Internet addiction disorder
Internet addiction disorder (IAD), or, more broadly, Internet overuse, problematic computer use or pathological computer use, is excessive computer use that interferes with daily life. These terms avoid the term addiction and are not limited to any single cause.
IAD was originally proposed as a disorder in a satirical hoax by Ivan Goldberg, M.D., in 1995. 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. It is not, however, included in the current DSM as of 2009. IAD receives coverage in the press, and possible future classification as a psychological disorder continues to be debated and researched in the psychiatric community.
Online activities which, if done in person, would normally be considered troublesome, such as compulsive gambling, or shopping, are sometimes called net compulsions. Other habits such as reading, playing computer games, or watching a staggering amount of internet videos or movies are all troubling only to the extent that these activities interfere with normal life. Supporters of disorder classification often divide IAD 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.
Disputed disorder 
Over the past decade, the concept of Internet addiction has grown in terms of acceptance as a legitimate clinical disorder often requiring treatment. However, known academic authorities take stances in either supporting or opposing the existence of Internet addiction disorder (IAD). In 2006, the American Medical Association declined to recommend to the American Psychiatric Association that they include IAD as a formal diagnosis in DSM-V, and recommended further study of "video game overuse." Some members of the American Society of Addiction Medicine opposed identifying Internet overuse and video game overuse as disorders. Among the research identified as necessary is to find ways to define "overuse" and to differentiate an "Internet addiction" from obsession, self-medicating for depression or other disorders, and compulsion. A debate over whether to include "Internet Addiction" as a diagnosis in DSM-V, may conclude in the May, 2013 edition of the DSM. Some argue that Internet addiction disorder exists and should be included, and some that it is neither an addiction nor a specific disorder and should not be included in DSM-V.
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. The case is pending before the court in the Southern District of New York (case summarized in Glaser & Carroll, 2007).
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. yes Data from China Internet Network Information Center (CNNIC), as of January 16 2012 showed that over 513 million Chinese are now connected online, which is 55.4% of the "netizen" population in Asia, and 23.2% of the similar population in the world.[dead link] The China Communist Youth League claimed in 2007 that over 17% of Chinese citizens between 13 and 17 were addicted to the Internet.
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.
The Ottawa Citizen reports that a 1996 report in the UK "Advances in Psychiatric Treatment" claimed that a "significant minority" suffer from "Internet addiction".
Another supporter, David Greenfield, PhD of the [Center for Internet and Technology Addiction] conducted a study with ABC News.com in 1999 and is author of Virtual Addiction. He believes that some services available over the Internet have unique psychological properties which induce dissociation, time distortion, and instant gratification, with about 6% of individuals experiencing some significant impact on their lives. However, he says it may not best be seen as an addiction but rather as a compulsion. Greenfield claims that sex, gaming, gambling, and shopping online can produce a mood-altering effect.
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." Over 60% of people seeking treatment for IAD claim involvement with sexual activities online which they consider inappropriate, such as excessive attention to pornography or involvement in explicit sexual conversations online. More than half are also addicted to alcohol, drugs, tobacco, or sex.
In 2008 Jerald J. Block, M.D., Hilarie Cash, PhD, Kim McDaniel MA, argued that Internet addiction should be included as a disorder in the DSM-V. Block observed that diagnosis was complicated because 86% of study subjects showing IA symptoms also exhibited other diagnosable mental health disorders. 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.
In his essay Internet Addiction: Does it Really Exist? 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. On the other hand, increases in the density of the right parahippocampal gyrus and a spot called the left posterior limb of the internal capsule were also found. 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. Patricia Wallace PhD 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.
Psychiatrist Dr. Goldberg states 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 at the end of 2008 (Byun et al., 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 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.
In an article titled Internet Over-Users' Psychological Profiles: A Behavior Sampling Analysis on Internet Addiction  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.
Psychiatric Services study 
Psychiatric Services conducted a study  in which visitors to a virtual mental health clinic could discuss their ailments with 100 volunteer mental health professionals. Psychiatric Services hypothesized, internet users who suffered from existing mental health problems, specifically depression and symptoms of social impairment, had a higher risk of developing IAD. The study was conducted between May and October 2000. All visitors to the virtual clinic completed Young's IAD questionnaire  a brief seven-item instrument that adapts DSM-IV criteria for pathological gambling.
 total of 251 clients completed the questionnaire. The mean±SD age of the clients was 25.04±6.19 years, with a range of 14 to 44 years. Most were female (67 percent) and single (84 percent). Most had an education beyond the college level (63 percent), and about a third (36 percent) were students. A majority (56 percent) reported that they had never visited a real mental health clinic.
Internet Addiction Test 
The Internet Addiction Test (IAT) is the first validated instrument to assess Internet addiction. Studies have found that the IAT is 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 can be utilized in outpatient and inpatient settings and adapted accordingly to fit the needs of the clinical setting. Furthermore, beyond validation in English, the IAT has also been validated in Italy (Ferraro, Caci, D' Amico, & Di Blasi, 2007) and France (Khazaal et al., 2008) making it the first global psychometric measure.
The test consists of twenty questions with answers rated from 1 to 5, which produces a score from 20 to 100.
Griffiths criteria 
- 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 correction 
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 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.
Related addictions 
Communication addiction disorder 
Communication addiction disorder is a behavior disorder related to the necessity of being in constant communication with other people, even when there is no practical necessity for such communication. Within an article titled 'Communication Addiction Disorder: Concern over Media, Behavior and Effects' internet overuse or Internet Addiction (IAD) is linked to communication addiction disorder, a theorized disorder in which users become addicted to the social elements of the internet, such as Facebook and YouTube. Users become addicted to one-on-one/group communication in the form of social support, relationships and entertainment however interference with these activities can result in conflict and guilt.
Online gaming addiction 
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). Runescape 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 on-line 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 saysvariable ratio reinforcement 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.[clarification needed] 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 0.001% 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.
Orzack, a clinical psychologist at McLean Hospital in Massachusetts claims that 40 percent of World of Warcraft (WoW) players are addicted.
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. 
See also 
- Addictive personality
- Compulsive gambling
- Pornography addiction
- Soft addiction
- Online Gamers Anonymous
- Media multitasking
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Further reading 
- Block, J.J. (2008). "Issues for DSM-V: Internet Addiction". American Journal of Psychiatry. 165:3; March 2008; p. 306–307.
- Byun, S., et al. (2008). Internet Addiction: Metasynthesis of 1996–2006 Quantitative Research. Cyberpsychology & Behavior, 12, 1–5.available online
- Caruso, D. (1998). Critics Pick Apart Study on Internet and Depression. available online.
- Chopra, D. (1997). Overcoming Addictions. New York: Harmony Books.
- Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. (1994). Washington D.C.: American Psychiatric Association.
- Dowling, N. A., & Quirk, K. L. (2008). Screening for Internet Dependence: Do the Proposed Diagnostic Criteria Differentiate Normal from Dependent Internet Use? CyberPsychology & Behavior, 12 (1), 1.
- Dreier, M., Tzavela, E., Wölfling, K., Mavromati, F., F., Duven, E., Karakitsou, Ch., Macarie, G., Veldhuis, L., Wójcik , S., Halapi, E., Sigursteinsdottir, H., Oliaga, A., Tsitsika, A. (2012). The development of adaptive and maladaptive patterns of Internet use among European adolescents at risk for internet addictive behaviours: A Grounded theory inquiry. National and Kapodistrian University of Athens (N.K.U.A.), Athens: EU NET ADB. Available at www.eunetadb.eu. available online
- Garcia Duran, M. (2003, December 14). Internet Addiction Disorder. Allpsych .
- Grohol, J. M. (1999). Internet Addiction Guide. Psych Central available online.
- Hansen S (2002). "Excessive Internet usage or 'Internet Addiction'? The implications of diagnostic categories for student users". Journal of Computer Assisted Learning 18 (2): 232–236.
- Padilla-Walker, L.M., Nelson, L.J., Carroll, J.S. & Jensen, A.C. (2009). More than just a game: Video game and Internet use during emerging adulthood. Journal of Youth and Adolescence. DOI 10.1007/s10964-008-9390-8.pdf *requires login at BYU*
- Potera C (Mar/Apr 1998). "Trapped in the Web?". Psychology Today 31 (2): 66–70.
- Quinn, M. J. (2009). Ethics for the Information Age (3rd ed.). (M. Hirsch, Ed.) Boston: Pearson.
- Surratt, Carla G (1999). Netaholics? : the creation of a pathology Commack, NY : Nova Science Publishers.
- Turel, O., Serenko, A. & Bontis, N. (2011). Family and Work-Related Consequences of Addiction to Organizational Pervasive Technologies. Information & Management, 48(2–3): 88–95. available online
- University, T. A. (2007, August 18). What exactly is 'Internet Addiction; and What is the Treatment? Science Daily .
- Welch, E. T. (2001). Addictions: a Banquet in the Grave. Phillipsburg, Pennsylvania: P & R Publishing.
- Young, Kimberly S. (2001). Caught in the Net: How to Recognize the Signs of Internet Addiction—and a Winning Strategy for Recovery
- Zur, O. & Zur, A. (2009). On Digital Immigrants & Digital Natives. Zur Institute available online