Internet addiction: reappraisal of an increasingly inadequate concept

Relationship between problematic Internet use and age at initial weekly Internet use

BACKGROUND AND AIMS

An important proportion of infants and adolescents in Japan are using Internet-equipped devices, including smartphones, tablets, and game consoles. However, the relationship between the risk of IA and the age at initial habitual Internet use remains unknown. We aimed to investigate this relationship among adolescents.

METHODS

We surveyed 1,775 subjects in seven public junior high schools in Kanagawa prefecture, Japan, in November 2017. Students were asked to complete the Young's Diagnostic Questionnaire (YDQ), which captured information regarding gender, school grade, night sleep, age at which they first started using the Internet at least once weekly, Internet usage situation, and Internet use time for purposes other than study. Data from subjects who reported experience of weekly Internet use were analyzed.

RESULTS

Junior high school students who were younger at initial weekly Internet use tended to have problematic Internet use (PIU) and to spend more time on Internet activities. In particular, initial weekly Internet use before the age of five in boys was associated with a significantly increased risk of PIU (YDQ ≥ 5), with an odds ratio of 14.955, compared with initial weekly Internet use after the age of 12. Smartphone ownership significantly increased the risk of PIU compared with no ownership among the total population and among girls.

DISCUSSION AND CONCLUSIONS

Junior high school male students displayed a robust relationship between initial weekly Internet use and PIU, whereas junior high school female students displayed a particularly strong relationship between smartphone ownership and PIU. Therefore, longitudinal IA preventive education from an early age is necessary.

Smartphone use motivation and problematic smartphone use in a national representative sample of Chinese adolescents: The mediating roles of smartphone use time for various activities

BACKGROUND AND AIMS

Previous studies on smartphone use motivation (SUM) and problematic smartphone use (PSU) have been limited in the utilization of regional samples of emerging adults (e.g., college students) and also in the foci on the direct association between SUM and PSU. To address such gaps, using data from a large, national representative sample of Chinese young adolescents and their parents this study examined the associations between adolescents' various types of SUM and their PSU, and also tested the potential mediating roles of smartphone use time (SUT) that adolescents spent on various activities in such associations.

METHODS

A nationwide representative sample of 8,261 Chinese adolescents (Mage = 12.86 years old, SD = 1.76; 42.6% females) and their parents (49% mothers) participated in this survey study.

RESULTS

Instrumental SUM (i.e., to expand knowledge or acquire information) was associated negatively with PSU via longer SUT spent on learning and shorter SUT spent on entertainment and communication. Self-expression SUM (i.e., to gain acceptance and recognition of others by maintaining or improving self-images) was associated with longer SUT spent on both learning and entertainment, which, in turn, predicted lower and higher levels of PSU, respectively. Last, hedonic SUM (i.e., to gain pleasure) was associated positively with PSU via longer SUT spent on entertainment and communication.

DISCUSSION

These findings contribute to the literature by adding greater specificity in our understanding of the implications of SUM and SUT in the etiology of PSU during the critical life stage of adolescence in a Chinese cultural context.

An Empirical Exploration of Longitudinal Predictors for Problematic Internet Use and Problematic Gaming Behavior

Problematic gaming (PG) has been included in the DSM-5 and ICD-11. But, it is still controversially discussed, if problematic (online-) gaming is a subtype of problematic Internet use (PIU) or if both behavior patterns should be distinguished. In joint samples, the relationships between PIU and PG and correlates have so far only been investigated in cross-sectional studies. This is the first longitudinal study to determine predictors of PIU, PG, and a combined occurrence of PIU and PG (PIU + PG) together in one sample. Overall, 985 family dyads (one parent and her/his child) were interviewed twice (at t1 and t2, with one year in between) with a standardized questionnaire regarding PIU, PG and psychosocial aspects. Predictors for adolescent PIU, PG, and PIU + PG were determined with a multinomial logistic regression analysis. The following were our findings: (a) PIU (t2) was predicted by stronger emotional distress (t1) and PIU (t1); (b) PG (t2) by male gender, more self-esteem problems (t1), stronger hyperactivity/inattention (t1), and PG (t1); and (c) PIU + PG (t2) by male gender, stronger hyperactivity/inattention (t1), and PG (t1). Partly different patterns of predictors were observed for the development of PIU and PG. The results indicate not only commonalities but also differences in the etiology of these behavior patterns.

Problematic Internet Use in Lonely Adolescents: The Mediating Role of Detachment from Parents

OBJECTIVE

The relationship between Problematic Internet Use (PIU) and loneliness in adolescence is a disputed issue. In the current study, we explored whether the relationship between loneliness and PIU in adolescence is mediated by detachment from parents.

METHOD

A community sample of 356 adolescents completed self-report questionnaires assessing Internet addiction symptoms, peer- and parent-related loneliness, and detachment from parents. Linear regression and mediation analyses were performed to explore the role of loneliness and detachment from parents in predicting PIU.

RESULTS

Peer-related loneliness positively predicted PIU, whereas detachment from parents fully mediated the association between parent-related loneliness and PIU.

CONCLUSIONS

Multidimensional assessment of subjective solitary experience is needed to explain the relationship between loneliness and PIU in adolescence. This is in line with previous research on adolescents' PIU, suggesting that peer-related loneliness is more strictly related with maladjustment, whereas parent-related loneliness is maladaptive in the context of a lack of parental support.

Measurement invariance across young adults from Hong Kong and Taiwan among three internet-related addiction scales: Bergen Social Media Addiction Scale (BSMAS), Smartphone Application-Based Addiction Scale (SABAS), and Internet Gaming Disorder Scale-Short Form (IGDS-SF9) (Study Part A)

Internet addiction has been found to be prevalent worldwide, including Asian countries, and related to several negative outcomes and other behavioral addictions. The Bergen Social Media Addiction Scale (BSMAS), Smartphone Application-Based Addiction Scale (SABAS), and nine-item Internet Gaming Disorder Scale-Short Form (IGDS-SF9) have been extensively used to assess internet-related addictions. However, the three aforementioned instruments have rarely been used in Asian countries. The aim of the present study was to investigate whether the BSMAS, SABAS, and IGDS-SF9 were appropriate for use in heterogeneous subsamples from Hong Kong and Taiwan. University students from Hong Kong (n = 306) and Taiwan (n = 336) were recruited via an online survey. Multigroup confirmatory factor analysis (MGCFA) was used to assess measurement invariance of the BSMAS, SABAS, and IGDS-SF9 across the two subcultures. The original unidimensional structures of BSMAS, SABAS and IGDS-SF9 were confirmed through confirmatory factorial analysis in both subcultures. The MGCFA results showed that the unidimensional structures of the BSMAS and IGDS-SF9 were invariant across the two Chinese cultural areas (Hong Kong and Taiwan). However, the measurement invariance of the SABAS was established after some model modifications. In conclusion, the present study found that the Chinese BSMAS, SABAS, and IGDS-SF9 were all adequate instruments to validly assess internet-related addictions among university students. The three brief instruments used for assessing addictions to social media, smartphone applications, and online gaming are valid and psychometrically robust across two Chinese subcultures and can be used by healthcare professionals in these regions.

Predicting tendencies towards the disordered use of Facebook's social media platforms: On the role of personality, impulsivity, and social anxiety

The present study aimed at investigating personality underpinnings of Social Networks Use Disorder. Instead of focusing on social media in broad or on a single platform, specifically, it was focused on various social media platforms, namely, Facebook, WhatsApp, and Instagram, each offering different functions to their users. N = 494 (n = 358 males) participants filled in questionnaires on the Big Five of personality, impulsivity, and social anxiety. Additionally, participants who endorsed using Facebook, and/or WhatsApp, and/or Instagram also completed scales assessing tendencies towards Facebook, and/or WhatsApp, and/or Instagram Use Disorder. Generalized linear models revealed that impulsivity and especially extraversion were positively associated with Facebook, WhatsApp, and Instagram Use Disorder scores. Conscientiousness (negatively) and particularly neuroticism (positively) were only significantly related to Facebook Use Disorder scores. However, the non-significant associations of WhatsApp and Instagram Use Disorder scores with neuroticism were most likely due to neuroticism's overlap with impulsivity and social anxiety. In conclusion, the present study provides insights into potential common and distinct predisposing factors for the development of Use Disorders of various social media platforms providing different content and functions to their users. Future studies should aim at causally investigating why different platforms are addictive to people with distinct personality profiles.

Predictors of Spontaneous Remission of Problematic Internet Use in Adolescence: A One-Year Follow-Up Study

Problematic use of the Internet is becoming increasingly important and especially for adolescents, high prevalence rates are reported in many countries. Despite the growing international research activities and the reported prevalence estimates, comparatively very few studies have focused on spontaneous remission and its possible causes. In a risk population of 272 adolescents, we used standardized diagnostic instruments to investigate which socio-demographic and psychosocial characteristics at baseline (at t1) predicted spontaneous remission of problematic Internet use one year later (at t2). The predictors were determined by bivariate and multivariate logistic regression analyses. In the bivariate regressions, we found male gender, higher self-efficacy (t1), a lower level of maladaptive emotion regulation strategies (t1), lower depression (t1), lower performance and school anxiety (t1), lower social-interaction anxiety (t1), and lower procrastination (t1) to predict spontaneous remission of problematic Internet use at t2. In the multivariable analysis, a lower level of maladaptive emotion regulation strategies (t1) was the sole statistically significant predictor for the remission one year later (t2). For the first time, the high relevance of emotion regulation for spontaneous remission of adolescent problematic Internet use was observed. Based on these findings, emotion regulation could be specifically trained and promoted in future prevention measures.

The psychology of "swiping": A cluster analysis of the mobile dating app Tinder

BACKGROUND AND AIMS

The use of the smartphone dating application Tinder is increasingly popular and has received much media attention. However, no empirical study to date has investigated the psychological characteristics driving its adaptive or problematic use. The aim of this study is to determine whether reliable subtypes of users can be identified via a cluster analysis approach.

METHODS

A total of 1,159 Tinder users were recruited. Survey questions investigated user characteristics, including: motives for app use, sexual desire, attachment styles, impulsivity traits, self-esteem, problematic use, depressive mood, and patterns of use.

RESULTS

Four reliable clusters were identified: two with low levels of problematic use ("regulated" and "regulated with low sexual desire"), one with an intermediate level of problematic use ("unregulated-avoidants"), and one with a high level of problematic use ("unregulated-highly motivated"). The clusters differed on gender, marital status, depressive mood, and use patterns.

CONCLUSION

The findings provide insight into the dynamic relationships among key use-related factors and shed light on the mechanisms underlying the self-regulation difficulties that appear to characterize problematic Tinder use.

Problematic use of the Internet is a unidimensional quasi-trait with impulsive and compulsive subtypes

BACKGROUND

Problematic use of the Internet has been highlighted as needing further study by international bodies, including the European Union and American Psychiatric Association. Knowledge regarding the optimal classification of problematic use of the Internet, subtypes, and associations with clinical disorders has been hindered by reliance on measurement instruments characterized by limited psychometric properties and external validation.

METHODS

Non-treatment seeking individuals were recruited from the community of Stellenbosch, South Africa (N = 1661), and Chicago, United States of America (N = 827). Participants completed an online version of the Internet Addiction Test, a widely used measure of problematic use of the Internet consisting of 20-items, measured on a 5-point Likert-scale. The online questions also included demographic measures, time spent engaging in different online activities, and clinical scales. The psychometric properties of the Internet Addiction Test, and potential problematic use of the Internet subtypes, were characterized using factor analysis and latent class analysis.

RESULTS

Internet Addiction Test data were optimally conceptualized as unidimensional. Latent class analysis identified two groups: those essentially free from Internet use problems, and those with problematic use of the Internet situated along a unidimensional spectrum. Internet Addiction Test scores clearly differentiated these groups, but with different optimal cut-offs at each site. In the larger Stellenbosch dataset, there was evidence for two subtypes of problematic use of the Internet that differed in severity: a lower severity "impulsive" subtype (linked with attention-deficit hyperactivity disorder), and a higher severity "compulsive" subtype (linked with obsessive-compulsive personality traits).

CONCLUSIONS

Problematic use of the Internet as measured by the Internet Addiction Test reflects a quasi-trait - a unipolar dimension in which most variance is restricted to a subset of people with problems regulating Internet use. There was no evidence for subtypes based on the type of online activities engaged in, which increased similarly with overall severity of Internet use problems. Measures of comorbid psychiatric symptoms, along with impulsivity, and compulsivity, appear valuable for differentiating clinical subtypes and could be included in the development of new instruments for assessing the presence and severity of Internet use problems.

Peer victimization and problematic internet use in adolescents: The mediating role of deviant peer affiliation and the moderating role of family functioning

The role of social-environmental factors in adolescent problematic Internet use (PIU) has attracted considerable attention recently. Several studies have documented that peer victimization is positively associated with PIU. However, little is known about "how" (i.e., mediation mechanisms) and "under what conditions" (i.e., moderation mechanisms) peer victimization is associated with adolescent PIU. To contribute to this gap in the knowledge, this study used a large sample of Chinese adolescents (N = 2758; M_age = 13.53 years, SD = 1.06) to examine deviant peer affiliation (DPA) as a mediator and family functioning as a moderator in this relationship. Students completed anonymous questionnaires to measure the main variables. After controlling for important covariates related to PIU, the results indicated that (a) peer victimization was positively associated with PIU, (b) DPA partially mediated the link between peer victimization and PIU, and (c) family functioning moderated the association between peer victimization and DPA. Specifically, for adolescents with better family functioning, the relationship between peer victimization and DPA was weaker. The current research deepens our understanding of "how" and "under what conditions" peer victimization is related to PIU in adolescents.

Problematic Internet use two decades later: apps to wean us off apps

Two decades of research into problematic Internet use have not yielded an established definition, much less an accepted treatment algorithm that is based on the psychopharmacological and psychotherapeutic interventions that have been tested. Meanwhile, technology-mediated tools that purport to curb unnecessary use of Internet-related technologies and the associated negative consequences are gaining in popularity, despite the lack of rigorous clinical trials into their efficacy and safety. Some popular new offerings that vary in browser, operating system and platform compatibility are reviewed. While they share similar goals as "traditional" treatments, they may be more efficient, scalable, and affordable. Using technology against itself may be counter-intuitive, but the popularity of these tools and their potential advantages make them worthy of researchers' attention. Telepsychiatry platforms, which are gaining a foothold in the treatment of established disorders, may, paradoxically, also prove beneficial for the management of problematic use of Internet-related technologies.

Brain response features during forced break could predict subsequent recovery in internet gaming disorder: A longitudinal study

Although internet gaming disorder (IGD) is associated with negative health measures, individuals may recover without professional intervention. Exploring neural features associated with natural recovery may provide insights into how best to promote health among people with IGD. Seventy-nine IGD subjects were scanned when they were performing cue-craving tasks before and after gaming was interrupted with a forced break. After one year, 20 individuals no longer met IGD criteria and were considered recovered. We compared brain responses in cue-craving tasks between these 20 recovered IGD subjects and 20 matched IGD subjects still meeting criteria at one year (persistent IGD). Recovered IGD subjects showed lower dorsolateral prefrontal cortex (DLPFC) activation than persistent IGD subjects to gaming cues at both pre- and post-gaming times. Significant group-by-time interactions were found in the bilateral DLPFC and insula, and these involved relatively decreased DLPFC and increased insula activation in the persistent IGD group during the forced break. Relatively decreased DLPFC activity and increased insula activity in response to gaming cues following recent gaming may underlie persistence of gaming. These findings suggest that executive control and interoceptive processing warrant additional study in understanding recovery from IGD.

The Current Status of Psychological Intervention Research for Internet Addiction and Internet Gaming Disorder

This integrative review assesses the effectiveness of psychological interventions for reducing the severity of Internet addiction and/or Internet gaming disorder. We searched five databases, and both a narrative synthesis and meta-analyses were conducted. Five randomized controlled trials (RCTs) and six quasi-experimental studies met the inclusion criteria. The included interventions were categorized as cognitive-behavioral therapy, family-based intervention, and counseling program. A meta-analysis showed significant effects of psychological interventions, whereas a narrative synthesis showed some evidence that they could reduce addiction severity. Psychological interventions may help to reduce addiction severity, but further RCTs are needed to identify the most effective type.

Development of a short form of the compulsive internet use scale in Switzerland

OBJECTIVES

The study aims to develop a short form of the compulsive internet use scale (CIUS), which can be used in multitopic and general population health surveys and is invariant across different sexes, linguistic regions, and ages.

METHODS

Two general population surveys from 2013 and 2015 were used as learning (n = 1,371) and validation samples (n = 1,550), respectively. Reducing items from the original CIUS was based on the following: (a) correlated errors between items, (b) differential item functioning, and (c) measurement invariance. Methods used item response theory and latent confirmatory factor analysis for ordinal variables.

RESULTS

The eight-item short form maintained the five dimensions of the original scale and was metric and mostly scale invariant for sex, region, and age. It fell marginally short of scale invariance (ΔCFI < 0.01) for regions in the learning sample and for sexes in the validation sample (both ΔCFI = 0.013, p < 0.01). Root mean square error of approximation was 0.045 and 0.036, and comparative fit index was 0.989 and 0.995, in the learning and validation samples, respectively, showing excellent fit of the model to data. Correlations with the full scale were r = 0.966 (learning) and r = 0.969 (validation).

CONCLUSION

If the full 14-item CIUS is a valid, reliable screening instrument, then the short eight-item form is too, and can be used in multitopic, general population health surveys.

Search, sense making and learning: closing gaps

Purpose

This paper aims to discuss how search, sense making and learning have become more closely integrated, as search services have leveraged new technologies and large and media-diverse data streams.

Design/methodology/approach

The paper reviews progress in search over the past 60 years, summarizes different theories of sense making and learning and proposes a framework for integrating these activities.

Findings

The arguments are supported with examples from search in 2018 and suggest that even as search becomes an automated process during learning, search strategies must continue to evolve to insure that complex information needs can be met.

Research limitations/implications

The work is limited to search that uses electronic search systems. Implications include the need to understand that multiple levels of system inferences/estimates are used to present search results and that different kinds of learning processes are affected by search systems.

Social implications

The importance of information literacy is implied.

Originality/value

This paper will provide readers with an understanding of how search services and systems have evolved and their implications for human learning.

The role of childhood emotional maltreatment and body image dissatisfaction in problematic smartphone use among adolescents

Growing empirical evidence has identified specific psychological and contextual risk factors associated with problematic smartphone use (PSU). However, the potential direct and indirect impact of childhood emotional maltreatment (CEM) on PSU remains largely unexplored, despite the established role of CEM in the onset of other excessive, problematic, and addictive behaviors. Consequently, the purpose of the present study was to test the direct and indirect relationships of emotional abuse and neglect (two facets of CEM) with PSU via specific mediational pathways including body image dissatisfaction (BID), social anxiety, and depression. The sample comprised 443 adolescents who completed a questionnaire that included assessment tools of aforementioned variables. Multiple mediation model results indicated that CEM was directly and indirectly associated with PSU via BID, depression, BID-related depression, and BID-related social anxiety. Results suggested that emotionally traumatic experiences were associated with PSU in adolescents and that this relationship may partially be explained by BID and psychosocial risk factors. The present study draws caution to the amplifying roles of CEM and BID on increased PSU. The results of the study have important clinical and public health implications, but additional research is needed before interventions can be developed and implemented on the basis of present results.

Adição à internet ou uso problemático da internet? Qual dos termos usar?

Resumo O uso da internet tem aumentado exponencialmente a nível mundial. Ainda que ele não seja por si só negativo, já que integra benefícios vários, alguns indivíduos parecem exibir problemas relacionados com o seu uso excessivo, descontrolado e disfuncional. Consequentemente, tem sido crescente, particularmente nas últimas duas décadas, o interesse dos investigadores em explorar este uso, quando excessivo e pouco saudável. Porém, e sendo um tema/constructo tratado por diferentes autores com quadros teóricos também diferentes, são vários os termos usados na literatura para descrever este fenómeno. Neste sentido, este artigo propõe-se a apresentar o trabalho uma revisão de literatura de dois dos conceitos mais usados e espartilhados na literatura científica, ou seja, adição à internet e uso problemático da internet.

Treatment of Internet Addiction and Internet Gaming Disorder in Adolescence

Internet use is growing year after year and adolescents represent a large proportion of internet users. There is a scholarly interest in teen internet gaming disorder (IGD) and internet addiction (IA) is constantly increasing, but little is known about the treatments of IA and IGD. This study systematically reviews the literature of the last fifteen years, focusing on two main aspects: adolescence, and IA and IGD intervention programs. The inclusion criteria were (1) contain empirical data, (2) include an analysis relating to IA or IGD, (3) include teen samples aged between 13 and 19 years or with an average age within this range, and (4) provide a full-text article published in English. A total number of 17 papers were included, 7 focused on IA and 10 focused on IGD. Prevalence and different treatment-related outcomes are discussed.

Game Addiction Scale Assessment Through a Nationally Representative Sample of Young Adult Men: Item Response Theory Graded-Response Modeling

BACKGROUND

The 7-item Game Addiction Scale (GAS) has been validated under standard confirmatory factor analysis and exhibits good psychometric properties. Whether this scale satisfies the necessary conditions for consideration by item response theory (IRT) modeling remains unknown. However, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) recently proposed criteria, in its section 3, to define internet gaming disorder (IGD) to promote research on this possible condition.

OBJECTIVE

The objective of our study was to (1) analyze GAS in the context of IRT (graded-response) modeling; (2) investigate differential item functioning (DIF), a feature of IRT modeling, in 2 subsamples; and (3) contribute to the ongoing (IGD) debate related to the validity of the DSM-5 criteria using GAS items as a proxy.

METHODS

We assessed 2 large representative samples of Swiss men (3320 French-speaking and 2670 German-speaking) with GAS.

RESULTS

All items comprised high discrimination parameters. GAS items such as relapse, conflict, withdrawal, and problems (loss of interests) were endorsed more frequently in more severe IGD stages, whereas items related to tolerance, salience (preoccupation), and mood modification (escape) were endorsed more widely among participants (including in less severe IGD stages). Several DIF effects were found but were classified as negligible.

CONCLUSIONS

The results of the analyses partly support the relevance of using IRT to further establish the psychometric properties of the GAS items. This study contributes to testing the validity of the IGD criteria, although cautious generalization of our findings is required with GAS being only a proxy of the IGD criteria.

Interference with Processing Negative Stimuli in Problematic Internet Users: Preliminary Evidence from an Emotional Stroop Task

Although it has been proposed that problematic Internet use (PIU) may represent a dysfunctional coping strategy in response to negative emotional states, there is a lack of experimental studies that directly test how individuals with PIU process emotional stimuli. In this study, we used an emotional Stroop task to examine the implicit bias toward positive and negative words in a sample of 100 individuals (54 females) who also completed questionnaires assessing PIU and current affect states. A significant interaction was observed between PIU and emotional Stroop effects (ESEs), with participants who displayed prominent PIU symptoms showing higher ESEs for negative words compared to other participants. No significant differences were found on the ESEs for positive words among participants. These findings suggest that PIU may be linked to a specific emotional interference with processing negative stimuli, thus supporting the view that PIU is a dysfunctional strategy to cope with negative affect. A potential treatment implication for individuals with PIU includes a need to enhance the capacity to process and regulate negative feelings.

Positive outcome expectancy mediates the relationship between social influence and Internet addiction among senior high-school students

Background and aims Based on the foundations of Bandura's social cognitive theory and theory of triadic influence (TTI) theoretical framework, this study was designed to examine the mediating role of positive outcome expectancy of Internet use in the relationship between social influence and Internet addiction (IA) in a large representative sample of senior high-school students in Taiwan. Methods Using a cross-sectional design, 1,922 participants were recruited from senior high schools throughout Taiwan using both stratified and cluster sampling, and a comprehensive survey was administered. Results Structural equation modeling and bootstrap analyses results showed that IA severity was significantly and positively predicted by social influence, and fully mediated through positive outcome expectancy of Internet use. Discussion and conclusions The results not only support Bandura's social cognitive theory and TTI framework, but can also serve as a reference to help educational agencies and mental health organizations design programs and create policies that will help in the prevention of IA among adolescents.

Association between Internet Gaming Disorder or Pathological Video-Game Use and Comorbid Psychopathology: A Comprehensive Review

The addictive use of video games is recognized as a problem with clinical relevance and is included in international diagnostic manuals and classifications of diseases. The association between "Internet addiction" and mental health has been well documented across a range of investigations. However, a major drawback of these studies is that no controls have been placed on the type of Internet use investigated. The aim of this study is to review systematically the current literature in order to explore the association between Internet Gaming Disorder (IGD) and psychopathology. An electronic literature search was conducted using PubMed, PsychINFO, ScienceDirect, Web of Science and Google Scholar (r.n. CRD42018082398). The effect sizes for the observed correlations were identified or computed. Twenty-four articles met the eligibility criteria. The studies included comprised 21 cross-sectional and three prospective designs. Most of the research was conducted in Europe. The significant correlations reported comprised: 92% between IGD and anxiety, 89% with depression, 85% with symptoms of attention deficit hyperactivity disorder (ADHD), and 75% with social phobia/anxiety and obsessive-compulsive symptoms. Most of the studies reported higher rates of IGD in males. The lack of longitudinal studies and the contradictory results obtained prevent detection of the directionality of the associations and, furthermore, show the complex relationship between both phenomena.

Increased Attentional Bias Toward Visual Cues in Internet Gaming Disorder and Obsessive-Compulsive Disorder: An Event-Related Potential Study

Internet gaming disorder (IGD) is a newly identified potential addiction disorder associated with compulsive internet-game playing behavior and attentional bias toward online gaming- related cues. Attentional bias toward addiction-related cues is the core feature of addiction that is associated with craving, but the pathophysiology of attentional bias in IGD is not well-understood, such as its relationship to compulsivity. In this study, we used the electrophysiological marker of late positive potential (LPP) to compare attentional bias in IGD and obsessive compulsive disorder (OCD). Twenty patients with IGD, 20 patients with OCD, and 23 healthy control (HC) subjects viewed a series of game-related, OCD-related, and neutral pictures while their event-related potentials (ERPs) were recorded. The game-related cues included in-game screen captures of popular internet games. The OCD-related cues included pictures which provokes obsessive and compulsive symptoms of contamination/washing or checking. LPPs were calculated as the mean value of amplitudes between 350 and 750 ms at the centro-parietal (CP1, CPz, CP2) and parietal (P1, Pz, P2) electrode sites. Higher LPP amplitudes were found for game-related cues in the IGD group than in the HCs, and higher LPP amplitudes were observed in the OCD group for OCD-related cues. The IGD group did not exhibit LPP changes in response to OCD-related cues. Subjective scales demonstrated increased arousal to game-related cues and OCD-related cues in both the IGD and OCD groups compared with the HC group. Increased LPPs in response to disorder-specific cues (game-related and OCD-related) were found in both IGD and OCD groups respectively, although the groups showed overlapping arousal on subjective scales. Our results indicate that LPP is a candidate neurophysiological marker for cue-related craving in IGD.

The association between the nicotinic acetylcholine receptor α4 subunit gene (CHRNA4) rs1044396 and Internet gaming disorder in Korean male adults

The primary aim of this study was to investigate the genetic predisposition of Internet gaming disorder (IGD), and the secondary aim was to compare the results to those of alcohol dependence (AD). Two independent case-control studies were conducted. A total of 30 male participants with IGD, diagnosed according to the 5^th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, and 30 sex-matched controls participated in study 1. We designed targeted exome sequencing (TES) to test for 72 candidate genes that have been implicated in the pathogenesis of addiction. The genes included seven neurotransmitter (dopamine, serotonin, glutamate, r-aminobutyric acid (GABA), norepinephrine, acetylcholine, and opioid) system genes. A total of 31 male in-patients with AD and 29 normal male controls (NC) were enrolled in study 2. The same 72 genes included in study 1 and ten additional genes related to alcohol-metabolic enzyme were selected as the target genes, and we identified the genetic variants using the same method (TES). The IGD group had a lower frequency of the T allele of rs1044396 in the nicotinic acetylcholine receptor alpha 4 subunit (CHRNA4), and this variant represents a protective allele against IGD. However, we did not find a significant difference in the polymorphisms of the 72 genes that encode neurotransmitter systems between the AD and NC groups. This study demonstrated that rs1044396 of CHRNA4 was significantly associated with IGD.

Investigating the differential effects of social networking site addiction and Internet gaming disorder on psychological health

Background and aims Previous studies focused on examining the interrelationships between social networking site (SNS) addiction and Internet gaming disorder (IGD) in isolation. Moreover, little is known about the potential simultaneous differential effects of SNS addiction and IGD on psychological health. This study investigated the interplay between these two technological addictions and ascertained how they can uniquely and distinctively contribute to increasing psychiatric distress when accounting for potential effects stemming from sociodemographic and technology-related variables. Methods A sample of 509 adolescents (53.5% males) aged 10-18 years (mean = 13.02, SD = 1.64) were recruited. Results It was found that key demographic variables can play a distinct role in explaining SNS addiction and IGD. Furthermore, it was found that SNS addiction and IGD can augment the symptoms of each other, and simultaneously contribute to deterioration of overall psychological health in a similar fashion, further highlighting potentially common etiological and clinical course between these two phenomena. Finally, the detrimental effects of IGD on psychological health were found to be slightly more pronounced than those produced by SNS addiction, a finding that warrants additional scientific scrutiny. Discussion and conclusion The implications of these results are further discussed in light of the existing evidence and debates regarding the status of technological addictions as primary and secondary disorders.

Peer attachment, specific patterns of internet use and problematic internet use in male and female adolescents

Problematic internet use may lead to serious psychosocial dysfunction. Recent studies have found comparable prevalence in both male and female adolescents. We pursue the neglected questions how male and female adolescents differ regarding their patterns of internet use and how gender, peer attachment and patterns of use are related to pathological internet use. In 2410 adolescents (1307 girls and 1103 boys) aged 12-18 years from different types of school we assessed peer attachment, frequency and use of eight specific applications and indicators of pathological internet use. Three patterns of internet use, 'social'; 'sex and games" and 'functional' were identified and connections between variables were modeled by ordered sequences of regression. We found that problematic internet use-sex and games as well as social usage-was more prevalent in boys. Insecure peer attachment predicted problematic internet use in both sexes. Also, excessive usage of internet games and sex mediated the influence of peer attachment insecurity on problematic internet use, but only for boys. Our study identified that adolescents with insecure peer attachment are at higher risk for problematic internet use. With regard to specific types of internet use, the consumption of online games and sex was identified as risk factor in boys with increasing age. Further studies are needed to understand and possibly subgroup problematic internet use behavior in girls. Our findings suggest that increasing the quality of peer relationships may be promising approach in the prevention and treatment of problematic internet use.

Self-reported dependence on mobile phones in young adults: A European cross-cultural empirical survey

Background and aims Despite many positive benefits, mobile phone use can be associated with harmful and detrimental behaviors. The aim of this study was twofold: to examine (a) cross-cultural patterns of perceived dependence on mobile phones in ten European countries, first, grouped in four different regions (North: Finland and UK; South: Spain and Italy; East: Hungary and Poland; West: France, Belgium, Germany, and Switzerland), and second by country, and (b) how socio-demographics, geographic differences, mobile phone usage patterns, and associated activities predicted this perceived dependence. Methods A sample of 2,775 young adults (aged 18-29 years) were recruited in different European Universities who participated in an online survey. Measures included socio-demographic variables, patterns of mobile phone use, and the dependence subscale of a short version of the Problematic Mobile Phone Use Questionnaire (PMPUQ; Billieux, Van der Linden, & Rochat, 2008). Results The young adults from the Northern and Southern regions reported the heaviest use of mobile phones, whereas perceived dependence was less prevalent in the Eastern region. However, the proportion of highly dependent mobile phone users was more elevated in Belgium, UK, and France. Regression analysis identified several risk factors for increased scores on the PMPUQ dependence subscale, namely using mobile phones daily, being female, engaging in social networking, playing video games, shopping and viewing TV shows through the Internet, chatting and messaging, and using mobile phones for downloading-related activities. Discussion and conclusions Self-reported dependence on mobile phone use is influenced by frequency and specific application usage.

Chaos and confusion in DSM-5 diagnosis of Internet Gaming Disorder: Issues, concerns, and recommendations for clarity in the field

Background The umbrella term "Internet addiction" has been criticized for its lack of specificity given the heterogeneity of potentially problematic behaviors that can be engaged in online as well as different underlying etiological mechanisms. This has led to the naming of specific online addictions, the most notable being Internet Gaming Disorder (IGD). Methods Using the contemporary literature concerning IGD and cognate topics, issues and concerns relating to the concept of IGD are examined. Results Internet addiction and IGD are not the same, and distinguishing between the two is conceptually meaningful. Similarly, the diagnosis of IGD as proposed in the appendix of the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) remains vague regarding whether or not games need to be engaged in online, stating that IGD typically involves specific Internet games, but can also include offline games, adding to the lack of clarity. A number of authors have voiced concerns regarding the viability of including the word "Internet" in IGD, and instead proposed to use the term "video gaming disorder" or simply "gaming disorder," suggesting addiction to video gaming can also occur offline. Conclusion The DSM-5 has caused more confusion than clarity regarding the disorder, reflected by researchers in the field contesting a supposedly reached consensus for IGD diagnosis.

Internet gaming disorder: Inadequate diagnostic criteria wrapped in a constraining conceptual model

Background and aims The paper "Chaos and confusion in DSM-5 diagnosis of Internet Gaming Disorder: Issues, concerns, and recommendations for clarity in the field" by Kuss, Griffiths, and Pontes (in press) critically examines the DSM-5 diagnostic criteria for Internet gaming disorder (IGD) and addresses the issue of whether IGD should be reconceptualized as gaming disorder, regardless of whether video games are played online or offline. This commentary provides additional critical perspectives on the concept of IGD. Methods The focus of this commentary is on the addiction model on which the concept of IGD is based, the nature of the DSM-5 criteria for IGD, and the inclusion of withdrawal symptoms and tolerance as the diagnostic criteria for IGD. Results The addiction framework on which the DSM-5 concept of IGD is based is not without problems and represents only one of multiple theoretical approaches to problematic gaming. The polythetic, non-hierarchical DSM-5 diagnostic criteria for IGD make the concept of IGD unacceptably heterogeneous. There is no support for maintaining withdrawal symptoms and tolerance as the diagnostic criteria for IGD without their substantial revision. Conclusions The addiction model of IGD is constraining and does not contribute to a better understanding of the various patterns of problematic gaming. The corresponding diagnostic criteria need a thorough overhaul, which should be based on a model of problematic gaming that can accommodate its disparate aspects.

Problem Internet Use and Internet Gaming Disorder: a survey of health literacy among psychiatrists from Australia and New Zealand

OBJECTIVES

Research is limited on psychiatrists' opinions on the concepts of Internet Gaming Disorder (IGD) and Problematic Internet Use (PIU). We aimed to assess health literacy among psychiatrists on IGD/PIU.

METHODS

A self-report survey was administered online to members of the Royal Australia and New Zealand College of Psychiatrists (RANZCP) ( n=289).

RESULTS

The majority (93.7%) were familiar with the concepts of IGD/PIU. The majority (78.86%) thought it is possible to be 'addicted' to non-gaming internet content, and 76.12% thought non-gaming addictions could possibly be included in classificatory systems. Forty-eight (35.6%) felt that IGD maybe common in their practice. Only 22 (16.3%) felt they were confident in managing IGD. Child psychiatrists were more likely to screen routinely for IGD (11/45 vs. 7/95; Fishers Exact test χ²=7.95, df=1, p<0.01) and were more likely to elicit specific symptoms of addiction (16/45 vs. 9/95; Fishers Exact test χ²=14.16, df=1, p<0.001).

CONCLUSIONS

We recommend adoption of terms alternate to PIU/IGD which are more in line with the content of material irrespective of medium of access. Screening instruments/ protocols are needed to assist in early diagnosis and service planning. Barriers to screening would need to be addressed both in research and service settings.

The Internet's effect on personality traits: An important casualty of the "Internet addiction" paradigm

Background and aims The "Internet addiction" paradigm has been criticized for several shortcomings, including inattention to specific online behaviors, not distinguishing the Internet from other media, insufficient focus on comorbidities, and definitions that do not take into account the constant access now possible. The paradigm's biggest casualty, however, may be that it has diverted attention away from subtle personality changes that seem to occur online, including in users who cannot be considered "addicted" under any definition. Methods A narrative assessment of the literature was conducted, focusing on the Internet's effects on personality traits as revealed in studies of Internet users. Results Impulsivity, narcissism, and aggression are some of the personality traits that seem to be nurtured by the Internet, with possible negative offline consequences. Discussion Ignoring the Internet's subtle effects on personality as we embrace an addiction model that implies severe pathology makes the majority of Internet users feel deceptively immune to the psychological effects of new technologies. It also limits our understanding of the big cultural shifts that are happening as a result. Conclusion The Internet's potentially negative effect on personality, and by extension on society at large, is a fundamental part of online psychology, one well worthy of further investigation.

Relationships between Behavioural Addictions and Psychiatric Disorders: What Is Known and What Is Yet to Be Learned?

This article provides a narrative review of the relationships between several behavioural addictions [pathological gambling, problematic Internet use (PIU), problematic online gaming, compulsive sexual behaviour disorder, compulsive buying, and exercise addiction] and psychiatric disorders. Associations between most behavioural addictions and depressive and anxiety disorders are strong and seem relatively non-specific. Strong links with substance use disorders may support the notion that some people are more prone to addictive behaviours, regardless of whether these involve substances or problematic activities. Other associations seem relatively specific, for example, those between PIU/online gaming and attention-deficit/hyperactivity disorder, between compulsive buying on the one hand and eating disorders and hoarding on the other hand and between exercise addiction and eating disorders. The quality of the research varies, but most studies suffer from methodological limitations, including a cross-sectional or correlational design, non-representative study populations, small sample sizes, reliance on self-report assessment instruments, diverse diagnostic criteria, and conceptual heterogeneity of most behavioural addictions. Due to these limitations, generalisability of the findings is questionable and the direction of causality, if any, is unknown in the relationships between behavioural addictions and psychiatric disorders. Regardless of the aetiological uncertainty, these relationships often call for a modified treatment approach. Prospective studies are needed to clarify the longitudinal relationships between behavioural addictions and psychiatric disorders.

Understanding the psychology of mobile gambling: A behavioural synthesis

This manuscript reviews the extant literature on key issues related to mobile gambling and considers whether the potential risks of harm emerging from this platform are driven by pre‐existing comorbidities or by psychological processes unique to mobile gambling. We propose an account based on associative learning that suggests this form of gambling is likely to show distinctive features compared with other gambling technologies. Smartphones are a rapidly growing platform on which individuals can gamble using specifically designed applications, adapted websites or text messaging. This review considers how mobile phone use interacts with psychological processes relevant to gambling, the games users are likely to play on smartphones, and the interactions afforded by smartphones. Our interpretation of the evidence is that the schedules of reinforcement found in gambling interact with the ways in which people tend to use smartphones that may expedite the acquisition of maladaptive learned behaviours such as problem gambling. This account is consistent with existing theories and frameworks of problem gambling and has relevance to other forms of mobile phone use.