Problematic pornography use is linked to craving, shame, depression, and loneliness, meta-analysis finds

A systematic review and meta-analysis of 111 samples found that problematic pornography use tends to be higher among people who report stronger cravings, more sexual shame, depression, loneliness, emotion dysregulation, and moral disapproval of pornography. The strength of these links varied widely across studies and may partly depend on how problematic use was measured. The paper was published in Addictive Behaviors Reports.

In modern times, pornography is widely accessible through the internet. Many people worldwide use it without problems in their daily lives. However, for some individuals, pornography use becomes difficult to control and begins to interfere with relationships, work, sexual functioning, or emotional well-being. This pattern is often called problematic pornography use.

Problematic pornography use is not a formal psychiatric diagnosis. Rather, it is an umbrella term for a range of self-reported difficulties, such as feeling unable to control one’s use, being preoccupied with pornography, or feeling distressed about it. It is less about how often pornography is viewed than about whether use feels compulsive or causes significant distress or impairment.

Researchers have examined a range of factors linked to problematic pornography use. These include impulsivity, difficulties with emotion regulation, loneliness, stress, anxiety, depression, and a tendency to use pornography as a way of coping with negative emotions. Sexual factors, such as high sexual desire or dissatisfaction with one’s sex life, also seem to play a role for some people.

In addition, moral or religious conflict about pornography can intensify feelings of guilt and distress, sometimes making people perceive their use as more problematic than its behavioral pattern alone would suggest. Easy availability, privacy, novelty, and the virtually unlimited variety of online sexual content may further reinforce repeated use in susceptible individuals.

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These different perspectives are reflected in the questionnaires researchers use. Some measures focus mainly on loss of control, such as unsuccessful attempts to cut back, compulsive use, or continued use despite negative consequences. These are known as dysregulation-oriented measures. Others focus more on the emotional distress associated with pornography use, such as guilt, shame, worry, or moral conflict, and are known as distress-oriented measures.

Study author Sonay Sheikhi and colleagues at Kharazmi University in Tehran, Iran, conducted a systematic review of existing studies to identify psychological characteristics associated with problematic pornography use. They also conducted a meta-analysis, a statistical technique that combines results across studies, to estimate how strong these associations are. In addition, they examined whether the strength of these associations depended on which kind of measure a study had used.

The researchers searched the PubMed/MEDLINE, Scopus, and Web of Science databases, and supplemented the results with searches of Google Scholar, Iranian databases (SID, Magiran, and Noormags), and gray literature sources such as the Open Access Theses and Dissertations database. They included studies published in English or Persian between 2012 and 2025.

In the search, they used keywords related to problematic pornography use (e.g., problematic pornography use, pornography addiction, compulsive pornography use, problematic online pornography use, cyber pornography) combined with terms referring to psychological correlates (e.g., impulsivity, emotion regulation, attachment, craving, moral incongruence, depression, anxiety, and personality).

The search identified over 38,000 unique records, from which the authors selected 925 full-text documents for review. Of these, 97 articles met the inclusion criteria. Together, they described 111 independent samples totaling 121,728 participants. The average participant age was about 27.5 years, and around 46% of participants were women.

The studies were published between 2012 and 2025, with about 85% of participants coming from studies published between 2017 and 2025. Nearly all of the data were collected online.

The psychological characteristics most strongly associated with problematic pornography use were craving (a strong desire to view pornography) and sexual shame, each with an average correlation of 0.54. Correlations range from −1 to 1, with values near zero indicating no relationship. The weakest associations were with the personality trait of extraversion and with indicators of family environment, both close to zero.

Problematic pornography use was also associated with depression (0.32), emotion dysregulation (0.29), moral disapproval, meaning the belief that pornography is morally wrong (0.27), and loneliness (0.23). The craving and sexual shame estimates, however, were each based on only four or five studies, compared with 12 to 21 studies for these other characteristics.

Results also varied widely from study to study. For most characteristics, the range in which future studies’ results would be expected to fall was wide and often included values near zero, meaning a given study could find a much weaker association or none at all. The authors therefore describe the pooled results as average tendencies rather than effects that apply equally across all populations.

The authors also examined whether the type of measure mattered. Studies using dysregulation-oriented measures tended to show stronger associations with impulsivity and craving, whereas studies using distress-oriented measures tended to show stronger associations with shame and moral disapproval. However, the authors describe these patterns as descriptive, and formal statistical tests found few reliable differences between the two kinds of measures.

In one case, the subgroup results ran against this pattern: religiousness was more strongly associated with problematic use in studies using dysregulation-oriented measures than in those using distress-oriented ones. The authors conclude that measurement differences may account for some, but not all, of the variation across studies.

“Across the available evidence, PPU [problematic pornography use] was associated with a broad range of psychological variables spanning behavioral self-regulation, emotional functioning, interpersonal processes, and evaluative distress. However, the magnitude of these associations varied considerably across psychological domains and across studies, indicating that PPU cannot be adequately characterized as a single, homogeneous construct,” the study authors concluded.

The study sheds light on the psychological characteristics linked to problematic pornography use. However, the authors note that the studies they analyzed were predominantly cross-sectional, meaning they measured everything at a single point in time, which rules out conclusions about cause and effect or about which came first. Additionally, most studies relied on self-report questionnaires for both pornography use and psychological characteristics, which the authors say may have inflated some of the observed associations.

The authors also note that their two categories of measures are rough groupings, since many questionnaires capture both loss of control and distress. The differences between them should not be read as evidence of distinct types of problematic pornography use.

The paper, “Psychological correlates of problematic pornography use: A systematic review and meta-analysis of measurement and conceptualization differences,” was authored by Sonay Sheikhi, Shahram Mohammadkhani, and Mehdi Akbari.