Internet Addiction, Part 1
Internet Addiction, Part 1
December 8, 2008 — Editor's note: Internet addiction disorder (IAD) is an increasingly recognized condition, and one in which psychiatric nurses can play a key role in management, according to a presentation at the 22nd Annual Meeting of the American Psychiatric Nurses Association. The various manifestations of IAD include cybersexual addiction, cyber-relationship addiction, net compulsions, information overload, and addiction to interactive computer games.
To learn more about the clinical presentation of IAD, Medscape interviewed presenter Diane M. Wieland, PhD, PMHCNS-BC, a psychiatric nurse in private practice in Lansdale, Pennsylvania, and associate professor at the School of Nursing and Health Sciences, La Salle University, in Philadelphia, Pennsylvania. Part 1 of this interview (below) describes the clinical manifestations of the spectrum of conditions comprising IAD, and part 2 describes the diagnosis, assessment, and management of IAD.
Medscape:What is Internet addiction disorder?
Dr. Wieland: The terms Internet addiction disorder (IAD) and pathological Internet use are used interchangeably and are identified on the basis of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) definition of substance abuse and pathological gambling. Problematic Internet use may belong to the obsessive-compulsive spectrum of disorders, making it responsive to selective serotonin reuptake inhibitors. The affected person has an inability to control his or her use of the Internet. This lack of control causes marked distress and/or functional impairment.
Medscape: How does IAD overlap with other psychiatric conditions?
Dr. Wieland: Individuals with IAD can have comorbidities, such as alcohol and drug addiction, depression, or obsessive-compulsive disorder. IAD is described under the category of impulse control disorder, not otherwise specified. IAD has been described as being similar to other addictive behaviors, such as compulsive gambling, chronic overeating, sexual compulsions, and television watching.
It is the feelings that a person experiences while on the Internet that reinforce Internet overuse. IAD fits into our definition of addiction in that it is associated with craving, loss of control, and persistence in the behavior despite accruing adverse consequences. Examples of the use of denial and rationalization concerning IAD include the use of stonewalling, minimizing, blaming, excusing, and attacking.
Medscape: What are the signs and symptoms of IAD?
Dr. Wieland: Signs and symptoms of IAD include general disregard for one's health, reduction in physical activities, craving for more time on the computer, neglect of family and friends, lying, and decreased socialization. Physical signs of computer overuse can include poor posture, migraine headaches, poor hygiene, sleep deprivation, and carpal tunnel syndrome. Psychological manifestations can include euphoria when online, a compulsive drive to be online, an inability to control one's behavior related to being online, and feelings of anxiety, depression, and anger when not online or when asked to stop being online.
Medscape: What is cybersexual addiction?
Dr. Wieland: Cybersexual addiction involves using the Internet to meet sexual needs, most notably through the use of pornographic material. The most frequently searched topic on the Internet is sex. A study on sexuality and the Internet showed that approximately 9 million people, or 15% of Internet users, accessed one of the many top adultWeb sites in a 1-month period. Three primary factors that promote online compulsive sexual behavior, which have been referred to as the triple-A engine, include easy accessibility, affordability, and anonymity.
The National Council on Sexual Addiction and Compulsivity estimates that there are 2 million Americans who are sexually addicted Internet users, both in and out of recovery. Online sexual behaviors fall in a range, fromnormal, or even life-enhancing, to pathological. Compulsive users use the Internet to continue to act out their issues through pornography, sex with multiple and anonymous partners, phone sex, and paraphilias.
Medscape: What is cyber-relationship addiction?
Dr. Wieland: Cyber-relationship addiction is a virtual relationship in which the risk for marital infidelity exists, because the Internet creates an environment where people can take on false personas, where emotional intimacy is expressed through text, and where communication is more rapid than in face-to-face interactions. Computer or virtual relationships prevent conflict resolution in an individual's real-life relationship. Instead, the Internet contact can be triangulated into the marital relationship.
Secrecy and shame can develop as deeper involvement occurs between Internet users. Computer interaction can also lead to face-to-face meetings. Often, cyber-relationships threatening the marriage are identified as Internet infidelity, which can result in divorce from the real-life partner. Online cybersexual activities can occur as a result of cyber-relationships.
Medscape: Are there other manifestations or syndromes associated with IAD?
Dr. Wieland: Net compulsions are activities performed on the computer such as online gambling, shopping, or stock trading. An affected person can spend hours online ordering books, clothing, playing poker, or compulsively checking stocks.
Information overload encompasses activities such as excessive web-surfing and database searching. Men are usually more interested in information seeking and games. Women tend to use the Internet for shopping and seeking friendship, romance, and support.
Medscape: How widespread is IAD, and what are the demographics of those who have it?
Dr. Wieland: The demographics of IAD are not clear, but they appear to be similar to those of compulsive gambling.
Medscape: How should practitioners screen for IAD among their patients and among the family members of patients?
Dr. Wieland: The Center for Internet Addiction and Recovery Web site is an excellent source of instruments for screening for all variations of IAD. The Internet Sex Screening Test is also an important resource.
Dr. Wieland has disclosed no relevant financial relationships.
December 8, 2008 — Editor's note: Internet addiction disorder (IAD) is an increasingly recognized condition, and one in which psychiatric nurses can play a key role in management, according to a presentation at the 22nd Annual Meeting of the American Psychiatric Nurses Association. The various manifestations of IAD include cybersexual addiction, cyber-relationship addiction, net compulsions, information overload, and addiction to interactive computer games.
To learn more about the clinical presentation of IAD, Medscape interviewed presenter Diane M. Wieland, PhD, PMHCNS-BC, a psychiatric nurse in private practice in Lansdale, Pennsylvania, and associate professor at the School of Nursing and Health Sciences, La Salle University, in Philadelphia, Pennsylvania. Part 1 of this interview (below) describes the clinical manifestations of the spectrum of conditions comprising IAD, and part 2 describes the diagnosis, assessment, and management of IAD.
Medscape:What is Internet addiction disorder?
Dr. Wieland: The terms Internet addiction disorder (IAD) and pathological Internet use are used interchangeably and are identified on the basis of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) definition of substance abuse and pathological gambling. Problematic Internet use may belong to the obsessive-compulsive spectrum of disorders, making it responsive to selective serotonin reuptake inhibitors. The affected person has an inability to control his or her use of the Internet. This lack of control causes marked distress and/or functional impairment.
Medscape: How does IAD overlap with other psychiatric conditions?
Dr. Wieland: Individuals with IAD can have comorbidities, such as alcohol and drug addiction, depression, or obsessive-compulsive disorder. IAD is described under the category of impulse control disorder, not otherwise specified. IAD has been described as being similar to other addictive behaviors, such as compulsive gambling, chronic overeating, sexual compulsions, and television watching.
It is the feelings that a person experiences while on the Internet that reinforce Internet overuse. IAD fits into our definition of addiction in that it is associated with craving, loss of control, and persistence in the behavior despite accruing adverse consequences. Examples of the use of denial and rationalization concerning IAD include the use of stonewalling, minimizing, blaming, excusing, and attacking.
Medscape: What are the signs and symptoms of IAD?
Dr. Wieland: Signs and symptoms of IAD include general disregard for one's health, reduction in physical activities, craving for more time on the computer, neglect of family and friends, lying, and decreased socialization. Physical signs of computer overuse can include poor posture, migraine headaches, poor hygiene, sleep deprivation, and carpal tunnel syndrome. Psychological manifestations can include euphoria when online, a compulsive drive to be online, an inability to control one's behavior related to being online, and feelings of anxiety, depression, and anger when not online or when asked to stop being online.
Medscape: What is cybersexual addiction?
Dr. Wieland: Cybersexual addiction involves using the Internet to meet sexual needs, most notably through the use of pornographic material. The most frequently searched topic on the Internet is sex. A study on sexuality and the Internet showed that approximately 9 million people, or 15% of Internet users, accessed one of the many top adultWeb sites in a 1-month period. Three primary factors that promote online compulsive sexual behavior, which have been referred to as the triple-A engine, include easy accessibility, affordability, and anonymity.
The National Council on Sexual Addiction and Compulsivity estimates that there are 2 million Americans who are sexually addicted Internet users, both in and out of recovery. Online sexual behaviors fall in a range, fromnormal, or even life-enhancing, to pathological. Compulsive users use the Internet to continue to act out their issues through pornography, sex with multiple and anonymous partners, phone sex, and paraphilias.
Medscape: What is cyber-relationship addiction?
Dr. Wieland: Cyber-relationship addiction is a virtual relationship in which the risk for marital infidelity exists, because the Internet creates an environment where people can take on false personas, where emotional intimacy is expressed through text, and where communication is more rapid than in face-to-face interactions. Computer or virtual relationships prevent conflict resolution in an individual's real-life relationship. Instead, the Internet contact can be triangulated into the marital relationship.
Secrecy and shame can develop as deeper involvement occurs between Internet users. Computer interaction can also lead to face-to-face meetings. Often, cyber-relationships threatening the marriage are identified as Internet infidelity, which can result in divorce from the real-life partner. Online cybersexual activities can occur as a result of cyber-relationships.
Medscape: Are there other manifestations or syndromes associated with IAD?
Dr. Wieland: Net compulsions are activities performed on the computer such as online gambling, shopping, or stock trading. An affected person can spend hours online ordering books, clothing, playing poker, or compulsively checking stocks.
Information overload encompasses activities such as excessive web-surfing and database searching. Men are usually more interested in information seeking and games. Women tend to use the Internet for shopping and seeking friendship, romance, and support.
Medscape: How widespread is IAD, and what are the demographics of those who have it?
Dr. Wieland: The demographics of IAD are not clear, but they appear to be similar to those of compulsive gambling.
Medscape: How should practitioners screen for IAD among their patients and among the family members of patients?
Dr. Wieland: The Center for Internet Addiction and Recovery Web site is an excellent source of instruments for screening for all variations of IAD. The Internet Sex Screening Test is also an important resource.
Dr. Wieland has disclosed no relevant financial relationships.
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