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Current Opinion in Behavioral Sciences
Professor Cindy Lustig, PhD
Guide for a
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University of Michigan, Ann Arbor, Michigan, United States of America

Menu & cognitiveSearch

Cognition in thisAging.
neuroscience. journal
Motivation-cognition interactions. Cholinergic
contributions to cognitive control, including in genetic and patient populations.

Professor Trevor W. Robbins, PhD

University of Cambridge Behavioural and Clinical Neuroscience Institute, Cambridge, United

Kingdom

Cognitive Neuroscience, Behavioural Neuroscience, Neuropsychopharmacology, Prefrontal cortex

function Cortico-striatal systems

Editorial Board Members

Professor Verity Brown, BSc, MBA, PhD, FRSE

University of St Andrews School of Psychology and Neuroscience, St. Andrews, United Kingdom

Exploring the neural basis of the control of movement

Dr. Roberto Cabeza

Duke University, Durham, North Carolina, United States of America

Episodic memory, semantic memory, visual memory, attention effects on memory, healthy
aging, Alzheimer', s Disease, fMRI, TMS, cognitive neuroscience

Assist. Prof. Luke Chang, PhD

Dartmouth College, Department of Psychological and Brain Sciences, Hanover, New Hampshire,
United States of America

Neurobiological and psychological processes underlying social interactions

Professor Michael Chee, MBBS, FRCP

National University of Singapore Centre for Sleep and Cognition, Singapore, Singapore

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Sleep deprivation, cognitive aging, sleep and cognition, fMRI

Prof. Dr. Roshan Cools, PhD

Radboud University Donders Institute for Brain Cognition and Behaviour, Nijmegen, Netherlands

Human cognitive neuropsychiatry

Professor Jacqueline Crawley, PhD

University of California Davis, Department of Psychiatry and Behavioral Sciences, Sacramento,

California, United States of America

Behavioral neuroscience, mouse behavioral genetics, and translational neuropharmacology

Assoc. Professor Molly Crockett, PhD

Yale University, Department of Psychology, New Haven, Connecticut, United States of America

Experimental Psychology, Neural and computational mechanisms of social behaviour

Dr. Wim Crusio, PhD

University of Bordeaux, CNRS, Bordeaux, France

Neurobiology of behaviour, Behavior genetics, Mouse, Mouse models of neuropsychiatric

disorders, Behavioral phenotyping of mice

Dr. Nathan Emery, PhD

Queen Mary University of London School of Biological and Chemical Sciences, London, United
Kingdom

Animal cognition, Creativity, Innovative problem-solving, Gaze following

Dr. Stan Floresco, PhD

The University of British Columbia, Vancouver, British Columbia, Canada

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Behavioural neuroscience, animal cognition, Schizophrenia

Professor Robert Gerlai, PhD

University of Toronto Mississauga, Mississauga, Ontario, Canada

Behaviour genetics, behavioural neuroscience, zebrafish, mouse, animal learning and

memory, animal models of alcoholism, animal models of fear and anxiety, social behaviour,
behavioural phenotyping

Professor Matthieu Guitton, PhD

Laval University, Québec, Quebec, Canada

Cyberbehavior - Human behavior in virtual spaces

Professor Shihui Han, PhD

Peking University, Beijing, China

Psychology, culture and social cognitive neuroscience, imaging genetics, self-related processing

Assist. Prof. Catherine Hartley, PhD

New York University, Department of Psychology, New York, New York, United States of America

Neuroimaging, psychophysiology, computational modeling, development and genetics

Professor Masahiko Haruno

National Institute of Information and Communications Technology Center for Information and
Neural Networks, Suita, Japan

Fields of specialization- Computational neuroscience, social neuroscience, decision making

Professor Fumiko Hoeft, MD. PhD

University of Connecticut, Storrs, Connecticut, United States of America

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Brain development, Neuroimaging, Individual differences, Literacy acquisition, Dyslexia

Professor Alex Kacelnik, FRS

University of Oxford, Oxford, United Kingdom

Evolutionary biology, ecology, comparative cognition and economic theory

Professor Simon Killcross, BA, MA, PhD (Cantab)

University of New South Wales School of Psychology, Kensington, New South Wales, Australia

Brain mechanisms underlying learning and cognition, neural substrates underlying executive
function, animal models of schizophrenia, schizophrenia

Dr. Yina Ma, PhD

Beijing Normal University, Beijing, China

Social Neuroscience, hyper-scanning, social decision-making, intergroup interaction

Professor Earl Miller, PhD

Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America

Brain rhythms and cognition, neuroscience, pyschology, neurology, brain and cognitive
sciences, neuropsychology

Dr. Richard Morris, PhD

University of New South Wales School of Accounting Auditing & Taxation, Sydney, Australia

International accounting, Financial reporting

Dr. Mathias (Charlie) Pessiglione, PhD

Institute of Brain and Spinal Cord, Paris, France

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Cognitive neuroscience, primate neurophysiology and computational modeling

Professor Jonathan Roiser, PhD

University College London, London, United Kingdom

Cognitive psychology, functional neuroimaging, psychopharmacology, computational modelling

and genetics

Prof. Dr. Carmen Sandi, PhD

Federal Polytechnic School of Lausanne, Lausanne, Switzerland

Neuroscience, stress, psychopathology, brain function, behavior and cognition

Dr. Daphna Shohamy, PhD

Columbia University, New York, New York, United States of America

Cognitive Neuroscience, learning and memory, judgement and decision making

Professor Andy Sih, PhD

University of California Davis, Davis, California, United States of America

Ecology, Animal Behavior, and Population Biology

Professor Dénes Szücs, MA, PhD

University of Cambridge, Department of Psychology, Cambridge, United Kingdom

Cognitive neuroscience, psycho-physiology, electro-physiology, numerical cognition, visual

working memory, developmental science

Dr. Hikaru Takeuchi

Tohoku University, Sendai, Japan

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Neural and molecular basis of social behaviour and creativity in animals

Dr. Natalie Tronson, PhD

University of Michigan, Ann Arbor, Michigan, United States of America

Mechanisms by which neuroimmune signaling and stress lead to enhancements or impairments

in long term memory formation, Learning and memory, reconsolidation, consolidation, molecular
mechanisms if memory, neuroimmune, stress, psychiatric disorders, cytokines, long
COVID, Alzheimer's disease, dementia, aging and memory, animal models, hormonal
contraceptives, depression, sex differences, Behavior

Professor Lawrence Wilkinson

Cardiff University, Cardiff, United Kingdom

Focused on how genetic and epigenetic mechanisms influence the way the brain functions

All members of the Editorial Board have identified their affiliated institutions or organizations,
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to any jurisdictional claims.

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Cognition in the Wild, edited by Alexandra Rosati, Zarin Machanda and Katie Slocombe

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individuality: strategic use or byproduct

Megan T Wyman, Britta Walkenhorst, Marta B. Manser

Article 101140

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Answering big questions with small data: the use of field experiments in primate
cognition

Marcela E Benítez, Melissa C Painter, Nicole Guisneuf, Thore J Bergman

Article 101141

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Behavioral and cognitive perspectives on the evolution of tool use from wild
chimpanzees

Elizabeth V Lonsdorf, Crickette M Sanz

Article 101144

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A “thinking animal” in conflict: studying wild elephant cognition in the shadow of

anthropogenic change

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Article 101148

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The role of natural history in animal cognition

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Article 101154

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Socially scripted vocal learning in primates

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Article 101153

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Learning and skill development in wild primates: toward a better understanding of

cognitive evolution

Luz Carvajal, Caroline Schuppli

Article 101155

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Fish ecology and cognition: insights from studies on wild and wild-caught teleost fishes

Redouan Bshary, Zegni Triki

Article 101174

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Beyond the dichotomy between field and lab — the importance of studying cognition in
context

Lisa Horn, Giulia Cimarelli, Palmyre H Boucherie, Vedrana Šlipogor, Thomas Bugnyar

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Article 101172

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Robust capuchin tool use cognition in the wild

Tiago Falótico
Article 101170

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Chimpanzee vocal communication: what we know from the wild

Katie E Slocombe, Nicole J Lahiff, Claudia Wilke, Simon W Townsend

Article 101171

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Cooperation and cognition in wild canids

Andreas Berghänel, Martina Lazzaroni, Giulia Cimarelli, Sarah Marshall-Pescini, Friederike Range
Article 101173

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How do animals navigate the urban jungle? A review of cognition in urban-adapted

animals

Rohan Sarkar, Anindita Bhadra

Article 101177

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Advanced cognition in wild chimpanzees: lessons from observational studies

Ian C Gilby, Zarin P Machanda

Article 101183

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Internet Addiction, edited by Naomi Fineberg and Marc Potenza

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A review of the genetic basis of problematic Internet use

Anna Maria Werling, Edna Grünblatt

Article 101149

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The current status of Cyberbullying research: a short review of the literature

Matteo Vismara, Nicolaja Girone, Dario Conti, Gregorio Nicolini, Bernardo Dell’Osso
Article 101152

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Problematic Internet use (PIU) in youth: a brief literature review of selected topics

Ruckwongpatr Kamolthip, Paratthakonkun Chirawat, Simin Ghavifekr, Wan Ying Gan, ... Chung-Ying Lin
Article 101150

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Health-policy approaches for problematic Internet use: lessons from substance use
disorders

Dan J Stein, Anna Hartford

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Article 101151

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Pharmacological interventions for Problematic Usage of the Internet (PUI): a narrative

review of current progress and future directions

Jeremy E Solly, Jon E Grant, Samuel R Chamberlain

Article 101158

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New challenges in facing cyberchondria during the coronavirus disease pandemic

Matteo Vismara, Alberto Varinelli, Luca Pellegrini, Arun Enara, Naomi A Fineberg
Article 101156

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Insights from an online self-help forum for people with gaming problems

Cam Adair, Heather Luna-Rose

Article 101157

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Clinical services for problematic internet usage

Amanda Roberts, Steve Sharman, Henrietta Bowden-Jones

Article 101180

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Prevalence of problematic Internet use during the coronavirus disease 2019 pandemic

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Article 101179

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STEM foundations, edited by Denes Szucs, Yiming Cao and Valeska Grau Cardenas

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The Intelligence Quotient-math achievement link: evidence from behavioral and

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Supporting mathematics learning: a review of spatial abilities from research to practice

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Core foundations of early mathematics: refining the number sense framework

Nancy C Jordan, Brianna L Devlin, Megan Botello

Article 101181

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Social determinants of mathematics and science achievement in historical context

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Article 101182

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Executive Control of Eating, edited by Géraldine Coppin and Lucas Spierer

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Efficacy of a combined food-response inhibition and attention training for weight loss

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Constructing value signals for food rewards: determinants and the integration

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Article 101178

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Problematic Internet use (PIU) in youth: a brief literature

review of selected topics
Ruckwongpatr Kamolthip 1, Paratthakonkun Chirawat 2,#, ]]
]]]]]]
]]

Simin Ghavifekr 3,#, Wan Ying Gan 4,#, Serene EH Tung 5,#,
Ira Nurmala 6,#, Siti R Nadhiroh 7,#, Iqbal Pramukti 8,# and
Chung-Ying Lin 1,9,10,11

We aimed to discuss several selected topics related to

Current Opinion in Behavioral Sciences 2022, 46:101150
problematic Internet use (PIU), including fear of missing out,
This review comes from a themed issue on Internet Addiction
nomophobia, cyberchondria, cyberbullying, and certain health
conditions (e.g. autism-spectrum disorder and schizophrenia) Edited by Naomi Fineberg and Marc Potenza
among youth. We also aimed to review some recent evidence
examining PIU during COVID-19. The review was conducted
using keywords relevant to the selected topics and searching in
https://doi.org/10.1016/j.cobeha.2022.101150
the PubMed database and Google Scholar. The results of this
review indicate that PIU could be associated with health issues 2352-1546/© 2022 Elsevier Ltd. All rights reserved.
in a minority of the youth population. Moreover, the COVID-19
pandemic may lead to PIU and subsequent health problems.
Information from this review could help healthcare providers to
design individualized and appropriate interventions to tackle
health issues related to PIU among youth.
Introduction
The Internet has been widely used since the 1990s [1]
Addresses
1
Institute of Allied Health Sciences, College of Medicine, National
and can be defined as a tool for information access and
Cheng Kung University, Tainan 701401, Taiwan exchange that aids people in their daily lives [2]. In­
2
College of Sports Science and Technology Mahidol University, Sala ternet users can be categorized into two groups: adaptive
Ya, Phutthamonthon 73170, Nakhon Pathom, Thailand Internet users and users with pathological behaviors [3].
3
School of Education, Faculty of Social Sciences, University of
Adaptive users use the Internet for different and various
Nottingham, UK
4
Department of Nutrition, Faculty of Medicine and Health Sciences, purposes, including and beyond connection and sociali­
Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia zation. On the other hand, those with pathological be­
5
Department of Public Health Medicine, Universiti Malaysia Sabah, haviors spend a lot of time on online activities (i.e.
88400 Kota Kinabalu, Sabah, Malaysia excessive gaming, excessive online shopping) [3,4]. Ex­
6
Division of Health Promotion and Behavioral Sciences, Faculty of
Public Health, Universitas Airlangga, Surabaya, Indonesia
cessive Internet use can lead to negative consequences
7
Department of Nutrition, Faculty of Public health, Universitas such as psychological problems or a disturbed personal
Airlangga, Surabaya, Indonesia life [2,3]. The use of Internet and smartphone technol­
8
Faculty of Nursing, Universitas Padjadjaran, West Java, Indonesia ogies has increased rapidly, along with Internet-based
9
Department of Occupational Therapy, College of Medicine, National platforms and applications, and these new behaviors
Cheng Kung University, Tainan 701401, Taiwan
10
Department of Public Health, College of Medicine, National Cheng
come with possible adverse outcomes, including health
Kung University, Tainan 701401, Taiwan problems and risks of overuse and dependency [1,5]. For
11
Biostatistics Consulting Center, National Cheng Kung University example, previous research has indicated that proble­
Hospital, College of Medicine, National Cheng Kung University, Tainan matic Internet use (PIU) can lead to a lack of sleep
701401, Taiwan among youth, which can cause negative health outcomes
Corresponding author: Chung-Ying Lin ([email protected])
such as insomnia and physical weakness [3]. Ad­
#
These authors have contributed equally to this work. ditionally, overuse of the Internet can lead to psycho­
social problems [5••]. Therefore, PIU has been defined

www.sciencedirect.com Current Opinion in Behavioral Sciences 46( 2022) 101150

2 Internet Addiction

as excessive Internet use that causes a variety of psy­ of interest. We believe that this review may encourage
chosocial problems (e.g. impairments in academic, oc­ the development of strategies to prevent PIU and to
cupational, and social relationships) [6]. Moreover, due raise public awareness regarding the related issues.
to lockdowns and remote learning, the COVID-19 pan­
demic has increased Internet use among youth, which
Methods
may further exacerbate PIU [7,8]. Therefore, the present
After determining the relevant topics mentioned in the
paper is a brief narrative review aimed at understanding
Section ‘Introduction’, the first author searched both
PIU from a variety of viewpoints, including PIU during
PubMed and Google Scholar using relevant keywords
the COVID-19 pandemic.
for each topic. Specifically, “Internet addiction”, “PIU”,
“problematic use of Internet”, “problematic gaming”,
The literature indicates that the characteristics of PIU
“problematic social media use”, “problematic smart­
do not meet the diagnostic criteria of a disorder, because
phone use (PSU)”, and “Internet dependence” were
there is no evidence for functional impairment in PIU.
used together with “adolescent”, “adolescence”,
Researchers have reported that PIU is likely an addictive
“youth”, and “young adults” to search for all the topics.
behavior [9]. However, the diagnostic criteria of Internet
For specific topics, the topic terms (i.e. FoMO, nomo­
gaming disorder (IGD) in Diagnostic and Statistical
phobia, cyberchondria, cyberbully, and COVID-19,
Manual of Mental Disorders, fifth edition (DSM-5) and
generalized and specific) were additionally used to
gaming disorder (GD) in International Classification of
combine in the search, except for the topic on PIU with
Diseases, eleventh revision (ICD-11) provide different
a health condition. For the topic on PIU with a health
diagnostic guidelines due to a lack of consensus,
condition, keywords of “autism spectrum disorder”,
meaning that experts should further address the accurate
“ADHD”, and “schizophrenia” were used. The pub­
diagnosis of these types of disorders [10]. In other words,
lication period of the search was set between 2017 and
both DSM-5 and ICD-11 need more evidence on PIU
2022. The first author then worked with the corre­
[11,12]; therefore, the topic of PIU should be in­
sponding author to decide which publications would be
vestigated in future research [9].
included for the present narrative review.
Although the American Psychiatric Association does not
support calling PIU a diagnosable disease [2,13], its Review findings
discussion and investigation are of significant concern Problematic Internet use during the COVID-19 pandemic
among healthcare providers. Apart from the negative Since the outbreak of COVID-19 in 2019, governments
consequences (e.g. psychological impairments [2]), sev­ around the world have taken many measures to control
eral recent meta-analyses have found high prevalence of the rapid spread of the virus [17–22]. As one of the
PIU among youth: 27.1% among young adults in Ban­ governments’ responses to COVID-19, lockdowns and
gladesh [14], 34.5% among high school and university school-closure policies were implemented in different
students in Africa [15], and 35% among 15–23-year-old countries [22•]. However, one result of these policies
Iranians [16]. Although only a minority of young adults was that young people increased their Internet use, and
suffer severely negative health consequences as a result this has been reported to have caused health problems
of PIU, the issues of PIU have been revealed to be re­ [23,24]. Therefore, exploring the issue of youth Internet
markable [3]. Therefore, the investigation of the po­ use during the COVID-19 pandemic is crucial for future
tential risks of PIU is warranted [3]. policymaking and educational reforms.

This brief literature review covers generalized and spe­ In the face of sudden and dramatic changes during
cific PIU, PIU during the COVID-19 pandemic, PIU COVID-19 isolation, teenagers have been more prone to
with a health condition (such as attention-deficit hy­ psychological problems, such as depression and anxiety,
peractivity disorder (ADHD)), PIU and fear of missing than adults [21]. Meanwhile, due to the need for online
out (FoMO), PIU and nomophobia, PIU and cyberch­ education, Internet-usage rates among youth have in­
ondria, and PIU and cyberbullying. Studies conducted creased significantly. During the COVID-19 pandemic,
before the pandemic found that PIU with the main adolescents have been at a high risk of PIU development
feature of excessive use of the Internet could lead to [17]. Therefore, network-based problematic behavior
psychological problems among young adults. Moreover, during the COVID-19 pandemic and its impact have
evidence shows that Internet overuse has risen among attracted the attention of many scholars. Islam et al.
youth during the COVID-19 pandemic. In this review, [22•] found a reciprocal relationship between PIU and
we discuss the current research on Internet use and PIU. psychological distress through a quantitative analysis.
The research question is whether these current main Similarly, Chen et al. [17–20] pointed out that COVID-
topics might lead to uncontrolled Internet use and could 19 has had a significant impact on the mental health of
be associated with PIU. Additionally, how PIU associ­ schoolchildren and has affected the relationship be­
ates with adverse health consequences in these topics is tween PIU and psychological distress. To this end,

Current Opinion in Behavioral Sciences 46( 2022) 101150 www.sciencedirect.com

 PIU in youth Kamolthip et al. 3

studies by Chen et al. [17–20] and Fung et al. [25] have antisocial behavior; and narcissism — indicating extreme
determined the mediating effects of both generalized self-involvement) [6,29], suggesting that different char­
and specific PIU based on a screen time and a psycho­ acteristics are expressed in different forms of PIU [29].
logical-distress model. One of the significant factors is gender differences,
which are associated with both generalized and specific
However, evidence from Spain shows that increased PIU. On the one hand, the male sex is associated with
Internet usage during the COVID-19 lockdown was not specific PIU, such as IGD; on the other hand, the female
related to PIU, except for problematic video gaming and sex is often associated with chatting and social net­
TV-series watching [26]. The researchers indicated that working [27,30,31]. Furthermore, investigating the type
people may have changed their behaviors and adapted of device, the application, and the circumstance (such as
their coping strategies to deal with stress during business or private) can improve our understanding on
COVID-19 [26]. Internet overuse during the pandemic the effects of PIU and its negative consequences [32••].
may thus have both positive and negative effects on However, there is a scarcity of studies on the specific
people. Therefore, more observations are required in characteristics that can help us distinguish between
future studies. young people who have generalized and specific PIU.
Moreover, investigating the remarkable external and
The impacts of COVID-19 on Internet use and mental structural factors of generalized and specific PIU may
health have recently become a focus of scholarly re­ help us to differentiate between the two.
search. Given that the COVID-19 pandemic is ongoing
worldwide, with different policies and treatments im­ Problematic Internet use with a health condition
plemented across countries, comparing PIU across Individuals with a health condition such as autism-
countries during the COVID-19 pandemic should be of spectrum disorder (ASD), ADHD, and severe mental
interest for future research. health disorders (e.g. schizophrenia) are vulnerable to
PIU [33–38] because the Internet serves as a coping
Generalized problematic Internet use and specific strategy to help them deal with their psychological pro­
problematic Internet use of gaming, gambling, and blems and regulate their emotions [36,37]. Furthermore,
social networking those with alexithymia who have difficulties identifying,
In the literature, PIU is categorized into two subtypes. expressing, and communicating their emotions may also
Generalized PIU refers to the general behavior of mul­ overuse the Internet for social interactions to cope with
tidimensional Internet use. Specific PIU, meanwhile, their negative feelings [39–42].
refers to a particular type of Internet use, and the pre­
sent review especially focuses on gaming, gambling, and A cross-sectional study by Kawabe et al. [33] reported
social networking (i.e. other specific PIU such as por­ that Japanese adolescents with ASD had a 11.8% higher
nography use and compulsive buying were not discussed prevalence of PIU as compared with the general ado­
in the present review) [1,2,5,6,27]. However, the litera­ lescent population. Their results further showed that
ture indicated that it is relevant to differentiate between ASD adolescents with ADHD symptoms had an even
both subtypes [1,2,5,6,27]. For example, PSU is viewed higher risk of PIU [33]. Paulus et al. [34] found that al­
as generalized PIU, while problematic social-media use though boys with ASD utilized computer-mediated
and problematic gaming are examples of specific PIU. communication less frequently than those without ASD,
Moreover, one subtype of PIU (i.e. problematic gaming) they spent more time playing video games, in which
has been listed as a tentative disorder: DSM-5 includes a they preferred to play alone rather than with others.
section of “substance use disorder and IGD” and in­ Thus, people with ASD are likely to have specific PIU
dicates this as an important direction for future study with regard to gaming [32]. Individuals with schizo­
[9,26]. Additionally, GD in the ICD-11 is included as phrenia may use activities on the Internet (such as on­
a “disorder due to substance use or addictive line gaming and social-media use) to cope with their
behavior” [9,28]. symptoms and the adverse effects related to their psy­
chological problems [36,37]. However, when they de­
Several studies have proposed that both generalized and velop PIU, young people with schizophrenia had a
specific PIU should be evaluated independently, and higher risk of developing psychological distress [36,37].
that different treatments should be offered for them Moreover, a recent study among Chinese undergraduate
[27]. Specifically, one study found that both subtypes students with alexithymia suggested that mindfulness
were associated with poor mental health outcomes such skills might be helpful for tackling PIU [40]. Similar
as risk of psychological distress [5••]. Studies have also findings have been reported by other studies on Chinese
shown that PIU is associated with dark-triad character­ and Egyptian students [41,42]. However, evidence re­
istics (i.e. Machiavellianism — indicating manipulative­ garding the mechanism of comorbidity between PIU and
ness, callousness, and indifference to morality; different psychiatric problems (e.g. ASD, ADHD, and
psychopathy — indicating impaired empathy and mental health disorders) is lacking. More information

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4 Internet Addiction

regarding interventions for youth with comorbid ASD/ phone phobia) [51]. Nomophobia is defined as the fear
ADHD/alexithymia and PIU is needed. of being deprived of a mobile phone and being un­
reachable. This fear is also accompanied by feelings of
Problematic Internet use and fear of missing out anxiety if one is unable to use a mobile phone or take
The definition of ‘FoMo’ is a feeling of fear, worry, or advantage of the conveniences provided by these de­
concern regarding missing out on what others are ex­ vices [52]. Individuals with nomophobia experience an­
periencing, which is perceived as being more socially xiety, distress, and fear when not able to use a device
rewarding, or of not obtaining useful information as and keep up with messages, recent events, and various
compared with other individuals [43,44]. We found that experiences shared on social media [53]. Therefore,
most of the studies indicated a link between FoMO and nomophobia is a health problem because it negatively
various PIUs in adolescents and young adults (e.g. pro­ affects an individual’s physical, mental, and social
blematic usage of mobile or smartphones and proble­ health.
matic gaming). Many youth are especially attracted to
the use of various social-media sites such as Facebook Studies have shown that PIU, especially generalized
and Instagram, as well as engaging in Internet gaming PIU with smartphones, may cause nomophobia and that
activities through smartphone devices [43,45]. Engaging age may be a factor associated with nomophobia [53–55].
in such activities using gadgets can lead to various in­ Specifically, the older an individual’s age, the lower the
terferences at work, school, or even socially, making this risk of experiencing nomophobia [55]. Therefore, youth
a critical issue to be studied. FoMO seems to be one of are at a high risk of developing nomophobia with ne­
the many reasons why youth are engaged in such pro­ gative impacts on their academic performance [51]. Re­
blematic activities online, therefore, it is an important garding sex, studies have found no relationship with
variable to be studied among youth. The link between nomophobia [50,54]. Moreover, research has shown that
FoMO and such problematic or addictive behaviors may there was a positive relationship between extraversion
be related to impulsivity. In addition, the urge to check and nomophobia, which may be due to social interac­
one’s phone for notifications on various social-media tions and the desire for sociability with others, especially
platforms is a characteristic of FoMO because of in those with low self-esteem [50]. As a result, PIU has a
the concern of missing out on new opportunities or significant relationship with nomophobia, given that the
updates [46]. absence of the smartphone may trigger their nomo­
phobia [54]. Nevertheless, there are no proper guide­
FoMO acts as a mediator of various factors that lead to lines on smartphone use, which should be provided at
PSU and IGD. A study that examined mental health home, in school, and in clinical settings to raise aware­
variables in relation to PSU among 316 U.S. under­ ness about the risk of nomophobia. Therefore, more
graduate students found that FoMO was a mediator of studies are needed to identify risk groups and to estab­
the relationship between depression severity and non­ lish treatment programs and adequate prevention stra­
social-related smartphone use [47]. Another study con­ tegies. Moreover, classifying and differentiating PIU and
ducted among 296 nonclinical participants in the anxiety disorder pose a challenge to defining nomo­
United States also identified that FoMO acted as a phobia, therefore, more discussion on identifying no­
mediator in the relationship between fear of negative/ mophobia is needed.
positive evaluation and problematic social smartphone
use [48]. A mediating role of FoMO, however, was not Problematic Internet use and cyberchondria
fully supported by two other longitudinal studies [43,49]. There has been an exponential increase in the number
Therefore, we should point out the caution of causal of people engaging with digital technologies, particularly
links between FoMO and PIU. Moreover, a gap in the during the COVID-19 pandemic, including the use of
literature exists regarding cultural differences in FoMO, Internet searches to find health information.
as evidenced by the apparent causal relationship be­ Information-seeking by people who have become in­
tween FoMO and PIU and the association of FoMO fected with COVID-19 or perceive themselves to be at
with specific PIU. high risk if infected has been associated with more
psychological symptoms [56], and a higher level of an­
Problematic Internet use and nomophobia xiety has been reported in people related to the pan­
New technology brings many advantages to modern demic [57]. Excessive or repeated use of the Internet to
life, however, excessive use of technology such as seek health‐related information, which leads to distress,
smartphones may have negative effects on some people, typically in the form of health anxiety, is referred to as
especially students [50]. Excessive use of smartphones cyberchondria [58]. Two studies have offered substantial
may jeopardize students’ scholastic performance. In new observed evidence to add to the (limited) existing
particular, when students feel anxious about being away body of evidence on the relationship between PIU and
from their smartphones, this may indicate that they are cyberchondria [59,60]. Durak Batıgün et al. [60•] found
likely to experience nomophobia or NMP (no mobile that PIU, together with anxiety, was a significant

Current Opinion in Behavioral Sciences 46( 2022) 101150 www.sciencedirect.com

 PIU in youth Kamolthip et al. 5

mediator of the association between distress tolerance YouTube, SnapChat, Instagram, or Tiktok) [62]. Cy­
and cyberchondria in Turkey. Meanwhile, Fergus and berbullying has been found to be related to PIU [63,64].
Spada [59] found an association between cyberchondria In a Spanish study, PIU was associated with cyberbul­
and PIU among U.S. adults. Moreover, Fergus and lying in several youth profiles, including low, moderate,
Spada [59] indicated that metacognitive treatment ap­ high, and very high levels of intra- and interpersonal
proaches might be beneficial for treating cyberchondria conflict [63]. A study also found that social-media use
when accounting for PIU. However, given that the cur­ may trigger cyberbullying among adolescents [64]. Ad­
rent evidence on cyberchondria is limited, future studies ditionally, a study among Chinese adolescents found
investigating any aspect of cyberchondria associated that rejection sensitivity significantly mediated the re­
with PIU (e.g. considerations of FoMO, nomophobia, or lationship between PIU and cyberbullying. Those with
the COVID-19 pandemic) are needed. higher rejection sensitivity were more likely to have
higher PIU [65]. However, the causality between PIU
Problematic Internet use and cyberbullying and cyberbullying is unclear, and future studies should
Cyberbullying (including forms of flaming, harassment, investigate the potential causal relationships be­
cyber stalking, denigration, impersonation, outing, tween them.
trickery, and exclusion) has been found to be a serious
issue that has impacted adolescents and students’
mental health [61]. In a study conducted in the Discussion
United States, the prevalence of cyberbullying ranged The present review describes the issues of PIU among
from 1% to 30% for suspected perpetrators and from 3% youth. The issues related to PIU among youth are
to 72% for suspected victims [62]. Cyberbullying may summarized in Figure 1. We have observed increased
take the form of personal blogs, text messages, broadcast Internet use among youth during the COVID-19 pan­
messages, and messages posted on websites (e.g. demic. Some studies have reported that Internet overuse

Figure 1

Current Opinion in Behavioral Sciences

Overview of PIU and associated subtopics in the present brief review.

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6 Internet Addiction

is not associated with increased PIU, and that, in fact, it PIU is related to health conditions (i.e. ASD, ADHD,
acts as a coping strategy to prevent mental distress and schizophrenia). Moreover, the COVID-19 pandemic
during the COVID-19 pandemic [17,66]. Although this may exacerbate the issues of PIU among youth. This
evidence presents positive results, we should closely review could be helpful for investigating the prevalence
monitor the situation to prevent the negative con­ and influencing factors, which are related to PIU and its
sequences of PIU that can occur following Internet negative health outcomes.
overuse. Additionally, we have demonstrated that no
conclusion on the diagnostic criteria of PIU could be Conflict of interest statement
drawn from the literature because the specific char­ All the authors declare that there is no conflict of in­
acteristics of PIU are various. However, providing defi­ terest.
nitions of the different types of PIU might help promote
precise diagnosis and accurate prognosis, in addition to Acknowledgements
increasing the success of interventions to decrease PIU The authors acknowledge financial support from the Ministry of Science
[5••]. Moreover, our research highlighted the significant and Technology, Taiwan (MOST 110-2410-H-006-115), the Higher
Education Sprout Project, the Ministry of Education at the Headquarters of
issues (i.e. health conditions (such as ADHD), FoMO, University Advancement at the National Cheng Kung University (NCKU),
nomophobia, cyberchondria, and cyberbullying) that and the 2021 Southeast and South Asia and Taiwan Universities Joint
may be associated with uncontrolled Internet use. We Research Scheme (NCKU 31).
found that these vulnerable populations might be prone
to PIU and its adverse outcomes. However, little evi­ References and recommended reading
dence has been published regarding issues of PIU Papers of particular interest, published within the period of review, have
been highlighted as:
among youth since the COVID-19 pandemic began.
Future studies should explore the mechanisms of the •• of special interest
association between these phenomena to reduce their •• of outstanding interest.
potential risks.
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Current Opinion in Behavioral Sciences 46( 2022) 101150 www.sciencedirect.com

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