1. BY
Dr. Soheir H. ElGhonemy
Assistant Professor of Psychiatry- Ain Shams University
MD in Psychiatry and Addiction
Arab Board in Psychiatry
Member of International Society of Addiction Medicine
(ISAM

2. Objectives:
 Distinguish addiction from habits, and identify the
signs of addiction.
 Discuss the addictive process; The new gate way
for chemical addiction.
 Describe types of process addictions, including
gambling, work, exercise, sexual, and Internet
addictions, as well as codependence.
 Evaluate treatment and recovery options for
addicts.

3. Habit versus Addiction
 Addiction is continued involvement with a
substance or an activity despite ongoing
negative consequences.
 Habit is repeated behavior in which the
repetition may be unconscious.
 Compulsion is present if considerable
discomfort is experienced if the behavior is
not performed.
 The mental health community considers process addiction a treatable
medical condition, Many people view it as moral condition and believe
addiction is no more than habit; they feel behaviors such as smoking,
gambling, and biting your nails are self-selected.

4. Cycle of Psychological Addiction

5. Risk Factors for Addiction

6. Internet
Food
Shopping
Addiction
Work Gambling
Exercise Sex

7. Addictive Behaviors
Process addictions are behaviors known to be
addictive because they are mood altering.
Termed a “Process” addiction because it is a
type of behaviour (a process) that the person is
involved with, not a substance.
Substance-related phenomena; tolerance,
withdrawal, greater quantity or intensity than
intended, time spent (preparing, engaging…etc),
loss of other life domains, continued despite
hazardous consequences.

8. Common and Problematic Process
addictions:
 Compulsive gambling
 Compulsive overeating
 Compulsive shopping and borrowing
 Work addiction
 Exercise addiction; Addictive exercisers- Muscle
dysmorphia
 Internet addiction
 Sexual addiction
 Multiple addictions; as many as 60 % of people in treatment have
problems with more than one addiction.

9. Exercise Dependence
 Other names:
 Exercise addiction
 Obligatory exercise
 Compulsive athleticism
 Compulsive exercise
 Exercise abuse
 Anorexia athletica

10. 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
irresistible impulse to exercise even when
injury, fatigue, or other personal demons
persist.

11. 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

12. 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)

13. 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.

14. Consequences
 Psychological  Physical
 Anxiety  Damaged tendons,
ligaments, bones,
 Depression
cartilage, and joints
 Worthlessness  Loss of muscle mass
 Insomnia  Ammhenorea (females)
 Social - Osteoperosis
 Eating Disorders
 Neglect relationships
 Gastro-intestinal blood
 Social withdrawal loss and anemia
 Myocardial infarction
and death.

15. Compulsive Overeating
 Bulimia Nervosa and Binge Eating Disorder
 Most people feeling control over eating
habits; eating when you are hungry and
stopping when you are satisfied.
 Compulsive overeating usually in the form
of bingeing or excessive snacking

16. Binge
 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

17. 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
 Occur on average, at least twice (once) a
week for 3 months.
 Stems from a negative perception body
shape and weight.

18. 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.

19. Causes of Compulsive Overeating
 Socio-cultural issues:
 Body image
 Fast Food Society
 Diet craze
 Interpersonal issues:
 Emotional eating
 Susceptibility to addiction
 Self-Regulation Issues

20. Compulsive Overeating
 More food/binges for satiety (tolerance)
 Depressed mood, guilt, shame and irritation (withdrawal)
 Binge is defined as excessive (excessive intake)
 Loss of control of bingeing
 Social withdrawal, lie about and hide eating activities,
steal and hoard food ( behavioral changes)
 Extreme dieting attempts, obesity, psychological distress
(continue despite consequences)

21.  Laboratory findings; binge eating, like addictions, might
involve the endogenous opioid systems and the mesocortical
dopamine system.
 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)
 Compulsive overeating may occur to compensate for reduced
activation of reward circuits which are modulated by
dopamine. (Volkow & Wise, 2005)

22. Internet Addiction
 Time-consuming, incontrollable, or distressing
internet use which results in social occupational, or
financial difficulties.
 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.

23. Types of Internet Addiction
 Addiction to online video games (role
playing games)
 Online gambling
 Cybersex
 Chat rooms
 FACEBOOK

24. Almost half of Facebook's users visit it
every day. And some of its users spend an
inordinate amount of time on Facebook,
allowing the hours to while away unnoticed,
the chores to go uncompleted, and even
going so far as to ignore family and friends
in the actual world.

25. Signs of a Facebook addiction:
 You wake up and the first thing you do is "check Facebook". And it's
the last thing you do at night.
 Nothing else thrills you or you feel "empty" without Facebook. All you
want to do is spend time on Facebook, even to the exclusion of
getting work done that needs to be done, or meeting family
obligations.
 You're not able to go for more than a day without using Facebook. If
forced to do so, you find yourself suffering from Facebook
"withdrawal" symptoms, such as finding nothing else interesting,
trying to find ways to get back to Facebook even if it means using a
computer that is either out of bounds, or difficult to get to, or you find
yourself intensely worried about missing out on Facebook updates.

26.  Even if you're not on Facebook constantly (indicating you
need a reality check), checking it many times during the
day is a sign of compulsive behavior. Spending more
than an hour on Facebook a day will easily cut into all the
other obligations you have in life and may cause social
dysfunction problems.
 Your real life isn't going so well and Facebook presents a
fantasy escape life where everything seems neat, happy,
and easy – all things that are the opposite of your
everyday life.
 Adequate sleep ceases to be important to you. Instead,
you're prepared to stay up way too late just to be able to
accommodate your Facebook neediness.
 You have tons of friends on Facebook but you still feel
very lonely.

27. Possible Causes/Risk Factors of
Internet Addiction
 Quality of Family and Social Life
 Problems with Partner/Friends
 Addictive personality
 Loneliness
 Social phobias
Unlike drugs of abuse, the internet is usually a vital tool for every
day life, thus People tend to rationalize their excessive use of the
internet

28. Problem Gambling
 Gambling behavior which causes
disruptions in any major area of life:
psychological, physical, social or
vocational.”
 Other names: compulsive gambling,
pathological gambling

30. 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

31. Sexual Addiction
 Sexually related compulsive behavior that interfere
with normal living and cause severe distress.
 Individuals learn to relay on sex to relieve pain and
stress
 Three levels:
1. Compulsive masturbation, pornography and
multiple sexual partners .
2. Exhibitionism , voyeurism
3. Sexual acts that are abusive to others.

32. Spending Addiction
 Chronic repetitive purchasing that becomes a
primary response to negative events or feelings.
 The “purchase on credit” mentality.
 Common feelings: depression, anxiety, frustration
and low self esteem.
 Financial problems, shoplifting, bad check writing
are the possible consequences.

33. The recently posted first draft of DSM-5 has suggested a
whole new category of mental disorders called the
“Behavioral Addictions.” The category would begin life in
DSM-5 nested alongside the substance addictions and it
would start with just one disorder (gambling). None of
the other “behavioral addictions” suggested for DSM-5
would gain official status as a stand alone diagnosis. if
suspected presence, this could be diagnosed as
“Behavioral Addiction Not Otherwise Specified” and thus
receive the dignity of an official DSM code.

34. Behavioral Addiction Treatments
 Neuropsychological Assessment.
 Cognitive behavioral therapy (CBT): teaches patients how to
recognize triggers and learn healthier coping strategies.
 Group Therapy that gives patients an opportunity to learn from
each other and develop a support network during their
behavioral addiction treatment
 Spiritual Therapy that uses yoga, creative visualization,
breathing exercises, and other holistic therapies to bring calm
and centeredness to the patient‟s life

35. If a person shops till she drops
because this is fun, it should not be
called „addiction‟ no matter how
much trouble it causes.”

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