Problematic porn use remains stable over time and is strongly linked to mental distress, study finds

A new longitudinal study has found that problematic pornography use tends to remain stable over time and is strongly associated with psychological distress such as anxiety and depression. The findings, published in the journal Addictive Behaviors, suggest that while some people may experience short-term relief from distress through pornography use, long-term patterns of dysregulation are tied to more persistent psychological difficulties.

Pornography is widely used in the United States and globally, but for some individuals, it can become problematic. People who experience problematic pornography use often report difficulty controlling their use and suffer negative consequences in their personal, professional, or emotional lives. The condition has recently gained clinical recognition under the diagnostic label of Compulsive Sexual Behavior Disorder in the World Health Organization’s latest classification system. Despite this recognition, little research has explored how problematic pornography use develops and changes over time, especially in relation to mental health symptoms.

Robin Engelhardt of Bundeswehr University, the lead author, was motivated by “the necessity to scientifically catch up in this field. Previous studies depicted comparatively high prevalence rates of problematic pornography use and associations with psychological distress.”

The researchers conducted a one-year, three-wave longitudinal study of over 4,300 U.S. adults. They wanted to examine how problematic pornography use and psychological distress influence each other over time and whether these patterns are stable or fluctuate. Their work builds on previous research that identified a link between pornography dysregulation and psychological distress but could not determine whether one causes the other.

Participants were recruited through a national polling company and included a combination of a general population sample and an oversample of sports bettors to increase statistical power. The final sample included 4,363 individuals between the ages of 18 and 96, with an average age of 50 and a gender distribution of roughly equal numbers of men and women. The study took place over three timepoints: March-April 2022, September-October 2022, and March-April 2023.

To assess problematic pornography use, the researchers used the Brief Pornography Screen, a five-item questionnaire designed to measure symptoms of dysregulation, such as difficulty resisting urges or using pornography in ways that cause distress. A score of 4 or higher on this measure was considered a potential indicator of problematic use. Psychological distress was measured through widely used tools for assessing anxiety and depression: the Generalized Anxiety Disorder-2 and the Patient Health Questionnaire-9. The researchers combined responses from both scales into a single composite reflecting overall distress.

The study found that problematic pornography use was highly consistent across time. Correlations between timepoints were strong, and most participants remained in the same clinical category—either below or above the threshold for potential problematic use—throughout the year. About 67% of participants consistently scored below the clinical threshold, while 14% consistently scored above it. Only a small proportion moved between categories, indicating either recovery or the development of problematic use.

Psychological distress was also stable across timepoints, and the researchers found a strong positive association between pornography dysregulation and distress at the level of individuals. That is, people who tended to score higher on pornography problems also tended to report more distress, and vice versa. This suggests a stable, trait-like relationship between the two.

Interestingly, when the researchers examined how changes in one variable might predict changes in the other over time, the results were more nuanced. They found small, negative within-person effects: when an individual experienced an increase in pornography dysregulation at one time point, they were slightly less likely to report increased psychological distress six months later. The reverse was also true. This pattern was unexpected, as many theories in psychology predict that distress and problematic behaviors reinforce one another over time.

The researchers offered a few potential explanations for this finding. One possibility is that pornography use may provide temporary relief from emotional distress, functioning as a short-term coping strategy. People experiencing anxiety or depression may turn to pornography for distraction or mood regulation, which could lead to a slight reduction in distress in the short run. However, over time, this pattern may backfire, leading to a worsening of dysregulation and deepening of psychological problems.

Another interpretation centers on the effects of depression itself. Depression can dampen a person’s general motivation and reduce interest in activities, including sexual ones. This might result in lower pornography use during depressive episodes, even among people with a history of dysregulation. In this way, depression could inhibit some of the behavioral patterns associated with problematic pornography use, at least temporarily.

Despite these small short-term effects, the dominant pattern was one of a strong and consistent link between problematic use and psychological distress across individuals. This means that, in general, people who have more difficulty regulating their pornography use are also more likely to struggle with anxiety and depression. These findings echo previous research and align with the idea that both problematic pornography use and psychological distress can reinforce each other in the long term, even if their moment-to-moment dynamics are more complex.

The findings provide evidence of “a trait-like connection between problematic pornography use and psychological distress,” Engelhardt told PsyPost. “They appear to be the same construct — problematic pornography use appears a part of psychological distress and psychological distress a part of problematic pornography use. However, cross-sectional studies may not depict this underlying strong time-consistent association due to small time-dependent inhibition effects that let the association appear smaller.”

The study has several important strengths, including its large sample size, use of validated measurement tools, and robust statistical modeling techniques that distinguish between stable traits and temporary fluctuations. However, the authors caution that the findings are based on self-report data, which can be influenced by social desirability or memory biases. Additionally, the study focused on dysregulation rather than the frequency of pornography use, which could be an important factor in understanding how and why pornography affects mental health.

Future research, the authors suggest, should investigate these dynamics in clinical populations and over longer periods. They also recommend using more fine-grained, daily tracking methods to examine short-term interactions between distress and pornography use in real-world settings. Experimental studies could also help clarify whether reducing pornography use leads to improved mental health outcomes.

The study, “Problematic pornography use and psychological distress: A longitudinal study in a large US sample,” Robin Engelhardt, Rahel Geppert, Joshua B. Grubbs, Timo von Oertzen, Dominik Trommer, Jürgen Maes, and Shane W. Kraus.