We have no idea what levels or kinds of computer usage are "normal." Therefore, we cannot state which behavior is always pathological. There have been heated and contentious arguments about these issues in an online forum devoted to research on the Internet (see http://www.cmhc.com/mlists). Discussions include topics such as the validity of scales to measure Internet addiction, with exact indicators defining a pathological or addictive behavior.
What is it about using computers that makes some people behave in ways in which they would not ordinarily? Is it the technology itself, or is it the way people interact with that technology? Is the behavior pathological or creative? Why are some people so connected to life on the screen that they have difficulty coming back to reality? Who are the people who act this way, and if they come to your office for help, how do you treat them?
Signs and Symptoms
Based on contact with my own patients, numerous requests for referrals from other therapists, and many online requests for help (see table), I have designed a behavior list based on an impulse control model very similar to one used for gambling. These are the signs and symptoms of computer addiction, or, as I now prefer to call it, impulse-control disorder, not otherwise specified. I make no other claim for the validity of this diagnostic paradigm, since it is based on a highly selected population.
Tolerance, withdrawal and compulsive use are requisites for any diagnosis of dependency (American Psychiatric Association, 1994). Psychological tolerance is indicated by the need to spend increasing amounts of time on computer activities such as playing games, arranging files or participating in online discussion groups. Even though computer users are aware of problem behavior, they continue to use the computer compulsively. They often blame others for the problem. Withdrawal symptoms are indicated by an increase in irritability and anxiety when a person is unable to access a computer. Even though one investigator (Anderson, 1998) used a three-day abstinence as an indicator of problems, at least one patient has said that it is a matter of only hours before he starts to feel irritable, depressed or anxious.
The physical symptoms associated with computer addiction can have serious consequences. For instance, resulting carpal tunnel syndrome often requires months of care and may result in surgery. Eating habits change so that some people eat while at the computer and never exercise. Others may skip meals altogether. One patient has told me that she sometimes does not get to the bathroom in time. Failure to blink can cause migraines. Optometrists and ophthalmologists often prescribe special lenses for computer use because patients spend so much time looking at the screen.
The following cases illustrate the signs and symptoms described above:
Patient A, a recovering substance abuser, stated that she craved participating in an online chat and that she returned to it at earlier and earlier hours each day. She had such an intense relationship with a cyber friend that she lost her sobriety when that person suddenly disappeared from her screen.
Patient B also has a history of substance abuse, and compared his feelings when he was on a chat line to an amphetamine high.