افزایش استفاده از اینترنت در سطح جامعه و اختلالات شخصیتی اسکیزوفرنی گونه در بزرگسالان

Abstract Introduction In the past decade, the use of the Internet as a forum for communication has exponentially increased, and research indicates that excessive use is associated with psychiatric symptoms. The present study examined the rate of Internet use in adolescents with personality disorders, with a focus on schizotypal personality disorder (SPD), which is characterized by marked interpersonal deficits. Because the Internet provides an easily accessible forum for anonymous social interaction and constitutes an environment where communication is less likely to be hampered by interpersonal deficits, it was hypothesized that SPD youth will spend significantly more time engaging in social activities on the Internet than controls. Methods Self-reports of daily Internet use in adolescents with SPD (n = 19), a control group with other personality disorders (n = 22) and a non-psychiatric control group (n = 28) were collected. Results Analyses revealed that the SPD participants reported significantly less social interaction with ‘real-life’ friends, but used the Internet for social interaction significantly more frequently than controls. Chat room participation, cooperative Internet gaming, and to a lesser degree, e-mail use, were positively correlated with ratings of SPD symptom severity and Beck Depression Inventory scores. Discussion Findings are discussed in light of the potential benefits and risks associated with Internet use by socially isolated SPD youth.

Introduction Internet use is a rapidly growing technological and social phenomenon that has increased from 26.2% of U.S. homes having access in 1998 to 41.5% in 2000, and roughly 9.6% (581 million users) of the world population uses the Internet (NTIA Release, 2000). There is an expanding body of literature indicating that Internet use is linked with psychiatric symptoms and syndromes. Numerous case reports document that some heavy Internet users (i.e., individuals using the Internet for more than several hours per day for non-work related activity) suffer from psychiatric disorders (Treuer et al., 2001, Sa'adiah, 2002 and Iftene et al., 2004). Similarly studies of young adult samples indicate that self-reported loneliness is positively correlated with the rate of Internet use (Engelberg and Sjoberg, 2004 and Nichols and Nicki, 2004), and individuals who report excessive Internet use are characterized by an elevated rate of psychiatric disorders (Black et al., 1999, Shapira et al., 2000, Shapira et al., 2003 and Yoo et al., 2004). A recent study of normal high school students revealed that heavy Internet use was associated with heightened psychiatric symptoms on self-report measures (Yang et al., 2005). Some mental health experts have expressed concern that excessive Internet use may have a negative impact and contribute to psychiatric symptoms (Bremer, 2005). For example, Shapira et al. (2003) argue that heavy Internet use may negatively impact social and emotional functioning. As a reflection of these concerns, it has been suggested that heavy Internet use should be considered a disorder in its own right; and researchers have variously labeled it “Internet addiction disorder”, “Internetomania”, and “pathological Internet use” (Orzack and Orzack, 1999). In contrast, it has been suggested by some researchers that for many individuals the Internet can serve as a resource for social support that is unavailable elsewhere (Berger et al., 2005). For example, Wolak et al. (2003) conducted a telephone survey to explore the characteristics of youth who had formed close relationships via the Internet. They found that youth who had online relationships were more likely to report depression, sexual assault, and conflict or poor communication with parents. Thus, troubled youth may use the Internet as a venue for social involvement. Of course, the findings linking high rates of Internet use with adjustment problems may simply indicate that individuals with such problems are drawn to the Internet. In other words, high rates of Internet use may reflect a dysfunctional tendency to avoid direct social interaction. Because Internet use is a relatively new and burgeoning phenomenon, systematic research aimed at characterizing problematic Internet use and understanding its relation with psychiatric disorders is in its infancy (Goldsmith and Shapira, 2006). In particular, there is a dearth of empirical studies of the psychiatric correlates of Internet use by adolescents, and we are aware of no studies of Internet use in clinical samples of youth. Yet, researchers and clinicians recognize that the Internet is rapidly growing, and that excessive Internet use appears to be linked with psychiatric symptoms and may be detrimental. For these reasons, there is a need for systematic research aimed at identifying the nature and correlates of Internet use by youth with adjustment problems. Schizotypal personality disorder (SPD) involves a variety of social and cognitive deficits that are viewed as subclinical manifestations of schizophrenia. It can be reliably diagnosed in adolescents and is a risk factor for later psychotic disorder (Tyrka et al., 1995 and Walker et al., 1998). The diagnostic criteria for SPD include excessive social anxiety, odd speech, constricted affect, suspiciousness/paranoia, ideas of reference, odd beliefs/magical thinking, and unusual perceptual experiences (DSM-IV, 2004). A key criterion for SPD is a “lack of close friends or confidants other than first-degree relatives” (Criterion 7, APA, 2000). The symptoms of SPD interfere with social interaction (Ambelas, 1992). During adolescence, a time period characterized by an increasing degree of peer evaluation or scrutiny, odd or eccentric behavior will likely hamper peer relations (Wolff, 1991). For example, the inappropriate or constricted affect (Criterion 6) associated with SPD impairs communicative ability (Dworkin et al., 1993). Further, researchers have found that, compared to psychiatric and non-psychiatric controls, adolescents with SPD exhibit marked nonverbal deficits including irregular and limited gesturing (Mittal et al., 2006), higher frequencies of motor abnormalities (Walker et al., 1999 and Mittal et al., 2007bb), and problems in interpreting non-verbal cues (Logan, 1999). Given these findings, it is plausible that individuals with SPD would be drawn to the Internet because it is a venue in which receptive and expressive interpersonal deficits are less likely to reciprocate in exclusionary behavior from peers. Specific symptoms of SPD might be associated with specific patterns of Internet use. For example, a proclivity toward magical thinking or an over-active fantasy life (Criterion 2) might be associated with a preference to use fantasy games on the Internet as a platform for interacting with peers. Further, it is possible that cognitive stores that would have been used while compensating for interpersonal and social deficits during real-world social interactions (Logan, 1999), may be freed up while interacting in a virtual environment; because this could potentially result in an enhancement of performance in interactive goal driven tasks, it is possible that individuals with SPD might prefer this sort of game. Another point to consider is that odd speech (Criterion 4) and inappropriate or constricted affect (Criterion 6) may lead to peer rejection during real-life encounters. However, those individuals with SPD who yearn for interaction with peers might find chat rooms to be an outlet where these symptoms are less likely to interfere. Finally, there are some symptoms that are likely to relate to social Internet use across domains. More specifically, excessive social anxiety (Criterion 9) may lead schizotypal individuals to choose gaming, e-mailing, and chatting as a social platform. Factors potentially contributing to social anxiety, such as misinterpreting interpersonal situations, and fear of negative peer appraisal, would be limited in this environment. Furthermore, it would also be considerably easier to escape from anxiety provoking situations on the Internet. The present study tests the hypothesis that, compared to control groups, individuals with SPD would report spending more time on the Internet, including both chartrooms and online games. Also, based on past research findings, it was predicted that greater Internet use would be associated with more severe SPD symptoms.

. Results One-way analyses of variance (ANOVAs) were conducted to test for demographic differences among the diagnostic groups. There were no significant group differences in mean age of participant, or mean years of parental education across the three groups. In addition, results indicated no significant differences in intelligence tests scores (WISC-III, Donders, 1997). Chi-squared tests revealed no significant group differences in sex. Furthermore, there were no significant correlations between intelligence and daily time spent e-mailing, chatting online, or playing Internet games. One-way ANOVAs were conducted to compare the diagnostic groups on interpersonal relationships (this information was taken from SIDP-IV, Close Relationships: item #2, “lacks close friends or confidants other than first-degree relatives”). As expected there was a significant difference between groups for number of interpersonal ‘real-life’ friendships, F(2, 67) = 9.49, p < 0.01 (η2 = 0.22). Post hoc tests indicated that NC and OPD groups were not significantly different and that both groups showed higher mean frequency of friendships than the SPD group, p < 0.05. ANOVAs were also conducted on the data from the Internet survey (see Table 3 for descriptive statistics and a summary of the analyses). To facilitate interpretation, the Likert scale points (each representing a 1/2-h increment) were converted to minutes. Consistent with the hypotheses, there was a significant group difference for time spent in chat rooms F(2,67) = 3.93, p < 0.05 (η2 = 0.10) and time spent playing online games F(2,67) = 3.04, p < 0.05. Post hoc testing for both analyses revealed that the SPD group spent significantly greater time than both NC and OPD groups, and that there was no significant difference between the latter two groups. In terms of overall Internet use, there was a significant group difference F(2,67) = 3.07, p < 0.05; post hoc tests indicated that while SPD group spent significantly more time on the Internet than OPD but not NC controls and that there were no significant differences between controls. There were no significant diagnostic group differences for time spent writing and receiving e-mails (see Fig. 1 for an illustration of the group differences). Although the SPD group was slightly elevated on the BDI, there were no significant group differences for this measure. Table 3. Group differences of Internet use, social isolation and depression 1 2 3 Grand total (n = 69) Group difference No disorder (n = 28) Schizotypal (n = 19) Other disorder (n = 22) Number of real-life friendships M 3.75 2.73 3.38 3.35 2 < 1, 3⁎⁎; 1 = 3 (SD) (0.58) (0.99) (0.80) (0.87) Effect size η2 = 0.22 Daily time spent writing and receiving e-mail a M 58.8 66.9 51.9 58.8 1 = 2 = 3 (SD) (49.2) (44.4) (57.3) (50.1) Effect size N.S. Daily time spent in Internet chat rooms a M 36.3 60.0 38.1 43.2 2 > 1, 3⁎⁎; 1 = 3 (SD) (29.4) (47.7) (26.4) (31.5) Effect size η2 = 0.10 Daily time spent in interactive on-line games a M 64.8 202.2 47.4 66.9 2 > 1, 3⁎⁎; 1 = 3 (SD) (60.3) (82.5) (45.0) (65.7) Effect size η2 = 0.10 Daily time spent on Internet a M 116.4 145.5 119.4 119.4 2 > 3⁎; 1 = 2, 1 = 3 (SD) (68.1) (85.5) (73.2) (77.4) Effect Size η2 = 0.07 BDI score M 9.17 14.15 11.32 11.33 1 = 2 = 3 (SD) (6.89) (8.23) (9.02) (8.11) Effect size N.S. Note.⁎⁎p ≤ 0.01. p ≤ 0.05. a Daily time is reported in minutes. Table options Schizotypal individuals have significantly fewer interpersonal relationships, ... Fig. 1. Schizotypal individuals have significantly fewer interpersonal relationships, but spend significantly more time participating in social Internet activities. ⁎⁎Schizotypal adolescents reported significantly fewer “real-life” friends, while there were not differences between controls. Adolescents with SPD reported spending significantly more time than controls participating in Internet chat rooms and playing socially interactive online games but not sending e-mails; there were no differences between control groups. Figure options Bivariate correlations were used to test the associations of Internet use with self-reported friendships and BDI score. Because previous studies have shown that increased Internet use is associated with depression among youngsters (e.g., Wolak et al., 2003), partial correlations, controlling for BDI, were used to test for association of Internet use with SPD symptoms (as assessed by the SIPD-IV; nine symptoms each rated from 0 to 3) and the results are presented in Table 4. The number of ‘real-life’ interpersonal friendships was not associated with time spent e-mailing, but was significantly negatively correlated with time spent in a chat room, and showed a strong negative trend for time spent participating in online games. Thus adolescents with fewer friendships spend more time in chat rooms on the Internet. Consistent with the prediction, daily time in chat rooms was positively associated with SPD symptoms and the BDI score, indicating that those who spend more time in chat rooms have more severe symptom ratings. Daily time spent participating in online games was associated with three SPD symptoms, and showed a positive trend with elevated BDI scores. Again, more severe ratings of odd/eccentric behavior and unusual perceptual experiences were linked with more time spent in online games, whereas inappropriate/constricted affect was not associated with participation in online games. Time spent e-mailing was associated with odd/eccentric behavior and social anxiety. Table 4. Associations between social Internet use and psychiatric symptoms (n = 69) Psychiatric symptoms Email Chat room On-line games “Real-life” friendshipsa 0.02 − 0.20⁎ − 0.18 Beck depression inventoryb 0.12 0.39⁎⁎ 0.18 Schizotypal symptomsa Ideas of reference 0.07 0.42⁎⁎ 0.19 Odd beliefs/magical thinking − 0.21 0.02 − 0.05 Unusual perceptual experience − 0.08 0.24⁎ 0.26⁎ Odd thinking and speech 0.18 0.12 0.25 Suspicious/Paranoid 0.11 0.26⁎ 0.15 Inappropriate/Constricted affect 0.02 0.17 − 0.13 Odd and/or eccentric behavior 0.23⁎ 0.24⁎ 0.29⁎ Lack of close friends 0.05 0.07 0.06 Excessive social anxiety 0.24⁎ 0.24⁎ 0.33⁎⁎ a Partial correlations controlling for BDI. b Bivariate correlations. ⁎ p ≥ 0.05. ⁎⁎ p ≥ 0.0.