Topic 4 Definitions, Signs, and Symptoms of Problematic Use of Internet among Children and Adolescents

Problematic Internet use (PUI) can be broadly conceptualised as an inability to control one’s use of the Internet which leads to negative consequences in daily life, and envelops a wide range of activities including video gaming, pornography viewing (and other compulsive sexual behaviours), buying, gambling, web-streaming, social media use and other behaviours (Fineberg et al., 2018).

The diagnosis of PIU does not appear in any official diagnostic system, and there are no widely accepted diagnostic criteria; hence, it is usually identified through criteria in scientific papers (e.g., Meerkerk et al., 2009; Li et al., 2016).

However, ICD-11 recognises Gaming Disorder, which may be online (i.e., over the internet) or offline, while in DSM-5, Internet Gaming Disorder is a “condition for further study”. It can broadly be defined as persistent and recurrent participation in computer gaming, typically group games, for many hours, and the comparison of signs and symptoms of gaming disorder from DSM-5 and ICD-11 can be found in Table 7.

It should be noted that a recent study indicated that experts evaluated the ICD-11 criteria to be more relevant than the DSM-5 criteria (see Castro-Calvo et al., 2021).

Comparison of diagnostic criteria for problematic internet use in ICD-11 and DSM-5

Diagnostic criteria ICD-11 Gaming Disorder – online and offline DSM-5 Internet Gaming Disorder

Preoccupation with Internet games - Internet gaming becomes the dominant activity in daily life

Unsuccessful attempts to control the participation in Internet games

Loss of interests in previous hobbies and entertainment as a result of, and with the exception of Internet games

Continued excessive use of Internet games despite knowledge of psychosocial problems and negative consequences

Deceiving family members, therapists, or others regarding the amount of Internet gaming

Use of Internet games to escape or relieve a negative mood (e.g., feelings of helplessness, guilt, anxiety)

A significant relationship, job, or educational or career opportunity was jeopardized or lost because of participation in Internet games

Tolerance (the need to spend increasing amounts of time engaged in Internet games)

Withdrawal (typically described as irritability, anxiety, or sadness)

Moreover, European Parliament (2019) defined gaming disorder as a pattern of persistent or recurrent gaming behaviour (‘digital gaming’  or  ‘video-gaming’), which  may  be  online  (i.e., over  the  internet)  or  offline,  manifested  by: 

  1. impaired control over gaming (e.g., onset, frequency, intensity, duration, termination, context)
  2. increasing priority given to gaming to the extent that gaming takes precedence over other life interests and daily activities
  3. continuation or escalation of gaming despite the occurrence of negative consequences.

The behaviour pattern is of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning. The pattern of gaming behaviour may be continuous or episodic and recurrent. The gaming behaviour and other features are normally evident over a period of at least 12 months in order for a diagnosis to be assigned, although the required duration may be shortened if all diagnostic requirements are met, and symptoms are severe.

In line with this functional definition, the key criterion for PUI is functional impairment (i.e., that it causes the person problems in school life, social life and other forms of functioning).

Besides gaming disorder, in context of PUI, what is usually addressed in the literature are problematic social media use, compulsive online buying-shopping, problematic online gambling, and the problematic online pornography use.

As social media use is currently one of the most popular leisure activities among adolescents (Lenhart et al., 2010), we will focus here on this form of problematic Internet use; however, there is no consensus among researchers regarding the definition of problematic social media use due to the conceptual confusion surrounding the classification of problematic internet use.

Several scales have been proposed for assessing problematic social media use, such as Bergen Social Media Addiction Scale (BSMAS; Andreassen et al., 2017), which includes items referring to:

  1. spending a lot of time thinking about social media or planning how to use it,
  2. feeling an urge to use social media more and more,
  3. using social media in order to forget about personal problems,
  4. trying to cut down on the use of social media without success,
  5. becoming restless or troubled if you are prohibited from using social media,
  6. using social media so much that it has had a negative impact on your job/studies, where rating 4 or more of these items as often or very often could be an indicator of social media addiction.

Activity 2: Match the diagnostic criterion for problematic Internet use with specific behaviour

In this activity, an existing scale developed for parents (Social Media Disorder Scale for Parents – SMDS-P; Austermann, Thomasius, & Paschke, 2021) based on nine criteria for Internet Gaming Disorder from the DSM-5 criteria will be analysed. The task is to match the diagnostic criterion for problematic Internet use with specific behaviour:

Criteria Behaviour
PreoccupationTries to spend less time online, but fails
WithdrawalUsing Internet to escape from negative feelings
ToleranceHas arguments with others because of his/her Internet use
PersistenceHas serious conflicts with others because of his/her Internet use
DisplacementOften feels bad when he/she can’t not be online
ProblemLying about the amount of time he/she spends online
DeceptionNeglects other activities (e.g., hobbies, sport) because he/she wants to be online
EscapeRegularly feels dissatisfied because he/she wanted to spend more time online
ConflictRegularly finds that he/she can’t think of anything else but the moment that he/she will be able to be online again