Ghosh: Smartphone Addiction 148
Viewpoint Article
Smartphone Addiction: new disorder or just a hype
Prosenjit Ghosh
Assistant Professor, Department of Psychiatry, Silchar Medical College, Assam.
Corresponding Author: Prosenjit Ghosh
E-mail: p_ghosh72@yahoo.com
ABSTRACT
For last few years there has been a considerable interest in the field of Behavioral addiction. As a result of
which Pathological gambling has been included in DSM-V as a disease entity. With the advent of
smartphone and its huge popularity among youngsters, has raised the issue of Smartphone addiction. We
searched the internet with the key words – smartphone addiction, adolescents, practical solution, digital
literacy and behavioral addiction. From the selected studies we analyzed the – risk factors, assessment and
diagnosis, consequences and practical solutions for the smartphone addiction in youngsters.
Keywords: Smartphone addiction, Digital literacy, Behavioral addiction, Peer support network, Cyber
psychology.
(Paper received – 27th January 2020, Peer review completed – 16th February 2020)
(Accepted – 19th February 2020)
Definition
Several behaviors produce short-term reward that may engender persistent behavior despite knowledge of
adverse consequences, i.e., diminished control over the behavior. This similarity has given rise to the
concept of non-substance or “behavioral” addictions, i.e., syndromes analogous to substance addiction,
but with a behavioral focus other than ingestion of a psychoactive substance.
Background
The recent development of the multifunctional smartphone and its huge global popularity has changed the
communication and information landscape; ignited the interests, values, and desires of many users; and
raised concerns around the world about overuse and possible addiction [1].
However, till date, no mention has been made of smartphone addiction in either the DSM-5 or in the ICD-
11’s draft although Internet addiction has been mentioned as area of interest in DSM-V. Nevertheless,
research on smartphone and mobile phone addiction has notably increased in recent years [2-5]
particularly in east Asian countries including – Korea, Taiwan, China etc.
Most of the screening studies estimate that smartphone addiction ranges from anywhere between just
above 1% and 35%6. One study reported that 48% of undergraduate university students were smartphone
addicted [2]. One reason put forward for high smartphone use in Asian countries is that lack of
opportunity for adolescents to mix freely with members of opposite gender in social situations and that’s
why they depend on virtual world to make friends.
Kardefelt-Winther and others [6] proposed a model of Behavior Addiction: (a) significant functional
impairment or distress as a direct consequence of the behavior and (b) persistence of the behavior over
time. If the harm is not significantly severe, the disorder would be better classified as problematic or
maladaptive use. The major criticisms against the disease model of Smartphone addiction [7] are the lack
of longitudinal data, lack of consistency in methodology, lack of a clinical sample, lack of better explained
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Ghosh: Smartphone Addiction 149
by criteria’ as for example those used for Pathological Gambling – the behavior of gambling is not better
explained as part of Manic episode.
However, there are many studies favoring for a disease entity of Smartphone addiction. Leung’s study
showed that the possibility of becoming a smartphone addict for adolescents seeking sensation due to
boredom was higher [8]. Excess use of smartphones may harm people’s functionality and lead to a
psychological and behavioral addiction [9]. Students use Smartphone for easy communication, free
texting, photo-sharing, talk, entertainment, and obtaining and sharing information [10]. But when it starts
to affect their functional capacity in – academics, social relationship, interpersonal relationships, family
relationships or occupational field then it becomes a diagnosable condition. Use of smartphones among
youth is fast gaining prevalence. This fast increase brings along smartphone addiction.
Consequences
Although evidence is limited, excessive use can have a small negative impact on mental wellbeing [11].
Excessive use of digital technologies and Smartphone use are associated with mental illness [12]. There is a
significant association between playing video games in the evening and sleep deprivation [13]. Smartphone
may provide tools for cyber-bullying [14]. It may also cause body image distortions [15] and eating
disorders [16].
Greater social media use, night-time social media use are all associated with higher levels of anxiety and
depression [17]. Using screen entertainment for more than 2 hours a day is found to be associated with
emotional and conduct problems in 5-year-old girls [18].
Its effect on driving performance increases the number of car accidents [19]. Excessive smartphone use can
interfere with concentration at school or work [20] and can cause headache, dizziness, blurred vision, wrist
pain [21].
Diagnosis
Hsuan Lin and others [22] developed a diagnostic criterion by evaluating 281 college students. Each study
subject was assessed systematically for smartphone use behavior by psychiatrists structured diagnostic
interview. The accuracy, sensitivity and specificity of the candidate symptom criteria were analyzed by
using psychiatrist’s clinical global impression. The optimal model selection with definite cut off points of
the diagnostic criteria differentiating smartphone addicts from those not addicted to smartphone was then
done by best diagnostic accuracy. The final smartphone addiction diagnostic criteria consisted of – six
symptoms criteria, four functional impairment criteria and one exclusion criteria with minimum three
months’ duration and three symptoms cut off and two functional impairment criteria for diagnosis. This
diagnostic criterion has an accuracy of 85%.
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Ghosh: Smartphone Addiction 150
Min Kwon and others [23] developed a Smartphone Addiction Scale (SAS-SV) by assessing 540
participants of both genders with an average age of 14.5 years. It consisted of ten questions which can be
scored in a six point Likert scale. The scale showed good reliability and validity for assessing smartphone
addiction.
Risk factors
Various studies have showed that there are some definite risk factors for developing smartphone addiction.
Perceived stress, female gender, alcohol use, anxiety, social phobia, high need to belong, difficulties in
emotional regulation are all positively related to smartphone addiction. On the other hand, academic
performance, school satisfaction, self-esteem, peer support network, family support and membership in
some organizations are all negatively associated with smartphone addiction.
Smartphone can bring both considerable benefits to children’s education as well as exposure to online risks
such as access to inappropriate content and abusive interaction with others, which could have a
detrimental effect on their mental health [24]. Schools should develop digital literacy, providing young
people with digital skills to recognize risks such as cyber-bullying and excessive use of social media, as well
as strengthening emotional resilience. Governments should promote parental controls for different devices,
as well as encourage co-viewing of content with children to help children understand what they are seeing
and apply it to the world around them. In Japan, legislation has funded increased education on
appropriate internet use and promoted internet filtering and monitoring to parents.
The children’s commissioner for England formulated a ‘Digital 5 A Day’ framework for safe smartphone
use [25].
Connect – Keeping an open dialogue so that parents can understand how their children is spending time
online and enabling the children to seek help.
Be Active – Should have time to switch off and get moving.
Get Creative – Encourages children to learn and be creative. It discourages children to spend time online
passively consuming content.
Give to Others – Posting positive messages, reporting harmful content, not sharing content that is fake or
abusive. Encouraging family, friends and community offline as well.
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Be Mindful – It may be difficult for children to put their phones down when apps are encouraging them to
engage. Parents can help children with time management by using some app or by logging the amount of
time.
Korea was the first country in the world to develop a national policy and allocate a budget [26]. The Korea
Youth Counselling and Welfare Institute provides prevention and counselling services for young people.
Counselling is available individually, in groups or via telephone, as well as at home when an individual
has cut themselves off from social relationships in the real world. In extreme cases internet abstinence
rehabilitation camps are offered by the National Center for Youth Internet Addiction Treatment, where
young people receive a range of treatments for 12 days, including opportunities to engage in outdoor sports
and activities [27].
Governments should encourage online broadcasters, digital developers and entrepreneurs to produce
technology that fits a child’s development via ‘age-appropriate’ content, as well as ensure inappropriate
content is not accessible. Microsoft and Sony provide online guides and video demonstrations on setting
time limits and content restrictions on their gaming systems [27]. Apps are now available to help limit
children and young people’s screen time and track their online activity, whether tracking and setting limits
on daily social media usage via Moment, using Space and App Detox to set screen locks and time use
goals. In response to this demand, Google, Apple, Facebook and Instagram are also introducing new tools
for users to monitor daily use and set screen time limits.
Put the phone away during meals: sitting down to eat with family or friends, is a rare opportunity to talk
face-to-face. Wonderful things can happen in conversation.
Make your last 30 minutes before bed a screen-free zone: our mind might starts worrying with every text,
Instagram post or email we look at. Any light tends to keep us awake – or wake us up – and that includes
the phone screen.
Turn off all notifications: Limit notifications to the stuff that really matters. Just get rid of a lot of apps.
Track usage: with Moment, Flipd, Quality Time and SPACE. these apps track your smartphone activities
and provide tools and training to curb that usage.
Start a conversation with a stranger: when alone in a public place, see if a live-and-in-person
conversation might kill some time rather than diving into your phone. Sometimes the chat is brief,
sometimes you learn something really interesting, and once in a while, you make a new friend.
Go outside: Walk, bike, hike, hit the gym, or just go for a walk. Trade an hour a day on your phone for an
hour of some sort of exercise, and you're just going to feel better. The great thing about group yoga or
fitness is that it's impossible to check the phone while you're doing it, and that frees your mind.
Test your brain: With the smartphone, facts are literally at our fingertips. Before you opt for the phone,
spend a minute or two racking your brain (or your friends') for the answer.
Keep your child engaged: With shrinking play spaces, more and more children are forced to stay indoors.
As a result, children get hooked to gadgets like smartphones. Take your child out to the park or some
nearby playground to allow him to spend his time running and playing. If that is not an option, enroll him
in a neighborhood sports club.
Set a good example: There are a number of parents who spend a lot of time on their smartphones. In such
cases, instructing children may not be of much use. So, be a good role model for your child by limiting
your usage of the phone. However, if your profession demands using phones a lot, do it away from the
eyes of your child.
Bond with your child: It is important to take the time out for family bonding activities with children. You
can also join your child in pursuing hobbies like listening to music, gardening, reading or painting.
What is the right Age: No two kids are the same, and there’s no magic number? A kid’s age is not as
important as his or her own responsibility or maturity level. Some experts said 12 was the ideal age, while
others said 14. The longer you wait to give your children a smartphone, the better. Ultimately, parents will
determine when their child truly needs a smartphone. There are approaches for testing the waters before
handing one to the child. One popular option is to start the child off with feature phones that can only send
text messages or place phone calls, and to assess whether they can use those devices responsibly. A family
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contract listing the rules of smartphone use, which may include promises never to take nude selfies and
never to try to meet strangers from the internet in real life.
Indian Psychiatric Society Recommendations (0 to 5 Years)
• Co-view with children of 2-5 yrs. of age, not more than 1 hour a day.
• Avoid fast paced programs with lots of distracting contents.
• Avoid media as a way to calm your child.
• Be a good role model.
• Try to enhance interactions with your child.
• There is no substitute for a real human being.
Indian Psychiatric Society Recommendations (5 to 18 Years)
• Digital Literacy – Help the child embrace technology in healthy ways.
• Realistic and reasonable ground rules, mutually agreed upon.
• Gadget be used in a common room, not in seclusion.
• Promote daily physical activity for at least one hour. Designate media free time.
• Monitor children’s media use and apps used. Test apps before the child uses them.
• Communicate the guidelines to other caregivers. Rules are followed uniformly.
Conclusions
Smartphone has become a part of our life because of its multifunctional nature. We must however use the
smartphone rationally and keep track of our daily use. We must be good role model to our children.
Smartphone addiction is a type of behavioral addiction although no official diagnostic category has yet
been assigned. Children and adolescents are most vulnerable group. Parents should monitor the duration,
pattern, type of contents used by their children. A little bit of internet use is positive, while excessive use
has a negative impact on mental wellbeing.
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Acknowledgements – Nil
Conflict of Interest – Nil
Funding – Nil
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