Presentation discuss on Internet addiction and Some information about Blue Whale challenge... (Regarding blue whale the information is from w=various media)

1. Internet Addiction Disorder
Blue Whale Challenge
Dr. Raj Kiran
Senior Resident
Dept. of Psychiatry,
KIMS, Amalapuram

2. • Brief history of internet
• Internet Addiction Disorder
– Introduction
– Prevalence
– Etiology
– Clinical features
– Diagnosis
– Treatment approaches
• Blue Whale Challenge

3. Internet
• Vinton Cerf and Robert Kahn- inventors of internet.
• Tim Berners Lee- introduced www.
• Invented for defense purposes.
• In 40 yrs, it metamorphosed from a military
communication network into a vast global
cyberspace.

4. • Till recently internet was considered a amenity but
now it is becoming more of a necessity…
• Especially so after the launch of Jio in India, the users
are expected to cross 420 million…!!!
• Almost 7 out of 20 Indians are using internet

5. Internet vs Substance use
• Internet offers several direct benefits as a technological
advancement and not a device to be criticized as
“addictive”.
• In comparison, substance dependence is not an integral
aspect of our life nor does it offer any direct benefit.
• Detection and diagnosis is difficult, necessitating to
understand thin difference between normal and
pathological use.

6. Internet addiction disorder
• First proposed by Kimberly Young.
• Initially addiction was applied only to ingestion of a drug.
• Defining addiction, has moved beyond this to include a
number of behaviors which do not involve an intoxicant.
• Similarities exist with substance use disorders- tolerance,
withdrawal, difficulty in controlling, impairment in
normal functioning.
Young KS. Internet addiction: symptoms, evaluation and treatment. Innovations in clinical
practice. Vol 17 by Vande creek & Jackson.

7. Magnitude of problem
• South Korea witnessed 10 cardiopulmonary related deaths
in internet café and estimated approx 2.1% of teens
affected.
• China reported 13.7% of adolescents qualify for internet
addiction and began restricting computer use.
• Probably South Korea and China were the first to consider
internet addiction a serious public health problem.
Block JJ. Issues for DSM V: Internet addiction. Am J Psychiatry 165:3, Mar 2008.

8. • Aka-
– Internet use disorder
– Problematic Internet Use
– Computer Addiction
– Internet Dependence
– Compulsive Internet Use
– Pathological Internet Use
• 3 subtypes-
1. Excessive gaming
2. Sexual preoccupation
3. e-mail/ Text messaging

9. Prevalence
• Western literature- 0.7 to 38%
• Study by Deepak Goel in 2013 among 1000
college students in Mumbai-
– 0.7% addicts
– Male > Female
– More commonly- Social networking, chatting &
downloading media files
A Study on the prevalence of internet addiction and its association with psychopathology in
Indian adolescents. D Goel A Subramanyam & R Kamath. IJP. 2013 Apr-Jun; 55(2): 140-3

10. Measuring the problem
• Variety of assessment tools
are available.
• Youngs Internet Addiction
Test, Problematic Internet
Use Questionnaire,
Compulsive Internet Use
Scale.
Youngs Internet Addiction Test
• 20 questions.
• 7 point likert scale.
• Ranges from 0 to 6 (does
not apply to always).
• Score of 80 to 100-
significant problems
Young KS. Caught in the net. New York: John Wiley & Sons (1998)

11. Etiology
• Neurological vulnerabilities-
Activates Reward/ Pleasure pathway
Release of dopamine, opiate and others
Tolerance
• Reinforcement/ Reward-
– Internet uses variable ratio reinforcement schedule (VRRS).
– Application- support unpredictable & variable reward
structures  reward experience is intensified when
combined with mood enhancing/ stimulating content.
Internet Addiction: A brief summary of research and practice. Cash H, Rae CD, steel AH
& Winkler A. Current Psychiatry Reviews, 2012, 8, 292-8.

12. • Biological predisposition-
 Inadequate dopamine receptors or insufficient
amount of 5HT/ dopamine
 Difficulty in experiencing normal levels of pleasure
 Involve in activities that increase dopamine
• Mental Health Vulnerabilities-
– Variety of mental disorders co-occur
– Depression, anxiety, hostility, interpersonal problems..

13. • Psychological theory (ACE model)
– Accessibility- easy & immediate access to
gambling, shopping, gaming at any time.
– Control- no restriction to use
– Excitement- feeling of rush with winning an online
auction, game, gambling.

14. Clinical features
Behavioral symptoms
• Sleep deprivation
• Fatigue
• Solitary life
• Family problems (Cyberwidow)
• Disruption in close relationships
• Decline in academics
• Problems at occupation
• Abuse of drugs- caffeine
Physical symptoms
• Carpal tunnel syndrome
• Dry eyes
• Backache
• Headache
• Irregular eating habits
• Poor personal hygiene
• Sleep disturbances
Young KS. Internet addiction: symptoms, evaluation and treatment. Innovations in clinical
practice. Vol 17 by Vande creek & Jackson.

15. Criteria
• Addiction, when 5 or more are reported-
– Preoccupied with the internet use.
– Need to use with increasing amounts of time.
– Unsuccessful attempts to control, cut down or stop.
– Attempting to cut down has caused restless, moody, depressed
or irritable.
– Staying on line longer than originally intended.
– Loss of significant relationship, job, educational or career
opportunity.
– Lying to conceal the extent of involvement.
– Using to escape problems or relieving a dysphoric mood.

16. Treatment
• Goal-
– Abstinence from problematic applications.
– Controlled and balanced internet usage.
– Total abstinence is not the goal.
• Most treatment studies were of low
methodological quality.
• Broadly classified into Pharmacological,
Psychological and Multi-modal approaches

17. Pharmacological approaches
• SSRIs
– Because of co morbid depression, anxiety.
– Escitalopram- found to reduce internet usage from
36hrs/week to 16hrs/week.
• Bupropion
– Decreased craving, total game play and cue
induced brain activity.
•Dell'Osso . Escitalopram in the treatment of….J of Clin Psy. 2008 Mar; 69(3): 452-6.
•Han DH. Bupropion sustained release treatment decreases … Exp & Clinical
Psychopharmacology. 2010 Aug; 18(4): 297-304.

18. • Methylphenidate-
– Used in children with ADHD, internet usage time
reduced significantly.
• Mood stabilizers-
– Might improve symptoms.
• Others- citalopram+quetiapine, naltrexone
•Han DH. The effect of methylphenidate on Internet … Com Psy. 2009 May-Jun; 50(3): 251
•Shapira NA. Psychiatric features of ... Journal of affective disorders. 2000 Jan-Mar; 57(1-
3): 267-72.

19. Psychological approaches
• Some strategies-
– New activities in place of internet use.
– Using of real life external stoppers.
– Setting goals with time of use.
– Abstain from a particular application.
– Using of reminder cards.
– Entering a support group.
– Engaging in family therapy.
Young KS. Internet Addiction: Symptoms, Evaluation, And Treatment. Innovations in
Clinical Practice. 1999; 17

20. Therapies
• Motivational interviewing
– Enhancing intrinsic motivation to change by exploring
and resolving client ambivalence.
• Reality therapy
– Clients are shown that addiction is a choice.
– Time management & alternative activities in
problematic behavior are taught.
• CBT

21. Multi Modal approaches
• Implementation of several different types of
treatment
• reSTART- Internet Addiction Recovery Program
– IP internet addiction recovery program.
– Integrates technology detoxification, CBT,
Experiential adventure based therapy, Brain
enhancing interventions, Animal assisted therapy,
Mindfulness based stress reduction… etc..,
reSTART: Internet Addiction Recovery Program. First detox center for Internet addicts
opens its doors. 2009 Available from: http: //www.netaddictionrecovery.com.

22. Interesting !!!
• Pacenza v IBM corp, 2010 (New york)-
– IBM fired plaintiff for visiting an adult chat during working
hrs.
– Plaintiff sued IBM of $5 million, claiming he is an internet
addict who deserves treatment and sympathy rather than
dismissal.
– Further stated that stress caused him to become internet
addict and claimed protection under American with
Disabilities Act.
– Claim was nonetheless dismissed.

23. “I feel technology has brought so much joy into my life.
No other activity relaxes me or stimulates me like
technology.
However, when depression hits, I tend to use technology as
a way of retreating and isolating”
-21 yr old of Internet Addiction

24. Blue Whale Challenge

25. Origins
• Game reportedly started in Russia in 2013 with F57
(death group of Vkontakte- Russia’s social network).
• Alleged to caused its first suicide in Dec 2015.
• Philipp Budeikin claimed to have created the game.
• He was a Psychology student who was expelled from
University.

26. Philipp Budeikin
• Purpose- ‘Clean’ the society by pushing
suicide to those he deemed as having no
value.
• Arrested for inciting 16 teenagers to kill
themselves.
• Pleaded guilty and sentenced to 3yr
imprisonment.

27. Why the name?
• Blue Whale- comes from Bleached whales, which
is linked to suicide.
• Bleaching- phenomenon in which cetaceans
strand themselves on land, usually on beach.
• Die due to dehydration, collapsing under their
own weight or drowning when high tide covers
the blowhole.

28. Magnitude of problem
• First alleged case- Mumbai, a 14yr old jumped
from 7th floor to death.
• India- around 7 suspected cases were reported.
• Worldwide around 130 cases were reported.
• Reportedly spread over various countries like-
Russia, US, China, Saudi Arabia, Spain etc..,

29. Structure of game
• Dare game monitored by a curator.
• Curator instructs participants to complete 50 tasks
spread over 50 days, which include self injury, watching
horror clips and listening to audio clips.
• As the game progresses the complexity of task
increases and on the final day it culminates in suicide.
• Participants must prove the completion of task by
sending photos or videos of tasks.

30. Traits of victims
• Age group- Teenage
• Want to please everyone
• Acceptance from others/ fear of rejection
• Fear of negative emotions
• Dependent on others
• Lack of assertiveness and ability to say ‘no’
• Clinical depression

31. Psychology of game
• Initially victims get attracted by peer pressure or curiosity or thrill.
• Once they enter, they are blackmailed to prevent them from leaving.
• The game tricks to make victim depressed by giving them disturbing
content to watch and listen repeatedly.
• Victim is exposed to doing self injury. Initially with small tasks which
escalate over time like small cut on skin or prick.
• Interestingly the self injury gives feeling of relief from negative mental
state for short time. By this victim finds emotional connection for
curator.

32. • Curator does not allow the victim for adequate sleep.
• Disrupted/ Inadequate sleep  Increase in tension, vigilance,
irritability, fatigue and so decline in fitness level.
• A vicious cycle of inactivity and disturbed day sets in. This in turn
turns off the normal defence mechanisms.
• Each step is monitored by asking to post photos or videos of task
and at intervals to talk to other victims to be in the loop.
• Ultimate result is poor self esteem and feeling of loss. By which
victim is willing to do anything asked by curator

33. Self harm- Positive feeling???
• Self harm behavior is commonly seen in
individuals with Unstable Personality Disorder.
• Studies-
– Decreases or distracts from aversive thoughts or
feelings  temporary relief.
– Repeated exposure causes decrease in physiological
arousal and improvement in relationship.
– Others- Causes pain analgesia, identification with
others.
Nock MK. Why do people hurt themselves? New insgihts into the nature and functions of
self injury. Curr Dir Psychol Sci. 2009 April 1; 18(2): 78-83.

34. Patterns of self injury

35. Identifying the victim
• Cuts or bruising on body parts like left arm or leg.
• Using internet at odd times and all day and hiding
something.
• Hiding the screen when approached.
• Staying in isolation.
• Wake up at 4:20am and going outside.
• Visiting graveyard.
• Possessing drawings of blue whale.
• Writing things like “#IamWhale”, “F57”.
• Changes in behaviour.

36. What can be done?
• Creating widespread media awareness.
• Awareness program for children and parents.
• Introducing a “Whistle blower” scheme where students
report to authorities about any abnormal behavior of
other students.
• Appointing an “Internet Counselor” to address
students and meet any one who like to seek guidance.

37. Legal angle
• Madras HC directed the centre to use diplomatic
relationship with Russia to block URLs/links to the game.
• MeitY had written to MS India, Fb India, Yahoo India &
other social media to remove the link to the game.
• Google India washed off hands of any responsibility when
asked to remove the game.
• Game is not downloadable, but it is available via Whatsapp,
Wickr, ShareIt etc.., where a anonymity of the users is
ensured.

38. Anti Blue Whale campaign

39. Others…
• Ghost pepper challenge
– Sticking ghost pepper in mouth
• Cinnamon challenge
– Swallowing cinnamon powder without water
• Choking challenge
– Choking to experience euphoria
• Ice & Salt challenge
– Pouring salt on body followed by placing ice over it
• Car Surfing challenge
– Riding a car tied to an object

40. Madras High Court
“Online games tap such tendencies innate in individuals.
They challenge the player to move from one level to the next
higher level.
They are addictive.
Mostly, they are a meaningless waste of time, though some are
psychologically harmful.
But where the end result is fatal, it can no longer be ignored as
something private.
Blue Whale is one such game”
-Justice KK Sasidharan & Justice GR Swaminathan (4th Sept 17)