Emotional interference and attentional bias in compulsive sexual behaviors disorder - An fMRI study on heterosexual males.

Background and aims: Despite the inclusion of the Compulsive Sexual Behavior Disorder (CSBD) in the 11th edition of the International Classification of Diseases, emotional and cognitive impairments related to CSBD remains unclear. This study aimed to investigate the behavioral and neuronal effects of emotional interference on cognition among CSBD patients. Methods: Thirty heterosexual males with CSBD and matched healthy controls (HC) were studied with the Emotional Stroop Task using 5 categories of emotionally arousing words (sex-related, positive, fear-related, negative, neutral) during functional magnetic imaging. Results: At the behavioral level, we found the main effect of the condition: sex-related words evoked a stronger Stroop effect than other conditions. At the neural level, we found a significant group effect. Among CSBD patients processing of sex-related words was related to increased activity in the right putamen, right thalamus, hippocampi, and left pulvinar, when compared to HC. We also found a negative correlation between neuronal activation and time spent on sexual activity during the week preceding study and numerous group differences in brain regions connected to the emotional and motivational processing of sexually explicit material, correlating with CSBD symptoms. Conclusions: Behavioral results indicate a specific attentional bias toward sex-related stimuli in both groups, while neural data uncovered stronger reactivity to sex-related words in CSBD compared to HC. This reactivity is related to CSBD symptoms and provides evidence for the interference of sex-related stimuli with cognition. Such results are firmly in line with the Incentive Salience Theory and conceptualizing CSBD as a behavioral addiction.

Pornography use, demographic and sexual health characteristics among university students: a gender-based comparative study of non-users, non-problematic users, and problematic users.

BACKGROUND: Limited gender-based research has compared sexual health among pornography users (PUs) and non-users, including non-problematic pornography users (non-PPUs) and problematic pornography users (PPUs), particularly in non-Western cultures. METHODS: A 2022 cross-sectional study involving 450 Iranian university students categorized participants as PUs or non-users based on 12 months of use. PUs were further classified as non-PPUs or PPUs using the 'Problematic Pornography Use Scale' cutoff point, with comparisons of demographic and sexual variables made between these groups. RESULTS: Pornography use was reported among 39.6% of students, including 51.7% of men and 33.6% of women. In general, 9.5% of participants were PPUs, including 17.4% of men and 5.6% of women. PUs were mainly men, had fewer children, shorter marriages, lower religiosity, and lower levels of education. Compared with non-users, PUs reported earlier sexual relationships, lower satisfaction with sex frequency and communication, and greater rates of extramarital relationships, masturbation, sexual desire, and sexual distress. PPUs reported more sexual desire, pornography use, masturbation, and extramarital affairs than non-PPUs. Similar patterns in demographics, sexual history, and health were observed in pornography use across genders. The regression indicated being male (OR: 2.42, 95% CI: 1.44-4.06), having lower education (OR: 0.89, 95% CI: 0.81-0.97), fewer children (OR: 0.64, 95% CI: 0.48-0.86), higher masturbation (OR: 1.31, 95% CI: 1.14-1.49), more extramarital relationship (OR: 1.69, 95% CI: 1.07-2.67), less religiosity (OR: 0.87, 95% CI: 0.82-0.93), more sexual excitement (OR: 0.79, 95% CI:0.62-1), and more sexual distress (OR: 1.20, 95% CI: 1.02-1.32) were associated with pornography use. Two-way ANOVA found no significant effects of gender or pornography use on sexual satisfaction. Women had worse sexual function regardless of usage. Pornography users, regardless of gender, experienced higher sexual distress.

The Associations Between Attachment Insecurity and Compulsive Sexual Behavior Disorder or Problematic Pornography Use: The Mediating Role of Emotion Regulation Difficulties.

Compulsive sexual behavior disorder (CSBD) was previously considered an attachment disorder, while emotion dysregulation was thought to potentially be a key characteristic of it. However, this theoretical model was not tested in previous empirical research. In our cross-sectional study, we tested whether emotional regulation (ER) difficulties can be adopted as an explanatory mechanism for the relationships between attachment avoidance and anxiety, as well as CSBD and its most prevalent behavioral presentation-problematic pornography use (PPU). Participants (n = 1002; Mage = 50.49 years, SD = 13.32; men: 50.2%) completed an online survey regarding the investigated variables. In mediation analyses, attachment avoidance and anxiety were treated as simultaneous predictors, ER difficulties as a mediating variable, with CSBD/PPU severity as dependent variables. Emotion regulation difficulties and attachment anxiety had a direct positive effect on both CSBD and PPU. The direct effect of attachment avoidance on PPU was non-significant, and significant for CSBD depending on the measure used. Moreover, all the relationships between both insecure attachment dimensions and CSBD/PPU symptom severity were at least partially mediated by ER difficulties. Our results corroborate the theoretical claim that ER difficulties may be a useful framework for explaining the impact of attachment insecurity on CSBD/PPU. Theoretical and practical implications of the findings are discussed.

Pornography, identification, alcohol, and condomless sex.

Using national probability data from the 2022 National Survey of Sexual Health and Behavior, the present study evaluated whether moderators of the association between frequency of pornography exposure and condomless sex are consistent with the sexual script acquisition, activation, application model's (3AM) suppositions about the facilitating effects of wishful identification and decreased self-regulation and forethought capacity. Consistent with the 3AM, two-way interaction effect analysis indicated that the strength of the positive association between exposure frequency and condomless sex increased as identification intensified. Inconsistent with the 3AM, two-way interaction effect analysis indicated that the association between exposure frequency and condomless sex was not significantly different among those who had and had not consumed alcohol before their last sexual encounter. However, the three-way interaction between exposure frequency, identification, and alcohol use did suggest a role for each 3AM moderator, as the catalyzing effect of identification was operable among those who had consumed alcohol only.

Associations Between Pornography Use Through Different Media and Sexual and Relationship Satisfaction Among Cohabiting Couples.

Pornography can be used through multiple media and its associations with couples' relationship and sexual satisfaction are mixed. The aims of this study were to examine the proportion of use of different pornographic media (i.e., videos, pictures, audio material, and written material), including different contents (i.e., sexual activities and nudity), gender-based differences in the frequency of use of these media, and the associations between an individual's frequency of use of different pornographic media and their own and their partner's sexual and relationship satisfaction, considering potential gender differences. A sample of 706 adult couples (1368 participants; Mage = 32.19 years) completed online self-report questionnaires. Results of actor-partner interdependence models indicated that video use was associated with lower relationship and sexual satisfaction, and partners' lower sexual satisfaction. Picture use was associated with lower relationship satisfaction and partners' lower sexual satisfaction. Written material use was associated with lower sexual satisfaction. Cisgender women's audio use was associated with their own higher sexual satisfaction, whereas cisgender men's audio use was associated with their partner's lower sexual satisfaction. These findings suggest different associations with sexual and relationship satisfaction depending on the pornographic media.

Corrigendum: Individuals under voluntary treatment with sexual interest in minors: what risk do they pose?

[This corrects the article DOI: 10.3389/fpsyt.2023.1277225.].

Loneliness and problematic pornography Use: What is the role of emotion regulation and interaction with content Creators?

Problematic pornography use is a growing area of interest necessitating a deeper understanding of its contributing factors. Loneliness and emotion regulation difficulties have been advanced as factors that may exacerbate or perpetuate PPU, however, to date, researchers typically consider these factors in isolation. In addition, the evolving landscape of problematic pornography is further shaped by the emergence of pornography content creators. This study explores the relationships between loneliness, emotion regulation difficulties and problematic pornography use and individuals' interactions with pornography content creators. Specifically, we examine whether emotion regulation difficulties mediate the relationship between loneliness and PPU and whether this mediation is contingent on interactions with content creators. A total of 213 adults (Mage = 35.57 years, SD = 16.90; 77.50 % men) participants completed an online questionnaire assessing PPU, emotion regulation difficulties and loneliness. Results revealed loneliness is associated with increased PPU and emotion regulation difficulties. Emotion regulation difficulties, in turn, relate to PPU. Though interaction with pornographic content creators was associated with reduced PPU, interacting with content creators did not moderate the effect of emotion regulation on the relationship between loneliness and PPU. Our findings support the hypothesised model, suggesting that emotion regulation difficulties mediate the relationship between loneliness and PPU. The identified mediating role of emotion regulation difficulties provides a foundation for further investigations into the underlying mechanisms connecting emotional well-being and problematic pornography use, offering potential directions for future research.

How much online pornography is too much? A comparison of two theoretically distinct assessment scales.

BACKGROUND: Online pornography use, an ever more common activity, has raised myriad psychosocial and clinical concerns. While there is a need to screen for and measure its problematic dimension, there is a debate about the adequacy of existing assessment tools. OBJECTIVE: The study compares two instruments for measuring pathological online pornography use (POPU) that are based on different theoretical frameworks-one in line with DSM-5 criteria and the six-component addiction model and one in line with ICD-11 criteria. METHODS: An international sample of 1,823 adults (Mean age = 31.66, SD = 6.74) answered an online questionnaire that included the Short Version of the Problematic Pornography Consumption Scale (PPCS-6) and the Assessment of Criteria for Specific Internet-Use Disorders (ACSID-11). Factorial, correlational, and network analyses were conducted on the data. RESULTS: Both tools adequately screened for online "addictive" behavior, but the ACSID-11 was superior in assessing the degree of clinical risk. CONCLUSION: Depending on the specific aim of the assessment (screening vs. clinical diagnostics), both online pornography measurement tools may be useful.

Appetitive conditioning with pornographic stimuli elicits stronger activation in reward regions than monetary and gaming-related stimuli.

Appetitive conditioning plays an important role in the development and maintenance of pornography-use and gaming disorders. It is assumed that primary and secondary reinforcers are involved in these processes. Despite the common use of pornography and gaming in the general population appetitive conditioning processes in this context are still not well studied. This study aims to compare appetitive conditioning processes using primary (pornographic) and secondary (monetary and gaming-related) rewards as unconditioned stimuli (UCS) in the general population. Additionally, it investigates the conditioning processes with gaming-related stimuli as this type of UCS was not used in previous studies. Thirty-one subjects participated in a differential conditioning procedure in which four geometric symbols were paired with either pornographic, monetary, or gaming-related rewards or with nothing to become conditioned stimuli (CS + porn, CS + game, CS + money, and CS-) in an functional magnetic resonance imaging study. We observed elevated arousal and valence ratings as well as skin conductance responses for each CS+ condition compared to the CS-. On the neural level, we found activations during the presentation of the CS + porn in the bilateral nucleus accumbens, right medial orbitofrontal cortex, and the right ventral anterior cingulate cortex compared to the CS-, but no significant activations during CS + money and CS + game compared to the CS-. These results indicate that different processes emerge depending on whether primary and secondary rewards are presented separately or together in the same experimental paradigm. Additionally, monetary and gaming-related stimuli seem to have a lower appetitive value than pornographic rewards.

Problematic pornography use and novel patterns of escalating use: A cross-sectional network analysis with two independent samples.

Modern internet pornography allows users to harness sexual novelty in numerous ways, which can be used to overcome desensitisation through increasing volume of use (quantitative tolerance), progressing to more stimulating genres (qualitative escalation), skipping between stimuli (tab-jumping), delaying orgasm ('edging'), and engaging in pornographic binges. However, existing research has not yet evaluated how these potentially reciprocal consumption patterns relate to problematic pornography use (PPU). To this end, we recruited two independent samples of male pornography users (N1 = 1,356, Mage = 36.86, SD = 11.26; N2 = 944, Mage = 38.69, SD = 12.26) and examined the relationships between these behavioural dimensions and self-reported difficulties in controlling one's pornography use. Data were analysed through the network analysis approach (using Gaussian graphical models). As hypothesised, i) quantitative tolerance was centrally placed within the overall network, and ii) acted as a statistical bridge node between other patterns of pornography use (e.g., pornographic binges), and all measured facets of PPU. Our results are consistent with other emerging literature suggesting that tolerance, pornographic binges, tab-jumping, and edging behaviours as relevant features ofPPU, and that upscaling overall usage may connect broader patterns of use with problematic engagement. Clinical and theoretical implications, as well as future research directions, are discussed.

The standardization of a new Explicit Pornographic Picture Set (EPPS).

Pictures with affective content have been extensively used in scientific studies of emotion and sexuality. However, only a few standardized picture sets have been developed that offer explicit images, with most lacking pornographic pictures depicting diverse sexual practices. This study aimed to fill this gap through developing a standardized affective set of diverse pornographic pictures (masturbation, oral sex, vaginal sex, anal sex, group sex, paraphilia) of same-sex and opposite-sex content, offering dimensional affective ratings of valence, arousal, and dominance, as well as co-elicited discrete emotions (disgust, moral and ethical acceptance). In total, 192 pornographic pictures acquired from online pornography platforms and 24 control IAPS images have been rated by 319 participants (Mage = 22.66, SDage = 4.66) with self-reported same- and opposite-sex sexual attraction. Stimuli were representative of the entire affective space, including positively and negatively perceived pictures. Participants showed differential affective perception of pornographic pictures according to gender and sexual attraction. Differences in affective ratings related to participants' gender and sexual attraction, as well as stimuli content (depicted sexual practices and sexes). From the stimuli set, researchers can select explicit pornographic pictures based on the obtained affective ratings and technical parameters (i.e., pixel size, luminosity, color space, contrast, chromatic complexity, spatial frequency, entropy). The stimuli set may be considered a valid tool of diverse explicit pornographic pictures covering the affective space, in particular, for women and men with same- and opposite-sex sexual attraction. This new explicit pornographic picture set (EPPS) is available to the scientific community for non-commercial use.

Barriers and recommendations for parent-child conversations about pornography.

Introduction: Parents consistently report being worried about the impact of online pornography on their adolescent and pre-adolescent children's development. Yet, most parents do not discuss pornography as part of parent-child conversations about sexuality. The current study sought to identify the barriers to parent-child conversations about pornography. Methods: We present two studies. The first study employed one-to-one interviews to explore parents' (n = 14) beliefs about their role in their child's pornography education. The second study involved the quantitative assessment of Study 1 findings in a sample of parents of pre-adolescent and adolescent children (n = 408). Results: Findings indicate that three overarching themes prevent parents from addressing pornography with their adolescent children, parents' practical ability to discuss pornography, their attitudes toward discussing pornography, and the perceived positive impact of addressing pornography with their adolescent children. Practical ability was most often reported as the greatest barrier to parents engaging in parent-child conversations about pornography. Most notably, parents reported hesitancy in discussing pornography because they did not know how to define pornography or how to address pornography in an age-appropriate way. Fathers were also significantly less likely to believe that talking about pornography was socially acceptable. Discussion: We discuss the implications of these findings and present recommendations for developing a parents' pornography education resource.

Examination of Gender Differences in Depression, Relationship Satisfaction, and Problematic Pornography Use Among Romanian Gay Men and Lesbian Women.

This study investigates factors influencing the psychological well-being of gay and lesbian individuals in Romania. Participants (N = 172) included 61.6% gay and 38.4% lesbians, currently in relationships, aged between 18 and 62 years (M = 28.28; SD = 9.53). Surveys assessed relationship satisfaction, depression, and problematic pornography use. Significant associations were found among these variables, with gender differences observed. We tested a regression model for problematic pornography use, where depression provided additional explanatory power to the initial model. Age, gender, and depression accounted for 18% of the variance in problematic pornography use. The theoretical and practical implications are discussed.

Validation of the ACSID-11 for consistent screening of specific Internet-use disorders based on ICD-11 criteria for gaming disorder: A multitrait-multimethod approach.

INTRODUCTION: With the inclusion of gaming disorder in the ICD-11, diagnostic criteria were introduced for this relatively new disorder. These criteria may be applied to other potential specific Internet-use disorders. The 11-item Assessment of Criteria for Specific Internet-use Disorders (ACSID-11) was developed for consistent screening of gaming disorder, online buying-shopping disorder, online pornography-use disorder, social networks-use disorder, and online gambling disorder. This study tested the construct validity of the ACSID-11, including convergent and divergent measures. METHODS: The ACSID-11 measures five behavioral addictions with the same set of items by following the principles of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ACSID-11 was administered to a convenience sample of active Internet users (N = 1597) together with validated and established measures of each specific Internet-use disorder along with screeners for mental health. Included are the Ten-Item Internet Gaming Disorder Test (IGDT-10), the Bergen Shopping Addiction Scale (BSAS), the Problematic Pornography Consumption Scale (PPCS), the Bergen Social Media Addiction Scale (BSMAS) and the Berlin Inventory of Gambling behavior - Screening (BIG-S). The ACSID-11 was compared convergently and divergently through a multitrait-multimethod approach along with contingency tables with the other Internet-use disorder screeners. RESULTS: The multitrait-multimethod results shows that each behavior assessed with the ACSID-11 has moderate to strong correlations (r's from 0.462 to 0.609) with the scores of the corresponding established measures and, furthermore, positive correlations (r's from 0.122 to 0.434) with measures of psychological distress and further shows that the ACSID-11 can be used for a comprehensive assessment of different behaviors. The contingency tables reveal large divergences between the ACSID-11 and other screening instruments concerning the classification of problematic specific Internet use based on the given cut-off values. CONCLUSION: The current work provides additional validation for the ACSID-11. Accordingly, this tool can be considered as reliable and valid for the simultaneous assessment of different Internet-use disorders: gaming disorder, online buying-shopping disorder, online pornography use disorder, social networks use disorder, and online gambling disorder. With a subsequent clinical validation of the scale and the proposed cut-off score, the ACSID-11 will be a thoroughly validated useful screening tool for clinical practice.

Increased sensitivity for negative emotional images in individuals with problematic pornography use.

Background: Despite the frequent comorbidity of affective and addictive disorders, the significance of affective dysregulation in problematic pornography use (PPU) is commonly disregarded. The objective of this study is to investigate whether individuals with PPU demonstrate increased sensitivity to negative emotional stimuli in comparison to healthy controls (HCs). Methods: Electrophysiological responses were captured via event-related potentials (ERPs) from 27 individuals with PPU and 29 HCs. They completed an oddball task involving the presentation of deviant stimuli in the form of highly negative (HN), moderately negative (MN), and neutral images, with a standard stimulus being a neutral kettle image. To evaluate participants' subjective feelings of valence and arousal, the Self-Assessment Manikin (SAM) was employed. Results: Regarding subjective evaluations, individuals with PPU indicated diminished valence ratings for HN images as opposed to HCs. Concerning electrophysiological assessments, those with PPU manifested elevated N2 amplitudes in response to both HN and MN images when contrasted against neutral images. Additionally, PPU participants displayed an intensified P3 response to HN images in contrast to MN images, a distinction not evident within the HCs. Discussion: These outcomes suggest that individuals with PPU exhibited heightened reactivity toward negative stimuli. This increased sensitivity to negative cues could potentially play a role in the propensity of PPU individuals to resort to pornography as a coping mechanism for managing stress regulation.

Reoffending after convictions related to child sexual exploitation material: Data from the German Federal Central Criminal Register.

BACKGROUND: As digitalization has made it easier to produce, copy, and distribute child sexual exploitation material (CSEM), the possession and distribution of child sexual abuse images has become more widespread. Thus, the need to assess the risk of subsequent sex offenses - above all, sexual abuse of children by individuals who have been convicted of CSEM offenses - becomes more and more important. OBJECTIVE: The main objective of this paper is to contribute to the understanding of the respective size of two groups of offenders: first, offenders who commit CSEM offenses without ever crossing the line to sexual abuse of children, and second, so-called crossover offenders, that is, individuals who commit CSEM offenses and engage in child sexual abuse. Identification of differences between these two groups facilitates analyzing the risk that someone convicted of a CSEM offense might in the future sexually assault children. METHOD: We used data from the German Federal Central Criminal Register (Bundeszentralregister), a data set that includes information about all persons convicted of any criminal offense, including "child pornography" offenses, by a court in Germany. RESULTS: For persons convicted of CSEM offenses only, with no additional concurring sex offenses, the rate of subsequent convictions for child sexual abuse is very low (1.1 % after a six-year follow-up period, adult offenders). This risk is even lower if offenders are older than 30 years of age, and it is slightly higher for offenders with previous offense-specific convictions (i.e., previous sex offenses). CONCLUSIONS: The mere existence of a conviction for a CSEM offense is not an indication that the convicted person poses a significant risk of committing child sexual abuse. To pinpoint such a risk more accurately, the following factors should be examined: the existence of offense-specific prior records, the presence of crossover-offending in the form of concurring offenses, and the age of the offender.

"I Feel Like a Fraud Who Acts Like a Feminist": The Discussion Themes and Sexual Scripts in the Porn Free Women Online Forum.

Research on online pornography abstinence movements has predominantly focused on men's perspectives, often within the context of the broader manosphere. This focus has overshadowed the unique experiences and viewpoints of women in these movements. Our study aimed to fill this gap by exploring women-centric perspectives in pornography abstinence forums, particularly Porn Free Women (r/pornfreewomen). Using a mixed methods approach, this study examined the sexual scripts presented in women-dominated pornography abstinence communities. Our structural topic modeling analysis delineated the interplay of therapeutic, heteronormative, and empowerment themes that were evident in women's narratives and expressions. Further, our discourse analysis elucidated three specific scripts: the addiction script, the heterosexual script, and the liberation script. These interweaving narratives show that discussions of women's pornography abstinence are multifaceted and include a variety of perspectives to negotiate. These results contribute to a nuanced understanding of the values of health and well-being, sexual liberation, and feminism within women's pornography abstinence communities.

Sexual Norms Across Pornography Use, Sexual Fantasy, and In-Person Sexuality.

Sexual norms define perceptions of who is acceptable to partner with, how many partners are appropriate, and what sexual behaviors are acceptable to engage in. This shapes, in part, who has access to sexual pleasure and who is minoritized based on their sexuality. Though well theorized and researched for "in-person" sexuality, much less is known about sexual norms in other contexts/modalities, such as porn use and sexual fantasy, or how norms connect across these contexts. In the present study, we investigated sexual norms in porn, fantasy, and in-person sexuality, and similarities or differences between these. In an online study, gender/sex and sexually diverse participants (N = 706) manipulated digital circles representing porn use, sexual fantasy, and in-person sexuality. They used circle overlap to represent branchedness (i.e., distinction) and coincidence (i.e., similarity) in norm content, and circle size to indicate perceived norm strength. We found evidence that norm content was perceived to be more branched (i.e., distinct) than coincident (similar) and that norm strength for each context was high. This provides evidence that when people engage in each of these sexual contexts, they tend to do so through distinct normative lenses, rather than a singular lens that represents a universal set of norms applying across all sexual situations. This has implications for how we understand the associations between porn use, fantasy, and in-person sexuality, and highlights the importance of attending to sexuality in context.

Digital Media and Developing Brains: Concerns and Opportunities.

Purpose of Review: The incorporation of digital technologies and their use in youth's everyday lives has been increasing rapidly over the past several decades with possible impacts on youth development and mental health. This narrative review aimed to consider how the use of digital technologies may be influencing brain development underlying adaptive and maladaptive screen-related behaviors. Recent Findings: To explore and provide direction for further scientific inquiry, an international group of experts considered what is known, important gaps in knowledge, and how a research agenda might be pursued regarding relationships between screen media activity and neurodevelopment from infancy through childhood and adolescence. While an understanding of brain-behavior relationships involving screen media activity has been emerging, significant gaps exist that have important implications for the health of developing youth. Summary: Specific considerations regarding brain-behavior relationships involving screen media activity exist for infancy, toddlerhood, and early childhood; middle childhood; and adolescence. Transdiagnostic frameworks may provide a foundation for guiding future research efforts. Translating knowledge gained into better interventions and policy to promote healthy development is important in a rapidly changing digital technology environment.

Pornography Use and Sexual Coercion: Examining the Importance of Frequency, Type, and Other Factors.

Research on pornography use and sexual coercion has provided some evidence that there is an association between these two behaviors. One area in this body of research where there is a need for improvement is the operationalization of pornography use. In particular, a need for researchers to capture all relevant aspects of pornography use that are associated with sexual coercion. These aspects include frequency of use, type of pornography used, investment in use, sexual scripts adopted from pornography, compulsive use, and first exposure. The current study aims to examine which of these aspects of pornography use are significantly associated with sexual coercion. A sample of 365 college males was surveyed on their pornography use, engagement in sexually coercive behaviors, and other relevant variables. Results show that sexual scripts and investment in pornography use are significantly related to self-reported sexual coercion. These findings indicate that the frequency with which someone views pornography may not be driving the relationship between pornography use and sexual coercion and that an individual's monetary investment in their pornography use habit, as well as their adoption of sexual scripts from pornography, may be what is driving this relationship. In addition, these findings have implications for the aspects of pornography use that researchers should focus on when examining the relationship between pornography use and sexual coercion.