Theories, prevention, and treatment of pornography-use disorder
03. September 2019 (online)
Introduction 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.
Methods Based on theoretical considerations, empirical studies are evaluated considering the question if the main characteristics and processes involved in addictive behaviors can also be observed in problematic pornography use.
Results 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. Randomized placebo-controlled clinical trials are needed to demonstrate the potential long-term effects of pharmacological interventions. Systematic studies on the efficacy of prevention methods for problematic pornography use are still missing, but a very important topic for future research and practice.
Conclusion Theoretical considerations and empirical evidence suggest that the psychological and neurobiological mechanisms involved in addictive disorders are also valid for pornography-use disorder. Systematic studies addressing potential intervention strategies are one of the main challenges for future research providing data for evidence-based prevention and treatment of pornography-use disorder.