Porn Use & Sex Addiction Studies

Sex Addiction Studies

Although this section is named “Porn Use & Sex Addiction Studies,” Internet porn addiction is not really sex addiction (see Porn Addiction Is Not Sex Addiction–And Why It Matters). Internet porn addiction is considered by many experts to be a subset of internet addiction.

YBOP has created several lists of porn studies. An (L) in front of the link indicates a lay article, usually about a study.

An official diagnosis? The world’s most widely used medical diagnostic manual, The International Classification of Diseases (ICD-11), contains a new diagnosis suitable for porn addiction: “Compulsive Sexual Behavior Disorder.” (2018)
Porn/sex addiction? This page lists over 56 neuroscience-based studies (MRI, fMRI, EEG, neuropsychological, hormonal). They provide strong support for the addiction model as their findings mirror the neurological findings reported in substance addiction studies.
The real experts’ opinions on porn/sex addiction? This list contains 34 recent literature reviews & commentaries by some of the top neuroscientists in the world. All support the addiction model.
Signs of addiction and escalation to more extreme material? Over 60 studies reporting findings consistent with escalation of porn use (tolerance), habituation to porn, and even withdrawal symptoms (all signs and symptoms associated with addiction). Additional page with 14 studies reporting withdrawal symptoms in porn users.
Debunking the unsupported talking point that “high sexual desire” explains away porn or sex addiction: At least 30 studies falsify the claim that sex & porn addicts “just have high sexual desire”
Porn and sexual problems? This list contains over 40 studies linking porn use/porn addiction to sexual problems and lower arousal to sexual stimuli. The first 7 studies in the list demonstrate causation, as participants eliminated porn use and healed chronic sexual dysfunctions.
Porn’s effects on relationships? Over 80 studies link porn use to less sexual and relationship satisfaction. (As far as we know all studies involving males have reported more porn use linked to poorer sexual or relationship satisfaction.)
Porn use affecting emotional and mental health? Over 85 studies link porn use to poorer mental-emotional health & poorer cognitive outcomes.
Porn use affecting beliefs, attitudes and behaviors? Check out individual studies: over 40 studies link porn use to “un-egalitarian attitudes” toward women and sexist views – or the summary from this 2016 meta-analysis: Media and Sexualization: State of Empirical Research, 1995–2015.
Over 85 studies demonstrating internet use & porn use causing negative outcomes & symptoms, and brain changes
See this page for over 100 studies linking porn use to sexual aggression, coercion & violence and an extensive critique of the often-repeated assertion that an increased availability of porn has resulted in decreased rape rates.

Several recent reviews of the literature & commentaries lend support to the addiction model:

See this 2015 paper by two medical doctors: Sex Addiction as a Disease: Evidence for Assessment, Diagnosis, and Response to Critics, which provides a chart from that takes on specific criticisms and offers citations that counter them.
For a thorough review of the neuroscience literature related to Internet addiction subtypes, with special focus on internet porn addiction, see – Neuroscience of Internet Pornography Addiction: A Review and Update (2015). The review also critiques two recent headline-grabbing EEG studies which purport to have “debunked” porn addiction.
Cybersex Addiction (2015). Excerpts: “In recent articles, cybersex addiction is considered a specific type of Internet addiction. Some current studies investigated parallels between cybersex addiction and other behavioral addictions, such as Internet Gaming Disorder. Cue-reactivity and craving are considered to play a major role in cybersex addiction. Neuroimaging studies support the assumption of meaningful commonalities between cybersex addiction and other behavioral addictions as well as substance dependency.”
Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports (2016) – An extensive review of the literature on porn-induced sexual problems by 7 US Navy doctors and Gary Wilson. The review provides the latest data revealing a tremendous rise in youthful sexual problems..The paper also reviews the neurological studies related to porn addiction and sexual conditioning. The doctors provide 3 clinical reports of men who developed porn-induced sexual dysfunctions. A second 2016 paper by Gary Wilson discusses the importance of studying the effects of porn by having subjects abstain from porn use: Eliminate Chronic Internet Pornography Use to Reveal Its Effects (2016).
This short review – Neurobiology of Compulsive Sexual Behavior: Emerging Science (2016) – concluded “Given some similarities between CSB and drug addictions, interventions effective for addictions may hold promise for CSB, thus providing insight into future research directions to investigate this possibility directly.”
A 2016 review of compulsive sexual behaviors (CSB) – Should compulsive sexual behavior be considered an addiction? (2016) – concluded that: “Overlapping features exist between CSB and substance use disorders. Common neurotransmitter systems may contribute to CSB and substance use disorders, and recent neuroimaging studies highlight similarities relating to craving and attentional biases.” Most of the neuroscience supporting the existence of “sex addiction” actually comes from studies on porn users, not sex addicts. Conflating internet porn addiction with sex addiction weakens the paper.
Compulsive Sexual Behaviour as a Behavioural Addiction: The Impact of the Internet and Other Issues (2016). Excerpts: “more emphasis is needed on the characteristics of the internet as these may facilitate problematic sexual behaviour.” and “clinical evidence from those who help and treat such individuals should be given greater credence by the psychiatric community.”
While the term “hypersexuality” should be discarded, this is a good review by Max Planck neuroscientists Neurobiological Basis of Hypersexuality (2016). Excerpt: “Taken together, the evidence seems to imply that alterations in the frontal lobe, amygdala, hippocampus, hypothalamus, septum, and brain regions that process reward play a prominent role in the emergence of hypersexuality. Genetic studies and neuropharmacological treatment approaches point at an involvement of the dopaminergic system.“
Searching for clarity in muddy water: future considerations for classifying compulsive sexual behavior as an addiction (2016) – Excerpts: We recently considered evidence for classifying compulsive sexual behavior (CSB) as a non-substance (behavioral) addiction. Our review found that CSB shared clinical, neurobiological and phenomenological parallels with substance-use disorders. Although the American Psychiatric Association rejected hypersexual disorder from DSM-5, a diagnosis of CSB (excessive sex drive) can be made using ICD-10. CSB is also being considered by ICD-11.
Integrating psychological and neurobiological considerations regarding the development and maintenance of specific Internet-use disorders: An Interaction of Person-Affect-Cognition-Execution model (2016). – A review of the mechanisms underlying the development and maintenance of specific Internet-use disorders, including “Internet-pornography-viewing disorder”. The authors suggest that pornography addiction (and cybersex addiction) be classified as internet use disorders and placed with other behavioral addictions under substance-use disorders as addictive behaviors.
Neuroscientific Approaches to Online Pornography Addiction (2017) – Excerpt: In the last two decades, several studies with neuroscientific approaches, especially functional magnetic resonance imaging (fMRI), were conducted to explore the neural correlates of watching pornography under experimental conditions and the neural correlates of excessive pornography use. Given previous results, excessive pornography consumption can be connected to already known neurobiological mechanisms underlying the development of substance-related addictions.
Is excessive sexual behaviour an addictive disorder? (2017) – Excerpts: Research into the neurobiology of compulsive sexual behaviour disorder has generated findings relating to attentional biases, incentive salience attributions, and brain-based cue reactivity that suggest substantial similarities with addictions. We believe that classification of compulsive sexual behaviour disorder as an addictive disorder is consistent with recent data and might benefit clinicians, researchers, and individuals suffering from and personally affected by this disorder.
Is excessive sexual behaviour an addictive disorder? (2017) – Excerpts: Research into the neurobiology of compulsive sexual behaviour disorder has generated findings relating to attentional biases, incentive salience attributions, and brain-based cue reactivity that suggest substantial similarities with addictions. We believe that classification of compulsive sexual behaviour disorder as an addictive disorder is consistent with recent data and might benefit clinicians, researchers, and individuals suffering from and personally affected by this disorder.
Neurobiology of Pornography Addiction – A clinical review (2017) – Excerpts: In total, 59 articles were identified which included reviews, mini reviews and original research papers on the issues of pornography usage, addiction and neurobiology. The research papers reviewed here were centered on those that elucidated a neurobiological basis for pornography addiction. This was further supplemented with the personal clinical experience of both the authors who work regularly with patients where pornography addiction and viewing is a distressing symptom.
The Proof of the Pudding Is in the Tasting: Data Are Needed to Test Models and Hypotheses Related to Compulsive Sexual Behaviors (2018) – Excerpts: Among the domains that may suggest similarities between CSB and addictive disorders are neuroimaging studies, with several recent studies omitted by Walton et al. (2017). Initial studies often examined CSB with respect to models of addiction (reviewed in Gola, Wordecha, Marchewka, & Sescousse, 2016b; Kraus, Voon, & Potenza, 2016b).
Promoting educational, classification, treatment, and policy initiatives Commentary on: Compulsive sexual behaviour disorder in the ICD-11 (Kraus et al., 2018) – Excerpts: The current proposal of classifying CSB disorder as an impulse-control disorder is controversial as alternate models have been proposed (Kor, Fogel, Reid, & Potenza, 2013). There are data suggesting that CSB shares many features with addictions (Kraus et al., 2016), including recent data indicating increased reactivity of reward-related brain regions in response to cues associated with erotic stimuli (Brand, Snagowski, Laier, & Maderwald, 2016; Gola, Wordecha, Marchewka, & Sescousse, 2016; Gola et al., 2017; Klucken, Wehrum-Osinsky, Schweckendiek, Kruse, & Stark, 2016; Voon et al., 2014
Compulsive Sexual Behavior in Humans and Preclinical Models (2018) – Excerpts: Compulsive sexual behavior (CSB) is widely regarded as a “behavioral addiction,” and is a major threat to quality of life and both physical and mental health. In conclusion, this review summarized the behavioral and neuroimaging studies on human CSB and comorbidity with other disorders, including substance abuse. Together, these studies indicate that CSB is associated with functional alterations in dorsal anterior cingulate and prefrontal cortex, amygdala, striatum, and thalamus, in addition to decreased connectivity between amygdala and prefrontal cortex.
Sexual Dysfunctions in the Internet Era (2018) – Excerpt: Among behavioral addictions, problematic Internet use and online pornography consumption are often cited as possible risk factors for sexual dysfunction, often with no definite boundary between the two phenomena. Online users are attracted to Internet pornography because of its anonymity, affordability, and accessibility, and in many cases its usage could lead users through a cybersex addiction: in these cases, users are more likely to forget the “evolutionary” role of sex, finding more excitement in self-selected sexually explicit material than in intercourse.
Neurocognitive mechanisms in compulsive sexual behavior disorder (2018) – Excerpt: To date, most neuroimaging research on compulsive sexual behavior has provided evidence of overlapping mechanisms underlying compulsive sexual behavior and non-sexual addictions. Compulsive sexual behavior is associated with altered functioning in brain regions and networks implicated in sensitization, habituation, impulse dyscontrol, and reward processing in patterns like substance, gambling, and gaming addictions. Key brain regions linked to CSB features include the frontal and temporal cortices, amygdala, and striatum, including the nucleus accumbens.
Ventral Striatal Reactivity in Compulsive Sexual Behaviors (2018) – Excerpt: Among currently available studies, we were able to find nine publications (Table 1) which utilized functional magnetic resonance imaging. Only four of these (36–39) directly investigated processing of erotic cues and/or rewards and reported findings related to ventral striatum activations. Three studies indicate increased ventral striatal reactivity for erotic stimuli (36–39) or cues predicting such stimuli (36–39). These findings are consistent with Incentive Salience Theory (IST) (28), one of the most prominent frameworks describing brain functioning in addiction.
A Current Understanding of the Behavioral Neuroscience of Compulsive Sexual Behavior Disorder and Problematic Pornography Use – Excerpt: Recent neurobiological studies have revealed that compulsive sexual behaviors are associated with altered processing of sexual material and differences in brain structure and function. Although few neurobiological studies of CSBD have been conducted to date, existing data suggest neurobiological abnormalities share communalities with other additions such as substance use and gambling disorders. Thus, existing data suggest that its classification may be better suited as a behavioral addiction rather than an impulse-control disorder.
Online Porn Addiction: What We Know and What We Don’t—A Systematic Review (2019) – Excerpt: As far as we know, a number of recent studies support this entity as an addiction with important clinical manifestations such as sexual dysfunction and psychosexual dissatisfaction. Most of the existing work is based off on similar research done on substance addicts, based on the hypothesis of online pornography as a ‘supranormal stimulus’ akin to an actual substance that, through continued consumption, can spark an addictive disorder.
Occurrence and development of online porn addiction: individual susceptibility factors, strengthening mechanisms and neural mechanisms (2019) – Excerpt: The long-term experience of online pornography has led to the sensitization of such people to online pornography-related clues, which has led to a growing sense of craving, compulsive use of online pornography under the dual factors of temptation and functional impairment. The sense of satisfaction gained from it is getting weaker and weaker, so more and more online pornography is needed to maintain the previous emotional state and become addicted.
Self-perceived Problematic Pornography Use: An Integrative Model from a Research Domain Criteria and Ecological Perspective (2019) – Excerpt: Self-perceived problematic pornography use seems to be related to multiple units of analysis and different systems in the organism. Based on the findings within the RDoC paradigm described above, it is possible to create a cohesive model in which different units of analysis impact each other (Fig. 1). These changes in internal and behavioral mechanisms among people with SPPPU are similar to those observed in people with substance addictions, and map into models of addiction.
Theories, prevention, and treatment of pornography-use disorder (2019) – Excerpt: Compulsive sexual behavior disorder, including problematic pornography use, has been included in the ICD-11 as impulse control disorder. The diagnostic criteria for this disorder, however, are very similar to the criteria for disorders due to addictive behaviors… Theoretical considerations and empirical evidence suggest that the psychological and neurobiological mechanisms involved in addictive disorders are also valid for pornography-use disorder.
Cybersex addiction: an overview of the development and treatment of a newly emerging disorder (2020) – Excerpts: Cybersex addiction is a non-substance related addiction that involves online sexual activity on the internet. Nowadays, various kinds of things related to sex or pornography are easily accessible through internet media. In Indonesia, sexuality is usually assumed taboo but most young people have been exposed to pornography. It can lead to an addiction with many negative effects on users, such as relationships, money, and psychiatric problems like major depression and anxiety disorders.
Which Conditions Should Be Considered as Disorders in the International Classification of Diseases (ICD-11) Designation of “Other Specified Disorders Due to Addictive Behaviors”? (2020) – Excerpts: Data from self-report, behavioral, electrophysiological, and neuroimaging studies demonstrate an involvement of psychological processes and underlying neural correlates that have been investigated and established to varying degrees for substance-use disorders and gambling/gaming disorders (criterion 3). Commonalities noted in prior studies include cue-reactivity and craving accompanied by increased activity in reward-related brain areas, attentional biases, disadvantageous decision-making, and (stimuli-specific) inhibitory control.
The Addictive Nature of Compulsive Sexual Behaviours and Problematic Online Pornography Consumption: A Review – Excerpts: Available findings suggest that there are several features of CSBD and POPU that are consistent with characteristics of addiction, and that interventions helpful in targeting behavioural and substance addictions warrant consideration for adaptation and use in supporting individuals with CSBD and POPU…. The neurobiology of POPU and CSBD involves a number of shared neuroanatomical correlates with established substance use disorders, similar neuropsychological mechanisms, as well as common neurophysiological alterations in the dopamine reward system.
Dysfunctional sexual behaviors: definition, clinical contexts, neurobiological profiles and treatments (2020) – Excerpts: Porn addiction, although distinct neurobiologically from sexual addiction, is still a form of behavioral addiction….The sudden suspension of porn addiction causes negative effects in mood, excitement, and relational and sexual satisfaction….The massive use of pornography facilitates the onset of psychosocial disorders and relationship difficulties…
What should be included in the criteria for compulsive sexual behavior disorder? (2020) – Excerpts: The classification of CSBD as an impulse control disorder also warrants consideration. … Additional research may help refine the most appropriate classification of CSBD as happened with gambling disorder, reclassified from the category of impulse control disorders to non-substance or behavioral addictions in DSM-5 and ICD-11. … impulsivity may not contribute as strongly to problematic pornography use as some have proposed (Bőthe et al., 2019).
Decision-Making in Gambling Disorder, Problematic Pornography Use, and Binge-Eating Disorder: Similarities and Differences (2021) – Excerpts: Similarities between CSBD and addictions have been described, and impaired control, persistent use despite adverse consequences, and tendencies to engage in risky decisions may be shared features (37••, 40). Individuals with these disorders often show impaired cognitive control and disadvantageous decision-making [12, 15,16,17]. Deficits in decision-making processes and goal-directed learning have been found across multiple disorders.
Cognitive processes related to problematic pornography use (PPU): A systematic review of experimental studies (2021) – Excerpts: In the current paper, we review and compile the evidence derived from 21 studies investigating the cognitive processes underlying PPU. In brief, PPU is related to: (a) attentional biases toward sexual stimuli, (b) deficient inhibitory control (in particular, to problems with motor response inhibition and to shift attention away from irrelevant stimuli), (c) worse performance in tasks assessing working memory, and (d) decision making impairments.
Cognitive processes related to problematic pornography use (PPU): A systematic review of experimental studies (2021) – Excerpts: In the current paper, we review and compile the evidence derived from 21 studies investigating the cognitive processes underlying PPU. In brief, PPU is related to: (a) attentional biases toward sexual stimuli, (b) deficient inhibitory control (in particular, to problems with motor response inhibition and to shift attention away from irrelevant stimuli), (c) worse performance in tasks assessing working memory, and (d) decision making impairments (in particular, to preferences for short-term small gains rather than long-term large gains, more impulsive choice patterns than non-erotica users, approach tendencies toward sexual stimuli, and inaccuracies when judging the probability and magnitude of potential outcomes under ambiguity). Some of this findings are derived from studies in clinical samples of patients with PPU or with a diagnosis of SA/HD/CSBD and PPU as their primary sexual problem (e.g., Mulhauser et al., 2014, Sklenarik et al., 2019), suggesting that these distorted cognitive processes may constitute ‘sensitive’ indicators of PPU.
At a theoretical level, the results of this review support the relevance of the main cognitive components of the I-PACE model (Brand et al., 2016, Sklenarik et al., 2019).
PDF of full review: Compulsive Sexual Behavior Disorder – the evolution of a new diagnosis introduced to the ICD-11, current evidence and ongoing research challenges (2021) – Abstract:
In 2019 Compulsive Sexual Behavior Disorder (CSBD) has been officially included in the forthcoming 11^th edition of the International Classification of Diseases published by the World Health Organization (WHO). The placement of CSBD as a new disease entity was preceded by a three-decade-long discussion on the conceptualization of these behaviors. Despite the potential benefits of WHO’s decisions, the controversy around this topic has not ceased. Both clinicians and scientists are still debating on gaps in the current knowledge regarding the clinical picture of people with CSBD, and the neural and psychological mechanisms underlying this problem. This article provides an overview of the most important issues related to the formation of CSBD as a separate diagnostic unit in the classifications of mental disorders (such as DSM and ICD), as well as a summary of the major controversies related to the current classification of CSBD.

Multiple studies have directly examined the brains of porn users & sex addicts (See this page for critiques and analysis of highly questionable and misleading studies):

Preliminary investigation of the impulsive and neuroanatomical characteristics of compulsive sexual behavior (2009) – Primarily sex addicts. Study reports more impulsive behavior in a Go-NoGo task in sex addicts (hypersexuals) compared to control participants. Brain scans revealed that sex addicts had greater disorganized prefrontal cortex white matter. This finding is consistent with hypofrontality, a hallmark of addiction.
Sexual Desire, not Hypersexuality, is Related to Neurophysiological Responses Elicited by Sexual Images (2013) – [greater cue-reactivity correlated with less sexual desire: sensitization and habituation] – This EEG study was touted in the media as evidence against the existence of porn/sex addiction. Not so. Steele et al. 2013 actually lends support to the existence of both porn addiction and porn use down-regulating sexual desire. Eight peer-reviewed papers explain the truth: Peer-reviewed critiques of Steele et al., 2013.
Brain Structure and Functional Connectivity Associated With Pornography Consumption: The Brain on Porn (2014) – A German study which found 3 significant addiction-related brain changes that correlated with the amount of porn consumed. It also found that the more porn consumed the less activity in the reward circuit, indicating desensitization, and increasing the need for greater stimulation (tolerance).
Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours (2014) – The first in a series of studies. It found the same brain activity as seen in drug addicts and alcoholics. It also found that porn addicts fit the accepted addiction model of wanting “it” more, but not liking “it” more. One other major finding (not reported in the media), was that over 50% of subjects (average age: 25) had difficulty achieving erections/arousal with real partners, yet could achieve erections with porn.
Enhanced Attentional Bias towards Sexually Explicit Cues in Individuals with and without Compulsive Sexual Behaviours (2014) – Findings match those seen in drug addiction.
Novelty, Conditioning and Attentional Bias to Sexual Rewards (2015) – Compared to controls porn addicts preferred sexual novelty and conditioned cues associated porn. However, the brains of porn addicts habituated faster to sexual images. Since novelty preference wasn’t pre-existing, porn addiction drives novelty-seeking in an attempt to overcome habituation and desensitization.
Neural Substrates of Sexual Desire in Individuals with Problematic Hypersexual Behavior (2015) – This Korean fMRI study replicates other brain studies on porn users. Like the Cambridge University studies it found cue-induced brain activation patterns in sex addicts which mirrored the patterns of drug addicts. In line with several German studies it found alterations in the prefrontal cortex which match the changes observed in drug addicts.
Modulation of Late Positive Potentials by Sexual Images in Problem Users and Controls Inconsistent with “Porn Addiction” (2015) – Another SPAN Lab EEG study comparing the 2013 subjects from Steele et al., 2013 to an actual control group. The results: compared to controls porn addicts had less response to photos of vanilla porn. The lead author, Nicole Prause, claims these results debunk porn addiction, yet these findings align perfectly with Kühn & Gallinat (2014), which found that more porn use correlated with less brain activation in response to pictures of vanilla porn. Nine peer-reviewed papers agree that this study actually found desensitization/habituation in frequent porn users (consistent with addiction): Peer-reviewed critiques of Prause et al., 2015
HPA axis dysregulation in men with hypersexual disorder (2015) – A study with 67 male sex addicts and 39 age-matched controls. The Hypothalamus-Pituitary-Adrenal (HPA) axis is the central player in our stress response. Addictions alter the brain’s stress circuits leading to a dysfunctional HPA axis. This study on sex addicts (hypersexuals) found altered stress responses that mirror the findings with substance addictions (the press release).
The Role of Neuroinflammation in the Pathophysiology of Hypersexual Disorder (2016) – This study reported higher levels of circulating Tumor Necrosis Factor (TNF) in sex addicts when compared to healthy controls. Elevated levels of TNF (a marker of inflammation) have also been found in substance abusers and drug addicted animals (alcohol, heroin, meth).
Compulsive sexual behavior: Prefrontal and limbic volume and interactions (2016) – Compared to healthy controls CSB subjects (porn addicts) had increased left amygdala volume and reduced functional connectivity between the amygdala and dorsolateral prefrontal cortex DLPFC.
Ventral striatum activity when watching preferred pornographic pictures is correlated with symptoms of Internet pornography addiction (2016) – Finding #1: Reward center activity (ventral striatum) was higher for preferred pornographic pictures. Finding #2: Ventral striatum reactivity correlated with the internet sex addiction score. Both findings indicate sensitization and align with the addiction model. The authors state that the “Neural basis of Internet pornography addiction is comparable to other addictions.“
Altered Appetitive Conditioning and Neural Connectivity in Subjects With Compulsive Sexual Behavior (2016) – A German fMRI study replicating two major findings from Voon et al., 2014 and Kuhn & Gallinat 2014. Main Findings: The neural correlates of appetitive conditioning and neural connectivity were altered in the CSB group. According to the researchers, the first alteration – heightened amygdala activation – might reflect facilitated conditioning (greater “wiring” to previously neutral cues predicting porn images). The second alteration – decreased connectivity between the ventral striatum and the prefrontal cortex – could be a marker for impaired ability to control impulses. Said the researchers, “These [alterations] are in line with other studies investigating the neural correlates of addiction disorders and impulse control deficits.” The findings of greater amygdalar activation to cues (sensitization) and decreased connectivity between the reward center and the prefrontal cortex (hypofrontality) are two of the major brain changes seen in substance addiction. In addition, 3 of the 20 compulsive porn users suffered from “orgasmic-erection disorder”.
Compulsivity across the pathological misuse of drug and non-drug rewards (2016) – A Cambridge University study comparing aspects of compulsivity in alcoholics, binge-eaters, video game addicts and porn addicts (CSB). Excerpts: CSB subjects were faster to learning from rewards in the acquisition phase compared to healthy volunteers and were more likely to perseverate or stay after either a loss or a win in the Reward condition. These findings converge with our previous findings of enhanced preference for stimuli conditioned to either sexual or monetary outcomes, overall suggesting enhanced sensitivity to rewards (Banca et al., 2016).
Methylation of HPA Axis Related Genes in Men With Hypersexual Disorder (2017) – This found that sex addicts have dysfunctional stress systems – a key neuro-endocrine change caused by addiction. The current study found epigenetic changes on genes central to the human stress response and closely associated with addiction
Can Pornography be Addictive? An fMRI Study of Men Seeking Treatment for Problematic Pornography Use (2017) – Excerpts: Problematic pornography use (PPU) subjects when compared to control subjects showed increased activation of ventral striatum specifically for cues predicting erotic pictures but not for cues predicting monetary gains. Our findings suggest that, similar to what is observed in substance and gambling addictions, the neural and behavioral mechanisms associated with the anticipatory processing of cues specifically predicting erotic rewards relate importantly to clinically relevant features of PPU.
Conscious and Non-Conscious Measures of Emotion: Do They Vary with Frequency of Pornography Use? (2017) – Study assessed porn user’s responses (EEG readings & Startle Response) to various emotion-inducing images – including erotica. The study found several neurological differences between low frequency porn users and high frequency porn users. An excerpt: Findings suggest that increased pornography use appears to have an influence on the brain’s non-conscious responses to emotion-inducing stimuli which was not shown by explicit self-report.
Pornography Addiction Detection based on Neurophysiological Computational Approach (2018) – Excerpt: Experimental results show that the addicted participants had low alpha waves activity in the frontal brain region compared to non-addicted participants. The theta band also show there is disparity between addicted and non-addicted. However, the distinction is not as obvious as alpha band.
Gray matter deficits and altered resting-state connectivity in the superior temporal gyrus among individuals with problematic hypersexual behavior (2018) – fMRI study. Summary: …study showed gray matter deficits and altered functional connectivity in the temporal gyrus among individuals with PHB (sex addicts). More importantly, the diminished structure and functional connectivity were negatively correlated with the severity of PHB. These findings provide new insights into the underlying neural mechanisms of PHB.
Altered Prefrontal and Inferior Parietal Activity During a Stroop Task in Individuals With Problematic Hypersexual Behavior (2018) – fMRI & neuropsychological study comparing controls to porn/sex addicts. Findings mirror studies on drug addicts: sex/porn addicts exhibited poorer executive control & decreased PFC activation during a stroop test correlating with severity of addiction scores. All this indicates poorer prefrontal cortex functioning, which is a hallmark of addiction, and manifests as the inability to control use or suppress cravings.
Hypermethylation-associated downregulation of microRNA-4456 in hypersexual disorder with putative influence on oxytocin signalling: A DNA methylation analysis of miRNA genes (2019) – Study on subjects with hypersexuality (porn/sex addiction) reports epigenetic changes mirroring those occurring in alcoholics. The epigenetic changes occurred in genes associated with the oxytocin system (which is important in love, bonding, addiction, stress, sexual functioning, etc.).
Gray matter volume differences in impulse control and addictive disorders (Draps et al., 2020) – Excerpts: Affected individuals compulsive sexual behavior disorder (CSBD), gambling disorder (GD), and alcohol use disorder (AUD) compared to controls showed smaller GMVs in the left frontal pole, specifically in the orbitofrontal cortex… Higher severity of CSBD symptoms was correlated with decreased GMV in the right anterior cingulate gyrus… Our findings suggest similarities between specific impulse control disorders and addictions.
High Plasma Oxytocin Levels in Men With Hypersexual Disorder (2020) – Excerpts: The results suggest hyperactive oxytonergic system in male patients with hypersexual disorder which may be a compensatory mechanism to attenuate hyperactive stress system. A successful CBT group therapy may have effect on hyperactive oxytonergic system.
Normal Testosterone but Higher Luteinizing Hormone Plasma Levels in Men With Hypersexual Disorder (2020) – Excerpts: The proposed mechanisms might include the HPA and HPG interaction, the reward neural network, or the inhibition of regulation impulse control of prefrontal cortex regions.³²In conclusion, we report for the first time increased LH plasma levels in hypersexual men compared with healthy volunteers. These preliminary findings contribute to growing literature on the involvement of neuroendocrine systems and dysregulation in HD.
Inhibitory control and problematic Internet-pornography use – The important balancing role of the insula (2020) – Excerpts: Effects of tolerance and motivational aspects may explain the better inhibitory control performance in individuals with higher symptom severity which was associated with differential activity of the interoceptive and reflective system. Diminished control over IP use presumably results from the interaction between the impulsive, reflective, and interoceptive systems.
Sexual cues alter working memory performance and brain processing in men with compulsive sexual behavior (2020) Excerpts: These findings are in line with the incentive salience theory of addiction, especially the higher functional connectivity to the salience network with the insula as a key hub and the higher lingual activity during processing of pornographic pictures depending on recent pornography consumption.
Subjective reward value of visual sexual stimuli is coded in human striatum and orbitofrontal cortex (2020) – Excerpts: We not only found an association of NAcc and caudate activity with sexual arousal ratings during VSS viewing but the strength of this association was greater when the subject reported more problematic pornography use (PPU). The result supports the hypothesis, that incentive value responses in NAcc and caudate differentiate more strongly between differently preferred stimuli, the more a subject experiences PPU.
The Neurosciences of Health Communication: An fNIRS Analysis of Prefrontal Cortex and Porn Consumption in Young Women for the Development of Prevention Health Programs (2020) – Excerpts: The results indicate that the viewing of the pornographic clip (vs. control clip) causes an activation of Brodmann’s area 45 of the right hemisphere. An effect also appears between the level of self-reported consumption and the activation of right BA 45: the higher the level of self-reported consumption, the greater the activation. On the other hand, those participants who have never consumed pornographic material do not show activity of the right BA 45 compared to the control clip (indicating a qualitative difference between non-consumers and consumers. These results are consistent with other research made in the field of addictions.
Event-related potentials in a two-choice oddball task of impaired behavioral inhibitory control among males with tendencies towards cybersex addiction (2020) – Excerpts: Theoretically, our results indicate that cybersex addiction resembles substance use disorder and impulse control disorder in terms of impulsivity at electrophysiological and behavioral levels. Our findings may fuel the persistent controversy about the possibility of cybersex addiction as a novel type of psychiatric disorder.
White matter microstructural and Compulsive Sexual Behaviors Disorder – Diffusion Tensor Imaging study (2020) – Excerpts: This is one of the first DTI studies assessing differences between patients with the Compulsive Sexual Behaviors Disorder and healthy controls. Our analysis has uncovered FA reductions in six regions of the brain in CSBD subjects, compared to controls. Our DTI data shows that the neural correlates of CSBD overlap with regions previously reported in the literature as related both, to addiction and OCD.
Aberrant orbitofrontal cortex reactivity to erotic cues in Compulsive Sexual Behavior Disorder (2021) – Excerpts: The functional pattern observed in CSBD subjects comprising superior parietal cortices, supramarginal gyrus, pre and postcentral gyrus, and basal ganglia might be indicative of intensified (as compared to healthy controls) attentional, somatosensory, and motor preparation to erotic reward approach and consummation (wanting) in CSBD which is evoked by predictive cues. This is in line with Incentive Sensitization theory of addiction and existing data on cue-reactivity in addictive behaviors.

The following neuro-psychological studies add support to the above neurological studies:

Together these brain studies found:

The 3 major addiction-related brain changes: sensitization, desensitization, and hypofrontality.
More porn use correlated with less grey matter in the reward circuit (dorsal striatum).
More porn use correlated with less reward circuit activation when briefly viewing sexual images.
And more porn use correlated with disrupted neural connections between the reward circuit and prefrontal cortex.
Addicts had greater prefrontal activity to sexual cues, but less brain activity to normal stimuli (matches drug addiction).
Porn use/exposure to porn related to greater delayed discounting (inability to delay gratification). This is a sign of poorer executive functioning.
60% of compulsive porn addicted subjects in one study experienced ED or low libido with partners, but not with porn: all stated that internet porn use caused their ED/low libido.
Enhanced attentional bias comparable to drug users. Indicates sensitization (a product of DeltaFosb).
Greater wanting & craving for porn, but not greater liking. This aligns with the accepted model of addiction – incentive sensitization.
Porn addicts have greater preference for sexual novelty yet their brains habituated faster to sexual images. Not pre-existing.
The younger the porn users the greater the cue-induced reactivity in the reward center.
Higher EEG (P300) readings when porn users were exposed to porn cues (which occurs in other addictions).
Less desire for sex with a person correlating with greater cue-reactivity to porn images.
More porn use correlated with lower LPP amplitude when briefly viewing sexual photos: indicates habituation or desensitization.
Dysfunctional HPA axis and altered brain stress circuits, which occurs in drug addictions (and greater amygdala volume, which is associated with chronic social stress).
Epigenetic changes on genes central to the human stress response and closely associated with addiction.
Higher levels of Tumor Necrosis Factor (TNF) – which also occurs in drug abuse and addiction.
A deficit in temporal cortex gray matter; poorer connectivity between temporal corporate and several other regions.
Greater state impulsivity.
Decreased prefrontal cortex and anterior cingulate gyrus gray matter compared to healthy controls.
Reductions in white matter compared to healthy controls.

Prior to the above studies YBOP claimed that internet porn addiction was real and caused the same fundamental brain changes as seen in other addictions. We were confident in this claim because basic physiology rests on the fact that drugs do not create anything new or different; they simply increase or decrease normal brain functions. We already possess the machinery for addiction (mammalian mating/bonding/love circuitry), and for binging (storing calories, mating season). Moreover, years of addiction research have clearly demonstrated that addiction is a single condition, reflected in a typical constellation of signs, symptoms and behaviors (Natural Rewards, Neuroplasticity, and Non-Drug Addictions (2011).

These studies on Internet porn users should come as no surprise because over 380 brain studies had already confirmed that “Internet addicts” develop the same major addiction-related brain changes that occur in all addictions. Many more assessment-based Internet addiction studies back up what the brain studies found. Internet porn, internet gaming, and social media are now being viewed as separate applications or subcategories of Internet use. An individual can be addicted to Facebook or Internet porn, while not having a “generalized Internet addiction”. A 2006 Dutch study found that erotica had the highest addictive potential of all Internet applications.

No wonder. Internet erotica is an extreme version of natural rewards that we’re all wired to pursue: sexual arousal and apparent mating opportunities. Today’s extreme porn is as unnatural a “natural reinforcer” as today’s junk food is. See our article Porn Then and Now: Welcome to Brain Training, and this excellent peer-reviewed article, with a current review of where neuroscience is with respect to Internet porn addiction: Pornography addiction – a supranormal stimulus considered in the context of neuroplasticity (2013).

Recent research on brain changes in response to “highly palatable foods” is revealing evidence of an addiction process. If gambling, gaming, Internet use and food can alter the brain in this way, it would have been amazing to believe that Internet porn alone could not. This is why In 2011, 3000 doctors of the American Society for Addiction Medicine (ASAM) came out with a public statement clarifying that behavioral addictions (sexual, food, gambling) are fundamentally like substance addictions in terms of brain changes. Said ASAM:

“We all have the brain reward circuitry that makes food and sex rewarding. In fact, this is a survival mechanism. In a healthy brain, these rewards have feedback mechanisms for satiety or ‘enough.’ [And in] someone with addiction, the circuitry becomes dysfunctional such that the message to the individual becomes ‘more’, which leads to the pathological pursuit of rewards and/or relief through the use of substances and behaviors.”

In its faq’s ASAM specifically addressed sexual behavior addictions:

QUESTION: This new definition of addiction refers to addiction involving gambling, food, and sexual behaviours. Does ASAM really believe that food and sex are addicting?
ANSWER: The new ASAM definition makes a departure from equating addiction with just substance dependence, by describing how addiction is also related to behaviours that are rewarding. … This definition says that addiction is about functioning and brain circuitry and how the structure and function of the brains of persons with addiction differ from the structure and function of the brains of persons who do not have addiction. … Food and sexual behaviours and gambling behaviours can be associated with the “pathological pursuit of rewards” described in this new definition of addiction.

The big news is that the World Health Organization has corrected the DSM-5’s error. The new edition of ICD-11 includes a diagnosis for “Compulsive sexual behaviour disorder” as well as one for “Disorders due to addictive behaviours”. Here’s the current proposed language:

6C92 Compulsive sexual behaviour disorder is characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour. Symptoms may include repetitive sexual activities becoming a central focus of the person’s life to the point of neglecting health and personal care or other interests, activities and responsibilities; numerous unsuccessful efforts to significantly reduce repetitive sexual behaviour; and continued repetitive sexual behaviour despite adverse consequences or deriving little or no satisfaction from it.
The pattern of failure to control intense, sexual impulses or urges and resulting repetitive sexual behaviour is manifested over an extended period of time (e.g., 6 months or more), and causes marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. Distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviours is not sufficient to meet this requirement.

For an accurate account of the ICD-11, see this recent article by The Society for the Advancement of Sexual Health (SASH): “Compulsive Sexual Behaviour” has been classified by World Health Organization as Mental Health Disorder. For an expose on the shenanigans by agenda-driven PhD’s, see – Propagandists misrepresent papers to fuel false claim that WHO’s ICD-11 “rejected porn addiction and sex addiction”