Academic journal article International Journal of Child and Adolescent Health

Development of Internet Addictive Behaviors: Potential Pathophysiologic Mechanisms

Academic journal article International Journal of Child and Adolescent Health

Development of Internet Addictive Behaviors: Potential Pathophysiologic Mechanisms

Article excerpt


A certain proportion of adolescents will increase their time online to the point of interfering with certain obligatory functions, such as schoolwork, familial interactions, and even self-care.

As both clinicians and scientists, physicians always want to know why unhealthy behaviors occur, in order to develop effective therapeutic and preventative interventions. In the case of inappropriate time spent using the Internet, research into the cause of related "addictive" behaviors has been limited. What follows is an examination of some of the factors contributing to the relative paucity of research in this area. In addition, some speculations- derived from studies of addictive disorders-as to possible pathophysiologic mechanisms will be discussed.

Internet addiction: The argument over diagnosis

In order to accurately study any clinical entity, practitioners first must agree on how to define and diagnose the problem. The first proposed diagnostic criteria for Internet addiction (IA) were derived from the DSM-IV criteria for pathological gambling (1). In a commentary on this issue, Pies (2) argued against the inclusion of IA in the forthcoming DSM-V, based on the following points: the terms substance abuse and substance dependence-not addiction-appear in the DSM; dependence on a substance requires physiological tolerance and withdrawal, which have not been demonstrated with IA; and, given the high rate of comorbid psychiatric and behavioral problems associated with IA, the symptoms of IA would be better subsumed under well-established diagnostic categories. Even if IA were to qualify as an addiction, there would still be the need for a valid and reliable set of diagnostic criteria, especially for use in adolescents, the primary demographic group at risk for IA. Ko and colleagues have proposed such criteria (3), which, however, do not settle the debate over how IA should be diagnosed.

Internet addiction: The argument over categorization

If IA isn't an addiction, what is it? Pies also noted in his commentary (2) that IA actually describes behaviors that could be called compulsive or impulsive, i.e., the person feels compelled to be online excessively. The problem with categorizing excessive Internet use (EIU) as a compulsion is that, unlike the classic mental compulsions of obsessive- compulsive disorder (OCD), which are ego-dystonic (unwanted), the putative compulsions of IA/EIU are ego-syntonic (wanted). Describing the behaviors associated with IA as impulsive seems to be more relevant, as impulsivity implies emotionally based actions in the absence of awareness of, or concerns about, possible negative consequences. Cao, et al, explored the connection between impulsivity and IA in Chinese high school students (4). Using a well- validated questionnaire and a computer-based paradigm, the students with IA scored significantly higher on the measures of impulsivity than did controls without IA. Impulsivity is also known to be one of the core features of attention- deficit/hyperactivity disorder (ADHD). Yoo, et al, investigated the presence of IA in Korean elementary school students with or without ADHD (5). Using rating scales and checklists, the authors found "significant positive correlations" between ADHD scores and IA scores.

Internet addiction: Neurobiological features

Even if debates over how best to categorize and diagnose IA were resolved, the question of what causes IA would still be unanswered. In recent years researchers have looked at both brain structure and functions in an attempt to answer that question.

Zhou et al (6) using voxel-based morphometry (VBM) analysis of magnetic resonance imaging (MRI), compared the brains of a small group of Chinese adolescents with IA to those of healthy, matched controls (6). They found that, compared to the healthy controls, adolescents with IA had lower gray matter density in the left anterior and posterior cingulate cortices, the left insula, and the left lingual gyrus. …

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