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This page contains short summaries of the latest research on Internet Addiction. Other studies involving Internet gaming addiction can be found here. Internet addiction brain studies have already confirmed the presence of the same brain changes as seen in drug addiction.


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


Sexual Picture Processing Interferes with Decision-Making Under Ambiguity. (2013)

Arch Sex Behav. 2013 Jun 4.

Decision-making performance was worse when sexual pictures were associated with disadvantageous card decks compared to performance when the sexual pictures were linked to the advantageous decks. Subjective sexual arousal moderated the relationship between task condition and decision-making performance. This study emphasized that sexual arousal interfered with decision-making, which may explain why some individuals experience negative consequences in the context of cybersex use.


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

Journal of Behavioral Addictions. Volume 2, Number 2/June 2013

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.


Watching Pornographic Pictures on the Internet: Role of Sexual Arousal Ratings and Psychological-Psychiatric Symptoms for Using Internet Sex Sites Excessively (2011)

Cyberpsychol Behav Soc Netw. 2011 Jun;14(6):371-7. doi: 10.1089/cyber.2010.0222.

We found a positive relationship between subjective sexual arousal when watching Internet pornographic pictures and the self-reported problems in daily life due to the excessiveness of cybersex as measured by the IATsex. Subjective arousal ratings, the global severity of psychological symptoms, and the number of sex applications used were significant predictors of the IATsex score, while the time spent on Internet sex sites did not significantly contribute to explanation of variance in the IATsex score.

The finding that subjective sexual arousal ratings while watching Internet pornographic pictures is related to self-reported problems in daily life due to excessive use of cybersex sites may be interpreted in the light of previous studies on cue reactivity in individuals with substance dependency or behavioral addictions. As outlined in the introduction, cue reactivity as a mechanism potentially contributing to the maintenance of addicted behavior has been demonstrated in several patient groups with either substance dependence or behavioral addiction. 

These studies converge to the view that craving reactions on watching addiction-related stimuli are important correlates of the addictive behavior. Although we did not examine brain correlates of watching Internet pornographic pictures in our study, we found the first experimental evidence for the potential link between subjective reactivity on Internet pornographic stimuli and a tendency toward cybersex addiction.

This means that for problems in daily life (e.g., reduced control over online sexual activities, problems with the own partner or in other interpersonal relationships, as well as problems in academic or work life), the time spent on cybersex sites is not predictive. Our results indeed emphasize that higher sexual arousal is linked to a tendency toward being addicted to cybersex and related problems in everyday life.


Cybersex addiction in heterosexual female users of internet pornography can be explained by gratification hypothesis (2014)

Cyberpsychol Behav Soc Netw. 2014 Aug;17(8):505-11.

In the context of Internet addiction, cybersex is considered to be an Internet application in which users are at risk for developing addictive usage behavior. Regarding males, experimental research has shown that indicators of sexual arousal and craving in response to Internet pornographic cues are related to severity of cybersex addiction in Internet pornography users (IPU). Since comparable investigations on females do not exist, the aim of this study is to investigate predictors of cybersex addiction in heterosexual women.

We examined 51 female IPU and 51 female non-Internet pornography users (NIPU).

Results indicated that IPU rated pornographic pictures as more arousing and reported greater craving due to pornographic picture presentation compared with NIPU. Moreover, craving, sexual arousal rating of pictures, sensitivity to sexual excitation, problematic sexual behavior, and severity of psychological symptoms predicted tendencies toward cybersex addiction in IPU. Being in a relationship, number of sexual contacts, satisfaction with sexual contacts, and use of interactive cybersex were not associated with cybersex addiction. These results are in line with those reported for heterosexual males in previous studies.


Symptoms of cybersex addiction can be linked to both approaching and avoiding pornographic stimuli: results from an analog sample of regular cybersex users (2015)

Front Psychol. 2015 May 22;6:653.

There is no consensus regarding the phenomenology, classification, and diagnostic criteria of cybersex addiction. Some approaches point toward similarities to substance dependencies for which approach/avoidance tendencies are crucial mechanisms. Several researchers have argued that within an addiction-related decision situation, individuals might either show tendencies to approach or avoid addiction-related stimuli.

Analogous to substance dependencies, results suggest that both approach and avoidance tendencies might play a role in cybersex addiction. Moreover, an interaction with sensitivity toward sexual excitation and problematic sexual behavior could have an accumulating effect on the severity of subjective complaints in everyday life due to cybersex use. The findings provide further empirical evidence for similarities between cybersex addiction and substance dependencies. Such similarities could be retraced to a comparable neural processing of cybersex- and drug-related cues.


Pathological Internet use – It is a multidimensional and not a unidimensional construct


It is still a topic of debate whether pathological Internet use (PIU) is a distinct entity or whether it should be differentiated between pathological use of specific Internet activities like playing Internet games and spending time on Internet sex sites. The aim of the current study was to contribute to a better understanding of common and differential aspects of PIU in relation to different specific Internet activities. Three groups of individuals were examined which differed with respect to their use of specific Internet activities: one group of 69 subjects used exclusively Internet games (IG) (but not Internet pornography (IP)), 134 subjects used IP (but not IG), and 116 subjects used both IG and IP (i.e., unspecific Internet use).

The results indicate that shyness and life satisfaction are significant predictors for a tendency towards pathological use of IG, but not pathological use of IP. Time spent online was a significant predictor for problematic use of both IG and IP. Additionally, no correlation was found between symptoms of pathological use of IG and IP. We conclude that games may be used to compensate social deficits (e.g., shyness) and life satisfaction in real life, whereas IP is primarily used for gratification in terms of achieving stimulation and sexual arousal.


Effect of electro-acupuncture combined with psychological intervention on mental symptoms and P50 of auditory evoked potential in patients with internet addiction disorder (2017)

To observe the therapeutic effects of electro-acupuncture (EA) combined with psychological intervention on the symptom of somzatization or obsession and mental symptom of depression or anxiety and P50 of Auditory Evoked Potential (AEP) on internet addiction disorder (IAD).

One hundred and twenty cases of IAD were randomly divided into an EA group, a psycho-intervention (PI) group and a comprehensive therapy (EA plus PI) group. Patients in the EA group were treated with EA. Patients in the PI group were treated with cognition and behavior therapy. Patients in the EA plus PI group were treated with electro-acupuncture plus psychological intervention. Scores of IAD, scores of the symptom checklist 90 (SCL-90), latency and amplitude of P50 of AEP were measured before and after treatment.

The scores of IAD after treatment significantly decreased in all groups (P < 0.05), and the scores of IAD in the EA plus PI group were significantly lower than those in the other two groups (P < 0.05). The scores of SCL-90 assembled and each factor after treatment in the EA plus PI group significantly decreased (P < 0.05). After treatment in the EA plus PI group, the amplitude distance of S1P50 and S2P50 (S1-S2) significantly increased (P < 0.05).

EA combined with PI could relieve the mental symptoms of IAD patients, and the mechanism is possibly related to the increase of cerebrum sense perception gating function.



Brains online structural and functional correlates of habitual Internet use.

Addict Biol. 2014 Feb 24. doi: 10.1111/adb.12128.

Excessive use is a growing concern of health practitioners. Based on the assumption that excessive Internet use bears resemblance with addictive behaviour, we hypothesized alterations of the fronto-striatal network in frequent users.

We found a significant negative association between the IAT score and right frontal pole GM volume (P < 0.001, family wise error corrected). Functional connectivity of right frontal pole to left ventral striatum was positively associated with higher IAT scores. Furthermore, the IAT score was positively correlated to ALFF in bilateral ventral striatum.

The alterations in the fronto-striatal circuitry associated with growing IAT scores could reflect a reduction of top-down modulation of prefrontal areas, in particular, the ability to maintain long-term goals in face of distraction. The higher activation of ventral striatum at rest may indicate a constant activation in the context of a diminished prefrontal control. The results demonstrate that excessive Internet use may be driven by neuronal circuits relevant for addictive behaviour.


Neurobiological findings related to Internet use disorders (2016)

Psychiatry Clin Neurosci. 2016 Jul 23. doi: 10.1111/pcn.12422.

In the last ten years, numerous neurobiological studies have been conducted on Internet addiction or Internet use disorder. Various neurobiological research methods-such as magnetic resonance imaging; nuclear imaging modalities, including positron emission tomography and single photon emission computed tomography; molecular genetics; and neurophysiologic methods-have made it possible to discover structural or functional impairments in the brains of individuals with Internet use disorder. Specifically, Internet use disorder is associated with structural or functional impairment in the orbitofrontal cortex, dorsolateral prefrontal cortex, anterior cingulate cortex, and posterior cingulate cortex. These regions are associated with the processing of reward, motivation, memory, and cognitive control. Early neurobiological research results in this area indicated that Internet use disorder shares many similarities with substance use disorders, including, to a certain extent, a shared pathophysiology. However, recent studies suggest that differences in biological and psychological markers exist between Internet use disorder and substance use disorders. Further research is required for a better understanding of the pathophysiology of Internet use disorder.


Internet addiction and its facets: The role of genetics and the relation to self-directedness (2017)

Addict Behav. 2017 Feb;65:137-146. doi: 10.1016/j.addbeh.2016.10.018.

A growing body of research focuses on problematic behavior patterns related to the use of the Internet to identify contextual as well as individual risk factors of this new phenomenon called Internet addiction (IA). IA can be described as a multidimensional syndrome comprising aspects such as craving, development of tolerance, loss of control and negative consequences. Given that previous research on other addictive behaviors showed substantial heritability, it can be expected that the vulnerability to IA may also be due to a person's genetic predisposition. However, it is questionable whether distinct components of IA have different etiologies. 

For specific facets of IA and private Internet use in hours per week, heritability estimates ranged between 21% and 44%. Bivariate analysis indicated that Self-Directedness accounted for 20% to 65% of the genetic variance in specific IA facets through overlapping genetic pathways. Implications for future research are discussed.


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.


New developments on the neurobiological and pharmaco-genetic mechanisms underlying internet and videogame addiction.

Am J Addict. 2015 Mar;24(2):117-25.

There is emerging evidence that the psychobiological mechanisms underlying behavioral addictions such as internet and videogame addiction resemble those of addiction for substances of abuse.

Literature search of published articles between 2009 and 2013 in Pubmed using "internet addiction" and "videogame addiction" as the search word. Twenty-nine studies have been selected and evaluated under the criteria of brain imaging, treatment, and genetics.

Brain imaging studies of the resting state have shown that long-term internet game playing affected brain regions responsible for reward, impulse control and sensory-motor coordination. Brain activation studies have shown that videogame playing involved changes in reward and loss of control and that gaming pictures have activated regions similarly to those activated by cue-exposure to drugs. Structural studies have shown alterations in the volume of the ventral striatum possible as result of changes in reward. Furthermore, videogame playing was associated with dopamine release similar in magnitude to those of drugs of abuse and that there were faulty inhibitory control and reward mechanisms videogame addicted individuals. Finally, treatment studies using fMRI have shown reduction in craving for videogames and reduced associated brain activity.

Videogame playing may be supported by similar neural mechanisms underlying drug abuse. Similar to drug and alcohol abuse, internet addiction results in sub-sensitivity of dopamine reward mechanisms.


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].

The IAD subjects used the internet almost everyday, and spend more than 8 hours everyday in front of the monitor, mostly for chatting with cyber friends, playing online games, and watching online pornographies or adult movies. These subjects were initially familiar with internet mostly at the early stage of their adolescence  and had the indications of IAD for more than 6 years

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.


Impaired frontal-Basal Ganglia connectivity in adolescents with internet addiction (2014)

Sci Rep. 2014 May 22;4:5027. doi: 10.1038/srep05027.

Understanding the neural basis of poor impulse control in Internet addiction (IA) is important for understanding the neurobiological mechanisms of this syndrome. The current study investigated how neuronal pathways implicated in response inhibition were affected in IA using a Go-Stop paradigm and functional magnetic resonance imaging (fMRI).  The results showed that the indirect frontal-basal ganglia pathway was engaged by response inhibition in healthy subjects. However, we did not detect any equivalent effective connectivity in the IA group. This suggests the IA subjects fail to recruit this pathway and inhibit unwanted actions. This study provides a clear link between Internet addiction as a behavioral disorder and aberrant connectivity in the response inhibition network.

COMMENTS; Clear demonstration of hypofrontality in those with Internet addiction.


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


The dysfunction of face processing in patients with internet addiction disorders: an event-related potential study (2016)

Neuroreport. 2016 Aug 25.

To investigate face processing in patients with internet addiction disorders (IAD), an event-related brain potential experiment was conducted in IAD patients and healthy age-matched controls in which participants were instructed to classify each stimulus (face vs. nonface object) as quickly and accurately as possible. Although we did not find a significant difference in the performance between two groups, both the N110 and the P2 components in response to faces were larger in the IAD group than in the control group, whereas the N170 to faces decreased in the IAD group than in the control group. In addition, the source analysis of event-related potential components showed different generators between two groups. These data indicated that there was a dysfunction of face processing in IAD patients and the underlying mechanism of processing faces could be different from healthy individuals.


Brain anatomy alterations associated with Social Networking Site addiction (2017)

Sci Rep. 2017 Mar 23;7:45064. doi: 10.1038/srep45064.

This study relies on knowledge regarding the neuroplasticity of dual-system components that govern addiction and excessive behavior and suggests that alterations in the grey matter volumes, i.e., brain morphology, of specific regions of interest are associated with technology-related addictions. Using voxel based morphometry (VBM) applied to structural Magnetic Resonance Imaging (MRI) scans of twenty social network site (SNS) users with varying degrees of SNS addiction, we show that SNS addiction is associated with a presumably more efficient impulsive brain system, manifested through reduced grey matter volumes in the amygdala bilaterally (but not with structural differences in the Nucleus Accumbens). In this regard, SNS addiction is similar in terms of brain anatomy alterations to other (substance, gambling etc.) addictions. We also show that in contrast to other addictions in which the anterior-/ mid- cingulate cortex is impaired and fails to support the needed inhibition, which manifests through reduced grey matter volumes, this region is presumed to be healthy in our sample and its grey matter volume is positively correlated with one's level of SNS addiction. These findings portray an anatomical morphology model of SNS addiction and point to brain morphology similarities and differences between technology addictions and substance and gambling addictions.


Aberrant corticostriatal functional circuits in adolescents with Internet addiction disorder (2015)

Front Hum Neurosci. 2015 Jun 16;9:356.

Abnormal structure and function in the striatum and prefrontal cortex (PFC) have been revealed in Internet addiction disorder (IAD).  The aim of this study was to investigate the integrity of corticostriatal functional circuits and their relations to neuropsychological measures in IAD by resting-state functional connectivity (FC). Fourteen IAD adolescents and 15 healthy controls underwent resting-state fMRI scans.

Compared to controls, IAD subjects exhibited reduced connectivity between the inferior ventral striatum and bilateral caudate head, subgenual anterior cingulate cortex (ACC), and posterior cingulate cortex, and between the superior ventral striatum and bilateral dorsal/rostral ACC, ventral anterior thalamus, and putamen/pallidum/insula/inferior frontal gyrus (IFG), and between the dorsal caudate and dorsal/rostral ACC, thalamus, and IFG, and between the left ventral rostral putamen and right IFG. IAD subjects also showed increased connectivity between the left dorsal caudal putamen and bilateral caudal cigulate motor area. Moreover, altered cotricostriatal functional circuits were significantly correlated with neuropsychological measures. This study directly provides evidence that IAD is associated with alterations of corticostriatal functional circuits involved in the affective and motivation processing, and cognitive control.


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.


Effect of excessive Internet use on the time–frequency characteristic of EEG (2009)

Progress in Natural Science: Materials International > 2009 > 19 > 10 > 1383-1387

The event-related potentials (ERP) of normal subjects and excessive Internet users were acquired using the oddball paradigm experiment. We applied the wavelet transformed and event-related spectral perturbation to ERP in order to extract the time–frequency values. Excessive Internet use resulted in a significant decrease in the P300 amplitudes and a significant increase in the P300 latency in all electrodes. Thus, these data suggest that excessive Internet use affects information coding and integration in the brain.


The research of event-related potentials in working memory of the juvenile internet addiction (2010)

 E-Health Networking, Digital Ecosystems and Technologies (EDT), 2010 International Conference on

Internet addiction disorder, as a form of technological addiction, will cause neurological complications, psychological disturbances, and relational chaos. Teenagers are in the most vulnerable age group, who will develop more serious complications than other age groups when addicted to the Internet. The objective of this study was to analyze the damage in working memory of the juvenile Internet addiction (IAD). The Chinese words Recognition is used as the experimental paradigms of event-related potentials (ERP). 13 normal teenagers and 10 internet addiction received recognition task which use the old/new effects during Chinese words and the behavior data and electroencephalogram signals were recorded by the experiment equipment. After the data disposed, compared with the normal, both the ERP and the behavior data of the IAD have some obvious characteristics. The difference reveals the damage of the working memory from the neurophysiology.


Deficits in Early-Stage Face Perception in Excessive Internet Users (2011)

Cyberpsychology, Behavior, and Social Networking. May 2011, 14(5): 303-308.

Excessive Internet use is associated with a limited ability to communicate effectively socially, which depends largely on the capacity for perception of the human face. We used a passive visual detection paradigm to compare the early stages of the processing of face-related information in young excessive Internet users (EIUs) and healthy normal subjects by analyzing event-related potentials (ERPs) elicited by faces and by nonface stimuli (tables), each presented in the upright and inverted position. 

These data indicate that EIUs have deficits in the early stage of face-perception processing but may have intact holistic/configural processing of faces. Whether some deeper processes of face perception, such as face memory and face identification, are affected in EIUs needs to be investigated further with more specific procedures.


Electroencephalogram Feature Detection and Classification in People with Internet Addiction Disorder with Visual Oddball Paradigm (2015)

Journal of Medical Imaging and Health Informatics, Volume 5, Number 7, November 2015, pp. 1499-1503(5)

In this paper, the electroencephalogram (EEG) signals were recorded from ten healthy and ten Internet Addiction (IA)-afflicted university students during a visual oddball paradigm. It showed significant difference in P300 amplitudes between healthy subjects and Internet Addition subjects. The amplitudes of Internet Addition were lower (p < 0.05). The classification accuracy could reach above 93% using Bayesian-based method in active areas, while it was lower than 90% in central areas. The results show that there are negative influences on the brain response and memory abilities of IA-afflicted university students.


Electrophysiological studies in Internet addiction: A review within the dual-process framework (2017)

Addictive Behaviors

  • EEG studies in Internet addiction are reviewed within a dual-process framework.
  • Internet addiction is associated with hypo-activated reflective-control system.
  • Internet addicts also appear to present an hyper-activated affective system.
  • Internet addiction may thus be characterized by an imbalance between systems.
  • Future works should explore Internet addiction subtypes and the role of comorbiditie

The 14 articles finally selected show that Internet addiction shares essential features with other addictive states, mainly a joint hypo-activation of the reflective system (decreased executive control abilities) and hyper-activation of the automatic-affective one (excessive affective processing of addiction-related cues). Despite the currently limited data, dual-process models thus appear useful to conceptualize the imbalance between cerebral systems in Internet addiction. We finally propose that future electrophysiological studies should better characterize this disequilibrium between controlled-deliberate and automatic-affective networks, notably by using event-related potentials paradigms focusing on each system separately and on their interactions, but also by better specifying the potential differences between sub-categories of Internet addiction.


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.


Decreased frontal lobe function in people with Internet addiction disorder (2013)

Neural Regen Res. 2013 Dec 5;8(34)

In our previous studies, we showed that frontal lobe and brainstem functions were abnormal in on-line game addicts. In this study, 14 students with Internet addiction disorder and 14 matched healthy controls underwent proton-magnetic resonance spectroscopy to measure cerebral function. Results demonstrated that the ratio of N-acetylaspartate to creatine decreased, but the ratio of choline-containing compounds to creatine increased in the bilateral frontal lobe white matter in people with Internet addiction disorder. However, these ratios were mostly unaltered in the brainstem, suggesting that frontal lobe function decreases in people with Internet addiction disorder.


Higher Media Multi-Tasking Activity Is Associated with Smaller Gray-Matter Density in the Anterior Cingulate Cortex (2014)

September 24, 2014.  DOI: 10.1371/journal.pone.0106698

.Individuals who engage in heavier media-multitasking are found to perform worse on cognitive control tasks and exhibit more socio-emotional difficulties. Research has demonstrated that brain structure can be altered upon prolonged exposure to novel environments and experience.  This was confirmed via Voxel-Based Morphometry (VBM) analyses: Individuals with higher Media Multitasking Index (MMI) scores had smaller gray matter density in the anterior cingulate cortex (ACC). Functional connectivity between this ACC region and the precuneus was negatively associated with MMI. Our findings suggest a possible structural correlate for the observed decreased cognitive control performance and socio-emotional regulation in heavy media-multitaskers.


Disrupted Brain Functional Network in Internet Addiction Disorder: A Resting-State Functional Magnetic Resonance Imaging Study (2014)

PLoS ONE 9(9): e107306. doi:10.1371/journal.pone.0107306

Our results demonstrate that there is significant disruption in the functional connectome of IAD patients, particularly between regions located in the frontal, occipital, and parietal lobes. The affected connections are long-range and inter-hemispheric connections.  Our findings, which are relatively consistent between anatomically and functionally defined atlases, suggest that IAD causes disruptions of functional connectivity and, importantly, that such disruptions might link to behavioral impairments.


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. (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 (2012)

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)


Brain structures and functional connectivity associated with individual differences in Internet tendency in healthy young adults (2015)

Neuropsychologia. 2015 Feb 16. pii: S0028-3932(15)00080-9.

Internet addiction (IA) incurs significant social and financial costs in the form of physical side-effects, academic and occupational impairment, and serious relationship problems. The majority of previous studies on Internet addiction disorders (IAD) have focused on structural and functional abnormalities, while few studies have simultaneously investigated the structural and functional brain alterations underlying individual differences in IA tendencies measured by questionnaires in a healthy sample. Here we combined structural (regional gray matter volume, rGMV) and functional (resting-state functional connectivity, rsFC) information to explore the neural mechanisms underlying IAT in a large sample of 260 healthy young adults. These findings suggest the combination of structural and functional information can provide a valuable basis for further understanding of the mechanisms and pathogenesis of IA.


Physiological markers of biased decision making in problematic Internet users (2016)

J Behav Addict. 2016 Aug 24:1-8.

Problematic Internet use (PIU) is a relatively new concept and its classification as an addiction is debated. Implicit emotional responses were measured in individuals expressing nonproblematic and problematic Internet behaviors while they made risky/ambiguous decisions to explore whether they showed similar responses to those found in agreed-upon addictions.

The design of the study was cross sectional. Participants were adult Internet users (N = 72). All testing took place in the Psychophysics Laboratory at the University of Bath, UK. Participants were given the Iowa Gambling Task (IGT) which provides an index of an individual's ability to process and learn probabilities of reward and loss. Integration of emotions into current decision-making frameworks is vital for optimal performance on the IGT and thus, skin conductance responses (SCRs) to reward, punishment, and in anticipation of both were measured to assess emotional function.

Performance on the IGT did not differ between the groups of Internet users. However, problematic Internet users expressed increased sensitivity to punishment as revealed by stronger SCRs to trials with higher punishment magnitude.

PIU seems to differ on behavioral and physiological levels with other addictions. However, our data imply that problematic Internet users were more risk-sensitive, which is a suggestion that needs to be incorporated into in any measure and, potentially, any intervention for PIU.


Functional changes in patients with internet addiction disclosed by adenosine stressed cerebral blood flow perfusion imaging 99mTc-ECD SPET.

Hell J Nucl Med. 2016 Jun 22. pii: s002449910361.

To investigate the abnormal cerebral blood flow (CBF) perfusion in patients with internet addiction (IA) and its possible association with IA severity.Thirty-five adolescents who met the criteria for IA and 12 matched healthy volunteers were recruited for 99mTc-ethylcysteinate dimer based CBF perfusion imaging with single photon emission tomography (SPET) both at rest and in adenosine-stressed state. Regional CBF (rCBF) was measured and compared between IA subjects and the controls. Correlation analysis between those abnormal rCBF in adenosine-stressed state and the duration of IA was performed.

At the resting state, the IA individuals showed significantly increased rCBF in the left mid-frontal gyrus and left angular gyrus, but significantly decreased in the left paracentral lobule, compared to the controls. In adenosine-stressed state, more cerebral regions with abnormal rCBF were identified. Specifically, increased rCBF was identified in the right paracentral lobule, right mid-frontal gyrus and left superior temporal gyrus, while decreased rCBF were demonstrated in right transverse temporal gyrus, left inferior frontal gyrus and left precuneus. Those rCBF in rCBF-increased regions in stress state were positively correlated with the duration of IA, while those in rCBF-decreased regions were negatively correlated with the duration of IA.


Examination of neural systems sub-serving facebook "addiction" (2014)

Psychol Rep. 2014 Dec;115(3):675-95

Because addictive behaviors typically result from violated homeostasis of the impulsive (amygdala-striatal) and inhibitory (prefrontal cortex) brain systems, this study examined whether these systems sub-serve a specific case of technology-related addiction, namely Facebook "addiction." Using a go/no-go paradigm in functional MRI settings, the study examined how these brain systems in 20 Facebook users (M age = 20.3 yr., SD = 1.3, range = 18-23) who completed a Facebook addiction questionnaire, responded to Facebook and less potent (traffic sign) stimuli. The findings indicated that at least at the examined levels of addiction-like symptoms, technology-related "addictions" share some neural features with substance and gambling addictions, but more importantly they also differ from such addictions in their brain etiology and possibly pathogenesis, as related to abnormal functioning of the inhibitory-control brain system.


Internet Addiction and Excessive Social Networks Use: What About Facebook? (2016)

Clin Pract Epidemiol Ment Health. 2016 Jun 28;12:43-8. doi: 10.2174/1745017901612010043. eCollection 2016.

However, healthy and conscience Facebook use is contrasted by excessive use and lack of control, creating an addiction with severely impacts the everyday life of many users, mainly youths. If Facebook use seems to be related to the need to belong, affiliate with others and for self-presentation, the beginning of excessive Facebook use and addiction could be associated to reward and gratification mechanisms as well as some personality traits. Studies from several countries indicate different Facebook addiction prevalence rates, mainly due to the use of a wide-range of evaluation instruments and to the lack of a clear and valid definition of this construct. Further investigations are needed to establish if excessive Facebook use can be considered as a specific online addiction disorder or an Internet addiction subtype.


Internet-Communication Disorder: It's a Matter of Social Aspects, Coping, and Internet-Use Expectancies (2016)

Front Psychol. 2016 Nov 10;7:1747.

Online communication applications such as Facebook, WhatsApp, and Twitter are some of the most frequently used Internet applications. There is a growing amount of individuals suffering diminished control over their use of online communication applications which leads to diverse negative consequences in offline life. This could be referred to as Internet-communication disorder (ICD). The current study investigates the role of individual characteristics (e.g., psychopathological symptoms, feelings of loneliness) and specific cognitions. In a sample of 485 participants a structural equation model was tested to investigate predictors and mediators which may predict an excessive use. The results emphasize that a higher level of social loneliness and less perceived social support enhance the risk of a pathological use. The effects of psychopathological symptoms (depression and social anxiety) as well as individual characteristics (self-esteem, self-efficacy, and stress vulnerability) on ICD symptoms are mediated by Internet-use expectancies and dysfunctional coping mechanisms.


Psychological problems of young people resorting to the Internet communication (2017)

International Journal Of Professional Science 1 (2017).

The analysis of foreign and Russian psychological researches on the issue of Internet communication has allowed to identify the main personal problems of young people. The article presents the results of an experimental study of the psychological problems of young people resorting to the Internet communication.

The study involved 45 students from different universities in Russia at the age of 18 to 22 years. The general hypothesis of the study was in the statement that the Internet as a modern communicative medium contributes to the emergence psychological problems of young people, in particular: the manifestation of negative emotional states (the experience of depression); reduce the level of self-confidence and self-esteem; formation of uncertainty feeling the manifestation Internet addiction symptoms.


Online social networking addiction among college students in Singapore: Comorbidity with behavioral addiction and affective disorder (2017)

Asian J Psychiatr. 2017 Feb;25:175-178. doi: 10.1016/j.ajp.2016.10.027.

This study aimed to determine the prevalence of addiction to social networking sites/platforms (SNS) and its comorbidity with other behavioral addiction and affective disorder among college students in Singapore. 1110 college students (age: M=21.46, SD=1.80) in Singapore completed measures assessing online social networking, unhealthy food intake and shopping addiction as well as depression, anxiety and mania.

The prevalence rates of SNS, food and shopping addiction were 29.5%, 4.7% and 9.3% respectively for the total sample. SNS addiction was found to co-occur with food addiction (3%), shopping addiction (5%), and both food and shopping addiction (1%). The comorbidity rates of SNS addiction and affective disorder were 21% for depression, 27.7% for anxiety, and 26.1% for mania. Compared with the total sample, students with SNS addiction reported higher comorbidity rates with other behavioral addiction and affective disorder. In general, females as compared to males reported higher comorbidity rates of SNS addiction and affective disorder.


Media use and Internet addiction in adult depression: A case-control study (2017)

Computers in Human Behavior Volume 68, March 2017, Pages 96–103

The present case-control study explored tendencies of Internet addiction in a group of depressive patients compared with a control group of healthy persons. Standardized questionnaires were used to assess the extent of Internet addiction (ISS), depression symptoms (BDI), impulsivity (BIS) and global psychological stress (SCL-90R).

The results presented significantly higher tendencies for Internet addiction in the group of depressive patients. The prevalence of Internet addiction in this group was considerably high (36%). In addition, depressive patients with Internet addiction showed consistently but insignificantly higher symptom severity and psychological stress compared with patients without Internet addiction. Both groups of depressive patients were significantly higher burdened with depressive symptoms and psychological stress than the healthy controls. Low age and male sex were particularly important predictors of Internet addiction in the group of depressive patients. The results are in accordance with previously published findings in other fields of addiction disorders.


Sleep quality, internet addiction and depressive symptoms among undergraduate students in Nepal (2017)

BMC Psychiatry. 2017 Mar 21;17(1):106. doi: 10.1186/s12888-017-1275-5. 

Evidence on the burden of depression, internet addiction and poor sleep quality in undergraduate students from Nepal is virtually non-existent. While the interaction between sleep quality, internet addiction and depressive symptoms is frequently assessed in studies, it is not well explored if sleep quality or internet addiction statistically mediates the association between the other two variables.

We enrolled 984 students from 27 undergraduate campuses of Chitwan and Kathmandu, Nepal. We assessed sleep quality, internet addiction and depressive symptoms in these students using Pittsburgh Sleep Quality Index, Young's Internet Addiction Test and Patient Health Questionnaire-9 respectively.

Overall, 35.4%, 35.4% and 21.2% of students scored above validated cutoff scores for poor sleep quality, internet addiction and depression respectively. Higher internet addiction was associated with having lower age, being sexually inactive and having failed in previous year's board examination. Depressive symptoms were higher for students having higher age, being sexually inactive, having failed in previous year's board examination and lower years of study. Internet addiction statistically mediated 16.5% of the indirect effect of sleep quality on depressive symptoms. Sleep quality, on the other hand, statistically mediated 30.9% of the indirect effect of internet addiction on depressive symptoms.

In the current study, a great proportion of students met criteria for poor sleep quality, internet addiction and depression. Internet addiction and sleep quality both mediated a significant proportion of the indirect effect on depressive symptoms. However, the cross-sectional nature of this study limits causal interpretation of the findings. Future longitudinal study, where the measurement of internet addiction or sleep quality precedes that of depressive symptoms, are necessary to build upon our understanding of the development of depressive symptoms in students.


Online sexual activities: An exploratory study of problematic and non-problematic usage patterns in a sample of men (2016)

Computers in Human Behavior

Volume 29, Issue 3, May 2013, Pages 1243–1254

This study systematically tested whether the use of specific technologies or media (including certain types of Facebook use), technology-related anxieties, and technology-related attitudes (including multitasking preference) would predict clinical symptoms of six personality disorders (schizoid, narcissistic, antisocial, compulsive, paranoid and histrionic) and three mood disorders (major depression, dysthymia and bipolar-mania)

  • Technology use, anxiety, and attitudes predict symptoms of nine psychiatric disorders.
  • Facebook general use and impression formation were the best predictors.
  • More friends predict more symptoms of some disorders but fewer symptoms of others.
  • Multitasking preference predicts more clinical symptoms of nearly all disorders.


Cognitive flexibility in internet addicts: fMRI evidence from difficult-to-easy and easy-to-difficult switching situations (2013)

Addict Behav. 2013 Dec 11.

Behavioral and imaging data were collected from 15 IAD subjects (21.2±3.2years) and 15 healthy controls (HC, 22.1±3.6years).

Correlations were also performed between behavioral performances and brain activities in relevant brain regions. Taken together, we concluded that IAD subjects engaged more endeavors in executive control and attention in the switching task. From another perspective, IAD subjects show impaired cognitive flexibilities.


Effects of Internet Addiction on Heart Rate Variability in School-Aged Children (2013).

J Cardiovasc Nurs. 2013 Oct 1

This study explored the effects of Internet addiction on autonomic nervous system function through heart rate variability (HRV) analysis.Data were collected from 240 school-aged children who completed the Chinese Internet Addiction Scale and Pittsburgh Sleep Quality Index questionnaires.

Internet addicts had significantly lower high frequency (HF) percentage, logarithmically transformed HF, and logarithmically transformed total power and significantly higher low frequency percentage than did nonaddicts. Internet addiction is associated with higher sympathetic activity and lower parasympathetic activity. The autonomic dysregulation associated with Internet addiction might partly result from insomnia, but the mechanism still needs to be further studied.

COMMENTS: Heart rate variability is a measure of autonomic nervous system function and dysfunction. Those with IAD demonstrated autonomic dysfunction.


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.


Influence of dopaminergic system on internet addiction (2011)

Acta Medica Medianae 2011;50(1):60-66.

Subtypes of Internet Addiction Generalized Internet addiction is not as common and it includes a multidimensional, excessive usage of Internet service and content, commonly without a specific goal of this usage. However, it is more common that people grow addicted to the specific online content and activities rather than general Internet usage. There is no consensus with regards to the exact number of assumptions of the subtypes of Internet abuse. However, four or five types are most commonly defined, and, in his work, Hinić accentuates concept 6+1 subtypes:

  1. Cyber-Relational Addiction
  2. Cybersexual Addiction
  3. Information Overload
  4. Net Gaming
  5. Compulsive Online Shopping
  6. Computer and IT Addiction
  7. Mixed type of addiction


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)

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.


Resting-state beta and gamma activity in Internet addiction (2013)

Int J Psychophysiol. 2013 Jun 13. pii: S0167-8760(13)00178-5. doi: 10.1016/j.ijpsycho.2013.06.007.

Internet addiction is the inability to control one's use of the Internet and is related to impulsivity. Although a few studies have examined neurophysiological activity as individuals with Internet addiction engage in cognitive processing, no information on spontaneous EEG activity in the eyes-closed resting-state is available. The Internet addiction group showed high impulsivity and impaired inhibitory control. These EEG activities were significantly associated with the severity of Internet addiction as well as with the extent of impulsivity.

The present study suggests that resting-state fast-wave brain activity is related to the impulsivity characterizing Internet addiction. These differences may be neurobiological markers for the pathophysiology of Internet addiction.


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 (2013)

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


Differential resting-state EEG patterns associated with comorbid depression in Internet addiction (2014)

Prog Neuropsychopharmacol Biol Psychiatry. 2014 Apr 3;50:21-6.

Many researchers have reported a relationship between Internet addiction and depression. In the present study, we compared the resting-state quantitative electroencephalography (QEEG) activity of treatment-seeking patients with comorbid Internet addiction and depression with those of treatment-seeking patients with Internet addiction without depression, and healthy controls to investigate the neurobiological markers that differentiate pure Internet addiction from Internet addiction with comorbid depression.The Internet addiction group without depression had decreased absolute delta and beta powers in all brain regions, whereas the Internet addiction group with depression had increased relative theta and decreased relative alpha power in all regions. These neurophysiological changes were not related to clinical variables. The current findings reflect differential resting-state QEEG patterns between both groups of participants with Internet addiction and healthy controls and also suggest that decreased absolute delta and beta powers are neurobiological markers of Internet addiction.          


Internet addictive individuals share impulsivity and executive dysfunction with alcohol-dependent patients (2014)

Internet addiction disorder (IAD) should belong to a kind of behavioral addiction. Previous studies indicated that there are many similarities in the neurobiology of behavior and substance addictions.

Results showed that Barratt impulsiveness scale 11 scores, false alarm rate, the total response errors, perseverative errors, failure to maintain set of IAD and AD group were significantly higher than that of NC group, and hit rate, percentage of conceptual level responses, the number of categories completed, forwards scores, and backwards scores of IAD and AD group were significantly lower than that of NC group, however, no differences in above variables between IAD group and AD group were observed. These results revealed that the existence of impulsivity, deficiencies in executive function and working memory in an IAD and an AD sample, namely, Internet addictive individuals share impulsivity and executive dysfunction with alcohol-dependent patients.


Neural responses to various rewards and feedback in the brains of adolescent Internet addicts detected by functional magnetic resonance imaging (2014)

Psychiatry Clin Neurosci. 2014 Jun;68(6):463-70. doi: 10.1111/pcn.12154.

These findings suggest that AIA show reduced levels of self-related brain activation and decreased reward sensitivity irrespective of the type of reward and feedback. AIA may be only sensitive to error monitoring regardless of positive feelings, such as sense of satisfaction or achievement.


Blunted feedback processing during risk-taking in adolescents with features of problematic Internet use (2015)

Addict Behav. 2015 Jan 20;45C:156-163.

While the conceptualization of problematic Internet use (PIU) as a "behavioral addiction" resembling substance-use disorders is debated, the neurobiological underpinnings of PIU remain understudied. This study examined whether adolescents displaying features of PIU (at-risk PIU; ARPIU) are more impulsive and exhibit blunted responding in the neural mechanisms underlying feedback processing and outcome evaluation during risk-taking.

Compared to non-ARPIU, ARPIU adolescents displayed higher levels of urgency and lack of perseverance on the UPPS Impulsive Behavior Scale. Although no between-group difference in BART performance was observed, ERPs demonstrated overall decreased sensitivity to feedback in ARPIU compared to non-ARPIU adolescents, as indexed by blunted feedback-related negativity (FRN) and P300 amplitudes to both negative and positive feedback. The present study provides evidence for feedback processing during risk-taking as a neural correlate of ARPIU.


An Error-Related Negativity Potential Investigation of Response Monitoring Function in Individuals with Internet Addiction Disorder (2013)

Front Behav Neurosci. 2013 Sep 25;7:131.

Internet addiction disorder (IAD) is an impulse disorder or at least related to impulse control disorder. Deficits in executive functioning, including response monitoring, have been proposed as a hallmark feature of impulse control disorders.The error-related negativity (ERN) reflects individual's ability to monitor behavior. Since IAD belongs to a compulsive-impulsive spectrum disorder, theoretically, it should present response monitoring functional deficit characteristics of some disorders, such as substance dependence, ADHD, or alcohol abuse, testing with an Erikson flanker task. Up to now, no studies on response monitoring functional deficit in IAD were reported.

IAD group made more total error rates than did controls; Reactive times for total error responses in IAD group were shorter than did controls. The mean ERN amplitudes of total error response conditions at frontal electrode sites and at central electrode sites of IAD group were reduced compared with control group. These results revealed that IAD displays response monitoring functional deficit characteristics and shares ERN characteristics of compulsive-impulsive spectrum disorder.


Prefrontal Control and Internet Addiction A Theoretical Model and Review of Neuropsychological and Neuroimaging Findings (2014)

Front Hum Neurosci. 2014 May 27;8:375. eCollection 2014.

Some individuals suffer from a loss of control over their Internet use resulting in personal distress, symptoms of psychological dependence, and diverse negative consequences. This phenomenon is often referred to as Internet addiction. Only Internet Gaming Disorder has been included in the appendix of the DSM-5, but it has already been argued that Internet addiction could also comprise problematic use of other applications with cybersex, online relations, shopping, and information search being Internet facets at risk for developing an addictive behavior.

Neuropsychological investigations have pointed out that certain prefrontal functions in particular executive control functions are related to symptoms of Internet addiction, which is in line with recent theoretical models on the development and maintenance of the addictive use of the Internet. Control processes are particularly reduced when individuals with Internet addiction are confronted with Internet-related cues representing their first choice use. For example, processing Internet-related cues interferes with working memory performance and decision making. Consistent with this, results from functional neuroimaging and other neuropsychological studies demonstrate that cue-reactivity, craving, and decision making are important concepts for understanding Internet addiction. The findings on reductions in executive control are consistent with other behavioral addictions, such as pathological gambling.


The Internet Process Addiction Test: Screening for Addictions to Processes Facilitated by the Internet (2015)

Behav Sci (Basel). 2015 Jul 28;5(3):341-352.

The Internet Process Addiction Test (IPAT) was created to screen for potential addictive behaviors that could be facilitated by the internet. The IPAT was created with the mindset that the term "Internet addiction" is structurally problematic, as the Internet is simply the medium that one uses to access various addictive processes. The role of the internet in facilitating addictions, however, cannot be minimized. A new screening tool that effectively directed researchers and clinicians to the specific processes facilitated by the internet would therefore be useful. This study shows that the Internet Process Addiction Test (IPAT) demonstrates good validity and reliability. Four addictive processes were effectively screened for with the IPAT: Online video game playing, online social networking, online sexual activity, and web surfing. Implications for further research and limitations of the study are discussed.


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.


Problematic internet use is associated with structural alterations in the brain reward system in females. (2015)

2015 Sep 23.

Neuroimaging findings suggest that excessive Internet use shows functional and structural brain changes similar to substance addiction. Even though it is still under debate whether there are gender differences in case of problematic use, previous studies by-passed this question by focusing on males only or by using gender matched approach without controlling for potential gender effects. We designed our study to find out whether there are structural correlates in the brain reward system of problematic Internet use in habitual Internet user females.

According to MR volumetry, problematic Internet use was associated with increased grey matter volume of bilateral putamen and right nucleus accumbens while decreased grey matter volume of orbitofrontal cortex (OFC). Similarly, VBM analysis revealed a significant negative association between the absolute amount of grey matter OFC and problematic Internet use. Our findings suggest structural brain alterations in the reward system usually related to addictions are present in problematic Internet use.


Working memory, executive function and impulsivity in Internet-addictive disorders: a comparison with pathological gambling (2015)

2015 Sep 24:1-9.

The purpose of the present study was to test whether individuals with Internet addiction disorder (IAD) presented analogous characteristics of working memory, executive function and impulsivity compared with pathological gambling (PG) patients. The subjects included 23 individuals with IAD, 23 PG patients and 23 controls.

The results of this study showed that the false alarm rate, total response errors, perseverative errors, failure to maintain set and BIS-11 scores of both the IAD and PG groups were significantly higher than that of the control group. In addition, the forward scores and backwards scores, percentage of conceptual level responses, number of categories completed and hit rate of the IAD and PG groups were significantly lower than that of the control group. Furthermore, the false alarm rate and BIS-11 scores of the IAD group were significantly higher than those of PG patients, and the hit rate was significantly lower than that of the PG patients.

Individuals with IAD and PG patients present deficiencies in working memory, executive dysfunction and impulsivity, and individuals with IAD are more impulsive than PG patients.


Respiratory sinus arrhythmia reactivity of internet addiction abusers in negative and positive emotional states using film clips stimulation (2016)

Biomed Eng Online. 2016 Jul 4;15(1):69.

People with internet addiction (IA) suffer from mental, physical, social, and occupational problems. IA includes psychological and physiological syndromes, and among the syndromes, emotion was suggested important mental and physiological expressions of IA. However, few physiologically emotional characters of IA were investigated. Autonomic nervous system (ANS) activity was a good link between IA and emotion, and respiratory sinus arrhythmia (RSA) gained from ANS was hypothesized related to IA.

The results revealed that the changes in RSA values were biologically significantly different between HIA and LIA, especially when sadness, happiness, or surprise was induced. HIA people exhibited stronger RSA reactivity following negative emotion than LIA people, but the RSA reactivity following positive emotion was weaker. This study provides more physiological information about IA and assists further investigation on the regulation of the ANS for IA abusers. The results will benefit the further application, early detection, therapy, and even early prevention.


Decision-making and prepotent response inhibition functions in excessive internet users (2009)

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.


Exploring Associations between Problematic Internet Use Depressive Symptoms and Sleep Disturbance among Southern Chinese Adolescents (2016)

Int J Environ Res Public Health. 2016 Mar 14;13(3). pii: E313.

The primary aim of this study was to examine associations between problematic Internet use, depression and sleep disturbance, and explore whether there were differential effects of problematic Internet use and depression on sleep disturbance. A total of 1772 adolescents who participated in the Shantou Adolescent Mental Health Survey were recruited in 2012 in Shantou, China. Among the participants, 17.2% of adolescents met the criteria for problematic Internet use, 40.0% were also classified as suffering from sleep disturbance, and 54.4% of students had depressive symptoms. Problematic Internet use was significantly associated with depressive symptoms and sleep disturbance. There is a high prevalence of problematic Internet use, depression and sleep disturbance among high school students in southern China, and problematic Internet use and depressive symptoms are strongly associated with sleep disturbance. This study provides evidence that problematic Internet use and depression have partially mediating effects on sleep disturbance. These results are important for clinicians and policy makers with useful information for prevention and intervention efforts.


Loneliness as the Cause and the Effect of Problematic Internet Use: The Relationship between Internet Use and Psychological Well-Being (2009)

CyberPsychology & Behavior. July 2009, 12(4): 451-455. doi:10.1089/cpb.2008.0327.

The current research started from the assumption that one of the major motives driving individuals' Internet use is to relieve psychosocial problems (e.g., loneliness, depression). This study showed that individuals who were lonely or did not have good social skills could develop strong compulsive Internet use behaviors resulting in negative life outcomes (e.g., harming other significant activities such as work, school, or significant relationships) instead of relieving their original problems. Such augmented negative outcomes were expected to isolate individuals from healthy social activities and lead them into more loneliness. Even though previous research suggests that social use of the Internet (e.g., social networking sites, instant messaging) could be more problematic than entertainment use (e.g., downloading files), the current study showed that the former did not show stronger associations than the latter in the key paths leading to compulsive Internet use.


Internet Addiction and Relationships with Insomnia, Anxiety, Depression, Stress and Self-Esteem in University Students: A Cross-Sectional Designed Study (2016)

PLoS One. 2016 Sep 12;11(9):e0161126. doi: 10.1371/journal.pone.0161126.

Internet addiction (IA) could be a major concern in university medical students aiming to develop into health professionals. The implications of this addiction as well as its association with sleep, mood disorders and self-esteem can hinder their studies, impact their long-term career goals and have wide and detrimental consequences for society as a whole. The objectives of this study were to: 1) Assess potential IA in university medical students, as well as factors associated with it; 2) Assess the relationships between potential IA, insomnia, depression, anxiety, stress and self-esteem.

Our study was a cross-sectional questionnaire-based survey conducted among 600 students of three faculties: medicine, dentistry and pharmacy at Saint-Joseph University. Four validated and reliable questionnaires were used: the Young Internet Addiction Test, the Insomnia Severity Index, the Depression Anxiety Stress Scales (DASS 21), and the Rosenberg Self Esteem Scale (RSES).

 Potential IA prevalence rate was 16.8% and it was significantly different between males and females, with a higher prevalence in males (23.6% versus 13.9%). Significant correlations were found between potential IA and insomnia, stress, anxiety, depression and self-esteem; ISI and DASS sub-scores were higher and self-esteem lower in students with potential IA.


Association between Internet addiction and depression in Thai medical students at Faculty of Medicine, Ramathibodi Hospital (2017)

PLoS One. 2017 Mar 20;12(3):e0174209. doi: 10.1371/journal.pone.0174209.

A cross-sectional study was conducted at Faculty of Medicine, Ramathibodi Hospital. Participants were first- to fifth-year medical students who agreed to participate in this study. Demographic characteristics and stress-related factors were derived from self-rated questionnaires. Depression was assessed using the Thai version of Patient Health Questionnaire (PHQ-9). A total score of five or greater derived from the Thai version of Young Diagnostic Questionnaire for Internet Addiction was classified as "possible IA".

From 705 participants, 24.4% had possible IA and 28.8% had depression. There was statistically significant association between possible IA and depressio. Logistic regression analysis illustrated that the odds of depression in possible IA group was 1.58 times of the group of normal Internet use. Academic problems were found to be a significant predictor of both possible IA and depression.

IA was likely to be a common psychiatric problem among Thai medical students. The research has also shown that possible IA was associated with depression and academic problems. We suggest that surveillance of IA should be considered in medical schools.


Quality of Life in Medical Students With Internet Addiction (2016)

Acta Med Iran. 2016 Oct;54(10):662-666.

The aim of this study was to examine the quality of life in medical students who suffer from internet addiction. This cross-sectional survey was carried out in Tehran University of Medical Sciences, and a total of 174 fourth-to seventh-year undergraduate medical students were enrolled. 

Mean GPA was significantly lower in the addicted group. It seems that quality of life is lower in the internet addicted medical students; moreover, such students academically perform poorer in comparison with non-addicts. Since internet addiction is increasing at a rapid pace which may provoke considerable academic, psychological and social implications; as a result, it may require screening programs to the immediate finding of such problem to give consultations to prevent unwanted complications.


Factors associated with Internet addiction: Cross-sectional study of Turkish adolescents (2016)

Pediatr Int. 2016 Aug 10. doi: 10.1111/ped.13117.

The aim of this study was to investigate the prevalence of Internet addiction (IA), and the relationship between sociodemographic characteristics, depression, anxiety, attention-deficit-hyperactivity disorder (ADHD) symptoms and IA in adolescents.

This was a cross-sectional school-based study with a representative sample of 468 students aged 12-17 years at the first trimester of the 2013-2014 academic year. Approximately 1.6% of students were identified as having IA, whereas 16.2% had possible IA. There were significant correlations between IA and depression, anxiety, attention disorder and hyperactivity symptoms in adolescents. Smoking was also related to IA. There was no significant relationship between IA and age, sex, body mass index, school type, and SES. Depression, anxiety, ADHD and smoking addiction are associated with PIU in adolescent students. Preventive public health policies targeting the psychological wellbeing of young people are needed.


Potential impact of internet addiction and protective psychosocial factors onto depression among Hong Kong Chinese adolescents - direct, mediation and moderation effects (2016)

Compr Psychiatry. 2016 Oct;70:41-52. doi: 10.1016/j.comppsych.2016.06.011.

Internet addiction (IA) is a risk factor while some psychosocial factors can be protective against depression among adolescents. Mechanisms of IA onto depression in terms of mediations and moderations involving protective factors are unknown and were investigated in this study. A representative cross-sectional study was conducted among Hong Kong Chinese secondary school students (n=9518).

Among males and females, prevalence of depression at moderate or severe level  was 38.36% and 46.13%, and that of IA  was 17.64% and 14.01%, respectively. The high IA prevalence contributes to increased risk of prevalent depression through its direct effect, mediation (reduced level of protective factors) and moderation (reduced magnitude of protective effects) effects. Understanding to mechanisms between IA and depression through protective factors is enhanced. Screening and interventions for IA and depression are warranted, and should cultivate protective factors, and unlink negative impact of IA onto levels and effects of protective factors.


The Dark Side of Internet Use: Two Longitudinal Studies of Excessive Internet Use, Depressive Symptoms, School Burnout and Engagement Among Finnish Early and Late Adolescents (2016)

J Youth Adolesc. 2016 May 2.

Using two longitudinal data waves gathered among 1702 (53 % female) early (age 12-14) and 1636 (64 % female) late (age 16-18) Finnish adolescents, we examined cross-lagged paths between excessive internet use, school engagement and burnout, and depressive symptoms. Structural equation modeling revealed reciprocal cross-lagged paths between excessive internet use and school burnout among both adolescent groups: school burnout predicted later excessive internet use and excessive internet use predicted later school burnout.

Reciprocal paths between school burnout and depressive symptoms were also found. Girls typically suffered more than boys from depressive symptoms and, in late adolescence, school burnout. Boys, in turn, more typically suffered from excessive internet use. These results show that, among adolescents, excessive internet use can be a cause of school burnout that can later spill over to depressive symptoms.


Evidence for an internet addiction disorder: internet exposure reinforces color preference in withdrawn problem users (2016)

J Clin Psychiatry. 2016 Feb;77(2):269-274.

This study examined whether exposure to the Internet could create a preference for colors associated with visited Web sites and explored the possible relationship with self-reported problematic Internet use and Internet deprivation.

100 adult participants were divided into 2 groups; one was deprived access to the Internet for 4 hours, and the other was not. After this period, they were asked to choose a color and complete a series of psychometric questionnaires concerning mood (Positive and Negative Affect Schedule), anxiety (Spielberger State-Trait Anxiety Inventory), and depression (Beck Depression Inventory). They were then given a 15-minute exposure to the Internet, and the Web sites they visited were recorded. They were then asked to again choose a color, complete the same psychometric questionnaires, and complete the Internet Addiction Test.

For Internet-deprived, but not nondeprived, subjects, a reduction of mood and increased anxiety was noted in the higher problematic Internet users following Web cessation. There was also a shift toward choosing the color most prominent on the visited Web sites in these participants. No shift in mood, or toward choosing the dominant Web site color, was seen in the lower problem users.

These findings suggest that the Internet can serve as a negative reinforcer for behavior in higher problem users and that the reinforcement obtained from the alleviation of withdrawal symptoms becomes conditioned, with the color and appearance of the visited Web sites giving them a more positive value.


Problematic Internet Use and Problematic Online Gaming Are Not the Same: Findings from a Large Nationally Representative Adolescent Sample (2014)

Cyberpsychol Behav Soc Netw. 2014 Nov 21.

There is an ongoing debate in the literature whether problematic Internet use (PIU) and problematic online gaming (POG) are two distinct conceptual and nosological entities or whether they are the same. The present study contributes to this question by examining the interrelationship and the overlap between PIU and POG in terms of sex, school achievement, time spent using the Internet and/or online gaming, psychological well-being, and preferred online activities.

Questionnaires assessing these variables were administered to a nationally representative sample of adolescent gamers  Data showed that Internet use was a common activity among adolescents, while online gaming was engaged in by a considerably smaller group. Similarly, more adolescents met the criteria for PIU than for POG, and a small group of adolescents showed symptoms of both problem behaviors.

The most notable difference between the two problem behaviors was in terms of sex. POG was much more strongly associated with being male. Self-esteem had low effect sizes on both behaviors, while depressive symptoms were associated with both PIU and POG, affecting PIU slightly more. POG appears to be a conceptually different behavior from PIU, and therefore the data support the notion that Internet Addiction Disorder and Internet Gaming Disorder are separate nosological entities.


The exacerbation of depression, hostility, and social anxiety in the course of Internet addiction among adolescents: A prospective study (2014)

Compr Psychiatry. 2014 May 17. pii:

In adolescent populations worldwide, Internet addiction is prevalent and is often comorbid with depression, hostility, and social anxiety of adolescents. This study aimed at evaluating the exacerbation of depression, hostility, and social anxiety in the course of getting addiction to Internet or remitting from Internet addiction among adolescents.

This study recruited 2293 adolescents in grade 7 to assess their depression, hostility, social anxiety and Internet addiction. The same assessments were repeated one year later. The incidence group was defined as subjects classified as non-addicted in the first assessment and as addicted in the second assessment. The remission group was defined as subjects classified as addicted in the first assessment and as non-addicted in the second assessment.

Depression and hostility worsen in the addiction process for the Internet among adolescents. Intervention of Internet addiction should be provided to prevent its negative effect on mental health. Depression, hostility, and social anxiety decreased in the process of remission. It suggested that the negative consequences could be reversed if Internet addiction could be remitted within a short duration.                                            

COMMENTS: Study followed students for one year assessing internet addiction and evaluating depression, hostility, and social anxiety. They found internet addiction exacerbates depression, hostility, and social anxiety, while remission from addiction decreases depression, hostility, and social anxiety


Examination of the Correlation Between Internet Addiction and Social Phobia in Adolescents (2016)

West J Nurs Res. 2016 Aug 25. pii: 0193945916665820

This was a descriptive and cross-sectional study conducted with adolescents to examine the correlation between Internet addiction and social phobia. The population of the study consisted of 24,260 students aged between 11 and 15 years.

In this study, 13.7% of the adolescents had an Internet addiction, and 4.2% spent more than 5 hr on the computer every day. There was a positive correlation between Internet addiction and social phobia. The form of time spent on Internet was examined in terms of addiction and social phobia; although Internet addiction was related to games, dating sites, and web surfing, social phobia was related to homework, games, and web surfing.


Longitudinal Associations between Anhedonia and Internet-Related Addictive Behaviors in Emerging Adults (2016)

Comput Human Behav. 2016 Sep;62:475-479.

Internet addiction (including online gaming) has been associated with depression. The purpose of the current study was to examine potential longitudinal associations between anhedonia (i.e., difficulty experiencing pleasure, a key facet of depression) and internet-related addictive behaviors in 503 at-risk emerging adults (former attendees of alternative high schools). Participants completed surveys at baseline and approximately one year later (9-18 months later). Results indicated that trait anhedonia prospectively predicted greater levels of compulsive internet use and addiction to online activities as well as a greater likelihood of addiction to online/offline video games. These findings suggest that anhedonia may contribute to the development of internet-related addictive behaviors in the emerging adult population.


Low empathy is associated with problematic use of the Internet: Empirical evidence from China and Germany (2015)

Asian J Psychiatr. 2015 Jul 6.

As empathy has not been investigated in the context of problematic use of the Internet, we conducted a study to test for a potential link. In samples from China (N=438) and Germany (N=202), two self-report measures for empathic behavior and one self-report measure for problematic Internet use (PIU) were administered in adolescents/students. Across both cultures lower empathy was associated with more PIU. The present study underlines the importance to take into account empathy related questionnaires for a better understanding of Internet overuse in the future.


Screen time is associated with depressive symptomatology among obese adolescents: a HEARTY study (2016)

Eur J Pediatr. 2016 Apr 13.

Obese adolescents spend a disproportionate time in screen-based activities and are at higher risk for clinical depression compared to their normal-weight peers. While screen time is associated with obesity and cardiometabolic risk factors, little is known about the relationship between screen time and mental health. This cross-sectional study examines the association between duration and types of screen time and depressive symptomatology (subclinical symptoms) in a sample of 358 (261 female; 97 male) overweight and obese adolescents aged 14-18 years. . After controlling for age, ethnicity, sex, parental education, body mass index (BMI), physical activity, caloric intake, carbohydrate intake, and intake of sugar-sweetened beverages, total screen time was significantly associated with more severe depressive symptomatology. After adjustment, time spent playing video games and recreational computer time was associated with depressive symptoms, but TV viewing was not.


Screen time may represent a risk factor or marker of depressive symptomatology in obese adolescents. Future intervention research should evaluate whether reducing screen exposure reduces depressive symptoms in obese youth, a population at increased risk for psychological disorders.

What is Known:

  • Screen time is associated with an increased risk of obesity in youth.
  • Screen time is associated with an adverse cardio-metabolic profile in youth.

What is New:

  • Screen time is associated with more severe depressive symptoms in overweight and obese adolescents.
  • Time spent in recreational computer use and playing video games, but not TV viewing, was associated with more severe depressive symptoms in overweight and obese adolescents.


Internet Addiction in High School Students in Turkey and Multivariate Analyses of the Underlying Factors (2016)

J Addict Nurs. 2016 Jan-Mar;27(1):39-46.

The aim of this study is to examine the Internet addiction among adolescents in relation to their sociodemographic characteristics, communication skills, and perceived familial social support. This cross-sectional research is conducted in the high schools in some city centers, in Turkey, in 2013. One thousand seven hundred forty-two students aged between 14 and 20 years were included in the sample.The mean Internet Addiction Scale (IAS) score of the students was found to be 27.9 ± 21.2. According to the scores obtained from IAS, 81.8% of the students were found to display no symptoms (<50 points), 16.9% were found to display borderline symptoms (50-79 points), and 1.3% were found to be Internet addicts (≥80 points).


Factors associated with internet addiction: A cross-sectional study among Turkish adolescents (2016)

Pediatr Int. 2016 Aug 10. doi: 10.1111/ped.13117.

To investigate the prevalence of internet addiction and relationship between socio-demographic characteristics, depression, anxiety, attention-deficit/hyperactivity disorder symptoms, and internet addiction in adolescents.

This was a cross-sectional school-based study with a representative sample of 468 students aged 12-17 years at the first trimester of education year in 2013. About 1.6% were determined as addictive, whereas 16.2% were possible addictive. There were significant correlations between Internet Addiction and depression, anxiety, attention disorder and hyperactivity symptoms in adolescents. Smoking cigarette was also related with internet addiction. There was no significant relationship between IA and the students' age, sex, body-mass index, school type, socio-economic status.


Comparison of the personality and other psychological factors of students with internet addiction who do and do not have associated social dysfunction (2015)

Shanghai Arch Psychiatry. 2015 Feb 25;27(1):36-41.

Compared to persons with internet addiction without accompanying social dysfunction, those with social dysfunction had higher levels of interpersonal sensitivity, hostility, and paranoia; lower levels of social responsibility, anxiety, self-control, and family social support; and they were more likely to employ negative coping strategies. There were however, no differences in perceived parenting styles between the two groups.

A relatively small proportion of individuals who meet the physiological markers of internet addiction simultaneously report significant internet-related social dysfunction. There are several psychosocial measures that distinguish persons with internet addiction who do or do not have concurrent social dysfunction.

COMMENTS: It seems as though a lot of internet addicts do not have social dysfunction.


Pathological Internet Use and Risk-Behaviors among European Adolescents (2016)

Int J Environ Res Public Health. 2016 Mar 8;13(3). pii: E294.

The main objective of this study is to investigate the association between risk-behaviors and PIU in European adolescents.  Data on adolescents were collected from randomized schools within study sites across eleven European countries. Adolescents reporting poor sleeping habits and risk-taking actions showed the strongest associations with PIU, followed by tobacco use, poor nutrition and physical inactivity. Among adolescents in the PIU group, 89.9% were characterized as having multiple risk-behaviors. The significant association observed between PIU and risk-behaviors, combined with a high rate of co-occurrence, underlines the importance of considering PIU when screening, treating or preventing high-risk behaviors among adolescents.


Problem Internet Use and Internet Gaming Disorder: a survey of health literacy among psychiatrists from Australia and New Zealand (2017)

Australas Psychiatry. 2017 Jan 1:1039856216684714.

Research is limited on psychiatrists' opinions on the concepts of Internet Gaming Disorder (IGD) and Problematic Internet Use (PIU). We aimed to assess health literacy among psychiatrists on IGD/PIU. A self-report survey was administered online to members of the Royal Australia and New Zealand College of Psychiatrists (RANZCP) ( n=289).

The majority (93.7%) were familiar with the concepts of IGD/PIU. The majority (78.86%) thought it is possible to be 'addicted' to non-gaming internet content, and 76.12% thought non-gaming addictions could possibly be included in classificatory systems. Forty-eight (35.6%) felt that IGD maybe common in their practice. Only 22 (16.3%) felt they were confident in managing IGD. Child psychiatrists were more likely to screen routinely for IGD and were more likely to elicit specific symptoms of addiction.


Prevalence of Internet Addiction among Schoolchildren in Novi Sad (2015)

Srp Arh Celok Lek. 2015 Nov-Dec;143(11-12):719-25.

The aim of this study was an assessment of the prevalence of Internet use and Internet addiction among school children aged 14-18 years in the Municipality of Novi Sad, Serbia, and influence of sociodemographic variables on Internet use. A cross-sectional study was conducted in Novi Sad among final-year students from elementary and first- and second-year students from high schools.The prevalence of Internet addiction was assessed by using Young's Diagnostic Questionnaire.

Out of 553 participants, 62.7% were females, and the average age was 15.6 years. The sample consisted of 153 elementary school students and 400 high school students. Majority of respondents had a computer in their household. Our study showed widespread Internet use among adolescents. Facebook and YouTube were among most visited web-sites. The main purpose of Internet use was entertainment. Estimated prevalence of Internet addiction was high (18.7%),


A study on the influence of internet addiction and online interpersonal influences on health-related quality of life in young Vietnamese (2017)

BMC Public Health. 2017 Jan 31;17(1):138. doi: 10.1186/s12889-016-3983-z.

Internet addiction (IA) is a common problem found in young Asians. This study aimed to study the influence of IA and online activities on health-related quality of life (HRQOL) in young Vietnamese. This study also compared the frequencies of anxiety, depression and other addiction of young Vietnamese with and without IA.

This study recruited 566 young Vietnamese (56.7% female, 43.3% male) ranging from 15 to 25 years of age via the respondent-driven sampling technique. Results from this cross-sectional study showed that 21.2% of participants suffered from IA. Online relationship demonstrated significantly higher influences on behaviors and lifestyles in participants with IA than those without IA. Participants with IA were more likely to have problems with self-care, difficulty in performing daily routine, suffer from pain and discomfort, anxiety and depression. Contrary to previous studies, we found that there were no differences in gender, sociodemographic, the number of participants with cigarette smoking, water-pipe smoking and alcohol dependence between the IA and non-IA groups. IA was significantly associated with poor HRQOL in young Vietnamese.

IA is a common problem among young Vietnamese and the prevalence of IA is the highest as compared to other Asian countries. Our findings suggest that gender may not play a key role in IA. This can be an emerging trend when both genders have equal access to the internet. By studying the impact of IA on HRQOL, healthcare professionals can design effective intervention to alleviate the negative consequences of IA in Vietnam.



Facebook Role Play Addiction - A Comorbidity with Multiple Compulsive-Impulsive Spectrum Disorders (2016)

J Behav Addict. 2016 May 9:1-5.

 Problematic Internet use (PIU) is an emerging entity with varied contents. Behavioral addictions have high comorbidity of attention deficit hyperactivity disorder and obsessive-compulsive spectrum disorders. Social networking site (SNS) addiction and role playing game (RPG) addiction are traditionally studied as separate entities. We present a case with excessive Internet use, with a particular focus on phenomenology and psychiatric comorbidities.

Fifteen-year-old girl with childhood onset attention deficit disorder, obsessive-compulsive disorder, adolescent onset trichotillomania, and disturbed family environment presented with excessive Facebook use. Main online activity was creating profiles in names of mainstream fictional characters and assuming their identity (background, linguistic attributes, etc.). This was a group activity with significant socialization in the virtual world. Craving, salience, withdrawal, mood modification, and conflict were clearly elucidated and significant social and occupational dysfunction was evident.

This case highlights various vulnerability and sociofamilial factors contributing to behavioral addiction. It also highlights the presence of untreated comorbidities in such cases.


Internet addiction is associated with social anxiety in young adults (2015)

Ann Clin Psychiatry. 2015 Feb;27(1):4-9.

Problematic Internet use or excessive Internet use is characterized by excessive or poorly controlled preoccupations, urges, or behaviors regarding computer use, and Internet access that leads to impairment or distress. Cross-sectional studies on samples of patients reported high comorbidity of Internet addiction with psychiatric disorders, especially affective disorders (including depression), anxiety disorders (generalized anxiety disorder, social anxiety disorder), and attention-deficit/hyperactivity disorder.

We have investigated the association between Internet addiction and social anxiety in 2 samples of 120 university students (60 males and 60 females in each sample).

We found a correlation between Internet addiction and social anxiety in the 2 samples respectively. Secondly, we found no difference between males and females on the level of Internet addiction. Thirdly, we did not find a preference for social networks among participants with high levels of social anxiety. The results of the study support previous evidence for co-occurrence of Internet addiction and social anxiety, but further studies need to clarify this association.


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."


Problematic Internet Use and Its Correlates Among Students from Three Medical Schools Across Three Countries (2015)

Acad Psychiatry. 2015 Jul 1.

The authors aimed to assess and compare problematic internet use among medical students enrolled in a graduate degree course in one school each from Croatia, India, and Nigeria and to assess correlates of problematic use among these students. The questionnaire included a sociodemographic profile of participants and Young's Internet Addiction Test.

The final analysis included 842 subjects. Overall, 38.7 and 10.5 % of respondents scored in the mild and moderate categories. Only a small fraction (0.5 %) of students scored in the severe category. Moreover, a significantly higher proportion of participants who scored above the cutoff used the Internet for browsing, social networking, chatting, gaming, shopping, and viewing pornography. However, there was no difference between the two groups with regard to using the internet for e-mailing or academic activities.


Internet use and addiction among medical students of Universiti Sultan Zainal Abidin, Malaysia (2016)

Psychol Res Behav Manag. 2016 Nov 14;9:297-307

Internet addiction is a widespread phenomenon among students and academicians at universities in Malaysia. Students use the Internet for recreational purpose and personal and professional development. The Internet has become an integral part of day-to-day life of the university students, including medical students. The aim of the present study was to examine the Internet use and addiction among students of Universiti Sultan Zainal Abidin, Malaysia. This was a cross-sectional study in which a questionnaire, Internet Addiction Diagnostic Questionnaire, developed by the Center for Internet Addiction, USA, was used. One hundred forty-nine medical students of Universiti Sultan Zainal Abidin participated in this study.

The mean scores were 44.9±14.05 and 41.4±13.05 for male and female participants, respectively, which indicated that both the genders were suffering from mild Internet addiction.


Prevalence and factors associated with internet addiction among medical students - A cross-sectional study in Malaysia (2017)

Med J Malaysia. 2017 Feb;72(1):7-11.

This study aims to determine the prevalence and factors associated with internet usage among medical students in a public university in Malaysia. This cross-sectional study was performed among all the medical students (Year 1-5). Students were assessed on their internet activities using the internet addiction questionnaires (IAT).

The study was conducted among 426 students. The study population consisted of 156 males (36.6%) and 270 females (63.4%). The mean age was 21.6 ±1.5 years. Ethnicity distribution among the students was: Malays (55.6%), Chinese (34.7%), Indians (7.3%) and others (2.3%). According to the IAT, 36.9% of the study sample was addicted to the internet. Internet addiction is a relatively frequent phenomenon among medical students. The predictors of internet addiction were male students using it for surfing and entertainment purposes.


Self-rated Health and Internet Addiction in Iranian Medical Sciences Students; Prevalence, Risk Factors and Complications (2016)

Int J Biomed Sci. 2016 Jun;12(2):65-70.

Self-rated health is a brief measure for general health. It is a comprehensive and sensitive index for prediction of health in future. Due to the high internet usage in medical students, the current study designed to evaluate the self-rated health (SRH) in relationship with internet addiction risk factors in medical students.

This cross sectional study conducted on 254 students of Qom University of Medical Sciences 2014. More than 79.9% of students reported their general health good and very good. The student's mean score of general health was higher than the average. In addition, the prevalence of internet addiction was 28.7%. An inverse significant correlation observed between SRH and internet addiction score. Using internet for Entertainment, using private Email and chat rooms were the most important predictors of affecting to internet addiction. Moreover, internet addiction is the most predictors of SRH and increased the odds of bad SRH.


A Cross Cultural Study of Mental Health among Internet Addicted and Non-Internet Addicted: Iranian and Indian Students (2016)

Glob J Health Sci. 2016 May 19;9(1):58269.

This cross-sectional study was conducted on 400 students in various colleges from Pune and Mumbai cities of Maharashtra. Internet Addiction Test and Symptom Check List (SCL) 90-R were used. Data were analyzed using SPSS 16.

Internet addicted students were higher on Somatization, Obsessive-compulsive, Interpersonal sensitivity, Depression, Anxiety, Hostility, Phobic anxiety, Paranoid ideation, Psychoticism than Non-internet addicted students (P<0.05). Indian students had higher score on mental health domains compared to Iranian students (P<0.05). Female students had higher scores on Somatization, Obsessive-compulsive, Anxiety, Hostility, Phobic anxiety and Psychoticism than male students (P<0.05).

Psychiatrists and psychologists who are active in the field of mental hygiene must be aware of mental problems associated with Internet addiction such as depression, anxiety, obsession, hypochondria, paranoia, interpersonal sensitivity, and job and educational dissatisfaction among Internet addicts.


Prevalence and risk factors of problematic internet use and the associated psychological distress among graduate students of Bangladesh (2016)

Asian J Gambl Issues Public Health. 2016;6(1):11.

This study aimed to explore socio-demographic and behavioural correlates of PIU and examine its association with psychological distress. A total of 573 graduate students from Dhaka University of Bangladesh responded to a self-administered questionnaire that included internet addiction test (IAT), 12-items General Health Questionnaire and a set of socio-demographic and behavioural factors. The study found that nearly 24% of the participants displayed PIU on the IAT scale. The multiple regression analyses suggested that PIU is strongly associated with psychological distress regardless of all other explanatory variables


The effect of the internet addiction on the information-seeking behavior of the postgraduate students (2016)

Mater Sociomed. 2016 Jun;28(3):191-5. doi: 10.5455/msm.2016.28.191-195.

This study aims to investigate the effect of the internet addiction on the information-seeking behavior of the postgraduate students. The research population composed of 1149 postgraduate students of Isfahan University of Medical Sciences, of which 284 were selected using the stratified random sampling as the sample. Yang's internet addiction questionnaire and the researcher-developed questionnaire of the information-seeking behavior were used as the data collection instruments.

Based on the findings, there was no sign of internet addiction among the 86.6% of the students. However, 13% of the students were exposed to the internet addiction and only 0.4% of internet addiction was observed among the students. There was no significant difference between the information-seeking behavior of the male and female respondents. There was no sign of the internet addiction in any dimension of the information-seeking behavior of the students.


Exploring the association of ego defense mechanisms with problematic internet use in a Pakistani medical school (2016)

Psychiatry Res. 2016 Jul 11;243:463-468.

The present study was designed to analyze association between problematic internet use and use of ego defense mechanisms in medical students. This cross-sectional study was undertaken at CMH Lahore Medical College (CMH LMC) in Lahore, Pakistan from 1st March, 2015 to 30th May, 2015. 522 medical and dental students were included in the study.

Multiple regression analysis was used to delineate ego defenses as predictors of problematic internet use. A total of 32 (6.1%) students reported severe problems with internet usage. Males had higher scores on IAT i.e had more problematic use of internet. Scores on internet addiction test (IAT) were negatively associated with sublimation and positively associated with projection, denial, autistic fantasy, passive aggression and displacement.


Correlation between the Family Function Based on Circumplex Model and Students' Internet Addiction in Shahid Beheshti University of Medical Sciences in 2015 (2016)

Glob J Health Sci. 2016 Mar 31;8(11):56314. doi: 10.5539/gjhs.v8n11p223.

So, this study was conducted aimed to investigate the correlation between the family function based on Circumplex Model and students' Internet addiction in ShahidBeheshti University of Medical Sciences in 2015.

In this correlational study, 664 students were selected by stratified random sampling method. Findings showed, 79.2 percent of students did not have Internet addiction, 20.2 percent were at risk of addiction and 0.6 percent was addicted to the Internet. Female students were the most frequent users of the Internet among students (41.47% and p < 0.01) with the purpose of recreation and entertainment (79.5 percent). A significant negative correlation was seen between Internet addiction and cohesion (a family function aspect) (p<0.01), also a positive and significant relationship was seen between average time of using Internet every time, average weekly hours of Internet use and Internet addiction (p>0.01).


Maybe you should blame your parents: Parental attachment, gender, and problematic Internet use (2016)

J Behav Addict. 2016 Aug 24:1-5.

Prior research has generally established parental attachment as a predictor of problematic Internet use (PIU). An anonymous survey was completed by 243 undergraduate students in a public university in the U.S. Midwest. In addition to demographic information, the survey contained measurement scales to assess PIU and parental attachment (both maternal and paternal). Survey data show that (a) attachment anxiety, but not attachment avoidance, is significantly related to PIU and (b) gender significantly moderates this relationship, where paternal attachment anxiety leads to PIU in female students while maternal attachment anxiety contributes to PIU in male students.


Parenting approaches family functionality and internet addiction among Hong Kong adolescents (2016)

BMC Pediatr. 2016 Aug 18;16:130. doi: 10.1186/s12887-016-0666-y.

Internet addiction (IA) among adolescents has become a global health problem, and public awareness of it is increasing. Many IA risk factors relate to parents and the family environment. This study examined the relationship between IA and parenting approaches and family functionality.

A cross-sectional study was conducted with 2021 secondary students to identify the prevalence of IA and to explore the association between adolescent IA and familial variables, including parents' marital status, family income, family conflict, family functionality, and parenting approaches.

The results revealed that 25.3 % of the adolescent respondents exhibited IA, and logistic regression positively predicted the IA of adolescents from divorced families, low-income families, families in which family conflict existed, and severely dysfunctional families. Interestingly, adolescents with restricted Internet use were almost 1.9 times more likely to have IA than those whose use was not restricted.


No site unseen: predicting the failure to control problematic Internet use among young adults (2016)

Cogn Behav Ther. 2016 Jul 18:1-5.

Problematic Internet use has been associated with the neglect of valued activities such as work, exercise, social activities, and relationships. In the present study, we expanded the understanding of problematic Internet use by identifying an important predictor of the inability to curb Internet use despite the desire to do so. Specifically, in a college student sample reporting a mean of 27.8 h of recreational Internet use in the past week, we investigated the role of distress intolerance (DI)-an individual difference variable that refers to the inability of an individual to tolerate emotional discomfort and to engage in goal-directed behavior when distressed-to predict the failure to meet personal restrictions on Internet use. Consistent with hypotheses, DI emerged as a significant predictor of the failure to meet self-control goals in both bivariate and multivariate models, indicating that DI offers unique prediction of self-control failure with problematic Internet use. Given that DI is a modifiable trait, these results encourage consideration of DI-focused early intervention strategies.


Internet addiction and its determinants among medical students (2015)

Ind Psychiatry J. 2015 Jul-Dec;24(2):158-62. doi: 10.4103/0972-6748.181729.

The study was designed to evaluate the prevalence of internet addiction and its determinants among medical students.

We found prevalence of internet addiction among medical students to be 58.87% (mild - 51.42%, moderate -7.45%) and significantly associated factors with internet addiction being male gender, staying in private accommodation, lesser age of first internet use, using mobile for internet access, higher expenditure on internet, staying online for longer time, and using internet for social networking, online videos, and watching website with sexual content.


Internet Addiction among Iranian Adolescents: a Nationwide Study. (2014)

Acta Med Iran. 2014 Jun;52(6):467-72.

In Iran, despite the very high speed rate of Internet spread, there is not enough data on the rate of Internet addiction among the adolescents. This study is the first nationwide study that addresses this issue. Overall 4500 students of high school or pre-college schools were recruited. Two self-rated questionnaires (one demographics and one Young's Internet addiction scale) were filled b the participants.

962 (22.2%) of the study participants were labeled as having "internet addiction." Males were significantly more likely to be an internet addict. Students whose father and/or mother had a doctorate degree were most likely to have Internet addiction. Job engagement of mothers was significantly associated with students' internet addiction, and the least rate of addiction was observed when the mother was a housewife; having no exercise was associated with the highest rate of Internet addiction.


Adolescent Internet Addiction in Hong Kong: Prevalence, Change, and Correlates (2015)

J Pediatr Adolesc Gynecol. 2015 Oct 9. pii:

The prevalence rates of Internet addiction in Hong Kong adolescents ranged from 17% to 26.8% during the high school years. Male students consistently showed a higher prevalence rate of Internet addiction and more Internet addictive behaviors than did female students.

Longitudinal data suggested that while family economic disadvantage served as a risk factor for youth Internet addiction, the effects of family intactness and family functioning were not significant. Students' overall positive youth development and general positive youth development qualities were negatively related to Internet addictive behaviors whereas prosocial attributes had a positive relationship with youth Internet addiction.


Prevalence of internet addiction and associated factors among medical students from mashhad, iran in 2013.

Iran Red Crescent Med J. 2014 May;16(5):e17256.

Problematic internet use is on the increase and has caused serious problems in many areas. This issue seems to be more important for medical students.This study was designed to explore the prevalence of internet addiction and its related factors among the students of Mashhad University of Medical Sciences.

It was found that 2.1% of the studied population were at risk and 5.2% were addicted users. Chatting with new people, communicating with friends and families, and playing games were the most popular activities in these groups.


Investigation on Internet addiction disorder in adolescents in Anhui, People's Republic of China ()

Neuropsychiatr Dis Treat. 2016 Aug 29;12:2233-6. doi: 10.2147/NDT.S110156. eCollection 2016.

The purpose of this study was to describe the characteristics and prevalence of Internet addiction (IA) in adolescents so as to provide a scientific basis for the communities, schools, and families.


We conducted a survey by randomized cluster sampling on 5,249 students, grades ranging from 7 to 12, in Anhui province, People's Republic of China. The questionnaire consisted of general information and IA test. Chi-square test was used to compare the status of IA disorder (IAD).


In our results, the overall detection rate of IAD and non-IAD in students was 8.7% (459/5,249) and 76.2% (4,000/5,249), respectively. The detection rate of IAD in males (12.3%) was higher than females (4.9%). The detection rate of IAD was statistically different between students from rural (8.2%) and urban (9.3%) areas, among students from different grades, between students from only-child families (9.5%) and non-only-child families (8.1%), and among students from different family types.


Prevalence of IA is high among Chinese adolescents. IAD has more effect on male students, single-child families, single-parent families, and higher grade students. We should take more care of male students, only-child students, and students living with their fathers, and related education should be strengthen for susceptible subjects of IDA.


Internet; addictive behavior; adolescents; health surveys

PMID: 27621633

PMCID: PMC5010169

DOI: 10.2147/NDT.S110156


Time Is Money: The Decision Making of Smartphone High Users in Gain and Loss Intertemporal Choice (2017)

Front Psychol. 2017 Mar 10;8:363. doi: 10.3389/fpsyg.2017.00363.

Although a great number of studies have demonstrated that people affected by substance abuse, pathological gambling, and internet addiction disorder have lower self-control than average, scarcely any study has investigated the decision making of smartphone high users by using a behavioral paradigm. The present study employed an intertemporal task, the Smartphone Addiction Inventory (SPAI) and the Barratt Impulsiveness Scale 11th version (BIS-11) to explore the decision control of smartphone high users in a sample of 125 college students. Participants were divided into three groups according to their SPAI scores. The upper third (69 or higher), middle third (from 61 to 68) and lower third (60 or lower) of scores were defined as high smartphone users, medium users and low users, respectively. We compared the percentage of small immediate reward/penalty choices in different conditions between the three groups. Relative to the low users group, high users and medium users were more inclined to request an immediate monetary reward. These findings demonstrated that smartphone overuse was associated with problematic decision-making, a pattern similar to that seen in persons affected by a variety of addictions.


Problematic smartphone use: A conceptual overview and systematic review of relations with anxiety and depression psychopathology (2016)

J Affect Disord. 2016 Oct 2;207:251-259.

Research literature on problematic smartphone use, or smartphone addiction, has proliferated. However, relationships with existing categories of psychopathology are not well defined. We discuss the concept of problematic smartphone use, including possible causal pathways to such use.
We conducted a systematic review of the relationship between problematic use with psychopathology. Using scholarly bibliographic databases, we screened 117 total citations, resulting in 23 peer-reviewer papers examining statistical relations between standardized measures of problematic smartphone use/use severity and the severity of psychopathology.

Most papers examined problematic use in relation to depression, anxiety, chronic stress and/or low self-esteem. Across this literature, without statistically adjusting for other relevant variables, depression severity was consistently related to problematic smartphone use, demonstrating at least medium effect sizes. Anxiety was also consistently related to problem use, but with small effect sizes. Stress was somewhat consistently related, with small to medium effects. Self-esteem was inconsistently related, with small to medium effects when found. Statistically adjusting for other relevant variables yielded similar but somewhat smaller effects.


Stress and adult smartphone addiction: Mediation by self-control, neuroticism, and extraversion (2017)

Stress Health. 2017 Mar 23. doi: 10.1002/smi.2749.

This study employed descriptive statistics and correlation analysis to examine the influence of stress on smartphone addiction as well as the mediating effects of self-control, neuroticism, and extraversion using 400 men and women in their 20s to 40s followed by structural equation analysis. Our findings indicate that stress had a significant influence on smartphone addiction, and self-control mediates the influence of stress on smartphone addiction. As stress increases, self-control decreases, which subsequently leads to increased smartphone addiction. Self-control was confirmed as an important factor in the prevention of smartphone addiction. Finally, among personality factors, neuroticism, and extraversion mediate the influence of stress on smartphone addiction.


To use or not to use? Compulsive behavior and its role in smartphone addiction (2017)

Transl Psychiatry. 2017 Feb 14;7(2):e1030. doi: 10.1038/tp.2017.1.

Global smartphone penetration has led to unprecedented addictive behaviors. To develop a smartphone use/non-use pattern by mobile application (App) in order to identify problematic smartphone use, a total of 79 college students were monitored by the App for 1 month. The App-generated parameters included the daily use/non-use frequency, the total duration and the daily median of the duration per epoch. We introduced two other parameters, the root mean square of the successive differences (RMSSD) and the Similarity Index, in order to explore the similarity in use and non-use between participants. The non-use frequency, non-use duration and non-use-median parameters were able to significantly predict problematic smartphone use. A lower value for the RMSSD and Similarity Index, which represent a higher use/non-use similarity, were also associated with the problematic smartphone use. The use/non-use similarity is able to predict problematic smartphone use and reach beyond just determining whether a person shows excessive use.


Prevalence and correlates of problematic smartphone use in a large random sample of Chinese undergraduates (2016)

BMC Psychiatry. 2016 Nov 17;16(1):408.

Because the present scenario of problematic smartphone use (PSU) is largely unexplored, in the current study we aimed to estimate the prevalence of PSU and to screen suitable predictors for PSU among Chinese undergraduates in the framework of the stress-coping theory.

A sample of 1062 undergraduate smartphone users was recruited by means of the stratified cluster random sampling strategy between April and May 2015. The Problematic Cellular Phone Use Questionnaire was used to identify PSU. The prevalence of PSU among Chinese undergraduates was estimated to be 21.3%. The risk factors for PSU were majoring in the humanities, high monthly income from the family (≥1500 RMB), serious emotional symptoms, high perceived stress, and perfectionism-related factors (high doubts about actions, high parental expectations).


Comparison of risk and protective factors associated with smartphone addiction and Internet addiction (2015)

J Behav Addict. 2015 Dec;4(4):308-14.

Smartphone addiction is a recent concern that has resulted from the dramatic increase in worldwide smartphone use. This study assessed the risk and protective factors associated with smartphone addiction in college students and compared these factors to those linked to Internet addiction.

The risk factors for smartphone addiction were female gender, Internet use, alcohol use, and anxiety, while the protective factors were depression and temperance. In contrast, the risk factors for Internet addiction were male gender, smartphone use, anxiety, and wisdom/knowledge, while the protective factor was courage.


Incorporation of Mobile Application (App) Measures Into the Diagnosis of Smartphone Addiction.

J Clin Psychiatry. 2017 Jan 31. doi: 10.4088/JCP.15m10310.

Global smartphone expansion has brought about unprecedented addictive behaviors. The current diagnosis of smartphone addiction is based solely on information from clinical interview. This study aimed to incorporate application (app)-recorded data into psychiatric criteria for the diagnosis of smartphone addiction and to examine the predictive ability of the app-recorded data for the diagnosis of smartphone addiction.

The app-incorporated diagnosis, combining both psychiatric interview and app-recorded data, demonstrated substantial accuracy for smartphone addiction diagnosis. In addition, the app-recorded data performed as an accurate screening tool for app-incorporated diagnosis.


Smartphone addiction proneness in relation to sleep and morningness-eveningness in German adolescents (2016)

J Behav Addict. 2016 Aug 8:1-9.

 In this study, the relationships among smartphone addiction, age, gender, and chronotype of German adolescents were examined. Two studies focused on two different measures of smartphone addiction. The Smartphone Addiction Proneness Scale (SAPS) was applied to 342 younger adolescents (13.39 ± 1.77; 176 boys, 165 girls, and 1 not indicated) in Study 1 and the Smartphone Addiction Scale was applied to 208 older adolescents (17.07 ± 4.28; 146 girls and 62 boys) in Study 2, both samples in southwest Germany. In addition, a demographic questionnaire and the Composite Scale of Morningness (CSM) and sleep measures were implemented.

The most remarkable result of this study was that morningness-eveningness (as measured by CSM scores) is an important predictor for smartphone addiction; even stronger than sleep duration. Evening oriented adolescents scored higher on both smartphone addiction scales. In addition, gender is an important predictor for smartphone addiction and girls are more prone to become addicted. In addition, while sleep duration on weekdays negatively predicted SAPS, age, sleep duration on weekends, and midpoint of sleep on weekdays and weekends did not predicted smartphone addiction in both scales. T


Personality Factors Predicting Smartphone Addiction Predisposition Behavioral Inhibition and Activation Systems Impulsivity and Self Control (2016)

PLoS One. 2016 Aug 17;11(8):e0159788.

The purpose of this study was to identify personality factor-associated predictors of smartphone addiction predisposition (SAP). Participants were 2,573 men and 2,281 women (n = 4,854) aged 20-49 years (Mean ± SD: 33.47 ± 7.52); participants completed the following questionnaires: the Korean Smartphone Addiction Proneness Scale (K-SAPS) for adults, the Behavioral Inhibition System/Behavioral Activation System questionnaire (BIS/BAS), the Dickman Dysfunctional Impulsivity Instrument (DDII), and the Brief Self-Control Scale (BSCS).

We found that SAP was defined with maximal sensitivity as follows: weekend average usage hours > 4.45, BAS-Drive > 10.0, BAS-Reward Responsiveness > 13.8, DDII > 4.5, and BSCS > 37.4. This study raises the possibility that personality factors contribute to SAP. And, we calculated cut-off points for key predictors. These findings may assist clinicians screening for SAP using cut-off points, and further the understanding of SA risk factors.


Smartphone gaming and frequent use pattern associated with smartphone addiction (2016)

Medicine (Baltimore). 2016 Jul;95(28):e4068.

The aim of this study was to investigate the risk factors of smartphone addiction in high school students.A total of 880 adolescents were recruited from a vocational high school in Taiwan in January 2014 to complete a set of questionnaires, including the 10-item Smartphone Addiction Inventory, Chen Internet Addiction Scale, and a survey of content and patterns of personal smartphone use.

Of those recruited, 689 students (646 male) aged 14 to 21 and who owned a smartphone completed the questionnaire. Multiple linear regression models were used to determine the variables associated with smartphone addiction.Smartphone gaming and frequent smartphone use were associated with smartphone addiction. Furthermore, both the smartphone gaming-predominant and gaming with multiple-applications groups showed a similar association with smartphone addiction. Gender, duration of owning a smartphone, and substance use were not associated with smartphone addiction.Our findings suggest that smartphone use patterns should be part of specific measures to prevent and intervene in cases of excessive smartphone use.


Smartphone addiction among university students in Riyadh Saudi Arabia.

Saudi Med J. 2016 Jun;37(6):675-83.

This cross-sectional study was conducted in King Saud University, Riyadh, Kingdom of Saudi Arabia between September 2014 and March 2015. An electronic self administered questionnaire and the problematic use of mobile phones (PUMP) Scale were used. 
Out of 2367 study subjects, 27.2% stated that they spent more than 8 hours per day using their smartphones. Seventy-five percent used at least 4 applications per day, primarily for social networking and watching news. As a consequence of using the smartphones, at least 43% had decrease sleeping hours, and experienced a lack of energy the next day, 30% had a more unhealthy lifestyle  (ate more fast food, gained weight, and exercised less), and 25% reported that their academic achievement been adversely affected. There are statistically significant positive relationships among the 4 study variables, consequences of smartphone use (negative lifestyle, poor academic achievement), number of hours per day spent using smartphones, years of study, and number of applications used, and the outcome variable score on the PUMP. The mean values of the PUMP scale were 60.8 with a median of 60. 


Dependency on Smartphone Use and Its Association with Anxiety in Korea.

Public Health Rep. 2016 May-Jun;131(3):411-9.

South Korea has the highest rate of smartphone ownership worldwide, which is a potential concern given that smartphone dependency may have deleterious effects on health. We investigated the relationship between smartphone dependency and anxiety. Participants included 1,236 smartphone-using students (725 men and 511 women) from six universities in Suwon, South Korea.

On a scale from 25 to 100, with higher scores on the smartphone dependency test indicating greater dependency, women were significantly more dependent on smartphones than were men (mean smartphone dependency score: 50.7 vs. 56.0 for men and women, respectively, p<0.001). However, the amount of time spent using smartphones and the purpose of smartphone use affected smartphone dependency in both men and women. Particularly, when daily use time increased, smartphone dependency showed an increasing trend. Compared with times of use <2 hours vs. ≥6 hours, men scored 46.2 and 56.0 on the smartphone dependency test, while women scored 48.0 and 60.4, respectively (p<0.001). Finally, for both men and women, increases in smartphone dependency were associated with increased anxiety scores. With each one-point increase in smartphone dependency score, the risk of abnormal anxiety in men and women increased by 10.1% and 9.2%, respectively (p<0.001).


Smartphone use and smartphone addiction among young people in Switzerland (2015)

J Behav Addict. 2015 Dec;4(4):299-307.

This study investigated indicators of smartphone use, smartphone addiction, and their associations with demographic and health behaviour-related variables in young people. A convenience sample of 1,519 students from 127 Swiss vocational school classes participated in a survey assessing demographic and health-related characteristics as well as indicators of smartphone use and addiction.

Smartphone addiction occurred in 256 (16.9%) of the 1,519 students. Longer duration of smartphone use on a typical day, a shorter time period until first smartphone use in the morning, and reporting that social networking was the most personally relevant smartphone function were associated with smartphone addiction. Smartphone addiction was more prevalent in younger adolescents (15-16 years) compared with young adults (19 years and older), students with both parents born outside


Problematic internet use in Japan: current situation and future issues (2014)

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i68.

The Internet was originally designed to facilitate communication and research activities. However, there has been a dramatic increase in the use of the Internet in recent years for commerce, education, and entertainment, including video games. Problematic Internet use is a significant behavioral problem.Behavioral addictions can induce symptoms similar to substance-related addictions such as excessive use, loss of control, craving, tolerance, and negative repercussions. These negative repercussions can range from poor achievement and social isolation to dysfunction in the family unit and even greater rates of intimate partner violence.                                                                                                                  

Though there has been relatively little research on the neurobiology of behavioral addictions, studies mostly involving pathological gambling have suggested parallels with substance-related addictions. Social isolation has increasingly become a problem in Japan and has been hypothesized to be related to internet addiction. Particularly amongst students, problematic internet use may be a major factor of social withdrawal.

Internet addiction: Prevalence and relationship with mental states in adolescents (2016)

Psychiatry Clin Neurosci. 2016 May 14. doi: 10.1111/pcn.12402.

Internet addiction disrupts the daily lives of adolescents. We investigated the prevalence of Internet addiction in junior high school students, elucidated the relationship between Internet addiction and mental states, and determined the factors associated with Internet addiction in adolescents.

Junior high school students (age, 12-15 years) were assessed using Young's Internet Addiction Test (IAT), the Japanese version of General Health Questionnaire (GHQ), and a questionnaire on access to electric devices.

Based on total IAT scores, 2.0% (male, 2.1%; female, 1.9%) and 21.7% (male, 19.8%; female, 23.6%) of the total 853 participants were classified as Addicted and Possibly-addicted, respectively. Total GHQ scores were significantly higher in the Addicted (12.9 ± 7.4) and Possibly-addicted groups (8.8 ± 6.0) than in the Non-addicted group (4.3  4.6; P < 0.001, both groups). Comparison of the percentage of students in the pathological range of GHQ scores revealed significantly higher scores in the Possibly-addicted group than in the Non-addicted group. Further, accessibility to smartphones was significantly associated with Internet addiction.


Risk and protective factors of internet addiction: a meta-analysis of empirical studies in Korea (2014)

Yonsei Med J. 2014 Nov 1;55(6):1691-711.

A meta-analysis of empirical studies performed in Korea was conducted to systematically investigate the associations between the indices of Internet addiction (IA) and psychosocial variables.

Specifically, IA demonstrated a medium to strong association with "escape from self" and "self-identity" as self-related variables. "Attention problem", "self-control", and "emotional regulation" as control and regulation-relation variables; "addiction and absorption traits" as temperament variables; "anger" and "aggression" as emotion and mood and variables; "negative stress coping" as coping variables were also associated with comparably larger effect sizes. Contrary to our expectation, the magnitude of the correlations between relational ability and quality, parental relationships and family functionality, and IA were found to be small. The strength of the association between IA and the risk and protective factors was found to be higher in younger age groups.

Comments: Unexpectedly, the correlations between quality of relationships and Internet addiction were small.


Prevalence, correlates, psychiatric comorbidities, and suicidality in a community population with problematic Internet use (2016)

Psychiatry Res. 2016 Jul 14;244:249-256. doi: 10.1016/j.psychres.2016.07.009.

We examined the prevalence, correlates, and psychiatric comorbidities of community-dwelling subjects with problematic Internet use (PIU). In an epidemiological survey of mental disorders among Korean adults conducted in 2006, 6510 subjects (aged 18-64 years)

The prevalence of PIU was 9.3% in the general population of South Korea. Being male, younger, never married, or unemployed were all associated with increased risks of PIU. Significant positive associations were observed between PIU and nicotine use disorders, alcohol use disorders, mood disorders, anxiety disorders, somatoform disorders, pathological gambling, adult type ADHD symptoms, sleep disturbances, suicide ideas and suicide plans compare to subjects without PIU, after controlling for socio-demographic variables.


Sleep problems and internet addiction among children and adolescents: a longitudinal study.

J Sleep Res. 2016 Feb 8. doi: 10.1111/jsr.12388.

Although the literature has documented associations between sleep problems and internet addiction, the temporal direction of these relationships has not been established. The purpose of this study is to evaluate the bidirectional relationships between sleep problems and internet addiction among children and adolescents longitudinally. A four-wave longitudinal study was conducted with 1253 children and adolescents in grades 3, 5 and 8 from March 2013 to January 2014.

 Based on the results of time-lag models, dyssomnias, especially early and middle insomnias, sequentially predicted internet addiction, and internet addiction sequentially predicted disturbed circadian rhythm regardless of adjustment for gender and age. This is the first study to demonstrate the temporal relationship of early and middle insomnia predicting internet addiction, which subsequently predicts disturbed circadian rhythm. These findings imply that treatment strategies for sleep problems and internet addiction should vary according to the order of their occurrence.


Psychosocial risk factors associated with internet addiction in Korea (2014)

Psychiatry Investig. 2014 Oct;11(4):380-6.

The aim of this study was to examine the prevalence of Internet addiction in middle school students and to identify associated psychosocial risk factors and depression.

The subjects consisted of addicted users (2.38%), over users (36.89%) and normal Internet users (60.72%). Attention problems, sex, delinquent problems, K-CDI scores, thought problems, age and aggressive behavior were predictable variables of internet addiction. Age of initial Internet use negatively predicted Internet addiction.

This result showed similar to other researches about sociodemographic, emotional or behavioral factors related to internet addiction. Generally, subjects with more severe internet addiction had more emotional or behavioral problems.


Exploring depression, self-esteem and verbal fluency with different degrees of internet addiction among Chinese college students (2016)

Compr Psychiatry. 2016 Oct 15;72:114-120. doi: 10.1016/j.comppsych.2016.10.006.

The aims of this study were to explore depression, self-esteem and verbal fluency functions among normal internet users, mild internet addictions and severe internet addictions.

The survey sample consisted of 316 college students, and their internet addiction symptoms, depression and self-esteem symptoms were assessed using the Revised Chen Internet Addiction Scale (CIAS-R), Zung Self-Rating Depression Scale (ZSDS), Rosenberg Self-Esteem Scale (RSES), respectively. From this sample, 16 students with non-addictions, 19 students with mild internet addiction (sub-MIA) and 15 students with severe internet addiction (sub-SIA) were recruited and subjected to the classical verbal fluency tests, including the semantic and phonemic fluency task. The results indicated that severe internet addiction in the survey sample showed the highest tendency towards depressive symptoms and lowest self-esteem scores, and sub-SIA showed poor performance on the semantic fluency task.


Frequency of Internet addiction and development of social skills in adolescents in an urban area of Lima (2017)

Medwave. 2017 Jan 30;17(1):e6857. doi: 10.5867/medwave.2017.01.6857.

The degree of social skills and level of internet use was evaluated in adolescents from 10 to 19 years of 5th to 11th grades in two secondary schools in the town of Condevilla. Classrooms were randomly selected, and the questionnaires were applied to all adolescents. Two questionnaires were applied: Scale for Internet Addiction of Lima to determine the extent of Internet use, and the Social Skills Test from the Ministry of Health of Peru, which evaluates self-esteem, assertiveness, communication and decision-making. The analyses by Chi2 test and Fisher's exact test, as well as a generalized linear model (GLM) were performed using the binomial family.

Both questionnaires were applied to 179 adolescents, of whom 49.2% were male. The main age was 13 years, 78.8% of which were in secondary school. Internet addiction was found in 12.9% of respondents, of whom the majority were male (78.3%) and had a higher prevalence of low social skills (21.7%). In adolescents, there is a relationship between internet addiction and low social skills, among which the area of communication is statistically significant.


Problematic Internet use was more common in Turkish adolescents with major depressive disorders than controls.

Acta Paediatr. 2016 Feb 5. doi: 10.1111/apa.13355.

This study compared problematic Internet use (PIU) rates in 12 to 18 year olds with major depressive disorder (MDD) and healthy controls and explored potential links between PIU and suicide among MDD patients.

The study sample consisted of 120 MDD patients (62.5% girls) and 100 controls (58% girls) with a mean age of 15. Suicide ideation and suicide attempts were evaluated and sociodemographic data were collected. In addition, the Children's Depression Inventory, Young Internet Addiction Test and Suicide Probability Scale were applied.

The results showed that PIU rates were significantly higher in the MDD cases than the controls  The analysis of covariance results showed that there was no relationship between potential suicide and the Young Internet Addiction Test score in MDD cases. However, the hopelessness subscale scores of the MDD patients with PIU were significantly higher than the scores of those without PIU.


Psychopathological factors associated with problematic alcohol and problematic Internet use in a sample of adolescents in Germany (2016).

Psychiatry Res. 2016 Apr 22;240:272-277. doi: 10.1016/j.psychres.2016.04.057.

o our knowledge, this is the first investigation assessing psychopathological factors for both problematic alcohol and problematic Internet use in the same sample of adolescents. We surveyed a sample of 1444 adolescents in Germany regarding problematic alcohol use, problematic Internet use, psychopathology and psychological well-being. We conducted binary logistic regression analyses. 5.6% of the sample showed problematic alcohol use, 4.8% problematic Internet use, and 0.8% both problematic alcohol and problematic Internet use. Problematic alcohol use was higher in adolescents with problematic Internet use compared to those without problematic Internet use. Conduct problems and depressive symptoms were statistically significant associated with both problematic alcohol and problematic Internet use.


Prevalence of problematic internet use in Slovenia (2016)

Zdr Varst. 2016 May 10;55(3):202-211.

Problematic Internet Use Questionnaire (PIUQ) was included in European Health Interview Study (EHIS) on representative Slovenian sample. The frequency of Internet use and problematic Internet use were both assessed.

3.1% of Slovenian adult population are at risk of becoming problematic Internet users, whereas 3 out of 20 Slovenian adolescents aged from 18 to 19 years are at risk (14.6%). Prevention programs and treatment for those affected are paramount, especially for the young generation.


Positive metacognitions about Internet use: The mediating role in the relationship between emotional dysregulation and problematic use.

Addict Behav. 2016 Apr 4;59:84-88.

The present study hypothesized that two specific positive metacognitions about Internet use (i.e. the belief that Internet use is useful in regulating negative emotions and the belief that it affords greater controllability) mediate the association between emotional dysregulation and problematic Internet use (PIU). Variables accounted for 46% of the variance in PIU levels. A partial mediation model in which emotional dysregulation predicted PIU levels through positive metacognitions associated with Internet use was found. The presence of a direct relationship between emotional dysregulation and PIU was also detected. Moreover, the study found that emotional dysregulation might drive symptoms of PIU to a greater extent than high negative emotionality.


Epidemiology of Internet Behaviors and Addiction Among Adolescents in Six Asian Countries (2014)

Cyberpsychol Behav Soc Netw. 2014 Nov;17(11):720-728.

A total of 5,366 adolescents aged 12-18 years were recruited from six Asian countries: China, Hong Kong, Japan, South Korea, Malaysia, and the Philippines. Participants completed a structured questionnaire on their Internet use in the 2012-2013 school year.

Internet addiction was assessed using the Internet Addiction Test (IAT) and the Revised Chen Internet Addiction Scale (CIAS-R). The variations in Internet behaviors and addiction across countries were examined.

  • The overall prevalence of smartphone ownership is 62%, ranging from 41% in China to 84% in South Korea.
  • Moreover, participation in online gaming ranges from 11% in China to 39% in Japan.
  • Hong Kong has the highest number of adolescents reporting daily or above Internet use (68%).
  • Internet addiction is highest in the Philippines, according to both the IAT (5%) and the CIAS-R (21%).


Multi-family group therapy for adolescent Internet addiction: Exploring the underlying mechanisms (2014)

Addict Behav. 2014 Oct 30;42C:1-8. doi: 10.1016/j.addbeh.2014.10.021.

Internet addiction is one of the most common problems among adolescents and effective treatment is needed. This research aims to test the effectiveness and underlying mechanism of multi-family group therapy (MFGT) to reduce Internet addiction among adolescents.

A total of 92 participants consisting of 46 adolescents with Internet addiction, aged 12-18years, and 46 their parents, aged 35-46years, were assigned to the experimental group (six-session MFGT intervention) or a waiting-list control.

The six-session multi-family group therapy was effective in reducing Internet addiction behaviors among adolescents and could be implemented as part of routine primary care clinic services in similar populations.


The impact of sensation seeking on the relationship between attention deficit/hyperactivity symptoms and severity of Internet addiction risk.

Psychiatry Res. 2015 May 1. pii: S0165-1781(15)00243-7.

The aim of this study was to investigate the relationship of attention deficit/hyperactivity symptoms (ADHS) with severity of Internet addiction risk (SIAR), while controlling the effects of variables such as depression, anxiety, anger, sensation seeking and lack of assertiveness among university students. The participants were classified into the two groups as those with high risk of Internet addiction (HRIA) (11%) and those with low risk of Internet addiction (IA) (89%).  Lastly, a hierarchical regression analysis suggested that severity of sensation seeking and ADHS, particularly attention deficiency, predicted SIAR.


Exploring personality characteristics of Chinese adolescents with internet-related addictive behaviors: Trait differences for gaming addiction and social networking addiction (2014)

Addict Behav. 2014 Nov 1;42C:32-35.

This study investigated the associations between personality traits, based on the Big Five model, and addictive behaviors to different online activities among adolescents. A sample of 920 participants was recruited from four secondary schools in different districts using random cluster sampling.

The results demonstrated a significant difference in personality traits for addictive behaviors related to different online activities. Specifically, higher neuroticism and less conscientiousness displayed significant associations with internet addiction in general; less conscientiousness and low openness were significantly associated with gaming addiction; and neuroticism and extraversion were significantly associated with social networking addiction.


Big five personality and adolescent Internet addiction: The mediating role of coping style (2016)

Addict Behav. 2016 Aug 12;64:42-48. doi: 10.1016/j.addbeh.2016.08.009.

This study examined the unique associations between big five personality traits and adolescent Internet addiction (IA), as well as the mediating role of coping style underlying these relations. Our theoretical model was tested with 998 adolescents. 

After controlling for demographic variables, it was found that agreeableness and conscientiousness were negatively associated with IA, whereas extraversion, neuroticism, and openness to experience were positively associated with IA. Mediation analyses further indicated that conscientiousness had an indirect impact on adolescent IA through decreased emotion-focused coping, whereas extraversion, neuroticism, openness to experience had indirect impacts on adolescent IA through increased emotion-focused coping. In contrast, problem-focused coping had no mediating role.


Experiential Avoidance and Technological Addictions in Adolescents (2016)

J Behav Addict. 2016 Jun;5(2):293-303.

The relationship of ICT use and experiential avoidance (EA), a construct that has emerged as underlying and transdiagnostic to a wide variety of psychological problems, including behavioral addictions, is examined. EA refers to a self-regulatory strategy involving efforts to control or escape from negative stimuli such as thoughts, feelings, or sensations that generate strong distress. This strategy, which may be adaptive in the short term, is problematic if it becomes an inflexible pattern. A total of 317 students of the Spanish southeast between 12 and 18 years old were recruited to complete a questionnaire that included questions about general use of each ICTs, an experiential avoidance questionnaire, a brief inventory of the Big Five personality traits, and specific questionnaires on problematic use of the Internet, mobile phones, and video games. Correlation analysis and linear regression showed that EA largely explained results regarding the addictive use of the Internet, mobile phones, and video games, but not in the same way. As regards gender, boys showed a more problematic use of video games than girls. Concerning personality factors, conscientiousness was related to all addictive behaviors.


Pathological Buying Online as a Specific Form of Internet Addiction: A Model-Based Experimental Investigation.

PLoS One. 2015 Oct 14;10(10):e0140296.

The study aimed to investigate different factors of vulnerability for pathological buying in the online context and to determine whether online pathological buying has parallels to a specific Internet addiction. According to a model of specific Internet addiction by Brand and colleagues, potential vulnerability factors may consist of a predisposing excitability from shopping and as mediating variable, specific Internet use expectancies. Additionally, in line with models on addiction behavior, cue-induced craving should also constitute an important factor for online pathological buying. The theoretical model was tested in this study by investigating 240 female participants with a cue-reactivity paradigm, which was composed of online shopping pictures, to assess excitability from shopping. Craving (before and after the cue-reactivity paradigm) and online shopping expectancies were measured. The tendency for pathological buying and online pathological buying were screened with the Compulsive Buying Scale (CBS) and the Short Internet Addiction Test modified for shopping (s-IATshopping). The results demonstrated that the relationship between individual's excitability from shopping and online pathological buying tendency was partially mediated by specific Internet use expectancies for online shopping. Furthermore, craving and online pathological buying tendencies were correlated and an increase in craving after the cue presentation was observed solely in individuals scoring high for online pathological buying  In line with the model for specific Internet addiction, the study identified potential vulnerability factors for online pathological buying and suggests potential parallels. The presence of craving in individuals with a propensity for online pathological buying emphasizes that this behavior merits potential consideration within the non-substance/behavioral addictions.


Heritability of compulsive Internet use in adolescents (2015)

Addict Biol. 2015 Jan 13. doi: 10.1111/adb.12218.

The participants form a sample that is informative for genetic analyses, allowing the investigation of the causes of individual differences in compulsive Internet use. The internal consistency of the instrument was high and the 1.6-year test-retest correlation in a subsample (n = 902) was 0.55. CIUS scores increased slightly with age. Remarkably, gender did not explain variation in CIUS scores, as mean scores on the CIUS were the same in boys and girls. However, the time spent on specific Internet activities differed: boys spent more time on gaming, whereas girls spent more time on social network sites and chatting.

The heritability estimates were the same for boys and girls: 48 percent of the individual differences in CIUS score were influenced by genetic factors. The remaining variance (52 percent) was due to environmental influences that were not shared between family members.


Internet Addiction and Attention Deficit Hyperactivity Disorder Among Schoolchildren (2015)

Isr Med Assoc J. 2015 Dec;17(12):731-4.

Use of the internet and videogames by children and adolescents has risen dramatically over the last decade. Increasing evidence of internet and videogame addiction among children is causing concern due to its harmful physical, emotional and social consequences. There is also emerging evidence for an association between computer and videogame addiction and attention deficit/hyperactivity disorder (ADHD).

We compared 50 male schoolchildren, mean age 13 years, diagnosed with ADHD to 50 male schoolchildren without ADHD on measures of internet addiction, internet use and sleep patterns.

Children with ADHD had higher scores on the Internet Addiction Test (IAT), used the internet for longer hours, and went to sleep later than those without ADHD. These findings indicate an association of ADHD, sleep disorders and internet/videogame addiction.


Social skills deficits and their association with Internet addiction and activities in adolescents with attention-deficit/hyperactivity disorder (2017)

J Behav Addict. 2017 Mar 1:1-9. doi: 10.1556/2006.6.2017.005

The aims of this study were to examine the association between social skills deficits and Internet addiction and activities in adolescents with attention-deficit/hyperactivity disorder (ADHD) as well as the moderators for this association.  A total of 300 adolescents, aged between 11 and 18 years, who had been diagnosed with ADHD participated in this study. Their Internet addiction levels, social skills deficits, ADHD, parental characteristics, and comorbidities were assessed. The various Internet activities that the participants engaged in were also examined.

The associations between social skills deficits and Internet addiction and activities and the moderators of these associations were examined using logistic regression analyses. Social skills deficits were significantly associated with an increased risk of Internet addiction after adjustment for the effects of other factors. Social skills deficits were also significantly associated with Internet gaming and watching movies.


Internet addiction and self-evaluated attention-deficit hyperactivity disorder traits among Japanese college students (2016)

Psychiatry Clin Neurosci. 2016 Aug 30. doi: 10.1111/pcn.12454.

Internet addiction (IA), also referred to as Internet use disorder, is a serious problem all over the world, especially in Asian countries. Severe IA in students may be linked to academic failure, attention-deficit hyperactivity disorder (ADHD), and forms of social withdrawal, such as hikikomori. In this study, we performed a survey to investigate the relation between IA and ADHD symptoms among college students.

Out of 403 subjects, 165 were male. The mean age was 18.4 ± 1.2 years, and mean total IAT score was 45.2 ± 12.6. One hundred forty-eight respondents (36.7%) were average Internet users (IAT < 40), 240 (59.6%) had possible addiction (IAT 40-69), and 15 (3.7%) had severe addiction (IAT ≥ 70). Mean length of Internet use was 4.1 ± 2.8 h/day on weekdays and 5.9 ± 3.7 h/day on the weekend. Females used the Internet mainly for social networking services while males preferred online games. Students with a positive ADHD screen scored significantly higher on the IAT than those negative for ADHD screen (50.2 ± 12.9 vs 43.3 ± 12.0).


The association of Internet addiction symptoms with impulsiveness, loneliness, novelty seeking and behavioral inhibition system among adults with attention-deficit/hyperactivity disorder (ADHD). (2016)

Psychiatry Res. 2016 Mar 31;243:357-364. doi: 10.1016/j.psychres.2016.02.020.

The aims of this study were to test the associations of the Internet addiction symptoms with impulsiveness, loneliness, novelty seeking and behavioral inhibition systems among adults with attention-deficit/hyperactivity disorder (ADHD) and adults with non-ADHD. A total of 146 adults aged between 19 and 33 years involved in this study. The results of hierarchical regression analysis indicated that impulsiveness, loneliness, and behavioral inhibition system were significant predictors of Internet addition among adults with ADHD. Higher loneliness was significantly associated with more severe Internet addition symptoms among the non-ADHD group.


Internet addiction in young people (2014)

Ann Acad Med Singapore. 2014 Jul;43(7):378-82.

In our technology-savvy population, mental health professionals are seeing an increasing trend of excessive Internet use or Internet addiction. Researchers in China, Taiwan and Korea have done extensive research in the field of Internet addiction. Screening instruments are available to identify the presence of Internet addiction and its extent. Internet addiction is frequently associated with mental illnesses such as anxiety, depression, conduct disorder and attention deficit hyperactivity disorder (ADHD). future research in this area is needed to address its growing trend and to minimise its negative psychological and social impact on the individuals and their families.


The association of Internet addiction symptoms with anxiety, depression and self-esteem among adolescents with attention-deficit/hyperactivity disorder (2014)

Compr Psychiatry. 2014 Jun 12. pii: S0010-440X(14)00153-9.

The aims of this study were to examine the associations of the severity of Internet addiction symptoms with various dimensions of anxiety (physical anxiety symptoms, harm avoidance, social anxiety, and separation/panic) and depression symptoms (depressed affect, somatic symptoms, interpersonal problems, and positive affect) and self-esteem among adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) in Taiwan.

A total of 287 adolescents aged between 11 and 18 years who had been diagnosed with ADHD participated in this study. The association between the severity of Internet addiction symptoms and anxiety and depression symptoms and self-esteem were examined using multiple regression analyses.

The results indicated that higher physical symptoms and lower harm avoidance scores on the MASC-T, higher somatic discomfort/retarded activity scores on the CES-D, and lower self-esteem scores on the RSES were significantly associated with more severe Internet addiction symptoms.


Multi-dimensional correlates of Internet addiction symptoms in adolescents with attention-deficit/hyperactivity disorder (2014)

Psychiatry Res. 2014 Nov 12. pii: S0165-1781(14)00855-5.

This study examined the associations of the severity of Internet addiction symptoms with reinforcement sensitivity, family factors, Internet activities, and attention-deficit/hyperactivity disorder (ADHD) symptoms among adolescents in Taiwan diagnosed with ADHD. A total of 287 adolescents diagnosed with ADHD and aged between 11 and 18 years participated in this study. Their levels of Internet addiction symptoms, ADHD symptoms, reinforcement sensitivity, family factors, and various Internet activities in which the participants engaged were assessed.

The results indicated that low satisfaction with family relationships was the strongest factor predicting severe Internet addiction symptoms, followed by using instant messaging, watching movies, high Behavioral Approach System (BAS) fun seeking, and high Behavioral Inhibition System scores.

Meanwhile, low paternal occupational SES, low BAS drive, and online gaming were also significantly associated with severe Internet addiction symptoms.


Impaired inhibition and working memory in response to internet-related words among adolescents with internet addiction: A comparison with attention-deficit/hyperactivity disorder (2016)

Psychiatry Res. 2016 Jan 5.

Impairments in response inhibition and working memory functions have been found to be closely associated with internet addiction (IA) symptoms and attention-deficit/hyperactivity disorder (ADHD) symptoms. In this study, we examined response inhibition and working memory processes with two different materials (internet-related and internet-unrelated stimuli) among adolescents with IA, ADHD and co-morbid IA/ADHD.

In comparison to the NC group, subjects with IA, ADHD and IA/ADHD demonstrated impaired inhibition and working memory. In addition, in comparison to internet-unrelated conditions, IA and co-morbid subjects performed worse on the internet-related condition in the Stop trials during the stop-signal task, and they showed better working memory on the internet-related condition in the 2-Back Task. The findings of our study suggest individuals with IA and IA/ADHD may be impaired in inhibition and working memory functions that might be linked to poor inhibition specifically


Internet Addiction Is Related to Attention Deficit but Not Hyperactivity in a Sample of High School Students (2014)

Int J Psychiatry Clin Pract. 2014 Oct 30:1-21.

To assess the effects of attention-deficit/hyperactivity disorder (ADHD) symptom dimensions on Internet addiction (IA) after controlling for Internet usage features among high school students. This study consisted of 640 students (331 females, 309 males) ranging from 14 to 19 years of age.

According to the logistic regression analysis, attention deficit and playing online games were significant predictors of IA in both sexes. Other predictors of IA included: behavioural problems for females, total weekly Internet usage time, and lifelong total Internet use for males. Hyperactivity and other Internet usage features did not predict IA.


Pathological Internet use among European adolescents: psychopathology and self-destructive behaviours (2014)

Eur Child Adolesc Psychiatry. 2014 Jun 3.

Rising global rates of pathological Internet use (PIU) and related psychological impairments have gained considerable attention in recent years. In an effort to acquire evidence-based knowledge of this relationship, the main objective of this study was to investigate the association between PIU, psychopathology and self-destructive behaviours among school-based adolescents in eleven European countries. mean age: 14.9.

Results showed that suicidal behaviours (suicidal ideation and suicide attempts), depression, anxiety, conduct problems and hyperactivity/inattention were significant and independent predictors of PIU.


Self-harm and its association with internet addiction and internet exposure to suicidal thought in adolescents (2016)

J Formos Med Assoc. 2016 May 1. pii: S0929-6646(16)30039-0. doi: 10.1016/j.jfma.2016.03.010.

This study was a cross-sectional survey of students who self-completed a series of online questionnaires including a sociodemographic information questionnaire, questionnaire for suicidality and SH, Chen Internet Addiction Scale (CIAS), Patient Health Questionnaire (PHQ-9), multi-dimensional support scale (MDSS), Rosenberg self-esteem scale (RSES), Alcohol Use Disorder Identification Test-Consumption (AUDIT-C), and questionnaire for substance abuse.

A total of 2479 students completed the questionnaires (response rate = 62.1%). They had a mean age of 15.44 years (range 14-19 years; standard deviation 0.61), and were mostly female (n = 1494; 60.3%). The prevalence of SH within the previous year was 10.1% (n = 250). Among the participants, 17.1% had internet addiction (n = 425) and 3.3% had been exposed to suicidal content on the internet (n = 82). In the hierarchical logistic regression analysis, internet addiction and internet exposure to suicidal thoughts were both significantly related to an increased risk of SH, after controlling for gender, family factors, exposure to suicidal thoughts in the real life, depression, alcohol/tobacco use, concurrent suicidality, and perceived social support.


Relationship of Internet addiction with cognitive style, personality, and depression in university students (2014)

Compr Psychiatry. 2014 May 6. pii: S0010-440X(14)00112-6. doi: 10.1016/j.comppsych.2014.04.025.

The results indicated that 52 (7.2%) of the students had Internet addiction. There were 37 (71.2%) men, 15 (28.8%) women in the addicted group. While the addicted groups' BDI, DAS-A perfectionistic attitude, need for approval,  According to the multiple binary logistic regression analysis, being male, duration of Internet usage, depression, and perfectionistic attitude have been found as predictors for Internet addiction. It has been found that perfectionistic attitude is a predictor for Internet addiction even when depression, sex, duration of Internet were controlled.


Treatment of Internet Addiction with Anxiety Disorders: Treatment Protocol and Preliminary Before After Results Involving Pharmacotherapy and Modified Cognitive Behavioral Therapy (2016)

JMIR Res Protoc. 2016 Mar 22;5(1):e46. doi: 10.2196/resprot.5278.

Individuals addicted to the Internet usually have comorbid psychiatric disorders. Panic disorder (PD) and generalized anxiety disorder (GAD) are prevalent mental disorders, involving a great deal of damage in the patient's life. This open trial study describes a treatment protocol among 39 patients with anxiety disorders and Internet addiction (IA) involving pharmacotherapy and modified cognitive behavioral therapy (CBT).
Before treatment, anxiety levels suggested severe anxiety, with an average score of 34.26 (SD 6.13); however, after treatment the mean score was 15.03 (SD 3.88) (P<.001). A significant improvement in mean Internet addiction scores was observed, from 67.67 (SD 7.69) before treatment, showing problematic internet use, to 37.56 (SD 9.32) after treatment (P<.001), indicating medium Internet use. With respect to the relationship between IA and anxiety, the correlation between scores was .724.


Prevalence of Internet Addiction and Its Association With Psychological Distress and Coping Strategies Among University Students in Jordan.

Perspect Psychiatr Care. 2015 Jan 30. doi: 10.1111/ppc.12102.

The purpose of this study was to measure the prevalence of Internet addiction (IA) and its association with psychological distress and coping strategies among university students in Jordan. A descriptive, cross-sectional, correlational design was used with a random sample of 587 university students in Jordan. The Perceived Stress Scale, Coping Behavior Inventory, and Internet Addiction Test were used.:

The prevalence of IA was 40%. IA was associated with high mental distress among the students. Students who used problem solving were more likely to experience a lower level of IA.


The relationship between addictive use of social media and video games and symptoms of psychiatric disorders A large scale cross sectional study.

Psychol Addict Behav. 2016 Mar;30(2):252-262.

Over the last decade, research into "addictive technological behaviors" has substantially increased. Research has also demonstrated strong associations between addictive use of technology and comorbid psychiatric disorders. In the present study, 23,533 adults (mean age 35.8 years, ranging from 16 to 88 years) participated in an online cross-sectional survey examining whether demographic variables, symptoms of attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, and depression could explain variance in addictive use (i.e., compulsive and excessive use associated with negative outcomes) of two types of modern online technologies: social media and video games. Correlations between symptoms of addictive technology use and mental disorder symptoms were all positive and significant, including the weak interrelationship between the two addictive technological behaviors. Age appeared to be inversely related to the addictive use of these technologies. Being male was significantly associated with addictive use of video games, whereas being female was significantly associated with addictive use of social media. Being single was positively related to both addictive social networking and video gaming. Hierarchical regression analyses showed that demographic factors explained between 11 and 12% of the variance in addictive technology use. The mental health variables explained between 7 and 15% of the variance. The study significantly adds to our understanding of mental health symptoms and their role in addictive use of modern technology, and suggests that the concept of Internet use disorder (i.e., "Internet addiction") as a unified construct is not warranted.


The association between internet addiction and psychiatric co-morbidity: a meta-analysis (2014)

BMC Psychiatry 2014, 14:183  doi:10.1186/1471-244X-14-183

Meta-analyses were conducted on cross-sectional, case-control and cohort studies which examined the relationship between IA and psychiatric co-morbidity. Internet Addiction is significantly associated with alcohol abuse, attention deficit and hyperactivity, depression and anxiety.


Stress moderates the relationship between problematic internet use by parents and problematic internet use by adolescents (2015)

J Adolesc Health. 2015 Mar;56(3):300-6.

Based on the theoretical framework of Problem Behavior and Stress Reduction theories for problematic Internet use (PIU), this study aimed to investigate the relationship between parental PIU and the PIU among adolescents taking into consideration the stress levels of young people.

Of the total 1,098 parent and adolescent dyads with usable information, 263 adolescents (24.0%) and 62 parents (5.7%) could be classified as moderate and severe problematic users of the Internet. There was a significant parent and adolescent PIU relationship; however, this relationship is differentially affected by the stress status of the adolescent. The direct implication of the results is that parental Internet use should also be assessed and included as part of the treatment regime for adolescents.Adolescents; Dyad study; Internet addiction; Parent; Problematic Internet use; Stress


Is excessive online usage a function of medium or activity? An empirical pilot study (2014)

J Behav Addict. 2014 Mar;3

The purpose of the study was to seek a better insight into whether the online medium or the online activity was more important in relation to excessive online use. It is not clear whether those people who spend excessive amounts of time on the Internet are engaged in general Internet or whether excessive Internet use is linked to specific activities.

These results show that time spent with Internet activity is not random and/or generalized, but appears more focused. Attraction or addiction on Internet to one or more specific behavior(s) may be a better way forward in the quest for better understanding excessive human behavior in the online environment.


The impact of digital media on health: children's perspectives (2015)

Int J Public Health. 2015 Jan 20.

Focus groups and interviews were conducted with children between the ages of 9 and 16 in 9 European countries (N = 368).

In this study, children reported several physical and mental health problems without indicating internet addiction or overuse. Physical health symptoms included eye problems, headaches, not eating, and tiredness. For mental health symptoms, children reported cognitive salience of online events, aggression, and sleeping problems. Sometimes they reported these problems within 30 min of technology usage. This suggests that even shorter time usage can cause self-reported health problems for some children.

Parents and teachers should also be informed about the possible physical and mental health issues associated with children's average usage of technology.


Pathological Internet Use Is on the Rise Among European Adolescents.

J Adolesc Health. 2016 Jun 3. pii: S1054-139X(16)30037-4.

Comparable data from two large cross-sectional multicentre, school-based studies conducted in 2009/2010 and 2011/2012 in five European countries (Estonia, Germany, Italy, Romania, and Spain) were used. The Young's Diagnostic Questionnaire was used to assess the prevalence of PIU.

The comparison of the two samples provides evidence that the prevalence of PIU is on the rise (4.01%-6.87%, odds ratio = 1.69, p < .001) except in Germany. Comparison with data on Internet accessibility suggests that the rise in prevalence of adolescent PIU may be a consequence of increased Internet accessibility.

Our findings are the first data to confirm the rise of PIU among European adolescents. They definitively warrant further efforts in the implementation and evaluation of preventive interventions.


The problematic use of Information and Communication Technologies in adolescents by the cross sectional JOITIC study (2016)

BMC Pediatr. 2016 Aug 22;16(1):140. doi: 10.1186/s12887-016-0674-y.

The objective is to determine the prevalence of the problematic use of ICT such as Internet, mobile phones and video games, among adolescents enrolled in mandatory Secondary Education (ESO in Spanish) and to examine associated factors. 5538 students enrolled in years one to four of ESO at 28 schools in the Vallès Occidental region (Barcelona, Spain).

Questionnaires were collected from 5,538 adolescents between the ages of 12 and 20 (77.3 % of the total response), 48.6 % were females. Problematic use of the Internet was observed in 13.6 % of the surveyed individuals; problematic use of mobile phones in 2.4 % and problematic use in video games in 6.2 %. Problematic Internet use was associated with female students, tobacco consumption, a background of binge drinking, the use of cannabis or other drugs, poor academic performance, poor family relationships and an intensive use of the computer. Factors associated with the problematic use of mobile phones were the consumption of other drugs and an intensive use of these devices. Frequent problems with video game use have been associated with male students, the consumption of other drugs, poor academic performance, poor family relationships and an intensive use of these games.


Psychological risk factors of addiction to social networking sites among Chinese smartphone users (2014)

J Behav Addict. 2013 Sep;2(3):

The findings revealed that those who spent more time on SNSs also reported higher addictive tendencies. The findings of this study suggest that, compared to demographics, psychological factors provide a better account for addictive tendencies towards SNSs among Chinese smartphone users in Macau. The three psychological risk factors were low Internet self-efficacy, favorable outcome expectancies, and high impulsivity trait.


The Impact of Internet and PC Addiction In School Performance of Cypriot Adolescents (2013)

Stud Health Technol Inform. 2013;191:90-4.

Data were collected from a representative sample of the adolescent student population of the first and fourth grades of high school. Total sample was 2684 students, 48.5% of them male and 51.5% female. Research material included extended demographics and an Internet security questionnaire, the Young's Diagnostic questionnaire (YDQ), the Adolescent Computer Addiction Test (ACAT). Results indicated that the Cypriot population had comparable addiction statistics with other Greek-speaking populations in Greece; 15.3% of the students were classified as Internet addicted by their YDQ scores and 16.3% as PC addicted by their ACAT scores.


Parental mental health and Internet Addiction in adolescents (2014)

Addict Behav. 2014 Nov 1;42C:20-23. doi: 10.1016/j.addbeh.2014.10.033.

This study aimed to investigate the relationship between parental mental health, particularly depression, and Internet Addiction (IA) among adolescents.

A total of 1098 parent-and-child dyads were recruited and responded to the survey providing usable information. For IA, 263 (24.0%) students could be classified as at risk of moderate to severe IA. About 6% (n=68), 4% (n=43), and 8% (n=87) of parents were categorised to be at risk of moderate to severe depression, anxiety, and stress respectively. Regression analysis results suggested a significant association between parental depression at the level of moderate to severe and IA in adolescents after adjusting for potential confounding factors. On the other hand, no associations between parental anxiety and stress and child's IA were observed.

The result suggested that there was a significant relationship between parental mental health, particularly depression, and the IA status of their children. These results have direct implications on the treatment and prevention of Internet Addiction among young people.


Clinical characteristics and diagnostic confirmation of Internet addiction in secondary school students in Wuhan, China (2014)

Psychiatry Clin Neurosci. 2014 Jun;68(6):471-8. doi: 10.1111/pcn.12153.

Of a total of 1076 respondents (mean age 15.4 ± 1.7 years; 54.1% boys), 12.6% (n = 136) met the YIAT criteria for IAD. Clinical interviews ascertained the Internet addiction of 136 pupils and also identified 20 students (14.7% of IAD group) with comorbid psychiatric disorders. Results from multinomial logistic regression indicated that being male, in grade 7-9, poor relationship between parents and higher self-reported depression scores were significantly associated with the diagnosis of IAD.


The association between suicidality and Internet addiction and activities in Taiwanese adolescents (2013

Compr Psychiatry. 2013 Nov 27

The aims of this cross-sectional study were to examine the associations of suicidal ideation and attempt with Internet addiction and Internet activities in a large representative Taiwanese adolescent population.9510 adolescent students aged 12-18 years were selected using a stratified random sampling strategy in southern Taiwan and completed the questionnaires.  After controlling for the effects of demographic characteristics, depression, family support and self-esteem, Internet addiction was significantly associated with suicidal ideation and suicidal attempt.   Online gaming, MSN, online searching for information, and online studying were associated with an increased risk of suicidal ideation. While online gaming, chatting, watching movies, shopping, and gambling were associated with an increased risk of suicidal attempt, watching online news was associated with a reduced risk of suicidal attempt.                                                                                                                                                              

COMMENTS: Even after controlling for depression, self esteem, family support, and demographics the study found a correlation between internet addiction and suicidal ideation and attempt.


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 relationship of Internet addiction severity with Attention Deficit Hyperactivity Disorder symptoms in Turkish University students; impact of personality traits, depression and anxiety (2014)

Compr Psychiatry. 2014 Apr;55(3):497-503. doi: 10.1016/j.comppsych.2013.11.01

The aim of this study was to investigate the relationship of Internet addiction (IA) with Attention Deficit Hyperactivity Disorder (ADHD) symptoms while controlling the effect of personality traits, depression and anxiety symptoms in Turkish university students.

According to IAS, participants were separated into three groups, namely, moderate/high, mild and without IA groups. The rates of groups were 19.9%, 38.7% and 41.3%, respectively.

The severity of ADHD symptoms has predicted the severity of IA even after controlling the effect of personality traits, depression and anxiety symptoms among Turkish university students. University students with severe ADHD symptoms, particularly hyperactivity/impulsivity symptoms may be considered as a risk group for IA.


Effects of electroacupuncture combined with psychologic interference on anxiety state and serum NE content in the patient of internet addiction disorder (2008)

Zhongguo Zhen Jiu. 2008 Aug;28(8):561-4.

To observe therapeutic effect of electroacupuncture (EA) on internet addiction disorder (lAD) and to preliminarily probe the mechanism.

Forty-seven cases of TAD were randomly divided into a psychotherapy group and an EA plus psychotherapy group. T Changes of score of lAD, score of anxiety self-rating scale (SAS), score of Hamilton anxiety scale (HAMA) and serum norepinephrine (NE) content before and after treatment were observed. The total effective rate was 91.3% in the EA plus psychotherapy group and 59.1% in the psychotherapy group,  Electroacupuncture combined with psychologic interference can significantly improve anxiety state and the mechanism is possibly related with the decrease of NE in the body.


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 "internetaddiction." The objective of this article is to review the research on ADHD as a risk factor for Internetaddiction 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


Personality Disorders in Female and Male College Students With Internet Addiction (2016)

J Nerv Ment Dis. 2016 Jan 5.

Males with IA showed a higher frequency of narcissistic PD, whereas females with IA showed a higher frequency of borderline, narcissistic, avoidant, or dependent PD when compared with those without IA. The high rate of PD among Internet addicts may be associated with the core features of specific PD psychopathology. Sex differences in the PD frequencies among IA individuals provide indications for understanding the psychopathological characteristics of PDs in Internet addicts.


Predictive factors and psychosocial effects of Internet addictive behaviors in Cypriot adolescents (2014)

Int J Adolesc Med Health. 2014 May 6.

A cross-sectional study design was applied among a random sample (n=805) of Cypriot adolescents (mean age: 14.7 years).

Among the study population, the prevalence rates of borderline addictive Internet use (BIU) and addictive Internet use (AIU) were 18.4% and 2%, respectively. Adolescents with BIU had an increased likelihood of concomitantly presenting with abnormal peer relations , conduct problems, hyperactivity and emotional symptoms. Adolescent AIU was significantly associated with abnormal conduct, peer problems, emotional symptoms, and hyperactivity. The determinants of BIU and AIU included accessing the Internet for the purposes of retrieving sexual information and participating in games with monetary awards.

Conclusions: Both BIU and AIU were adversely associated with notable behavioral and social maladjustment among adolescents.


Attention deficit hyperactivity symptoms and internet addiction (2004)

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


The relationship of Internet addiction severity with Attention Deficit Hyperactivity Disorder symptoms in Turkish University students; impact of personality traits, depression and anxiety (2013)

Compr Psychiatry. 2013 Nov 27. pii: S0010-440X(13)00350-7. doi: 10.1016/j.comppsych.2013.11.018.

The aim of this study was to investigate the relationship of Internet addiction (IA) with Attention Deficit Hyperactivity Disorder (ADHD) symptoms while controlling the effect of personality traits, depression and anxiety symptoms in Turkish university students.

The severity of ADHD symptoms has predicted the severity of IA even after controlling the effect of personality traits, depression and anxiety symptoms among Turkish university students. University students with severe ADHD symptoms, particularly hyperactivity/impulsivity symptoms may be considered as a risk group for IA.


The Difference in Comorbidities and Behavioral Aspects between Internet Abuse and Internet Dependence in Korean Male Adolescents (2014)

Psychiatry Investig. 2014 Oct;11(4):

This study examined the differences in psychiatric comorbidities and behavioral aspects in accordance with the severity of Internet addiction in male adolescents. One hundred and twenty-five adolescents from four middle and high schools in Seoul were enrolled in this study. The subjects were divided into non-addict, abuse, and dependence groups according to a diagnostic interview by psychiatrists.

The psychiatric comorbidity distributions were significantly different in the abuse and dependence groups, particularly in terms of attention-deficit hyperactivity disorder and mood disorder items. There were significant differences in seven items between the non-addict and abuse groups, but no differences between subjects in the abuse and dependence groups. Significant differences were observed in three items between the abuse and dependence groups, but there were no significant differences between the non-addict and abuse groups. In terms of behavioral aspects, scores for abusive, sexual, and decreased social interest behaviors were highest in the dependence group, and lowest in the non-addict group. However, the behavioral aspects of decreased interpersonal relationships did not show this difference between groups.


High risk of internet addiction and its relationship with lifetime substance use, psychological and behavioral problems among 10 (th) grade adolescents. (2014)

Psychiatr Danub. 2014 Dec;26(4):330-9.

Cross-sectional online self-report survey conducted in 45 schools from the 15 districts in Istanbul, Turkey. A representative sample of 4957 10(th) grade students was studied between October 2012 and December 2012.

The participants were classified into two groups as those with HRIA (15.96%) and those with lower risk of Internet addiction. The rate of HRIA was higher in the males. The findings indicated that HRIA is related with negative consequences in school, lifetime use of tobacco, alcohol and/or drug, suicidal thoughts, self-harming and delinquent behaviors.


Dysfunctional inhibitory control and impulsivity in Internet addiction (2013)

Psychiatry Res. 2013 Dec 11. pii: S0165-1781(13)00764-6.

The IA group exhibited more trait impulsivity than the healthy control group. They also scored higher for novelty seeking and harm avoidance. The IA group performed more poorly than the healthy control group in a computerized stop signal test, a test for inhibitory function and impulsivity; no group differences appeared for other neuropsychological tests.

The IA group also scored higher for depression and anxiety, and lower for self-directedness and cooperativeness. In conclusion, individuals with IA exhibited impulsivity as a core personality trait and in their neuropsychological functioning.


Is Internet addiction a psychopathological condition distinct from pathological gambling? (2014)

Addict Behav. 2014 Mar 3. pii: S0306-4603(14)00054-9. doi: 10.1016/j.addbeh.2014.02.016.

The behavioural-addiction perspective suggests that Internet addiction (IA) and pathological gambling (PG) could share similar characteristics with substance dependence.

.Despite IA and PG showing similar differences with the control group on the levels of depression, anxiety and global functioning, the two clinical groups showed different temperamental, coping and social patterns. Specifically IA patients compared with the PG patients showed a greater mental and behavioural disengagement associated with an important interpersonal impairment. The two clinical groups shared an impulsive coping strategy and socio-emotional impairments.

Despite IA and PG patients presenting similar clinical symptoms, IA condition was characterised by a more relevant mental, behavioural, and social disengagement compared to PG condition.


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 internetaddiction, 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 parallells addiction withdrawal.


Are Adolescents with Internet Addiction Prone to Aggressive Behavior? The Mediating Effect of Clinical Comorbidities on the Predictability of Aggression in Adolescents with Internet Addiction (2015)

Cyberpsychol Behav Soc Netw. 2015 Apr 22.

Previous studies have reported associations between aggression and Internet addiction disorder (IAD), which has also been linked with anxiety, depression, and impulsiveness. However, the causal relationship between aggression and IAD has thus far not been clearly demonstrated. Three groups were identified based on the Y-IAT: the usual user group (n=487, 68.2%), the high-risk group (n=191, 26.8%), and the Internet addiction group (n=13, 1.8%). The data revealed a linear association between aggression and IAD such that one variable could be predicted by the other. The current findings suggest that adolescents with IAD seem to have more aggressive dispositions than do normal adolescents. If more aggressive individuals are clinically prone to Internet addiction, early psychiatric intervention may contribute to the prevention of IAD.


Effect of Pathological Use of the Internet on Adolescent Mental Health: A Prospective Study (2010)

Arch Pediatr Adolesc Med. 2010 Oct;164(10):901-6.

To examine the effect of pathological use of the Internet on the mental health, including anxiety and depression, of adolescents in China. It is hypothesized that pathological use of the Internet is detrimental to adolescents’ mental health.A prospective study with a randomly generated cohort from the population.

Adolescents aged between 13 and 18 years.

After adjusting for potential confounding factors, the relative risk of depression for those who used the Internet pathologically was about 21⁄2 times that of those who did not exhibit the targeted pathological internet use behaviors. No significant relationship between pathological use of the Internet and anxiety at follow-up was observed.

Results suggested that young people who are initially free of mental health problems but use the Internet pathologically could develop depression as a consequence. These results have direct implications for the prevention of mental illness in young people, particularly in developing countries.

It is hypothesized that pathological use of the Internet is detrimental to the mental health of adolescents such that young people who use the Internet extensively and pathologically would have an increased risk of anxiety and depression.

COMMENTS: One of the rare studies that tract Internet users over time.This study found that Internet use caused depression in adolescents.


Internet abusers associate with a depressive state but not a depressive trait (2013)

Psychiatry Clin Neurosci. 2013 Dec 8. doi: 10.1111/pcn.12124

The present study investigated three issues: (i) whether Internet abusers display a depressive state without a depressive trait; (ii) which symptoms are shared between Internet abuse and depression; and (iii) which personality characteristics were shown in Internet abusers.

Ninety-nine male and 58 female participants aged 18-24 years were screened with the Chen Internet Addiction Scale.

In a comparison of the symptoms of depression and Internet abuse, it was found that high-risk Internet abuse participants shared some common behavioral mechanisms with depression, including the psychiatric symptoms of loss of interest, aggressive behavior, depressive mood, and guilty feelings. High-risk Internet abuse participants may be more susceptible to a temporal depressive state but not a permanent depressive trait.

COMMENTS: Internet addiction was associated with depression states, but not with chronic depression. This means that Internet use is a likely cause of depression. This indicates that depression was not a pre-existing condition



Internet addiction and its correlates among high school students: a preliminary study from Ahmedabad, India (2013)

Asian J Psychiatr. 2013 Dec;6(6):500-5. doi: 10.1016/j.ajp.2013.06.004.

Internet addiction (IA) is an upcoming and less researched entity in psychiatry, especially in low and middle income countries. This is the first such effort to study IA amongst Indian school students of class 11th and 12th and to find its correlation with socio-educational characteristics, internet use patterns and psychological variables, namely depression, anxiety and stress.

Six hundred and twenty one students of six English medium schools of Ahmedabad participated, of which 552 (88.9%) who completed forms were analyzed. Sixty-five (11.8%) students had IA; it was predicted by time spent online, usage of social networking sites and chat rooms, and also by presence of anxiety and stress. Age, gender and self-rated academic performance did not predict IA. There was a strong positive correlation between IA and depression, anxiety and stress.

IA may be a relevant clinical construct, and needs extensive research even in developing nations. All high school students suffering from depression, anxiety and stress must be screened for IA, and vice versa.


A Cross-Sectional Study on the Prevalence, Risk Factors, and Ill Effects of Internet Addiction Among Medical Students in Northeastern India.

Prim Care Companion CNS Disord. 2016 Mar 31;18(2). doi: 10.4088/PCC.15m01909.

The cross-sectional study sample comprised 188 medical students from Silchar Medical College and Hospital (Silchar, Assam, India). Students completed a sociodemographic form and an Internet use questionnaire, both created for this study, and the Young's 20-Item Internet Addiction Test after they received brief instructions. Data were collected during a10-day period in June 2015.

Of the 188 medical students, 46.8% were at increased risk of Internet addiction. Those who were found to be at increased risk had longer years of Internet exposure and always online status. Also, among this group, the men were more prone to develop an online relationship. Excessive Internet usage also led to poor performance in college  and feeling moody, anxious, and depressed.

The ill effects of Internet addiction include withdrawal from real-life relationships, deterioration in academic activities, and a depressed and nervous mood. Internet use for nonacademic purposes is increasing among students, thus there is an immediate need for strict supervision and monitoring at the institutional level. The possibility of becoming addicted to the Internet should be emphasized to students and their parents through awareness campaigns so that interventions and restrictions can be implemented at the individual and family levels.


The relationship of problematic internet use with dissociation among South Korean internet users (2016)

Psychiatry Res. 2016 Apr 30;241:66-71.

This study examined patterns of problematic internet use (PIU) among South Korean internet users to investigate the association between PIU and dissociative experiences. Five hundred and eight participants between 20 and 49 years old were recruited through an online panel survey. Using logistic regression analysis with PIU as the dependent variable, we observed that the participants with PIU were more likely to have alcohol-related behaviors or problems, higher levels of perceived stress, and dissociative experiences.

Participants' scores on the Korean version of the Dissociative Experiences Scale were positively correlated with the severity of PIU. Individuals with PIU and dissociation had more severe PIU and more severe mental-health problems than those with PIU but without dissociation.


Effect of Facebook on the life of Medical University students (2013)

Int Arch Med. 2013 Oct 17;6(1):40.

It was a cross sectional, observational and questionnaire based study conducted in Dow University OF Health Sciences during the period of January 2012 to November 2012. Participants were in the age group of 18--25 years with a mean age of 20.08 years.

Youngsters are willing to compromise their health, social life, studies for the sake of fun and entertainment or whatever satisfaction they get after using Facebook. What we observed in our study was that although majority of our subjects showed multiple signs of Facebook addiction, they don't realize it and if even they realize it they don't want to quit Facebook and even if they want to quit, they can't. Our observance concluded that majority of the users are highly addicted.


Craving Facebook? Behavioral addiction to online social networking and its association with emotion regulation deficits (2014)

Addiction. 2014 Aug 29. doi: 10.1111/add.12713.

Cross-sectional survey study targeting undergraduate students. Associations between disordered online social networking use, internet addiction, deficits in emotion regulation, and alcohol use problems were examined using univariate and multivariate analyses of covariance. Undergraduate students (n=253, 62.8% female, 60.9% white, age M=19.68, SD=2.85), largely representative of the target population. Response rate was 100%.

Disordered online social networking use was present in 9.7% of the sample surveyed, and significantly and positively associated with scores on the Young Internet Addiction Test  greater difficulties with emotion regulation and problem drinking.         The use of online social networking sites is potentially addictive. Modified measures of substance abuse and dependence are suitable in assessing disordered online social networking use. Disordered online social networking use seems to arise as part of a cluster of symptoms of poor emotion regulation skills and heightened susceptibility to both substance and non-substance addiction.


Attention bias in social networking sites-addicted individuals (2014)

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i50.

Numerous studies have revealed that addicted individuals have attention bias related to addictive subjects, however, little is known about the relationship between attention bias and internet addiction. In this study, we have investigated whether social networking sites (SNS)-addicted individuals show attention bias for SNS- related pictures.

Results of t-tests revealed that the SNS-addiction group showed attention bias for SNS stimuli in the 500 ms (t(45) = 2.77, p < .01) condition and not in the 5000 ms condition (t(45) = .22, n.s.), when compared with the non-SNS addiction group. This result suggested that SNS-addicted individuals have attention bias for SNS-related stimuli during attention capture as well as other addictive disorder or dependence (e.g. alcohol or nicotine dependence).


Longitudinal study shows that addictive Internet use during adolescence was associated with heavy drinking and smoking cigarettes in early adulthood (2016)

Acta Paediatr. 2016 Dec 15. doi: 10.1111/apa.13706.

This longitudinal study investigated the association between addictive Internet use during adolescence and heavy drinking and cigarette smoking in early adulthood. We focused on middle school students from the Korea Youth Panel Study who were 16 in 2003:1,804 who did not drink alcohol and 2,277 who did not smoke. Multivariate logistic analysis investigated the relationships between Internet use at the age of 16, with regard to location, time spent and reason for use, and drinking and smoking at the age of 20.

Using the Internet for chatting, games, and adult websites at the age of 16 had a significant association with heavy drinking at the age of 20. The Internet café as the location for Internet use at the age of 16 was associated with smoking behaviour at the age of 20. This study confirmed significant associations between addictive use of the Internet at the age of 16 and heavy drinking and cigarette smoking at the age of 20. The findings demonstrated the negative effects of addictive Internet use, one of the biggest problems with adolescents.


Association between Internet Overuse and Aggression in Korean Adolescents (2013)

Pediatr Int. 2013 Jun 30. doi: 10.1111/ped.12171.

A total of 2,336 (boys, 57.5%; girls, 42.5%) high school students in South Korea completed the structured questionnaire. The severity of Internet overuse was evaluated using Young's Internet Addiction Test. 

The proportions of boys who were classified as severe addicts and moderate addicts were 2.5% and 53.7%, respectively. For girls, the corresponding proportions were 1.9% and 38.9%, respectively. This study shows that Internet overuse is strongly associated with aggression in adolescents.


Development and Validation of the Smartphone Addiction Inventory (SPAI) (2014)

PLoS One. 2014 Jun 4;9(6):e98312. doi: 10.1371/journal.pone.0098312.

The aim of this study was to develop a self-administered scale based on the special features of smartphone. The reliability and validity of the Smartphone Addiction Inventory (SPAI) was demonstrated.

A total of 283 participants were recruited from Dec. 2012 to Jul. 2013 to complete a set of questionnaires. There were 260 males and 23 females, with ages 22.9±2.0 years. Exploratory factor analysis, internal-consistency test, test-retest, and correlation analysis were conducted to verify the reliability and validity of the SPAI.

In summary, the results from this study provide evidence that the SPAI is a valid and reliable self-administered screening tool to identify smartphone addiction. The consistent taxonomy with substance related and addictive disorder in DSM implies the property of “addiction” identical in smartphone addiction.


Overview of internet addiction (2014)

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i19.

Problematic Internet Use or Internet addiction is generally considered as an inability to control the use of the Internet, which eventually involves psychological, social, academic, and/or professional problems in a person's life. Dysfunctional use of the Internet has been related to a variety of different activities such as cybersex, online gambling, online video game playing, or social network involvement, thereby emphasizing that this problematic behavior can take very different forms across individuals and should not be viewed as a homogeneous construct.


Prevalence of Pathological Internet Use in a Representative German Sample of Adolescents: Results of a Latent Profile Analysis (2014)

Psychopathology. 2014 Oct 22.

Background: Pathological internet use is of increasing significance in several industrial nations.Sampling and Methods: We surveyed a representative German quota sample of 1,723 adolescents (aged 14-17 years) and 1 caregiver each. We conducted a latent profile analysis to identify a high-risk group for pathological internet use.

Results: Overall, 3.2% of the sample formed a profile group with pathological internet use. In contrast to other published studies, the results of the latent profile analysis were verified not only by self-assessments of the youth's but also by external ratings of the caregivers. In addition to the pathological internet use, the high-risk group showed lower levels of family functioning and life satisfaction as well as more problems in family interactions.


Associations between overuse of the internet and mental health in adolescents (2013)

Nurs Health Sci. 2013 Aug 29. doi: 10.1111/nhs.12086.

This study examined the factors influencing internet addiction levels and mental health in a nationally-representative sample of 74,980 Korean middle- and high-school students who completed the 2010 Korea Youth Risk Behavior Web-Based Survey. The prevalence rates of potential internet addiction and internet addiction were 14.8% and 3%, respectively.

The odds ratios for potential internet addiction were higher in both boys and girls who reported suicidal ideation, depressive mood, moderate or higher subjective stress, moderate or more happiness, or ever having engaged in problematic substance use. Adolescents at high risk for internet addiction had poor mental health outcomes.


Internet use and addiction among Finnish Adolescents: 15-19years. (2014)

J Adolesc. 2014 Feb;37(2):123-31. doi: 10.1016/j.adolescence.2013.11.008.

This study investigates Internet use among Finnish adolescents (n = 475) combining qualitative and quantitative research. Internet use was evaluated using the Internet Addiction Test (Young, 1998a, 1998b). The data was divided into three parts according to the test scores: normal users (14.3%), mild over-users (61.5%), and moderate or serious over-users (24.2%).

As disadvantages of using the Internet, students reported that it is time-consuming and causes mental, social, and physical harm and poor school attendance. Four factors of Internet addiction were found, and for two of them, a statistical difference between females and males was found.


The presence of altered craniocervical posture and mobility in smartphone addicted teenagers with temporomandibular disorders.

J Phys Ther Sci. 2016 Jan;28(2):339-46.

Smartphones are widely used by teenagers and adults for various purposes. As teenagers use smartphones more actively than adults, they are more prone to be addicted to smartphones. Furthermore, excessive usage of smartphones can lead to various psychosocial and physical symptoms.

Cephalometric analysis showed no significant difference in the craniocervical angles of the resting positions of the two groups. However, measurement using an inclinometer revealed a significantly flexed cervical posture while using smartphones and decreased cervical range of motion in the smartphone-addicted teenagers. The clinical profile of temporomandibular disorders revealed that muscular problems were more frequently presented in the smartphone-addicted teenagers.


Internet addiction disorder and youth (2014)


The association between pathological internet use and comorbid psychopathology: a systematic review (2013)

Psychopathology. 2013;46(1):1-13. doi: 10.1159/000337971. Epub 2012 Jul 31.

The primary objective of this systematic review was to identify and evaluate studies performed on the correlation between PIU and comorbid psychopathology.

The majority of research was conducted in Asia and comprised cross-sectional designs. Twenty articles met the preset inclusion and exclusion criteria; 75% reported significant correlations of PIU with depression, 57% with anxiety, 100% with symptoms of ADHD, 60% with obsessive-compulsive symptoms, and 66% with hostility/aggression. No study reported associations between PIU and social phobia.

The majority of studies reported a higher rate of PIU among males than females. The strongest correlations were observed between PIU and depression; the weakest was hostility/aggression.

Depression and symptoms of ADHD appeared to have the most significant and consistent correlation with PIU. Associations were reported to be higher among males in all age groups.


The severity of Internet addiction risk and its relationship with the severity of borderline personality features, childhood traumas, dissociative experiences, depression and anxiety symptoms among Turkish University Students (2014)

Psychiatry Res. 2014 Mar 3.

The aim of this study was to investigate the relationship of Internet addiction (IA) risk with the severity of borderline personality features, childhood traumas, dissociative experiences, depression and anxiety symptoms among Turkish university students. A total of 271 Turkish university students participated in this study.

The rates of students were 19.9% (n=54) in the high IA risk group, 38.7% (n=105) in the mild IA risk group and 41.3% (n=112) in the group without IA risk.

Univariate covariance analysis indicated that the severity of borderline personality features, emotional abuse, depression and anxiety symptoms were the predictors of IAS score, while gender had no effect on IAS score. Among childhood trauma types, emotional abuse seems to be the main predictor of IA risk severity. Borderline personality features predicted the severity of IA risk together with emotional abuse, depression and anxiety symptoms among Turkish university students.


Association between problematic internet use, socio-demographic variables and obesity among European adolescents (2016)

Eur J Public Health. 2016 Apr 25. pii: ckw028.

Overweight of children and adolescents continues to be an important and alarming global public health problem. As the adolescent's time spent online has increased, problematic internet use (PIU) potentially leads to negative health consequences. This study aimed to examine the relation between PIU and overweight/obesity among adolescents in seven European countries and assess the effect of demographic and lifestyle factors recorded in the European Network for Adolescent Addictive Behaviour (EU NET ADB) survey (

A cross-sectional school-based survey of 14- to 17-year-old adolescents was conducted in seven European countries: Germany, Greece, Iceland, the Netherlands, Poland, Romania and Spain. Anonymous self-completed questionnaires included sociodemographic data, internet usage characteristics, school achievement, parental control and the Internet Addiction Test. Associations between overweight/obesity and potential risk factors were investigated by logistic regression analysis, allowing for the complex sample design.

The study sample consisted of 10 287 adolescents aged 14-17 years. 12.4% were overweight/obese, and 14.1% presented with dysfunctional internet behavior. Greece had the highest percentage of overweight/obese adolescents (19.8%) and the Netherlands the lowest (6.8%). Male sex [odds ratio (OR) = 2.89, 95%CI: 2.46-3.38], heavier use of social networking sites (OR = 1.26, 95%CI: 1.09-1.46) and residence in Greece (OR = 2.32, 95%CI: 1.79-2.99) or Germany (OR = 1.48, 95%CI: 1.12-1.96) were independently associated with higher risk of overweight/obesity. A greater number of siblings (OR = 0.79, 95%CI: 0.64-0.97), higher school grades (OR = 0.74, 95%CI: 0.63-0.88), higher parental education (OR = 0.89, 95%CI: 0.82-0.97) and residence in the Netherlands (OR = 0.49, 95%CI: 0.31-0.77) independently predicted lower risk of overweight/obesity.


Internet Addiction Among Elementary and Middle School Students in China: A Nationally Representative Sample Study. (2013)

Cyberpsychol Behav Soc Netw. 2013 Aug 24.

The data were from the National Children's Study of China (NCSC) in which 24,013 fourth- to ninth-grade students were recruited from 100 counties in 31 provinces in China.

the prevalence of Internet addiction in the total sample was 6.3%, and among Internet users was 11.7%. Among the Internet users, males (14.8%) and rural students (12.1%) reported Internet addiction more than females (7.0%) and urban students (10.6%)

When considering the location and purpose of Internet use, the percentage of Internet addicts was highest in adolescents typically surfing in Internet cafes (18.1%) and playing Internet games (22.5%).


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.


Prevalence of internet addiction and its association with stressful life events and psychological symptoms among adolescent internet users (2014)

Addict Behav. 2014 Mar;39(3):744-7.

Internet addiction (IA) among adolescents is a serious public health problem around the world. The prevalence rate of internet addiction was 6.0% among adolescent internet users. Logistic regression analyses indicated that stressors from interpersonal problem and school related problem and anxiety symptoms were significantly associated with IA after controlling for demographic characteristics.


Changes of internet addiction among the adult population of Japan in five years: results of two major surveys (2014)

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i51.

The number of people with Internet addiction (IA) in Japan is assumed to have rapidly increased, but the actual conditions have not been unknown.  Our first survey was conducted in 2008, and the subjects were 7,500 men and women. Our second survey was conducted in 2013, and the subjects were 7,052 people. Both of the two survey, the subjects were selected from the entire adult population of Japan by stratified two-stage random sampling.

In the first survey, 51% of the replied that they used the Internet, and 20% scored 40 or higher on the IAT. We estimated the number of adullts with IA tendency was 2.7 million in Japan. Problem users were more prevalent in the younger generation and tended to have a higher education level. The second survey revealed a much higher prevalence of IA than the first survey. We estimated the number of adullts with IA tendency was 4.21 million in Japan.


Depression, loneliness, anger behaviours and interpersonal relationship styles in male patients admitted to internet addiction outpatient clinic in Turkey (2014)

Psychiatr Danub. 2014 Mar;26(1):39-45.

'Internet addiction' is excessive computer use that interferes with daily life of a person. We designed this study in order to evaluate the predictor effect of depression, loneliness, anger and interpersonal relationship styles for internet addiction as well as develop a model.The results of this study showed that the 'duration of internet use' and STAXI  'anger in' subscale were the predictors of internet addiction. When the clinicians suspect for the internet overuse, regulation of internet usage might be helpful. Psychiatric treatments for expressing anger and therapies that focus on validation of the feelings may be useful.           


The association between Internet addiction and personality disorders in a general population-based sample (2016)

J Behav Addict. 2016 Dec;5(4):691-699. doi: 10.1556/2006.5.2016.086.

Cross-sectional analysis data are based on a German sub-sample (n = 168; 86 males; 71 meeting criteria for IA) with increased levels of excessive Internet use derived from a general population sample (n = 15,023). IA was assessed with a comprehensive standardized interview using the structure of the Composite International Diagnostic Interview and the criteria of Internet Gaming Disorder as suggested in DSM-5. Impulsivity, attention deficit hyperactivity disorder, and self-esteem were assessed with the widely used questionnaires. Participants with IA showed higher frequencies of personality disorders (29.6%) compared to those without IA (9.3%; p < .001).


Shared psychological characteristics that are linked to aggression between patients with Internet addiction and those with alcohol dependence (2014)

Ann Gen Psychiatry. 2014 Feb 21;13(1):6.

Internet addiction (IA) is considered as one of behavioral addictions. Although common neurobiological mechanisms have been suggested to underlie behavioral addiction and substance dependence, few studies have directly compared IA with substance dependence, such as alcohol dependence (AD).

We compared patients with IA, AD, and healthy controls (HC) in terms of the Five Factor Model of personality and with regard to impulsiveness, anger expression, and mood to explore psychological factors that are linked to aggression.

The IA and AD groups showed a lower level of agreeableness and higher levels of neuroticism, impulsivity, and anger expression compared with the HC group, which are characteristics related to aggression. The addiction groups showed lower levels of extraversion, openness to experience, and conscientiousness and were more depressive and anxious than the HCs, and the severity of IA and AD symptoms was positively correlated with these types of psychopathology.

IA and AD are similar in terms of personality, temperament, and emotion, and they share common characteristics that may lead to aggression.


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.

 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


The Relationship between Alexithymia, Anxiety, Depression, and Internet Addiction Severity in a Sample of Italian High School Students (2014)

ScientificWorldJournal. 2014;2014:504376.

We aimed to assess whether Internet addiction (IA) severity was related to alexithymia scores among high school students, taking into account the role of gender differences and the possible effect of anxiety, depression, and age. Participants in the study were 600 students (ages ranging from 13 to 22; 48.16% girls) recruited from three high schools in two cities from Southern Italy.

The findings of the study showed that IA scores were associated with alexithymia scores, over and above the effect of negative emotions and age. Students with pathological levels of alexithymia reported higher scores on IA severity. In particular, results showed that difficulty in identifying feelings was significantly associated with higher scores on IA severity.


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".


A case of withdrawal psychosis from internet addiction disorder (2014)

Psychiatry Investig. 2014 Apr;11(2):207-9. doi: 10.4306/pi.2014.11.2.207.

Similar to substance use disorder, patients with Internet addiction disorder (IAD) show excessive use, tolerance and withdrawal symptoms. We report a case of a patient with withdrawal psychosis who showed persecutory delusion and disorganized behaviors in addition to common withdrawal symptoms such as agitation and irritability.

With antipsychotic medication (quetiapine up to 800 mg), his psychotic symptoms rapidly subsided and after four days of treatment, he no longer showed any signs of psychosis. This case report suggests that brief psychosis can develop during withdrawal from long-term excessive use of an Internet and the central pathology beneath the IAD is more likely a form of addiction than impulse control.


Commonalities in the psychological factors associated with problem gambling and Internet dependence (2010)

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 use, Facebook intrusion, and depression: Results of a cross-sectional study.

Eur Psychiatry. 2015 May 8. pii: S0924-9338(15)00088-7.

The main objective of our study was to examine the potential associations between Internet use, depression, and Facebook intrusion. A total of 672 Facebook users took part in the cross-sectional study.  Our results provides additional evidence that daily Internet use time in minutes, gender, and age are also predictors of Facebook intrusion: that Facebook intrusion can be predicted by being male, young age, and an extensive number of minutes spent online. On the basis of this study, it is possible to conclude that there are certain demographic - variables, such as age, gender, or time spent online - that may help in outlining the profile of a user who may be in danger of becoming addicted to Facebook.


Internet addiction: Prevalence and risk factors: A cross-sectional study among college students in Bengaluru, the Silicon Valley of India (2015)

Indian J Public Health. 2015 Apr-Jun;59(2):

The Internet is a widely used tool known to foster addictive behavior, and Internet addiction threatens to develop into a major public health issue in the near future in a rapidly developing country like India. This cross-sectional study intends to estimate prevalence, understand patterns, and evaluate risk factors for Internet addiction among college students in the city of Bengaluru, India.

This study of college students aged 16-26 years (mean ± SD 19.2 ± 2.4 years), with marginally high female representation (56%), identified 34% and 8%  as students with mild and moderate Internet addiction respectively.


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.


The Relationship Between Personality, Defense Styles, Internet Addiction Disorder, and Psychopathology in College Students (2014)

Cyberpsychol Behav Soc Netw. 2014 Sep 16.

The purpose of this study is to assess any underlying links between personality, defense styles, Internet addiction disorder (IAD), and psychopathology in a college student sample. A path model that was tested using Partial Least Squares (PLS) methodology showed that the defense styles employed by the students and certain personality traits (Impulsivity, Sensation Seeking, Neuroticism/Anxiety, and Aggression-Hostility) contributed to the prediction of variability in IAD, with IAD in turn predicting variability in overt psychopathology.


Depressive Symptoms and Problematic Internet Use Among Adolescents: Analysis of the Longitudinal Relationships from the Cognitive-Behavioral Model (2014)

Cyberpsychol Behav Soc Netw. 2014 Nov;17(11):714-719.

The objective of this study was to analyze the temporal and reciprocal relations between the presence of depressive symptoms and various components of problematic Internet use (i.e., the preference for online relationships, use of the Internet for mood regulation, deficient self-regulation, and the manifestation of negative outcomes).

Consequently, a longitudinal design was employed with two times separated by a 1 year interval. The sample consisted of 699 adolescents (61.1% girls) between 13 and 17 years of age.

The results indicated that depressive symptoms at time 1 predicted an increase in preference for online relationships, mood regulation, and negative outcomes after 1 year. In turn, negative outcomes at time 1 predicted an increase in depressive symptoms at time 2.


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? 


Characteristics of online compulsive buying in Parisian students (2014)

Addict Behav. 2014 Aug 6;39(12):1827-1830.

To better understand its clinical aspects by focusing on (i) prevalence rate, (ii) correlation with other addictions, (iii) influence of means of access, (iv) motivations to shop to the internet and (v) financial and time-consuming consequences. Cross-sectional study. 200 students in two different centers of Paris Diderot University.                                                                                                                                                        

Prevalence of online compulsive buying was 16.0%, while prevalence of internet addiction was 26.0%. We found no significant relationship with cyberdependence, alcohol or tobacco use disorders. 

Online compulsive buying seems to be a distinctive behavioral disorder with specific factors of loss of control and motivations, and overall financial and time-consuming impacts. More research is needed to better characterize it.


Overlapping of different addictions including alcohol, tobacco, internet and gambling (2014)

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i10.

Subjects were Japanese adults randomly selected from throughout Japan. The questionnaire included screening tests for alcohol dependence, nicotine dependence, internet addiction, gamble addiction. The results were compared with the results from 2008 nationwide survey.

The prevalence of addiction was higher among males than females across all addictive behaviors. For male, most prevalent situation was alcohol use disorder only, followed by gambling addiction only, nicotine dependence only, internet addiction only. For female, most prevalent situation was internet only, followed by gambling addiction only, alcohol use disorder only, nicotine dependence only. The patterns of associations among the four addictive behaviors were different for men and women. Significant associations among four additive behaviors were found among women, while among men, internet addiction was associated only with nicotine addiction, but not with other behaviors.


Exercise rehabilitation for smartphone addiction (2013)

J Exerc Rehabil. 2013 Dec 31;9(6):500-505.

Internet addiction after launching smartphone is becoming serious. Therefore this paper has attempted to sketch out the diverse addiction treatment and then check the feasibility of exercise rehabilitation. The reason to addict the internet or smartphone is personalized individual characters related personal psychological and emotional factors and social environmental factors around them. We have shown that 2 discernible approaches due to 2 different addiction causes: that is behavioral treatment and complementary treatment.


College students with Internet addiction decrease fewer Behavior Inhibition Scale and Behavior Approach Scale when getting online (2014)

Asia Pac Psychiatry. 2014 May 27. doi: 10.1111/appy.12135.

The aim of the study is to compare the reinforcement sensitivity between online and offline interaction. The effect of gender, Internet addiction, depression, and online gaming on the difference of reinforcement sensitivity between online and offline were also evaluated.

The results showed that reinforcement sensitivity was lower when interacting online than when interacting offline. College students with Internet addiction decrease fewer score on BIS and BAS after getting online than did others. The higher reward and aversion sensitivity are associated with the risk of Internet addiction.

The fun seeking online might contribute to the maintenance of Internet addiction. This suggests that reinforcement sensitivity would change after getting online and would contribute to the risk and maintenance of Internet addiction.


The bidirectional associations between the family factors and internet addiction among adolescents in a prospective investigation (2014)

Psychiatry Clin Neurosci. 2014 May 19. doi: 10.1111/pcn.12204.

A total of 2293 adolescents in grade 7 participated in the study. We assessed their Internet addiction, family function, and family factors with a 1-year follow-up.
In the prospective investigation, inter-parental conflict predicted the incidence of internet addiction one year later in forward regression analysis, followed by not living with mother and allowance to use internet more than 2 hours per day by parents or caregiver (AIU>2H). The inter-parental conflict and AIU>2H also predicted the incidence in girls. Not cared for by parents and family APGAR score predicted the incidence of internet addiction among boys.


Problematic Internet use, well-being, self-esteem and self-control: Data from a high-school survey in China (2016)

Addict Behav. 2016 May 12;61:74-79. doi: 10.1016/j.addbeh.2016.05.009.

The present study examines the association between problematic Internet use (PIU), demographic variables, and health-related measures among Chinese adolescents. Survey data from 1552 adolescents (male=653, mean age=15.43 years) from Jilin Province, China, were collected. According to the Young Diagnostic Questionnaire for Internet Addiction (YDQ), 77.8% (n=1207), 16.8% (n=260), and 5.5% (n=85) showed adaptive, maladaptive, and problematic Internet use, respectively. 

Well-being, self-esteem, and self-control were related to severity of problematic Internet use, with greater severity typically associated with poorer measures in each domain. The findings that severity of problematic Internet use is associated with specific socio-demographic features and temperamental and well-being measures suggest that specific groups of youth may be particularly vulnerable to developing problematic Internet use.



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)

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 (2011)

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.


Is it meaningful to distinguish between generalized and specific Internet addiction? Evidence from a cross-cultural study from Germany, Sweden, Taiwan and China (2014)

Asia Pac Psychiatry. 2014 Feb 26. doi: 10.1111/appy.12122.

It has been hypothesized that two distinctive forms of Internet addiction exist. Here, generalized Internet addiction refers to the problematic use of the Internet covering a broad range of Internet-related activities. In contrast, specific forms of Internet addiction target the problematic use of distinct online activities such as excessive online video gaming or activities in social networks.

The present study investigates the relationship between generalized and specific Internet addiction in a cross-cultural study encompassing data from China, Taiwan, Sweden and Germany in n = 636 participants. In this study, we assessed - besides generalized Internet addiction - addictive behavior in the domains of online video gaming, online shopping, online social networks and online pornography.

The results confirm the existence of distinct forms of specific Internet addiction. One exception, however, was established in five of the six samples under investigation: online social network addiction correlates in large amounts with generalized Internet addiction. In general, it is of importance to distinguish between generalized and specific Internet addiction.


Internet addiction in Hong Kong adolescents: a three-year longitudinal study (2013)

J Pediatr Adolesc Gynecol. 2013 Jun;26(3 Suppl):S10-7. doi: 10.1016/j.jpag.2013.03.010.

Three waves of data were collected over 3 years from students in 28 secondary schools in Hong Kong (Wave 1: 3,325 students, age = 12.59 ± 0.74 y; Wave 2: 3,638 students, age = 13.64 ± 0.75 y; Wave 3: 4,106 students, age = 14.65 ± 0.80 y).

At Wave 3, 22.5% of the participants met the criterion of Internet addiction, which was lower than those observed at Wave 1 (26.4%) and Wave 2 (26.7%). Using different measures at Wave 1 to predict Internet addiction at Wave 3, it was found that male students showed more problematic Internet use behavior than did female students; good family functioning predicted lower probability of having Internet addiction; positive youth development indicators negatively predicted Internet addictive behaviors over time.


The comorbid psychiatric symptoms of Internet addiction: attention deficit and hyperactivity disorder (ADHD), depression, social phobia, and hostility (2007)

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.


Psychometric Properties of the Revised Chen Internet Addiction Scale (CIAS-R) in Chinese Adolescents (2014)

J Abnorm Child Psychol. 2014 Mar 2.

The Revised Chen Internet Addiction Scale (CIAS-R) was developed to assess Internet addiction in Chinese populations, but its psychometric properties in adolescents have not been examined. This study aimed to evaluate the factor structure and psychometric properties of CIAS-R in Hong Kong Chinese adolescents.                                                                                                                                                                                         

860 Grade 7 to 13 students (38 % boys) completed the CIAS-R, the Young's Internet Addiction Test (IAT), and the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) in a survey. The prevalence of Internet addiction as assessed by CIAS-R was 18 %. High internal consistency and inter-item correlations were reported for the CIAS-R. Results from the confirmatory factor analysis suggested a four-factor structure of Compulsive Use and Withdrawal, Tolerance, Interpersonal and Health-related Problems, and Time Management Problems.


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.

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.

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.


Prevalence of Internet Addiction and its Contributory Factors among Nursing Students (2017)

International Journal of Nursing Education, Year : 2017, Volume : 9, Issue : 1 Article DOI : 10.5958/0974-9357.2017.00003.4

An exploratory study was carried out among 300 nursing students in selected nursing colleges in city Ludhiana, Punjab. Systematic sampling technique was used to select the sample. Data was collected with standardized internet addiction scale (Dr. K. Young) and structured checklist to assess contributory factors of internet addiction by using self-report method.

The study results revealed that most of the students 97.7% had an easy access to internet. More than one fourth addicted to mild internet addiction. More than half 180 (60.0%) nursing students were in age group 16–20 years. Contributory factors “Unlimited access to internet”, “Use internet as a way to escape problems”, “Get more respect online than real life” had significant association with internet addiction. Student's age, mother's education, father's occupation, quality of your parent's relationship had significant association with internet addiction. Prevalence of internet addiction among nursing students was 70.3%.


Social Networking Addiction among Health Sciences Students in Oman (2015)

Sultan Qaboos Univ Med J. 2015 Aug;15(3):e357-63.

Addiction to social networking sites (SNSs) is an international issue with numerous methods of measurement. The impact of such addictions among health science students is of particular concern. This study aimed to measure SNS addiction rates among health sciences students at Sultan Qaboos University (SQU) in Muscat, Oman.

In April 2014, an anonymous English-language six-item electronic self-reporting survey based on the Bergen Facebook Addiction Scale was administered to a non-random cohort of 141 medical and laboratory science students at SQU. The survey was used to measure usage of three SNSs: Facebook (Facebook Inc., Menlo Park, California, USA), YouTube (YouTube, San Bruno, California, USA) and Twitter (Twitter Inc., San Francisco, California, USA). Two sets of criteria were used to calculate addiction rates (a score of 3 on at least four survey items or a score of 3 on all six items). Work-related SNS usage was also measured.

 Of the three SNSs, YouTube was most commonly used (100%), followed by Facebook (91.4%) and Twitter (70.4%). Usage and addiction rates varied significantly across the three SNSs. Addiction rates to Facebook, YouTube and Twitter, respectively, varied according to the criteria used (14.2%, 47.2% and 33.3% versus 6.3%, 13.8% and 12.8%). However, addiction rates decreased when work-related activity was taken into account.


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.


Alexithymia components in excessive internet users: A multi-factorial analysis (2014)

Psychiatry Res. 2014 Aug 6. pii: S0165-1781(14)00645-3.

The increasing use of computers and the internet - especially among young people - apart from its positive effects, sometimes leads to excessive and pathological use.  Excessive use of the internet among Greek university students was studied within a multi-factorial context and was associated with the alexithymia and demographic factors in nonlinear correlations, forming thus a personalized emotional and demographic profile of the excessive internet users.


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)

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.


Determinants of Problematic Internet Use Among El-Minia High School Students, Egypt (2013)

Int J Prev Med. 2013 Dec;4(12):1429-37.

Problematic Internet Use (PIU) is a growing problem in Egyptian adolescents. This study was designed to assess the prevalence of PIU among high school students in El-Minia Governorate and to determine the personal, clinical, and social characteristics of them.

Of the 605 students, 16 (2.6%) were Problematic Internet Users (PIUs), 110 (18.2%) were Potential (PIUs). Adolescents with PIU were associated with male gender, poor friends' relations, bad family relations, irregular bedtime, and bad personal hygiene. PIUs were more likely to suffer from physical symptoms; weight gain, joint stiffness, lack of physical energy, and emotional symptoms.

The prevalence of PIU reported in this study is low, however, the Potential PIUs was high and preventative measures are recommended.


Addictive Internet Use among Korean Adolescents: A National Survey (2014)

PLoS One. 2014 Feb 5;9(2):e87819. doi: 10.1371/journal.pone.0087819.

A psychological disorder called 'Internet addiction' has newly emerged along with a dramatic increase of worldwide Internet use. However, few studies have used population-level samples nor taken into account contextual factors on Internet addiction.

We identified 57,857 middle and high school students (13-18 year olds) from a Korean nationally representative survey, which was surveyed in 2009.

To identify associated factors with addictive Internet use, two-level multilevel regression models were fitted with individual-level responses (1st level) nested within schools (2nd level) to estimate associations of individual and school characteristics simultaneously. Gender differences of addictive Internet use were estimated with the regression model stratified by gender. Significant associations were found between addictive Internet use and school grade, parental education, alcohol use, tobacco use, and substance use. Female students in girls' schools were more likely to use Internet addictively than those in coeducational school


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

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.


Prevalence and risk factors of Internet addiction in high school students (2013)

Eur J Public Health. 2013 May 30.

Our study population included 1156 students, among whom 609 (52.7%) were male. The mean age of the students was 16.1 ± 0.9 years. Seventy-nine percent of the students had a computer at home, and 64.0% had a home Internet connection. In this study, 175 (15.1%) students were defined as Internet addicts. Whereas the addiction rate was 9.3% in girls, it was 20.4% in boys (P < 0.001). In this study, Internet addiction was found to have an independent relationship with gender, grade level, having a hobby, duration of daily computer use, depression and negative self-perception.


The relationship of affective temperament and emotional-behavioral difficulties to internet addiction in Turkish teenagers (2013)

ISRN Psychiatry. 2013 Mar 28;2013:961734.

The purpose of this study was to investigate the association of affective temperament profiles and emotional and behavioural characteristics with Internet addiction among high school students. The study sample included 303 high school students.

Of the sample, 6.6% were found to be addicted to Internet. According to these findings, there is a relation between the Internet addiction and affective temperament profiles, especially with anxious temperament. Furthermore, emotional and behavioural problems are more frequent in adolescents who have problematic Internet use.


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.

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)

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.


Lifestyle and Depressive Risk Factors Associated With Problematic Internet Use in Adolescents in an Arabian Gulf Culture (2013)

J Addict Med. 2013 May 9.

A total of 3000 students (12-25 years of age) were selected through multistage stratified random sampling from public and private schools and university under the overall administration of Qatar Supreme Council of Education.

Among them, 2298 students (76.6%) consented to participate in the study during September 2009 to October 2010. Data were collected using a structured questionnaire including sociodemographic details, lifestyle, and dietary habits. Problematic Internet use and depressive tendencies were measured through validated Internet Addiction Test (IAT) and BDI

Of 2298, 71.6% were males and 28.4% were females. The overall prevalence of PIU was 17.6%. This study revealed that a significantly larger proportion of males (64.4%; P = 0.001) and Qatari students (62.9%; P < 0.001) had PIU.


Effect of social support on depression of internet addicts and the mediating role of loneliness (2014)

Int J Ment Health Syst. 2014 Aug 16;8:34.

Many studies have determined the existence of an extremely close association between Internet addiction and depression. However, the reasons for the depression of Internet addicts have not been fully investigated. A total of 162 male Internet addicts completed the Emotional and Social Loneliness Scale, Multidimensional Scale of Perceived Social Support, and Self-Rating Depression Scale.

Loneliness and lack of social support are significantly correlated with depression among Internet addicts. Structural Equation Modeling results indicate that social support partially mediates loneliness and depression.


Associations Between Problematic Internet Use and Adolescents' Physical and Psychological Symptoms: Possible Role of Sleep Quality (2014)

J Addict Med. 2014 Jul 14.

To evaluate the associations between problematic Internet use (PIU) and physical and psychological symptoms among Chinese adolescents, and to investigate the possible role of sleep quality in this association.

Prevalence rates of PIU, physical symptoms, psychological symptoms, and poor sleep quality were 11.7%, 24.9%, 19.8%, and 26.7%, respectively. Poor sleep quality was found to be an independent risk factor for both physical and psychological symptoms. The effects of PIU on the 2 health outcomes were partially mediated by sleep quality.

Problematic Internet use is becoming a significant public health issue among Chinese adolescents that requires urgent attention. Excessive Internet use may not only have direct adverse health consequences but also have indirect negative effects through sleep deprivation.


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.

COMMENTS: IAD was associated with depression, anxiety, and alexithymia


Usefulness of Young's Internet Addiction Test for clinical populations (2012)

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 users who do have significant issues. Young's test relies on time spent using. The test is poor assessment tool for Internet porn addiction or related problems as time spent using has been found to be less important than applications 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 rates are much higher non-European studies due the population studied - the studies from Europe include much older subjects, and some use subjects who have never used the internet. Closer examination of the data show up to 20% of males, ages 13-30 have IAD in some European 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)

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 use 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 closely with Internet addiction than with "biogenetic temperament". That means Internet addiction caused the depression rather than depression caused the addiction.


The prevalence of computer and Internet addiction among pupils (2009)

Postepy Hig Med Dosw (Online). 2009 Feb 2;63:8-12.

This study was based on a diagnostic survey in which 120 subjects participated. The participants were pupils of three kinds of schools: primary, middle, and secondary school (high school)

The results confirmed that every fourth pupil was addicted to the Internet. Internet addiction was very common among the youngest users of computers and the Internet, especially those who had no brothers and sisters or came from families with some kind of problems. Moreover, more frequent use of the computer and the Internet was connected with higher levels of aggression and anxiety.

COMMENTS: More frequent use was associated with anxiety and aggression.


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.

COMMENTS: It takes about a decade for problematic computer usage to manifest. IAD associated with depression, anxiety and social isolation.


Internet use, abuse, and dependence among students at a southeastern regional university (2007)

J Am Coll Health. 2007 Sep-Oct;56(2):137-44.

 Approximately half of the sample met criteria for Internet abuse, and one-quarter met criteria for Internet dependence. Men and women did not differ on the mean amount of time accessing the Internet each day; however, the reasons for accessing the Internet differed between the 2 groups. In addition, individuals meeting criteria for Internet abuse and dependence endorsed more depressive symptoms, more time online, and less face-to-face socialization than did those not meeting the criteria.