The Rise of Sex, Pornography, and Online Addiction During the Pandemic

What’s happening – People who feel moral incongruence (ie, a misalignment of moral feelings about behavior and engagement in that behavior) about using pornography may perceive themselves as being addicted to porn – the same is true for internet use, social networking, and online gaming, according to a new study. Research into the relationship between moral incongruence and the use of pornography is well established – but this study is unique in that it links that relationship to other online behaviors. With people spending more time at home during the pandemic, many are turning to new ways (or old habits) to cope with the stress of lockdowns, financial uncertainty, and isolation.

The details – Read the full study by Lewczuk et al in Addiction.

The perspectives

  • An April letter to the editor of the Journal of Behavioral Addictions reviewed global changes in patterns of pornography use as lockdowns began and discussed how problematic pornography use can disrupt lives. The authors question whether changes in use will lead to long-term behavioral problems for people. More from the corresponding author, Yale’s Marc Potenza, MD, PhD, in this week’s Psy-Q trivia.
  • A three-part series on addiction during COVID-19 covers how isolation could increase substance abuse, eating disorders, and sex/porn addiction. A similar article discusses an increase in junk food, gambling, and gaming during the pandemic.
  • A webinar dives into the rise in porn addiction during the COVID-19 pandemic, including an overview of the problems that compulsive pornography users face and the increased usage stats of porn consumption after a major pornography website made access free in March.
  • Resources for where to direct patients to get help include a meetings locator from Sex Addicts Anonymous (telemeetings are available) and tips for alleviating porn addiction from an addiction recovery center.

Why it’s complicated – Clinicians will not find sex addiction or pornography addiction listed as diagnoses in the DSM-5; they are considered behavioral addictions or non-substance addictions. These and other problematic behaviors, such as addiction to exercise and shopping were considered for inclusion, but there was no agreement on how to define the diagnostic criteria. DSM-5 replaced the DSM-IV category of “Substance-related Disorders” with “Substance-related and Addictive Disorders.” Currently the only disorder in the subsection “Non-substance-related disorders” is gambling disorder, although Internet gaming disorder is listed as a condition requiring further study. More in this week’s trivia Q&A.

  • A meta-analysis discusses similarities between sex addiction, internet addiction, and compulsive buying, and evaluates treatments for these behavioral addictions compared to those for substance abuse and gambling disorder.
  • A study in Addiction examines compulsive sexual behavior (CSB) and similarities to substance addictions, and a commentary in the same issue discusses the history of diagnosis options for CSB in the DSM and the WHO’s International Classification of Diseases (ICD).
  • Practically speaking, treatment strategies are outlined in the second edition of Clinical Management of Sex Addiction, published last year.

In practice – The pandemic has triggered those with anorexia nervosa, bulimia nervosa, and binge-eating disorders as well. Here’s how mHealth apps may improve treatment adherence.

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

Get the answer with Yale's Marc Potenza, PhD, MD

Get the Answer

COVID Isolation and the Mental Health Consequences Among Nursing Home Residents

What’s happening – Quarantine and lockdown measures have been especially difficult for older adults living in nursing homes and long-term care facilities, where visitors were prohibited for weeks or months at a time this year in an effort to stop the spread of COVID-19 to this vulnerable population. Keeping older adults isolated seems logical to protect them from the virus as they are at increased risk, but what are the effects of quarantine on their mental health? Not good, as several studies have revealed. The social isolation is taking a serious toll.

The perspectives

  • Canadian nursing home re-opening policies for visitors and family caregivers were influenced by the rapid decline of not only the mental health, but also the physical, functional, and cognitive health of residents. The health risks associated with restrictive visitor policies were deemed to “outweigh the potential benefits” of trying to prevent infection among residents through isolation. Guidelines for creating evidence-based, expert-informed visitor policies are presented in JAMDA.
  • A study out of The Netherlands discusses the problems faced by mental health and nursing home facilities during COVID and shares solutions.
  • Depression and anxiety increased among people with Alzheimer’s disease in nursing homes during the pandemic, according to a paper in Psychiatry Research. (More on understanding Alzheimer’s through music below.)

Worth noting

  • We know that healthcare workers are being pushed to the limit. High levels of post-traumatic symptomatology and anxiety were reported in residential nursing and care home workers in a study conducted in Italy after the first wave of the virus this past spring.
  • Some good news: This week, the CDC’s advisory group recommended that the first available COVID vaccines should go to healthcare workers and residents in nursing homes and other long-term care facilities. If the CDC director approves the plan, states will most likely follow it (although they are not required to) and the first round of vaccinations could be administered by the end of December 2020.
  • A recent AP story reports on a “surge” in nursing home deaths due to neglect, suggesting that HCPs are so busy with COVID-19 patients that they are not able to provide other patients with the care that they need. Several families who lost loved ones are profiled.
  • A psychologist calls for better integration of psychological services within nursing homes.

The conversation

  • @NBCNews tweeted, “The hidden coronavirus health crisis: Elderly people are dying of isolation in nursing homes” and linked to their article about the physical and mental health declines of seniors in long-term care facilities.
  • This graphic from @VectorSting (Dr. Victor Tseng) predicts the aftershocks of the pandemic in healthcare and was noted in The Netherlands study (mentioned above) as something that the healthcare industry should prepare to deal with. Dr. Tseng engages with the many comments and questions he received about his graphic.
  • @kathryniveyy, an ICU nurse, posted her version of the “How it started/How it’s going” meme and it went viral last week. Kathryn became a nurse in May and discusses her experience with CNN.

In practiceCould pets help with isolation and loneliness in older adults? Plus, how to manage growing substance use among older adults during COVID.

Music and TikTok Are Educating Teens about Alzheimer’s and Dementia

What’s happening – Empathy is having a moment. Dementia was recently a trending topic among young people on social media, with many teens moved to tears by the effects of an artist’s audio imagining of the condition. The melodies in the six-and-a-half-hour album, called Everywhere at the End of Time, deteriorate and distort through six stages of decline, allowing listeners to experience confusion and repetition until things become unintelligible, thus mimicking the disease. Song titles like “Advanced Plaque Entanglements” and “Synapse Retrogenesis” show the artist’s research into the subject.

Listeners expressed empathy for family members who were diagnosed with dementia and Alzheimer’s disease, and reading through the video’s comments reveals connections that people made with their feelings toward their own loved ones.

The details – Check out the video, which includes chapters for each song in each of the album’s six stages, by The Caretaker. The New York Times and Daily Dot reported on a TikTok challenge to listen to the entire album.

Why it’s complicated – In both research and practice, music has demonstrated a therapeutic effect on individuals with dementia, but the underlying mechanisms between music and memory are not fully understood. A body of research on the relationship between music, cognition, memory, and emotion aims to try to improve outcomes for those living with dementia.

Worth noting

The conversation

  • @LeylandKirby (Leyland Kirby aka The Caretaker), creator of Everywhere at the End of Time, acknowledged his video’s 2.6 million views this year (at 5.4 million at the time of this reporting) and thanked fans for listening and supporting his work.
  • @UATheatreDance, the University of Alabama’s theater and dance program, tweeted a link to a moving viral video of a former ballerina with Alzheimer’s dancing from her wheelchair, saying, “All her years of training come rushing back and she remembers the Swan Lake choreography she performed many years prior.”
  • A similar video of a 92-year-old woman with dementia playing Beethoven on the piano was highlighted by @abc7newsbayarea, quoting the pianist’s daughter as saying, “My mom, a professional musician, has significant dementia, but life makes sense to her at the piano.”
  • @AlzheimersLA (Alzheimer’s Los Angeles) tweeted details about “Music to Remember,” an upcoming workshop by the LA Opera, saying, “Listening to or singing songs can provide emotional & behavioral benefits for people living with #Alzheimers or other #dementia & their care partners.”

In practice – More on the links between sleep and cognitive decline, sleep and schizophrenia, and how to assess for pain in those struggling with dementia and neurocognitive disorders.



Last Updated: Apr 20, 2021