|
Internet addiction:
symptom or disorder?
(June 2008
Issue)
By Nan Shnitzler
Research has been sparse, but case reports are rich in evidence
that problematic Internet use can tip into the pathological. As
a result, a diagnosis around Internet addiction is being considered
for the fifth edition of the "Diagnostic and Statistical Manual
of Mental Disorders" published by the American Psychiatric Association.
Maressa Orzack, Ph.D., director of the Computer Addiction Study
Center at McLean Hospital in Belmont, Mass., told New England
Psychologist two years ago that she was "swamped" with clients
and e-mails, and problems have gotten worse since then. She has
advocated for a DSM category related to Internet addiction.
Nashua, N.H., psychologist Carl Hindy, Ph.D., says more clients
are seeking help with Internet addiction but disagrees it should
be codified as a diagnostic entity.
About half his practice is couples counseling and the Internet
is a factor in about a third of the cases. It usually surfaces as
a contributor to communication break-downs and intimacy issues.
It becomes more of a problem when a partner brushes the family aside
for a simulated life on The Sims or Second Life.
"When needs and gratifications and fulfillment are met over a computer
at the expense of face to face interactions, it begins to cross
the defining line of addiction," Hindy says.
Hindy suggests excessive Internet use is a coping mechanism and
a form of self-comfort that can become addictive, though he doesn't
like the word. He fears an "Internet addiction" diagnosis in DSM
could ultimately limit treatment if not enough of the diagnostic
criteria are manifested.
"The idea was that diagnostic categories exist for the purpose
of making better predictions which you can test with research,"
Hindy says. "The heterogeneity of the Internet and its users makes
it difficult to come up with good predictions to test."
"I'm on all the [insurance] plans and I've never wanted an Internet
addiction diagnosis to provide treatment. I'm treating the underlying
issues," Hindy adds.
Yale associate professor of psychiatry Marc N. Potenza, M.D., Ph.D.
is an addiction psychiatrist who studies the intersection of substance
dependence and impulse control disorders, one of them being Internet
dependency.
"There does appear to be an association between problematic Internet
use and adverse measures of functioning, particularly mood disorders
like depression," Potenza says. "So I think more research needs
to be done to try to define appropriate diagnostic criteria and
to examine those criteria with respect to prevalence and understanding
the clinical impact."
Parsing Internet addiction is made difficult by the dearth of legitimate
studies (most research has been done in South Korea), the overlaps
between Internet-enabled compulsions like gaming, sexual behavior
and social networking, and co-morbidities.
William E. Narrow, M.D., M.P.H., a DSM research director, says
a growing chorus is calling for an examination of Internet behaviors
but it remains to be seen where it will be grouped. Pathological
gambling is the only behavioral addiction listed in DSM-IV. Internet
addiction shares symptoms with several groups. When certain symptoms
could go either way, the DSM workgroups look at the underlying neurobiology
to distinguish one disorder from another.
"For a lot of psychiatry, neurobiology is really the key question
and one of the validators the workgroups use to look at groupings
of disorders," Narrow says. "For example, are there similarities
in neurocognitive processes; are there temperamental antecedents
common to this group?"
Dave Greenfield, Ph.D, of the Center for Internet Behavior in West
Hartford, Conn. says that while Internet abuse is a unique and new
phenomenon, it is similar in action to other "mood altering and
consciousness shifting behaviors."
"It is important to note that any behavior, whether substance-based
or behavioral, is maintained by powerful reinforcement contingencies
with clear neurochemical implications," Greenfield says in an e-mail.
"Addiction and compulsive behavior is not new. The unconscious need
to numb ourselves has been around since civilization began."
PsychCentral.com publisher, Mass.-based John M. Grohol, Psy.D.,
thinks clinicians need to dig deeper to understand how excessive
time online is playing a role in people's lives, rather than labeling
it as inherently dysfunctional.
"The Internet is a brand new type of resource that we have to understand
and deal with," Grohol says. "Most people learn to incorporate the
Internet in their lives. But some who can't get over the sheer amount
of information and enjoy playing games may do so at the expense
of other things. There's no need to add another diagnosis to incorporate
that - because we already have plenty of diagnoses to choose from."
|
