Young 1998

CyberPsychology & Behavior
Volume 1, Number 3, 1998

Mary Ann Liebert, Inc.
Internet Addiction:
The Emergence of a New Clinical Disorder
KIMBERLY S. YOUNG, Psy.D.
ABSTRACT
Anecdotal reports indicated that some on-line users were becoming addicted to the Internet
in much the same way that others became addicted to drugs or alcohol, which resulted in aca-
demic, social, and occupational impairment. However, research among sociologists, psychol-
ogists, or psychiatrists has not formally identified addictive use of the Internet as a prob-
lematic behavior. This study investigated the existence of Internet addiction and the extent
of problems caused by such potential misuse. Of all the diagnoses referenced in the Diag-
nostic and Statistical Manual of Mental Disorders—Fourth Edition (DSM-IV; American Psy-
chiatric Association, 1995), Pathological Gambling was viewed as most akin to the patholog-
ical nature of Internet use. By using Pathological Gambling as a model, addictive Internet use
can be defined as an impulse-control disorder that does not involve an intoxicant. Therefore,
this study developed a brief eight-item questionnaire referred to as a Diagnostic Question-
naire (DQ), which modified criteria for pathological gambling to provide a screening instru-
ment for classification of participants. On the basis of this criteria, case studies of 396 de-
pendent Internet users (Dependents) and 100 nondependent Internet users (Nondependents)
were classified. Qualitative analyses suggest significant behavioral and functional usage dif-
ferences between the two groups such as the types of applications utilized, the degree of dif-
ficulty controlling weekly usage, and the severity of problems noted. Clinical and social im-
plications of pathological Internet use and future directions for research are discussed.
INTRODUCTION Similar addiction models have been

applied to
technological overuse,8 computer depen-
that some on-line
Recent reports indicated
users were becoming addicted to the Inter-
net in much the same way that others became
dency,9 and obsessive video game playing.10
However, research among sociologists, psy-
addicted to drugs, alcohol, or gambling, which
chologists, or psychiatrists has not formally
identified addictive use of the Internet as a
resulted in academic failure,1'2 reduced work
problematic behavior. Therefore, the purpose
performance,3 and even marital discord and of this exploratory study was to investigate if
separation.4 Clinical research on behavioral ad- Internet usage could be considered addictive,
dictions has focused on compulsive gambling,5 and to identify the extent of problems created
overeating,6 and compulsive sexual behavior.7 by such misuse.
With the popularity and wide-spread pro-
motion of the Internet, this study first sought
to determine a set of criteria that would define
Department of Psychology, University of Pittsburgh,
Bradford, PA 16701. addictive from normal Internet usage. If a
237
238 YOUNG
workable set of criteria could be effective in di- of this study. The cutoff score of five or more
agnosis, then such criteria could be used in clin- criteria is consistent with the number used to
ical treatment settings and facilitate future re- diagnose Pathological Gambling. Furthermore,
search on addictive Internet use. However, the DSM-IV outlines 10 criteria for Pathologi-
proper diagnosis is often complicated by the cal Gambling, although two items were viewed
fact that the term addiction is not listed in the as nonapplicable to Internet usage and omitted
Diagnostic and Statistical Manual of Mental Dis- from this adaptation. It was hypothesized that
orders—Fourth Edition (DSM-IV).11 Of all the di- meeting five of eight rather than 10 criteria
agnoses referenced in the DSM-IV, Pathologi- would be a slightly more rigorous cutoff score
cal Gambling was viewed as most akin to the to differentiate normal from addictive Internet
use. It should be noted that while this scale pro-
pathological nature of Internet use. By using
Pathological Gambling as a model, Internet ad- vides a workable measure of pathological In-
diction can be defined as an impulse-control ternet use, further study is needed to determine
disorder that does not involve an intoxicant. its construct validity and clinical utility. It
Therefore, this study developed a brief eight- should also be noted that the term Internet is
item questionnaire referred to as a Diagnostic used to denote all types of on-line activity.
Questionnaire (DQ) that modified criteria for
pathological gambling to provide a screening
instrument for classification of participants: DESIGN
1. Do you feel preoccupied with the Internet Participants
(think about previous on-line activity or an-
ticipate next on-line session)? Participants were volunteers who responded
2. Do you feel the need to use the Internet with to: (a) nationally and internationally dispersed
increasing amounts of time in order to newspaper advertisements, (b) flyers posted
achieve satisfaction? among local college campuses, (c) postings on
3. Have you repeatedly made unsuccessful ef- electronic support groups geared towards In-
forts to control, cut back, or stop Internet ternet addiction for electronic respondents
use? (e.g., the Internet Addiction Support Group,
4. Do you feel restless, moody, depressed, or the Webaholics Support Group), and (d) those
irritable when attempting to cut down or who searched for the keywords "Internet" or
stop Internet use? "addiction" on popular Web search engines
5. Do you stay on-line longer than originally (e.g., Yahoo).
intended?
6. Have you jeopardized or risked the loss of Measurements
a significant relationship, job, educational,
or career opportunity because of the Inter- Anexploratory survey consisting of both
net? open-ended and closed-ended questions was
7. Have you lied to family members, a thera- constructed for this study that could be ad-
pist, or others to conceal the extent of in- ministered by telephone interview or electronic
volvement with the Internet? collection. The survey administered the struc-
8. Do you use the Internet as a way of escap- tured DQ containing the eight-item classifica-
ing from problems or of relieving a dys- tion list. Subjects were then asked: (a) how long
phoric mood (e.g., feelings of helplessness, they have used the Internet, (b) how many
guilt, anxiety, depression)? hours per week they estimated spending on-
line for non-essential use, (c) what types of ap-
who answered "yes" to five or
Participants plications they most utilized, (d) what made
more of the criteria were classified as depen- these particular applications attractive, (e)
dent Internet users (Dependents), and the re- what problems, if any, did their Internet use
mainder were classified as nondependent In- cause in their lives, and finally, (f) to rate any
ternet users (Nondependents) for the purposes noted problems in terms of mild, moderate, or
INTERNET ADDICTION 239
severe impairment. Lastly, demographic infor- Usage differences

mation from each subject such as age, gender,
highest educational level achieved, and voca- The following will outline the differences be-
tional background were also gathered. tween the two groups, with an emphasis on the
Dependents to observe attitudes, behaviors,
Procedures and characteristics unique to this population of
users.
Telephone respondents were administered Length of time using Internet. The length of
the survey verbally at an arranged interview
time. The survey was replicated electronically using the Internet differed substantially
time
between Dependents and Nondependents.
and existed as a World-Wide Web (WWW)
Among Dependents, 17% had been on-line for
page implemented on a UNIX-based server more than 1 year, 58% had only been on-line
that captured the answers into a text file. The
WWW location of the survey was submitted to between 6 months to 1 year, 17% said between
3-6 months, and 8% said less than 3 months.
several popular search engines and new groups
available to assist on-line users in finding Web Among Nondependents, 71 % had been on-line
for more than 1 year, 5% had been on-line be-
pages of interest. On-line users entering key- tween 6 months to 1 year, 12% between 3-6
word searches using "Internet" or "addiction"
would find the survey and have the option to months, and 12% for less than 3 months. A to-
tal of 83% of Dependents had been on-line for
follow the link to the survey to fill it out. An-
less than 1 full year, which might suggest that
swers to the survey were sent to a text file di-
addiction to the Internet happens rather
rectly to the principal investigator's electronic quickly from one's first introduction to on-line
mailbox for analysis.
services. In many cases, Dependents had been
The results yielded 605 total responses in a
3-month period with 596 valid responses that computer illiterate, and described how they ini-
were classified from the DQ as 396 Dependents tially felt intimidated by using such informa-
tion technology. However, they quickly felt a
and 100 Nondependents. Approximately 55%
sense of competency and exhilaration as their
of the respondents replied via the electronic
survey method, and 45% via the telephone sur-
navigational ability and technical mastery
vey method. The qualitative data gathered
rapidly improved.
Hours per week. To ascertain how much time
were then subjected to content analysis to iden-
tify the range of characteristics, behaviors, and respondents spent on-line, they were asked
to provide a best estimate of the number of
attitudes found.
hours per week they currently used the Inter-
net. It is important to note that estimates were
based upon the number of hours spent "surf-
FINDINGS
ing the Internet" for non-essential (e.g., per-
sonal e-mail, scanning newsgroups, playing in-
Demographics teractive games) rather than for academic or
The sample of Dependents included 157 employment related purposes. Dependents es-
males and 239 females. Mean ages were 29 for timated a M 38.5, SD 8.04 hours per week
= =
males, and 43 for females. Mean educational compared to Nondependents who estimated
background was 15.5 years. Vocational back- M 4.9, SD = 4.70 hours per week. These es-
=
ground was classified as 42% none (i.e., timates show that Dependents spent nearly
homemaker, disabled, retired, students), 11 % eight times the number of hours per week as
blue-collar employment, 39% nontech white- that of Nondependents in using the Internet.
collar employment, and 8% high-tech white- Dependents gradually developed a daily Inter-
collar employment. The sample of Nonde- net habit of up to 10 times their initial use as
pendents included 64 males and 36 females. their familiarity with the Internet increased.
Mean ages were 25 for males, and 28 for fe- This may be likened to tolerance levels that de-
males. Mean educational background was 14 velop among alcoholics who gradually increase
years. their consumption of alcohol to achieve the de-
240 YOUNG
sired effect. In contrast, Nondependents re- sage sent. It should be noted that MUDs differ
ported that they spent a small percentage of from chat rooms, as these are an electronic spin-
their time on-line with no progressive increase off of the old Dungeon and Dragons games
in use. Centralized use of the Internet, coupled where players take on character roles. There are
with the lack of desire to control routine usage, literally hundreds of MUDs, ranging in themes
appears to be a distinguishable characteristic from space battles to medieval duels. To log
among Dependents. into a MUD, a user creates a character name,
Applications used. The Internet itself is a term for example, Hercules, who fights battles, du-
that represents different types of functions that els other players, kills monsters, saves maid-
are accessible on-line. Table 1 displays the var- ens, or buys weapons in a make-believe role-
ious applications rated as "most utilized" playing game. MUDs can be social in a similar
among Dependents and Nondependents. Re- fashion as in the chat room, but typically all di-
sults suggest that clear differences existed alogue is communicated while "in character."
among the specific Internet applications uti- Newsgroups, or virtual bulletin-board mes-
lized between the two groups. Nondependents sage systems, were the third most utilized ap-
predominantly used those aspects of the Inter- plication among Dependents. Newsgroups can
net that allowed them to gather information range on a variety of topics from organic chem-
(i.e., Information Protocols and the World Wide istry to favorite television programs to the best
Web) and electronic mail (e-mail). Nondepen- tasting cookie dough. Literally, there are thou-
dents viewed the Internet as a useful resource sands of specialized newsgroups that an indi-
tool and a medium for personal and business vidual user can subscribe to and post and read
communication. new electronic messages. The World-Wide
Comparatively, Dependents predominately Web and Information Protocols, or data base

used the two-way communication functions search engines that access libraries or electronic
available on the Internet (i.e., chat rooms, means to download files or new software pro-
MUDs, newsgroups, or e-mail). Chat rooms grams, were the least utilized among Depen-
and Multiuser Dungeons, more commonly dents. This may suggest that database searches,
known as MUDs, were the two most utilized while interesting and perhaps time consuming,
mediums by Dependents. Both applications al- are not the actual reasons Dependents become
low multiple on-line users to simultaneously hooked on the Internet.
communicate in real time; similar to having a Dependents enjoyed those aspects of the In-
telephone conversation except in the form of ternet, which allowed them to meet, socialize,
typed messages. The number of users present and exchange ideas with new people through
in these forms of virtual space can range from these highly interactive mediums. Dependents
two to over thousands of occupants. Text commented that the formation of on-line rela-
scrolls quickly up the screen with answers, tionships increased their immediate circle of
questions, or comments to one another. Send- friends among a culturally diverse set of world-
ing a "private message" is another available op- wide users. On-line relationships were often
tion that allows only a single user to read a mes- seen as highly intimate, confidential, and less
threatening than real-life friendships, and re-
Table 1. Internet Applications Most Utilized duced the perceived loneliness in the Depen-
by Dependents and Nondependents dent's life. Additional probing revealed that
Fype of computer user
Dependents mainly used e-mail to arrange
"dates" to meet on-line or to keep in touch be-
Application Dependents Nondependent tween real-time interactions with new-found
on-line friends. Dependents often preferred
Chat rooms 35% 7%
MUDs 28% 5%
their on-line friends over their real-life rela-
Newsgroups 15% 10% tionships, due to the ease of anonymous com-
E-mail 13% 30% munication and the extent of control in reveal-
WWW 7% 25%
Information Protocols 2% 24% ing personal information among other on-line
users.
Extent of problems. One major component of Table 2. Comparison of Type of Impairment

toSeverity Level Indicated
this study was to examine the extent of prob-
lems caused by excessive Internet use. Again, Impairment level
significant differences were noted between Mild Moderate Severe
Nondependents and Dependents. Nondepen- Impairment None
dents reported that time distortion was the ma- Academic 0% 2% 40% 58%
jor consequence of Internet use, however, not Relationship 0% 2% 45% 53%
to the extent that real-life responsibilities were Financial 0% 10% 38% 52%
Occupational 0% 15% 34% 51%
neglected. However, Dependents reported that Physical 75% 15% 10% 0%
excessive use of the Internet resulted in per-
sonal, family, and occupational problems sim-
ilar to those documented in other established
addictions such as pathological gambling,12 fun, leave me alone," might be
an addict's re-
eating disorders,13 and alcoholism.14'15 Prob- sponse. Finally, similar to alcoholics who will
lems reported were classified into five cate- try to hide their addiction, Dependents en-
gories: academic, relationship, financial, occu- gaged in the same efforts to lie or hide how
pational, and physical. Table 2 shows a long they spent on-line. These behaviors cre-
breakdown of the problems rated in terms of ated distrust that over time hurt the quality of
none, mild, moderate, and severe impair- once-stable relationships.
ment. Marriages and dating relationships were the
Although the merits of the Internet make it most disrupted when Dependents formed new
an ideal research tool, students experienced relationships with "on-line friends." On-line
significant academic problems when they friends were viewed as exciting, and in many
surfed irrelevant web sites, engaged in chat- cases lead to romantic interactions and Cyber-
room gossip, conversed with Internet pen pals, sex (i.e., on-line sexual fantasy role-playing).
and played interactive games at the cost of pro- Cybersex and romantic conversations were
ductive activity. Students had difficulty com- perceived by Dependents as harmless interac-
pleting homework assignments, studying, or tions as these sexual on-line affairs did not in-
getting enough sleep to be alert for class the volve touching and electronic lovers lived
next morning due to such Internet misuse. Of- thousands of miles away. However, Depen-
tentimes, they were unable to control their In- dents neglected their spouses in place of con-
ternet use, which eventually resulted in poor tinual electronic rendezvous with on-line
grades, academic probation, and even expul- lovers, leaving no quality time for their mar-
sion from the university. riages. Finally, Dependents continued to emo-
Marriages, dating relationships, parent- tionally and socially withdraw from their mar-
child relationships, and close friendships were riages, exerting more effort to maintain
also disrupted by excessive use of the Internet. recently discovered on-line relationships.
Dependents gradually spent less time with Financial problems were another problem
friends and family in exchange for solitary time that arose for Dependents who paid for their
in front of a computer. Loved ones first ratio- on-line service. For example, one woman spent
nalized the obsessed Internet user's behavior as nearly $800.00 in one month for on-line service
"a phase," in hopes that the attraction would fees. Instead of reducing the amount of time
soon dissipate. However, when addictive be- she spent on-line to avoid such charges, she re-
havior continued, arguments about the in- peated this process until her credit cards were
creased volume of time and energy spent on- overextended. Today, financial impairment is
line soon ensued. Such complaints were often less of an issue as flat rate fees are now being
deflected as part of the denial exhibited by De- offered. However, the movement towards flat
pendents. They became angry and resentful at rate fees raises another concern that users are
others who questionned or tried to take away able to stay on-line longer without suffering fi-
their time from using the Internet. For exam- nancial burdens, that may encourage addictive
ple, "I don't have a problem," or "I am having use.
242 YOUNG
Dependents reported a significant amount of scribed time limits. When time limits failed, De-
work-related problems when they used their pendents canceled their Internet service, threw
employee access on-line for personal use. New out their modems, or completely dismantled
monitoring devices allow bosses to track Inter- their computers to stop themselves from using
net usage, and one major company tracked all the Internet. Yet, they felt unable to live with-
traffic going across its Internet connection and out the Internet for such an extended period of
discovered that only 23% of the usage was busi- time. They reported developing a preoccupa-
ness related.16 The benefits of the Internet such tion with being on-line again, which they com-
as assisting employees with anything from pared to "cravings" that smokers feel when
market research to business communication they have gone a length of time without a cig-
outweigh the negatives for any company, yet arette. Dependents explained that these crav-
there is a definitive concern that it is a distrac- ings felt so intense that they resumed their In-
tion to many employees. Any misuse of time ternet service, bought a new modem, or set up
in the workplace creates a problem for man- their computer again to obtain their "Internet
agers, especially as corporations are providing fix."
employees with a tool that can easily be
abused.17
Finally, mild to moderate physical com-
plaints were noted among Dependents. De- CONCLUSIONS
pendents estimated a M =
38.5 per week, for
non-essential use, with a range of 20-100 hours There are several limitations involved in this
per week. To accommodate such excessive use, study which must be addressed. Initially, the
sleep patterns were typically disrupted due to sample size of 396 Dependents is relatively
late night log-ins. Dependents typically stayed small compared to the estimated 56 million cur-
up past normal bedtime hours and reported be- rent Internet users.18 In addition, the Nonde-
ing on-line until 2, 3, or 4 in the morning, with pendent group was not demographically
the reality of having to wake for work or school matched, which weakens the comparative re-
at 6 a.m. In extreme cases, caffeine pills were sults. Therefore, generalizability of results
used to facilitate longer Internet sessions. Such must be interrupted with caution, and contin-
sleep deprivation caused excessive fatigue, of- ued research should include larger sample
ten making academic or occupational func- sizes and a well-balanced control group to
tioning impaired, and decreased one's immune draw more accurate conclusions.
system leaving Dependents' vulnerable to dis- Furthermore, this study has inherent biases
ease. Additionally, the sedentary act of pro- present in its methodology by utilizing an ex-
longed computer use resulted in a lack of pedient and convenient self-selected group of
proper exercise and lead to an increased risk Internet users. Motivational factors among par-
for carpal tunnel syndrome, back strain, or eye- ticipants responding to this study should be
strain. discussed. It is possible that those individuals
Despite the negative consequences reported classified as Dependent were more likely to re-
among Dependents, 54% had no desire to cut spond to advertisements for this study because
down the amount of time they spent on-line. It they experienced an exaggerated set of nega-
was at this point that several participants re- tive consequences related to their Internet use.
ported feeling "completely hooked" on the In- If this is the case, the volume of moderate to
ternet and felt unable to kick their Internet severe consequences noted may have elevated
habit. The remaining 46% of Dependents made findings making the harmful affects of Internet
several unsuccessful attempts to cut down the overuse greatly overstated. Approximately
amount of time they spent on-line in an effort 20% more women than men responded to this
to avoid such negative consequences. Self-im- study, which should also be interpreted with
posed time limits were typically initiated to caution. This result shows a significant dis-
manage on-line time. However, Dependents crepancy from the Stereotypie profile of an "In-
were unable to restrict their usage to the pre- ternet addict" as a young, computer-savvy
male,19 and is counter to previous research that Finally, these results also suggested that De-
has suggested males predominantly utilize and pendents were relative beginners on the Inter-
feel comfortable with information technolo- net. Therefore, it may be hypothesized that
gies.9'20 Women may be more likely to discuss new-comers higher
to the Internet may be at a
an emotional issue or problem more than risk fordeveloping addictive patterns of Inter-
men21 and therefore, were more likely than net use. However, it is likely that "hi-tech" or
men to respond to advertisements in this study. more advanced users suffer from a greater
Future research efforts should attempt to ran- amount of denial, because their Internet use has
domly select samples to eliminate these become an integral part of their daily lives.
methodological limitations. Given that, individuals who constantly utilize
Although these limitations are significant, the Internet may not recognize compulsive use
this exploratory data provides a workable as a problem and, therefore, saw no need to
framework for further exploration of compul- participate in this survey. This may explain
sive use of the Internet. Individuals were able their low representation in this sample. There-
to meet a set of diagnostic criteria that show fore, additional research should examine per-
signs of impulse-control difficulty similar to sonality traits that may mediate addictive In-
symptoms of pathological gambling as defined ternet use, particularly among new users, and
by the DSM-IV. In the majority of cases, De- how denial is fostered by its encouraged prac-
pendents reported that their Internet use di- tice.
rectly caused moderate to severe problems in A recent on-line survey22 and two campus-
their real lives due to their inability to control wide surveys conducted at the University of
use. Their unsuccessful attempts to gain con- Texas at Austin23 and Bryant College24 have
trol may be paralleled to alcoholics who further documented that pathological Internet
are unable to regulate or stop their excessive use is problematic for academic performance
drinking despite relationship or occupational and relationship functioning. With the rapid
problems caused by drinking; or compared to expansion of the Internet into previously re-
compulsive gamblers who are unable to stop mote markets and another estimated 11.7 mil-
betting despite their excessive financial debts. lion planning to go on-line in the next year,18
The reasons underlying such an impulse con- the Internet may pose a potential clinical threat
trol failure over Internet usage should be fur- where little is understood about the treatment
ther examined. One interesting issue raised in implications for this emergent disorder. Based
this study is that, in general, the Internet itself upon these findings, future research should de-
is not addictive. Specific applications appeared velop treatment protocols and conduct out-
to play a significant role in the development of come studies for effective management of this
pathological Internet use. Dependents were symptom. It may be beneficial to monitor such
less likely to control their use of highly inter- cases of addictive Internet use in clinical set-
active features than other on-line applications. tings by utilizing the adapted criteria presented
These findings suggest that there exists an in- in this study. Finally, future research should fo-
creased risk for pathological Internet use the cus on the prevalence, incidence, and the role
more interactive the application utilized by the of this type of behavior in other established ad-
on-line user. It is possible that a unique rein- dictions (e.g., other substance dependencies or
forcement exists that on-line relationships have pathological gambling) or psychiatric disor-
the ability to provide fulfillment of unmet real- ders (e.g., depression, bipolar disorder, obses-
life social needs. Individuals who feel misun- sive-compulsive disorder, attention deficit dis-
derstood and lonely may use virtual relation- order).
ships to seek out feelings of comfort and
community. However, greater research is
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CyberPsychology & Behavior

Volume 1, Number 3, 1998

KIMBERLY S. YOUNG, Psy.D.

INTRODUCTION Similar addiction models have been

severe impairment. Lastly, demographic infor- Usage differences

Comparatively, Dependents predominately Web and Information Protocols, or data base

Extent of problems. One major component of Table 2. Comparison of Type of Impairment

Psychology Forum, 76,14-19. University of Chicago Press.

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