Throughout history, the introduction of technology has generally had positive effects on the quality of the human existence. Nevertheless, in many cases even the most innocuous of innovations have come with an associated negative effect; a dark lining on a silver cloud. Passenger jets have made the world smaller, for example, but have also brought about jetlag, highjacking and a global risk of epidemic and disease. Computers have revolutionized everything from research science to communications, but have also introduced the world to cybercrime, cat fishing, and tech support. Few would argue that technology is a bad thing, but an equally small number would dispute the negative effects associated with transformative tech. The Internet was the double-edged sword of the 1990’s, connecting the world but also creating a new breed of addicts, pale as the moon, asleep during the day, and fixing in chat rooms at night.
Today’s most recent class of junky no longer needs a bulky desktop or even a large-screen MacBook to feed their addiction. Cellphones, smartphones in particular, are the latest tools of abuse. According to a 2012 survey, 84% of those polled believed they would not last a day without their smartphone (Parasuraman, Sam, Yee, Chuon & Ren, 2017). A meta-analysis of studies on mobile phone addiction concluded that 50% of all adolescents and 27% of parents surveyed across 206 studies believed they were addicted to their cell phone (Parasuraman et al., 2017). Despite these lofty and disturbing numbers, there is little agreement on what exactly constitutes a cellphone addition and more pointedly, whether such a phenomenon exists at all (Gutierrez, Rodriguez de Fonseca & Rubio, 2016). Even among those psychologists that believe cellphone addiction should be added to the Diagnostic and Statistical Manual of Psychiatric Disorders, there is little agreement as to whether addiction to an iPhone is a cause of cognitive and affective disruption or a symptom thereof (Gutierrez, Rodriguez de Fonseca & Rubio, 2016). This paper will explore the current literature on cellphone addiction and attempt to synthesize the current prevailing opinions on the abuse of cellphones. Literature Search and Review
A literature search was conducted using a variety of key words and phrases. A master search of academic databases using the terms “cell phone addiction” returned over 5,591 peer-reviewed articles that met the preliminary search criteria. The results were then limited to peer-reviewed articles from the past five years, which reduced the number of studies available for possible inclusion to 2,660. Additional searches were conducted with added keywords such as “student,” “abuse,” and “mobile phone.” Eventually, nine studies were selected for inclusion in this paper, representing several different methodologies and topical specificity. Of the studies, one was a declarative review, six were survey-based primary research studies using non-RTC methodology, one was a study of the neurobiology of cell phone addiction, and one was a declarative paper discussing ways of mitigating cellphone mediated social media abuse in the college classroom.
The point regarding the random and uneven definition and demarcation of cell phone addiction made by Gutierrez and et al. seems to be valid (2016). The papers consulted did not reference any common scale or empirical tool to assess the prevalence of cell phone addiction in whatever cohort was being studied. As a result, prevalence figures were so varied as to be nearly unusable (Gutierrez, Rodriguez de Fonseca & Rubio, 2016). This is not to say that the studies were all flawed or poorly controlled and interpreted, merely that the state of the science has yet to mature (Gutierrez, Rodriguez de Fonseca & Rubio, 2016). In most cases, the methodologies were well documented and seemed to have some degree of reliability. The question remains, however, whether the dimensions measured and reported are actually valid indicators of a psychology disorder.
Most of the studies focused on a specific geographical area, ranging in size from a single college campus to the entire country of China (Wang et al., 2016). What is of note and perhaps lends some weight to the argument that cell phone addiction is a genuine, diagnosable dysfunction with a biological basis are the extremely diverse regions of study. One study took place in a University in Iran (Ghasempour & Mahmoodi-Aghdam, 2015). Another took place in Taiwan (Kuang-Tsan & Fu-Yuan, 2017). In general, Pacific Rim nations including China and Korea were over-represented, perhaps due to a higher prevalence of the disorder in these countries (Parausraman et al., 2017). Based on the widespread research occurring in extremely disparate parts of the world it seems there will eventually be some consensus on the existence of a disorder related to unhealthy overuse of cellphones.
Definition of Disorder
Part of the problem with defining cell phone dependence as a disorder is the almost exclusive use of self-report surveys to estimate the prevalence of the putative addition (Gutierrez, Rodriguez de Fonseca & Rubio, 216). All six of the survey-based studies examined for this paper followed this design. In essence, if a respondent said they felt addicted to their cellphone then they were. Gutierrez and et al. carefully delineate the difference between physical (Chemical) dependence and behavioral addictions (2016). This is a critical distinction because it strikes at the heart of the problem: Physical addictions can be readily studied via various biomarkers and physically verifiable signs and symptoms while behavioral dependencies have no measurable dimensions to detect (Gutierrez, Rodriguez de Fonseca & Rubio, 2016).
Gutierrez and et al. do make a suggestion that may help to clarify the matter for future investigation. The Diagnostic and Statistical Manual of Psychiatric Disorders 5th Edition (DSM-V) is one of two tools used by mental health clinician to diagnose various mental illness such as mood and personality disorders. Gutierrez and et al. make an apt comparison between the diagnostic criteria for substance abuse disorder, gambling disorder which is the only non-substance related addictive disorder listed in the DSM-V, and the common characteristics associated with cell phone addiction (2016). The Table below summarizes their findings: The behavioral manifestations of cell phone addition appear suspiciously similar to both gambling and substance addiction (Gutierrez, Rodriguez de Fonseca & Rubio, 2016). Using this similarly as proof positive the conceptual basis of the disorder is sound seems like a way to create some congruency between future studies.
Dysfunctions: Chicken or Egg?
Definitions aside, there is also some confusion as to whether the dysfunctions seen in cell phone addiction are actually symptoms of the overuse of the device itself, or if the cellphone dependency is a result of a preexisting disorder (Gutierrez, Rodriguez de Fonseca & Rubio, 216). There does appear to be some physical symptomology associated with cell phone addiction. Dry eyes have been reported amonst over-users, thumb and finger weakness and various over-use disorders such as carpal tunnel syndrome and tenosynovitis, and neck pain and injury (Parausraman et al., 2017). Other non-specific physical problems have been cited in the literature reviewed, although actual verifiable data is limited (Kuang-Tsan & Fu-Yuan, 2017). One of the clear signs of a persistent maladaptive behavior is continuation of that behavior despite clearly associated physical damage produced by that behavior. Thus, if excessive cell phone use continuations despite physical pain then one of the clear determinants of diagnosable mental illness has been met. This is compelling since the reverse- an underlying physical problem driving excessive cell phone use- seems extremely unlikely.
Dysregulated affect is more commonly associated with cell phone addiction but is also less clearly causally linked. Depression, for instance, is cited in numerous studies as a mood disorder triggered by cell phone addiction (Kuang-Tsan & Fu-Yuan, 2017). Both the study by Kuang-Tsan and the study by Gao and et al. list depression as a result of cell phone addition (2017, 2018). The study conducted in Iran however, begins with a definition of the symptoms of depression but not to demark them as signs of cell phone addiction (Ghasempour & Mahmoodi-Aghdam, 2015). The Iranian study contends rather, that depression is a risk factor for the development of cell phone addition (2015). Presently, there is no way to be sure which association is correct. In order to determine which is the cause and which is the effect, a retrospective study would have to be constructed that measured self-reported depression and cell phone addiction with a temporal correlation to see if one disorder precedes the other in a statistically meaningful way. So far, there does not seem to be such a study in the extant literature.
One study of Chinese mobile phone users found an association between cell phone addiction and alexithymia (Gao et al., 2018). Alexithymia is a disorder characterized by flat affect, or at least a difficulty in conveying emotional states, an inhibited ability to differentiate between physical sensation and emotional state, and a cognitive style focused on an external locus of control (Gao et al., 2018). This constellation of symptoms was originally associated with people who suffered from unsubstantiated physical ailments who were then frequently exhibited a lack of humor and joy, a failure to see any purpose in life, generalized anxiety, and stereotypical inflexible thinking (Gao et al., 2018). In this case, the researchers found a positive correlation but concluded that alexithymia was a predictor of cell phone addiction and not a result there of (Gao et al., 2018). From a diagnosable dysfunction standpoint, there seems to be a no real consensus on what is cause and what is effect.
What does it look like?
Cause and effect aside, there are clear behaviors associated with cell phone addiction. One facet of the disorder that is cited by nearly every study is the compulsion to constantly check and be communicating on a mobile device (Sekhon, 2018). The criteria that differentiates addiction from simply being fond of an activity can be measured a number of ways. The first is the exhibition of a behavior at inappropriate times. For an alcoholic, this might be drinking at work at seven o’clock in the morning. For a cellphone addict, constant use of their phone during college lectures, while other people are attempting to communicate with them, or in other social situations where cell phone use is considered rude is an analogous behavior (Benjamin, 2016). Inappropriate use can also involve chronic cell phone usage in situations where that usage is unsafe (Kuang-Tsan & Fu-Yuan, 2017). Most states have past legislation that outlaws the use of a mobile device without a hands-free attachment while operating a motor vehicle (Gutierrez, Rodriguez de Fonseca & Rubio, 2016). In the case of a cell phone addict, the urge to check their phone would be so overpowering that even after multiple citations for using a mobile device while operating a motor vehicle, they would still be incapable of resisting the impulse.
Impulsivity is a trait that has also been associated with cellphone addiction, both as a symptom and as a risk factor for its development (Gao et al, 2018). Here again there is a question of cause and effect, but there is no dispute amongst the various studies that there is a correlation (Kuang-Tsan & Fu-Yuan, 2017). Poor impulse control is associated with addiction in general, and as noted above, cell phone addicts find the urge to check and use their phones nearly irresistible. This may be why there is a reported significant comorbidity with cell phone addiction and substance abuse (Kuang-Tsan & Fu-Yuan, 2017). This is another behavioral symptom where the underlying cause is indeterminate. Substance abuse has long been correlated with anxiety and life and environmental stressors (Kuang-Tsan & Fu-Yuan, 2017). In the case of substance abuse, the addict turns to alcohol or drugs to escape from or relive chronic anxiety even though in the long run the addictive behavior makes life-stress worse (Kuang-Tsan & Fu-Yuan, 2017). Some researchers see a correlation here, and regard cell pane addiction as a similarly maladaptive response to stress and anxiety Kuang-Tsan & Fu-Yuan, 2017). Others, however, see stress and anxiety as a result of the addiction itself. Again, what is not in dispute is that cell phone addicts experience a higher level of stress and anxiety than their peers.
There is a sort of grab bag of other behaviors and symptoms associated with cellphone addition. A gradual loss of the ability to interact socially, at least in in-person situations is commonly found in cell phone addicts (Dziurzynska, Pawlowska, & Potembska, 2016). This is similar to what is seen in people suffering from internet addiction, although in the case of those struggling with excessive time spent online, the evidence points to a predisposition to social anxiety and ineptitude that is a risk factor for internet addition (Dziurzynska, Pawlowska, & Potembska, 2016). Low self-esteem has also been associated with cell phone addiction (Ghasempour & Mahmoodi-Aghdam, 2015). This is not an uncommon comorbidity with several of the other disorders tentatively tied to cell phone addiction such as depression and anxiety, so this is not surprising. Finally, there are a number of “disorders” that have been invented to describe the behavior of cell phone addicts but that have absolutely no genuine diagnostic value or status. FOMO or “Fear of Missing out” describes the compulsion to constantly check a mobile device in fear that a momentary lapse in vigilance will cause the user to miss something important. Nomophobia describes the fear of being out of cellphone range or contact (Kuang-Tsan & Fu-Yuan, 2017). It has been suggested that this condition is better described as a subset of generalized anxiety disorder rather than as a phobia (Kuang-Tsan & Fu-Yuan, 2017). In any event, neither FOMO nor nomophobia are terms in clinical use.
Studies examining the physiology of cellphone addiction are few and far between, mostly because brain dysfunctions are usually only diagnosed post-mortem. One study however, used functional MRI scanning (fMRI) to measure the integrity of white matter in the brain as a way to examine if cell phone addiction either was a product of or caused alterations in brain structure. What the investigators determined was that much like in persons with impaired impulse control, there were significant deficits in white matter in certain regions of the brain including the right superior frontal gyrus (Wang et al., 2016). Whether these deficits are a result of brain alterations after addiction to mobile devices or risk factor for their development remains to be seen, but it is compelling evidence that the behavioral alterations seen in cell phone addicts are the result of genuine physical phenomenon.
It seems that the number of behaviors, objects, and activities that are presumed to be addictive exponentially expands every year. Cell phones might be the latest in this fad of assigning addictive properties to any maladaptive behavior.