Phenomenology and treatment of behavioural addictions
Professor of Psychiatry, Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois.Canadian journal of psychiatry. Revue canadienne de psychiatrie (Impact Factor: 2.55). 05/2013; 58(5):252-9.
Behavioural addictions are characterized by an inability to resist an urge or drive resulting in actions that are harmful to oneself or others. Behavioural addictions share characteristics with substance and alcohol abuse, and in areas such as natural history, phenomenology, and adverse consequences. Behavioural addictions include pathological gambling, kleptomania, pyromania, compulsive buying, compulsive sexual behaviour, Internet addiction, and binge eating disorder. Few studies have examined the efficacy of pharmacological and psychological treatment for the various behavioural addictions, and therefore, currently, no treatment recommendations can be made.
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- "Far from being rare disorders only of theoretical interest, these conditions are relatively common, with lifetime prevalence rates for each estimated at 0.5–3% (Christenson et al., 1991b;Bohne et al., 2002;Odlaug et al., 2013). Collectively, these conditions subtend a considerable burden of suffering to affected individuals and their families (Grant et al., 2013c). The behavioural addiction model is tempting at face value: individuals with pathological types of various behaviours (gambling , excess grooming, stealing, setting fires, excess use of the internet) do share remarkable phenomenological parallels to people with addictive substances – including impaired control, functional impairment, and persisting engagement in the behaviour despite negative consequences. "
ABSTRACT: The term 'addiction' was traditionally used in relation to centrally active substances, such as cocaine, alcohol, or nicotine. Addiction is not a unitary construct but rather incorporates a number of features, such as repetitive engagement in behaviours that are rewarding (at least initially), loss of control (spiralling engagement over time), persistence despite untoward functional consequences, and physical dependence (evidenced by withdrawal symptoms when intake of the substance diminishes). It has been suggested that certain psychiatric disorders characterized by maladaptive, repetitive behaviours share parallels with substance addiction and therefore represent 'behavioural addictions'. This perspective has influenced the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which now has a category 'Substance Related and Addictive Disorders', including gambling disorder. Could other disorders characterised by repetitive behaviours, besides gambling disorder, also be considered 'addictions'? Potential examples include kleptomania, compulsive sexual behaviour, 'Internet addiction', trichotillomania (hair pulling disorder), and skin-picking disorder. This paper seeks to define what is meant by 'behavioural addiction', and critically considers the evidence for and against this conceptualisation in respect of the above conditions, from perspectives of aetiology, phenomenology, co-morbidity, neurobiology, and treatment. Research in this area has important implications for future diagnostic classification systems, neurobiological models, and novel treatment directions.
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- "Nevertheless, there is a sum of different terms used in the scientific literature when referring to an overuse of the Internet, such as Internet addiction (Young, 1998b, 2004; Hansen, 2002; Chou et al., 2005; Widyanto and Griffiths, 2006; Young et al., 2011), compulsive Internet use (Meerkerk et al., 2006, 2009, 2010), Internet-related addictive behavior (Brenner, 1997), Internet-related problems (Widyanto et al., 2008), problematic Internet use (Caplan, 2002), and pathological Internet use (Davis, 2001). We prefer the term Internet addiction, since we see some important parallels between Internet addiction and other so-called behavioral addictions (e.g., Grant et al., 2013) and substance dependency (see also Griffiths, 2005; Meerkerk et al., 2009), which we will summarize in Sections “Neuropsychological Correlates of Internet Addiction” and “Neuroimaging Correlates of Internet Addiction.” "
ABSTRACT: Most people use the Internet as a functional tool to perform their personal goals in everyday-life such as making airline or hotel reservations. However, some individuals suffer from a loss of control over their Internet use resulting in personal distress, symptoms of psychological dependence, and diverse negative consequences. This phenomenon is often referred to as Internet addiction. Only Internet Gaming Disorder has been included in the appendix of the DSM-5, but it has already been argued that Internet addiction could also comprise problematic use of other applications with cybersex, online relations, shopping, and information search being Internet facets at risk for developing an addictive behavior. Neuropsychological investigations have pointed out that certain prefrontal functions in particular executive control functions are related to symptoms of Internet addiction, which is in line with recent theoretical models on the development and maintenance of the addictive use of the Internet. Control processes are particularly reduced when individuals with Internet addiction are confronted with Internet-related cues representing their first choice use. For example, processing Internet-related cues interferes with working memory performance and decision making. Consistent with this, results from functional neuroimaging and other neuropsychological studies demonstrate that cue-reactivity, craving, and decision making are important concepts for understanding Internet addiction. The findings on reductions in executive control are consistent with other behavioral addictions, such as pathological gambling. They also emphasize the classification of the phenomenon as an addiction, because there are also several similarities with findings in substance dependency. The neuropsychological and neuroimaging results have important clinical impact, as one therapy goal should enhance control over the Internet use by modifying specific cognitions and Internet use expectancies.
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