Inclusion of Gaming Disorder in ICD has more advantages than disadvantages

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.

Effectiveness of an integrated motivational cognitive-behavioral group intervention for adolescents with gaming disorder: a randomized controlled trial

AIMS, DESIGN AND SETTING

The aim of this study was to test the efficacy of the integrated cognitive-behavioral therapy with a strength-based motivational approach [integrated cognitive-behavioral therapy (ICBT)] intervention to change gaming disorder (GD) symptoms and other outcomes and to study the therapeutic mechanism. A two-arm parallel randomized waiting-list controlled trial with 3- and 6-month follow-ups were conducted in a secondary vocational school in mainland China.

PARTICIPANTS

Participants comprised 77 Chinese adolescents with GD symptoms with a mean age of 16.36 years [standard deviation (SD) = 0.93]; 88.3% were male INTERVENTIONS: Participants were randomized into an ICBT group (n = 38) and a waiting-list control (WLC, n = 39) group. ICBT intervention comprised eight weekly sessions to encourage participants to identify their interests and strengths and set goals for developing personally meaningful real-life activities.

MEASUREMENTS AND FINDINGS

The outcomes were measured at pre-treatment (t0 ), post-treatment (t1 ), 3-month (t2 ) and 6-month (t3 ) follow-ups. The primary outcome was GD symptoms at t3. Secondary outcomes included GD symptoms at t1 and t2 , and gaming motivation, maladaptive gaming cognition, depression and anxiety symptoms at t1 , t2 and t3 . With the intention-to-treat principle, the GD scores at t3 were significantly different between the CBT and WLC groups [mean difference 62.08 (SD = 10.48) versus 73.64 (SD = 11.70); Hedges' g = 1.15, 95% confidence interval = 0.67-1.62]. Linear mixed-effects modeling showed significant group × time interaction for the secondary outcomes (P < 0.01), with a moderate to strong between-group effect size in the reduction in depression symptoms (g = 0.67-0.84) and anxiety symptoms (g = 0.6-0.64). Path analysis shows ICBT leads to GD reduction through reducing gaming motivation and maladaptive gaming cognition.

CONCLUSIONS

An integrated cognitive-behavioral therapy with strength-based motivational approach intervention reduced gaming disorder symptoms and time spent gaming over a 6-month period by decreasing maladaptive gaming motivation and cognition.

Deep neural network to differentiate internet gaming disorder from healthy controls during stop-signal task: a multichannel near-infrared spectroscopy study

Internet Gaming Disorder (IGD), as one of worldwide mental health issues, leads to negative effects on physical and mental health and has attracted public attention. Most studies on IGD are based on screening scales and subjective judgments of doctors, without objective quantitative assessment. However, public understanding of internet gaming disorder lacks objectivity. Therefore, the researches on internet gaming disorder still have many limitations. In this paper, a stop-signal task (SST) was designed to assess inhibitory control in patients with IGD based on prefrontal functional near-infrared spectroscopy (fNIRS). According to the scale, the subjects were divided into health and gaming disorder. A total of 40 subjects (24 internet gaming disorders; 16 healthy controls) signals were used for deep learning-based classification. The seven algorithms used for classification and comparison were deep learning algorithms (DL) and machine learning algorithms (ML), with four and three algorithms in each category, respectively. After applying hold-out method, the performance of the model was verified by accuracy. DL models outperformed traditional ML algorithms. Furthermore, the classification accuracy of the two-dimensional convolution neural network (2D-CNN) was 87.5% among all models. This was the highest accuracy out of all models that were tested. The 2D-CNN was able to outperform the other models due to its ability to learn complex patterns in data. This makes it well-suited for image classification tasks. The findings suggested that a 2D-CNN model is an effective approach for predicting internet gaming disorder. The results show that this is a reliable method with high accuracy to identify patients with IGD and demonstrate that the use of fNIRS to facilitate the development of IGD diagnosis has great potential.

Gaming disorder and stigma-related judgements of gaming individuals: An online randomized controlled trial

BACKGROUND AND AIMS

The inclusion of gaming disorder (GD) in the International Classification of Diseases 11th Revision (ICD-11) has generated scholarly debate, including claims about its potential stigmatizing effects on the wider gaming population. The present study aimed to estimate the effect of addiction-based and non-addiction-based conceptualizations of problem gaming on stigma of gamers.

DESIGN

This preregistered experiment involved a 2 (health information: addiction-related or non-addiction-related) × 3 (vignette: problem, regular or casual gamer) randomized, between-subjects design.

SETTING

An international sample of participants was recruited via Prolific in June and July 2021.

PARTICIPANTS

Participants were eligible (n = 1228) if they were aged 35 to 50 years, played video games for no more than 6 hours per week and did not endorse DSM-5 or ICD-11 criteria for GD.

INTERVENTION AND COMPARATOR

Participants were provided with an explanation of problem gaming as related to either an addictive disorder (i.e. 'addiction' explanation) or personal choice and lifestyle factors (i.e. 'non-addiction' explanation).

MEASUREMENTS

The Attribution Questionnaire (AQ) and Universal Stigma Scale (USS) assessed stigma toward each gamer vignette. Vignettes described a problem gamer (with features of GD); a regular gamer (frequent gaming; some life interference); and a casual gamer (infrequent gaming; no life interference).

FINDINGS

Problem gamer vignettes (mean [M] = 113.3; 95% CI = 111.5-115.4) received higher AQ stigma ratings than regular (M = 94.0; 95% CI = 91.9-95.9) and casual gamers (M = 80.1; 95% CI = 78.2-82.1). Although significant, the effect of health information type on AQ stigma ratings was negligible (addiction group [M = 97.6; 95% CI = 95.9-99.1], non-addiction group [M = 94.1; 95% CI = 92.6-95.8]). However, the addiction information group scored lower on USS blame and responsibility than the non-addiction information group with at least a small effect (99.1% confidence).

CONCLUSIONS

Framing of problem gaming as an addictive disorder or non-addictive activity appears to have a negligible effect on stigma of different gamers among middle-age adults with minimal gaming experience. The concept of 'gaming addiction' seems unlikely to be an important influence on public stigma of gaming.

Effects of emotional working memory training on problematic internet use, inhibition, attention, and working memory among young problematic internet users: A randomized control study

Problematic internet use (PIU) has been defined as an inability to control impulses to use the internet, and is associated with psychological, social, educational, and/or occupational problems. Considering the harmful effects of PIU, the present study evaluated a treatment intervention aimed at controlling PIU. A randomized control study investigated the effectiveness of emotional working memory training (eWMT) in improving inhibition, attention, and working memory among individuals with PIU in comparison with a placebo group. Young adults (N = 36) with PIU were either trained for 20 sessions in an n-back dual emotional task (eWMT; n = 18) or a feature matching task (placebo; n = 18). Results showed that 20 continuous sessions of eWMT significantly reduced the symptoms of PIU and improved participants' working memory, attention, and inhibition (compared to the placebo group). These preliminary findings suggest that eWMT can be considered a promising treatment to reduce PIU by improving individuals' cognitive and emotional functioning.

Regulating Gambling-Like Video Game Loot Boxes: a Public Health Framework Comparing Industry Self-Regulation, Existing National Legal Approaches, and Other Potential Approaches

Purpose of Review

Loot boxes are gambling-like monetisation mechanics in video games that are purchased for opportunities to obtain randomised in-game rewards. Gambling regulation is increasingly being informed by insights from public health. Despite conceptual similarities between loot boxes and gambling, there is much less international consensus on loot box regulation. Various approaches to regulating loot boxes are reviewed via a public health framework that highlights various trade-offs between individual liberties and harm prevention.

Recent Findings

Many countries have considered regulation, but as yet only a few countries have taken tangible actions. Existing regulatory approaches vary greatly. More restrictively, Belgium has effectively ‘banned’ paid loot boxes and prohibits their sale to both children and adults. In contrast, more liberally, China only requires disclosure of the probabilities of obtaining potential rewards to provide transparency and perhaps help players to make more informed purchasing decisions. Most other countries (e.g., the UK) have adopted a ‘wait-and-watch’ approach by neither regulating loot box sales nor providing any dedicated consumer protection response. Industry self-regulation has also been adopted, although this appears to elicit lower rates of compliance than comparable national legal regulation.

Summary

Many potential public health approaches to loot box regulation, such as expenditure limits or harm-reducing modifications to loot box design (e.g., fairer reward structures), deserve further attention. The compliance and clinical benefits of existing interventions (including varying degrees of regulation, as adopted by different countries, and industry self-regulation) should be further assessed. The current international variation in loot box regulation presents opportunities to compare the merits of different approaches over time.

[Excessive Use Patterns and Internet Use Disorders: Effects on Psychosocial and Cognitive Development in Adolescence]

The growing availability of digital technologies has led to increased rates of using them as a part of daily recreational activity among adolescents. Despite their positive effects, there are ongoing debates of potential harm and health-related negative consequences, particularly when internet activities are performed excessively. This contribution provides an overview on negative aspects of digital technologies by presenting a selection of empirical findings. This overview focuses on a selection of recent methodologically sound studies investigating potential negative effects of digital technologies on the development of adolescents. As main constructs, effects on psychosocial and cognitive development and internet use disorders were investigated. Recently published studies point to substantial associations between internet overuse and negative consequences. Habitual, intense use of the internet is related to higher rates of internalizing symptoms, cognitive distortions, and heightened rates of internet use disorders among adolescents. Given these findings it seems recommendable to provide a close parental monitoring of adolescents discovering virtual worlds. By applying clear rules and supporting development of media literacy, functional use habits can be empowered and harmful effects prevented.The new clinical phenomenon of internet use disorder and its high prevalence among adolescents represents a new challenge for treatment services.

FOXN3 and GDNF Polymorphisms as Common Genetic Factors of Substance Use and Addictive Behaviors

Epidemiological and phenomenological studies suggest shared underpinnings between multiple addictive behaviors. The present genetic association study was conducted as part of the Psychological and Genetic Factors of Addictions study (n = 3003) and aimed to investigate genetic overlaps between different substance use, addictive, and other compulsive behaviors. Association analyses targeted 32 single-nucleotide polymorphisms, potentially addictive substances (alcohol, tobacco, cannabis, and other drugs), and potentially addictive or compulsive behaviors (internet use, gaming, social networking site use, gambling, exercise, hair-pulling, and eating). Analyses revealed 29 nominally significant associations, from which, nine survived an FDRbl correction. Four associations were observed between FOXN3 rs759364 and potentially addictive behaviors: rs759364 showed an association with the frequency of alcohol consumption and mean scores of scales assessing internet addiction, gaming disorder, and exercise addiction. Significant associations were found between GDNF rs1549250, rs2973033, CNR1 rs806380, DRD2/ANKK1 rs1800497 variants, and the “lifetime other drugs” variable. These suggested that genetic factors may contribute similarly to specific substance use and addictive behaviors. Specifically, FOXN3 rs759364 and GDNF rs1549250 and rs2973033 may constitute genetic risk factors for multiple addictive behaviors. Due to limitations (e.g., convenience sampling, lack of structured scales for substance use), further studies are needed. Functional correlates and mechanisms underlying these relationships should also be investigated.

Prefrontal cortical activation in Internet Gaming Disorder Scale high scorers during actual real-time internet gaming: A preliminary study using fNIRS

Background

Observation of real-time neural characteristics during gameplay would provide distinct evidence for discriminating the currently controversial diagnosis of internet gaming disorder (IGD), and elucidate neural mechanisms that may be involved in addiction. We aimed to provide preliminary findings on possible neural features of IGD during real-time internet gaming using functional near-infrared spectroscopy (fNIRS).

Methods

Prefrontal cortical activations accompanying positive and negative in-game events were investigated. Positive events: (1) participant's champion slays or assists in slaying an opponent without being slain. (2) the opposing team's nexus is destroyed. Negative events: (1) participant's champion is slain without slaying or assisting in slaying any opponent. (2) the team's nexus is destroyed. Collected data were compared between the IGD group and control group, each with 15 participants.

Results

The IGD group scored significantly higher than the CTRL group on the craving scale. Following positive events, the IGD group displayed significantly stronger activation in the DLPFC. Following negative events, the IGD group displayed significantly weaker activation in the lateral OFC.

Discussion and Conclusions

Individuals scoring high on the IGD scale may crave for more internet gaming after encountering desired events during the game. Such observations are supported by the correlation between the craving scale and DLPFC activation. The IGD group may also show diminished punishment sensitivity to negative in-game experiences rendering them to continue playing the game. The present study provides preliminary evidence that IGD may demonstrate neural characteristics observed in other addictive disorders and suggests the use of fNIRS in behavioral addiction studies.

Risk and protective factors of Internet gaming disorder among Chinese people: A meta-analysis

OBJECTIVES

Effective prevention and intervention of Internet gaming disorder require the identification of risk and protective factors. This study aims to exhaustively review the risk and protective factors of Internet gaming disorder among Chinese people.

METHOD

We searched for articles published from database inception to February 2020 in MEDLINE, PsycINFO, Embase, PubMed, Web of Science and two Chinese databases, CNKI and Wanfang Data. Studies were included in the meta-analysis if they addressed Internet gaming disorder, sampled people in China, presented correlational factors of Internet gaming disorder and reported the effect sizes for correlations. Reviewers independently selected the studies, assessed their validity and extracted the data. Pooled Pearson's correlations were calculated using the random effects model.

RESULT

In the meta-analysis, 153 studies covering 115,975 subjects were included. We identified 56 risk factors and 28 protective factors. Most risk factors strongly correlated with Internet gaming disorder fell into the category of maladaptive cognitions and motivations. Other factors that showed high effect sizes fell into various categories, including psychopathological characteristics, personality traits, cognition emotion regulation style and gaming-related factors. The only protective factor strongly correlated with Internet gaming disorder was self-control. We found that the factors related to the 'environments' show modest effect sizes compared to those related to the individual. The pooled effect sizes for most factors were not influenced by outliers and publication bias.

CONCLUSION

Factors strongly correlated with Internet gaming disorder, especially maladaptive cognitions and motivations, are more likely to be proximal correlates of Internet gaming disorder and may be considered the focus of interventions. We encourage further empirical and experimental studies to examine the causal pathway and the treatment efficacy.

Prevalence of gaming disorder: A meta-analysis

BACKGROUND

Gaming disorder (GD) has been listed in the International Classification of Diseases 11th Revision. Studies on GD prevalence have been highly heterogeneous, and there are significant gaps in prevalence estimates. Few studies have examined what methodological and demographic factors could explain this phenomenon. Therefore, this meta-analytic study quantifies globally reported GD prevalence rates and explores their various moderating variables.

METHODS

Prevalence estimates were extracted from 61 studies conducted before December 3, 2020, which included 227,665 participants across 29 countries. Subgroup and moderator analyses were used to investigate the potential causes of heterogeneity, including region, sample size, year of data collection, age group, study design, sampling method, survey format, sample type, risk of bias, terminology, assessment tool, and male proportion.

RESULTS

The overall pooled prevalence of GD was 3.3% (95% confidence interval: 2.6-4.0) (8.5% in males and 3.5% in females). By selecting only 28 representative sample studies, the prevalence estimate was reduced to 2.4% (95% CI 1.7-3.2), and the adjusted prevalence estimate using the trim-and-fill method was 1.4% (95% CI 0.9-1.9). High heterogeneity in GD prevalence rates was influenced by various moderators, such as participant variables (e.g., region, sample size, and age) and study methodology (e.g., study design, sampling method, sample type, terminology, and instrument). The moderator analyses revealed that the sample size, mean age, and study quality were negatively associated with GD prevalence.

CONCLUSIONS

This study confirms that GD prevalence studies were highly heterogeneous based on participant demographics and research methodologies. Various confounding variables, such as sampling methods, sample types, assessment tools, age, region, and cultural factors have significantly influenced the GD prevalence rates. Prevalence estimates are likely to vary depending on study quality. Further epidemiological studies should be conducted using rigorous methodological standards to more accurately estimate GD prevalence.

Gaming and social media use among adolescents in the midst of the COVID-19 pandemic

Background and aims: The COVID-19 pandemic has dramatically changed life circumstances for adolescents worldwide. With schools being closed and regular activities being cancelled, gaming and social media use are activities that might gain in importance. There is a risk that these online behaviours have negative effects on other important activities, such as being physically active, sleeping, and studying, as well as general well-being. The aim of this study was to investigate the effects of the COVID-19 pandemic on gaming and social media use, and its effects on the well-being of adolescents. Methods: A total of 1232 adolescents (82.5% female) participated in an anonymous web survey containing questions on gaming, social media use, and perceived negative consequences of gaming and social media use during the COVID-19 pandemic. The results were analysed with a quasi-Poisson regression model. Results: The results indicated an increase in gaming and social media use, which was associated with negative consequences and perceived well-being. A majority of adolescents reported that they used social media more than they felt comfortable with. There were large differences between boys and girls, with girls being more negatively affected across measures. Discussion: The increase in gaming and social media use during the COVID-19 pandemic might have negative effects on the well-being of adolescents, and on other activities that are important to health. Our interpretation of the findings is that gaming and social media use might partly function as coping mechanisms to deal with stress and/or boredom resulting from COVID-19 restrictions. There is a risk that these coping strategies become maladaptive over time. Conclusions: The restrictions from the COVID-19 pandemic have resulted in an increase in the amount of time adolescents spend gaming and on social media, which might have negative effects on their well-being. This study highlights the urgent need to consider adaptive and healthy coping strategies for adolescents given the pandemic may mean that daily living could continue to be altered in the near future.

[Inclusion of gaming disorder as a behavioral addiction in ICD-11]

Inclusion of gaming disorder as a behavioral addiction in ICD-11 Abstract. With the inclusion of the new category "disorders due to addictive behaviors" in ICD-11, it has been officially recognized by the WHO that highly rewarding behaviors, analogous to psychotropic substances, can become addictive. In addition to gambling disorder, which was already listed in ICD-10, computer gaming disorder was added as a new diagnosis in this category. The phenotype is characterized by loss of control, priority of gaming over other activities, continuation of gaming despite negative consequences, and the condition of significant impairment caused by the symptomatology. Disorder-typical pathomechanisms include consumption-dependent factors, developmental factors, changes in reward sensitivity and processing, and biased reward expectations (cognitions). Psychotherapeutic care for children, adolescents, and young adults with this disorder, who now comprise a substantial proportion of outpatient care, is challenging. In addition to the development of valid diagnostic tools and effective intervention methods, there is a great need for further training in child and adolescent psychiatry and psychotherapy on this new disorder.

Reliability, and Convergent and Discriminant Validity of Gaming Disorder Scales: A Meta-Analysis

Background: An association between gaming disorder (GD) and the symptoms of common mental disorders is unraveled yet. In this preregistered study, we quantitatively synthesized reliability, convergent and discriminant validity of GD scales to examine association between GD and other constructs. Methods: Five representative GD instruments (GAS-7, AICA, IGDT-10, Lemmens IGD-9, and IGDS9-SF) were chosen based on recommendations by the previous systematic review study to conduct correlation meta-analyses and reliability generalization. A systematic literature search was conducted through Pubmed, Proquest, Embase, and Google Scholar to identify studies that reported information on either reliability or correlation with related variables. 2,124 studies were full-text assessed as of October 2020, and 184 were quantitatively synthesized. Conventional Hedges two-level meta-analytic method was utilized. Results: The result of reliability generalization reported a mean coefficient alpha of 0.86 (95% CI = 0.85-0.87) and a mean test-retest estimate of 0.86 (95% CI = 0.81-0.89). Estimated effect sizes of correlation between GD and the variables were as follows: 0.33 with depression (k = 45; number of effect sizes), 0.29 with anxiety (k = 37), 0.30 with aggression (k = 19), -0.22 with quality of life (k = 18), 0.29 with loneliness (k = 18), 0.56 with internet addiction (k = 20), and 0.40 with game playtime (k = 53), respectively. The result of moderator analyses, funnel and forest plots, and publication bias analyses were also presented. Discussion and Conclusion: All five GD instruments have good internal consistency and test-retest reliability. Relatively few studies reported the test-retest reliability. The result of correlation meta-analysis revealed that GD scores were only moderately associated with game playtime. Common psychological problems such as depression and anxiety were found to have a slightly smaller association with GD than the gaming behavior. GD scores were strongly correlated with internet addiction. Further studies should adopt a rigorous methodological procedure to unravel the bidirectional relationship between GD and other psychopathologies. Limitations: The current study did not include gray literature. The representativeness of the five tools included in the current study could be questioned. High heterogeneity is another limitation of the study. Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42020219781].

Problematic Online Buying-Shopping: Is it Time to Considering the Concept of an Online Subtype of Compulsive Buying-Shopping Disorder or a Specific Internet-Use Disorder?

Purpose of Review

Problematic online buying-shopping became a recent research topic, and the question arises as to whether it would be useful to differentiate between a “predominantly online” and a “predominantly offline” compulsive buying-shopping disorder (CBSD) subtype by analogy with gaming disorder and gambling disorder in the ICD-11. This narrative review aims at reflecting the discussions on overlaps of problematic online buying-shopping with both offline CBSD and specific internet-use disorders.

Recent Findings

Preliminary data suggest that problematic online buying-shopping shares many commonalities with both offline CBSD and potential specific internet-use disorders (e.g., gaming disorder, pornography-use disorder, or social-network–use disorder). However, there is a lack of research addressing the etiology, underlying affective and cognitive mechanisms, psychosocial correlates, comorbidity profiles, and treatment of problematic online buying-shopping.

Summary

The question of whether online CBSD can develop independently from offline CBSD or only as medial transformation of offline CBSD still remains unanswered due to limited research on problematic online buying-shopping. Both perspectives are conceivable: that online CBSD represents a standalone specific internet-use disorder or the online subtype of CBSD. Future studies should examine which approach has clinical utility and indicates specific treatment options and better outcomes.

Evaluating the Social Cost of Conflict between New Media and Society: The Case of Gaming Disorder in South Korea

Historically, the introduction of a new media in mass market caused a strong conflict starting from the nineteenth century popular literature, comics, rock music and film. Interestingly, these conflicts have shown similar and repeated patterns, which is now called media panic and moral regulation, and games are following this pattern. In 2019, Gaming disorder (GD) was decided to be included in the International Classification of Diseases (ICD-11), and similar conflicts on games arenow expected. However, the social cost and damage have not been fully addressed until now. Thus, this study focuses on the estimation of the social cost induced by GD for policy design and decisions in the public healthcare of South Korea. Using the contingent valuation method, a popular valuation method in econometrics for non-market goods, this study has tried to estimate the social cost induced by the introduction of GD into the public healthcare practice. Focusing on a false positive problem in the diagnosis, this study estimates that the willingness to pay for GD diagnosis for children is about KRW 152 K (USD 135). Considering the difference between the prevalence of GD (1.9%) and GD suspicion rate of children in the respondents (12.54%), the excessive medical diagnosis cost due to the false positive problem is estimated to KRW 101 billion (USD 89.6 M), which is about four times more than the annual medical cost for Attention Deficit Hyperactivity Disorder (ADHD) treatment in South Korea. Thus, strong scientific proof and a cautious policy approach on GD are needed before the inclusion of GD in the public health practice.

Affective and cognitive processes involved in behavioral addictions

This special issue addresses the affective and cognitive processes and their interactions potentially reflecting mechanisms underlying the development, maintenance of, or recovery from behavioral addictions. Various specific types of behavioral addictions will be considered, including those already in ICD-11 (gambling disorder, gaming disorder), but also new phenomena that are not yet classified (e.g., buying-shopping disorder, social-network-disorder) and phenomena potentially belonging to behavioral addictions although they are currently classified elsewhere (e.g., compulsive sexual behavior disorder). The articles included in this special issue directly investigate affective processes (e.g., cue-reactivity, craving, mood, stress, social interactions) and/or cognitive processes (e.g., executive functions, attention, memory). The studies involve experimental paradigms, neuropsychological tasks, psychophysiological measures, and neuroimaging techniques. Specific articles also deal with the relationship between affective and cognitive processes. The special issue is complemented by articles covering current debates and reviewing current empirical findings in the field.

Autism, Problematic Internet Use and Gaming Disorder: A Systematic Review

The present study investigated the association between autism and problematic internet use (PIU) and gaming disorder (GD). A systematic literature search was conducted in accordance with PRISMA guidelines. A total of 2286 publications were screened, and 21 were deemed eligible for inclusion in the review. The majority of the studies found positive associations between PIU and subclinical autistic-like traits with weak and moderate effect sizes and between PIU and Autism Spectrum Disorder (ASD) with varying effect sizes. Additionally, individuals with ASD were more likely to exhibit symptoms of GD with moderate and strong effect sizes. Future research would benefit from high-quality studies examining GD and PIU at a clinical level and their relationship with both clinical and subclinical autism.

Awareness and Potential Impacts of the Medicalization of Internet Gaming Disorder: Cross-sectional Survey Among Adolescents in China

Background

The Eleventh Revision of International Classification of Diseases (ICD-11) newly listed gaming disorder, including internet gaming disorder (IGD), as a disease. The level of awareness and potential positive and negative impacts of this medicalization among adolescents were unknown.

Objective

This study investigated the levels, associated factors, and potential positive and negative impacts of awareness of the medicalization of IGD among adolescents in China.

Methods

In a cross-sectional survey, 1343 middle school students in Guangzhou, China, self-administered an anonymous questionnaire in classrooms (October to December 2019). Three risk subgroups were identified: those who scored ≥5 items in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition checklist (IGD-S), those who self-perceived having IGD currently (IGD-PC), and those who self-perceived having IGD within 12 months (IGD-P12M).

Results

Of the internet gamers, 48.3% (460/952) were aware of the medicalization of IGD; they were more likely to belong to the IGD-P12M/IGD-S risk subgroups. Within the IGD-PC/IGD-P12M (but not IGD-S) risk subgroups, IGD medicalization awareness was positively associated with favorable outcomes (reduced internet gaming time in the past 12 months, seeking help from professionals if having IGD, and fewer maladaptive cognitions). After being briefed about the ICD-11 inclusion of IGD, 54.2% (516/952) and 32.8% (312/952) expressed that it would lead to the reduction of gaming time and help-seeking behaviors, respectively; however, 17.9% (170/952), 21.5% (205/952), 15.9% (151/952), and 14.5% (138/952) perceived self-doubt for being diseased, stronger pressure from family members, negative emotional responses, and labeling effect, respectively. With a few exceptions, such perceived positive or negative impacts were stronger among the IGD-S, IGD-PC, and IGD-P12M risk subgroups.

Conclusions

The exploratory study shows that the medicalization of IGD may have benefits that need maximization and potentially harmful effects that need minimization. Future studies should test the efficacies of health promotion that increases IGD medicalization awareness.

Can Worried Parents Predict Effects of Video Games on Their Children? A Case-Control Study of Cognitive Abilities, Addiction Indicators and Wellbeing

Many parents worry over their children’s gaming habits, but to what extent do such worries match any detrimental effects of excessive gaming? We attempted to answer this question by comparing children of highly concerned parents with other adolescents of the same age. A cohort of parents who identified as highly concerned over their children’s video game habits were recruited for a public study in collaboration with a national television network. Using an online experimental platform in conjunction with surveys of parents’ beliefs and attitudes, we compared their children to age-matched peers in an exploratory case-control study. The scores of children with highly concerned parents on tests of cognitive control (cued task-switching and Iowa Gambling Task) and psychological wellbeing (WHO-5) were statistically similar to controls, suggesting no selective cognitive or psychological detriments from gaming or otherwise in the cases with concerned parents. The case group, however, did spend more time gaming, and scored higher than controls on problem gaming indicators (Gaming Addiction Scale), which also correlated negatively with wellbeing. Within the case group, wellbeing effects seemed mainly to consist in issues of relaxation and sleep, and related to gaming addiction indicators of playing to forget real-world problems, and the feeling of neglecting non-gaming activities. Where most results of research staged for TV never get published, making it difficult to interpret both methods and results, this paper describes findings and participant recruitment in detail. The relationship between parental concern and children’s gaming is discussed, as is the merits and challenges of research conducted with media, such as TV programs and their recruited on-screen participants.

More stringent criteria are needed for diagnosing internet gaming disorder: Evidence from regional brain features and whole-brain functional connectivity multivariate pattern analyses

BACKGROUND

Internet gaming disorder (IGD) is included in the DSM-5 as a provisional diagnosis. Whether IGD should be regarded as a disorder and, if so, how it should be defined and thresholded have generated considerable debate.

METHODS

In the current study, machine learning was used, based on regional and interregional brain features. Resting-state data from 374 subjects (including 148 IGD subjects with DSM-5 scores ≥5 and 93 IGD subjects with DSM-5 scores ≥6) were collected, and multivariate pattern analysis (MVPA) was employed to classify IGD from recreational game use (RGU) subjects based on regional brain features (ReHo) and communication between brain regions (functional connectivity; FC). Permutation tests were used to assess classifier performance.

RESULTS

The results demonstrated that when using DSM-5 scores ≥5 as the inclusion criteria for IGD subjects, MVPA could not differentiate IGD subjects from RGU, whether based on ReHo or FC features or by using different templates. MVPA could differentiate IGD subjects from RGU better than expected by chance when using DSM-5 scores ≥6 with both ReHo and FC features. The brain regions involved in the default mode network and executive control network and the cerebellum exhibited high discriminative power during classification.

DISCUSSION

The current findings challenge the current IGD diagnostic criteria thresholding proposed in the DSM-5, suggesting that more stringent criteria may be needed for diagnosing IGD. The findings suggest that brain regions involved in the default mode network and executive control network relate importantly to the core criteria for IGD.

Identifying individuals in need of help for their uncontrolled gaming: A narrative review of concerns and comments regarding gaming disorder diagnostic criteria

OBJECTIVE

In 2013, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) included the diagnostic criteria of Internet gaming disorder (IGD). Then, in 2019, the 11th Revision of the International Classification of Diseases (ICD-11) categorized gaming disorder (GD) as an addictive disorder. This review aimed to review the raised concerns, debate, and research of IGD or GD criteria and provide suggestions to resolve them.

METHODS

A narrative review was conducted, and PubMed was searched for articles mentioning concerns and research on the DSM-5 criteria for IGD, ICD-11 criteria for GD, or criteria for other synonyms, such as problematic gaming or gaming addiction. A total of 107 articles were identified.

RESULTS

Concerns were organized into three categories: conceptual framework, moral panic, and diagnostic validity. Most argumentations supported the proposition that GD and other substance use disorders have similar presentations. A clear definition of GD and adequate public education could prevent rather than exacerbate moral panic. Several researchers reported concerns regarding the nosology, diagnostic validity, and wording of each criterion. However, the threshold, five of the nine criteria with impaired function, demonstrated adequate validity in interview studies.

CONCLUSION

The current findings support the addiction framework, functional impairment, and validity of the GD criteria. However, further prospective, experimental, and clinical studies validating these findings are warranted. Moreover, an integrative review or debate conference could contribute to the organization of the available results and concept development. Aggregating adequate scientific information could allay or resolve concerns related to the diagnosis of GD.

Verhaltenssüchte in der ICD-11

Ziel Der Beitrag stellt die Verortung von Verhaltenssüchten in der ICD-11 dar und gibt einen Ausblick auf die zukünftige Entwicklung.

Methodik Sichtung der Literatur

Ergebnisse Auf Basis von Expertenmeetings der Weltgesundheitsorganisation (WHO) wurde ein Vorschlag entwickelt, auf Basis dessen die Gambling und Gaming Disorder in die aktuelle Fassung der International Classification of Diseases (ICD-11) aufgenommen wurden. Beide Störungen werden mit den gleichen 3 Kernmerkmalen beschrieben (Kontrollverlust, Priorität im Leben und Fortsetzung trotz negativer Konsequenzen) und erfordern darüber hinaus das Vorliegen einer funktionalen Beeinträchtigung. Eine Reihe von Studien belegt die klinische Relevanz dieser Entscheidung. Darüber hinaus lassen sich weitere spezifizierte Verhaltenssüchte kodieren, wobei nach Sichtung der Literatur insbesondere Buying-Shopping Disorder, Pornografy Use Disorder und Social Networks Use Disorder hierfür geeignet erscheinen.

Schlussfolgerung Insbesondere bei der Computerspielstörung ist zu erwarten, dass die Aufnahme in die ICD-11 die Entwicklung von Diagnostik, Prävention und Therapie diese Störung fördert. Unter Federführung der WHO werden derzeit diagnostische Verfahren für beide Störungen entwickelt, um Standardinstrumente bereit zu stellen.

Which conditions should be considered as disorders in the International Classification of Diseases (ICD-11) designation of "other specified disorders due to addictive behaviors"?

BACKGROUND

Gambling and gaming disorders have been included as "disorders due to addictive behaviors" in the International Classification of Diseases (ICD-11). Other problematic behaviors may be considered as "other specified disorders due to addictive behaviors (6C5Y)."

METHODS

Narrative review, experts' opinions.

RESULTS

We suggest the following meta-level criteria for considering potential addictive behaviors as fulfilling the category of "other specified disorders due to addictive behaviors":1. Clinical relevance: Empirical evidence from multiple scientific studies demonstrates that the specific potential addictive behavior is clinically relevant and individuals experience negative consequences and functional impairments in daily life due to the problematic and potentially addictive behavior.2. Theoretical embedding: Current theories and theoretical models belonging to the field of research on addictive behaviors describe and explain most appropriately the candidate phenomenon of a potential addictive behavior.3. Empirical evidence: Data based on self-reports, clinical interviews, surveys, behavioral experiments, and, if available, biological investigations (neural, physiological, genetic) suggest that psychological (and neurobiological) mechanisms involved in other addictive behaviors are also valid for the candidate phenomenon. Varying degrees of support for problematic forms of pornography use, buying and shopping, and use of social networks are available. These conditions may fit the category of "other specified disorders due to addictive behaviors".

CONCLUSION

It is important not to over-pathologize everyday-life behavior while concurrently not trivializing conditions that are of clinical importance and that deserve public health considerations. The proposed meta-level-criteria may help guide both research efforts and clinical practice.

Co-occurrences of substance use and other potentially addictive behaviors: Epidemiological results from the Psychological and Genetic Factors of the Addictive Behaviors (PGA) Study

BACKGROUND AND AIMS

Changes in the nomenclature of addictions suggest a significant shift in the conceptualization of addictions, where non-substance related behaviors can also be classified as addictions. A large amount of data provides empirical evidence that there are overlaps of different types of addictive behaviors in etiology, phenomenology, and in the underlying psychological and biological mechanisms. Our aim was to investigate the co-occurrences of a wide range of substance use and behavioral addictions.

METHODS

The present epidemiological analysis was carried out as part of the Psychological and Genetic Factors of the Addictive Behaviors (PGA) Study, where data were collected from 3,003 adolescents and young adults (42.6% males; mean age 21 years). Addictions to psychoactive substances and behaviors were rigorously assessed.

RESULTS

Data is provided on lifetime occurrences of the assessed substance uses, their co-occurrences, the prevalence estimates of specific behavioral addictions, and co-occurrences of different substance use and potentially addictive behaviors. Associations were found between (i) smoking and problematic Internet use, exercising, eating disorders, and gambling (ii) alcohol consumption and problematic Internet use, problematic online gaming, gambling, and eating disorders, and (iii) cannabis use and problematic online gaming and gambling.

CONCLUSIONS

The results suggest a large overlap between the occurrence of these addictions and behaviors and underlies the importance of investigating the possible common psychological, genetic and neural pathways. These data further support concepts such as the Reward Deficiency Syndrome and the component model of addictions that propose a common phenomenological and etiological background of different addictive and related behaviors.

How have excessive electronics devices and Internet uses been concerned? Implications for global research agenda from a bibliometric analysis

BACKGROUND AND AIMS

Excessive use of electronic devices has become a major global problem. However, little is known about the development and current landscape of research concerning this field. This study aimed at exploring the overall publication trend and topics of research on the overuse of electronic devices and the Internet from 1971 to 2017.

METHODS

We systematically searched the Web of Science (WoS) and Scopus databases for published articles on the excessive use of electronic devices and the Internet. Data regarding the publication volume, international collaborations, and geographical locations were analyzed by bibliometrics analysis. Latent Dirichlet Allocation (LDA) was undertaken to categorize publications into different research topics.

RESULTS

A total of 2,276 papers from the WOS and 600 papers from the Scopus were included. We found a dramatic increase in the number of scientific papers towards addiction to electronic devices and the Internet. The United State led in all publication parameters including the total number of papers and total citations. China, Korea and Taiwan were among the most prolific countries/regions. Smartphone addiction was the main concern, and the relationship between the overuse of electronic devices and the Internet and mental health issues have been highlighted. On the other hand, our study found a limited appearance of discussion on effective treatment and intervention.

DISCUSSION AND CONCLUSION

The findings of this study call for more national and international cooperation in evaluating and intervening addiction to electronic devices and the Internet to gather more knowledge about this phenomenon and evaluate the effectiveness of treatment.

The Development of a Screening Tool for Chinese Disordered Gamers: The Chinese Internet Gaming Disorder Checklist (C-IGDC)

Despite the increasing research attention being paid to gaming disorder globally, a screening tool developed specifically for the Chinese population is still lacking. This study aims to address this gap by constructing a screening tool to assess Internet gaming disorder (IGD) symptomology, defined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), among Chinese gamers. Based on expert interviews and consultations, a focus group of gamers, a background literature review, and the IGD criteria proposed by the DSM-5, we developed the Chinese Internet Gaming Disorder Checklist (C-IGDC). This study evaluated its dimensional structure, reliability, validity, and screening efficacy with 464 Chinese past-year gamers (53% female; mean age = 19.84). The two-level structure of the 27-item C-IGDC showed a satisfactory model fit, acceptable reliability, as well as good validity via expected associations with Internet addiction, gameplay frequency, and depressive symptoms. The optimal screening cutoff score (≥20) was proposed to detect probable IGD cases. The C-IGDC is the first DSM-5-based, multidimensional IGD screening tool designed specifically for Chinese gamers. Further evaluation of the C-IGDC in epidemiological studies and clinical settings is recommended.

Laxer Clinical Criteria for Gaming Disorder May Hinder Future Efforts to Devise an Efficient Diagnostic Approach: A Tree-Based Model Study

Internet Gaming Disorder (IGD) has been recognized in May 2013 and can be evaluated using the criteria developed by American Psychiatric Association (APA). The present study investigated the role each IGD criteria plays in diagnosing disordered gaming. A total of 3377 participants (mean age 20 years, SD = 4.3 years) participated in the study. The data collected was scrutinized to detect patterns of IGD using Conditional Inference Tree (Ctree), a sophisticated machine algorithm. Participants provided basic sociodemographic information and completed the Internet Gaming Disorder Scale–Short-Form (IGDS9-SF). The results identified classes of IGD-related symptoms, indicating that endorsing ‘withdrawal’ and ‘loss of control’ increases the probability of disordered gaming by 77.77% while endorsement of ‘withdrawal’, ‘loss of control’ and ‘negative consequences’ increases the probability of disordered gaming by 26.66%. Moreover, lack of endorsement of ‘withdrawal’ and endorsement of ‘preoccupation’ increases the likelihood of disordered gaming by 7.14%. Taken together, the results obtained illustrate that different IGD criteria can present with different clinical weighing as unique diagnostic roles in the development of disordered gaming can be evidenced by each criterion. Moreover, the present findings help inform future revisions of diagnostic manuals and helps enhancing the assessment of IGD in the future. Additional research and clinical implications are discussed.

Working Memory-Related Prefrontal Hemodynamic Responses in University Students: A Correlation Study of Subjective Well-Being and Lifestyle Habits

Identification of social risk factors and the promotion of stress coping mechanisms and mental resilience are topics of interest in the field of mental health. The relationships between risk- or tolerability-associated factors and task-related hemodynamic responses in the prefrontal cortex (PFC) in adolescents may have important implications for mental health challenges. The purpose of this study was to investigate the relationship between task-related PFC hemodynamic activities and subjective well-being or lifestyle habits using wearable near-infrared spectroscopy (NIRS). In this study, after sample refinement to reduce heterogeneity, 20 university students were included in verbal working memory (VWM) task analyses and 21 were included in spatial working memory (SWM) task analyses. The task-related hemodynamic responses were detected using wearable NIRS. To assess the risk- or tolerability-associated factors, the levels of positive and negative affect were assessed using the Subjective Well-Being Inventory (SUBI) and lifestyle habits (such as gaming) were evaluated using a nine-item questionnaire. There was a positive correlation between SUBI positive affect and VWM task-related oxy-hemoglobin signal changes in the right dorsolateral PFC (DLPFC), underlining the significance of subjective well-being as an important independent emotional domain and suggesting the possibility of the differential objective evaluations of subjective well-being in the right PFC. Negative correlations between PFC activities during both VWM and SWM tasks at the left DLPFC and the number of game playing days in 1 week were also statistically significant, suggesting the presence of modality-non-specific hemodynamic regulation by habitual game playing. Each correlation was still robust after the elimination of major confounding impacts. Although further replication studies are warranted to confirm these preliminary results, this investigation of the relationship between task-related PFC hemodynamic activities and emotional domains or lifestyle habits might have clinical significance with regard to primary prevention of mental health issues in university students. To our knowledge, this is the first demonstration of these relationships with the use of wearable NIRS, which enables measurement under near natural conditions and is easy to use in schools or workplaces.

Will esports result in a higher prevalence of problematic gaming? A review of the global situation

BACKGROUND AND AIMS

Video gaming is highly prevalent in modern culture, particularly among young people, and a healthy hobby for the majority of users. However, in recent years, there has been increasing global recognition that excessive video gaming may lead to marked functional impairment and psychological distress for a significant minority of players. Esports is a variant of video gaming. It is a relatively new phenomenon but has attracted a considerable number of followers across the world and is a multimillion dollar industry. The aim of this briefing paper is to review the global situation on esports and related public health implications.

METHODS

A non-systematic review was conducted. Information obtained from the Internet and PubMed was collated and presented as genres of games, varieties and magnitudes of impacts, popularity, fiscal impact in monetary terms, government involvement, and public health implications.

RESULTS

There are several different kinds of esports but there was no clear categorization on the genre of games. Many tournaments have been organized by gaming companies across the world with huge prize pools, and some of these events have government support. Little information on the health effects associated with esports was identified.

DISCUSSION AND CONCLUSIONS

A majority of the sources of information were from commercial settings, and failed to declare conflicts of interest, which may result in a biased picture of the current situation. When gaming activity is being further promoted under the umbrella of esports, it seems reasonable to expect an increase in problematic gaming and thus increased prevalence of gaming disorder and hazardous gaming. With increasing demand for treatment services for gaming addition/disorder in different countries across the world, it is a significant public health concern. More empirically based research on this topic is needed.

The cross-cultural expression of internet gaming distress in North America, Europe, and China

We compare the forms online gaming-related distress takes cross-culturally, and examine how much such distress resembles the World Health Organization's (WHO) “Gaming disorder,” understood to be an “addiction.” Our preliminary exploratory factor analysis (EFA) in North America (n = 2025), Europe (n = 1198), and China (n = 841) revealed a constant four-factor structure across the three regions, with classic “addiction” symptoms always clustering together on the first and most important factor, though with some variability in regional factors' exact item composition. In the present study, we use second-order confirmatory factor analysis (CFA) to further examine this factor structure and the cultural similarities and differences. Specifically, we focus on confirming the regional structure and composition of an ethnographically developed 21-item gaming distress scale, which contains a wider symptoms pool than typical gaming disorder scales, and thus allows us to better separate generalized gaming distress's “addictive” from other culturally-influenced “problem” experiences and behaviors in each regional case. We use propensity score matching to separate the impact on gaming-related distress of regional culture from demographic variables (North America/Europe: n = 1043 pairs; North America/China: n = 535 pairs). Although our results support current WHO formulations of gaming-related distress as an addictive disorder, we show how cultural forces can shape how “addictive” and “problem” gaming are experienced and thus psychiatrically presented in different parts of the world. In particular, generalized gaming distress's addictive and problematic dimensions seem to be shaped by culture-specific expressions of achievement motivations, social connection and disconnection, and unique psychosomatic experiences.

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Second-order CFA shows similarities and differences between online gaming distress in North America, Europe, and China.

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Our 21-item distress scale allows us to separate “addictive” from “problem” experiences and behaviors in each regional case.

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Propensity score matching helps us separate the impact on gaming distress of regional culture from demographic variables.

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Generalized gaming distress consists of four dimensions, with three closely related to addiction experiences and behaviors.

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Our results support current WHO and APA formulations of gaming-related distress as an addictive disorder.

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Culture also shapes how “addictive” and “problem” gaming are experienced in different parts of the world.

The "ABCDE" of video gaming control: Arguments, basic research, conceptual models, documented lessons, and evaluation

This commentary responds to the review conducted by Király et al. (2018). The review enlightens and is useful in view of the limited studies on problematic use of video games and related control policies. It is argued that when considering regulation policies on video games, reference should be made to the arguments involved (A), basic research (B), conceptual models on problem video game use (C), documented lessons learning the broad field of addiction (D), and the need for rigorous evaluation (E). Besides "supply" reduction, it is vital to look at "demand" reduction in terms of how inner strengths may help to reduce the problematic use of video games.

The psychological and genetic factors of the addictive behaviors (PGA) study

OBJECTIVES

Most of the addiction studies focus on very specific aspects of addictions, often with contradictory results, and integrated studies are quite rare. Experimental studies comparing underlying mechanisms of addictions and analyzing data from an integrative psychological and genetic perspective are almost nonexistent. The aim of the present paper is to describe the research protocol of the Psychological and Genetic Factors of Addictive Behaviors (PGA) study, which applies an integrative approach to understanding the acquisition, development, and maintenance of addictive behaviors.

METHODS

A wide-spectrum national study was carried out. Data were collected from 3,003 adolescents. Addictions to both psychoactive substances and behaviors were thoroughly assessed via psychometrically robust scales, which also included assessment related to a wide range of related psychological dimensions. Additionally, a DNA sample was also collected from participants.

RESULTS

The paper presents the detailed methodology of the PGA study. Data collection procedures, instrumentation, and the analytical approach used to attain the research objectives are described.

CONCLUSIONS

Future plans, along with potential contributions of the PGA study, are also discussed. It is envisaged that the study will provide a unique opportunity to test possible mechanisms and causal pathways mediating the associations of genetic factors, psychological characteristics, and addictions.

The Role of Cognitive Emotion Regulation Strategies in Problem Gaming Among Adolescents: A Nationally Representative Survey Study

Explanatory theoretical models have proposed an association between problematic online gaming and abilities or strategies in alleviating distress or negative emotions in times of stress as proximal non-gaming-related personality factors. However, there is little research that has targeted how emotion regulation relates to problematic online gaming-especially during adolescence when gaming behavior is most prevalent. In emotion regulation research, there has been a particular emphasis on rumination because it is strongly associated with overall psychopathology. However, it is unknown whether this putatively maladaptive strategy relates to problematic online gaming and whether it is a gender-dependent association. Consequently, the present study examined how emotion regulation strategies, and particularly rumination, related to problem gaming and tested whether gender moderated this relationship in adolescents. In a national representative adolescent sample, 46.9% of the participants (N = 1,646) reported online gaming in the past 12 months and provided information on problematic gaming, and it was these data that were used for further analysis. Their data concerning problematic online gaming and emotion regulation strategies were analyzed, including rumination along with other putatively maladaptive (e.g., catastrophizing) and adaptive (e.g., positive reappraisal) strategies, while controlling for age, gender, and game genre preference. Results of linear regression analyses showed that all the putatively maladaptive emotion regulation strategies (including self-blame, other blame, catastrophizing, and rumination) were positively related to problematic online gaming. Positive reappraisal proved to be a protective factor; it was inversely related to problematic online gaming. In addition, the relationship between rumination and online gaming was moderated by gender (i.e., the relationship was stronger among boys). Based on the results, it is argued that emotion regulation is a useful framework to study problematic online gaming. The present study highlighted that the relative predictive value of rumination for problematic online gaming varied for boys and girls, suggesting that trait rumination might be a gender-specific vulnerability factor for problematic online gaming, but this requires further investigation and replication.

Breaking the habit

Internet gaming disorder has been widely recognized as a new health issue. At present, we are experiencing a rapid growth of knowledge on different aspects of this disorder, such as, for instance, prevalence rates, underlying neurobiological mechanisms, and treatment strategies. In contrast, preventing individuals from developing Internet gaming disorder is a matter that has not yet progressed sufficiently. Although we can basically refer to measures and techniques known to be effective in preventing other addictive behaviors, the special demands of preventing Internet gaming disorder remain largely obscured or disregarded. The policy actions identified in the review by Király et al. (2018) demonstrate that first preventive approaches have been initiated but, on the other hand, it also points out that empirical research on their feasibility and effectiveness needs improvement.

Including gaming disorder in the ICD-11: The need to do so from a clinical and public health perspective

The proposed introduction of gaming disorder (GD) in the 11th revision of the International Classification of Diseases (ICD-11) developed by the World Health Organization (WHO) has led to a lively debate over the past year. Besides the broad support for the decision in the academic press, a recent publication by van Rooij et al. (2018) repeated the criticism raised against the inclusion of GD in ICD-11 by Aarseth et al. (2017). We argue that this group of researchers fails to recognize the clinical and public health considerations, which support the WHO perspective. It is important to recognize a range of biases that may influence this debate; in particular, the gaming industry may wish to diminish its responsibility by claiming that GD is not a public health problem, a position which maybe supported by arguments from scholars based in media psychology, computer games research, communication science, and related disciplines. However, just as with any other disease or disorder in the ICD-11, the decision whether or not to include GD is based on clinical evidence and public health needs. Therefore, we reiterate our conclusion that including GD reflects the essence of the ICD and will facilitate treatment and prevention for those who need it.

Personality and Cognition in Gamers: Avoidance Expectancies Mediate the Relationship Between Maladaptive Personality Traits and Symptoms of Internet-Gaming Disorder

Internet-gaming disorder (IGD) has become a clinically relevant phenomenon worth investigating with respect to its mechanisms of development and maintenance. Considering theoretical models of specific Internet-use disorders, we assumed an interaction of maladaptive personality traits as unspecific predisposing factors and experience-based, gaming-related Internet-use expectancies in predicting symptoms of IGD. Therefore, 103 male and female regular Internet gamers were investigated with questionnaires assessing maladaptive personality traits in accordance to DSM-5, gaming-related positive and avoidance Internet-use expectancies, and symptoms of IGD. The results demonstrated that negative affectivity, detachment, antagonism, disinhibition, psychoticism as well as gaming-related positive and avoidance expectancies were related to symptoms of IGD. Moreover, the relationship between maladaptive personality traits as represented by negative affectivity, detachment, and psychoticism with symptoms of IGD was mediated by avoidance expectancies. Positive gaming-related use expectancies were related to detachment, and were not a significant mediator in the hypothesized model. The findings give reason to assume that maladaptive personality traits in combination with gaming-related positive expectancies and avoidance expectancies are important factors for the development of IGD, but that positive expectancies and avoidance expectancies play a differential role regarding there mediating role between personality characteristics and symptoms of IGD.

The impact of comorbid impulsive/compulsive disorders in problematic Internet use

Background and aims Problematic Internet use (PIU) is commonplace but is not yet recognized as a formal mental disorder. Excessive Internet use could result from other conditions such as gambling disorder. The aim of the study was to assess the impact of impulsive-compulsive comorbidities on the presentation of PIU, defined using Young's Diagnostic Questionnaire. Methods A total of 123 adults aged 18-29 years were recruited using media advertisements, and attended the research center for a detailed psychiatric assessment, including interviews, completion of questionnaires, and neuropsychological testing. Participants were classified into three groups: PIU with no comorbid impulsive/compulsive disorders (n = 18), PIU with one or more comorbid impulsive/compulsive disorders (n = 37), and healthy controls who did not have any mental health diagnoses (n = 67). Differences between the three groups were characterized in terms of demographic, clinical, and cognitive variables. Effect sizes for overall effects of group were also reported. Results The three groups did not significantly differ on age, gender, levels of education, nicotine consumption, or alcohol use (small effect sizes). Quality of life was significantly impaired in PIU irrespective of whether or not individuals had comorbid impulsive/compulsive disorders (large effect size). However, impaired response inhibition and decision-making were only identified in PIU with impulsive/compulsive comorbidities (medium effect sizes). Discussion and conclusions Most people with PIU will have one or more other impulsive/compulsive disorders, but PIU can occur without such comorbidities and still present with impaired quality of life. Response inhibition and decision-making appear to be disproportionately impacted in the case of PIU comorbid with other impulsive/compulsive conditions, which may account for some of the inconsistencies in the existing literature. Large scale international collaborations are required to validate PIU and further assess its clinical, cognitive, and biological sequelae.

Do gaming disorder and hazardous gaming belong in the ICD-11? Considerations regarding the death of a hospitalized patient that was reported to have occurred while a care provider was gaming

There has been much debate regarding the extent to which different types and patterns of gaming may be considered harmful from individual and public health perspectives. A recent event in which a hospitalized patient was reported to have died while a care provider was gaming is worth considering as an example as to how gaming may distract individuals from work-related tasks or other activities, with potential negative consequences. As the 11th edition of the International Classification of Diseases is being developed, events like these are important to remember when considering entities like, and generating criteria for, disordered or hazardous gaming.

A weak scientific basis for gaming disorder: Let us err on the side of caution

We greatly appreciate the care and thought that is evident in the 10 commentaries that discuss our debate paper, the majority of which argued in favor of a formalized ICD-11 gaming disorder. We agree that there are some people whose play of video games is related to life problems. We believe that understanding this population and the nature and severity of the problems they experience should be a focus area for future research. However, moving from research construct to formal disorder requires a much stronger evidence base than we currently have. The burden of evidence and the clinical utility should be extremely high, because there is a genuine risk of abuse of diagnoses. We provide suggestions about the level of evidence that might be required: transparent and preregistered studies, a better demarcation of the subject area that includes a rationale for focusing on gaming particularly versus a more general behavioral addictions concept, the exploration of non-addiction approaches, and the unbiased exploration of clinical approaches that treat potentially underlying issues, such as depressive mood or social anxiety first. We acknowledge there could be benefits to formalizing gaming disorder, many of which were highlighted by colleagues in their commentaries, but we think they do not yet outweigh the wider societal and public health risks involved. Given the gravity of diagnostic classification and its wider societal impact, we urge our colleagues at the WHO to err on the side of caution for now and postpone the formalization.

Impulsivity and compulsivity in Internet gaming disorder: A comparison with obsessive-compulsive disorder and alcohol use disorder

Background and aims Internet gaming disorder (IGD) is characterized by a loss of control and a preoccupation with Internet games leading to repetitive behavior. We aimed to compare the baseline neuropsychological profiles in IGD, alcohol use disorder (AUD), and obsessive-compulsive disorder (OCD) in the spectrum of impulsivity and compulsivity. Methods A total of 225 subjects (IGD, N = 86; AUD, N = 39; OCD, N = 23; healthy controls, N = 77) were administered traditional neuropsychological tests including Korean version of the Stroop Color-Word test and computerized neuropsychological tests, including the stop signal test (SST) and the intra-extra dimensional set shift test (IED). Results Within the domain of impulsivity, the IGD and OCD groups made significantly more direction errors in SST (p = .003, p = .001) and showed significantly delayed reaction times in the color-word reading condition of the Stroop test (p = .049, p = .001). The OCD group showed the slowest reading time in the color-word condition among the four groups. Within the domain of compulsivity, IGD patients showed the worst performance in IED total trials measuring attentional set shifting ability among the groups. Conclusions Both the IGD and OCD groups shared impairment in inhibitory control functions as well as cognitive inflexibility. Neurocognitive dysfunction in IGD is linked to feature of impulsivity and compulsivity of behavioral addiction rather than impulse dyscontrol by itself.

Established risk factors for addiction fail to discriminate between healthy gamers and gamers endorsing DSM-5 Internet gaming disorder

Background and aims The DSM-5 includes criteria for diagnosing Internet gaming disorder (IGD) that are adapted from substance abuse and widely used in research and clinical contexts, although evidence supporting their validity remains scarce. This study compared online gamers who do or do not endorse IGD criteria regarding self-control-related abilities (impulsivity, inhibitory control, and decision-making), considered the hallmarks of addictive behaviors. Method A double approach was adopted to distinguish pathological from recreational gamers: The first is the classic DSM-5 approach (≥5 criteria required to endorse the IGD diagnosis), and the second consists in using latent class analysis (LCA) for IGD criteria to distinguish gamers' subgroups. We computed comparisons separately for each approach. Ninety-seven volunteer gamers from the community were recruited. Self-reported questionnaires were used to measure demographic- and game-related characteristics, problematic online gaming (with the Problematic Online Gaming Questionnaire), impulsivity (with the UPPS-P Impulsive Behavior Scale), and depression (with the Beck Depression Inventory-II). Experimental tasks were used to measure inhibitory control (Hybrid-Stop Task) and decision-making abilities (Game of Dice Task). Results Thirty-two participants met IGD criteria (33% of the sample), whereas LCA identified two groups of gamers [pathological (35%) and recreational]. Comparisons that used both approaches (DSM-5 and LCA) failed to identify significant differences regarding all constructs except for variables related to actual or problematic gaming behaviors. Discussion The validity of IGD criteria is questioned, mostly with respect to their relevance in distinguishing high engagement from pathological involvement in video games.