The DSM (or Diagnostic and Statistical Manual of Mental Disorders) is the American “bible” of mental health. It is quoted by therapists, researchers, pharmaceutical companies and policy makers from all over the world. The DSM is also used by US health insurance companies to determine which mental disorder treatments they will pay out for.

Right now, porn addiction isn’t recognised by the DSM. Neither is sex addiction or internet addiction. In fact, the DSM doesn’t like the addiction word at all. But this might all change in the fifth revision, due to be released in 2013. Some proposed changes are:

• A category called “substance-related disorders” would include not only drug and alcohol addiction, but also gambling addiction. Recognition of a “non-substance” addiction like gambling in this category would be a considerable shift.
• Internet addiction might also be covered by this category, though subject to further research.
• Compulsive sexual behaviour issues, including obsession with pornography, would come under the new definition of “hypersexual disorder”. This would apply to people who repetitively engage in sexual “fantasies, urges and behavior”, and who repeatedly try and fail to control or significantly reduce the urges and behaviour.

So “pornography addiction” and “sex addiction” don’t get definitions in their own right, but would be recognised as hypersexuality issues. One line from the proposed criteria for hypersexual disorder particularly leapt out at me:

“Repetitively engaging in these sexual fantasies, urges, and behavior in response to dysphoric mood states (e.g., anxiety, depression, boredom, irritability).”

Now all these proposals are still being fleshed out, and they’ll be field tested for some time. Many experts have argued against inclusion of behavioural or “non-substance” addictions in the DSM on the basis that we will focus too much on the “addiction” and not the real, underlying problems.

Psychoanalyst Todd Essig is bang on the nail:

Making bad choices, developing destructive habits, and attempting solutions to problems in living that then become serious problems themselves will all become less important as the locus of responsibility shifts from the person doing something to the something being done.

To my mind, addiction therapy is a two-pronged approach:

• Help the person to directly address the behaviour; learn to develop an observing self that can notice and manage the specific trigger scenarios.
• Explore and address any underlying issues or trauma.

The balance and combination of both approaches is what makes good therapy. So the proposed new definition and criteria looks useful, even if “hypersexual disorder” might seem a somewhat misleading title at first. While I still have reservations about “addictions” in the DSM, I’m pretty optimistic about the inclusion of compulsive porn behaviour in this way.

You can read (and comment on) the proposed “hypersexual disorder” DSM-5 revision. Todd Essig’s excellent article about “internet addiction” is here in full.

• 70% of men and 30% of women view pornography online
• They come from all walks of life: students, teachers, lawyers, health practitioners and priests
• There are a lot of issues related to family breakdowns
• Porn addiction coexists with anxiety and depression

According to Dr Gomathi Sitharthan, who is leading the study:

Viewing porn online becomes a major problem only when people become so preoccupied that they spend 16 to 18 hours a day doing nothing else but watching porn, with serious impacts on relationships, work, studies, and finance.

Only when? I’d suggest that guys who watch porn for 25 minutes a day can still develop issues, but there’s no denying the negative impact on other aspects of their lives.

If you would like to participate in Dr Sitharthan’s survey, an online version can be found here

What’s the link between early childhood experiences and sexual fantasy or compulsion in adulthood?

Such questions make for plenty of debate on this site, so I can thoroughly recommend ‘Straight Men, Gay Porn’ and Other Brain Map Mysteries – a recent article by Marnia Robinson. Here’s an excerpt:

Heavy porn users sometimes notice that as tolerance builds for their earlier tastes, they move in new directions in their search for intense arousal. Instead of seeking porn that accords with their former brain maps, many seek out what shocks them—perhaps because “forbidden” and “fear-producing,” when combined with sexual arousal, offer a bigger brain chemical kick… at least for a time. Each shift wires the new tastes into the brain.

… some users’ porn choices, such as spanking or domination scenarios, may be related to subconscious, that is, implicit, childhood memories of which they are unaware. Once activated by the “right” porn, and reinforced with orgasm, such scenarios can more swiftly become compulsions.

Completely unanticipated sexual tastes can arise.

I’m a big fan of Marnia Robinson and Gary Wilson’s research and writing, and can highly recommend their website www.reuniting.info

The whole article can be read here.

1. YouTube
2. Google
3. Facebook
4. Sex
5. MySpace
6. Porn
7. Yahoo
8. Michael Jackson
9. Fred (YouTube star)
10. eBay

No great surprises there, except maybe the phenomenal success of ‘Fred’ – a cunning marketing campaign for a particular brand of handheld email gadgets. And the second most popular search is for the World’s most famous search engine – now that’s just lazy.

More interesting to me is the comment from Marian Merritt, Symantec’s own internet safety advisor:

“I think seeing how dominant the terms ’sex’ and ‘porn’ are, that they come up well within the top 10, doesn’t surprise us,” said Merritt. “You go down farther in the list, you see words of anatomy like ‘boobs,’ it almost makes you laugh because we remember what it was like to be a preteen or teen. Parents don’t often have context around this sort of thing.”

How refreshing.

Of course, there’s always someone who’ll find it disturbing that kids are enquiring about sex.

I’m reminded of the dog-eared, yellowing dictionary in my school library. The pages featuring sexual or toilet terminology were particularly well thumbed. Someone had highlighted the rudest entries, and even provided an illustration for one phallic term.

My ancient school dictionary didn’t list all the explicit terms that Google does, and it didn’t offer hardcore photos and streaming video. Of course, parents need to get savvy and take sufficient interest in what their kids get up to online. Adopting the balanced attitude of Symantec’s Ms Merritt is no bad way to begin.

In this Psychology Today article, Marnia Robinson suggests that repression still presents significant risks:

Excitement and risk intensify the wiring (learning) process in the brain because they increase dopamine and adrenaline. (So does novelty.)

A person whose initial sexual experiences have an illicit or dicey (“I may burn in hell for this”) aura, may therefore be at risk for seeking out future shocking, unsafe, and highly novel activities in connection with sexual expression, long after that person sheds any religious conditioning. Even guilt itself can become pleasurable. Why? Simply because a primitive part of the brain once put 2 (arousal) + 2 (risk or “Thou shalt not!”) together-without conscious input—and wired itself accordingly.

Kinsey took issue with strict and stifling attitudes towards sex. His own devoutly religious upbringing hadn’t done him any favours when it came to managing his sexual urges. Young people struggling with internet porn feel trapped in the search for increasingly extreme sexual stimulation, just like Kinsey. But they are far less likely to have endured such a restrictive upbringing.

Robinson considers a further theory:

The late psychiatrist and addiction expert Gerald G. May concluded that his profession took a wrong turn in the last century when it codified the belief that repression is our primary danger. May was no fan of repression. However, he felt that addiction was far more debilitating, given the way the brain works. As he put it, “addiction limits the freedom of human desire.” And without that freedom, a person cannot effectively address challenges—including overcoming repression.

In conclusion, Robinson suggests that Kinsey remains vindicated in his condemnation of sexual repression. In many respects, he was spot on. But for some of us, learning to skirt intense and addictive sexual stimuli may be more vital to sustained well-being than unfettered sexual expression.

Probably taking 20-30 minutes to complete, it’s quite an extensive survey. But the questions are thought provoking, and it’s good to see qualified academic research into the issue of porn addiction.

Click here to visit the survey website.

Studies show that when men view sexual images of women, and then interact with a woman in a real-world setting, they are more likely to have sexual words on their minds. They are also more likely to remember the woman’s physical appearance, and sit closer to her — for instance, at a job interview.

Susan Fiske, professor of psychology at Princeton University, also studied the effect of images of bikini-clad women on different areas of the male brain.

Although consistent with conventional wisdom, the way that men may depersonalize sexual images of women is not entirely something they control. In fact, it’s a byproduct of human evolution, experts say. The first male humans had an incentive to seek fertile women as the means of spreading their genes.

This is just the first study which was focused on the idea that men of a certain age view sex as a highly desirable goal, and if you present them with a provocative woman, then that will tend to prime goal-related responses.

They’re not fully conscious responses, and so people don’t know the extent to which they’re being influenced … It’s important to recognize the effects.

“Just like other addictions, pornography addiction will interrupt dopamine, which functions as a neurotransmitter, and it will cause a part of the brain to shrink,” Hilton claims. The shrinkage occurs in the Ventral Tegmental Area, or VTA, at the front of the brain.

And for many people facing up to their destructive habits or compulsions, 12-step can seem like the only option. Yes it’s widely accepted and long-established, with legions of evangelical supporters. And I certainly don’t doubt the life-changing impact quoted by many 12-step advocates.

But how relevant is 12-step to the specific challenge of overcoming an obsession with pornography? Could there be better options for achieving long-term freedom? Can we take a self-help path? For many, the 12-step doctrine dictates that such questions shouldn’t be asked; they represent denial and doubt. There is outright rejection of any alternative path to recovery.

To counter this, the Time article quotes research by the University of New Mexico, where two controlled trials were undertaken. Some people received spiritual guidance as part of the treatment — learning such practices as prayer, meditation and service to others, all of which are central to 12-step programs. Others received secular psychotherapy.

Both groups benefited from treatment, but the advantage of psychotherapy over 12-step methods became obvious. The group receiving spiritual guidance took longer to see improvement. They were generally more anxious and depressed throughout the treatment. This echoed the findings of earlier research, which concluded that non-faith-based treatments like cognitive behavioural therapy or mindfulness-based acceptance and commitment therapy might be preferable approaches.

The Time report also mentions ongoing research into alcoholism recovery through prescription drugs. In some countries, doctors already commonly prescribe medication to lower dopamine levels or testosterone, and this has reportedly benefitted people struggling with porn obsession.

It’s early days for such research and practice though, and the notion of prescribing drugs for porn addiction does concern me. For the vast majority of people struggling with a porn habit, I simply don’t believe that drugs are a necessary or particularly healthy solution.

When we do find ourselves locked into some form of porn habit, the underlying reasons are unique to us. From the broad selection of available therapies, some will suit us much better than others. A big part of recovery is trying things out and learning what will work for us, without getting too frustrated or despairing in the process.

From my experience, the ideal starting point is self-help and getting the issue into clear perspective. That’s the foundation of my Porn Game Over plan.

Yet the Electricpig writer has sneeking suspicion that 87 hours understates the reality, and I’m inclined to agree.

I’d like to see a survey that asks the same target group about how internet porn makes them feel. Do they recognise any problems caused by looking at porn? Do they feel hooked? What have they learned? Who can they talk to about it? Do they need to talk about it?

Can we really conclude that all these teenagers are ‘addicts’? Of course not.