Thursday, December 26, 2013

Internet Gaming Addictions and the DSM-5

Were it not for my practice, and now, the last section of the remarkable DSM-5, I wouldn't be blogging about this. It feels like such a scrooge-thing to do. A kid finds this awesome present, an X box 360 under the tree, and his mom reads ENT and warns. . .
Enjoy. But remember. It is a starter drug.
Like our first flip phone was a starter drug, too, right?

We can laugh, but couples do present in therapy, meaning they are in therapy because they disagree (fight) about one of them having a compulsion to play games online with friends. He isn't finishing his second shift responsibilities, and worse, isn't coming to bed at night. Every night is Christmas, up late waiting for an online Santa to lose.

Competition rocks, really raises those endorphins.

At the end of the DSM-5, page 795, we find a new disorder proposed for further study. Internet Gaming Disorder. No code yet.

Interestingly, Persistent Complex Bereavement Disorder is among these disorders under consideration. I have seen it in practice, had no proper way to diagnose the syndrome, other than to slap on Major Affective Disorder, Single Episode, Moderate. The patient's depressive episode felt severe, but different. Hopefully there will be a DSM-5 TR (text revised) or a DSM-6 coming up soon that includes Persistent Complex Bereavement Disorder, and provides an actual code, or number.

As you know, proper diagnosis has implications for treatment.

Not to get too distracted, sorry, but Internet Gaming Disorder, is among the conditions that haven't quite made it to prime time, are merely under consideration. But that is a big thing, implies we are certainly within our rights to warn kids, friends, co-workers about devices as starter drugs.

Here are the proposed criteria, paraphrased, for IGD, Internet Gaming Disorder.

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 five or more of the following within a year:
1.  Preoccupation with online games, even past and upcoming games. Internet gaming is the dominant daily life activity.
2.  Withdrawal when Internet gaming is taken away, meaning irritability, anxiety, or sadness.
3.  Developed Tolerance-, needing to spend increasing amounts of time in play online.
4.  Unsuccessful attempts to control Internet game participation.
5.  Loss of interest in previous hobbies.
6.  Knowing it is creating problems in self and relationships, yet continuing to play excessively.
7. Has deceived others about the amount of time gaming online.
8. Uses Internet gaming to escape a negative mood.
9. Loss of relationships, jobs, or academic opportunity and success, due to Internet gaming.

Note: The above applies to nongambling Internet games, and does not include required professional use and is limited to gaming, not other recreational or social, sexual sites.

We will be asked to specify the severity, mild, moderate, or severe.

I, for one, am grateful that my particular obsession, blogging here, is back. Only yesterday Simon and Schuster sent me a book that is likely to roast everything we therapists do, Promise Land, My Journey Through America's self-help Culture, (note the grammar), written by a woman who has been through many different types of therapy none of them good. and probably is going to tell us that Everyone Does Not Need Therapy. Could be, but it sure feels that way.

I'm looking forward to reading Jessica Lamb-Shapiro's amazing read. The reviews so far are amazing.

Light reading, as opposed to the DSM. And let's talk. Until you've been to six AA meetings and hate them all, can you really say that AA isn't for you? Same thing with therapy.

Six therapydocs and you have the right to complain.

I'll get to it this weekend.


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