Paraphilia

The Internet is altering patterns of social communication and interpersonal relationships. This is nowhere more true than in the field of sexuality (Cooper, Delmonico, & Burg, 2000). Furthermore, sex is the most frequently searched-for topic on the Internet (Freeman-Longo & Blanchard, 1998). Young, Griffin-Shelley, Cooper, O'Mara, and Buchanan (2000) claim that the convenience of online pornography and adult chat sites provides an immediately available vehicle to easily fall into compulsive patterns of online use.

Sexually Related Uses of the Internet

Pornographers have always been the first to exploit new publishing technologies (e.g., photography, videotape, Internet etc.). It is estimated that the online pornography industry will reach $366 million by 2001 (Sprenger, 1999) although other estimates suggest it is already worth $1 billion ("Blue Money," 1999). In addition, the research company Datamonitor reported that over half of all spending on the Internet is related to sexual activity ("Blue Money," 1999). This includes the conventional (e.g., Internet versions of widely available pornographic magazines like Playboy), the not so conventional (e.g., Internet versions of very hardcore pornographic magazines), and what can only be described as the bizarre (e.g., discussion groups on almost any sexual paraphilia, perversion, and deviation). There are also pornographic picture libraries (commercial and free-access), videos and video clips, live strip-shows, live sex shows, and voyeuristic Web-Cam sites (Griffiths, 2000a).

Before any examination of the addictiveness potential of the Internet and its relationship to sex addiction, Griffiths (2000a) has argued that the first step is to examine all the different ways that the Internet can be used for sexually related purposes. The reasoning behind this is that only some of these activities may be done to excess and/or be potentially addictive. Griffiths (2000a) goes on to outline that the Internet can (and has) been used for a number of diverse activities surrounding sexually motivated behavior. These include the use of the Internet for seeking out sexually related material for educational use, buying or selling sexually related goods for further use offline, visiting and/or purchasing goods in online virtual sex shops, seeking out material for entertainment/masturbatory purposes for use online, seeking out sex therapists, and seeking out sexual partners for an enduring relationship. Other sexually motivated uses of the Internet include seeking out sexual partners for a transitory relationship (i.e., escorts, prostitutes, swingers) via online personal advertisements/"lonely hearts" columns, escort agencies, and/or chat rooms; seeking out individuals who then become victims of sexually related Internet crime (online sexual harassment, cyberstalking, pedophilic "grooming" of children); engaging in and maintaining online relationships via e-mail and/or chat rooms; exploring gender and identity roles by swapping gender or creating other personas and forming online relationships; and digitally manipulating images on the Internet for entertainment and/or masturbatory purposes (e.g., celebrity fake photographs where heads of famous people are superimposed onto someone else's naked body).

It is evident from these types of sex-related Internet behavior that very few of these are likely to be potentially excessive, addictive, obsessive, and/or compulsive. The most likely behaviors include the use of online pornography for masturbatory purposes, engaging in online relationships, and sexually related Internet crime (e.g., cyberstalking). Before examining the implications of these behaviors, the next section briefly overviews the concept of Internet addiction more generally.

Internet Addiction: A Brief Overview

Although there is opposition to the general concept of behavioral (i.e., nonchemical) addictions, there is a growing movement (e.g., Griffiths, 1996a; Marks, 1990; Orford, 1985) which views a number of diverse behaviors as potentially addictive, including gambling, overeating, sex, exercise, shopping, and computer game playing. Internet addiction is another such area since it has been alleged by some academics that social pathologies (i.e. technological addictions) may be beginning to surface in cyberspace (e.g. Brenner, 1997; Cooper, 1998a; Griffiths, 1996b, 1998, 2000b, 2000c; Scherer, 1997; Young, 1998a, 1998b). Furthermore, researchers investigating the addictive potential of the Internet have noted the correlations between time spent online and negative consequences reported by users (e.g. Cooper, Scherer, Boises & Gordon, 1999; Young & Rogers, 1998).

Technological addictions are nonchemical (behavioral) addictions that involve excessive human-machine interaction. They can either be passive (e.g., television) or active (e.g., computer games), and usually contain inducing and reinforcing features which may contribute to the promotion of addictive tendencies (Griffiths, 1995a). They also feature the core components of addiction, including salience, mood modification, tolerance, withdrawal, conflict, and relapse (Griffiths, 1996a, 1996c). It has been argued by Griffiths (1996c) that any behavior (e.g., Internet use) which fulfils these criteria can be operationally defined as addictions. These core components have been expanded upon by Griffiths (2000a) in relation to Internet sex of whatever type it happens to be (e.g. downloading pornography, cybersex relationships etc.).

Salience occurs when Internet sex becomes the most important activity in the person's life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings), and behavior (deterioration of socialized behavior). For instance, even if the person is not actually on their computer engaged in Internet sex they will be thinking about the next time they will be. Mood modification refers to the subjective experiences that people report as a consequence of engaging in Internet sex, and can be seen as a coping strategy (i.e., they experience an arousing "buzz" or a "high" or paradoxically tranquilizing feel of "escape" or "numbing"). Tolerance is the process whereby increasing amounts of Internet sex are required to achieve the former mood modificating effects. This basically means that for someone engaged in Internet sex, they gradually build up the amount of the time they spend in front of the computer engaged in the behavior. Withdrawal symptoms are the unpleasant feeling states and/or physical effects which occur when Internet sex is discontinued or suddenly reduced (e.g., the shakes, moodiness, irritability, etc.). Conflict refers to the conflicts between the Internet user and those around them (interpersonal conflict), conflicts with other activities (job, social life, hobbies, and interests), or conflicts within the individual themselves (intrapsychic conflict and/or subjective feelings of loss of control), which are concerned with spending too much time engaged in Internet sex. Relapse is the tendency for repeated reversions to earlier patterns of Internet sex to recur and for even the most extreme patterns typical of the height of excessive Internet sex to be quickly restored after many years of abstinence or control.

Young (1999a) claims Internet addiction is a broad term which covers a wide variety of behaviors and impulse control problems. She claims this is further categorized by five specific subtypes: (a) cybersexual addiction, typically involving the compulsive use of adult websites for cybersex and cyberporn; (b) cyber-relationship addiction, typically involving the over-involvement in online relationships; (c) Net compulsions, typically involving obsessive/compulsive activities such as online gambling, shopping, day-trading, and so forth; (d) information overload, typically involving compulsive web surfing or database searching; and (e) computer addiction, typically involving obsessive computer game playing on games such as Doom, Myst, Solitaire etc.

Only two of these specifically refer to potential sexually based addictions (i.e., cybersexual addiction and cyber-relationship addiction). Such distinctions are potentially very useful as it would be helpful if researchers in the area used the same words and had exemplar descriptions of such behaviors so that everyone could be clear as to what exactly they are researching. This would be helpful for both comparative and evaluative purposes.

In addition to definitional considerations, Young's classification also raises the question of what people are actually addicted to. On a primary level, is it the sexually related behavior or is it the Internet? Griffiths (1999a, 2000b) has argued that many of the excessive users highlighted by Young (1999a) are not Internet addicts but just use the Internet excessively as a medium to fuel other addictions. Griffiths (1999a, 2000b) argues that a gambling addict or a computer game addict is not addicted to the Internet. The Internet is just the place where they engage in the behavior The same argument can be applied to Internet sex addicts. However, there are case study reports of individuals who appear to be addicted to the Internet itself. These are usually people who use Internet chat rooms or play fantasy role-playing games--activities that they would not engage in except on the Internet itself (some of which are sex-related). To some extent, these individuals are engaged in text-based virtual realities and take on other personas and social identities as a way of making themselves feel good about themselves.

In these cases, the Internet may provide an alternative reality to the user and allow them feelings of immersion and anonymity (which may lead to an altered state of consciousness). This in itself may be highly psychologically and/or physiologically rewarding. The anonymity of the Internet has been identified as a consistent factor underlying excessive use of the Internet (Griffiths, 1995b; Young, 1998b). This is perhaps particularly relevant to those using Internet pornography. There may be many people who are using the medium of the Internet because (a) it overcomes the embarrassment of going into shops to buy pornography over the shop counter and (b) it is faster than waiting for other non-face-to-face commercial transactions (e.g., mail order). Anonymity may also encourage deviant, deceptive, and criminal online acts such as the development of aggressive online personas or the viewing and downloading of illegal images (e.g., pornography) (Young, 1999b).

Cybersex and Cyber-relationships

Probably one of the most unexpected uses surrounding the growth of the Internet concerns the development of online relationships and their potentially addicting nature. Young, Griffin-Shelley, Cooper, O'Mara, and Buchanan (2000) define an online relationship (a cyberaffair) as a romantic and/or sexual relationship that is initiated via online contact and maintained predominantly through electronic conversations that occur through e-mail and in virtual communities such as chat rooms, interactive games, or newsgroups. Young et al. (2000) report that what starts off as a simple email exchange or an innocent chat room encounter can escalate into an intense and passionate cyberaffair, and eventually into face-to-face sexual encounters. Further to this, those in online relationships often turn to mutual erotic dialogue (often referred to as cybersex). In this instance, cybersex involves online users swapping text-based sexual fantasies with each other. These text-based interactions may be accompanied by masturbation. Online chat rooms provide opportunities for online social gatherings to occur almost at the push of a button without even having to move from your desk. Online group participants can--if they so desire--develop one-to-one conversations at a later point either through the use of continuous e-mails or by instant messages from chat rooms. It could, perhaps, be argued that electronic communication is the easiest, most disinhibiting, and most accessible way to meet potential new partners--factors that may facilitate excessive online use among some people.

There are a number of factors that make online contacts potentially seductive and/or addictive. Such factors (mentioned previously) include the disinhibiting and anonymous nature of the Internet. This may be very exciting to those engaged in an online affair. Disinhibition is clearly one of the Internet's key appeals as there is little doubt that the Internet makes people less inhibited (Joinson, 1998). Online users appear to open up more quickly online and reveal themselves emotionally much faster than in the offline world. What might take months or years in an offline relationship may only takes days or weeks online. As Cooper and Sportolari (1997) have pointed out, the perception of trust, intimacy, and acceptance has the potential to encourage online users to use these relationships as a primary source of companionship and comfort.

Some researchers have made attempts to explain how and why online relationships and affairs occur. Cooper (1998a) suggested there are three primary factors that facilitate increased online sexuality (accessibility, affordability and anonymity). This was termed the Triple A Engine and the factors are defined as accessibility, in that there are millions of sites available 24 hours a day, seven days a week; affordability, in that competition on the Web keeps prices low and there are many ways to access "free" sex; and anonymity, in that people perceive their communications to be anonymous. Cooper (1998a) asserts that the components of the Triple A Engine appear to be risk factors for Internet users who already have a problem with sexual compulsivity or to those who have psychological vulnerabilities rendering them at risk for developing such compulsivity.

Young (1999b) also developed a variant of the Triple A Engine which she called the ACE model (Anonymity, Convenience, Escape). Neither ACE nor AAA are strictly models, as neither explains the process of how online relationships develop. However, they do provide (in acronym form) the variables and factors involved the in acquisition, development, and maintenance of emotional and/or sexual relationships on the Internet (i.e., anonymity, accessibility, convenience, affordability, and escape). It would also appear that virtual environments have the potential to provide short-term comfort, excitement, and/or distraction. Other "attractive" factors outlined by Schneider (2000) include the fact that cybersex is legal, available in the privacy of one's home, inexpensive, and does not put the user at risk of a sexually transmitted disease. It is also ideal for hiding the activity from a partner because it does not leave any obvious evidence of any sexual encounter. For those online, Internet sex may provide a sense of safety and ready access to partners. Furthermore, for disenfranchised groups (e.g., homosexuals) this might prove an advantage.

Young et al. (2000) claim the anonymity of electronic transactions provides the user with a greater sense of perceived control over the content, tone, and nature of the online sexual experience. They claim that unlike real life sexual experiences, a woman can quickly change partners if her cyber-lover isn't very good or a man can log off after his orgasm without any long goodbyes. Young et al. (2000) also raise questions that the Internet might help in answering. For instance, what if a man privately wondered what it would be like to have sex with another man? Within the anonymous context of cyberspace conventional messages about sex are eliminated, allowing users to play out hidden or repressed sexual fantasies without the fear of being caught. For anyone who has ever been curious about a whole range of sexual behaviors, cybersex offers a private, safe, and anonymous way to explore those fantasies. Young et al. (2000), therefore, claim that individuals are more likely to experiment sexually, as online users feel encouraged to engage in their adult fantasies and validated by the acceptance of the cyberspace culture.

Cyber-relationship Typologies

A number of researchers have forwarded typologies of the different kinds of Internet users in relation to online sexual and/or relationship activity (i.e., Cooper, 1998a; Griffiths, 1999b; Young, 1999a). Cooper, Putnam, Planchon, and Boies (1999) in their survey of 9177 Internet users found that 8% spent 11 hours or more per week engaged in online sexual pursuits. On the basis of these findings, Cooper, Putnam, et al. (1999) put forward a continuum model of people who use the Internet for sexual purposes (recreational users, at-risk users, and sexual compulsive users):

1. Recreational users are those who access online sexual material more out of curiosity or for entertainment purposes and are not typically seen as having any problems associated with their online sexual behavior.

2. At-risk users are those who, if it were not for the availability of the Internet, may never have developed a problem with online sexuality. Cooper, Putnam, et al. (1999) claim that for these people, the interaction between the AAA factors and underlying personality factors leads to patterns of behavior that may develop into online sexually compulsive behaviors.

3. Sexual compulsive users are those use the Internet as a forum for their sexual activities because of their propensity for pathological sexual expression. Although Cooper, Putnam, et al.'s (1999) continuum is of descriptive interest, it tells us little about the Internet user except their frequency and type of use.

Griffiths (1999b) has outlined three basic types of online relationship in relation to actual online behavior. They can be summarized as:

1. Virtual online relationships involve people who never actually meet. They usually engage in sexually explicit text exchanges (i.e., cybersex), and may swap gender roles. Although they may have real-life partners they do not feel they are being unfaithful. The relationship is usually short-lived.

2. Developmental online relationships involve people meeting online but who eventually want the relationship to move from online to offline after becoming emotionally intimate with each other. The shared emotional intimacy and commitment often leads to cybersex and/or a strong desire to communicate constantly with each other on the Internet. The relationship is often long lasting.

3. Maintaining online relationships involve people first meeting offline but then maintaining their relationship online for the majority of the time. This is usually because they are geographically distant. The relationship may or may not be long lasting depending upon the level of emotional intimacy and commitment. With regards to addiction, it is only the first type outlined here that may be addicted to the Internet. The latter two types are more likely to be addicted to the person rather than the activity--particularly as their Internet usage stops almost completely when they meet up offline with their online partner (Griffiths, 2000a).

Internet Sex Addiction: The Claims

As we have seen, Young (1999a) claims that cybersexual addiction and cyber-relationship addiction are specific subtypes of Internet Addiction. She estimates that one in five Internet addicts are engaged in some form of online sexual activity (primarily viewing online pornography and/or engaging in cybersex). However, there appears to be no empirical evidence to back up this statistic. Furthermore, Young et al. (2000) claim that men are more likely to view online pornography, while women are more likely to engage in erotic chat. Young et al. (2000) have also produced a checklist of warning signs for cybersexual addiction. These are routinely spending significant amounts of time in chat rooms and private messaging with the sole purpose of finding cybersex; feeling preoccupied with using the Internet to find on-line sexual partners; frequently using anonymous communication to engage in sexual fantasies not typically carried out in real-life; anticipating the next on-line session with the expectation of finding sexual arousal or gratification; frequently moving from cybersex to phone sex (or even real-life meetings); hiding on-line interactions from significant others; feeling guilt or shame from or about on-line use; accidentally being aroused by cybersex at first, and now actively seeking it out when online; masturbating online while engaged in erotic chat; and less investment with real-life sexual partner and preferring cybersex as the primary form of sexual gratification.

Young et al. (2000) go on to claim that people who suffer from low self-esteem, a severely distorted body image, untreated sexual dysfunction, or a prior sexual addiction are more at risk to develop cybersexual addictions. In particular, sex addicts often turn to the Internet as a new and safe sexual outlet to fulfill their compulsions without the expense of costly premium rate telephone lines, the fear of being seen at an adult bookstore, or the fear of disease among prostitutes. However, most of these assertions appear to have been made in the absence of reported empirical data.

In addition to the work by Young (1998b), many screening tools have been designed to help people identify a possible problem with their online sexual behavior (see Appendix for some of the most popular screening instruments available on the Internet). Most of the questionnaires available are self-exploration tools that have yet to be researched for their psychometric properties. Embedded within the majority of the questionnaires are questions which relate to a number of psychosocial dimensions (e.g., life interference, emotional distress, obsessive-compulsive behavior, tolerance and withdrawal, destructive impairment, etc.)--some of which are not mutually exclusive. The questions are not usually specific and can refer to any sexual activity that one may engage in online. The questions are meant to be answered in relation to any sexual material or encounters online (including chatrooms, email, bulletin boards, pictures, audio, and video). It will be interesting to see the results of research using these screening instruments, as the findings may help us to assess whether Internet sex addiction (if it exists) is fundamentally different from "traditional" forms of sex addiction. There also needs to be an examination of how meeting for a sexual activity on the Internet or examining pornography in its various forms on the Internet are similar or dissimilar to other ways that non-Internet users have met for sex or used pornography. The often-repeated claim is that ease of online sex availability may have the potential to promote sexual experimentation among those who normally would not engage in such behavior. Such a claim needs to be examined empirically.

Although there are some strong similarities between men and women in the way that they view cybersex (e.g., both view it as a way of hiding physical appearance), there are important differences. Young et al. (2000) claim that women prefer cybersex because it removes the social stigma that women should not enjoy sex, and allows them a safe means to concentrate on their sexuality in new, uninhibited ways. Men prefer cybersex because it removes performance anxiety that may be underlying problems with premature ejaculation or impotence. It is unclear what empirical evidence Young et al. (2000) provide for all these assertions although such claims would form a good basis for further research. As we shall see on the following section, empirical data appears to substantiate Young et al.'s (2000) claims that men and women use cybersex differently-although not in the way that they assert.

Internet Sex Addiction: Empirical Data

Until very recently, empirical data surrounding excessive online sexual behavior was lacking. However, this situation is slowly starting to change. There have been a few studies of excessive Internet use which have found that a small proportion of users admitted using the Internet for sexual purposes (e.g., Cooper et al., 1999, 2000; Morahan-Martin & Schumacher, 1997; Scherer, 1997; Schwartz & Southern, 2000; Young, 1998b). Very few researchers have used the term Internet sex addiction, although their descriptions of excessive Internet sex among the populations they have observed appear to feature the general components of addiction outlined earlier.

Apart from case study accounts, only two major studies of cybersex addicts have been reported in the literature. The most impressive data set was collected by Cooper and colleagues and has been used as the basis for a number of empirically-based publications (e.g., Cooper et al. 1999, 2000). Perhaps the most relevant paper is the one by Cooper et al. (2000) which examined a group of "cybersexually compulsive" Internet users. They used the Kalichman Sexual Compulsivity Scale (SCS) (Kalichman et al., 1994) combined with time online in order to identify the group of users displaying cybersex compulsivity.

They presented new data on cybersex users, abusers and compulsives. Following reanalysis of previously collected data, four groups were identified: nonsexually compulsive (n = 7738), moderate SCS score (n = 1007), sexually compulsive (n = 424), and cybersexually compulsive (n = 96). Because time is only one dimension with which to identify individuals who may be sexually compulsive, other criteria were looked at. These included increased appetite, desire, or tolerance (contributing to increased time engaged in the activity); harm to self or others; denial or minimization of negative consequences; behavior interfering with social, academic, occupational, or recreational activities; obsession with the activity; and compulsion or loss of freedom in choosing whether to engage in a behavior (e.g., Carnes, 1991; Cooper, 1998b; Goodman, 1992; Schneider, 1994). Again, the criteria used to assess cyber sex compulsivity are highly compatible with the addiction components outlined earlier in the paper.

The cybersex compulsive group consisted of those who met the criteria for both sexual compulsivity on the SCS and who spent more than 11 hours a week online engaged in sexual pursuits. Only 1% of the sample fell into this group (n = 96). Cooper et al. (2000) claim this to be the "purest sample yet" of cybersex compulsives (p. 11). This group was 79% male, 63% heterosexual, and 38% married (with another 15% in committed relationships). In terms of demographics, overrepresented groups included being female, homosexual, bisexual, single, and a student, compared to the other three groups (see Table 1). Cooper et al. (2000) thus concluded that these overrepresented groups were therefore more vulnerable to developing cybersex compulsion. However, an alternative explanation may be that some groups (e.g., men) are more likely to deny that they have a problem.

Unfortunately, very few questions specifically asked about online sexual activity jeopardizing or interfering with their life. Overall, 79% of the sample reported that online sexual activity had not jeopardized any area of their life and 68% reported that they felt that online sexual activity had not interfered with any part of their life. It was concluded that the majority of Internet users engage in sexual pursuits that do not lead to any life difficulty. There are, of course, limitations to this study, the biggest problem being that the participants were self-selected. However, there are no other studies of this size in the literature to compare with. This makes their study very important given the dearth of empirical data. For the 1% of the sample who were cybersexual compulsives, online sexual pursuits can have major deleterious effects on their lives. The data suggest that there needs to be increased attention given to the issue of Internet sexuality, although it is clear that the vast majority of people do not (and will not) experience adverse reactions from online sexual activity.

The only other study that has isolated and examined a group of potential Internet sex addicts is that of Schwartz and Southern (2000). Descriptive data from a clinical population of cybersex abusers (n = 40; 19 males and 21 females) from an outpatient psychiatric clinic were reviewed. All were referred primarily or exclusively for problematic cybersexual activity. These typically involved masturbating or self-touching while communicating with someone over the Internet. Over two thirds (68%) had a history of sexual abuse, with females being more likely to present sexual abuse history and PTSD. Most of the male patients (90%) were self-diagnosed as sex addicts or fit the criteria for compulsive sexual behavior. Only half the females (52%) engaged in compulsive sexual behavior although their Internet usage and cybersex were considered by the patients and/or their referral sources to be pathological. A quarter of the patients participated in cybersex activities associated with atypical or special sexual interests.

Several generalizations from the descriptive data of patients seeking treatment were noted and were argued by Schwartz and Southern (2000) to be useful for ongoing review. Male compulsive users presented cybersex as a manifestation of sexual addiction. Female cybersex abusers may be vulnerable to trauma reenactment as they explored sexual preferences and reached out to anonymous partners. Male and female cybersex abusers experienced increasingly negative consequences as they continued to participate in this high-tech form of intimacy dysfunction. Schwartz and Southern (2000) claimed that 70% (n = 28) of their sample of cybersex abuse patients had a sexual addiction (90% male, 52% female). They also reported that 57.5% had a chemical dependency (74% male, 50% female) and that 47.5% had an eating disorder (26% male, 67% female). Table 2 compares the main demographic variables of Schwartz and Southern's sample population with that of Cooper et al. (2000). Although the samples are from different sources many of the variables (e.g., age, sexual orientation, occupation) appear demographically similar, although there are a greater percentage of females in Schwartz and Southern's study. This may be because females are more likely to seek treatment than males. Furthermore, any slight differences in the demographic breakdown of the two studies are most probably explained by the gender bias and sampling methods employed.

Schwartz and Southern (2000) also constructed four self-explanatory subtypes of cybersex addiction (i.e., male cybersex addicts, female cybersex addicts, loner cybersex addicts, paraphiliac cybersex addicts). The first two subgroups were based on gender, while the latter two subgroups reflected lifestyle limitations. The loner and paraphiliac subgroups were not mutually exclusive, but were argued to be clinically meaningful. In general, Schwartz and Southern argued that cybersex abusers are heavy users of the Internet, generally married, college-educated, depressed, and the survivors of sexual abuse.

In conclusion, Schwartz and Southern (2000) argued that compulsive cybersex was a survival mechanism involving dissociative reenactment and affect regulation. Dissociation was present when a person engaged in secretive illicit sex on the computer and then went to bed with the spouse without dissonance or discomfort. They also claimed that cybersex had become the new tea room for meeting anonymous partners and engaging in a fantasy world. Anonymous persons engaged in easily accessible, ritualized, affordable behavior that led to an impersonal and detached sexual outlet. Furthermore, it provided an immediate powerful reinforcement afforded by variable schedule hits that made it potentially addictive for many users.

The empirical data of both Schwartz &Southern (2000) and Cooper et al. (2000) gives credence to Young et al.'s (2000) claim that men and women use cybersex differently. However, the differences were not in the way that Young et al. (2000) postulated. For instance, Cooper et al. (2000) found that females preferred chat rooms to other mediums whereas males preferred the Web. No female cybersex compulsives reported using newsgroups for sexual pursuits. Since newsgroups are primarily for the exchange of erotic pictures, this supported the finding that women tend to desire cybersex in the context of a "relationship" rather than simply viewing images or text (Cames, 1991; Cooper, Scherer, et al., 1999). The study by Schwartz and Southern reported that male cybersex abusers had characteristics similar to problem Internet users, and were more likely to engage in sexual compulsivity or be labeled a sex addict. Female cybersex abusers displayed similar behavior to nonproblematic Internet users, and male cybersex abusers were likely to be older than female cybersex abusers (i.e., middle-aged).

Internet Sex Addiction: Indirect Empirical Data

Indirect evidence of Internet sex addiction comes from a number of studies. For instance, Schneider (2000) carded out a brief survey with 91 females and 3 males. All of her participants had experienced serious adverse consequences of their partner's cybersex involvement. Interestingly, 31% of her participants volunteered that the partner's cybersex activities were a continuation of preexisting compulsive sexual behaviors. Furthermore, 16 respondents (18%) reported that their partner's cybersex activities progressed to offline encounters with other people. These were people they had met in online chatrooms, through e-mail, and so forth. It was also reported that cybersex was a major contributing factor to separation and divorce. The major problem with this study in evaluating the evidence for Internet sex addiction is that the term cybersex addict was used informally and the decision to use the term was not made using any screening instrument. The diagnosis was thus from the perception of the respondents. Schneider claims that most people who engage in online sexual behavior are recreational users analagous to recreational drinkers or gamblers. However, she claims that a significant proportion of online users have preexisting sexual compulsions or addictions that are now finding a new outlet. For others, with no such history, cybersex is the first expression of an addictive disorder--one that lends itself to rapid progression, similar to the increased crack cocaine use by the previously occasional cocaine user.

Other indirect evidence for the existence of Internet sex addiction comes from Orzack and Ross (2000), who described the treatment of two Internet sex addicts who both fit the criteria for computer addiction, sexual addiction, and cybersexual addiction. They claimed that the majority of those addicted to virtual sex who present for inpatient and outpatient treatment usually have more pervasive sexual or other behavioral and/or chemical addictions. The aim of their research was to demonstrate the complexities of treating compulsive Internet sex. They compared cybersex addiction as an equivalent to an eating disorder. They stressed that they were not trying to imply that humans were dependent on computers for life sustenance. Furthermore, unlike human sexuality, computer usage is not an innate human need or drive. However, they argued that like, for example, the television and telephone, the computer is an essential feature of modern life. They further claimed that treatment modalities developed from treating other addictions (i.e., food and sex) were applicable in treating cybersex addiction. They concluded that cybersex addiction (i.e., Internet sex addiction) exists and is an extremely potent addiction that must be treated as such.

One area in which there appears to be very little data is in the area of sexual Internet use by children and adolescents. According to Freeman-Longo (2000), little is known about sexual addiction in these groups, and even less about children, teens, sex, and the Internet. At best we can only speculate what may occur based upon what we know about adults who develop sexual addiction. What we do know is that children and teenagers can and do develop compulsive sexual behavior, such as masturbation (Barbaree, Marshall & Hudson, 1993; Ryan & Lane, 1997), and that sexual addiction may be possible given that compulsivity is often a precursor to addiction. Additionally, there has been an increase in the number of counselors and therapists seeing children and teens in their practice who come in for problems associated with online sexual activities (see Freeman-Longo, 2000). Research regarding children and sexual activity on the Internet is therefore needed. There is uncertainty about children's potential to become sexual compulsives/addicts if they engage in online behaviors. In a population of children exposed to online pornography and adult-oriented materials, can we differentiate factors of emotional vulnerability and other personality traits that would predispose some to become sexual compulsives and addicts? Does online sexual behavior/activity predispose some children to act out sexually or to engage in sexually abusive behaviors (Freeman-Longo, 2000)? Such questions could form the basis for further empirical research.

CONCLUSION

If Internet sex addiction is to become a viable term there must be scientific evidence to support it, clarification of the criteria accepted by all, and quantification of its occurrence. The lack of data from representative samples using instruments of known quality make it very difficult to gauge how serious the problems in this area might be. Thus, the field is still in conceptual crisis as some researchers amalgamate categories of sex addiction together that have similarities, whereas some divide and subcategorize. At present the question of whether Internet sex addiction is fundamentally different from other, more traditional forms of sex addiction cannot be answered until the existence of more empirical research evidence. However, it does appear to be the case that Internet sex is a new medium of expression that may increase participation because of key factors, such as perceived anonymity and disinhibition.

There is growing empirical evidence that Internet sex addiction exists although none of the surveys to date conclusively show that Internet sex addiction is problematic to anyone but a small minority. The evidence appears to come from both direct (e.g., Cooper et al. 2000; Schwartz & Southern, 2000) and indirect (e.g., Orzack & Ross, 2000; Schneider, 2000) studies. These studies appear to indicate that Internet sex addiction exists for a small proportion of users. However, it is evident that the data collected clearly have methodological limitations (e.g., the use of self-selected samples, clinical samples of those who come in for treatment, self-reports by the partners of Internet sex addicts, reports by treatment providers, etc.). Despite methodological shortcomings, there is certainly enough evidence that online sexual activity can cause major negative consequences to a small minority of users and that for the majority of these, their behavior has commonalities with, and resembles, an addiction as most people would understand it. Such an observation also seems to indicate that Internet sex addiction is a useful framework and concept--both academically for formulating future research, prevention, intervention, and treatment plans, and in terms of increasing the public's perceptions and notions about the boundaries of addiction.

As has been argued, the Internet can easily be the medium of excessive, addictive, obsessive, and/or compulsive behaviors. One thing that may intensify this focus is the vast resources on the Internet available to feed or fuel other addictions or compulsions. For example, to a sex addict or a stalker, the Internet could be a very dangerous medium to users and/or recipients. There is also the problem that the Internet consists of many different types of activity (e.g., e-mailing, information browsing, file transferring, socializing, role-playing games, etc.). It could be the case that some of these activities (like Internet Relay Chat or role-playing games) are potentially more addictive than some other Internet activities. It is also worth noting that there has been no research indicating that sexually related Internet crimes such as cyberstalking are addictive. However, the small number of case studies that have emerged (e.g., Griffiths, Rogers, & Sparrow, 1998) do appear to indicate that cyberstalkers display addictive tendencies (e.g., salience, mood modification, conflict, etc.). However, further research is needed to ascertain whether these excessive behaviors a could be classed as bona fide behavioral addictions.

Another objective of any future research should be to determine the object of the Internet sex addiction. If some people appear addicted to the Internet, what are they addicted to? Is it the medium of communication (i.e., the Internet itself)? Aspects of its specific style (e.g., anonymity, disinhibition, etc.)? The information that can be obtained (e.g., hard-core pornography)? Specific types of activity (gender-swapping, role-playing games, playing sex computer games, cyberstalking)? Talking/fantasizing to others (in chat rooms or on Internet Relay Chat)? Perhaps it could even be a complex interaction between more than one of these. It is most likely that the Internet provides a medium for the "addiction" to flow to its object of unhealthy attachment (i.e., a secondary addiction to more pervasive primary problems). There are very few areas surrounding excessive Internet use and its relationship with sexuality that do not need further empirical research (e.g., online sexual addiction, Internet and computer addiction, and online relationship dependency and/or virtual affairs).

With regard to online relationships and affairs, the Internet presents a potential new dynamic in couple relationships. These sexually related Internet behaviors appear as though they can be used from the healthy and normal through to the unhealthy and abnormal (i.e., use, abuse, and addiction) (Cooper, Putnam, et al., 1999). Research is needed to more clearly delineate the identification and classification of problematic online sexual activities. Cooper, Putnam, et al.'s (1999) proposed continuum of Internet sexual activities needs to be replicated and further refined.

Online affairs also raise interesting theoretical and conceptual issues surrounding infidelity. Traditionally, infidelity has been viewed as someone having a physical sexual relationship with someone outside of marriage or a significant relationship. Internet sex has the potential to change the parameters of infidelity. Husbands, wives, and partners may view the discovery of a nonphysical online sexual liaison as a bona fide form of infidelity, and it may be just as damaging for the long-term future of the relationship as physical sexual infidelity.

As we have seen, the Internet is anonymous, disinhibiting, easily accessible, convenient, affordable, and escape-friendly. These appear to be some of the main reasons for online affairs (and Internet sex). The detection of online affairs may be difficult but that does not mean it should not be given serious consideration in either an academic or practitioner context. These groups, along with those who engage in or who are on the receiving end of such behaviors, need to recognize that the Internet adds a new dimension to relationships. This has implications for assessment and treatment of couples who may, knowingly or unknowingly, undergo a relationship breakdown due to the impact of excessive online communication.

If Internet sex addiction is a viable concept, there are also implications for treatment. At present, treatment programs for sexual addiction include patient, outpatient, and aftercare support, and self-help groups. They may also offer family counseling programs, support groups, and educational workshops for addicts and their families to help them understand the facets of belief and family life that are part of the addiction. Unlike recovering alcoholics who must abstain from drinking for life, sexual addicts are led back into a normal, healthy sex life much in the way those suffering from eating disorders must relearn healthy eating patterns. However, at present there are very few outlets for the treatment of Internet sex addiction, and like sex itself, total abstinence of computer use is probably not the best approach in the long term given the prevalence of computers and Internet use in everyday life. Clearly there is a need for establishment and evaluation of treatment strategies for online compulsivity/addiction.

Perhaps the most important future research area involves identifying both risk factors and protective factors among those susceptible to Internet sex addiction. The interplay between such factors is likely to be complex, but future research needs to identify the interaction between individual sociodemographic susceptibility risk factors (gender, age, ethnicity, etc.), psychological risk factors (e.g., personality type, attitude/belief systems, self-esteem), biological risk factors (e.g., genetic predispositions), situational risk factors (accessibility and availability to Internet services, advertising of Internet services, etc.), and structural risk factors (affordability of Internet services, speed of Internet services, etc.). Such studies could utilize both retrospective self-report techniques (interviews and questionnaires of those who experience problematic online sexual behavior) in addition to prospective longitudinal research that explores the changing nature of risk factors from adolescence and into adulthood. However, both types of research program need to use adequate and diverse samples (racial or ethnic minorities, females, rural/urban, etc.) rather than the self-selected samples that the current literature is based upon. One consequence of an upsurge of research of this type into Internet sex addiction, is that a risk factor model of those individuals who might be at the most risk of developing online sex addictions could be formulated. As research into the area grows, new items for such a list will be added while factors, signs, and symptoms already on these lists will be adapted and modified. Identification of such factors would clearly help in the formulation of intervention, prevention, and treatment programs.

There are already reports of an increase in the number of counselors and therapists seeing people who come in for problems associated with online sexual activities (Freeman-Longo, 2000). As Internet usage continues to increase, more and more clinicians will encounter patients whose presenting problem stems from or is manifestly online sexual compulsivity (Cooper et al., 2000). Such anecdotal speculations do appear to be grounded in growing empirical evidence that Internet sex addiction does appear to exist for a minority of individuals. Even if other researchers fail to acknowledge the existence of Internet sex addiction as a bona fide addiction, the limited empirical evidence appears to indicate that sex on the Internet is associated with serious, negative consequences for some users (albeit a small minority). The expansion of computer technology into more and more lives and into all parts of our lives almost certainly means that problems will increase (Orzack & Ross, 2000).

APPENDIX

Website addresses for professionally developed screening instruments for sex addiction (adapted from Young et al., 2000).

Cybersexual Addiction Test (www.netaddiction.com/cybersexual_addiction.htm) Online Sexual Addiction Questionnaire (www.onlinesexaddict.com/osaq.html) Male Sexual Addiction Screening Test (www.sexhelp.com) Women's Sexual Screening Addiction Test (www.sexhelp.com) Sexaholics Anonymous Test (www.sa.org) Sexual Compulsives Anonymous (www.sca-recovery.org) Sex Addicts Anonymous (www.saa.org) Sexual Codependency Sexual Coaddiction Questionnaire (www.azstarnet.com/~jschndr) S-Anon Checklist (www.sanon.org) COSA: Key Identifying Behaviors (www.shore.net/~cosa)

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Manuscript accepted October 10, 2001

The author would like to thank Irv Binik and the anonymous reviewers for their suggestions and amendments to this paper.

Address correspondence to Dr. Mark Griffiths, Psychology Division, Nottingham Trent University, Burton Street, Nottingham, NG1 4BU, United Kingdom; e-mail: mark.griffiths@ntu.ac.uk.

COPYRIGHT 2001 Society for the Scientific Study of Sexuality, Inc.
COPYRIGHT 2002 Gale Group