FROM SELF-DIAGNOSIS TO PROFESSIONAL HELP-SEEKING: DSM-5-BASED ONLINE SCREENING FOR PORNOGRAPHY-WATCHING DISORDER
Author(s)
Csaba Erdos, PhD1, Oguz Kelemen, MD, PhD2, Regina Molnár, PhD1, Edit Paulik, MD, PhD1, Dávid Pócs, MD, PhD2.
1Department of Public Health, University of Szeged, Albert Szent-Györgyi Medical School, Szeged, Hungary, 2Department of Behavioral Sciences, University of Szeged, Albert Szent-Györgyi Medical School, Szeged, Hungary.
1Department of Public Health, University of Szeged, Albert Szent-Györgyi Medical School, Szeged, Hungary, 2Department of Behavioral Sciences, University of Szeged, Albert Szent-Györgyi Medical School, Szeged, Hungary.
OBJECTIVES: Problematic pornography use is difficult to address in public health because many people either minimize clinically relevant symptoms or label themselves as addicted on the basis of frequency alone. This study examined whether an anonymous online screening approach, using DSM-5-based symptom criteria, can distinguish symptom-defined pornography-watching disorder (PWD) from self-identified pornography addiction.
METHODS: Data were collected from a large Hungarian cross-sectional web-based sexual health survey. In the young-adult pornography-user sample (n=7,187), PWD was assessed with ten items adapted from DSM-5 substance use disorder criteria, covering loss of control and negative consequences; endorsement of four or more symptoms indicated PWD. A secondary analytical sample of adults with complete pornography-use and self-identification data (n=8,705; multivariable n=8,088) was used to compare symptom-defined PWD with a single self-identification item. Logistic and multinomial regression models examined sociodemographic, psychosexual and sexual-health correlates.
RESULTS: In young adults, 4.4% met criteria for PWD. Compared with daily users, lower-frequency users had markedly reduced odds of PWD: weekly OR=0.45 (95% CI 0.33-0.62), monthly OR=0.18 (95% CI 0.11-0.28), and less than monthly OR=0.05 (95% CI 0.03-0.10; all p<0.001). Paraphilia showed the strongest association (OR=3.95; 95% CI 2.37-6.56), while adequate sexual education was protective (OR=0.67; 95% CI 0.53-0.87). In the broader adult sample, symptom-defined PWD was identified in 4.8%, while 3.1% self-identified as addicted. Agreement was only moderate (φ=.430; p<0.001): 63.7% of those with symptom-defined PWD did not self-identify as addicted, and 43.7% of self-identified addicted individuals did not meet symptom criteria. Each increase in pornography-use frequency approximately doubled the odds of PWD (OR=2.03; 95% CI 1.84-2.24).
CONCLUSIONS: DSM-5-inspired online screening may help separate high-frequency but non-clinical pornography use from clinically relevant dysregulation, supporting earlier, more targeted and less moralizing prevention.
METHODS: Data were collected from a large Hungarian cross-sectional web-based sexual health survey. In the young-adult pornography-user sample (n=7,187), PWD was assessed with ten items adapted from DSM-5 substance use disorder criteria, covering loss of control and negative consequences; endorsement of four or more symptoms indicated PWD. A secondary analytical sample of adults with complete pornography-use and self-identification data (n=8,705; multivariable n=8,088) was used to compare symptom-defined PWD with a single self-identification item. Logistic and multinomial regression models examined sociodemographic, psychosexual and sexual-health correlates.
RESULTS: In young adults, 4.4% met criteria for PWD. Compared with daily users, lower-frequency users had markedly reduced odds of PWD: weekly OR=0.45 (95% CI 0.33-0.62), monthly OR=0.18 (95% CI 0.11-0.28), and less than monthly OR=0.05 (95% CI 0.03-0.10; all p<0.001). Paraphilia showed the strongest association (OR=3.95; 95% CI 2.37-6.56), while adequate sexual education was protective (OR=0.67; 95% CI 0.53-0.87). In the broader adult sample, symptom-defined PWD was identified in 4.8%, while 3.1% self-identified as addicted. Agreement was only moderate (φ=.430; p<0.001): 63.7% of those with symptom-defined PWD did not self-identify as addicted, and 43.7% of self-identified addicted individuals did not meet symptom criteria. Each increase in pornography-use frequency approximately doubled the odds of PWD (OR=2.03; 95% CI 1.84-2.24).
CONCLUSIONS: DSM-5-inspired online screening may help separate high-frequency but non-clinical pornography use from clinically relevant dysregulation, supporting earlier, more targeted and less moralizing prevention.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH139
Topic
Epidemiology & Public Health
Disease
Reproductive & Sexual Health