Comorbidity of Internet use disorder and attention deficit hyperactivity disorder: Two adult case–control studies

Objectives There is good scientific evidence that attention deficit hyperactivity disorder (ADHD) is both a predictor and a comorbidity of addictive disorders in adulthood. These associations not only focus on substance-related addictions but also on behavioral addictions like gambling disorder and Internet use disorder (IUD). For IUD, systematic reviews have identified ADHD as one of the most prevalent comorbidities besides depressive and anxiety disorders. Yet, there is a need to further understand the connections between both disorders to derive implications for specific treatment and prevention. This is especially the case in adult clinical populations where little is known about these relations so far. This study was meant to further investigate this issue in more detail based on the general hypothesis that there is a decisive intersection of psychopathology and etiology between IUD and ADHD. Methods Two case–control samples were examined at a university hospital. Adult ADHD and IUD patients ran through a comprehensive clinical and psychometrical workup. Results We found support for the hypothesis that ADHD and IUD share psychopathological features. Among patients of each group, we found substantial prevalence rates of a comorbid ADHD in IUD and vice versa. Furthermore, ADHD symptoms were positively associated with media use times and symptoms of Internet addiction in both samples. Discussion Clinical practitioners should be aware of the close relationships between the two disorders both diagnostically and therapeutically. When it comes to regain control over one’s Internet use throughout treatment and rehabilitation, a potential shift of addiction must be kept in mind on side of practitioners and patients

Motivation and Diabetes: Time for a Paradigm Shift? - A Position Paper -

Non-adherence to treatment recommendations for patients with diabetes is widespread. This applies to medication as well as recommendations for a healthy lifestyle with appropriate physical activity, a healthy diet, and, if necessary, an end to smoking and weight control. Disregard of these recommendations has been shown to increase the risk of diabetes complications, morbidity and premature mortality. Physicians ' responses to this patient behavior include increased efforts to improve adherence to therapy and often result in a feeling of resignation in the long term. Research efforts focus on an increasing number of interventions to improve therapy adherence, with the results of meta-analyses indicating only moderate success. This position paper presents a practice-oriented approach for discussion that aims to improve the problems described. We reflect on the different roles and responsibilities of patients on the one hand and physicians and other professional groups (diabetes counsellors, nurses, and psychotherapists) on the other. A new classification of different types of non-adherence to therapy is proposed. These constitute the starting point for a practice-related algorithm for the medical handling of the different types of non-adherence, in which the roles and responsibilities of practitioners and patients are explicitly clarified. Thereby no adherence to therapy of patients is pushed. Rather, the aim is for patients to make an informed and responsible decision for or against a doctor's suggestion and for this to be accepted by the physician so that frustrations on both sides are avoided. Finally, theses regarding motivation problems in diabetes will be presented for discussion

Internet-Based Self-Assessment for Symptoms of Internet Use Disorder—Impact of Gender, Social Aspects, and Symptom Severity: German Cross-sectional Study

BackgroundInternet use disorder (IUD) is a new type of behavioral addiction in the digital age. At the same time, internet applications and eHealth can also provide useful support in medical treatment. ObjectiveThe purpose of this study is to examine if an internet-based eHealth service can reach individuals with IUD. In particular, it should be investigated whether both male and female individuals with more severe IUDs can be reached. MethodsData were retrieved from the OMPRIS (online-based motivational intervention to reduce problematic internet use and promote treatment motivation in internet gaming disorder and internet use disorder) project (DRKS00019925), an internet-based motivational intervention to reduce problematic internet use and promote treatment motivation in internet gaming disorder and IUD. During the recruitment process (August 2020-March 2022), a total of 3007 individuals filled out the standardized scale for the assessment of internet and computer game addiction (AICA-S). The assessment was accessible via the project homepage. There was no preselection of participants at this stage of the study; however, the offer was addressed to people with hazardous internet use and IUDs. The web-based assessment was free and could be found via search engines, but attention was also drawn to the service via newspaper articles, radio reports, and podcasts. ResultsOut of 3007 who participated in the web-based self-assessment, 1033 (34.4%) are female, 1740 (57.9%) are male, 67 (2.2%) are diverse individuals, and 167 (5.5%) did not disclose their gender. The IUD symptom severity score showed a wide range between the AICA-S extreme values of 0 and 27 points. On average, the total sample (mean 8.19, SD 5.47) was in the range of hazardous IUD behavior (AICA-S cutoff>7.0). Furthermore, 561 individuals (18.7% of the total sample; mean 17.42, SD 3.38) presented severe IUD (AICA-S cutoff>13.5). Focusing on female and male participants, 20.9% (363/1740) of the men and 14.9% (151/1033) of the women scored above 13.5 points, which can be considered pathological IUD behavior (χ22,2773=16.73, P<.001, effect size: Cramér V=0.078). Unemployment, being in vocational training or studying at a university, and being male were significantly associated with high IUD symptoms. ConclusionsUsing a large sample, the study showed that both mildly and severely IUD-affected individuals can be reached via the internet. An internet-based eHealth offer can thus be a good way to reach patients with IUD where they are addicted—on the internet. In addition, eHealth services increase the likelihood of reaching female patients, who hardly ever come to specialized outpatient clinics and hospitals. Since social problems, especially unemployment, have a strong association with disease severity, the integration of social counseling into treatment seems advisable in terms of a multidisciplinary approach. Trial RegistrationGerman Clinical Trials Register (DRKS) DRKS00019925; https://drks.de/search/de/trial/DRKS0001992

Alexithymia and internet gaming disorder in the light of depression

$\it Background:$ Social and emotional deficits are assumed to be involved in the development and maintenance of internet gaming disorder (IGD). Alexithymia refers to a personality construct, which is characterized by deficits in emotional awareness and processing. The constructs of alexithymia and depression share similarities, and depression is a common comorbidity of IGD patients. The aim of this study was to analyze the relationship between alexithymia and IGD when controlling for depression symptom severity. Moreover, we compared alexithymia traits of IGD patients with those of non-pathological video gamers. $\it Methods:$ In a cross-sectional study n = 38 male IGD patients (EG) were recruited at specialized healthcare services in Germany. In addition, n = 39 male non-pathological video gamers (CG) were recruited via social media and bulletin board announcement. Both groups completed questionnaires measuring alexithymia (TAS-20), depression symptom severity (BDI) and IGD severity (s-IAT). $\it Results:$ Alexithymia and depression symptom severity both predicted IGD severity. Yet, when including both factors in multiple regression analysis, only alexithymia predicted IGD severity. The prevalence of alexithymia in the EG was 34.2 % (n = 13). None of the non-pathological video gamers scored above the cut-off indicating alexithymia. IGD patients showed higher traits of alexithymia in general and on each subscale, irrespective of whether or not they were currently consuming video games. As previously observed, depression symptom severity was significantly greater in IGD patients compared to healthy video gamers. Yet, group differences in alexithymia traits remained stable, with a ~29 % decrease of effectiveness in the relationship, when controlling for depression symptom severity and sociodemographic factors. $\it Conclusion:$ The results reveal that alexithymia is associated with and predicts IGD severity independently of depression symptom severity. Moreover, alexithymia is highly prevalent in IGD patients

Predictive power of the DSM-5 criteria for internet use disorder

$\bf Introduction:$ Although the majority of internet users enjoy the internet as a recreational activity, some individuals report problematic internet use behaviors causing negative psychosocial consequences. Therefore, it is important to have precise and valid diagnostic criteria to ensure suitable treatment for those affected and avoid over-pathologization. $\bf Methods:$ The aim of the present study was to determine which of the nine DSM-5 criteria of internet gaming disorder (IGD) are crucial in distinguish pathological from non-pathological internet use based on the questionnaire-based response behavior of the participants by applying the Chi-squared automatic interaction detection (CHAID) decision tree analysis. Under consideration of the nine DSM-5 criteria for IGD and according to the short-form scale to assess Internet Gaming Disorder (IGDS-SF9) the DSM-5 criteria were formulated as questions and applied to the broader concept of Internet Use Disorder (IUD). The nine questions were answered on a 5-point Likert scale from "never" to "very often". In accordance with the IGDS-SF9 participants were assigned to IUD-5plus if at least 5 of the 9 criteria were answered with "very often". The study was conducted in Germany ($\it N$ = 37,008; $\it mean age$: 32 years, $\it SD$ = 13.18, 73.8% male). $\bf Results:$ Although "loss of control", "continued overuse" and "mood regulation" were the most endorsed criteria, the analysis indicated that the criterion "jeopardizing" was found as the best predictor for IUD-5plus, followed by "loss of interest" and "continued overuse". Overall 64.9% of all participants who were in the IUD-5plus, could been identified by the fulfillment of the three criteria mentioned above. $\bf Discussion:$ The results found support for adjustment of the DSM-5 criteria of IGD in accordance to ICD-11. If the predictive power of the three criteria can be replicated in future representative studies, such a decision tree can be used as guidance for diagnostics to capture the particularly relevant criteria

Telemedicine as bridge to the offline world for person affected with problematic internet use or internet use disorder and concerned significant others

$\bf Introduction$ Internet use disorder is a disorder of the digital age and presents a growing problem worldwide. It appears that due to structural and personal barriers, many persons affected (PA) and Concerned Significant Others (CSO) do not reach the health care system so far and thus a chronification of the pathology can proceed. $\bf Methods$ A telemedicine counseling service for PA and CSO of PA unwilling to enter treatment with two webcam-based sessions of 60 minutes for each group was created with the aim of reaching out to PA and CSO to provide a low-threshold support and refer the participants to the local health care system. Motivational interviewing for PA and CRAFT (Community Reinforcement and Family Training) for CSO were used as methods. Participants answered questions about their Internet use and sociodemographic data and six months after participation, participants were asked via email if they entered the local health care system. CSO answered the questions for themselves and in a third-party rating for PA unwilling to enter treatment. $\bf Results$ 107 PA (34 years ($\it SD$ = 13.64), 86% male) and 38 CSO (53 years ($\it SD$ = 6.11), 28.9% male) participated in the two telemedicine sessions. After participation, 43.9% of the PA and 42.1% of the CSO reached the health care system. When there was consistency between the location of telemedicine consultation and treatment locally, over 90% of participants arrived (PA: 92.3%, CSO: 100%). $\bf Conclusion$ The results from this study reveal that telemedicine services could be a promising approach to address PA and CSO and build a bridge to the local health care system. Future studies should verify if these results can be replicated in randomized controlled trials

Development and validation of a computer program for measuring emotional awareness in German

$\bf Introduction:$ Emotional awareness is the ability to identify, interpret, and verbalize the emotional responses of oneself and those of others. The Levels of Emotional Awareness Scale (LEAS) is an objective performance inventory that accurately measures an individual's emotional awareness. LEAS assessments are typically scored manually and are therefore both time consuming and cognitively demanding. This study presents a German electronic scoring program for the LEAS (geLEAS), the first non-English computerized assessment approach of the LEAS. $\bf Methods:$ Data were collected from a healthy German community sample ($\it N$ = 208). We developed a modern software for computerizing LEAS scoring, an open-source text-based emotion assessment tool called VETA (Verbal Emotion in Text Assessment). We investigated if the software would arrive at similar results as hand scoring in German and if emotional awareness would show similar associations to sociodemographic information and psychometric test results as in previous studies. $\bf Results:$ The most frequently used scoring method of the geLEAS shows excellent internal consistency ($\alpha$ = 0.94) and high correlations with hand scoring ($\it r$ = 0.97, $\it p$ < 0.001). Higher emotional awareness measured by the geLEAS is associated with female gender, older age, and higher academic achievement (all $\it p$ < 0.001). Moreover, it is linked to the ability to identify emotions in facial expressions ($\it p$ < 0.001) and more accurate theory of mind functioning ($\it p$ < 0.001). $\bf Discussion:$ An automated method for evaluating emotional awareness greatly expands the ability to study emotional awareness in clinical care and research. This study aims to advance the use of emotional awareness as a clinical and scientific parameter

Quality of life in internet use disorder patients with and without comorbid mental disorders

$\bf Introduction:$ Evidence from clinical studies on quality of life (QoL) in patients suffering from internet use disorders (IUD) is still limited. Furthermore, the impact of additional mental comorbidities on QoL in IUD patients has rarely been investigated yet. $\textbf {Materials and Methods:}$ In a cross-sectional clinical study 149 male subjects were analyzed for the presence and severity of an IUD as well as other mental disorders by experienced clinicians. The sample consisted of 60 IUD patients $\it with$ and $\it without$ comorbid mental disorders, 34 non-IUD patients with other mental disorders, and 55 healthy participants. Standardized clinical interviews (M.I.N.I. 6.0.0) and questionnaires on IUD symptom severity (s-IAT), QoL (WHOQOL-BREF), depression and anxiety symptoms (BDI-II and BAI), and general psychological symptoms (BSI) were used. $\bf Results:$ Internet use disorder patients showed significantly reduced QoL compared to healthy controls (Cohen's $\it d$ = 1.64–1.97). Furthermore, IUD patients suffering from comorbid mental disorders showed significantly decreased levels of physical, social, and environmental QoL compared to IUD patients without any comorbidity ($\it p$ < 0.05–0.001). Multiple linear regression analyses revealed that low levels of psychological, social and environmental QoL were mainly predicted by symptoms of depression. IUD factors were only significant predictors for the social and physical QoL. $\bf Discussion:$ Internet use disorder patients with comorbid mental disorder reported the lowest QoL. Depression symptom severity was the most significant predictor of low QoL in IUD. Strategies to reduce depressive symptoms should therefore be considered in IUD treatment to increase patients' QoL