Behavioral Health Conditions
We understand that many of the participants at the Greenfield Recovery Center are also addressing other mental health diagnoses. These disorders are successfully addressed and considered when a customized plan with specific goals are woven into the therapy and care process. Using evidence-based treatment modalities, we can help our participants challenge their cognitive distortions and identify and practice new behaviors and coping skills, as well as manage challenges and limitations form other concerns. We work with our clients to understand all aspects of their disorder and provide the care necessary for a sustainable recovery in their Internet and technology use.
Although more frequently initially diagnosed in young people, the individual will eventually reach 18 years old. Attention Deficit Hyperactivity Disorder (ADHD), affects roughly 4% of adults ages 18-44. ADHD is characterized by either inattention, hyperactivity, and impulsivity or a combination of the above. The above behaviors associated with ADHD can be difficult to control and can impact daily living including work, social, and academic performance.
Signs of inattention include:
- Easily distracted
- Bored with tasks quickly
- Difficulty focusing on tasks
- Trouble completing assignments
- Losing or misplacing things
- Difficulty paying attention
- Difficulty processing information quickly
Signs of hyperactivity include:
- Fidgeting and squirming
- Excessive talking
- Touching or playing with things
Signs of impulsivity include:
- Acting without regard for consequences
- Difficulty taking turns, waiting or sharing
- Interrupting others
The relationship between ADHD and Internet/Video Game Addiction
A diagnosis of ADHD is often seen with an Internet and video game addiction diagnosis. One study found that 22% of individuals with a diagnosis of ADHD also struggle with Internet and video game addiction (Clifford et al., 2017). Clinically, we have found in those individuals who present with an Internet or video game addiction, most of them will also have a diagnosis of ADHD. Boredom, a high need for stimulation, a desire for novelty, and variability are often observed in individuals with ADHD, it is reasonable to understand how Internet and screen use can fulfill many of these requirements (Greenfield, 2018, 2019).
Autism spectrum disorder (ASD) is a developmental condition characterized by difficulties in social interaction, verbal and non-verbal communication, and repetitive patterns of behavior. According to the Centers for Disease Control and Prevention (CDC), males are four times more likely than females to develop ASD symptoms.
“Spectrum” refers to the degree in which the symptoms of the disorder vary in individuals. There are two types of main behaviors – restricted/repetitive behaviors” and “social communication/interaction behaviors.” All people diagnosed do not show all the behaviors, but many will show several.
Restrictive/repetitive actions may include:
- Repetitive actions and unusual behaviors
- Overly focused interests, such as moving objects or parts of objects
- Constant, intense interest in certain areas
Social communication/interaction behaviors may include:
- Upsets easily by a slight change in a routine or being in a new or overly stimulating setting
- Kittle or inconsistent eye contact
- Rarely shares the enjoyment of objects or activities by pointing or showing things to others
- Responding in an unusual way when others show anger, distress, or affection
- Failing to, or being slow to, respond to someone calling their name or other verbal attempts
- Difficulties with the back and forth of conversations
- Talking at length about favorite subjects without noticing that others are not interested or without giving others a chance to respond
- Repeating words or phrases that they hear, a behavior called echolalia
- Making facial expressions, movements, and gestures that do not match what is being said
- Using an unusual tone of voice that may sound musical or flat and robot-like
- Difficulty understanding another’s point of view or being unable to predict or understand other people’s actions
Some people with ASD are mildly impaired by their symptoms, where others are severely disabled. Additionally, symptoms can overlap with other mental health disorders.
The relation between Autism Spectrum Disorder (ASD) and Internet/Video Game Addiction
Given that difficulties with social communication/interaction are predominant in individuals with ASD, interpersonal and social situations can be quite challenging. Often social competence needs are met through Internet and video gaming. Given that social interactions are often hyper-stimulating or anxiety-provoking for individuals with ASD, video games may be an especially appealing activity due to their predictability and low social demands (Engelhartdt, Mazurek & Hilgard, 2017; Greenfield, 2019).
We all experience anxiety in our lives, however, when these feelings become overwhelming and interfere with our daily lives, an anxiety disorder may be present. According to the National Alliance on Mental Illness (NAMI), over 40 million US adults have an anxiety disorder, the most common mental illness in the country.
There are many types of anxiety disorders by the most common include:
- Generalized Anxiety Disorder (GAD) produces chronic worrying that consumes daily life and makes it difficult to finish tasks.
- Social Anxiety Disorder is more than being shy and produces an intense fear around social interaction, typically due to worries about humiliation. Panic attacks are common to anticipated social interaction. Social anxiety is a very common co-occurring condition in Internet, Video Game, and Technology Addiction.
- Panic Disorder is characterized by panic attacks, often mistaken for a heart attack, sometimes striking repeatedly and without warning. Individuals who suffer from panic disorders will often go to desperate measures to avoid an attack.
- Phobias evoke a strong, irrational fear in individuals around certain places, events, or objects. Those who have phobias will attempt to avoid these triggers, but the intense fear can take over a person’s life.
Many people with an anxiety disorder develop symptoms before age 21. Symptoms vary as anxiety disorders are a group of related conditions with unique symptoms, such as:
- Feelings of apprehension
- Feeling tense
- Restlessness or irritability
- Feelings of intense fear
- Chest pains
- Dry mouth
- Muscle tension
- Shortness of breath
- Sweating, tremors, and twitches
- Headaches, fatigue, and insomnia
- Upset stomach
Anxiety Disorders and Internet/Video Game Addiction
Research has found that individuals with video game and Internet addictions present with a higher degree of social anxiety and experience frequent anxiety symptoms when removed from their technology. For individuals with social anxiety, the thoughts of meeting others face to face can be very scary. The Internet allows these individuals to feel as though they are connecting with others, without the anxiety of face to face interactions and encounters; unfortunately, this lack of real-time social skills can facilitate further avoidance of in-person social interaction further increasing social anxiety.
Depression is a common problem affecting millions of Americans of all ages. It is often marked by sad mood, lack of pleasure in activities, poor attention/concentration, excessive or lack of sleep, increased or declared appetite, lack of motivation, reduced libido, anxiety, irritability, and thoughts of self-harm.
Depression, Reward Deficiency Syndrome, and Internet/Video Game Addiction
Research has found that individuals with video game and Internet addiction may end up more depressed from the excessive amount of time they spend online or on gaming. The reason for this is that dopamine levels in the brain end up being functionally depleted after long-term and/or excessive periods of screen use. The development of reward deficiency syndrome from excessive screen use is not uncommon and can lead to decreased motivation and interest in other real-time activities and loss of interest in previously pleasurable behaviors; isolation, and a lack of ability to delay gratification, and poor concentration on life activities that are not immediately stimulating is very common.
Each year, just over five million adults in the U.S. experience repetitive, unwanted, intrusive thoughts and irrational, excessive urges to do certain actions known as Obsessive-compulsive disorder (OCD). Although individuals with OCD are aware of their obsessions and compulsions are irrational, they are unable to stop them.
Many people have occasional obsessive thoughts or compulsive behaviors, however, someone with OCD will have symptoms that generally last more than an hour each day and interferes with daily functioning.
Obsessions are intrusive, recurrent impulses, thoughts, or images. Individuals know the thoughts are irrational, but the obsession tends to interfere more when they try to ignore or suppress them.
Some obsessions and symptoms may include:
- Preoccupation with dirt and germs
- Excessive focus on religion
- Obsession with order
- Sexually explicit thoughts
- Fear of losing things
- Fear of shouting obscenities
- Doubting something has been done correctly
- Anxiety over hurting oneself or others
- Excessive focus on morality
- Obsession with superstitions
- Intrusive violent thoughts or images
- Fear for safety
- Skin lesions (due to picking)
- Fear of “unlucky” numbers
- Fear of doing something bad
Compulsions are repetitive thoughts or actions that temporarily relieve anxiety. As with an obsession, the individual feels forced to perform the act to relieve their anxiety or to prevent something that is perceived to be bad from happening.
Some common compulsions may include:
- Ritualistic counting
- Hoarding possessions
- Obsessive “checking
- Repetitive motions or activities
- Repeatedly checking the stove
- Obsessive cleaning
- Placing items “in order”
- Need for constant reassurance
- Washing skin until it becomes raw
- Counting in patterns
Obsessive-compulsive Disorder and Internet/Video Game Addiction
Since OCD patients tend to engage in ritualistic behavior because of the nature of the underlying disorder, there may be an increased risk of developing an Internet and/or video game addiction. For example, individuals with OCD may experience unwanted and recurrent thoughts of specific Internet content or the act of playing a video game and these thoughts may become obsessional. In addition, individuals with OCD may experience repeated, persistent, difficult-to-resist urges (compulsions) to surf the Internet, YouTube or remain online for multiple hours, though they do not want to), which leads to anxiety and distress. Similarly, like with other compulsions, once the individual goes online, he or she may be less able to control their behavior and will keep surfing the Internet repeatedly, though this is often followed by distress, guilt, and shame afterward. For individuals with OCD, the act of using the Internet or video game may serve as a trigger to a cycle of repetitive behavior with both obsessional and compulsive components. This makes it difficult for these individuals to go offline once they start browsing, though they might like to stop.
Learning disabilities have been found in 10% of children. Since difficulties with reading, writing and/or math are recognizable problems during an individual’s early school years, the signs and symptoms of learning disabilities are most often diagnosed during that time (Learning Disabilities Association of America, 2020). However, some individuals do not receive an evaluation until they are in post-secondary education or adults in the workforce.
Other individuals with learning disabilities may never receive an evaluation and go through life, never knowing why they experience difficulties with academics and why they may be having problems in their jobs, or in relationships with family and friends.
For the school-age population, the most used definition is found in the federal special education law, the Individuals with Disabilities Education Act (IDEA), which uses the term “specific learning disability (SLD).” A specific learning disability is diagnosed when there are difficulties learning and using academic skills, including inaccurate or slow and effortful reading, difficulty understanding the meaning of what is read, difficulties with spelling, difficulties with written expression, difficulties mastering number facts or calculation, or difficulty with mathematical reasoning. Specific learning disorder has been found to be more common in males than females (ratios range from 2:1 to 3:1) (Learning Disabilities Association of America, 2020).
There are several types of learning disabilities, the most common include:
Dyslexia: refers to problems with accurate or fluent word recognition, poor decoding, and poor spelling abilities.
Dyscalculia: refers to problems with numerical processing, learning arithmetic facts, and difficulty performing accurate calculations.
Dysgraphia: refers to problems in executing written responses, organizing information, sequencing ideas, grammatical structure, and poor handwriting.
Nonverbal Learning Disability: refers to problems associated with right hemisphere dysfunction, evident in poor math ability, interpretation of symbols (numbers, graphs, charts), poor sense of proprioception (sense of body in space), balance and social pragmatics.
Dyspraxia: refers to problems with fine and gross motor skills, physical coordination, posture, eye-hand coordination, balance, and manual dexterity.
(Learning Disabilities Association of America, 2020).
Learning Disabilities and Internet/Video Game Addiction
Our clinical experience suggests a stronger relationship with neuro-atypical individuals and Internet, Technology, and Video Game addiction. The Internet and video gaming are an ideal place to create an intense focus thus avoiding thresholds that are experienced with school and academic performance. In other words, spending time online facilitates coping strategies that help manage (avoid) the challenges associated with a learning disability.