Time to log off: New diagnostic criteria for problematic Internet use

Chomorbidities. Given the high incidence of psychiatric comorbidity,¹ it is important to complete a thorough psychiatric evaluation and treat any underlying illness. Whether the illness is primary or comorbid, it is likely exacerbating the symptoms of problematic Internet use.

Changing problematic behaviors

Psychotherapy. Once you find the motives and possible causes of Internet overuse, what is the best form of treatment? This question warrants further study, but cognitive-behavioral therapy (CBT) is the primary treatment at this time.

The goal of CBT is for patients to disrupt their problematic computer use and reconstruct their routines with other activities. They can:

• use external timers to keep track of time online
• set goals of brief, frequent sessions online
• carry cards listing the destructive effects of their Internet use and ranking other activities they have neglected.¹⁷

Using emotion journals or mood monitoring forms may help the patient discover which dysfunctional thoughts and feelings are triggering excessive Internet use.¹² Support groups and family therapy can help repair damaged relationships and engage friends and family in the treatment plan.

Drug therapy. No studies have looked at drug therapy for problematic Internet use, beyond treating comorbid psychiatric illnesses.

Treatment declined. Mr. A declined treatment for his problematic Internet use. As in many other psychiatric illnesses, insight into impulse control disorders tends to be limited. We can address the problem directly and offer to help patients change their online behaviors, but we cannot force them into treatment if they are not endangering themselves or others.

Related resources

• Computer Addiction Services. Maressa Hecht Orzack, PhD. www.computeraddiction.com; (617) 855-2908.
• Center for Online Addiction. Kimberly S. Young, PhD. www.netaddiction.com; (877) 292-3737.