Pornography-Watching Disorder and Its Risk Factors Among Young Adults: Cross-Sectional Survey
Authors: Erdős Csaba , Kelemen Oguz , Pócs Dávid , Paulik Edit , Papp András , Horváth Edina , Golan Arbel , Széll Krisztián 
Published: October 2024

Background
The widespread availability of internet-based pornography has led to growing concerns about its impact on mental health, particularly among young adults. Despite increasing recognition of problematic pornography use, standardized diagnostic criteria for pornography addiction are lacking.

Objective
This study aimed to address this gap by applying adapted DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) criteria to evaluate “pornography-watching disorder” (PWD) in a large sample of young adults in Hungary. The primary objective was to assess the prevalence of PWD among young adults and identify key risk factors associated with its development using DSM-5 criteria adapted for pornography use. It also aimed to advance the understanding of PWD as a potential behavioral addiction.

Methods
A cross-sectional web-based survey was conducted between September and December 2018, targeting young adults aged 18-35 years in Hungary. Participants were recruited through social media and the University of Szeged Albert Szent-Györgyi Medical School’s web page. Of the 9397 respondents, 7187 (76.5%) had previously consumed pornography and were included in the analysis. PWD was measured using 10 statements adapted from the DSM-5 substance use disorder criteria. Multivariable binary logistic regression was used to identify significant predictors of PWD.

Results
The prevalence of PWD in the sample was 4.4% (n=315). Frequent pornography consumption was a significant risk factor, with weekly users (odds ratio [OR] 0.45, 95% CI 0.33-0.62, P<.001), monthly users (OR 0.18, 95% CI 0.11-0.28, P<.001), and less than monthly users (OR 0.05, 95% CI 0.03-0.10, P<.001) showing significantly lower odds compared with daily users as a reference category. Male sex was associated with a higher risk (OR 0.53, 95% CI 0.39-0.72, P<.001), as were early exposure to pornography (OR 0.94, 95% CI 0.90-0.98, P=.006), paraphilia (OR 3.95, 95% CI 2.37-6.56, P<.001), dissatisfaction with sexual life (OR 0.94, 95% CI 0.90-0.98, P=.006), difficulty forming personal relationships (OR 0.93, 95% CI 0.88-0.98, P=.005), and strong adherence to religious norms (OR 1.12, 95% CI 1.06-1.19, P<.001). Protective factors included adequate sexual education (OR 0.67, 95% CI 0.53-0.87, P=.02) and residing in the capital (OR 0.52, 95% CI 0.30-0.91, P=.02). The use of an anonymous web-based questionnaire likely reduced the influence of stigma, resulting in more accurate self-reporting of sensitive behaviors.

Conclusions
This study is among the first to apply DSM-5 criteria to evaluate PWD, providing important insights into its prevalence and associated risk factors in young adults. The findings highlight the need for standardized diagnostic tools for PWD and suggest targeted interventions, particularly for high-risk groups. These results contribute to the ongoing discussion about whether pornography addiction should be recognized as a distinct behavioral disorder.