by Dr Paula Hall
What’s the latest research on porn addiction and sex addiction?
I have just returned from the International Society for the Study of Behavioural Addictions (ISSBA) annual conference and I’m buzzing with new information, insights and inspiration. The field of behavioural addictions is growing rapidly and at this year’s conference, not only were there even more researchers sharing their papers on CSBD (sex and porn addiction as it’s more commonly known), but also research papers on shopping/buying disorder and social media disorders. As acceptance of behavioural addictions grows amongst professional communities, so does the research. And this is great news because as our understanding grows, so does our ability to provide help and care for those who struggle with these unwanted behaviours.
One of the things I particularly enjoyed about the conference was the honesty and humility of the researchers. Throughout all the presentations it was made clear that this is what we know ‘now’; this is our ‘current’ thinking. No-one was claiming to have all the answers or any definitive answers. We are constantly learning and what research does is allow us to test hypotheses and discover those that are accurate and those that are wrong. It also allows us to see the gaps in our knowledge and where more research is needed. In this blog I’m going to share just two general areas – a theoretical model called I-PACE and moral incongruence.
Is porn really addictive?
Well, so far, from what the science is currently telling us, the answer is ‘yes’ as can be seen by just a few recent papers listed at the bottom of this page. Porn and sexual behaviours can become addictive, but, like alcohol, gambling and gaming, there are many millions of people who enjoy porn recreationally without experiencing any problems. A model of behavioural addiction that was shared by many researchers was the I-PACE model, initially developed by Matthias Brand 1. This model is a really helpful foundation for all the behavioural addictions that demonstrates both why, and how, people can get addicted to porn and other sexual behaviours. I-PACE is short for the Interaction of Person-Affect-Cognition-Execution and it’s a bio-psycho-social model that is equally relevant to both online and offline behaviours.
Why people get addicted to porn
In the I-PACE model, it’s the ‘P’ that explains the predisposing, or vulnerability factors that make some people more likely than others to be susceptible to addiction. This includes things like genetics, early childhood experiences including attachment difficulties and trauma. It also includes psychological factors such as whether someone has ADHD or struggles with anxiety, or depression, or low self-esteem and personality traits such as being more impulsive by nature or a perfectionist. The ‘P’ is also where we see why some people are susceptible to say, compulsive porn use, rather than gambling or shopping. And why it might be a certain type of pornography or perhaps an offline behaviour such as visiting sex workers.
The next part of the model, the A and the C looks at how people react both emotionally and cognitively to both internal and external triggers. For example, emotional includes how well someone is able to cope with stress, be that the stress of daily life or a more specific stressful event. It also relates to how positively the behaviour is experienced; is the behaviour an effective way of experiencing pleasure or escaping pain? The cognitive aspect also covers cognitive distortions and desire thinking. For example, telling yourself that no-one will ever find out so it doesn’t matter and that watching porn is the only way, and the best way to relax. But more than that, the ‘C’ of cognitive also relates to what is happening within the brain. There is growing evidence that as addiction progresses the brain reacts more quickly and more strongly to triggers – known as cue reactivity 2. And that the addicted brain begins to notice and focus more on the addictive substance or behaviour, known as attentional bias.
Why addiction feels ‘out of control’
The ‘E’ of the I-PACE model is about executive functioning. In other words, how our brain is working neurologically. What we know about addiction is that over time the brain changes so it becomes harder and harder to control the behaviour. Craving for the addictive substance or behaviour increases whilst simultaneously we experience decreased sensitivity to natural, non-addiction related reinforcers. Meanwhile changes in our pre-frontal cortex makes it harder for us to control the way we react to triggers and diminishes our ability to make healthy decisions. What started as a conscious choice, moved more towards a habitual response. This is all well researched in chemical addiction and there is now evidence that the same processes occur with behavioural addictions, including with problematic pornography use 3. During this process there is also a change in how the behaviour is experienced, from engaging in the behaviour for pleasure to engaging in the behaviour to get a relief from craving. Within the I-PACE model this is referred to as moving from the goal of gratification to compensation. This is when the behaviour feels increasingly out of control.
But what about moral incongruence?
Those of you who’ve been following the field of sex and porn addiction for a while will know that some people self-diagnose themselves with porn addiction when they do not meet the necessary clinical criteria. What they’re experiencing is ‘moral incongruence’. In other words, they believe their behaviour is morally wrong, but because they continue to do it, they think they must be addicted. This hypothesis has been well tested and research presented at the conference suggests that it’s particularly common in the US where sexual attitudes are more conservative 4. Recent research has shown that moral incongruence is the 4th highest predictor of problematic pornography use. This research came from the International Sex Survey that covered 42 countries and over 80,000 people. The highest predictor was frequency of porn use and the second highest was using porn for emotional regulation. Moral incongruence is an area that continues to need more research so we can understand how to help this sub-clinical population.
In light of this, it’s unsurprising and totally fair that people might question whether they actually have a problem or not. While researchers continue to explore and understand the underlying mechanisms, many people are struggling with sexual behaviours that they no longer enjoy. If you’re feeling conflicted about your own sexual behaviours or know someone who’s having these issues, we have an assessment tool you can access below. Or if you’d like to speak to a therapist, you can reach out via our “Talk to a Therapist” service for a no-strings-attached, initial session.
