Withdrawal symptoms in internet gaming disorder: A systematic review

Distinct roles of specific metacognitive beliefs in adolescent problematic mobile phone use: A Cross-Lagged panel network analysis

Problematic mobile phone use (PMPU) among adolescents is increasingly recognized as a significant behavioral health concern. Previous studies have found general metacognitive beliefs can positively predict PMPU. However, the longitudinal relationship between specific metacognitive beliefs and addictive behaviors has not been fully explored. This study aimed to explore the longitudinal relationship between metacognitions about mobile phone use, metacognitions about desire thinking, and PMPU among adolescents using cross-lagged panel network analysis. A sample of 993 adolescents were surveyed at two points over six months. Findings indicated that negative metacognitions about mobile phone use and positive metacognitions about desire thinking emerged as two prominent bridge nodes. Negative metacognitions about mobile phone use were strongly associated with withdrawal and relapse symptoms, while positive metacognitions about desire thinking correlated with tolerance and relapse. These results suggest that interventions aimed at addressing PMPU should consider the distinct impacts of different metacognitive beliefs and tailor their approaches accordingly.

Methodological issues in behavioral addictions' research: A call for an unbiased analysis of excessive behaviors

In the psychological literature, there has been a proliferation of new behavioral addictions, often biased by an aprioristic and confirmatory approach that applied the addiction framework without adequately considering other potential explanations of excessive behaviors. This position paper further extends the critiques previously pointed out in the literature by highlighting the methodological issues underlying the current behavioral addiction research and the need for future studies to avoid a confirmatory and aprioristic approach (whatever the etiological hypothesis). Analyzing repetitive behaviors in their own specifies could help find a balance between the risk of over-pathologizing common behaviors and not exploring new potential clinical disorders related to everyday (excessive) behaviors associated with functional impairment and deserving public health attention. Finally, we underline the value of recalling that if an existing diagnosis might explain the problematic behavior under consideration, a new clinical disorder should not be introduced in the literature.

Addicted brains on brief abstinence: Similarities and differences in functional connectivity patterns between internet gaming disorder and tobacco use disorder

BACKGROUND

Many studies have attempted to understand the neural basis of internet gaming disorder (IGD) to explore if IGD could be diagnosed as an addictive behavior. However, those findings were often inconsistent due to the participants having varying craving levels. Individual brain activities in the abstinence state are different from that in the neutral state. Therefore, exploring the responses of the brain during abstinence in IGD and comparing them with substance addiction is crucial in understanding this complex, craving-prone disorder.

METHODS

Three groups of male participants were recruited: IGD (61), tobacco use disorder (TUD) (61), and health controls (80). Resting-state functional Magnetic Resonance Imaging data were collected after brief abstinence (not gaming/smoking for about 1.5 h). First, we identified abnormal brain regions with altered amplitude of low-frequency fluctuations (ALFF) in IGD and TUD. Then, using these regions as the regions of interest, we conducted a functional connectivity (FC) analysis to explore the similarities and differences between IGD and TUD. Finally, we used a neural network analysis to build a classification model based on ALFF results.

RESULTS

The abnormal brain regions with altered ALFF were observed in both IGD and TUD, including the superior frontal gyrus, orbitofrontal cortex, precentral gyrus, caudate, and thalamus. FC analysis showed similarities in the orbitofrontal regions, specifically between caudate-nucleus accumbens and thalamus-precentral gyrus, and differences in the executive control and reward regions. Neural network analysis demonstrated that abnormal ALFF brain regions can effectively classify addicted individuals from health controls.

CONCLUSIONS

This study showed that brain regions in IGD and TUD had similar ALFF changes during brief abstinence. However, FC analyses revealed contrasting results. FC in IGD increased, while it decreased in TUD. These differences may be due to IGD's internal craving, unlike nicotine for TUD. These findings deepen our understanding of the neural mechanisms of IGD.

Similarities and differences in core symptoms of problematic smartphone use among Chinese students enrolled in grades 4 to 9: A large national cross-sectional study

Children and adolescents are highly susceptible to problematic smartphone usage. We employed network analysis to explore the similarities and differences in the core symptoms of problematic smartphone use across grades 4-9, using a large nationwide sample. This study included 8552 children and adolescents (Mage = 12.98, SD=1.51) who met the critical value for problematic smartphone use. The results showed that the core symptoms of problematic smartphone use exhibit both similarities and differences between grades 4 and 9. 'Withdrawal symptoms' and 'preoccupation symptoms' were the stable core symptoms of problematic smartphone use across grades 4 to 9, suggesting that problematic smartphone use begin to appear from earlier grades, such as grade 4. 'Feel impatient and fretful', 'never give up' and 'always thinking about' were the core symptoms in grades 4 and 5. 'Longer than I had intended' and 'hard to concentrate' emerged as additional core symptoms in grade 6, with the intensity indicators peaking in grades 8 and 9, suggesting that the issue of problematic smartphone use among Chinese children and adolescents has become intensified and intricate. Symptoms of problematic smartphone use vary across grades and exhibit both continuity and stage specificity. Consequently, to address this issue, the formulation of intervention measures should comprehensively consider both the grade levels and symptoms.

Scoping review of withdrawal's role in contemporary gaming disorder research: Conceptualizations and operationalizations

The global gaming community now exceeds 3 billion players, prompting increased attention from social and medical sciences regarding gaming-related disorders. Internet Gaming Disorder (IGD) was incorporated into DSM-5 in 2013, and Gaming Disorder (GD) found its place in ICD-11 in 2019. A contentious criterion in IGD, not present in GD, revolves around withdrawal symptoms. This paper offers a theoretical foundation on gaming withdrawal symptoms in gaming-related disorders and conducts a scoping review of withdrawal operationalization and conceptualization in 40 selected studies, following PRISMA-ScR guidelines. Most studies employed a correlation framework, relying on convenience samples and self-assessment questionnaires. A smaller portion focused on clinical samples and case studies. Withdrawal was predominantly conceptualized in terms of affective components, with less emphasis on behavioural, cognitive, physical, or neurological aspects. The prevailing terminology for gaming-related disorders was IGD, with only three studies referencing GD as defined in ICD-11. Notably, just six experimental studies included abstinence control. We advocate for an expansion of research on withdrawal symptoms, particularly through experimental studies that implement abstinence within experimental groups and offer alternative operationalizations beyond dominant self-assessment measures.

The symptom network of internet gaming addiction, depression, and anxiety among children and adolescents

Internet gaming addiction (IGA), depression, and anxiety are significant issues among children and adolescents, with substantial social implications. Understanding the specific characteristics of this relationship is crucial for developing effective prevention and intervention strategies. The present study employed network analysis to explore the symptom network of IGA, depression, and anxiety among 1,548 Chinese children and adolescents. The results showed that the core symptoms of IGA among children and adolescents were "tolerance", "withdrawal", and "conflict". There was no significant gender difference in the structure, global strength, and core symptoms of IGA. Although there were no significant differences in the structure of the symptom network of IGA among children and adolescents of different ages, there were significant differences in global strength and some core symptoms ("conflict"). The core symptoms of the comorbidity of IGA, depression, and anxiety in children and adolescents included "feeling downhearted and blue", "breathing difficulty", "difficult to work up the initiative to do things", and "withdrawal". The comorbidity network did not show significant gender and age differences in network structure, but there were significant gender differences in global strength. Furthermore, there were significant gender and age differences in some core symptoms. The social impact of these findings is profound, highlighting the need for targeted interventions in schools and communities to address IGA and its comorbidities. Our results also suggest that interventions should be tailored to consider gender and age differences to maximize effectiveness.

Network analysis of childhood maltreatment and internet addiction in adolescents with major depressive disorder

BACKGROUND

Childhood maltreatment (CM) is closely linked to internet addiction (IA), especially in adolescents with Major Depressive Disorder (MDD). Previous studies have shown that adolescents who experience CM are more likely to develop IA and other psychological problems. This study aims to explore the complex relationship between CM and IA through network analysis, particularly identifying the core symptoms and bridge symptoms to better understand the development of IA in these adolescents.

METHODS

A cross-sectional study was conducted in seven hospitals in Anhui Province, China, involving 332 adolescents diagnosed with MDD using DSM-5 criteria. The Childhood Trauma Questionnaire - Short Form (CTQ-SF) and the Internet Addiction Test (IAT) were used to assess CM and IA symptoms, respectively. Gender-based network analysis was also performed.

RESULTS

Network analysis constructed a CM-IA network and identified core and bridge symptoms. "Depress/moody/nervous being offline", "Request an extension for longer time", "Sleep loss due to late-night logins", and "emotional abuse" emerged as central symptoms within the CM-IA network. Additionally, "emotional abuse", "sexual abuse", and "complaints about online time" were identified as key bridge symptoms linking CM and IA. These symptoms demonstrated significant connectivity, underscoring their critical role in linking CM and IA.

CONCLUSION

The findings highlight the complex relationship between CM and IA in adolescents with MDD. Specific symptoms, such as emotional abuse and online-related symptoms, play important roles in understanding and intervening in adolescent IA. Future interventions should target these core and bridge symptoms for more effective prevention and treatment.

Comparing psychopathological symptoms, life satisfaction, and personality traits between the WHO and APA frameworks of gaming disorder symptoms: A psychometric investigation

INTRODUCTION

The inclusion of Internet Gaming Disorder (IGD) in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association and Gaming Disorder in the 11th revision of the International Classification of Diseases (ICD-11) by the World Health Organization requires consistent psychological measures for reliable estimates. The current study aimed to investigate the psychometric properties of the Gaming Disorder Test (GDT), the Ten-Item Internet Gaming Disorder Test (IGDT-10), and the Five-Item Gaming Disorder Test (GDT-5) and to compare the WHO and the APA frameworks of gaming disorder symptoms in terms of psychopathological symptoms, life satisfaction, and personality traits.

METHODS

A sample of 723 Swedish gamers was recruited (29.8% women, 68.3% men, 1.9% other, Mage = 29.50 years, SD = 8.91).

RESULTS

The results indicated notable differences regarding the estimated possible risk groups between the two frameworks. However, the association between gaming disorder symptoms and personality traits, life satisfaction, and psychopathological symptoms appeared consistent across the two frameworks. The results showed excellent psychometric properties in support of the one-factor model of the GDT, IGDT-10, and GDT-5, including good reliability estimates (McDonald's omega) and evidence of construct validity. Additionally, the results demonstrated full gender and age measurement invariance of the GDT, IGDT-10, and GDT-5, indicating that gaming disorder symptoms are measured equally across the subgroups.

CONCLUSION

These findings demonstrate that the IGDT-10, GDT-5, and GDT are appropriate measures for assessing gaming disorder symptoms and facilitating future research in Sweden.

Longitudinal Relationships Between School Climate, Academic Achievement, and Gaming Disorder Symptoms Among Chinese Adolescents

Despite growing concerns regarding the development of gaming disorder symptoms among adolescents, the longitudinal relationship between school factors and gaming disorder symptoms remains far from being fully understood. This two-year longitudinal study examined the relationship between school climate perceptions, academic achievement, and gaming disorder symptoms among three distinct demographic cohorts: preadolescents (n = 1513; 46.9% girls, Mage = 10.64 years, SD = 0.56), early adolescents (n = 1771; 48.3% girls, Mage = 13.54 years, SD = 0.70), and late adolescents (n = 2385; 50.1% girls, Mage = 16.41 years, SD = 0.59). A four-wave study was conducted (six months apart) using random intercept cross-lagged panel models (RI-CLPMs) to separate the within-person (state level) from the between-person (trait level) effects. The results obtained from the RI-CLPMs indicated that fluctuations in school climate perceptions negatively predicted subsequent changes in gaming disorder symptoms among preadolescents at the within-person level, but not among early and late adolescents. Fluctuations relating to gaming disorder symptoms also negatively predicted subsequent changes regarding academic achievement in late adolescents, but not in preadolescents and early adolescents. The effect of school-related factors on gaming disorder symptoms varies across different developmental stages. While preadolescents may represent a particularly susceptible subgroup for gaming disorder in terms of being predicted by their school environment, late adolescents appear to be more vulnerable to predictors of gaming disorder symptoms. The current study also discusses the implications of school-wide programs aimed at improving school climate and preventing the development of gaming disorder symptoms during key developmental periods.

Impaired control and gaming-related harm in relation to gaming Disorder

The concept of impaired control (IC) over gaming is an important element of assessment and interventions for problem gaming and gaming-related harm. Past studies have reported that gaming disorder (GD) is associated with various negative consequences, but there is limited research on the relationship between IC over gaming and negative outcomes. To address this gap, the study investigated the relationship between impaired control and gaming-related harm among individuals with self-identified gaming disorder. It was hypothesized that IC would be positively associated with gaming-related harm and harm severity. In addition, it was predicted that IC would be a significant predictor of harm when controlling for age, gender, psychological distress, and gaming urges. The current study recruited 513 participants through an online survey platform. The Impaired Control Over Gaming Scale (ICOGS) was used to measure IC, and modified items from Browne et al.'s taxonomy of gambling harms were used to assess gaming harm severity. The logistic regression results showed that IC was positively related to all forms of harm, after controlling for other variables. The predictive value of IC was similar across financial, psychological, relationship, social and work/school domains. These results supported the importance of IC as a mechanism that contributes to the experience of gaming-related harm, and the need to target IC in interventions for GD.

Is Problematic Physical Activity (PPA) a Uni- or Multi-Dimensional Concept? A Bifactor Analysis of the Exercise Dependence Scale-Revised (EDS-R)

The study of exercise dependence, or as we prefer, problematic physical activity (PPA), faces both theoretical and methodological challenges. Different factorial solutions were obtained for the widely used Exercise Dependence Scale-Revised (EDS-R), leading us to question both its latent underlying construct and the interpretation of its factor solutions. Through confirmatory factor analysis (CFA) and the use of a bifactor model (BCFA), we assessed the dimensionality of a French version of the EDS-R. We recruited 745 students from Paris Nanterre University, but we removed 88 responses (16.8%) to retain only those who (a) engaged in a moderate to high levels of physical activity, according to the Global Physical Activity Questionnaire (GPAQ; N = 494; 9.5%), and (b) completed the EDS-R. We used a final sample of 435 students (58.4% of the total population) for a factorial analysis of the EDS-R. We conducted a three-step CFA in Mplus, producing three models: (a) unidimensional, (b) second-order, and (c) bi-factor (BCFA). The results of the BCFA indicated that most EDS-R items were better indicators of a general factor than their respective group factors, except for the second factor measuring a withdrawal construct. These results add to an ongoing debate in the field of behavioral addiction as to how to better conceptualize and measure exercise dependence or PPA. Withdrawal appears to have a special position in this debate, since our BCFA suggested that it is the only specific sub-dimension of the EDS-R scale.

Validation of a modified problematic use of mobile phones scale to examine problematic smartphone use and dependence

Over the past decade, the world population has experienced rapid and widespread adoption of smartphones due to their usefulness and convenience. However, researchers have identified a range of adverse behaviours associated with the adoption of smartphones and their higher use. These behaviours are collectively described as Problematic Smartphone Use and Dependence (PSUD). Despite growing research, the underlying processes and drivers leading to these behaviours are inadequately understood. This can partly be attributed to the absence of developed statistical tools and measures that allow researchers to build a comprehensive conceptual understanding of PSUD. To address this issue, this study proposes and evaluates a validated extension to the Problematic Use of Mobile Phones (PUMP) scale. The extension of this tool incorporates factors associated with substance dependence outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), including additional items to measure PSUD accurately, referred to as the modified problematic use of mobile phones (MPUMP) scale. The newly developed tool was used in a cross-sectional online survey during September and October 2022, drawing on 1018 adult Australian participants. Principal Component Analysis (PCA) and Exploratory Factor Analysis (EFA) were conducted to derive the underlying factors. The EFA revealed two distinct factors: Distraction and Dysregulation. Both factors exhibited high internal consistency, with Cronbach's Alpha coefficients of 0.92 and 0.86, respectively. A one-way analysis of variance (ANOVA) revealed significant variations inthe identified factors' mean scores across different socio-demographic characteristics. The study provides evidence that the MPUMP scale is a validated and reliable measure for accurately assessing PSUD. The study findings offer novel insights into the psychosocial and physical aspects of PSUD, providing a foundation for exploring the causes and potential interventions for PSUD.

Reexploring Problematic Social Media Use and Its Relationship with Adolescent Mental Health. Findings from the "LifeOnSoMe"-Study

Purpose

Previous approaches used to assess problematic social media use risk inflating prevalence numbers and classifying unproblematic social media use as problematic. The main aim of this study was to take an exploratory view as to how different types of activities, experiences, and motivations on social media are associated with problematic mental health outcomes in adolescents.

Patients and Methods

This study is based on a cross-sectional survey of 2023 adolescents (mean age 17.4 years (SD 0.9), 44.4% males) from the year 2020. Exploratory graph analysis and exploratory factor analysis were performed on 28 pre-selected items assessing adolescents' use of social media, to identify underlying potentially problematic factors associated with social media use. Sets of gender-adjusted multiple linear regression analyses were performed to assess the degree to which social media factors predicted depression, anxiety, well-being, and time spent on social media.

Results

Three factors were identified: 1) "subjective overuse", 2) "social obligations", and 3) "source of concern". All three factors showed significant positive associations with mental health problems. The factor "source of concern", which identifies feelings of being overwhelmed and concerned over social media use, had the strongest association to mental health problems and simultaneously the weakest association to time spent on social media.

Conclusion

Three identified factors measuring problematic social media use showed positive associations with mental health problems. This lends support to the notion that problematic social media use is a multidimensional phenomenon and demonstrates the need to move beyond addiction criteria when assessing problematic social media use.

Operationalization and measurement of compulsivity across video gaming and gambling behavioral domains

BACKGROUND

Compulsivity is the hallmark of addiction progression and, as a construct, has played an important role in unveiling the etiological pathways from learning mechanisms underlying addictive behavior to harms resulting from it. However, a sound use of the compulsivity construct in the field of behavioral addictions has been hindered to date by the lack of consensus regarding its definition and measurement. Here we capitalize on a previous systematic review and expert appraisal to develop a compulsivity scale for candidate behavioral addictions (the Granada Assessment for Cross-domain Compulsivity, GRACC).

METHODS

The initial scale (GRACC90) consisted of 90 items comprising previously proposed operationalizations of compulsivity, and was validated in two panel samples of individuals regularly engaging in gambling and video gaming, using exploratory structural equation modeling (ESEM) and convergence analyses.

RESULTS

The GRACC90 scale is unidimensional and structurally invariant across samples, and predicted severity of symptoms, lower quality of life, and negative affect, to similar degrees in the two samples. Additionally, poorer quality of life and negative affect were comparably predicted by compulsivity and by severity of symptoms. A shorter version of the scale (GRACC18) is proposed, based on selecting the 18 items with highest factor loadings.

CONCLUSIONS

Results support the proposal that core symptoms of behavioral addictions strongly overlap with compulsivity, and peripheral symptoms are not essential for their conceptualization. Further research should clarify the etiology of compulsive behavior, and whether pathways to compulsivity in behavioral addictions could be common or different across domains.

Restricting social networking site use for one week produces varied effects on mood but does not increase explicit or implicit desires to use SNSs: Findings from an ecological momentary assessment study

Recent research on the addictive potential of modern technologies such as the internet, smartphones, or social networking sites (SNSs) has suggested that emotional and motivational changes associated with the sudden discontinuation of engagement with the technology mirror the aversive consequences seen when drug use is ceased abruptly. This has been observed even in moderate users and interpreted as a manifestation of withdrawal, an important marker of physical dependence in substance use disorders. On the other hand, a growing literature emphasises the positive effects of "digital detox" on mental health and well-being. Using a battery of affective and motivational measures, both explicit and implicit, the present study tracked the effects of a week of significantly reduced SNS use in moderate to heavy SNS users (N = 51). Our pre-registered analyses showed that the intervention elicited affective changes neither consistent with a general withdrawal syndrome (i.e., increased negative affect and cravings) nor with a general beneficial effect on well-being: While our data indicated some abstinence-related decreases of negative affect and boredom, they also showed a reduction of positive affect. These changes occurred regardless of problematic/addictive use behaviours. Importantly, restricting SNS use for one week had no effect on implicit measures of SNS use motivation (i.e., approach biases, time distortion and effort expenditure for SNS access) nor did it influence explicit cravings and SNS cue-reactivity. Together our findings suggest that restricting SNS use has nuanced and potentially offsetting effects on well-being. These could arise because use reduction may concurrently remove experiences that trigger negative emotions (e.g., upward social comparisons or Fear of Missing Out) but also those that elicit positive emotions (e.g., social approval). The hypothesised lack of a net effect on well-being would be consistent with our finding that voluntary reduction of SNS use does not mitigate or exacerbate SNS-related urges.

Severity identification for internet gaming disorder using heart rate variability reactivity for gaming cues: a deep learning approach

Background

The diminished executive control along with cue-reactivity has been suggested to play an important role in addiction. Hear rate variability (HRV), which is related to the autonomic nervous system, is a useful biomarker that can reflect cognitive-emotional responses to stimuli. In this study, Internet gaming disorder (IGD) subjects' autonomic response to gaming-related cues was evaluated by measuring HRV changes in exposure to gaming situation. We investigated whether this HRV reactivity can significantly classify the categorical classification according to the severity of IGD.

Methods

The present study included 70 subjects and classified them into 4 classes (normal, mild, moderate and severe) according to their IGD severity. We measured HRV for 5 min after the start of their preferred Internet game to reflect the autonomic response upon exposure to gaming. The neural parameters of deep learning model were trained using time-frequency parameters of HRV. Using the Class Activation Mapping (CAM) algorithm, we analyzed whether the deep learning model could predict the severity classification of IGD and which areas of the time-frequency series were mainly involved.

Results

The trained deep learning model showed an accuracy of 95.10% and F-1 scores of 0.995 (normal), 0.994 (mild), 0.995 (moderate), and 0.999 (severe) for the four classes of IGD severity classification. As a result of checking the input of the deep learning model using the CAM algorithm, the high frequency (HF)-HRV was related to the severity classification of IGD. In the case of severe IGD, low frequency (LF)-HRV as well as HF-HRV were identified as regions of interest in the deep learning model.

Conclusion

In a deep learning model using the time-frequency HRV data, a significant predictor of IGD severity classification was parasympathetic tone reactivity when exposed to gaming situations. The reactivity of the sympathetic tone for the gaming situation could predict only the severe group of IGD. This study suggests that the autonomic response to the game-related cues can reflect the addiction status to the game.

Correlation Between Attention Deficit Hyperactivity Disorder, Internet Gaming Disorder or Gaming Disorder

OBJECTIVE

Individuals with internet gaming disorder (IGD) or gaming disorder (GD) had a higher prevalence of ADHD than individuals without IGD or GD. The overpathologizing of excessive gaming behaviors may be associated with the functional impairment due to ADHD in individuals with GD.

METHODS

The present study was designed to compare the gaming patterns, accompanying psychopathology, and co-occurring psychiatric disorders, especially ADHD, between clinical and general gamer samples (17-29 years old).

RESULTS

Out of the nine IGD criteria, the item "functional impairment" had low diagnostic accuracy in participants with IGD or GD. The IGD (GD) group had a higher prevalence of ADHD compared to the general gamer group. Conversely, there was a higher prevalence of IGD (GD) in the ADHD group compared to the non-ADHD group.

DISCUSSION

The possibility of ADHD should be considered when IGD or GD is diagnosed in patients with problematic Internet gaming.

Case report for an internet- and mobile-based intervention for internet use disorder

BACKGROUND AND AIMS

Internet use disorder (IUD), characterized as the inability to control one's internet use, is associated with reduced quality of life and mental health comorbidities such as depression, substance abuse, or anxiety. Evidence-based treatment options are scarce due to the novelty of the diagnosis. Internet- and mobile-based interventions (IMI) may be an effective means to deliver psychological treatment to individuals with IUD as they address affected individuals in their online setting. This study presents a newly developed IMI for IUD disclosing treatment satisfaction and preliminary effects by exemplifying with a case report.

METHODS

The case of a female participant with IUD, characterized by an excessive use of social media, is analyzed. The case report follows the CARE guidelines and presents qualitative and quantitative outcomes regarding potential symptom reduction measured by the Internet Addiction Test (IAT) and Compulsive Internet Use Scale (CIUS), treatment satisfaction measured by the Client Satisfaction Questionnaire (CSQ) and feasibility by analyzing participant's written feedback during treatment.

RESULTS

The case report shows that internet- and mobile-based interventions may be feasible in supporting an individual in reducing symptoms of IUD as well as depressive symptoms, anxiety and procrastination behavior. Treatment satisfaction was reported as good.

DISCUSSION AND CONCLUSIONS

This case report illustrates that IMIs can have the potential to be an easily accessible and possibly effective treatment option for IUD. Case studies on IMIs may provide insights into important mechanisms for symptom change. Further studies are needed to expand our understanding of this diverse disorder to provide adequate treatment.

CLINICAL TRIAL REGISTRATION

https://clinicaltrials.gov/,DRKS00015314.

Effects of a 7-Day Pornography Abstinence Period on Withdrawal-Related Symptoms in Regular Pornography Users: A Randomized Controlled Study

Little is known about whether withdrawal-like symptoms manifest when regular pornography users attempt to abstain from pornography. The present study used a randomized controlled design to examine whether (1) negative abstinence effects that may be potentially reflective of withdrawal-related symptoms manifest when a non-clinical sample of regular pornography users attempt to abstain from pornography for a 7-day period and (2) these negative abstinence effects would only manifest (or manifest more strongly) for those with higher levels of problematic pornography use (PPU). A total of 176 undergraduate students (64.2% female) who were regular pornography users (defined as having used pornography ≥ three times a week in the past 4 weeks) were randomly assigned to an abstinence group (instructed to attempt abstinence from pornography for 7 days, n = 86) or a control group (free to watch pornography as usual, n = 90). Participants completed measures of craving, positive and negative affect, and withdrawal symptoms at baseline and each night of the 7-day period. Contrary to the confirmatory hypotheses, there were no significant main effects of group (abstinence vs. control) or group × PPU interaction effects on any of the outcome measures, controlling for baseline scores. These findings indicate that no evidence of withdrawal-related symptoms was found for abstaining participants, and this was not dependent on level of PPU. However, exploratory analyses showed a significant three-way interaction (group × PPU × past 4-week frequency of pornography use [FPU]) on craving, where an abstinence effect on craving was found at high levels of PPU only once past 4-week FPU reached the threshold of daily use. While these exploratory findings should be interpreted with caution, they suggest that abstinence effects could potentially manifest when there is a combination of high PPU and high FPU-a hypothesis that warrants investigation in future prospective abstinence studies.

Psychometric validity and the appropriateness of tolerance as a criterion for internet gaming disorder: A systematic review

Tolerance is a controversial but still an omnipresent criterion in measuring problematic gaming and Internet Gaming Disorder (IGD). Despite criticisms, a systematic review of its suitability has not been conducted until now. The aim of this study was to assess the evidence of psychometric validity and the appropriateness of tolerance as a criterion for IGD. A total of 61 articles were included in the review, 47 quantitative, 7 qualitative studies,plus 7 studies that introduce potential item wordings for operationalizing tolerance. Results showed that the tolerance item tends to have acceptable to high factor loadings on the single IGD factor. While tolerance sometimes did not adequately differentiate the engaged gamers from those with a probable disorder, it was endorsed at medium to high levels of IGD severity and had a good performance in the interviews. It, however, showed weak relations with distress and well-being. In qualitative studies, tolerance as currently defined by DSM-5 and measured by questionnaires (i.e., increasing amounts of time spent on gaming) was almost unequivocally rejected by gamers. The solid performance of tolerance in psychometric studies was probably due to deficiencies of the IGD construct, which also contains other disputed criteria. Tolerance lacks relevance in measuring IGD and care should be taken when using and interpreting IGD measures with this criterion.

Withdrawal and tolerance as related to compulsive sexual behavior disorder and problematic pornography use - Preregistered study based on a nationally representative sample in Poland

Background

The addiction model of compulsive sexual behavior disorder (CSBD) and problematic pornography use (PPU) predicts the presence of withdrawal symptoms and increased tolerance for sexual stimuli in the disorder phenotype. However, clear empirical evidence supporting this claim has largely been lacking.

Methods

In the preregistered, nationally representative survey (n = 1,541, 51.2% women, age: M = 42.99, SD = 14.38), we investigated the role of self-reported withdrawal symptoms and tolerance with respect to CSBD and PPU severity.

Results

Both withdrawal and tolerance were significantly associated with the severities of CSBD (β = 0.34; P < 0.001 and β = 0.38; P < 0.001, respectively) and PPU (β = 0.24; P < 0.001 and β = 0.27; P < 0.001, respectively). Of the 21 withdrawal symptom types investigated, the most often reported symptoms were frequent sexual thoughts that were difficult to stop (for participants with CSBD: 65.2% and with PPU: 43.3%), increased overall arousal (37.9%; 29.2%), difficult to control level of sexual desire (57.6%; 31.0%), irritability (37.9%; 25.4%), frequent mood changes (33.3%; 22.6%), and sleep problems (36.4%; 24.5%).

Conclusions

Changes related to mood and general arousal noted in the current study were similar to the cluster of symptoms in a withdrawal syndrome proposed for gambling disorder and internet gaming disorder in DSM-5. The study provides preliminary evidence on an understudied topic, and present findings can have significant implications for understanding the etiology and classification of CSBD and PPU. Simultaneously, drawing conclusions about clinical importance, diagnostic utility and detailed characteristics of withdrawal symptoms and tolerance as a part of CSBD and PPU, as well as other behavioral addictions, requires further research efforts.

Influences of Emotional Information on Response Inhibition in Gaming Disorder: Behavioral and ERP Evidence from Go/Nogo Task

BACKGROUND

Gaming disorder (GD) may impair executive functions such as response inhibition. According to the tripartite neurocognitive model, the interoceptive system generates a state of craving that exacerbates the dysfunction of GD. We speculate that emotional information may play an important role in the mechanism, which leads to impaired response inhibition in people with GD.

METHODS

A three-factor mixed experimental design was adopted in this go/nogo task. The between-subject factor was group (GD or control group), and the within-subject factors were two types of emotional information, task relevance (related or unrelated) and emotional valence (negative or positive).

RESULTS

The GD group had lower nogo accuracies than the control group in the task-unrelated condition and also in the negative condition. Parallelly, the GD group showed faster reactions and lower accuracy in the go trials than the control group under task-unrelated negative conditions. At the neural level, the GD group had smaller amplitudes of nogo-N2 and larger amplitudes of nogo-P3 than the control group in the task-unrelated condition.

CONCLUSIONS

The findings prove the hypothesis of this study that emotional information could be a factor leading to impaired response inhibition in GD individuals. The response inhibition abilities of GD are weakened when processing task-unrelated or negative information, which may be caused by failure of behavioral inhibition and weakened conflict control, resulting in more cognitive resources to complete response suppression under specific conditions. This study provides evidence for weaker response inhibition in GD individuals from the perspective of cognitive-emotional interaction and provides more detailed information for interventions for GD.

Functional impairment, insight, and comparison between criteria for gaming disorder in the International Classification of Diseases, 11 Edition and internet gaming disorder in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

AIM

This study evaluated the consistency between the International Classification of Diseases, 11th Edition (ICD-11) for gaming disorder (ICD-11-GD) and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for internet gaming disorder (DSM-5-IGD). Moreover, the functional impairment of participants and their insight of their GD were evaluated.

METHODS

We recruited 60 participants with GD, 45 participants who engaged in hazardous gaming (HG), and 120 controls based on a diagnostic interview. Their operationalization of functional impairment and stage of change were evaluated by interviews and questionnaires, including the Brief Gaming Negative Consequence Scale (BGNCS).

RESULTS

We observed satisfactory consistency (kappa value = 0.80) with a diagnostic accuracy of 91.5% between the ICD-11-GD and DSM-5-IGD criteria. Furthermore, 16 participants with IGD in DSM-5 were determined to have HG based on the ICD-11 criteria. Participants of GD group experienced impaired functioning in their health (96.7%), career (73.3%), social life (61.6%), academic performance (36.7%), and job performance (35%). Moreover, a proportion of them were in the pre-contemplation (25.0%), contemplation (61.7%), preparation (10%), and action stages (3.3%).

CONCLUSION

There is a good consistency between ICD-11-GD and DSM-5-IGD criteria. The ICD-11 criteria have a high threshold for diagnosing GD. HG criteria could compensate for this high threshold and identify individuals with a gaming-related functional impairment who require help. Most of the participants with GD were in the early stage of change. Interventions to promote their insight are essential. The BGNCS can be used to examine the negative consequences of gaming and aid mental health professionals in assessing functional impairment.

Evaluation of the Psychometric Properties of the Arab Compulsive Internet Use Scale (CIUS) by Item Response Theory Modeling (IRT)

INTRODUCTION

The psychometric properties of the Arab translation of the Compulsive Internet Use Scale (CIUS) have been previously studied by confirmatory factor analysis (CFA) with AMOS software using the asymptotically distribution-free (ADF) estimator. Unidimensionality has been achieved at the cost of correlating several item variance errors. However, several reviews of SEM software packages and estimation methods indicate that the option of robust standard errors is not present in the AMOS package and that ADF estimation may yield biased parameter estimates. We therefore explored a second analysis through item response theory (IRT) using the parametric graded response model (GRM) and the marginal maximum likelihood (MML) estimation method embedded in the LTM package of R software. Differential item functioning (DIF) or item bias across subpopulations was also explored within IRT framework as different samples were investigated. The objective of the current study is to (1) analyze the Arab CIUS scale with IRT, (2) investigate DIF in three samples, and (3) contribute to the ongoing debate on Internet-use-related addictive behaviors using the CIUS items as a proxy.

METHODS

We assessed three samples of people, one in Algeria and two in Lebanon, with a total of 1520 participants.

RESULTS

Almost three out of every five items were highly related to the latent construct. However, the unidimensionality hypothesis was not supported. Furthermore, besides being locally dependent, the scale may be weakened by DIF across geographic regions. Some of the CIUS items related to increasing priority, impaired control, continued use despite harm, and functional impairment as well as withdrawal and coping showed good discriminative capabilities. Those items were endorsed more frequently than other CIUS items in people with higher levels of addictive Internet use.

CONCLUSIONS

Contrary to earlier ADF estimation findings, unidimensionality of the CIUS scale was not supported by IRT parametric GRM in a large sample of Arab speaking participants. The results may be helpful for scale revision. By proxy, the study contributes to testing the validity of addiction criteria applied to Internet use related-addictive behaviors.

Longitudinal association between parental involvement and internet gaming disorder among Chinese adolescents: Consideration of future consequences as a mediator and peer victimization as a moderator

BACKGROUND AND AIMS

Internet gaming disorder (IGD) in adolescents is a concerning issue. Positive parenting has been found to protect against adolescent IGD, but the underlying mechanisms await further investigation. As such, this study examined the longitudinal association between parental involvement (PI) - a specific type of positive parenting understudied in the literature of adolescent gaming disorder - and IGD. Moreover, this study also tested consideration of future consequences (CFC) as a mediator and peer victimization (PV) as a moderator.

METHODS

A two-wave longitudinal research spanning 6 months apart was conducted. Participants were Chinese adolescents (final N = 434; 222 females; Mage = 14.44 years, SD = 1.56). They provided ratings on PI, PV, and IGD at Wave 1, and CFC-immediate, CFC-future, and IGD at Wave 2.

RESULTS

Descriptive statistics showed that the prevalence rate of IGD was 10.81% and 9.45% at Waves 1 and 2, respectively. Moreover, results of moderated mediation model found that after controlling for Wave 1 IGD and covariates, Wave 1 PI was associated with Wave 2 IGD via preventing adolescents who had higher levels of PV from developing a tendence of CFC-immediate and via promoting adolescents who had lower levels of PV to develop a tendence of CFC-future.

DISCUSSION AND CONCLUSIONS

Altogether, these results suggest that facilitative ecological systems (e.g., positive parenting and good relationships with peers) and personal strengths (e.g., positive future orientation) jointly contribute to the mitigation of adolescent IGD.

Effectiveness of multimodal psychotherapeutic intervention for internet gaming disorder

BACKGROUND

Large number of studies on Internet gaming disorder (IGD) have primarily focused on ascertaining its psychological correlates. Few studies have focused on developing and assessing effectiveness of multimodal psychotherapeutic intervention programs. This intervention focused on minimizing salience, pre-occupation, conflict related to gaming and enhancing the overall quality of life, inclusive of psychological health, physical health, and environmental problems in individuals with IGD. At present, there appear to be no such studies in the Indian context.

METHODS

In this study, we developed and assessed the effectiveness of an intervention manual for IGD. The intervention program consisted of ten 60-minutes sessions with one therapist administering sessions once in each week. The interventions included motivational enhancement strategies, cognitive restructuring, behavioral strategies and relapse prevention. The outcomes from intervention were measured in terms of improvement in IGD, IAT, and overall quality of life. Our assessments, both at baseline and post-intervention consisted of Internet Addiction Test (IAT), Internet Gaming Disorder Test (IGD-20) and the Whoqol-Bref. A total sample of 40 was selected out of which 33 individuals completed the 10 sessions of multimodal psychotherapy program and post assessments.

RESULTS

A total of 40 participants (age: M = 20.25, SD = 5.39) enrolled, out of which 33 completed the entire intervention program of 10 sessions and showed significant improvements. The IAT and IGD-20 showed significant difference in the scores for before treatment (M = 52.88, SD = 16.25) and after treatment (M = 42.87, SD = 11.31; t (32) = 5.10, p = 0.000) conditions; and right before treatment (M = 56.88, SD = 19.25) and after treatment (M = 47.87, SD = 15.31; t (32) = 6.94, p = 0.000) conditions respectively. The internet addiction and internet gaming disorder scores showed a similar degree of severity reductions on the IAT and IGD-20 respectively at the end of week 8. In addition, the participants showed significant improvements in the quality of life inclusive of physical and psychological health post the completion of intervention program.

LIMITATIONS

The sample size of the study was small and assessments for evaluation of other psychological symptoms like depression, anxiety could have been conducted.

CONCLUSION

The intervention program indicated a substantial change in the IGD scores at post- assessment. A study on a larger sample to assess the validity of the manualized multimodal psychotherapy program for IGD needs to be conducted. In addition, this manualized intervention program can be useful for administering structured intervention for IGD by mental health professionals working in the area of internet gaming disorder.

The gaming problem: A latent class analysis of DSM-5 criteria for Internet Gaming Disorder in a non-clinical sample

Background: In this study we aimed to test whether suggested DSM-5 criteria for Internet Gaming Disorder (IGD) share a similar latent structure to formally recognised addiction. Methods: We used latent class analysis on a dichotomous measure of IGD. The data was collected from a convenient general population sample (500) and a targeted gaming forum sample (236). Results: We found a four or six-class model to be most appropriate, ranging from ‘casual/non-gamer’ to ‘potentially disordered’ with increasing symptom severity. The majority of ‘potentially disordered’ gamers (5+ criteria) were found to be 18-30 years old, and no ‘potentially disordered’ gamers were over 42. Conclusions: The results suggest that gaming may share a similar latent structure to established addictions, with adolescents and young adults being more at risk. Studies replicating these results would be beneficial, with further emphasis on a critical evaluation of the criteria and symptom cut-off point.

Compulsive Sexual Behavior Disorder should not be classified by solely relying on component/symptomatic features •

The paper by Sassover and Weinstein (2022) contributes to a timely and complex debate related to the classification of Compulsive Sexual Behavior Disorder (CSBD). The recent inclusion of CSBD as an impulse-control disorder in the ICD-11 has generated debate since a competitive view is that CSBD should rather be classified as an addictive disorder. Sassover and Weinstein (2022) reviewed existing evidence and concluded it does not support the conceptualization of CSBD as an addictive disorder. Although we agree regarding the relevance and timely nature of considering the classification of CSBD, we respectfully disagree with the position that relying on the components model of addiction (Griffiths, 2005) is the optimal approach for determining whether or not CSBD is an addictive disorder. In this commentary, we discuss potential pitfalls of relying on the components model to conceptualize CSBD as an addictive disorder and argue that considering a process-based approach is important for advancing this timely debate.

Novel approaches for treating Internet Gaming Disorder: A review of technology-based interventions

Internet Gaming Disorder (IGD) has become a significant issue in mental healthcare over the past decades as the number of people engaging in excessive and unhealthy gaming increases with each year. Despite its inclusion in the 5th Edition of Diagnostic Statistical Manual and the development of a number of treatment methods that have been designed and tested for IGD, treatment remains a challenge. This review attempts to give an overview of the current state of IGD and its treatment with a specific focus on the potential of technology-based solutions, such as web-based programs, mobile applications, and virtual reality. The review also highlights the need for additional work in the area of treatment development for IGD and the preliminary evidence for the usefulness and importance of technology-based treatment methods which offer unique advantages, such as accessibility, scalability, and cost-effectiveness, over other existing treatment options.

Exploring subtypes and correlates of internet gaming disorder severity among adolescents during COVID-19 in China: A latent class analysis

The WHO recently included Gaming Disorder as a psychiatric diagnosis. Whether there are distinct groups of adolescents who differ based on severity of gaming disorder and their relationships with other mental health and addictive behavior outcomes, including problematic smartphone use (PSU), remains unclear. The current study explored and identified subtypes of Internet Gaming Disorder (IGD) severity and estimated the association between these subtypes and other disorders. Participants completed online questionnaires assessing the severity of IGD, PSU, depression, and anxiety during COVID-19. We conducted a latent class analysis of IGD symptoms among 1,305 Chinese adolescents (mean age = 15.2; male = 58.5%) from 11 secondary schools in Macao (SAR), China. Multinomial logistic regression estimated correlates of latent class membership and PSU. A 4-class model adequately described the sample subgroups. Classes were labeled as normative gamers (30.9%), occasional gamers (42.4%), problematic gamers (22.7%), and addictive gamers (4.1%). Relative to normative gamers, PSU severity, depression, and being male were significantly higher among problematic gamers, addictive gamers, and occasional gamers. Only problematic gamers showed significant positive associations with anxiety severity compared to the other groups. The study revealed the differences in severity of gaming disorder and its association with psychopathology outcomes. Application in screening for IGD and comorbidity is discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03133-8.

Epidemiology of gaming disorder and its effect on anxiety and insomnia in Chinese ethnic minority adolescents

BACKGROUND

The growing popularity and frequency of online game use have resulted in a large number of studies reporting various mental problems associated with game abuse in adolescents. In this article, we examined the prevalence of gaming disorder (GD) and explored the associations of GD with anxiety and insomnia symptoms in minority youth in China.

METHODS

A total of 1494 students completed the Problematic Online Gaming Questionnaire Short-Form (POGQ-SF), the Generalized Anxiety Disorder 7-item questionnaire (GAD-7), and Athens Insomnia Scale (AIS). Chi-square and binary logistic regression analyses were used to explore the associations between gaming disorder and anxiety/insomnia.

RESULTS

A total of 356 (23.83%) respondents reported that they had gaming disorder. Chi-square analysis showed that gender, grade, marital status of parents and exercise situation were significantly associated with GD. Binary logistic regression analysis showed that those who had GD were at significantly higher risk for anxiety and insomnia than those without GD.

CONCLUSION

We found a high incidence of GD and a positive association among anxiety, insomnia and GD. Thus, special attention should be paid to those who have suffered from GD. It is worth addressing the adverse effects of GD on anxiety and insomnia.

A Review of the Components of Problematic Exercise in Psychometric Assessment Instruments

Backgrounds

The range of theoretical conceptualizations of problematic exercise in psychometric assessment instruments makes it difficult to identify the components that define this phenomenon. A better understanding of the underlying components of problematic exercise may contribute to progress toward providing scientific evidence that allows for deciding whether problematic exercise should be considered a substantive mental health disorder. The objective of the present review was to examine and compare, through a content analysis of their items, the components of problematic exercise in psychometric assessment instruments identified in a recent systematic review.

Methods

A total of 33 components of problematic exercise were identified in the 17 assessment instruments included in the present review.

Results

The results show that, despite the lack of consensus in the operational definition of their factors and the variety of ways of wording their items, the instruments reflect some common components that might indicate core criteria (i.e., salience, withdrawal, and mood modification) or candidate components (i.e., conflict, and continuance despite problems) of problematic exercise. However, other components of different nature were shown to be specific to some of the problematic exercise conceptualizations on which the assessment instruments are based.

Conclusion

In the interest of reaching a consensus that allows to advance in this research field, further studies are needed to resolve which components are inherently problematic.

The withdrawal-related affective, gaming urge, and anhedonia symptoms of internet gaming disorder during abstinence

Aim

The study explores IGD withdrawal-related presentations, including autonomic reaction, affective symptoms, anhedonia, and gaming urge during abstinence from gaming. We prospectively evaluated these withdrawal-related symptoms (WRS) and gaming craving during abstinence from gaming.

Methods

We examined 69 individuals with IGD and 69 regular gamers and evaluated their WRS (using an exploratory questionnaire), affective and behavioral WRS (using the Questionnaire on Gaming Urge-Brief Version gaming disorder questionnaire), and heart rate. All the participants attempted to abstain from gaming before our assessment. Subsequently, some participants' WRS and gaming craving before they engaged in gaming were prospectively evaluated.

Results

In the IGD group, 85.5% experienced gaming WRS, including affective, anhedonia, and gaming urge symptoms. They could relieve these symptoms through gaming. The IGD group experienced more severe gaming WRS, gaming craving, and a higher heart rate than the regular gamer group. Gaming urge was most associated WRS of IGD. Participants with IGD experienced more severe gaming cravings when their gaming abstinence before the assessment was shorter. WRS attenuated at night and the following morning when they maintained their gaming abstinence after assessment.

Conclusion

Individuals with IGD experience withdrawal-related affective, anhedonia, and gaming urge symptoms and a higher heart rate during abstinence. The WRS attenuated in 1 day. Most participants agreed that these symptoms could be relieved through gaming. Further prospective evaluation by objective assessment in an adequate sample was required to understand gaming withdrawal symptoms comprehensively.

Effects of retrieval-extinction training on internet gaming disorder

BACKGROUND AND AIMS

Internet gaming disorder (IGD) leads to serious impairments in cognitive functions, and lacks of effective treatments. Cue-induced craving is a hallmark feature of this disease and is associated with addictive memory elements. Memory retrieval-extinction manipulations could interfere with addictive memories and attenuate addictive syndromes, which might be a promising intervention for IGD. The aims of this study were to explore the effect of a memory retrieval-extinction manipulation on gaming cue-induced craving and reward processing in individuals with IGD.

METHODS

A total of 49 individuals (mean age: 20.52 ± 1.58) with IGD underwent a memory retrieval-extinction training (RET) with a 10-min interval (R-10min-E, n = 24) or a RET with a 6-h interval (R-6h-E, n = 25) for two consecutive days. We assessed cue-induced craving pre- and post-RET, and at the 1- and 3-month follow-ups. The neural activities during reward processing were also assessed pre- and post-RET.

RESULTS

Compared with the R-6h-E group, gaming cravings in individuals with IGD were significantly reduced after R-10min-E training at the 3-month follow-up (P < 0.05). Moreover, neural activities in the individuals with IGD were also altered after R-10min-E training, which was corroborated by enhanced reward processing, such as faster responses (P < 0.05) and stronger frontoparietal functional connectivity to monetary reward cues, while the R-6h-E training had no effects.

DISCUSSION AND CONCLUSIONS

The two-day R-10min-E training reduced addicts' craving for Internet games, restored monetary reward processing in IGD individuals, and maintained long-term efficacy.

Interaction Effects of DRD2 Genetic Polymorphism and Interpersonal Stress on Problematic Gaming in College Students

Problematic gaming has become a public concern, influenced both by genetic factors and stressful environments. Studies have reported the effects of dopamine-related genes and interpersonal stressors on problematic gaming, but gene and environment interaction (G × E) studies have not been conducted. In this study, we investigated the interaction effects of dopamine receptor D2 (DRD2) polymorphisms and interpersonal stress on problematic gaming and the mediating effect of avoidant coping to reveal the mechanism of the G × E process. We recruited 168 college students (mean age = 22; male 63.1%) and genotyped their DRD2 C957T (rs6277) and Taq1 (rs1800497) polymorphisms. The results of the mediated moderation analysis showed that, when experiencing interpersonal stressors, individuals with both the C957T T allele and the Taq1 A1 allele showed more elevated problematic gaming scores than non-carriers. Moreover, the interaction effect of the combined DRD2 polymorphisms and interpersonal stress was significantly mediated by avoidant coping. These findings suggest that the influence of interpersonal stress on problematic gaming can be changed as a function of DRD2 genotypes, which may be because of the avoidant coping styles of C957T T allele and Taq1 A1 allele carriers in response to stress.

The Associations Between Gaming Motivation and Internet Gaming Disorder: Systematic Review and Meta-analysis

BACKGROUND

There has been a surge in interest in examining internet gaming disorder (IGD) and its associations with gaming motivation. Three broad components of gaming motivation have been proposed: achievement, immersion, and social. Achievement-oriented players are motivated by gaining in-game rewards, immersion-oriented players are motivated by the experience of immersion in the virtual world, and social-oriented players are motivated by the need to socialize with other players through gaming.

OBJECTIVE

This study aimed to (1) quantitatively synthesize the growing body of literature to systematically examine the discrepancies in the magnitude of associations between various components of gaming motivation and IGD and (2) examine the moderating role of cultural dimension on the association between escapism gaming motivation and IGD.

METHODS

We conducted a systematic search of multiple databases between 2002 and 2020. Studies were included if they (1) included quantitative data, (2) used measures assessing both gaming motivation and IGD, and (3) contained sufficient information for effect size calculation.

RESULTS

The findings revealed IGD to have a stronger association with achievement motivation (r=0.32) than with immersion (r=0.22) or social motivation (r=0.20), but the strongest such association was found to be with escapism motivation (r=0.40), a subcomponent of immersion motivation. Our cross-cultural comparison further showed a stronger association between escapism motivation and IGD in studies conducted in individualistic (vs collectivistic) regions.

CONCLUSIONS

This meta-analysis highlights the importance of acknowledging the discrepancies among different components of gaming motivation with respect to their role in the development of IGD, as well as the potential cultural variations in the strength of such associations.

Gaming Disorder Symptom Questionnaire: The Development and Validation of a Screening Tool for ICD-11 Gaming Disorder in Adolescents

BACKGROUND

Gaming disorder (GD) has been recognized as an official diagnostic entity in the latest revision of the International Classification of Diseases (ICD-11). However, the majority of previous studies used different instruments, which are not fully consistent with the concept of GD in ICD-11. The development of a screening assessment instrument based on ICD-11 for this new disease entity is very urgent and important.

METHODS

The ICD-11 Gaming Disorder Symptom Questionnaire (GDSQ), based on the ICD-11 diagnostic guidelines for GD, was developed by a team of GD experts. A total of 7,790 adolescents were included in this study. Criterion validity was assessed by GDSQ, Video Gaming Dependency Scale (VGDS), weekly game playing time, weekly game video viewing time, and monthly money spent on games. Item structure was measured by factorial analysis. Discrimination between GD and non-GD was examined based on the receiver characteristic curve (ROC).

RESULTS

The GDSQ was very well described by three symptoms of GD (i.e., impaired control, increasing priority to gaming, and continued use despite the occurrence of negative consequences). The internal consistency was excellent (Cronbach's α = 0.964) with good criterion validity and good discriminatory power. The optimal cutoff point for determining the profile of gamers was found to be ≥62 points. The GDSQ revealed that the prevalence of GD was 2.27% in this adolescent sample.

CONCLUSION

The ICD-11-based GDSQ is a successfully validated measurement scale for GD among adolescents. This study provides a new tool (GDSQ) for us to effectively identify individuals with risk of GD in medical and non-medical settings.

Influence of abstinence on automatic detection bias to gaming cues in individuals with Internet gaming disorder: Evidence from visual mismatch negativity

Internet gaming disorder (IGD) has been classified by the DSM-5 as a condition for further study, and many studies have shown that the occurrence and maintenance of IGD and the automatic detection bias to gaming cues of individuals with IGD may be significantly related. However, whether abstinence, a common intervention method in behavioral addiction, can adjust the automatic detection bias in individuals with IGD and its underlying neural mechanisms is unclear. In this study, we investigated the effects of 7 days of abstinence from gaming on automatic detection bias, negative affect and craving in individuals with IGD with event-related potential technology. A total of 50 IGD subjects were recruited in this study and randomly divided into abstinence and control groups. Visual mismatch negativity (vMMN) was induced using a standard-deviant reversed oddball paradigm, and differences in automatic detection bias, negative affect, and craving between the two groups were recorded and compared at baseline, day 3, and day 7. The results showed that compared with baseline, vMMN, negative affect and craving were significantly enhanced on day 3 and significantly diminished on day 7 in the abstinence group but not in the control group, and the changes in vMMN were significantly correlated with changes in negative affect and craving in both groups. This study demonstrates that abstinence can restore automatic detection bias in individuals with IGD and that abstinence has to last for 7 days to have a significant effect, while recovery may be related to the negative affect and craving.

Video Game Addictive Symptom Level, Use Intensity, and Hedonic Experience: An Empirical Analysis of a Novel Survey Instrument (Preprint)

Background

The effects of behavioral addiction to video games has received increasing attention in the literature, given increased use intensity among subgroups of video game players.

Objective

This study seeks to empirically determine the relationship between intensity of video gaming and hedonic experience of the player.

Methods

We conducted a survey of 835 individuals who regularly play video games to determine the relationship between intensity of use and hedonic experience. We divided the sample into quartiles by self-reported video game addictive symptom level (from the Internet Gaming Disorder Scale) and conducted polynomial regressions separately for each quartile.

Results

We found that the higher video game addictive symptom level groups experienced a U-shaped (curvilinear) relationship between hedonic experience and intensity of play, whereas groups with lower video game addictive symptom levels exhibited no such relationship. The coefficients for the highest addictive symptom level group (quartile 4) for marginal effects for hours played per week and hours played per week squared were significantly negative (P=.005) and significantly positive (P=.004), respectively.

Conclusions

Our results are consistent with sensitization and tolerance theories, which suggest that high-symptom groups experience frustration and disappointment until they achieve excessive dopamine release, at which point their hedonic experience is expected to improve with additional play. Conversely, low-symptom groups experience no such fall-and-rise pattern. This result is consistent with the outcome that members of the latter group play the game for the direct experience, such that their hedonic experience is more directly related to events occurring in the game than to the increasingly elusive pursuit of excessive dopamine release. We also find that high-symptom groups spend substantially more time and money to support video game use and are much more likely to engage in video game use at the expense of other important activities, such as working, sleeping, and eating.

Expert appraisal of criteria for assessing gaming disorder: an international Delphi study

BACKGROUND AND AIMS

Following the recognition of 'internet gaming disorder' (IGD) as a condition requiring further study by the DSM-5, 'gaming disorder' (GD) was officially included as a diagnostic entity by the World Health Organization (WHO) in the 11th revision of the International Classification of Diseases (ICD-11). However, the proposed diagnostic criteria for gaming disorder remain the subject of debate, and there has been no systematic attempt to integrate the views of different groups of experts. To achieve a more systematic agreement on this new disorder, this study employed the Delphi expert consensus method to obtain expert agreement on the diagnostic validity, clinical utility and prognostic value of the DSM-5 criteria and ICD-11 clinical guidelines for GD.

METHODS

A total of 29 international experts with clinical and/or research experience in GD completed three iterative rounds of a Delphi survey. Experts rated proposed criteria in progressive rounds until a pre-determined level of agreement was achieved.

RESULTS

For DSM-5 IGD criteria, there was an agreement both that a subset had high diagnostic validity, clinical utility and prognostic value and that some (e.g. tolerance, deception) had low diagnostic validity, clinical utility and prognostic value. Crucially, some DSM-5 criteria (e.g. escapism/mood regulation, tolerance) were regarded as incapable of distinguishing between problematic and non-problematic gaming. In contrast, ICD-11 diagnostic guidelines for GD (except for the criterion relating to diminished non-gaming interests) were judged as presenting high diagnostic validity, clinical utility and prognostic value.

CONCLUSIONS

This Delphi survey provides a foundation for identifying the most diagnostically valid and clinically useful criteria for GD. There was expert agreement that some DSM-5 criteria were not clinically relevant and may pathologize non-problematic patterns of gaming, whereas ICD-11 diagnostic guidelines are likely to diagnose GD adequately and avoid pathologizing.

Global prevalence of gaming disorder: A systematic review and meta-analysis

BACKGROUND

Gaming disorder was included in the latest revision of the International Classification of Diseases (11th ed.). Worldwide, prevalence estimates of gaming disorder are considerably heterogeneous and often appear to be exceedingly high. However, few studies have examined the methodological, cultural and/or demographic factors that might explain this phenomenon. This review employed meta-analytic techniques to compute the worldwide-pooled prevalence of gaming disorder and evaluate the potential contributing factors for varied prevalence estimates.

METHOD

Prevalence estimates were extracted from 53 studies conducted between 2009 and 2019, which included 226,247 participants across 17 different countries. Study findings were meta-analyzed using a random-effects model. Subgroup and moderator analyses examined potential sources of heterogeneity, including assessment tool and cut-off, participant age and gender, sample size and type, study region, and year of data collection.

RESULTS

The worldwide prevalence of gaming disorder was 3.05% (confidence interval: [2.38, 3.91]); this figure was adjusted to 1.96% [0.19, 17.12] when considering only studies that met more stringent sampling criteria (e.g. stratified random sampling). However, these estimates were associated with significant variability. The choice of screening tool accounted for 77% of the variance, with the Lemmens Internet gaming disorder-9, Gaming Addiction Identification Test and Problematic Videogame Playing scales associated with the highest estimates. Adolescent samples, lower cut-off scores and smaller sample size were significant predictors of higher prevalence. Gaming disorder rates were approximately 2.5:1 in favor of males compared to females.

CONCLUSION

The worldwide prevalence of gaming disorder appears to be comparable to obsessive-compulsive disorder and some substance-related addictions, but lower than compulsive buying and higher than problem gambling. Gaming disorder prevalence rates appear to be inflated by methodological characteristics, particularly measurement and sampling issues.

Hooked on virtual social life. Problematic social media use and associations with mental distress and addictive disorders

Background

Social media is an important and growing part of the lives of the vast majority of the global population, especially in the young. Although still a young and scarce subject, research has revealed that social media has addictive potential. The aim of this cross-sectional study was to explore the associations between problematic use of social media and mental distress, problematic gaming and gambling, within the Swedish general population.

Methods

Data from 2,118 respondents was collected through self-report questions on demographics and validated scales measuring addiction-like experiences of social media, problem gaming, problem gambling, and mental distress. Associations were analyzed in unadjusted analyses and–for variables not exceedingly inter-correlated–in adjusted logistic regression analyses.

Results

In adjusted analyses, problematic use of social media demonstrated a relationship with younger age, time using instant messaging services, and mental distress, but not with education level, occupational status, or with treatment needs for alcohol or drug problems. Behavioral addictions (internet, gaming and gambling) were substantially inter-correlated, and all were associated with problematic use of social media in unadjusted analyses.

Conclusions

Social media use is associated with other addictive behaviors and mental distress. While factors of causality remain to be studied, these insights can motivate healthcare professionals to assess social media habits, for example in individuals suffering from issues concerning gambling, gaming or mental health.

Frequency of use, moral incongruence and religiosity and their relationships with self-perceived addiction to pornography, internet use, social networking and online gaming

BACKGROUND AND AIMS

Moral incongruence involves disapproval of a behavior in which people engage despite their moral beliefs. Although considerable research has been conducted on how moral incongruence relates to pornography use, potential roles for moral incongruence in other putative behavioral addictions have not been investigated. The aim of this study was to investigate the role of moral incongruence in self-perceived addiction to: (i) pornography; (ii) internet addiction; (iii) social networking; and (iv) online gaming.

DESIGN

A cross-sectional, preregistered, online survey using multivariable regression.

SETTING

Online study conducted in Poland.

PARTICIPANTS

1036 Polish adults aged between 18 and 69 years.

MEASUREMENTS

Measures included self-perceived behavioral addiction to pornography, internet use, social networking and online gaming and their hypothesized determinants (moral incongruence, frequency of use, time of use, religiosity, age and gender).

FINDINGS

Higher moral incongruence (β = 0.20, P < 0.001) and higher religiosity (β = 0.08, P < 0.05) were independently associated with higher self-perceived addiction to pornography. Additionally, frequency of pornography use was the strongest of the analyzed predictors (β = 0.43, P < 0.001). A similar, positive relationship between high moral incongruence and self-perceived addiction was also present for internet (β = 0.16, P < 0.001), social networking (β = 0.18, P < 0.001) and gaming addictions (β = 0.16, P < 0.001). Religiosity was uniquely, although weakly, connected to pornography addiction, but not to other types of addictive behaviors.

CONCLUSIONS

Moral incongruence may be positively associated with self-perception of behavioral addictions including not only pornography viewing, but also internet use, social networking and online gaming.

Incentive sensitization in binge behaviors: A mini review on electrophysiological evidence

Introduction

Binge behavior not only refers to the consumption of substances such as alcohol or food, but is also used in relation to gaming, watching and gambling. Dependent on context it makes for a widespread, benign recreational activity or can pose a serious mental health problem with deleterious consequences. Incentive sensitization theory describes the attribution of salience towards stimuli strongly associated with dopamine-mediated reward as a result of repeated consumption. The sensitized neural networks cause cue-triggered craving and excessive desire, but thus, this mechanism may also be applicable to stimulus-induced behaviors not associated with classical withdrawal symptoms. Event-related potentials (ERP) are a useful method of examining motivated attention towards incentive stimuli. This mini review aims to synthesize ERP findings from different types of binge behaviors in order to compare cue-reactivity to incentive stimuli.

Methods

Studies investigating binge drinking, binge eating as well as binge watching, gaming and gambling were screened. To limit the influence of concurrent task demands, ERP studies applying picture viewing paradigms with incentive stimuli were selected.

Results

Across binge behaviors, evidence on altered mid-latency ERPs has been mixed. However, studies investigating later stages of attentional processes more consistently find enlarged P300 and late positive potentials (LPP) amplitudes to relevant cues.

Conclusion

An altered attentional processing of incentive stimuli reflecting motivated attention is in line with incentive sensitization theory. Considering the limited number of studies, especially regarding binge behaviors not involving substances, more research is needed to attain a more thorough understanding of incentive sensitization across binge behaviors.

The recognition of gaming disorder in China: a case series of 223 patients

Background

Internet gaming disorder (IGD) was listed in the appendix of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a condition requiring further study in 2013, and gaming disorder (GD) was considered a mental disorder and listed in the 11th International Classification of Diseases Manual (ICD-11) in 2018. The study aims to obtain preliminary knowledge of the recognition of GD in China.

Methods

A total of 223 Chinese patients who met both the ICD-11 and DSM-5 criteria for GD participated in the study, and a self-administered questionnaire was used to collect demographic information, gaming use characteristics, and previous diagnoses.

Results

The average age of patients with GD was 20.5 years, and 71.3% were male. Most patients were diagnosed with emotion-related disorders at their first psychiatric visit: mood disorders (59.2%), bipolar affective disorder (18.4%), depressive episode (12.6%), and anxiety disorder (4.9%). Among the adolescent patients with a first diagnosis of mood disorders, 71.2% and 33.3% were diagnosed with bipolar affective disorder and personality disorders, respectively, at subsequent visits. Overall, after the first visit, the most common diagnosis was bipolar affective disorder (61.0%), followed by personality disorders (34.1%), mood disorders (17.0%), depressive episode (17.0%), and other disorders. Only three patients had Internet overuse.

Conclusion

The identification rate of GD is extremely low in routine psychiatric clinical practice in China. Most patients with GD were previously misdiagnosed with emotion-related disorders. Psychiatrists should be trained to improve their ability to recognize and manage GD.

The Influence of Online Game Behaviors on the Emotional State and Executive Function of College Students in China

Background and Objective: Since the classification of gaming disorder (GD) by the World Health Organization (WHO) as "mental disorder caused by addictive behaviors," there has been controversy regarding whether online game behaviors can lead to mental disorder. This study aims to clarify the correlation between the online game behaviors of college students and anxiety, depression, and executive function of college students in China, from a questionnaire-based investigation. Methods: Based on the whole class random sampling method, a questionnaire survey was conducted among college students in Northern Anhui, China from March 7 to March 27, 2020. The questionnaires included the Internet Game Addiction (IGA) Scale, Behavior Rating Inventory of Executive Function (Adult Version, BRIEF-A), Generalized Anxiety Disorder Scale (GAD-7) and Patient Health Questionnaire Scale (PHQ-9). Results: A total of 850 participants completed the survey, including 353 males (41.53%) and 497 females (58.47%). The primary age group was 18-27 years (91.53%), and the educational background was a bachelor's degree (94.7%). The study found that the online behavior of 17.76% of college students was online game behavior. This study did not identify any students who met the criteria for IGA, and 3% met the criteria for indulgent behavior. A dual role of online games was identified; moderate online game activities can improve the emotional state and executive function of college students, while excessive online game behaviors that may not reach the degree of addiction can also harm emotional state and executive function. Conclusions: This study suggests that although IGA has been regarded as a mental disease, online game behavior should be treated differently. Online game activities should not be entirely denied, but mental disorders caused by excessive gaming activities deserve attention. In particular, the emotional state and executive function of students with excessive online game behaviors should be monitored and intervened in advance to avoid game behaviors turning into indulgent behaviors or addiction. As a cognitive control process, executive function may play a key role in regulating IGA and emotional state.

Current Research and Viewpoints on Internet Addiction in Adolescents

PURPOSE OF REVIEW

This review describes recent research findings and contemporary viewpoints regarding internet addiction in adolescents including its nomenclature, prevalence, potential determinants, comorbid disorders, and treatment.

RECENT FINDINGS

Prevalence studies show findings that are disparate by location and vary widely by definitions being used. Impulsivity, aggression, and neuroticism potentially predispose youth to internet addiction. Cognitive behavioral therapy and medications that treat commonly co-occurring mental health problems including depression and ADHD hold considerable clinical promise for internet addiction.

SUMMARY

The inclusion of internet gaming disorder in the DSM-5 and the ICD-11 has prompted considerable work demonstrating the validity of these diagnostic approaches. However, there is also a movement for a conceptualization of the disorder that captures a broader range of media-use behaviors beyond only gaming. Efforts to resolve these approaches are necessary in order to standardize definitions and clinical approaches. Future work should focus on clinical investigations of treatments, especially in the USA, and longitudinal studies of the disorder's etiology.