- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Neurosurgery, University of Texas School of Law, Austin, TX, USA
Department of Neurosurgery, University of Texas School of Law, Austin, TX, USA
DOI:10.4103/2152-7806.76977© 2011 Hilton DL This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Hilton DL, Watts C. Pornography addiction: A neuroscience perspective. Surg Neurol Int 21-Feb-2011;2:19
How to cite this URL: Hilton DL, Watts C. Pornography addiction: A neuroscience perspective. Surg Neurol Int 21-Feb-2011;2:19. Available from: http://sni.wpengine.com/surgicalint_articles/pornography-addiction-a-neuroscience-perspective/
A significant postulate of this commentary is that all addictions create, in addition to chemical changes in the brain, anatomical and pathological changes which result in various manifestations of cerebral dysfunction collectively labeled hypofrontal syndromes. In these syndromes, the underlying defect, reduced to its simplest description, is damage to the “braking system” of the brain. They are well known to clinical neuroscientists, especially neurologists and neurosurgeons, for they are also seen with tumors, strokes, and trauma. Indeed, anatomically, loss of these frontal control systems is most apparent following trauma, exemplified by progressive atrophy of the frontal lobes seen in serial MRI scans over time.
Although the key elements of hypofrontal syndromes—impulsivity, compulsivity, emotional lability, impaired judgment—are well described, much of the process is still unknown. One emerging aspect of these hypofrontal states is their similarity to findings in addictive patients. Addressing hypofrontality, Fowler et al. noted, “studies of addicts show reduced cellular activity in the orbitofrontal cortex, a brain area…[relied upon]…to make strategic, rather than impulsive, decisions. Patients with traumatic injuries to this area of the brain display problems–aggressiveness, poor judgment of future consequences, inability to inhibit inappropriate responses that are similar to those observed in substance abusers.”[
In 2002, a study on cocaine addiction demonstrated measurable volume loss in several areas of the brain, including the frontal lobes.[
Even more instructive are similar findings seen with the abuse of a normal biological behavior, eating, leading to addiction and obesity. In 2006, a VBM study was published looking specifically at obesity, and the results were very similar to the cocaine and methamphetamine studies.[
Eating, of course, is essential to individual survival, necessary for survival of the species. Another activity necessary for survival of the species is sex, an observation which leads to a series of logical questions derived from the work on obesity. Would the findings seen in eating addiction be seen in excessive sexual behavior? Can sex be addictive in the neurological sense? If so, are there associated with the addiction anatomical changes in the brain seen with other addictions?A recent study supports growing evidence that compulsive sexuality can indeed be addictive. In 2007, a VBM study out of Germany looked specifically at pedophilia, and demonstrated almost identical finding to the cocaine, methamphetamine, and obesity studies.[
A decade ago Dr. Howard Shaffer at Harvard wrote, “I had great difficulty with my own colleagues when I suggested that a lot of addiction is the result of experience … repetitive, high-emotion, high-frequency experience. But it’s become clear that neuroadaptation—that is, changes in neural circuitry that help perpetuate the behavior—occurs even in the absence of drug-taking.”[
In 2005, Dr. Eric Nestler wrote a landmark paper describing all addiction as a dysfunction of the mesolimbic reward centers of the brain. Addiction occurs when pleasure/reward pathways are hijacked by exogenous drugs such as cocaine or opioids, or by natural processes essential and inherent to survival such as food and sex. The same dopaminergic systems include the ventral tegmental area with its projections to the nucleus accumbens and other striatal salience centers. He wrote, “Growing evidence indicates that the VTA-NAc pathway and the other limbic regions cited above similarly mediate, at least in part, the acute positive emotional effects of natural rewards, such as food, sex and social interactions. These same regions have also been implicated in the so-called ‘natural addictions’ (that is, compulsive consumption for natural rewards) such as pathological overeating, pathological gambling, and sexual addictions. Preliminary findings suggest that shared pathways may be involved: (an example is) cross-sensitization that occurs between natural rewards and drugs of abuse.”[
This attention to process (or natural) addictions requires focus on metabolic dysfunction in the mesolimbic salience pathways. Just as exogenously administered drugs cause downgrading of dopamine receptors in the nucleus accumbens in addiction, evidence supports endogenously functioning neurotransmitters causing similar pathology.
The prestigious Royal Society of London, founded in the 1660s, publishes the longest running scientific journal in the world. In a recent issue of the Philosophical Transactions of the Royal Society, the current state of the understanding of addiction was reported as it was discussed by some of the world’s leading addiction scientists at a meeting of the Society. The title of the journal issue reporting the meeting was “The neurobiology of addiction—new vistas.” Interestingly, of the 17 articles, two were specifically concerned with evidence for natural addiction: pathologic gambling[
Even more pertinent are recent papers published in 2010 describing the effect of sexuality on neuroplasticity. In one study, sexual experience has been shown to induce alterations in medium spiny neurons in the nucleus accumbens similar to those seen with drugs of abuse.[
Dr. Nora Volkow, Head of the National Institute on Drug Abuse (NIDA), and one of the most published and respected scientists in the field of addiction is, in recognition of the change in the understanding of natural addiction, advocating changing the name of the NIDA to the National Institute on Diseases of Addiction, as quoted in the journal Science: “NIDA Director Nora Volkow also felt that her institute’s name should encompass addictions such as pornography, gambling, and food, says NIDA adviser Glen Hanson. ‘She would like to send the message that [we should] look at the whole field.’”[
With the increasing evidence that overeating can be an actual addiction as defined by measurable, verifiable changes in the limbic salience centers, our attention to this problem is appropriately increasing. Yet sexuality, with its moral ties, is handled much less objectively in scientific debate. This was apparent in the aftermath of the Hogg study published in 1997, which demonstrated a 20-year decrease in life expectancy for male homosexuals.[
The proposed DSM-5, slated to publish in May of 2014, contains in this new addition the diagnosis of Hypersexual Disorder, which includes problematic, compulsive pornography use.[
In 2006 world pornography revenue was 97 billion dollars, more than Microsoft, Google, Amazon, eBay, Yahoo, Apple, and Netflix combined.[
Certainly our role as healers suggests we can do more to investigate and treat human pathology related to this new entity of process or natural addiction, particularly given the growing weight of evidence supporting the neural basis of all addictive processes. Just as we consider food addiction as having a biologic basis, with no moral overlay or value-laden terminology, it is time we looked at pornography and other forms of sexual addiction with the same objective eye. Currently, social pressures relegate the management of pornography primarily to proceedings in civil or in criminal judicial venues.[
In concluding this thought, a Public Health profile of pornography might be useful. Any such profile by its nature will be somewhat primitive because of the current status of the knowledge of the addiction and the environment in which it occurs.
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