Behavioral addictions raise significant public health concerns (1). Research suggests common mechanisms underlying substance-use disorders, such as alcohol use disorder, and non-substance related addictive or maladaptive behaviors, such as gambling disorder (2) or problematic pornography use [PPU; Love et al. (3), Gola et al. (4), and Leeman et al. (5)]. PPU can be considered a subtype of Compulsive Sexual Behavior Disorder (CSBD), which constitutes a large part of the behavioral patterns (6, 7). A growing number of studies support the assumption that PPU may constitute a disorder due to addictive behaviors (8) comparable to the classifications of gambling disorder and gaming disorder in the ICD-11 (9). Accordingly, main features of PPU are considered similar to those of gaming disorder including impaired control over the use, growing priority given to the use, and continuation of use despite the experience of negative consequences. As argued recently, there appears to be enough empirical evidence and theoretical background to consider PPU as a candidate for the ICD-11’s residual category of “other specified disorders due to addictive behaviors” (8).

From a neurocognitive dual-process perspective [e.g., Bechara (10)], addictive behaviors result from an inability to resist temptations, which is characterized by impulsive processes (associated with craving and reward orientation) undermining the control attempts by reflective processes (associated with self-control and executive functions). In other words, an imbalance between (affective) driving paths towards addiction and their (cognitive) counterpart (i.e., self-control) is made responsible for the development of (online) behavioral addictions (11). According to the I-PACE model (12), which is inspired by dual-process approaches, individual predisposing factors, such as trait impulsivity may affect the way in which situational behavior-related cues are perceived. For example, pictures showing sexual content might elicit higher cravings in highly impulsive compared to less impulsive individuals. Cognitive control functions are assumed to moderate the effect of specific cue-induced responses on the actual behavior/ usage. Accordingly, reduced cognitive control abilities are a risk factor for the development and maintenance of addictive behaviors. Executive functions comprise a diversity of cognitive control processes with varying complexity (13, 14). These “cold” functions include monitoring and rapid change of content in working memory as well as flexibly switching between tasks or mental sets and play a key role in decision making as they enable to deliberate about options and adapt behavior [see also (15–17)]. Meta-analytical results by Ioannidis et al. (18) show that individuals with (unspecified) problematic Internet use show deficits in executive functions (working memory, cognitive flexibility, motor inhibition) as well as deficits in risky decision making measured by tasks such as the Iowa Gambling Task (IGT), Balloon Analogue Risk Task (BART), Cambridge Gambling Task (CGT), and Game of Dice Task (GDT) – Tasks for which reduced performance has also been reported in individuals with substance use disorders (19).

In the context of PPU, research on decision making and executive functions is relatively scarce. Castro-Calvo and colleagues (20) reviewed experimental studies and summarized that PPU is associated with attentional bias towards sexual cues as well as with reductions in executive functions (especially motor inhibition and working memory) and decision making. Looking more closely, most of the studies used tasks that included sexual stimuli. For example, the study by Sinke et al. (21) indicates that men with PPU, as compared to healthy controls, only showed deficits in a working memory task when sexual pictures were presented in the background, and not when neutral pictures were presented. Similar interferences were shown for other executive function tasks [e.g., Schiebener et al. (22) and Wang and Dai (23)] and decision making tasks [IGT with pornographic and neutral cues; Laier et al. (24)]. Other PPU studies that the review summarized under “decision making” used either Approach/Avoidance tasks (25–28) or delay discounting tasks (29, 30). The former represents implicit behavioral tendencies while the latter represents a measure of trait impulsivity (the tendency to prefer smaller sooner over larger later rewards), which both is to be distinguished from risky choice. The only study mentioned using a risky decision-making task (IGT) without interference of sexual stimuli (31) compared hypersexual with control participants (all male). The groups did not differ with regard to decision-making performance (i.e., number of choices for advantageous versus disadvantageous decks; groups only differed with regard to gain/loss frequency). Looking more broadly at (further) studies of problematic/ compulsive sexual behavior draws an inconsistent picture. Some studies reported reduced executive functions (working memory, cognitive flexibility, and motor inhibition) and poorer decision-making performance (CGT) in individuals with CSBD compared to control participants (31–33). Contrarily, others reported no such differences using very similar measures (34, 35). What virtually all these studies report consistently is that PPU is associated with heightened trait impulsivity [see also (36, 37)]. Heightened impulsivity also characterizes problematic usage of the Internet (38) and a variety of other psychiatric disorders.

Taken together, reductions in executive functions and risky decision-making, and elevated impulsivity appear to be critically involved in addictive behaviors. Research on the impact of these functions in PPU is scarce and results are mixed. This study investigates risky decision making and executive functions in PPU. To take the intertemporal nature of decision-making in addiction into account (i.e., preferring short-term gratification by neglecting long-term risks), we used a risky decision-making task including conflicting short- and long-term consequences: the Cards and Lottery Task (CLT). The CLT represents decision making in situations, in which striving for immediate gratification increases the risk of negative long-term outcomes, while resisting immediate temptations increases the likelihood of positive long-term outcome. We hypothesized that individuals with PPU show deficits in the CLT as compared to individuals without PPU. We further expected PPU to be associated with deficits in other cognitive domains as well as with increased trait impulsivity.

This study investigated executive functions and decision making under objective risk in individuals with high compared to low severity in PPU. The extreme-group comparisons indicate that high PPU severity is associated with heightened psychopathological symptoms (depression and anxiety), heightened facets of trait and state impulsivity and elevated use duration (but not frequency). Contrary to our hypothesis, the groups did not differ regarding performance in measures of executive function and decision-making performance.

The findings are in line with previous studies showing increased impulsivity in PPU [although impulsivity might play a more prominent role in hypersexual behavior than in PPU; Bőthe et al. (52)]. Heightened impulsivity is also characteristic for other specified domains of problematic Internet use, such as gaming disorder (53) or problematic social-network use (54–57) as well as for other types of addictive behaviors like gambling disorder or substance use disorders [for reviews see (2, 58)]. This is consistent with the assumptions of theoretical models of addiction [e.g., Bechara (10), Brand et al. (12), Wiers et al. (59), and Everitt and Robbins (60)]. Neuroscientific research shows functional and structural differences in brain regions associated with the “reward system” in individuals with compared to those without PPU (7, 61).

Individuals with higher severity of PPU, as compared to those with low problem severity, performed equally well in the tasks measuring risky decision-making (CLT) and executive functions (three-back and TMT). Accordingly, individuals with high problem severity for PPU do not appear to have any significant deficits in weighing long-term versus short-term consequences. These results are in contrast to empirical findings on gambling disorder and gaming disorder, which are commonly characterized by impairments in risky decision-making and executive functions (58, 62). This trend is also reflected in the results of a large meta-analysis of problematic online behaviors, which included mainly studies on gaming (18). Previously, PPU has also been associated with deficits in executive functions, including inhibitory control and working memory, and decision making (20), which appears to be contrary to the results of this study. Looking more closely, the great majority of the previous studies on executive functions (e.g., inhibitory control, working memory) in PPU used tasks with pornographic pictures (as stimuli or in the background) indicating deficits in case arousing pictures are present. These findings point at stimuli-specific reductions in cognitive/inhibitory control which, according to the I-PACE model, emerge in later phases of addiction development (12). Part of the participants in this study underwent an additional fMRI part including a modified Stop-Signal-Task, the results of which have been reported previously (41). At the behavioral level, symptom severity was associated with faster reaction times, indicating better (and not reduced) inhibitory control, which might be explained by increased insula activity during inhibitory control processing (41). When individuals were under acute stress a higher symptom severity was associated with longer reaction times, indicating reduced inhibitory control (40). These results indicate that, situational factors might impact executive control abilities. Deficits in decision making have previously mainly been referred to a preference for smaller sooner over larger later rewards (i.e., increased delay discounting), which captures individuals’ trait impulsivity rather than decision-making competence (63), or as a result of the interference between presentation of pornographic pictures and risky choice options [see (20)]. The latter can be assumed to result from biases towards pornography-related stimuli, which divert attention from decision-relevant content leading to reduced performance in such tasks.

In the absence of addiction-related stimuli, however, as it was the case in this study, individuals with PPU do not seem to make more risky/disadvantageous decisions. Similar findings have been reported for other types of problematic Internet use apart from gaming (64–66). In accordance with findings from a recent meta-analysis (67), risky decision-making tendencies might be a specific feature of gaming disorder, and not (or not so markedly) of other internet-related disorders such as problematic social networks use or PPU. Also, our results indicate that general working memory and cognitive flexibility (measured with tasks that do not present pornographic content) might not be impaired in PPU. However, studies on PPU that used cognitive measures without pornographic pictures, are yet very rare. Further research is needed to determine the extent and specificity of cognitive impairment in individuals with PPU.

A limitation of the current study is the non-clinical sample. The instrument used to identify high and low severity of PPU (sIATporn) has been used previously, however, it does not allow valid classification. From today’s point of view, we would recommend instruments that have been developed based on current diagnostic criteria for CSBD [e.g., the Compulsive Sexual Behavior Disorder Scale, CSBD-19; Bőthe et al. (68)] or for disorders due to addictive behaviors [e.g., the Assessment of Criteria for Specific Internet Use Disorders, ACSID-11; Müller et al. (69)]. Furthermore, the sample included only male participants, which limits the generalizability of the current findings. The restriction to exclusively male subjects was due to the design of the additional fMRI examination [described in Antons and Brand (41)]. Although some differences between men and women with CSBD are identified, impulsivity is associated with CSBD and PPU regardless of gender (70). The role of decision making and executive functions in women with PPU needs to be explored in future research.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by Ethics committee of the Department of Computer Science and Applied Cognitive Science at the University of Duisburg-Essen. The patients/participants provided their written informed consent to participate in this study.

SA conceptualized and carried out the study and analyzed the data. SM wrote the first draft of the manuscript that was reviewed by SA. All authors contributed to the article and approved the submitted version.

The work of SM and SA on this article was carried out in the context of the Research Unit ACSID, FOR2974, funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) – 411232260.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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