Added: Laquitta Nielsen - Date: 01.05.2022 02:40 - Views: 47445 - Clicks: 6557
Try out PMC Labs and tell us what you think. Learn More. 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. 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. This problematic use might have adverse effects in sexual development and sexual functioning, especially among the young population. We aim to gather existing knowledge on problematic online pornography use as a pathological entity. Here we try to summarize what we know about this entity and outline some areas worthy of further research.
This represents the ongoing paradigm shift in the field of addictions that relates to addictive behavior, and paves the way for new research in the light of cultural changes caused by the new technologies. There is apparently an existing common neurobiological [ 2 ] and environmental [ 3 ] ground between the varying addictive disorders, including both substance abuse and addictive behavior; this can manifest as an overlapping of both entities [ 4 ].
Phenomenologically, behaviorally addicted individuals frequently exhibit a problematic consumption model: impaired control e. Whether these behaviors also meet physiological criteria relating to addiction tolerance, withdrawal is more debatable [ 456 ].
Hypersexual disorder is sometimes considered one of those behavioral addictions. It is used as an umbrella construct that encompasses various problematic behaviors excessive masturbation, cybersex, pornography use, telephone sex, sexual behavior with consenting adults, strip club visitations, etc. The lack of robust scientific data makes its research, conceptualization, and assessment difficult, leading to a variety of proposals to explain it, but is usually associated with ificant distress, feelings of shame and psychosocial dysfunction [ 8 ], as well as other addictive behaviors [ 10 ] and it warrants direct examination.
Concurrently, the rise of the new technologies has also opened up a pool of problematic addictive behavior, mainly Internet Addiction. This addiction may focus on a specific application on the internet gaming, shopping, betting, cybersex… [ 11 ] with potential for risk-addictive behavior; in this case, it would act as a channel for concrete manifestations of said behavior [ 412 ].
This means inevitable escalation, providing new outlets for established addicts as well as tempting people due to increased privacy, or opportunity who would not have ly engaged in these behaviors. Online pornography use, also known as Internet pornography use or cybersex, may be one of those Internet-specific behaviors with a risk for addiction.
It corresponds to the use of Internet to engage in various gratifying sexual activities [ 13 ], among which stands the use of pornography [ 1314 ] which is the most popular activity [ 151617 ] with an infinite of sexual scenarios accessible [ 13181920 ]. Continued use in this fashion sometimes derives in financial, legal, occupational, and relationship trouble [ 621 ] or personal problems, with diverse negative consequences. Due to this model, pornography-related masturbation may be more frequent nowadays, but this is not necessarily a of pathology [ 21 ].
We know that a considerable proportion of young male population access Internet for pornography consumption [ 2425 ]; in fact, it is one of their key sources for sexual health [ 26 ]. Some have expressed concern about this, addressing the time gap between when porn material is consumed for the first time ever, and an actual first sexual experience; specifically, how the former can have an impact on sexual development [ 27 ] like abnormally low sexual desire when consuming online pornography [ 28 ] and erectile dysfunction, which has spiked dramatically among young men in the past few years when compared to a couple decades ago [ 2930313233 ].
We systematically reviewed the existing literature on the subject of POPU to try and summarize the various recent advances made in terms of epidemiology, clinical manifestations, neurobiological evidence that supports this model of problematic use, its diagnostic conceptualization in relation to hypersexual disorder, its proposed assessment instruments and treatment strategies. Given the relatively new body of evidence regarding this subject, we conducted our review with no specific time-delimitation.
Priority was placed upon literature reviews and articles published via a newest to oldest methodology, preferentially for already published reviews on the subject. PubMed and Cochrane were the main databases used, though a of articles were compiled through cross-referencing. Since our focus was mainly online pornography and addictive sexual behavior, we excluded those articles that had only a peripheral association with it in our search: those with a focus on generalized Internet addiction, those centered on the pornographic equivalent of varying paraphilias, and those that approached the subject from a social perspective.
The reference management tool Zotero was used to build a database of all articles considered. They show the overall increasing consumption of pornography over the years, especially among male population in contrast to females. This is particularly prevalent among young adults, and it steadily decreases with age. Some interesting facts about pornography consumption tendencies stand out. One of them is that the and male cohort showed only a very small decline on their usage from the year onwards, suggesting that porn consumption among these groups has remained relatively constant since [ 35 ].
The other one is that is also the year the tendency for women aged 18 to 26 to consume pornography became three times as likely than the ones aged 45 to 53, instead of just two times as likely as it used to be up until that point [ 35 ]. These two facts could be related to changing tendencies in pornography consumption motivated by technology switching from the offline to the online model of consumptionbut it is impossible to know for sure since the original data does not for differences in both offline and online variants when tracking pornography usage.
As for POPU, there is no clear and reliable data in the literature reviewed that can offer a solid estimation of its prevalence. Adding up to the already mentioned motives for lack of data on general pornography consumption, part of it might stem from the perceived taboo nature of the topic at hand by possible participants, the wide range of assessment tools used by researchers, and the lack of consensus on what actually constitutes a pathological usage of pornography, which are all issues also reviewed further into this paper.
The vast majority of studies pertaining POPU or hypersexual behavior prevalence use convenience samples to measure it, usually finding, despite population differences, that very few users consider this habit an addiction, and even when they do, even fewer consider that this could have a negative effect on them. Some examples:. A study assessing behavioral addictions among substance users, found that only 9.
A Swedish study that recruited a sample of participants through a web questionnaire, 7. A Spanish study with a sample of college students found that 8. The only study with a representative sample to date is an Australian one, with a sample of 20, participants; 1. Similar findings also apply to hypersexual behavior outside of pornography [ 39 ].
Predictors for problematic sexual behavior and pornography use are, across populations: being a man, young age, religiousness, frequent Internet use, negative mood states, and being prone to sexual boredom, and novelty seeking [ 17374041 ]. Some of this risk factors are also shared by hypersexual behavior patients [ 3942 ]. Conceptualizing pathological behaviors continues to be a challenge today. POPU comprises a very specific set of sexual behaviors that involve technology. Due to problematic technology use especially online technology being relatively recent, we need first to talk about hypersexual behavior not related to technology in order to understand the place of online pornography in it.
Sexuality as a behavior is vastly heterogeneous, and its potential pathological side has been studied for centuries [ 43 ]. Therefore, it represents a challenge to models trying to adequately define it, since it can incorporate practices ranging from solitary fantasizing to sexual violence [ 21 ]. It is also difficult to define what constitutes an actual dysfunction and manage to avoid the possible misuse of that definition to stigmatize and pathologize individuals [ 44 ]. For example, some set the limit between normal and pathological sexual behavior at more than seven orgasms in a week [ 43 ] p.
This lack of uniformity and consistency in its classification may hinder future research on investigating hypersexual behavior [ 45 ] and ignore the quality aspects that focus on the negative emotions associated with it [ 4647 ]. There have been proposals to redeem this issue using certain tools, already developed as part of the hypersexual disorder proposal used in the DSM-5 field trial [ 4347 ]. Hypersexuality generally acts as an umbrella construct [ 7 ].
Its nomenclature is still a matter of debate to this day, and it is frequent to encounter several terms that refer to the same concept: compulsive sexual behavior, sex addiction, sexual impulsivity, hypersexual behavior or hypersexual disorder. Although definitions are not uniform, they usually focus on the frequency or intensity of symptoms [ 46 ] of otherwise normal urges and fantasies, that would result in dysfunction. This differentiates it from paraphilic sexual behavior, though the need for a better clarification of possible differences, similarities, and overlap between the two types still persists [ 45 ].
Usually included in hypersexual behavior are excessive masturbation and various sexual related behaviors, like dependence on anonymous sexual encounters, repetitive promiscuity, internet pornography, telephone sex, and visiting strip clubs [ 4344495051 ]. He presented a set of criteria for it, as part of the sexual disorders chapter.
This proposal was ultimately rejected due to several reasons; the main was said to be absence of consolidated epidemiological and neuroimaging data regarding this behavior [ 5253 ], but also its potential for forensic abuse, a not specific enough set of diagnostic criteria, and potential politic and social ramifications of pathologizing an integral area of behavior to human life [ 54 ]. It is interesting to compare it to the other two set of criteria present in the reviewed literature, those of Patrick Carnes and Aviel Goodman [ 9 ].
This reflects in broad strokes the lack of consensus in conceptualizing hypersexual behavior across the years. Currently, the main options propose hypersexual behavior either as an impulse control disorder or a behavioral addiction [ 55 ]. From an impulse control disorder perspective, hypersexual behavior is generally referred to as Compulsive Sexual Behavior CSB. Coleman [ 56 ] is a proponent of this theory. While he includes paraphilic behavior under this term [ 57 ], and they may coexist in some cases, he distinctly differentiates it from nonparaphilic CSB, which is what we want to focus on in this review.
Interestingly, nonparaphilic hypersexual behavior is usually as frequent, if not more, than some paraphilias [ 4358 ]. While there are definite overlaps between hypersexuality and conditions such as obsessive-compulsive disorder OCD and other impulse control disorders [ 61 ], there are also some notable differences pointed out: for example, OCD behaviors do not involve reward, unlike sexual behavior. Moreover, while engaging in compulsions might result in temporary relief for OCD patients [ 62 ], hypersexual behavior is usually associated by guilt and regret after committing the act [ 63 ].
Goodman thinks that addiction disorders lie at the intersection of compulsive disorders which involve anxiety reduction and impulsive disorders which involve gratificationwith the symptoms being underpinned by neurobiological mechanisms serotoninergic, dopaminergic, noradrenergic, and opioid systems [ 65 ]. Stein agrees with a model combining several ethiopathogenical mechanisms and proposes an A-B-C model affective dysregulation, behavioral addiction, and cognitive dyscontrol to study this entity [ 61 ].
From an addictive behavior standpoint, hypersexual behavior relies on sharing core aspects of addiction. These aspects, according to the DSM-5 [ 1 ], refer to the mentioned problematic consumption model applied to hypersexual behavior, both offline and online [ 66667 ]. Evidence of tolerance and withdrawal in these patients might probably be key in characterizing this entity as an addictive disorder [ 45 ]. Problematic use of cybersex is also often conceptualized as a behavioral addiction [ 1368 ].
However, the term needs to be used with caution, since it can be interpreted as a justification for an irresponsible search for gratification and hedonist pleasure, and blame the disruptive consequences on it. There has long been a debate between Patrick Carnes and Eli Coleman over the diagnostics of hypersexual behavior. The main concerns are aimed towards quantity of large-scale prevalence, longitudinal and clinical data defining main symptoms and its diagnostic limitssupported by neuropsychological, neurobiological, and genetic data, as well as some information regarding possible treatment screening and prevention, and points to digital technology in hypersexual behavior as a key point for future research.
The rise of the Internet increases the possibilities for sexual interactions, and not just online pornography webcamming, casual sex websites. Even whether Internet use represents a conduit for other types of repetitive behavior e. Nevertheless, if the case is the former, the evidence and considerations could very well apply to its online counterpart.
There is currently a need for empirically derived criteria that takes into unique factors characterizing online versus offline sexual behaviors, since most of them do not have an offline version that can be compared to [ 73 ]. This dissociation has already been described in relation to other online activities [ 75 ], which supports the notion that cybersex problematic use could be related to both internet and sex addiction [ 76 ]. The inclusion of this category in the ICD may be a response to the relevance of this issue and attest to its clinical utility, whereas the growing but yet inconclusive data prevents us from properly categorizing it as a mental health disorder [ 72 ].Adult searching sex MD
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Online Porn Addiction: What We Know and What We Don’t—A Systematic Review