PSYCHOLOGY RESEARCH PROGRESS

INTERNET ADDICTION
PREVALENCE, RISK FACTORS AND
HEALTH EFFECTS

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 PSYCHOLOGY RESEARCH PROGRESS

INTERNET ADDICTION
PREVALENCE, RISK FACTORS AND
HEALTH EFFECTS

MARGARET ADAMS
EDITOR

New York
Copyright © 2017 by Nova Science Publishers, Inc.

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 CONTENTS

Preface vii
Chapter 1 Internet and Novel Technology Addiction:
The Latest Epidemic 1
Donatella Marazziti, Stefano Baroni and
Federico Mucci
Chapter 2 Towards an Epidemiological Model of
Internet Addiction 11
Andres Fontalba-Navas, Virginia Gil-Aguilar and
Jose Miguel Pena-Andreu
Chapter 3 Internet Addiction and Flow Experience 23
Kazuki Hirao
Chapter 4 The Role of Attachment Style and Social Anxiety in
Internet Addiction 29
Carlo Lai, Gaia Romana Pellicano,
Daniela Altavilla, Navkiran Kalsi and
Michela D’Argenzio
Chapter 5 The Mental Health Literacy of Internet Addiction
among Adolescents: An Initial Measure
Development and Validation 53
Lawrence T. Lam
Chapter 6 A Reflective Study of the Dilemmas in the Digital
Addiction Policy of Korea 71
Koh Young-Sam
vi Contents

Bibliography 93
Related Nova Publications 125
Index 137
 PREFACE

According to the World Health Organization, pathological addiction is the

psychic, and sometimes even physical, condition arising from the interaction
between a living organism and an exogenous substance, characterized by
behavioral responses and other reactions that always include a compulsive
need to take the substance continuously or periodically, in order to get its
psychic effects and/or to avoid the distress related to its withdrawal. This book
presents a review on Internet addiction, which is considered an emergent
problem especially amongst adolescents, and examines the risk factors and
health effects of this addiction.
Chapter 1 - During the last decades a novel addictive group, the so-called
“behavioral or no-drug addictions,” has been recognized. This group includes
pathological gambling, compulsive shopping, TV-internet-social network-
videogame (new technologies) addictions, workaholism, sex and relationship
addictions, orthorexia and overtraining syndrome. Substance and behavioral
addictions show similar phenomenological features, such as craving,
dependence, tolerance and abstinence, and perhaps they share a common
possible pathophysiology. It is, however, controversial whether all or at least
some of them should be considered real disorders or just normal, albeit
extreme behaviors. Currently, the new technologies addiction is attracting a
great attention for its relevant social impact, given the widespread use mobile
phones since childhood and adolescence. Mobile phones partially cancelled
the spatio-temporal, emotional and relational distance, and promoted novel
emotional experiences and relationships that may become progressively
prominent. The risk, especially in young people who are the major users of
this tool, is to develop a full-fledged addiction. Increasing worsening of stress
and generalized anxiety levels would be due to continuous web access and sms
viii Margaret Adams

and mail control, at any place and time. Preliminary findings of the authors’
study, carried out in a large cohort of students from three major Italian
Universities, show that the use of new technologies exceeds their real use and
can be considered a real addiction. Therefore, preventive strategies of Internet
abuse should be rapidly implemented to avoid the possibility of an irreversible
“mind change” of next generations that can be detrimental.
Chapter 2 - Internet addiction has, as of yet, not been completely
recognised as a disorder by the International Classification of Diseases ICD 10
and DSM 5.
Despite the debate on diagnostic criteria and validity, its health
consequences as well as risk and protective factors have been widely proven.
Regardless of the controversy, people who suffer from this addiction
experience significant limitations in their psychosocial functioning. This is
why they seek treatment and help.
The main characteristics of this disorder include: worrying about the
Internet and digital media; loss of control of time spent connected to digital
technology; an increasing need for more time or new applications; mood
repercussions; withdrawal symptoms when not connected; behaviour that
continues despite negative consequences; deterioration of social relationships;
and negative impact on academic and work life.
Prevalence rates are high, but differ between countries. It is estimated that
prevalence rates in Europe and the USA are between 1.5 and 8.2%,
respectively. In Asia, prevalence is even higher with 20%.
The prevalence rate of young people who meet Internet addiction criteria
in specific populations, such as adolescent students in Hong Kong, has reached
26.7%.
Adolescents are a particularly vulnerable group. Life stressors such as
social relationship problems or difficulties adapting to study life correlate
positively with the disorder.
There are many explanations as to the link between the disorder and
adolescence including use of the Internet to relieve stress and tension.
Risk factors include environmental factors such as parental control and
family attitudes, internal and personality factors such as lack of achievement
of personal goals, alienation and personal dissatisfaction.
Longitudinal studies have shown that the main psychopathological risk
factors are attention deficit hyperactivity disorder, withdrawal, thought
disorder, anxiety, depression and thought disorder in childhood.
The main long term effect on mental health is an increase in the incidence
rate of depressive disorders.
 Preface ix

The high prevalence rates, risk factors and health effects of Internet
addiction in adolescents require different approaches and a primary focus on
the specific needs of this age group, where early detection and promotion of
healthy habits are of utmost importance.
Chapter 3 - Internet addiction (IA) is a serious problem and a common
disorder leading to mental health concerns especially in adolescents and young
adults around the world. Although different from IA, the concept of flow
refers to the state of being immersed in an activity and is often used in a
positive context. This chapter discusses similarities and differences between
IA and flow.
Chapter 4 - Pathological Internet use is characterized by excessive or
poorly controlled preoccupations or behaviors regarding computer use that
results in impairments or distress. Previous studies reported high comorbidity
of Internet addiction with psychiatric conditions like affective and
anxiety disorders.
Among anxiety disorders, social anxiety is often associated with relational
impairments in adolescent. Many studies suggested that social anxiety is
promoted by an insecure attachment style.
Attachment style plays an important role in socio-emotional relationships
with others and forms the generalized basis of self-worth. Insecure
attachment, in particular, implicates a higher non specific risk factor for
psychopathologies. Previous study reported that attachment style predicts
online social interaction in the same way that it does in the offline context.
Individuals with high attachment anxiety have more frequent internet use and
are constantly concerned about how others perceive them.
Insecure attachment and social anxiety were reported to be more strongly
associated with Internet Addiction. Thus, the association between the insecure
attachment style and social anxiety seems to have a very relevant role as risk
factors for the problematic use of Internet.
Chapter 5 - This study aims to describe the initial development and to
investigate the psychometric properties of an instrument for measuring the
Mental Health Literacy (MHL) of Internet Addiction (IA). The formation of
the items was based on the Australian National Survey of Mental Health
Literacy and Stigma Youth Survey. It was designed as a vignette-based
questionnaire depicting behavioural characteristics of a severe problem with
Internet usage. These symptomatic behaviours were based on the description
in the Young Internet Addiction Test (IAT). This newly developed instrument
was administered to 348 adolescents aged between 15-18 years randomly
recruited from high schools in a large city. Responses on the recognition of the
x Margaret Adams

problem from the vignette with the recognition of another vignette depicting
depression were compared. The convergent validity of the intended action to
seek help was investigated using the Self-Stigma of Seeking Help Scale
(SSOSH), and the personal identification of the problem by the IAT. The
results of this study provided supporting evidence for the validity of the MHL
of IA measure. As the unique measure of the MHL of IA, this could play an
important role in understanding the level of MHL in the population of an
emerging area of psychiatric problem.
Chapter 6 - South Korea has rapidly developed the infrastructure for a
digital information society. The rapid development of its infrastructure,
however, has caused social problems such as internet addiction, for which
countermeasures were implemented at the national level early on. Such
response measures include the 3-year master plans, annual nationwide surveys
on the current conditions, training of professional counselors, counseling
programs tailored to different age groups, and regional counseling centers.
However, as is the case with all other policies, there are dilemmas in the
Internet addiction policy in regard to the cause and true nature of digital
addiction, the inter-departmental implementation systems of the central
government, and the division of roles and cooperation among the central and
local governments and citizens. This chapter is a reflective study about the
future policies to be improved with the previous successful Internet addiction
policies in S. Korea. S. Korea's experience in responding the Internet addiction
problems may offer good case studies for other countries that have recently
experienced it.
In: Internet Addiction ISBN: 978-1-53610-436-3
Editor: Margaret Adams © 2017 Nova Science Publishers, Inc.

Chapter 1

INTERNET AND NOVEL TECHNOLOGY

ADDICTION: THE LATEST EPIDEMIC

Donatella Marazziti, Stefano Baroni

and Federico Mucci
Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry,
University of Pisa, Pisa, Italy

ABSTRACT
During the last decades a novel addictive group, the so-called
“behavioral or no-drug addictions,” has been recognized. This group
includes pathological gambling, compulsive shopping, TV-internet-social
network-videogame (new technologies) addictions, workaholism, sex and
relationship addictions, orthorexia and overtraining syndrome. Substance
and behavioral addictions show similar phenomenological features, such
as craving, dependence, tolerance and abstinence, and perhaps they share
a common possible pathophysiology. It is, however, controversial
whether all or at least some of them should be considered real disorders
or just normal, albeit extreme behaviors. Currently, the new technologies
addiction is attracting a great attention for its relevant social impact,
given the widespread use mobile phones since childhood and


Corresponding authors: Dr. Donatella Marazziti, Dipartimento di Medicina Clinica e
Sperimentale, Section of Psychiatry, University of Pisa, Via Roma, 67, 56100 Pisa, Italy.
Telephone: + 39 050 2219768. Fax: + 39 050 2219787. E-mail:[email protected].
unipi.it.
2 Donatella Marazziti, Stefano Baroni and Federico Mucci

adolescence. Mobile phones partially cancelled the spatio-temporal,

emotional and relational distance, and promoted novel emotional
experiences and relationships that may become progressively prominent.
The risk, especially in young people who are the major users of this tool,
is to develop a full-fledged addiction. Increasing worsening of stress and
generalized anxiety levels would be due to continuous web access and
sms and mail control, at any place and time. Preliminary findings of our
study, carried out in a large cohort of students from three major Italian
Universities, show that the use of new technologies exceeds their real use
and can be considered a real addiction. Therefore, preventive strategies of
Internet abuse should be rapidly implemented to avoid the possibility of
an irreversible “mind change” of next generations that can be detrimental.

INTRODUCTION
According to the World Health Organization [1], pathological addiction is
the psychic, and sometimes even physical, condition arising from the
interaction between a living organism and an exogenous substance,
characterized by behavioral responses and other reactions that always include
a compulsive need to take the substance continuously or periodically, in order
to get its psychic effects and/or to avoid the distress related to its withdrawal.
The different editions of the Diagnostic and Statistical Manual of Mental
Disorders (DSM) and the International Classification of Diseases, 10th edition
(ICD-10) [1] continue to propose a notion of “addiction” exclusively referred
to the intake of substances with psychotropic activity. This term is increasingly
used also in the classification of syndromic entities arising from the
development of addictive behaviors developing in the absence of substance
intake. The DSM system has long avoided the term “addiction,” while
preferring to apply the terms “substance use” and “dependence.” According to
its 4th edition (DSM-IV) [2], significant impairment of work, school, and
social life. On the other hand, the definition of “addiction” relates to that of
“drug dependence”: a relevant amount of time spent to obtain the substance,
increased tolerance to it, physical or psychological damage caused by its use,
failed attempts to stop it, and withdrawal symptoms. The 5th edition of the
DSM (DSM-5) does not separate the diagnoses of substance abuse and
dependence as in the previous editions, while eliminating the confusion
between the two terms, and provides criteria for substance use disorder,
accompanied by those for intoxication, withdrawal, substance/medication-
induced disorders, and unspecified substance-induced disorders, where
 Internet and Novel Technology Addiction 3

relevant [3]. Therefore, DSM-5 substance use disorder criteria are nearly
identical to the DSM-IV substance abuse and dependence criteria combined
into a single list, with two exceptions. In the DSM-5 draft, the American
Psychiatric Association (APA) originally proposed the inclusion of a new
chapter entitled “Behavioral Addictions,” but this chapter was not included in
the final edition. Nevertheless, the DSM-5 chapter “Substance-Related and
Addictive Disorders” includes gambling disorder, and, as such, it reflects the
increasing and consistent evidence that brain reward system may be disturbed
in both drug abuse and behavioral addictions. Another behavioral addiction,
the “Internet addiction,” has been included in Section 3, which encompasses
conditions that require further research before they can be formally considered
“full disorders.” By contrast, the proposed “hypersexuality category,” which
some authors considered simply as a subtype of sex addiction, was rejected.
The terms “new addictive syndromes” or “no-drug addictions” refer to a wide
range of abnormal behaviors including pathological gambling, compulsive
shopping, the so-called “new technologies addiction” (addiction to TV,
Internet, social networks, videogames), work addiction syndrome
(workaholism), sex (sex addiction) and emotional relationships, orthorexia,
and overtraining syndrome. In 1999, Francisco Alonso-Fernandez [4]
proposed a broad classification of the concept of “addiction” based on social
regulators, while distinguishing social or legal dependencies, including legal
drugs, namely those allowed for free sale (tobacco, alcohol, drugs), and
socially accepted activities (such as eating, working, shopping, playing
videogames, surfing the Internet), from antisocial or illegal dependencies.
Both classical and new addictions share several features that include the
following:

 Pleasure and relief: pleasant sensations, albeit restricted to initial

periods of substance use (or of the implementation of behavior). It is
the so-called “honeymoon” phase, during which a denial of the
problem is always present.
 Dominance: the substance (or behavior) constantly dominates the
thinking (main ideation); there is an inability to resist the impulse to
take the drug (or perform the behavior), experienced in a compulsive
manner.
 Craving: there is a feeling and the increasing sense of tension before
taking the substance (or implementing the behavior).
4 Donatella Marazziti, Stefano Baroni and Federico Mucci

 Mood instability: this is initially limited to the beginning of substance

intake (or behavioral implementation), then increasingly generalized
and extended to all aspects of existence.
 Tolerance: the need to increase the amount of substance (or the time
dedicated to behavior) to get the “positive” effect, that otherwise
lessens over time.
 Loss of control: the increasing feeling of loss of control on substance
intake (or on implementation of behavior).
 Abstinence: a deep psychic and physical distress when substance
intake (or the period dedicated to behavior) is stopped or reduced.
 Conflict: the consequence of chronic use of the substance (or
behavior), which leads to great impairment of familial, social,
educational, and work adjustment.
 Persistence: substance use (or behavior) continues notwithstanding the
progressive and clear association with increasingly severe and
negative consequences.
 Impact: there is the frequent tendency to use substances (or behavior)
again after a period of interruption.
 Polydrug abuse and cross-addiction: high-frequency of intake of more
substances (or running multiple behaviors), and “jumping” from one
dependency to another. It should be noted that there is an important
phenomenon of cross-dependence between substance and no-drug
addictions.
 The similarity of the main risk factors: impulsivity, sensation-seeking,
cognitive styles, inadequate and disturbed parental environment.

Currently, the pharmacological treatment of no-drug addictions is

established only on empirical assessments and based on clinical
characteristics, similar to those of obsessive-compulsive (OCD) and impulsive
spectrum disorders, or substance use and mood disorders, especially those
belonging to the bipolar spectrum [5]. Several treatment options have been
investigated, including different antidepressants, mood stabilizers, opioid
antagonists, glutamatergic modulators, and atypical antipsychotics, that
showed a good effectiveness in symptoms reduction and craving control. In
addition, according to our clinical experience, in most cases, it seems useful to
combine psychopharmacological treatments with psychotherapeutic and
psychosocial intervention, although controlled studies exploring the real
effectiveness of this strategy are not available. Further, all the data on
 Internet and Novel Technology Addiction 5

treatment of behavioral addictions are limited, and no specific guidelines are

available. The aim of this article is to present a review on Internet addiction,
which is considered an emergent problem especially amongst adolescents, as
well as to highlight possible interventions to stop and prevent this epidemic.

INTERNET AND NEW TECHNOLOGY ADDICTIONS

In 1995, Goldberg [6] proposed the ironic and provocative introduction in
DSM of a new addictive syndrome called “Internet addiction disorder.” In
1996, Young [7] published the first clinical research on a sample of 396
dependent Internet users (“dependents”) vs a control group of 100
nondependent Internet users (“nondependents”). Diagnosis was carried out by
using a specific test (“Diagnostic Questionnaire”), published directly on the
Web, which modified criteria for pathological gambling to provide a screening
instrument for addictive Internet use; cut-off was reached when users
answered affirmatively to at least 5-8 questions [7]. The use of internet
becomes pathological when it takes too much time and the subjects show an
impairment of work, school and sound relationships. Other unspecific and
therefore under-recognized symptoms of new technology addiction can be
alterations of sleep-wake rhythm, chronic fatigue (due to the common
preference for nighttime web connection), reduced efficiency of immune
system, abnormal appetite, poor self-care, headache, visual problems, back
pain, and carpal tunnel syndrome due to prolonged mouse utilization. Some
patients may be predisposed to the onset of seizures elicited by the continuous
visual stimulation due to the long stay in front of a computer screen.
Young described 5 subtypes of Internet addiction [7]:

 cyber-sexual addiction (a compulsive need to access virtual sex and

pornographic Web sites)
 cyber-relational addiction (excessive involvement in relations arising
in the network)
 net-compulsion (compulsive behaviors related to online activities such
as gambling, shopping, and e-trade)
 information overload (an obsessive search for news on the Web)
 computer addiction (a tendency to excessive involvement in virtual
games such as multi-user dimensions and role playing games)
6 Donatella Marazziti, Stefano Baroni and Federico Mucci

Among the several Internet addiction variants, the so-called cyber-

relational addiction is of particular interest. It is characterized by a tendency to
establish friendly or even love relationships with people met online, mostly via
chat, forum, or social networks. It is a form of relationship where anonymity
plays a main role, that allows one to “create” specific physical and
personologic profiles, often different from their real personalities. Virtual
relations become progressively more important than real-life relationships, and
the subject undergoes a progressive isolation, while living in a parallel world,
full of idealized people, and where communication is often symbolized
through a special linguistic, grammatical, and visual form called IRC (Internet
relay chat) that includes well known emoticons. It is possible to distinguish
two subtypes of Internet addicted people: those who have already suffered
from other psychopathological disorders (most frequently mood, anxiety,
eating, conduct, impulse control, but also personality and psychotic disorders),
and those who have never presented, at least apparently, any
psychopathological feature. In the first type of patients, the previous disorders
would represent facilitating factors toward the onset of any type of addiction.
In the second, by contrast, first contacts with the “substance” (i.e., the Internet)
would trigger the need to maintain and intensify its “intake” (i.e., web
connection). Mobile phones represent a technological tool that are increasingly
widespread and sophisticated. In parallel with the substantial and rapid
increase in communication services, availability of accessories, and
multiplication of technical features (short message service (sms), multimedia
messaging service (mms), video calling, e-mailing, instant-messaging),
psychosocial aspects of this tool rapidly transformed. Mobile phones partially
cancelled the spatio-temporal, emotional, and relational distances, and
promoted novel emotional experiences and relationships that may become
progressively prominent. The risk, especially in young people, who are the
major users of this tool, is developing a full-fledged addiction. Increased
worsening of stress and generalized anxiety levels would be due to continuous
Web access and sms and e-mail control, at any place and time. Addictive
syndrome starts when most of a person’s time and energies are spent in
instrument use or related activities, and provokes personal, relational,
emotional, familial, or school maladjustment. Mobile phone addiction may
develop rapidly and worsen, while showing similar phenomena to those of
substance addiction, such as craving, tolerance, and habituation. Other features
that might indicate a dependence risk are the intense attachment towards a
mobile phone, the refusal to abandon it even for a short time, and its use as the
main, or even only means of knowledge and interpersonal relationships.
 Internet and Novel Technology Addiction 7

Excessive use of mobile phones may lead to the development of specific

disorders, such as the so-called “disconnection syndrome” and “ring or
phantom vibration syndrome.” Similar to most addictions, mobile phone
addiction occurs more easily in individuals with low self-esteem, social
difficulties, high anxiety levels, marked interpersonal sensitivity, obsessive
thoughts, and compulsive behaviors. Television addiction configures an
excessive (“teleabuse,” or exaggerated stay in front of TV screen) and/or
abnormal (habit of TV watching alone, motionless, in strict silence, preventing
contact with other people, or presenting violence if stopped during TV
watching) TV use.

PHARMACOLOGICAL TREATMENT OF
NEW TECHNOLOGY ADDICTIONS
No specific indications exist for drug treatment of Internet addiction.
Recent data have suggested the potential effectiveness of bupropion and
methylphenidate in reducing videogames craving [8, 9] and of naltrexone in
reducing the search for pornographic sites [10]. A case report suggested the
possible effectiveness of escitalopram (10 mg/day in internet addiction) [11],
which was subsequently confirmed in an open-label trial [12].

CONCLUSION
Despite the significant amount of clinical, genetic, biochemical, and
neuropsychological data, the field of behavioral addiction is still largely
unknown [13-15]. Epidemiological data are meager, and there is a wide
heterogeneity of tools used for diagnostic assessment, treatment, and
interventions. Similarly, the pathophysiology of behavioral addictions, which
might lead to specific treatments, remains obscure and mainly hypothetical.
However, it is interesting to mention that neuropsychological tests have
revealed that behavioral and drug addictions share similar abnormalities in
complex executive functions, such as planning, attention, response inhibition,
elaboration of problem-solving strategies with tendency to perseveration error,
exaggerated reward sensitivity, maintenance of abnormal and increased levels
of excitation, and deficit of self-control. The need to satisfy a drive is always
present, with the increasing inability to postpone it [13]. Such deficits have
8 Donatella Marazziti, Stefano Baroni and Federico Mucci

been linked to disturbances of the reward system, so-called “reward deficiency

syndrome,” and of frontal lobe modulation, particularly of the prefrontal
cortex. Moreover, biochemical and genetic studies in drug addictions and
pathological gambling have suggested the possible role of altered 5-HT,
norepinephrine, and dopamine, as well as glutamate and betaendorphin
regulation [14, 15]. Therefore, there is an urgent need for studies to explore
patients with different behavioral addictions by brain imaging techniques of
peripheral markers of central nervous system parameters. In conclusion, it is
not surprising that no specific prevention protocol is available, especially in
vulnerable populations, nor standardized treatment and rehabilitation
interventions. It is not yet possible to define the essential levels of assistance
(LEA) that are scientifically oriented; in some cases (e.g., gambling), a pushy,
persuasive, incentive-based bearer of deceptive messages is legally permitted
[16]. Behavioral addictions, therefore, represent one of the most important
challenges of contemporary psychiatry. Clinical data, neurobiological profiles,
and response to specific therapeutic strategies would indicate their intimate
connection with substance addiction. However, there is a current and
increasing debate on whether all, or at least some of them, should be
considered real disorders or just normal, albeit maladjusted, behaviors [17,
18]. The hope is, in the near future, to build a standardized, comprehensive,
and multidisciplinary approach that is able to coordinate biochemical and
genetic research, behavioral restructuring, social/environmental conditioning
factors (risk and resiliency) analysis, programming and organization of social
and health systems, political acts, and appropriate legislative changes leading
to focused prevention and tailored pharmacological treatment, when necessary.
The school and the families are the main educational agencies that should be
involved in increasing awareness on the possible dangers related to excessive
Internet use, but also politicians should make their part. It would appear,
therefore, very important to implement educational programs related to
behavioral addictions in order to prevent the onset of psychiatric disorders in
childhood and adolescents. Teenagers could become motivated to understand
the phenomenon by seminars and/or meetings involving also parents and
teachers with the support of psychologists and psychiatrists who should
prepare guidelines to approach new technology use by exploring cognitive,
emotional, behavioral and social factors related to it.
 Internet and Novel Technology Addiction 9

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10 Donatella Marazziti, Stefano Baroni and Federico Mucci

[14] Goudriaan, AE; de Ruiter, MB; van den Brink, W; Oosterlaan, J;

Veltman, DJ. Brain activation patterns associated with cue reactivity and
craving in abstinent problem gamblers, heavy smokers and healthy
controls: an fMRI study. Addiction biology, 2012; 15(4): 491-503.
[15] Marazziti, D; Catena Dell’osso, M; Conversano, C; Consoli, G;
Vivarelli, L; Mungai, F; Di Nasso, E; Golia, F. Executive function
abnormalities in pathological gamblers. Clinical practice and
epidemiology in mental health, 2008, 4(1): 7.
[16] Serpelloni, G. Gioco d’azzardo problematico e patologico:
inquadramento generale, meccanismi fisio-patologici, vulnerabilita,
evidenze scientifiche per la prevenzione, cura e riabilitazione. In:
Dipartimento Politiche Antidroga, Presidenza del Consiglio dei Ministri,
Manuale per i Dipartimenti delle Dipendenze. Rome, Italy; 2013.
[17] Sbrana, A; Bizzarri, JV; Rucci, P; Gonnelli, C; Doria, MR; Spagnolli, S;
Ravani, L; Raimondi, F; Dell’Osso, L; Cassano, GB. The spectrum of
substance use in mood and anxiety disorders. Comprehensive psychiatry,
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Spagnolli, S; Doria, MR; Raimondi, F; Endicott, J; Dell’Osso, L;
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Disorders, 2007, 9(3), 213-220.
In: Internet Addiction ISBN: 978-1-53610-436-3
Editor: Margaret Adams © 2017 Nova Science Publishers, Inc.

Chapter 2

TOWARDS AN EPIDEMIOLOGICAL MODEL

OF INTERNET ADDICTION

Andres Fontalba-Navas 1,, Virginia Gil-Aguilar 1

and Jose Miguel Pena-Andreu 2
1
Northern Almeria Health Area. Huercal-Overa. Spain
2
University of Malaga. Spain

ABSTRACT
Internet addiction has, as of yet, not been completely recognised as a
disorder by the International Classification of Diseases ICD 10 and DSM
5.
Despite the debate on diagnostic criteria and validity, its health
consequences as well as risk and protective factors have been widely
proven.
Regardless of the controversy, people who suffer from this addiction
experience significant limitations in their psychosocial functioning. This
is why they seek treatment and help.
The main characteristics of this disorder include: worrying about the
Internet and digital media; loss of control of time spent connected to
digital technology; an increasing need for more time or new applications;
mood repercussions; withdrawal symptoms when not connected;
behaviour that continues despite negative consequences; deterioration of
social relationships; and negative impact on academic and work life.


Corresponding author email: [email protected].
12 A. Fontalba-Navas, V. Gil-Aguilar and J. M. Pena-Andreu

Prevalence rates are high, but differ between countries. It is

estimated that prevalence rates in Europe and the USA are between 1.5
and 8.2%, respectively. In Asia, prevalence is even higher with 20%.
The prevalence rate of young people who meet Internet addiction
criteria in specific populations, such as adolescent students in Hong
Kong, has reached 26.7%.
Adolescents are a particularly vulnerable group. Life stressors such
as social relationship problems or difficulties adapting to study life
correlate positively with the disorder.
There are many explanations as to the link between the disorder and
adolescence including use of the Internet to relieve stress and tension.
Risk factors include environmental factors such as parental control
and family attitudes, internal and personality factors such as lack of
achievement of personal goals, alienation and personal dissatisfaction.
Longitudinal studies have shown that the main psychopathological
risk factors are attention deficit hyperactivity disorder, withdrawal,
thought disorder, anxiety, depression and thought disorder in childhood.
The main long term effect on mental health is an increase in the
incidence rate of depressive disorders.
The high prevalence rates, risk factors and health effects of Internet
addiction in adolescents require different approaches and a primary focus
on the specific needs of this age group, where early detection and
promotion of healthy habits are of utmost importance.

Keywords: Internet addiction, prevalence, risk factors

INTRODUCTION
In today’s society, Internet use has become a necessary tool for daily tasks
related to work or leisure; it is a means of communication though which
information is shared.
Incorrect use of this source of gratification is called Internet addiction. It is
an extreme way of using this tool; the person is incapable of stopping the
behaviour despite the negative consequences on his or her daily life.
This phenomenon is relatively recent and has not yet been included in
international diagnostic classifications.
A new element introduced by the DSM 5 (Diagnostic and Statistical
Manual of Mental Disorders) is the inclusion of non-substance addictions in
relation to psychiatric diagnoses [1].
There was some dispute over whether to include Internet addiction under
behavioural addiction. In the end the team decided to only include Internet
 Towards an Epidemiological Model of Internet Addiction 13

gaming disorder based on previous studies that described its characteristics,

which also include other non-work-related Internet use such as communication
via social networks. This particular disorder’s prevalence rates and severity
data resulted in it being considered a significant behavioural addiction [2].
The difficulties involved in describing diagnostic criteria for this disorder
include deciding how to approach it due to the similarity between internet
addiction and, for example, substance use addictions. It can also be considered
a type of compulsive gambling or impulse control disorder.
One of the main reasons for its inclusion in the manual are the
neurobiological similarities between the disorder and substance use disorders
due to the involvement of brain reward circuits and similar symptoms.
The DSM 5 describes Internet gaming disorder as a “condition for further
study” and can be found in section III.
According to the DSM 5 the diagnostic criteria for Internet gaming
disorder includes repetitive use of Internet-based games, often with other
players, that leads to significant issues with state of functioning. Five of the
following criteria must be met within one year:

1) Preoccupation or obsession with Internet games.

2) Withdrawal symptoms when not playing Internet games.
3) A build-up of tolerance–more time needs to be spent playing the
games.
4) The person has tried to stop or curb playing Internet games, but has
failed to do so.
5) The person has had a loss of interest in other life activities, such as
hobbies.
6) A person has had continued overuse of Internet games even with the
knowledge of how much they impact a person’s life.
7) The person lied to others about his or her Internet game usage.
8) The person uses Internet games to relieve anxiety or guilt–it’s a way
to escape.
9) The person has lost or put at risk an opportunity or relationship
because of Internet games.

The inclusion of the disorder in the DSM 5 is a great advance as it will

trigger more research on this category and encourage alternative therapeutic
measures in a clinical setting [3].
14 A. Fontalba-Navas, V. Gil-Aguilar and J. M. Pena-Andreu

Despite the controversy, it is an emergent disorder with health

consequences which affect the state of functioning of people who experience
it. This is linked to suffering and results in the patient seeking help and
treatment.

EPIDEMIOLOGY
High prevalence rates of Internet addiction have become a global
phenomenon; however, these rates differ from country to country. These
differences could be explained by the use of heterogeneous definitions of the
disorder or different diagnostic criteria.
In an extensive meta-analysis by authors Cheng and Li [4], prevalence
rates of 164 samples from 31 countries were compared and their conclusion
was a global prevalence of 6%; at the same time, they associated differences in
prevalence with indicators of Internet access as well as subjective,
environmental and quality of life indicators.
Most prevalence studies focus on young people, fewer extensive
epidemiological studies have been carried out on the general population; like
the ones in the USA (which showed a prevalence of 1%) [5], or in Norway
(0.7%) [6].
One of the countries most concerned about the disorder is China. In Hong
Kong, prevalence rates of Internet addiction in adolescents ranged from 17%
to 26.8% during high school years [7].
Through the study on Child Safety and Morals of Children on the
Internet”, we can conclude that all children use the Internet regularly and
consistently. The connection time is moderate. Thus, 65% of children are
connected less than 5 hours a week. 66% of children use the Internet as a
leisure tool, ignoring its wide range of information 11% of children who are
connected, develop characteristics of Internet addiction disorder, 50.5% of
those only find the information they want sometimes or rarely, which
highlights their lack of skills to function successfully in the network [8].
The study on “Child Safety and Habits of Children in the Use of Mobile
Telephony” [9], it was noted that: 24% of children make calls and 50% send
text messages (SMS) daily. The same study demonstrated that 30% of children
who use mobile phones have already purchased games for it, 72% of children
report having received SMS messages inviting them to participate in
sweepstakes or gambling, 28% felt overwhelmed and 10% say they have been
 Towards an Epidemiological Model of Internet Addiction 15

terrible and forced to do without their mobile, and 11% claim to have lied to
their parents and even stolen money at some stage to recharge the balance.
In the study on “Video Games, Children and Parental Responsibility”[10],
it was noted that during school days, 9% of children engaged in play between
1 and 2 hours. At the weekend, 23% play more than 2 hours, 57% use pirated
games, 27% discussed with their parents the amount of time spent playing,
14% of respondents say they are “hooked” on a video game, 11% recognize
that video games can make them more violent and 57% of children recognize
that they play games in which they destroy things and torture and kill people.
The high prevalence of this disorder and its possible long-term
consequences requires the development of preventive activities in this
susceptible population.

PREDICTORS OF INTERNET ADDICTION

Studies on predictors and risk factors have also mainly been carried out on
the adolescent population, which is also where the highest prevalence rates
have been found.
Adolescents are a particularly vulnerable group. Life stressors such as
social relationship problems or difficulties adapting to study life can correlate
positively with the disorder.
There are many explanations as to the link between the disorder and
adolescence including use of the Internet to relieve stress and tension.
Risk factors for the development of Internet addiction include [11]:

 Diagnosis of attention deficit hyperactivity disorder

 Hostility
 Withdrawal
 Anxiety/depression
 Parent/child conflicts
 Not living with the mother
 Use of Internet to play games

On the other hand, identified protective factors include:

 Good communication between parent and child

 Positive youth development
16 A. Fontalba-Navas, V. Gil-Aguilar and J. M. Pena-Andreu

The use of diagnostic models also allows predictive sociodemographic

factors to be identified with sensitivity and specificity in relation to incorrect
Internet use [12].
There is an open debate on whether emotional problems can be the cause
or consequence of Internet addiction. Strittmatter and cols. [13] demonstrated
that only previous problematic Internet use symptoms and emotional problems
were significant predictors of problematic Internet use 2 years later. The
categorical stability of problematic Internet use in adolescents over those 2
years was lower than previously reported. However, current problematic
Internet use symptoms were the best predictor of later problematic Internet
use; emotional symptoms also predicted problematic Internet use over and
above the influence of previous problematic Internet use. Both problematic
Internet use symptoms and emotional problems may contribute to the vicious
cycle that supports the perpetuation of problematic Internet use.
In regard to social factors, living in metropolitan areas was associated with
problematic Internet use in European adolescents [14]. Students not living
with a biological parent, low parental involvement and parental unemployment
showed the highest relative risks of both maladaptative Internet use and
problematic Internet use.
Another cross-sectional study implemented within the framework of the
European Union project: “Saving and Empowering Young Lives in Europe”
showed correlation between problematic Internet use, conduct problems and
hyperactivity/inattention stronger among females, while the link between
problematic Internet use and symptoms of depression, anxiety and peer
relationship problems was stronger among males [15]. The association
between problematic Internet use, psychopathology and self-destructive
behaviours was stronger in countries with a higher prevalence of problematic
Internet use and suicide rates. These findings ascertain that psychopathology
and suicidal behaviours are strongly related to problematic Internet use. This
association is significantly influenced by gender and country suggesting socio-
cultural influences.

CONSEQUENCES ON HEALTH
Internet addiction is characterised by an elevated amount of time spent
carrying out activities on the Internet, playing computer or video games in a
non-work related setting. Mood swings are also present as well as worrying
about the activity, loss of sense of time spent carrying out the activities, sense
 Towards an Epidemiological Model of Internet Addiction 17

of needing more time or new applications, withdrawal symptoms and

persistence of the behaviour despite its negative consequences. [16].
There is evidence indicating that Internet addiction subjects had multiple
structural changes in the brain. The gray matter atrophy and white matter
fractional anisotropy changes of some brain regions were significantly
correlated with the duration of internet addiction in a study developed by Yuan
and cols. [17].
A voxel-based morphometric study comparison between Internet
addiction subjects and matched healthy controls indicated decreased gray
matter volume in several clusters, i.e., the bilateral right dorsolateral prefrontal
cortex, the supplementary motor area, the orbitofrontal cortex, the cerebellum
and the left rostral anterior cingulated cortex, after controlling for potential
confounding variables including age, gender effects and total intracranial
volume.
In addition, gray matter volumes of the right dorsolateral prefrontal cortex,
the left anterior cingulated cortex and the right supplementary motor area
showed a negative correlation with months of internet addiction.
These changes in brain structure are very important because they appear
during adolescence, which is a developmental stage. This neural substrate can
explain part of the high comorbidity with mental disorders too.
Among adolescents, Internet addiction has been repeatedly found to be
related to attention-deficit/hyperactivity disorder, depression, anxiety, stress,
negative self-perception and suicidal ideation [18].
The results of the study of Yen and cols. revealed that adolescents with
Internet addiction had higher self-reported ADHD symptoms, which correlate
with Internet addiction mostly in the regression model for both male and
female students [19].
Medication-naive adolescents with ADHD showed significantly reduced
brain activation in the right inferior prefrontal cortex during successful motor
response inhibition and in the precuneus and posterior cingulate gyrus during
inhibition failure, both of which correlated with behavioral scores of ADHD.
This abnormal brain activity is associated with impairment of inhibitions in
performance, and this could explain the difficulty in controlling internet use.
[20].
The relationship between depression and Internet addiction is well
established. Depression levels are associated with those who become addicted
to the Internet and clinical depression is significantly associated with increased
levels of personal Internet use. Low self-esteem, poor motivation, fear of
18 A. Fontalba-Navas, V. Gil-Aguilar and J. M. Pena-Andreu

rejection, and the need for approval associated with depression contribute to
increased Internet use [21].
Similar neurochemical changes in serotoninergic transmission can occur
in Internet addiction and depression [22].
In the clinical presentation, patients suffering from IA are preoccupied
with internet usage, so they are more likely to be noncompliant with
psychotropic medication and psychotherapy and the treatment of symptoms
can be difficult.
Depression and anxiety can be part of the internet withdrawal syndrome.
In regard to anxiety disorders, excessive internet usage may serve as a
maintaining factor by reinforcing the avoidance of anticipatory anxiety
stemming from stressful situations and life events [23].
In a systematic review Lam identified seven studies that contained
potentially useful information to address the question of whether addictive
Internet gaming and problematic Internet use are related to sleep problems,
including insomnia and poor sleep quality, but with the need of new well-
designed studies with a clear focus on the relationship under investigation,
strong research methodology, and the use of valid approaches for the
assessment of the exposure and outcome variables, in order to search for
stronger evidence [24].
This comorbidity or direct consequences of excessive and pathological use
could be ill-health effects on the adolescents such as impaired psychological
well-being, less peer and family interaction, poor academic performance, and
difficulties achieving psychosocial developmental tasks [25].

DISCUSSION
The high prevalence of this disorder and its possible long-term
consequences requires the development of preventive activities in this
susceptible population.
The best way to approach misuse of internet is to start from earlier levels
of intervention, such as prevention and health promotion. Young people are a
very susceptible group to work with in the early stages of these kinds of
disorders regarding detection and prevention [26].
Our main aim is not to convince the teenager of our point of view. In fact,
they should dissent when they disagree and they may give an opinion based on
their own perspective. It is important that adolescents have the possibility to
maintain their judgments respecting tolerance and to incorporate new
 Towards an Epidemiological Model of Internet Addiction 19

knowledge about healthy behaviors. In this sense, a type of intervention is

needed that encourages active learning, with a high level of interaction
between participants. Health professionals must try to develop psychological
defense strategies in adolescents against this harmful behavior with emphasis
on early detection [27].
Most adolescents might not think that this is a behaviour problem. In this
sense, it is very important to consider that adolescents need a different
approach, and a different focus. For this reason, professionals should consider
talking about positive habits to this population as this will have better results.
In this sense, this study will try to overcome the negative image of mental
health services and illnesses and will build a new perspective based on the
promotion of healthy habits and activities.
The promotion of mental health has important health benefits on
individuals and in society in general; promoting the welfare and quality of life
of the population. The development of activities to promote mental health
involves the creation of individual, social and environmental conditions that
enable optimal psychological and physiological development [28].
Health promotion activity must aim to explain warning signs of internet
addiction to adolescents, because the negation of this problematic behavior is
very usual. On the other hand, early detection enables an intervention in the
early stages of this disorder. A positive perspective of internet use is very
important, because if we only use a negative view of this behavior in
adolescents it is possible that we inadvertently induce it.
The strategy of promoting mental health in Internet addiction is a priority.
This strategy must work by establishing objectives and intersectoral tagging
activities, aimed at encouraging greater well-being and quality of life of this
vulnerable population.

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In: Internet Addiction ISBN: 978-1-53610-436-3
Editor: Margaret Adams © 2017 Nova Science Publishers, Inc.

Chapter 3

INTERNET ADDICTION
AND FLOW EXPERIENCE

Kazuki Hirao*, PhD, OTR

Department of Occupational Therapy,
School of Health Science and Social Welfare,
Kibi International University, Takahashi, Okayama, Japan

ABSTRACT
Internet addiction (IA) is a serious problem and a common disorder
leading to mental health concerns especially in adolescents and young
adults around the world. Although different from IA, the concept of flow
refers to the state of being immersed in an activity and is often used in a
positive context. This chapter discusses similarities and differences
between IA and flow.

Keywords: addictive behavior, positive psychology, optimal experience,

rehabilitation

*
Corresponding Author address Email: [email protected].
24 Kazuki Hirao

INTRODUCTION
The Internet is a tool, which is now essential to everyday life. We use the
Internet to gather information, shop, and communicate with others. Therefore,
the Internet is tremendously beneficial to us.
However, sometimes if we are too enthusiastic about the Internet, we are
prone to have troubled daily lives. Such a state is sometimes referred to as
Internet addiction (IA). IA is a serious problem and a common disorder
leading to mental health concerns especially in adolescents and young adults
around the world [1]. In fact, we reported that in university students, the
prevalence of IA was 15% [2].
Previous studies have reported that IA is positively associated with
depression and anxiety [1, 3, 4, 5]. One study reported that IA is positively
associated with low academic achievement, inadequate social support, and
communication skills [6]. Another reported that IA is negatively associated
with self-esteem [7]. Thus, IA has adverse effects on academic achievement,
communication skills, and mental health.
Although different from IA, the concept of flow refers to the state of being
immersed in an activity and flow is often used in a positive context. The
definition of flow is “the holistic sensation that people feel when they act with
total involvement” [8].
We have the following evidence regarding flow: (1) In college students,
frequency of flow experiences showed significant correlation with mental
Quality of Life (QOL) [9]; (2) subjective stress was significantly reduced in a
high-flow group when compared with a low-flow group of college students
suggesting that a brief flow experience could alleviate subjective stress [10];
(3) in community-dwelling elderly people, physical health was significantly
better in groups experiencing flow or relaxing during important daily activities
in comparison with the apathetic group [11]; (4) in college students, ambiguity
tolerance and shyness were associated with frequency and quality of flow
experience [12]; (5) in undergraduate students the following was observed:
negative correlation between frequency of flow experience and self-disgust;
significant correlation between duration of flow activity and guilt; and quality
of flow experience and guilt [13]; (6) people who tended to achieve flow were
associated with a significantly higher mental QOL and coherence than average
in unemployed people [14]; (7) among male undergraduate students, frequency
of flow was significantly reduced after 1 year when compared with the
baseline values [15]; (8) in undergraduate students, energy consumption in
prefrontal activation was negatively correlated with feeling of satisfaction
 Internet Addiction and Flow Experience 25

during a flow experience [16]; (9) inferiority feelings were significantly lower
in undergraduate students who tended to achieve flow than in those who did
not [17]; (10) in undergraduate students, schizotypal personality and distress
associated with paranoid ideation were associated with the degree of flow
experience [18]. Thus, for the most part, flow has a healthy influence on
people.
This chapter describes the relationship between IA and flow experience
[2]. Participants in this study were 160 Japanese undergraduate students (mean
age, 20.07 ± 1.27 years; 96 males and 64 females) [2].

INTERNET ADDICTION AND FREQUENCY

OF FLOW EXPERIENCE [2]

Of participants, 160 were classified into the Internet addiction group

(IAG; n = 24) or into the non-Internet addiction group (NIAG; n = 136) by the
Japanese version of the Internet Addiction Test [19]. Flow in daily life was
also assessed for frequency and quality using the Flow Experience Checklist
[20]. Results showed that the frequency of flow experience was significantly
higher for IAG. This result might reflect the “absorption” common to IA and
flow. In this study, absorption represents the frequency of flow experience in
one activity. Therefore, the one activity is likely to be using the Internet. A
previous study suggested that experiencing flow in more than one activity has
a positive impact on QOL [14]. Therefore, on the Internet as well, being
immersed in a plurality of activities is important. In future research, studying
the relationship between IA and an evaluation of activities for experiencing
multiple flows will be necessary.

INTERNET ADDICTION AND QUALITY

OF FLOW EXPERIENCE [2]

In contrast, quality of flow experience did not differ significantly between

IAG and NIAG. Thus, NIAG showed the possibility of experiencing flow in
activities other than the Internet. In social life, any activity wherein an
individual is so enthusiastic that the enthusiasm hinders a normal daily life can
be defined as being undesirable. However, being immersed in a favorite
activity that does not cause trouble for others is good. Therefore, if an
26 Kazuki Hirao

individual does not bother others, there is no need to intervene forcefully. In

many cases, people with IA have also been a problem in terms of public health
because they cause a nuisance to others as well. Therefore, even though IA
might be problematic, immediate intervention and support are unnecessary.
However, after sufficiently assessing and understanding the individual’s
background, performing intervention and support might become necessary.

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Christakis, D. A., Moreno, M. A., (2009). Trapped in the net: will Internet
addiction become a 21st-century epidemic? Arch Pediatr Adolesc Med.
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Csikszentmihalyi, M., (1975). Beyond Boredom and Anxiety. San Francisco;
CA: Jossey-Bass.
Goel, D., Subramanyam, A., Kamath, R., (2013). A study on the prevalence of
Internet addiction and its association with psychopathology in Indian
adolescents. Indian J Psychiatry 55, 140-143.
Ha, J. H., Kim, S. Y., Bae S. C., Bae S., Kim H., et al., (2007). Depression and
Internet addiction in adolescents. Psychopathology. 40, 424-430.
Hirao, K., (2015). Difference in mental state between Internet-addicted and
non-addicted Japanese undergraduates. Int J Adolesc Med Health. 27(3),
307-310.
Hirao, K., (2014). Changes in flow experience among occupational therapy
students: a 1-year longitudinal study. J Educ Eval Health Prof. 11, 14.
Hirao, K., (2014). Prefrontal hemodynamic responses and the degree of flow
experience among occupational therapy students during their performance
of a cognitive task. J Educ Eval Health Prof. 11, 24.
Hirao, K., (2014). Comparison of Feelings of Inferiority among University
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Hirao, K., (2016). Associations of schizotypal personality and paranoid
ideation with the degree of flow experience in daily life. Arch Neurosci.
3(2), e21382.
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Hirao, K., Kobayashi, R., Okishima, K., Tomokuni, Y., (2011). Influence of
flow experience during daily life on health-related quality of life and
salivary amylase activity in Japanese college students. Jpn J Occup Med
Traumatol. 59(1), 13-18.
Hirao K., Kobayashi R., Okishima, K., Tomokuni, Y., Yabuwaki., K., (2011).
Influence of different intensities of brief flow experiences on subjective
and objective stress. Med Biol. 155(10), 713-720.
Hirao, K., Kobayashi, R., Okishima, K., Tomokuni, Y., (2012). Flow
experience and health-related quality of life in community dwelling
elderly Japanese. Nurs Health Sci. 14(1), 52-57.
Hirao, K., Kobayashi, R., Yabuwaki, K., (2012). Association of cognitive
judgment and shyness with frequency and quality of flow experience.
Psychol Res Behav Manag. 5, 159-162.
Hirao, K., Kobayashi, R., (2013). The relationship between self-disgust, guilt,
and flow experience among Japanese undergraduates. Neuropsychiatr Dis
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Hirao, K, Kobayashi, R., (2013). Health-related quality of life and sense of
coherence among the unemployed with autotelic, average, and non-
autotelic personalities: a cross-sectional survey in Hiroshima, Japan. PLoS
One. 8(9), e73915.
Ishimura I., (2014). Psychological study on enhancing factors and positive
functions of flow experiences, 1th ed. Tokyo: Kazamashobo.
Kilic M., Avci D., Uzuncakmak T., (2016). Internet Addiction in High School
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Naseri, L., Mohamadi, J., Sayehmiri, K., Azizpoor, Y., (2015). Perceived
Social Support, Self-Esteem, and Internet Addiction Among Students of
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In: Internet Addiction ISBN: 978-1-53610-436-3
Editor: Margaret Adams © 2017 Nova Science Publishers, Inc.

Chapter 4

THE ROLE OF ATTACHMENT STYLE AND

SOCIAL ANXIETY IN INTERNET ADDICTION

Carlo Lai*, Gaia Romana Pellicano, Daniela Altavilla,

Navkiran Kalsi and Michela D’Argenzio
Department of Dynamic and Clinical Psychology, Sapienza,
University of Rome, Italy

ABSTRACT
Pathological Internet use is characterized by excessive or poorly
controlled preoccupations or behaviors regarding computer use that
results in impairments or distress. Previous studies reported high
comorbidity of Internet addiction with psychiatric conditions like
affective and anxiety disorders.
Among anxiety disorders, social anxiety is often associated with
relational impairments in adolescent. Many studies suggested that social
anxiety is promoted by an insecure attachment style.
Attachment style plays an important role in socio-emotional
relationships with others and forms the generalized basis of self-worth.
Insecure attachment, in particular, implicates a higher non specific risk
factor for psychopathologies. Previous study reported that attachment
style predicts online social interaction in the same way that it does in the
offline context. Individuals with high attachment anxiety have more

* Corresponding Author, Email: [email protected].

30 Carlo Lai, Gaia Romana Pellicano, Daniela Altavilla et al.

frequent internet use and are constantly concerned about how others
perceive them.
Insecure attachment and social anxiety were reported to be more
strongly associated with Internet Addiction. Thus, the association
between the insecure attachment style and social anxiety seems to have a
very relevant role as risk factors for the problematic use of Internet.

Keywords: attachment theory, social anxiety, internet addiction

INTRODUCTION
The deep relationship between men and technology is rapidly becoming
more complex and more intricate in the daily life and influencing the everyday
routine of everyone. At the same speed of the diffusion of this human-
technology relationship, the attention and the scientific interest are quickly and
extensively directed at the consequences of this relationship.
Particularly, Internet and the virtual reality have a very important role as
factors of social, cultural and psychological changing.
The new technologies magnify our action on “virtual realms”, amplifying,
hence, the concept of reality and increasing the psychic and sensorial human
faculties. Internet and its instruments act, therefore, almost as “psychic
prostheses”, allowing us to enhance the dimensions of the virtual experience in
nearly inexhaustible way. Moreover, the technology and Internet can make the
reality more recreational, giving back to the mind a more acceptable and
harmless world, very similar to the reverie of the game and of the
omnipotence, and then a world able to raise a sensation of strengthened
efficiency of mental faculties. The creation of this sensation can create
temporary dissociative parentheses in which everyone can take cover.
The problematic use of Internet can be considered in relation with
micro/macro dissociative phenomena. It is intended on a continuum from
normal to pathological, in which the common element is to isolate and snatch
the Self from the reality unintelligible by the ordinary state of consciousness.
In a certain sense, Internet and its network creates for us in an artificial
way the “refuge of the mind” (Steiner, 1993) as a defensive dissociation,
separating a part of information or of mental processes from the rest of
consciousness. As reported by Young (1998), the dissociation is a process of
active inhibition that normally excludes internal or external perceptions from
the field of consciousness and it is a defence mechanism that protects the
 The Role of Attachment Style and Social Anxiety … 31

ordinary consciousness from a flood of excessive stimuli. Therefore, the

dissociation is adaptive and it has an aim that is both defensive and
supplementary in relation with the reality.
However, the separate part of consciousness that becomes a mental
identity independent from the global personality detriments the relation with
the reality. This mechanism and the easiness and the rapidity with which the
experience online can be replicated and protracted seems to play a crucial role
in the development of Internet addiction (Caretti and La Barbera, 2005).

INTERNET ADDICTION: A DIFFICULT DEFINITION

The term “addiction”, borrowed from the drug’s dependences, is been
broadly accepted for the abuse behaviour of the web (Holden, 2001). The use
of “addiction” (from Latin “addictus” = slave for debits) underlines as the
subject becomes a slave of the solution that he finds for cope the mental
suffering, is an act that has in it the illusion of doing something to confront and
overcome the difficulties of everyday life.
Coherently with the multifaceted essence of the web, and with the several
worlds that Internet opens, its abuse and addiction behaviour extends in
different contexts and has different features depending on the specific use of
the web. Thus, in the last years there was a intensive debate to reach an
unambiguous definition of the Internet addiction and there have been many
proposals for its categorization.
In the latest edition of the Diagnostic and Statistical Manual of Mental
Disorders- Fifth Edition (DSM-5) the Internet Addiction Disorder (IAD) is
introduced as a clinical condition that requires more observation and more
scientific data.
The Internet Addiction Disorder has different shared psychopathological
aspects with other addiction behaviours, such as the craving, the abstinence
and negative effects on the social relationship. Moreover, some preliminary
studies reported a dysfunction in opioid receptors, as in many other
dependences (Nestler, 2005; Mick and Hollander, 2006). These evidences can
indicate that Internet Addiction can be considered as a discrete addiction
behaviour.
The clear comprehension and definition of the disorder as a clinical
condition can also help to raise awareness among people towards a more
responsible use of the web. At the other hand, the recognition of the IAD,
separated from the other psychopathologies, can increase the stigmatization
32 Carlo Lai, Gaia Romana Pellicano, Daniela Altavilla et al.

toward the Internet use also creating specific pathologies for each
technological devices, such as smartphone addiction, virtual reality addiction,
etc... .
Some of the symptoms reported by the studies on IAD are very similar to
symptoms of the depression and anxiety disorders, moreover many studies
showed a co-morbidity with these disorders (Can et al., 2012; Carli, et al.,
2012; Tonioni et al., 2012; Caplan, et al., 2007; Shapira et al., 2000). In
addition, the Internet addiction shares several elements also with the Impulse
Control Disorder (ICD) and some researchers proposed to consider the IAD as
another aspect of the ICD category (Beard e Wolf, 2001; Shapira et al., 2000;
Treuer et al., 2001).
These issues underline the unclear pathogenesis of the IAD and its
inclusion in a defined diagnostic category. Despite the increasing number of
researches in this field, we need still more evidences on the reliability of the
criteria, on the stability of the disease during the lifetime and more importantly
the risk factors that leads to the onset of the Internet Addiction.
The development of psychopathology is always a combination of cultural,
psychological and biological dimensions. It is particularly true for an addiction
behaviour like IAD that include new technologies which are broadly changing
our everyday life.
The Internet addicted people spend more time on the interactive activities
offered by the web, they showed a high social inhibition, a low level of self-
esteem, a tendency toward the sensation seeking, high levels of hostility and a
dysfunctional family functioning compared to people non-addicted (Moody, et
al. 2001; Kim et al., 2009; Ghassemzadeh, et al., 2008; Whang et al., 2003;
Young, 1998).
These studies have led researchers to hypothesize the role of social anxiety
and the family relationship as the possible risk factors of IAD.
Among anxiety disorders, the social anxiety is usually more pronounced
in adolescents and young adults. Many studies suggest that the social anxiety
is positively associated with the insecure attachment style.
In addition, insecure attachment with social anxiety were reported to be
more strongly associated with Internet Addiction. These associations between
these variables attachment style, social anxiety and Internet Addiction need to
be further explored that might open new perspectives to better explain IAD.
 The Role of Attachment Style and Social Anxiety … 33

SOCIAL ANXIETY
The social contacts and the interpersonal relationships has been identified
as having a primary role in the development of problematic use of Internet
(Paris, et al., 2002; Kraut et al., 1998). Internet can be used to satisfy social
needs that are not satisfied in face to face interactions. Some people have
difficulty to express themselves in the daily social environments, which trigger
anxiety and fear of the others' judgment. The intense fear of embarrassment,
humiliation, and negative evaluation by others in social situations, and a
tendency to avoid feared situations is better known as social anxiety disorder.
People with social anxiety have the desire to make a positive impression of
one’s self on others and tend to minimize their chances of making undesired
impression (Schlenker and Leary, 1985).
Central tasks during childhood and adolescence are to become
autonomous from the family, acceptance among peers, develop romantic and
sexual interests, in order to create a sense of integration of the Self, which is
fundamental in social relations (Ladd, 1999; Buhrmester, 1990; Kelly and
Hansen, 1987).
A dysfunctional management of these tasks can lay the groundwork for a
weak self-integrity that exposes the individual to the fear of others’ judgment,
perceived as threat for self-identity.
The maladaptive familial environment, parental criticism and over-control
(Whaley, et al., 1999; Bruch and Heimberg, 1994), peer rejection, violence
(LaGreca and Lopez, 1998; Slee, 1994; Vernberg, et al., 1992) and perceived
traumatic social-evaluative situations (Hofmann, et al., 1995; Barlow, 1988)
during the growing period can negatively affect the building of strong self.
Each of these experiences has the potential to set in motion negative
feedback loops involving anxiety, avoidance behaviors, and potential deficits
in social competence. The pathways from a reliance on parental guidance to
the building of a structured sense of self, the reaching of self-regulation and
the creation of stable relationships with peers can be broadly modeled by
parent’s behavior. If the parents put excessive importance and reliance on the
other’s approval or if there is a lack of communication and emotional
regulation by parents, it is probable that child experiences low sociability and
shyness (Melfsen, et al., 2000). An anxiety behavior of parents, such as
avoiding social situations, can transmit the same social fear to the young
individual, contributing to creation and maintenance of social anxiety (Bruch,
1989). Previous studies reported that adults with social anxiety tend to
perceive their parents as more restrictive to engage them in social activities
34 Carlo Lai, Gaia Romana Pellicano, Daniela Altavilla et al.

with relatives and friends, encouraging social isolation and avoidance (Bruch
and Heimberg, 1994; Bruch, et al., 1989).
During the development, thus, it is fundamental that parents enhance the
shifting from a reliance to an emotional self-regulation of child that is
necessary for the creation of intimate relationship with peer.
In presence of an effective menace, social anxiety may be an
evolutionistic adaptive warning system that is in charge to ensure the strength
of social bonds, alarming the individual when it’s or other’s behavior increase
the likelihood of social threat (Miller and Leary, 1992). This “social warning
system” should alert the individual to stop erroneous social behaviors that put
him in possible rejection or isolation position, increasing instead the prosocial
behaviors that increase the social networking. However, the occurring of the
psychological and environmental variables mentioned above can lead the
“social warning system” to become dysfunctional and produce a pathological
social fear. But because the social warning system can lose own adaptive
functionality, the social anxiety needs to be maintained in a vicious circle that
strengthen the dysfunctional aspects. Cognitive biases, deficit in social skills
and operant conditioning are considered the three principal factors involved in
the maintenance of social anxiety. From a cognitive perspective, the
fundamental nucleus of social anxiety is a strong desire to make a positive
presentation to others associated with a perceived inability to do so (Musa and
L´epine, 2000; Clark and Wells, 1995). These individuals have the conviction
that their behaviors will elicit rejection and negative judgments from others
and they use these convictions as parameters to evaluate whole social
situation, resulting in negative self-statements in social performances
(Hartman, 1986) and leading to behavioral manifestations of anxiety. From the
other hand, the physiological reactions are interpreted as signals of negative
social performance and this interpretation, strengthening the negative
convictions, will affect further social interaction increasing anxiety and
reinforce poor self-efficacy in social conditions. This self-focused attention
and the subsequent negative thoughts about own public reactions interfere with
satisfactory social functioning and sustain a self-perception as not socially
skilled. In this way it become easy the creation of the vicious circle. The
negative experience of self in social situation reinforces behavior of avoidance
of social contacts. Avoiding the social situations that create fear and anxiety,
the individual receives negative reinforcement when experiences a sense of
relief upon the termination of anticipatory anxiety. Unfortunately, these
avoidance coping patterns can have deleterious effects on development that
normally lead the individual to reach new and mature social abilities, and can
 The Role of Attachment Style and Social Anxiety … 35

produce negative effects which are difficult to modify with age (Ollendick et
al., 2000). For example, the fear of trying out social rejection and failure can
greatly prevent the opportunities to improve social interaction skills, that are
necessary for developing friendship or romantic relationship, joining peer
groups and becoming autonomous from parental guidance.
In this perspective, Internet offers an incredible possibility to create a
“protected place” in which the social interactions can be controlled. As
reported by Caplan (2003; 2002), the preference for online social interaction
can be considered as a cognitive individual difference characterized by beliefs
that one is safer, more efficacious, more confident, and more comfortable with
online interpersonal interaction and relationship, reducing the social anxiety
present in face to face interactions.

ATTACHMENT THEORY
Attachment is a deep and enduring emotional bond that connects one
person to another. Attachment theory is a psychological model emphasizing
the importance of “attachment” in regards to personal development and
describes the dynamics of long-term and short-term interpersonal relationships
between humans. Attachment theory was conceptualized by John Bowlby
(Bowlby, 1969) based on the concepts from ethology, information processing,
developmental psychology, and psychoanalysis. The basic principle of
attachment theory is that an infant needs to develop a relationship with at least
one primary caregiver for the child's successful social and emotional
development, and in particular for learning how to effectively regulate their
feelings (Levy and Orlans, 1998).
Attachment theory conceptualizes “the propensity of human beings to
make strong affectional bonds to particular others” and Bowlby hypothesizes
that an attachment system evolved to maintain proximity between infants and
their caregivers under conditions of danger or threat (Bowlby, 1977). Children,
gradually, internalize experiences with caregivers in such a way that early
attachment relations come to form a prototype for later relationships outside
the family. It identifies two key features of these internal representations or
working models of attachment: (a) whether or not the attachment figure is
judged to be responsive to calls for support and protection; (b) whether or not
the self is judged to be as a person towards whom anyone and the attachment
figure, in particular, is likely to be responsive in a helpful way (Bowlby, 1977,
36 Carlo Lai, Gaia Romana Pellicano, Daniela Altavilla et al.

p. 204). The first indicates the child's image of others; the second indicates the
child's image of the self.
More recent formulations view the attachment system as functioning
model that continuously provide children a sense of security which facilitates
exploration of the outer world by the child (Ainsworth et al., 1978; Sroufe and
Waters, 1977). The quality of early attachment relationships is thus rooted in
the degree to which the infant has come to rely on the attachment figure as a
source of security (Ainsworth and Bowlby, 1991).

ATTACHMENT STYLES
On the basis of infants' responses to separation and the eventual reunion
with caregivers in Strange Situation (a structured laboratory procedure to
observe m) four distinct patterns of infant attachment are identified: secure,
anxious-resistant, avoidant, and Disorganized/disoriented (Main, 1995).

Secure Attachment

A toddler classified as securely attached explores freely in the presence of

the caregiver, typically engages with strangers. The child is often visibly upset
on separation with the caregiver and readily welcomes the caregiver's return.
Parents who consistently respond to their child's needs contributes to create
securely attached children. Such children are certain that they their parents will
be responsive to their needs and they will receive nourishment both physically
and emotionally. Securely attached children if distressed, seek proximity to the
attachment figure and are readily comforted which provides a sense of security
in them (Ainsworth, 1968).

Anxious-Resistant/Ambivalent Insecure Attachment

A child with an anxious-resistant attachment style will typically explore

little and is often wary of strangers, even in the presence of the caregiver.
When the caregiver departs, the child seems to be highly distressed. The child
is generally ambivalent and often displays anger towards the caregiver on
return (Ainsworth, Blehar, Waters and Wall, 2015). The Anxious-
Ambivalent/Resistant strategy is a response to unpredictably responsive
 The Role of Attachment Style and Social Anxiety … 37

caregiving, and the displays of anger towards the caregiver on reunion can be
regarded as a conditional strategy for maintaining the availability of the
caregiver by taking control of the interaction (Crittenden, 1999; Solomon,
George and De Jong, 1995). It was found that children with abusive childhood
experiences were more likely to develop this attachment. The study also found
that children with such attachments are more likely to experience difficulties
in maintaining intimate relationships as adults (McCarthy and Taylor, 1999;
Simpson et al., 1992).

Avoidant Insecure Attachment

A child with the avoidant insecure attachment style will avoid or ignore
the caregiver, showing little emotion when the caregiver departs or returns.
The child will not explore its surrounding very much regardless of presence of
the caregiver. Infants classified as avoidant did not exhibit distress on
separation, and often ignored the caregiver on their return and do not seek
contact with the attachment figure when distressed. These avoidant behaviours
allows the infant to maintain a conditional proximity with the caregiver: close
enough to maintain protection, but distant enough to avoid rebuff. Such
children are likely to have a caregiver who is consistently insensitive and
unresponsive to their needs (Ainsworth, 1969).

Disorganized/Disoriented Attachment

If the behaviour of the infant does not appear to the observer to be

coordinated in a smooth way across episodes to achieve either proximity or
some relative proximity with the caregiver, then it is considered 'disorganised'
as it indicates a disruption or flooding of the attachment system (e.g., by fear).
Infant behaviours in the Strange Situation are considered as
disorganised/disoriented when display overt fear; contradictory behaviours
occurring simultaneously or sequentially; have stereotypic, asymmetric and
jerky movements; or freezing and apparent dissociation (Ainsworth, et al.
1978).
It was reported that most of the mothers of these children had suffered
major losses or other trauma shortly before or after the birth of the infant and
had reacted by becoming severely depressed. In fact, 56% of mothers who had
lost a parent by death before they completed high school subsequently had
38 Carlo Lai, Gaia Romana Pellicano, Daniela Altavilla et al.

children with disorganized attachments (Main and Hesse, 1990). Further

studies, while emphasising the potential importance of unresolved loss, have
stated that an unresolved trauma in mother’s infancy tend to be associated with
disorganised attachment with their children (Solomon, J. and George, C. 2006;
Madigan et al., 2006)

ATTACHMENT IN ADULTS
According to Bowlby's theory (Bowlby, 1977), the attachment
representations of themselves and others in relationships subsequently shape
expectations about future relationships (Bowlby 1980). Thus, a person might
develop beliefs about whether others would be consistently available or not,
and whether they would be responsive and caring, or cold and rejecting; in
parallel they would develop beliefs about whether she or he was worthy of
receiving love and care, and about the value of close relationships.
When testing this theory in studies of adults, most researchers have
focused on the systematic pattern of relational expectations, emotions, and
behaviours that result from one’s attachment style in childhood. Attachment
styles reflect both the person’s sense of attachment security and the ways in
which he or she deals with threats and distress. People with avoidant
attachment tend to rely on deactivating strategies like trying not to seek
proximity, denying attachment needs, and avoiding closeness and dependence
on others in relationships (Mikulincer and Shaver, 2007). These strategies
develop in relationships with attachment figures disapproving closeness and
expressions of need or vulnerability (Crowell and Treboux, 1995). In contrast,
adults with high attachment anxiety tend to rely on hyperactivating strategies –
energetic attempts to achieve proximity, support, and love combined with lack
of confidence and show resentment and anger when fail to do so (Rutter,
1995). These strategies develop in individuals who had inconsistent
attachment figures and worry about being unloved or abandoned and thus seek
reassurance. On the other hand, the adults secure attachment considers
themselves as worthy of love and care and have a positive representation of
the others. This arises when children have received consistently warm and
responsive caregiving in their infancy (Ainsworth et al., 1978).
The attachment representations, thus, can be conceptualised as schema
for future relationships, formed in response to experience with childhood
caregivers, which drive attachment behaviours, such as reassurance
seeking or avoidance of relationships (Waters, Merrick, Treboux, Crowell
 The Role of Attachment Style and Social Anxiety … 39

and Albersheim, 2000). The interactions with inconsistent, unreliable, or

insensitive attachment figures may interfere with the development of a secure,
stable mental foundation. This may reduce resilience in coping with stressful
life events; and predispose a person to break down psychologically in times of
crisis (Ainsworth, 1968; Bowlby, 1988). Attachment insecurity can therefore
be viewed as a general vulnerability to mental disorders.

ATTACHMENT STYLES AND SOCIAL ANXIETY

As previously explained, social anxiety is a disorder characterized by an
intense fear of embarrassment in social situation and a fear of been judged
negatively, that lead to a compromised social functioning. Moreover, social
anxiety has a negative effect on the ability to have a social or romantic
relationship, on the participation in discussion at the workplace and on joining
recreational group (Schneier et al., 1994; Erozkan, 2009). Social anxiety is in
co-morbidity with other conditions, such as loneliness and depression (Eng et
al., 2001, Erozkan, 2009) as well as it commonly reported to be positively
associated with insecure attachment (Hazan and Shaver, 1990; Mikulincer et
al., 1993; Shaver and Brennan, 1992; Erozkan, 2009; Cash et al., 2004; Eng et
al. 2001; Kashdan et al., 2008; Erozkan, 2009).
Attachment style seems to influence interpersonal relationship, while
social anxiety seems to be an indicator of adaptation difficulties in such
relationships (Erozkan, 2009).
Many factors play an interactive role in the development of social anxiety,
such as genetic factors, behavioural inhibition, parent-child interaction, social
skills deficits, social cognition processing, parental psychopathology and peer
relationship. Regarding parent-child interaction, much investigation
demonstrated association between insecure attachment style and later
development of mental health problems, like anxiety disorders (Warren et al.,
1997; Joan and Neville, 2004).
Thus, the type of parent-child relationship have a considerable effect on
social development and childhood anxiety disorders, such as social anxiety
(Joan and Neville, 2004).
Previous research reported the deep relationship between attachment
styles and social anxiety, proposing two hypothesis: the first one regards the
possibility that children with ambivalent or avoidant attachments are at risk for
development of anxiety symptoms; the second hypothesis is that only
40 Carlo Lai, Gaia Romana Pellicano, Daniela Altavilla et al.

ambivalent attachment is strongly related to the anxiety symptoms (Brumariu

and Kerns, 2008).
Regarding the first hypothesis, it was found that social anxiety was
positively correlated with fearful, preoccupied and dismissing attachment
styles and negatively correlated with secure attachment (Erozokan, 2009);
moreover, attachment security was associated with good social functioning
and no differences between avoidantly and ambivalently attached children
were found. It means that secure attachment may represent a factor of
protection against social anxiety and a manifestation of constructive coping
strategies: securely attached children have positive social expectation and are
more able to establish group belongingness, compared to insecurely attached
(avoidant as well as ambivalent) children; in contrast, people with insecure
attachment style, having negative working models of themselves, tend to feel
social avoidance and social inadequacy and to experience hypervigilance and
worry about social rejection in their own relationship, reducing their
communication skills (Bohlin et al., 2000).
According to this perspective, studies reported that college students with a
secure attachment perceived more social support from their peers (Kobak and
Sceery, 1998; Parade et al., 2010) and experienced more positive friendship
qualities and lower friendship conflict (Lieberman et al., 1999; Parade et al.,
2010). Moreover, adolescents with a secure attachment style reported less
social anxiety (Papini et al., 1991; Parade et al., 2010).
The social anxiety seems to play a mediating effect, influencing the
development and the quality of interpersonal relationships.
The second hypothesis regards the possibility that social anxiety is related
specifically to ambivalent attachment. It was demonstrated that there were
higher levels of reported school and social phobias among adolescents who
were ambivalently attached in infancy (Bar-Haim et al., 2007), and that
ambivalent attachment was correlated with distress specific to new situation,
that is one of three dimensions of social anxiety; instead, secure attachment
was not correlated with generalized social avoidance and distress (Brumariu
and Kerns, 2008). It means that ambivalent attachment seems to be a greater
risk for some aspect of social anxiety symptoms than either secure or avoidant
attachment. Children with avoidant attachment reported less social anxiety in
new situation, indicating that avoidance may serve an adaptive function in
some contexts such as unfamiliar low intimacy social situation, while it may
interfere with forming close friendship or romantic relationship. Thus, in this
specific situation, avoidance may contribute to the development of social
anxiety.
 The Role of Attachment Style and Social Anxiety … 41

The most studies about the relationship between attachment style and
social anxiety concern a non-clinic population.
Each of these studies supported a strong relationship between attachment
style and the development of social anxiety. In particular, secure attachment
style seems to be a protection's factor for the risk of social anxiety, while
insecure attachment style, with high levels of anxiety or avoidance, is
associated to deficits in interpersonal relationships; it represents a great risk
for anxious symptomathology.

SOCIAL ANXIETY, ATTACHMENT STYLE

AND INTERNET ADDICTION

As reported above, Internet addiction has been conceptualized as similar

to impulse control or addictive disorders, there is still a debate of whether
Internet addiction should be considered as a primary disorder (Lai et al.,
2015).
Problematic Internet Use (PIU) and Internet addiction negatively impact
the individual’s social and emotional functioning (Young, 2009) disrupting the
daily lives of users and relationships with family members (Young and
Rogers, 1998; Lin and Tsai, 2002; Young, 2004) as well as a dysfunctional
family functioning can make individuals vulnerable to Internet addiction (Yen
et al., 2007; Park et al., 2008).
In literature has been amply demonstrated the association between Internet
addiction and social anxiety (Lai et al., 2015; Taranto et al., 2015;
Lehenbauer-Baum et al., 2015; Casale et a., 2015; Lee and Leeson, 2015;
Weinstein et al., 2015; Yen et al., 2012; Lee and Stapinski, 2012; Tonioni at
al., 2012; Caplan, 2007; Lo, 2005).
Social anxiety has also been well-documented in leading significant
distress and impairments in social, daily routine, academic, and family
functioning (Kashdan and Herbert, 2001; Beidel et al., 1999), and often
followed by substantial emotional distress, namely dysphoria and depression
(Roza et al., 2003).
According to the findings previously explained, the attachment appears to
be a predictor of social anxiety.
Poor family functioning has been found to be associated with youths'
addictive Internet use, and parental use of active and restrictive mediation has
been found to reduce online risk. This association resulted stronger for higher
42 Carlo Lai, Gaia Romana Pellicano, Daniela Altavilla et al.

levels of attachment, communication, and comfort in family, implying that the

effectiveness of restrictive mediation varies with the degree of warmth and
support in the general family environment (Chng et al., 2015).
The Attachment Theory is an inborn motivational system that plays a
significant role for the entire life cycle, in adolescence and adulthood. The
attachment system leads individuals to seek a safe retreat and a secure base
from close and intimate relationships (Bifulco and Thomas, 2012; Schimmenti
et al., 2014). The representations built during the first experiences of
interactions with primary caregivers could be predict the pathological Internet
use.
There are still few studies that have investigated in this direction, but the
results seem to confirm the hypothesis.
Dysfunctional parental attachment has a greater influence than peer
attachment upon the likelihood of adolescents becoming addicted to Internet–
related activities and concluded that the need to relieve dysphoria resulting
from poor adolescent–parent relationships may be a major reason for Internet
addiction (Soh et al., 2014).
Some evidences suggest that insecure attachment plays a relevant role in
PIU (Shin et al., 2011; Lin, 2011), and that attachment disorganisation is a key
factor for understanding the most problematic cases of Internet addiction
(Schimmenti et al., 2012).
Schimmenti and colleagues (2014) showed that the PIU was predicted by
male gender, having suffered from physical and sexual abuse in childhood,
and preoccupation with relationships. Findings of this study support the
hypothesis that insecure attachment attitudes (particularly the preoccupation
with relationships) are involved in the development of PIU among late
adolescents.
Recent research demonstrated that Internet addiction has a negative
relationship with secure attachment style and a positive one with anxious and
avoidant attachment style (Anderson, 2001; Lin et al., 2011b; Shin, et al.,
2011; Kang, et al., 2012; Betül et al.,, 2014;Nazli Tavakoli et al., 2014) where
the anxious attachment style could predict Internet addiction more than the
avoidant (Betül et al., 2014; Lin et al., 2011b).
Moreover, about social network use specifically, Oldmeadow, Quinn and
Kowert (2012) observed in adulthood a relationship between anxious and
avoidant attachment style and the use of Facebook. The people with a high
anxious attachment style used Facebook more frequently. They also used it
greater when experiencing negative emotions and were worried about how
others think of them on Facebook. To confirmation of this, recently, Lai et al.
 The Role of Attachment Style and Social Anxiety … 43

(2016) found a positive association between need to approval, a dimension of

anxious attachment, and the fear of missing out (FOMO).
The findings indicated the possible role of emotion dysregulation as a
preceding factor of Internet addiction in affecting individual psychosocial
well-being (Lai et al., 2015) and, in this regard, the Attachment theory can
contribute to the understanding of the pathogenesis of Internet addiction
(Eichenberg et al., 2016) and the secure attachment style may represent an
important protective factor for the onset of the pathological use of Internet.

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In: Internet Addiction ISBN: 978-1-53610-436-3
Editor: Margaret Adams © 2017 Nova Science Publishers, Inc.

Chapter 5

THE MENTAL HEALTH LITERACY OF

INTERNET ADDICTION AMONG
ADOLESCENTS: AN INITIAL MEASURE
DEVELOPMENT AND VALIDATION

Lawrence T. Lam*
Faculty of Health and Graduate School of Health
University of Technology Sydney, Australia

ABSTRACT
This study aims to describe the initial development and to investigate
the psychometric properties of an instrument for measuring the Mental
Health Literacy (MHL) of Internet Addiction (IA). The formation of the
items was based on the Australian National Survey of Mental Health
Literacy and Stigma Youth Survey. It was designed as a vignette-based
questionnaire depicting behavioural characteristics of a severe problem
with Internet usage. These symptomatic behaviours were based on the
description in the Young Internet Addiction Test (IAT). This newly
developed instrument was administered to 348 adolescents aged between
15-18 years randomly recruited from high schools in a large city.
Responses on the recognition of the problem from the vignette with the

*
Corresponding author: Lawrence T Lam, Faculty of Health and Graduate School of Health,
University of Technology, Building 10, Level 3, Rom 215, 235 Jones Street, Ultimo, NSW
2007, Australia, Telephone: +612 9514 4242, E-mail: [email protected].
54 Lawrence T. Lam

recognition of another vignette depicting depression were compared. The

convergent validity of the intended action to seek help was investigated
using the Self-Stigma of Seeking Help Scale (SSOSH), and the personal
identification of the problem by the IAT. The results of this study
provided supporting evidence for the validity of the MHL of IA measure.
As the unique measure of the MHL of IA, this could play an important
role in understanding the level of MHL in the population of an emerging
area of psychiatric problem.

Keywords: mental health literacy, internet gaming disorder, internet

addiction, assessment, psychometric, validity, reliability

INTRODUCTION
Mental Health Literacy (MHL) is a term defined by Jorm as the
“knowledge and beliefs about mental disorders which aid their recognition,
management or prevention” [1]. This was based on the concept of health
literacy established by the US Institute of Medicine (IoM) in 2004 and
subsequently enriched by the World Health Organisation (WHO) in 2007 [2-
3]. To provide a comprehensive concept of MHL, Jorm also included six main
characteristics, namely: 1) the ability to recognise specific disorders; 2) the
knowledge of how to seek mental health-related information; 3) the knowledge
about risk factors and causes of mental health disorders; 4) the knowledge
about how to self-treat and of the availability of professional help; 5) the
attitudes that promote the recognition of mental health problems; and 6) the
attitudes that promote seeking appropriate help [1].
In terms of the measurement and assessment of MHL, Jorm designed and
utilised a vignette-based method to examine the ability of individuals to
recognise mental disorders or problems in the national population survey in
1995 [1]. He also reported the use of rating scales to assess respondents’
perceptions of a list of pharmacological and non-pharmacological treatments
related to the vignettes [1]. Since then, this approach of MHL assessment has
been further developed to include questions on other important aspects of the
MHL concept. These include: intention to seek help; belief and intention about
first aid; belief about intervention and prevention [4]. This assessment
approach has been widely adopted in many studies in the area of MHL for
Depression, Depression with suicidal thought, Psychosis/early Schizophrenia,
 The Mental Health Literacy of Internet Addiction … 55

Social phobia, Depression and Substance abuse, and Post Traumatic Stress
Disorder [5-11].
Excessive use of the Internet is a form of human interaction with
information and communication technologies that has, for many years, been
viewed as problematic [12]. Different terms have been used to describe such
behaviour including: “compulsive computer use”; “pathological Internet use
(PIU)”; “Internet addiction (IA)”; and “Internet dependency” [13-16]. Internet
Gaming Addiction (IGA) has been listed as an emerging disorder worthy of
further investigation in the latest version of the Diagnostic and Statistical
Manual of Mental Disorders V (DSM-V), while a condition called “Internet
addiction” (IA) is still yet to be recognised as an established disorder, with the
controversial debate is still on-going [17-18]. In this study PIU and IA are
used interchangeably.
The mental health outcome of PIU has been well documented and reported
in the literature, particularly depression among adolescents 19-24]. In the most
recent review of studies on the relationship between pathological Internet use
and psychopathological co-morbidities, it was reported that depression had the
most significant and consistent association with PIU among a number of the
different psychopathologies investigated [19]. However, the review was not
able to draw any conclusion on the causality of the relationship owing to the
fact that all, but one, were cross-sectional studies [19]. In a recent longitudinal
study on healthy young people aged between 13 and 18 years who were
depression free, it was found that after 9 months of exposure to the Internet,
moderate and severe problematic users were about 2.5 times more likely to
develop depressive symptoms and scored high enough on the Zung Depression
Scale to return clinically meaningful scores in comparison to normal users
[25]. Other longitudinal studies conducted subsequently also yielded similar
results [26-27]. These studies suggested a potentially causal relationship
between PIU and depression. These finding further suggested that PIU per se
could be considered as a mental health problem.
The development of Mental Health Literacy measures for other disorders
and mental health problems are emerging in the literature. These include
Autism Spectrum disorders, Conduct disorders, personality disorders, and
Eating disorders [28-32]. However, for PIU there has not been a single study
examining MHL and PIU. As Internet Gambling Addiction has been identified
as a potential disorder to be further investigated in the DSM-V, the Mental
Health Literacy aspect of PIU will soon become an important issue for
exploration. The immediate question is whether there is a suitable measuring
instrument for assessing the MHL of PIU. So far, there is none in the PIU
56 Lawrence T. Lam

literature. The aim of this study is to bridge this gap by attempting an initial
development and validation of an instrument for measuring the MHL of PIU,
particularly among adolescents.

MATERIAL AND METHODS

Sample and Procedure

The sample was generated using a two-stage random clustering sampling

technique. First, two high schools were randomly selected from the list of high
schools in a large city of Southern China. Second, four classes were selected
randomly from each school with all students in the class recruited in the
sample. As a result, a sample of adolescents aged between 15-18 years was
included in this development and validation study. The survey was conducted
on campus at different schools within the same week. Selected students were
invited to participate in the study by school principals and teachers, and were
encouraged to fill in a self-reported questionnaire designed specifically for the
study. Consent was implicated by a voluntarily response to the questionnaire.
Institute ethics approval for the study was granted by the Human Ethics
committee of the Hong Kong Institute of Education.

Materials

The conceptualisation of the instrument and the formation of the items

were based on the Australian National Survey of Mental Health Literacy and
Stigma Youth Survey designed and developed by Reavley and Jorm [33]. The
MHL Youth assessment includes all the aforementioned six domains of MHL.
Recognition of disorders was assessed using a vignette-based question that
presented a young person with symptoms characteristic of a disorder such as
depression. The respondent was then asked the question: “What, if any, do you
think is wrong with the young person?” Recognition of the disorder was
indicated by the respondent’s answer from a list of multiple-choices. Adopting
the same format, the domain for disorder/problem recognition for the MHL of
PIU was also designed as a vignette-based question presenting a young person
with behaviours characteristic of an individual who might have a severe
problem with Internet usage. These symptomatic behaviours were based on the
 The Mental Health Literacy of Internet Addiction … 57

description depicted in the Yong Internet Addiction Test (IAT) [34]. The IAT
was designed by Young as a 20 item self-reported scale in accordance to the
behavioural diagnostic criteria of pathological gambling detailed in the DSM-
IV but applied to the scenario of the Internet usage [34]. It included questions
that reflect typical behaviours of addiction. After reading the vignette
description, the respondent was asked to select an answer from a list of
possible disorders or mental health problems.
At this initial developmental stage of the instrument, not all six domains
of MHL were included in the design of the MHL of PIU. Included in this
instrument were questions covering areas of intended action to seek help,
perceived barriers, and exposure to the disorder/problem. Questions in these
domains were all formatted after the original questions presented in the Mental
Health Literacy and Stigma Youth Survey with minor modification to adapt to
local cultural and language requirements. For example, for the intended help
seeking action, the respondent was asked: “If you had a problem right now like
the young person described above, would you seek help?” If the answer to the
question is affirmative, then it would be followed by another question asking
the respondent to indicate from whom he/she would seek the help.

Psychometric Analyses

Owing to the fact that the design of the original MHL instrument included
vignette-based questions and other questions with multiple-choice answers, the
conventional approach of psychometric analyses that mostly applied to
numeric scales might not be appropriate in this situation. Hence, other
approaches were adopted to examine the psychometric properties, including
the validity and reliability of the newly developed instrument. To investigate
the construct validity of the MHL of PIU, particularly discriminant validity,
questions on the same three domains of the MHL of depression were also
included in the study questionnaire. Respondents were also asked to answer
those questions for the MHL of depression. It was assumed that PIU and
depression were two different disorders/problems therefore they were of two
different constructs. Hence, the recognition of these separate mental health
problems should be independent of each other. In other words, the correct
recognition of the problem should only be dependent on the behavioural
characteristics depicted in the vignette itself, but not on the description of the
other vignette. As a result, there should be a significant discordance between
the correct recognition responses elicited from PIU and that from depression.
58 Lawrence T. Lam

In terms of the analysis this can be tested by using the McNemar Chi-squared
test with correct/incorrect recognitions on the PIU and depression vignettes as
responses.
To examine the convergent validity, particularly in the domain of the
intended action to seek help, the Self-Stigma of Seeking Help Scale (SSOSH)
was included in the questionnaire [35]. The SSOSH was designed to measure
self-stigma associated with seeking professional psychological help. It was
validated with a uni-dimensional structure and good reliability of 0.9,1 and a
test-retest reliability of 0.72 [35]. A higher score on the SSOSH scale indicated
a strong self-stigmatisation towards seeking professional psychological help
and it was demonstrated that SSOSH was negatively and significantly
associated with the intention to seek professional help [35]. In terms of the
convergent validity for the domain of intended action to seek help,
theoretically speaking, those who had indicated a positive intent to seek help
should score lower than those who had indicated otherwise. This was tested by
comparing the mean SSOSH scores between groups using an independent
student’s t-test. For the exposure to the problem, specifically on the question
whether the respondent had ever had a similar problem as the person depicted
in the vignette, the IAT was also included in the questionnaire as an objective
assessment of the severity of PIU. Respondents who had indicated having
experienced a similar problem should score higher on the IAT in comparison
to those who did not have a similar experience. This was also examined by
comparing the mean IAT scores between groups.
For the reliability of the MHL of PIU items, the test-retest reliability was
examined with the same questionnaire re-administered to a randomly selected
group of about 50 students at an interval of 2 weeks. Responses on the main
MHL of PIU items were compared between the two test times. The agreement
and the 95% Confidence Intervals of responses between the two test-times
were calculated with the discordance examined using McNeMar Chi-squared
tests. A significant level of 5% was used for testing all hypotheses.

RESULTS
The sample consisted of 348 young people with 150 (43%) males and 198
(57%) females and a mean age of 16.7 years (s.d. = 0.83). The demographic
characteristics of the sample were summarised in Table 1. Of these, 127 (37%)
were single children and the majority (n = 309, 89%) were living with both
biological parents. Most of the parents received formal education up to
 The Mental Health Literacy of Internet Addiction … 59

secondary or post-secondary levels with only 7% (n = 24) of fathers and 5% (n

= 18) of mothers attaining university or higher education. As shown, there
were no significant differences in the mean ages or the proportion distributions
in any of the demographic characteristics between those who recognised PIU
correctly and incorrectly.
The correct and incorrect recognition of PIU and depression responses
were presented in Table 2. To confirm the construct validity of the MHL of
PIU, particularly the discriminant validity, the discordance of these responses
was tested with variables cross-tabulated for McNemar Chi-squared analysis.
The results indicated that there was a significant discordance in the responses
to the two vignettes (McNamar χ2 p < 0.001). Information on other MHL items
of the PIU and depression were also presented descriptively in Table 2.

Table 1. Frequency (%) or means (s.d.) of the demographics by

recognition of PIU and results on comparisons (N = 348)

Total
Variables Recognition of the problem Results
sample
Yes (n = No (n = 145)
203)
Age 16.7 16.7 (0.81) 16.8 (0.86) t346 = -1.22,
(0.83) p = 0.223
Sex
Male 150 (43%) 80 (39%) 70 (48%) χ21 =2.71,
Female 198 (57%) 123 (61%) 75 (52%) p = 0.100
Single child
Yes 127 (37%) 77 (38%) 50 (35%) χ21 = 0.43,
No 221 (63%) 126 (62%) 95 (65%) p = 0.510
Living with biological
parents 309 (89%) 184 (91%) 125 (86%) χ21 = 1.67,
Yes 39 (11%) 91 (9%) 25 (14%) p = 0.196
No
Father’s Education level
University or above 24 (7%) 13 (6%) 11 (8%) χ22 = 0.49,
Secondary and Post- 261 (75%) 155 (76%) 106 (73%) p = 0.782
secondary 63 (18%) 35 (18%) 28 (19%)
Primary or below/deceased
Mother’s Education level
University or above 18 (5%) 9 (4%) 9 (6%) χ22 = 2.08,
Secondary and Post- 254 (73%) 154 (76%) 100 (69%) p = 0.353
secondary 763 (22%) 40 (20%) 36 (25%)
Primary or below/deceased
60 Lawrence T. Lam

Table 2. Frequency and percentagea of responses to Mental Health

Literacy items for PIU and Depression (N = 348)

MHL items PIU Depression Comparison results

Recognition of disorder
Correctly 203 (58%) 69 (20%) McNamar χ2 p < 0.001
Incorrectly 145 (42%) 279 (80%)
Recognition of disorder
Problematic Internet Use 203 (58%) -
Depression 14 (4%) 69 (20%)
Schizophrenia/paranoid 3 (1%) 6 (2%)
schizophrenia
Psychosis/psychotic - - -
Mental illness 2 (1%) -
Stress 14 (4%) 89 (26%)
Nervous breakdown 2 (1%) 6 (2%)
Psychological/mental/ emotional 88 (25%) 147 (42%)
problems - 16 (5%)
Has a problem
Cancer - 1 (0.3%)
Other (specify) 10 (3%) 13 (4%)
Nothing 6 (2%) 1 (0.3%)
Don’t know 6 (2%) -
Intended action to seek help
Yes 191 (55%) 210 (60%) McNamar χ2 p = 0.064
No/Don’t know 157 (45%) 138 (40%)
Of those who seek help, seek help
from
Father 30 (16%) 28 (13%)
Mother 46 (24%) 57 (27%)
A family member 14 (7%) 14 (7%) McNamar-Bowkerc
My teacher 10 (5%) 8 (4%) χ23 = 0.8, p=0.064
A school social worker or 3 (2%) 3 (1%)
counsellor
Friends met on the Internet 6 (3%) 5 (2%)
Friends in school 65 (34%) 68 (32%)
Others 11 (6%) 21 (10%)
Don’t know 6 (3%) 6 (3%)
Barrier of seeking help(multiple McNamar χ2
responses) 60 (29%) p = 0.081
Person might feel negatively about 65 (35%)
you
What the person might say is wrong 41 (22%) 41 (20%) p = 1.000
Other people think of you seeing 21 (11%) 27 (13%) p = 0.481
the person
Thinking that nothing can help 33 (18%) 48 (23%) p = 0.080
Too embarrassed/shy 49 (27%) 49 (23%) p = 0.473
Other 10 (5%) 11 (5%) p = 0.774
Don’t know 34 (18%) 57 (27%) p = 0.093
 The Mental Health Literacy of Internet Addiction … 61

MHL items PIU Depression Comparison results

Exposure to the problem
Family or friends had a similar
problem
Yes 139 (39%) -
No/Don’t know 213 (61%)
Did they receive professional help?b
Yes 14 (10%)
No/Don’t know 120 (90%) -
Have you ever had a similar
problem?
Yes 97 (28%) -
No/Don’t know 251 (72%)
Did you receive professional help? b
Yes 16 (17%) -
No/Don’t know 79 (83%)
a
Percentage did not add up to 100% due to rounding; b Follow-up question only for
those who answered yes in the previous question, c Categories were collapsed into
father, mother, and others,

To examine the convergent validity for the intended action to seek help,
the mean SSOSH scores between those who had indicated a positive intent to
seek help and those who had indicated otherwise were compared (Table 3).
There was a significant difference in the mean scores between groups (t346 = -
4.14, p < 0.001). Those who had indicated a positive intent scored lower than
who had indicated otherwise with mean SSOSH scores of 24.2 (s.d. = 4.62)
and 26.1 (s.d. = 3.97) respectively. For the convergent validity of the question
on the exposure to the problem, results also suggested a significant difference
in the IAT scores between those who had experienced a similar problem and
those who did not have similar experience (t346 = 6.66, p < 0.001). The mean
scores of IAT for the former group were 48.6 (s.d. = 13.77) and 39.6 (s.d. =
10.68) of the latter.
The test-retest reliability of the MHL of PIU items was investigated and
the results were summarised in Table 3. As shown, the agreements of all MHL
items between the two test-times were moderately high ranging from 70.6% to
84.3%. The test for discordance for each item did not yield any significant
result, suggesting no obvious discordance of responses between the two test-
times.
62 Lawrence T. Lam

Table 3. Results on test-retest reliability and convergent

validity of MHL items (N = 51)

Agreement
MHL items Test Retest in % Results
(95%C.I.)
Recognition of disorder
Correctly 27 (53%) 26 (51%) 70.6 McNamar χ2
Incorrectly 24 (47%) 25 (49%) (56.0-82.1) p = 1.000
Intended action to seek help
Yes 30 (59%) 30 (59%) 84.3 McNamar χ2
No/Don’t know 21 (41%) 21 (41%) (70.9-92.5) p = 1.000
Exposure to the problem
Family/friends had a problem
Yes 25 (49%) 23 (45%) 76.4 McNamar χ2
No/Don’t know 26 (51%) 28 (55%) (50.0-77.2) p = 0.815
You ever had a problem
Yes 17 (33%) 18 (35%) 82.4 McNamar χ2
No/Don’t know 34 (67%) 33 (65) (68.6-91.1) p = 1.000
ITA scores Results on comparison
You ever had a problem
Yes 48.9 (13.77) t346 = 6.66, p < 0.001
No/Don’t know 39.6 (10.68)
SSOSH scores
Intended action to seek help
Yes 24.2 (4.62) t346 = - 4.14, p < 0.001
No/Don’t know 26.1 (3.97)

DISCUSSION
This study aims to examine the psychometric properties of a newly
developed instrument for measuring the Mental Health Literacy of
Problematic Internet Use. As aforementioned, this is the first attempt of the
development of a Mental Health Literacy measure in the area of Problematic
Internet Use. Previous studies have reported the development of MHL for
other disorders [28-32], however according to Jorm’s MHL concept for
instrument design, MHL measures are disorder or problem specific. As a
result, each vignette depicts one disorder and the MHL questions are referred
to the same disorder described in the vignette. Hence, there are six different
vignettes for six different disorders in the Mental Health Literacy and Stigma
Youth Boost Survey [33].
 The Mental Health Literacy of Internet Addiction … 63

The results of this study provide some supporting evidence for the validity
of the MHL of PIU measure. The significant discordance in responses to the
PIU and depression vignettes renders support for the hypothesis that the
responses of correct recognition of the disorder depicted in the two vignettes
are independent from each other and also vignette specific. This in turn also
provides evidence that the vignettes clearly depict two different sets of
symptom characteristics, and thus two distinct constructs. Applying the same
logic to the test of discordance on data collect at two test times, the results also
provide evidence for the concordance of responses at the two test times with
moderately strong agreements on the main MHL items. These results suggest
reasonably good test-retest reliability of these items. Other results on the
comparison of the IAT and SSOSH scores between groups also give support to
the validity of the MHL items on intended action to seek help and exposure to
the problem.
The role of MHL in the prevention of mental health problems and the
promotion of better mental health is undeniably important, as argued by Jorm
[36]. The value of enhancing MHL in the community across all ages comes
not only in an increase in the ability to recognise mental health disorders and
problems, but also a better understanding of the risk factors of these disorder
and problems, resulting in the reduction of negative attitudes and
stigmatisation towards people who are suffering from these disorders. More
importantly, a greater benefit could be gained by developing the ability to seek
information on these problems, cultivating a more positive attitude towards
seeking appropriate help, and possibly more knowledge in self-treatment or
seeking professional help. It is through the early detection, and in turn early
intervention, of the problem that the goal of primary and secondary prevention
can be achieved [36]. As the onset of many mental health problems occurs
during adolescence, it would be more important to develop and implement
MHL programs for children. However, a recent study reviewing the available
school-based MHL programs for adolescents in the literature yielded
disappointing results. It was found that, on one hand the quality of the
reviewed studies was far from promising, and on the other the quality of
evidence for help-seeking behaviour and knowledge was very low [37]. This
demonstrates a greater and urgent need to invest in research for better design
and development of MHL programs based on strong and proven theoretical
frameworks.
There are strengths and weaknesses in this study. The design of the PIU
vignette is based on the conceptual framework embedded in the design of the
Internet Addiction Test which is a well validated and widely used instrument
64 Lawrence T. Lam

in many countries. The symptom characteristics depicted in the vignette are in

line with Davis’s concept of Generalised Problematic Internet Use [18]. The
questions included in the instrument adopt the format of the original Mental
Health Literacy and Stigma Youth Boost Survey that allow for comparisons of
responses among different disorders. One obvious limitation of the instrument
is that it only includes three main domains of MHL. Further studies are
required to develop and to validate the remaining domains to complete the full
MHL of PIU instrument.

ACKNOWLEDGMENTS
The authors would like to acknowledge the School of Public Health,
Guangxi Medical University, PR China in providing filed support for the
study.

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BIOGRAPHICAL SKETCH

Lawrence T. Lam

Lawrence Lam has received training in areas of Medical Sciences,

Psychology, Public Health, Epidemiology and Medical Statistics. He worked
as a hospital Epidemiologist and a Medical Statistician in the Royal Alexandra
Hospital for Children, Sydney, Australia, for many years. During the period,
he was also teaching Master classes in Epidemiology and Biostatistics at the
School of Public Health, The University of Sydney. He was the Head of
Epidemiology and Medical Statistics, as well as the Deputy Chair of the
Population and Public Health Domain in the School of Medicine Sydney,
the University of Notre Dame Australia during 2009-2012. He is also
appointed a Fellow of the American College of Epidemiology.
68 Lawrence T. Lam

Research Administration
In 2006, he established the Centre for Trauma Care, Prevention,
Education, and Research (CTCPER) in conjunction with clinical colleagues of
the Surgery Division of the Children’s Hospital at Westmead. He was also
appointed to the position of the Scientific Director of the centre with full
responsibility of promoting and developing research program in the area of
trauma care, management, and injury prevention. (http://www.kidsresearch.
org.au/research/trauma-care/index.php)
Lawrence has been managing many different local and internal projects
for a number of years. He was one of the founding members serving on the
advisory committee at the onset of the DRIVE Study which is the world
largest study on young drivers’ risky behaviour and crash injuries. He has also
served as members of the Research Committee of the School of Medicine
Sydney and School of Nursing Sydney, the University of Notre Dame
Australia while serving a faculty member. He is also a founder and a co-
director of the Asia-Pacific Research Collaboration in Child and Adolescent
Public Health based in the Chinese University of Hong Kong. More
recently, he also established the Child and Adolescent Mental Health
Research Collaboration group with colleagues in Hong Kong, China, Macau,
and Singapore with a flagship multicentre project held in different cities within
the region. He has been appointed as the Co-chair of the Scientific Committee
of the Hong Kong Society of Behavioural Health, am affiliated member of the
International Society of Behavioural Medicine. He has also been nominated as
an in-coming Vice President of the society.

Research Profile
Being an Epidemiologist, a Statistician, and a research Psychologist in
clinical and academic settings, Lawrence has experience in many different
sub-specialties in Epidemiology and Medicine. These include Behavioural,
Clinical, and Environmental Epidemiology. His works cover a range of
research areas including Clinical Trauma Management and Injury Prevention,
Paediatric and Adolescent Mental Health, Environmental Child Health, Risky
Behaviours among young people particularly young people’s Internet
problematic behaviour and psychology, and Rehab of traumatic brain injury
among children and young people. While serving at the School of Medicine
Sydney as a faculty member, he also provided consultations to and
collaborated with clinicians of the St Vincent’s and Mater Hospitals Sydney,
the Cunningham Centre for Palliative Care, as well as a member of the
advisory committee of the ImPaCCT (Improving Palliative Care through
 The Mental Health Literacy of Internet Addiction … 69

Clinical Trials) NSW. He has also taught Master classes in different

universities including University of New South Wales, and the Chinese
University of Hong Kong. Lawrence has been involving and leading many
international collaboration.
In: Internet Addiction ISBN: 978-1-53610-436-3
Editor: Margaret Adams © 2017 Nova Science Publishers, Inc.

Chapter 6

A REFLECTIVE STUDY OF THE

DILEMMAS IN THE DIGITAL ADDICTION
POLICY OF KOREA

Koh Young-Sam
Executive Principal (Ph.D., social psychology),
National Information Society Agency, Seoul, South Korea

ABSTRACT
South Korea has rapidly developed the infrastructure for a digital
information society. The rapid development of its infrastructure,
however, has caused social problems such as internet addiction, for which
countermeasures were implemented at the national level early on. Such
response measures include the 3-year master plans, annual nationwide
surveys on the current conditions, training of professional counselors,
counseling programs tailored to different age groups, and regional
counseling centers. However, as is the case with all other policies, there
are dilemmas in the Internet addiction policy in regard to the cause and
true nature of digital addiction, the inter-departmental implementation
systems of the central government, and the division of roles and
cooperation among the central and local governments and citizens. This
chapter is a reflective study about the future policies to be improved with
the previous successful Internet addiction policies in S. Korea. S. Korea's
experience in responding the Internet addiction problems may offer good
case studies for other countries that have recently experienced it.
72 Koh Young-Sam

1. INTRODUCTION
There are distinct channels through which the issue of Internet addiction
emerges as a social issue or becomes designated as a subject of a national
policy. For instance, it may occur as a result of case discovery and in-depth
research by academics in related fields such as psychology, counseling, and
neuropsychiatry. In this case, academic research raises awareness of the
seriousness of the issue, and the problem becomes designated as a national
policy issue. On the other hand, it may be selected as a policy issue by the
national government, after which the budget allocated is used toward finding
the basis for the policy and program implementation. While the situation in the
U.S.A. and Germany is illustrated by the former case, S. Korea and China
have been following the path of the latter.
The unique factor in S. Korea’s case, with respect to dealing with Internet
addiction, which is regarded as a mental health issue, is that it was initiated by
a government department that oversees the information technology (IT) and
gaming industries, rather than the one in charge of healthcare. More recently,
the department in charge of healthcare has also been implementing response
measures in relation to this issue. However, the fact of the matter is that the
department in charge IT and gaming industry policies allocates a more
substantial amount of budget to countering this issue, and those who are not
familiar with the background of this story may be surprised by this
phenomenon.
S. Korea has been working to stop Internet addiction for a relatively
longer time than any other countries in the world. Nevertheless, this does not
mean S. Korea’s national response measures are the most rational or
successful. All policies are formulated based on the background unique to that
particular society, and this is also the case for S. Korea’s Internet addiction
policy. Since 2002, the South Korean government has been conducting a
nationwide Internet addiction survey every year, and readjusting the direction
of its policy. It has been actively dealing with the issue, developing a scale for
collective screening of addiction tendencies, developing and providing
standard counseling programs tailored to different life cycle stages, training
professional counselors, and providing free counseling services.
 A Reflective Study of the Dilemmas in the Digital Addiction … 73

More recently, however, an environment rendering people more

vulnerable to Internet addiction has been created. To be more specific,
smartphones have become an integral part of the daily life for nearly all
citizens of S. Korea, and it is highly likely that people will become more
dependent on digital technologies such as wearable computers, virtual reality
(VR) and augmented reality (AR). In addition, due to the economic slowdown,
the national government has been allocating more budget to utilize IT to drive
forth economic development, rather than to mitigate the side effects of IT.
Amid the changing environment, it has become important to consider how a
more efficient preventive and resolution policy could be implemented.
This is a reflective study regarding the successes of the Internet addiction
policy of Korea as well as the matters for improvement. Of particular note, the
issue will be examined from the viewpoint of the dilemma theory. As many
are already aware, the Internet addiction policy of Korea, with a long history,
is accompanied by an excellent system. Nevertheless, this does not mean there
is no need to seek better countermeasures.

2. POLICY DILEMMA THEORY

Today, the government is in a very complex environment. From the
spatial perspective, for instance, the emergence of a “global community” has
resulted in policy issues that are discussed and disputed across national
borders, instead of strictly affecting one nation. Even within the country, there
exist numerous interest parties to policy issues. For this reason, there may be
several government departments handling a single issue, and there are issues
that give rise to conflicts among multiple local governments. Conflict between
the government and the citizens occurs frequently. There are times when the
interest parties in conflict have differing views that make it impossible for
them to yield. In such cases, it becomes a huge challenge to reach a conclusion
that satisfies all of the interested parties.
When there are issues causing conflict, the government must determine
the importance of the situation, the values claimed by the interested parties,
and the degree of benefits and losses before seeking a measure to resolve the
situation. However, there are cases when the government cannot make a
decision and merely wish to avoid a situation where the problem is further
exacerbated.
74 Koh Young-Sam

The phenomenon in which contradicting demands exist simultaneously

when implementing a policy is referred to as a “policy paradox (Stone, D. A.,
1988).” A paradox is a logical structure regarding a situation, and when an
issue falling into this type of logical structure causes a conflict between two
parties to surface and intensify, without a resolution, rendering it difficult for
the decision-maker to make a choice, it is called a “policy dilemma (Young-
Jin, Soh 2003: 33).” In other words, policy dilemmas arise when logical
conditions composing a dilemma are accompanied by corresponding social
conditions.
The logical conditions composing a dilemma are as follows (Young-Jin,
Soh, 2003: 33): (a) discreteness: the two choices are completely different in
nature and reaching a compromise is impossible; (b) trade-off: the two choices
contradict each other and only one of the choices must be selected; (c)
equality: the results expected from the two choices are nearly equal in value,
thus making it difficult to make a choice; (d) unavoidability: making a choice
is unavoidable and at least one of the choices must be selected. The social
conditions corresponding to the said logical conditions are summarized in
Table 1 (Young-Jin, Soh, 1999:200).
In this chapter, the dilemmas in the national policy regarding Internet
addiction in S. Korea were summarized into three types: the cause and true
nature of digital addiction, the inter-departmental implementation systems of
the central government, and the division of roles and cooperation among the
central and local governments and citizens. The history and current situation of
the Internet addiction policy in S. Korea will be examined first for a better
understanding.

Table 1. Social conditions of a policy dilemma

 A Reflective Study of the Dilemmas in the Digital Addiction … 75

3. THE DIGITAL ADDICTION POLICY AND ADDICTION

SITUATION IN S. KOREA

3.1. History of the Digital Addiction Countermeasure Policy

S. Korea initiated a national policy regarding Internet addiction in 2002.

This was extremely early, considering that the American Psychiatric
Association announced only “Internet gaming” may be referred to as an
Internet addiction in 2013 (http://www.dsm5.org/Pages/Default.aspx).
In order to understand the reason behind selecting Internet addiction as a
policy issue in 2002, one must first understand the economic situation of S.
Korea at the time. As it is generally known, the Korean War occurred in the
1950s. The war devastated the country, destroying nearly all of the
manufacturing factories and driving the people into extreme poverty. With
hard work, dedication and fervor for education, however, the people of S.
Korea restored their nation at a rapid pace. Following the dramatic economic
growth after the 1960s, S. Korea became one of the world’s top 10 countries,
in terms of trade volume, in the early 1990s, but was soon faced with a
stagnant economy. While the advanced nations strove to build a knowledge-
based economy, S. Korea remained dependent on the traditional
manufacturing industry. Then, Korea faced a foreign exchange reserve crisis in
1997, and had to be managed by the International Monetary Fund.1
The new President of S. Korea who took office in the following year made
“revival of the national economy” as the ultimate objective, which was
to be achieved through “informatization.”2 In other words, successful
informatization was expected to revive the national economy. The problem is
that amidst the relentless implementation of a state-led informatization policy,
problematic behavioral patterns were observed among those who continually

1
The 1997 Asian financial crisis was a period of financial crisis that affected much of East Asia,
including Korea. As a means to stabilize the currencies, the Korean government received a
loan from the International Monetary Fund (IMF), under the condition that it tighten its
financial and fiscal policies, implement a policy for opening to foreign investment,
restructure its financial sector and companies, and improve corporate transparency (Young-
Sam, Koh, 2015: 220).
2
Informatization involves establishing communication infrastructure, introducing information
technology in the manufacturing sector to enhance productivity, and industrializing games
and computer software as a means to become an information-based society (Young-Sam,
Koh, 2015: 220).
76 Koh Young-Sam

played Internet games.3 At the time, the informatization policy experts voiced
concerns that the rapid progression of informatization for economic revival
would not only lead to positive impacts, but also produce unintended adverse
effects. Thus, in the late 1990s, they began to advise the government officials
that it was important to minimize the adverse impacts of informatization such
as Internet addiction, even for ensuring “successful” informatization.
Ultimately, in 2002, the Internet Addiction Prevention and Counseling Center
(IAPC) was established under the National Information Society Agency,
which was in charge of national informatization planning.4
IAPC, launched in 2002, undertook projects to develop a scale for
determining Internet addicts, develop and run counseling programs, train
professional counselors, and conduct surveys to examine the current situation
pertaining to Internet addicts. Meanwhile, the issue of Internet addiction began
garnering more attention from the public after the turn of the new millenium,
as Internet use became more widespread. For this reason, other government
departments including the Ministry of Culture, Sports and Tourism and the
Ministry of Gender Equality and Family began attempting to address this issue
in a competitive manner. This is how S. Korea formulated an Internet
addiction policy far earlier than any other country. Furthermore, the
circumstances stated above served as the background for those responsible for
the informatization policy, rather than those in charge of healthcare, to initiate
the policy, even though Internet addiction is a mental health issue.

3.2. Current Situation of Digital Addiction

In S. Korea, a nationwide survey is conducted to examine the Internet

addiction situation.5 In 2015, 6.8% of the population was found to be in the

3
For example, there were cases in which individuals were fired from their jobs or ruined their
marriages due to their online gaming addictions, or committed heinous crimes because they
confused virtual reality with actual reality. http:// news.naver.com/ main/ read.nhn?
mode=LSD&mid=sec&sid1=102&oid=015&aid=0000358434
4
The said institution received funding for its operations from the Ministry of Information and
Communication, which was implementing informatization programs at the time.
5
K-scale, used to measure over-dependency on the Internet and smartphones in S. Korea, has
been supplemented and utilized since its development in 2002. Although the Young Scale
(1996) was initially used, there were significant discrepancies in the number of subordinate
factors, which were found to range from one to four in the follow-up studies, and a
validation study was not conducted in regard to the calculation of the cutoff scores. Due to
these limitations, the Young Scale was not adapted into a Korean version, and the K-scale
was developed instead. The results of follow-up factorial analyses of the Young Scale: 6
 A Reflective Study of the Dilemmas in the Digital Addiction … 77

risk group for being overly dependent on the Internet (High risk group – 1.2%;
Potential risk group - 5.6%).6 In terms of age groups, the risk group was
mostly comprised of people in their twenties (13.3%) and teens (13.1%), who
especially spend a lot of time playing online games and using social
networking services (SNS). Nonetheless, the rate of over-dependency on the
Internet has been declining over the years, recording 9.2% in 2006, 8.5% in
2009 and 7.2% in 2012, so there has been a gradual improvement (Ministry of
Science, ICT and Future Planning (Ministry of Science, ICT and Future
Planning and National Information Society Agency, 2016).
The survey also examines the over-dependency on smartphones. The
results show that while the over-dependency on the Internet has been declining
over the years, the over-dependency on smartphones has been on a continuous
rise. To be more specific, the at-risk population to total population ratio for
over-dependency increased from 8.4% in 2011 to 11.1% in 2012, 11.8% in
2013 and 14.2% in 2014, and it markedly rose to 16.2% in 2012 (High risk
group: 2.4%; Potential risk group: 13.8%). Dependence on smartphones has
become intensified as they have become an essential item in people’s daily
lives, and this is causing concerns that the number of people who are
overdependent on smartphones will grow even further. In terms of age groups,
a vast percentage of those in the over-dependency risk group were in their
teens (31.6%), prompting the need for special countermeasures. The second
largest age group was 20s (24.2%) followed by 30s (16.1%). The age group
that is drawing especially a lot of attention is infants and children(3~9 years
old).
They comprise 12.4% of the risk group, which is higher than the
percentage of those in their 40s (10.7%) and 50% (5.3%). This is a cause for
concern as children under the age of 10 are in an important stage of cognitive
and emotional development.

factors (Widyanto et al., 2004; Ferraro et al., 2007), single factor (Khazaal et al., 2008;
Korkeila et al., 2010), 3 factors (Chang & Man Law, 2008; Widyanto, Griffiths, &
Brunsden, 2011), etc. Citation: Psychometric Properties of the Internet Addiction Test in
Hong Kong Secondary Students. http://netaddiction.com/wp-content/ uploads/ 2014/ 05/
IADQ.HongKong.Validation.pdf) (Narae, Um, 2015: 59).
6
The K-scale is a screening scale that was standardized and developed in S. Korea based on the
norm-reference method. T-scores of 70 or higher are classified as “high risk group,” and T-
scores of 67 to 69 are classified as “potential risk group.” In the national survey conducted
by the government, the results of these two scores are combined and announced as the “risk
group.” Although the K-scale is relatively valid for counseling intervention, but it has
limitations as a diagnostic tool for treatment intervention. One should understand that the K-
scale was developed for policy purposes to prepare a national response system, which was
urgently needed to prevent Internet addiction (Narae, Um, 2015: 62~67).
78 Koh Young-Sam

4. DIGITAL ADDICTION POLICY EXAMINED FROM THE

PERSPECTIVE OF POLICY DILEMMAS

4.1. Dilemma in the Cause and True Nature of Digital Addiction

The causes of Internet addiction are extremely multi-dimensional. One of

the key aspects of all types of addiction including Internet addiction is
probably the failure to exert self-regulation (Kyoheon, Kim, 2006; Kyoheon,
Kim and Hun-seok, Choi, 2008). The process through which an individual gets
addicted to the Internet can be divided into three stages: experimental contact,
impulsive pursuit, and compulsive obsession. In each of these stages, the
individual must practice adequate self-control, but instead, acting upon his or
her impulsivity can lead to addiction (Kyoheon, Kim, 2015: 9-11).7
However, when it comes to the causes of Internet addiction, they cannot
be explained simply based on individual factors because there are a multiple of
other factors involved. Davis (2001) divided the causes of Internet addiction
into proximal contributory causes and distal contributory causes by
incorporating the cognitive behavioral theory with the concept of pathological
Internet use (PIU), and explained the importance of situational factors.8 Orford
(2001), on the other hand, referred to the cases in which something that
generally provides satisfaction to humans actually deteriorates the quality of
life when in excess as “excessive appetites,” while explaining the excessive
use of the Internet. He also stressed that there are no cases in which addiction
exists irrespective of history, culture and social status by arranging social
and moral contexts around individual psychological characteristics in his
social behavioral cognitive-moral model. Meanwhile, the public health
approach provided a comprehensive explanation, proposing that sociocultural

7
What becomes heavily involved in causing impulsivity and determining success or failure of
self-regulation in each of these stages are mechanisms of reward learning and memory. All
types of addiction behaviors reward the affected individual by allowing them to experience
joy or avoid the pain and affliction they are under. Such rewards leave distinct traces in the
brain. The affected individual may realize that the impulsive behavior is wrong and try to
break away, but if he or she continues failing to break the addiction and relies on
impulsivity, he or she will fall into serious addiction.
8
Examples of distal contributory causes include the individual psychopathological factors, the
incident through which the individual first encountered the Internet or the time period
thereof, and the advancement of Internet technology. Proximal contributory causes include
maladaptive cognition, low self-efficacy, and poor social support.
 A Reflective Study of the Dilemmas in the Digital Addiction … 79

environmental factors are just as important as individual and biological factors

when it comes to illnesses.
When these models, the theories of which can be easily comprehended,
are implemented in reality, it gives a rise to a policy dilemma as follows: (a)
The biggest cause of Internet addiction may be the government allowing easy
access to online games and smartphones, but the government is being
accusatory, suggesting that it is caused by bad parenting or poor impulsivity
regulation of the individual. (Argument made by a parent of school-aged
children; (b) Internet addiction problem is caused by problems at home, but
the public is accusing games as the main culprit. This will prevent
advancement of the gaming industry, which is the future growth engine for the
economy. (Argument made by the gaming industry); (c) The stress caused by
the competitive education environment centering on the college scholastic
ability test (CSAT) and social survival in our society is the main cause of
Internet addiction, yet the government is remaining silent about the
fundamental structural problems of society and is only paying attention to the
secondary and trivial causes. (Argument made by a non-governmental
organization (NGO)); (d) The pathological use of the Internet is described by
the various government departments using different terms such as “addiction,”
“over-flow,” and “over-dependency,” and this is confusing. (Argument made
by an NGO)
The Internet addiction policy of Korea was not formulated based on
sufficient research results that provided its implications. In the beginning, the
government took a micro-approach of helping the affected individuals regain
their mental health and providing social skills development training, as a
means to prevent social incidents caused by addicts. However, when there was
an uproar among the parents of school-aged children, heavily criticizing online
games, a direct regulation of service activities of relevant enterprises such as
the shut-down system was implemented. This could be described as an
intermediate-level approach. As a result, there were frequent conflicts between
the gaming industry advocating for the micro-approach and parents supporting
the intermediate-level approach, which in turn led to a policy dilemma.
More recently, however, civic organizations have opined that this issue
will not be resolved, unless the social structural conditions are restructured.
They are arguing that it is the CSAT-centered education system and the
performance-prioritizing corporate environment that are the fundamental
reasons the public are becoming immersed in online games. The notion that
the early micro-approach, while it is not unimportant in a broader sense,
80 Koh Young-Sam

cannot be the sole solution to this problem is being raised by people, one after
another.

Figure 1. Top causes of Internet addition suggested by experts.

In this study, a survey was conducted with 19 experts in the Internet

addiction field to examine the causes of Internet addiction in S. Korea using
the Delphi method (Figure 1). The responses given by the experts in the
questionnaire, which allowed for multiple responses, were classified into three
levels depending on the frequency. The experts responded that the biggest
causes were “easy access to devices and contents (22 respondents),” “family
culture where empathetic communication is lacking (22 respondents),” “severe
competition incl. CSAT-centered education and job promotion (21
respondents),” “lack of restraint against impulsivity (20 respondents),” and
“engaging contents (19 respondents).”
The second-level group included “lack of social interactions that allow
emotional empathy (16 respondents),” “lack of a sense of belonging and trust
in communities (16 respondents),” “insufficient mediation by the parents (15
respondents),” “destruction of the family system (15 respondents),” “other
mental health issues incl. depression and anxiety (14 respondents),” and “a
culture that embraces new technologies and services (14 respondents).”
The dilemma in the Internet addiction resolution policy of Korea is that
countermeasures are implemented only for the peripheral causes, without
addressing the underlying or biggest causes of Internet addiction. For example,
 A Reflective Study of the Dilemmas in the Digital Addiction … 81

in the aforementioned survey, the experts noted that “easy access to devices
and contents,” “family culture where empathetic communication is lacking,”
and “severe competition incl. CSAT-centered education and job promotion”
were the first-level factors contributing to Internet addiction. However, under
the premises of the national Internet policy for “S. Korea to become a country
where anyone can access the Internet anywhere, anytime,” the necessary
measures to mitigate the issue of “easy access to devices and contents” cannot
be taken. Also, because “S. Korea must become a highly competitive nation,”
even though “severe competition incl. CSAT-centered education and job
promotion” is indeed one of the biggest causes of Internet addiction, nothing
can be done about it. While resolving the issue of Internet addiction is
important, the Internet addiction policy is pushed to the back burner in order to
pursue a greater vision of national development and operation. This issue
associated with the paradigm of national operation is clearly a policy dilemma.
There is a dilemma even in the terminology used in relation to the
pathological use of the Internet. For example, the Ministry of Health and
Welfare and the Ministry of Gender Equality and Family opt to use the term,
“addiction,” as it is more advantageous for them. In contrast, the Ministry of
Culture, Sports and Tourism, which must promote the gaming industry, uses
the term, “over-flow,” rather than “addiction.” On the other hand, the Ministry
of Science, ICT and Future Planning, which must cultivate the information and
communications technology (ICT) industry, officially use the term, “over-
dependency.” While the latter two ministries partially acknowledge the
pathological aspect of Internet use, they wish to avoid the stigma that typically
arise from the term, “addiction.” Resolving this terminology dilemma will be
most difficult.
The concept of “over-dependency,” the term used by Ministry of Science,
ICT and Future Planning, has a different perspective of the pathological use of
the Internet compared to that of “addiction.” Ministry of Science, ICT and
Future Planning views “addiction” as a term conforming to a disease model,
with the supposition of diagnosis, treatment and recovery of patient.9 In
contrast, “over-dependency” is viewed as a term conforming to the choice
theory or the competence build-up model, which focuses on the growth-
oriented nature of humans.10 In other words, from this perspective, misuse of

9
In the disease model, addiction is viewed as a chronic and incurable disease that renders the
affected individuals powerless (White, W. L. 1998).
10
Gene. M. Heyman’s choice theory (2009) is based on the view that all human behaviors arise
from intrinsic motivations. From this viewpoint, addiction is not deterministic and can be
overcome (http://www.corwin.com/sites/default/files/upm-binaries/2983_11tcp01.pdf). The
82 Koh Young-Sam

the Internet is not a disease that clearly requires medical treatment, even
though it may be pathological, and it is a characteristic that can be fully
overcome by the affected individuals if they improve their self-regulation
ability and gain a balance in their daily lives. It is also believed that a thorough
analysis of one’s own symptoms and dispositions related to becoming
immersed in online chatting, searching and gaming may even become an
impetus for growth. This perspective is completely different from the view of
alcohol addiction, where it is believed that addicts will never fully recover
from their addictions and instead always be in the middle of recovery. In the
case of alcohol addiction treatment, Alcoholics Anonymous (A.A.) is regarded
as a major self-help-group of alcohol addicts who are expected to never fully
recover from their addictions (Lloyd, E. R. and David, L. A., 1992). In
contrast, Ministry of Science, ICT and Future Planning actually has reported a
number of cases in which most of the individuals determined to be at risk for
Internet addiction were treated effectively through counseling. The individuals
who finished the counseling program are not “in the middle of recovery,” but
are actually practicing their self-regulation skills from day to day and leading
healthy lives.11 This will need to be supported by more research results, but the
term, “Internet over-dependency,” focuses on the positive aspect in that it
differs from substance addiction. As such, this situation in which multiple
terms such as “addiction,” “over-flow” and “over-dependency” are used by
different government departments of the same nation to describe the same
phenomenon is clearly a case of policy dilemma.

term, “over-dependency,” used by Ministry of Science, ICT and Future Planning was
inspired by “dependency” used in DSM; however, strictly speaking, it was conceptualized
at a policy level rather than based on an academic basis. In order to understand the
discourse on Internet addiction in S. Korea, it is important to first understand this term.
11
For example, 8 adolescents at risk of Internet addiction were provided with solution-focused
counseling therapy, and the results of the quantitative study showed that depression and
stress in the family relationship was significantly reduced. Also, in a qualitative study using
Colaizzi’s phenomenological research method, changes in learning attitude and
achievement, effective time management, practice of alternative activities, changes in
spending habit, becoming physically healthier, some psychological changes, positive
changes in relationship with friends, positive changes in family relationship, and positive
changes in relationship with school teachers were observed (Hyoun-Sil, Moon, 2010).
 A Reflective Study of the Dilemmas in the Digital Addiction … 83

4.2. Dilemma of Business-Centered Entities among the

Government Departments

The Korean response to Internet addiction is unusual in that the

government stands very much at the frontline. Even more unique, it is not just
one specific bureau or office providing this response; rather, a variety of
federal bureaus help to fight Internet addiction (Young-Sam, Koh, 2015: 222).
This type of implementation system is probably difficult to understand for the
nationals of countries where national responses are rarely made. At present, in
S. Korea, the Internet addiction issue is dealt with by a total of 8 government
departments: Ministry of Science, ICT and Future Planning, Ministry of
Culture, Sports and Tourism, Ministry of Gender Equality and Family,
Ministry of Health and Welfare, Ministry of Education, the Ministry of
National Defense, Ministry of Justice, and Korea Communications
Commission. The 8 government departments are handling this problem, based
on their own identities, but there have been discussions in regard to operating
an Internet addiction policy implementation council, as a consultative body for
inter-departmental work, to enable mutual exchange of information and
minimize service redundancies.
Despite this, however, there is a dilemma in this implementation system.
First, some experts and citizens are not content with this implementation
system for the following reasons: (a) The involvement of multiple departments
has not lead to satisfying services; rather, it has resulted in redundant services
that waste government funds, and create a blind spot among the beneficiaries.
(Argument made by an NGO); (b) Although there are diverse departments
involved, the policies are not effective due to the absence of a control tower.
We should consider the prime minister playing the role of controlling,
adjusting and coordinating the related policies. (Argument made by Ministry
of Health and Welfare); (c) Because Internet addiction is an issue related to
mental health, the Ministry of Health and Welfare should be placed in charge
of the policy, thereby eliminating the dilemma involving the Ministry of
Science, ICT and Future Planning in charge of promoting the ICT industry and
the Ministry of Culture, Sports and Tourism in charge of promoting the
gaming industry. (Argument made by Ministry of Health and Welfare)
In order to accede to the above opinions, the current system must be
reformed in a revolutionary manner. However, these opinions are advocated
strongly, without any agreements among the interested parties and experts, and
thus the dilemma remains. For instance, a former psychiatrist and current
National Assemblyman of the ruling party proposed the enactment of a law
84 Koh Young-Sam

that would designate Internet games, together with illicit drugs, alcohol and
gambling as the “Top 4 Addictions,” to be dealt with in a comprehensive
manner at a center called the Addiction Management Center that would be
newly established in every region across the country. Also, efficient execution
of this program would require an addiction management committee to be
established under the Prime Minister’s Office, and to be operated by Ministry
of Health and Welfare. This was an attempt made by Ministry of Health and
Welfare, which had not taken an active stance in regard to the Internet
addiction issue prior to 2013, to change the then-circumstances and play a
leading role in the addiction policy.
The legislative bill was met with a strong opposition, as expected. There
were especially strong objections against categorizing gaming addiction along
with addiction to illicit drugs, viewed with abhorrence. Heavy criticisms
especially came from professional gamers, game content developers and
producers, workers in the cultural sector, and gaming industry associations,
who pointed out the problems at offline public hearings and in online spaces,
and engaged in protests in front of the National Assembly Building in Seoul.
Even the Ministry of Culture, Sports and Tourism advocated against the
legislation because, as a government department that is responsible for
promoting the gaming industry as a new growth engine, they knew they would
find themselves in a conundrum if the legislative bill, placing games in the
same category as drugs, were to pass.
Then, organizations formed by parents of school-aged children who
believed that children do not study solely because of “games” and Protestant
organizations that believed gaming took time and attention away from
religious activities proceeded to sign petitions showing their support for the
bill. At one point, the members of the ruling party, conscious of the voting
power of parents of school-aged children, attempted to pass the bill. However,
due to the objections against the bill, the importance of fostering the gaming
industry as the future growth engine of S. Korea, and the convincing argument
that functional games can be used in education, a deadlock was reached.
Finally in May 2016, the bill was rescinded, but the awareness of the issue
still remains. At present, there are those in S. Korea that believe Internet
games have been recognized as an independent disease, i.e., “addiction,” in
DSM-5.12 When more research results accumulate and the negotiating power

12
“Internet addiction (Internet Gaminig Disorder)” is identified in Section III of DSM-5, based
on the argument that there is a need for more research in order to find adequate grounds for
designating the pathological online gaining as a disease. However, some individuals,
 A Reflective Study of the Dilemmas in the Digital Addiction … 85

of doctors become more effective, it may be claimed by Ministry of Health

and Welfare that it should be the sole and principal entity dealing with the
Internet addiction issue, while the argument for classifying the “Top 4
Addictions” may be eliminated. In summary, this issue is in an unstable
position, amidst the arguments made by numerous interested parties.
As this issue concerns the interests of not only Ministry of Culture, Sports
and Tourism and Ministry of Health and Welfare, but also other government
departments, the policy dilemma is expected to remain, especially since their
interests are predicated on their roles in the government organization. For
instance, because the proportion of young people experiencing Internet
Addiction is high, the Ministry of Gender Equality and Family is one of the
organizations involved in developing the response. The Ministry of Culture,
Sports and Tourism which oversees the video game industry, has also been
involved in developing this response, because online games are a significant
facet of Internet addiction. The Ministry of Education is involved in educating
elementary, middle and high school students, who display relatively higher
Internet addiction rates. The Ministry of Health and Welfare is also involved,
as Internet addiction is associated with psychological mechanisms. The reason
for the involvement of the Ministry of National Defense is reflected by the
number of soldiers experiencing Internet addiction, while the involvement of
the Ministry of Justice is reflected in the volume of crimes committed by
Internet addicts. It is the Ministry of Science, ICT and Future Planning, which
currently plays the key role in this work. Overseeing the ICT promotion
policy, the Ministry considers the Internet addiction policy a specialized field
of ICT promotion policy (Young-Sam, Koh, 2015: 222).
In order to resolve this dilemma, the government is currently operating an
organization called the Internet Addiction Policy Council, in which the
representatives of the 8 relevant government departments participate.
However, the fact of the matter is that the council is too weak to coordinate the
interests of the departments involved. The law concerned may be amended to
reinforce its coordination and adjustment functions, but it will be faced with
resistance from the government departments that are wary of granting more
power to another government department.

depending on their interests, are interpreting this as the recognition of Internet addiction as
an independent disease.
86 Koh Young-Sam

4.3. Dilemma in the Division of Roles and Cooperation among

the Central and Local Governments and the Citizens

Will the dilemma in relation to policy implementing entities be resolved if

the roles of multiple government departments were to be readjusted? It
probably will not be easy, as there is another related problem. It is the dilemma
concerning the authority and responsibility of the central and local
governments, which is as follows: The Internet addiction resolution policy
determined by the central government is passed on to the local governments
after budget allocation. The local governments then implement the policy in
their regional spheres with the allocated budget. In other words, the local
governments directly execute the policy conceptualized by the central
government. Are there any problems in this method? Following criticisms
have been voiced in regard to the government roles: (a) The issue of Internet
addiction arises in the living spheres of the public, and thus must be dealt with
by the local governments, instead of the central government. (Argument made
by some experts); (b) In order to resolve the issue of Internet addiction, the
government must form a governance system together with the private sector
such as the media, enterprises and NGOs. (Argument made by the central
government, NGOs and some experts); (c) The government must endeavor to
create a healthy culture, rather than responding to this issue with a policy that
leans to one side. (Argument made by some experts)
These valid points that were raised began to persuade the public, and
gradually caused a policy dilemma. Recently, there have been new discourses
among S. Koreans regarding the authority, role and responsibility of the
government. Until now, in Korea, the State has been authoritarian in nature,
with a substantive authority and role in conceptualizing and executing policies
as well as strong implementation power. Nowadays, citizens are arguing that
such centralized governance system, in which the central government exerts
excessive regulation power and monopolizes the duties that should be
undertaken by the local governments, must be done away with, especially
since it is not in line with the current trends of the time.
Let us now examine the policy dilemma pertaining to the legal restrictions
set forth by the State in regard to Internet addiction. The most representative
regulation is the compulsory shut-down system, which prevents children and
adolescents under the age of 16 from accessing online games from midnight
until 6 a.m. the next morning (Enforced in Nov. 2011). There is also a
selective shut-down system, which requires children and adolescents under the
age of 18 to obtain parental consent to access games and cybercafes and
 A Reflective Study of the Dilemmas in the Digital Addiction … 87

restricts the gaming hours of children if such is requested by their parents

(Enforced on July 1, 2012) (Jong-Moon, Cho, 2015: 259-262).
The enforcement of these systems gave rise to a serious policy dilemma.
Civic organizations filed petitions to the Constitutional Court, insisting that
these systems infringe the adolescents’ rights to freedom of action, the parents’
right to educate their children, and the Internet game providers’ freedom to
perform work. Also, children and adolescents under the age of 16 resorted to
using their parents’ residential residence numbers and IDs, and this problem
became rampant. Moreover, the gamin hours of adolescents did not decrease.
Based on these reasons, a study reported that the systems were ineffective
(Ug-Jun, Sung, 2013). Furthermore, there were criticisms that these systems
caused the domestic gaming industry to shrink (Cultural Action Alliance,
2014). Adolescents voiced severe criticisms online against the Ministry of
Gender Equality and Family, which was the administrator behind the law in
question.
However, the Constitutional Court ruled that the law was constitutional in
April 2004. This court decision was wholly welcomed by the parents, who
wanted to control their children’s gaming behavior, but the negative public
opinion of the shut-down system remained and there were still those arguing
for its discontinuance. Criticisms that parents, who were responsible for
educating their own children, were abandoning their duties and being reliant
solely on government regulations also continued. As a result, the Ministry of
Gender Equality and Family, the principal entity behind the law, announced
that they will change the compulsory shutdown system to allow adolescents to
play online games even at night, if such is requested by the parents (Jong-
Moon, Cho, 2015: 259-262).
What caused such confusions and policy dilemmas? It was probably due
to the presence of conflicting views in society in regard to the role of the State.
In the past, under the authoritarian regime, the State ran the country with iron-
handed leadership to strive toward its goals, but now, there are a growing
number of people insisting that such method should be obsolete in this day and
age and that the State must share the role in planning, executing and evaluating
policies with the citizens. They are demanding a shift from a “government
paradigm” to a “governance paradigm,” which is driven based on the values of
openness, sharing and participation.13

13
Governance means that a cooperative and participatory government, rather than a government
that exerts its power in a unilateral, top-down manner. This concept arose from the
recognition that the government cannot solve all problems in today’s society where there
are a complexity of interests of different individuals and entities. (Sae-Eok, Han & Young-
88 Koh Young-Sam

However, in order for governance to be established as an administrative

culture, there needs to be a groundbreaking change. Citizens demand that
some of the authorities of the central government be passed down to the local
governments and then to the people. However, it is unlikely for the central
government to give up their present authority and budget, and it will try to
retain the authorities, even if they could and should be transferred to the local
governments for decentralization purposes.
The prevention and resolution of Internet addiction corresponds to the
office work performed by the local governments. From the theoretical
perspective, local governments must handle the office work related to resident
welfare promotion, regional development and residential living environment,
and promotion of education, sports, culture and the arts. Resolving the issue of
Internet addiction is associated with promoting resident welfare and improving
living standards, and thus should be undertaken by the local governments. If
Internet addiction among adolescents is mainly caused by online games or
communications policies, then it should be handled solely by the central
government. However, in actuality, Internet addiction is a complex issue that
occurs or is resolved due to a wide range of intricate factors related to the
communities in which children and their families live as well as family issues
concerning the affected children.
In these cases, the central government should not be the sole entity
endeavoring to prevent and resolve the Internet addiction issue. Based on this,
regulation-centered policies led by the central government will inevitably have
limitations. The government must innovate their operating methods on its own.
In other words, the government must “enable” people to take action rather than
simply “provide” something, and to “steer” people into the right direction
instead of “rowing” on its own. Because this complex issue cannot be resolved
by the central government on its own, it should stop commanding and being
controlling, and instead make the necessary changes so that the parties
concerned help and cooperate with one another (Leach and Percy-Smith, 2001:
5-7).
From this perspective, in regard to the Internet addiction issue, the local
governments should play a central role, analyzing the causes of addiction in
their respective communities and using the diverse resources that are present
such as schools, enterprises, religious institutions, specialized hospitals and
clinics, natural recuperation centers, training centers, NGOs, libraries and

Sam, Koh, 2012: 464).. In other words, it refers to a method in which the government,
enterprises and citizens participate in all of the policy processes from conceptualization,
execution and evaluation
 A Reflective Study of the Dilemmas in the Digital Addiction … 89

music halls, to create resilient communities. The problem is that, despite the
ongoing demand for a system that suits the time period, the central
government will not likely make such changes. The local governments do not
wish to fight for leadership in this issue due to their low budgets. Amid this
ironic situation, creating highly resilient communities is being delayed.

5. CONCLUSION
The current situation pertaining to the Internet addiction policy of S.
Korea was examined above. Just as is the case with the majority of national
policies, the Internet addiction resolution policy has been formed on the
boundaries where the demands of the interested parties are in conflict. The
competition between the government departments to claim leadership in the
issue, opposition and cooperation between the government and civic
organizations, and conflicts among the gaming industry, parents, and
organizations with different aims and interests all combine together and exert
complex impacts to create a new type of terrain. For this reason, there cannot
exist a national policy that can satisfy everyone.
In this paper, three policy dilemmas were brought to attention in order to
reflect on the national policy implemented for Internet addiction, an issue
where there are numerous interested parties. Such policy dilemmas were the
cause and true nature of digital addiction, the inter-departmental
implementation systems of the central government, and the division of roles
and cooperation among the central and local governments and citizens. Of the
issues causing policy dilemmas, the shutdown system and the Top 4
Addictions classification system resulted in severe conflicts, so much so that
these issues were frequently reported by the media. What is of a greater
concern though are the recent advancements of digital technology that will
lead to new environmental changes, with the use of wearable computers, and
VR and AR systems. At this point, we have not yet clearly identified the true
nature of Internet addiction, yet we must prepare for addiction to new
technologies. Consequently, there will be more affected age groups than the
pathological use of the Internet, and it will require more diverse services to
prevent and resolve the new addictions. This will inevitably result in a new
dilemma.
90 Koh Young-Sam

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 BIBLIOGRAPHY

#hooked
LCCN 2011051052
Type of material Book
Personal name Jantz, Gregory L.
Main title #hooked / Gregory L. Jantz; with Ann McMurray.
Published/Created Lake Mary, Fla.: Siloam, c2012.
Description ix, 241 p.; 23 cm.
ISBN 9781616382575 (trade paper)
9781616388591 (ebook)
LC classification T14.5 .J346 2012
Variant title Hooked
Related names McMurray, Ann.
Contents A locked front door and a wide open web -- Multi-
taxed -- This is your brain on YouTube -- Thank you
for being a friend -- Just like real life -- Real
connection -- Instant download -- The angst of off-line
-- Transfer of power -- Who are you, really? -- Find the
off switch -- The ultimate filter.
Subjects Technology--Social aspects--Popular works.
Technological innovations--Social aspects--Popular
works.
Internet addiction--Popular works.
Compulsive behavior--Popular works.
Notes Includes bibliographical references (p. 231-241).
94 Bibliography

#Stolen: is social media stealing your identity?

LCCN 2015014541
Type of material Book
Personal name Fralin, Jessica.
Main title #Stolen: is social media stealing your identity? /
Jessica Fralin.
Published/Produced Nashville: Abingdon Press, [2015]
ISBN 9781426789069 (binding: soft back)
LC classification BV4596.I57 F73 2015
Subjects Social media--Religious aspects--Christianity.
Social media addiction.
Self-esteem in women--Religious aspects--
Christianity.
Identity (Psychology)--Religious aspects--Christianity.
Internet and women--Psychological aspects.
Internet and youth--Psychological aspects.
Internet addiction--Religious aspects--Christianity.
Notes Includes bibliographical references.
Additional formats Online version: Fralin, Jessica. #Stolen Nashville:
Abingdon Press, [2015] 9781501800542 (DLC)
2015016559

A review of research on problematic internet use and well-being: with

recommendations for the U.S. Air Force
LCCN 2015935310
Type of material Book
Personal name Breslau, Joshua, author.
Main title A review of research on problematic internet use and
well-being: with recommendations for the U.S. Air
Force / Joshua Breslau, Eyal Aharoni, Eric R.
Pedersen, Laura L. Miller.
Published/Produced Santa Monica, Calif.: RAND Corporation, [2015]
Description xiv, 43 pages; 28 cm
Links Publisher description https://www.loc.gov/catdir/
enhancements/fy1611/2015935310-d.html
ISBN 9780833088246
0833088246
LC classification RC569.5.I54 B74 2015
Related names Aharoni, Eyal, author.
 Bibliography 95

Pedersen, Eric R., author.

Miller, Laura L., 1967- author.
Project Air Force (U.S.)
Subjects United States. Air Force--Airmen--Mental health.
United States. Air Force.
Internet addiction.
Internet addiction--Treatment.
Behavior, Addictive--Review.
Internet--Review.
Notes "RAND Project Air Force."
"RR-849-AF."--Cover page 4.
Includes bibliographical references (pages 30-43).
Series Research report; RR-849-AF
Research report (Rand Corporation); RR-849-AF.

Behavioral addictions: criteria, evidence, and treatment

LCCN 2012278133
Type of material Book
Main title Behavioral addictions: criteria, evidence, and treatment
/ edited by Kenneth Paul Rosenberg, Laura Curtiss
Feder.
Published/Created London; Waltham, MA: Academic Press, c2014.
Description xxxi, 381 p.; 24 cm.
ISBN 9780124077249 (hbk.)
0124077242 (hbk.)
LC classification RC533 .B447 2014
Related names Rosenberg, Kenneth Paul. edt
Feder, Laura Curtiss edt
Contents An introduction to behavioral addictions / Kenneth
Paul Rosenberg, Laura Curtiss Feder -- Behavioral
addiction: the nexus of impulsivity and compulsivity /
Natalie L. Cuzen, Dan J. Stein -- Diagnosis and
treatment of bambling disorder / Jon E. Grant, Brian L.
Odlaug -- Problematic online gaming / Orsolya Király,
Katalin Nagygyörgy, Mark D. Griffiths, Zsolt
Demetrovics -- Internet addiction disorder: overview
and controversies / Aviv Weinstein, Laura Curtiss
Feder, Kenneth Paul Rosenberg, Pinhas Dannon --
Social networking addiction: an overview of
96 Bibliography

preliminary findings / Mark D. Griffiths, Daria J.

Kuss, Zsolt Demetrovics -- Food addiction: evidence,
evaluation, and treatment / Yvonne H.C. Yau, Carrie
D. Gottlieb, Lindsay C. Krasna, Marc N. Potenza --
New directions in the pharmacological treatment of
food addiction, overeating, and obesity / Amelia A.
Davis, Paula J. Edge, Mark S. Gold -- Sex addiction:
an overview / Kenneth Paul Rosenberg, Suzanne
O'Connor, Patrick Carnes -- The tyranny of love: love
addiction - an anthropologist's view / Helen E. Fisher -
- Picking up the pieces: helping partners and family
members survive the impact of sex addiction / Stefanie
Carnes, Mari A. Lee -- Compulsive buying disorder /
Emma Racine, Tara Kahn, Eric Hollander -- Exercise
addiction / Krisztina Berczik, Mark D. Griffiths, Attila
Szabó, Tamás Kurimay, Róbert Urban, Zsolt
Demetrovics -- Meditation and spirituality-based
approaches for addiction / Sri Sri Ravi Shankar,
Kenneth Paul Rosenberg, Anju Dhawan, Achar
Vedamurthachar -- Behavioral addiction in American
law: the future and the expert's role / Daniel H.
Willick.
Subjects Compulsive behavior.
Psychology, Pathological.
Notes Includes bibliographical references and index.

Behavioral addictions: DSM-5® and beyond

LCCN 2014047897
Type of material Book
Uniform title Behavioral addictions (Petry)
Main title Behavioral addictions: DSM-5® and beyond / edited
by Nancy M. Petry.
Published/Produced Oxford; New York: Oxford University Press, [2016]
ISBN 9780199391547 (alk. paper)
LC classification RC533
Related names Petry, Nancy M., editor.
Contents Gambling disorder: the first officially recognized
behavioral addiction / Nancy M. Petry -- Internet
gaming disorder: a new behavioral addiction / Florian
 Bibliography 97

Rehbein, Simone Kühn, Hans-Jürgen Rumpf and

Nancy M. Petry -- Internet addiction: a future addictive
disorder? / Hans-Jürgen Rumpf, Ran Tao, Florian
Rehbein and Nancy M. Petry -- Hypersexual disorder /
Megan M. Campbell and Dan J. Stein -- Compulsive
shopping as a behavioral addiction / Donald W. Black
-- Exercise addiction: diagnosis, psycho-biological
mechanisms and treatment / Aviv Weinstein and
Yitzhak Weinstein -- Food addiction / Susan Murray,
Mark S. Gold and Nicole M. Avena -- Addicted to
UV: evidence for tanning addiction / Jerod L.
Stapleton, Joel Hillhouse and Elliot J. Coups.
Subjects Diagnostic and statistical manual of mental disorders.
5th ed.
Behavior, Addictive--diagnosis.
Impulse Control Disorders--diagnosis.
Notes Includes bibliographical references.

Cell phone distraction, human factors, and litigation

LCCN 2016011900
Type of material Book
Main title Cell phone distraction, human factors, and litigation /
edited by T. Scott Smith; contributors, Grant Chaisson,
Patrick L. Dunn, Chelsea Schaeffer, Mary Sciaraffa,
Elizabeth R. Smith, RN, MSN, Mary Sciaraffa.
Published/Produced Tucson, Arizona: Lawyers and Judges Publishing
Company, Inc., 2016.
ISBN 9781936360390 (hardcover: alk. paper)
193636039X (hardcover: alk. paper)
LC classification HE9713 .C43 2016
Related names Smith, T. Scott (Theodore Scott) editor.
Contents Introduction -- Introduction -- Main questions --
History -- Cell phone use in contemporary society --
Interpreting research -- Locating relevant research --
Selecting expert witnesses -- Cognition -- Foundations
of cognitive science -- Original research: false memory
-- Original student research: effects of cell phone
distraction on geometric planning with applications to
collegiate classroom -- Driving -- Hands-free debate --
98 Bibliography

Federal initiatives -- State-by-state restrictions on cell

phone use while driving in the United States -- Failures
of visual awareness -- Change blindness -- Visual
masking -- Human factors and social interactions --
Cell phone addiction -- Developmental aspects of cell
phone distraction -- Mobile media and young children
-- Childhood cognition and eyewitness testimony --
Emerging adulthood (college students) and collegiate
performance -- Distracted walking -- Distracted
walking -- Nursing performance -- Nursing and critical
thinking skills -- Nursing and social media -- Patient
safety: health care distraction study in Pennsylvania --
Litigating an impaired employee performance case --
Driver characteristics -- Phone-related distracted
behaviors -- Perceptions of distracted driver safety --
Future directions -- Future directions -- References --
About the author -- About the contributors -- Index.
Subjects Cell phones--Social aspects.
Cell phones and traffic accidents.
Cell phones--Law and legislation.
Internet addiction.
Compulsive behavior.
Notes Includes bibliographical references and index.

Evolving psychological and educational perspectives on cyber behavior

LCCN 2012005386
Type of material Book
Main title Evolving psychological and educational perspectives
on cyber behavior / Robert Zheng, editor.
Published/Created Hershey, PA: Information Science Reference, c2013.
Description xxvi, 309 p.: ill.; 30 cm.
ISBN 9781466618589 (hbk.)
9781466618596 (ebook)
9781466618602 (print and perpetual access)
LC classification BF637.C45 .E86 2013
Related names Zheng, Robert.
Summary "This book identifies learners' online behavior based
on the theories in human psychology, defines online
education phenomena as explained by the social and
 Bibliography 99

cognitive learning theories and principles, and

interprets the complexity of cyber learning"--Provided
by publisher.
Subjects Internet--Psychological aspects.
Internet users--Psychology.
Internet addiction.
Web-based instruction--Psychological aspects.
Notes Includes bibliographical references and index.

Facebook nation: total information awareness

LCCN 2014951523
Type of material Book
Personal name Lee, Newton.
Main title Facebook nation: total information awareness /
Newton Lee.
Edition Second edition.
Published/Produced New York: Springer, [2014]
©2014
Description xv, 412 pages: illustrations; 24 cm
ISBN 1493902091
9781493902095
1493917390
9781493917396
LC classification QA76.575 .L44 2014
Contents Part I. Prologue: From 1984 to Total Information
Awareness: President Ronald Reagan in 1984; Total
Information Awareness; Edward Snowden's NSA leads
and PRISM; Social networks' responses to NSA leaks
and PRISM; Reform government surveillance and
reset the net -- Part II. Privacy in the age of big data:
Social networks and privacy: Zero privacy and the
Central Intelligence Agency; The archer, carrier
pigeons, and President Jimmy Carter; The
pervasiveness of Facebook; Chairs are like Facebook;
Facebook and personal privacy; Facebook friends and
personal privacy; Facebook, children, and COPPA;
Facebook, peer pressure, and social issues; Reality TV
and social media; YouTube and Facebook videos: Am
I pretty or ugly?; Netflix and social apps on Facebook;
100 Bibliography

Facebook timeline and Open Graph; Ambient social

apps; Stalking apps and Facebook for sex; Facial
recognition apps; Facial recognition on Facebook,
Google+, and iPhone; Virtual passports: from privacy
to data use; Social search: Google, plus Your World
and Microsoft's Bing; Self-destructing messages;
Facebook anonymous login; Anonymous social apps;
Responses to zero privacy -- Smartphones and privacy:
Smartphones; Location tracking on iPhone and iPad;
Carrier IQ; Smartphone data collection transparency;
Always on; Mobile apps privacy invasion; Mobile
apps for children; Android market and Google Play;
Apple's app store; Facebook app center -- Privacy
breaches: Google street view; Google Easter eggs in
disguise; Apple software bugs; Facebook user tracking
bug and online behavioral tracking; Carrier IQ and
other privacy blunders -- Part III. Business intelligence
in social media: Business intelligence: Intelligent
digital billboards; Data mining, Amazon.com, Lowe's
and Target, True and Co.; Tumblr and Gmail: yes to
advertisements; Social ads on Facebook; News Feed,
Sponsored Stories, Custom Stories, and Facebook
Exchange; Mobile market 2011-present: Facebook for
every phone; Mobile market 2012-present: Instagram
and mobile app install ads; Mobile market 2013-
present: Facebook home and parse; Mobile market
2014-present: WhatsApp and Facebook Audience
Network; Location-based mobile advertisements;
Business communication on Facebook; B2B, B2C,
H2H on social media -- Facebook analytics,
advertising, and marketing / Dennis Yu and Alex
Hong: The viral cycle; Metrics analysis action (MAA);
Everything you need to know about Website Custom
Audiences (WCA); Ten questions any Facebook
marketing consultant should by able to answer; The
insider's guide to Facebook traffic; Using exclusion
targeting to filter out unwanted targets; Guess where
users are spending more time: TV or mobile/Web?;
The mechanics of Facebook ad budgeting; How
 Bibliography 101

spending a few dollars on Facebook can turn you into

an influencer; The danger of buying Facebook fans;
How to tell if your ad is working and diagnose
newsfeed burnout -- Part IV. The rise of Facebook
nation: Twitter: a world of immediacy: The pen is
mightier than the sword; Citizen journalists; A world
of immediacy; Prevalence of Twitter; Advertisements
and campaigns on Twitter; Cuban Twitter: ZunZunco;
Creative uses of Twitter; The downside of Twitter --
Misinformation and disinformation: The war of the
worlds; Misinformation and disinformation on Twitter
and Facebook; Ramifications and repercussions of
misinformation and disinformation; Trustworthiness of
Wikipedia; Google search sabotage; Advertising
misinformation and disinformation; Authenticity of
Facebook Profiles, Twitter accounts, and YouTube
videos; Facebook account verification; Twitter verified
accounts; Abuse of power -- Wikipedia and the new
Web / Emily Temple-Wood: History of Wikipedia;
Standard of quality; Learning curve; Wikipedia as
major news source; Wikipedians; Acceptance of
Wikipedia; Wikipedia educational program; Systemic
bias and WikiProject women scientists; Native
language Wikipedia; Wikipedia Zero -- E-government
and E-activism: President Barack Obama and Web 2.0;
Gov 2.0 apps; The Kony 2012 phenomenon; Reactions
to Kony 2012; SOPA/PIPA blackout day; Reactions to
SOPA/PIPA blackout; Battles over Internet
legislations: OPEN, ACTA, CISPA; Peace on
Facebook and Facebook Donate; Internet activism and
Occupy Democracy; Transnational (Arab-Israeli)
Facebook nation; Internet censorship in western
democracies; Internet censorship in China; Arab spring
uprisings. Egypt. Syria, Saudi Arabia, and Turkey; The
rise of Facebook nation; Electoral College, social
network constitution, cyber civil rights. Part V. Total
Information Awareness in Facebook nation:
Generation C in the age of big data: Digital omnivores
and Generation C; Big data research and development
102 Bibliography

initiative; Big data in public health and economics; Big

data in Facebook and Google -- Living in Facebook
nation: Digital personalities and identities;
Intertwining lives, online and offline; Digital footprint
and exhaust data; Social media regrets; Facebook
social plug-in: Like; Facebook knows who, when,
where; Online births and deaths in Facebook nation;
Memorialization on Facebook and life after death on
social networks; The Facebook cleanse or face-to-
Facebook; Connected cars: in-vehicle social networks
and eXpressive Internet Architecture -- Connected
home, Internet of Things, and Internet of me; Internet
addiction and digital detox -- Personal privacy and
information management: Personal information for
sale; Personal information at risk Identity theft
prevention; Privacy protection; Privacy on Facebook;
Privacy on Google; Privacy on Smartphones; Data
vault: data is the new oil; Personal analytics and social
networks; Community analytics and social networks --
Personal Total Information Awareness: Humanity's
dashboard; Ambient awareness and suicide prevention;
Parental awareness, school bullying and cyberbullying;
Student awareness and school safety; Crime awareness
and video surveillance; Community awareness and
neighborhood watch; Situational awareness and traffic
safety; Location awareness and personal safety;
Information awareness and law enforcement; Self-
awareness and online dating; Pandora's box of Total
Information Awareness -- Part VI. Epilogue: From
Total Information Awareness to 1984: Brave new
world of Total Information Awareness; George
Orwell's 1984; Aldous Huxley's Brave New World;
Point of no return: and Internet.org: "Every one of us,
everywhere connected"; Privacy and e-activism: mesh
networks and peer-to-peer social networks; Facebook
questions: Two-way street of Total Information
Awareness -- Appendix A. Facebook timeline
(October 2003 -- August 2014 -- Appendix B.
Facebook's two-year historical stock prices (May
 Bibliography 103

18,2012-May 18, 2013).

Subjects Facebook (Firm)
Facebook (Electronic resource)
Multimedia systems.
Data protection.
Online social networks.
Internet--Security measures.
Online social networks--Social aspects.
Big data--Social aspects.
Privacy, Right of.
Notes Includes bibliographical references and index.

Human developmental research: experience from research in Hong Kong

LCCN 2013020303
Type of material Book
Main title Human developmental research: experience from
research in Hong Kong / Daniel T.L. Shek, PhD.,
Cecilia M.S., Ma, PhD., Yu Lu, PhD. and Joav
Merrick, M.D., editors.
Published/Produced New York: Nova Science Publishers, [2014]
Description xiv, 295 pages: illustrations; 26 cm.
ISBN 9781628081664 (hardcover)
LC classification H62.5.H6 H86 2014
Related names Shek, Daniel T. L .
Contents Introduction -- Human developmental research --
Human development research -- Use of structural
equation modeling in human development research /
Daniel T.L. Shek and Lu Yu -- Application of SPSS
linear mixed methods to adolescent development
research: basic concepts and steps / Daniel T.L. Shek
and Cecilia M.S. Ma -- How to plot growth curves
based on SPSS output?: illustrations based on a study
on adolescent development / Cecilia M.S. Ma and
Daniel T.L. Shek -- Confirmatory factor analysis using
AMOS: a demonstration / Daniel T.L. Shek and Lu Yu
-- Testing factorial invariance across groups: an
illustration using AMOS / Lu Yu and Daniel T.L. Shek
-- The use of confirmatory factor analyses in
adolescent research: project P.A.T.H.S. in Hong Kong
104 Bibliography

/ Daniel T.L. Shek and Cecilia M.S. Ma -- Family

functioning, positive youth development and internet
addiction in junior secondary school students:
structural equation models using AMOS / Lu Yu and
Daniel T.L. Shek -- Application -- Using structural
equation modeling to examine consumption of
pornographic materials in Chinese adolescents in Hong
Kong / Daniel T.L. Shek and Cecilia M.S. Ma --
Intention to engage in sexual behavior: influence of
family functioning and positive youth development
over time / Cecilia M.S. Ma and Daniel T.L. Shek --
Objective outcome evaluation of a positive youth
development program in China / Daniel T.L. Shek, Lu
Yu, Rachel C.F. Sun, Tak Yan Lee, Xiao Yan Han, Xi
Xi Li and Xin Zhao -- Subjective outcome evaluation
of the training program of the project P.A.T.H.S.:
findings based on the revised training program / Daniel
T.L. Shek and Hildie Leung -- Subjective outcome
evaluation of a positive youth development program in
China / Daniel T.L. Shek, Xiao Yan Han, Tak Yan Lee
and Lu Yu -- The Chinese adolescent materialism
scale: psychometric properties and normative profiles /
Daniel T.L. Shek, Cecilia M.S. Ma and Li Lin -- The
Chinese adolescent egocentrism scale: psychometric
properties and normative profiles / Daniel T.L. Shek,
Lu Yu and Andrew M.H. Siu -- Acknowledgement --
About the editors -- About the department of applied
social sciences, the Hong Kong Polytechnic
University, hong Kong, PRC -- About the national
institute of child health and human development in
Israel -- About the book series "Pediatrics, child and
adolescent health" -- Index.
Subjects Social sciences--Research--China--Hong Kong.
Social sciences--Research--Methodology.
Notes Includes bibliographical references and index.
Series Pediatrics, Child and Adolescent Health
 Bibliography 105

iDisorder: understanding our obession with technology and overcoming

its hold on us
LCCN 2011037963
Type of material Book
Personal name Rosen, Larry D.
Main title iDisorder: understanding our obession with technology
and overcoming its hold on us / Larry D. Rosen, Ph.D.
Published/Created New York: Palgrave Macmillan, c2012.
Description x, 246 p.: ill.; 25 cm.
ISBN 9780230117570 (hardback)
LC classification T58.5 .R667 2012
Summary "iDisorder: changes to your brain's ability to process
information and your ability to relate to the world due
to your daily use of media and technology resulting in
signs and symptoms of psychological disorders--such
as stress, sleeplessness, and a compulsive need to
check in with all of your technology. Based on decades
of research and expertise in the "psychology of
technology," Dr. Larry Rosen offers clear, down-to-
earth explanations for why many of us are suffering
from an "iDisorder." Rosen offers solid, proven
strategies to help us overcome the iDisorder we all feel
in our lives while still making use of all that
technology offers. Our world is not going to change,
and technology will continue to penetrate society even
deeper leaving us little chance to react to the
seemingly daily additions to our lives. Rosen teaches
us how to stay human in an increasingly technological
world"-- Provided by publisher.
Contents Machine generated contents note: -- 1. We Didn't Start
the Fire * 2. Mini Generations 3. Internet of the Future
* 4. Our Social Selves * 5. Who Am I Anyway? Am I
My Online Persona or My Real Self? * 6. Is Anything
Private Anymore? * 7. Information Overload * 8. The
Myth of ADHD/OCD * 9. Taking an Emotional Toll *
10. How Does the Brain Work and What Are We
Doing to Drive it to its Limits * 11. Distracting
Ourselves to Death * 12. It's Not About Managing
Your Time. It is About Managing Your Technology.
106 Bibliography

Subjects Information technology--Psychological aspects.

Internet addiction.
Psychology / Cognitive Psychology
Psychology / General
Psychology / Neuropsychology
Psychology / Social Psychology

Internet addiction: a public health concern in adolescence

LCCN 2013017748
Type of material Book
Main title Internet addiction: a public health concern in
adolescence / Artemis Tsitsika, Mari Janikian, Donald
E. Greydanus, Hatim A. Omar and Joav Merrick,
editors.
Published/Produced New York: Nova Publishers, [2013]
©2013
Description xviii, 227 pages; 23 cm
ISBN 9781626189256 (hardcover)
1626189250 (hardcover)
LC classification RC569.5.I54 I55 2013
Related names Tsitsika, Artemis, editor of compilation.
Subjects Internet addiction.
Internet and teenagers--Health aspects.
Teenagers--Health and hygiene.
Notes Includes index.
Series Pediatrics child and adolescent health

Internet addiction in psychotherapy

LCCN 2014451979
Type of material Book
Personal name Kuss, Daria J.
Main title Internet addiction in psychotherapy / Daria J. Kuss,
Nottingham Trent University, UK, and Mark D.
Griffiths, Nottingham Trent University, UK.
Published/Created Houndmills, Basingstoke, Hampshire: Palgrave
Macmillan, 2015.
Description viii, 128 pages; 23 cm.
ISBN 9781137465061 (hardcover)
1137465069 (hardcover)
 Bibliography 107

LC classification RC569.5.I54 K87 2015

Related names Griffiths, Mark, 1966-
Subjects Internet addiction--Treatment.
Psychotherapy.
Behavior, Addictive--therapy.
Internet.
Attitude to Computers.
Psychotherapy--methods.
Notes Includes bibliographical references (pages 115-124)
and index.
Series Palgrave studies in cyberpsychology
Palgrave pivot
Palgrave studies in cyberpsychology.
Palgrave pivot.

Internet addiction.
LCCN 2014960140
Type of material Book
Main title Internet addiction.
Published/Produced New York, NY: Springer Berlin Heidelberg, 2015.
Links Table of contents only http://www.loc.gov/catdir/
enhancements/fy1508/2014960140-t.html
Publisher description http://www.loc.gov/catdir/
enhancements/fy1508/2014960140-d.html
ISBN 9783319072418

Internet addiction
LCCN 2014932573
Type of material Book
Personal name Perdew, Laura, author.
Main title Internet addiction / by Laura Perdew; content
consultant, Dr. Keith W. Beard, Marshall University,
Department of Psychology.
Published/Produced Minneapolis, Minnesota: Essential Library, an imprint
of Abdo Publishing, [2015]
Description 112 pages: color illustrations; 24 cm.
ISBN 9781624034213 (lib. bdg.)
1624034217 (lib. bdg.)
LC classification RC569.5.I54 P47 2015
108 Bibliography

Summary Discusses the issues surrounding Internet addiction,

including the history of the Internet, why Internet
addiction is hard to diagnose, and how people can
recover from this addiction.
Contents Lost in the digital world -- Origins of the Internet --
Internet addiction emerges -- Gaming --
Communicating -- Social networking -- Shopping and
gambling -- Media multitasking -- Seeking help.
Subjects Internet addiction--Juvenile literature.
Compulsive behavior--Juvenile literature.
Internet addiction.
Compulsive behavior.
Compulsive behavior.
Internet addiction.
Form/Genre Juvenile works.
Notes Includes bibliographical references (pages 104-109)
and index.
Series Essential issues
Essential issues.

Internet and social media addiction

LCCN 2014026932
Type of material Book
Personal name Nakaya, Andrea C., 1976-
Main title Internet and social media addiction / by Andrea C.
Nakaya.
Published/Produced San Diego, CA: ReferencePoint Press, Inc. ®, 2015.
ISBN 9781601527608 (hardback)
1601527608 (hardback)
LC classification RC569.5.I54 N35 2015
Contents Is internet and social media addiction a serious
problem? -- What causes online addiction? -- How do
online addictions affect health and well-being? -- How
can people overcome internet and social media
addictions?
Subjects Internet addiction.
Social media addiction.
Notes Includes bibliographical references and index.
Grade 9 to 12
 Bibliography 109

Series Compact research series

Is online addiction a serious problem?

LCCN 2013029018
Type of material Book
Personal name Netzley, Patricia D.
Main title Is online addiction a serious problem? / Patricia D.
Netzley.
Published/Produced San Diego, CA: ReferencePoint Press, [2014]
Description 96 pages: color illustrations; 24 cm.
ISBN 9781601526205 (hardback)
1601526202 (hardback)
LC classification RC569.5.I54 N48 2014
Subjects Internet addiction--Popular works.
Notes Includes bibliographical references and index.
Grade 9 to 12.
Series In controversy

Making sense of social problems: new images, new issues

LCCN 2012017855
Type of material Book
Personal name Best, Joel.
Main title Making sense of social problems: new images, new
issues / edited by Joel Best, Scott R. Harris.
Published/Created Boulder, Colo.: Lynne Rienner Publishers, 2012.
Description 335 p.; 23 cm.
ISBN 9781588268556 (hc: alk. paper)
9781588268808 (pb: alk. paper)
LC classification HN18.3 .B47 2012
Related names Harris, Scott R., 1969 September 16-
Contents Preface -- Introduction -- Studying the construction of
social problems / Scott R. Harris -- The nature of
claims -- Teen suicide: a tale of two communities /
Marguerite L. O'Leary and Joel Best -- Cell phone use
while driving: claimsmaking in the media / Peter F.
Parilla -- Claimsmakers -- The pet grief industry:
framing the problem of pet death / Nancy Berns -- The
movement linking vaccines to autism: parents and the
internet / Victor W. Perez -- Old skeletons, pagans, and
110 Bibliography

museums: why ancient human remains are a bone of

contention / Tiffany Jenkins -- Questioning experts --
Wankers, inverts, and addicts: the scientific
construction of sexuality as a social problem / Liahna
E. Gordon -- Murdered mothers: the social
construction of troubling statistics / Keith Roberts
Johnson -- Predicting financail collapse: when
claimsmaking activities fail / John Barnshaw -- The
role of the media -- "Choosing life": abortion,
adoption, and the problem of regret / Jennifer L. Dunn
-- The evolution of internet addiction / David
Schweingruber and Michelle Horstmeier -- Breaking
news on nancy grace: violent crime in the media /
Brian A. Monahan and R.J. Maratea -- Policy
outcomes -- In the shadow of saturated fat: the struggle
to get trans fats noticed / Rachel J. Bacon -- Casinos
and smoke-free legislation: claimsmaking about policy
outcomes / Jenine K. Harris -- Global policy outcomes:
comparing reactions to post-tsunami aid / Lynn
Letukas -- Afterword -- Three questions for
constructionism / Scott R. Harris and Joel Best --
References -- Contributors -- Index.
Subjects Social problems.
Social perception.
Notes Includes bibliographical references (p. 295-329) and
index.
Series Social problems, social constructions

New media in the information society

LCCN 2011478781
Type of material Book
Main title New media in the information society / Ntombizandile
Carol (Zandi) Lesame, Blessing Mbatha, Sibongile
Sindane, editors.
Edition 1st ed.
Published/Created Pretoria: Van Schaik, c2012.
Description xii, 229 p.: ill., maps, ports.; 25 cm.
ISBN 9780627029974
0627029973
 Bibliography 111

LC classification HM851 .N865 2012

Related names Lesame, N. C.
Mbatha, B. (Blessing)
Sindane, S. (Sibongile)
Subjects Information society.
Internet addiction.
Internet.
Mass media--Information technology.
Notes Includes bibliographical references and index.

Online addiction: The Internet

LCCN 2012014191
Type of material Book
Personal name Parks, Peggy J., 1951-
Main title Online addiction: The Internet / by Peggy J. Parks.
Published/Created San Diego, CA: ReferencePoint Press, 2013.
Description 96 pages: illustrations (chiefly color): 24 cm.
ISBN 9781601522702 (hardback)
1601522703 (hardback)
LC classification RC569.5.I54 P37 2013
Contents Is online addiction real? -- Can people get addicted to
social networking? -- How serious a problem Is
compulsive online gaming and gambling? -- Can
people recover from online addiction?
Subjects Internet addiction--Popular works.
Notes Includes bibliographical references (pages 88-90) and
index.
Series Compact research series

Online health and safety: from cyberbullying to internet addiction

LCCN 2015032650
Type of material Book
Personal name Schell, Bernadette H. (Bernadette Hlubik), 1952-
Main title Online health and safety: from cyberbullying to
internet addiction / Bernadette H. Schell.
Published/Produced Santa Barbara, California: Greenwood, ©2016.
Description x, 345 pages; 27 cm
ISBN 9781440838965 (hardback: alk. paper)
LC classification HV6773.15.C92 S36 2016
112 Bibliography

Subjects Cyberbullying.
Internet addiction.
Notes Includes bibliographical references and index.

Positive youth development: a new school curriculum to tackle adolescent

developmental issues
LCCN 2012008885
Type of material Book
Main title Positive youth development: a new school curriculum
to tackle adolescent developmental issues / Editors:
Hing Keung Ma (Hong Kong Baptist University, Hong
Kong, PRC), Daniel TL Shek (The Hong Kong
Polytechnic University, Hunghom, Hong Kong, PRC),
Joav Merrick (Health Services, Division for
Intellectual and Developmental Disabilities, Ministry
of Social Affa).
Published/Produced Hauppauge, New York: Nova Science Publisher's,
Inc., [2012]
Description xii, 190 pages: illustrations; 27 cm
ISBN 9781620813843 (hardcover)
LC classification HQ799.C552 H677 2012
Related names Ma, Hing Keung.
Shek, Daniel T. L.
Merrick, Joav, 1950-
Contents A brief overview of adolescent developmental
problems in Hong Kong / Daniel TL Shek, Hing
Keung Ma and Rachel CF Sun -- Development of a
new curriculum in a positive youth development
program / Daniel TL Shek, Hing Keung and Rachel
CF Sun -- Construction of an integrated positive youth
development conceptual framework for the prevention
of the use of psychotropic drugs among adolescents /
Tak Y Lee -- Importance of emotional competence in
designing an anti-drug education curriculum for junior
secondary school students in Hong Kong / Ben MF
Law and Tak Yan Lee -- Parent engagement in youth
drug prevention in Chinese families: advancement in
program development and evaluation / Sandra KM
Tsang -- Using positive youth development constructs
 Bibliography 113

to design a drug education curriculum for junior

secondary students in Hong Kong / Ching Man Lam,
Patrick SY Lau, Ben MF Law and Yu H Poon --
Teaching money literacy in a positive youth
development program / Tak Yan Lee and Ben MF Law
-- Using positive youth development constructs to
design a money management curriculum for junior
secondary school students in Hong Kong / Patrick SY
Lau, Ching-Man Lam, Ben MF Law and Yu H Poon --
Bystander position-taking in school bullying: the role
of positive identity, self-efficacy and self-
determination / Sandra KM Tsang, Eadaoin KP Hui
and Bella CM Law -- Combating school bullying
through developmental guidance for positive youth
development and promoting harmonious school culture
/ Eadaoin KP Hui, Sandra KM Tsang and Bella CM
Law -- Internet addiction and antisocial internet
behavior of adolescents / Hing Keung Ma --
Construction of a teaching package on promoting
prosocial internet use and preventing antisocial internet
use / Hing Keung Ma, Miranda KY Chu and Winnie
WY Chan.
Subjects Youth development--China--Hong Kong.
Problem youth--Behavior modification--China--Hong
Kong.
Juvenile delinquency--China--Hong Kong--Prevention.
Notes Includes bibliographical references and index.

Psychological and social implications surrounding internet and gaming

addiction
LCCN 2015012041
Type of material Book
Main title Psychological and social implications surrounding
internet and gaming addiction / Jonathan Bishop,
Centre for Research into Online Communities and E-
Learning Systems, [editor].
Published/Produced Hershey, PA, USA: Information Science Reference, an
imprint of IGI Global, [2015]
Description xx, 335 pages: illustrations; 29 cm.
114 Bibliography

ISBN 9781466685956 (hardcover)

1466685956 (hardcover)
LC classification RC569.5.I54 P76 2015
Related names Bishop, Jonathan, 1979-
Summary "This book focuses on the dark side of technology and
the ways in which individuals are falling victim to
compulsive internet use as well as gaming and
gambling addictions"-- Provided by publisher.
Contents Internet gaming disorder: a deeper look into addiction
vs. high engagement / Mario Lehenbauer-Baum,
Martina Fohringer -- New concepts, old known issues:
The DSM-5 and internet gaming disorder and its
assessment / Halley M Pontes, Mark D. Griffiths --
Determining the risk of digital addiction to adolescent
targets of internet trolling: implications for the UK
legal system / Jonathan Bishop -- Dangers of playing
with the virtual other in mind: a psychoanalytical view
on digital role-playing games and the edge between
facilitating personality development and endangering
the player's psyche / Katharina Mittlbèock -- Avoiding
adverse consequences from digital addiction and
retaliatory feedback: the role of the participation
continuum / Ashu M. G. Solo, Jonathan Bishop -- "I
can't do it by myself": an IPA of clients seeking
psychotherapy for their MMORPG addiction / Daria
Joanna Kuss -- Cyber-stalking or just plain talking?:
investigating the linguistic properties of rape-threat
messages as compulsive behaviours / Mark Beech,
Jonathan Bishop -- A theoretical model, including
user-experience, aesthetics, and psychology, in the 3D
design process / Thomas Photiadis, Nicos Souleles --
Using "on-the-fly corpus linguistics" to systematically
derive word definitions using inductive abstraction and
reductionist correlation analysis: considering seductive
and gratifying properties of computer jargon / Jonathan
Bishop -- The association between internet addiction
and psychosocial variables / Bahadir Bozoglan, Veysel
Demirer -- The impacts of alcohol on e-dating activity:
increases in flame trolling corresponds with higher
 Bibliography 115

alcohol consumption / Jason Barratt, Jonathan Bishop -

- Consulting the British public in the digital age:
technological innovation and internet addiction in the
Web 2.0 era / Shefali Virkar -- Responsible gambling
laws' contributions to behaviour change in problem
gamblers in online poker / Wynford Compton, Dino
M. Minoli, Mark M. H. Goode -- The games people
play: exploring digital addiction within the context of
the gamification of ICT project design for public sector
administration reform / Shefali Virkar.
Subjects Internet addiction.
Internet--Psychology.
Internet--Social aspects.
Compulsive gambling.
Notes "Premier reference source"--Cover.
Includes bibliographical references (pages 291-328)
and index.
Series Advances in psychology, mental health, and behavioral
studies (APMHBS) book series

Reclaiming conversation: the power of talk in a digital age

LCCN 2016297278
Type of material Book
Personal name Turkle, Sherry, author.
Main title Reclaiming conversation: the power of talk in a digital
age / Sherry Turkle.
Published/Produced New York: Penguin Press, 2015.
©2015
Description 436 pages; 25 cm
Links Contributor biographical information http://www.loc.
gov/catdir/enhancements/fy1606/2016297278-b.html
Publisher description http://www.loc.gov/catdir/
enhancements/fy1606/2016297278-d.html
ISBN 9781594205552 (cloth)
1594205558 (cloth)
9781101980460 (paperback: international edition)
110198046X (paperback: international edition)
LC classification P95.45 .T86 2015
Summary "Preeminent author and researcher Sherry Turkle has
116 Bibliography

been studying digital culture for over thirty years.

Long an enthusiast for its possibilities, here she
investigates a troubling consequence: at work, at
home, in politics, and in love, we find ways around
conversation, tempted by the possibilities of a text or
an email in which we don't have to look, listen, or
reveal ourselves. We develop a taste for what mere
connection offers. The dinner table falls silent as
children compete with phones for their parents'
attention. Friends learn strategies to keep
conversations going when only a few people are
looking up from their phones. At work, we retreat to
our screens although it is conversation at the water
cooler that increases not only productivity but
commitment to work. Online, we only want to share
opinions that our followers will agree with - a politics
that shies away from the real conflicts and solutions of
the public square. The case for conversation begins
with the necessary conversations of solitude and self-
reflection. They are endangered: these days, always
connected, we see loneliness as a problem that
technology should solve. Afraid of being alone, we
rely on other people to give us a sense of ourselves,
and our capacity for empathy and relationship suffers.
We see the costs of the flight from conversation
everywhere: conversation is the cornerstone for
democracy and in business it is good for the bottom
line. In the private sphere, it builds empathy,
friendship, love, learning, and productivity. But there
is good news: we are resilient. Conversation cures.
Based on five years of research and interviews in
homes, schools, and the workplace, Turkle argues that
we have come to a better understanding of where our
technology can and cannot take us and that the time is
right to reclaim conversation. The most human--and
humanizing--thing that we do. The virtues of person-
to-person conversation are timeless, and our most basic
technology, talk, responds to our modern challenges.
We have everything we need to start, we have each
 Bibliography 117

other"-- Source other than Library of Congress.

Contents The case for conversation. The empathy diaries; The
flight from conversation -- One chair. Solitude; Self-
reflection -- Two chairs. Family; Friendship; Romance
-- Three chairs. Education; Work -- The path forward.
The public square; The nick of time -- A fourth chair?.
The end of forgetting.
Subjects Conversation.
Communication--Technological innovations.
Online social networks.
Social interaction.
Internet and teenagers.
Cell phones and teenagers.
Internet addiction.
Digital media--Social aspects.
Cell phones and teenagers.
Communication--Technological innovations.
Conversation.
Digital media--Social aspects.
Internet addiction.
Internet and teenagers.
Online social networks.
Social interaction.
Neue Medien.
Interpersonale Kommunikation.
Zwischenmenschliche Beziehung.
Notes Includes bibliographical references (pages 367-416)
and index.

The behavioral addictions

LCCN 2014035470
Type of material Book
Uniform title Behavioral addictions (Ascher)
Main title The behavioral addictions / edited by Michael S.
Ascher, M.D., Petros Levounis, M.D., M.A.
Edition First edition.
Published/Produced Washington, DC: American Psychiatric Publishing, a
division of American Psychiatric Association, [2015]
©2015
118 Bibliography

Description xvii, 217 pages; 23 cm

ISBN 9781585624850 (pbk.: alk. paper)
1585624853 (pbk.: alk. paper)
LC classification RC552.R44 B44 2015
Related names Ascher, Michael S., 1980- , editor.
Levounis, Petros, editor.
American Psychiatric Association, issuing body.
Contents Helping people behave themselves: identifying and
treating behavioral addictions / Marc N. Potenza --
Forensic implications of behavioral addictions / Robert
L. Sadoff, Eric Y. Drogin, Samson Gurmu --
Problematic exercise: a case of alien feet / Elias
Dakwar -- Food addiction: sugar high / Jessica A.
Gold, Kimberly A. Teitelbaum, Mark S. Gold --
Gambling: Lord, I was born a gambling man / Carla J.
Rash, Nancy M. Petry -- Internet gaming disorder:
virtual or real? / Tolga Taneli, Yu-Heng Guo, Sabina
Mushtaq -- Internet addiction: the case of Henry, the
"reluctant hermit" / Sean X. Luo, Timothy K. Brennan,
Justine Wittenauer -- Texting and e-mail problem use /
Tauheed Zaman, Daniel Lache -- Kleptomania: to steal
or not to steal: that is the question / Erin Zerbo, Emily
Deringer -- Sex addiction: the fire down below / Lisa J.
Cohen -- Love addiction: what's love got to do with it?
/ Alexis Briggie, Clifford Briggie -- Shopping
addiction: if the shoe fits, buy it in every color! /
Najeeb Hussain, Nicole Guanci, Mahreen Raza,
Dmitry Ostrovsky -- Tanning addiction: when orange
is the new bronze / Petros Levounis, Omar Mohamed -
- Work addiction: taking care of business / Michael
Ascher, Jonathan Avery, Yael Holoshitz.
Subjects Compulsive behavior.
Behavior therapy.
Behavior, Addictive--therapy.
Notes Includes bibliographical references and index.
 Bibliography 119

The distraction addiction: getting the information you need and the
communication you want without enraging your family, annoying your
colleagues, and destroying your soul
LCCN 2013935729
Type of material Book
Personal name Pang, Alex Soojung-Kim.
Main title The distraction addiction: getting the information you
need and the communication you want without
enraging your family, annoying your colleagues, and
destroying your soul / Alex Soojung-Kim Pang.
Edition 1st ed.
Published/Created New York: Little, Brown, [2013].
Description 290 p.: ill.; 25 cm.
ISBN 0316208264 (hardcover)
9780316208260 (hardcover)
9780316247528 (pbk.)
0316247529 (pbk.)
LC classification HM851 .P345 2013
Summary The question of our time: can we reclaim our lives in
an age that feels busier and more distracting by the
day? We have all found ourselves checking email at
the dinner table, holding our breath while waiting for
Outlook to load, or sitting hunched in front of a screen
for an hour longer than we intended. Mobile devices
and the web have invaded our lives, and this is a big
idea book that addresses one of the biggest questions
of our age: can we stay connected without diminishing
our intelligence, attention spans, and ability to really
live? Can we have it all? Here the author, a Stanford
University technology guru, says yes. His book is
packed with fascinating studies, compelling research,
and crucial takeaways. Whether it is breathing while
Facebook refreshes, or finding creative ways to take a
few hours away from the digital crush, this book is
about the ways to tune in without tuning out. -
Publisher.
Contents Introduction: Two monkeys -- Breathe -- Simplify --
Meditate -- Deprogram -- Experiment -- Refocus --
Rest -- Eight steps to contemplative computing --
120 Bibliography

Appendix 1: Keeping a tech diary -- Appendix 2:

Rules for mindful social media -- Appendix 3: DIY
digital sabbath.
Subjects Information technology--Social aspects.
Communication and technology.
Technology--Social aspects.
Technology--Psychological aspects.
Internet addiction.
Notes Includes bibliographical references (p. 245-280) and
index.

The Internet in China 1980s-2000s: cultural, political, and social

dimensions
LCCN 2013030328
Type of material Book
Main title The Internet in China 1980s-2000s: cultural, political,
and social dimensions / editors, Ashley Esarey,
Randolph Kluver.
Published/Produced Great Barrington, Massachusetts: Berkshire Publishing
Group, [2014]
Description iv, 266 pages; 26 cm
ISBN 9781933782607 (hardcover: alkaline paper)
9781614729358 (paperback: alkaline paper)
LC classification TK5105.875.I57 I55625 2014
Related names Esarey, Ashley.
Kluver, Randy.
Contents Introduction / by Randolph Kluver -- Part 1. Business
and economics -- Internet service providers (ISPs) --
Internet and political development -- Advertising
online -- Shopping online -- Consumers online --
Telecommunications industry -- User generated
content -- Part 2. Governance, law, and politics -- E-
government -- Great firewall -- Internet content
filtering -- Monitoring -- Internet governance --
Internet regulation -- Part 3. Entertainment and
education -- Blogging -- Chinese language and
computing -- Digital divides -- Distance education --
Email -- Online game industry -- Microblogging --
Parody -- Text messaging -- Virtual reality -- Part 4.
 Bibliography 121

Society and social welfare -- Children online --

Chinese diaspora online -- Community online -- Social
and political impacts -- Internet cafes -- Internet events
-- Internet in everyday life -- Internet addiction --
Dating online -- Cybersex -- Conclusion / by Ashley
Esarey.
Subjects Internet--China.
Internet--Social aspects--China.
Social change--China.
China--Social conditions--1976-2000.
China--Social conditions--2000-
Notes Includes bibliographical references and index.

Threat talk: the comparative politics of internet addiction

LCCN 2011030410
Type of material Book
Personal name Manjikian, Mary.
Main title Threat talk: the comparative politics of internet
addiction / Mary Manjikian.
Published/Created Farnham Surrey, England; Burlington, VT: Ashgate,
c2012.
Description x, 187 p.; 25 cm.
ISBN 9781409433941 (hardback: alk. paper)
9781409433958 (ebook)
LC classification RC569.5.I54 M36 2012
Subjects Internet addiction--Social aspects.
Internet addiction--United States.
Internet addiction--China.
Notes Includes bibliographical references (p. [165]-179) and
index.

Treatment strategies for substance and process addictions

LCCN 2015002551
Type of material Book
Main title Treatment strategies for substance and process
addictions / [edited by] Robert L. Smith.
Published/Produced Alexandria, VA: American Counseling Association,
[2015]
©2015
122 Bibliography

Description xv, 347 pages: illustrations; 25 cm.

ISBN 9781556203534 (pbk.: alk. paper)
1556203535 (pbk.: alk. paper)
LC classification RC564 .T754 2015
Related names Smith, Robert L. (Robert Leonard), 1943- , editor.
American Counseling Association, issuing body.
Contents Addictions: an overview / Robert L. Smith -- Alcohol
addiction / Todd F. Lewis -- Tobacco (nicotine)
addiction / Robert L. Smith -- Marijuana addiction /
Richard S. Balkin -- Methamphetamine addiction /
Helena G. Rindone -- Prescription drug addiction /
Todd F. Lewis -- Pathological gambling / Stephen
Southern -- Sex addiction / Stephen Southern, Dawn
Ellison, and Mark Hagwood -- Disordered eating /
Tamara Duarte and Fredericka DeLee -- Work
addiction / Summer M. Reiner -- Exercise addiction /
Michele Kerulis -- Compulsive buying/shopping
addiction / Kimberly Frazier -- Internet addiction /
Joshua C. Watson -- Addictions: status, research, and
future / Robert L. Smith.
Subjects Substance abuse--Treatment.
Compulsive behavior--Treatment.
Substance-Related Disorders--therapy.
Behavior, Addictive--therapy.
Evidence-Based Practice--methods.
Notes Includes bibliographical references and index.

Youth and internet addiction in China

LCCN 2013004276
Type of material Book
Personal name Bax, Trent.
Main title Youth and internet addiction in China / Trent Bax.
Published/Produced New York: Routledge, 2014.
Description 228 pages; 25 cm.
ISBN 9780415656917 (hbk)
LC classification HQ799.9.I58 B39 2014
Contents Introduction: turn on -- Log in -- The internet addiction
disorder -- Critiques of the internet addiction disorder
model -- The humanistic intensive internet use model -
 Bibliography 123

- The family war-machine and the search for freedom -

- Push and pull factors -- DSM-IV: internet addiction
disorder -- Conclusion: log off.
Subjects Internet and youth--China.
Internet addiction--China.
Families--China.
Notes Includes bibliographical references and index.
Series Routledge culture, society, business in East Asia
series; 1
 RELATED NOVA PUBLICATIONS

INTERNET ADDICTION:
A PUBLIC HEALTH CONCERN IN ADOLESCENCE

Editors: Artemis Tsitsika, Mari Janikian,

Donald E. Greydanus, Hatim A. Omar and Joav Merrick
Division for Intellectual and Developmental Disabilities, Ministry of
Social Affairs and Social Services Jerusalem, Israel

ISBN: 978-1-62618-925-6 Publication Date: 2013

126 Related Nova Publications

The Internet has become an important channel for communication, source

of information, education tool, entertainment hub and social network in the
contemporary world. With the popular use of smart phones, people can
connect to the internet at any place, at any time. However, easy accessibility,
anonymity, rich entertainment programs, and information explosion in the
internet also attract young people to an extent that may adversely affect their
physical health, psychological well-being, family life and academic
performance. Although there is no agreed upon definition and assessment of
“internet addiction”, there are research findings showing that problems or
pathological use of the internet can lead to a wide range of personal,
interpersonal, family and social problems. Hence, internet addiction is an
emerging public health concern in different places in the world.
Overall speaking, this is a valuable piece of work which is very useful to
pediatricians, health professionals and researchers in the field of Internet
addiction.

BONDING AND INTERNET ADDICTION IN HONG KONG*

Daniel TL Shek, PhD, FHKPS, BBS, SBS, JP 1-5,†,

Moon YM Law, BSW, MSW, RSW1,2
and Jianqiang Liang1,2
Department of Applied Social Sciences,
1

The Hong Kong Polytechnic University, Hong Kong, PRC

2
Centre for Innovative Programmes for Adolescents and Families,
The Hong Kong Polytechnic University, Hong Kong, PRC
3
Kiang Wu Nursing College of Macau, Macau, PRC
4
Dept. of Social Work, East China Normal University, Shanghai, PRC
5
Division of Adolescent Medicine, Department of Pediatrics, Kentucky
Children’s Hospital, University of Kentucky College of Medicine,
Lexington, Kentucky, USA

* The full version of this chapter can be found in Adolescence and Health: Some International
Perspectives, edited by Joav Merrick, published by Nova Science Publishers, Inc, New
York, 2015.
† Correspondence: Professor Daniel TL Shek, PhD, FHKPS, BBS, SBS, JP, Chair Professor of
Applied Social Sciences, Department of Applied Social Sciences, Faculty of Health and
Social Sciences, The Hong Kong Polytechnic University, Room HJ407, Core H, Hunghom,
Hong Kong. E-mail: [email protected]
 Related Nova Publications 127

This chapter examines the role of gender and bonding in Internet addiction
in Hong Kong junior secondary school students. A total of 3,328 Secondary 1
(Grade 7) students responded to validated measures of positive youth
development and Internet addiction. Consistent with the predictions, results
showed gender differences in bonding, with adolescent girls showing a higher
level of perceived bonding than did adolescent boys; adolescent boys also
showed a higher level of Internet addiction symptoms than did girls. The
findings provided support for the literature on the prediction of the positive
youth development that bonding was related to risk behavior indexed by
Internet addiction. The theoretical and practical implications of the findings
are discussed.

BONDING AND INTERNET ADDICTION IN ADOLESCENT

BOYS AND GIRLS IN HONG KONG*

Daniel TL Shek, PhD, FHKPS, BBS, SBS, JP 1-5,†,

Tracy Wong, BSSc 1
and Moon YM Law, BSW, MSW, RSW1
1
Department of Applied Social Sciences, The Hong Kong
Polytechnic University, Hong Kong, PRC
2
Centre for Innovative Programmes for Adolescents and Families,
The Hong Kong Polytechnic University, Hong Kong, PRC
3
Kiang Wu Nursing College of Macau, Macau, PRC
4
Department of Social Work, East China Normal University, PRC
5
Division of Adolescent Medicine, Department of Pediatrics,
Kentucky Children’s Hospital, University of Kentucky College
of Medicine, Lexington, Kentucky, United States of America

This study examined the role of gender and bonding in Internet addiction
in Hong Kong junior secondary school students. A total of 3,328 Secondary 1

*
The full version of this chapter can be found in Child and Adolescent Health Yearbook 2014,
edited by Joav Merrick, published by Nova Science Publishers, Inc, New York, 2015.
† Correspondence: Professor Daniel TL Shek, PhD, FHKPS, BBS, SBS, JP, Chair Professor of
Applied Social Sciences, Faculty of Health and Social Sciences, Department of Applied Social
Sciences, The Hong Kong Polytechnic University, Room HJ407, Core H, Hunghom, Hong
Kong. E-mail: [email protected].
128 Related Nova Publications

(Grade 7) students responded to validated measures of positive youth

development and Internet addiction. Consistent with the predictions, results
showed gender differences in bonding, with adolescent girls showing a higher
level of perceived bonding than did adolescent boys; adolescent boys also
showed a higher level of Internet addiction symptoms than did girls. The
findings provided support for the prediction of the positive youth development
literature that bonding was related to risk behavior indexed by Internet
addiction. The theoretical and practical implications of the findings are
discussed.

INTERNET ADDICTION PHENOMENON IN EARLY

ADOLESCENTS IN HONG KONG*

Daniel TL Shek, PhD, FHKPS, BBS, SBS, JP†,1,2,3,4

and Lu Yu, PhD1
1
Department of Applied Social Sciences, The Hong Kong Polytechnic
University, Hong Kong, PRC
2
Centre for Innovative Programmes for Adolescents and Families,
The Hong Kong Polytechnic University, Hong Kong, PRC
3
Department of Social Work, East China Normal University,
Shanghai, PRC
4
Kiang Wu Nursing College of Macau, Macau, PRC

The present study investigated the prevalence and demographic correlates

of Internet addiction in Hong Kong adolescents as well as the change in
related behavior at two time points over a one-year interval. Two waves of
data were collected from a large sample of students (Wave 1: 3,328 students,
age = 12.59 ± 0.74 years; Wave 2: 3,580 students, age = 13.50 ± 0.75 years) at
28 secondary schools in Hong Kong. Comparable to findings at Wave 1

* The full version of this chapter can be found in Child Health and Human Development
Yearbook 2013, edited by Joav Merrick, published by Nova Science Publishers, Inc, New
York, 2014.
† Correspondence: Professor Daniel TL Shek, PhD, FHKPS, BBS, SBS, JP, Associate Vice
President (Undergraudate Programme), Chair Professor of Applied Social Sciences,
Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong
Kong Polytechnic University, Room HJ407, Core H, Hunghom, Hong Kong, PRC. E-mail:
[email protected]
 Related Nova Publications 129

(26.4%), 26.7% of the participants met the criterion of Internet addiction at

Wave 2 as measured by Young’s 10-item Internet Addiction Test. The
behavioral pattern of Internet addiction was basically stable over time. While
the predictive effects of demographic variables including age, gender, family
economic status, and immigration status were not significant, Internet
addictive behaviors at Wave 1 significantly predicted similar behaviors at
Wave 2. Students who met the criterion of Internet addiction at Wave 1 were
7.55 times more likely than other students to be classified as Internet addicts at
Wave 2. These results suggest that early detection and intervention for Internet
addiction should be carried out.

DEVELOPMENT OF AN INTEGRATED INTERVENTION

MODEL FOR INTERNET ADDICTION IN HONG KONG*

Daniel TL Shek, PhD, FHKPS, BBS, JP†,1,2,3,4,5

and Hildie Leung1
1
Department of Applied Social Sciences,
The Hong Kong Polytechnic University, Hong Kong, PRC,
2
Centre for Innovative Programmes for Adolescents and Families,
The Hong Kong Polytechnic University, Hong Kong, PRC,
3
Kiang Wu Nursing College of Macau, Macau, PRC,
4
Department of Social Work, East China Normal University,
Shanghai, PRC
5
Division of Adolescent Medicine, Department of Pediatrics, Kentucky
Children’s Hospital, University of Kentucky College of Medicine,
Lexington, KY, USA

In response to the severe lack of indigenously developed preventive and

counseling services for young people displaying Internet addiction problem,
the Community Chest of Hong Kong funded a pioneering project entitled
“Youngster Internet addiction prevention and counseling service”. Besides

*
The full version of this chapter can be found in Child and Adolescent Health Yearbook 2013,
edited by Joav Merrick, published by Nova Science Publishers, Inc, New York, 2014.
† Correspondence: Professor Daniel TL Shek, PhD, FHKPS, BBS, JP, Chair Professor of Applied
Social Sciences, Faculty of Health and Social Sciences, Department of Applied Social
Sciences, The Hong Kong Polytechnic University, Room HJ407, Core H, Hunghom, Hong
Kong. E-mail: daniel.shek@ polyu.edu.hk
130 Related Nova Publications

provision of preventive services at the community, school, family and

individual levels, individual-based and family-based counseling services were
developed for young people displaying Internet addiction problem. In this
paper, the major features of the counseling model are outlined, including
emphases on controlled and healthy use of the Internet, understanding the
change process in adolescents with Internet addiction problem, use of
motivational interview methods, adoption of a family perspective, multi-level
counseling at the individual, peer and family levels, and the use of both case
and group approaches. The process of intervention in this counseling model is
also described. Evaluation findings provide support for this integrated
intervention model.

INTERNET ADDICTION, MEDIA USE, AND DIFFICULTIES

ASSOCIATED WITH SLEEPING IN ADOLESCENTS*

Stephanie J Stockburger, MD, FAAP

and Hatim A Omar, MD, FAAP†
Division of Adolescent Medicine, Department of Pediatrics,
University of Kentucky, Lexington, Kentucky, United States

The objective of this review article is to summarize the current literature

regarding internet addiction; media use, and sleep disruption in adolescents.
Design: Systematic review of current literature. Methods: The data was
obtained through literature review of articles published in the last 10 years.
Conclusion: Internet addiction and media use have the power to have great
influence over the sleep of children and adolescents and it is important to take
advantage of the positive effects of media while minimizing the potentially
negative, but severe, consequence of sleep disruption.

*
The full version of this chapter can be found in Child and Adolescent Health Yearbook 2013,
edited by Joav Merrick, published by Nova Science Publishers, Inc, New York, 2014.
† Correspondence: Professor Hatim A Omar, MD, Division of Adolescent Medicine, UK
Healthcare, Department of Pediatrics, KY Clinic Room J422, Lexington, KY 40536-0284,
United States. E-mail: [email protected]
 Related Nova Publications 131

INTERNET ADDICTION AND PSYCHIATRIC

COMORBIDITIES*

Ahsan Nazeer, MD, Donald Greydanus†, MD, DR HC

(Athens) and Joseph Calles, MD
Department of Child and Adolescent Psychiatry and Department of
Pediatric and Adolescent Medicine, Western Michigan University Homer
Stryker M.D. School of Medicine, Kalamazoo, Michigan, United States of
America

Internet addictive disorder is a term used to encompass numerous

behaviors associated with Internet overuse. In academia, IAD continues to be a
controversial concept and is currently not a part of Diagnostic and Statistical
Manual-IV-TR. Recent research, mostly from Asian countries has played an
increasingly important role in delineating the prevalence, diagnostic structure
and associated medical and psychiatric comorbidities of this disorder. The
following is a brief review of the current literature regarding IAD and
psychiatric comorbidities.

*
The full version of this chapter can be found in Child and Adolescent Health Yearbook 2013,
edited by Joav Merrick, published by Nova Science Publishers, Inc, New York, 2014.
† Correspondance: Donald E Greydanus, MD, Dr. HC (ATHENS), Professor and Chair,
Department of Pediatric and Adolescent Medicine, Western Michigan University Homer
Stryker M.D. School of Medicine, 1000 Oakland Drive, D48G, Kalamazoo, MI 49008-
1284, United States. E-mail: [email protected]
132 Related Nova Publications

FAMILY FUNCTIONING, POSITIVE YOUTH

DEVELOPMENT AND INTERNET ADDICTION IN JUNIOR
SECONDARY SCHOOL STUDENTS: STRUCTURAL
EQUATION MODELS USING AMOS*

Lu Yu1,† and
Daniel TL Shek, PhD, FHKPS, BBS, JP1,2,3,4,5
1
Department of Applied Social Sciences, The Hong Kong Polytechnic
University, Hong Kong, PR China
2
Centre for Innovative Programmes for Adolescents and Families, The
Hong Kong Polytechnic University, Hong Kong, PR China
3
Kiang Wu Nursing College of Macau, Macau, PR China
4
Department of Social Work, East China Normal University,
Shanghai, PR China
5
Division of Adolescent Medicine, Department of Pediatrics, Kentucky
Children’s Hospital, University of Kentucky College of Medicine,
Lexington, Kentucky, US

This chapter illustrates the procedure of testing full latent variable models
using AMOS. Based on a sample of 4,106 secondary school students in Hong
Kong, the relationships among family functioning, positive youth
development, and Internet addiction were tested with AMOS 17.0 program.
Several competing models were examined and compared. The results revealed
that both positive youth development and family functioning predicted Internet
addition among adolescents negatively. Higher level of family functioning also
had indirect effects on students’ Internet addictive behaviors through partial
mediation of positive youth development. This study highlights the importance
of promoting positive youth development and strengthening family
functioning in reducing Internet addiction in Hong Kong secondary school
students.

*
The full version of this chapter can be found in Human Developmental Research: Experience
from Research in Hong Kong, edited by Daniel T.L. Shek, Cecilia M.S. Ma, Lu Yu and Joav
Merrick, published by Nova Science Publishers, Inc, New York, 2013.
† Correspondence: Lu Yu, PhD, Assistant Professor, Faculty of Health and Social Sciences,
Department of Applied Social Sciences, The Hong Kong Polytechnic University, Room
HJ430, Core H, Hung Hom, Hong Kong. E-mail: [email protected]
 Related Nova Publications 133

INTERNET ADDICTION IN CHINESE ADOLESCENTS IN

HONG KONG: ASSESSMENT, PROFILES AND
PSYCHOSOCIAL CORRELATES *

Daniel TL Shek, PhD, FHKPS, BBS, JP†,1-5

and Rachel CF Sun, PhD6
Department of Applied Social Sciences,
1

The Hong Kong Polytechnic University, Hong Kong, PRC

2
Centre for Innovative Programmes for Adolescents and Families,
The Hong Kong Polytechnic University, Hong Kong, PRC
3
Department of Social Work, East China Normal University,
Shanghai, PRC
4
Kiang Wu Nursing College of Macau, Macau, PRC
5
Division of Adolescent Medicine, Department of Pediatrics,
Kentucky Children’s Hospital,
University of Kentucky College of Medicine,
Lexington, Kentucky, US
6
Faculty of Education, The University of Hong Kong,
Hong Kong, PRC

Internet addiction behavior was examined in 6,121 Chinese primary and

secondary school students in Hong Kong based on the assessment frameworks
of Ivan Goldberg and Kimberly Young. Result showed that scales derived
from both frameworks (CIA-Young Scale and CIA-Goldberg Scale) were
internally consistent and evidence supporting their validity was found.
Descriptive statistical analyses revealed that roughly one-fifth of the
respondents could be classified as Internet addicted based on either scale.
Further analyses showed that Internet addicted and non-addicted respondents
differed in the Internet use and related behavior. Logistic regression analyses
showed that engagement in certain on-line activities (such as playing on-line

*
The full version of this chapter can be found in Adolescence and Behavior Issues in a Chinese
Context, edited by Daniel T.L. Shek, Rachel C.F. Sun, and Joav Merrick, published by Nova
Science Publishers, Inc, New York, 2013.
† Correspondence: Professor Daniel TL Shek, PhD, FHKPS, BBS, JP, Chair Professor of
Applied Social Sciences, Faculty of Health and Social Sciences, Department of Applied
Social Sciences, The Hong Kong Polytechnic University, Room HJ407, Core H, Hunghom,
Hong Kong. E-mail: [email protected].
134 Related Nova Publications

games and downloading software) and replacement of pastimes activities

(such as watching TV and going out with friends) by Internet activities
predicted higher probability of Internet addiction.

INTERNET ADDICTION IN HONG KONG ADOLESCENTS:

PROFILES AND PSYCHOSOCIAL CORRELATES*

Daniel TL Shek†, PhD, FHKPS, BBS, JP1-5

and Lu Yu, PhD1
Department of Applied Social Sciences,
1

The Hong Kong Polytechnic University, Hong Kong, PRC

2
Public Policy Research Institute,
The Hong Kong Polytechnic University, Hong Kong, PRC
3
Deapartment of Social Work, East China Normal University,
Shanghai, PRC
4
Kiang Wu Nursing College of Macau, Macau, PRC
5
Division of Adolescent Medicine, Department of Pediatrics,
Kentucky Children’s Hospital, University of Kentucky College of
Medicine, Lexington, Kentucky, US

This chapter examines the prevalence of Internet addition among Hong

Kong adolescents and its psychosocial correlates in a large sample of early
adolescents in Hong Kong. A total of 3,328 students (age = 12.59 ± 0.74
years) were recruited from 28 secondary schools in Hong Kong. Using
Young’s 10-item Internet Addiction Test, 26.4% of the participants were
classified as having Internet addiction. Age and having divorced parents were
positively correlated with pathological use of Internet, while higher academic
competence, general positive youth development, and positive and clear
identity predicted a lower probability of Internet addiction. These results
demonstrate that Internet addiction has become an emergent youth problem in

*
The full version of this chapter can be found in Adolescence and Behavior Issues in a Chinese
Context, edited by Daniel T.L. Shek, Rachel C.F. Sun, and Joav Merrick, published by Nova
Science Publishers, Inc, New York, 2013.
† Correspondence: Professor Daniel TL Shek, PhD, FHKPS, BBS, JP, Chair Professor of
Applied Social Sciences, Faculty of Health and Social Sciences, Department of Applied
Social Sciences, The Hong Kong Polytechnic University, Room HJ407, Core H, Hung
Hom, Hong Kong. E-mail: [email protected].
 Related Nova Publications 135

Hong Kong, which deserves more attention from researchers and

professionals. Preventive strategies aiming at risk and protective factors
identified in the present study should be developed and implemented.

INTERNET ADDICTION PHENOMENON IN EARLY

ADOLESCENTS IN HONG KONG*

Daniel T. L. Shek†,1,2,3,4,5 and Lu Yu1

Department of Applied Social Sciences,
1

The Hong Kong Polytechnic University, Hong Kong, PRC;

2
Public Policy Research Institute,
The Hong Kong Polytechnic University, Hong Kong, PRC;
3
Department of Sociology, East China Normal University, Shanghai, PRC;
4
Kiang Wu Nursing College of Macau, Macau, PRC;
5
Division of Adolescent Medicine, Department of Pediatrics,
Kentucky Children’s Hospital, University of Kentucky College of
Medicine, Lexington, Kentucky, USA

The present study investigated the prevalence and demographic correlates

of Internet addiction in Hong Kong adolescents as well as the change in
related behavior at two time points over a one-year interval. Two waves of
data were collected from a large sample of students (Wave 1: 3,328 students,
age = 12.59 ± 0.74 years; Wave 2: 3,580 students, age = 13.50 ± 0.75 years) at
28 secondary schools in Hong Kong. Comparable to findings at Wave 1
(26.4%), 26.7% of the participants met the criterion of Internet addiction at
Wave 2 as measured by Young’s 10-item Internet Addiction Test. The
behavioral pattern of Internet addiction was basically stable over time. While
the predictive effects of demographic variables including age, gender, family
economic status, and immigration status were not significant, Internet
addictive behaviors at Wave 1 significantly predicted similar behaviors at

*
The full version of this chapter can be found in Developmental Issues in Chinese Adolescents,
edited by Daniel T.L. Shek, Rachel C.F. Sun, and Joav Merrick, published by Nova Science
Publishers, Inc, New York, 2012.
† Correspondence: Professor Daniel TL Shek, PhD, FHKPS, BBS, JP, Chair Professor of
Applied Social Sciences, Faculty of Health and Social Sciences, Department of Applied
Social Sciences, The Hong Kong Polytechnic University, Room HJ407, Core H, Hunghom,
Hong Kong. E-mail: [email protected]
136 Related Nova Publications

Wave 2. Students who met the criterion of Internet addiction at Wave 1 were
7.55 times more likely than other students to be classified as Internet addicts at
Wave 2. These results suggest that early detection and intervention for Internet
addiction should be carried out.

INTERNET ADDICTION AND ANTISOCIAL INTERNET

BEHAVIOR OF ADOLESCENTS*

Hing Keung Ma†

Department of Education Studies, Hong Kong Baptist University, Hong
Kong, PRC

Internet addiction and the moral implication of antisocial Internet behavior

will be investigated in this paper. More and more people use the Internet in
their daily life. Unfortunately the percentage of people who use the internet
excessively also increases. The concept of Internet addiction or pathological
use of Internet is discussed in detail, and the characteristics of Internet addicts
are also delineated. The social, (especially the antisocial), use of Internet is
discussed. It is argued that the behavior of Internet use is similar to daily life
social behavior. In other words, Internet behavior is a kind of social behavior.
Kohlberg’s theory of moral development is employed to delineate the moral
reasoning of the antisocial Internet behavior. The following behaviors are
regarded as antisocial Internet behavior: 1) the use of Internet to carry out
illegal activities such as selling faked products or offensive pornographic
materials, 2) the use of Internet to bully others (i.e., cyberbullying) such as
distributing libelous statements against a certain person, 3) the use of Internet
to cheat others and 4) to use Internet to do illegal gambling. The characteristics
of the moral stages that are associated with these antisocial Internet behaviors
are investigated in detail.

*
The full version of this chapter can be found in Positive Youth Development: A New School
Curriculum to Tackle Adolescent Developmental Issues, edited by Hing Keung Ma, Daniel TL
Shek and Joav Merrick, published by Nova Science Publishers, Inc, New York, 2012.
† Correspondence: Professor Hing Keung Ma, BSc, DipEd, PhD , Faculty of Social Sciences,
Department of Education Studies (RL2-1/F), Hong Kong Baptist University , University Road
Campus, Kowloon Tong, Hong Kong, PRC. E-mail: [email protected].
 INDEX

agencies, 8
A aggression, 50
Air Force, 94, 95
abstraction, 114
alcohol consumption, 115
abuse, viii, 2, 3, 4, 31, 55, 122
alcohol use, 49
academic performance, 18, 126
alienation, viii, 12
academic settings, 68
American Psychiatric Association (APA), 3,
access, vii, 2, 5, 6, 14, 79, 80, 81, 86, 98
9, 19, 65, 75, 90, 117, 118
accessibility, 126
amylase, 27
activism, 101
anger, 36, 38
actuality, 88
anisotropy, 17
adaptation, 39
antidepressants, 4
addictive behavior, 2, 23, 129, 133, 137
anxiety, vii, viii, ix, 2, 6, 10, 12, 13, 16, 17,
ADHD, 17, 21, 105
18, 24, 29, 30, 32, 33, 34, 38, 39, 40, 41,
adjustment, 4, 44, 46, 85
43, 44, 45, 46, 48, 49, 50, 51, 80
adolescent boys, 127, 128
anxiety disorder, ix, 10, 18, 29, 32, 39, 46,
adolescent development, 103, 112
48
adolescents, vii, ix, 5, 8, 12, 14, 16, 17, 18,
appetite, 5
19, 20, 21, 22, 23, 24, 26, 32, 40, 42, 46,
Asia, viii, 12, 68
47, 48, 49, 51, 53, 55, 56, 63, 66, 82, 86,
Asian countries, 46, 132
87, 88, 104, 112, 129, 130, 131, 133,
assessment, 7, 18, 44, 45, 54, 56, 58, 114,
136, 137
126, 134
adulthood, 42, 48, 98
atrophy, 17
adults, 20, 33, 37, 38, 48
attachment, ix, 6, 29, 30, 32, 35, 36, 37, 38,
advancement, 78, 79, 89, 112
39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49,
adverse effects, 24, 76
50
advertisements, 100
attachment style, ix, 29, 30, 32, 36, 37, 38,
aesthetics, 114
39, 40, 41, 42, 43, 48, 49, 50
age, ix, x, 12, 17, 21, 25, 35, 50, 58, 71, 77,
attachment theory, 30, 35, 43
86, 87, 89, 99, 115, 119, 129, 136, 137
attitudes, viii, 12, 42, 49, 54, 65, 67
138 Index

authority, 86, 88 categorization, 31

autism, 66, 109 category a, 13, 84
avoidance, 18, 33, 34, 38, 40, 41 causal relationship, 55
avoidance behavior, 33 causality, 55
awareness, 8, 31, 72, 84, 98, 99, 102 censorship, 101
central nervous system, 8
cerebellum, 17
B challenges, 8, 116
changing environment, 73
back pain, 5
chat rooms, 48
barriers, 57
Chicago, 47
base, 42, 44
childhood, vii, viii, 1, 8, 12, 33, 37, 38, 39,
behavioral manifestations, 34
42, 43, 45, 46, 48
behavioral theory, 78
childrearing, 49
behaviors, vii, ix, 1, 2, 4, 8, 19, 29, 34, 50,
children, 9, 14, 15, 36, 37, 38, 39, 40, 45,
78, 98, 129, 132, 133, 137, 138
47, 48, 50, 58, 63, 68, 77, 79, 84, 86, 87,
beneficiaries, 83
88, 98, 99, 116, 131
benefits, 19, 65, 73
China, 14, 56, 64, 68, 72, 101, 104, 113,
bias, 101
120, 121, 122, 123, 127, 128, 129, 130,
bilateral, 17
133, 134, 136, 137
bipolar disorder, 10, 66
Chinese diaspora, 121
births, 102
Christianity, 94
blind spot, 83
chronic fatigue, 5
blindness, 98
CIA, 134
bonding, 127, 128
cities, 68
bonds, 34, 35, 44
citizens, x, 71, 73, 74, 83, 86, 87, 88, 89
bone, 110
civil rights, 101
brain, 3, 8, 9, 13, 17, 21, 78, 93, 105
classes, 56, 67, 69
brain activity, 9, 17
classification, 2, 89, 93, 94, 95, 96, 97, 98,
brain structure, 17
99, 103, 105, 106, 107, 108, 109, 111,
breakdown, 60
112, 114, 115, 118, 119, 120, 121, 122
breathing, 119
classroom, 97
Britain, 90
clients, 114
budget allocation, 86
clinical depression, 17
bullying, 102, 113
clinical presentation, 18
burnout, 101
close relationships, 38
clustering, 56
C clusters, 17
CNS, 20
campaigns, 101 cognition, 78, 98
caregivers, 35, 36, 38 cognitive perspective, 34
caregiving, 37, 38 cognitive science, 97
carpal tunnel syndrome, 5 cognitive style, 4
Carter, President Jimmy, 99 coherence, 24, 27
case studies, x, 71 collaboration, 69
 Index 139

college students, 24, 27, 40, 43, 46, 47, 65, counseling, x, 71, 72, 76, 77, 82, 130
98 covering, 57
color, 107, 109, 111, 118 craving, vii, 1, 4, 6, 7, 9, 10, 31
communication, 6, 12, 13, 15, 24, 33, 40, crimes, 76, 85
49, 55, 75, 80, 81, 100, 119 critical thinking, 98
communication skills, 24, 40 cross-sectional study, 16
communication technologies, 55 cultural influence, 16
community, 24, 27, 63, 65, 67, 73, 80, 88, culture, 78, 80, 81, 86, 88, 116, 123
109, 130 cures, 116
comorbidity, ix, 17, 18, 29 curriculum, 112
competition, 80, 81, 89 cyberbullying, 102, 111, 138
compilation, 106
complexity, 87, 99
comprehension, 31 D
compulsion, 5
danger, 35, 101
compulsive behavior, 5, 7
data collection, 100
compulsive personality disorder, 67
deaths, 102
computer, ix, 5, 16, 29, 55, 65, 75, 114
decentralization, 88
computer software, 75
defence, 30
computer use, ix, 29, 55
deficiency, 8
computing, 119, 120
deficit, viii, 7, 9, 12, 15, 17, 21, 34
conceptualization, 88
delinquency, 113
concordance, 63
democracy, 116
conditioning, 8, 48
demographic characteristics, 59
conduct disorder, 66
denial, 3
conflict, 40, 73, 74, 89
Department of Education, 138
confounding variables, 17
depression, viii, x, 12, 15, 16, 17, 18, 21, 24,
Congress, 117
32, 39, 41, 44, 46, 51, 54, 55, 56, 57, 59,
consciousness, 30, 31
63, 66, 80, 82
consensus, 19
depressive symptoms, 55
construct validity, 57, 59
depth, 72
construction, 109
destruction, 80
consumption, 104, 115
detection, ix, 12, 18, 19, 63, 129, 137
control group, 5
development of Mental Health Literacy
controlled studies, 4
measures, 55
controversial, vii, 1, 55, 132
developmental psychology, 35
controversies, 95
developmental psychopathology, 48
conversations, 116
Diagnostic and Statistical Manual of Mental
conviction, 34
Disorders, 2, 9, 12, 19, 31, 55, 65
cooperation, x, 71, 74, 89
diagnostic criteria, viii, 9, 11, 13, 14, 43, 57
coordination, 85
diffusion, 30
coping strategies, 40
digital technologies, 73
correlation, 16, 17, 24, 48, 114
disclosure, 45
correlation analysis, 114
discordance, 57, 58, 59, 61, 63
cortex, 17
discreteness, 74
140 Index

disease model, 81 emotional problems, 16, 48, 60

disgust, 24, 27 empathy, 80, 116, 117
disorder, viii, ix, 2, 5, 9, 11, 12, 13, 14, 15, endangered, 116
17, 18, 19, 21, 23, 24, 31, 33, 39, 41, 47, energy, 24
50, 51, 54, 55, 56, 57, 60, 62, 63, 65, 66, energy consumption, 24
95, 96, 114, 118, 122, 132 enforcement, 87
dissatisfaction, viii, 12 England, 121
dissociation, 30, 37, 49 environment, 4, 33, 73, 79
distress, vii, ix, 2, 4, 25, 29, 37, 38, 40, 41 environmental change, 89
doctors, 85 environmental conditions, 19
DOI, 45 environmental factors, viii, 12, 79
dopamine, 8 environmental variables, 34
dorsolateral prefrontal cortex, 17 epidemic, 5, 26
draft, 3 epidemiology, 10
drawing, 77 equality, 74
drug abuse, 3 equity, 64
drug addiction, vii, 1, 3, 4, 7, 122 error detection, 21
drug dependence, 2 escitalopram, 7
drug education, 112 ethics, 56
drug treatment, 7 ethology, 35
drugs, 3, 84 etiology, 46
DSM, viii, 2, 5, 11, 12, 13 Europe, viii, 12, 16, 21
dysphoria, 41, 42 European Union, 16
everyday life, 24, 31, 32, 121
evidence, x, 3, 9, 17, 18, 24, 54, 63, 67, 95,
E 96, 97, 134
evolution, 110
East Asia, 75, 123
excitation, 7
Easter, 100
exclusion, 100
eating disorders, 67
execution, 84, 88
economic development, 73
executive function, 7
economic growth, 75
exercise, 118
economic status, 129, 137
expertise, 105
economics, 102, 120
exposure, 18, 55, 57, 58, 61, 63
editors, 9, 103, 104, 106, 110, 120
extreme poverty, 75
education, 75, 79, 80, 81, 84, 88, 98, 113,
120, 126
educational programs, 8 F
egocentrism, 104
Egypt, 101 Facebook, 42, 48, 99, 103, 119
elaboration, 7 factor analysis, 103
e-mail, 6, 118 factories, 75
emotion, 37, 43, 48 families, 8, 47, 88, 112
emotional disorder, 45 family environment, 42, 45
emotional distress, 41 family factors, 48
emotional experience, vii, 2, 6 family functioning, 32, 41, 49, 104, 133
 Index 141

family life, 126

family members, 41, 96
H
family relationships, 44
habituation, 6
family system, 80
headache, 5
fear, 17, 33, 34, 37, 39, 43
healing, 47
feelings, 25, 35
health, vii, viii, ix, 8, 11, 12, 14, 18, 19, 20,
financial, 75
22, 27, 54, 55, 63, 64, 65, 66, 67, 95, 98,
financial crisis, 75
104, 106, 108, 111, 126
financial sector, 75
health care, 98
first aid, 54
health effects, vii, ix, 12, 18
flame, 114
health problems, 54, 63
flight, 116, 117
health promotion, 18
flooding, 37
heterogeneity, 7
flow experience, 24, 25, 26, 27
high school, ix, 14, 37, 45, 47, 53, 56, 85
fMRI, 10
higher education, 59
food, 96
history, 73, 74, 78, 108
foreign exchange, 75
homes, 116
foreign investment, 75
Hong Kong, viii, 12, 14, 20, 56, 68, 69, 77,
formal education, 58
103, 104, 112, 113, 127, 128, 129, 130,
formation, ix, 53, 56
133, 134, 136, 137, 138
framing, 109
hostility, 21, 32
freedom, 87, 123
hub, 126
freezing, 37
human, 30, 35, 44, 55, 81, 97, 98, 103, 105,
friendship, 35, 40, 44, 116
110, 116
frontal cortex, 9
human behavior, 81
frontal lobe, 8
human development, 44, 103
funding, 76
human psychology, 98
human remains, 110
G hygiene, 106
hyperactivity, viii, 9, 12, 15, 16, 17, 21
gambling, vii, 1, 3, 5, 8, 13, 14, 57, 65, 84, hypothesis, 39, 40, 42, 63
108, 111, 114, 115, 118, 122, 138
gender differences, 127, 128
gender effects, 17
I
genetic factors, 39
identification, x, 54
Germany, 72
identity, 31, 33, 94, 113, 136
glutamate, 8
illusion, 31
Google, 100
image, 19, 36, 109
governance, 86, 87, 88, 120
IMF, 75
government funds, 83
immigration, 129, 137
governments, 86, 88, 89
immune system, 5
gray matter, 17
impairments, ix, 29, 41
growth, 79, 81, 84, 103
impulsive, 4, 9, 78
guidance, 33, 35, 113
impulsivity, 4, 78, 79, 80, 95
guilt, 13, 24, 27
142 Index

inattention, 16
incidence, viii, 12
J
India, 65
Japan, 23, 27
indirect effect, 133
journalists, 101
individuals, 7, 19, 34, 38, 41, 42, 49, 54, 76,
79, 81, 82, 84, 87, 114
industries, 72 K
industry, 72, 75, 79, 81, 83, 84, 85, 87, 89,
109, 120 kill, 15
infancy, 38, 40, 43, 45 knowledge-based economy, 75
infants, 35, 36, 77 Korea, v, x, 49, 71, 72, 73, 74, 75, 76, 77,
inferiority, 25 79, 80, 82, 83, 84, 86, 89, 91
information processing, 35
information technology, 72, 75
infrastructure, x, 71, 75 L
inhibition, 7, 17, 21, 30, 32, 39
injury prevention, 68 lack of confidence, 38
insecurity, 39 law enforcement, 102
insomnia, 18 laws, 115
integration, 33 LEA, 8
integrity, 33 lead, 7, 34, 39, 76, 78, 83, 89, 126
intelligence, 100, 119 leadership, 87, 89
International Classification of Diseases, viii, leaks, 99
2, 9, 11 learners, 98
International Monetary Fund, 75 learning, 19, 35, 78, 82, 99, 116
internet addiction, ix, 29 legislation, 84, 98, 110
internet gaming disorder, 13, 19, 54, 96, leisure, 12, 14
114, 118 life cycle, 42, 72
interpersonal relations, 6, 33, 35, 39, 40, 41, lifetime, 32
47 linguistics, 114
interpersonal relationships, 6, 33, 35, 40, 41, literacy, 54, 64, 65, 66, 67, 113
47 litigation, 97
intervention, 4, 18, 19, 26, 44, 47, 54, 63, living environment, 88
77, 129, 130, 137 local government, x, 71, 73, 74, 86, 88, 89
intimacy, 40 loneliness, 39, 48, 116
intoxication, 2 longitudinal study, 20, 26, 55, 66
intrinsic motivation, 81 love, 6, 38, 96, 116, 118
Iran, 26, 27 LSD, 76
IRC, 6 Luo, 118
iron, 87
isolation, 6, 34 M
Israel, 104, 125
issues, 13, 73, 80, 88, 89, 99, 108, 109, 112, major depression, 65
114 majority, 58, 89
Italy, 1, 10, 29 management, 33, 54, 68, 82, 84, 102, 113
 Index 143

management committee, 84 multiplication, 6

manufacturing, 75 museums, 110
marketing, 100 music, 89
masking, 98
materialism, 104
materials, 104, 138 N
maternal care, 49
national borders, 73
matter, 72, 85
national policy, 72, 74, 75, 89
measurement, 54
National Survey, ix, 53, 56
media, viii, 11, 86, 89, 94, 98, 99, 105, 108,
negative attitudes, 63
109, 110, 111, 117, 120, 131
negative consequences, viii, 4, 11, 12, 17
mediation, 41, 45, 80, 133
negative effects, 31, 35
medical, 82, 132
negative emotions, 42
medication, 2, 18, 21
negative reinforcement, 34
memory, 78, 97
negative relation, 42
mental disorder, 17, 39, 54, 64, 65, 67, 97
negotiating, 84
mental health, viii, ix, 10, 12, 19, 22, 23, 24,
networking, 95, 108
39, 54, 55, 57, 63, 64, 65, 66, 67, 72, 76,
neuroimaging, 9
79, 80, 83, 115
neuropsychiatry, 72
mental health literacy, 54, 64, 65, 66, 67
neuropsychological tests, 7
mental processes, 30
New South Wales, 69
mental state, 26
next generation, viii, 2
mesh networks, 102
NGOs, 86, 88
messages, 8, 14, 100, 114
nicotine, 122
meta-analysis, 14, 20, 21, 47
non-pharmacological treatments, 54
methamphetamine, 122
norepinephrine, 8
methodology, 18
Norway, 14
methylphenidate, 7, 9
NSA, 99
metropolitan areas, 16
nucleus, 34
Microsoft, 100
nuisance, 26
Ministry of Education, 83, 85
nurses, 65
Minneapolis, 107
misuse, 18, 81
mobile phone, vii, 1, 6, 14, 20 O
modelling, 46
models, 16, 35, 40, 79, 104, 133 Obama, President Barack, 101
mood disorder, 4 obesity, 96
moon, 82, 87, 90, 127, 128 occupational therapy, 26
moral development, 138 OCD, 4, 105
moral reasoning, 138 officials, 76
morbidity, 21, 32, 39 oil, 102
morphometric, 17 online dating, 102
motivation, 17 openness, 87
MSW, 127, 128 operant conditioning, 34
multimedia, 6 operations, 76
144 Index

opportunities, 35 positive psychology, 23

optimal experience, 23 PRC, 104, 112, 127, 128, 129, 130, 134,
organism, vii, 2 136, 137, 138
overtraining, vii, 1, 3 prefrontal cortex, 8, 17
preschool, 47
President, 75, 99
P prevalence, 1, iii, viii, ix, 12, 13, 14, 15, 16,
18, 20, 21, 24, 26, 45, 47, 48, 66, 101,
P.A.T.H.S., 103
129, 132, 136, 137
Pacific, 68
prevalence rate, viii, 12
pain, 78
prevention, 8, 18, 54, 63, 88, 102, 112, 130
parallel, 6, 38
primary caregivers, 42
paranoid schizophrenia, 60
principles, 44, 99
parental consent, 86
private sector, 86
parental control, viii, 12
probability, 20, 135, 136
parental criticism, 33
problem drinking, 45
parental involvement, 16
problem-solving, 7
parent-child relationship, 39
producers, 84
parenting, 79
professionals, 19, 65, 126, 136
parents, 8, 15, 33, 34, 36, 58, 59, 79, 80, 84,
programming, 8
87, 89, 109, 116, 136
project, 16, 68, 103, 115, 130
participants, 19, 25, 129, 136, 137
prosocial behavior, 34
pathogenesis, 32, 43
prostheses, 30
pathophysiology, vii, 1, 7
protection, 35, 37, 40, 41, 102, 103
pathways, 33
protective factors, viii, 11, 15, 136
peer group, 35
prototype, 35
peer rejection, 33
psychiatric disorder, 8, 50, 66
peer relationship, 16, 39, 46, 50
psychiatric disorders, 8
personal development, 35
psychiatrist, 83
personal goals, viii, 12
psychiatry, 8, 9, 10, 46
personality, viii, 6, 12, 25, 26, 31, 43, 49,
psychoanalysis, 35, 50
55, 66, 114
psychological well-being, 18, 45, 46, 126
personality disorder, 55, 66
psychology, 23, 68, 72, 105, 114, 115
personality factors, viii, 12
psychometric, ix, 53, 54, 57, 62, 77, 104
pharmacological treatment, 4, 8, 96
psychometric properties, ix, 53, 57, 62, 104
phobia, 44, 45, 55
psychopathology, 16, 21, 26, 32, 39, 45, 66
physical health, 24, 126
psychopharmacological treatments, 4
playing, 3, 13, 15, 16, 77, 83, 114, 134
psychopharmacology, 9
PM, 46
psychosocial development, 18
policy, x, 71, 72, 73, 74, 75, 76, 77, 79, 80,
psychosocial functioning, viii, 11
82, 83, 84, 85, 86, 87, 88, 89, 90, 110
psychotherapy, 18, 44, 45, 106, 114
policy issues, 73
psychotropic drugs, 112
politics, 116, 120, 121
public health, 26, 78, 102, 106, 126
polymorphism, 21
public opinion, 87
population, x, 14, 15, 18, 19, 41, 54, 66, 76,
public sector, 115
77
 Index 145

risk, vii, viii, ix, 2, 4, 6, 8, 11, 12, 13, 15,

Q 16, 29, 30, 32, 39, 40, 41, 45, 47, 54, 63,
65, 77, 82, 102, 114, 127, 128, 136
quality of life, 14, 19, 27, 78
risk factors, vii, viii, ix, 4, 12, 15, 20, 30,
questionnaire, ix, 53, 56, 57, 58, 80
32, 47, 54, 63
role playing, 5, 49, 114
R romantic relationship, 35, 39, 40
root, 64
rape, 114 rowing, 88
rating scale, 54
reactions, vii, 2, 34, 110
S
reactivity, 10
reading, 57
sabotage, 101
Reagan, Ronald, 99
sadness, 44
reality, 30, 31, 32, 73, 76, 79, 120
safety, 47, 98, 102, 111
receptors, 31
saturated fat, 110
recognition, ix, 31, 53, 54, 56, 57, 59, 63,
Saudi Arabia, 101
67, 85, 87, 100
schema, 38
recommendations, 94
school, 2, 5, 6, 8, 15, 40, 50, 56, 60, 63, 67,
recovery, 81
79, 82, 84, 88, 102, 112, 113, 116, 130,
recreational, 30, 39
133
reform, 99, 115
school culture, 113
regression, 17, 134
secondary school students, 104, 112, 127,
regression model, 17
128, 133, 134
regulations, 87
secondary schools, 129, 136, 137
rehabilitation, 8, 23
secondary students, 113
rejection, 18, 34, 40
security, 36, 38, 40
relatives, 34
self help, 82
reliability, 32, 54, 57, 58, 61, 62, 63
self-control, 7, 44, 78
relief, 3, 34
self-efficacy, 34, 78, 113
requirements, 57
self-esteem, 7, 17, 24, 32, 44
researchers, 32, 38, 126, 136
self-reflection, 116
resentment, 38
self-regulation, 33, 78, 82
resilience, 39
seminars, 8
resistance, 85
sensation, 3, 4, 10, 24, 30, 32
resolution, 73, 74, 80, 86, 88, 89
sensation seeking, 10, 32
resources, 64, 88
sensitivity, 7, 10, 16
response, x, 7, 17, 36, 38, 56, 71, 72, 77, 83,
service provider, 120
85, 130
services, 6, 19, 45, 72, 77, 80, 83, 89, 130
restrictions, 86, 98
sex, vii, 1, 3, 5, 9, 96, 100
restructuring, 8
sexual abuse, 42
rewards, 78
sexual behavior, 104
rhythm, 5
sexuality, 110
rights, 87
shape, 38
showing, 6, 37, 84, 126, 127, 128
146 Index

shyness, 24, 27, 33 statistics, 110

side effects, 73 stigma, 58, 67, 81
signals, 34 stimulation, 5
signs, 19, 105 stock, 102
Singapore, 22, 65, 68 stock price, 102
SMS, 14 stress, vii, viii, 2, 6, 12, 15, 17, 24, 27, 79,
SNS, 77 82, 105
sociability, 33 stressful life events, 39
social activities, 33 stressors, viii, 12, 15
social anxiety, ix, 29, 30, 32, 33, 34, 35, 39, structural changes, 17
40, 41, 45, 46, 47, 49, 50, 51 structural equation modeling, 103
social behavior, 34, 48, 78, 138 structure, 48, 58, 74, 132
social cognition, 39 style, ix, 29, 30, 32, 36, 37, 38, 39, 40, 41,
social competence, 33, 46 42, 43, 48
social construct, 110 styles, 36, 38, 39, 40, 49, 50
social development, 39 substance abuse, 2, 10
social environment, 33 substance addiction, 6, 8, 12, 82
social interaction, ix, 29, 34, 35, 44, 80, 98 substance use, 2, 3, 4, 10, 13, 51
social interactions, 35, 80, 98 substance use disorders, 13
social life, 2, 25 substrate, 17
social network, vii, 1, 3, 6, 13, 34, 42, 77, suicidal ideation, 17, 65, 66
101, 103, 111, 117, 126 suicide, 16, 102, 109
social phobia, 21, 40, 43, 44, 45, 48, 66 suicide rate, 16
social problems, x, 71, 109, 126 sun, 104, 112, 134, 136, 137
social psychology, 49, 71 surveillance, 99
social relations, viii, 11, 12, 15, 31, 33 survival, 79
social relationships, viii, 11 symptoms, 4, 5, 9, 13, 16, 17, 18, 21, 26, 32,
social sciences, 104 39, 40, 50, 56, 66, 82, 105, 127, 128
social situations, 33, 34 syndrome, vii, 1, 3, 5, 6, 8, 18
social skills, 34, 39, 48, 79 Syria, 101
social status, 78
social support, 24, 40, 78
social welfare, 121 T
society, x, 12, 19, 68, 71, 72, 75, 79, 87, 97,
Taiwan, 47
105, 110, 111, 123
teachers, 8, 56, 82
software, 100, 135
techniques, 8
solitude, 116
technology, viii, 1, 3, 5, 8, 11, 21, 30, 46,
solution, 31, 80, 82
78, 80, 81, 89, 105, 106, 111, 114, 116,
South Korea, x, 48, 71, 72
119, 120
Spain, 11
teens, 77
spending, 82, 100
telephone, 20
spirituality, 96
temperament, 21
stability, 16, 32
tension, viii, 3, 12, 15
stabilizers, 4
testing, 38, 58, 133
state, ix, 13, 14, 23, 24, 30, 47, 66, 75, 98
test-retest reliability, 58, 61, 62, 63
 Index 147

theft, 102 video games, 9, 15, 16

therapy, 82, 107, 118, 122 videos, 99
thoughts, 7, 34 violence, 7, 33
threats, 38 violent crime, 110
tobacco, 3 virtual reality (VR), 73
top-down, 87 vision, 81
torture, 15 voting, 84
trade, 5, 74, 75, 93 vulnerability, 38, 39
trade-off, 74
training, x, 67, 71, 72, 79, 88, 104
transmission, 18, 47, 49 W
transparency, 75, 100
walking, 98
trauma, 37, 47, 68
war, 75, 101, 123
traumatic brain injury, 68
Washington, 9, 19, 64, 65, 117
traumatic experiences, 47
waste, 83
treatment, viii, 4, 7, 9, 11, 14, 18, 43, 45, 51,
water, 116
63, 64, 67, 77, 81, 95, 97
web, vii, 2, 5, 6, 31, 32, 93, 119
trial, 7, 9
welfare, 19, 88
Turkey, 27, 101
well-being, 19, 43, 44, 46, 94, 108
white matter, 17
U withdrawal, vii, viii, 2, 11, 12, 17, 18
withdrawal symptoms, viii, 2, 11, 17
United States (USA), viii, 12, 14, 95, 98, witnesses, 97
113, 121, 127, 128, 130, 131, 132, 137 workers, 49, 84
universities, 26, 69 workplace, 39, 116
World Health Organization (WHO), vii, 2,
9, 54, 64,
V worry, 38, 40

validation, 56, 76
validity, viii, x, 11, 54, 57, 58, 59, 61, 62, Y
63, 134
variables, 18, 32, 59, 114, 129, 137 yield, 61, 73
vibration, 7 young adults, ix, 23, 24, 32, 50
Vice President, 68, 129 young people, vii, viii, 2, 6, 12, 14, 22, 45,
victimisation, 49 55, 58, 68, 85, 126, 130