diagnostic and statistical manual of mental disorders internet addiction

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diagnostic and statistical manual of mental disorders internet addictionPlease review the contents of the article and add the appropriate references if you can. Unsourced or poorly sourced material may be challenged and removed.Specialty Psychiatry psychology This and other relationships between digital media use and mental health have been under considerable research, debate and discussion amongst experts in several disciplines, and have generated controversy from the medical, scientific and technological communities. Such disorders can be diagnosed when an individual engages in online activities at the cost of fulfilling daily responsibilities or pursuing other interests, and without regard for the negative consequences.Controversy around the diagnosis includes whether the disorder is a separate clinical entity, or a manifestation of underlying psychiatric disorders. Research has approached the question from a variety of viewpoints, with no universally standardised or agreed definitions, leading to difficulties in developing evidence based recommendations.Because gambling is available online, it increases the opportunity for problem gamblers to indulge in gambling without social influences swaying their decisions. This is why this disorder has become more a problem at this date in time and is why it is so difficult to overcome. The opportunity to gamble online is almost always available in this century opposed to only having the opportunity in a public forum at casinos for example. Online gambling has become quite popular especially with today's adolescents. Today's youth has a greater knowledge of modern software and search engines along with a greater need for extra money. So not only is it easier for them to find opportunities to gamble over any subject, but the incentive to be granted this money is desperately desired.Incidence and severity grew in the 2000s, with the advent of broadband technology, games allowing for the creation of avatars, 'second life' games, and MMORPGs ( massive multiplayer online role playing games ).http://escueladeballet.com/fotos/braun-series-5-8985-manual.xml

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World of Warcraft has the largest MMORPG community online and there have been a number of studies about the addictive qualities of the game. Addicts of the game range from children to mature adults.If a behavior is rewarded, it is more likely to be repeated.Orzack says that the best way to optimize the desired behavior in the subject is to provide rewards for correct behavior, and then adjust the number of times the subject is required to exhibit that behavior before a reward is provided. For instance, if a rat must press a bar to receive food, then it will press faster and more often if it does not know how many times it needs to press the bar. The rarity of the item and difficulty of acquiring the item gives the player a status amongst their peers once they obtain the item.Users become addicted to one-on-one or group communication in the form of social support, relationships, and entertainment. However, interference with these activities can result in conflict and guilt. This kind of addiction is called problematic social media use.Various screening instruments have been employed to detect Internet addiction disorder. Current diagnoses are faced with multiple obstacles.Laura Widyanto and Mary McMurran's 2004 article titled The Psychometric Properties of the Internet Addiction Test. The Test score ranges from 20 to 100 and a higher value indicates a more problematic use of the Internet:When addicts were treated with certain anti-depressants it reduced time online by 65 and also reduced cravings of being online. The anti-depressants that have been most successful are selective serotonin reuptake inhibitors such as escitalopram and a heterocyclic atypical anti-depressant called bupropion.Like 12-step fellowships such as Overeaters Anonymous, Workaholics Anonymous, or Sex and Love Addicts Anonymous, most members find that they cannot choose to not use technology at all.https://gites-morbihan-sud.com/userfiles/braun-series-3-shaver-user-manual.xml ITAA members come up with their own definitions of abstinence or problem behaviors, such as not using the computer or internet at certain hours or locations or not going to certain websites or categories of websites that have proven problematic in the past. Meetings provide a source of live support for people who are trying to build connections with people outside the computer, to share struggles and victories, and to learn to better function in life once less of it is spent on problematic technology use.A couple, obsessed with online child-raising games, left their young daughter die of malnutrition.In 2017, the Academy was accused of using severe corporal punishment against students, the majority of which are Internet addicts.University of Michigan Press.Studies in Neuroscience, Psychology and Behavioral Economics.Studies in Neuroscience, Psychology and Behavioral Economics.ISSN 0362-4331. Retrieved 2018-02-28. Retrieved 2018-03-02. New York: J. Wiley. ISBN 9780471191599.Adams, Margaret E. Hauppauge, New York.Retrieved 2018-10-10. ISSN 0362-4331. Retrieved 2018-02-27. Archived from the original (PDF) on 2015-04-21. Metamorfosi del sistema uomo-macchina. Editoriale Delfino. Milan, Italy. Psych Central. Netaholics?: The creation of a pathology. Commack, NY: Nova Science Publishers. Zur Institute. By using this site, you agree to the Terms of Use and Privacy Policy. PMCID: PMC2719452 PMID: 19724746 Should DSM-V Designate “Internet Addiction” a Mental Disorder. Ronald Pies, MD Ronald Pies Dr. Pies is Professor of Psychiatry, SUNY Upstate Medical University, Syracuse, New York, and Clinical Professor of Psychiatry, Tufts University School of Medicine, Boston, Massachusetts Find articles by Ronald Pies Author information Copyright and License information Disclaimer Ronald Pies, Dr.http://www.drupalitalia.org/node/78137 Pies is Professor of Psychiatry, SUNY Upstate Medical University, Syracuse, New York, and Clinical Professor of Psychiatry, Tufts University School of Medicine, Boston, Massachusetts; Corresponding author. Copyright notice This article has been cited by other articles in PMC. Abstract There is considerable controversy with respect to so-called internet addiction and whether it ought to be reified as a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The relationship between “addiction” and various compulsive or impulsive behaviors is also a source of confusion. Some psychiatrists have argued that internet addiction shows the features of excessive use, withdrawal phenomena, tolerance, and negative repercussions that characterize many substance use disorders; however, there are few physiological data bearing on these claims. It is not clear whether internet addiction usually represents a manifestation of an underlying disorder, or is truly a discrete disease entity. The frequent appearance of internet addiction in the context of numerous comorbid conditions raises complex questions of causality. In order to make nosological decisions regarding internet addiction, we require a more general model of what counts as “disease,” and as a specific disease. Based on a model emphasizing intrinsic suffering and incapacity, as well as data regarding course, prognosis, temporal stability, and response to treatment, it appears premature to consider internet addiction as a discrete disease entity. However, growing research suggests that some individuals with internet addiction are at significant risk and merit our professional care and treatment. Carefully controlled studies are required to settle these controversies. It is a truism that psychiatric disorders have proliferated like rabbits in recent years, and there appears to be no end in sight.http://erka-techserv.com/images/boxing-training-manual-pdf-free-download.pdf Many in the general public are convinced that the issue of what counts as a psychiatric “disorder” is settled in the academic equivalent of the “smoke-filled room,” by the simple expedient of “vote by committee.” Though this popular view is a gross distortion of the careful (if also flawed) process that led to the development of the third and fourth editions of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-III and - IV ), 1 public perception matters, in so far as it affects public trust in psychiatry. There are enduring philosophical controversies regarding fundamental concepts in psychiatry, 2 such as the boundaries between “normal” and “disordered” mental states; 3 and the degree to which certain behaviors represent biologically based disorders as opposed to freely chosen lifestyles. 4 Though these protean issues are far beyond the scope of the present commentary, they do impinge on the narrower question of what constitutes an “addiction” or an “addictive disorder.” These issues, in turn, affect our position with respect to so-called “internet addiction” (IA) and whether it ought to be reified as a diagnosis in the upcoming fifth edition of the DSM. The term addiction is not used in the DSM-IV; rather, the terms substance dependence and substance abuse are used. 5 The relationship between addiction and certain kinds of compulsive or impulsive behavior is also a source of definitional confusion. However, to my knowledge, putative withdrawal and tolerance have not been established in IA subjects using physiological measures comparable to those used in, say, patients dependent on opiates or barbiturates. For example, we do not have systematic data on autonomic nervous function in subjects diagnosed with IA who are prohibited from using the internet; and thus, in a putative withdrawal state.http://www.oknookna.pl/wp-content/plugins/formcraft/file-upload/server/content/files/1627ec82a9c629---brother-printer-instruction-manuals.pdf Furthermore, if tolerance is taken to mean the need, over time, for increasingly intense or frequent internet-based stimuli to produce the same specified psychological effect, I am not aware of any studies providing objective measures of tolerance in IA-diagnosed individuals. Thus, applying the terms withdrawal and tolerance to IA appears to involve either metaphorical use of these terms, or else the use of fairly coarse behavioral criteria, such as the patient’s complaints of feeling irritable or anxious. Nonetheless, we should not dismiss clinical reports of intense distress, and perhaps physiologic hyperarousal, in some IA-diagnosed patients who have been denied use of the internet. It would be instructive and important to obtain physiological measures (e.g., blood pressure, pulse rate) of IA patients experiencing such symptoms. Whatever the essential nature or putative pathophysiology of IA, those who receive the diagnosis appear to be at substantial risk. For example, Block 8 cites recent data from South Korea and China, 7, 9 pointing not only to a high prevalence of IA, but also to significant public health consequences (e.g., in South Korea, as many as 24 of children diagnosed with IA required hospitalization). 9 Ha et al 7 note a plethora of problems associated with IA, including conflicts with family and friends; impairment in social and vocational activities; depression, anxiety, or obsessive-symptoms; and psychophysiological problems, such as insomnia, tension headache, and dry eyes. Using Young’s Internet Addiction Scale (IAS) and several structured assessment tools, Ha et al 7 found that of 12 adolescents with IA, three had major depressive disorder, one had schizophrenia, and one had obsessive compulsive disorder. These findings raise complex difficulties regarding cause, effect, and primary vs.3dtechgroup.com/uploads/image/files/8-port-nway-switch-encore-manual.pdfIn a German study of 30 subjects with “pathological internet use” (PIU), Kratzer and Hegerl (2008) 10 found that fully 27 had some comorbid or underlying psychiatric disorder (anxiety disorders were seen in half of these subjects). In control subjects without PIU, only 7of 31 were diagnosed with a psychiatric diagnosis. The high rates of other psychiatric disorders prompted the authors to voice skepticism that IA is an “independent disease.” Indeed, some critics of IA argue that excessive use of the internet is a secondary manifestation of depression or a personality disorder and may represent adaptive “self soothing” or avoidance of interpersonal discomfort associated with these underlying disorders. Other critics of IA as a discrete disorder point out that “the internet” is merely a communications medium—not a substance, like cocaine, or an intrinsically rewarding behavior, such as kleptomania or pathological gambling. These critics argue that the pathological need to “game” or view pornography on the internet merely represents underlying psychopathology or defense mechanisms that would be manifest in some other way, if the internet were not available. These concerns cannot be dismissed lightly. Some experts in addiction medicine appear particularly skeptical of IA as a discrete disorder. Even those who advocate recognition of IA do not necessarily endorse the term internet addiction. A Case Worth Noting Recently, Bostwick and Bucci 11 reported a case of internet sex addiction that raised intriguing questions as to the specific pathophysiology of IA. However, it was not until the opiate antagonist, naltrexone, was added to his ongoing sertraline that the patient showed significant improvement. When he took naltrexone again, they receded.” 11 Obviously, a single case report cannot sustain any sweeping claims or hypotheses, regarding the pathophysiology of IA.https://g-ortho.com.br/wp-content/plugins/formcraft/file-upload/server/content/files/1627ec83bef971---brother-printer-manual-duplex.pdf Nonetheless, Bostwick and Bucci provide plausible arguments suggesting that this patient’s addictive syndrome may have involved dopaminergic, gabaergic, and opiatergic mechanisms, which are believed to operate in other addictive behaviors. Indeed, evidence for striatal dopamine release during video game playing was detected in a positron emission tomography study. 12 Recently, genetic polymorphisms of the serotonin transport gene have also been found in a group of male adolescents with “excessive internet use (EIU).” 13 Compared with controls, EIU subjects also showed higher scores on the Beck Depression Inventory and a measure of “harm avoidance,” suggesting to the authors that EIU subjects may have genetic and personality traits similar to depressed patients. This interpretation, of course, does not support the notion that EIU or IA is a discrete and autonomous mental disorder. On the other hand, it is particularly interesting that, in the Bostwick and Bucci report, the patient’s maladaptive sexual behaviors were not greatly modified by antidepressant treatment or psychotherapy alone. This might argue against the objection that the patient’s IA was merely an epiphenomenon of underlying depression. Clearly, much more systematic research involving large numbers of carefully defined subjects with IA will be needed to clarify these issues. What Counts as “Disease?” What Constitutes a Discrete Disease. Disease is not diagnosed, in the first place, by medical specialists using high-tech imaging devices or laboratory tests—though these may help determine the specific disease entity. In psychiatry, as in general medicine, it is often a family member or the soon-to-be patient who first recognizes that something is terribly wrong. This is based on our ordinary perception of suffering and incapacity in the absence of an obvious external cause (such as a knife wound).https://www.dekleinewerf.nl/wp-content/plugins/formcraft/file-upload/server/content/files/1627ec84b16365---brother-printer-manual-feed-insert-paper-error.pdf” 14 In short, disease is fundamentally a condition of substantial and prolonged dis -ease (suffering), accompanied by significant degrees of physical, social, or vocational impairment (incapacity). I qualified my argument regarding “suffering” by specifying that it must not arise solely as a consequence of society’s punitive responses to the patient’s behavior. Rather, at least some of the suffering must be intrinsic to the condition itself—epitomized in what I call, “The Desert Island Test.” For example, a patient with psychotic depression would likely experience suffering, even if marooned alone on a desert island. Someone with strongly held racist ideas would likely not suffer so, all other things being equal. On these grounds, I argued that only in certain very restricted instances should bigotry be regarded as an instantiation of disease. Now, how might this line of reasoning apply to IA. In essence, if a patient diagnosed with IA (by some specified set of criteria) experienced both suffering and incapacity, and further, if the suffering were due at least in part to intrinsic experiential aspects of the manifest condition, then that individual would be experiencing clinical disease. On the other hand, if the patient diagnosed with IA experienced distress or suffering only when society applied punitive sanctions (e.g., prosecuting the patient for soliciting sex using the internet) or only when the internet was not available, the “intrinsic suffering” criterion would not be met. In such cases, we might agree that the individual exhibited socially and vocationally maladaptive behaviors, but not that he or she was experiencing disease ( dis -ease). In my view, the literature on IA is not yet precise enough to allow such fine-grained determinations.https://localhost/travestismexico/paneldecontrol/files/8-manual-impulse-bag-sealer.pdf That is, it is not clear whether most patients with IA typically experience suffering as an intrinsic part of their condition or whether their dyphoria and distress occur only—or primarily—when the individual is denied access to the internet or is punished in some way for “bad behavior.” In short, we do not yet have enough data to conclude that IA is usually an instantiation of disease, as I have defined that term. Indeed, we are unlikely to obtain such data until we have agreed on precise, research-oriented criteria for IA. Nonetheless, we should not dismiss the possibility that some individuals with IA (however diagnosed) do experience true disease. Indeed, Dr. Block’s research and that of researchers in other countries suggest that some individuals who meet criteria for IA are both suffering and incapacitated. Finally, simply because someone does not fit criteria for disease, (however defined), does not mean that he or she is unworthy of our professional aid and support. The “V” codes of DSM-IV clearly recognize that conditions such as “parent-child relational problem” may justifiably be the focus of clinical concern, without reaching the threshold of disease or disorder. This is fully consistent with medical practice in general: a person seeking cosmetic facial surgery to “improve my appearance” might not qualify as having disease, but would appropriately be the focus of medical attention and possibly treatment. See Table 1 for pros and cons of including IA in DSM-V. TABLE 1 Pros and cons of including IA in DSM-V ARGUMENTS IN FAVOR OF INCLUDING IA AS DSM-V DIAGNOSIS ARGUMENTS AGAINST INCLUDING IA AS DSM-V DIAGNOSIS KEY: IA— internet addition DSM-V The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition OCD obsessive compulsive disorder PET positron emission tomography Those diagnosed with IA show pattern similar to that of other addictive disorders, such as excessive use, withdrawal, tolerance, and negative social repercussions, including impaired vocational and academic performance. Genuine physiological withdrawal and tolerance have not been demonstrated in controlled studies of IA. Impairments in social and vocational realms are probably due to underlying disorders, such as depression or OCD. Preliminary evidence points to an opiatergic component to IA, possibly treatable with opioid receptor blockers. This is consistent with general mechanisms known to underlie addictive disorders. This claim is based on a single case report. Large-scale, randomized, controlled studies using PET and other neuroimaging techniques are needed before IA may be assimilated into the realm of addictive disorders based on pathophysiology. By classifying IA as a psychiatric disorder, we will encourage those with IA symptoms to seek help and treatment, thus reducing morbidity and mortality, hospitalization, and legal and psychiatric complications. Classification of IA as a bona fide disorder may also reduce unnecessary barriers, stereotypes, and discrimination associated with public perceptions about excessive internet use. By classifying IA as a “disorder,” we will pathologize what is probably a developmentally “normal” (even if disapproved of) behavior, further expanding an already mushrooming catalogue of supposed “disorders.” This will further undermine the public’s trust in psychiatric diagnosis. Receiving a diagnosis of IA will increase, not decrease, unnecessary barriers, stereotypes, and discrimination. A discrete diagnostic category for IA will focus clinical attention on a severely impaired, at-risk population to a degree not possible if IA were incorporated into existing DSM categories or relegated to the Appendix of DSM-V. Research and teaching efforts will also be stimulated if IA is an official DSM-V diagnosis. If such research fails to support IA as a discrete disorder, it can be dropped from the revised DSM-V. IA symptoms should be subsumed under existing DSM categories, such as OCD or various impulse control disorders. Creating a separate category for IA will open the door to all kinds of new “disease” categories, as new technologies develop (e.g., iPhone addiction, holograph addiction, virtual reality addiction). Open in a separate window If IA Is a Disease, What Kind Is It. But now, let’s stipulate that an individual diagnosed with IA is indeed suffering as a direct result of the condition (i.e., experiences intrinsic suffering) and is also incapacitated to a significant degree (e.g., he or she is unable to fulfill normal social or vocational roles, unable to concentrate, unable to obtain adequate sleep). If this constitutes disease in the generic sense, what kind of disease or disorder might it be. Here, in my view, we need to investigate an area of psychodynamic theory that is barely acknowledged in DSM-IV, though to some degree, it is subsumed in the DSM-IV construct of obsessive compulsive disorder (OCD). In psychoanalytic theory, it is important to distinguish between so-called ego-alien and ego-syntonic thoughts, desires, and impulses. In the classic formulation of OCD, the patient experiences obsessional thoughts or impulses as “intrusive” and “inappropriate”—in some sense, as alien to one’s sense of self. These features are actually retained in the DSM-IV criteria for OCD. This “sense of the alien” is not described in most impulse-control disorders, such as pathological gambling. Whereas, according to DSM-IV criteria, the pathological gambler may feel “restless” or “irritable” when trying to cut down or stop gambling, 5 thoughts about gambling per se are largely ego-syntonic (i.e., they are experienced as “self”). There are insufficient psychodynamic studies of IA to know what percentage of patients experience their preoccupations as ego-alien versus ego-syntonic. This hypothesis requires more investigation and has implications for our placement of IA within existing DSM-IV categories. It also seems likely that—just as we speak of “secondary mania”—there may be many instances of “secondary IA,” in which the primary condition is actually a mood, anxiety, or personality disorder. Conclusions and Recommendations for DSM-V A constellation of related signs and symptoms—essentially, a syndrome—may ultimately be understood as a specific disease entity when at least one of the following criteria are met: 15, 16 A pattern of genetic transmission is discovered, sometimes leading to the identification of a specific genetic locus. The syndrome’s course, prognosis, stability, and response to treatment are seen to be relatively predictable and consistent across many different populations. Notwithstanding the impressive research on IA emerging from Asia, I do not believe that what is termed internet addiction reaches the threshold of specific disease entity, based on any one of these criteria. It is not even clear that IA typically reaches the threshold of “disease” in the clinical sense of pronounced intrinsic suffering and incapacity that I have defined. At present, IA remains a label for a syndrome that most likely represents numerous etiological pathways and diverse clinical manifestations. This conclusion may change over the coming years, and our diagnostic system may someday reflect that. But in my view, it is too early to reify IA as a discrete DSM-V diagnosis. Before IA is considered a discrete disorder or disease, I believe we need extensive prospective investigation, using a specific, albeit provisional, set of criteria for IA. If such investigations began to point toward a coherent and discrete disorder, I would then favor including IA as a diagnosis, perhaps in the expected revision of DSM-V. Whether IA would best be placed among the “impulse control disorders not elsewhere classified” or in another existing DSM category (e.g., mood or anxiety disorders) would depend on the nature of the emergent research data. In my view, the term pathological use of electronic media (PUEM) is less emotionally “loaded” and more encompassing than internet addiction. PUEM would permit incorporation of problems related to new electronic technologies without endlessly multiplying psychiatric diagnoses. At present, PUEM should not be considered a discrete diagnosis. However, in my view, a detailed description of PUEM should be added to the DSM-V appendix, as a “condition for further study.” There may also be several places within the text of DSM-V to indicate that PUEM is indeed a maladaptive and potentially harmful condition, perhaps best understood as an impulse control disorder with a prominent affective component. In the mean time, PUEM-type symptoms, including those corresponding to IA, could be categorized under the current DSM-IV category of “impulse-control disorder not otherwise specified (NOS)” (312.30). Despite the disadvantages of “NOS” designations—arguably a kind of nosological wasteland in DSM-IV —I believe this is a better solution than creating a discrete diagnosis of IA or PUEM at this time. In the longer term, we may need to revise our entire classification to reflect more sophisticated genetic and pathophysiological data. For example, Blum et al 17 present a review of what they term reward-deficient aberrant behavior (RDAB), which they persuasively link to abnormal dopaminergic function in the nucleus accumbens. 18 These authors argue that RDABs include not only conventional substance-use disorders, but also excessive internet gaming and related activities that stimulate excessive dopamine release. Perhaps subsequent editions of the DSM will use the category of “RDAB” to encompass conditions we now allocate to several seemingly diverse diagnostic categories. Clinical Implications In clinical terms, psychiatrists should first decide if the patient’s IA or PUEM symptoms represent expressions of a well-recognized, existing diagnosis, such as bipolar disorder, major depressive disorder, schizophrenia, or OCD. Careful attention should be paid to “which came first” (e.g., did the patient first develop depressive symptoms, followed by symptoms of PUEM. Or did the depression begin only after PUEM symptoms were well established?) Family history may also be a clue (e.g., if there is a strong family history of mood disorder, the clinician might suspect a form of “secondary PUEM.”) Similarly, if there is a strong family history of impulse control problems or OCD, the patient’s PUEM symptoms might be evaluated in this light. Some mild cases of excessive internet use, especially in young patients with developmental adjustment problems, might best be considered under the “V” code of “phase of life problem” (V62.89). In my view, treatment ought to “track” with the primary or underlying disorder, whenever possible. Adjunctive approaches, such as 12-step programs, may be useful in some cases, but definitive recommendations for treatment must await controlled studies of well-defined cohorts with PUEM symptoms. So-called internet addiction should not be written off as another attempt by psychiatry to “medicalize” unfortunate or self-destructive behaviors. We already know that some individuals exhibiting severe overuse of the internet are in danger of serious emotional and physical 18 complications. However, in my view, it is too soon to consider IA a full-fledged and discrete mental disorder.