Case 31: Behaviour Addiction in Young Adults: Blind Analysis through Somatic Inkblot Test
Bhavya Mishra, Anand Dubey & Satyadhar Dwivedi
Online games are becoming increasingly popular every day. Internet gaming addiction has caused negative consequences for young adults. The establishment of specialized treatment centers in South-East Asia, the United States, and Europe reflects the growing need for professional help. It is argued that by understanding the appeal of Internet gaming, its context, and neurobiological correlates, it can be comprehensively understood. The index case of a 20-year-old young adult, having internet Game addiction, was administered the Somatic Inkblot Test (SIS-II) for the assessment of personality and underlying unconscious conflict. The responses have been analyzed using content analysis and psychoanalytic interpretation. The blind analysis validates the history reported by the client and his parents and serves as an aid to plan further therapeutic intervention. The findings revealed the client has poor interpersonal relationships with his father and mother, low self-esteem, aggressive behavior and depression.
Introduction:
With the rapid growth of technology, smartphones have become an essential part of everyday life. It provides easy access to communication, information, and entertainment. However, spending too much time on smartphones has raised concerns about possible addiction and its negative effects on thinking ability, social relationships and mental health. The World Health Organization (2016) defines addiction as a pattern of repeated use that provides relief or pleasure but leads to cravings and dependence. Smartphone addiction fits this description, as it involves using the phone too much, feeling anxious without it, losing control over usage, and continuing to use it even when it causes problems (Billieux et al., 2015; Kuss & Griffiths, 2017; Samaha & Havi, 2016; Soni et al., 2017).
What makes the use of smartphones problematic is when they begin to interfere with daily routines. Research studies show that addiction may be present when a person constantly thinks about the phone, ignores responsibilities, becomes upset when they cannot use it (Cheever, et al., 2014; King et al., 2013), and fails to cut down their usage despite trying to stop it (Lee et al., 2014). More impulsive people, who have trouble controlling their emotions or seek attention online, are more likely to develop such an addiction (Billieux et al., 2007). Studies have also shown that smartphone addiction is especially common among teenagers and young adults. According to a meta-analysis by Sohn et al. (2019), about 23.3% of children and adolescents throughout the world show signs of problematic use of smartphones. The problem seems worse in Asia, especially among college students. In India, Dharmadhikari et al. (2019) found that 46.15% of medical students were addicted to smartphones. Another review by Zhong et al. (2022) found that around 41.93% of Asian medical students showed signs of addiction. Although not many studies have been conducted on Indian adolescents, one study found that out of all smartphone users, 33.3% showed a high level of usage. These students also scored very high on the Depression, Anxiety, and Stress Scale (DASS-21) and on the Pittsburgh Sleep Quality Index (PSQI). The findings also indicated that the more use of phones has been linked to more stress and poor sleep (Soni et al. 2017)
Smartphone use is linked to increased aggression, detachment from reality, and hallucinations among adolescents. Notably, 37% of 13-year-olds reported aggressive behavior, and 20% experienced hallucinations. The study suggests that excessive screen time may disrupt brain and social development, blurring the line between reality and virtual experiences. (Kliesener et al. 2022). Studies show that too much smartphone use might be linked to depression, anxiety, and poor sleep. This overuse could cause depression or anxiety, which then leads to sleep issues (Demirci et al., 2015; Thomee et al., 2011). Hwang et al. (2012) found that students who overused smartphones had higher levels of anxiety and depression than those who used them moderately. Adams et al. (2013) explained that increased levels of technology use after the onset of sleep are linked to poorer sleep quality, and poorer sleep quality results in symptoms of depression or anxiety. Similarly, Lemola et al. (2015) found that using electronic devices at night was linked to sleep problems and symptoms of depression. While smartphones bring many benefits, young people should be careful about how much they use them, as addiction can harm their mental health. Although smartphone addiction is not officially classified as a mental disorder, many studies have estimated its prevalence ranging from above 0% to 35% (Lopez et al. 2014). Aljomaa et al. (2016) in a study on university students reported that about 48 percent of students were addicted to smartphones. Other studies also reported the rate of smartphone addiction is most frequently reported to be between 10% and 20% (Billieux, Maurage, et al., 2015 and Carbonell et al., 2012).
The present case study is a modest attempt to find out the personality factors and unconscious forces leading to an uncontrolled desire to use a smartphone in a young adult student, average in studies and losing interest in studies. He remains socially isolated, avoids responsibilities normally expected at this age and continues to complain of body aches and pain.
Measure:
Somatic Inkblot Test:
The Somatic Inkblot Test (62-image version) is a structured, projective diagnostic tool designed to explore underlying suppressed unconscious material and is an adjunct to psychotherapy and counselling. It is designed for self-administration. Originally conceptualized in 1959, it underwent extensive research and field testing, leading to a reliable and valid instrument (Cassell, 1980, 1990; Cassell & Dubey, 2003; Dubey & Cassell, 1993; Dubey et al.,2019). The SIS images are a mixture of unstructured, semi-structured and structured inkblots designed to bring out the unprocessed material from the unconscious mind. The stimuli presented are structured to elicit both typical and atypical response patterns, making the tool inherently projective in nature. Responses are spontaneous, often revealing deep-seated intrapsychic associations unique to each person.
The diagnostic strength of the SIS lies in its ability to evoke symbolic content and personal meaning, which can be compared against normative peer data and analyzed using recognized diagnostic criteria. Its therapeutic value emerges from the opportunity it provides to explore the responses further, formulating treatment planning and opening avenues for follow-up discussions. In many cases, the process evokes emotional reactions, sometimes intensely offering the potential for catharsis and deeper therapeutic engagement (Dubey et al. 2018).
The Case:
Mr. AB is a 20-year-old unmarried male, the youngest child in a nuclear family, living with his parents and elder sister. He has completed his 12th grade but is currently not engaged in any academic, occupational, or social activity. He came to the OPD at the Institute of Mental Health and Hospital, Agra, accompanied by his parents. The primary complaints as reported were persistent severe headaches and generalized body aches that have been ongoing for the past two years. According to his parents, the client was a bright student and had scored 96% in his 10th-grade board examinations. He expressed a strong interest in pursuing commerce; however, his parents insisted that he take the science stream, which left him dissatisfied. After completing the 10th grade, he joined the school in 11th grade but did not attend the classes regularly. Simultaneously, he started preparing for the Indian Institute of Technology (IIT) entrance exams through online classes.
The onset of his symptoms coincided with the beginning of his IIT preparation. He found it increasingly difficult to cope with the rigorous study schedule and began accumulating academic backlogs, leading to heightened stress and somatic complaints such as persistent body pain. He reported being unable to carry out even basic tasks due to the discomfort. Although he expressed a desire to skip the 12th board exams due to his poor health condition, he eventually took the examination at the insistence of his parents and scored 70 percent. Over the period, he withdrew from his social environment. He stopped going out, ceased meeting or playing with friends, and abandoned hobbies, such as craftwork, as he is no longer capable of doing anything. He spent most of his time lying in bed, complaining of severe body pain. His condition deteriorated to the extent that he began eating meals in bed and avoided all physical activity. To distract him from his distress, his parents provided him with a smartphone. However, this backfired as he began spending more time -typically from 9.00 PM to 2.00 AM playing mobile games and browsing. When his parents tried to limit his screen time, he showed resentment and displayed defiant behavior. He often responded with statements such as, "You do not understand my pain; I cannot do anything. It hurts a lot, and I won't do the task." He also justified his behavior by comparing himself to his sister, saying, “You don’t ask her to stop using the phone, so why are you stopping me?”
He became increasingly irritable, socially withdrawn, and possessive of his phone, refusing to give it up. He rationalized his smartphone use as a necessary distraction from his ongoing physical and emotional discomfort. In one alarming incident, when his phone was confiscated, he stood on the rooftop of the building and threatened to jump from the 15th floor unless the phone was returned to him.
Current Status:
At present, the client is not enrolled in any educational or vocational course. He remains socially isolated, avoids all responsibilities, and continues to complain of body aches and pain. His clinical presentation aligns with patterns of behavioral addiction, particularly smartphone addiction. This behavior appears to function as a maladaptive coping mechanism for dealing with academic stress, emotional dysregulation, and a perceived sense of failure, leading to a cycle of avoidance, dependency, and psychosocial withdrawal.
Findings of Somatic Inkblot Test (SIT):
A few clinically significant responses given on the Somatic Inkblot test are interpreted using content analysis, symbolism and psychoanalytic interpretation.
Image A 9: “Two people are doing something and someone is watching them”. Two people are the most typical response in this image, but “someone is watching” indicates his suspicious attitude towards his father. He has reported in the case history that his parents are constantly monitoring him, which he finds very distressing. He feels at peace while using his phone, but when his parents question why his body hurts during other activities, but not while using the phone. He interprets it as a sign that they do not want to see him happy and is always very critical.
Image A10: “Two living beings are in the container filled with boiling water”. It indicates his aggressive behavior and shows his feelings of being punished. He always says his parents do not empathize with his pain, and even after knowing, they force him to do a different task.
Image A11: “Dolphin gets cut into two,” which indicates his hostile attitude and aggressive behavior. He gets irritated with his parents and other family members whenever they try to communicate with him.
Image A13: “It is someone’s hand, and he is trying to remove it from fire,” which indicates his tension and suffering, which he is managing. The client is dealing with psychosomatic pain and feels as if it is never-ending. He keeps on ruminating that he will get well soon and will lead a normal life.
Image A15: “Someone is falling”. This response indicates his pensive mood and suicidal ideation. The client once threatened his parents that he would jump from the building if he did not get back his phone.
Image A19: “Two animals are fighting.” This response shows his aggressive behavior.
Image A21: “Flying animal with two other animals” indicates his aggressive attitude towards his father. The client always blames his father for not caring about his sufferings and being forced to continue his studies and get engaged in some extracurricular activity.
Image A25: “Some body part; mosquito/insect.” The client avoided perceiving the female body in this image, which may indicate his low interest in the opposite sex.
Image A27: “Person appears to sit on animal”. He avoided perceiving the common response to the female torso, which may indicate conflicts with his mother. He feels as if his mother favors his sister and keeps on asking him not to lie in bed and do some productive work. He feels that she scolds him, but never to his sister.
Image A31: “Two faces can be seen”. He avoided specifying them, which may indicate conflicts with his parents.
Image B1: “Small animal is sitting on someone’s hand; and two animals sitting together” might indicate his sexual fantasy. The “small animal” may symbolize children (Philips & Smith, 1953) and may again indicate conflict with his father.
Image B3: “Cactus tree; two rats on top of something and celebrating”. The Cactus tree symbolizes protection and strength. It can help enhance communication and understanding of other people. Here, it may symbolize the mother, and the two children might symbolize the client and his sister. The response may further indicate his desire to get attention and have affection from his mother.
Image B4: “Two faces”. He avoided pointing out who they are, which may indicate conflict with the father.
Image B14: “Two people sitting and standing in front of a train gate” may indicate his sexual fantasy.
Image B15: “Fighting” may indicate his hostility and aggression, which must be addressed during therapy sessions.
Image B18: “Bone” in this image may indicate his sexual fantasy. Normally, people see the male phallic part in this image.
Image B19: “Virus-like Covid-19”. The response may indicate frustration and interpersonal conflict. He has avoided perceiving two hearts, which is a common response in this image, may further indicate interpersonal conflicts and frustration.
Image B20: “One animal is caught; Body part” may indicate anxiety and fear of being punished.
Image B27: “Two animals, one is dead, and the other is shocked,” may indicate his pensive mood and conflict. This might be an indication of potentially latent suicidal ideation.
Image B28: “Someone has kidnapped someone”, indicates his feelings of helplessness and dependency. He avoided perceiving the most typical response -mother and child, which may indicate affectionate deprivation and poor interpersonal relationships with his mother.
Discussion:
The client is a 20-year-old young adult who has complaints of psychosomatic pain, emotional withdrawal, and signs of behavioral addiction, particularly smartphone overuse. Although he reported a generally happy and deprivation-free childhood, psychological testing using the Somatic Inkblot Test indicates the presence of unresolved familial conflicts and internal emotional distress. The inkblot responses highlight themes of parental conflict—specifically with the father and mother—marked by aggression, avoidance, and issues with authority. There is also emotional tension associated with the mother, indicating deprivation and unmet emotional support, which may have contributed to the current psychological state. Marked hostility, pensive mood and suicidal ideation are also projected on inkblot responses.
These findings align with literature indicating that unresolved family dynamics in adolescence can significantly impact emotional regulation and self-concept in early adulthood (Allen et al, 1994). The index case shows patterns of emotional regression, irritability, and avoidance behavior, likely originating from internalized emotional conflicts. Emotional suppression and a lack of coping strategies may contribute to his irritability and oppositional behavior, particularly within family settings.
The client’s persistent somatic complaints and his refusal to engage in daily activities further suggest the presence of psychosomatic defenses, where emotional pain is manifested as physical discomfort. This is consistent with psychodynamic models that explain somatization as an expression of intrapsychic conflict (McDougall, J,1989). Additionally, the patient's intense emotional dependency and withdrawal from social interactions indicate an underlying fear of rejection and failure, particularly after experiencing academic setbacks.
The particular concern in this case study is the client’s reliance on his smartphone, which seems to function as an emotional buffer against distressing thoughts and interpersonal rejection. Rather than promoting distraction or relaxation, excessive smartphone use in this case appears to reinforce emotional avoidance and compulsive behavior patterns. Studies in this area have shown that behavioural addictions such as problematic smartphone use are often associated with emotional dysregulation and serve as coping mechanisms in individuals with unmet psychological needs (Elhai et al., 2017).
The client’s expressions of suicidal ideation, emotional numbness, and the desire to escape highlight the urgency for comprehensive psychological intervention. These symptoms reflect not only current distress but also deeper existential concerns about self-worth, autonomy, and perceived failure. The findings on the Somatic Inkblot Test, thus, offer a valuable lens through which the therapist can understand the emotional underpinnings of the suffering individual’s behavior and psychological symptoms.
Conclusion:
The present case study highlights the value of projective assessments in uncovering underlying psychological dynamics which are not always evident in clinical interviews. Despite the absence of overt trauma, the Somatic Inkblot Test revealed significant emotional conflict, familial distress and internalized anxiety. His behavior suggests that the smartphone serves as a maladaptive coping mechanism for unresolved psychological tension and emotional pain.
Understanding the emotional and relational roots of the patient’s distress—especially in the context of family dynamics and academic pressure—can inform a more targeted and holistic intervention strategy. Early identification and psychotherapeutic intervention are essential to address emotional dysregulation, strengthen coping mechanisms, and reduce dependence on avoidance behaviors such as the excessive use of smartphones. This case underscores the importance of integrating projective techniques with clinical evaluation to better understand and manage the complex emotional needs of young adults facing psychosocial and behavioral challenges. The SIT is a reliable, dependable projective test as its findings match the history given by parents and behavioral symptoms of the patient.
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