Craving for internet games? Withdrawal symptoms from an 84-h abstinence from Massively Multiplayer Online gaming

How adolescents lose control over social networks: A process-based approach to problematic social network use

Social networks (SNs) are immensely popular, especially among teenagers, yet our understanding of problematic SNs remains limited. Understanding motivations and patterns of use is crucial given the current prevalence of problematic SNs use. Perarles et al. (2020) distinguish two behavioral control modes: Model-Free Control, where actions are characterized by actions driven by immediate gratification without reflective consideration for long-term consequences, and Model-Based Control, enabling planned and goal-directed actions. Both control modes can lead to problematic social network use. This study aims to delve into problematic SNs use and the underlying motives behind adolescents' participation in SNs, drawing upon the theoretical proposal by Perales et al. (2020). We conducted four focus groups with adolescents aged 13-17 (50 % female; Mage = 14.5, SD = 1.75), comprising two public school and two Catholic private school groups. Thematic analysis using Atlas.ti software revealed three themes. The first uncovers characteristics of problematic SNs use, including withdrawal, increased usage time, impaired control, behavioral salience and attentional capture and cognitive hijacking. The second spotlights motives, emphasizing emotional regulation, finding out what is going on, and social interaction. The third theme explores consequences such as compromised academic performance and physical harm. In conclusion, addressing both motives and problematic behaviors present a more effective approach to confronting SNs use challenges and fostering healthier online experiences for adolescents.

Internet Addiction and Psychological Distress: Can Social Networking Site Addiction Affect Body Uneasiness Across Gender? A Mediation Model

Introduction

The Internet, with its unlimited information, revolutionary communication capabilities, and innovative potential to expand knowledge, is ubiquitous throughout the world, but it also has significant implications for users' mental health. Given the not yet clearly defined and distinguishable nosographic categories of online addiction and the resulting difficulties in describing the impact on users' mental health, the present cross-sectional study aimed to gain new insights into the relationship between Internet addiction (especially social networking site [SNS] addiction), psychological distress, and physical discomfort, as well as gender differences in impact among users.

Method

A sample of 583 Italian speakers (50.8% males; 48.7% females) with a mean age of 30.96 (SD = 12.12) completed an online survey in July 2021. A set of psychometric self-report instruments was administered to assess the study variables. Mediation analyses were performed for both the whole sample and across genders.

Results

The study found that men exhibited higher levels of Internet addiction and craving than women, but no differences were found for SNS addiction. Furthermore, indicators of psychological distress (i.e., anxiety, depression, stress, loneliness, insomnia, and self-esteem) mediated the association between SNS addiction and body uneasiness, with slight differences across genders.

Conclusion

This paper contributes to the existing literature on online addictive behaviors by also highlighting gender differences. The findings underscore the need for educational experiences that can prevent problematic use of the Internet and SNSs.

Longitudinal network relations between symptoms of problematic internet game use and internalizing and externalizing problems among Chinese early adolescents

OBJECTIVE

There has been growing evidence of comorbidity between problematic internet game use and internalizing and externalizing problems in young people. However, little is known about the directionality and gender differences in these longitudinal relations at the symptoms level in the framework of network theory among youth. This study estimated the longitudinal relations between the symptoms of problematic internet game use, internalizing and externalizing problems, and the gender differences of these relations in Chinese youth using cross-lagged panel network modeling (CLPN).

METHODS

A sample of 1269 Chinese youth (M age = 10.35 years) participated in this study semi-annually at two time points. CLPN analysis was used to calculate the network model of problematic internet game use and internalizing and externalizing problems to explore bridge symptoms and find transmission pathways between problematic internet game use and internalizing and externalizing problems.

RESULTS

The CLPN revealed significant gender differences. For boys, depressed mood, which leads to relationships turning sour in order to play online games, bridges the relations between internalizing symptoms and problematic internet game use. For girls, irritability is the central predictive symptom, causing a range of problems related to problematic internet game use, which can, in turn, lead to fights or feelings of worthlessness. However, the effect sizes for the pathways between problematic internet game use and internalizing/externalizing problems were relatively weak, and the comorbidity between their relations should not be over-interpreted.

CONCLUSIONS

The current findings provide new evidence for understanding the directional relationship between the central characteristics of problematic internet game use and internalizing and externalizing problems in boys and girls. Gender-specific interventions targeting the central symptoms of internalizing and externalizing problems and problematic internet game use can help mitigate the vicious cycle of comorbidity among adolescents.

Stigmatizing attitudes toward Internet gaming disorder, Problematic smartphone use and Problematic social networking site use: An experimental vignette study

Public stigma on substance and gambling disorders have been well documented. Negative effects of stigma include shame, embarrassment, fear being judged and the determent of help-seeking behaviors among stigmatized individuals. Less is known about the public perception toward Internet gaming disorder (IGD) and other widespread problematic behaviors that share some characteristics with established behavioral addictions, such as Problematic smartphone use (PSU) and Problematic social networking sites use (PSNSU). The purpose of this study is to compare the public perception of problematic Internet gamers, problematic smartphone users and problematic social networking sites users using an experimental within-group vignette study design. A sample of 280 adults (F = 72.1%; M_age = 32.84, SD = 13.85) was recruited and completed the study online. Participants were presented with male OR female vignettes (i.e. the gender of the target in the vignette was randomized) describing an individual with IGD, PSU, and PSNSU. A repeated-measures ANOVA followed by post hoc tests using Bonferroni's correction was used. IGD was seen as more serious, more noticeable, and less understandable than both PSU and PSNU. Moreover, participants' emotional reaction (e.g., anger and sadness) and desired social distance were significantly stronger toward IGD. However, vanity attributions were higher for individuals with PSNSU, which were also more blamed compared to both IGD and PSU. PSU was seen as more controllable than both IGD and PSNSU. The results, taken together, suggest that IGD is perceived as more inherently problematic, but PSNSU also seem to deserve scientific attention as individuals showing symptoms of PSNSU are blamed more than problematic Internet gamers. Our findings provide initial information that can be used when developing interventions to impact stigma toward technological addictions.

Effects of a 7-Day Pornography Abstinence Period on Withdrawal-Related Symptoms in Regular Pornography Users: A Randomized Controlled Study

Little is known about whether withdrawal-like symptoms manifest when regular pornography users attempt to abstain from pornography. The present study used a randomized controlled design to examine whether (1) negative abstinence effects that may be potentially reflective of withdrawal-related symptoms manifest when a non-clinical sample of regular pornography users attempt to abstain from pornography for a 7-day period and (2) these negative abstinence effects would only manifest (or manifest more strongly) for those with higher levels of problematic pornography use (PPU). A total of 176 undergraduate students (64.2% female) who were regular pornography users (defined as having used pornography ≥ three times a week in the past 4 weeks) were randomly assigned to an abstinence group (instructed to attempt abstinence from pornography for 7 days, n = 86) or a control group (free to watch pornography as usual, n = 90). Participants completed measures of craving, positive and negative affect, and withdrawal symptoms at baseline and each night of the 7-day period. Contrary to the confirmatory hypotheses, there were no significant main effects of group (abstinence vs. control) or group × PPU interaction effects on any of the outcome measures, controlling for baseline scores. These findings indicate that no evidence of withdrawal-related symptoms was found for abstaining participants, and this was not dependent on level of PPU. However, exploratory analyses showed a significant three-way interaction (group × PPU × past 4-week frequency of pornography use [FPU]) on craving, where an abstinence effect on craving was found at high levels of PPU only once past 4-week FPU reached the threshold of daily use. While these exploratory findings should be interpreted with caution, they suggest that abstinence effects could potentially manifest when there is a combination of high PPU and high FPU-a hypothesis that warrants investigation in future prospective abstinence studies.

Gamers' and non-gamers' perspectives on the development of problematic video game play

Gaming Disorder was recently included in the 11th Edition of the International Classification of Diseases and Internet Gaming Disorder may be introduced in the sixth edition of The Diagnostic and Statistical Manual. Much is not understood about how problems with video games develop. This qualitative study aimed to better understand the development of problematic gaming through focus groups. Eleven young adult "frequent gamers," twelve young adult "non-frequent or non-gamers," and five older adult "non-gamers" discussed vulnerabilities and risk factors of problematic gaming. Participants across all groups believed that problematic gaming developed when people used video games as a primary means of meeting basic psychological needs that were unsatisfied, thwarted, or blocked outside of video games. Frequent and non-frequent gamers, compared to older adult non-gamers, were more likely to view video games as a healthy way to meet basic psychological needs and less likely to stereotype gamers. Video games are equipped to meet basic psychological needs for autonomy, competence, and relatedness. That is, gamers often experience a sense of agency, skill, and connection to others when playing video games. However, problematic gaming may develop when people with unmet psychological needs rely exclusively on video games to meet them. Treatment and prevention approaches to problematic gaming can benefit from greater attention to helping at risk individuals meet needs for autonomy, competence, and relatedness outside of video games.

Withdrawal and tolerance as related to compulsive sexual behavior disorder and problematic pornography use - Preregistered study based on a nationally representative sample in Poland

Background

The addiction model of compulsive sexual behavior disorder (CSBD) and problematic pornography use (PPU) predicts the presence of withdrawal symptoms and increased tolerance for sexual stimuli in the disorder phenotype. However, clear empirical evidence supporting this claim has largely been lacking.

Methods

In the preregistered, nationally representative survey (n = 1,541, 51.2% women, age: M = 42.99, SD = 14.38), we investigated the role of self-reported withdrawal symptoms and tolerance with respect to CSBD and PPU severity.

Results

Both withdrawal and tolerance were significantly associated with the severities of CSBD (β = 0.34; P < 0.001 and β = 0.38; P < 0.001, respectively) and PPU (β = 0.24; P < 0.001 and β = 0.27; P < 0.001, respectively). Of the 21 withdrawal symptom types investigated, the most often reported symptoms were frequent sexual thoughts that were difficult to stop (for participants with CSBD: 65.2% and with PPU: 43.3%), increased overall arousal (37.9%; 29.2%), difficult to control level of sexual desire (57.6%; 31.0%), irritability (37.9%; 25.4%), frequent mood changes (33.3%; 22.6%), and sleep problems (36.4%; 24.5%).

Conclusions

Changes related to mood and general arousal noted in the current study were similar to the cluster of symptoms in a withdrawal syndrome proposed for gambling disorder and internet gaming disorder in DSM-5. The study provides preliminary evidence on an understudied topic, and present findings can have significant implications for understanding the etiology and classification of CSBD and PPU. Simultaneously, drawing conclusions about clinical importance, diagnostic utility and detailed characteristics of withdrawal symptoms and tolerance as a part of CSBD and PPU, as well as other behavioral addictions, requires further research efforts.

How to pin a compulsive behavior down: A systematic review and conceptual synthesis of compulsivity-sensitive items in measures of behavioral addiction

Experimental models identify the transition from choice to compulsivity as the main mechanism underlying addiction. In behavioral addictions research, however, the adjective compulsive is used to describe virtually any kind of excessive or dysregulated behavior, which hinders the connection between experimental and clinical models. In this systematic review, we adopted a preliminary definition of compulsive behavior based on previous theoretical work. Subsequently, a systematic review following PRISMA guidelines was conducted (a) to identify the validated instruments, currently used in behavioral addictions research, that include items that are sensitive (intendedly or not) to compulsivity, and (b) to categorize those items into differentiable operationalizations of compulsivity. Six operationalizations of compulsivity emerged from item content analysis: 1. Automatic or habitual behavior occurring in absence of conscious instrumental goals; 2. Behavior insensitive to negative consequences despite conscious awareness of them; 3. Overwhelming urge or desire that impels the individual to initiate the activity and jeopardizes control attempts; 4. Bingeing, or inability to stop or interrupt the activity once initiated, resulting in an episode substantially longer or more intense than intended; 5. Attentional capture and cognitive hijacking; and 6. Inflexible rules, stereotyped behaviors, and rituals related to task completion or execution. Subsequently, a list of 15 representative items per operationalization was elaborated for independent assessment and identification of delimitation problems. A high degree of agreement was reached in assessing them as instantiating compulsivity, as well as in their assignment to the corresponding categories. However, many of them were also considered overinclusive, i.e., uncapable of distinguishing compulsivity from value-based momentary choice. To increase their discriminative value, items in future compulsivity scales should be refined to explicitly mention disconnection between behavior and declarative goals. Further research on factorial structure of a pool of items derived from these operational definitions is warranted. Such a factorial structure could be used as an intermediate link between specific behavioral items and explanatory psychobiological, learning, and cognitive mechanisms.

Development and Validation of the RAFFLE: A Measure of Reasons and Facilitators for Loot Box Engagement

Qualitative studies have identified a diverse array of motivations for purchasing items within video games through chance-based mechanisms (i.e., "loot boxes"). Given that some individuals-particularly those at risk of disordered gaming and/or gambling-are prone to over-involvement with loot box purchasing, it is important to have a reliable, valid means of measuring the role of different motivations in driving purchasing behaviour. Building on prior qualitative research, this paper reports the development and validation of the "RAFFLE" scale, to measure the Reasons and Facilitators for Loot box Engagement. A 23-item, seven-factor scale was developed through cognitive interviews (n = 25) followed by two surveys of UK-based gamers who purchase loot boxes; analysed via exploratory (n = 503) and confirmatory (n = 1495) factor analysis, respectively. Subscales encompassed "enhancement'; "progression'; "social pressure'; "distraction/compulsion'; "altruism'; "fear of missing out'; and "resale". The scale showed good criterion and construct validity (correlating well with measures of loot box engagement; the risky loot box index (r = 0.63) and monthly self-reported spend (r = 0.38)), and good internal validity (Cronbach's alpha = 0.84). Parallels with, and divergence from, motivations for related activities of gaming and gambling, and alignment with broader theoretical models of motivation, are discussed.

Beyond internalizing and externalizing symptoms: The association between body disconnection and the symptoms of Internet gaming disorder

As the vast majority of online videogames imply the immersion into an alternative reality where a virtual body is also involved, the current cross-sectional study aims to investigate the contribution of low body awareness (i.e. low attention to sensory cues indicating bodily state) and body dissociation (i.e. low emotional connection with one's own body) in predicting Internet gaming disorder (IGD) symptoms, after controlling for internalizing (i.e., depression, anxiety, and stress) and externalizing symptoms (i.e., aggression). A total of 370 online-game players (73% men; mean age 29.63 ± 7.64 years) recruited in online player communities took part in the study and were given a survey that included gaming characteristics, the Depression, Anxiety and Stress Scale -21, the Aggression Questionnaire, the Body Disconnection Scale, and the Internet Gaming Disorder Scale- Short Form. A hierarchical regression analysis showed that low body awareness and high body dissociation predicted IGD scores after controlling for all the other factors. Moreover, we found an interaction effect between physical aggression and body dissociation in predicting IGD scores. On the one hand, these results provide support to previous studies that stressed the potential association between dissociative detachment (in terms of bodily disconnections) and problematic videogaming; on the other hand, the current study provides first evidence of the opportunity to focus on the integration of bodily experiences in clinical practice with people suffering from problematic gaming, as this factor might be incisively related to their aggressive and internalizing symptoms.

Influence of abstinence on automatic detection bias to gaming cues in individuals with Internet gaming disorder: Evidence from visual mismatch negativity

Internet gaming disorder (IGD) has been classified by the DSM-5 as a condition for further study, and many studies have shown that the occurrence and maintenance of IGD and the automatic detection bias to gaming cues of individuals with IGD may be significantly related. However, whether abstinence, a common intervention method in behavioral addiction, can adjust the automatic detection bias in individuals with IGD and its underlying neural mechanisms is unclear. In this study, we investigated the effects of 7 days of abstinence from gaming on automatic detection bias, negative affect and craving in individuals with IGD with event-related potential technology. A total of 50 IGD subjects were recruited in this study and randomly divided into abstinence and control groups. Visual mismatch negativity (vMMN) was induced using a standard-deviant reversed oddball paradigm, and differences in automatic detection bias, negative affect, and craving between the two groups were recorded and compared at baseline, day 3, and day 7. The results showed that compared with baseline, vMMN, negative affect and craving were significantly enhanced on day 3 and significantly diminished on day 7 in the abstinence group but not in the control group, and the changes in vMMN were significantly correlated with changes in negative affect and craving in both groups. This study demonstrates that abstinence can restore automatic detection bias in individuals with IGD and that abstinence has to last for 7 days to have a significant effect, while recovery may be related to the negative affect and craving.

Person-centred interventions for problem gaming: a stepped care approach

BACKGROUND

Problem gaming is reported by approximately 1-3% of the population and is associated with decreased health and wellbeing. Research on optimal health responses to problem gaming remains limited. This study aimed to identify and describe the key components of a person-centred approach to interventions for problem gaming for individuals who voluntary seek assistance.

METHODS

Online interviews were conducted with 20 adults (90% male; M_age = 23y) currently seeking help for problem gaming. The interview protocol was guided by a health care access framework which investigated participants' experiences and needs related to accessing professional support. Transcripts were analysed in NVivo using qualitative content analysis to systematically classify participant data into the themes informed by this framework.

RESULTS

Participants had mixed views on how the negative consequences of problem gaming could be best addressed. Some indicated problems could be addressed through self-help resources whereas others suggested in-person treatment with a health professional who had expertise in gaming. Participants described the essential components of an effective health service for problem gaming as including: valid and reliable screening tools; practitioners with specialist knowledge of gaming; and access to a multimodal system of intervention, including self-help, internet and in-person options that allow gamers to easily transition between types and intensity of support.

CONCLUSION

A comprehensive health care approach for interventions for problem gaming is in its infancy, with numerous service access and delivery issues still to be resolved. This study highlights the importance of involving individuals with gaming-related problems in developing solutions that are fit for purpose and address the spectrum of individual preferences and needs. These findings recommend a stepped healthcare system that adheres to evidence-based practice tailored to each individual and the implementation of standard assessment and routine outcome monitoring.

Digital Addiction: Systematic Review of Computer Game Addiction Impact on Adolescent Physical Health

The advancement of technology has enabled powerful microprocessors to render high-quality graphics for computer gaming. Despite being intended for leisure purposes, several components of the games alongside the gamer’s environmental factors have resulted in digital addiction (DA) towards computer games such as massively multiplayer online games (MMOG). Excessive gaming among adolescents has various negative impacts on an individual. However, only a few researchers have addressed the impact of DA on physical health. Thus, the primary objective of this research is to study the impact of DA on physical health among Malaysian adolescents. This study focuses on Malaysian adolescents of ages 12–18 years old who are addicted to computer games, specifically the MMOG. The methodology used for the study involves focus group discussions (FGD) and extensive literature study. The FGD sessions have involved both medical experts and game experts. The outcome of FGD discussion is recorded and justified with the existing relevant literature from high-impact journals, theses, conferences, books, and reports. This paper provides evidence of five physical health impacts of DA associated with adolescents. The factors of DA, the addiction components existing in MMOG computer games, and the DA health risk assessment are presented in the results section. Based on the study, it is concluded that DA among Malaysian adolescents can cause various impacts on physical health such as obesity, back pain, and neck pain, orthopaedic/joint muscle, eyesight problem, hearing problem, as well as physical inactivity.

A systematic review of metacognitions in Internet Gaming Disorder and problematic Internet, smartphone and social networking sites use

Background

The use of new technologies is growing, and some authors have suggested that frequent use might hide a non‐chemical addiction (i.e., technological addiction). Over the last 5 years, several studies investigating the role of metacognitions in technological addictions have been published. We aim to provide the first systematic review focused on this topic, by updating the initial evidence highlighted by a previous systematic review on metacognitions across addictive behaviours (Hamonniere & Varescon, 2018).

Methods

Electronic literature databases (Pubmed, PsychINFO, SCOPUS and Web of Science) were searched to identify studies that examined the relationship between metacognitions and four different technological addictions (Internet Gaming Disorder, IGD; problematic Internet use, PIU; problematic smartphone use, PSU; and problematic social networking sites use, PSNSU).

Results

We found 13 empirical studies published between 2018 and 2021. Positive low to moderate cross‐sectional associations between the four technological addictions and both generic and specific metacognitions were found, in accordance with the metacognitive model of addictive behaviours. Positive beliefs about worry, negative beliefs about thoughts concerning uncontrollability and danger, beliefs about the need to control thoughts and a lack of cognitive confidence were associated with IGD, PIU, PSU and PSNSU.

Conclusions

The absence of longitudinal studies prevents us from providing definitive answers about the role of metacognitions in technological addictions. Despite this limitation, interventions that target metacognitions could be beneficial for people presenting with technological addictions.

Promoting Consumer Engagement in Online Communities through Virtual Experience and Social Identity

With the development and proliferation of online games, understanding how to seize these players has become an essential issue for academic scholars and practitioners. Based on virtual experience in online gaming communities and consumer engagement perspectives, this research developed and verified a multi-dimensional framework for assessing how to retain and encourage players continuous dedication and engagement behaviors. The proposed framework illustrates the interrelationships among six constructs in online gaming communities: social presence, telepresence, cognitive social identity, affective social identity, psychological engagement, and behavioral engagement. Data collected from 338 players who have experience in engagement behaviors in online gaming communities. The collected data were examined against the research framework using structural equation modeling (SEM). The research findings offer sufficient evidence that behavioral engagement is influenced by psychological engagement, which consecutively, are determined by cognitive social identity, affective social identity, social presence, and telepresence. More importantly, the mediating analysis indicated that psychological engagement is a crucial mediator, meaning that consumer engagement is a sequential process, and behavioral engagement cannot independently exist without psychological engagement. Taken together, the research results of this study have several critical theoretical and practical implications for future academic researchers and practitioners to have better understanding of consumer engagement. By doing so, the game companies can have sustainable competitive advantage and support sustainable development.

The Development of the Turkish Craving for Internet Gaming Scale (CIGS): A Validation Study

As the use of digital technology has increased, abuse and addiction to technology have been identified among a minority of users. In the mid-1990s, the concept of internet addiction was first used. Today, almost every digital technology use has been claimed to have a minority of disordered users. One key aspect of addictive substance behaviors is craving. Craving is also an important component of behavioral addictions including digital technology disorders such as Internet Gaming Disorder. The aim of the present study was to develop the Turkish version of the Craving for Internet Gaming Scale (CIGS) via an adaptation of the Penn Alcohol Craving Scale (PACS). The present study comprised 368 adolescents from four different samples. The measures used included the Craving for Internet Gaming Scale, Digital Game Addiction Scale, and Brief Self-Control Scale. The structural validity of CIGS was investigated with Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and criterion validity. The reliability of CIGS was evaluated using Cronbach α internal consistency reliability coefficient and corrected item total correlation coefficients. As a result of EFA, it was found that the five-item CIGS had a single-factor structure. The unidimensional CIGS obtained as a result of EFA was tested with CFA. As a result of CFA, the unidimensional structure of CIGS was confirmed in two different samples. Criterion validity of CIGS was assessed via digital gaming addiction, self-discipline, impulsiveness, daily internet gaming duration, and internet gaming history. As a result of criterion analysis, CIGS was associated with these variables in the expected direction. Finally, according to reliability analysis, the CIGS was found to be a reliable scale. When validity and reliability analysis of the CIGS are considered as a whole, it is concluded that the CIGS is a valid and reliable scale that assesses craving for internet gaming.

Associations between attention deficit hyperactivity and internet gaming disorder symptoms: Is there consistency across types of symptoms, gender and countries?

BACKGROUND

Videogame addiction has been suggested as a tentative disorder in 2013 by the American Psychiatric Association (APA) and was recently officially recognized as a mental health disorder by the World Health Organization (WHO). Although a few studies have identified attention deficit and hyperactivity disorder (ADHD) as a key risk factor for Internet Gaming Disorder (IGD), the interplay between ADHD and IGD symptoms with gender differences across cultures remains to be further examined.

OBJECTIVE

This study examined the moderating effects of gender in the association between ADHD and IGD across two nations.

METHOD

A cross-sectional online survey was developed to recruit 164 Australian (Mage = 23.01, SD = 3.35, Minage = 18, Maxage = 31, Males n = 121, 73.80%) and 457 U.S.-North American (Mage = 25.25 years, SD = 2.76, Minage = 18 years, Maxage = 29 years, Males = 265, 57.98%) Massively Multiplayer Online (MMO) players aged between 18 and 29 years.

RESULTS

The hierarchical linear regression, moderation and moderated moderation analyses revealed that participants presenting greater inattention and hyperactivity symptoms exhibited higher levels of IGD-related behaviors in the two samples. Moreover, these associations differed across genders between the two countries. Specifically, more hyperactive-impulsive, as well as inattentive males in the USA presented higher levels of disordered gaming.

CONCLUSION

The results highlight the need for more cross-cultural and symptom-focused research in the broader IGD field.

The concept of "harm" in Internet gaming disorder

Internet gaming disorder (IGD) is a proposed condition that refers to persistent gaming leading to clinically significant impairment. However, there have been few attempts to study the different types and degrees of harm caused by IGD. This commentary describes some of the negative intrapersonal and interpersonal effects of an extreme time investment in gaming activities in the context of IGD. Future research should examine the way in which IGD harms may occur at different levels and degrees. This may enhance the screening of individuals whose behavior is suspected to meet the definition of the proposed IGD criteria.

Does "forced abstinence" from gaming lead to pornography use? Insight from the April 2018 crash of Fortnite's servers

In April 2018, the servers of the popular video game "Fortnite" crashed for 24 hr. During this period, Pornhub (a popular pornographic website) analyzed trends in pornography access, finding that: (a) the percentage of gamers accessing Pornhub increased by 10% and (b) the searches of pornographic videos using the key term "Fortnite" increased by 60%. In this letter, we discuss these observations in the context of ongoing debate regarding the validity of "withdrawal" when applied to problematic involvement in video gaming and the potential use of pornography as a "compensation behavior" during the periods of "forced abstinence" from gaming.

Internet gaming disorder in children and adolescents: a systematic review

AIM

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

METHOD

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

RESULTS

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

INTERPRETATION

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

WHAT THIS PAPER ADDS

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

Therapeutic mechanisms of Mindfulness-Oriented Recovery Enhancement for internet gaming disorder: Reducing craving and addictive behavior by targeting cognitive processes

: Findings suggest that effects of mindfulness treatment in reducing maladaptive gaming-related cognitions might lead to reductions in IGD severity and cravings for video game playing. This cognitive mechanism should be evaluated in a future, full-scale RCT.

Clinical predictors of gaming abstinence in help-seeking adult problematic gamers

Research into the effectiveness of interventions for problematic gaming has been limited by a lack of data concerning the clinical characteristics of voluntary treatment-seekers; the nature and history of their gaming problems; and, their reasons for seeking help. The study aimed to identify variables predictive of short-term commitment to gaming abstinence following initial voluntary contact with an online help service. A total of 186 adult gamers with gaming-related problems were recruited online. Participants completed the DSM-5 Internet gaming disorder (IGD) checklist, Depression Anxiety Stress Scales-21, Internet Gaming Cognition Scale, Gaming Craving Scale, and Gaming Quality of Life Scale. A one-week follow up survey assessed adherence with intended gaming abstinence. Abstainers were less likely to have withdrawal symptoms and less likely to play action shooting games. Participants with mood symptoms (40% of the total) reported significantly more IGD symptoms, stronger maladaptive gaming cognitions (e.g., overvaluing game rewards), more previous occurrences of gaming problems, and poorer quality of life. However, mood symptoms did not predict abstinence from or continuation of gaming. Adults with gaming disorder seeking help to reduce their gaming may benefit initially from strategies that manage withdrawal and psychoeducation about riskier gaming activities.

Tolerance in Internet gaming disorder: A need for increasing gaming time or something else?

Background and aims The criterion of tolerance in DSM-5 Internet gaming disorder (IGD) refers to a need for increasing time spent gaming. However, this focus on "need for gaming time" may overlook some of the broader motivations, outcomes, or effects of gaming that underlie excessive play. This study aimed to explore regular and problematic gamers' experiences and perceptions of tolerance in IGD. Methods An online survey of 630 adult gamers yielded 1,417 text responses to open-ended questions. A thematic analysis of 23,373 words was conducted to extract dominant themes. Results Participants reported that they increasingly desired game items, status, or story progress as they became more involved or invested in games. As players develop higher standards of play in games, an increasing number of potential reward outcomes may have diminishing mood-modifying effects. None of the participants, including those with self-reported IGD, explicitly referred to a need for increasing time spent gaming. Discussion and conclusions These results suggest that players may be motivated by preferences for specific goals or reinforcers in games rather than wanting an amount of time spent gaming. Thus, problematic gaming may involve a need for completion of increasingly intricate, time-consuming, or difficult goals to achieve satisfaction and/or reduce fears of missing out. Further research is needed to determine whether these cognitive and motivational factors related to gaming stimuli should extend or replace the concept of tolerance in IGD or be considered as separate but related processes in disordered gaming.

Internet gaming disorder: Inadequate diagnostic criteria wrapped in a constraining conceptual model

Background and aims The paper "Chaos and confusion in DSM-5 diagnosis of Internet Gaming Disorder: Issues, concerns, and recommendations for clarity in the field" by Kuss, Griffiths, and Pontes (in press) critically examines the DSM-5 diagnostic criteria for Internet gaming disorder (IGD) and addresses the issue of whether IGD should be reconceptualized as gaming disorder, regardless of whether video games are played online or offline. This commentary provides additional critical perspectives on the concept of IGD. Methods The focus of this commentary is on the addiction model on which the concept of IGD is based, the nature of the DSM-5 criteria for IGD, and the inclusion of withdrawal symptoms and tolerance as the diagnostic criteria for IGD. Results The addiction framework on which the DSM-5 concept of IGD is based is not without problems and represents only one of multiple theoretical approaches to problematic gaming. The polythetic, non-hierarchical DSM-5 diagnostic criteria for IGD make the concept of IGD unacceptably heterogeneous. There is no support for maintaining withdrawal symptoms and tolerance as the diagnostic criteria for IGD without their substantial revision. Conclusions The addiction model of IGD is constraining and does not contribute to a better understanding of the various patterns of problematic gaming. The corresponding diagnostic criteria need a thorough overhaul, which should be based on a model of problematic gaming that can accommodate its disparate aspects.

Trajectories of abstinence-induced Internet gaming withdrawal symptoms: A prospective pilot study

Internet Gaming Disorder (IGD) is positioned in the appendix of the DSM-5 as a condition requiring further study. The IGD criteria refer to withdrawal symptoms, including irritability, anxiety, or sadness, that follow cessation of Internet gaming (APA, 2013). The aim of this study was to prospectively examine the nature of Internet gaming withdrawal symptoms, if they occur, under gaming abstinence conditions. This study employed a repeated-measures protocol to examine the cognitive-affective reactions of participants undertaking an 84-h Internet gaming abstinence period. The sample included individuals who met the IGD criteria as well as those who regularly played Internet games but did not meet the IGD criteria. Outcome variables included affect (positive and negative), psychological distress (depression, anxiety, stress), and Internet gaming withdrawal symptoms (craving/urge, thoughts about gaming, inability to resist gaming). A total of 24 participants (M_age = 24.6 years, SD = 5.8) were recruited from online gaming communities, and completed a series of online surveys before, during, and after abstaining from Massively Multiplayer Online (MMO) games. Both the IGD group and the non-IGD group experienced an abstinence-induced decline in withdrawal symptomatology, negative affect, and psychological distress. The IGD group experienced its largest decline in withdrawal symptomatology within the first 24 h of abstinence. These preliminary data suggest that gaming withdrawal symptoms may follow, at least initially, negative linear and quadratic trends. Further prospective work in larger samples involving longer periods of abstinence is required to verify and expand upon these observations.