Research Article: Diagnostic Criteria for Problematic Internet Use among U.S. University Students: A Mixed-Methods Evaluation

Date Published: January 11, 2016

Publisher: Public Library of Science

Author(s): Wen Li, Jennifer E. O’Brien, Susan M. Snyder, Matthew O. Howard, Aviv M. Weinstein.


Empirical studies have identified increasing rates of problematic Internet use worldwide and a host of related negative consequences. However, researchers disagree as to whether problematic Internet use is a subtype of behavioral addiction. Thus, there are not yet widely accepted and validated diagnostic criteria for problematic Internet use. To address this gap, we used mixed-methods to examine the extent to which signs and symptoms of problematic Internet use mirror DSM-5 diagnostic criteria for substance use disorder, gambling disorder, and Internet gaming disorder. A total of 27 university students, who self-identified as intensive Internet users and who reported Internet-use-associated health and/or psychosocial problems were recruited. Students completed two measures that assess problematic Internet use (Young’s Diagnostic Questionnaire and the Compulsive Internet Use Scale) and participated in focus groups exploring their experiences with problematic Internet use. Results of standardized measures and focus group discussions indicated substantial overlap between students’ experiences of problematic Internet use and the signs and symptoms reflected in the DSM-5 criteria for substance use disorder, gambling disorder, and Internet gaming disorder. These signs and symptoms included: a) use Internet longer than intended, b) preoccupation with the Internet, c) withdrawal symptoms when unable to access the Internet, d) unsuccessful attempts to stop or reduce Internet use, e) craving, f) loss of interest in hobbies or activities other than the Internet, g) excessive Internet use despite the knowledge of related problems, g) use of the Internet to escape or relieve a negative mood, and h) lying about Internet use. Tolerance, withdrawal symptoms, and recurrent Internet use in hazardous situations were uniquely manifested in the context of problematic Internet use. Implications for research and practice are discussed.

Partial Text

Problematic Internet use may lead to serious psychosocial dysfunction [1]. Problematic Internet use is a serious problem for 6% to 11% of Internet users in the United States [2]. Compared to other age groups, college-aged youth and young adults appear to be at greater risk for problematic Internet use given the pervasiveness of Internet access on college campuses and possibly the freedom from parental supervision many college students experience when living away from home for the first time [3–5]. Epidemiological studies indicate that approximately 5% of U.S. university students suffer from problematic Internet use [6–8].

To obtain detailed descriptions of college students’ experiences with problem Internet use, our team employed exploratory in-depth focus groups. Quantitative data regarding participants’ sociodemographic characteristics and Internet usage patterns were also collected. In addition, two standardized measures were included to assess signs and symptoms that are associated with problematic Internet use. The University of North Carolina-Chapel Hill Institutional Review Board approved the research project.

Almost half (48.1%) of the student sample scored five or more on Young’s Diagnostic Questionnaire (YDQ), and therefore scored above the suggested cut-off point for Internet addiction. Another 40.7% scored a three or four on the YDQ, reflecting the suggested cut off for sub-threshold Internet addiction. The internal consistency of the YDQ in this study was .69. Almost the entire sample (96.3%) exceeded the recommended cutoff for problematic Internet use according to the Compulsive Internet Use Scale (CIUS). In this study, the CIUS had an α = .92. Many participants felt their problematic Internet use could validly be described as an addiction. In discussing this, participants likened their Internet use to substance dependence. In the words of one participant, “If you’re addicted to cigarettes, you can’t really go a day without smoking. Probably you can’t go many days without (the) Internet.” In fact, many participants used terms that referred to the signs and symptoms of substance use disorder when discussing their problematic Internet use, including “withdrawal,” “tolerance,” and “craving.” Participant quotes regarding their problematic Internet use are shown in Table 2. These quotes are reflective of the signs and symptoms generally used for substance use disorder and behavioral addictions. These signs and symptoms are: (a) use longer than intended; (b) preoccupation; (c) withdrawal signs/symptoms; (d) tolerance; (e) unsuccessful attempts to stop or reduce Internet use; (f) craving; (g) loss of interest in other hobbies or activities; (h) excessive use despite problems; (i) use the Internet to escape or relieve negative mood; and (j) lying about use.

This study explored the extent to which problematic Internet use behaviors described by university students mirror the DSM-5 criteria for substance use disorder, gambling disorder, and Internet gaming disorder. Overall, signs and symptoms associated with problematic Internet use described by students in this study were similar to those of substance use disorder, gambling disorder, and Internet gaming disorder [31]. Importantly, participant quotes provided detailed descriptions of signs and symptoms of problematic Internet use, and contextualized the related quantitative findings. Although clearly, more rigorous studies are needed, our findings supported the previous evidence suggesting that problematic Internet use could be a type of behavioral addiction [1–2,20,22]. In a recently published qualitative study using the same sample [4], the authors explored the natural history of problematic Internet use; common affective, interpersonal, and situational triggers of Internet overuse; patterns of Internet use; and negative consequence of problematic Internet use among university students. The findings from the recent published study suggested that students’ self-reports of problematic Internet use were consistent with results of standardized measure which were developed based on diagnostic criteria for substance use disorder and gambling disorder, including Young’s Diagnostic Criteria and Compulsive Internet Use Scale [4]. Building upon previous work, the findings of this study further suggest that the signs and symptoms “volunteered” by university students who self-identified as having problems with Internet overuse mirrored signs and symptoms of substance use disorder, gambling disorder, and Internet gaming disorder assessed by DSM-5 criteria.