From the Editor
May, 2014. Among the many discussions by the DSM-5 Task Force were debates about addictive behavior, ranging from familiar substance-related addictions to more controversial areas such as food addiction, sexual addiction, and addictive habits and behavior related to new technology. Only one new technology-related addiction made it into the book, one of several proposed disorders classified as Conditions for Further Study in Section III (“Emerging Measures and Models”). This preliminary diagnosis, which is termed “Internet Gaming Disorder,” is described as “persistent and recurrent use of the Internet to engage in games, often with other players, leading to clinically significant impairment or distress” as indicated by at least 5 of 9 criteria, reflecting extensive preoccupation with and excessive use of Internet games, to the detriment of social relationships and occupational success.
In the few discussions in which I participated, I suggested that a more appropriate label might be “Internet Use Disorder,” since I believe that addiction-like use of the Internet is common and growing. Although I have no hard data to report, I am struck by the scene at every Starbucks, in every airport terminal, in the shopping mall, just about everywhere—it’s a long list. Lines of people side by side, heads down, fixated on a small screen. Sometimes the same thing happens in a group of people who know each other, at the same table! And, of course, I do it too. How hard is it for us to be in a meeting, especially a long and boring one, and not check our email or tweet or send a text? (We may have forgotten that an alternative might be to make a creative suggestion or present an idea that could perk up the meeting.) Most of us, most of the time, can control and resist these urges, but there is a magnetic, compelling, perhaps addictive attraction to this at-a-distance, more impersonal form of communication. I could go on, but you get the picture, and we’re all part of it. How to differentiate adaptive behavior in a transforming world from psychopathology is our challenge.
In DSM-5 Section III, under Internet Gaming Disorder, a note specifies that “this disorder is distinct from Internet gambling, which is included under gambling disorder.” And, interestingly, Gambling Disorder is classified in DSM-5 as the only Non-Substance-Related Disorder in the section on Substance-Related and Addictive Disorders, a change from its DSM-IV-TR designation as Pathological Gambling in the section on Impulse Disorders Not Elsewhere Classified. I don’t think it’s a black and white issue, since some gambling patterns reflect driven compulsions while others may represent impulsive loss of control.
It gives me great pleasure to congratulate the winner of this year’s Journal of Psychiatric Practice Resident Paper Award, Dr. Iman Parhami, as well as his co-authors, for their excellent paper in this issue of the Journal entitled “Gambling and the Onset of Comorbid Mental Disorders: A Longitudinal Study Evaluating Severity and Specific Symptoms.” Utilizing data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), the authors examined longitudinal patterns of comorbidity that correlate with Gambling Disorder, sub-threshold Gambling Disorder, and recreational gambling, demonstrating that, in this large population of participants, those diagnosed with Gambling Disorder were at the highest risk for the new onset of comorbid psychopathology, emphasizing not just the clinically significant impairment or distress that characterizes the disorder itself, but the risk of intensified symptomatology due to the development of other conditions such as mood, anxiety, and substance-related disorders.