Evaluation of the diagnostic criteria of Internet gaming disorder in the DSM-5 among young adults in Taiwan

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.

A Typical Case Report: Internet Gaming Disorder Psychotherapy Treatment in Private Practice

Background: Online or internet gaming disorder (IGD) is currently not recognized as a mental disorder in the actual Diagnostic and Statistical Manual of Mental Disorders (DSM-5), although it is an emerging disease. Non-substance-related addictions often have similarities with substance addictions. It is therefore important to have a good understanding of the client but also to have a good endurance. Due to the rise of e-sports, there is an anticipated and therefore possible trend to have many more patients with a non-substance addiction. There are many parallels, for instance tolerance, withdrawal and social problems, resulting from an increasing investment of time spent on the internet. Case presentation: To reduce possible inhibition in treating a patient with IGD, we present a case of a 19-year-old adolescent man who exhibited IGD and showed social problems associated with his addiction. Conclusions: This paper shows the importance and the effects of treating a non-substance addiction with cognitive behavioral therapy (CBT). After having successfully coped with an addiction, several shifts in addiction were often reported. In this case, no shifts were reported. The absence of such shifts makes our case a distinct and unique case. This is not a multimorbidity case, and that is the reason why we think this is an excellent example to show what we achieved, how we achieved it, and what we could establish. Of course, additional research and manuals are urgently needed.

Coping, Resilience, and Perceived Stress in Individuals with Internet Gaming Disorder in Taiwan

Aim: Gaming escapism is an essential factor for developing internet gaming disorder (IGD). We evaluated coping strategies, resilience, stress, and depression in individuals with IGD. Methods: We included 69 participants with IGD and 138 controls (69 regular gamers and other non-gamers) in Taiwan. The self-reported coping strategies, coping stress with gaming, resilience, perceived stress, and depression were assessed. Results: Participants with IGD had higher dysfunctional coping, coping stress by gaming, perceived stress, and depression, as well as lower problem-focused coping and resilience. Regression analysis revealed that coping by gaming was associated with dysfunctional coping mechanisms, particularly venting and self-distraction. Compared with participants with adequate resilience, those with lower resilience had higher perceived stress, depression, and coping by gaming, and lower problem-focused and emotion-focused coping. Dysfunctional coping and coping by gaming were associated with perceived stress and depression in both IGD and control groups. Problem-focused coping was negatively associated with perceived stress and depression in controls. Conclusion: Individuals with IGD had higher perceived stress and depression, as they were more likely to cope with stress by dysfunctional coping and gaming and less likely to try problem-focused coping, particularly those with lower resilience. Interventions for IGD should promote problem-focused coping, such as active coping and planning strategies, particularly among those with lower resilience.

Enhanced neural responses in specific phases of reward processing in individuals with Internet gaming disorder

BACKGROUND AND AIMS

Internet gaming disorder (IGD) has become a global health problem. The self-regulation model noted that a shift to reward system, whether due to overwhelming reward-seeking or impaired control, can lead to self-regulation failures, e.g., addiction. The present study focused on the reward processing of IGD, aiming to provide insights into the etiology of IGD. Reward processing includes three phases: reward anticipation, outcome monitoring and choice evaluation. However, it is not clear which phases of reward processing are different between individuals with IGD and healthy controls (HC).

METHODS

To address this issue, the present study asked 27 individuals with IGD and 26 HC to complete a roulette task during a functional MRI scan.

RESULTS

Compared with HC, individuals with IGD preferred to take risks in pursuit of high rewards behaviorally and showed exaggerated brain activity in the striatum (nucleus accumbens and caudate) during the reward anticipation and outcome monitoring but not during the choice evaluation.

DISCUSSION

These results reveal that the oversensitivity of the reward system to potential and positive rewards in college students with IGD drives them to approach risky options more frequently although they are able to assess the risk values of options and the correctness of decisions properly as HC do.

CONCLUSIONS

These findings provide partial support for the application of the self-regulation model to the IGD population. Moreover, this study enriches this model from the perspective of three phases of reward processing and provides specific targets for future research regarding effective treatment of IGD.

Validation study of the Indonesian internet addiction test among adolescents

BACKGROUND

Internet addiction is a serious problem that can negatively impact both the physical and mental health of individuals. The Internet Addiction Test (IAT) is the most common used instrument to screen internet addiction worldwide. This study sought to investigate the psychometric properties of an Indonesian version of the IAT.

METHODS

The IAT questionnaire was made the focus of forward translation, expert panel discussions, back translation, an item analysis (30 subjects), a pilot study (385 subjects), and field testing (643 subjects). Factor structure was analysed by exploratory (EFA) and confirmatory factor (CFA) analyses, whereas reliability was measured with Cronbach's alpha coefficient.

RESULTS

Factor analysis revealed that the Indonesian version of IAT, consisted of 3 domains, and had good validity (χ2 p < 0.001; RMSEA = 0.076; CFI = 0.95; SRMR = 0.057, and AIC = 784.63). The Cronbach's alpha score is 0.855. A significant association was also observed between the level of internet addiction with gender (p = 0.027) and the duration of internet use per day (p = 0.001).

CONCLUSION

The Indonesian version of IAT provides good validity and reliability in a three-dimensional model. Therefore, it can be utilised as a tool for screening internet addiction in the Indonesian population.

Proposing and Validating the Diagnosis Scale for Internet Gaming Disorder in Taiwanese ADHD Adolescents: Likert Scale Method Based on the DSM-5

The paper aims to adjust the Taiwanese version of Internet gaming disorder-short form Likert scale with Likert (IGD-SF-T-L) based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria to a Likert scale model and test its psychometric property among children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD). Confirmatory factor analysis (CFA) was conducted for validity and the Cronbach’s α for reliability of IGD-SF-T-L. The ROC (receiver operating curves) was used to propose the cut-off point for assessing the instrument’s psychometric properties and its corresponding indices for the diagnostic accuracy. In total, 102 children and adolescents with ADHD were recruited. The construct validity of IGD-SF-T by CFA was model well fitted with excellent reliability (Cronbach’s α = 0.918). The ROC using the Chen’s CIAS > 56 as the state variable for IGD diagnosis showed the AUC (areas under the curves) was 0.918. The cut-off point proposed for IGD-SF-T-L to indicate a diagnosis of IGD was ≥ 10. The corresponding indices of accuracy: sensitivity, specificity, LR (likelihood ratio) +, LR-, and AUC were 0.893, 0.826, 5.134, 0.130, and 0.859, respectively. The proposed IGD-SF-T-L is an adequate, standardized psychometrical measurement for diagnosing IGD among Taiwanese adolescents with ADHD. More attention should be paid toward recent ADHD youth with Internet gaming disorder and their family.

The imbalance between goal-directed and habitual systems in internet gaming disorder: Results from the disturbed thalamocortical communications

BACKGROUND

Converging evidence has identified the imbalance between goal-directed systems and habitual systems in the addiction process. The thalamocortical loop plays an important role in the habitual/goal-directed system. However, little is known about the role of the thalamus in goal-directed and habitual systems in Internet gaming disorder (IGD) patients. This study investigated whether thalamocortical circuit was disrupted and how they affected goal-directed and habitual behaviors in IGD patients.

METHODS

This is a functional magnetic resonance imaging (fMRI) study. Twenty-five IGD patients and 25 matched recreational game users (RGUs) were scanned when they were in a resting state and were performing an instrumental learning task to obtain behavioral data related to habitual/goal-directed behavior. We used the whole-brain seed-based functional connectivity (FC) of the four thalamic nuclei (bilateral) and correlation analyses to examine the thalamocortical loop difference and relationship with habitual/goal-directed performance.

RESULTS

Compared with RGUs, IGD patients demonstrated significantly increased FC between the left midline nucleus (MN) and the right postcentral gyrus (PCG), and between the pulvinar and medial frontal gyrus (MFG). Correlation results showed that within the IGD group, the correct response rates of the participants to inconsistent stimulus-result pairs were positively correlated with the FC between the pulvinar and MFG. Inhibition-control scores were negatively correlated with the FC between the left MN and the PCG.

CONCLUSIONS

IGD patients showed disrupted thalamocortical communication that could further result in an imbalance between the goal-directed and habitual systems in IGD patients. These findings provide more information about the involvement of the thalamus in the pathophysiology of IGD, and as potential circuit-level biomarkers of IGD patients, these circuit alterations may be useful in treatment development and in monitoring treatment outcomes.

Avatar identification and problematic gaming: The role of self-concept clarity

Some video-gaming activities feature customizable avatars that enable users to fulfil self-identity needs. Research evidence (e.g., fMRI and survey studies) has suggested that poorer self-concept and stronger avatar identification are associated with problematic gaming. Player-avatar relationships have thus been proposed to require attention in gaming disorder assessment and interventions. To examine the interplay of player-avatar interactions in problematic gaming, this study investigated whether avatar identification differed according to avatar characteristics and game types, and whether the association between avatar identification and problem gaming was mediated by self-concept clarity. A total of 993 adult respondents completed an online survey that assessed problematic gaming, avatar identification, and self-concept clarity. The results indicated that avatar identification scores were generally unrelated to avatar characteristics (e.g., human resemblance, degree of customizability, and in-game perspective). Avatar identification was significantly positively related to problematic gaming and significantly negatively related to self-concept clarity. There was a significant indirect relationship between avatar identification on problem gaming mediated through self-concept clarity. These findings suggest that poorer self-concept clarity may be one mechanism by which avatar identification affects problem gaming. Future research with clinical samples may help to gain a better understanding of avatar-related processes and psychological vulnerabilities related to problematic gaming.

Problematic Use of the Internet in Subjects With Bipolar Disorder: Relationship With Posttraumatic Stress Symptoms

Background: Literature shows a high risk for problematic use of the Internet (PUI) in mood disorders, especially in bipolar disorder (BD). In subjects with BD, traumatic events and posttraumatic stress disorder (PTSD) are related to alcohol or substance use disorder, as well as to gambling disorder. However, little is known about the possible association between traumatic exposure and PUI. The present study was aimed at examining the relationship between PUI and trauma exposure, besides PTSD symptoms, in subjects with BD. Methods: A sample of 113 subjects with BD was screened to putative PUI. Furthermore, they completed the Trauma and Loss Spectrum Self-Report (TALS-SR) to assess traumatic events and posttraumatic stress symptoms. Results: Twenty-four subjects (21.2%) reported putative PUI. Subjects with putative PUI presented significantly higher scores in the TALS-SR domains Potentially Traumatic Events, Re-experiencing, Maladaptive coping, and Arousal, as well as in the TALS-SR total score. In a logistic regression model, a positive association emerged between Potentially Traumatic Events and Arousal TALS-SR domains and putative PUI. Conclusion: One in five patients with BD screened positive for PUI. A significant association between PUI and lifetime traumatic events as well as PTSD symptoms emerged, highlighting the relevance of the comorbidity between PTSD and PUI in subjects with BD.

Gaming and Social Media Addiction in University Students: Sex Differences, Suitability of Symptoms, and Association With Psychosocial Difficulties

Background: Previous research has shown that addictions to digital media can have negative impact on psychosocial health. Although Internet Gaming Disorder (IGD) has received most scholarly recognition, the potential negative consequences of Social Media Disorder (SMD) have also been found. However, few studies have assessed the symptoms of these two digital media addictions in the same way, making comparisons difficult. The present study aims to fill this gap by investigating differences and similarities regarding how common the symptoms are, sex differences, the suitability of the symptoms, and their association with psychosocial difficulties. Method: A total of 688 university students (63.2% women, Mean age = 25.98) completed a questionnaire measuring symptoms of IGD and SMD, as well as psychosocial difficulties (i.e., psychosomatic symptoms, low self-concept, and social problems). Results: Results showed that 1.2% of the men and 0.9% of the women met the symptom criteria for IGD (non-significant difference), whereas 3.2% men and 2.8% women met the symptom criteria for SMD (non-significant difference). Dimensional analyses indicated that men had higher IGD scores compared to women, whereas the opposite was found for SMD. Symptoms of heavy involvement in digital media (i.e., Preoccupation, Tolerance, Withdrawal, Unsuccessful attempts to control, and Escape) had high sensitivity, but low positive predictive value (PPV). However, symptoms associated with negative consequences of digital media use (i.e., Loss of interest, Continued excessive use, Deception, and Jeopardizing career/relationships) had low sensitivity, but high PPV. These symptom patterns were similar for IGD and SMD. Meeting the criteria for IGD or SMD as well as being at risk of these disorders were significantly associated with psychosocial difficulties. Symptoms of SMD generally had stronger associations with psychosomatic symptoms compared to symptoms of IGD. Conclusions: We conclude that heavy involvement in digital media seems common among individuals with IGD or SMD, but also among those not meeting the symptom criteria, whereas negative consequences are less common but highly predictive of digital media addictions once present. Further attention to SMD is warranted, as it seems more common than IGD and also seems to be equally or more strongly associated with psychosocial difficulties.

Diagnostic Contribution of the DSM-5 Criteria for Internet Gaming Disorder

Background: Internet gaming disorder (IGD) can have long-term severe consequences in affected individuals, especially adolescents and young people. Empirical studies of IGD using the DSM-5 criteria are still lacking. This study aimed to evaluate the contribution of specific criteria to the diagnosis of IGD based on the DSM-5 in the context of Chinese culture. Methods: The Chinese version of the Internet Gaming Disorder Scale-Short Form (IGDS9-SF) was applied to investigate the prevalence of IGD in a general sample of 28,689 middle school students aged 12-19 years from two cities in China. Results: The prevalence of IGD was 4.6% among this adolescent sample. The group of IGD students reported longer weekly gaming times and worse academic performance than the group of non-IGD students. Although "preoccupation" and "playing to escape" were the most frequently reported criteria, the conditional inference trees showed that "give up other activities," 'negative consequences," and "continue despite problems" contributed most to the diagnosis of IGD based on the DSM-5. Conclusions: The prevalence of IGD among Chinese adolescents (ages 12-19) was 4.6%. This study provides evidence for retaining or deleting specific diagnostic criteria by the DSM framework in the future.

Structural and Functional Brain Abnormalities in Internet Gaming Disorder and Attention-Deficit/Hyperactivity Disorder: A Comparative Meta-Analysis

Background: Patients with Internet gaming disorder (IGD) and attention-deficit/hyperactivity disorder (ADHD) have high comorbidity but it is still unknown whether these disorders have shared and distinctive neuroimage alterations. Objective: The aim of this meta-analysis was to identify shared and disorder-specific structural, functional, and multimodal abnormalities between IGD and ADHD. Methods: A systematic literature search was conducted for whole-brain voxel-based morphometry (VBM) and functional magnetic resonance imaging (fMRI) studies comparing people with IGD or ADHD with healthy controls. Regional gray matter volume (GMV) and fMRI differences were compared over the patient groups and then a quantitative comparison was performed to find abnormalities (relative to controls) between IGD and ADHD using seed-based d mapping meta-analytic methods. Result: The meta-analysis contained 14 IGD VBM studies (contrasts covering 333 IGDs and 335 HCs), 26 ADHD VBM studies (1,051 patients with ADHD and 887 controls), 30 IGD fMRI studies (603 patients with IGD and 564 controls), and 29 ADHD fMRI studies (878 patients with ADHD and 803 controls). Structurally, VBM analysis showed disorder-specific GMV abnormality in the putamen among IGD subjects and orbitofrontal cortex in ADHD and shared GMV in the prefrontal cortex. Functionally, fMRI analysis discovered that IGD-differentiating increased activation in the precuneus and shared abnormal activation in anterior cingulate cortex, insular, and striatum. Conclusion: IGD and ADHD have shared and special structural and functional alterations. IGD has disorder-differentiating structural alterations in the putamen and ADHD has alterations in the orbitofrontal cortex. Disorder-differentiating fMRI activations were predominantly observed in the precuneus among IGD subjects and shared impairing function connection was in the rewards circuit (including ACC, OFC, and striatum).

Why is Internet gaming disorder more prevalent among Chinese male than female adolescents? The role of cognitive mediators

BACKGROUND

Adolescent males were consistently reported to have a higher prevalence of Internet gaming disorder (IGD) than females. The mechanisms underlying the sex difference were potentially important for designing sex-specific interventions but were under-researched. Maladaptive cognitions were potential mediators between sex and adolescent IGD, as they were positively associated with both sex and adolescent IGD.

METHODS

A total of 3,075 students participated in a cross-sectional survey that was conducted in Guangzhou and Chengdu, China. IGD was measured by using the DSM-5 checklist and maladaptive cognitions were measured by the validated Chinese version of Revised Internet Gaming Cognition Scale (C-RIGCS). Structural equation modeling was used to test the mediation hypotheses.

RESULTS

Adolescent males showed a significantly higher prevalence of IGD than females (19.2% versus 7.8%, p < .05). Significant positive associations were found between sex and both maladaptive cognitions and IGD. The sex difference in IGD prevalence was partially mediated by the overall scale of C-RIGCS and its three subscales (i.e., perceived overvaluation of rewards of Internet gaming, perceived urges for playing Internet games, and perceived unwillingness to stop playing without completion of gaming tasks), with large mediation effect sizes ranging from 35.0% to 60.0% (Sobel test, p < ,01).

CONCLUSIONS

The higher levels of maladaptive cognitions among adolescent males explained a relatively large part of the substantially higher prevalence of IGD among adolescent males than females. Interventions targeting adolescent males may consider modifying such cognitions to reduce their IGD.

Relationship of Internet Gaming Disorder with Psychopathology and Social Adaptation in Italian Young Adults

Internet addiction is currently considered a worldwide problem, with a possible impact on mental health. This study aimed to investigate the prevalence of internet gaming disorder (IGD) among Italian young adults and to explore its association with psychopathological symptoms. Our sample included 566 young adults (324 males/242 females; age: 22.74 ± 4.83 years). Participants were asked to state their favorite games and complete the following questionnaires: the Internet Gaming Disorder Scale Short Form (IGD9-SF); the APA symptom checklist, based on DSM-5 diagnostic criteria for IGD; the Symptom Checklist-90 Revised (SCL-90 R); and the Social Adaptation Self Evaluation Scale (SASS). Use of video games was common among study participants (95% of the sample). Thirty subjects (5.3% of the sample) matched criteria for a clinical diagnosis of IGD. Data showed a positive correlation between higher use of online games and higher levels of depression (r = 0.501), anxiety (r = 0.361) and psychoticism (r = 0.431), and lower family and extra-family relationships (r = −0.383). At linear regression analysis, somatization (p = 0.002), depression (p = 0.001) and sleep disturbances (p = 0.003) were predictors of IGD diagnosis. IGD was significantly associated to mental health distress. Healthcare professionals should be aware of the problematic consequences of online gaming.

Utility of DSM-5 Criteria for Internet Gaming Disorder

The American Psychiatric Association (APA) has called for further research on Internet Gaming Disorder (IGD) by placing it in Section III of the Diagnostic and Statistical Manual (DSM-5). Research on prevalence, risk factors, and development of criteria for a diagnosis of IGD is mixed in the literature. This study sought to contribute to these topics by examining a diverse sample of Internet gamers (N = 1,881) from around the world. Results showed a prevalence rate of 4.2%, with varying prevalence rates based on demographic characteristics. Significant risk factors for IGD included gender and hours spent gaming. Finally, frequency counts of IGD criteria showed significant differences between participants meeting IGD criteria and those not meeting criteria, as well as significant differences by gender and age. Low frequency counts and significant differences based on demographics point to criteria that may be less appropriate for a diagnosis, as well as considerations for diagnosing diverse populations. Limitations and future research are discussed.

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.

The psychometric properties of the Revised Illness Perception Questionnaire (IPQ-R) regarding Internet gaming disorder in a general population of Chinese adults

BACKGROUND AND AIMS

Internet gaming disorder (IGD) has been recognized as a mental illness. Cognitive and emotional illness representations affect coping and health outcomes. Very little is known about such perceptions related to IGD, in both general and diseased populations. This study examined the psychometric properties of the Revised Illness Perception Questionnaire (IPQ-R) for IGD in a general population that included mostly non-cases while a small proportion of the sample was IGD cases.

METHODS

An anonymous cross-sectional telephone survey was conducted in a random sample of 1,501 Chinese community-dwelling adults (41.3% male; mean age = 40.42, SD = 16.85) in Macao, China.

RESULTS

The confirmatory factor analysis identified a modified 6-factor model (i.e., timeline cyclical, consequences, personal control, treatment control, illness coherence, and emotional representations) of 26 items that showed satisfactory model fit and internal consistency. Criterion-related validity was supported by the constructs' significant correlations with stigma (positive correlations: timeline cyclical, consequence, emotional representations; negative correlations: illness coherence). Ever-gamers, compared to never-gamers, reported higher mean scores in the subscales of personal control and illness coherence, and lower mean scores in time cyclical, consequence, and emotional representations. Among the sampled gamers, probable IGD cases were more likely than non-IGD cases to perceive IGD as cyclical and involved more negative emotions.

CONCLUSIONS

This study shows that the revised 26-item version of IPQ-R is a valid instrument for assessing illness representation regarding IGD in a general population of Chinese adults. It can be used in future research that examines factors of incidence and prevention related to IGD.

Self-Efficacy and Clinical Characteristics in Casual Gamers Compared to Excessive Gaming Users and Non-Gamers in Young Adults

This study investigated differences in the self-efficacy and clinical characteristics which were found relevant to addictive behaviors in young adults according to time spent gaming. To our knowledge, this is the first study to explore self-efficacy in casual gamers relative to patients with internet gaming disorder (IGD) and non-gamers. In total, 158 young adults participated in this study and were divided into three groups: excessive gamers, who were diagnosed with IGD based on the Diagnostic and Statistical Manual of Mental Disorder-fifth edition (DSM-5, n = 71); casual gamers, who played games regularly but did not meet the criteria for IGD (n = 37); and non-gamers/controls, who did not engage in gaming (n = 50). All participants completed self-administered questionnaires, including measures of self-efficacy and clinical features such as the Barratt Impulsiveness Scale, Beck Depression Inventory, Beck Anxiety Inventory, Behavioral Activation/Inhibition Systems, aggression, and psychosocial well-being. There were significant differences in the self-efficacy according to the extent of gaming (excessive gamers < casual gamers < non-gamers). In addition, aggression, impulsivity, depression, anxiety, level of stress, and behavioral inhibition system scores were significantly higher in excessive gamers than in casual gamers and non-gamers. These findings showed that individuals who spend more time playing games tend to have lower self-efficacy. Our study suggests that self-efficacy may protect against or constitute a risk of excessive gaming, particularly among casual gamers. It is necessary to pay attention to enhancing psychological well-being through self-efficacy to prevent addiction in young adult gamers.

Diagnostic Usefulness of an Ultra-Brief Screener to Identify Risk of Online Gaming Disorder for Children and Adolescents

OBJECTIVE

This study examined the diagnostic validity of a three-item ultra-brief screening tool for online gaming disorder in line with the gaming disorder criteria in the International Classification of Diseases 11th Revision.

METHODS

The Three-item Gaming disorder Test-Online-Centered (TIGTOC) was composed of three items using a four-point Likert scale selected from the Internet Game Use-Elicited Symptom Screen (IGUESS). Among a cohort of 2319 young-adolescent Internet users, the baseline data of 228 healthy controls and 45 Internet-gaming-disorder cases were analyzed. Receiver operation characteristic (ROC) analysis was performed using mental health specialists' diagnoses as the gold standard.

RESULTS

The ROC curve analysis showed an area under the curve of 86%. Using a cut-off score of 4 from a full range of 0-9, the sensitivity, specificity, and Cronbach's α were 72%, 90%, and 0.811, respectively. TIGTOC scores was positively associated with time spent on online gaming, depressive symptoms, attention-deficit/hyperactivity disorder symptoms, and addictive Internet use.

CONCLUSION

The TIGTOC appears to be a brief, valid, and reliable screening tool for online gaming disorder within the community or in primary care settings.

[Media-associated disorders in childhood and adolescence: Evidence paper of the joint addiction commision of the German societies and professional associations of child and adolescent psychiatry and psychotherapy]

Media-associated disorders in childhood and adolescence: Evidence paper of the joint addiction commision of the German societies and professional associations of child and adolescent psychiatry and psychotherapy Abstract. Media-associated disorders (MAD) describe the problematic use of the internet, certain electronic devices in general as well as digital applications. During childhood and adolescence, digital games and social media are the most commonly used applications. In May 2019, as first MAD "gaming disorder" was included as a clinical diagnosis in the ICD-11. The prevalence of MAD in German children and adolescents is estimated to lie between 3 % and 5 %. In most cases, MAD are accompanied by psychiatric comorbidities. MAD ensue because of dysfunctional learning processes in combination with general and specific risk factors. They are associated with neural changes like those of substance-associated addictions. Diagnostics can be based on validated questionnaires and clinical exploration, though a standardized diagnostic path is not yet common. Treatment depends on the level of severity and generally comprises outpatient, day-clinic, and inpatient therapy approaches with elements from cognitive-behavioral therapy and under parental involvement. Suitable treatments are not yet available in all German regions and have also not been sufficiently evaluated. Moreover, only a few studies exist on the efficacy of prevention measures addressing MAD in children and adolescents. Thus, further research is strongly required.

The psychometric properties of the Chinese version internet gaming disorder scale

INTRODUCTION

The study tested the psychometric properties of two Chinese version Internet Gaming Disorder scales (IGDSs): a dichotomous IGDS with yes/no type of response and a polytomous IGDS with a 0-5 Likert-type response.

METHODS

The reliability and validity of two scales were tested separately, among two population-based samples of Chinese adolescents and adults (351 for dichotomous IGDS and 378 for polytomous IGDS). The diagnostic accuracy of the dichotomous IGDS was assessed in an independent sample of 114 gamers (56 disordered gamers and 58 average gamers) using Receiver Operating Characteristic (ROC) analysis.

RESULTS

The results demonstrated good internal consistency (α_dichotomous = 0.80 and α_polytomous = 0.89) and test-retest reliability (r_dichotomous = 0.83 and r_polytomous = 0.84) for both scales. Both scales showed sound validity, as indicated by significant correlations with measurements of internet addiction, aggression, impulsivity, craving for gaming and time spent playing games. Factor analysis demonstrated that both Chinese IGDSs have a similar single-component structure to the original scales. The ROC analysis indicated an excellent diagnostic accuracy of the dichotomous IGDS. When apply the five or more cutoff points, the prevalence of IGD was 7.41% in the population-based sample.

CONCLUSION

This study demonstrated robust psychometric properties of the Chinese version dichotomous IGDS and polytomous IGDS, and suggests that these scales are valid tools that suitable for clinical and research purposes.

Validity, functional impairment and complications related to Internet gaming disorder in the DSM-5 and gaming disorder in the ICD-11

BACKGROUND

Many concerns have been raised regarding the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria for Internet gaming disorder and International Classification of Diseases, 11th Revision (ICD-11) criteria for gaming disorder.

AIMS

In this study, we demonstrated the diagnostic validity of each criterion for Internet gaming disorder in the DSM-5 in terms of their intensity and frequency thresholds and evaluated functional impairments, unhealthy behaviors and complications among adults with Internet gaming disorder and gaming disorder.

METHODS

We recruited 69 subjects with Internet gaming disorder, 69 regular gamers and 69 controls without regular gaming based on diagnostic interviewing conducted by a psychiatrist according to the DSM-5 Internet gaming disorder criteria.

RESULTS

Except for the 'deceiving' and 'escapism' criteria, all criteria for Internet gaming disorder had a diagnostic accuracy ranging from 84.7% to 93.5% in differentiating between adults with Internet gaming disorder and regular gamers. A total of 44 participants with Internet gaming disorder (63.8%) fulfilled the gaming disorder criteria. In addition, 89% and 100% of the Internet gaming disorder and gaming disorder groups, respectively, had academic, occupational or social functional impairment. Both the Internet gaming disorder and gaming disorder groups had higher rates of delayed sleep phase syndrome and insomnia. The gaming disorder group also had a higher obesity proportion.

CONCLUSION

The 'deceiving' and 'escapism' criteria had relatively lower diagnostic accuracy. Both the Internet gaming disorder and gaming disorder groups demonstrated functional impairments and unhealthy behaviors. They also exhibited complications, such as obesity and sleep disorders. These results support the utility of the DSM-5 Internet gaming disorder and ICD-11 gaming disorder criteria in identifying individuals who need treatment for both gaming addiction symptoms and complications resulting from the addiction.

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.

Symptoms of Internet Gaming Disorder in Youth: Predictors and Comorbidity

Internet gaming disorder (IGD) was included in the Addendum to DSM-5 as a condition for further study. Studies of community samples using a diagnostic interview are lacking, and evaluations of the proposed symptoms, comorbidities, and predictors of IGD are scarce. To provide such information participants in a Norwegian prospective community study were assessed with a clinical interview at age 10 years. Symptoms of other psychiatric disorders were measured with the Child and Adolescent Psychiatric Assessment at ages 8 and 10 (n = 740). Children, parents, and teachers provided information on demographics, temperament, intelligence, executive functions, self-concept, social skills, victimization, emotion regulation, family climate, and parenting. Results indicated that IGD was present in 1.7% (95% confidence interval, 0.7–2.7) of the participants (3.0% boys and 0.5% girls). Factor analysis revealed two factors: heavy involvement and negative consequences. The positive predictive value of withdrawal, tolerance, and unsuccessful attempts to control gaming symptoms to the disorder was low. Symptoms of other common disorders correlated weakly with IGD-symptoms (i.e., from r = 0.07 to r = 0.15). Upon adjusting for gender and gaming at age 8, only limited social and emotion regulation skills at age 8 predicted more age-10 IGD symptoms. In conclusion, IGD is already present in a small percentage of Norwegian 10-year olds. At least three of the proposed symptoms -- withdrawal, tolerance and unsuccessful attempts to control gaming -- merit further study given their weak associations with the disorder. Symptoms of IGD are only marginally associated with symptoms of other psychiatric disorders and only predicted by social skills and emotion regulation deficits.

The adaptive decision-making, risky decision, and decision-making style of Internet gaming disorder

Background:

Persistent gaming, despite acknowledgment of its negative consequences, is a major criterion for individuals with Internet gaming disorder (IGD). This study evaluated the adaptive decision-making, risky decision, and decision-making style of individuals with IGD.

Methods:

We recruited 87 individuals with IGD and 87 without IGD (matched controls). All participants underwent an interview based on the Diagnostic and Statistical Manual of Mental Disorders (5th Edition) diagnostic criteria for IGD and completed an adaptive decision-making task; the Preference for Intuition and Deliberation Scale, Chen Internet Addiction Scale, and Barratt Impulsivity Scale were also assessed on the basis of the information from the diagnostic interviews.

Results:

The results demonstrated that the participants in both groups tend to make more risky choices in advantage trials where their expected value (EV) was more favorable than those of the riskless choice. The tendency to make a risky choice in advantage trials was stronger among IGD group than that among controls. Participants of both groups made more risky choices in the loss domain, a risky option to loss more versus sure loss option, than they did in the gain domain, a risky option to gain more versus sure gain. Furthermore, the participants with IGD made more risky choices in the gain domain than did the controls. Participants with IGD showed higher and lower preferences for intuitive and deliberative decision-making styles, respectively, than controls and their preferences for intuition and deliberation were positively and negatively associated with IGD severity, respectively.

Conclusions:

These results suggested that individuals with IGD have elevated EV sensitivity for decision-making. However, they demonstrated risky preferences in the gain domain and preferred an intuitive rather than deliberative decision-making style. This might explain why they continue Internet gaming despite negative consequences. Thus, therapists should focus more on decision-making styles and promote deliberative thinking processes to mitigate the long-term negative consequences of IGD.

A preliminary study of disrupted functional network in individuals with Internet gaming disorder: Evidence from the comparison with recreational game users

Although online gaming may lead to Internet gaming disorder (IGD), most players are recreational game users (RGU) who do not develop IGD. So far, the topological organization of whole-brain functional networks in IGD remains poorly understood. The inclusion of RGU as a control group could minimize the potential effects of gaming experience and gaming-related cue familiarity on the neural characteristics of IGD subjects. In the present study, we applied graph theoretical analysis to preliminarily explore the topological organization of intrinsic functional brain networks in IGD. 61 IGD participants and 61 matched RGU participants were recruited to undergo a resting-state functional magnetic resonance imaging scan. The whole-brain functional networks were constructed by thresholding partial correlation matrices of 90 brain regions, and graph-based approaches were applied to analysis their topological attributes, including small-world, efficiency, and nodal centralities. Both of IGD and RGU groups showed efficient and economic small-world topology in brain functional networks. Although there was no significant group difference in global properties, subjects with IGD as compared to those with RGU showed increased nodal centralities in the reward, craving, emotional memory and sensory-motor processing regions. These results suggest that the functional network dysfunction, characterizing by heightened incentive motivation and sensory-motor coordination, may provide a new perspective for understanding the neural characteristics underlying IGD.

Is monetary reward processing altered in drug-naïve youth with a behavioral addiction? Findings from internet gaming disorder

Current models of addiction biology highlight altered neural responses to non-drug rewards as a central feature of addiction. However, given that drugs of abuse can directly impact reward-related dopamine circuitry, it is difficult to determine the extent to which reward processing alterations are a trait feature of individuals with addictions, or primarily a consequence of exogenous drug exposure. Examining individuals with behavioral addictions is one promising approach for disentangling neural features of addiction from the direct effects of substance exposure. The current fMRI study compared neural responses during monetary reward processing between drug naïve young adults with a behavioral addiction, internet gaming disorder (IGD; n = 22), and healthy controls (n = 27) using a monetary incentive delay task. Relative to controls, individuals with IGD exhibited blunted caudate activity associated with loss magnitude at the outcome stage, but did not differ from controls in neural activity at other stages. These findings suggest that decreased loss sensitivity might be a critical feature of IGD, whereas alterations in gain processing may be less characteristic of individuals with IGD, relative to those with substance use disorders. Therefore, classic theories of altered reward processing in substance use disorders should be translated to behavioral addictions with caution.

Prevalence and Interpersonal Correlates of Internet Gaming Disorders among Chinese Adolescents

This study investigated the prevalence and interpersonal correlates of Internet gaming disorders (IGD) among Chinese adolescents. A cross-sectional survey was conducted in two cities (Shanghai and Xi’an) in China. A total of 2666 (Mean_age = 12.77 ± 0.75) year-one students from eight middle schools completed a self-reported questionnaire. It tested their levels of IGD, parental psychological control, negative interpersonal events (physical/verbal abuse by parents, verbal abuse by teachers, peer/online bullying), social support from parents/peers, and positive relationships with parents/peers. Results showed that 346 participants (13.0%) were classified as having IGD. Gender, city, single-parent family, family socio-economic status, and mother’s education level were significantly associated with the risk of IGD. Logistic regression analyses with and without controlling for the significant background variables showed that the studied interpersonal variables were significantly associated with IGD, respectively. Forward stepwise logistic regression showed that the significant correlates of IGD included parental psychological control, physical/verbal abuse by parents, verbal abuse by teachers, and peer/online bullying. Results highlight the importance of addressing interpersonal risk factors to reduce adolescent IGD. Limitations and implications of this study are discussed.

Psychometric Evaluation and Comparison of Two Gaming Disorder Measures Derived From the DSM-5 and ICD-11 Frameworks

Gaming disorder was listed as a condition for further study in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013, and measures of the disorder have mushroomed in the years since. The Gaming Disorder Test (GDT) was developed after gaming disorder was officially included in the 11th Revision of the International Classification of Diseases (ICD-11) in 2018. However, it remains unknown whether the GDT, which is based on the ICD-11 framework, is psychometrically similar to or different from the popular nine-item Internet Gaming Disorder Scale-Short Form (IGDS9-SF) based on the DSM-5 framework. To address this important but unexplored issue, the present study evaluated and compared the psychometric properties of the GDT and IGDS9-SF in a sample of 544 adult gamers (56.2% men; mean age = 28.8, SD = 8.55). The results revealed both measures to have good reliability, structural validity, and criterion validity, with the exception of one IGDS9-SF item with a low factor loading. Moreover, the IGDS9-SF exhibited scalar measurement invariance for gender and age but only partial metric invariance for employment status, whereas the GDT exhibited scalar measurement invariance for all three demographic characteristics. Finally, the GDT displayed incremental validity over the IGDS9-SF in explaining gaming time, but not social anxiety and depressive symptoms. This study thus contributes to the literature by comparing measures derived from distinct gaming disorder diagnostic frameworks empirically. Recommendations for the selection of gaming disorder measures by researchers and practitioners are discussed.

Validation of the Chinese Version of the Revised Internet Gaming Cognition Scale among Adolescents in China: Maladaptive Cognitions as Potential Determinants of Internet Gaming Disorder

Maladaptive gaming cognitions are important determinants of Internet gaming disorder (IGD). Based on a systematic review, a 4-factor Internet gaming cognition scale (IGCS) was previously developed and cross-cultural validation of IGCS is warranted. The present study assesses the validation of the IGCS and its revised version, the Chinese version of Revised IGCS (C-RIGCS), among adolescents in China. Altogether, 755 students were recruited from junior middle schools in Guangzhou and Chengdu, China. The psychometric properties of the C-RIGCS were assessed by using appropriate statistical methods. The 4-factor model of the original IGCS was not supported by confirmatory factor analysis (CFA). In the split-half sub-samples, exploratory factor analysis suggested a 3-factor model for C-RIGCS, which was confirmed by CFA. The C-RIGCS and its three subscales showed satisfactory internal reliability, test-retest reliability, content validity, and absence of ceiling and floor effects (except on one case). Besides, the C-RIGCS and its three subscales were significantly correlated with external variables including IGD, gaming time, impulsivity, and self-control, and perceptions that Internet gaming is the primary source of self-esteem and social acceptance. The C-RIGCS proposed a new 3-factor model that showed satisfactory psychometric properties. It can be applied to understand maladaptive gaming cognitions of adolescent IGD.

Purpose in life, social support, and internet gaming disorder among Chinese university students: A 1-year follow-up study

AIMS

Given the high prevalence of Internet gaming disorder (IGD) among university students and the beneficial effects of positive psychological factors on mental illness, the present longitudinal research aimed to investigate whether purpose in life and social support yields long-term results in protecting university students from IGD.

METHODS

We recruited 469 Chinese university students to voluntarily fill out an anonymous questionnaire at baseline, and 283 of them were followed up and given similar measures after one year.

RESULTS

The prevalence of probable IGD at the baseline and follow-up surveys was 14.8% and 9.9% respectively. Purpose in life and social support were negatively correlated with IGD symptoms in both surveys (p < .05). The results of a cross-lagged analysis showed that purpose in life, but not social support, assessed at baseline predicted fewer IGD symptoms at follow-up (p < .001). In addition, social support and purpose in life predicted one another across time.

CONCLUSIONS

The prevalence of probable IGD was high among Chinese university students. Purpose in life was shown to be an effective significant protective factor against IGD, while the effect of social support might be indirect. Positive psychology interventions, which promote the search for and attainment life purpose, may be incorporated in school-based program for IGD prevention.

The Effects of Need Satisfaction and Dissatisfaction on Flourishing among Young Chinese Gamers: The Mediating Role of Internet Gaming Disorder

Given the increasing popularity of online game playing, the negative impacts of game addiction on both adolescents and adults attracted our attention. Previous studies based on the self-determination theory have examined the effects of the three basic psychological needs of autonomy, competence, and relatedness on problematic video game playing among Chinese young adults. Yet, as more evidence emerged pointing to the possible relation between need dissatisfaction and higher vulnerability for ill-being and psychopathology, the present study aimed to incorporate the impacts of both satisfaction and dissatisfaction for autonomy, competence, and relatedness in explaining Internet gaming disorder (IGD), a condition that may in turn impede eudaimonic well-being as indicated by flourishing. In a self-administered online survey with a valid sample of 1200 Chinese young adults aged 18-24 years (mean age = 19.48 years), the prevalence of probable IGD (for those who reported five or more symptoms in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) symptom list for IGD) was 7.5%. Our results showed that relatedness dissatisfaction positively predicted IGD symptoms after controlling for other need satisfaction and dissatisfaction. Also, flourishing was found to be negatively predicted by IGD. Finally, IGD was found to mediate the effect of relatedness dissatisfaction on flourishing. Our findings suggested a risk factor of relatedness dissatisfaction in predicting IGD, thereby significantly predicting flourishing.

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.

Associations Among Resilience, Stress, Depression, and Internet Gaming Disorder in Young Adults

Background and Aims: Using gaming to escape emotional difficulty has been suggested to be a candidate mechanism contributing to Internet gaming disorder (IGD). This study evaluated the associations among resilience, perceived stress, depression, and IGD. Methods: A total of 87 participants in an IGD group and 87 participants in a control group were recruited into this study. IGD was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders. Stress levels, resilience, and depression were measured by a self-reported questionnaire. Results: The IGD group had a lower resilience, higher perceived stress, and depression than the control group. Hierarchical regression analysis demonstrated that resilience was associated with IGD when perceived stress was controlled. After depression was controlled, resilience and perceived stress were not associated with IGD. Among the IGD group, those with low resilience had higher depression. Furthermore, discipline was the resilience characteristic associated with IGD. Conclusions: Low resilience was associated with a higher risk of IGD. IGD individuals with low resilience had higher depression. Depression was more associated with IGD than resilience. Depression assessments and stress coping interventions should be provided for individuals with IGD who exhibit low resilience or high stress.

Performance of the DSM-5-based criteria for Internet addiction: A factor analytical examination of three samples

BACKGROUND AND AIMS

The diagnosis "Internet Gaming Disorder" (IGD) has been included in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders. However, the nine criteria have not been sufficiently reviewed for their diagnostic value. This study focuses on a broader approach of Internet addiction (IA) including other Internet activities. It is not yet clear what the construct of IA is in terms of dimensionality and homogeneity and how the individual criteria contribute to explained variance.

METHODS

Three separate exploratory factor analyses and multinomial logistic regression analyses were carried out based on information collected from a general population-based sample (n = 196), a sample of people recruited at job centers (n = 138), and a student sample (n = 188).

RESULTS

Both of the adult samples show a distinct single-factor solution. The analysis of the student sample suggests a two-factor solution. Only one item (criterion 8: escape from a negative mood) can be assigned to the second factor. Altogether, high endorsement rates of the eighth criterion in all three samples indicate low discriminatory power.

DISCUSSION AND CONCLUSIONS

Overall, the analysis shows that the construct of IA is represented one dimensionally by the diagnostic criteria of the IGD. However, the student sample indicates evidence of age-specific performance of the criteria. The criterion "Escape from a negative mood" might be insufficient in discriminating between problematic and non-problematic Internet use. The findings deserve further examination, in particular with respect to the performance of the criteria in different age groups as well as in non-preselected samples.

Why and how to include parents in the treatment of adolescents presenting Internet gaming disorder?

BACKGROUND AND AIMS

Clinicians and researchers are increasingly interested in investigating excessive use of video gaming recently named Internet gaming disorder (IGD). As is the case with extensively researched adolescent problem behaviors such as substance use disorder, several studies associate IGD with the young person's family environment and the parent-adolescent relationship in particular. Evidence-based treatments for a range of adolescent clinical problems including behavioral addictions demonstrate efficacy, the capacity for transdiagnostic adaptation, and lasting impact. However, less attention has been paid to developing and testing science-based interventions for IGD, and at present most tested interventions for IGD have been individual treatments (cognitive behavioral therapy).

METHODS

This article presents the rationale for a systemic conceptualization of IGD and a therapeutic approach that targets multiple units or subsystems. The IGD treatment program is based on the science-supported multidimensional family therapy approach (MDFT). Following treatment development work, the MDFT approach has been adapted for IGD.

RESULTS

The article discusses recurring individual and family-based clinical themes and therapeutic responses in the MDFT-IGD clinical model, which tailors interventions for individuals and subsystems within the young person's family.

DISCUSSION AND CONCLUSIONS

Basic science developmental research can inform conceptualization of IGD and a systemic logic model of intervention and change. This paper aims to expand treatment theorizing and intervention approaches for practitioners working with frequently life-altering behaviors of excessive Internet gaming. We operationalize this aim by addressing the question of why and how parents should be involved in youth IGD treatment.

Evaluating an Internet Gaming Disorder Scale Using Mokken Scaling Analysis

Internet Gaming Disorder (IGD) was recently included as a condition for further study in the fifth and latest version of the Diagnostic and Statistical Manual of Mental Disorders. The present study investigated whether the IGD criteria comprise a unidimensional construct. Data stemmed from a sample of Norwegians aged 17.5 years in 2012 and 19.5 years in 2014 (N = 1258). The study used the Mokken scale analysis to investigate whether the score of the different items on the IGD scale measured a single latent variable and if the scale functions differently for males and females. Correlation analysis was conducted between the scores on the IGD scale (count) and the Gaming Addiction Scale for Adolescents (GASA, categorical), both assessed in 2014. Negative binomial regression analyses were applied in order to investigate how different predictors of mental health assessed in 2012 were associated with IGD assessed in 2014. The Mokken scale analysis showed that all item-coefficients of homogeneity exceeded 0.3 when the whole sample completed the scale and when females completed the scale, indicating that the items reflect a single latent variable. In both cases moderate (H > 0.40) unidimensionality was shown. The item measuring "tolerance" did not exceed 0.3 in the scale when completed by males, indicating that only eight out of nine items reflect a single latent variable when applied to males only. The eight-item scale containing males showed weak (H > 0.30) unidimensionality. The correlation analysis showed a positive correlation between the scores on the IGD scale and the GASA (r = 0.71, p < 0.01) when assessed simultaneously and a positive but lower correlation (r = 0.48, p < 0.01) when assessed longitudinally. Results from the negative binomial regression analysis showed that previous video-game addiction, being male, depression, aggression and loneliness were significant predictors of IGD. The associations were small for all independent variables except previous video game addiction and gender where the associations were large. Although the results from the correlation analysis and regression analysis showed predictive validity of the scale, the results from the Mokken analysis suggest that the IGD scale may not be applied as a unidimensional scale when the tolerance item is included.

Gender-related differences in neural responses to gaming cues before and after gaming: implications for gender-specific vulnerabilities to Internet gaming disorder

Backgrounds

More males than females play video games and develop problems with gaming. However, little is known regarding how males and females who game on the Internet may differ with respect to neural responses to gaming cues.

Methods

Behavioral and functional magnetic resonance imaging (fMRI) data were recorded from 40 female and 68 male Internet gamers. This study included three components including participation in a pre-gaming cue-craving task, 30 min of online gaming and a post-gaming cue-elicited-craving task. Group differences were examined at pre-gaming, post-gaming and post- vs pre-gaming times. Correlations between brain responses and behavioral performance were calculated.

Results

Gaming-related cues elicited higher cravings in male vs female subjects. Prior to gaming, males demonstrated greater activations in the striatum, orbitofrontal cortex (OFC), inferior frontal cortex and bilateral declive. Following gaming, male subjects demonstrated greater activations in the medial frontal gyrus and bilateral middle temporal gyri. In a post–pre comparison, male subjects demonstrated greater thalamic activation than did female subjects.

Conclusions

Short-term gaming elicited in males vs females more craving-related activations to gaming cues. These results suggest neural mechanisms for why males may be more vulnerable than females in developing Internet gaming disorder.

Current diagnostic procedures and interventions for Gaming Disorders: A Systematic Review

Background: Despite the growth in the number of studies on Gaming Disorders (GD), assessing the characteristics of clinical subjects is still limited. Driven by the need to overcome this limitation, a broad systematic review is essential to cover the studies that have already assessed the clinical characteristics of individuals diagnosed with GD.

Objectives: The aim of this systematic review is to provide a broad cross-cultural picture of the current diagnostic procedures and interventions used for GDs in clinical practice.

Methods: A total of 28 studies met the inclusion criteria, and data were synthesized in these categories: (1) the cultural background of the country where the research took place; (2) the instruments used to measure GD; (3) the diagnostic criteria for GD; (4) the diagnostic procedures used; and (5) the treatment protocol applied.

Results: Results of this systematic review suggest that in GD clinical practice, there is a great deal of heterogeneity in the choice of instruments, the diagnostic and intervention processes for GD.

Conclusions: This systematic review indicates that a validation process of standard procedures in clinical populations with GD is necessary to create clear shared guidelines for practitioners.

Wu AM, Pun N. Disentangling the effects of empathy components on Internet gaming disorder: A study of vulnerable youth in China

BACKGROUND AND AIMS

Previous research shows that empathy can be one of the potential protective factors for Internet gaming disorder (IGD), yet the complex relationships between multidimensional factors of empathy and IGD remain understudied. Thus, a major question moving forward is to resolve the mixed empirical data by examining the specific contributions of empathy components. In this study, we disentangle the effects of cognitive component (i.e., perspective taking) and affective component (i.e., empathic concern and personal distress) on IGD symptoms and propose affect-oriented mediation pathways between them.

METHODS

We surveyed a large sample (N = 3,348) of Chinese vocational school students, one of the most vulnerable groups to online gaming addiction.

RESULTS

Our structural equation modeling results revealed that only personal distress, but not empathic concern or perspective taking, positively predicted IGD symptoms. However, empathic concern and personal distress were negatively and positively predicted gaming motive of escape from reality, respectively, which in turn predicted IGD symptoms. Furthermore, we found an indirect effect of perspective taking on IGD through empathic concern and then gaming motive of escape from reality.

DISCUSSION AND CONCLUSION

The findings underscore the importance of separating the affective and cognitive components to understand the complex relationships between the empathy and IGD, and support our theorizing of the affect-oriented mediation mechanism.

Psychometric Testing of Three Chinese Online-Related Addictive Behavior Instruments among Hong Kong University Students

Given that there is a lack of instruments assessing internet-related addictions among Chinese population, this study aimed to validate the Chinese version of the nine-item Internet Gaming Disorder Scales- Short Form (IGDS-SF9), Bergen Social Media Addiction Scale (BSMAS), and Smartphone Application-Based Addiction Scale (SABAS) among Hong Kong university students. Participants aged between 17 and 30 years participated in the present study (n = 307; 32.4% males; mean [SD] age = 21.64 [8.11]). All the participants completed the IGDS-SF9, BSMAS, SABAS, and the Hospital Anxiety and Depression Scale (HADS). Confirmatory factor analyses (CFAs) were used to examine the factorial structures and the unidimensionality for IGDS-SF9, BSMAS, and SABAS. CFAs demonstrated that the three scales were all unidimensional with satisfactory fit indices: comparative fit index = 0.969 to 0.992. In addition, the IGDS-SF9 and BSMAS were slightly modified based on the modification index in CFA. The Chinese IGDS-SF9, BSMAS, and SABAS are valid instruments to assess the addiction levels of internet-related activities for Hong Kong university students.

A clinical evaluation of the DSM-5 criteria for Internet Gaming Disorder and a pilot study on their applicability to further Internet-related disorders

BACKGROUND AND AIMS

Internet Gaming Disorder (IGD) and other Internet-related disorders (IRDs) have become growing health concerns in our today's lives. Based on defined diagnostic criteria, IGD has been recognized as a condition for further research in the DSM-5; however, other IRDs have been excluded. Since the release of the DSM-5, representativeness and appropriateness of the nine diagnostic criteria have been debated. Although some first evidence has been published to evaluate these criteria, our knowledge is still limited. Thus, the purpose of this study was to provide data on the clinical validity of the DSM-5 criteria for IGD and other types of IRD. We were also interested in examining the additional diagnostic validity of craving that is currently not being considered in the DSM-5.

METHODS

Analyses on a sample of n = 166 treatment seekers for IRDs were performed. The clinician's diagnosis was used as a main reference for determining the DSM criteria's diagnostic performance. Secondary criteria (depression and anxiety) were defined as indicators for the construct validity.

RESULTS

The overall diagnostic accuracy ranged between 76.6% for deceiving and 92% for loss of control and craving. Considerable differences occurred in the degree of sensitivity and specificity between the single criteria. No particular differences were found for the applicability of the criteria to other forms of IRDs.

DISCUSSION AND CONCLUSIONS

Our results confirm the validity of the DSM criteria. However, the diagnostic utility of the criterion escaping aversive moods is critically discussed. Considering craving as an additional diagnostic indicator might be recommendable.

Gender-related functional connectivity and craving during gaming and immediate abstinence during a mandatory break: Implications for development and progression of internet gaming disorder

BACKGROUND

Although males more frequently develop Internet gaming disorder (IGD) as compared with females, few studies have examined gender-related neurocognitive differences in IGD. TASK AND DESIGN: fMRI and subjective data were collected from 119 subjects (IGD, male 29, female 25; recreational game use (RGU), male 34, female 31) when they were actively playing games and during a forced mandatory break. Analyses investigating effects of group (IGD, RGU) and gender (male, female) on the functional connectivity (FC) of executive control and reward systems linked to the dorsolateral prefrontal cortex (DLPFC) and striatum, respectively, were performed. Correlations between FC and subjective craving measures were also calculated.

RESULTS

Gaming-group-by-gender interactions were observed. During gaming in males but not in females, the FC between the DLPFC and superior frontal gyrus was relatively decreased, and that between the striatum and thalamus was relatively increased. During the mandatory break, changes in the FC between DLPFC and superior frontal gyrus and the FC between the striatum and thalamus varied by gender with greater RGU-IGD differences observed in females. Significant correlations between FC and self-reported craving were observed.

CONCLUSIONS

During both gaming and a forced mandatory break, brain regions implicated in executive control and reward processing showed changes in FC that varied by gender. Brain regions implicated in executive control showed differential FC in males during gaming, and FC during the forced mandatory break appeared relevant to both genders, and perhaps particularly for females. The findings suggest possible neural mechanisms for why males appear more likely to develop IGD, and why it may be particularly difficult for individuals with IGD to cease gaming.

A longitudinal study on psychosocial causes and consequences of Internet gaming disorder in adolescence

BACKGROUND

In 2013, Internet gaming disorder (IGD) was incorporated in the current version of the DSM-5. IGD refers to a problematic use of video games. Longitudinal studies on the etiology of IGD are lacking. Furthermore, it is currently unclear to which extent associated psychopathological problems are causes or consequences of IGD. In the present survey, longitudinal associations between IGD and adolescent and parental mental health were investigated for the first time, as well as the temporal stability of IGD.

METHODS

In a cross-lagged panel design study, family dyads (adolescent with a parent each) were examined in 2016 (t1) and again 1 year later (2017, t2). Overall, 1095 family dyads were assessed at t1 and 985 dyads were re-assessed at t2 with standardized measures of IGD and several aspects of adolescent and parental mental health. Data were analyzed with structural equation modeling (SEM).

RESULTS

Male gender, a higher level of hyperactivity/inattention, self-esteem problems and IGD at t1 were predictors of IGD at t2. IGD at t1 was a predictor for adolescent emotional distress at t2. Overall, 357 out of the 985 adolescents received a diagnosis of IGD at t1 or t2: 142 (14.4%) at t1 and t2, 100 (10.2%) only at t1, and 115 (11.7%) only at t2.

CONCLUSIONS

Hyperactivity/inattention and self-esteem problems seem to be important for the development of IGD. We found first empirical evidence that IGD could prospectively contribute to a deterioration of adolescent mental health. Only a subgroup of affected adolescents showed IGD consistently over 1 year.