Expert highlights interventions for OCD-linked internet, gaming, sex addictions

Excessive behaviors related to internet, gaming and sex that may be linked to obsessive-compulsive disorder lack a clear treatment approach and thus warrant consideration of various factors, according to a presenter at Psych Congress.

“There's no set criteria for [these disorders], they don't technically exist in the DSM-5, and there are no FDA-approved medication treatments or even first-line psychotherapy treatments,” Jon E. Grant, MD, MPH, a professor of psychiatry and behavioral neuroscience at the University of Chicago, said during a virtual presentation.

Because of the lack of clear treatment options for these excessive behaviors, Grant highlighted the afforded flexibility in terms of treatment approach. Screening questions included the following: “Has there ever been a behavior, urge or thought that you may have enjoyed but felt you could not control that caused problems for you?” and, “Did these behaviors or urges or thoughts have an effect on your life or bother you?”

Sparse data have shown that a form of cognitive behavioral therapy, often involving motivational interviewing or motivational enhancement techniques, may be beneficial, according to Grant. For adolescents, family therapy added to the therapy may provide benefit. However, the ideal treatment length for CBT remains unknown, Grant noted. Reduction is often easier to achieve than abstinence, Grant said.

“It's absurd to think that [people] will not be on the internet, and it's absurd to think people aren't going to have sex,” Grant said. “Maybe gaming is a little bit easier, because you can kind of imagine a life without gaming in it, but the other two are much harder in terms of an abstinence model. Part of [treatment] is carving out what the client feels are healthy internet behaviors and healthy sexual behaviors that are not out of control vs. the ones that are and trying to shift the energy toward the healthier options.”

Other interventions that may benefit patients with these behaviors include imaginal exposure, 12-step programs and pharmacotherapies, such as selective serotonin reuptake inhibitors, opioid antagonists, n-acetyl cysteine and memantine.