Criteria For Identification of Smartphone Addiction

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Smartphone abusers tend to be young and female and seeking social gratification, while internet-addicted individuals are more likely to be male and socially introverted.
Smartphone abusers tend to be young and female and seeking social gratification, while internet-addicted individuals are more likely to be male and socially introverted.

The nearly universal availability of smartphones in Western cultures has created a new potential for widespread abuse of the technology in ways that suggest addiction. Due to the many applications available for smartphones, vulnerable personalities are often likely to develop attachments that interfere with daily activities and promote distress and anxiety upon withdrawal.1-4 Physical symptoms can include muscle pain and eye problems,5,6 and more extreme psychological disturbances such as auditory and tactile delusions can also emerge.7,8

Smartphone addiction also appears to be linked to comorbid conditions associated with poor mental health, such as sleep disorders, anxiety and stress disorders, and greater consumption of alcohol and tobacco.9

The range of smartphone functions — including Internet use, online gaming, digital cameras, Global Positioning System (GPS) navigation, and interactive applications such as Pokémon GO and Fitbit® — present an immediate distraction that can take the user's attention away from real-time events, including school and work, social activities, and driving.

Although the concept of smartphone addiction is increasingly becoming accepted, the definitions vary. De-Sola and colleagues10 described features of craving, “an unstoppable and uncontrollable desire that can lead to use (a drug, a technology), despite its negative and detrimental effects.” They cited the positive signs of smartphone addiction as urgency, abstinence, dependency, difficulty of control, increased use and the need to stay connected,11-13 with prominent negative signs of irritability, restlessness, stress, and mood changes associated with inaccessibility to the smartphone.3,14-19

The problematic behaviors associated with smartphone use that are most suggestive of addiction include9:

  • Use in dangerous situations
  • Harm or repeated interruptions to work, social life, family life, and/or physical and mental well-being
  • Urges and drives to repeat behavior
  • Dependence, tolerance, and increasing need for stimulation to achieve satisfaction
  • Anxiety or negative feelings associated with inability to send or receive immediate responses

The extent to which smartphone dependence crosses into addiction is an area of current debate, as clear delineations between normal use, abuse, misuse, dependence and addiction have not yet been made.20   

Defining Cell Phone Addiction

As a relatively new target of addiction, smartphone use does not easily fit into the standard classifications of impulse disorders provided by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which does separate behavioral addictions from substance addictions. Behavioral excesses related to video games, exercise, food, shopping, work, and the Internet in general (and online sex and gambling in particular) have all shown indications of addictive behavior, but only online gambling has been classified as such by the DSM-5.

Smartphone Addiction Profile

Overlaps between smartphone overuse and internet addiction (a well-studied phenomenon) are commonly observed, although a recent review by De-Sola Gutierrez, et al 9 suggested prominent features that clearly distinguish the two. The investigators determined that smartphone addiction and internet addictions had different user profiles and motives; smartphone abusers tend to be young and female and seeking social gratification, while internet-addicted individuals are more likely to be male and socially introverted. The review suggested that young women are neurotically drawn to messaging and social networks available on smartphones.

The Gutierrez evaluation pointed to a known vulnerability to many forms of addiction, and most prominently to behavioral addictions, in people with low self-esteem who demonstrate conflict-avoidance tendencies, impulsivity, sensation seeking, low tolerance to physical or psychological pain, and a greater tendency toward depression or dysphoria.21

Diagnostic Criteria for Smartphone Addiction

Recent work by Lin, et al 22 identified 6 behavioral criteria that had the highest diagnostic accuracy for the diagnosis of smartphone addiction:

  1. Continued inability to resist the impulse to use the smartphone
  2. Symptoms of dysphoria, anxiety, or irritability after a period of withdrawal from use
  3. Using the smartphone for a period longer than intended
  4. Persistent desire and/or unsuccessful attempts to quit or reduce smartphone use
  5. Heightened attention to using or quitting smartphone use
  6. Persistent smartphone use despite recurrent physical or psychological consequences

In addition, they identified 4 functional criteria:

  1. Excessive use resulting in persistent or recurrent physical or psychological problems
  2. Use in a physically hazardous situations (such as while driving or crossing the street) or situations that have other negative impacts on daily life
  3. Use that impairs social relationships or performance at school or work
  4. Use that is very time-consuming or causes significant distress

Diagnosis rests upon the presence of 3 or more main criteria plus 2 or more functional criteria, and in which addictive behavior is not associated with obsessive-compulsive disorder or bipolar disorder.

An alternative or adjunctive tool, the Mobile Phone Addiction Craving Scale (MPACS) was developed by De Sola, et al10 in 2017 consisting of 8 Likert-style questions and designed to help a smartphone user self-evaluate the degree of anxiety or restlessness felt by the lack of availability of their smartphone.

Summary

Smartphone addiction is increasingly recognized as a type of behavioral addiction, although it is not yet recognized as such by the DSM-5.The profile of smartphone abuse indicates a pattern that is most prevalent in young females who may have low self-esteem and demonstrate an excessive need for social networking.

Recent research has identified criteria that help establish a diagnosis of smartphone addiction. It is also recommended that clinicians screen for smartphone addiction using the same criteria to identify adolescent patients at risk.

References

  1. Chesley N. Blurring boundaries? Linking technology use, spillover, individual distress, and family satisfaction. J Marriage Fam 2005;67:1237-1248.
  2. Rosell MC, Sánchez-Carbonell X, Jordana CG, Fargues MB. El adolescente ante las tecnologías de la información y la comunicación: internet, móvil y videojuegos. Papeles del Psicólogo. 2007;28:196-204.
  3. Chóliz M, Pinto L, Phansalkar SS, et al. Mobile-phone addiction in adolescence: the test of mobile phone dependence (TMD). Prog Health Sci. 2012;7:650.  doi:10.3389/fpsyg.2016.00650
  4. Sahin S, Ozdemir K, Unsal A, Temiz N. Evaluation of mobile phone addiction level and sleep quality in university students. Pak J Med Sci 2013;29:913-918.
  5. Aggarwal KK. Twenty-six percent doctors suffer from severe mobile phone-induced anxiety: excessive use of mobile phone can be injurious to your health. Indian J Clin Pract 2013;24:7-9.
  6. Ali M, Asim M, Danish SH, Ahmad F, Iqbal A, Hasan SD. Frequency of De Quervain's tenosynovitis and its association with SMS texting. Muscles Ligaments Tendons J 2014;4:74-78.
  7. Lin YH, Lin SH, Li P, Huang WL, Chen CY. Prevalent hallucinations during medical internships: phantom vibration and ringing syndromes. PLoS One. 2013;8(5):e65152.  doi:10.1371/journal.pone.0065152.  
  8. Verma RK, Rajiah K, Cheang A, Barua A. Textaphrenia: an emerging silent pandemic. Afr J Psychiatry 2014;17:510–511. doi:10.4172/1994-8220.1000e103
  9. De-Sola Gutiérrez J, Rodríguez de Fonseca F, Rubio G. Cell-phone addiction: a review. Front Psychiatry 2016;24;7:175.
  10. 1De-Sola J, Telledo H, Rubio G, de Fonseca FR. Development of a mobile phone addiction craving scale and its validation in a Spanish adult population. Front Psychiatry 2017;8:90.
  11. Hooper V, Zhou Y. Addictive, dependent, compulsive? A study of mobile phone usage. 20th Bled eConference eMergence: Merging and Emerging Technologies, Processes and Institutions; June 3-6, 2007, Bled, Slovenia.
  12. Leung L. Leisure, boredom, sensation seeking, self-esteem, addiction symptoms and patterns of cell phone use. In: Konijn EA, Tanis MA, Utzy S, Linden A, editors. , editors. Mediated Interpersonal Communication. Mahwah, NJ: Lawrence Erlbaum Associates; 2007: pp 359-381.
  13. Jonnes T. Students' cell phone addiction and their opinions. Elon J Undergrad Res Commun 2014;5:74-80.
  14. Ha JH, Chin B, Park DH, Ryu SH, Yu J. Characteristics of excessive cellular phone use in Korean adolescents. Cyberpsychol Behav. 2008;11:783784. doi:10.1089/cpb.2008.0096
  15. Chóliz M, Villanueva V, Chóliz MC. Ellas, ellos y su móvil: uso, abuso (¿ y dependencia?) del teléfono móvil en la adolescencia. Revista Española de Drogodependencias. 2009;34:74-88.
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