Nomophobia: The Modern-Day Pathology

Claustrophobia, arachnophobia, acrophobia . . . there are phobias of all kinds, but perhaps the most modern-day phobia is nomophobia, or “no–mobile-phone phobia.” While the irrational fear of losing or not having access to one’s mobile phone has not been officially recognized as a psychiatric condition, there have been calls to include it in the Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition (DSM-V).¹ So, what exactly underlies mobile phone dependency and is it something we need to be concerned about?

What is Nomophobia?

Do your patients experience anxiety, panic, or stress when the battery on their phone becomes dangerously low, or if their phone isn’t close by? Often associated with separation anxiety, nomophobia comes with a set of identifiable symptoms: increased heart rate and blood pressure, shortness of breath, anxiety, nausea, trembling, dizziness, depression, discomfort, fear, and panic. However, there is debate among the medical community on its classification; is it a phobia, anxiety disorder, lifestyle disorder, or addiction?

Although nomophobia has yet to find a formal place within the DSM-V, it is commonly perceived as a phobia based on DSM-V diagnostic criteria²:

• An excessive and unreasonable fear or anxiety associated with an object or anticipated situation
• Exposure to the feared object or situation causes immediate anxiety
• The person recognizes that their fear is out of proportion
• Avoidance of the feared situation
• Routines and relationships are disrupted due to the phobia

These criteria certainly fit the profile of someone who is anxious when they do not have their mobile device and who go to great lengths to ensure they always have their phone with them. However, to be diagnosed with a phobia, the DSM-V also states that the anxiety or panic cannot be better explained by another condition such as separation anxiety disorder. This is where our understanding of what underlies nomophobia becomes blurry, as could it simply be the outcome of living in a digital world where we connect with people through our phones? Other theories include that nomophobia is an anxiety disorder, techno-phobia, or addiction. Indeed, there is the perception by some that smartphone addiction and nomophobia are synonymous.³

Whether it is addiction, anxiety driven, or a phobia, the impact of being chained to your phone — and the distress experienced when not — is far-reaching.

According to Professor Gail Kinman of the University of Bedfordshire, in the United Kingdom, the consequences of nomophobia are akin to any other addiction: “Nomophobia can drive individuals to become preoccupied with their phone and turn to it if they are depressed, anxious, and lonely. This is especially true for individuals with pre-existing anxiety, who may equate their phones with a comfort blanket.”

Nomophobia not only affects the mind, but also relationships, where a person is physically present but psychologically absent. “Phone dependency may also put jobs at risk if people are unable to resist checking online or answering calls or texts when in meetings or with customers,” Dr Kinman adds. “This will impact their job performance by reducing attention span and focus. Multitasking is also a big problem as moving between tasks (work and phone) impairs concentration and can add about 2 hours onto the working day. In turn, this can reduce opportunities to recover from work, leading to stress that can impair mental health over time.”

The detrimental effect of nomophobia on cognitive ability is further evidenced in academics. A study of more than 500 dental students highlighted the adverse influence smartphone addiction can have on academic performance. Nearly 40% of the participants agreed that their low grades could be attributed to the time they spent on their phones.⁴ While hands-on proximity to smartphones may drive nomophobia, others hypothesize that even the presence of such devices affects cognitive abilities.⁵

Assessing and Treating Nomophobia

According to Dr Mark Griffiths, Distinguished Professor of Behavioral Addiction at Nottingham Trent University, in the United Kingdom, “At present, those researching this area assess nomophobia using a 20-question scale [Nomophobia Questionnaire (NMP-Q)], which comprises four categories: not being able to communicate; losing connectedness; not being able to access information; and, giving up convenience.⁶ Dr Griffiths explains that this questionnaire can only evaluate those at risk of developing nomophobia, not diagnose them.

Therapies for nomophobia range from interpersonal counseling, cognitive behavioral therapy, and addiction therapy. Exposure therapy can also be used, first exposing the individual to their phobia in therapy (ie, not taking the phone in the room with them) and gradually moving to real-life scenarios (ie, moving the phone to another room for gradually increasing amounts of time). Mindfulness has been found to reduce nomophobia tendencies, particularly among women.⁷

Another intrinsic aspect of treating nomophobia is self-help, and clinicians can educate patients on how to take control of their phone rather than their phone having control over them.

• Timing: Patients can be helped to refrain from checking their phone for a few hours daily, especially at night.
• Social Media: Social media browsing can be limited to help individuals learn to connect in other ways.
• Notifications: Individuals who keep glancing at app notifications can be encouraged to turn them off. The more notifications, the more drawn they will be to their device and the more stress they are likely to experience.
• Declutter: If a device is packed with photos, apps, and games, it can be useful to explore the feelings associated with deleting some of these. This can facilitate a gradual decluttering process of both their phone and their mind.

Of course, in a state of addiction, these seemingly simple steps may not be easy to implement. According to one study, approximately 47% of smartphone users in the United States attempted to limit usage, but only 30% succeeded.⁸ With increasing research in the area, public awareness is on the rise regarding the conscious need for self-regulating smartphone use. In China, for example, digital detox camps are common. There are also apps, such as Hold, that provide incentives for lowering phone usage.

An Epidemic?

With technology continuing to govern most aspects of human life, is nomophobia the next epidemic waiting in the wings? Dr Kinman says, “There is evidence that people are increasingly finding it difficult to separate themselves from their mobile devices – they may feel high levels of separation anxiety and experience feelings of panic and stress if they are unable to access their phone. It is a particular problem for people who are high users.”

Dr Kinman also shares that, “There is evidence that older people are becoming more dependent on their mobile phones and younger people may be setting ‘rules of engagement’ whereby they have some time phone free.” However, she says, “Like any major change in history, there is a moral panic about this issue and, in reality, most people manage their phone use well.” Dr Griffiths concurs, stating, “Very few people are genuinely dependent on their smartphone, and the number of individuals who would likely be debilitated about a fear of not having their smartphone is probably few and far between.”

References

1. Bragazzi NL, Giovanni DP. A proposal for including nomophobia in the new DSM-V. Psychol Res Behav Manage.  2014;7:155-160.
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5^th edition. Washington, DC; 2013.
3. Davie N, Hilber T. Nomophobia: is smartphone addiction a genuine risk for mobile learning?  Presentation at: 13^th International Conference Mobile Learning. South Westphalia University of Applied Sciences. 2017. Available at: https://files.eric.ed.gov/fulltext/ED579211.pdf. Accessed July 29, 2018.
4. Prasad M, Patthi B, Singla A, et al. Nomophobia: a cross-sectional study to assess mobile phone usage among dental students. J Clin Diagn Res. 2017;11(2):34-39.
5. Ward A, Duke K, Gneezy A, Bos M. Brain drain: the mere presence of one’s own smartphone reduces available cognitive capacity. J Assoc Consumer Res. 2017;2(1).
6. Yildirim C, Correia A. Exploring the dimensions of nomophobia: Development and validation of a self-reported questionnaire. Computers Hum Behav. 2015;49(C):130-137.
7. Arpaci I, Baloğlu M, Kozan HIO, Kesici S. Individual differences in the relationship between attachment and nomophobia among college students: the mediating role of mindfulness.J Med Internet Res. 2017;19(2):e404. 
8. Godschalk B. In China, there are military-style boot camps for internet addiction rehabilitation, Techly. October 29, 2017. Available at: www.techly.com.au/2017/10/30/china-military-style-boot-camps-internet-addiction-rehabilitation/. Accessed July 30, 2018.