Is Internet addiction a psychopathological condition distinct from pathological gambling?

The influence of adolescents essential and non-essential use of technology and Internet addiction on their physical and mental fatigues

This study explores the impact of Internet addiction (IA), age, and essential and non-essential technology usage time on the physical and mental fatigue of adolescents. The research surveyed 477 adolescents from Qatar and employed the Internet Addiction Diagnostic Questionnaire (IADQ) and Chalder's Fatigue Scale for data collection. Multiple linear regression and Mann-Whitney U tests were utilized for analysis. The findings indicate that IA, non-essential usage time, and age are positively associated with overall fatigue among adolescents. IA and non-essential usage time are positively linked to physical fatigue, while IA, non-essential usage time, and age are positive predictors of mental fatigue. However, essential usage time is negatively associated with mental fatigue. These results highlight the importance of distinguishing technology usage based on intent and necessity, as well as differentiating between physical and mental fatigue when examining problematic technology usage. This study is among the few conducted in the Middle Eastern context.

The Role of Attachment in Gambling Behaviors and Gambling Disorder: A Systematic Review

In recent years, a growing number of attachment-based studies have contributed to the understanding of both substance and behavioral addictions. Although gambling is a form of addictive behavior widespread all over the world, both among young people and adults, the evidence on the association between attachment-related phenomena and gambling has not yet been systematized in literature. The aim of the present study, therefore, is to provide a systematic literature review aimed at summarizing the empirical evidence on this topic. Following the updated 2020 PRISMA guidelines, a systematic search in four electronic scientific databases (Scopus, PubMed, PsycInfo and Web of Science) was conducted. After removing duplicates, 146 records were double-screened, with 12 articles meeting the inclusion criteria. Additionally, by means of a backward search a further article was selected. Altogether, 13 articles were selected for the present systematic review. With few exceptions, the results underline the significant role played by attachment-related phenomena in gambling behaviors, highlighting that specific attachment contexts have a different influence on gambling, also depending on whether gamblers are youths or adults. In particular, while secure attachment has proven to be a protective factor for the onset of gambling behavior, insecure attachment has emerged to be a vulnerability factor in two ways. On the one hand, it directly favors gambling behaviors; on the other, it affects coping strategies and the individual's ability to identify and regulate emotions, which in turn predict gambling. Limitations, strengths, and implications of the present systematic review are discussed.

Neural cue-reactivity in pathological gambling as evidence for behavioral addiction: a systematic review

Increasing incidence of problem gambling has led to prioritizing the problem from the point of view of public health. Additionally, gambling disorder has been recently classified as a behavioral addiction, with implications for both its diagnosis and treatment. However, the shared neural substrate of addictions, to substances and behavioral, is still discussed. Thus, this systematic review aims to provide up-to-date knowledge from the past five years (2017-2022) concerning the neural correlates of gambling related stimuli (cue-reactivity) on the basis of a previous review (Brevers et al., Cognitive, Affective and Behavioral Neuroscience 18:718-729, 2019). A total of five studies were included in the review. Activation of brain areas related to memory, reward and executive functions could be the underlying mechanism of this behavioral addiction. Specifically, nucleus accumbens and striatum (ventral and dorsal), parahippocampal regions, the right amygdala and several prefrontal cortex regions have systematically been found more active in those subjects exposed to gambling-related cues. Also, the insula could play a pivotal role connecting these three systems in a highly integrated neural network with several implications for reward processing modulation, associative learning and top-down attentional regulation to improve saliency of addiction-related cues. These results are consistent with previous findings on other substance addictions, such as alcohol, tobacco, marijuana or cocaine. The study of neural reactivity to stimuli related to addiction could be useful as a biomarker of the severity of the disorder, the efficacy of the treatment, the risk of relapse, in addition to being an objective criterion to measure the effectiveness of prevention campaigns.

Cognitive behavioral intervention in dealing with Internet addiction among Arab teenagers in Israel

The current study examines the effectiveness of a cognitive-behavioral intervention program for improving self-control and reducing Internet addiction among Arab adolescents in Israel. The study sample included 160 students who were 7th to 9th graders, recruited from eight schools in northern Israel. All participants exhibited high scores on a questionnaire indicating elevated symptoms of Internet addiction. Students were randomized to one of two groups: the experimental group underwent a systematic intervention to reduce Internet addiction and the control group met once a week for a group conversation. The experimental group (n = 80) included 58 boys and 22 girls with an average age of 13.45 (SD = 1.46). The control group (n = 80) included 54 boys and 26 girls with an average age of 13.91 (SD = 1.92). Each intervention consisted of 8 sessions, with the experimental group receiving cognitive-behavioral treatment and the control group having a weekly classroom conversation. The results demonstrated preliminary efficacy for the intervention, as higher levels of self-control were reported among the experimental group (p < .01) but not the control group, and this contributed to a reduction in scores on the questionnaire assessing Internet addiction in the experimental group (p < .01). The findings suggest that cognitive-behavioral treatments may be a promising avenue for enhancing self-control and reducing symptoms of Internet addiction among this unique student population.

The impact of perceived relationship to ancestors on the association between self-transcendence and psychopathology: A cross-cultural examination

Self-transcendence has been associated with lower levels of psychopathology. Most studies of self-transcendence have focused on samples of Western participants, and used scales addressing such concepts as self-awareness and feelings of oneness with the larger universe. However, a common Eastern notion of transcendence-perception of ongoing relationships with ancestors-has not been studied. We conducted a cross-cultural investigation of the association between self-transcendence, perceived degree of relationship to ancestors and depression and anxiety in the United States (N = 1499), China (N =  3,150), and India (N = 863). Degrees of perceived relationship to ancestors differed across countries, with the highest rates in India and China, and lowest rates in the United States. Self-transcendence was negatively associated with risks for depression and anxiety in the United States. In India, self-transcendence was also negatively associated with risks for depression and anxiety, and a strong perceived relationship with ancestors had further protective benefit. In China, those with a high level of perceived relationship to ancestors and a high level of self-transcendence exhibited lower levels of psychopathology. Results suggest that measures of relationship to ancestors might be included in future cross-cultural studies of transcendence.

Factors related to the dual condition of gambling and gaming disorders: A path analysis model

BACKGROUND AND AIMS

Gaming disorder has experienced rapid growth in the last decade among youth and adult populations, in parallel to the expansion of the videogame industry. The objective of this study was to explore the underlying process to explain the dual diagnosis of gaming with gambling disorder.

METHODS

The sample included n = 117 patients who met clinical criteria for gaming disorder, recruited from a tertiary care unit specialized in the treatment of behavioral addictions. Path analysis (implemented through structural equation modeling) assessed the direct and mediational mechanisms between the dual condition of gaming + gambling disorder and sociodemographic variables and personality traits.

RESULTS

The comorbid gaming + gambling disorder was met for 14.5% of the participants (additionally, 6.0% of the sample also met criteria for problematic gambling). The dual diagnosis was directly related to an older age at onset of the addiction problems, a higher level of the novelty seeking trait and being in active work. Employment status also mediated the relationship between persistence levels and chronological age. Greater psychopathological distress was related to females, higher levels of harm avoidance and persistence and lower levels of self-directedness.

CONCLUSIONS

The results of this study provide empirical evidence for the specific factors that increase the likelihood of the dual gaming + gambling disorder. Clinical settings should consider these features to improve gaming diagnosis and treatment. Preventive programs should also be focused on the most vulnerable groups to prevent onset and progression of this comorbid condition.

Assessing online gaming and pornography consumption patterns during COVID-19 isolation using an online survey: Highlighting distinct avenues of problematic internet behavior

Background and aim

The Coronavirus (COVID-19) pandemic has required drastic safety precautions to contain virus spread, involving a protracted self-isolation period. Those with greater perceived or actual life stress are vulnerable to develop problematic internet behaviors. Thus, we assessed how COVID-19 social isolation affected online gaming (OG) and pornography viewing (PV) in the general population.

Methods

We developed an online cross-sectional survey, Habit Tracker (HabiT), completed by 1,344 adults (≥18 years). HabiT was released internationally with individuals from 80 countries participating; a majority residing in the United States and United Kingdom. We measured changes in OG (IGDS9-SF) and PV (CYPAT) behaviors before and during the COVID-19 quarantine period. We also assessed psychiatric factors such as anxiety, depression (HADS), and impulsivity (SUPPS-P). The primary outcome measures were change in amount of, and current OG and PV severity during quarantine. These measures were related to ten COVID-19-related stress factors.

Results

Overall, we observed a large increase in OG and a minor increase in PV. Those who increased OG (63%) and PV (43%) during quarantine were younger individuals, males, those who left the quarantine household infrequently, those who reported low frequency or poor quality social interactions, and those with higher depression, anxiety, and urgency impulsivity.

Discussion

Our findings highlight similarities between forms of problematic internet behaviors driven by stress, depression, anxiety; while highlighting distinct avenues which these behaviors can manifest.

Conclusion

We emphasize the relevance of identifying those in need of emotional regulation interventions, to mitigate problematic internet behaviors in the context of COVID-19 isolation.

The mediating effect of student school burnout on the relationship between coping strategies and Internet addiction

BACKGROUND

Each person receives and experiences stress differently and applies more or less effective ways of coping. However, the lack of such skills can lead to burnout. As Różańska-Kowal (2004) writes, the most important predictor of burnout is stress. Everyone is different, has different resources, so there are differences in how to deal with difficult and stressful situations. Some young people with poor coping strategies try to deal with the overwhelming stress by engaging in problematic behaviors, and this heightens the risk of developing substance or Internet addictions.

PARTICIPANTS AND PROCEDURE

The aim of this study was to examine the association between coping strategies (CS), student school burnout (SSB) and problematic use of the Internet (PUI), and to check if SSB may be a mediator between CS and PUI.

RESULTS

Further analyses revealed that a lower level of the problem - focused coping strategies (active coping and acceptance) and a higher level of helplessness and avoidance behaviors are directly associated with addictive Internet behaviors. However, school burnout mediates only links between active coping, helplessness and avoidance behaviors and problematic Internet use. In addition, gender appeared as a moderator between SSB and PUI. Finally, the results suggested that gender plays a significant role in the relationship between the tested variables.

CONCLUSIONS

Male adolescents with poor coping strategies were more prone to school burnout and, because of being burned out, were at a higher risk of excessive Internet use. In the female group school, burnout insignificantly predicted problematic Internet use.

Metacognitions as a predictor of online gaming in adolescents: Psychometric properties of the metacognitions about online gaming scale among Iranian adolescents

The Metacognitions about Online Gaming Scale (MOGS) measures maladaptive metacognitions about online gaming. The purpose of the present study was to evaluate psychometric properties of the MOGS, including its factor structure, reliability, and predictive validity among Iranian adolescents. The scale was administered to 769 Iranian adolescents (577 male, mean age = 16.39 ± 1.68 years) with an age range of 15-19 years. The participants completed the Persian-translated version of the MOGS, the Big Five Inventory-10, the Depression, Anxiety and Stress Scale 21, the Video-Game Related Cognitions Scale, the Motives for Online Gaming Questionnaire, and the Problematic Online Gaming Questionnaire. The results of the Exploratory Factor Analysis (n = 350) and Confirmatory Factor Analysis (n = 419) confirmed three-factors similar to the parent version, including "negative metacognitions about uncontrollability of online gaming" (N-MOGU), "negative metacognitions about dangers of online gaming" (N-MOGD), and "positive metacognitions about online gaming" (P-MOG). The Persian MOGS's reliability showed a suitable internal consistency for the P-MOG, the N-MOGU, the N-MOGD, and the total score in both confirmatory and exploratory samples (range 0.79 to 0.93). A hierarchical regression analysis showed that the Persian MOGS predicted 33.9% of the variance in problematic online gaming independently of personality traits, anxiety, depression, stress, and both gaming-related cognitions and gaming motives. Furthermore, the results of analyses of variance with follow-up Bonferroni pairwise comparisons showed that interaction between the factors of MOGS and types of game and tools of gaming was significant. The findings provide evidence that the Persian MOGS among Iranian adolescents appears psychometrically appropriate to be used by researchers and practitioners dealing with the prevention and treatment of problematic online gaming.

Gaming Disorder in Adults with Autism Spectrum Disorder

Gaming disorder (GD) is a clinical addiction to video or internet games. This study investigated whether GD symptoms are heightened in adults with autism spectrum disorder (ASD) in comparison to a control group, and explored predictors of GD in 230 adults with ASD and 272 controls. The relationship between GD and gelotophobia was examined. Measures included the Ten-Item Internet Gaming Disorder Test, GELOPH < 15 >, Autism Spectrum Quotient-10 items, Inventory of Parent and Peer attachment, Emotional Regulation Questionnaire, Social Functioning Questionnaire (SFQ) and the NEO-FFI-3. Individuals in the ASD group showed significantly higher symptoms of GD. Peer-attachment, emotional regulation and extraversion significantly predicted GD scores. Gelotophobia and GD were related to each other with a small effect size.

Perceived Strain Due to COVID-19-Related Restrictions Mediates the Effect of Social Needs and Fear of Missing Out on the Risk of a Problematic Use of Social Networks

The occurrence of the COVID-19-virus led to drastic short-term measures to reduce its spread and influence. Regulations such as "physical distancing," mentioned as "social distancing," and the closure of public facilities during the lockdown could be perceived as burdensome especially by individuals who feel a strong need for social exchange and belonging. These components such as need to belong and the fear of missing out also play a major role in the development and maintenance of a problematic use of social networks. Researchers have argued recently that an increase of addictive (online) behaviors may be a likely consequence of subjectively experienced restrictions in the context of the COVID-19 pandemic. The current study investigates the interplay of perceived strain due to COVID-19-related restrictions and the fear of missing out (FoMO) as well as of symptoms of problematic social-networks use. We hypothesized that perceived strain due to COVID-19-related restrictions mediates the effect of specific predisposing variables related to social needs on the symptom severity of a problematic use. To assess the perceived strain due to COVID-19-related restrictions, we developed a specific questionnaire asking for perceived COVID-19-related strain in several domains of everyday-life. An exploratory factor analysis identified five factors: perceived strain related to restrictions of (1) social contacts, (2) travel, (3) childcare, (4) work, and (5) own health. In a sample of 719 German participants and data collection during the first COVID-19 lockdown (March 30th until April 3rd 2020), a structural equation model was calculated showing that higher levels of need to belong and FoMO increase perceived COVID-19-related strain, which is related to symptoms of a problematic social-networks use. The effect of need to belong on problematic social-networks use is mediated by experienced COVID-19-related strain and FoMO-online. Even if the use of social networks is not pathological per se, it may be associated with suffering for a vulnerable part of users. We conclude that specific needs and fear-associated predisposing variables contribute to experiencing physical distance and other pandemic-related restrictions as more stressful, which may increase problematic social-networks use and potentially other addictive behaviors as well in the context of the COVID-19-related lockdown.

Perceived Stress and Cyberloafing among College Students: The Mediating Roles of Fatigue and Negative Coping Styles

Cyberloafing has increasingly attracted the attention of scholars because of the widespread use of digital devices in educational environments. This research was conducted to investigate the roles of fatigue and negative coping styles in mediating the relationship between perceived stress and cyberloafing. A total of 730 undergraduates (reduced to 716 due to incomplete data) completed self-report questionnaires measuring perceived stress, fatigue, negative coping styles, and cyberloafing. Perceived stress was shown to be a significant predictor of cyberloafing. Furthermore, negative coping styles played a unique mediating role and fatigue and negative coping styles exerted a sequential mediating effect on the association between perceived stress and cyberloafing. We envision the findings as being helpful in guiding educators develop interventions for minimizing cyberloafing by college students and its disrupting effects.

Problematic internet use: The effect of comorbid psychopathology on treatment outcomes

Problematic Internet use (PIU) behaviours involve one's maladaptive Internet use and have been often described as secondary manifestations of pre-existing psychopathology. Furthermore, different profiles of PIU sufferers have been proposed. However, little is known of the impact these may be having on treatment responses. Thus, this study aims to investigate the psychopathological profiles of those who seek treatment for PIU within a specialised public outpatient unit and whether these influence treatment outcomes. This research utilised 203 treatment seekers of the Specialized Department of Problematic Internet Use (SD-PIU) of the Psychiatric Hospital of Attica, in Greece (mean age = 26.02; SD = 7.9). To assess psychopathology, the Symptom Checklist-90 Revised (SCL-90-R) was used. Treatment responses were reported either as completed, continued, or drop out. A Latent Class/Profiling-Analysis (LCA) was performed, guided by variations across the SCL-90-R psychopathologies. It indicated two naturally occurring profiles of comorbid psychological symptoms; 66% were classified as the "High Comorbidity" (HC) and 34% as the "Low Comorbidity" (LC) profile. Regarding treatment outcomes, LC patients presented with significantly lower dropout rates and higher levels of completion. The present study poses imperative clinical implications regarding the necessity of specialized treatment planning based on the different PIU treatment seekers psychopathological comorbidities.

The Effects of the Fear of Missing Out on People's Social Networking Sites Use During the COVID-19 Pandemic: The Mediating Role of Online Relational Closeness and Individuals' Online Communication Attitude

Forced isolation induced by COVID-19 pandemic dramatically impacted individuals' well-being, reducing the opportunities for social encounters, consequently resulting in a greater use of social media in order to maintain social relationships. Although the range of friend-related activities appeared to be severely constrained during quarantine, the Fear of Missing Out (FoMO) needs to be carefully examined, especially in relation to problematic social networking site use (PSNSU). Indeed, FoMO might enhance individuals' need to stay connected and communicate with other people, leading to PSNSU, in order to face the fear of being invisible in the world of social media in circumstances of physical isolation. The present study sought to evaluate the predictive role of FoMO on PSNSU during the COVID-19 pandemic, testing the mediating effect of online relational closeness and online communication attitude. A total of 487 Italian adults (59.3% women), aged between 18 and 70 years (mean age = 29.85 years; SD = 9.76), responded to an online survey during the period of COVID-19 pandemic lockdown in Italy. The survey included self-report measures assessing perceived FoMO, online communication attitude, relational closeness with online friends, and PSNSU. Participants declared they spent significantly more time social networking during the pandemic, particularly women. The total model accounted for a significant amount of variance in participants' PSNSU [R 2 = 0.54; F (9, 447) = 58.285, p < 0.001). Despite the other people's social rewarding experiences had been drastically reduced by the lockdown, findings showed a direct effect of FoMO on PSNSU. Moreover, FoMO had an effect on online communication attitude and online relational closeness, although only online communication attitude predicted, in turn, PSNSU. Conversely, relational closeness on social networking sites did not predict PSNSU. The present study suggests that, during COVID-19 lockdown, FoMO levels may have strengthened attitudes toward online communication, which, in turn, may have put some individuals at risk of PSNSU.

Associations Between Internet Addiction and Gender, Anxiety, Coping Styles and Acceptance in University Freshmen in South China

Objective: Internet addiction (IA) has become a global public health issue. Although previous studies revealed several risk factors related to IA, most of them focused on the western societies. The present study assesses the relationships between gender and other factors with IA in university freshmen in the South China. Methods: A total of 3,380 first-year college students (1,995 males and 1,385 females) participated in an evaluation of their experiences surfing on the Internet. We investigated the severity of IA in the participants by considering their psychological characteristics, such as acceptance, anxiety levels, and coping styles. Then, we compared the results between males and females and between those in addiction group (Chinese Internet Addiction Scale, CIAS, scores≥64) and non-addiction group (CIAS scores ≤27). We also conducted a logistic regression analysis to detect the relationships between severity of IA and psychological characteristics and gender differences. Results: We observed that males showed significantly higher scores in CIAS than females. The addiction group exhibited significantly higher state anxiety and trait anxiety, and experienced less acceptance of self and others and acceptance by others, and adopted less positive coping style and preferred negative coping style than non-addiction group. The logistic regression analysis revealed that three factors (negative coping styles, acceptance of self and others, state anxiety levels) had a significant association with more severe IA. Conclusion: Gender differences affect the severity of IA in the first-year students in South China. Males with state anxiety and negative coping styles deserve attention because they are likely to be addicted to the Internet. Thus, health practitioners should perform efficient strategies while considering gender differences to precaution first-year college students with the risk factors for IA.

Impulsivity, Social Support and Depression Are Associated With Latent Profiles of Internet Addiction Among Male College Freshmen

Background: The rate of internet addiction is increasing in college students. The first year at college is a particularly vulnerable period for internet addiction. Students' psychological characteristics are likely to play an important role in internet addiction. Our study aimed to assess the relationship between impulsivity, social support, depression and internet addiction among male college freshmen. Materials and Methods: The current study utilized latent profile analysis (LPA) to identify at-risk profiles among 734 college freshmen (100% male) based on their Internet Addiction Test item ratings. We compared the levels of impulsivity, social support and depression among different profiles and investigated whether these variables could predict each latent internet addiction class. Results: LPA resulted in three distinct profiles: the low internet addiction group (42.10%), the moderate internet addiction group (35.70%) and the high internet addiction group (22.20%). Impulsivity and depression increased with internet addiction severity levels, whereas social support was inversely related to the severity of internet addiction. Male freshmen with high impulsivity, low social support and high depression were more likely to be included in the high internet addiction group. Conclusion: This study highlights that impulsivity, social support and depression may predict internet addiction in male college freshmen. Our findings have important practical implications for college educators and counselors in developing interventions for internet addiction.

Violence in video game produces a lower activation of limbic and temporal areas in response to social inclusion images

Exposure to violence in video games has been associated with a desensitization toward violent content, a decrease of empathy, and prosocial behavior. Moreover, violent video games seem to be related to a reduction of neural activation in the circuits linked to social emotional processing. The purpose of the present study was to compare the neural response to social inclusion images after violent and nonviolent video game playing. Electroencephalographic data of the 32 participants were recorded during a visual task with three presentations (T0, T1, T2) of 60 stimuli (30 social inclusion vs. 30 neutral images). After the T0 presentation, the participants played with a video game (orientation or violent). After the T1 presentation, the participants played with the other video game (orientation or violent). The two types of video games were randomly displayed. Event-related potential (ERP) components and low-resolution electromagnetic tomography (sLORETA) were analyzed. The main findings showed a longer latency of the P2 component on occipito-temporal montage and a lower activation of the limbic and temporal areas in response to the social inclusion images post violent video game compared with the post orientation video game. The findings suggest a reduction of emotional engagement in social processing after playing violent video game.

Problematic Internet Use and Perceived Quality of Life: Findings from a Cross-Sectional Study Investigating Work-Time and Leisure-Time Internet Use

Avoiding the potential negative impact brought by problematic internet use is becoming more important. To better understand public health and addiction, this study investigated to what extent work-time and leisure-time internet use relate to problematic internet use and perceived quality of life among college students and highly educated adults. An online cross-sectional survey with 446 individuals was assessed in Germany. Linear regression analyses were used to predict problematic internet use. Ordinal regression analyses were applied to predict perceived quality of life. Results showed that leisure-time internet use, but not work-time internet use, was positively associated with problematic internet use. Participants whose work-time internet use could be considered balanced (5–28 h/week in this study) indicated a higher perceived quality of life compared to individuals with little or large amount of internet use for work. The findings still emerged when taking negative feelings, perceived stress, smoking status and alcohol consumption into account. As both work-time and leisure-time internet use can be risk factors for mental health in terms of problematic internet use and perceived quality of life, well-controlled internet use rather than excessive use is recommended. This should be kept in mind when dealing with the Coronavirus pandemic and its aftermath.

Attachment and behavioral addictions in adolescents: The mediating and moderating role of coping strategies

Gambling, video gaming, and Internet use are typically included as everyday activities that could potentially become behavioral addictions. There is growing evidence that views non-substance related addictions as coping mechanisms, and considers that attachment styles are likely to play a pivotal role on the development of such addictions, especially on young people. Therefore, the present study aimed to: (1) explore the association between attachment, coping, and behavioral addictions (i.e., gambling disorder, video game addiction, and problematic Internet use); and (2) to analyze the mediating/moderating effect that coping has in the relationship of attachment and these behavioral addictions. A sample consisting of 472 students from secondary education (Mean age = 15.6; SD = 1.33; 51.6% females) was recruited. The findings showed a negative association between attachment and behavioral addictions. Most coping strategies were found to be associated with attachment styles, except for self-critique and emotional avoidance. In particular, problem avoidance was significantly correlated to all behavioral addictions. In addition, self-blame and problem solving were significantly correlated to video game addiction and problematic Internet use. Finally, coping was found to act as a mediator and moderator between attachment and video game addiction and problematic Internet use.

Effects of Internet and Smartphone Addictions on Depression and Anxiety Based on Propensity Score Matching Analysis

The associations of Internet addiction (IA) and smartphone addiction (SA) with mental health problems have been widely studied. We investigated the effects of IA and SA on depression and anxiety while adjusting for sociodemographic variables. In this study, 4854 participants completed a cross-sectional web-based survey including socio-demographic items, the Korean Scale for Internet Addiction, the Smartphone Addiction Proneness Scale, and the subscales of the Symptom Checklist 90 Items-Revised. The participants were classified into IA, SA, and normal use (NU) groups. To reduce sampling bias, we applied the propensity score matching method based on genetics matching. The IA group showed an increased risk of depression (relative risk 1.207; p < 0.001) and anxiety (relative risk 1.264; p < 0.001) compared to NUs. The SA group also showed an increased risk of depression (relative risk 1.337; p < 0.001) and anxiety (relative risk 1.402; p < 0.001) compared to NCs. These findings show that both, IA and SA, exerted significant effects on depression and anxiety. Moreover, our findings showed that SA has a stronger relationship with depression and anxiety, stronger than IA, and emphasized the need for prevention and management policy of the excessive smartphone use.

Predicting Effects of Psychological Inflexibility/Experiential Avoidance and Stress Coping Strategies for Internet Addiction, Significant Depression, and Suicidality in College Students: A Prospective Study

The aims of this study were to evaluate the predicting effects of psychological inflexibility/experiential avoidance (PI/EA) and stress coping strategies for Internet addiction, significant depression and suicidality among college students during the follow-up period of one year. A total of 500 college students participated in this study. The level of PI/EA and stress coping strategies were evaluated initially. One year later, 324 participants were invited to complete the Chen Internet Addiction Scale, Beck Depression Inventory-II and the questionnaire for suicidality to evaluate depression symptoms and internet addiction and suicidality. The predicting effects of PI/EA and stress coping strategies were examined by using logistic regression analysis controlling for the effects of gender and age. The results indicated that PI/EA at the initial assessment increased the risk of Internet addiction (OR = 1.087, 95% CI: 1.042–1.135), significant depression (OR = 1.125, 95% CI: 1.081–1.170), and suicidality (OR = 1.099, 95% CI: 1.053–1.147) at the follow-up assessment. Less effective coping at the initial assessment also increased the risk of Internet addiction (OR = 1.074, 95% CI: 1.011–1.140), significant depression (OR = 1.091, 95% CI: 1.037–1.147), and suicidality (OR = 1.074, 95% CI: 1.014–1.138) at the follow-up assessment. Problem focused and emotion-focus coping at the initial assessment was not significantly associated with the risks of Internet addiction, significant depression, and suicidality at the follow-up assessment. College students who have high PI/EA or are accustomed to using less effective stress coping strategies should be the target of prevention programs for IA (internet addiction), depression, and suicidality.

Validation of the Italian Yale Food Addiction Scale in postgraduate university students

PURPOSE

This study was aimed to examine the structural and construct validity of the Italian version of the Yale Food Addiction Scale in a multisite sample of postgraduate students.

METHODS

Two hundred and fifty-six subjects (78.1% females) aged from 18 to 53 years (mean = 23.93, SD = 4.96) and attending different postgraduate university programs at multiple Italian universities completed the Italian YFAS, the Italian Binge Eating Scale (BES), the Italian Eating Attitudes Test-26 and the Italian Dutch Eating Behavior Questionnaire (DEBQ) online through Qualtrics.

RESULTS

Confirmatory Factor Analysis showed that the single-factor model of the Italian YFAS including all original items had adequate fit indexes (χ²252 = 454.183; p < 0.001; normed χ² = 1.802; RMSEA = 0.056; 90% CI 0.048-0.076; CFI = 0.761; WRMR = 1.592). However, item analysis revealed that item#25 had zero variance (all subjects were assigned the same score after item dichotomization) and item#24 had a low factor loading, and were thus removed. Furthermore, item#10 and item#11 showed to be almost perfectly correlated (r = 0.998) and were thus parceled. The resulting 19-item single-factor model revealed a better fit to the data (χ²152 = 235.69; p < 0.001; normed χ² = 1.556; RMSEA = 0.046; 90% CI 0.034-0.058; CFI = 0.858; WRMR = 1.236) and its internal consistency was acceptable (KR-20 = 0.72). Also, a single-factor model including the seven diagnostic symptoms was tested and showed adequate fit values (χ²20 = 41.911; p < 0.003; normed χ² = 2.09; RMSEA = 0.065; 90% CI 0.037-0.093; CFI = 0.946; WRMR = 1.132). Statistically significant and small-to-high correlations were found with all convergent measures, in particular with the BES.

CONCLUSION

The Italian 19-item YFAS resulted to be a valid and reliable tool for the assessment of food addiction in postgraduate students.

LEVEL OF EVIDENCE

Level V, descriptive study.

Pathological Internet Use-An Important Comorbidity in Child and Adolescent Psychiatry: Prevalence and Correlation Patterns in a Naturalistic Sample of Adolescent Inpatients

Background

Few studies have examined the prevalence of problematic internet use (PIU) in young people undergoing inpatient treatment in child and adolescent psychiatry centers. The aims of our study were thus (a) to assess the frequency of comorbid PIU in a sample of adolescent psychiatric inpatients and compare it with a control group of nonreferred adolescents and (b) to gain insights into correlations between PIU and psychiatric comorbidities.

Methods

111 child and adolescent psychiatry inpatients (CAP-IP, mean age 15.1 ± 1.4 years; female : male 72.4% : 27.6%) undergoing routine psychodiagnostics were screened for the presence of PIU. The widely used Compulsive Internet Use Scale (CIUS) was chosen for this purpose. Prevalence rates of PIU were then compared to matched nonreferred control subjects from a school sample. Additionally, comorbidities of inpatients with PIU were compared to inpatients without PIU.

Results

Our inpatient sample showed a much higher prevalence of PIU than that found in previous populational samples of young people. Compared with a matched school sample, addictive internet use was 7.8 times higher and problematic internet use 3.3 times higher among our adolescent sample. PIU was significantly associated with characteristic patterns of psychopathology, that is, suicidality, difficulties in establishing stable and consolidated identity, and peer victimization.

Conclusion

PIU among adolescents undergoing inpatient psychiatric treatment is much more frequent than among their peers in the general population and is associated with specific patterns of psychopathology.

Pornography Use and Loneliness: A Bidirectional Recursive Model and Pilot Investigation

Sexuality is presumptively and observably a powerful core element of the human pair-bond relationship. Technological advances of the last half-century have made media a dominant cultural and developmental presence, including scripting sexual relationship attitudes and behavior. Theoretically and empirically, we examine loneliness as it relates to pornography use in terms of pornography's relational scripting and its addictive potential. Empirically, we examine the associative nature between pornography use and loneliness using a measurement model and two structural equation models where pornography use and loneliness are regressed on each other, respectively. Survey data were collected from a sample of 1,247 participants, who completed an online questionnaire containing questions on pornography use, the University of California-Los Angeles Loneliness Scale (UCLALS), and other demographic variables. Results from our analyses revealed significant and positive associations between pornography use and loneliness for all three models. Findings provide grounds for possible future bidirectional, recursive modeling of the relation between pornography use and loneliness.

Neural correlate of Internet use in patients undergoing psychological treatment for Internet addiction

BACKGROUND

The new version of Diagnostic and Statistical Manual of Mental Disorders (DSM-5th) proposed the Internet Gaming Disorder for the diagnosis of Internet addiction (IA) considering the neurobiological evidence of the craving.

AIMS

The aim was to test the neural correlate in response to the Internet cue in patients with IA.

METHODS

Sixteen males with IA diagnosis (clinical group) and 14 healthy male (control group) were recruited for an experimental visual task composed of Internet images and emotional images. During the visual presentation of Internet cue, electroencefalographic data were recorded using Net Station 4.5.1 with a 256-channels HydroCel Geodesic Sensor Net. Event-related potential (ERP) components and low-resolution electromagnetic tomography (sLoreta) were analysed.

RESULTS

sLoreta analyses showed that patients from the clinical group presented a higher primary somatosensorial cortex and lower paralimbic, temporal and orbito-frontal activation in response to both Internet and emotional images compared to those of the control group.

CONCLUSIONS

These results suggest that clinically recognized pathological use of Internet could be linked to dissociative symptoms.

Internet Addiction in adolescence: Neurobiological, psychosocial and clinical issues

Despite it has not been formally included in DSM-5 as a disorder, 'Internet addiction (IA)' has become a worldwide issue. It can be broadly defined as a non-chemical, behavioral addiction, which involves human-machine interaction. We pinpoint it as an "instrumental" form of social interaction (i.e. mediated by machines), a notion that appears useful for the sake of possible preclinical modeling. The features of Internet use reveals as addictive when this comes at the expense of genuine real-life sociability, with an overlap towards the hikikomori phenomenon (i.e., extreme retreat to one's own room). Due to the specific neuro-developmental plasticity in adolescence, IA poses risks to youths' mental health, and may likely produce negative consequences in everyday life. The thwarted development of adolescents' identity, self-image and adaptive social relationships is discussed: the IA adolescents often suffer loss of control, feelings of anger, symptoms of distress, social withdrawal, and familial conflicts. Further, more severe clinical conditions are also associated to IA, such as dysthymic, bipolar, affective, social-anxiety disorders, as well as major depression. This paper overviews the literature on IA, from neuro-biological, psycho-social and clinical standpoints, taking into account recent debates on diagnostic criteria, nosographic label and assessment tools. Neuroimaging data and neurochemical regulations are illustrated with links to pathogenetic hypotheses, which are amenable to validation through innovative preclinical modeling.

Internet-Communication Disorder: It's a Matter of Social Aspects, Coping, and Internet-Use Expectancies

Online communication applications such as Facebook, WhatsApp, and Twitter are some of the most frequently used Internet applications. There is a growing amount of individuals suffering diminished control over their use of online communication applications which leads to diverse negative consequences in offline life. This could be referred to as Internet-communication disorder (ICD). The current study investigates the role of individual characteristics (e.g., psychopathological symptoms, feelings of loneliness) and specific cognitions. In a sample of 485 participants a structural equation model was tested to investigate predictors and mediators which may predict an excessive use. The results emphasize that a higher level of social loneliness and less perceived social support enhance the risk of a pathological use. The effects of psychopathological symptoms (depression and social anxiety) as well as individual characteristics (self-esteem, self-efficacy, and stress vulnerability) on ICD symptoms are mediated by Internet-use expectancies and dysfunctional coping mechanisms. The results illustrate mediation effects which are in line with the theoretical model by Brand et al. (2016). As suggested in the model social aspects seem to be key predictors of ICD symptoms. Further research should investigate convergent and divergent factors of other types of specific Internet-use disorders.

Integrating psychological and neurobiological considerations regarding the development and maintenance of specific Internet-use disorders: An Interaction of Person-Affect-Cognition-Execution (I-PACE) model

Within the last two decades, many studies have addressed the clinical phenomenon of Internet-use disorders, with a particular focus on Internet-gaming disorder. Based on previous theoretical considerations and empirical findings, we suggest an Interaction of Person-Affect-Cognition-Execution (I-PACE) model of specific Internet-use disorders. The I-PACE model is a theoretical framework for the processes underlying the development and maintenance of an addictive use of certain Internet applications or sites promoting gaming, gambling, pornography viewing, shopping, or communication. The model is composed as a process model. Specific Internet-use disorders are considered to be the consequence of interactions between predisposing factors, such as neurobiological and psychological constitutions, moderators, such as coping styles and Internet-related cognitive biases, and mediators, such as affective and cognitive responses to situational triggers in combination with reduced executive functioning. Conditioning processes may strengthen these associations within an addiction process. Although the hypotheses regarding the mechanisms underlying the development and maintenance of specific Internet-use disorders, summarized in the I-PACE model, must be further tested empirically, implications for treatment interventions are suggested.

Working memory, executive function and impulsivity in Internet-addictive disorders: a comparison with pathological gambling

OBJECTIVE

The purpose of the present study was to test whether individuals with Internet addiction disorder (IAD) presented analogous characteristics of working memory, executive function and impulsivity compared with pathological gambling (PG) patients.

METHODS

The subjects included 23 individuals with IAD, 23 PG patients and 23 controls. All of the participants were measured with the digit span task, Wisconsin Card Sorting Test, go/no-go task and Barratt Impulsiveness Scale-11 (BIS-11) under the same experimental conditions.

RESULTS

The results of this study showed that the false alarm rate, total response errors, perseverative errors, failure to maintain set and BIS-11 scores of both the IAD and PG groups were significantly higher than that of the control group. In addition, the forward scores and backwards scores, percentage of conceptual level responses, number of categories completed and hit rate of the IAD and PG groups were significantly lower than that of the control group. Furthermore, the false alarm rate and BIS-11 scores of the IAD group were significantly higher than those of PG patients, and the hit rate was significantly lower than that of the PG patients.

CONCLUSIONS

Individuals with IAD and PG patients present deficiencies in working memory, executive dysfunction and impulsivity, and individuals with IAD are more impulsive than PG patients.

Internet addiction and problematic Internet use: A systematic review of clinical research

AIM

To provide a comprehensive overview of clinical studies on the clinical picture of Internet-use related addictions from a holistic perspective. A literature search was conducted using the database Web of Science.

METHODS

Over the last 15 years, the number of Internet users has increased by 1000%, and at the same time, research on addictive Internet use has proliferated. Internet addiction has not yet been understood very well, and research on its etiology and natural history is still in its infancy. In 2013, the American Psychiatric Association included Internet Gaming Disorder in the appendix of the updated version of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) as condition that requires further research prior to official inclusion in the main manual, with important repercussions for research and treatment. To date, reviews have focused on clinical and treatment studies of Internet addiction and Internet Gaming Disorder. This arguably limits the analysis to a specific diagnosis of a potential disorder that has not yet been officially recognised in the Western world, rather than a comprehensive and inclusive investigation of Internet-use related addictions (including problematic Internet use) more generally.

RESULTS

The systematic literature review identified a total of 46 relevant studies. The included studies used clinical samples, and focused on characteristics of treatment seekers and online addiction treatment. Four main types of clinical research studies were identified, namely research involving (1) treatment seeker characteristics; (2) psychopharmacotherapy; (3) psychological therapy; and (4) combined treatment.

CONCLUSION

A consensus regarding diagnostic criteria and measures is needed to improve reliability across studies and to develop effective and efficient treatment approaches for treatment seekers.

Pathological Internet Use and Risk-Behaviors among European Adolescents

Risk-behaviors are a major contributor to the leading causes of morbidity among adolescents and young people; however, their association with pathological Internet use (PIU) is relatively unexplored, particularly within the European context. The main objective of this study is to investigate the association between risk-behaviors and PIU in European adolescents. This cross-sectional study was conducted within the framework of the FP7 European Union project: Saving and Empowering Young Lives in Europe (SEYLE). Data on adolescents were collected from randomized schools within study sites across eleven European countries. PIU was measured using Young's Diagnostic Questionnaire (YDQ). Risk-behaviors were assessed using questions procured from the Global School-Based Student Health Survey (GSHS). A total of 11,931 adolescents were included in the analyses: 43.4% male and 56.6% female (M/F: 5179/6752), with a mean age of 14.89 ± 0.87 years. Adolescents reporting poor sleeping habits and risk-taking actions showed the strongest associations with PIU, followed by tobacco use, poor nutrition and physical inactivity. Among adolescents in the PIU group, 89.9% were characterized as having multiple risk-behaviors. The significant association observed between PIU and risk-behaviors, combined with a high rate of co-occurrence, underlines the importance of considering PIU when screening, treating or preventing high-risk behaviors among adolescents.

Functional magnetic resonance imaging of internet addiction in young adults

AIM: To report the results of functional magnetic resonance imaging (fMRI) studies pertaining internet addiction disorder (IAD) in young adults.

METHODS: We conducted a systematic review on PubMed, focusing our attention on fMRI studies involving adult IAD patients, free from any comorbid psychiatric condition. The following search words were used, both alone and in combination: fMRI, internet addiction, internet dependence, functional neuroimaging. The search was conducted on April 20^th, 2015 and yielded 58 records. Inclusion criteria were the following: Articles written in English, patients’ age ≥ 18 years, patients affected by IAD, studies providing fMRI results during resting state or cognitive/emotional paradigms. Structural MRI studies, functional imaging techniques other than fMRI, studies involving adolescents, patients with comorbid psychiatric, neurological or medical conditions were excluded. By reading titles and abstracts, we excluded 30 records. By reading the full texts of the 28 remaining articles, we identified 18 papers meeting our inclusion criteria and therefore included in the qualitative synthesis.

RESULTS: We found 18 studies fulfilling our inclusion criteria, 17 of them conducted in Asia, and including a total number of 666 tested subjects. The included studies reported data acquired during resting state or different paradigms, such as cue-reactivity, guessing or cognitive control tasks. The enrolled patients were usually males (95.4%) and very young (21-25 years). The most represented IAD subtype, reported in more than 85% of patients, was the internet gaming disorder, or videogame addiction. In the resting state studies, the more relevant abnormalities were localized in the superior temporal gyrus, limbic, medial frontal and parietal regions. When analyzing the task related fmri studies, we found that less than half of the papers reported behavioral differences between patients and normal controls, but all of them found significant differences in cortical and subcortical brain regions involved in cognitive control and reward processing: Orbitofrontal cortex, insula, anterior and posterior cingulate cortex, temporal and parietal regions, brain stem and caudate nucleus.

CONCLUSION: IAD may seriously affect young adults’ brain functions. It needs to be studied more in depth to provide a clear diagnosis and an adequate treatment.

Association of stress coping strategies with Internet addiction in college students: The moderating effect of depression

BACKGROUND

This study examined the association between stress-related coping strategies and Internet addiction and the moderating effect of depression in a sample of Taiwanese college students.

METHOD

A total of 500 college students (238 men and 262 women) participated in this study. Internet addiction was assessed using the Chen Internet Addiction Scale. Participants' stress coping strategies and depressive symptoms were measured using the Coping Orientation to Problems Experienced and the Beck Depression Inventory-II, respectively. We used t and chi-square tests to examine differences in demographic characteristics, depression, and stress coping strategies between participants with and without Internet addiction. Significant variables were used in a logistic regression model to examine the association between stress coping strategies and Internet addiction and the moderating effect of depression on the association.

RESULTS

Results indicated that use of restraint coping was negatively associated with Internet addiction (odds ratio [OR]=0.886, 95% confidence interval [CI]: 0.802-0.977), whereas denial (OR=1.177, 95% CI: 1.029-1.346) and mental disengagement (OR=2.673, 95% CI: 1.499-4.767) were positively associated with Internet addiction. Depression had a moderating effect on the association between denial and Internet addiction (OR=0.701, 95% CI: 0.530-0.927).

CONCLUSIONS

Stress coping strategies and depression are important factors to evaluate when developing intervention programs targeting college undergraduate students with Internet addiction.

The Chinese version of the Yale Food Addiction Scale: An examination of its validation in a sample of female adolescents

INTRODUCTION

The present study developed and tested a Chinese version of the Yale Food Addiction Scale (YFAS-R-C) in a sample of female normal-school students, with the aim of producing a psychometrically sound tool for assessing food addiction in female adolescents.

METHODS

A preliminary study of 72 normal-school students tested the YFAS-R-C and collected suggestions to improve it. Twenty days later, the formal YFAS-R-C, the Binge Eating Scale (BES), Eating Attitude Test (EAT-26), BIS/BAS Reactivity (BIS/BAS) scale, and Regulatory Emotional Self-efficacy (RES) scale were administrated to a sample of 950 normal-school students. Test-retest reliability was assessed in 53 students who took the YFAS-R-C twice.

RESULTS

The single factor structure of the YFAS-R-C could be confirmed in our study. The internal consistency (KR-20) for 21 original items (0.857) and diagnostic criteria (0.75) were good. Confirmatory factor analysis verified a one-factor structure with an acceptable fit. The test-retest reliability of the YFAS-R-C was good, with interclass correlations of 0.72 for symptom items and 0.69 for the diagnostic criteria. The YFAS-R-C had good convergent and discriminant validity: symptom and diagnosis versions both had significant correlations with measures of related eating behavior constructs (BES and EAT-26), but had no or moderate correlations with measures of related, yet separate constructs (BIS/BAS and RES).

DISCUSSION

The results indicate the YFAS-R-C has a good psychometric validity to differentiate population with and without food addiction in a group of female normal-school students. Future studies should validate the YFAS-R-C in diverse samples.

Predicting treatment failure in pathological gambling: the role of personality traits

INTRODUCTION

The aim of this study was twofold: First, to assess the personality profile of treatment-seeking adult outpatients with pathological gambling compared to a matched control group under the Alternative Five Factor Model perspective, and second, to determine which personality variables would predict treatment outcome.

METHODS

The final total sample consisted of 44 consecutive treatment-seeking pathological gamblers (PGs) and 88 controls paired by age and sex who completed the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). Twelve months after starting an open program of individual cognitive-behavioral therapy, PGs were categorized as abstinent or treatment failure.

RESULTS

PGs scored significantly higher on Neuroticism-Anxiety. Those who had relapsed or dropped out showed higher Impulsivity and Sensation Seeking scores. Impulsivity emerged as a significant predictor of treatment failure. Treatment-seeking PGs scored higher on Neuroticism-Anxiety and Impulsivity appeared as a risk factor of relapsing or dropping out.

CONCLUSIONS

Our findings support the importance of individual differences in personality on therapy outcomes. The ZKPQ may constitute a useful tool to identify these individual differences that might be considered when making personalized treatment decisions to improve the effectiveness and quality of treatment interventions.

Internet addiction: coping styles, expectancies, and treatment implications

Internet addiction (IA) has become a serious mental health condition in many countries. To better understand the clinical implications of IA, this study tested statistically a new theoretical model illustrating underlying cognitive mechanisms contributing to development and maintenance of the disorder. The model differentiates between a generalized Internet addiction (GIA) and specific forms. This study tested the model on GIA on a population of general Internet users. The findings from 1019 users show that the hypothesized structural equation model explained 63.5% of the variance of GIA symptoms, as measured by the short version of the Internet Addiction Test. Using psychological and personality testing, the results show that a person’s specific cognitions (poor coping and cognitive expectations) increased the risk for GIA. These two factors mediated the symptoms of GIA if other risk factors were present such as depression, social anxiety, low self-esteem, low self-efficacy, and high stress vulnerability to name a few areas that were measured in the study. The model shows that individuals with high coping skills and no expectancies that the Internet can be used to increase positive or reduce negative mood are less likely to engage in problematic Internet use, even when other personality or psychological vulnerabilities are present. The implications for treatment include a clear cognitive component to the development of GIA and the need to assess a patient’s coping style and cognitions and improve faulty thinking to reduce symptoms and engage in recovery.

Video game addiction in gambling disorder: clinical, psychopathological, and personality correlates

OBJECTIVE

We studied the prevalences of video game use (VGU) and addiction (VGA) in gambling disorder (GD) patients and compared them with subjects with non-video game use (non-VGU) in relation to their gambling behavior, psychopathology, and personality characteristics.

METHOD

A sample of 193 GD patients (121 non-VGU, 43 VGU, and 29 VGA) consecutively admitted to our pathological gambling unit participated in the study. Assessment. Measures included the video game dependency test (VDT), symptom checklist-90-revised, and the temperament and character inventory-revised, as well as a number of other GD indices.

RESULTS

In GD, the observed prevalence of VG (use or addiction) was 37.3% (95% CI :30.7% ÷ 44.3),VGU 22.3% (95% CI :17.0% ÷ 28.7), and VGA 15% (95% CI :10.7% ÷ 20.7). Orthogonal polynomial contrast into logistic regression showed positive linear trends for VG level and GD severity and other measures of general psychopathology. After structural equation modeling, higher VG total scores were associated with younger age, general psychopathology, and specific personality traits, but not with GD severity. Patients' sex and age were involved in the mediational pathways between personality traits and VG impairment.

CONCLUSIONS

GD patients with VG are younger and present more dysfunctional personality traits, and more general psychopathology. The presence of VG did not affect the severity of GD.