After I shared on a first date that I used to work with sex and porn addicts at a trauma treatment center, the gentleman sitting across from me leaned over and said, “Just so you know, I am 100 percent porn free!” He seemed to be as proud of this feat as I was both surprised and refreshed by his vulnerable admission.

My date went on to share that he used to be addicted to porn but kicked the habit during a religious conversion. I was happy for him especially since I know that faith alone isn’t enough for many people wanting to get sober from porn use. Covenant Eyes, a leading accountability and filtering software, reports that “1 in 5 youth pastors and 1 in 7 senior pastors use porn on a regular basis” and are struggling to stop. Even leadership in a faith community doesn’t prevent struggles with compulsive porn use.

It’s not surprising that men of the cloth are susceptible to pornography; it’s a risk of being a human today with access to the internet. Pornhub brags that there are “over 100 billion video views a year” on their platform, which is “about 12.5 porn videos per person on earth.” That’s a lot of porn being consumed from just one online porn distributor among an ocean of others.

While there is general agreement that pornography use is widespread, there is some disagreement on whether its prevalence is a problem and whether some people’s use of it constitutes an addiction. There is a growing body of research that shows that the brains of habitual porn users resemble the brains of opioid users.

Though porn addiction is not listed among disorders in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), University of Cambridge researcher Dr. Valerie Voon is on the cutting edge of research on “Compulsive Sexual Behavior” or CSB. According to her team’s work, CSB is characterized by “craving, impulsivity, social/occupational impairment,” and it impacts 3 to 6 percent of the population. It’s hard to know what the true numbers are because whether CBS is a disorder is hotly debated. And among the experts who recognize CSB as a legitimate condition, there is a lack of consensus on whether it truly rises to the level of addiction or is an impulse control disorder or is on the spectrum of hypersexuality disorder.

Why does it matter whether porn addiction is called a disorder?

How a condition is classified or not classified in the DSM-5 really matters. One of the most obvious ways is what is and is not covered by insurance. Insurance companies require a legitimate and recognized diagnosis to cover services. If there isn’t a valid diagnosis code, insurance claims can be denied. So a person struggling with an issue that does not meet diagnostic criteria in the DSM-5 may not be covered by their insurance and will have to pay for treatment out of pocket.

Additionally, fewer clinicians will have experience treating a condition that isn’t widely recognized. Clinicians may not even realize that asking about compulsive porn use or sexual behavior is an important assessment question because it isn’t a widely known or understood issue. Though some exists, there is limited research available on compulsive sexual behavior because typical funding sources including the National Institute of Health and pharmaceutical companies don’t fund this kind of research. If the experts don’t recognize an issue, that means that the average person who is struggling in their porn use may not realize there is help available or think it worthwhile to ask.

I have had multiple clients share with me that they have been to therapy before but that I am the first therapist to ask about their porn use. It’s also usually the first time they admit to another person that they don’t like their relationship with pornography.

Where compulsive sexual behavior comes from

In an effort to make sense of the controversial world of treating compulsive sexual behavior, there are different theories of the causes. Leading sex addiction expert, Dr. Patrick Carnes, finds that “97 percent of people with sex addiction suffered emotional abuse in childhood or adolescence, while 81 percent suffered sexual abuse.” In other words, Dr. Carnes’s research has found that there is a link between trauma and compulsive sexual behavior.

But as any statistics teacher will tell you, “correlation does not equal causation.” Does experiencing trauma mean a person will become a sex addict? No. Do all sex addicts have a history of trauma? It depends on what you mean by trauma.

As a trauma-informed therapist, my go-to definition for trauma is Pia Mellody’s: “Anything less than nurturing.” When I share this definition with my clients I usually get wide eyes of surprise and understanding or the eye roll that says they aren’t buying it. The “anything less than nurturing” definition is both encompassing and personalized. While there are some important nurturing aspects that are universal, nurturance is ultimately tied to being emotionally and physically attuned to a child in real time—what’s nurturing to one child may not be to another. And what’s nurturing right now may not be what that child needs tomorrow. Nurturance is dependent on deep attunement and re-attunement.

Studying this kind of trauma is quite difficult. After all, empirical research requires strict controls. Personalized definitions of trauma don’t fit into that category. However, one seminal study, the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente Adverse Childhood Experiences (ACE) Study identifies 10 childhood experiences that break down universal examples of trauma that include: emotional abuse; physical abuse; sexual abuse; violent treatment of mother; substance use in the household; mental illness in the household; parental separation or divorce; incarcerated household member; emotional neglect; and physical neglect. This groundbreaking study finds that there is a compelling link between “adverse childhood experiences” and later problems. As one addiction specialist, Jane Ellen Stevens distills it:

The ACE Study found that the higher someone’s ACE score–the more types of childhood adversity a person experienced–the higher their risk of chronic disease, mental illness, violence, being a victim of violence and a bunch of other consequences. The study found that most people (64 percent) have at least one ACE; 12 percent of the population has an ACE score of 4. Having an ACE score of 4 nearly doubles the risk of heart disease and cancer.

Subsequent research on adverse childhood experiences have found that there is a strong link between having an ACE score of one or more and developing an addiction. Stevens continues:

It increases the likelihood of becoming an alcoholic by 700 percent and the risk of attempted suicide by 1200 percent. . . . Compared with people who have zero ACEs, people with ACE scores are two to four times more likely to use alcohol or other drugs and to start using drugs at an earlier age. People with an ACE score of 5 or higher are seven to 10 times more likely to use illegal drugs, to report addiction and to inject illegal drugs.

Other research has found that having Post Traumatic Stress Disorder (PTSD), a trauma diagnosis that can but does not have to include childhood experiences, also increases a person’s chance of developing an addiction.

Does trauma affect compulsive sexual behavior?

Among experts who believe that CSB is an addiction, there is a lot of speculation as to whether trauma and/or adverse childhood experiences are risk factors for developing compulsive sexual behavior. Those who believe that CSB is an addiction also tend to believe that experiencing trauma is a risk factor for developing CSB and/or porn addiction, just as it is a risk factor for developing other addictions.

Though researchers like Dr. Valerie Voon have found that the brain scans of compulsive pornography users resemble the brain scans of opiate users, for the purposes of this article I am going to put aside identifying a causal or empirical link between experiencing trauma and developing CSB or pornography addiction. Instead, I want to shed light on some of the great work being done to help people recover from their struggle with pornography that involves acknowledging and exploring how personal experiences that were “less than nurturing” impact compulsive sexual activity and pornography use.

How people overcome porn addiction

Before diving into the deeper therapeutic work that involves a dive into a person’s history and experiences around relationships, attachment, safety, and vulnerability, there are some practical interventions that are critical to recovery from compulsive sexual activity and pornography use. First, removing or placing limits on opportunities to act out is critical. With pornography use, taking an inventory of devices—phones, laptops, tablets, and so on—used to access porn and either replacing or putting boundaries in place around using the devices is critical. Sometimes this means getting rid of devices, including even replacing a smartphone with a flip phone. But because technology is essentially a requirement of modern living, all devices should be loaded with filtration software that blocks pornographic or other questionable material. Covenant Eyes is one of the best systems out there because it also includes another invaluable aspect of accountability. When utilizing Covenant Eyes, a person elects accountability allies who get email reports of electronic activity and will flag content of questionable material.

Whether recovering from compulsive sexual behavior that involves pornography use or other sexual acting out, the accountability piece of recovery is essential. It is an added layer of logistical protection from acting out and can act as a support in the event that there is a relapse, but it also introduces the important element of relationship into the healing process.

Sex literally primes the body for bonding. If sexual experiences are happening outside the context of a relationship, a person’s ability to connect and attach to others is impacted. And in serious cases, a person’s capacity for authentic intimacy becomes very warped. And this does not just happen with physical intimacy. In fact in severe cases, a person's capacity for non-sexual intimacy can become nearly nonexistent.

But this does not mean that hope for healthy and meaningful relationships is lost. Matt Fradd, author of The Porn Myth: Exposing the Reality Behind the Fantasy of Pornography, writes:

One of the reasons many people find it difficult to break free from porn and remain free is that they confuse sexual desire with a craving for pornography. Whatever protocols you put in place to distance yourself from pornography, remember: the goal is not the long-term squelching of sexual desire. The goal is the healing of your sexual cravings so that you can pursue them in a manner that pushes you toward a healthy and satisfying marital relationship.

In my work with people struggling from compulsive sexual behavior, whether using pornography or other acting out behavior, I rely most heavily on the work of Dr. Patrick Carnes and the research and training putting forth by his organization, the International Institute for Trauma and Addiction Professionals (IITAP). Their treatment model has a multi-pronged approach that recommends logistical and practical interventions like those I listed above. Carnes and the group of professionals trained by IITAP, also known as Certified Sex Addiction Therapists (CSAT), utilize a treatment model that addresses the developmental and relational trauma that they have identified that 97 percent of “sexual addicts” deal with.

To assess this trauma, CSAT therapists use the Post-Traumatic Stress Index assessment, which is an assessment developed by IITAP “designed to assess how trauma has impacted a client’s life.” One of the categories of how trauma has impacted a person’s life is what’s called the “Trauma Repetition” category. This category draws connections between how past experiences shape acting out behaviors in present-day life.

Trauma repetition has been studied by other researchers including psychiatrist Dr. Bessel Van Der Kolk, author of one of my favorite books on trauma, The Body Keeps the Score. Dr. Van Der Kolk finds:

Victims of trauma may respond to contemporary stimuli as a return of the trauma, without conscious awareness that past injury rather than current stress is the basis of their physiologic emergency responses. Hyperarousal interferes with the ability to make rational assessments and prevents resolution and integration of the trauma. This activation explains how current stress is experienced as a return of the trauma; it causes a return to earlier behavior patterns.

Dr. Van der Kolk’s work sheds some light on why CSAT professionals pay special attention to childhood trauma in their treatment. They help their patient discover patterns and themes from experiences in their past and connect to acting out behaviors and even kinds of pornography that they view. Since pornography is built on fantasy, what a person looks for in images may be connected to the desire to be powerful and in control in response to times when they did not feel this way. Or, they may get caught up in what I call “working out their abuse” by fantasizing and trying to “enjoy” something horrible that happened to them in the past.

This concept of trauma repetition has gained some attention as dramatic examples of it have appeared in the news. In 2014, a story came out about a high-level U.S. Senate staffer who completed suicide after being arrested on child pornography charges. He left behind a note in which he “apologizes for his ‘painful and humiliating’ crimes and reveals that his own sexual abuse began at the age of 5.”

Acknowledging the complexities of an issue does not remove culpability. But it can create a way forward for healing. Jay Stringer, therapist and author of the award-winning book Unwanted: How Sexual Brokenness Reveals Our Way to Healing, raises (and answers) the bold question, “What if your porn use could be a roadmap to healing, not a life sentence to sexual shame or addiction?” Like Carnes and his community of CSAT professionals, Stringer has found that recovery from unwanted sexual activity includes exploring how past wounding from trauma informs the sexual appetite revealed in porn use activity.

Critics of the idea of trauma repetition are quick to point out that the danger of calling instances of abusive sexual behavior “trauma repetition” is that it minimizes and excuses abuse. It doesn’t have to. I find that identifying trends of trauma helps porn users stop their cycles of behavior, and puts the responsibility back in the hands of the person to seek recovery. In contrast, a culture that embraces compulsive sexual behavior and porn use as harmless, does more to minimize problems that can be worsening under such circumstances.

Porn recovery advocate, Matt Fradd, argues “Sex and porn addictions are realities; and just as with alcoholics or drug addiction, the label ‘addict’ does not excuse a person for his actions. Addiction is slavery to be sure, but it is a chosen slavery.” People can choose to get out of it by seeking help, because there are many resources available for those committed to finding freedom from addictive behaviors.

If you or a loved one is struggling with compulsive sexual behavior, there is hope and help available.

For more information or to get help