Is (Disordered) Social Networking Sites Usage a Risk Factor for Dysfunctional Eating and Exercise Behavior?

BACKGROUND

Research over the past years has shown that exposure to thin and beauty ideals in the media can be associated with disordered eating and related variables. Nowadays, interactive media, such as social networking sites, have gained growing popularity and represent a major part of people's lives. It is therefore crucial to investigate how far users might be negatively influenced by social networking sites regarding eating pathology or excessive exercise behavior and if there are particular links to social media use disorder.

METHODS

Data were collected by an online-survey encompassing questions on regular social networking site use, eating disorders, and excessive exercise behavior.

RESULTS

Analyses showed that disordered social networking sites use was significantly related to eating pathology and a poorer body image in men and women. The frequency of active or passive social networking sites usage however was not associated with exercise behavior.

CONCLUSIONS

Our results confirm that disordered social networking sites use represents a risk factor for body image dissatisfaction and associated eating disorders.

The impact of life satisfaction in the treatment of gaming disorder and other internet use disorders: Results from a randomized controlled trial

OBJECTIVE

According to ICD-11 gaming disorder is currently defined as a behavioral addiction. While our understanding of crucial aspects of this new condition including other subtypes of internet use disorders is growing, less is known about treatment strategies and their effectiveness. Particularly, dimensions of life satisfaction and their meaning for internet use disorders are poorly investigated. The aim of this study was addressing the role of life satisfaction dimensions in a randomized controlled trial. We examined life satisfaction as an additional treatment outcome and investigated in how far life satisfaction is predictive for symptom reduction and related to personality traits.

METHODS

A multicenter randomized controlled trial with three measure points (baseline, post-treatment, 6-month follow-up) was conducted based on N = 143 patients aged 17 and above meeting diagnostic criteria for internet use disorders. A cognitive-behavioral disorder specific intervention was applied in n = 72 and compared to a wait list control (n = 71). Endpoints included symptoms of internet use disorders, psychosocial functioning, and life satisfaction. Personality traits were assessed as moderating factors.

RESULTS

Life satisfaction (η2 = 0.106) and health satisfaction (η2 = 0.173) significantly increased in the intervention group with large effect sizes. Decreasing symptoms of internet use disorders at follow-up were predicted by life satisfaction at post-treatment (ß = -0.51) with extraversion (B = 1.606) and openness (B = 2.069) moderating this association.

CONCLUSION

Life satisfaction yields additional value as a secondary treatment outcome in internet use disorders and can be therapeutically addressed in order to stabilize treatment effects in the long run. Our study indicates that existing treatment strategies might benefit from explicitly addressing and enhancing psychosocial resources in order to prevent relapses in patients.

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.

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.

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.

Prävalenz von Internetsucht vor und während der COVID-19 Pandemie unter Studierenden der Johannes Gutenberg-Universität Mainz

Ziel der Studie Internetsucht ist eine Verhaltensstörung, von welcher v. a. Jugendliche und junge Erwachsene, unter ihnen auch Studierende an Hochschulen betroffen sind. Die COVID-19 Pandemie führte aufgrund der Maßnahmen zu ihrer Eindämmung zu starken Einbußen sozialer Beziehungen, Studium und Freizeitaktivitäten der Studierenden. Diese Studie untersuchte, wie hoch die Prävalenz der Internetsucht unter Studierenden vor und während der COVID-19 Pandemie ausfällt und welche soziodemografischen (Geschlecht, Fachgruppe) und Gesundheitsfaktoren (Depressionssymptome, Einsamkeit, Ängste, Impulsivität) mit Internetsuchtsymptomen assoziiert sind.

Methodik In der vorliegenden Studie nahmen 2 Stichproben der Studierenden der Johannes Gutenberg-Universität Mainz im Sommer 2019 (N=4351) vor und im Sommer 2020 (N=3066) während der COVID-19 Pandemie im Rahmen des Modellvorhabens „Healthy Campus Mainz-gesund studieren“ zur Prävention und Gesundheitsförderung zu verschiedenen Gesundheitsthemen und Studienbedingungen an Online-Umfragen teil. Es wurde die Prävalenz von Internetsucht erhoben und mittels logistischer Regression Zusammenhänge mit Geschlecht, Depressionssymptomen, Einsamkeit, Ängsten und Impulsivität analysiert.

Ergebnisse Die Prävalenz der Internetsucht lag 2019 bei 3,9% und lag 2020 signifikant höher bei 7,8%. Während 2019 männliches Geschlecht noch mit Internetsucht assoziiert war (OR2019=0,685, p<0,05), konnten 2020 keine Geschlechtsunterschiede mehr festgestellt werden. Sowohl vor als auch während der Pandemie gingen Depressionssymptome (OR2019=1,121, p<0,001; OR2020=1,175, p<0,001) und Einsamkeit (OR2019=1,121, p<0,001; OR2020=1,071, p<0,05) mit Internetsucht einher, während der Pandemie auch Angstgefühle (OR2020=1,156, p<0,05).

Schlussfolgerung Studierende stellen eine gefährdete Gruppe für Internetsucht dar. Während der COVID-19 Pandemie trat die Symptomatik deutlich häufiger auf als noch ein Jahr zuvor. Es müssen unbedingt geeignete Präventions- und Interventionsangebote für Studierende implementiert werden, die sowohl Internetsucht, aber auch damit einhergehende Probleme wie Depression und Einsamkeit in den Blick nehmen.

Vereinheitlichung der Bezeichnungen für Verhaltenssüchte

Zusammenfassung. Fragestellung: Es existiert eine Vielzahl von Begriffen für Verhaltenssüchte, die Mängel in Operationalisierung, Bezug zum Verhalten, Kompatibilität mit internationalen Klassifikationen sowie nicht stigmatisierender Nutzung aufweisen. Daher werden einheitliche Begriffe für Verhaltenssüchte benötigt. Methode: Im Rahmen einer Leitlinie zur Diagnostik und Behandlung Internetbezogener Störungen wurden Lösungen in Form eines Expertenkonsens entwickelt. Ergebnisse: Als Grundlage wurde die Einteilung von Verhaltenssüchten in der 11. Revision der International Classification of Diseases (ICD-11) genutzt. Es wurden die Begriffe Computerspielstörung (CSS) und Glücksspielstörung (GSS) für die beiden in ICD-11 enthaltenen Verhaltenssüchte gewählt sowie drei weitere spezifizierte Verhaltenssüchte vorgeschlagen: Soziale-Netzwerke-Nutzungsstörung (SNS), Shoppingstörung (ShS) und Pornografie-Nutzungsstörung (PNS). Für CSS, GSS und ShS wird weiterhin zwischen vorwiegend online oder vorwiegend offline unterschieden. Als Oberbegriff wird Störungen aufgrund von Verhaltenssüchten vorgeschlagen. Für Störungen aufgrund von Verhaltenssüchten, die sich vorwiegend auf online ausgeübte Verhaltensweisen beziehen, kann alternativ der Oberbegriff Internetnutzungsstörungen verwendet werden. Schlussfolgerung: Die vorgeschlagenen Termini weisen Verbesserungen im Vergleich zu uneindeutigen oder aus anderen Gründen ungünstigen Begriffen dar. Gleichzeitig konnte eine Kompatibilität mit der ICD-11 ermöglicht werden.

[Undiagnosed Internet-Related Disorder in the Psychotherapeutic Care System: Prevalence and Gender-Specific Characteristics]

OBJECTIVE

Internet-related disorders (IRD) are characterized by uncontrolled use of various Internet applications, which is associated with impairments in various sections and an increased rate of other forms of mental illness. The aim was to identify undiagnosed comorbid IRD and to examine gender-specific differences.

METHODS

In 19 psychotherapeutic institutions 501 patients (65.3 % women) were recruited.

RESULTS

Comorbid IRD was found in 20.7 % of men and 15.9 % of women. IBS was not identified by the practitioners in 94.6 % of women and 66.6 % of men. In particular affective disorders and substance-related addiction occurred very frequently and regardless of gender. Women were significantly more often affected by eating and personality disorders, men were significantly more often affected by pathological gambling.

CONCLUSION

A high rate of IBS remains undetected in the psychotherapeutic care system. Women with IBS have other referral diagnoses and are more often affected by severe mental disorders than men.

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.

The relationship between acculturation and mental health of 1st generation immigrant youth in a representative school survey: does gender matter?

BACKGROUND

Although gender plays a pivotal role in the psychological adaptation of immigrant youth, its association with acculturation strategy and mental health among 1st generation immigrant adolescents are still scarce and inconsistent. Therefore, the purpose of the current study was to investigate gender-related differences in acculturation patterns and their association with mental health (internalizing and externalizing problems).

METHODS

Self-reported data of immigrant adolescents (N = 440) aged between 12 and 19 years (M = 16.2; SD = 1.6) was collected in a representative German school survey. Fifty-one percent of the sample were female (n = 224). Almost half of the sample was born in the Former Soviet Union, followed by Poland (9.3%). Sociodemographic variables, acculturation strategies, and internalizing as well as externalizing problems were assessed by questionnaires.

RESULTS

Confirmatory factor analysis supported the four- dimensional model of acculturation styles (assimilation, integration, separation and marginalization). Whereas girls more often showed an integration pattern, boys scored higher on the separation and marginalization scale. After adjusting for age and educational level, regression analyses revealed for both gender that marginalization was associated with more internalizing problems. Separation was related to more externalizing problems.

CONCLUSION

1st generation adolescents experiencing a lack of belongingness to German society, socio-economic and educational disadvantages might be particularly vulnerable to mental distress. Findings are discussed in terms of gender-related differential socialization processes in context of immigration.

Prä-klinische Ansätze der Computerspiel- und Internetsucht: Schulbasierte Präventionsansätze, Medientraining und eine Empfehlung für finanzielle Obergrenzen bei In-Game-Käufen (MIRPPU)

Ausgewählte Beiträge eines internationalen Reviews zu schulbasierten Präventionsansätzen werden vorgestellt. Aufgrund ihrer Wirksamkeit werden 2 internationale Ansätze dargestellt. Ergänzend werden 5 z.T. evaluierte Ansätze des deutschen Sprachraumes beschrieben.

Um einer subklinisch exzessiven Nutzungsgruppe ein benötigtes präventives Angebot zur Verfügung zu stellen, wurde von der Ambulanz für Spielsucht Mainz ein Medientraining konzipiert. Dieser verhaltenstherapeutische Präventionsansatz wird konzeptuell und mit seinen ersten Pilotergebnissen abgebildet. Beim Medientraining handelt es sich um eine gruppentherapeutische Frühintervention für Kinder und Jugendlichen mit problematischer Computerspiel- und Internetnutzung im Alter von 12–17 Jahren. Das prä-klinische Medientraining erweist sich als effektive Präventionsmaßnahme, denn es wurde eine deutliche Reduktion der Nutzungszeiten unter der Woche und am Wochenende erwirkt. Es kam zu Verbesserungen der Bewertung der Zukunftsperspektiven, einer Steigerung des Problemverständnis, einer Identifikation individueller suchtauslösender Faktoren, einer Verbesserung der familiären als auch schulischen Situation sowie zu einer Verbesserung der seelischen und körperlichen Situation.

Strukturelle präventive Maßnahmen wie politische Regulationen des Jugendschutzes sollten weiter diskutiert und auf ihre Umsetzbarkeit hin überprüft werden. Eine Anregung dazu sind altersadäquate finanzielle Obergrenzen für Mikrotransaktionen (MIRPPU; Maximum Individual Revenue Per Paying User per month).

Efficacy of Short-term Treatment of Internet and Computer Game Addiction: A Randomized Clinical Trial

IMPORTANCE

Internet and computer game addiction represent a growing mental health concern, acknowledged by the World Health Organization.

OBJECTIVE

To determine whether manualized cognitive behavioral therapy (CBT), using short-term treatment for internet and computer game addiction (STICA), is efficient in individuals experiencing internet and computer game addiction.

DESIGN, SETTING, AND PARTICIPANTS

A multicenter randomized clinical trial was conducted in 4 outpatient clinics in Germany and Austria from January 24, 2012, to June 14, 2017, including follow-ups. Blinded measurements were conducted. A consecutive sample of 143 men was randomized to the treatment group (STICA; n = 72) or wait-list control (WLC) group (n = 71). Main inclusion criteria were male sex and internet addiction as the primary diagnosis. The STICA group had an additional 6-month follow-up (n = 36). Data were analyzed from November 2018 to March 2019.

INTERVENTIONS

The manualized CBT program aimed to recover functional internet use. The program consisted of 15 weekly group and up to 8 two-week individual sessions.

MAIN OUTCOMES AND MEASURES

The predefined primary outcome was the Assessment of Internet and Computer Game Addiction Self-report (AICA-S). Secondary outcomes were self-reported internet addiction symptoms, time spent online on weekdays, psychosocial functioning, and depression.

RESULTS

A total of 143 men (mean [SD] age, 26.2 [7.8] years) were analyzed based on intent-to-treat analyses. Of these participants, 50 of 72 men (69.4%) in the STICA group showed remission vs 17 of 71 men (23.9%) in the WLC group. In logistic regression analysis, remission in the STICA vs WLC group was higher (odds ratio, 10.10; 95% CI, 3.69-27.65), taking into account internet addiction baseline severity, comorbidity, treatment center, and age. Compared with the WLC groups, effect sizes at treatment termination of STICA were d = 1.19 for AICA-S, d = 0.88 for time spent online on weekdays, d = 0.64 for psychosocial functioning, and d = 0.67 for depression. Fourteen adverse events and 8 serious adverse events occurred. A causal relationship with treatment was considered likely in 2 AEs, one in each group.

CONCLUSIONS AND RELEVANCE

Short-term treatment for internet and computer game addiction is a promising, manualized, short-term CBT for a broad range of internet addictions in multiple treatment centers. Further trials investigating the long-term efficacy of STICA and addressing specific groups and subgroups compared with active control conditions are required.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01434589.

Assessing Procrastination

Abstract. The short form of the General Procrastination Scale (GPS-K; Klingsieck & Fries, 2012 ; Lay, 1986 ) is a reliable self-report scale measuring general procrastination. The presumed one-dimensional factor structure of the scale, however, has never been examined. Thus, the purposes of this representative study were to examine its dimensionality and factorial invariance across age and sex, and to provide norm values of the German general population. The GPS-K was administered to a representative community sample ( N = 2,527; age range 14–95 years). A confirmatory factor analysis (CFA) was conducted. To explore convergent validity, standardized scales of distress and life satisfaction were used. Measurement invariance across sex and age was tested. The CFA revealed an unsatisfactory model fit of the presumed unidimensional factor structure of the GPS-K. Therefore, a 5-item one-dimensional version of the scale was suggested (General Procrastination Scale – Screening; GPS-S). Correlations between GPS-S, distress and reduced life satisfaction provide evidence on its convergent validity. The one-dimensional GPS-S can be assumed to be scalar invariant across sex and for participants older than 29 years. The scale can be administered in only a few minutes providing an economic screening for research and practice.

[Internet-related disorders-old and new challenges. Conference report on the 10th symposium of the German Association on Internet-Related Disorders]

Internet-related disorders have become a growing challenge for psychosocial healthcare and society. For ten years, the German Association on Internet-Related Disorders has been a cooperative network, bringing together caregiving professionals and researchers, fostering our knowledge and expertise in facing this health issue. The conference "Categorically after 10 years," held in November 2018, was the annual meeting of these experts.This proceeding aims to depict the history of the conference, by referring to the many national and international experts of the past years that had crucial impact on the growing expertise of the association's members. The current conference mainly dealt with the expected inclusion of "gaming disorder" as a new diagnosis and other internet-related disorders in the ICD-11 that were announced by the World Health Organization (WHO) in summer 2018.Internet-related disorders have been clinically described as excessive and poorly controlled online behaviors that are causing detrimental consequences and result in decreasing psychosocial functioning. The main subtypes of internet-related disorders encompass the uncontrolled use of (online) computer games, pornography, and social networking sites.As in past years, this conference again offered the opportunity for exchange between researchers and healthcare professionals. The program contained an eclectic mix of lectures and workshops, offering a sound review of current developments in internet-related disorders and future perspectives of prevention, diagnostics, and intervention strategies. A particular emphasis was set on the addictive potential of modern computer games, for instance by the implementation of monetarization strategies.

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.

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

BACKGROUND AND AIMS

Internet Gaming Disorder (IGD) and other Internet-related disorders (IRDs) have become growing health concerns in our today's lives. Based on defined diagnostic criteria, IGD has been recognized as a condition for further research in the DSM-5; however, other IRDs have been excluded. Since the release of the DSM-5, representativeness and appropriateness of the nine diagnostic criteria have been debated. Although some first evidence has been published to evaluate these criteria, our knowledge is still limited. Thus, the purpose of this study was to provide data on the clinical validity of the DSM-5 criteria for IGD and other types of IRD. We were also interested in examining the additional diagnostic validity of craving that is currently not being considered in the DSM-5.

METHODS

Analyses on a sample of n = 166 treatment seekers for IRDs were performed. The clinician's diagnosis was used as a main reference for determining the DSM criteria's diagnostic performance. Secondary criteria (depression and anxiety) were defined as indicators for the construct validity.

RESULTS

The overall diagnostic accuracy ranged between 76.6% for deceiving and 92% for loss of control and craving. Considerable differences occurred in the degree of sensitivity and specificity between the single criteria. No particular differences were found for the applicability of the criteria to other forms of IRDs.

DISCUSSION AND CONCLUSIONS

Our results confirm the validity of the DSM criteria. However, the diagnostic utility of the criterion escaping aversive moods is critically discussed. Considering craving as an additional diagnostic indicator might be recommendable.

Decreased Occupational Functioning and Increased Physical Health Complaints in Treatment Seekers with Internet-Related Disorders: Compared to Patients with Gambling Disorder

BACKGROUND

Internet-related disorders (IRDs) as a growing mental health issue will probably be included in the upcoming ICD-11. While research on psychological aspects has progressed, less data are available regarding the physical health status of patients. Thus, we provide new data on physical health complaints, prediagnosed illness, level of functioning, and work ability in a clinical sample.

METHODS

From consecutive treatment seekers, we included n = 286 patients with IRD, n = 95 subjects with excessive yet not disordered Internet use, and n = 106 patients with gambling disorder (GD). All 3 groups were compared regarding lifestyle habits, medical history, somatic complaints, sleep disturbances, level of functioning and work ability using standardized self-reports, and clinical ratings.

RESULTS

Patients with IRD differed from nonclinical controls by higher somatic complaints, a lower level of functioning, and a higher degree of impairment in social and occupational contexts. Only few differences were found between patients with IRD and GD.

CONCLUSIONS

Compared to individuals with excessive, not addictive online behaviors, patients diagnosed with IRD displayed higher somatic symptoms, and more sleep problems. This implies that psychotherapeutic interventions should also consider physical and psychosomatic problems when treating patients. Among patients with IRD, significant social and occupational deficits were comparable to patients with GD. This emphasizes that IRD are causing severe impairment in relevant aspects of the patients' lives.

The Relationship Between Trait Procrastination, Internet Use, and Psychological Functioning: Results From a Community Sample of German Adolescents

Adolescents with a strong tendency for irrational task delay (i.e., high trait procrastination) may be particularly prone to use Internet applications simultaneously to other tasks (e.g., during homework) and in an insufficiently controlled fashion. Both Internet multitasking and insufficiently controlled Internet usage may thus amplify the negative mental health implications that have frequently been associated with trait procrastination. The present study explored this role of Internet multitasking and insufficiently controlled Internet use for the relationship between trait procrastination and impaired psychological functioning in a community sample of N = 818 early and middle adolescents. Results from multiple regression analyses indicate that trait procrastination was positively related to Internet multitasking and insufficiently controlled Internet use. Insufficiently controlled Internet use, but not Internet multitasking, was found to partially statistically mediate the association between trait procrastination and adolescents’ psychological functioning (i.e., stress, sleep quality, and relationship satisfaction with parents). The study underlines that adolescents with high levels of trait procrastination may have an increased risk for negative outcomes of insufficiently controlled Internet use.

Prevalence, risk factors, and psychosocial adjustment of problematic gambling in adolescents: Results from two representative German samples

Background and aims Gambling disorder is a significant public health concern. Especially, male minors have been shown to gamble in a problematic way, despite legal prohibitions. Methods We examined representative samples of students aged from 12 to 18 years (N = 9,309) in two German federal states to provide prevalence data and clinical description of risk factors for problematic gambling. Results We found that about 40% of the adolescents reported engaging in gambling activities within the past 12 months and found prevalence rates of 1.7% and 2.2% for problematic gambling. Especially, use of online gambling and slot machines was found to be related to problematic gambling. Male adolescents with a migration background were of higher risk for problematic gambling and psychopathological symptoms were significantly elevated among that group. Discussion The results indicate that participation in gambling activities is common among underaged adolescents and that prevalence of problematic gambling exceeds rates of adults. Similarly, problematic gambling is associated with increased psychopathological strain. Conclusion Given that a high proportion of adult gamblers report having started gambling in adolescents, our data emphasize the need for prevention and early intervention strategies for problematic gambling.

Insights Into Aspects Behind Internet-Related Disorders in Adolescents: The Interplay of Personality and Symptoms of Adjustment Disorders

PURPOSE

Problematic Internet use (PIU) that has recently been referred to as Internet-related disorder is a growing health concern. Yet, it is unclear why some adolescents are developing problematic use, whereas others sustain control. Based on previous research, we hypothesize that personality traits (low conscientiousness and high neuroticism) act as predispositions for PIU. We further hypothesize that PIU can be understood as a maladaptive reaction toward critical life events and that these maladaptive reactions are exacerbated by dysfunctional personality traits.

METHODS

The study investigates the prevalence of distinct subtypes of PIU among a sample of adolescents (n = 1,489; 10-17 years). Personality traits (Big Five Inventory-10 [BFI-10]), perceived stress (Perceived Stress Scale 4 [PSS-4]), and their relations to PIU (Scale for the Assessment of Internet and Computer Game Addiction [AICA-S]) were examined. As novel research questions, associations between PIU and adjustment disorders (Adjustment Disorder-New Module [ADNM]-6) and the mediating role of personality were investigated.

RESULTS

The prevalence of PIU was 2.5%; girls (3.0%) were more often affected than boys (1.9%). Social networking sites in girls and online games in boys were most often associated with PIU. Low conscientiousness and high neuroticism generally predicted PIU. Significantly more adolescents with PIU (70%) reported critical life events compared with those without PIU (42%). PIU was related to heightened stress and higher adjustment disorder symptoms. These associations were exacerbated by conscientiousness and neuroticism.

CONCLUSIONS

Although the overall prevalence for PIU is in line with previous studies, it appeared unexpectedly that girls were affected more often than boys. Adjustment disorders and stress showed strong associations with PIU. This bears implications for adapting etiopathological assumptions and early intervention strategies.

Under the umbrella

The inclusion of Internet Gaming Disorder as a preliminary diagnosis subsumed in Section III of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has provoked mixed reactions. On the one hand, it has been appreciated as an important sign stressing the negative health-related impact of that disorder. Likewise, the definition of diagnostic criteria helps scientists and clinicians to refer to mandatory indicators associated with a health problem. On the other hand, it has been objected that this new diagnosis bears the danger of pathologizing normal behaviors that are a feature of healthy recreational activity for many people. However, the existence of diagnostic criteria is meant to avoid this danger. This emphasizes the necessity of being able to refer to as accurate defined criteria as possible. In its current version, the DSM criteria display not only strengths but also ambiguities. Both types will be discussed and necessary ideas to resolve those ambiguities will be presented for further research.

Both sides of the story: Addiction is not a pastime activity

The proposed inclusion of Internet gaming disorder (IGD) into the upcoming ICD-11 has caused mixed reactions. Having a sound diagnostic framework for defining this new phenomenon has been applauded but concerns have risen regarding overpathologizing a mere pastime activity. The review by Aarseth et al. (2016) provides a fine but one-sided impression on IGD. What has been totally left out in the argumentation is the clinical perspective. Although the concerns depicted must not be ignored, the conclusion provided by the authors is reflecting quite subjective speculations while objectivity would rather be needful.

The microstructure and micromechanics of the tendon-bone insertion

The exceptional mechanical properties of the load-bearing connection of tendon to bone rely on an intricate interplay of its biomolecular composition, microstructure and micromechanics. Here we identify that the Achilles tendon-bone insertion is characterized by an interface region of ∼500 μm with a distinct fibre organization and biomolecular composition. Within this region, we identify a heterogeneous mechanical response by micromechanical testing coupled with multiscale confocal microscopy. This leads to localized strains that can be larger than the remotely applied strain. The subset of fibres that sustain the majority of loading in the interface area changes with the angle of force application. Proteomic analysis detects enrichment of 22 proteins in the interfacial region that are predominantly involved in cartilage and skeletal development as well as proteoglycan metabolism. The presented mechanisms mark a guideline for further biomimetic strategies to rationally design hard-soft interfaces.

The Berlin Inventory of Gambling behavior - Screening (BIG-S): Validation using a clinical sample

BACKGROUND

Published diagnostic questionnaires for gambling disorder in German are either based on DSM-III criteria or focus on aspects other than life time prevalence. This study was designed to assess the usability of the DSM-IV criteria based Berlin Inventory of Gambling Behavior Screening tool in a clinical sample and adapt it to DSM-5 criteria.

METHODS

In a sample of 432 patients presenting for behavioral addiction assessment at the University Medical Center Mainz, we checked the screening tool's results against clinical diagnosis and compared a subsample of n=300 clinically diagnosed gambling disorder patients with a comparison group of n=132.

RESULTS

The BIG-S produced a sensitivity of 99.7% and a specificity of 96.2%. The instrument's unidimensionality and the diagnostic improvements of DSM-5 criteria were verified by exploratory and confirmatory factor analysis as well as receiver operating characteristic analysis.

CONCLUSIONS

The BIG-S is a reliable and valid screening tool for gambling disorder and demonstrated its concise and comprehensible operationalization of current DSM-5 criteria in a clinical setting.

Adding Clinical Validity to the Statistical Power of Large-Scale Epidemiological Surveys on Internet Addiction in Adolescence: A Combined Approach to Investigate Psychopathology and Development-Specific Personality Traits Associated With Internet Addiction

OBJECTIVE

Research has indicated that internet addiction is associated with psychosocial maladjustment in adolescence. Many epidemiologic surveys are lacking representativeness, and knowledge on disorder-specific risk factors is scarce. One weakness of epidemiologic studies often regards their lack of generalizability to clinical reality. The aim of this study was to provide a detailed description of internet addiction among adolescents, focusing on its prevalence in a population-based context, psychopathological correlates, and predisposing factors.

METHODS

The main analyses were based on 2 large representative samples of German adolescents (N = 9,293; 12-19 years) collected in 2012, and the results were validated on a consecutive sample of 237 treatment-seeking adolescents (from 2009-2014). The Scale for the Assessment of Internet and Computer Game Addiction (AICA-S), Strengths and Difficulties Questionnaire (SDQ), Symptom Checklist-90 Revised (SCL-90R), and NEO-Five Factor Inventory (NEO-FFI) were administered.

RESULTS

Internet addiction occurred in 2.6% of adolescents, with almost comparable rates in both genders, whereas female patients (1.3%) were underrepresented among the treatment seekers. Internet-addicted adolescents from the clinical and the nonclinical setting displayed higher psychopathology (SDQ: P < .001) and functional impairment (Global Assessment of Functioning: P < .001) than adolescents with nonproblematic internet use. Low conscientiousness (in boys: β = -0.161 to -0.220; in girls: β = -0.103 to -0.240) and high negative affect (in boys: β = 0.141 to -0.193; in girls: β = 0.175 to 0.290) were personality correlates of internet addiction.

CONCLUSIONS

Internet addiction is a widespread problematic behavior among male and female adolescents, and it is related to psychopathological symptoms. Low conscientiousness and high negative affect were identified as stable correlates for internet addiction independent of age and gender and can therefore be considered as risk factors for internet addiction.

[Psychological Distress and Acceptance of Violence Legitimizing Masculinity Norms among Adolescents]

The proportion of adolescent migrants in Germany aged 15-20 years has risen to about 29.5% in 2014 according to Federal census statistics. The purpose of the current study was to describe and to compare the psychological strains of adolescent 1^st and 2^nd generation migrants with non-migrants in a representative school survey. Acceptance of violence legitimizing masculinity norms was explored and its correlation with psychological strain was analyzed. Self-reported data of psychological strain (internalizing and externalizing problems) and acceptance of violence legitimizing masculinity were gathered among 8 518 pupils aged 12-19 years across different school types. Among the surveyed adolescents, 27.6% reported a migration background (5.8% 1^st generation migrants; 21.8% 2^nd generation migrants). Particularly 1^st generation migrants scored higher in internalizing and externalizing problems than 2^nd generation migrants or non-migrants. The differences, however, were small. Adolescents with migration background suffered from educational disadvantage, especially 1^st generation migrants. Male adolescents reported significantly higher acceptance of violence legitimizing masculinity norms than their female counterparts. Strong agreement with the measured concept of masculinity was found among pupils of lower secondary school and adolescents reported regularly tobacco and cannabis consumption. The acceptance of violence legitimizing masculinity norms was greater among migrants, particularly 1^st generation migrants, than non-migrants. Overall, high acceptance of violence legitimizing masculinity norms was related to externalizing problems, which can be understood as dysfunctional coping mechanisms of social disadvantage and a lack of prospects.

Addictive Potential of Internet Applications and Differential Correlates of Problematic Use in Internet Gamers versus Generalized Internet Users in a Representative Sample of Adolescents

AIMS

This paper examines the addictive potential of 8 different Internet applications, distinguishing male and female users. Moreover, differential correlates of problematic use are investigated in Internet gamers (IG) and generalized Internet users (GIU).

METHOD

In a representative sample of 5,667 adolescents aged 12-19 years, use of Internet applications, problematic Internet use, psychopathologic symptoms (emotional problems, hyperactivity/inattention, and psychosomatic complaints), personality (conscientiousness and extraversion), psychosocial correlates (perceived stress and self-efficacy), and coping strategies were assessed. The addictive potential of Internet applications was examined in boys and girls using regression analysis. MANOVAs were conducted to examine differential correlates of problematic Internet use between IG and GIU.

RESULTS

Chatting and social networking most strongly predicted problematic Internet use in girls, while gaming was the strongest predictor in boys. Problematic IG exhibited multiple psychosocial problems compared to non-problematic IG. In problematic Internet users, GIU reported even higher psychosocial burden and displayed dysfunctional coping strategies more frequently than gamers.

CONCLUSION

The results extend previous findings on the addictive potential of Internet applications and validate the proposed distinction between specific and generalized problematic Internet use. In addition to Internet gaming disorder, future studies should also focus on other highly addictive Internet applications, that is, chatting or social networking, regarding differential correlates of problematic use.

Is Sensation Seeking a correlate of excessive behaviors and behavioral addictions? A detailed examination of patients with Gambling Disorder and Internet Addiction

Sensation Seeking has repeatedly been related to substance use. Also, its role as a correlate of Gambling Disorder has been discussed although research has led to heterogeneous results. Likewise, first studies on Internet Addiction have indicated increased Sensation Seeking, to some extent contradicting clinical impression of patients suffering from internet addiction. We assessed Sensation Seeking in a clinical sample of n=251 patients with Gambling Disorder, n=243 patients with internet addiction, n=103 clients with excessive but not addictive internet use, and n=142 healthy controls. The clinical groups were further sub-divided according to the preferred type of addictive behavior (slot-machine gambling vs. high arousal gambling activities and internet gaming disorder vs. other internet-related addictive behaviors). Decreased scores in some subscales of Sensation Seeking were found among male patients compared to healthy controls with no differences between patients with Gambling Disorder and Internet Addiction. The type of preferred gambling or online activity was not related to differences in Sensation Seeking. Previous findings indicating only small associations between Sensation Seeking and Gambling Disorder were confirmed. Regarding Internet Addiction our results contradict findings from non-clinical samples. Sensation Seeking might be relevant in initiating contact to the health care system.

The German version of the Perceived Stress Scale - psychometric characteristics in a representative German community sample

BACKGROUND

The Perceived Stress Scale Cohen (J Health Soc Behav 24:385-96, 1983) is a widely and well-established self-report scale measuring perceived stress. However, the German version of the PSS-10 has not yet been validated. Thus, the purposes of this representative study were to psychometrically evaluate the PSS-10, and to provide norm values for the German population.

METHODS

The PSS-10 and standardized scales of depression, anxiety, fatigue, procrastination and life satisfaction were administered to a representative, randomly selected German community sample consisting of 1315 females and 1148 male participants in the age range from 14 to 90 years.

RESULTS

The results demonstrated a good internal consistency and construct validity. Perceived stress was consistently associated with depression, anxiety, fatigue, procrastination and reduced life satisfaction. Confirmatory factor analysis revealed a bi-dimensional structure with two related latent factors. Regarding demographic variables, women reported a higher level of stress than men. Perceived stress decreased with higher education, income and employment status. Older and married participants felt less stressed than younger and unmarried participants.

CONCLUSION

The PSS-10 is a reliable, valid and economic instrument for assessing perceived stress. As psychological stress is associated with an increased risk of diseases, identifying subpopulations with higher levels of stress is essential. Due to the dependency of the perceived stress level on demographic variables, particularly age and sex, differentiated norm values are needed, which are provided in this paper.

Procrastination, Distress and Life Satisfaction across the Age Range - A German Representative Community Study

Addressing the lack of population-based data the purpose of this representative study was to assess procrastination and its associations with distress and life satisfaction across the life span. A representative German community sample (1,350 women; 1,177 men) between the ages of 14 and 95 years was examined by the short form of the General Procrastination Scale (GPS-K; 1) and standardized scales of perceived stress, depression, anxiety, fatigue and life satisfaction. As hypothesized, procrastination was highest in the youngest cohort (14–29 years). Only in the youngest and most procrastinating cohort (aged 14 to 29 years), men procrastinated more than women. As we had further hypothesized, procrastination was consistently associated with higher stress, more depression, anxiety, fatigue and reduced satisfaction across life domains, especially regarding work and income. Associations were also found with lack of a partnership and unemployment. Findings are discussed with regard to potential developmental and cohort effects. While procrastination appears to be a pervasive indicator for maladjustment, longitudinal analyses in high-risk samples (e.g. late adolescence, unemployment) are needed to identify means and mechanisms of procrastinating.

Bipolar spectrum disorders in a clinical sample of patients with Internet addiction: hidden comorbidity or differential diagnosis?

BACKGROUND AND AIMS

Behavioral addictions and bipolar disorders have a certain probability of co-occurrence. While the presence of a manic episode has been defined as an exclusion criterion for gambling disorder, no such exclusion has been formulated for Internet addiction.

METHODS

A clinical sample of 368 treatment seekers presenting with excessive to addictive Internet use was screened for bipolar spectrum disorders using the Mood Disorder Questionnaire. Psychopathology was assessed by the Symptom Checklist 90R and a clinical interview was administered to screen for comorbid disorders.

RESULTS

Comorbid bipolar disorders were more frequent in patients meeting criteria for Internet addiction (30.9%) than among the excessive users (5.6%). This subgroup showed heightened psychopathological symptoms, including substance use disorders, affective disorders and personality disorders. Further differences were found regarding frequency of Internet use regarding social networking sites and online-pornography.

DISCUSSION

Patients with Internet addiction have a heightened probability for meeting criteria of bipolar disorders. It is not possible to draw conclusions regarding the direction of this association but it is recommended to implement screening for bipolar disorders in patients presenting with Internet addiction.

CONCLUSION

Similar to gambling disorder, it might prove necessary to subsume bipolar disorders as an exclusion criterion for the future criteria of Internet addiction.

Prevalence and correlates of depersonalization in students aged 12-18 years in Germany

BACKGROUND

Depersonalization (DP) involves unpleasant experiences of detachment from one's sense of self or unreality in the environment. DP may occur in a broad range of conditions, among healthy persons due to sleep loss, drug induced, secondary to anxiety disorders or primary in depersonalization disorder. Although DP has an early age of onset, little is known about the prevalence and correlates of DP among adolescents.

METHODS

Between January and June 2011, we conducted a questionnaire-based representative survey of pupils aged 12-18 years in the federal state Rhineland-Palatinate of Germany. The final sample comprised 3,809 pupils. We analyzed the prevalence of depersonalization and its correlates regarding sociodemographic characteristics, substance abuse, global mental distress and resilience factors.

RESULTS

One-third of the sample showed severe global mental distress, and 11.9 % were in the range of clinically significant depersonalization. Depersonalized students were less often living with both parents (67.3 vs. 75.7 %), came more often from an disadvantaged socioeconomic background, had a very severe level of global mental distress (comparable to psychiatric inpatients), were more often smoking and abusing cannabis and they suffered from specific impairments regarding social insecurity, global self-efficacy and active coping abilities.

CONCLUSIONS

Experiences of depersonalization were very common among adolescents and may indicate an increased risk for poor academic achievement and mental health in the long term. Prospective studies are needed to investigate the course and clinical relevance of depersonalization for the development of the adolescents.

Regular gaming behavior and internet gaming disorder in European adolescents: results from a cross-national representative survey of prevalence, predictors, and psychopathological correlates

Excessive use of online computer games which leads to functional impairment and distress has recently been included as Internet Gaming Disorder (IGD) in Section III of the DSM-5. Although nosological classification of this phenomenon is still a matter of debate, it is argued that IGD might be described best as a non-substance-related addiction. Epidemiological surveys reveal that it affects up to 3% of adolescents and seems to be related to heightened psychosocial symptoms. However, there has been no study of prevalence of IGD on a multi-national level relying on a representative sample including standardized psychometric measures. The research project EU NET ADB was conducted to assess prevalence and psychopathological correlates of IGD in seven European countries based on a representative sample of 12,938 adolescents between 14 and 17 years. 1.6% of the adolescents meet full criteria for IGD, with further 5.1% being at risk for IGD by fulfilling up to four criteria. The prevalence rates are slightly varying across the participating countries. IGD is closely associated with psychopathological symptoms, especially concerning aggressive and rule-breaking behavior and social problems. This survey demonstrated that IGD is a frequently occurring phenomenon among European adolescents and is related to psychosocial problems. The need for youth-specific prevention and treatment programs becomes evident.

A single charge in the actin binding domain of fascin can independently tune the linear and non-linear response of an actin bundle network

Actin binding proteins (ABPs) not only set the structure of actin filament assemblies but also mediate the frequency-dependent viscoelastic moduli of cross-linked and bundled actin networks. Point mutations in the actin binding domain of those ABPs can tune the association and dissociation dynamics of the actin/ABP bond and thus modulate the network mechanics both in the linear and non-linear response regime. We here demonstrate how the exchange of a single charged amino acid in the actin binding domain of the ABP fascin triggers such a modulation of the network rheology. Whereas the overall structure of the bundle networks is conserved, the transition point from strain-hardening to strain-weakening sensitively depends on the cross-linker off-rate and the applied shear rate. Our experimental results are consistent both with numerical simulations of a cross-linked bundle network and a theoretical description of the bundle network mechanics which is based on non-affine bending deformations and force-dependent cross-link dynamics.

Altered reward processing in pathological computer gamers--ERP-results from a semi-natural gaming-design

INTRODUCTION

Internet Gaming Disorder has been added as a research diagnosis in section III for the DSM-V. Previous findings from neuroscientific research indicate an enhanced motivational attention toward cues related to computer games, similar to findings in substance-related addictions. On the other hand in clinical observational studies tolerance effects are reported by patients with Internet Gaming disorder. In the present study we investigated whether an enhanced motivational attention or tolerance effects are present in patients with Internet Gaming Disorder.

METHODS

A clinical sample from the Outpatient Clinic for Behavioral Addictions in Mainz, Germany was recruited, fulfilling the diagnostic criteria for Internet Gaming Disorder. In a semi-natural EEG design participants played a computer game during the recording of event-related potentials to assess reward processing.

RESULTS

The results indicated an attenuated P300 for patients with Internet Gaming Disorder in response to rewards in comparison to healthy controls, while the latency of N100 was prolonged and the amplitude of N100 was increased.

CONCLUSIONS

Our findings support the hypothesis that tolerance effects are present in patients with Internet Gaming Disorder, when actively playing computer games. In addition, the initial orienting toward the gaming reward is suggested to consume more capacity for patients with Internet Gaming Disorder, which has been similarly reported by other studies with other methodological background in disorders of substance-related addictions.

Excessive internet use in European adolescents: what determines differences in severity?

OBJECTIVES

This study investigated the differences between non-excessive, moderately excessive, and highly excessive internet use among adolescents. These differences were explored in terms of personal characteristics, psychological difficulties, environmental factors, and manner of internet use.

METHODS

A representative sample was investigated, consisting of 18,709 adolescents aged 11-16 and their parents, from 25 European countries. Excessive internet use was measured using a five item scale covering following factors: salience, conflict, tolerance, withdrawal symptoms, and relapse and reinstatement. The main data analysis utilised multinomial and binary logistic regression models.

RESULTS

The vast majority of respondents reported no signs of excessive internet use. Moderately excessive users (4.4%) reported higher emotional and behavioural difficulties, but also more sophisticated digital skills and a broader range of online activities. The highly excessive users (1.4%) differed from the non-excessive and moderately excessive users in their preference for online games and in having more difficulties with self-control.

CONCLUSIONS

Adolescents who struggle with attention and self-control and who are inclined toward online gaming may be especially vulnerable to the otherwise uncommon phenomenon of excessive internet use.

A contribution to the clinical characterization of Internet addiction in a sample of treatment seekers: validity of assessment, severity of psychopathology and type of co-morbidity

OBJECTIVE

Internet addiction becomes a growing health problem worldwide with prevalence rates up to 3%. Still, uncertainties exist regarding its diagnostics and clinical characterization. Especially the lacking clinical evidence regarding self-report measures assessing Internet addiction has been criticized.

METHODS

This study aimed to characterize 290 German treatment seekers and to determine the diagnostic accuracy of a self-report scale for Internet addiction. Patients filled in self-report measures (SCL-90R, PHQ, AICA-S - Scale for the Assessment of Internet and Computer game Addiction) and underwent diagnostic interviews to assess symptoms of Internet addiction and level of functioning.

RESULTS

Of the predominantly male treatment seekers 71% met the clinical diagnosis of Internet addiction. These displayed higher levels of psychopathology, especially depressive and dissociative symptoms. Half of the patients met criteria for one further psychiatric disorder according to clinical interviews, especially depressive disorders. Their level of functioning was decreased in all domains. AICA-S showed good psychometric properties and satisfying diagnostic accuracy (sensitivity: 80.5%; specificity: 82.4%).

DISCUSSION

In this sample, Internet addiction was associated with high levels of psychosocial distress that is mainly related to depressive symptoms. Co-morbid disorders were common among those patients. First analyses on diagnostic accuracy of AICA-S (using the therapist's rating on Internet addiction as an independent external criterion) showed promising results.

Investigating risk factors for Internet gaming disorder: a comparison of patients with addictive gaming, pathological gamblers and healthy controls regarding the big five personality traits

Engaging in online games has become increasingly important as a part of leisure activity in adolescents and adults. While the majority of people use these games in a healthy way, epidemiological studies show that some develop excessive use and symptoms that are related to those of substance-related addictions. Despite increasing research concerning the epidemiology of internet gaming disorder (IGD), predisposing factors have been examined to a lesser extent. Knowing about specific risk factors would help clarify the nosological features of IGD and enhance prevention and intervention. This study aimed to evaluate the relationships between personality traits and IGD. A total of 115 patients meeting the criteria for IGD were compared to 167 control subjects displaying either regular or intense use of online games. Additionally, 115 patients meeting diagnostic criteria for pathological gambling were included. IGD was associated with higher neuroticism, decreased conscientiousness and low extraversion. The comparisons to pathological gamblers indicate that low conscientiousness and low extraversion in particular are characteristic of IGD. An integration of personality variables into an etiopathological model describing presumable mechanisms fostering and maintaining addictive online gaming is proposed. This model could be helpful for the theoretical understanding of addictive gaming, public health campaigns and psychoeducation within therapeutic settings.

Suchtartige Internetnutzung als komorbide Störung im jugendpsychiatrischen Setting

Einleitung: Die exzessiv suchtartige Internetnutzung bei Kindern und Jugendlichen, welche sich in ähnlichen Symptomen äußern kann wie klassische Abhängigkeitserkrankungen, ist ein Phänomen, dem Wissenschaft und Praxis immer mehr Beachtung schenken. Prävalenzen von 3 % unter Kindern und Jugendlichen deuten auf ein häufig vorkommendes Problem hin, das bei Betroffenen zu Funktionseinschränkungen führt und mit hohem Leidensdruck einhergeht. Ungeklärt ist, wie häufig Internetsucht unter Patienten jugendpsychiatrischer Einrichtungen auftritt. Methodik: Zur erstmaligen Bestimmung der Prävalenz von Internetsucht unter psychiatrisch behandelten Jugendlichen wurde ein standardisiertes Screening-Instrument (OSV-S) zur Klassifikation der Internetnutzung an 81 Patienten zwischen 8 und 17 Jahren eingesetzt. Eine weitere klinische Beschreibung erfolgte mittels des Youth Self-Reports und der Child Behavior Checkliste. Ergebnisse: 11.3 % der Patienten erfüllten die Kriterien der Internetsucht. Diese Patienten haben ein höheres Durchschnittsalter und wiesen erhöhte Werte in Ängstlichkeit und Depressivität auf. Schlussfolgerungen: Diese Pilotstudie verdeutlicht, dass in jugendpsychiatrischen Einrichtungen komorbide Internetsucht häufig vorkommt. Patienten mit komorbider Internetsucht zeichnen sich durch spezifische Symptombelastungen aus. Eine gezielte störungsspezifische Psychotherapie ist zu diskutieren.

[Internet addiction as a co-morbid disorder among patients of german addiction rehabilitation facilities: an exploratory investigation of clinical prevalence]

OBJECTIVE

Excessive internet use is being discussed as a non-substance-related addiction disorder. Estimations of its prevalence show that 1% of the German general population is affected by internet addiction. However, it is still unclear, whether internet addiction as a co-morbid disorder is also common among patients of the general health care system, especially in patients being treated in inpatient addiction rehabilitation centers. It seems plausible that these patients have a heightened proneness to co-morbid internet addiction.

METHODS

In order to address this issue, a government-funded cooperation project was conducted. Within six months every new patient admitted to one of 15 rehabilitation facilities was screened for internet addiction.

RESULTS

4.2% of the patients fulfilled criteria for internet addiction. Male patients of younger age with main diagnosis of cannabis dependence or pathological gambling were found to be at higher risk.

CONCLUSIONS

Internet addiction is more common among patients of the rehabilitation system than in the general population. Especially young, male patients in treatment for cannabis dependence or pathological gambling are at risk for co-morbid internet addiction. It is recommended that regular screening for internet addiction should be implemented in facilities with patients at risk in order to offer indicative treatment.

Effects of a manualized short-term treatment of internet and computer game addiction (STICA): study protocol for a randomized controlled trial

Background

In the last few years, excessive internet use and computer gaming have increased dramatically. Salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse have been defined as diagnostic criteria for internet addiction (IA) and computer addiction (CA) in the scientific community. Despite a growing number of individuals seeking help, there are no specific treatments of established efficacy.

Methods/design

This clinical trial aims to determine the effect of the disorder-specific manualized short-term treatment of IA/CA (STICA). The cognitive behavioural treatment combines individual and group interventions with a total duration of 4 months. Patients will be randomly assigned to STICA treatment or to a wait list control group. Reliable and valid measures of IA/CA and co-morbid mental symptoms (for example social anxiety, depression) will be assessed prior to the beginning, in the middle, at the end, and 6 months after completion of treatment.

Discussion

A treatment of IA/CA will establish efficacy and is desperately needed. As this is the first trial to determine efficacy of a disorder specific treatment, a wait list control group will be implemented. Pros and cons of the design were discussed.

Trial Registration

ClinicalTrials (NCT01434589)

Emotionale Befindlichkeit und dysfunktionale Stressverarbeitung bei Personen mit Internetsucht

Ziele: Die suchtartige Nutzung des Internet ist ein Phänomen, das immer stärker in das öffentliche Bewusstsein vordringt. Eine hinreichende klinische Charakterisierung, wie auch Befunde zu ätiopathologischen Faktoren fehlen bislang jedoch. In der vorliegenden Studie wurden zwei verschiedene Klientengruppen hinsichtlich Symptombelastung, Coping und Affektivität mit gesunden Kontrollprobanden verglichen. Methodik: Es nahmen insgesamt 45 Personen an der Studie teil; jeweils zu gleichen Teilen Personen, die wegen des Verdachts auf Internetsucht regionale Beratungsstellen aufsuchten bzw. Personen, die in einer spezialisierten Spielsuchtambulanz vorstellig wurden, sowie gesunde Kontrollpersonen. Alle Probanden füllten standardisierte psychometrische Inventare zur Diagnostik der Internetsucht, der psychischen Symptombelastung, Coping und zur Affektivität aus. Ergebnisse: Personen mit Internetsucht zeichnen sich durch den Einsatz dysfunktionaler Stressbewältigungsstrategien und erhöhter Negativer Affektivität aus. Darüber hinaus liegt eine deutliche psychische Symptombelastung (SCL-90R) in multiplen Bereichen vor. Schlussfolgerungen: Die Ergebnisse verdeutlichen, dass Internetsucht mit erheblichen psychopathologischen Beeinträchtigungen einher geht. Dysfunktionale Stressverarbeitung und erhöhte Negative Affektivität sind als prädisponierende bzw. aufrechterhaltende Faktoren zu diskutieren und lassen den Einsatz entsprechender Interventionsstrategien notwendig erscheinen.

Regular and problematic leisure-time Internet use in the community: results from a German population-based survey

In our study, we attempted to identify systematically the use of Internet applications in the German population in order to derive risk factors for problematic use. In a representative survey of the German population, we queried 1,401 women and 1,111 men between the ages of 14 and 94 years by specific questions and standardized questionnaires on depression, anxiety (HADS), and depersonalization (CDS-2). The majority of the German population (55%) used the Internet in their leisure time. Users were younger and had a higher socioeconomic status (education, employment, income). Leisure-time use included e-mail and information search, as well as shopping. Chatting, online communities, games and sex were domains of young, mostly male adults. Overall, 9.3% reported at least one negative consequence of Internet use, especially neglect of recreational activities and problems with family/partner, work or education, and health. Problematic use was associated with longer average daily online times, avoidance of negative emotions, preference for certain applications (gaming, gambling, online sex) and an increased rate of depersonalization. The extent of Internet use per se is not sufficient as an addiction criterion and other negative consequences; rather, specific adverse consequences need to be identified. If the Internet is used excessively to cope with negative affect states and alternative means of coping (e.g., social support, health-promoting behavior) are diminished, a vicious cycle may ensue with increasing stress and reliance on the reinforcing properties of certain online activities that may finally lead to addictive behavior.

[Reliability and validity of the Scale for the Assessment of Pathological Computer-Gaming (CSV-S)]

Growing numbers of young adults are preoccupied with excessive computer gaming. Nevertheless the scientific sight on classification, diagnostics and prevalence of the so called computer game addiction isn't yet clarified. This study was conducted to introduce a validated instrument (CSV-S) with sound psychometric properties to distinguish between regular and excessive computer gaming. The CSV-S was applied in 2 independent samples (N=1,710) of juveniles aged between 13 and 18 years in order to determine validity of the CSV-S in a cross-validation-design. Results emphasize psychometric quality of the CSV-S concerning reliability and validity. The CSV-S provides an useful inventory to assess excessive computer gaming.

[Computer game playing: clinical characteristics of dependence and abuse among adolescents]

OBJECTIVE AND METHODS

The aim of the study was to investigate the prevalence of excessive computer game playing behaviour among adolescents with psychopathological tendencies that resemble the classic symptoms of addiction. To address this question, criteria for excessive computer game playing behaviour were developed on the basis of diagnostic criteria for substance-related disorders according to ICD-10.

RESULTS

Excessive computer playing corresponding to addictive behaviour were found in 12.3% of the adolescents (n = 1068; 9.6% showed abusive and 2.7% dependent behaviour). Adolescents with excessive computer and video game playing behaviour also show substantial correlations with other psychosocial and psychopathological abnormalities, such as alterations in the intensity of social conflict, concentration deficits, maladaptive coping behaviour, stress and psychosomatic challenge, and school phobia.

CONCLUSIONS

The study provides the first empirical data about excessive computer game playing among adolescents in Austria. It shows that pathological computer game playing can be well described by criteria developed in accordance to substance dependence, and that abusive or dependent computer game playing shows specific connections with psycho-social, psychopathological and motivational factors. Overall, the results demonstrate a clear need for deeper research on this subject and the need for a design of prevention measures.

[Application of the Isler and Ganz classification of pelvic ring fractures in clinical practice]

The classification of pelvic fractures proposed by Isler and Ganz was applied to 152 patients. On the basis of this experience, the following conclusion were drawn. 1. It is possible to classify all pelvic ring injuries by dividing them in lesions of the anterior and of the posterior ring segment. 2. The classification requires a thorough examination; often a CT scan is needed. The original classification of 9 out of 18 patients based on X-ray morphology had to be revised after CT examination. 3. Once the pelvic injury is definitely classified the mode of therapy is determined as well.

A concept for detecting unexpected changes in the environment early

A project was established under the auspices of the German Federal Ministry of Research and Technology with the task of developing a concept for the early recognition of signals for unexpected deleterious changes in the environment. Predictive assessments of products (e.g., chemicals) and technologies as regards their potential environmental impacts contain numerous sources of error and uncertainties. Therefore, appropriate observation systems are needed in order to detect unexpected developments in the environment and in human health. Long-term storage of samples (environmental specimen banking) is the third basic activity that must be undertaken within an early warning system. When monitoring the environment for unwanted changes, it is not sufficient to trace some individual agents, preselected for their well-known capacity to inflict harm. The following avenues of identifying symptoms of change in the environment were identified: development and deployment of "key indicators"; acquisition and correlative treatment of conventional monitoring data from different sources; and execution of concise studies in environmental problem areas. Key indicators are defined as scientific measurement and observation methods which respond to early stages of anthropogenically induced environmental changes and are capable of responding to a multitude of simultaneously present agents. A series of examples is discussed. Approaches concerning how the statistical evaluation of available sets of environment-related data could reveal unexpected developments are presented.