Interestingly, many also may struggle with a stunning array of mental illnesses, including manic depression and anxiety disorders, report University of Florida and University of Cincinnati psychiatrists, who describe findings from a new study in the March issue of the Journal of Affective Disorders. On average, each participant in the UF/Cincinnati study had five other major psychiatric problems.

The study is the first to rely on face-to-face interviews using standardized questionnaires to profile people whose Internet use is characterized as problematic - uncontrollable as well as markedly distressing, time-consuming or resulting in social, occupational or financial difficulties.

"It surprised me how destructive the Internet apparently was in their lives, and how much they liked being online," said Dr. Nathan A. Shapira, an assistant professor of psychiatry at UF's College of Medicine. "Of those we evaluated, some had very profound problems, like staying online three days straight at a time. A number failed out of school, and a bunch had affairs or were losing their jobs."

Shapira collaborated with UF psychiatrist Dr. Toby Goldsmith and the University of Cincinnati's Dr. Paul E. Keck Jr., Uday M. Khosla, and Dr. Susan L. McElroy.

The news comes at a time when the Internet has ignited a firestorm of debate over the social and cultural implications of surfing the Web, with critics arguing it is damaging - or replacing - interpersonal relationships.

An estimated 5 percent to 10 percent of people who use the Internet can be classified as having a problem, various online surveys report. According to the American Psychological Association, that translates to 200,000 cyberspace addicts.

In the UF/Cincinnati study, most of the 20 participants - 11 men and nine women whose average age was 36 - had experienced problems for three years. Their heavy Internet habits led to devastating social consequences: severe marital strife or even divorce, failure in school or on the job, substantial debt and isolation from friends and family. Many went without sleep, were frequently late for work, ignored family responsibilities and suffered financial or legal consequences.

On average, they spent roughly 30 hours per week online during their nonworking hours. Most were employed, but logged only about three hours a week in work-related Internet activities. Most favored spending time in chat rooms, exchanging e-mail, surfing the Web or engaging in multi-user domains. Many described the thrill of being on multiple sites simultaneously.

"When you talk about psychiatric illness, some people picture the stereotype of a strange or weird person," Shapira said. "But overall the people we evaluated were intelligent, very nice and well-respected in the community, and they had good jobs and had families."

One unexpected finding: Every study participant's Internet use met established diagnostic criteria for the family of psychiatric illnesses known as impulse control disorders, which include kleptomania, a recurrent failure to resist impulses to shoplift, and trichotillomania, the recurrent pulling out of one's hair. In fact, Shapira has coined the problem "Internetomania" because their behavior so closely mirrored that of those grappling with these syndromes.

"It's interesting, because in impulse control disorders what you see is someone who has a building urge or anxiety about doing a behavior, and until they do that behavior that anxiety or push or drive won't dissipate," he said. "Once they've done that behavior there is often pleasure or relief associated with it."

Their problems were compounded by other multiple psychiatric problems: Nearly all met the criteria for manic depression or a psychotic disorder with similar features; others had a history of anxiety disorder, substance abuse problems, impulse control disorders and eating disorders.

Fifteen study participants previously had received psychiatric medications. By evaluating the treatments participants had received and their previous Internet use, researchers determined that mood-stabilizing medications appeared to be the best for controlling study participants' Internet use. Antidepressant medications also were helpful for some.

Larger studies are needed to definitively determine whether Internet addiction is a distinct disorder, merely the symptom of an already-characterized psychiatric problem, or both, Shapira said.

"These individuals displayed a significant amount of treatable psychiatric illness, and it really raises the question: Are we talking about a distinct disorder or something that is a symptom of these other psychiatric illnesses?" he said. "The real question is: Does the Internet put people at risk? Can the Internet make psychiatric illness worse? Did people have trouble regulating Internet use because they had a pre-existing psychiatric illness, or did they develop an illness because of Internet use? More work is going to need to be done to pin all this down."

University of Pittsburgh psychologist Kimberly Young said "anonymity, convenience and escape" explain how cyberspace enables addictive behavior.

"There's something about this that's unique compared to TV, which is not interactive," said Young, who is also the executive director of Pittsburgh's Center for On-line Addiction and author of "Caught in the Net," a recovery guide.

"In a nutshell I think Shapira's work is very important," Young said. "It's certainly something we need more of, to really tease apart some of the intricacies of what is unique about people bingeing on the Internet. That's certainly a question we're all trying to figure out answers to."

Note: If no author is given, the source is cited instead.

• Mental Health Research
• Workplace Health

• Psychiatry
• Disorders and Syndromes

• Internet
• Communications

• Substance abuse
• Procrastination
• Webcast
• Cyber-bullying
• Personality disorder
• Adult attention-deficit disorder