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Two decades of research into problematic Internet use have not yielded an established definition, much less an accepted treatment algorithm that is based on the psychopharmacological and psychotherapeutic interventions that have been tested. Meanwhile, technology-mediated tools that purport to curb unnecessary use of Internet-related technologies and the associated negative consequences are gaining in popularity, despite the lack of rigorous clinical trials into their efficacy and safety. Some popular new offerings that vary in browser, operating system and platform compatibility are reviewed. While they share similar goals as “traditional” treatments, they may be more efficient, scalable, and affordable. Using technology against itself may be counter-intuitive, but the popularity of these tools and their potential advantages make them worthy of researchers’ attention. Telepsychiatry platforms, which are gaining a foothold in the treatment of established disorders, may, paradoxically, also prove beneficial for the management of problematic use of Internet-related technologies.
This article re-examines the popular concept of Internet addiction, discusses the key problems associated with it, and proposes possible alternatives. The concept of Internet addiction is inadequate for several reasons. Addiction may be a correct designation only for the minority of individuals who meet the general criteria for addiction, and it needs to be better demarcated from various patterns of excessive or abnormal use. Addiction to the Internet as a medium does not exist, although the Internet as a medium may play an important role in making some behaviors addictive. The Internet can no longer be separated from other potentially overused media, such as text messaging and gaming platforms. Internet addiction is conceptually too heterogeneous because it pertains to a variety of very different behaviors. Internet addiction should be replaced by terms that refer to the specific behaviors (eg, gaming, gambling, or sexual activity), regardless of whether these are performed online or offline.
The Internet has positively altered many aspects of life. However, for a subset of users, the medium may have become a consuming problem that exhibits features of impulse control disorders recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.
This is the first large-scale epidemiological study of problematic Internet use through a random-digit-dial telephone survey of 2,513 adults in the United States. Given the lack of validated criteria, survey questions were extrapolated from established diagnostic criteria for impulse control disorders, obsessivecompulsive disorder, and substance abuse. Four possible diagnostic criteria sets were generated.The least restrictive set required the respondent to report an unsuccessful effort to reduce Internet use or a history of remaining online longer than intended, Internet use interfering with relationships, and a preoccupation with Internet use when offline.
The response rate was 56.3%. Interviews averaged 11.3 minutes in duration. From 3.7% to 13% of respondents endorsed ≥1 markers consistent with problematic Internet use. The least restrictive proposed diagnostic criteria set yielded a prevalence of problematic Internet use of 0.7%.
Potential markers of problematic Internet use seem present in a sizeable proportion of adults. Future studies should delineate whether problematic Internet use constitutes a pathological behavior that meets criteria for an independent disorder, or represents a symptom of other psychopathologies.
This chapter deals with clinical aspects of problematic Internet use. It suggests that formal diagnostic criteria would enhance recognition of and research regarding problematic Internet use. Factor analysis extracted six factors from the Internet Addiction Test (IAT): salience, excessive use, neglect of work, anticipation, lack of control, and neglect of social life. These six factors strongly correlated with each other and showed good to moderate internal consistency. Caplan has described the Generalized Problematic Internet Use Scale (GPIUS), which was reliable and valid in a preliminary study. Patients' Internet use often appears to become problematic soon after they first use the Internet, possibly within 6 months to a year a time when they feel intimidated as well as fascinated by the new technology. Problematic Internet use may respond to serotonin reuptake inhibitors, although larger and longer controlled trials are needed to investigate this possibility.
In the last decade, much needed attention and research has been focused on the group of psychiatric conditions termed 'impulse control disorders' or ICDs. Pathological gambling, compulsive shopping, kleptomania, hypersexuality, Internet 'addiction', among other disorders, are characterized by a recurrent urge to perform a repetitive behavior that is gratifying in the moment but causes significant long-term distress and disability. Despite the high rate of co-morbidity with obsessive compulsive disorder, ICDs are now clearly distinguished from these disorders with a unique clinical approach for diagnosis and treatment. A wide array of psychopharmacologic and psychotherapeutic options is now available for treating these disorders. Drs Elias Aboujaoude and Lorrin M. Koran have collated the world's foremost experts in ICD research and treatment to create a comprehensive book on the frequency, evolution, treatment, and related public policy, public health, forensic, and medical issues of these disorders. This is the first book to bring together medical and social knowledge bases related to impulse control disorders.
This chapter focuses on the link between playing violent video games and exhibiting aggressive behavior. Experimental and correlational studies have reported that playing violent video games is associated with increased levels of physiological arousal, decreased prosocial behaviors, greater hostility, more frequent arguments with teachers and poorer school performance, and more frequent physical fights and aggressive or antisocial behavior. Numerous video games contain some degree of violence, frequently with the player's character as both protagonist and perpetrator of the violence. In the virtual world of violent video games, the player may kill or injure computer-generated characters or other online gamers without any consequence, including punishment. Parental involvement is particularly important to ensure that children and adolescents with high levels of anger and hostility, conduct disorder, or antisocial behavior have restricted or no access to violent video games and other violent media.