Internet addiction

Disease Description (Causes and Symptoms)

• Definition summary: A condition in which a person is unable to control their own internet use (such as gaming, chatting, and social media), showing excessive immersion and preoccupation, resulting in significant impairment in daily functioning, including schoolwork, work, interpersonal relationships, and sleep.
• Causes and pathophysiology:
  • Individual factors: Emotional instability, low self-esteem, lack of social confidence, a tendency to avoid reality (fantasy-based thinking), impulsivity/impulse-control problems, and others.
  • Neurobiological mechanisms: Repeated use is reinforced through strengthening of the reward circuit (dopaminergic system) and reward learning, increased reward sensitivity, and an imbalance in self-regulation circuits.
  • Social and environmental factors: Easily accessible digital devices and the internet, and internet use as a means of avoiding peer-relationship problems and stress.
• Main symptoms:
  • Inability to control internet use time; anxiety and restlessness when unable to access the internet; reduced sleep, eating, and exercise; decline in academic or job performance; family and social conflicts; and avoidance of real-life relationships.
  • Associated symptoms: Depressed mood, guilt, reduced concentration, increased impulsivity, and interpersonal problems.

Treatment Methods

• Basic principles: Depending on the severity of the problem and the presence of co-occurring mental disorders (such as depression, ADHD, or anxiety), psychological therapy is tailored to the individual and combined with medication when necessary.
• Psychological therapy (recommended as first-line treatment)
  • Cognitive behavioral therapy (CBT): Impulse control and time management, restructuring negative thoughts, planning alternative activities, and so on. CBT programs specialized for internet and gaming exist.
  • Family therapy and parent education: Establishing household rules, parental supervision and modeling, and improving family dynamics.
  • Motivational interviewing and group therapy (with the goal of restoring peer relationships).
• Medication treatment
  • There is no approved specific medication for internet addiction itself. If an underlying condition such as depression, anxiety, or ADHD is present, appropriate medication treatment for that condition (for example, SSRIs or ADHD medications) may be considered to improve symptoms.
  • Medication selection and indications should be determined by a psychiatrist.
• Environmental and behavioral interventions
  • Limiting usage time and content, adjusting device accessibility (placing devices in shared spaces and using internet-blocking software), controlling payment methods, and promoting alternative activities (exercise, hobbies, and social activities).
  • A gradual reduction plan (such as a digital detox program).
• Severe cases
  • If there is severe deterioration in daily functioning, a risk of self-harm or suicide, or refusal of treatment, intensive outpatient or inpatient treatment and residential rehabilitation programs may be considered.
• Precautions (related to treatment)
  • Before diagnosis, it is essential to assess for other psychiatric conditions (depression, ADHD, anxiety, substance use, and others).
  • Forced restriction alone carries a high risk of relapse — psychosocial alternative strategies and family support must be provided together.
  • Actively manage the restoration of sleep, nutrition, and physical activity during treatment.

Outpatient Visit Checklist (Including Examples of Items to Bring and Records to Prepare)

• Items and records to prepare
  • A list of currently used medications (including prescriptions, over-the-counter medications, and dietary supplements).
  • Records or screenshots/logs of when symptoms began and their patterns (average daily usage time and differences between weekends and weekdays).
  • Records of changes in sleep, eating, and exercise habits.
  • Notes on specific incidents related to changes in school or work performance and attendance, or family and interpersonal problems (for example, absences from work or disputes).
  • Previous mental health treatment records (such as medical certificates, prescriptions, and psychological test results) and major test results, if any.
  • An honest statement about whether there are thoughts of self-harm or suicide.
• Items to review with the doctor during the outpatient visit
  • Internet usage patterns (what, with whom, when, and how much the person does).
  • The extent of impairment in daily functioning (effects on schoolwork, work, family relationships, and health).
  • Associated symptoms (depression, anxiety, reduced concentration, and sleep disturbance).

Examples of General Questions to Ask the Doctor

• "How severe is my current condition (or my child's condition)? What is the diagnosis?"
• "What treatment do you recommend, and what are the treatment duration and goals?"
• "What are the expected effects and possible side effects of the prescribed medication (or recommended treatment)?"
• "What behaviors or environmental factors should I change first in daily life?"
• "What is the follow-up plan to prevent relapse during treatment?"

Examples of Condition-Specific Questions

• "Could you suggest a specific action plan (such as a schedule or reward system) for reducing internet use safely and realistically?"
• "Co-occurring depression (or ADHD) is suspected. How do you determine whether medication treatment is needed or whether psychological therapy should be started first?"

(Note: Diagnosis and treatment plans vary greatly among individuals, so the information above is general guidance. Consult a psychiatrist for an accurate evaluation and treatment decisions.)