Addictive Behaviors

Volume 39, Issue 1, January 2014, Pages 3-6

Mini Review

An overview of problematic Internet use

Marcantonio M. Spada

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Abstract

Problematic Internet use (PIU), which has become a global social issue, can be broadly conceptualized as an
inability to control one's use of the Internet which leads to negative consequences in daily life. The aim of
this paper is to give a brief overview of the gradually evolving body of literature on PIU. This shows that the
definitions and diagnostic criteria that have been proposed, and the assessment tools that have been
developed, stress similarities between PIU, addictive behaviours and impulse-control disorders.
Disagreements regarding diagnostic criteria and the lack of large epidemiological studies have resulted in
difficulties in establishing the prevalence of PIU in the general population. Studies suggest high comorbidity
rates between PIU and numerous psychiatric disorders highlighting the importance of focusing on
comorbidity in treatment. There is growing evidence that genetic, personality and individual differences in
automatic and controlled aspects of self-regulation may promote the development of PIU. Pharmacological
and psychotherapeutic treatments specific to PIU have received limited testing in large, rigorous studies
however preliminary evidence suggests that both psychotropic medications (Escitalopram, Naltrexone and
Methylphenidate) and cognitive behaviour therapy may have some utility in the treatment of PIU. More
research is needed on areas which remain unclear and contribute to the prognosis of PIU, in particular the
temporal relationships between psychiatric disorder and PIU, mechanisms of comorbidity and the more
subtle psychological changes that occur through Internet use.

Introduction

Over the last twenty years global Internet users have grown to almost two and half billion (Internet World
Stats, 2013). In the UK and USA over 80% of the population has access to the Internet (International
Telecommunications Union, ITC, 2013). Similar access rates have been observed in Asia (particularly Japan,
South Korea and Taiwan) and lower rates, in the range from 45.0 to 55.0%, in South America (ITC, 2013).
Internet use is comparatively lower in Africa and the Middle East but respectively grew by more than 3600%
and 2600% between 2000 and 2012 (Internet World Stats, 2013).

The growth in Internet use has been paralleled by emerging concerns about problematic Internet use (PIU),
also variously termed Internet addiction (Brenner, 1997, Young, 1998), pathological Internet use (Davis,
2001) and Internet dependence (Scherer, 1997). PIU can be defined as “use of the Internet that creates
psychological, social, school and/or work difficulties in a person's life” (Beard & Wolf, 2001, p.378). Scientific
understanding of PIU has lagged behind media attention mainly because of inconsistencies in defining PIU,
disagreement about its very existence, and the variable methodological approaches used in studying it
(Aboujaoude, 2010). In spite of this, a global body of data unequivocally highlights the Internet's potential to
bring about considerable psychological harm (Aboujaoude, 2010).

Section snippets

Definition and diagnosis

The diagnosis of PIU does not appear in any official diagnostic system, including DSM-V, and there are no
widely accepted diagnostic criteria. Researchers investigating PIU still need to distinguish between
dependence on the Internet, and dependence to the Internet, according to Griffiths (2000) who argues that a
majority of individuals presenting with PIU are simply using it as a medium to fuel other addictive
behaviours. Griffiths (2000) also argues that some behaviours engaged on the…

Prevalence

Disagreements regarding diagnostic criteria and the lack of large epidemiological studies have resulted in
difficulties establishing the prevalence of PIU in the general population. Only two large epidemiological
studies examining the prevalence of PIU in the general population have been conducted in Norway (Bakken,
Wenzel, Götestam, Johansson, & Oren, 2009) and the US (Aboujaoude, Koran, Gamel, Large, & Serpe, 2006)
yielding, respectively, prevalence rates of 0.7% and 1.0%. Prevalence rates in …

Comorbidity

PIU has been found to frequently be comorbid with other psychiatric disorders (Ko, Yen, Yen, Chen, & Chen,
2012). Research has shown that adolescents who display problem drinking are more likely to have PIU (Ko,
Yen, Chen, Chen, & Yen, 2008). Some have argued that individuals presenting with difficulties in
disengagement from Internet use may be at greater risk of gambling-related problems (Phillips, Ogeil, &
Blaszczynski, 2012). Yoo et al. (2004) have also observed the association between…

Development

There is growing evidence that genetic factors may influence the development of PIU. A Korean study by Lee
et al. (2008) comparing adolescents diagnosed with PIU with healthy control participants found that those
diagnosed with PIU anomalies in serotonin transporter genes have greater harm avoidance and higher levels
of depression. The results of this study suggest that PIU patients may have genetic and personality traits
similar to depressed patients.

In two South Korean studies, personality…

Treatment

The associations between psychiatric disorders and PIU clearly indicate that the clinical evaluation of the
patient presenting with PIU should include a careful assessment of comorbid psychiatric disorders as
treating these disorders could improve outcomes. Furthermore, since comorbid psychiatric disorders might
predispose to PIU, appropriate screening and treatment for these disorders might prevent the emergence of
PIU. Pharmacological and psychotherapeutic treatments specific to PIU have…

Conclusions

PIU remains an ill-defined and heterogeneous construct, however two features appear fundamental to its
conceptualisation. The first pertains to the aspects of Internet use, described as excessive or compulsive,
along with preoccupation with and loss of control over the Internet use. The second refers to various
adverse consequences of spending too much time on the Internet, such as neglecting social activities,
relationships, health and work or school duties, and altering sleep and eating…

Role of funding sources

The study was completely self-funded.…

Contributors

Marcantonio Spada wrote the entire manuscript.…

Conflict of interests

There are no conflicts of interest to declare.…

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