Is there evidence supporting the existence of pornography addiction? (2013)
Donald L. Hilton
Yes, according to Donald L Hilton, MD, author of “Pornography addiction – a supranormal stimulus considered in the context of neuroplasticity” in Socioaffective Neuroscience & Psychology. But one needs the perspective and education to understand the supporting evidence—and why it will eventually overtake the competing viewpoint that compulsive porn use is due to “hypersexual disorder,” or as it is often euphemistically described, “high sexual desire.”
According to Hilton, science is shifting with respect to understanding the neurological commonalities of addiction. Yet, “to accept the evidence supporting the concept of sexual addiction, it is necessary to have an understanding of the current concepts of cellular learning and plasticity.”
Already, a host of studies on the brains of gambling addicts have revealed strong parallels with the brain changes seen in substance addicts. As a consequence, the American Psychiatric Association’s DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) now includes gambling addiction in its new section on addictive disorders.
According to the manual’s psychiatrist authors, this change “reflects the increasing and consistent evidence that some behaviors, such as gambling, activate the brain reward system with effects similar to those of drugs of abuse and that gambling disorder symptoms resemble substance use disorders to a certain extent.”
Already, some 50 similar studies on Internet addicts and videogame addicts are also showing these telltale addiction-related brain changes. Yet, the new DSM-5 banished Internet addictions to the section for disorders needing further study, and completely omitted any mention of Internet pornography. Hilton points out that this makes little sense:
Consider hypothetically two individuals, frantically fixated to their computers, both trying to win an intermittently reinforced reward. Both spend hours a night at their task, and have for some period, to the point of exhaustion. Work and personal relationships are affected negatively, yet they cannot stop. One is looking at pornography, searching for just the right clip for sexual consummation; the other is engrossed in an online poker game. One reward is masturbatory, and the monetary, yet the DSM-5 classifies only the poker as an addiction. This is both behaviorally and biologically inconsistent.
The biology of addiction
One of the strengths of Hilton’s article is that he cogently summarizes the medical research and addresses the evolutionary pressures which demonstrate that the biological bases of addiction, behavioral or chemical, are the same. He writes,
Rather than focusing on whether the addictive behavior involves injecting drugs or viewing highly arousing sexual images, an increased knowledge of cellular mechanisms allows us to understand that addiction involves and alters biology at the synaptic level, which then affects subsequent behavior. Addiction neuroscience is now as much about neuronal receptor reactivity, modulation, and subsequent plasticity as it is about destructive and repetitive behavior.
Today’s Internet porn, with its artificially enhanced actors and unending novelty, is illustrative of Nikolaas Tinbergen’s concept of the ‘supranormal stimulus’. Tinbergen discovered that birds, butterflies, and other animals could be duped into preferring fake substitutes that were larger or had bigger spots than the animal’s normal eggs and mates.
As Hilton says, “Regardless of how higher cortical function colors sex with other recreational nuances, evolutionary procreative pressures eventually trump purely recreational motives in biologically successful species, including humans.”
Sex (the urge to reproduce) doesn’t merely drive evolution. Scientists are also learning that the brain mechanisms hijacked by addictive substances and activities are the same mechanisms that evolved for insuring that the brain wires up to relevant sexual stimuli. “Addiction, of course, can be described as disordered salience. Instead of wanting that which will enhance survival, the addicted are motivated to want even when it is clearly harmful, a neuroplastic process that recalibrates the hedonic set point.”
Supernormal sexual stimuli, then, are prime candidates for addiction. This means that the “hypersexual syndrome” label is inadequate. Although the term describes the behavior, it ignores decades of research revealing how learning alters the brain, and
does a disservice to both professionals and the public in inconsistently exempting the most powerful natural dopaminergic reward in the nervous system, sexual orgasm (Georgiadis, 2006), from neuroplastic learning.
Sex, as the most potent natural reward, merits “the addiction label when compulsively and destructively expressed.” The correct label would also encourage investigation into the possibility that “high sexual desire” may, in fact, have nothing to do with underlying libido. It may simply be addiction-related cravings stemming from the same kind of brain changes seen in gambling and other addicts. Are alcoholics just really thirsty? Or morbidly obese food addicts just really hungry? Were they born that way? No, both suffer addiction-related cravings.
It’s worth nothing that the addiction-hypersexual distinction has implications for treatment. Removing the supernormal stimulus to which the brain has become sensitized is very helpful in addictions. In contrast, if one is persuaded s/he merely has high sexual desire then acceptance, a search for suitable outlets, or, worst case, libido-suppressing drugs, are often advised.
Kuhnian Revolution In Progress?
Half a century ago, Kuhn pointed out in The Structure Of Scientific Revolutions, that when established paradigms are challenged by anomalies, scientists tend to defend the status quo until emerging evidence and theory render the status quo obsolete. The resulting friction can be bitter and destructive as Galileo, Ignaz Semmelweis, and others who challenged prevailing dogma found.
Hilton notes that one strategy of the defenders of the “hypersexual disorder” model is to demand a higher—or rather, impossible—standard of proof for sexual behaviors than has been required for defining addiction to other behaviors and substances. For example, one defender declared that for “pornography to be labeled addictive, we would have to prospectively addict one cohort of children, protect another, functionally scan both cohorts before and after, and compare behavioral outcomes.” Of course, ethical considerations forbid such a study, so it will never happen. Yet we all accept that tobacco and other substances are addictive without prospective, child-based studies.
Hopefully such transparent tactics will fade as the mainstream learns to “see addiction, whether to smoking, cocaine, or sex, through the lens of the neural receptor and subsequent neuroplastic change, and not solely from a behavioral perspective.”