A clinical evaluation of the DSM-5 criteria for Internet Gaming Disorder and a pilot study on their applicability to further Internet-related disorders

Psychometric Validation of the Compulsive Internet Use Scale in Spanish Adolescents

Despite problematic internet use being especially high among adolescents, there are no screening instruments in Spain specifically for adolescents that would facilitate early detection of this problem. The main goal of this study was to validate the Compulsive Internet Use Scale (CIUS) in the adolescent Spanish population as well as to analyze the discriminative capacity of CIUS based on sociodemographic characteristics, grade point average, and other addictive behaviors. Data were obtained from the ESTUDES, a representative survey of addictive behaviors of Spanish adolescents. The sample consisted of a total of 34,308 adolescents aged between 14 and 18 years old (Mage = 15.70; SD = 1.19; 51.7% females). Results indicated that the CIUS fit a unidimensional structure, exhibited measurement invariance with respect to sex and age, and demonstrated excellent reliability (ω = .94). Past-month tobacco, alcohol, and cannabis use, as well as past-year gambling and gaming, were related to CIUS scores. A standardized screening instrument that provides valid, reliable information on young people's use of the Internet in Spain is a critical requirement for successful early detection and intervention in this population.

Sex differences of neural connectivity in internet gaming disorder and its association with sleep quality: an exploratory fMRI study

Objectives

Sex-specific differences in internet gaming disorder (IGD) neurophysiology remain underexplored. Here we investigated sex-related variability in regional homogeneity (ReHo) and functional connectivity (FC) in IGD and their correlations with sleep quality.

Methods

Resting-state functional magnetic resonance imaging (fMRI) scans were performed on 52 subjects with IGD and 50 healthy controls (HCs). Two-way ANOVA was used to examine sex and diagnosis interactions in ReHo and FC, followed by post-hoc analyses to explore FC biomarkers for different sexes.

Results

In ReHo analysis, the four groups showed significant sex and diagnosis interactions in the right middle frontal gyrus (rMFG). FC analysis with rMFG as the seed region revealed a significant sex and diagnosis interaction effect in FC of the rMFG with the bilateral postcentral gyrus (PoCG). In male IGD group, FC between the rMFG and the bilateral PoCG correlates strongly with daytime dysfunction score and the Pittsburgh sleep quality inventory (PSQI) total score.

Conclusion

These findings emphasize the importance of considering sexual dimorphism in the neurobiology of IGD, which might influence subsequent treatment strategies.

Gaming passion contributes to the definition and identification of problematic gaming

Even if for most people playing video games is a healthy leisure activity, a minority of vulnerable users present an excessive use associated to negative consequences (e.g., psychosocial maladjustment, sleep interference) and functional impairment. The current study first aims to identify psychological factors that contribute to discriminate highly involved (but healthy) gamers from problematic gamers. For that purpose, we used a cluster analysis approach to identify different groups of gamers based on their profiles of passion towards gaming (using the Dualistic Model of Passion). Another objective of the present study is to explore, using supervised machine-learning, how gaming disorder symptoms, assessed within the substance use disorder framework (e.g., tolerance, withdrawal), might be linked to harmonious and/or an obsessive passion for gaming. Three distinct clusters of gamers were identified based on their passion profiles, including risky gamers, engaged gamers, and casual gamers. Supervised machine-learning algorithms identified that specific gaming disorder symptoms (salience, mood modification, tolerance, low level of conflict) were predominantly related to harmonious passion, whereas others (withdrawal, high level of conflict, relapse) were more directly related to obsessive passion. Our results support the relevance of person-centered approaches to the treatment of problematic gaming.

The Effect of Distress Tolerance Training on Problematic Internet Use and Psychological Wellbeing Among Faculty Nursing Students: A Randomized Control Trial

Background

Distress tolerance skills have the potential to decrease problematic internet use and improve psychological wellbeing by cognitive reframing and goal-oriented problem-solving.

Aim

To assess the impact of distress tolerance training on problematic internet use and psychological wellbeing among university nursing students.

Methods

A randomized control trial used at the faculty of nursing using simple random sampling method. Tools: Distress Tolerance Scale, problematic internet use questionnaire, and Ryff psychological wellbeing scale. Data were collected from 60 nursing students over a period of 4 months.

Results

Distress tolerance level was increased among study group from 20.75±14.29 to 72.75±24.09 and sustained for 3 months to 62.44 ±20.77 with statistically significant (f=7.090, p=0.006) and large effect size 0.75. When compared to no change among the control group as mean scare start by 22.35±14.29 to 23.44±16.09 and after 3 months to 21.75± 17.44 with insignificant difference (f=0.454, p=0.574). The mean score of problematic internet use shows highly statistically significant decrement in the study group between three period of time (pretest= 62.93, immediately post= 52.13, and post 3 months=52.70) with large effect size 0.78 (f=95.029, p<0.001), in compared to control group that showed insignificant no changes (pretest= 64.0±14.54, immediately post= 63.13±12.87, and post 3 months=63.53±11.36) with (f=1.012, p=0.332). In addition, the total mean score of psychological well-being was increased immediately after therapy and later for three months of therapy (pretest= 128.47, immediately post=148.77, and post 3 months= 153.60) with highly statistically significant (f=41.197, p<0.001) with effect size 0.85, compared to no change among control group (pretest=125.97±32.58, immediately post= 126.23±30.86, and post 3 months=126.43±29.78) with (f=0.208, p=0.698).

Conclusion

Efficacy of distress tolerance skills intervention had been proven in altering poor psychological wellbeing among students with problematic internet use. It helps students to learn new skills and use more adaptive strategies to overcome distress tolerance difficulties.

Correlation Between Attention Deficit Hyperactivity Disorder, Internet Gaming Disorder or Gaming Disorder

OBJECTIVE

Individuals with internet gaming disorder (IGD) or gaming disorder (GD) had a higher prevalence of ADHD than individuals without IGD or GD. The overpathologizing of excessive gaming behaviors may be associated with the functional impairment due to ADHD in individuals with GD.

METHODS

The present study was designed to compare the gaming patterns, accompanying psychopathology, and co-occurring psychiatric disorders, especially ADHD, between clinical and general gamer samples (17-29 years old).

RESULTS

Out of the nine IGD criteria, the item "functional impairment" had low diagnostic accuracy in participants with IGD or GD. The IGD (GD) group had a higher prevalence of ADHD compared to the general gamer group. Conversely, there was a higher prevalence of IGD (GD) in the ADHD group compared to the non-ADHD group.

DISCUSSION

The possibility of ADHD should be considered when IGD or GD is diagnosed in patients with problematic Internet gaming.

Online compulsive buying-shopping disorder and social networks-use disorder: More similarities than differences?

BACKGROUND

Studies in convenience, non-clinical samples of young adults suggest overlap between online compulsive buying-shopping disorder (OCBSD) and social-networks-use disorder (SNUD). Considering the dearth of research, this study investigated OCBSD and SNUD in clinical samples.

METHODS

Women with either OCBSD (n = 37) or SNUD (n = 41) were compared regarding sociodemographic variables, use time of the first-choice application, OCBSD/SNUD severity, general internet use, impulsivity, materialism, perceived chronic stress and the frequency of viewing posts of influencers and the urge to visit shopping websites or social networks after viewing influencer posts.

RESULTS

Women in the OCBSD group were older, more often employed, had less often a qualification for university entrance, indicated a lower daily use time of the first-choice application and higher materialistic values as compared to those in the SNUD group. No group differences emerged regarding general internet use, impulsivity and chronic stress. Regression models indicate that chronic stress predicted the symptom severity in the SNUD but not in the OCBSD group. The SNUD group reported a higher frequency of viewing influencer posts as compared to the OCBSD group. The urge for online shopping or using social networks after viewing influencer posts did not significantly differ between both groups.

CONCLUSION

The findings suggest commonalities and distinct features of OCBSD and SNUD which require further investigation.

Physical Activity in Immersive Virtual Reality: A Scoping Review

Physical activity has benefits for health, but many adolescents are inactive. However, video games such as Immersive Virtual Reality (IVR) have grown in popularity as a leisure activity among young people, allowing them to manipulate objects in virtual environments increasing the practice of physical activity. The evidence indicates that the interest in physical activity through IVR is greater than in traditional methods, and different experiences have been reported. However, few studies indicate the sample evaluated, the effects found, or the IVR instruments used. Due to this, is the aim of this study is to identify the publications referring to IVR and physical activity, characterize them, and present the obtained main findings. For this, the guidelines described in the PRISMA-ScR for scoping reviews were applied. After the use of the inclusion and exclusion criteria, eight articles were included. Results show evidence regarding physiological outcomes, perceptual variables, interest and enjoyment, and psychological effects regarding physical activity through IVR. Additionally, the use of different devices and their prescriptions are explored. It is concluded that there is interest from the scientific community for the practice of physical activity through IVR, as well as for its application for the maintenance of active habits. This is important as it positions IVR as a method that can be a more experiential and effective way to develop and maintain a healthy lifestyle.

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.

Predictive power of the DSM-5 criteria for internet use disorder: A CHAID decision-tree analysis

Introduction

Although the majority of internet users enjoy the internet as a recreational activity, some individuals report problematic internet use behaviors causing negative psychosocial consequences. Therefore, it is important to have precise and valid diagnostic criteria to ensure suitable treatment for those affected and avoid over-pathologization.

Methods

The aim of the present study was to determine which of the nine DSM-5 criteria of internet gaming disorder (IGD) are crucial in distinguish pathological from non-pathological internet use based on the questionnaire-based response behavior of the participants by applying the Chi-squared automatic interaction detection (CHAID) decision tree analysis. Under consideration of the nine DSM-5 criteria for IGD and according to the short-form scale to assess Internet Gaming Disorder (IGDS-SF9) the DSM-5 criteria were formulated as questions and applied to the broader concept of Internet Use Disorder (IUD). The nine questions were answered on a 5-point Likert scale from "never" to "very often." In accordance with the IGDS-SF9 participants were assigned to IUD-5plus if at least 5 of the 9 criteria were answered with "very often." The study was conducted in Germany (N = 37,008; mean age: 32 years, SD = 13.18, 73.8% male).

Results

Although "loss of control," "continued overuse" and "mood regulation" were the most endorsed criteria, the analysis indicated that the criterion "jeopardizing" was found as the best predictor for IUD-5plus, followed by "loss of interest" and "continued overuse." Overall 64.9% of all participants who were in the IUD-5plus, could been identified by the fulfillment of the three criteria mentioned above.

Discussion

The results found support for adjustment of the DSM-5 criteria of IGD in accordance to ICD-11. If the predictive power of the three criteria can be replicated in future representative studies, such a decision tree can be used as guidance for diagnostics to capture the particularly relevant criteria.

Nosological Characteristics in Women with Social Media Disorder: The Role of Social Functional Impairment and Agreeableness

Social media disorder (SMD) is a frequently occurring subtype of Internet-related disorders (IRD), which has recently become a focus of research. It is noticeable that women are among those affected, whose nosological characteristics need to be examined. A clinical sample of n = 294 women (14-68 years, M = 36.88 years) was generated. The questionnaire included questions about demography, IRD, SMD, personality traits, psychopathological distress, functional impairment and comorbid mental illnesses. IRD was found in 17.5 percent and SMD in 12.5 percent of women. Compared to women with global IRD Women with SMD reported lower scores on the personality traits neuroticism and agreeableness. They are more frequently functionally impaired in the social dimension, more often reported comorbid substance-dependency and less eating disorders. The results suggest that although have similar characteristics to the comparison group, women with SMD differ in their nosological characteristics from women with global IRD.

Inanspruchnehmende einer Spielsuchtambulanz mit „Doppeldiagnosen“

Zusammenfassung: Zielsetzung: Internetnutzungsstörungen werden als wichtiges gesundheitsrelevantes Phänomen akzeptiert und sind bekanntermaßen mit hohen Raten an komorbiden psychischen Erkrankungen assoziiert. Jedoch ist das Wissen über das gleichzeitige Auftreten mit einer weiteren Verhaltenssucht begrenzt. Die vorliegende Arbeit bietet eine erste klinische Charakterisierung bei gleichzeitig auftretender Internetnutzungs- und Glücksspielstörung (Doppeldiagnose). Methodik: Die Analyse beruhte auf einer konsekutiven klinischen Stichprobe von Betroffenen ( N=1813), die sich wegen einer Verhaltenssucht ambulant vorstellten. Daten wurden aus der klinischen Exploration sowie psychometrischen Verfahren zur Erfassung von Depressivität, Stress, Angstsymptomen und Funktionsniveau erhoben und mit Betroffenen, die entweder eine Computerspiel- oder Glücksspielstörung aufwiesen, verglichen. Ergebnisse: Bei n=46 Betroffenen wurde eine Doppeldiagnose gestellt. Diese Gruppe wies zudem eine höhere Anzahl weiterer psychischer Störungen auf. Die Auswertung der klinischen Inventare wies auf eine insgesamt hohe Symptombelastung hin, ohne dass sich die Gruppen signifikant voneinander unterschieden. Schlussfolgerungen: Eine kleine Gruppe Inanspruchnehmender erfüllt die Kriterien einer Internetnutzungs- und einer Glücksspielstörung. Es ergeben sich keine auffälligen Unterschiede in der Symptombelastung zu Betroffenen mit singulärer Abhängigkeit, jedoch ist zu vermuten, dass Doppeldiagnosen eine differenzierte therapeutische Herangehensweise erfordern.

Risk and protective factors of Internet gaming disorder among Chinese people: A meta-analysis

OBJECTIVES

Effective prevention and intervention of Internet gaming disorder require the identification of risk and protective factors. This study aims to exhaustively review the risk and protective factors of Internet gaming disorder among Chinese people.

METHOD

We searched for articles published from database inception to February 2020 in MEDLINE, PsycINFO, Embase, PubMed, Web of Science and two Chinese databases, CNKI and Wanfang Data. Studies were included in the meta-analysis if they addressed Internet gaming disorder, sampled people in China, presented correlational factors of Internet gaming disorder and reported the effect sizes for correlations. Reviewers independently selected the studies, assessed their validity and extracted the data. Pooled Pearson's correlations were calculated using the random effects model.

RESULT

In the meta-analysis, 153 studies covering 115,975 subjects were included. We identified 56 risk factors and 28 protective factors. Most risk factors strongly correlated with Internet gaming disorder fell into the category of maladaptive cognitions and motivations. Other factors that showed high effect sizes fell into various categories, including psychopathological characteristics, personality traits, cognition emotion regulation style and gaming-related factors. The only protective factor strongly correlated with Internet gaming disorder was self-control. We found that the factors related to the 'environments' show modest effect sizes compared to those related to the individual. The pooled effect sizes for most factors were not influenced by outliers and publication bias.

CONCLUSION

Factors strongly correlated with Internet gaming disorder, especially maladaptive cognitions and motivations, are more likely to be proximal correlates of Internet gaming disorder and may be considered the focus of interventions. We encourage further empirical and experimental studies to examine the causal pathway and the treatment efficacy.

Development and validation of the Reward Deficiency Syndrome Questionnaire (RDSQ-29)

BACKGROUND

The reward deficiency syndrome (RDS) integrates psychological, neurological, and genetic factors of addictive, impulsive, and compulsive behaviors. However, to date, no instrument has been validated to assess the RDS construct.

AIMS

The present study developed and tested a tool to assess RDS.

METHODS

Data were collected on two college and university samples. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed on Sample 1 (N = 1726), and confirmatory analysis was conducted on an independent sample (N = 253). Impulsivity and sensation-seeking were assessed.

RESULTS

Based on EFAs, a 29-item Reward Deficiency Syndrome Questionnaire (RDSQ-29) was developed, containing four subscales (lack of sexual satisfaction, activity, social concerns, and risk-seeking behavior). CFA indicated good fit (comparative fit index (CFI) = 0.941; Tucker-Lewis index (TLI) = 0.933; root mean square error of approximation (RMSEA) = 0.068). Construct validity analysis showed strong relationship between sensation-seeking and the RDS scale.

CONCLUSION

The RDSQ-29 is an adequate scale assessing psychological and behavioral aspects of RDS. The RDSQ-29 assesses psychological and behavioral characteristics that may contribute to addictions generally.

Professional Esports Players: Motivation and Physical Activity Levels

The professionalisation of esports has increased in recent years, generating the need for further study. Its evolution and continuous development have led the consideration of esports as a profession, increasing the number of players, practice modalities, and hours of play dedicated to this field. The aim of this study was to analyse the relationship between physical activity levels and motivational orientations in an international sample of professional esports players. A cross-sectional and observational study was conducted in European and Latin American countries. The sample was non-probabilistic by convenience, and 260 male professional esports players were recruited. A survey was used that included demographic data, body composition, physical activity (International Physical Activity Questionnaire), and motivation (Sport Motivation Scale). The results show that 92.7% of professional esports players have moderate and high levels of physical activity and that players with low levels of physical activity have positive values in all dimensions of motivation. It is concluded that extrinsic and intrinsic motivation correlates inversely with energy expenditure.

Pilot Study of a Brief Intervention to Treating Internet Use Disorders

Abstract: Aim: Studies on brief interventions for Internet use disorders (IUD) are lacking. In this pilot study we tested the feasibility and preliminary efficacy of an approach applying Motivational Interviewing and elements of cognitive behavioral therapy. Methods: Clients in four job centers and the job agency in Lübeck, Germany, were approached for a proactive screening in order to identify problematic Internet use or IUD with the Compulsive Internet Use Scale (CIUS). Screening-positives were checked in a clinical interview for fulfilling three or more criteria according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Participants were randomized into intervention (personal counselling and up to three counselling sessions via telephone) and control group. A two-month follow-up was conducted. Results: Of all 3,600 clients approached, 1680 clients could be screened and 298 were screening-positive (17.7%). After a diagnostic interview 36 participants could be allocated to intervention and control group. In the two-months follow-up, decrease of problematic Internet use was higher in the intervention group, although not statistically significant (p=.216) (0.216) a small to medium effect size could be observed. Conclusion: The feasibility of this early intervention approach was evident. Larger sample sizes are needed to examine the efficacy of similar interventions. Findings of this study are promising and suggest future research. Evidence of effectiveness of such short interventions could enhance the impact and magnitude of measures and make an important contribution to preventative efforts.

Evidence on Problematic Online Gaming and Social Anxiety over the Past Ten Years: a Systematic Literature Review

Purpose of Review

The present study aimed to review the literature concerning the relationship between problematic online gaming (POG) and social anxiety, taking into account the variables implicated in this relationship. This review included studies published between 2010 and 2020 that were indexed in major databases with the following keywords: Internet gaming, disorder, addiction, problematic, social phobia, and social anxiety.

Recent Findings

In recent years, scientific interest in POG has grown dramatically. Within this prolific research field, difficulties associated with social anxiety have been increasingly explored in relation to POG. Indeed, evidence showed that individuals who experience social anxiety are more exposed to the risk of developing an excessive or addictive gaming behavior.

Summary

A total of 30 studies satisfied the initial inclusion criteria and were included in the present literature review. Several reviewed studies found a strong association between social anxiety and online gaming disorder. Furthermore, the relationships among social anxiety, POG, age, and psychosocial and comorbid factors were largely explored. Overall, the present review showed that socially anxious individuals might perceive online video games as safer social environments than face-to-face interactions, predisposing individuals to the POG. However, in a mutually reinforcing relationship, individuals with higher POG seem to show higher social anxiety. Therefore, despite online gaming might represent an activity able to alleviate psychopathological symptoms and/or negative emotional states, people might use online gaming to counterbalance distress or negative situations in everyday life, carrying out a maladaptive coping strategy.

Internet-Related Disorders and Their Effects on Personality Development in Adolescents from Germany-Results from a Prospective Study

Internet-related disorders (IRD) are increasingly becoming a major health issue. IRD are defined as the predominant use of online content, related to a loss of control and continued use despite negative consequences. Despite findings from cross-sectional studies, the causality of pathways accelerating the development of IRD are unclear. While etiological models emphasize the role of personality as risk factor, mutual influences between IRD and personality have not been examined. A prospective study with two assessments was conducted with n = 941 adolescents (mean age of 13.1 years; 10–17 years). Our aim was to validate etiological assumptions and to examine the effects of IRD-symptoms on the maturation of personality. IRD were measured with the Scale of the Assessment of Internet and Computer game Addiction (AICA-S). Personality traits were assessed using the Brief Five Factor Inventory (BFI). Conscientiousness and neuroticism were predictive for IRD symptoms one year later, and were likewise prone to changes depending on incidence or remission of IRD. Conscientiousness and openness moderated the course of IRD symptoms. Our findings point to complex trait–pathology associations. Personality influences the risk of development and maintenance of IRD symptoms and pre-existing IRD-symptoms affect the development of personality. Adaptations to etiological models are discussed and perspectives for novel intervention strategies are suggested.

Reliability, and Convergent and Discriminant Validity of Gaming Disorder Scales: A Meta-Analysis

Background: An association between gaming disorder (GD) and the symptoms of common mental disorders is unraveled yet. In this preregistered study, we quantitatively synthesized reliability, convergent and discriminant validity of GD scales to examine association between GD and other constructs. Methods: Five representative GD instruments (GAS-7, AICA, IGDT-10, Lemmens IGD-9, and IGDS9-SF) were chosen based on recommendations by the previous systematic review study to conduct correlation meta-analyses and reliability generalization. A systematic literature search was conducted through Pubmed, Proquest, Embase, and Google Scholar to identify studies that reported information on either reliability or correlation with related variables. 2,124 studies were full-text assessed as of October 2020, and 184 were quantitatively synthesized. Conventional Hedges two-level meta-analytic method was utilized. Results: The result of reliability generalization reported a mean coefficient alpha of 0.86 (95% CI = 0.85-0.87) and a mean test-retest estimate of 0.86 (95% CI = 0.81-0.89). Estimated effect sizes of correlation between GD and the variables were as follows: 0.33 with depression (k = 45; number of effect sizes), 0.29 with anxiety (k = 37), 0.30 with aggression (k = 19), -0.22 with quality of life (k = 18), 0.29 with loneliness (k = 18), 0.56 with internet addiction (k = 20), and 0.40 with game playtime (k = 53), respectively. The result of moderator analyses, funnel and forest plots, and publication bias analyses were also presented. Discussion and Conclusion: All five GD instruments have good internal consistency and test-retest reliability. Relatively few studies reported the test-retest reliability. The result of correlation meta-analysis revealed that GD scores were only moderately associated with game playtime. Common psychological problems such as depression and anxiety were found to have a slightly smaller association with GD than the gaming behavior. GD scores were strongly correlated with internet addiction. Further studies should adopt a rigorous methodological procedure to unravel the bidirectional relationship between GD and other psychopathologies. Limitations: The current study did not include gray literature. The representativeness of the five tools included in the current study could be questioned. High heterogeneity is another limitation of the study. Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42020219781].

Expert appraisal of criteria for assessing gaming disorder: an international Delphi study

BACKGROUND AND AIMS

Following the recognition of 'internet gaming disorder' (IGD) as a condition requiring further study by the DSM-5, 'gaming disorder' (GD) was officially included as a diagnostic entity by the World Health Organization (WHO) in the 11th revision of the International Classification of Diseases (ICD-11). However, the proposed diagnostic criteria for gaming disorder remain the subject of debate, and there has been no systematic attempt to integrate the views of different groups of experts. To achieve a more systematic agreement on this new disorder, this study employed the Delphi expert consensus method to obtain expert agreement on the diagnostic validity, clinical utility and prognostic value of the DSM-5 criteria and ICD-11 clinical guidelines for GD.

METHODS

A total of 29 international experts with clinical and/or research experience in GD completed three iterative rounds of a Delphi survey. Experts rated proposed criteria in progressive rounds until a pre-determined level of agreement was achieved.

RESULTS

For DSM-5 IGD criteria, there was an agreement both that a subset had high diagnostic validity, clinical utility and prognostic value and that some (e.g. tolerance, deception) had low diagnostic validity, clinical utility and prognostic value. Crucially, some DSM-5 criteria (e.g. escapism/mood regulation, tolerance) were regarded as incapable of distinguishing between problematic and non-problematic gaming. In contrast, ICD-11 diagnostic guidelines for GD (except for the criterion relating to diminished non-gaming interests) were judged as presenting high diagnostic validity, clinical utility and prognostic value.

CONCLUSIONS

This Delphi survey provides a foundation for identifying the most diagnostically valid and clinically useful criteria for GD. There was expert agreement that some DSM-5 criteria were not clinically relevant and may pathologize non-problematic patterns of gaming, whereas ICD-11 diagnostic guidelines are likely to diagnose GD adequately and avoid pathologizing.

Metacognitions as a predictor of online gaming in adolescents: Psychometric properties of the metacognitions about online gaming scale among Iranian adolescents

The Metacognitions about Online Gaming Scale (MOGS) measures maladaptive metacognitions about online gaming. The purpose of the present study was to evaluate psychometric properties of the MOGS, including its factor structure, reliability, and predictive validity among Iranian adolescents. The scale was administered to 769 Iranian adolescents (577 male, mean age = 16.39 ± 1.68 years) with an age range of 15-19 years. The participants completed the Persian-translated version of the MOGS, the Big Five Inventory-10, the Depression, Anxiety and Stress Scale 21, the Video-Game Related Cognitions Scale, the Motives for Online Gaming Questionnaire, and the Problematic Online Gaming Questionnaire. The results of the Exploratory Factor Analysis (n = 350) and Confirmatory Factor Analysis (n = 419) confirmed three-factors similar to the parent version, including "negative metacognitions about uncontrollability of online gaming" (N-MOGU), "negative metacognitions about dangers of online gaming" (N-MOGD), and "positive metacognitions about online gaming" (P-MOG). The Persian MOGS's reliability showed a suitable internal consistency for the P-MOG, the N-MOGU, the N-MOGD, and the total score in both confirmatory and exploratory samples (range 0.79 to 0.93). A hierarchical regression analysis showed that the Persian MOGS predicted 33.9% of the variance in problematic online gaming independently of personality traits, anxiety, depression, stress, and both gaming-related cognitions and gaming motives. Furthermore, the results of analyses of variance with follow-up Bonferroni pairwise comparisons showed that interaction between the factors of MOGS and types of game and tools of gaming was significant. The findings provide evidence that the Persian MOGS among Iranian adolescents appears psychometrically appropriate to be used by researchers and practitioners dealing with the prevention and treatment of problematic online gaming.

The Moderating Role of Coping Mechanisms and Being an e-Sport Player Between Psychiatric Symptoms and Gaming Disorder: Online Survey

BACKGROUND

The emerging popularity of playing video games (gaming) as a hobby and as a professional sport raises awareness about both the benefits and possible downsides of the activity. Although a healthy and passionate hobby for most, a minority of gamers experience addiction-like symptoms and are considered to have gaming disorder (GD). GD has previously been found to be related to aversive conditions, such as depression or anxiety, as well as putatively maladaptive coping strategies.

OBJECTIVE

The aim of this study is twofold: to explore the moderating effect of different coping strategies and type of video game usage (professional [e-sport] or recreational) on the relationship between psychiatric symptoms and GD.

METHODS

A sample of 3476 gamers (n=3133, 90.13% males; mean age 23.20, SD 6.48 years) was recruited via the website and social networking site of the most popular gaming magazine in Hungary (GameStar).

RESULTS

The main effect of psychiatric symptoms was moderate to large in all models, whereas the moderation effects were significant (P<.001) for 4 out of 8 coping strategies (ie, self-blame/self-distraction, denial, emotional/social support, and active coping). However, the explained variance of the models only increased negligibly (from 0.3% to 0.5%) owing to the moderation effect. The direction of the moderations was as expected (ie, putatively maladaptive strategies were associated with more GD symptoms when the level of psychiatric symptoms was high, while putatively adaptive strategies were associated with less). Furthermore, no considerable moderation effect of the player type (recreational vs professional players) was found on the association between psychiatric symptoms and GD (β=.04; P=.02; 0.1% change in the explained variance).

CONCLUSIONS

Future studies should be designed to better understand coping-related mechanisms in the context of video gaming and GD.

Application of the eleventh revision of the International Classification of Diseases gaming disorder criteria to treatment-seeking patients: Comparison with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders Internet gaming disorder criteria

The World Health Organization included gaming disorder (GD) in the eleventh revision of International Classification of Diseases in 2019. Due to the lack of diagnostic tools for GD, a definition has not been adequately applied. Therefore, this study aimed to apply an operationalized definition of GD to treatment-seekers. The relationship between the diagnoses of GD and Internet gaming disorder (IGD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders was also examined. Methods: Study participants comprised 241 treatment-seekers who had engaged in excessive gaming and experienced related problems. Psychiatrists applied the GD diagnostic criteria to the participants using a diagnostic form developed for this study. Information on gaming behavior and functional impairment was obtained through face-to-face interviews conducted by clinical psychologists. Results: In total, 78.4 and 83.0% of the participants fulfilled the GD and IGD diagnostic criteria, respectively. The sensitivity and specificity of GD diagnosis were both high when the IGD diagnosis was used as the gold standard. Participants with GD preferred online PC and console games, spent significantly more time gaming, and showed a higher level of functional impairment compared to those who did not fulfill the GD diagnostic criteria. Discussion and Conclusion: The definition of GD can be successfully applied to treatment-seekers with excessive gaming and related problems. A high concordance of GD and IGD diagnoses was found in those participants with relatively severe symptoms. The development and validation of a diagnostic tool for GD should be explored in future studies.

Gaming and Social Media Addiction in University Students: Sex Differences, Suitability of Symptoms, and Association With Psychosocial Difficulties

Background: Previous research has shown that addictions to digital media can have negative impact on psychosocial health. Although Internet Gaming Disorder (IGD) has received most scholarly recognition, the potential negative consequences of Social Media Disorder (SMD) have also been found. However, few studies have assessed the symptoms of these two digital media addictions in the same way, making comparisons difficult. The present study aims to fill this gap by investigating differences and similarities regarding how common the symptoms are, sex differences, the suitability of the symptoms, and their association with psychosocial difficulties. Method: A total of 688 university students (63.2% women, Mean age = 25.98) completed a questionnaire measuring symptoms of IGD and SMD, as well as psychosocial difficulties (i.e., psychosomatic symptoms, low self-concept, and social problems). Results: Results showed that 1.2% of the men and 0.9% of the women met the symptom criteria for IGD (non-significant difference), whereas 3.2% men and 2.8% women met the symptom criteria for SMD (non-significant difference). Dimensional analyses indicated that men had higher IGD scores compared to women, whereas the opposite was found for SMD. Symptoms of heavy involvement in digital media (i.e., Preoccupation, Tolerance, Withdrawal, Unsuccessful attempts to control, and Escape) had high sensitivity, but low positive predictive value (PPV). However, symptoms associated with negative consequences of digital media use (i.e., Loss of interest, Continued excessive use, Deception, and Jeopardizing career/relationships) had low sensitivity, but high PPV. These symptom patterns were similar for IGD and SMD. Meeting the criteria for IGD or SMD as well as being at risk of these disorders were significantly associated with psychosocial difficulties. Symptoms of SMD generally had stronger associations with psychosomatic symptoms compared to symptoms of IGD. Conclusions: We conclude that heavy involvement in digital media seems common among individuals with IGD or SMD, but also among those not meeting the symptom criteria, whereas negative consequences are less common but highly predictive of digital media addictions once present. Further attention to SMD is warranted, as it seems more common than IGD and also seems to be equally or more strongly associated with psychosocial difficulties.

Diagnostic Contribution of the DSM-5 Criteria for Internet Gaming Disorder

Background: Internet gaming disorder (IGD) can have long-term severe consequences in affected individuals, especially adolescents and young people. Empirical studies of IGD using the DSM-5 criteria are still lacking. This study aimed to evaluate the contribution of specific criteria to the diagnosis of IGD based on the DSM-5 in the context of Chinese culture. Methods: The Chinese version of the Internet Gaming Disorder Scale-Short Form (IGDS9-SF) was applied to investigate the prevalence of IGD in a general sample of 28,689 middle school students aged 12-19 years from two cities in China. Results: The prevalence of IGD was 4.6% among this adolescent sample. The group of IGD students reported longer weekly gaming times and worse academic performance than the group of non-IGD students. Although "preoccupation" and "playing to escape" were the most frequently reported criteria, the conditional inference trees showed that "give up other activities," 'negative consequences," and "continue despite problems" contributed most to the diagnosis of IGD based on the DSM-5. Conclusions: The prevalence of IGD among Chinese adolescents (ages 12-19) was 4.6%. This study provides evidence for retaining or deleting specific diagnostic criteria by the DSM framework in the future.

Identifying individuals in need of help for their uncontrolled gaming: A narrative review of concerns and comments regarding gaming disorder diagnostic criteria

OBJECTIVE

In 2013, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) included the diagnostic criteria of Internet gaming disorder (IGD). Then, in 2019, the 11th Revision of the International Classification of Diseases (ICD-11) categorized gaming disorder (GD) as an addictive disorder. This review aimed to review the raised concerns, debate, and research of IGD or GD criteria and provide suggestions to resolve them.

METHODS

A narrative review was conducted, and PubMed was searched for articles mentioning concerns and research on the DSM-5 criteria for IGD, ICD-11 criteria for GD, or criteria for other synonyms, such as problematic gaming or gaming addiction. A total of 107 articles were identified.

RESULTS

Concerns were organized into three categories: conceptual framework, moral panic, and diagnostic validity. Most argumentations supported the proposition that GD and other substance use disorders have similar presentations. A clear definition of GD and adequate public education could prevent rather than exacerbate moral panic. Several researchers reported concerns regarding the nosology, diagnostic validity, and wording of each criterion. However, the threshold, five of the nine criteria with impaired function, demonstrated adequate validity in interview studies.

CONCLUSION

The current findings support the addiction framework, functional impairment, and validity of the GD criteria. However, further prospective, experimental, and clinical studies validating these findings are warranted. Moreover, an integrative review or debate conference could contribute to the organization of the available results and concept development. Aggregating adequate scientific information could allay or resolve concerns related to the diagnosis of GD.

Career as a Professional Gamer: Gaming Motives as Predictors of Career Plans to Become a Professional Esport Player

Increasing numbers of young video gamers view esports (i.e., competitive video gaming) as a career opportunity, rather than just a recreational activity. Previous studies have explored the motivational differences between esport and recreational gamers and the motivational changes through career journey to become a professional esport player. The present study explored the predictors of career plans to become a professional esport player, with a specific focus on gaming motivations. Gaming time, gaming motivations, and esport-related playing experience were also examined among Hungarian gamers with competitive gaming experience (N = 190), such as years spent in esports, medium and frequency of participating in esport tournaments, the effort put into training before the tournaments, and the plans to become a professional esport player. Binary logistic regressions were carried out and results showed that the gaming motivations of competition, skill development, and social motivations predicted career planning as a professional esport player. Additionally, results showed that younger players were more likely to seek career opportunity as professional esport players than older players. Future studies should focus on novice esport players’ psychological exposure to the hypercompetitive scene of esports, such as high expectations or the risk of becoming problematic videogame users due to their motivational changes.

Discounting delayed monetary rewards and decision making in behavioral addictions - A comparison between patients with gambling disorder and internet gaming disorder

Behavior addictions, such as Gambling Disorder and Internet Gaming Disorder, have been demonstrated to have severe negative impact. Heightened impulsivity, deficits in decision making, and cognitive biases in the preference of immediate rewards have been shown to be crucial aspects in addictive disorders. While for Gambling Disorder (GD), dysfunctional decision making has been documented before, data for Internet Gaming Disorder (IGD) are still underrepresented. In order to allow for a direct comparison of both disorders, we assessed different measures of impulsivity (trait, impulsive choice, and decision making) in a clinical sample. N = 31 patients meeting criteria for GD and n = 30 patients with IGD were recruited from an outpatient clinic and compared regarding their performance in a Delay Discounting Task (DDT), the Iowa Gambling Task (IGT), and self-report data on impulsivity (Barratt Impulsiveness Scale). Healthy controls (n = 27) were included as a reference group. In the DDT, the area under the curve was associated with the severity of GD only. No correlations were found for the impulsivity subscales and the area under the curve which, however, was similar between the two patient groups in contrast to controls. The GD-group performed poorer then the other groups in the IGT while IGD-patients performed poorer only at the beginning of the experiment. Although only few significant differences occurred, similarities between GD and IGD regarding the DDT point towards a tendency on discounting rewards faster. Likewise, both patient groups were performing worse in the IGT than healthy controls which indicates deficiencies in decision making. Interestingly, the IGD-group was able to shift towards more advantageous decision making, which might have important implications for therapeutic interventions.

Altered core networks of brain connectivity and personality traits in internet gaming disorder

BACKGROUND AND AIMS

Although the Internet has provided convenience and efficiency in many areas of everyday life, problems stemming from Internet use have also been identified, such as Internet gaming disorder (IGD). Internet addiction, which includes IGD, can be viewed as a behavioral addiction or impulse control disorder. This study investigated the altered functional and effective connectivity of the core brain networks in individuals with IGD compared to healthy controls (HCs).

METHODS

Forty-five adults with IGD and 45 HCs were included in this study. To examine the brain networks related to personality traits that influence problematic online gaming, the left and right central executive network (CEN) and the salience network (SN) were included in the analysis. Also, to examine changes in major brain network topographies, we analyzed the default mode network (DMN).

RESULTS

IGD participants showed lower functional connectivity between the dorsal lateral prefrontal cortex (DLPFC) and other regions in the CEN than HC participants during resting state. Also, IGD participants revealed reduced functional connectivity between the dorsal anterior cingulate cortex and other regions in the SN and lower functional connectivity in the medial prefrontal cortex of the anterior DMN. Notably, in IGD individuals but not HC individuals, there was a positive correlation between IGD severity and effective connectivity and a positive correlation between reward sensitivity and effective connectivity within the ventral striatum of the SN.

CONCLUSIONS

Problematic online gaming was associated with neurofunctional alterations, impairing the capacity of core brain networks.

Clarifying terminologies in research on gaming disorder and other addictive behaviors: distinctions between core symptoms and underlying psychological processes

There exists ongoing debate regarding the clinical validity of single symptoms of and diagnostic criteria for gaming disorder. In particular, the potential symptom of gaming disorder that addresses coping with and escaping from negative feelings has received much attention and remains a focus of intensive discussion. We argue that it is important to consider differences or distinguish between, on the one hand, symptoms of and criteria for a disorder due to addictive behaviors, such as gaming disorder, versus, on the other hand, motivations, mechanisms, and psychological processes that may be involved in promoting addictive behaviors and that may explain symptom severity and course of the addictive disorder including potential treatment responses.

The Association Between Video Gaming and Psychological Functioning

Video gaming is an extremely popular leisure-time activity with more than two billion users worldwide (Newzoo, 2017). However, the media as well as professionals have underscored the potential dangers of excessive video gaming. With the present research, we aimed to shed light on the relation between video gaming and gamers' psychological functioning. Questionnaires on personality and psychological health as well as video gaming habits were administered to 2,734 individuals (2,377 male, 357 female, M age = 23.06, SD age = 5.91). Results revealed a medium-sized negative correlation between problematic video gaming and psychological functioning with regard to psychological symptoms, affectivity, coping, and self-esteem. Moreover, gamers' reasons for playing and their preferred game genres were differentially related to psychological functioning with the most notable findings for distraction-motivated players as well as action game players. Future studies are needed to examine whether these psychological health risks reflect the causes or consequences of video gaming.