Abstract
BackgroundProblematic use of the Internet has been highlighted as needing further study by international bodies, including the European Union and American Psychiatric Association. Knowledge regarding the optimal classification of problematic use of the Internet, subtypes, and associations with clinical disorders has been hindered by reliance on measurement instruments characterized by limited psychometric properties and external validation.MethodsNon-treatment seeking individuals were recruited from the community of Stellenbosch, South Africa (N = 1661), and Chicago, United States of America (N = 827). Participants completed an online version of the Internet Addiction Test, a widely used measure of problematic use of the Internet consisting of 20-items, measured on a 5-point Likert-scale. The online questions also included demographic measures, time spent engaging in different online activities, and clinical scales. The psychometric properties of the Internet Addiction Test, and potential problematic use of the Internet subtypes, were characterized using factor analysis and latent class analysis.ResultsInternet Addiction Test data were optimally conceptualized as unidimensional. Latent class analysis identified two groups: those essentially free from Internet use problems, and those with problematic use of the Internet situated along a unidimensional spectrum. Internet Addiction Test scores clearly differentiated these groups, but with different optimal cut-offs at each site. In the larger Stellenbosch dataset, there was evidence for two subtypes of problematic use of the Internet that differed in severity: a lower severity “impulsive” subtype (linked with attention-deficit hyperactivity disorder), and a higher severity “compulsive” subtype (linked with obsessive-compulsive personality traits).ConclusionsProblematic use of the Internet as measured by the Internet Addiction Test reflects a quasi-trait - a unipolar dimension in which most variance is restricted to a subset of people with problems regulating Internet use. There was no evidence for subtypes based on the type of online activities engaged in, which increased similarly with overall severity of Internet use problems. Measures of comorbid psychiatric symptoms, along with impulsivity, and compulsivity, appear valuable for differentiating clinical subtypes and could be included in the development of new instruments for assessing the presence and severity of Internet use problems.
Highlights
Problematic use of the Internet has been highlighted as needing further study by international bodies, including the European Union and American Psychiatric Association
Gaming Disorder, a manifestation of Problematic Use of the Internet’ (PUI), is likely to be included in the International Classification of Diseases Version 11 (ICD-11), and Internet gaming disorder has been listed as being in need of further study in the Diagnostic and Statistical Manual Version 5 (DSM-5) [1]
Simulations have shown that the Bootstrapped Likelihood Ratio Test (BLRT) is sensitive to inclusion of covariates in mixture modeling and performs less reliably when class separation is high (E ~ 90) [17]
Summary
Problematic use of the Internet has been highlighted as needing further study by international bodies, including the European Union and American Psychiatric Association. While the Internet offers many benefits, it is recognized that some users develop excessive use, referred to by the umbrella term ‘Problematic Use of the Internet’ (PUI). Gaming Disorder, a manifestation of PUI, is likely to be included in the International Classification of Diseases Version 11 (ICD-11), and Internet gaming disorder has been listed as being in need of further study in the Diagnostic and Statistical Manual Version 5 (DSM-5) [1]. People with PUI exhibit elevated rates of psychiatric disorders, including anxiety disorders, impulse control disorders, attention-deficit hyperactivity disorder [ADHD], and addictions [e.g. gambling, alcohol]; and associated physical health issues such as obesity [12, 30, 65]. It should be noted that causality has not yet generally been established, but these above-noted associations highlight the need to better define and operationalize PUI
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