By Anne Federwisch
Illustration by Malcolm Garris/Photodisc
August 8, 1997

Early in 1995, New York psychiatrist Ivan Goldberg, MD, announced the appearance of a new addiction: people abandoning their family obligations to sit gazing into their computer monitor as they surfed the Internet. Although Goldberg’s posting was a spoof on society's fascination with its own addictive behaviors, the hoax took on a cyberlife of its own, and news of this new disorder spread among netizens. But some researchers insist people are becoming addicted to the Internet, and they have preliminary research to back them up.
Across the board, mental health experts agree the Internet has provided a valuable service to people looking for support groups, treatment options, and other help. Web sites, newsgroups, and e-mail lists all are very powerful resources for people to find the information and help they need," said psychologist John Suler, PhD, professor of psychology at Rider University in New Jersey and webmaster of the Psychology of Cyberspace Web site.

But could the anonymity of the Net offer too much of a good thing to some netizens? That is the question some mental health experts are asking. Many researchers even use the same term Goldberg used in his hoax, "Internet addiction disorder" (IAD), to describe the addiction.

Goldberg, who specializes in treating people with treatment-resistant mood disorders, fabricated and posted a list of IAD symptoms on PsyCom.Net, a site he operates and which sponsors Internet-based information services for mental health professionals. Goldberg said it was intended to be a parody of the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the bible for the diagnosis and reimbursement for treatment of mental health disorders. He compounded the irony by starting an Internet addiction support group online, akin to holding an Alcoholics Anonymous meeting in the middle of a cocktail party.
"I don’t think Internet addiction disorder exists any more than tennis addictive disorder, bingo addictive disorder, and TV addictive disorder exist. People can overdo anything. To call it a disorder is an error," Goldberg said.

Clinical psychologist Kimberly Young, PsyD, assistant professor of psychology at the University of Pittsburgh at Bradford in Pennsylvania, doesn’t like the term IAD either, but she does think the phenomenon exists. She has been researching it since the fall of 1994. Her interest began after watching students in computer labs and listening to a friend lamenting her husband’s preoccupation with the Internet.

In an exploratory study, Young used a seven-item questionnaire about Internet use to interview 496 Internet users responding to her online and off-line advertisements seeking "Avid Internet Users." Based on their responses, she classified 396 as "dependent Internet users."

In her paper "Internet Addiction: The Emergence of a New Clinical Disorder", she writes, "This paper concludes that people can and do become addicted to the Internet, which should be a growing concern among mental health practitioners." She said that symptoms include preoccupation with the Internet, an inability to control Internet use, and restlessness or irritability when attempting to cut down on Internet use.

Sharing Young's belief is Maressa Hecht Orzack, PhD, founder and coordinator of the year-old Computer Addiction Service at McLean Hospital in Belmont, Massachusetts. "There are unique things here [on the Internet] that don’t seem to exist in other areas of addiction," she said. "The connection that people get from chats and e-mail is quite different than sitting there doing word processing."

Suler has written an article about Internet addiction and corresponds via e-mail with people who want to talk about their preoccupation with the Internet and computers. He agrees the lure of a cyberlife can be overwhelming. Some people can "get preoccupied with their computers and the Internet to the point where their ‘obsession’ causes them to neglect their marriages, family, and/or job, thereby resulting in problems."

But Suler said the question of whether Internet addiction is a bona fide mental disorder is a far more complex question, contingent upon extensive research. He said a diagnosis must meet two important criteria: 1) identification of a consistent, reliably diagnosed set of symptoms that constitutes the disorder. 2) correlation of similar elements in the histories, personalities, effective treatment, and prognosis of people who are diagnosed with the disorder (i.e., etiologic, concurrent, and predictive validity of the diagnosis). "If not, where’s the beef? It’s simply a label that is related to nothing," Suler said.

The joke has gotten out of hand, said clinical psychologist John Grohol, PsyD, director of the Dublin, Ohio-based Mental Health Net, a nonprofit organization that sponsors a comprehensive mental health Web site. "The problem is that that’s not how we create new mental disorder in the scientific field of mental health. People don’t just dream up the criteria and post it to the Internet. That’s not the way it’s done. It’s done after years of research that shows this is a distinct and unique disorder," he said in an interview with Nurseweek/Healthweek.

But in another twist, Mental Health Net itself legitimized IAD by including at its Web site Goldberg’s symptoms and other online addiction resources without any comment about Goldberg’s parody until Nurseweek/Healthweek pointed it out. Since then, Grohol has changed the page titled Internet Addiction Disorder to read: "Due to the fact the so-called ‘Internet addiction disorder’ has not yet been validated by empirical research, we believe it to be fueling the fire behind the misinformation to publish the joke criteria for the disorder (which began as a parody) here."

Like Goldberg, Grohol has not done research on Internet use. He said Young’s research was based on a biased population that was self-selecting for the type of problems she was seeking to research (overuse of the Internet). "You can’t make many assumptions from research that only looks at a population that you’ve preselected like that," he said.

And while he believes further research may eventually prove that IAD is a distinct disorder, he said, "Until we do get that research, I’m more likely to sit back, take a wait-and-see attitude, and make sure that we’re not jumping the gun here on something that we think is a unique phenomena."

Young agrees more research is needed, and both she and Orzack are pursuing further studies. While she is not advocating premature inclusion of pathological Internet use (a term she prefers to IAD) in the DSM, she wants the disorder to be taken seriously. "If any psychologist or psychiatrist wants to dispute that it [pathological Internet use] exists, then how do they explain all the people seeking treatment?" she said.