A 21st Century Epidemic: Problematic Internet Use in Connecticut Students

You are sitting in class, taking notes as you intently listen to the professor. Next to you, someone is tapping furiously at their cell phone. In front of you, someone snickers quietly as they scroll through the latest pictures of their friends on Facebook. You return to your room after class and begin your reading for your next class. At some point, your roommate returns from class. Without acknowledging you, he turns on his computer to open Classes*v2, Gmail, Facebook, and 53 other pages… You are slightly annoyed, but only because you are resisting the urge to do the same thing. Scenes like this are all too common at Yale, and apparently throughout the world.

In June 2011, a paper titled “Problematic Internet Use and Health in Adolescents: Data from a High School Survey in Connecticut,” was published in the Journal of Clinical Psychiatry. The study, completed by the team of Dr. Marc Potenza of the Yale University School of Medicine, surveyed 3,560 students in Connecticut high schools and was the first epidemiologic study of problematic Internet use among U.S. high school students. Potenza’s team produced some relatively straightforward results. According to the paper, the overall prevalence of problematic Internet use in Connecticut high school students is 4%. Problematic Internet use is more common in Asian (7.86%) and Hispanic (6.07%) students; boys spend more time on the Internet and girls are more likely to self-report excessive Internet use.

Even among today’s youth, there is recognition of the fact that greater access to the Internet, with all its benefits, will come at a certain cost. The statistic of 4%, however, seems low given the ubiquity of Wi-Fi, smartphones, and Internet portals. What, then, accounts for the figure of 4%? A key aspect is the definition of “problematic Internet use” that is used and applied in research investigations.

Defining “Problematic Internet Use”

“Problematic Internet use” is not as simple as crossing an arbitrary threshold for the number of hours spent on the Internet per week. It is not currently a diagnosable condition, though it has been recommended for inclusion in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Potenza, Professor of Psychiatry and Neurobiology at the Yale School of Medicine and the Child Study Center, says that there is “no formal agreed-upon criteria for problematic Internet use.” In his research on adolescent risk behaviors and their correlates, Potenza believes that “problematic Internet use” may be grouped with “pathological gambling, kleptomania, pyromania, and compulsive engagement in non-paraphilic sexual behaviors” as an impulse control disorder, which itself is nebulously classified as “not elsewhere classified” in the current DSM-IV.

This study reflects a growing interest within the public health community to investigate trends in non-communicable diseases that had not previously been formally recognized. Without a standard definition for problematic Internet use, Potenza and other members of the investigative team (including co-authors Drs. Rani Desai and Suchitra Krishnan-Sarin) formulated a definition based on the criteria for other impulse control disorders as found in the Minnesota Impulsive Dis-order Inventory. From their survey data, Potenza, first author Dr. Timothy Liu, and the rest of the investigative team reached the chilling conclusion that problematic Internet use, perhaps through intermediary phenotypes like self-control and impulsivity, is associated with aggression, depression, and substance abuse.

Yale, an Experimental Microcosm

Aggression, depression, and substance abuse read like a list of the three most common conditions faced by college students. Potenza remarks, “Now available due to technological advances are video game playing and Internet use. With changes in the availability and popularity of these behaviors, people might develop problems with them. When I was an undergraduate at Yale, many of the students did not have computers, and cell phones and smart phones were not available… I imagine that Yale undergraduates today have grown up with the Internet to a much greater extent than many of the faculty.” But just how many Yale students, using the same definition as Liu, Potenza, and colleagues, would be considered to have problematic Internet use? To that end, 100 random Yale freshmen were asked to anonymously answer a survey on Internet use, of which the first seven questions were taken directly from Liu and Potenza’s study of Connecticut high school students:
1. How many hours do you spend using the Internet in a typical week?
2. Do you think you have a problem with excessive Internet use?
3. Have you ever experienced an irresistible urge or uncontrollable need to use the Internet?
4. Have you ever experienced a growing tension or anxiety that can be relieved only by using the Internet?
5. Have you ever missed school, work, or an important social activity because you were using the Internet?
6. Have you ever tried to cut back on your Internet use?
7. Has a family member ever expressed concern about the amount of time you use the Internet?

As in the Liu et al. study, “Problematic Internet use was defined as simultaneously endorsing questions 3, 4, and 6.”According to the 100 survey responses, 9 students met these criteria for problematic Internet use. The average Yale freshman spends 21 hours using the Internet in a typical week, with school activities reported as the most common use of Internet and social activities as the second most common use. Among females surveyed, 29% thought they had a problem with excessive Internet use, compared to 13% of males, although Internet use was not significantly different between females and males. Racial differences were not significant, though Asians (22 hours/week) and Hispanics (25 hours/week) tended to use the Internet slightly more than blacks (19 hours/week) and whites (21 hours/week) did. Yale, evaluated as a microcosm with Potenza’s guidelines, follows his experimental findings despite the high prevalence of laptops and smartphones and nearly campus-wide wireless access.

Internet Use as a Disorder?

The comparison between problematic Internet use and other impulse-control disorders is unproven but suggestive. Potenza suggests, “Today there are different expectations about how quickly things should be done, and the ability to delay gratification may be related to impulse-control disorders.” He also notes that although Internet use is widespread, the prevalence of problems associated with Internet use is relatively small. Over-engagement is problematic, but what causes over-engagement in an individual? For some, Potenza remarks, it is difficult to “refrain from a pleasurable behavior at the cost of other things that might need to be done.” For others, “if people avoid coping with the stressor and escape into other worlds without dealing with what is leading to the negative state, it has the potential to exacerbate the stressful or depressing situation,” says Potenza.

Much research is still needed on problematic Internet use, an emerging issue that has yet to be followed over an extended time. The advent of the Internet has ushered in a new culture for Generation Y, but how adolescents have and will continue to respond to life in the digital age is left up to question.

About the Author
DENNIS WANG is a sophomore Molecular Biophysics & Biochemistry major in Calhoun College. He works in Professor Lin’s lab at the Yale Stem Cell Center.

The author would like to thank Dr. Potenza for his time and for his comments on this article.

Further Reading
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association; 2000.
Grant JE, Potenza MN. The Oxford Handbook of Impulse Control Disorders. Oxford University Press; 2011.
Liu TC, Desai RA, Potenza MN, et al. Problematic Internet Use and Health in Adolescents: Data From a High School Survey in Connecticut. J Clin Psychiatry. 2011;72(6):836-845.
Liu T, Potenza MN. Problematic Internet use: clinical implications. CNS Spectr. 2007;12(6):453-466.
Morahan-Martin J, Schumacher P. Incidence and correlates of pathological Internet use among college students. Comput Human Behav. 2000;16(1):13-29.
Pies R. Should DSM-V designate “Internet addiction” a mental disorder? Psychiatry (Edgmont). 2009;6(2):31-37.
Young KS. Internet Addiction: the emergence of a new clinical disorder. CyberpsycholBehav. 1998;1(3):237-244.