Psy-Q: Can sex or viewing pornography provide a mental health boost (if there’s no addiction)?

Answer:

Possibly, as sex can be an important way for people to express intimacy, but there are many factors to consider. Psycom Pro discussed this issue with Marc Potenza, PhD, MD, professor of Psychiatry, Child Study, and Neuroscience at the Yale University School of Medicine.*

“It’s unclear the extent to which pornography viewing may be done to relieve stress or other factors,” Dr. Potenza says. In a study that looked at the rise in pornography use during the early weeks of the COVID-19 pandemic, his team reported that peak viewing time for pornography was between 1:00 am and 3:00 am local time, which makes him question whether people were choosing a healthy pattern of behavior. “It seems like people were perhaps not sleeping and engaging in pornography viewing; even if this pattern of viewing is not addictive, it may be disruptive and reflect something upsetting or disturbing going on in someone’s life,” he says.

He emphasizes the importance of gathering data. “One can have hypotheses about whether there will be negative or positive effects to specific patterns of internet use,” he says. “It’s important for people not to over-pathologize everyday behaviors.”

On the other hand, Dr. Potenza says that it is important to understand when people are experiencing negative impacts from the types and patterns of their engagement and to understand the more nuanced and subtle aspects of behavioral addictions and how they affect people’s lives.

In terms of treatment for compulsive sexual behaviors (CSBs), we may learn from approaches used to treat behavioral addictions like gambling disorder, he suggests. These methods include CBT, motivational interviewing, brief intervention, a 12-step program, and partner-based self-help. No medications have FDA indications for gambling disorder or other behavioral addictions, and studies of gambling disorder have shown a high placebo response rate. ACT has some support for compulsive sexual behavior and pornography viewing, but research is in the early stages.

More research is necessary, but unfortunately, Dr. Potenza says this is not a “heavily funded” area of study in the US. Evaluation of treatments will be valuable in order to obtain further empirical support for specific treatments and to gain a better understanding of what works best for different people, he says.

“We also should consider behaviors within a developmental framework, particularly because children and adolescents are viewing pornography,” says Dr. Potenza. “We need to understand what impact such viewing may be having on the development of their sexual arousal templates, their future relationships, how they function sexually within relationships—all of this is something that we need to understand better, particularly given the content of pornography readily available on the internet.”

And although compulsive sexual behaviors do not have a formal diagnostic description in the DSM-5 (hypersexual disorder was considered but not included), perhaps with more research that could change. Dr. Potenza adds, “It may be that as more data accumulate over time, compulsive sexual behavior disorder may follow the path of gambling disorder and be classified together with substance use disorders as addictive disorders. Time will tell.”

Clinical Resources

Dr. Potenza recommends these resources to psychiatrists and mental health clinicians working with clients on compulsive sexual behaviors and/or online addiction:

 

*Of note, Dr. Potenza also serves as director of Yale’s Division on Addictions Research, the Center of Excellence in Gambling Research, the Yale Program for Research on Impulsivity and Impulse Control Disorders, the Women and Addictive Disorders Core for Women’s Health Research, and is a senior scientist at the Connecticut Council on Problem Gambling.

Last Updated: Apr 21, 2021