A cognitive-behavioral model of Internet gaming disorder: theoretical underpinnings and clinical implications

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

BACKGROUND

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

METHODS

Narrative review, experts' opinions.

RESULTS

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

CONCLUSION

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

Relationships of internet gaming reasons to biological indicators and risk of internet gaming addiction in Korean adolescent male game users

BACKGROUND

There are no standard diagnostic criteria or interventions for internet gaming addiction (IGA) even though IGA is one of the most pervasive public health issues among youth worldwide. Internet gaming reasons or motivations have been studied as a potential predictor of IGA, but the results have been inconsistent and biological indicators of gaming reasons have rarely been studied. We sought to (1) identify categories of internet gaming reasons, (2) examine the relationship of gaming reasons to risk of IGA, and (3) describe biological indicators associated with reasons for gaming.

METHODS

We used a multi-phase cross-sectional design including individual interviews; focus group discussion; and descriptive, comparative analysis. Fifteen Korean adolescent male internet gamers participated in individual interviews and eight participated in a focus group aimed at identifying reasons for internet gaming. Using the identified gaming reasons from these sources we surveyed 225 adolescent game users using a self-report questionnaire. Participants provided blood samples for assessment of norepinephrine (NE) and serum cortisol.

RESULTS

We identified four major categories of internet gaming reasons: entertainment, getting along with friends, stress relief, and habitual gaming. The habitual group showed significantly greater risk of IGA than the other groups (p < .001) and the lowest plasma NE levels (p = .035), possibly indicating an alteration in autonomic function.

CONCLUSION

Health care providers are encouraged to screen adolescents for excessive internet gaming and to intervene with those who report habitual gaming behaviors. When feasible, assessment of biological indicators, such as plasma NE, may help to identify youth at greatest risk of IGA.

A Multimodal Analysis Combining Behavioral Experiments and Survey-Based Methods to Assess the Cognitive Effect of Video Game Playing: Good or Evil?

This study aims to bridge the gap between the discrepant views of existing studies in different modalities on the cognitive effect of video game play. To this end, we conducted a set of tests with different modalities within each participant: (1) Self-Reports Analyses (SRA) consisting of five popular self-report surveys, and (2) a standard Behavioral Experiment (BE) using pro- and antisaccade paradigms, and analyzed how their results vary between Video Game Player (VGP) and Non-Video Game Player (NVGP) participant groups. Our result showed that (1) VGP scored significantly lower in Behavioral Inhibition System (BIS) than NVGP (p = 0.023), and (2) VGP showed significantly higher antisaccade error rate than NVGP (p = 0.005), suggesting that results of both SRA and BE support the existing view that video game play has a maleficent impact on the cognition by increasing impulsivity. However, the following correlation analysis on the results across individual participants found no significant correlation between SRA and BE, indicating a complex nature of the cognitive effect of video game play.

Low self-control and aggression exert serial mediation between inattention/hyperactivity problems and severity of internet gaming disorder features longitudinally among adolescents

OBJECTIVES

We examined serial mediating roles of low self-control and aggression in explaining relationships between levels of inattention and hyperactivity problems (IHPs) and severity of Internet gaming disorder (IGD) features when exposed to online games among adolescents without Attention deficit hyperactivity disorder (ADHD) stratified by gender using three-wave longitudinal study.

METHOD

The sample comprised a total of 1,732 family dyads from a study that was conducted among seventh graders without diagnoses of ADHD at baseline. Levels of IHPs were assessed by the parent reported Korean version of the ADHD rating scale at baseline (wave1). Severity of IGD features was assessed by the Internet Game Use-Elicited Symptom Screen (IGUESS) at wave3. Both levels of self-control (wave1) and aggression (wave2) were assessed by self-report. The mediating role of low self-control and aggression in the relationships between level of IHPs and severity of IGD were evaluated using serial mediation analysis separately for each gender.

RESULTS

Levels of IHPs were related directly to severity of IGD features in both genders. The indirect effects via low self-control were also significant in both genders, however, the indirect effects via aggression was significant only in women. The serial mediation effect via low self-control and aggression between levels of IHPs and IGD features was significant in both genders (men, coefficient:0.009, 95%CI 0.005-0.019; women, coefficient:0.010, 95%CI:0.005-0.026).

CONCLUSION

We revealed a possible mechanism underlying a serial mediation chain from low self-control to aggression explaining the effects of IHPs on severity of IGD features. However, this conclusion should be taken with a caution, because the effect sizes were very low.

Inhibitory neuromodulation of the putamen to the prefrontal cortex in Internet gaming disorder: How addiction impairs executive control

BACKGROUND AND AIMS

Individuals with addictive disorders are usually characterized by impaired executive control, persistent craving and excessive reward-seeking. However, it is unclear whether there is a deviation in the connection pattern among the neural systems implicated in these problem behaviors.

METHODS

One hundred thirty-six online gaming players were recruited in the current study (68 Internet gaming disorder (IGD) subjects and 68 recreational game users (RGUs) who served as controls matched on age, sex, years of education, and years of gaming). Dynamic interactions among the reward system (striatum), control system (prefrontal cortex), and the interoceptive awareness system (insula) were calculated and compared when subjects were facing gaming cues.

RESULTS

The results revealed that RGUs showed a significant positive correlation in the putamen-middle frontal gyrus (MFG)-insula neural pathway when facing gaming cues, which was missing in the IGD subjects. Additionally, dynamic causal modeling (DCM) analysis revealed that the MFG region was more inhibited by the putamen in the IGD subjects relative to the RGUs.

CONCLUSIONS

These findings suggest that the inhibitory neuromodulation of the putamen to the prefrontal cortex in IGD individuals undermines the balance among the tripartite systems. Our findings provide novel neurobiological evidence for understanding the internal connection bias of the addicted individual's neural system and how the addictive disorder impairs executive control; consequently, the pathway from the striatum to the prefrontal cortex may serve as a potential biomarker to predict the risk of developing an addiction.

Aberrant structural network of comorbid attention deficit/hyperactivity disorder is associated with addiction severity in internet gaming disorder

BACKGROUND

Internet gaming disorder (IGD) is commonly comorbid with attention-deficit/hyperactivity disorder (ADHD). Although the addiction is more severe when comorbid with ADHD, little is known about the neural correlates of the association. This study aimed to identify whether an ADHD-related structural brain network exists in IGD patients with comorbid ADHD (IGDADHD+) by comparing them with those without comorbid ADHD (IGDADHD-) and elucidating how the sub-network is associated with addiction severity.

METHODS

Brain structural networks were constructed based on streamline tractography with diffusion tensor imaging in a cohort of 46 male IGDADHD+ patients, 48 male IGDADHD- patients, and 34 healthy controls (HC). We used network-based statistics (NBS) to identify the sub-network differences between the two IGD groups. Furthermore, the edges in the sub-network that significantly contributed to explaining the Young Internet Addiction Scale (YIAS) score were delineated using partial least square (PLS) regression analyses in IGD patients.

RESULTS

The YIAS score was higher in the IGDADHD+ group than in the IGDADHD- group and was correlated with the Korean Dupaul's ADHD scale score (r = 0.42, p <0.01). The NBS detected a sub-network with stronger connectivity in the IGDADHD+ group than in the IGDADHD-group. The PLS regression model showed that the sub-network is associated with the YIAS score in the IGDADHD+ group (q2 = 0.019). Edges connecting the left pre- and postcentral gyri, bilateral superior frontal gyri, medial orbital parts, and left fusiform to the inferior temporal gyrus were most important predictors in the regression model.

CONCLUSION

Our results suggest that an aberrant increase in some structural connections within circuits related to inhibitory function or sensory integration can indicate how comorbid ADHD is associated with addiction severity in IGD.

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.

Cognitive control and reward/loss processing in Internet gaming disorder: Results from a comparison with recreational Internet game-users

Although playing of Internet games may lead to Internet gaming disorder (IGD), most game-users do not develop problems and only a relatively small subset experiences IGD. Game playing may have positive health associations, whereas IGD has been repeatedly associated with negative health measures, and it is thus important to understand differences between individuals with IGD, recreational (non-problematic) game use (RGU) and non-/low-frequency game use (NLFGU). Individuals with IGD have shown differences in neural activations from non-gamers, yet few studies have examined neural differences between individuals with IGD, RGU and NLFGU. Eighteen individuals with IGD, 21 with RGU and 19 with NFLGU performed a color-word Stroop task and a guessing task assessing reward/loss processing. Behavioral and functional imaging data were collected and compared between groups. RGU and NLFGU subjects showed lower Stroop effects as compared with those with IGD. RGU subjects as compared to those with IGD demonstrated less frontal cortical activation brain activation during Stroop performance. During the guessing task, RGU subjects showed greater cortico-striatal activations than IGD subjects during processing of winning outcomes and greater frontal brain during processing of losing outcomes. Findings suggest that RGU as compared with IGD subjects show greater executive control and greater activations of brain regions implicated in motivational processes during reward processing and greater cortical activations during loss processing. These findings suggest neural and behavioral features distinguishing RGU from IGD and mechanisms by which RGU may be motivated to play online games frequently yet avoid developing IGD.

The Associations between Family-Related Factors and Excessive Internet Use in Adolescents

This study examined the relationship between Excessive Internet Use (EIU) in adolescents and their family environment, namely the family type, the family economic status, the effect of parental care, the level of parental control, the amount of parental monitoring, the quality of communication, and the time spent together. The study was based on data from an international survey, Health Behaviour in School Aged Children (HBSC), conducted in Slovakia. The sample representative for adolescents included 2547 participants (51% boys) aged 13–15. Multiple-step linear regression revealed that higher parental care and parental monitoring predicted lower EIU, while higher parental overprotection and lower socioeconomic status predicted higher EIU. The results suggest that both so-called optimal parenting (i.e., the balance of emotional warmth and protection) and the adolescent′s autonomy lower the risk of EIU. Family factors explained about 14% of the variance, which suggests that aside from personal, cognitive and affective factors, a close social environment also plays an important role in adolescence EIU.

Interactions of impulsivity, general executive functions, and specific inhibitory control explain symptoms of social-networks-use disorder: An experimental study

While the use of social media and online-communication applications has become an integral part of everyday life, some individuals suffer from an excessive, uncontrolled use of social media despite experiencing negative consequences. In accordance with neuropsychological models of addiction, we assume the tendency of a social-networks-use disorder to be related to an interplay of predisposing personality traits (e.g., impulsivity), and reductions in cognitive functions (e.g., executive functions, inhibitory control). The current study makes first strides towards examining this interplay. In addition to a newly developed social-networks-specific auditory Go-NoGo paradigm, other neuropsychological paradigms were used. Impulsivity and social-networks-use-disorder symptoms were assessed by standardized questionnaires. The results show that the symptom severity of a social-networks-use disorder is mainly associated with attentional impulsivity. General executive functions and specific inhibitory control of social-networks-related cues have no direct effect on symptom severity. However, moderated regression analyses emphasize that increased symptom severity is associated with higher attentional impulsivity, especially if there are additionally reductions in executive functions or specific inhibitory control. The results complement previous findings and inform future research on social-networks-use disorder. The findings support the applicability of theoretical models of addictive behaviors to the social-networks-use disorder and point to social-networks-related specificities regarding attention-related facets.

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.

Altered brain activities associated with cue reactivity during forced break in subjects with Internet gaming disorder

BACKGROUND

Studies have proven that forced break can elicit strong psychological cravings for addictive behaviors. This phenomenon could create an excellent situation to study the neural underpinnings of addiction. The current study explores brain features during a cue-reactivity task in Internet gaming disorder (IGD) when participants were forced to stop their gaming behaviors.

METHODS

Forty-nine IGD subjects and forty-nine matched recreational Internet game users (RGU) were asked to complete a cue-reactivity task when their ongoing gaming behaviors were forced to break. We compared their brain responses to gaming cues and tried to find specific features associated with IGD.

RESULTS

Compared with RGU, the IGD subjects showed decreased activation in the anterior cingulate cortex (ACC), parahippocampal gyrus, and dorsolateral prefrontal cortex (DLPFC). Significant negative correlations were observed between self-reported gaming cravings and the baseline activation level (bate value) of the ACC, DLPFC, and parahippocampal gyrus.

CONCLUSIONS

IGD subjects were unable to suppress their gaming cravings after unexpectedly forced break. This result could also explain why RGU subjects are able to play online games without developing dependence.

Impaired regulation of both addiction-related and primary rewards in individuals with internet gaming disorder

Poor executive function (EF) has been implicated in addictions. Among "hot" EFs (i.e., those involving motivations and emotions), poor regulation of craving has been proposed to underlie addiction development in substance-use disorders (SUDs), making such regulation a potential treatment target. However, regulation of craving remains poorly understood in internet gaming disorder (IGD). Additionally, prior studies of cold EFs (e.g., inhibition and cognitive flexibility under neutral conditions) in IGD have provided mixed results and mostly included only male subjects. We addressed these issues by instructing 54 participants (26 with IGD including males and females, and 28 control subjects) to perform a regulation-of-craving (ROC) task and a Stroop color-word-interference task. Compared to control subjects, individuals with IGD revealed deficits in regulation for both gaming- and food-related craving, but no differences in Stroop performance. The current study provides initial empirical support suggesting regulation impairments for both addiction-related and primary rewards among individuals with IGD. The findings are consistent with studies in SUDs, suggesting that impaired regulation of craving may be a relevant transdiagnostic construct across SUDs and behavioral addictions. The findings suggest targeting regulation of "hot" processes should be considered in IGD treatment development.

Screening and assessment tools for gaming disorder: A comprehensive systematic review

The inclusion of gaming disorder (GD) as an official diagnosis in the ICD-11 was a significant milestone for the field. However, the optimal measurement approaches for GD are currently unclear. This comprehensive systematic review aimed to identify and evaluate all available English-language GD tools and their corresponding evidence. A search of PsychINFO, PsychArticles, ScienceDirect, Scopus, Web of Science, and Google Scholar identified 32 tools employed in 320 studies (N = 462,249 participants). The evaluation framework examined tools in relation to: (1) conceptual and practical considerations; (2) alignment with DSM-5 and ICD-11 criteria; (3) type and quantity of studies and samples; and (4) psychometric properties. The evaluation showed that GD instrumentation has proliferated, with 2.5 tools, on average, published annually since 2013. Coverage of DSM-5 and ICD-11 criteria was inconsistent, especially for the criterion of continued use despite harm. Tools converge on the importance of screening for impaired control over gaming and functional impairment. Overall, no single tool was found to be clearly superior, but the AICA-Sgaming, GAS-7, IGDT-10, IGDS9-SF, and Lemmens IGD-9 scales had greater evidential support for their psychometric properties. The GD field would benefit from a standard international tool to identify gaming-related harms across the spectrum of maladaptive gaming behaviors.

The influence of environmental pressure on Internet Use Disorder in adolescents: The potential mediating role of cognitive function

PURPOSE

The current study attempts to clarify the mediating role of cognitive function on the relationship between environmental pressure (pressure caused by negative parenting styles and dysfunctional school environments) and Internet Use Disorder (IUD); this study explores the effects of sex and left-behind children (LBC).

METHODS

A cross-sectional sample of adolescents aged 12-15 years was recruited in 2018. A total of 3048 junior high school adolescents in rural areas of the Sichuan province in western China completed a series of psychological inventories, including the Adolescent Pathological Internet Use Scale (APIUS), the Junior High School Students' Perceived School Climate Inventory (PSCI-M), the Egna Minnen av. Barndoms Uppfostran (EMBU), and the Mental Health Screening Inventory for Children and Adolescents (MHS-C), for an analysis of IUD, school climate, parenting styles and cognition, respectively.

RESULTS

Among the participants, 18.5% (N = 565) exhibited significant symptoms of IUD. The correlation analysis showed that IUD was positively correlated with parents' punishment, rejection and over-interference and academic pressure, whereas IUD was negatively associated with good teacher-student relationships, good schoolmate relationships and cognitive function scores. Structural equation modelling (SEM) showed that cognitive function partially contributed to the association between family and school pressures and IUD.

DISCUSSION

Cognitive function is one of the mediating pathways through which environmental pressures may predict IUD among junior high school students. Interventions may target the mediating pathway of cognitive function to alleviate the negative impact of environmental pressure on IUD.

Differences in associations between problematic video-gaming, video-gaming duration, and weapon-related and physically violent behaviors in adolescents

Seemingly mixed findings have been reported on possible relationships between video-gaming and violent or aggressive behaviors. Given the prevalence of gaming in adolescents and potential harms associated with violent behaviors, relationships between problematic gaming, gaming engagement, and risk behaviors involving weapons and physical violence require further research. This study examined in a large sample of high-school students the relationships between problem-gaming severity, gaming duration, and violence-related measures including weapon-carrying, having been threatened by someone with a weapon, perceived insecurity, physical fights and serious fights leading to injuries. Potential moderation by sensation-seeking and impulsivity was also tested. Participants were 3,896 Connecticut high-school adolescents. Chi-square, logistic regression, and moderation models were conducted. Adolescents with at-risk/problem gaming, compared to low-risk and non-gaming adolescents, reported more weapon-carrying, having been threatened with weapons, feeling unsafe at school, and serious fighting leading to injury. Among those reporting gaming, weekly time spent gaming was associated with problem-gaming severity. Those with longer (versus shorter) gaming durations were more likely to report weapon-carrying and feeling unsafe at school. Sensation-seeking moderated associations between at-risk/problem gaming and weapon-carrying frequency. Associations between gaming quantity and problem-gaming severity and measures of weapon-carrying and physical violence in adolescents suggest that understanding further their mechanistic relationships may be important in promoting safer developmental trajectories for youth. Future longitudinal studies may provide important insight into the etiologies underlying these relationships and such information may help develop more effective prevention and intervention strategies.

Depression and Disordered Gaming: Does Culture Matter?

The dearth of evidence related to cultural and gender variations of established associations between Internet Gaming Disorder (IGD) and other psychopathologies has been highlighted. Accordingly, the present study examined the association between depression and disordered gaming behaviors, while considering cultural perspectives of vertical individualism (independence and hierarchy) and gender as potentially variating factors. To achieve this, an ethnically diverse online sample of internet gamers from multicultural societies (N = 1032; Australia = 738; 71.5%; USA = 222; 21.5%; other multicultural countries = 72; 13.3%; Mage = 24 years; males = 503 [48.7%], females = 529 [51.3%]) completed the Internet Gaming Disorder Scale–Short-Form (IGDS9-SF); the Depression, Anxiety and Stress Scale (DASS-21) and the Individualism and Collectivism Scale (ICS). Regression, moderation and moderated moderation analyses were conducted. Results demonstrated that gamers presenting concurrently with symptoms of depression and vertically individualistic inclinations reported higher levels of disordered gaming behaviors, with no significant gender differences. The findings obtained imply that practitioners globally, and especially in multicultural societies (e.g., Australia, USA), should consider cultural differences when developing prevention and intervention strategies for disordered gaming.

Video Game Addiction and Emotional States: Possible Confusion Between Pleasure and Happiness?

Internet gaming disorder is characterized by a severely reduced control over gaming, resulting in an increasing gaming time and leading to negative consequences in many aspects of the individual life: personal, family, social, occupational and other relevant areas of functioning (World Health Organization). In the last years, the significant boom in using video games has been raising health issues that remain insufficiently understood. The extent of this phenomenon (the estimated prevalence is between 1.7 and 10% of the general population) has led the mentioned Organization to include gaming disorders in the list of mental health conditions (2018). Several studies show converging findings that highlight the common brain activities between substance use disorders and behavioral addictions (i.e., gaming disorders). Addiction specialists observed that addict subjects tend to confuse pleasure with happiness when linking emotional states to their addictive activities. As far as we know, beyond the mentioned observations, distinguishing the perception of these two emotional states in the frame of an addiction has not been yet the object of formal research. This study aims at examining the possible confusion between pleasure and happiness within the addiction sphere. Video game addiction has been chosen to explore the possible occurrence of this perceptional distortion. A mixed design lab-based study was carried out to compare between video games addicts and non-addicts (between-subjects), and video games-related activities and neutral activities (within-subject). Emotional reactions were gauged by self-reported scales and physiological data acquired through a range of biosensors: Relaxation and Hearth Rate. From a therapeutic standpoint, this research intends to explore alternatives to deal with this sort of disorders. More specifically, at the cognitive level, the idea is elaborating guidelines to develop patients' insights into these emotional states and thus increasing their ability to handle them. Overall, several indices resulting from this study constitute a bundle of arguments that argue in favor of the confusion between pleasure and happiness made by addict users when associating their affective states to video gaming. Furthermore, this approach illustrates how reappraising emotions may contribute to reducing the perceptional distortion of these emotional states.

Cue-elicited craving-related lentiform activation during gaming deprivation is associated with the emergence of Internet gaming disorder

Internet gaming disorder (IGD) is associated with negative health measures. However, little is known regarding the brain mechanisms or cognitive factors that may predict transitions from regular game use (RGU) to IGD. Such knowledge may help identify individuals who are particularly vulnerable to IGD and aid in prevention efforts. One hundred forty-nine individuals with RGU were scanned when they were performing a cue-elicited-craving task before gaming and after gaming was suddenly ceased. One year later, 23 were found to have developed IGD (RGU_IGD). We compared the original data from these 23 RGU_IGD subjects and 23 one-to-one matched subjects still meeting criteria for RGU (RGU_RGU). RGU_IGD and RGU_RGU subjects showed similarities in the cue-elicited-craving task before gaming. Significant group-by-time interaction identified the bilateral lentiform nucleus. Post hoc analysis showed the interaction was related to increased activation in the RGU_IGD subjects following gaming. Significant correlations were observed between self-reported cravings and lentiform activation in the RGU_IGD subjects. Among individuals with RGU, gaming-cue-induced lentiform activation following a session of gaming may predict subsequent development of IGD. The findings suggest a biological mechanism for emergence of IGD that may help inform prevention interventions.

Functional neural changes and altered cortical-subcortical connectivity associated with recovery from Internet gaming disorder

BACKGROUND AND AIMS

Although studies have suggested that individuals with Internet gaming disorder (IGD) may have impairments in cognitive functioning, the nature of the relationship is unclear given that the information is typically derived from cross-sectional studies.

METHODS

Individuals with active IGD (n = 154) and those individuals no longer meeting criteria (n = 29) after 1 year were examined longitudinally using functional magnetic resonance imaging during performance of cue-craving tasks. Subjective responses and neural correlates were contrasted at study onset and at 1 year.

RESULTS

Subjects' craving responses to gaming cues decreased significantly at 1 year relative to study onset. Decreased brain responses in the anterior cingulate cortex (ACC) and lentiform nucleus were observed at 1 year relative to onset. Significant positive correlations were observed between changes in brain activities in the lentiform nucleus and changes in self-reported cravings. Dynamic causal modeling analysis showed increased ACC-lentiform connectivity at 1 year relative to study onset.

CONCLUSIONS

After recovery from IGD, individuals appear less sensitive to gaming cues. This recovery may involve increased ACC-related control over lentiform-related motivations in the control over cravings. The extent to which cortical control over subcortical motivations may be targeted in treatments for IGD should be examined further.

Spiritual experiences are related to engagement of a ventral frontotemporal functional brain network: Implications for prevention and treatment of behavioral and substance addictions

BACKGROUND AND AIMS

Spirituality is an important component of 12-step programs for behavioral and substance addictions and has been linked to recovery processes. Understanding the neural correlates of spiritual experiences may help to promote efforts to enhance recovery processes in behavioral addictions. We recently used general linear model (GLM) analyses of functional magnetic resonance imaging data to examine neural correlates of spiritual experiences, with findings implicating cortical and subcortical brain regions. Although informative, the GLM-based approach does not provide insight into brain circuits that may underlie spiritual experiences.

METHODS

Spatial independent component analysis (sICA) was used to identify functional brain networks specifically linked to spiritual (vs. stressful or neutral-relaxing) conditions using a previously validated guided imagery task in 27 young adults.

RESULTS

Using sICA, engagement of a ventral frontotemporal network was identified that was engaged at the onset and conclusion of the spiritual condition in a manner distinct from engagement during the stress or neutral-relaxing conditions. Degree of engagement correlated with subjective reports of spirituality in the scanner (r = .71, p < .001) and an out-of-the-magnet measure of spirituality (r = .48, p < .018).

DISCUSSION AND CONCLUSION

The current findings suggest a distributed functional neural network associated with spiritual experiences and provide a foundation for investigating brain mechanisms underlying the role of spirituality in recovery from behavioral addictions.

Preliminary evidence of altered gray matter volume in subjects with internet gaming disorder: associations with history of childhood attention-deficit/hyperactivity disorder symptoms

Attention-deficit/hyperactivity disorder (ADHD) is commonly comorbid with Internet gaming disorder (IGD). Although childhood ADHD symptoms may decline during late brain maturation, structural alterations in some brain areas may persist into adulthood. This study investigated whether young adults with IGD and a history of childhood ADHD symptoms had gray matter volume (GMV) alterations that were distinct from subjects without a history of childhood ADHD. As an exploratory investigation, we conducted a whole-brain voxel-based morphometry with the diffeomorphic anatomical registration using an exponentiated Lie algebra algorithm and applied an uncorrected threshold at the voxel level for multiple comparisons. GMVs of IGD subjects with a history of childhood ADHD (IGD_ADHD+ group; n = 20; 24.5 ± 2.5 years) were compared to those of subjects without a history of childhood ADHD (IGD_ADHD- group; n = 20; 23.9 ± 2.5 years) and controls (n = 20; 22.7 ± 2.4 years). Compared with controls, both IGD groups had a smaller GMV in the right anterior cingulate cortex, the left inferior frontal gyrus, and the left insula, yet had a larger GMV in the right angular gyrus. The IGD_ADHD+ group had a larger GMV in the right precuneus than the IGD_ADHD- group and controls. When controlling for other comorbid psychiatric symptoms, the IGD_ADHD+ group also had a smaller GMV in the right inferior frontal gyrus. In conclusion, we found that young adults with IGD and a history of childhood ADHD symptoms had characteristic GMV alterations, which may be linked with their manifestation of childhood ADHD.

Maladaptive player-game relationships in problematic gaming and gaming disorder: A systematic review

While certain player vulnerabilities are known to increase risk of gaming disorder (GD), the topic of maladaptive player × game relationships in GD has received limited attention. This review aimed to: (1) identify game types associated with GD symptomatology; and (2) evaluate individual differences (e.g., age, personality, depression) in the relationship between gaming and GD symptomatology. A systematic review of six databases identified 23 studies of the relations between game types and GD, including 13 studies employing multivariate analyses. Player vulnerabilities implicated in GD included impulsivity, risk-taking, psychopathological symptoms (e.g., depression, anxiety), and stronger gaming motivations (e.g., escapism, achievement). MMORPG involvement had the strongest positive association with GD. Problematic MMORPG players tend to have a socially anxious profile and may be attracted to the work-like roles and conventions of this genre. Problematic players of shooters tend to score higher on measures of sensation-seeking and impulsivity than other players. These findings suggest that GD may develop more readily and at more severe levels in complex, endless, socially driven games, irrespective of person-level characteristics. Some player vulnerabilities may selectively increase risk of GD for certain game types. Further research should investigate different player-game interactions to refine current models and interventions for GD.

The Clinical Utility of the Chen Internet Addiction Scale-Gaming Version, for Internet Gaming Disorder in the DSM-5 among Young Adults

Objectives: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) includes the diagnostic criteria for Internet gaming disorder (IGD). This study evaluated (1) the screening, diagnostic, and prevalence-estimated cutoff points of the Chen Internet Addiction Scale–Gaming Version (CIAS-G) for IGD in the DSM-5; and (2) the differences in the CIAS-G and subscale scores among individuals with IGD, regular gamers (RGs), and other control subjects. Methods: We recruited 69 participants with IGD, 69 RGs, and 69 healthy participants based on diagnostic interviews conducted by a psychiatrist according to DSM-5 IGD criteria. All participants completed the CIAS-G and were assessed using the clinical global impression scale. Results: The optimal screening and diagnostic cutoff points were 68 or more (sensitivity, 97.1%; specificity, 76.8%) and 72 or more (sensitivity, 85.5%; specificity, 87.0%) for IGD based on DSM-5 criteria, respectively. The 76 or more cutoff point had the highest number needed to misdiagnose and was the optimal prevalence estimated cutoff point. Conclusions: The screening cutoff point could be used to identify individuals with IGD for further diagnostic interviewing to confirm the diagnosis in the clinical setting or for two-stage epidemiological evaluation. The diagnostic cutoff point provides a provisional diagnosis of IGD when diagnostic interviewing is unavailable. The prevalence-estimated cutoff point could be used to estimate the prevalence of IGD in large-scale epidemiological investigations when further diagnostic interviewing is impractical. The clinical and epidemiological utility of CIAS-G warrants further study.

The role of school connectedness and maladaptive cognitions in the association between stress and Internet addiction: A serial mediation model

PURPOSE

To explore the mediating effect of school interest and maladaptive cognitions in the relationship between stress and Internet addiction.

DESIGN AND METHODS

A total of 2271 high school students were recruited from a Chinese high school. Serial mediation model was used.

RESULTS

School interest and maladaptive cognitions had 0.03 and 0.13 indirect effects in the association between stress and Internet addiction, and accounting for 7.9% and 34.2% of the total effect, respectively. The serial indirect effect of school interest and maladaptive cognition was 0.05, accounting for 13.2% of the total effect.

PRACTICE IMPLICATIONS

The present study highlights the need of reducing stress and increasing school interest among high school students to prevent and intervene the occurrence of Internet addiction.

Altered brain functional networks in Internet gaming disorder: independent component and graph theoretical analysis under a probability discounting task

OBJECTIVES

Internet gaming disorder (IGD) is becoming a matter of concern around the world. However, the neural mechanism underlying IGD remains unclear. The purpose of this paper is to explore the differences between the neuronal network of IGD participants and that of recreational Internet game users (RGU).

METHODS

Imaging and behavioral data were collected from 18 IGD participants and 20 RGU under a probability discounting task. The independent component analysis (ICA) and graph theoretical analysis (GTA) were used to analyze the data.

RESULTS

Behavioral results showed the IGD participants, compared to RGU, prefer risky options to the fixed ones and spent less time in making risky decisions. In imaging results, the ICA analysis revealed that the IGD participants showed stronger functional connectivity (FC) in reward circuits and executive control network, as well as lower FC in anterior salience network (ASN) than RGU; for the GTA results, the IGD participants showed impaired FC in reward circuits and ASN when compared with RGU.

CONCLUSIONS

These results suggest that IGD participants were more sensitive to rewards, and they were more impulsive in decision-making as they could not control their impulsivity effectively. This might explain why IGD participants cannot stop their gaming behaviors even when facing severe negative consequences.

Lateral orbitofrontal gray matter abnormalities in subjects with problematic smartphone use

BACKGROUND AND AIMS

Smartphone use is becoming commonplace and exerting adequate control over smartphone use has become an important mental health issue. Little is known about the neurobiology underlying problematic smartphone use. We hypothesized that structural abnormalities in the fronto-cingulate brain region could be implicated in problematic smartphone use, similar to that has been reported for Internet gaming disorder and Internet addiction. This study investigated fronto-cingulate gray matter abnormalities in problematic smartphone users, particularly those who spend time on social networking platforms.

METHODS

The study included 39 problematic smartphone users with excessive use of social networking platforms via smartphone and 49 normal control male and female smartphone users. We conducted voxel-based morphometric analysis with diffeomorphic anatomical registration using an exponentiated Lie algebra algorithm. Region of interest analysis was performed on the fronto-cingulate region to identify whether gray matter volume (GMV) differed between the two groups.

RESULTS

Problematic smartphone users had significantly smaller GMV in the right lateral orbitofrontal cortex (OFC) than healthy controls, and there were significant negative correlations between GMV in the right lateral OFC and the Smartphone Addiction Proneness Scale (SAPS) score, including the SAPS tolerance subscale.

CONCLUSIONS

These results suggest that lateral orbitofrontal gray matter abnormalities are implicated in problematic smartphone use, especially in social networking platform overuse. Small GMV in the lateral OFC was correlated with an increasing tendency to be immersed in smartphone use. Our results suggest that orbitofrontal gray matter abnormalities affect regulatory control over previously reinforced behaviors and may underlie problematic smartphone use.

Meta-analyses of the functional neural alterations in subjects with Internet gaming disorder: Similarities and differences across different paradigms

Internet gaming disorder (IGD) has become a global public health concern due to its increasing prevalence and potential negative consequences. Researchers have sought to identify which brain regions are associated with this disorder. However, inconsistent results have been reported among studies due to the heterogeneity of paradigms and subjects. The present research aimed to combine the results of individual studies to provide a more coherent and powerful explanation. By selecting 40 studies utilizing a qualified whole-brain analysis, we performed a comprehensive series of meta-analyses that employed seed-based d mapping. We divided the existing experimental paradigms into 3 categories: game-related cue-reactivity, executive control, and risk-reward-related decision-making tasks. We divided all studies into three subgroups according to their paradigms. In cue-reactivity tasks, patients with IGD exhibited significant hyperactivation in the bilateral precuneus and bilateral cingulate and significant hypoactivation in the insula, but there were no differences in the striatum. In executive control tasks, patients with IGD displayed significant hyperactivation in the right superior temporal gyrus, bilateral precuneus, bilateral cingulate, and insula and hypoactivation in the left inferior frontal gyrus. In risky decision-making paradigms, IGD patients exhibited significant hyperactivation in the left striatum, right inferior frontal gyrus, and insula and hypoactivation in the left superior frontal gyrus, left inferior frontal gyrus, and right precentral gyrus. Our study aimed to discover the similarities among all studies and to explore the uniqueness of the different paradigms. This study further confirmed the critical role of reward circuitry and executive control circuitry in IGD but not under all conditions.

The Interaction of Person-Affect-Cognition-Execution (I-PACE) model for addictive behaviors: Update, generalization to addictive behaviors beyond internet-use disorders, and specification of the process character of addictive behaviors

We propose an updated version of the Interaction of Person-Affect-Cognition-Execution (I-PACE) model, which we argue to be valid for several types of addictive behaviors, such as gambling, gaming, buying-shopping, and compulsive sexual behavior disorders. Based on recent empirical findings and theoretical considerations, we argue that addictive behaviors develop as a consequence of the interactions between predisposing variables, affective and cognitive responses to specific stimuli, and executive functions, such as inhibitory control and decision-making. In the process of addictive behaviors, the associations between cue-reactivity/craving and diminished inhibitory control contribute to the development of habitual behaviors. An imbalance between structures of fronto-striatal circuits, particularly between ventral striatum, amygdala, and dorsolateral prefrontal areas, may be particularly relevant to early stages and the dorsal striatum to later stages of addictive processes. The I-PACE model may provide a theoretical foundation for future studies on addictive behaviors and clinical practice. Future studies should investigate common and unique mechanisms involved in addictive, obsessive-compulsive-related, impulse-control, and substance-use disorders.

Diagnostic and Classification Considerations Regarding Gaming Disorder: Neurocognitive and Neurobiological Features

Video gaming and Internet use have become a part of the everyday lives of many individuals, especially during adolescence. Given the health concerns related to problematic gaming behaviors, gaming disorder (GD) has been included in the version of the 11th edition of The International Classification of Diseases (ICD-11) ratified by the secretariat of the World Health Organization. Given these considerations and others (including debate regarding the most appropriate classification of GD and how best to prevent and treat the condition), there is a need for further research into GD. Specifically, we suggest that researching intermediate phenotypes focusing on cognitive and neurobiological function may help clarify GD's relationships to other addictive disorders and more accurately define their relationships with core and associated features of GD. Overlaps in neural activity, cognitive functioning, and other features suggest that GD shares similarities with gambling and substance-use disorders and may best be classified as an addictive disorder. Individuals with GD differ from those with regular game use (RGU) on neurocognitive levels. However, concerns have been raised with respect to the differences between GD and substance-use disorders in certain dimensional features, such as tolerance. Additionally, it has been argued that differences between GD and RGU may not be fully captured by nomenclature systems like the ICD-11. Nonetheless, individuals seek treatment for help with GD, despite the limited data available for effective treatments. As more data are gathered from investigations of GD, they should be translated into refining criteria for GD and optimizing interventions.

Alterations in functional networks during cue-reactivity in Internet gaming disorder

BACKGROUND

Cue-induced brain reactivity has been suggested to be a fundamental and important mechanism explaining the development, maintenance, and relapse of addiction, including Internet gaming disorder (IGD). Altered activity in addiction-related brain regions has been found during cue-reactivity in IGD using functional magnetic resonance imaging (fMRI), but less is known regarding the alterations of coordinated whole brain activity patterns in IGD.

METHODS

To investigate the activity of temporally coherent, large-scale functional brain networks (FNs) during cue-reactivity in IGD, independent component analysis was applied to fMRI data from 29 male subjects with IGD and 23 matched healthy controls (HC) performing a cue-reactivity task involving Internet gaming stimuli (i.e., game cues) and general Internet surfing-related stimuli (i.e., control cues).

RESULTS

Four FNs were identified that were related to the response to game cues relative to control cues and that showed altered engagement/disengagement in IGD compared with HC. These FNs included temporo-occipital and temporo-insula networks associated with sensory processing, a frontoparietal network involved in memory and executive functioning, and a dorsal-limbic network implicated in reward and motivation processing. Within IGD, game versus control engagement of the temporo-occipital and frontoparietal networks were positively correlated with IGD severity. Similarly, disengagement of temporo-insula network was negatively correlated with higher game-craving.

DISCUSSION

These findings are consistent with altered cue-reactivity brain regions reported in substance-related addictions, providing evidence that IGD may represent a type of addiction. The identification of the networks might shed light on the mechanisms of the cue-induced craving and addictive Internet gaming behaviors.

Brain response features during forced break could predict subsequent recovery in internet gaming disorder: A longitudinal study

Although internet gaming disorder (IGD) is associated with negative health measures, individuals may recover without professional intervention. Exploring neural features associated with natural recovery may provide insights into how best to promote health among people with IGD. Seventy-nine IGD subjects were scanned when they were performing cue-craving tasks before and after gaming was interrupted with a forced break. After one year, 20 individuals no longer met IGD criteria and were considered recovered. We compared brain responses in cue-craving tasks between these 20 recovered IGD subjects and 20 matched IGD subjects still meeting criteria at one year (persistent IGD). Recovered IGD subjects showed lower dorsolateral prefrontal cortex (DLPFC) activation than persistent IGD subjects to gaming cues at both pre- and post-gaming times. Significant group-by-time interactions were found in the bilateral DLPFC and insula, and these involved relatively decreased DLPFC and increased insula activation in the persistent IGD group during the forced break. Relatively decreased DLPFC activity and increased insula activity in response to gaming cues following recent gaming may underlie persistence of gaming. These findings suggest that executive control and interoceptive processing warrant additional study in understanding recovery from IGD.

Social media addiction and sexual dysfunction among Iranian women: The mediating role of intimacy and social support

BACKGROUND AND AIMS

Social media use has become increasingly popular among Internet users. Given the widespread use of social media on smartphones, there is an increasing need for research examining the impact of the use of such technologies on sexual relationships and their constructs such as intimacy, satisfaction, and sexual function. However, little is known about the underlying mechanism why social media addiction impacts on sexual distress. This study investigated whether two constructs (intimacy and perceived social support) were mediators in the association of social media addiction and sexual distress among married women.

METHODS

A prospective study was conducted where all participants (N = 938; mean age = 36.5 years) completed the Bergen Social Media Addiction Scale to assess social media addiction, the Female Sexual Distress Scale - Revised to assess sexual distress, the Unidimensional Relationship Closeness Scale to assess intimacy, and the Multidimensional Scale of Perceived Social Support to assess perceived social support.

RESULTS

The results showed that social media addiction had direct and indirect (via intimacy and perceived social support) effects on sexual function and sexual distress.

DISCUSSION AND CONCLUSIONS

The findings of this study facilitate a better understanding of how problematic engaging to social media can affect couples' intimacy, perceived social support, and constructs of sexual function. Consequently, sexual counseling should be considered an essential element for assessing individual behaviors in the context of social media use.

Measuring facets of reward sensitivity, inhibition, and impulse control in individuals with problematic Internet use

INTRODUCTION

Problematic Internet Use (PIU) is the inability to control the amount of time spent on the Internet. Research indicates that abnormalities in reward sensitivity, sensitivity to punishment, and impulse control drive addictive behaviors such as substance abuse and gambling disorders, but it is unclear whether this is also the case in PIU.

METHODS

Behavioral tasks and scales were completed by 62 participants (32 PIU individuals and 30 no-PIU individuals) to assess reward sensitivity, sensitivity to punishment, as well as inhibitory function and impulse control. Measures administered included Go/No-Go, delay discounting, Behavioral Inhibition/Activation (BIS/BAS) scales and the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ).

RESULTS

The PIU group endorsed greater reward sensitivity and punishment sensitivity as indexed by the SPSRQ. However, there were no group differences with regards to delay discounting, performance in the Go/No-Go task, or endorsement in the BIS/BAS scales.

DISCUSSION

The present study found increased reward sensitivity and sensitivity to punishment in PIU individuals, though impulse control was not observably affected. Future experimental studies are needed to inform our conceptualization of the etiology of addictive behavior as it pertains to PIU. Further investigation will aid in informing prevention and intervention efforts.

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

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

The Relationship Between Personality Traits, Psychopathological Symptoms, and Problematic Internet Use: A Complex Mediation Model

BACKGROUND

There are many empirical studies that demonstrate the associations between problematic internet use, psychopathological symptoms, and personality traits. However, complex models are scarce.

OBJECTIVE

The aim of this study was to build and test a mediation model based on problematic internet use, psychopathological symptoms, and personality traits.

METHODS

Data were collected from a medical addiction center (43 internet addicts) and internet cafés (222 customers) in Beijing (mean age 22.45, SD 4.96 years; 239/265, 90.2% males). Path analysis was applied to test the mediation models using structural equation modeling.

RESULTS

Based on the preliminary analyses (correlations and linear regression), two different models were built. In the first model, low conscientiousness and depression had a direct significant influence on problematic internet use. The indirect effect of conscientiousness-via depression-was nonsignificant. Emotional stability only affected problematic internet use indirectly, via depressive symptoms. In the second model, low conscientiousness also had a direct influence on problematic internet use, whereas the indirect path via the Global Severity Index was again nonsignificant. Emotional stability impacted problematic internet use indirectly via the Global Severity Index, whereas it had no direct effect on it, as in the first model.

CONCLUSIONS

Personality traits (ie, conscientiousness as a protective factor and neuroticism as a risk factor) play a significant role in problematic internet use, both directly and indirectly (via distress level).

Hair hormones in male youth with internet gaming disorder

Objectives: Internet gaming disorder (IGD) is associated with altered physiological reactivity to psychosocial stress. Findings from a previous study on alterations of basal hypothalamic-pituitary-adrenal (HPA) axis functioning, indexed by differences in hair hormone levels (i.e., cortisol) in IGD patients compared to matched controls, were limited by a small sample size. Methods: Following the protocol of the previous study, male patients with IGD (n = 31) and controls (n = 31) matched for age, educational status and smoking were recruited. Sociodemographic and clinical characteristics were assessed using structured interviews and self-reports. Hair samples were taken for the analysis of cortisol, cortisone, testosterone, progesterone, dehydroepiandrosterone (DHEA), and corticosterone. Results: Groups showed no significant differences on cortisol (d = -0.10, 95%CI (-0.60; 0.40)), cortisone (d = -0.10, 95%CI (-0.60; 0.40)), testosterone (d = -0.00, 95%CI (-0.51; 0.51)), progesterone (d = -0.46, 95%CI (-0.96; 0.05)), DHEA (d = -0.04, 95%CI (-0.54; 0.47)) or corticosterone (d = -0.19, 95%CI (-0.69; 0.32)). Associations between hair hormone concentrations, symptom severity and sociodemographic variables were weak and did not survive correction for multiple testing. Conclusions: Unlike other psychiatric disorders, effects of IGD and associated psychopathology on basal HPA axis functioning, indexed by hair hormone levels, are negligible. Future studies need to rule out potential effects of sex, age and long-term pathology on these findings.

Bio-psychosocial factors of children and adolescents with internet gaming disorder: a systematic review

Previous large-scale studies suggest that internet gaming disorder (IGD) among children and adolescents has become an important public concern. Minors are known to be particularly susceptible to problematic internet gaming use owing to age-related underdevelopment of cognitive control. It has been shown that precursors of addictions appear during adolescence; therefore, prevention efforts must be established targeting minors who have their first experience with addictive substances and behaviors during pubescence. Since the DSM-5 classification of IGD in 2013, studies on IGD have drastically increased in number. Thus, we performed an updated review of studies of IGD in children and adolescents to assess the clinical implications of IGD. The search included all publication years, using PubMed, MEDLINE, and PsycINFO. Across studies, the presence of IGD had a negative effect on sleep and schoolwork in minors. Additionally, family factors, including the quality of parent-child relationships, were important social factors in minors with IGD. Brain imaging studies indicate that impaired cognitive control in minors with IGD is associated with abnormal function in the prefrontal cortex and striatum. Persistent pathological online game use from childhood may aggravate abnormal brain function; therefore, preventive care and early intervention are increasingly important. Although extant research supports the effectiveness of cognitive behavioral therapy for minors with IGD, effective psychological intervention for minors with IGD is an urgent issue that requires further research. This review, which presents updated findings of IGD in minors, is expected to contribute to the development of future research and be useful in clinical practice in the field of child and adolescent psychiatry.

The Correlation between the Frontostriatal Network and Impulsivity in Internet Gaming Disorder

As excessive use of internet gaming has become a serious public health concern, increasing studies have revealed that impulsivity is one of the important risk factors of internet gaming disorder (IGD). This study was designed to investigate the altered resting-state functional connectivity (FC) of the bilateral orbitofrontal cortex (OFC) in IGD participants and to examine its relationship with impulsivity compared with the normal controls (NC). Seed-based analyses verified that participants with IGD displayed decreased FC between the OFC and frontal, striatal, temporal and occipital regions different from NC. Moreover, IGD participants showed weankened FC from the OFC with dorsal anterior cingulate cortex as well as with dorsolateral prefrontal cortex and dorsal striatum as the results of group difference. These results could suggest that the decreased frontostriatal connectivity was associated with excessive internet gaming. Also, the increased FC in frontostriatal regions was correlated with impulse control in the NC but not the IGD participants. Further insight into the brain circuitry on frontostriatal could provide the target for developing treatment approaches of impulse control in IGD.

Females are more vulnerable to Internet gaming disorder than males: Evidence from cortical thickness abnormalities

BACKGROUND

Male predominance is a well-known feature of Internet gaming disorder (IGD), with a reported male to female ratio of 3:1. Because of the overwhelming focus on males, little is known about the neural basis of sex differences in IGD, especially neuroanatomical features. Thus, investigations on sex differences with an adequate sample size are critical for improving the understanding of biological mechanisms underlying IGD.

METHODS

Structural magnetic resonance imaging data were acquired from 62 IGD subjects (29 males, 33 females) and 71 recreational game users (RGUs) (37 males, 34 females) with well-matched age and education levels. Group-by-sex interaction in cortical thickness was analyzed, and the correlations between cortical thickness and addiction severity were calculated.

RESULTS

We detected a group-by-sex interaction in the bilateral rostral middle frontal gyri (MFG), left superior frontal gyrus (SFG), left supramarginal gyrus (SMG), right posterior cingulate cortex (PCC), and right superior parietal lobule (SPL). Post-hoc analyses revealed that, compared with same-sex RGUs, male IGD subjects had increased cortical thickness and female IGD subjects had reduced cortical thickness beside their right PCC. By contrast, male IGD subjects had reduced cortical thickness and female IGD subjects had increased cortical thickness in their right PCC. Moreover, only females showed significant negative correlations between the cortical thickness and their self-reported cravings and Internet addiction test scores.

CONCLUSIONS

For female IGD subjects, the reduced cortical thickness, combined with the negative correlations of addiction severities, suggests the great effect created by IGD in the brain regions. Males and females may be affected differently by IGD, with females being more vulnerable to it.

The relative contribution of motives and maladaptive cognitions to levels of Internet Gaming Disorder

This study aimed at determining whether motives and/or maladaptive cognitions would predict levels of Internet Gaming Disorder independently of negative affect and problematic Internet use. Seventy-nine Internet gamers completed the following questionnaires: Ten-Item Internet Gaming Disorder Test, Problematic Internet Use Questionnaire Short Form, Depression Anxiety and Stress Scale 21, Motives for Online Gaming Questionnaire, and Maladaptive Gaming-Related Cognitions Scale. Results showed that all variables were positively and significantly correlated with levels of Internet Gaming Disorder with the exception of motives relating to recreation. Furthermore, a hierarchical linear regression analysis showed that motives relating to coping and skills development and maladaptive cognitions relating to overvaluing of game rewards were the only significant predictors of levels of Internet Gaming Disorder when controlling for negative affect and problematic Internet use. The implications of these findings are discussed.

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Motives and maladaptive cognitions predict levels of IGD.

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Motives relating to coping skills development and maladaptive cognitions relating to overvaluing game rewards were the strongest predictors of IGD.

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Findings were independent of negative affect and problematic Internet use.

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.

Relationships between Internet addiction and clinicodemographic and behavioral factors

BACKGROUNDS AND AIMS

While the Internet became an indispensable component of our contemporary life, public and academic attention is also gathered to its negative impact, namely Internet addiction (IA). Although clinicodemographic and behavioral factors are hypothetically implicated in the mechanism of IA, it still remains largely unknown how such factors are linked to IA severity. Thus, this study sought to examine relationships among IA severity and factors potentially associated with IA in Japanese students in different educational stages.

METHODS

We conducted a questionnaire-based survey, which included questions about types of online activities and clinicodemographic information, the IA test for IA severity, and the K6 scale for psychological distress in 3,224 students at elementary, junior, and senior high schools, and universities. A multiple regression analysis was performed to predict IA severity with clinicodemographic and behavioral factors.

RESULTS

IA severity was significantly positively related to the following factors: e-messaging, social networking services (SNS), games, holiday Internet usage, and K6 scores, while IA severity had negative correlation with using Internet for educational purposes, age of first exposure to the Internet, and sleep duration. Age was not related to IA severity among participants using both SNS and e-messaging.

CONCLUSIONS

IA was linked to various online activities and the degree of psychological distress. This indicates the importance of comprehensive assessment of online behavior and psychological factors for further understanding of IA.

Orbitofrontal gray matter deficits as marker of Internet gaming disorder: converging evidence from a cross-sectional and prospective longitudinal design

Internet gaming disorder represents a growing health issue. Core symptoms include unsuccessful attempts to control the addictive patterns of behavior and continued use despite negative consequences indicating a loss of regulatory control. Previous studies revealed brain structural deficits in prefrontal regions subserving regulatory control in individuals with excessive Internet use. However, because of the cross-sectional nature of these studies, it remains unknown whether the observed brain structural deficits preceded the onset of excessive Internet use. Against this background, the present study combined a cross-sectional and longitudinal design to determine the consequences of excessive online video gaming. Forty-one subjects with a history of excessive Internet gaming and 78 gaming-naive subjects were enrolled in the present study. To determine effects of Internet gaming on brain structure, gaming-naive subjects were randomly assigned to 6 weeks of daily Internet gaming (training group) or a non-gaming condition (training control group). At study inclusion, excessive Internet gamers demonstrated lower right orbitofrontal gray matter volume compared with Internet gaming-naive subjects. Within the Internet gamers, a lower gray matter volume in this region was associated with higher online video gaming addiction severity. Longitudinal analysis revealed initial evidence that left orbitofrontal gray matter volume decreased during the training period in the training group as well as in the group of excessive gamers. Together, the present findings suggest an important role of the orbitofrontal cortex in the development of Internet addiction with a direct association between excessive engagement in online gaming and structural deficits in this brain region.