OVERVIEW OF BEHAVIORAL
ADDICTION
BY
MOSTAFA MAHMOUD ELSABBAN
ASSISTANT LECTURER OF PSYCHIATRY
AL AZHAR UNIVERSITY-DAMIETTA

CASE VIGNETTE
• THE 13 Y OLD GIRL WANTS TO ACCESS THE INTERNET USING
HER FATHERS LAPTOP COMPUTER.
• SUDDENLY, SHE IS CONFRONTED WITH A HIDDEN FOLDER
CONTAINING THOUSANDS OF PORNOGRAPHIC IMAGES.
• WITHIN HER, A WORLD IS BREAKING APART. HER FATHER
WHOM SHE HAS ADMIRED, THE GOOD TEACHER, HOW DOES
IT FIT WITH SUCH MATERIAL.
• SHE STARTED TO CRY ALL THE DAY , STOP EATING, SKIP
SCHOOL.
• SHE SMASHES THE LAPTOP BY THROWING IT OUT OF THE
WINDOW.
• THE WHOLE FAMILY IS IN A DRAMATIC CRISIS. IT IS IN THIS

CLASSIFICATION OF ADDICTIVE
DISORDERS
Substance-
related
addictions
Non-substance-
related
addictions
(Behavioral
addictions)

BEHAVIORAL ADDICTIONS
With forensic
implications
• Gambling,
• Internet Gaming,
• Internet Addiction,
• Kleptomania,
• Pyromania
• Sexual Addiction and
• Buying Addiction
without obvious
forensic
implications
• Compulsive Exercising,
• Compulsive Eating,
• Compulsive Tanning,
• Trichotillomania and
• Excoriation [skin
pulling])

INTERNET ADDICTION
PHENOTYPES
INTERNET
ADDICTIO
N
Pornography
Addiction
Internet
Gaming
Disorder
Gambling
Addiction

INTERNET ADDICTION
CONTRIBUTING PSYCHOLOGICAL
FACTORS

IS IT A DISEASE OR BEHAVIORAL
PROBLEM?
• DIAGNOSTIC CATEGORY
FOLLOWING ICD-10 / DSM-5
UNCLEAR
• OCD?
• DISORDERS OF IMPULSE CONTROL?
• NON-SUBSTANCE ADDICTION?
KIMBERLY S. YOUNG

INTERNET ADDICTION DISORDER (IAD)
PROPOSED DIAGNOSTIC CRITERIA
• A MALADAPTIVE PATTERN OF INTERNET USE, LEADING TO
CLINICALLY SIGNIFICANT IMPAIRMENT OR DISTRESS AS
MANIFESTED BY THREE (OR MORE) OF THE FOLLOWING
OCCURRING AT ANY TIME IN THE SAME 12-MONTH PERIOD:
1. INTERNET IS OFTEN ACCESSED MORE OFTEN OR FOR LONGER
PERIODS OF TIME THAN WAS INTENDED.
2. THERE IS A PERSISTENT DESIRE OR UNSUCCESSFUL EFFORTS TO
CUT DOWN OR CONTROL INTERNET USE.
3. A GREAT DEAL OF TIME IS SPENT IN ACTIVITIES RELATED TO
INTERNET USE
Author: Ivan Goldberg,
M.D.

INTERNET ADDICTION DISORDER (IAD)
DIAGNOSTIC CRITERIA
4. CRAVING, OR A STRONG DESIRE OR URGE TO USE THE
INTERNET.
5. RECURRENT USE OF THE INTERNET RESULTING IN A
FAILURE TO FULFILL MAJOR ROLE OBLIGATIONS AT WORK,
SCHOOL, OR HOME.
6. IMPORTANT SOCIAL, OCCUPATIONAL, OR RECREATIONAL
ACTIVITIES ARE GIVEN UP OR REDUCED BECAUSE OF
INTERNET USE.
7. RECURRENT INTERNET USE IN SITUATIONS IN WHICH IT IS
PHYSICALLY HAZARDOUS.
8. TOLERANCE
9. WITHDRAWAL

COMORBIDITIES
• A REVIEW OF THIS LITERATURE IDENTIFIED 20
STUDIES:
100% with
ADHD
75% with
Depression
60 % with
OCD
50 % with
Anxiety
(Carli et al., 2013)

DIFFERENCES BETWEEN MEN AND
WOMEN
• MEN
• KICK THROUGH VISUAL MATERIAL
• SEXUAL EXCITEMENT WITH MASTURBATION.
• TENDENCY TOWARDS VIOLENT AND ABASING
CONTENT.
• WOMEN:
• KICK THROUGH COMMUNICATION (CHAT).
• ROMANTIC STORIES AND IMAGES
• SEXUAL EXCITEMENT IS SECONDARY.

1. Visual Stimulus
2. Sexual Excitement
3. Dopamin –
„Happiness“
4. Adaptation – Desire
for more and stronger
stimuli
5. Loss of control
Limbic
System
frontal
brain
BRAIN FUNCTIONS IN PORN
ADDICTION
1
2
3
4 5
Genital Stimulation 2

TREATMENT
Psychopharmacol
ogy
Psychothera
py

PSYCHOPHARMACOLOGY
CONCLUSION:
• MEDICATION (UNFORTUNATELY) IS NOT A
SOLUTION.
• EXCEPT IF ASSOCIATED PSYCHIATRIC DISORDER.
Antidepressan
ts
Opioid Receptor
Antagonists
Mood stabilizers Antipsychotic
s

PSYCHOTHERAPY
CBT Motivational
Interviewing
Group
Therapy
Family
Therapy

CONCLUSION
• DEVELOPING A STANDARD OF PRACTICE FOR THE
TREATMENT OF IA IS STILL IN ITS INFANCY.
• BECAUSE IA IS NOT A CURRENTLY ACCEPTED
DIAGNOSIS IN DSM-5, WE DO NOT YET KNOW IF IA
IS EVEN A VALID DISEASE STATE.
• CURRENT APPROACHES RELY MAINLY ON
ANECDOTAL EVIDENCE AND A PRELIMINARY
UNDERSTANDING OF SOCIOBIOLOGICAL CAUSAL
FACTORS OF THIS PHENOMENON.

CONCLUSION
• EXISTING LITERATURE AND CLINICAL EXPERIENCE SUGGEST THAT
IN DESIGNING A TREATMENT PROGRAM FOR THESE PATIENTS,
SEVERAL ELEMENTS ARE ESSENTIAL:
• FIRST, TREATMENT OF PSYCHIATRIC COMORBIDITIES SUCH AS
ANXIETY AND DEPRESSION AND OTHER SUBSTANCE USE
DISORDERS IS AN IMPORTANT ELEMENT.
• SECOND, THERE IS GOOD EVIDENCE THAT A CBT PROGRAM
INCORPORATING ELEMENTS OF RESTRUCTURING DISTORTED
THINKING AND PROMOTING ACTIVE BEHAVIORAL CHANGE CAN BE
EFFECTIVE.
• THIRD, INVOLVING FAMILY AND OTHER SOCIAL SUPPORT
NETWORKS CAN BE USEFUL AND EFFECTIVE

THANK