Ominous News for Porn Users: Internet Addiction Atrophies Brains

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If Internet gaming creates addicts, how can Internet porn not?

Here's some headline news for anyone who has been trained that Internet porn use is harmless: Physical evidence of addiction processes is showing up in the brains of avid Internet video-gamers. What's more, use of online erotica has greater potential for becoming compulsive than online gaming according to Dutch researchers.

According to NIDA head Nora Volkow, MD, and her team these three physical changes define addiction: desensitization (numbing of the brain's pleasure response), sensitization, and hypofrontality. These same brain changes (which are now showing up in Internet addicts) also show up in pathological gamblers and drug abusers.

For example, cocaine use floods the brain's reward circuitry with dopamine. Nerve cells respond, more or less quickly, by decreasing their responsiveness to dopamine. As a result, some users feel "off" (desensitization). They crave more intense stimulation (tolerance), and tend to neglect interests, stimuli, and behaviors that were once important to them.

At the same time, because their brains have recorded that cocaine use feels good, they grow hypersensitive to anything they associate with cocaine. White powder, the word "snow," the neighborhood where they smoked, or friends with whom they used will all trigger spurts of high dopamine in the reward circuitry, driving them to use (sensitization). Also, ΔFosB, a protein that helps preserve intense memories and promotes relapse, accumulates in key brain regions. Incidentally, ΔFosB also rises with sexual activity. (ΔFosB is a transcription factor, that activates and inhibits certain genes to alter synaptic communication)

If heavy cocaine use continues, the desensitization of the reward circuitry decreases corresponding activity in the frontal lobes of their brains. Now, the users' abilities to control impulses and make sound choices weaken, and their frontal cortex may atrophy (hypofrontality). Taken together, decreased pleasure response, marked cravings to use, and compromised impulse control fuel the vicious cycle of addiction.

Behavioral addictions

The study of non-drug addictions is still quite new. Yet already experts have uncovered decisive physical evidence that today's extreme versions of natural rewards can change the brain in ways that drugs do. "Natural rewards" are activities/substances that entice us because they enhanced our ancestors' survival, or the survival of their genes.

Moreover, it's not just a tiny minority with pre-existing disorders who are at risk. Normal, healthy brains can also change. Said a healthy 37-year old, "When I first watched porn online at age 35, I felt like I was going to have an orgasm without an erection. That's how powerful an effect the it had on me."

So far, here's the research scorecard. (Dates indicate when brain-scan research turned up evidence of the last of the three key addiction-related brain changes.)

  • Pathological gambling - studied for 10 years, and added to the upcoming DSM-5 as an addiction (2010)
  • Food addiction - (2010)
  • Internet video-gaming addiction - (2011)
  • Internet porn addiction - still not studied via brain scans

Incidentally, the reason the Internet addiction studies address addiction to gaming, not porn, is that they were done in countries that block access to porn sites—and have for years (China, 2006 and Korea, 2007). Unlike other countries, they don't have a lot of heavy porn users.

Here are studies showing the three critical, physical changes in the brains of Internet addicts (two just released in June, 2011):

  • Numbed pleasure response:  A reduction of striatal D2 dopamine receptors is the main marker for desensitization of the reward circuitry, a hallmark of all addictions. In this study PET scans of men with and without Internet addiction were compared.

Reduced Striatal Dopamine D2 Receptors in People With Internet Addiction (2011) 

"An increasing amount of research has suggested that Internet addiction is associated with abnormalities in the dopaminergic brain system... [In this study] individuals with Internet addiction showed reduced levels of dopamine D2 receptor availability."

  • Sensitization: In this study, college students played Internet video games for 6 weeks. Measures were done before and after. Those subjects with the highest cravings also had the most changes in their brains that indicate early addiction process. The control group, which played a less stimulating game, had no such brain changes.

Changes in Cue Induced Prefrontal Cortex Activity with Video Game Play (2010) 

"These changes in frontal-lobe activity with extended video-game play may be similar to those observed during the early stages of addiction."

  • Hypofrontality: In this study, researchers found a 10-20% reduction in frontal cortex gray matter in adolescents with Internet addiction. Research on other addictions has already established that decreases in frontal-lobe gray matter and functioning reduce both impulse control and the ability to foresee consequences.

Microstructure Abnormalities in Adolescents with Internet Addiction Disorder. (2011) 

"The presence of relatively immature cognitive control, makes [adolescence] a time of vulnerability and adjustment, and may lead to a higher incidence of affective disorders and addiction among adolescents. As one of the common mental health problems amongst Chinese adolescents, internet addiction disorder (IAD) is currently becoming more and more serious. ... The incidence rate of internet addiction among Chinese urban youths is about 14%. ... These results demonstrated that as internet addiction persisted, brain atrophy ... was more serious." (Also see this earlier Chinese study.) 

Online porn and video gaming stimulate the brain in comparable ways

Compare these two quotations. Which is about porn addiction and which is about gaming addiction?

We don't have sex anymore. We don't go on date nights or anything together. I feel so guilty because I just can't take it anymore. Ever since 2 weeks into our marriage I was threatening to divorce him.

Three of my friends did realize they had a problem, but 2 of them said they've made attempts to quit, and they literally think there's nothing they can do about it. *

The characteristics that make Internet porn and video gaming so popular are the same characteristics that give both the power to dysregulate dopamine in some brains. Novelty and 'stimuli that violate expectations' both release dopamine, sending the brain the message that the activity is more valuable than it is. Successful video games deliver a rapid-fire of both novelty and surprise. Each new generation of games exceeds the last in these respects.

Today's porn also delivers both, and constantly ratchets them up. There's unending novelty and something more startling always beckoning just beyond the next click. There's also the dopamine released by the "hunt" for the perfect shot. Novelty, shock and hunting absorb the user's attention because they raise dopamine levels. Intense focus allows users to override their natural satiety mechanisms and, often, to rewire their brains in ways that take a lot of effort to undo. Addiction is "pathological learning."

Online gamers are sometimes called "adrenaline junkies." However, adrenaline (which is released in the adrenal glands) appears to have little effect on addiction processes. Dopamine, not adrenaline, is at the heart of all addictions. Fear and anxiety can enhance addiction processes due to neurochemicals released in the brain (such as norepinephrine), but they don't cause those processes.

Sexual cues can be more compelling than gaming activities

Mock warfare and risky quests were no doubt high priorities for our ancestors. That's why we find play rewarding enough to get hooked. Yet reproduction is our genes' top priority. Like food, sex is essential to genetic success.

In terms of effects on the brain, Internet porn use combines elements of consuming highly palatable food and video gaming's constant stimulation. Like junk food, Internet erotica is a hyperstimulating version of something we evolved to value highly. Today's erotica is also delivered via a rapid-fire, mesmerizing medium, very similar to online video games. A double whammy in terms of addictiveness.

It's worth considering what brain researchers have learned about food. When rats had unlimited access to cafeteria food, nearly all of them showed a rapid drop in D2 (dopamine) receptors (numbed pleasure response), and then binged to obesity. The D2-receptor drop apparently motivates mammals to grab as much as possible while the getting is good—whether high-calorie foods or a willing harem.

Keep in mind that unlimited cafeteria-type food stimulation was not the norm during our evolution, until recently. That's why unlimited access to junk food is risky to rats and humans. Clicking effortlessly to hundreds of hot, novel mates is also an evolutionary anomaly, and 9 out of 10 of college-age men were already using Internet porn three years ago. Risky, given its inherent addictiveness. Also, reversible. When heavy users give up porn, they report increased pleasure from all aspects of life (often after a miserable withdrawal).

Back to food. In recent years, brain researchers have also turned up evidence of all three key addiction processes in the brains of overeaters:

  • Numbed pleasure response: A 2010 study showed that overeating blunts the reward circuitry, increasing the risk for future weight gain. After 6 months, the brains of those who had eaten more "pleasurable" foods (i.e., more fattening) showed less response to pleasure than the others.
  • Sensitization: A 2011 study found that those who score high on a food addiction test (brain activation in response to pictures of food) show brain responses similar to drug addicts' responses to drugs.
  • Hypofrontality: A 2006 study revealed that obese individuals have brain abnormalities in areas associated with taste, self-control, and reward—including a reduction of gray matter in the frontal lobes (atrophy). It's likely that overeating causes these changes, as the study mentioned above confirmed brains changes from overeating. 

If overstimulation via highly palatable food can cause brain changes in so many humans (30% of Americans are obese, and only about 10% due to metabolic abnormalities according to neuroscientist David Linden), how is it possible that over-stimulation via highly erotic online sexual activity could not change brains? Internet porn use/cybersex is surely no less stimulating than tempting food.

Is history repeating itself?

History is full of examples of "common knowledge" that turned out to be erroneous upon investigation. Consider margarine. Everyone "knew" it was better for you than butter. Experts were so confident of this "fact," that they didn't even test it for years, and regularly advised people to substitute margarine for butter.

Finally, experts did test the healthfulness of margarine. It turns out that trans-fatty acids (found in margarine) are among the most dangerous fats. They are far worse for humans than butter.

Critics may claim that it is "unscientific" to suggest that Internet porn can cause addiction processes in the brain just because Internet addiction clearly does. Actually, it's unscientific to suggest the reverse. All addictions, including behavioral ones (gambling, food, video games) show hypofrontality (atrophy and lack of impulse control). Frankly, what critics now need to supply is solid, scientific evidence showing that Internet porn addiction is an exception to the rule. To suggest there's still major doubt about its addictiveness is most unscientific, as it presumes there must be some other brain circuitry for porn use that has yet to be discovered.

Sex is healthy, but the assumption that Internet porn use is safe is increasingly tenuous.

* The first remarks are about gaming addiction, the second about porn addiction.


UPDATE.

Many studies have been published since this article was written. See this List of Internet & Video Game Brain Studies

See this 2014 review of the literature - The prefrontal dysfunction in individuals with Internet gaming disorder: a meta-analysis of functional magnetic resonance imaging studies (2014)excerpts from the review:

  • The results [of the review] converge to the view that an addictive use of the Internet is linked to functional brain changes involving parts of the prefrontal cortex, accompanied by changes in other cortical (e.g., temporal) and subcortical (e.g., ventral striatum) regions.
  • Additionally, there are some hints for structural brain changes, which also involve parts of the prefrontal cortex. The functional changes in prefrontal and striatal areas are primarily observable when individuals with Internet addiction perform certain tasks, in particular those measuring executive functions and cue-reactivity.
  • These results, together with those emerging from neuropsychological studies, suggest that prefrontal control processes are reduced in individuals who are addicted to the Internet and may be related to the patients’ loss of control over their Internet use.
  • Most of the current articles on neuropsychological and neuroimaging correlates of Internet addiction conclude that this clinically relevant disorder should be classified as a behavioral addiction. We agree with this conclusion

Comments

COMMENTS: One of several new studies indicating brain changes mimicking those found in drug addicts. Study does not say what type of internet addiction it measured. Was it all encompassing Internet addiction, including porn, or was it only Internet video games?

Enhanced Reward Sensitivity and Decreased Loss Sensitivity in Internet Addicts: An fMRI Study During a Guessing Task.

J Psychiatr Res. 2011 Jul 16.
Dong G, Huang J, Du X.

Source
Department of Psychology, Zhejiang Normal University, Jinhua City, Zhejiang Province, PR China.

Abstract
As the world's fastest growing "addiction", Internet addiction should be studied to unravel the potential heterogeneity. The present study is set to examine reward and punishment processing in Internet addicts as compared to healthy controls while they subjectively experience monetary gain and loss during the performance of a guessing task. The results showed that Internet addicts associated with increased activation in orbitofrontal cortex in gain trials and decreased anterior cingulate activation in loss trials than normal controls. The results suggested that Internet addicts have enhanced reward sensitivity and decreased loss sensitivity than normal comparisons.

Copyright © 2011 Elsevier Ltd. All rights reserved.
PMID: 21764067

COMMENTS: Study found problematic Internet porn use in 18% of adolescents...in a sample that was more than half girls! What would it have been had the sample been all male?

Confirmation of the Three Factor Model of Problematic Internet Use on Off Line Adolescent and Adult Samples. (2011)

Cyberpsychol Behav Soc Netw. 2011 Jun 28.
Koronczai B, Urbán R, Kökönyei G, Paksi B, Papp K, Kun B, Arnold P, Kállai J, Demetrovics Z.

Source
1 Institutional Group on Addiction Research, Eötvös Loránd University , Budapest, Hungary .

Abstract

Abstract As the Internet became widely used, problems associated with its excessive use became increasingly apparent. Although for the assessment of these problems several models and related questionnaires have been elaborated, there has been little effort made to confirm them. The aim of the present study was to test the three-factor model of the previously created Problematic Internet Use Questionnaire (PIUQ) by data collection methods formerly not applied (off-line group and face-to-face settings), on the one hand, and by testing on different age groups (adolescent and adult representative samples), on the other hand.

Data were collected from 438 high-school students (44.5 percent boys; mean age: 16.0 years; standard deviation=0.7 years) and also from 963 adults (49.9 percent males; mean age: 33.6 years; standard deviation=11.8 years). We applied confirmatory factor analysis to confirm the measurement model of problematic Internet use. The results of the analyses carried out inevitably support the original three-factor model over the possible one-factor solution.

Using latent profile analysis, we identified 11 percent of adults and 18 percent of adolescent users characterized by problematic use. Based on exploratory factor analysis, we also suggest a short form of the PIUQ consisting of nine items. Both the original 18-item version of PIUQ and its short 9-item form have satisfactory reliability and validity characteristics, and thus, they are suitable for the assessment of problematic Internet use in future studies.

Comments: Another study measuring the characteristics of addiction that Internet addiction and substance abuse share. Every study that studies a characteristic finds that Internet addiction parallels chemical addictions.

Cue-Induced Positive Motivational Implicit Response In Young Adults With Internet Gaming Addiction.

Psychiatry Res. 2011 Aug 3.
Yen JY, Yen CF, Chen CS, Tang TC, Huang TH, Ko CH.

Source
Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.

Abstract

This study evaluated the positive motivational implicit response to internet gaming cues (i.e., screenshots of popular online games) to identify potential mechanisms of dyscontrolled internet use in young adults with internet gaming addiction (IGA). The final analysis included 64 young adults with IGA and 71 control subjects. The subjects completed the implicit association task to test their reaction to congruent pairing (internet gaming screenshot paired with liked words) and incongruent pairing (internet gaming screenshot paired with disliked words).

The results demonstrated that, compared to the control group, the IGA group reacted faster to congruent pairing. It suggests that the IGA group had a positive motivational implicit response to screenshots of online games. Implicit cognition is an important mechanism of dyscontrolled substance use, such as alcohol dependence. This result suggests that implicit cognition might also associate with dyscontrolled online gaming. The findings also demonstrate the important role of implicit cognition in dyscontrolled internet use in young adults with IGA.

Copyright © 2011 Elsevier Ltd. All rights reserved.

Comments: This study, like other recent fMRI studies on Internet addicts, showed reductions in executive control. Reductions in executive control in addicts indicate a decline in frontal cortex activity. This decline parallels loss of impulse control, and is found in all addictions.

Male Internet Addicts Show Impaired Executive Control Ability Evidence From A Color-Word: Stroop Task.

Neurosci Lett. 2011 Jul 20;499(2):114-8.
Dong G, Zhou H, Zhao X.

Source
Department of Psychology, Zhejiang Normal University, PR China. dongguangheng@zjnu.edu.cn

Abstract

This study investigated the executive control ability of male students with Internet addiction disorder (IAD) by recording event-related brain potentials (ERP) during a color-word Stroop task. Seventeen IAD and 17 male normal university students participated. Behavior results showed that IAD students were associated with longer reaction time and more response errors in incongruent conditions than the control group. ERP results revealed that participants with IAD showed reduced medial frontal negativity (MFN) deflection in incongruent conditions than the control group. Both of the behavioral performance and ERP results indicate that people with IAD show impaired executive control ability than the normal group.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
PMID: 21645588

Problematic Internet use in Chinese adolescents and its relation to psychosomatic symptoms and life satisfaction.
BMC Public Health. 2011 Oct 14;11(1):802.

Cao H, Sun Y, Wan Y, Hao J, Tao F.

ABSTRACT:

Background
Problematic Internet use (PIU) is a growing problem in Chinese adolescents. Little is known about associations of PIU with physical and psychological health.
This study was designed to investigate the prevalence of PIU and to test the relationships between PIU and psychosomatic symptoms and life satisfaction among adolescents in mainland China. Methods A cross-sectional survey was conducted comprising a large representative sample of 17,599 students in eight cities of China. PIU was assessed by the 20-item Young Internet Addiction Test (YIAT). The Multidimensional Sub-health Questionnaire of Adolescents and the Multidimensional Students' Life Satisfaction Scale were administered to obtain information on psychosomatic symptoms and life satisfaction. Demographics and Internet usage patterns were also collected. Logistic regression was used to assess the effects of PIU on psychosomatic symptoms and life satisfaction.

Results
Approximately 8.1% of subjects showed PIU. Adolescents with PIU were associated with males, high school students, urban, eastern and western areas, upper self-report family economy, service type mostly used for entertainment and relieving loneliness and more frequency of Internet use. Compared with normal Internet users, adolescents with PIU were more likely to suffer from psychosomatic symptoms (P0.001), including lack of physical energy (P0.001), physiological dysfunction (P0.001), weakened immunity (P0.001), emotional symptoms (P0.001), behavioural symptoms (P0.001) and social adaptation problems (P0.001). Adolescents with PIU had lower scores on total and all dimensions of life satisfaction (all P0.001). Adjusted for the demographic and Internet-related factors, there was positive significant relationship between PIU and psychosomatic symptoms, but negatively related to life satisfaction.

Conclusions
PIU is common among Chinese students, and PIU was significantly associated with psychosomatic symptoms and life satisfaction. Effective measures are needed to prevent the spread of this problem and interventions to prevent the effects of PIU on psychosomatic symptoms and life satisfaction should be conducted as early as possible

Internet addiction: hours spent online, behaviors and psychological symptoms.

Gen Hosp Psychiatry. 2011 Oct 28.

Tonioni F, D'Alessandris L, Lai C, Martinelli D, Corvino S, Vasale M, Fanella F, Aceto P, Bria P.

Source
Institute of Psychiatry and Psychology, Catholic University of Sacred Heart, 00185 Rome, Italy.

Abstract

OBJECTIVE:
The aim of this study was to investigate psychopathological symptoms, behaviors and hours spent online in patients with internet addiction disorder (IAD) at a new psychiatric service for IAD inside a policlinic.

METHOD:
Eighty-six subjects participated in the study. Thirty-three patients asking for psychiatric consultation regarding their excessive use of the internet were assessed with IAD interview, internet addiction test (IAT), Symptom Checklist-90-Revised (SCL-90-R) and a brief sociodemographic survey. Moreover, patients had to respond to the following question: Over the last month, how much time have you spent online per week? At the end of psychiatric assessment, 21 of the 33 patients satisfied inclusion (IAD interview) and exclusion (psychotic disorders, neurocognitive deficits, dementia, serious mental delay, current alcohol or drug abuse) criteria. Twenty-one patients of the clinical group were compared with 65 subjects of a control group who were recruited online using IAT.

RESULTS:
IAD patients showed significantly higher scores on the IAT compared to subjects of the control group. Only item 7 (How often do you check your e-mail before something else that you need to do?) showed a significant inverse trend. SCL-90-R anxiety and depression subscale scores and item 19 (How often do you choose to spend more time online over going out with others?) of the IAT were positively correlated with number of weekly hours spent online in IAD patients.

CONCLUSION:
Findings suggest that a misuse of internet, characterized by many hours spent online avoiding interpersonal relationships with real and known people, could be an important criterion in the clinical interview in order to diagnose the IAD. The association between the lost interest in communicating with real people and psychological symptoms such as anxiety and depression could be relevant to detect IAD patients.

PMID: 22036735

Comments: Unlike most studies this one included both controls and former Internet addicts. This study found that those with Internet addiction had different cue-induced activation patterns similar to those with drug addictions. Former Internet addicts pattern of activation was similar to controls, demonstrating that abstinence leads to normalization.

Brain correlates of craving for online gaming under cue exposure in subjects with Internet gaming addiction and in remitted subjects. (2011)

Addict Biol. 2011 Oct 26. doi: 10.1111/j.1369-1600.2011.00405.x.

Ko CH, Liu GC, Yen JY, Chen CY, Yen CF, Chen CS.

Source

Departments of Psychiatry Medical Imaging Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan, Departments of Psychiatry Medical Imaging Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan and Department of Psychiatry, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Taiwan.

Abstract

This study aimed to evaluate brain correlates of cue-induced craving to play online games in subjects with Internet gaming addiction (IGA), subjects in remission from IGA and controls. The craving response was assessed by event-related design of functional magnetic resonance images (fMRIs).

Fifteen subjects with IGA, 15 in remission from IGA and 15 controls were recruited in this study. The subjects were arranged to view the gaming screenshots and neutral images under investigation of fMRIs. The results showed that bilateral dorsolateral prefrontal cortex (DLPFC), precuneus, left parahippocampus, posterior cingulate and right anterior cingulate were activated in response to gaming cues in the IGA group and their activation was stronger in the IGA group than those in the control group. Their region-of-interest was also positively correlated with subjective gaming urge under cue exposure. These activated brain areas represent the brain circuit corresponding to the mechanism of substance use disorder. Thus, it would suggest that the mechanism of IGA is similar to substance use disorder.

Furthermore, the IGA group had stronger activation over right DLPFC and left parahippocampus than did the remission group. The two areas would be candidate markers for current addiction to online gaming and should be investigated in future studies.

© 2011 The Authors, Addiction Biology © 2011 Society for the Study of Addiction.

PMID: 22026537

The effect of psychiatric symptoms on the internet addiction disorder in Isfahan’s University students (2011)

J Res Med Sci. 2011 Jun;16(6):793-800.

Alavi SS, Maracy MR, Jannatifard F, Eslami M.

Source

Management and Medical Informatics Faculty, Isfahan University of Medical Sciences, Isfahan, Iran.

Abstract

BACKGROUND:

Internet addiction disorder is an interdisciplinary phenomenon and it has been studied from different viewpoints in terms of various sciences such as medicine, computer, sociology, law, ethics, and psychology. The aim of this study was to determine the association of psychiatric symptoms with Internet addiction while controlling for the effects of age, gender, marital status, and educational levels. It is hypothesized, that high levels of Internet addiction are associated with psychiatric symptoms and are specially correlated with obsessive-compulsive disorder symptoms.

METHODS:

In a cross-sectional study, a total number of 250 students from

Isfahan's universities were randomly selected. Subjects completed the demographic questionnaire, the Young Diagnostic Questionnaire (YDQ) and the Symptom Checklist-90-Revision (SCL-90-R). Data was analyzed using the multiple logistic regression method.

RESULTS:

There was an association between psychiatric symptoms such as somatization, sensitivity, depression, anxiety, aggression, phobias, and psychosis with exception of paranoia; and diagnosis of Internet addiction controlling for age, sex, education level, marital status, and type of universities.

CONCLUSIONS:

A great percentage of youths in the population suffer from the adverse effects of Internet addiction. It is necessary for psychiatrists and psychologists to be aware of the mental problems caused by Internet addiction.

Super-rewards. Good point. We just got our kids Wii (the latest from Nintendo) for Sinterklaas, the Dutch version of Christmas. The thrill of the action is so intense that one of them peed in his pants while playing.

So, yes, technology and culture, which are really just extensions of natural selection, keep raising the power of rewards to give pleasure and distraction (which relieves us from anxiety). I guess that invites addiction, since we haven't yet evolved the self-regulation skills needed to counteract these attractions. I wonder if we ever will.

What should you do to overcome it? I just now realized that the internet may also be apart of my numb pleasure response problem. After learning this I really decreased internet consumption from basically all day to a couple of hours. Is this beneficial at all or am I just wasting time being on the internet period? I really want to feel again and maybe its working because I feel even worse than I did without the computer while doing this porn reboot as well.