The Intersection of Pornography Consumption and Mental Well-being

HTHSCI 3MH3 Critical Examination of Mental Health

Winter 2021

Dr. Kristina Trim, MSW, PhD

Anna-Lisa Tam-Vi Nguyen (400166683)

April 13th, 2021

 Introduction

The rise of the internet gave birth to online pornography (OP), an industry that is rapidly

growing. OP can be consumed through various mediums, including videos, photos, cybersex,

telephone sex, and sexual chatting: this can be followed by masturbation. While masturbation

may be a manifestation of OP addiction, it is not necessarily a pathology (de Alarcón et al.,

2019). There are concerns surrounding OP use due to its triple A factors: accessibility,

affordability, and anonymity (de Alarcón et al., 2019). The triple A factors arose with the

evolution of the internet and added to OP's addictive qualities. Furthermore, these factors

increase OP ubiquity among the population and at earlier stages in life. Studies have shown that

children are accessing OP at ages 11 to 13 through cell phone and internet usage. Some reports

include children as young as 8 years old (McCormack & Wignall, 2017). OP addiction, which

can sometimes be called hypersexual behaviour, may present as compulsive behaviour that

dominates one's life that results in dysfunctional sexual behaviours. With the growth of the OP

industry and its potential impacts on the psychological well-being of consumers, there has been a

rise of alarmist movements such as the state of Utah declaring that pornography is a "public

health crisis" (Weiler, 2016) and a Canadian Parliament study on the public health effects of

violent pornography (Casey, 2017). This paper will discuss how both online and offline

pornography has shown associations to various mental illnesses and decreased biopsychosocial

function and the potential benefits of consumption.

Current research in OP addiction

Despite its ubiquity, measuring OP consumption can be difficult due to the triple A

factors: anonymity and accessibility allow for private and widespread usage (de Alarcón et al.,

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2019). Additionally, many existing studies either focused on men or found higher OP usage in

men. The ages of participants typically remained over 18 years old, with some studies examining

adolescent consumption levels (Kohut & Štulhofer, 2018; Mitra & Rath, 2017; Setyawati et al.,

2020). Studies have attempted to characterize OP addiction, suggesting that it could be

categorized under the umbrella of hypersexual disorders, impulse control disorders, or

behavioural disorders (de Alarcón et al., 2019). Other descriptions include "online sexual

compulsivity" or Problematic OP Use (POPU) (de Alarcón et al., 2019). Current predictors of

POPU include being: a young man, religious, having frequent Internet use, negative mood states,

sexual boredom, and novelty seeking. These predictors were shared by identified hypersexual

behaviour patients; however, this condition is difficult to diagnose and remains a grey area in

pathological behaviours and typical behaviours. POPU was rejected from inclusion in the

DSM-5 because of several concerns (Setyawati et al., 2020). Worries of forensic abuse,

unspecific diagnostic criteria, and potential political and social implications of pathologizing an

area of human nature resulted in this conclusion (Reid & Kafka, 2014). Conversely, Compulsive

Sexual Behaviour Disorder (CSBD) is now included in the 11th edition of the International

Classification of Diseases (ICD) manual and classified as an impulse-control disorder (de

Alarcón et al., 2019). Accordingly, it is reported that more than 80% of CSBD individuals

display signs of POPU. For simplicity throughout this paper, POPU will be used to describe

frequent and problematic consumption of pornography, and may be used interchangeably with

OP addiction. Further clarification on diagnostic criteria and factors that make OP behaviours

unique compared to offline pornography is needed. Research included in this paper is based on

both OP and offline pornography.

Mental health in the age of pornography

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Depression and anxiety

Mental illnesses have been studied in conjunction with pornography, showing that

depression and anxiety may be comorbid with OP addiction. In Camilleri et al. (2020),

depression and anxiety were measured by the Depression, Anxiety, and Stress Scale (DASS-21)

and showed intriguing results in a university-aged population. Results showed no significant

differences in depression between males and females, but a significantly higher prevalence of

severe or extremely severe levels of anxiety in females. Meanwhile, males reported normal

levels of both anxiety and stress relative to their female counterparts. Furthermore, the study

looked at the frequency of pornography use in relation to depression, anxiety, and stress. In both

males and females, higher scores were reported in the group that used pornography within the

past year than the group that has never used pornography. Males that accessed pornography

reported higher depression and anxiety only, while females that accessed pornography reported

higher scores on all three measurements. These results show similarities to other studies where

university males experienced high scores on anxiety and depression scales alongside other

emotional and cognitive issues. Another study shows this same pattern in a younger adolescent

population (Setyawati et al., 2020).

Personality disorders

Interestingly, personality disorders may also be associated with pornography

consumption. A study explored how pornography is related to personality disorder traits such as

impulse control, emotional regulation, and a superior sense of sexual desirability (Hughes et al.,

2020). In previous studies, it was found that Cluster B personality traits (e.g. poor impulse

control, emotional regulation, and anger) may be connected to sexual aggression (Hughes et al.,

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2020). When considering narcissistic personality traits in men, these traits are positively

associated with rape-supporting beliefs and negatively associated with empathy for victims.

Furthermore, male narcissists tended to enjoy films where affection was followed by rape, more

so than other men. Similarly, women with higher scores of narcissistic personality traits tended to

have negative relationship communication and were more likely to participate in sexual

harassment (Hughes et al., 2020). Women with these high scores were equally as likely as their

male counterparts to be persistent and coercive after being rejected during a sexual advance.

Pertinently, pornography effort was associated with women’s use of nonverbal sexual arousal and

emotional manipulation and deception (Hughes et al., 2020) as previously reported by other

studies (Blinkhorn et al., 2015); however, compulsive pornography consumption was not

associated with sexually coercive behaviours unlike the results found in male participants

(Gonsalves et al., 2015). Another relevant condition would be histrionic personality disorder.

Histrionic personality traits include excessive attention-seeking, impulsive and emotional

behaviours, and inappropriate sexual conduct (Hughes et al., 2020). Previous studies that

considered personality disorders and their association to pornography usage were more focused

on narcissistic personality traits (Hughes et al., 2020).

Psychosocial impacts of pornography

Relationships

Although there are various types of relationships, OP addiction has been noted to affect

familial relationships, friendships, and romantic relationships. For individuals in a romantic

relationship, effects can be both mental and physical. In a national sample of 20,000 married

individuals, those who viewed an adult film within the last year were 12% less likely to have a

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happy marriage (Maas et al., 2018). Women in heterosexual relationships report feeling less

desirable when their male partner views pornography. While the definition of OP includes

cybersex and telephone sex, it was found that women perceive these two mediums as infidelity,

but not pornography films or photographs (Maas et al., 2018). Accepting attitudes towards

pornography likely shape the symbolic meaning of pornography use within a relationship, which

may affect these perceptions. Furthermore, attachment types may also be linked to relationship

satisfaction when consuming pornography. Anxious attachment is demonstrated by worries of

abandonment and rejection by one’s partner. These individuals may view pornography

differently, and thus, are often less satisfied with their relationships. This may be due to the

stronger link between sexual satisfaction and relationship satisfaction in anxiously-attached

individuals. Some studies show that consumption of pornography within a relationship may

increase closeness (Bőthe et al., 2020), which could be related to secure attachment. This

association between relationship satisfaction and pornography may also be dependent on

one-sided consumption and could be moderated by attachment style, pornography acceptance

levels, and gender (Maas et al., 2018). Negative associations between pornography use and

relationship satisfaction were stronger for individuals with lower pornography acceptance. This

negative association was decreased when pornography acceptance was higher, especially for

women.

Sexual satisfaction

Based on male-focused studies, OP usage may be associated with erectile dysfunction

where the individual is unable to gain an erection without porn or with an in-person partner;

however, these studies have shown mixed results (de Alarcón et al., 2019). One study reported

60% of patients with sexual dysfunction did not have POPU (Voon et al., 2014). Despite these

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mixed results in erectile dysfunction, OP usage has been associated with sexual dissatisfaction

for both males and females. Dissatisfaction may be multifactorial; factors such as perception of

one's body or their partner's body, increased pressure on sexual performance, paid sex, and

multiple sexual partners could play a role (de Alarcón et al., 2019). Dissatisfaction may be more

likely when these behaviours are one-sided: in heterosexual relationships, males were more

likely than women to report sexual dissatisfaction with their partner after pornography

consumption. Contrastly, pornography has been associated with increased sexual satisfaction in

partnered women, which only emphasizes the inconclusive research in this field. In a dyadic

study, couples that viewed pornography together over several weeks experienced a short-term

increase in sexual activity (Pornography, 1971). Furthermore, women’s pornography

consumption frequency could be associated with higher levels of sexual and relational

satisfaction (Campbell & Kohut, 2017).

Violence and aggression

Due to the potentially violent nature of OP, the Canadian Parliament has launched a study

to examine the public health effects (Casey, 2017). There are multiple other studies that suggest

pornography may play a role in violent and aggressive behaviours (Blinkhorn et al., 2015;

DeKeseredy & Rennison, 2020; Hughes et al., 2020; Narcissism, Sexual Refusal, and

Aggression, n.d.). Transcripts from a study that included recorded interviews revealed that

certain individuals objectified women and had thoughts of rape: these thoughts can be intrusive

and distracting, as noted in the transcripts (Setyawati et al., 2020). Moreover, the ubiquity of

violent OP, gore pornography, and sexualized horror films may perpetuate the myth that women

enjoy the "rough sex" depicted by these media sources (DeKeseredy & Rennison, 2020). These

profitable genres may cater to males that are abusive or follow patriarchal beliefs. As mentioned

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in the Personality Disorders subsection, individuals with narcissistic traits may reap more

enjoyment from these genres (DeKeseredy & Rennison, 2020). It is critical to understand that

pornography does not cause or lead to violence or aggression, but has a role in the broader

sociocultural perspective that encourages male-on-female violence.

Potential positive aspects of pornography

Although there is an abundance of research on the negative implications of OP usage, it

remains an inconclusive area of research. Certainly, the amount of completed research on OP

usage favours the belief that pornography is related to lower levels of mental well-being.

However, there are no established causal relationships. Studies done on pornography elicited

mixed results and sometimes failed to consider the interrelation between social connectedness,

attachment, and the context of pornography consumption.

Psychosocial benefits

Individuals that approached OP with an accepting attitude tend to see themes of sexual

empowerment and autonomy (Weinberg et al., 2010). Some studies have shown positive

correlations between OP use and self-esteem levels among young adult males. Aside from the

sexual benefits, pornography is still considered a form of entertainment: some pornography users

reported watching for pure entertainment reasons or to improve negative states of being (e.g.

boredom, stress, or depression). Viewing pornography as an entertainment medium can also be

done in groups as a bonding activity (McCormack & Wignall, 2017).

Educational benefits

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 Despite its harmful implications, OP's triple A factors can also be seen as beneficial in

improving sexual education. OP was noted to be instructional in providing sexual pleasure as in

the case of young men that learned about clitoral stimulation (Marston, 2018). Some

interviewees commented on the absence of such content from current sexual health curricula.

Other education benefits include exploring sexual interests, demonstrated through watching

various genres of pornography (McCormack & Wignall, 2017). During interviews, many male

participants attributed pornography as a primary factor in discovering these kinks and

preferences. Some individuals may begin to accept their sexuality and preferences by finding

pornography suited to their tastes. The anonymity, accessibility, and affordability of pornography

can also create a safe-space for sexual exploration (McCormack & Wignall, 2017).

Areas for future study and consideration

Pornography use, especially POPU, continues to be an emerging area of research.

Currently, studies show mixed results on various outcomes and may have suboptimal study

design (Campbell & Kohut, 2017). There are still many questions regarding the assessment,

causes, and treatment of POPU, and existing studies typically had small sample sizes among

other concerns (de Alarcón et al., 2019). Furthermore, the social psychology research that looks

at pornography’s impact on relationships has typically been done on coupled individuals.

Campbell et al. (2017) argues that relationship-based research regarding pornography should be

performed on dyads instead. Consolidated research on the diagnostic criteria of POPU, followed

by research into appropriate treatments would be areas of interest. Continued research on the

psychosocial impacts would be beneficial, especially determining contextual factors that

aggravate relationship dysfunction in relation to pornography.

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 Conclusion

Pornography has become ubiquitous in the age of the Internet due to a combination of the

triple A factors: accessibility, affordability, and anonymity. With this growth, there are concerns

surrounding the impacts of pornography on the cognition, physical, and mental well-being of

both single and coupled individuals. Some investigations into adolescent pornography use has

also been completed. Current research has mainly focused on the detrimental implications of

pornography consumption, attempting to characterize problematic use and the biopsychosocial

impacts. While results show that POPU has links to depression, anxiety, narcissistic personality

disorder, and histrionic personality disorder, these outcomes may also be influenced by gender

and other demographic data. POPU has also been linked to increased sexual and relationship

dysfunction, but these findings may be dependent on age, gender, attachment-type, and other

characteristics. Furthermore, POPU may play a role in aggressive or violent behaviour, but no

causal relationships can be made. Despite the many negative implications, there are some

positive effects such as improved self-esteem and education on sexual pleasure. It is important to

discern between POPU and non-problematic use. There are multiple factors that may change

non-problematic behaviour into POPU. Overall, further research should be conducted on the

impacts of pornography on the individual, couple, and societal levels with considerations for

dyadic observations, relationship status, and demographic differences.

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