Chapter 2: Review of the Literature
The chapter consists of the internet pornographic addiction concept through literature on 1.) Internet pornography and sexuality on internet, 2.) Psychological theories of sex addiction, 3.) Internet pornography and compulsive behavior in men, 4.) Healthy and unhealthy sexual behavior, 5.) Therapies used for the treatment of internet pornographic addiction. The theoretical background will cover the etiology of online pornographic materials. The current literature will have focus in the direction of theoretical description online sexual behavior and male compulsive behavior, internet pornographic addiction and treatments from addictive behavior.
Internet in the present scenario is used in almost every walk of our life from communication to online shopping (Rambaree, 2004). There have been various studies in last one decade that identified use of internet in the area of sharing and accessing pornographic material and involving in sexual acts. According to Goldberg, Peterson, Rosen & Sara (2008) Nua Internet Surveys of 2001 indicated that sex is one of the most popular search terms over the internet.
“No truly random study has been conducted to determine the number of people accessing sexual Internet sites, some estimate that 31% of people online visit sites with sexual content, and of those, 5.5% of individuals exhibited compulsive behaviors and an additional 17% are “at risk” of becoming sexually addicted (Cooper, Delmonico, & Burg, 2000). Based on these estimates, as many as 69.7 million people are using the Internet for sexual purposes (cybersex), and as many as 11.8 million may be experiencing problems controlling their behaviors with cybersex.”
Cooper et al., 2000 explained the role of internet in changing the traditional mode of sexuality as “Sexuality is one aspect of human social behavior that is being dramatically impacted by the Internet” (as cited by Rambaree, 2004). Sherman (2003) explains reasons of the growing sexuality over the internet as internet offered a fast, quantity leap in distribution of pornographic materials, equips users with facilities of quick download, easily access and view, allows them to store various pornographic media files on their on their personal computers (Kendall, 2007). According to Kendall (2007) pornography can be regarded as one of the oldest professions of the world. The term ‘porno’ is derived from the Greek term for a prostitute that is ‘pórni̱’. Internet technology is advancing demand for pornography contents. Online sexual content and materials are sold and shared by huge community of people. This is a highly profitable and advanced business in the present scenario. This has created its place in the modern culture and society (Wondracek, Holz , Platzer, Kirda and Kruegel, 2010).
Pornographic materials available online can be targeted for variety of users from those who want to improve their regular sex activities to those who want to utilize this platform for sexual fantasies’ and desires. Rambaree (2004) explains that people coming and joining the chat rooms for interaction, enjoyment and exploring each others’ sexual properties. However at the same time the anonymity and interactivity allows them to communicate fearless and without being concerned of what other person would think (Rambaree, 2004).
Prior to the use of internet, people used to visit stores and shops for sexual or pornographic materials. Physical access was usually restricted to be sold to particular age group. However access to pornographic material has become easier for different age groups due to online access. This also ensure that their privacy is maintained (Kendall, 2007)
Types of Pornographic Material
Today internet created an opportunity for individuals to have access unlimited range of pornographic materials, still images and audio/video materials effortlessly. There is large availability of pornographic materials on internet. These materials can be classified in various ways on the basis of the nature of material like image, literotica (erotic literature), erotic images and erotic videos. On the other hand, in terms of type of content, it is classified as Erotica, Degrading and violent pornography.
Erotica generally carry sexual or erotic materials without degrading and violent type of pornographic contents and sexual activities. Erotica may be indicates towards positive, loving human sexual interaction between willing individuals (Glascock, 2005).
Non-violent or degrading pornography:
Non violent pornography is different from erotica type of pornography materials. It contains verbal abuse or it is portrait as having animal kind of characteristics. However it does not contain any type of physical violence. Non violent pornographic materials generally consist of man dominating over women and women representation in such content is objectified as a plaything responding to male sexual needs immediately (Glascock, 2005).
Violent pornographic materials:
These kinds of materials include pain and physically forced such as rape, bondage, discipline, bestiality, sadism and other forms of paraphilic linked sexual activities (Glascock, 2005). These materials are degrading and present violent sexual encounters. Dominant-submissive behavior can be seen between male to male, male to female, female to male or female to female or in groups.
Most of the studies related to cybersex have been in the areas of understanding negative consequences of cybersex. Some researchers have argued on the positive implications of cybersex on some group of people like committed couples looking for expanding their sexual experiences, gay adolescents, people with difficulty in finding partners like physically or mentally challenged, unattractive and shy, women seeking to rejuvenating sexual knowledge with limited opportunity to do otherwise and others (Waskul, 2004 as cited by Philaretou, Mahfouz & Allen, 2005)
Review of Current Research Literature
Online Sexual Behavior
Online sexual behavior is one of the extensively researched areas. Goldberg et al,(2008) identified exponential growth of the adaptive and pathological use of sexual component over the internet. Cooper (2002) has identified three subcategories of the online sexual behavior of various individuals. These are “cybersex and its own subcategory of cybering, online sexual problems (OSPs) and online sexual compulsivity”.
Cybersex as cybering consists of the behaviors that gratify sexual behavior through various tools of pornography, chatting, erotic mails and live video chats through online camera and sharing same sexual fantasy. OSPs consist of the problems people face or might face by using internet medium for their sexual desires. These problems can be individual, social or financial. Individual problems consist of guilt, shame, breach of trust, broken relationship, loss of respect, financial loss and others. Loss of family and friends, divorce and criminal charges for illegal activities can be other problems people might face. Online sexual compulsivity is part of OSP but signifies a state where an individual completely looses his control over daily activities and is dominated by the compulsion of online pornographic activities.
Goldberg et al (2008) used the term ‘cybersex addiction’ to cover pathological and compulsive behaviors that have negative impact on the user and his surroundings. Addiction or compulsion of cybersex is related to uncontrolled use of internet for sexual desires and impulsive control (Goldberg et al, 2008). There have been various studies were in different symptoms of changes in behavior has been reported with the cybersex addiction such as lack of sleep, isolation, loss of productivity, loss of interest in other relationships, loss of interest in normal sex and fading sense of responsibilities (Schneider; 1991; Young, 1999; Boies, Cooper and Osborne, 2004; Goldberg et al, 2008). Indirect victims of the cybersex are primarily spouses who feel betrayal, rejection and other negative implications that might lead to ending up or distorting a healthy relationship. Children, family members and other social relations also suffer in such cases.
Sex addicts can exhibit ten types of sexual behavior (Carnes, 1991 as cited by Carnes and Adams, 2002). These are “fantasy sex, seductive role sex, and voyeuristic sex, exhibitionistic sex, paying for sex, trading sex, intrusive sex, anonymous sex, pain exchange sex and exploitive sex”. These sexual behaviors are encouraged and aroused online (Carnes and Adams, 2002).
Philaretou, Mahfouz & Allen (2005) have studied different forms of cybersex behavior. There are various aspects of online sexual behavior that includes wide range of online behaviors. Cooper (2002) listed various online sexual activities like “answering sexual personal ads; chat rooms/message boards; webcam sites; private member chat rooms; adult online sex shops and catalogs; e-mails; flirting and sexual innuendo; actual overt sex talk with the goal of arousal/orgasm; telephone sex; and actual, real time sexual encounters.” According to Carnes (2001) Sexual addiction cycle consists of four-steps of preoccupation, ritualization, compulsive sexual behavior and despair. Preoccupation is the stage of sexual stimulation resulted from the thoughts of sex. This is followed by ritualization where addict seeks more arousal and excitement. Third stage individual loses his control to stop his obsessive behavior. Last stage of despair is helplessness and powerlessness. Carnes (2001) further explains,
“The addictive system starts with a belief system containing faulty assumptions, myths, and values that support impaired thinking. The resulting delusional thought processes insulate the addiction cycle from reality….All the other support systems, including relationship, work, finance, and health become unmanageable.”(p 25)
Figure: The Addictive System (Carnes, 2001)
Weiss (2008) identified various areas of sexual addiction similar to those of other addictions. These are “Loss of control and escalation in frequency of the sexual activity and/or content; Inability to stop the behavior despite previous agreements with self or others; Consequences directly related to the sexual behavior in areas such as social functioning, relationships, parenting, financial, career, emotional / physical health and legal; Significant loss of time and focus to the pursuit of or engagement in sexual activity to the detriment of other life goals or priorities.; Irritability, extreme defensiveness or anger when having to address, change or stop a particular sexual behavior”.
Sexual addiction behavior falls in four categories of shameful, secret, abusive and void of relatedness (Carnes, 1978 as cited by Weiss, 2008).
|Psychological symptoms||Physical symptom|
|(a) experiencing a sense of well-being or euphoria while online,
(b) feeling unable or unwilling to stop online surfing,
(c) increasingly desiring and spending more and more time online,
(d) neglecting interpersonal relationships with intimate partners, friends, and family, (e) experiencing feelings of emptiness, distress, and irritability when prevented from pursuing online activities,
(f) lying to employers and family to cover up extent of online activities, and
(g) experiencing general problems with school or work responsibilities
|a) carpal tunnel syndrome,
(b) dry eyes,
(c) migraine headaches,
(d) back aches,
(e) eating irregularities,
(f) neglect of personal hygiene, and
(g) sleep disturbances due to change in sleep patterns
Source: Developed on the basis of Orzack (2004 as cited by (Philaretou, Mahfouz & Allen, 2005).
Sexual Compulsive Behavior
Sexual compulsion is a stage of “uncontrollable urge to perform an irrational sexual act” with or without complete knowledge of negative consequences (Cooper 1998 as cited by Philaretou, Mahfouz & Allen 2005). Factors that can determine the compulsiveness of online pornographic addiction are frequency of sexual activities online, time spent on cybersex and its relation with the negative consequences of their lives, feeling of guilt and depression and obsession for particular pornographic material (Philaretou, Mahfouz & Allen, 2005).
Internet Pornographic Addiction
According to Cooper et al (2002) cybersex addicts are those individuals who spend more than eleven hours in a week in computer sex. This leads to lack of time for other important aspects of life like family, children and social circles. These individuals tend to avoid time needed for other things for cyber sex fun, prolonged hours of sitting in front of system and screen has negative implications on their physical and mental health. This also leads to isolation. Coombs (2004) argues that this heavy involvement affects the sexual activities with the primary partners. “Male sex addicts may be physically unable to have more sex after a session on the computer. A survey of partners of cybersex addicts found that among 68% of the couples, one or both had lost interest in relational sex; 51% of addicts had decreased interest in sex with their spouse as did 34% of partners”.
Coombs (2004) argues that these addicts tend to normalize the illegal or deviant sexual activities like bondage and submission, sex with minors, forced sex, fetish and various unimaginable sexual activities which are possible in the normal life. Cyber sex addicts tend to be using their nights without sleeps and diverted mind. As a result their productivity goes down and their professional lives get adversely affected. There has been increase in number of arrests for the illegal online sexual activities particularly for stalking, contacting or alluring minors for online sex.
Weiss (2004) lists impacts of cybersex affair on relationship of a couple and argues that the emotional impacts are similar to the offline affair that can result in damaging self-esteem, hurting the partner,
“betrayal, abandonment, loneliness, shame, isolation, jealousy and unrealistic comparison of partner’s psychical and traits and sexual performances to the fantasy partners, loss of interest in intimacy and mutual sexuality.”
Treatment of Sex Addictive Behavior
The sex addiction, particularly the cyber sex addiction is comparatively new disorder. This is the reason that this particular problem borrows treatment approaches of various other addiction treatments. In last one decade, it has been identified as a growing concern with different individual, social and psychological implications. 12-Step Programs (i.e. Sexaholics Anonymous), Cognitive-behavior Therapy (CBT), Interpersonal Therapy, Group Therapy and Medication are some of common sex addiction treatment programs (Herkov, 2006). According to Taintor (2005) addiction to online pornography needs to be treated like any other addiction. There are various ways clinicians and therapists can provide treatment such as online, face to face, medication, individual psychotherapy, group psychotherapy, self help groups, reimbursement and others (545).
Weiss (2004) focuses on the tools and principle for appropriate assessment of the addiction and mental health state of the client. This assessment should be used as the basic information for determining the overall approach of treatment. This can be cognitive-behavioral approach or integration of different therapies like Psychodrama, Art Therapy and EMDR. CBT and 12-step social support has been most effective and proven strategy to help addicts to develop healthy habits and cope up with the problems of sexual addictions (Weiss, 2004). Psychodrama, Art Therapy and EMDR help in stabilizing the sober behavior.
“These therapies can help elicit subconscious motivations and concerns, often uncovering blocks to therapy and recovery.” (Weiss , 2004)
Carnes and Adams (2002) listed objectives of successful therapy. This consists of:
“Establishing relationship of trust and empathy, promoting an understanding of the difference between emotion, feeling and affect; increasing awareness regarding impairments in attachment and bonding; facilitating awareness regarding impairments in attachment and bonding; facilitating awareness regarding the relationship between disrupted bonding and the inability to develop strategies to regulate affect, increasing skills helpful in the recognition, identification and modulation of affect; increasing awareness of environmental, emotional and situational stressors associated with dysregulated affect”. (Carnes and Adams, 2002:85)
The treatment is individual approach for individual client based on the individual characteristics and severity of the problem (Goldberg et al, 2008). There is no single therapy that has been developed for the treatment of the online pornographic addicted patients. The therapies used in the present scenario have been modified therapies that have been used for other addiction treatments like alcoholism, eating disorders and others (Goldberg, 2004; Goldberg, et al, 2008).
Therapist and Clinicians
Clinicians face various challenges when it comes to the dealing with sexually addicted clients such as preventing clients from sexually acting, fantasizing about clinicians, using sexually explicit language, creating physical proximity with the clinicians and try to develop sexual relationship with the clinicians. It is very challenging for the clinicians to handle their own biases. The boundary between appropriate and inappropriate can get easily blurred in lack of clear sense of therapeutic boundaries.
Most of the studies are focused on the sex addicted clients, social and psychological implications and others. There are limited studies that have covered issues of therapists and clinicians while dealing with internet pornography addicted clients. One of the initial studies in this area has been conducted by Young (1999) and covered incident rates, complaints at the primary level, psychiatric problems along with the addictions, attitude of therapists and their backgrounds. This study provided the therapists view of the internet addiction in overall and internet pornography was one part of this study. In this study therapists explained deceptive and illegal behavior of their patients like forced sex, bondage fantasies and others. However, there are very limited studies conducted in the area of understanding uniformity of etiology of online pornographic addiction among the therapists and clinicians (Young, 1999; Goldberg, 2004, Goldberg, Peterson, Rosen, & Sara, 2008).
According to Weiss (2004),
“Working with sexual addicts requires a new skill set- one that combines the empathy, insight and relational abilities of a good psychotherapist with the limited setting, confrontation and cognitive-behavioral strategies of an addiction specialist.” (p 234)
There are various aspects of challenges working with online pornography addicted clients for the health professionals. There were very limited studies conducted in this aspect till late 1990s. Young (1999) covered some aspects of the therapist perspectives in the internet addiction studies with one subset of cybersex. However, last one decade attracted attention of young researchers towards this aspect of the online pornography addiction therapies (Erickson, 2002; Goldberg, 2004; Weiss, 2004; Chiou, 2006; Goldberg et al, 2008).
“Many chemical dependency counselors and mental health professionals, while expressing interest in furthering their understanding of such work, are under –standably anxious and uncomfortable at the thought of actually working with client issues such as compulsive masturbation, exhibitionism, anonymous sex, and the frequenting of strip clubs.” (Weiss, 2004)
According to Cooper & Griffin-Shelley (2002) the knowledge of Triple-A-Engine helps clinicians to familiarize with different aspects of the sexual compulsive tendencies. Cooper and Griffin-Shelley (2002) argue that exposure of internet can disturb sexual life of people without any sexual problems and risks of developing range of sexual problems.
“Therapists would be wise to stay current in this rapidly developing area through readings, workshops, and discussion and consultation with colleagues. Treatment for Online Sexual Problems and Online Sexual Compulsivity can include cognitive and behavioral interventions, individual, group, and couples therapies, medication, Twelve Step and online support groups and residential care” (Cooper, McCloughlin as cited by Cooper and Griffin-Shelley, 2002).
Weiss (2008) provides some insights on the client concerns regarding their treatment. This list was prepared on the basis of survey with the clients who took professional helps to deal with their sexual addiction problems. The problematic issues identified by various respondents were lack of understanding of the therapist about the power or intensity of the compulsion act, lack of knowledge of online and offline sexual activities, under-informed, lack of decision making, failure of insisting on eliminating self destructive sexual behavior, lack of understanding of the impact on the spouse or partner of the addict, adopting wrong approach to deal with spouse or include spouse in the treatment process and others. Weiss (2008) recommended that the therapists should be provided special training and awareness of the online sexual addiction and compulsive behavior in order to access and manage the challenges of addict successfully.
Outdoor Behavioral Healthcare programs
These behavioral healthcare programs are comparatively new and found effective in reducing behavioral and emotional symptoms of young clients particularly in the cases of substance abuse. There are limited studies that have covered to study the effectiveness of this approach.
“Though several studies appear in the literature on outcomes associated with OBH programs (Hattie, Marsh, Neill, & Richards, 1997), few studies have specifically addressed the degree to which the treatment approach is effective in reducing symptoms associated with substance use and depression disorders.” (Russell, 2005)
OBH is also known as Wilderness therapy. Russell (2001) lists various terms used for this therapy such as “challenge courses,” “adventure– based therapy,” or “wilderness experience programs MEPs) or “wilderness therapy” and “boot camp”. Boot camp is the term giving negative impression of overall therapy which portrays it as a cruel process (Russell, 2006). Russell (2003) identified OBH as one of the widely accepted program for the individuals with mental health needs. OBH programs are run by licensed agencies who utilize services of licensed and non-licensed clinicians. Duration of OBH program varies from individual to individual. Individuals with similar needs can be grouped together (Russell, 2003). The natural elements of the wilderness creates essential environment for the change in mental and psychological level. Personal learning and growth through the activities in the natural environment leads an individual to the third aspect of socialization (Russell, 2006).
There are six components of any OBH program i.e. wilderness, eclectic therapeutic model that combines family systems theory, CBT, and experiential process, alone time, communication skills training, Native American reference and continuum of care (Russell, Hendee, & Phillips-Miller 2002; p. 211).
Evaluation of Research Literature
It is evident from the literature reviewed that internet provided an easy access to all kind of pornographic materials to the users that can be useful for him under very special circumstances but in most of the cases the overuse and dependence on these materials lead to addiction among the users. Addiction of internet pornography leads to the compulsive behavior among the users that can have serious psychological and physiological health implications. An individual suffering with online pornography addiction requires help to get back to a healthy routine of life. There are various therapies used for treatment of internet pornography addicts. These therapies are similar to the one used for the treatment of other addictions, with some modifications. The most common treatment approaches for the treatment of internet pornography addiction as identified in literature are 12-step programs, CBT and OBH.
It is evident that there have been limited efforts to identify the origin of sexual addition over internet, identifying the patterns of internet pornographic sexual addiction and effectiveness of treatments with respect to time taken to treat clients and their social and demographic backgrounds and history of repeated cybersex addiction problems.
However there has been gap in therapists’ understanding the etiology of internet pornography addiction, different aspects of client assessment and evaluation and therapists’ perspectives of online pornography addiction. CBT and OBH are growing in acceptance due to effectiveness.