We are pleased that our article is obviously recognized and stimulates important discussion. Our study’s finding that pornography use disorder (PUD) was not overrepresented in a substance use disorder (SUD) sample as compared with a control group leads Dr. Hesse to question whether “CSB and PUD are truly a form of ‘addiction.’” We agree with Dr. Hesse that PUD differs from SUD in many ways, most notably in the fact that, unlike SUD, external psychotropic substances do not play a relevant role in addictive behavior disorders. However, it must be noted that the various SUDs do not represent a homogeneous entity but differ in many important addiction-related aspects.1,2 This begs the central question of what the core characteristics of addiction really are. Addiction criteria from the DSM-5 and ICD-11 are very helpful, but the discussion of which criteria are mandatory and which are optional is ongoing, especially for PUD.3 Therefore, in contrast to Dr. Hesse, we do not see the need to question the addiction framework for the explanation of the development and maintenance of PUD in general. This is particularly the case because we see the loss of control, the inability to control the problematic behavior despite massive negative consequences, as the central common feature of all addictive disorders. Perhaps the debates about what is essential about addiction can be ended only by a paradigmatic shift from categorical nosologic classification to dimensional approaches as proposed by Research Domain Criteria4 or modern network approaches.5
Contributor Information
Rudolf Stark, Department for Psychotherapy and Systems Neuroscience, University of Giessen, Giessen, 35394, Germany; Bender Institute of Neuroimaging, University of Giessen, Giessen, 35394, Germany; Center for Mind, Brain and Behavior (CMBB), Phillips-University Marburg and Justus-Liebig-University Giessen, Marburg/Giessen, 35032/35394, Germany.
Bertram Walter, Department for Psychotherapy and Systems Neuroscience, University of Giessen, Giessen, 35394, Germany; Center for Mind, Brain and Behavior (CMBB), Phillips-University Marburg and Justus-Liebig-University Giessen, Marburg/Giessen, 35032/35394, Germany.
Isabel Bengesser, Salus Klinik, Friedrichsdorf, 61381, Germany.
Dietmar Kramer, Salus Klinik, Friedrichsdorf, 61381, Germany.
Christian Muhl, Salus Klinik, Friedberg, 61169, Germany.
Nadja Tahmassebi, Salus Klinik, Friedrichsdorf, 61381, Germany.
Said Khatib, Department for Psychotherapy and Systems Neuroscience, University of Giessen, Giessen, 35394, Germany.
Florian Storz, Department for Psychotherapy and Systems Neuroscience, University of Giessen, Giessen, 35394, Germany.
Charlotte Markert, Department for Psychotherapy and Systems Neuroscience, University of Giessen, Giessen, 35394, Germany; Bender Institute of Neuroimaging, University of Giessen, Giessen, 35394, Germany; Center for Mind, Brain and Behavior (CMBB), Phillips-University Marburg and Justus-Liebig-University Giessen, Marburg/Giessen, 35032/35394, Germany.
Sarah Golder, Department for Psychotherapy and Systems Neuroscience, University of Giessen, Giessen, 35394, Germany.
Author contributions
Drafting the article: R.S. Revising it for intellectual content: F. S., S.G. Final approval of the completed article: I. B., S. G., D. K., C. Muhl, C. Markert, F. S., R. S., N. T., S. K., B. W.
Funding
The work was funded by the Innovation Fund of the Joint Federal Board (G-BA, registration 01NVF21073).
Conflicts of interest
The authors report no conflicts of interest.
References
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