Managing Problematic Usage of the Internet and Related Disorders in an Era of Diagnostic Transition: An Updated Review

Bernardo Dell’Osso1, 2, 3, Ilaria Di Bernardo1, *, Matteo Vismara1, Eleonora Piccoli1, Federica Giorgetti1, Laura Molteni1, Naomi A. Fineberg4, 5, 6, Calogero Virzì1, 7, Henrietta Bowden-Jones8, Roberto Truzoli1, Caterina Viganò1
1 Department of Psychiatry, University of Milan, Department of Biomedical and Clinical Sciences “Luigi Sacco”, ASST Fatebenefratelli-Sacco, Milan, Italy
2 Department of Psychiatry, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, Stanford, CA, USA
3 Aldo Ravelli” Center for Neurotechnology and Brain Therapeutic, University of Milan, 20142 Milan, Italy
4 Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Welwyn Garden City, Hertfordshire AL8 6HG, UK
5 Center for Clinical & Health Research Services, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
6 School of Clinical Medicine, University of Cambridge, Cambridge, UK
7 Department of Clinical and Molecular Biomedicine, Psychiatry Unit, University of Catania, Catania, Italy
8 Central North West London NHS Trust, Division of Brain Science, Imperial College London, London, UK

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© 2021 Dell’Osso et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Psychiatry, University of Milan, ASST Fatebenfratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy; Tel: +390239042803; +390239042904; E-mails:;



Problematic Usage of the Internet (PUI) refers to a broad and likely heterogeneous group of Internet-related conditions associated with behavioural disturbances and functional impairment.


Within PUI several conditions have been reported, including Gaming Disorder, Shopping Addiction, Cyberchondria, Gambling Disorder, Cyberpornography Addiction and Cyberbullying. While increasing reports in the field try to define the epidemiologic and clinical boundaries of these conditions, the rapid and continuous evolution of Internet related behaviours as well as their problematic/pathological expressions are often difficult to diagnose, assess, approach with treatment interventions and follow-up.


In addition, some of the PUI-related conditions show characteristics of addiction to the Internet as a preferential tool to engage in specific behaviours, while some others exclusively manifest on the Internet, making it necessary to find distinct assessment and treatment pathways.


The inclusion of Internet Gaming Disorder in Section III by the DSM-5 and the recognition of Gaming Disorder by the ICD-11 opened the way for a systematic clinical investigation of this and other PUI-related conditions, particularly in terms of preventive and therapeutic strategies. The present article is aimed at offering an updated clinical overview on the main expressions of PUI, focussing on the latest acquisitions in this evolving field.

Keywords: Problematic usage of the internet, Management, Internet gaming disorder, Online gambling disorder, Cyberchondria, Cyberpornography addiction, Cyberbullying, Online shopping addiction.