Internet addiction disorder

Internet addiction disorder (IAD), or, more broadly, Internet overuse, problematic computer use or pathological computer use, is excessive computer use that interferes with daily life.^[1] These terms avoid the distracting and divisive term addiction and are not limited to any single cause.

IAD was originally proposed as a disorder in a satirical hoax by Ivan Goldberg, M.D., in 1995.^[2] He took pathological gambling as diagnosed by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as his model for the description^[3] of IAD. It is not however included in the current DSM as of 2009. IAD receives coverage in the press, and possible future classification as a psychological disorder continues to be debated and researched.

Online activities which, if done in person, would normally be considered troublesome, such as compulsive gambling or shopping, are sometimes called net compulsions.^[4] Others, such as reading or playing computer games, are troubling only to the extent that these activities interfere with normal life. Supporters of disorder classification often divide IAD into subtypes by activity, such as excessive, overwhelming, or inappropriate pornography use,^[5] gaming,^[6] online social networking, blogging,^[7] email^[8], or Internet shopping.^[9] Opponents note that compulsive behaviors may not themselves be addictive.^[10]

[edit] Possible disorder

There is debate over whether to include "Internet Addiction" as a diagnosis in DSM-V, the next (May 2013) edition of the DSM. Some argue that Internet addiction disorder exists and should be included, and some that it is neither an addiction nor a specific disorder and should not be included in DSM-V.

In June 2007, the American Medical Association declined to recommend to the American Psychiatric Association that they include IAD as a formal diagnosis in DSM-V,^[11] and recommended further study of "video game overuse."^[12] Some members of the American Society of Addiction Medicine opposed identifying Internet overuse and video game overuse as disorders.^[13] Among the research identified as necessary is to find ways to define "overuse" and to differentiate an "Internet addiction" from obsession, self-medication for depression or other disorders, and compulsion.

While the existence of Internet addiction is debated, self-proclaimed sufferers are resorting to the courts for redress. In one American case (Pacenza v. IBM Corp.), the plaintiff argued he was illegally dismissed from his employment in violation of the Americans with Disabilities Act because of Internet addiction triggered by Vietnam War-related Post-Traumatic Stress Disorder.^[14][15] The case is pending before the court in the Southern District of New York (case summarized in Glaser & Carroll, 2007).

[edit] Support

According to Maressa Orzack, director of the Computer Addiction Study Center at Harvard University's McLean Hospital, between 5% and 10% of Web surfers suffer some form of Web dependency.^[16]

Another supporter, Jeremy Greenfield, Ph.D. of the Center for Internet Behavior conducted a study with ABC News.com in 1999 and is author of Virtual Addiction. He believes that some services available over the Internet have unique psychological properties which induce dissociation, time distortion, and instant gratification, with about 6% of individuals experiencing some significant impact on their lives. However, he says it may not best be seen as an addiction but rather as a compulsion. Greenfield claims that sex, gaming, gambling, and shopping online can produce a mood-altering effect.

According to the Center for Internet Addiction Recovery (whose director is Kimberly S. Young,^[17] a researcher who has lobbied for the recognition of net abuse as a distinct clinical disorder), "Internet addicts suffer from emotional problems such as depression and anxiety-related disorders and often use the fantasy world of the Internet to psychologically escape unpleasant feelings or stressful situations."^[18] Over 60% of people seeking treatment for IAD claim involvement with sexual activities online which they consider inappropriate, such as excessive attention to pornography or involvement in explicit sexual conversations online.^[19] More than half are also addicted to alcohol, drugs, tobacco, or sex.^[18]

In 2008 Jerald J. Block, M.D.,^[20] Hilarie Cash, PhD,^[21] Kim McDaniel MA,^[21] argued that Internet addiction should be included as a disorder in the DSM-V. Block observed that diagnosis was complicated because 86% of study subjects showing IA symptoms also exhibited other diagnosable mental health disorders.^[20] A 2009 study suggested that brain structural changes were present in those classified by the researchers as Internet addicted, similar to those classified as chemically addicted.^[22]

[edit] Opposition

Psychiatrist Dr. Goldberg acknowledges that Internet addiction disorder is not a true addiction and may in fact be no more than a symptom of other, existing disorders.^[23] An overbroad description of addiction leaves open the possibility of every compensatory behavior being declared an addiction. For example, a person who has lengthy telephone conversations with a friend to avoid an unpleasant situation could be declared "addicted to the telephone" with equal validity as a person who chats on the Internet with the same underlying goal.

Most, if not all "Internet addicts", already fall under existing diagnostic labels.^[24] For many individuals, overuse or inappropriate use of the Internet is a manifestation of their depression, anxiety, impulse control disorders, or pathological gambling.^[25] IAD is compared to food addiction, in which patients overeat as a form of self-medication for depression, anxiety, etc., without actually being truly addicted to eating.

It is possible that a person could have a pathological relationship with a specific aspect of the Internet, such as bidding on online auctions, viewing pornography, online gaming, or online gambling (which is included under the existing Pathological Gambling), but that does not make the Internet medium itself addictive. For example,^[26], whether gambling is done on a computer or face-to-face does not affect whether or not it is pathological; a person with poor impulse control can lose sleep over a suspenseful novel or favorite television show or a computer game or the temptation to click on another web link.

Also, there are significant and critical differences between common Internet activities (e-mail, chatting, web surfing) and pathological gambling, which the IAD notion heavily parallels. The Internet is largely a pro-social, interactive, and information-driven medium, while gambling is seen as a single, anti-social behavior that has very little social redeeming value. So-called Internet addicts do not suffer from the same damage to health and relationships that are common to established addictions.^[24]

A complete review of the Internet addiction research at the end of 2008 (Byun et al., 2008) demonstrated significant, multiple flaws in most studies in this area. The researchers wrote in that article, "The analysis showed that previous studies have utilized inconsistent criteria to define Internet addicts, applied recruiting methods that may cause serious sampling bias, and examined data using primarily exploratory rather than confirmatory data analysis techniques to investigate the degree of association rather than causal relationships among variables."^[27] This suggests that much of the prior research done on this issue is invalid.^{[citation needed]}

[edit] Prevalence

The prevalence of IAD can be attributed to the fact that it has become increasingly difficult to distinguish between the online and offline worlds. The Internet has tremendous potential to affect the emotions of humans and in turn, alter our self-perception and anxiety levels.^[28]

25% of users fulfill Internet addiction criteria within the first six months of using the Internet. Many individuals initially report feeling intimidated by the computer but gradually feel a sense of "competency and exhilaration from mastering the technology and learning to navigate the applications quickly by visual stimulation" (Beard 374). The feeling of exhilaration can be explained by the way IAD sufferers often describe themselves as: bold, outgoing, openminded, intellectually prideful, and assertive.^[29]

The Ottawa Sun reports that a 1996 report in the UK "Advances in Psychiatric Treatment" claimed that a "significant minority" suffer from "Internet addiction".^[30]

Up to 30% of South Koreans under 18, or about 2.4 million people, are at risk of Internet addiction, said Ahn Dong-hyun, a child psychiatrist at Hanyang University in Seoul who just completed a three-year government-financed survey of the problem.^[31]

Data from China Internet Network Information Center (CINIC), as of June 30, 2006, showed that 123 million people had gone online, of which 14.9% were teenagers below 18 years old. Chou and Hsiao reported that the incidence rate of Internet addiction among Taiwan college students was 5.9%.^[32] Wu and Zhu^[33] identified 10.6% of Chinese college students as Internet addicts.^[34]

A leading Beijing judge, Shan Xiuyun, claimed in 2005 that 90% of juvenile crime in the city was Internet-related.^[35] The China Communist Youth League claimed in 2007 that over 17% of Chinese citizens between 13 and 17 are addicted to the Internet.^[36]

[edit] Prevention and correction

In many cases, though not all, Internet overuse corrects itself. Sarah Kershaw wrote for the New York Times in 2005: "It was Professor Kiesler who called Internet addiction a fad illness. In her view, she said, television addiction is worse. She added that she was completing a study of heavy Internet users, which showed the majority had sharply reduced their time on the computer over the course of a year, indicating that even problematic use was self-corrective."^[37]

Corrective strategies include content-control software, counseling, and cognitive behavioural therapy.^{[38][39][40][41]}

Families in China have turned to unlicensed training camps that offer to "wean" their children, often in their teens, from overuse of the Internet. The training camps have been associated with the death of at least one youth.^[42]

In August 2009, ReSTART, a residential treatment center for "pathological computer use", opened near Seattle, Washington, United States.^[43] It offers a 45-day program intended to help people wean themselves from pathological computer use, and can handle up to six patients at a time.^[44]

In November 2009, the government in China banned physical punishment to "wean" teens from the Internet. Electro-shock therapy had already been banned.^[45]