Problematic pornography use is considered the most common clinical manifestation of compulsive sexual behavior disorder, a diagnosis formally included in the eleventh revision of the International Classification of Diseases. The disorder is defined not by how often someone watches pornography but by a persistent inability to control repetitive sexual urges and behaviors, coupled with personal distress. International surveys across 42 countries have estimated PPU prevalence among adults at between 3.2 and 16.6 percent, but adolescents have remained largely understudied, even though impaired control over consumption appears to predict future problematic use and many adult patients trace their difficulties back to their teenage years.

The new research drew on the fourth national Swedish study of adolescent sexuality and exposure to sexual assault and exploitation. Researchers from Karolinska Institutet, Marie Cederschiöld University and Linköping University selected a stratified, representative sample of 210 schools using the national education register, collecting data between December 2019 and March 2021, with a pandemic-related interruption that forced a shift from classroom surveys to a digital platform. The final analytical sample comprised 3,106 third-year senior high school students, 1,369 boys and 1,737 girls, with a median age of 18. Participants answered 112 main questions covering sociodemographics, sexuality, alcohol and drug use, abusive experiences, psychological well-being and internet use.

Crucially, the study defined PPU by self-perceived impaired control rather than frequency alone. Adolescents who rated either statement, that it was difficult to refrain from watching pornography or difficult to stop once started, at four or higher on a five-point agreement scale were classified as having PPU. This distinction matters clinically, because frequency of use by itself does not indicate pathology; a teenager who watches pornography often but feels fully in control differs fundamentally from one who watches rarely yet experiences the consumption as uncontrollable and distressing. In total, 324 participants, 257 boys and 67 girls, met the study’s threshold.

The behavioral profile of adolescents with PPU diverged sharply from their peers. Nearly half of the boys with PPU reported watching pornography more or less daily, compared with 16.1 percent of boys in the reference group, and both genders with PPU spent substantially longer per session. The content itself also differed: violent or coercive pornography was consumed by 37.3 percent of girls with PPU versus 11.8 percent of reference girls, and by 26.1 percent of boys with PPU versus 8.7 percent of reference boys. Lifetime use of sexual material involving children or animals was reported by roughly one in ten of the PPU groups, around three times the rate of their peers, a finding the authors interpret cautiously given that participants were themselves recently minors and the circumstances of exposure remain unclear.

Sexual experience followed strikingly different gendered pathways. Girls with PPU were more sexually experienced than reference girls, with 28.4 percent reporting more than six lifetime partners compared with 14.6 percent, and nearly 30 percent reporting a sexual debut before age 15, Sweden’s legal age of consent, versus 12.9 percent. Boys with PPU showed the opposite pattern: they were less likely to have had vaginal sex than reference boys, 51.4 versus 59.4 percent, suggesting a profile of social withdrawal in which online sexual activity substitutes for offline intimacy. Most alarmingly, 5.1 percent of boys with PPU reported exposing someone else to nonconsensual sexual acts, roughly four times the rate in the reference group, echoing adult research linking compulsive sexual behavior with coercive conduct.

Mental health and adversity emerged as central threads. Both boys and girls with PPU scored significantly higher on validated measures of emotion regulation difficulties and trauma symptoms, and reported more nonsuicidal self-injury. Nearly a quarter of girls with PPU, 23.9 percent, reported using sex as a form of self-injury, triple the reference rate. Girls with PPU also showed elevated risk behaviors: 44.8 percent reported high-risk alcohol consumption, defined by former national guidelines as four or more units on a single occasion at least monthly, and 35.8 percent reported lifetime drug use, roughly double the reference rates. Exposure to bullying, physical abuse and multiple forms of abuse was more common in both PPU groups, and girls with PPU reported more sexual abuse and grooming.

Multivariable logistic regression sharpened these patterns into distinct predictive profiles. For girls, the strongest independent predictors of PPU were being born outside Sweden, high-risk alcohol consumption and higher trauma symptom scores. The authors suggest that girls raised in environments with stricter sexual norms may experience moral incongruence, a conflict between personal disapproval of pornography and actual use, which is known to inflate self-perceived loss of control; notably, half of the girls with PPU reported only occasional use. For boys, the predictors were less sexual experience, more frequent sending of sexually explicit images, having exposed someone to nonconsensual acts, and higher trauma scores. Sociodemographic factors otherwise showed no significant associations, contrasting with studies of Israeli adolescents that linked compulsive sexual behavior to higher socioeconomic status.

The researchers emphasize that these adolescents appear to be using pornography as a coping strategy to regulate negative emotions, consistent with adult findings that compulsive sexual behavior frequently co-occurs with psychiatric comorbidity and emotion dysregulation. Although no direct association with formal psychiatric diagnoses emerged, possibly because participants were young and diagnoses take time to establish, the constellation of self-harm, trauma symptoms and substance use points to underlying vulnerability rather than simple excess. The authors argue that strengthening coping skills could benefit these youths, and that assessments should consider moral incongruence, risk behaviors and adverse childhood experiences rather than focusing narrowly on consumption itself.

The clinical implications are concrete. With PPU affecting one in ten adolescents, the authors urge professionals in schools, youth clinics and child health services to raise the topic in a balanced, destigmatizing way, particularly when other risk behaviors or emotional difficulties are present, while avoiding pathologizing normal sexual curiosity. The study’s cross-sectional design prevents conclusions about causality, and its two-item measure of PPU may not capture the construct’s full complexity, limitations the authors acknowledge alongside a possible pandemic influence on their sample. Still, the large, nationally representative school-based sample lends the findings considerable ecological validity, and the researchers call for longitudinal studies and culturally diverse replications to determine whether adolescent PPU, left unaddressed, hardens into the adult disorder that so many patients describe as having begun in their teenage years.

Subject of Research: Prevalence and correlates of self-perceived problematic pornography use among Swedish adolescents

Article Title: Problematic Pornography Use Among Swedish Adolescents: Characteristics and Clinical Implications

Article References: Piwowar, M., Jonsson, L. S., Bladh, M., Landberg, Å., Svedin, C. G., & Savard, J. (2026). Problematic Pornography Use Among Swedish Adolescents: Characteristics and Clinical Implications. Archives of Sexual Behavior. https://doi.org/10.1007/s10508-026-03544-9

Image Credits: AI Generated

DOI: 10.1007/s10508-026-03544-9

Keywords: problematic pornography use, adolescents, compulsive sexual behavior disorder, mental health, trauma symptoms, emotion regulation, gender differences, risk behaviors, sexual behavior, Sweden, self-injury, moral incongruence

The starting point for the research is a long-standing diagnostic dilemma. Clinicians and researchers have found that people who describe their pornography use as problematic often fall into two very different groups. Some show genuine behavioral dysregulation, meaning they use pornography compulsively, lose control over the habit, and continue despite real harm to work, relationships, or well-being. Others experience distress not because their consumption is out of control, but because their use conflicts with deeply held moral or religious convictions, a phenomenon researchers call moral incongruence. Distinguishing between these two pathways is critical, because treating a moral conflict as an addiction, or an addiction as mere guilt, can send people down the wrong therapeutic path.

Decades of research have established that religiosity is a powerful driver of this second pathway. People with strong religious commitments are more likely to morally disapprove of pornography, more likely to perceive themselves as addicted even at moderate levels of use, and more likely to experience religious and spiritual struggles when they consume it. But religion and spirituality are not the same construct. Religion typically involves organized doctrine, communal practice, and explicit behavioral rules, while spirituality refers to a broader, often individual sense of meaning, connection, and transcendence. Whether that broader spiritual orientation also fuels pornography-related distress had never been systematically tested, and that gap is what Fiennes and Pontes set out to fill.

The researchers recruited 121 participants from the general population, with a mean age of 27.3 years and a standard deviation of 5.05, and a slight male majority of 53.7 percent. Each participant completed an online survey measuring problematic pornography use, patterns of pornography consumption, psychological health and well-being, moral disapproval of pornography, and spirituality. The battery also captured emotion regulation strategies, including expressive suppression, the tendency to inhibit the outward expression of emotions, a factor that prior work on compulsive sexual behavior has repeatedly linked to dysregulated use. By measuring all of these dimensions simultaneously, the team could examine which factors independently predicted problematic pornography use when the others were held constant.

The results, analyzed through multiple regression, painted a clear and somewhat surprising picture. Four variables significantly predicted problematic pornography use: male gender, weekly pornography use, psychological distress, and expressive suppression as an emotion regulation strategy. Together, these factors explained 38.2 percent of the variability in problematic use scores, a substantial proportion for research in this field. Each predictor aligns with a distinct strand of theory. Male gender reflects consistent epidemiological findings that men report higher rates of both use and problematic use. Weekly use captures the behavioral frequency component, since regular exposure creates more opportunities for dysregulated engagement. Psychological distress echoes a growing longitudinal literature linking emotional suffering with compulsive sexual behavior, possibly reflecting self-medication cycles in which negative affect drives use and use deepens distress.

The role of expressive suppression is particularly interesting from a technical standpoint. Emotion regulation research distinguishes between strategies like cognitive reappraisal, which reinterprets emotional situations, and suppression, which clamps down on emotional expression without changing the underlying feeling. Suppression is metabolically and cognitively costly, tends to amplify physiological arousal, and is associated with poorer mental health outcomes. In the context of pornography, individuals who habitually suppress their emotions may be more likely to use sexual material as an escape valve for feelings they cannot otherwise process, and less likely to seek help or articulate their struggles, allowing the pattern to escalate unchecked. This finding situates problematic pornography use squarely within the broader framework of emotion dysregulation that underpins contemporary models of addictive behaviors, such as the interaction of person-affect-cognition-execution model, which frames addictive behaviors as maladaptive coping arising from the interplay of personal predispositions, affective states, and cognitive control deficits.

The most consequential result, however, was what did not predict problematic use. Spirituality showed no significant relationship with problematic pornography use, and neither did self-esteem nor age. This null finding is theoretically loaded. If spirituality behaved like religiosity, it should have been associated with greater moral disapproval and, through moral incongruence, with higher perceived addiction and distress. Its absence suggests that spiritual values, unlike religious doctrines, are not inherently incongruent with pornography use. In other words, a person can hold a rich sense of meaning, connection, and transcendence without importing a moral prohibition against sexual media, whereas religious frameworks often encode explicit rules that turn use into transgression.

The authors interpret this as initial evidence for an important distinction between spiritual and religious value systems in shaping pornography-related experiences. The distinction has practical implications. Screening tools and clinical interviews that lump spirituality and religiosity together may misclassify patients, attributing distress to a general value system when the real driver is doctrine-specific moral conflict. Conversely, interventions that draw on spiritual resources, which have shown benefits in substance use treatment and mental health contexts, may not carry the same moral baggage when applied to pornography-related concerns. A clinician working with a spiritually oriented but non-religious client might therefore focus on emotion regulation skills and behavioral control rather than on resolving value conflicts that may not exist.

Several limitations temper these conclusions. The sample of 121 general-population participants is modest, and brief reports by design offer a snapshot rather than a deep exploration. The cross-sectional design cannot establish causality: psychological distress may drive problematic use, or problematic use may generate distress, or both may feed each other in a loop that only longitudinal data can untangle. Self-report measures of sensitive behaviors are vulnerable to shame-driven underreporting, and the null finding for spirituality could reflect measurement choices, since spirituality is notoriously difficult to operationalize and different instruments capture different facets. Age and self-esteem null results should likewise be read within the restricted age range of a young adult sample rather than as universal truths.

Even with those caveats, the study makes a meaningful contribution to a field in the midst of conceptual housekeeping. The inclusion of compulsive sexual behavior disorder in the ICD-11 has intensified efforts to separate genuine dysregulation from moral incongruence, and large international projects have begun mapping pornography-use profiles across dozens of countries. This brief report adds a new axis to that mapping effort, suggesting that the moral landscape of pornography use is carved by religious doctrine rather than by spirituality in general. As the authors conclude, a complex interplay of behavioral, psychological, and moral characteristics informs experiences of problematic pornography use, but spiritual values appear to stand apart from that interplay, a finding that could reshape how researchers measure, and clinicians treat, pornography-related distress in an increasingly secular yet still spiritually curious world.

Subject of Research: Psychosocial, moral, and spiritual predictors of problematic pornography use

Article Title: Investigating the Role of Psychosocial and Values-Based Factors in Problematic Pornography Use

Article References: Fiennes, E., & Pontes, H. M. (2026). Investigating the Role of Psychosocial and Values-Based Factors in Problematic Pornography Use. Archives of Sexual Behavior. https://doi.org/10.1007/s10508-026-03546-7

Image Credits: AI Generated

DOI: 10.1007/s10508-026-03546-7

Keywords: problematic pornography use, moral incongruence, spirituality, religiosity, emotion regulation, psychological distress, behavioral addiction, compulsive sexual behavior, self-esteem, Archives of Sexual Behavior, Investigating, Role