When Is Pornography a Problem?

Pornography has never been easier to access and consume. While experts don’t agree on labeling its problematic use as “addiction,” its use targets the same areas of the brain as substances. And its use can be detrimental to health and well-being. We’re joined by licensed marriage and family therapist Danielle Sukenik, assistant professor of psychiatry at the University of Colorado Anschutz Medical Campus. She shares what the research says about the problematic use of pornography – and the impact its use has on the individuals and couples she sees in practice. You'll also hear what researchers know about the impact pornography has on the developing brain. 

Transcript

Chris Casey:

Internet pornography is a multi-billion dollar industry, and one that's increasingly accessible to young people in our online world. How does viewing pornography affect the brain's reward system and can it lead to an addiction? How can a person tell if they've reached a problematic level of use? And what are the affects on relationships? What are the impacts of watching explicit content on developing adolescent brains? How can parents help their teens navigate this part of their online life?

We'll explore these topics and more on today's episode. Welcome to Health Science Radio, where we talk about current health and science issues with University of Colorado Anschutz Medical Campus experts. My name is Chris Casey and I'm the director of digital storytelling at our Office of Communications, joined by Carie Behounek, a science writer on our content team.

How are you today, Carie?

Carie Behounek:

I'm doing well. I'm glad to be here. This is a big topic, and I am one of those parents raising a teen in this day-and-age so I'm very interested to learn more.

Chris Casey:

It is, it is a very big topic. To help us dig into it is our guest Danielle Sukenik, an assistant professor of psychiatry and a licensed marriage and family therapist based in Denver. Danielle specializes in working with healthcare providers in training to aid in addressing difficult life transitions, anxiety, trauma, and relationship challenges.

Welcome, Danielle.

Danielle Sukenik:

Yes. Thank you so much. Excited to be here and talk about a pretty interesting topic.

Chris Casey:

How about we start, Danielle, with getting an idea of the definition of pornography. How would you define pornography?

Danielle Sukenik:

Yeah. The working definition of pornography is any content or media that is intended to arouse sexual pleasure or sexual arousal.

Chris Casey:

What are the main modalities that its consumed these days? I imaging the internet being the biggest medium.

Danielle Sukenik:

Yeah, absolutely. Which is quite a contrast to its origins. Pornography has been around for thousands, and thousands, and thousands of years, I think since the beginning of human existence. There's ancient art and evidence of that. Of course, as technology has transformed in recent decades, the internet and our cellphones and computers have become the main source of how pornography is consumed.

Chris Casey:

In general terms, would you say the data shows that usage or consumption of pornography is on the increase? Why would that be?

Danielle Sukenik:

There was a study that compared numbers between 2004 and 2016 that showed pornography increase, the numbers are tripling.

Chris Casey:

Wow.

Danielle Sukenik:

Likely due to the rise of the internet and accessibility.

Carie Behounek:

Yeah, it's changed pretty significantly across the generations how its accessed these days. Is it okay if I just read some of these quick facts that we found?

Most kids are exposed to porn by age 13. One study said that 73% of teens have seen porn, with 44% saying they viewed it intentionally and 58% saying by accident. What's going on with the easier access that teens are having?

Danielle Sukenik:

Yeah. Of course, with easier access comes more access. Children, teens, young people are inherently very curious and will go about whatever ways to educate themselves with that curiosity. Given the accessibility of technology and cellphones being in the hands of our youth, they're able to access this content more frequently than maybe they had been able to prior to the internet and cellphones.

Carie Behounek:

I understand it also has a lot of impacts on adult relationships as well. Is there anything that you can share about that?

Danielle Sukenik:

There's quite a spectrum of the impact of pornography on a human. It's not all negative, there can be positive impact on human relationships. It can be a place of exploration, entertainment. It can help with coping and boredom. Like anything, there can be a line in which a behavior or a pattern crosses and becomes problematic.

The ways that it does impact adult relationships can really vary. Research shows there's some association with less relationship satisfaction, less relationship stability, higher rates of infidelity, lower levels of commitment, loss of trust, unrealistic expectations, decreased interest in their partner. Higher levels of sexual performance and dysfunction have also reported in evidence with higher levels of pornography use.

Carie Behounek:

Danielle, how did you come to start speaking on this topic and studying this topic?

Danielle Sukenik:

Yeah. After I finished graduate school, I relocated to Tennessee from Georgia. I worked at a residential treatment facility and we specialized in the treatment of trauma-informed care and a variety of different challenges, like eating disorders and substance abuse. We also had a female and male sex, love, relationship disorder program. That was my first exposure of really getting into the world of intimacy disorders, and that included pornography and problematic use.

Then I moved here to Colorado several years ago. I don't work in a residential facility anymore, however I have had some clients walk through my door who have had some experience with partners struggling with pornography use. 

Chris Casey:

Could you talk about how the brain's reward system comes into play here, how it can create maybe a spiraling effect of usage? Can use of pornography turn into an actual addiction?

Danielle Sukenik:

Yeah, that's a great question. Pornography triggers the release of dopamine, which is a neurotransmitter associated with pleasure and reward. When the brain is flooded with dopamine, it protects itself as our brains do for survival. What that means in this context is it will desensitize the brain to the flooding of dopamine. Users will then require more frequent use or exacerbating content. There's been surveys and studies shown that individuals that use pornography with frequency end up stepping into pornography they once found disgusting or immoral because the brain requires more and more of that stimulation. Because that is happening, that also means that an individual may struggle with accessing pleasure in other areas of their lives as well.

It depends on who you ask, in terms of if pornography addiction is a real thing. There's mixed opinions on the matter. There's actually been some more recent studies saying that it's not so much addiction as it is how it's talked about. Pornography is really influenced by moral disapproval and immorality, and calling it addiction actually keeps someone stuck in a shame cycle and can reinforce the behaviors. Science is showing that it's not super helpful to label it as addiction, however I do think there is a full spectrum of use and one side of that being an addictive process.

Carie Behounek:

Well, I wonder, too. We even talk about "addiction," I use air quotes there, in terms of your use on social media and the advent of the quick scans of the videos and how we all are somewhat addicted to our phones. Can you relate those two things together with the way that information is presented, especially on our smartphones?

Danielle Sukenik:

Yeah, absolutely. I think what I just described about pornography and dopamine, we can replace pornography with screens and cellphone use. We can replace pornography also with substances and food. There's lots of other ways in which our brains experience dopamine surges and can experience some of the problems around the desensitization of it.

Chris Casey:

With developing brains, especially teenagers who are starting to get exposed to this, has there been any studies as to how that can have a deleterious effect on their cognitive ability? Or maybe just affect their developing brain, but later on have ripple effects in their abilities to cope and have functional relationships?

Danielle Sukenik:

A teenager's brain does have more elevated dopamine production and neuroplasticity as it is developing. There are some studies that show more pornography use during teenage years could indicate more problematic use in adult years. As the research continues to evolve, there are more concerns not so much about an addiction evolving, but other implications of pornography use in earlier years.

For example, the messaging that pornography relays to the viewers, such as the beliefs that teenagers or young people may instill. Women, they learn their bodies have to look a certain way, and it creates a sense of perfectionism and body dissatisfaction. Men receive messaging around macho-ism, and being dominant, and strong, and emotionally detached. Pornography also doesn't typically show consent, so young people are not learning about consent if they're only learning about sex and whatnot through pornography.

It is problematic in that it can contain sexual violence and aggression. It has the potential to exploit children and dehumanize women. When we look at pornography through that lens, that is concerning more than just jumping to the possibility of addiction.

Carie Behounek:

Right. The research we did beforehand, it said at least one-in-three porn videos showed sexual violence or aggression. Then 53% of boys and 39% of girls believe pornography is a realistic depiction of sex. Talk about what that actually means when a teenager, or not even a teenager, but as you enter into a consensual relationship with another human, how might that impact somebody in terms of mental health and just the ability to have connection with another human being?

Danielle Sukenik:

Yeah, yeah, because these young people are watching something that essentially fantasy. Then having these real life experiences, there's a mismatch of expectations around what's actually happening. That can be really disturbing, it can be upsetting, it's misleading. It could lead to esteem and worth issues. That's something that's really important when parents are talking with their kids about sexuality and pornography, to really highlight the nature of fantasy that pornography shows.

Chris Casey:

I thought I saw a reference that there was a study that connected use of pornography to possibly a reduction in gray matter in people's brains over time. Can you talk about that?

Danielle Sukenik:

Yeah. This was a study I believe in 2014 and it was one of the first studies to study the impact of pornography and the brain. The population was a group of men and it showed a reduction of gray matter in the brain. Largely in the prefrontal cortex area, which impacts decision making and is likely related to the urges and cravings that might come with escalated pornography use.

Carie Behounek:

What kind of behaviors would that lead to? What would you just guess might happen because of that?

Danielle Sukenik:

Yeah. Anything that is addictive or there's urges, impulses involved I think really has a potential to lend to some secrecy and can be really consuming. Depending on the person's spectrum of use and the challenges they're facing, it could very much not only impact the relationships with their partners and their family and friends, but it can also impact workplace relationships. Really, it invites a life of secrecy and that shame cycle that keeps people stuck and their mental health suffering, anxiety and depression either exacerbated or it creates a space of that kind of mental health struggle.

Carie Behounek:

I don't have any numbers in front of me, but I think any time you watch any kind of TV or any kind of news programming on mental health, our mental health is terrible in general. Do you think these type of things are part of the reason that many people are experiencing poor health?

Danielle Sukenik:

It's definitely a question of what comes first.

Carie Behounek:

Sure.

Danielle Sukenik:

There is evidence that shows people who struggle with pornography use often turn to it for coping skills, and maybe were not taught how to cope or how to experience emotions. They turn to behaviors such as these, that do not align with what's important to them, the values that they have, and again, keeps them stuck in that shame spiral.

Chris Casey:

You've touched on this a little bit already, Danielle. What are the key things parents need to know when confronting this problem or this landscape that's out there, this media landscape that's out there for their kids? And knowing that they're probably experimenting with watching explicit content, what would be your tips for parents?

Danielle Sukenik:

Yeah, great question because parents really hold the power in this. Anything that we don't talk about reinforces secrecy. By talking about pornography, talking about sexuality, talking about body parts, that takes away power.

It's advised to begin talking about sexuality and naming body parts from a child's earliest years. Maybe from zero to five, that languaging is starting to take place from parent to child. Then when they start getting on screen, it's important to have some dialogue around you might see naked pictures or naked videos when you're on the screen. If you do, come tell me. Inviting the child to have that conversation with a parent figure when they come across those things, to talk about how did that feel? What was that like? Really, the onus is on the child and the experience that they're having.

Then, maybe ages five to nine, just increasing the dialogue around what they might come across. I think the most important thing is really highlighting it's okay to be curious. When you're curious, come to me, let's talk about. It's normal to be curious, it's normal to have these feelings. Weaving in talking about emotions and coping, and even talking about sexual arousal and that's normal, and it's okay to sit with those feelings. It doesn't mean we have to act on them or do anything about them. Just normalizing their sexual development throughout their life.

Chris Casey:

Is there a point when a person can know their use of pornography has reached a problematic level? Are there any clear signs?

Danielle Sukenik:

Yeah. I think that is when somebody is engaging in a behavior, pornography or otherwise, and it's impacting their life, their relationships, their work, how they view themselves. That's usually a good indication that it's stepping into a problematic behavior territory. Especially if there's been trials of discontinuing, an ability to stop, and it just becomes a really all-consuming nature, it's probably a pretty good indication that it's problematic and some steps can be taken to seek some help.

Carie Behounek:

What kind of help do you recommend? For example, I got up this morning to go for a run. Instead, I sat and scrolled on social media for an hour, and then had to get to work. For those of us who might be struggling a little bit in some of those areas, what are some good steps we might take?

Danielle Sukenik:

Yeah, it sounds like you're a human.

Carie Behounek:

Yeah, I am! I am. Gosh darn it.

Danielle Sukenik:

Yeah, yeah. Of course, yeah, replacing habits with more healthy habits is definitely a great baseline to work from. If an individual doesn't have great coping skills, they're going to keep going back to the thing they do know to use, in this case pornography.

Of course, working with a trained professional, a therapist or a coach to help build those coping skills is usually my first line of advice. Or maybe even before that, backing up, is having conversations with loved ones, trusted support, friends, family about what's going on. Once we name something, it takes the power away and it can turn the volume down on that shame and secrecy. Of course, getting connected with a therapist.

There's support groups out there that revolve around this specific topic, which can be really helpful at reducing feelings of isolation with individuals. Maybe some couples counseling if this is within a partnership and it's impact the relationship, and that's usually advised.

Carie Behounek:

Yeah, I imagine that shame might be something that's hard for someone to overcome to even start having that conversation. Is there anything that you could tell us about, or maybe just help anybody listening, normalize that experience of shame and what steps they might take next?

Danielle Sukenik:

Yeah. Well, shame, it's a normal feeling to have. All humans experience shame at some point. It's really good information for us. Something is misaligning with how we want to be or who we want to be, how we want to show up. Being able to just name "I'm feeling shameful" and having that internal dialogue can help create a pathway to having that conversation with other people.

I think having these conversations like we're having today can help take away some of the stigma associated with pornography or mental health issues. Creating spaces to vocalize that with yourself, or with friends and family, and allowing that to be a back-and-forth conversation really takes the power away.

Chris Casey:

On this topic, where do you think more research needs to take place? Where do you think more research should be focused?

Danielle Sukenik:

Yeah, I definitely think more research in general will be helpful. There's a lot out there and it's also a bit limited because pornography use is not in the diagnostic manual for mental health. I don't think it gets quite as much attention from a scientific lens as maybe some of the other mental health challenges that are officially in there.

I do really think that, again, I've said this and I'm going to say it again, the power of intervening on pornography being problematic really lies in the hands of parents and creating that foundation with their kids at a young age. There is research in that realm, and maybe more research in how to talk with kids about pornography and sexuality can help intervene in some of these problematic cycles from continuing as technology continues and continues to advance.

Carie Behounek:

Well, it made me think about the idea that probably every parent's threshold with something like pornography might be a little bit different, based on your own moral compass, your own morality. I was raised Catholic, there are things in my life that I experienced because of that. Is that something that makes this actually a really difficult area to quantify and do research on? Because a lot of it is pretty subjective, I would think.

Danielle Sukenik:

Yeah, yeah. There absolutely is that morality, or religious tone or influence that can get in the way of parents having these conversations with their kids. They're hard conversations to have.

I was listening to an expert in this area talking about talking with kids about pornography. She was speaking to having her own kids, and still having difficulty having these conversations. Really wanting to normalize how difficult it is, while also how important is.

Carie Behounek:

Yeah. It seems like the parent relationship with the child and those open lines of dialogue, it crosses over so many different areas. Certainly, this is a big one.

Danielle Sukenik:

Yeah, yeah. It really comes down to the parent-child relationship, and that warm, loving, affectionate space, and just working from that. Even when a child reports behaviors that misaligne with them or the family values, continuing to have that compassion and exploring, "Okay, is this the kind of person that you want to be? Does it align?" And continuing to extend that warm affection to them can really go a long way.

Carie Behounek:

I imagine that it's probably a similar conversation that you might have with a partner or somebody who maybe you suspect there might be an issue. Can you speak a little bit more about what people might do if they suspect their partner is a little bit more attuned with that then they are with their own relationships?

Danielle Sukenik:

Yeah. When somebody is presenting and their partner is experiencing use?

Carie Behounek:

Yeah, yeah.

Danielle Sukenik:

Yeah, yeah. Yeah, that's its own unique territory because with an individual in relationship with someone who may be using pornography problematically, there can be a sense of betrayal that comes with that. That can be really traumatic and really difficult to sit with. I think that's a really important area to shine some light on is how partners are impacted by individuals and problematic use.

Again, yeah, same thing applies. It's really inviting that compassion and curiosity that they can extend towards their partner that's struggling with that use. Compassion. Compassion is the answer because without compassion, then there's the shame and the secrecy. That's just going to make things more amplified.

Chris Casey:

Well, I think this has been an outstanding conversation. You have given folks a lot of very applicable tools that they can take away into their own lives when they're confronting this because any parent will confront it at some point. Appreciate your thoughts and expertise on this, Danielle. Very much appreciate you joining us here today to talk about this.

Carie Behounek:

Yes, thank you so much. I need to have some conversations that I don't want to have.

Danielle Sukenik:

You can do it.

Carie Behounek:

I can.

Danielle Sukenik:

You can do hard things.

Carie Behounek:

I can. I can do hard things. That is absolutely true. Yeah. Yeah, raising a teenager right now, Chris and I have talked about that. About how his child is older and he didn't have to go through at least the smartphone aspect of it. We've had issues with social media already. Yeah, secrecy. It's a really big topic for a lot of us. It's the first time we've gone through it as a society even. Yeah, I appreciate all the help.

Danielle Sukenik:

Yeah, absolutely. Well, the soil is rich for opportunity and growth in those teenage years.

Carie Behounek:

Yes, yes.

Danielle Sukenik:

Well, thank you so much for having me.

Chris Casey:

Thanks again, Danielle.