It must be March, because “Internet addiction disorder” is again making the news rounds, spurred on by a new editorial in the American Journal of Psychiatry. It published an editorial by Jerald J. Block, M.D. pushing for “Internet addiction disorder’s” inclusion in the upcoming DSM-V. Block is an Oregon psychoanalytic psychiatrist, not a researcher. So I couldn’t help but wonder what leads him to write such an editorial?
Dr. Block owns a patent on technology that can be used to restrict computer access. Dr. Freedman has reviewed this editorial and found no evidence of influence from this relationship.
So wait a minute… A patent is potentially worth money if turned into a product (or if the patent holder sues others who already have products that use their patent). A patent that describes a process that is used to restrict computer access appears to be something very useful to people suffering from “Internet addiction disorder,” no? To stop them from accessing the computer, therefore reducing their use and “addiction.” And the writer just happens to hold such a patent. If approved to the DSM-V, Block could make money from marketing his patent. How is that not a pretty direct and clear conflict of interest?
Worse, the author doesn’t even pretend to take an objective point of view in the editorial, and suggests the research clearly shows this thing exists. But the research in this area is all over the map: the self-selecting surveys done show exactly what we expect to find — people complaining of an issue that they said was an issue in the first place. It’s funny, but if you ask 100 Boston Red Sox whether they like the Red Sox or not, I bet you I could predict what their response will be. That’s the quality of much of the research into “Internet addiction disorder.”
There are zero studies that have been conducted to monitor whether these behaviors change over time and with increased or decreased usage (e.g., is it possibly a type of learning curve that most people successfully negotiate on their own, as with any new technology). Or whether such Internet use really is just a coping mechanism for a pre-existing but unscreened psychiatric condition (e.g., the psychiatric disorder — such as depression — is causing increased and excessive use of the Internet, not the other way around).
Have we done enough studies to untangle the different ways different age groups use and view the Internet? Teens and children today rely on the Internet as adults relied on the telephone when they were growing up. Are there any diagnostic criteria being proposed that understand and make these important distinctions?
Significantly, most of Block’s citations used in the editorial are from conference presentations or magazine articles, not peer reviewed journal articles or large scale clinical trials, the gold standard of psychiatric and psychological research. In one of the two peer reviewed studies actually published about Korea (but not one included in Block’s editorial), the researchers who studied 1,291 teens and children note:
By structured interview, we found that Internet-addicted subjects had various comorbid psychiatric disorders. The most closely related comorbidities differ with age. Though we can not conclude that Internet addiction is a cause or consequence of these disorders, clinicians must consider the possibility of age-specific comorbid psychiatric disorders in cases of Internet addiction.
As noted above, the occurrence of coexisting conditions causes most researchers to suspect people are turning to the Internet as a coping mechanism to deal with their mental health concern, like ADHD or depression. But since we already can diagnose ADHD and depression (and know very well how to treat them), it’s not clear why Block feels the need for yet another diagnostic category.
Imagine someone goes to college for their first time and feels depressed, misses home and their old friends. They start procrastinating and stop doing much of their schoolwork. Instead, they turn to music and greatly enjoy playing piano, first for the college jazz band, then at local nightclubs. What’s the problem here — too much piano playing? Or is it depression?
People spend a lot of time online for one of a couple of reasons, according to the research: sex, gaming or social relationships. Taken in any other context, these activities are all fun, enjoyable activities! Imagine researchers having this conversation if a wave of book-reading overtook America… And with the popularity of reading devices like Amazon.com’s Kindle reader, it’s within the realm of possibility to consider such a scenario.
That is the kind of absurdity Block is proposing for the DSM-V. If successful, look to reading, television watching, talking on the telephone, and yes, even piano playing to make it into the DSM-VI shortly thereafter.
Block, J.J. (2008). Issues for DSM-V: Internet Addiction. Am J Psychiatry, 165, 306-307.
Ha, J.H. et al. (2006). Psychiatric Comorbidity Assessed in Korean Children and Adolescents Who Screen Positive for Internet Addiction. Journal of Clinical Psychiatry, Vol 67(5), 821-826.