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

Scoping review of withdrawal's role in contemporary gaming disorder research: Conceptualizations and operationalizations

The global gaming community now exceeds 3 billion players, prompting increased attention from social and medical sciences regarding gaming-related disorders. Internet Gaming Disorder (IGD) was incorporated into DSM-5 in 2013, and Gaming Disorder (GD) found its place in ICD-11 in 2019. A contentious criterion in IGD, not present in GD, revolves around withdrawal symptoms. This paper offers a theoretical foundation on gaming withdrawal symptoms in gaming-related disorders and conducts a scoping review of withdrawal operationalization and conceptualization in 40 selected studies, following PRISMA-ScR guidelines. Most studies employed a correlation framework, relying on convenience samples and self-assessment questionnaires. A smaller portion focused on clinical samples and case studies. Withdrawal was predominantly conceptualized in terms of affective components, with less emphasis on behavioural, cognitive, physical, or neurological aspects. The prevailing terminology for gaming-related disorders was IGD, with only three studies referencing GD as defined in ICD-11. Notably, just six experimental studies included abstinence control. We advocate for an expansion of research on withdrawal symptoms, particularly through experimental studies that implement abstinence within experimental groups and offer alternative operationalizations beyond dominant self-assessment measures.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

Gaming Disorder: The role of a gamers flow profile

Digital games are widely popular and integral to contemporary entertainment. Nevertheless, a proportion of users present with disordered/excessive gaming behaviours, provisionally classified as Internet Gaming Disorder (IGD). Previous literature suggests examining the contribution of an individual's profile of immersive engagement with their gaming activity, known as online flow, for disordered gaming behaviours. Therefore, the main goals of this study were (1) to categorise gamers into distinct profiles based on their online flow experiences and (2) to investigate the differences in disordered gaming among these different flow profiles. A sample of 565 gamers (12-68 years, Mage = 29.3 years) was assessed twice over six months with the Online Flow Questionnaire (OFQ), the Internet Gaming Disorder Scale-Short-Form (IGDS9-SF), and the Gaming Disorder Test (GDT). Latent profile analysis (LPA) identified five distinct profiles encompassing 'High-Flow with High Loss of Control' (HF-HLOC; 14.0 %), 'Low Flow with Low Enjoyment' (LF-LE; 11.9 %), 'Average Flow with Low Enjoyment' (AF-LE; 17.5 %), 'Low Flow with High Enjoyment' (LF-HE; 20.2 %), and 'High Loss of Sense of Time with Low Loss of Control' groups (HLOT-LLOC; 36.5 %). As hypothesised, individuals across varying profiles evidenced differences in their concurrent and longitudinal disordered gaming behaviours. Overall, findings suggest that 'loss of sense of time' may be the most pivotal factor in differentiating flow states and profiles during gaming, advocating its consideration in disordered gaming assessment and treatment.

Meta-Analysis of Internet Gaming Disorder Prevalence: Assessing the Impacts of DSM-5 and ICD-11 Diagnostic Criteria

With the inclusion of Internet gaming disorder (IGD) in both the DSM-5 and ICD-11, understanding the prevalence and diagnostic discrepancies is crucial for developing appropriate interventions. This study presents a meta-analysis of the prevalence of IGD based on two diagnostic criteria. We systematically searched the PubMed and Web of Science databases. A total of 22 studies were included in the final analysis. The analysis incorporated studies employing the DSM-5 and ICD-11 criteria and focused on the impact of various factors, including study location, sample characteristics, sample size, and quality score, on the reported prevalence rates using a random-effects model. The pooled prevalence of IGD is 6.7% (95% CI: 5.7-7.7%). The subgroup analysis indicated significant differences in the prevalence rates of IGD (DSM-5 criteria) and GD (ICD-11 criteria) (Q b = 38.46, p < 0.01). There were also significant differences in IGD prevalence rates between different scales (Q b = 54.23, p < 0.001). Our findings indicate that different diagnostic criteria and different assessment scales have a significant impact on the prevalence of IGD. This underscores the importance of adopting standardized methodologies to guide public health interventions. However, given the limited research based on ICD-11 diagnostic criteria, further investigation is necessary to determine the variations in prevalence rates of IGD under different diagnostic standards.

Internet gaming disorder and psychological well-being among university students in Egypt

BACKGROUND

Internet gaming disorder (IGD) is a serious rising problem affecting people of all ages. Many researchers reported that students' addictive gaming behavior resulted in the loss of function and the development of psychological problems. In this study, we aimed mainly to measure the prevalence of internet gaming disorder among Mansoura University students and find its relationship with psychological well-being.

METHODS

A cross-sectional observational study was carried out during the academic year (2021-2022) at the University of Mansoura. Students from four different faculties were included. Participants ages ranged from 18 to 25 years old. An online Google Form questionnaire gathering the tools (questionnaire of demographic and clinical data, Internet Gaming Disorder Short Form scale, Ryff's scale of psychological well-being) was distributed among them.

RESULTS

In this study, 870 students were included. The age range was 18-25 years. They were divided into three groups: 315 normal gamers (36%), 500 risky gamers (58%), and 55 disordered gamers (6%), with no significant gender difference in each group (p-value = 0.138). A negative correlation was found between IGD and psychological well-being (r = -0.303).

CONCLUSIONS

The prevalence of IGD was 6% among Mansoura University students. Participants in the theoretical faculties who started playing internet gaming at a younger age and spent more than 2 h per week playing and more than 3 h per week thinking about playing internet games were more likely to develop IGD. Whenever IGD scores increased, psychological well-being scores were found to decrease (r = -0.303).

Translation and Validation of the Gaming Disorder Test and Gaming Disorder Scale for Adolescents into Chinese for Taiwanese Young Adults

PURPOSE

To translate and cross-culturally adapt the Gaming Disorder Test (GDT) and Gaming Disorder Scale for Adolescents (GADIS-A) for use in Taiwan and to validate their internal consistency, construct validity, measurement invariance, and convergent validity in Taiwanese young adults.

METHODS

The GDT and GADIS-A were translated into traditional (unsimplified) Chinese characters and culturally adapted according to standard guidelines. A sample of 608 Taiwanese university students were recruited online. All participants completed the GDT, GADIS-A, Internet Gaming Disorder Scale - Short Form (IGDS9-SF), and Depression Anxiety Stress Scale-21 (DASS-21). Internal consistency was assessed using Cronbach's α and McDonald's ω. Factor structure was examined using Confirmatory Factor Analysis (CFA). Measurement invariance in gender was assessed by three nested models in CFA. Convergent validity was determined by calculating Pearson's r among the GDT, GADIS-A, IGDS9-SF, and DASS-21.

RESULTS

The GDT and GADIS-A showed adequate internal consistency (both α and ω = 0.90). The CFA results supported a one-factor structure for the GDT and a two-factor structure for the GADIS-A. Measurement invariance across gender was supported for both the GDT and GADIS-A. The convergent validity of the GDT and GADIS-A were acceptable.

CONCLUSIONS

The Chinese versions of the GDT and GADIS-A are valid and reliable tools that can be used to assess gaming disorder in Taiwanese young adults. Measurement invariance across genders was supported for both tools. The convergent validity of the GDT and GADIS-A were also satisfactory.

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.

Which is more stable and specific: DSM-5 internet gaming disorder or ICD-11 gaming disorder? A longitudinal study

AIM

The high comorbidity rates of internet gaming disorder (IGD) and gaming disorder (GD) with other psychiatric disorders are concerning. A follow-up study of gamers from clinical and nonclinical samples with and without diagnoses of IGD or GD was conducted to investigate the changes in diagnoses over a 1-year period, compare their diagnostic stability, and examine the patterns of co-occurrence between IGD and GD with other psychiatric disorders over the same period.

METHODS

Baseline and 1-year follow-up data of 279 participants, including 120 problematic gaming patients and 159 gamers from the general population, were analyzed. Information on demographics, gaming habits, and self-reported psychological status was collected. Additionally, a structured interview was conducted using the Gaming Diagnostic Interview and the Mini-International Neuropsychiatric Interview.

RESULTS

Although there was no significant difference between the changes in IGD/GD diagnosis during the 1-year period, 34.7% of the participants had a change in IGD diagnosis, while the number of GD cases increased to 60.4%. When evaluating the fixed effects of comorbidity on IGD and GD, attention-deficit/hyperactivity disorder had the highest odds ratio for both IGD (75.23; 95% confidence interval [CI], 10.67-530.61) and GD (117.02 × 10⁶ ; 95% CI, 2.23 × 10⁶ -6132.64 × 10⁶ ).

CONCLUSION

These results reveal that a GD diagnosis might be more prone to change than an IGD diagnosis. GD was also found to be more affected by comorbid psychiatric disorders.

A network analysis of the Internet Disorder Scale-Short Form (IDS9-SF): A large-scale cross-cultural study in Iran, Pakistan, and Bangladesh

The Internet Disorder Scale-Short Form (IDS9-SF) is a validated instrument assessing internet disorder which modified the internet gaming disorder criteria proposed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, the relationships between the nine items in the IDS9-SF are rarely investigated. The present study used network analysis to investigate the features of the IDS9-SF among three populations in Bangladesh, Iran, and Pakistan. Data were collected (N = 1901; 957 [50.3%] females; 666 [35.0%] Pakistani, 533 [28.1%] Bangladesh, and 702 [36.9%] Iranians) using an online survey platform (e.g., Google Forms). All the participants completed the IDS9-SF. The central-stability-coefficients of the nine IDS9-SF items were 0.71, 0.89, 0.96, 0.98, 0.98, 1.00, 0.67, 0.79, and 0.91, respectively. The node centrality was stable and interpretable in the network. The Network Comparison Test (NCT) showed that the network structure had no significant differences among Pakistani, Bangladeshi, and Iranian participants (p-values = 0.172 to 0.371). Researchers may also use the IDS9-SF to estimate underlying internet addiction for their target participants and further explore and investigate the phenomenon related to internet addiction.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03284-8.

Network analyses of internet gaming disorder symptoms and their links with different types of motivation

The study used regularized partial correlation network analysis (EBICglasso) to examine the structure of DSM-5 internet gaming disorder (IGD) symptoms (network 1); and the associations of the IGD symptoms in the network with different types of motivation as defined in the self-determination theory i.e., intrinsic motivation (engaging in an activity for something unrelated to the activity), identified regulation (engaging in the activity because it aligns with one's values and/or goals), external regulation (engagement in activity being driven by external rewards and/or approval), and amotivation (engaging in an activity without often understanding why) (network 2). Participants were 968 adults from the general community. They completed self-rating questionnaires covering IGD symptoms and different types of motivation. The findings for network 1 showed mostly positive connections between the symptoms within the IGD network. The most central symptom was loss of control, followed by continuation, withdrawal symptoms, and tolerance. In general, these symptoms were more strongly connected with each other than with the rest of the IGD symptoms. The findings for network 2 showed that the different types of motivation were connected differently with the different IGD symptoms. For instance, the likeliest motivation for the preoccupation and escape symptoms is intrinsic motivation, and for negative consequences, it is low identified regulation. Overall, the findings showed a novel understanding of the structure of the IGD symptoms, and the motivations underlying them. The clinical implications of the findings for assessment and treatment of IGD are discussed.

Is the proposed distinction of gaming disorder into a predominantly online vs. offline form meaningful? Empirical evidence from a large German speaking gamer sample

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Disordered gaming is distinguished by predominantly online, offline, and unspecific gaming.

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Online gamers showed the highest tendencies towards disordered gaming.

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Gaming via desktop computers was linked with the highest disordered gaming levels.

In the eleventh revision of the International Classification of Diseases (ICD-11), Gaming Disorder (GD) is distinguished between disordered gaming occurring predominantly online, offline, and unspecified. Currently, no study has investigated whether such a distinction is meaningful in diagnosing disordered gaming. Therefore, a large group of gamers with varied tendencies towards disordered gaming was recruited to examine this issue. A large sample (N = 2,768) was recruited and data were collected on disordered gaming, along with information on their preferred gaming mode and device used to play. The present study shows that the distinction between online and offline gaming mode proposed by the WHO is meaningful because online gamers presented with the highest disordered gaming scores followed by mixed gamers (those stating to equally prefer online and offline gaming), and offline gamers. Finally, it was also observed that the type of device for gaming used associated with disordered gaming levels. Specifically, those reporting mostly to use their desktop computer for gaming showed the highest disordered gaming scores. The present study lends empirical support for the consideration of both gaming mode and gaming device in the study of disordered gaming.

Internet Gaming Disorder in adolescence: investigating profiles and associated risk factors

Background

Electronic gaming is a popular free-time activity and its deleterious effects have been considered by the American Psychiatric Association and World Health Organization. More recently ‘Gaming Disorder’ (GD) has been added to the 11^th revision of the International Classification of Diseases, while ‘Internet Gaming Disorder’ (IGD) remains as a tentative disorder in the 5^th revision of the Diagnostic and Statistical Manual of Mental Disorders. This study aimed to explore the characteristics of young gamers at risk for developing IGD.

Methods

To achieve this, a quantitative and nationally representative study was conducted in primary schools in Slovenia with eighth grade as the primary sampling unit (N = 1071, Mean_age = 13.44 years, SD_age = 0.59). Psychometric testing assessing IGD was conducted to identify participants’ IGD risk levels and to compare ‘high risk gamers’, ‘low risk gamers’, and ‘non-gamers’ in relation to free-time activities, self-control, and parent-child relationship. A one-way ANOVA analysis was conducted with Games-Howell post-hoc test to compare the three groups of participants. Statistically significant IGD factors were then included in a multinomial logistic regression analysis to identify the most relevant predictors of IGD.

Results

About 4.7% (n = 48) [95% CI: 3.4–6.0%] of Slovenian adolescents were found to be ‘high risk gamers’ when considering risk of IGD. These were mostly males (n = 42, 87.5%), and their preferred leisure activities involved more screen time activities (e.g., watching TV, playing video games, using social media). Moreover, ‘high risk gamers’ showed significantly lower levels of self-control compared to ‘low risk gamers’, and poorer understanding with their parents. Perceived satisfaction with life and mental health did not differ significantly between the three groups. The multinomial logistic regression identified four key predictors of IGD: male gender, gaming as a frequent free-time activity, attending music school or a choir and self-control.

Conclusion

Public health measures should target adolescents at increased risk of developing IGD in early age because they are particularly drawn to excessive gaming behaviors and present greater IGD vulnerability.

Internet Gaming Disorder profiles and their associations with social engagement behaviours

Internet Gaming Disorder (IGD), describes the abuse of Internet games with detrimental impact to the real-life social engagement of some gamers. Indeed, evidence suggests that gamers differ on the severity and way in which they express IGD symptoms, as well as their social engagement behaviours. The present study aimed to: a) profile gamers regarding their experience of IGD symptoms and; b) examine how different IGD profiles varied on social engagement behaviours.

METHODS

A sample consisting of 1032 gamers (18-72 years, Mage = 24) was assessed with the Internet Gaming Disorder Scale 9 Items Short Form (IGDS9-SF) and social engagement questions regarding their participation in employment, education, romantic relationships and living status.

RESULTS

Latent class analyses (LCA) resulted in 4 distinct IGD classes. These entailed 'IGD aversive' (11.5%), 'Normative' (47.9%), 'Moderate IGD risk' (31.2%) and 'High IGD risk' (9.4%) gamers. The high IGD risk profile linked with higher unemployment, lower level of education and tended to live with divorced parents, friends and/or had transient accommodation.

CONCLUSION

Findings suggest that there are different IGD profiles driven by symptom severity, whilst gamers higher on IGD risk present with lower social engagement signs. Thus, social engagement and participation should be particularly targeted by IGD immunization and treatment protocols.

The Persian Version of the COVID-19 Phobia Scale (Persian-C19P-S) and the Differences in COVID-19-Related Phobic Reactions in Patients with Anxiety Disorders

Coronavirus disease 2019 (COVID-19) is a pandemic outbreak increasing several psychological distress, such as anxiety and phobia, and may affect patients with anxiety disorders. A scale has been recently designed to assess COVID-19-related phobic reactions named the COVID-19 Phobia Scale (C19P-S). The present study aimed to evaluate factor structure, reliability, and validity of the Persian version of the C19P-S (Persian-C19P-S) in patients with anxiety disorders and to compare COVID-19-related phobia among these patients. Three hundred patients with anxiety disorders completed the Persian-C19P-S and other scales assessing anxiety traits (e.g., the Short Health Anxiety Inventory (SHAI), the Health Concerns Questionnaire-54 (HCQ-54), and the Patient Health Questionnaire-4 (PHQ-4)) and COVID-19-related distress (e.g., the COVID Stress Scales (CSS) and the Fear of COVID-19 Scale (FCV-19)). The results showed that the Persian-C19P-S replicated the four-factor structure of the original C19P-S. Internal consistency and test-retest reliability coefficients evidenced the reliability of the scale. The validity of the scale (convergent and discriminant validity) was confirmed. Patients who had generalized anxiety and panic disorders showed higher phobic reactions related to COVID-19 than those with social anxiety disorder and specific phobia. This study indicates that the Persian version of the C19P-S is a valid scale to be used in Iranian patients with anxiety disorders to evaluate COVID-19-related phobia. Moreover, COVID-19-related phobic reactions are higher in some specific types of anxiety disorders.

In search of the optimum structural model for Internet Gaming Disorder

BACKGROUND

Internet gaming Disorder (IGD) constitutes a recently proposed clinical disorder (American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 2013). The present study examined if IGD is best conceptualized as categorical (present/absent), or dimensional (severity ranging from low to high), or both (i.e., hybrid of categorical/dimensional).

METHODS

Ratings of the nine DSM-5 IGD symptoms, as presented in the Internet Gaming Disorder Scale 9-Short Form (Pontes & Griffiths, Comput Hum Behav 45:137-143, 2015), from 738 gamers, aged 17 to 72 years, were collected. Confirmatory factor analysis (CFA), latent class analysis (LCA), and factor mixture modelling analysis (FMMA) procedures were applied to determine the optimum IGD model.

RESULTS

Although the findings showed most support for a FFMA model with two classes and one factor, there was also good statistical and substantive support for the one-factor CFA model, and the LCA model with three classes.

CONCLUSION

It was concluded that while the optimum structure of IGD is most likely to be a hybrid model (i.e., concurrently categorical and dimensional), a uni-dimensional model and/or a three-class categorical model are also plausible.

Measurement, Profiles, Prevalence, and Psychological Risk Factors of Problematic Gaming Among the Turkish Community: A Large-scale National Study

The present study investigated the prevalence, the potential different profiles, and the associated psychological factors of disordered gaming using data from a large-scale epidemiological study (TURBAHAR [Turkey’s Addiction and Mental Health Risk Profile Map Project]) carried out in Turkey in 2018 with 24,494 participants aged 18–81 years. Participants completed a comprehensive survey comprising a demographic questionnaire, Gaming Addiction Risk Questionnaire, Brief Symptom Inventory, Personal Well-Being Index Adult Form, Positive and Negative Affect Schedule, Toronto Alexithymia Scale, and Experiences in Close Relationships-Revised Scale. Latent class analysis showed the existence of eight different game profiles, which differed in relation to the intensity and specific features of the behavior. Results showed that 1.6% of the participants were problematic gamers. Being male, being younger, lower education level, being single, using alcohol and cigarettes, psychiatric distress, positive and negative affect, and anxious adult attachment were positively associated with problematic gaming.