Process Addictions

Erik Sanchez
Elizabeth Tse
Maleenee Beuhler
Nishant Munugala

Exercise Dependence
Other names:

Exercise addiction
Obligatory exercise
Compulsive athleticism
Compulsive exercise
Exercise abuse
Anorexia athletica

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Definition
There is no formal DSM-IV
definition
is physical activity that is
extreme in frequency and
duration, relatively resistant
to change, and often
accompanied by an
irresistable impulse to
exercise even when injury,
fatigue, or other personal
demans persist

Source: University of Florida College of Health and

Human Performance exercise, Center for Exercise Science

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Criteria for Exercise

Dependence

(1) Tolerance: need for increased amounts of exercise to achieve desired effect;
diminished effect with continued use of same amount of exercise
(2) Withdrawal: characteristic withdrawal symptoms for exercise (e.g., anxiety,
fatigue) or exercise is taken to relieve or avoid symptoms
(3) Intention Effect: exercise is often taken in larger amounts or over a longer
period than was intended
(4) Lack of Control: a persistent desire or unsuccessful effort to cut down or
control exercise
(5) Time: a great deal of time is spent in activities necessary to obtain exercise
(e.g., physical activity vacations)
(6) Reduction in Other Activities: social, occupational, or recreational activities
are given up or reduced because of exercise
(7) Continuance: exercise is continued despite knowledge of having a
persisting/recurriing physical or psychological problem that is likely to have been
caused or exacerbated by the exercise (e.g., continued running despite injury).
(Hausenblas and Downs, 2002)

Signs of Exercise
Dependence
It interferes with daily activities and relationships.
You believe that bad things will happen if you dont work
out.
You develop a perfectionist attitude toward exercise and
your body.
You ignore the signs of illness, injury or fatigue and work
out
despite them.
You set unattainable goals (miles run, hours worked out,
percentage of body fat, etc.)
You ignore friendships or satisfying hobbies in order to
exercise.
National Association of Anorexia Nervosa and Associated

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Consequences
Physical

Psychological

Anxiety
Depression
Worthlessness
Insomnia

Social
Neglect
relationships
Social withdrawal

Damaged tendons,
ligaments, bones,
cartilage, and joints
Loss of muscle mass
Ammhenorea (females) Osteoperosis
Eating Disorders
Gastro-intestinal blood
loss and anemia
Myocardial infarction
and death
Jim Fixx - tolerant to
ischemic heart disease

Treatment
OCD Therapist
Third wave cognitive-behavioral therapy
Acceptance and commitment therapy
(ACT) for treating many disorders
including addiction
Major advocate, Steve Hayes
Not to fight negative feelings but to accept
them as part of life
Mindfulness
Work toward life values

Treatment (continued)
Cognitive therapy strategy is normally to change
negative feelings, not accept them
Multiple studies showed that ACT proved more
effective than regular cognitive therapy including ones
on depression (Haynes 2006) and psychotics (Haynes
2002)
Criticized for being too much like a religion

Tranquilizers
Medicine
Tranquilizers
Antidepressants

Treament Centers

Related Disorders
Obsessive Compulsive Disorder
(OCD)
Bulimia Nervosa

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Compulsive Overeating
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Compulsive Overeating
Most people feeling control over eating
habits, meaning eating when you are
hungry and stopping when you are
satisfied.
Compulsive behavior is defined as acting
on an internal force that leads one to act
against their will.
Compulsive overeating usually in the form
of bingeing or excessive snacking
Bulimia Nervosa and Binge Eating Disorder

Binge (DSM-IV)
Eating, in a discrete period of time an
amount of food that is definitely larger than
most people would eat in a similar period of
time under similar circumstances
A sense of lack of control over eating during
the episode
People describe feeling that they cannot
stop eating or control what or how much
they are eating

Bulimia Nervosa
Recurrent episodes of binge eating.
Recurrent inappropriate compensatory
behavior in order to prevent weight gain
Purge subtype: self-induced vomiting; misuse of
laxatives, diuretics, enemas, or other medications
Non-purge subtype: fasting; or excessive exercise

These behaviors both occur, on average, at

least twice (once) a week for 3 months.
Stems from a negative perception body shape
and weight.

Binge Eating Disorder

Recurrent episodes of binge eating.
Marked distress regarding binge
eating.
The binge eating occurs, on average,
at least 2 days a week for 6 months.
The binge eating is not associated
with the regular use of inappropriate
compensatory behaviors.

Causes of Compulsive
Overeating
Socio-cultural issues:
Body image
Fast Food Society
Diet craze

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Interpersonal issues:
Emotional eating
Susceptibility to addiction

Self-Regulation Issues

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Is Compulsive Eating an
Addiction?

Other Indications of
Addiction
Laboratory findings have provided evidence that binge
eating, like addictions, might involve the endogenous opioid
systems (Grigson, 2002; Volkow & Wise, 2005) and the
mesocortical dopamine system (Davis, Strachan, & Berkson,
2004; Volkow & Wise, 2005).
Low levels of dopamine D2 receptors have been reported in
individuals with compulsive disorders, including both drug
addiction and compulsive overeating
Eating disorders and substance-use disorders co-occur at
higher than expected rates, particularly among individuals
who binge eat(elevated rates of eating disorders are reported
by individuals with substance-use disorders)
# It has been postulated that compulsive overeating may
occur to compensate for reduced activation of reward circuits
which are modulated by dopamine Wang et al. (2001)

No Gold Standard
It is difficult to determine whether
binge eating is an addiction because
no gold standard exists by which to
judge a behavior as an addiction.
Ultimately, whether binge eating is
considered an addiction will depend
on the breadth of the definition
selected.

DSM-IV Substance
Dependence Criteria
Binge eating larger amounts than
intended
Persistent desire or unsuccessful
efforts to control binge eating
Withdrawal (e.g., restlessness,
irritability, headaches)
Great deal of time spent binge
eating or recovering from the effects

Study
Community women (N=79) with a current
diagnosis of BED
The substance-dependence module was used
to assess current substance dependence,
with the term substance referring to binge
eating rather than psychoactive drugs.
Data collected via interviews

Stephanie E. Cassina and Kristin M. von Ranson, a,

Department of Psychology, University of Calgary, 2500 University Dr. N.W., Calgary,
Alberta, Canada T2N 1N4

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Results
92.4% of participants qualified as addicts
Participants engaged in a mean of 4.0 eating
binges/week (SD=1.8) and had been binge
eating for a mean of 14.8 years (SD=11.9).
Eating disorder treatment had been sought by
20 participants (25.3%) from a physician,
psychiatrist, psychologist, counselor, support
group, or 12-step program.
Only 6 participants (7.6%) had been formally
diagnosed with an eating disorder by a
psychologist or psychiatrist.

Current Views & Future

Implications
Increasing view that some foods are addictive and that
eating disorders are a form of addiction is widespread
among mental health professionals (Benton, 2010; von
Ranson & Cassin, 2007; Wilson, Perrin, Rosselli,
Striegel-Moore, DeBar, & Kraemer, 2009).
More recently, the notion that obesity might be a form
of addiction has been gaining popularity, with the case
being made that the study of drug addiction may
inform our understanding of obesity (Volkow & Wise,
2005).
Future approaches considering treating eating
disorders(Bulimia Nervosa and BED)as an addiction
may be a key step in finding better treatments

Internet Addiction

What is Internet Addiction?

Internet addiction is defined as timeconsuming, incontrollable, or distressing
internet use which results in social
occupational, or financial difficulties.

(DellOsso et al, 2008)

Some Internet Facts

The internet became commercially
available only 20 years ago in the early
1990s.
According to the International
Telecommunications Union, as of 2009,
almost a quarter (~22%) of the worlds
population uses the internet.
Since the internet is so young, relative to other
drugs, internet addiction is a fairly new disorder
and has only recently been considered a major
treat to society due to its addictive nature.

Types of Internet Addiction

Addiction to online video games
(role playing games)
Online gambling
Cybersex
Chat rooms

Prevalence of Internet
Addiction
In an early survey regarding
internet addiction it was found that
an estimated 6% of internet users
fit the profile of an internet addict
as is currently defined by the DSM
IV. (Greenfield 1999)
Similar research has been done
around the world.

Prevalence (continued)
Since there is no standard diagnostic
criteria there is variability in the
estimated number of users who are
addicted ranging from 6-15%.
It was found that the highest rate of
addiction was among college students
ranging from 13-18.4%.
Adolescents from 12-18 years of age had
the lowest risk of internet addiction
ranging from 4.6-4.7%.

Symptoms of Internet
Addiction
Excessive, non-essential use of the
internet defined by 8-60+ hours/week
depending on the criteria used.
Loss of sleep.
Delay of work.
Disregard for normal drives.
Seclusion

Possible Causes/Risk
Factors of Internet
Addiction

Quality of Family and Social Life

Problems with Partner/Friends
Addictive personality
Loneliness
Social phobias

Consequences of Internet
Addiction
Loss of Spouse/Significant
Other/Problems with relationships

Loss of real friends

Withdrawal

Dysphoria
Depression
Need of internet
Loss of interest

Follows typical addiction cycle

Problems with Diagnosis

Unlike recreation drugs or drugs of
abuse, the internet is usually a
vital tool for every day life
People tend to rationalize their
excessive use of the internet

Prevention of Internet
Addiction
In India, internet use has been
restricted to daytime hours.
Various companies have set
programs that monitor employee
internet use such as Spymonkey
Restrictive use set by parents and
school for children in grade school
(U.S.)

Treatment of Internet
Addiction
Many treatments have been employed
but since internet addiction is such a
new phenomenon most treatments
have yet to be adequately studied
These treatments include: Structured
Cognitive Behavioral therapy,
interventions, abstinence,
restrictive/controlled use, group
therapy, 12 step recovery programs and
medication

Medication
Antidepressant Escitalopram (Lexapro)
Open label study (n = 19)
This means that people knew what they
were taking during the first phase
Then given placebo or the drug in a
double blind study
Results: peoples usage of the internet
dropped from an average of 36
hours/week to 16 hours/week

Gambling

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Problem Gambling
Problem gambling is gambling
behavior which causes disruptions
in any major area of life:
psychological, physical, social or
vocational. - National Council on
Problem Gambling
Other names: compulsive
gambling, pathological gambling

DSM-IV Symptoms of
Problem Gambling
May apply to three or more of the following
categories:
Tolerance
Withdrawal
Larger amounts - After losing money gambling, often returns
another day to get even-chasing
Impaired control - neglect of relationships, career,
preoccupation of gambling
Time spent
Continued use despite problems
From: American Psychiatric Association, Diagnostic and Statistical Manual of Mental
Disorders, 4th edition, 1994.

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Diagnostic Criteria
Must apply to five or more of the following:
Gambling preoccupation
Increasing amount of money gambled
Lack of success in halting gambling habits
Uses gambling as an escape
Lies to family members or significant other
At risk of losing career or education
Lost relationships of close friends/family to
gambling
Bailout - Needs financial assistance from others

Possible Motivations for

Problem Gambling
Age - teens and
older citizens
more at risk
Depression
Low levels of
norepinephrine

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Norepinephrine
Believed that lower
serotonin would be the
reason for problem gambling
Low norepinephrine levels
lead to problem gambling
Prone to engaging in high
risk activity
May also be a way for
people to stave off
depression

Source: New York Times, 1989

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Study
(Roy et. al., 1988)
Subject pool of 17 chronic gamblers
Tested urine to measure levels of norepinephrine
Results: Had significantly lower amounts of
norepinephrine
What does this mean?
Gives strong evidence that people with lower
levels of norepinephrine are more likely to
engage in gambling!
But the study needs to be repeated for more
validity

Gamblers Fallacy
Assumes the likelihood of
winning is higher than the
likelihood of losing

Jane: "I'll be able to buy that car I

always wanted soon."
Bill: "Why, did you get a raise?"
Jane: "No. But you know how I've been
playing the lottery all these years?"
Bill: "Yes, you buy a ticket for every
drawing, without fail."
Jane: "And I've lost every time."
Bill: "So why do you think you will win
this time?"
Jane: "Well, after all those losses
I'm due for a win."

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Consequences of Problem
Gambling
Financial Debt
Increase in the likelihood of
engaging in criminal activity
Possible suicide

Prevalance
About 0.5% of the US population
have experienced pathological
gambling
0.9-2.3% experienced subclinical
pathological gambling

Treatment

Step-based programs
Cognitive Behavioral Therapy
Antidepressants - SSRIs
Group Therapy

References (Exercise)

http://kidshealth.org/parent/emotions/behavior/compulsive_exercise.html#
Compulsive Exercise Mary L. Gavin, MD Date reviewed: October 2010
D. M. W. De Coverley Veale, Exercise Dependence British Journal of Addiction 1987,
82, 735-740
Hollyann E. Jenkins and M. Williams, Ph.D., Clinical Psychologist. Source: American
Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition, Text Revision.
Washington, DC, American Psychiatric Association, 2000.
http://www.brainphysics.com/exerciseaddiction.php
When working out shifts from a healthy habit to obsession, Marina Benjamen, Ph.D.
http:// www.anad.org/news/when-working-out-shifts-from-a-healthy-habit-toobsession/
Eating Disorders Review September/October 2010 Volume 21, Number 5 Adria N.
Pearson, Michelle Heffner, and Victoria M. Follette. Foreword by Steven C. Hayes
Addiction Rerearch, 1997, Vol. 5 (2) pp.161-168 EXERCISE ADDICTION: A CASE
STUDY MARK CRIFFITHS http://www.hhp.ufl.edu/apk/ces/affil/exPsy/topics.php
Heather A. Hausenblas and Danielle Symons Downs, Exercise Dependence Scale-21
Manual The Third Wave of Therapy By John Cloud Monday, Feb. 13, 2006 Time
Magazine

References cont.

Dell'Osso, B., and Et Al. "Escitalopram in the Treatment of Impulsive-compulsive Internet

Usage Disorder: an Open-label Trial
Followed by a Double-blind Discontinuation
Phase." Journal of Clinical Psychiatry 3rd ser. 69 (2008): 452-56. Web. 1 Mar. 2011.
Young, Kimberly S., and Cristiano Nabuco De. Abreu. Internet Addiction: a Handbook
and Guide to Evaluation and Treatment.
Hoboken, NJ: John Wiley & Sons,
2011. Print.
http://www.nytimes.com/1989/10/03/science/biology-of-brain-may-hold-key-for-gambl
ers.html?pagewanted=print&src=pm
http://psychcentral.com/archives/gambling04.htm
http://www.nizkor.org/features/fallacies/gamblers-fallacy.html
Adam, T., and E. Epel. "Stress, Eating and the Reward System." Physiology & Behavior
91.4 (2007): 449-58. Print.
Cassin, S., and K. Vonranson. "Is Binge Eating Experienced as an Addiction?" Appetite
49.3 (2007): 687-90. Print.
Cota, Daniel. "Cannabinoids, Opioids and Eating Behavior: The Molecular Face of
Hedonism?" Web. 08 Mar. 2011. <http://www.ncbi.nlm.nih.gov/pubmed/16364446>.
"Eating Disorders, Addictions, and Unconscious Fantasy." Web. 08 Mar. 2011.
<http://www.ncbi.nlm.nih.gov/pubmed/7795562>.
"Eating Disorders, Obesity and Addiction - Wilson - 2010 - European Eating Disorders
Review." Wiley Online Library. Web. 08 Mar. 2011.
<http://onlinelibrary.wiley.com/doi/10.1002/erv.1048/full>.