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

The nature and characteristics of problem gaming, with a focus on ICD-11 diagnoses

PURPOSE OF REVIEW

This review describes the diagnoses related to problem gaming that are included in ICD-11, published by the WHO in 2022. It summarizes the recent literature on the prevalence of Gaming Disorder, its structure, antecedents and comorbidities, and explores whether the range of diagnoses currently available adequately covers the range of experiences seen with problem gaming.

RECENT FINDINGS

Overall, between 3 and 6% of the population worldwide are reported to have a gaming disorder as defined by ICD-11 or DSM-5. However, most studies are constrained by methodological issues such as nonrepresentative samples and the use of brief questionnaires to determine prevalence. ICD-11 Gaming Disorder is a psychometrically sound diagnosis. There is no diagnosis that currently captures the experience of harm from gaming, where the requirements for the diagnosis of Gaming Disorder are not reached.

SUMMARY

There is evidence in support of the proposed new entity of 'Harmful Gaming', which encompasses mental and physical harm/impairment due to a repeated pattern of gaming, but where requirements for the diagnosis of Gaming Disorder are not met. Such a diagnosis would complete the spectrum of diagnoses available for problem or unhealthy gaming, similar to those for unhealthy substance use, and would provide a framework for a public health approach to reducing the overall harm from unhealthy gaming.

Two Sides of the Same Virtual Coin: Investigating Psychosocial Effects of Video Game Play, including Stress Relief Motivations as a Gateway to Problematic Video Game Usage

Video gamers can play to negate the psychological impact of stress, which may become problematic when users over-rely on the stress relief potential of gaming. This study used a repeated measures experimental design to investigate the relationships between stress, video gaming, and problematic video gaming behaviours in a convenience sample of 40 students at a UK university. The results indicated that positive affect increased and negative affect decreased, whilst a biological stress measure (instantaneous pulse rate) also decreased after a short video gaming session (t(36) = 4.82, p < 0.001, d = 0.79). The results also suggested that video gaming can act as a short-term buffer against the physiological impact of stress. Further research should focus on testing individuals who have been tested for gaming disorder, as opposed to the general population. Research could also utilise variations of the methodological framework used in this study to examine the intensity of a stress relief effect under different social situations. The study's findings in relation to published works are also discussed.

Neural correlates of model-based behavior in internet gaming disorder and alcohol use disorder

Background

An imbalance between model-based and model-free decision-making systems is a common feature in addictive disorders. However, little is known about whether similar decision-making deficits appear in internet gaming disorder (IGD). This study compared neurocognitive features associated with model-based and model-free systems in IGD and alcohol use disorder (AUD).

Method

Participants diagnosed with IGD (n = 22) and AUD (n = 22), and healthy controls (n = 30) performed the two-stage task inside the functional magnetic resonance imaging (fMRI) scanner. We used computational modeling and hierarchical Bayesian analysis to provide a mechanistic account of their choice behavior. Then, we performed a model-based fMRI analysis and functional connectivity analysis to identify neural correlates of the decision-making processes in each group.

Results

The computational modeling results showed similar levels of model-based behavior in the IGD and AUD groups. However, we observed distinct neural correlates of the model-based reward prediction error (RPE) between the two groups. The IGD group exhibited insula-specific activation associated with model-based RPE, while the AUD group showed prefrontal activation, particularly in the orbitofrontal cortex and superior frontal gyrus. Furthermore, individuals with IGD demonstrated hyper-connectivity between the insula and brain regions in the salience network in the context of model-based RPE.

Discussion and Conclusions

The findings suggest potential differences in the neurobiological mechanisms underlying model-based behavior in IGD and AUD, albeit shared cognitive features observed in computational modeling analysis. As the first neuroimaging study to compare IGD and AUD in terms of the model-based system, this study provides novel insights into distinct decision-making processes in IGD.

Comparing psychopathological symptoms, life satisfaction, and personality traits between the WHO and APA frameworks of gaming disorder symptoms: A psychometric investigation

INTRODUCTION

The inclusion of Internet Gaming Disorder (IGD) in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association and Gaming Disorder in the 11th revision of the International Classification of Diseases (ICD-11) by the World Health Organization requires consistent psychological measures for reliable estimates. The current study aimed to investigate the psychometric properties of the Gaming Disorder Test (GDT), the Ten-Item Internet Gaming Disorder Test (IGDT-10), and the Five-Item Gaming Disorder Test (GDT-5) and to compare the WHO and the APA frameworks of gaming disorder symptoms in terms of psychopathological symptoms, life satisfaction, and personality traits.

METHODS

A sample of 723 Swedish gamers was recruited (29.8% women, 68.3% men, 1.9% other, Mage  = 29.50 years, SD = 8.91).

RESULTS

The results indicated notable differences regarding the estimated possible risk groups between the two frameworks. However, the association between gaming disorder symptoms and personality traits, life satisfaction, and psychopathological symptoms appeared consistent across the two frameworks. The results showed excellent psychometric properties in support of the one-factor model of the GDT, IGDT-10, and GDT-5, including good reliability estimates (McDonald's omega) and evidence of construct validity. Additionally, the results demonstrated full gender and age measurement invariance of the GDT, IGDT-10, and GDT-5, indicating that gaming disorder symptoms are measured equally across the subgroups.

CONCLUSION

These findings demonstrate that the IGDT-10, GDT-5, and GDT are appropriate measures for assessing gaming disorder symptoms and facilitating future research in Sweden.

Reconsidering item response categories in gaming disorder symptoms measurement

Gaming disorder (GD) screening often involves self-report survey measures to detect the presence of symptoms. Studies have shown that gamers' responses vary greatly across survey items. Some symptoms, such as preoccupation and tolerance, are frequently reported by highly engaged but non-problematic gamers, and therefore these symptoms are thought to lack specificity and are suggested to be less important in classification decisions. We argue that the influence of response categories (e.g., dichotomous responses, such as 'yes' or 'no'; or frequency categories, such as 'rarely' and 'often') on item responses has been relatively underexplored despite potentially contributing significantly to the psychometric performance of items and scales. In short, the type of item response may be just as important to symptom reporting as the content of survey questions. We propose some practical alternatives to currently used item categories across GD tools. Research should examine the performance of different response categories, including whether certain response categories aid respondents' comprehension and insight, and better capture pathological behaviours and harms.

Severity identification for internet gaming disorder using heart rate variability reactivity for gaming cues: a deep learning approach

Background

The diminished executive control along with cue-reactivity has been suggested to play an important role in addiction. Hear rate variability (HRV), which is related to the autonomic nervous system, is a useful biomarker that can reflect cognitive-emotional responses to stimuli. In this study, Internet gaming disorder (IGD) subjects' autonomic response to gaming-related cues was evaluated by measuring HRV changes in exposure to gaming situation. We investigated whether this HRV reactivity can significantly classify the categorical classification according to the severity of IGD.

Methods

The present study included 70 subjects and classified them into 4 classes (normal, mild, moderate and severe) according to their IGD severity. We measured HRV for 5 min after the start of their preferred Internet game to reflect the autonomic response upon exposure to gaming. The neural parameters of deep learning model were trained using time-frequency parameters of HRV. Using the Class Activation Mapping (CAM) algorithm, we analyzed whether the deep learning model could predict the severity classification of IGD and which areas of the time-frequency series were mainly involved.

Results

The trained deep learning model showed an accuracy of 95.10% and F-1 scores of 0.995 (normal), 0.994 (mild), 0.995 (moderate), and 0.999 (severe) for the four classes of IGD severity classification. As a result of checking the input of the deep learning model using the CAM algorithm, the high frequency (HF)-HRV was related to the severity classification of IGD. In the case of severe IGD, low frequency (LF)-HRV as well as HF-HRV were identified as regions of interest in the deep learning model.

Conclusion

In a deep learning model using the time-frequency HRV data, a significant predictor of IGD severity classification was parasympathetic tone reactivity when exposed to gaming situations. The reactivity of the sympathetic tone for the gaming situation could predict only the severe group of IGD. This study suggests that the autonomic response to the game-related cues can reflect the addiction status to the game.

Risk and protective factors for (internet) gaming disorder: A meta-analysis of pre-COVID studies

This large-scale meta-analysis aimed to provide the most comprehensive synthesis to date of the available evidence from the pre-COVID period on risk and protective factors for (internet) gaming disorder (as defined in the DSM-5 or ICD-11) across all studied populations. The risk/protective factors included demographic characteristics, psychological, psychopathological, social, and gaming-related factors. In total, we have included 1,586 effects from 253 different studies, summarizing data from 210,557 participants. Apart from estimating these predictive associations and relevant moderating effects, we implemented state-of-the-art adjustments for publication bias, psychometric artifacts, and other forms of bias arising from the publication process. Additionally, we carried out an in-depth assessment of the quality of underlying evidence by examining indications of selective reporting, statistical inconsistencies, the typical power of utilized study designs to detect theoretically relevant effects, and performed various sensitivity analyses. The available evidence suggests the existence of numerous moderately strong and highly heterogeneous risk factors (e.g., male gender, depression, impulsivity, anxiety, stress, gaming time, escape motivation, or excessive use of social networks) but only a few empirically robust protective factors (self-esteem, intelligence, life satisfaction, and education; all having markedly smaller effect sizes). We discuss the theoretical implications of our results for prominent theoretical models of gaming disorder and for the existing and future prevention strategies. The impact of various examined biasing factors on the available evidence seemed to be modest, yet we identified shortcomings in the measurement and reporting practices.

Psychometric validity and the appropriateness of tolerance as a criterion for internet gaming disorder: A systematic review

Tolerance is a controversial but still an omnipresent criterion in measuring problematic gaming and Internet Gaming Disorder (IGD). Despite criticisms, a systematic review of its suitability has not been conducted until now. The aim of this study was to assess the evidence of psychometric validity and the appropriateness of tolerance as a criterion for IGD. A total of 61 articles were included in the review, 47 quantitative, 7 qualitative studies,plus 7 studies that introduce potential item wordings for operationalizing tolerance. Results showed that the tolerance item tends to have acceptable to high factor loadings on the single IGD factor. While tolerance sometimes did not adequately differentiate the engaged gamers from those with a probable disorder, it was endorsed at medium to high levels of IGD severity and had a good performance in the interviews. It, however, showed weak relations with distress and well-being. In qualitative studies, tolerance as currently defined by DSM-5 and measured by questionnaires (i.e., increasing amounts of time spent on gaming) was almost unequivocally rejected by gamers. The solid performance of tolerance in psychometric studies was probably due to deficiencies of the IGD construct, which also contains other disputed criteria. Tolerance lacks relevance in measuring IGD and care should be taken when using and interpreting IGD measures with this criterion.

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.

Abnormal psychological performance as potential marker for high risk of internet gaming disorder: An eye-tracking study and support vector machine analysis

Individuals with high risk of internet gaming disorder (HIGD) showed abnormal psychological performances in response inhibition, impulse control, and emotion regulation, and are considered the high-risk stage of internet gaming disorder (IGD). The identification of this population mainly relies on clinical scales, which are less accurate. This study aimed to explore whether these performances have highly accurate for discriminating HIGD from low-risk ones. Eye tracking based anti-saccade task, Barratt impulsiveness scale (BIS), and Wong and Law emotional intelligence scale (WLEIS) were used to evaluate psychological performances in 57 individuals with HIGD and 52 matched low risk of internet gaming disorder (LIGD). HIGD group showed significantly increased BIS total (t = −2.875, p = 0.005), attention (t = −2.139, p = 0.035), motor (t = −2.017, p = 0.046), and non-planning (t = −2.171, p = 0.032) scores, but significantly decreased WLEIS emotion regulation score (t = 2.636, p = 0.010) and correct rate of eye tracking anti-saccade task (t = 2.294, p = 0.024) compared with LIGD group. BIS total score was negatively correlated with the WLEIS total (r = −0.473, p &lt; 0.001) and WLEIS emotion regulation (r = −0.366, p &lt; 0.001) scores. A combination of the WLEIS emotion regulation score and the correct rate of anti-saccade task could discriminate HIGD from LIGD with 91.23% sensitivity, 82.69% specificity, and 87.16% accuracy. Participants with higher gaming hours daily were 40 times more likely to be high risk than their counterparts (p &lt; 0.001). Hence, psychological performances were worse in HIGD. A combination of abnormal emotion regulation and response inhibition might be a potential marker to identify HIGD individuals.

Compulsive Sexual Behavior Disorder should not be classified by solely relying on component/symptomatic features •

The paper by Sassover and Weinstein (2022) contributes to a timely and complex debate related to the classification of Compulsive Sexual Behavior Disorder (CSBD). The recent inclusion of CSBD as an impulse-control disorder in the ICD-11 has generated debate since a competitive view is that CSBD should rather be classified as an addictive disorder. Sassover and Weinstein (2022) reviewed existing evidence and concluded it does not support the conceptualization of CSBD as an addictive disorder. Although we agree regarding the relevance and timely nature of considering the classification of CSBD, we respectfully disagree with the position that relying on the components model of addiction (Griffiths, 2005) is the optimal approach for determining whether or not CSBD is an addictive disorder. In this commentary, we discuss potential pitfalls of relying on the components model to conceptualize CSBD as an addictive disorder and argue that considering a process-based approach is important for advancing this timely debate.

Maladaptive cognitions, loneliness, and social anxiety as potential moderators of the association between Internet gaming time and Internet gaming disorder among adolescent Internet gamers in China

The significance of Internet gaming time's dosage effect on Internet gaming disorder (IGD) may depend on gamers' characteristics. Majority of the gamers with extensive gaming time do not develop IGD. This study investigated moderation effects of cognitive/psychosocial factors on the association between Internet gaming time and probable IGD among adolescent Internet gamers in China. The cross-sectional, self-administered, and anonymous survey was conducted from October to December of 2018 among seven conveniently selected secondary school students in Chengdu and Guangzhou, China. Probable IGD was measured by using the DSM-5 checklist. The cognitive/psychosocial moderators were assessed by using validated instruments. Of the 2,503 students who had played Internet games (past 12 months), the prevalence of probable IGD was 17.7%. Internet gaming time [adjusted odds ratio (ORa) = 1.06], the three maladaptive cognitions specific to Internet gaming (perceived overvaluation of rewards, perceived urges, and perceived unwillingness to stop playing) (ORa = 1.17 to 1.44), and the two types of psychosocial factors (loneliness and social anxiety) (ORa = 1.09 to 1.13) were independent risk factors of probable IGD. Moderation analyses showed that overall maladaptive cognitions, perceived urges, and loneliness (but not the other two types of cognitions and social anxiety) were significant moderators of the association between Internet gaming time and probable IGD. The dose-effect relationship of Internet gaming time on probable IGD was significantly and slightly stronger among those with higher levels of perceived urges and loneliness. Interventions to reduce the levels of such moderators may reduce probable IGD directly and buffer the dosage effect among adolescents.

The Bergen Facebook Addiction Scale: its psychometric properties and invariance among women with eating disorders

OBJECTIVE

Facebook addiction is increasing, giving rise to limited real-life social networks, loneliness, poor work and academic performance, psychopathology, and low well-being. Facebook entails numerous factors that increase the risk for disordered eating attitudes and behaviors (e.g., use time and Facebook activities such as social grooming and photo sharing). This study aimed to evaluate the psychometric properties of the Bergen Facebook Addiction Scale (BFAS) among patients with eating disorders (EDs) given lack of validation of Facebook addiction measures in this population.

METHODS

A cross-sectional study involving 123 inpatient and outpatient women with EDs (Mean age = 27.3, SD = 10.6, range = 14-59 years) used confirmatory factor analysis (CFA), multigroup CFA, structural equation modeling (SEM), Spearman's rho Spearman's analysis, McDonald's Omega (ω), Cronbach's alpha (α), and item-total correlations to examine the structure, invariance, criterion validity, reliability, and discriminant validity of the BFAS.

RESULTS

Correlating the residuals of items 2, 3, and 5 resulted in an excellent fit of a one-factor structure of the BFAS (χ2(7) = 8.515, p = .289, CFI = .998, TLI = .996, RMSEA = .042, SRMR = .0099). The BFAS was invariant at the configural, metric, and scalar levels across groups of EDs, age, education, and marital status. High values of ω and α (.96) as well as item-total correlations (.851-.929) indicated excellent reliability and high discrimination index of the BFAS.  Criterion validity is noted by strong positive correlation with the Six-item Internet Addiction Test (S-IAT, r = .88) and SEM using the S-IAT to predict the BFAS (χ2(49) = 103.701, p = .001, CFI = .975, TLI = .966, RMSEA = .096, SRMR = .0317)..

CONCLUSION

The BFAS is a reliable unidimensional measure. Its high discrimination index and invariance across different groups make it useful for detecting Facebook addiction among patients with ED.

The Nine-Item Internet Gaming Disorder Scale (IGDS9-SF): Its Psychometric Properties among Sri Lankan Students and Measurement Invariance across Sri Lanka, Turkey, Australia, and the USA

The prevalence of internet gaming disorders (IGD) is considerably high among youth, especially with the social isolation imposed by the ongoing COVID-19 pandemic. IGD adversely affects mental health, quality of life, and academic performance. The Internet Gaming Disorder Scale (IGDS9-SF) is designed to detect IGD according to DSM-IV diagnostic criteria. However, inconsistent results are reported on its capacity to diagnose IGD evenly across different cultures. To ensure the suitability of the IGDS9-SF as a global measure of IGD, this study examined the psychometric properties of the IGDS9-SF in a sample of Sri Lankan university students (N = 322, mean age = 17.2 ± 0.6, range = 16–18 years, 56.5% males) and evaluated its measurement invariance across samples from Sri Lanka, Turkey, Australia, and the USA. Among Sri Lankan students, a unidimensional structure expressed good fit, invariance across different groups (e.g., gender, ethnicity, and income), adequate criterion validity (strong correlation with motives of internet gaming, daily gaming duration, and sleep quality), and good reliability (alpha = 0.81). Males and online multiplayers expressed higher IGD levels, greater time spent gaming, and more endorsement of gaming motives (e.g., Social and Coping) than females and offline players. Across countries, the IGDS9-SF was invariant at the configural, metric, and scalar levels, although strict invariance was not maintained. The lowest and highest IGD levels were reported among Turkish and American respondents, respectively. In conclusion, the IGDS9-SF can be reliably used to measure IGD among Sri Lankan youth. Because the scale holds scalar invariance across countries, its scores can be used to compare IGD levels in the studied countries.

Patterns and Predictors of Internet Gaming Disorder: An Observational Study from Jordan

Objective:

Internet Gaming Disorder (IGD) is a rapidly growing public health problem that may have detrimental effects. The purpose of this study is to identify factors associated with IGD status.

Methods:

In this cross-sectional observational study, a convenient sample of gamers in Jordan was recruited and asked to participate in an online survey based on the nine criteria of the 20-item Internet Gaming Disorder (IGD-20) used to assess gaming disorder. Sociodemographic and psychosocial data were also obtained.

Results:

A total of 504 gamers participated in this study. The mean age of respondents was 21.6 ± 3.90 years. Using the standard IGD-20 scale, 96 participants (19%) were classified as potential IGD cases, compared to 408 (80.9%) non-disordered gamers. Males were dominant among the population, constituting 348 (69%) of gamers. Males also played significantly more hours per week [17.8 ±16.75] compared to females [13 ± 17.65]. The majority of gamers (411 (81.5%)) were students, although unemployed adults played for the highest total time [23.9 ± 30.84 hours/week]. Device type used for gaming also significantly (p <0.05) affected the time spent playing. Predictors of IGD included educational level (p< 0.05) and playing hours/week (p< 005). Conversely, no significant associations were found between IGD and gender, age, employment, or sleeping hours. IGD is increasingly being diagnosed among both genders and presents a health challenge for internet users.

Conclusion:

Establishing gamer profiles and recognizing predictors of IGD is therefore vital for guiding clinical classification and diagnosis of the disease.

Relationship Between Gaming Disorder, Self-Compensation Motivation, Game Flow, Time Spent Gaming, and Fear of Missing Out Among a Sample of Chinese University Students: A Network Analysis

Background and Aims: In previous correlational research, the relationship between gaming disorder (GD), compensation motivation, game flow, time spent gaming, and fear of missing out (FoMO) has been examined. However, network analysis has rarely been applied to explore the relationship between GD, self-compensation motivation, game flow, time spent gaming, and FoMO. Therefore, the present study used network analysis to examine the relationship between the aforementioned variables among a sample of gamers. Methods: The present study comprised gamers (N = 1,635) recruited from three Chinese universities, who completed an online survey including the Gaming Disorder Test, Self-Compensation Motivation Questionnaire, Game Flow Questionnaire, and Trait-State Fear of Missing Out Scale, as well as four items related to time spent gaming. Results: Self-compensation motivation, game flow, time spent gaming, and FoMO were all significantly and positively associated with GD. In the domain-level and facet-level networks, weekday gaming hours and weekend gaming hours had the strongest edge intensity. The domain-level, facet-level, and item-level networks analysis also showed that GD was connected with self-compensation motivation, game flow, time spent gaming, and FoMO. The network structure demonstrated a significant difference between males and females (2.33 vs. 2.81, p = 0.001) using the domain-level network comparison test (NCT). Conclusions: The results suggest that GD is closely associated with self-compensation motivation, game flow, time spent gaming, and FoMO. FoMO and gaming motivation (i.e., self-compensation and game flow) may increase time spent gaming and facilitate GD. Therefore, interventions that decrease game immersion and time spent gaming are likely to decrease GD.

Impulsivity, Self-control, Interpersonal Influences, and Maladaptive Cognitions as Factors of Internet Gaming Disorder Among Adolescents in China: Cross-sectional Mediation Study

Background

Gaming disorder, including internet gaming disorder (IGD), was recently defined by the World Health Organization as a mental disease in the 11th Revision of the International Classification of Diseases (ICD-11). Thus, reducing IGD is warranted. Maladaptive cognitions related to internet gaming (MCIG) have been associated with IGD, while impulsivity, self-control, parental influences, and peer influences are key risk factors of IGD. Previous literature suggests that MCIG is associated with the aforementioned 4 risk factors and IGD, and may thus mediate between these risk factors and IGD. These potential mediations, if significant, imply that modification of MCIG may possibly alleviate these risk factors’ harmful impacts on increasing IGD. These mediation hypotheses were tested in this study for the first time.

Objective

This study tested the mediation effects of MCIG between intrapersonal factors (impulsivity and self-control) and IGD, and between interpersonal factors (parental influences and peer influences) and IGD among adolescents in China.

Methods

An anonymous, cross-sectional, and self-administered survey was conducted among secondary school students in classroom settings in Guangzhou and Chengdu, China. All grade 7 to 9 students (7 to 9 years of formal education) of 7 secondary schools were invited to join the study, and 3087 completed the survey. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) checklist was used to assess IGD. MCIG was assessed by using the Chinese version of the Revised Internet Gaming Cognition Scale. Impulsivity, self-control, and parental or peer influences were measured by using the motor subscale of the Barratt Impulsiveness Scale, the Brief Self-Control Scale, and the modified interpersonal influence scale, respectively. Structural equation modeling was conducted to examine the mediation effects of MCIG between these risk factors and IGD.

Results

The prevalence of IGD was 13.57% (418/3081) and 17.67% (366/2071) among all participants and adolescent internet gamers, respectively. The 3 types of MCIG (perceived rewards of internet gaming, perceived urges for playing internet games, and perceived unwillingness to stop playing without completion of gaming tasks) were positively associated with IGD. Impulsivity, self-control, parental influences, and peer influences were all significantly associated with the 3 types of MCIG and IGD. The 3 types of MCIG partially mediated the associations between the studied factors and IGD (effect size of 30.0% to 37.8%).

Conclusions

Impulsivity, self-control, and interpersonal influences had both direct and indirect effects via MCIG on IGD. Modifications of the 3 types of MCIG can potentially reduce the harmful impacts of impulsivity and interpersonal influences on IGD and enhance the protective effect of self-control against IGD. Future longitudinal studies are warranted.

Video Game Addictive Symptom Level, Use Intensity, and Hedonic Experience: An Empirical Analysis of a Novel Survey Instrument (Preprint)

Background

The effects of behavioral addiction to video games has received increasing attention in the literature, given increased use intensity among subgroups of video game players.

Objective

This study seeks to empirically determine the relationship between intensity of video gaming and hedonic experience of the player.

Methods

We conducted a survey of 835 individuals who regularly play video games to determine the relationship between intensity of use and hedonic experience. We divided the sample into quartiles by self-reported video game addictive symptom level (from the Internet Gaming Disorder Scale) and conducted polynomial regressions separately for each quartile.

Results

We found that the higher video game addictive symptom level groups experienced a U-shaped (curvilinear) relationship between hedonic experience and intensity of play, whereas groups with lower video game addictive symptom levels exhibited no such relationship. The coefficients for the highest addictive symptom level group (quartile 4) for marginal effects for hours played per week and hours played per week squared were significantly negative (P=.005) and significantly positive (P=.004), respectively.

Conclusions

Our results are consistent with sensitization and tolerance theories, which suggest that high-symptom groups experience frustration and disappointment until they achieve excessive dopamine release, at which point their hedonic experience is expected to improve with additional play. Conversely, low-symptom groups experience no such fall-and-rise pattern. This result is consistent with the outcome that members of the latter group play the game for the direct experience, such that their hedonic experience is more directly related to events occurring in the game than to the increasingly elusive pursuit of excessive dopamine release. We also find that high-symptom groups spend substantially more time and money to support video game use and are much more likely to engage in video game use at the expense of other important activities, such as working, sleeping, and eating.

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

BACKGROUND AND AIMS

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

METHODS

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

RESULTS

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

DISCUSSION AND CONCLUSIONS

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

Event-related brain response to visual cues in individuals with Internet gaming disorder: relevance to attentional bias and decision-making

This study investigated attentional bias toward game-related cues in Internet gaming disorder (IGD) using electrophysiological markers of late positive potential (LPP) and identifying the sources of LPP. In addition, the association between LPP and decision-making ability was investigated. The IGD (n = 40) and healthy control (HC; n = 39) participants viewed a series of game-related and neutral pictures, while their event-related potentials (ERPs) were recorded. LPPs were calculated as the mean amplitudes between 400 and 700 ms at the centro-parietal (CP3, CP1, Cpz, CP2, and CP4) and parietal (P3, P1, Pz, P2, and P4) electrode sites. The source activations of LPP were estimated using standardized low-resolution brain electromagnetic tomography (sLORETA). In addition, decision-making ability was evaluated by the Cambridge Gambling Task. Higher LPP amplitudes were found for game-related cues in the IGD group than in the HC group. sLORETA showed that the IGD group was more active in the superior and middle temporal gyri, which are involved in social perception, than in the HC group, whereas it was less active in the frontal area. Individuals with IGD have deficits in decision-making ability. In addition, in the HC group, the lower the LPP when looking at the game-related stimuli, the better the quality of decision-making, but not in the IGD group. Enhanced LPP amplitudes are associated with emotional arousal to gaming cues and decision-making deficits in IGD. In addition, source activities suggest that patients with IGD perceive game-related cues as social stimuli. LPP can be used as a neurophysiological marker of IGD.

Internet addiction in adolescents: Development and validation of Internet Addiction Diagnostic Questionnaire (KDAI)

Internet addiction (IA) is an emerging behavioral problem that constitutes a major health threat to vulnerable populations, including adolescents. However, there is a paucity of IA screening tools specifically designed for adolescents, especially in Indonesia. Therefore, the current study developed and validated the IA Diagnostic Questionnaire (KDAI) in adolescents while acknowledging local cultural influences. The KDAI was conceived through extensive literature reviews, expert discussions based on Delphi methods, a face validity study, focus group discussion (N = 31) for initial reliability testing, and a recruited pilot study (N = 385) and main study (N = 643) for exploratory and confirmatory factor analyses, respectively. The multi-sample analyses demonstrated that the KDAI model with the best fit and reliability comprised a seven-factor structure, including withdrawal, loss of control, increase of priority, negative consequences, mood modification, salience, and impairment. These factors were scrutinized against domains of IA Test, and concurrent validity was ascertained. Subsequently, a receiver operating characteristic curve and area under the curve determined a cutoff score of 108 to discern adolescents with IA. Taken together, the KDAI displayed excellent psychometric indices and sensitivity as a screening tool for IA in adolescents.

Effects of Electroacupuncture Combined With Psychological Intervention on Depressive Status and Contingent Negative Variation in Patients With Internet Addiction Disorder: A Randomized Controlled Trial

Background: Depressive symptoms often accompany people with Internet addiction syndrome (IAD). Acupuncture has been found to have significant advantages in improving the severity and depressive symptoms of IAD. Contingent negative variation (CNV) is a common method to explore the mechanism of neurophysiology. Objective: The purpose of this study was to observe the efficacy of electroacupuncture (EA), psychological intervention (PI), and comprehensive intervention (CI) in the treatment of depression in Internet addiction disorder (IAD), and to observe the changes of contingent negative variation (CNV) in each group. Methods: One hundred and twenty subjects diagnosed with IAD were randomly assigned to the EA group, the PI group, or the CI group. They received EA, PI, or a combination of EA and PI for 40 days. The Internet Addiction Test (IAT), the Zung Self-rating Depression Scale (SDS), and the Hamilton Depression Scale (HAMD) were evaluated for all subjects at baseline, 20th, and 40th days of treatment, while CNV data were collected at baseline and 40th days of treatment. Results: Three treatments effectively reduced IAT, SDS, and HAMD scores, and the intergroup comparison showed that CI was superior to EA, while EA was superior to PI. CNV results indicated that the CNV amplitude increased in all three groups of IAD patients after treatment. The CNV latency of point A and A-S2' wave area of the EA group and the CI group did not change significantly after treatment. Only the A-S2' wave area of the PI group increased significantly compared with the baseline period. In addition, IAD's IAT score was positively correlated with SDS and HAMD score at baseline but negatively correlated with CNV latency. After treatment, only the change of HAMD score in the CI group was negatively correlated with amplitude. Conclusion: Our results demonstrate the efficacy of acupuncture and psychological intervention in the treatment of IAD from an electrophysiological perspective. Simultaneously, the increase in CNV amplitude might be the underlying neurophysiological mechanism by which CI improves depression and cognitive function in IAD patients. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT02362698.

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.

Diagnostic Usefulness of an Ultra-Brief Screener to Identify Risk of Online Gaming Disorder for Children and Adolescents

OBJECTIVE

This study examined the diagnostic validity of a three-item ultra-brief screening tool for online gaming disorder in line with the gaming disorder criteria in the International Classification of Diseases 11th Revision.

METHODS

The Three-item Gaming disorder Test-Online-Centered (TIGTOC) was composed of three items using a four-point Likert scale selected from the Internet Game Use-Elicited Symptom Screen (IGUESS). Among a cohort of 2319 young-adolescent Internet users, the baseline data of 228 healthy controls and 45 Internet-gaming-disorder cases were analyzed. Receiver operation characteristic (ROC) analysis was performed using mental health specialists' diagnoses as the gold standard.

RESULTS

The ROC curve analysis showed an area under the curve of 86%. Using a cut-off score of 4 from a full range of 0-9, the sensitivity, specificity, and Cronbach's α were 72%, 90%, and 0.811, respectively. TIGTOC scores was positively associated with time spent on online gaming, depressive symptoms, attention-deficit/hyperactivity disorder symptoms, and addictive Internet use.

CONCLUSION

The TIGTOC appears to be a brief, valid, and reliable screening tool for online gaming disorder within the community or in primary care settings.

Correlates of social media fatigue and academic performance decrement

Purpose

The current study aims to investigate if different measures related to online psychosocial well-being and online behavior correlate with social media fatigue.

Design/methodology/approach

To understand the antecedents and consequences of social media fatigue, the stressor-strain-outcome (SSO) framework is applied. The study consists of two cross-sectional surveys that were organized with young-adult students. Study A was conducted with 1,398 WhatsApp users (aged 19 to 27 years), while Study B was organized with 472 WhatsApp users (aged 18 to 23 years).

Findings

Intensity of social media use was the strongest predictor of social media fatigue. Online social comparison and self-disclosure were also significant predictors of social media fatigue. The findings also suggest that social media fatigue further contributes to a decrease in academic performance.

Originality/value

This study builds upon the limited yet growing body of literature on a theme highly relevant for scholars, practitioners as well as social media users. The current study focuses on examining different causes of social media fatigue induced through the use of a highly popular mobile instant messaging app, WhatsApp. The SSO framework is applied to explore and establish empirical links between stressors and social media fatigue.

Psychometric Evaluation and Comparison of Two Gaming Disorder Measures Derived From the DSM-5 and ICD-11 Frameworks

Gaming disorder was listed as a condition for further study in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013, and measures of the disorder have mushroomed in the years since. The Gaming Disorder Test (GDT) was developed after gaming disorder was officially included in the 11th Revision of the International Classification of Diseases (ICD-11) in 2018. However, it remains unknown whether the GDT, which is based on the ICD-11 framework, is psychometrically similar to or different from the popular nine-item Internet Gaming Disorder Scale-Short Form (IGDS9-SF) based on the DSM-5 framework. To address this important but unexplored issue, the present study evaluated and compared the psychometric properties of the GDT and IGDS9-SF in a sample of 544 adult gamers (56.2% men; mean age = 28.8, SD = 8.55). The results revealed both measures to have good reliability, structural validity, and criterion validity, with the exception of one IGDS9-SF item with a low factor loading. Moreover, the IGDS9-SF exhibited scalar measurement invariance for gender and age but only partial metric invariance for employment status, whereas the GDT exhibited scalar measurement invariance for all three demographic characteristics. Finally, the GDT displayed incremental validity over the IGDS9-SF in explaining gaming time, but not social anxiety and depressive symptoms. This study thus contributes to the literature by comparing measures derived from distinct gaming disorder diagnostic frameworks empirically. Recommendations for the selection of gaming disorder measures by researchers and practitioners are discussed.

Laxer Clinical Criteria for Gaming Disorder May Hinder Future Efforts to Devise an Efficient Diagnostic Approach: A Tree-Based Model Study

Internet Gaming Disorder (IGD) has been recognized in May 2013 and can be evaluated using the criteria developed by American Psychiatric Association (APA). The present study investigated the role each IGD criteria plays in diagnosing disordered gaming. A total of 3377 participants (mean age 20 years, SD = 4.3 years) participated in the study. The data collected was scrutinized to detect patterns of IGD using Conditional Inference Tree (Ctree), a sophisticated machine algorithm. Participants provided basic sociodemographic information and completed the Internet Gaming Disorder Scale–Short-Form (IGDS9-SF). The results identified classes of IGD-related symptoms, indicating that endorsing ‘withdrawal’ and ‘loss of control’ increases the probability of disordered gaming by 77.77% while endorsement of ‘withdrawal’, ‘loss of control’ and ‘negative consequences’ increases the probability of disordered gaming by 26.66%. Moreover, lack of endorsement of ‘withdrawal’ and endorsement of ‘preoccupation’ increases the likelihood of disordered gaming by 7.14%. Taken together, the results obtained illustrate that different IGD criteria can present with different clinical weighing as unique diagnostic roles in the development of disordered gaming can be evidenced by each criterion. Moreover, the present findings help inform future revisions of diagnostic manuals and helps enhancing the assessment of IGD in the future. Additional research and clinical implications are discussed.

Associations between Problematic Gambling, Gaming, and Internet Use: A Cross-Sectional Population Survey

Background

While pathological gambling, or gambling disorder, is an established diagnosis, a link to other potential behavioural addictions has been suggested. The present study aimed to investigate whether signs of problem gaming and problematic internet use are related to problem gambling in the general population, while including other potential risk factors.

Methods

A cross-sectional study design, using an electronical questionnaire, administered through a marketing survey company for relative representativeness with respect to age and gender. Potential correlates of problem gambling were measured in binary analyses, and significant associations were entered in a logistic regression analysis controlling them for one another. Problem gambling, gaming, and internet use were measured through established screening instruments (the CLiP, the GAS, and the PRIUSS).

Results

Statistically significant associations were found between problem gambling and both problem gaming and problematic internet use, as well as with male gender. In logistic regression, problem gaming, problematic internet use, and male gender remained associated with problem gambling.

Conclusion

After controlling for potential demographic risk factors, problem gaming and problematic internet use may be related to problem gambling, suggesting that these constructs may interact or may share similar risk factors. More research is needed to clarify factors mediating the links between these conditions.

S. W. Psychometric validation of the Internet Gaming Disorder-20 Test among Chinese middle school and university students

BACKGROUND AND AIMS

Internet gaming disorder (IGD) was proposed in Diagnostic and Statistical Manual of Mental Disorders of American Psychiatric Association as an area warranting more research attention. High prevalence of excessive Internet game use and related addictions has been reported in China, especially among youth; however, there is a lack of psychometrically and theoretically sound instruments for assessing IGD in the Chinese language.

METHODS

This study aimed to examine the psychometric properties of a Chinese version of the Internet Gaming Disorder Test (IGD-20 Test) among Chinese middle school (n = 569; Mage = 13.34; 46.2% females) and university students (n = 523; Mage = 20.12; 48.4% females) samples in Beijing, China. All participants voluntarily completed an anonymous questionnaire.

RESULTS

Confirmatory factor analysis results showed that the Chinese version of the IGD-20 Test had five factors (i.e., salience-tolerance, mood modification, withdrawal, conflict, and relapse). Measurement invariance was confirmed across the two samples. The test score was positively associated with the modified Young's Internet Addiction Test for gaming addiction. Concurrent validation was further demonstrated by the IGD-20 Test's positive correlation with weekly gameplay and depression symptoms. The latent profile analysis showed four different gamer classes (i.e., regular gamers, low-risk engaged gamers, high-risk engaged gamers, and probable disordered gamers), with the estimated prevalence of 2.1% of the last group.

DISCUSSION AND CONCLUSION

The IGD-20 Test was applicable to Chinese youth and its Chinese version generally demonstrated good psychometric properties.

Evaluating an Internet Gaming Disorder Scale Using Mokken Scaling Analysis

Internet Gaming Disorder (IGD) was recently included as a condition for further study in the fifth and latest version of the Diagnostic and Statistical Manual of Mental Disorders. The present study investigated whether the IGD criteria comprise a unidimensional construct. Data stemmed from a sample of Norwegians aged 17.5 years in 2012 and 19.5 years in 2014 (N = 1258). The study used the Mokken scale analysis to investigate whether the score of the different items on the IGD scale measured a single latent variable and if the scale functions differently for males and females. Correlation analysis was conducted between the scores on the IGD scale (count) and the Gaming Addiction Scale for Adolescents (GASA, categorical), both assessed in 2014. Negative binomial regression analyses were applied in order to investigate how different predictors of mental health assessed in 2012 were associated with IGD assessed in 2014. The Mokken scale analysis showed that all item-coefficients of homogeneity exceeded 0.3 when the whole sample completed the scale and when females completed the scale, indicating that the items reflect a single latent variable. In both cases moderate (H > 0.40) unidimensionality was shown. The item measuring "tolerance" did not exceed 0.3 in the scale when completed by males, indicating that only eight out of nine items reflect a single latent variable when applied to males only. The eight-item scale containing males showed weak (H > 0.30) unidimensionality. The correlation analysis showed a positive correlation between the scores on the IGD scale and the GASA (r = 0.71, p < 0.01) when assessed simultaneously and a positive but lower correlation (r = 0.48, p < 0.01) when assessed longitudinally. Results from the negative binomial regression analysis showed that previous video-game addiction, being male, depression, aggression and loneliness were significant predictors of IGD. The associations were small for all independent variables except previous video game addiction and gender where the associations were large. Although the results from the correlation analysis and regression analysis showed predictive validity of the scale, the results from the Mokken analysis suggest that the IGD scale may not be applied as a unidimensional scale when the tolerance item is included.

A Novel Cue-Induced Abdominal Reaction Analysis for Internet Gaming Disorder

Individuals with Internet gaming disorder (IGD) frequently play online games to achieve satisfaction. Numerous signal processing questions regarding the negative consequences and characteristic respiration in a long-term sitting posture remain unanswered. This study recruited 50 individuals with high-risk and low-risk IGD (HIGD and LIGD); these participants were taught to perform a specific respiration during game-film stimuli. The instantaneous frequencies on abdominal movement (f_DF) were calculated with ensemble empirical mode decomposition (EEMD). The difference value (Δf_DF) between rest and stimulus statuses was calculated and found that HIGD showed Δf_DF values of 0.060 during positive stimuli and 0.055 during negative stimuli before the exercise but 0.020 and 0.016, respectively, after the exercise. However, the Δf_DF value for those with LIGD during negative stimuli before the exercise was 0.013, and it increased to 0.025 after the exercise. This is the first approach to IGD discrimination toward abdominal response with EEMD.

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.

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.

Maladaptive daydreaming as a new form of behavioral addiction

BACKGROUND AND AIMS

Maladaptive daydreaming (MD) has many features of behavioral addiction, but research exploring this syndrome is limited. This case study provides a qualitative exploration of MD.

METHODS

A structured clinical interview and mental state examination of a patient with MD were video-recorded and transcribed verbatim. Transcripts were subjected to the interpretative phenomenological analysis.

RESULTS

MD was developed as a strategy to cope with distress but led to uncontrollable absorption in fantasy, social withdrawal, and neglecting aspects of everyday life. It was coupled with excessive Internet use and viewing porn.

DISCUSSION AND CONCLUSIONS

Patients should be questioned about MD during clinical assessment. Further studies are necessary to determine whether MD constitutes a separate syndrome or is a part of other behavioral addictions.

Spanish validation of the Sexual Addiction Screening Test

BACKGROUND AND AIMS

Sexual addiction is a pathological behavior characterized by a combination of excessive sexual desire and impaired ability to control it. Its incidence ranges between 1.2% and 32.2%, although this number may vary depending on the screening tool used. This wide variability is largely due to the use of non-validated instruments (e.g., structural validity relying on exploratory analyses, instruments translated without an additional validation process, or instruments validated in another format). To deal with these limitations, this study tested the psychometric properties of the Spanish paper-and-pencil and online versions of the Sexual Addiction Screening Test (SAST).

METHODS

A total of 2,528 participants (1,163 males) completed the Spanish version of the SAST, along with other instruments assessing sexual compulsivity (1,585 = paper-and-pencil, 943 = online).

RESULTS

The exploratory factor analysis yielded a four-factor structure explaining 57.39% of the variance for the SAST paper-and-pencil version. This factor structure was then verified for the online version through the use of confirmatory factor analysis [χ2(264) = 441.59; χ2/df = 1.66; RMSEA = 0.02; CFI = 0.94; IFI = 0.94]. This methodology was also used to support measurement invariance (configural, metric, and scalar invariance) according to gender. The reliability of the total score ranged from .82 to .85. Similarly, correlations with related scales were positive and significant (r between .22 and .71). Temporal stability 1 year after the first application was 0.65 (paper-and-pencil format) and 0.60 (online version).

CONCLUSION

These results, together with the absence of questionnaires translated into Spanish to assess this construct, justify the use of the SAST in the evaluation of sexual addiction in Spanish-speaking countries.