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I am delighted to introduce a guest blog post by Dr Philip Tam, a Child and Adolescent Psychiatrist based in Sydney, Australia. Philip has an interest in ‘internet addiction’  in young people, and has appeared in the media discussing this subject. He has written a fantastic post below. Please do comment: it would be great to get a discussion going on this controversial topic…

Problematic Internet Use – A 21st-Century Affliction?

In recent months, there has been much interest in the Australian media and in the broader public about the modern phenomenon of ‘problematic internet use’, or internet addiction as it commonly termed. In my own clinical practice, and that of some colleagues, we have been seeing young people – generally male, but often female – presenting to us for about the past 5 or 6 years; it may come as a surprise that the first ‘cases’ of problematic internet use, or PIU, were being described in the psychiatric literature back in 1996 in the USA. As with other modern-day afflictions with a ‘pop-cultural’ element, such as ‘sex addiction’ and ‘shopping addiction’, there is heated debate within my profession as to whether this a real mental condition, deserving of diagnosis, research and treatment, or simply a form of human behaviour responding to the huge changes brought about by the ‘internet revolution’ of the past 2 decades. Diagnosing a mental condition requires a concise definition, so here is one suggestion : PIU is the pervasive, long-term and heavy use by a person of internet and computer-based technologies, including gaming, which is out of keeping with one’s educational, social or occupational role, and which results in a clinically significant negative impact on schooling, work, relationships or general well-being and health.

As a colleague of Dr. D, and also as another ‘Psychiatrist Parent’, I’d like to start a new discussion thread about this issue if anyone is interested. I’d be keen to hear of anyone’s clinical experience with the condition, or even if they could share any personal/ family experience of the problem! As I note below, we still don’t know much about the phenomenon, let alone how best to address it, and the best way is to listen to people’s own stories.

The 3 questions I am most commonly asked by concerned families, other clinicians, or media commentators are: How extensive is the problem in Australia? How do we recognise the signs of a problem in a teenager or young adult? What can be done to assist these people? Unfortunately, the short answer is: we don’t really know. While formal research has been done for some years in China, South Korea and the USA, Australia appears to lag behind in investigating the issue at a ‘population-based’ level. Good quality surveys are expensive, time-consuming and require major commitment, a situation which has affected attempts to investigate mental conditions such as depression and anxiety in the Australian community. And, as some readers will know, there is currently no official recognition of PIU in the ‘bible’ of psychiatry and classification, the DSM-IV – though it is possible it may be included in the 5th edition, due to come out in 2012.

I am also well aware that many sceptical members of the public may accuse clinicians such as myself of scare-mongering, or indeed of disease-mongering, and that the issue is primarily one about personal responsibility and common-sense, and decent, firm parenting. I must state unequivocally that I agree that, for most people with problems spending too much time online, it is about better time-management and discipline; however, there is a small percentage (probably around 5% of regular users), who do tip into true PIU as defined above, and who often do not recognise that they have a problem. Analogous to other disorders of impulse-control such as pathological gambling and alcoholism, the sufferers themselves often are oblivious that they have a problem; it is concerned family members or their teachers who refer them to specialists. Since clients with more severe PIU are at risk of dropping out of school, affecting their physical health, or losing their job, it would be unethical not to address their problems in a professional manner. In my personal experience, the key to successful treatment is getting the client to fully recognise that they have a problem – what we term ‘gaining insight’.

Clearly, the internet has brought about immense changes in human society, affecting business, recreation, education and science; it is almost impossible now to imagine going through daily life without the great benefits that it has given us. However, there are clearly a few less-desirable effects of this revolution, and since technology is likely to continue to expand rapidly, and in ways we cannot yet imagine, we need an open, active and informed debate as to how we best manage these issues! Thanks for any input you can provide.

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