Internet addiction disorder

Mental health consequences A longitudinal study of Chinese high school students (2009) suggests that individuals with moderate to severe risk of Internet addiction are 2.5 times more likely to develop depressive symptoms than their IAD-free counterparts. Researchers studied pathological or uncontrolled Internet use, and later mental health problems in 1,041 teenage students in China. The students were free of depression and anxiety at the start of the study. Nine months later, the students were evaluated again for anxiety and depression, and 87 were judged as having developed depression, while 8 reported significant anxiety symptoms. Internet Addiction Disorder (IAD) is linked to a wide range of negative psychological outcomes. Excessive or uncontrolled internet use can interfere with emotional regulation, social relationships, and cognitive functioning. The major mental health consequences include: • Depression and Anxiety • IAD is strongly associated with increased risk of depressive symptoms, social anxiety, and generalized anxiety disorder. • Sleep Disturbances & Fatigue • Excessive internet use, especially late at night, contributes to insomnia, poor sleep quality, and daytime dysfunction. • Stress and Emotional Dysregulation • Individuals with IAD often experience higher levels of perceived stress and difficulty regulating emotions, leading to irritability and mood swings. • Social Isolation and Loneliness • Despite increased online interactions, IAD is linked to decreased face-to-face communication, loneliness, and impaired social functioning. • Comorbid Disorders (ADHD, Substance Use, Impulse Control Problems) • Research shows strong associations between IAD and attention-deficit/hyperactivity disorder (ADHD), substance abuse, and other impulse-control disorders. Social consequences Internet addiction increases the risk of many negative social and health outcomes, including poor academic performance, harmful personality effects, anxiety and depression. The best-documented evidence of Internet addiction so far is time-disruption, which subsequently results in interference with regular social life, including academic, professional performance and daily routines. Keith W. Beard (2005) states that "an individual is addicted when an individual's psychological state, which includes both mental and emotional states, as well as their scholastic, occupational and social interactions, is impaired by the overuse of [Internet]". As a result of its complex nature, some scholars do not provide a definition of Internet addiction disorder and throughout time, different terms are used to describe the same phenomenon of excessive Internet use. Internet addiction disorder is used interchangeably with problematic Internet use, pathological Internet use, and Internet addictive disorder. In some cases, this behavior is also referred to as Internet overuse, problematic computer use, compulsive Internet use, Internet abuse, harmful use of the Internet, and Internet dependency. Mustafa Savci and Ferda Aysan, reviewed existing research on internet addiction and identified a number of social and emotional factors that have been linked to this phenomenon. These include loneliness, social anxiety, depression, and low self-esteem. They argued that these factors can lead individuals to use the internet as a way of coping with negative emotions or social isolation, which can in turn lead to addictive behavior. == Signs and symptoms ==

Physical symptoms Physical symptoms include a weakened immune system due to lack of sleep, loss of exercise, and increased risk for carpal tunnel syndrome. Additionally, headaches, eye and back strain are common for those struggling with excessive internet use. Psychological and social symptoms The type of IAD (e.g. overuse of social media, gaming, gambling, etc.) will affect the types of symptoms experienced. For example, overuse of social media can lead to disruption in real-world relationships. The overuse of video games can lead to neglecting family, home, and work-related responsibilities. Additionally, the overconsumption of pornographic content can create interpersonal and relational problems and can negatively affect mental health. Symptoms of withdrawal might include agitation, depression, anger and anxiety when the person is away from technology. These psychological symptoms might even turn into physical symptoms such as rapid heartbeat, tense shoulders and shortness of breath. == Theoretical model ==

Current researchers have proposed different theoretical models of IAD from different perspectives. Theories based on the characteristics of the Internet ACE model This theory suggests that addiction is caused by the characteristics of the Internet itself, including anonymity, convenience and escape, referred to as the ACE model. Anonymity means that individuals are able to hide their true identity and personal information on the Internet and are thus freer to do what they want. Because of this anonymity, it is difficult to regulate what individuals do on the Internet, thus creating an Internet addiction. Convenience may be a benefit of the development of the Internet, as people can do certain things such as shopping online and watching movies without leaving their homes. However, this convenience can also lead to addiction and dependence on the Internet. Escape refers to the ability of users to find solace online when faced with difficulty or irritation, because the Internet offers a free virtual environment that entices people away from the actual world. Originally the ACE Model was used to describe Internet pornography addiction, but now it is applied to the whole field of IAD. Reduced social cues The invention of email and SMS made online chatting a reality. However, in online communication, the individual's ability to judge the mood, tone and content of the other person is reduced because the necessary social cues, such as situational and personal cues, are missing. As online norms are currently imperfect, it is difficult to regulate individuals' behaviors on the Internet, and the anonymity of the Internet can make individuals' perceptions of themselves and others diminish, resulting in some anti-social behavior. Consequently, this can lead to inappropriate Internet use and addiction without proper restraints. Theories based on interaction orientation Cognitive-behavioral model of pathological Internet use This model defines IAD as pathological Internet use (PIU). In 2001, the cognitive-behavioral model for excessive use of the Internet was created. This model proposed that already existing psychosocial problems (e.g., depression, anxiety, substance abuse) were more likely to lead to the development of excessive and maladaptive behaviors related to the Internet. Importantly, Davis categorized problematic behaviors on the Internet into two categories: specific pathological Internet use (SPIU) and generalized pathological Internet use (GPIU). SPIU behaviors include frequently accessing things such as pornography or other sexually explicit material, stock trading, and online gambling. GPIU behaviors simply include fixating on the Internet itself, rather than particular materials that are accessed through the Internet. Additionally, people engaged in GPIU behaviors are drawn by the different forms of communication that the Internet allows them to engage in. It was first introduced by Csikszentmihalyi in the 1960s, and he also proposed a systematic model of the flow experience. According to his theory, the flow experience comes from performing challenges at a level similar to the individual's own, which means that people could fully commit to the challenge and do their best to complete it. When individuals are faced with a challenge that is too different from their own level, they may lose interest because it is too easy or too difficult. Online games are a real-life application of this model. Based on Csikszentmihalyi's theory, the theory called GameFlow suggests 8 characteristics that can create a sense of immersion in players: concentration, challenge, skills, control, clear goals, feedback, immersion, and social interaction. With these elements, games would be really addictive and result in Internet addiction. • Enchantment: This stage serves as the introduction to the Internet. Oftentimes, scholars will describe this phase as an obsession. The Internet fascinates those new to it. In the first stage, users might be excited and curious about the Internet, leading to an increase in the amount of time spent on the Internet. • Disillusionment: Users start avoiding something addictive. After devoting a long time to using the Internet, individuals might realize that they should not spend too much time on the Internet, so they may reject games or websites that might be addictive. This leads to a decline in the amount of usage. Another study that looked further into the effect of COVID-19 on the prevalence of IAD was "Internet Addiction Increases in the General Population During COVID‐19". The study looked at how the likely increase in stress related to COVID-19 induced quarantine contributed to an increase in IAD among the Chinese population. The study was conducted among 20,472 participants who were asked to fill out the Internet Addiction Test (IAT) online. The study ultimately shows that the overall prevalence of Internet addiction amounted to 36.7% among the general, and according to IAT scores the level of severe Internet addiction was 2.8%. The conclusion drawn was that the pandemic increased the prevalence and severity of Internet addiction among the general population in China. == Related disorders ==

Problem gambling (online gambling disorder) Risks to gamblers and their families of problematic gambling have increased with the advent of online gambling. This is particularly true for minors. Video game addiction Video game addiction (VGA), also known as gaming disorder or internet gaming disorder, is generally defined as a psychological addiction that is problematic, compulsive use of video games that results in significant impairment to an individual's ability to function in various life domains over a prolonged period of time. Internet sex addiction Internet sex addiction, also known as cybersex addiction, has been proposed as a sexual addiction characterized by virtual Internet sexual activity that causes serious negative consequences to one's physical, mental, social, and financial well-being. Compulsive talking (communication addiction disorder) Communication addiction disorder (CAD) is a supposed behavioral disorder related to the necessity of being in constant communication with other people, even when there is no practical necessity for such communication. CAD has been linked to Internet addiction. Users become addicted to the social elements of the Internet, such as Facebook and YouTube. Users become addicted to one-on-one or group communication in the form of social support, relationships, and entertainment. However, interference with these activities can result in conflict and guilt. This kind of addiction is called problematic social media use. Social network addiction is a dependence of people by connection, updating, and control of their and their friend's social network page. For some people, in fact, the only important thing is to have a lot of friends in the network regardless if they are offline or only virtual; this is particularly true for teenagers as a reinforcement of egos. Sometimes teenagers use social networks to show their idealized image to others. However, other studies claim that people are using social networks to communicate their real personality and not to promote their idealized identity. Compulsive VR use Compulsive VR use (colloquially virtual-reality addiction) is a compulsion to use virtual reality or virtual, immersive environments. Currently, interactive virtual media (such as social networks) are referred to as virtual reality, whereas future virtual reality refers to computer-simulated, immersive environments or worlds. Experts warn about the dangers of virtual reality, and compare the use of virtual reality (both in its current and future form) to the use of drugs, bringing with these comparisons the concern that, like drugs, users could possibly become addicted to virtual reality. == Risk factors ==

Interpersonal difficulties It is argued that interpersonal difficulties such as introversion, social problems, and poor face-to-face communication skills often lead to internet addiction. Internet-based relationships offer a safe alternative for people with aforementioned difficulties to escape from the potential rejections and anxieties of interpersonal real-life contact. As a matter of fact, the most prevalent applications among Internet addicts are chat rooms, interactive games, instant messaging, or social media. Protective factors such as quality communication between parents and children and positive youth development are demonstrated, in turn, to reduce the risk of IA. Psychological factors Prior addictive or psychiatric history are found to influence the likelihood of being addicted to the Internet. Some individuals with prior psychiatric problems such as depression and anxiety turn to compulsive behaviors to avoid the unpleasant emotions and situation of their psychiatric problems and regard being addicted to the Internet a safer alternative to substance addictive tendency. But it is generally unclear from existing research which is the cause and which is the effect partially due to the fact that comorbidity is common among Internet addicts. The most common co-morbidities that have been linked to IAD are major depression and attention deficit hyperactivity disorder (ADHD). The rate of ADHD and IAD associating is as high as 51.6%. Symptoms of ADHD are positively correlated with symptoms of IAD. Internet addicts with no previous significant addictive or psychiatric history are argued to develop an addiction to some of the features of Internet use: anonymity, easy accessibility, and its interactive nature. A study conducted by Aviv Weinstein and Michel Lejoyeux (2020) titled "Neurobiological mechanisms underlying internet gaming disorder" highlights that IGD is associated with alterations in brain regions involved in reward processing, impulse control, decision-making, and executive functioning. These changes in neural activity may result in the persistent and excessive use of internet gaming and may contribute to the development of IGD. The study also highlights the role of neurotransmitters, such as dopamine, in the reinforcement and reward-seeking behavior associated with IGD. They suggest that the neurobiological mechanisms involved in IGD are similar to those observed in substance use disorders, and they propose a framework for understanding IGD as a behavioral addiction. The authors also discuss the potential implications of these findings for the treatment of IGD, suggesting that interventions targeting the neurobiological mechanisms underlying IGD may be effective in reducing problematic internet gaming behaviors. == Identification ==

Identifying Internet addiction disorder is empirically difficult. Various screening instruments have been employed to detect Internet addiction disorder. Initial indicators A study conducted by Lori C. Soule, L. Wayne Shell, and Betty A. Kleen (2003) titled "Exploring Internet Addiction: Demographic Characteristics and Stereotypes of Heavy Internet Users" found that heavy internet users were more likely to be male and younger than non-heavy users. The study also found that heavy internet users were more likely to use the internet for gaming and entertainment purposes, rather than for work or education. It also went on further to suggest that heavy internet use may be related to certain personality traits, such as sensation-seeking and impulsivity, and highlight the need for further research to better understand the psychological factors that contribute to internet addiction. The study also highlights the need for interventions that target specific groups, such as young males who are heavy internet users, and that address the underlying factors that contribute to problematic internet use behaviors. A few obstacles are present in creating an applicable diagnostic method for Internet addiction disorder. • Wide and extensive use of the Internet: Diagnosing Internet addiction is often more complex than substance addiction as internet use has largely evolved into being an integral or necessary part of human lives. The addictive or problematic use of the internet is thus easily masked or justified. Also, the Internet is largely a pro-social, interactive, and information-driven medium, while other established addiction behaviors such as gambling are often seen as a single, antisocial behavior that has very little socially redeeming value. Many so-called Internet addicts do not experience the same damage to health and relationships that are common to established addictions. • High comorbidity: Internet addiction is often accompanied by other psychiatric disorders such as personality disorder and intellectual disability. It is found that Internet addiction is accompanied by another DSM-IV diagnosis 86% of the time. In one study conducted in South Korea, 30% of the identified Internet addicts have accompanying symptoms such as anxiety or depression and another 30% have a second disorder such as attention deficit hyperactivity disorder (ADHD). Another study in South Korea found an average of 1.5 other diagnoses among adolescent internet addicts. It generally remains unclear from existing literature whether other psychiatric disorders is the cause or manifest of Internet addiction. Despite the advocacy of categorizing Internet addiction as an established illness, neither DSM-IV (1995) nor DSM-5 (2013) considers Internet addiction as a mental disorder. A subcategory of IAD, Internet gaming disorder is listed in DSM-5 as a condition that requires more research in order to be considered as a full disorder in May 2013. The WHO's International Classification of Diseases (ICD-11) recognizes gaming disorder as an illness category. Screening instruments DSM-based instruments Most of the criteria utilized by research are adaptations of listed mental disorders (e.g., pathological gambling) in the Diagnostic and Statistical Manual of Mental Disorders (DSM) handbook. • Preoccupation with the Internet; • A need for increased time spent online to achieve the same amount of satisfaction; • Repeated efforts to curtail Internet use; • Irritability, depression, or mood liability when Internet use is limited; • Staying online longer than anticipated; • Putting a job or relationship in jeopardy to use the Internet; • Lying to others about how much time is spent online; and • Using the Internet as a means of regulating mood. While Young's YDQ assessment for IA has the advantage of simplicity and ease of use, Keith W. Beard and Eve M. Wolf in 2001 further asserted that all of the first five and at least one of the final three criteria (in the order above) be met to delineate Internet addiction in order for a more appropriate and objective assessment. Young further extended her eight-question YDQ assessment to the now most widely used Internet Addiction Test (IAT), which consists of 20 items with each on a five-point Likert scale. Questions included on the IAT expand upon Young's earlier eight-question assessment in greater detail and include questions such as "Do you become defensive or secretive when anyone asks you what you do online?" and "Do you find yourself anticipating when you go online again?". A complete list of questions can be found in Dr. Kimberly S. Young's 1998 book Caught in the Net: How to Recognize the Signs of Internet Addiction and A Winning Strategy for Recovery and Laura Widyanto and Mary McMurran's 2004 article titled The Psychometric Properties of the Internet Addiction Test. The Test score ranges from 20 to 100 and a higher value indicates a more problematic use of the Internet: • 20–39 = average Internet users, • 40–69 = potentially problematic Internet users, and • 70–100 = problematic Internet users. Over time, a considerable number of screening instruments have been developed to diagnose Internet addiction, including the Internet Addiction Test (IAT), the Chinese Internet Addiction Inventory (CIAI), the Korean Internet Addiction Self-Assessment Scale (KS Scale), the Compulsive Internet Use Scale (CIUS), the Generalized Problematic Internet Use Scale (GPIUS), the Internet Consequences Scale (ICONS), and the Problematic Internet Use Scale (PIUS). Among others, the Internet Addiction Test (IAT) by Young (1998) exhibits good internal reliability and validity and has been used and validated worldwide as a screening instrument. • Excessive use: compulsive Internet use and excessive online time-use; • Withdrawal symptoms: withdrawal symptoms including feelings such as depression and anger, given restricted Internet use; • Tolerance: the need for better equipment, increased internet use, and more applications/software; • Negative repercussions: Internet use caused negative consequences in various aspects, including problematic performance in social, academic, or work domains. More recently, researchers Mark D. Griffiths in 2000 and Jason C. Northrup and colleagues in 2015 claim that Internet per se is simply the medium and that the people are in effect addicted to processes facilitated by the Internet. Based on Young's Internet Addiction Test (IAT), As a consequence of studies being conducted in divergent contexts, studies constantly modify scales for their own purposes, thereby imposing a further challenge to the standardization in assessing Internet addiction disorder. The extent to which Internet use can cause negative health consequences is, however, not clear from such a measure. Neuroimaging studies revealed that IAD contributes to structural and functional abnormalities in the human brain, similar to other behavioral and substance additions. Therefore, objective non-invasive neuroimaging can contribute to the preliminary diagnosis and treatment of IAD. Electroencephalography-based diagnosis Using electroencephalography (EEG) readings allows identifying abnormalities in the electrical activity of the human brain caused by IAD. Studies revealed that individuals with IAD predominantly demonstrate increased activity in the theta and gamma band and decreased delta, alpha, and beta activity. Following these findings, studies identified a correlation between the differences in the EEG readings and the severity of IAD, as well as the extent of impulsivity and inattention. A 1999 study asserts that Internet addiction is a broad term which can be decomposed into several subtypes of behavior and impulse control problems, namely, • Cybersexual addiction: compulsive use of adult websites for cybersex and cyberporn (see Internet sex addiction) • Cyber-relationship addiction: Over-involvement in online relationships • Net compulsions: Obsessive online gambling, shopping or day-trading • Information overload: Compulsive web surfing or database searches • Computer addiction: Obsessive computer game playing (see Video game addiction) For a more detailed description of related disorders please refer to the related disorders section above. Public concern Internet addiction has raised great public concern in Asia and some countries consider Internet addiction as one of the major issues that threatens public health, in particular among adolescents. Internet addiction has been seen as a growing concern among adolescents, with many spending a significant amount of time online and exhibiting problematic use behaviors such as compulsive internet use and withdrawal symptoms when offline. Certain demographic factors, such as gender and socioeconomic status, may be associated with higher rates of internet addiction. Various factors may contribute to the development of Internet addiction, including individual factors such as depression, anxiety, and poor self-regulation, as well as environmental factors such as parental monitoring and peer influence. Poor academic performance, disrupted sleep patterns, and social isolation were found to be potential negative consequences of Internet addiction. ==Treatment==

Current interventions and strategies used as treatments for Internet addiction stem from those practiced in substance abuse disorder. In the absence of "methodologically adequate research", treatment programs are not well corroborated. Psychosocial treatment is the approach most often applied. Several key aspects are embedded in this therapy: • Learning time management strategies; • Recognizing the benefits and potential harms of the Internet; • Increasing self-awareness and awareness of others and one's surroundings; • Identifying "triggers" of Internet "binge behavior", such as particular Internet applications, emotional states, maladaptive cognitions, and life events; • Learning to manage emotions and control impulses related to accessing the Internet, such as muscles or breathing relaxation training; • Improving interpersonal communication and interaction skills; • Improving coping styles; • Cultivating interests in alternative activities. Three phases are implemented in the CBT-IA therapy: 12-step recovery programs Gaming Addicts Anonymous, founded in 2014 is a 12-step program focused on recovery from computer gaming addiction. Internet and Technology Addicts Anonymous (ITAA), founded in 2017, is a 12-step program supporting users coping with the problems resulting from compulsive internet and technology use. Some common sub-addictions include smartphone addiction, binge watching addiction, and social media addiction. There are face-to-face meetings in some cities. Telephone / online meetings take place every day of the week, at various times (and in various languages) that allow people worldwide to attend. Similar to 12-step fellowships related to behavioral addictions, such as Overeaters Anonymous, Workaholics Anonymous, or Sex and Love Addicts Anonymous, most members do not define sobriety as avoiding all technology use altogether. Instead, most ITAA members come up with their own definitions of abstinence or problem behaviors, such as not using the computer or internet at certain hours or locations or not going to certain websites or categories of websites that have proven problematic in the past. They refer to these problematic behaviors as "bottom lines". In contrast, "top lines" are activities, both online and offline, they can do to enhance self esteem without falling into compulsive use. "Middle lines" are behaviors that may be OK sometimes, but can lead to bottom lines if a user is not careful. == Prevalence ==

Different samples, methodologies, and screening instruments are employed across studies. == Terminology ==

The notion of "Internet addictive disorder" was initially conjured up by Ivan K. Goldberg in 1995 as a joke to parody the complexity and rigidity of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM). In his first narration, Internet addictive disorder was described as having the symptoms of "important social or occupational activities that are given up or reduced because of Internet use", "fantasies or dreams about the Internet", and "voluntary or involuntary typing movements of the fingers". The definition of Internet addiction disorder has troubled researchers ever since its inception. In general, no standardized definition has been provided despite that the phenomenon has received extensive public and scholar recognition. Below are some of the commonly used definitions. In 1998, Jonathan J. Kandell defined Internet addiction as "a psychological dependence on the Internet, regardless of the type of activity once logged on." English psychologist Mark D. Griffiths (1998) conceived Internet addiction as a subtype of broader technology addiction, and also a subtype of behavioral addictions. In recent years, the validity of the term "Internet addiction" as a single psychological construct has been criticized. New empirical evidence is emerging to support this view. == Society and culture ==

Internet addiction has raised great public concern in Asia and some countries consider Internet addiction as one of the major issues that threatens public health, in particular among adolescents. China Internet addiction is commonly referred to as "electronic opium" or "electronic heroin" in China. A government entity in China became the first governmental body worldwide to recognize internet addiction when it established "Clinical Diagnostic Criteria for Internet Addiction" in 2008. China's Ministry of Health does not formally recognize Internet addiction as a medical condition. As a result of public outcry over parent-child online gaming conflicts, the government issued legislation. Mistreatment and abuse in China Internet addiction camps in China are private or semi-private. Several forms of mistreatment have been well-documented by news reports. One of the most commonly used treatments for Internet-addicted adolescents in China is inpatient care, either in a legal or illegal camp. It is reported that children were sent to these camps against their will. Some are seized and bound by staff of the camp, some are drugged by their parents, and some are tricked into treatment. In many camps and clinics, corporal punishment is frequently used in the treatment of Internet addiction disorder. The types of corporal punishment practiced include, but are not limited to, kilometers-long hikes, intense squats, standing, starving, and confinement. After physical abuse caused the death of an adolescent at a treatment camp in 2009, the Chinese government officially prohibited the use physical violence in such places. Among Internet addiction rehab centers that use corporal punishment in treatment, Yuzhang Academy in Nanchang, Jiangxi Province, is the most notorious. In 2017, the academy was accused of using severe corporal punishment against students, the majority of which are Internet addicts. Former students claimed that the academy hit problematic students with iron rulers, "whip them with finger-thick steel cables", and lock students in small cells week long. Several suicidal cases emerged under the great pressure. In November 2017, the academy stopped operating after extensive media exposure and police intervention. Electroconvulsive therapy In China, electroconvulsive therapy (ECT) is legally used for schizophrenia and mood disorders. Its use in treating adolescent Internet addicts has raised great public concern and stigmatized the legal use of ECT. The most reported and controversial clinic treating Internet addiction disorder is perhaps the Linyi Psychiatric Hospital in Shandong Province. Various interviews of Yongxin Yang confirm that Yang has created a special therapy, ("brain-waking") therapy, to treat Internet addiction. As part of the therapy, electroconvulsive therapy is implemented with currents of 1–5 milliampere. As Yang put it, the electroconvulsive therapy only involves sending a small current through the brain and will not harm the recipient. As a psychiatric hospital, patients are deprived of personal liberty and are subject to electroconvulsive treatment at the will of hospital staffs. and can cause great pain and muscle spasm to recipients. An Interview of the Internet addiction treatment center in Linyi Psychiatric Hospital is accessible via the following link. Since neither the safety nor the effectiveness of the method was clear, the Chinese Ministry of Health banned electroconvulsive therapy in treating Internet addiction disorder in 2009. Drugs In Yang's clinic, patients are forced to take psychiatric medication In 2009, a 15-year-old, Senshan Deng, was found dead eight hours after being sent to an Internet-addiction center in Nanning, Guangxi Province. It is reported that the teenager was beaten by his trainers during his stay in the center. South Korea Being almost universally connected to the Internet and boasting online gaming as a professional sport, South Korea deems Internet addiction one of the most serious social issues and describes it as a "national crisis". Nearly 80% of the South Korean population have smartphones. As of 2013, according to government data, about two million of the country's population (less than 50 million) have Internet addiction problem, and approximately 680,000 10–19-year-olds are addicted to the Internet, accounting for roughly 10% of the teenage population. Even the very young generation are faced with the same problem: Approximately 40% of South Korean children between age three to five are using smartphones over three times per week. According to experts, if children are constantly stimulated by smartphones during infancy period, their brain will struggle to balance growth and the risk of Internet addiction. It is believed that due to Internet addiction, many tragic events have happened in South Korea: A mother, tired of playing online games, killed her three-year-old son. A couple, obsessed with online child-raising games, let their young daughter die of malnutrition. A 15-year-old teenager killed his mother for not letting him play online games and then committed suicide. One Internet gaming addict stabbed his sister after playing violent games. Another addict killed one and injured seven others. Typically, counselor- and instructor-led music therapy and equine therapy and other real-life group activities including military-style obstacle courses and therapeutic workshops on pottery and drumming are used to divert IAs' attention and interest from screens. US lawsuits Numerous lawsuits have been filed in US courts by US states, US school districts and others asserting that social media platforms are deliberately designed to be addictive to minors and seeking damages. These lawsuits include: • In October 2023, several public school systems in Maryland joined to sue Meta Platforms, Snapchat, ByteDance, and Google, claiming that these companies knowingly cause harm to students by providing addictive social media platforms. This lawsuit was one of many filed in the US as part of a mass action with many other entities around the US filing similar lawsuits. According to attorneys representing the plaintiffs, these lawsuits, may or may not be combined into a class action. These lawsuits were in part inspired by the success of a similar lawsuit against Juul Labs, makers of electronic cigarettes that were marketed to minors. It is expected that the defendant social media companies will seek to have these cases dismissed. • In October 2023, Maryland, Virginia, and Washington, D.C. filed federal and state lawsuits against Facebook and Instagram, claiming that those platforms are designed to get children and teens addicted to social media. Meta Platforms, the parent company of Facebook and Instagram, responded that they have implemented many safety features and are disappointed that the states have not worked cooperatively with them. • In February 2024, the city of New York filed a lawsuit in the California Superior Court against Facebook, Instagram, TikTok, Snapchat, and YouTube, seeking to have the companies' behavior declared a public nuisance and seeking monetary damages. The tech companies have responded that they have policies and procedures in place to ensure public safety. == See also ==