Internet addiction disorder
Internet addiction disorder (IAD) is now more commonly called problematic internet use (PIU) or compulsive internet use (CIU). Other overlapping terms include internet overuse, problematic computer use or pathological computer use – and even iDisorder. These terms avoid the word addiction and are not limited to any single cause, but only reflect a general statement about excessive computer use that interferes with daily life.
IAD was originally proposed as a disorder in a satirical hoax by Ivan Goldberg, M.D., in 1995, though some later researchers have taken his essay seriously. He took pathological gambling as diagnosed by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as his model for the description of IAD. IAD receives coverage in the press, and possible future classification as a psychological disorder continues to be debated and researched in the psychiatric community. A systematic review of PIU identified a lack of standardization of the conceptualization of PIU as a major impediment to advancing this area of study.
Other habits such as reading, playing computer games, or watching very large numbers of internet videos or movies are all troubling only to the extent that these activities interfere with normal life. IAD is often divided into subtypes by activity, such as excessive, overwhelming, or inappropriate pornography use, gaming, online social networking, blogging, email, or internet shopping. Opponents note that compulsive behaviors may not themselves be addictive.
Internet addiction is a subset of a broader "technology addiction". Obsession with technology started with radio in the 1930s and with television in the 1960s, but has recently exploded in importance during the current digital age.
- 1 A multidimensional construct
- 2 Disputed disorder: DSM
- 3 Prevalence and supportive studies
- 4 Non-supportive studies
- 5 Causes and effects
- 6 Measurement
- 7 Prevention and treatment
- 8 Related disorders
- 9 See also
- 10 References
- 11 Further reading
A multidimensional construct
A conceptual model of PIU has been developed based on primary data collected from addiction researchers, psychologists, and health providers as well as older adolescents themselves. That study identified seven concepts, or clusters, that make up PIU using a concept mapping approach. These seven clusters are: psychosocial risk factors; physical impairment; emotional impairment; social and functional impairment; risky internet use; impulsive internet use; and internet use dependence. The last three constructs have not been previously identified. Risky internet use are behaviors that increase risks of adverse consequences. It is not just the amount of time spent on the internet that puts an adolescent at risk; how the time is spent is also an important consideration. The impulsive use construct describes an inability to maintain balance or control of internet use in relation to everyday life. Finally, the dependent use construct reflects the more severe symptoms that are typically associated with addictions, such as withdrawal symptoms. Thus, internet addiction may represent a severe form of PIU.
Other research also stresses the fact that the internet addiction disorder is not a unidimensional but a multidimensional construct. Various facets of internet use must be differentiated because of their differential predictors, mechanisms and consequences. Online activities which, if done in person, would normally be considered troublesome, such as compulsive gambling, or shopping, are sometimes called net compulsions.
Disputed disorder: DSM
Internet addiction disorder is not listed in the latest DSM manual (DSM-5, 2013), which is commonly used by psychiatrists. Gambling disorder is the only behavioural (non-substance related) addiction included in DSM-5. However internet gaming disorder is listed in an appendix as a disorder requiring further study.
Jerald J. Block, M.D. has argued that internet addiction should be included as a disorder in the DSM-5. However, Block observed that diagnosis was complicated because 86% of study subjects showing symptoms also exhibited other diagnosable mental health disorders.
Prevalence and supportive studies
Over the past decade, the concept of internet addiction has grown in terms of acceptance as a legitimate clinical disorder often requiring treatment. Researchers are divided over whether Internet addiction is a disorder on its own or a symptom of another underlying disorder. There is also debate over whether it should be classified as an impulse-control disorder or an obsessive-compulsive disorder rather than an addiction.
While the existence of internet addiction is debated, self-proclaimed sufferers are resorting to the courts for redress. In one American case (Pacenza v. IBM Corp.), the plaintiff argued he was illegally dismissed from his employment in violation of the Americans with Disabilities Act because of internet addiction triggered by Vietnam War-related post-traumatic stress disorder (PTSD). The case was dismissed by the United States District Court for the Southern District of New York and affirmed on appeal to the United States Court of Appeals, Second Circuit in 2010 (case summarized in Glaser & Carroll, 2007).
About 25% of users fulfill internet addiction criteria within the first six months of using the Internet. Many individuals initially report feeling intimidated by the computer but gradually feel a sense of "competency and exhilaration from mastering the technology and learning to navigate the applications quickly by visual stimulation" (Beard 374). The feeling of exhilaration can be explained by the way IAD sufferers often describe themselves as: bold, outgoing, open-minded, intellectually prideful, and assertive.
Public concern, interest in, and the study of, internet over use can be attributed to the fact that it has become increasingly difficult to distinguish between the online and offline worlds. The Internet has tremendous potential to affect the emotions of humans and in turn, alter our self-perception and anxiety levels.
According to the Center for Internet Addiction Recovery (whose director is Kimberly S. Young, a researcher who has lobbied for the recognition of net abuse as a distinct clinical disorder), "Internet addicts suffer from emotional problems such as depression and anxiety-related disorders and often use the fantasy world of the Internet to psychologically escape unpleasant feelings or stressful situations." More than half are also addicted to alcohol, drugs, tobacco, or sex.
Mark Griffiths states that "[t]he way of determining whether nonchemical (i.e., behavioral) addictions are addictive in a nonmetaphorical sense is to compare them against clinical criteria for other established drug-ingested addictions", and although his data is dated, and may no longer represent average internet use accurately, Griffiths comes to the conclusion that the internet does meet that criteria for addiction in a small number of users.
Scientists have found that compulsive internet use can produce morphological changes in the structure of the brain. A study which analyzed Chinese college students who had been classified as computer addicts by the study designers and who used a computer around 10 hours a day, 6 days a week, found reductions in the sizes of the dorsolateral prefrontal cortex, rostral anterior cingulate cortex, supplementary motor area and parts of the cerebellum compared to students deemed "not addicted" by the designers. It has been theorized that these changes reflect learning-type cognitive optimizations for using computers more efficiently, but also impaired short-term memory and decision-making abilities—including ones in which may contribute to the desire to stay online instead of be in the real world.
Patricia Wallace PhD, Senior Director, Information Technology and CTY Online, at the Johns Hopkins University Center for Talented Youth argues that based on the case histories that have surfaced, no one denies that excessive involvement with certain psychological spaces on the net can have serious effects on a person’s life. She explains that, at a large university in New York, the dropout rate among freshmen newcomers rose dramatically as their investment in computers and Internet access increased, and the administrators learned that 43% of the dropouts were staying up all night on the Internet.
Many researchers say that Internet addiction disorder is not a true addiction and may in fact be no more than a symptom of other, existing disorders. An overbroad description of addiction leaves open the possibility of every compensatory behavior being declared an addiction. For example, a person who has lengthy telephone conversations with a friend to avoid an unpleasant situation could be declared "addicted to the telephone" with equal validity as a person who chats on the Internet with the same underlying goal.
Most, if not all "internet addicts", already fall under existing diagnostic labels. For many individuals, overuse or inappropriate use of the Internet is a manifestation of their depression, anxiety, impulse control disorders, or pathological gambling. IAD is compared to food addiction, in which patients overeat as a form of self-medication for depression, anxiety, etc., without actually being truly addicted to eating. It is possible that a person could have a pathological relationship with a specific aspect of the Internet, such as bidding on online auctions, viewing pornography, online gaming, or online gambling (which is included under the existing Pathological Gambling), but that does not make the internet medium itself addictive. For example, whether gambling is done on a computer or face-to-face does not affect whether or not it is pathological; a person with poor impulse control can lose sleep over a suspenseful novel or favorite television show or a computer game or the temptation to click on another web link.
Also, there are significant and critical differences between common internet activities (e-mail, chatting, web surfing) and pathological gambling, which the IAD notion heavily parallels. The internet is largely a pro-social, interactive, and information-driven medium, while gambling is seen as a single, anti-social behavior that has very little social redeeming value. Many so-called internet addicts do not suffer from the same damage to health and relationships that are common to established addictions.
A complete review of the internet addiction research by Byun et al. in 2008 demonstrated significant, multiple flaws in most studies in this area. The researchers wrote in that article, "The analysis showed that previous studies have utilized inconsistent criteria to define Internet addicts, applied recruiting methods that may cause serious sampling bias, and examined data using primarily exploratory rather than confirmatory data analysis techniques to investigate the degree of association rather than causal relationships among variables."
Causes and effects
Dr. Kimberly S. Young says that prior research links Internet Addiction Disorder with existing mental health issues, most commonly depression. This may be due to the fact that virtual engagements do not stimulate the release of neurotransmitters responsible for feelings of satisfaction and relaxation, such as oxytocin and endorphin, the way real interactions do. Young states that the disorder has significant effects socially, psychologically and occupationally. Addicts were known to use the internet an average of 38 hours a week for nonacademic and non-employment purposes resulting in poor grades among students, discord among couples and reduced work performance.
According to a Korean study into the disorder, pathological use of the internet results in negative life consequences 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. The authors of the article conducted a study utilising Kimberly Young's questionnaire. The study showed that the majority of those who met the requirements of internet addiction disorder suffered from interpersonal difficulties and stress and that those addicted to online games specifically responded that they hoped to avoid reality.
Dr. Kimberly S. Young states that 52% of the respondents to her own study said that they were following recovery programs for other addictions. These included alcoholism, chemical dependency, compulsive gambling, or chronic overeating. These participants could see the same excessive behaviour, the need for a crutch to help them relax, in their use of the Internet, that they had exhibited in prior addictions. Though they believed that Internet addiction was not as serious as alcoholism, they still felt disheartened that a new addiction had substituted for the old one. Young also discusses the findings of Dr. Maressa Hecht-Orzack of McLean Hospital who set up a service for computer and Internet addiction in the spring of 1996. Orzack noted that primarily depression and bi-polar disorder in its depressive swing were co-morbid features of pathological Internet use, along with this Orzack indicated that referrals received were from various clinics throughout the hospital rather than direct self-referrals for Internet addiction.
Determining the cause of excessive internet use as it relates to negative outcomes may require a consideration of moderating factors. For example, excessive use accompanied by the cognitive factor of high preoccupation with the internet (excessive thinking about the internet) has been found to be related to greater amounts of negative outcomes.
A 2009 study suggested that brain structural changes were present in those classified by the researchers as internet addicted, similar to those classified as chemically addicted.
Internet Addiction Test
The Internet Addiction Test (IAT) of Kimberly Young was the first instrument to assess internet addiction. Initial studies have found that the IAT was a reliable measure that covers the key characteristics of pathological online use. The test measures the extent of a client’s involvement with the computer and classifies the addictive behavior in terms of mild, moderate, and severe impairment. The IAT was utilized in outpatient and inpatient settings and adapted accordingly to fit the needs of the clinical setting. The IAT was not validated during its development, but later studies have established its validity in English, and also in Italy and France, making it the first global psychometric measure.
Compulsive Internet Use (CIUS)
The Compulsive internet Use Scale (CIUS) was developed in 2009 by Meerkerk and colleagues at the Addiction Research Institute, Rotterdam, Netherlands. It was tested on two representative samples: 447 heavy internet users, and 16,925 regular internet users. The CIUS contains 14 items rated on a 5-point scale from 0 = never to 4 = very often. Example item: "How often do you find it difficult to stop using the internet when you are online?".
Problematic Internet Use (PRIUSS)
A newer 18-item measure is the PRIUSS, the Problematic And Risky Internet Use Screening Scale, has been developed by Jelenchick and colleagues in 2012 at the University of Wisconsin School of Medicine. This scale differed in that it was based on a conceptual model of PIU created in an earlier study and has been validated through factor analysis during its development. The instrument is currently being launched in several schools and clinics, as well as being evaluated through further research. It contains 18 items.
- Salience: Using the internet dominates the person’s life, feelings and behaviour.
- Mood modification: The person experiences changes in mood (e.g. a ‘buzz’) when using the Internet.
- Tolerance: Increasing amounts of Internet use are needed to achieve the same effects on mood.
- Withdrawal symptoms: If the person stops using the Internet, they experience unpleasant feelings or physical effects.
- Relapse: The addict tends to relapse into earlier patterns of behaviour, even after years of abstinence or control.
Prevention and treatment
In many cases, though not all, internet overuse corrects itself. Sarah Kershaw wrote for the New York Times in 2005:
It was Professor Kiesler who 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.
Corrective strategies include content-control software, counselling, and cognitive behavioural therapy. One of the major reasons that the Internet is so addicting is the lack of limits and the absence of accountability.
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 2009, ReSTART, a residential treatment center for "pathological computer use", opened near Seattle, Washington, United States. It offers a 45-day program intended to help people wean themselves from pathological computer use, and can handle up to six patients at a time.
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.
Online gaming addiction (internet gaming disorder)
Video game addiction is a known issue around the world. Incidence and severity grew in the 2000s, with the advent of broadband technology, games allowing for the creation of avatars, 'second life' games, and MMORPGs (massive multiplayer online role playing games). World of Warcraft has the largest MMORPG community on-line and there have been a number of studies about the addictive qualities of the game. Addicts of the game range from children to mature adults. A well-known example is Ryan van Cleave, a university professor whose life declined as he became involved in online gaming. Andrew Doan, MD, PhD, a physician with a research background in neuroscience, battled his own addictions with video games, investing over 20,000 hours of playing games over a period of nine years.
Online gaming addiction may be considered in terms of B.F. Skinner's theory of operant conditioning, which claims that the frequency of a given behaviour is directly linked to rewarding and punishment of that behavior. If a behaviour is rewarded, it is more likely to be repeated. If it is punished, it becomes suppressed.
Orzack, a clinical psychologist at McLean Hospital in Massachusetts claims that 40 percent of World of Warcraft (WoW) players are addicted. Orzack says that the best way to optimize the desired behaviour in the subject is to provide rewards for correct behaviour, and then adjust the number of times the subject is required to exhibit that behaviour before a reward is provided. For instance, if a rat must press a bar to receive food, then it will press faster and more often if it doesn't know how many times it needs to press the bar. An equivalent in World of Warcraft would be purple (epic) loot drops. Players in World of Warcraft will often spend weeks hunting for a special item which is based on a chance system, sometimes with only a 0.01% chance of it being dropped by a slain monster. The rarity of the item and difficulty of acquiring the item gives the player a status amongst their peers once they obtain the item.
Online Gamers Anonymous, an American non-profit organization formed in 2002, is a twelve-step, self-help, support and recovery organization for gamers and their loved ones who are suffering from the adverse effects of addictive computer gaming. It offers resources such as discussion forums, online chat meetings, Skype meetings and links to other resources.
Jim Rossignol, a finance journalist who reports on internet gaming has described how he overcame his own addiction, and channeled his compulsion into a desirable direction as a reporter of internet gaming and gaming culture.
Communication addiction disorder (compulsive talking)
Communication addiction disorder (CAD) is a supposed behavioral disorder related to the necessity of being in constant communication with other people, even when there is no practical necessity for such communication. CAD had been linked to internet addiction. Users become addicted to the social elements of the internet, such as Facebook and YouTube. Users become addicted to one-on-one or group communication in the form of social support, relationships and entertainment. However interference with these activities can result in conflict and guilt. This kind of addiction is called social network addiction.
Social network addiction is a dependence of people by connection, updating and control of their and their friends social network page. The correlation between the social network use and a decreasing of offline social relationships is a complex issue, depending not only from the time spent on them but also from the motivation in using them. For some people in fact, the only important thing is to have a lot of friends in the network regardless if they are offline or only virtual; this is particularly true for teenagers as a reinforcement of egos. Sometimes teenagers use social networks to show their idealized image to the others. They generally start using social networks to improve face-to-face relationships. However, some of them use these tools as a showcase creating an idealized image to be accepted by groups and to reach a big number of friends. They spend a reduced time for face-to-face relationships, passing instead at least six hours per day on social networks. However, other studies claim that people are using social networks to communicate their real personality and not to promote their idealized identity.
- Addictive personality
- Compulsive gambling
- Internet sex addiction
- List of repetitive strain injury software (i.e. Break reminders)
- Media multitasking
- Pornography addiction
- Soft addiction
- Underearners Anonymous
- Digital addict
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