Castimonia

A few years ago, I was sitting in front of my class of graduate students in a therapy training program when one of the students was describing some difficulty he was having with a case diagnostically coded in the DSM-5 (basically the diagnostic bible for mental health), but with a relatively rare prevalence. It made treatment trickier than some of the more common presentations assigned to the rest of his cohort.

Trying to empathize, I said that I could remember almost three decades earlier when I was assigned the only pornography case in the clinic, which was also associated with other paraphilic behaviors identified in the DSM-III-R (the version of the DSM at that time—which has since been altered to exclude any reference to sexual addiction). I added that as an early 20-something female, I had a “why me,” attitude when the intake staff informed me that they specifically wanted me to take the case so the male would have a real-life experience with a female instead of objectifying females in images.

The disbelief in the room was palpable. It took me a minute to decipher the incredulous stares boring into me from around the table. Suddenly, it clicked, “Oh,” I recognized, “You’re all thinking I can’t be telling the truth because you can’t imagine a time when couples weren’t bringing compulsive pornography use in as a problem at least 50% of the time, right?” “Yeah,” one student confirmed, “What do you mean you had the ONLY case of compulsive porn use?”

I knew it was the only case back then because the intake staff had driven the point home, explaining why they wanted me to agree to take it. “Well,” I continued, “Who in here is aware that Gambling Disorder is in the DSM?” All the hands went up. “OK, now, who in here is treating a gambling disorder case right now?” No hands went up. “So, you know it exists as a clinical presentation, but no one in here has that type of case. Well, that’s what compulsive pornography use was like before the internet.”

As I said the words out loud, a wave of nostalgia flooded my system. After watching the proliferation of compulsive pornography use through the decades, I longed for a return to the 80’s. I had anecdotally seen a shift in how pornography was impacting marriages, in a way the larger mental health community refused to openly acknowledge because the research was lagging and qualitative processes are always difficult to measure. Besides that, pornography covers such a broad range of materials and behaviors that trying to conceptualize it to regulate it is problematic when it’s viewed as normative and acceptable in varying degrees by a large percentage of the population. Another problem diagnostic professionals face is where to draw the line when pathologizing a natural biological human drive (except the DSM has an entire section on eating disorders, including binge eating–so…….).

However, regardless of whether pornography use is mentioned in the DSM, or whether it is officially an “addiction,” or not, it is showing up in couples’ therapy sessions in record numbers, and NOT just in religious populations. I tire of conservative religions taking the heat for sexual problems when the broader cultural messages and displays of sexuality are at least as much or more complicit in contributing to constraining sexual scripts for both males and females, which exacerbate disconnection in couples. In fact, research is verifying a clear decrease in religious beliefs and behaviors in general, so any increases in couples’ sexual challenges don’t seem to be correlated with increased religiosity (not to mention the fact that research also shows that higher rates of religiosity are significantly correlated with lower rates of pornography consumption).

The fact is that most media presentations of sexuality are dramatized and dichotomized in a way that denies the more complex and incremental ranges that exist for most people.Authentic displays about the emotional processes inherent to sexual intimacy are mostly absent at the societal level. Healthy relationship models of sexuality are nearly non-existent.

In my clinical opinion, many of the problems that come up with porn use in marriage have less to do with religious imperatives and more to do with attachment processes in long-term monogamous relationships. Sexuality is an expected part of a long-term monogamous romantic attachment, and is generally laden with special meaning. An expectation of sexual fidelity is normative in marriage. While some people report that porn can be beneficial to creating an erotic climate, or increasing comfort with sex, there are many partners who view it as betrayal and it makes them question whether they are loved or not.

Even in instances of consensual polyamory, attachment processes come into play in often unanticipated ways. I once attended a training with marriage researcher Dr. John Gottman in which he was questioned about long-term research related to polyamory, and he replied that his institute had problems gaining longitudinal research on those couples because they weren’t stable enough; in other words, too many of them ended their relationships to provide enough reliable data, implying that the lifestyle isn’t necessarily tenable for long-term couple relationships. Whenever I have treated polyamorous couples in therapy (which is admittedly not a lot), it is also my experience that they might agree to the arrangement but then struggle with emotions that arise when attachment security and a sense of “specialness,” to their partners are questioned. They start worrying that their partners will start caring about someone else more, and it often creates emotional pain for which they are unprepared. When many engage in the process, they report that it wasn’t “just sex,” like they thought it would be–there was emotional meaning attached.

Religious or not, many couples are displaying clinical challenges related to increased pornography use. After seeing hundreds of couples as a clinician and as a supervisor to therapists, if I said otherwise, it would be a lie. There are some anecdotally discernible differences in couples now compared to three decades ago, directly related to pornography. Now, research is emerging verifying the clinical challenges I have witnessed for some time.

Here is a short summary of what some of the research indicates about pornography use and its impact on marriage and other long-term romantic relationships, and which I have also seen clinically.

1. Male pornography use is correlated with lower sexual satisfaction for both the porn users and their partners(and sexual satisfaction is highly correlated with overall relationship satisfaction, so relationship happiness is likely collaterally impacted through this pathway).
2. Some studies have shown that male porn use is associated with lower interest in relational sex, and lower satisfaction with sexual partners.
3. In some studies, porn use was related to weakened commitment to romantic partners (as measured by both self-report and outward observation).
4. Porn use is associated with higher rates of extra-relationship flirtation, considering alternative partners, and infidelity.
5. Women whose spouses use porn report lower self-esteem and increased insecurity about physical appearance.
6. Some studies show that higher porn use is related to higher divorce and infidelity.
7. Some research shows an association between higher porn use and less global happiness.
8. Recent longitudinal research (2017) shows that higher rates of porn use are associated with decreased marital quality OVER TIME (this matters, because most of the research is cross-sectional, so cause and effect can’t be determined).
9. Females whose partners use porn report decreased attraction for their partners and more damaged senses of self.
10. Increased porn use is sometimes associated with a negative impact on financial well-being and work productivity, which impacts relationships.

It’s important to note that men use pornography at a higher rate than females. The research has demonstrated some subtle differences among gender. It seems that female use doesn’t necessarily have the deleterious impact on marriage that male use has, which could be that females use porn more frequently in a relational context while men use it more individually, or that the fewer females users don’t provide enough statistical power to show significant associations.

Also, most porn research has been cross-sectional, self-report, which can be biased, and with limited sample sizes, so generalizability is limited. Longitudinal research that is finally emerging is demonstrated more causality between porn use and decreased relationship quality.

What have I seen clinically?

For what it’s worth, as a clinician, I have seen several changes in couples that I believe have arisen from increased porn use. I’m just one clinician, but in my conversations with other couples’ clinicians, they are verifying these shifts as well:

1. More instances of low relationship sexual desire in porn-viewing males and females married to porn-viewing males. I was learning sex therapy back in 1989-1990, and fewer instances of low male desire in young adults appeared clinically than now.
2. More instances of male erectile dysfunction. I used to see this presentation almost exclusively in older males or those with a health condition. Now, I see it in young men with no known medical conditions, but with high rates of porn use.
3. More instances of lower sexual quality reported for males and females. 
4. More instances of males blaming their inabilities to perform on their partners’ appearances.
5. More instances of wives’ unwillingness to engage in sexual experiences, often because they don’t want to be compared to pornography. In general, sexual safety is diminished.
6. More women reporting what looks like a type of porn betrayal trauma in which they can’t safely engage in sex because images of what their partners may have been viewing flash in their heads.
7. More women reporting inability to engage sexually because of increased self-monitoring about their own bodies, after feeling compared to pornography.
8. More women reporting feeling manipulated into sexual behaviors with which they are uncomfortable, reportedly introduced by pornography.
9. Seeming lower relational sex frequency. Again, I don’t have research numbers on this–it’s just a clinical impression. It seems like couples are having less relational sex in part because porn users are having sex by themselves with porn.

In many ways, sex therapy was easier back in the early 1990’s. I actually had an easier time getting females to engage in sex therapy exercises because to them, collaboration didn’t feel like competing with supernormal images.

One of the biggest indicators that pornography is a problem appeared via an open letter on pornography posted by Dr. John Gottman, viewable here. He is a gold star researcher. Like many clinicians, he used to support couple porn use for upregulating desire and sexual quality. This letter explains how he has shifted his position because the supernormal images presented in porn have a negative impact, as well as increased portrayals of violence toward women.

Anyone who says pornography isn’t having a negative impact overall on long-term marriage is either lying, ignorant, or in denial.

Some of the studies including for this post are listed below, and the abstracts are easy to find online for anyone interested. There are many resources available for people who want to decrease porn use, or feel betrayed and injured by partners who use porn. Patrick Carnes and his daughter, Stefanie Carnes, have worked extensively in this area. I recommend both authors’ books to couples who want to deal with compulsive pornography use.

References:

A Love That Doesn’t Last: Pornography Consumption and Weakened Commitment to One’s Romantic Partner (2012) by Lambert, N. M., Negash, S., Stillman, T., Olmstead, S. B. & Fincham, F. D. in Journal of Social and Clinical Psychology, 31(4), 410-438.

Does Viewing Pornography Reduce Marital Quality Over Time? Evidence from Longitudinal Data (2017), Perry, S. L. in Archives of Sexual Behavior, 46(2), 549-559.

Pornography and Marriage (2014) by Doran, K. & Price, J. in Journal of Family and Economic Issues, 35:489-498.

Pornography Use: Who Uses It and How It Is Associated with Couple Outcomes (2013), Poulsen, F. O., Busby, D. M. & Galovan, A. M. in Journal of Sex Research, 50(1), 72-83.

Photo credit: Copyright: georgemuresan / 123RF Stock Photo