with the Internet is
a new behavior,
consider the
possibility that there
might be an
underlying medical cause.
The first report of Internet gambling addiction
in a patient on dopamine-agonist medications
for Parkinson’s disease was in 2005.
The patient was a 41 year-old computer
programmer with Parkinson’s disease. Soon
after reaching a therapeutic dose of the
dopamine-agonist medication he became
“consumed” with Internet gambling. He lost
$5000 in just a few months. This behavior was
entirely new and out of character for the
patient. Once the medication was discontinued,
the patient’s gambling obsession ceased--just
as suddenly as it had begun.
In 2006, Dr. Andrew Larner published another
case report entitled, “Medical Hazards of the
Internet: Gambling in Parkinson’s Disease.”
This
patient was a man in his mid-40’s with
Parkinson’s disease. After Dr. Larner increased
the patient’s dopamine-agonist medication
dosage, a behavioral change occurred. The
patient became obsessed with gambling on the
Internet. He also subscribed to several Internet
services, including a pornography site. Again,
this behavior was entirely uncharacteristic for
the patient. Because the medication change
had improved the patient’s mobility, it was only
after the patient had accrued considerable
debt that was he willing to stop taking it.
Individuals with Parkinson’s disease who are
taking dopamine-agonist medications have an
increased risk of developing an impulse control
disorder, most commonly: gambling,
compulsive sexual behavior, and/or compulsive
spending. In today’s world, the Internet may
be utilized to give expression to these impulses.
Fronto-Temporal Dementia
In 2011, Mario Mendez and Jill Shapira
published a letter in which they reported the
case of a 55 year-old man who was
compulsively addicted to Internet
pornography.
The situation was extreme. This college-
educated man had become obsessed with
Internet pornography to the point of actually
viewing pornography sites on his laptop in
public places such as restaurants. This behavior
was associated with other personality changes
and had been going on for 2 years before he
came to medical attention. This man had
fronto-temporal dementia (FTD).
Individuals with FTD start to behave in ways
that they never would have allowed of
themselves before their brain disease began to
manifest itself. The individual in this report had
started to urinate in public places and also to
masturbate excessively. He compulsively ate
sweets and gained a striking 100 lbs. He began
to wear the same clothes day after day. He
failed to inquire about his dying father.
What is remarkable and crucial for readers to
note is that this man’s memory for recent
events was excellent. Also, when he was initially
medically evaluated, his brain MRI (magnetic
resonance imaging) was unremarkable.
Evidence of brain disease was revealed only
with a thorough neurological examination and
PET (positron emission tomography) imaging.
Most people picture dementia as memory loss
in an elderly individual; that is the usual course
of Alzheimer’s disease. But fronto-temporal
dementia (FTD) is different. Most often FTD
begins in mid-life, although people may be
affected in their 30’s or as late as in their 90’s.
The personality changes come on gradually,
and this leads people around the patient to
interpret the new behavior as having
psychological roots. Early symptoms are usually
apathy and lack of initiative; this can look like
depression. Other early manifestations are
impulsivity and decreased inhibition. Additional
symptoms include: diminished concern about
the consequences of actions, lack of empathy,
lack of flexibility, and a dramatic absence of
insight.
FTD is not a rare disease. It accounts for up to
half of all the dementias in people who are
under 65 years of age. Many components of
FTD can contribute to Internet addiction:
impulsivity, diminished inhibition, lack of regard
for moral and social norms, a tendency toward
compulsive behavior, and excessive self-
involvement.
Conclusion
There are some needles in the haystack of
Internet addiction.
Researchers have found a significant
association between Internet addiction and a
variety of psychiatric conditions: alcohol abuse,
attention deficit hyperactivity disorder,
depression, and anxiety. In addition, there are
a small percent of people with Internet
addiction who have medical conditions that are
driving their behavior. As with any covert
medical condition, an accurate diagnosis can
be game changing.
Barbara Schildkrout
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