Within this Italian sample the entire population was found to be positive for the phenomenon of nomophobia. One out of ten participants (11.5% of cases) had a form defined as severe, according to the criteria established by the test developers themselves. The majority of severe cases occurred in the youngest age group (between 18 and 25 years).
In the most recent systematic review on nomophobia prevalence, conducted by Leon-Mejıa and colleagues in 2021, positivity to this phenomenon is estimated to affect up to 73% of the population(31). The prevalence of this phenomenon appears destined to increase and become a major problem at a social level, due to the constant massive use of telephones(32).
We chose to evaluate nomophobia with the aim of offering a small overview of the diffusion of this emerging phenomenon in our local reality. Severe cases are the 11.5% and these values have a significant correlation with impulsivity and, in particular, with its motor subcategory. Results pointing towards a correlation between internet addiction or nomophobia and impulsivity are not totally unexpected. Recently conducted studies had in fact found a relationship between telephone addiction and impulsivity and sensation seeking(33, 34). This can be explained by the fact that nomophobia is characterized by the tendency to engage in an activity, such as excessive smartphone use, without thinking about its consequences, a characteristic that is often observed in individuals with high impulsivity(35).
A strong link is suggested between impulsive sensation seeking and the desire for new and exciting experiences, which can intensify emotional attachment to mobile devices(36). Furthermore, the impulsive nature of seeking immediate rewards or stimulation aligns with the constant connectivity offered by mobile phones, potentially reinforcing dependency on these devices(37).
Despite this finding, the presence of nomophobia throughout the entire population presupposes underlying elements that go beyond the problems linked to the impulsivity spectrum. How then can such high prevalence levels be explained?
A recent meta-analysis conducted on the spread of nomophobia reports prevalence values close to 100%, in a young population, between 18 and 25 years old(38). In particular, the study refers to the university student population, which appears to represent the segment of the population most affected by the phenomenon, especially in its serious manifestations. This trend is found also in our sample, with the young population (18–25 years) representing 55.2% of cases with serious manifestations. However, it is certainly interesting to note how, again in relation to the most serious cases, in our sample, students do not represent the majority of cases, but are indeed equally represented compared to workers (both cover 44.8% of severe cases).
Since its inception, nomophobia has been considered as a branch or manifestation of social phobia disorder, a chronic anxiety disorder characterized by the onset of intense anxiety triggered by social situations that require interpersonal contacts and interactions(13). The DSM-5 emphasizes that at the basis of the diagnosis there must be significant interference in at least one important area of the individual's life, which can include work, social relationships but also studies or moments of leisure(13). New technologies, from tablets to smartphones, have certainly contributed to the genesis of new and constant comforts for users, as well as to an improvement in performance and effectiveness in personal, interpersonal, and working life(39). But, at the same time, they have the ability to reinforce dysfunctional behaviors, such as social isolation(39). The excessive use of mobile phones is identified by several studies as one of the coping methods in managing anxiety and stress in daily life(40).
A study, conducted on a sample of university students in 2012, evaluated peer relationship skills, conducted both in person and online and demonstrated how the internet has excellent potential as a mediator of relationships, representing a way viable alternative in the presence of social anxiety(41). Individuals seem to prefer this indirect communication route and even appear more open and self-confident through the use of it, as the screen probably constitutes a protective barrier towards the outside from this perspective(42). This increases enormously when we consider the burgeoning reality of social media, which is based first and foremost on the creation of an online universe, parallel to “real” life situations and relationships, in which people choose what to show of themselves and how to show it(41). This could mimic an individual overcoming introversion, anxiety, and low self-esteem, but in reality, strengthening them and making them more debilitating when one returns to one's daily life(43). The relationship between social anxiety and seeking refuge in the internet world is nothing new. The Internet represents a cause of social withdrawal but also an alternative in interpersonal communication even in the widely described phenomenon of Hikikomori(44, 45). Currently, the term Hikikomori is applied to individuals who do not leave theirs rooms or homes and is often conceptualized as a “culturally boundless syndrome of modern society”(46, 47). It is a condition that mainly affects adolescents or young adults, who live isolated from the world, using the Internet profusely, considering it the only method of interaction with others(48, 49). The fact that it is precisely the younger population groups that are more familiar with the use of these modern tools could be one of the key elements in explaining the prevalence distribution in our population, which sees the under 25 age group as particularly affected.
An interesting correlation with nomophobia, recently described for the first time, is that with unsatisfactory sleep. Unsatisfactory sleep seems to be at the basis of both insomnia and nomophobia(50). Furthermore, it is an element that historically has a positive correlation with various psychiatric disorders such as depression and anxiety(51). The relationship between insomnia and nomophobia is certainly bidirectional in nature, as, on the one hand, the lack of sleep and the need to fill the night hours leads to the use of electronic devices more easily, but on the other, blue light emitted by the devices themselves alters the functionality of the epiphysis, which produces melatonin and regulates the circadian rhythm, altering our ability to fall asleep(50, 51).
Experts are starting to focus their attention on an additional factor that can play a role in the problematic use of social media and electronic devices in general: FOMO(52). FOMO is an acronym that stands for Fear Of Missing Out, therefore "fear of missing something", understood, in a very broad sense, as any event or experience that happens around us and that could be within our reach(53). The definition, coined in 2013, describes the phenomenon as "the pervasive apprehension that others may be having exciting and/or satisfying experiences from which one is absent"(53). It is a condition that has been associated with depression, anxiety, reduced levels of both physical and mental well-being, as well as problematic sleep(54). Sleep would be affected by the need to avoid the feeling of missing typical of FOMO, especially in the evening and night hours, satisfying one's need for autonomy, competence, and self-determination, thus fomenting nomophobia(55). As in the previous case, here too the relationship can be of a bimodal nature, because certainly the constant search for the telephone can depend on the fear of missing something that is about to happen around us, but at the same time the massive use of the internet and social media does nothing but present new experiences lived by others and new possibilities that one was not aware of, fomenting FOMO itself(52).
The relevance of the very concept of nomophobia and, consequently, of its study lies in its association with mental health problems, such as increased stress, anxiety, irritability, insomnia, and depression. It can also correlate with self-esteem problems, social self-isolation, loneliness and, in a broader sense, unhappiness(56). It can also impair individuals' ability to concentrate on the activities they are carrying out, leading to a tendency towards impulsive action. This is particularly relevant if we observe the university population, for which an increased level of nomophobia is associated with difficulties in cultivating interpersonal relationships and a reduction in academic performance(38). The lack of concentration that can result from the use of technological means in cases of severe nomophobia is also associated with an increase in harm to oneself and others, primarily being correlated to an increased risk of road accidents(57).
It is easy to conclude by stating that we do not have certain answers at the moment in this area, which is so innovative and dynamic that it is always one step ahead of research. In this discussion we asked ourselves questions regarding the development of nomophobia, but to date research does not offer us unequivocal answers, but mostly further questions.
Limits
The main limitation of the study is represented by the analysis of results relating to the abuse of internet and mobile phone use through a questionnaire distributed via the internet itself, which therefore may constitute a selection bias. It has to be also considered the small size of the sample, as well as the restricted psychopathological area investigated, limited to the impulsivity trait. It may also be considered appropriate to evaluate and discuss the sensitivity of the test, which could be called into question on the basis of such high prevalence of the phenomenon itself.