Socioaffective Neuroscience & Psychology

ISSN: (Print) 2000-9011 (Online) Journal homepage: https://www.tandfonline.com/loi/zsnp20

Pornography addiction – a supranormal stimulus

considered in the context of neuroplasticity

Donald L. Hilton Jr.

To cite this article: Donald L. Hilton Jr. (2013) Pornography addiction – a supranormal stimulus
considered in the context of neuroplasticity, Socioaffective Neuroscience & Psychology, 3:1, 20767,
DOI: 10.3402/snp.v3i0.20767

To link to this article: https://doi.org/10.3402/snp.v3i0.20767

© 2013 Donald L. Hilton

Published online: 19 Jul 2013.

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BRAIN AND ADDICTION
æ

Pornography addiction
a supranormal

stimulus considered in the context of
neuroplasticity
Donald L. Hilton Jr., MD*
Department of Neurosurgery, The University of Texas Health Sciences Center at San Antonio, USA

Addiction has been a divisive term when applied to various compulsive sexual behaviors (CSBs), including
obsessive use of pornography. Despite a growing acceptance of the existence of natural or process addictions
based on an increased understanding of the function of the mesolimbic dopaminergic reward systems, there
has been a reticence to label CSBs as potentially addictive. While pathological gambling (PG) and obesity
have received greater attention in functional and behavioral studies, evidence increasingly supports the
description of CSBs as an addiction. This evidence is multifaceted and is based on an evolving understanding
of the role of the neuronal receptor in addiction-related neuroplasticity, supported by the historical behavioral
perspective. This addictive effect may be amplified by the accelerated novelty and the ‘supranormal stimulus’
(a phrase coined by Nikolaas Tinbergen) factor afforded by Internet pornography.
Keywords: brain; addiction; pornography; neuroplasticity; sexuality

Received: 4 March 2013; Revised: 1 June 2013; Accepted: 1 June 2013; Published: 19 July 2013

uch of the consternation regarding whether substances of abuse, there has hitherto been a reticence

M compulsive sexual behavior (CSB) is an addic-

tion or some milder malady likely relates
to how we define the term itself. It is evident that the
regarding its application to what are now referred to as
endogenous, process, or natural addictions.
In 1983, Patrick Carnes introduced the term ‘sexual
word ‘addiction’ has been reluctantly utilized in mental addiction’ based on behavioral parameters (Carnes,
health nomenclature; one need look no further than the 1983). Others have supported a behavioral model for
Diagnostic and Statistical Manual of Mental Disorders sexual addiction; consider, for instance, the recent paper
(DSM) for evidence of this. In past versions, addictive by Garcia and Thibaut, which stated, ‘The phenomenol-
behavior was more diffusely described in various sections; ogy of excessive nonparaphilic sexual disorder favors its
the DSM-5 has changed this and has added a classifica- conceptualization as an addictive behavior, rather than
tion using the word addiction. an obsessive-compulsive, or an impulse control disorder’
The DSM manuals have historically been atheoretical, (Garcia & Thibaut, 2010).
that is, based on behavioral observation and interview Angres and Bettanardi-Angres (2008) defined addic-
rather than focusing on biological etiology. The practical tion as ‘the continued use of mood-altering addicting
significance is that the DSM can thus function as a substances or behaviors (e.g. gambling, CSBs) despite
manual for clinicians in the field; they can diagnose and adverse consequences’, and Bostwick and Bucci (2008)
treat mental illness, including addictive behavior, based have used the addition label in the context of Internet
on observation and interview, rather than by relying on pornography. There is a growing tendency to apply the
diagnostic scans and laboratory results. term sexual addiction to CSBs, with a realization that
To understand why the word addiction has met sexual motivation is complex, with affective, motiva-
resistance in this context, it is useful to consider its tional, and cognitive factors affecting expression of the
historical meaning in the lexicon. An early, and possibly biologic drive to reproduce. For instance, Estellon and
the first, recorded use of the word addiction in a medical Mouras (2012) described a progressive convergence of
context was a statement in the Journal of the American psychoanalytic and neuroscientific perspectives as ap-
Medical Association in 1906: ‘It matters little whether plied to sexual addiction.
one speaks of the opium habit, the opium disease, or the Addiction neurobiologists increasingly support the
opium addiction’ (Jelliffe, 1906). While few now dispute concept of the existence of natural addictions, as func-
using the word in relation to exogenously consumed tional and cellular evidence continues to accumulate.

Socioaffective Neuroscience & Psychology 2013. # 2013 Donald L. Hilton. This is an Open Access article distributed under the terms of the Creative Commons Attribution 1
3.0 Unported (CC BY 3.0) Licence (http://creativecommons.org/licenses/by/3.0/), permitting all non-commercial use, distribution, and reproduction in any medium,
provided the original work is properly cited. Citation: Socioaffective Neuroscience & Psychology 2013, 3: 20767 - http://dx.doi.org/10.3402/snp.v3i0.20767
(page number not for citation purpose)
Donald L. Hilton

This model is based on a motivational platform emanat- Zohar, Tavares, & Potenza, 2011), thus meriting the
ing from a robustly conserved mesolimbic reward system, addiction label, it is inconsistent to deny the same label
with a dopamine-mediated salience drive projecting from to Internet pornography addiction. It is precisely this
the midbrain to other systems essential to survival. This inconsistency that supports the premise that cultural
process enables and enhances neuronal learning through and political biases tend to minimize addictive sexual
micro- and macro-neuroplastic change. Addiction is no behavior.
longer defined simply by behavioral criteria. It is surprising that food addiction would not be
Human consumptive behavior regarding food and sex included as a behavioral addiction, despite studies
is more complex than a simple stimulus
response reflex. demonstrating dopaminergic receptor downregulation
Georgiadis (2012) stated that human sexuality demon- in obesity (Wang et al., 2001), with reversibility seen
strates ‘clear involvement of high end cerebral cortical with dieting and normalization of body mass index
areas, possibly hinting at high level ‘‘human functions’’, (BMI) (Steele et al., 2010). The concept of a ‘supra-
like perspective taking’. Executive input from frontal normal stimulus’, invoking Nikolaas Tinbergen’s term
regions can modulate the mesencephalic dopaminergic (Tinbergen, 1951), has recently been described in the
reward impetus projecting to the nucleus accumbens
context of intense sweetness surpassing cocaine reward,
ventral striatal reward region. Nevertheless, the powerful which also supports the premise of food addiction
drives to eat and to procreate are successfully expressed (Lenoir, Serre, Laurine, & Ahmed, 2007). Tinbergen
in species that survive, and lines that do not reproduce originally found that birds, butterflies, and other animals
with net-positive fertility rates, for whatever reason, could be duped into preferring artificial substitutes
become extinct. Regardless of how higher cortical func- designed specifically to appear more attractive than the
tion colors sex with other recreational nuances, evolu- animal’s normal eggs and mates. There is, of course,
tionary procreative pressures eventually trump purely a lack of comparable functional and behavioral work in
recreational motives in biologically successful species, the study of human sexual addiction, as compared to
including humans. gambling and food addictions, but it can be argued that
The evidence supporting the concept of natural addic- each of these behaviors can involve supranormal stimuli.
tion is multithreaded, with the behavioral thread being Deirdre Barrett (2010) has included pornography as an
only one component of the growing tapestry of support- example of a supranormal stimulus.
ing research. Functional imaging studies, correlated Support for the existence of process addictions,
with behavior, are of obvious interest, but metabolic though, has increased with our understanding of synaptic
and genetic factors are becoming more relevant. It was and dendritic plasticity. Is there evidence supporting the
over a decade ago that realization began to increase existence of pornography addiction? It depends on what
regarding the existence of process addictions (Holden, one accepts, or can understand, as evidence, and this is
2001). This awareness has engendered a maturation in a function of perspective and education. Perspective can
understanding the role of the mesolimbic dopaminergic introduce bias, and our perspectives are influenced by
reward pathways in both drug and natural addictions factors such as our personal educational and life experi-
(Nestler, 2005, 2008), a process that culminated in the ences. What may be meaningless to one may be definitive
American Society of Addiction Medicine’s (ASAM) defi- proof to another depending on differences in knowledge
nition in August 2011 (known as the ASAM long that is esoteric to the field in question. As T. S. Eliot
definition). The new ASAM definition describes addic- said, ‘Where is the knowledge we have lost in informa-
tion as a chronic disease of the brain that affects tion?’ (T. S. Eliot, Choruses from The Rock, opening
the reward, motivation, and memory systems, and stanza, 1934).
combines both substance and behavioral addiction under Information, or data, becomes knowledge as it is
a common umbrella. organized into theory and as theory is coalesced into
The addition of a sub-section on behavioral addiction belief systems, or paradigms. Kuhn (1962/2012) noted
in the DSM-5 is also recognition of this change of that when established paradigms are challenged by
perspective on natural addiction. However, this sub- anomalies, scientists tend to defend the status quo until
section includes only one process addiction, pathological it becomes apparent that emerging evidence and theory
gambling (PG) (Reuter et al., 2005), while relegating have rendered the status quo obsolete, thus precipitating
Internet gaming disorder, overconsumtion of food and a paradigm shift. Paradigm shifts are not painless, as
sex, and other process addictions to a section titled Galileo, Ignaz Semmelweis, and others who challenged
‘Conditions for Further Study,’ or ignoring them com- prevailing dogma learned.
pletely. While it is consistent with recent behavioral Addiction’s initial paradigm was defined solely based
and functional data that PG is now recognized as on behavioral criteria. What Kuhn would term a para-
more closely modeling substance abuse rather than digmatic ‘crisis’ has emerged with neuroscience develop-
obsessive
compulsive disorders (El-Guebaly, Mudry, ing what is essentially a parallel
and, obviously to the

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 Pornography addiction

strict behavioralists, a competing
paradigm with the Another summary of the arguments against the con-
introduction of the concept of behavioral (process) cept of addictive sexuality is found in The Myth of Sex
addictions. From the neuroscience vantage point, these Addiction by David Ley. The book also describes CSBs
are indeed parallel, and even contiguous, paradigms, from a behavioral vantage point, with neurobiological
as former diagnostic criteria defining substance addiction evidence informing debate on the existence of natural
appear to some (Garcia & Thibaut, 2010) to dovetail with addiction being dismissed with the previously referenced
those defining behavioral addictions. quote from the Reid response to the Hilton-Watts
The crisis exists in the strictly behavioral paradigm, editorial: ‘speculative not scientific’.
particularly with regard to labeling CSBs as addic- Interestingly, the brain is seen by Ley as a ‘complex,
tive. For instance, a paper supporting the concept of multidetermined ‘‘black box’’ that we are just barely
natural addiction, specifically focusing on pornography beginning to understand . . . complex behaviors such as
(Hilton & Watts, 2011), argued that both micro- and sex promise to be a riddle for many long years to come’
macro-neuroplasticity substantiate the existence of such (Ley, 2012). Again, this paradigmatic gap is seen in
addictions. A response (Reid, Carpenter, & Fong, 2011) the veiling of neuroscience with a veneer of mystery
countered that the studies cited supporting macroscopic and ‘riddle’, and a promise that we will not be able to
neuroplasticity in addictive behaviors, being correlative, understand sexual neuroscience for many years; certainly
have no bearing on causation with regard to addiction. not now!
Focusing on any changes likely relating more to meta- Rather than focusing on whether the addictive beha-
bolic effects (high blood sugar, high lipid levels, and so vior involves injecting drugs or viewing highly arousing
on), this response is dismissive of a neuroplastic effect sexual images, an increased knowledge of cellular mecha-
relating to learning. Skeptical of any natural addiction nisms allows us to understand that addiction involves and
alters biology at the synaptic level, which then affects
causing morphologic changes, they discount evidence
subsequent behavior. Addiction neuroscience is now as
corroborating the existence of food or exercise addiction,
much about neuronal receptor reactivity, modulation,
and specifically the inference that these behaviors could
and subsequent plasticity as it is about destructive and
affect morphological changes in the brain. Interestingly,
repetitive behavior.
they admit that they are more accepting ‘of a causal
Some demand a higher standard of proof for sex
mechanism . . . when substances are involved’, thus
than for other behaviors and substances when it comes
demonstrating the resistance that Kuhn predicted to
to defining addiction. For instance, a strictly behavioralist
changes in the old paradigm that substances alone can
perspective was illustrated in declaring that for pornogra-
cause true addictions. This gap between the behavioral
phy to be labeled addictive, we would have to prospectively
and biologic paradigms is further demonstrated in their
addict one cohort of children, protect another, function-
assessment of the importance of molecular biology in
ally scan both cohorts before and after, and compare
the addiction debate. Strict behavioralists minimize the behavioral outcomes (Clark-Flory, 2012). Obviously, this
relevance of DeltaFosB, for instance, to addiction, and study cannot be conducted, given the ethical issues
opine that DeltaFosB cannot inform the pornography involved. Yet, we presume that even those supporting
debate because there are no studies in humans specifically this behavioral perspective would accept the premise that
investigating DeltaFosB in the context of pornography. tobacco is addictive without demanding the same pro-
In discussing their perspective, Reid et al. cite their spective, child-based study. In other words, where is
own work and avoid identifying sexuality as potentially the comparative prospective study with tobacco in chil-
addictive. They see problematic consumptive behaviors, dren? The one that divides the children, gives half
whether to cocaine, food, alcohol, or sex, as separate cigarettes, protects the others, and follows them longi-
disorders (as per the DSM) and therefore resist any tudinally? It does not exist, of course, and never will,
generalization as being ‘speculative not scientific’ (Reid and therefore some will still say that smoking is not
et al., 2011). This stance is not surprising when con- addictive. So said the seven tobacco executives in front
sidered in the context of the paradigm in which they were of Henry Waxman’s subcommittee on Health and the
trained, which has focused more on behavior rather than Environment in 1994: in succession, each said ‘No’ when
on integrating emerging biological evidence as well. The asked if smoking was addictive, included supporting
reader is encouraged to study the commentary on expert testimony (UCSF Tobacco Control Archives,
the Reid response by Hilton and Watts immediately 1994). Yet based on an extensive body of research, virtually
following and contiguous with the response. That a sepa- everyone
excluding these tobacco executives and their
rate neuroscience addiction paradigm has emerged has experts
believes that evidence exists for tobacco’s
provoked a Kuhnian crisis, as these views merge into a addictive properties. For that matter, where are the
new and cohesive biological
behavioral paradigm defin- prospective child-based cocaine, heroin, and alcohol
ing addictions both to substances and to behaviors. studies?

Citation: Socioaffective Neuroscience & Psychology 2013, 3: 20767 - http://dx.doi.org/10.3402/snp.v3i0.20767 3

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The main difference is that we now understand increases dendritic spine density in medium spiny neu-
learning-mediated neuroplasticity and neuronal recep- rons in the nucleus accumbens in addicted animals during
tor reactivity, including nicotinic acetylcholine, opioid, extended periods of abstinence through stimulation of the
glutamate, and dopamine receptors, much better than we protein Cdk5, thus becoming a bridge to more extended
did in the past. We can now see addiction, whether to neuroplasticity (Bibb et al., 2001; Norrholm et al., 2003).
smoking, cocaine, or sex, through the lens of the neural DeltaFosB has been shown to function in a positive
receptor and subsequent neuroplastic change, and not feedback loop with Calcium/Calmodulin-Dependent Pro-
solely from a behavioral perspective. tein Kinase II to effect neuroplastic cellular responses in
To accept the evidence supporting the concept of cocaine addiction. Significantly, this association was also
sexual addiction, it is necessary to have an understanding demonstrated, for the first time, in human cocaine
of the current concepts of cellular learning and plasticity. addiction (Robison et al., 2013).
Dendritic arborization and other cellular changes precede Recent evidence has demonstrated that DeltaFosB is
gyral sculpting (Zatorre, Field, & Johansen-Berg, 2012) critical to this dendritic plasticity through its effect on
with learning, and reward-based learning is no different. the mesolimbic reward system in both sexual and drug
Addiction thus becomes a powerful form of learning, rewards, an effect that is mediated by the D1 dopamine
with the associated neuroplasticity being detrimental receptor in the nucleus accumbens (Pitchers et al., 2013).
(Kauer & Malenka, 2007). Addiction-related learning Dopamine is critical in assigning salience to sexual cues
is merely an extension of reward-based learning in this (Berridge & Robinson, 1998), and recent studies support
model, and it therefore involves similar transcription a physiologic role in sexual function as well through its
factors and neurotransmitters. For instance, DeltaFosB effect on and interaction with the hypothalamic oxytoci-
was found over a decade ago to be chronically elevated nergic systems (Baskerville, Allard, Wayman, & Douglas.,
specifically in the medium spiny neurons of the nucleus 2009; Succu et al., 2007). This influence has been broadly
accumbens in the brains of drug-addicted laboratory conserved across phyla (Kleitz-Nelson, Dominguez, &
animals (Kelz et al., 1999). Subsequent studies have Ball, 2010; Kleitz-Nelson, Dominguez, Cornil, & Ball,
shown it to be elevated in these same cells in animals 2010, Pfaus, 2010), ensuring that sex, which is essential to
manifesting pathologic overconsumption of natural re- species survival, remains salient. Hypersexuality as a
wards, including food and sex (Nestler, 2005). consequence of dopaminergic pharmacologic interven-
Supraphysiologic levels of DeltaFosB appear to tion is a known morbidity of such treatment, and it is
portend hyperconsumptive states of natural addiction related to ‘exaggerated cue-triggered incentive salience-
(Nestler, 2008). That DeltaFosB is not only a marker but based motivation’ (Politis et al., 2013). Addiction, of
also a facilitator of hyperconsumptive behavior (as a course, can be described as disordered salience. Instead of
neuroplasticity enabler) has been well demonstrated. wanting that which will enhance survival, the addicted
Two closely related mechanisms have been used to gene- are motivated to want even when it is clearly harmful,
tically manipulate DeltaFosB independent of behavioral a neuroplastic process that recalibrates the hedonic set
variables. One involves producing lines of bitransgenic point.
mice that selectively overexpress DeltaFosB specifi- We see this neuroplasticity at the cellular level through
cally in the striatal reward areas, and the second involves dendritic arborization and other cellular changes that
the transfer of genes through adeno-associated viral provide a neuroplastic ‘scaffolding’ of sorts for new
vectors into adult animals, which then induce over- or synapses to form. Severe craving states associated with
underexpression of DeltaFosB. These genetically altered subsequent satiation have produced these micromor-
animals exhibit addictive hyperconsumptive behavior phologic changes, as demonstrated by such diverse
involving food (Olausson et al., 2006), wheel running depletion
repletion models as cocaine (Robinson &
(Werme et al., 2002), and sex (Wallace et al., 2008). For Kolb, 1999), amphetamine (Li, Kolb, & Robinson,
instance, when overexpression of DeltaFosB was im- 2003), salt (Roitman, Na, Anderson, Jones, & Berstein,
posed through these viral vectors in laboratory animals, 2002), and sex (Pitchers, Balfour et al., 2012). Salt
they exhibited a supraphysiologic enhancement of sexual depletion
repletion craving models have been shown to
performance (Hedges, Chakravarty, Nestler, Meisel, robustly mobilize the same gene sets activated by cocaine
2009; Wallace et al., 2008). Conversely, repression of models, and this mobilization is attenuated by dopamine
DeltaFosB decreases performance (Pitchers et al., 2010), antagonists, suggesting that drug addiction usurps an-
thus confirming that it has a role in normal physiologic cient incentive pathways that are essential to survival
homeostasis. (Liedtke et al., 2011).
It now appears that DeltaFosB is a molecular tran- Glutamate receptor trafficking is indicative of synaptic
scription switch that turns on other gene sets, which plasticity. Sex, as a powerful brain reward, has shown
then mediate neuroplastic change in these neurons; in evidence of increasing silent synapses, which manifest
other words, they promote neuronal learning. DeltaFosB as an increase in the NMDA
AMPA receptor ratio, a

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 Pornography addiction

harbinger of subsequent synaptic plasticity and learning as has been demonstrated in the learning plasticity studies
as these synapses are subsequently unsilenced, similar previously cited.
to what occurs with cocaine use (Pitchers, Schmid et al., Our brains naturally seek novelty, and sexuality can
2012). Specifically, this ratio change was immediate and condition a powerful reward with novelty. Primitive
long-lasting, and it was found in nucleus accumbens organisms exhibit trophic behavior conducive to survival,
neurons afferent to the prefrontal cortex, an area that is and evidence exists of dopamine-related survival incentive
important in mediating CSBs (Pitchers, Schmid et al., in chordate ancestors. Dopamine-powered motivation
2012). In this, sex is unique among natural rewards, in projected in early amniotes from the primitive mesence-
that food reward did not cause this same persistent phalon to the progressively complex telencephalon
change in synaptic plasticity (Chen et al., 2008). Criti- throughout the course of phylogeny (Yamamoto &
cally, neuroplastic changes in both dendritic morphology Vernier, 2011). Obviously, human sexual drive and sub-
and glutamate receptor trafficking were correlated with sequent volitional motivation and reward procurement
increased sexual experience and increased amphetamine are much more complex (Georgiadis, 2012) than unicel-
sensitivity, another hallmark of addiction. Even after lular trophism, but the more primitive mesolimbic dopa-
28 days, when these changes receded, the sex-induced minergic salience centers share these basic drives.
hypersensitivity to amphetamine persisted (Pitchers et al., ‘Hypersexual syndrome’, while descriptive behavio-
2013), further strengthening the evidence for natural rally, falls short of the term ‘sexual addiction’ in
addiction. describing the current state of understanding of CSBs.
Neuroplasticity as a result of learning is seen not It ignores two decades of research about how learning
only with microcellular changes, such as with arbori- changes the brain both micro- and macroscopically, and
zation, but also macroscopically with gyral sculpting it does a disservice to both professionals and the public
(Zatorre et al., 2012). Numerous studies over the last two in inconsistently exempting the most powerful natural
decades have established the fact that learning physically dopaminergic reward in the nervous system, sexual
changes the brain. Such diverse learning templates as orgasm (Georgiadis, 2006), from neuroplastic learning.
music (Elbert, Pantev, Wienbruch, Rockstroh, & Taub, Pornography is a perfect laboratory for this kind of
1995; Schwenkreis et al., 2007), juggling (Draganski novel learning fused with a powerful pleasure incentive
et al., 2004), taxi driving (Maguire, Woollett, & Spiers, drive. The focused searching and clicking, looking for the
2006), and intense studying (Draganski et al., 2006) have perfect masturbatory subject, is an exercise in neuro-
all been shown to affect morphologic alterations in gyri, plastic learning. Indeed, it is illustrative of Tinbergen’s
and negative neuroplasticity has been seen with disuse concept of the ‘supranormal stimulus’ (Tinbergen, 1951),
(Coq & Xerri, 1999). with plastic surgery
enhanced breasts presented in
This is consistent with Kauer and Malenka’s state- limitless novelty in humans serving the same purpose
ment, in their paper on synaptic plasticity and addiction, as Tinbergen’s and Magnus’s artificially enhanced
that ‘addiction represents a pathologic but powerful form female butterfly models; the males of each species prefer
of learning and memory’ (Kauer & Malenka, 2007). It is the artificial to the naturally evolved (Magnus, 1958;
therefore not surprising to learn that addiction studies Tinbergen, 1951). In this sense, the enhanced novelty
correlate with cortical atresia macroscopically. Virtually provides, metaphorically speaking, a pheromone-like
every study on addiction has demonstrated atrophy of effect in human males, like moths, which is ‘inhibiting
multiple areas of the brain, particularly those associated orientation’ and ‘disrupting pre-mating communica-
with frontal volitional control and the reward
salience tion between the sexes by permeating the atmosphere’
centers. This is true for drug addictions such as to cocaine (Gaston, Shorey, & Saario, 1967).
(Franklin et al., 2002), methamphetamine (Thompson Consider hypothetically two individuals, frantically
et al., 2004), and opioids (Lyoo et al., 2005), and also fixated to their computers, both trying to win an inter-
for behavioral conditions associated with pathologic mittently reinforced reward. Both spend hours a night
overconsumption of natural rewards and behaviors such at their task, and have for some period, to the point
as food (Pannacciulli et al., 2006), sex (Schiffer et al., of exhaustion. Work and personal relationships are
2007), and Internet addiction (Yuan, Quin, Lui, & Tian, affected negatively, yet they cannot stop. One is looking
2011; Zhou et al., 2011). at pornography, searching for just the right clip for
Recovery from addiction has been correlated with sexual consummation; the other is engrossed in an online
positive neuroplastic changes as well, such as a return to poker game. One reward is masturbatory, and the
more normal gyral volumes with recovery from metham- monetary, yet the DSM-5 classifies only the poker as an
phetamine addiction (Kim et al., 2006), and enlargement addiction. This is both behaviorally and biologically
of gray matter after mindfulness therapy (Hölzel et al., inconsistent.
2011). This reversibility is supportive of causation despite Even public opinion seems to be trying to describe this
the correlative intent of the study designs of these papers, biologic phenomenon, as in this statement from Naomi

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Donald L. Hilton

Wolf; ‘For the first time in human history, the images’ Paradigm shifts are usually best viewed historically,
power and allure have supplanted that of real naked after those who cling to outdated paradigms have become
women. Today real naked women are just bad porn’ irrelevant. During the shifts, crisis and tension predomi-
(Wolf, 2003). Just as Tinbergen’s and Magnus’s ‘butterfly nate, clouding the significance of the shift in the present.
porn’ successfully competed for male attention at the Nevertheless, the new combined paradigm that amalga-
expense of real females (Magnus, 1958; Tinbergen, 1951), mates addictions to both substances and behaviors is
we see this same process occurring in humans. beginning to assert itself, as seen in the new ASAM
Even if pornography can become addictive, the ques- definition. The DSM’s monopoly on defining all the
tion remains for some, can it be harmful? The content of parameters of mental illness, including whether or not
the most popular pornography currently consumed biological considerations may contribute, is dissolving
does appear to overwhelmingly portray aggression to- as a result of inconsistencies in the latest edition. It is not
ward women (Bridges, Wosnitzer, Scharrer, Chyng, & surprising that Thomas Insel, director of the National
Liberman, 2010), and, in homosexual pornography, men Institute of Mental Health, has lamented this continued
(Kendall, 2007). The Hald meta-analysis supports the deficiency in the DSM in stating, ‘‘A diagnostic approach
premise that pornography does indeed increase attitudes based on the biology as well as the symptoms must
of aggression toward women (Hald, Malamuth, & Yuen, not be constrained by the current DSM categories . . .’’
2010), as does the paper from Foubert and colleagues (April 29, 2013, http://www.nimh.nih.gov/about/director/
(Foubert, Brosi, & Bannon, 2011). The Hald report 2013/transforming-diagnosis.shtml). The dismissal of a
concludes, ‘In contrast to the earlier meta-analysis, the biological contribution to mental illness through the
current results showed an overall significant positive DSM’s silence and continued atheoretical stance is
association between pornography use and attitudes actually accentuating and accelerating the realization
supporting violence against women in nonexperimental that a new combined paradigm is emerging. This is
studies’ (Hald et al., 2010). Consistent with this pattern illustrated in the recent Scientific American article decry-
of aggression in pornography, the Bridges et al.’s (2010) ing the DSM’s ‘fundamental flaw: it says nothing about
study found that a representative sample of scenes the biological underpinnings of mental disorders’ (Jabr,
from the top 250 selling and renting pornographic films 2013). As Bruce Cuthbert stated, ‘We understand so
from 2004 to 2005 revealed that 41% of the scenes much more about the brain than we used to. We are really
depicted rectal followed by oral penetration, thus expos- in the middle of a big shift’ (Jabr, 2013). Indeed,
ing the woman not only to a misogynistic and demeaning it is a paradigm shift, and as understanding of the power
role, but to potentially pathogenic coliform bacteria as of the supranormal stimulus in the context of neuroplas-
well (Bridges et al., 2010). tic change continues to emerge, the contrast will be ever
This information has negative implications, in that clearer.
the vast majority of college-aged males, and a growing
number of females, use pornography regularly (Carroll Conflict of interest and funding
et al., 2008). Indeed, pornography has passed from The author has not received any funding or benefits from
toleration and acceptance to preference, with many uni- industry or elsewhere in writing this review.
versities now hosting and sponsoring ‘sex weeks’. Having
dismissed any reticence to pornography as a Victorian
moralistic, value-laden infringement on First Amend- References
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in nucleus accumbens and sensitizes rats to amphetamine. Suite 610
Journal of Neuroscience, 22(11), RC225:1
5. San Antonio
Robison, A. J., Violou, V., Mazei-Robison, M., Feng, J., Texas, 77829
Kourrich, S., Collins, M., et al. (2013). Behavioral and struc- USA
tural responses to chronic cocaine require a feedforward loop Email: [email protected]

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