use the CPUI as an actual porn addiction test

Reality check: other researchers describe the CPUI as an actual porn addiction assessment questionnaire (as that’s what it was validated as), and use it as such in their published studies:

  1. An Examination of Internet Pornography Usage among Male Students at Evangelical Christian Colleges (2011)
  2. Questionnaires and scales for the evaluation of the online sexual activities: A review of 20 years of research (2014)
  3. Problematic cybersex: Conceptualization, assessment, and treatment (2015)
  4. Clarifying the Links Among Online Gaming, Internet Use, Drinking Motives, and Online Pornography Use (2015)
  5. Cyberpornography: Time Use, Perceived Addiction, Sexual Functioning, and Sexual Satisfaction (2016)
  6. Examining Correlates of Problematic Internet Pornography Use Among University Student (2016)

The last study above used a longer version of the Grubbs CPUI and an Internet pornography addiction questionnaire derived from the DSM-5 Internet video-gaming addiction criteria. The graphs below show the same subjects scores on the two different porn addiction questionnaires:

——

No surprise: very similar results and distribution for the Grubbs CPUI and the researchers’ DSM-5-based porn addiction questionnaire. If the CPUI could differentiate “perceived addiction” from “actual addiction” the graphs and distributions would be sharply dissimilar. They are not.

Suggestion: whenever you read a Grubbs paper or a Grubbs sound-bite in the media, eliminate the word “perceived” and see how differently it reads – and how it aligns with other research on porn addiction. For example, two sentences from the introduction of a Grubbs’s paper with the word “perceived” deleted:

Addiction to Internet pornography is associated with lower levels of well-being. Recent research has found porn addiction to be related to anxiety, depression, and stress (Grubbs, Stauner, Exline, Pargament, & Lindberg, 2015; Grubbs, Volk et al., 2015).

Eliminate the unsupported claim that the CPUI assesses “perceived porn addiction” and we have completely different study results and no misleading headlines. Again, such actual findings of porn addiction being associated with anxiety, depression and stress align with decades of “actual,” not “perceived,” addiction research. Inability to control use is distressing.


SECTION 2: Claimed Correlations? “Hours of use” and “Religiosity”

Contrary to Grubbs’s claim the amount of porn viewed is significantly related to porn addiction scores (CPUI)

While we will see that “hours of use” is never used as the sole proxy for addiction, media sound-bites claim that Grubbs found no relationship between “hours of porn use” and scores on the porn addiction test (CPUI). This is not the case. Let’s start with Grubb’s 2013 study that decreed (by fiat) the CPUI-9 a “perceived porn addiction” test:

“Scores on the total CPUI-9, the compulsivity subscale, and the access efforts subscale were all associated with increased use of online pornography, indicating that perceived addiction [total CPUI score] is related to greater frequency of use.”

Remember “perceived addiction” is shorthand for the total CPUI score. As described earlier, this 2015 Grubbs study reported a pretty strong correlation between hours of use and CPUI scores. From p. 6 of the study:

“Additionally, average daily pornography use in hours was significantly and positively associated with depression, anxiety, and anger, as well as with perceived addiction [total CPUI score].”

In other words, contrary to the headlines and Grubbs’s claims in the press, subjects’ total CPUI-9 scores were significantly associated with hours of porn use. But how does “average daily pornography use in hours” compare with religiosity? Which is more correlated with the CPUI- total score?

We will use data from a 2015 Grubbs paper (“Transgression as Addiction: Religiosity and Moral Disapproval as Predictors of Perceived Addiction to Pornography“), as it contains 3 separate studies and its provocative title suggests that religiosity causes porn addiction. Table 2 below contains data from 2 separate studies. These data reveal correlations between a few variables (hours of porn use; religiosity) and CPUI scores (entire CPUI-9 and broken down into the 3 CPUI subsections).

Tips for understanding the numbers in the table: zero means no correlation between two variables; 1.00 means a complete correlation between two variables. The bigger the number the stronger the correlation between the 2 variables. If a number has a minus sign, it means there’s a negative correlation between two things. (For example, there’s a negative correlation between exercise and heart disease. Thus, in normal language, exercise reduces the chances of heart disease. On the other hand, obesity has a positive correlation with heart disease.)

Highlighted below are the correlations between total CPUI-9 scores (#1) and “Use In Hours” (#5) and the “Religiosity Index (#6) for two of Grubbs’s studies:

The correlations between total CPUI scores and religiosity:

  • Study 1: 0.25
  • Study 2: 0.35
    • Average: 0.30

The correlations between total CPUI scores and “hours of porn use”:

  • Study 1: 0.30
  • Study 2: 0.32
    • Average 0.31

Shockingly, CPUI-9 scores have a slightly stronger relationship to “hours of porn use” than to religiosity! Put simply “hours of porn use” predicts porn addiction better than does religiosity. Yet the study’s abstract assures us that religiosity is “robustly related to perceived addiction” (CPUI scores). If this is the case, then “hours of porn use” are evidently also “robustly related” to scores on the CPUI. It’s curious how religiosity’s relationship to porn addiction is emphasized, while hours of use is overlooked or hidden by doublespeak.

There’s no other way to say this – Grubbs’s data flat out contradict his claims in the media and in his studies’ abstracts. To refresh your memory, Grubbs’s claims in this Psychology Today feature article:

Being labeled “porn addict” by a partner, or even by oneself, has nothing to do with the amount of porn a man views, says Joshua Grubbs, assistant professor of psychology at Bowling Green University. Instead, it has everything to do with religiosity…

In reality, the opposite is true: porn addiction is more related to hours of use than to religiosity. The next section will reveal that actual “porn addiction,” as measured by CPUI questions 1-6, is far more related to “hours of porn use” than it is to religiosity.

Grubbs’s studies reveal that actual porn addiction is far more related to “hours of porn use” than to religiosity

Grubbs found that porn addiction (CPUI-9 total score) is more strongly correlated with “current hours of porn use” than to religiosity. But you may be thinking, “Grubbs was right about one claim: porn addiction (CPUI scores) is related to religiosity.” Not really. In the next section we will see why this claim is not what it seems.

Sticking with Grubbs’s numbers for now, there is a relationship between actual porn addiction and religiosity. However, it’s far weaker than indicated in the previous section. Just as important, the correlation between actual porn addiction and “hours of porn use” is far stronger than indicated in the previous section.

On closer examination, questions 1-6 of the CPUI-9 assess the signs and symptoms common to all addictions, while questions 7-9 (Emotional Distress) assess guilt, shame and remorse. As a result, “actual addiction” closely aligns with questions 1-6 (Compulsivity & Access Efforts).

Compulsivity:

  1. I believe I am addicted to Internet pornography.
  2. I feel unable to stop my use of online pornography.
  3. Even when I do not want to view pornography online, I feel drawn to it

Access Efforts:

  1. At times, I try to arrange my schedule so that I will be able to be alone in order to view pornography.
  2. I have refused to go out with friends or attend certain social functions to have the opportunity to view pornography.
  3. I have put off important priorities to view pornography.

Emotional Distress:

  1. I feel ashamed after viewing pornography online.
  2. I feel depressed after viewing pornography online.
  3. I feel sick after viewing pornography online.

First, let’s examine the correlations between each of the 3 CPUI subsections and Religiosity. In the following table the three CPUI subsections are numbered 2, 3 and 4, and the Religiosity Index is number 6.

The correlation between Religiosity and Perceived Compulsivity (questions 1-3)

  • Study 1: 0.25
  • Study 2: 0.14
    • Average: 0.195

The correlation between Religiosity and Access Efforts (questions 4-6)

  • Study 1: 0.03
  • Study 2: 0.11
    • Average: 0.07

The correlation between Religiosity and Emotional Distress (questions 7-9)

  • Study 1: 0.32
  • Study 2: 0.45
    • Average: 0.385

The key finding is that religiosity is strongly related (.39) to only the Emotional Distress section of the CPUI-9: questions 7-9, which asks porn users how they feel after viewing porn (ashamed, depressed, or sick). Religion is far less related to the two sub-sections (questions 1-6) that most accurately assess actual porn addiction: Compulsivity (.195) and Access Efforts (.07). Simplified: the shame and guilt questions (7-9) powerfully skew the total CPUI scores upward for religious individuals. Take away the 3 shame questions and the correlation between religiosity and the CPUI drops to a mere 0.13.

Examining the actual-addiction CPUI questions, it’s evident that the 3 “Access Efforts” questions 4-6 assess principal addiction criteria for any addiction: “The inability to stop despite severe negative consequences.” Compulsive use is a hallmark of addiction.

In contrast, question #1 in the Compulsivity section relies on subjective interpretation (“Do I feel addicted?”).

Now, back to those Access Efforts questions 4-6, which assess specific behaviors, not beliefs or feelings. The key takeaway: there’s an extremely weak correlation between Religiosity and the 3 Access Efforts questions (only 0.07). In summary, religiosity has very little relationship with actual porn addiction. (In fact, there’s good reason to suggest there is virtually no relationship as we will see in the next section.)

Next, let’s examine the correlations between each of the 3 CPUI subsections and “Hours of Porn Use.” In the following table the three CPUI subsections are numbered 2, 3 and 4, and “[Porn] Use In Hours” is number 5.

The correlation between “[Porn] Use In Hours” and Perceived Compulsivity (questions 1-3)

  • Study 1: 0.25
  • Study 2: 0.32
    • Average: 0.29

The correlation between “[Porn] Use In Hours” and Access Efforts (questions 4-6)

  • Study 1: 0.39
  • Study 2: 0.49
    • Average: 0.44

The correlation between “[Porn] Use In Hours” and Emotional Distress (questions 7-9)

  • Study 1: 0.17
  • Study 2: 0.04
    • Average: 0.10

This is the exact opposite of what we saw with religiosity. “[Porn] Use In Hours” correlates very strongly with the CPUI questions (1-6), which, again, most accurately assess actual porn addiction (0.365). More importantly, “[Porn] Use In Hours” correlate even more strongly with the CPUI’s core addiction questions 4-6 (0.44). This means that actual porn addiction (as assessed by behaviors) is robustly related to how much porn a person views.

On the other hand, “[Porn] Use In Hours” is weakly related (0.10) to the “Emotional Distress” questions (7-9). These 3 questions ask porn users how they feel after viewing porn (ashamed, depressed, or sick). In summary, actual porn addiction (1-6) is strongly related to the amount of porn viewed, yet shame and guilt (7-9) are not. To put this another way, porn addiction has a whole lot to do with how much porn is viewed, and very little to do with shame (religious or otherwise).

Summary of Grubbs’s actual findings

  1. Total CPUI-9 scores were better correlated with “[Porn] Use In Hours” than with religiosity. This finding directly contradicts claims in the media by Joshua Grubbs.
  2. Removing the 3 “Emotional Distress” questions leads to an even stronger relationship between “[Porn] Use In Hours” and actual porn addiction as assessed by questions 1-6.
  3. Removing the 3 “Emotional Distress” questions (which assess shame and guilt) leads to a much weaker relationship between religiosity and actual porn addiction as assessed by questions 1-6.
  4. A very strong relationship exists between “hours of porn use” and the core addiction behaviors as assessed by the “Access Efforts” questions 4-6. Put simply: porn addiction is very strongly related to amount of porn viewed.
  5. The relationship between “religiosity” and the core addiction behaviors (Access Efforts questions 4-6) is virtually non-existent (0.07). Put simply: addiction-related behaviors, rather than religiosity, predict porn addiction. Religiosity has next to nothing to do with porn addiction.  

Here’s what a more accurate conclusion in Grubbs’s study might have looked like:

Actual porn addiction is robustly related to hours of porn use and very weakly related to religiosity. Hours of porn use is a far better predictor of actual porn addiction than is religiosity. Why religiosity has any relationship to porn addiction is unknown. It could be the result of a skewed sample. When compared to non-religious individuals, a far lower percentage of religious individuals regularly view pornography. Perhaps this skewed sample of “religious porn users” contains a far higher percentage of individuals with pre-existing conditions (OCD, ADHD, depression, bipolar disorder, etc.) or familial/genetic influences commonly associated with addiction.

Finally, a recent study (by a non-Grubbs team) examined the relationships between pornography use and sexual satisfaction/functioning employing the CPUI-9. The study found that the amount of porn used was robustly related to questions 1-6 (0.50), yet not at all related to questions 7-9 (0.03). This means that the amount of porn used is a very strong factor in the development of a porn addiction. On the other hand, shame and guilt were not associated with porn use, and had nothing to do with porn addiction.

Studies recognize that current hours of porn use are not linearly related to porn addiction

As explained above, the amount of porn used is far more related to actual porn addiction than is religiosity. That said, we need to address Grubbs’s insinuation that hours of porn use is synonymous with “real porn addiction.” That is, that the extent of a “genuine porn addiction” is best indicated simply by “current hours of internet porn viewing,” rather than by standard porn addiction tests or by porn-induced symptoms.

The hole in these author’s underpinnings, which you could drive a truck through, is that research on internet porn and internet addictions (1, 2, 3, 4, 5, 6, 7, 8, 9) has reported that internet addiction sub-types do not correlate linearly with hours of use. In fact, the variable ‘hours of use’ is an unreliable measure of addiction. Established addiction assessment tools evaluate addiction using multiple other, more reliable factors (such as those listed in the first two sections of the CPUI). The following cybersex addiction studies, which Grubbs omitted, report little relationship between hours and indications of addiction:

1) Watching Pornographic Pictures on the Internet: Role of Sexual Arousal Ratings and Psychological-Psychiatric Symptoms for Using Internet Sex Sites Excessively (2011)

“Results indicate that self-reported problems in daily life linked to online sexual activities were predicted by subjective sexual arousal ratings of the pornographic material, global severity of psychological symptoms, and the number of sex applications used when being on Internet sex sites in daily life, while the time spent on Internet sex sites (minutes per day) did not significantly contribute to explanation of variance in Internet Addiction Test sex score (IATsex). We see some parallels between cognitive and brain mechanisms potentially contributing to the maintenance of excessive cybersex and those described for individuals with substance dependence.”

2) Sexual Excitability and Dysfunctional Coping Determine Cybersex Addiction in Homosexual Males (2015)

“Recent findings have demonstrated an association between CyberSex Addiction (CA) severity and indicators of sexual excitability, and that coping by sexual behaviors mediated the relationship between sexual excitability and CA symptoms. Results showed strong correlations between CA symptoms and indicators of sexual arousal and sexual excitability, coping by sexual behaviors, and psychological symptoms. CyberSex Addiction was not associated with offline sexual behaviors and weekly cybersex use time.”

3) What Matters: Quantity or Quality of Pornography Use? Psychological and Behavioral Factors of Seeking Treatment for Problematic Pornography Use (2016)

According to our best knowledge this study is the first direct examination of associations between the frequency of porn use and actual behavior of treatment-seeking for problematic porn use (measured as visiting the psychologist, psychiatrist or sexologist for this purpose). Our results indicate that the future studies, and treatment, in this field should focus more on impact of porn use on the life of an individual (quality) rather than its mere frequency (quantity), as the negative symptoms associated with porn use (rather than porn use frequency ) are the most significant predictor of treatment-seeking behavior.

Relation between PU and negative symptoms was significant and mediated by self-reported, subjective religiosity (weak, partial mediation) among non-treatment seekers. Among treatment-seekers religiosity is not related to negative symptoms.

4) Examining Correlates of Problematic Internet Pornography Use Among University Student (2016)

Higher scores on addictive measures of internet porn use were correlated with daily or more frequent use of internet porn. However, the results indicate that there was no direct link between the amount and frequency of an individual’s pornography use and struggles with anxiety, depression, and life and relationship satisfaction. Significant correlations to high internet porn addiction scores included an early first exposure to internet porn, addiction to video games, and being male. While some positive effects of internet porn use have been documented in previous literature our results do not indicate that psychosocial functioning improves with moderate or casual use of internet porn.

5) Viewing Internet Pornography: For Whom is it Problematic, How, and Why? (2009)

This study investigated the prevalence of problematic Internet pornography viewing, how it is problematic, and the psychological processes that underlie the problem in a sample of 84 college-age males using an anonymous online survey. It was found that approximately 20%–60% of the sample who view pornography find it to be problematic depending on the domain of interest. In this study, the amount of viewing did not predict the level of problems experienced.

Thus, from the outset this study and its assertions collapse because its conclusions rest upon equating current hours of use with the level of addiction/problems/distress reported by subjects as a valid measure of addiction.

Why don’t addiction specialists rely solely on hours of use?

Imagine trying to assess the presence of addiction by simply asking, “How many hours do you currently spend eating (food addiction)?” or “How many hours do you spend gambling (gambling addition)?” or “How many hours do you spend drinking (alcoholism)?” To demonstrate how problematic “hours of use” would be as an indicator of addiction, consider alcohol as an example:

  1. A 45-year old Italian man has a tradition of drinking 2 glasses of wine every night with dinner. His meal is with his extended family and it takes 3 hours to complete (lots of yakking). So he drinks for 3 hours a night, 21 hour per week.
  2. A 25 year-old factory worker only drinks on the weekends, but binge drinks both Friday and Saturday night to the point of passing out or getting sick. He regrets his actions and wants to stop, but can’t, drives drunk, gets in fights, is sexually aggressive, etc. He then spends all of Sunday recovering, and feels like crap until Wednesday. However, he spent only 8 hours a week drinking.

Which drinker has a problem? How helpful is applying “hours of use” to gambling addiction? Take these two gamblers;

  1. A retired elementary school teacher who lives in Las Vegas. She and three of her friends regularly spend weekday afternoons on the strip playing nickel slot machines and video-poker at various non-smoking casinos. Afterwards they usually eat dinner at the CircusCircus $9.99 buffet. Total losses could be as high as $5.00, but they often break even. Total time per week – 25 hours.
  2. A 43-year old electrician with 3 teenage kids, who is now living alone in a seedy motel. Betting on the ponies has led to divorce, lost jobs, bankruptcy, inability to pay child support, and the loss of visitation rights. While he only visits the track 3 times a week, about 2 hours each time, his compulsive gambling ruined his life. He can’t stop and is contemplating suicide. Total time gambling per week – 6 hours.

But, you wonder, surely the amount of drug used must equate to the level of addiction? Not necessarily. For example, millions of Americans with chronic pain are users of prescription opioids (Vicodin, Oxycontin) on a regular basis. Their brains and tissues have become physically dependent on them, and immediate cessation of use could cause severe withdrawals symptoms. However, very few chronic pain patients are addicted. Addiction involves multiple well-indentified brain changes that lead to the signs and symptoms experts recognize as addiction. (If the distinction is unclear, I recommend this simple explanation by NIDA.) The vast majority of chronic pain patients would happily throw away their narcotics in exchange for a life free of debilitating pain. This is quite different from true opioid addicts who often risk everything to continue their addiction.

Neither “current hours of use” nor “the amount used” alone can inform us as to who is addicted and who is not. There’s a reason why “continued use despite severe negative consequences” helps experts define addiction, and “current hours of use” does not. Remember, the 3 “Access Efforts” CPUI questions assessed “the inability to stop despite severe negative consequences.” In Grubbs’s data, these questions were the strongest predictors of actual porn addiction.

Bottom line: Grubbs’s claims depend upon “current hours of use” being the sole valid criterion for true addiction. They are not. Even if hours of use were a proxy for addiction, Grubbs’s full studies reveal that “current hours of porn use” is strongly related to total CPUI-9 scores (i.e., “perceived” addiction). More importantly, “hours of porn use” is far more related to actual porn addiction (CPUI questions 1-6) than it is to religiosity.  So Grubbs’s conclusions are both untrue and not based on existing addiction science.

“Current hours of porn use” omits many variables

A secondary methodological problem is that Grubbs assessed porn use by asking subjects about their “current hours of porn use.” That question is troublingly vague. Over what period? One subject may be thinking “How much did I use yesterday?” another “over the last week?” or “on average since I decided to quit viewing because of unwanted effects?” The result is data that are not comparable and cannot be analyzed for the purpose of drawing reliable conclusions, let alone the vast, unsupported conclusions Grubbs draws.

More important, the “current porn use” question, on which the study’s conclusions rest, fails to ask about key variables of porn use: age use began, years of use, whether the user escalated to novel genres of porn or developed unexpected porn fetishes, the ratio of ejaculation with porn to ejaculation without it, amount of sex with a real partner, and so forth. Those questions would likely enlighten us more about who really has a problem with porn use than simply “current hours of use.”


SECTION 3: Is Religiosity Related to Actual Porn Addiction?

Introduction: Anecdotal evidence from sex therapists suggests there are clients who feel addicted to porn, yet view it only occasionally. It’s possible that some of these clients are religious and experience guilt and shame surrounding their occasional porn use. Are these individuals suffering only from “perceived addiction” and not real porn addiction? Perhaps. That said, these individuals want to stop yet they continue to use porn. Whether or not these “occasional porn users” are truly addicted or just feeling guilt and shame, one thing is for sure: the Grubbs CPUI cannot distinguish “perceived addiction” from actual addiction in these individuals or anyone else.

One third of CPUI questions assess remorse and shame, resulting in higher scores for religious individuals

Because the last 3 of the 9 CPUI questions assess guilt, shame and remorse, religious porn users’ CPUI scores tend to be skewed upward. For example, if an atheist and devout Christian have identical scores on CPUI questions 1-6, it’s almost certain that the Christian will end up with far higher CPUI-9 scores, after questions 7-9 are added.

  1. I feel ashamed after viewing pornography online.
  2. I feel depressed after viewing pornography online.
  3. I feel sick after viewing pornography online.

Grubbs’s actual findings are that religious porn users may feel more guilt about porn use (questions 7-9), but they are not any more addicted (questions 4-6).

In the end, all we can take from Grubbs’s studies is that some religious porn users experience regret and shame. No surprise there. Since a much lower percentage of religious individuals use porn, Grubb’s findings tell us nothing about religious people as a whole. The key point: Grubbs is using a skewed sample of religious subjects – the porn using minority – to claim that porn addiction is related to religiosity.

It’s important to note that assessment questionnaires for other types of addiction rarely have questions about guilt and shame. Certainly, none make one third of their questionnaires about guilt and shame. For example, the DSM-5 criteria from Alcohol Use Disorder contain 11 questions. Yet none of the questions assess remorse or guilt after a drinking binge. Nor does the DSM-5 Gambling Addiction questionnaire contain a single question about remorse, guilt or shame. Rather, both of these DSM-5 addiction questionnaires emphasize dysfunctional behaviors, similar to questions 4-6 of the CPUI-9:

  1. At times, I try to arrange my schedule so that I will be able to be alone in order to view pornography.
  2. I have refused to go out with friends or attend certain social functions to have the opportunity to view pornography.
  3. I have put off important priorities to view pornography.

Remember, CPUI questions 4-6 are far more related to current “Hours of Porn Use” than any other factor (0.44). Meaning that “hours of use” is by far the strongest predictor of actual porn addiction in Grubbs’s data. On the other hand, questions 4-6 bore very little relation to “religiosity” (0.07). Meaning that religiosity is not really related to porn addiction. The very small relation between religiosity and actual porn addiction are likely better explained by Grubb’s s skewed sample and other factors discussed below.

Religiosity does NOT predict porn addiction. Not even a wee bit.

In Section 2 we pointed out that “hours of porn use” was more related to total CPUI-9 scores than was religiosity. Or as a researcher might say: “hours of porn use” predicted porn addiction slightly better than did religiosity. We also pointed out that the correlation between actual porn addiction (CPUI questions 4-6) and Religiosity averaged 0.07, while the correlation actual porn addiction (CPUI questions 4-6) and “hours of porn use” was 0.44. To put it another way: “hours of porn use” predicted porn addiction 600+% more strongly than did religiosity.

That said, Grubbs still reports a weak positive relationship between religiosity and core addiction questions 4-6 (0.07). So is Grubbs is right, that religiosity predicts porn addiction? No, religiosity does not predict porn addiction. Quite the opposite. Religious individuals are far less likely to use porn and thus less likely to become porn addicts.

Grubbs’s studies did not use a cross-section of religious individuals. Instead, only current porn users (religious or nonreligious) were questioned. The preponderance of studies report far lower rates of porn use in religious individuals as compared with non-religious individuals (study 1, study 2, study 3, study 4, study 5, study 6, study 7, study 8, study 9, study 10, study 11, study 12, study 13, study 14, study 15, study 16, study 17, study 18, study 19).

Grubbs’s sample of religious porn users is therefore skewed to the small percentage of religious men using porn. Put simply, religiosity is protective against porn addiction.

As an example, this 2011 study (The Cyber Pornography Use Inventory: Comparing a Religious and Secular Sample) reported the percentage of religious and secular college men who used porn at least once a week:

  • Secular: 54%
  • Religious: 19%

Another study on college aged religious men (I believe it is wrong but I still do it – A comparison of religious young men who do versus do not use pornography, 2010) revealed that:

  • 65% of religious young men reported viewing no pornography in the past 12 months
  • 8.6% reported viewing two or three days per month
  • 8.6% reported viewing daily or every other day

In contrast, cross-sectional studies of college-age men report relatively high rates of porn viewing (US – 2008: 87%, China – 2012: 86%, Netherlands – 2013 (age 16) – 73%). In short, given that a large majority of college-age, religious men rarely views porn, Grubbs’s targeted sample of “religious porn users” is quite skewed, while his sample of “secular porn users” is fairly representative.

Religious porn users are likely to have higher rates of pre-existing conditions

Given that a large majority of college-age, religious men rarely views porn, the Grubbs and Leonhardt, et al. targeted samples of “religious porn users” represented a small minority of the religious population. In contrast, samples of “secular porn users” tend to represent the majority of the non-religious population.

Most young religious porn users say they would rather not watch porn (100% in this study). So why do these particular users watch? It’s extremely likely that the non-representative sample of “religious porn users” contains a far higher percentage of the slice of the entire population that struggles with the pre-existing conditions or comorbidities. These conditions are often present in addicts (i.e. OCD, depression, anxiety, social anxiety disorder, ADHD, family histories of addiction, childhood trauma or sexual abuse, other addictions, etc.).

This factor alone could explain why religious porn users, as a group, score slightly higher on the Grubbs porn addiction questionnaire. This hypothesis is supported by studies on treatment seeking porn /sex addicts (whom we could expect to hail disproportionately from that same disadvantaged slice). Treatment seekers reveal no relationship between religiosity and measurements of addiction and religiosity (2016 study 1, 2016 study 2). If Grubbs’s conclusions were valid, we’d surely see a disproportionate number of religious porn users seeking treatment.

Most young religious porn users say they would rather not watch porn (100% in this above study). So why do they watch? It’s extremely likely that the non-representative sample of “religious porn users” contains a far higher percentage of the cross-population slice of the population who inevitably have pre-existing conditions (OCD, depression, anxiety, ADHD), genetic vulnerabilities, family histories of addiction, or childhood trauma that can make addiction more likely. This hypothesis is supported by studies on treatment seeking porn /sex addicts which reveal no relationship between religiosity and measurements of addiction and religiosity (2016 study 1, 2016 study 2).

At high levels of porn use religious individuals return to religious practices and religion becomes more important

This 2016 study on religious porn users reported an odd finding that by itself could explain Grubbs’s slight correlation between actual porn addiction and religiosity. The relationship between porn use and religiosity is curvilinear. As porn use increases, religious practice and the importance of religion decrease – up to point. Yet when a religious individual begins using porn once or twice a week this pattern reverses itself: The porn user starts attending church more often and the importance of religion in his life increases. An excerpt from the study:

“However, the effect of earlier pornography use on later religious service attendance and prayer was curvilinear: Religious service attendance and prayer decline to a point and then increase at higher levels of pornography viewing.”

This graph, taken from this study, compares religious service attendance with the amount of porn used:

It seems likely that as religious individuals’ porn use grows increasingly out of control, they return to religion as a means to address their problematic behavior. This is no surprise, as many addiction recovery groups based on the 12-steps include a spiritual or religious component. The author of the paper suggested this as a possible explanation:

…studies of addiction suggest that those who feel helpless in their addiction often elicit supernatural help. Indeed, twelve-step programs that seek to help persons struggling with addictions ubiquitously include teachings about surrendering to a higher power, and a rising number of conservative Christian twelve-step programs make this connection even more explicit.  It could very well be that persons who use pornography at the most extreme levels (i.e., use levels that might be characteristic of a compulsion or addiction) are actually pushed toward religion over time rather than pulled away from it.

This phenomenon of religious porn users returning to their faiths as addiction worsens could easily explain the slight correlation between actual porn addiction and religiosity.

In contrast to religious subjects, secular porn using subjects may not recognize porn’s effects because they never try to quit

Is it possible that religious porn users score higher on porn addiction questionnaires because they’ve actually tried to quit, unlike their secular brethren? In doing so they would be more likely to recognize the signs and symptoms of porn addiction as assessed by the Leonhardt, et al. 5-item questionnaire.

Based on years of monitoring porn recovery forums online, we suggest that researchers should segregate users who have experimented with quitting porn from those who haven’t, when asking them about porn’s self-perceived effects. It is generally the case that today’s porn users (both religious and nonreligious) have little understanding of internet porn’s effects on them until after they attempt to quit (and pass through any withdrawal symptoms).

In general, agnostic porn users believe porn use is harmless, so they have no motivation to quit…until they run into intolerable symptoms (perhaps, debilitating social anxiety, inability to have sex with a real partner or escalation to content they find confusing/disturbing or too risky). Prior to that turning point, if you ask them about their porn use, they will report that all is well. They naturally assume they are “casual users,” who could quit anytime, and that symptoms they have, if any, are due to something else. Shame? Nope.

In contrast, most religious porn users have been warned that porn use is risky. They are therefore more likely to have used less porn and to have experimented with giving it up, perhaps more than once. Such experiments with quitting internet porn are very enlightening, as that is when porn users (religious or not) discover:

  1. How difficult it is to quit (if they’re addicted)
  2. How porn use has affected them adversely, emotionally, sexually and otherwise (often because symptoms begin to recede after quitting)
  3. [In the case of such symptoms] How withdrawal can make symptoms worse for a while, before the brain returns to balance
  4. How bad it feels when they want to give something up and can’t (This is shame, but not necessarily “religious/sexual shame” – as researchers sometimes assume because religious users report it more often. Most all addicts unfortunately feel shame when they feel powerless to quit, whether or not they are religious.)
  5. That they experience strong cravings to use porn. Cravings often increase in severity with a week or longer break from using porn.

Such experiences make those who have tried quitting far more wary about porn use. Since more religious users will more frequently have made such experiments, psychological instruments will show that they are more concerned about their porn use than non-religious users – even though they are likely using less porn!

In other words, shouldn’t researchers also be investigating whether secular porn users sometimes misperceive porn use as harmless, rather than assuming it’s the religious people who are misperceiving the existence of porn-related problems even though they’re using less? Addiction, after all, is not assessed based on quantity or frequency of use, but rather debilitating effects.

In any case, the failure to segregate those who have experimented with quitting from those who have not, is a huge confound in research attempting to draw conclusions about the implications of the relationship between religiosity, shame and porn use. It’s easy to misinterpret data as evidence that “religion makes people concerned about porn even if they’re using less than others, and that if they weren’t religious they wouldn’t be concerned.”

The more valid conclusion may be that those who have tried to quit, and realized the points above are more concerned, and that religion is merely the cause of their making such experiments (and otherwise largely irrelevant). It’s disheartening to see psychologists make simplistic correlations with religion/spirituality and draw “shaming” conclusions, without realizing that they are comparing “apples” with “oranges” when they compare users who have tried to quit with users who haven’t. Again, only the former tend to see the risks and harms of porn use clearly, whether or not they are religious.

This confound is too often exploited by those who want to draw attention away from the severe symptoms that non-religious users frequently experience. Agnostic users tend to have more severe symptoms by the time they do quit, simply because they tend to quit at a lower point in the downward spiral of symptoms than religious porn users do. Why aren’t researchers studying this phenomenon?

In fact, we would wager that the lion’s share of those with porn-induced sexual dysfunctions are agnostics. Why? Because the non-religious tend to be so persuaded of the harmlessness of internet porn use that they continue using it well past the warning signs, such as increasing social anxiety, escalation to extreme material, apathy, difficulty achieving an erection without porn, difficulty using condoms or climaxing with a partner, and so forth.

The fact is, even casual, or relatively infrequent, porn use can condition some users’ sexuality such that it interferes with their sexual and relationship satisfaction. Here’s one man’s account. Escalation to porn content that was once uninteresting or repelling is common in half of internet porn users. In short, as discussed above, infrequent use is no panacea. Those who do not use frequently but are anxious about their porn use may have good reason to be concerned based on their own experiments, quite apart from what they hear about porn during religious services.

Might it be better to construct research that asks porn users (both religious and otherwise) to quit porn for a time and compare their experiences with controls? See Eliminate Chronic Internet Pornography Use to Reveal Its Effects for a possible study design.

The biological reasons why intermittent porn users might score higher on porn addiction questionnaires

Very frequent internet porn use has familiar risks for many of today’s users. These include escalation to more extreme material, poorer sexual and relationship satisfaction, addiction, and/or the gradual loss of attraction to real partners (as well as anorgasmia and unreliable erections).

Less well known is the fact that intermittent use (for example, 2 hours of porn bingeing followed by a few weeks of abstinence before another porn session) poses a substantial risk of addiction. The reasons are biological, and there is an entire body of addiction research on intermittent use in animals and humans elucidating the brain events responsible.

For example, both drug and junk food studies reveal that intermittent use can lead more quickly to addiction-related brain changes (whether or not the user slips into full blown addiction). The primary change is sensitization which blasts the brain’s reward center with signals that produce hard to ignore cravings. With sensitization, brain circuits involved in motivation and reward seeking become hyper-sensitive to memories or cues related to the addictive behavior. This deep pavlovian conditioning results in increased “wanting” or craving while liking or pleasure from the activity diminishes. Cues, such as turning on the computer, seeing a pop-up, or being alone, trigger intense cravings for porn. (Studies reporting sensitization or cue-reactivity in porn users: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18.)

Even more remarkable is that periods of abstinence (2-4 weeks) lead to neuroplastic changes that don’t occur in a user that doesn’t take such long breaks. These alterations in the brain increase cravings to use in response to triggers. Furthermore, the stress system changes such that even minor stress can cause cause cravings to use.

Intermittent consumption (especially in the form of a binge) can also produce severe withdrawal symptoms, such as lethargy, depression and cravings. In other words, when someone uses after an interim of abstinence, and binges, it can hit the user harder – perhaps because of the heightened intensity of the experience.

Based on this research, scientists have concluded that everyday consumption of say cocaine, alcohol, cigarettes, or junk food is not necessary to generate addiction-related brain changes. Intermittent bingeing can do the same thing as continuous use, and in some cases do more.

Now, let’s return to a comparison of religious and nonreligious porn users. Which group is likely to include more intermittent users? Given research showing that religious porn users prefer not to be using porn, there are probably more religious than secular users stuck in a binge-abstinence cycle. Religious users would tend to be “intermittent users.” Secular users generally report that they seldom take breaks of more than a few days – unless they become intermittent users because they are trying to quit porn use.

Another important effect of the binge-abstinence cycle is that intermittent porn users experience extended gaps (and often improvements). They can clearly see how their porn use has affected them, in contrast with frequent users. This alone might lead to higher scores on a porn addiction questionnaire. A second, more important result is that intermittent porn users will experience more frequent episodes of strong cravings. Third, when intermittent users do cave in, the science mentioned above predicts that they will often feel more out of control, and experience more of a letdown after the binge. In short, intermittent users can be quite addicted and score surprisingly high on porn addiction tests, even though they are using with less frequency than their secular brethren.

Under the circumstances, it is premature to conclude that shame accounts for the difference between religious and nonreligious users. Researchers must control for the impact of intermittent use. Said differently, if more of Leonhardt et al’s religious subjects included a higher percentage of intermittent users than their nonreligious subjects, one would expect the religious users to score higher on addiction tests despite using significantly less frequently.

Of course, the intermittent use addiction risk is not confined to religious porn users. This phenomenon shows up in animal models and secular porn users who are trying to quit but still bingeing occasionally. The point is that the phenomenon of intermittent use and porn addiction needs to be studied independently prior to drawing and publicizing assumptions about shame (or “perceived” pornography addiction) as the only possible explanation for why religious porn users report higher addiction scores in concert with less frequent use.

Summary of Religiosity and Porn Use:

  1. Religiosity does not predict porn addiction (perceived or otherwise). A far larger percentage of secular individuals use porn.
  2. Since a much smaller percentage of religious people use porn, religiosity is evidently protective against porn addiction.
  3. Grubbs and Leonhardt, et al. samples taken from the minority of “religious porn users” is skewed with respect to religious users, likely resulting in a much higher percentage of the religious sample having comorbidities. As a result religious porn users have slightly higher overall scores on porn-addiction instruments and report more difficulty controlling use.
  4. As porn use becomes frequent or compulsive, religious porn users return to their faiths. This means that those scoring highest on porn addiction tests will also score higher on religiosity.
  5. Most religious porn users have been warned that porn use is risky. They are therefore more likely to have used less porn and to have experimented with giving it up. In doing so they are more likely to recognize the signs and symptoms of porn addiction as assessed by the Grubbs CPUI-9 or Leonhardt, et al. 5-item questionnaire(s) – regardless of amount of porn use.
  6. Intermittent porn users can be quite addicted and score surprisingly high on porn addiction tests, even though they are using with less frequency than their secular brethren.

SECTION 4: Grubbs Distorts the Current State of Addiction Research

The validity of internet pornography addiction is addressed in at least three of Joshua Grubbs’s studies (Grubbs et al., 2015; Bradley et al., 2016; Grubbs et al., 2016.) All three papers casually toss aside decades of neuropsychological and other addiction research (and related assessment tools) to attempt to persuade readers that the scientific literature shows that internet porn addiction doesn’t exist (thus supporting the Grubbs claim that all evidence of porn addiction must be “perceived,” not real).

The studies Grubbs cited to dismiss porn addiction

In their opening paragraphs, Grubbs’s three studies mentioned in the previous paragraph demonstrate their profound bias by basing their claim about the nonexistence of internet porn addiction on the papers of two self-proclaimed “internet porn addiction debunkers”: David Ley, author of The Myth of Sex Addiction, and former UCLA researcher Nicole Prause, whose work has been formally criticized in the medical literature for weak methodology and unsupported conclusions. The three papers Grubbs believes debunk porn addiction:

  1. The Emperor Has No Clothes: A Review of the ‘Pornography Addiction’ Model (2014), by David Ley, Nicole Prause & Peter Finn
  2. Sexual Desire, Not Hypersexuality, is Related to Neurophysiological Responses Elicited by Sexual Images (2013), Vaughn R. Steele, Cameron Staley, Timothy Fong, Nicole Prause
  3. Viewing Sexual Stimuli Associated with Greater Sexual Responsiveness, Not Erectile Dysfunction (2015), Nicole Prause & Jim Pfaus

Paper #1 (Ley et al., 2013) is a one-sided propaganda piece by Ley, Prause and their colleague Peter Finn, which claimed to be a review of the porn addiction model. It was not. First, Ley et al. omitted all published studies showing ill effects from porn use on the grounds that they are “merely” correlational. You read that right. Secondly, it cherry-picked random, misleading lines from within studies, failing to report the researchers’ actual opposing conclusions. Third, Ley et al. cited numerous studies that were entirely irrelevant to the claims made. We realize these are very strong assertions, yet they are fully supported and documented in this line-by-line critique. It should be noted that Ley et al. editor, Charles Moser, has long been a vocal critic of porn and sex addiction. Also know that Current Sexual Health Reports has a short and rocky history. It started publishing in 2004, and then went on hiatus in 2008, only to be resurrected in 2014, just in time to feature Ley et al.

Paper #2 (Steele et al., 2013) was an EEG study touted in the media as evidence against the existence of porn addiction. This SPAN Lab study actually lends support to the existence of porn addiction. How so? The study reported higher EEG readings (P300) when subjects were briefly exposed to pornographic photos. Studies show that an elevated P300 occurs when addicts are exposed to cues (such as images) related to their addiction. However, due to methodological flaws the findings are uninterpretable: 1) subjects were heterogeneous (males, females, non-heterosexuals); 2) subjects were not screened for mental disorders or addictions; 3) study had no control group for comparison; 4) questionnaires were not validated for porn addiction. In line with the Cambridge University fMRI studies, this EEG study reported greater cue-reactivity to porn correlated with less desire for partnered sex. Put another way, individuals with more brain activation and cravings for porn preferred to masturbate to porn than have sex with a real person. Study spokesperson Nicole Prause claimed that these porn users merely had high libido, yet the results of the study say the exact opposite (their desire for partnered sex was dropping in relation to their porn use). As neither result matched the study’s headlines, Grubbs perpetuated flawed conclusions of the original authors (the “debunkers of porn addiction”). Five peer-reviewed papers have formally analyzed Steele et al., concluding that its findings are consistent with the porn addiction model it claims to debunk: 1, 2, 3, 4, 5. Also see the extensive critique.

Paper #3 (Prause & Pfaus 2015) was presented by Grubbs as evidence for the positive effects of porn:

…some studies even suggest potentially positive outcomes associated with pornography use (Prause & Pfaus, 2015).

Prause and Pfaus wasn’t a real study and it did not find “positive outcomes” related to porn use. None of the data from the Prause & Pfaus (2015) paper matched the four earlier studies on which it was based. The discrepancies were not small and have not been explained. A comment by researcher Richard A. Isenberg MD, published in Sexual Medicine Open Access, points out several (but not all) of the discrepancies, errors, and unsupported claims. The solitary positive outcome Prause & Pfaus claimed was a slightly higher “subjective arousal rating” after viewing porn in subjects who watched more porn at home. Several problems with this claim:

  1. The more science-based way to interpret this arousal difference is that the men who used more porn experienced greater cravings to use porn. Interestingly, they had less desire for sex with a partner and more desire to masturbate than those who logged fewer hours watching porn.
  2. Prause & Pfaus could not have accurately assessed the subjects’ arousal because:
  • the underlying 4 studies used different types of porn. Two studies used a 3-minute film, one study used a 20-second film, and one study used still images.
  • the underlying 4 studies employed different number scales. One used a 0 to 7 scale, one used a 1 to 7 scale, and one study did not report sexual arousal ratings.

Richard A. Isenberg MD asked Prause & Pfaus to explain how they could claim this result in the absence of supporting data. Neither author has been able to provide a comprehensible answer.

The studies Grubbs omitted

With respect to Grubbs’s bias, it is even more telling that the 3 studies named above omit every neurological and neuropsychological study that found evidence in support of the porn addiction model (over 30 collected here). In addition, Grubbs omitted 12 recent reviews of literature on porn and sex addiction (in the same list). Many of these studies and reviews are by some the top neuroscientists at Yale University, Cambridge University, University of Duisburg-Essen, and the Max Planck Institute. (Some of these were not yet published when Grubbs’s studies went to press, but many were, and were simply ignored.)

Contrast those eminent researchers with Ley and Prause. Ley has no background in neuroscience and had published nothing until Ley et al., 2014. Prause hasn’t been associated with any university since December, 2014, and her claims surrounding her 2 EEG studies have been repeatedly discredited in the peer-reviewed literature (2013: 1, 2, 3, 4. 5.; 2015: 1, 2, 3, 4, 5, 6.)

We can speculate that acknowledging the existence of 32 neurological studies and 12 reviews of literature supporting the porn addiction model would severely undercut Grubbs’s thesis that porn addiction….

“has everything to do with religiosity and moral attitudes toward sex. In short, he says, “It’s shame-motivated.”…

If “porn addiction is simply shame” how does Grubbs explain away the growing number of neurological studies that have found brain changes in problematic porn users that align with substance addiction? How could shame cause the same brain changes that occur with drug addiction? How could evidence of shame disprove the presence of addiction in brains showing evidence of addiction? It can’t.

Op-ed: Who exactly is misrepresenting the science on pornography?

8 neuroscientists fail to cite a single neuroscience study to support their claims

By Clay Olsen, Gail Dines, Mary Anne Layden, Gary Wilson, Jill Manning, Donald Hilton and John Foubert

Charges of misrepresenting science are serious. We write in response to a recent op-ed’s critique of Fight the New Drug’s scientific claims. Rather than mere “activists” as the op-ed authors labeled us, we represent some 130 years of combined professional experience researching or assisting those impacted by pornography.

While the authors of the earlier op-ed acknowledge “some cause for concern” regarding pornography consumption, nearly half their commentary highlights the “positive effects of sex film use,” while minimizing any serious harm. It is this kind of “balanced view,” they argue, FTND has failed to acknowledge in their work in schools.

Citing only one study, their expansive list of purported benefits from pornography range from “enhancing sex,” to greater “happiness and joy” and improved “comfort with one’s own appearance.” On the basis of a single citation we are asked to believe the production of pornography promotes “higher self-esteem” for performers while its consumption “reduc[es] violence and sexual assaults”—this, without mention of either six studies confirming mental and physical health problems of female performers or a full 50 peer-reviewed studies directly linking porn use to sexual violence.

The authors assert that a more accurate scientific analysis confirms only a “tiny percentage of those who viewed sex films” as having any negative effects—quoting “less than 2 percent of men, less than 0.05 percent of women.” They do so without citation, and without mentioning either the 2016 US study in which 28% of porn users scored at (or above) the cutoff for possible hypersexual disorder, or the 2016 Belgian study in which 28% of porn users self-assessed their porn consumption as problematic (alarmingly high rates, given that users of potentially addictive stimuli are typically among the last to recognize they have problems). Despite this, the authors of the op-ed go on to contend that pornography does “not have even primarily negative effects” and instead “mostly positive effects.”

Passed over are 45 peer-reviewed studies—a preponderance of the evidence to date—linking pornography use to lower relationship or sexual satisfaction (yes, most examined positive effects too). Also disregarded are 19 studies linking porn consumption to sexual problems and lower arousal, 15 studies documenting pornography escalation or habituation and a full 12 scientific reviews that establish serious risks with pornography use.

Such research, these authors argue, ought to be dismissed in a more “balanced” assessment. By contrast, those who disagree with their rosy analysis have, in their words, simply “disregarded the scientific method” or failed to conduct sufficiently “rigorous” studies.

Would that apply to the now 33 published neuroscience studies from universities like Cambridge, Yale and Max Planck exploring patterns in the brains of frequent pornography users? Virtually every neuroscience study has found brain changes consistent with addiction, including 18 studies documenting sensitization or cue-reactivity, eight documenting impaired prefrontal circuits and six documenting desensitization.

How eight neuroscientists could overlook these studies is difficult to understand, especially when over sixty neuroscientists have concluded their own brain data supports pornography’s addictive potential. Indeed, the single team interpreting their data from the brains of porn users otherwise is the one led by the lead author of the op-ed. When five outside reviews published re-analyses of these data, they concluded the team was overlooking evidence of the very habituation and desensitization characterizing all addictive patterns. Contrary to claims of the lead author that her team’s anomalous study had singlehandedly “debunked porn addiction,” the evidence in that study just doesn’t stand up.

Despite this, these authors argue that the real public harm comes not from pornography use, but from insisting publicly that it can be harmful!  To share a message about pornography’s potential harms with youth, they insist, is the true danger—imploring school authorities to ensure youth hear a “balanced” view that also acknowledges pornography’s “positive” effects.

Given how sharply out of line the authors’ proposals are with the preponderance of evidence consistently documenting an array of potential harms associated with pornography consumption, we are compelled to ask:  Who are the activists here?  And, whose interest would be served by passing along these authors’ conclusions to our children?

In light of the documented social, emotional, cognitive, sexual and developmental impacts on youth, we propose it is time to develop a robust, evidenced-based public health approach to educating and protecting youth from pornography’s harm. Our children deserve at least that much.

[For responses to the many additional claims made in this op-ed, see below]

Clay Olsen is CEO and co-founder of Fight the New Drug, and the founder, lead developer and artistic director of Fortify, an educational support community for those facing compulsive pornography issues.

Gail Dines, Ph.D. is a professor of sociology and women’s studies at Wheelock College in Boston, and founding president of Culture Reframed, a public health organization building resilience and resistance in youth to the porn culture.

Mary Anne Layden, Ph D, is the Director of Sexual Trauma and Psychopathology Program and Center for Cognitive Therapy in the Department of Psychiatry at the University of Pennsylvania

Gary Wilson is the creator of YourBrainOnPorn.com and the author of “Your Brain on Porn: Internet Pornography and the Emerging Science of Addiction.”

Jill Manning, Ph.D. is a licensed marital and family therapist, researcher and author based in Colorado. She currently serves on the board of directors for Enough is Enough, a non-profit organization dedicated to making the Internet safer for children and families.

Donald Hilton, MD, is an adjunct associate professor of neurosurgery at the University of Texas Health Science Center at San Antonio and a fellow of the American Association of Neurological Surgeons.

John D. Foubert, Ph.D., is an Endowed Professor of College Student Development at Oklahoma State University and is the author of the new book, How Pornography Harms: What Teens, Young Adults, Parents and Pastors Need to Know.

Addendum: Seven more points of response:

1. Philosophy of science. After contending that FTND is “systematically misrepresenting science” and “disregard[ing] the scientific method” the authors spend a long paragraph walking through principles they claim have been violated, namely:

The scientific method requires forming a falsifiable hypothesis, then creating experiments to disprove this hypothesis. Only if data consistently fail to disprove the hypothesis can one conclude that the hypothesis is supported, not proven.

Got it!  And right on.  We’re following you so far…

They continue, “The FTND letter suggests that (a) there has been rigorous testing seeking to disprove the hypothesis that pornography is addictive or harmful

Yep. There has!

(b) this testing has consistently failed to disprove this hypothesis

Yep. It has!

and (c) no contradictory evidence has been found.”

Not a whole lot. Nope!

It’s baffling why eight neuroscientists would overlook the direction this preponderance of evidence is pointing.

2. Study representativeness. The Op-Ed authors say, “Sex film users were not sampled in any representative way, and the studies ended up with biased samples reporting distress regarding their sex film use.”

In fact, our list of 50 studies correlating porn use with sexual or relationship satisfaction has the only studies that sampled this satisfaction issue in a representative way: both cross-sectional and longitudinal.

3. Addiction language and distress. The authors say, “the conceptualization of behavior as ‘addictive’ has documented significant psychological harm.

Yet the study they reference did not assess the psychological harm done to people who felt their behavior was addictive. Their link goes to a study that found that scores on a porn addiction test related to psychological distress. Simply put, higher levels of porn addiction correlated with higher levels of distress, which is to be expected in problematic users. For a full critique of this study click here.

4. Addiction language and sexual dysfunction. The authors say, “the conceptualization of behavior as ‘addictive’…has caused boys to think they have erectile dysfunction when they do not.”

False again. The link goes to a paper with 4 complex case studies of young men who had erectile dysfunction (not “believed” they had ED as the authors claim). There is no mention of porn use or porn addiction in that paper.

5. Pornography and women’s rights. They say, “Sex-film viewing also has been associated with more egalitarian attitudes….

The study referenced by the authors framed ‘egalitarianism’ as support for: Feminist identification, Women holding positions of power, Women working outside home, and Abortion. Secular populations tend to be more liberal, and have significantly higher rates of porn use than religious populations. This reality produces a stronger correlation between porn use and (what this study defines as) “egalitarianism.”

6. Pornography and higher education/religiosity. The authors say, “Sex-film viewing also has been associated with…higher education, more prayer and religiosity at high use, and are commonly used in sex therapy.”

The link the authors supply addresses only the “egalitarianism” correlation reported by a single study – not the authors’ other claims. Moreover, many studies report opposing results, including studies linking porn to sexist attitudes, objectification and less egalitarianism: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12.

7. Diagnostic Manuals. With respect to the ICD (International Classification of Diseases and Related Health Problems), which the authors mentioned, the important point is that the upcoming ICD-11 proposes a diagnosis for “Compulsive Sexual Behavior Disorder,” the acknowledged “narrower term” for which is “sex addiction.”

Clearly, the international medical field is moving in the direction of the preponderance of the neuroscience and other evidence. Doubt about the validity of pornography addiction as a risk for some users is rapidly fading despite efforts like the current one to kick dust in the eyes of the public. Incidentally, the World Health Organization’s ICD “outranks” the foot-dragging Diagnostic and Statistical Manual (DSM) as a diagnostic guide. The the ICD is the most widely used classification of mental disorders worldwide, and its diagnostic codes are mandated for use in the US and elsewhere by international treaty as opposed to DSM-5 diagnoses, which enjoy no such mandate. Finally, the assertion that our initial reply referred to descriptive codes in the current diagnostic manuals rather than standalone diagnoses is incorrect, as made clear by DSM veteran psychiatrist Richard Krueger, MD.

How to Recognize Biased Articles: They Cite Prause et al. 2015 (falsely claiming it debunks porn addiction), While Omitting Over 30 Neurological Studies Supporting Porn Addiction

Several recent articles and interviews have attempted to pushback at the TIME article (“Porn and the Threat to Virility”) and the Utah resolution declaring internet porn a public health problem (one example).

What might be a few “dead giveaways” that such an article is nothing more than a propaganda piece?

  1. Psychologists David Ley and/or Nicole Prause are cited as “the experts,” while actual top addiction neuroscientists, who have published recent studies on porn users (Voon, Kraus, Potenza, Brand, Laier, Hajela, Kuhn, Gallinat,Klucken, Banca, etc.), are omitted. Neither Ley nor Prause are affiliated with any university, yet “journalists” prefer both over the top neuroscientists at Yale University, Cambridge University, University of Duisburg-Essen, and the Max Planck Institute. Go figure.
  2. The article cites Prause’s lone, anomalous 2015 EEG study as proof porn addiction doesn’t exist, while simultaneously omitting 33 neurological studies and 12 recent reviews of the literature: Current list of brain studies on porn users. (a few articles cite Prause’s 2013 EEG study, which actually lends support to the porn addiction model and porn-induced sexual conditioning)
  3. The article omits the many studies linking porn use/porn addiction to sexual dysfunctions, low libido, less arousal to vanilla porn, less sexual satisfaction and poorer intimate relationships. See this page: Studies linking porn use or porn/sex addiction to sexual dysfunctions, lower brain activation to sexual stimuli, and lower sexual satisfaction

Reality Check Concerning Prause’s 2015 EEG Study (Prause et al., 2015)

Prause’s 2015 EEG study (claiming to debunk porn addiction) actually supports the existence of porn addiction because her team found desensitization in the heavy porn users.

Compared to controls, more frequent porn users had lower brain activation to one-second exposure to photos of vanilla porn. The lead author, Nicole Prause claims these results debunk porn addiction. However, these findings align perfectly with Kühn & Gallinat (2014), which found that more porn use correlated with lower brain activation in response to pictures of vanilla porn (and less gray matter in the dorsal striatum). In other words, the frequent porn users were desensitized to still images and needed greater stimulation than occasional porn users. Five peer-reviewed papers agree with the PSC analysis, namely that what Prause actually found is consistent with the effects of addiction in her study’s subjects:

  1. Neuroscience of Internet Pornography Addiction: A Review and Update – Excerpt critiquing Prause et al., 2015
  2. Neurobiology of Compulsive Sexual Behavior: Emerging Science (2016)
  3. Should compulsive sexual behavior be considered an addiction? (2016) – Excerpt analyzing Prause et al., 2015
  4. Decreased LPP for sexual images in problematic pornography users may be consistent with addiction models. Everything depends on the model. (Commentary on Prause, Steele, Staley, Sabatinelli, & Hajcak, 2015)
  5. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports – Excerpt analyzing Prause et al., 2015
  6. Conscious and Non-Conscious Measures of Emotion: Do They Vary with Frequency of Pornography Use? (2016) – Excerpt analyzing Prause et al., 2015

Author of the second critique, neuroscientist Mateusz Gola, summed up it up nicely:

“Unfortunately the bold title of Prause et al. (2015) article has already had an impact on mass media, thus popularizing a scientifically unjustified conclusion.”

What legitimate researcher would ever claim to have debunked an entire field of research and to refute all previous studies with a single EEG study? Not only was the title scientifically unjustified, Nicole Prause claimed her study contained 122 subjects (N). In reality, the study had only 55 subjects who were “experiencing problems regulating their viewing of sexual images”. The subjects were recruited from Pocatello Idaho, which is over 50% Mormon. The other 67 participants were controls.

In a second dubious claim, Prause et al., 2015 stated in both the abstract and in the body of the study:

“These are the first functional physiological data of persons reporting VSS regulation problems”.

This is clearly not the case, as the Cambridge University fMRI study was published nearly a year earlier.

In a third claim Nicole Prause has consistently asserted that Prause et al., 2015 is the largest neuroscience study published on porn addiction. Two problems with this claim:

  1. It’s not a study on porn addiction if it has no porn addicts. This study, and 2 earlier Prause studies (Prause et al., 2013 & Steele et al., 2013) did not assess whether any of the subjects were porn addicts or not. Prause admitted in a an interview that many of the subjects had little difficulty controlling use. All of the subjects would have to have been confirmed porn addicts to permit a legitimate comparison with a group of non-porn addicts. Three of the five peer-reviewed critiques point out this fatal flaw.
  2. HPA axis dysregulation in men with hypersexual disorder (2015) is the largest neuroscience based study to date on “hypersexuals” (67 subjects).  The study assessed the brain’s response to stress by assessing a hormone release by the brain (ACTH), and a hormone controlled by the brain (cortisol). While this study was a published a few months after Prause et al., 2015, Nicole Prause continues to claim her EEG study as the largest.

You Can’t “Debunk Porn Addiction” If Your Subjects Are Not Porn Addicts

The 3 Prause Studies (Prause et al., 2013, Prause et al., 2015, Steele et al., 2013.) all involved the same subjects. Here’s what we know about the “porn addicted users” in Prause’s 3 studies (the “Prause Studies”): They were not necessarily addicts, as they were never assessed for porn addiction. Thus, they can’t legitimately be used to “falsify” anything to do with the addiction model. As a group they were desensitized or habituated to vanilla porn, which is consistent with predictions of the addiction model. Here’s what each study actually reported about the “porn addicted” subjects:

  1. Prause et al., 2013: “Porn addicted users” reported more boredom and distraction while viewing vanilla porn.
  2. Steele et al., 2013: Individuals with greater cue-reactivity to porn had less desire for sex with a partner, but not less desire to masturbate.
  3. Prause et al., 2015: “Porn addicted users” had less brain activation to static images of vanilla porn. Lower EEG readings mean that the “porn addicted” subjects were paying less attention to the pictures.

A clear pattern emerges from the three studies: The “porn addicted users” were desensitized or habituated to vanilla porn, and those with greater cue-reactivity to porn preferred to masturbate to porn than have sex with a real person. Put simply they were desensitized (a common indication of addiction) and preferred artificial stimuli to a very powerful natural reward (partnered sex). There is no way to interpret these results as falsifying porn addiction.

Make no mistake, neither Steele et al., 2013 nor Prause et al., 2015 described these 55 subjects as porn addicts or compulsive porn users. The subjects only admitted to feeling “distressed” by their porn use. Confirming the mixed nature of her subjects, Prause admitted in 2013 interview that some of the 55 subjects experienced only minor problems (which means they were not porn addicts):

“This study only included people who reported problems, ranging from relatively minor to overwhelming problems, controlling their viewing of visual sexual stimuli.”

Besides not establishing which of the subjects were porn addicted, the Prause Studies did not screen subjects for mental disorders, compulsive behaviors, current drug use, or other addictions. This is critically important for any “brain study” on addiction, lest confounds render results meaningless.

In summary, the 3 Prause Studies did not assess whether the subjects were porn addicts or not. The authors admitted that many of the subjects had little difficulty controlling use. All of the subjects would have to have been confirmed porn addicts to permit a legitimate comparison with a group of non-porn addicts.

In 2013 Prause Said That Less Brain Activation Would Indicate Habituation or Addiction

You read that correctly. Prause’s 2015 claim of “debunking porn addiction” represents a flip-flop from her 2013 study’s claim of “debunking porn addiction.”

In her 2013 EEG study and related blog post, Prause admits that reduced brain activation would indicate habituation or addiction, but claimed her subjects didn’t show reduced activation. This claim, however, was groundless as explained here. She had no control group, so she could not compare “porn addicts'” EEG readings to “non-addicts'” readings. As a result, her 2013 study told us nothing about the EEG readings for either healthy individuals or “hypersexuals.”

Finally, in 2015 she added control subjects and published a second study. Sure enough, her “porn addicted” subjects displayed reduced brain activation in comparison to controls – just as would be expected in porn users suffering from habituation or addiction. Undaunted by findings that undermined her 2013 conclusion, she boldly, and without any basis in science, claimed that her corrected findings – which were consistent with the presence of addiction – “dismantled porn addiction.” And this is the talking point these propaganda pieces latch onto, with no support other than Prause’s unfounded claims.

Let’s back up and look more closely at Prause’s views from her 2013 study (Steele et al.):

“Therefore, individuals with high sexual desire could exhibit large P300 amplitude difference between sexual stimuli and neutral stimuli due to salience and emotional content of the stimuli. Alternatively, little or no P300 amplitude difference could be measured due to habituation to VSS.

In 2013, Prause said that porn addicts, when compared to controls, could either exhibit:

  1. higher EEG readings due to cue-reactivity to images, or
  2. lower EEG readings due to habituation to porn (VSS).

Five months before her 2013 EEG study was published, Prause and David Ley teamed up to write this Psychology Today blog post about her upcoming 2013 study (and its unsupported claims). In it they admit that “diminished electrical response” would indicate habituation or desensitization:

“But, when EEG’s were administered to these individuals, as they viewed erotic stimuli, results were surprising, and not at all consistent with sex addiction theory. If viewing pornography actually was habituating (or desensitizing), like drugs are, then viewing pornography would have a diminished electrical response in the brain. In fact, in these results, there was no such response. Instead, the participants’ overall demonstrated increased electrical brain responses to the erotic imagery they were shown, just like the brains of “normal people”…

So, we have 2013 Prause saying “diminished electrical response” would indicate habituation or desensitization. Later, however, in 2015, when Prause added controls for comparison and found evidence of desensitization (common in addicts), she tells us “diminished electrical response” debunks porn addiction. Huh?

In the intervening two years it took Prause to compare her same tired subject data with an actual control group, she executed a complete flip-flop. In 2015, she claimed the evidence of desensitization that she found when she added the control group isn’t evidence of addiction (which she claimed in 2013 it would have been). Instead, evidence of desensitization now (magically) “disproves addiction” (even though it aligns with addiction perfectly). This is inconsistent and unscientific, and suggests that regardless of opposing findings, she will always claim to have “disproven addiction.”

What About Brain Studies That Refute Porn Addiction?

There are none (really). This page lists all the studies assessing the brain structure and functioning of internet porn users. To date, every study offers support for the porn addiction model (including Prause’s two studies just discussed). However, whenever an article claiming to debunk porn addiction cites a study, I expect you will find one of her two EEG studies, or an irresponsible “review” by Prause, Ley and Finn. Here they are for easy reference:

  1. Sexual Desire, not Hypersexuality, is Related to Neurophysiological Responses Elicited by Sexual Images (Steele et al., 2013)
  2. Modulation of Late Positive Potentials by Sexual Images in Problem Users and Controls Inconsistent with “Porn Addiction” (Prause et al., 2015)
  3. The Emperor Has No Clothes: A Review of the ‘Pornography Addiction’ Model, by David Ley, Nicole Prause & Peter Finn (Ley et al., 2014)

Kinsey Institute grad Nicole Prause is the lead author on studies 1 and 2, and is the second author on paper #3. We already saw above that study #2 (Prause et al., 2015) lends support to the porn addiction model. But how does Prause’s 2013 EEG study (Steele et al., 2013), touted in the media as evidence against the existence of porn addiction, actually support the porn addiction model?

This study’s only significant finding was that individuals with greater cue-reactivity to porn had less desire for sex with a partner (but not lower desire to masturbate to porn). Put another way, individuals with more brain activation and cravings for porn would rather masturbate to porn than have sex with a real person. This is typical of addicts, not healthy subjects.

Study spokesman Nicole Prause claimed that frequent porn users merely had high libido, yet the results of the study say something quite different. As Valerie Voon (and 10 other neuroscientists) explained, Prause’s 2013 findings of greater cue-reactivity to porn coupled with lower desire for sex with real partners aligned with their 2014 brain scan study on porn addicts. Put simply, the actual findings of the 2013 EEG study in no way match the unsupported “debunking” headlines. Five peer-reviewed papers expose the truth about this earlier study by Prause’s team: 1, 2, 3, 4, 5.

As a side note, this same 2013 study reported higher EEG readings (P300) when subjects were exposed to porn photos. Studies consistently show that an elevated P300 occurs when addicts are exposed to cues (such as images) related to their addiction. This finding supports the porn addiction model, as the above peer-reviewed papers explained and psychology professor emeritus John A. Johnson pointed out in a comment under a 2013 Psychology Today Prause interview:

My mind still boggles at the Prause claim that her subjects’ brains did not respond to sexual images like drug addicts’ brains respond to their drug, given that she reports higher P300 readings for the sexual images. Just like addicts who show P300 spikes when presented with their drug of choice. How could she draw a conclusion that is the opposite of the actual results?

Dr. Johnson, who has no opinion on sex addiction, commented a second time under the Prause interview:

Mustanski asks, “What was the purpose of the study?” And Prause replies, “Our study tested whether people who report such problems [problems with regulating their viewing of online erotica] look like other addicts from their brain responses to sexual images.”

But the study did not compare brain recordings from persons having problems regulating their viewing of online erotica to brain recordings from drug addicts and brain recordings from a non-addict control group, which would have been the obvious way to see if brain responses from the troubled group look more like the brain responses of addicts or non-addicts…..

Aside from the many unsupported claims in the press, it’s disturbing that Prause’s 2013 EGG study passed peer-review, as it suffered from serious methodological flaws:

  1. subjects were heterogeneous (males, females, non-heterosexuals);
  2. subjects were not screened for mental disorders or addictions;
  3. study had no control group for comparison;
  4. questionnaires were not validated for porn addiction.

The third paper listed above is not a study at all. Instead, it poses as an impartial “review of the literature” on porn addiction and porn’s effects. Nothing could be farther from the truth. The lead author, David Ley, is the author of The Myth of Sex Addiction and Nicole Prause is its second author. Ley & Prause not only teamed up to write paper #3, they also teamed up to write a Psychology Today blog post about paper #1. The blog post appeared 5 months before Prause’s paper was formally published (so no one could refute it). You may have seen Ley’s blog post with the oh-so-catchy title: “Your Brain on Porn – It’s NOT Addictive”. Ley zealously denies both sex and porn addiction. He has written 20 or so blog posts attacking porn-recovery forums, and dismissing porn addiction and porn-induced ED. He is not an addiction scientist, but rather a clinical psychologist, and like Prause is not associated with any university or research institute. Read more about Ley & Prause and their collaborations here.

The following is a very long analysis of paper #3, which goes line-by-line, showing all the shenanigans Ley & Prause incorporated in their “review”: The Emperor Has No Clothes: A Fractured Fairytale Posing As A Review. It completely dismantles the so-called review, and documents dozens of misrepresentations of the research they cited. The most shocking aspect of the Ley review is that it omitted ALL the many studies that reported negative effects related to porn use or found porn addiction!

Yes, you read that right. While purporting to write an “objective” review, Ley & Prause justified omitting hundreds of studies on the grounds that these were correlational studies. Guess what? Virtually all studies on porn are correlational, even those they cited, or misused. There are, and pretty much will be, only correlational studies, because researchers have no way to prove causation by comparing users with “porn virgins” or by keeping subjects off of porn for extended periods in order compare effects. (Thousands of guys are quitting porn voluntarily on various forums, however, and their results suggest that removing internet porn is the key variable in their symptoms and recoveries.)

Inherent Bias?

It’s unprecedented for a legitimate researcher to claim that their lone anomalous study has debunked a hypothesis supported by multiple neurological studies and decades of relevant research. Moreover, what legitimate researcher would be constantly tweeting that has debunked porn addiction? What legitimate researcher would personally attack young men who run porn-recovery forums? What’s going on here? By her own admission, rejects the concept of porn addiction. For example, a quote from this recent Martin Daubney article about sex/porn addictions:

Dr Nicole Prause, principal investigator at the Sexual Psychophysiology and Affective Neuroscience (Span) Laboratory in Los Angeles, calls herself a “professional debunker” of sex addiction.

In addition, Nicole Prause’s former Twitter slogan suggests she may lack the impartiality required for scientific research:

“Studying why people choose to engage in sexual behaviors without invoking addiction nonsense”

Updates on Nicole Prause’s twitter slogan:

  1. UCLA did not renew Prause’s contract. She hasn’t been affiliated with any university since early 2015.
  2. In October, 2015 Prause’s original Twitter account is permanently suspended for harassment

While many articles continue to describe Prause as a UCLA researcher, she hasn’t been employed by any university since the beginning of 2015. Finally, it’s important to know that the enterprising Prause offered (for a fee) her “expert” testimony against sex addiction and porn addiction. It seems as though Prause is attempting to sell her services to profit from the unsupportable anti-porn addiction conclusions of her two EEG studies (1, 2), even though 9 peer-reviewed analyses say both studies support the addiction model

Interestingly, David Ley also profits from denying sex and porn addiction. At the end of this Psychology Today blog post Ley states:

Disclosure: David Ley has provided testimony in legal cases involving claims of sex addiction.

Ley also makes money selling two books which deny sex and porn addiction (“The Myth of Sex Addiction“, 2012 and “Ethical Porn for Dicks“, 2016). Pornhub is one of the four Amazon.com endorsements listed for Ley’s 2016 book.

Dismantling The Naysayers’ Talking Points

If you want a quick refutation of the naysayers’ pseudoscientific claims that they have “dismantled porn addiction,” watch Gabe Deem’s video: PORN MYTHS – The Truth Behind Addiction And Sexual Dysfunctions.

The following articles cite numerous studies, furnish illustrative examples, and elaborate logical arguments to dismantle many common anti-porn addiction propaganda talking points:

This section collects studies about which many experts have reservations – Questionable & Misleading Studies. In some, the methodology raises concerns. In others, the conclusions appear inadequately supported. In others, the title or terminology used is misleading given the actual study results. Some grossly misrepresent the actual findings.

All the Neuroscience Supports the Porn Addiction Model

Listed below are all the studies assessing the brain structure and functioning of Internet porn users (even the one claiming to have debunked porn addiction). To date every study offers support for the porn addiction model. The results of these 28 studies (and upcoming studies) are consistent with 220+ Internet addiction brain studies, many of which also include internet porn use. All support the premise that internet porn use can cause addiction-related brain changes, as do recent neuroscience-based reviews of the literature:

  1. Neuroscience of Internet Pornography Addiction: A Review and Update (2015). The review also critiques two recent headline-grabbing EEG studies which purport to have “debunked” porn addiction.
  2. Sex Addiction as a Disease: Evidence for Assessment, Diagnosis, and Response to Critics (2015), which provides a chart that takes on specific criticisms and offers citations that counter them.
  3. Neurobiology of Compulsive Sexual Behavior: Emerging Science (2016) Excerpt: “Given some similarities between CSB and drug addictions, interventions effective for addictions may hold promise for CSB, thus providing insight into future research directions to investigate this possibility directly.”
  4. Should Compulsive Sexual Behavior be Considered an Addiction? (2016) Excerpt: “Overlapping features exist between CSB and substance use disorders. Common neurotransmitter systems may contribute to CSB and substance use disorders, and recent neuroimaging studies highlight similarities relating to craving and attentional biases. Similar pharmacological and psychotherapeutic treatments may be applicable to CSB and substance addictions”
  5. Neurobiological Basis of Hypersexuality (2016). Excerpt: “Taken together, the evidence seems to imply that alterations in the frontal lobe, amygdala, hippocampus, hypothalamus, septum, and brain regions that process reward play a prominent role in the emergence of hypersexuality. Genetic studies and neuropharmacological treatment approaches point at an involvement of the dopaminergic system.
  6. Compulsive Sexual Behaviour as a Behavioural Addiction: The Impact of the Internet and Other Issues (2016)  Excerpts: “more emphasis is needed on the characteristics of the internet as these may facilitate problematic sexual behaviour.” and “clinical evidence from those who help and treat such individuals should be given greater credence by the psychiatric community.”
  7. Cybersex Addiction (2015) Excerpts: In recent articles, cybersex addiction is considered a specific type of Internet addiction. Some current studies investigated parallels between cybersex addiction and other behavioral addictions, such as Internet Gaming Disorder. Cue-reactivity and craving are considered to play a major role in cybersex addiction. Neuroimaging studies support the assumption of meaningful commonalities between cybersex addiction and other behavioral addictions as well as substance dependency.
  8. Searching for clarity in muddy water: future considerations for classifying compulsive sexual behavior as an addiction (2016) – Excerpts: We recently considered evidence for classifying compulsive sexual behavior (CSB) as a non-substance (behavioral) addiction. Our review found that CSB shared clinical, neurobiological and phenomenological parallels with substance-use disorders. Although the American Psychiatric Association rejected hypersexual disorder from DSM-5, a diagnosis of CSB (excessive sex drive) can be made using ICD-10. CSB is also being considered by ICD-11.
  9. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports (2016) – An extensive review of the literature related to porn-induced sexual problems. Involving US Navy doctors, the review provides the latest data revealing a tremendous rise in youthful sexual problems. It also reviews the neurological studies related to porn addiction and sexual conditioning via Internet porn. The doctors provide 3 clinical reports of men who developed porn-induced sexual dysfunctions.
  10. Integrating psychological and neurobiological considerations regarding the development and maintenance of specific Internet-use disorders: An Interaction of Person-Affect-Cognition-Execution model (2016) – A review of the mechanisms underlying the development and maintenance of specific Internet-use disorders, including “Internet-pornography-viewing disorder”. The authors suggest that pornography addiction (and cybersex addiction) be classified as internet use disorders and placed with other behavioral addictions under substance-use disorders as addictive behaviors.
  11. Sexual Addiction chapter from Neurobiology of Addictions, Oxford Press (2016) – Excerpt: We review the neurobiological basis for addiction, including natural or process addiction, and then discuss how this relates to our current understanding of sexuality as a natural reward that can become functionally “unmanageable” in an individual’s life.
  12. Neuroscientific Approaches to Online Pornography Addiction (2017) – Excerpt: In the last two decades, several studies with neuroscientific approaches, especially functional magnetic resonance imaging (fMRI), were conducted to explore the neural correlates of watching pornography under experimental conditions and the neural correlates of excessive pornography use. Given previous results, excessive pornography consumption can be connected to already known neurobiological mechanisms underlying the development of substance-related addictions.

See Questionable & Misleading Studies for highly publicized papers that are not what they claim to be.

See this page for the many studies linking porn use to sexual problems and decreased sexual & relationship satisfaction

“Brain Studies” (fMRI, MRI, EEG, Neuro-endocrine):

  1. Brain Structure and Functional Connectivity Associated With Pornography Consumption: The Brain on Porn (2014) – This Max Planck Institute fMRI study found less gray matter in the reward system (dorsal striatum) correlating with the amount of porn consumed. It also found that more porn use correlated with less reward circuit activation while briefly viewing sexual photos. Researchers believed their findings indicated desensitization, and possibly tolerance, which is the need for greater stimulation to achieve the same high. The study also reported that more porn viewing was linked to poorer connections between the reward circuit and prefrontal cortex – a common addiction-related brain change.
  2. Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours (2014) – The first in a series of Cambridge University studies found the same brain activity as seen in drug addicts and alcoholics. It also found that porn addicts (CSB subjects) fit the accepted addiction model of wanting “it” more, but not liking “it” more. The researchers also reported that 60% of subjects (average age: 25) had difficulty achieving erections/arousal with real partners, yet could achieve erections with porn.
  3. Enhanced Attentional Bias towards Sexually Explicit Cues in Individuals with and without Compulsive Sexual Behaviours (2014) – The second Cambridge University study. An excerpt: “Our findings of enhanced attentional bias… suggest possible overlaps with enhanced attentional bias observed in studies of drug cues in disorders of addictions. These findings converge with recent findings of neural reactivity to sexually explicit cues in [porn addicts] in a network similar to that implicated in drug-cue-reactivity studies and provide support for incentive motivation theories of addiction underlying the aberrant response to sexual cues in [porn addicts].
  4. Novelty, Conditioning and Attentional Bias to Sexual Rewards (2015) – Compared to controls porn addicts preferred sexual novelty and conditioned cues associated porn. However, the brains of porn addicts habituated faster to sexual images. Since novelty preference wasn’t pre-existing, porn addiction drives novelty-seeking in an attempt to overcome habituation and desensitization.
  5. Neural Substrates of Sexual Desire in Individuals with Problematic Hypersexual Behavior (2015) – This Korean fMRI study replicates other brain studies on porn users. Like the Cambridge University studies it found cue-induced brain activation patterns in sex addicts which mirrored the patterns of drug addicts. In line with several German studies it found alterations in the prefrontal cortex which match the changes observed in drug addicts.
  6. Sexual Desire, not Hypersexuality, is Related to Neurophysiological Responses Elicited by Sexual Images (2013) – This EEG study was touted in the media as evidence against the existence of porn/sex addiction. Not so. This SPAN Lab study, like #7 below, actually lends support to the existence of both porn addiction and porn use downregulating sexual desire. How so? The study reported higher EEG readings (P300) when subjects were briefly exposed to pornographic photos. Studies consistently show that an elevated P300 occurs when addicts are exposed to cues (such as images) related to their addiction. However, due to methodological flaws the findings are uninterpretable: 1) subjects were heterogeneous (males, females, non-heterosexuals); 2) subjects were not screened for mental disorders or addictions; 3) the study had no control group for comparison; 4) the questionnaires were not validated for porn addiction. In line with the Cambridge University brain scan studies, this EEG study also reported greater cue-reactivity to porn correlating with less desire for partnered sex. To put another way – individuals with greater brain activation to porn would rather masturbate to porn than have sex with a real person. Shockingly, study spokesman Nicole Prause claimed that porn users merely had “high libido”, yet the results of the study say something quite different. Four peer-reviewed papers expose the truth: 1, 2, 3, 4Read an extensive critique here.
  7. Modulation of Late Positive Potentials by Sexual Images in Problem Users and Controls Inconsistent with “Porn Addiction” (2015) – Another SPAN Lab EEG study comparing the 2013 subjects from the above study to an actual control group. The results: compared to controls porn addicts had less response to photos of vanilla porn. Ignoring all the other studies on this page, lead author Nicole Prause, boldly claims that her results “debunked porn addiction”. What legitimate scientist would claim that their lone anomalous study has debunked an entire field of study?  In reality, the findings of Prause et al. 2015 align perfectly with Kühn & Gallinat (2014), which found that more porn use correlated with less brain activation in response to pictures of vanilla porn. Prause’s findings also align with Banca et al. 2015 which is #4 in this list. Moreover, another EEG study found that greater porn use in women correlated with less brain activation to porn. Lower EEG readings mean that subjects are paying less attention to the pictures. Put simply, frequent porn users were desensitized to static images of vanilla porn. They were bored. Read an extensive critique here. Six peer-reviewed papers agree with this critique of the study – 1, 2, 3, 4, 5, 6.
  8. HPA axis dysregulation in men with hypersexual disorder (2015) – A study with 67 male sex addicts and 39 age-matched controls. The Hypothalamus-Pituitary-Adrenal (HPA) axis is the central player in our stress response. Addictions alter the brain’s stress circuits leading to a dysfunctional HPA axis. This study on sex addicts (hypersexuals) found altered stress responses that mirror drug addiction.
  9. The Role of Neuroinflammation in the Pathophysiology of Hypersexual Disorder (2016) – This study reported higher levels of circulating Tumor Necrosis Factor (TNF) in sex addicts when compared to healthy controls. Elevated levels of TNF (a marker of inflammation) have also been found in substance abusers and drug addicted animals (alcohol, heroin, meth). There were strong correlations between TNF levels and rating scales measuring hypersexuality.
  10. Methylation of HPA Axis Related Genes in Men With Hypersexual Disorder (2017) – This is a follow-up of #8 above which found that sex addicts have dysfunctional stress systems – a key neuro-endocrine change caused by addiction. The current study found epigenetic changes on genes central to the human stress response and closely associated with addiction. With epigenetic changes, the DNA sequence isn’t altered (as happens with a mutation). Instead, the gene is tagged and its expression is turned up or down (short video explaining epigenetics). The epigenetic changes reported in this study resulted in altered CRF gene activity. CRF is a neurotransmitter and hormone that drives addictive behaviors such as cravings, and is a major player in many of the withdrawal symptoms experienced in connection with substance and behavioral addictions, including porn addiction.
  11. Compulsive sexual behavior: Prefrontal and limbic volume and interactions (2016) – Compared to healthy controls CSB subjects (porn addicts) had increased left amygdala volume and reduced functional connectivity between the amygdala and dorsolateral prefrontal cortex DLPFC. Reduced functional connectivity between the amygdala and the prefrontal cortex aligns with substance addictions. It is thought that poorer connectivity diminishes the prefrontal cortex’s control over a user’s impulse to engage in the addictive behavior. This study suggests that drug toxicity may lead to less gray matter and thus reduced amygdala volume in drug addicts. The amygdala is consistently active during porn viewing, especially during initial exposure to a sexual cue. Perhaps the constant sexual novelty and searching and seeking leads to a unique effect on the amygdala in compulsive porn users. Alternatively, years of porn addiction and severe negative consequences is very stressful – and chronic social stress is related to increased amygdala volume. Study #8 above found that “sex addicts” have a overactive stress system. Could the chronic stress related to porn/sex addiction, along with factors that make sex unique, lead to greater amygdala volume?
  12. Ventral striatum activity when watching preferred pornographic pictures is correlated with symptoms of Internet pornography addiction (2016) – Finding #1: Reward center activity (ventral striatum) was higher for preferred pornographic pictures. Finding #2: Ventral striatum reactivity correlated with the internet sex addiction score. Both findings indicate sensitization and align with the addiction model. The authors state that the “Neural basis of Internet pornography addiction is comparable to other addictions.
  13. Altered Appetitive Conditioning and Neural Connectivity in Subjects With Compulsive Sexual Behavior (2016) – A German fMRI study replicating two major findings from Voon et al., 2014 and Kuhn & Gallinat 2014. Compared to controls compulsive porn users had 1) greater conditioned cue-induced activity in the amygdala, while having 2) decreased coupling between the ventral striatum and the prefrontal cortex. Number 1 indicates sensitization, while number 2 indicates hypofronatlity. In addition, 3 of the 20 compulsive porn users suffered from “orgasmic-erection disorder”.
  14. Compulsivity across the pathological misuse of drug and non-drug rewards (2016) – A Cambridge University study comparing aspects of compulsivity in alcoholics, binge-eaters, video game addicts and porn addicts (CSB). Excerpts: CSB subjects were faster to learning from rewards in the acquisition phase compared to healthy volunteers and were more likely to perseverate or stay after either a loss or a win in the Reward condition. These findings converge with our previous findings of enhanced preference for stimuli conditioned to either sexual or monetary outcomes, overall suggesting enhanced sensitivity to rewards (Banca et al., 2016).
  15. Can pornography be addictive? An fMRI study of men seeking treatment for problematic pornography use (2017) – Excerpts: Men with and without problematic porn sue (PPU) differed in brain reactions to cues predicting erotic pictures, but not in reactions to erotic pictures themselves, consistent with the incentive salience theory of addictions. This brain activation was accompanied by increased behavioral motivation to view erotic images (higher ‘wanting’). Ventral striatal reactivity for cues predicting erotic pictures was significantly related to the severity of PPU, amount of pornography use per week and number of weekly masturbations. Our findings suggest that like in substance-use and gambling disorders the neural and behavioral mechanisms linked to anticipatory processing of cues relate importantly to clinically relevant features of PPU. These findings suggest that PPU may represent a behavioral addiction and that interventions helpful in targeting behavioral and substance addictions warrant consideration for adaptation and use in helping men with PPU.
  16. Conscious and Non-Conscious Measures of Emotion: Do They Vary with Frequency of Pornography Use? (2017) – Study assessed porn user’s responses (EEG readings & Startle Response) to various emotion-inducing images – including erotica. The study found several neurological  differences between low frequency porn users and high frequency porn users. An excerpt: Findings suggest that increased pornography use appears to have an influence on the brain’s non-conscious responses to emotion-inducing stimuli which was not shown by explicit self-report.
  17. Preliminary investigation of the impulsive and neuroanatomical characteristics of compulsive sexual behavior (2009) – Primarily sex addicts. Study reports more impulsive behavior in a Go-NoGo task in sex addicts (hypersexuals) compared to control participants. Brain scans revealed that sex addicts had greater disorganized prefrontal cortex white matter. This finding is consistent with “hypofrontality”, a hallmark of addiction.

The above studies are all the “brain studies” published (or in the press) on internet porn users.

Together these brain studies found:

  1. The 3 major addiction-related brain changes: sensitization, desensitization, and hypofrontality.
  2. More porn use correlated with less grey matter in the reward circuit (dorsal striatum).
  3. More porn use correlated with less reward circuit activation when viewing sexual images.
  4. More porn use correlated with disrupted neural connections between the reward circuit and prefrontal cortex.
  5. Addicts had greater prefrontal activity to sexual cues, but less brain activity to normal stimuli (matches drug addiction).
  6. Porn addicts have greater preference for sexual novelty yet their brains habituated faster to sexual images. Not pre-existing.
  7. 60% of compulsive porn addicted subjects in one study experienced ED or low libido with partners, but not with porn: all stated that internet porn use caused their ED/low libido.
  8. Enhanced attentional bias comparable to drug users. Indicates sensitization (a product of DeltaFosb).
  9. Greater wanting & craving for porn, but not greater liking. This aligns with the accepted model of addiction – incentive sensitization.
  10. The younger the porn users the greater the cue-induced reactivity in the reward center.
  11. Higher EEG (P300) readings when porn users were exposed to porn cues (which occurs in other addictions).
  12. Less desire for sex with a person correlating with greater cue-reactivity to porn images.
  13. More porn use related with lower LPP amplitude when viewing sexual photos: indicates habituation or desensitization.
  14. Dysfunctional HPA axis which reflects altered brain stress circuits (and greater amygdala volume, which is associated with chronic social stress).
  15. Epigenetic changes on genes central to the human stress response and closely associated with addiction.
  16. Higher levels of Tumor Necrosis Factor (TNF) – which also occurs in drug abuse and addiction.

Neuro-Psychological Studies on Porn Users (with excerpts):

  1. Watching Pornographic Pictures on the Internet: Role of Sexual Arousal Ratings and Psychological-Psychiatric Symptoms for Using Internet Sex Sites Excessively (2011) Results indicate that self-reported problems in daily life linked to online sexual activities were predicted by subjective sexual arousal ratings of the pornographic material, global severity of psychological symptoms, and the number of sex applications used when being on Internet sex sites in daily life, while the time spent on Internet sex sites (minutes per day) did not significantly contribute to explanation of variance in IATsex score. We see some parallels between cognitive and brain mechanisms potentially contributing to the maintenance of excessive cybersex and those described for individuals with substance dependence
  2. Pornographic picture processing interferes with working memory performance (2013)Some individuals report problems during and after Internet sex engagement, such as missing sleep and forgetting appointments, which are associated with negative life consequences. One mechanism potentially leading to these kinds of problems is that sexual arousal during Internet sex might interfere with working memory (WM) capacity, resulting in a neglect of relevant environmental information and therefore disadvantageous decision making. Results revealed worse WM performance in the pornographic picture condition of the 4-back task compared with the three remaining picture conditions. Findings are discussed with respect to Internet addiction because WM interference by addiction-related cues is well known from substance dependencies.
  3. Sexual Picture Processing Interferes with Decision-Making Under Ambiguity (2013) Decision-making performance was worse when sexual pictures were associated with disadvantageous card decks compared to performance when the sexual pictures were linked to the advantageous decks. Subjective sexual arousal moderated the relationship between task condition and decision-making performance. This study emphasized that sexual arousal interfered with decision-making, which may explain why some individuals experience negative consequences in the context of cybersex use.
  4. Cybersex addiction: Experienced sexual arousal when watching pornography and not real-life sexual contacts makes the difference (2013)The results show that indicators of sexual arousal and craving to Internet pornographic cues predicted tendencies towards cybersex addiction in the first study. Moreover, it was shown that problematic cybersex users report greater sexual arousal and craving reactions resulting from pornographic cue presentation. In both studies, the number and the quality with real-life sexual contacts were not associated to cybersex addiction. The results support the gratification hypothesis, which assumes reinforcement, learning mechanisms, and craving to be relevant processes in the development and maintenance of cybersex addiction. Poor or unsatisfying sexual real life contacts cannot sufficiently explain cybersex addiction.
  5. Empirical Evidence and Theoretical Considerations on Factors Contributing to Cybersex Addiction From a Cognitive-Behavioral View (2014) Dysfunctional use of sex mediated the relationship of sexual excitability with cybersex addiction (CA). The results of the study show that there are factors of vulnerability to CA and provide evidence for the role of sexual gratification and dysfunctional coping in the development of cybersex addiction.
  6. Cybersex addiction in heterosexual female users of internet pornography can be explained by gratification hypothesis (2014) Results indicated that Internet porn users rated pornographic pictures as more arousing and reported greater craving due to pornographic picture presentation compared with non-users. Moreover, craving, sexual arousal rating of pictures, sensitivity to sexual excitation, problematic sexual behavior, and severity of psychological symptoms predicted tendencies toward cybersex addiction in porn users. Being in a relationship, number of sexual contacts, satisfaction with sexual contacts, and use of interactive cybersex were not associated with cybersex addiction.
  7. Prefrontal control and internet addiction: a theoretical model and review of neuropsychological and neuroimaging findings (2015)Consistent with this, results from functional neuroimaging and other neuropsychological studies demonstrate that cue-reactivity, craving, and decision making are important concepts for understanding Internet addiction. The findings on reductions in executive control are consistent with other behavioral addictions, such as pathological gambling. They also emphasize the classification of the phenomenon as an addiction, because there are also several similarities with findings in substance dependency.  Moreover, the results of the current study are comparable to findings from substance dependency research and emphasize analogies between cybersex addiction and substance dependencies or other behavioral addictions.
  8. Implicit associations in cybersex addiction: Adaption of an Implicit Association Test with pornographic pictures. (2015) Recent studies show similarities between cybersex addiction and substance dependencies and argue to classify cybersex addiction as a behavioral addiction. In substance dependency, implicit associations are known to play a crucial role. Results show positive relationships between implicit associations of pornographic pictures with positive emotions and tendencies towards cybersex addiction, problematic sexual behavior, sensitivity towards sexual excitation as well as subjective craving.
  9. Symptoms of cybersex addiction can be linked to both approaching and avoiding pornographic stimuli: results from an analog sample of regular cybersex users (2015) Results showed that individuals with tendencies toward cybersex addiction tended to either approach or avoid pornographic stimuli. Additionally, moderated regression analyses revealed that individuals with high sexual excitation and problematic sexual behavior who showed high approach/avoidance tendencies, reported higher symptoms of cybersex addiction. Analogous to substance dependencies, results suggest that both approach and avoidance tendencies might play a role in cybersex addiction.
  10. Getting stuck with pornography? Overuse or neglect of cybersex cues in a multitasking situation is related to symptoms of cybersex addiction (2015)Individuals with tendencies towards cybersex addiction seem to have either an inclination to avoid or to approach the pornographic material, as discussed in motivational models of addiction. The results of the current study point towards a role of executive control functions, i.e. functions mediated by the prefrontal cortex, for the development and maintenance of problematic cybersex use (as suggested by Brand et al., 2014). Particularly a reduced ability to monitor consumption and to switch between pornographic material and other contents in a goal adequate manner may be one mechanism in the development and maintenance of cybersex addiction.
  11. Trading Later Rewards for Current Pleasure: Pornography Consumption and Delay Discounting (2015)Study 1: 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:  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. It is therefore important to treat pornography as a unique stimulus in reward, impulsivity, and addiction studies and to apply this accordingly in individual as well as relational treatment.
  12. Sexual Excitability and Dysfunctional Coping Determine Cybersex Addiction in Homosexual Males (2015)Recent findings have demonstrated an association between CyberSex Addiction (CA) severity and indicators of sexual excitability, and that coping by sexual behaviors mediated the relationship between sexual excitability and CA symptoms. The aim of this study was to test this mediation in a sample of homosexual males.  Questionnaires assessed symptoms of CA, sensitivity to sexual excitation, pornography use motivation, problematic sexual behavior, psychological symptoms, and sexual behaviors in real life and online. Moreover, participants viewed pornographic videos and indicated their sexual arousal before and after the video presentation. Results showed strong correlations between CA symptoms and indicators of sexual arousal and sexual excitability, coping by sexual behaviors, and psychological symptoms. CA was not associated with offline sexual behaviors and weekly cybersex use time. Coping by sexual behaviors partially mediated the relationship between sexual excitability and CA. The results are comparable with those reported for heterosexual males and females in previous studies and are discussed against the background of theoretical assumptions of CA, which highlight the role of positive and negative reinforcement due to cybersex use.
  13. Subjective Craving for Pornography and Associative Learning Predict Tendencies Towards Cybersex Addiction in a Sample of Regular Cybersex Users (2016)There is no consensus regarding the diagnostic criteria of cybersex addiction. Some approaches postulate similarities to substance dependencies, for which associative learning is a crucial mechanism. In this study, 86 heterosexual males completed a Standard Pavlovian to Instrumental Transfer Task modified with pornographic pictures to investigate associative learning in cybersex addiction. Additionally, subjective craving due to watching pornographic pictures and tendencies towards cybersex addiction were assessed. Results showed an effect of subjective craving on tendencies towards cybersex addiction, moderated by associative learning. Overall, these findings point towards a crucial role of associative learning for the development of cybersex addiction, while providing further empirical evidence for similarities between substance dependencies and cybersex addiction
  14. Exploring the Relationship between Sexual Compulsivity and Attentional Bias to Sex-Related Words in a Cohort of Sexually Active Individuals (2016) – This study replicates the findings of this 2014 Cambridge University study that compared the attentional bias of porn addicts to healthy controls. The new study differs: rather than comparing porn addicts to controls, the new study correlated scores on a sex addiction questionnaire to the results of a task assessing attentional bias (explanation of attentional bias). The study described two key results: 1) Higher sexual compulsivity scores correlated with greater interference (increased distraction) during the attentional bias task. This aligns with substance abuse studies. 2) Among those scoring high on sexual addiction, fewer years of sexual experience were related to greater attentional bias. The authors concluded that this result could indicate that more years of “compulsive sexual activity” lead to greater habituation or a general numbing of the pleasure response (desensitization). An excerpt from the conclusion section: “One possible explanation for these results is that as a sexually compulsive individual engages in more compulsive behaviour, an associated arousal template develops and that over time, more extreme behaviour is required for the same level of arousal to be realised. It is further argued that as an individual engages in more compulsive behaviour, neuropathways become desensitized to more ‘normalised’ sexual stimuli or images and individuals turn to more ‘extreme’ stimuli to realise the arousal desired.”
  15. Mood changes after watching pornography on the Internet are linked to symptoms of Internet-pornography-viewing disorder (2016) – Excerpts: The main results of the study are that tendencies towards Internet Pornography Disorder (IPD) were associated negatively with feeling generally good, awake, and calm as well as positively with perceived stress in daily life and the motivation to use Internet pornography in terms of excitation seeking and emotional avoidance.  Furthermore, tendencies towards IPD were negatively related to mood before and after watching Internet pornography as well as an actual increase of good and calm mood. The relationship between tendencies towards IPD and excitement seeking due to Internet-pornography use was moderated by the evaluation of the experienced orgasm’s satisfaction. Generally, the results of the study are in line with the hypothesis that IPD is linked to the motivation to find sexual gratification and to avoid or to cope with aversive emotions as well as with the assumption that mood changes following pornography consumption are linked to IPD (Cooper et al., 1999 and Laier and Brand, 2014).
  16. Problematic sexual behavior in young adults: Associations across clinical, behavioral, and neurocognitive variables (2016) – Individuals with Problematic Sexual Behaviors (PSB) exhibited several neuro-cognitive deficits. These findings indicate poorer executive functioning (hypofrontality) which is a key brain feature occuring in drug addicts. A few excerpts: From this characterization, it is be possible to trace the problems evident in PSB and additional clinical features, such as emotional dysregulation, to particular cognitive deficits…. If the cognitive problems identified in this analysis are actually the core feature of PSB, this may have notable clinical implications.
  17. Executive Functioning of Sexually Compulsive and Non-Sexually Compulsive Men Before and After Watching an Erotic Video (2017) Exposure to porn affected executive functioning in men with “compulsive sexual behaviors”, but not healthy controls. Poorer executive functioning when exposed to addiction-related cues is a hallmark of substance disorders (indicating both altered prefrontal circuits and sensitization). Excerpts: This finding indicates better cognitive flexibility after sexual stimulation by controls compared with sexually compulsive participants. These data support the idea that sexually compulsive men do not to take advantage of the possible learning effect from experience, which could result in better behavior modification. This also could be understood as a lack of a learning effect by the sexually compulsive group when they were sexually stimulated, similar to what happens in the cycle of sexual addiction, which starts with an increasing amount of sexual cognition, followed by the activation of sexual scripts and then orgasm, very often involving exposure to risky situations.

Debunking the debunker: Critique of letter to the editor “Prause et al. (2015) the latest falsification of addiction predictions”

Introduction: In various comments, articles and tweets Nicole Prause has claimed that not only did Prause et al., 2015 falsify “a core tenet of the addiction model, the cue reactivity biomarker,” but that “a series of behavioral studies replicated by independent laboratories [falsify] other predictions of the addiction model.” Prause cites the Letter to the Editor (critiqued here) as her supporting evidence. Put simply, Prause has gathered all her debunking eggs into one basket – the single paragraph excerpted below. This response serves as a debunking of the debunker (Nicole Prause) and all her favorite “eggs.”

In response to neuroscientist Matuesz Gola’s critical analysis of their 2015 EEG study (Prause et al., 2015), Prause et al. wrote their own letter to the editor, entitled, “Prause et al. (2015) the latest falsification of addiction predictions,” which we will refer to as the “Reply to Gola.” (Interestingly, the editor’s original “accepted manuscript” of the Reply to Gola listed only Nicole Prause as the author, so it’s unclear if her co-authors participated in crafting the Reply to Gola, or whether it was a solo effort by Prause.)

Certainly, most of the Reply to Gola is devoted to defending Prause’s interpretations. Back in 2015 Prause made over-the-top claims that her team’s anomalous study had singlehandedly “debunked porn addiction.” What legitimate researcher would ever claim to have “debunked” an entire field of research and to have “falsified” all previous studies with a single EEG study?

Now, in 2016, the Reply to Gola’s closing paragraph puts forward an equally unwarranted assertion that a handful of papers, spearheaded by Prause’s single EEG study, falsify “multiple predictions of the addiction model.”

In Section #1 below we debunk the falsification claim by revealing what the papers cited in the Reply to Gola actually found (and did not find), as well as bringing to light the many relevant studies omitted. In Section #2 below, we examine other unsupported claims and inaccuracies in the Reply to Gola. Before we begin, here are links to the pertinent items:


SECTION ONE: Debunking the Prause et al. Claimed Falsification of The Addiction Model

This is the closing paragraph where Prause et al. summarizes the evidence purporting to falsify the porn addiction model:

“In closing, we highlight the Popperian falsification of multiple predictions of the addiction model using multiple methods. Most addiction models require that addicted individuals exhibit less control over their urge to use (or engage in the behavior); those reporting more problems with viewing sexual images actually have better control over their sexual response (replicated by Moholy, Prause, Proudfit, Rahman, & Fong, 2015; first study by Winters, Christoff, & Gorzalka, 2009). Addiction models typically predict negative consequences. Although erectile dysfunction is the most commonly suggested negative consequence of porn use, erectile problems actually are not elevated by viewing more sex films (Landripet & Štulhofer, 2015; Prause & Pfaus, 2015; Sutton, Stratton, Pytyck, Kolla, & Cantor, 2015). Addiction models often propose that the substance use or behavior is used to ameliorate or escape negative affect. Those reporting problems with sex films actually reported less negative affect at baseline/pre-viewing than controls (Prause, Staley, & Fong, 2013). Meanwhile, two more compelling models have received more support since the publication of Prause et al. (2015). These include a high sex drive model (Walton, Lykins, & Bhullar, 2016) supporting the original high-drive hypothesis (Steele, Prause, Staley, & Fong, 2013). Parsons et al. (2015) have suggested that high sex drive may represent a subset of those reporting problems. Also, distress related to viewing sex films has been shown to be most strongly related to conservative values and religious history (Grubbs et al., 2014). This supports a social shame model of problem sex film viewing behaviors. The discussion should move from testing the addiction model of sex film viewing, which has had multiple predictions falsified by independent laboratory replications, to identifying a better fitting model of those behaviors.”

Before we address each of the above assertions, it’s important to reveal what Prause et al. chose to omit from the so-called “falsification”:

  1. Studies on actual porn addicts. You read that right. Of all the studies cited, only one contained a group of porn addicts, and 71% of those subjects reported severe negative effects. Bottom line: You cannot falsify “porn addiction” if the studies you cite don’t investigate porn addicts.
  2. All the neurological studies published on porn users and sex addicts – because all support the addiction model. This page lists 33 neuroscience-based studies (MRI, fMRI, EEG, Neurospych, Hormonal) providing strong support for the addiction model.
  3. All the peer-reviewed reviews of the literature – because all support the porn addiction model. Here are 12 literature reviews by some of the top neuroscientists in the world, supporting the porn addiction model.
  4. 19 studies linking porn use/sex addiction to sexual problems. The first 3 studies in the list demonstrate causation, as participants eliminated porn use and healed chronic sexual dysfunctions.
  5. Over 45 studies linking porn use to less sexual and relationship satisfaction.
  6. Over a dozen studies reporting findings consistent with escalation of porn use (tolerance), habituation to porn, and even withdrawal symptoms.
  7. All the many studies on adolescents, which report porn use is related to poorer academics, more sexist attitudes, more aggression, poorer health, poorer relationships, lower life satisfaction, viewing people as objects, increased sexual risk taking, less condom use, greater sexual violence, greater sexual coercion, less sexual satisfaction, lower libido, greater permissive attitudes, and a whole lot more. (In short, ED is not the “most commonly suggested negative consequence of porn use” as claimed in the Reply to Gola below.)

In the Reply to Gola, Prause et al. attempt to falsify each of the following Claims (“predictions”) relating to the addiction model. The relevant excerpts and supporting studies from the Reply to Gola are given in full, followed by comments.


Claim 1: The inability to control use despite negative consequences.

PRAUSE: “Most addiction models require that addicted individuals exhibit less control over their urge to use (or engage in the behavior); those reporting more problems with viewing sexual images actually have better control over their sexual response (replicated by Moholy, Prause, Proudfit, Rahman, & Fong, 2015; first study by Winters, Christoff, & Gorzalka, 2009)”

The 2 studies cited falsified nothing as they did not assess if subjects had trouble controlling their porn use. Most importantly, neither study started by assessing who was or wasn’t a “porn addict.” How can you debunk the porn addiction model if you don’t begin by assessing subjects with clear evidence of (what addiction experts define as) addiction? Let’s briefly examine what the 2 studies actually assessed and reported, and why they falsify nothing:

Winters, Christoff, & Gorzalka, 2009 (Dysregulated Sexuality and High Sexual Desire: Distinct Constructs?):

  • The purpose of this study was to see if men could dampen their self-reported sexual arousal while watching sex films. The important findings: the men best at suppressing sexual arousal were also best at making themselves laugh. The men least successful at suppressing sexual arousal were generally hornier than the rest. These findings have nothing to do with actual porn addicts’ “inability to control use despite severe negative consequences.”
  • This online anonymous survey did not assess who was and who wasn’t a “porn addict,” because the assessment tool was the “Sexual Compulsivity Scale” (SCS). The SCS isn’t a valid assessment test for Internet-porn addiction or for women, so the study’s findings do not apply to internet porn addicts. The SCS was created in 1995 and designed with uncontrolled sexual relations in mind (in connection with investigating the AIDS epidemic). The SCS says:

“The scale has been shown to predict rates of sexual behaviors, numbers of sexual partners, practice of a variety of sexual behaviors, and histories of sexually transmitted diseases.”

Moholy, Prause, Proudfit, Rahman, & Fong, 2015 (Sexual desire, not hypersexuality, predicts self-regulation of sexual arousal):

  • This study, like the above study, did not assess which participants were or were not “porn addicts.” This study relied upon the CBSOB, which has zero questions about Internet porn use. It only asks about “sexual activities,” or if subjects are worried about their activities (e.g., “I am worried I am pregnant,” “I gave someone HIV,” “I experienced financial problems”). Thus any correlations between scores on the CBSOB and ability to regulate arousal are not relevant to many internet porn addicts, who do not engage in partnered sex.
  • Like the Winters study above, this study reported that hornier participants had a harder time down-regulating their sexual arousal while watching porn. Prause et al. are right: this study replicated Winters, et al., 2009: hornier people have higher sexual desire. (Duh)
  • This study has the same fatal flaw seen in other Prause-team studies: The researchers chose vastly different subjects (women, men, heterosexuals, non-heterosexuals), but showed them all standard, possibly uninteresting, male+female porn. Put simply, the results of this study were dependent on the premise that males, females, and non-heterosexuals do not differ in their response to a set of sexual images. This is clearly not the case.

Even though neither study identified which participants were porn addicts, the Reply to Gola seems to claim that actual “porn addicts” should be the least able to control their sexual arousal while viewing porn. Yet why would the Reply to Gola’s authors think porn addicts should have “higher arousal’ when Prause et al., 2015 reported that “porn addicts” had less brain activation to vanilla porn that did controls? (Incidentally, another EEG study also found that greater porn use in women correlated with less brain activation to porn.) The findings of Prause et al. 2015 align with Kühn & Gallinat (2014), which found that more porn use correlated with less brain activation in response to pictures of vanilla porn.

Prause et al. 2015’s EEG findings also align with Banca et al. 2015, which found faster habituation to sexual images in porn addicts. Lower EEG readings mean that subjects are paying less attention to the pictures. The more frequent porn users were probably bored by vanilla porn shown in the lab. Moholy & Prause’s compulsive porn users did not “have better control over their sexual response.” Instead, they had become habituated or desensitized to static images of vanilla porn.

It is not uncommon for frequent porn users to develop tolerance, which is the need for greater stimulation in order to achieve the same level of arousal. A similar phenomenon occurs in substance abusers who require bigger “hits” to achieve the same high. With porn users, greater stimulation is often achieved by escalating to new or extreme genres of porn.

New genres that induce shock, surprise, violation of expectations or even anxiety can function to increase sexual arousal, which often flags in those who overuse internet porn. A recent study found that such escalation is very common in today’s internet porn users. 49% of the men surveyed had viewed porn that “was not previously interesting to them or that they considered disgusting.” In sum, multiple studies have reported habituation or escalation in frequent porn users – an effect entirely consistent with the addiction model.

Key point: This entire claim in the Reply to Gola rests upon the unsupported prediction that “porn addicts” should experience greater sexual arousal to static images of vanilla porn, and thus less ability to control their arousal. Yet the prediction that compulsive porn users or addicts experience greater arousal to vanilla porn and greater sexual desire have repeatedly been falsified by several lines of research:

  1. 17 studies link porn use to lower sexual arousal or sexual dysfunctions with sex partners.
  2. 18 studies falsify the claim that sex and porn addicts “have high sexual desire” (more below).
  3. Multiple studies correlate porn use with lower sexual satisfaction.

In summary:

  • The two studies cited have nothing to do with porn addicts’ inability to control use despite negative consequences.
  • The two studies cited did not identify who was or wasn’t a porn addict, so can tell us nothing about “porn addiction.”
  • Those subjects who scored higher on the sex addiction questionnaire (not porn addiction) did not “control their arousal better” while viewing vanilla porn. They were very likely bored by the vanilla porn (i.e., desensitized, which is an addiction-related brain change).

Claim 2: Addicts use the substance or behavior to escape negative emotions

PRAUSE: “Addiction models often propose that the substance use or behavior is used to ameliorate or escape negative affect. Those reporting problems with sex films actually reported less negative affect at baseline/pre-viewing than controls (Prause, Staley, & Fong, 2013).”

While addicts often do use to escape negative affect (emotions), once again the Reply to Gola cites as support a study that has nothing to do with falsifying the above addiction prediction. Prause, Staley & Fong 2013 did not examine this phenomenon at all. Here’s what it actually reported:

“Unexpectedly, the VSS-P group exhibited significantly less coactivation of positive and negative affect to the sexual film than VSS-C.”

Translation: the so-called “porn addicts” (VSS-P group) had less emotional reaction to porn than did the control group (VSS-C). Put simply, “porn addicts” experienced less emotional response to both sexual and neutral films. Key point: Prause’s 2013 study used the same subjects as Prause et al., 2015, which is the very same 2015 EEG study that found less brain activation to static images of vanilla porn.

There’s a very simple explanation for the “more frequent porn users” having less emotional response to viewing vanilla porn. Vanilla porn no longer registered as all that interesting. The same goes “more frequent porn users” reactions to the neutral films – they were desensitized. Prause, Staley, & Fong, 2013 (also called Prause et al., 2013) has been thoroughly critiqued here.

A few patterns emerge in the Reply to Gola’s claims of falsification:

  1. The studies cited have nothing to do with the falsification of the porn addiction model.
  2. Prause often cites her own studies.
  3. The 3 Prause Studies (Prause et al., 2013, Prause et al., 2015, Steele et al., 2013.) all involved the same subjects.

Here’s what we know about the “porn addicted users” in Prause’s 3 studies (the “Prause Studies“): They were not necessarily addicts, as they were never assessed for porn addiction. Thus, they can’t legitimately be used to “falsify” anything to do with the addiction model. As a group they were desensitized or habituated to vanilla porn, which is consistent with predictions of the addiction model. Here’s what each study actually reported about the “porn addicted” subjects:

  1. Prause et al., 2013: “Porn addicted users” reported more boredom and distraction while viewing vanilla porn.
  2. Steele et al., 2013:  Individuals with greater cue-reactivity to porn had less desire for sex with a partner, but not less desire to masturbate.
  3. Prause et al., 2015: “Porn addicted users” had less brain activation to static images of vanilla porn. Lower EEG readings mean that the “porn addicted” subjects were paying less attention to the pictures.

A clear pattern emerges from the three studies: The “porn addicted users” were desensitized or habituated to vanilla porn, and those with greater cue-reactivity to porn preferred to masturbate to porn than have sex with a real person. Put simply they were desensitized (a common indication of addiction) and preferred artificial stimuli to a very powerful natural reward (partnered sex). There is no way to interpret these results as falsifying porn addiction.

You cannot falsify the porn addiction model if your “porn addicts” are not really porn addicts.

A major flaw in the Prause Studies is that no one knows which, if any, of Prause’s subjects were actually porn addicts. This is why there are often quotation marks around “porn addicts” in our descriptions of these 3 studies. The subjects were recruited from Pocatello, Idaho via online advertisements requesting people who were “experiencing problems regulating their viewing of sexual images.” Pocatello, Idaho is over 50% Mormon, so many of the subjects may feel that any amount of porn use is a serious problem.

In a 2013 interview Nicole Prause admits that a number of her subjects experienced only minor problems (which means they were not porn addicts):

“This study only included people who reported problems, ranging from relatively minor to overwhelming problems, controlling their viewing of visual sexual stimuli.”

Again, the questionnaire employed in the 3 studies to assess “porn addiction” (Sexual Compulsivity Scale) was not validated as a screening instrument for porn addiction. It was created in 1995 and designed with uncontrolled sexual relations (with partners) in mind, in connection with investigating the AIDS epidemic. The SCS says:

“The scale has been should [shown?] to predict rates of sexual behaviors, numbers of sexual partners, practice of a variety of sexual behaviors, and histories of sexually transmitted diseases.”

Moreover, the Prause Studies administered the questionnaire to the female subjects. Yet the SCS’s developer warns that this tool won’t show psychopathology in women,

“Associations between sexual compulsivity scores and other markers of psychopathology showed different patterns for men and women; sexual compulsivity was associated with indexes of psychopathology in men but not in women.”

Besides not establishing which of the subjects were porn addicted, the Prause Studies did not screen subjects for mental disorders, compulsive behaviors, or other addictions. This is critically important for any “brain study” on addiction, lest confounds render results meaningless. Another fatal flaw is that the Prause study subjects were not heterogeneous. They were men and women, including 7 non-heterosexuals, but were all shown standard, possibly uninteresting, male+female porn. This alone discounts any findings. Why? Study after study confirms that men and women have significantly different brain responses to sexual images or films. This is why serious addiction researchers match subjects carefully.

In summary,

  • The study cited in the Reply to Gola (Prause et al., 2013) has nothing to do with assessing a porn addicts’ motivations for using porn. It certainly does not assess the extent to which porn addicts use porn to escape negative feelings.
  • The Prause Studies did not assess whether the subjects were porn addicts or not. The authors admitted that many of the subjects had little difficulty controlling use. All of the subjects would have to have been confirmed porn addicts to permit a legitimate comparison with a group of non-porn addicts.
  • All valid brain studies must have homogeneous subjects for accurate comparisons. Since the Prause Studies did not, the results are unreliable, and cannot be used to falsify anything.

Claim: Porn addicts simply have a “high sex drive”

PRAUSE: Meanwhile, two more compelling models have received more support since the publication of Prause et al. (2015). These include a high sex drive model (Walton, Lykins, & Bhullar, 2016) supporting the original high-drive hypothesis (Steele, Prause, Staley, & Fong, 2013). Parsons et al. (2015) have suggested that high sex drive may represent a subset of those reporting problems.

The claim that porn and sex addicts simply have “high sexual desire,” has been falsified by 18 recent studies. In fact, Nicole Prause stated in this Quora post that she no longer believes that “sex addicts” have high libidos:

“I was partial to the high sex drive explanation, but this LPP study we just published is persuading me to be more open to sexual compulsivity.”

No matter what any study has reported it’s important to address the spurious claim that “high sexual desire” is mutually exclusive with porn addiction. Its irrationality becomes clear if one considers hypotheticals based on other addictions. (For more, see this critique of Steele, Prause, Staley, & Fong, 2013 High desire’, or ‘merely’ an addiction? A response to Steele et al., 2013). For example, does such logic mean that being morbidly obese, unable to control eating, and being extremely unhappy about it, is simply a “high desire for food?”

Extrapolating further, one must conclude that alcoholics simply have a high desire for alcohol, right? The fact is that all addicts have “high desire” for their addictive substances and activities (called “sensitization“), even when their enjoyment of such activities declines due to other addiction-related brain changes (desensitization). However, it doesn’t annul their addiction (which remains a pathology).

Most addiction experts consider “continued use despite negative consequences” to be the prime marker of addiction. After all, someone could have porn-induced erectile dysfunction and be unable to venture beyond his computer in his mother’s basement due to porn’s effects on his motivation and social skills. Yet, according to these researchers, as long as he indicates “high sexual desire,” he has no addiction. This paradigm ignores everything known about addiction, including symptoms and behaviors shared by all addicts, such as severe negative repercussions, inability to control use, cravings, etc.

Let’s look more closely at the 3 studies cited in support of the above “high desire” claim:

1. Steele, Prause, Staley, & Fong, 2013 (Sexual desire, not hypersexuality, is related to neurophysiological responses elicited by sexual images):

We discussed this study above (Steele et al., 2013). In 2013 spokesperson Nicole Prause made two unsupported public claims about Steele et al., 2013:

  1. That subjects’ brain response differed from those seen in other types of addicts (cocaine was the example)
  2. That frequent porn users merely had “high sexual desire.”

Claim #1) The study reported higher EEG readings when subjects were briefly exposed to pornographic photos. Studies consistently show that an elevated P300 occurs when addicts are exposed to cues (such as images) related to their addiction. This finding supports the porn addiction model, as peer-reviewed papers explained ( 1, 2, 3, 4, 5) and psychology professor emeritus John A. Johnson pointed out in a comment under a 2013 Psychology Today Prause interview:

“My mind still boggles at the Prause claim that her subjects’ brains did not respond to sexual images like drug addicts’ brains respond to their drug, given that she reports higher P300 readings for the sexual images. Just like addicts who show P300 spikes when presented with their drug of choice. How could she draw a conclusion that is the opposite of the actual results?”

Dr. Johnson, who has no opinion on sex addiction, commented critically a second time under the Prause interview:

Mustanski asks, “What was the purpose of the study?” And Prause replies, “Our study tested whether people who report such problems [problems with regulating their viewing of online erotica] look like other addicts from their brain responses to sexual images.”

But the study did not compare brain recordings from persons having problems regulating their viewing of online erotica to brain recordings from drug addicts and brain recordings from a non-addict control group, which would have been the obvious way to see if brain responses from the troubled group look more like the brain responses of addicts or non-addicts…..

Claim #2) Study spokesperson Nicole Prause claimed that porn users merely had “high sexual desire,” yet the study reported greater cue-reactivity to porn correlating with less desire for partnered sex. To put another way, individuals with greater brain activation to porn would rather masturbate to porn than have sex with a real person. That’s not “high sexual desire.” An excerpt from a critique of Steele et al. taken from this 2015 review of the literature:

Moreover, the conclusion listed in the abstract, “Implications for understanding hypersexuality as high desire, rather than disordered, are discussed” [303] (p. 1) seems out of place considering the study’s finding that P300 amplitude was negatively correlated with desire for sex with a partner. As explained in Hilton (2014), this finding “directly contradicts the interpretation of P300 as high desire” [307]. The Hilton analysis further suggests that the absence of a control group and the inability of EEG technology to discriminate between “high sexual desire” and “sexual compulsion” render the Steele et al. findings uninterpretable [307].

Bottom line: The findings of Steele et al., 2013 actually falsify the assertions made in the Reply to Gola.

2. Parsons et al., 2015 (Hypersexual, Sexually Compulsive, or Just Highly Sexually Active? Investigating Three Distinct Groups of Gay and Bisexual Men and Their Profiles of HIV-Related Sexual Risk):

Like nearly every study cited in the Reply to Gola, this study failed to assess which subjects were, in fact, porn addicted. It employed two questionnaires that asked only about sexual behaviors: the “Sexual Compulsivity Scale” (discussed above), and the “Hypersexual Disorder Screening Inventory.” Neither questionnaire contained a single item about internet porn use, so this study can tell us nothing about internet porn addiction.

While Parsons et al., 2015 only concerns itself with sexual behaviors in gay and bisexual men, its findings actually falsify the claim that “sex addiction is merely high sexual desire.” If high sexual desire and sex addiction were the same, there would only be one group of individuals per population. Instead, this study reported several distinct sub-groups, yet all groups reported similar rates of sexual activity.

Emerging research supports the notion that sexual compulsivity (SC) and hypersexual disorder (HD) among gay and bisexual men (GBM) might be conceptualized as comprising three groups—Neither sexually compulsive nor hypersexual; Sexually compulsive only, and Both sexually compulsive and hypersexual—that capture distinct levels of severity across the SC/HD continuum. Nearly half (48.9 %) of this highly sexually active sample was classified as Neither SC nor HD, 30 % as SC Only, and 21.1 % as Both SC and HD. While we found no significant differences between the three groups on reported number of male partners, anal sex acts….

Simplified: High sexual desire, as measured by sexual activity, tells us very little about whether a person is a sex addict or not. The key finding here is that sex addiction is not the same as “high sexual desire.”

3. Walton, Lykins, & Bhullar, 2016 (Beyond Heterosexual, Bisexual, and Homosexual A Diversity in Sexual Identity Expression):

Why this “letter to the editor” is cited remains a mystery. It’s not a peer-reviewed study and it has nothing to do with porn use, porn addiction, or hypersexuality. Are the authors of the Reply to Gola padding their citation count with irrelevant papers?

In summary:

  • The three studies cited did not assess whether any subject was porn addicted or not. As a result, they can tell us little about the claim that porn addicts simply have high sexual desire.
  • Steele, Prause, Staley, & Fong, 2013 reported that greater cue-reactivity to porn was related to less desire for sex with a partner. This falsifies the claim that porn addicts have high sexual desire.
  • Parsons et al., 2015 reported that sexual activity was unrelated to measures of hypersexuality. This falsifies the claim that “sex addicts” simply have high sexual desire.
  • Walton, Lykins, & Bhullar, 2016 is a letter to the editor that has nothing to do with the subject at hand.

Claim: Erectile dysfunction is the most commonly suggested negative consequence of porn use.

PRAUSE: Addiction models typically predict negative consequences. Although erectile dysfunction is the most commonly suggested negative consequence of porn use, erectile problems actually are not elevated by viewing more sex films (Landripet & Štulhofer, 2015; Prause & Pfaus, 2015; Sutton, Stratton, Pytyck, Kolla, & Cantor, 2015).

The claim that “erectile dysfunction is the most common negative consequence of porn use” is without support. It’s a straw man argument as:

  1. No peer-reviewed paper has ever claimed that erectile dysfunction is the #1 consequence of porn use.
  2. The #1 consequence of porn use has never been described in a peer-reviewed paper (and probably never will be).
  3. This claim limits itself to the consequences of porn use, which is not the same as the consequences of porn addiction.

How could erectile dysfunction be the #1 negative consequence of porn use when the female half of the population is omitted? If any sexual problem were the number one consequence of porn use it would have to be low libido or anorgasmia, so as to include females.

In any case, only one of the three studies cited actually identified which subjects, if any, were porn addicted: Sutton, Stratton, Pytyck, Kolla, & Cantor, 2015. Indeed, this is the only study cited in the entire Reply to Gola that identifies any study participants as porn addicts. The two other studies cited here (Landripet & Štulhofer, 2015; Prause & Pfaus, 2015) tell us nothing about the relationship between porn addiction and erectile dysfunction because neither assessed whether any subject was porn addicted or not. Sound familiar?

So, let’s first examine the only relevant study cited in the Reply to Gola.

Sutton, Stratton, Pytyck, Kolla, & Cantor, 2015 (Patient Characteristics by Type of Hypersexuality Referral: A Quantitative Chart Review of 115 Consecutive Male Cases):

It’s a study on men (average age 41.5) seeking treatment for hypersexuality disorders, such as paraphilias and chronic masturbation or adultery. 27 were classified as “avoidant masturbators,” meaning they masturbated (typically with porn use) one or more hours per day or more than 7 hours per week. 71% of the compulsive porn users reported sexual functioning problems, with 33% reporting delayed ejaculation (often a precursor to porn-induced ED).

What sexual dysfunction do 38% of the remaining men have? The study doesn’t say, and the authors have ignored repeated requests for details. Two primary choices for male sexual dysfunction in this age group are ED and low libido. The men were not asked about their erectile functioning without porn. Often men have no idea that they have porn-induced ED if they aren’t having partnered sex and all their climaxes entail masturbation to porn. This means sexual problems might have been higher than 71% in the porn addicts. Why the Reply to Gola cited this study as evidence that “negative consequences” are not associated with porn addiction remains a mystery.

Sutton et al., 2015 has been replicated by the only other study to directly investigate the relationships between sexual dysfunctions and problematic internet porn use. A 2016 Belgian study from a leading research university found problematic internet porn use was associated with reduced erectile function and reduced overall sexual satisfaction. Yet problematic porn users experienced greater cravings. The study also appears to report escalation, as 49% of the men viewed porn that “was not previously interesting to them or that they considered disgusting.”

In fact, 17 studies have replicated this link between porn use/porn addiction and sexual dysfunctions or decreased sexual arousal. The first 3 studies in that list demonstrate causation as participants eliminated porn use and healed chronic sexual dysfunctions. In addition, over 30 studies correlate porn use with lower sexual and relationship satisfaction. Sounds like “negative consequences of porn use” to me.

While “debunking” porn-induced sexual dysfunctions has no bearing on the existence of “porn addiction,” we turn next to examining the first two studies cited above for the claim there’s little relationship between erectile dysfunction and current levels of porn use.

First, it’s important to know that studies assessing young male sexuality since 2010 report historic levels of sexual dysfunctions, and startling rates of a new scourge: low libido. All are documented in this 2016 peer-reviewed paper.

Prause & Pfaus 2015 (Viewing Sexual Stimuli Associated with Greater Sexual Responsiveness, Not Erectile Dysfunction):

Since this cobbled together paper did not identify any subjects as porn addicted, its findings cannot support the claim that the porn addiction model has been falsified. Prause & Pfaus 2015 wasn’t a study at all. Instead, Prause claimed to have gathered data from four of her earlier studies, none of which addressed erectile dysfunction. Additional problem: None of the data of the Prause & Pfaus (2015) paper match the data in the four earlier studies. The discrepancies are not small and have not been explained.

A comment by researcher Richard A. Isenberg MD, published in Sexual Medicine Open Access, points out several (but not all) of the discrepancies, errors, and unsupported claims (a lay critique describes more discrepancies). Nicole Prause & Jim Pfaus made a number of false or unsupported claims associated with this paper.

Many journalists’ articles about this study claimed that porn use led to better erections, yet that’s not what the paper found. In recorded interviews, both Nicole Prause and Jim Pfaus falsely claimed that they had measured erections in the lab, and that the men who used porn had better erections. In the Jim Pfaus TV interview Pfaus states:

“We looked at the correlation of their ability to get an erection in the lab.”

“We found a liner correlation with the amount of porn they viewed at home, and the latencies which for example they get an erection is faster.”

In this radio interview Nicole Prause claimed that erections were measured in the lab. The exact quote from the show:

“The more people watch erotica at home they have stronger erectile responses in the lab, not reduced.”

Yet this paper did not assess erection quality in the lab or “speed of erections.” The paper only claimed to have asked guys to rate their “arousal” after briefly viewing porn (and it’s not clear from the underlying papers that even that actually happened in the case of all subjects). In any case, an excerpt from the paper itself admitted that:

“No physiological genital response data were included to support men’s self-reported experience.”

In a second unsupported claim, lead author Nicole Prause tweeted several times about the study, letting the world know that 280 subjects were involved, and that they had “no problems at home.” However, the four underlying studies contained only 234 male subjects, so “280” is way off.

A third unsupported claim: Dr. Isenberg wondered how it could be possible for Prause & Pfaus 2015 to have compared different subjects’ arousal levels when three different types of sexual stimuli were used in the 4 underlying studies. Two studies used a 3-minute film, one study used a 20-second film, and one study used still images. It’s well established that films are far more arousing than photos, so no legitimate research team would group these subjects together to make claims about their responses. What’s shocking is that in their paper Prause & Pfaus unaccountably claim that all 4 studies used sexual films:

“The VSS presented in the studies were all films.”

This statement is false, as clearly revealed in Prause’s own underlying studies.

A fourth unsupported claim: Dr. Isenberg also asked how Prause & Pfaus 2015 compared different subjects’ arousal levels when only 1 of the 4 underlying studies used a 1 to 9 scale. One used a 0 to 7 scale, one used a 1 to 7 scale, and one study did not report sexual arousal ratings. Once again Prause & Pfaus inexplicably claim that:

“Men were asked to indicate their level of “sexual arousal” ranging from 1 “not at all” to 9 “extremely.”

This too is false as the underlying papers show. In summary, all the Prause-generated headlines about porn improving erections or arousal, or anything else, are unwarranted. Prause & Pfaus 2015 also claimed they found no relationship between erectile functioning scores and the amount of porn viewed in the last month. As Dr. Isenberg pointed out:

“Even more disturbing is the total omission of statistical findings for the erectile function outcome measure. No statistical results whatsoever are provided. Instead the authors ask the reader to simply believe their unsubstantiated statement that there was no association between hours of pornography viewed and erectile function. Given the authors’ conflicting assertion that erectile function with a partner may actually be improved by viewing pornography the absence of statistical analysis is most egregious.”

In the Prause & Pfaus response to the Dr. Isenberg critique, they once again failed to provide any data to support their “unsubstantiated statement.” As this analysis documents, the Prause & Pfaus response not only evades Dr. Isenberg’s legitimate concerns, it contains several new misrepresentations and several transparently false statements. Finally, a review of the literature by seven US Navy doctors commented on Prause & Pfaus 2015:

“Our review also included two 2015 papers claiming that Internet pornography use is unrelated to rising sexual difficulties in young men. However, such claims appear to be premature on closer examination of these papers and related formal criticism. The first paper contains useful insights about the potential role of sexual conditioning in youthful ED [50]. However, this publication has come under criticism for various discrepancies, omissions and methodological flaws. For example, it provides no statistical results for the erectile function outcome measure in relation to Internet pornography use. Further, as a research physician pointed out in a formal critique of the paper, the papers’ authors, “have not provided the reader with sufficient information about the population studied or the statistical analyses to justify their conclusion” [51]. Additionally, the researchers investigated only hours of Internet pornography use in the last month. Yet studies on Internet pornography addiction have found that the variable of hours of Internet pornography use alone is widely unrelated to “problems in daily life”, scores on the SAST-R (Sexual Addiction Screening Test), and scores on the IATsex (an instrument that assesses addiction to online sexual activity) [52, 53, 54, 55, 56]. A better predictor is subjective sexual arousal ratings while watching Internet pornography (cue reactivity), an established correlate of addictive behavior in all addictions [52, 53, 54]. There is also increasing evidence that the amount of time spent on Internet video-gaming does not predict addictive behavior. “Addiction can only be assessed properly if motives, consequences and contextual characteristics of the behavior are also part of the assessment” [57]. Three other research teams, using various criteria for “hypersexuality” (other than hours of use), have strongly correlated it with sexual difficulties [15, 30, 31]. Taken together, this research suggests that rather than simply “hours of use”, multiple variables are highly relevant in assessment of pornography addiction/hypersexuality, and likely also highly relevant in assessing pornography-related sexual dysfunctions.”

The US Navy paper highlighted the weakness in correlating only “current hours of use” to predict porn-induced sexual dysfunctions. The amount of porn currently viewed is just one of many variables involved in the development of porn-induced ED. These may include:

  1. Ratio of masturbation to porn versus masturbation without porn
  2. Ratio of sexual activity with a person versus masturbation to porn
  3. Gaps in partnered sex (where one relies only on porn)
  4. Virgin or not
  5. Total hours of use
  6. Years of use
  7. Age started using porn
  8. Escalation to new genres
  9. Development of porn-induced fetishes (from escalating to new genres of porn)
  10. Level of novelty per session (i.e. compilation videos, multiple tabs)
  11. Addiction-related brain changes or not
  12. Presence of hypersexuality/porn addiction

The better way to research this phenomenon, is to remove the variable of internet porn use and observe the outcome, which was done in the Navy paper and in two other studies. Such research reveals causation instead of fuzzy correlations open to varying interpretation. My site has documented a few thousand men who removed porn and recovered from chronic sexual dysfunctions.

Landripet & Štulhofer 2015 (Is Pornography Use Associated with Sexual Difficulties and Dysfunctions among Younger Heterosexual Men? A Brief Communication):

As with Prause & Pfaus, 2015, this “Brief Communication” failed to identify any subjects as porn addicted. With no porn addicts to assess it cannot falsify the “negative consequences” of porn addiction. The Reply to Gola claimed that Landripet & Štulhofer, 2015 found no relationships between porn use and sexual problems. This is not true, as documented in both this YBOP critique and the US Navy review of the literature:

A second paper reported little correlation between frequency of Internet pornography use in the last year and ED rates in sexually active men from Norway, Portugal and Croatia [6]. These authors, unlike those of the previous paper, acknowledge the high prevalence of ED in men 40 and under, and indeed found ED and low sexual desire rates as high as 31% and 37%, respectively. In contrast, pre-streaming Internet pornography research done in 2004 by one of the paper’s authors reported ED rates of only 5.8% in men 35–39 [58]. Yet, based on a statistical comparison, the authors conclude that Internet pornography use does not seem to be a significant risk factor for youthful ED. That seems overly definitive, given that the Portuguese men they surveyed reported the lowest rates of sexual dysfunction compared with Norwegians and Croatians, and only 40% of Portuguese reported using Internet pornography “from several times a week to daily”, as compared with the Norwegians, 57%, and Croatians, 59%. This paper has been formally criticized for failing to employ comprehensive models able to encompass both direct and indirect relationships between variables known or hypothesized to be at work [59]. Incidentally, in a related paper on problematic low sexual desire involving many of the same survey participants from Portugal, Croatia and Norway, the men were asked which of numerous factors they believed contributed to their problematic lack of sexual interest. Among other factors, approximately 11%–22% chose “I use too much pornography” and 16%–26% chose “I masturbate too often” [60].

As the Navy doctors described, this paper found a pretty important correlation: Only 40% of the Portuguese men used porn “frequently,” while the 60% of the Norwegians used porn “frequently.” The Portuguese men had far less sexual dysfunction than the Norwegians. With respect to the Croats, Landripet & Štulhofer, 2015 acknowledge a statistically significant association between more frequent porn use and ED, but claim the effect size was small. However, this claim may be misleading according to an MD who is a skilled statistician and has authored many studies:

Analyzed a different way (Chi Squared), … moderate use (vs. infrequent use) increased the odds (the likelihood) of having ED by about 50% in this Croatian population. That sounds meaningful to me, although it is curious that the finding was only identified among Croats.

In addition, Landripet & Stulhofer 2015 omitted two significant correlations, which one of the authors presented to a European conference. He reported a significant correlation between erectile dysfunction and “preference for certain pornographic genres”:

“Reporting a preference for specific pornographic genres were significantly associated with erectile (but not ejaculatory or desire-related) male sexual dysfunction.”

It’s telling that Landripet & Stulhofer chose to omit this significant correlation between erectile dysfunction and preferences for specific genres of porn from their paper. It’s quite common for porn users to escalate into genres that do not match their original sexual tastes, and to experience ED when these conditioned porn preferences do not match real sexual encounters. As we and the US Navy pointed out above, it’s very important to assess the multiple variables associated with porn use – not just hours in the last month, or frequency in the last year.

The second significant finding omitted by Landripet & Stulhofer 2015 involved female participants:

“Increased pornography use was slightly but significantly associated with decreased interest for partnered sex and more prevalent sexual dysfunction among women.”

A significant correlation between greater porn use and decreased libido and more sexual dysfunction seems pretty important. Why didn’t Landripet & Stulhofer 2015 report that they found significant correlations between porn use and sexual dysfunction in women, as well as a few in men? And why hasn’t this finding been reported in any of Stulhofer’s many studies arising from these same data sets? His teams seem very quick to publish data they claim debunks porn-induced ED, yet very slow to inform women about the negative sexual ramifications of porn use.

Finally, Danish porn researcher Gert Martin Hald’s formal critical comments echoed the need to assess more variables (mediators, moderators) than just frequency per week in the last 12 months:

The study does not address possible moderators or mediators of the relationships studied nor is it able to determine causality. Increasingly, in research on pornography, attention is given to factors that may influence the magnitude or direction of the relationships studied (i.e., moderators) as well as the pathways through which such influence may come about (i.e., mediators). Future studies on pornography consumption and sexual difficulties may also benefit from an inclusion of such focuses.

Bottom line: All complex medical conditions involve multiple factors, which must be teased apart. In any case, Landripet & Stulhofer’s statement that, “Pornography does not seem to be a significant risk factor for younger men’s desire, erectile, or orgasmic difficulties” goes too far, since it ignores all the other possible variables related to porn use that might be causing sexual performance problems in users – including escalation to specific genres, which they found, but omitted in the “Brief Communication.”

Before confidently claiming that we have nothing to worry about from internet porn, researchers still need to account for the very recent, sharp rise in youthful ED and low sexual desire, and the many studies linking porn use to sexual problems.


Claim: Religious porn users have slightly more distress about their porn use than atheists.

PRAUSE: Also, distress related to viewing sex films has been shown to be most strongly related to conservative values and religious history (Grubbs et al., 2014). This supports a social shame model of problem sex film viewing behaviors.

Here the Reply to Gola’s attempt to debunk porn addiction drifts even farther from the target. What are we to make of a seemingly obvious finding that deeply religious individuals experience a bit more distress about their porn use than do atheists? How does this finding falsify the porn addiction model? It doesn’t. Moreover, the study cited did not concern itself with “distress related to sex film viewing.

That said, several lay articles about the Joshua Grubbs studies (“perceived addiction studies”) have tried to paint a very misleading picture of what his perceived addiction studies actually reported and what these findings mean. In response to these spurious articles, YBOP published this extensive critique of the claims made in the perceived addiction studies and in the related misleading articles.

Grubbs et al., 2014 (Transgression as Addiction: Religiosity and Moral Disapproval as Predictors of Perceived Addiction to Pornography):

The reality of this study:

  1. This study failed to identify who was and was not a porn addict, so it’s not relevant to assessing the porn addiction model.
  2. Contrary to the Reply to Gola’s assertion above, this study was not concerned with “distress related to sex film viewing.” The word “distress” is not in the study’s abstract.
  3. Contrary to the Reply to Gola and the Grubbs et al., 2014 conclusion, the strongest predictor of porn addiction was actually hours of porn use, not religiosity! See this extensive section with the study’s tables, the correlations, and what the study actually found.
  4. When we break down the Grubbs’s porn addiction questionnaire (CPUI-9), the relationship between “religiosity” and the core addiction behaviors (Access Efforts questions 4-6) is virtually non-existent. Put simply: religiosity has next to nothing to do with actual porn addiction.
  5. On the other hand, a very strong relationship exists between “hours of porn use” and the core addiction behaviors as assessed by the “Access Efforts” questions 4-6. Put simply: Porn addiction is very strongly related to amount of porn viewed.

The Reply to Gola, bloggers like David Ley, and even Grubbs himself, seem to be endeavoring to construct a meme that religious shame is the “real” cause of porn addiction. Yet it’s simply not true that the “perceived addiction” studies are evidence of this trendy talking point. Again, this extensive analysis debunks the “porn addiction is only religious shame” claim. The meme crumbles when we consider that:

  1. Religious shame doesn’t induce brain changes that mirror those found in drug addicts. In contrast, there are now 28 neurological studies reporting addiction-related brain changes in compulsive porn users/sex addicts.
  2. The perceived addiction studies did not use a cross-section of religious individuals. Instead, only current porn users (religious or nonreligious) were questioned. All cross-sectional studies report far lower rates of compulsive sexual behavior and porn use in religious individuals (study 1, study 2, study 3, study 4, study 5, study 6, study 7, study 8,).
    • This means Grubbs’s sample of “religious porn users” is relatively tiny and inevitably skewed towards individuals with pre-existing conditions or underlying issues.
    • It also means that “religiosity” does not predict porn addiction. Instead, religiosity apparently protects one from developing a porn addiction.
  3. Many atheists and agnostics develop porn addiction. Two 2016 studies on men who had used porn in the last the last 6 months, or in the last 3 months, reported extraordinarily high rates of compulsive porn use (28% for both studies).
  4. Being religious doesn’t induce chronic erectile dysfunction, low libido and anorgasmia in healthy young men. Yet numerous studies link porn use to sexual dysfunctions and lower sexual satisfaction, and ED rates have inexplicably skyrocketed by 1000% in men under 40 since “tube” porn captured porn viewers’ attention beginning at the end of 2006.
  5. This 2016 study on treatment-seeking porn addicts found that religiosity did not correlate with negative symptoms or scores on a sex addiction questionnaire. This 2016 study on treatment-seeking hypersexuals found no relationship between religious commitment and self-reported levels of hypersexual behavior and related consequences.
  6. Research shows that as the severity of their porn addiction increases, religious individuals often return to religious practices, attend church more often, and become more devout as a way of coping/seeking recovery (think 12 Steps). This alone could account for any relationship between porn addiction and religiosity.

In summary:

  • Both the Reply to Gola assertion and the single study cited have nothing to with the porn addiction model.
  • The 2014 Grubbs “perceived addiction” study actually found porn addiction was more strongly correlated with the amount of porn viewed than with religiosity.
  • There’s no evidence that religious “shame” induces addiction-related brain changes, and yet these changes have repeatedly been found in problematic porn users’ brains.
  • There’s much evidence that religiosity actually protects individuals from porn use and thus porn addiction.
  • Grubbs’s sample of “religious porn users” is not cross-sectional, and therefore inevitably skewed towards higher rates of genetic predispositions or underlying issues.
  • Two recent studies reported no relationship between porn addiction and religiosity in men seeking treatment.

SECTION TWO: Critique of a Few Selected Claims

Introduction

In this section we examine a few of the unsupported assertions and false statements put forth in the Reply to Gola. While it’s tempting to challenge the Reply to Gola line by line, its major weakness is that its arguments are specious. They fail to address the content of the YBOP critique or the 5 peer-reviewed analyses of Prause et al. 2015 (including Matuesz Gola’s): 1, 2, 3, 4. 5. All 5 expert analyses agree that Prause et al., 2015 actually found desensitization or habituation, which is consistent with the addiction model.

The following assertions of the Reply to Gola relate to Mateusz Gola’s concerns about the Prause et al., 2015 methodological flaws. Several major flaws in this and the other Prause Studies leave any study results and associated claims in serious doubt:

  1. Subjects were not screened for porn addiction (potential subjects only answered a single question).
  2. Questionnaires used did not ask about porn use and were not valid for assessing “porn addiction.”
  3. Subjects were heterogeneous (males, females, non-heterosexuals).
  4. Subjects were not screened for confounding psychiatric conditions, drug use, psychotropic medications, drug addictions, behavioral addictions, or compulsive disorders (any single one of which is exclusionary).

Reply To Claim: Prause et al., 2015 employed “proper” methodology in recruiting and identifying which subjects were porn addicts and Voon et al., 2014 did not.

Nothing could be further from the truth, as the Prause et al. methodology failed on every level, while Voon et al. employed meticulous methodology in the recruitment, screening and assessment of its “porn addicted” subjects (Compulsive Sexual Behaviors subjects).

A little background. Prause compared the average EEG readings of 55 “porn addicts” to the average EEG readings of 67 “non-addicts.” Yet the validity of Prause et al., 2015 would be entirely dependent on comparing the brain activation patterns of a group of porn addicts to a group of non-addicts. For Prause’s claims of falsification and the resulting dubious headlines to be legitimate, all of Prause’s 55 subjects would have to have been actual porn addicts. Not some, not most, but every single subject (as Voon’s were). All signs point to a good number of the 55 Prause subjects being non-addicts. An excerpt from Steele et al., 2013 describes the entire selection process and exclusion criteria employed in the 3 Prause Studies (Prause et al., 2013Steele et al., 2013, Prause et al., 2015):

“Initial plans called for patients in treatment for sexual addiction to be recruited, but the local Institutional Review Board prohibited this recruitment on the grounds that exposing such volunteers to VSS could potentiate a relapse. Instead, participants were recruited from the Pocatello, Idaho community by online advertisements requesting people who were experiencing problems regulating their viewing of sexual images.”

That’s it. The only criterion for inclusion was answering yes to a single question: “Are you experiencing problems regulating your viewing of sexual images.” The first noticeable error involves the screening question used, which asks only about viewing sexual images, and not about viewing internet porn, especially streaming videos (which appear to be the form of porn causing the most severe symptoms).

A much bigger flaw is that the Prause Studies did not screen potential subjects by using a sex or porn addiction questionnaire (as Voon et al. did). Nor were potential subjects asked whether porn use had negatively affected their lives, whether they considered themselves addicted to porn, or whether they experienced addiction-like symptoms (as Voon et al. did).

Make no mistake, neither Steele et al., 2013 nor Prause et al., 2015 described these 55 subjects as porn addicts or compulsive porn users. The subjects only admitted to feeling “distressed” by their porn use. Confirming the mixed nature of her subjects, Prause admitted in 2013 interview that some of the 55 subjects experienced only minor problems (which means they were not porn addicts):

“This study only included people who reported problems, ranging from relatively minor to overwhelming problems, controlling their viewing of visual sexual stimuli.”

Compounding the failure to screen subjects for actual porn addiction, the 3 Prause Studies chose to ignore standard exclusion criteria normally employed in addiction studies to prevent confounds. The Prause Studies did not:

  • Screen subjects for psychiatric conditions (an automatic exclusion)
  • Screen subjects for other addictions (an automatic exclusion)
  • Ask subjects if they were using psychotropic medications (often exclusionary)
  • Screen subjects for those currently using drugs (automatic exclusion)

Voon et al., 2014 did all the above and much more to ensure they were investigating only homogeneous, porn addicted subjects. Yet Prause et al., 2015 admitted they employed no criteria for excluding subjects:

“As hypersexuality is not a codified diagnosis and we were expressly prohibited from recruiting patients, no thresholds could be used to empirically identify problem users”

It appears that in Prause’s view simply answering the single-question ad met the exclusion criteria for the Prause Studies. This brings us to Matuesz Gola’s concern about Prause’s subjects not being porn addicts, as they only viewed an average of 3.8 hours of porn per week, while Voon’s subjects viewed 13.2 hours per week:

Mateusz Gola: “It is worthy to notice that in Prause et al. (2015) problematic users consume pornography in average for 3.8 h/week it is almost the same as non-problematic pornography users in Kühn and Gallinat (2014) who consume in average 4.09 h/week. In Voon et al. (2014) non-problematic users reported 1.75 h/week and problematic 13.21 h/week (SD = 9.85) – data presented by Voon during American Psychological Science conference in May 2015.”

The hours of porn use per week for each study:

  • Voon et al: 13.2 hours (all were porn addicts)
  • Kuhn & Gallinat: 4.1 hours (none were porn addicts)
  • Prause et al: 3.8 hours (no one knows)

Gola also pondered how Prause’s 55 subjects could possibly be porn addicts (for purpose of “falsifying porn addiction”) when they watched less porn than the Kühn & Gallinat, 2014 non-addicts. How in the world can all of the Prause subjects be “porn addicts” when none of the Kühn & Gallinat subjects are porn addicts? However they are labeled, subjects have to be comparable across studies before you can claim to have “falsified” competing research. This is elementary science procedure.

So, how did Prause & company address the many gaping holes in their subjects’ recruitment and assessment process? By attacking the meticulous methodology of Voon et al., 2014! First, the description of recruitment process, assessment criteria for porn addiction, and exclusion criteria excerpted from Voon et al., 2014 (also see Schmidt et al., 2016 & Banca et al., 2016):

“CSB subjects were recruited via internet-based advertisements and from referrals from therapists. Age-matched male HV were recruited from community-based advertisements in the East Anglia area. All CSB subjects were interviewed by a psychiatrist to confirm they fulfilled diagnostic criteria for CSB (met proposed diagnostic criteria for both hypersexual disorder [Kafka, 2010; Reid et al., 2012] and sexual addiction [Carnes et al., 2007]), focusing on compulsive use of online sexually explicit material. This was assessed using a modified version of the Arizona Sexual Experiences Scale (ASES) [Mcgahuey et al., 2011], in which questions were answered on a scale of 1–8, with higher scores representing greater subjective impairment. Given the nature of the cues, all CSB subjects and HV were male and heterosexual. All HV were age-matched (±5 years of age) with CSB subjects. Subjects were also screened for compatibility with the MRI environment as we have done previously [Banca et al., 2016; Mechelmans et al., 2014; Voon et al., 2014]. Exclusionary criteria included being under 18 years of age, having a history of SUD, being a current regular user of illicit substances (including cannabis), and having a serious psychiatric disorder, including current moderate-severe major depression or obsessive-compulsive disorder, or history of bipolar disorder or schizophrenia (screened using the Mini International Neuropsychiatric Inventory) [Sheehan et al., 1998]. Other compulsive or behavioral addictions were also exclusions. Subjects were assessed by a psychiatrist regarding problematic use of online gaming or social media, pathological gambling or compulsive shopping, childhood or adult attention deficit hyperactivity disorder, and binge-eating disorder diagnosis. Subjects completed the UPPS-P Impulsive Behavior Scale [Whiteside and Lynam, 2001] to assess impulsivity, and the Beck Depression Inventory [Beck et al., 1961] to assess depression. Two of 23 CSB subjects were taking antidepressants or had comorbid generalized anxiety disorder and social phobia (N = 2) or social phobia (N = 1) or a childhood history of ADHD (N = 1). Written informed consent was obtained, and the study was approved by the University of Cambridge Research Ethics Committee. Subjects were paid for their participation.”

“Nineteen heterosexual men with CSB (age 25.61 (SD 4.77) years) and 19 age-matched (age 23.17 (SD 5.38) years) heterosexual male healthy volunteers without CSB were studied (Table S2 in File S1). An additional 25 similarly aged (25.33 (SD 5.94) years) male heterosexual healthy volunteers rated the videos. CSB subjects reported that as a result of excessive use of sexually explicit materials, they had lost jobs due to use at work (N = 2), damaged intimate relationships or negatively influenced other social activities (N = 16), experienced diminished libido or erectile function specifically in physical relationships with women (although not in relationship to the sexually explicit material) (N = 11), used escorts excessively (N = 3), experienced suicidal ideation (N = 2) and using large amounts of money (N = 3; from £7000 to £15000). Ten subjects either had or were in counselling for their behaviours. All subjects reported masturbation along with the viewing of online sexually explicit material. Subjects also reported use of escort services (N = 4) and cybersex (N = 5). On an adapted version of the Arizona Sexual Experiences Scale [43], CSB subjects compared to healthy volunteers had significantly more difficulty with sexual arousal and experienced more erectile difficulties in intimate sexual relationships but not to sexually explicit material (Table S3 in File S1).”

The Reply to Gola excerpt attacking Voon et al., 2014:

“Gola notes that hours of film consumption appeared lower in our participants than in two other studies of problem erotica use. We pointed this out in our paper (paragraph beginning “The problem group reported significantly more…”). Gola argues that our sample of problem users reported fewer hours of sex film viewing than the problem sample from Voon et al. (2014). However, Voon et al. specifically recruited for participants high in sexual shame, including advertisements on shame-based websites about sex-film use, “treatment-seeking” men despite “porn” use not being recognized by the DSM-5, and with funding by a television show framed as the “harms” of “porn”. Those who adopt addiction labels have been shown to have a history of socially conservative values and high religiosity (Grubbs, Exline, Pargament, Hook, & Carlisle, 2014). It is more likely that the Voon et al. (2014) sample is characterized by high sexual shame in online communities that encourage reporting of high use. Also, “porn” use was assessed during a structured interview, not a standardized questionnaire. Thus, the psychometrics and implicit biases inherent in a structured interview are unknown. This makes it difficult to compare sex film use measures between studies. Our strategy for identifying groups is consistent with widely-cited work demonstrating the importance of distress criterion in sexual difficulties (Bancroft, Loftus, & Long, 2003).”

This is nothing more than a web of easily debunked false statements and unwarranted claims calculated to divert the reader’s attention away from Prause’s deficient screening process. We start with:

Reply to Gola: However, Voon et al. specifically recruited for participants high in sexual shame, including advertisements on shame-based websites about sex-film use, “treatment-seeking” men despite “porn” use not being recognized by the DSM-5, and with funding by a television show framed as the “harms” of “porn.”

First, the Reply to Gola supplies no evidence to support the claim that participants experienced “high sexual shame” or were recruited from so-called “shame based websites.” This is nothing more than baseless propaganda. On the other hand, the Prause Studies recruited subjects from Pocatello, Idaho which is over 50% Mormon. It’s very likely that Prause’s religious subjects experienced shame or guilt in relationship to their porn use, in contrast to Voon’s subjects recruited publicly in the UK.

Second, many of Voon’s participants were seeking treatment for porn addiction and referred by therapists. What better way is there to ensure porn-addicted subjects? It’s very odd that the Reply to Gola would spin this as a negative (rather than an unarguable strength), when the Prause Studies wanted to use only “treatment seeking” sex addicts, but were prohibited by the university review board. Taken from the first Prause EEG study:

Steele et al., 2013:Initial plans called for patients in treatment for sexual addiction to be recruited, but the local Institutional Review Board prohibited this recruitment on the grounds that exposing such volunteers to VSS could potentiate a relapse.”

Third, the Reply to Gola stoops to an outright lie by claiming that Voon et al. 2014 was funded by a “television show.” As clearly stated in Voon et al., 2014, the study was funded by “Wellcome Trust“:

Voon et al., 2014: Funding: Funding provided by Wellcome Trust Intermediate Fellowship grant (093705/Z/10/Z). Dr. Potenza was supported in part by grants P20 DA027844 and R01 DA018647 from the National Institutes of Health; the Connecticut State Department of Mental Health and Addiction Services; the Connecticut Mental Health Center; and a Center of Excellence in Gambling Research Award from the National Center for Responsible Gaming. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.”

This is followed by more false and misleading statements. For example, the Reply to Gola throws in another untruth about the Voon et al. recruitment/assessment methodology:

Reply to Gola: Also, “porn” use was assessed during a structured interview, not a standardized questionnaire.

False. In screening potential subjects Voon et al., 2014 used four standardized questionnaires and employed an extensive psychiatric interview. The following is a shortened description of the screening process taken from Banca et al., 2016 (CSB is Compulsive Sexual Behaviors):

Voon et al., 2014: CSB subjects were screened using the internet sex screening test (ISST; Delmonico and Miller, 2003) and an exhaustive experimenter-designed questionnaire which included items pertaining to age of onset, frequency, duration, attempts to control use, abstinence, patterns of use, treatment and negative consequences. CSB participants were interviewed by a psychiatrist to confirm they fulfilled two sets of diagnostic criteria for CSB (proposed diagnostic criteria for Hypersexual Disorder; criteria for sexual addiction; Carnes et al., 2001; Kafka, 2010; Reid et al., 2012), focusing on compulsive use of online sexually explicit material.  These criteria emphasize failure to cut down or control sexual behaviors, including consumption of pornography, despite social, financial, psychological and academic or vocational problems. Detailed description of CSB symptoms are described in Voon et al. (2014).

It’s shocking that the Reply to Gola would dare to compare the virtually nonexistent screening procedure used in the Prause Studies (subjects answered a single-question advertisement) with the exhaustive, expert screening procedures used for Voon et al., 2014:

  1. Internet Sex Screening Test, Delmonico and Miller, 2003
  2. Interviewed by a psychiatrist who used criteria for sexual addiction from the 3 most widely used questionnaires: Carnes et al., 2001; Kafka, 2010; Reid et al., 2012)
  3. Extensive investigator-designed questionnaire on details including age of onset, frequency, duration, attempts to control use, abstinence, patterns of use, treatment and negative consequences.

Incidentally, this process was merely the screening to confirm the existence of porn addiction; Voon et al. didn’t stop there. More questionnaires and interviews excluded those with psychiatric conditions, drug or behavioral addictions, OCD or compulsive disorders, and current or past substance abusers. The researchers in the Prause Studies did none of this.

Finally, the Reply to Gola regurgitates the unsupported claim that porn addiction is nothing more than religious shame,

Reply to Gola: “Those who adopt addiction labels have been shown to have a history of socially conservative values and high religiosity (Grubbs, Exline, Pargament, Hook, & Carlisle, 2014).”

The claimed correlation between porn addiction and religiosity was addressed above and thoroughly debunked in this extensive analysis of the Joshua Grubbs material.


Reply to Gola evades serious flaw in Prause et al., 2015: Unacceptable diversity of subjects

Critiques of Nicole Prause’s controversial EEG studies (Steele et al., 2013, Prause et al., 2015) have raised grave concerns about the diverse nature of the “distressed” porn using subjects. The EEG studies included males and females, heterosexuals and non-heterosexuals, yet the researchers showed them all standard, possibly uninteresting, male+female porn. This matters, because it violates standard procedure for addiction studies, in which researchers select homogeneous subjects in terms of age, gender, orientation, even similar IQ’s (plus a homogeneous control group) in order to avoid distortions caused by such differences.

In other words, the results of the 2 EEG studies were dependent on the premise that males, females, and non-heterosexuals are no different in their brain responses to sexual images. Yet study after study confirms that males and female have significantly different brain responses to sexual images or films. Gola knew this and mentioned this fatal flaw in a note:

Mateusz Gola: “It is worthy to notice that the authors present results for male and female participants together, while recent studies shows that sexual images ratings of arousal and valence differs dramatically between genders (see: Wierzba et al., 2015).”

In an evasive maneuver, the Reply to Gola ignores this elephant in the room: Male and female brains respond quite differently to sexual imagery. Instead, the Reply to Gola informs us that both men and women become aroused by sexual imagery, and other irrelevant fun facts:

“Gola claims that data for men and women should not be presented together, because they do not respond to the same sexual stimuli. Actually, men and women’s preferences for sexual stimuli overlap heavily (Janssen, Carpenter, & Graham, 2003). As we described, the images were pretested to equate subjective sexual arousal in both men and women. “Sexual” images from the International Affective Picture System were supplemented, because they are processed as romantic rather than sexual by both men and women (Spiering, Everaerd, & Laan, 2004). More importantly, research has shown that differences in sexual arousal ratings attributed to gender are better understood as attributable to sexual drive (Wehrum et al., 2013). Since sexual desire was a predictor in the study, it was not appropriate to segment the sexual arousal reports by the known confound: gender.”

The above response has nothing to do with Mateusz Gola’s criticism: When viewing the exact same porn male and female brains exhibit very different brain wave (EEG) and blood flow (fMRI) patterns. For example, this EEG study found that women had far higher EEG readings than men when viewing the same sexual pictures. You can’t average together male and female EEG readings, as the Prause Studies did, and end up with anything meaningful. Nor can you compare the brain responses of a mixed group to the brain responses of another mixed group, as the Prause Studies did.

There’s a reason why none of the published neurological studies on porn users (except for Prause’s) mixed males and females. Every single neurological study involved subjects who were all the same sex and same sexual orientation. Indeed, Prause herself stated in an earlier study (2012) that individuals vary tremendously in their response to sexual images:

“Film stimuli are vulnerable to individual differences in attention to different components of the stimuli (Rupp & Wallen, 2007), preference for specific content (Janssen, Goodrich, Petrocelli, & Bancroft, 2009) or clinical histories making portions of the stimuli aversive (Wouda et al., 1998).”

“Still, individuals will vary tremendously in the visual cues that signal sexual arousal to them (Graham, Sanders, Milhausen, & McBride, 2004).”

A 2013 Prause study stated:

“Many studies using the popular International Affective Picture System (Lang, Bradley, & Cuthbert, 1999) use different stimuli for the men and women in their sample.”

Large variations are to be expected with a sexually diverse group of subjects (males, females, non-heterosexuals), rendering comparisons and conclusions of the type made in the Prause Studies unreliable.

A collection of studies confirming that male and female brains respond very differently to the same sexual imagery:

In summary, the Prause Studies suffered from serious methodological flaws that call into question the studies’ results and the authors’ claims about “falsifying” the porn addiction model:

  1. Subjects were heterogeneous (males, females, non-heterosexuals)
  2. Subjects were not screened for porn addiction, mental disorders, substance use, or drug and behavioral addictions
  3. Questionnaires were not validated for porn addiction or porn use

Analysis of “Perceived Effects of Pornography on the Couple Relationship: Initial Findings of Open-Ended, Participant-Informed, Bottom-Up Research” (2016)

COMMENTS: Is the intention behind this study to (attempt to) counter the many studies that show porn use has negative effects on relationships? The two main problems with this study are:

  1. It does not contain a representative sample. Whereas most studies show that a tiny minority of porn users’ partners use porn, in this study 95% of the women used porn on their own. And 85% of the women had used porn since the beginning of the relationship (in some cases for years). Those rates are higher than in college-aged men! In other words, the researchers appear to have skewed their sample to produce the results they were seeking.
  • Reality: Cross-sectional data from the largest US survey (General Social Survey) reported that only 2.6% of women had visited a “pornographic website” in the last month. Data from 2000, 2002, 2004. For more see –  Pornography and Marriage
  1. The study used “open ended” questions where the subject could ramble on and on about porn. Then the researchers read the ramblings and decided, after the fact, what answers were “important,” and how to present (spin?) them in their paper. Then the researchers then had the gall to suggest that all the other studies on porn and relationships, which employed more established, scientific methodology and straightforward questions about porn’s effects were flawed. Is this really science?

In reality, large cross sectional studies and the only longitudinal study all find significant negative effects related to porn use.

A bit more. There were 430 participants and who provided a total of 3963 responses to 42 open-ended questions about the effects of pornography use on their couple relationship. The researchers identified 66 “themes,” with each theme represented by between 621 and 5 individual responses. Despite these fatal flaws and despite the negative effects reported by some of their sample, the researchers claimed porn’s impact was overwhelmingly positive.

A few excerpts from the study showing that some couples reported significant negative effects from porn use:

  • Porn Replaces Partner: 90 Responses involved the perception that pornography was replacing or was in competition with partnered sex. Some responses provided a rationale by mentioning that pornography is easier, more interesting, more arousing, more desirable, or more gratifying than sex with a partner. Alternatively, some porn users pointed out their partners’ may feel like they are in competition with pornography
  • Decreased Arousal Response: 71 Responses discussed how pornography use is desensitizing, decreases the ability to achieve or maintain sexual arousal, or to achieve orgasm. Note as above, it can was sometimes difficult to differentiate true arousal responses from sexual interest responses so there is overlap with Decreases Interest in Sex
  • Sexual Desensitization (subtheme): 17 of 71 Responses that specifically described desensitization as the effect of pornographyuse. Often the context is vague, making it difficult to infer much meaning from surrounding context. In other places it is explicitly connected to impaired sexual arousal
  • Addiction: 60 Responses revolved around too much use,‘‘reliance’’ or dependence on pornography, pornography using being obsessive, or becoming a sex addict. The reliance and dependence terminology suggests theoretical connections with decreased sexual interest and arousal as well as desensitization, though this terminology was used infrequently in discussions of addiction in this sample
  • Loss of Intimacy or Love: 42 Responses concerned a loss of intimacy or love. There was some diversity in this category of responses. Some indicated that pornography makes sex more recreational and less about love or closeness, while others said that their partner does not like their porn use, which creates a distance in the relationship. A couple of comments suggest that distancing is a function of the discrepancy between desired pornography-inspired behavior and actual sexual behavior with a partner. Finally, at least one participants suggested that porn use contributes to a fear of intimacy
  • Mistrust: 29 Responses discussed how pornography use contributes to mistrust or damaged trust
  • Reinforces Stereotypes About Sex and Gender: 28 Responses were concerned pornography’s perpetuation of sexism, contribution to male domination or degradation of women, or reinforcement of sexual objectification
  • Damaged Relationship: 28 Responses described how pornography use damages or puts strain on relationships, marriages and sex life. There was some discussion of how people want less sex from a partner because the partner uses pornography
  • Relationship Dissolution: 23 Responses involved how pornography use contributes or may contribute to relationship dissolutions. The reasons that were offered for this consequence were diverse: porn contributes to infidelity or is perceived as possible infidelity, porn use negatively impacts sexual behavior, or porn use leads to a loss of interest in having sexual relations with the current partner
  • Less Enjoyment of Real Sex: 17 Responses suggested that pornography makes real sex more boring, more routine, less exiting, or less enjoyable. A minority of responses described a loss of intimacy, or loving component of having sex together
  • Less Satisfied with Partner: 17 Responses indicated that pornography use lowers interest in, or satisfaction with, or desire for, or attraction to a sexual partner. Partners feel like they are in competition with porn or porn stars

 

Arch Sex Behav. 2016 Jul 8. 

Kohut T1, Fisher WA2,3, Campbell L2.

Abstract

The current study adopted a participant-informed, “bottom-up,” qualitative approach to identifying perceived effects of pornography on the couple relationship. A large sample (N = 430) of men and women in heterosexual relationships in which pornography was used by at least one partner was recruited through online (e.g., Facebook, Twitter, etc.) and offline (e.g., newspapers, radio, etc.) sources. Participants responded to open-ended questions regarding perceived consequences of pornography use for each couple member and for their relationship in the context of an online survey. In the current sample of respondents, “no negative effects” was the most commonly reported impact of pornography use. Among remaining responses, positive perceived effects of pornography use on couple members and their relationship (e.g., improved sexual communication, more sexual experimentation, enhanced sexual comfort) were reported frequently; negative perceived effects of pornography (e.g., unrealistic expectations, decreased sexual interest in partner, increased insecurity) were also reported, albeit with considerably less frequency. The results of this work suggest new research directions that require more systematic attention.

KEYWORDS: Pornography; Relationship quality; Relationship satisfaction; Relationships; Sexual satisfaction; Sexually explicit material

“Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports” – Excerpt analyzing Steele et al., 2013

Excerpt analyzing Steele et al., 2013:


A 2013 EEG study by Steele et al. reported higher P300 amplitude to sexual images, relative to neutral pictures, in individuals complaining of problems regulating their Internet pornography use [48]. Substance abusers also exhibit greater P300 amplitude when exposed to visual cues associated with their addiction [148]. In addition, Steele et al. reported a negative correlation between P300 amplitude and desire for sex with a partner [48]. Greater cue reactivity to Internet pornography paired with less sexual desire for partnered sex, as reported by Steele et al., aligns with the Voon et al. finding of “diminished libido or erectile function specifically in physical relationships with women” in compulsive Internet pornography users [31]. Supporting these findings, two studies assessing sexual desire and erectile function in “hypersexuals” and compulsive Internet pornography users reported associations between measures of hypersexuality, and reduced desire for partnered sex and sexual difficulties [15,30]. Additionally, the 2016 survey of 434 men who viewed Internet pornography at least once in the last three months reported that problematic use was associated with higher levels of arousabilty, yet lower sexual satisfaction and poorer erectile function [44]. These results should be viewed in light of the multiple neuropsychology studies that have found that sexual arousal to Internet pornography cues and cravings to view pornography were related to symptom severity of cybersex addiction and self-reported problems in daily life due to excessive Internet pornography use [52,53,54,113,115,149,150]. Taken together, multiple and varied studies on Internet pornography users align with the incentive-salience theory of addiction, in which changes in the attraction value of an incentive correspond with changes in activation of regions of the brain implicated in the sensitization process [31,106]. To sum up, in alignment with our hypothesis, various studies report that greater reactivity toward pornographic cues, cravings to view, and compulsive pornography use are associated with sexual difficulties and diminished sexual desire for partners.

“Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports” – Excerpt analyzing Prause et al., 2015

Excerpt analyzing Prause et al., 2015


A 2015 EEG study by Prause et al. compared frequent viewers of Internet pornography (mean 3.8 h/week) who were distressed about their viewing to controls (mean 0.6 h/week) as they viewed sexual images (1.0 s exposure) [130]. In a finding that parallels Kühn and Gallinat, frequent Internet pornography viewers exhibited less neural activation (LPP) to sexual images than controls [130]. The results of both studies suggest that frequent viewers of Internet pornography require greater visual stimulation to evoke brain responses when compared with healthy controls or moderate Internet pornography users [167,168]. In addition, Kühn and Gallinat reported that higher Internet pornography use correlated with lower functional connectivity between the striatum and the prefrontal cortex. Dysfunction in this circuitry has been related to inappropriate behavioral choices regardless of potential negative outcome [169]. In line with Kühn and Gallinat, neuropsychological studies report that subjects with higher tendency towards cybersex addiction have reduced executive control function when confronted with pornographic material [53,114].

Decreased LPP for sexual images in problematic pornography users may be consistent with addiction models. Everything depends on the model. (Commentary on Prause, Steele, Staley, Sabatinelli, & Hajcak, 2015) by Matuesz Gola PhD. (2016)


Biol Psychol. 2016 May 24. pii: S0301-0511(16)30182-X. doi: 10.1016/j.biopsycho.2016.05.003.

Link to PDF

  • 1Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California San Diego, San Diego, USA; Institute of Psychology, Polish Academy of Science, Warsaw, Poland. Electronic address: mgola@ucsd.edu.

Internet technology provides affordable and anonymous access to a wide range of pornography content (Cooper, 1998). Avail-able data show that 67.6% of male and 18.3% of female Danish young adults (18–30 years old) use pornography on the regular weekly basis (Hald, 2006). Among USA college students 93.2% of boys and 62.1% of girls were watching online pornography before age of 18 (Sabina, Wolak, & Finkelhor, 2008). For the majority of users, pornography viewing plays a role in entertainment, excitement, and inspiration (Rothman, Kaczmarsky, Burke, Jansen, & Baughman, 2014) (Häggström-Nordin, Tydén, Hanson,& Larsson, 2009), but for some, frequent pornography consumption is a source of suffering (about 8% out of users according to Cooper et al., 1999) and becomes a reason for seeking treatment (Delmonico and Carnes, 1999; Kraus, Potenza, Martino, & Grant,2015; Gola, Lewczuk, & Skorko, 2016; Gola and Potenza, 2016). Due to its widespread popularity and conflicting clinical observations, pornography consumption is an important social issue, garnering much attention in the media, (e.g., high-profile movies: “Shame” by McQueen and “Don Jon” by Gordon-Levitt) and from politicians(e.g., UK prime minister David Cameron’s 2013 speech on pornography use by kids), as well as neuroscience research (Steele, Staley, Fong, & Prause, 2013; Kühn and Gallinat, 2014; Voon et al., 2014). One of the most frequently asked questions is: whether pornography consumption can be addicting?

The finding of Prause, Steele, Staley, Sabatinelli, & Hajcak, (2015) published in the June issue of Biological Psychology delivers interesting data on this topic. The researchers showed that men and women reporting problematic pornography viewing (N = 55),1 exhibited lower late positive potential (LPP – an event related potential in EEG signaling associated with significance and subjective silence of the stimuli) to sexual images as compared with non-sexual images, when compared with the responses of controls. They also show that problematic pornography users with higher sexual desire have smaller LPP differences for sexual and non-sexual images. The authors concluded that: “This pattern of results appears inconsistent with some predictions made by addiction models” (p. 196) and announced this conclusion in the article’s title: “Modulation of late positive potentials by sexual images in problem users and controls inconsistent with “porn addiction””.

Unfortunately, in their article, Prause et al. (2015) did not explicitly define which model of addiction they were testing. Presented results when considered in relation to the most established models either do not provide clear verification of the hypothesis that problematic pornography use is an addiction (like in case of Incentive Salience Theory; Robinson and Berridge, 1993; Robinson, Fischer, Ahuja, Lesser, & Maniates, 2015) or support this hypothesis (like in case of Reward Deficiency Syndrome; Blum et al., 1996; 1996; Blum, Badgaiyan, & Gold, 2015). Below I explain it in details.

Correspondence address: Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California San Diego, 9500 Gilman Drive, San Diego, CA 92093-0559, USA. E-mail address: mgola@ucsd.edu

1 It is worthy to notice that the authors present results for male and female participants together, while recent studies shows that sexual images ratings of arousal and valence differs dramatically between genders (see: Wierzba et al., 2015)

2 This guess is supported by fact that references used in Prause et al. (2015) also refer to IST (i.e. Wölfling et al., 2011

Why theoretical framework and clear hypothesis matter

Based on the multiple uses of the term “cue-reactivity” by the authors we may guess that the authors have in mind Incentive Salience Theory (IST) proposed by Robinson and Berridge (Berridge, 2012; Robinson et al., 2015).2 This theoretical frame-work distinguishes two basic components of motivated behavior − “wanting” and “liking”. The latter is directly linked to the experienced value of the reward, while the former is related to the expected value of the reward, typically measured in relation to a predictive cue. In terms of Pavlovian learning, reward is an unconditioned stimulus (UCS) and cues associated with this reward through learning are conditioned stimuli (CS). Learned CSs acquire incentive salience and evoke “wanting”, reflected in motivated behavior (Mahler and Berridge, 2009; Robinson & Berridge, 2013). Thus they acquire similar properties as the reward itself. For example domesticated quail willingly copulate with a terrycloth object (CS) previously paired with the opportunity to copulate with a female quail (UCS), even if a real female is available (Cetinkaya and Domjan, 2006)

According to IST, addiction is characterized by increased “wanting” (elevated cue-related reactivity; i.e. higher LPP) and decreased “liking” (diminished reward-related reactivity; i.e. lower LPP). In order to interpret data within the IST framework researchers must clearly disentangle cue-related “wanting” and reward-related “liking.” Experimental paradigms testing both processes introduce separate cues and rewards (i.e. Flagel et al., 2011; Sescousse, Barbalat, Domenech, & Dreher, 2013; Gola, Miyakoshi, & Sescousse, 2015). Prause et al. (2015) instead use a much simpler experimental paradigm, wherein subjects passively view different pictures with sexual and non-sexual content. In such simple experimental design the crucial question from the IST perspective is: Do the sexual images play the role of cues (CS) or rewards (UCS)? And therefore: does the measured LPP reflect “wanting” or “liking”?

The authors assume that sexual images are cues, and there-fore interpret decreased LPP as a measure of diminished “wanting.”Diminished “wanting” with respect to cues would indeed be inconsistent with the IST addiction model. But many studies show that sexual pictures are not mere cues. They are rewarding in them-selves (Oei, Rombouts, Soeter, van Gerven, & Both, 2012; Stoléru,Fonteille, Cornélis, Joyal, & Moulier, 2012; reviewed in: Sescousse, Caldú, Segura, & Dreher, 2013; Stoléru et al., 2012). Viewing sexual images evokes ventral striatum (reward system) activity (Arnowet al., 2002; Demos, Heatherton, & Kelley, 2012; Sabatinelli, Bradley,Lang, Costa, & Versace, 2007; Stark et al., 2005; Wehrum-Osinskyet al., 2014), dopamine release (Meston and McCall, 2005) and both self-reported and objectively measured sexual arousal (review: Chivers, Seto, Lalumière, Laan, & Grimbos, 2010).

The rewarding properties of sexual images may be innate due to the fact that sex (like food) is a primary reward. But even if some-one rejects such innate rewarding nature, rewarding properties of erotic stimuli may be acquired due to Pavlovian learning. Under natural conditions, visual erotic stimuli (such as a naked spouse or pornographic video) may be a cue (CS) for sexual activity leading to the climax experience (UCS) as a result of either dyadic sex or solitary masturbation accompanying pornography consumption. Furthermore in the case of frequent pornography consumption, visual sexual stimuli (CS) are strongly associated with orgasm (UCS)and may acquire properties of reward (UCS; Mahler and Berridge, 2009; Robinson & Berridge, 2013) and then lead to approach (i.e.seeking pornography) and consummatory behaviors (i.e., hours of viewing before reaching climax).

Regardless of innate or learned reward value, studies show that sexual images are motivating in themselves, even without the possibility of climax. Thus they have intrinsic hedonic value for humans (Prévost, Pessiglione, Météreau, Cléry-Melin, & Dreher,2010) as well as rhesus macaques (Deaner, Khera, & Platt, 2005). Their rewarding value may even be amplified in an experimental setting, where a climax experience (natural UCS) is unavailable, as in the Prause et al.’s (2015) study (“participants in this study were instructed not to masturbate during the task”, p. 197). According to Berridge, task context influences reward prediction (Berridge,2012). Thus, as no other pleasure than sexual images was available here, the viewing of pictures was the ultimate reward (rather than simply a cue).

Decreased LPP for sexual rewards in problematic pornography users is consistent with addiction models

Taking all of the above into account we may assume that sexual images in the Prause et al. (2015) study, instead of being cues, might have played the role of rewards. If so, according to the IST framework, lower LPP for sexual vs. non-sexual pictures in problematic pornography users and subjects with high sexual desire indeed reflects diminished “liking”. Such a result is in line with the addiction model proposed by Berridge and Robinson (Berridge, 2012; Robinson et al., 2015). However, to fully verify an addiction hypothesis within IST framework, more advanced experimental studies, disentangling cue and reward are required. A good example of a well designed experimental paradigm was used in studies on gamblers by Sescousse, Redouté, & Dreher (2010). It employed monetary and sexual cues (symbolic stimuli) and clear rewards(monetary wins or sexual pictures). Due to lack of well defined cues and rewards in Prause et al. (2015) study, role of sexual pictures remains unclear and therefore obtained LPP effects are ambiguous within IST framework. For sure conclusion presented in the study’s title “Modulation of late positive potentials by sexual images in problem users and controls inconsistent with “porn addiction” is ungrounded with respect to IST

If we take another popular addiction model – Reward Deficency Syndrome (RDS; Blum et al., 1996, 2015) the data obtained by the authors actually speaks in favor of addiction hypothesis. RDS frame-work assumes that genetic predisposition to lower dopaminergic response for rewarding stimuli (expressed in diminished BOLD and electrophysiological reactivity) is related to sensation-seeking, impulsivity and higher risk of addiction. The authors’ findings of lower LPPs in problematic pornography users is entirely consistent with the RDS addiction model. If Prause et al. (2015) were testing some other model, less well known than IST or RDS, it would be highly desirable to present it briefly in their work.

Final remarks

The study by Prause et al. (2015) delivers interesting data on problematic pornography consumption.3 Yet, due to the lack of clear hypothesis statement which addiction model is tested and ambiguous experimental paradigm (hard to define role of erotic pictures), it is not possible to say if the presented results are against, or in favor of, a hypothesis about “pornography addiction.” More advanced studies with well defined hypotheses are called for. Unfortunately the bold title of Prause et al. (2015) article has already had an impact on mass media,4 thus popularizing scientifically unjustified conclusion. Due to the social and political importance of the topic of the effects of pornography consumption, researchers should draw future conclusions with greater caution.

3 It is worthy to notice that in Prause et al. (2015) problematic users consume pornography in average for 3.8 h/week (SD = 1.3) it is almost the same as non-problematic pornography users in Kühn and Gallinat (2014) who consume in average 4.09 h/week (SD = 3.9). In Voon et al. (2014) problematic users reported 1.75 h/week (SD = 3.36) and problematic 13.21 h/week (SD = 9.85) – data presented by Voon during American Psychological Science conference in May 2015.

4 Examples of titles of popular science articles about Prause et al. (2015):“Porn is not as harmful as other addictions, study claims” (http://metro.co.uk/2015/07/04/porn-is-not-as-harmful-as-other-addictions…), “Your Porn Addiction Isn’t Real” (http://www.thedailybeast.com/articles/2015/06/26/your-porn-addiction-isn…), “Porn ’Addiction’ Isn’t Really Addiction, Neuroscientists Say” (http://www.huffingtonpost.com/2015/06/30/porn-addiction- n7696448.html)

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Critique of: “Is Pornography Use Associated with Sexual Difficulties and Dysfunctions among Younger Heterosexual Men?” (2015)


THE ARTICLE

Study on young men: ED rates of 31%; low libido 37%, but, hey, it can’t be porn

This is an analysis of Is Pornography Use Associated with Sexual Difficulties and Dysfunctions among Younger Heterosexual Men? (A Brief Communication) by Landripet I, Štulhofer A.

The conclusion of this brief paper on young men in Portugal, Croatia and Norway stated that:

Pornography does not seem to be a significant risk factor for younger men’s desire, erectile, or orgasmic difficulties.

Let’s’ examine a few major problems with this overly confident conclusion.

PROBLEM 1: Study reports incredibly high rates of ED & low sexual desire

This simple cross-sectional study comparing a pair of existing databases found rates of ED as high as 31% and rates of ‘low sexual desire’ as high as 37% in men 18-40. Yet the title and abstract mention neither of these findings. Instead, the authors reassure us that “It’s not the porn”, even though the study acknowledges an ED epidemic in young men:

 “Several large-scale epidemiological studies recently pointed to a high prevalence of erectile dysfunction (ED) among younger men.”

What were the ED rates in young men in the new study, which is based on a 2011 questionnaire and another from 2014?

“In Study 1, 14.2–28.3% of participants reported ED” (2011)

“In Study 2, 30.8% of men were classified as having ED” (2014)

Note the continued rise in ED rates even between the 2011 survey and the 2014 survey. Back in 2004, Stulhofer’s research showed that ED rates in men 35-39 were only 5.8%!

This study found the same extraordinarily high rates of unexplained ED in young men found in several other studies. What were ED rates before the Internet? Kinsey (1948) reported less than 3% rate of ED for men under 40, and less than 1% for men 19 and under. The only cross-sectional study of ED rates in American men reported a 5% rate of ED in men ages 18-59. This was based on data from 1992, and one third of the men were over 40. Similarly, a 2002 meta-analysis by Dutch researchers reported that of 6 studies analyzed, 5 found ED rates for men under 40 were approximately 2%. The other one reported rates of 9%.

Also note that in the first survey, “low sexual desire” rates were an alarming 16.3% to 37.4%. How can almost 40% of young men have low libido? Such high rates were unheard of only a few short years ago. For example, in 2004, Italian urologist Carlo Foresta found low-sexual-desire rates of only 1.7% in teens. However, rates had jumped 600% to 10.3% by 2012.

Bottom line: ED rates for men under 40 have increased at least 600% in the last 20 years, and the study’s authors assert that porn is not the cause. What other variable has changed radically in the last 15-20 years?


PROBLEM 2: The only variable assessed was frequency of use in the last 12 months

The authors only assess one variable related to porn use across all subjects: self-reported frequency of use (not hours of use) over the last 12 months. There are several problems with this limited measure:

  1. Frequency of use may have no relationship to hours per week, let alone various other, more relevant, variables of use
  2. It tells us nothing about porn use prior to the last 12 months
  3. It tells us nothing about total porn use over a lifetime

The authors conclude that in their cross-sectional study, using the questions they used, there is little evidence that frequency of porn determines which young men develop sexual dysfunctions. This result is not altogether surprising. In fact, one of the most common questions posed on recovery forums is, “Why did I develop PIED when my friends watch as much (or more) porn than I do?”

Instead of frequency of use, a combination of variables appear to be involved in porn-induced ED. These include:

  1. Total hours of use
  2. Years of use
  3. Age started consistent porn use
  4. Escalation to new genres
  5. Development of porn-induced fetishes (from escalating to new genres of porn)
  6. Ratio of masturbation to porn versus masturbation without porn
  7. Ratio of sexual activity with a person versus masturbation to porn
  8. Gaps in partnered sex (where one relies only on porn)
  9. Virgin or not
  10. Addiction-related brain changes or not
  11. Presence of porn addiction/hypersexuality
  12. Genetics

What other aspects of internet porn use might better explain porn-related sexual dysfunctions? German researchers found that intensity of arousal and number of applications opened were associated with porn-related problems, while time spent watching was not.

Results indicate that self-reported problems in daily life linked to online sexual activities were predicted by subjective sexual arousal ratings of the pornographic material, global severity of psychological symptoms, and the number of sex applications used when being on Internet sex sites in daily life, while the time spent on Internet sex sites (minutes per day) did not significantly contribute to explanation of variance in IATsex score. Personality facets were not significantly correlated with the IATsex score. [emphasis added]

To reiterate, the Germans found that time spent watching porn was not a factor in either porn addiction or the negative consequences of using. Instead it was the number of applications (genres), and one’s response to porn use, that made the difference. That is, a need for novelty and more stimulation. Similarly, hours of use by internet videogamers also do not predict problems. Rather, motives and obsessive passion for gaming are predictive.

In short, criteria for diagnosing problems with internet use need to be broader than hours/frequency of use. This casts doubt of the usefulness and conclusions of the “Brief Communication” under discussion here. Danish porn researcher Gert Martin Hald’s editorial comments echoed the need to assess more variables (mediators, moderators) than just frequency per week in the last 12 months:

Third, the study does not address possible moderators or mediators of the relationships studied nor is it able to determine causality. Increasingly, in research on pornography, attention is given to factors that may influence the magnitude or direction of the relationships studied (i.e., moderators) as well as the pathways through which such influence may come about (i.e., mediators). Future studies on pornography consumption and sexual difficulties may also benefit from an inclusion of such focuses.

Bottom line: All complex medical conditions involve multiple factors which must be teased apart. In any case, the authors’ statement that, Pornography does not seem to be a significant risk factor for younger men’s desire, erectile, or orgasmic difficulties is unsupported, since it ignores all the other possible variables related to porn use that might be causing sexual performance problems in users. Before confidently claiming that we have nothing to worry about from internet porn, one still needs to explain away the very recent, astonishing rise in youthful ED and low sexual desire.


PROBLEM 3: Study excluded virgins and men who hadn’t had intercourse in the last 12 months

The two populations most likely to report porn-induced ED, virgins and men not having sex, were excluded from the survey. It’s not unusual for men with PIED to say they have remained virgins because they cannot achieve strong enough erections to penetrate. Many sexually experienced men say they no longer attempt sex due to PIED.

In other words, this survey wouldn’t pick up new ED in guys who had sex almost a year ago. It also wouldn’t pick up sexual dysfunctions in those who haven’t had sex in the last year, or who have exclusively been using internet porn to climax, or those who are virgins because they can’t get it up without porn. And were these men to be included (and asked if they can masturbate without internet porn), it may well be that a correlation between frequency of porn use and ED/low sexual desire would have appeared.


PROBLEM 4: The study actually found a few correlations between ED and porn use

The abstract doesn’t mention a pretty important correlation: Only 40% of the Portuguese men used porn “frequently”, while the 60% of the Norwegians used porn “frequently”. The Portuguese men had far less sexual dysfunction than the Norwegians.

Elsewhere, the authors acknowledge a statistically significant association between more frequent porn use and ED, but claim the effect size was small. However, this claim may be misleading according to an MD who is a skilled statistician and has authored many studies:

Analyzed a different way (Chi Squared), … moderate use (vs. infrequent use) increased the odds (the likelihood) of having ED by about 50% in this Croatian population. That sounds meaningful to me, although it is curious that the finding was only identified among Croats.

The authors blow this finding off and ignore it in reaching their conclusions, but in Gert Martin Hald’s formal comments about the study he says:

However, in pornography research, the interpretation of “size” may depend as much on the nature of the outcome studied as the magnitude of the relationship found. Accordingly, if the outcome is to be considered “sufficiently adverse” (e.g., sexual aggressive behaviors), even small effect sizes may carry considerable social and practical significance [2].

Landripet and Stulhofer omitted two correlations which they presented to a European conference:

However, increased pornography use was slightly but significantly associated with decreased interest for partnered sex and more prevalent sexual dysfunction among women.

Reporting a preference for specific pornographic genres were significantly associated with erectile, but not ejaculatory or desire-related male sexual dysfunction.

It’s quite telling that Landripet & Stulhofer chose to omit a very significant correlation between erectile dysfunction and preferences for specific genres of porn from their paper. It’s quite common for porn users to escalate into genres that do not match their original sexual tastes, and to experience ED when these conditioned porn preferences do not match real sexual encounters. As pointed out below, it’s very important to assess the multiple variables associated with porn use – not just hours in the last month, or frequency in the last years.


PROBLEM 5: Claiming a 1000% increase in youthful ED can be explained by other factors.

So how do the authors explain the current ED epidemic in men under 40? They suggest the epidemic must arise from he same old factors that existed before the internet.

Epidemiological studies suggest that unhealthy lifestyles, substance abuse, stress, depression, intimacy deficit, and misinformation about sexuality are more likely factors behind male sexual dysfunctions than pornography use.”

The authors are simply quoting earlier studies that suggest smoking, lack of exercise, and drug use may be factors, because those are the historical factors, but this conclusion is difficult to swallow.

First, smoking, obesity, diabetes, and lack of exercise are not major factors for young men. It takes years for these to manifest as organic ED, in the form of cardiovascular disease or nerve dysfunction. Moreover, smoking rates have drastically declined in the last 30 years, and the use of drugs and exercise rates have held steady over recent years. Obesity rates have only increased by 4% over the last 15 years. From the 20110 study, “Erectile dysfunction and correlated factors in Brazilian men aged 18-40 years.”

“Prevalence of ED in 1,947 men was 35.0% (73.7% mild, 26.3% moderate/complete)…. Also, no association was found between ED and smoking, alcoholism, obesity, sedentary life, diabetes, hypertension, cardiovascular disease, hyperlipidemia, depression or anxiety.”

But what about the claim that “misinformation about sexuality” and “intimacy deficits” are now playing a major role in ED? Simply pulled out of the air, an exercise in creative writing.

And why have the authors ignored the research showing evidence of a link porn use and sexual dysfunction? Cambridge University, for example, reported that 60% of their porn-addicted subjects had problems with erections and desire with real partners, but not with porn. In this 2014 case study a man with low libido and anorgasmia healed his both sexual dysfunctions by eliminating porn for 8 months.

We are back to asking “What one major variable influencing sexuality has changed since 1992?” Let me guess: internet porn.

Comment on: “Is Pornography Use Associated with Sexual Difficulties and Dysfunctions among Younger Heterosexual Men?” by Gert Martin Hald PhD (2015)

Link to PubMed version

by Gert Martin Hald

Article first published online: 14 MAY 2015

J Sex Med 2015;12:1140–1141

Surprisingly, given its potential clinical relevance, very few studies have attempted to investigate relationships between pornography consumption and common sexual dysfunctions and problems (in the following referred to as “sexual difficulties”). When having done so, the designs employed have predominantly been case study designs or focus group designs and the method of data collection qualitative. Alternatively, personal or clinical experiences have been utilized. Although important, such studies and experience alone may not be brought to bear on effects of the consumption of pornography. Consequently, the study by Landripet and Stulhofer offers a long and valuable cross-cultural beginning to the quantitative exploration of associations between pornography consumption and sexual difficulties.

More generally, elements of the study by Landripet and Stulhofer reflect critical issues in research on pornography. First, the sample most likely constitutes a non-probability sample. This is characteristic of much of the available research on pornography today [1]. This problem may somewhat be offset by including short, valid, and reliable measures of pornography consumption in future large population based national studies on sexuality and sexual behaviors. Considering the prevalence rates of pornography consumption and the frequency by which pornography is consumed, in particular among men, this seems both highly relevant and high time.

Second, the study finds only one significant association between pornography consumption and the outcomes studied (i.e., erectile dysfunction) and emphasizes that the size (magnitude) of this relationship is small. However, in pornography research, the interpretation of “size” may depend as much on the nature of the outcome studied as the magnitude of the relationship found. Accordingly, if the outcome is to be considered “sufficiently adverse” (e.g., sexual aggressive behaviors), even small effect sizes may carry considerable social and practical significance [2].

Third, the study does not address possible moderators or mediators of the relationships studied nor is it able to determine causality. Increasingly, in research on pornography, attention is given to factors that may influence the magnitude or direction of the relationships studied (i.e., moderators) as well as the pathways through which such influence may come about (i.e., mediators) [1,3]. Future studies on pornography consumption and sexual difficulties may also benefit from an inclusion of such focuses.

Fourth, in  their concluding statement, the authors suggest that a number of factors are more likely related to sexual difficulties than pornography consumption. To better assess this, as well as the relative contribution of each of these variables, the use of comprehensive models able to encompass both direct and indirect relationships between variables known or hypothesized to influence the outcome may be advised [3].

Overall, the study by Landripet and Stulhofer provides first and an interesting cross-cultural and quantitative insights into possible associations between pornography consumption and sexual difficulties. Hopefully comparable future studies may use this as a stepping stone to further advance the research on relationships between pornography consumption and sexual difficulties among both men and women.

Gert Martin Hald, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

References

1  Hald GM, Seaman C, Linz D. Sexuality and pornography. In: Tolman D, Diamond L, Bauermeister J, George W, Pfaus J, Ward M, eds. APA handbook of sexuality and psychology: Vol. 2. Contextual approaches. Washington, DC: American Psychological Association; 2014:3–35.

2  Malamuth NM, Addison T, Koss M. Pornography and sexual aggression: Are there reliable effects and can we understand

them? Annu Rev Sex Res 2000;11:26–91.

3  Rosenthal R. Media violence, antisocial behavior, and the social consequences of small effects. J Soc Issues 1986;42:141–54.

Problematic Porn Use: Quantity vs. Consequences – By Robert Weiss LCSW, CSAT-S

porn addictionA new study by Mateusz Gola, Karol Lewczuk, and Maciej Skorko, published in The Journal of Sexual Medicine, looks at the factors that drive people into treatment for problematic porn use. In particular, Gola and his team wanted to determine if frequency of porn use or consequences related to porn use are more important. Unsurprisingly, as sex addiction treatment specialists like myself and Dr. Patrick Carnes have been stating and writing for more than a decade, when diagnosing and treating porn addicts the amount of porn a person uses is considerably less relevant than his or her porn-related consequences. In fact, Dr. Carnes and I have consistently defined porn addiction based on the following three factors:

  1. Preoccupation to the point of obsession with highly objectified pornographic imagery
  2. Loss of control over the use of pornography, typically evidenced by failed attempts to quit or cut back
  3. Negative consequences related to porn use—diminished relationships, trouble at work or in school, depression, isolation, anxiety, loss of interest in previously enjoyable activities, shame, sexual dysfunction with real world partners, financial woes, legal issues, etc.

As you may have noticed, none of these criteria mention how much porn a person is looking at (or any other quantitative measure). In this respect, porn addiction is like substance abuse disorders, where it’s not how much you drink/use, it’s what drinking and using does to your life.

In recent years, of course, we’ve seen numerous studies linking the amount of porn use to potential negative consequences. But until this recently published research appeared we’ve had little to no scientific support for our claim that consequences (rather than some sort of quantified usage) is the primary measure we should use when identifying and treating pornography addiction.

The Study

Data for the Gola study was collected from March 2014 through March 2015 from a sample of heterosexual male Polish citizens. The test sample of 569 men (mean age 28.71) included 132 men who self-identified as seeking treatment for problematic porn use. (The rest of the sample served as the control group.) “Negative consequences” were identified using a Polish adaptation of the Sexual Addiction Screening Test-Revised (SAST-R), with twenty yes/no questions geared toward assessment of preoccupation, affect, relationship disturbance, and feeling as if one’s sexual behavior is out of control.

The study initially looked at amount of porn use and propensity for seeking treatment, finding a significant correlation. This mirrors earlier research looking (peripherally) at this issue. For instance, studies led by Valerie Voon (Cambridge, UK) and Daisy Mechelmans (Cambridge, UK) found that a non-treatment seeking control group looked at porn approximately 1.75 hours per week, whereas treatment-seeking test subjects looked at porn approximately 13.21 hours per week. However, the Cambridge studies did not consider the relationship between amount of porn use, consequences, and seeking treatment—instead focusing on aspects of neurobiology and cue reactivity.

When Gola’s team adjusted for the full mediation effect of negative consequences, the relationship between amount of porn use and seeking treatment disappeared. Meanwhile, the link between negative consequences and seeking treatment was strong, and it stayed strong relative to multiple potentially mediating factors (age of first porn use, years of porn use, subjective religiosity, and religious practices).

These findings led Gola, Lewczuk, and Skorko to conclude: “Negative symptoms associated with porn use more strongly predict seeking treatment than mere quantity of pornography consumption. Thus, treatment of problematic porn use should address qualitative factors, rather than merely mitigating the frequency of the behavior, because frequency of porn use might not be a core issue for all patients.”

Preaching to the Choir

In some ways, this new research is simply telling us what we already know. If a person is looking at porn and that behavior is impacting his or her life in negative ways, he or she might want/need to do something about it. Conversely, if a person is looking at porn and it’s not causing problems, then he or she probably doesn’t need to make any changes in that area. And this is true regardless of the amount of porn a person is using. So, once again, it’s not the amount of porn a person is using, it’s what porn use is doing to his or her relationships, self-image, and wellbeing that counts.

Still, this study is an important step forward in terms of legitimizing sexual addiction as an official psychiatric diagnosis. After all, the American Psychiatric Association has so far turned a blind eye toward sex/porn addiction, failing to list this very real and debilitating disorder in the DSM-5 despite an APA-commissioned position paper by Harvard’s Dr. Martin Kafka recommending exactly the opposite. And the APA’s only publicly stated reason for doing so appears in the DSM-5’s introduction to the Addictive Disorders section:

Groups of repetitive behaviors, which some term behavioral addictions, with such subcategories as “sex addiction,” “exercise addiction,” or “shopping addiction,” are not included because at this time there is insufficient peer-reviewed evidence to establish the diagnostic criteria and course descriptions needed to identify these behaviors as mental disorders.

In reality, as Dr. Kafka rather eloquently detailed in his position paper, there is more than enough evidence for the APA to officially recognize sex/porn addiction. In fact, many of the disorders currently listed in the DSM-5 (particularly the sex-related disorders) have significantly less supportive evidence. Nevertheless, the APA has opted for “lack of research” (rather than “political/financial pressure from pharmaceutical and insurance companies”) as grounds for its obstinate, behind-the-times stance.

Happily, new research on sex addiction emerges on a relatively regular basis, including this new study from Gola, Lewczuk, and Skorko, which confirms a portion of Dr. Kafka’s recommended diagnostic criteria (and the strikingly similar criteria that sex addiction treatment specialists have been using for many years).

So is the APA likely to move forward with an addendum to the DSM-5 that officially recognizes sex/porn addiction as an identifiable and treatable disorder? Based on just this study, probably not. After all, when it comes to making significant changes to the ways in which clinicians view psychiatric disorders the APA is nearly always late to the party. But as the evidence mounts, the APA will eventually have to concede, acknowledging the growing incidence of porn addiction in all segments of the population. Until then, of course, nothing much changes. Porn addicts hoping to heal will still seek therapy and 12-step recovery, and the clinicians who treat these men and women will do so in the ways they know best, with or without the APA’s recognition and support.

Studies linking porn use/sex addiction to sexual problems, lower arousal to sexual stimuli, and less sexual & relationship satisfaction

Regardless of what you may read in some journalistic accounts, multiple studies reveal a link between porn use and sexual performance problems, relationship and sexual dissatisfaction, and reduced brain activation to sexual stimuli.

Let’s start with sexual dysfunctions. Studies assessing young male sexuality since 2010 report historic levels of sexual dysfunctions, and startling rates of a new scourge: low libido. Documented in this lay article and in this literature review by the US Navy.

Erectile dysfunction rates in very recent studies range from 14% to 35%, while rates for low libido (hypo-sexuality) range from 16% to 37%. Some studies involve teens and men 25 and under, while other studies involve men 40 and under.

Prior to the advent of free streaming porn, cross-sectional studies and meta-analysis consistently reported erectile dysfunction rates of 2-5% in men under 40. That’s nearly a 1000% increase in youthful ED rates in the last 20 years. What variable has changed in the last 15 years that could account for this astronomical rise?

Below are two lists:

  1. List One: Studies linking porn use or porn addiction to sexual problems and lower arousal in response to sexual stimuli or partnered sex.
  2. List Two: Studies linking porn use to lower relationship or sexual satisfaction.

List One: Studies linking porn use or porn addiction to ED, anorgamsia, low sexual desire, delayed ejaculation, and lower brain activation to sexual stimuli. In addition to the studies below, this page contains articles and videos by about 100 experts (urology professors, urologists, psychiatrists, psychologists, sexologists, MDs) who acknowledge and have successfully treated porn-induced ED and porn-induced loss of sexual desire.

  • The first 3 studies demonstrate causation as participants eliminated porn use and healed chronic sexual dysfunctions:

1) Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports (2016) – An extensive review of the literature related to porn-induced sexual problems. Involving US Navy doctors, the review provides the latest data revealing a tremendous rise in youthful sexual problems. It also reviews the neurological studies related to porn addiction and sexual conditioning via Internet porn. The doctors provide 3 clinical reports of men who developed porn-induced sexual dysfunctions. Two of the three men healed their sexual dysfunctions by eliminating porn use. The third man experienced little improvement as he was unable to abstain from porn use. Excerpt:

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.

2) Male masturbation habits and sexual dysfunctions (2016)It’s by a French psychiatrist who is the current president of the European Federation of Sexology. While the abstract shifts back and forth between Internet pornography use and masturbation, it’s clear that he’s mostly referring to porn-induced sexual dysfunctions (erectile dysfunction and anorgasmia). The paper revolves around his clinical experience with 35 men who developed erectile dysfunction and/or anorgasmia, and his therapeutic approaches to help them. The author states that most of his patients used porn, with several being addicted to porn. The abstract point to internet porn as the primary cause of the problems (keep in mind that masturbation does not cause chronic ED, and it is never given as a cause of ED). Excerpts:

Intro: Harmless and even helpful in his usual form widely practiced, masturbation in its excessive and pre-eminent form, generally associated today to pornographic addiction, is too often overlooked in the clinical assessment of sexual dysfunction it can induce.

Results: Initial results for these patients, after treatment to “unlearn” their masturbatory habits and their often associated addiction to pornography, are encouraging and promising. A reduction in symptoms was obtained in 19 patients out of 35. The dysfunctions regressed and these patients were able to enjoy satisfactory sexual activity.

Conclusion: Addictive masturbation, often accompanied by a dependency on cyber-pornography, has been seen to play a role in the etiology of certain types of erectile dysfunction or coital anejaculation. It is important to systematically identify the presence of these habits rather than conduct a diagnosis by elimination, in order to include habit-breaking deconditioning techniques in managing these dysfunctions

3) Unusual masturbatory practice as an etiological factor in the diagnosis and treatment of sexual dysfunction in young men (2014) – One of the 4 case studies in this paper reports on a man with porn-induced sexual problems (low libido, fetishes, anorgasmia). The sexual intervention called for a 6-week abstinence from porn and masturbation. After 8 months the man reported increased sexual desire, successful sex and orgasm, and enjoying “good sexual practices. This is the first peer-reviewed chronicling of a recovery from porn-induced sexual dysfunctions Excerpts from the paper:

“When asked about masturbatory practices, he reported that in the past he had been masturbating vigorously and rapidly while watching pornography since adolescence. The pornography originally consisted mainly of zoophilia, and bondage, domination, sadism, and masochism, but he eventually got habituated to these materials and needed more hardcore pornography scenes, including transgender sex, orgies, and violent sex. He used to buy illegal pornographic movies on violent sex acts and rape and visualized those scenes in his imagination to function sexually with women. He gradually lost his desire and his ability to fantasize and decreased his masturbation frequency.”

In conjunction with weekly sessions with a sex therapist, the patient was instructed to avoid any exposure to sexually explicit material, including videos, newspapers, books, and internet pornography.

After 8 months, the patient reported experiencing successful orgasm and ejaculation. He renewed his relationship with that woman, and they gradually succeeded in enjoying good sexual practices.

4) The Dual Control Model – The Role Of Sexual Inhibition & Excitation In Sexual Arousal And Behavior (2007) – Newly discovered and very convincing paper from the Kinsey Institute. In an experiment employing video porn, 50% of the young men couldn’t become aroused or achieve erections with porn (average age was 29). The shocked researchers discovered that the men’s erectile dysfunction was,

related to high levels of exposure to and experience with sexually explicit materials.

The men experiencing erectile dysfunction had spent a considerable amount of time in bars and bathhouses where porn was “omnipresent,” and “continuously playing“. The researchers stated:

Conversations with the subjects reinforced our idea that in some of them a high exposure to erotica seemed to have resulted in a lower responsivity to “vanilla sex” erotica and an increased need for novelty and variation, in some cases combined with a need for very specific types of stimuli in order to get aroused.”

5) Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours (2014) – This fMRI study by Cambridge University found cue-reactivity in porn addicts which mirrored sensitization in drug addicts. It also found that porn addicts (CSB) fit the accepted addiction model of wanting “it” more, but not liking “it” more. The researchers also reported that 60% of subjects (average age: 25) had difficulty achieving erections/arousal with real partners as a result of using porn, yet could achieve erections with porn. From the study (CSB is compulsive sexual behaviours – or porn addicts):

CSB subjects reported that as a result of excessive use of sexually explicit materials….. experienced diminished libido or erectile function specifically in physical relationships with women (although not in relationship to the sexually explicit material)”

“Compared to healthy volunteers, CSB subjects had greater subjective sexual desire or wanting to explicit cues and had greater liking scores to erotic cues, thus demonstrating a dissociation between wanting and liking. CSB subjects also had greater impairments of sexual arousal and erectile difficulties in intimate relationships but not with sexually explicit materials highlighting that the enhanced desire scores were specific to the explicit cues and not generalized heightened sexual desire.

6) Online sexual activities: An exploratory study of problematic and non-problematic usage patterns in a sample of men (2016) A Belgian study that found problematic Internet porn use was associated with reduced erectile function and reduced overall sexual satisfaction. Yet problematic porn users experienced greater cravings. The study appears to report escalation, as 49% of the men viewed porn that “was not previously interesting to them or that they considered disgusting.” An excerpt:

This study is the first to directly investigate the relationships between sexual dysfunctions and problematic involvement in OSAs. Results indicated that higher sexual desire, lower overall sexual satisfaction, and lower erectile function were associated with problematic OSAs (online sexual activities). These results can be linked to those of previous studies reporting a high level of arousability in association with sexual addiction symptoms (Bancroft & Vukadinovic, 2004; Laier et al., 2013; Muise et al., 2013).”

In addition, we finally have a study that asks porn users about possible escalation to new or disturbing porn genres. Guess what it found?

Forty-nine percent mentioned at least sometimes searching for sexual content or being involved in OSAs that were not previously interesting to them or that they considered disgusting, and 61.7% reported that at least sometimes OSAs were associated with shame or guilty feelings.”

Note – This is the first study to directly investigate the relationships between sexual dysfunctions and problematic porn use. Two other studies claiming to have investigated correlations between porn use and erectile functioning cobbled together data from earlier studies in an unsuccessful attempt to debunk porn-induced ED. Both were criticized in the peer-reviewed literature: paper #1 was not an authentic study, and has been thoroughly discredited; paper #2 actually found correlations that support porn-induced ED. Moreover, paper #2 was only a “brief communication” that did not report important data which the authors presented at a sexology conference.

7) Adolescents and web porn: a new era of sexuality (2015) – An Italian study analyzed the effects of Internet porn on high school students, co-authored by urology professor Carlo Foresta, president of the Italian Society of Reproductive Pathophysiology. The most interesting finding is that 16% of those who consume porn more than once a week report abnormally low sexual desire compared with 0% in non-consumers (and 6% for those who consume less than once a week). From the study, concerning pornography use:

21.9% define it as habitual, 10% report that it reduces sexual interest towards potential real-life partners, and the remaining, 9.1% report a kind of addiction. In addition, 19% of overall pornography consumers report an abnormal sexual response, while the percentage rose to 25.1% among regular consumers.

8) Patient Characteristics by Type of Hypersexuality Referral: A Quantitative Chart Review of 115 Consecutive Male Cases (2015) – Study on men (average age 41.5) with hypersexuality disorders, such as paraphilias and chronic masturbation or adultery. 27 were classified as “avoidant masturbators,” meaning they masturbated (typically with porn use) one or more hours per day or more than 7 hours per week. 71% reported sexual functioning problems, with 33% reporting delayed ejaculation (a precursor to porn-induced ED). What sexual dysfunction do 38% of the remaining men have? The study doesn’t say, and the authors have ignored requests for details. Two primary choices for male sexual dysfunction are ED and low libido. The men were not asked about their erectile functioning without porn. If all their sexual activity involved masturbating to porn, and not sex with a partner, they would never realize they had porn-induced ED.

9)  The effects of sexually explicit material use on romantic relationship dynamics (2016) – As with many other studies, solitary porn users report poorer relationship and sexual satisfaction. Employing the Pornography Consumption Effect Scale (PCES), the study found that higher porn use was related to poorer sexual function, more sexual problems, and a “worse sex life”. An excerpt describing the correlation between the PCES “Negative Effects” on “Sex Life” questions and frequency of porn use:

There were no significant differences for the Negative Effect Dimension PCES across the frequency of sexually explicit material use; however, there were significant differences on the Sex Life subscale where High Frequency Porn Users reported greater negative effects than Low Frequency Porn Users.

10) Altered Appetitive Conditioning and Neural Connectivity in Subjects With Compulsive Sexual Behavior (2016) “Compulsive Sexual Behaviors” (CSB) means the men were porn addicts, because CSB subjects averaged nearly 20 hours of porn use per week. The controls averaged 29 minutes per week. Interestingly, 3 of the 20 CSB subjects suffered from “orgasmic-erection disorder,” while none of the control subjects reported sexual problems.

11) Brain Structure and Functional Connectivity Associated With Pornography Consumption: The Brain on Porn (2014) – A Max Planck study which found 3 significant addiction-related brain changes correlating with the amount of porn consumed. It also found that the more porn consumed the less reward circuit activity in response to brief exposure (.530 second) to vanilla porn. In a 2014 article lead author Simone Kühn said:

We assume that subjects with a high porn consumption need increasing stimulation to receive the same amount of reward. That could mean that regular consumption of pornography more or less wears out your reward system. That would fit perfectly the hypothesis that their reward systems need growing stimulation.”

A more technical description of this study from a review of the literature by Kuhn & Gallinat – Neurobiological Basis of Hypersexuality (2016).

“The more hours participants reported consuming pornography, the smaller the BOLD response in left putamen in response to sexual images. Moreover, we found that more hours spent watching pornography was associated with smaller gray matter volume in the striatum, more precisely in the right caudate reaching into the ventral putamen. We speculate that the brain structural volume deficit may reflect the results of tolerance after desensitization to sexual stimuli.”

12) Sexual Desire, not Hypersexuality, is Related to Neurophysiological Responses Elicited by Sexual Images (2013) – In line with the Cambridge University brain scan studies, this EEG study reported greater cue-reactivity to porn correlated with less desire for partnered sex. To put another way – individuals with more brain activation and cravings for porn would rather masturbate to porn than have sex with a real person. Shockingly, study spokesperson Nicole Prause claimed that porn users merely had “high libido”, yet the results of the study say the exact opposite (their desire for partnered sex was dropping in relation to signs of addiction). Read an extensive critique here. Five peer-reviewed papers expose the truth: 1, 2, 3, 4, 5.

13) Modulation of Late Positive Potentials by Sexual Images in Problem Users and Controls Inconsistent with “Porn Addiction” (2015) – Another SPAN Lab EEG study comparing the 2013 subjects from the above study to an actual control group. The results: compared to controls “compulsive porn users” had less response to photos of vanilla porn. Ignoring all the other studies on this page, lead author Nicole Prause, boldly claims that her results “debunked porn addiction”. What legitimate scientist would claim that their lone anomalous study has debunked an entire field of study?  In reality, the findings of Prause et al. 2015 align perfectly with Kühn & Gallinat (2014), which found that more porn use correlated with less brain activation in response to pictures of vanilla porn. Prause’s findings also align with Banca et al. 2015 which is #4 in this list. Moreover, another EEG study found that greater porn use in women correlated with less brain activation to porn. Lower EEG readings mean that subjects are paying less attention to the pictures. Put simply, frequent porn users were desensitized to static images of vanilla porn. They were bored. Read an extensive critique here. Six peer-reviewed papers have stated that this study actually found desensitization or habituation in frequent porn users (a sign of addiction): 1, 2, 3, 4, 5, 6.

14) Erectile Dysfunction, Boredom, and Hypersexuality among Coupled Men from Two European Countries (2015) – Survey reported a strong correlation between erectile dysfunction and measures of hypersexuality. The study omitted correlation data between erectile functioning and pornography use. An excerpts

Among Croatian and German men, hypersexuality was significantly correlated with proneness to sexual boredom and more problems with erectile function.

15) Masturbation and Pornography Use Among Coupled Heterosexual Men With Decreased Sexual Desire: How Many Roles of Masturbation? (2015) – Masturbating to porn was related with decreased sexual desire and low relationship intimacy. Excerpts:

“Among men who masturbated frequently, 70% used pornography at least once a week. A multivariate assessment showed that sexual boredom, frequent pornography use, and low relationship intimacy significantly increased the odds of reporting frequent masturbation among coupled men with decreased sexual desire.”

“Among men [with decreased sexual desire] who used pornography at least once a week [in 2011], 26.1% reported that they were unable to control their pornography use. In addition, 26.7% of men reported that their use of pornography negatively affected their partnered sex and 21.1% claimed to have attempted to stop using pornography.”

16) Use of pornography in a random sample of Norwegian heterosexual couples (2009) – Porn use was correlated with more sexual dysfunctions in the man and negative self perception in the female. The couples who did not use porn had no sexual dysfunctions.  A few excerpts from the study:

In couples where only one partner used pornography, we found more problems related to arousal (male) and negative (female) self-perception.

In those couples where one partner used pornography there was a permissive erotic climate. At the same time, these couples seemed to have more dysfunctions.

The couples who did not use pornography… may be considered more traditional in relation to the theory of sexual scripts. At the same time, they did not seem to have any dysfunctions.

Couples who both reported pornography use grouped to the positive pole on the ‘‘Erotic climate’’ function and somewhat to the negative pole on the ‘‘Dysfunctions’’ function.

17) Men’s Sexual Life and Repeated Exposure to Pornography. A New Issue? (2015) – Excerpts:

Mental health specialists should take in consideration the possible effects of pornography consumption on men sexual behaviors, men sexual difficulties and other attitudes related to sexuality. In the long term pornography seems to create sexual dysfunctions, especially the individual’s inability to reach an orgasm with his partner. Someone who spends most of his sexual life masturbating while watching porn engages his brain in rewiring its natural sexual sets (Doidge, 2007) so that it will soon need visual stimulation to achieve an orgasm.

Many different symptoms of porn consumption, such as the need to involve a partner in watching porn, the difficulty in reaching orgasm, the need for porn images in order to ejaculate turn into sexual problems. These sexual behaviors may go on for months or years and it may be mentally and bodily associated with the erectile dysfunction, although it is not an organic dysfunction. Because of this confusion, which generates embarrassment, shame and denial, lots of men refuse to encounter a specialist

Pornography offers a very simple alternative to obtain pleasure without implying other factors that were involved in human’s sexuality along the history of mankind. The brain develops an alternative path for sexuality which excludes “the other real person” from the equation. Furthermore, pornography consumption in a long term makes men more prone to difficulties in obtaining an erection in a presence of their partners.

18) An Online Assessment of Personality, Psychological, and Sexuality Trait Variables Associated with Self-Reported Hypersexual Behavior (2015) – Survey reported a common theme found in several other studies listed here: Porn/sex addicts report greater arousabilty (cravings related to their addiction) combined with poorer sexual function (fear of experiencing erectile dysfunction).

Hypersexual” behavior represents a perceived inability to control one’s sexual behavior. To investigate hypersexual behavior, an international sample of 510 self-identified heterosexual, bisexual, and homosexual men and women completed an anonymous online self-report questionnaire battery.

Thus, the data indicated that hypersexual behavior is more common for males, and those who report being younger in age, more easily sexually excited, more sexually inhibited due to the threat of performance failure, less sexually inhibited due to the threat of performance consequences, and more impulsive, anxious, and depressed

19) Study sees link between porn and sexual dysfunction (2017) – The findings of an upcoming study presented at the American Urological Association’s annual meeting. A few excerpts:

Young men who prefer pornography to real-world sexual encounters might find themselves caught in a trap, unable to perform sexually with other people when the opportunity presents itself, a new study reports. Porn-addicted men are more likely to suffer from erectile dysfunction and are less likely to be satisfied with sexual intercourse, according to survey findings presented Friday at the American Urological Association’s annual meeting, in Boston.

The rates of organic causes of erectile dysfunction in this age cohort are extremely low, so the increase in erectile dysfunction that we have seen over time for this group needs to be explained,” Christman said. “We believe that pornography use may be one piece to that puzzle”.

20) – Associative pathways between pornography consumption and reduced sexual satisfaction (2017) – This study is in both lists. While it links porn use to lower sexual satisfaction, it also reported that frequency of porn use was related to a preference for porn over people to achieve sexual arousal. An excerpt:

Finally, we found that frequency of pornography consumption was also directly related to a relative preference for pornographic rather than partnered sexual excitement. Participants in the present study primarily consumed pornography for masturbation. Thus, this finding could be indicative of a masturbatory conditioning effect (Cline, 1994; Malamuth, 1981; Wright, 2011). The more frequently pornography is used as an arousal tool for masturbation, the more an individual may become conditioned to pornographic as opposed to other sources of sexual arousal.

21) “I think it has been a negative influence in many ways but at the same time I can’t stop using it”: Self-identified problematic pornography use among a sample of young Australians (2017) – Online survey of Australians, aged 15-29.  Those who had ever viewed pornography (n=856) were asked in an open-ended question: ‘How has pornography influenced your life?’.

Among participants who responded to the open-ended question (n=718), problematic usage was self-identified by 88 respondents. Male participants who reported problematic usage of pornography highlighted effects in three areas: on sexual function, arousal and relationships. Responses included “I think it has been a negative influence in many ways but at the same time I can’t stop using it” (Male, Aged 18–19). Some female participants also reported problematic usage, with many of these reporting negative feelings like guilt and shame, impact on sexual desire and compulsions relating to their use of pornography. For example as one female participant suggested; “It makes me feel guilty, and I’m trying to stop. I don’t like how I feel that I need it to get myself going, it’s not healthy.” (Female, Aged 18–19)

22) Exploring the Relationship Between Erotic Disruption During the Latency Period and the Use of Sexually Explicit Material, Online Sexual Behaviors, and Sexual Dysfunctions in Young Adulthood (2009) – Study examined correlations between current porn use (sexually explicit material – SEM) and sexual dysfunctions, and porn use during “latency period” (ages 6-12) and sexual dysfunctions. The average age of participants was 22. While current porn use correlated with sexual dysfunctions, porn use during latency (ages 6-12) had an even stronger correlation with sexual dysfunctions. A few excerpts:

Findings suggested that latency erotic disruption by way of sexually explicit material (SEM) and/or child sexual abuse may be associated to adult online sexual behaviors.

Furthermore, results demonstrated that latency SEM exposure was a significant predictor of adult sexual dysfunctions.

We hypothesized that exposure to latency SEM exposure would predict adult use of SEM. Study findings supported our hypothesis, and demonstrated that latency SEM exposure was a statistically significant predictor of adult SEM use. This suggested that individuals who were exposed to SEM during latency, may continue this behavior into adulthood. Study findings also indicated that latency SEM exposure was a significant predictor of adult online sexual behaviors.

23)  2014 lecture describing upcoming studies – by Urology professor Carlo Foresta, president of the Italian Society of Reproductive Pathophysiology – The lecture contains the results of longitudinal and cross-sectional studies. One study involved a survey of high school teens (pages 52-53). The study reported that sexual dysfunction doubled between 2005 and 2013, with low sexual desire increasing 600%.

  • The percentage of teens that experienced alterations of their sexuality: 2004/05: 7.2%, 2012/13: 14.5%
  • The percentage of teens with low sexual desire: 2004/05: 1.7%, 2012/13: 10.3% (that’s a 600% increase in 8 years)

Foresta also describes his upcoming study, “Sexuality media and new forms of sexual pathology sample 125 young males, 19-25 years” (Italian name – “Sessualità mediatica e nuove forme di patologia sessuale Campione 125 giovani maschi“). The results from the study (pages 77-78), which used the International Index of Erectile Function Questionnaire, found that regular porn users scored 50% lower on sexual desire domain and 30% lower of the erectile functioning domain.

24) Not peer-reviewed. Here’s a popular article about an extensive analysis of comments and questions posted on MedHelp concerning erectile dysfunction. What’s shocking is that 58% of the men asking for help were 24 or younger. Many suspected that internet porn could be involved in their dysfunction, as described in the results from the study:

EXCERPT: The most common phrase is “erectile dysfunction” – which is mentioned more than three times as often as any other phrase – followed by “internet porn,” “performance anxiety,” and “watching porn.” Clearly, porn is a frequently discussed subject: “I have been viewing internet pornography frequently (4 to 5 times a week) for the past 6 years,” one man writes. “I am in my mid-20s and have had a problem getting and maintaining an erection with sexual partners since my late teens when I first started looking at internet porn.”


List two: Studies reporting correlations between porn use and less sexual or relationship satisfaction:

1) Does Viewing Pornography Reduce Marital Quality Over Time? Evidence from Longitudinal Data (2016) – First longitudinal study on a representative cross-section of married couples. It found significant negative effects of porn use on marriage quality over time.  Excerpt:

This study is the first to draw on nationally representative, longitudinal data (2006-2012 Portraits of American Life Study) to test whether more frequent pornography use influences marital quality later on and whether this effect is moderated by gender. In general, married persons who more frequently viewed pornography in 2006 reported significantly lower levels of marital quality in 2012, net of controls for earlier marital quality and relevant correlates. Pornography’s effect was not simply a proxy for dissatisfaction with sex life or marital decision-making in 2006. In terms of substantive influence, frequency of pornography use in 2006 was the second strongest predictor of marital quality in 2012

2) Associations between young adults’ use of sexually explicit materials and their sexual preferences, behaviors, and satisfaction (2011) – Excerpts:

Higher frequencies of sexual explicit material (SEM) use were associated with less sexual and relationship satisfaction. The frequency of SEM use and number of SEM types viewed were both associated with higher sexual preferences for the types of sexual practices typically presented in SEM. These findings suggest that SEM use can play a significant role in a variety of aspects of young adults’ sexual development processes.

Specifically, higher viewing frequency was associated with less sexual and relationship satisfaction when controlling for gender, religiosity, dating status and the number of SEM types viewed.

Because a substantial proportion of the young adults in this study reported using SEM, the potential implications are especially noteworthy, particularly for young men.

3) Pornography’s Impact on Sexual Satisfaction (1988) – Excerpt:

Male and female students and nonstudents were exposed to videotapes featuring common, nonviolent pornography or innocuous content. Exposure was in hourly sessions in six consecutive weeks. In the seventh week, subjects participated in an ostensibly unrelated study on societal institutions and personal gratifications. [Porn use] strongly impacted self-assessment of sexual experience. After consumption of pornography, subjects reported less satisfaction with their intimate partners—specifically, with these partners’ affection, physical appearance, sexual curiosity, and sexual performance proper. In addition, subjects assigned increased importance to sex without emotional involvement. These effects were uniform across gender and populations.

4) Adolescents’ Exposure to Sexually Explicit Internet Material and Sexual Satisfaction: A Longitudinal Study (2009) – Excerpt:

Between May 2006 and May 2007, we conducted a three-wave panel survey among 1,052 Dutch adolescents aged 13–20. Structural equation modeling revealed that exposure to SEIM consistently reduced adolescents’ sexual satisfaction. Lower sexual satisfaction (in Wave 2) also increased the use of SEIM (in Wave 3). The effect of exposure to SEIM on sexual satisfaction did not differ among male and female adolescents.

5) Individuals who never viewed SEM reported higher relationship quality on all indices than those who viewed SEM alone (2011)Excerpt:

As expected, individuals who did not view SEM (sexually explicit material) at all reported lower negative communication and higher dedication than individuals who viewed SEM alone or both alone and with their partner.

6) Sexual media use and relational satisfaction in heterosexual couples (2010) – Excerpt:

Results revealed that a higher frequency of men’s sexual media use related to negative satisfaction in men, while a higher frequency of women’s sexual media use related to positive satisfaction in male partners. Reasons for sexual media use differed by gender: Men reported primarily using sexual media for masturbation, while women reported primarily using sexual media as part of lovemaking with their partners.

7) Young Adult Women’s Reports of Their Male Romantic Partner’s Pornography Use as a Correlate of Their Self-Esteem, Relationship Quality, and Sexual Satisfaction (2012) – Excerpt:

The purpose of this study was to examine the relationships between men’s pornography use, both frequency and problematic use, on their heterosexual female partner’s psychological and relational well-being among 308 young adult college women. Results revealed women’s reports of their male partner’s frequency of pornography use were negatively associated with their relationship quality. More perceptions of problematic use of pornography was negatively correlated with self-esteem, relationship quality, and sexual satisfaction.

8) Korean Men’s Pornography use, Their Interest in Extreme Pornography, and Dyadic Sexual Relationships (2014) – Excerpt:

Six-hundred eighty-five heterosexual South Korean male college students participated in an online survey. The majority (84.5%) of respondents had viewed pornography, and for those who were sexually active (470 respondents), we found that higher interest in degrading or extreme pornography was associated with the experience of role-playing sexual scenes from pornography with a partner, and a preference for using pornography to achieve and maintain sexual excitement over having sex with a partner.

We found that higher interest in viewing degrading or extreme pornography … has a significant positive … association with sexual concerns.

9) Pornography and the Male Sexual Script: An Analysis of Consumption and Sexual Relations (2014) – Excerpt:

We argue pornography creates a sexual script that then guides sexual experiences. To test this, we surveyed 487 college men (ages 18-29 years) in the United States to compare their rate of pornography use with sexual preferences and concerns. Results showed the more pornography a man watches, the more likely he was to use it during sex, request particular pornographic sex acts of his partner, deliberately conjure images of pornography during sex to maintain arousal, and have concerns over his own sexual performance and body image. Further, higher pornography use was negatively associated with enjoying sexually intimate behaviors with a partner.

10) Adult Social Bonds and Use of Internet Pornography (2004) – Excerpt:

Complete data on 531 Internet users are taken from the General Social Surveys for 2000. Social bonds measures include religious, marital, and political ties. Measures of participation in sexual and drug-related deviant lifestyles, and demographic controls are included. The results of a logistic regression analysis found that among the strongest predictors of use of cyberporn were weak ties to religion and lack of a happy marriage.

11) A Common-Fate Analysis of Pornography Acceptance, Use, and Sexual Satisfaction Among Heterosexual Married Couples (2016) – Excerpt:

Results indicated that the shared variance of pornography acceptance was positively associated with both spouses’ pornography use and that spouses’ pornography use was negatively associated with their own sexual satisfaction.Wives’ pornography use was found to be positively associated with the couple’s shared variance of sexual satisfaction, but pornography use did not significantly mediate the relationship between pornography acceptance and sexual satisfaction.

12) Differences in Pornography Use Among Couples: Associations with Satisfaction, Stability, and Relationship Processes (2016) – Excerpt:

The present study utilized a sample of 1755 adult couples in heterosexual romantic relationships to examine how different patterns of pornography use between romantic partners may be associated with relationship outcomes. While pornography use has been generally associated with some negative and some positive couple outcomes, no study has yet explored how differences between partners may uniquely be associated with relationship well-being. Results suggested that greater discrepancies between partners in pornography use were related to less relationship satisfaction, less stability, less positive communication, and more relational aggression. Mediation analyses suggested that greater pornography use discrepancies were primarily associated with elevated levels of male relational aggression, lower female sexual desire, and less positive communication for both partners which then predicted lower relational satisfaction and stability for both partners.

13) Factors Predicting Cybersex Use and Difficulties in Forming Intimate Relationships among Male and Female Users of Cybersex (2015)Excerpt:

This study used the Cybersex addiction test, Craving for pornography questionnaire, and a Questionnaire on intimacy among 267 participants (192 males and 75 females) mean age for males 28 and for females 25,  who were recruited from special sites that are dedicated to pornography and cybersex on the Internet. Results of regression analysis indicated that pornography, gender, and cybersex significantly predicted difficulties in intimacy and it accounted for 66.1% of the variance of rating on the intimacy questionnaire. Second, regression analysis also indicated that craving for pornography, gender, and difficulties in forming intimate relationships significantly predicted frequency of cybersex use and it accounted for 83.7% of the variance in ratings of cybersex use.

14) Pornography use: who uses it and how it is associated with couple outcomes (2013) – Excerpt:

This study examined associations among pornography use, the meaning people attach to its use, sexual quality, and relationship satisfaction. Participants were couples (N = 617 couples) who were either married or cohabiting at the time the data were gathered. Overall results from this study indicated substantial gender differences in terms of use profiles, as well as pornography’s association with relationship factors. Specifically, male pornography use was negatively associated with both male and female sexual quality, whereas female pornography use was positively associated with female sexual quality.

15) A Love That Doesn’t Last: Pornography Consumption and Weakened Commitment to One’s Romantic Partner (2012) – The study had subjects try to abstain from porn use for 3 weeks. Upon comparing the two groups, those who continued using pornography reported lower levels of commitment than those who tried to abstain. Excerpts:

Study 1 found that higher pornography consumption was related to lower commitment

Study 3 participants were randomly assigned to either refrain from viewing pornography or to a self-control task. Those who continued using pornography reported lower levels of commitment than control participants.

Study 5 found that pornography consumption was positively related to infidelity and this association was mediated by commitment. Overall, a consistent pattern of results was found using a variety of approaches including cross-sectional (Study 1), observational (Study 2), experimental (Study 3), and behavioral (Studies 4 and 5) data.

16) Male Partners’ Perceived Pornography Use and Women’s Relational and Psychological Health: The Roles of Trust, Attitudes, and Investment (2015) – Excerpt:

Results revealed that women’s reports of their male partners’ pornography use were related to less relationship satisfaction and more psychological distress. Results from the moderation analyses indicated that the direct effect of male partners’ perceived pornography use and relationship trust and the conditional indirect effects of male partners’ perceived pornography use on both relationship satisfaction and psychological distress were contingent on relationship investment. These findings indicated that when male partners’ perceived pornography use is high, women who have low or mean levels of relationship investment have less relationship trust. Finally, our results revealed that the relationship between male partners’ perceived pornography use and relational and psychological outcomes exist regardless of women’s own attitudes toward pornography

17) Relationship of love and marital satisfaction with pornography among married university students in Birjand, Iran (2015) – Excerpts:

This descriptive-correlation study was conducted on 310 married students studying at private and public universities in Birjand, in 2012-2013 academic year using random quota sampling method. It appears that pornography has a negative impact on love and marital satisfaction.

18)  Sexual media use and relational satisfaction in heterosexual couples (2011) – Excerpt:

This study assessed how sexual media use by one or both members of a romantic dyad relates to relationship and sexual satisfaction. A total of 217 heterosexual couples completed an Internet survey that assessed sexual media use, relationship and sexual satisfaction, and demographic variables. Results revealed that a higher frequency of men’s sexual media use related to negative satisfaction in men, while a higher frequency of women’s sexual media use related to positive satisfaction in male partners. Reasons for sexual media use differed by gender

19) Wives’ Experience of Husbands’ Pornography Use and Concomitant Deception as an Attachment Threat in the Adult Pair-Bond Relationship (2009)

Evidence is growing that pornography use can negatively impact attachment trust in the adult pair-bond relationship. Analyses uncovered three attachment-related impacts from husbands’ pornography use and deception: (1) the development of an attachment fault line in the relationship, stemming from perceived attachment infidelity; (2) followed by a widening attachment rift arising from wives’ sense of distance and disconnection from their husbands; (3) culminating in attachment estrangement from a sense of being emotionally and psychologically unsafe in the relationship. Overall, wives reported global mistrust indicative of attachment breakdown.

20)  Men’s leisure and women’s lives: The impact of pornography on women (1999) – Excerpt:

The section of the interview where the women discussed their own current or past relationships with men revealed additional insight into the effect of pornography on such relationships. Fifteen of the women were in, or had been in, relationships with men who rented or bought pornography at least on an occasional basis. Of these 15 women, four expressed strong dislike of their husband’s or partner’s leisure time interest in pornography. It was clear that the husbands’ use of pornography affected the wives’ feeling about themselves, their sexual feelings, and their marital relationships in general

21)  From Bad to Worse? Pornography Consumption, Spousal Religiosity, Gender, and Marital Quality (2016) – Excerpts:

I test the above hypotheses using data from Wave 1 of the Portraits of American Life Study (PALS), which was fielded in 2006. PALS is a nationally representative panel survey with questions focusing on a variety of topics….Looking at bivariate correlations, for the full sample, viewing pornography is negatively associated with overall marital satisfaction, suggesting that those who view pornography more often tend to be less satisfied in their marriage than those who view pornography less often or never

22) Pornography and Marriage (2014) – All bad news, and it’s getting worse. The abstract:

We used data on 20,000 ever-married adults in the General Social Survey to examine the relationship between watching pornographic films and various measures of marital well-being. We found that adults who had watched an X-rated movie in the past year were more likely to be divorced, more likely to have had an extramarital affair, and less likely to report being happy with their marriage or happy overall. We also found that, for men, pornography use reduced the positive relationship between frequency of sex and happiness. Finally, we found that the negative relationship between pornography use and marital well-being has, if anything, grown stronger over time, during a period in which pornography has become both more explicit and more easily available.

23) Exploring actor and partner correlates of sexual satisfaction among married couples (2010) – Excerpt:

Using the Interpersonal Exchange Model of Sexual Satisfaction, we consider how infidelity, pornography consumption, marital satisfaction, sexual frequency, premarital sex, and cohabitation are associated with married couples’ sexual satisfaction. Data from 433 couples are analyzed with structural equation models to determine the contributions. Finally, some evidence suggests that pornography consumption is costly for own and spouse’s sexual satisfaction, especially when pornography is used by only one spouse.

24) Sexually explicit media use and relationship satisfaction a moderating role of emotional intimacy? (2016) – The authors attempt to obfuscate their findings in the abstract by stating that once sexual and relationship variables were “controlled for”, they found no link between between porn use and relationship satisfaction. Reality: The study found significant correlations between porn use and poorer relationship & sexual satisfaction in both males and females. Excerpt from discussion section:

For both men and women, significant, yet modest negative zero-order correlations between SEM use and relationship satisfaction were found, indicating that increased SEM use was associated with lower relationship satisfaction across gender.

25) Sex in America Online: An Exploration of Sex, Marital Status, and Sexual Identity in Internet Sex Seeking and Its Impacts (2008) – Excerpt:

This was an exploratory study of sex and relationship seeking on the Internet, based on a survey of 15,246 respondents in the United States Seventy-five percent of men and 41% of women had intentionally viewed or downloaded porn. Men and gays/lesbians were more likely to access porn or engage in other sex-seeking behaviors online compared with straights or women. A symmetrical relationship was revealed between men and women as a result of viewing pornography, with women reporting more negative consequences, including lowered body image, partner critical of their body, increased pressure to perform acts seen in pornographic films, and less actual sex, while men reported being more critical of their partners’ body and less interested in actual sex.

26) Effect of soft core pornography on female sexuality (2016) – Excerpt:

An overall 51.6% of participants who were aware that their husbands were positive watchers reported experiencing negative emotions (depression, jealous), whereas 77% reported changes in their husbands’ attitude. Non-watchers watchers were more satisfied with their sexual life compared with their counterparts. Although watching soft-core pornography had a statistically significant effect on sexual desire, vaginal lubrication, ability to reach orgasm, and masturbation, it had no statistically significant effect on coital frequency. Watching soft-core pornography affects female sexual life by increasing sexual boredom in both men and women, causing relational difficulties.

27) Internet Pornography Consumption and Relationship Commitment of Filipino Married Individuals (2016) – Excerpt:

Internet pornography has many adverse effects, especially to the relationship commitment. The use of pornography directly correlates to a decrease in sexual intimacy. Hence, this might lead to weakening of the relationship of their partner. To find out the relevance of the claim, the researchers aimed to explore the relationship of Internet pornography consumption to the relationship commitment of married individuals in the Philippines. It is revealed that Internet pornography consumption has an adverse effect on the relationship commitment of married Filipino couples. Furthermore, watching porn online weakened the relationship commitment that leads to an unstable relationship. This investigation found out that internet pornography consumption has a nominal negative effect on the relationship commitment of Filipino married individuals.

28) Till Porn Do Us Part? Longitudinal Effects of Pornography Use on Divorce (2017) – This longitudinal study used nationally representative General Social Survey panel data collected from thousands of American adults. Respondents were interviewed three times about their pornography use and marital status — every two years from 2006-2010, 2008-2012, or 2010-2014. Excerpts:

Beginning pornography use between survey waves nearly doubled one’s likelihood of being divorced by the next survey period, from 6 percent to 11 percent, and nearly tripled it for women, from 6 percent to 16 percent. Our results suggest that viewing pornography, under certain social conditions, may have negative effects on marital stability. Conversely, discontinuing pornography use between survey waves was associated with a lower probability of divorce, but only for women.

Additionally, the researchers found that respondents’ initially reported level of marital happiness played an important role in determining the magnitude of pornography’s association with the probability of divorce. Among people who reported they were “very happy” in their marriage in the first survey wave, beginning pornography viewership before the next survey was associated with a noteworthy increase — from 3 percent to 12 percent — in the likelihood of getting divorced by the time of that next survey.

Additional analyses also showed that the association between beginning pornography use and the probability of divorce was particularly strong among younger Americans, those who were less religious, and those who reported greater initial marital happiness

29) Perceptions of relationship satisfaction and addictive behavior: Comparing pornography and marijuana use (2016) – Excerpt:

This study contributes to the broader literature on how pornography use impacts perceptions of romantic relationships. This study examined if negative outcomes due to a romantic partner’s excessive pornography use are different than negative outcomes produced by other compulsive or addictive behaviors, specifically marijuana use. This study suggests that problematic partner pornography use and problematic partner marijuana use are perceived to similarly impact romantic relationships and contribute to a decrease in relationship satisfaction.

30) Psychological, Relational, and Sexual Correlates of Pornography Use on Young Adult Heterosexual Men in Romantic Relationships (2014) – Excerpt:

Thus, the purpose of this study was to examine theorized antecedents (i.e., gender role conflict and attachment styles) and consequences (i.e., poorer relationship quality and sexual satisfaction) of men’s pornography use among 373 young adult heterosexual men. Findings revealed that both frequency of pornography use and problematic pornography use were related to greater gender role conflict, more avoidant and anxious attachment styles, poorer relationship quality, and less sexual satisfaction. In addition, the findings provided support for a theorized mediated model in which gender role conflict was linked to relational outcomes both directly and indirectly via attachment styles and pornography use.

31) Associations between relational sexual behaviour, pornography use, and pornography acceptance among US college students (2014) – Excerpt:

Using a sample of 792 emerging adults, the present study explored how the combined examination of pornography use, acceptance, and sexual behaviour within a relationship might offer insight into emerging adults’ development. Results suggested clear gender differences in both pornography use and acceptance patterns. High male pornography use tended to be associated with high engagement in sex within a relationship and was associated with elevated risk-taking behaviours. High female pornography use was not associated with engagement in sexual behaviours within a relationship and was general associated with negative mental health outcomes.

32) The effects of sexually explicit material use on romantic relationship dynamics (2016) – Excerpts:

More specifically, couples, where no one used, reported more relationship satisfaction than those couples that had individual users. This is consistent with the previous research (Cooper et al., 1999; Manning, 2006), demonstrating that the solitary use of sexually explicit material results in negative consequences.

With gender effects held constant, individual users reported significantly less intimacy and commitment in their relationships than non-users and shared users.

Overall, how frequently someone views sexually explicit material can have an impact on users’ consequences. Our study found that high frequency users are more likely to have lower relationship satisfaction and intimacy in their romantic relationships.

33) Viewing Sexually-Explicit Materials Alone or Together: Associations with Relationship Quality (2011) –  Excerpt:

This study investigated associations between viewing sexually-explicit material (SEM) and relationship functioning in a random sample of 1291 unmarried individuals in romantic relationships. More men (76.8%) than women (31.6%) reported that they viewed SEM on their own, but nearly half of both men and women reported sometimes viewing SEM with their partner (44.8%).  Individuals who never viewed SEM reported higher relationship quality on all indices than those who viewed SEM alone. Those who viewed SEM only with their partners reported more dedication and higher sexual satisfaction than those who viewed SEM alone. The only difference between those who never viewed SEM and those who viewed it only with their partners was that those who never viewed it had lower rates of infidelity.

34) Cyberpornography: Time Use, Perceived Addiction, Sexual Functioning, and Sexual Satisfaction (2016) – Excerpt:

First, even when controlling for perceived addiction to cyberpornography and overall sexual functioning, cyberpornography use remained directly associated with sexual dissatisfaction. Even though this negative direct association was of small magnitude, time spent viewing cyberpornography seems to be a robust predictor of lower sexual satisfaction.

35) Internet pornography and relationship quality: A longitudinal study of within and between partner effects of adjustment, sexual satisfaction and sexually explicit internet material among newly-weds (2015) – Excerpts:

The data from a considerable sample of newlyweds showed that SEIM use has more negative than positive consequences for husbands and wives. Importantly, husbands’ adjustment decreased SEIM use over time and SEIM use decreased adjustment. Furthermore, more sexual satisfaction in husbands predicted a decrease in their wives’ SEIM use one year later, while wives’ SEIM use did not change their husbands’ sexual satisfaction.

36) More than a dalliance? Pornography consumption and extramarital sex attitudes among married U.S. adults (2014)Excerpts:

This brief report used national panel data gathered from two separate samples of married U.S. adults. Data were gathered from the first sample in 2006 and in 2008. Data were gathered from the second sample in 2008 and in 2010. Consistent with a social learning perspective on media, prior pornography consumption was correlated with more positive subsequent extramarital sex attitudes in both samples, even after controlling for earlier extramarital sex attitudes and nine additional potential confounds.

In total, the results of the present study are consistent with the theoretical premise that pornography consumption leads to the acquisition and activation of sexual scripts, which are then used by many consumers to inform their sexual attitudes (Wright, 2013a; Wright et al., 2012a).

37) Internet Pornography Exposure and Women’s Attitude Towards Extramarital Sex: An Exploratory Study (2013) – Excerpt:

This exploratory study assessed the association between adult U.S. women’s exposure to Internet pornography and attitude towards extramarital sex using data provided by the General Social Survey (GSS).  A positive association between Internet pornography viewing and more positive extramarital sex attitudes was found.

38) Pornography sexual socialization and satisfaction among young men (2010) – Excerpt:

An on-line survey dataset that included 650 young Croatian men aged 18-25 years was used to explore empirically the model. Descriptive findings pointed to significant differences between mainstream and paraphilic SEM users in frequency of SEM use at the age of 14, current SEM use, frequency of masturbation, sexual boredom, acceptance of sex myths, and sexual compulsiveness. Structural equation analyses suggested that negative effects of early exposure to SEM on young men’s sexual satisfaction, albeit small, could be stronger than positive effects.

39) Influence of popular erotica on judgments of strangers and mates (1989) – Excerpt:

In Experiment 2, male and female subjects were exposed to opposite sex erotica. In the second study, there was an interaction of subject sex with stimulus condition upon sexual attraction ratings. Decremental effects of centerfold exposure were found only for male subjects exposed to female nudes. Males who found the Playboy-type centerfolds more pleasant rated themselves as less in love with their wives.

40)  Effects of Prolonged Consumption of Pornography on Family Values (1988) – Excerpt:

Male and female students and nonstudents were exposed to videotapes featuring common, nonviolent pornography or innocuous content. Exposure was in hourly sessions in six consecutive weeks. In the seventh week, subjects participated in an ostensibly unrelated study on societal institutions and personal gratifications. Marriage, cohabitational relationships, and related issues were judged on an especially created Value-of-Marriage questionnaire. The findings showed a consistent impact of pornography consumption. Exposure prompted, among other things, greater acceptance of pre- and extramarital sex and greater tolerance of nonexclusive sexual access to intimate partners. It enhanced the belief that male and female promiscuity are natural and that the repression of sexual inclinations poses a health risk. Exposure lowered the evaluation of marriage, making this institution appear less significant and less viable in the future. Exposure also reduced the desire to have children and promoted the acceptance of male dominance and female servitude. With few exceptions, these effects were uniform for male and female respondents as well as for students and nonstudents.

41)  The Role of Internet Pornography Use and Cyber Infidelity in the Associations between Personality, Attachment, and Couple and Sexual Satisfaction (2017) – Excerpts:

Our results indicated that pornography use is associated with couple and sexual difficulties through increased cyber infidelity.

Pornography use was negatively related to sexual satisfaction for men, but positively for women. In men, pornography use is associated with higher sexual desire, stimulation, and gratification. However, these effects may lead to decreased sexual desire their partner and decreased sexual satisfaction within the couple.

42) Relationship quality predicts online sexual activities among Chinese heterosexual men and women in committed relationships (2016)

In this study, we examined the online sexual activities (OSAs) of Chinese men and women in committed relationships, with a focus on the characteristics of OSAs and the factors prompting men and women with steady partners to engage in OSAs. Almost 89% of the participants reported OSA experiences in the past 12 months even when they had a real-life partner. As predicted, individuals with lower relationship quality in real life, including low relationship satisfaction, insecure attachment, and negative communication patterns, engaged in OSAs more frequently. Overall, our results suggest that variables influencing offline infidelity may also influence online infidelity.

43) Pornography Consumption and Satisfaction: A Meta-Analysis (2017) – This meta-analysis of various other studies assessing sexual and relationship satisfaction reported that porn use was consistently related to lower sexual & relationship satisfaction (interpersonal satisfaction). While some studies report little effect of porn use on sexual & relationship satisfaction in women, it’s important to know that relatively small percentage of coupled females regularly consume internet porn. Cross-sectional data from the largest US survey (General Social Survey) reported that only 2.6% of women had visited a “pornographic website” in the last month (2002-2004). An excerpt:

However, pornography consumption was associated with lower interpersonal satisfaction outcomes in cross-sectional surveys, longitudinal surveys, and experiments. Associations between pornography consumption and reduced interpersonal satisfaction outcomes were not moderated by their year of release or their publication status. But analyses by sex indicted significant results for men only.

44)  The Development of the Problematic Pornography Consumption Scale (PPCS) (2017) – This paper’s goal was the creation of a problematic porn use questionnaire. In the process of validating the instruments, the researchers found that higher scores on the porn use questionnaire were related to lower sexual satisfaction. An excerpt:

Satisfaction with sexual life was weakly and negatively correlated with PPCS scores.

45) Explicit Sexual Movie Viewing in the United States According to Selected Marriage and Lifestyle, Work and Financial, Religion and Political Factors (2017) – Excerpts:

Analyses involved 11,372 adults who responded to questions about demographics and explicitly sexual movie use in the General Social Survey (GSS) from 2000 to 2014. Viewing such movies was related to less happiness in marriage, multiple sex partners in past year, less satisfaction with one’s financial situation, no religious preference, and a more liberal political orientation.

Explicit sexual movie viewing is associated with factors from diverse domains, including poorer relationship quality, more liberal sexual views and practices, poorer economic conditions, lower religious orientation or commitment, and more liberal political views.

46)  Are Pornography Users More Likely to Experience A Romantic Breakup? Evidence from Longitudinal Data (2017)

This study examined whether Americans who use pornography, either at all or more frequently, are more prone to report experiencing a romantic breakup over time. Longitudinal data were taken from the 2006 and 2012 waves of the nationally representative Portraits of American Life Study. Binary logistic regression analyses demonstrated that Americans who viewed pornography at all in 2006 were nearly twice as likely as those who never viewed pornography to report experiencing a romantic breakup by 2012, even after controlling for relevant factors such as 2006 relationship status and other sociodemographic correlates. This association was considerably stronger for men than for women and for unmarried Americans than for married Americans. Analyses also showed a linear relationship between how frequently Americans viewed pornography in 2006 and their odds of experiencing a breakup by 2012.

46)  Associative pathways between pornography consumption and reduced sexual satisfaction (2017) – Excerpt:

Guided by sexual script theory, social comparison theory, and informed by prior research on pornography, socialization, and sexual satisfaction, the present survey study of heterosexual adults tested a conceptual model linking more frequent pornography consumption to reduced sexual satisfaction via the perception that pornography is a primary source of sexual information, a preference for pornographic over partnered sexual excitement, and the devaluation of sexual communication. The model was supported by the data for both men and women.

Pornography consumption frequency was associated with perceiving pornography as a primary source of sexual information, which was associated with a preference for pornographic over partnered sexual excitement and the devaluation of sexual communication. Preferring pornographic to partnered sexual excitement and devaluing sexual communication were both associated with less sexual satisfaction.

47)  Effect of Erotica on Young Men’s Aesthetic Perception of Their Female Sexual Partners (1984) – Excerpt:

Male undergraduates were exposed to (a) nature scenes or (b) beautiful versus (c) unattractive females in sexually enticing situations. Thereafter, they assessed their girl friends’ sexual appeal and evaluated their satisfaction with their mates. On pictorial measures of bodily appeal profiles of flat through hypervoluptuous breast and buttock, preexposure to beautiful females tended to suppress mates’ appeal, while preexposure to unattractive females tended to enhance it. After exposure to beautiful females, mates’ aesthetic value fell significantly below assessments made after exposure to unattractive females; this value assumed an intermediate position after control exposure. Changes in mates’ aesthetic appeal did not correspond with changes in satisfaction with mates, however.

48)  The use of pornography and sexual behaviour among Norwegian men and women of differing sexual orientation (2013) – Hidden away in the study: Greater pornography use in men was correlated with lower sexual satisfaction (or “greater sexual dissatisfaction”).

49)  IASR Fortieth Annual Meeting Book of Abstracts – Dubrovnik, Hrvatska, 25.-28. lipnja, 2014 – This is an abstract of a presentation given by Landripet and Stulhofer a sexology conference. These 2 researchers published a portion of their data in this “brief communication”, which is often cited as finding no relationship between porn use and sexual problems. In reality, their “brief communication” doesn’t mention a pretty important correlation: Only 40% of the Portuguese men used porn “frequently”, while the 60% of the Norwegians used porn “frequently”. The Portuguese men had far less sexual dysfunction than the Norwegians. In a shocking move, Landripet & Stulhofer omitted three other correlations between porn use and sexual problems which they presented to a European conference:

However, increased pornography use was slightly but significantly associated with decreased interest for partnered sex and more prevalent sexual dysfunction among women.

Reporting a preference for specific pornographic genres were significantly associated with erectile, but not ejaculatory or desire-related male sexual dysfunction.

It’s quite telling that Landripet & Stulhofer chose to omit a very significant correlation between erectile dysfunction and preferences for specific genres of porn from their paper. It’s quite common for porn users to escalate into genres that do not match their original sexual tastes, and to experience ED when these conditioned porn preferences do not match real sexual encounters. As pointed out in this review of the literature (and this critique of Landripet & Stulhofer), it’s very important to assess the multiple variables associated with porn use – not just hours in the last month, or frequency in the last years.

50)  The pervasive role of sex mindset: Beliefs about the malleability of sexual life is linked to higher levels of relationship satisfaction and sexual satisfaction and lower levels of problematic pornography use (2017) – Excerpt:

The examined model showed that growth sex mindset had moderate positive association with sexual satisfaction and relationship satisfaction while problematic pornography use only showed a negative, but weak one.

51)  He’s Just Not That Into Anyone: the Impact of Sex Fantasy on Attraction (2017) This “extended abstract” discusses 4 experiments that involved fantasizing about sexual stimuli. All results suggested that sexual fantasy reduces desire for romantic relationships. Excerpt:

Engaging in sexual fantasy increases attraction to sexual targets, but decreases attraction to romantic targets. This research adds to the literature on sex fantasy, attraction, and offers practical implications on porn watching, sex in advertising, and relationships.

52) Is the Relationship Between Pornography Consumption Frequency and Lower Sexual Satisfaction Curvilinear? Results From England and Germany (2017) – Excerpts:

Several studies using different methods have found that pornography consumption is associated with lower sexual satisfaction. The language used by media-effects scholars in discussions of this association implies an expectation that lowered satisfaction is primarily due to frequent-but not infrequent-consumption. Actual analyses, however, have assumed linearity. Linear analyses presuppose that for each increase in the frequency of pornography consumption there is a correspondingly equivalent decrease in sexual satisfaction.

Survey data from two studies of heterosexual adults, one conducted in England and the other in Germany, were employed. Results were parallel in each country and were not moderated by gender. Simple slope analyses suggested that when the frequency of consumption reaches once a month, sexual satisfaction begins to decrease, and that the magnitude of the decrease becomes larger with each increase in the frequency of consumption.


Finally, this anomalous 2016 study is often cited as evidence that porn use offers nothing but benefits to couples: Perceived Effects of Pornography on the Couple Relationship: Initial Findings of Open-Ended, Participant-Informed, “Bottom-Up” Research. (2016).

Two glaring methodical flaws produce meaningless results:

  1. The study does not contain a representative sample. Whereas most studies show that a tiny minority of porn users’ female partners use porn, in this study 95% of the women used porn on their own. And 85% of the women had used porn since the beginning of the relationship (in some cases for years). Those rates are higher than in college-aged men! In other words, the researchers appear to have skewed their sample to produce the results they were seeking. Reality: Cross-sectional data from the largest US survey (General Social Survey) reported that only 2.6% of women had visited a “pornographic website” in the last month. Data from 2000, 2002, 2004. For more see Pornography and Marriage (2014)
  1. The study used “open ended” questions where the subject could ramble on and on about porn. Then the researchers read the ramblings and decided, after the fact, what answers were “important,” and how to present (spin?) them in their paper. Then the researchers then had the gall to suggest that all the other studies on porn and relationships, which employed more established, scientific methodology and straightforward questions about porn’s effects were flawed. How is this method justified?

Despite these fatal flaws several couples reported significant negative effects from porn use, such as:

  • Pornography is easier, more interesting, more arousing, more desirable, or more gratifying than sex with a partner
  • Pornography use is desensitizing, decreases the ability to achieve or maintain sexual arousal, or to achieve orgasm.
  • Some said that specifically described desensitization as the effect of pornography use
  • Some were concerned a loss of intimacy or love.
  • It was suggested that pornography makes real sex more boring, more routine, less exiting, or less enjoyable

For some reason these negative effects did not appear in articles about the study. The lead author’s new website and his attempt at fundraising raise a few questions.

Should compulsive sexual behavior be considered an addiction? (2016): Excerpt analyzing “Prause et al., 2015”

Link to original paper – Should compulsive sexual behavior be considered an addiction? (2016)

COMMENTS: This review, like the other papers, says that Prause et al., 2015 aligns with Kühn & Gallinat, 2014 (Citation 72) which found that more porn use correlated with less brain activation in response to pictures of vanilla porn. In other words, “porn addicts” were either desensitized or habituated, and needed greater stimulation than non-addicts

Excerpt Describing Prause et al., 2015 (Citation 73)


In contrast, other studies focusing on individuals without CSB have emphasized a role for habituation. In non-CSB men, a longer history of pornography viewing was correlated with lower left putaminal responses to pornographic photos, suggesting potential desensitization [72]. Similarly, in an event-related potential study with men and women without CSB, those reporting problematic use of pornography had a lower late positive potential to pornographic photos relative to those not reporting problematic use. The late positive potential is elevated commonly in response to drug cues in addiction studies [73]. These findings contrast to, but are not incompatible with, the report of enhanced activity in the fMRI studies in CSB subjects; the studies differ in stimuli type, modality of measure and the population under study. The CSB study used infrequently shown videos compared to repeated photos; the degree of activation has been shown to differ to videos versus photos and habituation may differ depending on the stimuli. Furthermore, in those reporting problematic use in the event-related potential study, the number of hours of use was relatively low [problem: 3.8, standard deviation (SD) = 1.3 versus control: 0.6, SD = 1.5 hours/week] compared to the CSB fMRI study (CSB: 13.21, SD = 9.85 versus control: 1.75, SD = 3.36 hours/week). Thus, habituation may relate to general use, with severe use potentially associated with enhanced cue-reactivity. Further larger studies are required to examine these differences.”

 

“Neuroscience of Internet Pornography Addiction: A Review and Update” – Excerpt critiquing Prause et al., 2015

Excerpt critiquing Prause et al., 2015:


Another EEG study involving three of the same authors was recently published [309]. Unfortunately, this new study suffered from many of the same methodological issues as the prior one [303]. For example, it used a heterogeneous subject pool, the researchers employed screening questionnaires that have not been validated for pathological internet pornography users, and the subjects were not screened for other manifestations of addiction or mood disorders.

In the new study, Prause et al. compared EEG activity of frequent viewers of Internet pornography with that of controls as they viewed both sexual and neutral images [309]. As expected, the LPP amplitude relative to neutral pictures increased for both groups, although the amplitude increase was smaller for the IPA subjects. Expecting a greater amplitude for frequent viewers of Internet pornography, the authors stated, “This pattern appears different from substance addiction models”.

While greater ERP amplitudes in response to addiction cues relative to neutral pictures is seen in substance addiction studies, the current finding is not unexpected, and aligns with the findings of Kühn and Gallinat [263], who found more use correlated with less brain activation in response to sexual images. In the discussion section, the authors cited Kühn and Gallinat and offered habituation as a valid explanation for the lower LPP pattern. A further explanation offered by Kühn and Gallinat, however, is that intense stimulation may have resulted in neuroplastic changes. Specifically, higher pornography use correlated with lower grey matter volume in the dorsal striatum, a region associated sexual arousal and motivation [265].

It’s important to note that the findings of Prause et al. were in the opposite direction of what they expected [309]. One might expect frequent viewers of Internet pornography and controls to have similar LPP amplitudes in response to brief exposure to sexual images if pathological consumption of Internet pornography had no effect. Instead, the unexpected finding of Prause et al. [309] suggests that frequent viewers of Internet pornography experience habituation to still images. One might logically parallel this to tolerance. In today’s world of high-speed Internet access, it is very likely that frequent consumers of Internet pornography users view sexual films and videos as opposed to still clips. Sexual films produce more physiological and subjective arousal than sexual images [310] and viewing sexual films results in less interest and sexual responsiveness to sexual images [311]. Taken together, the Prause et al., and Kühn and Gallinat studies lead to the reasonable conclusion that frequent viewers of internet pornography require greater visual stimulation to evoke brain responses comparable to healthy controls or moderate porn users.

In addition, the statement of Prause et al. [309] that, “These are the first functional physiological data of persons reporting VSS regulation problems” is problematic because it overlooks research published earlier [262,263]. Moreover, it is critical to note that one of the major challenges in assessing brain responses to cues in Internet pornography addicts is that viewing sexual stimuli is the addictive behavior. In contrast, cue-reactivity studies on cocaine addicts utilize pictures related to cocaine use (white lines on a mirror), rather than having subjects actually ingest cocaine. Since the viewing of sexual images and videos is the addictive behavior, future brain activation studies on Internet pornography users must take caution in both experimental design and interpretation of results. For example, in contrast to the one-second exposure to still images used by Prause et al. [309], Voon et al. chose explicit 9-second video clips in their cue reactivity paradigm to more closely match Internet porn stimuli [262]. Unlike the one-second exposure to still images (Prause et al. [309]), exposure to 9-second video clips evoked greater brain activation in heavy viewers of internet pornography than did one-second exposure to still images. It is further concerning that the authors referenced the Kühn and Gallinat study, released at the same time as the Voon study [262], yet they did not acknowledge the Voon et al. study anywhere in their paper despite its critical relevance.

Neurobiology of Compulsive Sexual Behavior: Emerging Science (2016): Analyzes Prause et al., 2015

COMMENTS: While this paper (below) is only a brief summation, it contains a few key observations. For example, it states that both Prause et al., 2015 and Kuhn & Gallinat, 2014 report a similar finding: greater porn use correlating with greater habituation to porn. Both studies reported lower brain activation in response to brief exposure to photos of vanilla porn. In the following excerpt “Lower late positive-potential” refers to the EEG findings of Prause et al.:

“In contrast, studies in healthy individuals suggest a role for enhanced habituation with excessive use of pornography. In healthy men, increased time spent watching pornography correlated with lower left putaminal activity to pornographic pictures (Kühn and Gallinat, 2014). Lower late positive-potential activity to pornographic pictures was observed in subjects with problematic pornography use.”

Why is this important? Lead author Nicole Prause claimed that her single EEG study debunked “porn addiction”. Five peer-reviewed critiques involving neuroscientists say otherwise.


Neuropsychopharmacology 41, 385-386 (January 2016) | doi:10.1038/npp.2015.300

Shane W Kraus 1, 2, Valerie Voon 3, and Marc N Potenza 2, 4

1 VISN 1 Mental Illness Research Education and Clinical Centers, VA Connecticut Healthcare System, West Haven, CT, USA; 2 Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA;

3 Department of Psychiatry, University of Cambridge, Cambridge, UK;

4 Department of Neurobiology, Child Study Center and CASA Columbia, Yale University School of Medicine, New Haven, CT, USA

E-mail: marc.potenza@yale.edu


Compulsive sexual behavior (CSB) is characterized by craving, impulsivity, social/occupational impairment, and psychiatric comorbidity. Prevalence of CSB is estimated around 3–6%, with a male predominance. Although not included in DSM-5, CSB can be diagnosed in ICD-10 as an impulse control disorder. However, debate exists about CSB’s classification (eg, as an impulsive-compulsive disorder, a feature of hypersexual disorder, an addiction, or along a continuum of normative sexual behavior).

Preliminary evidence suggests that dopamine may contribute to CSB. In Parkinson’s disease (PD), dopamine replacement therapies (Levo-dopa, dopamine agonists) have been associated with CSB and other impulse control disorders (Weintraub et al, 2010). A small number of case studies using naltrexone support its effectiveness at reducing urges and behaviors associated with CSB (Raymond et al, 2010), consistent with the possible opioidergic modification of mesolimbic dopamine function in reducing CSB. Currently, larger, adequately powered, neurochemical investigations and medication trials are needed to further understand CSB.

Incentive motivational processes relate to sexual cue reactivity. CSB vs non-CSB men had greater sex-cuerelated activation of the anterior cingulate, ventral striatum, and amygdala (Voon et al, 2014). In CSB subjects, functional connectivity of this network associated with cue-related sexual desire, thus resonating with findings in drug addictions (Voon et al, 2014). CSB men further show enhanced attentional bias to pornographic cues, implicating early attentional orienting responses as in addictions (Mechelmans et al, 2014). In CSB vs non-CSB PD patients, exposure to pornographic cues increased activation in the ventral striatum, cingulate and orbitofrontal cortex, linking also to sexual desire (Politis et al, 2013). A small diffusion-tensor imaging study implicates prefrontal abnormalities in CSB vs non-CSB men (Miner et al, 2009).

In contrast, studies in healthy individuals suggest a role for enhanced habituation with excessive use of pornography. In healthy men, increased time spent watching pornography correlated with lower left putaminal activity to pornographic pictures (Kühn and Gallinat, 2014). Lower late positive- potential activity to pornographic pictures was observed in subjects with problematic pornography use. These findings, while contrasting, are not incompatible. Habituation to picture cues relative to video cues may be enhanced in healthy individuals with excessive use; whereas, CSB subjects with more severe/pathological use may have enhanced cue reactivity.

Although recent neuroimaging studies have suggested some possible neurobiological mechanisms of CSB, these results should be treated as tentative given methodological limitations (eg, small sample sizes, cross-sectional designs, solely male subjects, and so on). Current gaps in research exist complicating definitive determination whether CSB is best considered as an addiction or not. Additional research is needed to understand how neurobiological features relate to clinically relevant measures like treatment outcomes for CSB. Classifying CSB as a ‘behavioral addiction’ would have significant implications for policy, prevention and treatment efforts; however, at this time, research is in its infancy. Given some similarities between CSB and drug addictions, interventions effective for addictions may hold promise for CSB, thus providing insight into future research directions to investigate this possibility directly.

  1. Kühn S, Gallinat J (2014). Brain structure and functional connectivity associated with pornography consumption: the brain on porn. JAMA Psychiatry 71: 827–834.
  2. Mechelmans DJ, Irvine M, Banca P, Porter L, Mitchell S, Mole TB et al (2014). Enhanced attentional bias towards sexually explicit cues in individuals with and without compulsive sexual behaviours. PloS One 9: e105476.
  3. Miner MH, Raymond N, Mueller BA, Lloyd M, Lim KO (2009). Preliminary investigation of the impulsive and neuroanatomical characteristics of compulsive sexual behavior. Psychiatry Res 174: 146–151.
  4. Politis M, Loane C, Wu K, O’Sullivan SS, Woodhead Z, Kiferle L et al (2013). Neural response to visual sexual cues in dopamine treatment-linked hypersexuality in Parkinson’s disease. Brain 136: 400–411.
  5. Raymond NC, Grant JE, Coleman E (2010). Augmentation with naltrexone to treat compulsive sexual behavior: a case series. Ann Clin Psychiatry 22: 55–62.
  6. Voon V, Mole TB, Banca P, Porter L, Morris L, Mitchell S et al (2014). Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours. PloS One 9: e102419.
  7. Weintraub D, Koester J, Potenza MN, Siderowf AD, Stacy M, Voon V et al (2010). Impulse control disorders in Parkinson disease: a cross-sectional study of 3090 patients. Arch Neurol 67: 589–595. Neuropsychopharmacology Reviews (2016) 41, 385–386; doi:10.1038/npp.2015.300

Research confirms sharp rise in youthful sexual dysfunctions

Young men today appear to be experiencing a sharp increase in ED (and other sexual dysfunctions) since the advent of streaming internet. All studies assessing young male sexuality since 2010 report historic levels of erectile dysfunction, and startling rates of a new scourge: low libido.

Erectile dysfunction rates ranged from 14 to 33%, while rates for low libido (hypo-sexuality) ranged from 16% to 37%. The lower ranges are taken from studies involving teens and men 25 and under, while the higher ranges are from studies involving men 40 and under.

These high rates are a recent phenomenon, but comparing ED rates in men over time can be challenging. Traditionally, ED rates have been negligible in young men, and did not begin to rise sharply until after age 40. For example, here’s a graph from a Dutch study comparing data from prior to 2004.

The next challenge is to understand the extent to which ED rates have risen. This is thorny because ED rates have been measured using various different instruments in the last 25 years. Some researchers asked a single (yes/no) question and requested those with ED to rate its severity. Others use a 5- or 6-question version of a more recent instrument that employs Likert scales. It’s called the IIEF (The International Index of Erectile Function), and is used widely today. Still other researchers used different questionnaires.

GSSAB ED results over time

We’ll discuss a number of study results that show the upward trend, but let’s start with some of the most irrefutable research. It demonstrates a radical rise in ED rates over a decade using very large samples (which increase reliability). All the men were assessed using the same (yes/no) question about ED, as part of the Global Study of Sexual Attitudes and Behavior (GSSAB), administered to 13,618 sexually active men in 29 countries. That occurred in 2001-2002. A decade later, in 2011, the same “sexual difficulties” (yes/no) question from the GSSAB was administered to 2,737 sexually active men in Croatia, Norway and Portugal. The first group, in 2001-2002, were aged 40-80. The second group, in 2011, were 40 and under.

Based on the findings of prior studies one would predict the older men would have far higher ED scores than the younger men, whose scores should have been negligible. Not so. In just a decade, things had changed radically. The 2001-2002 ED rates for men 40-80 were about 13% in Europe. By 2011, ED rates in young Europeans, 18-40, ranged from 14-28%!

What changed in men’s sexual environment during this time? Well, major changes were internet penetration and access to porn videos (followed by access to streaming porn in 2006, and then smartphones on which to view it). In the 2011 study on Croatians, Norwegians and Portuguese, the Portuguese had the lowest rates of ED and the Norwegians had the highest. In 2013, internet penetration rates in Portugal were only 67%, compared with 95% in Norway.

Historical ED rates

What about other historical rates of ED in peer-reviewed literature using various instruments? First, here are results from the 2 major cross-sectional studies on ED in sexually active American men. Both predated heavy internet penetration.

  1. In the 1940s, the Kinsey report concluded that the prevalence of ED was less than 1% in men younger than 30 years, less than 3% in those 30–45.
  2. A 1999 cross-sectional study (based on data gathered in 1992) published by the Journal of the American Medical Association reported erectile dysfunction rates of only 5%, and low sexual desire in 5%. In that study, the ages of the men surveyed ranged from 18 to 59, so a third of them were over 40, which means the rates for sexually active men under 40 were lower.

In 2002 Dutch researchers did a meta-analysis of 6 high-quality ED studies. All of the studies reviewed from Europe (5) reported ED rates for men under 40 of approximately 2%. The sixth was the one reported immediately above.

Note: Keep in mind that ED rates for all men in every age group are higher than rates for sexually active men. For example, in the 1992 data for sexually active men 18-59, the average ED rate was only 5%. However, the rates for men (both sexually active and not) were 7% in men 18-29, 9% in men 30-39, 11% in men 40-49, and 18% in men 50-59. In order to compare “apples to apples,” we, like most researchers, focus on rates for sexually active men. This unfortunately fails to count ED problems in young men who avoid sex due to porn-induced sexual dysfunctions.

Before we turn back to recent studies, it’s important to understand a bit more about the pathology of erectile dysfunction. ED is usually classified as either psychogenic or organic. Traditionally, psychogenic ED is associated with psychological factors (e.g., depression, stress, or anxiety) while organic ED is attributed to physical conditions (e.g., neurological, hormonal, or anatomical.) The most common diagnosis for guys under 40 is psychogenic ED.

Studies investigating ED risk factors in men under 40 typically fail to find the causes commonly associated with ED in older men, such as smoking, alcoholism, obesity, sedentary life, diabetes, hypertension, cardiovascular disease, and hyperlipidemia. Be very skeptical if you read that the preceding causes of organic ED in older men are also the cause of a sharp rise in youthful ED. It takes years for various lifestyle factors to manifest as vasculogenic or neurogenic ED.

Recent studies on young men

Now, we turn to other recent studies on young men (~40 and under). Using the IIEF-5, a 2012 cross-sectional study of Swiss men aged 18-24 found ED rates of 30%, and a 2010 Brazilian study of men 18-40 reported ED rates of 35%. A 2013 Italian study reported one in four patients seeking help for new onset ED were younger than 40. Astonishingly, the rate of severe ED was nearly 10% higher in younger men than in men over 40. The University of Florence urology clinic reported that first time ED patients under 40 comprised about 5% of the total patient population. By 2014-2015 men under 40 seeking help for ED comprised 15% of first time patients. Also, a 2015 paper about 4,211 Italians who sought outpatient help for sexual dysfunction found that compulsive masturbators were younger than the other men and had higher rates of ED (and were likely masturbating to internet porn).

A 2014 study of new diagnoses of ED in active duty servicemen reported that rates had more than doubled between 2004 and 2013. Rates of psychogenic ED increased more than organic ED, and rates of unclassified ED remained relatively stable. A 2014 cross-sectional study of active duty, relatively healthy, male military personnel aged 21-40 found an overall ED rate of 33.2%, using the IIEF-5. About half of them also had PTSD (a known risk factor for ED). In a further military study published in 2015, the researchers found that ED was associated with sexual anxiety and genital self-image, both of which could easily be tied to heavy internet porn use.

The next studies reveal that abnormally low sexual desire is also cropping up in young men.

  1. A 2014 study on Canadian adolescents reported that 53.5% of males aged 16-21 have symptoms indicative of a sexual problem. Erectile dysfunction was the most common (27%), followed by low sexual desire (24%), and problems with orgasm (11%). The authors were baffled why rates were so high, and were surprised that sexual dysfunction rates for males surpassed females, unlike in earlier published literature.
  2. The same Canadian researchers published a 2-year longitudinal study in 2016, in which they found that, over several checkpoints during the 2 years, the following percentages of 16-21 year old males reported:
    low sexual satisfaction (47.9%)
    low desire (46.2%)
    problems in erectile function (45.3%)
    While females’ sexual problems improved over time the males’ sexual problems did not: “Unlike for male adolescents, we found a clearer picture of improvement over time for female adolescents, suggesting that learning and experience played a role in improving their sexual lives.” And, “The only factor that emerged as a strong predictor was relationship status: Adolescents who were not in a sexual relationship were approximately three times more likely to report a problem in sexual functioning compared to those who were in a sexual relationship.” [All subjects were sexually active, but who would be using the most porn?]
  3. The same Canadian researchers published a 2-year longitudinal study in 2016, in which they found that, over several checkpoints during the 2 years, the following percentages of 16-21 year old males reported:
    1. low sexual satisfaction (47.9%)
    2. low desire (46.2%)
    3. problems in erectile function (45.3%)
  4. A 2015 study on Italian high school seniors (18-19) found that 16% of those who use porn more than once per week  reported abnormally low sexual desire. Non-porn users reported 0% low sexual desire.
  5. A 2014 survey of Croatian men 40 and under reported ED rates of 31% and low sexual desire rates of 37%.

A 2015 study, which asked Canadian men using porn 7 or more hours per week about their sexual functioning, found that 71% had sexual dysfunctions, with 33% reporting difficulty orgasming. Average age 41.5.

Together, these studies suggest a recent increase in ED in men ~40 and under, as well as startling rates of anorgasmia and low sexual desire, starting quite young (as does internet porn use).

None of these studies had young men remove porn use to investigate internet porn’s effects on their sexual performance, despite the fact that its use represents a drastic change in men’s sexual environment in the digital age. However, the peer-reviewed evidence supporting internet porn as the culprit in youthful sexual dysfunction continues to accumulate. See this list of 19 studies linking porn use or porn addiction to sexual dysfunctions and lower arousal to sexual stimuli. The first 3 studies in this list demonstrate causation as participants eliminated porn use and healed chronic sexual dysfunctions.

In line with anecdotal  evidence and peer-reviewed research

Graph showing age of forum participants seeking help for ED

The image to the right appeared in an analysis of ED posts from MedHelp forums. “Nearly 60% of men posting on the forums were under 24 years old. This was a surprising finding for researchers, as erectile dysfunction is generally considered a condition that strikes older men.”

An Irish Times poll asked thousands of readers about ED, and the number of men 24-34 with issues was 28%:


Click on graphics from 2015 Irish Times poll to see ED rates, which show higher rates in young men than in men 35-49!

Hundreds of self-reports of recovery from ED and other sexual dysfunctions after quitting internet porn can be found on these pages:

n addition to the studies below, this page contains articles and videos by about 100 experts (urology professors, urologists, psychiatrists, psychologists, sexologists, MDs) who acknowledge and have successfully treated porn-induced ED and porn-induced loss of sexual desire.


Studies reporting links between porn use and ED, anorgamsia, low sexual desire, delayed ejaculation, and lower brain activation to sexual images.

Already, a handful of studies have correlated use of internet porn and porn addiction with arousal, attraction, and sexual performance problems. Results link its use with diminished libido or erectile function, delayed ejaculation, a preference for using porn to achieve and maintain arousal over having sex with a partner, negative effects on partnered sex, decreased enjoyment of sexual intimacy, and lower brain activation to sexual images.

  • The first 3 studies demonstrate causation as participants eliminated porn use and healed chronic sexual dysfunctions:

1) Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports (2016) – An extensive review of the literature related to porn-induced sexual problems. Involving US Navy doctors, the review provides the latest data revealing a tremendous rise in youthful sexual problems. It also reviews the neurological studies related to porn addiction and sexual conditioning via Internet porn. The doctors provide 3 clinical reports of men who developed porn-induced sexual dysfunctions. Two of the three men healed their sexual dysfunctions by eliminating porn use. The third man experienced little improvement as he was unable to abstain from porn use. Excerpt:

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.

2) Male masturbation habits and sexual dysfunctions (2016)It’s by a French psychiatrist who is the current president of the European Federation of Sexology. While the abstract shifts back and forth between Internet pornography use and masturbation, it’s clear that he’s mostly referring to porn-induced sexual dysfunctions (erectile dysfunction and anorgasmia). The paper revolves around his clinical experience with 35 men who developed erectile dysfunction and/or anorgasmia, and his therapeutic approaches to help them. The author states that most of his patients used porn, with several being addicted to porn. The abstract point to internet porn as the primary cause of the problems (keep in mind that masturbation does not cause chronic ED, and it is never given as a cause of ED). Excerpts:

Intro: Harmless and even helpful in his usual form widely practiced, masturbation in its excessive and pre-eminent form, generally associated today to pornographic addiction, is too often overlooked in the clinical assessment of sexual dysfunction it can induce.

Results: Initial results for these patients, after treatment to “unlearn” their masturbatory habits and their often associated addiction to pornography, are encouraging and promising. A reduction in symptoms was obtained in 19 patients out of 35. The dysfunctions regressed and these patients were able to enjoy satisfactory sexual activity.

Conclusion: Addictive masturbation, often accompanied by a dependency on cyber-pornography, has been seen to play a role in the etiology of certain types of erectile dysfunction or coital anejaculation. It is important to systematically identify the presence of these habits rather than conduct a diagnosis by elimination, in order to include habit-breaking deconditioning techniques in managing these dysfunctions

3) Unusual masturbatory practice as an etiological factor in the diagnosis and treatment of sexual dysfunction in young men (2014) – One of the 4 case studies in this paper reports on a man with porn-induced sexual problems (low libido, fetishes, anorgasmia). The sexual intervention called for a 6-week abstinence from porn and masturbation. After 8 months the man reported increased sexual desire, successful sex and orgasm, and enjoying “good sexual practices. This is the first peer-reviewed chronicling of a recovery from porn-induced sexual dysfunctions Excerpts from the paper:

“When asked about masturbatory practices, he reported that in the past he had been masturbating vigorously and rapidly while watching pornography since adolescence. The pornography originally consisted mainly of zoophilia, and bondage, domination, sadism, and masochism, but he eventually got habituated to these materials and needed more hardcore pornography scenes, including transgender sex, orgies, and violent sex. He used to buy illegal pornographic movies on violent sex acts and rape and visualized those scenes in his imagination to function sexually with women. He gradually lost his desire and his ability to fantasize and decreased his masturbation frequency.”

In conjunction with weekly sessions with a sex therapist, the patient was instructed to avoid any exposure to sexually explicit material, including videos, newspapers, books, and internet pornography.

After 8 months, the patient reported experiencing successful orgasm and ejaculation. He renewed his relationship with that woman, and they gradually succeeded in enjoying good sexual practices.

4) The Dual Control Model – The Role Of Sexual Inhibition & Excitation In Sexual Arousal And Behavior (2007) – Newly discovered and very convincing paper from the Kinsey Institute. In an experiment employing video porn, 50% of the young men couldn’t become aroused or achieve erections with porn (average age was 29). The shocked researchers discovered that the men’s erectile dysfunction was,

related to high levels of exposure to and experience with sexually explicit materials.

The men experiencing erectile dysfunction had spent a considerable amount of time in bars and bathhouses where porn was “omnipresent,” and “continuously playing“. The researchers stated:

Conversations with the subjects reinforced our idea that in some of them a high exposure to erotica seemed to have resulted in a lower responsivity to “vanilla sex” erotica and an increased need for novelty and variation, in some cases combined with a need for very specific types of stimuli in order to get aroused.”

5) Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours (2014) – This fMRI study by Cambridge University found cue-reactivity in porn addicts which mirrored sensitization in drug addicts. It also found that porn addicts (CSB) fit the accepted addiction model of wanting “it” more, but not liking “it” more. The researchers also reported that 60% of subjects (average age: 25) had difficulty achieving erections/arousal with real partners as a result of using porn, yet could achieve erections with porn. From the study (CSB is compulsive sexual behaviours – or porn addicts):

CSB subjects reported that as a result of excessive use of sexually explicit materials….. experienced diminished libido or erectile function specifically in physical relationships with women (although not in relationship to the sexually explicit material)”

“Compared to healthy volunteers, CSB subjects had greater subjective sexual desire or wanting to explicit cues and had greater liking scores to erotic cues, thus demonstrating a dissociation between wanting and liking. CSB subjects also had greater impairments of sexual arousal and erectile difficulties in intimate relationships but not with sexually explicit materials highlighting that the enhanced desire scores were specific to the explicit cues and not generalized heightened sexual desire.

6) Online sexual activities: An exploratory study of problematic and non-problematic usage patterns in a sample of men (2016) A Belgian study that found problematic Internet porn use was associated with reduced erectile function and reduced overall sexual satisfaction. Yet problematic porn users experienced greater cravings. The study appears to report escalation, as 49% of the men viewed porn that “was not previously interesting to them or that they considered disgusting.” An excerpt:

This study is the first to directly investigate the relationships between sexual dysfunctions and problematic involvement in OSAs. Results indicated that higher sexual desire, lower overall sexual satisfaction, and lower erectile function were associated with problematic OSAs (online sexual activities). These results can be linked to those of previous studies reporting a high level of arousability in association with sexual addiction symptoms (Bancroft & Vukadinovic, 2004; Laier et al., 2013; Muise et al., 2013).”

In addition, we finally have a study that asks porn users about possible escalation to new or disturbing porn genres. Guess what it found?

Forty-nine percent mentioned at least sometimes searching for sexual content or being involved in OSAs that were not previously interesting to them or that they considered disgusting, and 61.7% reported that at least sometimes OSAs were associated with shame or guilty feelings.”

Note – This is the first study to directly investigate the relationships between sexual dysfunctions and problematic porn use. Two other studies claiming to have investigated correlations between porn use and erectile functioning cobbled together data from earlier studies in an unsuccessful attempt to debunk porn-induced ED. Both were criticized in the peer-reviewed literature: paper 1 was not an authentic study, and has been thoroughly discredited; paper 2 actually found correlations that support porn-induced ED. Moreover, paper 2 was only a “brief communication” that did not report important data.

7) Adolescents and web porn: a new era of sexuality (2015) – An Italian study analyzed the effects of Internet porn on high school students, co-authored by urology professor Carlo Foresta, president of the Italian Society of Reproductive Pathophysiology. The most interesting finding is that 16% of those who consume porn more than once a week report abnormally low sexual desire compared with 0% in non-consumers (and 6% for those who consume less than once a week). From the study, concerning pornography use:

21.9% define it as habitual, 10% report that it reduces sexual interest towards potential real-life partners, and the remaining, 9.1% report a kind of addiction. In addition, 19% of overall pornography consumers report an abnormal sexual response, while the percentage rose to 25.1% among regular consumers.

8) Patient Characteristics by Type of Hypersexuality Referral: A Quantitative Chart Review of 115 Consecutive Male Cases (2015) – Study on men (average age 41.5) with hypersexuality disorders, such as paraphilias and chronic masturbation or adultery. 27 were classified as “avoidant masturbators,” meaning they masturbated (typically with porn use) one or more hours per day or more than 7 hours per week. 71% reported sexual functioning problems, with 33% reporting delayed ejaculation (a precursor to porn-induced ED). What sexual dysfunction do 38% of the remaining men have? The study doesn’t say, and the authors have ignored requests for details. Two primary choices for male sexual dysfunction are ED and low libido. The men were not asked about their erectile functioning without porn. If all their sexual activity involved masturbating to porn, and not sex with a partner, they would never realize they had porn-induced ED.

9)  The effects of sexually explicit material use on romantic relationship dynamics (2016) – As with many other studies, solitary porn users report poorer relationship and sexual satisfaction. Employing the Pornography Consumption Effect Scale (PCES), the study found that higher porn use was related to poorer sexual function, more sexual problems, and a “worse sex life”. An excerpt describing the correlation between the PCES “Negative Effects” on “Sex Life” questions and frequency of porn use:

There were no significant differences for the Negative Effect Dimension PCES across the frequency of sexually explicit material use; however, there were significant differences on the Sex Life subscale where High Frequency Porn Users reported greater negative effects than Low Frequency Porn Users.

10) Altered Appetitive Conditioning and Neural Connectivity in Subjects With Compulsive Sexual Behavior (2016) “Compulsive Sexual Behaviors” (CSB) means the men were porn addicts, because CSB subjects averaged nearly 20 hours of porn use per week. The controls averaged 29 minutes per week. Interestingly, 3 of the 20 CSB subjects suffered from “orgasmic-erection disorder,” while none of the control subjects reported sexual problems.

11) Brain Structure and Functional Connectivity Associated With Pornography Consumption: The Brain on Porn (2014) – A Max Planck study which found 3 significant addiction-related brain changes correlating with the amount of porn consumed. It also found that the more porn consumed the less reward circuit activity in response to brief exposure (.530 second) to vanilla porn. In a 2014 article lead author Simone Kühn said:

We assume that subjects with a high porn consumption need increasing stimulation to receive the same amount of reward. That could mean that regular consumption of pornography more or less wears out your reward system. That would fit perfectly the hypothesis that their reward systems need growing stimulation.”

A more technical description of this study from a review of the literature by Kuhn & Gallinat – Neurobiological Basis of Hypersexuality (2016).

“The more hours participants reported consuming pornography, the smaller the BOLD response in left putamen in response to sexual images. Moreover, we found that more hours spent watching pornography was associated with smaller gray matter volume in the striatum, more precisely in the right caudate reaching into the ventral putamen. We speculate that the brain structural volume deficit may reflect the results of tolerance after desensitization to sexual stimuli.”

12) Sexual Desire, not Hypersexuality, is Related to Neurophysiological Responses Elicited by Sexual Images (2013) – In line with the Cambridge University brain scan studies, this EEG study reported greater cue-reactivity to porn correlated with less desire for partnered sex. To put another way – individuals with more brain activation and cravings for porn would rather masturbate to porn than have sex with a real person. Study spokesman Nicole Prause claimed that porn users merely had high libido, yet the results of the study say something quite different.. The study’s actual findings do not match the concocted headlines.   Read an extensive critique here. Five peer-reviewed papers expose the truth: 1, 2, 3, 4, 5.

13) Modulation of Late Positive Potentials by Sexual Images in Problem Users and Controls Inconsistent with “Porn Addiction” (2015) – Another SPAN Lab EEG study comparing the 2013 subjects from the above study to an actual control group. The results: compared to controls “compulsive porn users” had less response to photos of vanilla porn. Ignoring all the other studies on this page, lead author Nicole Prause, boldly claims that her results “debunked porn addiction”. What legitimate scientist would claim that their lone anomalous study has debunked an entire field of study?  In reality, the findings of Prause et al. 2015 align perfectly with Kühn & Gallinat (2014), which found that more porn use correlated with less brain activation in response to pictures of vanilla porn. Prause’s findings also align with Banca et al. 2015 which is #4 in this list. Moreover, another EEG study found that greater porn use in women correlated with less brain activation to porn. Lower EEG readings mean that subjects are paying less attention to the pictures. Put simply, frequent porn users were desensitized to static images of vanilla porn. They were bored. Read an extensive critique here. Six peer-reviewed papers have stated that this study actually found desensitization or habituation in frequent porn users – 1, 2, 3, 4, 5, 6.

14) Erectile Dysfunction, Boredom, and Hypersexuality among Coupled Men from Two European Countries (2015) – Survey reported a strong correlation between erectile dysfunction and measures of hypersexuality. The study omitted correlation data between erectile functioning and pornography use. An excerpts

Among Croatian and German men, hypersexuality was significantly correlated with proneness to sexual boredom and more problems with erectile function.

15) Masturbation and Pornography Use Among Coupled Heterosexual Men With Decreased Sexual Desire: How Many Roles of Masturbation? (2015) – Masturbating to porn was related with decreased sexual desire and low relationship intimacy. Excerpts:

“Among men who masturbated frequently, 70% used pornography at least once a week. A multivariate assessment showed that sexual boredom, frequent pornography use, and low relationship intimacy significantly increased the odds of reporting frequent masturbation among coupled men with decreased sexual desire.”

“Among men [with decreased sexual desire] who used pornography at least once a week [in 2011], 26.1% reported that they were unable to control their pornography use. In addition, 26.7% of men reported that their use of pornography negatively affected their partnered sex and 21.1% claimed to have attempted to stop using pornography.”

16) An Online Assessment of Personality, Psychological, and Sexuality Trait Variables Associated with Self-Reported Hypersexual Behavior (2015) – Survey reported a common theme found in several other studies listed here: Porn/sex addicts report greater arousabilty (cravings related to their addiction) combined with poorer sexual function (fear of experiencing erectile dysfunction).

Hypersexual” behavior represents a perceived inability to control one’s sexual behavior. To investigate hypersexual behavior, an international sample of 510 self-identified heterosexual, bisexual, and homosexual men and women completed an anonymous online self-report questionnaire battery.

Thus, the data indicated that hypersexual behavior is more common for males, and those who report being younger in age, more easily sexually excited, more sexually inhibited due to the threat of performance failure, less sexually inhibited due to the threat of performance consequences, and more impulsive, anxious, and depressed

17) Use of pornography in a random sample of Norwegian heterosexual couples (2009) – Porn use was correlated with more sexual dysfunctions in the man and negative self perception in the female. The couples who did not use porn had no sexual dysfunctions.  A few excerpts from the study:

In couples where only one partner used pornography, we found more problems related to arousal (male) and negative (female) self-perception.

In those couples where one partner used pornography there was a permissive erotic climate. At the same time, these couples seemed to have more dysfunctions.

The couples who did not use pornography… may be considered more traditional in relation to the theory of sexual scripts. At the same time, they did not seem to have any dysfunctions.

Couples who both reported pornography use grouped to the positive pole on the ‘‘Erotic climate’’ function and somewhat to the negative pole on the ‘‘Dysfunctions’’ function.

18) Men’s Sexual Life and Repeated Exposure to Pornography. A New Issue? (2015) – Excerpts:

Mental health specialists should take in consideration the possible effects of pornography consumption on men sexual behaviors, men sexual difficulties and other attitudes related to sexuality. In the long term pornography seems to create sexual dysfunctions, especially the individual’s inability to reach an orgasm with his partner. Someone who spends most of his sexual life masturbating while watching porn engages his brain in rewiring its natural sexual sets (Doidge, 2007) so that it will soon need visual stimulation to achieve an orgasm.

Many different symptoms of porn consumption, such as the need to involve a partner in watching porn, the difficulty in reaching orgasm, the need for porn images in order to ejaculate turn into sexual problems. These sexual behaviors may go on for months or years and it may be mentally and bodily associated with the erectile dysfunction, although it is not an organic dysfunction. Because of this confusion, which generates embarrassment, shame and denial, lots of men refuse to encounter a specialist

Pornography offers a very simple alternative to obtain pleasure without implying other factors that were involved in human’s sexuality along the history of mankind. The brain develops an alternative path for sexuality which excludes “the other real person” from the equation. Furthermore, pornography consumption in a long term makes men more prone to difficulties in obtaining an erection in a presence of their partners.

19) Study sees link between porn and sexual dysfunction (2017) – The findings of an upcoming study presented at the American Urological Association’s annual meeting. A few excerpts:

Young men who prefer pornography to real-world sexual encounters might find themselves caught in a trap, unable to perform sexually with other people when the opportunity presents itself, a new study reports. Porn-addicted men are more likely to suffer from erectile dysfunction and are less likely to be satisfied with sexual intercourse, according to survey findings presented Friday at the American Urological Association’s annual meeting, in Boston.

The rates of organic causes of erectile dysfunction in this age cohort are extremely low, so the increase in erectile dysfunction that we have seen over time for this group needs to be explained,” Christman said. “We believe that pornography use may be one piece to that puzzle”.

20) – Associative pathways between pornography consumption and reduced sexual satisfaction (2017) – This study is found in both lists. While it links porn use to lower sexual satisfaction, it also reported that frequency of porn use was related to a preference (or need?) for porn over people to achieve sexual arousal. An excerpt:

Finally, we found that frequency of pornography consumption was also directly related to a relative preference for pornographic rather than partnered sexual excitement. Participants in the present study primarily consumed pornography for masturbation. Thus, this finding could be indicative of a masturbatory conditioning effect (Cline, 1994; Malamuth, 1981; Wright, 2011). The more frequently pornography is used as an arousal tool for masturbation, the more an individual may become conditioned to pornographic as opposed to other sources of sexual arousal.

21) “I think it has been a negative influence in many ways but at the same time I can’t stop using it”: Self-identified problematic pornography use among a sample of young Australians (2017) – Online survey of Australians, aged 15-29.  Those who had ever viewed pornography (n=856) were asked in an open-ended question: ‘How has pornography influenced your life?’.

Among participants who responded to the open-ended question (n=718), problematic usage was self-identified by 88 respondents. Male participants who reported problematic usage of pornography highlighted effects in three areas: on sexual function, arousal and relationships. Responses included “I think it has been a negative influence in many ways but at the same time I can’t stop using it” (Male, Aged 18–19). Some female participants also reported problematic usage, with many of these reporting negative feelings like guilt and shame, impact on sexual desire and compulsions relating to their use of pornography. For example as one female participant suggested; “It makes me feel guilty, and I’m trying to stop. I don’t like how I feel that I need it to get myself going, it’s not healthy.” (Female, Aged 18–19)

22) 2014 lecture describing upcoming studies – by Urology professor Carlo Foresta, president of the Italian Society of Reproductive Pathophysiology – The lecture contains the results of longitudinal and cross-sectional studies. One study involved a survey of high school teens (pages 52-53). The study reported that sexual dysfunction doubled between 2005 and 2013, with low sexual desire increasing 600%.

  • The percentage of teens that experienced alterations of their sexuality: 2004/05: 7.2%, 2012/13: 14.5%
  • The percentage of teens with low sexual desire: 2004/05: 1.7%, 2012/13: 10.3% (that’s a 600% increase in 8 years)

Foresta also describes his upcoming study, “Sexuality media and new forms of sexual pathology sample 125 young males, 19-25 years” (Italian name – “Sessualità mediatica e nuove forme di patologia sessuale Campione 125 giovani maschi“). The results from the study (pages 77-78), which used the International Index of Erectile Function Questionnaire, found that regular porn users scored 50% lower on sexual desire domain and 30% lower of the erectile functioning domain.

23) Not peer-reviewed. Here’s a popular article about an extensive analysis of comments and questions posted on MedHelp concerning erectile dysfunction. What’s shocking is that 58% of the men asking for help were 24 or younger. Many suspected that internet porn could be involved in their dysfunction, as described in the results from the study:

EXCERPT: The most common phrase is “erectile dysfunction” – which is mentioned more than three times as often as any other phrase – followed by “internet porn,” “performance anxiety,” and “watching porn.” Clearly, porn is a frequently discussed subject: “I have been viewing internet pornography frequently (4 to 5 times a week) for the past 6 years,” one man writes. “I am in my mid-20s and have had a problem getting and maintaining an erection with sexual partners since my late teens when I first started looking at internet porn.”

Article about the latest spin campaign: Sexologists Deny Porn-induced ED by Claiming Masturbation Is the Problem (2016)


References

1.         Papagiannopoulos D, Khare N, Nehra A. “Evaluation of young men with organic erectile dysfunction.” Asian journal of andrology. 2015;17(1):11-6. Epub 2014/11/06. doi: 10.4103/1008-682x.139253. PubMed PMID: 25370205; PubMed Central PMCID: PMCPmc4291852.

2.         Martins FG, Abdo CH. “Erectile dysfunction and correlated factors in Brazilian men aged 18-40 years.” The journal of sexual medicine. 2010;7(6):2166-73. Epub 2009/11/06. doi: 10.1111/j.1743-6109.2009.01542.x. PubMed PMID: 19889149.

3.         “Erectile dysfunction among male active component service members, U.S. Armed Forces, 2004-2013.” Msmr. 2014;21(9):13-6. Epub 2014/10/01. PubMed PMID: 25267600.

4.         Wilcox SL, Redmond S, Hassan AM. “Sexual functioning in military personnel: preliminary estimates and predictors.” The journal of sexual medicine. 2014;11(10):2537-45. Epub 2014/07/22. doi: 10.1111/jsm.12643. PubMed PMID: 25042933.

5.         Laumann EO, Paik A, Rosen RC. “Sexual dysfunction in the United States: prevalence and predictors.” JAMA : the journal of the American Medical Association. 1999;281(6):537-44. Epub 1999/02/18. PubMed PMID: 10022110.

6.         Prins, J., M. H. Blanker, A. M. Bohnen, S. Thomas, and J. L. H. R. Bosch. “Prevalence of Erectile Dysfunction: A Systematic Review of Population-Based Studies.” International Journal of Impotence Research 14, no. 6 (December 2002): 422–32. doi:10.1038/sj.ijir.3900905.

7.         de Boer, B. J., M. L. Bots, A. A. B. Lycklama a Nijeholt, J. P. C. Moors, H. M. Pieters, and Th J. M. Verheij. “Erectile Dysfunction in Primary Care: Prevalence and Patient Characteristics. The ENIGMA Study.” International Journal of Impotence Research 16, no. 4 (February 12, 2004): 358–64. doi:10.1038/sj.ijir.3901155.

8.         Mialon A, Berchtold A, Michaud PA, Gmel G, Suris JC. “Sexual dysfunctions among young men: prevalence and associated factors.” The Journal of adolescent health : official publication of the Society for Adolescent Medicine. 2012;51(1):25-31. Epub 2012/06/26. doi: 10.1016/j.jadohealth.2012.01.008. PubMed PMID: 22727073.

9.         Capogrosso P, Colicchia M, Ventimiglia E, Castagna G, Clementi MC, Suardi N, et al. “One patient out of four with newly diagnosed erectile dysfunction is a young man–worrisome picture from the everyday clinical practice.” The journal of sexual medicine. 2013;10(7):1833-41. Epub 2013/05/09. doi: 10.1111/jsm.12179. PubMed PMID: 23651423.

10.         O’Sullivan LF, Brotto LA, Byers ES, Majerovich JA, Wuest JA. “Prevalence and characteristics of sexual functioning among sexually experienced middle to late adolescents.” The journal of sexual medicine. 2014;11(3):630-41. Epub 2014/01/15. doi: 10.1111/jsm.12419. PubMed PMID: 24418498.

11.         Ivan Landripet, PhD and Aleksandar Štulhofer, PhD. “Is Pornography Use Associated with Sexual Difficulties and Dysfunctions among Younger Heterosexual Men?” (Brief Communication) The journal of sexual medicine, Epub 2015/03/26. doi: 10.1111/jsm.12853

12.         Wilcox SL1, Redmond S, Davis TL., “Genital Image, Sexual Anxiety, and Erectile Dysfunction Among Young Male Military Personnel.” J Sex Med. 2015 Apr 30. doi: 10.1111/jsm.12880.

13.       Sutton, Katherine S., Natalie Stratton, Jennifer Pytyck, Nathan J. Kolla, and James M. Cantor. “Patient Characteristics by Type of Hypersexuality Referral: A Quantitative Chart Review of 115 Consecutive Male Cases.” Journal of Sex & Marital Therapy 41, no. 6 (December 2015): 563–80. doi:10.1080/0092623X.2014.935539.

14.       Voon V, Mole TB, Banca P, Porter L, Morris L, Mitchell S, et al. “Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours.” PloS one. 2014;9(7):e102419. Epub 2014/07/12. doi: 10.1371/journal.pone.0102419. PubMed PMID: 25013940; PubMed Central PMCID: PMCPmc4094516.

15.       Carvalheira A, Traeen B, Stulhofer A. “Masturbation and Pornography Use Among Coupled Heterosexual Men With Decreased Sexual Desire: How Many Roles of Masturbation?” Journal of sex & marital therapy. 2014:1-10. Epub 2014/09/06. doi: 10.1080/0092623x.2014.958790. PubMed PMID: 25189834.

16.       Sun C, Bridges A, Johnason J, Ezzell M. “Pornography and the Male Sexual Script: An Analysis of Consumption and Sexual Relations.” Archives of sexual behavior. 2014. Epub 2014/12/04. doi: 10.1007/s10508-014-0391-2. PubMed PMID: 25466233.

17.       Morgan, E. M. Associations between young adults’ use of sexually explicit materials and their sexual preferences, behaviors, and satisfaction. J. Sex Res. 2011, 48, 520–530.

18.       Maddox, A. M.; Rhoades, G. K.; Markman, H. J. Viewing Sexually-Explicit Materials Alone or Together: Associations with Relationship Quality. Arch. Sex. Behav. 2011, 40, 441–448.

19.       Bridges, A. J.; Morokoff, P. J. Sexual media use and relational satisfaction in heterosexual couples. Pers. Relatsh. 2011, 18, 562–585.

20.       Stewart, D. N.; Szymanski, D. M. Young Adult Women’s Reports of Their Male Romantic Partner’s Pornography Use as a Correlate of Their Self-Esteem, Relationship Quality, and Sexual Satisfaction. Sex Roles 2012, 67, 257–271.

21.       Sun, C.; Miezan, E.; Lee, N.-Y.; Shim, J. W. Korean Men’s Pornography use, Their Interest in Extreme Pornography, and Dyadic Sexual Relationships. Int. J. Sex. Health 2015, 27, 16–35.

22.       Pornography’s Impact on Sexual Satisfaction – Zillmann – 2006 – Journal of Applied Social Psychology – Wiley Online Library http://onlinelibrary.wiley.com/doi/10.1111/j.1559-1816.1988.tb00027.x/ab… (accessed Jul 4, 2015).

23.        Giovanni Castellini, Giovanni Corona, Egidia Fanni, Elisa Maseroli, Valdo Ricca and Mario Maggi, “Does compulsive sexual behavior really exist? Psychological, relational, and biological correlates of compulsive masturbation in a clinical setting.”

24.        Voon V,  Mole TB,  Banca P,  Porter L,  Morris L,  Mitchell S, et al. Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours. PloS one. 2014;9(7):e102419. Epub 2014/07/12. doi: 10.1371/journal.pone.0102419. PubMed PMID: 25013940; PubMed Central PMCID: PMCPmc4094516.

25.        Kuhn S,  Gallinat J. Brain structure and functional connectivity associated with pornography consumption: the brain on porn. JAMA psychiatry. 2014;71(7):827-34. Epub 2014/05/30. doi: 10.1001/jamapsychiatry.2014.93. PubMed PMID: 24871202.

26      Aline Wéry,  J. Billieux  Online sexual activities: An exploratory study of problematic and non-problematic usage patterns in a sample of men.  Computers in Human Behavior.  Volume 56, March 2016, Pages 257–266

27       The Psychophysiology of Sex., Chapter: The Dual-Control Model: The role of sexual inhibition & excitation in sexual arousal and behavior“. Publisher: Indiana University Press, Editors: Erick Janssen, pp.197-222

“Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours” (2014): Excerpt analyzing Steele et al., 2013

Link to full study – Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours” (2014)

Excerpt analyzing “Steele et al., 2013″ (citation 25 is Steele et al.):


Our findings suggest dACC activity reflects the role of sexual desire, which may have similarities to a study on the P300 in CSB subjects correlating with desire [25]. We show differences between the CSB group and healthy volunteers whereas this previous study did not have a control group. The comparison of this current study with previous publications in CSB focusing on diffusion MRI and the P300 is difficult given methodological differences. Studies of the P300, an event related potential used to study attentional bias in substance use disorders, show elevated measures with respect to use of nicotine [54], alcohol [55], and opiates [56], with measures often correlating with craving indices. The P300 is also commonly studied in substance-use disorders using oddball tasks in which low-probability targets are frequently mixed with high-probability non-targets. A meta-analysis showed that substance-use-disordered subjects and their unaffected family members had decreased P300 amplitude compared to healthy volunteers [57]. These findings suggest substance-use disorders may be characterized by impaired allocation of attentional resources to task-relevant cognitive information (non-drug targets) with enhanced attentional bias to drug cues. The decrease in P300 amplitude may also be an endophenotypic marker for substance-use disorders. Studies of event-related potentials focusing on motivation relevance of cocaine and heroin cues further report abnormalities in the late components of the ERP (>300 milliseconds; late positive potential, LPP) in frontal regions, which may also reflect craving and attention allocation [58][60]. The LPP is believed to reflect both early attentional capture (400 to 1000 msec) and later sustained processing of motivationally significant stimuli. Subjects with cocaine use disorder had elevated early LPP measures compared to healthy volunteers suggesting a role for early attentional capture of motivated attention along with attenuated responses to pleasant emotional stimuli. However, the late LPP measures were not significantly different from those in healthy volunteers [61]. The generators of the P300 event-related potential for target-related responses is believed to be the parietal cortex and cingulate [62]. Thus, both dACC activity in the present CSB study and P300 activity reported in a previous CSB study may reflect similar underlying processes of attentional capture. Similarly, both studies show a correlation between these measures with enhanced desire. Here we suggest that dACC activity correlates with desire, which may reflect an index of craving, but does not correlate with liking suggestive of on an incentive-salience model of addictions.


 

“Neuroscience of Internet Pornography Addiction: A Review and Update” – Excerpt critiquing Steele et al., 2013

Link to full paper – “Neuroscience of Internet Pornography Addiction: A Review and Update” (2015)

Excerpt critiquing “Steele et al., 2013″:


An EEG study on those complaining of problems regulating their viewing of internet pornography has reported the neural reactivity to sexual stimuli [303]. The study was designed to examine the relationship between ERP amplitudes when viewing emotional and sexual images and questionnaire measures of hypersexuality and sexual desire. The authors concluded that the absence of correlations between scores on hypersexuality questionnaires and mean P300 amplitudes when viewing sexual images “fail to provide support for models of pathological hypersexuality” [303] (p. 10). However, the lack of correlations may be better explained by arguable flaws in the methodology. For example, this study used a heterogeneous subject pool (males and females, including 7 non-heterosexuals). Cue-reactivity studies comparing the brain response of addicts to healthy controls require homogenous subjects (same sex, similar ages) to have valid results. Specific to porn addiction studies, it’s well established that males and females differ appreciably in brain and autonomic responses to the identical visual sexual stimuli [304,305,306]. Additionally, two of the screening questionnaires have not been validated for addicted IP users, and the subjects were not screened for other manifestations of addiction or mood disorders.

Moreover, the conclusion listed in the abstract, “Implications for understanding hypersexuality as high desire, rather than disordered, are discussed” [303] (p. 1) seems out of place considering the study’s finding that P300 amplitude was negatively correlated with desire for sex with a partner. As explained in Hilton (2014), this finding “directly contradicts the interpretation of P300 as high desire” [307]. The Hilton analysis further suggests that the absence of a control group and the inability of EEG technology to discriminate between “high sexual desire” and “sexual compulsion” render the Steele et al. findings uninterpretable [307].

Finally, a significant finding of the paper (higher P300 amplitude to sexual images, relative to neutral pictures) is given minimal attention in the discussion section. This is unexpected, as a common finding with substance and internet addicts is an increased P300 amplitude relative to neutral stimuli when exposed to visual cues associated with their addiction [308]. In fact, Voon, et al. [262] devoted a section of their discussion analyzing this prior study’s P300 findings. Voon et al. provided the explanation of importance of P300 not provided in the Steele paper, particularly in regards to established addiction models, concluding,

“Thus, both dACC activity in the present CSB study and P300 activity reported in a previous CSB study[303] may reflect similar underlying processes of attentional capture. Similarly, both studies show a correlation between these measures with enhanced desire. Here we suggest that dACC activity correlates with desire, which may reflect an index of craving, but does not correlate with liking suggestive of on an incentive-salience model of addictions.” [262] (p. 7)

So while these authors [303] claimed that their study refuted the application of the addiction model to CSB, Voon et al. posited that these authors actually provided evidence supporting said model.


 

Critique of “Perceived Addiction to Internet Pornography and Psychological Distress: Examining Relationships Concurrently and Over Time” (2015)

Here are a few of the headlines birthed from this new study  by Joshua B. Grubbs, Nicholas Stauner, Julie J. Exline, Kenneth I. Pargament, and Matthew J. Lindberg (Grubbs et al.):

  • Watching Porn Is OK. Believing In Porn Addiction Is Not
  • Perceived Addiction To Porn Is More Harmful Than Porn Use Itself
  • Believing You Have Porn Addiction Is the Cause of Your Porn Problem, Study Finds

In essence the study’s main claim is reported as: “perceived addiction” to pornography is more related to psychological distress than are current daily hours of porn viewing. An excerpt from one of the above articles:

A new study in the journal Psychology of Addictive Behaviors has found that perceived addiction to pornography—that is, “feeling addicted to Internet pornography irrespective of actual pornography use”—is associated with forms of psychological distress including depression, anxiety, anger, and stress. Pornography use itself, the authors found, was “relatively unrelated to psychological distress.”

While the above quote contains inaccuracies which we will explore, let’s take it at face value. The reader is left with the impression that actual porn use is no big deal, but “believing” you are addicted to porn will cause you psychological distress. The take away: It’s perfectly healthy to use porn as long as you don’t believe you are addicted.

Grubbs et al.’s claim, and all the resulting headlines, are built upon this finding: Subjects’ current hours of porn use did not correlate strongly enough (in researchers’ subjective view) with scores on Grubbs’s own porn use questionnaire (the Cyber Pornography Use Inventory “CPUI”). To put it another way, if porn addiction really existed there “should” be, in the authors’ view, a one-to-one relationship between current hours of use and scores on the CPUI. Grubbs et al. also reported that “psychological distress” was related to scores on the CPUI, but not as strongly related to current hours of use.

Here’s the thing: There’s absolutely no scientific basis for declaring the CPUI a measure of “perceived addiction,” and yet that’s what all the inflated headlines rest on! The CPUI was never validated for “perceived” as opposed to “real” addiction.

For Grubbs et al.’s claims and interpretations to be valid, BOTH of the following must be true and supported by actual research:

1) The Cyber Pornography Use Inventory (CPUI) must assess “perceived addiction” to porn but not actual porn addiction.

  • Grubbs himself developed the 9-item CPUI as an inventory of online porn problems, not a “perceived addiction” test. Here he chose to use it in lieu of other validated addiction tests, precisely to create the illusion that he could measure “perceived addiction” rather than addiction. In fact, the CPUI measures the same signs, symptoms and indications of addiction as do standard addiction tests.
  • In the current study, Grubbs et al. use the phrase “perceived porn addiction” synonymously with subjects’ scores on the CPUI, without scientific justification.

2) Internet porn addiction must equal hours of porn viewing.

  • This is refuted by the scientific literature. Internet porn addiction ≠ hours of porn viewing.
  • Shockingly, the Grubbs et al. study reveals there actually was a strong correlation between hours of use and the CPUI! From p. 6 of the study:

“Additionally, average daily pornography use in hours was significantly and positively associated with depression, anxiety, and anger, as well as with perceived addiction.”

With respect to the first point, Grubbs developed his own porn addiction questionnaire (CPUI), and then later capriciously declared that it measures only “perceived addiction to porn” – without demonstrating any justification for his recharacterization. (Really!)

With respect to the second point, previous research teams have found that the variable “hours of use” is not correlated with cybersex addiction (or video-gaming addiction). That is, addiction is more accurately predicted by other variables than “hours of use.” As you can see from the above excerpt, Grubbs actually found a significant correlation between hours of use and psychological distress.

We’ll look at details about why Grubbs et al.’s assumptions are neither true nor supportable below, but here’s how the researchers could have described their actual findings without misleading the public:

“Study finds that porn addiction is strongly related to psychological distress and less strongly (but still) related to current hours of use.”

The cliff notes version: Addiction is related to psychological distress, and so are hours of use. So much for the attention-grabbing, misleading headlines spawned by the study.

The CPUI Assesses Porn Addiction, Not “Perceived Addiction”

This is really simple: Grubbs et al. relabeled Grubbs’s self-created porn addiction test as a “perceived porn addiction” test. However, his Cyber Pornography Use Inventory (CPUI) questionnaire is in fact similar to many other drug and behavioral addiction questionnaires. Like other addiction tests, the CPUI assesses behaviors and symptoms common to all addictions, such as: the inability to control use; compulsion to use, cravings to use, negative psychological, social and emotional effects; and preoccupation with using. In fact, only 1 of the 9 questions below even hints at “perceived addiction.” Yet we are told that a person’s total score for all 9 questions is synonymous with “perceived addiction” rather than addiction itself. Very misleading, very clever, and without any scientific basis. Agnotology fodder, anyone? (Agnotology is the study of culturally induced ignorance or doubt, particularly the publication of inaccurate or misleading scientific data.) Reality check: other researchers describe the CPUI as an actual porn addiction assessment questionnaire, and use it as such in their published studies:

  1. Questionnaires and scales for the evaluation of the online sexual activities: A review of 20 years of research (2014)
  2. Problematic cybersex: Conceptualization, assessment, and treatment (2015)
  3. Examining Correlates of Problematic Internet Pornography Use Among University Student (2016)

The last study above used a longer version of the Grubbs CPUI and an Internet pornography addiction questionnaire derived from the DSM-5 Internet video-gaming addiction criteria. The graphs show the same subjects’ scores on the two different porn addiction questionnaires:

——

No suprise. Very similar results and distribution for the Grubbs CPUI and the “actual” porn addiction questionaire. That’s because the CPUI is an addiction test, invalidating Grubbs’ attempt to relabel it as a “perceived addiction test.”

Note that decades of established addiction assessment tests for both chemical and behavioral addictions rely on similar questions to assess actual, not merely perceived, addiction. Let’s compare the CPUI to a commonly used addiction assessment tool known as the “4 Cs.” The CPUI questions that correlate with the four Cs are noted as well.

  • Compulsion to use (2, 3)
  • Inability to Control use (2, 3, maybe 4-6)
  • Cravings to use (3 especially, but 1-6 could be interpreted as cravings)
  • Continued use despite negative consequences (4-6, perhaps 7-9)

The Cyber Pornography Use Inventory (CPUI) – developed by Grubbs

COMPULSIVITY:

1. I believe I am addicted to Internet pornography.

2. I feel unable to stop my use of online pornography.

3. Even when I do not want to view pornography online, I feel drawn to it

ACCESS EFFORTS:

4. At times, I try to arrange my schedule so that I will be able to be alone in order to view pornography.

5. I have refused to go out with friends or attend certain social functions to have the opportunity to view pornography.

6. I have put off important priorities to view pornography.

EMOTIONAL DISTRESS:

7. I feel ashamed after viewing pornography online.

8. I feel depressed after viewing pornography online.

9. I feel sick after viewing pornography online.

Addiction experts rely on assessment tools like the 4Cs as indicating addiction because neuroscientists have correlated the symptoms those questions address with underlying addiction-related brain changes in decades of basic-research studies. As a medical matter, addiction is a disorder of the brain. It shows up in very specific behaviors, but can’t be assessed from superficial indications such as hours of use. See the public policy statement of the American Society of Addiction Medicine.

In short, the CPUI does a better job at actually identifying that which it purports to differentially diagnose against (actual addiction) than at identifying “perceived addiction,” as Grubbs claims it does.

Finally, we must ask why Grubbs found it necessary to create his own internet porn addiction test. Others, well established and thoroughly validated, were available to him. Might it be that as the author of the CPUI he assumes he has the power to re-label it as a “perceived addiction to porn” test in order to fool readers into believing that all porn addicts are misdiagnosing themselves? Sorry, if it walks like a duck and talks like a duck….

Bottom Line: The CPUI assesses actual porn addiction, not “perceived” porn addiction. Delete the word “perceived” from the study, and every article about it, and you are left with an unsurprising finding: psychological distress is related to perceived porn addiction.

Current Hours of Use Are Not Related To Porn Addiction

Grubbs et al.’s conclusion is largely based on a faulty premise: The extent of a porn addiction is best assessed simply by hours of internet porn viewing. As Grubbs et al. did not find a tight enough correlation (in their view) in their subjects, they concluded their subjects merely had “perceived addiction” instead. Two huge holes in the story render Grubbs et al.’ claim highly suspect.

As described earlier, the first gaping hole is that Grubbs et al. actually found a pretty strong correlation between hours of use and the CPUI! From p. 6 of the study:

“Additionally, average daily pornography use in hours was significantly and positively associated with depression, anxiety, and anger, as well as with perceived addiction.”

Stop the presses! This excerpt directly contradicts all the headlines, which claim that pornography use was NOT strongly correlated with psychological distress or “perceived addiction.” Again, whenever you see the phrase “perceived addiction” it actually denotes the subjects’ total score on the CPUI (which is a porn addiction test).

To say all of this another way: Both psychological distress and CPUI scores were significantly correlated with hours of use. Does any journalist or blogger ever read an actual study?

The second hole in this study’s underpinnings, which you could drive a truck through, is that research on internet porn and videogame use (1, 2, 3, 4, 5, 6, 7, 8) has established that neither addiction correlates with hours of use. The variable ‘hours of use’ is an unreliable measure of addiction, and established addiction assessment tools evaluate addiction using multiple other factors (such as those listed in the CPUI). The following cybersex addiction studies, which Grubbs omitted, report little relationship between hours and indications of addiction:

1) Watching Pornographic Pictures on the Internet: Role of Sexual Arousal Ratings and Psychological-Psychiatric Symptoms for Using Internet Sex Sites Excessively (2011)

“Results indicate that self-reported problems in daily life linked to online sexual activities were predicted by subjective sexual arousal ratings of the pornographic material, global severity of psychological symptoms, and the number of sex applications used when being on Internet sex sites in daily life, while the time spent on Internet sex sites (minutes per day) did not significantly contribute to explanation of variance in Internet Addiction Test sex score (IATsex). We see some parallels between cognitive and brain mechanisms potentially contributing to the maintenance of excessive cybersex and those described for individuals with substance dependence.”

2) Sexual Excitability and Dysfunctional Coping Determine Cybersex Addiction in Homosexual Males (2015)

Recent findings have demonstrated an association between CyberSex Addiction (CA) severity and indicators of sexual excitability, and that coping by sexual behaviors mediated the relationship between sexual excitability and CA symptoms. Results showed strong correlations between CA symptoms and indicators of sexual arousal and sexual excitability, coping by sexual behaviors, and psychological symptoms. CyberSex Addiction was not associated with offline sexual behaviors and weekly cybersex use time.

3) What Matters: Quantity or Quality of Pornography Use? Psychological and Behavioral Factors of Seeking Treatment for Problematic Pornography Use (2016)

According to our best knowledge this study is the first direct examination of associations between the frequency of porn use and actual behavior of treatment-seeking for problematic porn use (measured as visiting the psychologist, psychiatrist or sexologist for this purpose). Our results indicate that the future studies, and treatment, in this field should focus more on impact of porn use on the life of an individual (quality) rather than its mere frequency (quantity), as the negative symptoms associated with porn use (rather than porn use frequency ) are the most significant predictor of treatment-seeking behavior.

Relation between PU and negative symptoms was significant and mediated by self-reported, subjective religiosity (weak, partial mediation) among non-treatment seekers. Among treatment-seekers religiosity is not related to negative symptoms.

4) Examining Correlates of Problematic Internet Pornography Use Among University Student (2016)

Higher scores on addictive measures of internet porn use were correlated with daily or more frequent use of internet porn. However, the results indicate that there was no direct link between the amount and frequency of an individual’s pornography use and struggles with anxiety, depression, and life and relationship satisfaction. Significant correlations to high internet porn addiction scores included an early first exposure to internet porn, addiction to video games, and being male. While some positive effects of internet porn use have been documented in previous literature our results do not indicate that psychosocial functioning improves with moderate or casual use of  internet porn.

Thus, from the outset this study and its assertions collapse because its conclusions rest upon equating current hours of use with the level of addiction/problems/distress reported by subjects as a valid measure of addiction.

Why don’t addiction specialists rely on hours of use? Imagine trying to assess addictions by simply asking, “How many hours do you currently spend eating (food addiction)?” or “How many hours do you spend gambling (gambling addition)?” or “How many hours do you spend drinking (alcoholism)?” To demonstrate how problematic hours of use would be, consider alcohol as an example:

  1. A 45-year old Italian man has a tradition of drinking 2 glasses of wine every night with dinner. His meal is with his extended family and it takes 3 hours to complete (lots of yakking). So he drinks for 3 hours a night, 21 hour per week.
  2. A 25 year-old factory worker only drinks on the weekends, but binge drinks both Friday and Saturday night to the point of passing out or getting sick. He regrets his actions and wants to stop, but can’t, drives drunk, gets in fights, is sexually aggressive, etc. He then spends all of Sunday recovering, and feels like crap until Wednesday. However, he spent only 8 hours a week drinking.

Which drinker has a problem? This is why “current hours of use” alone cannot inform us as to who is addicted and who is not.

Finally, we must ask why Grubbs et al. chose to create the CPUI when other, thoroughly validated addiction tests were readily available.

Bottom line: The study’s claims depend upon “current hours of use” being a valid criterion for true addiction. They are not. Moreover, once you get past the abstract, the full study reveals that “current hours of use” is actually related to both psychological distress and CPUI scores!

“Current Hours of Use” Omits Many Variables

A secondary methodological problem is that Grubbs et al. assessed porn use by asking subjects about their “current hours of porn use.” That question is troublingly vague. Over what period? One subject may be thinking “How much did I use yesterday?” another “over the last week?” or “on average since I decided to quit viewing because of unwanted effects?” The result is data that are not comparable can’t be analyzed for the purpose of drawing reliable conclusions.

More important, the “current porn use” question, on which the study’s conclusions rest, fails to ask about key variables of porn use: age use began, years of use, whether the user escalated to novel genres of porn or developed unexpected porn fetishes, the ratio of ejaculation with porn to ejaculation without it, amount of sex with a real partner, and so forth. Those questions would likely enlighten us more about who really has a problem with porn use than simply “current hours of use.”

Deeper Analysis: Addiction Correlates With Addiction, not Emotional Distress

We have established that the CPUI is in no way a “perceived addiction” test. Instead, the CPUI is an actual porn addiction test assessing 3 categories of compulsive pornography use:

  1. Compulsion to use & Inability to control use
  2. Efforts to use (negative consequences)
  3. Emotional Distress after using (shame, depression, feel sick)

What do the conspicuous headlines claim and the authors assert? That psychological distress about one’s porn addiction is the real problem, rather than the addiction itself. If that were true, we would expect “porn addicts” to score especially high in Emotional Distress category of the CPUI. Not so. From p. 9 of the study:

“In all SEM analyses, emotional distress consistently had the weakest loadings on the latent factor of perceived addiction…… Such a consistent pattern across studies strongly indicates that emotional distress regarding use is not the primary driving factor in the link between perceived addiction and psychological distress.”

Translation: Scores on the CPUI Emotional Distress section were the least related to scores on separate Psychological Distress questionnaires (which measure such things as stress, depression and anger). Put simply, the psychological distress of porn addiction does NOT arise from shame or guilt. Instead, psychological distress arises from the inability to control use despite negative consequences, as measured by CPUI sections 1 and 2. From pg 9 of the study:

By contrast, perceived compulsivity—the direct acknowledgment of feelings of addiction to pornography—was consistently the primary factor driving perceived addiction. Additionally, access efforts [negative consequences] loaded more strongly on perceived addiction than emotional distress regarding use.

Translation: The inability to control use (questions 1-3) coupled with negative consequences (questions 4-6), was more strongly related to “psychological distress.” Put simply, guilt and shame weren’t such a big deal, but inability to control use, the compulsion to watch porn when subjects don’t want to, refusing to go out with friends or attend social functions in order to view pornography, and putting off important priorities to view pornography, are what really upset subjects.

This is a very different reality than readers got from either the misleading headlines or study abstract.

Grubbs Introduction Distorts Current State of the Research

In the introduction and discussion sections Grubbs et al. toss aside decades of neuropsychological and other addiction research (and related assessment tools) to attempt to persuade readers that the scientific literature shows that internet porn addiction doesn’t exist (and that therefore that all evidence of porn addiction must be “perceived,” not real). A new review shows just how farfetched this contention is. See Neuroscience of Internet Pornography Addiction: A Review and Update, which aligns decades of addiction neuroscience research with recent neuroscience and neuropsych studies on porn users themselves. It concludes (logically and scientifically) that internet pornography addiction is quite real, and in fact a subset of internet addiction (based on more than 100 brain studies, as well as hundreds of other relevant studies).

In their opening paragraphs, Grubbs et al. demonstrate their profound bias by basing their claim about the nonexistence of internet porn addiction on the papers of two self-proclaimed “internet porn addiction debunkers”: David Ley, author of The Myth of Sex Addiction, and former UCLA researcher Nicole Prause, whose work has been formally criticized in the medical literature for weak methodology and unsupported conclusions.

For example, Grubbs et al. rely on a one-sided paper by Ley, Prause and their colleague Peter Finn, which claimed to be a review (that is, an impartial analysis of the existing literature). However, it omitted or misrepresented nearly every study that found negative effects of internet porn use, while also ignoring the dozens of recent internet addiction studies demonstrating addiction-related structural brain changes in internet addicts’ brains. (Line-by-line critique can be found here.)

Equaling telling is Grubbs et al.’s omission of every brain scan and neuropsychological study that found evidence in support of the porn addiction model (over a dozen collected here). Instead of hard science from the many omitted studies, the reader is given an overreaching conclusion:

In sum, there is a fair amount of evidence suggesting that many individuals feel addicted to Internet pornography, even in the absence of a clinically verified diagnosis to subsume such a disorder.

Finally, the only neurological study cited by Grubbs as refuting porn addiction (Steele et al.) actually supports the porn addiction model. Steele et al. reported higher EEG readings (P300) when subjects were exposed to porn photos. Studies consistently show that an elevated P300 occurs when addicts are exposed to cues (such as images) related to their addiction. In addition, the study reported that greater cue-reactivity to porn correlated with less desire for partnered sex. As neither result matched the headlines, Grubbs perpetuated the flawed conclusions of the original authors (the “debunkers of porn addiction”).

Conclusion

Given its unsupported conclusions and biased claims about the non-existence of porn addiction, it seems likely that Grubbs et al. designed this study to meet a specific agenda – to re-label porn addiction as “perceived addiction” and persuade readers that porn use is harmless and they need only worry about believing it can harm. Agnotology mission accomplished!

This saying comes to mind: What the abstract giveth, the full study taketh away. The headlines and claims spawned by Grubbs et al. are not even supported by the underlying study. Again,

  1. Both internet gaming and internet porn addiction studies have already established that hours of use do not correlate well with addiction. This fact alone guts this entire study and its misleading headlines.
  2. The Cyber Pornography Use Inventory (CPUI) assesses the signs, symptoms and behaviors of an addiction, not “perceived addiction”. Don’t be fooled; the CPUI was never validated for “perceived” as opposed to “real” addiction.
  3. Grubbs et al.’s study reveals that the “average daily pornography use in hours was significantly and positively associated with depression, anxiety, and anger, as well as with perceived addiction (the CPUI).” This directly contradicts the press claims that say hours of use were not related to CPUI scores or psychological distress.

Any one of the above dismantles this study, but all three mean that this study should be ignored as the work of agnotology that it is.

Research such as this contributes to the ongoing campaign to confuse the public about the reality of internet porn addiction. For example, one frequently sees attempts by Grubbs’s colleagues to conflate internet porn addiction with sex addiction and then sweep both away as “unsupported,” even though the neuropsychological and medical evidence demonstrating internet addiction is already overwhelming. Another tactic is to conflate internet porn addiction with “Hypersexual disorder” and then claim that the DSM-5, by rejecting the latter, has rejected the former. In fact, internet porn addiction was never formally proposed, or evaluated, for inclusion in the DSM-5. It’s time it was, given the mounting evidence that both internet addiction and its subtype internet porn addiction are true addictions.

In the same tradition, Grubbs et al., without justification, now attempt to sweep aside decades of addiction research and assessment tests developed for all kinds of addictions, and substitute their own worldview (that internet porn addiction doesn’t exist and should be recast as “perceived addiction”). Should society and its headline-hungry journalists allow this? You be the judge.

Current List of Brain Studies on Porn Users

Listed below are all the “brain” studies on porn users currently published (or in the press). These study results are consistent with 220+ Internet addiction brain studies, some of which also include internet porn use.

In short, there’s ample (and growing) peer-reviewed scientific support for the addiction model. All support the premise that internet porn use can cause addiction-related brain changes, as do 12 recent neuroscience-based reviews of the literature (no studies have yet to falsify the porn addiction model):

  1. Sex Addiction as a Disease: Evidence for Assessment, Diagnosis, and Response to Critics (2015), which provides a chart that takes on specific criticisms and offers citations that counter them.
  2. For a thorough review of the neuroscience literature related to Internet addiction subtypes, with special focus on internet porn addiction, see – Neuroscience of Internet Pornography Addiction: A Review and Update (2015). Excerpt: “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.” The review also critiques two recent headline-grabbing EEG studies which purport to have “debunked” porn addiction.
  3. Cybersex Addiction (2015) – Excerpts: “In recent articles, cybersex addiction is considered a specific type of Internet addiction. Some current studies investigated parallels between cybersex addiction and other behavioral addictions, such as Internet Gaming Disorder. Cue-reactivity and craving are considered to play a major role in cybersex addiction. Neuroimaging studies support the assumption of meaningful commonalities between cybersex addiction and other behavioral addictions as well as substance dependency.”
  4. Neurobiology of Compulsive Sexual Behavior: Emerging Science (2016) – Excerpt: “Given some similarities between CSB and drug addictions, interventions effective for addictions may hold promise for CSB, thus providing insight into future research directions to investigate this possibility directly.”
  5. Should compulsive sexual behavior be considered an addiction? (2016) – Excerpt: “Overlapping features exist between CSB and substance use disorders. Common neurotransmitter systems may contribute to CSB and substance use disorders, and recent neuroimaging studies highlight similarities relating to craving and attentional biases. Similar pharmacological and psychotherapeutic treatments may be applicable to CSB and substance addictions, although considerable gaps in knowledge currently exist.
  6. Compulsive Sexual Behaviour as a Behavioural Addiction: The Impact of the Internet and Other Issues (2016) Excerpts: “more emphasis is needed on the characteristics of the internet as these may facilitate problematic sexual behaviour.” and “clinical evidence from those who help and treat such individuals should be given greater credence by the psychiatric community.”
  7. Neurobiological Basis of Hypersexuality (2016) – Excerpt: “Taken together, the evidence seems to imply that alterations in the frontal lobe, amygdala, hippocampus, hypothalamus, septum, and brain regions that process reward play a prominent role in the emergence of hypersexuality. Genetic studies and neuropharmacological treatment approaches point at an involvement of the dopaminergic system.
  8. Searching for clarity in muddy water: future considerations for classifying compulsive sexual behavior as an addiction (2016) – Excerpts: “We recently considered evidence for classifying compulsive sexual behavior (CSB) as a non-substance (behavioral) addiction. Our review found that CSB shared clinical, neurobiological and phenomenological parallels with substance-use disorders. Although the American Psychiatric Association rejected hypersexual disorder from DSM-5, a diagnosis of CSB (excessive sex drive) can be made using ICD-10. CSB is also being considered by ICD-11.”
  9. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports (2016)A review of the literature related to porn-induced sexual problems. Involving US Navy doctors, the review provides the latest data revealing a tremendous rise in youthful sexual problems. It also reviews the neurological studies related to porn addiction and sexual conditioning. The doctors provide 3 clinical reports of men who developed porn-induced sexual dysfunctions.
  10. Integrating psychological and neurobiological considerations regarding the development and maintenance of specific Internet-use disorders: An Interaction of Person-Affect-Cognition-Execution model (2016) – A review of the mechanisms underlying the development and maintenance of specific Internet-use disorders, including “Internet-pornography-viewing disorder“. The authors suggest that pornography addiction (and cybersex addiction) be classified as internet use disorders and placed with other behavioral addictions under substance-use disorders as addictive behaviors.
  11. Sexual Addiction chapter from Neurobiology of Addictions, Oxford Press (2016) – Excerpt: We review the neurobiological basis for addiction, including natural or process addiction, and then discuss how this relates to our current understanding of sexuality as a natural reward that can become functionally “unmanageable” in an individual’s life.
  12. Neuroscientific Approaches to Online Pornography Addiction (2017) – Excerpt: In the last two decades, several studies with neuroscientific approaches, especially functional magnetic resonance imaging (fMRI), were conducted to explore the neural correlates of watching pornography under experimental conditions and the neural correlates of excessive pornography use. Given previous results, excessive pornography consumption can be connected to already known neurobiological mechanisms underlying the development of substance-related addictions.

Recent studies assessing brain structure & functioning of Internet porn users and sex addicts (click on name to be taken to original study):

  1. Brain Structure and Functional Connectivity Associated With Pornography Consumption: The Brain on Porn (2014) – This Max Planck Institute fMRI study found less gray matter in the reward system (dorsal striatum) correlating with the amount of porn consumed. It also found that more porn use correlated with less reward circuit activation while briefly viewing sexual photos. Researchers believed their findings indicated desensitization, and possibly tolerance, which is the need for greater stimulation to achieve the same high. The study also reported that more porn viewing was linked to poorer connections between the reward circuit and prefrontal cortex – a common addiction-related brain change.
  2. Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours (2014) – The first in a series of Cambridge University studies found the same brain activity as seen in drug addicts and alcoholics. It also found that porn addicts (CSB subjects) fit the accepted addiction model of wanting “it” more, but not liking “it” more. The researchers also reported that 60% of subjects (average age: 25) had difficulty achieving erections/arousal with real partners, yet could achieve erections with porn.
  3. Enhanced Attentional Bias towards Sexually Explicit Cues in Individuals with and without Compulsive Sexual Behaviours (2014) – The second Cambridge University study. An excerpt: “Our findings of enhanced attentional bias… suggest possible overlaps with enhanced attentional bias observed in studies of drug cues in disorders of addictions. These findings converge with recent findings of neural reactivity to sexually explicit cues in [porn addicts] in a network similar to that implicated in drug-cue-reactivity studies and provide support for incentive motivation theories of addiction underlying the aberrant response to sexual cues in [porn addicts].
  4. Novelty, Conditioning and Attentional Bias to Sexual Rewards (2015) – Compared to controls porn addicts preferred sexual novelty and conditioned cues associated porn. However, the brains of porn addicts habituated faster to sexual images. Since novelty preference wasn’t pre-existing, porn addiction drives novelty-seeking in an attempt to overcome habituation and desensitization.
  5. Neural Substrates of Sexual Desire in Individuals with Problematic Hypersexual Behavior (2015) – This Korean fMRI study replicates other brain studies on porn users. Like the Cambridge University studies it found cue-induced brain activation patterns in sex addicts which mirrored the patterns of drug addicts. In line with several German studies it found alterations in the prefrontal cortex which match the changes observed in drug addicts.
  6. Sexual Desire, not Hypersexuality, is Related to Neurophysiological Responses Elicited by Sexual Images (2013) – This EEG study was touted in the media as evidence against the existence of porn/sex addiction. Not so. This SPAN Lab study, like #7 below, actually lends support to the existence of both porn addiction and porn use downregulating sexual desire. How so? The study reported higher EEG readings (P300) when subjects were briefly exposed to pornographic photos. Studies consistently show that an elevated P300 occurs when addicts are exposed to cues (such as images) related to their addiction. However, due to methodological flaws the findings are uninterpretable: 1) subjects were heterogeneous (males, females, non-heterosexuals); 2) subjects were not screened for mental disorders or addictions; 3) the study had no control group for comparison; 4) the questionnaires were not validated for porn addiction. In line with the Cambridge University brain scan studies, this EEG study also reported greater cue-reactivity to porn correlating with less desire for partnered sex. To put another way – individuals with greater brain activation to porn would rather masturbate to porn than have sex with a real person. Shockingly, study spokesman Nicole Prause claimed that porn users merely had “high libido”, yet the results of the study say something quite different. Four peer-reviewed papers expose the truth: 1, 2, 3, 4, 5. For more read an extensive critique here.
  7. Modulation of Late Positive Potentials by Sexual Images in Problem Users and Controls Inconsistent with “Porn Addiction” (2015) – Another SPAN Lab EEG study comparing the 2013 subjects from the above study to an actual control group. The results: compared to controls porn addicts had less response to photos of vanilla porn. Ignoring all the other studies on this page, lead author Nicole Prause, boldly claims that her results “debunked porn addiction”. What legitimate scientist would claim that their lone anomalous study has debunked an entire field of study?  In reality, the findings of Prause et al. 2015 align perfectly with Kühn & Gallinat (2014), which found that more porn use correlated with less brain activation in response to pictures of vanilla porn. Prause’s findings also align with Banca et al. 2015 which is #4 in this list. Moreover, another EEG study found that greater porn use in women correlated with less brain activation to porn. Lower EEG readings mean that subjects are paying less attention to the pictures. Put simply, frequent porn users were desensitized to static images of vanilla porn. They were bored. Read an extensive critique here. Six peer-reviewed papers agree with this critique of the study – 1, 2, 3, 4, 5, 6.
  8. HPA axis dysregulation in men with hypersexual disorder (2015) – A study with 67 male sex addicts and 39 age-matched controls. The Hypothalamus-Pituitary-Adrenal (HPA) axis is the central player in our stress response. Addictions alter the brain’s stress circuits leading to a dysfunctional HPA axis. This study on sex addicts (hypersexuals) found altered stress responses that mirror drug addiction.
  9. The Role of Neuroinflammation in the Pathophysiology of Hypersexual Disorder (2016) – This study reported higher levels of circulating Tumor Necrosis Factor (TNF) in sex addicts when compared to healthy controls. Elevated levels of TNF (a marker of inflammation) have also been found in substance abusers and drug addicted animals (alcohol, heroin, meth). There were strong correlations between TNF levels and rating scales measuring hypersexuality.
  10. Methylation of HPA Axis Related Genes in Men With Hypersexual Disorder (2017) – This is a follow-up of #8 above which found that sex addicts have dysfunctional stress systems – a key neuro-endocrine change caused by addiction. The current study found epigenetic changes on genes central to the human stress response and closely associated with addiction. With epigenetic changes, the DNA sequence isn’t altered (as happens with a mutation). Instead, the gene is tagged and its expression is turned up or down (short video explaining epigenetics). The epigenetic changes reported in this study resulted in altered CRF gene activity. CRF is a neurotransmitter and hormone that drives addictive behaviors such as cravings, and is a major player in many of the withdrawal symptoms experienced in connection with substance and behavioral addictions, including porn addiction.
  11. Compulsive sexual behavior: Prefrontal and limbic volume and interactions (2016) – Compared to healthy controls CSB subjects (porn addicts) had increased left amygdala volume and reduced functional connectivity between the amygdala and dorsolateral prefrontal cortex DLPFC. Reduced functional connectivity between the amygdala and the prefrontal cortex aligns with substance addictions. It is thought that poorer connectivity diminishes the prefrontal cortex’s control over a user’s impulse to engage in the addictive behavior. This study suggests that drug toxicity may lead to less gray matter and thus reduced amygdala volume in drug addicts. The amygdala is consistently active during porn viewing, especially during initial exposure to a sexual cue. Perhaps the constant sexual novelty and searching and seeking leads to a unique effect on the amygdala in compulsive porn users. Alternatively, years of porn addiction and severe negative consequences is very stressful – and chronic social stress is related to increased amygdala volume. Study #8 above found that “sex addicts” have a overactive stress system. Could the chronic stress related to porn/sex addiction, along with factors that make sex unique, lead to greater amygdala volume?
  12. Ventral striatum activity when watching preferred pornographic pictures is correlated with symptoms of Internet pornography addiction (2016) – Finding #1: Reward center activity (ventral striatum) was higher for preferred pornographic pictures. Finding #2: Ventral striatum reactivity correlated with the internet sex addiction score. Both findings indicate sensitization and align with the addiction model. The authors state that the “Neural basis of Internet pornography addiction is comparable to other addictions.
  13. Altered Appetitive Conditioning and Neural Connectivity in Subjects With Compulsive Sexual Behavior (2016) – A German fMRI study replicating two major findings from Voon et al., 2014 and Kuhn & Gallinat 2014. Compared to controls compulsive porn users had 1) greater conditioned cue-induced activity in the amygdala, while having 2) decreased coupling between the ventral striatum and the prefrontal cortex. Number 1 indicates sensitization, while number 2 indicates hypofronatlity. In addition, 3 of the 20 compulsive porn users suffered from “orgasmic-erection disorder”.
  14. Compulsivity across the pathological misuse of drug and non-drug rewards (2016) – A Cambridge University study comparing aspects of compulsivity in alcoholics, binge-eaters, video game addicts and porn addicts (CSB). Excerpts: CSB subjects were faster to learning from rewards in the acquisition phase compared to healthy volunteers and were more likely to perseverate or stay after either a loss or a win in the Reward condition. These findings converge with our previous findings of enhanced preference for stimuli conditioned to either sexual or monetary outcomes, overall suggesting enhanced sensitivity to rewards (Banca et al., 2016).
  15. Can pornography be addictive? An fMRI study of men seeking treatment for problematic pornography use (2017) – Excerpts: Men with and without problematic porn sue (PPU) differed in brain reactions to cues predicting erotic pictures, but not in reactions to erotic pictures themselves, consistent with the incentive salience theory of addictions. This brain activation was accompanied by increased behavioral motivation to view erotic images (higher ‘wanting’). Ventral striatal reactivity for cues predicting erotic pictures was significantly related to the severity of PPU, amount of pornography use per week and number of weekly masturbations. Our findings suggest that like in substance-use and gambling disorders the neural and behavioral mechanisms linked to anticipatory processing of cues relate importantly to clinically relevant features of PPU. These findings suggest that PPU may represent a behavioral addiction and that interventions helpful in targeting behavioral and substance addictions warrant consideration for adaptation and use in helping men with PPU.
  16. Conscious and Non-Conscious Measures of Emotion: Do They Vary with Frequency of Pornography Use? (2017) – Study assessed porn user’s responses (EEG readings & Startle Response) to various emotion-inducing images – including erotica. The study found several neurological  differences between low frequency porn users and high frequency porn users. An excerpt: Findings suggest that increased pornography use appears to have an influence on the brain’s non-conscious responses to emotion-inducing stimuli which was not shown by explicit self-report.
  17. Preliminary investigation of the impulsive and neuroanatomical characteristics of compulsive sexual behavior (2009) – Primarily sex addicts. Study reports more impulsive behavior in a Go-NoGo task in sex addicts (hypersexuals) compared to control participants. Brain scans revealed that sex addicts had greater disorganized prefrontal cortex white matter. This finding is consistent with “hypofrontality”, a hallmark of addiction.

Together these brain studies found:

  1. The 3 major addiction-related brain changes: sensitization, desensitization, and hypofrontality.
  2. More porn use correlated with less grey matter in the reward circuit (dorsal striatum).
  3. More porn use correlated with less reward circuit activation when viewing sexual images.
  4. More porn use correlated with disrupted neural connections between the reward circuit and prefrontal cortex.
  5. Addicts had greater prefrontal activity to sexual cues, but less brain activity to normal stimuli (matches drug addiction).
  6. Porn addicts have greater preference for sexual novelty yet their brains habituated faster to sexual images. Not pre-existing.
  7. 60% of compulsive porn addicted subjects in one study experienced ED or low libido with partners, but not with porn: all stated that internet porn use caused their ED/low libido.
  8. Enhanced attentional bias comparable to drug users. Indicates sensitization (a product of DeltaFosb).
  9. Greater wanting & craving for porn, but not greater liking. This aligns with the accepted model of addiction – incentive sensitization.
  10. The younger the porn users the greater the cue-induced reactivity in the reward center.
  11. Higher EEG (P300) readings when porn users were exposed to porn cues (which occurs in other addictions).
  12. Less desire for sex with a person correlating with greater cue-reactivity to porn images.
  13. More porn use related with lower LPP amplitude when viewing sexual photos: indicates habituation or desensitization.
  14. Dysfunctional HPA axis which reflects altered brain stress circuits (and greater amygdala volume, which is associated with chronic social stress).
  15. Epigenetic changes on genes central to the human stress response and closely associated with addiction.
  16. Higher levels of Tumor Necrosis Factor (TNF) – which also occurs in drug abuse and addiction.

Neuro-Psychological Studies on Porn Users (with excerpts):

  1. Self-reported differences on measures of executive function and hypersexual behavior in a patient and community sample of men (2010) Patients seeking help for hypersexual behavior often exhibit features of impulsivity, cognitive rigidity, poor judgment, deficits in emotion regulation, and excessive preoccupation with sex. Some of these characteristics are also common among patients presenting with neurological pathology associated with executive dysfunction. These observations led to the current investigation of differences between a group of hypersexual patients (n = 87) and a non-hypersexual community sample (n = 92) of men using the Behavior Rating Inventory of Executive Function-Adult Version  Hypersexual behavior was positively correlated with global indices of executive dysfunction and several subscales of the BRIEF-A. These findings provide preliminary evidence supporting the hypothesis that executive dysfunction may be implicated in hypersexual behavior.
  2. Watching Pornographic Pictures on the Internet: Role of Sexual Arousal Ratings and Psychological-Psychiatric Symptoms for Using Internet Sex Sites Excessively (2011) Results indicate that self-reported problems in daily life linked to online sexual activities were predicted by subjective sexual arousal ratings of the pornographic material, global severity of psychological symptoms, and the number of sex applications used when being on Internet sex sites in daily life, while the time spent on Internet sex sites (minutes per day) did not significantly contribute to explanation of variance in IATsex score. We see some parallels between cognitive and brain mechanisms potentially contributing to the maintenance of excessive cybersex and those described for individuals with substance dependence
  3. Pornographic picture processing interferes with working memory performance (2013)Some individuals report problems during and after Internet sex engagement, such as missing sleep and forgetting appointments, which are associated with negative life consequences. One mechanism potentially leading to these kinds of problems is that sexual arousal during Internet sex might interfere with working memory (WM) capacity, resulting in a neglect of relevant environmental information and therefore disadvantageous decision making. Results revealed worse WM performance in the pornographic picture condition of the 4-back task compared with the three remaining picture conditions. Findings are discussed with respect to Internet addiction because WM interference by addiction-related cues is well known from substance dependencies.
  4. Sexual Picture Processing Interferes with Decision-Making Under Ambiguity (2013) Decision-making performance was worse when sexual pictures were associated with disadvantageous card decks compared to performance when the sexual pictures were linked to the advantageous decks. Subjective sexual arousal moderated the relationship between task condition and decision-making performance. This study emphasized that sexual arousal interfered with decision-making, which may explain why some individuals experience negative consequences in the context of cybersex use.
  5. Cybersex addiction: Experienced sexual arousal when watching pornography and not real-life sexual contacts makes the difference (2013)The results show that indicators of sexual arousal and craving to Internet pornographic cues predicted tendencies towards cybersex addiction in the first study. Moreover, it was shown that problematic cybersex users report greater sexual arousal and craving reactions resulting from pornographic cue presentation. In both studies, the number and the quality with real-life sexual contacts were not associated to cybersex addiction. The results support the gratification hypothesis, which assumes reinforcement, learning mechanisms, and craving to be relevant processes in the development and maintenance of cybersex addiction. Poor or unsatisfying sexual real life contacts cannot sufficiently explain cybersex addiction.
  6. Empirical Evidence and Theoretical Considerations on Factors Contributing to Cybersex Addiction From a Cognitive-Behavioral View (2014) Dysfunctional use of sex mediated the relationship of sexual excitability with cybersex addiction (CA). The results of the study show that there are factors of vulnerability to CA and provide evidence for the role of sexual gratification and dysfunctional coping in the development of cybersex addiction.
  7. Cybersex addiction in heterosexual female users of internet pornography can be explained by gratification hypothesis (2014) Results indicated that Internet porn users rated pornographic pictures as more arousing and reported greater craving due to pornographic picture presentation compared with non-users. Moreover, craving, sexual arousal rating of pictures, sensitivity to sexual excitation, problematic sexual behavior, and severity of psychological symptoms predicted tendencies toward cybersex addiction in porn users. Being in a relationship, number of sexual contacts, satisfaction with sexual contacts, and use of interactive cybersex were not associated with cybersex addiction.
  8. Prefrontal control and internet addiction: a theoretical model and review of neuropsychological and neuroimaging findings (2015)Consistent with this, results from functional neuroimaging and other neuropsychological studies demonstrate that cue-reactivity, craving, and decision making are important concepts for understanding Internet addiction. The findings on reductions in executive control are consistent with other behavioral addictions, such as pathological gambling. They also emphasize the classification of the phenomenon as an addiction, because there are also several similarities with findings in substance dependency.  Moreover, the results of the current study are comparable to findings from substance dependency research and emphasize analogies between cybersex addiction and substance dependencies or other behavioral addictions.
  9. Implicit associations in cybersex addiction: Adaption of an Implicit Association Test with pornographic pictures. (2015) Recent studies show similarities between cybersex addiction and substance dependencies and argue to classify cybersex addiction as a behavioral addiction. In substance dependency, implicit associations are known to play a crucial role. Results show positive relationships between implicit associations of pornographic pictures with positive emotions and tendencies towards cybersex addiction, problematic sexual behavior, sensitivity towards sexual excitation as well as subjective craving.
  10. Symptoms of cybersex addiction can be linked to both approaching and avoiding pornographic stimuli: results from an analog sample of regular cybersex users (2015) Results showed that individuals with tendencies toward cybersex addiction tended to either approach or avoid pornographic stimuli. Additionally, moderated regression analyses revealed that individuals with high sexual excitation and problematic sexual behavior who showed high approach/avoidance tendencies, reported higher symptoms of cybersex addiction. Analogous to substance dependencies, results suggest that both approach and avoidance tendencies might play a role in cybersex addiction.
  11. Getting stuck with pornography? Overuse or neglect of cybersex cues in a multitasking situation is related to symptoms of cybersex addiction (2015)Individuals with tendencies towards cybersex addiction seem to have either an inclination to avoid or to approach the pornographic material, as discussed in motivational models of addiction. The results of the current study point towards a role of executive control functions, i.e. functions mediated by the prefrontal cortex, for the development and maintenance of problematic cybersex use (as suggested by Brand et al., 2014). Particularly a reduced ability to monitor consumption and to switch between pornographic material and other contents in a goal adequate manner may be one mechanism in the development and maintenance of cybersex addiction.
  12. Trading Later Rewards for Current Pleasure: Pornography Consumption and Delay Discounting (2015)Study 1: 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:  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. It is therefore important to treat pornography as a unique stimulus in reward, impulsivity, and addiction studies and to apply this accordingly in individual as well as relational treatment.
  13. Sexual Excitability and Dysfunctional Coping Determine Cybersex Addiction in Homosexual Males (2015)Recent findings have demonstrated an association between CyberSex Addiction (CA) severity and indicators of sexual excitability, and that coping by sexual behaviors mediated the relationship between sexual excitability and CA symptoms. The aim of this study was to test this mediation in a sample of homosexual males.  Questionnaires assessed symptoms of CA, sensitivity to sexual excitation, pornography use motivation, problematic sexual behavior, psychological symptoms, and sexual behaviors in real life and online. Moreover, participants viewed pornographic videos and indicated their sexual arousal before and after the video presentation. Results showed strong correlations between CA symptoms and indicators of sexual arousal and sexual excitability, coping by sexual behaviors, and psychological symptoms. CA was not associated with offline sexual behaviors and weekly cybersex use time. Coping by sexual behaviors partially mediated the relationship between sexual excitability and CA. The results are comparable with those reported for heterosexual males and females in previous studies and are discussed against the background of theoretical assumptions of CA, which highlight the role of positive and negative reinforcement due to cybersex use.
  14. Subjective Craving for Pornography and Associative Learning Predict Tendencies Towards Cybersex Addiction in a Sample of Regular Cybersex Users (2016)There is no consensus regarding the diagnostic criteria of cybersex addiction. Some approaches postulate similarities to substance dependencies, for which associative learning is a crucial mechanism. In this study, 86 heterosexual males completed a Standard Pavlovian to Instrumental Transfer Task modified with pornographic pictures to investigate associative learning in cybersex addiction. Additionally, subjective craving due to watching pornographic pictures and tendencies towards cybersex addiction were assessed. Results showed an effect of subjective craving on tendencies towards cybersex addiction, moderated by associative learning. Overall, these findings point towards a crucial role of associative learning for the development of cybersex addiction, while providing further empirical evidence for similarities between substance dependencies and cybersex addiction
  15. Exploring the Relationship between Sexual Compulsivity and Attentional Bias to Sex-Related Words in a Cohort of Sexually Active Individuals (2016) – This study replicates the findings of this 2014 Cambridge University study that compared the attentional bias of porn addicts to healthy controls. The new study differs: rather than comparing porn addicts to controls, the new study correlated scores on a sex addiction questionnaire to the results of a task assessing attentional bias (explanation of attentional bias). The study described two key results: 1) Higher sexual compulsivity scores correlated with greater interference (increased distraction) during the attentional bias task. This aligns with substance abuse studies. 2) Among those scoring high on sexual addiction, fewer years of sexual experience were related to greater attentional bias. The authors concluded that this result could indicate that more years of “compulsive sexual activity” lead to greater habituation or a general numbing of the pleasure response (desensitization). An excerpt from the conclusion section: “One possible explanation for these results is that as a sexually compulsive individual engages in more compulsive behaviour, an associated arousal template develops and that over time, more extreme behaviour is required for the same level of arousal to be realised. It is further argued that as an individual engages in more compulsive behaviour, neuropathways become desensitized to more ‘normalised’ sexual stimuli or images and individuals turn to more ‘extreme’ stimuli to realise the arousal desired.”
  16. Mood changes after watching pornography on the Internet are linked to symptoms of Internet-pornography-viewing disorder (2016) – Excerpts: The main results of the study are that tendencies towards Internet Pornography Disorder (IPD) were associated negatively with feeling generally good, awake, and calm as well as positively with perceived stress in daily life and the motivation to use Internet pornography in terms of excitation seeking and emotional avoidance.  Furthermore, tendencies towards IPD were negatively related to mood before and after watching Internet pornography as well as an actual increase of good and calm mood. The relationship between tendencies towards IPD and excitement seeking due to Internet-pornography use was moderated by the evaluation of the experienced orgasm’s satisfaction. Generally, the results of the study are in line with the hypothesis that IPD is linked to the motivation to find sexual gratification and to avoid or to cope with aversive emotions as well as with the assumption that mood changes following pornography consumption are linked to IPD (Cooper et al., 1999 and Laier and Brand, 2014).
  17. Problematic sexual behavior in young adults: Associations across clinical, behavioral, and neurocognitive variables (2016) – Individuals with Problematic Sexual Behaviors (PSB) exhibited several neuro-cognitive deficits. These findings indicate poorer executive functioning (hypofrontality) which is a key brain feature occuring in drug addicts. A few excerpts: From this characterization, it is be possible to trace the problems evident in PSB and additional clinical features, such as emotional dysregulation, to particular cognitive deficits…. If the cognitive problems identified in this analysis are actually the core feature of PSB, this may have notable clinical implications.
  18. Executive Functioning of Sexually Compulsive and Non-Sexually Compulsive Men Before and After Watching an Erotic Video (2017) Exposure to porn affected executive functioning in men with “compulsive sexual behaviors”, but not healthy controls. Poorer executive functioning when exposed to addiction-related cues is a hallmark of substance disorders (indicating both altered prefrontal circuits and sensitization). Excerpts: This finding indicates better cognitive flexibility after sexual stimulation by controls compared with sexually compulsive participants. These data support the idea that sexually compulsive men do not to take advantage of the possible learning effect from experience, which could result in better behavior modification. This also could be understood as a lack of a learning effect by the sexually compulsive group when they were sexually stimulated, similar to what happens in the cycle of sexual addiction, which starts with an increasing amount of sexual cognition, followed by the activation of sexual scripts and then orgasm, very often involving exposure to risky situations.
  19. Exposure to Sexual Stimuli Induces Greater Discounting Leading to Increased Involvement in Cyber Delinquency Among Men (2017) – In two studies exposure to visual sexual stimuli resulted in: 1) greater delayed discounting (inability to delay gratification), 2) greater inclination to engage in cyber-deliquency, 3) greater inclination to purchase counterfeit goods & hack someone’s Facebook account. Taken together this indicates that porn use increases impulsivity and may reduce certain executive functions (self-control, judgment, foreseeing consequences, impulse control). Excerpt: These findings provide insight into a strategy for reducing men’s involvement in cyber delinquency; that is, through less exposure to sexual stimuli and promotion of delayed gratification. The current results suggest that the high availability of sexual stimuli in cyberspace may be more closely associated with men’s cyber-delinquent behavior than previously thought.
  20. Predictors for (Problematic) Use of Internet Sexually Explicit Material: Role of Trait Sexual Motivation and Implicit Approach Tendencies Towards Sexually Explicit Material (2017) – Excerpts: The present study investigated whether trait sexual motivation and implicit approach tendencies towards sexual material are predictors of problematic SEM use and of the daily time spent watching SEM. In a behavioral experiment, we used the Approach-Avoidance Task (AAT) for measuring implicit approach tendencies towards sexual material. A positive correlation between implicit approach tendency towards SEM and the daily time spent on watching SEM might be explained by attentional effects: A high implicit approach tendency can be interpreted as an attentional bias towards SEM. A subject with this attentional bias might be more attracted to sexual cues on the Internet resulting in higher amounts of time spent on SEM sites.

Analysis of “Modulation of late positive potentials by sexual images in problem users and controls inconsistent with ‘porn addiction’ (2015)”, by SPAN Lab

COMMENTS: Published July 2015, we will refer to it as Prause, et al., 2015. Because this paper reported less brain activation to vanilla porn (pictures) related to greater porn use, it is listed as supporting the hypothesis that chronic porn use down regulates sexual arousal. Put simply, chronic porn users were bored by static images of ho-hum porn (its findings parallel Kuhn & Gallinat., 2014). These findings are consistent with tolerance, a sign of addiction. Tolerance is defined as a person’s diminished response to a drug or stimulus that is the result of repeated use.

To date 6 peer-reviewed analyses by neuroscientists and medical doctors agree with the following critique – that Prause et al., 2015 actually supports the porn addiction model:

  1. Neuroscience of Internet Pornography Addiction: A Review and Update – Excerpt critiquing Prause et al., 2015
  2. Neurobiology of Compulsive Sexual Behavior: Emerging Science (2016)
  3. Should compulsive sexual behavior be considered an addiction? (2016) – Excerpt analyzing Prause et al., 2015
  4. Decreased LPP for sexual images in problematic pornography users may be consistent with addiction models. Everything depends on the model. (Commentary on Prause, Steele, Staley, Sabatinelli, & Hajcak, 2015)
  5. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports – Excerpt analyzing Prause et al., 2015
  6. Conscious and Non-Conscious Measures of Emotion: Do They Vary with Frequency of Pornography Use? (2016) – Excerpt analyzing Prause et al., 2015

Hyperbole & Inaccurate Claims

Let’s start with the lead author’s hyperbole. Nicole Prause, boldly claimed on her SPAN lab website that this solitary study “debunks porn addiction”:

What researcher would ever claim to debunk an entire field of research and to refute all previous studies with a single study?

In addition, Nicole Prause claimed her study contained 122 subjects (N). In reality, the study had only 55 subjects who were “experiencing problems regulating their viewing of sexual images”. The subjects were recruited from Pocatello Idaho, which is over 50% Mormon. The other 67 participants were controls.

In another dubious claim, Prause, et al. 2015 stated in both their abstract and in the body of the study:

These are the first functional physiological data of persons reporting VSS regulation problems“.

This is clearly not the case, as the Cambridge fMRI study was published nearly a year ago.

In a third claim Nicole Prause has consistently asserted that Prause et al., 2015 is “the largest neuroscience investigation of porn addiction ever conducted”. It should be noted that compared to brain scan studies, EEG studies are far less expensive per subject. It’s easy to gather a large group of “porn addicted” subjects if you don’t screen the subjects for porn addiction or any exclusionary condition (mental problems, addictions, psychotropic drug use, etc.). A few problems with Prause’s claim:

  1. It’s not a study on porn addiction if it has no porn addicts. This study, and 2 earlier Prause studies (Prause et al., 2013 & Steele et al., 2013) did not assess whether any of the subjects were porn addicts or not. Prause admitted in an interview that many of the subjects had little difficulty controlling use: they were not addicts. All of the subjects would have to have been confirmed porn addicts to permit a legitimate comparison with a group of non-porn addicts. In addition the Prause Studies did not screen subjects for mental disorders, drug use, compulsive behaviors, or other addictions. Three of the five peer-reviewed critiques point out these fatal flaws: 2, 3, 4.
  2. “HPA axis dysregulation in men with hypersexual disorder” (2015) could be considered the largest neuroscience-based study to date on “hypersexuals” (with 67 subjects in treatment for sex addiction, as compared to Prause’s 55 subjects who were upset about their porn use). The study assessed the brain’s response to stress by assessing a hormone release by the brain (ACTH), and a hormone controlled by the brain (cortisol). While this study was a published a few months after Prause et al., 2015, Nicole Prause continues to claim her EEG study as the largest.
  3. Brain Structure and Functional Connectivity Associated With Pornography Consumption: The Brain on Porn (2014) – Could be considered larger than Prause et al., 2015, because it had 64 subjects, and all were carefully screened for exclusionary items such as addictions, substance use, mental disorders, and medical & neurological disorders. The 3 Prause studies did not do this.

Prause et al., 2015 Assessed Brain Wave Activity

Prause, et al. was an Electroencephalography or EEG study. EEG’s measure electrical activity, or brain waves, on the scalp. Although EEG technology has been around for 100 years, debate continues as to what actually causes brain waves, or what specific EEG readings really signify. As a consequence, experimental results may be interpreted in a variety of ways. Spikes in electrical activity are called amplitudes (below).

Researchers believe that certain EEG amplitudes (LPP, P3) may assess attention given to a particular stimulus, such as a picture. Put simply, greater amplitudes indicate the subject is paying greater attention to the visual stimulus presented in the experiment. In the Prause study the stimulus was a one-second exposure to a sexual photo. A few important points:

  1. Greater attention, and the corresponding EEG spike, cannot tell us if the person was sexually aroused or if they were repulsed. A higher spike may just as easily be caused by negative emotions, such as disgust or shock.
  2. Nor can an EEG spike tell us if the brain’s reward circuitry was activated or not. In contrast, other recent studies on porn users by Voon et al., 2014 and Kuhn & Gallinat 2014 used fMRI scanners to pinpoint structural changes and reward circuit activity.

In this study, Prause et al. compared the EEG activity of so called “porn addicts” (average 3.8 hours of porn/week) to controls (average 0.6 hours of porn/week). As expected, both “porn addicts” and controls had greater EEG activity (LPP amplitude) when viewing sexual photos. However, the amplitude was smaller for the “porn addicts.”

Prause et al., 2015 Actually Supports Porn Addiction

Expecting a greater amplitude for “porn addicts”, the authors stated, “This pattern appears different from substance addiction models.” But does that really make sense?

As a researcher friend says, in any study there are results…and there are the researcher’s interpretations. The results are pretty clear: Porn addicts paid less attention to photos of vanilla sex flashed on the screen for one second. This is no surprise to anyone who over-consumes today’s porn.

Prause’s findings of lower LPP amplitudes for “porn addicts” when compared to controls actually aligns with the addiction model, notwithstanding her interpretation that she has “debunked porn addiction.” Her finding indicates both desensitization (or habituation) and tolerance, which is the need for greater stimulation. Both are commonly seen in addicts, and, somewhat alarmingly, have also been recorded in heavy porn users who were not addicts (more below).

Key point: If porn use had no effect on Prause’s subjects, we would expect controls and “porn addicts” to have the same LPP amplitude in response to sexual photos. Instead, Prause’s so-called “porn addicts” had less brain activation (lower LPP) to still images of vanilla porn. I use quotation marks because Prause did not actually employ a screening instrument for internet pornography addicts, so we have no idea whether some, or any, of her subjects were porn addicts. For Prause’s claims of falsification and the resulting dubious headlines to be legitimate, all of Prause’s 55 subjects would have to have been actual porn addicts. Not some, not most, but every single subject. All signs point to a good number of the 55 Prause subjects being non-addicts

The subjects were recruited from Pocatello Idaho via online advertisements requesting people who were “experiencing problems regulating their viewing of sexual images”. Pocatello Idaho is over 50% Mormon, so many of the subjects may feel that any amount of porn use is a serious problem. In a serious methodological flaw, none of the subjects were screened for porn addiction. In another methodological flaw, the ad limited recruitment to participants who had problems with only “sexual images”. Since most compulsive porn users view streaming video clips, did this skew the participants even further?

Make no mistake, neither Steele et al., 2013 nor Prause et al., 2015 described these 55 subjects as porn addicts or compulsive porn users. The subjects only admitted to feeling “distressed” by their porn use. Confirming the mixed nature of her subjects, Prause admitted in 2013 interview that some of the 55 subjects experienced only minor problems (which means they were not porn addicts):

“This study only included people who reported problems, ranging from relatively minor to overwhelming problems, controlling their viewing of visual sexual stimuli.”

Key point: How can you debunk the porn addiction model if many of your “porn addicts” are not really porn addicts?

The Prause et al. finding aligns perfectly with Kühn & Gallinat (2014), which found that more porn use correlated with less brain activation in heavy users (who were not addicts) when exposed to sexual photos (.530 seconds). Said the researchers:

“This is in line with the hypothesis that intense exposure to pornographic stimuli results in a downregulation of the natural neural response to sexual stimuli.”

Kühn & Gallinat also reported more porn use correlating with less reward circuit grey matter and disruption of the circuits involved with impulse control. In this article researcher Simone Kühn, said:

“That could mean that regular consumption of pornography more or less wears out your reward system.”

Kühn says existing psychological, scientific literature suggests consumers of porn will seek material with novel and more extreme sex games.

“That would fit perfectly the hypothesis that their reward systems need growing stimulation.”

Another EEG study found that greater porn use in women correlated with less brain activation to porn. Put simply, those who use more porn may need greater stimulation for the response level seen in lighter consumers, and photos of vanilla porn are unlikely to register as all that interesting. Less interest, equates to less attention, and lower EEG readings. End of story.

Prause et al., 2015 Concedes That Kühn & Gallinat 2014 May Be Right

In the discussion section, Prause et al., 2015 cited Kühn & Gallinat 2014 and offered it as a possible explanation for the lower LPP pattern. She was on the right track, and it’s too bad her interpretation then took a U-turn from her data. Perhaps Prause’s strong biases against porn addiction shaped her interpretations. Her former Twitter slogan suggests she may lack the impartiality required for scientific research:

“Studying why people choose to engage in sexual behaviors without invoking addiction nonsense”

Incidentally, the still images employed by both Kühn and Prause et al. differed significantly from the 9-second “explicit” video clips used in last year’s Cambridge University fMRI study, which found similarities between porn addicts’ brains and those of drug addicts. Those researchers found greater reward center activity in porn addicts in response to the video clips, which is typical of addicts.

Internet porn studies and their interpretation are complicated by the fact that viewing pornographic images (stills or videos) is the addictive behavior, rather than solely a cue. By comparison, viewing images of vodka bottles is a cue for an alcoholic. While that cue may light up her brain more than a control’s brain, the alcoholic needs greater amounts of alcohol to get a buzz. The heavy porn users in the Kühn and Prause studies clearly needed greater stimulation (videos?) to exhibit their buzz. They didn’t respond normally to mere stills. This is evidence of tolerance (and underlying addiction-related brain changes).

Updates on Nicole Prause’s twitter slogan:

  1. UCLA did not renew Prause’s contract. She hasn’t been affiliated with any university since early 2015.
  2. In October, 2015 Prause’s original Twitter account is permanently suspended for harassment.

In Her 2013 EEG Study and a Blog Post Prause States That LESS Brain Activation Would Indicate Habituation or Addiction

Prause claimed that her 2013 EEG study was the first time EEG readings were recorded for so-called “hypersexuals.” Since this was a “first” Prause admits it’s pure speculation as to whether “hypersexuals” should have higher or lower EEG readings than healthy controls:

“Given that this is the first time ERPs were recorded in hypersexuals, and literature on addiction (higher P300) and impulsivity (lower P300) suggest opposite predictions, the direction of the hypersexual effect was specified mainly on theoretical grounds.” [That is, without much basis at all.]

As explained here Prause’s 2013 EEG study had no control group, so it could not compare “porn addicts'” EEG readings to “non-addicts.” As a result, her 2013 study told us nothing about the EEG readings for either healthy individuals or “hypersexuals.” Let’s continue with Prause’s views from 2013:

“Therefore, individuals with high sexual desire could exhibit large P300 amplitude difference between sexual stimuli and neutral stimuli due to salience and emotional content of the stimuli. Alternatively, little or no P300 amplitude difference could be measured due to habituation to VSS.

In 2013, Prause said that porn addicts, when compared to controls, could exhibit:

  1. higher EEG readings due to cue-reactivity to images, or
  2. lower EEG readings due to habituation to porn (VSS).

Five months before her 2013 EEG study was published, Prause and David Ley teamed up to write this Psychology Today blog post about her upcoming study. In it they claim that “diminished electrical response” would indicate habituation or desensitization:

But, when EEG’s were administered to these individuals, as they viewed erotic stimuli, results were surprising, and not at all consistent with sex addiction theory. If viewing pornography actually was habituating (or desensitizing), like drugs are, then viewing pornography would have a diminished electrical response in the brain. In fact, in these results, there was no such response. Instead, the participants’ overall demonstrated increased electrical brain responses to the erotic imagery they were shown, just like the brains of “normal people”…

So, we have 2013 Prause saying “diminished electrical response” would indicate habituation or desensitization. Now, however, in 2015, when Prause found evidence of desensitization (common in addicts), she is telling us “diminished electrical response” debunks porn addiction. Huh?

In the intervening two years it took Prause to compare her same tired subject data with an actual control group, she has done a complete flip-flop. Now, she claims the evidence of desensitization that she found when she added the control group isn’t evidence of addiction (which she claimed in 2013 it would have been). Instead, once again, she insists she has “disproved addiction.” This is inconsistent and unscientific, and suggests that regardless of opposing findings, she will claim to have “disproven addiction.” In fact, unless 2015 Prause rejects the 2013 Prause study and blog post she would be obliged to “invoke addiction nonsense.”

By the way, the above excerpt –“participants’ overall demonstrated increased electrical brain responses to the erotic imagery” – is misleading. Of course it’s normal to have a greater response to sexual pictures than to neutral landscape pictures. However, Prause’s 2013 study had no control group, and it did not compare EEG readings of porn addicts to non-addicts. Once she added the control group, it was evident that arousal in response to erotic imagery is normal and the effect disappeared. Instead, her subjects turned out to be suffering from desensitization, an addiction process. In short, Prause’s 2013 results were meaningless (see below), while her 2015 headlines contradict everything she had previously stated. She claims to disprove addiction while discovering evidence of it.

Poor Methodology Once Again

1) As with Prause’s 2013 EEG study (Steele et al., 2015), the subjects in this study were males, females and possibly “non-heterosexuals”. All evidence suggests Prause used the same subjects for her current study and her 2013 study: the number of females are identical (13) and the total numbers very close (52 vs. 55). If so, this current study also included 7 “non-heterosexuals”. This matters, because it violates standard procedure for addiction studies, in which researchers select homogeneous subjects in terms of age, gender, orientation, even similar IQ’s (plus a homogeneous control group) in order to avoid distortions caused by such differences. This is especially critical for studies like this one, which measured arousal to sexual images, as research confirms that men and women have significantly different brain responses to sexual images or films (Studies: