Clinical Topics in Japan
Internet Addiction among Students:
Prevalence and psychological problems in Japan
JMAJ 49(7 • 8): 279–283, 2006
Takeshi Sato*1
Key words Internet addiction, Diagnostic criteria, Prevalence, Psychological problem
The explosive growth of the Internet in the last pare clinicians for this issue.
decade has had a huge impact on communication The best method clinically to detect compul-
and interpersonal behavior. Psychological research sive use of the internet is to compare it with
during the same period has sought to increase criteria for other established addictions. Of all
understanding of this impact. The Internet was the diagnoses referenced in the Diagnostic and
originally designed to facilitate communication Statistical Manual of Mental Disorders (DSM-
and research activities. However, the dramatic IV)1 pathological gambling was viewed as most
increase in the use of the Internet in recent years akin to this phenomenon. Prior research defined
has led to pathological use (Internet addiction). internet addiction as an impulse control disorder
The effect of Internet addiction includes the that does not entail an intoxicant.
impairment of academic performance, psycho- Using pathological gambling as a model,
logical well-being, and interaction with peers and Young2 developed eight items of criteria of
family members. Internet dependency that modified the DSM-IV
To understand the current status in Japan, this criteria to be used as a screening device to differ-
study reviews the prevalence of Internet addic- entiate “dependent” from “non-dependent” users.
tion among students and compares it with that in The questions are shown in Table 1.
foreign countries. It also introduces psychologi- Patients are considered “addicted” when answer-
cal problems concerned with Internet addiction ing “yes” to five or more of the questions and when
and mobile phone E-mail encountered in a pri- their behavior cannot be better accounted for by
mary care practice. a manic episode. The cut off score of “five” is
consistent with the number of criteria used for
Definition of Internet Addiction pathological gambling and seen as an adequate
number of criteria to differentiate normal from
Addictive use of the internet is a new phenom- pathological internet use.
enon that many practitioners are unaware of and Official criteria for the diagnosis of Internet
consequently unprepared to treat. Some practi- Addiction Disorder (IAD) along with more infor-
tioners are unfamiliar with the Internet, making mation on IAD and subscription information for
its seductive powers difficult to understand. the Internet Addiction Support Group (IASG)
Sometimes its impact on the afflicted person’s are available on Ivan Goldberg’s website.3
life is underestimated as many practitioners do
not recognize the legitimacy of the disorder. Screening Devices for Internet Addiction
Hence, this paper starts with a review of the diag-
nostic criteria of internet addiction to help pre- How do patients know if they are already addicted
*1 Health Care Center, Saga University, Saga
Correspondence to: Takeshi Sato MD, PhD, Health Care Center, Saga University, 1-Honjo, Saga, Saga 840-8502, Japan.
Tel: 81-952-28-8181, Fax: 81-952-28-8184, E-mail: satot@cc.saga-u.ac.jp
JMAJ, July / August 2006 — Vol. 49, No. 7 • 8 279
Sato T
Table 1 Diagnostic criteria for Internet addiction according to DSM-IV 2
1. Do you feel preoccupied with the Internet (think about previous on-line activity or anticipate the next on-line
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 a 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 your involvement with the Internet?
8. Do you use the Internet as a way of escaping from problems or of relieving a dysphoric mood (for example,
feelings of helplessness, guilt, anxiety, depression)?
Table 2 Internet Addiction Test (IAT) 2
To assess level of addiction, answer the following questions using this scale:
1=Rarely, 2=Occasionally, 3=Frequently, 4=Often, 5=Always.
1. How often do you find that you stay on-line longer than you intended?
2. How often do you neglect household chores to spend more time on-line?
3. How often do you prefer the excitement of the Internet to intimacy with your partner?
4. How often do you form new relationships with fellow on-line users?
5. How often do others in your life complain to you about the amount of time you spend on-line?
6. How often do your grades or school work suffer because of the amount of time you spend on-line?
7. How often do you check your e-mail before something else that you need to do?
8. How often does your job performance or productivity suffer because of the Internet?
9. How often do you become defensive or secretive when anyone asks you what you do on-line?
10. How often do you block out disturbing thoughts about your life with soothing thoughts of the Internet?
11. How often do you find yourself anticipating when you will go on-line again?
12. How often do you fear that life without the Internet would be boring, empty, and joyless?
13. How often do you snap, yell, or act annoyed if someone bothers you while you are on-line?
14. How often do you lose sleep due to late-night log-ins?
15. How often do you feel preoccupied with the Internet when off-line, or fantasize about being on-line?
16. How often do you find yourself saying “just a few more minutes” when on-line?
17. How often do you try to cut down the amount of time you spend on-line and fail?
18. How often do you try to hide how long you’ve been on-line?
19. How often do you choose to spend more time on-line over going out with others?
20. How often do you feel depressed, moody, or nervous when you are off-line, which goes away once you are back
on-line?
280 JMAJ, July / August 2006 — Vol. 49, No. 7 • 8
INTERNET ADDICTION AMONG STUDENTS
Table 3 Prevalence of Internet addiction among students
Percentage
Number of
Year Authors Country Subjects of Internet Assessment Tool
Subjects
Addiction
1997 Scherer 5 South America college 531 13.0 Internet dependence
6
2000 Chou & Hsiao Taiwan college 910 5.9 IAS
2000 Morahan-Martin & US college 283 8.1 PIU scale
Schumacher 4
2001 Anderson7 US college 1,300 9.8 Internet dependence
8
2001 Wang Australia college 293 9.6 IAD
9
2002 Mingyi China college 500 6.4 IAD
10
2002 Lin & Tsai Taiwan high school 753 11.7 Chinese IAS
2004 Johansson & Norway 12–18 years 3,237 10.7 IAS 40 or more
Gotestam11
2004 Sato12 Japan college 242 9.1 IAS 40 or more
13
2005 Niemz et al. UK college 371 18.3 PIU scale
14
2006 Kim et al. Korea high school 1,573 39.6 IAS 40 or more
(IAS: Internet Addiction Scale; PIU: Pathological Internet Use; IAD: Internet Addiction Disorder)
or rapidly tumbling toward trouble? Everyone’s to obtain a final score. The higher their score, the
situation is different, and it’s not simply a matter greater their level of addiction and the greater
of time spent on-line. Some patients feel they are the number of problems their Internet usage
addicted with only twenty hours of Internet use, causes. Here’s a general scale to help measure
while others who spent forty hours on-line insist their score:
it is not a problem to them. It’s more important to 20–49 points: You are an average on-line user.
measure the damage their Internet use causes in You may surf the Web a bit too long at times, but
their life. What conflicts have emerged in family, you have control over your usage.
relationships, work, or school? 50–79 points: You are experiencing occasional or
The Internet Addiction Test (IAT) developed frequent problems because of the Internet. You
by Young2 appears in his book, Caught in the Net. should consider its full impact on your life.
This is a simple exercise that helps people in two 80–100 points: Your Internet usage is causing sig-
ways: 1) If patients already know or strongly nificant problems in your life. You should evalu-
believe they are addicted to the Internet, this ate the impact of the Internet on your life and
guide will assist them in identifying the areas address the problems directly caused by your
in their life most impacted by their excessive Internet usage.
Net use; and 2) If they are not sure whether they Another scale includes Pathological Internet
are addicted or not, this will help determine the Use Scale (PIUS) developed by Morahan-Martin
answer and begin to assess the damage done. and Schumacher.4
When answering, respondents should only con-
sider the time they spent on-line for non-academic Prevalence of Internet Addiction
or non-job related purposes. The IAT has been
already translated into Japanese and can be used The prevalence of Internet addiction is shown
by clinicians for screening in their clinic if they in Table 3. These studies were undertaken using
want to rule out Internet addiction (Table 2). varying instruments, and show that 8–10% of col-
After patients have answered all the questions, lege students have Internet dependence.4–14 These
add the numbers they selected for each response results were obtained from many college student
JMAJ, July / August 2006 — Vol. 49, No. 7 • 8 281
Sato T
Table 4 Gender difference in addiction15 to addictive behaviors. Armstrong et al. investi-
Gender Gender
gated whether low self-esteem was associated
Addiction Addiction with Internet addiction, and found that self-
Difference Difference
esteem was a good predictor of Internet addic-
Substances Activities
tion and amount of time spent on-line per week.
Alcohol M⬎W Exercise MW
According to Kim et al. 14 the level of depression
Cigarettes M⬎W Television MW
and suicidal ideation were highest in the Internet-
Caffeine M⬍W Internet use M⬎W
addicts group. Further studies should investigate
Chocolate M⬍W Video games M⬎W
the direct relationship between psychological
Gambling M⬎W
health problems and Internet dependence.
Future Problems of Internet Addiction
in Japan
population studies and are similar to results in
Japan, but primary care physicians may also need Recently, the use of E-mail on mobile phones
data based on community samples. among adolescents in Japan has been increasing.
It is difficult to predict the future prospects of New and serious psychological problems have
Internet dependence. It might be on the increase, arisen relative to the spread of mobile phones.
or it may fade out. Before drawing any conclu- Some Japanese adolescents with school refusal
sions about this, it is necessary to perform a use the mobile phone E-mail to communicate
prevalence study of Internet addiction on a large with their friends excessively. I encountered two
scale in Japan. Case studies of Internet addicts cases of high school students with school refusal
may also provide more insight into the specific in a primary care practice. They sent E-mail to
nature of the disorder. their friends more than 200 times a day. They
could not stop using mobile phone E-mail, and
Characteristics of Internet Addiction then were exhausted from sending mail all day,
which resulted in depression. They had developed
With regard to gender and addiction, Greenberg addictive and compulsive behavior to E-mail use
et al.15 reported an interesting pattern of gender on mobile phones, which impaired their aca-
differences in addictive tendencies (Table 4). demic performance, psychological well-being,
Analyses on the individual substances and activi- and interpersonal relationships with friends and
ties revealed that men reported greater level family members.
of addiction to cigarettes, alcohol, video games, As shown in the case vignettes of these two
gambling, and internet use. On the other hand, high school students, new psychological prob-
women reported greater levels of addiction to lems have developed as a result of the change
chocolate and caffeine. No significant differences of communication media in Japan. We should
were found for exercise or television. Men tend pay more attention to adolescents’ feelings and
to be addicted to the Internet. then propose possible solutions for problematic
Furthermore, low self-esteem has been linked behavior among students.
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