The dramatic increase in internet access and digital engagement, while beneficial to society, has created an emerging public health issue: problematic internet use (PIU). PIU is conceptualized as a compulsive, poorly regulated pattern of internet engagement that leads to significant psychological, social, and functional impairments(Spada & Marcantonio, 2014). Characterized by withdrawal-like symptoms, compulsive use, and impaired control, PIU mirrors behavioral addiction syndromes and is increasingly recognized as a mental health issue with transdiagnostic relevance (Pérez‐Sáenz, Ortuo‐Sierra, Pérez‐Albéniz, Mason, & Fonseca‐Pedrero, 2023).

Adolescents are particularly vulnerable to PIU due to ongoing developmental maturation in emotional regulation, executive functioning, and impulse control (Lozano-Blasco, Robres, & Sanchez, 2022). This susceptibility is underscored by rising prevalence rates in youth populations globally: 28.4 % in China (Zhao et al., 2021), 21.1 % in Turkey(Cam & Ustuner Top, 2020), 20.6 % in the United States (Błachnio et al., 2019), 12.5 % in Spain (Romero-Rodríguez, Marín-Marín, Hinojo-Lucena, & Gómez-García, 2021), and 12.4 % in Japan(Suzuki, Miyatake, & Kusaka, 2023). Emerging epidemiological data also reveal gender-related differences in PIU, with some studies indicating higher susceptibility among adolescent girls (Nogueira-López, Rial-Boubeta, Guadix-García, Villanueva-Blasco, & Billieux, 2023).

A growing corpus of evidence links PIU with a range of adverse mental and physical health outcomes, including visual fatigue (Condori-Meza et al., 2021), emotional dysregulation (anxiety/depression)(Ansar et al., 2020), addictive comorbidities, sleep disturbances (Alimoradi et al., 2019), self-harming behaviors (Cheng, Tseng, Lin, Chen, & Wu, 2018), and impaired social functioning. The mind–body interaction model proposes that PIU and chronic anxiety can lead to autonomic nervous system dysfunction, resulting in somatic symptoms such as palpitations, muscle tension, sleep disturbances, and fatigue (Ezra, Hammerman, & Shahar, 2019). Of particular concern is the triadic interplay between PIU, anxiety symptoms, and somatic complaints. These conditions interact bidirectionally: PIU can worsen anxiety and somatic symptoms, while these symptoms may in turn increase PIU. (Li, Li, Liu, & Wu, 2020). Common somatic symptoms like headaches, chest pain, gastrointestinal discomfort, and sleep disturbances are now understood to function as both causes and effects in this pathological cycle.

Despite these associations, much of the existing literature has relied on latent variable models such as regression analysis, which fail to illuminate the dynamic interplay of individual symptoms across comorbid domains. Unlike traditional approaches, network analysis views psychiatric disorders as emerging from interactions between symptoms, not as latent entities (Borsboom & Cramer, 2013). This method maps symptoms as nodes and their relationships as weighted edges, revealing the structure of mental health conditions (Hofmann, Curtiss, & Mcnally, 2016). Network models can pinpoint bridge symptoms that link different disorder clusters, making them key targets for transdiagnostic treatments.

To date, no study has applied network analysis to the complexity of associations of PIU, anxiety, and somatic symptoms in adolescents—a critical oversight given the developmental sensitivity of this population. Furthermore, the role of gender in modulating these symptom networks remains underexplored. Identifying gender-specific bridge symptoms may inform precision mental health interventions that are both age- and sex-sensitive.

To address these gaps, the present study employs network analysis to investigate the interrelations among PIU, anxiety, and somatic symptoms in a large, community-based sample of Chinese adolescents. Specifically, we aim to:1.

Elucidate how dimensions of PIU (withdrawal & social problems, time management & performance, and reality substitution) are associated with subtypes of anxiety (physical symptoms, harm avoidance, social phobia, separation anxiety) and common somatic complaints (e.g., headaches, sleep problems, gastrointestinal issues).

2.

Identify core and bridging symptoms that underline comorbidity across these three domains.

3.

Examine gender-based differences in the structure and strength of these symptom networks.

By integrating contemporary analytical techniques with a transdiagnostic framework, this study aspires to provide actionable insights into adolescent mental health, enhance clinical conceptualization of PIU-related psychological problems, and inform targeted, evidence-based interventions.