NOMOPHOBIA: NO MObile PHone PhoBIA

Abstract

The term NOMOPHOBIA or NO MObile PHone PhoBIA is used to describe a psychological condition when people have a fear of being detached from mobile phone connectivity. The term NOMOPHOBIA is constructed on definitions described in the DSM-IV, it has been labelled as a “phobia for a particular/specific things”. Various psychological factors are involved when a person overuses the mobile phone, e.g., low self-esteem, extrovert personality. The burden of this problem is now increasing globally. Other mental disorders like, social phobia or social anxiety, and panic disorder may also precipitate NOMOPHOBIC symptoms. It is very difficult to differentiate whether the patient become NOMOPHOBIC due to mobile phone addiction or existing anxiety disorders manifest as NOMOPHOBIC symptoms. The signs and symptoms are observed in NOMOPHOBIA cases include- anxiety, respiratory alterations, trembling, perspiration, agitation, disorientation and tachycardia. NOMOPHOBIA may also act as a proxy to other disorders. So, we have to be very judicious regarding its diagnosis. Some mental disorders can precipitate NOMOPHOBIA also and vice versa. The complexity of this condition is very challenging to the patients’ family members as well as for the physicians as NOMOPHOBIA shares common clinical symptoms with other disorders. That's why NOMOPHOBIA should be diagnosed by exclusion. We have to stay in the real world more than virtual world. We have to re-establish the human-human interactions, face to face connections. So, we need to limit our use of mobile phones rather than banning it because we cannot escape the force of technological advancement.

Introduction

The term NOMOPHOBIA or NO MObile PHone PhoBIA is used to describe a psychological condition when people have a fear of being detached from mobile phone connectivity.[1] However, the term “phobia” is a misnomer, because mostly it seems to be a kind of anxiety disorder.[2]

Overview

The term NOMOPHOBIA is constructed on definitions described in the DSM-IV, it has been labelled as a “phobia for a particular/specific things”.[3]

The various psychological factors are involved when a person overuses the mobile phone, e.g. low self-esteem, extrovert personality. Other mental disorders like, social phobia or social anxiety,[4,5] and panic disorder may also precipitate NOMOPHOBIC symptoms. It is very difficult to differentiate whether the patient becomes NOMOPHOBIC due to mobile phone addiction or existing anxiety disorders manifest as NOMOPHOBIC symptoms.[6]

The term, “NOMOPHOBIA,”[7] was coined by the United Kingdom (UK) Post Office in 2008 during a study who commissioned YouGov, a UK-based research organization. The objective of that study was to evaluate the possibility of anxiety disorders occurred due to overuse of mobile phones. The study found that nearly 53% British who used mobile phones, pretend to be apprehensive when they “lose their mobile phone, run out of battery or credit, or have no network coverage”. That study also revealed that approximately 58% of male and 47% of female suffered from the mobile phone anxiety, and additionally 9% felt strained when their mobile phones were switched off. 55% of the participants agreed that they are not able to maintain connectivity with their dear and near one, which was the main reason for their phobia.[8] On comparing the stress levels it was found that the anxiety level was at-par with those of “wedding day jitters.”[8]

A study was conducted among undergraduate students in Health Services, found that out of 547 males, 23% of the students were labeled as nomophobic, while 64% students were at risk of developing nomophobia. Almost 77% students checked their cell phones more than 35 times per day.[9]

Another study revealed that more than 50% nomophobics never switch off their mobile phones.[10]

Available research evidence

We cannot escape from the influence of modern technology in 21^st century. Day by day it is changing and due to technological advancement, new challenges are creeping up on a regular basis. The phobia due to technological advancement is also called TECHNOPHOBIA. In 1983, the first mobile phone was introduced in the market, now a days these instruments have become lifeline in most of the societies.[11]

According to Shambare et al. (2012), cell phones are “possibly the biggest non-drug addiction of the 21^st century”. Now a day's college students are spending more than 9 hours per day on their mobile phones, which leads to addiction. It is an example of “a paradox of technology” having both the property of freeing and enslaving. Freeing from the real world and enslaving to the virtual world.[11]

It is evident from surveys that young adults are more likely to be addicted from nomophobia (Secur Envoy study). The survey described that most of the teens (77%) reported anxiety when they were without their mobile phones. Scientists proposed certain psychological predictors for suspecting nomophobia in a person which are - “self-negative views, younger age, low esteem, self-efficacy, high extroversion/introversion, impulsiveness and sense of urgency and seeking”.[4]

It has been observed among students that low grade point average (GPA) and increased anxiety levels are correlated with frequent cell phone usage. The decrease in GPA among students may be due to distraction by the over-usage of mobile phones during class. Pressure for continually being connected to social (virtual) networks may increase anxiety as it leaves no time for relieving daily stress during solitude, which is an essential component of our well-being.[12]

As per study, 61% of people do check their smartphones after awakening in the morning.[13]

A mobile phone research study conducted in Australia examined the relationship between the participants’ frequency of mobile phone use and their psychological involvement with the use of Mobile Phone Involvement Questionnaire (MPIQ). Several psychological factors were assessed by the researchers that might influence participants’ mobile phone use.[13]

A moderate difference was observed between the participants’ psychological relationships with the mobile phones and their excessive mobile phone use. Though no pathological conditions were found, but signs of attachment were observed due to excessive use of mobile phones. Mobile phone dependency was found in another study conducted on adolescents and emerging adults as they might be going through a social identity crisis phase in their life.[13]

It is documented that victims of anxiety disorders and panic disorders were more vulnerable to nomophobia. A study in Brazil revealed that out 44% of participants from panic disorders group felt “secure” when they had their mobile phones. On the contrary, 46% of healthy group reported that they would not feel the same with no mobile phones. The study revealed that 68% of total participants reported mobile phone dependency. Participants with panic disorder reported significantly more emotional symptoms and dependency on mobile phones compared to the control group when their access to the mobile phone was restricted.[6]

A mobile phone dependence study among the medical graduates was conducted by Dixit et al. (2009). The study revealed that most of the (73%) students kept their mobile phones for 24 × 7 hours. 20% students responded that they became stressed when they do not have their mobile phones or its battery is drained. 38.5% students responded they keep on checking their mobile phones for messages and calls, repeatedly. About 56% students replied they feel secured when their phone is kept within their pocket.[14]

Usual symptoms and signs of NOMOPHOBIA

The below mentioned signs and symptoms are observed in Nomophobia cases

• Anxiety

• Respiratory alterations

• Trembling

• Perspiration

• Agitation

• Disorientation

• Tachycardia.

Dealing with NOMOPHOBIA: Role of health promotion

Level 1

Policy and law

In India there is no limit of mobile phone use. Single person can use multiple phones. It is adding fuel to the pre-existing problem of NOMOPHOBIA. Telecom Regulatory Authority of India (TRAI) should play an active role by making a policy/law that “setting based approach” on mobile phone restriction among people should be followed. An ACT may be formulated, under this Act. there should be minimum upper limit of age for mobile use. It will help a lot to curb the situation.

Values

Parents should motivate their children to participate in outdoor games, religious festivals. It will give them more chance for face to face interaction.

Education

Parents must have awareness regarding such psychological problems like NOMOPHOBIA. School authorities should appoint counsellor and health team personnel for educating and dealing with such incidences.

In many schools/colleges mobile phone restriction is strictly enforced.

Encouraging social activities

Youngsters’ energy needs to be channelized in a creative way. Mechanisms may be devised to engage them in physical activities, outings, social interaction, etc.

Level 2 and Level 3

Prevention of NOMOPHOBIA

The NOMOPHOBIC person should be identified using a “settings-based” approach by their colleagues/supervisors.

They may be referred to receive on-site counselling. Thus, the risk of NOMOPHOBIA can be reduced.

Medical treatment of acute health problems and treating symptoms:

Presently, the treatment modalities are very limited due to the disease concept is relatively new. However, treatment modalities like cognitive-behavior therapy, combined with pharmacological interventions shows promising results. Tranylcypromine and Clonazepam drugs are becoming quite successful in treating nomophobia signs and symptoms.[6]

Cognitive behavioral therapy seems to be very useful as it reinforces the autonomous behavior which is independent from techno-addictions. However, this treatment approach is not approved by any randomized control trial. Another promising treatment modality has emerged as “Reality Approach,” or Reality therapy. In this therapy the patient is advised to focus on behaviors (gardening, painting, playing, etc.) other than using mobile phones. Drugs like benzodiazepines and antidepressants (in normal dosage) are sometimes used in severe cases to control the symptoms. Tranylcypromine and Clonazepam combination are used quite successfully for treating nomophobia cases. Though these drugs are formulated to anxiety disorders and not for nomophobia directly.[6] We have to keep in our mind that NOMOPHOBIA should be diagnosed by exclusion and for that we have to investigate very cautiously, identify and treat any underlying pre-existing mental disorders, if any.

There are certain validated psychometric scales which are available to diagnose nomophobia, among all, “Questionnaire of Dependence of Mobile Phone/Test of Mobile Phone Dependence (QDMP/TMPD)” scale is popularly used.

Level 4 and 5

Mental health services: This plays paramount in rehabilitation as person goes through the phases of anxiety and depression. After addressing the persons immediate health and safety needs psychosocial assessment should be advised with existing psychometric tools. Psychological rehabilitation of addicted needs to be ensured through counseling and parental care. Care should be provided by supporting and non-offending parent/caregiver. Skills for managing anxiety and stress for the victims need to be stressed upon by counsellor and parents need to be taught regarding these skills.

Discussion

Basically, human beings are social creatures. Previously our social bonding was quite strong. We used to do a lot of face to face social interaction. Due to rapid urbanization, migration and increasing numbers of nuclear families, disintegration of social fabric has taken place in our society leading to a vacuum kind of situation. Mobile phones have effectively filled this vacuum, e.g., with the help of social media through which we are connected with others, nearly all the time. Now we have thousands of social media friends (virtual friends), while in reality, may be with very few we really interact. The continuous pressure of remaining on social media, we tend to use our mobile phones continuously and that is creating problem for us, viz., NOMOPHOBIA.

Now a days, after college education most children are usually away from their home for education or job purpose. Overuse of mobile phone by parents and their children is a way to obtain a mutual sense of security and social control via mobile phones.

Simultaneously, when children use their mobile phones, they are virtually free from parental supervision in spite of the fact that they are sitting in the same room. They can be blissfully 1000 miles away through mobile phones networking/chatting with their peers. Mobile phone gives them a sense of “connection” with people, virtually.

It is a type of an “over-connection syndrome” because our excessive mobile phone use reduces the amount of face-to-face interactions. This interferes with our social and family interactions, significantly. The terminology “techno-stress” is frequently used to address a similar condition when people avoid face-to-face social interactions and are restricted within themselves, without concern for others. Eventually they become depressed in later life.[3]

As already described, anxiety is induced in nomophobia cases by many factors, such as the loss of a cell phones, loss of signal, and with drained batteries of mobile phones. NOMOPHOBICS show some peculiar characteristics, such as – using mobile phone impulsively, as a protective mechanism to avoid social communication. Sometimes they carry multiple mobile phones along with battery charger to avoid the experience of disconnection from the virtual world.[3]

Nomophobics prefer virtual interactions and avoid face to face social interactions. As a result, they keep their phone in reach even when they are sleeping (the phone remains on 24 × 7 hours). Some of them look at the phone screen frequently to avoid missing any notification, which is termed as “ringxiety”.

NOMOPHOBIA can put economic strain in the family due to use of excessive data which is costly also. NOMOPHOBIA may also lead to physical problems like pain in elbows, hands, and necks due to constant use.[15]

Anxiety and stress reactions may be experienced by a normal individual in public settings where mobile phone use is restricted (such as in airports, teaching institutions, and workplace). Overusing a mobile phone apps for purchasing like “Amazon”, “Flipkart” etc., items can cause financial insecurity for the individual. The ability to remain in touch through a mobile phone gives the individual peace of mind and security unless they feel anxious and depressed.[3]

NOMOPHOBIA may also act as a proxy to other disorders. So, we have to be very judicious regarding its diagnosis. Some mental disorders can precipitate nomophobia also and vice versa. The complexity of this condition is very challenging to the patients’ family members as well as for the physicians as nomophobia shares common clinical symptoms with other disorders. That's why NOMOPHOBIA should be diagnosed by exclusion.[3]

As previously described, that, NOMOPHOBIC behavior reinforces social anxiety tendencies. The affected persons get addicted to virtual and digital communications to ventilate their stress generated by social anxiety.[6]

Conclusion

NOMOPHOBIA is emerging as a threat to our “social, mental as well as physical health.”

Recommendation

We have to stay in the real world more than virtual world. We have to re-establish the human-human interactions, face to face connections. So, we need to limit our use of mobile phones rather than banning it because we cannot ignore the force of technological advancement.