Vale*

(valentineame) background image

(valentineame) portrait photo

TREATMENT FOR INTERNET, GAMING, TEXTING, AND VIDEO GAME EXCESSIVE USE

[In July, a counselor in Fall City, Washington, named Hilarie Cash opened reStart, the first Internet treatment center in the US. “China is in an enviable position because they’re taking action,” she says. “We’re not.”]

Am J Psychiatry 165:306-307, March 2008
doi: 10.1176/appi.ajp.2007.07101556
© 2008 American Psychiatric Association

Editorial

Issues for DSM-V: Internet Addiction

Jerald J. Block, M.D.

Internet addiction appears to be a common disorder that merits inclusion in DSM-V. Conceptually, the diagnosis is a compulsive-impulsivespectrum disorder that involves online and/or offline computerusage (1, 2) and consists of at least three subtypes: excessivegaming, sexual preoccupations, and e-mail/text messaging (3).All of the variants share the following four components: 1) excessive use, often associated with a loss of sense of timeor a neglect of basic drives, 2) withdrawal, including feelingsof anger, tension, and/or depression when the computer is inaccessible,3) tolerance, including the need for better computer equipment,more software, or more hours of use, and 4) negative repercussions, including arguments, lying, poor achievement, social isolation,and fatigue (3, 4).

Some of the most interesting research on Internet addictionhas been published in South Korea. After a series of 10 cardiopulmonary-relateddeaths in Internet cafés (5) and a game-related murder(6), South Korea considers Internet addiction one of its mostserious public health issues (7). Using data from 2006, theSouth Korean government estimates that approximately 210,000 South Korean children (2.1%; ages 6–19) are afflictedand require treatment (5). About 80% of those needing treatmentmay need psychotropic medications, and perhaps 20% to 24% requirehospitalization (7).

Since the average South Korean high school student spends about23 hours each week gaming (8), another 1.2 million are believedto be at risk for addiction and to require basic counseling.In particular, therapists worry about the increasing numberof individuals dropping out from school or work to spend timeon computers (5). As of June 2007, South Korea has trained 1,043counselors in the treatment of Internet addiction and enlistedover 190 hospitals and treatment centers (7). Preventive measuresare now being introduced into schools (9).

China is also greatly concerned about the disorder. At a recentconference, Tao Ran, Ph.D., Director of Addiction Medicine atBeijing Military Region Central Hospital, reported 13.7% ofChinese adolescent Internet users meet Internet addiction diagnosticcriteria—about 10 million teenagers. As a result, in 2007China began restricting computer game use; current laws nowdiscourage more than 3 hours of daily game use (10).

In the United States, accurate estimates of the prevalence ofthe disorder are lacking (11, 12). Unlike in Asia, where Internetcafés are frequently used, in the United States gamesand virtual sex are accessed from the home. Attempts to measurethe phenomenon are clouded by shame, denial, and minimization(3). The issue is further complicated by comorbidity. About86% of Internet addiction cases have some other DSM-IV diagnosispresent. In one study, the average patient had 1.5 other diagnoses(7). In the United States, patients generally present only forthe comorbid condition(s). Thus, unless the therapist is specificallylooking for Internet addiction, it is unlikely to be detected(3). In Asia, however, therapists are taught to screen for it.

Despite the cultural differences, our case descriptions areremarkably similar to those of our Asian colleagues (8,13–15),and we appear to be dealing with the same issue. Unfortunately,Internet addiction is resistant to treatment, entails significantrisks (16), and has high relapse rates. Moreover, it also makescomorbid disorders less responsive to therapy (3).

References

1. Dell’Osso B, Altamura AC, Allen A, Marazziti D, Hollander E: Epidemiologic and clinical updates on impulse control disorders: a critical review. Eur Arch Psychiatry Clin Neurosci 2006; 256:464–475[CrossRef][Medline]
2. Hollander E, Stein DJ (eds): Clinical Manual of Impulse-Control Disorders. Arlington, Va, American Psychiatric Publishing, 2006
3. Block JJ: Pathological computer use in the USA, in 2007 International Symposium on the Counseling and Treatment of Youth Internet Addiction. Seoul, Korea, National Youth Commission, 2007, p 433
4. Beard KW, Wolf EM: Modification in the proposed diagnostic criteria for Internet addiction. Cyberpsychol Behav 2001; 4:377–383[CrossRef][Medline]
5. Choi YH: Advancement of IT and seriousness of youth Internet addiction, in 2007 International Symposium on the Counseling and Treatment of Youth Internet Addiction. Seoul, Korea, National Youth Commission, 2007, p 20
6. Koh YS: Development and application of K-Scale as diagnostic scale for Korean Internet addiction, in 2007 International Symposium on the Counseling and Treatment of Youth Internet Addiction. Seoul, Korea, National Youth Commission, 2007, p 294
7. Ahn DH: Korean policy on treatment and rehabilitation for adolescents’ Internet addiction, in 2007 International Symposium on the Counseling and Treatment of Youth Internet Addiction. Seoul, Korea, National Youth Commission, 2007, p 49
8. Kim BN: From Internet to “family-net”: Internet addict vs. digital leader, in 2007 International Symposium on the Counseling and Treatment of Youth Internet Addiction. Seoul, Korea, National Youth Commission, 2007, p 196
9. Ju YA: School-based programs for Internet addiction prevention and intervention, in 2007 International Symposium on the Counseling and Treatment of Youth Internet Addiction. Seoul, Korea, National Youth Commission, 2007, p 243
10. The more they play, the more they lose. People’s Daily Online, April 10, 2007
11. Aboujaoude E, Koran LM, Gamel N, Large MD, Serpe RT: Potential markers for problematic Internet use: a telephone survey of 2,513 adults. CNS Spectr 2006; 11:750–755[Medline]
12. Block JJ: Prevalence underestimated in problematic Internet use study (letter). CNS Spectr 2007; 12:14[Medline]
13. Lee HC: Internet addiction treatment model: cognitive and behavioral approach, in 2007 International Symposium on the Counseling and Treatment of Youth Internet Addiction. Seoul, Korea, National Youth Commission, 2007, p 138
14. Block JJ: Pathological computer game use. Psychiatric Times, March 1, 2007, p 49
15. Ko CH: The case of online gaming addiction without other comorbid psychiatric disorders, in 2007 International Symposium on the Counseling and Treatment of Youth Internet Addiction, Seoul, Korea, National Youth Commission, 2007, p 401
16. Block JJ: Lessons from Columbine: virtual and real rage. Am J Forensic Psychiatry 2007; 28:5–33

[In 2008, Jerald J. Block, an Oregon psychotherapist, argued in The American Journal of Psychiatry that Internet addiction should be included in the next Diagnostic and Statistical Manual of Mental Disorders, the bible of the mental health industry. “Despite the cultural differences,” he wrote, “our case descriptions are remarkably similar to those of our Asian colleagues, and we appear to be dealing with the same issue.”]

[In 2006, a Stanford University study found that one in eight American adults showed signs of Web addiction.]

Concerned by a number of high-profile Internet-related deaths and juvenile crime, the Chinese government reacted quickly and forcefully. Teens were officially banned from Web cafés, an edict that police enforced through periodic raids. The government stopped issuing licenses for new cafés and shut down thousands of illegal establishments — 16,000 in 2004. Three years ago, it began requiring gaming companies to develop anti-addiction safeguards that would limit play after three hours. And a year ago, government officials began to talk about formally defining Internet addiction as a clinical disorder. But the most visible initiative by far was the boot camp.

Beijing’s Military General Hospital created the country’s first center in 2004. It was the brainchild of Tao Ran, a military researcher and colonel in the People’s Liberation Army. […] Tao’s camp proved hugely successful and won international acclaim. (In 2007, Reuters described it as “the front line of China’s battle.”) Before long, similar deprogramming centers began popping up throughout Asia — in South Korea, Thailand, and Vietnam.

Even health experts in the US began worrying about Internet addiction. In 2006, a Stanford University study found that one in eight American adults showed signs of Web addiction. In 2008, Jerald J. Block, an Oregon psychotherapist, argued in The American Journal of Psychiatry that Internet addiction should be included in the next Diagnostic and Statistical Manual of Mental Disorders, the bible of the mental health industry. “Despite the cultural differences,” he wrote, “our case descriptions are remarkably similar to those of our Asian colleagues, and we appear to be dealing with the same issue.” In July, a counselor in Fall City, Washington, named Hilarie Cash opened reStart, the first Internet treatment center in the US. “China is in an enviable position because they’re taking action,” she says. “We’re not.”

Combining sympathy with discipline, a military-style boot camp near Beijing is at the front-line of China’s battle against Internet addiction, a disorder afflicting millions of the nation’s youth: the Internet Addiction Treatment Center (IATC) in Daxing county, run by the army colonel Tao Ran under the Beijing Military Hospital, uses a blend of therapy and military drills to treat the children of China’s nouveau riche addicted to online games, Internet pornography, cybersex and chats.

Qihang Salvation Training Camp in rural China promised to cure children of so-called Internet addiction, an ailment that has grown into one of China’s most feared public health hazards.

The Internet-addiction treatment facility looked more like a poorly tended jailhouse than a traditional school-like setting.

The camp’s brochure claimed that an estimated 80 percent of Chinese youth suffered from it.

Fifteen-year-old Deng Senshan seemed to be among them. He was once a top student, but his grades had plummeted over the past couple of years, and he had stopped exercising almost completely. He spent most of his time playing games like World of Warcraft at Internet cafés or on his desktop computer. The Chinese news media was filled with terrifying stories of WOW-crazed kids dropping dead or killing their parents, and Deng Fei and Zhou Juan worried that they might lose their only son to a technological demon they barely understood. So they were lured in by the camp’s pledge to end his “bad behavior.”

“Parents have always worried about the pernicious impact of youth culture, whether from comic books, rock and roll, or videogames. But in China’s rigid, hypercompetitive society, the Internet explosion represents more than a disciplinary annoyance. It is seen as an existential threat. And that helps explain why treating kids with supposed Internet addiction has become a national obsession.”

The Ministry of Health has ordered a hospital in Shandong Province to stop using electric shock therapy to cure young people of Internet addiction, saying there was no scientific evidence that it worked.

In China, citizens showing signs of internet addiction could go to one of several scary-sounding boot camp-style rehabilitation clinics. Treatment includes not just counselling but military discipline, drugs, hypnosis and mild electric shocks.

Psychologists in China want ‘internet addiction’ officially recognised as a clinical disorder.

China could become the first nation to classify the problem.

So what constitutes an official diagnosis?

A manual expected to be approved by the Chinese Ministry of Health says staying online for more than six hours a day, instead of working or studying, and having adverse reactions from not being able to get online, are two major symptoms of Internet Addiction Disorder (IAD).

(Illustration)

Is spending too much time online a prevalent and damaging condition, or simply a bad habit among a select few? School of Medicine researchers have taken an important step toward resolving the debate over whether compulsive use of the Internet merits a medical diagnosis.

In a first-of-its-kind, telephone-based study, the researchers found that more than one out of eight Americans exhibited at least one possible sign of problematic Internet use.

“We often focus on how wonderful the Internet is—how simple and efficient it can make things,” elaborated lead author Elias Aboujaoude, MD. “But we need to consider the fact that it creates real problems for a subset of people.”

Aboujaoude, clinical assistant professor in psychiatry and behavioral sciences and director of Stanford’s Impulse Control Disorders Clinic, said that a small but growing number of Internet users are starting to visit their doctors for help with unhealthy attachments to cyberspace. He said these patients’ strong drive to compulsively use the Internet to check e-mail, make blog entries or visit Web sites or chat rooms, is not unlike what sufferers of substance abuse or impulse-control disorders experience: a repetitive, intrusive and irresistible urge to perform an act that may be pleasurable in the moment but that can lead to significant problems on the personal and professional levels.

Centre for Internet Addiction Recovery

If you answer ‘yes’ to five or more of these questions, you may have an internet addiction.

· Do you feel preoccupied with the internet? (Think about your online activity or anticipate your next online session.)

· Do you need increasing amounts of time on the net in order to achieve satisfaction?

· Have you repeatedly made unsuccessful efforts to control, cut back or stop internet use?

· Do you feel restless, moody, depressed, or irritable when attempting to cut down or stop internet use?

· Do you stay online longer than originally intended?

· Have you jeopardised or risked the loss of a significant relationship, job, educational or career opportunity because of the internet?

· Have you lied to family members, a therapist or others to conceal the extent of your involvement with the internet?

· Do you use it to escape from problems (eg, feelings of helplessness, guilt, anxiety, depression)?

Source: Centre for Internet Addiction Recovery netaddiction.com

Internet addiction is now a serious public health issue that should be officially recognised as a clinical disorder, according to a leading psychiatrist.

Excessive gaming, viewing online pornography, emailing and text messaging have been identified as causes of a compulsive-impulsive disorder by Dr Jerald Block, author of an editorial for the respected American Journal of Psychiatry. Block argues that the disorder is now so common that it merits inclusion in the Diagnostic and Statistical Manual of Mental Disorders, the profession’s primary resource to categorise and diagnose mental illnesses. He says internet addiction has four main components:

· Excessive use, often associated with a loss of sense of time or a neglect of basic drives;

· Withdrawal, including feelings of anger, tension and/or depression when the computer is inaccessible;

· The need for better computers, more software, or more hours of use;

· Negative repercussions, including arguments, lying, poor achievement, social isolation and fatigue.

A primary case study is South Korea, which has the greatest use of broadband in the world. Block points out that 10 people died from blood clots from remaining seated for long periods in internet cafes and another was murdered because of an online game. Their country now ‘considers internet addiction one of its most serious public health issues’. The government estimates that around 210,000 South Korean children are affected and in need of treatment, of whom 80 per cent might need drugs targeting the brain and nearly a quarter could need to go to hospital. Since the average high school pupil there spends about 23 hours per week gaming, Block notes, another 1.2 million are believed to be at risk of addiction and require basic counselling. There has been alarm over a rising number of addicts dropping out of school or quitting their jobs to spend more time on computers. In China it has been reported that 13.7 per cent of adolescent internet users, about 10 million, could be considered addicts.

Block, a psychiatrist at the Oregon Health & Science University in Portland, writes that the extent of the disorder is more difficult to estimate in America because people tend to surf at home instead of in internet cafes. But he believes there are similar cases, concluding: ‘Unfortunately internet addiction is resistant to treatment, entails significant risks and has high relapse rates.’ He told The Observer that he did not believe specific websites were responsible. ‘The relationship is with the computer,’ he said. ‘First, it becomes a significant other to them. Second, they exhaust emotions that they could experience in the real world on the computer, through any number of mechanisms: emailing, gaming, porn. Third, computer use occupies a tremendous amount of time in their life. Then if you try to cut the cord in a very abrupt fashion, they’ve lost essentially their best friend. That can take the form of depression or rage.’

Justin Timberlake and Aaron Sorkin Not That Into Facebook

———-

If asked about the veracity of my me*, I’d have to tell Colbert, too, that it was/it is “fiction. I’m sorry, fact!”. “Socializing on the Internet is to socializing what reality TV is to reality.”

In the mid-1990s, Stephen Fry, the British actor and comedian, had a moment of crisis. He recalled in 2006:

Eleven years ago, in the early hours of the morning, I came down from my flat in central London. I went into my garage, sealed the door with a duvet I’d brought and got into my car. I sat there for at least, I think, two hours in the car, my hands on the ignition key. It was, you know, a suicide attempt, not a cry for help.

Fry didn’t end up killing himself. We know that. Instead, he left the country, heading first to Europe, then to the US where he sought treatment and, at the age of 37, received a diagnosis explaining “the massive highs and miserable lows” he had experienced his whole life: manic depression.

Once he learned to live with manic depression, Fry decided to talk publicly about his struggle and break the taboos around the condition. So, in partnership with the BBC, Fry helped produce the 2006 documentary Stephen Fry: The Secret Life Of The Manic Depressive. Originally aired in two parts (find Part 1 above, Part 2 here), the program puts Fry’s personal experience center stage. But it also brings Fry to talk with other celebrities (Richard Dreyfuss & Carrie Fisher) and everyday people living with bipolar disorder.

Upon the documentary’s release, the BBC published a helpful companion booklet that explores what it means to live with and manage bipolar disorder. You can read it online here. You might also want to watch this related video coming out of Stanford: Robert Sapolsky Breaks Down Depression

The Anatomy of Melancholy

Csíkszentmihályi, Mihály. (1997). Finding Flow: the Psychology of Engagement with Everyday Life (pg. 22). Basic Books.

In the 1960s, Hungarian-born student named Mihály Csíkszentmihályi accidently came to attend a lecture of Jung’s and from that point on decided to become a psychologist. Csíkszentmihályi went on, beginning in 1978, to incorporate Jung’s psychic entropy theory into a flow theory of optimal experience in positive psychology, where psychic entropy, in Csíkszentmihályi’s view, is interpreted as disorder in the consciousness or as mental states that produce conflict with individual goals.

In the converse situation, he states:

“Positive emotions like happiness, strength, or alertness are states of ‘psychic negentropy’ because we don’t need attention to ruminate and feel sorry for ourselves, and psychic energy can flow freely into whatever thought or task we choose to invest it in … therefore intentions, goals, and motivations are also manifestations of psychic negentropy. They focus psychic energy, establish priorities, and this create order in the consciousness.”

Cass Bird, Hugh Laurie

Marlene Dietrich

Romy Schneider photographed by Giancarlo Botti

Christian Kettiger, Marion Cotillard

Paris vs New York: la course

Casta

Angelina Jolie

volevoesserluva (volevo esser l’uva: collezione di volpette)

Elliott Erwitt: “Tutto è serio. Niente è serio”

cmyk 3 (by beamahan)

Closed Contact #10, 1995-1996 (via Jenny Saville & Glen Luchford - January 12 - February 9, 2002 - Images - Gagosian Gallery)

“[Saville] presses her skin against glass to disfigure and manipulate it, emphasizing her negative body image.”