PROBLEMATIC INTERNET USAGE: THE RELATIONSHIP BETWEEN

COMORBID ANXIETY DISORDERS, SELF-MEDICATION, NEUROTICISM,

AND SENSATION SEEKING WITHIN A DSM-5 CONCEPTUALIZATION

A dissertation submitted

by

ANDREW JUSTIN THRASHER III

To

FIELDING GRADUATE UNIVERSITY

In partial fulfillment of the
requirements for the degree of

DOCTOR OF PHILOSOPHY IN PSYCHOLOGY

With and Emphasis in
Clinical Psychology

This dissertation has been accepted for
the faculty of Fielding Graduate
University by


______________________________________
Raymond C. Hawkins II, PhD, ABPP
Chair

Committee:

Marilyn Freimuth, PhD, Facility Reader
Michele Harway, PhD, Faculty Research Specialist
Samuel D. Gosling, PhD, External Examiner
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ii

Problematic Internet Usage: The Relationship between Comorbid Anxiety Disorders,
Self-Medication, Neuroticism, and Sensation Seeking within a DSM-5 Conceptualization
by

Andrew Justin Thrasher III

Abstract
The DSM-5 introduced a paradigm shift concerning addictive disorders by including
gambling disorder, a non-substance-related disorder, in the Substance-Related and
Addictive Disorders section. The inclusion of gambling disorder in this section of the
DSM-5 opened the door for research of other non-substance-related disorders such as
problematic Internet usage. With the proliferation of the Internet into almost every aspect
of our lives, there is a need to study the potential addictiveness and the risk factors
associated with this technological phenomenon. This study used a validated problematic
Internet usage instrument, the Problematic Internet Use Questionnaire, to evaluate the
correlation between problematic Internet usage and multiple at risk variables that could
contribute to problematic Internet usage. These variables included worry, social anxiety,
sensation seeking, neuroticism, and endorsement of self-medication. I hypothesized that
problematic Internet usage scores on the Problematic Internet Use Questionnaire would
be higher for individuals endorsing higher scores on the at risk variables mentioned
above (worry, social anxiety, sensation seeking, neuroticism, and endorsement of self-
medication). To examine this hypothesis, a forced entry multiple regression analysis was
conducted to assess the simultaneous effects of worry, social anxiety, sensation seeking,
neuroticism, and self-medication on problematic Internet usage while also controlling for

iii

age and gender. All measured variables (age, gender, neuroticism, social anxiety, worry,
sensation seeking, and endorsement of self-medication) except gender contributed toward
problematic Internet usage. Neuroticism had the highest correlation with problematic
Internet usage (r = .40, p, < .001), and it was the best single predictor ( = .35, p = < .01)
of problematic Internet usage among all other predictor variables (social anxiety, worry,
sensation seeking, and self-medication). The study included a sample of 206 Internet
users from North America (128 females and 78 males) with an age range from 16 to 68
years. The mean age of the participants was 35 years with a SD 11 years.
Keywords: addiction, DSM 5, Internet, neuroticism, problematic Internet use, self-
medication


iv





Copyright by
Andrew Justin Thrasher III
2013


v

Acknowledgements
This research project would not have been possible without an incredibly
supportive committee. I want to thank my Chair, Ray Hawkins, for his mentorship,
constructive feedback, and his ability to work with insanely short time lines (often caused
by my second job in the Army). My second reader, Marilyn Freimuth, provided some of
the best (if not the best) feedback I ever received in my graduate work. She provided
clarity and cohesiveness to a research novice as I worked through the process of pre-
proposal to final draft. Michele Harway, my methods expert, not only went out of her
way to provide me with timely feedback, but she also recommended multiple excellent
resources when I was stuck in a statistical rut. My external reader, Sam Gosling, gave
absolutely brilliant suggestions for my proposal which not only saved my data collection
when one source fell through, but also added a much needed level of depth to my
personality variable. It is obvious why he is a leader in the field of personality
psychology, and I was very fortunate to have him on my committee.
I would not have written one word on anything in graduate school if my wife,
Regan Thrasher, had not actively encouraged, nurtured, and occasionally forced me to
pursue my career goal in psychology. She is truly wonderful and made the arduous
process of dissertation as painless as it could possibly be for me and our two beautiful
children, Andy and Zoe. Finally, I want to thank my mother and father for their endless
support throughout my life and more specifically proof-reading numerous drafts.


vi

Table of Contents
CHAPTER ONE: INTRODUCTION ....................................................................1
Background of Problematic Internet Usage .....................................................1
Purpose of the Study.....................................................................................4
CHAPTER TWO: LITERATURE REVIEW ..........................................................6
Terminology ................................................................................................6
Specific vs. Generalized Problematic Internet Usage .....................................6
Problematic Internet Usage Conceptualized as a Psychological Disorder ............8
Problematic Internet Usage Conceptualized as an Impulse Control Disorder .... 10
DSM-5 Inclusion and Internet Gaming Disorder Recognition ...................... 14
Problematic Internet Usage and Excessive Use ........................................... 15
Problematic Internet Usage and Withdrawal ............................................. 16
Problematic Internet Usage and Negative Life Outcomes............................. 19
Measuring Problematic Internet Usage ..................................................... 20
Problematic Internet Usage and Self-Medication Hypothesis ........................... 23
Problematic Internet Usage and Social Anxiety.............................................. 24
Attractiveness of Computer-Mediated Communication ............................... 26
Caplans Deficient Social Skills Model ....................................................... 30
Measuring Social Anxiety ........................................................................ 33
Problematic Internet Usage and Worry ........................................................ 36
Measuring Worry ................................................................................... 39
Greenfields Motivational Theory of Problematic Internet Usage..................... 40
Personality Traits and Problematic Internet Usage ........................................ 47
Cattells Personality Theory and Problematic Internet Usage ...................... 48
Five-Factor Model of Personality .............................................................. 50
Five-Factor Model and Internet Usage ...................................................... 53
Five-Factor Model and Application Preference .......................................... 54
Neuroticism and Problematic Internet Usage ............................................. 57
Measuring the Five-Factors of Personality ................................................. 58
Problematic Internet Usage and Sensation Seeking ..................................... 61
Measuring Sensation-Seeking ................................................................... 62

vii

Statement of the Problem ............................................................................ 66
Statement of Hypotheses ............................................................................. 72
Hypothesis 1 .............................................................................................. 72
Hypothesis 1a ............................................................................................ 72
Hypothesis 1b ............................................................................................ 72
Hypothesis 2 .............................................................................................. 72
CHAPTER THREE: RESEARCH METHOD....................................................... 74
Methods .................................................................................................... 74
Participants............................................................................................ 74
Materials ............................................................................................... 74
Procedure .............................................................................................. 76
Analyses ................................................................................................ 77
CHAPTER FOUR: RESULTS .......................................................................... 78
Results ...................................................................................................... 78
Descriptive Data ..................................................................................... 78
Preliminary Analyses .............................................................................. 79
Hypothesis 1: The Role of Worry, Social Anxiety, Sensation Seeking,
Neuroticism, and Self-Medication in Problematic Internet Usage ................. 81
Hypothesis 1a: The Role of Six Facets of Neuroticism in Problematic Internet
Usage .................................................................................................... 83
Hypothesis 1b: The Role of Novelty and Intensity in Problematic Internet
Usage .................................................................................................... 86
Hypothesis 2: Self-Medication Moderating Worry, Social Anxiety, and
Neuroticism............................................................................................ 89
CHAPTER FIVE: DISCUSSION, CONCLUSIONS, AND RECOMMENDATIONS .. 90
Discussion ................................................................................................. 90
Limitations of the Study .............................................................................. 96
Conclusion ................................................................................................ 97
References ............................................................................................... 100
Appendix A: Problematic Internet Use Questionnaire .................................. 111
Appendix B: Penn State Worry Questionnaire............................................. 113
Appendix C: Liebowitz Social Anxiety Scale................................................ 114
Appendix D: Arnett Inventory of Sensation Seeking ..................................... 115

viii

Appendix E: Ten Item Personality Inventory .............................................. 116
Appendix F: International Personality Item Pool ......................................... 117
Appendix G: Informed Consent ................................................................. 118
Appendix H: Age and Gender Means for Problematic Internet Use Questionnaire
.............................................................................................................. 120
Appendix I: Hypothesis 2 Self-Medication Significance Values ...................... 121


ix

List of Tables
Table 1: Instrument Means, Standard Deviations, and Norms .................... 77
Table 2: Hypothesis 1 Correlational Statistics ............................................ 80
Table 3: Hypothesis 1 Regression Analysis................................................ 81
Table 4: Hypothesis 1a Correlational Statistics for the 6 Facets of
Neuroticism ................................................................................................ 83
Table 5: Hypothesis 1a Regression Analysis for the 6 Facets of Neuroticism
.................................................................................................................... 84
Table 6: Hypothesis 1b Correlational Statistics for Sensation Seeking
Traits........................................................................................................... 85
Table 7: Hypothesis 1b Regression Analysis for Sensation Seeking Traits 86
Table H-1: Age and Gender Means for Problematic Internet Use
Questionnaire ............................................................................................. 86






CHAPTER ONE: INTRODUCTION
Background of Problematic Internet Usage
Late one October night in 2007, Daniel Petric silently entered his parents
bedroom. The16-year-old boy approached his sleeping parents, pulled out a 9mm
handgun, and shot both of them in the head. His mother was killed instantly, while his
father miraculously survived. When questioned by police about a motive, Daniel detailed
that the shooting was the culmination of his parents revoking his online gaming
privileges (Kropko, 2009). In South Korea, a 28-year-old-man died from heart failure
brought on by exhaustion resulting from an Internet caf marathon that lasted for almost
three days without a single break (South Korean, 2005). A young Korean couple spent
12-hours a day nurturing and caring for their child. Unfortunately, the child who got all
this attention was an online, virtual character, while their real newborn starved to death in
a nearby apartment (South Korean couple, 2010). White House correspondent, Tommy
Christopher, tweeted through a heart attack, detailed the pain of the experience, and
continued tweeting even after being administered morphine (Brooks, 2010). Although
extremes, these are real-life examples of the potential addictiveness of the new
technological phenomenon, the Internet.
Addictive behaviors associated with the Internet made sensational headlines over
the last decade. In the most severe cases, addictive Internet use was linked to relationship
turmoil, financial ruin, child neglect, and even suicide and murder. A recent study
indicated that approximately 15% of women reported that online game playing by their
spouses was a major contributor to their divorces (Divorce Online, 2011). The term
Internet addiction has become a catchall phrase, and it now represents multiple activities


2
available online. Internet users engage in activities such as gambling, dating, chatting,
shopping, and viewing sexually explicit material (Kim & Kim, 2010). In the current
research, the general term Internet addiction was avoided to conform to the nomenclature
now utilized by the DSM-5 to avoid potential misinterpretation of the disorder by using
terms like abuse and addiction. It is important to highlight that while the DSM-5 uses the
terms Internet Use Disorder and Internet Gaming Disorder, this study examined usage,
not addiction or Internet Use Disorder, utilizing the Problematic Internet Use
Questionnaire. In order to emphasize this delineation, I use the term problematic Internet
use throughout this paper.
The Internet permeates virtually every aspect of modern society. With rapidly
advancing technology, individuals can connect to the Internet from almost any location
on Earth. Terms like Facebook, Twitter, and iPhone are now integrated within the general
lexicon. The Internet is no longer a fad for the privileged few, but a complete new form
of global communication and generational identification. This is evident as the United
Nations now considers the Internet a basic human right (Kravets, 2011). Limiting or
obstructing access to the Internet is considered a violation of Article 19 of the
International Covenant on Civil and Political Rights (1966) which implicates the
Internets significant role in the freedom to seek, receive and impart information and
ideas of all kinds.
Addictive and dependent behaviors associated with the Internet were documented
across multiple cultural boundaries (Chakraborty, Basu, & Kumar, 2010; Chou, Condron,
& Belland, 2005; Widyanto & Griffiths, 2006). Although the United States was at the


3
forefront for recognition of the problem, other countries, such as China, South Korea, and
Taiwan, are leaders in current research. South Korea recently initiated a blackout for late-
night Internet use among adolescents and teenagers in order to prevent fatigue at school
(Woong-ki, 2010). The Chinese government considers problematic Internet usage one of
the most important health issues facing the country. China opened the first problematic
Internet usage inpatient clinic in 2006, and South Korea currently maintains
approximately 150 addiction clinics specifically designated to treat Internet-related
problems (Young & Abreu, 2010).
The Internet was hailed as God in a Box (Greenfield, 2010, p. 141). This
expression symbolizes the unique properties of the Internet which are unlike any media
form in history. The Internet offers immediate, varied, and incredibly rewarding content
to users with a simple mouse click. The latency period between thought and content is
near instantaneous. This makes the user almost omniscient with the amount of control
and speed the Internet provides to locate exactly what he or she desires. The content
available at the end of each click is among the most stimulating available on the planet.
Within seconds, the user can interact with videos, music, games, books, shopping, and
even pursue social relationships. Although widely praised, the rapid proliferation of the
Internet has not come without caveats. The technology was allowed into our most private
sanctums relatively unchecked. The Internet provides few boundaries, and the threshold
between present reality and a timeless state of interactivity is tenuous. It is no wonder
research has now focused on the addictive properties of this new medium. Internet
gaming disorder was included in the Diagnostic and Statistical Manual of Mental


4
Disorders (5
th
ed.) (DSM-5) in Section III as a potential disorder in need of additional
research before it could be considered a mental disorder comparable to gambling disorder
(APA, 2013).
Purpose of the Study
With the current mandate from the DSM-5 to study Internet gaming and the rapid
proliferation of Internet use worldwide, it is important to examine Internet users to
determine if users are at risk for problematic Internet usage. This study examined
problematic Internet usage with guidelines suggested in Section III, Conditions for
Further Study, of the DSM-5. The recent diagnosis of gambling disorder as a non-
substance-related disorder in Section II, Substance-Related and Addictive Disorders, of
the DSM-5 opened the door for research of other non-substance-related addictive
disorders such as problematic Internet usage.
The risk factors for problematic Internet usage examined in the current study
included worry, social anxiety, sensation seeking, neuroticism, and endorsement of self-
medication. These variables were chosen because past research suggested they might play
a significant role in the development of problematic Internet usage.
I used the Problematic Internet Use Questionnaire, a validated problematic
Internet usage instrument, to evaluate the role that worry (measured by the Penn State
Worry Questionnaire), social anxiety (measured by the Liebowitz Social Anxiety Scale),
sensation seeking (measured by the Arnett Inventory of Sensation Seeking), neuroticism
(measured by the International Personality Item Pool), and self-medication (measured by
the endorsement of self-medication) play in excessive problematic Internet Use


5
Questionnaire scores. These variables were investigated to determine if they would be
powerful predictors of problematic Internet usage as measured by the Problematic
Internet Use Questionnaire.


6
CHAPTER TWO: LITERATURE REVIEW
Terminology
Problematic Internet usage is a fledgling concept with a rapidly growing body of
research. The infancy of problematic Internet usage is apparent in the lack of a consistent
nosology. Multiple literature reviews on the subject identified various terms that
represented the concept of problematic Internet usage. These included Internet addiction,
compulsive Internet use, Internet pathological use, Internet dependency, pathological
Internet use, problematic Internet use, Internetomania, and technological addiction
(Chakraborty et al., 2010; Chou, Condron, & Belland, 2005; Widyanto & Griffiths,
2006). Greenfield (2010) suggested the term digital media compulsion which
incorporated the limitless devices which now keep us permanently online. Kelley and
Gruber (2010) noted that recent articles favored problematic Internet use. Charkraborty et
al. (2010) found Internet addiction to be the most widely used term in the scientific
literature. For the sake of simplicity and consistency and to conform to current DSM-5
nomenclature, I will use the term problematic Internet usage throughout this paper.
Specific vs. Generalized Problematic Internet Usage
With all the different activities available on the Internet, it is difficult to determine
if the technology, that is, the Internet, or the specific activity is the mechanism for
addictive behavior. Davis (2001) distinguished between specific and generalized
problematic Internet usage. Specific problematic Internet usage is distinguished by a
predilection for one aspect or activity on the Internet. Individuals with a specific
problematic Internet usage would likely continue the problematic behavior if Internet


7
connectivity is lost. Online gambling, compulsive pornographic viewing, and shopping
addictions are considered common specific Internet pathologies. These activities are
generally not fueled by the technology of the Internet; however, the Internet makes these
pastimes easily accessible. In contrast, generalized problematic Internet usage involves
complete dependence on the technological medium from which it began and includes a
wider range of usage habits. Chat rooms, email, web surfing, and playing online games
are common Internet applications overused by individuals with a generalized Internet
pathology. Individuals with generalized problematic Internet usage use applications with
no plan, time limit, or to avoid work. There is sometimes, though not always, a
procrastination element involved with generalized problematic Internet usage. Davis
contended that generalized problematic Internet usage often stems from an enjoyment of
the communication medium of the Internet. The preference for life within a virtual
environment, observed in generalized problematic Internet usage, can have deleterious
effects on individuals social lives as they choose Internet-based communication over
face-to-face interactions.
The lines between specific and generalized problematic Internet usage are
becoming increasingly blurred. As Greenfield (2010) implies, it may be beneficial to
move away from the rigid definitions of Internet use as specific or generalized. The
Internet is now so prolific throughout modern society that many specific addictions begin
and end with the ability to connect online. Technology is also changing so rapidly that a
single application can contain multiple aspects of Internet activities (e.g., a single Internet
game can contain email, chat, web surfing, and gambling). The multitude of Internet


8
capable devices (phones, gaming consoles, televisions, etc.) also complicates rigid
definitions. The content viewed or interacted with is no longer as important as the
motivating factor of recreational usage. In this research, I evaluated Internet use that is
recreational and did not differentiate between potential specific and generalized Internet
usage. The instrument used for measuring problematic Internet usage in this paper, The
Problematic Internet Use Questionnaire, was designed to evaluate recreational computer
use.
Problematic Internet Usage Conceptualized as a Psychological Disorder
The majority of research on problematic Internet usage was based on the current
diagnostic criteria for impulse-control disorders (Chakraborty et al., 2010; Chou et al.,
2005; Czincz & Hechanova, 2009; Widyanto & Griffiths, 2006). Young (1996, 1998,
2010) was among the first to conceptualize problematic Internet usage within the major
diagnostic class of impulse-control disorders not elsewhere classified within the DSM-
IV-TR (APA, 2000). More specifically, she envisioned problematic Internet usage
similarly to the subcategory of pathological gambling. Other research compared
problematic Internet usage with the DSM-IV-TR model of substance related disorders
which also has impulse-control features (Czincz & Hechanova, 2009). Before delving
into the specific diagnostic criteria for problematic Internet usage, it is important to
highlight some criticism of Youngs use of impulse-control disorder as a model for
problematic Internet usage and additional criticism regarding addiction criteria in general.
Grohol (1999) concluded that Youngs substitution of problematic Internet usage
criteria for pathological gambling criteria was not only arbitrary but also lacked empirical


9
evidence. Wolf and Beard (2001) noted the broadness of criteria selection and the overall
subjective nature for diagnosing any impulse-control disorder much less problematic
Internet usage. Some debated that the core model of problematic Internet usage was more
appropriately defined as a deficiency in self-regulation rather than the current trend
toward pathological classification using addiction or disease templates such as impulse-
control disorder or substance-related disorders (Caplan & High, 2010). The challenge
problematic Internet usage currently faces with validity of diagnostic criteria mirrors a
larger debate regarding the general concept of addiction. This is particularly true for
behavioral addictions which some researchers contend lack a measurable physiological
component (Shapira Goldsmith, Keck, Khosla, & McElroy, 2000).
Kipnis (1997) stressed the lack of a gold standard for measuring the diagnostic
criteria for an impulse control disorder such as pathological gambling. He pointed out
there is no true objective method. He questioned if there was any way to measure an
individuals impulse to initiate or continue an addictive behavior. One possible solution
toward developing a gold standard would be an assessment that could consistently
measure neurochemical or activated neurological pathways associated with impulse-
control (Czincz and Hechanova, 2009). Schmitz (2005) maintained that while a
physiological measurement would be ideal that there were currently too many
confounding causal factors to make a gold standard physiological assessment instrument
gaging impulses as a reality in current neuropsychology. Shaffer (1999) argued even
further that there is no current gold standard for recognizing any type of addiction much
less a subcategory like pathological gambling or problematic Internet usage. According to


10
Shaffer, addiction must move beyond mere observable consensus between researchers in
order for it to become a practical construct. Simply labeling a disorder is not immutable
proof that it actually exists. Although not perfect, categorization and identification of
criteria within the impulse-control spectrum is the current standard for diagnosing
problematic Internet usage. Although critics emphasize the problems with accurately
diagnosing impulse-control disorders without physiological-based assessments (i.e., a
neurological measurement of impulse drive), they question the overall construct of
addiction. It is still important to recognize and categorize potential new behavioral
problems. For example, more people seek treatment for pathological gambling than
before it was recognized as a mental disorder. Researchers are now lowering the
thresholds needed for earlier detection of the disorder (Shaffer, 1999). As part of the first
step in recognizing problematic Internet usage as a potential mental disorder, the DSM-5
task force recently recommended that Internet Gaming Disorder be included in Section
III as an Addictive Disorder which needs additional research (Block, 2008; Young,
2010). In the final edition of the DSM-5 Internet gaming disorder was mentioned as an
excessive behavioral pattern that needed peer-reviewed research before it could be
considered a true disorder comparable to gambling disorder. In this study, it was my
intention to add to the body of literature recognizing problematic Internet usage as a
diagnosable mental disorder.
Problematic Internet Usage Conceptualized as an Impulse Control Disorder
Young (1996, 1998, 2010) conceptualized problematic Internet usage as an
impulse control disorder within the subcategory of pathological gambling in the DSM-


11
IV-TR (APA, 2000). The defining feature of impulse-control disorders in the DSM-IV-
TR is the failure to resist an impulse, drive, or temptation to perform an act that is
harmful to the person or to others (p. 663). The individual experiences tension or
arousal prior to the behavior, feels pleasure, gratification, or relief during the
behavior, and sometimes concludes the problematic behavior with regret, self-reproach,
and guilt (p. 663). Within the overarching category of impulse control disorder, the
DSM-IV-TR contains two core criteria for pathological gambling (Criterion A and B): (a)
pathological gambling behavior that disrupts multiple aspects of daily functioning (self,
interpersonal, work, etc.), and (b) the associated gambling behavior is not a diagnosable
manic episode. Criterion A consists of 10 subcriteria outlining key aspects of problematic
gambling. In order to be diagnosed with pathological gambling, an individual must meet
at least five of these subcriteria in Criterion A, and they must not meet Criterion B for a
manic episode.
Young (1996, 1998, 2010) reworded eight of the ten subcriteria under Criterion A
for pathological gambling to represent the diagnostic conditions associated with
problematic Internet usage. Young rephrased these criteria into questions and developed
the Internet Addiction Diagnostic Questionnaire. The Internet Addiction Diagnostic
Questionnaire contained the following items:
1. Do you feel preoccupied with the Internet (think about previous online activity
or anticipate next online session)?
2. Do you feel the need to use the Internet with increasing amounts of time in
order to achieve satisfaction?


12
3. Have you repeatedly made unsuccessful efforts to control, cut back, or stop
Internet use?
4. Do you feel restless, moody, depressed, or irritable when attempting to cut
down or stop Internet use?
5. Do you stay online longer than originally intended?
6. Have you jeopardized or risked the loss of a significant relationship, job, or
educational or career opportunity because of the Internet?
7. Have you lied to family members, therapists, or others to conceal the extent of
involvement with the Internet?
8. Do you use the Internet as a way of escaping from problems or of relieving a
dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression) (Young,
2010, p. 20)?
Young (1996, 1998, 2010) removed subcriteria eight and ten under Criterion A
for pathological gambling as she felt they did not apply to problematic Internet usage.
The two removed criteria included the following:
8. has committed illegal acts such as forgery, fraud, theft, or embezzlement to
finance gambling.
10. relies on others to provide money to relieve a desperate financial situation
caused by gambling (APA, 2000, p. 674).
Although the Internet Addiction Diagnostic Questionnaire contained only eight
items as compared to the ten in the criteria for pathological gambling, Young kept the
robust requirement of meeting five or more criteria for a diagnosis of addiction. Beard


13
and Wolf (2001) suggested all of the first five criteria and at least one of the last three
criteria of the Internet Addiction Diagnostic Questionnaire must be met in order to
diagnose an individual with problematic Internet usage. They considered the first five
items to be non-essential criteria for day-to-day living, while the last three dealt with
extreme impairments to an individuals overall psychological and interpersonal
functioning. Other research expanded on Youngs conceptualization of problematic
Internet usage as an impulse-control disorder (Shapira et al., 2003; Treuer et al., 2001)
Shapira et al. (2003) used broader criteria than Young to define problematic
Internet usage within the impulse control disorder spectrum. They outlined three core
criteria for problematic Internet usage: (a) loss of control; (b) noticeably distressing, time
consuming, or negative life outcomes (social, professional, etc.); and (c) absence of a
manic episode. They evaluated 20 individuals using the Structured Clinical Interview for
Diagnostic and Statistical Manual of Mental Disorders-IV and a modified YaleBrown
ObsessiveCompulsive Scale. They found all 20 individuals met the criteria for Impulse
Control Disorder NOS while only three meet DSM-IV criteria for obsessive-compulsive
disorder.
Treuer. Fabian, and Furedi (2001) evaluated 86 responses to a questionnaire
emphasizing attitudes and behaviors of Internet users. They found many responses
endorsing criteria similar to impulse control disorders. Over 70% of the respondents
endorsed the following items: (a) craving to be online when offline; (b) dull existence
without the Internet; (c) fantasies about the Internet; (d) anxious if unable to connect to
the Internet; and (e) aggressive behavior if thwarted from using the Internet.


14
Approximately 43% of respondents also endorsed depression and guilt after overusing
the Internet. Treuer et al. concluded that symptoms of dependents most closely related to
the current DSM-IV diagnoses of impulse control disorder.
DSM-5 Inclusion and Internet Gaming Disorder Recognition
The DSM-5 revisions brought about significant change to addiction and impulse-
control disorder classification. Substance-use disorders and non-substance-use disorders
were subsumed within the Substance Related and Addictive Disorders diagnostic
category. Gambling disorder, most likely the future template for problematic Internet
usage, was included in this new category. The DSM-5 version of gambling disorder
currently includes course specifiers (episodic, chronic, and in remission), and severity
levels (mild, moderate, and severe). These same types of specifiers and severity levels
could be easily adapted to the criteria needed to diagnose problematic Internet usage.
The following criteria were suggested in Section III of the DSM-5 for Internet
gaming disorder but could easily be adapted for use as criteria for problematic Internet
usage:
1. Preoccupation with Internet games. (The individual thinks about previous
gaming activity or anticipates playing the next game; Internet gaming
becomes the dominant activity in daily life).
2. Withdrawal symptoms when Internet gaming is taken away. (These symptoms
are typically described as irritability, anxiety, or sadness, but there are no
physical signs of pharmacological withdrawal.)


15
3. Tolerancethe need to spend increasing amounts of time engaged in Internet
games.
4. Unsuccessful attempts to control the participation in Internet games.
5. Loss of interests in previous hobbies and entertainment as a result of, and with
the exception of, Internet games.
6. Continued excessive use of Internet games despite knowledge of psychosocial
problems.
7. Has deceived family members, therapists, or others regarding the amount of
Internet gaming.
8. Use of Internet games to escape or relieve a negative mood (e.g., feelings of
helplessness, guilt, anxiety).
9. Has jeopardized or lost a significant relationship, job, or educational or career
opportunity because of participation in Internet games (APA, 2013, p. 795).
The current recommended criteria for Internet gaming disorder incorporated
Blocks (2008) suggested compulsive-impulsive spectrum conceptualization which
included the key concepts of (a) excessive use, involving a loss of time or problems in
daily functioning; (b) withdrawal, including emotionally upset reactions toward loss of
computer usage; and (c) negative repercussions from Internet usage, such as lying,
exhaustion, and social isolation.
Problematic Internet Usage and Excessive Use
Common sense would suggest that time spent online is an important factor in
determining problematic Internet usage; however this is not the case. Young (1998)


16
found that dependents spent approximately 40 hours per week using the Internet, while
non-dependents were online only 8 hours per week. Morahan-Martin and Schumacher
(2000) documented 22 dependent users averaging 8.5 hours per week. Other research
reported that dependent users were online approximately 2 3 times more than healthy
users (Chou & Hsiao, 2000). Although time does have some correlation with problematic
Internet usage, it has not proven a reliable measure for differentiating between healthy
and addictive usage (Chakraborty et al., 2010; Chou et al., 2005; Czincz & Hechanova,
2009; Widyanto & Griffiths, 2006). When taken alone, time does not appropriately
consider context of online usage. For example, individuals that use the Internet for work
or distance relationships may spend more time online than the average user; yet show no
pathology (Czincz & Hechanova, 2009; Griffiths, 2000).
Excessive use is better measured by an individuals inability to keep track of time
while online as often manifested by a loss of time awareness or staying online longer than
intended (Block, 2008). In this study, I used the Problematic Internet Use Questionnaire
to evaluate excessive usage. The Problematic Internet Use Questionnaire has a unique
subscale, the Control scale, designed to measure excessive usage by highlighting the
inability to keep scheduled timelines and staying online longer than intended. As this was
one of the suggested criteria in the DSM-5, it is important to understand the significance
excessive usage plays in problematic Internet usage.
Problematic Internet Usage and Withdrawal
Withdrawal is defined by the DSM-IV-TR (APA, 2000) as having either of the
following: (a) meeting criteria for withdrawal syndrome for a given substance, and (b)


17
repeated use of a substance to avoid withdrawal symptoms (p. 197). Alcohol dependency
is the most recognized substance associated with the extremes of withdrawal. Hollywood
films have depicted countless characters in the throes of delirium tremens, a severe form
of withdrawal associated with abruptly quitting drinking.
Not all chemical substances create physical dependence with overuse, but instead
are prone to psychological dependence. Marijuana, hallucinogens, and numerous other
drugs do not create the same physiological reactions present when quitting a substance
such as nicotine; however, some individuals experienced similar symptomatology to
alcohol or heroin withdrawal (Freimuth, 2008). Individuals who abruptly stop using the
Internet cannot have the same biological reaction as heavy drinkers going cold-turkey,
but they can and do experience withdrawal symptoms (Greenfield, 2010; Young, Yue, &
Ying, 2010).
Problematic Internet usage is not a tissue-damaging substance, so it cannot induce
withdrawal symptoms as severe as alcohol-related delirium tremens; however,
individuals can exhibit measurable psychological withdrawal and even mild physical
withdrawal. The Internet can mimic a rapidly absorbing substance because of the
incredibly short latency time between clicking and viewing a desired Internet image
(Greenfield, 2010).
The physiological withdrawal associated with problematic Internet usage was
linked to dopamine (Greenfield, 2010; Young et al, 2010). This neurotransmitter was
associated with addictions to substance dependency and behavioral addictions such as
gambling, overeating, and exercise (Hartwell, Tolliver, & Brady, 2009). Individuals


18
become addicted to the intense hit of dopamine associated with the rapi d reward system
stemming from click to immediate gratification. From a physiological standpoint, an
individual with problematic Internet usage could be considered as having a dopamine
experience (Greenfield, 2010).
The psychological dependence and maladaptive patterns associated with
withdrawal seen in problematic Internet usage are similar to substance abuse and other
behavioral addictions (Chou & Hsiao, 2000; Kandell, 1998). Psychological withdrawal is
often the most prominent feature of problematic Internet usage (Greenfield 2010; Young
et al., 2010). Young (1998) noted the most common withdrawal symptom for dependents
was anxiety. Greenfield (2010) found a wide range of potential psychological withdrawal
symptoms which included strong emotions, frustration, separation anxiety, sense of loss,
and verbal protest. In younger Internet dependents, the removal of online access
sometimes resulted in defiance, verbal abuse, and even physical violence. This type of
violent outburst was exemplified in the sensational headline of the young man, Daniel
Petric, who shot his parents in their heads while they slept after losing his online gaming
privileges (Kropko, 2009). Another headline described how a father bashed in his 17-
month-old daughters skull when she accidently broke his Xbox which no longer had
Internet connectivity (Man sentenced, 2008).
Withdrawal symptoms were an important component of Blocks (2008)
conceptualization of problematic Internet usage. As highlighted above, withdrawal
symptoms were associated with the most extreme and violent outbursts associated with
problematic Internet usage. This study used the Problematic Internet Use Questionnaire


19
to evaluate the significance of withdrawal in problematic Internet usage. More
specifically, I used the Obsession subscale in the Problematic Internet Use Questionnaire
to evaluate withdrawal. As the DSM-5 marks the official legitimization of the need to
study problematic Internet usage (Internet gaming) as a mental disorder, it is crucial to
evaluate the role withdrawal symptomatology plays in problematic Internet usage criteria.
Problematic Internet Usage and Negative Life Outcomes
Young (1996, 1998, 2000) reported that over 50% of dependents reported serious
relationship problems due to Internet use. Kwiatkowska, Ziolko, Krysta, Muc-Wierzgon,
and Krupka-Matuszczyk (2007) found similar problematic relationship patterns after
assessing 68 college-age students labeled as dependents. The students with problematic
Internet usage reported that approximately half of family arguments stemmed from
Internet usage. It was not uncommon for stressed social interactions to bleed over into
work and school. Some dependents were described as cyberwidows to emphasize the
extreme relationship disruption caused by problematic Internet usage. Quantitative data
from online divorce sites now list problematic Internet usage as one of the top reasons for
separations (Divorce Online, 2011). Relationship difficulties were not limited to
significant others and family. Individuals flagged in the pathological range reported
trouble with fellow employees and in extreme cases almost complete social isolation
except for online relationships (Brenner, 1997). Dependent students reported severe
consequences such as poor grades, academic probation, and expulsion from school
(Young, 1998). Internet dependents reported experiencing similar negative life outcomes
to drug addicts, alcoholics, and compulsive gamblers (Young, 1996).


20
Dependents also reported a wide range of physical impairments such as eyestrain,
back problems, and carpal tunnel syndrome (Young, 1998). Brenner (1997) reported that
80% of heavy Internet users endorsed questions related to problems with time
management, sleep, and other daily functions such as missing meals. While these
impairments may seem minor, the cumulative effect can be devastating to work and
social functioning (Young et al., 2010).
The negative life outcomes resulting from problematic Internet usage was a key
component suggested by Block (2008). In this study, I examined negative life outcomes
as measured by the Problematic Internet Use Questionnaire. More specifically, I used the
Neglect subtest of the Problematic Internet Use Questionnaire to measure decrease in
performance and interest of daily living activities such as partner relationships, household
chores, work, and eating.
Measuring Problematic Internet Usage
Youngs Internet Addiction Diagnostic Questionnaire set the standard for
problematic Internet usage assessments (Young, 1996; Young et al., 2010). From her
early work with the Internet Addiction Diagnostic Questionnaire, Young (2010)
developed the Internet Addiction Test which provided a more specific assessment of
Internet usage. The Internet Addiction Test was primarily designed as a treatment
planning tool. The Internet Addiction Test consists of 20 questions rated on a 5-point
Likert scale (0, not applicable; 5, always). After calculating the total score for all
questions, the client was categorized in the normal, mild, moderate, or severe range of


21
Internet usage. Young recommended the therapist explore any questions the client
answered with a 4 (often) or 5 (always).
The Problematic Internet Use Questionnaire was built from the foundation of
Youngs Internet Addiction Diagnostic Questionnaire and Internet Addiction Test.
Although the Problematic Internet Use Questionnaire is a relatively new instrument for
measuring problematic Internet usage, it is already one of the most validated instruments
available. The Problematic Internet Use Questionnaire was developed from an attempt to
create a common tool to measure problematic Internet usage. The Problematic Internet
Use Questionnaire measures problematic Internet usage along three core subscales. The
Obsession scale assesses the tendencies to fixate on using the Internet, and the
psychological distress (e.g. anxiety) associated with withdrawal. The Neglect scale
measures how predominate the Internet is in a users life by assessing abandonment of
everyday chores and obligations. The Control Disorder scale measures an individuals
ability to manage Internet usage (Demetrovics, Szeredi, & Rozsa, 2008).
Demetrovics et al.s (2008) original study of the Problematic Internet Use
Questionnaire included 1,037 Hungarian participants of which 46% were female and 54%
were male. Approximately 51% were students, 44% worked, and 3% had no occupation.
The total participant pool included approximately 25% with a higher education degree
and 44% with a 12
th
grade education. The Problematic Internet Use Questionnaire
contained 30 questions which were administered online. The internal reliability was
reported at 0.91. Each individual item was reviewed on its weight, total correlation value,
and overall meaning which eventually led to removing 12 questions for a new total of 18.


22
The three subscales achieved an internal consistency ranging from 0.74 to 0.87. The
correlation with the total scale compared to each subscale was approximately 0.80. There
were no significant differences in overall scores and gender. Women scored higher on the
Control Disorder subscale, while men scored higher on the Neglect subscale. There was
also greater incidence of problematic Internet usage among students than those reporting
currently working.
The participants were placed into four categories: no problem, average problems,
problems present, and significant problems. The cutoff points were selected by standard
deviations from the mean total scores. Individuals with a Problematic Internet Use
Questionnaire score one standard deviation below the mean were placed in the no
problems category. Those scoring one standard deviation above the mean were placed in
the average problem group. Participants with scores greater than one standard deviation
were categorized in the problematic group, and those two standard deviations or greater
were placed in the significant problem group (Demetrovics et al., 2008).
Test-retest reliability was evaluated by administering the Problematic Internet Use
Questionnaire to 63 university students an initial time and again in 3 weeks. The
correlation for the total scale was approximately 0.90 and for the subscales ranged from
0.76 to 0.90 (Demetrovics et al., 2008).
Kelley and Gruber (2010) evaluated the psychometric properties of the
Problematic Internet Use Questionnaire using 278 American students, consisting of 148
women and 130 men. The particpants were administered a paper-and-pencil version of
the Problematic Internet Use Questionnaire. In order to evaluate the reliability and


23
construct validity of the Problematic Internet Use Questionnaire, the researchers also
administered well-established psychological and physical health assessments. These
additional instruments included the Beck Depression Inventory-II, the Beck Anxiety
Inventory, and the SF-36v2 Health Survey. The SF-36v2 Health Survey measured eight
distinct categories for physical and mental health.
The Cronbachs alpha for the overall Problematic Internet Use Questionnaire was
0.91. The three subscales internal consistency ranged from 0.77 to 0.81. The researchers
used one-way ANOVAs with each of the three subscales on the Problematic Internet Use
Questionnaire (obsession, neglect, and control disorder) as the independent variable and
each of the 10 variables on the SF-36v2, BDI-II, and BAI. For both the average usage
and problematic usage groups, there were significant (p < 0.05) results for at least seven
of the measured variables. Anxiety and depression were significant in both groups on the
Neglect and Control Disorder subscales; however, anxiety was not a significant factor in
the Obsession scale.
Problematic Internet Usage and Self-Medication Hypothesis
Addiction is a complicated and often contested concept. There are multiple
intersecting pathways to the development and maintenance of dependence. Self-
Medication hypothesis is one model of addiction which attempts to explain the initiation,
persistence, and remission of substance-use and behavioral disorders. Khantzian and
Albaneses (2008) model of SMH purports that psychological pain drives addiction.
Individuals use substances or behaviors in an attempt to relieve psychological distress
(depression, anxiety, mania, etc.). The addictive substance or behavior offers short-term


24
relief from psychological suffering; however, the immediate gain often exacerbates the
psychological dysfunction and creates additional long-term problems and stressors. SMH
also suggests that an individuals choice of substance or behavior has a quality which
relieves a specific distressful state. For example, a lethargic individual may enjoy the
activating effects of stimulants, while an irritated individual may become attracted to
opiates. The specificity of drug or behavioral choice is related to the precise relief it gives
for a particular feeling state.
Khantzian and Albanese (2008) recognized that behavioral addictions, such as
gambling, dieting, fitness, and sexual compulsions, had much in common with substance
addictions. Although nicotine and alcohol dependence continue to be the most prevalent
addictions, behavioral addictions are steadily growing in part due to the multiple
activities available online. Behavioral addictions share with other addictions continued
persistence despite severely negative consequences, and a dual aspect of relieving pain
while at the same time perpetuating it. This study examined if individuals with high
levels of social anxiety or worry would be attracted to the unique qualities of the Internet,
and therefore, be predisposed for addictive behaviors associated with the Internet.
Problematic Internet Usage and Social Anxiety
The Internet began as a primarily non-social application for obtaining
information. Today, the Internet is a thriving social technology that has grown far beyond
its original purpose (Amichai-Hamburger & Ben-Artzi, 2000). With applications like
Facebook and Twitter, the Internet is often the first choice for communication for many
individuals; however, the act of communicating online can limit social support outlets for


25
those that abuse the technology to the point of addiction. Kraut et al. (1998) found that
excessive Internet users spent less time communicating with significant others and family
members and had weaker overall social outlets. Suler (1999) stressed that the difference
between healthy and addictive Internet behavior greatly depended on how the Internet
met an individuals needs. In particular, Suler viewed the need for an intimate
relationship and the need for a sense of belonging as significant factors correlated with
potential addiction. The need for social interaction and support is greater for those
missing it in real life which is particularly true for those with social problems such as a
lack of social skills or social anxiety (Young, 1998).
In this study, I examined the variable of social anxiety as defined by the DSM-IV-
TR (APA, 2000) criteria for social phobia (social anxiety disorder). The core feature of
social anxiety is a fear of social or performance situations in which embarrassment
might occur (p. 450). Social anxiety can be debilitating if it becomes generalized to most
social situations. Erikson (1980) suggested that successful interpersonal relationships
were essential for navigation from one stage of healthy psychological development to the
next. Social anxiety can be a key factor in isolating an individual and preventing the
social interaction needed for psychological growth. The Internet has opened new
interpersonal communication channels which do not require face-to-face interactions that
individuals with social anxiety dread. For some, the Internet can act as a social crutch
allowing complete avoidance of face-to-face interactions while providing a form of social
interaction. There are several cues filtered-in communication theories which attempt to
explain the potential attractiveness of computer-mediated communication. The cue


26
filtered-in paradigm emphasizes the technical aspects of Internet-based interactions and
does not focus on potential addictive properties of computer-mediated communication;
however, it is essential to understand the basics of cues filtered-in theory in order to
better understand why those with social deficits, such as social anxiety, are so attracted to
this new medium.
Attractiveness of Computer-Mediated Communication
Computer-mediated communication opens new channels which can eventually
lead to a preference for online social interaction over face-to-face contact. There are two
competing paradigms regarding the differences between preference for online social
interaction and face-to-face interactions: the cues filtered-out model and cues filtered-in
model (Caplan & High, 2010). The cues filtered-out model is based on older theories that
focus primarily on the inadequacies of computer-mediated communication. These
somewhat dated theories emphasize that non-verbal cues severely limit the capacity of
computer-mediated communication to build the same intense relationships created by
face-to-face communication (Caplan & High, 2010; Tidwell & Walther, 2002; Walther,
1996). In contrast, the cues filtered-in model is based on more recent theories which
emphasize the unique advantages of limited non-verbal cues prevalent in computer-
mediated communication. The non-verbal cues associated with face-to-face interactions
can actually be a hindrance to individuals with a history of psychosocial problems. These
individuals therefore thrive in a computer-mediated communication environment. There
are several theories within the cues filtered-in paradigm which attempt to explain the
allure of computer-mediated communication (Tidwell & Walther, 2002; Walther, 1996).


27
Cues filtered-in theories. Social information-processing theory purports that
computer-mediated communication compensates for limited nonverbal cues by
emphasizing message substance, design, and timing of communications. Computer
mediated communication is not inferior in the ability to deliver significant interpersonal
messages when compared to face-to-face, but it is merely a different way of delivering
these messages. One of the core differences is that computer-mediated communication
takes longer to communicate meaningful messages compared to face-to-face. Although
the rate at which computer-mediated communication delivers information is slower, the
level of social relationship developed is the same as those with face-to-face (Tidwell &
Walther, 2002; Walther, 1996). Caplan and High (2010) hypothesized that the length of
time needed to build meaningful relationships could be one reason some individuals
experience negative outcomes in their offline lives.
Another cues filtered-in theory, social identity model of deindividuation effects,
emphasizes the group bonds formed by the cue limited and anonymous nature of
computer-mediated communication. Because of the lack of information regarding
personal identification, the conversation focuses on shared identities within the group.
Computer mediated communication becomes particularly palatable to individuals with a
history of negative face-to-face interactions. The design of computer-mediated
communication allows individuals to primarily focus on group similarities and common
goals (Postmes, Spears, & Lea, 1998).
A final cues filtered-in theory, hyperpersonal perspective, argues that computer-
mediated communication is superior to face-to-face interactions. The hyperpersonal


28
perspective asserts that missing nonverbal cues do not deter, but instead, strengthen the
social messages relayed during interpersonal communication (Tidwell & Walther, 2002;
Walther, 1996). Computer-mediated communication allows both parties to achieve
interpersonal goals without the interference of the nonverbal cues that often dominate
face-to-face exchanges. Because communications are usually typed in computer-
mediated communication, an individual can carefully screen each message weeding out
potentially undesirable statements. Computer-mediated communication allows
individuals to present themselves in a more positive light. The message sender can
present an extremely positive self-image which is rewarded and emphasized by the
receiver. This in turn, according to hyperperosnal perspective, creates a positive feedback
loop where the message receiver encourages the sender to continue and adopt the socially
desirable role created through computer-mediated communication (Caplan & High, 2010;
Tidwell & Walther, 2002; Walther, 1996). Individuals tend to overattribute the positive
presentation utilized with computer-mediated communication which results in an
idealistic and romanticized image of the communication partner. Because of the idealized
images formed during computer-mediated communication, relationships can develop
faster and encompass higher levels of intimacy than face-to-face.
Social information processing theory,social identity model of deindividuation
effects, and hyperpersonal theory bring to light the potential dangers of computer-
mediated communication for individuals with predisposed conditions. Face-to-face
conversation is often laden with contradictory nonverbal communications which can be
difficult for those with psychosocial conditions, such as social anxiety, to accurately


29
interpret (Caplan & High, 2010; Postmes et al., 1998; Tidwell & Walther, 2002; Walther,
1996). For example, an individual could verbalize approval of a conversation topic while
expressing boredom through behavioral cues and facial expressions. Computer-mediated
communication allows socially inept individuals to bypass the emotional layer of
communication, and allows them an unparalleled level of perceived safety and control.
Robbers Cave comparison. In their seminal work, the Robbers Cave
experiment, Sherif, Harvey, White, Hood, and Sherif (1954/1961) detailed core social
psychological principles which are relatable to modern computer-mediated
communication. In this experiment, two groups, the Rattlers and the Eagles, were created
with their own hierarchy, structure, and goals. The two groups were brought together in a
competitive situation which caused friction between each in-group. The conflict between
groups was lessened with a series of intergroup activities; however, the most significant
reduction came through the assignment of superordinate goals. This type of goal is
defined by an activity which involves an important reward for both groups which cannot
be attained by one single group alone. The Rattlers and Eagles performed several
superordinate goals including repairing a water supply which they needed to quench their
growing thirst, gathering enough money to obtain a film, and winning a tug-of-war
against a truck. Many forms of computer-mediated communication act as mediator or
referee to ensure all participants work toward superordinate goals. This is clearly
observable in MMOs. These games are set up with predesigned rule sets which force
multiple in-groups to cooperate in order to attain high yield rewards.


30
Caplans Deficient Social Skills Model
Caplans social model comprised three core theoretical hypotheses: (a)
Individuals with psychosocial distress had negative views about their overall social
abilities; (b) individuals with negative concepts about their ability to socialize in face-to-
face interactions gravitated toward using Internet-based communication methods; (c) the
new preference for online communication had negative long-term effects across a broad
spectrum of core social and functional aspects (i.e., family, work, etc.). Caplan noted that
his model implied psychosocial distress leads some to develop a preference to online
social interaction, which then sets the stage for problematic Internet usage (p. 631).
Caplan (2003) also differentiated between excessive and compulsive use of the Internet.
Excessive usage was simply defined as spending too much time online. Compulsive
usage emphasized guilt coupled with the inability to stop using the Internet despite
repeated attempts. Caplan placed excessive and compulsive use in the overarching
category of problematic Internet useage.
Caplans (2003) model highlighted the intrinsic rewards the Internet offered to
individuals with social skills deficits. Individuals who were predisposed to psychosocial
problems had a greater chance of spiraling into problematic Internet usage. These
individuals generally had low self-efficacy pertaining to social skills and were drawn to
the relatively safe interaction offered by the Internet. The social applications on the
Internet allowed users unprecedented control to present themselves to others in a socially
desirable manner. This view was similar to others which labeled the Internet as the
Prozac of social communication (Morahan-Martin & Schumacher, 2000, p. 26). Caplan


31
described this behavior as a preference for computer-mediated communication. The
inclination to choose computer-mediated communication over face-to-face interactions
allowed for short term efficacy building; however, the short-term gain from this behavior
typically worsened social problems and increased psychological distress. The preference
for computer-mediated communication created a vicious cycle. The use of social
applications on the Internet encouraged and mediated avoidance of potential ly painful or
embarrassing real world interactions. This led to a reward system where computer-
mediated communication was significantly preferred over face-to-face communication
and increased the likelihood of developing problematic Internet usage.
Caplan (2003) assessed his social skills model of problematic Internet usage in a
study consisting of 386 undergraduate students. The participants included 279 males and
116 females whose ages ranged from 18 to 57 years old. Caplan focused on the
psychological variables of loneliness and depression. He developed the Generalized
Problematic Internet Use Scale which evaluated cognitive and behavioral
symptomatology of problematic Internet usage, and the negative impact these symptoms
had on an individuals life (personal, professional, etc.). The Generalized Problematic
Internet Use Scale had a 5-point Likert scale (1, strongly disagree; 5, strongly agree) and
consisted of seven subscales. The scales included Mood Alteration, Perceived Social
Benefits, Perceived Social Control, Withdrawal, Compulsivity, Excessive Internet Use,
and Negative Outcomes. Caplan combined the Perceived Social Benefit and Perceived
Social Control scales to more accurately measure his theoretical definition for an
individuals preference toward computer-mediated communication. Statistical analysis


32
yielded a strong association between the merged scales (r = 0.54, p > 0.01), and a high
internal consistency at 0.84. The other five subscales reliability ranged from 0.80 to 0.85.
Individuals were also assessed for psychosocial health with the Beck Depression
Inventory-II and the UCLA Loneliness Scale.
Caplan (2003) analyzed three core hypotheses from the results. Firstly, he
predicted a positive relationship between preference for computer-mediated
communication, depression, and loneliness. Secondly, he anticipated preference for
computer-mediated communication would predict the severity of problematic Internet
usage symptomatology and associated negative life outcomes. Lastly, he predicted that
psychosocial well-being (loneliness and depression) would be strongly associated with
negative outcomes from problematic Internet usage for individuals who preferred
computer-mediated communication. Multiple regression analysis using preference for
computer-mediated communication as the dependent variable supported his primary
hypothesis. The psychosocial variables, loneliness and depression, were attributed for
19% of the variance toward an inclination for computer-mediated communication.
Preference for computer-mediated communication was also a significant predictor for
higher endorsement of Generalized Problematic Internet Use Scale scores. Loneliness
and depression, the two predictor variables, accounted for approximately 30% of the
variance for negative outcomes on those who preferred computer-mediated
communication.
Caplan (2003) noted his study concluded with two unexpected results. The first
was that loneliness played a more significant role toward the development of problematic


33
Internet usage than depression. He interpreted this as loneliness was a more central factor
resulting from deficient social skills which in turn predicted a preference for computer-
mediated communication. Individuals with high scores in loneliness were motivated to
use alternative methods of communication and therefore more prone to problematic
Internet usage. According to Caplan, depression had a potentially wider range of causes
beyond social deficits. Many sources of psychological distress other than lacking social
skills could be the catalyst for depressed mood like job satisfaction, financial hardships,
and physical illness. Caplan called for additional research into the significance of this
finding. A second noteworthy finding was that using the Internet for mood alteration did
not significantly predict negative outcomes. Caplan interpreted this as the desire to alter
emotional states that can result from a wide range of situations. Caplan used computer
games, reading, and viewing art as examples of applications that could soothe, relax, or
stimulate distressed moods. Unlike preferring computer-mediated communication over
face-to-face communications, an individual endorsing many items on the Mood
Alteration scale of the Generalized Problematic Internet Use Scale did not significantly
predict higher endorsement of the Compulsive or Negative Outcomes scales.
Measuring Social Anxiety
In this study, I proposed to examine the relationship between social anxiety and
problematic Internet usage in several unique ways. First, I built on Caplans (2003)
research of social skills deficits (i.e., loneliness) correlating with problematic Internet
usage by examining the variable of social anxiety. Second, I examined the role social
anxiety plays on problematic Internet usage as conceptualized as an impulse control


34
disorder. More specifically, I examined if social anxiety correlates higher with any of the
three subscales (Obsession, Neglect, and Control Disorder) of the Problematic Internet
Use Questionnaire. The three subscales on the Problematic Internet Use Questionnaire
relate to Blocks (2008) suggested features for criteria of problematic Internet usage
which included excessive usage (Control), withdrawal (Obsession), and negative
repercussions (Neglect). Lastly, I used the Liebowitz Social Anxiety Scale, a unique
assessment in the study of problematic Internet usage, to assess fear and avoidance
toward social and performance situations. The assessment of performance anxiety is new
in the study of problematic Internet usage and will allow for a more detailed
conceptualization of the underlying social deficits which correlate with problematic
Internet usage.
The Liebowitz Social Anxiety Scale (LSAS) will be used to measure social
anxiety. The LSAS is a questionnaire developed by Dr. Michael R. Liebowitz and is
currently used to determine the degree of social anxiety in adults. It has become one of
the most used scales for the assessment of social anxiety and phobia. The LSAS is a 24-
item questionnaire designed to measure performance anxiety and anxiety occurring in
other social situations. Each item presents a potential anxiety-producing situation and
assesses how the participant responds to the situation in terms of fear and avoidance
(Heimberg et al., 1999).
For example, the first situation deals with answering a public telephone. The
participant is asked to rate both fear and avoidance on separate 4-point Likert scales. The
fear scale ranges from 0 to 3 (none, mild, moderate, severe) and the avoidance scale also


35
ranges from 0 to 3 (never, occasionally, often, and usually). Each of the 24 items is
presented and the sum of the two scales, fear and avoidance (ranging from 0 to 144) is
used to determine the cut-off scores. Typically, a combined score of 55-65 suggests
moderate social anxiety, a combined score of 65-80 suggests marked social anxiety, a
combined score of 80-95 suggests severe social anxiety, and a combination score greater
than 95 suggests very severe anxiety. In this example of answering a public telephone,
the participant is asked to imagine the situation and respond how fearful she/he would
feel about performing this behavior and how often this type of behavior would be
avoided. If the participant chooses severe and usually respectively, the combined score
for this specific situation would be 6. In situations that are unfamiliar to the participant,
the participant is asked to imagine how it might feel to be in that social situation and
respond accordingly (Heimberg et al., 1999).
The psychometric properties of the LSAS were examined to determine the
reliability, validity, and treatment sensitivity of the scale by Heimberg, et al. (1999).
Their overall conclusions were that the LSAS was a reliable, valid, and treatment
sensitive measure of social anxiety. The LSAS has good reliability across studies with
Cronbachs alpha ranging from 0.81 to 0.92 for the fear subscales, 0.83 to 0.92 for the
avoidance subscales, and 0.96 for the total score. Heimberg et al. (1999) also reported a
convergent validity r = 0.52 with clinicians rating of social anxiety from a structured
interview.


36
Problematic Internet Usage and Worry
For some, the Internet can help to escape dysphoric states caused by real life
problems such as difficulty with work, school, or relationships (Young, 1996, 2010).
Internet use can provide a temporary barrier from dealing with the painful issues in the
real world (Kandell, 1998). Some use the Internet as a coping mechanism in which retreat
from everyday problems is exemplified by the immersion in online fantasy games
(Freimuth, 2008). One important theory for the use of the Internet to help relive
dysphoric states is the self-medication hypothesis.Young (2001, 2010) included self-
medication hypothesis in her four steps Start-Stop Cycle of relapse. The core components
of the Start-Stop relapse cycle include: (a) rationalization, (b) regret, (c) abstinence, and
(d) relapse. Young (2010) emphasized that relapse often occurred after an individual
recalled the self-medicating effects of being online and its associated relaxation and
excitement (p. 27).Greenfield (2010) suggested that addiction to the Internet created
negative life outcomes which increased the desire to alter mood and consciousness in
order to achieve psychic numbing and self-medication (p. 139). Kandell (1998)
considered self-medication hypothesis an important factor in excessive and addictive use
of the Internet. Internet use for the relief of dysphoric mood was likened to a form of
digital medication (Weaver et al., 2009).
LaRose, Lin, and Eastin (2003) implicated self-medication hypothesis in their
social-cognitive perspective of computer use. The motivation for excessive media
consumption begins when the self-regulatory system breaks down. A healthy self-
regulatory system accurately evaluates the impact of behaviors on self and others;


37
however, dysphoric states, like anxiety or boredom, motivate the individual to seek out
relief. The Internet can provide immediate stimulation and becomes a self-reactive
incentive. The use of the Internet rewards an individual by relieving dysphoric states.
Once an individual stops using the Internet, the dysphoric state returns and impairs
healthy self-regulation, and the individual begins a vicious cycle of Internet abuse.
Self-medication hypothesis emphasizes there is a correlation between dysphoric
states and a substance or behavioral addiction. Individuals with dysphoric moods, such as
anxiety, will use a substance or behavior to reduce their symptoms; however, it is
important to note that not all individuals affected by a dysphoric state will become
addicted (Khantzian & Albanese, 2008). Khantzian and Albanese also emphasized that if
there are no negative life consequences from a self-medicating substance or behavior,
then self-medication hypothesis can be an efficacious treatment for psychological
distress.
In their popular study, Bolton, Cox, Clara, and Sareen (2006) examined self-
medication hypothesis in relation to substance abuse prevalence among several core
anxiety disorders. The study included a sample of 5887 individuals with an age range
from 15 to 54 years. The sample was taken from a noninstitutionalized selection
representing the general United States population. A modified version of the Composite
International Diagnostic Interview (CIDI) was used to separate and diagnose participants
with anxiety disorders. Individuals who were diagnosed with an anxiety disorder were
then asked the following self-medication hypothesis question:


38
Did you ever drink more than usual or use drugs not prescribed (or in greater
amounts than prescribed) to help you reduce the fears? (p. 819)
The question was asked for each anxiety disorder determined to be present by the CIDI
which allowed for statistical data relating to SMH to be gathered for each specific anxiety
disorder. Participants were divided into two groups: (a) individuals who endorsed any
anxiety disorder and also endorsed self-medication hypothesis, and (b) individuals who
endorsed any anxiety disorder and did not endorse self-medication hypothesis. The final
statistical results indicated that individuals with generalized anxiety disorder had the
highest rates of self-medication at 35.6%. Panic disorder came in second at 23.0%, while
social phobia with generalized fears came in third at 21.2% for prevalence of self-
medication hypothesis behavior.
In this study, I modified Bolton et al.s (2006) self-medication hypothesis anxiety
study using the Penn State Worry Questionnaire (PSWQ) to determine clinical levels of
worry and the Problematic Internet Use Questionnaire to identify problematic Internet
usage. I used a modified version of their self-medication hypothesis question in order to
better relate with problematic Internet usage which will state the following:
Did you ever use the Internet or any Internet capable device (Blackberry, iPhone,
iPad, etc.) to help you reduce the fears?
Worry is a unique and previously unstudied variable in problematic Internet usage. With
this study, I hope to fill a gap in the literature regarding Internet use to relieve the
dysphoric state of worry. This study will also add to the conceptualization of self-


39
medication hypothesis as a behavioral response toward the development of problematic
Internet usage.
Measuring Worry
The Penn State Worry Questionnaire (PSWQ) was specifically designed to
measure worry associated with anxiety. The concept of worry is associated to some
degree with all anxiety disorders, but it is the primary criteria for generalized anxiety
disorder (GAD). Anxiety, more specifically GAD, is one of the top disorders among
substance abusers who turn to self-medications (Bolton et al., 2006; Zuckerman, 2007).
The PSWQ appears to be an excellent choice to assess the type of worry associated with
GAD (Meyer, Miller, Metzger, & Borkovec, 1990).
Meyer et al. (1990) administered the PSWQ to 405 college students consisting of
228 females and 177 males. Other psychological assessments were also administered in
conjunction with the PSWQ including the State-Trait Anxiety Inventory, Beck
Depression Inventory-II, and the Sensation Seeking Scale (SSS), the Self-Handicapping
Scale, the Self-Esteem Certainty Index to evaluate worry with other psychological
constructs. The average score on the PSWQ was 48.8 with a standard deviation of 13.8.
Females scored significantly higher than males (p > .002). Internal consistency was 0.93
for the entire group. The PSWQ highly correlated with the Self-Handicapping Scale at
0.33. Meyer et al. (1990) predicted this was due to worriers blaming uncontrollable
outside or internal forces for their distress. Low self-esteem, low thrill seeking, and low
boredom susceptibility were also highly correlated with the high worry scores on the
PSWQ.


40
In another study by Meyer et al. (1990), the PSWQ test-retest reliability,
discriminant validity, and construct validity were examined. A subset of 47 students from
the previous study was chosen from the highest, medium, and lowest score categories on
the PSWQ. The subset of participants was administered the PSWQ and the Cognitive
Somatic Anxiety Questionnaire (CSAQ) 8 to 10 weeks after the initial study. The CSAQ
is a 14-item instrument used to measure the somatic and cognitive factors associated with
trait anxiety. The participants were also interviewed by two researchers and asked to list
and rate specific worries. Test-retest reliability was found to be high at 0.92. The PSWQ
significantly correlated with the CSAQ at 0.69. The PSWQ was also highly correlated to
the number and rank of worry topics generated during interview.
Greenfields Motivational Theory of Problematic Internet Usage
Greenfields (2010) etiological model emphasized the duality of addiction. The
Internet is an intrinsically pleasurable experience driven by basic operant conditioning
principles that eventually develop into a desire to prevent anxiety associated with
withdrawal symptoms. The Internet couples a pleasurable act with the unique feature of
almost instantaneous reinforcement. The pleasure attained from Internet use increases the
likelihood that an individual will continue the behavior (Greenfield, 2010; Ferster &
Skinner, 1957). Greenfield highlights five core features which make the Internet highly
attractive and subject to dependency. These attractive features include (a) content factors,
(b) process and access factors, (c) reinforcement factors, (d) social factors, and (e) Gen-D
factors.


41
Content factors. The Internet is nothing more than a delivery system for content.
The raw content it delivers is not unique. Some of the most frequent activities on the
Internet include shopping, communicating, playing games, reviewing the news, and
viewing pornography. All of this content was available prior to the widespread use of the
Internet. What makes the Internet so addictive is the efficiency in which the content is
delivered. Greenfield (2010) succinctly writes, If content is the raw material, then the
Internet medium is the psychological syringe that delivers the content into our nervous
system for consumption (p. 140). The ease and speed of access to content is increasing
with the advent technologies like smart phones and tablets. This gives an almost
omniscient ability to bring thoughts and desires into instant reality with a simple click.
Process and availability factors. The Internet allows for an unprecedented sense
of anonymity. This can cause a loss of inhibition and a sense of safety to experience
unique processes. Similar to alcohol disinhibition, the anonymity afforded by the Internet
removes certain social barriers. This is particularly common with accessing sexual
content and assuming an alternate persona available in massive multiplayer online games.
From a psychodynamic perspective, the Internet can allow a user to access repressed or
subconscious personas. These can take the form of socially unacceptable identities with
little or no real world repercussions.
The Internet is always available. Broadband connections are now commonplace
and keep the user online 24/7. The Internet is also affordable and without boundaries. It is
affordable to multiple socioeconomic populations. Most forms of media have some type
of marker which indicates the beginning and end of the content. The Internet has no such


42
boundaries. A movie has a definitive time boundary which is marked by the opening
credits to the closing credits. A book has a physical boundary with the front page to the
last page. The Internet, however, is literally without boundaries. One activity can bleed
over into another, and an individual can get completely lost in time and content.
Reinforcement factors. Greenfield (2010) considered the reinforcement factors
as the most addictive aspect of the Internet which is based on a variable-ratio
reinforcement schedule (VRRS). This is the same type of reinforcement system seen in
highly addictive slot machines. This was emphasized when problematic Internet usage
was first compared to pathological gambling (Young, 1998). A VRRS is similar to a
fixed-ratio reinforcement schedule (FRRS) with one significant difference. The core
difference is the predictability of the reward. While an FRRS rewards at the exact same
response level each time, a VRRS rewards on the average of the same response level
(Ferster & Skinner, 1957). For example, an individual playing a slot machine set to an
FRRS would get a payout after the exact same number of pulls each time. Another
individual on a VRRS would get a reward at approximately the same time, but would not
be able to predict exactly when it would occur. The unpredictable nature of a VRRS
makes the behavior extremely resistant to extinction.
Greenfield (2010) noted the almost unlimited application of reinforcement
principles within the medium of the Internet. Everything from web surfing to checking
emails operates on a VRRS. With a simple click, we are rewarded with immediate
content with variable saliency. For example, it may take several searches to find a
particularly stimulating pornographic image. An individual checking his or her email may


43
be disappointed to find junk mail only to check again minutes later to find an exciting
letter from a friend. Each click on a new link provides a variable and unpredictably
rewarding experience.
The Internet not only offers a primary pleasure experience, but also provides the
potential for secondary gains. These secondary gains are often powerful reinforcements.
Avoiding stressful situations, work, or social interactions are just a few examples of the
secondary gains associated with problematic Internet usage. The Internet can move the
user out of the present and into a timeless and euphoric state. In one study, approximately
80% of users lost track of time when online (Suler, 1999). This unique timeless aspect of
the Internet makes it an excellent tool for escape. It is estimated that approximately 10%
of users utilize the Internet to escape real life problems or alter their mood (Aboujaoude,
Koran, Gamel, Large, & Serpe, 2006).
Social factors. The Internet creates a contradictory environment of simultaneous
social connection and isolation. It gives the communicator an unprecedented level of
personal power and opens doors to an almost unlimited audience. The individual can
tailor communication to a personal comfort level unique to any previous media forms.
Literally every individual with an Internet connection has the capacity for a global
audience. The power of this new medium is most evident in social networking which
emphasizes the strengths and weaknesses of Internet communication. The Internet offers
an unparalleled strength to communicate succulently and rapidly within an individuals
own social network; however, this is not without serious disadvantages.


44
The technology that connects us to the always-on, instant communication
channels of the Internet is complicated and time-consuming. The physical attention
needed to constantly update information to social networks can be exhausting. This level
of concentration can take the individual out of the real world moment and into the
timeless state of the Internet. Unfortunately, this constant state of connection and arousal
is becoming the norm. Because of new devices, such as smart phones and tablet PCs, the
user is expected to be available 24/7. This creates a form of technological peer-pressure
that creates an artificial manic environment (p. 146). The user is often left stressed and
compelled toward dependency. These social factors are exemplified in the Generation-
Digital (Gen-D) age group.
Gen-D factors. Todays children and adolescents were born into a world of
global, integrated communication. While emailing, texting, and social networking are
now the status quo among their peers, these activities are relatively new and occasionally
daunting to their parents and grandparents. In some cases, this has created a relational
parent to child role-reversal. Instead of the traditional role of the older, more experienced
individual imparting knowledge down to the younger generation, parents often find
themselves ill-equipped, confused, and even paralyzed to handle their childrens digital
social interactions. Because of this lack of technological competence, parents defer power
to their children. Unfortunately, younger individuals often lack the experience or
psychological maturity to monitor their usage behaviors.
Griffiths (1995) described the stereotypical Internet user as a young adolescent or
adult male. This stereotype has support within the literature. Several studies have


45
emphasized the prevalence of men to develop problematic Internet usage in greater
proportion to women. Greenfield (2010) also highlighted the vulnerability of the younger
Gen-D population who grew up with computer use as the norm. A meta-analysis of
problematic Internet usage literature through 2005 suggested that men and women use the
Internet differently, and that men, particularly young men, are more predisposed to
developing some form of problematic Internet usage. Young men ranged from 12% to
71% more likely to develop problematic Internet usage than women (Chien, Condron, &
Belland, 2005). Another meta-analysis reviewed 15 peer-reviewed articles exploring
problematic Internet usage from across cultures and found that seven studies had greater
ratios of young males with problematic Internet usage (Chakraborty et al., 2010).
The vulnerability of college students. In a recent and highly publicized study,
200 students from University of Maryland, College Park, documented 24-hours without
any type of media access. After the day without media, the students wrote about their
experiences. The event was so intense that the average student wrote 250 more words
than required by the assignment to describe their emotions. Several patterns emerged in
the students writings. Firstly, students used numerous addiction-based terms, such as
urges, cravings, and withdrawal, to describe their desire to reconnect with media.
Secondly, students consistently reported a preference for social contact through texting
and using Facebook over other forms of connection. Finally, students equated being cut
off from media as an almost total disconnect from their most important social networks.
Some common words used to describe the day included unbearable, difficult, boring,


46
lonely, anxious, miserable, crazy, and distracted. Many were unable to make it the entire
24-hours without connecting to media (Moeller et al., 2010).
College students are one of the highest rated groups on sensation seeking scales
and at the greatest risk for problematic Internet usage (Kandell, 1998). Besides sensation
seeking tendencies, environmental and developmental factors also put this group at
increased risk of problematic Internet usage. Environmental factors include easy Internet
access, requirement of a computer, large amounts of free time, and flexible schedules.
Kandell noted that college-age students are at the tenuous developmental stages of
identity formation and developing intimate relationships. Erikson (1980) theorized that
individuals are challenged to successfully navigate different crises throughout a lifetime.
In Eriksons theory of development, the key challenges for college-age students are (a)
identity versus confusion and (b) intimacy versus isolation. The Internet offers new
opportunities for students struggling to resolve these challenges; however, reliance on
social technology can give a sense of self-identity and social connection only when
online which could leave the student with a poor self-assessment and contribute to social
isolation when in the real world (Kandell, 1998). The repercussions of problematic
Internet usage on students scholastic careers have been extreme in severe cases. Some
colleges have recorded fewer students willing to take morning classes and excessive
tardiness for those that do. Students hooked on the Internet also receive lower grades to
the point of getting academic probation or expelled from universities (Chou et al, 2005).
Health and judgment issues from lack of sleep are also common issues reported from


47
individuals with problematic Internet usage making studying and test taking extremely
difficult (Young, 1999).
Personality Traits and Problematic Internet Usage
Young (1996) not only pioneered problematic Internet usage as a legitimate
mental disorder, but she also was among the first to study the relationship of personality
traits in respect to problematic Internet usage. Early research favored Cattells 16
Personality Factor Questionnaire (16PF) as the instrument of choice for assessing
personality traits and their relationship with problematic Internet usage (Young &
Rodgers, 1998; Yang, Choe, Baity, Lee, & Choi, 2005). Cattells model of personality is
now out of favor as the five-factor model (FFM) of personality has dominated research
over the last decade (John, Naumann, & Sotoi, 2008). As dominate as FFM currently is in
personality research, the body of problematic Internet usage literature has been slow to
adopt it; however, this is rapidly changing and new research focused primarily on FFM
and preference for Internet media applications has emerged. For example, Neuroticism
was linked with a preference for communication-based applications such as massively
multiplayer online games (MMOs), Facebook, instant messaging, and chat rooms. This
type of communication-based media was the most commonly associated Internet
application with problematic Internet usage (Young, 1996, 1998, 2010). The five-factor
model was essentially used to research problematic Internet usage by proxy through the
study of users personality traits and their application preferences. In this study, I
attempted to fill a gap in the literature by directly examining the relationship of FFM,
with an emphasis on Neuroticism, and problematic Internet usage. It is therefore


48
important to understand the early personality studies on problematic Internet usage, the
basics of FFM, and the current research relating to Internet application preference and
problematic Internet usage.
Cattells Personality Theory and Problematic Internet Usage
Young and Rodgers (1998) examined the personality traits associated with
problematic Internet usage among a sample of 259 individuals. Young and Rodgers used
a modified 8-item pathological gambling questionnaire to classify individuals with
problematic Internet usage. Individuals were classified as dependent if they answered five
or more of the items with yes, and their usage behavior could not be better diagnosed
as a manic episode. The 16PF was used to examine personality traits associated with
problematic Internet usage. Individuals with high problematic Internet usage scores were
found to be more self-reliant, inclined toward solitary activities, and limited their social
outlets more than those scoring lower. Individuals with high problematic Internet usage
scores also showed strong abstract reasoning skills, less conformance to societal norms,
sensitivity, vigilance, and a tendency to react emotionally in interpersonal relationships.
Young and Rodgers (1998) interpreted these results as an important step toward
future hypotheses which could predict predispositions for personality traits sensitive to
developing problematic Internet usage. They found that individuals with superior abstract
thinking skills were particularly vulnerable to problematic Internet usage because of the
vast mental stimulation available on the Internet. Individuals that were comfortable
spending time alone and had limited social outlets were also more vulnerable to
problematic Internet usage. These findings, particularly a preference for self-reliance,


49
were similar to previous research on computer addictions which found schizoid
personalities gravitating toward computer-intensive careers and recreational overuse
(Shotton, 1991). Young (1996) and Young and Rodgers (1998) contended that the
interactive nature of the Internet allowed those with isolating personality traits to fulfill
unmet social needs.
Yang et al., (2005) had similar findings to Young and Rodgers (1998) previous
work. They used Cattells 16 Personality Factor Questionnaire (16PF) and the Symptom
Checklist 90-R. A total of 328 South Korean high school students were divided into four
sub-groups according to scores on the Internet Addiction Test. The Internet Addiction
Test consists of 20 questions rated on a 5-point Likert scale (1, not at all; 5, always) with
a total high score of 100 possible. The items on the Internet Addiction Test measured
level of dependence, ability to control usage, withdrawal symptoms, and impact on
several quality of life factors. Moderate users were categorized with scores ranging from
40 to 59 and excessive users with scores from 60 and higher. Approximately 30% of the
students fell into the moderate category, while 5% were categorized as excessive users. A
total of 82% of all students used the Internet within the last month.
The 16 PF and the SCL-90-R were given to each of the four subgroups
categorized by Internet Addiction Test scores. Excessive users scored significantly
different than other groups on four 16 PF factors. The personality profile of excessive
users included low scores on emotional stability (C), high scores on imaginative thinking
(M), high scores on self-sufficiency (Q2), and high scores on creativity (CRE). Excessive
users tended to have a low threshold for boredom, difficulty facing reality, and classic


50
neurotic symptoms. They also were non-conformist, uninterested in everyday doldrums,
and lost in imagination. Yang et al. (2005) suggested that individuals with this profile
pattern (C, M, Q2, and CRE) were susceptible to using the Internet as a tonic for inner
conflicts (p. 413).
The excessive user group scored higher on both global indexes of the SCL-90-R
which indicated greater overall psychopathology. The excessive use group scored higher
than other groups on obsessive-compulsive, hostility, paranoia, somatization,
interpersonal sensitivity, depression, anxiety, and psychoticism scales. One interesting
finding was that non-Internet users reported significantly high levels of symptomatology
on 7 of the 9 scales.
The findings in both research studies using the 16PF were similar across cultural
boundaries. Young and Rodgers (1998) and Yang et al. (2005) found excessive users
were imaginative, abstract thinkers that preferred stimulating yet isolating activities. The
problematic Internet usage personality profile suggested an individual that derives intense
pleasure from the varied, and stimulating activities provided by the Internet; however,
this intense experience comes at a price of increased social isolation and susceptibility to
psychological pathologies. Both studies also found individuals with problematic Internet
usage to have a number of neurotic symptoms.
Five-Factor Model of Personality
The five-factor model (FFM) of personality is an empirically validated
overarching taxonomy into which all personality traits can be integrated. The five core
dimensions of FFM are Openness, Conscientiousness, Extraversion, Agreeableness, and


51
Neuroticism. The dimensions are frequently referred to by the acronym OCEAN. John et
al. (2008) described the broad definition of each factor. Openness is the breadth, depth,
originality, and complexity of an individuals mental and experiential life (p. 139).
Conscientiousness is the ability to adhere to social norms, evaluate consequences of
behavior, delay gratification, and manage tasks. Extraversion is an energetic personality
style that emphasizes a positive and active emotional attitude. Agreeableness contains a
body of prosocial traits such as altruism, empathy, and a general kindness toward others.
Neuroticism is the opposite of emotional stability. Individuals with high scores in
Neuroticism often have pathological levels of anxiety and emotional disorders, and they
have a general worried, pessimistic outlook on life. The core FFM dimensions (OCEAN)
are comparable to the large branches on a tree. Each large branch has smaller stems, or
traits, that make up an individuals complete personality.
The five core dimensions of FFM showed consistency across cultural boundaries
(De Raad, di Bias, & Perugini, 1998). The five-factor model was also examined in non-
humans. In a fascinating study, Gosling, Kwan, and John (2003) examined the FFM
personality traits of dogs and their owners. Both groups (dogs and owners) personality
traits were evaluated by multiple observers using the Big Five Inventory (BFI), an
assessment for FFM. Internal consistency was remarkably similar for both dogs and
humans across FFM traits as measured by the BFI. Consensus between the owner and an
acquaintance of the owner were also incredibly similar for dogs and humans. The dogs
and their owners FFM traits were also evaluated on the construct of correspondence
which is defined as the degree to which a measured variable conforms to reality. In order


52
to measure correspondence, three external judges observed each dog and owner at a local
dog park and rated performance for the dogs on several tasks and then ranked them using
BFI. The correspondence between the owners and judges BFI ratings for dogs and
humans were equally strong across the BFI scales. This research highlights the incredible
portability of FFM.
The impact of the FFM is obvious by the number of publications in the past 5
years. Approximately 1,500 journal articles were published about FFM from 2005
through 2009 compared to less than 100 from 1985 to 1989. The once dominant Eysenck
and Cattell models of personality declined to approximately 200 published articles from
2005 to 2009 (John et al., 2008). While the FFM dominated personality theory over the
last several years, it has not frequently been used as a tool for researching problematic
Internet usage. Four meta-analyses failed to mention the five-factor model as a significant
topic of research in problematic Internet usage (Chakraborty et al., 2010; Chou et al.,
2005; Czincz & Hechanova, 2009; Widyanto & Griffiths, 2006). Young and Abreu
(2010) recently completed a definitive volume on problematic Internet usage, Internet
Addiction: A Handbook and Guide to Evaluation and Treatment, with extensive articles
from leading theorists. In their book, the overarching FFM personality theory was not
mentioned once by a single contributing author. This highlights the need for more
research examining the relationship between FFM dimensions and problematic Internet
usage. In this study, I added to the FFM body of literature with an emphasis on
Neuroticisms relationship to problematic Internet usage. Fortunately, there is a much
needed body of research regarding FFM as it relates Internet use and application


53
preference (Landers & Lounsbury, 2006; Ross, Orr, Sisic, Arseneault, Simmering, & Orr,
2009).
Five-Factor Model and Internet Usage
Landers and Lounsbury (2006) added to the body of Internet usage knowledge by
examining FFM and several additional personality dimensions. They examined the
relationship of Internet usage and the core FFM personality traits. They also studied three
narrow traits that were not incorporated within FFM and primarily related to academic
performance. These traits were optimism, tough-mindedness, and work drive. They
detailed optimism as a predisposition toward a positive outlook. Tough-mindedness was
explained as the ability to base decisions on facts rather than feelings. Work drive was
identified as the disposition to expend significant time and effort to achieve goals.
With the FFM and narrow traits defined, Landers and Lounsbury (2006) enlisted
117 undergraduates at a Tennessee university. The students ranged from 18 to 22-years-
old with 41% males and 59% females. They used the Adolescent Personal Style
Inventory (APSI) to measure FFM as well as the previously described narrowed
personality traits. The Internet Use Questionnaire consisted of eight time-related choices
(1, less than 1 hour per week; 8, more than 10 hours per day). One question also asked
the percentage per week devoted to communication, leisure, and academic activities
online.
Agreeableness, Conscientiousness, and Extraversion were inversely related to
Internet usage. Individuals that exhibited less of these three traits (i.e., less agreeable, less
conscientious, and introverted) spent more time on the Internet. The narrower traits of


54
optimism and work drive were also inversely related to Internet usage. Tough-
mindedness was positively correlated to time spent on the Internet. Conscientiousness
and work drive were negatively correlated to the amount of time devoted to online leisure
activities. Conscientiousness was positively correlated with Internet usage for academic
pursuits.
They interpreted three significant FFM findings as follows: (a) extraverted
students were more likely to spend their time in social interactions, while introverted
students had smaller social networks, and therefore had more free time for computer
related activities; (b) less agreeable students, whose personality styles were more
palatable on the Internet, initiated fewer social interactions and were sought out less by
peers for social activities; and (c) less conscientious students were drawn to the
unstructured nature of Internet activities. The final interpretation regarding
Conscientiousness and the desire for structure was partially corroborated by preferred
Internet activities. Those with high Conscientiousness scores reported more usage of
academic activities compared to those with lower endorsement of this trait.
Five-Factor Model and Application Preference
Research focused much attention on preferred Internet application type and
problematic Internet usage. Four separate meta-analyses listed application selection as
one of the most researched and significant criteria for problematic Internet usage
(Chakraborty et al., 2010; Chou et al., 2005; Czincz & Hechanova, 2009; Widyanto &
Griffiths, 2006). Young (1996, 2000) pioneered the separation of various Internet
applications and their correlation with dependency. She found that dependent users


55
preferred communicative or interactive applications over information gathering and
email. Approximately 80% of dependents spent their time using chat rooms, MUDs, and
newsgroups while only 22% of non-dependents preferred these interactive mediums.
Young (2000) subdivided dependent users into five categories: (a) cyber-sexual
addiction, (b) cyber-relationship addiction, (c) net compulsions, (d) information overload,
and (e) computer addiction. She found dependency was significantly greater within
categories that used highly interactive applications. Youngs (1996, 1998, 2000) early
findings of a high correlation between interactive content and dependency were
corroborated by virtually every study evaluating applications preference over the last
decade (Czincz & Hechanova, 2009).
The emergence of social media applications, instant messaging programs, and
texting devices created research interest on the topic of which personality types were
drawn to this type of content. Previous research indicated the personality traits of
Neuroticism, openness, and extraversion were influential in the preference for social
media outlets (Butt & Phillips, 2008; Landers & Lounsbury, 2006; Wolfradt & Doll,
2001). Individuals who endorsed high levels of Neuroticism and a deep-rooted desire for
social connection were likely to seek out and prefer computer-mediated communication
modalities to fulfill this need (Wolfradt & Doll, 2001). Computer-mediated
communication usage was rated higher than other forms of communication (i.e., face-to-
face) for individuals with high Neuroticism scores (Butt & Phillips, 2008). Amichai-
Hamburger, Wainpel, and Fox, (2002) emphasized the significance of online identity and
extraversion. They suggested that introverts were more likely than extraverts to relate


56
with and reveal to others their true selves through an online persona. Therefore,
individuals with low extraversion scores were more likely to gravitate toward computer-
mediated communication. Openness to new experiences was consistently associated with
embracing computer-mediated communication (Butt & Phillips, 2008).
Ross et al. (2009) examined the personality traits of Facebook users. They noted
Facebook was a unique form of computer-mediated communication because the majority
of online friends were met in real life prior to being added as Facebook friends. In their
study, 92 Southwestern Ontario college-age students completed a 28-item Facebook
questionnaire, a computer-mediated communication competency questionnaire, and the
NEO Personality Inventory-Revised (NEO-PI-R). The NEO-PI-R is the most robust and
validated instrument for evaluating the personality dimensions of FFM (McCrae & Costa,
2008). The computer-mediated communication competency questionnaire focused on
three domains including motivation, knowledge, and efficacy. The Facebook
questionnaire contained categories regarding preference for using specific Facebook
features, attitudes about Facebook, and posting personally-identifying information.
Ross et al. (2009) hypothesized that the following results would emerge from
their study regarding Facebook use and FFM personality dimensions: (a) extraverts
would spend more time on Facebook, use more features, belong to more groups, and have
more online friends; (b) individuals high in Neuroticism would spend more time online,
share more personal information, and be less likely to use private messages; (c) agreeable
individuals would have more Facebook friends; (d) high endorsement of the openness
dimension would equate to more time on Facebook as a communication tool and the


57
willingness to try out more features; and (e) conscientious individuals would spend less
time on Facebook.
Ross et al. (2009) examined only data from students that scored in the top and
bottom third for each dimension along the NEO-PI-R which equated to a smaller effect
size. This placed all evaluated scores within three standard deviations from the mean.
High endorsement of extraversion items was found to be significant in number of
associated Facebook groups; however, high extraversion was not significant in number of
online friends, time spent online, or use of public status changes on Facebook.
Neuroticism was most significant in preference for posting via a group forum feature
unique to Facebook called the wall. Individuals with low Neuroticism scores preferred
posting photos over those with higher scores. Openness, agreeableness, and
conscientiousness did not reveal any preferences for particular features of Facebook. One
of the more interesting findings was that amount of time on Facebook correlated with
high computer-mediated communication motivation.
Neuroticism and Problematic Internet Usage
Neuroticism is a personality trait within FFM associated with the predisposition to
experience negative emotional states from stressors. The neurotic personality reacts with
over-the-top worry and anxiety to small events and non-threatening situations. Woody
Allen made a lucrative career by portraying neurotic characters, exemplified in the film
Play it Again Sam. Amichai-Hamburger and Ben-Artzi (2000) found that introversion
and Neuroticism were good predictors of the types of Internet services an individual
preferred. Individuals, particularly women, who scored high on Neuroticism and


58
introversion scales, preferred more social Internet services, like chat rooms, as compared
to their non-neurotic, extraverted counterparts. A study of 2,620 Chinese adolescents
found that out of the 88% that endorsed using the Internet, approximately 2.4% met the
criteria for addiction. The highest rated personality trait of those considered addicted was
Neuroticism (Cao & Su, 2006). In reviewing the literature on problematic Internet usage,
Chou, Condron, and Belland (2005) found that using interactive applications contributed
to problematic Internet usage more than any other type of Internet service. Since
individuals with neurotic traits can be drawn to socially interactive applications, they
could be at greater risk for problematic Internet usage.
Chen (2008) observed that overusing the Internet with interactive activities such
as online gaming was more common in neurotic individuals, and it had a negative impact
on overall well-being. Individuals scoring high in Neuroticism get a sense of mastery and
achievement when online that is lacking from the real world. Anxiety and other negative
emotional states are temporarily decreased when the neurotic individual feels a sense of
control when using the computer. This makes them potentially more vulnerable to
addictive Internet behaviors as they gain mastery over the computer, yet their underlying
needs remain unmet (Kandell, 1998; Suler, 1999).
Measuring the Five-Factors of Personality
The most comprehensive and widely used instrument to measure FFM personality
traits is the NEO Personality Inventory-Revised (NEO-PI-R). This instrument is massive
and includes 240 items subdivided within six aspects of each FFM domain. It can take
approximately one hour to complete the test which is often not feasible for research


59
projects incorporating multiple questionnaires. Because of this need, brief instruments
have been devised to accurately measure FFM personality traits. One of the most popular
brief instruments is the Big-Five Inventory (BFI) which is still somewhat lengthy with a
total of 44 questions. The Ten Item Personality Inventory (TIPI) is a relatively new, but
reliable and validated brief instrument for measuring core FFM traits. When compared to
the NEO-PI-R and the BFI, the TIPI weighs in at only 10 items. This is extremely
compatible with research studies, such as this one, employing multiple questionnaires
(Gosling, Rentfrow, & Swan, 2003).
The TIPI was designed with brevity in mind taking approximately one minute to
complete while at the same time allowing for a broad coverage of core personality traits
associated with longer instruments. The 10-items on the TIPI represent each pole of the
five-factor model. Using a unipolar and bipolar design style, each item contains two,
separated unipolar descriptors which are answered under the overarchi ng question of I
see myself as (Gosling, Rentfrow, & Swan, 2003, p. 516). Each Five-Factor trait
contains two bipolar questions on the TIPI emphasizing the extremes of the five core
FFM traits (Gosling, Rentfrow, & Swan, 2003).
Gosling, Rentfrow, and Swan. (2003) evaluated the TIPI in comparison to the BFI
and NEO-PI-R. In their study, a group of 1,813 college students were given the TIPI and
BFI. Each instrument was separated by additional assessments between administrations
to limit content carryover. The sample group consisted of 65% females and 35% males.
The BFI and TIPI had high convergent correlation across all FFM traits. The correlations


60
were approximately 0.87 for Extraversion, 0.70 for Agreeableness, 0.75 for
Conscientiousness, 0.81 for Emotional Stability, and 0.65 for Openness to Experience.
In the same study, the TIPI and NEO-PI-R were given 6 weeks after the initial
TIPI and BFI administrations. The TIPI convergent correlations with the NEO-PI-R were
similarly as strong as the correlations with the BFI. The FFM traits correlations were 0.65
for Extraversion, 0.59 for Agreeableness, 0.68 for Conscientiousness, -0.66 for
Neuroticism, and 0.56 for Openness to Experience. Since the TIPI measures emotional
stability, the polar opposite of neuroses, a negative correlation is a strong measure of
convergence with the NEO-PI-R within that factor. The TIPI convergent validity was
similar to that of the BFI with the NEO-PI-R. In comparison, the BFI correlated only
slightly higher with the NEO-PI-R than the TIPI (Gosling, Rentfrow, & Swan, 2003).
The 6-week test-retest reliability of the TIPI was strong. The mean correlation
across all five core traits was 0.72. Individual test-retest correlations were 0.77 for
Extraversion, 0.71 for Agreeableness, 0.76 for Conscientiousness, 0.70 for Emotional
Stability, and 0.62 for Openness to Experience (Gosling, Rentfrow, & Swan, 2003).
Overall the trait with the highest correlation compared to the NEO-PI-R and BFI
was Extraversion. The least correlated trait was Openness to Experience although this
was still within acceptable ranges. For the brevity, the TIPI offers a powerful alternative
to longer instruments such as the NEO-PI-R and the BFI (Gosling, Rentfrow, & Swan,
2003).


61
Problematic Internet Usage and Sensation Seeking
The personality trait of sensation seeking was associated with risky and addictive
behaviors (Zuckerman, 2007). Although sensation seekers often find themselves in
precarious and dangerous situations, it is not necessarily the pursuit of risk that defines
sensation seeking. Many activities of sensation seekers involve little or no risk. For
example, watching a horror movie or listening to violent themed music has little risk, yet
it involves the type of experience sensation seekers are after. It is the openness to new
and intense experiences and feelings that more accurately defines the trait of sensation
seeking (Zuckerman, 2007). The Internet is one of the most dynamic, evolving, and
multidimensional technological phenomena ever created. It is ripe for ful filling the
insatiable appetite sensation seekers have for new, intense experiences (Griffiths, 2000).
Freimuth (2008) compared the multiple activities available on the computer to a sensation
rush (p. 158). The term rush is often used to describe the euphoric feeling from substance
abuse. Problematic Internet usage shares the same core motivations in achieving this
state.
Zuckerman (2007) listed the three most significant motivations for using addictive
substances as curiosity, pleasure, and avoidance. Curiosity involves a desire to try a new
substance often due to positive rumors or stories from current users. Pleasure quickly
replaced curiosity as a motivator once an individual has a positive experience or kick
from a given substance (p. 107). The final motivator, avoidance, concerned escaping
physiological and psychological pain by continuing to use a given substance to avoid or
escape from withdrawal symptoms. With regard to problematic Internet usage, curiosity


62
and pleasure are likely primary motivators for continued use. Young (1999) contended
that pathological Internet users also experience withdrawal symptoms when away from
their favorite online activity. The mental pleasure when online is a stark contrast to the
off-line world, and the unpleasant real world feelings intensify the longer a pathological
user is away from the computer. The user becomes highly motivated to avoid negative
emotions, and increases his or her online time. If sensation seekers can withstand the
psychological withdrawal of their favorite activity, there is always the danger of a new
Internet pastime starting another motivation cycle of curiosity, pleasure, and eventually
more withdrawal.
Measuring Sensation-Seeking
Zuckermans (2007) Sensation-Seeking Scale (SSS) has remained the gold
standard for measuring the sensation seeking trait; however, it is not necessarily the best
instrument for assessing the unique type of sensation seeking observed with problematic
Internet usage. Lavin, Marvin, McLarney, Nola, and Scott (1999) assessed over 300
college students with Zuckermans sensation seeking gold standard, the Sensation-
Seeking Scale (SSS). The participants were also evaluated on attitudes and behaviors
toward the Internet. The study yielded interesting results. Individuals with more
problematic Internet usage scored lower on the SSS than those with less problematic
usage. Lavin et al. interpreted this finding as a potential flaw with the type of sensation-
seeking measured by the SSS. The SSS is loaded with questions relating to physically
risky activities. They suggested a more sensitive instrument to the types of behaviors
associated with problematic Internet usage could yield more valid results. They also


63
emphasized the limitations of the assessment used to measure problematic Internet usage,
and the lack of any consistent and highly validated problematic Internet usage
instruments available at the time.
In another study utilizing the SSS, Lin and Tsai (2002) assessed 750 Taiwanese
high school students; problematic Internet usage was determined by a cutoff score on the
Internet Addiction Scale for Taiwan High Schoolers (IAST). Approximately 17% of all
participants were categorized with problematic Internet usage. Participants classified with
problematic Internet usage scored higher on the overall SSS than those without
problematic Internet usage. Scores on the subscales of the SSS confirmed Lavin et al.s
assumption that the SSS was measuring a different form of sensation-seeking. Individuals
with problematic Internet usage scored higher on the disinhibition subscale; however,
problematic Internet usage and non-problematic Internet usage groups scored similarly on
the life-experience and thrill and adventure seeking subscales.
Arnett (1994) developed the Arnett Inventory of Sensation Seeking (AISS) with
the intention to examine the components of novelty and intensity within sensation-
seeking. Zuckerman (2007) gave the AISS high marks for the inclusion of intensity
which is lacking in other sensation-seeking measures. The definition and importance of
intensity are evident in Zuckermans redefinition of sensation-seeking to include intensity
as equally important as novelty and complexity within the chosen activities of sensation
seekers.
The AISS attempts to modernize and broaden the popular Sensation Seeking
Scale (SSS) developed by Zuckerman (2007). The AISS removes forced choices that


64
polarize respondents to extremes when they often endorse items moderately in reality.
Arnetts scale also attempts to eliminate the items that are solely based on physical,
strenuous tasks. Although sensation seekers are apt to be drawn toward action-oriented
hobbies, this is by no means the norm, and it does not apply to the type of sensation
seeking seen in hobbies such as Internet use. Another important difference in the AISS
compared to the standard SSS is the use of substance, alcohol, and sexual-related
questions (Arnett, 1994).
Arnetts (1994) guideposts for developing the AISS are congruent to the type of
sensation-seeking associated with problematic Internet usage. The focus on many
sensation-seeking measures leans toward abnormal and deviant behaviors often along the
psychopathic spectrum; however, the AISS emphasizes more socially acceptable forms of
sensation-seeking. As previously mentioned, age-related activities (e.g. rock climbing)
are also eliminated from the questions, and so are applicable to a wider-range of
participants. Overall these originating factors associated with the creation of the AISS
make the assessment an excellent measure for sensation-seeking components associated
with problematic Internet usage.
The reliability and validity of the AISS with Zuckermans SSS, the gold standard,
is well documented. In one study, Arnett (1994) explored the correlation between the
AISS, SSS, and a risk activities questionnaire among 116 high school students. The
students mean age was 17.4 years with a composition of 54 boys and 62 girls. The
students completed the 20-item AISS, 40-item SSS, and a 16-item questionnaire
pertaining to the types of risk behaviors an individual had engaged in within the past


65
year. On the 16-item risk-assessment questionnaire, the students indicated the number of
times within the last year they had engaged in risky activities such as aggressive driving
behavior, sexual promiscuity, substance-abuse, theft, and vandalism. A 3-month test-
retest reliability evaluation on this risk assessment averaged slightly over 0.80 for all
items. For all items, the AISS was correlated more strongly with risk-associated
behaviors than the SSS. The subscale correlations ranged from 0.47 to 0.08. The AISS
novelty subscale correlated the highest at 0.47 with the SSS adventure-seeking subscale
while the same novelty subscale only correlated at 0.08 with the SSS boredom
susceptibility scale. The AISS correlation with the SSS was approximately 0.41 for the
total scales. Internal reliability for the intensity and novelty subscales was 0.64 and 0.50.
The internal validity for the complete AISS was approximately 0.70.
A second study was conducted by Arnett (1994) one-year later at the same high
school used in the previous study. In this new research, the AISS, the 16-item risk
assessment, and the Aggression subscale of the California Psychological Inventory (CPI)
were used. The Aggression subscale was used to measure construct validity of the AISS.
The study consisted of 177 participants of which 139 were high school students and 38
were adults. In this study, age was an important factor and had varying results on
correlations. Younger participants endorsed significantly higher sensation-seeking items
than did adults. Within the AISS subscales, students scores on the Intensity subscale
were significant (p < 0.001) when compared to items endorsed by adults. The Novelty
subscale showed no significant differences between age groups. Aggression, as measured


66
by the subscale of the CPI, was significantly correlated to sensation-seeking
endorsements of the AISS (0.36, p < 0.001).
The AISS was more strongly associated to numerous sensation-seeking behaviors
than the SSS gold standard. It is important to note that the AISS does not contain any
items that directly relate to specific risk-type behaviors unlike the SSS. The lack of
specific items allows for the measurement of a much broader range of behavi ors that are
underrepresented by sensation-seeking research. This allows the AISS to be more
appropriate to socially acceptable sensation-seeking behaviors often associated with
problematic Internet usage (Arnett, 1994).
Statement of the Problem
Are we facing a hidden epidemic of problematic Internet usage in North America?
According to the DSM-5 we have lagged behind Asian countries in problematic Internet
usage research. The prevalence and risk factors of problematic Internet usages in North
America are practically unknown. The following statement from the DSM-5 summed up
the current need for research in Internet gaming disorder:
The prevalence of Internet gaming disorder is unclear because of
the varying questionnaires, criteria and thresholds employed, but it seems
to be highest in Asian countries and in male adolescents 1220 years of
age. There is an abundance of reports from Asian countries, especially
China and South Korea, but fewer from Europe and North America, from
which prevalence estimates are highly variable. (APA, 2013, p.797)


67
Unfortunately, the above statement was limited to Internet gaming disorder rather
than addressing the broader diagnostic category of problematic Internet usage. In
addition, the DSM-5 reported, No consistent personality types associated with Internet
gaming disorder have been identified (APA, 2013, p.797). This research addressed the
broader category of problematic Internet usage as an overarching disorder intended to
include all sub-categories of problematic Internet usage including Internet gaming
disorder. The need to research risk factors and personality factors that could contribute to
problematic Internet usage was the driving force behind this research.
To help fill this research gap, my study used a validated problematic Internet
usage instrument, the Problematic Internet Use Questionnaire, to evaluate problematic
Internet usage coinciding with multiple variables previously associated in the literature
with problematic Internet usage. These variables included worry, social anxiety,
sensation-seeking, neuroticism, and endorsement of self-medication. I hypothesized that
problematic Internet usage scores on the Problematic Internet Use Questionnaire would
be higher for individuals endorsing higher scores on the variables mentioned above. This
is not meant to imply that only these variables are salient in researching problematic
Internet usage but rather should be considered as a starting point for adding to the peer-
reviewed evidence needed to establish the relationship these risk factor variables might
have on problematic Internet usage. These five potential risk variables (worry, social
anxiety, sensation-seeking, neuroticism, and endorsement of self-medication) encompass
three broad correlates of problematic Internet usage including comorbid anxiety (worry
and social anxiety), self-medication, and personality (neuroticism and sensation-seeking).


68
Social anxiety was chosen as a salient variable due to its relationship with the
social aspects of the Internet. The Internet is now a thriving social medium. Many
younger individuals within Generation Digital (Gen-D) prefer the Internet over all other
forms of communication (Greenfield, 2010; Moeller et al., 2010). The generational
switch to computer-mediated communication makes social variables and their
relationship to problematic Internet usage particularly important. Communication-based
media (Facebook, Twitter, MMOs, etc.) was linked with excessive usage and problematic
Internet usage (Czincz & Hechanova, 2009; Young, 1996, 1998, 2000). Previous research
highlighted the predilection of individuals with inadequate social skills to be more
attracted to communication-based media (Caplan, 2003; Caplan & High, 2010). Based on
this research, Caplan argued for a social deficit theory of Internet use. This current study
took Caplans (2003) social deficit theory one step further and examined a pathological
disorder often associated with limited social skills; social anxiety. The Liebowitz Social
Anxiety Scale was used to examine social anxiety and its relationship to problematic
Internet usage. This added needed information regarding the contribution of the social
factors underlying problematic Internet usage.
Worry was selected as a potential risk variable for problematic Internet usage due
to research showing its link to substance use as a form of self-medication that alleviates
such negative affect (Young, 1998, 2001, 2010; Khantzian & Albanese, 2008). Previous
research reported that individuals who indicated high levels of anxiety were more likely
to endorse self-medication as a primary reason for their substance abuse (Bolton et al.,
2006). A key aspect of the current study modified Bolton et al.s (2006) research to


69
examine if self-medication contributed to problematic Internet usage in a similar fashion
as substance abuse. Worry was selected because it is a primary attribute of generalized
anxiety disorder which is one of the most common disorders associated with abusing
substances and use of behaviors to relieve dysphoric mood (APA, 2000; Bolton, et al.,
2006; Khantzian & Albanese, 2008). The Penn State Worry Questionnaire, a gold
standard instrument, was employed to assess worry.
The study also examined personality type as a risk factor for problematic Internet
usage. The DSM-5 statement, No consistent personality types associated with Internet
gaming disorder have been identified points out the need for research in this area.
Young and Rodgers (1998) studied personality traits and problematic Internet usage;
unfortunately, their early research focused heavily on Cattells model of personality.
Current personality research has made a paradigm shift toward the five-factor model
largely supplanting Cattells model as the primary theory driving new studies (John et al.,
2008). While problematic Internet usage research has been slow to adopt the five-factor
model, there has been a recent increase in research focusing on the five-factor model and
Internet application preference (Butt & Phillips, 2008; Ross et al., 2009). Previous
research using the five-factor model focused primarily on personality traits associated
with preference for Internet applications. The current research extended this research by
looking at whether a factor of FFM was associated with problematic Internet usage.
Although incorporation of the five-factor model in the body of problematic Internet usage
literature has been limited, new research has begun to focus on neuroticism as a risk
factor in problematic Internet usage (Amichai-Hamburger & Ben-Artzi, 2000; Cao & Su,


70
2006; Chen, 2008). This study focused on neuroticism, one of the five core personality
dimensions of FFM, to add to the body of literature associated with the correlation of
neuroticism as a risk factor for problematic Internet usage. The current study used the
TIPI to examine the correlation of neuroticism and problematic Internet usage. The
International Personality Item Pool (IPIP) was utilized for a more detailed review of
Neuroticism. More specifically, the IPIP examined six facets of Neuroticism including
anxiety, anger, depression, self-consciousness, immoderation, and vulnerability.
Sensation seeking as a potential risk variable to problematic Internet usage was
also studied. The personality trait of sensation-seeking directly relates to the Generation
Digital (Gen-D) population. Younger individuals, who make up Gen-D, were shown to
have higher levels of the sensation-seeking personality trait which was associated with
problematic Internet usage (Greenfield, 2010). Previous research assessed sensation-
seeking based on physical, high-risk activities (i.e., parachuting, mountain climbing,
driving fast, etc.) which are not necessarily related to the kind of sensation provided by
Internet use (Lavin et al., 1999; Zuckerman, 2007). This study used a more sensitive
instrument, the Arnett Inventory of Sensation Seeking (AISS), to evaluate sensation-
seeking traits associated with Internet use. The Arnett Inventory of Sensation Seeking
emphasizes intensity of experience with its Intensity subscale and eliminates items based
on physical activities (Arnett, 1994). The AISS also has a second subscale, Novelty,
which measures preference for new and varied activities which is a defining characteristic
of the wide range of applications available on the Internet. The current study better


71
conceptualizes the criteria associated with sensation-seeking in the extremely vulnerable
Gen-D group.
The risk variable involved with using the Internet as a form of self-medication
was selected because it was one of the nine criteria suggested in the DSM-5 for
diagnosing Internet gaming disorder (APA, 2013). The exact criterion for diagnosing
Internet gaming disorder reads, Use of Internet games to escape or relieve a negative
mood (e.g., feelings of helplessness, guilt, anxiety) (APA, 2013, p.795). While this
criterion was limited to Internet gaming disorder in the DSM-5, it could easily be adapted
to problematic Internet usage. Khantzian and Albaneses (2008) model of self-medication
hypothesis suggested that psychological pain drives addiction. In the self-medication
hypothesis model, individuals use substances or behaviors in an attempt to relieve
psychological distress (depression, anxiety, mania, etc.). The model of self-medication
could well apply to problematic Internet usage and was considered, in this research, as a
high-risk variable that could lead to problematic Internet usage.
In summary, the risk variables in this research (worry, social anxiety, sensation-
seeking, neuroticism, and endorsement of self-medication) were chosen to examine their
relationship to problematic Internet usage and how this research related to addiction in
general, especially, to non-substance-related disorders as defined in the Substance-
Related and Addictive Disorders section of the DSM-5. The main hypothesis of this study
predicted the selected variables would significantly contribute to higher scores on the
Problematic Internet Use Questionnaire (the instrument used in this study to measure
problematic Internet usage).


72
Statement of Hypotheses
Hypothesis 1
Controlling for age and gender, high levels of worry (as measured by the Penn
State Worry Questionnaire), social anxiety (as measured by the Liebowitz Social Anxiety
Scale), sensation-seeking (as measured by the Arnett Inventory of Sensation Seeking),
neuroticism (as measured by the International Personality Item Pool), and endorsement of
self-medication (as defined by confirmation of the self-medication question) will predict
greater levels of problematic Internet usage (as measured by the Problematic Internet Use
Questionnaire).
Hypothesis 1a
Controlling for age and gender, high scores on the neuroticism facets of anxiety
and immoderation (as measured by the International Personality Item Pool) will be the
most significant neuroticism factors when predicting problematic Internet usage (as
measured by the Problematic Internet Use Questionnaire).
Hypothesis 1b
Controlling for age and gender, high levels of the sensation-seeking traits novelty
and intensity (as measured by the Arnett Inventory of Sensation Seeking) will predict
higher levels of problematic Internet usage (as measured by the Problematic Internet Use
Questionnaire).
Hypothesis 2
Controlling for age and gender, the endorsement of self-medication (as defined by
confirmation of the self-medication question) will significantly moderate the relationship


73
of problematic Internet usage (as measured by the Problematic Internet Use
Questionnaire) with the variables of worry (as measured by the Penn State Worry
Questionnaire), social anxiety (as measured by the Liebowitz Social Anxiety Scale),
neuroticism (as measured by the International Personality Item Pool), and sensation-
seeking (as measured by the Arnett Inventory of Sensation Seeking).


74
CHAPTER THREE: RESEARCH METHOD
Methods
Participants
Data were collected from volunteers using Amazons Mechanical Turk website.
Filters were put in place, so that only participants within the Continental United States
could participate. The participants completed multiple questionnaires anonymously
online pertaining to sensation-seeking, neuroticism, emotional stability, worry, social
anxiety, self-medication, and a problematic Internet usage scale. There were two
demographic questions regarding age and gender, and the problematic Internet Use
Questionnaire emphasized that each item was based on recreational Internet use only. A
prior power analysis was calculated for multiple regression using 8 predictor variables
and an effect size (f
2
) of 0.15. A sample size of 160 was determined to be sufficient with
95% power to yield statistically significant results. The study collected data from 206
participants.
Materials
Problematic Internet Use Questionnaire (PIUQ). The Problematic Internet Use
Questionnaire is an 18-item questionnaire assessing problematic Internet usage. The
Problematic Internet Use Questionnaire uses a 5-point Likert scale (5, Always; 0, Never),
and measures problematic Internet usage across three domains: obsession, neglect, and
control disorder. Each of the three subscales is composed of six questions. Cronbachs
alpha is approximately 0.87 for the Problematic Internet Use Questionnaire. The
subscales also have high internal consistency with obsession at 0.85, neglect at 0.74, and


75
control disorder at 0.76. The test-retest reliability is approximately 0.90 (Demetrovics,
Szeredi, & Rozsa, 2008).
Arnett Inventory of Sensation Seeking (AISS). The AISS was used to measure
sensation-seeking. It consists of two subscales (Novelty and Intensity) with 20 questions
on a 4-point Likert scale (4, describes me well). The subscales and total scales have an
internal reliability of approximately 0.70. Test-retest reliability is approximately 0.80
(Arnett, 1994).
International Personality Item Pool (IPIP). The IPIP is a public domain
instrument designed to closely resemble the items on the NEO Personality Inventory
Revised (NEO-PI-R) which is considered the gold standard of five factor model
assessments. The IPIP six facets of neuroticism (anxiety, anger, depression, self-
consciousness, immoderation, and vulnerability) used in this dissertation have been found
to be significantly correlated with their NEO-PI-R counterparts (anxiety, anger, hostility,
depression, self-consciousness, impulsiveness, and vulnerability). The correlations
between each facet were the following: anxiety (0.75), anger (0.76), depression (0.80),
self-consciousness (0.72), immoderation (0.73), and vulnerability (0.77) (Goldberg et al.,
2006).
Ten-Item Personality Inventory (TIPI). The TIPI is a 10-item questionnaire
with a 7-point Likert scale (1, Disagree strongly; 7, Agree strongly), and was used to
measure Emotional Stability. The TIPI measures the core five personality traits
associated with FFM. The convergent validity between the TIPI and NEO-PI-R ranged


76
from 0.68 to 0.56 (Neuroticism = 0.66). Test-retest reliability on the TIPI was 0.72
(Gosling, Rentfrow, & Swann 2003).
Penn State Worry Questionnaire (PSWQ). The PSWQ is a 16 item
questionnaire with a 5-point Likert scale (5, Very typical of me; 1, Not at all like me). The
total score ranges from 16 to 80. Cutoff scores of 62 yielded high specificity (0.86) with
generalized anxiety disorder. Internal consistency for the total 16 questions is
approximately 0.93. Test-retest reliability was found to be high at 0.92 (Behar, Alcaine,
Zuellig, & Borkovec, 2003).
Liebowitz Social Anxiety Scale (LSAS). The LSAS is a 24-item questionnaire
for assessing social anxiety with a 4-point Likert scale (3, Severe; 0, None) with subscales
measuring fear and avoidance. The subscales of fear and avoidance were highly
correlated with each other at 0.91. The LSAS has good reliability across studies with
Cronbachs alpha ranging from 0.81 to 0.92 for the fear subscales, 0.83 to 0.92 for the
avoidance subscales, and 0.96 for the total score. The LSAS also has solid convergent
validity r = 0.52 with clinicians rating of social anxiety (Heimberg et al., 1999).
Procedure
Testing was completed in one online session. Participants were given the URL
link to the questionnaires on SurveyMonkey within the Mechanical Turk website. The
main forum post included a brief background for the purpose, estimated time, and
participation requirements of the study. During the online survey, the participants were
presented the pathological Internet use questionnaire first to reduce possible demand
characteristics that could be present in other questionnaires which could potentially bias a


77
participants responses to other questions concerning problematic Internet usage
(Heiman, 1999, p. 274).
Analyses
All analyses were conducted using SPSS 20 for Windows. The null hypothesis
was tested that none of the predictor variables have an effect on the criterion variable
(Problematic Internet Use Questionnaire). The criterion for significance was set at 0.05.


78
CHAPTER FOUR: RESULTS
Results
Descriptive Data
The mean SD age of participants was 35 11 years (range, 18 - 68 years) which
included 128 females (62%) and 78 males (38%). Instrument means, standard deviations,
and norms are listed in Table 1. The mean scores on the dependent variable (Problematic
Internet Use Questionnaire) broken down by age of the 206 individuals who completed
all protocols is summarized in Appendix H. Compared to the norm group, the sample
group showed slightly more problematic Internet usage, much less social anxiety, and
similar endorsement of worry and sensation-seeking.
Table 1
Instrument Means, Standard Deviations, and Norms
M SD Norm M Norm SD
Problematic Internet Usage
(PIUQ)
39.31 11.93 32.51 9.85
Worry (PSWQ) 47.58 16.49 49.28 13.64
Social Anxiety (LSAS) 43.30 24.06 68.02 27.38
Sensation Seeking (AISS) 49.31 7.63 50.21 6.10
Emotional Stability (TIPI) 9.57 3.27 4.83 1.42
Neuroticism (IPIP)* 32.18 9.90 ----- -----
Note: *The International Personality Item Pool (IPIP) uses only locally derived scores
and therefore has no normative data.


79
Preliminary Analyses
Out of 209 individuals, 206 completed all protocols. One female and two male
participants were removed from the final data analysis due to lack of completion across
multiple assessments. Among those who remained in the sample occasional incomplete
responses were converted to the mean of responses for the specific question. The core
assessments, except for the Problematic Internet Use Questionnaire, had no more than
four incomplete answers across any one individual question for all 206 participants. Item
8 on the Problematic Internet Use Questionnaire (How often do you choose the Internet
rather than being with your partner?) had the highest incompletion rate with a total of
11. Because of the high number of incomplete responses as compared to other questions,
Item 8 was evaluated with an independent samples t-test across multiple variables.
Participants were divided into two groups: (a) those that completed Item 8 and (b) those
that did not complete Item 8. There were significant mean differences between the two
groups on the Intensity Scale of the Arnett Sensation Seeking Inventory. Participants who
did not complete Item 8 had lower mean scores (M = 19.82, SE = 1.61) on the Intensity
Scale than those who answered the item (M = 22.89, SE = .32). This difference was
significant t(204) = 2.18, p < .05. Although significance was found, it represented a
relatively small effect r = .15. The item was left in for all analyses.
The variable of social anxiety as measured by the Liebowitz Social Anxiety Scale
was found to be positively skewed (p < .01). Log and square root transformations
worsened skew, so outliers greater than three standard deviations were converted to the
mean plus two times the standard deviation (M = 43.24, SD = 24.03.). The subscale of


80
vulnerability as measured by the International Personality Item Pool was also found to be
positively skewed (p < .01). Several transformations were attempted but worsened skew.
The positive skew of the vulnerability subscale did not affect the overall total
measurement for neuroticism.
The assessments in this research were targeted to detect psychopathologies which
were highly intercorrelated; therefore, it was important to evaluate all variables for
potentially problematic low tolerance (< .2) and high VIF (> 5) scores (Field, 2009).
There was an issue with multicollinearity between two assessments, IPIP and TIPI, which
measured neuroticism. The IPIPs measure of neuroticism was significantly correlated to
the TIPIs measurement of emotional stability, r = -.80, p < .001. It was intended that the
TIPI and IPIP would be used in conjunction; however, there were problematic
collinearity statistics (tolerance = .22, VIF = 4.57) between the two variables. This was
remedied by using only the IPIP to measure neuroticism in the regression equations.
Age and gender were controlled for in all analyses. Dummy variables were
created for gender (male = 0; female = 1). Age was found to have a significant negative
relationship with problematic Internet usage (r = -.27, p < .001), while gender had no
significant correlation; however, gender was found to have significant correlations with
several predictor variables. Age accounted for a significant amount of unique variance of
problematic Internet usage in all regression models, while gender did not.
After the aforementioned modifications, all regression models were evaluated for
assumptions of normality. Informal analysis using histograms and scatterplots revealed


81
no serious threats to the assumption of linearity or distributional assumptions of residuals
of the dependent variable (problematic Internet usage).
Hypothesis 1: The Role of Worry, Social Anxiety, Sensation Seeking, Neuroticism,
and Self-Medication in Problematic Internet Usage
Hypothesis 1 predicted individuals with higher levels of worry, social anxiety,
sensation-seeking, neuroticism, and endorsement of self-medication would show higher
levels of addiction to the Internet. To examine this hypothesis, a forced entry multiple
regression analysis was conducted to assess the simultaneous effects of worry, social
anxiety, sensation-seeking, neuroticism, and self-medication on problematic Internet
usage while also controlling for age and gender. Correlation and significance values of all
pairs of variables in the analysis are shown in Table 2.
Table 2
Hypothesis 1 Correlational Statistics
1 2 3 4 5 6 7 8
1. Problematic Internet
Usage
--- -.27*** -.02 .26*** .26*** .35*** -.13* .40***
2. Age --- .16** -.14* -.10 -.17** -.18** -.24***
3. Gender --- .03 .20** .13* -.34*** .05
4. Self-Medication --- .28*** .12* .05 .25***
5. Worry --- .52*** -.31*** .80***
6. Social Anxiety --- -.29*** .63***
7. Sensation Seeking --- -.25***
8. Neuroticism . ---
*p < .05, **p < .01, ***p < .001


82
There was a significant positive correlation between problematic Internet usage
and worry p < .001, social anxiety p < .001, neuroticism p < .001, and self-medication p <
.001, and there was a significant negative correlation between problematic Internet usage
and age p < .001 and sensation-seeking p < .03; problematic Internet usage was not
significantly correlated with gender.
Table 3
Hypothesis 1 Regression Analysis
Variables R2 R2 Change B SE B
Step 1
Constant
Age
Gender
.07 .07**
49.52
-.30
.52

2.82
.08
1.68


-.27***
.02
Step 2
Constant
Age
Gender
Self-Medication
Worry
Social Anxiety
Sensation Seeking
Neuroticism
.26 .18***
43.32
-.18
-1.02
4.99
-.15
.09
-.18
.42

8.04
.07
1.65
1.63
.08
.04
.11
.14


-.16*
-.04
.20**
-.20
.16*
-.12
.35**
*p < .05, **p < .01, ***p < .001


83
The regression model for Hypothesis 1 controlled for age and gender in Step 1
and placed worry, social anxiety, sensation-seeking, neuroticism, and self-medication in
Step 2. Regression results in Step 1 indicated only age = -.27, p = < .001 (negative beta
score indicates that the younger the age the more the problematic usage), significantly
predicted problematic Internet usage, R
2

=
.07, R
2
adj
= .06, F (2, 203) = 7.87, p < .01. In
the first model, age accounted for 7% of the variance in problematic Internet usage.
Regression results in Step 2 indicated an overall model of four predictor variables
including age = -.16, p = < .05, social anxiety = .16, p = < .05, neuroticism = .35, p
= < .01, and self-medication = .20, p = < .01 that significantly predicted problematic
Internet usage, R
2
= .26, R
2
adj
= .23, F (7, 198) = 9.75, p < .001. This model accounted for
26% of the variance in problematic Internet usage. The R
2
change in Step 2 was .18, p <
.001 indicating that (worry, social anxiety, sensation-seeking, neuroticism, and self-
medication accounted for 18% of the variance in predicting problematic Internet usage
over and above the effects of age and gender. A summary of the regression model for
Hypothesis 1 is shown in Table 3.
Hypothesis 1a: The Role of Six Facets of Neuroticism in Problematic Internet Usage
Hypothesis 1a specifically examined the core facets of neuroticism. It predicted a
positive relationship between neurotic anxiety and neurotic immoderation and
problematic Internet usage. A correlational analysis was conducted. A forced entry
multiple regression analysis was also conducted to assess the simultaneous effects of six
facets of neuroticism on problematic Internet usage while also controlling for age and
gender. These facets included anxiety, anger, depression, self-consciousness,


84
immoderation, and vulnerability. Correlation and significance values of all pairs of
variables in the analysis are shown in Table 4.
Table 4
Hypothesis 1a Correlational Statistics for the 6 Facets of Neuroticism
1 2 3 4 5 6 7 8 9
1. Problematic
Internet Usage
--- -.27*** -.02 .23*** .36*** .31*** .31*** .35*** .24***
2. Age --- .17** -.07 -.22** -.12* -.31*** -.21** -.16*
3. Gender --- .16** .00 .01 .00 -.08 .12*
4. Anxiety --- .510*** .51*** .50*** .29*** .70***
5. Anger --- .39*** .31*** .32*** .48***
6. Depression --- .54*** .46 .52***
7. Self-Consciousness --- .37*** .50***
8. Immoderation --- .41***
9. Vulnerability ---
*p < .05, **p < .01, ***p < .001
There was a significant positive correlation between problematic Internet usage
and all six facets of neuroticism to include anxiety p < .001, anger p < .001, depression p
< .001, self-consciousness, p < .001, immoderation p < .001, and vulnerability p < .001,
and there was a significant negative relationship between problematic Internet usage and
age p < .001.





85
Table 5
Hypothesis 1a Regression Analysis for the 6 Facets of Neuroticism
Variables R2 R2 Change B SE B
Step 1
Constant
Age
Gender
.07 .07**
49.52
-.30
.52

2.82
.08
1.68


-.27***
.02
Step 2
Constant
Age
Gender
Anxiety
Anger
Depression
Self-Consciousness
Immoderation
Vulnerability
.23 .16***
27.69
-.16
.62
-.01
1.26
.53
.60
1.15
-.39

4.50
.08
1.60
.48
.42
.47
.45
.43
.48


-.15*
.03
.00
.23**
.10
.11
.20**
-.08
*p < .05, **p < .01, ***p < .001
The regression model for Hypothesis 1a controlled for age and gender in Step 1
and placed the six facets of neuroticism (anxiety, anger, depression, self-consciousness,
immoderation, and vulnerability) in Step 2. Regression results in Step 1 indicated only
age = -.27, p = < .001, significantly predicted problematic Internet usage, R
2

=
.07, R
2
adj


86
= .06, F (2, 203) = 7.87, p < .01. In the first model, age accounted for 7% of the variance
in problematic Internet usage. Regression results in Step 2 indicated an overall model of
three predictor variables including age = -.15, p = < .05, anger = .23, p = < .01, and
immoderation = .20, p = < .01 that significantly predicted problematic Internet usage,
R
2
= .23, R
2
adj
= .20, F (8, 197) = 7.51, p < .001. This model accounted for 23% of the
variance in problematic Internet usage. The R
2
change in Step 2 was .16, p < .001 which
indicated that the dependent variable (problematic Internet usage) and the core
independent variables (anxiety, anger, depression, self-consciousness, immoderation, and
vulnerability) were related over and above the effects of age and gender. A summary of
the regression model for Hypothesis 1a is shown in Table 5.
Hypothesis 1b: The Role of Novelty and Intensity in Problematic Internet Usage
Hypothesis 1b predicted a positive relationship between individuals levels of
novelty and intensity and level of problematic Internet usage. A correlational analysis
was conducted. A forced entry multiple regression analysis was also conducted to assess
the simultaneous effects of the two sensation-seeking traits of novelty and intensity on
problematic Internet usage while also controlling for age and gender. Correlation and
significance values of all pairs of variables in the analysis are shown in Table 6.







87
Table 6
Hypothesis 1b Correlational Statistics for Sensation-Seeking Traits
1 2 3 4 5
1. Problematic
Internet Usage
--- -.27*** -.02 -.11 -.11
2. Age --- .17** -.11 -.20**
3. Gender --- -.21** -.35***
4. Novelty --- .41***
5. Intensity ---
*p < .05, **p < .01, ***p < .001
There was no significant correlation between either intensity or novelty and
problematic Internet usage.












88
Table 7
Hypothesis 1b Regression Analysis for Sensation-Seeking Traits
Variables R2 R2 Change B SE B
Step 1
Constant
Age
Gender
.07 .07**
49.52
-.30
.52

2.82
.08
1.68


-.27***
.02
Step 2
Constant
Age
Gender
Novelty
Intensity
.11 .04*
66.88
-.33
-1.13
-.25
-.38

6.82
.08
1.76
.19
.20


-.30***
-.05
-.09
-.15
*p < .05, **p < .01, ***p < .001
The regression model for Hypothesis 1a controlled for age and gender in Step 1
and placed the two aspects of sensation-seeking (novelty and intensity) in Step 2.
Regression results in Step 1 and 2 indicated only age = -.27, p = < .001, significantly
predicted problematic Internet usage, R
2

=
.07, R
2
adj
= .06, F (2, 203) = 7.87, p < .01. In
the first and second model, age accounted for all of the variance in problematic Internet
usage. A summary of the regression model for Hypothesis 1a is shown in Table 7.


89
Hypothesis 2: Self-Medication Moderating Worry, Social Anxiety, and Neuroticism
Hypothesis 2 predicted that while controlling for age and gender, the relationship
between individuals levels of worry, social anxiety, and neuroticism wi th their level of
addiction to the Internet would be moderated by the use of the Internet for self-
medication. Each predictor variable (worry, social anxiety, neuroticism, and self-
medication) was centered and new interaction terms were created in SPSS 20. Three
separate models were analyzed with interaction variables for worry and self-medication,
social anxiety and self-medication, and neuroticism and self-medication. Self-medication
did not significantly modify any predictor variables relationship with problematic Internet
usage in any of the analyses conducted (see Appendix I for results table).



90
CHAPTER FIVE: DISCUSSION, CONCLUSIONS, AND RECOMMENDATIONS
Discussion
In this study, four key predictor variables including age, social anxiety,
neuroticism, and self-medication significantly predicted problematic Internet usage, as
measured by the Problematic Internet Use Questionnaire. These four central variables
accounted for 26% of the variance in problematic Internet usage. As expected, age was
negatively correlated with problematic Internet usage. Younger users were more at risk
for problematic Internet usage than older users. Neuroticism had the highest correlation
with problematic Internet usage and it was the biggest predictor of problematic Internet
usage among all other predictor variables (age, self-medication, sensation-seeking, social
anxiety, and worry). It was interesting to note that the specific neuroticism traits of anger
and immoderation were found to be important predictors of problematic Internet usage.
Social anxiety had the second highest correlation with problematic Internet usage and it
was a significant predictor of Internet use. Self-medication was significantly correlated
with problematic Internet usage and it was a significant predictor of problematic Internet
usage. Worry and sensation-seeking were also significantly correlated with problematic
Internet usage (worry was negatively correlated); however, they were not significant
variables when evaluated in a multiple regression equation.
Hypothesis 1 examined the relationship between five predictor variables including
worry, social anxiety, neuroticism, sensation-seeking, and self-medication and the
dependent variable, problematic Internet usage, while controlling for age and gender
effects. All measured predictor variables (age, gender, neuroticism, social anxiety, worry,


91
sensation-seeking, and endorsement of self-medication) except gender were significantly
correlated with problematic Internet usage; however, the regression analysis highlighted
the four most prominent risk variables which included age, social anxiety, self-
medication, and neuroticism.
The current findings, regarding the predictor variable of social anxiety ( = .16, p
= < .05), complement Caplans (2003) previous research that individuals with high levels
of psychosocial distress are often drawn to the comfort and safety of computer-mediated
communication. While Caplans research focused primarily on depression and loneliness,
this study examined the more socially salient variable of social anxiety.
Neuroticism had the highest correlation with problematic Internet usage (r = .40,
p, < .001), and it was the biggest predictor ( = .35, p = < .01) of problematic Internet
usage among all other predictor variables (social anxiety, worry, sensation-seeking, and
self-medication). Within the IPIP, a measure of six neuroticism factors, the specific
neuroticism traits of anger = .23, p = < .01 and immoderation = .20, p = < .01 were
found to be significant predictors of problematic Internet usage. The current findings
suggest that these specific neurotic traits are predictors of potential for problematic
Internet usage. It is interesting to note that social anxiety significantly correlated with
both neurotic anger r = .26, p < .001 and immoderation r = .40, p < .001. While the
weight of neurotic anger was an unexpected result, this trait could be a factor associated
with social skills deficits as it significantly correlated with soci al anxiety. It is unclear if
greater amounts of neurotic anger are due to lower levels of social skills or possibly
frustration and disappointment associated with a limited social network. While


92
immoderation was predicted to significantly correlate with problematic Internet usage, it
was surprising that it did not correlate with sensation-seeking. Impulsivity, a core concept
of immoderation, is often associated with sensation-seeking personalities. It is possible
that immoderation tapped into specific aspects of social skill deficits (lack of social
awareness, inappropriateness, inability to read others, etc.) as opposed to the impulsivity
associated with sensation-seeking.
The results from analysis of Hypothesis 1a supported a significant positive
correlation between problematic Internet usage and all six facets of neuroticism: anxiety
p < .001, anger p < .001, depression p < .001, self-consciousness p < .001, immoderation
p < .001, and vulnerability p < .001, and there was an expected significant negative
relationship between problematic Internet usage and age p < .001; however, as with
Hypothesis 1, regression analysis made clear the two key neuroticism facets were anger
and immoderation. Younger Internet users were more susceptible to problematic Internet
usage than were older users.
The results from analysis of Hypothesis 1b did not support the predicted
relationship between novelty and intensity-based sensation-seeking traits and problematic
Internet usage. Instead, novelty and intensity were negatively related to problematic
Internet usage. Neither of these variables were significant predictors for addiction to the
Internet. In fact, these results suggest a negative relationship between sensation-seeking
and problematic Internet usage.
The results in Hypothesis 2 did not support the prediction that self-medication
would significantly moderate the relationship between key psychopathological variables


93
(worry, social anxiety, and neuroticism) and problematic Internet usage; however, self-
medication was significantly correlated with problematic Internet usage, r = .26, p < 001.
This adds increased validity to Youngs (1999) initial definition of problematic Internet
usage and the new DSM-5 criteria concerning Internet gaming disorder to escape feelings
of distress (e.g., feelings of helplessness, guilt, depression, or anxiety).
Clinical implications of this study were focused primarily on risk variables
associated with problematic Internet usage. Researching the risk variables for
problematic Internet usage will be a beginning for the development of validated screening
protocols and measures which will be useful in early detection of problematic Internet
usage. This in turn could lead to a broadening of the DSM-5 concept of Internet gaming
disorder to include all types of potential Internet disorders into one overarching
diagnostic category, problematic Internet usage, with subcategories which could include
Internet gaming disorder.
As the DSM 5 indicated, there is little known about Internet gaming disorder in
North America; however, prevalence rates were high among adolescents in South Korea
and China which was convergent with the statistical findings of the North American
sample in this study. At the very least, frontline healthcare providers can begin to
implement screening measures based on younger age groups and the presenting problems
which may indicate problematic Internet usage. For example, a provider may find it
useful to ask a few questions about Internet use to a teenager presenting with social
phobia or one who displays high levels of neuroticism.


94
The current study offers a first step toward broadening public knowledge of a
largely unidentified and potentially devastating disorder for younger age Internet users.
Results, from the current study, indicated a high correlation between neuroticism and
problematic Internet usage. As Greenfield noted, Gen-D often lacks the cognitive and
emotional maturity to moderate their Internet behaviors. Targeting this young generation
for early screening for problematic Internet usage across multiple locations such as
school, youth groups, news media, and parenting classes would likely be a beneficial
preventative investment.
While previous research has shown comorbid disorders, like depression and
loneliness (Caplan, 2003), are correlated with problematic Internet usage, future research
in this area is paramount. The current study found social anxiety, worry, and endorsement
of using the Internet to self-medicate as salient variables correlated with problematic
Internet usage. Future research needs to continue to evaluate additional comorbid
disorders which interact with problematic Internet usage. In keeping with the DSM 5
theme of specifiers, it is particularly important to explore the levels of severity (mild,
moderate, severe, etc.) in which any particular comorbid disorder may impact
problematic Internet usage.
As stated in the DSM-5, little is known about problematic Internet usage and
personality. The current study utilized the five-factor model of personality, with an
emphasis on Neuroticism, to better understand personality traits correlated with
problematic Internet usage. The five factor model was also emphasized in the DSM-5 as
the core paradigm for diagnosing personality disorders. Future research regarding


95
problematic Internet usage needs to continue to build on the five factor paradigm of
personality. The current study not only found neuroticism to be the most highly
correlated variable with problematic Internet usage, but it also highlighted that the sub-
traits of neurotic anger and immoderation were also highly correlated with problematic
Internet usage. Future research should continue to build on all aspects of Neuroticism
along with the other core traits of Openness, Conscientiousness, Extraversion, and
Agreeableness.
As the Internet becomes an integrated part of everyday life, it is essential for
research to focus on the full impact it has on society, both positive and negative. The
DSM-5 offered the first step in officially recognizing problematic Internet usage (Internet
gaming) as a problem which needs further study. The current study attempted to answer
the call for more empirical research. More specifically, it examined the relationship of
self-reported problematic Internet usage with self-reports of worry, social anxiety,
neuroticism, sensation-seeking, and self-medication. The current study also attempted to
use a wider lens of pathology to examine the relationship between problematic Internet
usage and the broad personality trait of neuroticism. The study predicted that the use of
the Internet as a form of self-medication would moderate problematic Internet usage
particularly for those who report more anxiety or have an overall emotionally unstable
outlook on life. More precise facets of neuroticism (anxiety, anger, depression, self-
consciousness, immoderation, and vulnerability) were also examined. In past research,
sensation-seeking was shown to be a predisposing trait of individuals with problematic


96
Internet usage. This study operationalized sensation-seeking behaviors into the two
separate traits of intensity and novelty.
Results suggested that problematic Internet usage was associated with younger
age groups but not with gender. As Greenfield (2010) asserted in his definition of Gen-D,
this young generation grew up with the Internet embedded into their everyday lives. They
not only are desensitized to the potential for the Internet to be abused, but they also often
lack the cognitive maturity to monitor their own Internet behaviors. This finding is
similar to previous studies which indicated young college-age individuals were more
susceptible to addictive Internet use.
Limitations of the Study
The current study was an initial step to answer the call put forth by the DSM-5 for
additional research of a relatively narrow diagnostic disorder, Internet gaming disorder.
This study took a broad track and viewed Internet gaming as a potential subtype of the
greater problem of problematic Internet usage. With this approach, there are several
limitations which are important to address.
The sample was taken from Internet users located only in North America. This
population limited the amount of generalizability the research will have to different
cultures. The research sample also had greater endorsement of problematic Internet usage
when compared to a normative group. This most likely occurred because the average
participant was more adept at using the Internet, and likely had more time for leisure
Internet activities than most. This will limit the amount of generalizability the research
will have to less experienced Internet users and individuals with less free time.


97
Any study, including this research, is only as good as the instruments used to
operationalize the research constructs. The measure used to evaluate self-medication was
a single question based primarily on research for alcohol and substance abuse. The use of
a single yes/no question, and the lack of previous research validating this instrument with
behavioral addiction and more specifically problematic Internet usage, is a serious
limitation to the self-medication aspect of this study.
Problematic Internet usage does not yet have a consensually agreed upon
nosology much less a fully formed theoretical conceptualization. Therefore, the core test
used to measure problematic Internet usage represented a conceptualization based on the
core subtests of Obsession, Neglect, and Lack of Control as defined by the Problematic
Internet Use Questionnaire. This limitation will no doubt continue until a true diagnostic
disorder category, with established criteria, is developed for problematic Internet usage.
Unfortunately, this study was reduced to using an available instrument, the Problematic
Internet Use Questionnaire, for measuring problematic Internet usage. In addition, this
study did not focus on the exact types of applications (Facebook, Twitter, MMOs, etc.)
preferred by each user which will be important if these subtypes (Facebook, Twitter,
MMOs) are incorporated into a larger view of problematic Internet usage.
Conclusion
The need to research risk factors and personality factors that could contribute to
problematic Internet usage was the driving force behind this research. In conclusion, this
research supported the main hypothesis that high levels of worry, social anxiety,
sensation-seeking, neuroticism, and endorsement of self-medication were all significant


98
predictors of problematic Internet usage (as measured by the Problematic Internet Use
Questionnaire). Neuroticism had the highest correlation with problematic Internet usage
(r = .40, p < .001), and it was the best single predictor ( = .35, p = < .01) of problematic
Internet usage among all other predictor variables (social anxiety, worry, sensation-
seeking, and self-medication). This finding is important in exploring personality risks that
could lead to problematic Internet usage. It is also a beginning step to fill the void
suggested by the DSM-5 that No consistent personality types associated with Internet
gaming disorder have been identified (APA, 2013, p.797). In addition, the specific
neuroticism traits of anger and immoderation were found to be important predictors of
problematic Internet usage. The current findings suggest that specific neurotic traits are
also predictors of potential for problematic Internet usage.
Previous research showed age was an important predisposing factor for
problematic Internet usage. This study echoed that finding, and also emphasized the
significance of neuroticism and social anxiety as correlating factors with problematic
Internet usage. Adolescence and young adulthood are developmentally defined by self-
identity and social connections. While the Internet offers unique ways of communicating
with others, it can also potentially stunt psychological growth for this already vulnerable
age group especially when psychological pathologies are present.
The DSM-5 suggestion for additional research in Internet gaming is currently
quite narrow and should be broadened to include all areas of potential problematic
Internet usage. Addiction experts must decide whether to pursue highly focused research
on only Internet gaming or broaden studies to include other recreational activities and


99
social media across multiple platforms and applications. Technology is changing so
rapidly that Internet gaming may not even be recognizable, in the current DSM-5 form,
by the time it moves from condition for further study to an officially recognized disorder.
The future of problematic Internet usage research is not only exciting, but also a societal
necessity as we rely on the Internet more and more for daily functioning.


100
References
Aboujaoude, E., Koran, L. M., Gamel, N., Large, M. D., & Serpe, R. T., 2006. Potential
markers for problematic Internet use: A telephone surveyof 2,513 adults. CNS
Spectrums, 11, (10): 75 755.
American Psychiatric Association (APA). (2000). DSM-IV-TR: Diagnostic and statistical
manual of mental disorders (4th ed.). Washington, DC: American Psychiatric
Association.
American Psychiatric Association (APA). (2013). DSM-5: Diagnostic and statistical
manual of mental disorders (5th ed.). Washington, DC: American Psychiatric
Association.
Amichai-Hamburger, Y., & Ben-Artzi, E. (2000). The relationship between extraversion
and neuroticism and the different uses of the Internet. Computers in Human
Behavior, 16, 441449.
Amichai-Hamburger, Y., Wainpel, G., & Fox, S. (2002). On the Internet no one knows
Im an introvert: Extroversion, introversion, and Internet interaction.
CyberPsychology & Behavior, 5, 125128.
Arnett, J. (1994). Sensation seeking: A new conceptualization and a new scale.
Personality and Individual Differences, 16, 289-296.
Beard, K. W. & Wolf, E. M. (2001). Modification in the Proposed Diagnostic Criteria for
Internet Addiction. CyberPsychology & Behavior, 4, 377-383
Behar, E., Alcaine, O., Zuellig, A. R., & Borkovec, T. D. (2003). Screening for
generalized anxiety disorder using the Penn State Worry Questionnaire: A


101
receiver operating characteristic analysis. Journal of Behavior Therapy, 34, 25-
43. doi: 10.1016/S0005-7916(03)00004-1
Block, J. J. (2008). Issues for DSM V: Internet Addiction. The American Journal of
Psychiatry, 165, 306-307. doi:10.1176/appi.ajp.2007.07101556
Bolton, J., Cox, B., Clara, I., & Sareen, J. (2006). Use of alcohol and drugs to self-
medicate anxiety disorders in a nationally representative sample. Journal of
Nervous and Mental Disease, 11, 818-825.
Brenner, V. (1997). Psychology of computer use: XLVII. Parameters of internet use,
abuse and addiction: The first 90 days of the internet usage survey. Psychological
Reports, 80, 879-882.
Brooks, J. (2010, September 6). White house correspondent reports his own heart attack
on Twitter. Wireupdate. Retrieved from http://wireupdate.com/wires/9456/white-
house-correspondent-reports-his-own-heart-attack-on-twitter/
Butt, S., & Phillips, J. G. (2008). Personality and self-reported mobile phone use.
Computers in Human Behavior, 24, 346360.
Cao, F. & Su, L. (2006). Internet addiction among Chinese adolescents: Prevalence and
psychological features. Child: Care, Health and Development, 33, 275281
Caplan S. E. (2003). Preference for online social interaction: a theory of problematic
Internet use and psychosocial well-being. Communication Research, 30, 625-648.
Caplan S. E., & High, A. C. (2010). Online social interaction, psychological well-being,
and problematic Internet use. In K. S. Young & C. N. Abreu. Internet addiction:


102
A handbook and guide to evaluation and treatment (pp. 35-52). Hoboken, NJ:
John Wiley & Sons.
Chakraborty, K., Basu, D., & Kumar, V. (2010). Internet addiction: Consensus,
controversies, and the way ahead. East Asian Archive of Psychiatry, 20, 123-132.
Chen, L. S. (2008). Subjective well-being: evidence from the different personality traits
of online game teenager players. CyberPsychology & Behavior, 11, 57981.
Chien, C., Condron, L., & Belland, J. C. (2005). A review of the research on Internet
addiction. Educational Psychology Review, 17, 363-388. doi: 10.1007/s10648-
005-8138-1
Chou, C. & Hsiao, M-C. (2000). Internet addiction, usage, gratification, and pleasure
experience: the Taiwan college students case. Computers and Education, 65-80.
Czincz J. & Hechanova R. (2009). Internet addiction: Debating the diagnosis. Journal of
Technology in Human Services, 27, 257-272. doi: 10.1080/15228830903329815
Davis, R. A. (2001). A cognitive behavioral model of pathological Internet use.
Computers in Human Behavior, 17, 187195.
De Raad, B., di Blas, L., & Perugini, M. (1998). Two independently constructed Italian
trait taxonomies: Comparisions among Italian and between Italian and Germanic
languages. European Journal of Personality, 12, 19-41. doi: 10.1002/(SICI)1099-
0984(199801/02)12:1<19::AID-PER290>3.0.CO;2-6
Demetrovics, Z., Szeredi, B., & Rozsa, S. (2008). The three-factor model of Internet
addiction: The development of the Problematic Internet Use Questionnaire.
Behavior Research Methods, 40, 563-574.


103
Divorce Online. (2011). Games up for video addict husbands. Retrieved from
http://blog.divorce-online.co.uk/?p=2014
Erikson, E. H. (1980). Identity and the life cycle. New York, NY: W. W. Norton.
Ferster, C. B. & Skinner, B. F. (1957). Schedules of reinforcement. New York, NY:
Appleton-Century-Croft.
Freimuth, M. (2008). Addicted? Recognizing destructive behavior before its too late.
Lanham, MD: Rowman & Littlefield.
Goldberg, L. R., Johnson, J. A., Eber, H. W., Hogan, R., Ashton, M. C., Cloninger, C. R.,
& Gough, H. G. (2006). The international personality item pool and the future of
public-domain personality measures. Journal of Research in Personality, 40, 84-
96.
Gosling, S. D., Kwan, V. S. Y., & John, O. P. (2003). A dogs got personality: A cross-
species comparative approach to evaluating personality judgments. Journal of
Personality and Social Psychology, 85, 1161-1169.
Gosling, S. D., Rentfrow, P. J., & Swann, W. B. (2003). A very brief measure of the big-
five personality domains. Journal of Research in Personality, 37, 504-528.
Greenfield, D. (2010). The addictive properties of Internet usage. In K. S. Young & C. N.
Abreu. Internet addiction: A handbook and guide to evaluation and treatment (pp.
135-154). Hoboken, NJ: John Wiley & Sons.
Griffiths, M. D. (1995). Technological addictions. Clinical Psychology Forum, 76, 14-19.
Griffiths, M. D. (2000). Does Internet and computer addiction exist? Some case study
evidence. CyberPsychology and Behavior, 3, 211218.


104
Grohol, J. M. (1999). Too much time online: Internet addiction or healthy social
interactions. CyberPsychology and Behavior, 2, 395401.
Hartwell, K. J., Tolliver, B. K., & Brady, K. T. (2009). Biologic commonalities between
mental illness and addiction. Primary Psychiatry, 16, 3339.
Heiman, G. W. (1999). Research methods in psychology (2nd ed.). Boston, MA:
Houghton Mifflin.
Heimberg, R. G., Horner, K. J., Juster, H. R., Safren, S. A., Brown, E. J., Schneier, F. R.,
& Liebowitz, M. R. (1999). Psychometric properties of the Liebowitz Social
Anxiety Scale. Psychological Medicine, 29, 199-212.
International Covenant on Civil and Political Rights. (1966). Retrieved from
http://www2.ohchr.org/english/law/ccpr.htm
John, O. P., Naumann, L. P., & Soto, C. J. (2008). Paradigm shift to the integrative big
five trait taxonomy. In O. P John, R. W Robins, & L. A Pervin. Handbook of
personality theory and research (pp. 114-158). New York, NY: Guilford Press.
Kandell, J. J. (1998). Internet addiction on campus: The vulnerability of college students.
CyberPsychology and Behavior, 1, 1117.
Kelley, K. J. & Gruber, E. M. (2010) Psychometric properties of the Problematic Internet
Use Questionnaire. Computers in Human Behavior, 26, 1838-1845.
Khantzian, E. J., & Albanese, M. D. (2008). Understanding addiction as self medication:
Finding hope behind the pain. Lanham, MD: Rowman & Littlefield.


105
Kim, M. G. & Kim, J. (2010). Cross-validation of reliability, convergent and discriminant
validity for the Problematic Online Game Use Scale. Computers in Human
Behavior, 26, 389-398. doi:10.1016/j.chb.2009.11.010
Kipnis, D. (1997). Ghosts, taxonomies, and social psychology. American Psychologist,
52, 78-80.
Kraut, R., Patterson, M., Lundmark, V., Kiesler, S., Mukophadhyay, T., & Scherlis, W.
(1998). Internet paradox: A social technology that reduces social involvement and
psychological well-being? American Psychologist, 53, 1017-1031.
Kravets, D. (2011, June 3). U.N. report declares Internet access a human right. Wired.
Retrieved from http://www.wired.com/threatlevel/2011/06/Internet-a-human-
right/
Kropko, M. R. (2009, January 13). Ohio teen convicted of killing mom over video game.
The Associated Press.
Kwiatkowska, A., Ziolko, E., Krysta, K., Muc-Wierzgon, M., & Krupka-Matuszczyk, I.
(2007). Impact of Internet abuse on human relationships. European Psychiatry
2007, 22, 192. doi: 10.1016/j.eurpsy.2007.01.633
Landers, R. & Lounsbury, J. W. (2006). An investigation of Big Five and narrow
personality traits in relation to Internet usage. Computers and Human Behavior,
22, 283-293.
LaRose, R., Lin, C. A., & Eastin, M. A. (2003). Unregulated Internet usage: Addiction,
habit, or deficient self-regulation. Media Psychology, 5, 225-253.
doi:10.1207/s1532785xmep0503_01


106
Lavin, M., Marvin, K., McLarney, A., Nola, V., & Scott, L. (1999). Sensation seeking
and collegiate vulnerability to Internet dependence. CyberPsychology and
Behavior, 2, 425-430.
Lin, S. S. J., & Tsai, C. C. (2002). Sensation seeking and Internet dependence of
Taiwanese high school adolescents. Computer and Human Behavior, 18, 411-426.
Man sentenced for killing toddler over broken Xbox. (2008, March 13). Philadelphia
Region Local News. Retrieved from
http://cbs3.com/local/Tyrone.Spellman.Xbox.2.676702.htm
McCrae R. R., & Costa P. T., Jr. (2008). The five-factor theory of personality. In O. P
John, R. W Robins, & L. A Pervin. Handbook of personality theory and research
A Handbook of personality theory and research (pp. 159-181). New York, NY:
Guilford Press.
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and
validation of the Penn State Worry Questionnaire. Behavior Research and
Therapy, 28, 487-495.
Moeller, S., Chong, E., Golitsinski, S., Guo, J., McCaffry, R., Nynka, A., & Roberts, J.
(2010). A day without media. Retrieved from http://withoutmedia.wordpress.com/
Morahan-Martin, J. M., & Schumacher, P. (2000). Incidence and correlates of
pathological Internet use. Computers and Human Behavior, 16, 1329.
Postmes, T., Spears, R., & Lea, M. (1998). Breaching or building social boundaries?
Side-effects of computer-mediated communication. Communication Research, 25,
689715.


107
Ross, C., Orr, E. S., Sisic, M., Arseneault, J. M., Simmering, M. G., & Orr, R. R. (2009).
Personality and motivations associated with Facebook use. Computers in Human
Behavior, 25, 578-586.
Schmitz, J. M. (2005). The interface between impulse-control disorders and addictions:
Are pleasure pathway responses shared neurobiological substrates? Sexual
Addiction & Compulsivity, 12, 149-168.
Shaffer, H. (1999). Strange bedfellows: A critical review of pathological gambling and
addiction, Addiction, 94, 1145-1148.
Shapira, N.A., Goldsmith, T.D., Keck, P., Khosla, U. M., McElroy, S. L. (2000).
Psychiatric features of problematic Internet use. Journal of Affective Disorders,
57, 267-272.
Shapira, N. A., Lessing, M. C., Goldsmith, T.D., Szabo, S. T., Lazoritz, M., Gold, M. S.,
& Stein, D. J. (2003). Problematic Internet use: Proposed classification and
diagnostic criteria, Depression and Anxiety, 17, 207-216.
Sherif, M., Harvey, O. J., White, B. J., Hood, W. R., & Sherif, C. W. (1954/1961).
Intergroup conflict and cooperation: The Robbers Cave experiment. Retrieved
from http://psychclassics.yorku.ca/Sherif
Shotton, M. (1991). The costs and benefits of computer addiction. Behaviour and
Information Technology, 10, 219-230.
South Korean couple starved child while raising virtual baby. (2010, March 5). CNN
World. Retrieved from
http://www.cnn.com/2010/WORLD/asiapcf/03/05/korea.baby.starved/index.html


108
Suler, J. R. (1999). To get what you need: Healthy and pathological Internet use.
CyberPsychology and Behavior, 2, 355393.
Tidwell, L. C., & Walther, J. B. (2002). Computer-mediated communication effects on
disclosure, impressions, and interpersonal evaluations: Getting to know one
another a bit at a time. Human Communication Research, 28, 317348.
Treuer, T., Fabian, Z., & Furedi, J. (2001). Internet addiction associated with features of
impulse control disorder: Is it a real psychiatric disorder? Journal of Affective
Disorders, 66, 283.
Walther, J. B. (1996). Computer-mediated communication: Impersonal, interpersonal,
and hyperpersonal interaction. Communication Research, 23, 3-43.
Weaver, J. B., Mays, D. Weaver, S. S., Kannenberg, W., Hopkins, G. L., Erolu, D., &
Bernhardt, J. M. (2009). Health-risk correlates of video-game playing among
adults. American Journal of Preventative Medicine, 37, 299-305.
doi:10.1016/j.amepre.2009.06.014
Widyanto, L., & Griffiths, M. (2006). Internet addiction: A critical review.
International Journal of Mental Health Addiction, 4, 31-51. doi: 10.1007/s11469-
006-9009-9
Wolfradt, U., & Doll, J. (2001). Motives of adolescents to use the Internet as a function
of personality traits, personal and social factors. Journal of Educational
Computing Research, 24, 1327.


109
Woong-ki, S. (2010, April 12). Midnight ban imposed on online games. The Korean
Herald. Retrieved from
http://www.koreaherald.com/national/Detail.jsp?newsMLId=20100412000752
Yang, C-K., Choe, B-M., Baity, M., Lee, J-H., & Cho, J-C. (2005). SVL-90-R and 16PF
profiles of senior high school students with excessive Internet use. Canadian
Journal of Psychiatry, 50, 407-414.
Young, K. (2000). Internet addiction: Evaluation and treatment. Student British Medical
Journal, 7, 394-436. doi: 10.1136/sbmj.9910351
Young, K. S. (1996). Internet addiction: The emergence of a new clinical disorder. Paper
presented at the 104th American Psychological Association Annual Convention,
Toronto, ON.
Young, K. S. (1998). Internet addiction: The emergence of a new clinical disorder.
CyberPsychology & Behavior, 1, 237244.
Young, K. S. (1999). Internet addiction: Symptoms, evaluation, and treatment. In L.
Vande-Creek, & T. Jackson. Innovations in clinical practice: A source book Vol.
17 (pp. 1931). Sarasota, FL: Professional Resource Press.
Young K. S. (2001). Tangled in the web: Understanding cybersex from fantasy to
addiction. Bloomington, IN: Authorhouse.
Young, K.S. (2010). Clinical assessment of Internet-addicted clients. In K. S. Young, &
C. N. Abreu. Internet addiction: A handbook and guide to evaluation and
treatment (pp. 19-34). Hoboken, NJ: John Wiley & Sons.


110
Young, K. S. & Abreu, C. N. (2010). Internet addiction: A handbook and guide to
evaluation and treatment. Hoboken, NJ: John Wiley & Sons.
Young, K. S. & Rodgers, R. C. (1998). Internet addiction: Personality traits associated
with its development. Paper presented at the 69
th
Annual Meeting of the Eastern
Psychological Association, University of Pittsburg at Bradford, PA.
Young, K. S., Yue, X. D., & Ying, L. (2010). Prevalence estimates and etiologic models
of Internet addiction. In K. S. Young, & C. N. Abreu. Internet addiction: A
handbook and guide to evaluation and treatment (pp. 3-18). Hoboken, NJ: John
Wiley & Sons.
Zuckerman, M. (2007). Sensation seeking and risky behavior. Washington, DC:
American Psychological Association.



111

Appendix A: Problematic Internet Use Questionnaire
1

In the following you will read statements about your Internet
use. Please indicate on a scale from 1 to 5 how much these
statements characterize you.
N
e
v
e
r

R
a
r
e
l
y

S
o
m
e
t
i
m
e
s

O
f
t
e
n

A
l
w
a
y
s

1. How often do you fantasize about the Internet, or think about
what it would be like to be online when you are not on the
Internet?
1 2 3 4 5
2. How often do you neglect household chores to spend more
time online?
1 2 3 4 5
3. How often do you feel that you should decrease the amount of
time spent online?
1 2 3 4 5
4. How often do you daydream about the Internet? 1 2 3 4 5
5. How often do you spend time online when youd rather sleep? 1 2 3 4 5
6. How often does it happen to you that you wish to decrease the
amount of time spent online but you do not succeed?
1 2 3 4 5
7. How often do you feel tense, irritated, or stressed if you
cannot use the Internet for as long as you want to?
1 2 3 4 5
8. How often do you choose the Internet rather than being with
your partner?
1 2 3 4 5
9. How often do you try to conceal the amount of time spent
online?
1 2 3 4 5
10. How often do you feel tense, irritated, or stressed if you
cannot use the Internet for several days?
1 2 3 4 5
11. How often does the use of Internet impair your work or your
efficacy?
1 2 3 4 5

1
From The three-factor model of Internet addiction: The development of the Problematic Internet
Use Questionnaire by Z. Demetrovics, B. Szeredi, & S. Rozsa, (2008), Behavior Research
Methods, 40. Reprinted with permission.


112
12. How often do you feel that your Internet usage causes
problems for you?
1 2 3 4 5
13. How often does it happen to you that you feel depressed,
moody, or nervous when you are not on the Internet and these
feelings stop once you are back online?
1 2 3 4 5
14. How often do people in your life complain about spending
too much time online?
1 2 3 4 5
15. How often do you realize saying when you are online, just a
couple of more minutes and I will stop?
1 2 3 4 5
16. How often do you dream about the Internet? 1 2 3 4 5
17. How often do you choose the Internet rather than going out
with somebody to have some fun?
1 2 3 4 5
18. How often do you think that you should ask for help in
relation to your Internet use?
1 2 3 4 5



113
Appendix B: Penn State Worry Questionnaire
2

Instructions: Rate each of the following statements on a
scale of 1 (not at all typical of me) to 5 (very typical
of me). Please do not leave any items blank.
Not at
all
typical
of me
Very
typica
l of
me
1. If I do not have enough time to do everything, I do not
worry about it.
1 2 3 4 5
2. My worries overwhelm me. 1 2 3 4 5
3. I do not tend to worry about things. 1 2 3 4 5
4. Many situations make me worry. 1 2 3 4 5
5. I know I should not worry about things, but I just
cannot help it.
1 2 3 4 5
6. When I am under pressure I worry a lot. 1 2 3 4 5
7. I am always worrying about something. 1 2 3 4 5
8. I find it easy to dismiss worrisome thoughts. 1 2 3 4 5
9. As soon as I finish one task, I start to worry about
everything else I have to do.
1 2 3 4 5
10. I never worry about anything. 1 2 3 4 5
11. When there is nothing more I can do about a concern,
I do not worry about it anymore.
1 2 3 4 5
12. I have been a worrier all my life. 1 2 3 4 5
13. I notice that I have been worrying about things. 1 2 3 4 5
14. Once I start worrying, I cannot stop. 1 2 3 4 5
15. I worry all the time. 1 2 3 4 5
16. I worry about projects until they are all done. 1 2 3 4 5



2
This test is considered to be in the public domain.


114
Appendix C: Liebowitz Social Anxiety Scale
3

1. This measure assesses the way that social phobia plays a
role in your life across a variety of situations.
2. Read each situation carefully and answer two questions
about that situation.
3. The first question asks how anxious or fearful you feel in
the situation.
4. The second question asks how often you avoid the
situation.
5. If you come across a situation that you ordinarily do not
experience, we ask that you imagine "what if you were faced
with that situation," and then rate the degree to which you
would fear this hypothetical situation and how often you
would tend to avoid it. Please base your ratings on the way
that the situations have affected you in the last week.






Fear or
Anxiety:
0 = None
1 = Mild
2 =
Moderate
3 = Severe







Avoidance:
0 = Never
1 =
Occasionally
2 = Often
3 = Usually
1. Using a telephone in public.
2. Participating in a small group activity.
3. Eating in public.
4. Drinking with others.
5. Talking to someone in authority.
6. Acting, performing, or speaking in front of an audience.
7. Going to a party.
8. Working while being observed.
9. Writing while being observed.
10. Calling someone you don't know very well.
11. Talking face to face with someone you don't know very
well.

12. Meeting strangers.
13. Urinating in a public bathroom.
14. Entering a room when others are already seated.
15. Being the center of attention.
16. Speaking up at a meeting.
17. Taking a test of your ability, skill, or knowledge.
18. Expressing disagreement or disapproval to someone you
don't know very well.

19. Looking someone who you don't know very well straight
in the eyes.

20. Giving a prepared oral talk to a group.
21. Trying to make someone's acquaintance for the purpose of
a romantic/sexual relationship.

22. Returning goods to a store for a refund.
23. Giving a party.
24. Resisting a high pressure sales person.

3
This test is considered to be in the public domain.


115

Appendix D: Arnett Inventory of Sensation Seeking
4

For each item, indicate which response best applies to you:

(1) does not describe me at all
(2) does not describe me very well
(3) describes me somewhat
(4) describes me very well

1. I can see how it would be interesting to marry someone from a foreign country.
2. When the water is very cold, I prefer not to swim even if it is a hot day.
3. If I have to wait in a long line, Im usually patient about it.
4. When I listen to music, I like it to be loud.
5. When taking a trip, I think it is best to make as few plans as possible and just take it as
it comes.
6. I stay away from movies that are said to be frightening or highly suspenseful.
7. I think its fun and exciting to perform or speak before a group.
8. If I were to go to an amusement park, I would prefer to ride the rollercoaster or other
fast rides.
9. I would like to travel to places that are strange and far away.
10. I would never like to gamble with money, even if I could afford it.
11. I would have enjoyed being one of the first explorers of an unknown land.
12. I like a movie where there are a lot of explosions and car chases.
13. I dont like extremely hot and spicy foods.
14. In general, I work better when Im under pressure.
15. I often like to have the radio or TV on while Im doing something else, such as
reading or cleaning up.
16. It would be interesting to see a car accident happen.
17. I think its best to order something familiar when eating in a restaurant.
18. I like the feeling of standing next to the edge on a high place and looking down.
19. If it were possible to visit another planet or the moon for free, I would be among the
first in line to sign up.
20. I can see how it must be exciting to be in a battle during a war.



4
This test is considered to be in the public domain.


116
Appendix E: Ten Item Personality Inventory
5


Here are a number of personality traits that may or may not apply to you. Please write a
number next to each statement to indicate the extent to which you agree or disagree with
that statement. You should rate the extent to which the pair of traits applies to you, even
if one characteristic applies more strongly than the other.

Disagree
strongly
Disagree
moderately
Disagree
a little
Neither
agree nor
disagree
Agree a
little
Agree
moderately
Agree
strongly
1 2 3 4 5 6 7

I see myself as:
1. _____ Extraverted, enthusiastic.
2. _____ Critical, quarrelsome.
3. _____ Dependable, self-disciplined.
4. _____ Anxious, easily upset.
5. _____ Open to new experiences, complex.
6. _____ Reserved, quiet.
7. _____ Sympathetic, warm.
8. _____ Disorganized, careless.
9. _____ Calm, emotionally stable.
10. ____ Conventional, uncreative.


5
From A very brief measure of the big five personality domains by S. Gosling, P. J. Rentfrow, &
W. B. Swann, (2003), Journal of Research in Personality, 37. Reprinted with permission.


117
Appendix F: International Personality Item Pool
6


The following questions contain phrases describing people's behaviors. Please use the
rating scale below to describe how accurately each statement describes you.*

Describe yourself as you generally are now, not as you wish to be in the future. Describe
yourself as you honestly see yourself, in relation to other people you know of the same
sex as you are, and roughly your same age.

Please read each statement carefully, and then fill in the bubble that corresponds to the
number on the scale.

1: Very Inaccurate
2: Moderately Inaccurate
3: Neither Inaccurate nor Accurate
4: Moderately Accurate
5: Very Accurate


1. Worry about things.
2. Am not easily bothered by things.
3. Get angry easily.
4. Rarely get irritated.
5. Often feel blue.
6. Feel comfortable with myself.
7. Find it difficult to approach others.
8. Am not embarrassed easily.
9. Do things I later regret.
10. Easily resist temptations.
11. Panic easily.
12. Remain calm under pressure.

*The included items are the International Personality Item Pool's representation of Costa
and McCrae's (1992) Six Neuroticism NEO Facets.

Costa, P. T., Jr., & McCrae, R. R. (1992). Revised NEO Personality Inventory (NEO-PI-
R) and NEO Five-Factor Inventory (NEO-FFI) professional manual. Odessa, FL:
Psychological Assessment Resources.


6
This test is considered to be in the public domain.


118
Appendix G: Informed Consent
Fielding Graduate University
Informed Consent Form
problematic Internet usage: The Role of Social Anxiety, Worry, Sensation Seeking, and
Neuroticism
You have been asked to participate in a research study conducted by Andrew Thrasher, a
doctoral student in the School of Clinical Psychology at Fielding Graduate University,
Santa Barbara, CA. This study is supervised by Dr. Raymond Hawkins, PhD. This
research involves the study of anxiety and personality traits associated with pathological
Internet use and is part of Andrew Thrasher's Fielding dissertation. You are being asked
to participate in this study because you are a college student who is considered at risk for
developing excessive Internet habits.
Your participation in this research study is voluntary. You may choose not to
participate. If you decide to participate in this research survey, you may withdraw
at any time. If you decide not to participate in this study or if you withdraw from
participating at any time, you will not be penalized.

The procedure involves completing an online survey consisting of five
questionnaires. It will take approximately 20 to 25 minutes to complete the
entire survey. Your responses will be confidential and we do not collect
identifying information such as your name, email address or IP address. The
survey questions will be about Internet usage, personality traits, worry, and social
anxiety. The following are samples of the survey questions:

1. How often do you feel that you should decrease the amount of time
spent online?
2. I do not tend to worry about things.
3. I am anxious, fearful, or avoid going to a party.
4. When I listen to music, I like it to be loud.
5. Indicate the extent to which you agree or disagree with this
statement: I see myself as extraverted/enthusiastic. (Select one of
seven choices from Strongly Agree to Strongly Disagree).

We will do our best to keep your information confidential. All data is stored in a
password protected electronic format. To help protect your confidentiality, the
surveys will not contain information that will personally identify you. The results of
this research will be published in my dissertation and may be shared with
Fielding Graduate University representatives.


119
You may withdraw from this study at any time, either during or after your participation,
without negative consequences. Should you withdraw, your data will be eliminated from
the study and will be destroyed.
No compensation will be provided for participation.
You may develop greater personal awareness of problematic Internet usage and anxiety
symptoms as a result of your participation in this research. The risks to you are
considered minimal and there is a small chance that you may experience some emotional
discomfort during or after your participation. Should you experience such discomfort,
please refer to the Mental Health Resource referral list posted on SurveyMonkey.
If you have any questions about any aspect of this study or your involvement, please the
Fielding Graduate University IRB by email at irb@fielding.edu or by telephone at 805-
898-4033. You may also contact the supervising faculty, Raymond Hawkins, PhD by
email at rhawkins@fielding.edu or by telephone at 512-232-3354, if you have questions
or concerns your participation in this study. The supervising faculty has provi ded contact
information at the bottom of this form.
If you have questions or concerns about your rights as a research participant, contact the
Fielding Graduate University IRB by email at irb@fielding.edu or by telephone at 805-
898-4033.
ELECTRONIC CONSENT: Please select your choice below.

Clicking on the "agree" button below indicates that:

you have ready the above information
you voluntarily agree to participate
you are at least 18 years of age


Dr. Raymond Hawkins, PhD Andrew J. Thrasher,

Fielding Graduate University 3714 Spanish Dr.
2112 Santa Barbara Street Sulphur, LA 70665
Santa Barbara, CA 93105
805-687-1099 337-244-1641


120
Table I: Age and Gender Means for Problematic Internet Use Questionnaire

Table H-1
Age and Gender Means for Problematic Internet Use Questionnaire
Age / Gender N % PIUQ Mean
<21 11 5% 46.55
21 to 29 63 31% 41.43
30 to 39 71 34% 39.65
40 to 49 33 16% 37.45
50 to 59 26 13% 34.00
>59 2 1% 20.00
Female 128 62% 39.09
Male 78 38% 39.97




121
Appendix I: Hypothesis 2 Self-Medication Significance Values


Interaction Variables Significance
Worry Self-Medication p > .05
Social Anxiety Self-Medication p > .05
Neuroticism Self-Medication p > .05