CNS Drugs

, Volume 22, Issue 5, pp 353–365 | Cite as

Internet Addiction

Definition, Assessment, Epidemiology and Clinical Managemen
  • Martha Shaw
  • Donald W. BlackEmail author
Leading Article


Internet addiction is characterized by excessive or poorly controlled preoccupations, urges or behaviours regarding computer use and internet access that lead to impairment or distress. The condition has attracted increasing attention in the popular media and among researchers, and this attention has paralleled the growth in computer (and Internet) access.

Prevalence estimates vary widely, although a recent random telephone survey of the general US population reported an estimate of 0.3–0.7%.

The disorder occurs worldwide, but mainly in countries where computer access and technology are widespread. Clinical samples and a majority of relevant surveys report a male preponderance. Onset is reported to occur in the late 20s or early 30s age group, and there is often a lag of a decade or more from initial to problematic computer usage.

Internet addiction has been associated with dimensionally measured depression and indicators of social isolation. Psychiatric co-morbidity is common, particularly mood, anxiety, impulse control and substance use disorders. Aetiology is unknown, but probably involves psychological, neurobiological and cultural factors.

There are no evidence-based treatments for internet addiction. Cognitive behavioural approaches may be helpful. There is no proven role for psychotropic medication. Marital and family therapy may help in selected cases, and online self-help books and tapes are available. Lastly, a self-imposed ban on computer use and Internet access may be necessary in some cases.


Pathological Gambling Escitalopram Internet Addiction Impulse Control Disorder Compulsive Sexual Behaviour 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Dr Black has received research support from Shire and Forest Laboratories; speaker’s bureau honoraria from Pfizer; and honoraria for other consulting from Forest Laboratories and Shire. Ms Shaw reports no conflicts of interest that are directly relevant to this manuscript. No sources of funding were used to assist in the preparation of this review.


  1. 1.
    US Census Bureau. Computer and internet use in the United States: 2003. Washington, DC: US Department of Commerce, Economics and Statistics Administration, US Census Bureau, 2005 Oct 2Google Scholar
  2. 2.
    Aboujaoude E, Koran LM, Gamel N, et al. Potential markers for problematic internet use: a telephone survey of 2,513 adults. CNS Spectrums 2006; 11(10): 750–5PubMedGoogle Scholar
  3. 3.
    Weizenbaum J. Computer power and human reason. San Francisco (CA): W.H. Freeman, 1976Google Scholar
  4. 4.
    Zimbardo PG. The age of indifference. Psychol Today 1980; August: 71–6Google Scholar
  5. 5.
    Boden MA. The meeting of man and the machine. In: Jones KP, Taylor H, editors. The design of information systems for human beings. London: Association for Information Management, 1981Google Scholar
  6. 6.
    Shallis M. The silicon idol: the micro revolution and its social implications. Oxford: Oxford University Press, 1984Google Scholar
  7. 7.
    Griffiths MD. Internet addiction: fact or fiction? Psychologist 1999; 12: 246–51Google Scholar
  8. 8.
    Keepers GA. Pathological preoccupation with video games. J Am Acad Child Adolesc 1990; 29: 48–9CrossRefGoogle Scholar
  9. 9.
    Shotton MA. The cost and benefits of ‘computer addiction’. Behaviour Inform Technol 1991; 10: 219–30CrossRefGoogle Scholar
  10. 10.
    Sussman N. Session with Eric Hollander, MD: interview February 7, 2005, New York City [online]. Available from URL: [Accessed 2007 24 Aug]
  11. 11.
    Shapira N, Goldsmith T, Keck Jr P, et al. Psychiatric features of individuals with problematic internet use. J Affect Disord 2000; 57: 267–72PubMedCrossRefGoogle Scholar
  12. 12.
    Treuer T, Fabian Z, Furedi J. Internet addiction associated with features of impulse control disorder: is it a real psychiatric disorder [letter]? J Affect Disord 2001; 66: 283PubMedCrossRefGoogle Scholar
  13. 13.
    Young K. Internet addiction: the emergence of a new clinical disorder. Cyberpsychol Behav 1998; 3: 237–44CrossRefGoogle Scholar
  14. 14.
    Black DW, Belsare G, Schlosser S. Clinical features, psychiatric comorbidity, and health-related quality of life in persons reporting compulsive computer use behavior. J Clin Psychiatry 1999; 60: 839–43PubMedCrossRefGoogle Scholar
  15. 15.
    Davis R. A cognitive-behavioral model of pathological internet use. Comput Human Behav 2001; 17: 187–95CrossRefGoogle Scholar
  16. 16.
    Caplan SE. Preference for online social interaction: a theory of problematic internet use and psychosocial well-being. Comm Research 2003; 30: 625–48CrossRefGoogle Scholar
  17. 17.
    Scherer K. College life on-line: healthy and unhealthy internet use. J College Student Dev 1997; 38: 655–65Google Scholar
  18. 18.
    Goldberg I. Internet addiction disorder 1996 [online]. Available from URL: [Accessed 2007 May 7]
  19. 19.
    “Internetomania” sign of psychiatric illness [online]. Available from URL: [Accessed 2007 Aug 27]
  20. 20.
    Shapira NA, Lessig MC, Goldsmith TD, et al. Problematic internet use: proposed classification and diagnostic criteria. Depress Anxiety 2003; 17: 207–16PubMedCrossRefGoogle Scholar
  21. 21.
    McElroy SL, Keck PE, Harrison PG, et al. Compulsive buying: a report of 20 cases. J Clin Psychiatry 1994; 55: 242–8PubMedGoogle Scholar
  22. 22.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed., text rev. Washington, DC: American Psychiatric Association, 2000Google Scholar
  23. 23.
    Young K, Pistner M, O’Mara J, et al. Cyber-disorders: the mental health concern for the new millennium. Cyberpsychol Behav 2000; 3: 475–9Google Scholar
  24. 24.
    Stein DJ. Internet addiction, internet psychotherapy [letter]. Am J Psychiatry 1997; 153: 890Google Scholar
  25. 25.
    Hollander E, Allen A. Is compulsive buying a real disorder, and is it really compulsive? Am J Psychiatry 2006; 163: 1670–2PubMedCrossRefGoogle Scholar
  26. 26.
    Holden C. Behavioral addictions: do they exist? Science 2001; 294: 980–2PubMedCrossRefGoogle Scholar
  27. 27.
    Griffiths M. Does internet and computer “addiction” exist? Some case study evidence. Cyberpsychol Behav 2000; 3(2): 211–8CrossRefGoogle Scholar
  28. 28.
    Huisman A, van den Eijnden R, Garretsen H. ‘Internet addiction’: a call for systematic research. J Subst Use 2001; 6: 7–10CrossRefGoogle Scholar
  29. 29.
    Egger O, Rauterberg M. Internet behavior and addiction. Zurich: Swiss Federal Institute of Technology, 1996Google Scholar
  30. 30.
    Brenner V. Psychology of computer use: XLVII. Parameters of internet use, abuse, and addiction: the first 90 days of the Internet Usage Survey. Psych Rep 1997; 80: 879–82Google Scholar
  31. 31.
    Young K. Caught in the net: how to recognize the signs of internet addiction and a winning strategy for recovery. New York: John Wiley & Sons, 1998Google Scholar
  32. 32.
    Widyanto L, McMurran M. The psychometric properties of the internet addiction test. Cyberpsychol Behav 2004; 7: 443–50PubMedCrossRefGoogle Scholar
  33. 33.
    Morahan-Martin J, Schumacher P. Incidence and correlates of pathological internet use among college students. Comput Human Behav 2000; 16: 13–29CrossRefGoogle Scholar
  34. 34.
    Yoo HJ, Cho SC, Ha J, et al. Attention deficit hyperactivity symptoms and internet addiction. Psychiatry Clin Neurosci 2004; 58: 487–94PubMedCrossRefGoogle Scholar
  35. 35.
    Leung L. Net-generation attributes and seductive properties of the internet as predictors of online activities and internet addiction. Cyberpsychcol Behav 2004; 7: 333–48CrossRefGoogle Scholar
  36. 36.
    Greenfield DN. Psychological characteristics of compulsive internet use: a preliminary analysis. Cyberpsychol Behav 1999; 2: 403–12PubMedCrossRefGoogle Scholar
  37. 37.
    Whang LS-M, Lee S, Chang G. Internet over-users’ psychological profiles: a behavior sampling analysis on internet addiction. Cyberpsychol Behav 2003; 6: 143–50PubMedCrossRefGoogle Scholar
  38. 38.
    Niemz K, Griffiths M, Banyard P. Prevalence of pathological internet use among university students and correlations with self-esteem, the General Health Questionnaire (GHQ) and disinhibition. Cyberpsychol Behav 2005; 8: 562–70PubMedCrossRefGoogle Scholar
  39. 39.
    Chou C, Hsiao M-C. Internet addiction, usage, gratification, and pleasure experience: the Taiwan college students’ case. Comput Educ 2000; 35: 65–80CrossRefGoogle Scholar
  40. 40.
    Kaltiala-Heino R, Lintonen T, Rimpela A. Internet addiction? Potentially problematic use of the internet in a population of 12–18 year old adolescents. Addict Res Theory 2004; 12: 89–96CrossRefGoogle Scholar
  41. 41.
    Johansson A, Gotestam K. Internet addiction: characteristics of a questionnaire and prevalence in Norwegian youth (12–18 years). Scand J Psych 2004; 45: 223–9CrossRefGoogle Scholar
  42. 42.
    Kim K, Ryu E, Chon M-Y, et al. Internet addiction in Korean adolescents and its relationship to depression and suicidal ideation: a questionnaire survey. Int J Nurs Stud 2006; 43: 185–92PubMedCrossRefGoogle Scholar
  43. 43.
    Pallanti S, Bernardi S Leonardo Q. The shorter PROMIS questionnaire and the internet addiction scale in the assessment of multiple addictions in a high-school population: prevalence and related disability. CNS Spectrums 2006; 11(12): 966–74PubMedGoogle Scholar
  44. 44.
    Morahan-Martin J, Schumacher P. Incidence and correlates of pathological internet use among college students. Comput Human Behav 2000; 16: 13–29CrossRefGoogle Scholar
  45. 45.
    Ware J. Script for personal interview SF-36 administration (appendix C). In: SF-36 health survey manuals and interpretations. Boston (MA): Nimrod Press, 1993Google Scholar
  46. 46.
    Robins LN, Heizer JE, Cottier L, et al. National Institute of Mental Health diagnostic interview schedule, version III-R. St Louis (MO): Washington University School of Medicine, 1989Google Scholar
  47. 47.
    Christenson GA, Faber RJ, de Zwaan M, et al. Compulsive buying: descriptive characteristics and psychiatric comorbidity. J Clin Psychiatry 1994; 55: 5–11PubMedGoogle Scholar
  48. 48.
    Spitzer RL, Williams JBW, Gibbons M. Structured clinical interview for DSM-IV. New York: New York State Psychiatric Institute, Biometrics Research, 1994Google Scholar
  49. 49.
    Kraut R, Patterson M, Landmark V, et al. Internet paradox: a social technology that reduces social involvement and psychological well being? Am Psychol 1998; 53: 1017–31PubMedCrossRefGoogle Scholar
  50. 50.
    Nie NH, Erbring L. Internet and society: a preliminary report. Stanford Institute for the Quantitative Study of Society [online]. Available from URL: [Accessed 2007 Aug 26]
  51. 51.
    Young KS, Rodgers RC. The relationship between depression and internet addiction. Cyberpsychol Behav 1998; 1(1): 25–8CrossRefGoogle Scholar
  52. 52.
    Petrie H, Gunn D. Internet “addiction”: the effects of sex, age, depression and introversion. British Psychological Society London Conference; 1998 Dec 15–16; LondonGoogle Scholar
  53. 53.
    Beck AT, Steer RA, Brown GK. Beck depression inventory-II manual. San Antonio (TX): Psychological Corporation, 1996Google Scholar
  54. 54.
    Eysenck H, Eysenck S. Eysenck personality questionnaire. San Diego (CA); Educational and Industrial Testing Service, 1975Google Scholar
  55. 55.
    Hyler SE, Rieder RO, Spitzer RL. Personality diagnostic questionnaire, revised. New York: New York State Psychiatric Institute, 1989Google Scholar
  56. 56.
    Davis R. A cognitive-behavioral model of pathological internet use. Comput Human Behav 2001; 17: 187–95CrossRefGoogle Scholar
  57. 57.
    Caplan SE. Preference for online social interaction: a theory of problematic internet use and psychosocial well-being? Am Psychol 1998; 53: 1017–31CrossRefGoogle Scholar
  58. 58.
    Baldwin DS, Anderson IM, Nutt DJ, et al. Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. J Pharmacol 2005; 19: 567–96Google Scholar
  59. 59.
    Treuer T, Fabian Z, Furedi J. Internet addiction associated with features of impulse control disorder: is it a real psychiatric disorder? J Affective Disord 2001; 66: 283CrossRefGoogle Scholar
  60. 60.
    Stein DJ, Black DW, Shapira NA, et al. Hypersexual disorder and preoccupation with internet pornography. Am J Psychiatry 2001; 158: 1590–4PubMedCrossRefGoogle Scholar
  61. 61.
    Shotton MA. The costs and benefits of ‘computer addiction’. Behav Inform Tech 1991; 10(3): 219–30CrossRefGoogle Scholar
  62. 62.
    Belsare T, Gaffney GR, Black DW. Compulsive computer use [letter]. Am J Psychiatry 1997; 154: 289PubMedGoogle Scholar
  63. 63.
    Hadley SJ, Baker BR, Hollander E. Efficacy of escitalopram in the treatment of compulsive-impulsive computer use disorder [abstract]. Biol Psychiatry 2006; 59: 261SGoogle Scholar
  64. 64.
    Sattar P, Ramaswamy S. Internet gaming addiction. Can J Psychiatry 2004; 49: 871–2Google Scholar
  65. 65.
    Hall AS, Parsons J. Internet addiction: college student case study using best practices in cognitive behavior therapy. J Ment Health Couns 2001; 23(4): 312–27Google Scholar
  66. 66.
    Young K. A therapist’s guide to assess and treat internet addiction [online]. Available from URL: [Accessed y2007 May 16]
  67. 67.
    Beck AT. Cognitive therapy: a 30-year retrospective. Am Psychol 1991; 46(4): 368–75PubMedCrossRefGoogle Scholar
  68. 68.
    Ang A. China takes unique steps to combat web addiction. USA Today 2005 [online]. Available from URL: [Accessed 2007 Aug 23]

Copyright information

© Adis Data Information BV 2008

Authors and Affiliations

  1. 1.Department of PsychiatryUniversity of Iowa Roy J. and Lucille A. Carver College of MedicineIowa CityUSA

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