The concept of "harm" in Internet gaming disorder

Family-based therapy for internet addiction among adolescents and young adults: A meta-analysis

Background and aims

Internet addiction (IA) has been identified as a major public health problem that is more prominent in adolescents and young adults. Some researchers have indicated certain advantages of family-based therapy over other treatments in participants with IA, but no conclusive evaluation has been reported. The present meta-analysis aims to review the efficacy of family-based therapy on Internet addiction in adolescents and young adults.

Methods

Relevant articles published from 1996 to February 15th, 2024, were searched from 14 databases, including three Chinese databases. A total of 19,590 articles were identified using a combination of three sets of search terms (Internet addiction, family therapy, and adolescents). Only RCTs and nonrandomized controlled trials were included.

Results

18 studies, most of which were conducted in Asian countries, were included in the final data analysis. The overall severity of Internet addiction in the family-based therapy group was significantly lower than that in the control group. However, significant heterogeneity was detected. Subgroup analysis showed a beneficial effect of family-based therapy when compared with non-intervention and when added to another psychological or behavioural therapy in psychiatric patients with co-medication. Few studies have examined secondary outcomes or follow-up effects.

Discussion and Conclusions

Family-based therapy is most effective in reducing the severity of Internet addiction when combined with other therapies, especially medication treatments in psychiatric patients. It might also be helpful to relieve depression and enhance family functions, which needs further evidence. More studies following up on the post-intervention effects are recommended in the future.

Internet Gaming Disorder and the Incidence of Suicide-Related Ideation and Behaviors in College Students

OBJECTIVES

The longitudinal associations between DSM-5 Internet Gaming Disorder (IGD) and suicide-related ideation and behaviors have not been explored. In this study, we therefore seek to examine the association between baseline IGD and incident suicide ideation, plans, and attempts.

METHODS

This is a prospective cohort study of 2586 Mexican college students followed up from September 2018 to June 2022. We estimated hazards ratios modeling incidence of suicide ideation, plans, and attempts by fitting proportional hazards Cox models with person-time scaled in years.

RESULTS

Among 2140 students without suicide ideation at baseline, there were 467 incident cases in 3987.6 person-years; ideation incidence rates were 179 cases per 1000 person-years among students with IGD and 114 cases per 1000 person-years among those without IGD. Incidence rates for suicide plans were 67 and 39 per 1000 among IGD and non-IGD students, and 15 and 10 per 1000, respectively for attempts. After controlling for age, sex, and mood, anxiety, and substance use disorders, IGD was associated with an 83% increased risk of suicide ideation. Although incidence rate estimates for plans and attempts were higher among students with IGD, results were not statistically significant.

CONCLUSIONS

This study helps to raise awareness of the increased risk of at least suicidal ideation in people experiencing IGD. Clinicians treating patients with IGD may encounter complaints of suicide ideation over time, and even reports of suicidal behavior that should not be disregarded. Identifying these patients and treating/referring them for underlying suicidality should form part of IGD treatment.

Red box, green box: A self-report behavioral frequency measurement approach for behavioral addictions research

Behavior frequency measures in behavioral addictions research fail to account for how engagement in the activity relates to each respondent's personal circumstances. We propose a "Red Box, Green Box" method, an alternative to conventional self-report behavior questions. Participants report two distinct time-based values: (1) Green box: time spent engaged in the activity during 'free' time, and (2) Red box: engagement in the activity at times when the respondent should be doing something else (e.g., studying, working, sleeping, exercising, etc.). Some practical examples of the 'red box, green box' method are provided. This method may help to calibrate behavioral frequency for each respondent and yield clearer insights into displacement effects and risks associated with frequency of use. We suggest some future research directions to test the feasibility and utility of this approach in different implementations.

A multi-dimensional assessment of internet gaming disorder in children and adolescents: A case-control study

BACKGROUND

Internet gaming disorder (IGD) leads to social disturbances and isolation, neglect of daily responsibilities, behavioral disorders, and physical impairments.

OBJECTIVE

This study aimed to investigate the effect of IGD on spine biomechanics, range of motion in the neck and low back, and lung functions and respiratory muscle strength in children and adolescents.

METHODS

Sixty-four children and adolescents with IGD (Group I) and 41 healthy controls (Group II) were included in the study. The outcomes were assessed with the Visual Analogue Scale (VAS), Internet Addiction Scale, active range of motion (AROM) in the neck and lumbar spine, posture and spinal alignment, lung function tests, and respiratory muscle strength.

RESULTS

There is a significant difference in pain intensity at rest, during activity, and daily sitting time between groups (p < 0.05). Craniovertebral angle, shoulder asymmetry, thoracic kyphosis angle, cervical extension and rotation, and right lumbar rotation significantly decreased in Group I than in Group II (p < 0.05). Besides, the PEF, FEF 25-75%, and respiratory muscle strength were lower in Group I than in Group II (p < 0.05). With a multiple linear regression model, MEP, FEV1, and weekly time spent playing online games were significant predictors of internet addiction intensity (R2 = 0.28; p = 0.02, p = 0.01, and p < 0.001, respectively).

CONCLUSION

Postural misalignment and increased sedentary time cause physical health deterioration and negatively affect lung functions in children and adolescents with IGD. Consequently, considering both psychological and physical health is necessary to assess the problematic nature of internet gaming. A comprehensive assessment and multidisciplinary team approach is essential to managing the IGD.

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.

Psychological Effects of FIFA, PES, and Clash of Clans Games on Young Men at Risk of Developing Internet Gaming Disorder

BACKGROUND

The present study aimed to investigate the psychological effects of FIFA, PES, and Clash of Clans games on young men at risk of developing internet gaming disorder (IGD).

METHODS

The sample consisted of 150 young men, 50 of whom were in the FIFA and PES group, 50 in the Clash of Clans group, and 50 in the control group. Two groups of young men at risk of developing IGD were compared with a control group. The participants completed the General Health Questionnaire (GHQ), Quality of Relationships Inventory (QRI), Game Addiction Scale, and Behavior Rating Inventory of Executive Function (BRIEF).

FINDINGS

The results of the study showed that the scores of mental health problems, conflict with friends, and executive function problems in the Clash of Clans group were significantly higher than those of the FIFA, PES, and control groups. Concerning conflict with parents, the FIFA group had a higher score than the Clash of Clans and control groups. In addition, the results indicated that gaming addiction affects mental health by affecting executive functions.

CONCLUSION

The Clash of Clans game has more negative effects on psychological functions.

Psychological treatments for excessive gaming: a systematic review and meta-analysis

Despite widespread public interest in problematic gaming interventions, questions regarding the empirical status of treatment efficacy persist. We conducted pairwise and network meta-analyses based on 17 psychological intervention studies on excessive gaming (n = 745 participants). The pairwise meta-analysis showed that psychological interventions reduce excessive gaming more than the inactive control (standardized mean difference [SMD] = 1.70, 95% confidence interval [CI] 1.27 to 2.12) and active control (SMD = 0.88, 95% CI 0.21 to 1.56). The network meta-analysis showed that a combined treatment of Cognitive Behavioral Therapy (CBT) and Mindfulness was the most effective intervention in reducing excessive gaming, followed by a combined CBT and Family intervention, Mindfulness, and then CBT as a standalone treatment. Due to the limited number of included studies and resulting identified methodological concerns, the current results should be interpreted as preliminary to help support future research focused on excessive gaming interventions. Recommendations for improving the methodological rigor are also discussed.

Opposing associations of Internet Use Disorder symptom domains with structural and functional organization of the striatum: A dimensional neuroimaging approach

BACKGROUND

Accumulating evidence suggests brain structural and functional alterations in Internet Use Disorder (IUD). However, conclusions are strongly limited due to the retrospective case-control design of the studies, small samples, and the focus on general rather than symptom-specific approaches.

METHODS

We here employed a dimensional multi-methodical MRI-neuroimaging design in a final sample of n = 203 subjects to examine associations between levels of IUD and its symptom-dimensions (loss of control/time management, craving/social problems) with brain structure, resting state and task-based (pain empathy, affective go/no-go) brain function.

RESULTS

Although the present sample covered the entire range of IUD, including normal, problematic as well as pathological levels, general IUD symptom load was not associated with brain structural or functional alterations. However, the symptom-dimensions exhibited opposing associations with the intrinsic and structural organization of the brain, such that loss of control/time management exhibited negative associations with intrinsic striatal networks and hippocampal volume, while craving/social problems exhibited a positive association with intrinsic striatal networks and caudate volume.

CONCLUSIONS

Our findings provided the first evidence for IUD symptom-domain specific associations with progressive alterations in the intrinsic structural and functional organization of the brain, particularly of striatal systems involved in reward, habitual and cognitive control processes.

Gaming disorder and the COVID-19 pandemic: Treatment demand and service delivery challenges

Gaming activities have conferred numerous benefits during the COVID-19 pandemic. However, some individuals may be at greater risk of problem gaming due to disruption to adaptive routines, increased anxiety and/or depression, and social isolation. This paper presents a summary of 2019-2021 service data from specialist addiction centers in Germany, Switzerland, Japan, and the United Kingdom. Treatment demand for gaming disorder has exceeded service capacity during the pandemic, with significant service access issues. These data highlight the need for adaptability of gaming disorder services and greater resources and funding to respond effectively in future public health crises.

An Evaluation of Gaming-Related Harms in Relation to Gaming Disorder and Loot Box Involvement

The specific nature of harm and functional impairment in the context of gaming disorder (GD) has received limited attention. In this study, we present one of the first concerted attempts to measure the types and degree of harm experienced by people displaying signs of problem gaming. Attempts were made to assess the extent to which types of harm were attributable to gaming as opposed to other factors. The study also investigated potential behavioural indicators of harmful involvement, including exposure to loot boxes. A sample of 471 regular gamers (M = 380, F = 73), recruited through the online platform Prolific, completed a survey where problem gaming was identified using Petry et al.’s (2014) checklist. Individuals who met the cut-off for gaming disorder scored higher than the non-problem group on most dimensions of harm, with physical and psychological types being the most common issues. Loot box expenditure was low (M = $25 in 3 months, for the 10.8% of respondents who played loot boxes) but significantly positively associated with the degree of gaming-related financial harm. This study shows that problem gaming is most strongly associated with physical or psychological harm and that financial harms may manifest in gaming activities that facilitate continuous spending options.

Global prevalence of gaming disorder: A systematic review and meta-analysis

BACKGROUND

Gaming disorder was included in the latest revision of the International Classification of Diseases (11th ed.). Worldwide, prevalence estimates of gaming disorder are considerably heterogeneous and often appear to be exceedingly high. However, few studies have examined the methodological, cultural and/or demographic factors that might explain this phenomenon. This review employed meta-analytic techniques to compute the worldwide-pooled prevalence of gaming disorder and evaluate the potential contributing factors for varied prevalence estimates.

METHOD

Prevalence estimates were extracted from 53 studies conducted between 2009 and 2019, which included 226,247 participants across 17 different countries. Study findings were meta-analyzed using a random-effects model. Subgroup and moderator analyses examined potential sources of heterogeneity, including assessment tool and cut-off, participant age and gender, sample size and type, study region, and year of data collection.

RESULTS

The worldwide prevalence of gaming disorder was 3.05% (confidence interval: [2.38, 3.91]); this figure was adjusted to 1.96% [0.19, 17.12] when considering only studies that met more stringent sampling criteria (e.g. stratified random sampling). However, these estimates were associated with significant variability. The choice of screening tool accounted for 77% of the variance, with the Lemmens Internet gaming disorder-9, Gaming Addiction Identification Test and Problematic Videogame Playing scales associated with the highest estimates. Adolescent samples, lower cut-off scores and smaller sample size were significant predictors of higher prevalence. Gaming disorder rates were approximately 2.5:1 in favor of males compared to females.

CONCLUSION

The worldwide prevalence of gaming disorder appears to be comparable to obsessive-compulsive disorder and some substance-related addictions, but lower than compulsive buying and higher than problem gambling. Gaming disorder prevalence rates appear to be inflated by methodological characteristics, particularly measurement and sampling issues.

Prevention Strategies to Address Problematic Gaming: An Evaluation of Strategy Support Among Habitual and Problem Gamers

Psychosocial problems arising from excessive gaming are a public health issue across the developed world. In its most serious form, problematic gaming is recognized as gaming disorder (GD) in the ICD-11. Research has tended to focus on the value of outpatient treatment for GD, but less attention has been paid to broader prevention strategies to address less serious but nevertheless harmful gaming behaviors. Another gap in this literature has been the lack of involvement of the gaming community as stakeholders to identify feasible prevention approaches. This study investigated: (1) regular and problematic gamers' level of support for different prevention strategies within primary, secondary, and tertiary approaches; and, (2) whether self-efficacy is associated with greater support for prevention strategies, as predicted by the Health Belief Model. A total of 992 participants completed an online survey that evaluated support for problem gaming prevention strategies and included measures of self-efficacy, gaming involvement, and GD symptoms, psychological distress, and mental health help-seeking behaviors. Participants reported stronger support for primary prevention strategies, including education, screening, and warning labels, than for other prevention approaches. Overall, 61% of participants expressed support for primary prevention as compared to secondary (39%) and tertiary (36%) approaches. There was stronger support for outpatient care (48%) than inpatient services (25%). In-game shutdown features received the lowest support (65% disapproval). Contrary to the Health Belief Model, self-efficacy was not associated with prevention support. Younger, female, and less frequent gamers were more likely to support primary and secondary prevention strategies. These findings suggest that gamers may be more favorable toward prevention measures aligned with informed decision-making, autonomy, and self-directed actions. Gamers may be strongly opposed to modifications to the structure of gaming activities (e.g., shutdown features). Future research should evaluate the efficacy and cost-effectiveness of problem gaming prevention measures in different populations and regions.

Gender-related differences in frontal-parietal modular segregation and altered effective connectivity in internet gaming disorder

BACKGROUND

Although previous studies have revealed gender-related differences in executive function in internet gaming disorder (IGD), neural mechanisms underlying these processes remain unclear, especially in terms of brain networks.

METHODS

Resting-state fMRI data were collected from 78 subjects with IGD (39 males, 20.8 ± 2.16 years old) and 72 with recreational game use (RGU) (39 males, 21.5 ± 2.56 years old). By utilizing graph theory, we calculated participation coefficients among brain network modules for all participants and analyzed the diagnostic-group-by-gender interactions. We further explored possible causal relationships between networks through spectral dynamic causal modeling (spDCM) to assess differences in between-network connections.

RESULTS

Compared to males with RGU, males with IGD demonstrated reduced modular segregation of the frontal-parietal network (FPN). Male IGD subjects also showed increased connections between the FPN and cingulo-opercular network (CON); however, these differences were not found in female subjects. Further spDCM analysis indicated that the causal influence from CON to FPN in male IGD subjects was enhanced relative to that of RGU males, while this influence was relatively reduced in females with IGD.

CONCLUSIONS

These results suggest poor modular segmentation of the FPN and abnormal FPN/CON connections in males with IGD, suggesting a mechanism for male vulnerability to IGD. An increased "bottom-up" effect from the CON to FPN in male IGD subjects could reflect dysfunction between the brain networks. Different mechanisms may underlie in IGD, suggesting that different interventions may be optimal in males and females with IGD.

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.

Internet gaming as a coping method among schizophrenic patients facing psychological distress

BACKGROUND AND AIMS

Patients with schizophrenia are known to use potentially addictive psychoactive substances as self-medication and to ease psychological distress. Other potentially addictive behaviors such as online gaming are also used to self-medicate and ease psychological distress. However, the role of online gaming and problematic gaming (in the form of internet gaming disorder [IGD]) has not previously been investigated for patients with schizophrenia facing distress.

METHODS

One hundred and four participants diagnosed with schizophrenia were recruited and completed a number of psychometric scales including the Personal and Social Performance Scale (PSPS), Internet Gaming Disorder Scale-Short Form (IGDS-SF9), Self-Stigma Scale-Short (SSS-S), and Depression, Anxiety, Stress Scale (DASS-21).

RESULTS

The results showed significant negative associations between PSPS, IGDS-SF9, and DASS-21, and significant positive correlations between the IGDS-SF-9, SSS-S and DASS-21. Moreover, IGD did not mediate the association between self-stigma and depression. However, IGD significantly mediated the association between self-stigma and anxiety, and the association between self-stigma and stress. In addition, (i) age and self-stigma were significant predictors for IGD; (ii) social function and self-stigma were significant predictors for depression; (iii) social function, self-stigma, and IGD were significant predictors for anxiety; and (iv) self-stigma and IGD were significant predictors for stress.

CONCLUSION

The findings suggest that online gaming may be a coping strategy for individuals with schizophrenia with psychological stress and self-stigma and that for some of these individuals, their gaming may be problematic.

A framework for indirect elicitation of the public health impact of gambling problems

Gambling problems are increasingly understood as a health-related condition, with harms from excessive time and money expenditure contributing to significant population morbidity. In many countries, the prevalence of gambling problems is known with some precision. However, the true severity of gambling problems in terms of their impact on health and wellbeing is the subject of ongoing debate. We firstly review recent research that has attempted to estimate harm from gambling, including studies that estimate disability weights using direct elicitation. Limitations of prior approaches are discussed, most notably potential inflation due to non-independent comorbidity with other substance use and mental health conditions, and potential biases in the subjective attribution of morbidity to gambling. An alternative indirect elicitation approach is outlined, and a conceptual framework for its application to gambling is provided. Significant risk factors for propensity to develop gambling problems are enumerated, and relative risks for comorbidities are calculated from recent meta-analyses and reviews. Indirect elicitation provides a promising alternative framework for assessing the causal link between gambling problems and morbidity. This approach requires implementation of propensity score matching to estimate the counterfactual, and demands high quality information of risk factors and comorbid conditions, in order to estimate the unique contribution of gambling problems. Gambling harm is best understood as a decrement to health utility. However, achieving consensus on the severity of gambling problems requires triangulation of results from multiple methodologies. Indirect elicitation with propensity score matching and accounting for comorbidities would provide an important step towards full integration of gambling within a public health paradigm.

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.

Effect of the Frustration of Psychological Needs on Addictive Behaviors in Mobile Videogamers-The Mediating Role of Use Expectancies and Time Spent Gaming

Casual videogames (CVGs), played on smartphones, are becoming increasingly popular, especially among females and adults. Whereas the addictive potential of online (computer) videogames is well-established, there is yet insufficient evidence for Internet gaming disorder (IGD) in mobile gamers and for the mediating role of some mechanisms involved. The aim of this study is to investigate the impact of the frustration of psychological needs on mobile videogamers’ addictive behavior as well as the role of cognitions (game-use expectancies) and behaviors (time spent playing) through a hypothesized serial mediation model, while controlling for important correlates, such as game genre, age, gender and payment during play. A total of 471 mobile game users (211 males) with an average age of 21.73 replied to an online survey containing sociodemographic and game variables, the Need Satisfaction and Frustration Scale (NSFS), the Internet Gaming Disorder Scale-Short Form (IGDS9-SF) and a slightly modified version of the Internet Use Expectancies Scale (IUES). The results corroborate the negative effects of need frustration on IGD among mobile gamers and clarify the role of time spent playing and game-use expectancies in the development of IGD, highlighting the important role of cognitions in this relationship. We conclude that both the time spent playing and game-use expectancies should be important targets for clinical interventions, even though they are not included in the diagnostic criteria.

Validity, functional impairment and complications related to Internet gaming disorder in the DSM-5 and gaming disorder in the ICD-11

BACKGROUND

Many concerns have been raised regarding the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria for Internet gaming disorder and International Classification of Diseases, 11th Revision (ICD-11) criteria for gaming disorder.

AIMS

In this study, we demonstrated the diagnostic validity of each criterion for Internet gaming disorder in the DSM-5 in terms of their intensity and frequency thresholds and evaluated functional impairments, unhealthy behaviors and complications among adults with Internet gaming disorder and gaming disorder.

METHODS

We recruited 69 subjects with Internet gaming disorder, 69 regular gamers and 69 controls without regular gaming based on diagnostic interviewing conducted by a psychiatrist according to the DSM-5 Internet gaming disorder criteria.

RESULTS

Except for the 'deceiving' and 'escapism' criteria, all criteria for Internet gaming disorder had a diagnostic accuracy ranging from 84.7% to 93.5% in differentiating between adults with Internet gaming disorder and regular gamers. A total of 44 participants with Internet gaming disorder (63.8%) fulfilled the gaming disorder criteria. In addition, 89% and 100% of the Internet gaming disorder and gaming disorder groups, respectively, had academic, occupational or social functional impairment. Both the Internet gaming disorder and gaming disorder groups had higher rates of delayed sleep phase syndrome and insomnia. The gaming disorder group also had a higher obesity proportion.

CONCLUSION

The 'deceiving' and 'escapism' criteria had relatively lower diagnostic accuracy. Both the Internet gaming disorder and gaming disorder groups demonstrated functional impairments and unhealthy behaviors. They also exhibited complications, such as obesity and sleep disorders. These results support the utility of the DSM-5 Internet gaming disorder and ICD-11 gaming disorder criteria in identifying individuals who need treatment for both gaming addiction symptoms and complications resulting from the addiction.

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.

Early-Life Interpersonal and Affective Risk Factors for Pathological Gaming

Internet gaming is among the most popular entertainment options, worldwide; however, a considerable proportion of gamers show symptoms of pathological gaming. Internet gaming disorder (IGD) has been proposed to describe a behavioral addiction, which shares many similarities, both physical and psychological, with substance use disorder. Environmental factors, such as interpersonal and relationship dynamics during childhood and adolescence, have been suggested to modulate the onset and trajectories of IGD. However, studies exploring the contributions of dysfunctional family environments to the development of IGD remain limited. This minireview aims to offer an overview of the current knowledge regarding the impacts of early-life interpersonal and relationship dynamics on the development of IGD and to provide a snapshot of the current state of the literature in this field. Specifically, it underlines the modulatory role of early-life relational factors such as a) family function, b) parent-child relationships, c) childhood maltreatment, and d) bullying and cyberbullying on the development of IGD. Consistent with this evidence, therapeutic interventions that aim to "restructure" the emotional ties and familiar dynamics that are known to be associated with dysfunctional behaviors and feelings, and likely promote pathological gaming, are recognized as the most successful clinical therapeutic approaches for IGD.

A descriptive survey of online gaming characteristics and gaming disorder in Ireland

Objectives

The aim of this study was to carry out the first ever study of gaming characteristics of individuals engaging in online gaming in Ireland and to ascertain whether features of gaming disorder are present in this population.

Methods

An online survey (comprising 21 questions – 3 demographic questions and 18 questions related to gaming and gaming disorder) was distributed on numerous Irish online gaming forums and Irish online gaming communities. Participants were self-selected and invited to compete the online survey containing questions related to gaming behaviours (age of onset, hours played on weekdays/weekends, type of device used), mobile gaming, motives for online gaming, use of microtransactions, engagement in esports, and a screening tool for the presence of gaming disorder.

Results

A total of 166 participants engaged in the online survey. Among this study population of regular gamers in Ireland, 2.4% of the study population were classified as having gaming disorder, with up to 5.4% showing some evidence of disordered gaming. The main motivation for online gaming in the non-disordered gaming group was recreation (13.3, sd = 2.7) but only the fourth main motivation in the disordered gaming group behind competition (16.3, sd = 3.7), escape (16.2, sd = 4.3), and coping (15.1, sd = 3.7). Increased hours of gameplay on weekdays and weekends were noted in the disordered gaming group compared to non-disordered gamers.

Conclusions

A small percentage of gamers in Ireland demonstrate disordered gaming characteristics and gaming disorder, consistent with data from other international studies. Epidemiological studies are required in Ireland to enhance our knowledge of this disorder.

Maladaptive player-game relationships in problematic gaming and gaming disorder: A systematic review

While certain player vulnerabilities are known to increase risk of gaming disorder (GD), the topic of maladaptive player × game relationships in GD has received limited attention. This review aimed to: (1) identify game types associated with GD symptomatology; and (2) evaluate individual differences (e.g., age, personality, depression) in the relationship between gaming and GD symptomatology. A systematic review of six databases identified 23 studies of the relations between game types and GD, including 13 studies employing multivariate analyses. Player vulnerabilities implicated in GD included impulsivity, risk-taking, psychopathological symptoms (e.g., depression, anxiety), and stronger gaming motivations (e.g., escapism, achievement). MMORPG involvement had the strongest positive association with GD. Problematic MMORPG players tend to have a socially anxious profile and may be attracted to the work-like roles and conventions of this genre. Problematic players of shooters tend to score higher on measures of sensation-seeking and impulsivity than other players. These findings suggest that GD may develop more readily and at more severe levels in complex, endless, socially driven games, irrespective of person-level characteristics. Some player vulnerabilities may selectively increase risk of GD for certain game types. Further research should investigate different player-game interactions to refine current models and interventions for GD.

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.

Gender-related differences in cue-elicited cravings in Internet gaming disorder: The effects of deprivation

BACKGROUND

Online gaming has become a popular leisure activity, in which males more frequently develop Internet gaming disorder (IGD) compared to females. However, gender-related neurocognitive differences have largely not been systematically investigated in IGD.

METHODS

Cue-elicited-craving tasks were performed before game playing and immediately after deprivation operationalized as a forced break from gaming when the Internet was disconnected. Ninety-nine subjects with IGD (27 males and 22 females) or recreational game use (RGU; 27 males and 23 females) provided functional MRI and subjective data. Analyses investigating effects of group (IGD and RGU) × gender (male and female) at different times (pre-gaming, post-gaming, and post-pre) on cue-elicited craving and brain responses were performed. Correlations between brain responses and subjective measures were calculated.

RESULTS

In pre-, post-, and post-pre tests, significant gender-by-group interactions (p < .001, cluster size > 15 voxels) were observed in the left dorsolateral prefrontal cortex (DLPFC). Further analyses of the DLPFC cluster showed that in post-pre comparisons, results were related to less engagement of the DLPFC in IGD, especially in females. In addition, at post-test, significant interactions were observed in the caudate, as females with IGD showed greater activation as compared to those with RGU.

DISCUSSION

The results raise the possibility that women with RGU may show better executive control than men when facing gaming cues, which may provide resiliency against developing IGD; however, once they develop IGD, their gaming may impair their executive control and enhance their cravings for gaming, which may make it more difficult to quit gaming.