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

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

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

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

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

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

Compulsivity Section

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

Access Efforts Section

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

Emotional Distress Section

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

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

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

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

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

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

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

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

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

Josh Grubbs‏ @JoshuaGrubbsPhD

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

Nicole R Prause, PhD‏ @NicoleRPrause

You or reviewer?

Josh Grubbs‏ @JoshuaGrubbsPhD

Reviewer said it to me

Josh Grubbs‏ @JoshuaGrubbsPhD  Jul 14

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

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

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

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

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

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

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

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

or a study saying that:

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

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

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

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

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

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

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

Not true. This section debunks this claim.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Leonhardt, et al. said:

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

Without the inaccurate terms:

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

Leonhardt, et al. said:

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

Without the inaccurate terms:

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

Leonhardt, et al. said:

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

Without the inaccurate terms:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The study’s two major revelations:

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

Are these findings a surprise to anyone?

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

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

Religiosity does not correlate with porn use or porn addiction

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

Leonhardt, et al. and the Joshua Grubbs studies did not use a cross-section of religious individuals. Instead, only current porn users (religious or nonreligious) were questioned. Pretty much every study published reports far lower rates of porn use in religious individuals as compared with non-religious individuals (study 1, study 2, study 3, study 4, study 5, study 6, study 7, study 8, study 9, study 10, study 11, study 12, study 13, study 14, study 15, study 16, study 17, study 18, study 19, study 20, study 21).

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

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

  • Secular: 54%
  • Religious: 19%

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Summary of Religiosity and Porn Use:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Abstract

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

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

Leonhardt ND1, Willoughby BJ1, Young-Petersen B1.

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

PMID: 28287845

DOI: 10.1080/00224499.2017.1295013

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