Thursday June 19 2008
Are you addicted to the internet?
Internet addiction is a "clinical disorder", says The Daily Telegraph today. The newspaper quotes a leading psychiatrist who suggests that “obsessive internet use is a public health problem, which is so serious it should be officially recognised as a clinical disorder”.
The editorial which sparked this news story is a one-page opinion piece which responds to a call for work exploring the criteria for the diagnosis of psychiatric conditions. Any suggestions were to be considered by the American Psychiatric Association for inclusion in an update to the Diagnostic and Statistical Manual for Mental Health Disorders, currently known as DSM-IV.
This editorial has effectively put the case for more research into internet addiction. For any emerging clinical or policy issue, getting agreement from experts on accurate and consistent diagnostic criteria is an important first step, and this editorial will be a component of that process. It is not clear from this paper what the extent of the problem is in the UK.
Where did the story come from?
Dr Jerald J Block, from Portland, Oregon, wrote this editorial. No external funding is acknowledged. The author has declared that he owns a patent on technology that can be used to restrict computer access. The editorial was published following a review by Dr Robert Freedman, the editor of the medical journal American Journal of Psychiatry.
What kind of scientific study was this?
In this independent editorial, the author makes the case for including internet addiction as a common disorder in the next update of the DSM (DSM-V).
Dr Block argues that internet addiction should be included conceptually in the group of disorders known as compulsive–impulsive spectrum disorders, and that the definition should include online or offline computer usage, with recognition of at least three subtypes. The subtypes are: excessive gaming, sexual preoccupations and e-mail/text messaging.
Dr Block suggests that these subtypes share four common characteristics: excessive use, withdrawal, tolerance and negative repercussions. Excessive use is often associated with losing track of time or neglecting basic needs, such as eating or sleeping. A withdrawal state, similar to that found in other addictions, can include feelings of anger, tension or depression, brought on when the person does not have access to the computer. The tolerance he describes refers to the person becoming more and more tolerant or resistant to the benefit they get from the internet. Over time, they need better computer equipment, more software or more hours of use. The negative repercussions Dr Block lists include arguments, lying, poor achievement, social isolation and fatigue.
What were the results of the study?
In the editorial, which includes sixteen references, the author mainly describes research into the rates of internet addiction in South Korea and China and acknowledges that accurate estimates of the prevalence of the disorder in the US are lacking.
According to the editorial, the South Korean government estimates that about 210,000 South Korean children between the ages of six and 19 (2.1%) are affected by this disorder and require treatment. In China, the Director of Addiction Medicine at Beijing Military Region Central Hospital is reported as saying that about 10 million (13.7%) adolescent Chinese internet users meet the diagnostic criteria for internet addiction.
South Korea has tried to deal with this problem by introducing preventive measures into schools, and training 1,043 counsellors across 190 treatment centres and hospitals to treat internet addiction. China is apparently also concerned, and has begun to restrict computer game use by passing laws that discourage more than three hours of use a day.
What interpretations did the researchers draw from these results?
The author concludes that despite the cultural differences, the experience in the US is “remarkably similar to those of our Asian colleagues, and we appear to be dealing with the same issue”.
He also makes the point that internet addiction can involve “significant risks”. It is not easily treated, and a number of people can relapse after treatment. He believes that other psychiatric conditions can also respond less well to treatment if accompanied by internet addiction.
What does the NHS Knowledge Service make of this study?
This editorial has effectively put the case for more research into internet addiction. It is not a systematic review of the literature and therefore has not identified all the scientific literature about internet addiction.
It also illustrates the different approaches taken by South Korea, China and the US. For any emerging policy issue, getting agreement from experts on accurate and consistent diagnostic criteria is an important first step, and this editorial will be a component of that process. It is not clear from this paper what the extent of the problem is in the UK.
Sir Muir Gray adds...
Some people can become dependent on anything, so this is no surprise; if more cases are reported this could represent a real increase in incidence (the number of new cases?) or simply in medical fashion.