Pornography addiction (English: pornography addiction, compulsive pornography use) names a state in which the viewing or use of pornography becomes compulsive and repetitive, control of the amount used becomes difficult, and a marked impairment arises in daily life, work, relationships, or sexual function.

The debate over the disease concept

Pornography addiction is not at present listed as an independent diagnosis in the World Health Organization’s ICD-11 or the American Psychiatric Association’s DSM-5. ICD-11 (in force 2022) newly established the higher category of Compulsive Sexual Behaviour Disorder (CSBD), recording excessive sexual behaviour in general, but this is not a diagnosis specific to pornography use. At the time of the DSM-5’s drafting (2013), a proposed set of criteria for Hypersexual Disorder was considered but ultimately not included, as “research was insufficient”, a decision that has drawn debate between addiction researchers and sexual-medicine and psychiatric specialists. Regardless of the presence or absence of a disease concept, that “problems (dysfunction) arising from pornography use” actually exist is a shared recognition in clinical and self-help settings.

Neuroscientific findings

From the standpoint of the dopamine reward system, a hypothesis has been proposed that repeated exposure to pornography produces an escalation similar to substance dependence, “desensitisation, then a search for stronger stimulus”. The specific model is that the density of dopamine receptors in the nucleus accumbens declines, so the same stimulus no longer yields the former pleasure. The fMRI evidence, however, is not consistent: a study holding that “the brain of a pornography-dependent person shows changes similar to a substance-dependent brain” (Voon et al., 2014) is opposed by a critical analysis holding that “this merely reflects a high interest in pornography” (Prause et al.). A scientific consensus is still in formation.

Typical problem patterns

Problems reported in clinical settings include: use time lengthening and becoming uncontrollable; escalation toward more stimulating or specific niche genres; erectile difficulty in sex with a real partner (PIED, porn-induced erectile dysfunction); declining interest in sexual contact with a partner; an inability to reach orgasm without pornography; and impairment of daily life (work, study, family relations). PIED is a concept proposed from the observation that “the ED rate among young men rose after the spread of internet pornography”; though much disputed, it is widely recognised among clinicians.

The situation in Japan

In Japan, specialist outpatient services for sexual dependence and pornography dependence are limited, and psychiatric care is less developed for this than for, say, gaming dependence. As a self-help group, the Japanese-language group of SAA (Sex Addicts Anonymous) is active, and online forums and recovery communities also exist. Receiving treatment at a medical institution addressing sexual dependence in general (mainly psychiatry and psychosomatic medicine) is a realistic option.

Coping and recovery

Approaches taken include a staged reduction or cessation of viewing (including self-help approaches such as the “NoFap” movement), cognitive behavioural therapy (CBT) for trigger analysis and cognitive modification, mindfulness, and pharmacotherapy where needed (such as SSRIs for compulsive symptoms). The dominant view in contemporary sexual medicine and psychology judges “whether pornography use is a problem” not by the amount or time of use but by the person’s degree of distress and the impact on daily functioning.

See also

• Sexual dependence
• Dopamine and sexual pleasure
• Paraphilia
• Libido