A Case of Withdrawal Psychosis from Internet Addiction Disorder” (Paik, 2014)

The patient started playing in high school in a “PC Bang” (Internet Cafe) similar to this one in Korea

Journal Article Breakdown:

  • Case report published by Korean Neuropsychiatric Association 2014.
  •  25-year-old Korean male was admitted to a psychiatric inpatient unit with a psychotic episode.
  • Occurred one day after discontinuing his Internet Gaming habit.
  • Pattern of gaming eight hours a day for two years.
  • Reported somatic delusions and disorganised behavior.
  • Withdrawal symptoms described as agitation and irritability.
  • Normal brain imaging findings and laboratory tests.
  • Psychotic symptoms rapidly subsided and after four days of antipsychotic medication treatment.
  • Discharged on low dose antipsychotic maintenance.
The patient required admission to Hanyang University Guri Hospital for treatment

Weaknesses of report:
-Only one other known case report of psychosis during Internet withdrawal.
-Unclear if the actual contents of the game or the medium of which the game was played (the Internet) contributed to psychotic symptoms.
-Differential diagnosis of bipolar disorder manic episode excluded. No elevated  mood in report but patient subjectively reported “being a god,” disinhibition and irritability (all can be features of a manic episode).

Strengths of report:
-Detailed description of Gaming habit and behaviour immediately following play cessation.
-Reported tolerance, attempt to cut down, cognitive dissonance (internal conflict), disturbed sleep-wake cycle, impairment of psycho-social function.
-Normal investigations and organic/substance cause ruled out.

What were the main findings?
-Evidence of withdrawal psychosis may provide evidence that excessive Internet use may be better explained as a behavioural addiction, rather that an impulse control disorder.

The patient played the Korean version of the online game Lineage II.

Other Interesting aspects of the study:
-Online game was a source of self-esteem.
-Preferred speaking to people online than the real world.
-Auditory hallucinations reported may have been related to online characters.
-Delusions were related to technology use.
-Rapid symptom improvement and full recovery within 2 weeks.
-No further psychotic symptoms since discharge.

What can we learn from this?
-The concept of behavioural addictions such as Internet Gaming Disorder remains very controversial (Starcevic, 2013).
-This example of withdrawal psychosis following abrupt Internet Gaming cessation may give us some clues about non-substance addictions.
-Even if excessive Internet Gaming was not the cause for the psychosis, this example highlights the psychological vulnerability of individuals who may be excessively playing Internet Games.

Online gaming, more than just a battle?


Click to access pi-11-207.pdf

Paik, A., Oh, D., & Kim, D. (2014). A case of withdrawal psychosis from internet addiction disorder. Psychiatry investigation, 11(2), 207-209.

Starcevic, Vladan. “Is Internet addiction a useful concept?.” Australian and New Zealand Journal of Psychiatry 47.1 (2013): 16-19.