Problematic Internet Use: A General Perspective

Abstract

How the Internet is used and any negative outcomes of engagement with it—especially with regards to children—is a topic of great interest, bearing legitimate investigation. Proposed identifiers of problematic internet use(PIU) include aspects of use in correlation with distress or impairment across biological, psychological, sociological, and/or occupational/academic functioning. Adolescents and those with vulnerabilities across developmental or sociological domains are particularly susceptible. Although validated instruments have been utilized to assess PIU, concerns surrounding the methodology, currency, and some validation measures of existing and cross-sectional screening tools and a lack of those with true external validity and variance, combined with some disagreement surrounding PIU, have impeded its diagnostic acceptance. Current investigative approaches to PIU include clarifying problematic gambling and gaming criteria, psychotherapeutic therapy, pharmacological interventions, and non-invasive neurostimulation therapies targeting cortical brain regions. As child screen time appears to be increasing, further research, ethical health/social policy changes, and digital literacy programs are strongly endorsed. To avoid online engagement dysregulating or harming children, digital policy youth user protection standards, pragmatic key player dialogues, transparent reassessments of digital-centric business models without compromising less resourced countries, and even globally agreed child online safety regulations are also recommended.

Full text

179
© The Author(s) 2025
D. A. Christakis, L. Hale (eds.), Handbook of Children and Screens,
https://doi.org/10.1007/978-3-031-69362-5_25
Problematic Internet Use:
AGeneral Perspective
NaomiA.Fineberg, DonGrant, ZsoltDemetrovics,
MatthiasBrand, JuliusBurkauskas, OrnellaCorazza,
MeredithGansner, DouglasA.Gentile,
BiljanaGjoneska, MarkD.Griths, OrsolyaKirály,
MarcN.Potenza, andAvivM.Weinstein
1 Background
Digitalization brings both benets and risks for
individuals and civil society. For children and
adolescents using digital technologies, benets
include opportunities for transitioning from fami-
lies to wider peer communities, harvesting posi-
tive support, expanding social consciousness,
gaining new coping mechanisms, and communi-
cating. Challenges include problems balancing
time spent online and ofine, negative biological,
psychological, and sociological impacts, vulner-
ability to cyberaggression, and other digital risks.
While some studies associate the frequency of
Internet use with poor mental health, others nd
associations with positive well-being, with out-
comes overall depending not simply on the
amount of time spent online but on the specic
motivation, quality, and pattern of use (normative
vs. “addictive”) [1].
Problematic Internet Use (PIU) involves
diverse forms of maladaptive online activities.
PIU implies diminished control over Internet use
or hazardous use patterns that create unfavorable
consequences for health and well-being, includ-
ing neglect of normative behaviors and relation-
ships. Children and adolescents, especially those
with vulnerabilities in affective, cognitive, moti-
vational, and interpersonal domains, have imma-
ture cognitive control and may be particularly
susceptible to, and disproportionately affected
by, PIU.The impact of PIU may be particularly
damaging to youth by disrupting developmental
steps in transition to adulthood [1, 2].
N. A. Fineberg (*)
School of Life and Medical Sciences, University of
Hertfordshire, Hateld, UK
D. Grant
Center for Research and Innovation, Newport
Healthcare, Newport, RI, USA
Z. Demetrovics
Institute of Psychology, ELTE Eötvös Loránd
University, Budapest, Hungary
Centre of Excellence in Responsible Gaming,
University of Gibraltar, Gibraltar, Gibraltar
College of Education, Psychology and Social Work,
Flinders University, Adelaide, Australia
M. Brand
General Psychology: Cognition and Center for
Behavioral Addiction Research (CeBAR), University
of Duisburg-Essen, Duisburg, Germany
Erwin L.Hahn Institute for Magnetic Resonance
Imaging, Essen, Germany
J. Burkauskas
Lithuanian University of Health Sciences
Neuroscience Institute, Kaunas, Lithuania
O. Corazza
Department of Psychology and Cognitive Science,
University of Trento, Trento, Italy
University of Hertfordshire, Hateld, UK

180
2 Current State
2.1 Forms ofPIU
PIU involves frequent online activity associated
with marked functional impairment and/or dis-
tress. Activities can include online gaming, gam-
bling, shopping, video-streaming, cybersex, the
use of pornography, and social media [1]. Two
main subtypes of PIU, generalized and specic,
have been proposed. Some specic forms may be
more impulsive (online gaming, gambling, buy-
ing/shopping, cybersex/online pornography use,
social media use, video streaming) and others
more compulsive (cyberchondria, cyberstalking,
digital hoarding), although there is debate and
overlap of addictive, impulsive, and compulsive
features [2, 3]. The concept of PIU, however,
remains controversial. Some have suggested that
the Internet constitutes a channel for problematic
or addictive behaviors [4], whereas others pro-
pose that digital platforms play active roles [5].
Balancing research evidence with public
health needs, the World Health Organization
introduced two specic PIU-related diagnoses
into the ICD-11 category of Disorders due to
Addictive Behaviors; the online forms of
Gambling Disorder and Gaming Disorder [6].
Other PIU-related addictive disorders can condi-
tionally be given an ICD-11 diagnosis as Other
Specied or Unspecied Disorders due to
Addictive Behaviors (sic), with online activity
named as a diagnostic specier. Such specic
behaviors may include problematic online por-
nography viewing, shopping/buying, and social
media use [7]. Denitions of other possible PIU-
related disorders not yet dened in the ICD-11,
such as cyberchondria and cyberbullying, have
also been proposed [1].
2.2 Assessment
Recent progress has been made in rening and
simplifying assessment instruments, which his-
torically relied upon forms of the Internet
Addiction Test (IAT) [8]. The Compulsive
Internet Use Scale (CIUS) and its short versions
are also up-to-date instruments possessing estab-
lished psychometric properties validated in many
languages [9]. Over 30 screening instruments
have additionally been developed to assess prob-
lematic online gaming. Among them, the IGDT-
10 and the IGDS9-SF present advantages,
including reference to an identied nosography,
robust psychometric properties, cross-cultural
validation, and available cut-off points. Additional
WHO efforts are presently active [10].
However, validated assessment instruments
for many forms of PIU are lacking and there are
methodological concerns with many existing
assessment tools, including insufcient attention
M. Gansner
Department of Psychiatry, Boston Children’s
Hospital, Boston, MA, USA
D. A. Gentile
Iowa State University, Ames, IA, USA
B. Gjoneska
Macedonian Academy of Sciences and Arts,
Skopje, North Macedonia
M. D. Grifths
International Gaming Research Unit, Psychology
Department, Nottingham Trent University,
Nottingham, UK
O. Király
Institute of Psychology, ELTE Eötvös Loránd
University, Budapest, Hungary
M. N. Potenza
Department of Psychiatry, Yale University School of
Medicine, New Haven, CT, USA
Child Study Center, Yale University School of
Medicine, New Haven, CT, USA
Connecticut Mental Health Center,
New Haven, CT, USA
Connecticut Council on Problem Gambling,
Wetherseld, CT, USA
Department of Neuroscience, Yale University,
New Haven, CT, USA
Wu Tsai Institute, Yale University,
New Haven, CT, USA
A. M. Weinstein
Ariel University, Ariel, Israel
N. A. Fineberg etal.

181
to item-response theory, validation against appro-
priate measures of functional impairment, and
measurement variance across different countries
and cultures [10].
2.3 Epidemiology
According to a meta-analysis, around 7% of the
global population shows signs of PIU [11]. While
it is too early to determine if the increased time
on the Internet during the COVID-19 pandemic
has resulted in a higher global PIU prevalence
[12], a greater burden of PIU was found for those
living in low/lower–middle-income countries, for
whom higher prevalence estimates during the
pandemic compared with earlier estimates have
been reported [13]. Young people with existing
mental health problems and specic neurodevel-
opmental disorders (e.g., attention decit hyper-
activity disorder (ADHD), autism spectrum
disorder (ASD)) show increased vulnerability to
PIU, linked not only to increased digital media
use, but also to isolation, loneliness, nancial
hardship, substance misuse, anxiety, and depres-
sion, although there is considerable heterogene-
ity in study ndings [1, 12]. However, given the
heterogeneity and the relative lack of consistency
in terms of the diagnostic criteria for PIU and the
diversity of assessment instruments, samples,
and sampling designs, prevalence estimates of
PIU vary widely across different studies and
should be approached with caution [12].
PIU also appears to differ between males and
females. Problematic/excessive use and greater
severity of smartphone use, social media use, and
online buying–shopping have generally been
associated with the female gender, whereas males
may be more prone to problematic online gam-
ing, online gambling, and online pornography
use, although heterogeneity exists across studies
and jurisdictions [14].
PIU is associated with co-occurring disorders,
including among younger and older pediatric
samples [15]. ADHD, depression, aggressive
behaviors, social anxiety, obsessive-compulsive
disorder (OCD), and ASD have been implicated
both as candidate predictors and as consequences
of PIU [16]. Other associations have variously
been reported with suicidality [17], self-injurious
behaviors [18], somatization, eating disorders,
psychoticism, poor life skills, poor well-being,
poor self-esteem, decreased physical activity and
tness, poor dietary hygiene, problems in family
relationships, and loneliness [19, 20]. Problematic
use of social media has also been associated with
aggression, cyberbullying, fear of missing out
(FOMO), and poor sleep [21].
2.4 Underpinning Mechanisms
The Interaction of Person-Affect-Cognition-
Execution (I-PACE) model [3] describes poten-
tial vulnerabilities driving the risk of PIU, their
interactions with urges, impulses, and self-
control, and consequences for mental health.
Individual and relational factors include neuro-
developmental (ASD, ADHD), mental health
(anxiety, depression, OCD, addiction), personal-
ity (affect regulation), and inhibitory control (and
other executive functions) features. Societal fac-
tors include changing communication patterns
and platform features, including advertising and
regulation policies (e.g., minimum age limits,
parental control).
For young people with ADHD and conduct
disorders, impulsivity and positive reinforcement
motivations may represent key factors, while for
those with OCD and ASD, attentional inexibil-
ity may result in difculties disconnecting. For
those with internalizing symptoms such as anxi-
ety and depression, online activities (e.g., social
media use) may be used to escape from distress-
ing emotions (negative reinforcement motiva-
tions). However, fear of failure and body image
disturbances generated by exposure to social
comparisons may also induce anxiety, depressive
symptoms [22], dysmorphophobia, and eating
disorders, as well as an increased use (especially
during the COVID-19 pandemic) of certain sub-
stances such as performance and image-
enhancing drugs and related psychopathology
[23].
Digital platforms may inuence PIU via inter-
plays between diverse social factors and types of
Problematic Internet Use: AGeneral Perspective

182
human interactions to which young people may
be particularly attracted, including socialization,
support, and entertainment [2, 4]. This is espe-
cially relevant for platforms that provide inter-
mittent positive reinforcement, to which repeated
exposure may result in increasingly compulsive
online use with negative consequences. Attention-
focused designs intended to generate, or possibly
exploit, potentially addictive features (e.g.,
“likes”) and conditioned responses (e.g., notica-
tions) alongside powerful algorithm-based tech-
nologies may lead youth to stay online longer
than either intended or recommended [2, 4].
These “tools” operationalized by digital platform
designers may pose risks to a youth’s self-
management of their online behaviors by inu-
encing/manipulating choices, opinions, or
behaviors, potentially exposing them to human
rights violations (e.g., risk of addictions, under-
mining autonomous free will, abuse of minors,
trafcking, and connected liberties) [1].
Investigating the interactions of these factors
over time should be prioritized to identify poten-
tially causal relationships and risk determinants
as a basis for preventative or therapeutic inter-
ventions and health and social policy changes [1,
2, 4].
Functional brain mechanisms at cognitive/
affective levels, and/or changes in brain structure,
may also contribute signicantly to the etiology
of PIU and to early identication and interven-
tion. A meta-analysis of case-controlled studies
of cognition demonstrated that PIU (broadly
dened) was associated with signicant reduc-
tions in inhibitory control, decision-making, and
working memory. Age, gender, geographical area
of reporting, or the type of predominant online
behavior did not signicantly moderate the
observed relationships [24]. Another meta-
analysis of changes in structural brain measures
in PIU detected signicantly reduced gray matter
in the anterior cingulate cortex (ACC), dorsolat-
eral prefrontal cortex (DLPFC), and supplemen-
tary motor area (SMA), regions linked to reward
processing, habit learning, and inhibitory control
[25]. Data suggests reduced functional connec-
tivity in brain networks involved in cognitive
control, executive function, motivation, and
reward [26]. Taken together, ndings further sug-
gest specic brain structures and functions
related to cortical inhibition of the generation and
execution of reward-based responses, both in
generalized PIU and specic forms like gaming
disorder [2].
Because existing studies are largely cross-
sectional, it remains uncertain whether these
neuro-cognitive features represent a cause or
consequence of PIU or both. Longitudinal studies
following the progression from vulnerability to
full PIU may help identify cognitive and affective
risk factors and clarify the extent to which these
changes can be used to discriminate against an
individual at high risk of PIU, for future screen-
ing aids. The scarcity of studies employing robust
controls for confounding variables such as psy-
chiatric comorbidities [24, 25] and the limita-
tions of standardization and validation of existing
assessment tools and PIU denitions highlight
the need for additional research to delineate the
contributions of specic variables to the under-
pinning mechanisms of PIU.
2.5 Eective andEmerging
Interventions forPIU
Interventional research is steadily developing but
remains at an early stage, with most studies con-
ducted in adults and few in youth. Most studies
have focused on problematic gambling and gam-
ing. Various forms of psychotherapy (mainly
cognitive behavior therapy [CBT]) and to a lesser
extent pharmacotherapy (mainly antidepressants
and stimulants) have been tested in acute-phase
trials, with some promising ndings, particularly
in relation to the short-term effects of
CBT. However, while a recent study demon-
strated that CBT may reduce PIU symptom
severity among “at-risk” youth, reductions in the
incidence of new cases have not been established
[27]. Non-invasive neurostimulation targeting
cortical brain regions involved in cognitive con-
trol and craving, using techniques such as tran-
scranial magnetic stimulation and transcranial
direct current stimulation, is also emerging as
another promising area of study [28]. Overall,
N. A. Fineberg etal.

183
there is a need for higher-quality research, includ-
ing large, preregistered, randomized clinical tri-
als, to determine efcacious and cost-effective
options in PIU treatment.
3 Future Research
Many important gaps in knowledge about PIU
remain outstanding, including a qualitative and
quantitative understanding of the scale and
impact of PIU on youth health and well-being.
Child and adolescent screen time is increasing
annually, but the long-term health consequences
of this increase remain poorly understood [1].
Several studies associate PIU with negative
biological, health, psychological, and sociolog-
ical outcomes across diverse groups [2].
Reduced general quality of life in adolescence
was also found to be “dose dependently” linked
to PIU severity [29]. However, an accurate esti-
mation of the global burden of PIU in general
or that related to specic internet-use disorders
is also sorely lacking. Few longitudinal studies
exist, and most identied associations are based
on cross- sectional data. As health and well-
being issues can be seen as risk factors as well
as outcomes of PIU, causal relationships are
likely complicated [30]. To bridge existing
knowledge gaps, future studies should include
improved interpretation of causal relationships
(with insight from longitudinal data and inves-
tigations of bi-directional relationships),
address methodological weaknesses with a
more unied approach to the conceptualization
and assessment of PIU, include qualitative data
and use of convenience sampling, and account
for the wide variety of behaviors performed on
the Internet.
Other key research goals include improved
insight into the dynamics of PIU with reliable
methods for early identication of individuals at
risk for PIU, a better understanding of the course
and evolution of PIU-related problems across dif-
ferent age groups, genders, and specic vulnera-
ble groups, and efcacious and cost-effective
preventative and therapeutic interventions that
can be successfully implemented at scale.
Considering that PIU occurs within the digital
environment and can be captured using digital
tools, the ubiquity of smart technology, and the
considerable amounts of “real-time” information
they may gather through behavioral tracking
techniques, which may potentially be used to
make Internet use more addictive [31], (and
which may also be used in online gambling and
gaming disorder research to improve prevention
efforts), future research harnessing smart devices
is anticipated to hold promise for addressing spe-
cic research questions. Given the amount of
time spent on smartphones and inaccuracies in
recalling personal digital media use, the use of
digital technologies to identify PIU may prove of
particular benet to adolescents. By enabling the
characterization of “digital phenotypes” underly-
ing one or more forms of PIU (and thereby those
individuals at elevated risk), digital technologies
may also offer new opportunities for remote
interventions at scale.
4 Recommendations
• Given the convergence of changing digital
industries, widespread use, and youth vulner-
ability, it is vital to support the impetus for
change to address and prevent online harms
through ethical health and social policy
changes.
• Developments in diagnostic criteria for PIU
should be grounded in reliable data [32].
• Children’s and adolescents’ well-being should
be central to such interventions and strategies,
including improved digital literacy programs.
• Dialogue among key players (including the
government and technology companies), new
policy standards involving increased corpo-
rate responsibility, re-evaluation of the busi-
ness models steering digital services provision,
and potential regulation, including that of
transnational technology companies, are also
needed to ensure a nurturing digital
environment.
• Globally, wide variations exist in the range
and scope of regulatory, public, and clinical
health policies and models. As observed with
Problematic Internet Use: AGeneral Perspective

184
other potentially health-harming industries
(e.g., gambling), increased regulation or per-
ceived market penetration in some jurisdic-
tions may result in greater commercial
exploitation of low- and middle-income coun-
tries. Therefore, pragmatic, equitable, and
inclusive global solutions are needed.
• Stakeholders have called for governmental
regulation underpinned by international law
vis-a-vis children’s rights in the digital envi-
ronment, requiring technology companies to
ensure age-appropriate design safeguards for
all services likely to be accessed by children
[33], and including clear criteria for enforce-
ment. While some regulatory initiatives are
underway (e.g., the European Commission
Digital Services Act), the extent to which
young people at risk of PIU can be safeguarded
will depend on international standards govern-
ing the day-to-day practices of digital service
providers, the transparency of corporate behav-
ior, and the effectiveness of available remedies,
including digital literacy programming.
Conict of Interest and Funding Disclosure ZD’s con-
tribution was supported by the Hungarian National
Research, Development, and Innovation Ofce
(KKP126835). ZD also acknowledges that the University
of Gibraltar receives funding from the Gibraltar Gambling
Care Foundation, an independent, not-for-prot charity,
and the ELTE Eötvös Loránd University receives funding
from Szerencsejáték Ltd. (the gambling operator of the
Hungarian government) to maintain a telephone helpline
service for problematic gambling.NF has held research
grants paid to her institution by UK Research
and Innovation, UK National Institute for Health
Research,COST Action, Orchard, received payment for
lecturing from the Global Mental Health Academy and
participated as an investigatorin a study supported by
Compass Pathways.
References
1. Fineberg NA, Menchón JM, Hall N, etal. Advances in
problematic usage of the internet research– A narra-
tive review by experts from the European network for
problematic usage of the internet. Compr Psychiatry.
2022;118:152346. https://doi.org/10.1016/j.
comppsych.2022.152346.
2. Brand M. Can internet use become addictive?
Science. 2022;376:798–9. https://doi.org/10.1126/
science.abn4189.
3. ICD-11. n.d. https://icd.who.int/en (accessed August
17, 2022).
4. Starcevic V, Aboujaoude E.Internet addiction: reap-
praisal of an increasingly inadequate concept. CNS
Spectr. 2017;22(1):7–13.
5. Flayelle M, Brevers D, King DL, Maurage P, Perales
JC, Billieux J.A taxonomy of technology design fea-
tures that promote potentially addictive online behav-
iours. Nat Rev Psychol. 2023:1–15.
6. Brand M, Rumpf H-J, Demetrovics Z, Müller A, Stark
R, King DL, etal. Which conditions should be consid-
ered as disorders in the international classication of
diseases (ICD-11) designation of “other specied dis-
orders due to addictive behaviors”? J Behav Addict.
2020; https://doi.org/10.1556/2006.2020.00035.
7. Young KS.Caught in the net: how to recognize the
signs of Internet addiction– and a winning strategy
for recovery. NewYork: J.Wiley; 1998.
8. Lopez-Fernandez O, Grifths MD, Kuss DJ, Dawes
C, Pontes HM, Justice L, et al. Cross-cultural vali-
dation of the compulsive internet use scale in four
forms and eight languages. Cyberpsychol Behav
Soc Netw. 2019;22:451–64. https://doi.org/10.1089/
cyber.2018.0731.
9. Carragher N, Billieux J, Bowden-Jones H, etal. Brief
overview of the who collaborative project on the
development of new international screening and diag-
nostic instruments for gaming disorder and gambling
disorder. Addiction. 2022;117(7):2119–21. https://
doi.org/10.1111/add.15780.
10. Pan Y-C, Chiu Y-C, Lin Y-H. Systematic review and
meta-analysis of epidemiology of internet addiction.
Neurosci Biobehav Rev. 2020;118:612–22. https://
doi.org/10.1016/j.neubiorev.2020.08.013.
11. Burkauskas J, Gecaite-Stonciene J, Demetrovics Z,
Grifths MD, Király O. Prevalence of problematic
Internet use during the coronavirus disease 2019 pan-
demic. Curr Opin Behav Sci. 2022;46:101179. https://
doi.org/10.1016/j.cobeha.2022.101179. Epub 2022
Jun 15. PMID: 35719702; PMCID: PMC9197820.
12. Gjoneska B, Potenza MN, Jones J, Sales CM, Hranov
G, Demetrovics Z. Problematic use of the Internet
in low- and middle-income countries before and
during the COVID-19 pandemic: a scoping review.
Curr Opin Behav Sci. 2022;48:101208. https://doi.
org/10.1016/j.cobeha.2022.101208. Epub 2022 Jul
29. PMID: 35919788; PMCID: PMC9334935.
13. Mohler-Kuo M, etal. Stress and mental health among
children/adolescents, their parents, and young adults
during the rst COVID-19 lockdown in Switzerland.
J Environ Res Public Health. 2021;18:4668.
14. Baloğlu M, Sahin R, Arpaci I. A review of recent
research in problematic internet use: gender and cul-
tural differences. Curr Opin Psychol. 2020;36:124–9.
https://doi.org/10.1016/j.copsyc.2020.05.008.
15. Jeong H, Yim HW, Lee S-Y, Lee HK, Potenza MN,
Park M. Joint effects of children’s emotional prob-
lems and parental depressive symptoms on the
occurrence of internet gaming disorder among
children and adolescents: a longitudinal study.
J Behav Addict. 2021;10:244–52. https://doi.
org/10.1556/2006.2021.00030.
N. A. Fineberg etal.

185
16. Murray A, Koronczai B, Király O, Grifths MD,
Mannion A, Leader G, et al. Autism, problem-
atic internet use and gaming disorder: a systematic
review. Rev J Autism Dev Disord. 2021; https://doi.
org/10.1007/s40489- 021- 00243- 0.
17. Marchant A, Hawton K, Stewart A, Montgomery P,
Singaravelu V, Lloyd K, etal. A systematic review of
the relationship between internet use, self-harm and
suicidal behaviour in young people: the good, the
bad and the unknown. PLoS One. 2017;12:e0181722.
https://doi.org/10.1371/journal.pone.0181722.
18. Greenberg NR, Zhai ZW, Hoff RA, Krishnan-Sarin
S, Potenza MN. Difculties in impulse control
in adolescents with problematic use of the inter-
net and self-injurious behaviors. Psychiatry Res.
2022;317:114919.
19. Alimoradi Z, Lin CY, Broström A, Bülow PH, Bajalan
Z, Grifths MD, Ohayon MM, Pakpour AH.Internet
addiction and sleep problems: a systematic review
and meta-analysis. Sleep Med Rev. 2019;47:51–61.
https://doi.org/10.1016/j.smrv.2019.06.004. Epub
2019 Jul 4. PMID: 31336284.
20. Wacks Y, Weinstein AM.Excessive smartphone use
is associated with health problems in adolescents and
young adults. Front Psychol. 2021;12:669042. https://
doi.org/10.3389/fpsyt.2021.669042.
21. Weinstein A. Problematic social networking
site use- effects on mental health and the brain.
Front Psychiatry. 2023;13:1106004. https://doi.
org/10.3389/fpsyt.2022.1106004.
22. Cataldo I, Billieux J, Esposito G, Corazza
O.Assessing problematic use of social media: where
do we stand and what can be improved? Curr Opin
Behav Sci. 2022;45:101145.
23. Cataldo I, Burkauskas J, Dores AR, Carvalho IP,
Simonato P, De Luca I, et al. An international cross-
sectional investigation on social media, tspira-
tion content exposure, and related risks during the
COVID-19 self-isolation period. J Psychiatr Res.
2022;148:34–44.
24. Ioannidis K, Hook R, Goudriaan AE, Vlies S,
Fineberg NA, Grant JE, etal. Cognitive decits in
problematic internet use: meta-analysis of 40 stud-
ies. Br J Psychiatry. 2019;215:639–46. https://doi.
org/10.1192/bjp.2019.3.
25. Solly JE, Hook RW, Grant JE, et al. Structural gray
matter differences in Problematic Usage of the
Internet: a systematic review and meta-analysis. Mol
Psychiatry. 2022;27:1000–9. https://doi.org/10.1038/
s41380- 021- 01315- 7.
26. Weinstein A, Lejoyeux M. Neurobiological mecha-
nisms underlying Internet and Gaming Disorder
(IGD). Dialogues Clin Neurosci. 2020;22(2):113–26.
27. Lindenberg K, Kindt S, Szász-Janocha
C. Effectiveness of cognitive behavioral therapy-
based intervention in preventing gaming disorder
and unspecied internet use disorder in adolescents:
a cluster randomized clinical trial. JAMA Netw
Open. 2022;5(2):e2148995. https://doi.org/10.1001/
jamanetworkopen.2021.48995. PMID: 35179587;
PMCID: PMC8857686.
28. Xu LX, Geng XM, Zhang JL, Guo XY, Potenza MN,
Zhang JT. Neuromodulation treatments of prob-
lematic use of the internet. Curr Opin Behav Sci.
2022;48:101215.
29. Machimbarrena JM, González-Cabrera J, Ortega-
Barón J, Beranuy-Fargues M, Álvarez-Bardón A,
Tejero B.Proles of problematic internet use and its
impact on adolescents’ health-related quality of life.
Int J Environ Res Public Health. 2019;16(20):3877.
https://doi.org/10.3390/ijerph16203877. PMID:
31614899; PMCID: PMC6843246
30. Rumpf HJ, Brandt D, Demetrovics Z, Billieux J,
Carragher N, Brand M, etal. Epidemiological chal-
lenges in the study of behavioral addictions: a
call for high standard methodologies. Curr Addict
Rep. 2019;6:331–7. https://doi.org/10.1007/
s40429- 019- 00262- 2.
31. King DL, Delfabbro PH, Gainsbury SM, Dreier M,
Greer N, Billieux J. Unfair play? Video games as
exploitative monetized services: an examination of
game patents from a consumer protection perspective.
Comput Hum Behav. 2019;101:131–43.
32. Billieux J, Flayelle M, King DL. Addiction:
expand diagnostic borders with care. Nature.
2022;611(7937):665.
33. Hainsworth J.Baroness Beeban Kidron Chair 5Rights
Foundations n.d.:2. https://5rightsfoundation.com/
uploads/joint- ngo- letter- to- council- on- childrens-
rights- in- dsa.pdf.
Open Access This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License
(http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in
any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license and indicate if changes were made.
The images or other third party material in this chapter are included in the chapter's Creative Commons license,
unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons
license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to
obtain permission directly from the copyright holder.
Problematic Internet Use: AGeneral Perspective