Abstract
Introduction To date, multiple models of problematic pornography use have been proposed, but attempts to validate them have been scarce.
Aim In our study, we aimed to evaluate the Pornography Problems due to Moral Incongruence model proposing that self-appraisals of pornography addiction stem from (i) general dysregulation, (ii) habits of use, and (iii) moral incongruence between internalized norms and behavior. We investigated whether the model can be used to adequately explain the self-perceptions of addiction to pornography (model 1) and a broader phenomenon of problematic pornography use (model 2).
Methods An online, nationally representative study was conducted on a sample of 1036 Polish adult participants, of whom, 880 declared a lifetime history of viewing pornography.
Main Outcome Measure The outcomes were self-perceived pornography addiction, problematic pornography use, avoidant coping, frequency of pornography use, religiosity, moral disapproval of pornography, and related variables.
Results Our results indicated that avoidant coping (an indicator of general dysregulation), frequency of pornography use (indicator of habits of use), and the distress connected with incongruence between own sexual behavior and internalized norms, attitudes and beliefs positively contributed to self-perceived addiction (model 1) as well as problematic pornography use (model 2). This broadly confirms the basic shape of the PPMI model. There were, however, notable differences between the models. Moral incongruence related distress was only weakly related to self-perceived addiction (β = 0.15, P < .001), with a stronger relation for problematic pornography use (β = 0.31, P < .001). When controlling for other factors, religiosity weakly predicted problematic pornography use (β = 0.13, P < .001), but not self-perceived addiction to pornography (β = 0.03, P = .368). Frequency of pornography use was the strongest predictor of both self-perceived addiction (β = 0.52, P < .001) and problematic pornography use (β = 0.43, P < .001).
Clinical Implications Factors proposed within the PPMI model are distinctly relevant intervention targets, and they should be considered in the process of diagnosis and treatment.
Strengths & Limitations The presented study is the first to evaluate PPMI model. Its main limitation is that it has a cross-sectional design.
Conclusion The PPMI model is a promising framework for investigating the factors related to self-perceived addiction and problematic pornography use. Despite the differences between the models and in the strength of specific predictors, (i) dysregulation, (ii) habits of use, and (iii) moral incongruence all uniquely contribute to self-perceived addiction and problematic pornography use.
Discussion
The
presented work is one of only a few attempting a nonfragmentary
assessment of the validity of any model of pornography addiction,
problematic pornography use or problematic sexual behavior, and the
first to do so for the PPMI model. On a general level, our results
confirmed the appropriateness of the basic shape of the model to depict
the structure of predictors of both self-perceived addiction to
pornography (model 1, Figure 1) and problematic pornography use (model 2, Figure 2).
However in some places, our results diverge from the predictions
stemming from the model, and there are at least several specific but
important issues that require consideration as well as have potential
implications for the shape of the model and future research.
As
described previously, the analysis reported in the present study was
based on 3 paths proposed within the PPMI model: dysregulation path (as
indicated by avoidant coping), habits of use path (indicated by
frequency of pornography use) and moral incongruence path
(operationalized by religiosity, moral disapproval of pornography use,
and moral incongruence–related distress). Overall, the results showed
that all 3 paths uniquely and significantly contribute to explaining
both self-perceived addiction and a broader set of symptoms that fall
under the label of problematic pornography use. Moreover, our results
confirmed that problematic pornography use symptoms are distinct from
simple declarations of being an addict. The correlation between these 2
constructs was r = 0.55. Based on our results, none of the 3 paths
postulated within the model can be reduced to the other or eliminated
without deterioration in the quality and predictive value of the model.
This confirms the basic prediction stemming from the PPMI model.3
Estimated models explained a significant portion of variance in
self-perceived addiction (33.9%, model 1) and problematic pornography
use (35.9%, model 2).
Conclusions regarding each of the 3 paths of the model are delineated in the following section.
Moral Incongruence Path
People
experiencing moral incongruence–related distress reported higher levels
of self-perceived addiction and problematic pornography use. This
confirms the prediction of the authors of the PPMI model3,31 regarding the role that moral incongruence plays in shaping the self-appraisals of self-perceived addiction24
and extends it to more general problematic pornography use symptoms.
However, the prediction of the model is that moral incongruence should
be the stronger predictor of self-perceived addiction to pornography
than frequency of use and dysregulation,3,31
which is not confirmed by our findings. Our results are more in line
with recent work showing that frequency of pornography use is a stronger
predictor of self-perceived addiction to pornography than moral
incongruence26 (refer also to the study by Lewczuk et al27
for an analysis conducted on the same sample as the present study). It
is also possible that the lower impact of moral incongruence–related
distress on self-perceived addiction is at least partially caused by a
slightly lower level of moral disapproval of pornography use in the
current Polish sample, compared with, for example, a representative
sample of U.S. adults.25
In our study, 20.5% of participants who used pornography in their
lifetime agreed that pornography use is morally wrong (answer options
ranged from “somewhat agree” to “strongly agree”), while the same answer
was given by 24% of Americans. Moreover, based on the same measure,
U.S. participants declared to be slightly more religious on average (M =
4.10, SD = 1.9525)
than Polish participants in the current sample (M = 3.81, SD = 1.84),
which may also explain the weaker impact of the moral incongruence path
on self-perceived pornography addiction than the PPMI model based mostly
on research performed on the U.S. predicts.
In
addition, moral incongruence–related distress was more strongly
connected to problematic pornography use than to self-perception of
addiction. A possible explanation for this pattern is that, compared
with self-perceived addiction, problematic pornography use encompasses a
broader group of cognitive and affective consequences and determinants
of pornography use. One of them is increased levels of guilt regarding
pornography use, which can be a consequence of moral incongruence.20 One of the 5 statements in the BPS,34
which was an indicator of problematic pornography use in our study,
reads “You continue to use pornography even though you feel guilty about
it.” The relation between self-labeling as an addict and moral
incongruence–related distress is theoretically not as close as in other
studies, which is reflected by our findings.
Next, our
results generally confirmed the specifics of the chain of influence
between morality-related variables, although not without a caveat. More
religious people were more inclined to see pornography use as morally
reprehensible and were more prone to experiencing feelings of
incongruence between own sexual behavior and adopted beliefs, attitudes,
and norms. The impact of religion was not strong in these cases, as our
method of measuring it does not directly invoke a religious context
(see the Introduction
section for more information on this issue). As expected, distress
connected to behavior-attitudes misalignment was determined by 2
additional factors: frequency of the behavior (frequency of pornography
use) and restrictiveness of the attitudes (moral disapproval of
pornography; refer to the study by Grubbs et al3).
However, although religiosity and moral disapproval significantly
predicted moral incongruence–related distress, their contribution was
somewhat limited. Other possible predictors should be investigated, both
connected to other sources of norms that can determine disapproval of
pornography, for example, sociopolitical views, religious fundamentalism53,54 or certain branches of feminism,55
as well as variables related to the awareness and sensitivity to own
behaviors being incongruent with own beliefs, attitudes, and
internalized norms (eg, self, awareness, concern over mistakes,
perfectionism, the centrality of the norms that motivate attitudes
toward pornography and sexuality). Here, we echo the suggestions that
were voiced by other authors in their commentaries for the model.19,22
In
addition, our results showed that, controlling for other variables,
more religious people declared higher levels of problematic pornography
use. The influence of religiosity on problematic pornography use was
weak, but present—which is in agreement with at least a significant
portion of previous studies showing a weak, positive relationship
between religiosity and problematic pornography use symptoms25,26 (refer also to the study by Lewczuk et al27). A corresponding relation was not found for self-perceptions of addiction.
Habits of Use Path
Frequency
of pornography use was the strongest predictor of self-perceived
addiction in model 1 and of problematic pornography use in model 2. This
indicates that the self-appraisal of pornography-related problems does
not merely rely on perceiving this behavior as transgressing one's
personal norms, that is, it is not a function of mere convictions (refer
to the discussion in the study by Humphreys56).
A significant portion of the variance is better explained by the
frequency of use, which validates the disorder model of problematic
pornography use and is similar to the symptomology of at least some
cases of substance use disorders and other behavioral addictions, for
which excessive use during at least some part of the course of the
disorder is a definitional criterion (refer to the study by Kraus et al1 and Potenza et al57).
Frequency of pornography use was also a significant predictor of
problematic pornography use, although its influence was slightly weaker
than for self-perception of addiction (β = 0.43 vs β = 0.52). This is
understandable, given that problematic use has a broader scope than
self-perception of addiction, encompassing not only excessive
pornography use but also loss of control, using pornography as a coping
mechanism and guilt connected to pornography use.34
Dysregulation Path
Avoidant
coping style was an indicator of dysregulation in our model. People
using an avoidant coping style more frequently were also more inclined
to see themselves as pornography addicts and had a higher severity of
symptoms of problematic pornography use. This is in line with previous
research, which showed the specific importance of an avoidant coping
style for problematic sexual behavior.39, 40, 41
This result is also in agreement with studies showing that engagement
in sexual behaviors itself can constitute an avoidance strategy (eg,
avoiding negative emotions associated with other areas of one's life).
However, the impact on avoidant coping for both dependent variables was
weak (β = 0.15, P < .001) and was not stronger for
problematic pornography use than for self-appraisals of addiction. This
can be considered surprising, as problematic pornography use has a
pornography-as-coping component (“You find yourself using pornography to
cope with strong emotions, eg, sadness, anger, loneliness, etc.” is one
of BPS items that operationalized problematic pornography use in our
study).
Implications for the Shape of the Model and Future Research
Our
findings indicate that the PPMI model can serve as a general model of
factors contributing to self-perception of pornography addiction and
problematic pornography use. However, the dysregulation path is
underdeveloped in the current version of the model. This has also been
pointed out by other researchers.16 This path should be delineated with more detail and extended. In their initial proposition of the model, Grubbs et al3
focused on moral incongruence–related factors describing the
dysregulation path with less detail. This approach is understandable as
moral incongruence is a central focus of the model. However, as a
consequence, the current conceptualization of the PPMI model places all
dysregulation-related factors (such as emotion dysregulation,
impulsivity, coping, compulsivity) into one general and unspecified
category and abstains from depicting mechanisms of influence between
these variables, ascribing them differential degrees of importance or
depicting relations between dysregulation-related variables and moral
incongruence–related variables. Such relations have been proposed by
others16,22 and are also visible in our analysis, as avoidant coping was connected to moral incongruence–related distress (r = 0.21, P < .001) possibly indicating that avoidant coping strategies can serve as a way of dealing with moral incongruence.
As
the PPMI model was initially validated in the present study, we
postulate that it should be extended and possibly reshaped into an even
more ambitious, general model in which dysregulation-related variables
will be treated with the same degree of carefulness as morality-related
ones. To achieve this, specific models—such as the current version of
the PPMI model—should be merged with broader models (eg, I-PACE model12,58)
that go into more detail regarding behavior dysregulation–related
factors, but, as of now, neglect the role of morality-related variables.
It seems that only this approach would allow for the full picture of
factors influencing both lay self-perceptions of addiction and
problematic pornography use to be accounted for. These 2 branches of
research should not and cannot develop separately because of their
possible mutual influence.16,22
Because of this interdependence, the shape of the moral incongruence
path cannot be definitively established when the dysregulation-related
side of the model is underdeveloped.
In future studies,
other indicators of general dysregulation (eg, impulsivity, maladaptive
emotion regulation, perfectionism) should be tested within the PPMI
model to extend and provide further support for the discussed framework.
Such an extension seems to have been predicted and welcomed by the
authors of the model,31 which we fully agree with.
Another
issue worth pointing out is that our analysis is based on a
populational sample. One of the important future directions for further
research is to also verify the model based on clinical samples,
experiencing a clinical level of symptoms of problematic pornography.
This is crucially important because the significance of factors
predicting problematic pornography use can change the clinical level,
compared with populational investigations. Future studies should also
apply the PPMI model to CSBD recognized in the ICD-1113,14
when screening measures for this disorder become available for use. We
agree with other researchers who suggested studying behavior-norms
misalignment for sexual behaviors other than problematic pornography
use,20 which may lead to an extension of the model to explain general problematic sexual behavior symptoms.
Additional concerns about the issue of operationalizing moral incongruence vs moral disapproval of pornography use (see Material and Methods
section) and self-perceived addiction vs disordered pornography use
based on formal clinical definitions (such as problematic pornography
use, see the Introduction section) were noted in the earlier parts of the manuscript.
The
current research extends research on the PPMI model to another cultural
context, namely, Polish participants. However, Poland shares cultural
similarities with the United States as it is a predominantly Christian
country (77.3% of participants in the current analysis declared being
Catholic). Future research should further validate the model, based on
different religious and cultural circles.
Limitations
Some
of the limitations of the present study were already noted (single
dysregulation-related factor). We also note that the present work is
based on cross-sectional research design, which precludes analyses of
directionality or causality. That is, although the present work is
consistent with the PPMI, without longitudinal observations that examine
trajectories of these variables over time, it is impossible to
conclusively evaluate any model of problematic pornography use. Finally,
we did not include a definition of pornography for the participants in
the online survey.
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