Internet addiction disorder

Dr. Syed Faheem ShamsStudent, Dept of Psychiatry

BSMMU

Internet has bring the world into the palm of our hand

Over 60% of American households

have at least one PC Nearly 55% of households are

connected to the Internet

(U.S. Census Bureau, 2005)

Internet users distributed by Geographic Region,2010

Objectives

1. What is internet addiction disorder?2. Historical view3. Criteria4. Why it is important?5. Features6. How can it be managed?

Do any of these stories sound familiar to you?

A mother has difficulty getting her child to do homework when computer games occupy all after school time

A husband finds his wife increasingly neglects family duties, is irritable at family gatherings, and the net bill has risen astronomically

Various names

PathologicalInternet Use Problematic

Internet Use

Internetomania

Computer Addictio

n

History 1995 "The Lure and Addiction of Life On Line,"

published in the New York Times 1995 Ivan Goldberg borrowed criteria for

defining substance dependence and first coined the term "Internet addiction disorder" to represent those having problematic Internet use behavior

http://www.springerreference.com/docs/html/chapterdbid/333019.html

Dr. Kimberly Young presented the first

research on Internet addiction in 1996

At the American Psychological

Association’s annual conference held in

Toronto in her paper

Internet Addiction: The Emergence of a New Disorder

1996 Young adapted the criteria

for pathological gambling defined by the DSM-IV to diagnose the Internet addiction as a compulsive disorder

WHAT IS INTERNET ADDICTION DISORDER?

“ Internet addiction is defined as the compulsive urge to continually use the net, whether it be to spend hours surfing the web, hang around in chat rooms, or play on-line games”

Book Reviews, Chris Mitchell Kimberly S. Young: Caught In The Net

Where does it fit?

IAD

Impulse control disorder

Pathological

gambling

Substance use

disorder

OCD

Over enthusi

asm

Transitional

overuse

Young, Goldberg proposed seven criteria 

Internet use behavior meets three or more of the following criteria:

• Criteria I - Tolerance• Criteria II - Withdrawal• Criteria III - The Internet is accessed more often or for longer

periods of time than was intended.• Criteria IV - There is a persistent desire or unsuccessful efforts

to cut down or control Internet use.• Criteria V - A great deal of time is spent in activities related to

Internet use.• Criteria VI - Important social, occupational, or recreational

activities are given up or reduced because of Internet use.• Criteria VII - Internet use is continued despite knowledge of

having a persistent or recurrent physical, social, occupational, or psychological problem.

PROPOSED CRITERIABy Tao, Huang, Mai

PREOCCUPATION WITH THE INTERNET (thinks about previous online activity or anticipates next online session)

WITHDRAWAL, as manifested by a dysphoric mood, anxiety, irritability and boredom after several days without Internet activity

At least one (or more) of the following:• TOLERANCE, marked increase in Internet use required to achieve satisfaction• PERSISTENT DESIRE and/or unsuccessful attempts to control, cut back or

discontinue Internet use• CONTINUED EXCESSIVE USE of Internet despite knowledge of having a persistent

or recurrent physical or psychological problems likely to have been caused or exacerbated by Internet use

• LOSS OF INTEREST previous hobbies, entertainment as a direct result of, and with the exception of, Internet use

• USES THE INTERNET TO ESCAPE or relieve a dysphoric mood (e.g. feelings of helplessness, guilt, anxiety)

Functional impairments (reduced social, academic, working ability), including loss of a significant relationship, job, educational or career opportunities

Course Criterion:• Duration of Internet addiction must have lasted for an excess of 3 months, with at

least 6 hours Internet usage (non-business/non-academic) per day

Types

The Centre for On-Line Addiction (1998)

–Cyber sexual addiction–Cyber-relationship addiction–Net compulsions–Information overload–Computer addiction

Why internet is addictive?

Possible causes

Triple A Engine (Cooper, 1998)– Accessibility– Affordability– Anonymity

The ACE Model (Young, 1996)– Anonymity– Convenience– Escape

It is accessible 24/7 It can be anonymous It feels secure It is easy to use It provides the illusion of connection Inexpensive It is fun and very engaging

DSM V

Section 3 Disorders Internet use gaming disorder

Sales 66 billion worldwide in 2010 to $81 billion in 2016 (Takahashi 2011).

As a point of reference, video game sales are now greater than those of the music industry.

http://boards.medscape.com/forums?128@640.2gm6aLuHeSs@.2a2cf120!comment=1

SYMPTOMS OF TOO MUCH USE

• Carpal Tunnel Syndrome• Dry Eyes• Headaches• Back Aches

Physical

• Sleep disturbances• Feeling empty, depressed, irritable when not at the

computer• mood swings, anxiety, fear, irritability• Having a sense of well-being or euphoria while at

the computer

Psychological

• Problems with school or job• Neglect of family and friends• Eating irregularities (skipping meals)

Functional

Prevalence of Internet Addiction

USA Aboujaoude, Koran, Gamel, Large, & Serpe, 2006

A national telephone survey (N = 2,513 adults)5.9% Excessive Internet use

3.7% Preoccupied by the Internet when off-line

13.7% Difficult to stay away from the Internet for several days at a time

Finland 4.7% internet addicted

Norway 1.98% internet addicted

Turkey 40% (?)

Northern Cyprus 1.1% internet addicted

Country No of Studies No.of Respondent

Avg.% Addiction

China 8 7656 8.40

Taiwan 5 6463 17.55

Korea 6 4266 11.05

Hongkong 1 699 37.90

• India (2003) Nalwa & Anand conducted a study on Indian public school children

18% students were Internet dependent• In Bangladesh, 20% adolescent group of

people. Significantly associated with Information seeking behavior & chatting. Significant problem was found in 3% and occasional problem was found in 59%

(khan A et al, 2011)

Diagnoses, problems & comorbidity

– Depression & Social Introversion (Widyanto & Griffiths,

2006)– Attention Deficit Hyperactivity Disorder (Yoo et al.,

2004)– Social Phobia & depression (Yen, Ko, Yen, Wu, & Yang,

2007)– Sex addiction, i.e., cybersexual addiction/cyber

affairs (Young et. Al., 2000)– Gambling (Potera, 1998)– Compulsive buying (Raab & Neuner, 2006)– Illegal activity (Hall & Parsons, 2001)

Australia 2.3 times depression at 9-month follow-up

compared with students who did not exhibit pathologic Internet use.

Arch Pediatr Adolesc Med. 2009;163:937-943

Tests

Young's Brief 8-Item Questionnaire (addiction)

Young's 10-Item Questionnaire (dependence)

Young's 7-Item Questionnaire (dependence)

Internet-Related Addictive Behavior Inventory (IRABI)

Compulsive internet use scale (CIUS)

Imaging findings

Significant damage to white matter in the brain, mainly in the orbito-frontal regions

http://www.dailymail.co.uk/sciencetech/article-2085369/Internet-addiction-cause-physical-damage-brain-just-like-drugs-say-researchers.html#ixzz2Pt0eHQxg

glucose metabolism – right middle orbitofrontal gyrus left caudate nucleus right insula

Altered Regional Cerebral Glucose Metabolism in Internet Game Overusers: A 18F-fluorodeoxyglucose Positron Emission Tomography Study, 2010;15(3):159-166

metabolism- bilateral postcentral gyrus left precentral gyrus bilateral occipital regions

Altered Regional Cerebral Glucose Metabolism in Internet Game Overusers: A 18F-fluorodeoxyglucose Positron Emission Tomography Study, 2010;15(3):159-166

Intervention

The first treatment facility designed

to specifically deal with Internet addiction was Kimberly Young's Center for Internet Addiction Recovery, founded in 1995

In 2009, the first residential treatment center for Internet addiction in the United States, called reSTART

The reSTART offers a 45-day abstinence-based recovery program for people with pathological computer use

• Psycho education• CBT• MI • Training of recreational

activities• Reality therapy

Individual

• Psycho education• Family therapy

Family

• Vocational therapy• Social mixing• Group psychotherapy• Education at school

Social

Measures taken by different countries in Asia

• South Korea (Block, 2008)– Most serious public health issue (in South Korea)

• 10 reported deaths (due to cardio-pulmonary reasons)• Several Internet game-related murders

– As of 2007• 1,043 counselors have been trained in treating and

assessing Internet addiction• 190 hospital and treatment centers created• Preventative measures in schools

• China (Block, 2008)– In 2007, China restricted computer game use

• Current laws prohibit more than 3 hours of daily game use

Control yourself !Use The Internet smartly !

Objectives

1. What is internet addiction disorder?2. Historical view3. Criteria4. Why it is important?5. Features6. How can it be managed?

Are you net addicted?

• http://www.netaddiction.com/index.php?option=com_bfquiz&view=onepage&catid=46&Itemid=106

• http://www.netaddictionrecovery.com/

THANK YOU ALL