In the 20-plus years since emergence of the concept of internet addiction, whether it is simply a social phenomenon or a medical condition requiring medical intervention has been a point of controversy and debate. However, following inclusion of internet gaming disorder or gaming disorder in the DSM-5 and ICD-11, the concept has become a focus of much attention. Given the fact, we conducted a survey on the state and cases of internet game addiction encountered at university hospitals. In urban areas, about 25% of the patients using the internet primarily for game playing fell in the problematic internet user category, and about 8% in the pathological user group. Patients corresponding to the problematic and pathological internet user groups were noted having relatively high rates of background anxiety/depression symptoms, school refusal, and substance abuse including smoking and drinking. Moreover, the problematic and pathological internet users showed greater deterioration in overall daily living functioning, and problems regarding peer relationships after school hours compared to normal internet users. From these results, addiction tendencies to internet gaming were regarded as possible indication of underlying psychosocial factors requiring medical intervention, where step-by-step therapy tailored to the characteristics of each individual and their families were regarded as the realistic approach for actual treatment and support. This paper introduces two such cases experienced in the university hospital setting.

Nonsuicidal self-injury (NSSI) is defined as deliberately, superficially and directly injuring oneʼs own body with nonsuicidal intent, such as for reducing emotional distress, communicating with or manipulating others. Although this behavior had been considered a symptom of borderline personality disorder (BPD) up to DSM-IV-TR, it has come to be recognized as a deviated behavior independent of BPD since the DSM-5. This transition represents change in the therapeutic concept, making NSSI a direct target of treatment, more than merely an element in “limit setting.”

This paper reviews the historical changes in NSSI conceptions, discussed in association with addiction, suicide, and the strengths and weaknesses of the DSM-5 nonsuicidal self-injury category.

While behavioral addiction has become a focus of attention, recent studies have revealed that food addiction also involves dysfunction of the reward circuit and hypofunction of the prefrontal cortex, similar to other forms of addiction. However, the association between food addiction and eating disorders is for most part limited to binge eating disorder, and the food addiction hypothesis is only one among the many etiological hypotheses constructed to explain eating disorders.

Comorbidity rates of personality disorders among eating disorder patients is higher than expected. A combination of resolute therapist attitudes and externalization of the eating disorder is helpful in child and adolescent cases, to facilitate quick return to their peer groups increasing the potential for natural personal growth and development within the framework of close peer relationships. If patients have already become detached from their peer groups, active intervention to address the psychopathology of personality disorders is essential. Two spectra and their intervention prototypes: borderline personality disorder spectrum/multi-impulsivity (mood stabilizers, second-generation antipsychotic medication, psychodynamic psychotherapy) and social anxiety spectrum disorder/avoidant personality disorder (selective serotonin reuptake inhibitors, cognitive behavioral treatment) are concepts useful in guiding intervention for personality disorders among eating disorder patients.

In recent years, the spread of smartphones has given children and adolescents easy access to the Internet and games. Internet addiction can cause poor academic achievement and may lead to truancy, which could progress on to complete social withdrawal―a psychological condition known as ‘hikikomori’ in Japanese. Intervention for hikikomori begins with family support or individual therapy, followed by support in creating places the individual can find a sense of belonging (ibasho), and on to learning/work support aimed at increasing social participation. On the other hand, associations between Internet addiction and developmental disorders have been reported, for which cognitive behavior therapy and treatment camps are being incorporated for treatment. However, there are many regions that are as yet unequipped to offer such treatment and support. This paper provides an overview of existing literature on the association between hikikomori and Internet addiction, alongside report on the author's regional approach to these issues.

In the clinical practice of child and adolescent psychiatry, cases in which the patient cannot or will not come to the clinic (refusal to leave home, parent(s) unwilling to subject the child to sessions, etc.) leaving just the parent(s) available to participate in therapy are not rare. I have met many such parents who were rejected by other medical institutions because they could only treat patients in attendance. While I understand the reasoning behind rejecting such patients who cannot come in for treatment, it has been my aim to assist in these situations as best I can. To that end, I studied the effectiveness of using the systems approach, considered a possible method to treat a patient without his/her attendance, as was the situation in the case described herein. The patient in question and his parents came to our clinic for assistance with what was described as four years of kleptomania. The family subsequently decided the patient would not attend sessions regularly, resulting in the patient coming in only twice. The first occasion was the initial and only visit with me, and the second was for a psychological examination with another therapist. Given the limitation of the patient being absent, psychotherapy centered around the patient's mother using the systems approach. As a result, the parents reported dissipation in the patient's symptoms as well as some improvement in their relationship with the boy. The possibilities of extending treatment to a patient in their absence—with only the parents present in sessions as in this case—may suggest efficacy of psychotherapy using the systems approach as a treatment option worth considering in the field of child and adolescent psychiatry.

The aim of this study was to evaluate the effects of problem-solving training (PST) on children with autism spectrum disorder (ASD) and their families. PST was implemented on 15 elementary and junior high school-aged Japanese children with ASD and their mothers in three to four small groups. The effect of PST on children was assessed using the Interpersonal Self-Efficacy Scale (ISES), and the effect on mothers was assessed using both the Child Behavior Checklist (CBCL) and the Confidence Degree Questionnaire for families (CDQ). After PST, significant improvement (P=0.03) was noted in one ISES sub-item, and more significant improvement (P=0.01) in one CDQ sub-item scores for mothers. However, change did not reach levels of significance for most items assessed in this study.