청소년 온라인 문제 행동의 이질성: 중독의 가면을 쓴 비행

Heterogeneity of Problematic Online Behaviors in Adolescents: Delinquency Masked as Addiction

Adolescent problematic smartphone use (PSU) and related online behaviors are pressing clinical concerns, yet their heterogeneity complicates diagnosis and treatment. We distinguish two prototypical subtypes: (1) self-medicative behavioral addiction, driven by internal distress and impaired control; and (2) instrumental delinquency masked as addiction, where the online environment functions as a tool for goal attainment (e.g., cyberbullying, deepfakes, illicit drug distribution, online fraud) rather than an object of compulsion. As a core marker of the latter, we highlight the DSM-5 limited prosocial emotions (LPE) specifier in conduct-disorder. We compare motivational and psychopathological mechanisms across subtypes and synthesize evidence on LPE-linked neurobiology—amygdala hyporesponsivity, reward hypersensitivity, and valuation/control deficits—that helps explain poor response to conventional addiction treatments. We also review assessment approaches for LPE and evaluate behavioral, contingency-based, and highly structured interventions that show promise for this subgroup. We argue for moving beyond a uniform addiction model toward precision psychiatry that incorporates underlying psychopathology when evaluating and treating adolescent online problem behaviors.