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An Internet Pornography Addict Walks Into A
Clinic…
Robert Beshara
So what do you do as a
clinician?
Do you ignore the problem, saying: it does not
exist?
How do you diagnose and treat said client?
Clearly, each clinician will deal with this problem
in a different way. Is that helpful?
If applicable, what is the significant other’s role in
this scenario?
Why this topic?
Don Jon (2013)
Why this topic (cont’d)
Porn on the Brain (2013)
“Pornography addiction” is
a meme
From one Google search, you will find many
articles, books, and websites addressing the
topic in some shape or form. Is it media circus or
more?
 I am interested in the experience of people who
claim to be struggling with High-speed Internet
Pornography Addiction (HIPA), particularly what
they perceive to be detrimental consequences
on them both personally and interpersonally.
The basics
 High-speed Internet Pornography Addiction (HIPA) is
a modified version of a term popularized by retired
anatomy and physiology teacher, Gary Wilson
(2013)—of yourbrainonporn.com
 Traditionally, users chiefly consumed pornographic
films via purchasing or renting them from sex shops,
or viewing them in adult movie theatres; however,
Internet pornography (IP) is a unique phenomenon--
set apart from traditional pornography and closely
tied to the development of broadband (c. 2000)--
mainly because of what Cooper (1998) foresaw as
the “Triple-A Engine” effect of accessibility,
affordability, and anonymity.
Offline vs. online porn
The basics (cont’d)
Pornography is a loaded word, but
etymologically: “The word pornography, derived
from the Greek porni (“prostitute”) and graphein
(“to write”), was originally defined as any work
[...] depicting the life of prostitutes”
(“pornography”, 2014).
The technological novelty afforded by
broadband, among other factors, has
contributed to the addictive potential of IP, and
hence, its detrimental consequences on certain
vulnerable users (see Ford, Durtschi, & Franklin,
2012; Hilton, 2013; Levin, Lillis, & Hayes, 2012;
Shorrock, 2012).
Alternatives to the addiction
model
Alternatives to the addiction model, broadly include viewing IP use: as
a form of compulsion (see Griffiths, 2012), or as a non-pathological
high-frequency viewing of “visual sexual stimuli” (Ley, Prause, & Finn,
2014).
The distinction between healthy and unhealthy IP use could be
entirely subjective, but one way of differentiating between both could
involve an assessment by the user of the positive, neutral, or negative
consequences of IP use on them personally and interpersonally,
especially in the long run.
Addiction vs. compulsion
 Pleasure: “While people who have addictions suffer all manner of
discomforts, the desire to use the substance or engage in the behavior is
based on the expectation that it will be pleasurable. In contrast, someone
who experiences a compulsion as part of [OCD] may not get any pleasure
from the behavior he carries out. Often, it is a way of dealing with the
obsessive part of the disorder, resulting in a feeling of relief” (Hartney,
2011).
 Reality: “When people have obsessive-compulsive disorder, they are
usually aware that their obsession is not real. They are often disturbed by
feeling the need to carry out a behavior that defies logic, yet they do it
anyway to relieve their anxiety. In contrast, people with addictions are
often quite detached from the senselessness of their actions, feeling that
they are just having a good time, and that other concerns aren’t that
important. This is often known as denial because the addicted person
denies that his use or behavior is a problem” (Hartney, 2011).
My understanding of
addiction
Addiction in the context of this paper is informed
by two things: the American Society of Addiction
Medicine’s (ASAM) definition of addiction as
“characterized by inability to consistently
abstain, impairment in behavioral control,
craving, diminished recognition of significant
problems with one’s behaviors and interpersonal
relationships, and a dysfunctional emotional
response” (“Definition of Addiction”, n.d.), and
the use-abuse-dependence continuum.
The addiction cycle
What’s at stake?
How do we reconcile with the fact that many
clients in psychotherapy claim to be struggling
personally and interpersonally with the negative
consequences of HIPA? According to Ley et al.
(2014), the group who is against the IP addiction
model, 0.58% of men and 0.43% of women in the
USA claim to be struggling with said problem.
 These statistics seem insignificant at first sight;
however, in a country of more than 313 million,
this amounts to approximately 1.8 million men
and 1.3 million women struggling with HIPA, or
3.1 million in total.
What’s at stake? (cont’d)
Since HIPA is not listed as a disorder in the DSM-V, should it be
disregarded by psychotherapists? Or should each psychotherapist
deal with this undiagnosed phenomenon in their own way? The
proposition here is not for some kind of generic standardization
regarding HIPA and/or the pathologizing of IP use in general, which
would undoubtedly be oppressive.
Rather, the facts are: 1) a significant amount of clients come to
psychotherapists with the claim that they are struggling with HIPA, 2)
clinicians diagnose or treat said problem on a whim because it is not
listed in the DSM-V, therefore, it does not exist ‘officially’, and 3)
pathological gambling (PG) is the only process addiction listed as an
addiction disorder under the DSM-V, while other process addictions
(e.g., HIPA, food, sex, shopping, etc.) are not included.
Crisis? What crisis?
Regarding these points: should said clients not be taken seriously
because the empirical research on the matter is inconclusive? Should
clinicians impose their values on their clients regarding healthy or
unhealthy IP use? For example, a sex-positive psychotherapist may not
view HIPA as a problem. Why should PG be the only process addiction
included in the DSM-V when in the case of PG the reward is money,
while in the case of HIPA the reward is an orgasm? The difference
between both process addictions as far as the DSM is concerned has
more to do with sociocultural and politico-economic biases than
science, according to Hilton (2013); to him, we are experiencing a
paradigmatic crisis in the Kuhnian sense because there is a disconnect
between what he dubs the DSM’s atheoretical and behavioralist
approach and the latest findings in neuroscience.
Introduction | Statement
 I want to explore the perceived negative effects of
using Internet pornography*—specifically, videos—,
as experienced by the user, on the user’s
relationship with their significant other, particularly if
said user identifies herself as struggling with High-
Speed Internet Pornography Addiction (HIPA).
• Operationally defined as: “Any kind of [online]
material aiming at creating or enhancing sexual
feelings or thoughts in the recipient [as opposed to
aesthetic ones] and, at the same time containing
explicit exposure and/or descriptions of the genitals,
and clear and explicit sexual acts” (quoted in Short
et al., 2012).
Introduction | Purpose
The focus of the project is to the explicate the
perceived (negative) effects of HIPA on the
addict’s relationship with their significant other,
as reported by them—which is understood as a
specific experience of suffering. I hope that this
particular phenomenology of HIPA will add to
our understanding of the phenomenon as a
whole—be it a problem (i.e., addiction or
compulsion), a symptom of another problem or a
combination of problems (i.e., comorbidity), or
even a non-problem.
Literature Review | Methods
 Research articles directly related to HIPA from the last ten
years or more—found mainly through the GeorgiA LIbrary
LEarning Online (GALILEO)—will be reviewed critically. The
current psychological knowledge on the topic will be
established followed by a description of the limitations of
these studies.
 To understand the history and theories of addiction,
articles and books indirectly related to HIPA will be
considered, such as literature related to Internet and sex
addiction, or addiction in general, and more broadly,
literature related to: sexuality, love, relationships,
pornography, and masturbation. A holistic approach will
be adopted to understand the phenomenon from
different perspectives and levels: biologically (e.g.,
neuroscience), psychologically (e.g., depth psychology),
socially (e.g., critical theory), and spiritually (e.g., Buddhist
psychology).
LR | Methods (cont’d)
 There is a new journal published by Routledge called Porn
Studies, which will be one I will try to publish in. Other
relevant journals I will be looking at include but are not
limited to: Current Sexual Health Reports, Sexual Addiction
& Compulsivity, Addiction Research and Theory,
Cyberpsychology, Behavior, and Social Networking.
 My research will not address offline pornography or other
forms of cybersexuality other than online pornographic
videos (e.g., Internet chat rooms). The study will not
explore the ethics or legality of IP—which has been a
major public concern in the United States for decades—,
but rather the psychology of IP. I will primarily deal with
the qualia of HIPA, and so quantitative studies will mostly
be referenced in the literature review section, but no
quantitative research method will be employed.
LR | Aim
 In my literature review section, I will attempt to
establish the current knowledge on HIPA, and
highlight the areas that have not yet been explored
or that are contentious. Then I will follow that up
with a rich historical and theoretical survey related
to addiction, sexuality, pornography, love,
relationships, the Internet, etc., from neuroscientific,
depth psychological, critical, and Buddhist
perspectives among others. The aim will be to
create an integral bricolage that speaks to the
complexity of the phenomenon, and that will honor
some of the multiple interpretations that will ensue
as a result of my intersubjective investigation.
A critical review of the research
done on HIPA in the last 10+
years
3 theoretical papers (two take on a
neuroscientific perspective and one takes on a
sex-positive one)
2 clinical studies
1 quantitative research
2 comprehensive literature reviews
General Problems with the
Studies
Lack of an operational definition
Methodological diversity (e.g., lack of a standard
screening test for HIPA)
Most of the studies are quantitative
The near impossibility of studying HIPA empirically
—where do you find participants who have
never used IP?
Most of the studies were done in the West,
particularly on males
Methodology
 On a metalevel, I am inspired by an integral or
holistic paradigm that will allow me to explore the
biopsychsociospiritual dimensions of the
phenomenon I am investigating. My hope is that in
the research process, I will let the data guide me as
I switch back and forth between these different
dimensions. If I cannot honor them all equally in the
end, I will explain why I chose to highlight one more
than another. I cannot deny that I have specific
theoretical inclinations (e.g., depth and Buddhist
psychologies), which can be conceived of as
biases, but a bias is not necessarily a bag thing. If I
have one main bias in this project, it is to the
suffering experienced by my participants as a result
of IP dependence.
Methodology (cont’d)
Having mentioned my theoretical paradigm, the
data will be collected and analyzed using the
descriptive phenomenological (DP) method
developed by Amedeo Giorgi. I am considering
using a screening test as part of my filtering
process, but I have not made up my mind yet
and I still have not come across a specific test I
would use. Also, using a screening test, which is
usually used in quantitative studies, might be
against the ethos of the kind of qualitative
research I want to do.
Meth. | Population
 The population I am interested in is adults (18+) who claim
to be struggling with HIPA and who are in a relationship
with a significant other, so I can find out about the
perceived negative effects of HIPA on said relationship.
 My instinct is to focus on males, since they suffer from this
problem more than females according to most studies;
however, I am considering not limiting the population to
one gender. Nevertheless, given that I am a male
researcher, I feel like I would have a better intuitive
understanding of the experience of male participants.
 I will be looking for participants in the United States
regardless of their socioeconomic status or ethnicity. I still
have not decided on the number of participants I want to
interview. I am also considering whether or not I should
interview not only the IP user but also their significant
other.
Discussion
Future studies on HIPA could qualitatively investigate the experience
of IP users who are in minority groups and who are irreligious to
challenge any previous normative studies, be they heterosexist or
androcentric, and to also challenge the argument that the basis for
the concept of pornography addiction is moral. Additionally, cross-
cultural studies would shine a light on the universality and/or
particularity of HIPA as a problem. Other issues that ought to be
investigated would include: motivation (i.e., IP use as a substitute for or
improvement of embodied sex), comorbidity (i.e., HIPA as a
secondary disorder or as a symptom of some other primary disorder),
HIPA vis-à-vis other addictions, biopsychosociospiritual factors, HIPA
vis-à-vis trauma and sexual abuse, gender differences, and the
liberating potential of the Internet when it comes to sexual identity
and expression.
Discussion (cont’d)
To include or not to include: if HIPA is to be included as an addiction
disorder in future DSM publications, there is the undeniable risk of
overdiagnosis, pathologizing healthy IP use.
There is also no question that there are manipulative therapists out
there who are exploiting their clients based on this hyped
phenomenon. Which is one more reason why there needs to be more
research and understanding in this area.
Nevertheless, the inclusion of HIPA in the DSM could also be of benefit
to many of those who are struggling with HIPA, particularly because:
their problem would have a diagnosis and a guideline for treatment
that would, most importantly, be covered by health insurance
companies.

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An "Internet Pornography Addict" Walks Into A Clinic...

  • 1. An Internet Pornography Addict Walks Into A Clinic… Robert Beshara
  • 2. So what do you do as a clinician? Do you ignore the problem, saying: it does not exist? How do you diagnose and treat said client? Clearly, each clinician will deal with this problem in a different way. Is that helpful? If applicable, what is the significant other’s role in this scenario?
  • 3. Why this topic? Don Jon (2013)
  • 4. Why this topic (cont’d) Porn on the Brain (2013)
  • 5. “Pornography addiction” is a meme From one Google search, you will find many articles, books, and websites addressing the topic in some shape or form. Is it media circus or more?  I am interested in the experience of people who claim to be struggling with High-speed Internet Pornography Addiction (HIPA), particularly what they perceive to be detrimental consequences on them both personally and interpersonally.
  • 6. The basics  High-speed Internet Pornography Addiction (HIPA) is a modified version of a term popularized by retired anatomy and physiology teacher, Gary Wilson (2013)—of yourbrainonporn.com  Traditionally, users chiefly consumed pornographic films via purchasing or renting them from sex shops, or viewing them in adult movie theatres; however, Internet pornography (IP) is a unique phenomenon-- set apart from traditional pornography and closely tied to the development of broadband (c. 2000)-- mainly because of what Cooper (1998) foresaw as the “Triple-A Engine” effect of accessibility, affordability, and anonymity.
  • 8. The basics (cont’d) Pornography is a loaded word, but etymologically: “The word pornography, derived from the Greek porni (“prostitute”) and graphein (“to write”), was originally defined as any work [...] depicting the life of prostitutes” (“pornography”, 2014). The technological novelty afforded by broadband, among other factors, has contributed to the addictive potential of IP, and hence, its detrimental consequences on certain vulnerable users (see Ford, Durtschi, & Franklin, 2012; Hilton, 2013; Levin, Lillis, & Hayes, 2012; Shorrock, 2012).
  • 9. Alternatives to the addiction model Alternatives to the addiction model, broadly include viewing IP use: as a form of compulsion (see Griffiths, 2012), or as a non-pathological high-frequency viewing of “visual sexual stimuli” (Ley, Prause, & Finn, 2014). The distinction between healthy and unhealthy IP use could be entirely subjective, but one way of differentiating between both could involve an assessment by the user of the positive, neutral, or negative consequences of IP use on them personally and interpersonally, especially in the long run.
  • 10. Addiction vs. compulsion  Pleasure: “While people who have addictions suffer all manner of discomforts, the desire to use the substance or engage in the behavior is based on the expectation that it will be pleasurable. In contrast, someone who experiences a compulsion as part of [OCD] may not get any pleasure from the behavior he carries out. Often, it is a way of dealing with the obsessive part of the disorder, resulting in a feeling of relief” (Hartney, 2011).  Reality: “When people have obsessive-compulsive disorder, they are usually aware that their obsession is not real. They are often disturbed by feeling the need to carry out a behavior that defies logic, yet they do it anyway to relieve their anxiety. In contrast, people with addictions are often quite detached from the senselessness of their actions, feeling that they are just having a good time, and that other concerns aren’t that important. This is often known as denial because the addicted person denies that his use or behavior is a problem” (Hartney, 2011).
  • 11. My understanding of addiction Addiction in the context of this paper is informed by two things: the American Society of Addiction Medicine’s (ASAM) definition of addiction as “characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response” (“Definition of Addiction”, n.d.), and the use-abuse-dependence continuum.
  • 13. What’s at stake? How do we reconcile with the fact that many clients in psychotherapy claim to be struggling personally and interpersonally with the negative consequences of HIPA? According to Ley et al. (2014), the group who is against the IP addiction model, 0.58% of men and 0.43% of women in the USA claim to be struggling with said problem.  These statistics seem insignificant at first sight; however, in a country of more than 313 million, this amounts to approximately 1.8 million men and 1.3 million women struggling with HIPA, or 3.1 million in total.
  • 14. What’s at stake? (cont’d) Since HIPA is not listed as a disorder in the DSM-V, should it be disregarded by psychotherapists? Or should each psychotherapist deal with this undiagnosed phenomenon in their own way? The proposition here is not for some kind of generic standardization regarding HIPA and/or the pathologizing of IP use in general, which would undoubtedly be oppressive. Rather, the facts are: 1) a significant amount of clients come to psychotherapists with the claim that they are struggling with HIPA, 2) clinicians diagnose or treat said problem on a whim because it is not listed in the DSM-V, therefore, it does not exist ‘officially’, and 3) pathological gambling (PG) is the only process addiction listed as an addiction disorder under the DSM-V, while other process addictions (e.g., HIPA, food, sex, shopping, etc.) are not included.
  • 15. Crisis? What crisis? Regarding these points: should said clients not be taken seriously because the empirical research on the matter is inconclusive? Should clinicians impose their values on their clients regarding healthy or unhealthy IP use? For example, a sex-positive psychotherapist may not view HIPA as a problem. Why should PG be the only process addiction included in the DSM-V when in the case of PG the reward is money, while in the case of HIPA the reward is an orgasm? The difference between both process addictions as far as the DSM is concerned has more to do with sociocultural and politico-economic biases than science, according to Hilton (2013); to him, we are experiencing a paradigmatic crisis in the Kuhnian sense because there is a disconnect between what he dubs the DSM’s atheoretical and behavioralist approach and the latest findings in neuroscience.
  • 16. Introduction | Statement  I want to explore the perceived negative effects of using Internet pornography*—specifically, videos—, as experienced by the user, on the user’s relationship with their significant other, particularly if said user identifies herself as struggling with High- Speed Internet Pornography Addiction (HIPA). • Operationally defined as: “Any kind of [online] material aiming at creating or enhancing sexual feelings or thoughts in the recipient [as opposed to aesthetic ones] and, at the same time containing explicit exposure and/or descriptions of the genitals, and clear and explicit sexual acts” (quoted in Short et al., 2012).
  • 17. Introduction | Purpose The focus of the project is to the explicate the perceived (negative) effects of HIPA on the addict’s relationship with their significant other, as reported by them—which is understood as a specific experience of suffering. I hope that this particular phenomenology of HIPA will add to our understanding of the phenomenon as a whole—be it a problem (i.e., addiction or compulsion), a symptom of another problem or a combination of problems (i.e., comorbidity), or even a non-problem.
  • 18. Literature Review | Methods  Research articles directly related to HIPA from the last ten years or more—found mainly through the GeorgiA LIbrary LEarning Online (GALILEO)—will be reviewed critically. The current psychological knowledge on the topic will be established followed by a description of the limitations of these studies.  To understand the history and theories of addiction, articles and books indirectly related to HIPA will be considered, such as literature related to Internet and sex addiction, or addiction in general, and more broadly, literature related to: sexuality, love, relationships, pornography, and masturbation. A holistic approach will be adopted to understand the phenomenon from different perspectives and levels: biologically (e.g., neuroscience), psychologically (e.g., depth psychology), socially (e.g., critical theory), and spiritually (e.g., Buddhist psychology).
  • 19. LR | Methods (cont’d)  There is a new journal published by Routledge called Porn Studies, which will be one I will try to publish in. Other relevant journals I will be looking at include but are not limited to: Current Sexual Health Reports, Sexual Addiction & Compulsivity, Addiction Research and Theory, Cyberpsychology, Behavior, and Social Networking.  My research will not address offline pornography or other forms of cybersexuality other than online pornographic videos (e.g., Internet chat rooms). The study will not explore the ethics or legality of IP—which has been a major public concern in the United States for decades—, but rather the psychology of IP. I will primarily deal with the qualia of HIPA, and so quantitative studies will mostly be referenced in the literature review section, but no quantitative research method will be employed.
  • 20. LR | Aim  In my literature review section, I will attempt to establish the current knowledge on HIPA, and highlight the areas that have not yet been explored or that are contentious. Then I will follow that up with a rich historical and theoretical survey related to addiction, sexuality, pornography, love, relationships, the Internet, etc., from neuroscientific, depth psychological, critical, and Buddhist perspectives among others. The aim will be to create an integral bricolage that speaks to the complexity of the phenomenon, and that will honor some of the multiple interpretations that will ensue as a result of my intersubjective investigation.
  • 21. A critical review of the research done on HIPA in the last 10+ years 3 theoretical papers (two take on a neuroscientific perspective and one takes on a sex-positive one) 2 clinical studies 1 quantitative research 2 comprehensive literature reviews
  • 22. General Problems with the Studies Lack of an operational definition Methodological diversity (e.g., lack of a standard screening test for HIPA) Most of the studies are quantitative The near impossibility of studying HIPA empirically —where do you find participants who have never used IP? Most of the studies were done in the West, particularly on males
  • 23. Methodology  On a metalevel, I am inspired by an integral or holistic paradigm that will allow me to explore the biopsychsociospiritual dimensions of the phenomenon I am investigating. My hope is that in the research process, I will let the data guide me as I switch back and forth between these different dimensions. If I cannot honor them all equally in the end, I will explain why I chose to highlight one more than another. I cannot deny that I have specific theoretical inclinations (e.g., depth and Buddhist psychologies), which can be conceived of as biases, but a bias is not necessarily a bag thing. If I have one main bias in this project, it is to the suffering experienced by my participants as a result of IP dependence.
  • 24. Methodology (cont’d) Having mentioned my theoretical paradigm, the data will be collected and analyzed using the descriptive phenomenological (DP) method developed by Amedeo Giorgi. I am considering using a screening test as part of my filtering process, but I have not made up my mind yet and I still have not come across a specific test I would use. Also, using a screening test, which is usually used in quantitative studies, might be against the ethos of the kind of qualitative research I want to do.
  • 25. Meth. | Population  The population I am interested in is adults (18+) who claim to be struggling with HIPA and who are in a relationship with a significant other, so I can find out about the perceived negative effects of HIPA on said relationship.  My instinct is to focus on males, since they suffer from this problem more than females according to most studies; however, I am considering not limiting the population to one gender. Nevertheless, given that I am a male researcher, I feel like I would have a better intuitive understanding of the experience of male participants.  I will be looking for participants in the United States regardless of their socioeconomic status or ethnicity. I still have not decided on the number of participants I want to interview. I am also considering whether or not I should interview not only the IP user but also their significant other.
  • 26. Discussion Future studies on HIPA could qualitatively investigate the experience of IP users who are in minority groups and who are irreligious to challenge any previous normative studies, be they heterosexist or androcentric, and to also challenge the argument that the basis for the concept of pornography addiction is moral. Additionally, cross- cultural studies would shine a light on the universality and/or particularity of HIPA as a problem. Other issues that ought to be investigated would include: motivation (i.e., IP use as a substitute for or improvement of embodied sex), comorbidity (i.e., HIPA as a secondary disorder or as a symptom of some other primary disorder), HIPA vis-à-vis other addictions, biopsychosociospiritual factors, HIPA vis-à-vis trauma and sexual abuse, gender differences, and the liberating potential of the Internet when it comes to sexual identity and expression.
  • 27. Discussion (cont’d) To include or not to include: if HIPA is to be included as an addiction disorder in future DSM publications, there is the undeniable risk of overdiagnosis, pathologizing healthy IP use. There is also no question that there are manipulative therapists out there who are exploiting their clients based on this hyped phenomenon. Which is one more reason why there needs to be more research and understanding in this area. Nevertheless, the inclusion of HIPA in the DSM could also be of benefit to many of those who are struggling with HIPA, particularly because: their problem would have a diagnosis and a guideline for treatment that would, most importantly, be covered by health insurance companies.