Introduction
Communications has always been the main driver of the globalized world. The Internet
is a means which allows global sharing of knowledge, news, and entertainment. It has
enabled intersectoral exchange in education, healthcare, and business. The recent
COVID-19 pandemic has also emphasized the importance of the virtual world in telemedicine,
home based learning, and telecommuting (1, 2). The digital generation has raised concerns
about screen times (3), Internet addiction [Yu and Shek; Siste et al.; Fung et al.;
Nik Jaafar et al.; (4)] as well as potential risks in social media [Yu and Shek; (5)].
Computer addiction was a concern as early as the 1980s (6).
Evaluation of Internet Addiction/Gaming Disorders
The International Classification of Diseases (ICD-11) has recognized gaming disorder
to be one that is characterized by (a) impaired control over gaming, (b) increasing
priority given to gaming over other activities to the extent that gaming takes precedence
over other interests and activities, and (c) continuation of gaming despite experiencing
negative consequences. It is also defined to be severe enough to cause significant
functional impairment in various aspects of one's life (7). However, The American
Psychiatric Association has placed “Internet Gaming Disorder” under Section III of
Diagnostic and Statistical Manual of Mental Disorders (DSM-5), as a condition that
warrants more clinical research (8). Related maladaptive behavior such as excessive
use of Internet or social media, and their associated impact on mental health issues
need further exploration.
A holistic approach to clinical evaluation of disorders associated with Internet or
gaming addiction would involve (a) clear definition of problematic behaviors and disorders,
(b) use of accurate diagnostic tools (c) identification of risk factors, and (d) identification
of protective factors.
The Need for Clear Definition
The prevalence of maladaptive behavior patterns associated with Internet use has garnered
global interest. A study in Hong Kong showed that 11.4% of adolescents (n = 1,896)
had social networking addiction (Yu and Shek.) A study in Indonesia showed that 19.3%
of adolescents (n = 2,932) were determined to have Internet addiction (Siste et al.).
A South Korean study involving 2,984 adolescents explored defining various forms of
Internet users, including gamers. Overall, 7 different profiles were described. These
profiles showed variation in gender, problematic gaming behavior, as well as neuroticism
(Kim et al.). These studies suggested that addictions are associated with various
digital forms and need to be differentially identified in clinical assessment.
The use of Accurate Diagnostic Tools
Since the definition of Internet addiction continues to evolve, it becomes challenging
to adopt universal diagnostic tools. A meta-analysis that studied the reliability
and validity of 5 Gaming Disorder Scales (GAS-7, AICA, IGDT-10, Lemmens IGD-9, and
IGDS9-SF) showed that they had good internal consistency and test-retest reliability.
However, few studies had checked for test-retest reliability (9). A China-based study
evaluated the reliability and internal consistency of the “Chinese Internet Gaming
Disorder Checklist (C-IGDC)” in determining the presence of Internet gaming disorder
(Chen et al.). We need further research into the applicability of these tools in clinical
practice across the globe.
Identification of Risk Factors
As clinicians, we are also interested in risk stratification for a given disorder.
There have been various studies that have researched risk factors associated with
problematic Internet use and gaming addiction. A Hong Kong study identified social
competence and a positive identity to be associated with social networking addiction.
Parental roles have also been identified to be crucial in the development of social
networking addiction (Yu and Shek). An Indonesian study had also explored the implication
of the COVID-19 pandemic on Internet addiction. It found that increased duration of
Internet use, internalization, externalization, low prosocial behavior as well as
sleep disturbances have been associated with Internet addiction (Siste et al.). A
study from Malaysia showed that age, male gender, ethnicity, and psychosocial factors
(stress levels, loneliness, depression, anxiety) are also associated with Internet
overdependence (Nik Jaafar et al.). Furthermore, a study from China supported the
findings of psychological stress being associated with increased problematic smart
phone use and social media use (Fung et al.). This information provides opportunities
for preventive measures and interventions that target these risk factors.
Identification of Protective Factors
Studies have also investigated protective factors against the development of Internet
and gaming addiction. Two separate studies from Hong Kong had shown that psychological
resilience, emotional competence, behavioral competence, beliefs in future as well
as spirituality can serve as protective factors (Yu and Shek; Tsui and Cheng). Preventative
measures in the form of digital literacy for the public about proper use of the Internet
and parental supervision is crucial. Digital competency, which is a step up from literacy,
would be pertinent for parents, schools, and healthcare professionals. One needs to
be proficient in the use of technology to provide appropriate guidance to the young.
It is also important to regulate the use of the Internet in terms of duration and
content (10).
Discussion
A multi-disciplinary approach needs to be adopted in the management of Internet and
gaming addiction (Nik Jaafar et al.). Non-pharmacological methods should be prioritized
and should include treatment modalities such as psychotherapy, and behavioral interventions
(11–13). At this stage, the use of pharmacotherapy is limited as the understanding
of the conditions and their underlying mechanisms continue to evolve. There is a need
for further research in the field to understand how digital use affects the brains
and behaviors of individuals.
Author Contributions
KV researched on the topic and consolidated it into the first draft. DF provided critical
comments and editorial suggestions for revisions. KV then followed up with the changes.
All authors agreed on the submitted version.
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial
or financial relationships that could be construed as a potential conflict of interest.
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