Article

Emerging Conceptual Models of Excessive Behaviors

University of Hawaii-Manoa Department of Psychiatry, John Burns School of Medicine Honolulu USA
International Journal of Mental Health and Addiction (Impact Factor: 0.99). 05/2007; 5(2):107-116. DOI: 10.1007/s11469-007-9060-1

ABSTRACT

The clinical assessment of a common behavior that disrupts a person’s life only when it becomes excessive is controversial.
The inclusion of pathological gambling in the Diagnostic and Statistical Manual, Third Edition (DSM-III) in 1980 was one of
the initial formal attempts to develop diagnostic criteria for this type of behavior. The diagnostic criteria for pathological
gambling were based on substance dependency, but the disorder was classified as an impulse control disorder. One attempt to
resolve the controversy has been the development of a general psychological model of addiction that includes both substance
related behaviors and excessive behaviors. An example is the Griffiths component model that describes salience, mood modification,
tolerance, withdrawal, conflict and relapse as the central features of addiction. An addictive disorders section including
excessive behaviors and substance use disorders is one of the proposals for the DSM-V, scheduled to be published in 2012.

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    ABSTRACT: Background and Objectives: With the Cyberspace´s exponential growth of influence questions arise about its mental impacts. The presented study examines the question whether the dependent use of the Internet can be understood as an impulse control disorder, an addiction or as a symptom of other psychiatric conditions. Methods: Internet dependent patients seeking for psychiatric assistance and fulfilling the criteria for pathological Internet use (PIU) were examined with the Structured Clinical Interview according to DSM-IV (SCID), and a variety of questionnaires including the Barratt Impulsiveness Scale (BIS), the Beck Depression Inventory (BDI) and the Dissociative Experience Scale (DES). The patient group was compared to a matched group of healthy controls. Results: The adult patient-group consisted of 25 subjects, 76% male, with a mean age of 29.36 years. Average time spent in Cyberspace was 6.47 h/d, mostly in online-role-playing games. According to SCID I and BDI, 19 patients (76%) suffered from a depressive syndrome, with 10 cases of major depressive disorder (40%) and 8 cases of adjustment disorder with depression (32%). Six patients (24%) suffered from a comorbid anxiety disorder. Compared to controls, the patient group presented significantly higher levels of depression (BDI), impulsivity (BIS) and dissociation (DES). Conclusions: PIU shares common psychopathological features and comorbidities with substance related disorders. Therefore, it might be seen as a diagnostic entity in itself in a spectrum of behavioural and substance dependencies. Especially Internet role play may contain an addictive potential for adolescents and adults with subclinical psychopathology.
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    ABSTRACT: Abstract Background: Demand for treatment for Internet-related troubles in adolescents is rising. The profiles of patients in a clinical population are not accurately known and we hypothesize motivation could be useful for characterization. We describe a sample of outpatients, differentiate between two groups based on their motivation, and describe the clinical differences found between them. Methods: Outpatients referred to our Adolescent Addiction Unit with “Internet addiction” as a presenting complaint were evaluated using specific criteria for Internet addiction and, if included in the study, also using DSMIV- TR Axis I and II. They were categorized into two groups: “sheltered,” defined as having high levels of interpersonal problems and motivated to use the Internet as a way to escape, to avoid, to cope, or to feel sheltered; and “non-sheltered,” not showing this motivation. We prospectively assessed qualitative and quantitative data on clinical presentation, Internet applications and use profile, treatment and, progress. We conducted a descriptive analysis of differences. Results: A total of 34 out of 54 subjects met diagnostic criteria for Internet addiction (IA) (mean age 15.38; SD=1.26; 76.5% male). Seventeen subjects (50%) reported using the Internet as a shelter. Diagnoses were mainly internalizing in the sheltered group and externalizing and behavioral in the non-sheltered. Sheltered subjects were significantly younger, had more comorbid disorders, more previous interpersonal problems and an increased loss of contact with friends, used the Internet more often to cope with interpersonal problems, had received prior treatment more frequently, and more often required a combined approach to treatment. Moreover, their motivation was less likely to be a feeling of offline boredom or recreational and they had greater massively multiplayer online role-playing game (MMORPG) use and night-time use and increased school failure and loss of contact with peers. Conclusions: We found two IA adolescent profiles that could be defined by using the Internet as a shelter, showing high levels of social isolation and having differences in presentation, Internet use characteristics, comorbidity, treatment and progress.
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