The eShrink: treating internet addiction

Dr Elias Aboujaoude deals with patients suffering a particularly modern condition. Louise Ridley speaks to the psychiatrist who treats pathological internet use
6th June 2011

Are disorders caused by the internet recognised by the medical world?

They haven’t been verified through studies yet. Until these are conducted, we can’t credibly call something a disorder or pathology. But what my colleagues and I see is that people are transformed into a different version of themselves online. Narcissism, impulsivity, regression and grandiosity are personality traits that come out in many people and have real consequences in terms of their lives offline.

Why did you start treating disorders caused by the net?

I live in Silicon Valley: the birthplace of the net. People started coming to our clinic saying things like “My wife wants to leave me because I wait for her to go to sleep so I can check my email one more time.” Or “My boss threatened to fire me because of inappropriate internet use.” We conducted the largest study to date on internet addiction, which showed us it’s a widespread phenomenon. And that was in 2006, before Facebook and smartphones really took off.

Who is your typical patient?

We expected the typical profile to be that of a twenty-something male geek, but it turned out the average age was in the early forties and there was no significant male-to-female ratio. I have patients who are 17-year-old high-school students who are ‘addicted’ to videogames and retirees who have became completely enamoured with the net. Enamoured to the point where they spend their savings on purchases they don’t need or gamble their savings away.

What other problems do you see?

One problem that I see repeatedly is people that construct highly exaggerated, embellished profiles of themselves for online dating. One was in her late twenties and was very anxious. She liked the liberated, uninhibited version of herself that she’d concocted online, which made it even harder for her to meet people in the real world. She wanted to keep her relationships virtual because she didn’t have to deal with any of the anxieties that plagued her dating life offline.

Another patient started struggling with depression when he lost his mother and job, and as a result of his poor self-esteem he suspected his wife was having an affair. He installed software that records keystrokes on her computer and tracked her online behaviour for months. He didn’t find anything suspicious, but ended up feeling guilty to the point of being suicidal. Something that seemed like a quick fix actually intensified his depression and nearly ruined his marriage.

How do you treat patients?

We always consider whether there were psychiatric disorders that led them to online life in the first place. So in the case of the patient whose anxiety led her to virtual dating, we have to treat the primary problem, which is social anxiety. We then gradually try to wean them off their online life, by finding alternative activities that give some of the same stimulation, but will hopefully bring them away from the website. But this isn’t like treating alcohol addiction, where the goal is often to stop completely. You can’t be a fully functioning member of society today without having an online connection.

Do you use a computer during treatment?

If you look up ‘internet addiction’ online, the first things that pop up are websites designed to wean you off the net, and I find this ironic. Most of my patients are adults and I’m in no position to restrict their use against their will. If my patient spends a lot of time on a particular website that I’m not familiar with, I visit that website with them so they can explain to me what it is that appeals so much. But I don’t do it on a routine basis and I certainly don’t use any computerised treatment programmes in my work.

What are your personal online vices?

I’m certainly more impulsive and buy things online that I wouldn’t even consider in real life. I spend more time on eBay than I should because I have some collecting tendencies and that site’s a godsend for anyone with those. I’ve stayed away from Facebook. I’m afraid I might get hooked.

How can people avoid the negative effects of net use?

I’d love people to start asking themselves “Do I behave differently online to offline and, if so, how differently?” We don’t pause to ask ourselves these questions and we should, otherwise we’re involved in a huge psychological experiment with unknown consequences.