Psychiatric features of individuals with problematic internet use

Abstract

Background: Problematic internet use has been described in the psychological literature as ‘internet addiction’ and ‘pathological internet use’. However, there are no studies using face-to-face standardized psychiatric evaluations to identify behavioral characteristics, psychiatric comorbidity or family psychiatric history of individuals with this behavior. Methods: Twenty individuals with problematic internet use were evaluated. Problematic internet use was defined as (1) uncontrollable, (2) markedly distressing, time-consuming or resulting in social, occupational or financial difficulties and (3) not solely present during hypomanic or manic symptoms. Evaluations included a semistructured interview about subjects’ internet use, the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV (SCID-IV), family psychiatric history and the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS) modified for internet use. Results: All (100%) subjects’ problematic internet use met DSM-IV criteria for an impulse control disorder (ICD) not otherwise specified (NOS). All 20 subjects had at least one lifetime DSM-IV Axis I diagnosis in addition to their problematic internet use (mean±SD=5.1±3.5 diagnoses); 14 (70.0%) had a lifetime diagnosis of bipolar disorder (with 12 having bipolar I disorder). Limitations: Methodological limitations of this study included its small sample size, evaluation of psychiatric diagnoses by unblinded investigators, and lack of a control group. Conclusions: Problematic internet use may be associated with subjective distress, functional impairment and Axis I psychiatric disorders.

Introduction

Problematic internet use, wherein an individual’s inability to control his or her use of the internet causes marked distress and/or functional impairment, has been described in the psychological literature as ‘internet addiction’ and ‘pathological internet use’, based on the DSM-IV definition for substance dependence and pathological gambling, respectively (Griffiths, 1996, Griffiths, 1997, O’Reilly, 1996, Stein, 1997, Young, 1996, Young, 1998, Young and Rogers, 1998). Proposed treatments for afflicted individuals have included time-management techniques (Young, 1998) and participation in support groups (O’Reilly, 1996, Young, 1998).

Persons with problematic internet use have been reported to have high rates of depressive symptoms. An on-line survey utilizing the World Wide Web (WWW) and the Beck Depression Inventory in 259 individuals classified as having pathologic internet use demonstrated mild to moderate depression with a mean (SD) of 11.2 (13.9) (Young and Rogers, 1998). In addition, a recent prospective study of 169 subjects demonstrated an association between excessive internet use and depression (even when previous depression scores were controlled for), loneliness, declines in communication with household family members and social withdrawal (Kraut et al., 1998). However, the relationship between problematic internet use and formal mental disorders is unknown as there have been no studies utilizing standardized structured interviews to identify behavioral characteristics, co-occurring Axis I disorders, or family history of psychiatric illness in individuals displaying this behavior (Stein, 1997).

Over the last 15 years, a broad range of pathological repetitive behaviors have been hypothesized as possibly being related to obsessive–compulsive disorder (OCD), and are referred to as obsessive–compulsive (or OCD) spectrum disorders (Goldsmith et al., 1998). Many of these behaviors are associated with comorbid OCD and depressive disorders and possible preferential response to serotonin re-uptake inhibitors (SRIs). Examples include body dysmorphic disorder (BDD), hypochondriasis, anorexia nervosa, Tourette’s syndrome and possibly some impulse control disorders (ICDs). We hypothesized that problematic internet use might be another form of an OCD spectrum disorder and, in addition to repetitive behavior, be characterized by obsessive thinking, comorbidity with OCD and depressive disorders, and preferential response to SRIs. To further study individuals with problematic internet use, we systematically evaluated a consecutive group of users whose internet usage met criteria as described below utilizing face-to-face structured diagnostic interviews and rating instruments. We also systematically assessed treatment response histories in those subjects receiving prior treatment.