Problematic Internet use: an overview

Elias Aboujaoude
2010-06-01

Chen Internet Addiction ScaleDiagnostic criteriaInternet addictionProblematic Internet useYoung's Diagnostic Questionnaire
There is wide agreement that the Internet can serve as a tool that enhances well-being. It is more difficult, however, to find consensus around the issue of problematic Internet use. That may be in part because scientific investigation has lagged far behind technological advances and media attention. The diagnostic schemas that have been proposed since 1996, and the screening tools that have been developed, stress similarities with substance use, impulse control disorders, and obsessive-compulsive disorder. Prevalence figures vary as a function of the diagnostic definition used, the age group studied, and whether the surveys were conducted online. Studies suggest high comorbidity rates with mood disorders and, among younger individuals, attention-deficit/hyperactivity disorder. Treatment should address any comorbid conditions present, as those may be causing, or exacerbating, problematic Internet use. Interventions that may specifically target problematic Internet use include cognitive behavioral therapy and selective serotonin reuptake inhibitors, but detailed guidelines must await further studies. For a medium that has so radically changed how we conduct our lives, the Internet's effects on our psychology remain understudied. More research is needed into the pathophysiology, epidemiology, natural course, and treatment of problematic Internet use. In addition, the more subtle psychological changes, such as disinhibition, that seem to characterize people's online behavior also deserve attention, even if they cannot be seen as necessarily pathological.
1
Common assessment instruments (Young's Diagnostic Questionnaire, Young's Internet Addiction Test, Chen Internet Addiction Scale) show variable psychometric support and no consensus on underlying dimensions.
2
Empirical diagnostic studies (Ko et al.) propose criteria with high specificity (97.1%) and acceptable sensitivity (87.5%), but are limited by small, non-representative samples.
3
Limited treatment evidence: CBT shows sustained improvement in a 114-subject study; pharmacotherapy evidence is sparse and mixed (open-label escitalopram, case reports of naltrexone and quetiapine, methylphenidate for ADHD-related cases).
4
Population prevalence is uncertain; two general-population studies report point prevalences around 0.7%–1%, with 'at risk' rates up to 5.2% and higher rates in adolescents (2%–11%).
5
Problematic Internet use commonly co-occurs with other psychiatric disorders (mood, anxiety, substance use, ADHD), but causal relationships remain unclear.
6
Problematic Internet use lacks consensus diagnostic criteria, with multiple competing definitions (substance dependence, impulse control, problematic use).

Problematic Internet use (pathological or excessive use of the Internet/electronic media)

Clinical definition, diagnostic criteria, prevalence, comorbidity, assessment instruments, and treatment approaches for problematic Internet use

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2010-06-01
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Elias Aboujaoude
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