The relationship between gaming disorder and addiction requires a behavioral analysis

The gaming problem: A latent class analysis of DSM-5 criteria for Internet Gaming Disorder in a non-clinical sample

Background: In this study we aimed to test whether suggested DSM-5 criteria for Internet Gaming Disorder (IGD) share a similar latent structure to formally recognised addiction. Methods: We used latent class analysis on a dichotomous measure of IGD. The data was collected from a convenient general population sample (500) and a targeted gaming forum sample (236). Results: We found a four or six-class model to be most appropriate, ranging from ‘casual/non-gamer’ to ‘potentially disordered’ with increasing symptom severity. The majority of ‘potentially disordered’ gamers (5+ criteria) were found to be 18-30 years old, and no ‘potentially disordered’ gamers were over 42. Conclusions: The results suggest that gaming may share a similar latent structure to established addictions, with adolescents and young adults being more at risk. Studies replicating these results would be beneficial, with further emphasis on a critical evaluation of the criteria and symptom cut-off point.

[Inclusion of gaming disorder as a behavioral addiction in ICD-11]

Inclusion of gaming disorder as a behavioral addiction in ICD-11 Abstract. With the inclusion of the new category "disorders due to addictive behaviors" in ICD-11, it has been officially recognized by the WHO that highly rewarding behaviors, analogous to psychotropic substances, can become addictive. In addition to gambling disorder, which was already listed in ICD-10, computer gaming disorder was added as a new diagnosis in this category. The phenotype is characterized by loss of control, priority of gaming over other activities, continuation of gaming despite negative consequences, and the condition of significant impairment caused by the symptomatology. Disorder-typical pathomechanisms include consumption-dependent factors, developmental factors, changes in reward sensitivity and processing, and biased reward expectations (cognitions). Psychotherapeutic care for children, adolescents, and young adults with this disorder, who now comprise a substantial proportion of outpatient care, is challenging. In addition to the development of valid diagnostic tools and effective intervention methods, there is a great need for further training in child and adolescent psychiatry and psychotherapy on this new disorder.

Investigating the relationship between personality, chronotype, computer game addiction, and sleep quality of high school students: A structural equation modelling approach

This study examines the relationship between high school students' age, gender, personality, computer game addiction, chronotype, and sleep quality using structural equation modelling. For this purpose, the study was planned according to the correlational research design, one of the most common quantitative research methods. The sample of the study consisted of 922 students who accepted to participate and completed the scales. Of the 922 high school students in the sample, 528 were girls, and 394 were boys. In the study, the Computer Game Addiction Scale for Adolescents, Sleep Quality Scale, Composite Scale of Morningness (CSM), and Big Five Inventory were used to measure the variables. Among the variables involved, personality traits, such as consciousness, neuroticism, and openness to experience, were significantly related with morningness-eveningness. Besides, gender and being evening or morning types were found to be significantly related with game addiction. However, sleep quality was predicted by computer game addiction and morningness-eveningness. It was found that the fit indices of the model have an acceptable and good fit in explaining the variables.

Choice of Leisure Activities by Adolescents and Adults With Internet Gaming Disorder: Development and Feasibility Study of a Virtual Reality Program

Background

Excessive internet game use frequently leads to various physical, psychological, and social problems, and internet gaming disorder (IGD) has become a serious public health issue worldwide. Recently, virtual reality (VR) therapy has emerged as a promising method to increase psychological treatment motivation and accessibility. However, few studies have examined the potential of VR technology for the management of IGD, and VR content tailored to IGD characteristics remains scarce.

Objective

This preliminary study aimed to examine the potential of a VR-based program that was designed to help users identify their leisure time use patterns, especially those related to gaming, and to modify their gaming overuse by alternative activities provided in the VR content. Moreover, to investigate whether users’ VR activities reflect various clinical variables of IGD in youth, we examined the relationships among the leisure time activity selection pattern, built-in response, and speech data obtained from the VR program, as well as symptom severity of internet gaming, psychiatric comorbidities, and motivation of participants reported through relevant questionnaire data.

Methods

Three types of VR content (understanding my daily activities at home, finding an alternative activity to internet gaming at home, expressing contradictory opinions toward a friend’s gaming beliefs) were developed by simulating the daily situations in which patients with IGD can select alternative free-time leisure activities. We examined internet addiction, mental health problems, and motivation for 23 IGD and 29 control participants. Behavioral and self-rated responses from VR, such as alternative activity selection data and speech patterns (speech time, speech satisfaction, and speech accordance), and results from various questionnaires were compared between groups. The correlations between IGD behaviors in VR and real-life behaviors assessed by questionnaire measures were analyzed.

Results

Significant correlations were found between internet gaming behavior and user activity data, such as speech and activity selection pattern, in our VR program. Our results showed that the IGD group had fewer leisure activities and preferred game or digital activities to other types of activities compared to controls, even in VR. There was a positive relationship between the viability of alternative leisure activities the participants selected in VR and the amount of perceived satisfaction from that activity (r=.748, P<.001). Speech accordance in the IGD group was lower than in the control group and was correlated negatively with Internet Addiction Test and Internet Addiction Test–gaming scores (r=.300, P=.03) but positively with users’ motivation (r=.312, P=.02).

Conclusions

The results from our VR program can provide information about daily activity patterns of youths with IGD and the relationship between user VR activities and IGD symptoms, which can be useful in applying VR technology to IGD management.

An investigation into Video Game Addiction in Pre-Adolescents and Adolescents: A Cross-Sectional Study

BACKGROUND AND OBJECTIVES

Game addiction is an emerging problem in public health. A gaming disorder is characterized by a pattern of persistent or recurrent gaming behavior. The behavioral pattern is severe enough to implicate a significant involvement of family, social, educational, professional, or other relationships. Therefore, greater attention needs to be paid to potential addictive behaviors in terms of video games in order to identify both pre-adolescents and adolescents at risk and to provide them with adequate assistance. Materials and Methods: A random sample of 622 students including pre-adolescents and adolescents were enrolled from September 1st to October 31th 2016, and the Game Addiction Scale (GAS) interview was used to identify pathological students with both Monothetic and Polythetic analysis.

RESULTS

This study shows the presence of pathological students is equal to 1.93%, with 37.46% and 4.50% obtained with Monothetic and Polythetic analysis (global and partial), respectively. In our sample, the most frequent were students with a gaming time of 1 or 2 h, and students with a day gaming frequency of 1, 2, or 3 times a day. The items with more pathological students were Item 2 (i.e., Tolerance) and 4 (i.e., Withdrawal). Every item was positively correlated with Daily gaming time(hours) and Daily game frequency, excluding Item 4(i.e., Withdrawal). Finally, the Monothetic GAS score was positively correlated with Daily gaming time while the Polythetic Global GAS was positively correlated with Daily game frequency and negatively with Education level; instead, the Polythetic Partial GAS score was positively correlated with only Daily gaming time.

CONCLUSION

Males are pathological gamblers more so than females and spend more time playing video games. An increase in Daily game frequency or Daily gaming time implicates an increase in video game addictions, while an increase in Education level, which generally corresponds to a greater age, implicates a decrease in game addiction. Finally, we observed that the correlations obtained between the Polythetic Partial GAS score with the independent variables such as Age, Gender, Education level, Daily gaming time (hours), and Daily game frequency were analogous to the significant correlations obtained with the Monothetic GAS score, while these correlations were different for the Polythetic Global GAS and the independent variables. These results suggest that the use of the original Polythetic scale should not be neglected.

Computer Game Addiction and Loneliness in Children

BACKGROUND

We aimed to determine the level of computer game addiction and loneliness among 9-10-yr-old children.

METHODS

The study was conducted with 4th-grade students at a primary school, located at the city center, during 2017-2018 academic years. There was no sampling in the research, all 4th-grade students of the school were reached. "Personal Information Form", "Computer Game Addiction Scale" and "UCLA Loneliness Scale" were used for collecting data. Mann Whitney U test, Kruskal Wallis test, and Correlation Analysis were used to evaluate the data of the research.

RESULTS

50.7% (n=104) of the students were female, most frequent number of sister/brother was one 39.0% (n=80), both their mother 31.7% (n=65) and their father 34.1% (n=69) were mostly high school graduated. The average scores that students got from the scales were; 48.66±.27.02 (min.: 21.00, max.: 105) for "Computer Game Addiction Scale" and 40.55±8.50 (min: 22.00, max.: 64) for "UCLA Loneliness Scale". A weak, positive and significant relationship was found between students' loneliness scale scores and computer game addiction scale scores (r=0.357; P<0.000).

CONCLUSION

A significant relationship was found between students' computer game addiction and loneliness. It is suggested to perform children's loneliness and computer game addiction assessments, evaluate effectiveness and establish a rehabilitating treatment system among school-hospital-family for abnormal cases.

Including gaming disorder in the ICD-11: The need to do so from a clinical and public health perspective

The proposed introduction of gaming disorder (GD) in the 11th revision of the International Classification of Diseases (ICD-11) developed by the World Health Organization (WHO) has led to a lively debate over the past year. Besides the broad support for the decision in the academic press, a recent publication by van Rooij et al. (2018) repeated the criticism raised against the inclusion of GD in ICD-11 by Aarseth et al. (2017). We argue that this group of researchers fails to recognize the clinical and public health considerations, which support the WHO perspective. It is important to recognize a range of biases that may influence this debate; in particular, the gaming industry may wish to diminish its responsibility by claiming that GD is not a public health problem, a position which maybe supported by arguments from scholars based in media psychology, computer games research, communication science, and related disciplines. However, just as with any other disease or disorder in the ICD-11, the decision whether or not to include GD is based on clinical evidence and public health needs. Therefore, we reiterate our conclusion that including GD reflects the essence of the ICD and will facilitate treatment and prevention for those who need it.

Addressing problematic video game use: A multimethod, dual-context perspective on leisure-time use

A more integrative approach to the prevention of problematic gaming behavior is recommended in Király et al.'s review. We discuss the Dutch policy responses to problematic gaming behavior and suggest two alternatives to the dominant survey research approach to achieve this. Employing time-use/diary studies allows us to map out the full scope of leisure-time use and employing log-data analysis improves our understanding of gamer behavior within the virtual context. All of these approaches would benefit from accounting for the diversity of within-virtual context behavior. The approach is summarized as a multimethod, dual-context approach to understanding leisure-time behavior.

Social genomics of healthy and disordered internet gaming

OBJECTIVES

To combine social genomics with cultural approaches to expand understandings of the somatic health dynamics of online gaming, including in the controversial nosological construct of internet gaming disorder (IGD).

METHODS

In blood samples from 56 U.S. gamers, we examined expression of the conserved transcriptional response to adversity (CTRA), a leukocyte gene expression profile activated by chronic stress. We compared positively engaged and problem gamers, as identified by an ethnographically developed measure, the Positive and Negative Gaming Experiences Scale (PNGE-42), and also by a clinically derived IGD scale (IGDS-SF9).

RESULTS

CTRA profiles showed a clear relationship with PNGE-42, with a substantial linkage to offline social support, but were not meaningfully associated with disordered play as measured by IGDS-SF9.

CONCLUSIONS

Our study advances understanding of the psychobiology of play, demonstrating via novel transcriptomic methods the association of negatively experienced internet play with biological measures of chronic threat, uncertainty, and distress. Our findings are consistent with the view that problematic patterns of online gaming are a proxy for broader patterns of biopsychosocial stress and distress such as loneliness, rather than a psychiatric disorder sui generis, which might exist apart from gamers' other life problems. By confirming the biological correlates of certain patterns of internet gaming, culturally-sensitive genomics approaches such as this can inform both evolutionary theorizing regarding the nature of play, as well as current psychiatric debates about the appropriateness of modeling distressful gaming on substance addiction and problem gambling.

A weak scientific basis for gaming disorder: Let us err on the side of caution

We greatly appreciate the care and thought that is evident in the 10 commentaries that discuss our debate paper, the majority of which argued in favor of a formalized ICD-11 gaming disorder. We agree that there are some people whose play of video games is related to life problems. We believe that understanding this population and the nature and severity of the problems they experience should be a focus area for future research. However, moving from research construct to formal disorder requires a much stronger evidence base than we currently have. The burden of evidence and the clinical utility should be extremely high, because there is a genuine risk of abuse of diagnoses. We provide suggestions about the level of evidence that might be required: transparent and preregistered studies, a better demarcation of the subject area that includes a rationale for focusing on gaming particularly versus a more general behavioral addictions concept, the exploration of non-addiction approaches, and the unbiased exploration of clinical approaches that treat potentially underlying issues, such as depressive mood or social anxiety first. We acknowledge there could be benefits to formalizing gaming disorder, many of which were highlighted by colleagues in their commentaries, but we think they do not yet outweigh the wider societal and public health risks involved. Given the gravity of diagnostic classification and its wider societal impact, we urge our colleagues at the WHO to err on the side of caution for now and postpone the formalization.