No-mobile-phone-phobia and its inclusion in the DSM

            The rise of every generation always comes by hand with a new remarkable technology. As time goes on, we become emotionally attached to these new technologies like something we were predestined to do. In 2007 a new technology arose to change the way society worked and evolve: smartphones. Humans now live in a mobile age in which smartphones are the latest evolution of technology and have become an indispensable part of our lives. According to data from 2016, “58.7% of the world’s population (4.30 billion) was using mobile phones. Nearly half of this number (2.14 billion) is estimated to have been using smartphones and this number is expected to growth in the future years”.[1]According to Pew Research Center’s Mobile Technology Fact Sheet, “as of January 2014, 90% of the American adult population has a cell phone and, 58% of American adults own a smartphone”.[2]In context, Dr. Lee S. from National Yang-Ming University is quoted that “smartphones are particularly popular in young adults. Specifically, high school and college students”.[3]  When society first interacted with smartphones, some thoughts and opinions were oriented towards the long-run benefits of them, but others focused on speculations about the fact that this contemporary high tech could cause more harm than good. Eventually, that stance gain importance when a study conducted by the UK postal office brought insight to the issue in question. Data from questionnaires played a role in the results of this study. The study contained queries ranging from time, use, and level of anxiety in a relationship with smartphone. In the study, researchers reported that 53% of mobile users felt anxious when they were unable to use their mobile phones and over half of the users never shut their phones off. People have become dependent on their mobile phones more than ever, which, in turn, supposedly intensifies the feelings of anxiety caused by being out of mobile phone contact. At the end of the study, a new term was created and with that a new disorder: nomophobia.

The term nomophobia is an “abbreviation for no-mobile-phone phobia and is commonly known as the fear of not being able to use one’s smartphone, and the services it offers.”[4]Subsequent studies around the world have found that the numbers have increased since then. Although the UK study just explored the levels of anxiety regarding smartphone use, currently Psychologists and Researchers are fighting over the inclusion, recognition, and validation of nomophobia as a real disease against the medical community. The goal of this position paper is to present arguments for the validation of nomophobia by the American Psychologists Association (APA) and its further inclusion in the Diagnostic and Statistical Manual of Mental Disorders 6^thEdition (DSM-VI). Therefore, it is essential to explore the current existing literature of nomophobia, the relevance of this disorder to certain aspects of the human behavior and the psyche, the available empirical research, and lastly a possible treatment. This argument must be taken with care since as for now Nomophobia is a proposed disorder. Still, psychologists and researchers emphasize that nomophobia is the result of the development of new technologies and virtual communication devices and it must be taken seriously.

Nomophobia has not been officially recognized as a psychiatric disorder. However, there has been an enormous amount of effort to include the disorder in the (DSM-VI). The DSM is considered to be the gold standard manual for assessing the psychiatric diseases in the light of diagnosis, treatment of neuropsychiatric disorders, as well as the introduction of recent diagnosis criteria adapting it to the current medical tools. Historically a feature of the DSM is its “willingness to the inclusion of the latest medical developments, studies, and hypothesis through the years.”[5]The DSMis currently in its fifth version (DSM-V), that has just been released on May 2013.Psychologist and researchers think that further validation of nomophobia could potentially help people to cope with this disorder. In context, the use of surveys from a wide range of psychological questions has spunk remarkable and alarming data. For instance, surveys conducted in different countries and cultures like the “USA to India[6]through Europe (Spain, Poland,[7]Finland)[8]to Japan,[9]and Turkey”[10]have confirmed that not only experts are trying to deal with nomophobic patients but also that the numbers are increasing. Without a set of treatments and guidelines to follow these same people have been ignored by the lack of veridical guidelines to follow. The major factor is the lack of recognition of this disease, since the fight for validating it overseas the urge for adequate measurements when it comes to study and validate their own cases. Experts understand that this sort of peculiar data can be subject to bias and misinterpretation. Therefore, psychologists like Caglar Yildirim (Ph.D.) and Ana-Paula Correia (Ph.D.) from SUNY Oswego and Ohio State University respectively, have devoted extensive research to the elaboration for the development of a validated questionnaire for “medical or individual purposes.”[11]The questionnaire has questions ranging from timing, able to communicate, loss of connectedness, unable to access information, disturbed behaviors, negative feelings, social/laboral isolation, academic performance and economic problems due to smartphones. This survey is not the only one available to doctors, and the public in general. However, this rises a major problem: surveys can only evaluate people at risk of suffering nomophobia but not a way to diagnose them. Since the majority of the ways to deal with nomophobic patients are not empirically verified and tested at a large scale, it is important to monitor clinicians for the further education of their patients. The validation of nomophobia by the DSM could potentially help fulfill that goal by providing an “adequate diagnosis criterion, definition, recommendations, target population, new psychometric scales and more importantly a treatment.”[12]

Experts have arduously researched the topic of nomophobia. For instance, studies have help psychologists to identify a variety of different symptoms, and effects on the human psyche when it comes to patients dealing with nomophobia. Patients have experienced anxiety, panic, or stress when their smartphone’s battery is low, or when the phone is not available. This is linked to a set of identifiable symptoms that range from “increased heart rate, blood pressure, shortness of breath, anxiety, nausea, trembling, dizziness, depression, discomfort, fear, and panic.”[13]Moreover, Psychologists and researchers such as Jessica S. Mendoza (M.D), Benjamin C. Pody (M.S), Caglar Yildirim (Ph.D.), Ana-Paula Correia (Ph.D.), and Larry Rosen(M.D), among others argue that the same can be linked to symptoms of nomophobia. The action of not being able to use one’s smartphone impairs learning, memory in college students, increases stress from withdrawing as well as affecting productivity in the work environment, and affecting sleep patterns.This has led to a debate among doctors, psychologists, and researcher on its classification. The most popular stances vary from the argument that nomophobia is an “addiction,”[14]“a social phobia,”[15]“an object-oriented phobia,”[16]“anxiety disorder,”[17]“or a situation-specific phobia.”[18]This emphasizes that agreement and more importantly understanding of the topic are lacking. Although nomophobia has not yet found a place in the DSM-V, by considering the set of identifiable symptoms and the diagnostic criteria, the link between a phobia and nomophobia is clear. The DSM-V criteria for a phobia states that: “The person recognizes that their fear is out of proportion, avoidance of the feared situation, an excessive and unreasonable fear or anxiety associated with an object or anticipated situation, exposure to the feared object or situation causes immediate anxiety, and routines and relationships are disrupted due to the phobia”.[19]In context, the recent criteria for a phobia fits adequately the profile of someone who suffers from anxiety when the phone is not available, has a low battery, or simply cannot use it. These people go to great lengths just to ensure their phones are always available to them. Some psychologists like Nicola Luigi Bragazzi (M.D) and Giovanni Del Puente (M.D) from Genoa University in Italy go as far as to propose to modify the section of the DSM oriented to phobias and potentially including new clinically relevant pathologies such as nomophobia. This is the case because the existing literature of nomophobia presents an “overview of discussing the clinical relevance of this pathology, its epidemiological features, the available psychometric scales, and the proposed treatment.”[20]

The lack of inclusiveness in the DSM allows placing in check the validity of nomophobia. Thus, leaving nomophobic patients vulnerable to lack of treatment and more alarming a misdiagnosis. The validation of nomophobia could be beneficial for both parties because in one hand this could potentially help nomophobic patients cope with the disease and in the other hand could prevent the misdiagnosis of people with the actual phobia and others without it. For instance, a research paper wrote for Tayana Panova’s (M.D) and Carbonell X. (M.D) from Ramon Llull University in Spain is quoted “…itis the responsibility of academics to use more accurate language and diagnostic terms. The use of smartphones and other devices are associated with various negative consequences and research on them should continue; however, in order to address and treat their associated problems accurately and effectively, they should not be misdiagnosed as consequences of addiction.”[21]It should be noted that this research paper does not consider nomophobia as an addiction, and neither this one. This paper is oriented towards framing the issue in important terms from considering nomophobia as a phobia. The point to remember is that by validating nomophobia and including it to the DSM, a borderline between a severe addiction or disorder and nomophobia is created. This leads to the efficacy of the treatments such as cognitive behavioral therapy to help nomophobic patients and safeguards the mental health of the patient. By avoiding mismedication, and misdiagnosis, time, money, and effort are devoted towards the well-being of the patient, its resources and its family. According to a recent study from John Hopkins University at Baltimore “…more than 250,000 people in the U.S. die every year from medical errors, these range from misdiagnosis, mistreatment and failure at operation rooms.”[22]Since the field of medicine is constantly evolving, adequate legislations and more importantly research and the validation of contemporary diseases is needed. The validation of nomophobia could potentially save lives by broaden the spectrum of medicine with specific guidelines to help patients with nomophobia.

In our modern era, every single time a new technological invention is created a further control of certain aspects of the human life arises. Still, when it comes to nomophobia, psychologists argue that the creation of new innovations and further discussion among the bad and good things about it, is an inevitable cycle with no end in sight. “In reality only few people are genuinely dependent on their smartphones, and the number of individuals who would likely be debilitated about a fear of not having their smartphone is probably few and far between.” “Like any major change in history, there is a moral panic about this issue and, in reality, most people manage their phone use well.”[23]Says Dr. Mark Griffiths and Dr. Kinman from Nottingham Trent University. Therefore, the fact that only a handful of people become nomophobic and the prevalence of time regarding the moral panic of technologies should be signals that this is not an epidemic and something transient. However, empirical data is demonstrating that people are finding themselves in a difficult situation when it comes to separate themselves from their phones. Also, there is data that shows people with stress, anxiety, feelings of pain, panic, when they are unable to access their phones, with no battery or just loss signal. The same feelings that led to a phobia, or a disorder and what is worse the numbers are increasing. Still, it is true that some case studies like the ones conducted in India by Kanmani A (M.D), Bhavani U (M.S), and Maragatham R (M.S) show that the levels of nomophobia are present but not threatening to the extent to do not recommend medical advice. Still, there is a gradual increase in anxiety, pain, panic, stress among others that impairs and affects “academic performance in college students, labor performance, memory, sleep patterns, and attention.”[24]Some research papers go as far to show that “these results increase when family and friends are close.”[25]Yet, those problems have arisen because relatives avoid people from using their smartphones, also that not being able to use one’s smartphone affects and interrupts work at a high level. Among others, these are signs that we are constantly walking to a technological-total dependency era. If awareness and monitoring of behaviors in a relationship with smartphone use lacks, things may it go out hands until the point of debating if we are using technology or technology is using us. Dr. Kinman also is quoted that, “There is evidence that older people are becoming more dependent on their mobile phones and younger people may be setting ‘rules of engagement’ whereby they have some time phone free.[26]” But, when the time to leave the phone comes “just very few people achieve it” as some research indicates.[27]

To finalize, new phobias emerge very often, the most unusual ones are linked to contemporary routines and habits. The introduction of smartphones and new technologies has influenced our lives in positive and negative ways. For instance, we cannot imagine our normal routines without the help and interaction of these new technologies like smartphones, computers, video games, etc. They opened a new whole world of possibilities where the sky is the limit. Still, it is undeniable that technologies have come to impact our health in a positive and also negative way. Further research is essential, the most critical: academic and scholarly studies to research in-depth the psychological aspects of new modern disorders such as nomophobia. Providing an operational definition is needed. The inclusion of nomophobia in the DSM-V could be a useful tool for researchers, psychologists, doctors, and patients. However, experts must be cautious.

Footnotes

[1]Lee, S. Y. (2014). Examining the factors that influence early adopters’ smartphone adoption: The case of college students. Telematics and Informatics, 31(2), Page 308.

[2]Poushter, J. (2016). Smartphone ownership and internet usage continues to climb in emerging economies: But advanced economies still have higher rates of technology use. Pew Research Center: Global Attitudes and Trends.

[3]Lee, S. Y. (2014). Examining the factors that influence early adopters’ smartphone adoption: The case of college students. Telematics and Informatics, 31(2), Page 308.

[4]Stefan Tams, Renaud Legoux, Pierre-Majorique Léger. (2018). Smartphone withdrawal creates stress: A moderated mediation model of nomophobia, social threat, and phone withdrawal context, Computers in Human Behavior, Volume 81, Page 1.

[5]American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Washington, DC; 2013.

[6]Dixit S, Shukla H, Bhagwat A, Bindal A, Goyal A, Zaidi AK, Shrivastava A. A study to evaluate mobile phone dependence among students of a medical college and associated hospital of central India. Indian J Community Med. 2010;35(2): Pages 339–341.

[7]Krajewska-Kułak E, Kułak W, Stryzhak A, Szpakow A, Prokopowicz W, Marcinkowski JT. Problematic mobile phone using among the Polish and Belarusian University students, a comparative study. Prog Health Sci. 2012;2(1): Pages 45–50.

[8]Oksman V, Turtiainen J. Mobile communication as a social stage. The meanings of mobile communication among teenagers in Finland. N Med Soc. 2004; Pages6:319–339.

[9] Toda M, Monden K, Kubo K, Morimoto K. Mobile phone dependence and health-related life-style of university students. Soc Behav Pers. 2006;34: Pages 1277–1284.

[10]Hatice Yildiz Durak. (2018) Investigation of nomophobia and smartphone addiction predictors among adolescents in Turkey: Demographic variables and academic performance, The Social Science Journal, Page 3. Chóliz M.  Mobile Phone Addiction in Adolescence: Evaluation and Prevention of Mobile Addiction in Teenagers. Saarbrücken: Lambert Academic Publishing; 2010.

[11]Caglar Yildirim, Ana-Paula Correia. (2015). Exploring the dimensions of nomophobia: Development and validation of a self-reported questionnaire, Computers in Human Behavior, Volume 49, Page 131.

[12]Bragazzi, N. L., & Del Puente, G. (2014). A proposal for including nomophobia in the new DSM-V. Psychology research and behavior management, 7, Page 158.

[13]Bragazzi, N. L., & Del Puente, G. (2014). A proposal for including nomophobia in the new DSM-V. Psychology research and behavior management, 7, Page 156-157

[14]Şahin Gökçearslan, Çelebi Uluyol, Sami Şahin. (2018). Smartphone addiction, cyberloafing, stress and social support among university students: A path analysis, Children and Youth Services Review, Volume 91, Page 48.

[15]Stefan Tams, Renaud Legoux, Pierre-Majorique Léger. (2018). Smartphone withdrawal creates stress: A moderated mediation model of nomophobia, social threat, and phone withdrawal context, Computers in Human Behavior, Volume 81, Page 3.

[16]Hatice Yildiz Durak. (2018) Investigation of nomophobia and smartphone addiction predictors among adolescents in Turkey: Demographic variables and academic performance, The Social Science Journal, Page 3.

[17]Jessica S. Mendoza, Benjamin C. Pody, Seungyeon Lee, Minsung Kim, Ian M. McDonough. (2018). The effect of cellphones on attention and learning: The influences of time, distraction, and nomophobia, Computers in Human Behavior, Volume 86, Page 53.

Larry Rosen, Louis M. Carrier, Aimee Miller, Jeffrey Rokkum, Abraham Ruiz. (2016). Sleeping with technology: cognitive, affective, and technology usage predictors of sleep problems among college students, Sleep Health, Volume 2(1), Page 55.

[18]Caglar Yildirim, Ana-Paula Correia. (2015). Exploring the dimensions of nomophobia: Development and validation of a self-reported questionnaire, Computers in Human Behavior, Volume 49, Page 131.

[19]American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Washington, DC; 2013.

[20]Bragazzi, N. L., & Del Puente, G. (2014). A proposal for including nomophobia in the new DSM-V. Psychology research and behavior management, 7, Page 157

[21]Panova, T., & Carbonell, X. (2018). Is smartphone addiction really an addiction?. Journal of behavioral addictions, 7(2), Page 259.

[22]Sipherd, Ray. “The Third-Leading Cause of Death in America Most Doctors Don’t Want You to Know About.” CNBC, CNBC, 28 Feb. 2018, www.cnbc.com/2018/02/22/medical-errors-third-leading-cause-of-death-in-america.html.

[23]“Nomophobia: The Modern-Day Pathology.” Psychiatry Advisor, 17 Sept. 2018, www.psychiatryadvisor.com/anxiety/no-mobile-phone-phobia-a-modern-day-pathology/article/800569/.

[24]Caglar Yildirim, Ana-Paula Correia. (2015). Exploring the dimensions of nomophobia: Development and validation of a self-reported questionnaire, Computers in Human Behavior, Volume 49, Page 131.

[25]Kanmani A, Bhavani U, Maragatham R (2017), NOMOPHOBIA – An Insight into its Psychological Aspects in India, International Journal of Indian Psychology, Volume 4, Issue 2, No. 87, Page 15.

[26]“Nomophobia: The Modern-Day Pathology.” Psychiatry Advisor, 17 Sept. 2018, www.psychiatryadvisor.com/anxiety/no-mobile-phone-phobia-a-modern-day-pathology/article/800569/.

[27]Bragazzi, N. L., & Del Puente, G. (2014). A proposal for including nomophobia in the new DSM-V. Psychology research and behavior management, 7, Page 157.

 

Bibliography

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Washington, DC; 2013.

Bragazzi, N. L., & Del Puente, G. (2014). A proposal for including nomophobia in the new DSM-V. Psychology research and behavior management, 7, Pages 155-60.

Caglar Yildirim, Ana-Paula Correia. (2015). Exploring the dimensions of nomophobia: Development and validation of a self-reported questionnaire, Computers in Human, Volume49, Pages 130-137.

Chóliz M.  Mobile Phone Addiction in Adolescence: Evaluation and Prevention of Mobile Addiction in Teenagers. Saarbrücken: Lambert Academic Publishing; 2010.

Dixit S, Shukla H, Bhagwat A, Bindal A, Goyal A, Zaidi AK, Shrivastava A. A study to evaluate mobile phone dependence among students of a medical college and associated hospital of central India. Indian J Community Med. 2010;35(2): Pages 339–341.

Hatice Yildiz Durak. (2018) Investigation of nomophobia and smartphone addiction predictors among adolescents in Turkey: Demographic variables and academic performance, The Social Science Journal, Pages 1-23.

Jessica S. Mendoza, Benjamin C. Pody, Seungyeon Lee, Minsung Kim, Ian M. McDonough. (2018). The effect of cellphones on attention and learning: The influences of time, distraction, and nomophobia, Computers in Human Behavior, Volume 86, Pages 52-60.

Kanmani A, Bhavani U, Maragatham R (2017), NOMOPHOBIA – An Insight into its Psychological Aspects in India, International Journal of Indian Psychology, Volume 4, Issue 2, No. 87, Pages 5-15.

Krajewska-Kułak E, Kułak W, Stryzhak A, Szpakow A, Prokopowicz W, Marcinkowski JT. Problematic mobile phone using among the Polish and Belarusian University students, a comparative study. Prog Health Sci. 2012;2(1): Pages 45–50.

Lee, S. Y. (2014). Examining the factors that influence early adopters’ smartphone adoption: The case of college students. Telematics and Informatics, 31(2), Pages 308-310.

“Nomophobia: The Modern-Day Pathology.” Psychiatry Advisor, 17 Sept. 2018, www.psychiatryadvisor.com/anxiety/no-mobile-phone-phobia-a-modern-day-pathology/article/800569/.

Oksman V, Turtiainen J. Mobile communication as a social stage. The meanings of mobile communication among teenagers in Finland. N Med Soc. 2004;6: Pages 319–339.

Panova, T., & Carbonell, X. (2018). Is smartphone addiction really an addiction?. Journal of behavioral addictions, 7(2), Pages 252-259.

Poushter, J. (2016). Smartphone ownership and internet usage continues to climb in emerging economies: But advanced economies still have higher rates of technology use. Pew Research Center: Global Attitudes and Trends. Retrieved from: http://www.pewglobal.org/2016/02/22/smartphone-ownership-and-internet-usage-continues-to-climb-in-emerging-economies/.

Şahin Gökçearslan, Çelebi Uluyol, Sami Şahin. (2018). Smartphone addiction, cyberloafing, stress and social support among university students: A path analysis,Children and Youth Services Review, Volume 91, Pages 47-54.

Sipherd, Ray. “The Third-Leading Cause of Death in America Most Doctors Don’t Want You to Know About.” CNBC, CNBC, 28 Feb. 2018, www.cnbc.com/2018/02/22/medical-errors-third-leading-cause-of-death-in-america.html.

Stefan Tams, Renaud Legoux, Pierre-Majorique Léger. (2018). Smartphone withdrawal creates stress: A moderated mediation model of nomophobia, social threat, and phone withdrawal context, Computers in Human Behavior, Volume 81, Pages 1-9.

Toda M, Monden K, Kubo K, Morimoto K. Mobile phone dependence and health-related life-style of university students. Soc Behav Pers. 2006;34: Pages 1277–1284.