Problematic pornography use across countries, genders, and sexual orientations: Insights from the International Sex Survey and comparison of different assessment tools

Abstract

Background and aimsProblematic pornography use (PPU) is a common manifestation of the newly introduced Compulsive Sexual Behavior Disorder diagnosis in the 11th edition of the International Statistical Classification of Diseases and Related Health Problems. Although cultural, gender‐ and sexual orientation‐related differences in sexual behaviors are well documented, there is a relative absence of data on PPU outside Western countries and among women as well as gender‐ and sexually‐diverse individuals. We addressed these gaps by (a) validating the long and short versions of the Problematic Pornography Consumption Scale (PPCS and PPCS‐6, respectively) and the Brief Pornography Screen (BPS) and (b) measuring PPU risk across diverse populations.MethodsUsing data from the pre‐registered International Sex Survey [n = 82 243; mean age (Mage) = 32.4 years, standard deviation = 12.5], a study across 42 countries from five continents, we evaluated the psychometric properties (i.e. factor structure, measurement invariance, and reliability) of the PPCS, PPCS‐6, and BPS and examined their associations with relevant correlates (e.g. treatment‐seeking). We also compared PPU risk among diverse groups (e.g. three genders).ResultsThe PPCS, PPCS‐6, and BPS demonstrated excellent psychometric properties [for example, comparative fit index = 0.985, Tucker–Lewis Index = 0.981, root mean square error of approximation = 0.060 (90% confidence interval = 0.059–0.060)] in the confirmatory factor analysis, with all PPCS’ inter‐factor correlations positive and strong (rs = 0.72–0.96). A total of 3.2% of participants were at risk of experiencing PPU (PPU+) based on the PPCS, with significant country‐ and gender‐based differences (e.g. men reported the highest levels of PPU). No sexual orientation‐based differences were observed. Only 4–10% of individuals in the PPU+ group had ever sought treatment for PPU, while an additional 21–37% wanted to, but did not do so for specific reasons (e.g. unaffordability).ConclusionsThis study validated three measures to assess the severity of problematic pornography use across languages, countries, genders, and sexual orientations in 26 languages: the Problematic Pornography Consumption Scale (PPCS, and PPCS‐6, respectively), and the Brief Pornography Screen (BPS). The problematic pornography use risk is estimated to be 3.2–16.6% of the population of 42 countries, and varies among different groups (e.g. genders) and based on the measure used.

How much online pornography is too much? A comparison of two theoretically distinct assessment scales

“…The prevalence of POPU and CSBD is highly disputed in the literature, in part because of the diversity of instruments used to assess them, the difficulty in agreeing on cuff-off values, and doubts about sample representativeness [65]. The 1.5%, 3.2%, and 3.7% prevalence rates in our study represent a conservative cut-off and fall within the 1-15% prevalence range for online pornography "addiction" as reported by several studies published in the last 10 years [65,[70][71][72].…”

“…Still, most cases of online pornography use are likely non-problematic. Some, however, have been linked to dependence-like states and psychological symptoms [65], with studies of POPU showing prevalence rates between 1 and 15% [65,[70][71][72].…”

LGBQ-affirming clinical recommendations for compulsive sexual behavior disorder

“…According to recent measurement invariance testing, the original Compulsive Sexual Behavior Disorder Scale (Bőthe et al, 2020), as well as a short 7-item version, function similarly in LGBQ and heterosexual samples (Bőthe et al, 2023). Similarly, measurement invariance testing has been conducted on the Problematic Pornography Consumption Scale and Brief Pornography Screen, with results supporting the validity of these measures in sexual minority populations (Bőthe et al, 2024;Bőthe, Tóth-Király, Demetrovics, & Orosz, 2021;Bőthe, Vaillancourt-Morel, Dion, Stulhofer, & Bergeron, 2021). Although future research may identify ways in which minority stress confounds measurement of CSBD in LGBQ clients, these diagnostic instruments will ideally provide more valid measurement compared to existing instruments.…”

Uncovering the most robust predictors of problematic pornography use: A large-scale machine learning study across 16 countries.

“…Recent estimates suggest that 1%–38% of adults and 5%–14% of adolescents may experience PPU (Bőthe, Vaillancourt-Morel, et al, 2021; Grubbs, Kraus, et al, 2019; Lewczuk et al, 2020; Rissel et al, 2017; Štulhofer et al, 2020; Svedin et al, 2011). These varying prevalence estimates may stem from real group differences (e.g., PPU may be higher in some cultures or among specific populations, such as samples including only men; Ahorsu et al, 2023; Bőthe et al, 2023; Bőthe, Nagy, et al, 2024; Grubbs, Hoagland, et al, 2020). However, they may also derive from the different conceptualizations and measurements of PPU, leading to even higher prevalence estimates for PPU than for CSBD in some cases (Bőthe et al, 2023; Bőthe, Nagy, et al, 2024; Chen, Jiang, Wang, et al, 2022; Fernandez & Griffiths, 2021).…”

“…These varying prevalence estimates may stem from real group differences (e.g., PPU may be higher in some cultures or among specific populations, such as samples including only men; Ahorsu et al, 2023; Bőthe et al, 2023; Bőthe, Nagy, et al, 2024; Grubbs, Hoagland, et al, 2020). However, they may also derive from the different conceptualizations and measurements of PPU, leading to even higher prevalence estimates for PPU than for CSBD in some cases (Bőthe et al, 2023; Bőthe, Nagy, et al, 2024; Chen, Jiang, Wang, et al, 2022; Fernandez & Griffiths, 2021). There is a long-standing debate on the classification and symptomatology of PPU, with some suggesting that PPU may be best conceptualized as a behavioral addiction, while others consider it as an impulse control or a compulsivity-related disorder (Bőthe et al, 2022; Bőthe, Tóth-Király, et al, 2019; Brand et al, 2020; Castro-Calvo et al, 2022; Kraus et al, 2016; Ley et al, 2014; Rumpf & Montag, 2022; Sassover & Weinstein, 2020).…”