Is research into porn addiction being held back by the taboo around this disorder? In this Q&A, we chat with Rubén de Alarcón Gómez, the lead author on a systematic review into online porn addiction which has been recommended by the F1000Prime Faculty, to find out more about the nature of the condition, where we stand on the diagnosis and treatment and how official recognition could change the scope of research into this area.
Why did you want to pursue research on this topic?
I’ve been interested in the field of addictions for a long while, particularly the conceptualization of a behavior as an addiction. The underlying mechanisms of behavior in an addictive disorder, physiological dependence aside, are incredibly complex. I think behaviors that could prove problematic are a good way of approaching this subject with a fresh perspective, that could lead us to new insights. Research on hypersexual behavior and problematic cybersex just seemed like the best way to reconcile these two topics.
Why do you think porn addiction is a largely unexplored field of study?
Pornography has been around for centuries, but it’s only up until relatively recently when it became an industry and began to grow and expand. I guess it could be possible some individuals across history developed some sort of problematic behavior around it, but it hasn’t been until the rise of the internet that we’ve become aware of it. This is probably because the new model of consumption has spiked incidence rates making it so much more prevalent than before that it’s hard to even quantify it. I think this very rapid progression from normal sexual behavior to a potentially pathological one has taken almost everyone by surprise.
Do you feel that the lack of an official classification of porn addiction as a recognized disorder impacts the field of research in this area?
Certainly. And in some ways, not necessarily in a negative manner. Our lack of knowledge on this subject should warn us to be extremely careful when studying it and not haste into a classification with loosely defined criteria in something so vastly heterogeneous as human sexuality is.
I think ICD-11 did a good job including “Compulsive sexual behavior disorder” as a way to reflect that these patients need to be recognized and treated, and I can’t blame APA for being cautious and not including it in DSM-5, because the “addiction” label is a heavy one. On the other hand, while patients will mostly benefit from a diagnosis that allows for certain individual flexibility, I think the lack of consensus on some areas will slow down and even impede most of the breakthroughs in research.
What can be done to support and treat those that struggle with this disorder?
The evidence seems to be in favor of psychotherapy work when compared to potential drug treatments. I’d say raising awareness that sexual behavior could be problematic in some people, especially if they meet the predictors, would be an adequate first step for them to recognize when to seek help.
Do you feel the availability of porn has impacted the prevalence of this disorder?
Yes, without a doubt. Wider access is responsible for the increase in people who watch pornography. The data suggests this increase in people consuming pornography has grown alongside the latest technological advances, especially among the youngest populations.
The triple A factors (availability, affordability, accessibility) commonly associated with this disorder suggest a shift in the consumption model along the way, with the potential now not only for easier pornography consumption, but for a wide array of diversification in it, so that it can be catered to the taste of the consumer.
Do you feel that due to the nature of this addiction limits research in this area?
Potentially, yes. It seems as if hypersexual behavior was always a rare clinical entity up until very recently. Its taboo nature, the need for privacy, and society’s expectations might have played a part on what constituted a subjective distress situation for the patient. It is very possible that it has gone underreported for many years longer than it has been a problem for them.
In my view, if there is a reluctance among researchers to approach this disorder. It doesn’t come from the sexual component, but the addictive one. Some clinicians view substance addiction as heavily personality-influenced disorders where the chemical dependence is just the latest symptom, not the underlying cause. So even with the gambling disorder precedent, there is bound to be some skepticism towards the conceptualization of a behavior as “addictive”, especially behaviors that are an integral part of human life. Because defining what is pathological and what is not in these cases proves to be a real challenge, and worthy of a good headache or two.
I hope it makes things easier for future research and serves as a starting point to keep uncovering the relation between hypersexuality and addictive behavior, so we can help those patients who are in distress because of them. There are a few grey areas that require more solid evidence and other related issues that should be. I am aware that there are already some ambitious projects on the way from a few authors referenced in this paper that pursue some of these issues, so we might get the answers sooner than we know.
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