Volume 5 Issue 7 July 2015
Background-Definition-Concept– Subtypes
sage of internet is a universal phenomenon. However, when the usage becomes uncontrollable despite having damaging consequences for the user, it is labeled as „addiction‟. The existence of internet addiction (IA) as a discrete disorder was first proposed, albeit not seriously, in 1995 by Ivan Goldberg, a New York psychiatrist. But 1996 study by Kimberly Young of the University of Pittsburgh triggered the controversy. IA is also known as problematic internet use. Initially IA was conceptualized as an impulse control disorder (in line with pathological gambling) and later as addictive disorders because of its clinical, phenomenological, and biological overlap. Five subtypes of IA has been recognized: cyber sexual addiction (internet pornography), cyber relational addiction (adult chat rooms), net compulsion (online gambling), information overload (excessive web searching), and computer addiction (gaming).
Nosological status
Internet addiction falls under the broad rubric of behavioural addiction. Till the advent of DSM-V, behavioural addiction is not accepted nosologically.
IA criteria by Young (1998) requires 5 or more following criterion to be fulfilled over a period of 6 months: Preoccupation; tolerance; withdrawal; using longer than intended; unable to cut down-stop internet use; jeopardized relationship and functionality; deceiving family members /therapist about internet use; and using internet to control dysphoric mood.
Epidemiology & comorbidity
Two large-scale general population surveys from the US and Norway described a point prevalence of IA as 0.7% and 1% respectively. An Indian study amongst college students of Mumbai has observed similar prevalence figure (0.7%), another study done amongst school students found IA in 12% of respondents. Although the percentage (0.7-1%) seems to be meager, the huge number of internet users would make it enormous in terms of absolute figure. Young age, male gender, higher educational achievement, and financial stress are found to be positively associated with problematic Internet use. Comorbidity with IA is a rule rather than exception. Mood disorders (major depression and bipolar disorder), substance use disorders, attention deficit hyperactive disorder and impulse control disorders are the common co-morbidities.
Treatment
Pharmacologic and psychotherapeutic interventions specific to problematic Internet use have not yet received adequate testing in large, rigorous studies. Amongst medications SSRI (like escitalopram) and naltrexone were tried with limited success. Of the psychotherapy approaches, cognitive behavioral therapy (CBT) has received the most empirical investigation. Although not systematically studied, developing and nurturing real life social relationship, improvement in social and problem solving skills, restricting online behavior to predetermined goal and time, and parental control or supervision could have preventive value.
Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh
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