Addressing unsupported claims, personal attacks and defamation by Daniel A. Burgess, LMFT (Feb-March, 2018)

INTRODUCTION: Burgess is now claiming victim-hood, yet he initiated all contact (Facebook, Twitter), posting numerous defamatory comments and eventually infringing on YBOP’s trademark by creating ““.

Prior to February, 2018 I had never heard of Daniel Burgess LMFT. Suddenly, out of nowhere Mr. Burgess (@BurgessTherapy) employed multiple social media platforms to attack me and YBOP. Burgess’s targeted harassment and defamation occurred on Twitter (under several @YourBrainOnPorn tweets) and Facebook (the YBOP Facebook page, one of Burgess’s Facebook pages, and the Marriage and Family Therapists Facebook page).

In July of 2020 Daniel Burgess wrote a lie-filled letter for Nicole Prause to use in her defense against my Anti-SLAPP suit. I won the lawsuit as Prause, and her letter writers, were exposed as lying or fabricating evidence: Prause’s restraining order denied as frivolous & she owes substantial attorney fees in a ant-SLAPP ruling. Burgess’s letter, which has been tweeted dozens of times, insinuated that he was the victim because I created the current page to expose his defamation, cyberstalking and trademark infringement. Absolutely ludicrous, as Burgess initiated all contact with me (defamation on several social media accounts), and created, infringing on my trademark, while its Twitter account (@BrainOnPorn) defamed me and many others (including doxing my son and his mother). Burgess’s letter falsely claimed that:

  1. I posted his home address and phone number on YBOP (a bald-faced lie).
  2. I published “hundreds of pages of defamatory accusations” (Burgess provided zero examples of defamatory accusations). I only published this current page and two other primary pages describing:
  3. I put “pictures” of his wife & family on YBOP. Not true. He appears to referring to the avatar associated with his defamatory Facebook comments – which I reproduced below and are still present on my Facebook page!
  4. He received “multiple legal threats”. In reality, Burgess only received 2 cease and desist letters – both for illegal trademark infringement of YBOP.

You be the judge, is Daniel Burgess the victim or the perpetrator?

We begin with documentation of with Burgess’s one-sided reign of cyberstalking and defamation:

YourBrainOnPorn Facebook Page

Screenshots of Burgess posting numerous defamatory comments on the YBOP Facebook page (this is where I first encountered Daniel Burgess). Very important to note: as of November, 2020 Burgess libelous comments were still there. So any claims of me outing him, or his family, are ludicrous.

Link to the page I provided to Burgess (he had no comments): Nicole Prause’s Unethical Harassment and Defamation of Gary Wilson & Others. Note: Burgess is now claiming that the above screenshot of him harassing & defaming me on my Facebook page constitutes “doxing.” That’s a perfect example of DARVO – Deny the abuse ever took place, then Attack the victim for attempting to hold the abuser accountable; then lie and claim that the abuser is the real victim in the situation, thus Reversing the Victim and Offender.

By the way, ‘doxing’ refers to posting private information, which I did not do. His comments are public, and on the YBOP Facebook page.

Update (August, 2020): Court rulings expose Prause as the perpetrator, not the victim, confirming that Burgess knowingly engaged in defamation per se. In March of 2020, Prause sought a groundless temporary restraining order (TRO) against me using fabricated “evidence” and her usual lies (falsely accusing me of stalking). In Prause’s request for the restraining order she perjured herself, saying I posted her address on YBOP and Twitter (perjury is nothing new with Prause). I filed an lawsuit against Prause for misusing the legal system (TRO) to silence and harass me. On August 6, the Los Angeles County Superior Court ruled that Prause’s attempt to obtain a restraining order against me constituted a frivolous and illegal “strategic lawsuit against public participation” (commonly called a “SLAPP suit”). In essence, the Court found that Prause abused the restraining order process to bully me into silence and undercut his rights to free speech. By law, the SLAPP ruling obligates Prause to pay Wilson’s attorney fees.

On YBOP Twitter Threads

Not long after the above tirade of false statements and defamation, Burgess went to his little-used Twitter account to spew a bunch of venom and unsupported drivel. Nine tweets in a row targeting me (Burgess has since deleted these tweets and changed the name of the Twitter account to @MyAscentTherapy):

On the “Marriage and Family Therapists” Facebook Group

Soon after Burgess attacked me on the YBOP Facebook page and Twitter, he set his sights on the 6,000 member “Marriage and Family Therapists” Facebook group (his unsupported claims about YBOP and the research are addressed in the next section). Eighteen replies to Burgess by therapists Staci Sprout and Forest Benedict are the bulk of what remains of Burgess’s defamatory tirade. Here’s an example of one of the many MFT Facebook page comments where Burgess defamed me:

It appears that Burgess was kicked off the “Marriage and Family Therapists” Facebook group for defaming others in the thread, yet he is now spreading his fairy tale that I initiated contact with him. The only so-called ‘contact’ I initiated was a Cease & Desist letter to Burgess for trademark infringement.

Burgess Creates Fake Twitter Account to Defame & Harass Me

On June 14, 2019 I posted the following Twitter thread in response to harassment and defamation from the “RealYourBrainOnPorn” Twitter account. (As explained here, the RealYBOP website and social media accounts are engaging in illegal trademark infringement and attempted trademark squatting.) On June 15th the dormant “Ron Swanson” account entered my thread claiming to have a background in law, offering me legal assistance:

The “Ron Swanson” Twitter account is demonstrably fake. A quick examination of “Ron Swanson’s” Twitter revealed it was fake and probably conducting a fishing expedition.

I suspected “Swanson” was Burgess because, out of its mere 20 tweets in 3 years, one linked to pictures of Burgess and his wife engaging in a CrossFit competition (Burgess’s primary Facebook page is CrossFit Dan). The “Ron Swanson” tweet with a link:

The link goes to this NugentTherapy Instagram post (the page has since mysteriously vanished):

It’s no secret that Burgess and his wife met at CrossFit. He even created a Facebook page chronicling all this (update – in an attempt to hide evidence, Burgess deleted the page). Note: because Burgess is not only defaming me, trolling me, sending me threatening letters via his lawyer Wayne Giampietro, engaging in blatant trademark infringement, and related litigation, I have been forced to document his, and his alias’s, online behaviors.

The mystery of “Ron Swanson” solved.

Burgess continued to use his RonSwanson alias. The minute RealYBOP tweeted the SoCal ACLU letter (described on this page) “Ron Swanson” tweeted it four times, all at @YourBrainOnPorn. The “Ron Swanson” account hadn’t tweeted anything since his two June 15th tweets attempting to deceive me with his offer of sage legal advice. The four tweets:

Burgess no longer trying to hide the fact that he’s “Ron Swanson”.

On August 21, 2019, Burgess alias (@RonSwansonTime tweeted a screenshot of fraudulent porn URLs (of pages that never existed). It appeared under a NerdyKinkyCommie tweet ranting about me. Nerdy is a professional troll and Prause-collaborator who received a 7-day Twitter suspension for harassing me (entire saga explained here). RonSwansonTime was then joined in the thread by Nicole Prause and David Ley – what an amazing coincidence.

These tweets are the first I, or anyone else, had ever heard of the existence of the fake URLs (of nonexistent pages on YBOP’s Wayback Machine archive). Initial sequence of events on August 21st:

  1. NerdyKinkyCommie trolls me (for the 100th time or so)
  2. @RonSwansonTime immediately post 2 tweets on the thread, with screenshots and links to the WayBack Machine
  3. Nicole Prause immediately joins the thread
  4. David Ley adds his two cents

I then outed @RonSwansonTime as a likely Burgess alias, which resulted in “Ron” setting his Twitter account to “protected” (just more evidence that Ron Swanson is really Burgess).

Why would a fake Twitter account go private? To hide evidence?

In summary, Burgess is now fabricating stories that I initiated contact with him and “cyberstalked” him. As you can see, Burgess is lying. He is the perpetrator not the victim.

In August, 2019 some of Burgess’s comments and social media accounts vanished and a presumed alias Twitter account went private (@RonSwansonTime). This occurred after:

  1. legal actions revealed that Daniel Burgess is the current owner of the URL (for much more see – Aggressive Trademark Infringement Waged by Porn Addiction Deniers (
  2. the Twitter account (@BrainOnPorn) went on a 4-day, 110+ tweet defamatory rampage targeting Gary Wilson, while the email account harassed Wilson’s friends with the same defamatory garbage. For details, see:

In addition to the malicious character-impugning campaign conducted by the Real Brain On Porn” Twitter account (which mirrors Nicole Prause’s litany of falsehoods), the Twitter account (@BrainOnPorn) also explicitly accused me of at least 3 felonies:

  1. Stalking women in person
  2. Making death threats
  3. Hacking into websites

Publicly accusing people of moral turpitude and felonies is actionable. In fact, the above libelous statements are deemed “defamation per se” – which means that I need not show any commercial damages in order to recover (proceeds from my book go to charity). Legal counsel believes that Daniel Burgess is the legally culpable party. We have until August, 25th, 2020 to file a defamation lawsuit (others have also been defamed by “Real Brain On Porn” Twitter account).

A big wow: Prause and Daniel Burgess’s legal counsel in their trademark battles with me is Wayne B. Giampietro. He was one of the primary lawyers defending Backpage was shut down by the federal government “for its willful facilitation of human trafficking and prostitution.” (see this USA Today article: 93-count indictment on sex trafficking charges revealed against Backpage founders). The indictment charged backpage owners, along with others, of conspiring to knowingly facilitate prostitution offenses through the website. Authorities contend some of the trafficked people included teenage girls. For details on Giampietro’s involvement see – In an odd turn of events, assets were seized by Arizona, with Wayne B. Giampietro LLC listed as forfeiting $100,000.


1) Summer, 2019: On May 8, 2019 Donald Hilton, MD filed a defamation per se lawsuit against Nicole Prause & Liberos LLC. On July 24, 2019 Donald Hilton amended his defamation complaint to highlight (1) a malicious Texas Board of Medical Examiners complaint, (2) false accusations that Dr. Hilton had falsified his credentials, and (3) affidavits from 9 other Prause victims of similar harassment & defamation (John Adler, MD, Gary Wilson, Alexander Rhodes, Staci Sprout, LICSW, Linda Hatch, PhD, Bradley Green, PhD, Stefanie Carnes, PhD, Geoff Goodman, PhD, Laila Haddad.)

2) October, 2019: On October 23, 2019 Alexander Rhodes (founder of reddit/nofap and filed a defamation lawsuit against Nicole R Prause and Liberos LLC. See the court docket here. See this page for three primary court documents filed by Rhodes: NoFap founder Alexander Rhodes defamation lawsuit against Nicole Prause / Liberos.

3) November, 2019: Finally, some accurate media coverage on serial false accuser, defamer, harasser, trademark infringer, Nicole Prause: “Alex Rhodes of Porn Addiction Support Group ‘NoFap’ Sues Obsessed Pro-Porn Sexologist for Defamation” by Megan Fox of PJ Media and “Porn wars get personal in No Nut November”, by Diana Davison of The Post Millennial. Davison also produced this 6-minute video about Prause’s egregious behaviors: “Is Porn Addictive?”.

4) January, 2020: Alex Rhodes filed an amended complaint against Prause which also names the RealYBOP twitter account (@BrainOnPorn) as engaging in defamation. For the story, and all the courts documents, see this page: NoFap founder Alexander Rhodes defamation lawsuit against Nicole Prause / Liberos. RealYBOP’s lies, harassment, defamation, and cyberstalking have caught up with it. The @BrainOnPorn twitter is now being named in two defamation lawsuits. PDF’s of court documents naming @BrainOnPorn:

Who’s legally responsible: all the RealYBOP “experts”, or Prause, or maybe Daniel Burgess?

Relevant excerpts from the Rhodes complaint:

Daniel a Burgess, Nicole Prause & pro-porn allies create a biased twitter account to support the porn industry and to harass & defame anyone who speaks about porn’s negative effects


daniel a burgess LMFT owns realyourbrainonporn

On March 23, 2020 Alex Rhodes filed his opposition to Prause’s motion to dismiss. His court filings contain new incidents & evidence, additional victims of Prause, greater context/background: Brief – 26 pages, Declaration – 64 pages, Exhibits – 57 pages. @BrainOnPorn twitter account is named yet again. Excerpts describing these new incidents of harassment & defamation:

daniel a burgess LMFT owns realyourbrainonporn

Another incident:

daniel a burgess LMFT owns realyourbrainonporn

In reality, @BrainOnPorn has posted hundreds of additional tweets targeting Rhodes and Nofap: Nicole Prause, David Ley & @BrainOnPorn’s long history of harassing & defaming Alexander Rhodes of NoFap.

While Daniel Burgess is the last known owner of the RealYBOP URL (, the most credible evidence points towards Nicole Prause creating and operating the RealYBOP website and Twitter account.

RealYBOP constantly engages in harassment and defamation of those who speak about porn’s negative effects (over 800 such tweets in its first year). We wonder who’s legally responsible for @BrainOnPorn‘s defamation and harassment? Is it only Nicole Prause, or only Daniel Burgess, or maybe both? Or could all of the RealYBOP “experts” be held legally and financially responsible?

This question is not trivial as Prause and the RealYBOP Twitter are now implicated in two defamation lawsuits (Donald Hilton, MD & Nofap founder Alexander Rhodes), a trademark infringement case, and a trademark squatting case. In fact, several of the RealYBOP tweets have been included in filings for the two defamation lawsuits, and in associated affidavits filed by other victims of Prause and RealYBOP Twitter (affidavit #1, affidavit #2, affidavit #3, affidavit #4, affidavit #5, affidavit #6, affidavit #7, affidavit #8, affidavit #9, affidavit #10, affidavit #11, affidavit #12, affidavit #13, affidavit #14, affidavit #15, affidavit #16).

5) Update (August, 2020): In March of 2020, Prause sought a groundless temporary restraining order (TRO) against me using fabricated “evidence” and her usual lies (falsely accusing me of stalking). In Prause’s request for the restraining order she perjured herself, saying I posted her address on YBOP and Twitter (perjury is nothing new with Prause). I filed an lawsuit against Prause for misusing the legal system (TRO) to silence and harass me. On August 6, the Los Angeles County Superior Court ruled that Prause’s attempt to obtain a restraining order against me constituted a frivolous and illegal “strategic lawsuit against public participation” (commonly called a “SLAPP suit”). In essence, the Court found that Prause abused the restraining order process to bully Wilson into silence and undercut his rights to free speech. By law, the SLAPP ruling obligates Prause to pay Wilson’s attorney fees.

On to YBOP’s March, 2018 article countering Daniel Burgess’s defamation and assorted falsehoods:

Daniel Burgess defamed and harassed me on social media – regurgitating Nicole Prause’s usual set of lies and fabrications of victim-hood that she has spewed for several years. See these extensive pages for hundreds of documented incidents

Normally YBOP doesn’t engage the repetitive stream of defamation and ad hominem claptrap posted on social media. However, soon after Burgess defamed me on the YBOP Facebook page and Twitter, he set his sights on “Marriage and Family Therapists.” Because Burgess displayed his defamation before 6,000 licensed therapists and the YBOP Facebook audience, I felt it necessary to debunk his malicious comments (and his unsupported claims about the preponderance of porn research)

The eighteen replies to Burgess by therapists Staci Sprout and Forest Benedict are all that remains of Burgess’s defamatory tirade. It appears that Burgess was kicked off the “Marriage and Family Therapists” Facebook group for defaming me in this thread.

The current page contains several comments posted on a Marriage & Family Therapist Facebook by this Daniel Burgess Facebook account, followed by Gary Wilson’s responses. The Burgess comments are maroon and indented.

March, 2018: Daniel Burgess Falsehoods, Followed by Gary Wilson’s Responses

All of this is real simple: Lie and engage in ad hominem so that people won’t click on the links and see all the empirical evidence, which Burgess cannot refute. He has been trained well by Prause and Ley and their cronies, but knows nothing about the current state of the research or the neurobiology of addiction.

A comment to Daniel Burgess, on the Marriage and Family Therapists Facebook page (which contained a link to YBOP):

That was written in 1998 and we’ve come a long way since then:

Burgess begins his diatribe:

Daniel Burgess: thank you for your reply. Dr. Klein article is more relevant now than ever before. He still practice with the top researchers in sexology. Where as you linked me to Gary Wilson’s YBOP site. Gary is not only completely unknowledgeable about the topic. He has lied repeatably, misrepresents himself, his “credentials” and stalks women on line. Gary is a fraud, even the CBC identified him as a fraud. He lists hundreds of studies on his site proclaiming how it proves addiction like cocaine. But NOT research says such a thing. The man is delusional. Propaganda at best, potentially a case of malpractice diagnosis people outside of the dsm.


1) “GARY MISREPRESENTS HIMSELF”: I have never lied, and have never misrepresented myself. Burgess is getting his talking points from Ley & Prause, who also evade substance and engage in ad hominem and untruths. Prause regularly says that I called myself a professor, and she posts a screenshot from a defunct website, with which I never had contact, and whose hosts incorrectly called me a professor. See documentation here: Prause falsely claims that Wilson has misrepresented his credentials. (Others have mistakenly called me a psychologist, a neuroscientist, etc. That is beyond my control.) My description of myself has always been here, and has not changed –

2) “STALKS WOMEN ONLINE”: I have never stalked women online or offline. There is zero actual evidence for this libelous claim by Burgess or Prause, just as there is no evidence that Prause has a restraining order against me, or that she has filed police reports about me. These fabrications are addressed here, with many others:

In reality, it is Prause who has engaged in cyber-stalking, defamation and harassment of me and many others (over 7 years running). Several sections from the above pages chronicle dozens of usernames Prause employed to post comments on porn recovery forums. She did this to harass & libel me and to argue with men who are trying to quit porn or recover from porn-induced ED. A few such examples:

3) LISTS OF STUDIES: Burgess ignores the peer-reviewed studies listed on that page. All the studies on YBOP are there for everyone to see. None have been mischaracterized. In my lists, all the studies contain excerpts and have links to the original papers. Burgess needs to take on their substance. Here are the lists:

  1. Porn/sex addiction? This page lists 55 neuroscience-based studies (MRI, fMRI, EEG, neuropsychological, hormonal). They provide strong support for the addiction model as their findings mirror the neurological findings reported in substance addiction studies.
  2. The real experts’ opinions on porn/sex addiction? This list contains 29 recent literature reviews & commentaries by some of the top neuroscientists in the world. All support the addiction model.
  3. Signs of addiction and escalation to more extreme material? Over 55 studies reporting findings consistent with escalation of porn use (tolerance), habituation to porn, and even withdrawal symptoms (all signs and symptoms associated with addiction).
  4. An official diagnosis? The world’s most widely used medical diagnostic manual, The International Classification of Diseases (ICD-11), contains a new diagnosis suitable for porn addiction: “Compulsive Sexual Behavior Disorder.”
  5. Debunking the unsupported talking point that “high sexual desire” explains away porn or sex addiction: At least 25 studies falsify the claim that sex & porn addicts “just have high sexual desire”
  6. Porn and sexual problems? This list contains over 40 studies linking porn use/porn addiction to sexual problems and lower arousal to sexual stimuli. The first 7 studies in the list demonstrate causation, as participants eliminated porn use and healed chronic sexual dysfunctions.
  7. Porn’s effects on relationships? Over 75 studies link porn use to less sexual and relationship satisfaction. As far as we know all studies involving males have reported more porn use linked to poorer sexual or relationship satisfaction.
  8. Porn use affecting emotional and mental health? Over 85 studies link porn use to poorer mental-emotional health & poorer cognitive outcomes.
  9. Porn use affecting beliefs, attitudes and behaviors? Check out individual studies – over 40 studies link porn use to “un-egalitarian attitudes” toward women and sexist views – or the summary from this 2016 meta-analysis: Media and Sexualization: State of Empirical Research, 1995–2015. Excerpt:

The goal of this review was to synthesize empirical investigations testing effects of media sexualization. The focus was on research published in peer-reviewed, English-language journals between 1995 and 2015. A total of 109 publications that contained 135 studies were reviewed. The findings provided consistent evidence that both laboratory exposure and regular, everyday exposure to this content are directly associated with a range of consequences, including higher levels of body dissatisfaction, greater self-objectification, greater support of sexist beliefs and of adversarial sexual beliefs, and greater tolerance of sexual violence toward women. Moreover, experimental exposure to this content leads both women and men to have a diminished view of women’s competence, morality, and humanity.

  1. What about sexual aggression and porn use? Another meta-analysis: A Meta‐Analysis of Pornography Consumption and Actual Acts of Sexual Aggression in General Population Studies (2015). Excerpt:

22 studies from 7 different countries were analyzed. Consumption was associated with sexual aggression in the United States and internationally, among males and females, and in cross-sectional and longitudinal studies. Associations were stronger for verbal than physical sexual aggression, although both were significant. The general pattern of results suggested that violent content may be an exacerbating factor.

“But hasn’t porn use reduced rape rates?” No, rape rates have been rising in recent years: “Rape rates are on the rise, so ignore the pro-porn propaganda.”

  1. What about the porn use and adolescents? Check out this list of over 270 adolescent studies, or these reviews of the literature: review#1, review2, review#3, review#4, review#5, review#6, review#7, review#8, review#9, review#10, review#11, review#12, review#13, review#14, review#15, review #16.From the conclusion of this 2012 review of the research – The Impact of Internet Pornography on Adolescents: A Review of the Research:

Increased access to the Internet by adolescents has created unprecedented opportunities for sexual education, learning, and growth. Conversely, the risk of harm that is evident in the literature has led researchers to investigate adolescent exposure to online pornography in an effort to elucidate these relationships. Collectively, these studies suggest that youth who consume pornography may develop unrealistic sexual values and beliefs. Among the findings, higher levels of permissive sexual attitudes, sexual preoccupation, and earlier sexual experimentation have been correlated with more frequent consumption of pornography…. Nevertheless, consistent findings have emerged linking adolescent use of pornography that depicts violence with increased degrees of sexually aggressive behavior. The literature does indicate some correlation between adolescents’ use of pornography and self-concept. Girls report feeling physically inferior to the women they view in pornographic material, while boys fear they may not be as virile or able to perform as the men in these media. Adolescents also report that their use of pornography decreased as their self-confidence and social development increase. Additionally, research suggests that adolescents who use pornography, especially that found on the Internet, have lower degrees of social integration, increases in conduct problems, higher levels of delinquent behavior, higher incidence of depressive symptoms, and decreased emotional bonding with caregivers.

4) The CBC: The CBC did no such thing. One of its producers did, however, engage in deception and misconduct. Here are our posts describing on a porn recovery site about what went on with the CBC. Notice that Nicole Prause posted (as Real Science) in that same thread (as she often posted on the recovery forum using various aliases). For example, she asked about the size of my penis. (Very professional.)

NOTE: Nicole Prause’s maiden tweet for her new Twitter account was about Gary Wilson and the CBC interview. I can’t link to the tweet, as Prause’s original Twitter account was permanently suspended for harassing Todd Love, PsyD, JD, whose review of the literature dared to criticize her work. On December 18th & 19th “RealScience” posted several similar, equally misleading comments as the one below on sites that mentioned Gary Wilson (see several more posts on December 18th & 19th by “RealScience” or “Real Scientist”).

NOTE2: Prause has targeted me and many others over the last few years, including researchers, medical doctors, therapists, psychologists, colleagues from her short stint at UCLA, a UK charity, men in recovery, a TIME magazine editor, several professors, IITAP, SASH, Fight The New Drug, Exodus Cry, the academic journal Behavioral Sciences, its parent company MDPI, the head of the academic journal CUREUS, and the journal Sexual Addiction & Compulsivity (these 2 pages provide extensive documentation of said behaviors: page 1, page 2, page 3, and page 4

5) COCAINE: Nowhere on YBOP do I say “Porn is just like cocaine.” Another lie by Burgess. Here’s the YBOP FAQ saying that porn is NOT “just like cocaine”: Does porn addiction cause irreversible damage to the brain?.

NOTE: Even though YBOP never says that cocaine and meth are “just like porn”, sexual arousal and addictive drugs share similar neurological mechanisms and hormonal changes (which differ from other universal natural rewards, such as food and water):

  1. Sexual arousal and addictive drugs activate the exact same reward circuit nerve cells. In contrast, there’s only a small percentage of nerve-cell activation overlap between addictive drugs and other natural rewards such as food or water. Turning on the same nerve cells that make sexual stimulation so compelling helps explain why meth, cocaine, and heroin can be so addictive.
  2. Interestingly, heroin addicts often claim that shooting up “feels like an orgasm”. Supporting their experience, ejaculation mimics the effects of heroin addiction on the same reward circuit nerve cells. Specifically, ejaculation shrinks the same dopamine producing nerve cells that shrink with chronic heroin use. This doesn’t mean sex is bad. It simply informs us that addictive drugs hijack the exact same mechanisms that urge us back into the bedroom for a romp.
  3. Unlike other non-drug rewards (yummy food or sugar), but similar to drugs of abuse, sexual experience leads to a long-lasting changes in the numbers and types of reward center glutamate receptors. Glutamate is the main neurotransmitter relaying information from key brain regions to the reward center. These neuroadaptations make the reward center far more sensitive to sights, sounds, thoughts or memories associated potential sexual activity.
  4. In addition, both sex and drug use lead to the accumulation of DeltaFosB, a protein that activates genes involved with addiction. The molecular changes it generates are nearly identical for both sexual conditioning and chronic use of drugs. Whether it’s sex or drugs of abuse, high levels of DeltaFosB rewire the brain to crave “IT”, whatever “IT” is. Addictive drugs not only hijack the precise nerve cells activated during sexual arousal, they co-opt the same learning mechanisms that evolved to make us desire sexual activity.
  5. While far too complex to elucidate in detail, multiple temporary neurological and hormonal changes occur with orgasm that do not occur with any other natural rewards. These include decreased brain androgen receptors, increased estrogen receptors, increased hypothalamic enkephalins, and increased blood levels of oxytocin and prolactin.

Thus, familiar talking points such as this actual comment fall apart: “Well, lots of activities raise dopamine, so internet porn is no more addictive than watching sunsets or playing golf.” That’s a quote from an academic sexologist (with a very superficial understanding). Similarly, in sexologist Marty Klein’s reply to a Zimbardo & Wilson article he claimed that the brain response to watching porn is no different than watching a sunset:

“Besides, our brain responds in this same observable way when we cuddle a grandchild or enjoy a sunset.”

The Marty Klein claim was long ago tested and debunked, in a 2000 fMRI study:Cue-induced cocaine craving: neuroanatomical specificity for drug users and drug stimuli. The study had cocaine addicts and healthy controls view films of: 1) individuals smoking crack cocaine, 2) outdoor nature scenes, and 3) explicit sexual content. The results: cocaine addicts had nearly identical brain activation patterns when viewing porn and viewing cues related to their addiction. (Incidentally, both cocaine addicts and healthy controls had the same brain activation patterns for porn.) However, for both the addicts and controls, brain activation patterns when viewing nature scenes were completely different from the patterns when viewing for porn. Goodbye silly talking point!

PS – Prause’s talking point is that masturbating to porn is no different neurologically than watching puppies play (with her unthinking followers repeat this claim as they would repeat a mantra). This unbelievable assertion should excuse Prause from ever commenting on the neuroscience related to CSB.

Daniel Burgess: Let me give just one example of Gary’s thousands of misleading, misread scientific “findings”. In the highly over used, misquoted and misunderstood “Voon” research “,Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviors” Gary recklessly reports, conflates and concules porn is like or a drugs, or rather “users react to porn cues in the same way that drug addicts react to drug cues.” ; “The long-awaited Valerie Voon study highlighted in the UK documentary “Porn on the Brain” is finally out. As expected, Cambridge University researchers found that compulsive porn users react to porn cues in the same way that drug addicts react to drug cues. Link to full study – “Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours (2014)

WHAT I ACTUALLY SAID: Here’s the link to the original YBOP write-up about the first Voon study: My statement was accurate as Voon said the same as I did in an interview about her study and in her study: Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours (Voon et al., 2014)

Interview of Voon:

‘In many ways, they show similarities in their behaviour to patients with drug addictions. We wanted to see if these similarities were reflected in brain activity, too. ”There are clear differences in brain activity between patients who have compulsive sexual behaviour and healthy volunteers. These differences mirror those of drug addicts.”

From the Voon study:

Drug-cue-reactivity and craving studies of nicotine, cocaine and alcohol implicate networks including the ventral striatum, dACC and amygdala [13]. In the current study, these regions were activated during viewing of sexually explicit materials across the groups with and without CSB. The observation of stronger activations of these regions in CSB versus healthy volunteer participants is similar to findings observed for substance cues in substance addictions, suggesting neurobiological similarities across the disorders.

The second Valerie Voon CSB study summarizes the findings of the first two Cambridge University studies:

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 CSB subjects 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 CSB subjects This finding dovetails with our recent observation that sexually explicit videos were associated with greater activity in a neural network similar to that observed in drug-cue-reactivity studies. Greater desire or wanting rather than liking was further associated with activity in this neural network. These studies together provide support for an incentive motivation theory of addiction underlying the aberrant response towards sexual cues in CSB.

From a 2016 review By Valerie Voon, Shane Kraus and Marc Potenza: Should Compulsive Sexual Behavior be Considered an Addiction? (Kraus et al., 2016).

With the release of DSM-5, gambling disorder was reclassified with substance use disorders. This change challenged beliefs that addiction occurred only by ingesting of mind-altering substances and has significant implications for policy, prevention and treatment strategies. Data suggest that excessive engagement in other behaviors (e.g. gaming, sex, compulsive shopping) may share clinical, genetic, neurobiological and phenomenological parallels with substance addictions……

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

As all can see, Burgess simply lied.

Also, why is Burgess obsessed only with Voon et al., 2014? Why does Daniel Burgess ignore the other 52 neuroscience-based studies (MRI, fMRI, EEG, neuropsychological, hormonal) listed on YBOP’s brain studies page? (all 52 provide strong support for the addiction model as their findings mirror the neurological findings reported in substance addiction studies). Probably because Burgess is unaware that the other 52 neurological studies exist, because Prause appears to be spoon feeding him all his talking points.

Daniel Burgess: In another post Gary literally says “Porn is as addictive as meth.” and watch porn will cause you to rape. Using some random rape graph that has nothing to do with porn in any way. (

GARY WILSON: The page Burgess links to was not posted by me. I have never seen that post or that website until now. Burgess’s fake “Gary Wilson” has only one bizarre post. Important to note that Burgess never links to my site – because YBOP has never said that “Porn is as addictive as meth.” Burgess is once again lying.

Who supplied him with the fake post by a fake “Gary Wilson?” Prause scours the web for anything about me. For example, two weeks ago Prause placed my Southern Oregon University employment documents (along with multiple libelous claims about them) on Quora, Twitter, and on an adult industry website. She falsely claimed I was fired. She was able to create that illusion due to redacted information in the documents. Here’s the documentation of everything that occurred, including Prause placing a libelous story on a porn industry website: Nicole Prause & David Ley libelous claim that Gary Wilson was fired from Southern Oregon University

The documents were removed from Quora, and Prause permanently banned. Twitter banned her for one day and gave her a warning. The porn site has since removed the libelous article. See:

Daniel Burgess: Compulsive porn users craved porn (greater wanting), but did not have higher sexual desire (liking) than controls. This finding aligns perfectly with the current model of addiction, and refutes the theory that “higher sexual desire” causes compulsive porn use. Drug addicts are thought to be driven to seek their drug because they want – rather than enjoy – it. This abnormal process is known as incentive motivation, which is a hallmark of addiction disorders.” Submitted by admin on Thu, 07/10/2014 – 16:09

GARY WILSON: My description of Voon et al., 2014 was perfectly accurate. Voon said the same. From her study:

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.

Our findings focusing on CSB in the general population similarly dove tail with incentive motivation theories emphasizing aberrant wanting or motivation towards the drug or sexual cue, but not of ‘liking’ or hedonic tone [12].

The most widely accepted model of addiction is the “Incentive sensitization” model (IST). The markers for IST are greater cue-reactivity or cravings to use. There are now there are 25 neurological studies that have reported cue-reactivity or cravings (sensitization) in compulsive porn users or sex addicts – including Prause’s own Steele et al., 2013. (Note – Voon devoted a paragraph to Steele et al., 2013 saying that Prause’s findings mirrored her findings – greater cue-reactivity!)

Neurosceince-based studies reporting findings consistent with IST model 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)
  2. Sexual Desire, not Hypersexuality, is Related to Neurophysiological Responses Elicited by Sexual Images (2013)
  3. Cybersex addiction: Experienced sexual arousal when watching pornography and not real-life sexual contacts makes the difference (2013)
  4. Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours (2014)
  5. Cybersex addiction in heterosexual female users of internet pornography can be explained by gratification hypothesis (2014)
  6. Empirical Evidence and Theoretical Considerations on Factors Contributing to Cybersex Addiction From a Cognitive Behavioral View (Laier et al., 2014)
  7. Enhanced Attentional Bias towards Sexually Explicit Cues in Individuals with and without Compulsive Sexual Behaviours (2014)
  8. Novelty, Conditioning and Attentional Bias to Sexual Rewards (2015)
  9. Neural Substrates of Sexual Desire in Individuals with Problematic Hypersexual Behavior (2015)
  10. Implicit associations in cybersex addiction: Adaption of an Implicit Association Test with pornographic pictures. (2015)
  11. Symptoms of cybersex addiction can be linked to both approaching and avoiding pornographic stimuli: results from an analog sample of regular cybersex users (2015)
  12. Getting stuck with pornography? Overuse or neglect of cybersex cues in a multitasking situation is related to symptoms of cybersex addiction (2015)
  13. Sexual Excitability and Dysfunctional Coping Determine Cybersex Addiction in Homosexual Males (2015)
  14. The Role of Neuroinflammation in the Pathophysiology of Hypersexual Disorder (2016)
  15. Compulsive sexual behavior: Prefrontal and limbic volume and interactions (2016)
  16. Ventral striatum activity when watching preferred pornographic pictures is correlated with symptoms of Internet pornography addiction (2016)
  17. Altered Appetitive Conditioning and Neural Connectivity in Subjects With Compulsive Sexual Behavior (2016)
  18. Compulsivity across the pathological misuse of drug and non-drug rewards (2016)
  19. Subjective Craving for Pornography and Associative Learning Predict Tendencies Towards Cybersex Addiction in a Sample of Regular Cybersex Users (2016)
  20. Exploring the Relationship between Sexual Compulsivity and Attentional Bias to Sex-Related Words in a Cohort of Sexually Active Individuals (2016)
  21. Can Pornography be Addictive? An fMRI Study of Men Seeking Treatment for Problematic Pornography Use (2017)
  22. Predictors for (Problematic) Use of Internet Sexually Explicit Material: Role of Trait Sexual Motivation and Implicit Approach Tendencies Towards Sexually Explicit Material (2017)
  23. Tendencies toward Internet-pornography-use disorder: Differences in men and women regarding attentional biases to pornographic stimuli (2018)
  24. Facets of impulsivity and related aspects differentiate among recreational and unregulated use of Internet pornography (2019)
  25. Approach bias for erotic stimuli in heterosexual male college students who use pornography (2019)
  26. Sexual cues alter working memory performance and brain processing in men with compulsive sexual behavior (2020)
  27. Subjective reward value of visual sexual stimuli is coded in human striatum and orbitofrontal cortex (2020)
  28. The Neurosciences of Health Communication: An fNIRS Analysis of Prefrontal Cortex and Porn Consumption in Young Women for the Development of Prevention Health Programs (2020)

As for Voon’s study countering high desire, her subjects scored lower on the ASEX, and 11 of them had trouble being aroused without watching porn. I said this because Prause falsely claimed that her 2013 EEG study supported higher desire: Sexual Desire, not Hypersexuality, is Related to Neurophysiological Responses Elicited by Sexual Images (Steele et al., 2013). In reality, Steele et al., 2013 claim to have found only on ea single statistically significant correlation among all the data gathered:

“Larger P300 amplitude differences to pleasant sexual stimuli, relative to neutral stimuli, was negatively related to measures of sexual desire, but not related to measures of hypersexuality.”

Translation: Negatively means lower desire. Individuals with greater cue-reactivity to porn had lower desire to have sex with a partner (but not lower desire to masturbate). 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 (subjects’ desire for partnered sex was dropping in relation to their porn use). Eight peer-reviewed papers explain the truth: Peer-reviewed critiques of Steele et al., 2013. Also see an extensive YBOP critique.

Note: List of over 25 studies falsifying the claim that sex & porn addicts “just have high sexual desire”

Daniel Burgess The actual research says this in its conclusion; “These findings suggest overlaps in networks underlying disorders of pathological consumption of drugs and natural rewards. While this study may suggest overlaps with substance-use disorders, further clinical studies are required to determine whether CSB should be categorized as an impulse-control disorder, within an obsessive-compulsive spectrum or as a behavioural addiction.”

GARY WILSON: That’s what cautious scientists do (unlike Prause with her unsupported claims, such as her claim that she “debunked the porn addiction model” with a single flawed study). But that does not negate Valerie Voon’s findings in 2014, or her future conclusions. Important to note that 36 neurological studies have since been published, including 4 more by Valerie Voon. All report findings that mirror those seen in substance addition studies.

In 2017, Voon co-authored this commentary in Lancet, Is excessive sexual behaviour an addictive disorder? (Potenza et al., 2017). Here’s what Voon now says, demonstrating her current belief that CSB fits the addiction model:

Research into the neurobiology of compulsive sexual behaviour disorder has generated findings relating to attentional biases, incentive salience attributions, and brain-based cue reactivity that suggest substantial similarities with addictions. Compulsive sexual behaviour disorder is being proposed as an impulse-control disorder in ICD-11, consistent with a proposed view that craving, continued engagement despite adverse consequences, compulsive engagement, and diminished control represent core features of impulse-control disorders. This view might have been appropriate for some DSM-IV impulse-control disorders, specifically pathological gambling. However, these elements have long been considered central to addictions, and in the transition from DSM-IV to DSM-5, the category of Impulse Control Disorders Not Elsewhere Classified was restructured, with pathological gambling renamed and reclassified as an addictive disorder. At present, the ICD-11 beta draft site lists the impulse-control disorders, and includes compulsive sexual behaviour disorder, pyromania, kleptomania, and intermittent explosive disorder.

Compulsive sexual behaviour disorder seems to fit well with non-substance addictive disorders proposed for ICD-11, consistent with the narrower term of sex addiction currently proposed for compulsive sexual behaviour disorder on the ICD-11 draft website. We believe that classification of compulsive sexual behaviour disorder as an addictive disorder is consistent with recent data and might benefit clinicians, researchers, and individuals suffering from and personally affected by this disorder.

Daniel Burgess Furthermore Voon, the lead researcher is troubled by the interpretation, “Voon is quick to caution against using her studies to leap to conclusions about the addictiveness of sex or porn. “Much more research is required,” she explains.”

GARY WILSON: Voon’s 2014 comments have nothing to do with me; she’s just saying more studies need to be done. And many more studies have been published since July 2014. Here are 53 additional neuroscience-based studies, 29 reviews/commentaries:

Burgess should keep up to speed, as Voon has published 4 more neurological studies and 3 reviews/commentaries. All support the addiction model. Voon’s neuroscience studies:


From Valerie Voon’s most recent commentary – Is excessive sexual behaviour an addictive disorder? 2017)

Compulsive sexual behaviour disorder seems to fit well with non-substance addictive disorders proposed for ICD-11, consistent with the narrower term of sex addiction currently proposed for compulsive sexual behaviour disorder on the ICD-11 draft website. We believe that classification of compulsive sexual behaviour disorder as an addictive disorder is consistent with recent data.

Daniel Burgess “Nicole Prause (and trained researcher and scientist) at the University of California, Los Angeles, used electroencephalography (EEG) to measure the brain waves of people presented with sexual images and found something different. She observed that volunteers who believed they had a problem with porn reacted to the pictures with low levels of excitement in the brain, unlike other addicts faced with triggering cues. “These people may be having problems, but of some other type,” says Prause. “Addiction is not a good way of understanding it.”…/can-you-really-be...

GARY WILSON: Burgess is citing an article, which cites Prause et al., 2015. Prause claimed she “debunked porn addiction” with a solitary flawed paper. 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. Prause claims these results “debunk porn addiction.”

What legitimate scientist would claim that their lone study has debunked a well established 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 et al. findings also align with Banca et al. 2015. 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), which is consistent with addiction. See this extensive YBOP critique. Nine peer-reviewed papers agree that this study actually found desensitization/habituation in frequent porn users: YBOP critique of “Modulation of Late Positive Potentials by Sexual Images in Problem Users and Controls Inconsistent with ‘Porn Addiction’ (Prause et al., 2015)”

Ten peer-reviewed papers agree with YBOP’s assessment of Prause et al., 2015. Each link goes to relevant excerpts and a link to original paper.

  1. Decreased LPP for sexual images in problematic pornography users may be consistent with addiction models. Everything depends on the model (Commentary on Prause, 2015)
  2. Neuroscience of Internet Pornography Addiction: A Review and Update (2015)
  3. Neurobiology of Compulsive Sexual Behavior: Emerging Science (2016)
  4. Should compulsive sexual behavior be considered an addiction? (2016)
  5. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports (2016)
  6. Conscious and Non-Conscious Measures of Emotion: Do They Vary with Frequency of Pornography Use? (2017)
  7. Neurocognitive mechanisms in compulsive sexual behavior disorder (2018)
  8. Online Porn Addiction: What We Know and What We Don’t—A Systematic Review (2019)
  9. The Initiation and Development of Cybersex Addiction: Individual Vulnerability, Reinforcement Mechanism and Neural Mechanism (2019)
  10. Do Varying Levels of Exposure to Pornography and Violence Have an Effect on Non-Conscious Emotion in Men (2020)

Excerpts from Mateusz Gola’s critique of Prause et al., 2015 (Decreased LPP for sexual images in problematic pornography users may be consistent with addiction models. Everything depends on the model: Commentary on Prause, 2015).

The 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 [the accepted model of addiction]…

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

As Gola and others mentioned in their peer-reviewed critiques, Prause et al., 2015 suffered from fatal flaws (as did Steele at al., 2013), such as:

1) As with Prause’s 2013 EEG study (Steele et al.), 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: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14). This flaw alone calls into question both of Prause’s EEG studies.

2) Prause’s subjects were not pre-screened. Valid addiction brain studies screen out individuals with pre-existing conditions (depression, OCD, other addictions, etc.). This is the only way responsible researchers can draw conclusions about addiction. See the Cambridge University studies for an example of proper screening and methodology.

3) The two questionnaires Prause relied upon in both EEG studies to assess “porn addiction” are not validated to screen for internet porn use / addiction.

4) 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 – and her study can prove nothing about porn addiction):

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

You can’t debunk porn addiction if you are not assessing actual addicts. Even Prause’s findings did not align with the IST model, 24 other studies on CSB subjects report cue-reactivity & cravings in porn users/sex addicts: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24.

Daniel Burgess: What is Garys response to Nicole, a respected scientist? Essentially, “Prause is pro-porn”.

GARY WILSON: My response to Prause’s work are critiques where I cite peer-reviewed papers critiquing Prause, and PhD’s critiquing her claims. In all the following links I link to the both the original papers, and the excerpts analyzing Prause’s papers and claims. I challenge Burgess to avoid cheap ad hominem attacks and address the specific content of my critiques and the associated peer-reviewed critiques to which I link.

1) My critique, along with 9 peer-reviewed papers critiquing Prause et al., 2015 – YBOP critique of “Modulation of Late Positive Potentials by Sexual Images in Problem Users and Controls Inconsistent with ‘Porn Addiction’ (Prause et al., 2015)”

2) My critique, along with 8 peer-reviewed papers critiquing Steele et al., 2013 – YBOP analysis – A critique of “Steele et al., 2013″: actual findings support the porn addiction model.

YBOP critiques of papers and lay articles where Prause was one of the authors:

  1. Debunking “Why Are We Still So Worried About Wat­­ching Porn?”, by Marty Klein, Taylor Kohut, and Nicole Prause (2018)
  2. Critique of: Letter to the editorPrause et al. (2015) the latest falsification of addiction predictions (2016), Nicole Prause, Vaughn R. Steele, Cameron Staley, Dean Sabatinelli, Greg Hajcake
  3. The Emperor Has No Clothes: A Review of the ‘Pornography Addiction’ Model (2014), David Ley, Nicole Prause & Peter Finn (Ley et al., 2014)
  4. Analysis of “Data do not support sex as addictive” (Prause et al., 2017)
  5. Critique of Nicole Prause’s “Porn Is for Masturbation” (2019)
  6. Op-ed: Who exactly is misrepresenting the science on pornography? (2016)
  7. Propagandists misrepresent peer-reviewed papers and ICD-11 search features to fuel false claim that WHO’s ICD-11 “rejected porn addiction and sex addiction” (2018)”

Burgess has yet to address a single word in any of the above critiques.

As for Prause, she is a former academic (contract not renewed in late 2014/early 2015) with a long history of harassing and defaming authors, researchers, therapists, reporters, men in recovery, Journal editors, multiple organizations, and others who dare to report evidence of harms from internet porn use. She appears to be quite cozy with the pornography industry, as can be seen from this image of her (far right) on the red carpet of the X-Rated Critics Organization (XRCO) awards ceremony. (According to Wikipedia the XRCO Awards are given by the American X-Rated Critics Organization annually to people working in adult entertainment and it is the only adult industry awards show reserved exclusively for industry members.[1]). It also appears that Prause may have obtained porn performers as subjects through another porn industry interest group, the Free Speech Coalition. The FSC-obtained subjects were allegedly used in her hired-gun study on the heavily tainted and very commercial “Orgasmic Meditation” scheme (now being investigated by the FBI). Prause has also made unsupported claims about the results of her studies and her study’s methodologies. For much more documentation, see: Is Nicole Prause Influenced by the Porn Industry?

Daniel Burgess: But always revert to pseudoscience, ad hominem and yet have NOTHING to show for it, what is Gary’s success rate of eliminating porn use?

GARY WILSON: He has given zero examples of either pseudoscience or ad hominem by me. This is a typical tactic – accuse those of what you are actually doing. Propaganda at its finest.

Gary’s “success rate of eliminating porn use“?

What the hell is Burgess talking about?

Daniel Burgess: Anyway, one can spend years going through the thousands of posts from Gary and pointing out every flaw.

GARY WILSON: Please do. As others can see, Burgess mischaracterized the Valerie Voon study, while I described it accurately. Burgess also lied about what I said on YBOP (that meth and cocaine are “the same as porn”). Notice that Burgess never links to YBOP and never provides an excerpt from YBOP.

Daniel Burgess: Even BYU researchers are finding this is something other then “addiction”: Religious Conflict Makes Porn Bad for Relationships…/religious-conflict…

GARY WILSON: They did not find “something other than addiction”. Here’s my analysis and what the study actually found: Critique of: “Damaged Goods: Perception of Pornography Addiction as a Mediator Between Religiosity and Relationship Anxiety Surrounding Pornography Use (Leonhardt, Willoughby, & Young-Petersen, 2017)

Here are the authors of the study saying that David Ley’s Psychology Today post misrepresented their study –

Two recent studies by Joshua Grubbs report that believing you are “porn addict” is unrelated to religiosity. See this article for descriptions and links to the full studies: Religious People Use Less Porn and Are No More Likely to Believe They Are Addicted (2017).

Daniel Burgess And yet, more evidence against sexual addiction: “Brain Imaging of Human Sexual Response: Recent Developments and Future Directions”

GARY WILSON: The citation is not a study, its a narrative review of “the latest developments in the experimental brain study of human sexuality“. Nothing in the paper asserts that porn or sex addiction do not exist. An excerpt from the paper pertaining to CSB, which counters Burgess’s calims surrounding the paper:

Neuroscientific interest in the sexual wanting domain is increasingly narrowing down on sexual desire extremes. Several studies using visual sexual stimulation have shown that (perceived) hypersexual behavior (aka compulsive sexual behavior, sexual addiction, or problematic pornography use) is correlated with alterations in neural activation patterns [2532] and regional brain volume [33•, 34], particularly in areas of the sexual wanting network [14•]. Increased activity to sexual cues has been demonstrated in the VS [25, 27] and also in the amygdala in hypersexual men [25, 27, 28], which is suggestive of sexual cue sensitization. This is sometimes taken to support the addiction theory of hypersexuality [35]. Other studies, however, showed negative correlations between sexual cue-induced brain activity and hypersexual symptom severity, suggesting the involvement of different phenomena that are seemingly incompatible with addiction, like response extinction or emotional downregulation [26, 2830, 34]. These data may not be mutually exclusive. For instance, men with hypersexuality may be both sensitized to sexual cues or contingencies (a feature of addiction) and more easily lose interest or self-regulate if there is no possibility to advance the sexual response (as a learned adaptation). Indeed, in a paradigm with repeated exposure of cues predicting the presentation of a pornographic picture or a monetary reward, cue-induced activity in the ACC decreased faster with repeated exposure in men with hypersexuality—but only for the sexual cues [26].

(Note this paper did not review all the neurological studies on CSB subjects.)

On the other hand, we do have 29 actual reviews and commentaries, all of which lend support to the addiction model. The list of with links to original papers, and excerpts: Reproduced below:

1) Neuroscience of Internet Pornography Addiction: A Review and Update (Love et al., 2015). A thorough review of the neuroscience literature related to Internet addiction sub-types, with special focus on internet porn addiction. The review also critiques two headline-grabbing EEG studies by teams headed by Nicole Prause (who falsely claims the findings cast doubt on porn addiction). Excerpts:

Many recognize that several behaviors potentially affecting the reward circuitry in human brains lead to a loss of control and other symptoms of addiction in at least some individuals. Regarding Internet addiction, neuroscientific research supports the assumption that underlying neural processes are similar to substance addiction… Within this review, we give a summary of the concepts proposed underlying addiction and give an overview about neuroscientific studies on Internet addiction and Internet gaming disorder. Moreover, we reviewed available neuroscientific literature on Internet pornography addiction and connect the results to the addiction model. The review leads to the conclusion that Internet pornography addiction fits into the addiction framework and shares similar basic mechanisms with substance addiction.

2) Sex Addiction as a Disease: Evidence for Assessment, Diagnosis, and Response to Critics (Phillips et al., 2015), which provides a chart that takes on specific criticisms of porn/sex addiction, offering citations that counter them. Excerpts:

As seen throughout this article, the common criticisms of sex as a legitimate addiction do not hold up when compared to the movement within the clinical and scientific communities over the past few decades. There is ample scientific evidence and support for sex as well as other behaviors to be accepted as addiction. This support is coming from multiple fields of practice and offers incredible hope to truly embrace change as we better understand the problem. Decades of research and developments in the field of addiction medicine and neuroscience reveal the underlying brain mechanisms involved in addiction. Scientists have identified common pathways affected by addictive behavior as well as differences between the brains of addicted and non-addicted individuals, revealing common elements of addiction, regardless of the substance or behavior. However, there remains a gap between the scientific advances and the understanding by the general public, public policy, and treatment advances.

3) Cybersex Addiction (Brand & Laier, 2015). Excerpts:

Many individuals use cybersex applications, particularly Internet pornography. Some individuals experience a loss of control over their cybersex use and report that they cannot regulate their cybersex use even if they experienced negative consequences. 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. Also, neurocognitive mechanisms of development and maintenance of cybersex addiction primarily involve impairments in decision making and executive functions. 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 (Kraus et al., 2016). Excerpts:

Although not included in DSM-5, compulsive sexual behavior (CSB) can be diagnosed in ICD-10 as an impulse control disorder. However, debate exists about CSB’s classification. 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….. 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? (Kraus et al., 2016). Excerpts:

With the release of DSM-5, gambling disorder was reclassified with substance use disorders. This change challenged beliefs that addiction occurred only by ingesting of mind-altering substances and has significant implications for policy, prevention and treatment strategies. Data suggest that excessive engagement in other behaviors (e.g. gaming, sex, compulsive shopping) may share clinical, genetic, neurobiological and phenomenological parallels with substance addictions.

Another area needing more research involves considering how technological changes may be influencing human sexual behaviors. Given that data suggest that sexual behaviors are facilitated through Internet and smartphone applications, additional research should consider how digital technologies relate to CSB (e.g. compulsive masturbation to Internet pornography or sex chatrooms) and engagement in risky sexual behaviors (e.g. condomless sex, multiple sexual partners on one occasion).

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.

6) Neurobiological Basis of Hypersexuality (Kuhn & Gallinat, 2016). Excerpts:

Behavioral addictions and in particular hypersexuality should remind us of the fact that addictive behavior actually relies on our natural survival system. Sex is an essential component in survival of species since it is the pathway for reproduction. Therefore it is extremely important that sex is considered pleasurable and has primal rewarding properties, and although it may turn into an addiction at which point sex may be pursued in a dangerous and counterproductive way, the neural basis for addiction might actually serve very important purposes in primal goal pursuit of individuals…. 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.

7) Compulsive Sexual Behaviour as a Behavioural Addiction: The Impact of the Internet and Other Issues (Griffiths, 2016). Excerpts:

I have carried out empirical research into many different behavioural addictions (gambling, video-gaming, internet use, exercise, sex, work, etc.) and have argued that some types of problematic sexual behaviour can be classed as sex addiction, depending upon the definition of addiction used….

Whether problematic sexual behaviour is described as compulsive sexual behavior (CSB), sex addiction and/or hypersexual disorder, there are thousands of psychological therapists around the world who treat such disorders. Consequently, clinical evidence from those who help and treat such individuals should be given greater credence by the psychiatric community….

Arguably the most important development in the field of CSB and sex addiction is how the internet is changing and facilitating CSB. This was not mentioned until the concluding paragraph, yet research into online sex addiction (while comprising a small empirical base) has existed since the late 1990s, including sample sizes of up to almost 10 000 individuals. In fact, there have been recent reviews of empirical data concerning online sex addiction and treatment. These have outlined the many specific features of the internet that may facilitate and stimulate addictive tendencies in relation to sexual behaviour (accessibility, affordability, anonymity, convenience, escape, disinhibition, etc.).

8) Searching for Clarity in Muddy Water: Future Considerations for Classifying Compulsive Sexual Behavior as An Addiction (Kraus et al., 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, although its ultimate inclusion is not certain. Future research should continue to build knowledge and strengthen a framework for better understanding CSB and translating this information into improved policy, prevention, diagnosis, and treatment efforts to minimize the negative impacts of CSB.

9) Is Internet Pornography Causing Sexual Dysfunctions? A Review With Clinical Reports (Park et al., 2016). An extensive review of the literature related to porn-induced sexual problems. Involving 7 US Navy doctors and Gary Wilson, 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. A second 2016 paper by Gary Wilson discusses the importance of studying the effects of porn by having subjects abstain from porn use: Eliminate Chronic Internet Pornography Use to Reveal Its Effects (2016). Excerpts:

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.

3.4. Neuroadaptations Related to Internet Pornography-Induced Sexual Difficulties: We hypothesize that pornography-induced sexual difficulties involve both hyperactivity and hypoactivity in the brain’s motivational system [72, 129] and neural correlates of each, or both, have been identified in recent studies on Internet pornography users [31, 48, 52, 53, 54, 86, 113, 114, 115, 120, 121, 130, 131, 132, 133, 134].

10) Integrating Psychological and Neurobiological Considerations Regarding The Development and Maintenance of Specific Internet-Use Disorders: An Interaction of Person-Affect-Cognition-Execution model (Brand et al., 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. Excerpts:

Although the DSM-5 focuses on Internet gaming, a meaningful number of authors indicate that treatment-seeking individuals may also use other Internet applications or sites addictively….

From the current state of research, we suggest to include Internet-use disorders in the upcoming ICD-11. It is important to note that beyond Internet-gaming disorder, other types of applications are also used problematically. One approach could involve the introduction of a general term of Internet-use disorder, which could then be specified considering the first-choice application that is used (for example Internet-gaming disorder, Internet-gambling disorder, Internet-pornography-use disorder, Internet-communication disorder, and Internet-shopping disorder).

11) The Neurobiology of Sexual Addiction: Chapter from Neurobiology of Addictions, Oxford Press (Hilton et al., 2016) – Excerpts:

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….

It is clear that the current definition and understanding of addiction has changed based with the infusion of knowledge regarding how the brain learns and desires. Whereas sexual addiction was formerly defined based solely on behavioral criteria, it is now seen also through the lens of neuromodulation. Those who will not or cannot understand these concepts may continue to cling to a more neurologically naïve perspective, but those who are able to comprehend the behavior in the context of the biology, this new paradigm provides an integrative and functional definition of sexual addiction which informs both the scientist and the clinician.

12) Neuroscientific Approaches to Online Pornography Addiction (Stark & Klucken, 2017) – Excerpts:

The availability of pornographic material has substantially increased with the development of the Internet. As a result of this, men ask for treatment more often because their pornography consumption intensity is out of control; i.e., they are not able to stop or reduce their problematic behavior although they are faced with negative consequences…. 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.

Finally, we summarized the studies, which investigated the correlates of excessive pornography consumption on a neural level. Despite a lack of longitudinal studies, it is plausible that the observed characteristics in men with sexual addiction are the results not the causes of excessive pornography consumption. Most of the studies report stronger cue reactivity in the reward circuit toward sexual material in excessive pornography users than in control subjects, which mirrors the findings of substance-related addictions. The results concerning a reduced prefrontal-striatal-connectivity in subjects with pornography addiction can be interpreted as a sign of an impaired cognitive control over the addictive behavior.

13) Is excessive sexual behaviour an addictive disorder? (Potenza et al., 2017) – Excerpts:

Compulsive sexual behaviour disorder (operationalised as hypersexual disorder) was considered for inclusion in DSM-5 but ultimately excluded, despite the generation of formal criteria and field trial testing. This exclusion has hindered prevention, research, and treatment efforts, and left clinicians without a formal diagnosis for compulsive sexual behaviour disorder.

Research into the neurobiology of compulsive sexual behaviour disorder has generated findings relating to attentional biases, incentive salience attributions, and brain-based cue reactivity that suggest substantial similarities with addictions. Compulsive sexual behaviour disorder is being proposed as an impulse-control disorder in ICD-11, consistent with a proposed view that craving, continued engagement despite adverse consequences, compulsive engagement, and diminished control represent core features of impulse-control disorders. This view might have been appropriate for some DSM-IV impulse-control disorders, specifically pathological gambling. However, these elements have long been considered central to addictions, and in the transition from DSM-IV to DSM-5, the category of Impulse Control Disorders Not Elsewhere Classified was restructured, with pathological gambling renamed and reclassified as an addictive disorder. At present, the ICD-11 beta draft site lists the impulse-control disorders, and includes compulsive sexual behaviour disorder, pyromania, kleptomania, and intermittent explosive disorder.

Compulsive sexual behaviour disorder seems to fit well with non-substance addictive disorders proposed for ICD-11, consistent with the narrower term of sex addiction currently proposed for compulsive sexual behaviour disorder on the ICD-11 draft website. We believe that classification of compulsive sexual behaviour disorder as an addictive disorder is consistent with recent data and might benefit clinicians, researchers, and individuals suffering from and personally affected by this disorder.

14) Neurobiology of Pornography Addiction – A clinical review (De Sousa & Lodha, 2017) – Excerpts:

The review first looks at the basic neurobiology of addiction with the basic reward circuit and structures involved generally in any addiction. The focus then shifts to pornography addiction and studies done on the neurobiology of the condition are reviewed. The role of dopamine in pornography addiction is reviewed along with the role of certain brain structures as seen on MRI studies. fMRI studies involving visual sexual stimuli have been used widely to study the neuroscience behind pornography usage and the findings from these studies are highlighted. The effect of pornography addiction on higher order cognitive functions and executive function is also stressed.

In total, 59 articles were identified which included reviews, mini reviews and original research papers on the issues of pornography usage, addiction and neurobiology. The research papers reviewed here were centered on those that elucidated a neurobiological basis for pornography addiction. We included studies that had decent sample size and sound methodology with appropriate statistical analysis. There were some studies with fewer participants, case series, case reports and qualitative studies that were also analyzed for this paper. Both the authors reviewed all the papers and the most relevant ones were chosen for this review. This was further supplemented with the personal clinical experience of both the authors who work regularly with patients where pornography addiction and viewing is a distressing symptom. The authors also have psychotherapeutic experience with these patients that have added value to the neurobiological understanding.

15) The Proof of the Pudding Is in the Tasting: Data Are Needed to Test Models and Hypotheses Related to Compulsive Sexual Behaviors (Gola & Potenza, 2018) – Excerpts:

As described elsewhere (Kraus, Voon, & Potenza, 2016a), there is an increasing number of publications on CSB, reaching over 11,400 in 2015. Nonetheless, fundamental questions on the conceptualization of CSB remain unanswered (Potenza, Gola, Voon, Kor, & Kraus, 2017). It would be relevant to consider how the DSM and the International Classification of Diseases (ICD) operate with respect to definition and classification processes. In doing so, we think it is relevant to focus on gambling disorder (also known as pathological gambling) and how it was considered in DSM-IV and DSM-5 (as well as in ICD-10 and the forthcoming ICD-11). In DSM-IV, pathological gambling was categorized as an “Impulse-Control Disorder Not Elsewhere Classified.” In DSM-5, it was reclassified as a “Substance-Related and Addictive Disorder.”…. A similar approach should be applied to CSB, which is currently being considered for inclusion as an impulse-control disorder in ICD-11 (Grant et al., 2014; Kraus et al., 2018)….

Among the domains that may suggest similarities between CSB and addictive disorders are neuroimaging studies, with several recent studies omitted by Walton et al. (2017). Initial studies often examined CSB with respect to models of addiction (reviewed in Gola, Wordecha, Marchewka, & Sescousse, 2016b; Kraus, Voon, & Potenza, 2016b). A prominent model—the incentive salience theory (Robinson & Berridge, 1993)—states that in individuals with addictions, cues associated with substances of abuse may acquire strong incentive values and evoke craving. Such reactions may relate to activations of brain regions implicated in reward processing, including the ventral striatum. Tasks assessing cue reactivity and reward processing may be modified to investigate the specificity of cues (e.g., monetary versus erotic) to specific groups (Sescousse, Barbalat, Domenech, & Dreher, 2013), and we have recently applied this task to study a clinical sample (Gola et al., 2017). We found that individuals seeking treatment for problematic pornography use and masturbation, when compared to matched (by age, gender, income, religiosity, amount of sexual contacts with partners, sexual arousability) healthy control subjects, showed increased ventral striatal reactivity for cues of erotic rewards, but not for associated rewards and not for monetary cues and rewards. This pattern of brain reactivity is in line with the incentive salience theory and suggests that a key feature of CSB may involve cue reactivity or craving induced by initially neutral cues associated with sexual activity and sexual stimuli. Additional data suggest that other brain circuits and mechanisms may be involved in CSB, and these may include anterior cingulate, hippocampus and amygdala (Banca et al., 2016; Klucken, Wehrum-Osinsky, Schweckendiek, Kruse, & Stark, 2016; Voon et al., 2014). Among these, we have hypothesized that the extended amygdala circuit that relates to high reactivity for threats and anxiety may be particularly clinically relevant (Gola, Miyakoshi, & Sescousse, 2015; Gola & Potenza, 2016) based on observation that some CSB individuals present with high levels of anxiety (Gola et al., 2017) and CSB symptoms may be reduced together with pharmacological reduction in anxiety (Gola & Potenza, 2016)…

16) Promoting educational, classification, treatment, and policy initiatives Commentary on: Compulsive sexual behaviour disorder in the ICD-11 (Kraus et al., 2018) – The world’s most widely used medical diagnostic manual, The International Classification of Diseases (ICD-11), contains a new diagnosis suitable for porn addiction: “Compulsive Sexual Behavior Disorder.” Excerpts:

For many individuals who experience persistent patterns of difficulty or failures in controlling intense, repetitive sexual impulses or urges that result in sexual behavior associated with marked distress or impairment in personal, family, social, educational, occupational, or other important areas of functioning, it is very important to be able to name and identify their problem. It is also important that care providers (i.e., clinicians and counselors) from whom individuals may seek help are familiar with CSBs. During our studies involving over 3,000 subjects seeking treatment for CSB, we have frequently heard that individuals suffering from CSB encounter multiple barriers during their seeking of help or in contact with clinicians (Dhuffar & Griffiths, 2016). Patients report that clinicians may avoid the topic, state that such problems do not exist, or suggest that one has a high sexual drive, and should accept it instead of treating (despite that for these individuals, the CSBs may feel ego-dystonic and lead to multiple negative consequences). We believe that well-defined criteria for CSB disorder will promote educational efforts including development of training programs on how to assess and treat individuals with symptoms of CSB disorder. We hope that such programs will become a part of clinical training for psychologists, psychiatrists, and other providers of mental health care services, as well as other care providers including primary care providers, such as generalist physicians.

Basic questions on how best to conceptualize CSB disorder and provide effective treatments should be addressed. The current proposal of classifying CSB disorder as an impulse-control disorder is controversial as alternate models have been proposed (Kor, Fogel, Reid, & Potenza, 2013). There are data suggesting that CSB shares many features with addictions (Kraus et al., 2016), including recent data indicating increased reactivity of reward-related brain regions in response to cues associated with erotic stimuli (Brand, Snagowski, Laier, & Maderwald, 2016; Gola, Wordecha, Marchewka, & Sescousse, 2016; Gola et al., 2017; Klucken, Wehrum-Osinsky, Schweckendiek, Kruse, & Stark, 2016; Voon et al., 2014). Furthermore, preliminary data suggest that naltrexone, a medication with indications for alcohol- and opioid-use disorders, may be helpful for treating CSBs (Kraus, Meshberg-Cohen, Martino, Quinones, & Potenza, 2015; Raymond, Grant, & Coleman, 2010). With respect to CSB disorder’s proposed classification as an impulse-control disorder, there are data suggesting that individuals seeking treatment for one form of CSB disorder, problematic pornography use, do not differ in terms of impulsivity from the general population. They are instead presented with increased anxiety (Gola, Miyakoshi, & Sescousse, 2015; Gola et al., 2017), and pharmacological treatment targeting anxiety symptoms may be helpful in reducing some CSB symptoms (Gola & Potenza, 2016). While it may not yet be possible to draw definitive conclusions regarding classification, more data seem to support classification as an addictive disorder when compared to an impulse-control disorder (Kraus et al., 2016), and more research is needed to examine relationships with other psychiatric conditions (Potenza et al., 2017).

17) Compulsive Sexual Behavior in Humans and Preclinical Models (2018) – Excerpts:

Compulsive sexual behavior (CSB) is widely regarded as a “behavioral addiction,” and is a major threat to quality of life and both physical and mental health. However, CSB has been slow to be recognized clinically as a diagnosable disorder. CSB is co-morbid with affective disorders as well as substance use disorders, and recent neuroimaging studies have demonstrated shared or overlapping neural pathologies disorders, especially in brain regions controlling motivational salience and inhibitory control. Clinical neuroimaging studies are reviewed that have identified structural and/or function changes in prefrontal cortex, amygdala, striatum, and thalamus in individuals suffering from CSB. A preclinical model to study the neural underpinnings of CSB in male rats is discussed consisting of a conditioned aversion procedure to examine seeking of sexual behavior despite known negative consequences.

Because CSB shares characteristics with other compulsive disorders, namely, drug addiction, comparisons of findings in CSB, and drug-addicted subjects, may be valuable to identify common neural pathologies mediating comorbidity of these disorders. Indeed, many studies have shown similar patterns of neural activity and connectivity within limbic structures that are involved in both CSB and chronic drug use [87–89].

In conclusion, this review summarized the behavioral and neuroimaging studies on human CSB and comorbidity with other disorders, including substance abuse. Together, these studies indicate that CSB is associated with functional alterations in dorsal anterior cingulate and prefrontal cortex, amygdala, striatum, and thalamus, in addition to decreased connectivity between amygdala and prefrontal cortex. Moreover, a preclinical model for CSB in male rats was described, including new evidence of neural alterations in mPFC and OFC that are correlated with loss of inhibitory control of sexual behavior. This preclinical model offers a unique opportunity to test key hypotheses to identify predispositions and underlying causes of CSB and comorbidity with other disorders.

18) Sexual Dysfunctions in the Internet Era (2018) – Excerpt:

Low sexual desire, reduced satisfaction in sexual intercourse, and erectile dysfunction (ED) are increasingly common in young population. In an Italian study from 2013, up to 25% of subjects suffering from ED were under the age of 40 [1], and in a similar study published in 2014, more than half of Canadian sexually experienced men between the age of 16 and 21 suffered from some kind of sexual disorder [2]. At the same time, prevalence of unhealthy lifestyles associated with organic ED has not changed significantly or has decreased in the last decades, suggesting that psychogenic ED is on the rise [3]. The DSM-IV-TR defines some behaviors with hedonic qualities, such as gambling, shopping, sexual behaviors, Internet use, and video game use, as “impulse control disorders not elsewhere classified”—although these are often described as behavioral addictions [4]. Recent investigation has suggested the role of behavioral addiction in sexual dysfunctions: alterations in neurobiological pathways involved in sexual response might be a consequence of repeated, supernormal stimuli of various origins.

Among behavioral addictions, problematic Internet use and online pornography consumption are often cited as possible risk factors for sexual dysfunction, often with no definite boundary between the two phenomena. Online users are attracted to Internet pornography because of its anonymity, affordability, and accessibility, and in many cases its usage could lead users through a cybersex addiction: in these cases, users are more likely to forget the “evolutionary” role of sex, finding more excitement in self-selected sexually explicit material than in intercourse.

In literature, researchers are discordant about positive and negative function of online pornography. From the negative perspective, it represents the principal cause of compulsive masturbatory behavior, cybersex addiction, and even erectile dysfunction.

19) Neurocognitive mechanisms in compulsive sexual behavior disorder (2018) – Excerpts:

To date, most neuroimaging research on compulsive sexual behavior has provided evidence of overlapping mechanisms underlying compulsive sexual behavior and non-sexual addictions. Compulsive sexual behavior is associated with altered functioning in brain regions and networks implicated in sensitization, habituation, impulse dyscontrol, and reward processing in patterns like substance, gambling, and gaming addictions. Key brain regions linked to CSB features include the frontal and temporal cortices, amygdala, and striatum, including the nucleus accumbens.

CSBD has been included in the current version of theICD-11 as an impulse-control disorder [39]. As described by the WHO, ‘Impulse-control disorders are characterized by the repeated failure to resist an impulse, drive, or urge to perform an act that is rewarding to the person, at least in the short-term, despite consequences such as longer-term harm either to the individual or to others, marked distress about the behaviour pattern, or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning’ [39]. Current findings raise important questions regarding the classification of CSBD. Many disorders characterized by impaired impulse-control are classified elsewhere in the ICD-11 (for example, gambling, gaming, and substance-use disorders are classified as being addictive disorders) [123].

20) A Current Understanding of the Behavioral Neuroscience of Compulsive Sexual Behavior Disorder and Problematic Pornography Use (2018) – Excerpts:

Recent neurobiological studies have revealed that compulsive sexual behaviors are associated with altered processing of sexual material and differences in brain structure and function.

The findings summarized in our overview suggest relevant similarities with behavioral and substance-related addictions, which share many abnormalities found for CSBD (as reviewed in [127]). Although beyond the scope of the present report, substance and behavioral addictions are characterized by altered cue reactivity indexed by subjective, behavioral, and neurobiological measures (overviews and reviews: [128, 129, 130, 131, 132, 133]; alcohol: [134, 135]; cocaine: [136, 137]; tobacco: [138, 139]; gambling: [140, 141]; gaming: [142, 143]). Results concerning resting-state functional connectivity show similarities between CSBD and other addictions [144, 145].

Although few neurobiological studies of CSBD have been conducted to date, existing data suggest neurobiological abnormalities share communalities with other additions such as substance use and gambling disorders. Thus, existing data suggest that its classification may be better suited as a behavioral addiction rather than an impulse-control disorder.

21) Ventral Striatal Reactivity in Compulsive Sexual Behaviors (2018) Excerpts:

Compulsive Sexual Behaviors (CSB) are a reason to seek treatment. Given this reality, the number of studies on CSB has increased substantially in the last decade and the World Health Organization (WHO) included CSB in its proposal for the upcoming ICD-11…… From our point of view, it is worth investigating whether CSB can be distinguished into two subtypes characterized by: (1) dominant interpersonal sexual behaviors, and (2) dominant solitary sexual behaviors and pornography watching (48, 49).

The amount of available studies on CSB (and sub-clinical populations of frequent pornography users) is constantly increasing. Among currently available studies, we were able to find nine publications (Table 1) which utilized functional magnetic resonance imaging. Only four of these (3639) directly investigated processing of erotic cues and/or rewards and reported findings related to ventral striatum activations. Three studies indicate increased ventral striatal reactivity for erotic stimuli (3639) or cues predicting such stimuli (3639). These findings are consistent with Incentive Salience Theory (IST) (28), one of the most prominent frameworks describing brain functioning in addiction. The only support for another theoretical framework which predicts hypoactivation of the ventral striatum in addiction, RDS theory (29, 30), comes partially from one study (37), where individuals with CSB presented lower ventral striatal activation for exciting stimuli when compared to controls.

22) Online Porn Addiction: What We Know and What We Don’t—A Systematic Review (2019)– Excerpts:

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

As far as we know, a number of recent studies support this entity as an addiction with important clinical manifestations such as sexual dysfunction and psychosexual dissatisfaction. Most of the existing work is based off on similar research done on substance addicts, based on the hypothesis of online pornography as a ‘supranormal stimulus’ akin to an actual substance that, through continued consumption, can spark an addictive disorder. However, concepts like tolerance and abstinence are not yet clearly established enough to merit the labeling of addiction, and thus constitute a crucial part of future research. For the moment, a diagnostic entity encompassing out of control sexual behavior has been included in the ICD-11 due to its current clinical relevance, and it will surely be of use to address patients with these symptoms that ask clinicians for help.

23) Occurrence and development of online porn addiction: individual susceptibility factors, strengthening mechanisms and neural mechanisms (2019) – Excerpts:

Initiation and development of cybersex addiction have two stages with classical conditioning and operant conditioning. Firstly, individuals use cybersex occasionally out of entertainment and curiosity. On this stage, use of internet devices is paired with sexual arousal and The results in classical conditioning, further leads to sensitization of cybersex-related cues which trigger intense craving. Individual vulnerabilities also facilitate sensitization of cybersex-related cues. On the second stage, individuals make use of cybersex frequently to satisfy their sexual desires or During this process, cybersex-related cognitive bias like positive expectation of cybersex and coping mechanism like using it to deal with negative emotions are positively reinforced, those personal traits associated with cybersex addiction such as narcissism, sexual sensation seeking, sexual excitability, dysfunction use of sex are also positively reinforced, while common personality disorders like nervousness, low self-esteem and psychopathologies like depression, anxiety are negatively reinforced. Executive function deficits occur due to long-term cybersex use. Interaction of executive function deficits and intense craving promotes development and maintenance Of cybersex addiction. Researches using electrophysiological and brain imaging tools mainly to study cybersex addiction found that cybersex addicts may develop more and more robust craving for cybersex when facing cybersex-related cues, but they feel less and less pleasant when using it. Studies provide evidence for intense craving triggered by cybersex-related cues and impaired executive function. In conclusion, people who are vulnerable to cybersex addiction can’t stop cybersex use out of more and more intense craving for cybersex and impaired executive function, but they feel less and less satisfied when using it, and search for more and more original pornographic materials online at the cost of plenty of time and money. Once they reduce cybersex use or just quit it, they would suffer from a series of adverse effects like depression, anxiety, erection dysfunction, lack of sexual arousal.

24) Theories, prevention, and treatment of pornography-use disorder (2019) – Excerpts:

Compulsive sexual behavior disorder, including problematic pornography use, has been included in the ICD-11 as impulse control disorder. The diagnostic criteria for this disorder, however, are very similar to the criteria for disorders due to addictive behaviors, for example repetitive sexual activities becoming a central focus of the personʼs life, unsuccessful efforts to significantly reduce repetitive sexual behaviors and continued repetitive sexual behaviors despite experiencing negative consequences (WHO, 2019). Many researchers and clinicians also argue that problematic pornography use can be considered a behavioral addiction.

Cue-reactivity and craving in combination with reduced inhibitory control, implicit cognitions (e.g. approach tendencies) and experiencing gratification and compensation linked to pornography use have been demonstrated in individuals with symptoms of pornography-use disorder. Neuroscientific studies confirm the involvement of addiction-related brain circuits, including the ventral striatum and other parts of fronto-striatal loops, in the development and maintenance of problematic pornography use. Case reports and proof-of-concept studies suggest the efficacy of pharmacological interventions, for example the opioid antagonist naltrexone, for treating individuals with pornography-use disorder and compulsive sexual behavior disorder.

Theoretical considerations and empirical evidence suggest that the psychological and neurobiological mechanisms involved in addictive disorders are also valid for pornography-use disorder.

25) Self-perceived Problematic Pornography Use: An Integrative Model from a Research Domain Criteria and Ecological Perspective (2019) – Excerpts

Self-perceived problematic pornography use seems to be related to multiple units of analysis and different systems in the organism. Based on the findings within the RDoC paradigm described above, it is possible to create a cohesive model in which different units of analysis impact each other (Fig. 1). It appears that elevated levels of dopamine, present in the natural activation of the reward system related to sexual activity and orgasm, interfere with the regulation of the VTA-NAc system in people who report SPPPU. This dysregulation leads to greater activation of the reward system and increased conditioning related to the use of pornography, fostering approach behavior to pornographic material due to the increase in dopamine in the nucleus accumbens.

Continued exposure to immediate and easily available pornographic material seems to create an imbalance in the mesolimbic dopaminergic system. This excess dopamine activates GABA output pathways, producing dynorphin as a byproduct, which inhibits dopamine neurons. When dopamine decreases, acetylcholine is released and can generate an aversive state (Hoebel et al. 2007), creating the negative reward system found in the second stage of addiction models. This imbalance is also correlated to the shift from approach to avoidance behavior, seen in people who report problematic pornography use…. These changes in internal and behavioral mechanisms among people with SPPPU are similar to those observed in people with substance addictions, and map into models of addiction (Love et al. 2015).

26) Cybersex addiction: an overview of the development and treatment of a newly emerging disorder (2020) – Excerpts:

Cybersex addiction is a non-substance related addiction that involves online sexual activity on the internet. Nowadays, various kinds of things related to sex or pornography are easily accessible through internet media. In Indonesia, sexuality is usually assumed taboo but most young people have been exposed to pornography. It can lead to an addiction with many negative effects on users, such as relationships, money, and psychiatric problems like major depression and anxiety disorders.

27) Which Conditions Should Be Considered as Disorders in the International Classification of Diseases (ICD-11) Designation of “Other Specified Disorders Due to Addictive Behaviors”? (2020)A review by addiction experts concludes that pornography-use disorder is a condition that ought to be diagnosed with the ICD-11 category “other specified disorders due to addictive behaviors”. In other words, compulsive porn use looks like other recognized addictions. Excerpts:

Compulsive sexual behavior disorder, as has been included in the ICD-11 category of impulse-control disorders, may include a broad range of sexual behaviors including excessive viewing of pornography that constitutes a clinically relevant phenomenon (Brand, Blycker, & Potenza, 2019; Kraus et al., 2018). The classification of compulsive sexual behavior disorder has been debated (Derbyshire & Grant, 2015), with some authors suggesting that the addiction framework is more appropriate (Gola & Potenza, 2018), which can be particularly the case for individuals suffering specifically from problems related to pornography use and not from other compulsive or impulsive sexual behaviors (Gola, Lewczuk, & Skorko, 2016; Kraus, Martino, & Potenza, 2016).

The diagnostic guidelines for gaming disorder share several features with those for compulsive sexual behavior disorder and may potentially be adopted by changing “gaming” to “pornography use.” These three core features have been considered central to problematic pornography use (Brand, Blycker, et al., 2019) and appear to fit appropriately the basic considerations (Fig. 1). Several studies have demonstrated the clinical relevance (criterion 1) of problematic pornography use, leading to functional impairment in daily life including jeopardizing work and personal relationships, and justifying treatment (Gola & Potenza, 2016; Kraus, Meshberg-Cohen, Martino, Quinones, & Potenza, 2015; Kraus, Voon, & Potenza, 2016). In several studies and review articles, models from the addiction research (criterion 2) have been used to derive hypotheses and to explain the results (Brand, Antons, Wegmann, & Potenza, 2019; Brand, Wegmann, et al., 2019; Brand, Young, et al., 2016; Stark et al., 2017; Wéry, Deleuze, Canale, & Billieux, 2018). Data from self-report, behavioral, electrophysiological, and neuroimaging studies demonstrate an involvement of psychological processes and underlying neural correlates that have been investigated and established to varying degrees for substance-use disorders and gambling/gaming disorders (criterion 3). Commonalities noted in prior studies include cue-reactivity and craving accompanied by increased activity in reward-related brain areas, attentional biases, disadvantageous decision-making, and (stimuli-specific) inhibitory control (e.g., Antons & Brand, 2018; Antons, Mueller, et al., 2019; Antons, Trotzke, Wegmann, & Brand, 2019; Bothe et al., 2019; Brand, Snagowski, Laier, & Maderwald, 2016; Gola et al., 2017; Klucken, Wehrum-Osinsky, Schweckendiek, Kruse, & Stark, 2016; Kowalewska et al., 2018; Mechelmans et al., 2014; Stark, Klucken, Potenza, Brand, & Strahler, 2018; Voon et al., 2014).

Based on evidence reviewed with respect to the three meta-level-criteria proposed, we suggest that pornography-use disorder is a condition that may be diagnosed with the ICD-11 category “other specified disorders due to addictive behaviors” based on the three core criteria for gaming disorder, modified with respect to pornography viewing (Brand, Blycker, et al., 2019). One conditio sine qua non for considering pornography-use disorder within this category would be that the individual suffers solely and specifically from diminished control over pornography consumption (nowadays online pornography in most cases), which is not accompanied by further compulsive sexual behaviors (Kraus et al., 2018). Further, the behavior should be considered as an addictive behavior only if it is related to functional impairment and experiencing negative consequences in daily life, as it is also the case for gaming disorder (Billieux et al., 2017; World Health Organization, 2019). However, we also note that pornography-use disorder may currently be diagnosed with the current ICD-11 diagnosis of compulsive sexual behavior disorder given that pornography viewing and the frequently accompanying sexual behaviors (most frequently masturbation but potentially other sexual activities including partnered sex) may meet the criteria for compulsive sexual behavior disorder (Kraus & Sweeney, 2019). The diagnosis of compulsive sexual behavior disorder may fit for individuals who not only use pornography addictively, but who also suffer from other non-pornography-related compulsive sexual behaviors. The diagnosis of pornography-use disorder as other specified disorder due to addictive behaviors may be more adequate for individuals who exclusively suffer from poorly controlled pornography viewing (in most cases accompanied by masturbation). Whether or not a distinction between online and offline pornography use may be useful is currently debated, which is also the case for online/offline gaming (Király & Demetrovics, 2017).

28) The Addictive Nature of Compulsive Sexual Behaviours and Problematic Online Pornography Consumption: A Review (2020) – Excerpts:

Available findings suggest that there are several features of CSBD and POPU that are consistent with characteristics of addiction, and that interventions helpful in targeting behavioural and substance addictions warrant consideration for adaptation and use in supporting individuals with CSBD and POPU. While there are no randomized trials of treatments for CSBD or POPU, opioid antagonists, cognitive behavioural therapy, and mindfulness-based intervention appear to show promise on the basis of some case reports.

The neurobiology of POPU and CSBD involves a number of shared neuroanatomical correlates with established substance use disorders, similar neuropsychological mechanisms, as well as common neurophysiological alterations in the dopamine reward system.

Several studies have cited shared patterns of neuroplasticity between sexual addiction and established addictive disorders.

Mirroring excessive substance use, the use of excessive pornography has a negative impact on several domains of functioning, impairment and distress.

29) Dysfunctional sexual behaviors: definition, clinical contexts, neurobiological profiles and treatments (2020) – Excerpts:

1. The use of pornography among young people, who use it massively online, is connected to the decrease in sexual desire and premature ejaculation, as well as in some cases to social anxiety disorders, depression, DOC, and ADHD [30-32].

2. There is a clear neurobiological difference between “sexual employees” and “porn addicts”: if the former has a ventral hypoactivity, the latter instead are characterized by greater ventral reactivity for erotic signals and rewards without hypoactivity of the reward circuits. This would suggest that employees need interpersonal physical contact, while the latter tend to solitary activity [33,34]. Also, drug addicts exhibit greater disorganization of the white matter of the prefrontal cortex [35].

3. Porn addiction, although distinct neurobiologically from sexual addiction, is still a form of behavioral addiction and this dysfunctionality favors an aggravation of the person’s psychopathological condition, directly and indirectly involving a neurobiological modification at the level of desensitization to functional sexual stimulus, hypersensitization to stimulus sexual dysfunction, a marked level of stress capable of affecting the hormonal values of the pituitary-hypothalamic-adrenal axis and hypofrontality of the prefrontal circuits [36].

4. The low tolerance of pornography consumption was confirmed by an fMRI study which found a lower presence of gray matter in the reward system (dorsal striatum) related to the quantity of pornography consumed. He also found that increased use of pornography is correlated with less activation of the reward circuit while briefly watching sexual photos. Researchers believe their results indicated desensitization and possibly tolerance, which is the need for more stimulation to achieve the same level of arousal. Furthermore, signals of lower potential have been found in Putamen in porn-dependent subjects [37].

5. Contrary to what one might think, porn addicts do not have a high sexual desire and the masturbatory practice associated with viewing pornographic material decreases the desire also favoring premature ejaculation, as the subject feels more comfortable in solo activity. Therefore individuals with greater reactivity to porn prefer to perform solitary sexual acts than shared with a real person [38,39].

6. The sudden suspension of porn addiction causes negative effects in mood, excitement, and relational and sexual satisfaction [40,41].

7. The massive use of pornography facilitates the onset of psychosocial disorders and relationship difficulties [42].

8. The neural networks involved in sexual behavior are similar to those involved in processing other rewards, including addictions.

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