Transcript 14804955751_김연진x

인터넷 중독이란?:
Brief introduction to the concept of internet addiction
서울특별시 보라매병원
정신건강의학과
김연진
2016. 11. 14
Contents
Current situation due to internet addiction
Concept of internet addiction
Issues with identifying diagnostic criteria
Debates and future works
“
Internet gaming disorder (IGD)
Persistent and recurrent use of the Internet to engage in games,
often with other players, leading to clinically significant impairment or
distress
”
Why on public health issue?
 With Increasing use of internet-based technologies, some
adverse health consequences are documented
 Children and adolescents have particular high levels of exposure
 Rapidly developing communication and gaming opportunities
present new challenges for public health
 Limited knowledge on the impact on physical and psychosocial
development
 Acknowledgment of specific disorders due to excessive use of
Internet and electronic gaming and communication platforms
 High profile cases in many countries contributing to a “moral panic”
Social implications
중국
미국
부모가 PC방에서 게임을 할
비용을 마련하기 위해 세 명의
자녀를 팔아 넘김(2006)
10대 남자가 게임에 나오는
캐릭터를 모방하여 친구에게 불을
지름(2009)
유럽
영국에서 24세 남자가 86시간
연속 게임을 하던 중 사망함(2011)
16세 남자가 부모님이 게임
프로그램을 압수하자 부모를
총으로 쏘아 살해함(2007)
22세 여자가 아기가 울자 게임에
방해가 된다는 이유로
살해함(2010)
불 난 PC방
- 대피하라는 말에도
꿋꿋하게 계속 게임 중
한국
10대 남자가 50시간 연속 게임을
하던 중 사망함(2005)
부모가 PC방에서 게임을 하는
동안 영아를 굶겨서 사망함(2010)
16. Nov. 2010 MBC News
A middle school student, "A",
committed suicide after murdering
his mother. He was seriously
addicted to games, and this murder case
shows how critical game
addiction can be these days.
On November 15, one day before the murder, "
A" had a fight with his mother
Over playing internet games too much. The ver
y next day, his mother was found dead on the b
ed and "A" committed suicide
after leaving a note that says "I committed a
murder of my own mother for scolding
me over playing internet games, which I
never should have done. I am so sorry..."
2014 Prevalence of Internet addiction in Korea
(2014년 인터넷중독 실태 조사, 2015, 미래창조과학부)
7
2014 Prevalence of Internet addiction in Korea
(2014년 인터넷중독 실태 조사, 2015, 미래창조과학부)
8
중독 증상의 특징
내성
같은 정도의 만족감을 느끼기 위해 어떤 행위를 위해 점점 더 많은 시간이나 양
이 필요
금단
어떤 행위를 하지 않거나 갑자기 줄이면 불쾌감, 불안, 짜증, 불면 등의 증상이
생김
기분 변화
조절 실패
9
중독 증상의 발전
호기심/스트레스로 시작
“어!! 재미있네
“스트레스가 좀 풀리는 것
같어”
빈도의 증가
탐닉
금단
남용
안 하면 힘들어짐
집착
부작용이 두드러짐
문제 행동 시작
거짓말
신체적, 정신적, 대인관계
문제
몰래 숨기고 행동
경제적 문제
의존 증가
Boundary of “addiction”
 Impaired control over substance use behaviour
A.
Compulsion to seek and to take the drug
B. Loss of control in limiting intake
C. Emergence of a negative emotional state when access to
the drug is prevented
Behavioral addiction
Neuroadaptation
“chronic addiction”
DJ Kuss, MD griffins, 2012
Behavioral addiction
Mobile Addiction & Internet
Addiction
 Behavioral addiction model
 Technological addiction model
 Human-machine interaction and is non-chemical in nature
Internet addiction
Mobile addiction
Male (young)
Female (young)
Introversion
Extroversion
Low self confidence
Low self confidence
anonymity
real name
FY Hong, SI Chiu, DH Huang , 2012
Internet gaming addiction
4 factors of IGA
Environment
Lack of alternative entertainment
activities/ sound information culture
Internet
Interactive, instant, anonymous feature
Personal character
Poor relationship family, Lack of selfcontrol/self-respect
Psychology
Sense of alienation, helplessness,
loneliness, depression
H Xiuqin, Z Huimin, L Mengchen, W Jinan, Z Ying, 2010
Interaction of individual and environmental factor
(인터넷.게임 중독의 공중보건학적 모델개발 및 페해실태조사 종합결과 보고서, 2016)
Impact of physical health
 Physical inactivity, poor diet
 Eye and Vision symptoms due to prolonged screen
exposure
 Musculoskeletal problems due to prolonged use of
electronic screen products
 Hearing damage due to high volume audio entertainment
Impact of psychosocial functioning and development
 Cyber-bullying
 Hindering social skill development
 Sleep deprivation
 Risky sexual and aggressive behaviors
 Reduced work and academic performances
 Family problems
 Impact on the overall well-being
 Disorders of regulation of gaming and use of Internet
In the research field
 So many synonyms
A.
Problematic internet use
B.
Pathological internet gaming
C.
Internet addiction
D.
Excessive internet use
E.
Internet gaming disorder
Various form of “internet addiction”
 So many common internet activities
A.
Online chatting
B. Web-surfing and shopping
C. Cybersex and porn
D. Bidding on online auction
E.
Online gaming
Internet gaming disorder
DSM-5 in Section 3 (Conditions for Further study)
Internet Gaming Disorder (IGD)
Persistent and recurrent use of the Internet to engage in games, often with others players,
leading to clinically significant impairment or distress as indicated by five (or more) of the
following in a 12-month period.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Preoccupation with Internet games
Withdrawal symptoms
Tolerance
Unsuccessful attempts to control the participation in Internet games
Loss of interests in previous hobbies and entertainment as a result of, and with the
exception of, Internet games
Continued excessive use of Internet games despite knowledge of psychosocial problems
Has deceived family members, therapists, or others regarding the amount of Internet
gaming
Use of Internet games to escape or relieve a negative mood
Has jeopardized or lost a significant relationship, job, or educational or career opportunity
because of participation in Internet games
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Internet gaming disorder
DSM-5 in Section 3 (Conditions for Further study)
1.
Preoccupation with Internet games : 인터넷 게임에 몰두(일상생활의 주요 활동이 인터넷 게
임)-당신은 게임을 하고 있지 않을 때에도 게임을 생각하거나 이 다음에 언제 게임을 할 수 있을
지 계획을 세우는 데 많은 시간을 보냅니까?
2.
Withdrawal symptoms: 금단(짜증, 불안, 슬픔 등/약물금단의 징후는 없음)-게임시간을 줄이려고
시도하거나, 게임을 중단하거나, 혹은 할 수 없을 때에 당신은 무기력증, 짜증, 우울, 화남, 걱정,
슬픔 등의 감정을 느끼나요?
3.
Tolerance : 내성(인터넷 게임 시간의 증가)-게임에서 얻던 흥분 혹은 재미를 유지하기 위해 당신
은 게임하는 시간을 늘리거나, 더욱 신나는 게임을 하거나, 혹은 더 강력한 장비가 필요하다고 느
끼나요?
Unsuccessful attempts to control the participation in Internet games : 인터넷 게임 통제 실패
-당신은 게임을 더 적게 해야한다고 느끼지만, 게임하는 시간을 줄일 수가 없나요?
4.
5.
Loss of interests in previous hobbies and entertainment as a result of, and with the
exception of, Internet games : 기존의 취미와 오락에 대한 관심 상실-당신은 게임때문에 다른
여가활동 (취미, 친구 만나기) 참여에 흥미를 잃거나 참여가 줄었나요?
22
Internet gaming disorder
DSM-5 in Section 3 (Conditions for Further study)
6.
7.
Continued excessive use of Internet games despite knowledge of psychosocial problems:
인터넷 게임 통제 실패-당신은 게임을 더 적게 해야한다고 느끼지만, 게임하는 시간을 줄일 수가
없나요?
Has deceived family members, therapists, or others regarding the amount of Internet
gaming : 당신은 가족, 친구 혹은 다른 이들에게 당신이 어느 정도 게임을 하는 지에 대해 거짓말
하거나, 혹은 그들이 모르게 하려고 하나요?
8.
Use of Internet games to escape or relieve a negative mood : :불쾌한 기분(예, 무기력감, 죄책
감, 불안 등)의 완화 또는 회피 수단
9.
Has jeopardized or lost a significant relationship, job, or educational or career opportunity
because of participation in Internet games : 대인관계적, 교육적, 직업적 기회의 감소 또는 상실
-당신은 게임 때문에 중요한 관계, 직업, 혹은 학업이나 경력에서 중요한 기회를 잃거나, 혹은 잃
을 위험을 감수하나요?
23
“Behavioral addictions” in the draft of ICD-11
 Introduction of a section “Disorders due to substance use and
addictive behaviors” in Chap 7
 Conceptual integration of “Gambling disorder” with disorders
due to substance use(in ICD 10- under “impulse control
disorders”)
 Introduction of a new diagnostic category “Gaming disorder”
 Two sub-types for gambling and gaming disorder
A.
Gaming disorder, predominantly online
B.
Gaming disorder, predominantly offline
ICD-11 ?
Disorders due
to substance
use or addictive
behaviors
Disorders due
to substance
use
alcohol
Nicotine…
Disorders due
to addictive
behaviors
Gambling
Disorder
Gaming
Disorder
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ICD-11 ?
Definition
Gaming disorder : a persistent or recurrent gaming behaviour (i.e., ‘digital
gaming’ or ‘video-gaming’)
-an impaired control over gaming,
-increasing priority given to gaming over other activities to the extent that
gaming takes precedence over other interests and daily activities and
continuation of gaming despite the occurrence of negative consequences.
-The behaviour pattern is of sufficient severity to result in significant
impairment in personal, family, social, educational, occupational or other
important areas of functioning.
-These features and the underlying pattern of gaming are normally evident over
a period of at least 12 months in order for a diagnosis to be assigned,
although the required duration may be shortened if all diagnostic requirements
are met and symptoms are severe.
High level of co-occuracnce
 인터넷중독(N=1,641)에서의 정신과적 공존질환 조사
인터넷 중독은 4개 정신질환에서 모두 높은 비율의 유병율
•Ho RC, Zhang MW, Tsang TY, Toh AH, Pan F, Lu Y, et al. The association between internet
addiction and psychiatric co-morbidity: a meta-analysis. BMC psychiatry. 2014; 14(1): 1.
High level of co-occuracnce
 인터넷 중독: 높은 스트레스, 낮은 삶의 질
인터넷 중독군은 정상 대조군에 비해 주관적 삶의 질을 평가하는
모든 하위 척도에서 삶의 질 저하를 보고함.
• 출처 : Suh SW GA, Lim JA, Lee JY, Park SM, Lee JY, Jung HY, Choi JS, et al. Quality
of life and psychosocial well-being in internet gaming disorder: a comparison with
alcohol-dependent and healthy control groups. J Korean Academy of Addiction
Psychiatry. 2015; 19(1): 29-34.
Debates and future works
• Establishment of diagnostic criteria as a formal disorder
• Classification of internet addiction by its contents
• 인터넷게임 중독에 대한 포괄적 이해를 통한 문제 접근
– 미시(개인), 중범위(가족, 학교), 거시(지역, 정책 등)적 수준의 요인
– 공중보건학적 관점(개인, 매체, 환경)
• Identify neurobiological basis and diagnostic marker
• Identify risk & protective factors associated with
problematic/ at-risk internet using problems, especially
during developmental processes
Thank you for your attention