Understanding Porn Addiction - A Reply to The Good Men Project

Over at The Good Man Project there is a recent article called, no joke, "Theoretically a man could worry that he’s addicted to porn and it turns out he’s really not. Is there room in the diagnostic system for that possibility?”  Apparently this was a comment someone left on the post "Why Does Porn Seem Hotter Than My Partner?"

Please be aware, there is no diagnostic category for porn addiction - it's not a recognized mental illness, nor is sex addiction. Which is not to say that porn addiction does not exist - it most certainly does, and most porn addicts are not aware that they are addicts, and most of them certainly would not self-refer. 

The Editors, in their article based on this comment, offered their own definition of porn addiction:

Here’s where [the authors of the original post] are on solid ground: there are men who are aware that they have a problem with porn. These men know they have a problem because they feel like their porn habits are out of control. Their sense of being out of control gives them a lot of stress, and a part of each of them wants to change but is not sure how. I have no doubt the testimonials are genuine.

This is often how addiction or other psychological disorders are spotted and treated. Treatment often begins when the subject asks for help or when the subject identifies to himself that he has a problem. A diagnosis of porn addiction is literally “subjective” – based in large part on whether or not the subject thinks he has a problem. If he thinks he has a problem, then he probably does. This is a common threshold for a lot of conditions in the DSM-IV: the difference between a personal quirk and a disorder is how much it bothers the subject. If I have a problem with reliance on the subject’s own viewpoint, then I have a problem with psychiatry as a science in the first place.

So, if a man prefers to masturbate to porn instead of his partner and this bothers him, or if he can only get an erection to porn and this bothers him, then he has a problem.

My question is: if it doesn’t bother him very much, then can we still say that he has a porn problem? Maybe in some cases, maybe not. Maybe he’s addicted and he’s in denial, or maybe he doesn’t have a problem. That’s the tricky part.

Again, porn addiction is not in the DSM-IV, nor will it be in the DSM-5.

This brings me to my next point - porn addiction exists, for sure, but there are no standardized, agreed upon measures for diagnosing addicts. Patrick Carnes teaches counselors how to assess for this problem, but he is still an outsider in the mental health industry (this does not make him wrong, only a trailblazer).

There are differences in the brain scans of sex addicts than those of "normal" people. However, the scans of a sex addict are nearly identical to those of a cocaine addict - pretty much all addiction, with the technology we have today, looks alike in the brain. So a brain scan will not clearly identify a porn addict or a sex addict, largely because sexual addictions are very frequently comorbid with other chemical addictions.

So how do we identify a porn addict?

Obviously, if it is getting in the way of daily activities, or it is destroying an intimate relationship, or if you are acting out (viewing porn and/or masturbating) at work, you have a problem.

In my opinion, all addictions share one common element - the chemical or the activity serves to "self-medicate" our painful or disturbing feelings out of awareness. When we feel the need to engage in our addiction of choice, more than likely there is an uncomfortable feeling just beneath that urge, so we engage in our addiction, the feeling goes away (for now), and then if our addiction is sexual or otherwise troublesome (crack, heroin, meth, alcohol, etc.), then we feel shameful.

Here is how Patrick Carnes conceives of the addiction cycle - it would be the same for porn as it is for sex or drugs:

THE ADDICTION CYCLE 

For sexual addicts an addictive experience progresses through a four-step cycle that intensifies with each repetition: 

1. Preoccupation—the trance or mood wherein the addicts’ minds are completely engrossed with thoughts of sex. This mental state creates an obsessive search for sexual stimulation. 

2. Ritualization—the addicts’ own special routines that lead up to the sexual behavior. The ritual intensifies the preoccupation, adding arousal and excitement.

3. Compulsive sexual behavior—the actual sexual act, which is the end goal of the preoccupation and ritualization. Sexual addicts are unable to control or stop this behavior. 

4. Despair—the feeling of utter hopelessness addicts have about their behavior and their powerlessness. 

The pain the addicts feel at the end of the cycle can be numbed or obscured by sexual preoccupation that reengages the addiction cycle.

[Carnes, Out of the Shadows: Understanding Sex Addiction, 3rd Edition, 2001, Kindle Location 462-470]

From an earlier post I did on this topic, here is more from Carnes on the core beliefs of the sex addict (likely true as well for the porn addict).

Sex addiction, like all other addictions (sex, like gambling, is often considered a process addiction rather than a substance addiction), is generally a response to developmental damage in the child, who is neglected, abused, molested, raped, or otherwise exposed to violence and/or sexuality at a young age. The result is a brain that is wired differently, a brain prone to seeking ways to escape, to numb the psychological pain.

Carnes identifies four primary areas in development that get hijacked and become unhealthy core beliefs, leading to addictive behavior.

There are four factors in a child’s development that ultimately become part of the sexual addiction:

1. self-image—how children perceive themselves

2. relationships—how children perceive their relationships with others

3. needs—how children perceive their own needs

4. sexuality—how children perceive their own sexual feelings and needs

These perceptions ultimately become “core beliefs” central to the addictive system. They are conclusions that can govern choices and behaviors during the child’s adult life.

[Carnes, 2009, Out of the Shadows, Kindle Locations 1432-1437]

In the addict, each of these areas develops into an unhealthy core belief. In examining how these beliefs comes about, Carnes offers a series of examples, including a man named Morris. Here is a brief summary of this man's childhood:

First, there is alcoholism in the family. Second, physical and emotional abuse accompany sexual abuse. Third, sexual experience is both humiliating and comforting. And fourth, the reality of the child is denied when the child’s accounts of abuse are not taken seriously. All of these are potent contributors to the addiction, as we shall see. 

By far the most important factor, however, is a sense of having been abandoned. From a child’s point of view, “you can abuse me, humiliate me, exploit me, and even not believe me, but by far the worst is if you don’t even want me.” Fear of abandonment is a constant theme in all addictions, including alcoholism. Within the sexual addiction, it is especially powerful.

[Carnes, 1454-1459]

Abandonment, in some form or another, whether literal, emotional, physical, or otherwise, is a foundational wound for addicts, but especially for sex addicts.

The sexual addiction receives its power from a fundamental concern for survival.

The first core belief of the addict is “I am basically a bad, unworthy person.” Abandonment means being unwanted. The child can only conclude that being unwanted means being unworthy and bad.

[Carnes, 1467-1469]

Abandonment does take many forms, and aside from the versions mentioned above, attachment psychology recognizes poor attachment as a form of abandonment, especially the absence of "mirroring" for the infant as a way to develop affect regulation (see Allan Schore). Schore refers to this as relational trauma, and the results includes inability to regulate affect (thus the 4th core belief in some form another as shown below), a sense of worthlessness, feeling fundamentally flawed, and a variety of other issues, mostly stemming from the right brain's emotional centers.

Here are the other three core beliefs and how they play out:

A second core belief comes from the first core belief about the child being a bad person. Because of personal unworthiness, the child believes, “No one would love me as I am.” Relationships with others become more tenuous the deeper this belief is. Children grow up believing that no one will accept them unconditionally. People will not be there; they cannot be trusted or depended on. If they do want a relationship, it is because they want something—not because they care. There will always be a price to pay. Minimally, there will be something that must be overlooked, ignored, or denied. To be close will mean to lose reality or integrity somehow. So intimacy is avoided.

[Carnes, 1483-1488]

***

[I]n the lonely search for something or someone to depend on—which has already excluded parents—a child can start to find those things which always comfort, which always feel good, which always are there, and which always do what they promise. For some, alcohol and drugs are the answer. For others it is food. And there is always sex, which usually costs nothing and nobody else can regulate.

This choice stems from the addict’s third core belief that is about needs: “My needs are never going to be met if I have to depend upon others.” In healthy families, children have a deep sense that their parents care for them as opposed to abandoning them.

Healthy parenting includes touching, loving, affirming, and guiding. The child feels cared for even when struggling with rules and limits. Trust in one’s self, as well as trust of others, emerges in that relationship.

When a child’s exploration of sexuality goes beyond discovery to routine self-comforting because of the lack of human care, there is potential for addiction. Sex becomes confused with comforting and nurturing. Moreover, the assumption is made that everyone else feels and acts the same. Therefore, to feel secure means to be sexual.

Consequently, the child’s relationships with people have the potential for being replaced with an addictive relationship with sexuality. Addiction is a relationship—a pathological relationship in which sexual obsession replaces people. And it can start very early. The final core belief of the addict emerges clearly: “Sex is my most important need.”

The kinds of childhood situations described here are further complicated when the children are surrounded by negative rules, messages, and judgments about sex. When addicts and their spouses study their families of origin, they are flooded with memories of events where they were told that being sexual was bad or, worse, that they were bad for being sexual.

When children’s primary source of comfort is sex and yet they are told by those whose judgments count the most that to be sexual is perverse, the conclusions they make about themselves are clear. They are unlikable. They need to hide that central part of themselves, which others will despise. Rather than repressing the sexual behaviors, they hide them or keep them secret. Needing to keep that central part of themselves secret adds to the pain and loneliness—which, in turn, creates a need for comfort, making the sexual fix that much more necessary.

[Carnes, 1494-1512]

In summary, here are the four core beliefs held by most sex addicts in one form or another (and if you substitute something else for sex in the fourth one, like cocaine, heroin, or food, these may apply to all addicts).

1. I am basically a bad, unworthy person
2. No one would love me as I am
3. My needs are never going to be met if I have to depend upon others
4. Sex is my most important need

These core beliefs were the foundation of the child's life as s/he grew up (can also be a she) become the axis of the addict's adult life - with each belief adding to the disconnect between the addict's interiority (the "world the addict experiences, with its pain and shame") and the addict's exterior persona or image that is projected to protect his secret and keep his inner life hidden. 

To cope with this disconnect, to cope with the belief that "I am a bad, unworthy person," some addicts feel that any degradation or humiliation that comes their way is justified - it reinforces their sense of failure and inadequacy.

Other addicts develop a grandiose or detached  persona (mask) that they show to the world hide their foundational guilt and shame.

Addicts create a front of “normalcy” to hide their sense of inadequacy. They may even appear grandiose and full of exaggerated self-importance. The front contrasts with actions that appear degrading or self-defeating or both. Others see decisions or behaviors as irrational, unfathomable, or even self-destructive, but not “normal.” 

Close friends and family members become angry and frustrated with the addict’s egocentric quality, especially when there is insensitivity to others. They are troubled at what looks like destructive or curious behavior that does not fit the image the addict projects. 

The belief “No one would love me as I am” also sustains the secret world. Addicts continue to believe that everyone would abandon them if the truth were known. Consequently, they have a constant fear of being vulnerable or dependent on others.

[Carnes, 1568-1574]

A lot of sexual addicts proclaim extreme sexual propriety, or in some circles, "postconventional moral development" - the results of this can be moral self-righteousness around sexual activity, with those who call them on their behavior being dismissed as morally underdeveloped or morally rigid.

Cover-ups, lies, and deceptions are made to conceal personal sexual behavior. The addict’s protestations of high sexual morality are like a smoke screen, obscuring the impact of sexual obsession. Friends and family tend to reject suspicions of sexual compulsivity because of the addict’s “values.” However, as evidence of powerless behavior and unmanageability mounts, these persons are confused because they do not know what to believe. In addition, they do not wish to intervene in something so personal.

[Carnes, 1604-1607]

As this quote shows, people around the addict often dismiss accusations around the addict because they do not match their experience of the addict's professed morality in the sexual realm. Those who are closest to the addict risk becoming co-addicts, according to Carnes:

By definition, the addict replaces normal human relationships with sexual compulsiveness. Loved ones feel the loss, try to deny it, and become angry, feeling despair and sometimes hope. The coaddicts’ efforts to restore the relationship are not only ineffective, they can intensify and deepen the addictive system for the addict. To compound the tragedy, coaddicts will take actions which are self-destructive, degrading, or even profound violations of their own values. Family members, as coaddicts, become part of the problem. Hence, the prefix co-.

[Carnes, 1640-1644]

 I highly recommend Carnes' books as a good foundation for understanding this addiction - he is a recovering sex addict so he knows the terrain. More importantly, however, we can learn a LOT by talking with porn addicts and sex addicts who are will to share their stories so that others might understand their experience.