Pornography use is both ubiquitous and controversial in developed nations

Pornography Use and Psychological Science: A Call for Consideration. Joshua B. Grubbs, Shane W. Kraus. Current Directions in Psychological Science, January 15, 2021. https://doi.org/10.1177/0963721420979594

Abstract: Pornography use is both ubiquitous and controversial in developed nations. Although research related to pornography use has flourished in topical and special-interest journals for several decades, much of this work has remained in the periphery of mainstream interests. The current article reviews how pornography use is likely relevant to various domains within psychological science, particularly emphasizing its significance in relationship research, adolescent-development research, and clinical science. Specifically, pornography use is likely salient to research examining both sexual and romantic satisfaction. Additionally, it is also likely relevant to understanding adolescent sexual development, particularly among sexual-minority populations. Finally, a large body of research suggests that pornography use may become problematic, either because of excessive use or moral incongruence about such use, illustrating its salience in clinical psychological science. Collectively, the current research related to pornography use suggests that it is of interest to multiple domains in psychological science and that its effects can range from positive to neutral to negative.

Keywords: pornography, compulsive sexual behavior, sexually explicit media, media effects, technology

Clinical Concerns About Pornography

Beyond the above domains, there is a growing body of research aimed at illuminating the clinical relevance of pornography use. Various public advocacy groups, religious organizations, activist communities, and even mental health professionals have made claims of pornography’s inherently addictive nature and the growing epidemic of pornography addiction (for a review, see Grubbs, Perry, et al., 2019). Yet there is no consensus in scientific communities as to whether any of these claims are true. Although there is clear evidence that some people report high-frequency use of pornography (Kraus et al., 2016; Kraus & Sweeney, 2019), there is ongoing debate as to what is signified by such patterns of use.

Addiction and dysregulation

Over recent years, there has been much discussion around how to classify high-frequency pornography use. One line of thought suggests that such use of pornography is likely a clinical syndrome that warrants psychiatric diagnosis. Specifically, scholars have proposed classifications such as hypersexual disorder, impulse-control disorder, nonparaphilic compulsive sexual behavior disorder (CSBD), and behavioral addiction to describe individuals reporting excessive and problematic pornography use and other compulsive sexual behaviors. Until recently, none of these classifications had been adopted by any major medical organization or included in a diagnostic manual. However, in 2019, the World Health Organization included the novel diagnosis of CSBD in the 11th revision of the International Classification of Diseases. CSBD is described as “a persistent pattern of failure to control intense, repetitive sexual impulses or urges, resulting in repetitive sexual behaviour over an extended period (e.g., six months or more) that causes marked distress or impairment in personal, family, social, educational, occupational or other important areas of functioning” (Kraus et al., 2018, p. 109). With the advent of this new disorder, problematic pornography use may now be grouped with other sexual behaviors meeting diagnostic criteria for CSBD.

Systematic data are lacking regarding the prevalence of CSBD in the population at large. However, there is reason to suspect that it will be commonly encountered in clinical settings. As an example, a recent study of 2,325 U.S. adults found that 8.6% of the representative sample (7.0% of women and 10.3% of men) endorsed clinically relevant levels of distress or impairment associated with concerns controlling sexual feelings, urges, and behaviors (Dickenson et al., 2018). Of note, these data did not specify what sorts of sexual behaviors were problematic for participants. However, data from a nationally representative U.S. sample of 2,075 Internet users showed that approximately half reported past-year use of Internet pornography, and 11% of men and 3% of women reported feeling at least somewhat addicted to pornography (Grubbs, Kraus, & Perry, 2019). Collectively, the above prevalence rates suggest that, at the very least, a substantial subset of the population in the United States is concerned about excessive or compulsive use of pornography. Yet there may be reasons to be cautious in assuming that such high base rates reflect genuine compulsion, dysregulation, or addiction.

In contrast to the above discussion of excessive pornography use and CSBD, some research suggests that high-frequency pornography use is not inherently problematic. There is little research directly linking pornography use to psychological distress, and even less research has examined whether pornography use might be related to positive mental health outcomes. Undoubtedly, some people use pornography more frequently than others, and some individuals report using pornography excessively. Even so, a number of studies have shown that high-frequency use of pornography is not always or even often problematic (Bőthe et al., 2020; Vaillancourt-Morel et al., 2017). People who report problems or impairment associated with pornography use may do so quite independently of the actual frequency or duration of their use (Grubbs, Lee, et al., 2020; Vaillancourt-Morel et al., 2017). Thus, there is evidence that quantity or frequency may not be the only determining factor in whether a person reports feeling dysregulated or out of control in their use of pornography.

Pornography, religion, and morality

As we noted above, pornography use—even at high levels—is most often not problematic. Conversely, for some people, pornography use—even at quite low levels—is robustly associated with self-reports of dysregulation, distress, and addiction (Grubbs, Lee, et al., 2020). A sizable body of literature now suggests that another potential avenue by which pornography use may become problematic is actually more related to interpretations of that use rather than the use itself. Specifically, religious qualms about pornography and moral disapproval of pornography seem to shape self-interpretations of pornography users (Grubbs, Perry, et al., 2019).

In the Western world, conservative religious values are consistently related to moral disapproval of pornography (Grubbs, Perry, et al., 2019). Moreover, in at least some research in non-Western countries, conservative religiousness, particularly Christianity, is associated with greater moral disapproval of pornography use (Fernandez et al., 2017). Not surprisingly, then, religious individuals report using pornography less than nonreligious people (Grubbs, Lee, et al., 2020). However, religious individuals do indeed report using pornography with some regularity, which implies a mismatch of professed beliefs about pornography and actual behaviors (Perry, 2018). This mismatch of beliefs and behaviors gives rise to a phenomenon termed moral incongruence, which refers to the dissonance that arises from pornography use among individuals who morally disapprove of pornography (Grubbs, Perry, et al., 2019).

Importantly, moral incongruence is one of the most robust and consistent predictors of self-reported addiction to pornography. These findings are clear in cross-sectional, nationally representative U.S. samples and longitudinally over a 1-year time period (Grubbs, Kraus, et al., 2020). In short, there is evidence that religiously based moral disapproval of pornography is uniquely predictive of self-reports of addiction to pornography, suggesting that moral incongruence might obfuscate some aspects of the diagnostic process for CSBD. This possibility is not lost on the authors of the CSBD diagnostic criteria, given that they specifically note that moral distress over sexual behavior alone is not sufficient for a diagnosis of CSBD. However, it remains unclear whether clinicians will carefully adhere to these criteria, particularly given that past research has shown that more religious therapists tend to diagnose sexual behavior as addictive behavior (Droubay & Butters, 2020). Further, at present, there is simply no empirical study of the treatment of pornography problems due to moral incongruence. Although limited case studies do exist (Kraus & Sweeney, 2019), no rigorous empirical research has been systematically conducted to study the treatment of pornography-related problems due to moral incongruence.

Finally, we note that these moral objections to pornography use do not appear to be restricted to individual use. The desire to censor or regulate pornography use is also robustly predicted by conservative religiousness (Droubay et al., 2018). More than one third of U.S. states have drafted or passed legislation condemning pornography use as a public health crisis despite the skepticism of public health scholars and the absence of robust evidence for their claims (Nelson & Rothman, 2020). In most of these cases, such legislation has not produced any meaningful policy changes or regulatory action. However, much of the language in these proposals originated in conservative religious-advocacy groups and explicitly positions opposition to pornography as flowing from moral concerns (Nelson & Rothman, 2020). In sum, moral and religious objections to pornography use seem to predict both a greater likelihood of self-reporting addiction to pornography and a greater likelihood of supporting regulatory action against pornography.

Future Considerations

Pornography use is a common and largely normal human behavior in developed nations with unrestricted Internet access. The use of pornography rivals the use of other popular media, yet research into pornography use has been largely ignored by mainstream psychology. This is an unfortunate reality, but it does not have to remain this way. Rather than being thought of as a niche or topical interest, pornography use is likely a behavior that intersects with a plethora of other research domains in psychology more broadly and is likely influencing outcomes already being studied by psychological scientists. Accordingly, the rigorous scientific study of pornography use is an area in need of continued empirical attention from various domains in psychology, which should focus on the spectrum of use behaviors ranging from likely positive effects to likely negative effects.

Moving forward, we recommend a more balanced approach that is characterized by mainstream psychologists recognizing and examining how pornography use is relevant to their domains of research interest. Such engagement might be as simple as researchers regularly accounting for pornography use in ongoing studies (e.g., asking about pornography-use habits in studies of adolescent sexual and relational development or measuring private and partnered pornography use when examining sexual functioning, satisfaction, or performance). However, we also see a need for more rigorous research that intentionally studies the use of pornography itself as an extraordinarily common and uniquely human behavior. That is, although we see a clear need for pornography use to be considered as an important covariate or control in studies of mainstream research topics, we also see a need for rigorous studies of pornography use itself at the highest levels of psychological science.

In the domain of clinical science, we see a clear need for both intervention-related research and addiction science to take seriously the possibility for pornography use as a clinical concern. This point in particular highlights a need for rigorous epidemiological and treatment-focused research related to pornography use, self-reported pornography addiction, and other pornography-related problems (e.g., guilt or shame). As noted above, a growing body of research clearly suggests that pornography use is salient in a range of clinical contexts, yet there is a paucity of controlled clinical studies related to the treatment of problems related to pornography use.

We also see a clear need for funding agencies to support research related to pornography use, particularly as it pertains to individuals seeking treatment for problematic pornography use or other CSBD-related behaviors. As we have demonstrated throughout the present work, pornography use is relevant to domains of scientific inquiry that have historically been supported by a diverse array of funders (adolescent development, relationship science, addiction science). However, to date, funding for studies of pornography use and its concomitant effects has been lacking, resulting in missed opportunities for addressing sexual-health disparities in clinical populations. In the United States, the study of pornography use, similar to the study of many other uses and effects of technology, certainly does not fit within the Research Domain Criteria of the National Institute for Mental Health or within the current priorities of the National Science Foundation. However, this incompatibility speaks less to the validity of pornography use as an area of scientific inquiry and more to the limitations of current funding priorities. Given the widespread nature of pornography use and the clear potential for such use to impact well-being in a variety of domains, it is long past time for funding agencies to prioritize the rigorous scientific study of this behavior, particularly because clinical data suggest that compulsive pornography use often co-occurs with anxiety, depression, and substance use and gambling disorders (Kraus et al., 2015). Further well-funded research is needed to examine the co-occurrence of problematic pornography use and psychiatric mental disorders as it pertains to clinical populations.

Finally, we also encourage scholars already studying pornography to adopt more rigorous methodology such as ecological momentary assessments, longitudinal dyadic studies, and experimental methods. There is also a clear need for psychological researchers to study pornography use among diverse groups, particularly because scholarship is sorely lacking among older women, sexual-minority women, racial and ethnic minorities, and persons with disabilities. Further, we recommend that researchers should consider conceptualizing pornography use on a continuum ranging from healthy to compulsive, as we have alluded to throughout this work and illustrated in Figure 1. Such an approach would avoid the dichotomy of viewing pornography as good or bad and allow for greater expression of individual differences that naturally occur in groups. Lastly, future research is needed to employ robust research designs (e.g., nationally representative sampling, longitudinal cohort designs) when examining the relationships between pornography use and psychological well-being.