Die Pornografie-Nutzungsstörung und ihre Behandlung im Rahmen der
                    multizentrischen Studie „PornLoS“

Charlotte Markert; Sina Wehrum-Osinsky; Rudolf Stark

doi:10.1055/a-2500-8261

Suchttherapie, Inhaltsverzeichnis

Suchttherapie 2025; 26(01): 12-20
DOI: 10.1055/a-2500-8261

Schwerpunktthema

Die Pornografie-Nutzungsstörung und ihre Behandlung im Rahmen der multizentrischen Studie „PornLoS“

Pornography use disorder and its treatment in the multicenter study “PornLoS”

Charlotte Markert

¹Psychotherapie und Systemneurowissenschaften, Justus-Liebig-Universität Gießen, Giessen, Germany

²Center of Mind, Brain and Behavior, Universitäten von Marburg und Gießen, Gießen, Germany

,

Sina Wehrum-Osinsky

³Psychotherapie und System Neurowissenschaften, Justus-Liebig-Universität Gießen, Giessen, Germany

,

Rudolf Stark

³Psychotherapie und System Neurowissenschaften, Justus-Liebig-Universität Gießen, Giessen, Germany

⁴Bender Institute of Neuroimaging, Justus-Liebig-Universität Gießen, Gießen, Germany

²Center of Mind, Brain and Behavior, Universitäten von Marburg und Gießen, Gießen, Germany

› Institutsangaben

Abstract

Zusammenfassung

Die Pornografie-Nutzungsstörung kann als Variante der Störung mit zwanghaftem Sexualverhalten verstanden werden, für die in der ICD-11 spezifische diagnostische Kriterien entwickelt wurden. Die Symptomatik ist für Betroffene mit teils gravierenden Beeinträchtigungen und Leid verbunden. Während sie bislang zu den Impulskontrollstörungen zählt, gibt es einen wissenschaftlichen Diskurs darüber, ob sie auch als Verhaltenssucht verstanden werden kann. Bisher mangelt es an methodisch hochwertig durchgeführten Therapiestudien, um effektive Behandlungsmethoden zu entwickeln. Um die bislang schlechte Versorgungssituation von Betroffenen in Deutschland nachhaltig zu verbessern, wird die multizentrische Therapiestudie „PornLoS“ durchgeführt. Darin wird eine innovative Intensivtherapie mit einer Standardtherapie verglichen. Zusätzlich wird die Frage untersucht, ob eine vollständige Abstinenz oder eine reduzierte Nutzung von Pornografie das geeignetere Therapieziel darstellen. Der Artikel beschreibt zunächst das klinische Bild der Pornografie-Nutzungsstörung, um dann das vom Gemeinsamen Bundesausschuss geförderte Projekt „PornLoS“ vorzustellen.

Abstract

Pornography use disorder can be understood as a variant of the compulsive sexual behavior disorder, for which specific diagnostic criteria have been developed in the ICD-11. The symptoms are associated with serious impairment and suffering for those affected. While it has so far been classified as an impulse control disorder, there is a scientific discourse on whether it can also be understood as a behavioral addiction. To date, there has been a lack of methodologically high-quality therapy studies to develop effective treatment methods. The multi-center therapy study “PornLoS” is being carried out in order to sustainably improve the currently poor care situation for those affected in Germany. It compares an innovative intensive therapy with a standard therapy. In addition, the question of whether complete abstinence or reduced use of pornography is the more suitable therapeutic goal is being investigated. The article first describes the clinical characteristics of pornography use disorder and then presents the “PornLoS” project funded by the Federal Joint Committee.

Schlüsselwörter

Pornografie-Nutzungsstörung - Pornografie-Sucht - Störung mit zwanghaftem Sexualverhalten - Verhaltenssucht - kognitiv-behaviorale Therapie

Keywords

pornography use disorder - pornography addiction - compulsive sexual behavior disorder - behavioral addiction - cognitive behavioral therapy

Volltext

Referenzen

Literatur
1 Grubbs JB, Kraus SW, Perry SL. Self-reported addiction to pornography in a nationally representative sample: The roles of use habits, religiousness, and moral incongruence. Journal of Behavioral Addictions 2019; 8: 88-93
2 Lewczuk K, Glica A, Nowakowska I. et al. Evaluating Pornography Problems Due to Moral Incongruence Model. J Sex Med 2020; 17: 300-311
3 Rissel C, Richters J, Visser ROde. et al. A profile of pornography users in Australia: Findings from the Second Australian Study of Health and Relationships. J Sex Res 2017; 54: 227-240
4 Martyniuk U, Dekker A. Pornografienutzung von Erwachsenen in Deutschland. Zeitschrift für Sexualforschung 2018; 31: 237-249
5 World Health Organization. ICD-11 for Mortality and Morbidity Statistics: 6C72 Compulsive Sexual Behavior Disorder. Im Internet: https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1630268048; Stand: 22.03.2024
6 Reid RC, Carpenter BN, Hook JN. et al. Report of findings in a DSM-5 field trial for hypersexual disorder. J Sex Med 2012; 9: 2868-2877
7 Rush B. Medical inquiries and observations, upon the diseases of the mind. Merrit: Kimber & Richardson. 1812
8 Krafft-Ebing R. Psychopathia sexualis: mit besonderer Berücksichtigung der conträren Sexualempfindung: eine klinisch-forensische Studie. Enke. 1898
9 Cooper AI. Sexuality and the Internet: Surfing into the New Millennium. CyberPsychology & Behavior 1998; 1: 187-193
10 Coleman E. Compulsive Sexual Behavior: New concepts and treatments. Journal of Psychology & Human Sexuality 1991; 4: 37-52
11 Briken P, Basdekis-Jozsa R. Sexuelle Sucht? Wenn sexuelles Verhalten außer Kontrolle gerät. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010; 53: 313-318
12 Barth RJ, Kinder BN. The mislabeling of sexual impulsivity. J Sex Marital Ther 1987; 13: 15-23
13 Kafka MP. Hypersexual disorder: A proposed diagnosis for DSM-V. Arch Sex Behav 2010; 39: 377-400
14 Kraus SW, Voon V, Potenza MN. Should compulsive sexual behavior be considered an addiction?. Addiction 2016; 111: 2097-2106
15 American Psychiatric Association. Hrsg. Diagnostic and statistical manual of mental disorders. Washington DC: American Psychiatric Association; 2013
16 Kafka MP. What happened to hypersexual disorder?. Arch Sex Behav 2014; 43: 1259-1261
17 World Health Organization. The ICD-10 classification of mental and behavioural disorders: Diagnostic criteria for research. 1993
18 Gola M, Lewczuk K, Potenza MN. et al. What should be included in the criteria for compulsive sexual behavior disorder?. Journal of Behavioral Addictions 2020; 11: 160-165
19 Rumpf H-J, Montag C. Where to put Compulsive Sexual Behavior Disorder (CSBD)? Phenomenology matters •. Journal of Behavioral Addictions 2022; 11: 230-233
20 Brand M, Wegmann E, Stark R. et al. The Interaction of Person-Affect-Cognition-Execution (I-PACE) model for addictive behaviors: Update, generalization to addictive behaviors beyond internet-use disorders, and specification of the process character of addictive behaviors. Neurosci Biobehav Rev 2019; 104: 1-10
21 Brand M, Young KS, Laier C. et al. Integrating psychological and neurobiological considerations regarding the development and maintenance of specific Internet-use disorders: An Interaction of Person-Affect-Cognition-Execution (I-PACE) model. Neurosci Biobehav Rev 2016; 71: 252-266
22 Niemann A, Hillerich V, Wasem J. et al. Health economic evaluation of an online-based motivational program to reduce problematic media use and promote treatment motivation for Internet Use Disorder - Results of the OMPRIS study. Int J Environ Res Public Health 2023; 20
23 Markert C, Storz F, Golder S. et al. On the current psychotherapeutic situation for persons with pornography use disorder in Germany. Journal of Behavioral Addictions 2023; 12: 421-434
24 Briken P, Wiessner C, Štulhofer A. et al. Who feels affected by “out of control” sexual behavior? Prevalence and correlates of indicators for ICD-11 Compulsive Sexual Behavior Disorder in the German Health and Sexuality Survey (GeSiD). Journal of Behavioral Addictions 2022; 11: 900-911
25 Kafka MP. DSM-IV axis I psychopathology in males with non-paraphilic hypersexual disorder. Curr Addict Rep 2015; 2: 202-206
26 Kor A, Fogel Y, Reid RC. et al. Should hypersexual disorder be classified as an addiction?. Sexual Addiction & Compulsivity 2013; 20
27 Wéry A, Vogelaere K, Challet-Bouju G. et al. Characteristics of self-identified sexual addicts in a behavioral addiction outpatient clinic. Journal of Behavioral Addictions 2016; 5: 623-630
28 Reid RC, Meyer MD. Substance use disorders in hypersexual adults. Curr Addict Rep 2016; 3: 400-405
29 Ballester-Arnal R, Castro-Calvo J, Giménez-García C. et al. Psychiatric comorbidity in compulsive sexual behavior disorder (CSBD. Addict Behav 2020; 107: 106384
30 Bőthe B, Koós M, Tóth-Király I. et al. Investigating the associations of adult ADHD symptoms, hypersexuality, and problematic pornography use among men and women on a largescale, non-clinical sample. J Sex Med 2019; 16: 489-499
31 Engel J, Veit M, Sinke C. et al. Same same but different: A clinical characterization of men with hypersexual disorder in the Sex@Brain Study. J Clin Med 2019; 8
32 Karaca S, Saleh A, Canan F. et al. Comorbidity between behavioral addictions and attention deficit/hyperactivity disorder: a systematic review. Int J Ment Health Addiction 2017; 15: 701-724
33 Grubbs JB, Gola M. Is pornography use related to erectile functioning? Results from cross-sectional and latent growth curve analyses. J Sex Med 2019; 16: 111-125
34 Kowalewska E, Gola M, Kraus SW. et al. Spotlight on Compulsive Sexual Behavior Disorder: A systematic review of research on women. Neuropsychiatr Dis Treat 2020; 16: 2025-2043
35 Goldstein RZ, Volkow ND. Dysfunction of the prefrontal cortex in addiction: Neuroimaging findings and clinical implications. Nat Rev Neurosci 2011; 12: 652-669
36 Everitt BJ, Robbins TW. Drug Addiction: Updating actions to habits to compulsions ten years on. Annu Rev Psychol 2016; 67: 23-50
37 Robinson TE, Berridge KC. The neural basis of drug craving: An incentive-sensitization theory of addiction. Brain Res Brain Res Rev 1993; 18: 247-291
38 Bőthe B, Potenza MN, Griffiths MD. et al. The development of the Compulsive Sexual Behavior Disorder Scale (CSBD-19): An ICD-11 based screening measure across three languages. Journal of Behavioral Addictions 2020; 9: 247-258
39 Bőthe B, Tóth-Király I, Demetrovics Z. et al. The short version of the Problematic Pornography Consumption Scale (PPCS-6): A reliable and valid measure in general and treatment-seeking populations. J Sex Res 2021; 58: 342-352
40 Antons S, Engel J, Briken P. et al. Treatments and interventions for compulsive sexual behavior disorder with a focus on problematic pornography use: A preregistered systematic review. Journal of Behavioral Addictions 2022; 11: 643-666
41 Wölfling K, Müller KW, Dreier M. et al. Efficacy of Short-term Treatment of Internet and Computer Game Addiction: A randomized clinical trial. JAMA Psychiatry 2019; 76: 1018-1025
42 Fernandez DP, Kuss DJ, Griffiths MD. Short-term abstinence effects across potential behavioral addictions: A systematic review. Clin Psychol Rev 2020; 76: 101828
43 Rolová G, Lukavská K, Ghaisová Tibenská A. et al. Factors associated with abstinence in addiction inpatient treatment cohort: a five-year follow-up. Journal of Substance Use 2023; 1-7
44 Gola M, Potenza MN. Promoting educational, classification, treatment, and policy initiatives. Journal of Behavioral Addictions 2018; 7: 208-210
45 Dhuffar MK, Griffiths MD. Barriers to female sex addiction treatment in the UK. Journal of Behavioral Addictions 2016; 5: 562-567
46 Stark R, Markert C, Golder S. et al. The PornLoS Treatment Program: Study protocol of a new psychotherapeutic approach for treating pornography use disorder. Journal of Behavioral Addictions 2024;