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Comprehensive Psychiatry 55 (2014) 1385 1390
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Relationship of Internet addiction with cognitive style, personality, and

depression in university students
mer enormanc a,, zge Saral a , Nuray Atasoy a , Gliz enormanc b ,
Frzan Koktrk c , Levent Atik a
a
Blent Ecevit University School of Medicine, Psychiatry, Zonguldak, Turkey
b
Zonguldak Atatrk State Hospital
c
Blent Ecevit University School of Medicine, Biostatistics, Zonguldak, Turkey

Abstract

Background: The aim of the study was to investigate the relationship of dysfunctional attitudes, self-esteem, personality, and depression
with Internet addiction in university students.
Methods: A total of 720 university students participated in the study in Blent Ecevit University English Preparatory School which offers
intensive English courses. Students were evaluated with a sociodemographic data form, Beck Depression Inventory (BDI), Dysfunctional
Attitudes Scale form A (DAS-A), Internet Addiction Scale (IAS), Rosenberg Self-Esteem Scale (RSES), and Eysenck Personality
Questionnaire Revised/Abbreviated Form (EPQR-A).
Results: The results indicated that 52 (7.2%) of the students had Internet addiction. There were 37 (71.2%) men, 15 (28.8%) women in the
addicted group. While the addicted groups' BDI, DAS-A perfectionistic attitude, need for approval, RSES, EPQR-A neuroticism, and
psychoticism scores were significantly higher, EPQR-A lie scores were significantly lower than those of the non addicted group. According
to the multiple binary logistic regression analysis, being male, duration of Internet usage, depression, and perfectionistic attitude have been
found as predictors for Internet addiction. It has been found that perfectionistic attitude is a predictor for Internet addiction even when
depression, sex, duration of Internet were controlled.
Conclusions: To the knowledge of the researchers, this study is the first study to show the dysfunctional attitudes in Internet addiction. It can
be important to evaluate dysfunctional attitudes, personality, self-esteem and depression in people with Internet addiction. These variables
should be targeted for effective treatment of people with Internet addiction in cognitive behavioral therapy.
2014 Elsevier Inc. All rights reserved.

1. Introduction use of Internet. Internet addiction which is also used in our

The Internet which was developed to increase communi-
cation and facilitate information exchange has grown beyond
expectations, but some users are unable to control their
Internet use, and thus experience some problems in their
functioning at work and in social and private life [1]. In the
literature, various terms are used for overuse or uncontrolled
Author disclosure statement: No competing financial interests exist.
Corresponding author at: Blent Ecevit University School of
Medicine Esenler-Kozlu, Zonguldak, TR 67600. Tel.: +90 505 794 20 52;
fax: +90 212 572 95 95.
E-mail address: senorman_7@hotmail.com (. enormanc).
http://dx.doi.org/10.1016/j.comppsych.2014.04.025
0010-440X/ 2014 Elsevier Inc. All rights reserved.
article, is the most popular term used for this disorder that
should be considered as non-substance behavioral addictions
in the Diagnostic and Statistical Manual of Mental
Disorders-IV (DSM-IV) system [2]. Recently, the disorder
has been included in DSM-5. The problem of Internet
overuse was included as Internet use gaming disorder in
DSM-5 section 3 which highlights the need for more
research to diagnose the formal disorders. According to
DSM-5 addiction criteria, there is no difference between
chemical and behavioral addiction. DSM-5 focuses on
personal experiences rather than drug types [3].
Depression is the most comorbid disorder with Internet
addiction [4,5]. In a follow up study, dysfunctional attitudes
that are known to be related to depression have been found as
a predictor for problematic alcohol use when current
1386 . enormanc et al. / Comprehensive Psychiatry 55 (2014) 13851390
depressive symptoms, gender, and influence of alcohol
consumption were controlled. This conclusion has empha-
sized the cognitive structure as a risk factor for problem
drinking [6]. Considering the problematic behavioral model,
Internet addiction is related to problematic alcohol use [7]. It
has been also found that maladaptive perfectionism attitude
that is not direct relationship with Internet addiction is related
to Internet addiction [8].
Self-esteem is described as a person's attitude to himself. It
can be positive or negative. It is accepted that while a person
perceives himself positively, self-esteem is high, but if the
person perceives himself negatively, self-esteem is low [9]. It
has been suggested that low self-esteem is a principal
component of depression [10]. As a coping strategy, people
who have negative beliefs about themselves like having low
self-esteem may tend to be addicted to be relieved from the
their negative beliefs [11,12]. Self-esteem has a relationship
with perfectionism. Maladaptive perfectionism was found as a
negative predictor of self-esteem [13].
Internet addiction is seen with some personality traits [14].
A study that used Eysenck Personality Questionnaire has
shown that students addicted to the Internet showed higher
neuroticism/stability scores, higher psychoticism/socialization
scores, and lower lie scores [15]. Although these traits have
been found to be related to Internet addiction, neuroticism trait
has one of the main roles in Internet addiction [16]. People who
have high neuroticism traits tend to be Internet addicts [17,18].
People who have neurotic traits use the Internet for expressing
their ideas and feelings and showing their hidden skills
[19,20]. They have greater depression risk [21,22]. They are
hypervigilant to emotional stimulants. For this reason, they
show inadaptable reactions, and they have traits that can cause
depression [23].
There is a relationship between personality traits and self-
esteem. This relationship has a role in developing Internet
addiction [24]. Neuroticism and low self-esteem are predictors
for depression together, and they should be evaluated in
depressive illness [25]. Also, in some studies, a positive
correlation has been found between maladaptive perfectionism
and neuroticism [26,27]. Thus, it is possible that there can be a
relationship between dysfunctional attitudes, neuroticism, self-
esteem, depression, and Internet addiction.
The aim of the study was to investigate the relationship of
dysfunctional attitudes, self-esteem, personality, and depres-
sion with Internet addiction in university students.
2. Methods
2.1. Participants
The study was conducted at Blent Ecevit University
English Preparatory School which offers intensive English
courses in October 2013. The necessary permissions to
conduct the study were received from the Blent Ecevit
University School of Medicine Ethics Committee prior to the
initiation of the research. The school has 1026 students. We
could not reach 277 students, and 29 students' data were
excluded due to incomplete measurements. Thus, a total of
720 university students participated in the study. Before
submitting the questionnaires, the students were informed
about measurements and study protocol, and their written
consents were gathered. The students answered the mea-
surements anonymously.
2.2. Instruments
2.2.1. Sociodemographic data form
A form was developed by the researchers to collect the
sociodemographic data from the participants considering the
aim of the study.
2.2.2. Beck Depression Inventory (BDI)
This is a 21-item self-report scale measuring the emotional,
cognitive, somatic, and motivational symptoms of depression.
Each item is scored on a scale from 1 to 3, and total scores are
calculated by summing the scores on all the items [28]. The
cut-off score was set at 17 in a Turkish validity and reliability
study. The internal consistency reliability Chronbach's alpha
was 0.80 [29].
2.2.3. Dysfunctional Attitudes Scale form A (DAS-A)
DAS-A is a self-report scale, consisting of 40 items on a
seven-point Likert scale, which is developed for measuring
dysfunctional attitudes and beliefs. Ten items are reversely
coded (2, 6, 12, 17, 24, 29, 30, 35, 37 and 40) since they
point to functional attitudes. Each item is scored on a scale
from 1 to 7. Higher scores correspond to more frequent
dysfunctional attitudes [30]. Four factors including
perfectionistic attitude, need for approval, indepen-
dent attitude and variable attitude were reported in the
reliability and validity studies of the Turkish version of the
measurement. Cronbach alpha reliability coefficient was
found as 0.79, and the average of item total score
correlations was found to be 0.34 in the Turkish adaptation
study [31].
2.2.4. Internet Addiction Scale (IAS)
This is a 31-item self-report scale that measures patholog-
ical Internet use. Each item is scored on a scale from 1 to 5 [32].
Due to the low correlation, item 4 was deleted. The higher
score a person gets, the more likely that he/she is an Internet
addict The cut-off score was set at 90. In other words, 90 or
higher scores means Internet addiction. The internal
consistency reliability Chronbach's alpha was 0.80 [33].
2.2.5. Rosenberg Self-Esteem Scale (RSES)
This is a 63-item self-report scale that measures global
feelings of self-worth or self-acceptance. Higher scores on the
scale items indicate lower levels of self-esteem [9]. The scale
consists of 12 sub-categories. The aim of the current study was
considered, and the first 10 questions of the original scale that
measure self-esteem were used. The correlation between the
scale and psychiatric interview results was found to be 0.71 for
Turkish validity and reliability study [34].
 . enormanc et al. / Comprehensive Psychiatry 55 (2014) 13851390 1387

2.2.6. Eysenck Personality Questionnaire Revised/Abbreviated Table 1

Form (EPQR-A) Sociodemographic and clinical characteristics of study sample (N = 720).
This is an abbreviated form of the Eysenck personality Age, med (minmax) 19 (1735)
questionnaire. It is a 24-item self-report scale that includes Duration of Internet usage (hours/day), med (minmax) 2.5 (016)
Sex, n (%)
one validity scale and three personality scales. The EPQR-A
Female 362 (50.3)
was used to identify the three extraversion, neuroticism and Male 358 (49.7)
psychoticism dimensions of personality, and it includes six Living conditions, n (%)
items in each domain [35]. Four factors were found for Alone 27 (3.8)
Turkish validity and reliability study. Alpha coefficients of With someone (family, friend) 695 (96.3)
Divorced parents, n (%)
the scales for extraversion, neuroticism, psychoticism and lie
Yes 39 (5.4)
were found to be 0.78, 0.65, 0.42, 0.64, respectively, and the No 681 (94.6)
testretest reliabilities were found to be .84, .82, .69, and .69, Siblings, n (%)
respectively. It is important to note that lie sub-scale does not Yes 677 (94.0)
evaluate a personality dimension, but it measures validity of No 43 (6.0)
Having own room, n (%)
the other subscales [36].
Yes 520 (72.2)
No 200 (27.8)
Having own computer, n (%)
Yes 452 (62.8)
2.3. Statistical analysis No 268 (37.2)
Mostly used Internet activity, n (%)
SPSS 18 was used for all statistical analyses. Normal Internet surfing 461 (64)
distribution of the data was evaluated with the Kolmogorov E-mailing 70 (9.7)
Smirnov distribution test. MannWhitney U-test was used to Video sharing sites 72 (10)
Chat rooms 56 (7.8)
compare the quantitative variables that were not normally Online gaming 28 (3.9)
distributed. In all tables, the numeric variables are presented as Academic activities 33 (4.6)
mean SD or median (minmax), and the categorical Family income, n (%)
variables are presented in terms of both numbers of 0499 47 (6.5)
observations and percentages (%). Significance levels were 500999 171 (23.8)
10001499 178 (24.7)
set at p b 0.05 and p b 0.001. Logistic regression analysis 15001999 142 (19.7)
was performed. 2000 ve st 182 (25.3)
Alcohol/drug use, n (%)
No 621 (86.3)
Alcohol 91 (12.6)
3. Results Drug 4 (0.6)
Alcohol + drug 4 (0.6)
Psychiatric treatment history, n (%)
Our sample age was 19 (1735). Duration of Internet
Yes 48 (6.7)
usage was 2.5 (016). There are 362 (50.3%) female and 358 No 672 (93.3)
(49.7%) male students in the study. Sociodemographic and Family history of alcohol/drug abuse, n (%)
clinical characteristics of study sample were shown in Yes 20 (2.8)
Table 1. Comparison measurements scores between non- No 700 (97.2)
History of self-injury behaviour, n (%)
addicted and addicted groups are shown in Table 2.
Yes 25 (3.5)
The results indicated that 52 (7.2%) of the students who No 695 (96.5)
received 90 or higher IAS score had Internet addiction. Suicide attempt
There were 37 (71.2%) men, and 15 (28.8%) women in the Yes 6 (0.8)
addicted group. No 714 (99.2)
Age, duration of Internet usage, sex, living condition,
divorced parents, siblings, having own room, having own
computer, family income, psychiatric treatment history, 4. Discussion
family history of alcohol/drug abuse, history of self-injury
behaviour, suicide attempt, depression, perfectionistic This study aimed to investigate predictive effects of
attitude, need for approval, independent attitude, variable dysfunctional attitudes, self-esteem, personality, and depres-
attitude, self-esteem, extraversion, neuroticism, psychoti- sion on Internet addiction. The results indicated that 7.2% of
cism, and lie were entered in multiple binary logistic the students have Internet addiction. There are some Internet
regression analysis to detect the Internet addiction predic- addiction prevalence studies in our country wherein IAS was
tors. After the analysis, sex, duration of Internet usage, used. In these studies, Internet addiction rate was 11.6% in
depression, perfectionistic and attitude were found to be the high school students [37]. While a study reported the rate as
predictors for Internet addiction (Table 3). 12.2% [33], Dalbudak et al.'s study presented the rate as
1388 . enormanc et al. / Comprehensive Psychiatry 55 (2014) 13851390

Table 2 features that trigger, develop, and maintain stress; for this
Comparison of measurement scores between the nonaddicted and reason, they tend to have psychiatric disorders [43]. People
addicted groups.
with maladaptive perfectionism may have alcohol problems to
Non-addicted group Addicted group cope with stressful life events [44]. It has been also suggested
(n = 668) (n = 52) Z p
that the disparity between an individual's actual self and ideal
BDI 7 (046) 15 (039) 4.941 b 0.001 self causes maladaptive perfectionism. Creating an online
DAS-A
perfect persona can cause individuals to develop Internet
Perfectionistic 44 (1793) 60 (26101) 5.831 b 0.001
attitude addiction [8]. In the current study, the perfectionistic attitude
Need for 41 (1174) 48 (2071) 4.442 b 0.001 scores of the addicted group were significantly higher than
approval those of the non addicted group.
Independent 20 (683) 23 (635) 1.121 0.262 The need for approval refers to a person's attempts to gain
attitude
approval by pretending as if he/she possessed socially
Variable 19 (531) 18 (942) 0.885 0.376
attitude desirable characteristics [45]. It has been suggested that people
RSES 0.8 (05) 1.25 (04) 2.942 0.003 who have high needs for social approval are more likely to be
EPQR-A alcohol or drug addicts than the people with low needs for
Extroaversion 4 (06) 3 (06) 1.809 0.070 social approval [46,47]. The tendency has been explained by
Neuroticism 3 (06) 4 (06) 2.727 0.006
observational learning [46]. The relationship between low self
Psychoticism 1 (06) 2 (05) 4.049 b 0.001
Lie 4 (06) 3.5 (06) 2.880 0.004 esteem that may be related with the need for approval and
Internet addiction have been known well [48,49]. The Internet
MannWhitney U test, p b 0.05, p b 0.001 level of significance.
BDI = Beck Depression Inventory, DAS-A = Dysfunctional Attitudes
has suitable environment for people with low self esteem, low
Scale form, RSES = Rosenberg Self-Esteem Scale, EPQR-A = Eysenck motivation, fear of rejection, and need for approval. They can
Personality Questionnaire Revised/Abbreviated Form. explain themselves by taking less risks than real life. Internet
is a kind of safety tool for them. In the current study, the
7.2% in university students [38]. Our prevalence rate is similar addicted group has significantly more perfectionistic attitude
with the findings of Dalbudak et al.'s and lower than the rate in and less self esteem than the non-addicted group. To the
other studies. It is possible that these two study samples may knowledge of the researchers, this is the first study that showed
include conservative students (e.g. low rate of illicit drug use), dysfunctional attitudes in Internet addiction.
for this reason, lower rates may have been found [38]. In the According to Eysenc and Eysenc theory (1975), extra-
current study, males have 2.5 fold higher Internet addiction version represents being social, assertiveness, and enjoying
than females. In general, in these studies it is found that males risk taking. People with extravert trait like to socialize with
have three or fourfold higher Internet addiction than others and prefer to spend their time with their friends [50].
females [3941]. People high on extraversion are comfortable with face to face
In the current study, the addicted group's depression scores communication. They do not need to make alternative
were significantly higher than those of the non-addicted group. relationships using the Internet. They are satisfied with real
Studies on comorbidity of Internet addiction and depression did life activities [51]. In the current study, there is no difference
not have a pattern for demonstrating a causal relationship between the two groups in terms of the extraversion domain
between these disorders until Dong et al.'s study. This follow as expected [15,52].
up study could not find a solid pathological predictor for Neuroticism represents emotional instability or
Internet addiction disorder. The authors of this study have excessive reactivity. People who have neurotic traits can
suggested that Internet addiction disorder may bring some be anxious, depressive, nervous, shy, and have low self-
pathological problems to the addicts [42]. Loneliness and social confidence [50]. Considering the neuroticism domain,
isolation that are caused by excessive use of Internet may people high on neuroticism have difficulties in making
trigger comorbid depression in people with Internet addiction. healthy relationships. Extraverted people can be content with
Perfectionism is a cognitive schema that reflects high face to face interactions, and they can also meet new people
personal standarts, according to which people evaluate their on the Internet [51]. Thanks to the Internet, people high on
own performance. Perfectionist people have some cognitive neuroticism can relieve their loneliness that is caused by
anxiety, shyness, and insecurity [53]. Internet can be a
suitable social tool and can work for emotional regulation
Table 3 for people high on neuroticism. In the current study, the
Predictors for Internet addiction by multiple binary logistic regression analysis. neuroticism scores of the addicted group were significantly
Predictors Odds ratio 95% CI p higher than the scores of the non-addicted group. This result
Being male 3.202 1.5186.753 0.002 is consistent with the previous studies [15,52].
Duration of internet usage 1.229 1.1151.355 b 0.001 Psychoticism represents unusual personality traits like
Depression 1.071 1.0361.107 b 0.001 aggressiveness, making cold relationship with others, weird-
Perfectionistic attitude 1.045 1.0221.069 b 0.001
ness, being non-emphatic, insensitiveness [50]. People high on
Constant 0.001 b 0.001
psychoticism use Internet deviantly rather than social
 . enormanc et al. / Comprehensive Psychiatry 55 (2014) 13851390
communal use [54]. In the current study, the psychoticism
scores of the addicted group were significantly higher than the
scores of the non-addicted group. This result is also consistent
with the previous studies [15,52].
Although the lie subscale measures validity of the other
subscales in EPQR-A, it has been suggested that there is a
negative relationship between lie personality trait and social
maturity. Hence, the students who are less mature may be
more inclined to becoming Internet addicts. In the current
study, the lie scores of the addicted group were significantly
higher than the scores of the non-addicted group. This result
is consistent with the previous studies, too [15,52].
In the present study, regression model was used to
determine the predictors of Internet addiction. According to
the model, being male, duration of Internet usage, depres-
sion, and perfectionistic attitude have been found as the
predictors for Internet addiction. It has been acknowledged
in the literature that being male, duration of Internet usage,
and depression are important predictors for Internet
addiction. We also found that perfectionistic attitude is
another predictor for Internet addiction, even when depres-
sion, sex, duration of Internet were controlled. Although the
evidence of cognitive behavioral therapy is not strong, It is
the most promising treatment approach for Internet addiction
[55,56]. It can be important to evaluate the perfectionistic
attitude in people with Internet addiction. The perfectionistic
attitude should be targeted for effective treatment of people
with Internet addiction in cognitive behavioral therapy.
The current study has some limitations. The use of self-
rating measurement to detect Internet addicition can be
considered as a limitation of the study. Because the study
was cross-sectional, we could not establish a causal
relationship. The current study represents preparatory school
students' cognitive styles and personalities, for this reason,
the findings should be treated with caution because the
results cannot be generalized to different age groups. This
study can be replicated in another setting or with participants
from different age groups and backgrounds to reach at more
generalizable findings.
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