Friday, November 27, 2009

Does "Internet Addiction" Really Shrink Your Brain?

Internet addiction is a murky and controversial disorder that is the subject of intense debate over whether it should be included in the new DSM-V. Here are the proposed diagnostic criteria as developed by Dr. Kimberly Young:
  1. Do you feel preoccupied with the Internet (think about previous online activity or anticipate next online session)?

  2. Do you feel the need to use the Internet with increasing amounts of time in order to achieve satisfaction?

  3. Have you repeatedly made unsuccessful efforts to control, cut back, or stop Internet use?

  4. Do you feel restless, moody, depressed, or irritable when attempting to cut down or stop Internet use?

  5. Do you stay on-line longer than originally intended?

  6. Have you jeopardized or risked the loss of significant relationship, job, educational or career opportunity because of the Internet?

  7. Have you lied to family members, therapist, or others to conceal the extent of involvement with the Internet?

  8. Do you use the Internet as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression)?

Answering "yes" to five or more questions may mean you suffer from Internet addiction over a six month period and when not better accounted for by a manic episode.
You can rate your own level of addiction by taking the Internet Addiction Test (sponsored by The Center for Internet Addiction, of course).

Dr. Young was featured in a recent article, along with Dr. Vaughan Bell (of Mind Hacks fame) taking the contrary position:
Internet addiction: New-age diagnosis or symptom of age-old problem?

. . .

Kimberly Young, director of the online resource The Center for Internet Addiction, says that internet addiction may not yet be clearly defined, but you know it when you see it.

. . .

Young: “The internet has inherent value and utility, and there are many good things about it, but there is this dark side.”

Or is there? Not according to Vaughan Bell, a visiting research fellow with the Department of Clinical Neuroscience, Institute of Psychiatry at King's College London in the United Kingdom. Bell has argued that the internet is not an activity, and therefore internet addiction is a flawed idea (J Ment Health 2007;16[4]:445-57).

“Fundamentally, the internet is a medium of communication,” says Bell, who claims that one can no more be addicted to the internet than to radio waves. “The concept itself doesn’t make sense.”

Bell acknowledges that some people use the internet and other technologies to excess, but believes they do so to avoid dealing with underlying problems, such as depression or social anxiety disorder, which have well-established treatments.
Other prolific bloggers who are noted opponents of the IA diagnosis include Dr. Shock and Dr. John Grohol.1

On the other hand, internet addiction is accepted as a major a problem in several Asian countries, including China and South Korea. Some of you might be familiar with the stories of [alleged] abusive and illegal clinics in China. With this as background, it was inevitable that someone would do a neuroimaging study of individuals with IA, and it was a group in Shanghai that was the first to do so (Zhou et al., 2009).

In their study, 18 teenagers (2 females and 16 males, mean age = 17.23 ± 2.6) with IA were compared to 15 age-matched control participants. Structural MRIs were performed and quantified using voxel-based morphometry (VBM):
VBM is a neuroimaging analysis technique that allows investigation of focal differences in brain anatomy, using the statistical approach of so-called statistical parametric mapping. ... VBM registers every brain to a template, which gets rid of most of the large differences in brain anatomy among people. Then the brain images are smoothed so that each voxel represents the average of itself and its neighbors. Finally, the image volume is compared across brains at every voxel.
The paper was very light on analytic methods and mum on important details about possible co-morbid psychiatric diagnoses in the kids with IA. As noted by Vaughan, depression and social phobia -- along with bipolar disorder, obsessive-compulsive disorder, various addictions, and other impulse control disorders -- could compel one to spend more time on the internet for gambling, gaming, chatting, porn-watching, etc.

With all these caveats in mind, the results are shown below.
...the VBM of the MRI data illustrated that the IA group had lower GMD [gray matter density] in the left anterior cingulate cortex (ACC), left posterior cingulate cortex (PCC), left insula, and left lingulate gyrus. No significant difference was found in the white matter change between the two groups.

Fig. 1 (Zhou et al., 2009). Regions of decreased GM shown on the template in the left anterior cingulate cortex (A), left posterior cingulate cortex (B), left insula (C), and left lingual gyrus (D) in IA subjects compared with the controls.

Most of the changes look pretty small, so it's hard to know what to make of them. On top of that, some of the regions seem mislabeled (the posterior cingulate in particular looks way off). And the findings only demonstrate correlation, not causation.

So in the end we have no idea if "internet addiction" shrinks your brain...


1 Blogging and social media are not addictive at all. Right?


Zhou, Y., Lin, F., Du, Y., Qin, L., Zhao, Z., Xu, J., & Lei, H. (2009). Gray matter abnormalities in Internet addiction: A voxel-based morphometry study. European Journal of Radiology DOI: 10.1016/j.ejrad.2009.10.025

xkcd - Bored With the Internet

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At November 28, 2009 5:52 AM, Blogger Soundwave said...

I think I have to side with Bell on this one. I fail to see how the internet can be seen to be an addictive activity in it's own right (as Bell suggests, the internet isn't an activity). Inserting "internet addiction" into the next DSM would be a bad move in my (admittedly amateur, undergrad) opinion. Surely what people DO on the internet is the important thing to consider, as an artifact of a different disorder, rather than the internet itself being the addiction.

At November 28, 2009 8:33 PM, Anonymous Anna said...


Thank you for this very interesting post! I am wondering if you would be willing to share this article? I am a graduate student, researching and studying Problematic Internet Usage and am very interested in reading this article to see the methodology used, the literature review the authors used, in addition to seeing other images that may be located in the article. If you would be willing to share, could you please email me at:

Thanks and I hope you have a wonderful day!


At November 28, 2009 9:27 PM, Blogger The Neurocritic said...

Thanks, Anna. I sent you the article.

At November 29, 2009 1:12 AM, Anonymous Anonymous said...

About whether to call it an 'addiction' --

A few years ago I saw a comment from a mother of an autistic boy. She talked about his perseverating by using an interesting description. She called it 'stuckness.'

It seemes quite possible that some people who over-use the internet might not be addictive personalities in other ways. But they might have trouble with 'stuckness' in more parts of their life.

Workaholics come to mind. Some of them, anyway. They just can't give up and go home, they work late, they hang on and hang on. Stuckness.

Same thing with some people at a party. Whether they arrive early or late, they just can't go home. They still till every single other person is gone.

Stuckness, not necessarily addicdtion.

At December 05, 2009 9:57 AM, Blogger Neuroskeptic said...

Their "posterior cingulate" blob looks more like the lateral ventricle to me...

At December 05, 2009 11:04 AM, Blogger The Neurocritic said...

Yeah, I don't know how they got "posterior cingulate" from that one...

At December 08, 2009 1:26 AM, Anonymous Mark Walterfang said...

One of the problems with VBM is how it handles regions of variable gyrification - this is one of the problems with the cingulate, and its degree of folding. This can cause a major "false positive" in VBM studies, and so areas in the cingulate should be interpreted with caution. Also, the posterior region is probably periventricular, which always makes you think about a misregistration issue.

For VBM, I am using FSL-VBM now for its nice non-linear registration, and am always cautious of interpreting regions where 1) there is a high degree of gyral variability and 2) it is close to a major tissue plane.

At December 09, 2009 2:11 PM, Blogger The Neurocritic said...

Hi Mark,

Thanks for the info. Is anyone using VBM in conjunction with flat mapping methods?

At December 15, 2009 12:57 PM, Blogger Abby said...

This was great for my psychology project on an addiction--we needed a myth about ours, so thank you for this!

At December 16, 2009 11:00 PM, Anonymous Mark Walterfang said...

Yes, I think Paul Thompson's group at UCLA probably has the most mature method.


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