Diagnosing and Treating Pornography Addiction

Diagnosis

Sexual addiction involves aspects of compulsion or obsession: the addict 'cannot' stop (or cannot stay stopped), and suffers ill effects (social, economic, or other) traceable to the addiction. Such individuals do exist; on the other hand, not all users of pornography are addicts, any more than all users of alcohol are alcoholics.

The Diagnostic and Statistical Manual of Mental Disorders does not presently provide a formal definition for pornography addiction. Many informal "self-tests" have been written (for example, here), but do not appear to have been normed or statistically validated.

Formal criteria have been suggested along lines strictly analogous to the [DSM] criteria for alcohol and other substance addictions. See this article (online copy of Richard Irons, M. D. and Jennifer P. Schneider, M.D., Ph.D "Differential Diagnosis of Addictive Sexual Disorders Using the DSM-IV." In Sexual Addiction & Compulsivity 1996, Volume 3, pp 7-21, 1996). They cite Goodman (1990), who compared the DSM criteria lists for various addictive disorders and derived these general characteristics:

1. Recurrent failure to resist impulses to engage in a specified behavior.
2. Increasing sense of tension immediately prior to initiating the behavior.
3. Pleasure or relief at the time of engaging in the behavior.
4. At least five of the following:
   • Frequent engaging in the behavior to a greater extent or over a longer period than intended.
   • Repeated efforts to reduce, control, or stop the behavior.
   • A great deal of time spent in activities necessary for the behavior, engaging in the behavior, or recovering from its effects.
   • Frequent engaging in the behavior when expected to fulfill occupational, academic, domestic or social obligations.
   • Important social, occupational, or recreational activities given up or reduced because of the behavior.
   • Continuation of the behavior despite knowledge of having a persistent or recurrent social, financial, psychological, or physical problem that is caused or exacerbated by the behavior.
   • Tolerance: need to increase the intensity or frequency of the behavior in order to achieve the desired effect or diminished effect with continued behavior of the same intensity.
   • Restlessness or irritability if unable to engage in the behavior.
5. Some symptoms of the disturbance have persisted for at least one month, or have occurred repeatedly over a longer period of time.

These criteria can be applied to almost any behavior and would seem to characterize excessive and uncontrollable involvement regardless of the particular behavior. They thus provide one reasonable definition of what a pornography addiction would be.

Dr. Victor Cline provides a model of pornography addiction with 4 progressive steps:

• Addiction - A person compulsively views pornography.
• Escalation - As time progresses, the addict requires more extreme, more deviant material to get the same effect and satisfy the compulsions.
• Desensitization - The addict loses their perception of what is socially acceptable. Illegal material or those considered taboo, immoral, or repulsive seems "normal."
• Acting out sexually - "...an increasing tendency to act out sexually the behaviors viewed in the pornography, including compulsive promiscuity, exhibitionism, group sex, voyeurism, frequenting massage parlors, having sex with minor children, rape, and inflicting pain on themselves or a partner during sex."

Patrick Carnes has published extensive analyses of sexual addiction, including specific behavioral and psychological criteria. Virtually all sexual addicts use pornography; however, not all pornography users are sexual addicts.

A diagnosis of sexual addiction should not be made using a simple checklist, but by a psychologist or psychiatrist expert in the treatment of addictive disorders. Carnes and Cline note that such an addiction (like others), is very difficult to overcome without strong support and help.

Overcoming Pornography Addiction

According to the University of Texas at Dallas Student Counseling Center self-help library page on pornography addiction, "One of the great rewards of overcoming a pornography addiction is the ability to be fully committed to another person in a loving way, having nothing to hide and enjoying great sex." Many pornography addicts have recounted stories of trying to quit, and then, believing they had overcome the addiction, deciding to sample it one more time. For a true addict, one image can be enough to trigger an escalating pornography binge lasting several hours.

Recovery programs for porn addiction include counseling, in-patient and support group meetings.

Online Pornography Addiction

Online pornography addiction is a type of pornography addiction in which the user obtains the pornography through the Internet.

Those who believe in the concept of online pornography addiction argue that it is stronger, and more addictive, than ordinary pornography addiction because of the wide availability, increasingly hardcore nature of the content available, and the privacy that viewing online offers.

Allegations of Connections Between Pornography and Violence

It has been claimed that a small number of people who view pornography develop addictions which lead to violent and anti-social behavior. Pornography addictions have been linked to the enactments of serious crimes, notably in the cases of Ted Bundy and David Berkowitz. However, these links are disputed by some, since they come primarily from the criminals themselves, who have a vested interest in shifting the blame for their actions. No reputable study has uncovered a link between pornography and violence, including some which hypothesized and expected to prove such a connection, such as those of the Meese Commission.