Process Addictions
Erik Sanchez
Elizabeth Tse
Maleenee Beuhler
Nishant Munugala
Exercise Dependence
 Other names:
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Exercise addiction
Obligatory exercise
Compulsive athleticism
Compulsive exercise
Exercise abuse
Anorexia athletica
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Definition
 There is no formal DSMIV 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
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Source: University of Florida College of Health and
Human Performance exercise, Center for Exercise
Science
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Criteria for Exercise
Dependence
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(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 don’t 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
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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
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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, StriegelMoore, 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.
(Dell’Osso 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 world’s
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 1318.4%.
 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
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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
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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: people’s 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:
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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
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Source: New York Times, 1989
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Study
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(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
Gambler’s Fallacy
 Assumes the likelihood of
winning is higher than the
likelihood of losing
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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
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Step-based programs
Cognitive Behavioral Therapy
Antidepressants - SSRIs
Group Therapy
References (Exercise)
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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-to-obsession/
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.
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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-forgamblers.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>.