Sexual Orientation, Homophobic Attitudes, and Self-Perceived Pornography Addiction

Background: The World Health Organization (WHO) recently included compulsive sexual behaviour disorder in the ICD-11, the first diagnosis of its kind. Of concern is how this diagnosis might impact LGBQ+ individuals, whose sexuality has historically been pathologized by medical bodies. Because client self-report is key to treating professionals assigning a diagnosis, a primary aim of the current study was to better understand the relationship between sexual orientation and self-perceived addiction, with a specific focus on pornography use, as it is the most commonly endorsed hypersexual behavior.

Whether individuals perceive their pornography use as dysregulated is linked with sexual values. For instance, religiosity is a robust predictor of self-perceived pornography addiction. Given this, it seems probable that LGBQ+ individuals with conservative sexual values might be especially likely to pathologize their behavior, because not only does pornography viewing run counter to their beliefs, but they may be grappling with more core sexual identity issues. Our primary hypothesis was that homophobic attitudes would moderate the relationship between sexual orientation and self-perceived pornography addiction.

Methods: Data were derived from a survey administered through Amazon Mechanical Turk. Participants were U.S. adults who endorsed having viewed pornography in the past month (n=540). The outcome variable, self-perceived pornography addiction, was measured via the Cyber-Pornography Use Inventory-9 (CPUI-9), which includes three subscales: dysregulation (α=.92), access efforts (α=.89), and distress (α=.90). Four OLS regression models were constructed, with each of the subscales acting as separate outcome variables, along with the total scale score (α=.93). Sexual orientation was dichotomized to include heterosexual and LGBQ+ participants. Three items assessing homophobic attitudes were summed to create a short scale (α=.78). Moderation was assessed via a "sexual orientation × homophobic attitudes" interaction term. Control variables included gender identity, religiosity, and frequency of pornography viewing, among others.

Results: Sexual orientation was significantly associated with all subscales of the CPUI-9, as well as the total scale score (p<.001), with LGBQ+ participants endorsing higher scores. And as hypothesized, the sexual orientation/homophobic attitudes interaction term was significant, suggesting moderation. More specifically, LGBQ+ participants were especially likely to endorse addiction symptoms at higher levels of homophobic attitudes. In fact, at one standard deviation below the mean of homophobic attitudes, the relationship between sexual orientation and endorsement of CPUI-9 criteria was insignificant across models (p>.05).

Implications: The sexual orientation/homophobic attitudes interaction term might be seen as a proxy for internalized homophobia. If so, that LGBQ+ individuals with higher internalized homophobia are more likely to perceive their pornography use as addictive has significant clinical implications. For such individuals, pornography viewing may be making salient larger sexual identity concerns; persons’ propensity to pathologize their viewing may reflect underlying feelings that their sexual orientation itself is deviant. This suggests that treating professionals need to adopt a critical eye before assigning a diagnosis, as uncritical treatment might be a covert avenue of sexual orientation change efforts, which are damaging. These findings also raise concerns that the new WHO diagnosis could potentially pathologize LGBQ+ clients at higher rates than their heterosexual counterparts.