INTERNET ADDICTION STUDIES: SUMMARIES

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Here's the latest research on Internet Addiction (which includes porn use). Other studies involving Internet gaming addiction and video game addiction can be found here. Internet addiction studies have already confirmed the presence of the three major brain changes caused by addiction: sensitization, desensitization and hypofrontality.

Sexual politics discourage isolating porn use from other forms of Internet activities. Unfortunately, this could be obscuring the increased vulnerability of those pursuing cybersex/porn. A 2006 Dutch study found that erotica had the highest addictive potential of all Internet applications.

Pornographic Picture Processing Interferes with Working Memory Performance (2012)

J Sex Res. 2012 Nov 20. 

Some individuals report problems during and after Internet sex engagement, such as missing sleep and forgetting appointments, which are associated with negative life consequences. One mechanism potentially leading to these kinds of problems is that sexual arousal during Internet sex might interfere with working memory (WM) capacity, resulting in a neglect of relevant environmental information and therefore disadvantageous decision making.

Results revealed worse WM performance in the pornographic picture condition of the 4-back task compared with the three remaining picture conditions. Furthermore, hierarchical regression analysis indicated an explanation of variance of the sensitivity in the pornographic picture condition by the subjective rating of the pornographic pictures as well as by a moderation effect of masturbation urges. Results contribute to the view that indicators of sexual arousal due to pornographic picture processing interfere with WM performance. Findings are discussed with respect to Internet addiction because WM interference by addiction-related cues is well known from substance dependencies.

Comments: Internet porn interferes with working memory, just as addiction-related cues interfere with working memory in addicts. First study to assess the effects of porn on the brain

Internet and Gaming Addiction: A Systematic Literature Review of Neuroimaging Studies (2012)

Brain Sci. 2012, 2(3), 347-374; doi:10.3390/brainsci2030347

In the past decade, research has accumulated suggesting that excessive Internet use can lead to the development of a behavioral addiction. Internet addiction has been considered as a serious threat to mental health and the excessive use of the Internet has been linked to a variety of negative psychosocial consequences. The aim of this review is to identify all empirical studies to date that used neuroimaging techniques to shed light upon the emerging mental health problem of Internet and gaming addiction from a neuroscientific perspective.

A systematic literature search was conducted, identifying 18 studies. These studies provide compelling evidence for the similarities between different types of addictions, notably substance-related addictions and Internet and gaming addiction, on a variety of levels. On the molecular level, Internet addiction is characterized by an overall reward deficiency that entails decreased dopaminergic activity. On the level of neural circuitry, Internet and gaming addiction led to neuroadaptation and structural changes that occur as a consequence of prolonged increased activity in brain areas associated with addiction. On a behavioral level, Internet and gaming addicts appear to be constricted with regards to their cognitive functioning in various domains.

Comments: Real simple - all brain studies done so far have pointed in one direction: Internet addiction is a real as substance addiction and involves the same fundamental brain changes.

Reduced Striatal Dopamine Transporters in People with Internet Addiction Disorder (2012)

Journal of Biomedicine and Biotechnology Volume 2012 (2012), Article ID 854524,

In recent years, IAD has become more prevalent worldwide; the recognition of its devastating impact on the users and society has rapidly increased [7]. Importantly, recent studies have found dysfunctions of IAD are similar to other types of addictive disorders, such as substance abuse disorders and pathological gambling [7-10]. People experiencing IAD showed clinical features such as craving, withdrawal and tolerance [7, 8], increased impulsiveness [9], and impaired cognitive performance in tasks involving risky decision-making [10].

Conclusion: The results from this study provide evidence that IAD may induce significant DAT losses in the brain and these findings suggest that IAD is associated with dysfunctions in the dopaminergic brain systems and are consistent with previous reports in various types of addictions either with or without substances [21-23, 37]. Our findings support the claim that IAD may share similar neurobiological abnormalities with other addictive disorders [15].

COMMENTS: Study examined reward circuitry dopamine transporter levels in Internet addicts. Levels were compared to a control group whose members also used the Internet. Levels of dopamine transporters were comparable to those with drug addiction. A decline in dopamine transporters is a hallmark of addictions. It indicates a loss of nerve endings that release dopamine.

Abnormal White Matter Integrity in Adolescents with Internet Addiction Disorder: A Tract-Based Spatial Statistics Study (2012)

 PLoS ONE 7(1): e30253. doi:10.1371/journal.pone.0030253

Compared with the age, gender and education matched controls, IAD subjects had significantly reduced FA in the orbito-frontal white matter, together with cingulum, commissural fibers of the corpus callosum, association fibers including the inferior front-occipital fasciculus, and projection fibers comprising the corona radiation, internal capsule and external capsule. These results provide evidences of widespread deficits in white matter integrity and reflect a disruption in the organization of white matter tracts in IAD.

The orbito-frontal cortex has extensive connections with prefrontal, visceromotor, and limbic regions, as well as the association areas of each sensory modality [33]. It plays a critical role in emotional processing and addiction-related phenomena, such as craving, compulsive-repetitive behaviors, and maladaptive decision-making [34], [35]. Previous studies found that abnormal white matter integrity in the orbito-frontal cortex has been frequently observed in the subjects exposed to addictive substances, such as alcohol [36], cocaine [37], [38], marijuana [39], methamphetamine [40], and ketamine [41]. Our finding that IAD is associated with impaired white matter integrity in the orbito-frontal regions is consistent with these previous results.

Anterior cingulate cortex (ACC) connects to the frontal lobes and the limbic system, playing an essential role in cognitive control, emotional processing and craving [42]. Abnormal white matter integrity in the anterior cingulum has also been consistently observed in other forms of addiction, such as alcoholism [36], heroin dependence [43], and cocaine addiction [38]. The observation of decreased FA within the anterior cingulum of IAD subjects is consistent with these previous results and with the report that heavy Internet overuse[17] is associated with impaired cognitive control. More interestingly, the same group of IAD subjects had been shown to have significantly decreased gray matter density in the left ACC, compared to control [12]. Similar results have also been reported by another group [13].

COMMENTS: Another brain study on the white matter differences between control groups and those with Internet addiction. Those with Internet addiction have white matter changes that mimic those with substance addictions. White matter, also called myelin, wraps the axons of nerve cells.  The myelin covered axons function as the communication pathways connecting different parts of the brain.

Enhanced Reward Sensitivity and Decreased Loss Sensitivity in Internet Addicts: An fMRI Study During a Guessing Task (2011)

J Psychiatr Res. 2011 Jul 16.

As the world's fastest growing "addiction", Internet addiction should be studied to unravel the potential heterogeneity. The present study is set to examine reward and punishment processing in Internet addicts as compared to healthy controls.The results showed that Internet addicts associated with increased activation in orbitofrontal cortex in gain trials and decreased anterior cingulate activation in loss trials than normal controls. The results suggested that Internet addicts have enhanced reward sensitivity and decreased loss sensitivity than normal comparisons.

COMMENTS: Both enhanced reward sensitivity (sensitization) and decreased loss sensitivity (lessened aversion) are markers of an addiction process

Male Internet addicts show impaired executive control ability evidence from a color-word: Stroop task (2011).

Neurosci Lett. 2011 Jul 20;499(2):114-8. PR China

This study investigated the executive control ability of male students with Internet addiction disorder (IAD) by recording event-related brain potentials (ERP) during a color-word Stroop task. Behavior results showed that IAD students were associated with longer reaction time and more response errors in incongruent conditions than the control group. ERP results revealed that participants with IAD showed reduced medial frontal negativity (MFN) deflection in incongruent conditions than the control group. Both of the behavioral performance and ERP results indicate that people with IAD show impaired executive control ability than the normal group.

COMMENTS: This study, like other recent fMRI studies on Internet addicts, showed reductions in executive control. Reductions in executive control in addicts indicate a decline in frontal cortex activity. this decline parallels loss of impulse control, and is found in all addictions.

Microstructure Abnormalities in Adolescents with Internet Addiction Disorder. (2011).

PLoS ONE 6(6): e20708. doi:10.1371/journal.pone.0020708

Recent studies suggest that internet addiction disorder (IAD) is associated with structural abnormalities in brain gray matter. However, few studies have investigated the effects of internet addiction on the microstructural integrity of major neuronal fiber pathways, and almost no studies have assessed the microstructural changes with the duration of internet addiction.

As one of the common mental health problems amongst Chinese adolescents, internet addiction disorder (IAD) is currently becoming more and more serious. Data from the China Youth Internet Association (announcement on February 2, 2010) demonstrated that the incidence rate of internet addiction among Chinese urban youths is about 14%. It is worth noting that the total number is 24 million

Conclusions: We provided evidences indicating that IAD subjects had multiple structural changes in the brain. The gray matter atrophy and white matter FA changes of some brain regions were significantly correlated with the duration of internet addiction. These results may be interpreted, at least partially, as the functional impairment of cognitive control in IAD. The prefrontal cortex abnormalities were consistent with previous substance abuse studies hence we suggested that there may exist partially overlapping mechanisms in IAD and substance use.

COMMENTS: This study clearly shows that those with Internet addiction develop brain abnormalities that parallel those found in substance abusers. Researchers found a 10-20% reduction in frontal cortex gray matter in adolescents with Internet addiction. Hypofrontality is the common term for these frontal cortex changes caused by addiction. It is a key marker for all addiction processes.

Reduced Striatal Dopamine D2 Receptors in People With Internet Addiction (2011).

Neuroreport. 2011 Jun 11;22(8):407-11. Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea.

An increasing amount of research has suggested that Internet addiction is associated with abnormalities in the dopaminergic brain system. Consistent with our prediction, individuals with Internet addiction showed reduced levels of dopamine D2 receptor availability in subdivisions of the striatum including the bilateral dorsal caudate and right putamen. This finding contributes to the understanding of neurobiological mechanism of Internet addiction.

COMMENTS: More evidence that Internet addiction exists. A reduction of striatal D2 dopamine receptors is the primary marker for desensitization of the reward circuitry, which is one the major changes that occurs with addictions,

Gray Matter Abnormalities In Internet Addiction: A Voxel-Based Morphometry Study (2009).

Eur J Radiol. 2009 Nov 17.. Jiao Tong University Medical School, Shanghai 200127, PR China.

This study aims to investigate brain gray matter density (GMD) changes in adolescents with Internet addiction (IA) using voxel-based morphometry (VBM) analysis on high-resolution T1-weighted structural magnetic resonance images. Compared with healthy controls, IA adolescents had lower GMD in the left anterior cingulate cortex, left posterior cingulate cortex, left insula, and left lingual gyrus.

CONCLUSIONS: Our findings suggested that brain structural changes were present in IA adolescents, and this finding may provide a new insight into the pathogenesis of IA.

COMMENT: Adolescents with Internet addiction have decreased gray matter in portions of the frontal cortex. Decreases in size and functioning the frontal cortex (hypofrontality) are found in all addiction processes, and is related to declining D2 receptors. Another example of a non-drug addiction causing brain changes similar to substance abuse disorders.

Functional magnetic resonance imaging of brain of college students with Internet addiction (2011)

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2011 Aug;36(8):744-9. [Article in Chinese]

Objective:To explore the functional locations of brain regions related to Internet addiction (IA)with task-functional magnetic resonance imaging (fMRI).

Conclusions: Compared with the control group, the IA group showed increased activation in the right superior parietal lobule, right insular lobe, right precuneus, right cingulated gyrus, and right superior temporal gyrus. Abnormal brain function and lateral activation of the right brain may exist in Internet Addiction.

COMMENTS: Those with Internet Addiction had markedly different brain activation patterns than controls.

Increased regional homogeneity in Internet addiction disorder a resting state functional magnetic resonance imaging study (2009).

Chin Med J (Engl). 2010 Jul;123(14):1904-8.

Background: Internet addition disorder (IAD) is currently becoming a serious mental health problem among Chinese adolescents. The pathogenesis of IAD, however, remains unclear. The purpose of this study applied regional homogeneity (ReHo) method to analyze encephalic functional characteristic of IAD college students under resting state

Conclusions: There are abnormalities in regional homogeneity in IAD college students compared with the controls and enhancement of synchronization in most encephalic regions can be found. The results reflect the functional change of brain in IAD college students. The connections between the enhancement of synchronization among cerebellum, brainstem, limbic lobe, frontal lobe and apical lobe may be relative to reward pathways.

COMMENTS: Brain alteration found in Internet addicts that do not exist in controls. Synchronization of brain regions leading to reward activation.

Impulse inhibition in people with Internet addiction disorder: electrophysiological evidence from a Go/NoGo study. China. (2010)

Neurosci Lett. 2010 Nov 19;485(2):138-42. Epub 2010 Sep 15.

We investigated response inhibition in people with Internet addiction disorder (IAD) by recording event-related brain potentials during a Go/NoGo task. Results show that the IAD group exhibited lower NoGo-N2 amplitude, higher NoGo-P3 amplitude, and longer NoGo-P3 peak latency than the normal group. The results also suggest that the IAD students had lower activation in the conflict detection stage than the normal group; thus, they had to engage in more cognitive endeavors to complete the inhibition task in the late stage. In addition, the IAD students showed less efficiency in information processing and lower impulse control than their normal peers.

COMMENTS: Subjects with Internet addiction needed to "engage in more cognitive endeavors" to complete the inhibition task, and demonstrated lower impulse control - which can be related to hypofrontality.

Impaired inhibitory control in internet addiction disorder: A functional magnetic resonance imaging study.

Psychiatry Res. 2012 Aug 11.

'Internet addiction disorder' (IAD) is rapidly becoming a prevalent mental health concern in many countries around the world.  The present study examines the neural correlates of response inhibition in males with and without IAD using an event-related functional magnetic resonance imaging (fMRI) Stroop task. The IAD group demonstrated significantly greater 'Stroop effect'-related activity in the anterior and posterior cingulate cortices compared with their healthy peers. These results may suggest diminished efficiency of response-inhibition processes in the IAD group relative to healthy controls.

COMMENTS: Stroop effect is a measure of executive function (frontal cortex). Study found diminished frontal cortex functioning (hypofrontality)

FULL STUDY - P300 change and cognitive behavioral therapy in subjects with Internet addiction disorder: A 3 month follow-up study (2011)

CONCLUSION

The results of the current investigation of ERPs in individuals suffering from IAD were in accordance with the findings of previous studies of other addictions[17-20]. Specifically, we found reduced P300 amplitude and longer P300 latency in individuals exhibiting addictive behaviors compared with healthy controls. These results support the hypothesis that similar pathological mechanisms are involved in different addiction behaviors.

Comparison of Psychological Symptoms and Serum Levels of Neurotransmitters in Shanghai Adolescents with and without Internet Addiction Disorder: A Case-Control Study (2013)

PLoS ONE 8(5): e63089. doi:10.1371/journal.pone.0063089

Peripheral blood dopamine, serotonin and norepinephrine were assayed. The mean level of norepinephrine was lower in the IAD group than that in the typically developing participants, while dopamine and serotonin levels did not differ. The SDS, SAS and SCARED symptom scores were increased in the adolescents with IAD. A logistic regression analysis revealed that a higher SAS score and lower level of norepinephrine independently predicted IAD group membership. There was no significant correlation between hours spent online and scores of SAS/SDS in IAD group.

Effects of electroacupuncture combined psycho-intervention on cognitive function and event related potentials P300 and mismatch negativity in patients with internet addiction. (2012)

Chin J Integr Med. 2012 Feb;18(2):146-51. Epub 2012 Feb 5.

RESULTS: After treatment, in all groups, the IA score was lowered significantly (P <0.05) and scores of short-term memory capacity and short-term memory span increased significantly (P <0.05), while the decreased IA score in the CT group was more significant than that in the other two groups (P <0.05). ERP measurements showed that P300 latency was depressed and its amplitude raised in the EA group; MMN amplitude increased in the CT group (all P<0.05).

CONCLUSION:The EA in combination with PI could improve the cognitive function of IA patients, and its mechanism might be related to the speedup of cerebral discrimination on external stimulus and the enhancement of effective resource mobilization during information processing of the brain.

COMMENTS: Study compared 3 treatment protocols for Internet addiction. Interesting findings: 1) after 40 days of treatment all groups significantly improved in cognitive function; 2) Internet addiction scores were significantly lowered. If pre-existing condition were the cause, changes would not have occurred with treatment.

Abnormal brain activation of adolescent internet addict in a ball-throwing animation task: Possible neural correlates of disembodiment revealed by fMRI (2012) South Korea

Prog Neuropsychopharmacol Biol Psychiatry. 2012 Jun 9.

While adolescent internet addicts are immersed in cyberspace, they are easily able to experience 'disembodied state'. The purposes of this study were to investigate the difference of brain activity between adolescent internet addicts and normal adolescents in a state of disembodiment, and to find the correlation between the activities of disembodiment-related areas and the behavioral characteristics related to internet addiction.

The fMRI images were taken while the addiction group (N=17) and the control group (N=17) were asked to perform the task composed with ball-throwing animations. These results show that the disembodiment-related activation of the brain is easily manifested in adolescent internet addicts. Internet addiction of adolescents could be significantly unfavorable for their brain development related with identity formation.

Differentiation of Internet addiction risk level based on autonomic nervous responses: the Internet-addiction hypothesis of autonomic activity (2010)

Cyberpsychol Behav Soc Netw. 2010 Aug;13(4):371-8.

How high-risk Internet addiction (IA) abusers respond to different autonomic nervous activities compared with low-risk subjects may be a critical research goal with prevention and treatment implications. The aim of the present study was to address this issue by observing differences between high- and low-risk IA abusers in four physiological assessments when surfing the Internet: blood volume pulse (BVP), skin conductance (SC), peripheral temperature (PTEMP), and respiratory response (RESPR). Forty-two male and ten female participants aged 18-24 years were screened with the Chen Internet Addiction Scale (CIAS, 2003), and then separated into high- and low-risk IA groups.

Thus we suggest that four autonomic responses may be differentially sensitive to abusers' potency in terms of the IA hypothesis of autonomic activity. The stronger BVP and RESPR responses and the weaker PTEMP reactions of the high-risk IA abusers indicate the sympathetic nervous system was heavily activated in these individuals. However, SC activates parasympathetic responses at the same time in the high-risk IA abusers.

COMMENTS: Those classified as having an Internet addiction had much stronger sympathetic nervous system activation when surfing the Internet.

Impaired Error-Monitoring Function in People with Internet Addiction Disorder: An Event-Related fMRI Study

Eur Addict Res. 2013 Mar 23;19(5):269-275.

This study was set to investigate the error-monitoring ability in IAD subjects. Participants were asked to perform a fast Stroop task that may show error responses. Behavioral and neurobiological results in relation to error responses were compared between IAD subjects and HC.

Results: Compared to HC, IAD subjects showed increased activation in the anterior cingulate cortex (ACC) and decreased activation in the orbitofrontal cortex following error responses. Significant correlation was found between ACC activation and the Internet addiction test scores.

Conclusions: IAD subjects show an impaired error-monitoring ability compared to HC, which can be detected by the hyperactivation in ACC in error responses.

COMMENTS: Indicates hypofrontality

Influence of excessive internet use on auditory event-related potential (2008)

Sheng Wu Yi Xue Gong Cheng Xue Za Zhi. 2008 Dec;25(6):1289-93.

At present, young people's internet addiction has become a serious social problem and on important concern in China. Comparison studies of auditory event-related potential (ERP) between 9 excessive internet users and 9 common internet users were carried out. The obvious influences of excessive internet use on the users were observed. The result suggests that excessive internet use may have some influences on cerebral cognitive function.

Decision-making and prepotent response inhibition functions in excessive internet users.

CNS Spectr. 2009 Feb;14(2):75-81.

Excessive Internet use (EIU), also described as Internet addiction or pathological Internet use, has already become a serious social problem around the world. Some researchers consider EIU as a kind of behavioral addiction. However, there are few experimental studies on the cognitive functions of excessive Internet users (EIUers) and limited data are available to compare EIU with other addictive behaviors, such as drug abuse and pathological gambling.

These results showed some similarities and dissimilarities between EIU and other addictive behaviors such as drug abuse and pathological gambling. The findings from the Gambling Task indicated that EIUers have deficits in decision-making function, which are characterized by a strategy learning lag rather than an inability to learn from task contingencies.EIUers' better performance in the Go/no-go Task suggested some dissociation between mechanisms of decision-making and those of prepotent response inhibition.

However, EIUers could hardly suppress their excessive online behaviors in real life. Their ability of inhibition still needs to be further studied with more specific assessments.

COMMENTS: Using cognitive tests, researchers found similarities between Internet addicts and gambling addicts.

Cybersex addiction: Experienced sexual arousal when watching pornography and not real-life sexual contacts makes the difference (2013)

Journal of Behavioral Addictions.

The results show that indicators of sexual arousal and craving to Internet pornographic cues predicted tendencies towards cybersex in the first study. Moreover, it was shown that problematic cybersex users report greater sexual arousal and craving reactions resulting from pornographic cue presentation. In both studies, the number and the quality with real-life sexual contacts were not associated to cybersex addiction.

The results support the gratification hypothesis, which assumes reinforcement, learning mechanisms, and craving to be relevant processes in the development and maintenance of cybersex addiction. Poor or unsatisfying sexual reallife contacts cannot sufficiently explain cybersex addiction.

COMMENTS: Wow - an actual study about Internet porn addiction. Study found cue-induced cravings, similar to drug addicts, predicted porn addiction. Contrary to popular belief, unsatisfying sexual life had no correlation to porn addiction. Supporting the gratification hypothesis means addiction-like behaviors in response to ones chosen addiction.

The effect of psychiatric symptoms on the internet addiction disorder in Isfahan’s University students (2011) 

Res Med Sci. 2011 Jun;16(6):793-800.

Internet addiction is a problem of modern societies and many studies have considered this issue. The prevalent use of Internet is increasing markedly during these years. Internet addiction disorder is an interdisciplinary phenomenon and various sciences such as medicine, computer, sociology, law, ethics and psychology have surveyed it from different viewpoints.

Two hundred and fifty students participated in this cross-sectional study. Their age ranged from 19 to 30 years with average of of 22.5 ± 2.6 years.

IAT is a 20-item self-report with a 5-point scale, based on the DSM-IV diagnostic criteria for compulsive gambling and alcoholism. It includes questions that reflect typical behaviors of addiction.

The growing number of researches on Internet addiction indicates that Internet addiction is a psychosocial disorder and its characteristics are as follows: tolerance, withdrawal symptoms, affective disorders, and problems in social relations. Internet usage creates psychological, social, school and/or work difficulties in a person's life.

Eighteen percent of a study participants were considered to be pathological Internet users, whose excessive use of the Internet was causing academic, social, and interpersonal problems. Excessive Internet use may create a heightened level of psychological arousal, resulting in little sleep, failure to eat for long periods, and limited physical activity, possibly leading to the user experiencing physical and mental health problems such as depression, OCD, low family relationships and anxiety.

We found that Internet addicts had various co-morbid psychiatric disorders. It means that Internet addiction brings with it various dimensions of psychiatric symptoms, which suggests that the addiction could have a negative effect on the mental health status of youth. These findings are consistent with other studies and support previous findings.

Since it has yet to be established whether psychiatric symptoms are the cause or the outcome of Internet addiction, researchers need to conduct longitudinal research on the Internet and its users.

COMMENTS: Study found that 23% of male college students had developed Internet addiction. Researchers state that excessive use of the Internet can lead to "heightened level of psychological arousal, resulting in little sleep, failure to eat for long periods, and limited physical activity, possibly leading to the user experiencing physical and mental health problems such as depression, OCD, low family relationships and anxiety."

Precursor or Sequela: Pathological Disorders in People with Internet Addiction Disorder (2011)

 PLoS ONE 6(2): e14703. doi:10.1371/journal.pone.0014703

This study aimed to evaluate the roles of pathological disorders in Internet addiction disorder and identify the pathological problems in IAD, as well as explore the mental status of Internet addicts prior to addiction, including the pathological traits that may trigger Internet addiction disorder.

59 students were measured by Symptom CheckList-90 before and after they became addicted to the Internet. A comparison of collected data from Symptom Checklist-90 before Internet addiction and the data collected after Internet addiction illustrated the roles of pathological disorders among people with Internet addiction disorder. The obsessive-compulsive dimension was found abnormal before they became addicted to the Internet. After their addiction, significantly higher scores were observed for dimensions on depression, anxiety, hostility, interpersonal sensitivity, and psychoticism, suggesting that these were outcomes of Internet addiction disorder. Dimensions on somatisation, paranoid ideation, and phobic anxiety did not change during the study period, signifying that these dimensions are not related to Internet addiction disorder.

Conclusions: We can not find a solid pathological predictor for Internet addiction disorder. Internet addiction disorder may bring some pathological problems to the addicts in some ways.

COMMENTS: A unique study. It follows first year university students to ascertain what percentage develop Internet addiction, and what risk factors may be in play. The unique aspect is that the research subjects had not used the Internet prior to enrolling in college. Hard to believe. After only one year of school, a small percentage were classified as Internet addicts. Those who developed Internet addiction where higher on the obsessive scale, they were lower on scores for anxiety depression, and hostility.

The key point is Internet addiction caused behavioral changes. From the study:

  • After their addiction, significantly higher scores were observed for dimensions on depression, anxiety, hostility, interpersonal sensitivity, and psychoticism, suggesting that these were outcomes of Internet addiction disorder.
  • We can not find a solid pathological predictor for Internet addiction disorder. Internet addiction disorder may bring some pathological problems to the addicts in some ways.

The screens culture: impact on ADHD (2011)

Atten Defic Hyperact Disord. 2011 Dec;3(4):327-34.

Children's use of electronic media, including Internet and video gaming, has increased dramatically to an average in the general population of roughly 3 h per day. Some children cannot control their Internet use leading to increasing research on "internet addiction." The objective of this article is to review the research on ADHD as a risk factor for Internet addiction and gaming, its complications, and what research and methodological questions remain to be addressed. 

Previous research has demonstrated rates of Internet addiction as high as 25% in the population and that it is addiction more than time of use that is best correlated with psychopathology. Various studies confirm that psychiatric disorders, and ADHD in particular, are associated with overuse, with severity of ADHD specifically correlated with the amount of use. The time spent on these games may also exacerbate ADHD symptoms, if not directly then through the loss of time spent on more developmentally challenging tasks.

Comments: ADHD is associated with overuse, and may exacerbate symptoms

Attention deficit hyperactivity symptoms and internet addiction.

Psychiatry Clin Neurosci. 2004 Oct;58(5):487-94.

The objective of this study was to evaluate the relationship between attention deficit-hyperactivity/impulsivity symptoms and Internetaddiction. The ADHD group had higher Internet addiction scores compared with the non-ADHD group. Therefore, significant associations have been found between the level of ADHD symptoms and the severity of Internet addiction in children. In addition, current findings suggest that the presence of ADHD symptoms, both in inattention and hyperactivity-impulsivity domains, may be one of the important risk factors for Internet addiction.

Comments: Internet addiction is strongly associated with ADHD

Differential psychological impact of internet exposure on internet addicts (2013)

PLoS One. 2013;8(2):e55162. doi: 10.1371/journal.pone.0055162.

The study explored the immediate impact of internet exposure on the mood and psychological states of internet addicts and low internet-users. Participants were given a battery of psychological tests to explore levels of internet addiction, mood, anxiety, depression, schizotypy, and autism traits. They were then given exposure to the internet for 15 min, and re-tested for mood and current anxiety. Internet addiction was associated with long-standing depression, impulsive nonconformity, and autism traits. High internet-users also showed a pronounced decrease in mood following internet use compared to the low internet-users. The immediate negative impact of exposure to the internet on the mood of internet addicts may contribute to increased usage by those individuals attempting to reduce their low mood by re-engaging rapidly in internet use.

Similarly, exposure to the object of the problematic behaviours has been found to reduce mood [26], especially in individuals addicted to pornography [5], [27]. As both of these reasons (i.e. gambling and pornography) for use of the internet are strongly associated with problematic internet use [2], [3], [14], it may well be that these factors may also contribute to internet addiction [14]. Indeed, it has been suggested that such negative impacts of engagement in problematic behaviour may, in themselves, generate further engagement in these high probability problematic behaviours in an attempt to escape these negative feelings [28].

The results showed a striking negative impact of internet exposure on the positive mood of ‘internet addicts’. This effect has been suggested in theoretical models of ‘internet addiction [14], [21], and a similar finding has also been noted in terms of the negative effect of exposure to pornography on internet sex addicts [5], which may suggest commonalities between these addictions. It is also worth suggesting that this negative impact on mood could be considered as akin to a withdrawal effect, suggested as needed for the classification of addictions

COMMENTS: Researchers found a significant drop in mood after use which paralells addiction withdrawal.

Concurrent and predictive relationships between compulsive internet use and substance: use findings from vocational high school students in china and the USA (2012)

Int J Environ Res Public Health. 2012 Mar;9(3):660-73. Epub 2012 Feb 23.

PURPOSE: Compulsive Internet Use (CIU) has increasingly become an area of research among process addictions.

METHODS: . Path analyses were applied to detect the concurrent and predictive relationships between baseline and one-year follow-up measures of CIU level, 30-day cigarette smoking, and 30-day binge drinking.

RESULTS:

(1) CIU was not positively related with substance use at baseline.

(2) There was a positive predictive relationship between baseline CIU and change in substance use among female, but not male students.

(3) Relationships between concurrent changes in CIU and substance use were also found among female, but not male students.

(4) Baseline substance use did not predict an increase in CIU from baseline to 1-year follow-up.

CONCLUSIONS: While CIU was found to be related to substance use, the relationship was not consistently positive.

COMMENTS: This study found no correlation between compulsive Internet use and substance use. This does not align with often stated theory that Internet addiction must be due to pre-existing conditions or only occurring in those with "addict brains".

Internet Addiction (2012) [Article in Finnish]

Duodecim. 2012;128(7):741-8.

Internet addiction is defined as uncontrolled and harmful use of Internet, which manifests in three forms: gaming, various sexual activities and excessive use of emails, chats or SMS messaging. Several studies have found that abuse of alcohol and other substances, depression and other health problems are associated with Internet addiction. In boys and men depression may be more a consequence of the addiction than a cause for it. ADHD seems to be a significant background factor for developing the condition.

COMMENTS: First, they conclude that Internet addiction manifests is 3 forms, one of which is sexual activities. Second, they found depression to be caused by Internet addiction, rather than it being the result of Internet addiction. As for ADHD, we have seen a it decline or remit in many guys who recovered from porn addiction.

Impact of addiction to Internet on a number of psychiatric symptoms in students of Isfahan universities, Iran, 2010. (2012)

Int J Prev Med. 2012 Feb;3(2):122-7.

Alavi SS, Alaghemandan H, Maracy MR, Jannatifard F, Eslami M, Ferdosi M.

This study aimed to investigate the impact of Internet addiction on some psychiatric symptoms among university students. This cross-sectional study was conducted among 250 students selected via quota sampling from universities in Isfahan, Iran.

CONCLUSION: Psychiatrists and psychologists involved in the field of mental health need to be well informed about mental problems due to internet addiction, such as anxiety, depression, aggression, and job and educational dissatisfaction.

COMMENTS: From the study: "problems due to Internet addiction, such as anxiety, depression, aggression, and job and educational dissatisfaction." Correlation does not equal causation, but we see symptoms such as depression and anxiety remit through recovery from porn addiction

Impulsivity in Internet Addiction: A Comparison with Pathological Gambling (2012)

Cyberpsychol Behav Soc Netw. 2012 Jun 4.

Internet addiction has been considered to be associated with poor impulse control. The aim of this study is to compare the trait impulsivity of those suffering from Internet addiction with that of individuals suffering from pathological gambling. Our results show that those suffering from Internet addiction showed increased levels of trait impulsivity which were comparable to those of patients diagnosed with pathological gambling. Additionally, the severity of Internet addiction was positively correlated with the level of trait impulsivity in patients with Internet addiction. These results state that Internet addiction can be conceptualized as an impulse control disorder and that trait impulsivity is a marker for vulnerability to Internet addiction.

COMMENTS: In the new DSM5 pathological gambling will be categorized as an addiction. This study concludes that impulsivity of Internet addicts compares with those that have developed an "official addiction".

Commonalities in the psychological factors associated with problem gambling and Internet dependence.

Cyberpsychol Behav Soc Netw. 2010 Aug;13(4):437-41.

The most commonly applied conceptual approach for excessive Internet use has been as a behavioral addiction, similar to pathological or problem gambling. In order to contribute to the understanding of Internet dependence as a disorder resembling problem gambling, the current study aimed to examine the relationship between problem gambling and Internet dependence and the degree to which psychological factors associated with problem gambling are relevant to the study of Internet dependence.

The findings revealed that there is no overlap between the populations reporting problem gambling and Internet dependence, but that individuals with these disorders report similar psychological profiles.

Although requiring replication with larger community samples and longitudinal designs, these preliminary findings suggest that problem gambling and Internet dependence may be separate disorders with common underlying etiologies or consequences.

COMMENTS: Study found "that problem gambling and Internet dependence may be separate disorders with common underlying etiologies or consequences."

 Relationship between facebook use and problematic internet use among college students (2012)

Cyberpsychol Behav Soc Netw. 2012 Jun;15(6):324-7.

The popularity of Facebook and other online social-networking sites has led to research on the potential risks of use, including Internet addiction. Previous studies have reported that between 8 percent and 50 percent of college students report problems consistent with Internet addiction.  Undergraduate participants (N=281, 72 percent women) completed a battery of self-report measures, including the Internet Addiction Test. The results of the current study suggest that a sizable minority of students experience problems related to Internet use and that the use of Facebook may contribute to the severity of symptoms associated with Internet addiction

COMMENTS: Quite a claim that - "Previous studies have reported that between 8 percent and 50 percent of college students report problems consistent with Internet addiction" When it comes to Internet addiction is it facebook for women, gaming for guys, and porn for both?

Internet addiction in a group of medical students: a cross sectional study (2012)

Nepal Med Coll J. 2012 Mar;14(1):46-8.

The use of Internet for education, recreation and communication is increasing day by day. Nevertheless, the possibility of exploitation and addiction leading to impairment in academic performance and emotional balance cannot be denied, especially among young population.

The study was aimed to measure the degree of Internet addiction among a group of medical students. Internet addiction test questionnaire developed by Young was used to assess mild, moderate and severe addiction. Amongst the study population (n=130, age 19-23 years), 40% had mild addiction. Moderate and severe addiction was found in 41.53% and 3.07% of the participants respectively.

The study revealed that 24% often and 19.2% always found themselves using Internet longer than they had planned or thought.

Late night Internet surfing leading to sleep deprivation was found in 31.53% of the participants.

Almost one fourth of them (25.38%) occasionally tried to cut down the time they spent on the Internet but failed and 31.53% sometimes experienced restlessness when deprived of Internet access.

COMMENTS: Problematic Internet use was widpsread among medical students in Nepal

Effects of a manualized short-term treatment of Internet and computer game addiction (STICA): study protocol for a randomized controlled trial. (2012)

Trials. 2012 Apr 27;13(1):43.

In the last few years, excessive Internet use and computer gaming have increased dramatically. Salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse have been defined as diagnostic criteria for Internet addiction (IA) and computer addiction (CA) in the scientific community. Despite a growing number of individuals seeking help, there are no specific treatments of established efficacy.

According to Block [6], three subtypes of IA/computer game addiction (CA) (excessive gaming, sexual preoccupations, and email/text messaging) have four components in common: (a) excessive use (along with a loss of sense of time or the ignorance of basic drives); (b) withdrawal (for example tension, anger, agitation, and/or depression when access to a computer is blocked; (c) tolerance (increasing use or sophistication of computer equipment); and (d) negative repercussions (for example poor achievement/performance, fatigue, social isolation, or conflicts). Salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse are additional diagnostic criteria for IA and CA [7]. The addicted individual is increasingly attracted towards the excessive behavior and life is emotionally and cognitively preoccupied with the application (for example computer game), requiring more and more time in order to regulate his mood states. Empirical studies [4,8,9] have demonstrated that the symptom complex of IA/CA [10,11] matches the criteria of substance disorders. Results of neurobiological studies have identified neurophysiological mechanisms in IA/CA equivalent to substance abuse (alcohol [12] and cannabis addiction [13]).

Patients with CA and IA have increasingly sought help in addiction counseling [14], because of serious negative psychosocial consequences (social, work/education, health) which have been documented along with high mental co-morbidities [15-19].

COMMENTS: This study describes 3 categories of Internet addiction: excessive gaming, sexual preoccupations, and email/text messaging.

Evolution of Internet addiction in Greek adolescent students over a two-year period: the impact of parental bonding (2012)

Eur Child Adolesc Psychiatry. 2012 Feb 4.

We present results from a cross-sectional study of the entire adolescent student population aged 12-18 of the island of Kos and their parents, on Internet abuse, parental bonding and parental online security practices.  Our results indicate that Internet addiction is increased in this population where no preventive attempts were made to combat the phenomenon from the initial survey, 2 years ago. This increase is parallel to an increase in Internet availability. Parents tend to underestimate the level of computer involvement when compared to their own children estimates. Parental safety measures on Internet browsing have only a small preventive role and cannot protect adolescents from Internet addiction. The three online activities most associated with Internet addiction were watching online pornography, online gambling and online gaming.

COMMENTS: Says that Internet addiction is growing and correlated to increased availability. The three online activities most associated with Internet addiction were watching online pornography, online gambling and online gaming.

Confirmation of the Three Factor Model of Problematic Internet Use on Off Line Adolescent and Adult Samples. (2011)

Cyberpsychol Behav Soc Netw. 2011 Jun 28. Budapest, Hungary .

Data were collected from 438 high-school students (44.5 percent boys; mean age: 16.0 years; and also from 963 adults (49.9 percent males; mean age: 33.6 years; standard deviation=11.8 years). The results of the analyses carried out inevitably support the original three-factor model over the possible one-factor solution.

Using latent profile analysis, we identified 11 percent of adults and 18 percent of adolescent users characterized by problematic use.

COMMENTS: Study found problematic Internet use in 18% of adolescents - in a sample that was more than half girls! What would it have been had the sample been all male? 

The characteristics of decision making, potential to take risks, and personality of college students with Internet addiction (2010)

Psychiatry Res. 2010 Jan 30;175(1-2):121-5. doi: 10.1016/j.psychres.2008.10.004.
 
This study aimed to identify risk factors involved in Internet addiction.

The results revealed the following:

(a) 49% of males and 17% of females were addicted,

(b) the addicted students tended to select more advantageous cards in the last 40 cards of the Iowa test, indicating better decision making,

(c) no difference was found for the BART, indicating that addicted subjects were not more likely to engage in risk-taking behaviors and

(d) TPQ scores showed lower reward dependence (RD) and higher novelty seeking (NS) for the addicts.

Their higher performance on the Iowa gambling test differentiates the Internet addiction group from the substance use and pathologic gambling groups that have been shown to be deficient in decision making on the Iowa test.

Risk factors and psychosocial characteristics of potential problematic and problematic Internet use among adolescents: A cross-sectional study. (2011) Greece.

BMC Public Health. 2011; 11: 595.

The source population for the present study consisted of a random cluster sample of 20 public junior high and high schools, stratified according to their locality and surrounding population density, in Athens, Greece. All students enrolled in Grades 9 and 10 of the selected schools were invited to participate in the study (n = 937). No exclusion criteria, including demographic and/or socioeconomic characteristics, for study participation were applied. The source population of the study consisted of 438 (46.7%) boys and 499 (53.3%) girls (overall mean age: 14.7 years).

Among the study population, the prevalence rates of potential PIU and PIU were 19.4% and 1.5%, respectively

Overall maladaptive Internet use (MIU) Among the study population (n = 866), the prevalence rate of maladaptive Internet use (MIU) was 20.9% (n = 181).

Previous reports indicate that more than one quarter of frequent Internet users utilize the Internet for accessing sexual information and education. Both frequent Internet use and accessing the Internet for the purposes of sexual education have been found to be significant predictors of pornographic Internet site use. Hence, it is proposed that PIU may develop and/or manifest secondary to the specific content of Internet sites accessed, rather than to the Internet per se.

COMMENTS: Researchers found maladaptive Internet use use in 21% of 9th & 10th graders. What would the percentage have been if it was 100% male students?

Internet Addiction and Antisocial Internet Behavior of Adolescents

ScientificWorldJournal. 2011; 11: 2187–2196. 2011 November 3

In fact, there is no definition of Internet addiction that is universally accepted by psychologists and scholars in this field. While the investigation of the concept of Internet addiction is still a main agenda of many researchers the problems of excessive use of Internet, especially in school students, become more and more prevalent and disturbing

Young classifies Internet addiction into five different types of behaviors. (1) Cybersexual addiction: the addicts spent a lot of time in adult websites for cybersex and cyberporn. (2) Cyber-relationship addiction: the addicts involved heavily in online relationships. (3) Net compulsions: the addicts exhibited obsessive online gambling and shopping. They are compulsive online gamblers and shopaholics. (4) Information overload: the addicts displayed compulsive web surfing and database searches. (5) Computer game addiction: the addicts were obsessive online game players.

COMMENTS: This study acknowledges that Internet pornography (cybersexual) is one of five categories of Internet addiction. It also states the problem is growing.

The comorbid psychiatric symptoms of Internet addiction: attention deficit and hyperactivity disorder (ADHD), depression, social phobia, and hostility.

J Adolesc Health. 2007 Jul;41(1):93-8. Epub 2007 Apr 12.

To: (1) determine the association between Internet addiction and depression, self-reported symptoms of attention deficit and hyperactivity disorder (ADHD), social phobia, and hostility for adolescents; and (2) evaluate the sex differences of association between Internet addictionand the above-mentioned psychiatric symptoms among adolescents.            The results demonstrated that adolescents with Internet addiction had higher ADHD symptoms, depression, social phobia, and hostility. Higher ADHD symptoms, depression, and hostility are associated with Internet addiction in male adolescents, and only higher ADHD symptoms and depression are associated with Internet addiction in female students. These results suggest that Internet addiction is associated with symptoms of ADHD and depressive disorders. However, hostility was associated with Internet addiction only in males. 

Comments: Internet addiction associated with ADHD, depression, social phobia, and hostility.

Prevalence and Factors of Addictive Internet Use among Adolescents in Wuhan, China: Interactions of Parental Relationship with Age and Hyperactivity-Impulsivity (2013)

PLoS One. 2013 Apr 15;8(4):e61782.

This study examined the prevalence of addictive Internet use and analyzed the role of parental relationship in affecting this behavior among a random sample of adolescents in Wuhan, China.

The prevalence rate of Internet addiction was 13.5% (16.5% for boys and 9.5% for girls. Compared to non-addictive users, addictive Internet users were scored significantly lower on parental relationships and significantly higher on hyperactivity-impulsivity. Interaction analysis indicated that better parental relationship was associated with more reductions in risk of addictive Internet use for younger students than for older students, and with more risk of Internet addiction among higher than among lower hyperactivity-impulsivity students.

Prevalence and Psychosocial Risk Factors Associated with Internet Addiction in a Nationally Representative Sample of College Students in Taiwan. (2011)

Cyberpsychol Behav Soc Netw. 2011 Jun 8.

Lin MP, Ko HC, Wu JY

Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University , Tainan, Taiwan .

The aim of this study was to examine the prevalence of Internet addiction in a nationally representative sample of college students and to identify any associated psychosocial risk factors. The prevalence of Internet addiction was found to be 15.3 percent. The prevalence of Internet addiction among college students in Taiwan was high, and the variables mentioned were independently predictive.

COMMENTS: 15.3 with Internet addiction. What if the sample had been all male?

Psychosocial Profile of Iranian Adolescents' Internet Addiction (2013)

Cyberpsychol Behav Soc Netw. 2013 Apr 24.

Abstract In the present study, factors that could play an important role in Internet addiction (IA) in 4,177 Iranian high school and secondary school adolescents (age range: 14-19 years) were examined. Among the study participants, 21.1% of the students were in some way victims of IA, among whom 1.1% had significant problematic symptoms. Familial relationships was the most important factor related to IA; religious beliefs, moreover, was the second most important factor.

Internet Addiction Among Students of the Medical University of Białystok. (2011).

Comput Inform Nurs. 2011 Jun 21.

Internet addiction was confirmed among 24 (10.3%) nursing, 7 (9.9%) midwifery, and 5(9.1%) medical rescue students. The abstinence syndrome was noted among 11 (4.7%) nursing, 7(9.9%) obstetrics, and 7 (12.7%) medical rescue students. Several students had both an Internet addiction and the abstinence syndrome.

COMMENTS: Approximately 10% of students enrolled in a medical university were identified as Internet Addicts. Equal numbers developed withdrawal symptoms (abstinence syndrome) when they stopped using the Internet.

Internet addiction: development and validation of an instrument in adolescent scholars in Lima Perú. (2011)

 Rev Peru Med Exp Salud Publica. 2011 Sep;28(3):462-9.

The mean age was 14 years old. The bi-dimensional data analysis revealed a significant association (p<0,001) between Dimension I (symptoms of IA) and the weekly time spent on the Internet, male sex, past history of bad behavior in school and plans for the future.

Conclusions. The SIAL showed a good internal consistency, with moderate and significant inter-item correlations. The findings show that addiction has a dynamic role, which evidences a problem generated in family patterns and inadequate social networks.

COMMENTS: Another country studying Internet addiction.

The Relationship between Recent Stressful Life Events, Personality Traits, Perceived Family Functioning and Internet Addiction among College Students. (2013)

Stress Health. 2013 Apr 25. doi: 10.1002/smi.2490.

The results indicated that compared with non-addicted subjects, subjects with severe IA (9.98%) had lower family functioning, lower extraversion, higher neuroticism and psychoticism, and more stressful life events, and subjects with mild IA (11.21%) had higher neuroticism and more health and adaptation problems.

Internet addiction: hours spent online, behaviors and psychological symptoms. (2011)

Gen Hosp Psychiatry. 2011 Oct 28. Rome, Italy.

The aim of this study was to investigate psychopathological symptoms, behaviors and hours spent online in patients with Internet addiction disorder (IAD) at a new psychiatric service for IAD inside a policlinic

IAD patients showed significantly higher scores on the IAT compared to subjects of the control group.

Findings suggest that a misuse of Internet, characterized by many hours spent online avoiding interpersonal relationships with real and known people, could be an important criterion in the clinical interview in order to diagnose the IAD. The association between the lost interest in communicating with real people and psychological symptoms such as anxiety and depression could be relevant to detect IAD patients.

Internet addiction and web mediated psychopathology (2011). Italian.

Recenti Prog Med. 2011 Nov;102(11):417-20. doi: 10.1701/975.10605.

In this context, emerged disorders related to a pathological use of the network, up to forms of real addiction (Internet Addiction Disorder), similar to the use of psychotropic substances. The abuse of the Internet can seriously aggravate pre-existing psychopathological traits, which are the basis of addiction, resulting in a continuous process of disconnection from reality. The loss of interpersonal relationships, the change of mood, cognition completely oriented to the use of the network and disruption of temporal experience are common features in patients addicted to the Internet. There are also clear signs of intoxication and abstinence. Teenagers are particularly at risk, maybe because born in the "new virtual world" and therefore less aware of the risks that may ensue.

COMMENTS:  The translation is rough, but "intoxication" and "abstinence" refer to addictive behaviors and withdrawal symptoms.

Recognizing internet addiction: Prevalence and relationship to academic achievement in adolescents enrolled in urban and rural Greek high schools (2013)

J Adolesc. 2013 Apr 19. pii: S0140-1971(13)00045-6. doi: 10.1016/j.adolescence.2013.03.008.

This study aims: a) to estimate the prevalence of internet addiction among adolescents of urban and rural areas in Greece, b) to examine whether the Internet Addiction Test cut-off point is applicable to them and c) to investigate the phenomenon's association with academic achievement. Participants were 2090 adolescents (mean age 16, 1036 males, 1050 females). Young's (1998) Internet Addiction Test and her Diagnostic Questionnaire were applied. School records' grades were retrieved. A 3.1% prevalence revealed, while boys , urban residents and academic track high school students  were at higher risk. Finally, findings illustrated the syndrome's relation to worse academic achievement.

Problematic Internet use in Chinese adolescents and its relation to psychosomatic symptoms and life satisfaction. (2011).

 BMC Public Health. 2011 Oct 14;11(1):802.

Problematic Internet use (PIU) is a growing problem in Chinese adolescents. Little is known about associations of PIU with physical and psychological health.

Approximately 8.1% of subjects showed PIU. Adolescents with PIU were associated with males, high school students, urban, eastern and western areas, upper self-report family economy, service type mostly used for entertainment and relieving loneliness and more frequency of Internet use.

Conclusions. PIU is common among Chinese students, and PIU was significantly associated with psychosomatic symptoms and life satisfaction.

 COMMENTS: Study found 8% addiction rate for adolescents.

Internet use and pathological Internet engagement in a sample of college students. (2011) Greece.

Psychiatrike. 2011 Jul-Sep;22(3):221-30.

Recent studies indicate multiple consequences of pathologically excessive Internet use. This study investigated the correlate of Internet usage, with pathological Internet engagement. Participants were 514 college students from the University of Athens who completed a questionnaire covering various aspects of Internet use, Young's Internet Addiction Test, scales investigating online gambling addiction and cybersexual addiction and scales investigating suicidal ideation and the use of psychoactive substances. Subjects at risk for developing pathological Internet engagement had significantly higher levels of online gambling addiction, cybersexual addiction, suicidal ideation and alcohol abuse, compared with other groups.

COMMENTS: Specifically states that cybersexual addiction exists.

Problematic Internet Use among Greek university students: an ordinal logistic regression with risk factors of negative psychological beliefs, pornographic sites, and online games (2011)

Cyberpsychol Behav Soc Netw. 2011 Jan-Feb;14(1-2):51-8. Epub 2010 May 26.

The aim of this paper is to investigate the relationships between Problematic Internet Use (PIU) among university students in Greece. Data were gathered from 2,358 university students from across Greece. The prevalence of PIU was 34.7% in our sample. On average, problematic Internet users use MSN, forums, YouTube, pornographic sites, chat rooms, advertisement sites, Google, Yahoo!, their e-mail, ftp, games, and blogs more than non-problematic Internet users. Significant risk factors for PIU were being male, enrolment in unemployment programs, presence of negative beliefs, visiting pornographic sites, and playing online games. Thus PIU is prevalent among Greek university students and attention should be given to it by health officials.

COMMENTS: The prevalence of problematic Internet use was 35% among university students in Greece.

Adolescents Over-Use of The Cyber World: Internet Addiction or Identity Exploration? (2011) Israel.

J Adolesc. 2011 Jul 29.

Participants in the study were 278 adolescents (48.5% girls; 7th-9th graders) who completed questionnaires relating to their levels of Internet use, Internet addiction, ego development, self consciousness, self-concept clarity, and personal demographic data.

The study results support the general notion that adolescents' level of self-clarity is negatively related to Internet addiction and over-use. Hence, it is suggested that future studies on adolescents' Internet over-use should use qualitative rather than quantitative conceptualization and measurements in order to properly explore such a behavior and its, either positive or negative, implications.

COMMENTS: Study acknowledges that Internet addiction exists and negatively correlates it to "self-clarity". Suggests future studies examine type of Internet use, rather than amount.

Preliminary study of Internet addiction and cognitive function in adolescents based on IQ tests (2011)

Psychiatry Res. 2011 Dec 30;190(2-3):275-81. Epub 2011 Sep 6.

The Internet-addicted group had comprehension sub-item scores that were significantly lower than those of the non-addicted group. As the comprehension item reflects ethical judgement and reality testing, there may be a relationship between Internet addiction and weak social intelligence. Earlier onset of Internet addiction and longer addiction duration were associated with lower participant performance in areas related to attention. As this study is a cross-sectional study, it is not clear whether the persons who display weak cognitive functioning are susceptible to Internet addiction or if Internet addiction causes cognitive problems. However, as brain development remains active during adolescence, the possibility that Internet addiction adversely affects the cognitive functioning of adolescents cannot be ruled out.

COMMENTS: Weak cognitive function was correlated to Internet addiction

Predictive Values of Psychiatric Symptoms for Internet Addiction in Adolescents: A 2-Year Prospective Study. Taiwan (2009)

Arch Pediatr Adolesc Med. 2009;163(10):937-943.

Objectives: To evaluate the predictive values of psychiatric symptoms for the occurrence of Internet addiction and to determine the sex differences in the predictive value of psychiatric symptoms for the occurrence of Internet addiction in adolescents.

Design: Internet addiction, depression, attention-deficit/hyperactivity disorder, social phobia, and hostility were assessed by self-reported questionnaires. Participants were then invited to be assessed for Internet addiction 6, 12, and 24 months later (the second, third, and fourth assessments, respectively).

Results: Depression, attention-deficit/hyperactivity disorder, social phobia, and hostility were found to predict the occurrence of Internet addiction in the 2-year follow-up, and hostility and attention-deficit/hyperactivity disorder were the most significant predictors of Internet addiction in male and female adolescents, respectively.

COMMENTS: This study found correlation between depression, ADHD, social phobia, and Internet Addiction.

The association between Internet addiction and psychiatric disorder: A review of the literature. Taiwan (2011)

Eur Psychiatry. 2011 Dec 6.

Internet addiction is a newly emergent disorder. It has been found to be associated with a variety of psychiatric disorders. In this review, we have recruited articles mentioning coexisting psychiatric disorders of Internet addiction from the PubMed database as at November 3, 2009. We describe the updated results for such disorders of Internet addiction, which include substance use disorder, attention-deficit hyperactivity disorder, depression, hostility, and social anxiety disorder. On the other hand, Internet addiction should be paid more attention to when treating people with these coexisting psychiatric disorders of Internet addiction. Additionally, we also suggest future necessary research directions that could provide further important information for the understanding of this issue.

The screens culture: impact on ADHD. Canada (2011)

Atten Defic Hyperact Disord. 2011 Dec;3(4):327-34. Epub 2011 Sep 24.

Children's use of electronic media, including Internet and video gaming, has increased dramatically to an average in the general population of roughly 3 h per day. Some children cannot control their Internet use leading to increasing research on "Internet addiction." The objective of this article is to review the research on ADHD as a risk factor for Internet addiction and gaming, its complications, and what research and methodological questions remain to be addressed. Previous research has demonstrated rates of Internet addiction as high as 25% in the population and that it is addiction more than time of use that is best correlated with psychopathology. Various studies confirm that psychiatric disorders, and ADHD in particular, are associated with overuse, with severity of ADHD specifically correlated with the amount of use.

COMMENTS: States - Internet addiction may be as high as 25% in the population, and is associated with ADHD.

Problematic Internet Use in High School Students in Guangdong Province China (2011)

PLoS One. 2011; 6(5): e19660. doi: 10.1371/journal.pone.0019660

Problematic Internet Use (PIU) is a growing problem in Chinese adolescents. There are many risk factors for PIU, which are found at school and at home. This study was designed to investigate the prevalence of PIU and to investigate the potential risk factors for PIU among high school students in China.

A cross-sectional study was conducted. A total of 14,296 high school students were surveyed in four cities in Guangdong province. Problematic Internet Use was assessed by the 20-item Young Internet Addiction Test (YIAT). Information was also collected on demographics, family and school-related factors and Internet usage patterns. Of the 14,296 students, 12,446 were Internet users. Of those, 12.2% (1,515) were identified as problematic Internet users (PIUs).

Conclusions/Significance: PIU is common among high school students, and risk factors are found at home and at school. Teachers and parents should pay close attention to these risk factors. Effective measures are needed to prevent the spread of this problem.

Internet Addiction: A Brief Summary of Research and Practice. (2012)

Curr Psychiatry Rev. 2012 Nov;8(4):292-298.

Problematic computer use is a growing social issue which is being debated worldwide. Internet Addiction Disorder (IAD) ruins lives by causing neurological complications, psychological disturbances, and social problems. Surveys in the United States and Europe have indicated alarming prevalence rates between 1.5 and 8.2%. There are several reviews addressing the definition, classification, assessment, epidemiology, and co-morbidity of IAD and some reviews addressing the treatment of IAD. 

Relationship of Internet Addiction Severity with Depression, Anxiety, and Alexithymia, Temperament and Character in University Students (2013)

Cyberpsychol Behav Soc Netw. 2013 Jan 30.

Of the university students enrolled in the study, 12.2 percent (n=39) were categorized into the moderate/high IA group (IA 7.2 percent, high risk 5.0 percent), 25.7 percent (n=82) were categorized into the mild IA group, and 62.1 percent (n=198) were categorized into the group without IA.

Results revealed that the rate of moderate/high IA group membership was higher in men (20.0 percent) than women (9.4 percent).

Alexithymia, depression, anxiety, and novelty seeking (NS) scores were higher; whereas self-directedness (SD) and cooperativeness (C) scores were lower in the moderate/high IA group.

Usefulness of Young's Internet Addiction Test for clinical populations.

Nord J Psychiatry. 2012 Dec 18.

Background: Young's Internet Addiction Test (IAT) is one of the most widely used scales for assessing Internet addiction.

Aims: The purpose of the current study was to investigate the value of IAT for subjects clinically diagnosed with Internet addiction.

Results: The mean IAT score of our clinical subjects was 62.8 ± 18.2, which was below 70, the cut-off point indicating significant problems. The IAT detected only 42% of the clinical subjects as having significant problems with Internet addiction. No significant differences in IAT scores among those with mild, moderate and severe degrees of Internet addition were found, and no association between IAT scores and duration of illness was observed.

Conclusions: IAT scores were not significant correlated with clinical severity and duration of illness in a clinical population. This instrument had limited clinical utility for evaluating the severity of Internet addiction. Considerable caution is required in interpretations of IAT scores

Comments: Young's Internet addiction test was developed as a way to assess Internet addiction. This study finds that it is not all that great and misses many who do have significant issues. Young's test relies a lot on time spent using. The test is poor assessment tool for Internet porn addiction or related problems as time spent using has bee found to be less important than application used or use related symptoms.

Standardization study of internet addiction improvement motivation scale (2012)

Psychiatry Investig. 2012 Dec;9(4):373-8. doi: 10.4306/pi.2012.9.4.373.

 The problem of Internet addiction has drawn the attention of researchers worldwide, and because the Internet industry continues to grow, the incident rate of the disorder is increasing. In the Netherlands, it has been reported that the incident rate of Internet addiction reaches as high as 1.5 to 3.0%, and those who have Internet addiction have a difficult time adjusting to their school or workplace.1 According to another research study in Norway, 1% of the population can be classified as Internet addicted and 5.2% of the population can be classified as a latent risk group for Internet addiction. In particular, young male adults with a high education but low socioeconomic status are vulnerable to the disorder.2

In the case of Hong-Kong, 17% of research participants showed symptoms of Internet addiction and half experienced severe insomnia.3 With Internet addiction appearing to spread worldwide, it is becoming a disorder that aggravates many psychosocial problems.

Discussions of the concept and diagnosis criteria for Internet addiction are active in research circles. Goldberg used the term "addictive disorder" based on the substance addiction of Diagnostic and Statistical Manual for mental disorder 4th edition (DSM-IV) for the first time, and he refers to Internet addiction as "pathological computer use."4 Young also suggested Internet addiction diagnosis criteria, including obsessions with the Internet, tolerance, withdrawal symptoms, excessive computer use, lack of interest in other activities. He based these diagnostic criteria on those developed for pathological gambling.5

In this study, three criteria are adopted-tolerance, withdrawal, and deterioration of functional level in everyday life-to conceptualize Internet addiction.

 According to a study conducted in South Korea, Internet addiction was observed in more than 30% of people aged from 10 to more than 30 years old. In particular, 46.8% of those aged 10 to 19 years old showed signs of addiction.6 Another study reported that the prevalence of Internet addiction reached 9 to 40% among adolescent group in Korea.7 The prevalence rate of Internet addiction in South Korea is higher than any other country. Internet addiction, with such high prevalence, is associated with tolerance and withdrawal symptoms, much like other addictions. As such, more and more persons are exhibiting Internet addiction. Terminating the use of the Internet provokes various psychological symptoms, which eventually reduces the individual's functional level in daily life. It can thus be said that Internet addiction is a severe disorder.

Comments: IAD rtaes are much higher that Eurppean stuides due the population studied - the studies from europe include much older subjects, and some use subjects who have never used the internnet.  Closer examination of the data show up to 20%  males age 13-30 have IAD. in the eurpean studies.

Problematic internet and cell phone use Psychological behavioral and health correlates (2007)

2007, Vol. 15, No. 3 , Pages 309-320 (doi:10.1080/16066350701350247)  

This study aimed to assess pathological Internet and cell-phone use in college students, and to identify psychological, health, and behavioral correlates. Logistic regression analyses indicated that heavy Internet use is associated with high anxiety; high cell-phone use is associated to being female, and having high anxiety and insomnia. The developed measures seem to be promising tools for assessing these new behavioral addictions.

Comments: Study - "heavy Internet use is associated with high anxiety; high cell-phone use is associated to being female, and having high anxiety and insomnia."  This was before smartphones.

Prevalence of perceived stress symptoms of depression and sleep disturbances in relation to information and communication technology ICT use among young adults an explorative prospective study (2007) Sweden

Computers in Human Behavior Volume 23, Issue 3, May 2007, Pages 1300–1321

The aim of this study was to prospectively investigate whether high quantity of information and communication technology (ICT) use is a risk factor for developing psychological symptoms among young ICT users. A cohort of college students responded to a questionnaire at baseline and at 1-year follow-up (n = 1127). Exposure variables, such as different types of ICT use, and effect variables, such as perceived stress, symptoms of depression and sleep disturbances, were assessed. Prevalence ratios were computed, based on symptom-free subjects at baseline and prevalence of symptoms at follow-up.

For women, high combined use of computer and mobile phone at baseline was associated with increased risk of reporting prolonged stress and symptoms of depression at follow-up, and number of short message service (SMS) messages per day was associated with prolonged stress. Also online chatting was associated with prolonged stress, and e-mailing and online chatting were associated with symptoms of depression, while Internet surfing increased the risk of developing sleep disturbances. For men, number of mobile phone calls and SMS messages per day were associated with sleep disturbances. SMS use was also associated with symptoms of depression.

Comments: High levels of cell phone and Internet correlates with depression, anxiety, and sleep problems.

Depression and Internet addiction in adolescents. (2007)

Psychopathology. 2007;40(6):424-30. Epub 2007 Aug 20.

A total of 452 Korean adolescents were studied.

Internet addiction was significantly associated with depressive symptoms and obsessive-compulsive symptoms. Regarding biogenetic temperament and character patterns, high harm avoidance, low self-directedness, low cooperativeness and high self-transcendence were correlated with Internet addiction. In multivariate analysis, among clinical symptoms depression was most closely related to Internet addiction, even after controlling for differences in biogenetic temperament.

This study reveals a significant association between Internet addiction and depressive symptoms in adolescents. This association is supported by temperament profiles of the Internet addiction group. The data suggest the necessity of the evaluation of the potential underlying depression in the treatment of Internet-addicted adolescents.

Comments: High correlation with depression. More important, depression was correlated more closley with Internet addiction than with "biogenetic temperament". That means Internet addiction caused the depression rather than depression caused the addiction.

Internet addiction: definition, assessment, epidemiology and clinical management (2008)

CNS Drugs. 2008;22(5):353-65.

Internet addiction is characterized by excessive or poorly controlled preoccupations, urges or behaviours regarding computer use and internet access that lead to impairment or distress. The condition has attracted increasing attention in the popular media and among researchers, and this attention has paralleled the growth in computer (and Internet) access.

Clinical samples and a majority of relevant surveys report a male preponderance. Onset is reported to occur in the late 20s or early 30s age group, and there is often a lag of a decade or more from initial to problematic computer usage.

Internet addiction has been associated with dimensionally measured depression and indicators of social isolation. Psychiatric co-morbidity is common, particularly mood, anxiety, impulse control and substance use disorders