Not Playing Around: Gaming Disorder in the International Classification of Diseases (ICD-11)

How much online pornography is too much? A comparison of two theoretically distinct assessment scales

BACKGROUND

Online pornography use, an ever more common activity, has raised myriad psychosocial and clinical concerns. While there is a need to screen for and measure its problematic dimension, there is a debate about the adequacy of existing assessment tools.

OBJECTIVE

The study compares two instruments for measuring pathological online pornography use (POPU) that are based on different theoretical frameworks-one in line with DSM-5 criteria and the six-component addiction model and one in line with ICD-11 criteria.

METHODS

An international sample of 1,823 adults (Mean age = 31.66, SD = 6.74) answered an online questionnaire that included the Short Version of the Problematic Pornography Consumption Scale (PPCS-6) and the Assessment of Criteria for Specific Internet-Use Disorders (ACSID-11). Factorial, correlational, and network analyses were conducted on the data.

RESULTS

Both tools adequately screened for online "addictive" behavior, but the ACSID-11 was superior in assessing the degree of clinical risk.

CONCLUSION

Depending on the specific aim of the assessment (screening vs. clinical diagnostics), both online pornography measurement tools may be useful.

The prevalence and possible risk factors of gaming disorder among adolescents in China

BACKGROUND

Nowadays, moderate gaming behaviors can be a pleasant and relaxing experiences among adolescents. However, excessive gaming behavior may lead to gaming disorder (GD) that disruption of normal daily life. Understanding the possible risk factors of this emerging problem would help to suggest effective at preventing and intervening. This study aimed to investigate the prevalence of GD and analyze its possible risk factors that adolescents with GD.

METHODS

Data were collected between October 2020 and January 2021. In total, a sample of 7901 students (4080 (52%) boys, 3742 (48%) girls; aged 12-18 years) completed questionnaires regarding the Gaming-Related Behaviors Survey, Gaming Disorder Symptom Questionnaire-21 (GDSQ-21); Behavioral Inhibition System and Behavioral Activation System Scale (BIS/BAS Scale); Emotion Regulation Questionnaire (ERQ); Short-form Egna Minnenav Barndoms Uppfostran for Chinese (s-EMBU-C); and Adolescent Self-Rating Life Events Checklist (ASLEC).

RESULTS

The prevalence of GD was 2.27% in this adolescent sample. The GD gamers were a little bit older (i.e., a higher proportion of senior grades), more boys, with more gaming hours per week in the last 12 months, with more reward responsiveness, maternal rejecting and occurrence of negative life events (e.g., interpersonal relationships, being punished and bereavement factors).

CONCLUSION

These possible risk factors may influence the onset of GD. Future research in clinical, public health, education and other fields should focus on these aspects for provide target prevention and early intervention strategies.

From game engagement to craving responses - The role of gratification and compensation experiences during video-gaming in casual and at-risk gamers

Introduction

Although playing videogames is a common leisure activity some individuals develop problematic gaming behaviors or even symptoms of a gaming disorder. Game engagement may be involved in reinforcement learning that may result in experiences of craving, an important feature of gaming disorder. In the following study we aimed to approach the question which aspects contribute to increased craving for gaming.

Methods

Overall, 439 individuals participated in an online survey, answering questionnaires on game engagement, experience of gratification and compensation, craving, and symptoms of gaming disorder. A mediation model testing if the association between game engagement and facets of craving are mediated by the experience of gratification and compensation during gaming.

Results

Three facets of craving (reward/relief, physiological, obsessive craving) were statistically explained by game engagement and the experience of gratification and compensation. Models differed between casual gamers and at-risk gamers. The effects on reward/relief and physiological craving were fully mediated in the casual group and partially mediated in the at-risk group by gratification and compensation experiences.

Conclusion

Game engagement may contribute to the development of craving by increasing the experience of gratification and compensation and thus might be important in reinforcement learning. Games evoking a high engagement may therefore have a higher addictive potential. Further processes potentially related to game engagement, such as intrusive thoughts and desire thinking, which are related to craving experiences, should be considered in future studies.

The Role of Self-Control Dimensions, Game Motivation, Game Genre, and Game Platforms in Gaming Disorder: Cross-Sectional and Longitudinal Findings

Introduction

Gaming disorder (GD) is the result of an interplay between gaming-related factors, individual factors, and environmental factors. Current research primarily highlights single types of factors. Consequently, the present study simultaneously analyzed the role of individual factors, such as self-control dimensions and motives for gaming, and gaming-related factors, such as game genres, and gaming platforms in GD among female and male gamers. Additionally, the study provides a comprehensive analysis of these factors in relation to GD both cross-sectionally (Study 1) and longitudinally (Study 2).

Methods

Study 1 comprised 620 active gamers (M=22.16 years; SD=2.99), and Study 2 comprised 405 active gamers (M=28.05 years; SD=4.51). The instruments used in the studies included the Gaming Disorder Test, the nine-item Internet Gaming Disorder Short-Form (IGDS9-SF), Motives for Online Gaming Questionnaire, Video Game Questionnaire, and Self-Knowledge New Sheet.

Results

The results showed that GD was associated with (i) self-control deficits associated with difficulties in implementation control and taking actions related to goals without unnecessary delay, (ii) retaining information about intentions and long-term plans, (iii) refraining from immediate, impulsive behavior, and (iv) inhibiting emotional reactions. GD was also associated primarily with escape, coping, and competition motives for gaming. However, the longitudinal study showed that social, fantasy, and skill-development motives were also related to GD development over time. The action game genres associated with GD but were not very important for GD over time. The cross-sectional study results indicated a negative relationship between GD and tablets and consoles used as gaming platforms. However, the longitudinal study showed that desktop computers and consoles use as gaming platforms were associated with the GD over time. Moreover, gaming-related factors explained only 9% of the variance in the GD model among female gamers and only 10% of the variance in the GD model among male gamers in cross-sectional study. In contrast, individual factors such as self-control dimensions and gaming motivation explained 32% of the variance in the GD model among both female and male gamers.

Conclusion

Individual factors, such as self-control dimensions and motives for gaming, were more important in explaining GD than gaming-related factors, such as game genres and gaming platforms. Moreover, self-control deficits and motivation related to escape, coping and competence can be important factors to consider in the prevention and treatment of GD.

Psychometric properties of the Problematic Use of Social Networks (PUS) scale in Arabic among adolescents

BACKGROUND

The Problematic Use of Social Networks (PUSN) scale assesses for the first time the comparative use of social networks along with addictive tendencies. However, it has only been validated in a Spanish sample. This study aimed to evaluate the psychometric properties of the Arabic version of the PUSN (PUSN-Ar) among Lebanese adolescents.

METHODS

A total of 379 adolescents aged between 15 to 18 years (M = 16.07 years; 64.9% females) participated in this cross-sectional study conducted between January and May 2022. The problematic use of social networks-SNS (PUSN) scale yields of two subscales: addiction-related consequences of SNS use (SNS-ARC) and negative social comparison (SNS-NSC). The Beirut Distress Scale, the Smartphone Addiction Scale and the Jong-Gierveld Loneliness Scale were used to assess psychological distress, smartphone addiction and loneliness respectively.

RESULTS

The PUS-Ar scale exhibited a two-dimensional structure (Comparative Fit Index [CFI] = .97; Root Mean Square Error of Approximation [RMSEA] = .08), consistent with the original scale. Both subscales, Negative Social Comparison (α = .96) and Addictive Consequences (α = .92), demonstrated excellent reliability. Additionally, measurement invariance was verified between males and females at the configural, metric and scalar levels. No significant difference was found between males and females in terms of SNS-NSC (20.75 ± 10.15 vs 21.09 ± 9.51; t(377) = -.32; p = .751) and SNS-ARC (19.08 ± 8.61 vs 19.76 ± 6.77; t(377) = -.79; p = .430). The SNS-ARC subscale was more correlated to smartphone addiction than the SNS-NSC (r = .73; p < .001 vs r = .54; p < .001) whereas both subscales were significantly associated with more stress and more loneliness.

CONCLUSION

The data collected in this study provided support for all the hypotheses formulated. Consequently, the PUS-Ar was deemed a suitable scale to measure problematic SNS among Lebanese adolescents. The PUS-Ar is currently available to researchers for use in evaluating PSNSU in Lebanon. However, it is important to note that further research is needed to explore its applicability and generalizability across different populations and contexts.

Prevalence of problematic Internet use and problematic gaming in Spanish adolescents

Epidemiological studies on problematic Internet use and problematic gaming conducted so far have mainly been carried out with unrepresentative and self-selected convenience samples, resulting in unreliable prevalence rates. This study estimates the prevalence of problematic Internet use and problematic gaming in a large sample of Spanish adolescents (N = 41,507) and identifies risk and protective factors for these risky behaviours. Data were collected online using the Adolescent Problem Internet Use Scale and the Adolescent Gaming Addiction Scale. Using a cut-off approach with measurement instruments inspired by the DSM-5 framework, we found a prevalence of 33% for problematic Internet use and 3.1% for problematic gaming. With a more conservative approach inspired by the ICD-11 framework, prevalence rates decreased to 2.98% for problematic Internet use and 1.8% for problematic gaming. Female gender, higher parents' education, elevated Internet connection time, reporting being online after midnight and using the mobile phone in class predicted problematic Internet use; whereas male gender, "living situation" where families do not have a traditional structure or stable environment, elevated Internet connection time and reporting using the mobile phone in class predicted problematic gaming. A cut-off approach involving scales that recycle substance use criteria (as in the DSM-5) over-pathologize Internet use and gaming behaviours. In contrast, the ICD-11 approach seems to provide more realistic and reliable prevalence rates.

Measurement of craving among gamers with internet gaming disorder using repeated presentations of game videos: a resting-state electroencephalography study

BACKGROUND

Internet gaming disorder (IGD) is receiving increasing attention owing to its effects on daily living and psychological function.

METHODS

In this study, electroencephalography was used to compare neural activity triggered by repeated presentation of a stimulus in healthy controls (HCs) and those with IGD. A total of 42 adult men were categorized into two groups (IGD, n = 21) based on Y-IAT-K scores. Participants were required to watch repeated presentations of video games while wearing a head-mounted display, and the delta (D), theta (T), alpha (A), beta (B), and gamma (G) activities in the prefrontal (PF), central (C), and parieto-occipital (PO) regions were analyzed.

RESULTS

The IGD group exhibited higher absolute powers of D_C, D_PO, T_C, T_PO, B_C, and B_PO than HCs. Among the IGD classification models, a neural network achieves the highest average accuracy of 93% (5-fold cross validation) and 84% (test).

CONCLUSIONS

These findings may significantly contribute to a more comprehensive understanding of the neurological features associated with IGD and provide potential neurological markers that can be used to distinguish between individuals with IGD and HCs.

Is internet gaming disorder associated with suicidal behaviors among the younger generation? Multiple logistic regressions on a large-scale purposive sampling survey

The ubiquity of Internet gaming as part of the younger generation's (11-35 year-olds) lifestyle to-day warrants a deeper understanding of its impact on their mental health. In particular, there has been scant research investigating the link between Internet Gaming Disorder (IGD) and suicidal behaviors in this demographic group, even though several mental health symptoms of the former are known risk factors for the latter. This paper aims to establish the presence or absence of association between IGD and each of suicidal ideation, self-harm, and suicide attempt among the younger generation. A large-scale online survey on Internet gamers in Hong Kong was conducted in February 2019. 3430 respondents were recruited through purposive sampling. Study samples were stratified into distinct age groups and multiple logistic regression was conducted for each measured suicidal behavior in each age group. After controlling for sociodemographics, Internet usage, self-reported bullying perpetration and bullying victimization, social withdrawal, and self-reported psychiatric diagnoses such as depression and psychosis, analyses revealed that adolescent (11-17 year-old) gamers with IGD were more likely than their peers who had no IGD to have had suicidal ideation, self-harm, and suicide attempt in their lifetime. These associations did not hold for 18-35 year-old gamers. Findings suggest that it may be prudent to recognize IGD as a growing public mental health priority for the young populace, particularly adolescents. Existing suicide prevention efforts can be complemented through screening adolescents for IGD, and could be expanded to online gaming platforms to reach more hidden at-risk individuals.

The relationship between positive youth development and internet gaming disorder in Chinese adolescents: A moderated mediation model

Internet gaming disorder (IGD) is a social problem that cannot be ignored. Considerable research has shown that IGD can impede the healthy physical and mental development of adolescents. Based on positive youth development theory and stage-environment fit theory, the current study explored the mediating effect of depression and the moderating effect of gender to determine the association between positive youth development (PYD) and IGD. A sample of 1970 Chinese adolescents aged 11-18 years (1021 boys, 940 girls, and 10 unidentifiable individuals) completed questionnaires related to PYD, depression, IGD, and their background information. The results revealed that PYD negatively predicted IGD. After controlling for gender and age, this study found that depression mediated the relationship between PYD and IGD. Furthermore, gender moderated the relationship between depression and IGD. Boys with depressive symptoms were more likely to indulge in IGD than girls. This research contributes to a more thorough understanding of how PYD decreases the risk of IGD. These findings suggest that cultivating PYD attributes is a promising approach to prevent or reduce depression and IGD among adolescents in mainland China.

Assessment of Criteria for Specific Internet-use Disorders (ACSID-11): Introduction of a new screening instrument capturing ICD-11 criteria for gaming disorder and other potential Internet-use disorders

Background and aims

With the inclusion of gaming disorder in the ICD-11, diagnostic criteria were introduced for this relatively new disorder. These criteria may also be applied to other potential specific Internet-use disorders, which may be classified in ICD-11 as other disorders due to addictive behaviors, such as online buying-shopping disorder, online pornography-use disorder, social-networks-use disorder, and online gambling disorder. Due to the heterogeneity in existing instruments, we aimed to develop a consistent and economic measure of major types of (potential) specific Internet-use disorders based on ICD-11 criteria for gaming disorder.

Methods

The new 11-item Assessment of Criteria for Specific Internet-use Disorders (ACSID-11) measures five behavioral addictions with the same set of items by following the principles of WHO's ASSIST. The ACSID-11 was administered to active Internet users (N = 985) together with an adaptation of the Ten-Item Internet Gaming Disorder Test (IGDT-10) and screeners for mental health. We used Confirmatory Factor Analyses to analyze the factor structure of ACSID-11.

Results

The assumed four-factorial structure was confirmed and was superior to the unidimensional solution. This applied to gaming disorder and to the other specific Internet-use disorders. ACSID-11 scores correlated with IGDT-10 as well as with the measures of psychological distress.

Discussion and Conclusions

The ACSID-11 seems to be suitable for the consistent assessment of (potential) specific Internet-use disorders based on ICD-11 diagnostic criteria for gaming disorder. The ACSID-11 may be a useful and economic instrument for studying various behavioral addictions with the same items and improving comparability.

Prospective Association Between Online Game Use and Risk of Internet Gaming Disorder in Korea: 12-Month Follow-up Results From the iCURE Study

Children and adolescents' Internet game use has both functional and dysfunctional aspects. This study aimed to examine how changes in online gaming behaviors impact the risk of Internet gaming disorder (IGD). We observed 1318 adolescent online game users. Baseline and 12-month follow-up evaluations were performed, and it was defined whether the average online gaming time per day exceeded 1.5 hours and whether the number of gaming days per week exceeded 4 days. Gaming disorder was defined using the Internet Game Use-Elicited Symptom Screen. Multiple logistic regression was performed to examine the difference in the incidence rate ratio (IRR) of IGD risk according to changes in gaming time or frequency. Results indicated the IRR of IGD risk was 2.54 (P = .007) for the increased time spent group and 2.38 (P = .015) for the consistent higher time spent group against the consistent lower time spent group. The IRR was 3.76 (P = .007) for the increased frequency group and 2.92 (P = .029) for the consistent higher frequency group against the consistent lower frequency group. Therefore, managing Internet game use not to exceed 1.5 hours per day on average and 4 days per week would help prevent elevation of IGD risk.

Changes from ICD-10 to ICD-11 and future directions in psychiatric classification

This article provides a brief overview of the changes from ICD-10 to ICD-11 regarding the classification of mental, behavioral, or neurodevelopmental disorders. These changes include a new chapter structure, new diagnostic categories, changes in diagnostic criteria, and steps towards dimensionality. Additionally, we review evaluative field studies of ICD-11, which provide preliminary evidence for higher reliability and clinical utility of ICD-11 compared with ICD-10. Despite the extensive revision process, changes from ICD-10 to ICD-11 were relatively modest in that both systems are categorical, classifying mental phenomena based on self-reported or clinically observable symptoms. Other recent approaches to psychiatric nosology and classification (eg, neurobiology-based or hierarchical) are discussed. To meet the needs of different user groups, we propose expanding the stepwise approach to diagnosis introduced for some diagnostic categories in ICD-11, which includes categorical and dimensional elements.


Common neurofunctional dysregulations characterize obsessive-compulsive, substance use, and gaming disorders-An activation likelihood meta-analysis of functional imaging studies

Compulsivity and loss of behavioral control represent core symptoms in obsessive-compulsive disorder (OCD), substance use disorder (SUD), and internet gaming disorder (IGD). Despite elaborated animal models suggesting that compulsivity is mediated by cortico-striatal circuits and a growing number of neuroimaging case-control studies, common neurofunctional alterations in these disorders have not been systematically examined. The present activation likelihood estimation (ALE) meta-analysis capitalized on previous functional magnetic resonance imaging (fMRI) studies to determine shared neurofunctional alterations among the three disorders. Task-based fMRI studies of individuals with SUD, OCD, or IGD were obtained. ALE was performed within each disorder. Next, contrast and conjunction meta-analyses were performed to determine differential and common alterations. Task-paradigm classes were group according to Research Domain Criteria (RDoC) domains to determine contributions of underlying behavioral domains. One hundred forty-four articles were included representing data from n = 6897 individuals (SUD = 2418, controls = 2332; IGD = 361, controls = 360; OCD = 715, controls = 711) from case-control studies. Conjunction meta-analyses revealed shared alterations in the anterior insular cortex between OCD and SUDs. SUD exhibited additionally pronounced dorsal-striatal alterations compared with both, OCD and IGD. IGD shared frontal, particularly cingulate alterations with all SUDs, while IGD demonstrated pronounced temporal alterations compared with both, SUD and OCD. No robust overlap between IGD and OCD was observed. Across the disorders, neurofunctional alterations were mainly contributed by cognitive systems and positive valence RDoC domains. The present findings indicate that neurofunctional dysregulations in prefrontal regions engaged in regulatory-control represent shared neurofunctional alterations across substance and behavioral addictions, while shared neurofunctional dysregulations in the anterior insula may mediate compulsivity in substance addiction and OCD.

Impact of the COVID-19 lockdown on screen media use in patients referred for ADHD to child and adolescent psychiatry: an introduction to problematic use of the internet in ADHD and results of a survey

The COVID-19 outbreak and lockdown have been associated with multiple consequences for mental health, including an excessive and potentially harmful increase in screen media use. The specific consequences for children, adolescents and young adults with ADHD are still unknown. In the first part of this study, a short review of problematic use of the internet (PUI) in ADHD is presented, showing that patients with ADHD are at risk for different aspects of PUI, such as excessive gaming or problematic social media use. In the second part, we report original data of an online survey on screen media use before, during and after the lockdown completed by parents of children and adolescents clinically referred for ADHD. Parents rated children's/adolescents' media-related behavior and media time on a new screening questionnaire for PUI. Each item was rated three times, referring to the observed behavior before, during and 1-2 months after the lockdown. N = 126 parents of patients referred for ADHD aged 10-18 years participated in the study. Total media time increased by 46% during the lockdown and did not completely return to pre-Corona levels afterwards. Patients with difficulties concentrating, high irritability or deterioration of ADHD problems under lockdown spent more time with screen media than those with milder or no such problems. While the effects of the lockdown on screen media use and its negative impact on everyday life appear to be largely reversible, a small proportion of patients with ADHD apparently continue to show increased media use.

What Types of Internet Services Make Adolescents Addicted? Correlates of Problematic Internet Use

PURPOSE

This study investigated the prevalence and correlates of problematic internet use (PIU) in a large sample of adolescents based on the type of internet service used.

MATERIALS AND METHODS

The study was conducted from 2008 to 2010, and 223,542 adolescents aged 12 to 18 years participated in the study. The participants responded to a self-report questionnaire including items for demographic factors, internet usage time, most used internet service and mental health. The PIU was assessed with the Internet Addiction Proneness Scale for Youth-Short Form.

RESULTS

The overall prevalence rate of PIU was 5.2%, and the prevalence rates stratified by sex were 7.7% in boys and 3.8% in girls. The distribution of most used internet services was significantly different across sexes. The most commonly used internet services were gaming (58.1%) in boys and blogging (22.1%) and messenger/chatting (20.3%) in girls. The odds ratio for PIU was significantly different according to the most used internet service; using the internet mostly for pornography compared to information searching had the highest odds ratio (4.526-fold higher). Depressive episodes, suicidal ideation, and suicidal attempts were significantly associated with higher odds ratios for PIU (1.725-, 1.747- and 1.361-fold, respectively).

CONCLUSION

The present study identified clinically important information about PIU in adolescents. The distribution of PIU has different patterns based on sex and specific internet services. Studies of PIU with well-defined methodology and assessment tools for PIU of each specific internet service are needed.

Skin in the game: Video-game-related cutaneous pathologies in adolescents

Background

Following the inception of video games and the subsequent development of progressive innovations in videogame technology, many reports of videogame-related dermatologic conditions soon emerged in literature. Children and adolescents, in particular, are among the most avid consumers of online digital entertainment.

Methods

In an effort to better detail the impacts of these cutaneous manifestations and provide recommendations for injury prevention as it relates to video games, we performed an extensive systems-based literature review pertaining to the clinical features, etiology, diagnosis, and treatment of reported cases of dermatoses resulting from the misuse of video games.

Results

A literature review using PubMed, SCOPUS, Ovid MEDLINE and EMBASE was performed. Hardware implicated in the reported cases include video games consoles, personal computers, laptop computers, mobile phones and tablets. The dermatologic conditions are primarily localized to the extremities, particularly the palms and fingers. The majority are associated with repetitive friction and trauma, as well as allergic contact sensitivities. For all cutaneous manifestations induced by video gaming, early recognition and removal of the offending agent was most often described as effective in symptom resolution.

Conclusions

The universal use and pervasive popularity of video games for recreational purposes present an emerging dermatological concern. As videogames become increasingly advanced and immersive, various cutaneous conditions arising from intensive gaming will likely become common over time. Consequently, it is critical that dermatologists consider video games with a high index of suspicion when encountering dermatological ailments in underage patients engaging in persistent gaming behavior.

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.