1. Dr. Mainak Mukherjee, MD
National Chairperson 2016-17,
Website Sub-committee,
Indian Psychiatric Society
Uttaran Mental Health Care
Khosbagan, Burdwan
06 Oct 2016 1

2. Problematic computer use is a growing
social issue which is being debated
worldwide.
Internet Addiction Disorder (IAD) ruins
lives by causing neurological
complications, psychological disturbances,
and social problems.
06 Oct 2016
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3. “I feel technology has brought so
much joy into my life. No other activity
relaxes me or stimulates me like
technology. However, when
depression hits, I tend to use
technology as a way of retreating and
isolating.”
– A recovering patient of IAD.
06 Oct 2016
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4. Internet addiction disorder (IAD), (also
known as)
 Problematic Internet Use (PIU)
Compulsive Internet Use (CIU)
Internet Overuse
Problematic Computer Use
Pathological Computer Use
That refers to excessive computer use
which interferes with daily life.
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5.  Gaming
 Online Social Networking
 Blogging
 E-mailing
 Excessive, overwhelming, or inappropriate
Internet Pornography Use or
Internet Shopping (Shopping Addiction)
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6. Internet addiction is a subset of a broader
"technology addiction."
Widespread obsession with technology
goes back at least to the Radio in the
1930s and Television in the 1960s, but it
has exploded in importance during the
digital age.
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7.  Seven concepts, or clusters, making up
PIU
 Psychosocial risk factors
 Physical impairment
 Emotional impairment
 Social and functional impairment
 Risky Internet use
 Impulsive Internet use and
 Internet use dependence.
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8. Risky Internet use are behaviors that
increase risks of adverse consequences. It
is not just the amount of time spent on the
Internet that puts an adolescent at risk;
how the time is spent is also an important
consideration.
The impulsive use construct describes an
inability to maintain balance or control of
internet use in relation to everyday life.
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9. Finally, the dependent use construct
reflects the more severe symptoms that
are typically associated with addictions,
such as withdrawal symptoms.
Thus, internet addiction may represent a
severe form of PIU.
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10. Internet addiction disorder is not listed in
the latest DSM manual (DSM-5, 2013).
Gambling disorder is the only behavioural
(non-substance related) addiction included
in DSM-5.
However Internet gaming disorder is listed
in Section III, (conditions for Further
Study).
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11. It has been argued that Internet addiction
should be included as a disorder in the
DSM-5. However, it has also been
observed that diagnosis was complicated
because 86% of study subjects showing
symptoms also exhibited other
diagnosable mental health disorders.
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12. Over the past decade, the concept of
Internet addiction has grown in terms of
acceptance as a legitimate clinical disorder
often requiring treatment.
But, researchers are divided over whether
Internet addiction is a disorder on its own
or a symptom of another underlying
disorder.
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13. There is also a debate over whether it
should be classified as an impulse-control
disorder or an obsessive-compulsive
disorder, rather than an addiction.
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14. About 25% of users fulfill Internet addiction
criteria within the first six months of using
the Internet.
Many individuals initially report feeling
intimidated by the computer but gradually
feel a sense of "competency and
exhilaration from mastering the technology
and learning to navigate the applications
quickly by visual stimulation".
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15. According to a study by Kathy Scherer, a
psychologist from the University of Texas,
"13% of college internet users fit the
criteria for Internet addicts" (1997). In her
study, Scherer enlisted the help of 531
college students. She discovered that
"72% of the Internet addicted students
were men".
06 Oct 2016
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16.  The China Communist Youth League claimed in
2007 that over 17% of Chinese citizens between
13 and 17 were addicted to the Internet.
 Public concern, interest in, and the study of,
Internet over use can be attributed to the fact that it
has become increasingly difficult to distinguish
between the online and offline worlds. The Internet
has tremendous potential to affect the emotions of
humans and in turn, alter our self-perception and
anxiety levels.
06 Oct 2016
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17.  Based on the case histories that have surfaced, no
one denies that excessive involvement with certain
psychological spaces on the net can have serious
effects on a person's life.
 At a large university in New York, the dropout rate
among freshmen newcomers rose dramatically as
their investment in computers and Internet access
increased, and the administrators learned that 43%
of the dropouts were staying up all night on the
Internet.
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18. Studies suggest that 1 in 8 Americans
suffer from problematic Internet use.
Those estimates are higher in China,
Taiwan, and Korea where 30 percent or
more of the population may experience
problematic Internet use.
India is not lagging behind.
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19.  It has been observed that between 5% and
10% of Web surfers suffer some form of Web
dependency.
 Internet addicts suffer from emotional
problems such as depression and anxiety-
related disorders and often use the fantasy
world of the Internet to psychologically
escape unpleasant feelings or stressful
situations. More than half are also addicted to
alcohol, drugs, tobacco, or sex.
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20. Gender influences the types of
applications and underlying reasons for
Internet addiction.
Men tend to seek out dominance and
sexual fantasy online, while women seek
out close friendships, romantic partners,
and prefer anonymous communication in
which to hide their appearance.
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21. Men are more likely to become addicted to
online games, cyber porn, and online
gambling, while women are more likely to
become addicted to sexting, testing, social
media, eBay, and online shopping. It
seems to be a natural conclusion that
attributes of gender played out online
parallel the stereotypes men and women
have in our society.
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22.  Compulsive Internet use can produce
morphological changes in the structure of the
brain.
 A Chinese study analyzing computer addicts who
used a computer around 10 hours a day, 6 days a
week, found reductions in the sizes of the
dorsolateral prefrontal cortex, rostral anterior
cingulate cortex, supplementary motor area and
parts of the cerebellum compared to students
deemed "not addicted" by the designers.
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23. It has been theorized that these changes
reflect learning-type cognitive
optimizations for using computers more
efficiently, but also impaired short-term
memory and decision-making abilities—
including ones in which may contribute to
the desire to stay online instead of be in
the real world.
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24.  American national surveys revealed that over
70% of Internet addicts also suffered from
other addictions, mainly to drugs, alcohol,
smoking, and sex.
 Trends also show that the majority of Internet
addicts suffer from emotional problems such
as depression, mood disorders, social
disorders, and anxiety disorders and will use
the fantasy world of the Internet to
psychologically escape unpleasant feelings or
stressful situations.
06 Oct 2016
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25. Internet addicts also suffer from
relationship problems in almost 75% of the
cases and use interactive online
applications such as social media, virtual
communities, video games or online
gaming as a safe way of establishing new
relationships and more confidently relating
to others through the virtual world.
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26. Internet addiction can be understood by
comparing it to other types of addictions.
Individuals addicted to alcohol or other
drugs, for example, develop a relationship
with their “chemical(s) of choice” — a
relationship that takes precedence over
any and all other aspects of their lives.
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27. Addicts find they need drugs merely to
feel normal. In Internet addiction, a parallel
situation exists. The Internet — like food or
drugs in other addictions — provides the
“high” and addicts become dependent on
this cyberspace high to feel normal.
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28.  They substitute unhealthy relationships for healthy
ones. They opt for temporary pleasure rather than
the deeper qualities of “normal” intimate
relationships. Internet addiction follows the same
progressive nature of other addictions. Internet
addicts struggle to control their behaviors, and
experience despair over their constant failure to do
so. Their loss of self-esteem grows, fueling the
need to escape even further into their addictive
behaviors. A sense of powerlessness pervades the
lives of addicts.
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29.  There is increasing evidence that there can
be a genetic predisposition to addictive
behaviours. The theory is that individuals with
this predisposition do not have an adequate
number of dopamine receptors or have an
insufficient amount of serotonin/dopamine,
thereby having difficulty experiencing normal
levels of pleasure in activities that most
people would find rewarding.
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30. To increase pleasure, these individuals are
more likely to seek greater than average
engagement in behaviors that stimulate an
increase in dopamine, effectively giving
them more reward but placing them at
higher risk for addiction.
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31.  No single behaviour pattern defines Internet
addiction. These behaviours, when they have
taken control of addicts’ lives and become
unmanageable, include: compulsive use of the
Internet, a preoccupation with being online, lying or
hiding the extent or nature of one’s online
behavior, and an inability to control or curb such
behavior. If your Internet use pattern interferes with
your life in any way, shape or form, (e.g. does it
impact your work, family life, relationships, school,
etc.), you may have a problem.
06 Oct 2016
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32. In addition, if you find that you are using
the Internet as a means to regularly alter
your mood you may be developing a
problem. It is important to note that it is not
the actual time spent online that
determines if you have a problem, but
rather how that time you spend impacts
your life. To assess the disorder, consider
taking the IAT, the first validated measure
of Internet addiction.
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33. Treatment options for Internet addiction
include inpatient, outpatient, and aftercare
support, and self-help groups. Treatment
options may also include family
counseling, support groups, and
educational workshops for addicts and
their families to help them understand the
facets of belief and family life that are part
of the addiction.
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34. Unlike recovering alcoholics who must
abstain from drinking for life, treatment for
Internet addiction focuses on moderation
and controlled use of the Internet, much in
the way those suffering from eating
disorders must relearn healthy eating
patterns.
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35. Cognitive-behavioral techniques are used
to achieve a healthy digital diet of
moderated and controlled use along with a
comprehensive psychosocial approach to
address the underlying problems in a
person’s life creating the need to use the
Internet as a way of escape.
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36. Different medications have been used with
varying degree of success:
Escitalopram
Citalopram
Paroxetine
Quetiapin
Naltrexone
Methylphenidate
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37.  A few authors mentioned that physical
exercise could compensate the decrease of
the dopamine level.
 In addition, sports exercise prescriptions used
in the course of cognitive behavioral group
therapy may enhance the effect of the
intervention for IAD.
 Some experts have also used spiritual
principles with varying success.
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38. US National Library of
Medicine
IPCA innova
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39. Thank you for your interest and
attention.
If you intend to have a soft copy of
this presentation, please send me a
request at: dr.mainak@gmail.com
06 Oct 2016
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