Neuroscientific Approaches to (Online) Pornography Addiction

Part of the Studies in Neuroscience, Psychology and Behavioral Economics book series (SNPBE)


The availability of pornographic material has substantially increased with the development of the Internet. As a result of this, men ask for treatment more often because their pornography consumption intensity is out of control; i.e., they are not able to stop or reduce their problematic behavior although they are faced with negative consequences. There is a long lasting debate whether these kinds of problems should be conceptualized as a behavior addiction. 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. In the introduction, phenomenological, epidemiological, and diagnostic aspects of a syndrome, which is here labeled pornography addiction, will be described knowing that the adequacy of this terminology has to be further validated. In the second section, after aetiological considerations, contemporary neurobiological models will be presented to offer reference points for the question whether excessive pornography consumption can result in an addiction. In the third section of the chapter, neurobiological findings concerning three topics will be summarized: Neural correlates of watching pornography, cue reactivity and appetitive conditioning, and finally neurobiological characteristics of men with pornography addiction. The present contribution will be rounded off with a short conclusion highlighting possible future research questions.


Conditioned Stimulus Anterior Cingulate Cortex Unconditioned Stimulus Sexual Arousal Ventral Striatum 
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  1. Akins C (2004) The role of Pavlovian Conditioning in sexual behavior: a comparative analysis of human and nonhuman animals. Int J Comp Psychol 17:241–262Google Scholar
  2. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, ArlingtonCrossRefGoogle Scholar
  3. Arnow BA, Desmond JE, Banner LL, Glover GH, Solomon A, Polan ML, Atlas SW (2002) Brain activation and sexual arousal in healthy, heterosexual males. Brain 125(Pt 5):1014–1023CrossRefGoogle Scholar
  4. Banca P, Morris LS, Mitchell S, Harrison NA, Potenza MN, Voon V (2016) Novelty, conditioning and attentional bias to sexual rewards. J Psychiatr Res 72:91–101CrossRefGoogle Scholar
  5. Barth RJ, Kinder BN (1987) The mislabeling of sexual impulsivity. J Sex Marital Ther 13(1):15–23CrossRefGoogle Scholar
  6. Bocher M, Chisin R, Parag Y, Freedman N, Meir Weil Y, Lester H, Bonne O (2001) Cerebral activation associated with sexual arousal in response to a pornographic clip: a 15O-H2O PET study in heterosexual men. NeuroImage 14(1 Pt 1):105–117CrossRefGoogle Scholar
  7. Both S, Laan E, Spiering M, Nilsson T, Oomens S, Everaerd W (2008) Appetitive and aversive classical conditioning of female sexual response. J Sex Med 5(6):1386–1401CrossRefGoogle Scholar
  8. Both S, Brauer M, Laan E (2011) Classical conditioning of sexual response in women: a replication study. J Sex Med 8(11):3116–3131CrossRefGoogle Scholar
  9. Brand M, Snagowski J, Laier C, Maderwald S (2016) Ventral striatum activity when watching preferred pornographic pictures is correlated with symptoms of Internet pornography addiction. NeuroImage 129:224–232CrossRefGoogle Scholar
  10. Brom M, Both S, Laan E, Everaerd W, Spinhoven P (2014) The role of conditioning, learning and dopamine in sexual behavior: a narrative review of animal and human studies. Neurosci Biobehav Rev 38:38–59CrossRefGoogle Scholar
  11. Buchuk D (2013) UK online porn ban: web traffic analysis of Britain’s porn affair.
  12. Carnes P (2010) The same yet different: refocusing the Sexual Addiction Screening Test (SAST) to reflect orientation and gender. Sex Addict Compulsivity 17:7–30CrossRefGoogle Scholar
  13. Carnes S, Carnes PJ, Weinman EA (1983) Out of the shadows: understanding sexual addiction. CompCare Publishers, MinneapolisGoogle Scholar
  14. Carroll JS, Padilla-Walker LM, Nelson LJ, Olson CD, Barry CM, Madsen SD (2008) Generation XXX—Pornography acceptance and use among emerging adults. J Adolesc Res 23(1):6–30CrossRefGoogle Scholar
  15. Chase HW, Eickhoff SB, Laird AR, Hogarth L (2011) The neural basis of drug stimulus processing and craving: an activation likelihood estimation meta-analysis. Biol Psychiatry 70(8):785–793CrossRefGoogle Scholar
  16. Childress AR, Ehrman RN, Wang Z, Li Y, Sciortino N, Hakun J, O’Brien CP (2008) Prelude to passion: limbic activation by “unseen” drug and sexual cues. PLoS ONE 3(1):e1506CrossRefGoogle Scholar
  17. Coleman E (1991) Compulsive sexual behavior: new concepts and treatments. J Psychol Hum Sex 4:37–52CrossRefGoogle Scholar
  18. Cooper A (1998) Sexuality and the Internet: surfing into the new millennium. CyberPsychol Behav 1:187–193CrossRefGoogle Scholar
  19. Craig AD (2009) How do you feel—now? The anterior insula and human awareness. Nat Rev Neurosci 10(1):59–70MathSciNetCrossRefGoogle Scholar
  20. Day JJ, Carelli RM (2007) The nucleus accumbens and Pavlovian reward learning. Neuroscientist 13(2):148–159CrossRefGoogle Scholar
  21. Domjan M (1994) Formulation of a behavior system for sexual conditioning. Psychon Bull Rev 1(4):421–428CrossRefGoogle Scholar
  22. Ferretti A, Caulo M, DelGratta C, DiMatteo R, Merla A, Montorsi F, Romani GL (2005) Dynamics of male sexual arousal: distinct components of brain activation revealed by fMRI. NeuroImage 26(4):1086–1096CrossRefGoogle Scholar
  23. Garrison KA, Potenza MN (2014) Neuroimaging and biomarkers in addiction treatment. Curr Psychiatry Rep 16(12). doi: 10.1007/s11920-014-0513-5
  24. Georgiadis JR, Kringelbach ML (2012) The human sexual response cycle: brain imaging evidence linking sex to other pleasures. Prog Neurobiol 98(1):49–81CrossRefGoogle Scholar
  25. Georgiadis JR, Kringelbach ML, Pfaus JG (2012) Sex for fun: a synthesis of human and animal neurobiology. Nat Rev Urol 9(9):486–498CrossRefGoogle Scholar
  26. Gizewski ER, Krause E, Karama S, Baars A, Senf W, Forsting M (2006) There are differences in cerebral activation between females in distinct menstrual phases during viewing of erotic stimuli: A fMRI study. Exp Brain Res 174(1):101–108CrossRefGoogle Scholar
  27. Gold SN, Heffner CL (1998) Sexual addiction: many conceptions, minimal data. Clin Psychol Rev 18(3):367–381CrossRefGoogle Scholar
  28. Goldstein RZ, Volkow ND (2002) Drug addiction and its underlying neurobiological basis: neuroimaging evidence for the involvement of the frontal cortex. Am J Psychiatry 159(10):1642–1652CrossRefGoogle Scholar
  29. Hamann S, Herman RA, Nolan CL, Wallen K (2004) Men and women differ in amygdala response to visual sexual stimuli. Nat Neurosci 7(4):411–416CrossRefGoogle Scholar
  30. Kafka MP (2010) Hypersexual disorder: a proposed diagnosis for DSM-V. Arch Sex Behav 39(2):377–400CrossRefGoogle Scholar
  31. Kagerer S, Wehrum S, Klucken T, Walter B, Vaitl D, Stark R (2014) Sex attracts: investigating individual differences in attentional bias to sexual stimuli. PLoS ONE 9(9):e107795CrossRefGoogle Scholar
  32. Kalichman SC, Rompa D (1995) Sensation seeking and sexual compulsivity scales—reliability, validity, and predicting HIV risk behavior. J Pers Assess 65(3):586–601CrossRefGoogle Scholar
  33. Karama S, Lecours AR, Leroux JM, Bourgouin P, Beaudoin G, Joubert S, Beauregard M (2002) Areas of brain activation in males and females during viewing of erotic film excerpts. Hum Brain Mapp 16(1):1–13CrossRefGoogle Scholar
  34. Kauer JA, Malenka RC (2007) Synaptic plasticity and addiction. Nat Rev Neurosci 8(11):844–858CrossRefGoogle Scholar
  35. Klucken T, Schweckendiek J, Merz CJ, Tabbert K, Walter B, Kagerer S, Stark R (2009) Neural activations of the acquisition of conditioned sexual arousal: effects of contingency awareness and sex. J Sex Med 6(11):3071–3085CrossRefGoogle Scholar
  36. Klucken T, Wehrum S, Schweckendiek J, Merz CJ, Hennig J, Vaitl D, Stark R (2013) The 5-HTTLPR polymorphism is associated with altered hemodynamic responses during appetitive conditioning. Hum Brain Mapp 34(10):2549–2560CrossRefGoogle Scholar
  37. Klucken T, Kruse O, Wehrum-Osinsky S, Hennig J, Schweckendiek J, Stark R (2015) Impact of COMT Val158Met-polymorphism on appetitive conditioning and amygdala/prefrontal effective connectivity. Hum Brain Mapp 36(3):1093–1101CrossRefGoogle Scholar
  38. Klucken T, Wehrum-Osinsky S, Schweckendiek J, Kruse O, Stark R (2016) Altered appetitive conditioning and neural connectivity in subjects with compulsive sexual behavior. J Sex Med 13(4):627–636CrossRefGoogle Scholar
  39. Koob GF, Volkow ND (2010) Neurocircuitry of addiction. Neuropsychopharmacology 35(4):217–238CrossRefGoogle Scholar
  40. Kourrich S, Calu DJ, Bonci A (2015) Intrinsic plasticity: an emerging player in addiction. Nat Rev Neurosci 16(3):173–184CrossRefGoogle Scholar
  41. Kuehn S, Gallinat J (2014) Brain structure and functional connectivity associated with pornography consumption: the brain on porn. JAMA Psychiatry 71(7):827–834CrossRefGoogle Scholar
  42. Kuzma JM, Black DW (2008) Epidemiology, prevalence, and natural history of compulsive sexual behavior. Psychiatr Clin North Am 31(4):603–611CrossRefGoogle Scholar
  43. Laier C, Pawlikowski M, Pekal J, Schulte FP, Brand M (2013) Cybersex addiction: experienced sexual arousal when watching pornography and not real-life sexual contacts makes the difference. J Behav Addict 2(2):100–107CrossRefGoogle Scholar
  44. Martin-Soelch C, Linthicum J, Ernst M (2007) Appetitive conditioning: neural bases and implications for psychopathology. Neurosci Biobehav Rev 31(3):426–440CrossRefGoogle Scholar
  45. Mechelmans DJ, Irvine M, Banca P, Porter L, Mitchell S, Mole TB, Voon V (2014) Enhanced attentional bias towards sexually explicit cues in individuals with and without compulsive sexual behaviours. PLoS ONE 9(8):e105476CrossRefGoogle Scholar
  46. Meerkerk GJ, van den Eijnden R, Garretsen HF (2006) Predicting compulsive Internet use: it’s all about sex! CyberPsychol Behav 9(1):95–103CrossRefGoogle Scholar
  47. Miner MH, Raymond N, Mueller BA, Lloyd M, Lim KO (2009) Preliminary investigation of the impulsive and neuroanatomical characteristics of compulsive sexual behavior. Psychiatry Res 174(2):146–151CrossRefGoogle Scholar
  48. Most SB, Smith SD, Cooter AB, Levy BN, Zald DH (2007) The naked truth: positive, arousing distractors impair rapid target perception. Cogn Emot 21(5):964–981CrossRefGoogle Scholar
  49. Mouras H, Stoleru S, Bittoun J, Glutron D, PelegriniIssac M, Paradis AL, Burnod Y (2003) Brain processing of visual sexual stimuli in healthy men: a functional magnetic resonance imaging study. NeuroImage 20(2):855–869CrossRefGoogle Scholar
  50. Odlaug BL, Lust K, Schreiber Liana R N, Christenson G, Derbyshire K, Harvanko A, Grant JE (2013) Compulsive sexual behavior in young adults. Ann Clin Psychiatry 25(3):193–200Google Scholar
  51. Oei NY, Rombouts S, Soeter RP, van Gerven JM, Both S (2012) Dopamine modulates reward system activity during subconscious processing of sexual stimuli. Neuropsychopharmacology 37(7):1729–1737CrossRefGoogle Scholar
  52. Paul B, Shim JW (2008) Gender, sexual affect, and motivations for Internet pornography use. Int J Sex Health 20(3):187–199CrossRefGoogle Scholar
  53. Pawlikowski M, Altstoetter-Gleich C, Brand M (2013) Validation and psychometric properties of a short version of Young’s Internet Addiction Test. Comput Hum Behav 29(3):1212–1223CrossRefGoogle Scholar
  54. Pfaus JG, Kippin TE, Centeno S (2001) Conditioning and sexual behavior: a review. Horm Behav 40(2):291–321CrossRefGoogle Scholar
  55. Piazza PV, Deroche-Gamonet V (2013) A multistep general theory of transition to addiction. Psychopharmacology 229(3):387–413CrossRefGoogle Scholar
  56. Prause N, Janssen E, Hetrick WP (2008) Attention and emotional responses to sexual stimuli and their relationship to sexual desire. Arch Sex Behav 37(6):934–949CrossRefGoogle Scholar
  57. Redoute J, Stoleru S, Gregoire MC, Costes N, Cinotti L, Lavenne F, Pujol JF (2000) Brain processing of visual sexual stimuli in human males. Hum Brain Mapp 11(3):162–177CrossRefGoogle Scholar
  58. Reid RC, Garos S, Carpenter BN (2011a) Reliability, validity, and psychometric development of the hypersexual behavior inventory in an outpatient sample of men. Sex Addict Compulsivity 18:30–51CrossRefGoogle Scholar
  59. Reid RC, Li DS, Gilliland R, Stein JA, Fong T (2011b) Reliability, validity, and psychometric development of the Pornography Consumption Inventory in a sample of hypersexual men. J Sex Marital Ther 37(5):359–385CrossRefGoogle Scholar
  60. Reid RC, Carpenter BN, Hook JN, Garos S, Manning JC, Gilliland R, Fong T (2012) Report of findings in a DSM-5 field trial for hypersexual disorder. J Sex Med 9(11):2868–2877CrossRefGoogle Scholar
  61. Robinson TE, Berridge KC (1993) The neural basis of drug craving: an incentive-sensitization theory of addiction. Brain Res Brain Res Rev 18(3):247–291CrossRefGoogle Scholar
  62. Ross MW, Mansson S-A, Daneback K (2012) Prevalence, severity, and correlates of problematic sexual Internet use in Swedish men and women. Arch Sex Behav 41(2):459–466CrossRefGoogle Scholar
  63. Sabatinelli D, Bradley MM, Lang PJ, Costa VD, Versace F (2007) Pleasure rather than salience activates human nucleus accumbens and medial prefrontal cortex. J Neurophysiol 98(3):1374–1379CrossRefGoogle Scholar
  64. Schimmack U (2005) Attentional interference effects of emotional pictures: threat, negativity, or arousal? Emotion 5(1):55–66CrossRefGoogle Scholar
  65. Schultz W, Dayan P, Montague PR (1997) A neural substrate of prediction and reward. Science 275(5306):1593–1599CrossRefGoogle Scholar
  66. Sennwald V, Pool E, Brosch T, Delplanque S, Bianchi-Demicheli F, Sander D (2016) Emotional attention for erotic stimuli: cognitive and brain mechanisms. J Comp Neurol 524(8):1668–1675CrossRefGoogle Scholar
  67. Seok J-W, Sohn J-H (2015) Neural substrates of sexual desire in individuals with problematic hypersexual behavior. Front Behav Neurosci 9:e321CrossRefGoogle Scholar
  68. Stark R, Schienle A, Girod C, Walter B, Kirsch P, Blecker C, Vaitl D (2005) Erotic and disgust-inducing pictures—differences in the hemodynamic responses of the brain. Biol Psychol 70(1):19–29CrossRefGoogle Scholar
  69. Stark R, Kagerer S, Walter B, Vaitl D, Klucken T, Wehrum-Osinsky S (2015) Trait sexual motivation questionnaire: concept and validation. J Sex Med 12(4):1080–1091CrossRefGoogle Scholar
  70. Stoléru S, Fonteille V, Cornelis C, Joyal C, Moulier V (2012) Functional neuroimaging studies of sexual arousal and orgasm in healthy men and women: a review and meta-analysis. Neurosci Biobehav Rev 36(6):1481–1509CrossRefGoogle Scholar
  71. Traeen B, Nilsen TS, Stigum H (2006) Use of pornography in traditional media and on the Internet in Norway. J Sex Res 43(3):245–254CrossRefGoogle Scholar
  72. Volkow ND, Koob GF, McLellan AT (2016) Neurobiologic advances from the brain disease model of addiction. N Engl J Med 374(4):363–371CrossRefGoogle Scholar
  73. Voon V, Mole TB, Banca P, Porter L, Morris L, Mitchell S, Irvine M (2014) Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours. PLoS ONE 9(7):e102419CrossRefGoogle Scholar
  74. Walter M, Bermpohl F, Mouras H, Schiltz K, Tempelmann C, Rotte M, Northoff G (2008) Distinguishing specific sexual and general emotional effects in fMRI—subcortical and cortical arousal during erotic picture viewing. NeuroImage 40(4):1482–1494CrossRefGoogle Scholar
  75. Wehrum S, Klucken T, Kagerer S, Walter B, Hermann A, Vaitl D, Stark R (2013) Gender commonalities and differences in the neural processing of visual sexual stimuli. J Sex Med 10(5):1328–1342CrossRefGoogle Scholar
  76. Wehrum-Osinsky S, Klucken T, Kagerer S, Walter B, Hermann A, Stark R (2014) At the second glance: stability of neural responses toward visual sexual stimuli. J Sex Med 11(11):2720–2737CrossRefGoogle Scholar
  77. World Health Organization (1992) International statistical classification of diseases and related health problems (10th revision (ICD-10)). WHO, GenevaGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of Psychotherapy and Systems NeuroscienceUniversity of GiessenGiessenGermany
  2. 2.Department of Clinical PsychologyUniversity of SiegenSiegenGermany

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