Relevant Research and Articles About the Studies

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Below this long intro are many sub-sections containing relevant studies.

Relevant Research – first we have lists of studies that provide support for the claims made by YBOP. (See Questionable & Misleading Studies for highly publicized papers that are not what they claim to be.):

  1. Porn/sex addiction? This page lists 59 neuroscience-based studies (MRI, fMRI, EEG, neuropsychological, hormonal). All but one provide support for the addiction model as their findings mirror the neurological findings reported in substance addiction studies.
  2. The real experts’ opinions on porn/sex addiction? This list contains 34 recent neuroscience-based literature reviews & commentaries by some of the top neuroscientists in the world. All support the addiction model.
  3. Signs of addiction and escalation to more extreme material? Over 60 studies reporting findings consistent with escalation of porn use (tolerance), habituation to porn, and even withdrawal symptoms (all signs and symptoms associated with addiction). Additional page with 14 studies reporting withdrawal symptoms in porn users.
  4. An official diagnosis? The world’s most widely used medical diagnostic manual, The International Classification of Diseases (ICD-11), contains a new diagnosis suitable for porn addiction: “Compulsive Sexual Behavior Disorder.”
  5. Debunking the unsupported talking point that “high sexual desire” explains away porn or sex addiction: Over 25 studies falsify the claim that sex & porn addicts “just have high sexual desire”
  6. Porn and sexual problems? This list contains over 50 studies linking porn use/porn addiction to sexual problems and lower arousal to sexual stimuli. The first 7 studies in the list demonstrate causation, as participants eliminated porn use and healed chronic sexual dysfunctions.
  7. Porn’s effects on relationships? Over 80 studies link porn use to poorer sexual and relationship satisfaction. As far as we know all studies involving males have reported more porn use linked to poorer sexual or relationship satisfaction. While some studies report little effect of women’s porn use on women’s sexual and relationship satisfaction, many do report negative effects: Porn studies involving female subjects: Negative effects on arousal, sexual satisfaction, and relationships
  8. Porn use affecting emotional and mental health? Over 90 studies link porn use to poorer mental-emotional health & poorer cognitive outcomes.
  9. Porn use affecting beliefs, attitudes and behaviors? Check out individual studies – over 40 studies link porn use to “un-egalitarian attitudes” toward women and sexist views – or the summary from this 2016 meta-analysis of 135 relevant studies: Media and Sexualization: State of Empirical Research, 1995–2015. Excerpt:

The goal of this review was to synthesize empirical investigations testing effects of media sexualization. The focus was on research published in peer-reviewed, English-language journals between 1995 and 2015. A total of 109 publications that contained 135 studies were reviewed. The findings provided consistent evidence that both laboratory exposure and regular, everyday exposure to this content are directly associated with a range of consequences, including higher levels of body dissatisfaction, greater self-objectification, greater support of sexist beliefs and of adversarial sexual beliefs, and greater tolerance of sexual violence toward women. Moreover, experimental exposure to this content leads both women and men to have a diminished view of women’s competence, morality, and humanity.

  1. What about sexual aggression and porn use? Another meta-analysis: A Meta‐Analysis of Pornography Consumption and Actual Acts of Sexual Aggression in General Population Studies (2015). Excerpt:

22 studies from 7 different countries were analyzed. Consumption was associated with sexual aggression in the United States and internationally, among males and females, and in cross-sectional and longitudinal studies. Associations were stronger for verbal than physical sexual aggression, although both were significant. The general pattern of results suggested that violent content may be an exacerbating factor.

“But hasn’t porn use reduced rape rates?” No, rape rates have been rising in recent years: “Rape rates are on the rise, so ignore the pro-porn propaganda.” See this page for over 110 studies linking porn use to sexual aggression, coercion & violence, and an extensive critique of the often-repeated assertion that an increased availability of porn has resulted in decreased rape rates.

  1. What about the porn use and adolescents? Check out this list of over 280 adolescent studies, or these reviews of the literature: review#1, review2, review#3, review#4, review#5, review#6, review#7, review#8, review#9, review#10, review#11, review#12, review#13, review#14, review#15, review #16, review #17. From the conclusion of this 2012 review of the research – The Impact of Internet Pornography on Adolescents: A Review of the Research:

Increased access to the Internet by adolescents has created unprecedented opportunities for sexual education, learning, and growth. Conversely, the risk of harm that is evident in the literature has led researchers to investigate adolescent exposure to online pornography in an effort to elucidate these relationships. Collectively, these studies suggest that youth who consume pornography may develop unrealistic sexual values and beliefs. Among the findings, higher levels of permissive sexual attitudes, sexual preoccupation, and earlier sexual experimentation have been correlated with more frequent consumption of pornography…. Nevertheless, consistent findings have emerged linking adolescent use of pornography that depicts violence with increased degrees of sexually aggressive behavior. 

The literature does indicate some correlation between adolescents’ use of pornography and self-concept. Girls report feeling physically inferior to the women they view in pornographic material, while boys fear they may not be as virile or able to perform as the men in these media. Adolescents also report that their use of pornography decreased as their self-confidence and social development increase. Additionally, research suggests that adolescents who use pornography, especially that found on the Internet, have lower degrees of social integration, increases in conduct problems, higher levels of delinquent behavior, higher incidence of depressive symptoms, and decreased emotional bonding with caregivers.

  1. Aren’t all studies correlative? Nope: Over 90 Studies demonstrating internet use & porn use causing negative outcomes & symptoms, and brain changes.

For a debunking of nearly every naysayer talking point and cherry-picked study see this extensive critique: Debunking “Why Are We Still So Worried About Wat­­ching Porn?”, by Marty Klein, Taylor Kohut, and Nicole Prause (2018). How to recognize biased articles: They cite Prause et al., 2015 (falsely claiming it debunks porn addiction), while omitting over 50 neurological studies supporting porn addiction. For easy to understand presentations addressing many of the myths propagated by pro-porn researchers or bloggers, see 2 excellent videos by Gabe Deem: “PORN MYTHS – The Truth Behind Addiction And Sexual Dysfunctions“, and “Porn Playbook: Deny, Disinform and Defame“.

More on addiction

Understanding Internet porn addiction means understanding addiction mechanisms. All addictions hijack the same core neurocircuitry, which runs on the same neurochemicals (even though each addiction also involves additional neural circuits and neurochemicals that differ between addictions).

Recent research reveals that behavioral addictions (food addiction, pathological gambling, video gaming, Internet addiction and porn addiction) and substance addictions share many of the same fundamental mechanisms leading to a collection of shared alterations in brain anatomy and chemistry.

This is not surprising as drugs can only enhance or inhibit existing physiological functions. The specific way a drug alters cellular function is called its “mechanism of action”. All drugs and behaviors that can potentially cause addiction share one important mechanism of action: elevation of dopamine in the nucleus accumbens (often called the reward center). In light of the latest scientific advances, the criticisms of the sexual-behavior addiction model are unfounded and outdated (and no studies have yet to falsify the porn addiction model). Recent reviews of the literature & commentaries fully support this position:

  1. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports (2016) – An extensive review of the literature related to porn-induced sexual problems. Involving US Navy doctors and Gary Wilson, the review provides the latest data revealing a tremendous rise in youthful sexual problems. It also reviews the neurological studies related to porn addiction and sexual conditioning via Internet porn. The doctors provide 3 clinical reports of men who developed porn-induced sexual dysfunctions. A second 2016 paper by Gary Wilson discusses the importance of studying the effects of porn by having subjects abstain from porn use: Eliminate Chronic Internet Pornography Use to Reveal Its Effects (2016).
  2. See this 2015 paper by two medical doctors: Sex Addiction as a Disease: Evidence for Assessment, Diagnosis, and Response to Critics (2015), which provides a chart that takes on specific criticisms and offers citations that counter them.
  3. For a thorough review of the neuroscience literature related to Internet addiction sub-types, with special focus on internet porn addiction, see – Neuroscience of Internet Pornography Addiction: A Review and Update (2015). The review also critiques two recent headline-grabbing EEG studies which purport to have “debunked” porn addiction. (See this page for critiques and analysis of highly questionable and misleading studies)
  4. Cybersex Addiction (2015) Excerpts: In recent articles, cybersex addiction is considered a specific type of Internet addiction. Some current studies investigated parallels between cybersex addiction and other behavioral addictions, such as Internet Gaming Disorder. Cue-reactivity and craving are considered to play a major role in cybersex addiction. Neuroimaging studies support the assumption of meaningful commonalities between cybersex addiction and other behavioral addictions as well as substance dependency.
  5. A short review – Neurobiology of Compulsive Sexual Behavior: Emerging Science (2016) – which concluded: “Given some similarities between CSB and drug addictions, interventions effective for addictions may hold promise for CSB, thus providing insight into future research directions to investigate this possibility directly.”
  6. A 2016 review of compulsive sexual behaviors (CSB) – Should compulsive sexual behavior be considered an addiction? (2016) – concluded that: “Overlapping features exist between CSB and substance use disorders. Common neurotransmitter systems may contribute to CSB and substance use disorders, and recent neuroimaging studies highlight similarities relating to craving and attentional biases.” Note: most of the neuroscience supporting the existence of “sex addiction” actually comes from studies on porn users, not sex addicts. Conflating internet porn addiction with sex addiction weakens the paper.
  7. Compulsive Sexual Behaviour as a Behavioural Addiction: The Impact of the Internet and Other Issues (2016). Excerpts: “more emphasis is needed on the characteristics of the internet as these may facilitate problematic sexual behaviour.” and “clinical evidence from those who help and treat such individuals should be given greater credence by the psychiatric community.”
  8. While the term “hypersexuality” should be discarded, this is a pretty good review by Max Planck neuroscientists Neurobiological Basis of Hypersexuality (2016). Excerpt: “Taken together, the evidence seems to imply that alterations in the frontal lobe, amygdala, hippocampus, hypothalamus, septum, and brain regions that process reward play a prominent role in the emergence of hypersexuality. Genetic studies and neuropharmacological treatment approaches point at an involvement of the dopaminergic system.“
  9. Searching for clarity in muddy water: future considerations for classifying compulsive sexual behavior as an addiction (2016) – Excerpts: We recently considered evidence for classifying compulsive sexual behavior (CSB) as a non-substance (behavioral) addiction. Our review found that CSB shared clinical, neurobiological and phenomenological parallels with substance-use disorders. Although the American Psychiatric Association rejected hypersexual disorder from DSM-5, a diagnosis of CSB (excessive sex drive) can be made using ICD-10. CSB is also being considered by ICD-11.
  10. Integrating psychological and neurobiological considerations regarding the development and maintenance of specific Internet-use disorders: An Interaction of Person-Affect-Cognition-Execution model (2016) – A review of the mechanisms underlying the development and maintenance of specific Internet-use disorders, including “Internet-pornography-viewing disorder”. The authors suggest that pornography addiction (and cybersex addiction) be classified as internet use disorders and placed with other behavioral addictions under substance-use disorders as addictive behaviors.
  11. Sexual Addiction chapter from Neurobiology of Addictions, Oxford Press (2016) – Excerpt: We review the neurobiological basis for addiction, including natural or process addiction, and then discuss how this relates to our current understanding of sexuality as a natural reward that can become functionally “unmanageable” in an individual’s life.
  12. Neuroscientific Approaches to Online Pornography Addiction (2017) – Excerpt: In the last two decades, several studies with neuroscientific approaches, especially functional magnetic resonance imaging (fMRI), were conducted to explore the neural correlates of watching pornography under experimental conditions and the neural correlates of excessive pornography use. Given previous results, excessive pornography consumption can be connected to already known neurobiological mechanisms underlying the development of substance-related addictions.
  13. Is excessive sexual behaviour an addictive disorder? (2017) – Excerpts: Research into the neurobiology of compulsive sexual behaviour disorder has generated findings relating to attentional biases, incentive salience attributions, and brain-based cue reactivity that suggest substantial similarities with addictions. We believe that classification of compulsive sexual behaviour disorder as an addictive disorder is consistent with recent data and might benefit clinicians, researchers, and individuals suffering from and personally affected by this disorder.
  14. Neurobiology of Pornography Addiction – A clinical review (De Sousa & Lodha, 2017) – Excerpts: In total, 59 articles were identified which included reviews, mini reviews and original research papers on the issues of pornography usage, addiction and neurobiology. The research papers reviewed here were centered on those that elucidated a neurobiological basis for pornography addiction. This was further supplemented with the personal clinical experience of both the authors who work regularly with patients where pornography addiction and viewing is a distressing symptom.
  15. The Proof of the Pudding Is in the Tasting: Data Are Needed to Test Models and Hypotheses Related to Compulsive Sexual Behaviors (2018) – Excerpts: Among the domains that may suggest similarities between CSB and addictive disorders are neuroimaging studies, with several recent studies omitted by Walton et al. (2017). Initial studies often examined CSB with respect to models of addiction (reviewed in Gola, Wordecha, Marchewka, & Sescousse, 2016b; Kraus, Voon, & Potenza, 2016b).
  16. Promoting educational, classification, treatment, and policy initiatives Commentary on: Compulsive sexual behaviour disorder in the ICD-11 (Kraus et al., 2018) – Excerpts: The current proposal of classifying CSB disorder as an impulse-control disorder is controversial as alternate models have been proposed (Kor, Fogel, Reid, & Potenza, 2013). There are data suggesting that CSB shares many features with addictions (Kraus et al., 2016), including recent data indicating increased reactivity of reward-related brain regions in response to cues associated with erotic stimuli (Brand, Snagowski, Laier, & Maderwald, 2016; Gola, Wordecha, Marchewka, & Sescousse, 2016; Gola et al., 2017; Klucken, Wehrum-Osinsky, Schweckendiek, Kruse, & Stark, 2016; Voon et al., 2014.
  17. Compulsive Sexual Behavior in Humans and Preclinical Models (2018) – Excerpts: Compulsive sexual behavior (CSB) is widely regarded as a “behavioral addiction,” and is a major threat to quality of life and both physical and mental health. In conclusion, this review summarized the behavioral and neuroimaging studies on human CSB and comorbidity with other disorders, including substance abuse. Together, these studies indicate that CSB is associated with functional alterations in dorsal anterior cingulate and prefrontal cortex, amygdala, striatum, and thalamus, in addition to decreased connectivity between amygdala and prefrontal cortex.
  18. Sexual Dysfunctions in the Internet Era (2018) – Excerpt: Among behavioral addictions, problematic Internet use and online pornography consumption are often cited as possible risk factors for sexual dysfunction, often with no definite boundary between the two phenomena. Online users are attracted to Internet pornography because of its anonymity, affordability, and accessibility, and in many cases its usage could lead users through a cybersex addiction: in these cases, users are more likely to forget the “evolutionary” role of sex, finding more excitement in self-selected sexually explicit material than in intercourse.
  19. Neurocognitive mechanisms in compulsive sexual behavior disorder (2018) – Excerpt: To date, most neuroimaging research on compulsive sexual behavior has provided evidence of overlapping mechanisms underlying compulsive sexual behavior and non-sexual addictions. Compulsive sexual behavior is associated with altered functioning in brain regions and networks implicated in sensitization, habituation, impulse dyscontrol, and reward processing in patterns like substance, gambling, and gaming addictions. Key brain regions linked to CSB features include the frontal and temporal cortices, amygdala, and striatum, including the nucleus accumbens.
  20. A Current Understanding of the Behavioral Neuroscience of Compulsive Sexual Behavior Disorder and Problematic Pornography Use (2018) – Excerpt: Recent neurobiological studies have revealed that compulsive sexual behaviors are associated with altered processing of sexual material and differences in brain structure and function. Although few neurobiological studies of CSBD have been conducted to date, existing data suggest neurobiological abnormalities share communalities with other additions such as substance use and gambling disorders. Thus, existing data suggest that its classification may be better suited as a behavioral addiction rather than an impulse-control disorder.
  21. Ventral Striatal Reactivity in Compulsive Sexual Behaviors (2018) – Excerpt: Among currently available studies, we were able to find nine publications (Table 1) which utilized functional magnetic resonance imaging. Only four of these (36–39) directly investigated processing of erotic cues and/or rewards and reported findings related to ventral striatum activations. Three studies indicate increased ventral striatal reactivity for erotic stimuli (36–39) or cues predicting such stimuli (36–39). These findings are consistent with Incentive Salience Theory (IST) (28), one of the most prominent frameworks describing brain functioning in addiction.
  22. Online Porn Addiction: What We Know and What We Don’t—A Systematic Review (2019) – Excerpt: As far as we know, a number of recent studies support this entity as an addiction with important clinical manifestations such as sexual dysfunction and psychosexual dissatisfaction. Most of the existing work is based off on similar research done on substance addicts, based on the hypothesis of online pornography as a ‘supranormal stimulus’ akin to an actual substance that, through continued consumption, can spark an addictive disorder.
  23. Occurrence and development of online porn addiction: individual susceptibility factors, strengthening mechanisms and neural mechanisms (2019) – Excerpt: The long-term experience of online pornography has led to the sensitization of such people to online pornography-related clues, which has led to a growing sense of craving, compulsive use of online pornography under the dual factors of temptation and functional impairment. The sense of satisfaction gained from it is getting weaker and weaker, so more and more online pornography is needed to maintain the previous emotional state and become addicted.
  24. Theories, prevention, and treatment of pornography-use disorder (2019) – Excerpt: Compulsive sexual behavior disorder, including problematic pornography use, has been included in the ICD-11 as impulse control disorder. The diagnostic criteria for this disorder, however, are very similar to the criteria for disorders due to addictive behaviors… Theoretical considerations and empirical evidence suggest that the psychological and neurobiological mechanisms involved in addictive disorders are also valid for pornography-use disorder.
  25. Self-perceived Problematic Pornography Use: An Integrative Model from a Research Domain Criteria and Ecological Perspective (2019) – Excerpt: Self-perceived problematic pornography use seems to be related to multiple units of analysis and different systems in the organism. Based on the findings within the RDoC paradigm described above, it is possible to create a cohesive model in which different units of analysis impact each other (Fig. 1). These changes in internal and behavioral mechanisms among people with SPPPU are similar to those observed in people with substance addictions, and map into models of addiction.
  26. Cybersex addiction: an overview of the development and treatment of a newly emerging disorder (2020) – Excerpts: Cybersex addiction is a non-substance related addiction that involves online sexual activity on the internet. Nowadays, various kinds of things related to sex or pornography are easily accessible through internet media. In Indonesia, sexuality is usually assumed taboo but most young people have been exposed to pornography. It can lead to an addiction with many negative effects on users, such as relationships, money, and psychiatric problems like major depression and anxiety disorders.
  27. Which Conditions Should Be Considered as Disorders in the International Classification of Diseases (ICD-11) Designation of “Other Specified Disorders Due to Addictive Behaviors”? (2020) – Excerpts: Data from self-report, behavioral, electrophysiological, and neuroimaging studies demonstrate an involvement of psychological processes and underlying neural correlates that have been investigated and established to varying degrees for substance-use disorders and gambling/gaming disorders (criterion 3). Commonalities noted in prior studies include cue-reactivity and craving accompanied by increased activity in reward-related brain areas, attentional biases, disadvantageous decision-making, and (stimuli-specific) inhibitory control.
  28. The Addictive Nature of Compulsive Sexual Behaviours and Problematic Online Pornography Consumption: A Review – Excerpts: Available findings suggest that there are several features of CSBD and POPU that are consistent with characteristics of addiction, and that interventions helpful in targeting behavioural and substance addictions warrant consideration for adaptation and use in supporting individuals with CSBD and POPU….  The neurobiology of POPU and CSBD involves a number of shared neuroanatomical correlates with established substance use disorders, similar neuropsychological mechanisms, as well as common neurophysiological alterations in the dopamine reward system.
  29. Dysfunctional sexual behaviors: definition, clinical contexts, neurobiological profiles and treatments (2020) – Excerpts: Porn addiction, although distinct neurobiologically from sexual addiction, is still a form of behavioral addiction….The sudden suspension of porn addiction causes negative effects in mood, excitement, and relational and sexual satisfaction….The massive use of pornography facilitates the onset of psychosocial disorders and relationship difficulties…
  30. What should be included in the criteria for compulsive sexual behavior disorder? (2020) – Excerpts: The classification of CSBD as an impulse control disorder also warrants consideration. … Additional research may help refine the most appropriate classification of CSBD as happened with gambling disorder, reclassified from the category of impulse control disorders to non-substance or behavioral addictions in DSM-5 and ICD-11. … impulsivity may not contribute as strongly to problematic pornography use as some have proposed (Bőthe et al., 2019).
  31. Decision-Making in Gambling Disorder, Problematic Pornography Use, and Binge-Eating Disorder: Similarities and Differences (2021) – Excerpts: Similarities between CSBD and addictions have been described, and impaired control, persistent use despite adverse consequences, and tendencies to engage in risky decisions may be shared features (37••, 40). Individuals with these disorders often show impaired cognitive control and disadvantageous decision-making [12, 15,16,17]. Deficits in decision-making processes and goal-directed learning have been found across multiple disorders.
  32. Cognitive processes related to problematic pornography use (PPU): A systematic review of experimental studies (2021) – Excerpts: In the current paper, we review and compile the evidence derived from 21 studies investigating the cognitive processes underlying PPU. In brief, PPU is related to: (a) attentional biases toward sexual stimuli, (b) deficient inhibitory control (in particular, to problems with motor response inhibition and to shift attention away from irrelevant stimuli), (c) worse performance in tasks assessing working memory, and (d) decision making impairments.

Four major brain changes are involved with both drug and behavioral addictions, as outlined in this paper published this year in The New England Journal of Medicine: “Neurobiologic Advances from the Brain Disease Model of Addiction (2016)“. This landmark review by the Director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) George F. Koob, and the director of the National Institute on Drug Abuse (NIDA) Nora D. Volkow, not only outlines the brain changes involved in addiction, it also states in its opening paragraph that sex addiction exists:

“We conclude that neuroscience continues to support the brain disease model of addiction. Neuroscience research in this area not only offers new opportunities for the prevention and treatment of substance addictions and related behavioral addictions (e.g., to food, sex, and gambling)….”

In simple, and very broad, terms the major fundamental addiction-caused brain changes are: 1) Sensitization, 2) Desensitization, 3) Dysfunctional prefrontal circuits (hypofrontality), 4) Dysfunctional stress circuits. All 4 of these brain changes have been identified among the over 55 neuroscience-based studies on frequent porn users & sex addicts:

  1. Sensitization (cue-reactivity & cravings): Brain circuits involved in motivation and reward seeking become hyper-sensitive to memories or cues related to the addictive behavior. This results in increased “wanting” or craving while liking or pleasure diminishes. For example, cues, such as turning on the computer, seeing a pop-up, or being alone, trigger intense hard to ignore cravings for porn. Some describe a sensitized porn response as ‘entering a tunnel that has only one escape: porn’. Maybe you feel a rush, rapid heartbeat, even trembling, and all you can think about is logging onto your favorite tube site. Studies reporting sensitization or cue-reactivity in porn users/sex addicts: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28.
  2. Desensitization (decreased reward sensitivity & tolerance): This involves long-term chemical and structural changes that leave the individual less sensitive to pleasure. Desensitization often manifests as tolerance, which is the need for a higher dose or greater stimulation to achieve the same response. Some porn users spend more time online, prolonging sessions through edging, watching when not masturbating, or searching for the perfect video to end with. Desensitization can also take the form of escalating to new genres, sometimes harder and stranger, or even disturbing. This is because shock, surprise or anxiety can all elevate dopamine and waning sexual arousal. Some studies use the term “habituation” – which may involve learning mechanisms or addiction mechanisms. Studies reporting desensitization or habituation in porn users/sex addicts: 1, 2, 3, 4, 5, 6, 7, 8.
  3. Dysfunctional prefrontal circuits (weakened willpower + hyper-reactivity to cues): Dysfunctional prefrontal cortex functioning or alterations in the connections between the reward system and the prefrontal cortex lead to reduced impulse control, yet greater cravings to use. Dysfunctional prefrontal circuits manifests as the feeling that two parts of your brain are engaged in a tug-of-war. The sensitized addiction pathways are screaming ‘Yes!’ while your ‘higher brain’ is saying, ‘No, not again!’ While the executive-control portions of your brain are in a weakened condition the addiction pathways usually win. Studies reporting poorer executive functioning (hypofrontality) or altered prefrontal activity in porn users/sex addicts: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20.
  4. Malfunctioning stress system (greater cravings & withdrawal symptoms): Some addiction experts view addiction a stress disorder, as chronic use induces multiple alterations in the brain’s stress system, and also affect circulating stress hormones (cortisol and adrenaline). A malfunctioning stress system results in even minor stress leading to cravings and relapse because it activates powerful sensitized pathways. In addition, quitting an addiction activates the brain’s stress systems leading to many of withdrawal symptoms common to all addictions, including anxiety, depression, insomnia, irritability and mood swings. Finally, an over-active stress response inhibits the prefrontal cortex and executive functions, including impulse control and the ability fully comprehend the consequences of our actions. Studies indicating a dysfunctional stress system in porn users/sex addicts: 1, 2, 3, 4, 5.

Are these the only brain changes? No. Each of these broad-brush indicators reflects multiple subtler addiction-related cellular and chemical alterations—just as the scan of a cancer tumor wouldn’t show associated subtler cellular/chemical changes. Most of the subtler changes can’t be assessed in human models due to the invasiveness of the technologies required. However, they have been identified in animal models.

Together the above brain studies found:

  1. The 3 major addiction-related brain changes: sensitization, desensitization, and hypofrontality.
  2. More porn use correlated with less grey matter in the reward circuit (dorsal striatum).
  3. Greater porn use correlated with less reward system activation when briefly viewing sexual images.
  4. More porn use correlated with disrupted neural connections between the reward system and prefrontal cortex.
  5. Addicts had greater prefrontal activity to sexual cues, but less brain activity to normal stimuli (matches drug addiction).
  6. Porn use/exposure to porn related to greater delayed discounting (inability to delay gratification). This is a sign of poorer executive functioning.
  7. 60% of compulsive porn addicted subjects in one study experienced ED or low libido with partners, but not with porn: all stated that internet porn use caused their ED/low libido.
  8. Enhanced attentional bias comparable to drug users. Indicates sensitization (a product of DeltaFosb).
  9. Greater wanting & craving for porn, but not greater liking. This aligns with the accepted model of addiction – incentive sensitization.
  10. Porn addicts have greater preference for sexual novelty yet their brains habituated faster to sexual images. Not pre-existing.
  11. The younger the porn users the greater the cue-induced reactivity in the reward center.
  12. Higher EEG (P300) readings when porn users were exposed to porn cues (which occurs in other addictions).
  13. Less desire for sex with a person correlating with greater cue-reactivity to porn images.
  14. More porn use correlated with lower LPP amplitude when briefly viewing sexual photos: indicates habituation or desensitization.
  15. Dysfunctional HPA axis and altered brain stress circuits, which occurs in drug addictions (and greater amygdala volume, which is associate with chronic social stress).
  16. Epigenetic changes on genes central to the human stress response and closely associated with addiction.
  17. Higher circulating levels of Tumor Necrosis Factor (TNF) which also occurs in drug abuse and addiction.
  18. A deficit in temporal cortex gray matter; poorer connectivity between temporal corporate and several other regions.
  19. Greater state impulsivity.
  20. Decreased prefrontal cortex and anterior cingulate gyrus gray matter compared to healthy controls.
  21. Reductions in white matter compared to healthy controls.

Empirical evidence for “behavioral addictions” is overwhelming

Prior to publication of the above studies YBOP claimed that internet porn addiction was real and caused by the same fundamental brain changes as seen in other addictions. We were confident in this claim because basic physiology rests on the fact that drugs do not create anything new or different; they simply increase or decrease existing cellular functions. We already possess the machinery for addiction (mammalian mating/bonding/love circuitry), and for binging (storing calories, mating season). Moreover, years of addiction research have clearly demonstrated that addiction is a single condition, reflected in a typical constellation of signs, symptoms and behaviors (Natural Rewards, Neuroplasticity, and Non-Drug Addictions (2011).

In addition to brain studies on porn users/sex addicts, multiple studies reveal a link between porn use and sexual performance problems, relationship and sexual dissatisfaction, and reduced brain activation to sexual stimuli (see this continuously updated list of studies). We often see healthy guys who develop porn-related erectile dysfunction return to good health simply by avoiding internet porn. This suggests they didn’t have other issues that would have accounted for their vulnerability

The studies on Internet porn users should come as no surprise because more than 370+ brain studies also confirm that “Internet addicts” develop the same major addiction-related brain changes that occur in drug addictions. Hundreds more assessment-based Internet addiction studies back up what the brain studies found. See our collections:

Internet porn, internet gaming, and social media are now being viewed as separate applications or subcategories of Internet use. An individual can be addicted to Facebook or Internet porn, while not having a “generalized Internet addiction”, as explained in this 2015 review of the literature. A 2006 Dutch study found that erotica had the highest addictive potential of all Internet applications.

No wonder. Internet erotica is an extreme version of natural rewards that we’re all wired to pursue: sexual arousal and apparent mating opportunities. Today’s extreme porn is as unnatural a “natural reinforcer” as today’s junk food is. See our article Porn Then and Now: Welcome to Brain Training, and this excellent peer-reviewed article, with a current review of where neuroscience is with respect to Internet porn addiction: Pornography addiction – a supranormal stimulus considered in the context of neuroplasticity (2013).

Without a doubt, some brains are more sensitive than others to the potentially addictive effects of extreme stimuli. However, it’s likely that the more intense our culture’s sexual stimuli become, the greater the percentage of users who will show signs of imbalance—even those with fundamentally healthy brains. Also each generation uses more extreme synthetic stimulation than the previous one, and starts earlier with highspeed Internet porn (think smartphones.) Alas, adolescent brains are more vulnerable to addiction and sexual conditioning.

Recent research on brain changes in response to “highly palatable foods” is revealing evidence of an addiction process. If gambling, gaming, Internet use and food can alter the brain in this way, it would have been amazing to believe that Internet porn alone could not. This is why In 2011, 3000 doctors of the American Society for Addiction Medicine (ASAM) came out with a public statement clarifying that behavioral addictions (sexual, food, gambling) are fundamentally like substance addictions in terms of brain changes. Said ASAM:

“We all have the brain reward circuitry that makes food and sex rewarding. In fact, this is a survival mechanism. In a healthy brain, these rewards have feedback mechanisms for satiety or ‘enough.’ In someone with addiction, the circuitry becomes dysfunctional such that the message to the individual becomes ‘more’, which leads to the pathological pursuit of rewards and/or relief through the use of substances and behaviors.”

ASAM specifically addressed sexual behavior addictions:

QUESTION: This new definition of addiction refers to addiction involving gambling, food, and sexual behaviours. Does ASAM really believe that food and sex are addicting?

ANSWER: The new ASAM definition makes a departure from equating addiction with just substance dependence, by describing how addiction is also related to behaviours that are rewarding. … This definition says that addiction is about functioning and brain circuitry and how the structure and function of the brains of persons with addiction differ from the structure and function of the brains of persons who do not have addiction. … Food and sexual behaviours and gambling behaviours can be associated with the “pathological pursuit of rewards” described in this new definition of addiction.

Two world-renowned addiction researchers, and ASAM members, gave their opinions years before the new definition:

  1. The head of the National Institute on Drug Abuse (NIDA) Doctor Nora Volkow, has suggested the agency’s name be changed to the “National Institute for Diseases of Addiction,” to address behavioral addictions such as pathological gambling, overeating and compulsive pornography use (More Addictions, Less Stigma).
  2. Addiction researcher, Eric Nestler, has this Q & A on his website, Nestler Labs.

QUESTION: Do these changes occur naturally in your brain without the influence of a drug of abuse?

ANSWER: “It is likely that similar brain changes occur in other pathological conditions which involve the excessive consumption of natural rewards, conditions such as pathological over-eating, pathological gambling, sex addictions, and so on.”

But ‘porn addiction’ isn’t recognized, right?

As you may have heard in the media, the American Psychiatric Association (APA) has been dragging its feet on including a diagnosis for addictive/compulsive use of internet porn in its Diagnostic and Statistical Manual. Actually, the APA didn’t formally consider “internet porn addiction” for its 2013 edition (DSM-5), opting instead to debate “hypersexual disorder”. The latter umbrella term for problematic sexual behavior was recommended for inclusion by the DSM-5’s own Sexuality Work Group after years of effort. However, in an eleventh-hour “star chamber” session (according to a Work Group member), other DSM-5 officials unilaterally rejected hypersexuality, citing reasons that have been described as illogical. For example, the DSM-5 recommended further study of internet addiction subtype “Internet Gaming Disorder,” while declining to recommend further study of “Internet Addiction Disorder”.

In reaching this position, the DSM-5 disregarded both the widespread reports of sufferers and their clinicians of the signs, symptoms and behaviors consistent with addiction, and the formal recommendation of thousands of medical and research experts at the American Society of Addiction Medicine. A bit of history: the DSM has some distinguished critics who object to its approach of ignoring medical theory and grounding its diagnoses in symptoms (rather than underlying physiology). This results in some erratic, political decisions that defy reality. For example, it once incorrectly classified homosexuality as a mental disorder.

Just prior to the DSM-5’s publication in 2013, Director of the National Institute of Mental Health Thomas Insel warned that it was time for the mental health field to stop relying on the DSM. The DSM’s “weakness is its lack of validity,” he explained, and “we cannot succeed if we use DSM categories as the “gold standard.” He added, “That is why NIMH will be re-orienting its research away from DSM categories.”In other words, the NIMH would no longer fund research based on the diagnoses listed in the DSM.

Since the DSM-5’s publication, hundreds more internet addiction and internet gaming addiction studies, and dozens of internet porn addiction studies have come out that undercut the DSM-5’s position. Incidentally, despite media attention to the DSM-5’s stance, practitioners who work with those with problematic sexual behaviors have continued to diagnose such problems. They employ another diagnosis in the DSM-5 as well as one from the current ICD-10, the World Health Organization’s widely used diagnostic manual, the International Classification of Diseases.

The big news is that the World Health Organization has corrected the DSM-5’s error. Unlike the DSM-5 editors, the editors of the ICD-11 propose to add a new mental-health diagnosis that would encompass those with disorders relating to sexual addictive behaviors. Here’s the current proposed language:

6C92 Compulsive sexual behaviour disorder is characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour. Symptoms may include repetitive sexual activities becoming a central focus of the person’s life to the point of neglecting health and personal care or other interests, activities and responsibilities; numerous unsuccessful efforts to significantly reduce repetitive sexual behaviour; and continued repetitive sexual behaviour despite adverse consequences or deriving little or no satisfaction from it.

The pattern of failure to control intense, sexual impulses or urges and resulting repetitive sexual behaviour is manifested over an extended period of time (e.g., 6 months or more), and causes marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. Distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviours is not sufficient to meet this requirement.

For an accurate account of the ICD-11, see this recent article by The Society for the Advancement of Sexual Health (SASH): “Compulsive Sexual Behaviour” has been classified by World Health Organization as Mental Health Disorder. For an expose on the shenanigans by agenda-driven PhD’s, see – Propagandists misrepresent papers to fuel false claim that WHO’s ICD-11 “rejected porn addiction and sex addiction”

Sexual conditioning

Not everyone who suffers from problematic porn use is an addict. Many problems seem to the be result of consumers conditioning their sexual response to  online porn. For more see Sexual Conditioning.

Sections containing thousands of relevant studies: