Dr. Tariq Jagnarine
Fam Medicine, Endocrinology/Diabetes

Pornography has always been with us, and it’s always been controversial. Some people aren’t interested in it, and some are deeply offended by it; others partake of it occasionally, and others on a regular basis. It all boils down to personal preference and personal choice.
It’s important to note that “porn addiction” isn’t an official diagnosis recognised by the American Psychiatric Association (APA), but experiencing an uncontrollable compulsion to view porn can be as problematic for some people as other behavioural addictions. Since the existence of “porn addiction” is not recognised by the APA, no definitive diagnostic criteria guide mental health professionals in its diagnosis.
Since people may be reluctant to talk about porn, it’s difficult to know how many people enjoy it on a regular basis, or how many find it impossible to resist. A Kinsey Institute survey found that 9 percent of people who view porn have unsuccessfully tried to stop. This survey was taken in 2002, and it has since become much easier to access porn via the internet and streaming services. This easy access makes it more difficult to stop watching porn, if watching porn has become a problem.
The Diagnostic and Statistical Manual of Mental Disorders (DSM), a publication of the American Psychiatric Association, is used by healthcare professionals to help diagnose mental disorders. The DSM doesn’t recognise porn addiction as an official mental health diagnosis, but
research suggests that behavioural addictions are serious. One 2015 review article concluded that internet pornography shares basic mechanisms with substance addiction. Research comparing the brains of people who compulsively view porn to the brains of people who are addicted to drugs or alcohol has produced mixed results. Other researchers suggest it may be more of a compulsion than an addiction.
There’s a thin difference between compulsion and addiction.

Compulsions are repetitive behaviours with no rational motivation, but are often engaged in to reduce anxiety. Addictions involve an inability to stop the behaviour, despite negative consequences. Both involve a lack of control. Either way, if watching porn becomes problematic, there are ways to try to regain control.

Simply viewing or enjoying porn doesn’t make one addicted to it, nor does it require fixing. On the other hand, addictions are about a lack of control — and that can cause significant problems.
The Porn habit may be a cause for concern if:
* The amount of time spent watching porn keeps growing
* Feeling as though needing a porn “fix” — and that fix gives a “high”
* Feeling guilty about the consequences of viewing porn
* Spending hours on end perusing online porn sites, even if it means neglecting responsibilities or sleep
* Insisting that romantic or sexual partner views porn, or acts out porn fantasies, even though they don’t want to
* Being unable to enjoy sex without first viewing porn
* Being unable to resist porn even though it’s disrupting your life.

It’s hard to say why viewing porn can sometimes escalate into an out-of-control behaviour. People may start looking at porn because they like it, and watching it doesn’t seem to be a problem.

They may enjoy the rush it gives them, and find themselves wanting that rush more often. By then it may not matter that these viewing habits are causing a problem, or that they feel bad about it later; it’s that in-the-moment high they can’t resist. If they try to stop, it can be difficult to do so.
That’s how behavioural addictions sneak up on people. Research shows that certain behavioural addictions, such as internet addiction, involve neural processes that are similar to substance addiction — and that internet pornography addiction is comparable. It may start during a period when people feel bored, lonely, anxious, or depressed. Like other behavioural addictions, it can happen to anyone.

Here are a few things to try:
1. Delete electronic porn and bookmarks on all devices.
2. Discard all hard-copy porn.
3. Have someone else install anti-porn software on electronic devices without giving the password.
4. Have a plan — choose another activity or two to turn to when that powerful urge hits.
5. When wanting to view porn, remember the effect it had before; write it down, if that helps.
6. Consider if there are any triggers, and try to avoid them.
7. Partner up with someone else who would ask about porn habits and hold you accountable.
* Keep a journal to track setbacks and reminders, and alternate activities that work.

Consider seeing a therapist to discuss any concerns. They can come up with an individualised treatment plan to help you work through the concerns.

<* Therapy>
If a compulsion or addiction is suspected, it’s worth seeing a mental health professional for evaluation. This may be especially helpful if you also have anxiety, signs of depression, or obsessive-compulsive disorder (OCD).
Depending on how porn is impacting one’s life, a therapist may recommend individual, group, or family counselling. Be wary of therapists who claim to “specialise” in diagnosis and treatment of pornography. It’s difficult to “specialise” in a disorder that lacks a professionally- agreed-upon definition or uniformly outlined diagnostic criteria.
Counselling sessions would help to understand what caused the compulsion in the first place. A therapist can help persons to develop effective coping mechanisms to change their relationship with pornographic materials.

<* Support groups>
Many people find strength in talking to others who have firsthand experience with the same issue. Ask a primary care physician, mental health professional, or local hospital for information on pornography or sexual addiction support groups.

<* Medication>
Treatment for behavioural addictions generally involves talk therapy and cognitive behavioural therapy. But a doctor may recommend medication if persons have co-existing conditions, such as depression or OCD.

Untreated, compulsions or addictions can become a destructive force. Relationships, particularly romantic and sexual ones, may be negatively impacted. Porn addiction may lead to:
<* Poor relationship quality>
<* Lower sexual satisfaction>
<* Lower self-esteem>
<* It can also lead to the loss of a career or to financial problems if ignoring responsibilities or missing obligations or viewing porn at work; and is subject to disciplinary action.

Looking at porn isn’t always cause for concern. It could be a case of curiosity, or the person may genuinely enjoy porn with no ill effects. But it may be a problem if people:
*Watch while at work or at other inappropriate places and times
*Spend increasing amounts of time watching porn
*Are unable to keep up with their social, occupational, or other important obligations
*Are experiencing relationship difficulties
*Have tried to cut back or stop, but can’t keep themselves away from it
*Are showing signs of a compulsion or addiction.

It may then be time to open the lines of nonjudgmental communication.