INTERNETSUCHT

A study by H.D. Zimmerl, MD (co-author: B. Panosch, MD)

This study was initiated by my interest to scientifically approach the question if something like "Internet Addiction Disorder (IAD)" does exist (as claimed by American scientists).

Since it seems to me that this statement can be claimed primarily for the section: Chatrooms (according to the literature and also to my own estimation) an online- survey has been made within the most favoured german-speaking chat-program called Metropolis Chatsystem.
The questionnaire used has been written in HTML and has been placed on the GIN-server (University of Innsbruck). On the login-site of the chatsystem a link gave reference to the questionnaire- it was recallable online from February 17 to April 27 1998. The evaluation has been carried out by the Institute for Biostatistics and Documentation of the Medical Faculty of Innsbruck/Austria (head:Univ.Prof.Dr.Pfeiffer). During this time 519 sheets have been filled out, 473 worth to be further analyzed.

The questionnaire is divided into different parts: a sociodemographic part, a part assessing consumers’ habits and another part (19 questions) assessing motivations, feelings of ecstasylike sensations while intensively chatting and self-estimation (ask to be "addicted"). The questionnaire included a compact of 7 questions- defined as addiction specific cor-questions -referring to: 1) unsuppressable urge to log-in 2) guilt feelings because of lengthy online-times 3) frequent admonitions by closely related persons (like partner/family, friends, boss) 4) decreasing efficiency in work performance 5) frequent successless attempts to reduce chatting times 6) keeping online-activities secret 7) withdrawal symptoms as e.g. restlessness, nervousness when prevented from chatting. All questions had to be answered with: yes/no (like in MALT= Münchner Alkholismus-test).

The form of questioning was adapted to check-lists generally used in the USA, as well as to diagnostic criteriae of Pathological Gambling according to DSM III-R. In analogy to this it seemed necessary that at least 4 of the above mentioned criteriae should be conclusive to give diagnostical evidence of addiction.

According to this parameter there is good evidence that 12,7% of all persons investigated show a certain addictive-like behaviour that could be defined as: " Pathologischer Internet- Gebrauch (P.I.G.)". Furthermore it becomes evident that 30,8% of the sub-group "P.I.G." have experienced ecstasy-like sensations when chatting intensively. Thus, it can be assumed that there exists a biological background on the field of neurotransmitters and/or that of endorphin-metabolism - an assumption worth further research. Another point of consideration is the rather effective percentage ( 40,9% ) of the sub-group "P.I.G." which estimates itself as "addicted" - a fact apt to prove willingness to self-reflection, eventually supporting diagnosis. Statistically all these correlations are highly significant.

Nevertheless I want to emphasize here and now that I am aware that this study can deliver only indications- elaborated (possibly prospective) case-studies connected with follow-ups would have to be made before one actually can speak of a prevalence of a new addiction disorder. Nevertheless psychiatrists should consider taking up "P.I.G." in their diagnostics and, if occasion arises, offer therapeutic help to clients, although etiologically must be still closer researched (but does this not hold true for many other forms of sickness ?).

My suggested diagnostic criteriae are:

• frequent, unsuppressable urges to log-in to the net
• loss of control (= staying longer online as intended) wilth guilt feelings
• negative social behaviour in familiar and close environment
• decrease of working performance
• making a secret of the times spent online
• psychic irritability when prevented from being online
• frequent successless attempts to reduce times on-line

Suggested diagnostic schedule:

PLUS concomitant irreversible psychosocial injuries in consequence to it ( as e.g. loss of job, loss of  partner/family, social self-isolation, inadequately high depts caused by exorbitant telephone-costs) and maybe somatic injuries like injury of the visual system, the vertrebal column, or others.

Therapeutical suggestions should not actually be anticipated since "P.I.G." is not yet sufficiently researched, or else the diagnosis will make the indication from case to case. But in the same way as in substance-bound addiction also in "P.I.G." the so-called: "Integrative Psychotherapie" could be a good choice.

As to the ranking of this study: Critically speaking, it only was meant to draw my collegues’ attention to a further form of non-substance bound addictive behaviour, for which I tried to suggest a practicable diagnostic inventary, and consequently hope that it will become of interest to other addiction researchers.

Author: Hans D. Zimmerl, MD. A-1120 Vienna, Schwenkgasse 4, AUSTRIA; E-mail: hans.zimmerl@telecom.at

Co-Author: Beate Panosch, MD. E-mail: beate.panosch@e-health.at