The record

AASECT

The American Association of Sexuality Educators, Counselors and Therapists holds that there is insufficient empirical evidence to classify sex addiction or porn addiction as a mental health disorder, and that sex-addiction treatment methods are not adequately informed by accurate human sexuality knowledge.

Position on Sex Addiction, 29 November 2016. Source

What is contested. Actively. IITAP, the International Institute for Trauma and Addiction Professionals, published a formal rebuttal. It argues the statement is hedged, that the sex-addiction field disputes the evidentiary claim, and that more than twenty neuroscience studies support an addiction model. This is a live disagreement between two organised professional bodies, and we are not going to present it as settled.

American Psychiatric Association

Hypersexual Disorder was proposed for DSM-5, underwent a field trial, and was rejected by the APA Board of Trustees. It appears in neither DSM-5 (2013) nor DSM-5-TR (2022).

Kafka, M. P. (2014). What Happened to Hypersexual Disorder? Archives of Sexual Behavior, 43, 1259–1261. Source

Pornography addiction itself was never formally proposed for DSM-5. Hypersexual Disorder was the diagnosis under consideration.

A limit on this source. The APA does not publish rejection rationales, and it published none here. The fact of the exclusion is verifiable from DSM-5 itself. The reason is not attributable to the APA, and we do not attribute one.

What is contested. The exclusion is not in dispute. Its meaning is. Critics note that the field trial reported adequate reliability, and that the rejection may have reflected concern about forensic misuse rather than evidence alone. Others hold that ICD-11’s later inclusion of Compulsive Sexual Behaviour Disorder supersedes the DSM-5 decision.

ICD-11

The World Health Organization classifies Compulsive Sexual Behaviour Disorder (6C72) as an impulse control disorder. It sits outside the ICD-11 grouping for disorders due to substance use and addictive behaviours.

Adopted May 2019, in force 1 January 2022. Source

What is contested, and this one runs against us. The presence of CSBD in ICD-11 means the WHO recognises a real disorder of sexual behaviour control. Keel’s position is that most men who want to use less do not have one. Most is not all, and some of the people reading this page will have it. Presenting ICD-11 as ammunition while leaving out that it establishes a genuine diagnosis would be the selective citation this company exists to object to.

If your use may be compulsive, Keel is the wrong tool. Not for everyone

Moral incongruence

Research finds that self-perceived addiction to pornography tracks conflict between behaviour and personal values, rather than frequency or duration of use.

Grubbs, J. B., Perry, S. L., Wilt, J. A., & Reid, R. C. (2019). Pornography Problems Due to Moral Incongruence. Archives of Sexual Behavior, 48(2), 397–415. Source

What is contested. The paper was published as a target article with formal commentaries in the same issue, several of them critical, and the authors published a response. Critics argue that moral incongruence explains some but not all self-reported problems, and that dysregulated use exists independently of moral conflict. The model is influential and it is debated. We do not present it as settled.

Affect labeling

Naming an emotion in words changes how the brain responds to it. In imaging work, labelling an emotion lowered amygdala response and raised activity in the right ventrolateral prefrontal cortex, a region associated with inhibitory control.

Lieberman et al., Psychological Science, 2007. Source

A review a decade later found the effect held across studies: labelling an emotion present in a stimulus significantly reduced the odds of amygdala activity compared with simply looking at it.

Torre and Lieberman, Emotion Review, 2018. Source

What this does not show. This research is about emotion regulation in general. It is not evidence about masturbation, porn, or anything Keel counts. It is the reason the Note asks you to write a sentence. It is not a claim that Keel works.

What is contested. Compared directly, affect labeling did not differ significantly from plain distraction on self-reported distress. Part of the effect may be that writing a sentence moves your attention, and we are not going to present it as more than that. The review also notes that affect labeling may not feel like a regulatory process at all — useful in a tool like this, and awkward for anyone trying to measure it.