Mental Health

Background
Subscription-based adult content creator platforms (ACCPs; eg, OnlyFans) represent a rapidly expanding form of computer-mediated sexual media that blends monetized interaction, personalization, and ongoing engagement between users and creators, yet little is known about the psychological correlates of involvement with these platforms over time.

Aim
To examine longitudinal associations between paid engagement with ACCPs, loneliness, and symptoms of Compulsive Sexual Behavior Disorder (CSBD).

Methods
Associations between paid engagement with ACCPs, loneliness, and CSBD symptoms were examined in a weighted, census-matched sample of US adults (N = 4363) assessed across five waves over approximately two years in a longitudinal study. At each wave, participants reported frequency of paid engagement with sexual content creators, loneliness, and CSBD symptoms. Parallel process latent growth curve models were used to evaluate baseline associations and co-development over time.

Outcomes
Primary outcomes included ACCP engagement frequency, loneliness, and CSBD symptoms assessed across five waves.

Results
Parallel process latent growth curve models indicated that higher ACCP engagement was associated with greater CSBD symptoms and, to a lesser extent, loneliness at baseline. Over time, all three variables declined on average; however, their trajectories were significantly linked, such that changes in ACCP engagement corresponded with changes in loneliness and CSBD symptoms.

Clinical Implications
Engagement with ACCPs may represent a clinically relevant context for understanding loneliness and CSBD symptoms, and clinicians may benefit from assessing ACCP engagement when evaluating individuals with concerns related to loneliness or dysregulated sexual behavior, with interventions targeting social disconnection potentially particularly relevant given their co-development over time.

Strengths and limitations
Strengths include a large, census-matched US sample and longitudinal data across five waves. Limitations include reliance on self-report measures, a brief measure of loneliness, and a single-item measure of ACCP engagement.

Conclusion
These findings suggest that engagement with interactive, subscription-based sexual media is associated with both loneliness and dysregulated sexual behavior over time, highlighting ACCPs as an important context for understanding contemporary patterns of sexual behavior.