Pathways Linking Pornography Use to Obsessive–Compulsive Disorder: A Systematic Review and Clinical Perspective

Background Pornography use is common worldwide. While most individuals use it without significant problems, a subset develops maladaptive patterns characterized by loss of control, distress, and compulsivity resembling both addictive and obsessive–compulsive behaviors. Objective To synthesize current evidence on the psychological, neurobiological, and cognitive mechanisms linking pornography use with Obsessive–Compulsive Disorder (OCD) and to propose a clinical framework for assessment and treatment. Methods A systematic review of empirical studies and clinical reports was conducted through searches in PubMed, PsycINFO, and Web of Science up to 2023, focusing on mechanisms such as cue reactivity, inhibitory control, metacognition, affect regulation, and neurochemical dysfunction. Results Key overlapping mechanisms include heightened cue reactivity, impaired inhibitory control, maladaptive metacognitive processes (rumination, desire thinking), moral scrupulosity, and serotonergic–dopaminergic dysregulation. Limited but promising evidence supports cognitive behavioral therapy (CBT), serotonergic pharmacotherapy, and emerging behavioral interventions (e.g., imaginal retraining). Conclusion Pornography use and OCD share cognitive–behavioral and neurobiological substrates characterized by compulsivity and impaired self-regulation. Integrative approaches targeting OCD comorbidity, cognitive–behavioral dysfunction, and neural mechanisms may enhance treatment efficacy and guide future research.