Internet delusions. (Case Report).

Abstract: As the use of computers, the Internet, and Internet technology becomes more pervasive in society, psychopathological thought content characterized by the incorporation of the Internet into delusions and hallucinations will become increasingly common. In the following report, three cases of psychotic inpatients are briefly presented to exemplify this trend in pathoplasticity. Interestingly, patients with no real familiarity with the Internet may just as readily incorporate such computer-associated themes into delusional thought patterns. Clinicians should be familiar with the tendency for delusional thoughts to draw from ideas important to society in general. Several interesting points about these cases include the increasing prevalence of Internet delusions, the complete unfamiliarity of two of the patients with the Internet and computers in general, and the tendency for such delusions to be of the controlling, broadcasting, and persecutory types.

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In the June 1999 issue of the Southern Medical Journal, Catalano et al (1) reported two cases of men who had delusions that they were controlled by and entwined with the Internet. The authors encouraged clinicians encountering such Internet delusions to continue to report them so that prevalence and incidence can begin to be studied. The current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (2) defines a delusion as follows:

A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person's culture or subculture (eg, it is not an article of religious faith). When a false belief involves a value judgment, it is regarded as a delusion only when the judgment is so extreme as to defy credibility. Delusional conviction occurs on a continuum and can sometimes be inferred from an individual's behavior. It is often difficult to distinguish between a delusion and an overvalued idea (in which case the individual has an unreasonable belief or idea but does not hold it as firmly as is the case with a delusion).

Delusions can be further classified, according to content into several types including bizarre, jealous, erotomanic, grandiose, mood-congruent, mood-incongruent, of being controlled, of reference, persecutory, somatic, thought broadcasting, and thought insertion. The following reports will describe three cases of delusions involving the Internet. Such delusional content is likely increasingly common in patients with psychotic disorders.

Case Reports

Patient 1

A 53-year-old woman with a history of one hospitalization 1.5 years previously presented to the hospital after calling the police due to increasing worries at home--"the control had gotten especially strong." She described the belief that the Internet had been controlling her and her home for the past 3 years. For example, when she walked around in her home, if she bumped into furniture, she attributed this to the Internet controlling her. She believed that the Internet also controlled her appliances turning on and off, that it changed channels on the television, and that it caused her to burn herself on the iron or stove. Other psychiatric symptoms included auditory hallucinations of voices whispering to her, passive suicidal thoughts, and vague worries that her grandson was in danger in some way. When asked about computers and the Internet, the patient denied having any familiarity with computers or having ever used computers in any capacity. When asked to describe what the Internet is, she commented that s he assumes that it is "some big computer somewhere."

Patient 2

A 21-year-old woman with no history of psychiatric hospitalization was brought to the hospital by her family because she had been acting strangely for 5 to 6 months. Her bizarre behaviors included taking her clothes off while at home due to the belief that microchips had been implanted in her body and her clothes to record her actions. She thought that her apartment was wired with microphones. In addition, she believed that the photographs and recordings in her clothes and apartment were being broadcast on the Internet. Family members reported that the patient had been increasingly isolated, agitated, and paranoid, and had not been sleeping well. The patient also reported auditory hallucinations that were derogatory in nature. She had recently dropped out of school at a local college where she had been studying computer sciences. She was familiar with the Internet, the use of computers, and computer information systems.

Patient 3

A 64-year-old woman with no known psychiatric history was brought to the hospital because of a several-months' decline in psychosocial functioning, resulting in failure to pay her rent in an apartment where she had resided for many years. Family reported that although she had never seen mental health professionals, she had a chronic history of suspiciousness and mild paranoid tendencies. Staff at her apartment complex noted that she had become very reclusive and paranoid recently. Although she was very guarded, she was found to have a complex delusion that "the www people" (referring to the World Wide Web) had been following her. She stated that they are people who are able to "lay a wire on you" to track one's actions. She believed that "the www-people" had wired her furniture and appliances, as well as the vents in her apartment. She believed that they followed her into malls, shopping centers, and grocery stores, and broke into her house to put dope into her food. She also commented that there were cameras in her apartment, and that "the www-people" also taped conversations secretly and re-played recorded conversations over wired furniture. Although she had no familiarity with computers, when asked about how she knew about "the www-people", she stated that she had been hearing about them on the television and radio.

Discussion

These three cases comprised 2.3% of the 130 patients (60% of whom had diagnoses of primary psychiatric disorders) who were admitted during a 4-month period to this 24-bed inpatient psychiatric unit in a large urban county hospital that cares mostly for indigent and uninsured patients. This would seem to indicate that delusions incorporating ideas about the Internet are becoming increasingly common. In addition to this remarkable prevalence of delusions with Internet themes, there are several other points of interest. Two of the three patients presented here were completely unfamiliar with computers and the Internet. This is consistent with the two cases presented by Catalano et al. (1) In addition, the Internet delusions presented here tended to have themes involving being controlled, having one's private life broadcast to others, and being recorded, tracked, and persecuted.

The meaningfulness of the content of delusions is a controversial issue. (3) Many psychiatrists think that the content of delusions, and of psychotic processes in general, is shaped by social and psychological influences. In responding to Catalano et al's cases, Sher (4) commented that contemporary social events and scientific innovations change the content of delusions and may affect the course of psychiatric disorders. Delusional content may also reflect internal conflict--projected themes may be informative of inner worries. It is likely that in the three cases presented here, the fear, anxiety, and impulses revealed in these patients' delusions reflected their various individual psychological difficulties and conflicts. Yet, each of the three patients used a symbol of modern sociocultural significance (the Internet) as a construct through which their worries were presented. In the historical development of ideas about delusions, (5) some authors have argued that delusions are uninformative and that their content is only a fragment of information trapped at the time of delusional crystallization.

Catalano et al (1) postulated that their two patients felt so threatened by the Internet that it became incorporated into their delusions. An alternative explanation of the phenomenon of Internet delusions is that the patients felt threatened by their own confusing and frightening psychotic inner world, and they happened to use what was most readily available in modern society as a way of projecting their inner conflicts. For anyone living in modern America, the Internet is a readily available subject in the social conversation of advertisements, communications, and media. Catalano et al also remarked that their patients' ignorance of the Internet may have intensified their fantasies and amplified their fears. An extension of this hypothesis is that, regardless of these patients' technical unfamiliarity with the Internet, social conversation about the Internet has become pervasive, reaching individuals in all socioeconomic and educational strata.

Conclusion

As social familiarity with computers and the Internet increases, related themes will likely become incorporated into psychotic symptoms of patients with severe psychiatric illnesses. Three cases of delusions involving the Internet are presented here. The cases of Internet delusions published to date tend to be of the controlling, broadcasting, and persecutory types. Delusions are psychotic symptoms most simply defined as fixed false beliefs. The meaningfulness of delusional content is controversial but is likely related to sociocultural trends as well as inner psychologic difficulties in psychotic individuals.

Accepted July 23, 2001.

References

(1.) Catalano G, Catalano MC, Embi CS, Frankel RL. Delusions about the Internet. South Med J 1999;92:609-610.

(2.) American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Press, 2000.

(3.) Sedler MJ. Understanding delusions. Psychiatr Clin North Am 1995;18:251-262.

(4.) Sher L. Social events and scientific innovations may affect the content of delusions. South Med J 2000;93:440-441.

(5.) Berrios GE. Delusions as "wrong beliefs": A conceptual history. Br J Psychiatry 159(Suppl 14):6-13, 1991.

RELATED ARTICLE: Key Points

* A delusion is a firmly sustained false belief that is based on incorrect inference about external reality.

* Psychopathologic thought content characterized by the incorporation of the Internet into delusions and hallucinations is increasingly common.

* The meaningfulness of delusional content is controversial but is likely related to sociocultural trends as well as inner psychologic difficulties in psychotic individuals.

From the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine and Grady Memorial Hospital, Atlanta, GA.

Reprint requests to Michael T. Compton, MD, Emory University--West Campus, 1256 Briarcliff Road, Suite 165, Atlanta, GA 30306.

Copyright [c] 2003 by The Southern Medical Association 0038-4348/03/9601-0061