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Beforehand, informed consent was obtained consistent with the guidelines of the WHO and the declaration of Helsinki.
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First, a freelance general psychiatric history and examination was conducted by an experienced medical specialist for psychiatry and psychotherapy. Second, the clinical diagnosis was confirmed or adjusted by the Statistical Clinical Interview according to DSM-IV 19 , involving pre- and comorbidity. From the originally 37 patients only 25 In addition, 25 healthy control subjects, matched for sex, age and school education, were tested with the same psychometrical paradigm. The case load estimate of 25 participants per group, calculated with nQuery Advisor 5.
Data was assimilated and processed by the means of SPSS T-tests for unrelated populations were performed between patient and control group.
Experimentelle Psychologie und Internet-Forschung
Correlational calculations were done according to Pearson. Mean age of the patient group was However, eight patients The majority of the patients were playing massively multiplayer online role-playing games Within the clinical examination and in SCID I those 20 patients revealed a disorder with mainly depressive syptomatology see figure 1.
According to clinical examination and SCID 2 testing, nine patients Its interpretability is also limited by its small sample size.
According to the vast majority of studies, the average patient presenting with PIU is a young male, failing to grow into a mature adult with complete school education and professional training, financial independency and healthy relationships. Being narcissistically hurt or sociophobically intimidated he has withdrawn himself from real life and escapes into a virtual parallel world, mostly to alleviate his lack of self-esteem and self-confidence by playing the hero he could not be in real life.
The presented data however cannot explain, whether a manifest depression or anxiety disorder in this context is to be viewed as cause or effect of PIU, as opposed to personality disorders who are most likely preexisting.
MARKTFORSCHUNG - Definition and synonyms of Marktforschung in the German dictionary
As a first conclusion, the high amount of psychiatric comorbidity, which has been confirmed by other studies , and the significant level of clinical distress as measured by the global SCLR-scales underline the presumption, that the examined individuals with PIU did suffer from a clinically relevant psychopathology. To conclude that PIU is just a novel sym-ptom of well-known psychiatric diseases is problematic for reasons that rather let it appear as a diagnostic entity of its own comparable with addictions: First, there is a great phenomenal similarity between substance abuse disorders and the so called behavioural addictions , such as PIU 36, Secondly, it is well known, that depression, anxiety and personality disorders are a common comorbidity among substance abusers, especially in alcoholics 38,39 ; and in those, according to the diagnostic classification systems, it has become common practice to name comorbid disorders separately, regardless of alleged causal relations Third, the Internet and especially online-games hold an inherent addictive potential, which is novel for media in general but similar to that of gambling machines Forth, this addictive potential might push individuals, who may suffer from a subclinical level of depression, anxiety or personality pathology, over the limit to a significant clinical psychopathology And lastly, this may be especially relevant for children and adolescents, who ever more often seem to develop a dependency of the Internet, computer games and the combination of the two, also without a distinct comorbid pathology 43, To extend the chapters for substance abuse to the behavioural addictions has already been proposed for future revisions of the diagnostic classification systems However the syndrome might better be labeled as Internet dependency 15,41 , since the term addiction has been dropped in the favor of dependency in the diagnostic classification systems altogether Taking into account that the group of the other impulse control disorders seems to be a diagnostic construct rather related with the obsessive-compulsive spectrum of psychopathology 26 , and since in our study PIU did not show a significant correlation with the Barratt Impulsiveness Scale, the hypothesis that its classification as an ICD may be invalid.
Yet, despite the questionability of the ICD concept, it might be argued, that the term "Pathological Internet Use" is still of relevance, since it may imply not only quantitatively but also qualitatively excessive use of digital media. Yet, against the background of an ever increasing number of young and adult Internet dependent individuals, such as in countries like South Korea and Taiwan 35,36 , it has become undisputable that Internet dependency has to be taken seriously from a medical point of view.
To be able to treat the patients adequately and to grant further research, it is necessary to accept it as a diagnostic entity in itself.
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Therefore, in future revisions of ICD and DSM-IV a group of the so called behavioural addictions should be implemented, containing media dependency. The latter might be more valid in the long run, since not only the Internet but also computer games hold an addictive potential and since we cannot predict, what dangers the ever more quickly changing digital me-dia world may provide in the future. More research is needed, to exactly understand what makes digital media addictive and what distinguishes a behavioural dependency such as media dependency from substance abuse disorders. Prospective studies are needed to better understand the development of PIU and comorbid psychopathology and that also take into account different media formats and contents.
In the meantime, however, psychiatrists, who have to deal with this novel disease, must not forget to examine the patients for comorbid psychopathology, in order to provide a comprehensive treatment regimen.
Yet, to sufficiently understand and treat those patients, psychiatrists also have to be empathically interested in the parallel virtual lifes of their patients. All named authors have provided a significant contribution to the presented study. Psychological impact of the new digital media. Fortschr Neurol Psychiatr ; Kubey R, Csikszentmihalyi M. Television Addiction is no mere metaphor. Sci Am ; Genuine diagnosis or not? Diagnostic statistical manual of mental disorders: Diagnostic and Statistical Manual of Mental Disorders.
The possibility of including multimedia elements in surveys, and of accessing complex target groups are also important. Online fieldwork is used in diverse contexts: Online methodologies are also used in a wide variety of different sectors: We hope to shed some light on these topics and draw conclusions which not only permit a better understanding of the current market conditions, but also some predictions for the future of the youngest of the market research methodologies.
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