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Ask Stanford Med: Answers to your questions on the psychological effects of Internet use

Thank you for sharing your questions about the potential link between mental health disorders and Internet addiction. I hope these answers help increase your understanding of how excessive Internet use may be harmful to one's health.

@myr00dle asks: Is it true that a leading cause of ADHD is excessive Internet use?

Studies have suggested a link between excessive Internet use and attention deficit and hyperactivity disorder. For example, a 2004 South Korean study of 535 elementary students found that 33 percent of those with attention deficit disorder were "addicted" to the Internet. Similarly, a 2008 Taiwanese study of 216 college students reported that 32 percent of "Internet addicts" had attention deficit disorder compared with only 8 percent of non-addicts. However, while such studies show a strong correlation, they do not establish cause-and-effect. It is possible that kids who are already attention-deficient are more likely to gravitate to the Internet. Still, it seems intuitive that it would be hard to go from spending 56 seconds, on average, on every web page we visit to reading Dostoevsky.

James asks: Is there any evidence that Internet addiction is dopaminergic? On a related note, which psychological disorders are associated with increased Internet addition?

Based on the studies conducted so far, depression appears to be the most common condition occurring in individuals with problematic Internet use. The studies, however, don't tell us if the person sought to "self-medicate" a depression by going online or if the depression resulted from excessive time spent using the Internet, perhaps at the expense of more rewarding real-life interactions.

Problematic Internet use and problematic online video game use have been called "behavioral addictions." The neurotransmitter dopamine has long been implicated in addiction to substances and some preliminary small studies suggest a link between a dysfunctional dopamine system and problematic Internet or online video game use as well. In one study, "Internet addicts" were found to have altered glucose metabolism in brain regions that include major dopamine projections. Another study linked a variant of the dopamine D2 receptor gene with excessive online video game use. A third study used positron emission tomography (PET) to show lower levels of D2 dopamine receptors in parts of the brain of individuals with "Internet addiction." Finally, a recent study showed lower levels of the dopamine transporter in parts of the brain of problematic Internet users.

BV asks: What are the warning signs that a parent, or rather anyone, should consider when it comes to determining if a person's online activity may be harmful to his health? Additionally, what is considered "safe" when it comes to Internet usage and posting about one's daily activities?

There is no pre-determined "cut off" beyond which Internet use is problematic and below which it is automatically healthy. Instead of a fixed time limit, what determines whether one's Internet use might be a "pathology" is the downstream consequences. Are real life relationships suffering as a result of excessive online time, including virtual friendships and relationships? Is a student's school performance deteriorating because of needing to spend many hours online perfecting his or her score in a favorite video game? Is work productivity suffering because of online activities? The answers to such questions help determine what constitutes "safe" when it comes to usage of the Internet and related technologies.

Allison Truong asks: Can the Internet be used as a means to an end in helping cope or manage other forms of addiction, such as smoking and alcohol?

There is much valuable help to be found online for the entire spectrum of psychological problems, including compulsive or addictive conditions. I routinely refer my patients to online support groups and vetted online information sources. What seem more questionable are web sites that encourage the problematic Internet user to "Click here if you are addicted to the Internet."

Catharine Alvarez asks: Are there forms of online interaction that are psychologically and socially beneficial?

There is no doubt that certain online interactions are pro-social and serve to enhance a person's wellbeing and quality of life. Research has not so far "dissected" what particular online activities may be riskier or more likely to result in problems. However, it is often not the specific nature of the online activity that determines whether or not it is problematic, but, rather, the offline consequences to the person.

Hannah asks: Do age or generation play a role in Internet addiction?

So-called "digital natives," individuals born in the mid to late nineties and who don't know life before Google, have received the most research attention and are generally thought to be at higher risk for developing problematic Internet or online video game use. However, case reports and small studies exist for all age groups, and, taken together, they suggest that these issues are hardly limited to younger individuals.

Stanford psychiatrist Elias Aboujaoude, MD, is the author of Virtually You: The Dangerous Powers of the E-Personality, which explores how our online traits are unconsciously being imported into our offline lives

Previously: Ask Stanford Med: Stanford psychiatrist taking questions on psychological effects of Internet use, Exploring the Internet's dark side, 9/11: Grieving in the age of social media, Virtually You: The dangerous powers of the E-Personality and Stanford psychiatrist explores how people's online personas affect their real-world lives

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