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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
Not only are there significant health risks associated with compulsive hoarding, but scientists are also trying to pinpoint how significant the interference is with occupational and social functioning in a hoarder's daily life. In a pool of compulsive hoarders, 42% found their behavior problematic to the 63% of their family and friends who saw the behavior as problematic. The findings suggest that individuals who hoard may exhibit impaired sensitivity to their own and others’ emotions, and conversely, relate the world around them by forming attachments to possessions rather than to people. Lower emotional intelligence among hoarding patients may also impact their ability to discard and organize their possessions. With such detrimental characteristics, comprehensive research has been performed to find a cure. Although this is ongoing research, most investigations have found that only a third of patients who hoard show an adequate response to these medications and therapeutic interventions.
With the modifications to the DSM, insurance coverage for treatments will change as well as special education programs.
Since people buying more than they need is usual and accepted, even the most excessive behaviour takes a long time before being considered pathological. Shopping addiction generally manifests between 20–30 years old,
but is not usually detected until several years after, when the addiction has led the person to ruin and bankrupt.
There are usually two stages in coping with the problem. First, people around the addict or the health or social services detect the problem and try to treat it. When, because of the seriousness of the case, it is not possible to solve it in this way, specialised professionals, such as psychologist or psychiatrics, take part. The diagnosis and evaluation of shopping addiction is based on the analysis of confirmed behaviours and their consequences. Specific tests or questionnaires, as the FACC-II (Questionnaire on the psychological aspects of consumer addiction, debt and personal spending habits) are also used. These specific questionnaires or tests are useful in the diagnosis and evaluation of shopping addiction problems, and to drive the therapies in a proper way. FACC-II is one of the most specific and widest. The Edwards Scale is another approach which measures the tendency to compulsively buy. All these resources, as well as personal interviews of the addict and people who surround them, reports and other documents, enable knowledge of when people buy, what they buy and the methods of payment used.
A study done in 1995 of 811 university students in the United States found 5.2% of that population had results indicating they were talkaholics. A similar study from the same year with students from New Zealand found similar results, with 4.7% scoring above 40.
The most common instrument used to screen for "probable pathological gambling" behavior is the South Oaks Gambling Screen (SOGS) developed by Lesieur and Blume (1987) at the South Oaks Hospital in New York City. In recent years the use of SOGS has declined due to a number of criticisms, including that it overestimates false positives (Battersby, Tolchard, Thomas & Esterman, 2002).
The "DSM-IV" diagnostic criteria presented as a checklist is an alternative to SOGS, it focuses on the psychological motivations underpinning problem gambling and was developed by the American Psychiatric Association. It consists of ten diagnostic criteria. One frequently used screening measure based upon the DSM-IV criteria is the National Opinion Research Center DSM Screen for Gambling Problems (NODS). The Canadian Problem Gambling Inventory (CPGI) and the Victorian Gambling Screen (VGS) are newer assessment measures. The Problem Gambling Severity Index, which focuses on the harms associated with problem gambling, is composed of nine items from the longer CPGI. The VGS is also harm based and includes 15 items. The VGS has proven validity and reliability in population studies as well as Adolescents and clinic gamblers.
In 1993 James C. McCroskey and Virginia P. Richmond constructed the Talkaholic Scale, a Likert-type model, to help identify those who are compulsive talkers. A score of 40 or above, which indicates two standard deviations above the norm, would signal someone to be a true talkaholic.
A short 11-question Internet game screen called the BIGS was developed by reSTART to assist in the screening of problematic video game and Internet use.
Screening for problematic use in individuals due the ever-changing digital landscape. Researchers Northrup, Lapierre, Kirk and Rae developers of the Internet Process Addiction Test (IPAT) propose that tools measure different processes utilized over the Internet, such as video game play, social networking, sexual activity and web surfing, may be more helpful than a measure of Internet addiction itself, as the Internet is simply a medium which facilities a variety of interactions, some of which are highly addictive, and others less so.
Different assessment tools can be used to determine if an individual is addicted to exercise. Most tools used to determine risk for exercise addiction are modified tools that have been used for assessing other behavioral addictions. Tools for determining eating disorders can also show a high risk for exercise addiction.
The Obligatory Exercise Questionnaire was created by Thompson and Pasman in 1991, consisting of 20 questions on exercise habits and attitudes toward exercise and body image. Patients respond to statements on a scale of 1 (never) to 4 (always). This questionnaire aided in the development of another assessment tool, the Exercise Addiction Inventory.
The Exercise Addiction Inventory was developed by Terry "et al" in 2004. This inventory was developed as a self-report to examine an individual's beliefs toward exercise. The inventory is made up of six statements in relation to the perception of exercise, concerning: the importance of exercise to the individual, relationship conflicts due to exercise, how mood changes with exercise, the amount of time spent exercising, the outcome of missing a workout, and the effects of decreasing physical activity. Individuals are asked to rate each statement from 1 (strongly disagree) to 5 (strongly agree). If an individual scores above 24 they are said to be at-risk for exercise addiction.
Formal diagnosis may be performed by a psychologist, psychiatrist, clinical social worker, or other licensed mental health professional. To be diagnosed with OCD, a person must have obsessions, compulsions, or both, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). The Quick Reference to the 2000 edition of the DSM states that several features characterize clinically significant obsessions and compulsions. Such obsessions, the DSM says, are recurrent and persistent thoughts, impulses or images that are experienced as intrusive and that cause marked anxiety or distress. These thoughts, impulses or images are of a degree or type that lies outside the normal range of worries about conventional problems. A person may attempt to ignore or suppress such obsessions, or to neutralize them with some other thought or action, and will tend to recognize the obsessions as idiosyncratic or irrational.
Compulsions become clinically significant when a person feels driven to perform them in response to an obsession, or according to rules that must be applied rigidly, and when the person consequently feels or causes significant distress. Therefore, while many people who do not suffer from OCD may perform actions often associated with OCD (such as ordering items in a pantry by height), the distinction with clinically significant OCD lies in the fact that the person who suffers from OCD "must" perform these actions, otherwise they will experience significant psychological distress. These behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these activities are not logically or practically connected to the issue, or they are excessive. In addition, at some point during the course of the disorder, the individual must realize that their obsessions or compulsions are unreasonable or excessive.
Moreover, the obsessions or compulsions must be time-consuming (taking up more than one hour per day) or cause impairment in social, occupational or scholastic functioning. It is helpful to quantify the severity of symptoms and impairment before and during treatment for OCD. In addition to the peron's estimate of the time spent each day harboring obsessive-compulsive thoughts or behaviors, concrete tools can be used to gauge the people’s condition. This may be done with rating scales, such as the Yale–Brown Obsessive Compulsive Scale (Y-BOCS). With measurements like these, psychiatric consultation can be more appropriately determined because it has been standardized.
OCD is sometimes placed in a group of disorders called the obsessive–compulsive spectrum.
The inclusion of this problem in the obsessive-compulsive disorders and its relation with depression has led to some use of antidepressants as a treatment. Within antidepressant drugs, special attention has been paid to those related to serotonin, a brain neurotransmitter. This substance is supposed to be related to deficiencies in stimulus control, so that medicines like fluoxetine and fluvoxamine, which raise the level of serotonin in the brain, would be a pharmacological alternative to treat shopping addiction. Even though results are not conclusive, in the nineties some research was carried out which supported the effectiveness of tese treatments, at least in certain cases.
Obsessive-compulsive disorders are treated with various serotonergic antidepressants including the tricyclic antidepressant clomipramine and various SSRI medications. With existing drug therapy, OCD symptoms can be controlled, but not cured. Several of these compounds (including paroxetine, which has an FDA indication) have been tested successfully in conjunction with OCD hoarding.
Treatment is similar to that for other forms of obsessive–compulsive disorder. Exposure and response prevention (ERP), a form of behavior therapy, is widely used for OCD in general and may be promising for scrupulosity in particular. ERP is based on the idea that deliberate repeated exposure to obsessional stimuli lessens anxiety, and that avoiding rituals lowers the urge to behave compulsively. For example, with ERP a person obsessed by blasphemous thoughts while reading the Bible would practice reading the Bible. However, ERP is considerably harder to implement than with other disorders, because scrupulosity often involves spiritual issues that are not specific situations and objects. For example, ERP is not appropriate for a man obsessed by feelings that God has rejected and is punishing him. Cognitive therapy may be appropriate when ERP is not feasible. Other therapy strategies include noting contradictions between the compulsive behaviors and moral or religious teachings, and informing individuals that for centuries religious figures have suggested strategies similar to ERP. Religious counseling may be an additional way to readjust beliefs associated with the disorder, though it may also stimulate greater anxiety.
Little evidence is available on the use of medications to treat scrupulosity. Although serotonergic medications are often used to treat OCD, studies of pharmacologic treatment of scrupulosity in particular have produced so few results that even tentative recommendations cannot be made.
Treatment of scrupulosity in children has not been investigated to the extent it has been studied in adults, and one of the factors that makes the treatment difficult is the fine line the therapist must walk between engaging and offending the client.
Gambling self-exclusion (voluntary exclusion) programs are available in the US, the UK, Canada, Australia, South Africa, France, and other countries. They seem to help some (but not all) problem gamblers to gamble less often.
Some experts maintain that casinos in general arrange for self-exclusion programs as a public relations measure without actually helping many of those with problem gambling issues. A campaign of this type merely "deflects attention away from problematic products and industries," according to Natasha Dow Schull, a cultural anthropologist at New York University and author of the book "Addiction by Design" who was interviewed for The Fifth Estate (TV series) aired by the Canadian Broadcasting Corporation.
There is also a question as to the effectiveness of such programs, which can be difficult to enforce. In the province of Ontario, Canada, for example, the Self-Exclusion program operated by the government's Ontario Lottery and Gaming Corporation (OLG) is not effective, according to investigation conducted by the television series, revealed in late 2017. "Gambling addicts ... said that while on the ... self-exclusion list, they entered OLG properties on a regular basis" in spite of the facial recognition technology in place at the casinos, according to the Canadian Broadcasting Corporation. As well, a CBC journalist who tested the system found that he was able to enter Ontario casinos and gamble on four distinct occasions, in spite of having been registered and photographed for the self-exclusion program. An OLG spokesman provided this response when questioned by the CBC: "We provide supports to self-excluders by training our staff, by providing disincentives, by providing facial recognition, by providing our security officers to look for players. No one element is going to be foolproof because it is not designed to be foolproof".
Treatment involves becoming conscious of the addiction through studying, therapy, group work, etc...
Research done by Michel Lejoyeux and Aviv Weinstein suggests that the best possible treatment for CB is through cognitive behavioral therapy. They suggest that a patient first be "evaluated for psychiatric comorbidity, especially with depression, so that appropriate pharmacological treatment can be instituted." Their research indicates that patients who received cognitive behavioral therapy over 10 weeks had reduced episodes of compulsive buying and spent less time shopping as opposed to patients who did not receive this treatment (251).
Lejoyeux and Weinstein also write about pharmacological treatment and studies that question the use of drugs on CB. They declare "Few controlled studies have assessed the effects of pharmacological treatment on compulsive buying, and none have shown any medication to be effective" (252). The most effective treatment is to attend therapy and group work in order to prevent continuation of this addiction.
Selective serotonin reuptake inhibitors such as fluvoxamine and citalopram may be useful in the treatment of CBD, although current evidence is mixed. Opioid antagonists such as naltrexone and nalmefene are promising potential treatments for CBD. A review concluded that evidence is limited and insufficient to support their use at present, however. Naltrexone and nalmefene have also shown effectiveness in the treatment of gambling addiction, an associated disorder.
Theodore Millon identified five subtypes of the compulsive personality (2004). Any compulsive personality may exhibit one or more of the following:
Impulse-control disorders have two treatment options: psychosocial and pharmacological. Treatment methodology is informed by the presence of comorbid conditions.
The prevalence of scrupulosity is speculative. Available data do not permit reliable estimates, and available analyses mostly disregard associations with age or with gender, and have not reliably addressed associations with geography or ethnicity. Available data suggest that the prevalence of obsessive–compulsive disorder does not differ by culture, except where prevalence rates differ for all psychiatric disorders. No association between OCD and depth of religious beliefs has been demonstrated, although data are scarce. There are large regional differences in the percentage of OCD patients who have religious obsessions or compulsions, ranging from 0–7% in countries like the U.K. and Singapore, to 40–60% in traditional Muslim and orthodox Jewish populations.
The consequences of oniomania, which may persist long after a spree, can be devastating, with marriages, long-term relationships, and jobs all feeling the strain. Further problems can include ruined credit history, theft or defalcation of money, defaulted loans, general financial trouble and in some cases bankruptcy or extreme debt, as well as anxiety and a sense of life spiraling out of control. The resulting stress can lead to physical health problems and ruined relationships, or even suicide.
OCD is often confused with the separate condition obsessive–compulsive personality disorder (OCPD). OCD is egodystonic, meaning that the disorder is incompatible with the sufferer's self-concept. Because ego dystonic disorders go against a person's self-concept, they tend to cause much distress. OCPD, on the other hand, is egosyntonic—marked by the person's acceptance that the characteristics and behaviours displayed as a result are compatible with their self-image, or are otherwise appropriate, correct or reasonable.
As a result, people with OCD are often aware that their behavior is not rational, are unhappy about their obsessions but nevertheless feel compelled by them. By contrast people with OCPD are not aware of anything abnormal; they will readily explain why their actions are rational, it is usually impossible to convince them otherwise, and they tend to derive pleasure from their obsessions or compulsions.
A lot of studies and surveys are being conducted to measure the extent of this type of addiction. Dr.Kimberly S. Young has created s questionnaire based on other disorders to assess the level of addiction. It is called the Internet Addict Diagnostic Questionnaire or IADQ. Answering positively to five out of the eight questions may be indicative of an online addiction.
Kimberly Young indicates that previous research links internet/computer addiction with existing mental health issues, most notably depression. She states that computer addiction has significant effects socially such as low self-esteem, psychologically and occupationally which led many subjects to academic failure.
According to a Korean study on internet/computer addiction, pathological use of the internet results in negative life impacts such as job loss, marriage breakdown, financial debt, and academic failure. 70% of internet users in Korea are reported to play online games, 18% of which are diagnosed as game addicts which relates to internet/computer addiction. The authors of the article conducted a study using Kimberly Young's questionnaire. The study showed that the majority of those who met the requirements of internet/computer addiction suffered from interpersonal difficulties and stress and that those addicted to online games specifically responded that they hoped to avoid reality.
Diagnostic criteria have been proposed for ORS:
- Persistent (> six months), false belief that one emits an offensive odor, which is not perceived by others. There may be degrees of insight (i.e. the belief may or may not be of delusional intensity).
- This pre-occupation causes clinically significant distress (depression, anxiety, shame), social and occupational disability, or may be time-consuming (i.e. preoccupies the individual at least one hour per day).
- The belief is not a symptom of schizophrenia or other psychotic disorder, and not due to the effects of medication or recreational drug abuse, or any other general medical condition.
Compulsive talking goes beyond the bounds of what is considered to be a socially acceptable amount of talking. The two main factors in determining if someone is a compulsive talker are talking in a continuous manner, only stopping when the other person starts talking, and others perceiving their talking as a problem. Personality traits that have been positively linked to this compulsion include assertiveness, willingness to communicate, self-perceived communication competence, and neuroticism. Studies have shown that most people who are talkaholics are aware of the amount of talking they do, are unable to stop, and do not see it as a problem.
Cash, Rae and Winkler, in a paper titled "Internet Addiction: A brief summary of research and practice", describe early interventions used in the treatment of Internet addiction (IAD), and Internet Gaming Disorder (IGD).
Cognitive Behavior Therapy is designed to help individuals learn how to control their thoughts and feelings. This control is to prevent harmful functions that may trigger impulses to escape into the virtual world. The therapy is setup for three stages. The first stage is to instruct the patient to identify there is a problem and how much a problem computers are creating. Identification is done by using a log to document duration, events, day, of online activity. This can be used to show in black and white how much time is spent online and to help create a realistic goal for patients to strive for. Using this log the patients interact with a therapist to make a schedule for online activity to promote new healthier habits. The second aspect of the treatment program is more for the cognitive aspect, as in, digging into what triggers the excessive online activity. The third phase is to confront or resolve the issues in the patient's life that lead to them seeking escape things via the Internet.
One source states that a major reason the Internet is so appealing is the lack of limits and the absence of accountability.
Professionals generally agree that, for Internet overuse, controlled use is a more practical goal than total abstinence.
Families in the People's Republic of China have turned to unlicensed training camps that offer to "wean" their children, often in their teens, from overuse of the Internet. The training camps have been associated with the death of at least one youth. In November 2009, the government of the People's Republic of China banned physical punishment to "wean" teens from the Internet. Electro-shock therapy had already been banned.
In August 2013, researchers at the MIT Media Lab developed a USB-connected keyboard accessory that would "punish" users – with a small electric jolt – who spent too much time on a particular website.
In July 2014, an internet de-addiction center was started in Delhi, the capital city of India by a non profit organization, Uday Foundation. The Foundation provides counseling to the children and teens with internet addiction disorder.
In August 2009, "ReSTART", a United States-based residential treatment center for "problematic digital media use, internet addiction, and video game addiction", opened near Seattle, Washington, United States. It offers a 7- to 12-week intensive program for adolescents and adults intended to help people set device limits, and address digital distractions.
In 2005, Professor Kiesler called Internet addiction a fad illness. In her view, she said, television addiction is worse. She added that she was completing a study of heavy Internet users, which showed the majority had sharply reduced their time on the computer over the course of a year, indicating that even problematic use was self-corrective.
Compulsive decluttering is a pattern of behavior that is characterized by an excessive desire to discard objects in one's home and living areas. Other terms for such behavior includes obsessive compulsive spartanism. The homes of compulsive declutterers are often empty. It is the antonym of compulsive hoarding.
The fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5), a widely used manual for diagnosing mental disorders, defines obsessive–compulsive personality disorder (in Axis II Cluster C) as an extensive pattern of preoccupation with perfectionism, orderliness, and interpersonal and mental control, at the cost of efficiency, flexibility and openness. Symptoms must appear by early adulthood and in multiple contexts. At least four of the following should be present:
1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.
2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).
3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).
4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).
5. Is unable to discard worn-out or worthless objects even when they have no sentimental value.
6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.
7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.
8. Shows rigidity and stubbornness.