CYBER PSYCHIATRY

DR. SUBRATA NASKAR, MD

CONSULTANT PSYCHIATRIST
INSTITUTE OF NEUROSCIENCES KOLKATA
• CYBER (adjective)
relating to or characteristic of the culture of computers, information
technology, and virtual reality.

• PSYCHIATRY
the study and treatment of mental illness, emotional disturbance, and
abnormal behaviour.
CYBERPSYCHIATRY
• The study and treatment of mental illness, emotional disturbance,
and abnormal behaviour relating to or characteristic of the culture of
computers, information technology, and virtual reality.

• STUDY OF THE MENTAL ILLNESSES ASSOCIATED

• TREATMENT OF THE MENTAL ILLNESSESS ASSOCIATED AND IF
POSSIBLE USING COMPUTERS TO TREAT OR DELIVER WAYS OF
TREATMENT.
MENTAL ILLNESSES ASSOCIATED
• INTERNET ADDICTION
• CYBER SEX ADDICTION
• Cyber-relational addiction
• Net compulsions
• Information overload
• Computer addiction
• INTERNET GAMING ADDICTION
• CYBER BULLYING
INTERNET ADDICTION
• Black et al. described internet addiction as “compulsive computer use
that had contributed to personal distress, or social, occupational,
financial, or legal consequences.

DIFFERENT NAMES SUGGESTED

• compulsive computer use
• pathological internet use
• problematic internet use
• internet dependency
• The prevalence found by Greenfield was about 6% among the general
population, while Scherer found it to be 14% among the college-
based population.
• The addicted averaged 38.5 h/week on a computer, whereas the non-
addicted averaged 4.9 h/week
• A study on the prevalence of Internet addiction and its association with psychopathology in Indian adolescents. Available from: 
https://www.researchgate.net/publication/245030039_A_study_on_the_prevalence_of_Internet_addiction_and_its_association_with_psychopathology_in_Indian_adolescents
[accessed Mar 18 2021].
INDIAN DATA
• PREVALENCE - 0.3%–38%
(Chakraborty K, Basu D, Vijaya Kumar KG. Internet addiction: consensus, controversies, and the way ahead. East Asian Arch
Psychiatry. 2010;20(3):123–132)
• ASSOCIATED FACTORS IN INDIAN POPULATION

• MALE GENDER
• PERMANENT LOGIN STATUS
• URGE TO GET IN AN ONLINE FRIENDSHIP OR RELATIONSHIP
• LONG YEARS OF EXPOSURE TO THE INTERNET STARTING IN
EARLY ADOLESCENCE
• USING THE INTERNET FOR NONACADEMIC ACTIVITIES
WERE STRONGLY ASSOCIATED WITH INTERNET ADDICTION.
• THE ILL EFFECTS OF INTERNET ADDICTION INCLUDE
WITHDRAWAL FROM REAL-LIFE RELATIONSHIPS,
DETERIORATION IN ACADEMIC ACTIVITIES, AND A
DEPRESSED AND NERVOUS MOOD.
• ALTHOUGH ONLY 0.5% OF THE STUDY PARTICIPANTS WERE
FOUND TO BE INTERNET ADDICTS, IT WAS FOUND A HIGH
NUMBER OF STUDENTS IN THE CATEGORY OF POSSIBLE
ADDICTS (46.3%), WHICH IS ALARMING, AS WITH
INCREASING AND UNCONTROLLED INTERNET USE THEY
MAY PROGRESS TO AN ADDICTIVE STATE IN THE NEAR
FUTURE AND THUS ARE AT AN INCREASED RISK.
ACCORDING TO YOUNG ET AL. INTERNET ADDICTION IS A
BROAD TERM COVERING A WIDE VARIETY OF BEHAVIOURS
AND IMPULSE CONTROL PROBLEMS. THE FIVE SUBTYPES OF
INTERNET ADDICTION ARE AS FOLLOWS:
• 1. Cybersexual addiction: This occurs in individuals who are typically engaged in viewing, downloading and
trading online pornography or are involved in adult fantasy role-play chat rooms.
•
2. Cyber-relational addiction: This occurs in people who become overly involved in online relationships or may
engage in virtual adultery. Online relation- ships become more important than real life ones, and marital
discord and family instability may result.
•
3. Net compulsions: This subtype includes a broad category of behaviours, including online gambling, shopping
or stock trading. Significant financial losses may result, as well as relational and job disruptions.
•
4. Information overload: The World Wide Web has created a new kind of compulsive behaviour that involves
excessive web surfing and database searches. These individuals spend a disproportionate amount of time
searching for, collecting and organizing information.
•
5. Computer addiction: Most computers come equipped with pre-programmed games and people become
addicted to playing them at the cost of work performance or family obligations.
Following five diagnostic criteria are required for a diagnosis of Internet addiction:
1. Is preoccupied with the Internet (thinks about previous online activity or anticipate next online
session);
2. Needs to use the Internet with increased amounts of time in order to achieve satisfaction;
3. Has made unsuccessful efforts to control, cut back, or stop Internet use;
4. Is restless, moody, depressed, or irritable when attempting to cut down or stop Internet use;
5. Has stayed online longer than originally intended.
Additionally, at least one of the following must be present:
• Has jeopardized or risked the loss of a significant relationship, job, educational or career opportunity
because of the Internet;
• Has lied to family members, therapist, or others to conceal the extent of involvement with the Internet;
• Uses the Internet as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of
helplessness, guilt, anxiety, depression)
• Major depression
• Dysthymia
• Psychotic disorders
• Somatoform disorder
• Body-dysmorphic disorder
• Social phobia
• Obsessive–compulsive disorder
• Generalized anxiety disorder
• Panic disorder without agoraphobia Panic disorder with agoraphobia
• Substance abuse
TREATMENT
• Pharmacotherapy - SSRI trials (e.g. fluoxetine, paroxetine, sertraline)
shows favourable responses.
• Psychotherapy -
• Cognitive behavioural therapy has been modified to treat Internet
addiction. These techniques are familiar to many mental health
treatment providers and can apply not only to treating substance
misuse but also ‘nonchemical addictions’
• Young suggests the following exercises to achieve abstinence from problematic Internet:
• (i) practicing the opposite behaviour
• (ii) using external stoppers, such as a timer signalling when an Internet session should
end
• (iii) setting time limits
• (iv) setting task priorities to aid in Internet goals during each Internet session
• (v) using reminder cards (posted on the computer) with a list of the five major problems
caused by the Internet addiction, and a parallel list of the five major benefits of cutting
down on Internet use
• (vi) taking a personal inventory, whereby the therapist helps the client cultivate
alternative activities that take him/her away from the computer.
CYBER SEX ADDICTION
• Defined as any form of sexual expression accessed through the computer
or the Internet, has increased dramatically over the past few years.
• Cybersex addiction is a serious, harmful problem that can affect not only
the addict, but also his or her spouse, family, friends and employer.
• Cybersex activities include
• viewing, downloading pornography along with masturbation
• reading and writing sexually explicit letters and stories
• setting up live sex meetings
• visiting sexually oriented chat rooms
• engaging in interactive online affairs which include real-time viewing of each other
• Ongoing desire or effort to increase cyber sexual behavior
• Cyber Sexual obsession and fantasy which harms real sex life resulting
in erectile dysfunction, loss of libido.
• Severe mood changes around cyber sexual activity
• Inordinate amounts of time spent in obtaining cyber-sexual
gratification
• Neglect of important social, occupational or recreational activities
• 9-15 million people access internet daily
• Sex is the most frequently searched topic
• 38% admit to explicit sex talk with someone online.
• 31% admit to having a sexual relationship with someone
• they met online.
• 38% admit to masturbating while online
• Cybersex compulsives reported spending an average of 35-40 hours
per week online, with an average of 15-25 hours pursuing online
sexual material.
TREATMENT
• Therapists should treat the disease similarly to other sex addictions.
• Schneider (2010) notes that “initially, the addict needs to be helped to
break through the denial that a problem exists and to recognize the
impact of the behaviors on the partner and family.
• Develop strategies for dealing with sexual urges.
• Couples therapy: Maheu (2001) suggests some basic steps to help
recovering cyber addicts enhance their marriages and other
committed relationships.
• Underlying psychiatric disorders like OCD needs to be ruled out.
CYBERBULLYING
• Cyberbullying is any behavior performed through electronic or digital
media by individuals or groups that repeatedly communicates hostile
or aggressive messages intended to inflict harm or discomfort on
others.

• 1/3 children has been a victim of cyber-bullying.

• Nearly half of suicides among 10 to 14-year- olds are due to bullying.
• 1 in 7 teachers is a victim of cyber-bullying.
• Anxiety
• Depression
• Suicide
• Low Self Esteem
• Withdrawal from friends and activities
• Changes in mood, behaviour and appetite
• Emotional Distress during and after using technology
• Bullying others
Why Don’t Victims Ask for Help?
• Kids view the Internet is a lifeline to their peer group.
• Kids don’t want adults to know they have a problem with
cyberbullying because they fear that adults will take their computer
away.
How to help prevent cyberbullying?
• Block all communication with cyberbullies
• Do not forward any messages, comments, etc. that involve cyberbulling
• Always report any cyberbulling taking place to an adult
• Talk about bullying in general with friends, teachers and family.
• Discuss what personal information is appropriate to tell others, and what is
not.
• Visit some popular teen sites with your parents, teachers, or friends and
discuss what you see there and what could be a danger.
• Learn to develop realistic expectations for both personal and on-line
relationships.
INTERNET GAMING DISORDER
• CASE VIGNETTE

• “Messrs. A and B were two unmarried brothers, belonging to a nuclear family of upper socioeconomic
class of urban background of New Delhi, India. Mr. A is 19 years old, studying in 12 th standard while
Mr. B is 22 years old, studying in 2nd year of engineering in Haryana, India. The problem began when
both brothers used to stay together at home and started playing online game with their virtual
Internet friends from different countries. The duration of online gaming progressed from 2 to 4 hours
per day to 14 to 18 hours per day over the initial few months. The behavior and self-care of these
brothers became so compromised and disorganized that, while playing the games, they urinated and
defecated in their clothes, did not change clothes for days, did not bathe, skipped their meals, did not
pick up phones, or open doors even to their parents. Their home was robbed twice of cash and costly
articles in their presence, during the last 2 months while they were preoccupied in playing online
games.”

• Internet Gaming Addiction: A Technological Hazard.Sachdeva A, Verma R Int J High Risk Behav Addict. 2015 Dec; 4(4):e26359.
MASSIVELY MULTIPLAYER ONLINE
ROLE-PLAYING GAME
• Unlike others, MMORPGs have some particular characteristics.
• Those are:
• (a) Presence of a “persistent virtual world” with a huge user base. A “persistent virtual world”
is a virtual world that is independent of a user's login status; the world will exist and will be
modified in the absence of a particular user by the actions of other users who are online.
• (b) Player has the ability to create an avatar, which he/she will be able to modify according to
the needs. This includes creation of a body structure, face, attire, weapons, powers, race,
clan, gender, profession, morality, and many others.
• (c) Advancement will be rewarded by “level up” which may be an addition of skills, powers, or
unlocking of other missions.
• (d) Players are able to socially interact with fellow gamers through the in-game characters and
can form alliances to defeat their opponents.
INTERNET ADDICTION AND INTERNET GAMING
DISORDER – SAME ENTITY OR DIFFERENT?
• Internet addiction (IA) and internet gaming disorder (IGD) are not the same entity.
• Researchers out that many studies have used “the internet addiction questionnaire” or
“other nonvalidated versions of the tests to diagnose and assess the severity of online
gaming addiction.”
• According to the same report, this is possibly the reason why the Diagnostic and Statistical
Manual of Mental Disorders Fifth Edition (DSM-5) regarded IGD and IA disorder (IAD) as the
same disorder.
• The differences in demographic variables and behavioral pattern among the IGD and IAD
groups are quite significant.
• Individuals with IAD are usually males, invest a significant amount of time online doing any
kind of online activities such as social networking, chatting, watching social media including
gaming, whereas gaming disorder is specifically associated with gaming online. They
suggested that these two entities are entirely “conceptually different behaviors.”
PREVALENCE
• The prevalence of IGD varies worldwide and is estimated to be
between 0.2% and 8.5%
BEHAVIORAL ISSUES WITH
INTERNET GAMING DISORDER
• Addicted gamers experience significantly more irritability, agitation (less
calmness), sadness, and often report of confusing real life with the
virtual world.
• Researchers found a strong association between problematic gaming
and decreased psychosocial well-being and low school performance.
• They commented that, irrespective of gender, depressive mood, social
anxiety, negative self-esteem, and loneliness prevailed in gamers.
• A study on 3041 adults in Korea, which found that gamers at risk of
addiction are impulsive, exhibit more aggression than healthy controls,
and there is a 5 times more risk of attempted suicide in them
Characteristics and Psychiatric Symptoms of Internet Gaming Disorder among Adults Using Self-Reported DSM-5 Criteria.Kim NR, Hwang SS, Choi JS, Kim DJ,
Demetrovics Z, Király O, Nagygyörgy K, Griffiths MD, Hyun SY, Youn HC, Choi SW Psychiatry Investig. 2016 Jan; 13(1):58-66.
PREVENTION AND TREATMENT
• Griffiths et al.'s recommendation for prevention of internet gaming
addiction
Online support forums
• Computer Gaming Addicts Anonymous (
http://cgaa.info/discussion-forum/) and
• On-Line Gamers Anonymous (http://www.olganon.org/home)
The approach is mainly based heavily on the 12-step program of
recovery (honesty and acceptance, hope, faith or trust, action and
courage, integrity, willingness, humility, love, justice, perseverance,
spirituality or beauty, and service) used by such groups as Alcoholics
Anonymous and Gamblers Anonymous.
• Cognitive behavior therapy
• Motivational Interviewing
• Treatment with the self-discovery camp
• Components of therapy regimen
• 14 sessions of CBT by psychologists
• Three medical lectures by doctors
• Eight sessions of personal counseling
• One workshop
• Outdoor activities such as cooking, walk rally, trekking, and woodworking.
• Objective of self-discovery camp
• To foster awareness of health, wellness, and a well-regulated life
• To experience communication without the Internet or digital devices
• To collaborate with others and solve problems.
THANK
YOU