Cognitive Impairment and Problematic Internet Use

What is it about?

The authors state on page 8 that “Given that there are sufficient theoretically and empirically based similarities to established addictive disorders, further specific types of Problematic Usage of the Internet (PUI) may be classified as “other specified disorders due to addictive behaviors”. Currently, a broad consensus for further types of PUI that could be classified in this category exists for (the online manifestations of) problematic pornography use, problematic buying-shopping, and problematic social network use”. While the authors present a consensus among main experts in this area, the scientific evidence is not conclusive and these disorders are not classified as addictive behaviors according to DSM-5 (1) and ICD-11 (2). There is strong evidence that Internet Gaming Disorder (IGD) resembles drug and behavioral addictions in its cognitive and brain mechanisms (3, 4). There is further evidence that the brain mechanisms underlying compulsive sexual behavior (CSB) resemble those of behavioral and substance addictions (5). However, there are controversial findings regarding any impairment in cognitive function especially executive function in CSB. Reid et al. (6) argued that individuals with CSB show in general self-control at work, relationships, etc. but act impulsively in particular situations in response to sexual stimuli that have pleasurable value or salience. Several studies show negative findings of impairment in executive function in CSB and have led us to argue that the contradictory evidence for attentional and cognitive measures of impulsivity in CSB and online pornography users merits further investigation using cognitive tasks that require response to sexual stimuli in order to assess the various components of impulsivity in CSB and online pornography use (7). The lack of rigor scientific evidence raised our doubts as well as others whether compulsive sexual behavior (CSB) should be considered as a behavioral addiction (8). The ICD-11 currently considers problematic pornography use as a type of compulsive sexual behavior disorder, categorized as impulse control disorder not a behavioral addiction. Regarding compulsive buying disorder (BSD), we share the argument raised by Müller et al., (9) that BSD should be classified as a behavioral addiction, based on both research data and on long-standing clinical experience. However, as the authors stated, BSD is currently considered as other specified impulse control disorder not a behavioral addiction. Examination of the research in this area does not indicate strong evidence for an impairment of executive function in BSD. Few studies have shown lack of evidence or conflicting evidence for impairment of delay discounting, Stroop, trail making, IGT, Go No Go and stop signal tasks in individuals with BSD (10). These findings led Thomas et al., (10) to conclude that future research is required to systematically examine affective and cognitive interactions in compulsive BSD”. Finally, regarding excessive social media use, there are very few studies investigating cognitive function in this area, which led us to conclude that there is little evidence for cognitive impairments, but there is some preliminary event-related potentials (ERPs) evidence for inefficiency in allocating and monitoring resources and inhibitory control (11). Additionally, symptom severity of problematic SNS use correlated with attentional impulsivity but not with executive function or inhibitory control of SNS-related cues (12). The research reviewed so far, implies that in the areas of problematic pornography use, CBS and problematic SNS use, there is little convincing evidence for impairment in cognitive, particularly executive function abilities. Furthermore, there may be differences in the personality and emotional profiles of the 4 types of Internet users. Although using the internet excessively may be common to all, these are quite different behaviors. Those who use excessively computer games may not be similar in their personality and emotional responses to excessive pornography users, compulsive buyers or those with excessive SNS use. For example, there is evidence that IGD users are impulsive, sensation-seeking and risk-taking individuals (13), and those with excessive pornography use may share a combined mechanism of loss of interest or boredom from neutral stimuli, and seeking after novelty in sexuality just as in other domains of life (8). Those with BDS on the other hand, may incline more towards compulsivity and relief from negative affect as a motivation for buying (14). One of the reasons why compulsive buying was not included as a separate cat¬egory or as a behavioral addiction in the American Psychiatric Asso¬ciation’s DSM-5 (1) or the ICD-10 (15) was the lack of sufficient data, and overlap with other psychiatric disorders such as obsessive–compulsive disorders (OCDs), anxiety, and or depression. Those with excessive SNS use are characterized by the personality traits of conscientiousness, agreeableness and neuroticism (“Fear of Missing Out” FOMO) (11). Hence, in addition to the lack of convincing evidence for cognitive impairment in all 4 types of Internet use, there are also differences in personality and emotional profiles. Still, our critique is not against the grouping of these disorders as impulse control disorders that resemble behavioral addiction. Our claim is that the grouping them together is based on an assumption of neuro-cognitive homogeneity. Rather than comparing the 4 behaviors in neuro-cognitive function, the study divides the whole sample into pathological, risky, and non-problematic use of the internet. In our view, the research on these disorders shows that some disorders like IGD have strong evidence for a neuro-cognitive and particularly executive function impairment, such as IGD, whereas CSB, BSD and problematic SNS use do not show strong evidence for that. Furthermore, the 4 types of behaviors are not homogenous in terms of emotional or personality dimensions. In this case when you average responses for all types of internet use you may mask the differences between the various types of behavior. Our prediction is that the main cognitive impairment would be found in IGD, whereas CBS and CSB would show moderate effects and SNS would show no detrimental effects on cognitive function. The results reported by Müller et al., reflect an average between all types, which may mask their differences. Our recommendation would be to analyze the 4 types separately and to compare cognitive function between IGD, CSB, BSD and SNS users. It should enable us to learn what is different between the four types of behaviors and better explain the overall average, a worthwhile aim in our view. . References (1) American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) https://doi.org/10.1176/appi.books.9780890425596. (2) World Health Organization. (2019). International statistical classification of diseases and related health problems (11th ed.) https://icd.who.int. (3) Weinstein A, Livny A, Weizman: New developments in brain research of internet and gaming disorder. Neurosci Biobehav Rev 2017; 75:314-330. (4) Weinstein A, Lejoyeux M: Neurobiological mechanisms underlying Internet and Gaming Disorder (IGD). Dialogues Clin Neurosci 2020; 22(2): 113-126. doi:10.31887/DCNS.2020.22.2/aweinstein. (5) Voon V, Mole TB, Banca P, Porter L, Morris L, Mitchell S, Lapa TR, Karr J, Harrison NA, Potenza MN, Irvine M. Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours. PLoS One 2014; 9(7):e102419. doi: 10.1371/journal.pone.0102419. (6) Reid RC, Berlin HA, & Kingston DA: Sexual impulsivity in hypersexual men. Curr Behav Neurosci Rep 2015; 2: 1-8. https://doi.org/10.1007/s40473-015-0034-5. (7) Sassover E, Weinstein A: Compulsive sexual behavior disorder and impulsivity In Yuliya Richard, Ahmed Moustafa Eds: “The Psychology and Neuroscience of Impulsivity” Elsevier Masson Publishers, 2024. (8) Sassover E, Weinstein A: Should compulsive sexual behavior (CSB) be considered as a behavioral addiction? A debate paper presenting the opposing view. J Behav Addict 2020; 11(2):166–79. doi: 10.1556/2006.2020.00055. (9) Müller A, Brand M, Claes L, Demetrovics Z, de Zwaan M, Fernández-Aranda F, Frost RO, Jimenez-Murcia S, Lejoyeux M, Steins-Loeber S, Mitchell JE, Moulding R, Nedeljkovic M, Trotzke P, Weinstein A, Kyrios M: Buying-shopping disorder-is there enough evidence to support its inclusion in ICD-11? CNS Spectr. 2019; 24(4):374-379 doi: 10.1017/S1092852918001323. (10) Thomas, T.A., Joshi, M., Trotzke, P. et al. Cognitive Functions in Compulsive Buying-Shopping Disorder: a Systematic Review. Curr Behav Neurosci Rep 2023; 10: 1–19. https://doi.org/10.1007/s40473-023-00255-6 (11) Weinstein A: Problematic Social Networking Site Use- effects on mental health and the brain. Front Psychiatry 2023; 13:1106004. (12) Wegmann E, Müller SM, Turel O, Brand M: Interactions of impulsivity, general executive functions, and specific inhibitory control explain symptoms of social-networks-use disorder: an experimental study. Sci Rep 2020; 10:3866. doi: 10.1038/s41598-020-60819-4 (13) Weinstein A, Ben Abu H, Timor A, Mama Y: Delay discounting, impulsivity and rejection sensitivity among individuals with Internet Gaming Disorder. J Behav Addict 2016; 5(4): 674–682. (14) Weinstein A, Maraz A, Griffiths MD, Lejoyeaux M, Demetrovics Z Compulsive buying—Features and Characteristics of Addiction (2016). In "The Neuropathology of Drug Addictions and Substance Misuse" Preedy Victor (editor) 2016 pp 993-1007 Elsevier Academic Press USA. (15) World Health Organization. (2016). International statistical classification of diseases and related health problems (10th ed.) https://icd.who.int/browse10/2016/en

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