Proposed criteria can help physicians identify patients whose intense Internet use is unhealthy, according to an article in the 2003 issue of Depression and Anxiety.

Nathan Shapira, MD, PhD, and his American colleagues formulated a 5-question screen to characterize Internet use after interviewing 20 volunteers who reported problematic Internet use and 17 randomly selected peers with varying levels of Internet use. The English-language acronym MOUSE stands for (1) More than intended time spent online (2) Other responsibilities neglected (3) Unsuccessful attempts to decrease time (4) Significant relationship problems because of use and (5) Excessive thoughts or anxiety when not online.

The researchers found that volunteers who characterized themselves as problematic Internet users had, on average, 5 preexisting psychiatric problems such as bipolar disorder, depression, or alcohol abuse. In addition, this group was online more than 30 hours per week and their nonessential Internet use was 10 times greater than essential use such as job-related and school-related activities---28 hours compared with 2.8 hours.

The authors present a case study involving a 32-year-old man with bipolar disorder, obsessive-compulsive disorder, and depression. The volunteer's Internet use began when he started college at age 28, although he played computer games as an adolescent to the point it affected his grades. He estimated he was currently spending 24 hours online per week, primarily playing games and sending messages, but his actual time online averaged 35.9 hours per week. He felt a rise in tension before logging on to his computer and his college work was impaired. Furthermore, his Internet use did not occur exclusively during mood states caused by the pre-existing disorders.

Research is needed to determine whether Internet addiction should be a separate listing in the Diagnostic and Statistical Manual of Mental Disorders or whether problematic Internet use should fall under the umbrella of impulse control disorders, such as pathological gambling.

"It's disheartening to consider how little we know about the effects of the Internet on humans and how few resources from companies, foundations and the government are devoted to looking at the problems," Shapira said. "That's why we proposed our criteria - to enable doctors to make a diagnosis and to define a specific population for study.

Taking a random set of people and calling them Internet addicts without some scientific basis cannot lead to effective treatments."