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


STUDY SIXTEEN (actually a review by UK psychiatrist): “Internet pornography and paedophilia” (2013)

Clinical experience and now research evidence are accumulating to suggest that the Internet is not simply drawing attention to those with existing paedophilic interests, but is contributing to the crystallisation of those interests in people with no explicit prior sexual interest in children.


STUDY SEVENTEEN: How difficult is it to treat delayed ejaculation within a short-term psychosexual model? A case study comparison (2017) – A report on two “composite cases” illustrating the causes and treatments for delayed ejaculation (anorgasmia). “Patient B” represented several young men treated by the therapist. Interestingly, the paper states that Patient B’s “porn use had escalated into harder material”, “as is often the case”. The paper says that porn-related delayed ejaculation is not uncommon, and on the rise. The author calls for more research on porn’s effects of sexual functioning. Patient B’s delayed ejaculation was healed after 10 weeks of no porn. Excerpts related to escalation:

The cases are composite cases taken from my work within the National Health Service in Croydon University Hospital, London. With the latter case (Patient B), it is important to note that the presentation reflects a number of young males who have been referred by their GPs with a similar diagnosis. Patient B is a 19-year-old who presented because he was unable to ejaculate via penetration. When he was 13, he was regularly accessing pornography sites either on his own through internet searches or via links that his friends sent him. He began masturbating every night while searching his phone for image…If he did not masturbate he was unable to sleep. The pornography he was using had escalated, as is often the case (see Hudson-Allez, 2010), into harder material (nothing illegal)…

Patient B was exposed to sexual imagery via pornography from the age of 12 and the pornography he was using had escalated to bondage and dominance by the age of 15.

We agreed that he would no longer use pornography to masturbate. This meant leaving his phone in a different room at night. We agreed that he would masturbate in a different way…. The article calls for research into pornography usage and its effect on masturbation and genital desensitisation.


 

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.

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