Problematic Porn Use: Quantity vs. Consequences – By Robert Weiss LCSW, CSAT-S

A new study by Mateusz Gola, Karol Lewczuk, and Maciej Skorko, published in The Journal of Sexual Medicine, looks at the factors that drive people into treatment for problematic porn use. In particular, Gola and his team wanted to determine if frequency of porn use or consequences related to porn use are more important. Unsurprisingly, as sex addiction treatment specialists like myself and Dr. Patrick Carnes have been stating and writing for more than a decade, when diagnosing and treating porn addicts the amount of porn a person uses is considerably less relevant than his or her porn-related consequences. In fact, Dr. Carnes and I have consistently defined porn addiction based on the following three factors:

1. Preoccupation to the point of obsession with highly objectified pornographic imagery
2. Loss of control over the use of pornography, typically evidenced by failed attempts to quit or cut back
3. Negative consequences related to porn use—diminished relationships, trouble at work or in school, depression, isolation, anxiety, loss of interest in previously enjoyable activities, shame, sexual dysfunction with real world partners, financial woes, legal issues, etc.

As you may have noticed, none of these criteria mention how much porn a person is looking at (or any other quantitative measure). In this respect, porn addiction is like substance abuse disorders, where it’s not how much you drink/use, it’s what drinking and using does to your life.

In recent years, of course, we’ve seen numerous studies linking the amount of porn use to potential negative consequences. But until this recently published research appeared we’ve had little to no scientific support for our claim that consequences (rather than some sort of quantified usage) is the primary measure we should use when identifying and treating pornography addiction.

The Study

Data for the Gola study was collected from March 2014 through March 2015 from a sample of heterosexual male Polish citizens. The test sample of 569 men (mean age 28.71) included 132 men who self-identified as seeking treatment for problematic porn use. (The rest of the sample served as the control group.) “Negative consequences” were identified using a Polish adaptation of the Sexual Addiction Screening Test-Revised (SAST-R), with twenty yes/no questions geared toward assessment of preoccupation, affect, relationship disturbance, and feeling as if one’s sexual behavior is out of control.

The study initially looked at amount of porn use and propensity for seeking treatment, finding a significant correlation. This mirrors earlier research looking (peripherally) at this issue. For instance, studies led by Valerie Voon (Cambridge, UK) and Daisy Mechelmans (Cambridge, UK) found that a non-treatment seeking control group looked at porn approximately 1.75 hours per week, whereas treatment-seeking test subjects looked at porn approximately 13.21 hours per week. However, the Cambridge studies did not consider the relationship between amount of porn use, consequences, and seeking treatment—instead focusing on aspects of neurobiology and cue reactivity.

When Gola’s team adjusted for the full mediation effect of negative consequences, the relationship between amount of porn use and seeking treatment disappeared. Meanwhile, the link between negative consequences and seeking treatment was strong, and it stayed strong relative to multiple potentially mediating factors (age of first porn use, years of porn use, subjective religiosity, and religious practices).

These findings led Gola, Lewczuk, and Skorko to conclude: “Negative symptoms associated with porn use more strongly predict seeking treatment than mere quantity of pornography consumption. Thus, treatment of problematic porn use should address qualitative factors, rather than merely mitigating the frequency of the behavior, because frequency of porn use might not be a core issue for all patients.”

Preaching to the Choir

In some ways, this new research is simply telling us what we already know. If a person is looking at porn and that behavior is impacting his or her life in negative ways, he or she might want/need to do something about it. Conversely, if a person is looking at porn and it’s not causing problems, then he or she probably doesn’t need to make any changes in that area. And this is true regardless of the amount of porn a person is using. So, once again, it’s not the amount of porn a person is using, it’s what porn use is doing to his or her relationships, self-image, and wellbeing that counts.

Still, this study is an important step forward in terms of legitimizing sexual addiction as an official psychiatric diagnosis. After all, the American Psychiatric Association has so far turned a blind eye toward sex/porn addiction, failing to list this very real and debilitating disorder in the DSM-5 despite an APA-commissioned position paper by Harvard’s Dr. Martin Kafka recommending exactly the opposite. And the APA’s only publicly stated reason for doing so appears in the DSM-5’s introduction to the Addictive Disorders section:

Groups of repetitive behaviors, which some term behavioral addictions, with such subcategories as “sex addiction,” “exercise addiction,” or “shopping addiction,” are not included because at this time there is insufficient peer-reviewed evidence to establish the diagnostic criteria and course descriptions needed to identify these behaviors as mental disorders.

In reality, as Dr. Kafka rather eloquently detailed in his position paper, there is more than enough evidence for the APA to officially recognize sex/porn addiction. In fact, many of the disorders currently listed in the DSM-5 (particularly the sex-related disorders) have significantly less supportive evidence. Nevertheless, the APA has opted for “lack of research” (rather than “political/financial pressure from pharmaceutical and insurance companies”) as grounds for its obstinate, behind-the-times stance.

Happily, new research on sex addiction emerges on a relatively regular basis, including this new study from Gola, Lewczuk, and Skorko, which confirms a portion of Dr. Kafka’s recommended diagnostic criteria (and the strikingly similar criteria that sex addiction treatment specialists have been using for many years).

So is the APA likely to move forward with an addendum to the DSM-5 that officially recognizes sex/porn addiction as an identifiable and treatable disorder? Based on just this study, probably not. After all, when it comes to making significant changes to the ways in which clinicians view psychiatric disorders the APA is nearly always late to the party. But as the evidence mounts, the APA will eventually have to concede, acknowledging the growing incidence of porn addiction in all segments of the population. Until then, of course, nothing much changes. Porn addicts hoping to heal will still seek therapy and 12-step recovery, and the clinicians who treat these men and women will do so in the ways they know best, with or without the APA’s recognition and support.