292: How Pornographic Content Harms Sexual Development | Dr. Tori Cordiano

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1:02When the headlines are full of allegations of horrible sexual behavior, I think it's important for us to take a step back and ask, how can this even happen? When this does happen, there are always a lot of factors at play. One of those variables that we need to be talking about is the downstream effects of today's pornography. Today's pornography is full of non-consensual, degrading, often violent and always graphic sex. And what we know is that when people watch this, especially from young ages, it warps their understanding of what sexuality really should be about. And it desensitizes them to violent, non-consensual sexual activity.

1:48By age 17, more than three quarters of teenagers have seen pornography. And we also know that more than half of boys and more than a third of girls actually seek it out. And among the teens who seek it out, more than half of them watch it regularly. So this is something we need to talk about. And you and I know this is not an easy conversation to have. We don't want to have it. Our kids don't want to have it. Today for you, I have something that I think will help. My dear colleague, Dr. Tori Cordiano, and I are taking a letter about a teenage boy who will not stop watching porn. and what to do.

2:25She brings her ever-reliable, compassionate guidance to this question, and together we cover all the key points and also give you language for how to have this conversation. Let's get into it. All right, Tori, I got a doozy for us. All right. You ready? I am. All right. Hi, Dr. Lisa. I have two teen boys, and I'm concerned that one of them is on the path to porn addiction. While I realize it's natural to be curious, I wonder how much is too much. I'm very open with them and I've talked with them about, you know, understanding their natural curiosity and about the dangers of watching violent, disrespectful, and disturbing made-up fantasies.

3:06In the past, I've tried using apps to block it, view their history, they knew, and nothing works for my 15-year-old. He finds ways around it and with a laptop and a phone, I feel like I am fighting a losing battle. I should mention he is diagnosed with ADHD, and I think this gives him a dopamine hit. He was honest with me and said something about it makes him feel good, like he's getting away with something and being sneaky. I feel like I've done all the things available to me, but I have to be missing something. Please help. Okay, I have to see. What this reminds me of, do you remember when like, at least I felt this way early in my work as a clinician where sometimes like I'd be caring for a family and they would tell me what was going on and I was like 27 and I remember thinking like oh yeah man you need help and then being like oh I'm the help oh I'm the help right right I have a little bit of a reaction like that to this letter I hope you don't or are you with me or what are we going to do?

4:11Yeah. So actually, I see a lot of kids with ADHD in my practice. I think a lot in Venn diagrams. This, you know, internet or porn, heavy internet use, graphic content online, having a hard time stopping, and ADHD. In the Venn diagram, there's a lot of overlap there. Okay. So this is... Yeah. It's not uncommon for people with ADHD. Yeah. So I'm not really sure where to start with the kid. We're going to figure this out. I'm thinking about this parent, right, who is so on it. Yeah. Is saying all the things that we tell parents to say, doing all the things, and even has enough of a connection with a kid where he's like, actually, I'm kind of liking it and getting into it and it feels sneaky and I like that.

4:56Something is working really well, right? This was my exact thought, too. There's so much money in the bank here already with the relationship and the connection. This mom is having the hard conversations that we all know we should be having with our teenagers. But easier said than done. Her kid trusts her enough to share more about this really difficult thing that's happening. And kind of, you know, being honest with her. Like, I'm kind of into it. And it's sort of fun. so if I had to sort of put a like a headline on the letter I'd be like helpless city helpless city right like I am doing everything experts say to do I have a good working relationship with my kid they are being honest with me I am still helpless in the face of what's happening and you know it's a very realistic letter like this is violent this is disrespectful this is disturbing stuff so So I'm really glad this person wrote in.

5:51I hope we can be of help. Yes. So what are you thinking? Yeah, yeah. So if we disentangle these two things and we first think about the ADHD piece of it, we have to make sure the ADHD is actually effectively being treated. Okay. And there's nothing in the letter about whether or not it's being treated. But so there's enough, though, it sounds like for you to be like, let's start there. Okay. So what makes you think that maybe the ADHD is not as well treated as it could be? Well, if we think about that behavior, you know, kind of compulsively looking at graphic content online, knowing that there's a part of you that's getting really excited by it, you know, part of that is just natural curiosity and your body is responding the way it's porn is designed for your body to respond.

6:32But the not being able to stop part of it, the doing it more than seems typical or than seems healthy, this is an impulse control and regulation issue, and those are at the core of ADHD. I don't know that people always know that. I think when people think about ADHD, they think about a kid bouncing off the walls or being unable to pay attention. The impulsivity piece, the can't stop piece. Whenever I use the word compulsive or we use the word compulsive, I always try to substitute in can't stop. Because for me, it helps orient. So there's all sorts of stuff that can make kids compulsive. But I hear you saying that for kids with ADHD, that can't stop stuff can actually be more prevalent or heightened.

7:19Is that right? It's a really big challenge. And there's a few different pieces of ADHD that come into play here. The first is this idea of regulation, right? So ADHD is, you know, kids with ADHD have difficulty regulating their emotions, often regulating their behavior. And so they may be looking for external sources to kind of regulate or soothe or distract. this is an easy one. Okay. In terms of, I feel really stirred up, I'm going to go find something that I can engage with. Yeah. And often it's not even that thought out. It's just this impulse of like, I need something, right? And this is here.

7:56It's easy. I can keep doing it. It elicits some sort of response. Okay. So you've probably heard of that idea of hyperfocus for people with ADHD and people with ADHD who have that element of it can get sort of locked into something. They're not noticing how much time is passing. They're not meaning to engage for that long. But they just are completely focused on this activity at the exclusion of everything else. Okay. And knowing what I know about what's available to adolescents, porn would be one thing, but also video games. Video games, absolutely. Even things like YouTube is a huge one. Oh, because it's always offering.

8:33It doesn't end. You're not going to reach the end of YouTube. And so like just if you have hyper focus and you're looking for something to kind of engage with when you're feeling stirred up, it's right there for you and it's infinite. Gambling. So this feels like just so many areas of potential danger. One other thing before we continue. I also think there's something. I remember an old psychoanalytic paper which had the greatest name ever. and it was nagging, arguing, and spreading excitement was the name of the clinical paper. And then it had some like colon and then something else. And the idea in the paper, the fundamental idea in the paper is that sometimes when we're super stirred up on the inside, we want to stir up around us as a way to almost like disperse it or get some tension relief.

9:26And so what I also hear you saying is like, you know, having ADHD, like there may be a lot of kind of stirred up, you know, energy. And so like, let me find a video game, or let me find some porn to watch, or let me find some. Is that part of what you're describing? Absolutely. Yeah. And if we think about, you know, ADHD, and sort of there's the inattentive piece that also involves executive functioning, there's the hyperactive impulsive component of that. And by the time kids are adolescents, it may not be coming out in the like physically impulsive, hyperactive way that we sometimes see with younger kids.

9:58But there is still that energy. And it's a little bit what you're describing is this kind of being revved up or needing more sensation seeking to meet that need. Okay. Where's the dopamine piece? Yeah, so she mentions dopamine in here, and that's important. So many people with ADHD either have kind of baseline lower levels of dopamine or difficulty regulating their brain doesn't regulate dopamine quite as well. It's one thing to have a really great business idea. It's a completely other thing to actually get that business off the ground. So maybe this is you. Maybe you've got a really cool idea for the holidays, something you'd like to sell.

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12:42Okay. So what to do? Yeah. Against this landscape, what do you recommend? So first up, you're checking in with this kid's pediatrician or psychiatrist, whoever is treating the ADHD. If that's not already happening, that is step one, right? Making sure, and it doesn't always have to be medication, although for many people with ADHD, medication is a very important component of treatment. So making sure we're doing what we can to have the ADHD treated. Kind of unstack that deck a little bit. Yes. Right. The deck is stacked against this kid. Yes. If this is untreated ADHD, let's try to unstack that deck.

13:18Yes. Okay. Yeah. Say that's one option. What else should be considered or also done alongside this? I would say definitely alongside. So even if medication is just coming online for the first time and we're just starting that, there's also other things that we're going to want to implement. Part of this, kid is 15, there is still a level of control over where devices can be used in the house. And this is not going to limit all of it. You know, kids who want to access graphic content are going to find ways to be able to do it. They do it on the bus. They do it on the walk home from school. They'll do it in the bathroom at school.

13:52Like it's happening. But we can set some parameters around even in the home, where you're using devices, when you're using devices that maybe this is a kid for whom using a device in a bedroom behind a closed door or having a device in your room overnight is just not a good idea. And you know, I feel this way. I think you do too. Yeah. There's no kid for whom having a device in their room overnight is a good idea, right? Like it just, and I was just looking at this research paper by Jason Nagata, who is so good. Half of kids are using their devices between midnight and 4am. Yeah. Okay. This, like, even if they're doing like calculus, this is not good.

14:28They're not doing calculus. This is not good. So this feels to me like, and again, even if they have to take their devices in their room to do their homework, because that's the only place to get it done. There is no reason overnight, unless the kid is like acting like a 50 year old librarian about it and shutting it all down and using it well, which odds are on this one. I don't think that's happening. Yeah. Yeah. Yeah. Okay. So device management in terms of just where and when. Yes. Yeah. Okay. And then I think this mom has already started the hard work of having difficult conversations around this.

15:01So there's more conversations that probably need to happen. And, you know, not one sit down 45 minute lecture, but small conversations that can kind of build off of what this teenager has already shared. So normalizing the sort of like excitement that comes with it, you know, saying something like, it makes sense that this is really exciting and that you're drawn to it. That's what this kind of content is designed to do. Here's why I'm concerned about it. There are real mental health risks, even physical sexual health risks from early exposure to graphic content that can stay with people long into adulthood.

15:37Okay. So saying like, I get it. This feels good. It's not good for you. All right. So I'm a 15 year old. You're saying it's not good for me. how how is it not good for me like why is it bad for me to watch this yeah so if we start with just the the mental health piece of things right it can really shift the idea of what we think is typical or normal in terms of bodies in terms of sexuality if we look at things like body dysmorphia pornography is really going to contribute to that yeah and i'm just going to add here right if you haven't watched porn lately, the bodies don't look like regular bodies, right?

16:19In terms of the size and shape of what's happening on any of the people involved. And so if there's a lot of exposure to it, it really threatens ability to feel good about one's own body. And then I think about that against the landscape of like a developing young adolescent going through puberty, trying to feel good about their body on a good day, right? And then seeing what are, you know, kind of, I'll just say anatomical outliers across the board in pornography. Yeah. And if we add another factor to this, 15-year-olds haven't seen a lot of bodies, right? So they really, and most of them are not seeing a lot of naked bodies.

17:00This is sort of it. So it's setting the standard of like, oh, this is what a adult body looks like or a young adult body looks like, which is not the case. Definitely not the case. Definitely not the case. So couldn't a parent, I'm trying to imagine the words to say, right? Could you say, look, what you're going to see on that kind of content is showing you bodies that are very rare in nature. And I don't want you getting the impression that this is what bodies really look like. Is that the kind of thing? And I would take it a step further and that this is what sex looks like, right? So this is really graphic content.

17:36And if we get on to like the sexual health piece of things, you know, this is shaping adolescents idea of what sex looks like. And it's often derogatory. It can be really graphic. It can be really violent. And that's not a healthy way to enter into sexual maturity. OK. Like underline in bold highlight what you just said. But the addiction piece, right? You and I both know that there is research showing that if looking at this kind of imagery gets so closely paired with arousal. And you just said it, right? I mean, this imagery can be very rough, very strange. Yeah. it can lay down a pathway of both being super drawn to it and also not finding more conventional, healthier, I'm just going to say it, kinds of romantic activity.

18:43Right. Not to be too euphemistic about it all. Yeah, yeah. Not finding that compelling. Yep. Anymore. There's a desensitization that happens. And the younger this exposure starts, the worse off we see that go. And when you say desensitization, unpack that a little bit. Yeah. So if what you are used to seeing in terms of sexual content is graphic, violent, these, like you said, anatomical outliers, the normal healthy stuff is not as exciting. And that stuff, you know, your arousal level kind of adjusts. And so getting aroused by the normal, healthy, exciting stuff is less likely to happen. And it's harder to establish and maintain healthy romantic and sexual connections if that's the case.

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22:28Are those the words? What other words would you have? Absolutely, yeah. And I think we're speaking to the part of the kid who's maybe not present or online during that conversation, but the part of the kid who has good values and healthy relationships in other places and cares about the way that people are treated and having that kind of not match up with what's happening with this really graphic, explicit content. So it makes me think about what you and I talk with families about all the time, right? That teenagers have two sides. They have the side that is the side that's like, how much inappropriate content can I watch and where can I watch it?

23:03Right. And then they have the side that wants to have a healthy love life, cares about how people are treated, which often in this content is not so great. And I think what we're getting at is what is still on the table for this family is to actually try to stir up a conflict in the kid rather than like, kid, there's the stuff I don't want you to watch. I'm going to stand between you and the stuff, which is like, if any healthy teenager would be like, how do I get to it anyway? Exactly. Right. And also not that effective, especially if we think about a teenager who then becomes 18, 19, 20 years old.

23:36You got nothing. You got nothing. So the leverage that remains is to be like, you are a really kind and decent person who is looking forward to having a phenomenal love life. And watching this stuff all the time is not in line with that. It involves exploitation of people. It is not kind often. And it threatens the love life that you hope to have and that I want for you. So, buddy, this is why we don't want you watching it. What else would you add? I think that's a great place to start, right? And if with these things in place, if we are thinking about how, you know, speaking to the part that gets excited by it, right, that we need to find good, healthy ways to get that dopamine hit.

24:23And especially for kids who have ADHD, you know, you have to kind of think about what that looks like. Is it like, you know, rock climbing? Is it something different? Obviously, those aren't the same activities. But if we think about that reward center in the brain that's getting lit up, we need to find real life healthy places for kids to explore that and experience that. OK, I love that because I do think like risk taking, boundary pushing, right? This is built into the operating system of what it means to be a teenager. So, you know, every time I see a kid carrying a skateboard, I'm like, amen.

24:56Yes. Amen. Right. Like you're probably doing that somewhere. You're not supposed to be doing it. And you're also doing risky jumps. Like keep going. Yep. So would you make the case on this one, in addition to the conversation that we're talking about, to say, I hear you, that you need to be doing something that feels like a little edgy. I am on the side of that. Do you want to snowboard, to go hiking? Going to concerts, like things that like elicit that excitement and meet that need for kind of novelty and something different. There's some arousal there that happens. It's a little edgier, right?

25:31Okay, so concerts, what else? What other naughty things can we offer this child? Right, right. For some kids, it's like physical things, right? So it is like those physical endeavors and like mountain biking, like you said, things like that. For other kids, it's just new and different sorts of things. And so that may be like kind of – So it's not necessarily naughty, but like novel or grown up. Yes. Or edgy in a way. Yeah, yeah. Okay. Yeah. And then I would say beyond that, if we're having these conversations, the needle is not moving or it's not working. or it feels like there's enough there that we need some outside support, there are very good trained professionals who specialize in that overlap of ADHD and we'll call it addiction.

26:14And it can be Internet addiction. It can be pornography. It can be gambling. It can be other forms of addiction. But there are specialists who really this is their area of expertise. Okay. That's good to know, right, that this is not just a home problem. It can actually move beyond that. But would you ever or under what conditions would you say to this young man, hey, you know, this can't continue. We're trying all these ways to help you get a handle on this. If this isn't working, we're going to need to have you start talking to somebody about this or start working with somebody. So I wouldn't go so far as to call it a threat, but I'm not not calling it a threat.

26:57Right. Yeah. What do you think? Yeah, I think there's different ways to bring this up. And a lot of it depends on your kid and what you think they'd be open to. Some kids really love the idea of having someone who's not a parent, who doesn't really know them, not a teacher that they can talk to about this. So they may be waiting for you to bring that up, right? So and maybe not even just around the explicit content. But if a kid has ADHD, there may be other areas where they're struggling, whether it's social relationships or forgetting their homework or things that, you know, could be helpful to have somebody to work with on those sorts of things.

27:28things. For kids who are a little bit more resistant, it absolutely can be something that we put out there as we want to try our best to, you know, use these things that we're talking about to make this more manageable. But we care too much about you and about your mental health and the kind of life you want to have in the future to let this go unchecked. So we're going to, you know, maybe we're setting a date on the calendar, maybe we're checking in in two weeks, and then we'll decide if our next step should be meeting with somebody who specializes in this and getting us some more help to figure it out.

28:01Okay. What are we missing? What have we not covered here? What would be the bottom line on this? Yeah, yeah, yeah. I think one thing that stands out is that there are so many things like this in adolescence that kind of meet this perfect storm of executive functions are still developing. All of a sudden, much more of the world is open to them, even if It's just on their phone. And for some kids, it's the graphic content. For other kids, it's, you know, riding an e-scooter without a helmet. You know, it's anything that presents this kind of danger that we need to think through the impulse control, the regulation, and the environment.

28:40Okay. Tori, thank you so much. Thank you. This is a tricky one. I'm glad we got to talk it through. Really challenging. And so glad to have you to think it through with. Yeah.

28:52for parenting to go i want to underscore a really key point that came up in this conversation which is that teens need to push boundaries teens are designed by evolution to be interested in leaving the cave finding new and exciting things they are drawn to novelty they are drawn to risk taking it's basically how our species survived what this means is we have to create ways for them to do this. We cannot be put off by the fact that they want to do this. So it can look so different for so many kids. We had several examples in the episode, but I think it can also be things like learning to drive or getting a job, feeling independent in that way, being around people who aren't necessarily familiar or family.

29:38Anything like that is really important for young people to get to do, and it's something that we need to recognize that they're going to want to do. In no way should we feel like something's wrong if a kid wants to sort of push at the edge a little bit. And in fact, we should try to create conditions where they can do so safely. And be sure to join us next week. I have an incredible conversation with Olympian Lauren Regula, three-time Olympian Lauren Regula, who is also the mother of three kids who are playing sports today. It's a great and grounded conversation about what to make of youth sports culture and how to navigate it as a family.

30:14See you next week. Thanks for joining us. Be sure to subscribe to the Ask Lisa podcast so you get episodes just as soon as they drop. And send us your questions to asklisa at drlisademore.com. And now, a word from our lawyers. The information provided on this podcast is for educational purposes only and does not constitute or substitute for professional psychological treatment, therapy, medical advice, or other professional intervention. Views expressed by guests are their own and do not necessarily reflect the views of Dr. Lisa DeMoor or Ask Lisa. If you have concerns about your child's well-being or your own, please consult a physician or mental health professional.

30:59If you or someone you know is in crisis, contact the 988 Suicide and Crisis Lifeline by calling or texting 988. For additional resources, visit drlisademore.com.