Internet Gaming Disorder and the DSM-5: Conceptualization, Debates, and Controversies

Problematic gaming exists and is an example of disordered gaming

Background The recent paper by Aarseth et al. (2016) questioned whether problematic gaming should be considered a new disorder particularly because "Gaming Disorder" (GD) has been identified as a disorder to be included in the next (11th) revision of the World Health Organization's International Classification of Diseases (ICD-11). Methods This study uses contemporary literature to argue why GD should be included in the ICD-11. Results Aarseth and colleagues acknowledge that there is much literature (including papers by some of the authors themselves) that some individuals experience serious problems with video gaming. How can such an activity be seriously problematic yet not disordered? Similar to other addictions, gaming addiction is relatively rare and is in essence a syndrome (i.e., a condition or disorder characterized by a set of associated symptoms that tend to occur under specific circumstances). Consequently, not everyone will exhibit exactly the same set of symptoms and consequences, and this partly explains why those working in the problematic gaming field often disagree on symptomatology. Conclusions Research into gaming is not about pathologizing healthy entertainment, but about pathologizing excessive and problematic behaviors that cause significant psychological distress and impairment in an individual's life. These are two related, but (ultimately) very distinct phenomena. While being aware that gaming is a pastime activity which is enjoyed non-problematically by many millions of individuals worldwide, it is concluded that problematic gaming exists and that it is an example of disordered gaming.

Measurement Invariance of the Internet Gaming Disorder Scale-Short-Form (IGDS9-SF) Between Australia, the USA, and the UK

The Internet Gaming Disorder Scale–Short-Form (IGDS9-SF) is widely used to assess Internet Gaming Disorder behaviors. Investigating cultural limitations and implications in its applicability is imperative. One way to evaluate the cross-cultural feasibility of the measure is through measurement invariance analysis. The present study used Multigroup Confirmatory Factor Analysis (MGCFA) to examine the IGDS9-SF measurement invariance across gamers from Australia, the United States of America (USA), and the United Kingdom (UK). To accomplish this, 171 Australian, 463 USA, and 281 UK gamers completed the IGDS9-SF. Although results supported the one-factor structure of the IGD construct, they indicated cross-country variations in the strength of the relationships between the indicators and their respective factor (i.e., non-invariant loadings of items 1, 2, 5), and that the same scores may not always indicate the same level of IGD severity across the three groups (i.e., non-invariant intercepts for items 1, 5, 7, 9).

The Psychometric Properties of the Smartphone Application-Based Addiction Scale (SABAS)

The goal of the study was to validate the English version of the Smartphone Application-Based Addiction Scale (SABAS; Csibi et al. 2016), which is a short and easy-to-use tool for screening the risk of smartphone application-based addiction. Another aim was to identify the most frequently used smartphone applications and their perceived importance by the participants. Data were collected online from 240 English-speaking volunteers, aged 18 to 69 years. The instruments used were the SABAS, the Nomophobia Questionnaire (NMP-Q), the Brief Sensation Seeking Scale (BSSS), the Deprivation Sensation Scale (DSS), and the Patient Health Questionnaire (PHQ-9). Participants also ranked the importance of their most frequently used smartphone applications. The six items of the SABAS yielded one component, which accounted for 52.38% of the total variance. The internal reliability of the scale was good (Cronbach's alpha 0.81). NMP-Q was a significant predictor of SABAS, explaining 17.6% of the total variance. The regression analysis, with SABAS score as the dependent variable and NMP-Q, DSS, PHQ-9, and BSSS scores as predictors, indicated that approximately 47% of the variance in SABAS was accounted for by the predictors (R2 = 0.47). The English version of the SABAS appears to be a valid and reliable ultra-brief tool for a quick and easy assessment of smartphone application-based addiction symptoms.

Not good enough? Further comments to the wording, meaning, and the conceptualization of Internet Gaming Disorder

In their commentary, Kuss, Griffiths, and Pontes (2016) criticize the use of the term "Internet" in the recently proposed diagnosis for Internet Gaming Disorder (IGD) and its use as one of the included diagnostic criteria. We agree with the exclusion of the term "Internet" in the diagnosis, but have some considerations to the comments regarding the nine criteria for IGD. Specifically, we discuss the meaning, the wording, and the importance of the criteria, as well as the importance of distress or functional impairment in the proposed diagnosis. We also address the possibility of categorizing IGD as a subtype of a general behavioral addiction diagnosis.

Psychometric validation of the Persian nine-item Internet Gaming Disorder Scale - Short Form: Does gender and hours spent online gaming affect the interpretations of item descriptions?

Background and aims The nine-item Internet Gaming Disorder Scale - Short Form (IGDS-SF9) is brief and effective to evaluate Internet Gaming Disorder (IGD) severity. Although its scores show promising psychometric properties, less is known about whether different groups of gamers interpret the items similarly. This study aimed to verify the construct validity of the Persian IGDS-SF9 and examine the scores in relation to gender and hours spent online gaming among 2,363 Iranian adolescents. Methods Confirmatory factor analysis (CFA) and Rasch analysis were used to examine the construct validity of the IGDS-SF9. The effects of gender and time spent online gaming per week were investigated by multigroup CFA and Rasch differential item functioning (DIF). Results The unidimensionality of the IGDS-SF9 was supported in both CFA and Rasch. However, Item 4 (fail to control or cease gaming activities) displayed DIF (DIF contrast = 0.55) slightly over the recommended cutoff in Rasch but was invariant in multigroup CFA across gender. Items 4 (DIF contrast = -0.67) and 9 (jeopardize or lose an important thing because of gaming activity; DIF contrast = 0.61) displayed DIF in Rasch and were non-invariant in multigroup CFA across time spent online gaming. Conclusions Given the Persian IGDS-SF9 was unidimensional, it is concluded that the instrument can be used to assess IGD severity. However, users of the instrument are cautioned concerning the comparisons of the sum scores of the IGDS-SF9 across gender and across adolescents spending different amounts of time online gaming.

Associations between prospective symptom changes and slow-wave activity in patients with Internet gaming disorder: A resting-state EEG study

The identification of the predictive factors and biological markers associated with treatment-related changes in the symptoms of Internet gaming disorder (IGD) may provide a better understanding of the pathophysiology underlying this condition. Thus, the present study aimed to identify neurophysiological markers associated with symptom changes in IGD patients and to identify factors that may predict symptom improvements following outpatient treatment with pharmacotherapy. The present study included 20 IGD patients (mean age: 22.71 ± 5.47 years) and 29 healthy control subjects (mean age: 23.97 ± 4.36 years); all IGD patients completed a 6-month outpatient management program that included pharmacotherapy with selective serotonin reuptake inhibitors. Resting-state electroencephalography scans were acquired prior to and after treatment, and the primary treatment outcome was changes in scores on Young's Internet Addiction Test (IAT) from pre- to posttreatment. IGD patients showed increased resting-state electroencephalography activity in the delta and theta bands at baseline, but the increased delta band activity was normalized after 6 months of treatment and was significantly correlated with improvements in IGD symptoms. Additionally, higher absolute theta activity at baseline predicted a greater possibility of improvement in addiction symptoms following treatment, even after adjusting for the effects of depressive or anxiety symptoms. The present findings demonstrated that increased slow-wave activity represented a state neurophysiological marker in IGD patients and suggested that increased theta activity at baseline may be a favorable prognostic marker for this population.

Bindungsstile bei Probanden mit pathologischem Internetgebrauch

Zusammenfassung. Zielsetzung: In der Entstehung von pathologischem Internetgebrauch (PIG) wird diskutiert, ob das Internetverhalten als Surrogat zur Befriedigung von Bindungsbedürfnissen dienen kann. Dabei wird angenommen, dass die unerfüllten Bindungsbedürfnisse aus unsicheren Bindungsstilen resultieren. Die vorliegende Pilotstudie untersuchte den Zusammenhang zwischen PIG und Bindungsstilen. Methodik: Bei 10 Probanden mit PIG und 10 Probanden einer geschlechts-, alters- und bildungsgematchten Kontrollgruppe erfolgte erstmals eine interviewgestützte Erhebung des Bindungssystems mit dem Attachment Style Interview durch zwei geschulte Rater. Die Definition des PIG erfolgte kategorial mit dem Internetsucht-Interview (Distinguishing Characteristics of Internet Addiction) und dimensional durch die Skalen zum Onlinesucht- und Computerspielverhalten. Ergebnis: Probanden mit PIG wiesen signifikant häufiger unsichere und desorganisierte sowie seltener sichere Bindungsstile auf als gesunde Kontrollprobanden [χ²(2) = 7.505; p = .023]. Schlussfolgerung: Unsichere und desorganisierte Bindungsstile sollten in der multifaktoriellen Ätiopathogenese des PIG als Risikofaktor berücksichtigt werden.

Internet gaming disorder in early adolescence: Associations with parental and adolescent mental health

BACKGROUND

Internet gaming disorder (IGD) has been included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Currently, associations between IGD in early adolescence and mental health are largely unexplained. In the present study, the relation of IGD with adolescent and parental mental health was investigated for the first time.

METHODS

We surveyed 1095 family dyads (an adolescent aged 12-14 years and a related parent) with a standardized questionnaire for IGD as well as for adolescent and parental mental health. We conducted linear (dimensional approach) and logistic (categorical approach) regression analyses.

RESULTS

Both with dimensional and categorical approaches, we observed statistically significant associations between IGD and male gender, a higher degree of adolescent antisocial behavior, anger control problems, emotional distress, self-esteem problems, hyperactivity/inattention and parental anxiety (linear regression model: corrected R²=0.41, logistic regression model: Nagelkerke's R²=0.41).

CONCLUSIONS

IGD appears to be associated with internalizing and externalizing problems in adolescents. Moreover, the findings of the present study provide first evidence that not only adolescent but also parental mental health is relevant to IGD in early adolescence. Adolescent and parental mental health should be considered in prevention and intervention programs for IGD in adolescence.

Validation of the Internet Gaming Disorder Questionnaire in a Sample of Adult German-Speaking Internet Gamers

With the inclusion of Internet Gaming Disorder (IGD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders comes the need for a reliable and valid questionnaire to assess the diagnosis. The Internet Gaming Disorder Questionnaire (IGDQ) is a short tool that measures IGD. Our study aimed at investigating its psychometric properties in a sample of German gamers. Eight hundred ninety-four Internet game players (mean age: 26.5 ± 8.5 years, range: 18-75 years, 87.36% male) completed an online version of the IGDQ and the Compulsive Internet Use Scale (CIUS) and provided information on their Internet and gaming use. Item and reliability analyses were computed. To investigate the component structure, the sample was randomly divided into two subsamples. A maximum likelihood factor analysis was conducted for one subsample and a confirmatory factor analysis (CFA) for the other subsample. The IGDQ had a Cronbach's alpha of 0.70. The IGDQ score correlated with the CIUS score (r = 0.59) and the time spent playing (r = 0.24). The maximum likelihood factor analysis extracted one component, explaining 30.26% of the variance, which was confirmed by the CFA. The correlation of the IGDQ score with the CIUS score is a first indicator that the IGDQ allows for valid interpretations. In all, 7.94% of the gamers met the criteria for IGD.

Validation of the Ten-Item Internet Gaming Disorder Test (IGDT-10) and evaluation of the nine DSM-5 Internet Gaming Disorder criteria

INTRODUCTION

The inclusion of Internet Gaming Disorder (IGD) in the DSM-5 (Section 3) has given rise to much scholarly debate regarding the proposed criteria and their operationalization. The present study's aim was threefold: to (i) develop and validate a brief psychometric instrument (Ten-Item Internet Gaming Disorder Test; IGDT-10) to assess IGD using definitions suggested in DSM-5, (ii) contribute to ongoing debate regards the usefulness and validity of each of the nine IGD criteria (using Item Response Theory [IRT]), and (iii) investigate the cut-off threshold suggested in the DSM-5.

METHODS

An online gamer sample of 4887 gamers (age range 14-64years, mean age 22.2years [SD=6.4], 92.5% male) was collected through Facebook and a gaming-related website with the cooperation of a popular Hungarian gaming magazine. A shopping voucher of approx. 300 Euros was drawn between participants to boost participation (i.e., lottery incentive). Confirmatory factor analysis and a structural regression model were used to test the psychometric properties of the IGDT-10 and IRT analysis was conducted to test the measurement performance of the nine IGD criteria. Finally, Latent Class Analysis along with sensitivity and specificity analysis were used to investigate the cut-off threshold proposed in the DSM-5.

RESULTS

Analysis supported IGDT-10's validity, reliability, and suitability to be used in future research. Findings of the IRT analysis suggest IGD is manifested through a different set of symptoms depending on the level of severity of the disorder. More specifically, "continuation", "preoccupation", "negative consequences" and "escape" were associated with lower severity of IGD, while "tolerance", "loss of control", "giving up other activities" and "deception" criteria were associated with more severe levels. "Preoccupation" and "escape" provided very little information to the estimation IGD severity. Finally, the DSM-5 suggested threshold appeared to be supported by our statistical analyses.

CONCLUSIONS

IGDT-10 is a valid and reliable instrument to assess IGD as proposed in the DSM-5. Apparently the nine criteria do not explain IGD in the same way, suggesting that additional studies are needed to assess the characteristics and intricacies of each criterion and how they account to explain IGD.

Problematic internet use (PIU): Associations with the impulsive-compulsive spectrum. An application of machine learning in psychiatry

Problematic internet use is common, functionally impairing, and in need of further study. Its relationship with obsessive-compulsive and impulsive disorders is unclear. Our objective was to evaluate whether problematic internet use can be predicted from recognised forms of impulsive and compulsive traits and symptomatology. We recruited volunteers aged 18 and older using media advertisements at two sites (Chicago USA, and Stellenbosch, South Africa) to complete an extensive online survey. State-of-the-art out-of-sample evaluation of machine learning predictive models was used, which included Logistic Regression, Random Forests and Naïve Bayes. Problematic internet use was identified using the Internet Addiction Test (IAT). 2006 complete cases were analysed, of whom 181 (9.0%) had moderate/severe problematic internet use. Using Logistic Regression and Naïve Bayes we produced a classification prediction with a receiver operating characteristic area under the curve (ROC-AUC) of 0.83 (SD 0.03) whereas using a Random Forests algorithm the prediction ROC-AUC was 0.84 (SD 0.03) [all three models superior to baseline models p < 0.0001]. The models showed robust transfer between the study sites in all validation sets [p < 0.0001]. Prediction of problematic internet use was possible using specific measures of impulsivity and compulsivity in a population of volunteers. Moreover, this study offers proof-of-concept in support of using machine learning in psychiatry to demonstrate replicability of results across geographically and culturally distinct settings.

Online and offline video game use in adolescents: measurement invariance and problem severity

BACKGROUND

Despite the increasing popularity of video game playing, little is known about the similarities and differences between online and offline video game players.

OBJECTIVES

The aims of this study were (i) to test the applicability and the measurement invariance of the previously developed Problematic Online Gaming Questionnaire (POGQ) in both online and offline gamers and to (ii) examine the differences in these groups.

METHODS

Video game use habits and POGQ were assessed in a sample of 1,964 (71% male) adolescent videogame players. Those gamers who played at least sometimes in an online context were considered "online gamers," while those who played videogames exclusively offline were considered "offline gamers."

RESULTS

Confirmatory factor analysis supported the measurement invariance across online and offline videogame players. According to the multiple indicators multiple causes (MIMIC) model, online gamers were more likely to score higher on overuse, interpersonal conflict, and social isolation subscales of the POGQ.

CONCLUSION

The results of the present study suggest that online and offline gaming can be assessed using the same psychometric instrument. These findings open the possibility for future research studies concerning problematic video gaming to include participants who exclusively play online or offline games, or both. However, the study also identified important structural features about how online and offline gaming might contribute differently to problematic use. These results provide important information that could be utilized in parental education and the prevention program about the possible detrimental consequences of online vs. offline video gaming.

Internet Gaming Disorder Among Slovenian Primary Schoolchildren: Findings From a Nationally Representative Sample of Adolescents

Background and aims Since the inclusion of Internet Gaming Disorder (IGD) in the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a tentative disorder, a few psychometric screening instruments have been developed to assess IGD, including the 9-item Internet Gaming Disorder Scale - Short-Form (IGDS9-SF) - a short, valid, and reliable instrument. Methods Due to the lack of research on IGD in Slovenia, this study aimed to examine the psychometric properties of the IGDS9-SF in addition to investigating the prevalence rates of IGD in a nationally representative sample of eighth graders from Slovenia (N = 1,071). Results The IGDS9-SF underwent rigorous psychometric scrutiny in terms of validity and reliability. Construct validation was investigated with confirmatory factor analysis to examine the factorial structure of the IGDS9-SF and a unidimensional structure appeared to fit the data well. Concurrent and criterion validation were also investigated by examining the association between IGD and relevant psychosocial and game-related measures, which warranted these forms of validity. In terms of reliability, the Slovenian version IGDS9-SF obtained excellent results regarding its internal consistency at different levels, and the test appears to be a valid and reliable instrument to assess IGD among Slovenian youth. Finally, the prevalence rates of IGD were found to be around 2.5% in the whole sample and 3.1% among gamers. Discussion and conclusion Taken together, these results illustrate the suitability of the IGDS9-SF and warrants further research on IGD in Slovenia.

Impulsivity in Multiplayer Online Battle Arena Gamers: Preliminary Results on Experimental and Self-Report Measures

Background and aims Multiplayer Online Battle Arena (MOBA) games have become the most popular type of video games played worldwide, superseding the playing of Massively Multiplayer Online Role-Playing Games and First-Person Shooter games. However, empirical studies focusing on the use and abuse of MOBA games are still very limited, particularly regarding impulsivity, which is an indicator of addictive states but has not yet been explored in MOBA games. In this context, the objective of the present study is to explore the associations between impulsivity and symptoms of addictive use of MOBA games in a sample of highly involved League of Legends (LoL, currently the most popular MOBA game) gamers. Methods Thirty-six LoL gamers were recruited and completed both experimental (Single Key Impulsivity Paradigm) and self-reported impulsivity assessments (s-UPPS-P Impulsive Behavior Scale, Barratt Impulsiveness Scale), in addition to an assessment of problematic video game use (Problematic Online Gaming Questionnaire). Results Results showed links between impulsivity-related constructs and signs of excessive MOBA game involvement. Findings indicated that impaired ability to postpone rewards in an experimental laboratory task was strongly related to problematic patterns of MOBA game involvement. Although less consistent, several associations were also found between self-reported impulsivity traits and signs of excessive MOBA game involvement. Conclusions Despite these results are preliminary and based upon a small (self-selected) sample, the present study highlights potential psychological factors related to the addictive use of MOBA games.

Portuguese Validation of the Internet Gaming Disorder Scale-Short-Form

In the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Internet Gaming Disorder (IGD) was included as a tentative disorder worthy of future research. Since then, several psychometric instruments to assess IGD have emerged in the literature, including the nine-item Internet Gaming Disorder Scale-Short-Form (IGDS9-SF), the most brief tool available to date. Research on the effects of IGD in Portugal has been minimal and may be due to the lack of a psychometrically validated tool to assess this construct within this particular cultural background. Therefore, the aim of the present study was to develop and examine the psychometric properties of the Portuguese IGDS9-SF. A total of 509 adolescents were recruited to the present study. Construct validity of the IGDS9-SF was assessed in two ways. First, confirmatory factor analysis was performed to investigate the factorial structure of the IGDS9-SF in the sample, and the unidimensional structure of the IGDS9-SF fitted the data well. Second, nomological validation of the IGDS9-SF was carried out and the nomological network analyzed was replicated as expected, further supporting the construct validity of the IGDS9-SF. Criterion validity of the IGDS9-SF was also established using key criterion variables. Finally, the IGDS9-SF also showed satisfactory levels of reliability using several indicators of internal consistency. Based on the results found, the IGDS9-SF appears to be a valid and reliable instrument to assess IGD among Portuguese adolescents and further research on IGD in Portugal is warranted.

Problematic digital gaming behavior and its relation to the psychological, social and physical health of Finnish adolescents and young adults

BACKGROUND AND AIMS

The aim of this study was to identify problematic gaming behavior among Finnish adolescents and young adults, and evaluate its connection to a variety of psychological, social, and physical health symptoms.

METHODS

This cross-sectional study was conducted with a random sample of 293 respondents aged from 13 to 24 years. Participants completed an online survey. Problematic gaming behavior was measured with the Game Addiction Scale (GAS). Self-reports covered health measures such as psychological health (psychopathological symptoms, satisfaction with life), social health (preferences for social interaction), and physical health (general health, Body Mass Index [BMI], body discomfort, physical activity).

RESULTS

Problematic gaming behavior was found to relate to psychological and health problems, namely fatigue, sleep interference, depression and anxiety symptoms. Multiple linear regression indicated that the amount of weekly gaming, depression and a preference for online social interaction predicted increased problematic gaming symptoms.

CONCLUSIONS

This research emphasized that problematic gaming behavior had a strong negative correlation to a variety of subjective health outcomes.