Bipolar Support Groups.com blog

Internet Addiction is not an official disorder, and many mental health professionals are not certain if it ever should be considered a real disorder. Nevertheless, compulsive Internet use is a serious problem for some people, and there are methods that can be helpful in alleviating this problem. Discussion below will describe some of these methods.

Internet addiction is a problem of compulsive stimulation, much like drug addiction. Because of this similarity, well studied treatment procedures known to be useful for helping drug addicts towards recovery are adapted for use with Internet addicts when the need arises. The techniques we describe below are drawn from a popular school of therapy known as ‘cognitive-behavioral’ therapy. Cognitive behavioral forms of therapy are well studied and known to be helpful as applied to many different mental and behavioral difficulties. They are also very practical and focus directly on reducing out of control ‘addict’ behaviors, and preventing relapse. They are not the only valid forms of therapy, however.

In treating drug addiction, frequently the goal of therapy is abstainence. An alcoholic, for example, is often best off if he or she ceases to drink alcohol entirely and to maintain a sober lifestyle. While this makes sense for a drug like alcohol which we might argue is a at best a luxury recreational indulgence and not a necessity, but it doesn’t necessarily make sense for Internet over-usage. Much like the telephone, the Internet has become an essential part of modern business. To ask people to not use the Internet at all could be a significant burden for them. Instead of abstainence, then, a reasonable goal for Internet addiction therapy is a reduction in total use of the net. Because Internet addicts by definition will have difficulty moderating their use on their own, therapy techniques can be employed to help them to become more motivated to reduce their use, and to become more conscious of how they get into trouble with the Internet.

Motivational Interviewing may be employed to assess how motivated Internet addict may be to change their behavior and to help addicts to increase their motivation to make a lasting change. To accomplish the latter, a therapist may help addicts to develop genuine empathy for the people who are hurt by their addiction (e.g., family and friends, employers, etc.). By helping addicts to see how their actions affect others they care about or are dependent on economically, therapists can help increase addicts motivation to change.

Therapists will also generally help addicts to identify ‘triggers’ that lead to episodes of uncontrolled Internet use. Naive addicts of any type typically believe that their indulgences “just happen” and that they played little or no role in an episode happening. A more realistic appraisal of an addicts true situation will often reveal that a particular unconscious set of events occurred involving ‘triggers’ that prompted an addict to binge. Like a noun, a trigger is a “person, place or thing” that is a step in a chain of events that leads towards a relapse into addict behavior. To provide a fictitious but realistic example, a first trigger might be boredom, or horniness, or even a bad mood brought on by a fight. Addicts seek out their stimulation of choice in response to these triggers, most of the time without ever being all that aware of why they are acting as they do. Therapists will often discuss in detail episodes of indulgence with addicts so that they become conscious of their triggers and can choose to act in an alternative fashion when they next become vulnerable. They will also help addicts to generate lists of safer, more functional alternative behaviors they can engage in when they realize they are in danger so that they do not default to their addictive behavior.

Part and parcel with identifying triggers, is helping addicts to set realistic goals for their Internet use. It may be that Internet use is important at use, but needs to be restricted at home. It may be that particular websites need to be avoided, but other uses of the Internet are okay. Therapists work with their patients to set realistic and measurable goals for their Internet usage. Patients are then asked to actually record their Internet usage in a log which is used in therapy to track progress. For example, to help reduce the amount of time spent of the Internet, or one specific portion thereof, a user will set a maximum allowed time per day or week. The goal is to keep under this maximum–the farther under, the better. To ensure this goal is met, users can rely on timers or alarms, to monitor how long they have spent online. For example, if an Internet user feels he is spending too much time in chat rooms, he may set a goal to spend no more than two hours per week using the Internet for this purpose. He sets a thirty-minute timer for each of the four times per week he wants to use the Internet for chat rooms, and as soon as his timer goes off he exits the chat room. He also records his actual usage on the log so as to see how well he is able to conform to his goal.

As anyone can quickly surmise, conforming to goals and logging your behavior is hard, disciplined work that is difficult for many people to sustain on their own. Therapists help patients to sustain this disciplined work by having them give weekly progress reports (either in individual or group therapy settings), or setting up (healthy) rewards that patients can earn when goals have been met for an agreed upon amount of time. Since one of the main draws of the Internet is the secrecy it appears to give, sharing online experiences in the context of offline relationships may discourages a user from ‘hiding’ in the Internet. Sharing progress in a group therapy session, with a therapist, or with a family member can help motivation to cut back on Internet time.

Even with the best intentions, it is easy for an addict to ‘forget’ to record a lapse, or to simply not bring it up in sessions. Denial and people’s desire to please can be powerful forces to overcome. Objective monitoring can be useful when self-discipline and self-reporting are not enough to keep an addict on the straight and narrow. Regular urine, blood and hair samples are used for this purpose when dealing with drug addicts. With regard to Internet addiction, it is possible to install computer programs designed to monitor where someone surfs and how long they spend there to provide an accurate and objective report of someone’s surfing behavior. PC software such as Spy Buddy, SpectorSoft Spector Pro, Pearl Echo, Cyber Snoop and others will monitor the kinds and number of websites a person uses and the amount of time spent Web surfing or checking e-mail. Such programs can help compulsive Internet users supervise their own Internet use, but only if they are installed so as to be hard to tamper with.

The therapy techniques described above are best delivered by a trained mental health professional in the context of a therapy relationship. A fair amount of self-help literature in the form of books and websites are available for those whose problems are not so demanding, or those who simply wish to be more educated about this problem. See the reading suggestions below, or the Links section of this topic center for suggestions.

The bottom line when dealing with Internet Addiction is to identify triggers that lead to problematic use, to set realistic goals for reducing use, and to then stick to and monitor conformance with those goals, sharing this conformity data with someone else to encourage honesty and sticking to the plan.

Internet addiction is not recognized as a formal mental health disorder. However, mental health professionals who have written about the subject note symptoms or behaviors that, when present in sufficient numbers, may indicate problematic use. These include:

• Preoccupation with the Internet: User often thinks about the Internet while he or she is offline.
• Loss of control: Addicted users feel unable or unwilling to get up from the computer and walk away. They sit down to check e-mail or look up a bit of information, and end up staying online for hours.
• Inexplicable sadness or moodiness when not online: Dependency on any substance often causes mood-altering side effects when the addicted user is separated from the substance on which he or she depends.
• Distraction (Using the Internet as an anti-depressant): One common symptom of many Internet addicts is the compulsion to cheer one’s self up by surfing the Web.
• Dishonesty in regard to Internet use: Addicts may end up lying to employers or family members about the amount of time they spend online, or find other ways to conceal the depth of their involvement with the Internet.
• Loss of boundaries or inhibitions: While this often pertains to romantic or sexual boundaries, such as sharing sexual fantasies online or participating in cyber sex, inhibitions can also be financial or social. Online gambling sites can cause addicts to blow more money than they would in a real-life casino because users never actually see their money won or lost, so it is easier to believe the money is not real. Chat rooms can incite users to reveal secrets they would not reveal in face-to-face or phone conversations because of the same separation from reality. Also, addicted users are much more likely to commit crimes while online (e.g., ‘hacking’) than non-addicts.
• Creation of virtual intimate relationships with other Internet users: Web-based relationships often cause those involved to spend excessive amounts of time online, attempting to make connections and date around the Net.
• Loss of a significant relationship due to Internet use: When users spend too much time on the Web, they often neglect their personal relationships. Over time, such relationships may fail as partners simply refuse to be treated badly and break off from relations with the addicted individual.

Ten years ago, the only people who spent a majority of their leisure time on the computer were paid members of the technology industry. Today, however, surfing the Web has become a pastime as social and marketable as bar hopping or going to the movies. As the web has become a part of mainstream life, some mental health professionals have noted that a percentage of people using the web do so in a compulsive and out-of-control manner. In one extreme (1997) Cincinnati case, unemployed mother Sandra Hacker allegedly spent over 12 hours a day secluded from her three young and neglected children while she surfed the Web. For better or for worse, this phenomena of compulsive Internet use has been termed ‘Internet Addiction’ based on its superficial similarity to common addictions such as smoking, drinking, and gambling. Internet Addiction has even been championed as an actual disorder, notably by psychologists Kimberly Young, Ph.D and David Greenfield, Ph.D.. However, at this time the true nature of Internet Addiction is not yet determined.

In a true addiction, a person becomes compulsively dependent upon a particular kind of stimulation to the point where obtaining a steady supply of that stimulation becomes the sole and central focus of their lives. The addict increasingly neglects his work duties, relationships and ultimately even his health in his drive to remain stimulated. In some cases of addiction (such as addiction to alcohol or to heroin), a phenomenon known as tolerance occurs, wherein more and more stimulation is required to produce the same pleasurable effect. A related phenomena, withdrawal, can also occur, wherein the addicted person comes to be dependent upon their source of stimulation and experiences dramatically unpleasant (and even potentially lethal — as can be the case with alcohol) reactions when he goes without it. Sources of addictive stimulation can be chemical (as is the case with addictive drugs such as alcohol, cocaine, nicotine and heroin), sensual (as in sex) or even informational (as in gambling or workaholism). What all sources of addictive stimulation have in common is that they provoke a strong, usually positive (at first) reaction in the potential addict, who then seeks out the source of that stimulation so as to obtain that feeling on a regular basis.

While many people like to engage in sexual relations, or gamble, or have the occasionally drink because of the pleasure to be had, clearly not all people who do so are addicts. Rather, the term addiction only applies when someone’s stimulation seeking gets to the point where it starts interfering with their ability to function normally and non-neglectfully at work and in relationships.

Mental health professionals are split as to whether or not Internet addiction is real. No one disputes that some people use the Internet in a compulsive manner even to a point where it interferes with their their ability to function at work and in social relationships. What is disputed is whether people can become addicted to the Internet itself, or rather to the stimulation and information that the web provides. The controversy surrounding Internet Addiction is precisely whether people become addicted to the net itself, or to the stimulation to be had via the net (such as online gambling, pornography or even simple communication with others via chat and bulletin boards).

Some psychologists do not believe in addiction to the Internet itself, but rather in addiction to stimulation that the Internet provides. They suggests that new Internet users often show an initial infatuation with the novelty of the Web, but eventually lose interest and decrease their time spent online back to a normal, healthy amount. Those users who do go on to show compulsive Internet utilization, for the most part become compulsive only with regard to particular types of information to be had online, most often gambling, pornography, chat room or shopping sites. This is not an addiction to the Internet itself, but rather to risk-taking, sex, socializing or shopping. In essence then, the chief addictive characteristic of the Internet is its ability to enable instant and relatively anonymous social stimulation. “Addicted” Internet users are addicted to a favored kind of social stimulation and not to the Internet itself, although it is also true that the Internet has made it vastly easier and more convenient for someone to develop such a compulsion.

Because the Internet is used by many people as a normal part of their career or education, knowing how to separate excessive from normal use becomes difficult and cannot be accomplished using simple measures such as amount of time spent online in a given period. Most fundamental in differentiating normal from problem Internet use is the experience of compulsion to use the net. Normal users, no matter how heavy their usage, do not need to get online and do not neglect their occupational duties or their relationships with family and friends to get online.

Help for Internet related addiction is available from multiple sources. Anyone concerned about serious problem Internet usage should consider consulting with a local licensed psychologist, social worker or counselor, specifically one with experience treating addictions. Cognitive therapy based approaches are recommendable due to their systematic and direct focus on reducing problem use and preventing relapse, and the strong scientific support for the approach. Marital and or family therapy approaches may be useful as well when an individual’s Internet Addiction is affecting their larger family system (such as might be the case when a husband uses Internet-based pornography as his sole sexual outlet, leaving his wife frozen out). More than a few books and self-help resources (such as audio tape sets) are also available for those who want to educate themselves on the problem. Our Internet Addiction Treatment article provides further detail.

Intermittent Explosive Disorder Symptoms

Several discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property.

The degree of aggressiveness expressed during the episodes is grossly out of proportion to any precipitating psychosocial stressors.

The aggressive episodes are not better accounted for by another mental disorder (e.g., Antisocial Personality Disorder, Borderline Personality Disorder, a Psychotic Disorder, a

Manic Episode, Conduct Disorder, or Attention-Deficit/Hyperactivity Disorder) and are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., head trauma, Alzheimer’s disease).

Criteria summarized from:
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.

The Diagnostic and Statistical Manual of Mental Disorders includes a chapter on “Impulse-Control Disorders Not Elsewhere Classified”. Because we aim to mirror the DSM when this is practical, we offer this Impulse Control Disorders topic center.

The impulse control disorders are a loosely grouped set of conditions that have in common that they all centrally feature behavior that is acted out in an uncontrolled, and impulsive manner that often has self-destructive consequences. The DSM lists the following impulse control disorders:

• Intermittent Explosive Disorder (characterized by uncontrolled fits of extreme anger and violence)
• Kleptomania (characterized by irresistible urges to steal various items from stores and homes)
• Pyromania (characterized by irresistible urges to set fires)
• Pathological Gambling (characterized by compulsive, uncontrollable gambling)
• Trichotillomania (characterized by uncontrollable hair twisting and pulling, often resulting in bald spots on an otherwise normal-haired person)

The DSM treats the Impulse-Disorder category as a ‘catch-all’; other disorders involving irresistible urges exist, but are better treated as part of other ‘families’ of disorders. Although not listed here, impulse-control problems are at the heart of substance abuse disorders (addiction to alcohol or drugs), and many of the paraphillia/perversion sexual disorders (exhibitionism, frotterism, child molestation, etc.). DSM offers a sometimes arbitrary system of organization and classification, it’s true – but it mostly works.

The American Psychiatric Association publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM), which describes the criteria necessary for the diagnosis of all mental disorders, including Major Depression. In the DSM, Major Depression appears as a member of the Depressive Disorders category, which also includes the Bipolar Disorders, Dysthymic Disorder, Cyclothymia and Depressive Disorder Not Otherwise Specified. These various mood disorders are all similar in that they all have something to do with disordered mood, and more specifically, with depressed mood. They are distinguished by the extent and severity of a person’s mood disturbance, and by the direction (up or down) of the moods involved.

Here is a key point: The mood disorder diagnoses are essentially defined as patterns of mood disturbances observed through time. Clinicians choose from among the various mood-related diagnoses on the basis of their observation of patients’ sequence of mood episodes. Most people with mood disorders will have (or have already had) a history of multiple mood episodes. Individual mood episodes last for several weeks or months and then give way to normal mood, or to another mood episode.

In order to fully understand how mood disorders are defined, you first have to understand the concept of mood episodes. There are four kinds of mood episodes described in the DSM: Major Depressive, Manic, Hypomanic, and Mixed. Major Depressive episodes are characterized by the classic symptoms described above. Manic episodes are characterized by a persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary). In addition, three (or more) of the following symptoms must be present (four symptoms must be present if the person’s mood is only irritable):

• Inflated self-esteem or grandiosity
• Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
• More talkative than usual or pressure to keep talking
• Racing thoughts
• Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
• Increase in goal-directed activity (either socially, at work or school, or sexually) or feelings of agitation/restlessness
• Excessive involvement in risky activities (e.g., shopping sprees, sexual indiscretions, or foolish business investments)

Hypomanic episodes are a milder form of manic episodes. Both share the same list of symptoms described above. However, the DSM criteria for Hypomanic episodes state that the person’s mood disturbance occurs throughout at least 4 days (rather than 1 week as with a Manic Episode).

Mixed episodes are essentially a combination of manic and depressive episodes that become superimposed so that symptoms of both are present (at different times) during the same day. More specifically, the criteria are met both for a Manic Episode and for a Major Depressive Episode nearly every day during at least a 1-week period.

Major Depression is a distinct and separate condition from Bipolar Disorder and the other mood disorders. By definition, people diagnosed with Major Depression show only a history of one or more major depressive episodes. People with Major Depression never have a history of manic or mixed episodes, and neither do they show signs of hypomania. People with Major Depression also have relatively severe mood symptoms. People who show signs of depressive mood on a regular basis but who do not meet the formal criteria for a depressive mood episode cannot be diagnosed with Major Depression. Such individuals will instead tend to have some other mood diagnosis, such as Dysthymic Disorder.

In this article, we focus on the Unipolar forms of depression; namely Major Depressive Disorder, Dysthymic Disorder, and Depressive Disorder Not Otherwise Specified. The other mood disorders tend to be variations on the theme of bipolar disorder and are discussed in our Bipolar Disorders Topic Center. Throughout our discussion it is important to keep in mind that the term “depression” is not particularly specific. There are multiple kinds of depression; and the diagnosis of a particular disorder varies depending on the severity, duration, and persistence of symptoms.

Major Depression

The classic symptoms of Major Depression are described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)*, the widely accepted standard guidelines for psychiatric diagnoses. Symptoms associated with Major Depression cause clinically significant distress and impairment in social, occupational, or other areas of functioning.

Variations of Depression

Depressive symptoms can vary tremendously from one individual to the next. While one depressed person may experience feelings of sadness, hopelessness, and helplessness, another may feel angry, irritated, and discouraged.

• Depressive symptoms may also seem like a change in someone’s personality.
  • For example, a typical person might begin to lose his or her temper about things that normally would not be troubling to him or her.
• Depressive symptoms can also change across the course of the illness; someone who is initially withdrawn and sad can become highly frustrated and irritable as a result of decreased sleep and the inability to accomplish simple tasks or make decisions.

When Major Depression is severe, people may experience psychotic symptoms, such as hallucinations and delusions.

• Hallucinations are “phantom” sensations that appear to be real even though they are not caused by real things in the environment.
• Hallucinations may occur within any sensory realm (including sight, sound, taste, smell and touch), and can be very convincing (as well as disturbing) in their reality.
• The most common form of hallucination is auditory; involving hearing voices of people who are not actually present.

Delusions are very strongly held false beliefs that cause a person to misinterpret events and relationships.

• Delusions vary widely in their themes; they may be:
  • Persecutory (someone is spying on or following you).
  • Referential (a t.v. show or song lyrics contain special messages only for you).
  • Somatic (thinking that a body part has been altered or injured in some way).
  • Religious (false beliefs with religious or spiritual content).
  • Erotomanic (thinking that another person, usually someone of higher status, is in love with you).
  • Grandiose (thinking that you have special powers, talents, or that you are a famous person).

When someone is depressed and experiencing psychotic symptoms, the content of hallucinations and delusions is usually consistent with a depressed mood and focuses on themes of guilt, personal inadequacy, or disease.

• For instance, depressed people might truly believe that they are not able to perform their job or their parenting duties because they are inadequate (a feeling that may be reinforced by voices telling them that they are inadequate) and that everyone is snickering at them behind their back.
• A depressive episode that involves psychotic symptoms can be particularly problematic because a person can lose the ability to discriminate between real and imagined experiences.

Video: What is Depression?

Below is a TED Ed video by Helen M. Farrell on the symptoms of depression, its possible causes, and a few available treatment options.