World Health Organization recognizes compulsive porn use

The World Health Organization (WHO) has made important adjustments to its Compulsive Sexual Behaviour Disorder (CSBD) diagnosis. It is now beyond all contention that CSBD encompasses compulsive pornography use. While many clinicians already considered problematic porn use to fit under the CSBD diagnosis, the World Health Organization’s changes will help prevent further online misinformation.

These changes were made in the ICD-11. What is the ICD-11?

The ICD is commonly referred to as the “International Classification of Diseases.” It is the most widely used diagnostic manual in the world. Medical and mental healthcare professionals use it to report diagnoses and track important statistics. The ICD-11 refers to its eleventh edition, which was adopted May 25, 2019. The World Health Organization maintains the ICD.

According to Dr. Richard B. Krueger, a Harvard Medical School graduate currently affiliated with Columbia University, the World Health Organization’s ICD is the most widely utilized mental health diagnosis system. In Addiction, a peer-reviewed journal, Dr. Krueger commented that the ICD’s “diagnostic codes are mandated for use in the United States and other countries by international treaty as opposed to DSM-5 diagnoses, which have no such mandate.”

What’s new?

According to a notice published on WHO’s website (on February 11, 2022), the ICD-11 recently added further “clinical descriptions” and a “diagnostic requirements” section for mental health classifications. This update resulted in new content being added to the Compulsive Sexual Behaviour Disorder diagnosis. The changes include specifying that CSBD includes the “use of pornography” and “cybersex.” It also more thoroughly debunks the myths that CSBD has anything to do with moral judgments, high sex drives, religious conflicts, or cultural conflicts.

Why are these updates important?

There is a huge amount of misinformation online spread by activists who falsely claim that porn addiction is a fringe, debunked, or pseudoscientific concept. In reality, the mainstream mental healthcare community (and the public) largely recognizes that porn addiction is a genuine issue and that excessive porn use can also lead to other adverse effects. Hundreds of studies exist on problematic porn use, and many researchers and clinicians agree that out-of-control, excessive porn use fits within the behavioral addiction model.

The World Health Organization recognizing compulsive porn use officially documents what mainstream mental health providers and the scientific community support. These experts are not being dissuaded by fringe activists who deny the existence of problematic porn use as part of unrelated cultural porn wars.

Problematic porn use isn’t about religiosity. 

Sometimes, activists or porn industry affiliates misrepresent porn addiction as being religiously motivated. In reality, porn addiction has nothing to do with religious views. Indeed, NoFap, one of the largest porn addiction recovery platforms, is secular with a largely non-religious audience. One survey indicated that only 14% of NoFap’s users listed religious reasons as a factor in joining the peer support network.

The CSBD diagnosis clarifies that distress entirely related to religious judgments regarding sexual impulses, urges, or behaviors is insufficient to meet the criteria for CSBD.

“Individuals who make religious or moral judgments about their own sexual behaviour or view it with disapproval, or who are concerned about the judgments and disapproval of others or about other potential consequences of their sexual behaviour, may describe themselves as ‘sex addicts’ or describe their sexual behaviour as ‘compulsive’ or using similar terms. In such cases, it is important to examine carefully whether such perceptions are only a result of internal or external judgments or potential consequences or whether there is evidence that impaired control over sexual impulses, urges, or behaviours and the other diagnostic requirements of Compulsive Sexual Behaviour Disorder are actually present.”

World Health Organization, ICD-11

Problematic porn use isn’t about moral conflicts with using porn.

While some people do have moral disapproval about their otherwise clinically healthy, acceptable, or unremarkable sexual behavior, this does not accurately describe the experiences of those struggling with porn addiction. The WHO pretty thoroughly covered how somebody might have anti-porn views or attitudes, but how these are not components of CSBD. One central contention by the “porn addition isn’t real” activists is that it is usually one of two things: moral disapproval of porn use or using porn to cope with other mental health issues. Many of them argue that the problems that porn addicts report experiencing aren’t caused by the porn use itself but by users’ supposed sexual shame surrounding porn use – or by the other purported mental health factors that led them to use so much porn.

According to our survey data, 68% of NoFap’s users report not experiencing shame related to their porn use or relapsing. But that doesn’t mean that the 32% of users that do experience shame are automatically disqualified from being diagnosed with porn addiction, problematic porn use, or non-porn compulsive sexual behavior. While it may be true that some porn users (particularly those from religious backgrounds) may experience shame around their porn use, solid research supports that those who believe they are addicted or struggle with compulsive porn use often actually do struggle to control their porn use. Research supports that such moral incongruence is also present at similar rates in gambling and other addictions, so it’s normal for some people who are unable to control their behavior to be conflicted about it.

Problematic porn use isn’t just a manifestation of another mental health issue.

The new diagnostic criteria rules out short-lived episodes of sexual behavior:

“Compulsive Sexual Behaviour Disorder should not be diagnosed based solely on relatively brief periods (e.g., up to several months) of increased sexual impulses, urges, and behaviours during transitions to contexts that involve increased availability of sexual outlets that previously did not exist (e.g., moving to a new city, a change in relationship status).”

World Health Organization, ICD-11

The diagnosis specifically covers the differences between CSBD and bipolar, OCD, personality disorders, paraphilic disorders, and substance use:

“Individuals with Compulsive Sexual Behaviour Disorder often engage in sexual behaviour in response to feelings of depression, anxiety, boredom, loneliness, or other negative affective states. Although not diagnostically determinative, consideration of the relationship between emotional and behavioural cues and sexual behaviour may be an important aspect of treatment planning.”

World Health Organization, ICD-11

Problematic porn use isn’t just a high sex drive.

“Individuals with high levels of sexual interest and behaviour (e.g., due to a high sex drive) who do not exhibit impaired control over their sexual behaviour and significant distress or impairment in functioning should not be diagnosed with Compulsive Sexual Behaviour Disorder. The diagnosis should also not be assigned to describe high levels of sexual interest and behaviour (e.g., masturbation) that are common among adolescents, even when this is associated with distress.”

World Health Organization, ICD-11

Is CSBD an official diagnosis for porn addiction?

Many clinicians believe that CSBD is an appropriate preliminary diagnosis for porn addicts or for people who are often referred to as “sex addicts”, but there are some nuances to consider. The World Health Organization officially recognizing Compulsive Sexual Behaviour Disorder is a significant victory for porn addicts, but there is more work to be done.

CSBD is currently in the “impulse control disorders” section.

CSBD is currently in the “impulse control disorders” section of the ICD-11, rather than the “disorders due to substance use or addictive behaviours” section. However, Gambling Disorder (what people call “gambling addiction”) started in the impulse control section, as well, before being re-categorized.

The “impulse control disorders” section also includes pyromania (impulses to set fires), kleptomania (impulses to steal), and intermittent explosive disorder (out of control aggression). Clearly, CSBD has far more in common with Gaming Disorder and Gambling Disorder than the impulse control disorders! And many scientists agree with us. We hope to see CSBD recategorized to where it belongs, the “disorders due to addictive behaviours” section, as soon as possible.

We believe there should be a separate diagnosis for people struggling with porn versus non-porn partnered sexual behavior.

Lumping together compulsive porn use and non-porn partnered behavior under one diagnosis doesn’t accurately define the situation of many problematic porn users. Many porn addicts don’t engage in compulsive partnered sexual behavior. On the contrary, many porn addicts report being less interested in partnered sex. Indeed, there’s a huge difference between porn addiction and partnered compulsive sexual behavior, although some people struggle with both. Gambling Disorder currently has three listed subtypes: predominantly offline, predominantly online, and unspecified. We hope to see the World Health Organization follow this model and create a proper separate diagnosis for compulsive porn use to make it adequately distinct from partnered, offline compulsive sexual behavior.

What is a “disorder” versus an “addiction”?

“Addiction” is a word used by most people but is not used in the names of official diagnoses in the ICD. It’s kind of like how people call those pesky insects that munch on our food “fruit flies,” but scientists technically refer to that species as “Drosophila melanogaster.”

For example, alcohol addiction is referred to as “Alcohol Use Disorder” in the American Psychiatric Association’s DSM-5. Gambling addiction is referred to as “Gambling Disorder” in the World Health Organization’s ICD-11. While most people use “porn addiction,” if adopted as a standalone diagnosis by the World Health Organization or American Psychiatric Association, the official name would likely be something like “pornography disorder” or “pornography use disorder. It might eventually be referred to in the World Health Organization’s ICD as “Compulsive Sexual Behaviour Disorder, predominantly online.”

Porn addiction is real.

The Compulsive Sexual Behaviour Disorder diagnosis from the World Health Organization in 2019 – as clarified in 2022 – helps debunk online misinformation from those who mistakenly claimed that problematic porn use is somehow “pseudoscientific” or not recognized by the mental healthcare community. It’s a clear signal that the mainstream scientific and mental healthcare communities are moving forward towards officially recognizing porn addiction.

Not only has the World Health Organization recognized that excessive porn use can be a problem, but so do many researchers and clinicians from around the world. From Marc Potenza at Yale University, to Valarie Voon at Cambridge, to Philip Zimbardo at Stanford University, people have sounded the alarm about porn addiction. Indeed, a vast amount of porn research supports that excessive porn use can lead to a variety of adverse effects, including behavioral addiction.

“classification of [CSBD] as an addictive disorder is consistent with recent data & might benefit clinicians, researchers, & individuals suffering from and personally affected by this disorder”

– Dr. Potenza, Dr. Gola, Dr. Voon, Dr. Kor, Dr. Kraus

Article originally published April 13, 2022. Last modified April 13, 2022.

2 thoughts on “World Health Organization recognizes compulsive porn use”

  1. Interesting read. I’ve never been diagnosed for any problem for that matter. I wonder what my (eventual) psychologist would say.

    Thanks

  2. There’s a lot here to digest. But the fact that science is behind recognising the reality of a struggle faced by many is surely an important step forward.

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