The Wages of Sexual-Addiction Politics

Did addiction politics leave us stranded on a slippery slope?

Ever wonder why the brains of pathological gamblers, food addicts and video-game addicts have been studied, yet no one has studied the brains of porn addicts? We’ve certainly wondered—especially as one often hears the claim that the absence of studies is “proof” that porn addiction/sex addiction is a myth (even though clients and patients are increasingly complaining of being hooked on both).

Recently, we learned why brain-science research on porn and sex addiction is practically nonexistent. This fascinating bit of history also revealed the origins of the familiar assertion that sex and porn can never become addictive—and suggests we’ve lost our way.

In 1992, a political skirmish took place in the field of medicine, which has discouraged deeper understanding of human sexuality. According to David E. Smith MD, past president of the American Society of Addiction Medicine (ASAM), doctors bartered away the recognition of sex addiction as a pathology in order to address a more immediate risk. Smith, by the way, founded the free Haight-Ashbury medical clinic in San Francisco during the Summer of Love (1967). He has worked tirelessly ever since both to educate the medical profession about the plastic brain changes behind addiction and recovery and to treat addicted patients. He is the author of numerous books and journal articles.

According to Smith, here’s what happened: Jess Browley and he were the Delegate and Alternate Delegate, respectively, to the American Medical Association’s House of Delegates in search of endorsement of a new specialty: addiction medicine. It became clear that the AMA wouldn’t agree to approve the new specialty unless sex was excluded from the list of possible addictions. So, they tossed ‘sex addiction’ under the bus.

This exclusion was not based on science or Smith’s own clinical experience—both of which suggested that sexual behaviors indeed have the potential to become addictions under some circumstances. This is hardly surprising, as sexual arousal is the most compelling of all natural rewards and it arises in the brain’s reward circuitry (seat of all addiction).

The  reason was strategic. Doctors were bent on snuffing out the tobacco manufacturers’ spin. Big Tobacco was pulling out all the stops to prolong the illusion that “smoking is not addictive.” It claimed that the addiction experts’ evidence should be ignored because, “the experts are saying everything’s addictive.”

Excluding sex demonstrated that doctors weren’t saying everything is addictive. Besides, sex addicts were rare, while smokers were everywhere and suffering unnecessarily. Moreover, behavioral addiction brain science hadn’t reached today’s levels of reliability and conclusiveness.

Unforeseen repercussions

Carving sexual behaviors out of the addiction field has had perilous repercussions. Nearly two decades after experts extinguished the Smoke Spin, beginning with the tobacco papers published in the Journal of the American Medical Association (1994), we’re still in the Dark Ages of understanding sexuality.

The ASAM-AMA deal inadvertently shielded sexual addiction from the inquisitive eyes of the very medical researchers who could have shed the most light on sexual excess: neurobiologists. Why study something which, by medical fiat, does not exist? Therefore, there has been almost no direct investigation into the neurobiology of sexual excess. (In contrast, many studies confirm the existence addiction-related brain changes in other behavioral addicts.)

Instead, medical research has focused almost entirely on hyposexuality (lack of sexual responsiveness). Accordingly, we have sexual enhancement drugs and medically-prescribed vibrators and erotica. Doctors are even testing orgasm-producing implants for women’s spines.

Yet if a patient complains of inability to control behavior, porn tastes morphing in unsettling ways, or the need for increasing sexual stimulation—many a therapist will assure him that hypersexuality doesn’t exist. This is true even if he self-identifies as an addict. One academic sexologist proudly recounted that he told a guy masturbating to Internet porn for six hours per day that he didn’t have an addiction, but rather a procrastination problem. It’s theoretically possible, but….

Therapists who courageously point out that hypersexuality can lead to addiction, and attempt to treat clients accordingly, are either dismissed or shamed by their more dogmatic peers. In keeping with this mindset, the authors of the upcoming DSM-5 intend to banish the section on hypersexuality to the appendix.

Such tunnel vision is due, in part, to the historic pact discussed above. A generation of textbooks claims that (1) sexual repression is the prime threat to healthy sexuality, and (2) sexual behaviors cannot cause addiction. Academic training has not yet caught up with the radical changes of highspeed Internet and brain research on behavioral addicts.

For example, we asked a psychology professor and sex researcher what he thought about news of an Italian survey ordered by urologists, which confirmed what we’ve seen reported in hundreds of forum threads across 25 countries—namely that young, heavy porn users are developing erectile dysfunction, which reverses itself within months of stopping porn use. He scoffed at the possibility of excessive consumption of porn causing desensitization (an addiction-related brain change):

Why are so many silly news stories generated on this topic?  Hmm, does it represent excessive concern about something that doesn’t exist, like excessive concern about unicorns?

His response is comprehensible. After all, he has probably been drilling into his students for years the unexamined assumption that sexual behaviors, including Internet porn use, can never cause addiction processes in the brain. Since this position is not supported by actual brain science, circular explanations are common: “Internet porn is a masturbation aid…and there can be no such thing as too much masturbation (because sex can never be an addiction)… so there can be no such thing as too much porn use.”

Medical doctors recently began to close the knowledge gap. In The Brain That Changes Itself, psychiatrist Norman Doidge explained the brain plasticity principles behind the decreased sexual responsiveness in his heavy porn-using patients (and its reversibility). Yet most doctors who are not neuroscience specialists still hark back to their days of Penthouse use and continue to view Internet porn use as a harmless extension. They seem unaware that today’s porn delivers far more addiction-producing neurochemical stimulation to the brain than static porn of the past, that brain scans of Internet addicts are already revealing standard addiction-related brain changes, or that today’s kids are using Internet porn extensively while their brains are uniquely plastic. The latter is particularly disturbing given recent research suggesting that starting sex during adolescence can have lasting negative effects on both body and mood well into adulthood.

Also underlying the dismissive attitude of many experts is the assumption that, “Sex can’t become an addiction because people will stop when they’ve had enough orgasm.” Experts once assumed that this was true of highly palatable food, too, but we Americans have proved them dead wrong. Human neural satiation mechanisms appear to be set up for the kinds of food and sexual stimuli we evolved with. Today’s superstimulating junk food and ever-novel cyber erotica are enticing enough to override natural satiety programming in many of us. Moreover, Internet porn use doesn’t require orgasm. Orgasm is a ten-second phenomenon; Internet porn watching often goes on for hours…at work, school, and other places where masturbation isn’t an option. Result? As with junk food, we can consume until we numb our responsiveness to normal pleasures—a hallmark of addiction.

Diagnostic dissonance

Meanwhile, scientific research on other behavioral addictions has marched on unhindered by the compromise that helped hog-tie tobacco lobbyists. Brain scans of the obese, as well as scans of gambling and video-gaming addicts, reveal genuine addiction-related brain changes.

The symptoms that correlate with brain changes in these addictions are the very symptoms that many of today’s porn users have in abundance: inability to control use, severe cravings, tolerance (escalation), decreasing sexual responsiveness, concentration problems, depression, unhealthy desire to isolate, anxiety, severe withdrawal symptoms upon quitting, and so forth. Many of them also report that these symptoms reverse themselves within months of quitting Internet porn.

Meanwhile, what happens if a patient can’t stop self-destructive sexual behaviors, and seeks professional help? In many cases, the patient is presumed to suffer from some illness other than a sexual addiction. That’s right. The healthcare practitioner selects a different primary, or causal, illness—and refers him for counseling, psychotropic drugs, or both.

The assumption that sexual-behavior addiction is strictly a symptom of some other primary illness produces misleading diagnoses for those wrestling with addiction-related brain changes. These include performance anxiety, ADHD, OCD, depression, severe social anxiety, erectile dysfunction, performance anxiety (with one’s hand?), and so forth. Worse yet, the addicted patient is not informed that he may be able to reverse his symptoms by enduring withdrawal and changing behavior. Brain plasticity works both ways.

Researchers know from other behavioral addictions that the symptoms on which such other diagnoses rest can often be a function of addiction itself (anhedonia, concentration problems, severe anxiety, etc.). Seizing upon another diagnosis instead of educating the client/patient about addiction is the equivalent telling a patient with a broken leg to take pain pills instead of prescribing immobilization of the leg and use of crutches.

Of course, some patients do actually have these other illnesses and conditions in lieu of, or in addition to, self-destructive sexual behavior. But if they do not, and sexual addiction itself is the prime cause of their woes, the doctor often ignores that fact. S/he has been trained not to consider sexual-behavior addiction as a possible primary illness.

Alas, the assumption that other addictions can be primary, but sexual-behavior addiction cannot, is a biological impossibility. Only by excluding sex from the field of addiction research for decades could we fool ourselves into believing otherwise.

In any case, the presence of other conditions do not make an addiction less of an addiction. An alcoholic with social anxiety still has to deal with alcoholism, and an obese person still has to deal with compulsive eating…and that extra 200 pounds. Both need help changing their behavior to rewire their brains.

A new era for human sexuality

In August of this year (2011) a mighty sea-change began. The omission of sexual behavior as a possible addiction was corrected—not by the AMA, but by ASAM. In the FAQs relating to its recent public announcement, ASAM explains that,

We all have the brain reward circuitry that makes food and sex rewarding. In fact, this is a survival mechanism. In a healthy brain, these rewards have feedback mechanisms for satiety or ‘enough.’ In someone with addiction, the circuitry becomes dysfunctional such that the message to the individual becomes ‘more’, which leads to the pathological pursuit of rewards and/or relief through the use of substances and behaviors.

Thanks to advancements in behavioral addiction research, addiction experts and neurobiologists are now confident that sexual-behavior addictions are fundamentally the same as other addictions. It’s time to empower healthcare professionals to align with the reality that Internet porn/sex addicts may be suffering from the brain changes seen in other addicts. By bringing textbooks and protocols up to date, we free healthcare providers to steer us more directly toward healthy sexuality, and avert lawsuits brought by misdiagnosed porn addicts.

RethinkASAM’s statement is a great leap forward, but there’s a lot of catching up to do. Thanks to decades of blinders, researchers still have little idea what the brain chemistry of sexual balance looks like, or why it promotes wellbeing. The meme that excess is both normal and risk-free lingers, despite warning signs for men, women and adolescents.

Signs that the brain is developing addiction-related changes could soon be common knowledge, but as scientists study sex’s effects on the brain with more open minds, other interesting insights into human sexuality may come to light. For example, are changes associated with excess, even in milder forms, impairing our ability to enjoy long-term intimate relationships by speeding habituation between partners? What is the effect of regular attachment cues on partners’ brains?

Are we missing some important essentials about orgasm itself? For example, there’s evidence of hormonal and neurochemical ripples following orgasm, which would be well worth investigating further. Are men’s, women’s and adolescents‘ brains different in this regard? Do intercourse and masturbation produce different effects on the brain?

Neuroscience research could conceivably shed a lot more light on questions like these—now that the study of physiology of sexual excess is back in play.

The emperor isn’t wearing his thong

The historical ASAM-AMA pact inadvertently fostered an unhealthy meme:  “When it comes to sexual behaviors, including Internet porn use, there’s no such thing as too much or abnormal because sexual addiction is impossible.” It’s time to uproot this wishful thinking—without allowing the discussion to be polarized in superficial ways: “sex positive vs. sex negative,” “free speech vs. commandment” or “sexual diversity vs. heteronormative.” It’s not “sex positive” to discourage hard science on sex.

Instead of condemning or defending sexual behavior (promiscuity, porn content, sexual orientation, etc.), let’s focus on brain physiology: neurochemicals, receptors, frontal cortex alterations, striatal gray matter volume, and changes in limbic white matter, as has been done in Internet addiction, gambling and food addiction research.

Other countries are already hard at work investigating Internet addiction (which includes porn use in some countries). One group of researchers recently found that 18 percent of university students were hooked. Incidentally, the risk of Internet addiction in men was about three times that of women. They concluded:

A great percentage of youths in the population suffer from the adverse effects of Internet addiction. It is necessary for psychiatrists and psychologists to be aware of the mental problems caused by Internet addiction [such as OCD, anxiety, and depression].

Physiologically speaking, abnormal has nothing to do with the desirability or undesirability of a given behavior. It is strictly a function of brain/body imbalance. Some people can engage in lots of sexual (or other) stimulation with no harmful brain changes. Others cannot, and such behavior causes symptoms they find unsettling or intolerable. It’s really that simple.

It’s not what we do in the bedroom, in front of our computers, or in the bathhouse that matters. It’s how it affects our plastic brains. If someone’s brain happens to adapt quickly to intense stimulation, such that she needs more and more stimulation, or she shows other addiction-related symptoms, then the problem behavior is excessive for her. She has choices to make. This is no different from a man who doesn’t metabolize carbohydrates well. He must learn the effects of different diets on health.

When it comes to sexual behavior, there is such a thing as too much, and there is such a thing as abnormal. We can’t figure it out from any moral code, but our healthcare professionals can help us figure it out using the four Cs that indicate addiction-related brain changes:

  1. Loss of Control
  2. Compulsion
  3. Continued use despite adverse Consequences
  4. Cravings  – both psychological/physical

Never has humanity been better poised to understand its capacity for sexual balance and excess. The sexual-freedom genii has escaped the bottle for good. We can take a hard look at the effects of hypersexuality on the brain without fear of prudish reprisals. Let’s banish prior assumptions, sexual politics and slogans from sex research, and use all the new tools at our disposal to reveal a more complete understanding of human sexuality—its glories and its weak points.

Greater knowledge will empower those of us who love sex to steer for the results we choose while respecting our individual limitations. The alternative of continuing to underplay the peril of sexual-behavior addiction leaves us at risk for drowning in a sea of pharmaceuticals prescribed for secondary symptoms—while the primary cause of woe worsens, unacknowledged.

Decades ago we didn’t understand the science of addiction, but there’s no excuse for ignorance of addiction now.—David E. Smith, MD

Are You Hooked on Porn? Ask ASAM

AddictionLast month, 3000 doctors of the American Society for Addiction Medicine released a public statement bringing the definition of addiction into line with decades of addiction research. “[Addiction] is about brains…. It’s about underlying neurology, not outward actions,” explains ASAM’s Dr. Michael Miller.

ASAM’s definition captures the key elements of addiction described by NIDA head Nora Volkow, MD and her team in the review Addiction: Decreased Reward Sensitivity and Increased Expectation Sensitivity Conspire to Overwhelm the Brain’s Control Circuit Addiction behaviors are the consequence of measurable brain changes—and recovery entails reversing these changes. The telltale changes center around the reward circuitry of the brain: a numbed pleasure response, extreme sensitivity to addiction-related cues, and decrease in frontal-cortex function.

ASAM also affirms that sexual behaviors can be addictive:

We all have the brain reward circuitry that makes food and sex rewarding. In fact, this is a survival mechanism. In a healthy brain, these rewards have feedback mechanisms for satiety or ‘enough.’ In someone with addiction, the circuitry becomes dysfunctional such that the message to the individual becomes ‘more’, which leads to the pathological pursuit of rewards and/or relief through the use of substances and behaviors.

If you view porn, are you an addict or merely a user?

This question used to be a silly one for most porn users. Prior to the Internet, porn use (if any) bore some relation to authentic libido. When one had had enough, the magazine went back under the mattress. Internet porn, however, has the power to override natural satiety mechanisms in many brains. This increases the risk of the addiction-related brain changes ASAM addressed.

With respect to porn, it’s not time spent viewing or what you’re looking at that determines whether your brain has changed. Instead, watch for these signs:

  • Inability to abstain;
  • Impaired impulse control;
  • Cravings;
  • Diminished grasp of one’s problems; and
  • Problematic emotional responses. (Detailed ASAM list)

Curious how these telltale symptoms might show up in today’s porn users? We’ve culled the following questions from actual reports of self-identified porn addicts. Many users do not make the connection between their symptoms and their porn use until they abstain from porn for weeks, but these questions, and the remarks below them, may help you determine whether you need to seek help to reverse unwanted changes and restore your brain to balance.

  • Have you tried to stop using porn and failed? Did you notice withdrawal symptoms?
  • Do you experience intense cravings when you have no access to porn for several days?
  • When you use again do you notice rapid escalation to more extreme material?
  • Have you noticed changes in your sexual tastes?
    • Have you explored new types of porn in order to attain earlier levels of excitement?
    • Are you viewing things that never turned you on?
    • Are you using porn that does not match your sexual orientation?
  • Is porn viewing the most exciting thing in your life? Does life seem dull otherwise?
  • Do you feel powerless to stop yourself from using porn if you see or experience something you associate with porn use, such as:
    • being alone in the house,
    • seeing a TV show with your favorite fetish hinted at or portrayed,
    • seeing news about a favorite porn star?
  • Do you see potential mates differently—more as body parts than as people?
  • Since using Internet porn, do you feel more tongue-tied, unsafe, awkward or anxious around other people—especially potential mates?
  • Is it harder to connect with others? Do you feel lonelier? Are you more worried about what others think about you?
  • Have you (or those who care about you) noticed you:
    • procrastinate more than before using, have lower motivation (don’t care), chronic fatigue, brain-fog, or difficulty concentrating or remembering things?
    • have become more anxious, restless, impulsive, stressed, irritable, unhappy, pessimistic, emotionally numb, or depressed?
    • have become more secretive, or isolate more?
  • Have you noticed declines in your sexual function during sex: more rapid ejaculation (PE), inability to maintain an erection without self-stimulation, porn or porn fantasy (even if you can get rock-hard to porn), delayed ejaculation (or inability to orgasm), less satisfying orgasm, need the lights on during sex to get aroused, not turned on by attractive partner, no desire for sex?
  • Have you noticed declines in your sexual function during masturbation: unable to masturbate without porn or porn fantasy, need for more vigorous masturbation (“death grip,” faster strokes), weaker (or rapidly fading) erections, climaxing with a semi-erection, more frequent urination?
  • Since using Internet porn, do you feel like you’ve lost your “mojo,” or sex appeal? Do you doubt your attractiveness or feel more anxious about the dimensions/appearance of your genitals?
  • Does your voice feel more nervous, shallow, tight, or unnaturally high? Shallow breathing?
  • Have you masturbated to the point of abrasions or other physical damage?
  • Can you fall asleep without using porn? Do you have more trouble sleeping soundly through the night?
  • When under stress do you use more porn?
  • Do you have intrusive porn flashbacks?
  • Are you risking your job, education or relationship to watch porn, or spending too much money on it?
  • Have you lost a relationship or job, or dropped out of school due to your porn use (or symptoms related to it)?
  • After climaxing, do you notice more intense mood swings (irritability, depression, anxiety)?

These users have noticed symptoms that may indicate brain changes:

Juan: I’m 23. My family told me on numerous occasions I was a shell of myself compared to when I was 18 (in a loving way). My friends weren’t as direct with me, but it was clear. I wasn’t close to the same person. In only a few years of heavy porn use, I developed debilitating social anxiety, depression, lack of drive, physical exhaustion, mental exhaustion, couldn’t hold a job, couldn’t even walk down the university halls without feeling scared to death of people, felt creepy around females from young to old etc.

Greg: Every relapse to transsexual porn was my last one. (I’m straight.) Why was this material suddenly so enticing, in such a short time period? I was masturbating to material that disgusted me before, and would still disgust me after I orgasmed.

Ryan: I am afraid of binging if I use porn. I know from my recent experience that if I masturbate while watching porn, I do it continuously for days.

Davy: I had no concept that I was suffering from porn withdrawal. I had simply given up porn, as was my custom when dating a new girl. Apparently, I had never before reached this level of addiction. 90% of these symptoms were things I have NEVER experienced in my life. ALL of them have either been alleviated, or are significantly improved, by this point (13 days no porn/masturbation/orgasm).

  • Anxiety, chest tightness, panic attacks, high heart rate and blood pressure
  • Feelings of impending doom. Depression to the point of suicidal thoughts
  • Chronic Fatigue symptoms
  • Inability to take pleasure in anything whatsoever: eating, reading, watching a movie, playing music or creating artwork (I am a musician and an artist.)
  • Strange enjoyment of physical pain
  • Severe insomnia: total of about 18 hours of sleep over the course of three weeks
  • Increased urge to masturbate—up to 10 times in a day
  • Sexual fatigue, loss of libido, loss of interest in life, testicular and groin pain, but still a strong urge to masturbate (figure that one out)
  • ADD
  • Incoherent speech
  • Digestive problems
  • Headaches

Adrian: I never really knew how bad I was addicted until I tried to quit. I realize I can only get aroused with porn.

Tyrone: I have felt so emotionally numb for years now that I really feel like I have lost who I am. I don’t know what I feel about things. Nothing makes me happy/sad.

Ben: Had no idea I was addicted, which is funny considering I would spend hours a day in front of the computer watching increasingly novel video after video. If my Internet was running slowly and I couldn’t watch, I would go into rages and fits. I could do nothing else but wait until the video started again.

Tim: For about a month after giving up porn, I really couldn’t get hard enough to masturbate, and when I “forced” it my orgasms were pretty unsatisfying.

Will: I go all night until I’m exhausted, and then I go some more. I feel so tired the next day it’s unbelievable. I feel physically sick with body aches, a sore throat, red eyes, etc. It is very hard to focus on work. I stare at the computer screen, and forget what I am doing. Social anxiety is high after a relapse. I don’t want to be around anyone, and get irritated very easily. My body is extremely exhausted after a binge, but it is hard to fall asleep because my mind is worked up with anxiety. It’s like I’m only half there, just a shell of the man I could be. My voice is higher pitched, and sounds somewhat frail. I don’t even like looking in the mirror. Last time, there were a couple of girls interested in hanging out with me, but I got horribly stressed out at the thought of hanging out with them. I have zero libido after my masturbation marathon, and no desire to be around real women. All I feel is anxiety.

Kyle: I kinda just felt separate from everyone, and as a result would drink to excess in hopes of appearing more confident… Didn’t work LOL. Thing is, I used to be so confident and popular. I even saw a counselor about my ED, lack of confidence and social anxiety etc., but never was I asked about porn use.

Andrew: For a while at least, I always went back to the “tame” stuff in order to get off. There seemed to me something unseemly about getting off to something I was watching only out of a car crash rubber-necking, morbid curiosity. But then one day, I actually started masturbating to these kinds of videos. That’s when I knew I’d crossed the line. I was getting off to something I found repellant, not sexually arousing in the conventional sense. I could easily become aroused and orgasm via masturbation, but not when having sex with my wife. When you have difficulty being aroused or ejaculating with real partners, you know you’ve got an addiction. When you find yourself asking your spouse to put a live eel in her p—- while you f— her a–, and she says “No,” and you say, “You’d do it if you loved me. This is my fantasy.” That’s how you know you’re addicted.

Brains are plastic. That’s what makes them vulnerable to addiction, but it’s also what makes recovery possible. If you want to make a change, get support. Change is entirely possible. See additional self-reports of symptoms, escalation and withdrawal distress. Also see self-reports of effects reversing themselves after stopping.

Porn-Induced Erectile Dysfunction Is A Growing Problem

High-speed Internet pornography users in their twenties are increasingly developing sexual performance problems (erectile dysfunction, delayed ejaculation). Said one young man,

“Lots of guys, 20s or so, can’t get it up anymore with a real girl, and they all relate having a serious porn/masturbation habit. Guys will never openly discuss this with friends or co-workers, for fear of getting laughed out of town. But when someone tells their story on a health forum, and there are 50-100 replies from other guys who struggle with the same thing, this is for real.”

Italian urologists recently confirmed the impotence-porn use connection via a large survey. Italian men suffer ‘sexual anorexia’ after Internet porn use. When interviewed about the survey, urologist Carlo Foresta (head of the Italian Society of Andrology and Sexual Medicine and professor at the University of Padua) mentioned that 70% of the young men seeking clinical help for sexual performance problems had been using Internet pornography habitually.

No one yet knows the percentage of Americans affected. However, youthful impotence has implications for condom use and safe sex.

According to Foresta, porn-related impotence is reversible. Yet it appears that recovery requires 4 to 12 weeks of avoiding intense sexual stimulation. Read one man’s recovery story: “Day 64: Successful, great, normal sex.” More recovery accounts.

Of those who ultimately recover by terminating pornography use, many had previously been to doctors, undergone numerous tests, and been declared “just fine” physically. Neither they nor their health care providers considered excessive porn use as a potential cause of their continued performance problems.

Most were assured that “masturbation cannot cause erectile dysfunction.” This was no doubt sound advice before masturbation was coupled with the constant novelty and hyperstimulation of today’s Internet erotic possibilities. However, it may no longer be valid given the effects of superstimuli on the brain.

Among those who recover, progression is surprisingly similar. When the users completely stop using pornography (and masturbation as well for a time, because it is initially so closely associated with porn fantasy), here’s what occurs:

1) Withdrawal symptoms and cravings: Immediately

2) Complete loss of libido and erections: Begins towards the end of week one.

3) Absence of libido and erections, increased flaccidity (“shrinking or lifeless penis”): Continues for 2-6 weeks, dependent upon age and severity of porn use.

4) Gradual return of morning erections, libido and spontaneous erections at other times, no more “semen leakage” during bowel movements, etc.

5) Complete recovery of erectile health, sexual desire for real partners, reports of extremely pleasurable sex, contented condom use even if it was once a problem.

Sufferers typically recover within eight weeks. Those in their late teens generally require a shorter period of avoiding sexual stimulation to bounce back, but they also tend to relapse more often, which extends their recovery. Older men may need a longer period without stimulation in order to recover, but are typically more disciplined. Either way, reports are encouraging:

“I am a 25-year old male, masturbating a lot from 13 and using porn from 14. Gradually, it took more to turn me on: bigger fantasies or harder porn, and I stopped getting hard without touching. During sex I would struggle to get an erection or keep it, especially for intercourse. Over the past 7 years I haven’t held down a relationship, and the main reason for me has been this problem. Now the good news: When I realized the cause, I immediately gave up porn. Over the last 6 weeks I held off masturbating as much as I possibly could. (My best record was 9 days!) It all paid off. I just went away with a girl for the weekend and it was the best ever. I don’t think I’m out of the woods yet. I still get pretty anxious from all the bad experiences over the years. But I just wanted to tell you all it can work, and it’s well worth it!”

“Week 12, age 36 – I’m actually totally impressed how HUGE I get. It has been kinda hard to ignore. I mean, my erections are ROCK HARD and ENORMOUS. I remember asking other guys who went before me about when they noticed the return of their full erections. Well, I think I got mine back.”

Those affected report that escalating pornography tastes preceded their symptoms. Escalation, their withdrawal symptoms during recovery, and the sequence and time-dependence of their recovery all point to a common cause of their impotence, namely overstimulation of the reward mechanism in the brain.

Animal models have established that the mesolimbic dopamine pathway dopaminergic neurons activate the hypothalamic erection centers. It’s likely that porn-induced ED is tied to desensitization of the mesolimbic dopamine pathway. This is a hallmark of all known addiction processes. For a science teacher’s explanation of the science behind porn-related erectile dysfunction, see this video presentation: Erectile Dysfunction and Porn.

Most men are astonished to learn that pornography use can be a source of sexual performance problems. Only after they experiment for themselves do they become fully convinced that pornography use was indeed the source of their dysfunction.

“Day 64: Successful, great, normal sex”


MOOD CHART, x = days, y = mood

This guy, who could no longer use a condom successfully due to porn-induced ED, applied the recent scientific findings about how superstimuli can numb the pleasure response of the brain to his use of today’s hyperstimulating porn. He decided to allow his brain to “reboot.” Although each person’s rebooting experience is different (recoveries range from 4 to 12 weeks), his experience was typical and his data especially thorough. Here are excerpts from his blog.

[Week 2] So, I just completed 10 days of no PMO (porn/masturbation/orgasm). The first 5 days were difficult, but astonishing. I got extremely horny, probably as my brain was trying to get me to jack off, like I’ve been doing every day for 20 years, maybe longer. Erections just looking at girls, very hard to resist kissing a girl I was talking to in a bar.

Then after 5 days, it all went away, completely. Since then, I’ve been flat, numb, nothing. Occasional sparks of sexual spirit, but also a kind of glum, flat, nothingness. I wouldn’t say depressed, because I’m optimistic about the future, and I’m happy with the path I’m on, and committed. But more like empty, null. Girls that I was desperate to get with a week ago, now I don’t even feel like texting. I almost feel hostile, angry. The prospect of sex is not appealing.

I think my brain has accepted that I’m not going to be jerking it, so it has stopped the cravings. On the other hand, it doesn’t realize yet that porn is no more, and so it still is not allowing me to get excited by girls in real life. I think that’s going to be a very gradual process, and I’ll probably get intermittent flashes of horniness and arousal, and then absence again, as things gradually rewire.

I’m super-excited to be at day 10. I never even knew there could be a day 3! I thought it was physically impossible for me to not jack off that long. And actually the porn is at day 16, because I stopped looking at it a week before I stopped jerking it.

[Week 3] Earlier today I was getting pretty impatient with the lack of progress in the resensitization department. I mean, it’s only been a once a day habit, right? Why am I taking so long to get over it? But then I did the math. 20 years, 365 days a year, most of those including P – that’s more than a staggering 7,000 PMOs. Now I see why it’s possible that I have some habituation to get over.

[Week 4] Still getting the occasional REALLY STRONG flashback to some of the appealing images from P days. At first I was annoyed that a side effect of this process is getting these flashbacks and annoyed at having to resist them. Then I realized that it’s not a side effect – this IS the process. Every time you successfully resist, that takes you one step nearer to being free of them. That’s how progress is made in this crazy game.

Been driving a lot – late night driving has been one of my solaces in this crappy process. When I come home and I’m full of horn, I get in the car and drive for a couple of hours – on a twisty road, up in some hills, occasionally just on a freeway. Doesn’t really matter. Just sitting there a little preoccupied seems to soothe me somehow. Anyone else do this?

[Week 5] I was in such a good mood today. I literally don’t think I have been in such a good mood in 7 years. And I don’t mean because anything particularly great happened, but just for no reason at all. It’s been so long since I’ve had that buoyancy. I used to have it, and I haven’t seen it for 7 years, and had more or less got to thinking maybe life is inherently gloomy and uninteresting. Historically, I’ve been a very positive person, and the last 7 years have been so weird because it felt like nothing I did would make me feel cheerful inside. Patches of joy here and there, but always short-lived. Today, finally, I was socializing with people, chatting with people because it felt good to connect, to commune. I’ve missed that so much, and I only realize how much now that I’ve had a taste of it again.

I’m 100% sure the problem was the PMO thing. Quite simply, it made everything else boring. The M by itself was bad enough to make me lack-luster since I was 18 probably, but the broadband P I think finally killed any chance any real-world stimuli had of capturing my interest. Maybe I’m exaggerating a bit, but not that much. I’ve been going through the motions of being sociable and interested for the last 7 years, knowing how it was supposed to look, and doing it because I felt like I should, but all the while not giving a shit inside.

So yeah, the last few days, I’ve been getting little dribs and drabs of positive emotions, like when you think you feel a drop of rain every now and then, but you’re not sure. Today was the first day where I had a mood that was really sustained and didn’t disappear after a couple of hours. More like 8 hours and I’m still feeling it. I’m sure there will be lows again (not to be negative, but I’ve seen the neurochemical pendulum in action for long enough now to know this), but right now, this feels pretty damn good….

Stay strong, everyone. This is totally worth it. It may not be the only piece in your puzzle, but if you’ve been doing PMO, then it almost certainly will have been having major unsuspected effects.

[Week 6] A milestone reached the last few days. I actually feel back to normal. I’d got so used to feeling craving, or sad for no reason, or unbalanced, or anxious, or massively horny, or completely dead, or combinations of any of these at one time the last 40 days that I’d forgotten that I hadn’t always felt that way. Then 3 days ago it all just stopped. Just like that. In my journal two days ago, I wrote “Wow – I feel what I can only describe as ‘normal’ today”. That feeling has stayed with me, and none of the craziness has returned.

Now, just because the craving is gone doesn’t mean that I’ve healed my brain yet. It also doesn’t mean that I am safe from relapse! I’ve been fighting hard these last 6 weeks against the beast, and I’ve shut it out, but that doesn’t mean that it won’t come knocking subtly at some stage and try and get in again. I need to maintain lifelong vigilance. My motto: Real women only. For good.

I’m still pretty drained by the whole experience, physical partly, and massively mentally. I’m going to give myself a week or so of brain convalescing (maybe I’m being a wimp, but I really feel like I’ve been through something), and then I think I’ll feel restored enough to start pushing myself again in other areas of life, which have pretty much been on hold the last 6 weeks.

[A couple of days later] Really depressed today. Angry, bitterly critical of the paths I’ve taken in life, and where I’m at now, and of my abilities to go forward.

While I’ve eliminated a false pleasure from my menu of options, there is nothing there yet to replace it, because the other options still lack much power to please me. Also, I’m pretty mentally tired after all this PMO resistance, and I don’t have the strength to be buoyant today. But the cravings really have gone – I feel level headed, just “level headed grumpy” today.

I guess the other thing bothering me is that there definitely was a very significant improvement at the end of week 6, and I thought that meant all this bullsh*t was over. Apparently though, it just meant the crazy period was over. Now it’s replaced by sexual frustration combined with a dull, missing ache, that’s making it hard for me to be winning with women, I suspect because I’m communicating an inner sadness.

[Week 7] “Stupid glumness – 50 days and still missing PMO” To miss P for a few days, fine. But to be missing it 7 weeks later – what a baby! There’s also a second fear – that maybe the glumness is nothing to do with the PMO, and it’s just that my life is f*cked. Except that I don’t think it is, but the fear is still there, because it seems like a rational explanation for glumness.

So, those two demons combine and taunt me. One says, “You baby! Fancy being glum because you’re missing your P!” Then the other one says “Or maybe it’s not the P! Maybe you’re just a loser and you’re glum because you can’t get a decent life together!” Back and forth between them for hours at a time. So I try and prove them both wrong. I go out and meet women. I can hear myself talking to them, aping buoyancy, aping inner feelings of success and normalcy. But the second the performance is over, the dull monotonous drone is back. Glum.

[A few days later] Mood swings:

1) There’s a woman that I’m progressing towards. One day I’ll think about her and think that she is sweet and fun. The next day I don’t give a crap about her. Repeat until thoroughly confused.

2) One day I’ll be really up, great mood, gold is flowing from my lips unbidden. The next day, I’m a tiresome dolt, who gives a crap about no one and about whom no one gives a crap. Repeat until self-image completely unstable.

3) One day I’ll think I’m a cool dude, with tons going for him, and really getting a great life together. Next day, I’ll feel like a poor deluded fool, who thinks he is swimming, when really he’s just scrabbling around in the dust. Repeat until really fed up.

[Week 8] The biggest difference that quitting PMO makes is that it gives you incentive to be brave, to go out and meet girls. If you are whacking it every day to porn, and a real woman barely registers with you, why on earth would you even make the effort to go and talk to her? What do you have to gain? Nothing. What do you have to lose? The possibility of rejection, of humiliation, maybe even hostility and anger from her.

But imagine that you saw a woman that you liked, and I offered you $1,000,000 to go and talk to her – say anything, it doesn’t matter what. If you really believed I would pay up, you would find the courage to talk to her, even if you thought she might laugh at you. What’s changed? She’s going to respond exactly the same way she would have done without my $1m offer – it’s just that now you have an incentive.

[A couple of days later] You built a harem.

You know those science fiction comedies where a couple of teenagers somehow build themselves an ideal robot woman in their basement and fall in love with her? PMO is like that, except that it’s just one guy, and he’s built himself a whole harem of unfeasibly hot women. So when this guy goes outside of his basement, in the normal world, he is not interested at all in the normal women he sees because he’s got a harem of uber-hot women back home. Getting back to them as soon as possible is all he can think about.

Just like those kids in the movie, we have fallen in love with that harem. It is as simple as that. Your brain thinks the harem is real and is behaving accordingly. When you are at home, you are desperately excited to bang girls from your harem. When you are away, you are excited to get home.

You have to break up with the harem.

This process is so tough because it involves BREAKING UP WITH THAT HAREM. Your brain has to accept that you are saying goodbye to all those girls, never to see them again! Your brain fights you for 8 straight weeks, because IT DESPERATELY WANTS TO KEEP ITS HAREM. It will make you sad, angry, miserable, depressed, horny as hell, numb, null – it will drag you through the worst kinds of hell it possibly can to get you to go back to your harem, because it loves them so much. Look at my mood charts – my brain put me through horrible bullshit for 8 straight weeks.

But then, just like when you break up with a girlfriend (well, in fact exactly the same because it is the same), you wake up one day and the fever is gone. The brain says “OK. I get it. *sniff*. I guess they’re really all gone and I’ll never see them again. *sniff*… Hey – that woman waiting in line at the bank is cute though! Hey baby!” And you are healed. You are back in real life, and you have no magic, robotic harem at home.

I will share something embarrassing/amusing but also really important. Exactly a week ago, I had massively strong feelings of missing – you know those feelings you get after a break up with a girl. There’s a song that kept playing in my head, that one that goes ‘I ain’t been missing you at all – no matter what my friends say’. I played it on YOUTube, and listened to it on headphones. I cried for two hours straight, playing it over and over, while memories of all the girls I liked in all the porn I’d seen over the years – my favorite girls, the ones I felt closest to – scrolled around in my head. I was saying goodbye to them. It was like looking through photos of you with your ex-girlfriend after she broke up with you. So yeah, I cried for two hours, maybe more, doing that. Afterwards, I felt a huge sense of calm, peace, closure. They were really gone.

That night out in bars I got 3 numbers, and went out on a date with one of the girls I met the next day.

Eventually, your brain accepts.

So when you ask if it’s hard to continue to not PMO these days. No – it’s really, really easy. My brain knows that those girls are gone. It has accepted. It has given up trying to make me go back to them. It has moved on. Now when I’m at home, my brain knows there is nothing sexual there at all. When I go out, my brain knows there are fine women around that it might want to get with, but that the only way that anything sexual will happen is to have sex with them, because M is no longer on the menu, no longer an option.

But it took 8 weeks to get to that point. In the meantime my brain was screaming bloody murder. And sometimes it stopped screaming, but it’s only so that I got used to it not screaming, so that it could shock me even better when it started screaming again.

That’s also why I say cut out TV. If you’re at home, and a fine woman comes on the TV, your brain says “Hey! There’s a girl from my harem! I guess my harem didn’t disappear after all! Hummana-hummana-hummana.” And you get all excited again. Home has to be dead of women to you. Nothing there. No glimpses, no faces, no bodies, no nothing. World outside: women. Your home: boring as f*ck. That’s the only way your brain gets the message it needs, which is that the harem is no more. Gone.

[A couple of days later] I’ve been scoring my mood on a 0-10 scale: 0 is absolutely shitty, 10 is completely awesome. 8 is solidly great. Imagine you’re driving a BMW at 80mph down the freeway. You can hear its engine purring away happily and powerfully, cruising, but knowing it could easily push up to 120mph if it wanted to. 8/10 is when your engine feels like that engine – powerful, happy, cruising.

My mood has not dipped below an 8 in the last 6 days! The blues, the doldrums, the lack, the despondency – all GONE! This, to me, is amazing. Even reading other peoples’ reboot reports, I had a worry that even after rebooting, mood would still be up and down, especially in the absence of masturbation.

For clarity, I’m not saying I haven’t got frustrated this week, or briefly angry – I have. But it’s been normal frustration, responding to things that you would expect to be frustrating for anyone. There has been a core, immutable power and energy even in frustrating moments. It has felt remarkable to me, almost unbelievable, as I’ve been so used to the PMO ups and down (and of course the numbness before starting this process). But there it is. Solid great mood.

[His final mood chart from shortly after this post is at the beginning of this post]

[Week 9] Day 57 of no MO, day 64 of no P. Successful, great, ‘normal’ sex, with condom.

History: I’ve never liked using condoms. Frequently never got around to sex because I’d lose erection even thinking about having to get one out and use it. Frequently lost erection putting the condom on. Frequently lost erection once inside.

Last night: Stiff 🙂 Stayed as stiff while getting condom out, putting condom on, while starting sex and finding we needed lubrication, through getting the lubrication, putting the lubrication on, having sex. All with exemplary stiffness 🙂 My erection was just so natural, and correlated with being turned on, and felt so right, that somehow I just knew that it would stay with me through the condom shenanigans.

And the sex felt as great as sex used to without a condom. I suspect it was because of the increased drive and increased sensitivity down there. I’m really excited about having sex with a condom with her again, which has never happened before. Sex without condom used to be exciting enough for me to want to repeat. Sex with condom fell the other side of the line and wasn’t worth it. But now I’d be more than happy to repeat the experience, several times 🙂

Orgasm itself: very strong and pleasurable. None of the things I worried about happened. I was able to keep from coming for a perfectly acceptable length of time. In fact, I didn’t even really think about it, it just seemed like a normal, healthy sexual interaction. When I did come, my head didn’t explode and I didn’t rupture any blood vessels anywhere and I didn’t bellow ‘8 FUCKING WEEKS!!’ in her ear like I thought I might. In fact, it was just beautiful, intimate, very pleasurable sex 🙂

Guys, stick at this. The goal that you are striving towards is real and amazing. I guarantee that it is 100% worth the effort and will not disappoint. Allow yourself to believe that this place is worth going through 3,6 even 12 months of misery and bullshit, because it is. It won’t take you that long. It should take 2-3 months. But if it did take a year, hell 5 years, it would still be worth it. Good luck, fellow cock soldiers 🙂

[A few days later] Actually having sex and having more opportunities on the way has vastly cut down, maybe even eliminated frustration. But also, I think that my brain has adapted, has changed its expectations. Part of the reason that you get so frustrated post-PMO is that the brain has been used to a HUGE diet of ‘sex’ (OK, actually wanking to porn), so it thinks that level of stimulation and sexual activity is the norm. After it has thrown its temper tantrum for a while, it gives up and adapts to the new amount of sex in your life, i.e., once in a while

Yeah, I blew some opportunities through desperation because I wasn’t used to having that much desire. I almost couldn’t stop myself trying to kiss girls I was talking to, but you learn to control, and be grateful for, the extra drive.

In summary – your life changes because you are inspired to meet more girls, PLUS your brain adapts to the lower frequency of sexual activity after a while, PLUS you modify your social behavior to take into account the stronger sexual desire you are feeling, so you still come across as cool. It’s a process, i.e., it takes time, but trust me, TOTALLY worth it.

[Subsequent post, a couple weeks later] I feel a little bad about airing my private business, but at the same time I want my brothers in cock to have the positive evidence I am in a position to provide so: Yesterday, sex with a girl. Once with a condom.

Today, sex with another girl. Twice, with a condom, only about 30 minutes apart (I’m 40, people). So strictly speaking, with 2 condoms. All erections very nice and hard, maintained with no problem at all, condom put on in full view of girl (always used to be a danger point for me), even taking my time putting it in once the condom was on (I used to get it in as soon as possible hoping to regain the rapidly flagging erection).

This is miraculous. And I am definitely cured.

Oh, and the sex felt really great. I could happily use condoms for the rest of my life. It felt just like sex without one used to. I’m sure I have more sensitivity in my cock now that I’m not gripping it tightly and boffing it around every evening.

For those asking about ED: I guess I used to have pre-emptive ED. That is, I knew I would get ED, especially if I knew I’d need to use a condom, so I wouldn’t even go for sex, well actually I wouldn’t even pursue a girl. Two months ago, however, I did end up somehow in bed with a hot girl and no erection, which I found humiliating. That’s when I found my way here. Short story – yeah, probably would have had more ED if I hadn’t avoided sex through fear of it.

Thanks again so much to everyone who has shared their stories/thoughts/wisdom!

Rebooting is the path.

More “rebooting” accounts are available at Learn more about porn-related ED in this video series.

DSM-5 Attempts to Sweep Porn Addiction Under the Rug

"Sweeping porn addiction under the rug"

The Sexual and Gender Identity Disorders work group for the upcoming Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is currently discussing whether to demote the proposed “Hypersexual Disorder” (which addresses compulsive porn use, among other behaviors) from Sexual Dysfunctions to the appendix. Further, a member of the work group advises that “Hypersexual Disorder” may be banished altogether, offering no explanation.

The DSM is psychiatry’s bible. If a disorder isn’t in there, insurance companies won’t reimburse treatment costs for it, so psychiatrists don’t diagnose patients as having it. In the health care world, “Reality is what the DSM says it is.”

So, if you fall into compulsive Internet porn use…tough luck. Your condition doesn’t exist and you will be treated, if at all, for the unpleasant symptoms of addiction (such as anxiety, ED, depression, concentration problems) on the assumption that these conditions predated, and are unrelated to, your excessive porn use. No one will breathe a word to you about your actual pathology: addiction-related brain changes. It’s the equivalent of giving you Vicodin for the pain of your leg fracture instead of setting it—while allowing you to continue limping along on it without a cast.

This move comes just as the DSM’s pathological-gambling work group has determined that another highly stimulating, non-substance compulsion, gambling, will be upgraded to the renamed category: Addiction and Related Disorders—so that they can treat such patients for addiction. How, in the name of science, can one compulsion (gambling) be recognized an addiction risk while the other (compulsive sexual behavior) is casually dismissed?

All addiction is a matter of science

In recent years, the DSM has been taking a lot of heat for generating new mental health pathologies, some of which have resulted in over-diagnosis and over-medication. We understand its desire not to stick out its collective neck just because people chase booty or look at raunchy videos to excess.

However, as the gambling revision indicates, behavioral addictions are now verifiable pathologies “characterized by a loss of rational control, as well as significant and measurable changes in the neurochemistry of the brain.” The same physiological mechanisms and anatomical pathways are at work in gambling, video gaming, overeating, drug use and excessive sexual behavior. We now have the tools to measure (across populations) brain changes associated with all addiction. As a neurologist Max Wiznitzer explained,

We already know what the [brain] imaging profile is for addictive behavior and what the profile is for the reward system, which is the dopamine system. …[T]his is a nonspecific activation pattern that is not stimulus sensitive. No matter what the addiction, it’s going to affect the same areas.

Similarly, Stanford University psychologist Brian Knutson observed:

It stands to reason if you can derange [brain circuits that evolved to reward survival-enhancing behavior] with pharmacology, you can do it with natural rewards too.

In short, rather than demoting or removing “Hypersexual Disorder” from the DSM, the work group should move it to the new Addiction and Related Disorders. Already the DSM acknowledges that pathological gamblers and those suffering from compulsive sexual behaviors often show similar symptoms, such as inability to control use despite negative consequences and escalation to more extreme stimulation. (Compare criteria here and here.)

There are oodles of comforting studies on gamblers’ brains using scans and tests, all of which show clearly that excessive gambling can cause physiological changes that are very like the brain changes in substance abusers. In contrast, there are only a couple studies on the brain effects of excessive Internet porn use or sex addiction. However, they do reveal the kinds of ominous changes observed in gamblers’ brains.

These lopsided databases don’t indicate that today’s hyperstimulating porn/chat can’t cause addiction—as some sexologists assert. They mean that desperately needed research hasn’t been done—and isn’t likely to be done very promptly—for reasons we’ll get to in a moment.

Gambling researchers have already developed blood tests, cognitive tests and, of course, brain scans that measure key addiction characteristics objectively. While such tests are impractical for individual use, they have helped to establish the diagnostic criteria for addiction-related disorders. It may be that the DSM criteria for diagnosis of hypersexual addiction could already be honed to detect even more accurately the presence (or absence) of addiction-related changes: dopamine dysregulation (numbed pleasure response), sensitization and hypofrontality.

There may, for example, be a marked difference in the brain of someone presenting Tiger Woods-type behavior compared with someone hooked on today’s Internet porn and struggling to quit. Consider this young recovering porn user’s subjective experience:

After a couple weeks of no PMO (porn/masturbation/orgasm), I tried something completely different – M and O without P – something I’ve never considered. Two days later, I added the P to the MO on a whim and relapsed. The two experiences were vastly different. Just MO was almost shocking, because I had no uncomfortable buzz afterward, no shift of perception. It turned out to be a sweet, invigorating feeling. In contrast, the full PMO session felt like I was totally on a DRUG. Every picture turned my body into a searing blast of tension, each new one more powerful than the last. I felt almost like a “dope surge” run from my brain through my body. Suddenly I could hear and feel EVERYTHING more intensely. Then it was like a cloud of idiocy swept over me, and everything went numb. That feeling lasted two days at least. Enlightening.

It would be unwise to wait

No doubt the DSM work group would like to see more research before taking action to help those who prove susceptible to pathological brain changes due to today’s extremely sexual environment. We would, too. Here, however, delay would be negligent, and especially dangerous for those who fall into compulsive porn use early in life. (Unlike gambling, which is largely confined to adults with funds, Internet porn is free and available to all ages.) Without correct diagnosis, youngsters who start long before their brains are fully developed and slip into a spiral of mind-bending escalation may never discover what balance feels like.

The DSM should act now. Here’s why:

1.            Unlike gambling, today’s porn use isn’t confined to a relatively small minority of the population. 2008 statistics revealed that 87 percent of male, and 31 percent of female, computer users already viewed porn. This means that if the DSM work group is guessing wrong about porn’s harmlessness, there is potential for many to suffer needlessly until some future DSM work group changes course. A new survey of 2000 young Swedes using the Internet for sex reveals that 5% of women and 13% of men report problems with their use. A 2009 study of US college males found even higher percentages of users acknowledging porn-related problems. These data are significant given that younger porn/chat users are unlikely to see excessive sexual behavior as a problem. In fact, many troubled users, especially those who slide into erectile dysfunction, do not recognize that Internet porn use was the source of their addiction-related symptoms until weeks after they quit, and experience improvements in mood, desire to socialize, and sexual responsiveness. If you know your peers have been masturbating to Internet porn since they started, and experts insist there’s no such thing as “too much,” your symptoms have to get pretty bad before you rethink cause and effect. Italian urologists, however, are starting to make the impotence-porn connection.

2.            More research would be ideal, but is unnecessary to recognize compulsive porn use as an addiction-related disorder. Evidence of the last 10 years now firmly supports the addictive potential of natural rewards. Chairman of neuroscience at Mount Sinai Medical Center Eric Nestler says, “Growing evidence indicates that the VTA-NAc pathway and the other limbic regions … mediate, at least in part, the acute positive emotional effects of natural rewards, such as food, sex and social interactions. These same regions have also been implicated in the so-called ‘natural addictions’ (that is, compulsive consumption of natural rewards) such as pathological overeating, pathological gambling and sexual addictions.” In short, today’s hyperstimulating porn has the power to dysregulate dopamine in some users’ brains—whether or not scientists ever research Internet porn’s effects on the brain.

3.            Scientists have also isolated various factors that increase the risk of addiction, such as ease of access (unlimited porn is available 24/7 at a click) and novelty-on-demand. In other words, there are solid, scientific reasons to conclude that today’s porn has the potential to cause brain changes that can tamper with free will, dampen responsiveness to pleasure, and bloom into full-fledged addiction. Sexologists currently place all porn in the same “harmless” category, but, in fact, Internet porn is far more potentially addictive than static erotica, or even rented DVDs of the past. It’s unlikely one would develop ED masturbating to Playboy or a rental of the pizza boy doing a customer. In contrast, clicking effortlessly to endless novelty and variety and seeking out ideal, hotter, or more tension-producing material all release the dopamine that can override natural satiety and lead to dysregulation. Novelty can, in fact, serve as its own neurochemical reward quite apart from orgasm. You may not want another bite of burger…but you’ll eat three times the calories for dessert in the form of cheesecake. Squirts of dopamine in your brain override satiety.

4.            The risk of compulsive porn use may be growing as youthful viewers start out with increasingly stimulating material. (Young brains produce more dopamine and are more plastic.) Despite the mainstream belief that porn is innocuous, porn recovery websites are springing up all over the web. Visitors to such sites and visitors to Q&A sites like Medhelp and Yahoo Answers report compulsive use and other symptoms common to all addicts: withdrawal, tolerance (need for increasing stimulation), greater anxiety, altered priorities, and so forth. Some develop uncharacteristic social anxiety, concentration problems, and delayed ejaculation/ED. Brain research suggests that all of these symptoms may best be explained by dopamine dysregulation in the brain—a fundamental characteristic of all addictions.

5.            Finally, if the DSM dismisses compulsive porn use from the upcoming manual, who is likely to fund attempts at further brain research? The DSM is not proactive in demanding research. Sexology researchers aren’t encouraging it because most have not been trained to understand (and therefore dismiss) its relevance. Behavioral addiction researchers understand its relevance, but tend to focus their efforts elsewhere (obesity, gambling, video gaming)—in part to avoid strident accusations of “moralizing” by the uninformed. Moreover, there’s little point in waiting for the perfect research because researchers will remain hampered in their efforts to measure Internet porn’s actual effects. Mere surveys won’t get at the full scope of brain effects. Correctly designed studies face a serious hurdle: It’s hard to find control groups of porn “virgins.” Even if they could be found, it’s unlikely that ethics committees would sanction exposing naïve subjects to the kinds of extreme, and potentially brain-altering, material casually viewed by many of today’s users.

In short, if the DSM doesn’t act, we may be waiting a very long time for some future DSM work group to sort things out. Meanwhile, health care providers are left with no way to diagnose and effectively treat patients’ compulsive porn use because it doesn’t officially exist. Indeed, it’s likely that many clinicians (with clients desperate to stop porn use) would be outraged if they were fully aware of the work group’s intention to quietly move or remove “Hypersexual Disorder.”

Empowering the client

Contrary to the medical model, which declares all of us normal until we cross an imaginary line into pathology, use of hyperstimuli is a slippery slope for many. If the DSM were to acknowledge that excessive porn use is an addiction-related disorder, it would indirectly help to educate porn users about the symptoms that signal addiction processes at work before they become addicts.

For example, it would quickly become common knowledge that decreasing sexual responsiveness in porn users is not “normal,” but rather evidence of tolerance; that symptoms will recede if users stop and give their brains time to restore normal sensitivity; that withdrawal can be painful and anxiety-producing, depending upon the degree of dysregulation; and that full recovery can take months.

A clear understanding of what is going on in his/her brain, and how his behavior impacts those brain changes, empowers the patient/client. He can gauge his progress and his setbacks as he restores his brain’s natural sensitivity. He soon feels a sense of optimism, and even relapse is educational. Here are comments of four men who have applied the recent behavioral-addiction brain science to their heavy porn use:

I experienced a no-libido period for weeks right after I quit, but now I seem to walk around with a boner all day and feel like an animal I have to tame when around women. Not surprisingly, I have no trouble achieving and maintaining a solid erection during sex. This is opposed to sitting in front of the computer stroking a half-erect penis to hardcore pornography like I was 1-2 months ago.

This time around [13 days of abstinence from porn/masturbation] also assuaged some of my fears [about my attraction to transexual porn] and helped reinforce the fact that if I do quit this addiction, I will be completely able to have healthy sex with women. Yes, I binged, but along with the binge came a silver lining. Those first few times masturbating were very exciting and it was to very vanilla softcore porn. It showed me that without binging, my sexual tastes will begin to normalize and that was very, very reassuring. This vanilla stuff wouldn’t even have been a blip on my radar four weeks ago, but now it drove me wild. Of course, as I continued the binge I progressed onto more extreme material, again making all too clear how the addiction works on my tastes. I had to escalate to get that same rush.

It’s now been 34 days since I engaged in the full PMO cocktail I was using, and the longer I go, the more I can feel my willpower growing. I find myself more positive and productive and that’s helping a ton. I’ve got a couple of prospects on the online dating front – one that should lead to a date this week. I’ve also noticed myself appreciating the beauty of real women more, which is just awesome.

If you can manage at least 3 weeks, you’ll see how powerful all of this is. The clarity and lack of depression for me was extremely noticeable and I felt like a different person. It gave me some hope that there is nothing fundamentally wrong with me. I see myself having a spice of life again. Just with everybody. Honestly my life, socially speaking, is changing, and I see it even when I have an occasional relapse.

If the DSM sweeps porn problems under the rug, then these (mostly younger) people are left with no way to comprehend their circumstances accurately. They may easily end up on psychotropic drugs for life—in error.

This dismal outcome is the result of half a century of misguided dogma about hypersexuality. Academic sexologists presume that, unlike other addictions, hypersexuality arises from “pre-existing conditions” such as ADHD, OCD, depression or anxiety/shame. They presume this, in part, because of their rigid convictions that porn use cannot cause pathology. While it is true that genetics and childhood trauma can predispose some people toward addiction, it is rash to presume that this is always the case in hypersexuality, and that excess itself cannot dysregulate dopamine.

In fact, recovering porn users consistently report improvements in the symptoms of those very conditions, whether or not they supposedly had such a condition. In other words, whatever their starting point, changing their behavior is therapeutic. Indeed, for all we know, research might someday show that medications for commonly diagnosed conditions such as ADHD, depression and anxiety are less effective than simply stopping Internet porn use—much as antidepressants are less effective than exercise.

Probably the most distressing porn-related symptom for which young men now seek medical treatment is ED. They fear they are ruined for life, that nothing can be done, that they will never be able to sustain a relationship. Some are even suicidal. Yet if they think to ask their doctors about ED and excess, they inquire about “masturbation,” and are swiftly assured that masturbation can’t cause ED (probably true). However, nearly every younger guy who says “masturbation,” actually means “masturbation to Internet porn.” Thus, the message he takes away is that masturbation to Internet porn cannot be causing his ED (false).

Conflating today’s porn with masturbation confuses both patients and medical professionals. It’s hyperstimulation that overrides natural satiety and triggers pathological brain changes, not masturbation—or rather the combination of the two—that causes problems. Meanwhile, when doctors test their young ED patients’ hormones, etc., and don’t find anything wrong, they give them the pat answer, required by the deficient DSM, that their problems are “due to anxiety.” Small comfort indeed for a desperate young man whose problem is reversible if he is properly diagnosed and educated.

Let’s do the right thing

It’s time for the DSM to face the science of behavioral addiction squarely with respect to sexual compulsivity. Sexual compulsives need help understanding the changes in their brains so they can restore them to normal sensitivity. Pills and counseling for “pre-existing conditions” don’t do the job.

Academic sexologists traditionally shrink from modifying anyone’s sexual proclivities. However today’s “normal” (i.e., typical) porn use is giving rise to symptoms in some users that are very abnormal from a physiological standpoint. As a society, we need to get very clear about the effects of sexual superstimuli on the brain by employing recent addiction-science discoveries and diagnostic tools rather than historical academic presumptions.

Even academic sexologists may one day be glad if the DSM jumpstarts their awareness of the profound link between sex and recent brain science. Addiction research is revealing important information about the very brain circuitry most relevant to their profession. The reward circuitry governs/facilitates libido, erections and orgasm in addition to addiction. Better education about this circuitry of the brain would, in fact, foster a more enlightened understanding of critical aspects of human sexuality and pair bonding.

Meanwhile, nearly every computer savvy young man is finding his way to Internet porn/chat. Girls’ use is growing, too. Porn’s effects on their brains won’t go away because the DSM officially ignores them. For too long the key work group has been lulled into inertia by its unsupportable conviction that “All porn is harmless.” If these academics could just replace the word “porn” with “stimuli,” they would instantly see the weakness in their position.

Treating sexual compulsion as an addiction-related disorder because of its effects on the brain would align with the trend in psychiatry as a whole:

The intellectual basis of [psychiatry] is shifting from one discipline, based on subjective ‘mental’ phenomena, to another, neuroscience.” Thomas Insel

Unless the DSM reconsiders its recent decision, those who become hooked on today’s synthetic erotica will continue to be misdiagnosed and discouraged from making the changes that can reverse their pathology. If instead the authors of the new DSM act to underscore the connection between the brain’s reward circuitry and hypersexual disorders, they could do much to help protect everyone’s free will and appetite for sexual pleasure.