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

Problematic Pornography Use: Legal and Health Policy Considerations

Purpose of Review

Reports of sexual violence, especially towards women and children, are rapidly increasing. At the same time, rates of problematic pornography use (PPU) are accelerating across the world too. The purpose of this review is to consider the recent research on PPU and its contribution to sexual violence. The article offers guidance to governments on possible health policy interventions and legal actions to prevent the development of PPU and to reduce the incidence of sexual violence in society.

Recent Findings

Working from the consumer’s point of view, we identify PPU and ask how much pornography is needed to cause PPU. We examine how PPU drives sexual offending in children, adolescents and adults. The impact of PPU on some consumers’ behaviour suggests significant links to domestic violence. Sexual strangulation is highlighted as an example. Artificial intelligence algorithms play a key role in the pornography industry and appear to be driving escalation to more violent material, inducing high levels of sexual dysfunction in consumers and creating appetites for viewing child sexual abuse material (CSAM).

Summary

Easy access to internet pornography has led to an increase in PPU and sexual violence. Diagnoses and treatments for PPU are examined, as are legal transgressions of a civil and criminal nature arising from PPU. Legal remedies and government policy implications are discussed from the point of view of the precautionary principle. Strategies covered include age verification for pornography, public health campaigns and embedded health and legal warnings for users at the start of pornography sessions along with lessons for pupils about pornography’s impact on the brain.

Internet addiction in Gulf countries: A systematic review and meta-analysis

BACKGROUND AND AIMS

The prevalence of internet addiction (IA) varies widely in the Gulf Cooperation Council (GCC) countries (4%-82.6%). We aimed to assess the quality of IA studies from the GCC and pool their data to get an accurate estimate of the problem of IA in the region.

METHODS

A systematic review of available studies was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. PubMed, Embase, and Cochrane Controlled Register of Trials were systematically searched; studies conducted in GCC countries (i.e., Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) with a validated instrument for internet addiction assessment were eligible. Ten studies were eligible for the systematic review, all of which were included in the meta-analysis. The Newcastle Ottawa Scale was used for quality assessment.

RESULTS

Nine out of ten of the included studies had either adolescent and/or young adult participants (age < 25). Two studies were of 'good' quality, six were of 'satisfactory' quality, and two were of 'unsatisfactory' quality. The pooled internet addiction prevalence was 33%; it was significantly higher among females than males (male = 24%, female = 48%, P = 0.05) and has significantly increased over time (P < 0.05).

DISCUSSION AND CONCLUSIONS

One in every three individuals in GCC countries was deemed to be addicted to the internet, according to Young's Internet Addiction Test. A root cause analysis focusing on family structure, environment, and religious practices is needed to identify modifiable risk factors.

Subpopulations of Addictive Behaviors in Different Sample Types and Their Relationships with Gender, Personality, and Well-Being: Latent Profile vs. Latent Class Analysis

BACKGROUND

Relatively strong theoretical assumptions and previous studies concerning co-occurring addictive behaviors suggest a subpopulation representing general proclivity to behavioral addictions (BAs), and there are gender-specific subpopulations. This study aimed to compare latent profile analysis (LPA) and latent class analysis (LCA) as the methods of investigating different clusters of BAs in the general student population and among students positively screened for at least one BA. Participants and procedure: Analyses of six BAs (study, shopping, gaming, Facebook, pornography, and food) and their potential antecedents (personality) and consequences (well-being) were conducted on a full sample of Polish undergraduate students (N = 1182) and a subsample (n = 327) of students including individuals fulfilling cutoff for at least one BA.

RESULTS

LPA on the subsample mostly replicated the previous four profiles found in the full sample. However, LCA on a full sample did not replicate previous findings using LPA and showed only two classes: those with relatively high probabilities on all BAs and low probabilities. LCA on the subsample conflated profiles identified with LPA and classes found with LCA in the full sample.

CONCLUSIONS

LCA on dichotomized scores (screened positively vs. negatively) were less effective in identifying clear patterns of interrelationships between BAs based on relatively strong theoretical assumptions and found in previous research. BAs can be investigated on the whole spectrum of behavior, and person-centered analyses might be more useful when they are based on continuous scores. This paper provides more detailed analyses of the four basic clusters of BAs, prevalence, and co-occurrence of particular BAs within and between them, their gender and personality risk factors, relationships to well-being, and their interrelationships as emerging from the results of this and previous studies.

Problematic social media use and social support received in real-life versus on social media: Associations with depression, anxiety and social isolation

Social media platforms allow people to connect with each other and obtain social rewards. In some individuals, these reinforcing rewards can induce maladaptive, problematic social media use, with symptoms similar to substance use disorders. This problematic social media use has been associated with poorer mental health. Previous studies have demonstrated that social support can protect against poor mental health. People can receive social support both in real-life and on social media, however, so we investigated whether these two types of social support mediate the relationship between problematic social media use and poor mental health. We conducted an online survey, collecting measures of problematic social media use and mental health (depression, anxiety, and social isolation), as well as measures of real-life social support and social support received on social media. We then performed a path analysis on these data. Our analysis revealed that problematic social media use was significantly associated with decreased real-life social support and increased social support on social media. Importantly, real-life social support was then associated with reduced depression, anxiety, and social isolation, while social support on social media was not associated with these mental health measures. Our findings reveal the value of real-life social support when considering the relationship between problematic social media use and mental health. Implications for further research and practice are discussed.

Profiles of potential behavioral addictions' severity and their associations with gender, personality, and well-being: A person-centered approach

BACKGROUND

Addictions share common etiological factors associated with personality vulnerabilities such as narcissism or emotional instability. Also, there are gender differences in the type of and risk for addiction (e.g., men may be more prone to addictions, overall). These are considerably less understood in relation to behavioral addictions (BAs) than in substance use disorders. This study aimed to investigate associations between profiles of six potential BAs (study, shopping, gaming, Facebook, pornography, and food) and gender, personality, and well-being among Polish emerging adults, as a partial replication and extension of previous work.

PARTICIPANTS AND PROCEDURE

In a paper-and-pencil cross-sectional study, 1182 Polish undergraduate students (mean age = 20.33 years; SD = 1.68) completed questionnaires measuring six potential BAs alongside questions on demographic variables, personality traits (Big Five, narcissism), and well-being indicators (general quality of life, health quality, sleep quality, perceived stress, anxiety, and hopelessness).

RESULTS

Using latent profile analysis, four profiles were identified: (1) elevated levels of study, Facebook, shopping, and food addictions; (2) elevated levels of gaming and pornography addictions; (3) low or average levels of all potential BAs, and (4) highest levels of all potential BAs. The second and fourth profiles included men predominantly, and the first profile included almost exclusively women. The fourth profile, in comparison to all other profiles, demonstrated significantly higher scores on all potential BAs, narcissism, lowest conscientiousness and emotional stability, and lowest well-being.

CONCLUSIONS

The results suggest that there is a general proclivity to potential BAs. Furthermore, there are gender-specific profiles of potential BAs, which at present are poorly understood.

Problematic social media use is associated with the evaluation of both risk and ambiguity during decision making

BACKGROUND AND AIMS

People can engage in excessive, maladaptive use of social media platforms. This problematic social media use mirrors substance use disorders with regard to symptoms and certain behavioral situations. For example, individuals with substance use disorders demonstrate aberrations in risk evaluations during decision making, and initial research on problematic social media use has revealed similar findings. However, these results concerning problematic social media use have been clouded by tasks that involve learning and that lack a clear demarcation between risky and ambiguous decision making. Therefore, we set out to specifically determine the relationship between problematic social media use and decision making under both risk and ambiguity, in the absence of learning.

METHODS

We assessed each participant's (N = 90) self-reported level of problematic social media use. We then had them perform the wheel of fortune task, which has participants make choices between a sure option or either a risky or ambiguous gamble. In this way, the task isolates decisions made under risk and ambiguity, and avoids trial-to-trial learning. Results: We found that the greater an individual's problematic social media use, the more often that individual choses high-risk gambles or ambiguous gambles, regardless of the degree of ambiguity.

DISCUSSION AND CONCLUSIONS

Our findings indicate that greater problematic social media use is related to a greater affinity for high-risk situations and overall ambiguity. These findings have implications for the field, specifically clarifying and extending the extant literature, as well as providing future avenues for research.

Proposed diagnostic criteria for compulsive buying-shopping disorder: A Delphi expert consensus study

BACKGROUND AND AIMS

Consensus in acknowledging compulsive buying-shopping disorder (CBSD) as a distinct diagnosis has been lacking. Before research in this area can be advanced, it is necessary to establish diagnostic criteria in order to facilitate field trials.

METHODS

The study consisted of the following phases: (1) operationalization of a broad range of potential diagnostic criteria for CBSD, (2) two iterative rounds of data collection using the Delphi method, where consensus of potential diagnostic criteria for CBSD was reached by an international expert panel, and (3) interpretation of findings taking into account the degree of certainty amongst experts regarding their responses.

RESULTS

With respect to diagnostic criteria, there was clear expert consensus about inclusion of the persistent and recurrent experience of (a) intrusive and/or irresistible urges and/or impulses and/or cravings and/or preoccupations for buying/shopping; (b) diminished control over buying/shopping; (c) excessive purchasing of items without utilizing them for their intended purposes, (d) use of buying-shopping to regulate internal states; (e) negative consequences and impairment in important areas of functioning due to buying/shopping; (f) emotional and cognitive symptoms upon cessation of excessive buying/shopping; and (g) maintenance or escalation of dysfunctional buying/shopping behaviors despite negative consequences. Furthermore, support was found for a specifier related to the presence of excessive hoarding of purchased items.

CONCLUSIONS

The proposed diagnostic criteria can be used as the basis for the development of diagnostic interviews and measures of CBSD severity.

The Potential of Digital Phenotyping and Mobile Sensing for Psycho-Diagnostics of Internet Use Disorders

Purpose of Review

The present paper provides an accessible overview on the potential of digital phenotyping and mobile sensing not only shedding light on the nature of Internet Use Disorders (IUD), but also to provide new ideas on how to improve psycho-diagnostics of mental processes linked to IUD.

Recent Findings

In detail, the psycho-diagnostic areas of prevention, treatment, and aftercare in the realm of IUDs are focused upon in this work. Before each of these areas is presented in more specificity, the terms digital phenotyping and mobile sensing are introduced against the background of an interdisciplinary research endeavor called Psychoinformatics. Obstacles to overcome problems in this emerging research endeavor—sensing psychological traits/states from digital footprints—are discussed together with risks and chances, which arise from the administration of online-tracking technologies in the field of IUDs.

Summary

Given the limited validity and reliability of traditional assessment via questionnaires or diagnostic interviews with respect to recall bias and tendencies to answer towards social desirability, digital phenotyping and mobile sensing offer a novel approach overcoming recall bias and other limitations of usual assessment approaches. This will not only set new standards in precisely mapping behavior, but it will also offer scientists and practitioners opportunities to detect risky Internet use patterns in a timely manner and to establish tailored feedback as a means of intervention.

Player-avatar interactions in habitual and problematic gaming: A qualitative investigation

BACKGROUND AND AIMS

Previous studies have reported that stronger avatar identification and negative self-concept are associated with gaming disorder (GD). This study aimed to examine the value and significance of avatars based on firsthand accounts from regular and problematic gamers, and to identify any potential links between avatar-related experiences and excessive gaming.

METHODS

An online survey of 993 adult gamers yielded 3,972 text responses. Qualitative analysis of 59,059 words extracted 10 categories of avatar-related perspectives.

RESULTS

Some problem and non-problem gamers employed sentimental language (e.g., 'dear friend', 'like a child', 'part of my soul') to refer to their avatar. However, most participants perceived avatars as a means of achieving in-game goals and enabling greater interactivity (e.g., socializing). When asked to reflect on hypothetically losing their avatar, participants generally anticipated feeling temporary frustration or annoyance due to lost time and effort invested into the avatar. Although some participants reported that their avatar 'mattered', avatars were often considered as superficial ('just pixels') and peripheral to the primary reinforcement of achieving in-game rewards and objectives. Some broader psychological and identity issues such as gender dysphoria, rather than 'addiction', were cited as motivating persistent avatar-related interactions and attachment.

DISCUSSION AND CONCLUSIONS

Participants reported diverse views on the psychological value and function of avatars, but the relationship between avatars and problematic gaming or GD was largely unclear or inconsistent, and refuted by some participants. Future research with clinical samples may lead to a better understanding of player-avatar processes, including whether avatar-stimuli facilitate the development of maladaptive gaming habits, particularly among psychologically vulnerable players. Future investigations should be mindful of 'overpathologizing' avatar-related phenomena and recognize their important role in socializing, storytelling, and creative expression among gamers.

Social-networks-related stimuli interferes decision making under ambiguity: Interactions with cue-induced craving and problematic social-networks use

BACKGROUND AND AIMS

Social-networks-use disorder is discussed as a potential further type of disorders due to addictive behaviors. Theoretical models assume cue-induced craving and disadvantageous decision making to be relevant mechanisms. This study investigates if the presentation of social-networks-related cues interferes with decision making under ambiguity.

METHODS

Craving was induced with a cue-reactivity paradigm and assessed with a visual analogue scale. Participants (N = 146) played a modified Iowa Gambling Task with social-networks-related cues and neutral cues presented on the advantageous and disadvantageous decks respectively, or vice versa. Symptoms of social-networks-use disorder were measured with a modified version of the short Internet Addiction Test.

RESULTS

Overall, participants chose options with neutral cues more often than those with social-networks-related cues, even if it was disadvantageous. There was a significant interaction between decision-making performance and Iowa Gambling Task condition in predicting symptom severity. The results indicate that choosing decks with social-networks-related cues even if it was disadvantageous is associated with higher tendencies towards a social-networks-use disorder. The interaction with cue-induced craving did not explain further variance.

DISCUSSION AND CONCLUSIONS

The results highlight the relevance of cue reactivity, decision making, and their interaction as potential mechanisms explaining tendencies towards a social-networks-use disorder. Decision making was influenced by affective responses, which could result in a higher risk of a potential addictive behavior. This is consistent with the findings from addiction research and with theoretical approaches assuming an imbalance between affective and cognitive processes in addictive behaviors.

Affective and cognitive processes involved in behavioral addictions

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

Suchtartiges Arbeiten: Persönlichkeitsfaktoren und berufliche Rahmenbedingungen

Zusammenfassung. Fragestellung: Suchtartiges Arbeiten stellt ein ernst zu nehmendes Problem in unserer Gesellschaft dar. In dieser Studie wird der Frage nachgegangen, welche Rolle berufliche Rahmenbedingungen (Entgrenzung der Arbeit) und Persönlichkeitsfaktoren (Big Five) bei suchtartigem Arbeiten spielen. Methode: 111 Erwerbstätige im Alter von 19 bis 66 Jahren beantworteten online den Persönlichkeitstest Big Five Inventory-SOEP, den Fragebogen zur Erfassung zentraler Merkmale der Arbeit 4.0 und die Skala zur Erfassung von Arbeitssucht. Die statistischen Auswertungen (Korrelationsanalysen, moderierte Regressionsanalyse) erfolgten mittels „R“ und „PSPP“. Ergebnisse: Suchtartiges Arbeiten korreliert signifikant mit Entgrenzung (r = .208), Neurotizismus (r = .356) und dem Alter der Probanden (r = -.321). Alle drei Prädiktoren zusammen erklären insgesamt 29 Prozent der Varianz von suchtartigem Arbeiten. Es konnte kein moderierender Effekt der Variablen Entgrenzung der Arbeit auf den Zusammenhang zwischen Neurotizismus und suchtartigem Arbeiten gefunden werden. Schlussfolgerungen: Neben dem Persönlichkeitsfaktor Neurotizismus und dem Alter spielen bei der Vorhersage suchtartigen Arbeitens auch das Ausmaß der Entgrenzung der Arbeit eine relevante Rolle. Die Ergebnisse sind vor dem Hintergrund der Covid-19-Pandemie relevant, da bei Mitarbeitern im Homeoffice die Grenzen von Arbeit und Privatleben besonders stark verwischen.

Perceived Strain Due to COVID-19-Related Restrictions Mediates the Effect of Social Needs and Fear of Missing Out on the Risk of a Problematic Use of Social Networks

The occurrence of the COVID-19-virus led to drastic short-term measures to reduce its spread and influence. Regulations such as "physical distancing," mentioned as "social distancing," and the closure of public facilities during the lockdown could be perceived as burdensome especially by individuals who feel a strong need for social exchange and belonging. These components such as need to belong and the fear of missing out also play a major role in the development and maintenance of a problematic use of social networks. Researchers have argued recently that an increase of addictive (online) behaviors may be a likely consequence of subjectively experienced restrictions in the context of the COVID-19 pandemic. The current study investigates the interplay of perceived strain due to COVID-19-related restrictions and the fear of missing out (FoMO) as well as of symptoms of problematic social-networks use. We hypothesized that perceived strain due to COVID-19-related restrictions mediates the effect of specific predisposing variables related to social needs on the symptom severity of a problematic use. To assess the perceived strain due to COVID-19-related restrictions, we developed a specific questionnaire asking for perceived COVID-19-related strain in several domains of everyday-life. An exploratory factor analysis identified five factors: perceived strain related to restrictions of (1) social contacts, (2) travel, (3) childcare, (4) work, and (5) own health. In a sample of 719 German participants and data collection during the first COVID-19 lockdown (March 30th until April 3rd 2020), a structural equation model was calculated showing that higher levels of need to belong and FoMO increase perceived COVID-19-related strain, which is related to symptoms of a problematic social-networks use. The effect of need to belong on problematic social-networks use is mediated by experienced COVID-19-related strain and FoMO-online. Even if the use of social networks is not pathological per se, it may be associated with suffering for a vulnerable part of users. We conclude that specific needs and fear-associated predisposing variables contribute to experiencing physical distance and other pandemic-related restrictions as more stressful, which may increase problematic social-networks use and potentially other addictive behaviors as well in the context of the COVID-19-related lockdown.

Deficits in executive functions but not in decision making under risk in individuals with problematic social-network use

BACKGROUND

The tendency to strive for immediate gratification by neglecting potential negative long-term outcomes characterizes addictive behaviors, such as substance use or gaming disorder. Problematic social-network use is currently discussed as another potential addictive behavior, which is considered to result from an imbalance between affective and cognitive processes, indicated by traits such as increased impulsivity and/or decreased executive functions and decision-making abilities.

METHODS

This study investigates the respective functions in social-network users by use of the Cards and Lottery Task (CLT) - a decision-making task under risk conditions in which options contain conflicting immediate and long-term outcomes at the same time. A sample of German and Spanish participants (N = 290) performed the CLT as well as the Modified Card Sorting Test (MCST), Barratt Impulsiveness Scale (BIS), the short Internet Addiction Test specified for social-networking (sIAT-SNS), and screeners on other potentially problematic behaviors.

RESULTS

Comparing extreme groups based on sIAT-SNS scores (1SD above/below mean), individuals with problematic social-network use (n = 56), as compared to those with non-problematic social-network use (n = 50), showed increased attentional impulsivity and reduced executive functions. No differences were observed in decision-making performance.

CONCLUSION

The findings indicate that problematic social-network use is related to attentional rather than general decision-making deficits. Furthermore, problematic social-network use is likely to co-occur with other problematic Internet-use behaviors, particularly gaming or shopping.

Assessing Problematic Social Media Use in Adolescents by Parental Ratings: Development and Validation of the Social Media Disorder Scale for Parents (SMDS-P)

Background: The problematic use of social media (SM) is a rising phenomenon, especially in adolescents. It can be assessed by self-rating screeners such as the Social Media Disorder Scale (SMDS). However, young age or symptom denial might reduce adolescent assessment accuracy. Therefore, the development and validation of a parental scale (SMDS-P) is desirable. Method: A representative sample of 961 parents and corresponding frequently SM-using children aged 10 to 17 years participated in an online study. Factorial analyses were performed to determine item structure. Adolescents’ SMDS self-reports, SM usage time, emotional dysregulation, and academic performance were used to assess validity. The SMDS-P cut-off value was calculated by ROC-analysis. Results: A one-factorial structure of the SMDS-P could be confirmed. The internal consistency was good (Cronbach’s α = 0.85, McDonald’s ω = 0.88) and the accordance between parental and self-ratings moderate (kappa = 0.51). SMDS-P was positively associated with adolescents’ self-ratings (r = 0.68), SM usage time (r = 0.26) and frequency (ϱ = 0.16) as well as with emotional dysregulation (r = 0.35) in a highly significant manner. Conclusions: SMDS-P offers a promising new approach to assess problematic SM usage in adolescence. Further studies including clinical validations are required.

Adolescent gaming and social media usage before and during the COVID-19 pandemic

Abstract. Background: The COVID-19 pandemic has raised concerns about a potential increase of addictive behaviors. Adolescents are considered particularly vulnerable to a problematic usage of digital applications. For the first systematic investigation of screen time and problematic usage patterns over the course of the pandemic, a pre-pandemic survey on adolescent social media (SM) and gaming use was extended to a longitudinal study. Here we present the results of the first two measurements points (pre-pandemic/under lockdown). Methods: A representative sample of 1,221 adolescents (10–17 years) participated in an online survey in 09/2019, 824 of them in 04/2020. Prevalence rates were measured at baseline with standardized scales covering ICD-11 criteria for problematic usage patterns. These were statistically compared and related to pre- and under-lockdown screen time. Results: Pre-pandemic prevalence rates for pathological SM/gaming were about 3 % each, for at-risk usage 8–10 % including more boys than girls. Usage frequencies and screen times significantly increased under the lockdown. The predictive value of usage patterns for screen time decreased from before to during the lockdown. Changes in screen time could not be predicted by the usage pattern. Discussion: The stability of the observed rates and effects should be further examined over the course of the pandemic. This will lead to relevant implications for prevention measures and the allocation of intervention resources.

Problematische Nutzung sozialer Netzwerke

Hintergrund

Die Nutzung sozialer Netzwerke ist ein zentraler Bestandteil des Alltags. Neben vielen Vorteilen wird jedoch zunehmend von subjektiven Beeinträchtigungen und negativen Konsequenzen aufgrund einer exzessiven, unkontrollierten Nutzung berichtet. Parallelen zu anderen internetbezogenen Verhaltenssüchten und substanzgebundenen Störungen lassen vermuten, dass Konstrukte wie Impulsivität, das Erleben von Craving und eine beeinträchtige Inhibitionskontrolle ebenfalls Risikofaktoren bei der Entwicklung und Aufrechterhaltung einer problematischen Nutzung sozialer Netzwerke darstellen.

Material und Methode

In der vorliegenden Experimentalstudie mit 64 Teilnehmenden im Alter von 18 bis 59 Jahren wurden ein auditives „Cue-reactivity“-Paradigma sowie eine modifizierte Version der Stopp-Signal-Aufgabe zur Erfassung von Reizreaktivität und Inhibitionskontrolle eingesetzt. Zur Erhebung von Craving, Impulsivität und der Symptomschwere einer problematischen Nutzung sozialer Netzwerke wurden Fragebogen verwendet.

Ergebnisse

Die Ergebnisse zeigen, dass die Tendenz einer problematischen Nutzung mit einer höheren Impulsivität und Craving einhergeht. Die Inhibitionskontrolle sowie die Interaktion zwischen den verschiedenen Konstrukten konnten keine weitere Beiträge zur Varianzaufklärung der Symptomschwere leisten.

Schlussfolgerung

Die Ergebnisse illustrieren die Bedeutsamkeit von Impulsivität und Craving bei der Entwicklung und Aufrechterhaltung einer problematischen Nutzung sozialer Netzwerke. Darüber hinaus gilt es, die Spezifität der einzelnen Reize hinsichtlich des möglichen Konfliktpotenzials und Aufforderungscharakters sowie die damit einhergehende Relevanz spezifischer kognitiver Komponenten in weiteren Studien zu prüfen.

A systematic review on the intersection of attention-deficit hyperactivity disorder and gaming disorder

INTRODUCTION

Studies of Gaming Disorder (GD) consistently identify co-morbidity with various psychiatric disorders including major depression, obsessive compulsive disorder and anxiety disorders. One of the strongest associations has been with Attention Deficit Hyperactivity Disorder (ADHD). We present a systematic review of this association by pooling and integrating available evidence.

METHODS

PubMed, EMBASE, PsychInfo and CINHAHL were searched for articles that reported a quantitative association between GD and ADHD and its dimensions, using equivalent search terms. Quality appraisal was done using criteria adapted from the Critical Appraisal Skills Package (CASP) checklists.

RESULTS

1028 articles were identified, of which 29 studies were included for systematic review (n = 56650 participants). Most of these studies were observational in nature, and were of moderate quality, with deficits particularly in the domains of generalisability and confounding. Community surveys (n = 18) of purposive samples constituted the majority, with fewer clinic-based samples (n = 11). While ADHD symptoms were consistently associated with GD, More frequent associations were displayed with inattention associations with GD than other ADHD subscales. There were no conclusive findings regarding the type of game on severity of either condition, or on completion of treatment.

CONCLUSIONS

The findings suggest an association between ADHD and GD, although the direction of the relationship is unclear. This has implications for clinical practice, policy and research. We recommend that ADHD is screened for when evaluating IGD as part of routine practice."

Expanding on the multidisciplinary stakeholder framework to minimize harms for problematic risk-taking involving emerging technologies. •

As new types of problematic behaviors and new forms of online risk-taking emerge, forming collaborative relationships while understanding complexities of motivations may help to promote harm reduction and intervention. While it may be too early to form a stakeholder framework without first conceptually understanding the problematic behaviors involved, we attempt to build upon a proposed multidisciplinary stakeholder framework to minimize harms for problematic risk-taking involving emerging technologies. We propose an expansion of roles for individual stakeholders and an expansion of proposed roles for family stakeholders to include partner/spouses, others living in the household, and/or those with close relationships with individuals who are experiencing problems. Empowering individuals who use emerging technologies through participatory action research and knowledge translation/dissemination may lead to improvements in the quality of research and a greater impact on policy and practice. Also, we discuss benefits of industry self-regulation and collaboration on data-sharing practices. We recommend approaches to promote global collaboration with a larger group of relevant stakeholders (including but not limited to individual consumers of technology, families, communities, treatment and welfare providers, researchers, industries, and governments) to address protection of vulnerable populations and reduce harms for users of rapidly advancing technologies.

Problematic shopping and self-injurious behaviors in adolescents

BACKGROUND AND AIMS

Self-injurious behaviors (SIBs) and problematic shopping (PS) are both prevalent in adolescents. These behaviors have been proposed as behavioral addictions and linked to impulsivity (Imp) and sensation-seeking (SS). They are also associated with negative mental health and psychosocial measures. This study examined relationships between PS and SIB in adolescents. It also examined how PS and SIB relate to Imp and SS, and interactions between PS and SIB in relation to health/functioning measures.

METHODS

Survey data from 2,624 Connecticut high-school students were evaluated using chi-square analyses. Next, logistic regression models were used to assess relationships between PS and measures of SIB. T-tests compared Imp and SS in adolescents with and without PS and SIB. Interaction analyses assessed effects of PS on relationships between SIB and health/functioning measures.

RESULTS

Adolescents with PS had 3.43-fold higher odds of endorsing lifetime SIB than those without PS, and were more likely to exhibit severe SIB and disruption due to SIB. PS and SIB were associated with elevated Imp and SS. Interaction analyses revealed that in adolescents with PS, the relationships between SIB and substance use was weaker than in adolescents without PS. This suggests PS accounts for variance in relationships between SIB and substance use.

DISCUSSION AND CONCLUSIONS

PS is strongly related to SIB prevalence, severity, and impairment in adolescents, and weakens associations between SIB and substance use. PS should therefore be considered for prevention efforts for SIB. Further research should investigate mechanisms connecting PS and SIB and explore possible interventions targeting associated features like Imp and SS.

Addressing taxonomic challenges for Internet Use Disorders in light of changing technologies and diagnostic classifications. •

Drawing a distinction between mobile and non-mobile Internet Use Disorders is an important step to clarify blurred current concepts in the field of behavioral addictions. Similarly, future technological advances related to virtual or augmented reality, artificial intelligence or the Internet of things might lead to further modifications or new taxonomies. Moreover, diagnostic specifiers like offline/online might change with technological advances and trends of use. An important taxonomical approach might be to look for common structural characteristics of games and applications that will be amenable to new technical developments. Diagnostic and taxonomical approaches based on empirical evidence are important goals in the study of behavioral addictions.

[The Pathological Buying Screener: Validation in a Clinical Sample]

AIM

The aim of the study was to evaluate the psychometric properties of the 13-item Pathological Buying Screener (PBS, [1]) in a clinical sample.

METHOD

The PBS was administered to a total sample of 413 treatment-seeking patients (buying-shopping disorder n=151, gambling disorder n=59, alcohol dependency n=60, other mental disorders [anxiety, depressive, eating, somatoform disorders] n=143). Factor structure was tested in the total sample using confirmatory factor analysis (CFA), reliability was determined by means of Cronbach's α. Group comparisons were used to determine to which degree the PBS discriminates between patients with BSD and other clinical groups. The BSD-group completed a battery of other measures to explore convergent and divergent validity. A subgroup (n=29) answered the PBS before and after psychotherapy to investigate sensitivity to change. A receiver operating characteristic (ROC) curve analysis with PBS data of patients with buying-shopping disorder and those from a previous community sample 1 was performed to define a cut-off point for buying-shopping disorder.

RESULTS

The CFA showed a good model fit for both a one-factor and a two-factor structure with the subscales "loss of control/consequences" (10 items) and "excessive buying behavior" (3 items). The subscales were highly intercorrelated (r=0.92). A hierarchical regression analysis with another BSD measure as dependent variable did not indicate an own incremental validity of the subscale "excessive buying behavior". Good convergent, divergent and discriminative capacity was obtained for the PBS total score. At its recommended cut-off point of ≥29 the PBS has a sensitivity of 98% and a specificity of 94.7%.

CONCLUSION

The findings indicate good psychometric properties of the PBS and suggest that the PBS total score can be used in clinical settings.

Covid-19-Pandemie und Verhaltenssüchte

Zusammenfassung. Einführung und Zielsetzung: Die COVID-19 Pandemie und die entsprechenden Lockdown-Maßnahmen verdeutlichen, dass besondere Strategien der Verhaltens- und Verhältnisprävention für Online-Verhaltenssüchte notwendig sind. Begründung: Die Wahrscheinlichkeit ist hoch, dass die COVID-19 Krise und die begleitenden Maßnahmen zu deren Eindämmung die Risiken für die Entwicklung von Verhaltenssüchten erhöht haben. Dazu tragen Faktoren wie Fortfall von terrestrischen Angeboten, soziale Isolation und erzwungene Inaktivität sowie Bedeutungsgewinn von Online-Angeboten bei. Gleichzeitig können als Folge bei bereits bestehenden Störungen die Schwere zu- und Remissionschancen abgenommen haben. Auch von einem erhöhten Rückfallrisiko kann ausgegangen werden. Schlussfolgerung: Es sind epidemiologische Studien notwendig, um veränderte Prävalenzen, Versorgungsbedarfe und geänderte Risikofaktoren zu erfassen. Es besteht die Notwendigkeit, Maßnahmen der Verhältnis- und Verhaltensprävention zu entwickeln und umzusetzen. Die Identifizierung von Risikoverhalten wäre durch Tracking des Online-Verhaltens möglich und könnte Ausgangspunkt für Maßnahmen wie Spiel- oder Anwendungspausen, Warnhinweise und Verbraucherschutzinformationen sowie konkrete Angebote der Frühintervention oder weitergehende Hilfen sein. Die Anbieter stehen hier in der Pflicht, Verantwortung für ihre Produkte zu übernehmen, das Risiko von Verhaltenssüchten zu minimieren und Maßnahmen von Frühentdeckung und Intervention zu ermöglichen und bereitzustellen.

Self-Reported Screen Time on Social Networking Sites Associated With Problematic Smartphone Use in Chinese Adults: A Population-Based Study

Background: Problematic smartphone use (PSU) has been associated with screen time in general, but little is known about the effect of different screen-based activities. We examined the associations of self-reported time spent on overall and specific screen-based activities with PSU and its addictive symptoms in Hong Kong Chinese adults. Methods: We analyzed data from 562 smartphone owners (56.5% female; 82.1% aged 25-64 years) in a population-based telephone survey in 2017. PSU was measured using Smartphone Addiction Scale-Short Version (range 10-60) which includes symptoms of daily-life disturbance, withdrawal, cyberspace-oriented relationship, overuse, and tolerance. Screen time was self-reported as average hours per day spent on the internet, online book/newspaper/magazine, online video, and social networking sites (SNS). Multivariable linear regression analyzed the associations of self-reported screen time with PSU severity and symptoms. Interaction effects of sex, age group, educational attainment, and monthly household income were examined. Results: Self-reported time spent on overall screen-based activities was associated with PSU severity (β = 1.35, 95% CI 0.15, 2.55) and withdrawal and overuse symptoms, after adjusting for sociodemographic and health-related variables. Independent association was observed for self-reported SNS time with PSU severity (β = 1.42, 95% CI 0.35, 2.49) and symptoms of withdrawal and cyberspace-oriented relationship, after mutually adjusting for time on other activities. The strongest association between self-reported SNS time and PSU severity was observed in younger than older adults (β = 4.36, 95% CI 2.58, 6.13; P for interaction = 0.004). Conclusions: The independent association of self-reported SNS time with PSU and core addictive symptoms highlighted the addiction potential of SNS use, particularly in younger users.