Internet Addiction - A Mental Disorder?

The Ottaw Citizen is reporting on recent efforts to recognize and include internet addiction into psychiatry's official guidebook of mental disorders (The Diagnostic and Statistical Manual of Mental Disorders or DSM). The idea being that internet addicts (if they exist) experience the same type of symptoms and hardship as any other type of addicts.

"Like other addicts, users experience cravings, urges, withdrawal and tolerance, requiring more and better equipment and software, or more and more hours online, according to Dr. Jerald Block, a psychiatrist at the Oregon Health and Science University in Portland. Dr. Block says people can lose all track of time or neglect "basic drives," like eating or sleeping. Relapse rates are high, he writes, and some people may need psychoactive medications or hospitalization."

Over at Mind Hacks, a blogger dissents:

"Rather curiously, the editorial mentions the figure that 86% of people with 'internet addiction' have another mental illness. What this suggests is that heavy use of the internet is not the major problem that brings people into treatment.In fact, 'internet addiction', however it is defined, is associated with depression and anxiety but no-one has ever found this to be a causal connection."

It seems to me that the DSM just wants to bring back masturbation and homosexuality into the fold of mental disorders (until a few years ago both where listed as mental disorders :) Seriously, the DSM is a book that just keeps getting fatter and fatter. Are we discovering or just inventing more illnesses?

I am not against the DSM - not one of those people who thinks there are no mental disorders - but I do think that the book has both serious weakness and strengths.

Clearly, the most invaluable strength of the DSM is that it provided the mental care community with a language, a nomenclature that it could use. Prior to the DSM there was no reliable way for to mental health care practitioners to communicate. Two practitioners looking at the same patient would use different names for the same phenomena, or the same name for different phenomena. Even as late as 1959, English psychiatrist Erwin Stengel complained that :

"A...serious obstacle to progress in psychiatry is difficulty of communication. Everybody who has followed the literature and listened to discussions concerning mental illness soon discovers that psychiatrists, even those apparently sharing the same basic orientation, often do not speak the same language. They either use different terms for the same concept, or the same terms for different concepts, usually without being aware of it.”

Therefore by far the most important strength of the DSM is that it makes the whole practice of psychotherapy possible by providing a language that all can use and further their research and insights into mental disorders.

However, the most glaring weakness of the DSM is the by-product of classification and categorization. Once you have labeled someone with a disorder he/she is viewed by the outside world as a disorder. This was made very clear in David Rosenhan’s study “On Being Sane in Insane Places” (1973) in which he and seven colleges entered a number of mental hospitals as pseudopatients. The pseudopatiants entered under the pretext of hearing voices and were diagnosed as schizophrenics. However, once inside, Professor Rosenhan and his team acted completely normal. It took an average of nineteen days for each of the pseudopatient to be realized (one stayed in for forty-two days). and no member of the staff detected that they were being fooled (ironically, some patients had their suspensions). On the contrary, members of the staff often interpreted their behavior in abnormal ways. Rosenhan’s study shows the deleterious and somewhat useless meaning of term abnormal and insane. After all, what meaning can the term/category “mentally ill” actually have if those who were mentally healthy could not be differentiated from those who were sick?

If I were in charge of the DSM-V I would move from the categorical model of psychopathology to a dimensional one. As mention already, in the categorical model individual are said to either have or not have a mental disorder. Yet research has shown that normality and abnormality lie along a continuum. That is, that what the DSM has called a psychopathology is in fact an extreme variant of normal psychological phenomena and ordinary problems in living. Instead of classifying people or disorders, the dimensional model will identify and measure mood, emotion, and personal style.

It seems to me that that is the best approach with the internet addiction question as well.