Pornography as an addiction?

Pornography use in terms of the word “addiction” is a complicated and highly debated issue in the mental health arena.  There are pros and cons to the label “addiction.”  On the one hand it can be shaming and often misused when not diagnosed correctly.  On the other hand, when behavior is out of one’s control to stop, it can be helpful to understand this as an issue much more complicated than exerting enough willpower.  Some notes:

1. In the Diagnostic Criteria Manual – where the criteria for diagnoses are spelled out – the term “addiction” is not used.  There is “substance dependance” which is referring to dependence of an ingested substance such as alcohol, narcotics, nicotine, etc.  There is also another category called “impulse-control disorders” which speaks to certain maladaptive behaviors that are used in ways that feel out of one’s control (i.e. gambling, pulling out one’s hair, shopping, etc.).  I use the second diagnosis when addressing issues with pornography.   
2. Some of the things that should be present for an “impulse-control disorder” are a preoccupation with the behavior (i.e. incessantly thinking about it); increasing sense of tension (i.e. anxiety) before behavior is acted out;  has repeated, unsuccessful efforts to cut back or stop behavior; uses behavior as a coping mechanism for other problems or emotions (i.e. depression, guilt, anger, relational difficulty, etc.); lies about or tries to cover up behavior; has committed illegal acts to support behavior; and has jeopardized or lost a significant relationship, job or educational opportunity due to behavior.  One problem in diagnosing a true disorder from other behavior is that items 1-5 can also have to do with religious pressure to conform to high sexual standards.  In other words, a member of the church may read these criteria and diagnose themselves as having an impulse-control disorder when the frequency of said behavior is minimal and would not meet the standards for diagnoses (i.e. single adult looks at porn once every few months).  I’m not saying this behavior isn’t problematic, especially in light of their religious values – but it isn’t a mental health disorder.  Classifying it as such can, in some cases, become a self-fulfilling prophecy in that they worry about it more and more and the anxiety now provides the pathways and link to impulsivity.  
3. It can be helpful to phrase impulse-control disorders in “addict” language so the seriousness of brain pathology is taken into account when behavior is diagnosable.  In other words, you won’t be able to stop impulsive behavior just because you love somebody.  I hear these pleas from spouses or other family members often: “if you really loved me, you would stop doing something that hurts me.”  It is important to understand that brain chemistry is involved in complex ways that many neuroscientists are currently trying to better understand.  This has nothing to do with whether or not one loves another person.  
4. Shame is a huge problem in that it plays a role in all types of addictive behavior.   It is interesting to note that most people who qualify for sexual maladaptive behavioral diagnoses (i.e. “sexual addiction” as our culture is currently calling it) come from what we call “rigid” families.  Meaning there was little tolerance for variance and a lot of “all or nothing” type of thinking.  Unfortunately, depending on parenting styles and ecclesiastical styles of leaders, many traditionally religious households can fall under this category. 
5. The DSM-IV is currently under revision and it will be interesting to see how or if “sexual addiction” is addressed in light of the most recent evidence-based research.  
6. It is interesting that one of the current therapy models getting a lot of attention when it comes to treatment of impulsive behavior/compulsions is ACT (Acceptance and Commitment Therapy) which, simplified, focuses on accepting your feelings and thoughts instead of trying to change them (a form of mindfulness).  Somewhat similar are the 12-step programs that focus on an abandonment to a higher being instead of depending on yourself for change.  If change was as simple as wanting it, well – all of us would have significantly different things currently going on.  

Yes, porn affects the brain.  So do roller coaster rides.  So do a lot of things.  And yes, pornography viewing can become impulsive behavior warranting a diagnosis – getting in the way of daily functioning or relational health – these are very real issues.  At the same time – the rigid stance and fear inducing language we use surrounding pornography also play a role on how much power it has in the end.  In our religious culture we don’t normalize erotica at all and we don’t normalize arousal that happens naturally when we see something erotic or pornographic.  This, in my opinion, is also dangerous.  As is labeling curious teens – or adults who look at pornography intermittently for a variety of reasons – as addicts.  Finding a balanced approach to the education of the effects of pornography, the correct usage of diagnostic terms and the treatment of such disorders when they do exist is a challenge I hope we do a better job at as we come to know more about a healthy, balanced approach to sexuality as a whole.