As of now, there is not an official DSM-5 (the diagnostic manual used in the US and Canada) diagnosis for porn compulsivity/addiction. However, the World Health Organization recognizes Compulsive Sexual Behavior Disorder in the ICD-11 (the diagnostic manual used by the rest of the world), defining it as “a persistent pattern of failure to control intense, repetitive sexual impulses or urges, resulting in repetitive sexual behavior over an extended period (e.g., six months or more) that causes marked distress or impairment in personal, family, social, educational, occupational or other important areas of functioning.” This diagnosis certainly applies to compulsive/addictive porn use. It also meshes nicely with the criteria that Certified Sex Addiction Therapists have been using in the US and elsewhere for a couple of decades. These criteria boil down to:

• Preoccupation to the point of obsession with sex/porn.

• Loss of control over sex/porn behaviors, generally evidenced by multiple failed attempts to quit or cut back.

• Directly related negative life consequences – relationship woes, problems at work or in school, shame, depression, anxiety, loss of interest in previously enjoyable activities, financial trouble, legal issues, etc.

As stated in my response to the previous question, the most obvious signs of porn addiction are:

• Preoccupation to the point of obsession with sex/porn.

• Loss of control over sex/porn behaviors, generally evidenced by multiple failed attempts to quit or cut back.

• Directly related negative life consequences – relationship woes, problems at work or in school, shame, depression, anxiety, social and emotional isolation, sexual dysfunction (porn-induced erectile dysfunction), loss of interest in previously enjoyable activities, financial trouble, legal issues, etc.

Many of the people who self-identify as porn compulsives/addicts say they look at porn several hours per day and sometimes for all day or weekend-long binges. These individuals also tend to amass a collection of pornography, and then because of shame they feel about their behavior or some external factor, they delete their collection and swear off, only to find themselves starting a new collection soon thereafter.

Porn addiction starts with someone who is looking to fill a relational or sexual need that is unmet in their personal lives. At the start, porn is fun and exciting, and a great distraction. It meets many forms of emotional and physical needs right away with no relationship or social obligations required. Then porn use escalates, eventually becoming a compulsion/addiction.

This, of course, is the process with all addictions. The user experiments with it, enjoys it, uses it some more, and eventually starts to use it as a coping mechanism – a way to avoid uncomfortable feelings like loneliness, stress, anxiety, etc. This is also why alcoholics drink and drug addicts get high. It’s not about feeling good and having a good time; it’s about feeling less (avoiding emotional discomfort). This excellent YouTube video (https://www.youtube.com/watch?v=fwdb9NsaA1Q) has some individuals discussing their porn addiction, including how it started.

Around the world, anti-porn activists argue that porn is our number one public health crisis. To date, seven states have fallen prey to this tactic, with four others considering legislative passage of similar declarations. Meanwhile, porn proponents argue, “If it feels good, go for it. And if it doesn’t feel good, find a therapist who will help you find a way to make it feel good.”

In a recently published journal article, Constructing a Crisis: Porn Panics and Public Health, Valerie Webber and Rebecca Sullivan debunk the anti-porn extremists, writing, “Not one global health agency – the usual experts to identify and define the field of public health – supports [the idea of identifying porn as a public health crisis].” At the same time, the World Health Organization has debunked the “porn harms no-one” pro-porn argument by adding Compulsive Sexual Behavior Disorder as an official diagnosis in the ICD-11.

At the end of the day, the extremes of the porn debate are based on personal beliefs and assertions, and not on research-backed facts. Thus, my preference is not to enter into that debate. Instead, I focus my attention on the individuals who struggle with compulsive/addictive porn use. My job is to help those in need. Period. I am neither a porn advocate nor the sex police, nor do I care to be. Some people struggle with the use of pornography, just as some people struggle with alcohol and other addictive substances. Whether these things constitute a public health crisis is, from my perspective, irrelevant.

Yes. Depending on the research, anywhere from 17 percent to 58 percent of men who struggle with pornography report issues with erectile dysfunction (ED), delayed ejaculation (DE), or inability to reach orgasm (anorgasmia). Often, this is the most disturbing consequence of compulsive/addictive porn use, especially among younger male users. And without doubt, this issue is increasingly common. Stated simply, growing numbers of physically healthy men, including men in their sexual prime, are suffering from sexual dysfunction related to their use of pornography.

And no, this issue is not linked to frequency of masturbation and orgasm (i.e., the need for a sexual refractory period in which males reload, so to speak). In actuality, the problem is tied to the fact that when a male spends the majority (or all) of his sexual life masturbating to online pornography – endless images of visually perfect (whatever that means to the user), constantly changing partners and experiences – he is, over time, likely to find a real-world partner or a simple sexual fantasy less than stimulating. For these individuals, online porn creates an emotional and psychological disconnect that manifests physically as sexual dysfunction.

Please note that sexual dysfunction is just one among many symptoms of compulsive/addictive porn use. For many men, especially younger men, it's one of the more disturbing consequences, but there are plenty of other issues that heavy porn users may experience.

Because there is not an official “porn addiction” diagnosis (as of today), there are no official screening tools either. In my work, in my books, and at our Seeking Integrity treatment center in Los Angeles, we use a 25-question Sex and Porn Addiction Self-Test, which can be found online at this link (https://seekingintegrity.com/resources/sex-addiction-test/). Then, when individuals enter treatment, we do a full bio-psycho-social-sexual assessment looking not just for sexual issues, but other issues that may be related to the client’s sexual activities.

There is no set threshold for “too much” pornography. It’s a bit like alcohol and alcoholism, where it’s not what you drink or how much you drink, it’s how drinking affects your life and the lives of those around you. If porn use is creating negative consequences and causing you to feel shame, depression, and anxiety, you probably have an issue that you should seek help with. If you’ve tried to quit several times and failed, you probably have an issue that you should seek help with.

Asking if young people can become compulsive with or addicted to porn is a bit like asking if they can become alcoholic or drug addicted. Of course they can. In fact, they are every bit as vulnerable as adults to compulsivities and addictions of all types, perhaps more so because their emotional immaturity has prevented them from developing healthy coping skills, and because their brains are more malleable (and therefore more easily wired toward compulsive/addictive stimuli) than adult brains. Professionals are seeing increasing numbers of teens and young adults who report that they started using porn even before puberty, often as young as 7, 8, or 9. And it is clear that their neural and sexual development was profoundly influenced by this behavior.

That said, it is sometimes difficult to separate healthy teens and sex/porn addicted teens. To differentiate, we need to look at the individual holistically. Consider, for example, a boy who masturbates to pornography several nights per week before going to bed who is maintaining his grades, his social life, and other important aspects of life. This boy probably does not have a sex/porn addiction problem, even though his parents might be somewhat disturbed by his behavior. Now consider a boy who looks at and masturbates to pornography multiple hours nightly, whose grades have fallen off a cliff, and who has lost interest in normal teenaged social activities. In all likelihood, this boy does have a sex/porn related issue that needs to be addressed.

Like any intense, emotionally arousing experience, viewing pornography creates an intense dopamine and adrenaline rush. This “rush” exceeds what we get from “natural” rewards like eating, helping a friend, and even being sexual with a person we love. As this continues over time, the brain recognizes this and adjusts, attempting to return us to a more baseline level of neurochemical reward. It does this by reducing the number or neurons that produce and/or receive dopamine and adrenaline. When that happens, we must use more of or a more intense version of pornography to achieve the same “high” that we got when we started. (Happily, these changes are not permanent; with ongoing abstinence from porn, the brain can return to normal.)

In my book, Out of the Doghouse (https://www.amazon.com/Out-Doghouse-Step-Step-Relationship-Saving/dp/0757319211/ref=sr_1_1?dchild=1&keywords=out+of+the+dog+house&qid=1596560296&sr=8-1), I define cheating as “the breaking of trust that occurs when you keep intimate, meaningful secrets from your primary romantic partner.” Please note that this definition does not speak specifically about affairs, pornography, strip clubs, hookup apps, or any other specific sexual or romantic act. Instead, it focuses on what matters most in relationships: mutual trust. This definition also encompasses both online and real-world sexual behavior, as well as sexual and romantic activities that stop short of intercourse – everything from looking at porn to kissing to something as simple as flirting. Most importantly of all, that this definition is flexible depending on the couple. When we’re talking about pornography, that last point is extremely important. A couple gets to decide, based on their own beliefs and values, what is OK and what is not OK in their relationship. Thus, it might be fine for one partner to look at porn, as long as the other partner knows about this behavior and is OK with it. If, however, one partner is looking at porn and keeping it secret, or if the other partner knows about it and doesn’t find it acceptable, then the behavior is cheating. Ultimately, what causes problems in intimate relationships is as much about secrets and lies as the behavior that’s being covered up.

Generally speaking, treatment for porn compulsivity/addiction uses the same basic strategies and techniques as treatment for alcoholism, drug addiction, compulsive gambling, compulsive gaming, and eating disorders. Early treatment efforts focus on containing problematic behaviors and breaking through denial, managing the crisis or crises that pushed the individual into treatment, while also identifying and addressing (as appropriate) underlying trauma, psychological disorders, and related issues.

Treatment typically includes both individual and group therapies paired with social learning, psychoeducation, 12-step or other addiction-focused social support, and alternative methodologies like psychodrama, art and movement therapies, exercise, meditation, and experiential therapies. A psychiatrist might also suggest a trial-run of an antianxiety or antidepressant medication, as these can reduce not only anxiety and depression but cravings to engage in problem sexual behaviors.

Casual users of porn tend to not have porn-related problems. As usage escalates toward compulsion/addiction, problems may arise. Research tells us that compulsive/addictive porn users experience a wide variety of directly and indirectly related problems. For example, a survey of 350 self-identified sex and porn addicts identified the following issues:

Shame 70.5% Low Self-Esteem 65.0% Mental Health Issues 49.8% Loss of a Relationship 46.5% Sexual Dysfunction 26.7% Serious Suicidality 19.4% Sexually Transmitted Disease 19.4% Other (Non-STD) Physical Health Problems 15.7% Debt 14.7% Impaired Parenting 14.7% Legal Actions Against 06.0% Loss of Employment 04.1% Press Exposure 00.9%

Regardless of the study and who conducted it, the primary consequences of compulsive/addictive porn use tend to boil down to shame, mental health issues, relationship woes, social isolation, and sexual dysfunction.

No, not at all. Often, the opposite is true, where the porn user finds his or her partner far more attractive that what is viewed online. This may not seem to make sense, but it does when you understand the nature of addiction – a desire to “numb out” and “escape from” emotional discomfort. This is true for every addiction. At the end of the day, porn addiction is not about physical arousal; it’s about emotional escape. This is also why alcoholics drink and drug addicts get high. Your partner’s porn use has nothing to do with your looks, though it may well impact how you feel about your looks. In fact, it is very normal for anyone in an intimate relationship to feel less than when their partner is looking at porn. This can be exacerbated by the fact that porn addicts will sometimes blame their spouse (not attractive enough, nag too much, etc.) to justify their use of porn.

People who are not deeply motivated to change, don’t change. They may say they are going to change, but then they don’t because they are not motivated to do so. Typically, with addictions, profound behavioral changes only arise in response to pain, loss, and fear of loss. Healthy people will change their relationship with porn based on their circumstances, perhaps stopping porn altogether when they get into a relationship. Addicts, on the other hand, tend to change their relationship with porn only because they have lost or are going to lose a job, they’re losing or have lost a relationship, etc. Pain is what produces a desire for help and change in addicts.

Most sex and porn addicts in the early stages of recovery have little to no idea what the term “sexual sobriety” means. Often, they fear that sexual sobriety mirrors chemical sobriety, where permanent abstinence is the goal. However, unlike sobriety for alcoholism and drug addiction, sexual sobriety is not defined by long-term abstinence/celibacy. Recognizing this, we define sexual sobriety as we define sobriety with eating disorders – another area in which long-term abstinence is simply not feasible. Rather than permanently abstaining from all sexual activity, recovering sex and porn addicts think about sobriety as being sexual in non-compulsive, non-problematic, life-affirming ways. That said, if porn is a significant part of the problem, especially if it is the primary problem, then long-term abstinence from porn is generally necessary.

Sadly, not yet. However, as stated in my responses to earlier questions, the World Health Organization recognizes Compulsive Sexual Behavior Disorder (CSBD), defining it in their diagnostic guide (the ICD-11) as “a persistent pattern of failure to control intense, repetitive sexual impulses or urges, resulting in repetitive sexual behavior over an extended period (e.g., six months or more) that causes marked distress or impairment in personal, family, social, educational, occupational or other important areas of functioning.” As this diagnosis covers every country in the world excepting the US and Canada, it seems likely that the DSM will follow suit in its next revision.

Porn use for porn addicts can absolutely involve both tolerance and escalation. Stated simply, heavy porn users, must use more porn or more intense versions of porn to achieve the same level of sexual intensity, arousal, and pleasure they got when the first started. And sadly, this can lead some users into behaviors that violate their moral values and even laws. This concept is discussed in this excellent YouTube video. https://www.youtube.com/watch?v=fwdb9NsaA1Q

That said, there are people who try to use “addiction” as an excuse in an effort to reduce the judgment and consequences they may be facing. Sometimes these individuals are indeed addicted, but just as often they are not. And either way, being addicted does not let someone off the hook for his or her actions. In fact, part of addiction recovery is owning one’s behavior and accepting the consequences of that behavior.

In some people, porn abuse and major mental health disorders can be related. Thus, the essential need for a clinical and professional assessment/evaluation of the problem before anyone says, “I’m an addict.” Here is a partial list of mental health problems that can produce hypersexual behavior:

• Bipolar I and Bipolar II Disorder • Obsessive-Compulsive Disorder • Attention-Deficit/Hyperactivity Disorder • Narcissistic Personality Disorder • Social Anxiety Disorder (Social Phobia) • Autism Spectrum Disorder • Mood Disorders (anxiety/depression) • Profound Early Life Trauma • PTSD

At the end of the day, clinicians must recognize and understand that compulsive and impulsive sexual behaviors can arise related to any number of psychological conditions. Clinicians must also recognize and understand that the reverse may be true, meaning any number of psychological issues can arise related to compulsive and impulsive sexual behaviors. It is incumbent on the therapist to fully assess the client, including sexual issues – where they started, how they manifest, and why they manifest – before assigning a diagnosis and

The risk factors for porn addiction are, in most respects, the same as with other addictions. Adults who were abused, neglected, or otherwise traumatized as children are at high risk for all types of addiction (and other adult-life psychological issues). Furthermore, the more times a child is traumatized, the greater the likelihood of adverse reactions later in life. One study found that survivors of chronic childhood trauma (four or more significant trauma experiences prior to age 18) are:

• 1.8 times as likely to smoke cigarettes • 1.9 times as likely to become obese • 2.4 times as likely to experience ongoing anxiety • 3.6 times as likely to be depressed • 3.6 times as likely to qualify as promiscuous • 7.2 times as likely to become alcoholic • 11.1 times as likely to become an intravenous drug user.

So, there is an undeniable link between childhood trauma and numerous adult-life symptoms and disorders, including addiction.

Another relatively common risk factor for all types of addiction is early exposure. Numerous studies have found that the lower the age of first use, the higher the likelihood of addiction. This is true with all forms of addiction (n, including sexual addiction. Whether sex was vilified or glorified, a large percentage of sex addicts were exposed to it at an unusually early age. One recent survey of adult sex/porn addicts found that 41% were using pornography before the age of 12.

The term “gateway drug” has been around for several decades. Generally, we have thought about gateway drugs as cigarettes, alcohol, and marijuana. The basic idea is that using these substances, especially early in life, increases the likelihood of becoming addicted to these drugs later on, and also the likelihood of using and possibly becoming addicted to harder drugs like cocaine, meth, and opioids. Only recently has the term gateway drug been applied to pornography. And yes, it does appear that some of the more emotionally vulnerable and damaged people among us may well escalate from extensive early-life porn use into later-life addictions, in particularly sexual addiction/compulsivity. But please understand that I am not in any way saying that every person who is exposed to porn at a young age will develop later-life problems with sex and intimacy (or anything else). I am simply stating that using porn early in life presents risks that are similar to risks associated with the early-life use of cigarettes, alcohol, and marijuana.

Research from 2007 suggested that the average age of first exposure to pornography was 11. Today, given the ease of access to pornography, the age may be even younger.

Yes. I keep an updated list of resources for sex and porn addicts at this link (https://seekingintegrity.com/resources/#addicts) on the Seeking Integrity Treatment Center website. There are numerous 12-step groups for sex and porn addiction recovery and healing. Addicts can also access free webinars, discussion groups, podcasts, blogs, and more on our SexandRelationshipHealing.com website.

As stated in my response to earlier questions, porn compulsivity/addiction is not about sexual arousal and satisfaction; it’s about escaping emotional discomfort. Basically, porn has become your go-to coping mechanism for loneliness, boredom, stress, anxiety, and anything else you don’t want to feel. To overcome this, you will need help. No one recovers from addiction alone.

Most often, recovery is achieved through a combination of treatment (either inpatient or outpatient) and 12-step support. Individuals who are struggling to get their recovery off the ground can contact Seeking Integrity at this link (https://seekingintegrity.com/contact-us/). We will be happy to point you toward a therapist in your area. We also offer a wide variety of free resources (webinars, discussion groups, podcasts, blogs, daily inspirations, etc.) through our SexandRelationshipHealing.com website.

The criteria for sex/porn addiction are:

• Preoccupation to the point of obsession with sex/porn. • Loss of control over sex/porn behaviors, generally evidenced by multiple failed attempts to quit. • Directly related negative life consequences – relationship woes, problems at work or in school, shame, depression, anxiety, social isolation, sexual dysfunction, loss of interest in previously enjoyable activities, financial trouble, legal issues, etc.

If, after careful thought, you see yourself as meeting these criteria, you’ve progressed from casual use to addiction.

Sex and porn addiction may sound like fun, but they are just as devastating as any other addiction. Maybe even worse because of the shame and embarrassment of having a sexual problem -- the type of thing that almost nobody wants to talk about.

Mental health and addiction professionals must recognize that compulsive, addictive, and impulsive sexual behaviors can arise related to any number of psychological conditions. We must also recognize and understand that the reverse may be true, meaning any number of psychological issues can arise related to compulsive and impulsive sexual behaviors. It is incumbent on us to fully assess the client, including sexual issues – where they started, how they manifest, and why they manifest – before assigning a diagnosis and proceeding with treatment. A misdiagnosis on our part can send a client sprinting for the exit. That said, a client manifesting BPD traits, as I’m sure you’re aware, is as likely to leave treatment as stick with it. It’s possible you did everything right and the client was just not willing to face his or her demons and do the needed work. At the same time, almost all addicts, when they first enter treatment, can be highly narcissistic and potentially manifest BPD traits.

I keep an updated list of resources for partners of sex/porn addicts at this link (https://seekingintegrity.com/resources/#loved-ones) on the Seeking Integrity website. And on our free resources website, SexandRelationshipHealing.com, we host webinars and discussion groups for partners. We also publish podcasts and blogs meant to help partners and loved ones. Most importantly of all, I highly recommend my book, Prodependence: Moving Beyond Codependency (https://www.amazon.com/Prodependence-Moving-Codependency-Robert-Weiss/dp/075732035X/ref=sr_1_2?dchild=1&keywords=prodependence&qid=1596566352&sr=8-2). That book is written to help partners and other loved ones of addicts understand what they are experiencing and how they can help the addict more effectively while also taking care of their own needs.