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was statistically important in explaining several types of technology-related activity including gaming and cybersex. Network modeling found that the broad construct of Internet Addiction had high centrality parameters in the model examined i.e. In the alternative, PUI may be a syndrome in its own right, particularly if different online activities co-occur together to similar degrees with increasing symptom severity. The Internet may be viewed as a conduit through which individuals manifest discrete behavioral syndromes such as Gambling Disorder, Gaming Disorder, Compulsive Buying/Shopping Disorder, or Compulsive Sexual Behavior Disorder. PUI has been the subject of considerable interest and theoretical debate since being introduced as a topic of study over 20 years ago. It should be noted that causality has not yet generally been established, but these above-noted associations highlight the need to better define and operationalize PUI.

For example, people with PUI exhibit elevated rates of psychiatric disorders, including anxiety disorders, impulse control disorders, attention-deficit hyperactivity disorder, and addictions and associated physical health issues such as obesity. PUI has important public health consequences.

Gaming Disorder, a manifestation of PUI, is likely to be included in the International Classification of Diseases Version 11 (ICD-11), and Internet gaming disorder has been listed as being in need of further study in the Diagnostic and Statistical Manual Version 5 (DSM-5). While the Internet offers many benefits, it is recognized that some users develop excessive use, referred to by the umbrella term ‘Problematic Use of the Internet’ (PUI). Since its development in the 1980s, the Internet has become a global technology and is now used by > 50% of the world’s population, with penetrance being particularly high in North America, Europe, and parts of Asia (World Bank Global Data, 2018).

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