Can you be addicted to porn?

If you Google "porn addiction" you will be presented with hundreds of seemingly reputable articles about how to handle the problem. These pieces, published on websites like MedScape, Medical News Today, and Healthline, explain the condition, advise how to get help, and assure you are not alone.

In addition, there are many websites committed exclusively to supporting people afflicted with this so-called addiction, like "NoFap" and "Your Brain on Porn."

What's curious, however, is the fact that, according to all psychological classification frameworks, a person cannot actually be clinically addicted to pornography. Neither sex addiction nor porn addiction are part of the DSM, a classification system for mental disorders by the American Psychiatric Association (APA), or the ICD, a similar system for diseases of all kinds, maintained by the World Health Organization (WHO). 

But if you have ever experienced it yourself or seen it in your partner, you know: Porn consumption can get out of hand, to the point where it hurts your relationship. All those articles, websites, and Youtube confessions did not come from nowhere, after all. So what is actually going on with this so-called porn addiction?

Morality complicates

The phrase "porn addiction" first surfaced in the late 1970s in the US, according to a 2016 paper published in the journal Sexual Addiction and Compulsivity. It was tied to the moral majority movement, a political organization associated with the Christian right and Republican Party in the US that believed in promoting what they called "traditional family values." Movement leaders believed the consumption of porn posed a threat to a "pure" marriage and therefore to these values. 

Porn addiction is often self-diagnosed. According to Joshua Grubbs, an Ohio-based Bowling Green State University clinical psychologist and porn addiction researcher, whether a person believes they have a porn addiction often depends on their moral beliefs about porn consumption.

Grubbs calls this phenomenon "moral incongruence" — those who think porn is morally bad, but continue watching it, might believe they have a problem, even an actual addiction, although their consumption is considered normal by most standards.

For these people, porn is not impacting their lives in the way a classic addiction would impact them, and the problem may have more to do with shame and stigmatization than anything that could be considered an actual dependence.

Pathologization of sex

Part of the problem with including sex in addiction frameworks has to do with the stigma it is shrouded in.

Moral judgments often shape how socially acceptable sexual desire is "supposed" to look. This can play a role in the improper medical pathologization of sexual behaviors that may be perfectly ordinary despite not fitting accepted norms.

The best example of this is the pathologization of homosexuality. Until the early 1970s, homosexuality was considered an actual psychological illness in the US, a categorization steeped in moral and religious stigma.

Stanford psychologist and former Obama White House drug policy advisor Keith Humphreys told DW that when trying to understand whether someone's sexual behavior is causing problems that should be treated by psychologists or psychiatrists, he will ask a patient: "Are you genuinely enjoying this? Are you functioning in your life, or is this interfering with things you have to do, like your job or your health? Is it destroying your relationships with other people?"

"If none of those things are true, we say, okay, well, then it's down to how you want to live, right?" said Humpreys. "Because there isn't that harm. Until you get that damage — damage to the person, damage to other people — it really doesn't belong in medicine. That's not really what we're supposed to do. We're here for people who are in some ways impaired, ill, whatever word you like. We're not here to render judgments, sanctify people's moral opinions."

Moral debates aside, out-of-control sexual behavior exists

However, setting moral prejudices and judgements aside, excessive desire for porn and sex does exist and can cause harm, psychologists agree. It can become compulsive and endanger people's jobs and relationships.

Over the course of her 30-year career, Isabella Hauser, professor of psychiatry and director of the outpatient clinic for psychiatry and psychotherapy at the Charite University hospital in Berlin, has treated two patients for sex addiction. They were having sex or watching porn up to five times per day, every day, which interfered with their relationships and literally rubbed their penises raw, she said.

Sex-related impulse control issues are observed more often in men, but women can experience them too. 

Despite abundant chatter about so-called sex addicts — Harvey Weinstein famously identified as one in his legal defense — in-depth research on the ubiquity and causes of this problem is scant. Along with being difficult to study in general, sex and porn research is not well-funded, and stigma poses a big barrier to finding study participants.

"We have known for thousands of years that some people have excessive and out-of-control sexual behaviors that create major problems in their lives," said Grubbs. "Whether or not an excessive, compulsive, out-of-control behavior pattern is an addiction is a slightly separate question."

Can humans be addicted to more than drugs?

Traditionally, experts only thought people could become addicted to substances. But in the 1990s, psychologists started pushing to expand classification systems to include something called "behavioral" addictions — so-called porn or sex addiction would fall under this umbrella.

Psychologists said people could become behaviorally addicted to using the internet, playing video games, sex, gambling, exercise, eating, and shopping.

Whether these problems can be considered actual addictions or mere impulse control disorders is highly debated — there is no clear scientific consensus.

"The persistence of a behavior in the face of consequences that results in some sort of physiological dependence — that's how I would define addiction," said Grubbs. "But that's not a benchmark that everyone would hold. I know very good researchers that would say dependence doesn't matter. Or I know other researchers that would say, 'Well, no, dependence is the only thing that matters.' These kinds of factors are fuzzier than people want to admit."

Humphreys said he thinks impulsive behaviors only creep into addiction territory when they start producing genuine harm to a person and others. The person experiencing the problem might think, "I know this is bad, but I can't seem to stop doing it."

Classification systems do not mean much for individual care

Addiction experts don't seem overly concerned with the semantic debate over whether compulsive porn consumption, or hypersexuality, or video gaming should be considered actual addictions or not. Ultimately, they seem to say, it does not really matter.

Everyone consulted for this article agreed that these problems exist in some circumstances, even if they are not currently recognized as addictions by psychological classification systems.

Although it may be difficult to say a person can be "addicted" to porn in the way a person can be addicted to heroin, if they are watching porn 18 hours of the day or frequently enough that they do not spend time with their partner anymore, there is probably some kind of psychological problem going on that should be addressed — regardless of what you decide to call it.

Edited by: Carla Bleiker