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INTERNET ADDICTION: THE EMERGENCE OF A NEW CLINICAL DISORDER

في الخميس فبراير 21, 2013 1:13 pm
Kimberly S. Young
University of Pittsburgh at Bradford




Published in CyberPsychology and Behavior, Vol. 1 No. 3., pages 237-244


Anecdotal reports indicated that some on-line users were becoming addicted to the Internet in
much that same way that others became addicted to drugs or alcohol which resulted in academic,
social, and occupational impairment. However, research among sociologists, psychologists, or
psychiatrists has not formally identified addictive use of the Internet as a problematic behavior.
This study investigated the existence of Internet addiction and the extent of problems caused by
such potential misuse. This study utilized an adapted version of the criteria for pathological
gambling defined by the DSM-IV (APA, 1994). On the basis of this criteria, case studies of 396
dependent Internet users (Dependents) and a control group of 100 non-dependent Internet users
(Non-Dependents) were classified. Qualitative analyses suggests significant behavioral and
functional usage differences between the two groups. Clinical and social implications of
pathological Internet use and future directions for research are discussed.
Internet Addiction: The Emergence Of A New Clinical Disorder
Methodology
 Subjects
 Materials
 Procedures
Results
 Demographics
 Usage Differences
 Length Of Time Using Internet
Hours Per Week
Applications Used
Extent Of Problems
Discussion


INTERNET ADDICTION:
THE EMERGENCE OF A NEW CLINICAL DISORDER
Recent reports indicated that some on-line users were becoming addicted to the Internet in much
the same way that others became addicted to drugs, alcohol, or gambling, which resulted in
academic failure (Brady, 1996; Murphey, 1996); reduced work performance (Robert Half
International, 1996), and even marital discord and separation (Quittner, 1997). Clinical research
on behavioral addictions has focused on compulsive gambling (Mobilia, 1993), overeating
(Lesieur & Blume, 1993), and compulsive sexual behavior (Goodman, 1993). Similar addiction
models have been applied to technological overuse (Griffiths, 1996), computer dependency
(Shotton, 1991), excessive television viewing (Kubey & Csikszentmihalyi, 1990; McIlwraith et
al., 1991), and obsessive video game playing (Keepers, 1991). However, the concept of addictive
Internet use has not been empirically researched. Therefore, the purpose of this exploratory study
was to investigate if Internet usage could be considered addictive and to identify the extent of
problems created by such misuse.
With the popularity and wide-spread promotion of the Internet, this study first sought to
determine a set of criteria which would define addictive from normal Internet usage. If a
workable set of criteria could be effective in diagnosis, then such criteria could be used in
clinical treatment settings and facilitate future research on addictive Internet use. However,
proper diagnosis is often complicated by the fact that the term addiction is not listed in the
Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV; American
Psychiatric Association, 1994). Of all the diagnoses referenced in the DSM-IV, Pathological
Gambling was viewed as most akin to the pathological nature of Internet use. By using
Pathological Gambling as a model, Internet addiction can be defined as an impulse-control
disorder which does not involve an intoxicant. Therefore, this study developed a brief eight-item
questionnaire referred to as a Diagnostic Questionnaire (DQ) which modified criteria for
pathological gambling to provide a screening instrument for addictive Internet use:
1. Do you feel preoccupied with the Internet (think about previous on-line activity or
anticipate next on-line session)?
2. Do you feel the need to use the Internet with increasing amounts of time in order to
achieve satisfaction?
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 on-line longer than originally intended?
6. Have you jeopardized or risked the loss of significant relationship, job, educational or
career opportunity because of the Internet?
7. Have you lied to family members, therapist, 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)?
Respondents who answered "yes" to five or more of the criteria were classified as addicted
Internet users (Dependents) and the remainder were classified as normal Internet users (Non-
Dependents) for the purposes of this study. The cut off score of "five" was consistent with the
number of criteria used for Pathological Gambling. Additionally, there are presently ten criteria
for Pathological Gambling, although two were not used for this adaptation as they were viewed
non-applicable to Internet usage. Therefore, meeting five of eight rather than ten criteria was
hypothesized to be a slightly more rigorous cut off score to differentiate normal from addictive
Internet use. It should be noted that while this scale provides a workable measure of Internet
addiction, further study is needed to determine its construct validity and clinical utility. It should
also be noted that the term Internet is used to denote all types of on-line activity.
[Return to Index]
METHODOLOGY
Subjects
Participants were volunteers who respondent to: (a) nationally and internationally dispersed
newspaper advertisements, (b) flyers posted among local college campuses, (c) postings on
electronic support groups geared towards Internet addiction (e.g., the Internet Addiction Support
Group, the Webaholics Support Group), and (d) those who searched for keywords "Internet
addiction" on popular Web search engines (e.g., Yahoo).
Materials
An exploratory survey consisting of both open-ended and closed-ended questions was
constructed for this study that could be administered by telephone interview or electronic
collection. The survey administered a Diagnostic Questionnaire (DQ) containing the eight-item
classification list. Subjects were then asked such questions as : (a) how long they have used the
Internet, (b) how many hours per week they estimated spending on-line, (c) what types of
applications they most utilized, (d) what made these particular applications attractive, (e) what
problems, if any, did their Internet use cause in their lives, and (f) to rate any noted problems in
terms of mild, moderate, or severe impairment. Lastly, demographic information from each
subject such as age, gender, highest educational level achieved, and vocational background were
also gathered..
Procedures
Telephone respondents were administered the survey verbally at an arranged interview time. The
survey was replicated electronically and existed as a World-Wide-Web (WWW) page
implemented on a UNIX-based server which captured the answers into a text file. Electronic
answers were sent in a text file directly to the principal investigator’s electronic m ailbox for
analysis. Respondents who answered "yes" to five or more of the criteria were classified as
addicted Internet users for inclusion in this study. A total of 605 surveys in a three month period
were collected with 596 valid responses that were classified from the DQ as 396 Dependents and
100 Non-Dependents. Approximately 55% of the respondents replied via electronic survey
method and 45% via telephone survey method. The qualitative data gathered were then subjected
to content analysis to identify the range of characteristics, behaviors and attitudes found.
[Return to Index]
RESULTS
Demographics
The sample of Dependents included 157 males and 239 females. Mean ages were 29 for males,
and 43 for females. Mean educational background was 15.5 years. Vocational background was
classified as 42% none (i.e., homemaker, disabled, retired, students), 11% blue-collar
employment, 39% non-tech white collar employment, and 8% high-tech white collar
employment. The sample of Non-Dependents included 64 males and 36 females. Mean ages
were 25 for males, and 28 for females. Mean educational background was 14 years.
Usage Differences
The following will outline the differences between the two groups, with an emphasis on the
Dependents to observe attitudes, behaviors, and characteristics unique to this population of users.
Length of Time using Internet
The length of time using the Internet differed substantially between Dependents and Non-
Dependent. Among Dependents, 17% had been online for more than one year, 58% had only
been on-line between six months to one year, 17% said between three to six months, and 8% said
less than three months. Among Non-Dependents, 71% had been online for more than one year,
5% had been online between six months to one year, 12% between three to six months, and 12%
for less than three months. A total of 83% of Dependents had been online for less than one full
year w hich m ight suggest that addiction to the Internet happens rather quickly from one’s first
introduction to the service and products available online. In many cases, Dependents had been
computer illiterate and described how initially they felt intimidated by using such information
technology. However, they felt a sense of competency and exhilaration as their technical mastery
and navigational ability improved rapidly.
Hours Per Week
In order to ascertain how much time respondents spent on-line, they were asked to provide a best
estimate of the number of hours per week they currently used the Internet. It is important to note
that estimates were based upon the number of hours spent "surfing the Internet" for pleasure or
personal interest (e.g., personal e-mail, scanning news groups, playing interactive games) rather
than academic or employment related purposes. Dependents spent a M = 38.5, SD = 8.04 hours
per week compared to Non-Dependents who spent M= 4.9, SD = 4.70 hours per week. These
estimates show that Dependents spent nearly eight times the number of hours per week as that of
Non-Dependents in using the Internet. Dependents gradually developed a daily Internet habit of
up to ten times their initial use as their familiarity with the Internet increased. This may be
likened tolerance levels which develop among alcoholics who gradually increase their
consumption of alcohol in order to achieve the desired effect. In contrast, Non-Dependents
reported that they spent a small percentage of their time on-line with no progressive increase in
use. This suggests that excessive use may be a distinguishable characteristic of those who
develop a dependence to on-line usage.
Applications Used
The Internet itself is a term which represents different types of functions that are accessible online.
Table 1 displays the applications rated as "most utilized" by Dependents and Non-
Dependents. Results suggested that differences existed among the specific Internet applications
utilized between the two groups as Non-Dependents predominantly used those aspects of the
Internet which allowed them to gather information (i.e., Information Protocols and the World
Wide Web) and e-mail. Comparatively, Dependents predominantly used the two-way
communication functions available on the Internet (i.e., chat rooms, MUDs, news groups, or email).
Table 1: Internet Applications Most Utilized by Dependents and Non-Dependents
Type of Computer User
Application Dependents Non-Dependents
Chat Rooms 35% 7%
MUDs 28% 5%
News groups 15% 10%
E-mail 13% 30%
WWW 7% 25%
Information Protocols 2% 24%
Chat rooms and Multi-User Dungeons, more commonly known as MUDs were the two most
utilized mediums by Dependents. Both applications allow multiple on-line users to
simultaneously communicate in real time; similar to having a telephone conversation except in
the form of typed messages. The number of users present in these forms of virtual space can
range from two to over thousands of occupants. Text scrolls quickly up the screen

with answers,
questions, or comments to one another. Sending a "privatize message" is another available option
that allows only a single user to read a message sent. It should be noted that MUDs differ from
chat rooms as these are an electronic spin off of the old Dungeon and Dragons games where
players take on character roles. There are literally hundreds of different MUDs ranging in themes
from space battles to medieval duels. In order to log into a MUD, a user creates a character
name, Hercules for example, who fights battles, duels other players, kills monsters, saves
maidens or buys weapons in a make believe role playing game. MUDs can be social in a similar
fashion as in chat room, but typically all dialogue is communicated while "in character."
News groups, or virtual bulletin board message systems, were the third most utilized application
among Dependents. News groups can range on a variety of topics from organic chemistry to
favorite television programs to the best types of cookie-dough. Literally, there are thousands of
specialized news groups that an individual user can subscribe to and post and read new electronic
messages. The World-Wide Web and Information Protocols, or database search engines that
access libraries or electronic means to download files or new software programs, were the least
utilized among Dependents. This may suggest that the database searches, while interesting and
often times time-consuming, are not the actual reasons Dependents become addicted to the
Internet.
Non-Dependents viewed the Internet as a useful resource tool and a medium for personal and
business communication. Dependents enjoyed those aspects of the Internet which allowed them
to meet, socialize, and exchange ideas with new people through these highly interactive
mediums. Dependents commented that the formation of on-line relationships increased their
immediate circle of friends among a culturally diverse set of world-wide users. Additional
probing revealed that Dependents mainly used electronic mail to arrange "dates" to meet on-line
or to keep in touch between real time interactions with new found on-line friends. On-line
relationships were often seen as highly intimate, confidential, and less threatening than real life
friendships and reduced loneliness perceived in the D ependent’s life. O ften tim es, D ependents
preferred their "on-line" friends over their real life relationships due to the ease of anonymous
communication and the extent of control in revealing personal information among other on-line
users.
Extent of Problems
One major component of this study was to examine the extent of problems caused by excessive
Internet use. Non-Dependents reported no adverse affects due to its use, except poor time
management because they easily lost track of time once on-line. However, Dependents reported
that excessive use of the Internet resulted in personal, family, and occupational problems that
have been documented in established addictions such as pathological gambling (e.g., Abbott,
1995), eating disorders (e.g., Copeland, 1995), and alcoholism (e.g., Cooper, 1995; Siegal,
1995). Problems reported were classified into five categories: academic, relationship, financial,
occupational, and physical. Table 2 shows a breakdown of the problems rated in terms of mild,
moderate, and severe impairment.
Table 2: Comparison of Type of Impairment to Severity Level Indicated
Impairment Level
Impairment None Mild Moderate Severe
Academic 0% 2% 40% 58%
Relationship 0% 2% 45% 53%
Financial 0% 10% 38% 52%
Occupational 0% 15% 34% 51%
Physical 75% 15% 10% 0%
Although the merits of the Internet make it an ideal research tool, students experienced
significant academic problems as they surf irrelevant web sites, engage in chat room gossip,
converse with Internet pen-pals, and play interactive games at the cost of productive activity.
Students had difficulty completing homework assignments, studying for exams, or getting
enough sleep to be alert for class the next morning due to such Internet misuse. Often times, they
were unable to control their Internet use which eventually resulted in poor grades, academic
probation, and even expulsion from the university.
Marriages, dating relationships, parent-child relationships, and close friendships were also noted
to be poorly disrupted by excessive use of the Internet. Dependents gradually spent less time
with real people in their lives in exchange for solitary time in front of a computer. Initially,
Dependents tended to use the Internet as an excuse to avoid needed but reluctantly performed
daily chores such as doing the laundry, cutting the lawn, or going grocery shopping. Those
mundane tasks were ignored as well as important activities such as caring for children. For
example, one mother forgot such things as to pick up her children after school, to make them
dinner, and to put them to bed because she became so absorbed in her Internet use.
L oved ones first rationalize the obsessed Internet user’s behavior as "a phase" in hopes that the
attraction would soon dissipate. However, when addictive behavior continued, arguments about
the increased volume of time and energy spent on-line soon ensue, but such complaints were
often deflected as part of the denial exhibited by Dependents. Dependents become angry and
resentful at others who questioned or tried to take away their time from using the Internet, often
tim es in defense of their Internet use to a husband or w ife. F or exam ple, "I don’t have a
problem," or "I am having fun, leave me alone," might be an addict’s response. F inally, sim ilar
to alcoholics who hide their addiction, Dependents engaged in the same lying about how long
their Internet sessions really lasted or they hide bills related to fees for Internet service. These
behaviors created distrust that over time hurt the quality of once stable relationships.
Marriages and dating relationships were the most disrupted when Dependents formed new
relationships with on-line "friends." On-line friends were viewed as exciting and in many cases
lead to romantic interactions and Cybersex (i.e., on-line sexual fantasy role-playing). Cybersex
and romantic conversations were perceived as harmless interactions as these sexual on-line
affairs did not involve touching and electronic lovers lived thousands of miles away. However,
Dependents neglected their spouses in place of rendezvous with electronic lovers, leaving no
quality time for their marriages. Finally, Dependents continued to emotionally and socially
withdraw from their marriages, exerting more effort to maintain recently discovered on-line
relationships.
Financial problems were reported among Dependents who paid for their on-line service. For
example, one woman spent nearly $800.00 in one month for on-line service fees. Instead of
reducing the amount of time she spent on-line to avoid such charges, she repeated this process
until her credit cards were over-extended. Today, financial impairment is less of an issue as rates
are being driven down. America On-line, for example, recently offered a flat rate fee of $19.95
per month for unlimited service. However, the movement towards flat rate fees raises another
concern that on-line users are able to stay on-line longer without suffering financial burdens
which may encourage addictive use.
Dependents reported significant work-related problems when they used their employee on-line
access for personal use. New monitoring devices allow bosses to track Internet usage, and one
major company tracked all traffic going across its Internet connection and discovered that only
twenty-three percent of the usage was business-related (Neuborne, 1997). The benefits of the
Internet such as assisting employees with anything from market research to business
communication outweigh the negatives for any company, yet there is a definite concern that it is
a distraction to many employees. Any misuse of time in the work place creates a problem for
managers, especially as corporations are providing employees with a tool that can easily be
misused. For example, Edna is a 48 year old executive secretary found herself compulsively
using chat rooms during work hours. In an attempt to deal with her "addiction," she went to the
Employee Assistance Program for help. The therapist, however, did not recognize Internet
addiction as a legitimate disorder requiring treatment and dismissed her case. A few weeks later,
she was abruptly terminated from employment for time card fraud when the systems operator
had monitored her account only to find she spent nearly half her time at work using her Internet
account for non-job related tasks. Employers uncertain how to approach Internet addiction
among workers may respond with warnings, job suspensions, or termination from employment
instead of m aking a referral to the com pan y’s E m ployee A ssistance P rogram (Young, 1996b).
Along the way, it appears that both parties suffer a rapid erosion of trust.
The hallmark consequence of substance abuse are the medical risk factors involved, such as
cirrhosis of the liver due to alcoholism, or increased risk of stroke due to cocaine use. The
physical risk factors involved with Internet overuse were comparatively minimal yet notable.
Generally, Dependent users were likely to use the Internet anywhere from twenty to eighty hours
per week, with single sessions that could last up to fifteen hours. To accommodate such
excessive use, sleep patterns are typically disrupted due to late night log-ins. Dependents
typically stayed up past normal bedtime hours and reported being on-line until two, three, or four
in the morning with the reality of having to wake for work or school at six a.m. In extreme cases,
caffeine pills were used to facilitate longer Internet sessions. Such sleep depravation caused
excessive fatigue often making academic or occupational functioning impaired and decreased
one’s im m une system leaving D ependents’ vulnerable to disease. A dditionally, the sedentary act
of prolonged computer use resulted in a lack of proper exercise and lead to an increased risk for
carpal tunnel syndrome, back strain, or eyestrain.
Despite the negative consequences reported among Dependents, 54% had no desire to cut down
the amount of time they spent on-line. It was at this point that several subjects reported feeling
"completely hooked" on the Internet and felt unable to kick their Internet habit. The remaining
46% of Dependents made several unsuccessful attempts to cut down the amount of time they
spent on-line in an effort to avoid such negative consequences. Self-imposed time limits were
typically initiated to manage on-line time. However, Dependents were unable to restrict their
usage to the prescribed time limits. When time limits failed, Dependents canceled their Internet
service, threw out their modems, or completely dismantled their computers to stop themselves
from using the Internet. Yet, they felt unable to live without the Internet for such an extended
period of time. They reported developing a preoccupation with being on-line again which they
compared to "cravings" that smokers feel when they have gone a length of time without a
cigarette. Dependents explained that these cravings felt so intense that they resumed their
Internet service, bought a new modem, or set up their computer again to obtain their "Internet
fix."
[Return to Index]
DISCUSSION
There are several limitations involved in this study which must be addressed. Initially, the
sample size of 396 Dependents is relatively small compared to the estimated 47 million current
Internet users (Snider, 1997). In addition, the control group was not demographically wellmatched
which weakens the comparative results. Therefore, generalizability of results must be
interpreted with caution and continued research should include larger sample sizes to draw more
accurate conclusions.
Furthermore, this study has inherent biases present in its methodology by utilizing an expedient
and convenient self-selected group of Internet users. Therefore, motivational factors among
participants responding to this study should be discussed. It is possible that those individuals
classified as Dependent experienced an exaggerated set of negative consequences related to their
Internet use compelling them to respond to advertisements for this study. If this is the case, the
volume of moderate to severe negative consequences reported may be an elevated finding
making the harmful affects of Internet overuse greatly overstated. Additionally, this study
yielded that approximately 20% more women than men responded which should also be
interpreted with caution due to self-selection bias. This result shows a significant discrepancy
from the stereotypic profile of an "Internet addict" as a young, computer-savvy male (Young,
1996a) and is counter to previous research that has suggested males predominantly utilize and
feel comfortable with information technologies (Busch, 1995; Shotton, 1991). Women may be
more likely to discuss an emotional issue or problem more than men (Weissman & Payle, 1974)
and therefore were more likely than men to respond to advertisements in this study. Future
research efforts should attempt to randomly select samples in order to eliminate these inherent
methodological limitations.
While these limitations are significant, this exploratory study provides a workable framework for
further exploration of addictive Internet use. Individuals were able to meet a set of diagnostic
criteria that show signs of impulse-control difficulty similar to symptoms of pathological
gambling. In the majority of cases, Dependents reported that their Internet use directly caused
moderate to severe problems in their real lives due to their inability to moderate and control use.
Their unsuccessful attempts to gain control may be paralleled to alcoholics who are unable to
regulate or stop their excessive drinking despite relationship or occupational problems caused by
drinking; or compared to compulsive gamblers who are unable to stop betting despite their
excessive financial debts.
The reasons underlying such an impulse control disability should be further examined. One
interesting issue raised in this study is that, in general, the Internet itself is not addictive. Specific
applications appeared to play a significant role in the development of pathological Internet use as
Dependents were less likely to control their use of highly interactive features than other on-line
applications. This paper suggests that there exists an increased risk in the development of
addictive use the more interactive the application utilized by the on-line user. It is possible that a
unique reinforcement of virtual contact with on-line relationships may fulfill unmet real life
social needs. Individuals who feel misunderstood and lonely may use virtual relationships to seek
out feelings of comfort and community. However, greater research is needed to investigate how
such interactive applications are capable of fulfilling such unmet needs and how this leads to
addictive patterns of behavior.
Finally, these results also suggested that Dependents were relative beginners on the Internet.
Therefore, it may be hypothesized that new comers to the Internet may be at a higher risk for
developing addictive patterns of Internet use. However, it may be postulated that "hi-tech" or
more advanced users suffer from a greater amount of denial since their Internet use has become
an integral part of their daily lives. Given that, individuals who constantly utilize the Internet
may not recognize "addictive" use as a problem and therefore saw no need to participate in this
survey. This may explain their low representation in this sample. Therefore, additional research
should examine personality traits that may mediate addictive Internet use, particularly among
new users, and how denial is fostered by its encouraged practice.
A recent on-line survey (Brenner, 1997) and two campus-wide surveys conducted at the
University of Texas at Austin (Scherer, 1997) and Bryant College (Morahan-Martin, 1997) have
further documented that pathological Internet us is problematic for academic performance and
relationship functioning. With the rapid expansion of the Internet into previously remote markets
and another estimated 11.7 million planning to go on-line in the next year (Snider, 1997), the
Internet may pose a potential clinical threat as little is understood about treatment implications
for this emergent disorder. Based upon these findings, future research should develop treatment
protocols and conduct outcome studies for effective management of this symptoms. It may be
beneficial to monitor such cases of addictive Internet use in clinical settings by utilizing the
adapted criteria presented in this study. Finally, future research should focus on the prevalence,
incidence, and the role of this type of behavior in other established addictions (e.g., other
substance dependencies or pathological gambling) or psychiatric disorders (e.g., depression,
bipolar disorder, obsessive-compulsive disorder, attention deficit disorder).
[Return to Index]
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