Introduction:

The term self-abuse first may bring to the mind self-harm, self-medicating, drugs abuse, masochism and so on. While these behaviours are common and life wasting, threatening, at times lethal, and important to be reviewed and discussed on its own, this article is not on this subject. This paper will review and discuss more masked and perhaps unrecognized types of human behaviours that are self-abusive, deteriorating and the causes of morbidities and in long-run even life shortening. These behaviours will be classified into sacrificing sleep; restricting or indulging eating behaviours; lack or extreme of physical activities; and unhealthy social activities through social media and virtual life.

 

Sacrificing Sleep:

More and more people in this era of rat race, profit hunger for a few and financial struggle for the rest, and also dependency on digitalism, social media and alike, cannot get enough of sleep or enough of a good and restful one. Therefore deliberately sacrificing one’s sleep to stay up on their gadgets, social media and else, or having sleep deprivation due to work and else has become an epidemic world wide. Therefore it is not uncommon to see many with sunken eye, fatigue, daytime sleepiness on the wheel, at work and school, or looking clumsy and even with weight gain as a result. (1)

 It is not just the amount and the hours of sleep that people do not get enough, but the quality of sleep! The sleep is comprised of different stages: Stage 1 (when feeling drowsy and sleepy); Stage 2 (or light sleep); Stage 3 & 4 (deep sleep); and REM (Rapid Eye Movement) sleep when one dreams. Every night our sleep goes through 4 to 5 of such a cycle, the first starting from 1-4 then REM, and so on. People who do not wake up in the middle of the night and have a sound sleep, they do not go back to stage 1 after the first cycle. Stage 2 of sleep is the prominent part of the sleep in normal adults, about 45-50% and deep or stages 3 & 4 comprises about 15% and REM about 25%. But most adults with sleep deprivation, insomnia, any other sleep disturbances and disorders, people with anxiety, depression, stress, worries, etc. do not get much of deep sleep or none. While REM sleep is for the restoration of mental fatigue, so anxious and worried people have more of it, stage 3 &4 that is deep or slow wave sleep is for the restoration of physical fatigue, so children get more of it due to their higher physical activities. (2)

 

Unfortunately even children and teens nowadays due to addiction to their gadgets and games, staying up till late at night, first of all do not get enough hours of sleep, and since they are not physically active, not much of deep or restful sleep. The case for children could be worse and life determining as the growth hormone and many others alike do secrete during stages 3, 4 and REM. The low secretion of growth hormone not only causes slow and poor physical growth, also the growth and development of the rest of the body organs, specially the brain. (3)

 Moreover sleep disturbances such as nightmares, sleep talking, sleep walking, night-terrors, sleep apnea, restless leg syndrome in sleep are becoming more and more common. Although many children, teens and even youngsters whose population of unemployment and dropping schools is on the rise, may sleep in the day and try to compensate their lack of night sleep, their sleep-wake cycle is deranged. The sleep-wake cycle or circadian rhythm, one of the important and vital cycles of life and nature, works on the rise and set of sun, so that is why melatonin a hormone that with addition of sunlight, gives us skin and hair color, and Vitamin D that gets activated by sun to deliver calcium to our bones are all dependent on a normal and healthy sleep-wake cycle. As a result as they say “Nothing is like a good night sleep”! (4-8)

 In brief sacrificing sleep or sleep deprivation in any way or due to any reason, has irreparable cost to the physical and mental health, from poor growth and development to poor cognitive function and developing mental illness, and even lessen longevity, vocational, financial losses and costs to the individual and society at large. Since the scope of sleep sacrifice and deprivation is beyond the scope and pages of this site, the readers are invited to review the related references at the end of this paper. (9-16)       

Restricting or indulging eating:

Body image is a state of mind or perception of the body shape and weight and a concern of many, specially teenage and young girls. The media, fashion and certain careers beat up on this phenomenon to the extreme, to the point that thinness equals beauty and acceptance. So restriction and dieting of food intake is a major pathological problem of the modern society, in the past more in the west and now globally. Therefore eating disorders such as “Anorexia Nervosa” and “Bulimia Nervosa” have become epidemics of the modern world. Restricting food intake and dieting that could lead to starvation, and in some binge eating, could bring on more pathological eating behaviors such as induced vomiting, taking diuretics or water pills and laxatives to get rid of the digested calories. These will lead to the abuse of the body physically, emotionally and mentally and causing many medical illnesses, even rupture of the esophagus or food pipe and the heart due to the extreme increase of internal pressures caused by induced vomiting, or the loss of minerals and fluids of the body and cells. (17-27)

 

Medical complications of Anorexia Nervosa could include hypothermia or loss of the body heat due to calories deprivation; edema due to body fluid and electrolyte imbalance; hypotension or drop in the blood pressure that could cause dizziness, fatigue and poor physical and mental performance; bradycardia or lowering the heart rate that in turn affect the blood and oxygen transportation across the body; infertility, and osteoporosis or loss of bones’ calcium causing easy and early fractures. Medical complications of Bulimia Nervosa could include fluid or electrolyte imbalance that could cause muscle spasm, dizziness, edema, etc.; gastritis, esophagitis, gastric dilation, dental erosion, swollen parotid glands, and gingivitis all as a result of induced vomiting and other means of purging or getting rid of consumed food after binges. (28-29)

 

While eating disorders, dieting and body image is a major concern of the youth population, specifically the female gender in this superficial world of ours, where beauty and acceptance is skin deep, on the other extreme, overeating and obesity is a general population epidemic. A significant fraction of the inhabitants of the western world are overweight or obese. In the US, this has reached apocalyptic proportions, with 30% of the adult population overweight and an astonishing 35% being obese. In England, where the prevalence of obesity is among the highest in Europe, obesity is considered to be the second most important avoidable risk factor for cancer after smoking. The rest of the world, especially the rising-economic countries, is doing their best to catch up. (30-32)

 

Overeating and obesity is a disease on its own across life span, even affecting children, feeding businesses such as diet and weight loss clinics and gyms across the western world, nowadays expanding to the rest of the world. It is amazing and hypocritical that the capital world, makes its population fat through fast and junk food eating on one side and from the other, try helping them to lose weight, so its profit making machines run. Other than being a disease on its own and affecting the mobility and functionality of the individual, obesity is the leading cause or trigger of many other metabolic and non-metabolic diseases, such as type 2 diabetes, gallbladder and liver diseases, different joint arthritis and pains specifically the knees and lower back, osteoarthritis, hypertension, coronary artery disease leading to heart attacks, and more and more a major predisposing factor to many cancers such as uterine, breast and colon. (33-34)

 

Of the most common consequence of overeating and obesity is type 2 diabetes that comprises 90% of all diabetes worldwide, making genetic or type 1 diabetes mellitus only 10%. The western world and on the top, North America are the leading nations with a prevalence of about 8% of their population suffering from high blood sugar, while the average global prevalence is about 2.8%. While this disease of overeating is still the most common in adults, the children and teenagers are catching up, as a result of fast food consumption and inactivity, engaging in digital surfing and time wasting! This man-made diabetes that affected only 30 millions worldwide in 1985, climbed up more than 4 times to affect 135 millions in only 10 years in 1995, and 217 millions in 2005, and 392 millions in 2015. Overeating specially of junk foods and carbohydrates suppress the insulin production through overloading beta cells of pancreas in the production of insulin that finally gives up. As a result the high sugar runs wild in the blood and throughout all the body organs, damaging them all and cause morbidity and mortality. (35-36)

Physical activities: The Extremists

While many people are sedentary and physically inactive and do not exercise, others get into the extreme and involve in strenuous and improper exercises for their age. These people mostly adults of middle age and older who perhaps were not physically active most of their lives, suddenly get into extreme exercises only for maintaining their body shape and appearance and/or fighting their aging bodies. These exhaustive exercises in the forms of cardio, aerobics, weight lifting and else often cause more damages than benefits to the individuals, such as injuries to their musculoskeletal system, joints, cardiovascular and the whole body metastasis and even cellular damages at DNA and genetic level. Here instead of focusing on different body parts and organs impact of strenuous and age inappropriate exercises, the emphasis will be on the general impact of such exercises on the whole body system, more at the cellular level that instead of promoting health and well being, they will lead to more pathology, diseases and complications.

 

While regular, routine and moderate exercise that is built over time is health promoting, adaptive and ant-oxidant for cells, the exhaustive and acute exercises could cause more oxidative stress and cellular damages. One of the first result of exercise and muscle contractions is the release and elevation of serum creatine kinase (CK), lowering the serum potassium and hypokalemia. These are not the same in different racial groups as for example serum CK levels are higher in the black population. While skeletal muscle reveals notable plasticity in functional adaptation and remodeling in response to acute or chronic physical activity through training-induced adaptations, strenuous physical exercises without proper training and adaptation could also be accompanied by some adverse effects associated with the inflammatory response. Lactic acid accumulation and damage to muscle fibers in addition to rising in CK, it could also induce rise in the plasma activities of other enzymes including asparate aminotransferase (AST) and alanine aminotransferase (ALT), as well as the elevation of circulating cell free DNA. (37-39)

Of significance is the elevation of circulating cell free DNA (cf DNA) that could be either cell free nuclear DNA (cf n-DNA) and cell free mitochondrial DNA (cf mt-DNA), deriving from nucleus or cytoplasmic mitochondria’s, respectively. Increased levels of circulating cf n-DNA were observed under variety of pathological conditions including cancer, autoimmune diseases, stroke, traumatic brain, and other organs injury. In contrast to the afore-mentioned pathological conditions, exercise-induced increase in cf n-DNA is transient, probably due to the parallel elevation of serum DNAse 1 activity leading to its normalization within 0.5 to 2 hours of recovery. That is why exercise needs to be appropriate for age and the person and the level of training, built up gradually and under proper training, so allowing sufficient time for the body and cells to recover and adjust. Therefore extreme and inappropriate exercises, and exhausting the body and the cells, specially musculoskeletal ones will lead to pathological conditions and inflammation, instead of promoting health and well-being. While strenuous exercises in an average person could cause pathological damages, in the professional athletes that are used to such exercises under proper training have been shown that exercise surprisingly causes decline in cf mt-DNA. Having said that even professional athletes who go beyond their routines, over-train and exhaust their bodies could develop the overtraining syndrome and create muscle damage, immunological alterations, and inflammatory responses. (40-44)

 

Social activities: Social media and virtual life:

As detailed in another article on this site “Digital Addiction: The end of free thought and will” (45), social media and virtual lives nowadays have replaced real life and have become serious health hazards. The digital gadgets, specially the mobile phones most recently that were initially created for fast computing, and information technology and convenience, have now transformed to a global addiction and slaved humans. The unrestrained use of technological devices started to impact upon developmental, social, mental and physical well-being and resulted in symptoms akin to other behavioural addictions. Several clinics worldwide started offering treatment for internet addiction related disorders and several studies have sought to establish a connection between the use of the internet and patterns of abnormal behavior. Even some experts have suggested to list such addiction and disorders as a legitimate mental health disorder within the Diagnostic and Statistical Manual of Mental Disorders (DSM) soon in its sixth edition published by the American Psychiatric Association, that is currently in the appendix of DSM5. (46-47)

 

The digital addiction and its medical and psychological complications have become more of a concern world wide for children. The new generation spend less time interacting with their peers face to face and more time indoors than previous generations. In December 2013 researchers from the University of Maryland concluded the majority of students studied to be “addicted” to their technological devices, likening their symptoms when forcibly separated from technology to those experienced when withdrawn from an addictive substance. (48) Researchers have found that the use of these devices can cause or contribute to child obesity because children spend so much time on their devices. It is also common for these children suffer pain because they are looking at their screens for long period of time. Moreover, children in the future may experience having poorer muscle tone because of being hunched over while using the devices. With increased time spent in front of the screen, children spend less time playing sports, exercising or participating in other activities, such as reading or engaging with other children. This not only having a physical effect, but it is also affecting the children’s social development. Face-to-face interactions are highly crucial in a child’s development so that they can learn social and communication skills but increased technology time limits this and can impede development and learning. (49-51)

 

In addition to the obsessive compulsive dependency and use of digital devices by the youth and adults alike, there are other negative aspects of the digital addiction, such as online risks of harassment/cyber bullying, sexual solicitation, social isolation, depression, etc. A group of researchers in 9 European countries conducted a large study on children between the ages of 9 and 16 in regard with the Physical and psychological symptoms of digital addiction and found symptoms such as eye problems, headaches, malnutrition, and fatigue physically and cognitive decline, aggression, and sleeping problems mentally. Korea Youth Panel Survey collected over a four-year period, concluded the offline abnormal behaviors and self-control problems of youth were significantly associated with problematic online behaviors, with more peer influence than parental. A large survey in Germany with a sample of 1,444 students, found that 4.8 % of the participating students reported pathological internet use, and 14.5 % met criteria for risky Internet use. Overall, adolescents with risky or pathological internet use had more critical real life events, particularly within the context of interpersonal relationships and academic performance. (52-56)

 Studies on social media users range from prediction of the personality type of the individuals to the negative impact on the users lives, including their personal and romantic relationships. For example Facebook Addiction Scale has been developed and has shown that such addiction is positively related to neuroticism and extraversion, and negatively related to conscientiousness of personality factors and also high scores of the scale are associated with delayed bedtimes and rising times. Such addiction has affected up to 50 percent of college and university students’ academic performances. Addiction to the social media has wide spread globally and studies coming out from different countries, such as one from India reporting 24.74% of the teenage students having occasional or ‘frequency’ problems, while 2.02% of them experiencing severe problems, having caused decrease in real life social community participation and academic achievement. (57-61) Another study among Irish teenagers aged 11-16 years, has reported potential hazards of social media overuse, including bullying, inappropriate contact, overuse, addiction and invasion of users’ privacy, with 98% being unsupervised, and 27% reported inappropriate contact from others. A study among students in Turkey reported Facebook addiction cost weekly time commitment, severe depression, anxiety and insomnia. Another study in Peru, among students revealed 77.0% of the users being women, and poor sleep quality present in 55.0%. A study among 1000 medical students in the middle east reported daily use of 3-4 hours, 60% in women and 40% among men with a large number of participants (75%) complained of mood swings. (62-65)

Social media addiction has been linked with poor emotion regulation skills and heightened susceptibility to both substance and non-substance addiction. Digital addiction through functional MRI (Magnetic Resonance Imaging) has also shown to share some neural features with substance and gambling addictions, with some differences from such addictions in their brain etiology and possibly pathogenesis, as related to abnormal functioning of the inhibitory-control brain system. A study from among 211 employees in 13 enterprises in Thailand, revealed that people who are highly addicted to social media tended to have lower mindfulness and use emotion-focused coping to deal with stress. Lack of mindfulness and the decision to use emotion-coping strategy are also subsequently associated with higher emotional exhaustion. (66-68) Another study among Pakistani students reported Facebook addiction was positively correlated with narcissism and negatively with self-esteem. Other than physical and mental health problems of digital addiction that briefly detailed above, and the privacy intrusions and other associated risks that communication with others online may bring about, there are risks of accidents and injuries, morbidities and mortalities while engaging with these online activities and walking, driving and else. Although these risks are more during text messaging that will be presented briefly in the following, there are reports of social media and else browsing while walking or driving. (69-70)    

 

Texting or text messaging either through phone messaging or social media has become not only an addiction and overused, in comparison with face to face interactions or simple phone calls communications, it has become a life hazard. More and more people text while walking, crossing the road, bridges, driving or even operating machineries and even public transports. This obviously leads to increased distraction and loss of control and increased risk of accidents, injuries, morbidities and mortalities. A study in 2006, with 900 teens from over 26 high schools in US showed that 87% of students found texting to be “very” or “extremely” distracting. One example of distraction behind the wheel is the 2008 Chatsworth train collision, which killed 25 passengers, because the operator had sent 45 text messages while operating the train. Texting while driving has been compared with drunk driving, and even more dangerous. While being legally drunk added four feet to Alterman’s stopping distance while going 70 mph, reading an e-mail on a phone added 36 feet, and sending a text message added 70 feet. In 2009, the Virginia Tech Transportation Institute released the results of an 18-month study that involved placing cameras inside the cabs of more than 100 long-haul trucks, which recorded the drivers over a combined driving distance of three million miles. The study concluded that when the drivers were texting, their risk of crashing was 23 times greater than when not texting. (71-74)

 

Texting while walking has also become increasingly the practice of people being transfixed to their mobile device without looking in any direction but their personal screen while walking. Text messaging among pedestrians leads to increased cognitive distraction and reduced situation awareness, and may lead to increases in unsafe behavior leading to injury and death. Recent studies conducted on cell phone use while walking showed that cell phone users recall fewer objects when conversing, walk slower, have altered gait and are more unsafe when crossing a street. (75-77)

 Text messaging has affected students academically by creating an easier way to cheat on exams. In December 2002, a dozen students were caught cheating on an accounting exam through the use of text messages on their mobile phones. In December 2002, Hitotsubashi University in Japan failed 26 students for receiving e-mailed exam answers on their mobile phones. The number of students caught using mobile phones to cheat on exams has increased significantly in recent years. Most Japanese mobile phones can send and receive long text messages of between 250 and 3000 characters with graphics, video, audio, and Web links. In England, 287 school and college students were excluded from exams in 2004 for using mobile phones during exams. Some teachers and professors claim that advanced texting features can lead to students cheating on exams. Students in high school and college classrooms are using their mobile phones to send and receive texts during lectures at high rates. Further, published research has established that students who text during college lectures have impaired memories of the lecture material compared to students who do not. For example, in one study, the number of irrelevant text messages sent and received during a lecture covering the topic of developmental psychology was related to students’ memory of the lecture. (77-80)

 Text messaging has been a subject of interest for the police forces around the world. One of the issues of concern to law enforcement agencies is the use of encrypted text messages. In 2003, a British ompany developed a program called Fortress SMS which used 128 bit AES encryption to protect SMS messages. Police have also retrieved deleted text messages to aid them in solving crimes. For example, Swedish police retrieved deleted texts from a cult member who claimed she committed a double murder based on forwarded texts she received. The excessive use of the thumb for pressing keys on mobile devices has led to a high rate of a form of repetitive strain injury termed “BlackBerry thumb”. An inflammation of the tendons in the thumb caused by constant text-messaging is also called text-messager’s thumb, or texting tenosynovitis. Texting has also been linked as a secondary source in numerous traffic collisions, in which police investigations of mobile phone records have found that many drivers have lost control of their cars while attempting to send or retrieve a text message. Increasing cases of Internet addiction are now also being linked to text messaging, as mobile phones are now more likely to have e-mail and Web capabilities to complement the ability to text. (81-83)

Conclusion:

The only conclusion that one could reach from all the above examples and alike situations that are while normal behaviours but could be self-abusive and destructive, is practicing moderation. Sleeping, eating, exercise and the use of digital gadgets and engaging in social media, etc. in moderation could be healthy, but taking them to the extreme would be detrimental.

 Dr.Mostafa Showraki, MD, FRCP

 Lecturer, School of Medicine, University of Toronto

Author: ADHD-Revisited book

Adhdrevisited.com/medicinerevisited.com

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