The relationship with the digital environment: context, concerns and problems

In recent decades, the widespread adoption of digital technologies has brought about profound changes in society, and their rapid integration into daily life has revolutionized how we behave. This connectivity has shaped how we present ourselves socially and interact with others, as well as how we process information, memorize, learn, and even traditional ways of engaging with our environment. One of the greatest concerns is the impact this reality has had on children and young people.

While in previous years the use of these technologies was associated with devices and having profiles on digital social networks as a rite of passage into adolescence—which, at the same time, coincided with entering secondary school— their use is increasingly precocious and has become part of children's daily lives. This generation lives with devices as objects integrated from the very beginning. Thus, a smartphone or the internet connection itself becomes an everyday mechanism, providing them with a logic that complements the physical and in-person world. Differences are also observed with respect to gender: in the case of boys, screen use is associated with recreational activities, and in the case of girls, with its relational and conversational function.

Children and teenagers use very powerful technological devices, preferably portable, and always connected, which are simultaneously multifunctional: conversation, image storage, calendar and organization, games, messaging, schoolwork, etc. And, although the market is very dynamic and constantly introduces new formats, there are "star" applications: Instagram, TikTok, and YouTube have become established as standard channels. Furthermore, they are permanently connected (24 hours a day, seven days a week). Therefore, in this era of essential hyperconnectivity, one of the professional challenges must be defining disconnection and availability.

A smartphone or the internet connection itself becomes an everyday mechanism, providing them with a logic that complements the physical and face-to-face world.

Thus, new dimensions emerge (new forms of knowledge), trends and new influences (market, professional, referential, etc.) are constructed, and these become new "receptacles" (for discomfort, time management, etc.), creating new sources of connection , entertainment, and the management of daily life (with all its implications). As they age, in their development as individuals, digital technology "fulfills" different functions: to exist (I exist); to participate (in groups and socially); to inform (to learn and discover); to relate (they interact); to recognize themselves (by liking , among other possibilities); and to be recognized (by liking us , validating us). In this narrative, they tell their own stories and become the authors and protagonists of their lives.

At the same time, the ability to multitask is considered normal. For example, studying while checking a mobile phone. Despite this supposed multitasking ability, the speed of switching between tasks should not be confused with the capacity for deep attention.

Professional and adult concerns

Childhood and adolescence are crucial periods in a person's maturation and development. These life stages are particularly vulnerable to the development of addictive problems, both substance-related and behavioral.

The debate surrounding the use of digital technologies, the problems they entail, and how to address them is ongoing and generates concern in society. Are we using these devices properly? Do all the changes in behavior fall within the range of normality? What do we understand as normal use, misuse, or excessive or problematic use?

In this regard, an increase in the negative and problematic consequences associated with the excessive use of some applications has been observed: emotional distress, isolation at home, and the presence of other risky behaviors. In clinical practice, child and adolescent mental health services have detected a progressive increase in requests for treatment due to the abusive use of these environments (without it being clear whether the problem lies with the devices, social media, video games, etc.). The most recurring professional concerns are:

• The consequences of overuse and possible addiction.
• The imbalance of time spent on other activities, including face-to-face interactions.
• Its impact on basic aspects such as exercise and sleep . While evidence of causal relationships is still developing, there are studies that suggest correlations with weight, mood, and body image.
• Control over access to and viewing of certain content, with particular relevance to "new" pornography.
• New representations of harassment .
• New approaches to addressing certain behavioral problems : gambling, sex addiction, etc.
• The impact on psychiatric and psychological comorbidities ; and the risks linked to overexposure.

In summary, these concerns can be grouped into five categories:

1. Those that have to do with the construction of digital identity.
2. Those related to the relational issue.
3. The consequences of its overuse.
4. The access and impact of some content.
5. Aspects related to privacy and security.

Behavioral addictions, most of them in digital environments

Internet addiction is a complex issue. While numerous examples of problematic use (primarily dependence) exist, differing perspectives still exist on what constitutes addictive behavior . There is some consensus on concepts such as overuse, addiction, and dependence, but further investigation is needed to determine whether these problems are a cause or a symptom of an underlying disorder.

Although society is accustomed to discourses that oscillate between absolute normalization and pathological relationships –not all excesses end in addiction, nor are all addictions exclusively related to excessive use–, in the professional field one must be especially cautious when distinguishing problematic use (linked to overuse, probably) from an addictive disorder, with clear clinical indicators, which in most cases appear comorbid with other problems.

There is some consensus on concepts such as overuse, addiction or dependence, but further research is needed on whether these problems become a cause or symptom of an underlying disorder.

Despite the widespread acceptance of behavioral addictions by the scientific community, only gambling disorder has been included under the same heading as substance addictions in the latest version of the Diagnostic and Statistical Manual of Mental Disorders, DSM-5 (APA, 2013). Among the so-called "technology addictions," only internet gaming disorder has so far been included in this same manual, specifically in the appendix dedicated to "Disorders that require further research." On the other hand, the World Health Organization (WHO), in the International Classification of Diseases (ICD-11) (2019), includes gaming disorder for the first time in the section on "mental, behavioral, or neurodevelopmental disorders," immediately following gambling disorder . In fact, in this conceptualization, the WHO officially included video game addiction disorder in the presentation of this manual on January 1, 2022.

The evidence points to two main perspectives: on the one hand, externalized (behavioral) disorders, and on the other, internalized (affective and anxiety-related) disorders. Experience suggests that, in disorders linked to certain types of distress, the digital environment serves as a "refuge" or "escape valve": social anxiety, depression, and emotional loneliness emerge as major explanatory factors. The young person uses the internet as a self-efficacy mechanism to compensate for deficiencies or negatively experienced situations.

An increase in negative and problematic consequences associated with the excessive use of some applications has been observed: emotional distress, isolation at home, or the presence of other risky behaviors.

If we start from the hypothesis that addiction—to video games, social media, etc.—meets various criteria that classify it as a disorder in its own right, then the digital environment and its specific associated use would become a causal element in the emergence of certain problems. Similarly, if an underlying disorder develops into problematic internet use, it would become a symptom of another psychopathology or mental health problem that precedes it (isolation, lack of social relationships, communication difficulties). It is possible that, over time, the "dual pathology" model (known in the field of substance addictions) will eventually be applied: mental health disorders and internet addiction will influence each other throughout their development. This will be especially important because it is very likely that the symptom will eventually become overwhelming and significant enough to require individual intervention.

Conceptualizing the relationship with screen use: overuse, problematic use, and addiction

Amidst this complex web of concerns, practices, problems, etc., it is essential to clarify what falls within the "competence" of clinical treatment, without neglecting its social and community aspects, or of an intervention linked to psychoeducational support. Therefore, we begin with a proposal that distinguishes three main areas of problems:

On the one hand, overuse refers to use that exceeds, in frequency and intensity, what is reasonably expected for a given age and stage of life. It falls within a much more behavioral, episodic logic, where aspects such as schedules, limits, and rules are the main regulators. It is more common in shooting or sports games. And it is usually related to the person's feeling of boredom or to online interaction with acquaintances.

On the other hand, problematic use is linked to a problem related to a more specific action, not necessarily because of the number of hours, but because of the impact on the quality of relationships and on one's own identity: cyberbullying, relationship problems, etc.

Finally, addiction is understood as a disorder in its own right, where the function of the connection, the time spent using it, and the resulting interference generate significant problems for the individual and their environment. In this case, comorbidity with other psychiatric disorders is very common, especially those related to mood and interpersonal relationships. Many of these behaviors should be understood as symptoms of a much broader problem.