More people with problem porn use stayed away from treatment out of embarrassment than had ever gone, and people tell more in private

Embarrassment beat treatment

The International Sex Survey ran online in 26 languages from October 2021 to May 2022 and drew 82,243 adults in 42 countries¹. 2,377 of them scored in the problem range on the Problematic Pornography Consumption Scale, the one of its three porn use scales that flagged the fewest people¹. Each was asked whether they had ever sought treatment from a professional for their porn use. Those who had not picked one reason from a fixed list¹.

10.2% had sought treatment¹. 24.6%, 584 people, had not because they would have felt uncomfortable or embarrassed¹. More than twice as many stayed away out of embarrassment as had ever walked in. Only one answer beat it. 30% said it was not a serious problem¹. Practical barriers came a long way behind. 7% did not know where to seek help and 5% could not afford it¹.

The list had no option for privacy or fear of being found out, so embarrassment was the closest answer it offered¹. Each person could also give only one reason. Someone both embarrassed and unable to pay counts once¹. That rule pushes the embarrassment count down, not up.

Wherever the line is drawn

The survey drew the problem line three ways. On the short six-item version of the scale, 7,375 people were in the problem range¹. 15.7% of them were too embarrassed to seek treatment and 5.7% had ever sought it¹. On the Brief Pornography Screen, the widest net, 12,429 people were in range, with 14.1% too embarrassed against 4.3% who had sought help¹. The looser the line, the fewer had ever gone. Embarrassment came out ahead every time.

A second paper on the same survey looked at compulsive sexual behaviour in general rather than porn alone. Among 3,966 people at high risk, 13.7% had ever sought treatment and 18.5% had not because they would have felt embarrassed². In the low-risk group, 1.9% gave that answer². An older study points the same way. In a 2013 online survey of 1,298 men who used porn, 14.3% wanted professional help but had not sought it³. That question listed shame, embarrassment and not knowing where to go as examples together, so it cannot say which one held them back³.

The International Sex Survey was a volunteer sample, advertised on national news websites and, where that did not work, on social media and survey panels². 74% had completed tertiary education, such as college or university, and the survey does not stand for any country¹. Scoring in the problem range on a questionnaire is not a diagnosis either. Some people may score high because they disapprove of porn¹.

Is porn a special case?

Shame about sex could explain all of this. The next studies suggest the same pattern turns up without it, though none of them asked about porn use or compulsive sexual behaviour. They cover depression, anxiety and other common disorders⁴.

From 2001 to 2009 the WHO World Mental Health surveys interviewed 121,899 adults face to face in 24 countries⁴. Of the 63,678 who took the longer second part of the interview, 11,471 had a mental disorder in the past year and had not used any service⁴. Only 4,583 of them, 38.5%, felt they needed professional help, and only they were asked why they stayed away⁴. 63.8% said they wanted to handle it on their own⁴. 24.4% thought the problem was not severe, close to the answer that came top in the porn survey, and 15.9% were concerned about the cost⁴.

Stigma, asked as a single question, came low. 7.7% said they worried what others would think if they found out about the treatment, rising to 15.4% among the most severe cases⁴. Among 466 people who started treatment and dropped out, 50.2% wanted to handle it on their own and 23.1% named stigma⁴.

The authors note that self-stigma and avoiding a label can be related to wanting to handle the problem alone⁴. People who gave that answer were also less likely to name other barriers⁴. We suspect the two are often the same worry in different words. "I would rather sort it out myself" is an easier thing to say to an interviewer than "I do not want anyone to know". The fieldwork is also close to 20 years old, and some surveys had response rates the authors call below acceptable standards⁴.

The worry is being found out

A review of 144 studies by Clement and colleagues ranked stigma, on average, the fourth biggest barrier to care⁵. It also split stigma into the worries people named. Across 44 studies with 60,036 participants, fear of disclosure or confidentiality came first, named by a median of 32%⁵. Discrimination at work came next at 23%, being judged at 22% and shame or embarrassment at 21%⁵.

That fits the gap in the porn survey. Given a box for embarrassment and none for privacy, a quarter of the problem group picked embarrassment¹. Where people could say which kind of stigma they meant, being found out came ahead of shame⁵. Young people said the same. Of 13 qualitative studies of people aged 12 to 25, 10 found stigma as a barrier and 6 found worries about confidentiality and trust⁶.

The 32% is a median of study results, so it describes a typical study rather than a pooled count of people, and 69% of the studies in the review came from the US or Canada⁵. The authors call the overall link between stigma and seeking help small⁵. In studies of what people actually did, the median link was close to zero, and it was larger in studies of attitudes and intentions⁵.

People tell more when nobody is watching

If the fear is of being seen, the setting should change what people say. It does. In 1995 the National Survey of Adolescent Males gave 1,672 US boys aged 15 to 19 one of two methods at random⁷. Some read and filled in a paper form. Others heard each question from a recorded voice on headphones and entered the answer on a laptop. On the laptop 5.2% admitted injecting drugs, against 1.4% on paper⁷. 2.5% admitted paying for sex, against 0.7%, and 5.5% reported sex with another male, against 1.5%⁷. The laptop group also skipped fewer questions, 0.5% of them against 2.3%⁷.

The paper group was small, 368 boys before exclusions, so the rarest answers rest on a handful of boys⁷. A larger body of work gives smaller gaps in the same direction. Gnambs and Kaspar pooled 48 samples with 125,305 people by their own table, or 125,672 by their text⁸. On a computer, people admitted sexual behaviour more often than on paper, with an odds ratio of 1.29, and substance use with 1.17⁸. For delinquent behaviour and for having been a victim, the gap was not statistically significant⁸. Sex was the topic where the screen made the most difference.

What people believe about who is listening matters as much as the device. In a 2014 study, 154 adults had a mental health interview with an on-screen virtual human. Half were told a computer ran it, half that a person in another room did⁹. Those told it was only a computer were rated more willing to open up, 1.11 against 0.56 on a scale of minus 3 to 3⁹. They also scored lower on fear of telling things about themselves, 16.54 against 18.61⁹. Who really ran the interview made no difference. What people believed did⁹. That study measured willingness and comfort, not specific admissions, and recruited through Craigslist⁹.

Taking the person out of the room has the longest record. Across 7 older drug use experiments, people admitted use a median of 30% more often when they filled in the survey themselves than when an interviewer asked them¹⁰.

None of these disclosure studies asked about porn use⁷. They also assume that admitting more means telling the truth more⁸. Gnambs and Kaspar call this "more is better" assumption mostly untested, though the few studies they cite that checked answers against records or biomarkers suggest the higher answers were also more accurate⁸. Read next to the first half, the fit is close. People who screened for problem porn use named embarrassment more often than they had ever sought help, and people say more when no face is on the other side of the question.

How they found it

• The International Sex Survey ran online in 26 languages, was advertised on national news websites and, where that did not work, on social media and survey panels, and asked no names. One question asked whether people had ever sought treatment from a professional for their porn use. Those who had not picked one reason from a fixed list.
• In a 2013 online survey of 1,298 men who used porn, 14.3% wanted professional help but had not sought it. The question gave shame, embarrassment and not knowing where to go as examples of why.
• The WHO surveys interviewed 121,899 adults face to face. Of the 63,678 who took the longer second part, 11,471 had a mental disorder in the past year and had not used any service. Only 4,583 of them, 38.5%, felt they needed professional help. The others were never asked why they stayed away.
• The review of 144 studies ranked stigma, on average, the fourth biggest barrier to care. Among the stigma worries, fear of disclosure came first.
• On the laptop, a recorded voice read each question over headphones and the boy entered his answer. On paper, he read and filled in the form himself.
• In the 2014 study, half of 154 adults were told a computer ran their interview with a virtual human, half that a person in another room did. Who really ran it made no difference. What people believed did.

What it cannot tell you

• The International Sex Survey was a volunteer sample, and 74% had completed tertiary education. It does not stand for any country.
• Each person could give only one reason, and the list had no option for privacy or fear of being found out. Embarrassment is the closest answer it offered.
• Scoring in the problem range on a questionnaire is not a diagnosis, and some people may score high because they disapprove of porn.
• None of the mental health care or disclosure studies asked about porn use or compulsive sexual behaviour.
• Wanting to handle it alone and fear of others finding out can be the same worry in different words. The WHO authors say only that the two can be related, and the fieldwork is close to 20 years old.
• The disclosure studies assume that admitting more means telling the truth more. Few studies have checked answers against records or biomarkers, though the few that did suggest the higher answers are also more accurate.

In P-Minus

P-Minus is built for the person who wants to start on their own. It asks for an email address and a username, not your name. Your questionnaires and inventories are typed into the app, and no staff screen shows your answers against your account.

Sources

1. Bőthe B, Nagy L, Koós M, Demetrovics Z, Potenza MN, International Sex Survey Consortium, et al. Problematic pornography use across countries, genders, and sexual orientations: insights from the International Sex Survey and comparison of different assessment tools. Addiction. 2024;119(5):928-50.
2. Bőthe B, Koós M, Nagy L, Kraus SW, Demetrovics Z, Potenza MN, et al. Compulsive sexual behavior disorder in 42 countries: insights from the International Sex Survey and introduction of standardized assessment tools. J Behav Addict. 2023;12(2):393-407.
3. Kraus SW, Martino S, Potenza MN. Clinical characteristics of men interested in seeking treatment for use of pornography. J Behav Addict. 2016;5(2):169-78.
4. Andrade LH, Alonso J, Mneimneh Z, Wells JE, Al-Hamzawi A, Borges G, et al. Barriers to mental health treatment: results from the WHO World Mental Health surveys. Psychol Med. 2014;44(6):1303-17.
5. Clement S, Schauman O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N, et al. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychol Med. 2015;45(1):11-27.
6. Gulliver A, Griffiths KM, Christensen H. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry. 2010;10:113.
7. Turner CF, Ku L, Rogers SM, Lindberg LD, Pleck JH, Sonenstein FL. Adolescent sexual behavior, drug use, and violence: increased reporting with computer survey technology. Science. 1998;280(5365):867-73.
8. Gnambs T, Kaspar K. Disclosure of sensitive behaviors across self-administered survey modes: a meta-analysis. Behav Res Methods. 2015;47(4):1237-59.
9. Lucas GM, Gratch J, King A, Morency LP. It's only a computer: virtual humans increase willingness to disclose. Comput Human Behav. 2014;37:94-100.
10. Tourangeau R, Yan T. Sensitive questions in surveys. Psychol Bull. 2007;133(5):859-83.

Sources checked October 2026.