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General Hospital Psychiatry 33 (2011) e15 e16
Letter to the Editor
An adolescent case with Internet addiction and hacking:
how are we dealing with this diverse spectrum of disorder?
To the Editor,
We would like to bring your attention to an adolescent
case of internet addiction. This common disorder may be
placed in the Diagnostic and Statistical Manual of Mental
Disorder, Fifth Edition soon [1]. It has been characterized by
inability to limit Internet use despite an awareness of its harm
on academic and social life. The addicted people experience
intense anxiety when they face any limitation of their
Internet access. This type of addiction has been reported in
the literature since mid-1990s and has been increasing in
prevalence [2].
Our case was a 16-year-old adolescent who was a first-
year high school student and failed his classes due to
absenteeism. Before the last 2 years, he was a successful and
bright student in his class. However, he became addicted to
the Internet and had been spending as much as 20 hours per
day on the computer. To attempt to help him with this
addiction, the family removed the modem and the computer
from the house. This resulted in his using the Internet in cafs
during the day, instead of going to school. This resulted in
continuous conflict with his father, and eventually, he was
brought to our hospital.
In our interview, he showed a total awareness about his
addiction. He was a member of a hacker group that consisted
of six levels from beginner to competent hacker. He had
several duties within the group and believed that those need
to be completed. The group had a mission of hacking and
destroying pornography and enemy sites. They have
successfully achieved this mission hundreds of times.
There was no other idea in his mind but his mission, and
he had been awaiting new orders from the hacker's
committee. Because of the possibility of receiving an
imminent order, he had to stay on the Internet. There was
no day in which he decided to be off the Internet in the
last 2 years. When his father tried to prohibit him from
Internet access, he experienced episodes of anger and intense
anxiety. He was ready to separate from his father and to
reject other family members if they continue to try to limit
his Internet use.
In treatment, we first established a very close collabora-
tion with the family. Based on his previous success history at
0163-8343/$ see front matter 2011 Elsevier Inc. All rights reserved.
the school, a good rapport was built with the patient. He was
followed regularly for about 3 months with scheduled
interviews every other day in the first 2 weeks and then once
a week for the rest of the treatment period. His situation was
discussed in detail in each interview. He was a first-year high
school student and failed his classes due to absenteeism. As a
result of this, he became depressed and anxious. Use of the
Internet was the most important thing in his life; he neglected
everything else to engage in this behavior, and it compro-
mised most other areas of his life. He also built up tolerance
over time, experiencing withdrawal symptoms if he was
unable to use the Internet.
Outcome variables were evaluated over follow-up, such
as his motivation, online time management, improved social
relationships, engagement in offline activities and ability to
abstain from problematic applications. We assisted the
patient to develop critical problem-solving abilities and
coping skills that would help avoid symptom recurrence. The
treatment successfully stabilized his emotions. Furthermore,
he applied cognitive behavior skills in daily life continuous-
ly, and he did exercise and kept company with an individual
who helped reinforce appropriate behavior. He was directed
to the social activities and to team sports.
The psychological treatment was supported with sertra-
line, carbamazepine and risperidone. Sertraline was started
with the dose of 50 mg per day, and the dose was increased to
100 mg per day within 1 week. After 6 weeks, he showed
partial remission. Therefore, risperidone 1 mg per day and
carbamazepine 200 mg per day were added within 4 days. At
the end of the treatment, he was able to use the Internet
without any addiction.
Problematic Internet use has been proposed as an
explanation for uncontrollable and damaging use of the
Internet [3] and has been described in the psychiatric
literature. Despite valuable opportunities for psychoeduca-
tion and support, there are many potential dangers associated
with Internet overuse. The young population is the primary
target of this addiction. It can cause emotional and social
issues and can show comorbidity with other behavioral and
psychiatric disorders and also might show resistance to the
treatment [4]. As a result, we believe that Internet addiction
has been spreading faster than other types of addiction.
Physicians should be aware about early stages of this
addiction, and strategies should be developed as quickly as
possible to protect the young population.
e16 Letter to the Editor / General Hospital Psychiatry 33 (2011) e15e16
Mustafa Solmaz, M.D.
Hasan Belli, M.D.
Bagcilar Education And Research Hospital
Department of Psychiatry
Istanbul, Turkey
E-mail address: hasan.belli@hotmail.com
Sefa Saygili, M.D.
Bezmialem Vakf Gureba Education And Research Hospital
Department of Psychiatry
Istanbul, Turkey
doi:10.1016/j.genhosppsych.2011.04.001
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[4] Shapiro NA, Goldsmith TD, Keck Jr PE, Khosla UM, McElroy SL.
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