Latent-level relations between DSM-5 PTSD symptom clusters and problematic smartphone use
Open accessAbstract
Common mental health consequences following the experience of potentially traumatic events include Posttraumatic Stress Disorder (PTSD) and addictive behaviors. Problematic smartphone use is a newer manifestation of addictive behaviors. People with anxiety severity (such as PTSD) may be at risk for problematic smartphone use as a means of coping with their symptoms. Unique to our knowledge, we assessed relations between PTSD symptom clusters and problematic smartphone use. Participants (N = 347), recruited through Amazon’s Mechanical Turk (MTurk), completed measures of PTSD and smartphone addiction. Results of the Wald tests of parameter constraints indicated that problematic smartphone use was more related to PTSD’s negative alterations in cognitions and mood (NACM) than to PTSD’s avoidance factor, Wald χ2(1, N = 347) = 12.51, p = 0.0004; and more to PTSD’s arousal compared to PTSD’s avoidance factor, Wald χ2(1, N = 347) = 14.89, p = 0.0001. Results indicate that problematic smartphone use is most associated with negative affect and arousal among trauma-exposed individuals. Implications include the need to clinically assess problematic smartphone use among trauma-exposed individuals presenting with higher NACM and arousal severity; and targeting NACM and arousal symptoms to mitigate the effects of problematic smartphone use.
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The most commonly referenced cut-off point for determining when smartphone use becomes problematic was based on the work of Kwon, Lee, et al. (2013) and their Smartphone Addiction Scale.
“The most commonly referenced cut-off point for determining when smartphone use becomes problematic was based on the work of Kwon, Lee, et al. (2013) and their Smartphone Addiction Scale (Chotpitayasunondh & Douglas, 2016;Contractor et al., 2017;Enez;Enez Darcin et al., 2016;Hartanto & Yang, 2016).”
From Antecedents and consequences of problematic smartphone use: A systematic literature review of an emerging research area (2021) · cites this paper as Contractor et al., 2017
The Methods section (2.4.3; page unavailable) attributes the recommended cut-off scores to Kwon, Kim, et al. (2013) and the short version of the scale, not to Kwon, Lee, et al. (2013). The paper also does not say that these are the most commonly referenced cut-offs. (LLM, conf=0.85)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredProblematic use should not necessarily be considered an addiction prima facie as it may also derive from other sources such as obsessive compulsive checking, loneliness, anxiety, or unresolved real-life problems.
“It is argued that problematic use should not necessarily be considered an addiction prima facie as it may also derive from other sources such as obsessive compulsive checking (Steelman et al., 2012), loneliness (Kim, 2017(Kim, , 2018)), anxiety (Contractor et al., 2017), or unresolved real-life problems (Wang, Wang, Gaskin, & Wang, 2015).”
From Antecedents and consequences of problematic smartphone use: A systematic literature review of an emerging research area (2021) · cites this paper as Contractor et al., 2017
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Trauma‐Related Correlates of Alcohol Use in Recently Deployed OEF/OIF Veterans
Capone, C., McGrath, A. C., Reddy, M. K., & Shea, M. T. (2013) · Journal of Traumatic Stress · doi:10.1002/jts.21817 · Cited by 19 · see citing works
Latent dimensions of posttraumatic stress disorder and their relations with alcohol use disorder
Biehn, T. L., Contractor, A. A., Elhai, J. D., Tamburrino, M., Fine, T. H., Cohen, G. H., Shirley, E. R., Chan, P. K., Liberzon, I., Calabrese, J. R., et al. (2015) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-015-1135-x · Cited by 11 · see citing works
Self-citationThe moderating role of dysphoria in the relationship between intrusions and alcohol use
Contractor, A. A., Presseau, C., Capone, C., Reddy, M. K., & Shea, M. T. (2015) · Addictive Behaviors · doi:10.1016/j.addbeh.2015.12.010 · Cited by 7 · see citing works
Self-citation
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Busch, P. A., & McCarthy, S. (2021) · Computers in Human Behavior · doi:10.1016/j.chb.2020.106414 · Cited by 657 · see citing works
Excessive Smartphone Use Is Associated With Health Problems in Adolescents and Young Adults
Wacks, Y., & Weinstein, A. M. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.669042 · Cited by 424 · see citing works
Elhai, J. D., Levine, J. C., & Hall, B. J. (2018) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2018.11.005 · Cited by 354 · see citing works
Self-citationThomée, S. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15122692 · Cited by 340 · see citing works
“Furthermore, associations were seen with anxiety [7,39,42,50,62,67,68,74–76,80,89, 100,108,115,135,157,180,184,189,198,214,245,267] (but, a negative association between text message dependency and anxiety in Reference [185]), sleep problems or insomnia [7,32,115,269], reduced sleep quality [38,39,62,80,110,195,240], s…”
BackgroundThe use of crowdsourcing in addiction science research: Amazon Mechanical Turk.
Strickland, J. C., & Stoops, W. W. (2018) · Experimental and Clinical Psychopharmacology · doi:10.1037/pha0000235 · Cited by 249 · see citing works
Neophytou, E., Manwell, L. A., & Eikelboom, R. (2021) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-019-00182-2 · Cited by 231 · see citing works
Elhai, J. D., & Contractor, A. A. (2018) · Computers in Human Behavior · doi:10.1016/j.chb.2018.01.010 · Cited by 121 · see citing works
Self-citationLee, S., Kim, M., Mendoza, J. S., & McDonough, I. M. (2018) · Heliyon · doi:10.1016/j.heliyon.2018.e00895 · Cited by 99 · see citing works
“One of the few studies that examined addictive behavior and cellphones argued that addictive behaviors were attributed to coping mechanisms that are a part of common symptomology related to mental health adversities such as post-traumatic stress disorder (PTSD) (Contractor et al., 2017).”
BackgroundInfluentialWeiss, N. H., Darosh, A. G., Contractor, A. A., Schick, M. M., & Dixon‐Gordon, K. L. (2019) · Journal of Clinical Psychology · doi:10.1002/jclp.22768 · Cited by 78 · see citing works
Self-citationPTSD's relation with problematic smartphone use: Mediating role of impulsivity
Contractor, A. A., Weiss, N. H., Tull, M. T., & Elhai, J. D. (2017) · Computers in Human Behavior · doi:10.1016/j.chb.2017.05.018 · Cited by 63 · see citing works
“and found a positive significant relation between the two constructs (Contractor et al., 2017).”
BackgroundSelf-citationHarris, B., McCredie, M., & Fields, S. (2020) · Computers in Human Behavior Reports · doi:10.1016/j.chbr.2020.100011 · Cited by 62 · see citing works
A test of the pathway model of problematic smartphone use
Canale, N., Moretta, T., Pancani, L., Buodo, G., Vieno, A., Dalmaso, M., & Billieux, J. (2021) · Journal of Behavioral Addictions · doi:10.1556/2006.2020.00103 · Cited by 62 · see citing works
Cui, X., & Chi, X. (2021) · Psychology Research and Behavior Management · doi:10.2147/prbm.s305510 · Cited by 56 · see citing works
Wickersham, A., Petrides, P. M., Williamson, V., & Leightley, D. (2019) · DIGITAL HEALTH · doi:10.1177/2055207619842986 · Cited by 54 · see citing works
Kukreti, S., Ahorsu, D. K., Strong, C., Chen, I.-H., Lin, C.-Y., Ko, N.-Y., Griffiths, M., Chen, Y.-P., Kuo, Y.-J., & Pakpour, A. (2021) · Healthcare · doi:10.3390/healthcare9101288 · Cited by 45 · see citing works
“All these activities have the potential to exacerbate the feelings of anxiety if individuals are unable to use their smartphones [27].”
BackgroundArrivillaga, C., Rey, L., & Extremera, N. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.09.021 · Cited by 54 · see citing works
Hu, T., Wang, Y., Lin, L., & Tang, W. (2021) · Children and Youth Services Review · doi:10.1016/j.childyouth.2021.106012 · Cited by 50 · see citing works
Marino-Romero, J. A., Palos‐Sánchez, P. R., & Velicia-Martin, F. (2022) · Journal of Service Theory and Practice · doi:10.1108/jstp-04-2022-0095 · Cited by 58 · see citing works
Relation of positive memory recall count and accessibility with post-trauma mental health
Contractor, A. A., Banducci, A. N., Dolan, M., Keegan, F. S., & Weiss, N. H. (2019) · Memory · doi:10.1080/09658211.2019.1628994 · Cited by 39 · see citing works
Self-citationThe Psychology of Smartphone: The Development of the Smartphone Impact Scale (SIS)
Pancani, L., Preti, E., & Riva, P. (2020) · Assessment (Odessa, Fla.) · doi:10.1177/1073191119831788 · Cited by 38 · see citing works
Zhang, C., Li, G., Fan, Z., Tang, X., & Zhang, F. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.600352 · Cited by 36 · see citing works
“, 2015), and also associated with poor mental health (Contractor et al., 2017); psychological capital has a theoretical intervention model (Luthans et al.”
BackgroundRelation between PTSD symptom clusters and positive memory characteristics: A network perspective
Contractor, A. A., Greene, T., Dolan, M., Weiss, N. H., & Armour, C. (2019) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2019.102157 · Cited by 35 · see citing works
Self-citationChen, Z., Zeng, J., Liao, J., & Guo, C. (2025) · Journal of Youth and Adolescence · doi:10.1007/s10964-025-02151-6 · Cited by 33 · see citing works
“Individuals do not always use the Internet to pursue pleasure; sometimes, they use it as a distraction to avoid unpleasant emotions (Contractor et al., 2017).”
Addictive Use of Smartphones and Mental Disorders in University Students
Alavi, S. S., Ghanizadeh, M., Farahani, M., Jannatifard, F., Alamuti, S. E., & Mohammadi, M. R. (2020) · Iranian Journal of Psychiatry · doi:10.18502/ijps.v15i2.2681 · Cited by 32 · see citing works
“Studies have shown that compulsive use of smartphones may lead to psychological disorders (9, 20, 31-35) and different types of psychopathology, including depression (4, 9, 20, 26, 36, 37) and anxiety (4, 9, 19, 20, 26, 34, 36-38) in college students (9, 24).”
BackgroundTypologies of PTSD clusters and reckless/self-destructive behaviors: A latent profile analysis
Contractor, A. A., & Weiss, N. H. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.12.124 · Cited by 31 · see citing works
Self-citationYang, X., Wu, X., Qi, J., & Zhou, X. (2020) · Current Psychology · doi:10.1007/s12144-020-00816-y · Cited by 28 · see citing works
“For example, Contractor et al. (2017a) found that the NAMC symptom cluster had a significant predictive effect on IA, but that intrusive and avoidance symptoms were not related to IA.”
BackgroundInfluentialContractor, A. A., Weiss, N. H., & Elhai, J. D. (2018) · Social Science Computer Review · doi:10.1177/0894439318770745 · Cited by 27 · see citing works
Self-citationPosttraumatic Stress Disorder Symptoms and Reckless Behaviors: A Network Analysis Approach
Armour, C., Greene, T., Contractor, A. A., Weiss, N. H., Dixon–Gordon, K. L., & Ross, J. (2020) · Journal of Traumatic Stress · doi:10.1002/jts.22487 · Cited by 26 · see citing works
Self-citationContractor, A. A., Weiss, N. H., Kearns, N. T., Caldas, S. V., & Dixon–Gordon, K. L. (2019) · International Journal of Stress Management · doi:10.1037/str0000145 · Cited by 24 · see citing works
Self-citationShmulewitz, D., Levitin, M. D., Skvirsky, V., Vider, M., Eliashar, R., Mikulincer, M., & Lev‐Ran, S. (2024) · Psychological Medicine · doi:10.1017/s0033291724002794 · Cited by 27 · see citing works
“…PTSD, anxiety, and depression; such associations were found in previous studies (e.g. (Armour et al., 2020; Augner, Vlasak, Aichhorn, & Barth, 2023; Contractor, Frankfurt, Weiss, & Elhai, 2017; Fan et al., 2020; Lee et al., 2017; Melca, Teixeira, Nardi, & Spear, 2023; Tullett-Prado, Doley, Zarate,…”
PTSD, FOMO and fake news beliefs: a cross-sectional study of Wenchuan earthquake survivors
Gong, C., & Ren, Y.-J. (2023) · BMC Public Health · doi:10.1186/s12889-023-17151-z · Cited by 18 · see citing works
“PTSD is linked to problematic smart device use, which some academics have termed ‘iDisorder’ [3].”
BackgroundInfluentialContractor, A. A., Weiss, N. H., Dolan, M., & Mota, N. P. (2019) · International Journal of Stress Management · doi:10.1037/str0000133 · Cited by 18 · see citing works
Self-citationDSM-5 PTSD symptom clusters and suicidal ideation in veterans
Brown, L. A., Chen, S., Narine, K., Contractor, A. A., & Oslin, D. W. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.112942 · Cited by 19 · see citing works
Self-citationPersonality traits of university students with smartphone addiction
Kheradmand, A., Amirlatifi, E. S., & Rahbar, Z. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1083214 · Cited by 17 · see citing works
Predicting Patterns of Problematic Smartphone Use among University Students: A Latent Class Analysis
Parent, N., Bond, T. A., Wu, A. D., & Shapka, J. D. (2022) · Human Behavior and Emerging Technologies · doi:10.1155/2022/4287600 · Cited by 15 · see citing works
Liu, Y.-N., Wang, X.-N., Zhai, J.-Q., Luo, F., & Xin, T. (2023) · Cyberpsychology: Journal of Psychosocial Research on Cyberspace · doi:10.5817/cp2023-1-1 · Cited by 11 · see citing works
Caldas, S. V., Fondren, A. H., Batley, P. N., & Contractor, A. A. (2022) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2022.101752 · Cited by 12 · see citing works
Self-citationStudying Psychopathology in Relation to Smartphone Use
Rozgonjuk, D., Elhai, J. D., & Hall, B. J. (2019) · Studies in neuroscience, psychology and behavioral economics · doi:10.1007/978-3-030-31620-4_11 · Cited by 11 · see citing works
Self-citationBatley, P. N., Contractor, A. A., Weiss, N. H., Compton, S. E., & Price, M. (2021) · Assessment · doi:10.1177/10731911211036760 · Cited by 11 · see citing works
Self-citationGarcía‐Manglano, J., López-Madrigal, C., Sádaba, C., Serrano, C., & López-Fernández, O. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19010358 · Cited by 11 · see citing works
Evren, B., Dalbudak, E., Evren, C., & Ozen, S. (2018) · Psychiatry and Clinical Psychopharmacology · doi:10.1080/24750573.2018.1505422 · Cited by 10 · see citing works
“means of coping with their symptoms [28].”
BackgroundShmulewitz, D., Levitin, M. D., Skvirsky, V., Vider, M., Lev‐Ran, S., & Mikulincer, M. (2025) · Scientific Reports · doi:10.1038/s41598-025-16168-1 · Cited by 12 · see citing works
FoMO, Adicción a Facebook y Soledad como Determinantes del Phubbing en Universitarios Limeños
Correa-Rojas, J., Muchotrigo, M. P. G., & Malvaceda-Espinoza, E. (2022) · Psykhe (Santiago) · doi:10.7764/psykhe.2020.22579 · Cited by 9 · see citing works
“…(Franchina et al., 2018; Rodríguez Puentes & Fernández Parra, 2014), y está relacionado positivamente con el trastorno de estrés postraumático (Contractor et al., 2017), las dificultades para dormir (Demirci et al., 2015), la depresión y ansiedad (Elhai et al., 2017) y con los sentimientos de…”
BackgroundContractor, A. A., Jin, L., Weiss, N. H., & O'Hara, S. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113667 · Cited by 9 · see citing works
Self-citationSmartphone addiction and its relation to social phobia in female university students
Mohamed, Z. K., ElNahas, G. M., Hatata, H. A.-M., Elserafi, D. M., & Mahmoud, D. A.-M. (2023) · Middle East Current Psychiatry · doi:10.1186/s43045-023-00327-z · Cited by 8 · see citing works
Zhuang, C.-M., & Jenatabadi, H. (2022) · Healthcare · doi:10.3390/healthcare11010018 · Cited by 6 · see citing works
“If people are unable to use their smartphones, all of these activities could make people feel much more anxious [22].”
BackgroundChrist, N. M., Byllesby, B. M., & Elhai, J. D. (2022) · Substance Use & Misuse · doi:10.1080/10826084.2022.2129997 · Cited by 6 · see citing works
“…sudden, violent death of a close family member or friend (19.2%), life-threatening illness (15.0%), and life-threatening accident (11.4%), which are similar to those reported in other Mturk studies examining trauma-exposure and PTSD symptom severity (Contractor et al., 2017; Engle et al., 2020).”
ResultInfluentialSelf-citationGong, C., & Ren, Y. (2025) · Humanities and Social Sciences Communications · doi:10.1057/s41599-025-05467-7 · Cited by 3 · see citing works
“First, the DSM-5 PTSD scales (Contractor et al., 2017) have been recently updated and now include four clusters, with the addition of a ‘ negative alterations in cognition/mood ’ subtype.”
Zhang, H.-X. (2024) · Psychiatry Investigation · doi:10.30773/pi.2024.0112 · Cited by 2 · see citing works
“23,51,52 Aligning with those results, the present study further reported the significant association between COVID-19-related PTSD symptoms and SMA among university students.”
BackgroundResultMilam, L. C., Dick, O. G., McGettrick, C. R., Brown, J. B., & Woodward, M. J. (2024) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-024-01415-9 · Cited by 3 · see citing works
“Contrary to the hypotheses, no indirect effects were found between PTSD and PSU for problem-focused or emotion-focused coping.”
InfluentialPrimi, C., Garuglieri, S., Gori, C., Sanson, F., Giambi, D., Fogliazza, M., & Donati, M. A. (2023) · Behaviour and Information Technology · doi:10.1080/0144929x.2023.2212816 · Cited by 3 · see citing works
“The latter argue that problematic use should not necessarily be considered addiction as it can also derive from other sources such as loneliness (Kim 2017, 2018), anxiety (Contractor et al. 2017) or real-life problems unresolved (Wang et al. 2015).”
BackgroundWang, Y. C., Bi, H.-Y., Ding, K.-M., Zhu, J., Zhao, B., Zhang, D.-W., Chang, X.-L., Li, G.-H., Pan, Y., Zhu, L., et al. (2026) · BMC Psychology · doi:10.1186/s40359-026-04008-4 · Cited by 1 · see citing works
“Abnormal amygdala functioning is strongly associated with a variety of mood disorders (e.g., anxiety, depression, PTSD) [17, 19–22].”
Examining the Utility of Behavioral Economic Demand in Addiction Science
Strickland, J. C. (2019) · UKnowledge (University of Kentucky) · doi:10.13023/etd.2019.030 · Cited by 1 · see citing works
“technology-related behavioral addictions, such as mobile phone addiction (Bock et al. 2016; Contractor et al. 2017), social media addiction (Muench et al.”
BackgroundShi, W., Wang, S., Garabiles, M. R., Jia, P., Yuan, G. F., & Zhao, L. (2023) · Addiction Research & Theory · doi:10.1080/16066359.2023.2288820 · Cited by 1 · see citing works
“This study used data from the six-month follow-up survey, which included measures of PTSD and IA.”
InfluentialPang, F., Wang, S., Dan, H., Su, T., Yang, X., Xing, H., Xu, C., & Zhou, Z. (2025) · Applied Research in Quality of Life · doi:10.1007/s11482-025-10476-4
“Studies generally show a positive correlation between PSU and NA (Zhang et al., 2022; Li et al., 2020a , b, c ; Contractor et al., 2017; Yao et al., 2021), while find - ings on PA are less consistent (Horwood & Anglim, 2019).”
Zhang, X., He, H., Bifa, Z., & Zhu, X. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1976921
“This negative reinforcement process may contribute to the maintenance of smartphone use (Contractor et al., 2017).”
- Authors
- Contractor, A. A., Frankfurt, S. B., Weiss, N. H., & Elhai, J. D.
- Affiliations
- University of North Texas (US)
- Texas A&M Health Science Center (US)
- Yale University (US)
- University of Toledo (US)
- Corresponding author
- Contractor, Ateka A.
- Venue
- Computers in Human Behavior
- Publisher
- Elsevier BV
- Published
- 2017-07
- Volume
- 72
- Pages
- 170-177
- ISSN
- 0747-5632 (ISSN-L)
- PMC
- PMC5630169
- OpenAlex
- W2589539894
- Semantic Scholar
- a0a4aadd42829b35d0784d0f08946fda8db660c8
- Cited by
- 56
- References
- 80
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 3 · 2023: 6 · 2022: 6 · 2021: 9 · 2020: 7 · 2019: 10 · 2018: 8 · 2017: 1
- FWCI
- 18.21
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Computers in Human Behavior (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Department of Veterans Affairs
- Office of Academic Affiliations
- Central Texas Veterans Health Care System
- Topics
- Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Sexuality, Behavior, and Technology
- Keywords
- post-traumatic stress disorder, smartphone addiction, PTSD symptom clusters, DSM-5 PTSD criteria, hyperarousal, avoidance, trauma exposure, addictive behavior, coping with anxiety
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