Social Isolation and the “Sheltered” Profile in Adolescents with Internet Addiction

Background: Demand for treatment for Internet-related troubles in adolescents is rising. The profiles of patients in a clinical population are not accurately known and we hypothesize motivation could be useful for characterization. We describe a sample of outpatients, differentiate between two groups based on their motivation, and describe the clinical differences found between them. Methods: Outpatients referred to our Adolescent Addiction Unit with “Internet addiction” as a presenting complaint were evaluated using specific criteria for Internet addiction and, if included in the study, also using DSMIV-TR Axis I and II. They were categorized into two groups: “sheltered,” defined as having high levels of interpersonal problems and motivated to use the Internet as a way to escape, to avoid, to cope, or to feel sheltered; and “non-sheltered,” not showing this motivation. We prospectively assessed qualitative and quantitative data on clinical presentation, Internet applications and use profile, treatment and, progress. We conducted a descriptive analysis of differences. Results: A total of 34 out of 54 subjects met diagnostic criteria for Internet addiction (IA) (mean age 15.38; SD=1.26; 76.5% male). Seventeen subjects (50%) reported using the Internet as a shelter. Diagnoses were mainly internalizing in the sheltered group and externalizing and behavioral in the non-sheltered. Sheltered subjects were significantly younger, had more comorbid disorders, more previous interpersonal problems and an increased loss of contact with friends, used the Internet more often to cope with interpersonal problems, had received prior treatment more frequently, and more often required a combined approach to treatment. Moreover, their motivation was less likely to be a feeling of offline boredom or recreational and they had greater massively multiplayer online role-playing game (MMORPG) use and night-time use and increased school failure and loss of contact with peers. Conclusions: We found two IA adolescent profiles that could be defined by using the Internet as a shelter, showing high levels of social isolation and having differences in presentation, Internet use characteristics, comorbidity, treatment and progress.