BY SUE MacDONALD
The Cincinnati Enquirer
A University of Cincinnati psychiatrist has coined a new term for uncontrollable use of the Internet: "Internetomania."
WHAT IS EXCESSIVE?
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In Dr. Nathan Andrew Shapira's "Internetomania" study at the University of Cincinnati, 14 subjects were chosen because their Internet use was:
 Uncontrollable and distressing.
Negatively affecting their work, social lives or financial situations.
Present at times unrelated to heightened emotional excitement.
A story in the March/April Psychology Today also identifies signs of excessive Internet use as:
Spending 38 hours or more a week online.
Staying online longer than you intended.
Admitting you can't stop from signing on.
Neglecting loves ones, chores, sleep, friends, exercise, hobbies, sex or social events because of Internet use.
Feeling anxious, bored, sad, lonely, angry or stressed before going online, but feeling happy, excited, loved, calmed or confident while on the Internet.
Favoring chat rooms or interactive multi-user domains over other Internet activities.
-- Sue MacDonald
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Dr. Nathan Andrew Shapira's in-depth interviews with 14 "Internetomaniacs" found that most of them have underlying mental problems -- depression, mood disorders, compulsions or impulse-control disorders.
On average, the people in his admittedly small study had at least five diagnosable mental illnesses. When they received medical treatment for their moods and compulsions, Internet use became more manageable.
"We certainly did not expect to see these kinds of numbers," says Dr. Shapira, a third-year resident whose findings will be presented today at a media briefing at the American Psychiatric Association's annual convention in Toronto.
"If it's true that these people have psychiatric illnesses," he says, "we need to be treating them."
His research coincides with previous psychological and addiction studies that have described pathologic Internet use, or "Internet addiction," as a symptom of other underlying mental or emotional problems.
He hopes his findings will give therapists guidance in treating people whose Internet use, either by their own admission or because of complaints from spouses or family members, is interfering with and possibly ruining their lives.
"I've seen people have their whole lives destroyed over the Internet, and it's sad," says Dr. Kimberly Young, psychologist at University of Pittsburgh - Bradford and founder of the Center for On-Line Addiction in Bradford, Pa. She agrees that many chronic Internet users have other problems -- addictive personalities, depression, anxiety disorders and the like.
Dr. Shapira, however, prefers "Internetomania" to "addiction" because it more closely links uncontrolled Internet use with impulsiveness and the mood swings reported by people with other compulsive behaviors such as out-of-control shopping, gambling or fire-starting. "For most, it was like instant gratification as soon as they got online," he says. "They get a real burst of energy, their mood perks up; it's quite a thrill."
Many Internetomaniacs said the "rush" they felt as soon as they logged online lasted four to five hours, and only a few felt troubled by the time they spent online.
Eleven of the 14 study subjects had previously been treated for mental health problems; their current Internet use became more manageable during this study after treatment with antidepressants, lithium and - or mood-stabilizing drugs.
Dr. Shapira and his UC colleagues launched the study to look at underlying psychiatric problems rather than try to explain certain behaviors associated with chronic Internet use. He is among the first researchers to insist on face-to-face interviews with his subjects rather than online or telephone interviews. Among the stories told by the 14 subjects who volunteered for and followed through on three- to five-hour interviews:
A 19-year-old college freshman said he got so hooked on the Internet that he quit going to classes and couldn't be reached by his family. When campus police finally located him, he had spent seven straight days in the university computer lab and had run up $400 of log-on time.
A woman said she had an affair with someone she met on the Internet and ended up marrying him -- a relationship that fizzled after a few months.
A laid-off man said he spent, on average, 100 hours a week cruising the Internet.
"I'm not so sure this is a separate disorder," Dr. Shapira says. "It could be a symptom of an already well-known, characteristic and treatable illness. And I have a feeling we are just touching the tip of an iceberg.
"The way I look at it is that somebody with a propensity to have mood and anxiety swings gets on the Internet, and they're fascinated, excited and interested," he says. "It's a huge world, and they're connected to it. The Internet interacts with them in a way that accentuates the mood swings or anxiety problems that they already have."
Often, uncontrolled Internet behavior sets up a cycle of mood swings, lack of sleep, fatigue, poor eating habits and personal isolation -- factors which can worsen existing mental illnesses, he says.
Dr. Shapira's subjects spent an average of 31 hours a week online, although use ranged from a few hours to 100 hours a week. These hours were in addition to time they spent on computers at work.
Half were men; half were women. The average age was 35 and most had a college education or more.
Favorite online activities were chat rooms (20 percent), multi-user domains such as interactive fantasy games (16 percent), World Wide Web surfing (14 percent), e-mail (12 percent) and news - current events and news groups (8 percent each). Pornography accounted for about 7 percent of online time.
All of the subjects' Internet use would meet psychiatric definitions for impulse control disorders, Dr. Shapira says. Moreover, among the 14 people studied:
79 percent had been diagnosed at some time in life with bipolar disorder (formerly called manic-depression, marked by extreme emotional highs and lows).
Slightly more than half (57 percent) had alcohol or drug abuse problems, and the same percentage had anxiety disorders (especially fear of social situations).
29 percent had impulse control disorders.
Half had family histories of mental illness.
Dr. Shapira began studying "problematic" Internet use after the 1997 arrest of a Lower Price Hill woman whose three children were left dirty, alone and neglected while she spent up to 12 hours a day on the Internet. Sandra Hacker eventually was fined $100 for child endangering, placed on probation and ordered to take parenting classes.
Most treatment programs for online addiction, he notes, involve time management and support groups -- even support groups that are held online (an approach described by a June 1996 Canadian Medical Association Journal as "analogous to holding an AA meeting in a tavern").
Mental health professionals can begin to ask questions about a person's moods, feelings and family histories; and can assess how Internet use affects jobs, family life, finances, social skills and legal problems.
Other compulsive behaviors usually have noticeable consequences, he says. Compulsive gamblers run up huge debts or go broke. Pyromaniacs start fires that can damage property and kill others.
But compulsive Internet use, he says, often affects only the individual or the individual's family, so problems may not be readily noticeable.
"It's like any behavior -- dieting, gambling, overeating, shopping," he says. "If enough people are exposed to it, you'll find that some people can't work out a tolerability level to get along with it.
"We're finding that if you treat the underlying mood symptoms, their Internet behavior is more controllable."
