EXCERPTS FROM SELECTED STUDIES ON INTERNET PORN USE
Predicting Compulsive Internet Use: It’s All About Sex! (2006)
Meerkerk GJ, Van Den Eijnden RJ, Garretsen HF.
Cyberpsychol Behav. 2006 Feb;9(1):95-103.
The objective of this research was to assess the predictive power of various Internet applications on the development of compulsive Internet use (CIU). The study has a two-wave longitudinal design with an interval of 1 year.
On a cross-sectional basis, gaming and erotica seem the most important Internet applications related to CIU. On a longitudinal basis, spending a lot of time on erotica predicted an increase in CIU 1 year later. The addictive potential of the different applications varies; erotica appears to have the highest potential.
Watching Pornographic Pictures on the Internet: Role of Sexual Arousal Ratings and Psychological-Psychiatric Symptoms for Using Internet Sex Sites Excessively (2011)
Cyberpsychol Behav Soc Netw. 2011 Jun;14(6):371-7. doi: 10.1089/cyber.2010.0222.
The Internet Addiction Test (IAT) and a modified version of the IAT for online sexual activities (IATsex), as well as several further questionnaires measuring psychological symptoms and facets of personality were also administered to the participants.
Results indicate that self-reported problems in daily life linked to online sexual activities were predicted by subjective sexual arousal ratings of the pornographic material, global severity of psychological symptoms, and the number of sex applications used when being on Internet sex sites in daily life, while the time spent on Internet sex sites (minutes per day) did not significantly contribute to explanation of variance in IATsex score. Personality facets were not significantly correlated with the IATsex score.
Although the topic of cybersex addiction has high clinical relevance, it has been almost neglected in previous research. 16,17 In most of the studies on cognitive or personality correlates of Internet activities in general, online/computer gamers were primarily included in the samples18–20 or no distinction between different online activities has been made.21–24 Studies that particularly investigate experimentally potential mechanisms of cybersex addiction are missing.
we see some parallels between cognitive and brain mechanisms potentially contributing to the maintenance of excessive cybersex and those described for individuals with substance dependence or behavioral addiction (e.g., pathological gambling). For instance, it is known that the brain of subjects with alcoholism or other substance dependence reacts emotionally (activations of the ventral striatum) when being confronted with alcohol- or drug-related pictures.30–32 Other studies also emphasize that craving reactions (cue-reactivity) can be found in subjects with behavioral addictions, such as pathological gambling33 and—most recently—even in subjects who excessively play World of Warcraft19 or other computer games.18 These studies converge to the view that craving reactions on watching addiction-related stimuli are important correlates of the addictive behavior.
Therefore, it seems plausible that those brain regions involved in processing sexual stimuli, and sexual arousal and activity, as well as in craving reactions in individuals with behavioral addictions, are also crucially relevant for development and maintenance of addictive behavior in the context of cybersex.
Discussion
We found a positive relationship between subjective sexual arousal when watching Internet pornographic pictures and the self-reported problems in daily life due to the excessiveness of cybersex as measured by the IATsex. Subjective arousal ratings, the global severity of psychological symptoms, and the number of sex applications used were significant predictors of the IATsex score, while the time spent on Internet sex sites did not significantly contribute to explanation of variance in the IATsex score.
The finding that subjective sexual arousal ratings while watching Internet pornographic pictures is related to self-reported problems in daily life due to excessive use of cybersex sites may be interpreted in the light of previous studies on cue reactivity in individuals with substance dependency or behavioral addictions.
As outlined in the introduction, cue reactivity as a mechanism potentially contributing to the maintenance of addicted behavior has been demonstrated in several patient groups with either substance dependence or behavioral addiction. 18,19,30–33 These studies converge to the view that craving reactions on watching addiction-related stimuli are important correlates of the addictive behavior.
Although we did not examine brain correlates of watching Internet pornographic pictures in our study, we found the first experimental evidence for the potential link between subjective reactivity on Internet pornographic stimuli and a tendency toward cybersex addiction.
Pornographic Picture Processing Interferes with Working Memory Performance (2012)
Some individuals report problems during and after Internet sex engagement, such as missing sleep and forgetting appointments, which are associated with negative life consequences. One mechanism potentially leading to these kinds of problems is that sexual arousal during Internet sex might interfere with working memory (WM) capacity, resulting in a neglect of relevant environmental information and therefore disadvantageous decision making. Results revealed worse WM performance in the pornographic picture condition of the 4-back task compared with the three remaining picture conditions.
Furthermore, hierarchical regression analysis indicated an explanation of variance of the sensitivity in the pornographic picture condition by the subjective rating of the pornographic pictures as well as by a moderation effect of masturbation urges. Results contribute to the view that indicators of sexual arousal due to pornographic picture processing interfere with WM performance. Findings are discussed with respect to Internet addiction because WM interference by addiction-related cues is well known from substance dependencies.
Sexual Picture Processing Interferes with Decision-Making Under Ambiguity (2013).
Arch Sex Behav. 2013 Jun 4.
When browsing for sexual stimuli, individuals have to make several decisions, all possibly leading to positive or negative consequences. Decision-making research has shown that decisions under ambiguity are influenced by consequences received following earlier decisions. Sexual arousal might interfere with the decision-making process and should therefore lead to disadvantageous decision-making in the long run. In the current study, 82 heterosexual, male participants watched sexual pictures, rated them with respect to sexual arousal, and were asked to indicate their current level of sexual arousal before and following the sexual picture presentation. Afterwards, subjects performed one of two modified versions of the Iowa Gambling Task in which sexual pictures were displayed on the advantageous and neutral pictures on the disadvantageous card decks or vice versa (n = 41/n = 41).
Decision-making performance was worse when sexual pictures were associated with disadvantageous card decks compared to performance when the sexual pictures were linked to the advantageous decks. Subjective sexual arousal moderated the relationship between task condition and decision-making performance. This study emphasized that sexual arousal interfered with decision-making, which may explain why some individuals experience negative consequences in the context of cybersex use.
Cybersex addiction: Experienced sexual arousal when watching pornography and not real-life sexual contacts makes the difference (2013)
Journal of Behavioral Addictions.
Cybersex addiction is discussed controversially, while empirical evidence is widely missing. With respect to its mechanisms of development and maintenance Brand et al. (2011) assume that reinforcement due to cybersex should lead to the development of cue-reactivity and craving explaining recurrent cybersex use in the face of growing but neglected negative consequences. To support this hypothesis, two experimental studies were conducted.
The aim of the second study was to verify the findings of the first study by comparing healthy (n=25) and problematic (n=25) cybersex users.
The results show that indicators of sexual arousal and craving to Internet pornographic cues predicted tendencies towards cybersex addiction in the first study. Moreover, it was shown that problematic cybersex users report greater sexual arousal and craving reactions resulting from pornographic cue presentation. In both studies, the number and the quality with real-life sexual contacts were not associated to cybersex addiction.
The results support the gratification hypothesis, which assumes reinforcement, learning mechanisms, and craving to be relevant processes in the development and maintenance of cybersex addiction. Poor or unsatisfying sexual real life contacts cannot sufficiently explain cybersex addiction.
Cybersex addiction in heterosexual female users of internet pornography can be explained by gratification hypothesis (2014)
Cyberpsychol Behav Soc Netw. 2014 Aug;17(8):505-11.
In the context of Internet addiction, cybersex is considered to be an Internet application in which users are at risk for developing addictive usage behavior. Regarding males, experimental research has shown that indicators of sexual arousal and craving in response to Internet pornographic cues are related to severity of cybersex addiction in Internet pornography users (IPU). Since comparable investigations on females do not exist, the aim of this study is to investigate predictors of cybersex addiction in heterosexual women.
We examined 51 female IPU and 51 female non-Internet pornography users (NIPU).
Results indicated that IPU rated pornographic pictures as more arousing and reported greater craving due to pornographic picture presentation compared with NIPU. Moreover, craving, sexual arousal rating of pictures, sensitivity to sexual excitation, problematic sexual behavior, and severity of psychological symptoms predicted tendencies toward cybersex addiction in IPU. Being in a relationship, number of sexual contacts, satisfaction with sexual contacts, and use of interactive cybersex were not associated with cybersex addiction. These results are in line with those reported for heterosexual males in previous studies.
Empirical Evidence and Theoretical Considerations on Factors Contributing to Cybersex Addiction From a Cognitive-Behavioral View (2014)
Sexual Addiction & Compulsivity: The Journal of Treatment & Prevention, Volume 21, Issue 4, 2014
Previous work suggests that some individuals might be vulnerable to CA, while positive reinforcement and cue-reactivity are considered to be core mechanisms of CA development. In this study, 155 heterosexual males rated 100 pornographic pictures and indicated their increase of sexual arousal. Moreover, tendencies towards CA, sensitivity to sexual excitation, and dysfunctional use of sex in general were assessed. The results of the study show that there are factors of vulnerability to CA and provide evidence for the role of sexual gratification and dysfunctional coping in the development of CA.
Prefrontal control and internet addiction: a theoretical model and review of neuropsychological and neuroimaging findings (2015)
Front Hum Neurosci. 2014 May 27;8:375.
Most people use the Internet as a functional tool to perform their personal goals in everyday-life such as making airline or hotel reservations. However, some individuals suffer from a loss of control over their Internet use resulting in personal distress, symptoms of psychological dependence, and diverse negative consequences. This phenomenon is often referred to as Internet addiction. Only Internet Gaming Disorder has been included in the appendix of the DSM-5, but it has already been argued that Internet addiction could also comprise problematic use of other applications with cybersex, online relations, shopping, and information search being Internet facets at risk for developing an addictive behavior.
Neuropsychological investigations have pointed out that certain prefrontal functions in particular executive control functions are related to symptoms of Internet addiction, which is in line with recent theoretical models on the development and maintenance of the addictive use of the Internet. Control processes are particularly reduced when individuals with Internet addiction are confronted with Internet-related cues representing their first choice use. For example, processing Internet-related cues interferes with working memory performance and decision making. Consistent with this, results from functional neuroimaging and other neuropsychological studies demonstrate that cue-reactivity, craving, and decision making are important concepts for understanding Internet addiction. The findings on reductions in executive control are consistent with other behavioral addictions, such as pathological gambling. They also emphasize the classification of the phenomenon as an addiction, because there are also several similarities with findings in substance dependency. The neuropsychological and neuroimaging results have important clinical impact, as one therapy goal should enhance control over the Internet use by modifying specific cognitions and Internet use expectancies.
Regarding the development and maintenance of an addictive use of specific Internet applications (SIA), we argue – consistent with previous research and in accordance with the model by Davis (2001) – that psychopathological symptoms are particularly involved (Brand et al., 2011; Kuss and Griffith, 2011; Pawlikowski and Brand, 2011; Laier et al., 2013a; Pawlikowski et al., 2014). We also hypothesize that specific person’s predispositions increase the probability that an individual receives gratification from the use of certain applications and overuses these applications again. One example for such a specific predisposition is a high sexual excitation (Cooper et al., 2000a,b; Bancroft and Vukadinovic, 2004; Salisbury, 2008; Kafka, 2010), which makes it more likely that an individual uses Internet pornography, because he/she anticipates sexual arousal and gratification (Meerkerk et al., 2006; Young, 2008). We believe that the expectancy that such Internet applications can satisfy certain desires increases the likelihood that these Internet applications are used frequently, as assumed in addictive behavior in general (Robinson and Berridge, 2000, 2003; Everitt and Robbins, 2006) and that the individual can develop a loss of control over his/her use of such applications. As a result, gratification is experienced and consequently the use of such applications and also the specific Internet use expectancies and the coping style are reinforced positively. This has already been shown, for example for cybersex addiction (Brand et al., 2011; Laier et al., 2013a) and is most likely also a mechanism for online gaming (e.g., Tychsen et al., 2006; Yee, 2006). The more general psychopathological tendencies (e.g., depression and social anxiety) are supposed to be negatively reinforced. This may be due to the fact that also specific Internet applications (e.g., Internet pornography) can be used to distract from problems in the real life or to avoid negative feelings, such as loneliness or social isolation. The main arguments of our model are summarized in Figure Figure11.
Getting stuck with pornography? Overuse or neglect of cybersex cues in a multitasking situation is related to symptoms of cybersex addiction (2015)
J Behav Addict. 2015 Mar;4(1):14-21.
Some individuals consume cybersex contents, such as pornographic material, in an addictive manner, which leads to severe negative consequences in private life or work. One mechanism leading to negative consequences may be reduced executive control over cognition and behavior that may be necessary to realize goal-oriented switching between cybersex use and other tasks and obligations of life.
To address this aspect,we investigated 104 male participants with an executive multitasking paradigm with two sets: One set consisted of pictures of persons, the other set consisted of pornographic pictures. In both sets the pictures had to be classified according to certain criteria. We found that less balanced performance in this multitasking paradigm was associated with a higher tendency towards cybersex addiction. Persons with this tendency often either overused or neglected working on the pornographic pictures.
The results indicate that reduced executive control over multitasking performance, when being confronted with pornographic material, may contribute to dysfunctional behaviors and negative consequences resulting from cybersex addiction. However, individuals with tendencies towards cybersex addiction seem to have either an inclination to avoid or to approach the pornographic material, as discussed in motivational models of addiction.
The results of the current study point towards a role of executive control functions, i.e. functions mediated by the prefrontal cortex, for the development and maintenance of problematic cybersex use (as suggested by Brand et al., 2014). Particularly a reduced ability to monitor consumption and to switch between pornographic material and other contents in a goal adequate manner may be one mechanism in the development and maintenance of cybersex addiction.
Implicit associations in cybersex addiction: Adaption of an Implicit Association Test with pornographic pictures (2015)
Addict Behav. 2015 May 16;49:7-12.
Recent studies show similarities between cybersex addiction and substance dependencies and argue to classify cybersex addiction as a behavioral addiction. In substance dependency, implicit associations are known to play a crucial role, and such implicit associations have not been studied in cybersex addiction, so far. In this experimental study, 128 heterosexual male participants completed an Implicit Association Test modified with pornographic pictures.
Results show positive relationships between implicit associations of pornographic pictures with positive emotions and tendencies towards cybersex addiction, problematic sexual behavior, sensitivity towards sexual excitation as well as subjective craving. Moreover, a moderated regression analysis revealed that individuals who reported high subjective craving and showed positive implicit associations of pornographic pictures with positive emotions, particularly tended towards cybersex addiction. The findings suggest a potential role of positive implicit associations with pornographic pictures in the development and maintenance of cybersex addiction. Moreover, the results of the current study are comparable to findings from substance dependency research and emphasize analogies between cybersex addiction and substance dependencies or other behavioral addictions.
Symptoms of cybersex addiction can be linked to both approaching and avoiding pornographic stimuli: results from an analog sample of regular cybersex users (2015)
Front Psychol. 2015 May 22;6:653.
There is no consensus regarding the phenomenology, classification, and diagnostic criteria of cybersex addiction. Some approaches point toward similarities to substance dependencies for which approach/avoidance tendencies are crucial mechanisms. Several researchers have argued that within an addiction-related decision situation, individuals might either show tendencies to approach or avoid addiction-related stimuli.
Results showed that individuals with tendencies toward cybersex addiction tended to either approach or avoid pornographic stimuli. Additionally, moderated regression analyses revealed that individuals with high sexual excitation and problematic sexual behavior who showed high approach/avoidance tendencies, reported higher symptoms of cybersex addiction. Analogous to substance dependencies, results suggest that both approach and avoidance tendencies might play a role in cybersex addiction.
Moreover, an interaction with sensitivity toward sexual excitation and problematic sexual behavior could have an accumulating effect on the severity of subjective complaints in everyday life due to cybersex use.
The findings provide further empirical evidence for similarities between cybersex addiction and substance dependencies. Such similarities could be retraced to a comparable neural processing of cybersex- and drug-related cues.
Mental – and physical-health indicators and sexually explicit media use behavior by adults (2011)
J Sex Med. 2011 Mar;8(3):764-72.
Essentially unexplored, and the focus here, are potential relationships between SEMB and nonsexual mental- and physical-health indicators.
Variability in six continuously measured health indicators (depressive symptoms, mental- and physical-health diminished days, health status, quality of life, and body mass index) was examined across two levels (users, nonusers) of SEMB.
A sample of 559 Seattle-Tacoma Internet-using adults was surveyed in 2006. Multivariate general linear models parameterized in a SEMB by respondent gender (2 × 2) factorial design were computed incorporating adjustments for several demographics.
RESULTS: SEMB was reported by 36.7% (n = 205) of the sample. Most SEMB users (78%) were men. After adjusting for demographics, SEMB users, compared to nonusers, reported greater depressive symptoms, poorer quality of life, more mental- and physical-health diminished days, and lower health status.
Reduced Striatal Dopamine Transporters in People with Internet Addiction Disorder (2012)
Journal of Biomedicine and Biotechnology, Volume 2012
In recent years, internet addiction disorder (IAD) has become more prevalent worldwide and the recognition of its devastating impact on the users and society has rapidly increased. The present study was designed to determine if the striatal dopamine transporter (DAT) levels measured by 99mTc-TRODAT-1 single photon emission computed tomography (SPECT) brain scans were altered in individuals with IAD. SPECT brain scans were acquired on 5 male IAD subjects and 9 healthy age-matched controls.
The IAD subjects used the internet almost everyday, and spend more than 8 hours (mean?±?SD, 10.20±1.48 hours) everyday in front of the monitor, mostly for chatting with cyber friends, playing online games, and watching online pornographies or adult movies. These subjects were initially familiar with internet mostly at the early stage of their adolescence (mean age ± SD, 12.80±1.92 years old) and had the indications of IAD for more than 6 years (mean±SD, 7.60±1.52 years).
It was displayed that DAT expression level of striatum was significantly decreased and the V, W, and Ra were greatly reduced in the individuals with IAD compared to controls. Taken together, these results suggest that IAD may cause serious damages to the brain and the neuroimaging findings further illustrate IAD is associated with dysfunctions in the dopaminergic brain systems. Our findings also support the claim that IAD may share similar neurobiological abnormalities with other addictive disorders
Differential psychological impact of internet exposure on internet addicts (2013)
PLoS One. 2013;8(2):e55162. doi: 10.1371/journal.pone.0055162.
The study explored the immediate impact of internet exposure on the mood and psychological states of internet addicts and low internet-users. Participants were given a battery of psychological tests to explore levels of internet addiction, mood, anxiety, depression, schizotypy, and autism traits. They were then given exposure to the internet for 15 min, and re-tested for mood and current anxiety.
High internet-users also showed a pronounced decrease in mood following internet use compared to the low internet-users. The immediate negative impact of exposure to the internet on the mood of internet addicts may contribute to increased usage by those individuals attempting to reduce their low mood by re-engaging rapidly in internet use.
Similarly, exposure to the object of the problematic behaviours has been found to reduce mood [26], especially in individuals addicted to pornography [5], [27]. As both of these reasons (i.e. gambling and pornography) for use of the internet are strongly associated with problematic internet use [2], [3], [14], it may well be that these factors may also contribute to internet addiction [14]. Indeed, it has been suggested that such negative impacts of engagement in problematic behaviour may, in themselves, generate further engagement in these high probability problematic behaviours in an attempt to escape these negative feelings [28].
The results showed a striking negative impact of internet exposure on the positive mood of ‘internet addicts’. This effect has been suggested in theoretical models of ‘internet addiction [14], [21], and a similar finding has also been noted in terms of the negative effect of exposure to pornography on internet sex addicts [5], which may suggest commonalities between these addictions. It is also worth suggesting that this negative impact on mood could be considered as akin to a withdrawal effect, suggested as needed for the classification of addictions 1, [2], [27].
It should be pointed out that, as two of the key uses of the internet for a sizable number of internet users are to gain access to pornography and gambling [4], [5], and these latter activities are clearly subject to potentially-addictive states, it may be that any results relating to ‘internet addiction’ are actually manifestations of other forms of addiction (i.e. to pornography or gambling).
Evolution of Internet addiction in Greek adolescent students over a two year period the impact of parental bonding (2012)
Eur Child Adolesc Psychiatry. 2012 Feb 4.
We present results from a cross-sectional study of the entire adolescent student population aged 12-18 of the island of Kos and their parents, on Internet abuse.
Our results indicate that Internet addiction is increased in this population where no preventive attempts were made to combat the phenomenon from the initial survey, 2 years ago. This increase is parallel to an increase in Internet availability.
Parents tend to underestimate the level of computer involvement when compared to their own children estimates. Parental safety measures on Internet browsing have only a small preventive role and cannot protect adolescents from Internet addiction. The three online activities most associated with Internet addiction were watching online pornography, online gambling and online gaming.
Internet addiction (2012)
Duodecim. 2012;128(7):741-8.
Internet addiction is defined as uncontrolled and harmful use of Internet, which manifests in three forms: gaming, various sexual activities and excessive use of emails, chats or SMS messaging. In boys and men depression may be more a consequence of the addiction than a cause for it. ADHD seems to be a significant background factor for developing the condition.
Problematic Internet Use and Its Correlates Among Students from Three Medical Schools Across Three Countries (2015)
Acad Psychiatry. 2015 Jul 1.
The authors aimed to assess and compare problematic internet use among medical students enrolled in a graduate degree course in one school each from Croatia, India, and Nigeria and to assess correlates of problematic use among these students. The questionnaire included a sociodemographic profile of participants and Young’s Internet Addiction Test.
The final analysis included 842 subjects. Overall, 38.7 and 10.5 % of respondents scored in the mild and moderate categories. Only a small fraction (0.5 %) of students scored in the severe category. Moreover, a significantly higher proportion of participants who scored above the cutoff used the Internet for browsing, social networking, chatting, gaming, shopping, and viewing pornography. However, there was no difference between the two groups with regard to using the internet for e-mailing or academic activities.
Pathological Internet use – It is a multidimensional and not a unidimensional construct (2013)
May 15, 2013 ADDICTION RESEARCH &THEORY
It is still a topic of debate whether pathological Internet use (PIU) is a distinct entity or whether it should be differentiated between pathological use of specific Internet activities like playing Internet games and spending time on Internet sex sites. The aim of the current study was to contribute to a better understanding of common and differential aspects of PIU in relation to different specific Internet activities. Three groups of individuals were examined which differed with respect to their use of specific Internet activities: one group of 69 subjects used exclusively Internet games (IG) (but not Internet pornography (IP)), 134 subjects used IP (but not IG), and 116 subjects used both IG and IP (i.e., unspecific Internet use).
The results indicate that shyness and life satisfaction are significant predictors for a tendency towards pathological use of IG, but not pathological use of IP. Time spent online was a significant predictor for problematic use of both IG and IP. Additionally, no correlation was found between symptoms of pathological use of IG and IP. We conclude that games may be used to compensate social deficits (e.g., shyness) and life satisfaction in real life, whereas IP is primarily used for gratification in terms of achieving stimulation and sexual arousal.
These results support the demand for differentiating the various facets of Internet use in future studies instead of considering PIU as a unitary phenomenon.
Influence of dopaminergic system on internet addiction (2011)
Acta Medica Medianae 2011;50(1):60-66.
FULL PDF
Phenomenological, neurobiological, and pharmacological data indicates similarities in pathopsychology of substance addiction and pathological gambling, which are indirectly related to the similarity with the Internet addiction. Responding to stimuli from the game, addicts have shown more brain activity in the nape region, left dorsolateral, prefrontal cortex, and left parachipocampal gyrus than in the control group. After the six-week bupropion therapy, desire to play Internet and video games, the total duration of playing, and induced brain activity in dorsolateral prefrontal cortex are lowered with the addicts.
Subtypes of Internet Addiction (18) Generalized Internet addiction is not as common and it includes a multidimensional, excessive usage of Internet service and content, commonly without a specific goal of this usage. This form is mostly related to the social interaction such as chatting, instant messaging, forums and discussion groups, and general addiction for the computer and Internet, such as online surfing, search engine usages based on hobbies etc. However, it is more common that people grow addicted to the specific online content and activities rather than general Internet usage.
There is no consensus with regards to the exact number of assumptions of the subtypes of Internet abuse. However, four or five types are most commonly defined, and, in his work, Hinić accentuates concept 6+1 subtypes:
1. Cyber-Relational Addiction
2. Cybersexual Addiction
3. Information Overload
4. Net Gaming
5. Compulsive Online Shopping
6. Computer and IT Addiction
7. Mixed type of addiction
Internet Sex Addiction: Risk Factors, Stages of Development, and Treatment
American Behavioral Scientist, September 2008 vol. 52 no. 1 21-37
Kimberly S. Young
Internet sex addiction typically involves viewing, downloading, and trading online pornography or engagement in adult fantasy role-play rooms. Adult Web sites comprise the largest segment of electronic commerce catering to a wide variety of sexual interests. Given the widespread availability of sexually explicit material online, Internet sex addiction is the most common form of problem online behavior among users.
Internet use and pathological internet engagement in a sample of college students
Psychiatrike. 2011 Jul-Sep;22(3):221-30.
[Article in Greek, Modern]
Participants were 514 college students from the University of Athens who completed a questionnaire covering various aspects of internet use, Young’s Internet Addiction Test, scales investigating online gambling addiction and cybersexual addiction and scales investigating suicidal ideation and the use of psychoactive substances.
Subjects at risk for developing pathological internet engagement had significantly higher levels of online gambling addiction, cybersexual addiction, suicidal ideation and alcohol abuse, compared with other groups. Pathological internet engagement, particularly in young people, is a new psychopathological parameter that should be incorporated in the diagnostic and therapeutic horizon of mental health professionals.
Problematic Internet Use among Greek university students: an ordinal logistic regression with risk factors of negative psychological beliefs, pornographic sites, and online games (2011)
Cyberpsychol Behav Soc Netw. 2011 Jan-Feb;14(1-2):51-8.
On average, problematic Internet users use MSN, forums, YouTube, pornographic sites, chat rooms, advertisement sites, Google, Yahoo!, their e-mail, ftp, games, and blogs more than non-problematic Internet users. Significant risk factors for PIU were being male, enrolment in unemployment programs, presence of negative beliefs, visiting pornographic sites, and playing online games. Thus PIU is prevalent among Greek university students and attention should be given to it by health officials.
Risk factors and psychosocial characteristics of potential problematic and problematic internet use among adolescents: A cross-sectional study (2011)
BMC Public Health. 2011; 11: 595.
The study findings indicated that potential PIU and PIU were independently associated with utilizing the internet for the purposes of retrieving sexual information, socialization, and entertainment, including interactive game-playing. Moreover, it is noteworthy that potential PIU was inversely associated with utilizing the internet for educational purposes. Previous reports indicate that more than one quarter of frequent internet users utilize the internet for accessing sexual information and education [19,37,38].
Both frequent internet use and accessing the internet for the purposes of sexual education have been found to be significant predictors of pornographic internet site use [39,40] and consequent PIU [41]. Hence, it is proposed that PIU may develop and/or manifest secondary to the specific content of internet sites accessed, rather than to the internet per se.
Predictive factors and psychosocial effects of Internet addictive behaviors in Cypriot adolescents (2014)
Int J Adolesc Med Health. 2014 May 6.
A cross-sectional study design was applied among a random sample (n=805) of Cypriot adolescents (mean age: 14.7 years).
Among the study population, the prevalence rates of borderline addictive Internet use (BIU) and addictive Internet use (AIU) were 18.4% and 2%, respectively. The determinants of BIU and AIU included accessing the Internet for the purposes of retrieving sexual information and participating in games with monetary awards
Both BIU and AIU were adversely associated with notable behavioral and social maladjustment among adolescents.
The Internet Process Addiction Test: Screening for Addictions to Processes Facilitated by the Internet (2015)
Behav Sci (Basel). 2015 Jul 28;5(3):341-352.
The Internet Process Addiction Test (IPAT) was created to screen for potential addictive behaviors that could be facilitated by the internet. The IPAT was created with the mindset that the term “Internet addiction” is structurally problematic, as the Internet is simply the medium that one uses to access various addictive processes. The role of the internet in facilitating addictions, however, cannot be minimized.A new screening tool that effectively directed researchers and clinicians to the specific processes facilitated by the internet would therefore be useful. This study shows that the Internet Process Addiction Test (IPAT) demonstrates good validity and reliability. Four addictive processes were effectively screened for with the IPAT: Online video game playing, online social networking, online sexual activity, and web surfing. Implications for further research and limitations of the study are discussed.
Sexual Excitability and Dysfunctional Coping Determine Cybersex Addiction in Homosexual Males (2015)
Cyberpsychol Behav Soc Netw. 2015 Sep 16
Recent findings have demonstrated an association between CyberSex Addiction (CA) severity and indicators of sexual excitability, and that coping by sexual behaviors mediated the relationship between sexual excitability and CA symptoms. The aim of this study was to test this mediation in a sample of homosexual males. Questionnaires assessed symptoms of CA, sensitivity to sexual excitation, pornography use motivation, problematic sexual behavior, psychological symptoms, and sexual behaviors in real life and online. Moreover, participants viewed pornographic videos and indicated their sexual arousal before and after the video presentation. Results showed strong correlations between CA symptoms and indicators of sexual arousal and sexual excitability, coping by sexual behaviors, and psychological symptoms. CA was not associated with offline sexual behaviors and weekly cybersex use time. Coping by sexual behaviors partially mediated the relationship between sexual excitability and CA. The results are comparable with those reported for heterosexual males and females in previous studies and are discussed against the background of theoretical assumptions of CA, which highlight the role of positive and negative reinforcement due to cybersex use.
Internet Addiction, Psychological Distress, and Coping Responses Among Adolescents and Adults (2017)
Cyberpsychol Behav Soc Netw. 2017 Apr 17. doi: 10.1089/cyber.2016.0669.
As Internet use grows, so do the benefits and also the risks. Thus, it is important to identify when individuals’ Internet use is problematic. In the present study, 449 participants aged from 16 to 71 years of age were sourced from a wide range of English-speaking Internet forums, including social media and self-help groups. Of these, 68.9% were classified as nonproblematic users, 24.4% as problematic users, and 6.7% as addictive Internet users. High use of discussion forums, high rumination levels, and low levels of self-care were the main contributing factors to Internet addiction (IA) among adolescents. For adults IA was mainly predicted through engagement in online video gaming and sexual activity, low email use, as well as high anxiety and high avoidant coping. Problematic Internet users scored higher on emotion and avoidance coping responses in adults and higher on rumination and lower on self-care in adolescents. Avoidance coping responses mediated the relationship between psychological distress and IA. These findings may assist clinicians with designing interventions to target different factors associated with IA.
Pathological Internet use, cyberbullying and mobile phone use in adolescence: a school-based study in Greece (2017)
Int J Adolesc Med Health. 2017 Apr 22. pii: /j/ijamh.ahead-of-print/ijamh-2016-0115/ijamh-2016-0115.xml. doi:
This study investigated the prevalence of Internet addiction (IA) and cyberbullying and examined profiles of adolescents with increased risk to develop pathological behaviors. In this cross-sectional, school-based study, 8053 students of 30 middle and 21 high schools (12-18 years old) were invited to participate, based on a multistage stratified random sampling technique. The Internet aiddiction test (IAT) was used along with information on socio-demographics, Internet activities and cyberbullying experience.
Five thousand five hundred and ninety students participated (response rate 69.4%). Pathological Internet use (IAT ≥50) was found in 526 (10.1%), while 403 (7.3%) experienced cyberbullying as victims and 367 (6.6%) as perpetrators during the last year. In multivariable models, the odds of IA increased with online hours on mobile phones and Internet use during weekends, Internet café visits, chatrooms usage and engagement in cyberbullying. Cyberbullying victims were more likely to be older, female, Facebook and chatrooms users, while perpetrators were more likely to be male, older Internet users and fans of pornographic sites. A perpetrator was significantly more likely to have also been a victim [odds ratio (OR) = 5.51, confidence interval (CI): 3.92-7.74].
Problematic internet use among high school students: Prevalence, associated factors and gender differences (2017)
Psychiatry Res. 2017 Jul 24;257:163-171. doi: 10.1016/j.psychres.2017.07.039.
This study aimed to measure the prevalence of Problematic Internet Use (PIU) among high school students and to identify factors associated with PIU underlining gender differences. The students filled a self-administered, anonymous questionnaire collecting information on demographic characteristics and patterns of Internet use. Multiple logistic regression analysis was performed to identify factors associated with PIU in the overall sample and by gender.
Twenty-five schools and 2022 students participated in the survey. Prevalence of PIU was 14.2% among males and 10.1% among females. Males 15-year-olds and females 14-year-olds had the highest PIU prevalence that progressively lowered with age among females. Only 13.5% of pupils declared parents controlled their Internet use. The sensation of feeling lonely, the frequency of use, the number of hours of connection, and visiting pornographic websites were associated with the risk of PIU in both genders. Attending vocational schools, the activities of chatting and file downloading, and the location of use at Internet point among males, and younger age among females were associated with PIU, whilst information searching was protective among females. PIU could become a public health problem in the next years. The physical and mental health consequences should be studied.
Video game addiction in emerging adulthood: Cross-sectional evidence of pathology in video game addicts as compared to matched healthy controls (2017)
J Affect Disord. 2017 Aug 18;225:265-272. doi: 10.1016/j.jad.2017.08.045.
Stockdale L1, Coyne SM2.
The Internet Gaming Disorder Scale (IGDS) is a widely used measure of video game addiction, a pathology affecting a small percentage of all people who play video games. Emerging adult males are significantly more likely to be video game addicts. Few researchers have examined how people who qualify as video game addicts based on the IGDS compared to matched controls based on age, gender, race, and marital status.
Addicts had poorer mental health and cognitive functioning including poorer impulse control and ADHD symptoms compared to controls. Additionally, addicts displayed increased emotional difficulties including increased depression and anxiety, felt more socially isolated, and were more likely to display internet pornography pathological use symptoms. Female video game addicts were at unique risk for negative outcomes.
Problematic internet use as an age-related multifaceted problem: Evidence from a two-site survey (2018)
Addict Behav. 2018 Feb 12;81:157-166. doi: 10.1016/j.addbeh.2018.02.017.
Problematic internet use (PIU; otherwise known as Internet Addiction) is a growing problem in modern societies. Our aim was to identify specific internet activities associated with PIU and explore the moderating role of age and gender in those associations. We recruited 1749 participants aged 18 and above via media advertisements in an Internet-based survey at two sites, one in the US, and one in South Africa; we utilized Lasso regression for the analysis.
Specific internet activities were associated with higher problematic internet use scores, including general surfing (lasso β: 2.1), internet gaming (β: 0.6), online shopping (β: 1.4), use of online auction websites (β: 0.027), social networking (β: 0.46) and use of online pornography (β: 1.0). Age moderated the relationship between PIU and role-playing-games (β: 0.33), online gambling (β: 0.15), use of auction websites (β: 0.35) and streaming media (β: 0.35), with older age associated with higher levels of PIU. There was inconclusive evidence for gender and gender × internet activities being associated with problematic internet use scores. Attention-deficit hyperactivity disorder (ADHD) and social anxiety disorder were associated with high PIU scores in young participants (age ≤ 25, β: 0.35 and 0.65 respectively), whereas generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD) were associated with high PIU scores in the older participants (age > 55, β: 6.4 and 4.3 respectively).
Many types of online behavior (e.g. shopping, pornography, general surfing) bear a stronger relationship with maladaptive use of the internet than gaming supporting the diagnostic classification of problematic internet use as a multifaceted disorder. Furthermore, internet activities and psychiatric diagnoses associated with problematic internet use vary with age, with public health implications.
To summarize, DSM-5 highlights internet gaming disorder as a candidate disorder, but other types of online behavior (e.g. shopping, pornography, general surfing) bear a stronger relationship with maladaptive use of the internet than gaming. Psychiatric diagnoses and internet activities associated with Problematic internet use vary with age, a finding that has public health implications. These results contribute to the limited knowledge about internet activities associated with problematic internet use and may contribute to the diagnostic classification of problematic internet use as a multifaceted disorder.
Impulsivity traits and addiction-related behaviors in youth (2018)
J Behav Addict. 2018 Apr 12:1-14. doi: 10.1556/2006.7.2018.22.
Rømer Thomsen K1, Callesen MB1, Hesse M1, Kvamme TL1, Pedersen MM1, Pedersen MU1, Voon V2.
Background and aims
Impulsivity is a risk factor for addictive behaviors. The UPPS-P impulsivity model has been associated with substance addiction and gambling disorder, but its role in other non-substance addiction-related behaviors is less understood. We sought to examine associations between UPPS-P impulsivity traits and indicators of multiple substance and non-substance addiction-related behaviors in youth with varying involvement in these behaviors.
Methods
Participants (N = 109, aged 16-26 years, 69% males) were selected from a national survey based on their level of externalizing problems to achieve a broad distribution of involvement in addiction-related behaviors. Participants completed the UPPS-P Questionnaire and standardized questionnaires assessing problematic use of substances (alcohol, cannabis, and other drugs) and non-substances (Internet gaming, pornography, and food). Regression analyses were used to assess associations between impulsivity traits and indicators of addiction-related behaviors.
Results
The UPPS-P model was positively associated with indicators of all addiction-related behaviors except problematic Internet gaming. In the fully adjusted models, sensation seeking and lack of perseverance were associated with problematic use of alcohol, urgency was associated with problematic use of cannabis, and lack of perseverance was associated with problematic use of other drugs than cannabis. Furthermore, urgency and lack of perseverance were associated with binge eating and lack of perseverance was associated with problematic use of pornography.
Discussion and conclusions
We emphasize the role of trait impulsivity across multiple addiction-related behaviors. Our findings in at-risk youth highlight urgency and lack of perseverance as potential predictors for the development of addictions and as potential preventative therapeutic targets.
PMID: 29642723
Manifesto for a European research network into Problematic Usage of the Internet (2018)
October 2018, European Neuropsychopharmacology
DOI: 10.1016/j.euroneuro.2018.08.004
Project: COST Action 16207 European network for Problematic Internet Usage
Lab: Laboratory of Behavioral Medicine
The Internet is now all-pervasive across much of the globe. While it has positive uses (e.g. prompt access to information, rapid news dissemination), many individuals develop Problematic Use of the Internet (PUI), an umbrella term incorporating a range of repetitive impairing behaviours. The Internet can act as a conduit for, and may contribute to, functionally impairing behaviours including excessive and compulsive video gaming, compulsive sexual behaviour, buying, gambling, streaming or social networks use. There is growing public and National health authority concern about the health and societal costs of PUI across the lifespan. Gaming Disorder is being considered for inclusion as a mental disorder in diagnostic classification systems, and was listed in the ICD-11 version released for consideration by Member States. More research is needed into disorder definitions, validation of clinical tools, prevalence, clinical parameters, brain-based biology, socio-health-economic impact, and empirically validated intervention and policy approaches. Potential cultural differences in the magnitudes and natures of types and patterns of PUI need to be better understood, to inform optimal health policy and service development. To this end, the EU under Horizon 2020 has launched a new four-year European Cooperation in Science and Technology (COST) Action Programme (CA 16207), bringing together scientists and clinicians from across the fields of impulsive, compulsive, and addictive disorders, to advance networked interdisciplinary research into PUI across Europe and beyond, ultimately seeking to inform regulatory policies and clinical practice. This paper describes nine critical and achievable research priorities identified by the Network, needed in order to advance understanding of PUI, with a view towards identifying vulnerable individuals for early intervention. The network shall enable collaborative research networks, shared multinational databases, multicentre studies and joint publications.
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