Internet addiction disorder, also called problematic Internet use or PIU, refers to a compulsion to stay online that interferes with obligations of school or work and is indulged in preference to engaging directly with friends and participating in social activities. Because no substance abuse is involved, this addiction is behavioral rather than chemical.
Bill looked at his watch. He had just finished playing an online game for almost an hour and a half. He was due at his high school play practice in about 50 minutes; that meant he had about 30 minutes before he had to leave. He checked his e-mail; nothing much there. He thought he would take a quick look at his friends’ Facebook pages. He was looking through one of them when one of his cyber friends sent him an instant message. “Wassup?” she asked.
“How are you?” he shot back, not remembering that she thinks he is in an earlier time zone. “What are you doing online at this hour?” she asked.
He had to think of a good excuse. Why would a Hollywood talent scout be online so early in the afternoon? “I made a big score today, and I am meeting some important people for dinner so I came home early and now I am just chillin’ here.”
He continued this fantasy conversation until she had to leave. He then looked at his watch. He was a half hour late for practice, for the third time this week. The director would surely drop him now.
Bill felt frustrated. He was not doing well in school because he never made time for studying. He stayed up late, writing e-mails, sending instant messages, playing online games, making Facebook entries, or reading other people's Facebook pages. He did not make time for his school friends any longer. His online friends seemed more important; they bolstered his self-esteem. Unfortunately, most of them were people he would never meet, and most of them thought he was someone else, like a Hollywood talent scout.
Bill wondered if he had a mental health problem.
Using the Internet makes up a large part of many people's lives. Some are online as part of their job; others are online because the cyber world provides escape from the real world.
Internet addiction is a compulsion to be online that controls some people's lives. In 1998, Kimberly Young of the Center for Internet Addiction Recovery defined Internet addiction as a deterioration of impulse control much like pathological gambling. Adapting eight pathological gambling criteria to Internet use, Young designed a way to diagnose Internet addiction. She found that people meeting her criteria spent 10 times the amount of hours on the Internet as a comparison group did. Those with Internet addiction suffered severe deterioration in their studies, relationships, finances, and careers due to the excessive time they spent online.
The concept of Internet addiction disorder was controversial in the early 2000s. Some researchers accepted and used it, whereas others thought it was misleading. In Korea and China, the problem of young people ignoring their social and academic responsibilities to be online was so pervasive that Internet addiction was accepted as a disorder in and of itself. The Korean and Chinese statistics, gathered in public Internet cafés, indicated patterns of excessive use, tolerance * , withdrawal * , and negative repercussions, such as poor achievement and social isolation. In the United States, there is no nationwide effort to collect statistics regarding this behavior. Even so, Internet addiction is classified as an Internet-use disorder in the Diagnostic and Statistical Manual of Mental Health Disorders, fifth edition ( DSM-5) of the American Psychiatric Association (APA). Within the manual, Internet-use disorder is described as a condition “recommended for further study.”
Any behavior that is considered to be an addiction should show symptoms of tolerance and withdrawal. Tolerance means that the user needs more of the addictive experience over time in order to experience the original thrill. Withdrawal means that stopping the addictive behavior brings on severe negative physical responses. Kimberly Young recognized that tolerance and withdrawal must be part of the composition of this disorder if it is a genuine addiction. The question in her recommended survey for identifying tolerance is: “Do you feel the need to use the Internet with increasing amounts of time in order to achieve satisfaction?” The question in her recommended survey for identifying withdrawal is: “Do you feel restless, moody, depressed, or irritable when attempting to cut down or stop Internet use?” These are two out of eight symptoms identified as comprising Internet addiction, yet the recommended standard is five out of the eight. These two essential symptoms of an addiction could be absent, according to Young, in a diagnosis of Internet addiction. The other symptoms identified by Young in a diagnosis of Internet addiction are:
In an article written by Jerold J. Block and published in the American Journal of Psychiatry in 2008, the author lists four symptoms of Internet addiction: “excessive use,” tolerance, withdrawal, and maladaptive behavior. According to Block, tolerance is the constant need to upgrade computer equipment. Withdrawal is the display of negative moods when the Internet is not available. Block notes the seriousness of Internet addiction in China, where it has been defined as spending at least six hours per day on the Internet and having some other maladaptive symptom.
Internet-use disorder can be described as problematic computer use or pathological computer use. These terms refer to a pattern of excessive computer use that interferes with daily life.
“Problematic computer use” implies that there are possibly other problems leading to the excessive use of the computer or Internet. These underlying conditions may be depression or obsessive-compulsive disorder (OCD). Both underlying conditions would be better helped with treatment designed to solve that specific condition. Other problems may include a lack of basic social skills. This lack could be addressed through counseling and social training.
The main symptom of pathological computer use is the affected person's inability to distinguish between the virtual world and reality. People affected may also not be able to function well in reality because of situations in the virtual world.
Many mental health professionals distinguish between different types of problematic activities related to Internet use: pornography, explicit sexual conversations online, online gambling, inappropriate involvement in social networking, and compulsive Internet shopping. There may be an underlying psychological issue in all of these behaviors. For example, inappropriate sexual behavior online may be more symptomatic of a sexual disorder than of compulsive Internet use.
In any given case of problematic or pathological computer use, a qualified mental health professional should be consulted to make an evaluation. If certified by a clinic specializing in Internet addiction, the mental health professional will most likely use checklists designed by the clinic similar to those designed by Young. These self-styled clinics should also be careful to rule out other possible conditions. Treatment would follow the standard procedures for the most clearly manifested disorder. Complications may involve the coexistence and interaction of two or more conditions.
Before a professional can make a diagnosis, the reason for the excessive time on the Internet has to be determined. If the reason is not related to a recognized disorder, there are other considerations to be addressed: time management problems, limited social life, or difficulty in assuming personal responsibility. All of these are serious concerns but may not reach the level of a mental disorder.
In China and Korea where the problem was first identified, the recommended therapy is a so-called boot camp for affected young people. The boot camp emphasizes daily responsibility, time management, and social skills development. Graduates are encouraged to pursue more productive and creative pastimes than spending time on the Internet.
Because the description of Internet addiction is modeled on other obsessive behaviors, the therapy follows the model of effective programs for obsessive behavior. A 12-step program was recommended by a number of sources. The 12-step therapeutic program is based on the model developed by Alcoholics Anonymous and similar programs. The method begins with individuals publicly admitting that they have a problem. An important component is constant interaction with a support group. The participants must acknowledge the pain they have caused others through the obsession and work to make amends.
The first step in treatment is to help the person develop appropriate time management skills. Some techniques are designed to curb time spent on the Internet. While full abstinence from the Internet is not practical, avoiding trigger applications is encouraged. Therapy is focused on helping the person identify and avoid those websites or programs. Finally, group therapy is designed to provide support. Family therapy is encouraged for those who have hurt their families through Internet addiction. The first inpatient treatment center for Internet addiction in the United States was opened at Bradford Regional Medical Center in Pennsylvania in 2013. Directed by Kimberly Young, the 10-day hospitalbased program includes group and family therapy alongside individualized counseling.
The main complication in identifying and treating Internet addiction is the appeal of new technology and its fascination for young and old. The young always adapt to new technology faster than the older generation. This fact may explain why so many young people are hooked. But Young found many older women spending excessive time on the Internet. These women were old enough to remember when typing was considered a feminine skill. It seemed important to them that they were using a familiar skill in a way that gave them new power. A good typist can feel comfortable and self-assured making more entries and replies on blogs and bulletin boards.
The Internet is an avenue to virtual worlds. There is much that can be explored in these cyber worlds, and they are ever expanding. These two features may give many “explorers,” young and old, a sense of doing something important or creative.
There is also a possible generational component to the young adults who are addicted to online games that they have played for years. These young adults observed the early versions of these games and have watched the games and their roles in playing them evolve. In short, there are individual reasons why people are hooked on Internet activity.
Once schools and families learn about the dangers of excessive online use, education can include guidelines for productive use of the Internet for education and research. There are many online sources and commercial products to help parents control their children's use of the Internet in order to protect them from predators.
See also Addiction • Depressive Disorders: Overview • Obsessive-Compulsive Disorder
Montag, Christian, and Martin Reuter. Internet Addiction: Neuroscientific Approaches and Therapeutical Interventions. New York: Springer, 2015.
Schell, Bernadette H. Online Health and Safety: From Cyberbullying to Internet Addiction. Santa Barbara, CA: Greenwood, 2016.
Net Addiction. “FAQs.” http://netaddiction.com/faqs/ . (accessed March 17, 2016).
ReSTART. “Signs and Symptoms of Computer and Internet/Gaming Addiction.” http://www.netaddictionrecovery.com/the-problem/signs-and-symptoms.html (accessed March 17, 2016).
Bradford Regional Medical Center. 116 Interstate Pkwy., Bradford, PA 16701. Telephone: 814-368-4143. Website: https://www.brmc.com (accessed March 17, 2016).
ReSTART Center for Digital Technology and Sustainability. 1001 290th Ave. SE, Fall City, WA 98024. Toll-free: 800-682-6934. Website: http://www.netaddictionrecovery.com/ (accessed March 17, 2016).
* tolerance (TALL-uh-runce) is a condition or behavior in which a person needs more of a drug or behavior to feel the original effects of the drug.
* withdrawal is a group of symptoms that occurs when a drug or behavior that causes physical or psychological dependence is regularly used or engaged in for a long time and then is suddenly discontinued or decreased.