Physical Complaints Research Articles

Efeitos de exercícios mente-corpo em uma paciente com transtorno de humor: um relato de caso

ABSTRACT Introduction The rationale of this case study was to evaluate a subject with anxiety and depression under treatment for anxiety and depression with significant bodily symptoms and physical illness, configuring also a psychosomatic condition. We investigated a new protocol of mind-body exercise (MBE) and its effects on the body-mind relationship through qualitative and quantitative analysis Case Report M.S., 47 years old, diagnosed with depression, anxiety, and several other illnesses and physical complaints, was submitted a weekly seven sessions of MBE. After that, anxiety, depression, and interoception were evaluated. Moreover, affect and arousal scales were administered after each session. Discussion Improvements were identified in all dimensions of interoception, with more pronounced results in not-distracting (pre: 4/ post: 0,25), emotional awareness (pre: 1,6/ post: 5), self-regulation (pre: 2,29/ post: 4,29) and trusting (pre: 0/ post: 4), in addition to reducing symptoms of depression (pre: 17/ post: 14) and anxiety (pre: 29/ post: 24) and increase for positive affect (pre:2,2 ± 3,0/post: 3,6 ± 1,7) e arousal (pre:4,5 ± 1,9/post: 5,9 ± 0,4). Conclusion We conclude that MBE improved interoceptive ability and reduced symptoms of anxiety and depression. Through these perceived and reported changes, the patient was able to learn to deal with stress and anxiety and self-regulate.

Temporal stability of optimism and pessimism (LOT-R) over 6 years in the general population.

The aims of this study were to examine changes in habitual optimism over a six-year period and to analyze the relationship between changes in optimism and changes in other quality of life-related variables. A randomly selected community sample of the German adult general population (N = 4,965) was surveyed twice, with a time interval of 6.04 years. During the course of the 6 years, the mean score of the LOT-R total scale improved (effect size d = 0.11). The temporal stability in terms of the test-retest correlation was r = 0.61 for the total sample. There were only marginal gender differences in this temporal stability, however, the stability in the oldest age group ≥70 years (r = 0.50) was lower than the stability of the other age groups. The cross-sectional correlations showed clear relationships between optimism on the one hand and quality of life, life satisfaction, social support, and low levels of anxiety and physical complaints on the other. The corresponding longitudinal correlations between changes in optimism and changes in the other variables were less pronounced, but in the same direction. The study confirmed the applicability of the LOT-R in longitudinal studies. In samples with participants of 70 years and above, the limited stability in the optimism assessments needs to be considered in clinical practice and epidemiologic research.

Case report: Resolution of pathologic fracture from metastatic non-Hodgkin's lymphoma with compassionate therapy

Broad-spectrum anticancer treatments have limited cell selectivity. The sites of action of these treatments are targeted at blocking cell division and inducing apoptosis. This has a negative impact on the viability and proliferation of healthy cells, which can cause deterioration in the patient's quality of life. In this case report, an older patient with non-Hodgkin's lymphoma, follicular pattern grade 2 with invasion to the L3 vertebra, concluded a combination chemotherapy regimen of cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP). However, the patient reported severe and prolonged adverse reactions that caused physical and emotional complaints, thus she refused to continue with the subsequent radiotherapy. Given the impact on quality of life and uncertain survival, by personal decision, the patient started compassionate therapy based on chlorine dioxide (ClO2). This low-cost anticancer agent causes apoptosis in cancer cells by destabilizing the oxidative balance through the release of reactive oxygen species. ClO2 treatment was administered orally and by enema at a concentration below the EPA-reported toxicity threshold, in order to not compromise healthy cells, given that they do not experience the high levels of oxidative stress of cancer cells. During ClO2 treatment, the patient reported no adverse reactions and an increase in bone density was observed in pathological terrain. Rigorous clinical studies are needed to analyze the temporal sequence of the increase in bone density

Smartphone Addiction Screening Application Development Based on Android: A Preeliminary Study

The growing and increasing pattern of smartphone use in life from just a communication tool to an entertainment tool makes someone use a smartphone excessively. Excessive use of smartphones if not addressed immediately can have an impact on various disorders ranging from physical, psychological and social disorders. The purpose of this study was to produce an Android-based smartphone addiction screening application and to describe the quality of an Android-based smartphone addiction screening application. This research belongs to the type of Research & Development (R&D). The model used is the Dick & Carey model where the implementation of the developer includes data collection, planning and product development stages. At the data collection stage, 3 (three) were obtained, namely data on family members, smartphone use and complaints experienced and the smartphone addiction scale short version (SAS-SV) questionnaire. In the second stage, namely planning, researchers began to incorporate into an android-based application and develop it to be able to draw conclusions from filling out the questionnaire. Conclusions from filling in include demographic data, physical, psychological and social complaints and dependency categories. It is hoped that this application can be tested on the community, especially families, to measure the validity and reliability and then use it as an online measuring tool.

A Romanian adaptation of the Recovery Experience Questionnaire: Psychometric properties and measurement invariance across general and educational sector employees

Abstract Finding a balance between work-invested effort and recovery moments represents one of the key paths to preserving employee health and well-being. The present research aims to facilitate this line of study in the East European context by adapting the Recovery Experience Questionnaire (REQ; Sonnentag & Fritz, 2007) to the Romanian culture. Based on two cross-sectional designs, the REQ was administered online to Romanian employees from various occupations (N = 264, Study 1), and to a sample of Romanian higher education professionals (N = 176, Study 2). Confirmatory factor analyses were conducted, which supported the first-order four-factor structure and the two-factor second-order model of REQ. Nomological validity received support through the expected correlations between the recovery experiences factors and antecedent job demands (i.e., work pressure, role conflict) and an antecedent resource (i.e., autonomy). Criterion validity was sustained by the concurrent relationships with consequences of recovery (i.e., work engagement, job performance, mental and physical health complaints). REQ demonstrated excellent reliability with internal consistencies marginal to or above .90. Moreover, the instrument was invariant across genders and study populations. Overall, the present research suggests that the Romanian version of the REQ is an adequate measure that can be used in this cultural context to assess recovery experiences.

Assessment of Relationship between Lifestyle Behaviors and Severity of Perimenopausal Symptoms among Women

Menopause is a stage of transition from a reproductive to a non-reproductive state in the life of a woman. The perimenopause transition is defined as the period immediately before the menopause. The most common symptoms of menopause can be broken down into vasomotor, physical, emotional, or sexual complaints. Lifestyle behaviors play a significant role in women's experiencing menopausal symptoms during the perimenopause. Aims:It aims to assess the relationship between women's lifestyle behaviors and the severity of perimenopausal symptoms. Methods:Adescriptive correlational study of 120 perimenopausal women using a purposive sample was conducted at gynecology outpatient clinics and general medicine outpatient clinics at Assuit University hospitals from the first of January to the end of June 2023. Three tools were used for this study: a structured interview questionnaire, a modified menopausal rating scale, and a health promotion lifestyle profile. Results:This study reveals that 85.8% of perimenopausal women's lifestyle was poor. Also, 31.6% of perimenopausal women reported moderate perimenopausal symptoms. Somatic symptoms were the most prevalent symptoms on the menopausal rating scale, followed by psychological symptoms and, lastly, urogenital symptoms. There has been a highly statistically significant difference as regards the relationship between the severity of perimenopausal symptoms and women's lifestyle behaviors (p>0.001). Conclusion:There has been an intense negative correlation between women's lifestyle behaviors and the severity of perimenopausal symptoms. So, women need to get health education from the nurse specialists during perimenopause and nurses should plan and implement educational programs for the perimenopausal women about the healthy life style behaviors to reduce and manage their menopausal symptoms. Recommendation: Plan and implement a necessary educational program for perimenopausal women about healthy lifestyle behaviors to manage menopausal symptoms.

Patients' and professionals' experiences with remote care during COVID-19: a qualitative study in general practices in low-income neighborhoods.

To explore how patients and general practice professionals in low-income neighborhoods experienced the increase of remote care during COVID-19. As the GP (general practitioner) is the first point of contact in Dutch health care, there are concerns about access to remote care for patients from low-income neighborhoods. Now that general practice professionals have returned to the pre-pandemic ways of healthcare delivery, this paper looks back at experiences with remote care during COVID-19. It investigates experiences of both patients and general practice professionals with the approachability and appropriateness of remote care and their satisfaction. In this qualitative study, 78 patients and 18 GPs, 7 nurse practitioners and 6 mental health professionals were interviewed. Interviews were held on the phone and face-to-face in the native language of the participants. Remote care, especially telephone consultation, was generally well-approachable for patients from low-income neighborhoods. Contrarily, video calling was rarely used. This was partly because patients did not know how to use it. The majority of patients thought remote care was possible for minor ailments but would also still like to see the doctor face-to-face regularly. Patients were generally satisfied with remote care at the time, but this did not necessarily reflect their willingness to continue using it in the future. Moreover, there was lack in consensus among general practice professionals on the appropriateness of remote care for certain physical and mental complaints. Nurse practitioners and mental health professionals had a negative attitude toward remote care. In conclusion, it is important to take the opinions and barriers of patients and care providers into account and to increase patient-centered care elements and care provider satisfaction in remote care. Integrating remote care is not only important in times of crisis but also for future care that is becoming increasingly digitalized.

Multidimensional Well-Being of Remote Workers: A Qualitative Comparison Between Full-Remote and Hybrid Workers

The implementation of full-remote and hybrid working systems continues to improve and be maintained now. In addition to the convenience, remote working affects the psychological condition of workers. Human Resource (HR) workers who perform remote working need to ensure their psychological condition because they become role models for employees in the company. This study aims to get a comprehensive overview of the well-being of HR workers who implement full-remote and hybrid systems. Qualitative research methods are used with thematic comparison analysis. Data was collected through semi-structured interviews. The characteristics of the respondents in this study are 1) HR employees; 2) Work for a minimum of 6 months; 3) Implement a remote working system (full remote or hybrid working). The research respondents consisted of four people, which are two full-remote workers and two hybrid workers. This study shows that overall remote working can simplify the work processes of employees because its flexibility. On the other hand, the differences were found between the two types of remote working, specifically full-remote work system gives employees more flexibility in managing their work, but workers tend to feel social isolation. Meanwhile, the hybrid work system makes it easier for workers to meet social needs, but workers tend to increase physical complaints. The results of this study can become practical suggestions at the individual, managerial and organizational levels in providing specific guidelines for remote working.

Bilateral Involvement in Developmental Dislocation of the Hip: Analysis of 561 Patients Operated on Using the Limited Posteromedial Approach.

Our objective was to scrutinize the risk factors related to bilateral involvement in the developmental dysplasia of the hip (DDH) and to inspect the impact of bilaterality on the enduring results of the DDH. All patients, aged between 6 and 18 months, who underwent surgery using the limited posteromedial approach (734 hips from 561 patients), were included in this study. The number of births, birth type, history of consanguineous marriage, family history, and swaddling were analyzed. Physical examination and complaints of the patients were evaluated, and direct radiographs were examined in terms of the redislocation, avascular necrosis, and residual acetabular dysplasia. Among the 561 patients, bilateral DDH was observed in 173 patients (30.8%). The use of swaddling was found to be statistically significant between groups (p = 0.012). The use of swaddling for more than one month was associated with a higher odds ratio for bilaterality (p = 0.001, OR = 1.56, 95% CI: 1.2-2.0). Furthermore, bilaterality was associated with a higher risk for redislocation in DDH (p = 0.001, OR = 4.25, 95% CI: 1.6-11.2). The study concludes that swaddling for over a month is strongly linked with the bilateral involvement in DDH. It is important to note that bilaterality plays a crucial role in the development of redislocation after open reduction in DDH.

Comparing the Effectiveness of a Mindfulness-Based Intervention and Progressive Muscle Relaxation in a Military Context

ObjectivesWhile stressors of military deployment are known to have profound effects on health, less is known about effective methods for promoting health. A few studies have examined the effectiveness of mindfulness-based interventions (MBIs) in this context; however, fewer have used an active control group and objective health indicators. Therefore, this study examined the effects of an MBI in comparison to a similarly structured traditional stress management intervention (progressive muscle relaxation, PMR) on health indicators among military personnel.MethodUsing a 2 (pre vs. post) × 3 (group: MBI, PMR vs. inactive control group, ICG) experimental mixed design, participants (MBI, n = 118; PMR, n = 55; ICG, n = 156) answered baseline and post-intervention self-reported measures. Physiological parameters were assessed before and after each session.ResultsResults showed that MBI is superior to PMR and ICG, leading to higher increases in mindfulness, positive affect, and self-care, and greater decreases in physical complaints. This is also confirmed by objective data. Participants in the MBI demonstrated improved heart rate variability and reduced heart rate, while no change was evident for PMR and ICG. However, both MBI and PMR were equally effective in reducing strain.ConclusionsThis study provides further evidence for the effectiveness of MBIs in this specific professional group based on rigorous methodology (comparing to a competing intervention, self-reported and objective measures). MBI is even more effective than PMR as a traditional health intervention in terms of promoting mindfulness, positive affect, and health behavior, as well as reducing complaints.PreregistrationThis study is not preregistered.

The tendency to appraise stressful situations as more of athreat is associated with poorer health and well-being.

It has been argued that habitually appraising stressful events as more of a threat (i.e., situational demands exceed personal coping resources) may increase one's risk of ill-health (e.g., depression). However, while first theorized 15years ago, little research has tested this assertion. Thus, this study offered a novel test of the associations between trait challenge and threat appraisals and health-related outcomes (i.e., mental health symptomology, psychological well-being, and physical health complaints). Three hundred and ninety-five participants (251 female, 144 male; Mage=22.50years, SD=5.33) completed valid and reliable measures of trait challenge and threat appraisals, mental health (i.e., symptoms of depression and anxiety), well-being (e.g., subjective vitality), and physical health complaints (e.g., respiratory illnesses). Regression analyses revealed that trait challenge and threat appraisals accounted for a significant proportion of variance in all outcomes after controlling for age and gender, with a tendency to appraise stressful events as more of a threat associated with poorer mental health (i.e., greater depression symptomology), well-being (e.g., lower vitality), and physical health (e.g., more respiratory illnesses). Taken together, the findings highlight the importance of trait challenge and threat appraisals for health, although further research is needed using stronger designs (e.g., longitudinal) to enable a more causal understanding.

Subjective Physical Symptoms Related to Bad Weather Among Persons Undergoing Medical Check-Up: A Single-Center Observational Study.

Background and aim The prevalence and characteristics of physical complaints related to bad weather among the general population remain poorly understood. This study aimed to elucidate the characteristics of subjective physical symptoms related to bad weather. Methods A cross-sectional survey was conducted by using self-reported health-related questionnaires obtained from individuals undergoing annual medical check-ups at a municipal hospital in Japan. Participants were asked about the presence and details of physical symptoms related to bad weather, together with other health-related questions. Results Among the 133 participants, 42 (32%) (95%CI 24-40) reported experiencing physical conditions related to bad weather. Among these 42 patients, the most common ailment was headache (67%; n=28), followed by low back pain (21%; n=9), fatigue (19%; n=8), and stiff neck/shoulder discomfort (12%; n=5). Comparison between individuals with and without bad weather-related conditions revealed that those affected were younger (p=0.0014) and exhibited higher numerical rating scale scores for gastrointestinal problems (p=0.0027), irritability/agitation (p<0.0001), and sleep disorders (p=0.0295). These associations were confirmed even after adjusting for age and sex. Conclusions Physical conditions related to bad weather, represented by headache, fatigue, and back pain, can be seen in 25-40% of the general population, especially in younger age groups. Individuals with these conditions are more likely to experience irritability/agitation, gastrointestinal problems, and sleep disorders.

SENAM HAMIL DALAM MENURUNKAN KELUHAN KRAM KAKI PADA IBU HAMIL TRIMESTER III

Cramps in pregnant women can occur due to a lack of blood circulation to the lower part of the body, which is usually obstructed due to increased body weight and pressure in the uterus. One solution to avoid leg cramps is to do pregnancy exercises. Pregnancy exercises can optimize physical balance, attitude and movement during pregnancy, reduce physical complaints such as back pain and muscle spasms. The purpose of this research is to provide midwifery care to pregnant women by doing pregnant exercises in reducing leg cramps in third trimester pregnant women. This research was conducted using case study methodology, field observation, and descriptive qualitative methods. This study used one respondent. The results obtained were reduced leg cramps after routine pregnancy exercises. The conclusion that can be obtained is that pregnant gymnastics can reduce the intensity of leg cramps in third trimester pregnant women.

Smartphone-based evaluation of static balance and mobility in long-lasting COVID-19 patients.

SARS-CoV-2 infection can lead to a variety of persistent sequelae, collectively known as long COVID-19. Deficits in postural balance have been reported in patients several months after COVID-19 infection. The purpose of this study was to evaluate the static balance and balance of individuals with long COVID-19 using inertial sensors in smartphones. A total of 73 participants were included in this study, of which 41 had long COVID-19 and 32 served as controls. All participants in the long COVID-19 group reported physical complaints for at least 7 months after SARS-CoV-2 infection. Participants were evaluated using a built-in inertial sensor of a smartphone attached to the low back, which recorded inertial signals during a static balance and mobility task (timed up and go test). The parameters of static balance and mobility obtained from both groups were compared. The groups were matched for age and BMI. Of the 41 participants in the long COVID-19 group, 22 reported balance impairment and 33 had impaired balance in the Sharpened Romberg test. Static balance assessment revealed that the long COVID-19 group had greater postural instability with both eyes open and closed than the control group. In the TUG test, the long COVID-19 group showed greater acceleration during the sit-to-stand transition compared to the control group. The smartphone was feasible to identify losses in the balance motor control and mobility of patients with long-lasting symptomatic COVID-19 even after several months or years. Attention to the balance impairment experienced by these patients could help prevent falls and improve their quality of life, and the use of the smartphone can expand this monitoring for a broader population.

Sleep Deficiency in Pregnancy.

Sleep is a critical aspect of one's daily life for overall health, with a recommended 7 to 9 hours in adulthood (ages 26-64). Up to a third of women do not sleep sufficiently, and pregnant women are at an increased risk for sleep deficiency. Throughout pregnancy, sleep is affected in differing ways. For example, in the first trimester, hormones affect sleep cycles, but by the third trimester, physical complaints such as increasing frequent urination and fetal movement create frequent awakenings. Associations between sleep deficiency and gestational diabetes, hypertensive disorders, depression, and some evidence regarding preterm birth exist. A woman's labor course and perception of delivery are also negatively affected by short sleep duration.

Effect of Stress Management Training on the Mental Health of Medical Students and Interns Training Centers During the Pandemic: An Intervention Study

Background: Medical students, as a part of the first line of combating COVID-19, have been exposed to harm caused by mental disorders. Objectives: This study investigated how stress management training affects the mental health of medical students and interns during the COVID-19 pandemic.&#x0D; Methods: sixteen training and internship students of Birjand University of Medical Sciences from 2020-2021 were included in this intervention study. The intervention group completed the stress management training course in 6 sessions. Mental health dimensions were collected with the SCL90 questionnaire before and after intervention in both groups. SPSS 22 software and Mann-Whitney U-test, Wilcoxon, Chi-square, and Fisher’s exact test were utilized for data analysis.&#x0D; Results: The basic data showed no significant differences between groups (P &gt; 0.05). After the intervention, the mean scores of physical complaint, obsessive-compulsive, interpersonal relations, depression, anxiety, aggression, fear, paranoid and psychotic dimensions in the intervention group significantly decreased (P &lt; 0.05). In controls, the obsessive-compulsive, depression, anxiety, and aggression dimensions significantly decreased (P &lt; 0.05). However, in controls, there was no significant difference in the mean score of other dimensions before and after intervention (P &gt; 0.05). Before the intervention, the frequency distribution of various levels of sensitivity to interpersonal relationships in the two studied groups was the same (P &gt; 0.05); after the intervention, these levels were significantly different between groups (P &lt; 0.05). After intervention, the control group had a higher frequency distribution of individuals with degrees of depression (P &lt; 0.05).&#x0D; Conclusions: The mental health of medical internship students during a crisis can be improved by stress management training, which reduces anxiety and depression. Therefore, stress management courses are recommended in stressful situations.

The contribution of being physically active to successful aging.

Growing old involves changes in physical, psychological, and cognitive functions. Promoting physical and mental health has become one of the priorities for an aging population. Studies have demonstrated the benefits of engaging in regular physical activity. Here, we aimed to understand the relationships between physical activity and working memory complaints in attention, memory storage, and executive functions. We hypothesized that physical activity was negatively associated with complaints in working memory domains after controlling for socio-demographics and distress factors, such as anxiety, stress, and depression. Two hundred and twenty-three individuals aged between 65 and 100 years (74.84; SD = 7.74; 133 males) without self-reported neurological and/or psychiatric disorders completed a questionnaire on socio-demographic, with questions on physical activity and the Italian version of the working memory questionnaire (WMQ) and the DASS-21 measuring anxiety, stress, and depression. Results from three linear regression models showed that low physical activity was associated with complaints in attention (R2 = 0.35) and executive functions (R2 = 0.37) but not in memory storage (R2 = 0.28). Notably, age, gender, and total emotional distress (DASS score) were significant in all regression models. Our results suggested regular physical activity, even just walking, is crucial for maintaining efficient cognitive function. Theoretical and practical implications for engaging in physical activity programs and social aggregation during exercise are considered. Limitations are also presented.

Physical Complaints of Pain and Heartburn as Part of The Symptoms of Somatization

Introductions: One of the mental health disorders that have an impact on physical health is called somatization disorder. Somatization is characterized by the appearance of complaints of pain in body parts that occur repeatedly. Anxiety, various physical complaints, and an increasing number of symptoms accompany symptoms of somatization disorder. The most common physical complaint is heartburn. Case: This case report discusses the case of a 36-year-old woman who complained of heartburn by visiting various doctors, but no medical results showed any abnormalities. Purpose: This case report aims to provide a literature review of heartburn symptoms due to somatization. Discussion: The Relationship between Heartburn Levels and Somatoform Disorders Psychosocial stressors are related to psychological factors that influence medical conditions that cause prominent psychological and somatic disorders. Psychological disorders and vice versa can cause physical disturbances. The patient’s bodily medical condition can cause psychological disorders. Patients with severe acute pain will experience anxiety, fear, and sleep disturbances. This is due to the patient’s discomfort with his condition, where he suffers from the pain he experiences and cannot move. With increasing duration and intensity of pain, the patient may experience a depressive disorder, and then the patient will be frustrated and irritable towards those around him and himself. Conclusion: The high pain intensity in the patient will cause sensitivity and increase his concern for his physical, lowering the threshold for detecting physical sensations or expressing distress and pain.

The Effect of Music Therapy on Pain, Anxiety, Perceived Stress, and Biochemical Parameters in Hospitals Among Patients with Cancer

Background: Diagnosis of cancer and its long and hard treatment process induce great stress and anxiety in patients. Cancer patients may also suffer from severe pain due to their primary disease, metastases, or the received treatments. However, the patients’ chief physical complaint is the main aspect that physicians pay attention to, and the mental health of these patients is usually neglected. Objectives: This study aimed to predict the effect of music therapy (MT) on pain, perceived stress, anxiety, and biochemical parameters in patients with cancer. Methods: This semi-experimental study was conducted on cancer patients referring to the Oncology Clinic at Amir Hospital in Shiraz (affiliated with Shiraz University of Medical Sciences) from April to September 2016. A total number of sixty cancer patients were recruited using a random sampling method and divided into two groups of control and intervention. Patients in the intervention group listened to light music for at least 20 minutes for 8 weeks (two continuous sessions weekly). After the intervention group, a follow-up test and questionnaires were conducted on both groups. Data were analyzed by SPSS version 21 using the t-test, chi-square test, and paired t-test. Results: The results of this study showed that the control group had no significant difference regarding the McGill Pain Questionnaire (MPQ) (P-value = 0.797), cortisol (P-value = 0.841), and the Perceived Stress Scale (PSS) (P-value = 0.001) variables before and after the study, but it had a significant increase in the Beck Anxiety Inventory (BAI) (P-value = 0.026). Our findings indicated a significant difference in the MPQ, BAI, and cortisol variables in the MT group (P-value ≤ 0.001). In general, the PSS showed no significant difference between the two groups. Conclusions: The results of the present study showed that MT for eight weeks, selected by patients from a list, could significantly reduce patients’ anxiety, pain, and perceived stress. Therefore, we recommend the inclusion of this intervention in the routine care of patients with cancer.

Clarifying and extending our understanding of problematic pornography use through descriptions of the lived experience

Problematic pornography use (PPU) is a complex and growing area of research. However, knowledge of the PPU lived experience is limited. To address this gap, we conducted an online qualitative study with 67 individuals who self-identified as having problematic pornography use (76% male; Mage = 24.70 years, SD = 8.54). Results indicated several dimensions that have not been fully explored in the literature. These included various mental and physical complaints following periods of heavy pornography use, sexual functioning deficits with real partners, and a subjectively altered state of sexual arousal while using pornography. Moreover, we expanded on current knowledge regarding the inner conflict associated with PPU and clarified the ways that users can progress to increasingly intensified patterns of pornography use, such as tolerance/escalation and pornographic binges. Our study highlights the complex and nuanced nature of PPU and provides suggestions for future research and clinical practice.