Problematic Pornography Use (PPU) and its Psychopathological Correlates

Background The overarching aim of this doctoral work is to advance the empirical and methodological understanding of Problematic Pornography Use (PPU) by (a) systematically mapping existing scholarship and (b) generating robust cross-cultural evidence on its psychopathological correlates. To this end, two complementary studies (Study 1 and Study 2) were designed and performed. Study 1 adopted a scientometric perspective to investigate the existing literature: (1) analysing the global structure of knowledge on PPU (countries, journals, authors, keywords), (2) identifying the most influential documents, and (3) defining the field’s main thematic domains through a large-scale, data-driven mapping. Insights from that review revealed substantial gaps in gender-sensitive, affect-focused research and directly informed an empirical investigation on depression and anxiety symptoms’ associations with PPU across genders. Study 2 used the database of the International Sex Surevy (ISS), an international, multi-lab, multi-language study that uses cross-sectional and self-report survey methods in 42 countries, this doctoral work (1) compared mean levels of PPU, depression and anxiety across men, women and gender-diverse adults, (2) clarified overall depression- and anxiety-PPU associations, and (3) investigated whether those links are moderated by gender. Materials and Methods Study 1 extracted 516 Scopus-indexed articles published between 1973 and April 2024 and their 29,133 cited references. Using CiteSpace, a document co-citation network was generated and clustered; keyword-co-occurrence, country, journal and author analyses were also performed. Study 2 based on the International Sex Survey, analysing responses from 82,243 adults (39.6% men, 57.0% women, 3.4% genderdiverse) in 42 countries. PPU was assessed with the Problematic Pornography Consumption Scale (PPCS); depression and anxiety with the Brief Symptom Inventory (BSI-18). One-way ANOVAs compared group means; Pearson correlations gauged overall associations; and hierarchical linear regressions with interaction terms tested gender moderation. Results Study 1 produced a 407-node co-citation network (modularity = 0.865; mean silhouette = 0.964) that resolved into six main thematic clusters. Publication output grew around 6 % per year; the United States, United Kingdom and China were the most prolific countries; the Journal of Behavioral Addictions and Journal of Sexual Medicine were core outlets; and keyword evolution showed a shift from “pornography”/ “internet addiction” toward ICD-11-aligned terms such as “compulsive sexual behaviour disorder”. Study 2 found significant gender differences: men reported the highest PPU scores (M = 38.55), gender-diverse participants the highest depression (M = 10.64) and anxiety (M = 9.75), and women the lowest PPU (M = 24.24). Across the whole sample, PPU correlated weakly but positively with anxiety (r = 0.207) and depression (r = 0.249). Moderation analysis revealed that men exhibited the strongest association between psychological distress and PPU, suggesting that they may rely more heavily on pornography as a maladaptive coping mechanism Conclusions By coupling a macro-level scientometric map with a micro-level, gender-moderated test of affective correlates, this thesis provides (i) the first data-driven cartography of PPU scholarship and (ii) the largest cross-cultural evidence to date on how depression and anxiety relate to PPU across gender identities. The findings consolidate the field around six thematic domains, spotlight the theoretical salience of moral incongruence and gender norms, and underscore the need for gender-sensitive assessment tools and interventions that address both emotional dysregulation and sociocultural value conflict. Together, Study 1 and Study 2 lay an empirical foundation for longitudinal, intersectional and multi-method research aimed at refining diagnostic guidelines and informing evidence-based clinical practice.