Guidelines published for determining unhealthy internet use
Aug. 5, 2003
GAINESVILLE, Fla. --- University of Florida psychiatrists have published guidelines to help doctors determine when Web use is too extreme to be healthy, an important step in determining whether Internet addiction should be classified as a new psychiatric disorder.
Web surfing, e-mailing, instant messaging, gaming, shopping, downloading music and visiting chat rooms become troublesome when they interfere with someone’s job or social life, said Dr. Nathan Shapira of UF’s Evelyn F. and William L. McKnight Brain Institute.
The challenge for health-care professionals is to determine when high Internet use is dysfunctional, and whether unhealthy Internet use is a lone disorder or a byproduct of other disorders, such as manic depression.
Writing in the current issue of the journal Depression and Anxiety, UF scientists propose criteria to diagnose problematic Internet use that they formulated on the basis of their research findings and other available data.
“The only way we as psychiatrists will figure out whether Internet addiction exists as a separate entity from other psychiatric illnesses is if we have consistent criteria to evaluate it,” said Shapira, an assistant professor of psychiatry at UF’s College of Medicine.
At the heart of problematic use is an irresistible preoccupation with the Internet that impairs aspects of a patient’s life and that can’t readily be explained as another psychiatric disorder, Shapira found. Problem users may spend longer periods of time online than planned, underestimate the time they spend online and often feel a rise in tension just before going online.
“One of the first things we did is divorce problematic Internet use from the criteria used to describe other impulse control disorders,” Shapira said. “The problem with taking a predefined diagnosis, such as for pathological gambling, and just changing the word ‘gambling’ to ‘Internet’ in the description is that one tends to draw premature conclusions and not explore other diagnoses.”
In a related article, published recently in Current Psychiatry, UF researchers presented five questions to help practitioners get a sense of their patients’ Internet use. The points revolve around the computer-flavored acronym MOUSE - More than intended time spent online, Other responsibilities neglected, Unsuccessful attempts to cut down, Significant relationship discord because of use, and Excessive thoughts or anxiety when not online.
Shapira devised the criteria after conducting face-to-face psychiatric evaluations of 20 volunteers who identified themselves as having problems with the Internet and 17 randomly selected college students with varying levels of Internet use. He found the volunteers who called themselves problematic Internet users had, on average, five pre-existing psychiatric problems, such as bipolar disorder, depression or alcohol abuse. In addition, they were online more than 30 hours per week, and their nonessential Internet use was 10 times greater than their essential use, such as job- and school-related activities - 28 hours compared with 2.8 hours.
Separating cyberslackers from people who may need medical help has vast implications in business, where employees may use company time and bandwidth to surf and shop, and where instant messaging has become the virtual water cooler for office chat. Responses from more than 200 employers in a survey conducted by the Saratoga Institute and commissioned by Websense Inc., an international Internet access management company, revealed more than 60 percent of U.S. companies have disciplined - and more than 30 percent have terminated - employees for inappropriate Internet use.
“It’s very useful for some people to spend high amounts of time on the Internet for work, school and recreation,” said Jeffrey I. Cole, director of the University of California, Los Angeles Center for Communications Policy. “For the vast majority of Americans, Internet use doesn’t come at the expense of other activities. However, there is something inherently addictive in the Internet because it’s interactive and it’s dynamic - it’s never the same as you left it. Clearly, there are people who stay online longer than they intended, and other parts of their lives do suffer. It would be interesting to know whether that’s clinically diagnosable.”
Shapira presented a case study in Depression and Anxiety that described a 32-year-old man with bipolar disorder, obsessive-compulsive disorder and depression. The volunteer’s Internet use began when he started college at 28, although he played computer games in high school to the point where it affected his grades. He estimated he spent 24 hours online per week, primarily playing games and chatting, but his actual time online averaged 35.9 hours per week. He felt a rise in tension before logging on and his college work was impaired. Further, his Internet use did not occur exclusively during mood states caused by existing disorders.
“All of the studies that actually evaluated patients have a pretty consistent profile that problematic Internet users are older than what you might expect, in the (early) to mid-30s, they are male and female, they spend about 28 hours a week in pleasure, recreational or personal computer use, and they report problematic use for about three years,” Shapira said. “What we’ve defined are people who have dysfunctional high use. What’s missing is we have no idea if this is a separate disorder.”
Shapira submitted a chapter on problematic Internet use for an upcoming volume of the Handbook of Impulse Control Disorders, a publication of the American Psychiatric Association, at the request of the editors. But more research is needed to determine whether Internet addiction should be a separate listing in the Diagnostic and Statistical Manual of Mental Disorders - considered the standard for psychiatric diagnoses in the United States - or whether problematic Internet use should fall under the umbrella of impulse control disorders, such as pathological gambling. According to a report by UCLA researchers, 71 percent of Americans went online in 2002, averaging 11 online hours per week, yet comparatively little information exists about the relationship between the Internet and psychiatric illness, Shapira said.
“It’s disheartening to consider how little we know about the effects of the Internet on humans and how few resources from companies, foundations and the government are devoted to looking at the problems,” Shapira said. “That’s why we proposed our criteria - to enable doctors to make a diagnosis and to define a specific population for study. Taking a random set of people and calling them Internet addicts without some scientific basis cannot lead to effective treatments.”For more information contact: