What is internet addiction?

Causes

Some researchers have suggested that problematic Internet use stems from introversion, inability to communicate directly with others, and social isolation. Other experts have developed models to explain the etiology of this puzzling disorder.

One cognitive-behavioral model states that Internet use provides a way to escape
real or perceived problems, often for persons who tend to overgeneralize and hold
catastrophic and negative views of reality. The anonymous character of the
Internet appeals to persons with low self-esteem and with negative thinking.
The Internet offers a nonjudgmental environment and induces an artificial feeling
of self-worth and belonging.

The compensation theory, promoted by Chinese researchers, maintains that the
Internet serves a spiritual compensatory function and represents an avenue for
forming social networks in an increasingly demanding and threatening society.
Another explanation centers on the neurophysiology of Internet use and the
pleasurable, euphoric effect it induces. This effect leads to a host of phenomena,
such as reinforcement (in mitigating loneliness or social
awkwardness), repeated use, tolerance, and withdrawal,
all of which are analogous to other addictions. Finally, some research
indicates that situational factors, including the loss of a loved one,
unemployment, and relocation, might prompt a person to seek solace on the
Internet, thereby precipitating the development of IA.

Risk Factors

Internet access occurs anywhere, anytime. Although fraught with issues of sampling and standardization, a large body of research confirms the existence of problematic Internet use across cultures and age groups. IA, a newer disorder, is more prevalent in young and middle-aged people, especially males and college students. Homemakers also appear to be at risk for the disorder.

The status of the Internet in modern culture ensures that all susceptible persons
(that is, persons with a genetic predisposition to addiction or those with
psychological disturbances) spend time on the Internet and can develop IA. Persons
undergoing life-changing events (such as bereavement, divorce, or job loss) are
more vulnerable to developing problematic Internet use. In some young persons,
studies show, the pressure to succeed can lead to Internet overuse as a means to
relieve the stress.

Socially isolated persons and persons with attention
deficit hyperactivity disorder (ADHD), depression,
and other psychological disorders are at an increased risk for developing IA.
Depression, ADHD, social phobia, and hostility predicted the occurrence of IA in
follow-up studies. Hostility and ADHD were the most important predictors of IA in
male and female adolescents, respectively. Persons with multiple addictions have a
high risk of becoming addicted to the Internet and to subsequently relapsing.

Symptoms

IA lacks formal diagnosis criteria. Many researchers still consider excessive
Internet use a compulsive, rather than addictive, behavior. In addition, some
think of it as a coping mechanism, a symptom of underlying psychological
abnormalities, or even a lifestyle change inherent to technological advances.
Significant progress has been made, however, in diagnosing IA since it was first
described in the mid-1990s. The fifth edition of the American Psychiatric
Association's Diagnostic and Statistical Manual of Mental
Disorders (DSM-5), published in 2013, included Internet gaming
disorder in Section III as a disorder that warrants more clinical research before
it can be considered for inclusion as a formal diagnosis, signaling increased
acceptance in the psychiatric community for the existence of Internet addiction;
however, the DSM's criteria for the condition are limited to Internet gaming and
do not include problematic use of the Internet in general or of social media.

Overall, the fundamental components of the addictive process, in some ways similar
to gambling addiction, are the following:
preoccupation with Internet use, greater usage than desired, numerous unsuccessful
attempts to reduce usage, withdrawal (with anger and tension when not online),
tolerance (including the need for more hours and better equipment), and lying
about Internet usage. The DSM criteria for Internet gaming disorder include
playing Internet games compulsively, to the exclusion of other interests; causing
clinically significant impairment or distress due to Internet gaming; experiencing
withdrawal; and incurring negative consequences at school or work.

Several subtypes of problematic online behavior exist, as the criteria for
Internet gaming disorder indicate. These subtypes include addictions to
gaming , gambling, sexual activities such
as viewing pornography, shopping, social media
use, and email or text message exchange. Affected persons
also may overuse digital devices such as smartphones and tablets. Some of these
behaviors likely indicate underlying psychological disorders (such as gambling and
compulsive shopping), while others represent Internet-specific behaviors (such as
gaming, texting, and browsing). The affected person might turn to the Internet
when feeling lonely and might establish online relationships.

Ultimately, the computer or other digital device becomes the person’s primary relationship. The affected person undergoes a cycle that rationalizes online behavior and that progresses through regret, abstinence, and relapse. These behaviors can damage relationships with family members and friends, further deepening social isolation. In addition, affected persons may experience difficulty setting and achieving goals, and may display poor attention skills, an inability to delay gratification, and poor school or job performance. One study suggested that young people who are initially free of mental health problems, but who use the Internet pathologically, could develop depression as a consequence. Some people who present with depression, anxiety, or obsessive-compulsive manifestations later show signs of IA upon further examination.

In addition to mental problems, excessive Internet use can lead to physical
conditions. Using a computer for extended periods of time leads to weight gain,
sleep deprivation, back pain, carpal tunnel syndrome, and vision
impairment.

Screening and Diagnosis

Unlike illegal drugs or gambling, for example, the Internet has widespread
legitimate uses in fields such as education, research, business, industry, and
communications. In this context, IA can be easily masked. Therapists may not
detect the disorder unless they look for it. To this end, they obtain a history of
symptoms and previous treatment attempts, and information about other potential
addictions.

Screening tests used include Internet addiction expert Kimberly Young’s Internet
Addiction Test (IAT) and multiple clinical interactions. Even so, diagnosing IA
can prove difficult because of the lack of rigorous diagnostic criteria. Experts
agree, however, that Internet activities become problematic when the person loses
his or her ability to control the use and when time spent online impairs daily
functions and jeopardizes relationships, employment, education, and personal
health. Studies generally indicate significant distress if Internet usage exceeds
twenty to twenty-five hours per week.

The first validated instrument to assess the disorder is the IA Test (IAT). This
questionnaire addresses the duration and frequency of online activities, job
productivity, ability to form new offline and online relationships, fear of life
offline, attempts to reduce Internet use, and many other behaviors. The person
answers each IAT question using a scale of 0 to 5. The higher the final score, the
greater the level of addiction. In addition to the severity of the addiction, the
therapist identifies the applications (such as gaming, pornography, and chat
rooms) that are most problematic for a particular person. The assessment is
completed by obtaining a history of earlier treatment attempts, identifying the
most detrimental types of usage, analyzing the family environment, and conducting
a motivational interview.

Treatment and Therapy

While China was one of the first countries to label IA as a clinical disorder,
hospitals and clinics all over the world have established treatment centers and
“detox” facilities for Internet addiction. The programs aim to reconnect
Internet-dependent youth and adults to the offline world by temporarily
eliminating all avenues for electronic communication or by gradually reducing
online time. In the United States, Young founded and opened the country's first
inpatient treatment program for IA in a hospital in 2013 at Bradford Regional
Medical Center in Pennsylvania. A ten-day program, the treatment includes
evaluation, therapy sessions, and seminars. A 2014 documentary titled Web
Junkie, screened at the Sundance Film Festival, examined problematic
Internet use in Chinese culture and offered a glimpse into one of the treatment
centers for IA.

Given society’s increasingly online nature, many therapists argue that traditional
abstinence treatment models may not yield
good outcomes, at least for some types of IA. Reorganization of the time periods
usually spent online, using timers and reminder cards, and setting goals may help
to limit the extent of online activities. Cognitive-behavioral therapy is often recommended as a first
therapeutic approach, in addition to couples therapy (especially for networking
and “Internet infidelity” addictions), cultivating hobbies, home maintenance
skill-building, and socializing opportunities.

The majority of individuals with Internet addiction have an additional psychiatric
diagnosis. In these persons, IA remains highly resistant to treatment and, in
turn, can render the coexisting psychiatric disorder more difficult to treat.
Consequently, any therapeutic attempt should consider the addict’s
comorbid conditions and address them
promptly.

Prevention

Despite providing undeniable benefits, the Internet can be detrimental when used inappropriately or obsessively. An expanding body of research aims to clarify the causes, evaluation methods, and treatment outcomes for this phenomenon, which threatens to reach epidemic proportions. Meanwhile, persons at risk of IA, especially youth, can benefit from safeguards that ensure appropriate Internet usage in schools and colleges. Setting limits for usage time is necessary for children and adolescents at home. Guardians and teachers should monitor and limit online time, especially among at-risk children with preexisting psychosocial difficulties.

South Korea has seen at least ten cardiopulmonary-related deaths in Internet cafés and one murder related to online gaming. Also, because hundreds of thousands of South Korean youths age six to nineteen years are affected by and require treatment for IA, that country has identified IA as a prominent public health issue and started training counselors to address the problem. Competent, aware, technology-savvy professionals now help to identify populations at risk and provide correct diagnoses and therapeutic strategies.

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