Health: Diagnosis of porn addiction? Dopamine kicks to the point of losing control

"I saw porn for the first time when I was 13," remembers Niklas, whose real name is different.

Health: Diagnosis of porn addiction? Dopamine kicks to the point of losing control

"I saw porn for the first time when I was 13," remembers Niklas, whose real name is different. With puberty he watches more and more. Then came the pandemic - and his porn use "exploded," as he says. "From 2020 to 2021 it was definitely three to six hours a day. It could have been a good eight hours, I can't remember that exactly." The 25-year-old decided to seek help.

His story is not an isolated case: "Around three percent of adult men in Germany have a pornography use disorder," says Rudolf Stark, Professor of Psychotherapy at the Justus Liebig University in Giessen. About one percent of women are affected by so-called porn addiction. "Studies show that women consume significantly less pornography. This means that there is less risk of them falling into a spiral of addiction."

Disorder only recently recognized

That those affected like Niklas can get professional help is not yet a matter of course, says Stark. He has been researching pornography consumption for more than 15 years. "So far, the care has been very poor. Since the disorder has only recently been officially recognized, many psychotherapists are not yet well prepared for it."

In May 2019, the World Health Organization (WHO) adopted the so-called International Classification of Diseases (ICD-11), in which compulsive sexual disorders are included as impulse control disorders. "That was an incredibly important step," says Stark. Official recognition as an addiction is still missing. But the classification offers a basis for more targeted research and thus also the prerequisite for better therapy options.

This is also the goal of the "PornLoS" project, which Stark has been leading at Giessen University since July 2023. The title stands for: Treating Pornography Use Disorder Effectively - Living Without Addiction. "We want to test new approaches and draw conclusions for further treatment methods," explains the project manager. "We are currently still training therapists and are looking for participants." Around 300 patients will then be included in the study at the beginning of next year.

Disorder develops over years

According to Stark, the research project will be supported with around 5.4 million euros over the next three and a half years from the innovation fund of the Federal Joint Committee for joint self-government in the German healthcare system. "PornLoS" will initially run at eight locations in Hesse, Rhineland-Palatinate and Saarland. If successful, the new form of treatment will be included in standard care nationwide.

The pandemic was not a driver of the project, says Stark. According to this, there were publications after the first lockdown that indicated a sharp increase in usage disruption, but later studies have not been able to prove this so far. "It can take years for the disorder to become fully developed," emphasizes Stark. "We can't see that so soon after the pandemic."

The Munich couple and sex therapist Heike Melzer explains how the so-called porn addiction can develop: "It usually starts quite harmlessly." According to Melzer, many who later show problematic behavior flee from negative feelings in order to pick up a reward from porn whenever they need it. In the beginning, the reward also feels very good, says Melzer. "But over time you develop a tolerance. Then the addict has to do more, invest more time."

With great shame

In the final stage, there is a loss of control, says the therapist. One of her patients had reached financial limits due to paid live sex streams that he watched during his working hours. Another watch pornographic content 40 hours a week - "there is not much time left for friends, hobbies and work," says Melzer. Quitting does not succeed, the shame is great.

After some time of high consumption, the porn viewers would also become dull. The reason for this can be found primarily in the mind: "Dopamine is the currency of our reward system in the brain," says the therapist. The more often someone gets a "kick", the faster the value disappears. The reward is always smaller - as in the case of nicotine addiction, for example. "That means we need stronger and stronger stimuli," concludes Melzer. This influences the body's own regulation of the so-called happiness hormone. "This leads to an imbalance that is difficult to reverse," says the expert.

Niklas also experienced this. "The content I watched became harder, sometimes more violent." His relationship with his girlfriend also suffered. "She knew about it, but not to that extent," he says. However, the problems could hardly be hidden. He was limited by an erectile dysfunction and listlessness. Eventually they parted.

Those affected develop partner-related listlessness

According to Melzer, high porn consumption often leads to sexual dysfunction - not only in men. "Anyone who watches porn five times a day and holds a vibrator on their vulva no longer reacts to a non-motorized penis."

According to Melzer, those affected in relationships often develop a partner-related listlessness. "They appear to their partner as if they are not interested in sex, as if they are asexual," explains Melzer. "In fact, they're hypersexual and hide it out of shame."

The therapist recommends that anyone who suspects that their partner could be affected should find out more and share their concerns. It is usual for the partner to initially deny everything. "Patients with addictive and compulsive behaviors often mask their behavior, alienate it, and attack the person addressing it," she says. There are also support groups for relatives of porn addicts. She advises those affected to seek professional help.

"My therapy helped me enormously," says Niklas. His consumption has fallen sharply, he has completed his studies. But he continues to struggle with the reluctance. Coping with the aftermath of addiction since steady work.

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