Tobacco, alcohol, drugs – addiction comes in many shapes and sizes. But some addictive disorders fly under the radar. Gaming, hair-pulling and eating soap: Read up on three rare examples.
Failing to recognize and diagnose an addiction can worsen the situation for patients and might, in extreme cases, even result in suicide. Addiction is a mental illness and should be treated as such. Time for a quick recap: Here are some lesser-known addictions that doctors should keep in mind when assessing patients with potential addictive disorders. Note that all of these addictions can come with additional disorders and other comorbidities, such as mood disorders, substance abuse and anxiety disorders, that should be screened for before treatment.
Classified “as a pattern of gaming behavior characterized by impaired control over gaming, increasing priority given to gaming over other activities […] and continuation or escalation of gaming despite […] negative consequences”, gaming disorders include all manners of digital gaming, be it online or offline. But when does a beloved hobby turn into addiction? WHO guidelines state that behavioral patterns must be severe enough to significantly impair the patient’s life in all of its aspects (e. g. social, educational/professional, personal). There’s also the factor of time: Symptoms must persist for at least 12 months to qualify as markers of addiction.
However, gamers should not fret – despite its potential severity, only a few people engaging in digital gaming develop an addiction. Nevertheless, gaming disorder is included in the 11th Revision of the International Classification of Diseases (ICD-11), recognizing it as a relevant medical condition. Experts stress the need to further standardize gaming disorder and its treatments. Gamers should watch for changes in their behavior as well as physical and psychological health. Current treatments focus on Cognitive Behavioral Therapy (CBT) and psychotherapy.
Classified as “a pattern of persistent or recurrent gambling […], manifested by: 1. impaired control over gambling (e. g., onset, frequency, intensity, duration, termination, context); 2. increasing priority given to gambling […] and 3. continuation or escalation of gambling despite […] negative consequences”, the lines between gambling and gaming disorder are not as clear as they used to be. Tied to betting and spending money, gambling is now often associated with online activity. According to an older definition in Psychology Today, video games don’t come with financial risks and require skills to win, not luck. The article states that any analogy was flawed and there was no such thing as video game addiction, which no longer applies.
What’s more, with the emergence of pay-to-win, loot boxes (virtual containers that hold items for games and are bought with real-world money) and gamified online betting, the distinctions between the two addictions are blurring. Studies argue that both disorders co-occur and digital gaming might even pave the way for gambling disorder. The American Psychiatric Association warns that gambling disorders often go unnoticed: “Psychiatrists should familiarize themselves with the DSM-5-TR criteria for gambling disorder.” While there is no tried-and-true way to treat this addiction yet, CBT qualifies as the gold standard, yielding the best outcomes so far. Aspects of other treatments for substance use disorder have also proven successful and can be employed as well.
Classified as a habit and impulse disorder, Trichotillomania is “characterized by noticeable hair-loss due to a recurrent failure to resist impulses to pull out hairs. The hair-pulling is usually preceded by mounting tension and is followed by a sense of relief or gratification”. It should be differentiated from stereotyped movement disorders that involve hair plucking and dermatological diagnoses. The majority of patients are women and about 1–2 % of adults are affected, according to Mental Health America. Trichotillomania is often described as a chronic condition, although it may occur in waves and with varying degrees of severity.
It is unclear what causes the disorder to manifest. Stress or a genetic predisposition might be contributing factors as well as certain imbalances in parts of the brain, such as more gray matter or decreased cerebellar volume in people who experience the disorder. Methods of treatment include CBT, but also medication (e. g. fluoxetine, fluvoxamine and sertraline, among others). However, while medical therapy can help patients experiencing depression and obsessive-compulsive symptoms, addictive behavioral patterns are likely to return once medication is discontinued.
Classified as a feeding and eating disorder, Pica belongs to a range of addictive disorders that “involve abnormal eating or feeding behaviors that are not explained by another health condition and are not developmentally appropriate or culturally sanctioned”. Patients consume inedible items devoid of nutritional value – such as dirt, paper, soap, hair, pebbles, or ash. Symptoms must persist over at least one month and be incongruent with the patient’s developmental state. Children under two years of age, for example, tend to put various things in their mouths (mouthing) without qualifying for Pica.
This addictive disorder often coincides with other mental issues (e. g. intellectual disability, autism spectrum disorder, schizophrenia) and patients are not necessarily concerned with their weight or shape. It can be caused by anemia, malnutrition, or pregnancy. In these cases, Pica should be viewed as the body’s expression of deficiencies which can be easily corrected by supplementing the respective nutrients and/or medication. If this doesn’t change eating habits, behavioral therapy is in order. There are various methods of intervention that have also proven effective in dealing with autism, for example, rewarding patients for not choosing an inedible item.
Image source: Vinicius Löw, unsplash
