Gaming disorder: A summary of its characteristics and aetiology

The emergence, development, and maintenance of gaming disorder (GD) is the result of an interplay between gaming-related factors, individual factors, and environmental factors. None of these alone are sufficient to cause a disordered state, but it is the interactive co-occurrence of all these factors, which in some cases leads to GD. The goal of the present paper is to discuss in detail these three factors based on relevant and recent findings of the literature. Among gaming-related factors, we discuss online vs. offline videogames, the role of game genres, structural characteristics, game design elements, as well as some important monetization techniques. Among individual factors demographic risk factors, personality traits, motivational factors, comorbid psychopathology, genetic predisposition, and neurobiological processes are considered. Finally, among environmental factors we discuss family factors, early life experiences, the role of peers and school-related factors, as well as the broader context of culture including the popularity of esports.

Internet Gaming Disorder: Evidence for a Risk and Resilience Approach

Although previous research has noted a range of factors that predict developing Problematic Video Game Use (PVGU) and Internet Gaming Disorder (IGD), few studies have looked at risk and protective factors together, and there is scant empirical evidence examining whether risk for PVGU or IGD increases or decreases as risk or protective factors accumulate in the individual. The aim of the current study was to examine both issues using predictors from three demonstrated PVGU and IGD risk categories: executive dysfunction, unmet needs in everyday life, and unhelpful family environment. In a survey of N = 866 12–17-year-old school students, the risk/protective factors that most strongly predicted severity of IGD symptomology and meeting IGD diagnostic criteria were self-control and social exclusion. Other significant predictors included impulsivity, self-esteem, mastery, control of one’s external environment, and better parent-child attachment quality. Trend analyses revealed a linear increase in the risk of PVGU as risk and net-risk factors accumulated, and a decrease as protective and net-protective factors accumulated. Thus, a net accumulation of issues around impulse control and unmet needs in everyday life may predispose adolescents to PVGU or IGD. Results support a ‘risk and resilience’ approach to adolescent screen-based disorders and suggest potential benefits to a risk factor focus in treatment.

Associations between gaming disorder, parent-child relationship, parental supervision, and discipline styles: Findings from a school-based survey during the COVID-19 pandemic in Vietnam

BACKGROUND AND AIMS

Vietnam implemented numerous measures to reduce the transmission of COVID-19 among school students, including study-at-home/self-quarantine. During the study-at-home period, adolescents may engage in more video gaming than usual, potentially contributing to gaming disorder. However, the regionally-representative prevalence of gaming disorder and its association with parenting practice and discipline practice have not been described. We assessed the prevalence of gaming disorder among Vietnamese adolescents during the initial 6 months of the COVID-19 pandemic and the associations between gaming disorder and parenting practice and discipline practice.

METHODS

We conducted a school-based, self-administered cross-sectional survey of 2,084 students in Hanoi, Vietnam (response rate = 97.1%). The survey included standardized instruments translated from English to Vietnamese. We performed multilevel logistic regressions to assess the associations between parenting practice, discipline practice, and gaming disorder.

RESULTS

The prevalence of gaming disorder among the respondents was 11.6%. Healthy parent-child relationship was protective against gaming disorder (Adj OR = 0.36; 95% CI = 0.21, 0.62). Non-supervision, non-discipline, violent discipline were positively associated with gaming disorder.

DISCUSSION AND CONCLUSIONS

We found associations between gaming disorder and parent-child relationship, parental supervision, and parental discipline. Future interventional studies should consider assessing the effect of fostering healthy parent-child relationships and appropriate discipline on the occurrence or prognosis of gaming disorders.

“Who Am I” and “How Should I Be”: a Systematic Review on Self-Concept and Avatar Identification in Gaming Disorder

Purpose of Review

Gaming disorder (GD) appears to be associated with self-concept deficits and increased identification with one’s avatar. The goal of this literature review is to highlight study findings assessing psychological and neurobiological correlates of self-concept-related characteristics and avatar identification in GD.

Recent Findings

The review was based on three literature researches on GD: (1) self-esteem, (2) emotional, social, and academic self-concept domains and avatar identification, and (3) neurobiological correlates of self-concept and avatar identification. The results indicate that GD is associated with decreased self-esteem as well as deficits in physical, social, and emotional self-concept domains. A relatively stable relationship between higher avatar identification and GD was reported in addicted gamers. Furthermore, addicted gamers showed increased activation of brain regions associated with Theory-of-Mind processing while contemplating their own avatar.

Summary

The results point towards impairments in self-concept and increased identification with the virtual gaming character in addicted gamers. This virtual compensation fosters the formation of an idealized self-concept, which grows increasingly distant from their own self-image. Thus, additional empirically based psychological interventions should focus on the development of a realistic self-image by reducing the dysfunctional discrepancy between the ideal self and the real self.

School-Related Risk Factors of Internet Use Disorders

A growing body of research focusing on the risk factors of Internet use disorder (IUD) underlines the effect of sociodemographic variables like age and gender or comorbid mental disorders on IUD symptoms. The relation between IUD symptoms and school-related variables has to date been insufficiently studied. The present study closes this gap by investigating the relation between school-relevant factors such as absenteeism, school grades, procrastination, school-related social behavior, and learning behavior and IUD symptoms in a high-risk sample. n = 418 students between 11 and 21 years of age (M = 15.10, SD = 1.97), screened for elevated risk of IUD, participated in the study. Sociodemographic data, school grades and absent days, Internet use variables (time spent online and gaming), as well as school-related psychological variables (procrastination, learning behavior, and social behavior) were assessed via self-report questionnaires. IUD symptoms were assessed with an adapted version of the German Video Game Dependency Scale (CSAS), which is based on the 9 criteria for Internet gaming disorder in the DSM-5. The instrument was adapted to include the assessment of non-gaming IUD symptoms. Taking the hierarchical structure of the data into account, a multilevel modeling approach was used to analyze the data. Procrastination, time spent online, and gaming were significant predictors of IUD symptoms at the individual level, whereas social behavior significantly predicted symptoms of IUD at the school level. In addition to previous findings on risk factors of IUD, this study indicates the importance of school-related factors in the development of IUD, especially psychological factors that play a role in the school setting. The early age of IUD onset and the high relevance of prevention of IUD at the school age underline the relevance of this finding.

Behavioral Addictions: Excessive Gambling, Gaming, Internet, and Smartphone Use Among Children and Adolescents

The introduction of behavioral addictions is a relatively new concept in psychiatry. It was not until 2010 that the term behavioral addictions was added to the official classification of psychiatric diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Gambling, typically thought to be an adult behavior, has become commonplace among adolescents. Although technological advances have made accessing information and communication easier, excessive use of the Internet and smartphones can result in multiple mental and physical health issues. Gambling disorders, gaming disorders, Internet use disorder, and excessive smartphone use often begin during childhood and adolescence.

A Cross-Lagged Study of Developmental Trajectories of Video Game Engagement, Addiction, and Mental Health

Objectives: Video game addiction has been associated with an array of mental health variables. There is a paucity of longitudinal studies investigating such associations, and studies differentiating addicted gaming from problem and engaged (i.e., frequent but non-problem) gaming. The current explorative study investigate the natural course of gaming behavior in three sub-studies. The aim of study 1 was to investigate antecedents and consequences of video game addiction measured as a unidimensional construct (pathological gaming). Aim of study 2 was to investigate the same associations in terms of typologies of gamers (“engaged,” “problem,” “addicted”). Furthermore, study 3 aimed to investigate the estimated stability and transitions occurring between the aforementioned typologies, and a non-pathological gaming group.

Methods: A nationally representative sample of 3,000 adolescents aged 17.5 years was drawn from the population registry of Norway in 2012 and invited to participate in annual surveys spanning 3 years (N^T1 = 2,059, N^T2 = 1,334, N^T3 = 1,277). The respondents completed measures of video game addiction, depression, anxiety, loneliness, aggression, and alcohol use disorder. Statistical analysis comprised cross-lagged path modeling, Satorra-Bentler chi square test (study 1), regression analyses (study 2), hidden Markov model of transition probabilities (study 3).

Results: Findings in study 1 showed that depression and loneliness were reciprocally associated with pathological gaming. Physical aggression was identified as an antecedent, and anxiety was a consequence of pathological gaming. Investigation of the three typologies of gamers (study 2) identified loneliness and physical aggression as antecedents, and depression as a consequence of all typologies. Depression was found to be an antecedent of problem and engaged gamers. Loneliness was found as a consequence of problem gamers, and anxiety was a consequence of addicted gamers. High alcohol consumption was found antecedent to addicted gamers, and low alcohol consumption was found antecedent to problem gamers. The estimated stability of video game addiction was 35%.

Conclusion: A reciprocal relationship between pathological gaming and measures of mental health problems seems to exist. The stability of video game addiction indicates a condition that for a substantial number of people does not resolve spontaneously over the course of 2 years.

Internet gaming disorder in children and adolescents: a systematic review

AIM

Internet gaming disorder (IGD) is a serious disorder leading to and maintaining pertinent personal and social impairment. IGD has to be considered in view of heterogeneous and incomplete concepts. We therefore reviewed the scientific literature on IGD to provide an overview focusing on definitions, symptoms, prevalence, and aetiology.

METHOD

We systematically reviewed the databases ERIC, PsyARTICLES, PsycINFO, PSYNDEX, and PubMed for the period January 1991 to August 2016, and additionally identified secondary references.

RESULTS

The proposed definition in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition provides a good starting point for diagnosing IGD but entails some disadvantages. Developing IGD requires several interacting internal factors such as deficient self, mood and reward regulation, problems of decision-making, and external factors such as deficient family background and social skills. In addition, specific game-related factors may promote IGD. Summarizing aetiological knowledge, we suggest an integrated model of IGD elucidating the interplay of internal and external factors.

INTERPRETATION

So far, the concept of IGD and the pathways leading to it are not entirely clear. In particular, long-term follow-up studies are missing. IGD should be understood as an endangering disorder with a complex psychosocial background.

WHAT THIS PAPER ADDS

In representative samples of children and adolescents, on average, 2% are affected by Internet gaming disorder (IGD). The mean prevalences (overall, clinical samples included) reach 5.5%. Definitions are heterogeneous and the relationship with substance-related addictions is inconsistent. Many aetiological factors are related to the development and maintenance of IGD. This review presents an integrated model of IGD, delineating the interplay of these factors.

When addiction symptoms and life problems diverge: a latent class analysis of problematic gaming in a representative multinational sample of European adolescents

The proposed diagnosis of Internet gaming disorder (IGD) in DSM-5 has been criticized for "borrowing" criteria related to substance addiction, as this might result in misclassifying highly involved gamers as having a disorder. In this paper, we took a person-centered statistical approach to group adolescent gamers by levels of addiction-related symptoms and gaming-related problems, compared these groups to traditional scale scores for IGD, and checked how groups were related to psychosocial well-being using a preregistered analysis plan. We performed latent class analysis and regression with items from IGD and psychosocial well-being scales in a representative sample of 7865 adolescent European gamers. Symptoms and problems matched in only two groups: an IGD class (2.2%) having a high level of symptoms and problems and a Normative class (63.5%) having low levels of symptoms and problems. We also identified two classes comprising 30.9% of our sample that would be misclassified based on their report of gaming-related problems: an Engaged class (7.3%) that seemed to correspond to the engaged gamers described in previous literature, and a Concerned class (23.6%) reporting few symptoms but moderate to high levels of problems. Our findings suggest that a reformulation of IGD is needed. Treating Engaged gamers as having IGD when their poor well-being might not be gaming related may delay appropriate treatment, while Concerned gamers may need help to reduce gaming but would not be identified as such. Additional work to describe the phenomenology of these two groups would help refine diagnosis, prevention and treatment for IGD.

Maladaptive cognitions predict changes in problematic gaming in highly-engaged adults: A 12-month longitudinal study

Understanding the role of maladaptive gaming-related cognitions may assist in screening and interventions for problematic gaming, including Internet gaming disorder (IGD). Cognitive-behavioural interventions that target specific cognitions related to gaming may be more effective than more general approaches that focus only on preoccupation with games. Although past research has identified cross-sectional associations between maladaptive cognitions and problematic gaming, it is less clear whether these cognitions can predict future changes in problematic gaming behaviour. The present study employed an 18-item measure of gaming cognition, assessing perfectionism, cognitive salience, regret, and behavioural salience, to investigate potential changes in problematic gaming over a 12-month period. The sample included 465 Australian adults (84% male, M_age=26.2years). It was found that individuals who became problematic gamers over 12months had higher baseline scores on perfectionism (d=1.20), cognitive salience (d=0.74) and regret (d=0.69) than those who remained non-problematic gamers. Problematic gamers who became non-problematic gamers had lower baseline perfectionism scores (d=0.62) than those who remained problematic gamers. Cognitive change accounted for an additional 28% of variance in problematic gaming scores beyond gender, age, and frequency of gaming. These findings suggest that maladaptive gaming-related cognitions could be screened in clinical trials to aid in case formulation and inform decisions on needed interventions to deliver optimal client outcomes.

Video Gaming in a Hyperconnected World: A Cross-sectional Study of Heavy Gaming, Problematic Gaming Symptoms, and Online Socializing in Adolescents

AIMS

Examining online social interactions along with patterns of video gaming behaviors and game addiction symptoms has the potential to enrich our understanding of disorders related to excessive video game play.

METHODS

We performed latent class analysis in a sample of 9733 adolescents based on heavy use of games, social networking and instant messaging, and game addiction symptoms. We used latent class regression to determine associations between classes, psychosocial well-being and friendship quality.

RESULTS

We identified two types of heavy gaming classes that differed in probability of online social interaction. Classes with more online social interaction reported fewer problematic gaming symptoms than those with less online social interaction. Most adolescents estimated to be in heavy gaming classes had more depressive symptoms than normative classes. Male non-social gamers had more social anxiety. Female social gamers had less social anxiety and loneliness, but lower self-esteem. Friendship quality attenuated depression in some male social gamers, but strengthened associations with loneliness in some male non-social gamers.

CONCLUSIONS

In adolescents, symptoms of video game addiction depend not only on video game play but also on concurrent levels of online communication, and those who are very socially active online report fewer symptoms of game addiction.

Pathological Internet use among adolescents: Comparing gamers and non-gamers

"Internet gaming disorder" was recently included in Section 3 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Non-gaming Internet activities were not considered because of a lack of evidence. This study examined whether gamers differ from non-gamers with respect to their psychological well-being among students who show pathological Internet use (PIU). This cross-sectional study was conducted within the project "Working in Europe to Stop Truancy Among Youth (WE-STAY)". A total of 8807 European representative students from randomly selected schools were included. The Young Diagnostic Questionnaire was applied to assess PIU, and students with this condition were divided into gamers (PIU-G) and non-gamers (PIU-NG). Overall, 3.62% and 3.11% of the students were classified as having PIU-G and PIU-NG, respectively. A multinomial logistic regression revealed that students with PIU-G and those with PIU-NG showed similarly increased risks for emotional symptoms, conduct disorder, hyperactivity/inattention, self-injurious behaviors, and suicidal ideation and behaviors. Students with PIU-G were more likely to be male and have a higher risk for peer problems than those with PIU-NG. Students with PIU-NG had a higher risk of depression than those with PIU-G. The significant psychological impairment of PIU-NG suggests that it should be considered in future diagnostic criteria.

[Video game and internet addiction. The current state of research]

The use of interactive screen media is widespread and for some users leads to pathological symptoms that are phenomenologically similar to signs of addictive disorders. Addictive use of computer games and other Internet applications, such as social media can be distinguished. In the past standard criteria to classify this new disorder were lacking. In DSM-5, nine criteria are proposed for diagnosing Internet gaming disorder. The focus is currently on video games as most studies have been done in this field. Prevalence estimations are difficult to interpret due to the lack of standard diagnostic measures and result in a range of the frequency of Internet addiction between 1 % and 4.2 % in the general German population. Rates are higher in younger individuals. For computer game addiction prevalence rates between 0.9 % and 1.7  % can be found in adolescents. Despite substantial comorbidity among those affected current research points to addictive media use as a stand-alone disorder.

Position zu Problemdimensionen und Präventionsstrategien der Bildschirmnutzung

Zielsetzung: Dieses Positionspapier identifiziert, vergleicht und bewertet drei unterschiedliche Strategien zur Medienprävention für Kinder und Jugendliche im Hinblick auf ihr Potenzial zur Vorbeugung suchtartiger, aber auch bereits lediglich problematischer Bildschirmmediennutzung in drei, hier erstmals in dieser Form voneinander abgegrenzten Dimensionen (zeitlich, inhaltlich, funktional). Screen Time Reduction: Für die zeitliche und inhaltliche Problemdimension erscheint Bildschirmzeitenreduktion erfolgversprechend, dabei besonders die Stärkung elterlicher Medienerziehungskompetenzen zur Begrenzung von Geräteausstattung, Zeiten und Inhalten. Die Wirksamkeit solcher Interventionen wurde im Kontrollgruppendesign überprüft und kann als belegt gelten. Ressourcenorientierte Suchtprävention: Für jüngere Kinder erscheinen zur Medienprävention bzgl. aller drei Problemdimensionen Ansätze der klassischen ressourcenorientierten Suchtprävention, wie z. B. Life Skills Training, zielführend, welche für den Bereich Medien angepasst werden (Fokus auf bildschirmfreien Freizeitalternativen und unmittelbaren Sozialinteraktionen). Medienkompetenzförderung: Bei älteren Kindern könnten flankierend Medienkompetenzförderungsstrategien jenseits der rein technischen Anwendungsfertigkeiten eingesetzt werden, die jedoch vorwiegend für die Vermeidung inhaltlich problematischer Nutzung geeignet erscheinen.

Low 2D:4D values are associated with video game addiction

Androgen-dependent signaling regulates the growth of the fingers on the human hand during embryogenesis. A higher androgen load results in lower 2D:4D (second digit to fourth digit) ratio values. Prenatal androgen exposure also impacts brain development. 2D:4D values are usually lower in males and are viewed as a proxy of male brain organization. Here, we quantified video gaming behavior in young males. We found lower mean 2D:4D values in subjects who were classified according to the CSAS-II as having at-risk/addicted behavior (n = 27) compared with individuals with unproblematic video gaming behavior (n = 27). Thus, prenatal androgen exposure and a hyper-male brain organization, as represented by low 2D:4D values, are associated with problematic video gaming behavior. These results may be used to improve the diagnosis, prediction, and prevention of video game addiction.