What if the problem with frequent or problematic porn use was not the behavior itself, but how you, your partner, your religion and the culture around you judged it?  For the past twenty years since pornography became easily accessible online, there has been a tremendous amount of attention on the potential addictive qualities inherent in porn.  There has also been a huge growth in residential treatment facilities who offer sobriety and recovery programs for those that self-identify or whose partners identify them as “porn addicts.”

There have been much discussion in sexuality research and clinical circles on possible new diagnoses and treatment models including: hypersexual disorder, Impulsive/Compulsive Sexual Disorder (ICSD), nonparaphilic compulsive sexual behavior disorder (CSBD) and Out-Of-Control Sexual Behavior (OCSB). As a sex therapist who sees clients who frequently come to treatment in crisis when their out of control sexual behaviors are threatening their marriages, relationships or jobs, I often hear clients self-diagnose as “porn addicts.” I recently began to run Out of Control Sexual Behavior Men’s Group in my practice. While there was not enough research to warrant a formal diagnosis in the most recent revision of the Diagnostic and Statistical Manual (DSM5) in 2013, in 2019 the World Health Organization included the novel diagnosis of CSBD in the 11th revision of the International Classification of Diseases.  

Porn Use and Relationship Challenges

In a recent study by Beáta Bőthe et Al. from a large sample (13,778 participants) researching hypersexuality and problematic porn use, the results indicated that both impulsivity and compulsivity were weakly related to problematic pornography use among men and women, respectively. There is however, growing research that tells us that the frequency of porn use may not be the most critical variable associated with a person’s feeling dysregulated or out of control. Self-Perceived Problematic Porn Use (SPPPU) is a term referring to an individual who self-identifies as addicted to porn because they feel they are unable to regulate their porn consumption, and that use interferes with everyday life.

However, within academic research (Grubbs, Lee, et al., 2020; Vaillancourt- Morel et al., 2017) and my clinical practice, people who report problematic pornography use may do so independently of the actual number of times a week they’re using porn or the length of time spent online while watching porn. Thus, there is evidence that quantity or frequency may not be the only determining factor in whether a person reports feeling out of control in their use of porn. 

The problematic porn or self-described ‘porn addiction’’ use can be viewed more as a symptom of deeper psychiatric issues and/or relational conflicts the person has with others. 

In my clinical experience, which has been primarily with cisgender male clients, a client feels out of control due to the shame he feels when the type of porn he is watching is discovered by a partner and he/she feels disgusted by his erotic interests.

In other situations, a client may feel angry with himself for paying a large amount of money to watch porn secretly. He feels guilty for what his partner and he may look upon as a ‘filthy habit’ that has eaten away at their joint savings.  At other times, if a client feels resentful of the sense of powerlessness he feels in his relationship or at work, his use of porn may be an unconscious expression of anger, freedom, revenge and liberation, a powerful antidote to this concoction of emotions that centers erotic and sexual pleasure to silence the feelings he can’t communicate effectively.

Part of the Sex EsteemⓇ model used with clients is to teach them how to identify what he is feeling by using mindfulness techniques to initially locate the emotion in his body.  If it’s anxiety, frequently a client will feel tightness in his chest, with shame he may report a nauseous sensation in his stomach. If he has not come to terms with his own rage, he may feel clenching his jaw area.  Frequently these clients report masturbating to porn then feeling deep guilt and shame afterwards. What he learns through individual and group therapy is that although he had a moment of reprieve from these intrusive feelings, his conflicts have not been resolved or communicated to the person about or to whom he feels angry, frustrated, ignored or worried.

In a 2021 paper by Joshua B. Grubbs and Shane W. Kraus, the authors state that “although there is evidence that pornography use can be longitudinally predictive of negative relational outcomes, it is not clear whether such links are causal in nature, how prevalent such associations are in practical terms, and whether third variables (e.g., sexual orientation, sexual dissatisfaction, sexual misalignment between partners, religious differences between partners) are potential moderators.”  As a couples sex therapist, I hear about longstanding conflicts and misunderstandings that have been swept under the carpet repeatedly for years at times resulting in both partners feeling angry, defensive and frustrated.  The porn use may then be a strategy to avoid further conflict with a partner and more of a symptom of a deeper relational conflict.  

Porn Use and Internalized Cultural Shame

For clients brought up in highly strict families or communities, sexual activity is rarely discussed among family members and informed sex education may be missing from one’s development. Frequently children and young teens internalize shame and guilt about sex in general including the experience of having sexual fantasies. 

Many self-perceived addictions are shame-based. Unlike diagnosed addictions to substances, porn addiction which one prescribes to oneself is, more often than not part of an internal conflict with values learned implicitly and explicitly in one’s family of origin and larger culture as to the:

• “Right” way of having sex
• “Normal” masturbation frequency
• Accepted sexual orientation
• Unacceptable fantasies if one identifies as heterosexual 
• Potential sinful nature of masturbation in general 
• Derogatory views of a person paying for pornography

Therefore, part of the Sex EsteemⓇ assessment is an in-depth inquiry into the implicit and explicit lessons learned from childhood around sexuality, religious beliefs, cultural norms, familial expectations regarding marriage, erotic taboos and the use of sexually explicit media.  I have worked with clients who have had strict Catholic, Muslim, Hindi and Jewish religious upbringings and educations. While they may still practice these religions and believe in a deity, they have not come to terms with how they want to have sexuality in their lives and relationships. 

In another study by leading porn researchers Joshua B. Grubbs, Samuel L. Perry, Joshua A. Wilt & Rory C. Reid the authors regard the problematic sexual behaviors a person who self-describe as porn addicts better understood “ as functions of discrepancies—moral incongruence—between pornography-related beliefs and pornography-related behaviors.”

This study puts some finality into the answers as to whether porn addiction is a true addiction. By reframing “porn addiction” as an “an incongruity between morals and behaviors,” the paper showed that the amount of time spent using porn does not predict problems with porn; rather, religiosity seems to be the bigger problem.

New Findings About Religiosity and Porn Addiction 

An exciting new 2021 study from the Archives of Sexual Behavior by researchers David C De Jong and Casey Cook found that religiosity–the belief in a deity–had indirect effects on perceived addiction via shame. “…religious primes were associated with higher shame, and in turn, perceived addiction among individuals high on both organizational religiosity…” With regard to pornography addictions, those who self-reported as religious and who were more morally disapproving of porn were more likely to perceive addictions.

Religiosity, then, emphasizes the moral incongruence of porn by forming a system of belief. For those who worship a god, the use of porn depends less on the amount of minutes spent watching porn than the amount of pressure a sense of religiosity imbues on the time spent watching porn. Time is subjective. The misalignment between religious beliefs and pornography use can alter time.

Larger Cultural Myths in the Media 

Unfortunately, the self-help industry is able to perpetuate this sense of shame for their

profit. In this way, religiosity and capitalism promote feelings of shame in their own self-interest. These are some things a “porn addiction clinic” may try to shame people into thinking:

• “People can become addicted to pornography in much the same way they can become addicted to drugs.”
• They often conflate “sex disorder” with “porn addiction.”
• “Porn addiction is the result of smartphones, social media and the Internet.”
• “There is too much pornographic content in the world.”
• Do not thoroughly examine the root causes of the problem.
• They encourage a separation between the stresses of daily life and pornographic addiction. 
• “There is such a thing as excessive porn use.”

The treatment models of Sex EsteemⓇ and the Out of Control Sexual Behavior used in my practice looks at porn use as an expression of all sorts of internal conflicts including moral incongruence, relationship struggles and potential symptoms of some underlying disorders that have never been assessed or diagnosed. For example, a client may have ADHD and plays  out in the distraction of porn to avoid doing mundane aspects of their jobs.  He may have a debilitating Anxiety Disorder and the porn use is a way of overwhelming feelings of anxiety. 

When seeking help for what one might experience as problematic porn use, it is critical to ask a potential therapist what their beliefs are regarding pornography.  Many therapists are also impacted by the culture at large and may regard frequency as a sign of compulsivity rather than using a larger biopsychosocial lens to help clients get more focused on what the behaviors mean, if they want to moderate them and giving them tools to do that individually, in a group and/or in couples therapy.