Internet Use Disorder

Dr-Elze.de Dr. Elze

Internet Use Disorder (IUD), also called Internet Use Gaming Disorder, Web dependency or Internet addicition disorder (IAD), is characterized by an excessive use of computers or other devices, e.g. smartphones, tablet-pcs etc., for online activities, to an extent that other activities of dailiy life are severely compromized.

With a prevalence of about 1 to 10% among adolescents Internet Use Disorder is a relatively frequent phenomenon that can lead to severe functional impairment and distress.

There is still a dispute, if compulsive internet use is an actual mental health disorder or a symptom or subtype of other disorders, as for example depression or pathological gambling.

Despite all criticism, the American Psychiatric Association (APA) included the Internet-Gaming-Disorder as a condition “redommended for further study” in the 5th revision of the Diagnostic and Statistical Manual of Mental Disorders, DSM-5.

Read more: Internet Use Disorder: DSM-5 Citeria

Prevalence

Since the diagnostic criteria for Internet Use Disorder have not yet been fully established, previous studies on the prevalence of IUD can only be compared to some extent, since diagnostic criteria varied between countries and research groups.

In previous studies prevalence rates of Internet Use Disorder have been estimated to be between 1 and 10%. Further studies are required.

Read more: Internet Use Disorder: Prevalence

Symptoms

Symptoms of Internet Use Disorder include

• overwhelming preoccupation with online-activities to an extent, that leads to impairment or distress,
• loss of other interests,
• inability to limit time spent on the internet,
• the need to spend increasing time on the internet,
• unsuccessful attempts to quit internet-use,
• use of the internet to improve or escape aversive conditions, as for example dysphoric mood, anxiety, unfavorable duties etc.
• and withdrawal symptoms when the internet is no longer available.

Diagnosis

Although excessive Internet use and its impact on adults and adolescents has been widely publicized, Internet addiction or Internet Use Disorder have not been recognized as diagnostic categories in the 4th revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and in the International Classification of Diseases (ICD-10).

In the past, the lack of uniform diagnostic criteria lead to parallel definitions of the terms “Internet addiction” and “Internet Use Disorder”, which resulted in a conglomerate of names for the disorder and uncertanty about the diagnostic criteria.

Read more: Internet Use Disorder: Diagnosis

DSM-5 Criteria

Despite all criticism, the American Psychiatric Association (APA) included the Internet Gaming Disorder as a condition “redommended for further study” in the 5th revision of the Diagnostic and Statistical Manual of Mental Disorders, DSM-5.

Read more: Internet Use Disorder: DSM-5 Citeria

Psychological Tests

For the evaluation of Internet Use Disorder only a few psychological tests are available. Since the development of uniform diagnostic criteria is still a subject of discussion, some of the tests available show lacks in psychometric qualities.

The Internet Addiction Test (IAT), the Compulsive Internet Use Scale (CIUS), the Chen Internet Addiction Scale (CIAS) and the Problematic Internet Use Questionnaire (PIUQ) are some of the most used psychological tests for the assessment of Internet Use Disorder.

Read more: Internet Use Disorder: Psychological Tests

Subtypes

Several subtypes of Internet Use Disorder have been proclaimed, such as overwhelming, or inappropriate pornography use, online-gaming, online social networking, blogging, or internet-shopping.

In some cases, these “subtypes” may be symptoms of other mental health problems. Excessive internet-shopping for example may be a symptom of a depressive disorder, excessive social networking may be an avoidance-behaviour in persons with social phobia, etc.

Read more: Internet Use Disorder: Subtypes

Differential Diagnoses

Differential diagnoses for Internet Use Disorder include a variety of mental health disorders, such as mood disorders, obsessive-compulsive disorder, anxiety disorders, attention-deficit / hyperactivity disorder (ADHD), or personality disorders.

Read more: Internet Use Disorder: Differential Diagnoses

Comorbidity

Little is known about the comorbidity of Internet Use Disorder. There are reports of high comorbidity with affective disorders, especially depression, social anxiety disorder, attention deficit hyperactivity disorder (ADHD) and substance use disorder, but most of the previous studies have several methodological limitations.

In one of the first studies on the psychiatric comorbidity of compulsive computer use, Black et al. evaluated 21 individuals with self-reported excessive computer use. According to Black, of these 21 subjects 7 (33%) had a lifetime mood disorder, 8 (38%) a substance use disorder, 4 subjects (19%) had a lifetime anxiety disorder, and 11 subjects (52%) met criteria for at least one personality disorder.

Read more: Internet Use Disorder: Comorbidity

Treatment

Even though Internet Use Disorder has been extensively discussed in the media, there have been only a few double-blind, controlled trials on the treatment of Internet Use Disorder. Most of the previous treatment studies either used inconsistent criteria to define Internet Use Disorder or lacked an adequate methodological quality in assessing the therapeutic outcome, or both.

As far as is known, psychotherapy, especially Cognitive Behavioral Therapy (CBT), and self-help programs seem to be effective.

Based on the experience of the treatment of other addicitive or compulsive disorders, Psychoeducation and Familiy Counseling might be helpful.

So far, there are no sufficient data on the pharmacotherapy of Internet Use Disorder. The use of antidepressants, mood stabilizers, anxiolytics, and of Naltrexone has been proposed.

Read more: Internet Use Disorder: Treatment

Dr. Sandra Elze & Dr. Michael Elze