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Compulsive sexual behaviour driven by use of pornography
Pornography addiction is the scientifically controversial application of an addiction model to the use of pornography. Pornography may be part of compulsive behavior with negative consequences to one's physical, mental, social, or financial well being. While the World Health Organization's ICD 11 (2022) has recognized compulsive sexual behaviour disorder (CSBD) as an "impulsive control disorder", CSBD is not an addiction, and the American Psychiatric Association's DSM 5 (2013) and the DSM 5 TR (2022) do not classify compulsive pornography consumption as a mental disorder or a behavioral addiction. The only diagnostic criteria for a behavioral addiction in the current Diagnostic and Statistical Manual of Mental Disorders are for pathological gambling, and they are similar to those for substance abuse and dependence, such as preoccupation with the behavior, diminished ability to control the behavior, tolerance, withdrawal, and adverse psychosocial consequences. Diagnostic criteria have been proposed for other behavioral addictions, and these are usually also based on established diagnoses for substance abuse and dependence. Pornography use has also been associated to many issues with Sexual Satisfaction, Marital Quality, and Gender Violence. These are detailed in Opposition to Pornography. A proposed diagnosis for hypersexual disorder includes pornography as a subtype of this disorder. It included such criteria as time consumed by sexual activity interfering with obligations, repetitive engagement in sexual activity in response to stress, repeated failed attempts to reduce these behaviors, and distress or impairment of life functioning. A study on problematic Internet pornography viewing used the criteria of viewing Internet pornography more than three times a week during some weeks, and viewing causing difficulty in general life functioning. According to the American Society of Addiction Medicine, some psychological and behavioral changes characteristic of addiction brain changes include addictive cravings, impulsiveness, weakened executive function, desensitization, and dysphoria. BOLD fMRI results have shown that individuals diagnosed with compulsive sexual behavior (CSB) show enhanced cue reactivity in brain regions associated traditionally with drug cue reactivity. These regions include the amygdala and the ventral striatum. Neuropsychopharmacological and psychological researches on pornography addiction conducted between 2015 and 2021 have concluded that most studies have been focused entirely or almost exclusively on men in anonymous settings, and the findings are contradicting. and should be treated as such, whereas others have detected the increased activation of ventral striatal reactivity in men for cues predicting erotic but not monetary rewards and cues signaling erotic pictures, therefore suggesting similarities between pornography addiction and conventional addiction disorders. with problematic Internet and online pornography use reported to constitute an increasing burden in public mental health since the 2000s, psychopathological models and diagnostic criteria have lacked consensus, and the body of evidence on the effectiveness of therapeutic approaches is still scarce.

The status of pornography addiction as an addictive disorder, rather than simply a compulsivity, has been hotly contested. Furthermore, research suggests that the use of a pornography addiction label may indicate a socially (as opposed to clinically) driven nosology. blockquote|It is worth considering whether the apparent epidemic of self diagnosed pornography addicts seeking help today perhaps represents the ready uptake of a relatively new way to describe one's problematic behaviour, and not the development of a modern disease entity whose description should dictate its treatment. One other behavioral addiction, internet gaming disorder, appears in the conditions proposed for further study in DSM 5. and “inconsistent”. >

Porn addiction is not a diagnosis in DSM 5 (or any previous version). "Viewing pornography online" is mentioned verbatim in the DSM 5, which is consistent with a large body of research finding similar markers in other kinds of problematic internet users. and most addiction biomarkers have never been demonstrated for pornography. The International Classification of Disorders 11 (ICD 11) rejected "pornography addiction". However, ICD 11 does include the "Compulsive sexual behaviour disorder" (CSBD) in the "impulse control disorders" section. It is defined as "a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour." David J. Ley argued that that is not an endorsement of the concept of pornography addiction. Note that two studies now contradict this, finding that narcissism, especially antagonist narcissism, predicts identification as a pornography addict. Introductory psychology textbook authors Coon, Mitterer and Martini, passingly mentioning NoFap, speak of pornography as a "supernormal stimulus" but use the model of compulsion rather than addiction. Addiction and compulsion are models of mental disorders which cancel each other out, the term "addiction" being deprecated, but ICD 11 does not support the existence of "porn addiction"/"sex addiction". DSM 5 TR, published in March 2022, does not recognize a diagnosis of sexual addiction/compulsion (which would include internet pornography viewing). ICD 11 has added pornography to CSBD. However, this is categorized as an impulse control disorder, not an addictive disorder. Neither DSM 5, nor DSM 5 TR, nor ICD 10, nor ICD 11 recognize sex addiction or porn addiction as a valid diagnosis. Rothman has stated "pornography is not yet clearly established as a risk factor for multiple health outcomes". Scholars note that much of the research on the effects of pornography often confuses correlation with causation.

Cognitive behavioral therapy has been suggested as a possible effective treatment for pornography addiction based on its success with internet addicts, though no clinical trials have been performed to assess effectiveness among pornography addicts as of 2012. Acceptance and commitment therapy has also been shown to be a potentially effective treatment for problematic internet pornography viewing.

Some clinicians and support organizations recommend voluntary use of Internet content control software, internet monitoring, or both, to manage online pornography use. Sex researcher Alvin Cooper and colleagues suggested several reasons for using filters as a therapeutic measure, including curbing accessibility that facilitates problematic behavior and encouraging clients to develop coping and relapse prevention strategies. Compulsive sexual behavior has been treated with antidepressants including SSRIs and serotonin norepinephrine reuptake inhibitors, Naltrexone (a medication used to inhibit reward mechanisms in opiate or alcohol addictions), other mood stabilizers, and anti androgens.

A 2017 study using a representative sample of Australians researched distress about sex video use. It found that of 10,131 women surveyed, 0.5% of women agreed with the statement that they were "addicted" to pornography; 1.2% (of 4,218 who viewed) when limited to women who say they viewed sex films. The comparable figure limiting to men who view sex films was 4.4%. This was without any clinical screening that should eliminate primary disorders (e. g., depression) or religious based concerns, so these should be considered high end estimates for potential disorders, if any exist. Most studies of rates use a convenience sample. One 2000 study of a convenience sample of 9,265 people found that 1% of Internet users have concerns about their Internet use and 17% of users meet criteria for problematic sexual compulsivity, meaning they score above one standard deviation of the mean on the Kalichman Sexual Compulsivity Scale. A survey of 84 college age males found that 2060% of a sample of college age males who use pornography found it to be problematic. Research on internet addiction disorder indicates rates may range from 1.5 to 8.2% in Europeans and Americans. A 2019 study found that the average frequency of use for those self describing as addicted to porn was about ten times per year. The study found this identification correlated with male gender, higher frequency of use, and belief that pornography was morally wrong (whether for religious or other reasons).

Several support groups exist for people who wish to quit pornography use and/or believe themselves to be addicted to pornography. Twelve step programs such as Sex Addicts Anonymous (SAA), Sexaholics Anonymous (SA), Sex and Love Addicts Anonymous (SLAA), Sexual Recovery Anonymous (SRA), and Sexual Compulsives Anonymous (SCA) are fellowships of men and women who share their experience, strength and hope with each other so they may overcome their common problem and help others recover from addiction or dependency by using the twelve step program borrowed from Alcoholics Anonymous (AA) and other recovery tools. NoFap is website and community forum founded in 2011 that serves as a support group for those who wish to give up pornography and masturbation. It serves as a support group for those who wish to avoid the use of pornography, masturbation, and/or sexual intercourse. Recent peer reviewed data highlighted considerable levels of misogyny along with a poor understanding of human sexuality and relationships within this online community. Sociologist Kelsy Burke, author of The Pornography Wars, believes that this misogyny arises from blaming the female dominated profession of pornography for men's personal problems. Fight the New Drug, a Salt Lake City based non profit organization founded by members of the Church of Jesus Christ of Latter day Saints, is a non legislative organization which claims to seek to inform and educate individuals regarding pornography usage with science and personal stories. It is aimed at the youth demographic. There is also a PornFree reddit group which focuses on giving up porn rather than masturbation. Celebrate Recovery is a Christian inter denominational twelve step program with about 35,000 available groups and is open to any person who is struggling with life's bad habits, hurts, and hang ups. Celebrate Recovery was started in 1991 at Saddleback Church in California, and their program is based on the Beatitudes from the biblical Sermon on the Plain and the twelve step program from Alcoholics Anonymous.

In 2013, American actor Joseph Gordon Levitt wrote, directed, and starred in the comedy drama film Don Jon, in which the protagonist is addicted to pornography. In an interview to promote the film, Gordon Levitt discussed what he referred to as the "fundamental difference between a human being and an image on a screen". In 2014, American actor Terry Crews talked about his long standing pornography addiction, which he said had seriously affected his marriage and life and which he was able to overcome only after entering rehab in 2009. He now takes an active role in speaking out about pornography addiction and its impact. In 2015, English comedian Russell Brand appeared in videos by American anti pornography group Fight the New Drug, in which he discussed pornography and its harmful effects. In 2016, American comedian Chris Rock and his wife Malaak Compton divorced after 20 years of marriage, which Rock attributed to his infidelity and pornography addiction. He later discussed the details of his pornography addiction in his 2018 stand up comedy special Tamborine.