An international consensus for assessing internet gaming disorder using the new DSM-5 approach.
ABSTRACT For the first time, the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) introduces non-substance addictions as psychiatric diagnoses. The aims of this paper are to (i) present the main controversies surrounding the decision to include internet gaming disorder, but not internet addiction more globally, as a non-substance addiction in the research appendix of the DSM-5, and (ii) discuss the meaning behind the DSM-5 criteria for internet gaming disorder. The paper also proposes a common method for assessing internet gaming disorder. Although the need for common diagnostic criteria is not debated, the existence of multiple instruments reflect the divergence of opinions in the field regarding how best to diagnose this condition.
We convened international experts from European, North and South American, Asian and Australasian countries to discuss and achieve consensus about assessing internet gaming disorder as defined within DSM-5.
We describe the intended meaning behind each of the nine DSM-5 criteria for internet gaming disorder and present a single item that best reflects each criterion, translated into the 10 main languages of countries in which research on this condition has been conducted.
Using results from this cross-cultural collaboration, we outline important research directions for understanding and assessing internet gaming disorder. As this field moves forward, it is critical that researchers and clinicians around the world begin to apply a common methodology; this report is the first to achieve an international consensus related to the assessment of internet gaming disorder.
- SourceAvailable from: Halley M Pontes[Show abstract] [Hide abstract]
ABSTRACT: Background: Over the last decade, there has been growing concern about 'gaming addiction' and its widely documented detrimental impacts on a minority of individuals that play excessively. The latest (fifth) edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5) included nine criteria for the potential diagnosis of Internet Gaming Disorder (IGD) and noted that it was a condition that warranted further empirical study. Aim: The main aim of this study was to develop a valid and reliable standardised psychometrically robust tool in addition to providing empirically supported cut-off points. Methods: A sample of 1003 gamers (85.2% males; mean age 26 years) from 57 different countries were recruited via online gaming forums. Validity was assessed by confirmatory factor analysis (CFA), criterion-related validity, and concurrent validity. Latent profile analysis was also carried to distinguish disordered gamers from nondisordered gamers. Sensitivity and specificity analyses were performed to determine an empirical cut-off for the test. Results: The CFA confirmed the viability of IGD-20 Test with a six-factor structure (salience, mood modification, tolerance, withdrawal, conflict and relapse) for the assessment of IGD according to the nine criteria from DSM-5. The IGD-20 Test proved to be valid and reliable. According to the latent profile analysis, 5.3% of the total sample were classed as disordered gamers. Additionally, an optimal empirical cut-off of 71 points (out of 100) seemed to be adequate according to the sensitivity and specificity analyses carried. Conclusions: The present findings support the viability of the IGD-20 Test as an adequate standardised psychometrically robust tool for assessing internet gaming disorder. Consequently, the new instrument represents the first step towards unification and consensus in the field of gaming studies.PLoS ONE 09/2014; · 3.53 Impact Factor
- Addiction 11/2014; 109(11). · 4.60 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The reclassification of gambling disorder within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) addictions category marks an important step for addiction science. The similarities between gambling disorder and the substance use disorders have been well documented. As gambling is unlikely to exert actively damaging effects on the brain, the cognitive sequelae of gambling disorder may provide insights into addictive vulnerabilities; this idea is critically evaluated in light of recent structural imaging data. The second part of the review analyzes a fundamental question of how a behavior can become addictive in the absence of exogenous drug stimulation. The relative potency of drug and nondrug rewards is considered, alongside evidence that cognitive distortions in the processing of chance (for example, the illusion of control and the gambler's fallacy) may constitute an important added ingredient in gambling. Further understanding of these mechanisms at neural and behavioral levels will be critical for the classification of future behavioral addictions, and I consider the current research data for obesity and binge eating, compulsive shopping, and internet gaming disorder.Annals of the New York Academy of Sciences 10/2014; 1327(1). · 4.38 Impact Factor
An international consensus for assessing internet
gaming disorder using the new DSM-5 approach
Nancy M. Petry1, Florian Rehbein2, Douglas A. Gentile3, Jeroen S. Lemmens4,
Hans-Jürgen Rumpf5, Thomas Mößle2, Gallus Bischof5, Ran Tao6, Daniel S. S. Fung7,
Guilherme Borges8, Marc Auriacombe9, Angels González Ibáñez1,10, Philip Tam11&
Charles P. O’Brien12
University of Connecticut School of Medicine, Farmington, CT, USA,1Criminological Research Institute of Lower Saxony, Hanover, Germany,2Iowa State
University, Ames, IA, USA,3University of Amsterdam, Amsterdam, the Netherlands,4University of Lübeck, Lubeck, Germany,5General Hospital of Beijing Military
Region, Beijing, China,6Institute of Mental Health, Singapore,7National Institute of Psychiatry and Metropolitan Autonomous University, Mexico City, Mexico,8
Université de Bordeaux, Bordeaux, France,9Hospital de Mataró Barcelona, Barcelona, Spain,10Network for Internet Investigation and Research Australia, Sydney,
NSW, Australia11and University of Pennsylvania, Philadelphia, PA, USA12
substance addictions as psychiatric diagnoses. The aims of this paper are to (i) present the main controversies
surrounding the decision to include internet gaming disorder, but not internet addiction more globally, as
a non-substance addiction in the research appendix of the DSM-5, and (ii) discuss the meaning behind the DSM-5
criteria for internet gaming disorder. The paper also proposes a common method for assessing internet gaming
disorder. Although the need for common diagnostic criteria is not debated, the existence of multiple instruments
reflect the divergence of opinions in the field regarding how best to diagnose this condition. Methods
international experts from European, North and South American, Asian and Australasian countries to discuss
and achieve consensus about assessing internet gaming disorder as defined within DSM-5. Results
the intended meaning behind each of the nine DSM-5 criteria for internet gaming disorder and present
a single item that best reflects each criterion, translated into the 10 main languages of countries in which
research on this condition has been conducted. Conclusions
we outline important research directions for understanding and assessing internet gaming disorder. As this
field moves forward, it is critical that researchers and clinicians around the world begin to apply a common
methodology; this report is the first to achieve an international consensus related to the assessment of internet
For the first time, the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) introduces non-
Using results from this cross-cultural collaboration,
Addiction, behavioral addiction, diagnosis, DSM-5, gaming, internet gaming.
Correspondence to: Nancy M. Petry, Calhoun Cardiology Center, 263 Farmington Avenue, Farmington, CT 06030-3944, USA. E-mail: firstname.lastname@example.org
Submitted 25 July 2013; initial review completed 17 October 2013; final version accepted 6 December 2013
The Diagnostic and Statistical Manual of Mental Disorders
(DSM) is a primary method for classifying psychiatric
disorders. The fifth revision, DSM-5 , includes
non-substance addictions for the first time. This paper
addresses two contentious issues related to this change:
(i) the inclusion of behavioral addictions generally, and
internet gaming disorder specifically, in the DSM-5; and
(ii) the intended meaning behind the DSM-5 internet
gaming disorder criteria.
CONTROVERSY A: THE DECISION TO
ADDICTIONS IN DSM-5
In preparation for the DSM-5, the American Psychiatric
Association (APA) convened workgroups to recommend
improvements for diagnosing psychiatric disorders and
comprised of 12 members including four authors of this
© 2014 Society for the Study of Addiction
paper, to consider ‘behavioral addictions’.This is a highly
controversial topic. Some argue that excessive behavior
patterns are not well-aligned with substance use disor-
ders, or object to the construct of ‘addiction’ as a medical
condition (e.g. [2,3]). Others contend that excessive
and deserve equal footing with other psychiatric disor-
ders (e.g. ).
The DSM-5 Workgroup reviewed the literature on
non-substance addictive behaviors, including gambling,
internet gaming, internet use generally, work, shopping
substance-related and addictive disorders section in
DSM-5 because of its overlap with substance use disor-
ders in terms of etiology, biology, comorbidity and treat-
ment . In terms of the other putative non-substance
addictions, the DSM-5 Workgroup voted to include only
one other condition—internet gaming disorder.
This decision was based upon the large number of
studies of this condition and the severity of its conse-
quences. The DSM-5 Workgroup reviewed more than
250 publications on this topic, also referred to as gaming
or internet use disorder, gaming or internet addiction or
dependence, pathological or problematic gaming, etc.
Some reports demonstrated severe consequences, includ-
ing seizures  and deaths [7,8], following lengthy
periods of internet game-play lasting days without
[9–14]) and some from Europe [15–21], with relatively
few from North America [22,23]. Most focused on youth
or young adults [9–13,15,17,19–24], with only a
handful including adults [16,25,26]. Some explicitly
restricted study to gaming activities [9,16,17,19–23],
but others included multiple forms of internet use
[10,13–15]. Few studies compared different forms of
internet activities, and those that did found that internet
gaming appears to be distinct from other excessive online
or electronic communication activities such as social
media use, internet gambling (included under gambling
disorder), pornography viewing, etc. with respect to
prevalence rates, etiologies, characteristics of individuals
participating in them and risks for harm [13,27,28].
of clinically significant problems associated with gaming
of only internet gaming disorder in Section 3 of the
With the exception of gambling and internet gaming,
the DSM-5 Workgroup concluded that research on other
behavioral addictions was relatively limited, the adverse
consequences were less well documented or less reflective
of clinically significant impairment or the behavior
pattern was not well aligned with substance use disor-
ders. Therefore, no other non-substance addictions are
included in DSM-5. Although many researchers and cli-
nicians in these fields are likely to disagree with this deci-
sion, the issues and criteria outlined below ultimately
may guide the study of other conditions, with the explicit
understanding that application of internet gaming crite-
ria to other conditions is not appropriate unless the
reliability and validity of the criteria, and thresholds
for diagnosis, are independently established for other
manifestations of internet use or other non-substance-
related excessive behavioral patterns.
CONTROVERSY B: HOW TO ASSESS THE
DSM-5 CRITERIA FOR INTERNET
Although the DSM-5 Workgroup voted to include
internet gaming disorder in the DSM-5, they readily
determined that existing studies applied no standard
diagnostic criteria to assess the condition (see also ).
Some reports used criteria that parallel those for sub-
pathological gambling criteria [23,31] and still others
adapted impulse control or other criteria [22,32,33].
Some studies considered that individuals had a ‘disorder’
when they endorsed one or a small number of criteria
[11,34]; others required multiple or all criteria to be
endorsed [14,16,25].Thus, research on internet gaming
tic criteria. Depending on the criteria used and sample
studied, prevalence rates range from less than 1%
[16,26,35] to approximately 10% [9,20,23].
Table 1 outlines the nine DSM-5 internet gaming dis-
order criteria. They were derived in large part from
another report  that used an iterative process to
identify diagnostic criteria. The criteria were also
chosen and worded to parallel some substance use and
gambling disorder criteria, while considering that
expression of internet gaming disorder may differ from
these disorders. Table 1 also lists commonly utilized
instruments for assessing problems with internet
gaming [17,19,20,31,36–39] and denotes the DSM-5
criteria addressed in each instrument. Although many
of the instruments tap some of the DSM-5 criteria, the
instruments rarely assess a DSM-5 criterion in a similar
manner. For example, pre-occupation has been assessed
by items ranging from: ‘Did you spend much free time
on games?’ to ‘How often do you stay online until the
last minute when you have to leave?’ to ‘How often
do you look forward to your next internet session?’
Psychiatric diagnosis relies most typically upon struc-
tured interviews, and the use of consistent wording can
assist in more reliable assessment of each criterion and
ultimately may be useful for screening purposes. To this
Nancy M. Petry et al.
© 2014 Society for the Study of Addiction
Table 1 Representation of internet gaming disorder criteria in existing assessment instruments and suggestions for phrasing.
Substance use disorder
Suggested wording for intended meaning of criteria
Do you spend a lot of time thinking about games even when you are not
playing, or planning when you can play next?
Do you feel restless, irritable, moody, angry, anxious or sad when
attempting to cut down or stop gaming, or when you are unable to play?
Do you feel the need to play for increasing amounts of time, play more
exciting games, or use more powerful equipment to get the same
amount of excitement you used to get?
Do you feel that you should play less, but are unable to cut back on the
amount of time you spend playing games?
Give up other activities
Do you lose interest in or reduce participation in other recreational
activities (hobbies, meetings with friends) due to gaming?
Continue despite problems
Do you continue to play games even though you are aware of negative
consequences, such as not getting enough sleep, being late to school/
work, spending too much money, having arguments with others, or
neglecting important duties?
Do you lie to family, friends or others about how much you game, or try to
keep your family or friends from knowing how much you game?
Escape adverse moods
Do you game to escape from or forget about personal problems, or to
relieve uncomfortable feelings such as guilt, anxiety, helplessness or
Do you risk or lose significant relationships, or job, educational or career
opportunities because of gaming?
GAS = Game Addiction Scale ; PVGU = Pathological Video Game Use ; VGAS = Video Game Addiction Scale ; POGQ = Problematic Online Gaming Questionnaire ; CIUS = Compulsive Internet Use Scale ;
CIAI = Chinese Internet Addiction Inventory ;YIAS = Young Internet Addiction Scale ; CSAS = Video Game Addiction Scale-II .
Internet gaming disorder
© 2014 Society for the Study of Addiction
end, some European authors of this paper (F.R., J.L.,
H.-J.R., T.M., and G. Bischof) convened a group of inter-
the DSM-5 criteria, inviting four members of the DSM-5
Workgroup (N.P., G. Borges, M.A and C.O.) as well
as clinicians and researchers in countries throughout
the world (D.G., R.T., D.F., A.G.-I. and P.T.) to partici-
pate in the process. All individuals invited agreed to
After reviewing and adapting items from existing
instruments, the authors of this paper independently
suggested items they felt best captured each criterion in
full. They then discussed and voted on a pool of four to
five items per criterion. For some criteria, substantial dif-
ferences emerged in recommended content or wording
of items. For example, some suggested that an item
operationalizing adverse effects of gaming consist only
of having ‘fights or arguments with others’, while the
majority voted to include a more comprehensive list of
negative consequences. After much discussion, ‘being
late to school/work’ was determined to reflect the crite-
rion related to continuing gaming despite adverse conse-
quences, while receiving failing or substantially lower
course grades because of excessive gaming was more
consistent with the criterion related to losing important
opportunities. Although the descriptions below may, on
the surface, appear to be self-evident, the disparate
manner in which these criteria have been assessed across
instruments and investigators reflects the inherent con-
troversy surrounding assessment of internet gaming
Table 1 shows the items that received the highest
votes. Each item listed received a mean rating of ‘good’ to
‘very good’ (the highest rating) and was voted by the
majority of authors as the item best reflecting that crite-
Chinese, Japanese, Korean, Portuguese, German, Dutch,
Spanish, Italian, French and Turkish.
To distinguish specific aspects of criteria, suggested
items can be broken down, e.g. ‘Do you spend a lot of
time thinking about games even when you are not
playing?’ and ‘Do you spend a lot of time planning when
you can play next?’. The wording could also be adapted
for specific populations by, for example, eliminating
words such as ‘employment’ or ‘jobs’ when assessing
school-aged children. The goal here, however, was to
provide a single sentence that encompasses each of the
DSM-5 criteria to standardize more appropriately the
research in this field.
Pre-occupation relates to spending substantial amounts
of time thinking about an activity.This criterion parallels
one used in substance use and gambling disorders and
reflects the construct of ‘cognitive salience’ . This
criterion may overlap somewhat with that related to
loss of interests in other hobbies (criterion 5), but pre-
occupation is more a cognitive process, whereas loss
of interests manifests as a more behavioral one .
Prior instruments incorporated items that address pre-
occupation (Table 1), some of which included aspects
to fantasizing about games (e.g. ) or when one can
next play. Pre-occupation relates to being all-absorbed,
but it should be distinguished from transient enthusiasm
while playing. For this criterion to be met, the individual
must be thinking about games not only while playing but
also during times of non-play, with excessive thoughts
about gaming occurring throughout the day. Table 1
shows suggested wording.
Withdrawal refers to symptoms that emerge when one is
unable to engage in a behavior or is attempting to reduce
or stop it. In many substance use disorders, withdrawal
and tolerance are features of physiological dependence
[40,42]. Although gambling and some substances do not
induce physiological dependence, withdrawal symptoms
can also be present in people with these disorders ,
and individuals with gaming problems report them as
well [13,14]. As noted in Table 1, instruments have
assessed withdrawal in the context of gaming, often
using symptoms reflecting negative mood states (e.g. sad,
anxious) and active symptoms (e.g. restless, irritable).
Withdrawal symptoms associated with gaming must
be distinguished from emotions that arise in response to
an external force preventing or stopping a gaming
episode. If a parent abruptly disconnects the internet
during a game, a child is likely to express extreme emo-
tions. These abrupt emotional responses, however, are
not withdrawal. Withdrawal refers to symptoms that
arise when one is unable to initiate gaming, and/or when
one is purposefully trying to stop gaming.
Tolerance is characterized by an increasing dosage or
amount of time spent in an activity to feel its desired
ment.Tolerance is a criterion for substance use and gam-
bling disorders, and it has been represented in most
instruments evaluating internet gaming disorder, albeit
in different contexts. For example, some instruments
assess playing longer than intended, or feeling unable to
stop once starting play [17,39]. Many individuals who
play video games, including those without any problems,
report playing longer than intended [16,24,44] or being
Nancy M. Petry et al.
© 2014 Society for the Study of Addiction
unable to stop once they start . However, these
reactions can occur even the first time one plays, and
therefore do not represent tolerance which, by definition,
takes time and experience to develop. Table 1 shows the
wording that the authors of this paper voted as best
reflecting tolerance in the context of gaming. Tolerance
refers to feeling the need to play games for longer periods
of time to experience excitement; it may also involve the
need for more exciting games or more powerful media
Unsuccessful attempts to stop or reduce
A persistent desire or unsuccessful attempts to stop or
reduce is another criterion in diagnosing substance use
and gambling disorders, as well as internet gaming disor-
der. As seen inTable 1, this criterion has been assessed in
most gaming instruments. Inquiries about this criterion
should focus not only on attempts to stop but also
attempts to cut down or reduce gaming. Similarly, desir-
do so, would reflect the criterion, because such desires
presume that play has risen to a problematic level.
Loss of interest in other hobbies or activities
In diagnosing substance use disorders, another criterion
relates to marked reductions in other recreational activi-
ties. The substance use behaviors dominate, with a
decline in other social and recreational activities. This
construct has been referred to as ‘behavioral salience’, or
narrowing of activities in favor of the addictive behavior.
A method to address this criterion involves asking if indi-
viduals have lost interest in (or participate less often in)
other activities or hobbies, including meeting with
friends, because of gaming. Table 1 provides suggested
Excessive gaming despite problems
A substance use disorder criterion relates to continued
use despite knowledge of a persistent physical or psycho-
logical problem associated with drug use. In the case of
gaming, the individual continues to play even though he
is aware of significant negative consequences of this
behavior, which are more likely to be psychosocial than
physical in nature. This construct has been represented
in many internet gaming surveys (Table 1), but is often
item reflecting the criterion, detailing some negative con-
sequences such as being late to school/work, spending
too much money, having arguments or neglecting
important duties due to gaming. Gaming may adversely
influence health (e.g. losing too much sleep), although
and significant. To fulfill the criterion, negative conse-
quences must involve central areas of functioning, and
(e.g. neglecting household chores that do not cause diffi-
culties). Social and developmental aspects should be con-
sidered because dysfunction will manifest differentially
based on age (e.g. school, work, parents, partners).
Another criterion (criterion 9) relates to jeopardizing
or actually losing important relationships or vocational/
educational opportunities because of gaming. In distin-
guishing between the two criteria, the consequences
need not be as severe to meet this criterion relative to
This criterion, drawn from gambling disorder, refers to
individuals lying to others about, or covering up the
extent of, behaviors. Typically, deceit is directed towards
family members, friends or other important people.
Several instruments have inquired about concealing
gaming, leading to the recommended wording inTable 1.
to lie about or hide gaming than a child living with
parents. Nevertheless, gaming that has risen to a level
such that the individual is hiding it from others implies
that it has become problematic.
Escape or relief from a negative mood
This criterion also parallels one used to diagnose gam-
bling disorder. It relates to engaging in a behavior to
escape from or relieve negative moods, such as helpless-
ness, guilt, anxiety or depression. The problem behavior
becomes a method to modify moods or cope with difficul-
ties. This criterion can relate to playing games to escape
from or forget about real-life problems or relieve negative
emotional states, as noted in Table 1.
Gaming to escape adverse moods should be distin-
terion 2). Because some withdrawal symptoms have
overlap with adverse moods, the same symptoms and
responses to them should not be reflected in both criteria.
Importantly, this criterion is intended to refer to gaming
in response to feelings of sadness, depression or anxiety
that arise from personal situations largely unrelated to
Jeopardized or lost a relationship, job or educational or
This is one of the most severe symptoms associated with
nearly lost, an important relationship or opportunity
Internet gaming disorder
© 2014 Society for the Study of Addiction
related to schooling or employment due to the problem
behavior (Table 1). It is intended to reflect more substan-
tial issues than neglecting a homework assignment or
being late for school or work due to gaming, behaviors
more consistent with criterion 6. Arguments with
parents about gaming usually do not rise to a level in
which relationships are severed, but if a relationship
is jeopardized due to gaming (e.g. arguments involv-
ing physical force or leaving home) then this criterion
would be met. Similarly, if neglecting studies in order to
game occurs to the extent that a much worse than usual
overall course grade is achieved, courses are failed or the
person drops out of school, then this criterion would
The wording in Table 1 represents the authors’ votes
related to the intended meaning behind the internet
gaming disorder criteria proposed in the DSM-5. Others
not agree with the suggestions herein. Section 3 of the
DSM-5 is designed to stimulate further research, and for
internet gaming disorder research is needed foremost to
determine if these nine criteria represent defining fea-
tures of the condition and if the suggested wording is
appropriate. Similarly to other psychiatric disorders,
no gold standard exists by which to classify the condi-
tion and, typically, independent clinical interviews or
treatment-seeking behavior is used as a validator. Some
studies have found that particular criteria may not add to
diagnostic accuracy. For example, Tao et al.  found
ing those with a significant gaming problem from those
without and recommended its removal. In contrast,
Gentile [23,46] found that a deception item did add to
diagnostic accuracy, but that an item tapping gaming to
escape from bad feelings was very frequently endorsed
and not useful in distinguishing problems. Further
studies are needed to determine if each of the nine pro-
posed criteria add meaningfully to diagnosis.
In addition to ascertaining if each of these criteria is
unique and important in classifying internet gaming dis-
order, the optimal threshold for diagnosis must be deter-
mined. The proposed cut-point of five criteria was
conservatively chosen in the DSM-5, because low thresh-
olds will inflate diagnoses and result in classifying
individuals who have not suffered significant clinical
impairment. Overdiagnosis holds the potential to under-
mine the importance and significance of true psychiatric
disorders, especially in the context of ‘behavioral addic-
tions’ . When the criteria applied reflect clinically
significant symptoms, however, a lower cut-point may
classify people with a true disorder more accurately, as
appears to be the case with substance use and gambling
Research is also needed to evaluate the reliability and
creating screening instruments for unique populations.
Other wording than that suggested inTable 1 may gauge
the criteria more accurately or may be understood more
readily. To simplify the language or to determine specific
problems or consequences related to gaming, the all-
components; affirmative responses to any one emotion,
aspect or problem related to that criterion would reflect
meeting it. For younger children, parental versions may
need to be developed, focusing upon behavioral aspects.
Instruments are needed that gauge the criteria simply
and expeditiously, but comprehensively.
Establishing the psychometric properties of instru-
ments assessing these nine criteria should begin using a
cross-cultural perspective. The disorder may manifest
differently across cultures, and a greater understanding
of cultural differences in its expression is needed. Never-
theless, criteria should be valid across cultures. Simi-
larly, the criteria should be valid across gender and age
groups, ranging from primary-age children to teenagers
and young adults as well as older adults. Although dif-
ferences in consequences experienced may vary based
on gender and age, females as well as males, and chil-
dren as well as adults, develop problems with gaming,
and diagnostic criteria should be applicable regardless of
gender and age, even if response patterns to specific
The frequencies with which symptoms occur for a cri-
terion to be met also require study.The DSM-5 proposes a
past-year time-frame for diagnosis, but within a 1-year
period a single occurrence of some symptoms may be
sufficient to meet the criterion (i.e. jeopardize or lose a
significant relationship or vocational opportunity);
others may need to occur repeatedly for the criterion to
be endorsed (e.g. pre-occupation, attempts to reduce or
Once the optimal criteria, frequencies of symptoms,
threshold for diagnosis and reliable and valid question-
naires are established, epidemiological surveys, drawing
from representative samples spanning youth to older
adults in countries around the world, need to ascertain
prevalence rates. An understanding of the natural
course of the disorder is paramount, because if symp-
toms often subside within a short time-frame and do not
occur again, the condition might not reach clinical sig-
nificance. Research related to comorbidities with other
psychiatric conditions and assessment of biological fea-
tures will assist in determining if internet gaming disor-
der is an independent disorder or aligned more closely to
Nancy M. Petry et al.
© 2014 Society for the Study of Addiction
other disorders. Additionally, its potential overlap with
substance use and gambling disorders requires greater
study to determine if internet gaming disorder is best
represented as a ‘behavioral addiction’ or under another
Although many issues remain to be addressed, this
paper provides a clear direction for researchers and clini-
cians. The authors of this paper voted that the wording
and meanings outlined above best reflect the DSM-5 cri-
teria for internet gaming disorder, but achieving consen-
sus in theory is simpler than applying it in practice.
Preferences for particular instruments, or even the inclu-
sion or exclusion of specific DSM-5 criteria, are bound to
impact researchers’ and clinicians’ assessment of these
constructs. Nevertheless, to treat and ultimately prevent
or reduce problems with internet gaming, the field needs
to converge to ensure that all are referring to a similar
behavioral syndrome.This international consensus is the
first to provide such a perspective.
Declaration of interests
No authors report any financial conflicts of interest asso-
ciated with the paper. Drs Petry, Auriacombe, Borges and
O’Brien served on the American Psychiatric Association
Workgroup for Substance Use and Related Disorders
for the DSM-5. The views and opinions expressed in
this paper are those of the authors and should not be
construed to represent the views of any sponsoring
organizations, agencies or governments.
We thank Drs Jean-Marc Alexandre, Leonardo Andrade,
Ayse Baris, Duysen Baykut, Isadora Borges, Francesco
Bricolo, Romain Debrabant, Cécile Denis, Mélina Fatséas,
Janina Grothues, Michie Hesselbrock, Susumu Higuchi,
Suzuki, and Patricia Hahn, Adriana Coler, Donald Lee,
Harold Lee and Mamiko Merner for assistance with
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Additional Supporting Information may be found in the
online version of this article at the publisher’s web-site:
Appendix S1 Translations of the criterion items for
internet gaming disorder.
Nancy M. Petry et al.
© 2014 Society for the Study of Addiction