Hi I’m Dr. Stefanie Carnes, LMFT, CSAT-S and I am a sex and pornography addiction expert – Ask Me Anything!

How accurate are the scientific underpinnings of the r/NoFap and r/pornfree movements? As a corollary, how accurate is the information provided on the website YourBrainOnPorn?

It's my opinion that the research reviewed that YourBrainOnPorn provides is accurate and a solid overview of the research in the field at this time. I don't know a lot about NoFap and PornFree other than that they are forums that provide people support for people who are trying to abstain. I know that can be extremely helpful for people trying to quit.

Do you believe any amount of pornography at any age is healthy?

I would liken pornography to alcohol and drugs. For some people they can recreationally use porn and do not have problems but with a small minority it can create problems for them and become a compulsive behavior.

I am a recovering pornography addict, going sober for just over a year now. I'm glad to see that this is being taken more seriously. In your opinion, what is keeping this addiction from being recognized on the same level as, say, AA?

Congratulations on your recovery. Sexuality is a very controversial topic and research and clinicians are hesitant to pathologize anything sexual. Consider the fact that homosexuality was once considered a mental health diagnosis. So researchers and clinicians want to preserve the idea that sexuality is a wonderful positive thing with lots of different ways of healthy expression. Researchers and clinicians are reticent to pathologize anything sexual and put their own biases or agendas on other people. However sex and porn addiction have become so prevalent and problematic that they are being taken more seriously and researchers are struggling with ways to classify this issue so that it doesn't unduly pathologize people or perpetuate sexual shame.

What exactly causes an addiction to sex? I can understand addictions to things we eat/drink/smoke because you are adding something to your body that causes a reaction. But how does one become addicted to a biological function? And how do you treat it, since it comes from within the person (not from an outside source)?

Sex addicts are more likely to have histories of emotional, physical and sexual trauma in their background and they are also more likely to have a history of problems with attachment and intimacy. Those are some of the most common etiological factors to sex addiction. However we are seeing young people these days who are hooked on to porn that do not have the same trauma history and attachment histories that we see in the typical sex addict. They get exposed to graphic, intense, online pornography and become hooked.

Orgasm is the natural blast of dopamine to the brain. Dopamine is considered the master molecule of addiction. When an individual uses porn it stimulates its reward center with dopamine. When this is overstimulated, the brain compensates by reducing the number of receptor sites in the synapse. Therefore it takes more intense use to get the same high. They have flooded their reward centers with dopamine just like someone does with substance abuse. So the changes in the brain for a porn addict, are very similar to the brain changes to someone who is addicted to drugs and alcohol. This same process occurs with food as well as other natural addictions like video games and gambling. And the treatment is similar to that of an eating disorder. Individuals need to learn how to have a healthy relationship with food just like they need to learn how to have a healthy relationship with sexuality.

living in a digital age with porn so easily accessible. How are you seeing this affect relationships?

With porn as accessible as it is these days we have seen an increase in the amount of porn addictions. Research shows that when men are addicted to porn and they don't share this with their partners (which is typically the case) relationship satisfaction steadily decreases over time. The findings are not the same when women view porn because women tend to view porn more often with their partners and in a less secretive manner. Research has shown women's use of porn does not have the same deteriorating affect on relationships.

Will we ever be desensitized to porn because it's too ubiquitous?

Our culture has become desensitized to porn and is much more sexualized than it was 30 years ago. Consider how a Playboy compares to a typical porn site of today. There is a lot of pressure for young women to look like porn stars and act like porn stars. Young men are also trained culturally to objectify and sexualize women in ways that had't been occurring in our culture in the past. There is research that shows that there are some socio-cultural concerns with porn including an increase in sexual aggression towards women and the rape-ness acceptance. As a culture we are involved in a major social experiment to see how wide spread, easy access to porn will affect relationships and gender roles in society.

How does porn seen by a child affect them down the road? How do you suggest handling that now so there isn't an issue later in life?

When we are young it is the time when our sexuality is developing. So when people are exposed to sexual things it can impact what they become aroused by later life (their "arousal template".) So if a child sees a certain type of porn they can incorporate that in their arousal template and find it as a source of arousal all the way into adulthood.

We don't know all the consequences of pornography exposure for children at this point. Research on that is new. As a parent I would recommend educating children about porn early and to keep it an open dialogue so they know what it is and expect it when they see it and are comfortable talking to you about it. Communication is key. Educating them about healthy sexuality is equally important so they know that everything they see on the screen is not exactly what they will see in real life. I would be careful not to shame a child to being exposed to porn. I would treat it as a matter of fact and treat it from an educational perspective.

Do you work in conjunction with a long term therapist or do you play that role? I theorize most addiction isn't a primary disorder/disease but has a more base/root problem be it environmental or biological (in cases involving drug/alcohol abuse). I would think sex addicts could be on an even stronger gradient be it environment or the "pleasure button study".

When people enter recovery for sex addiction they are best served with "programatic care" which includes individual therapy, group therapy, family therapy and 12-step. Typically treatment for sex addiction is intensive and a long term process. For acute cases it can be a 3-5 year treatment process. The reason why treatment takes a long time is because often it does have problems underlying the addiction such as anxiety, depression, trauma, relationships problems, other mood disorders that also need to be treated. Because sex can destroy people's lives often the healing process takes time for people to put their lives back together. That tends to be long term.

Addiction to pornography seems like a serious problem plaguing our society today whether we want to acknowledge it or not. I'd like to know what the numbers for this addiction looks like worldwide? Also, what action plan would you recommend to addicts to help them get over their addiction?

Thank you.

Currently there is no large epidemiological study with prevalence rates for sex addiction. It's one area of research that's lacking. The current estimated prevalence rate ranges from anywhere from 2% to 10% of the population depending on age, location and cultural background. I would recommend someone struggling with sex or porn addiction to seek a certified sex addiction therapist, get an evaluation and get a treatment plan. There are lots of good in-patient and out-patient treatment programs all over the country to help people.

First: Do you believe that some like yourself can maintain an unbiased position and not skew scientific data if they are religious? Second: Do you believe that people who are born into a religion that holds a firm stance against pornography and are indoctrinated into that religion are more likely to become addicted?

I would say yes, people can remained unbiased if they are researchers. Sometimes bias can impact our research, the kind of questions we ask and how research is conducted. That being said i believe the field of sexuality has researchers from all different walks of life researching this topic. Some that are secular, some that are religious. Overall the research in this area is pretty solid.

People from religious backgrounds are more likely to have sexual shame and sometimes rigidity around their thinking about sexuality. As such sometimes those more conservative think they are addicted when they actually may not be. That being said research does show that people with religious backgrounds have a higher prevalence of sex addiction. This could be due to some of these false positives.

What percentage of addicts do you observe achieving long-term recovery?

Unfortunately we do not have good outcome data and stats for couples in recovery. I will say that it surprises me how many couples stay together and are successful in recovery. Especially if they've gotten the right treatment with a certified therapist. Recovery is absolutely possible and couples can heal from this.

Why do people sometimes feel depressed after masturbating?

One of 2 reasons. First, they may have a lot of shame around masturbation and been taught that it's a sin or unhealthy or they shouldn't be doing it. As a result this can cause despair or depression after. The second reason is when it occurs in an addiction. When a sex/porn addict acts out sexually they often get into a cycle where they engage in the addictive cycle. The addictive cycle starts with negative belief systems about themselves which can trigger distorted thought patterns such as rationalization, excuses, denial, "I'm not hurting anyone, I deserve this" which triggers preoccupation about acting out so they cannot stop thinking about it. Then they engage in porn/sexual acting out and they are filled with shame and remorse afterwards which contributes to unmanageability in their lives and confirms their negative belief system of themselves. And the cycle repeats...

There was an IAMA posted ages ago by a wife whose husband was arrested for possessing underaged porn. Really underaged in some instances. She said something along the lines that this husband grew addicted to porn and it started off with typical adult porn and regressed to horrific child porn, because he was seeking the next best thrill/extreme. Apparently it was only a small percentage of the porn found on his computer.

Is this possible? Or do you think this guy was just saying this to make her feel better? Can people's sexual urges take a dramatic dark 180 or do you feel this arousal was always there?

Yes this is possible. I've seen many cases in which a porn addict's sexual taste morphed into areas that they were not normally aroused by. Often times addicts will seek more intense or graphic, novel stimuli as the addiction progresses. So it is not uncommon for porn addicts to escalate to new genres of porn they are not interested in and to progress to sites that are even outside or their orientation or outside of their personal value system.

Do you find that a lot of sex and porn addicts are more likely to have other addictions as well (drugs, alcohol) or is there no correlation?

Absolutely. Drug addictions and sex addiction are highly co-occurring. Studies have shown that in chemical dependency treatment programs 4/10 males can meet criteria for sex addiction. Another study showed that 45% of sex addicts had chemical dependency and 35% had eating disorders. They are highly co-morbid.

What if, you read(can't stand video) porn for hours, but dislike actually having sex? This is me (obviously). I lose hours reading porn, but cringe at actually being with someone. Input? Advice?

Im a female in her 20's, should be noted this usually happens when I'm manic-y, but not always. When not in a manic state I have zero intrest in sex.

You might want to read the book "Sexual Anorexia" by Patrick Carnes. If this an area you want to work on in your life I would recommend going to see a certified therapist to help you. There can be many reasons for this so it would be most helpful for you to explore it in therapy.

when I try to talk to people about porn addiction online, I'm often (and I understand why) dismissed because I can only provide anecdotal evidence of r/nofap r/pornfree or yourbrainonporn.

are there any official / professional sources about porn addiction I can use?

what is your professional opinion about stopping porn addiction? standard r/nofap way is to stop all porn/masturbation/explicit material (and even any sexual activity with partner) and wait trough months of "flatline" (zero libido). is this correct approach?

thanks

A couple of other professional websites for info/resources from professionals: www.sash.net and www.sexhelp.com.

Most therapists recommend a period of 90 days of complete sexual absence and then move on to a sexual health plan you develop with a therapist (i.e. a 3 circle plan) in which individuals identify behaviors that are healthy for them and those that are unhealthy for them. These types of sexual health plans are individualized for the client's specific behaviors and circumstances. For example, masturbation can be a healthy behavior for someone whose never struggled with compulsive masturbation. For someone who has struggled with compulsive masturbation they may have to keep that on their abstinent list for a period of time or if it's severe, maybe indefinitely. In this way the plan is individualized depending on each client's needs.