Journal of Behavioral Addictions

Published by Akadémiai Kiadó
Online ISSN: 2062-5871
Publications
Article
Background: Following the publication of our paper ‘Muscle Dysmorphia: Could it be classified as an addiction to body image?’ in the Journal of Behavioral Addictions, two commentaries by Jon Grant and Johanna Nieuwoudt were published in response to our paper. Method: Using the ‘addiction components model’, our main contention is that muscle dysmorphia (MD) actually comprises a number of different actions and behaviors and that the actual addictive activity is the maintaining of body image via a number of different activities such as bodybuilding, exercise, eating certain foods, taking specific drugs (e.g., anabolic steroids), shopping for certain foods, food supplements, and purchase or use of physical exercise accessories. This paper briefly responds to these two commentaries. Results: While our hypothesized specifics relating to each addiction component sometimes lack empirical support (as noted explicitly by both Nieuwoudt and Grant), we still believe that our main thesis (that almost all the thoughts and behaviors of those with MD revolve around the maintenance of body image) is something that could be empirically tested in future research by those who already work in the area. Conclusions: We hope that the ‘Addiction to Body Image’ model we proposed provides a new framework for carrying out work in both empirical and clinical settings. The idea that MD could potentially be classed as an addiction cannot be negated on theoretical grounds as many people in the addiction field are turning their attention to research in new areas of behavioral addiction.
 
Article
Background and aims: Based on social disorganization theory, the present study examined the effects of neighborhood disadvantage on gambling behaviors and problems as well as on alcohol use and abuse. Methods: Findings were based on a combined sample of two representative U. S. telephone surveys of gambling and substance use. One survey (n = 2,631) included adults 18 years and older and the second survey (2,274) included young people aged 14-21 years old. Results: Neighborhood disadvantage had a highly significant effect on problem gambling over and above the significant individual effects of gender, age, race/ethnicity and socioeconomic status. Alcohol abuse did not show the same relationship to neighborhood disadvantage as did problem gambling. Furthermore, when neighborhood disadvantage was high and individual socioeconomic status was low, the highest levels of problem gambling were observed. Conclusions: This study provides strong evidence for the effects of neighborhood ecology on the occurrence of problem gambling.
 
Article
Background: Following the first association between the dopamine D2 receptor gene polymorphism and severe alcoholism, there has been an explosion of research reports in the psychiatric and behavioral addiction literature and neurogenetics. With this increased knowledge, the field has been rife with controversy. Moreover, with the advent of Whole Genome-Wide Studies (GWAS) and Whole Exome Sequencing (WES), along with Functional Genome Convergence, the multiple-candidate gene approach still has merit and is considered by many as the most prudent approach. However, it is the combination of these two approaches that will ultimately define real, genetic allelic relationships, in terms of both risk and etiology. Since 1996, our laboratory has coined the umbrella term Reward Deficiency Syndrome (RDS) to explain the common neurochemical and genetic mechanisms involved with both substance and non-substance, addictive behaviors. Methods: This is a selective review of peer-reviewed papers primary listed in Pubmed and Medline. Results: A review of the available evidence indicates the importance of dopaminergic pathways and resting-state, functional connectivity of brain reward circuits. Discussion: Importantly, the proposal is that the real phenotype is RDS and impairments in the brain's reward cascade, either genetically or environmentally (epigenetically) induced, influence both substance and non-substance, addictive behaviors. Understanding shared common mechanisms will ultimately lead to better diagnosis, treatment and prevention of relapse. While, at this juncture, we cannot as yet state that we have "hatched the behavioral addiction egg", we are beginning to ask the correct questions and through an intense global effort will hopefully find a way of "redeeming joy" and permitting homo sapiens live a life, free of addiction and pain.
 
Correlations between values of the BST, the BSI-GSI and the s-IATsex 
Article
Background and aims: Some individuals consume cybersex contents, such as pornographic material, in an addictive manner, which leads to severe negative consequences in private life or work. One mechanism leading to negative consequences may be reduced executive control over cognition and behavior that may be necessary to realize goal-oriented switching between cybersex use and other tasks and obligations of life. Methods: To address this aspect,we investigated 104 male participants with an executive multitasking paradigm with two sets: One set consisted of pictures of persons, the other set consisted of pornographic pictures. In both sets the pictures had to be classified according to certain criteria. The explicit goal was to work on all classification tasks to equal amounts, by switching between the sets and classification tasks in a balanced manner. Results: We found that less balanced performance in this multitasking paradigm was associated with a higher tendency towards cybersex addiction. Persons with this tendency often either overused or neglected working on the pornographic pictures. Discussion: The results indicate that reduced executive control over multitasking performance, when being confronted with pornographic material, may contribute to dysfunctional behaviors and negative consequences resulting from cybersex addiction. However, individuals with tendencies towards cybersex addiction seem to have either an inclination to avoid or to approach the pornographic material, as discussed in motivational models of addiction.
 
Article
Decision-making and risk-taking behavior undergo developmental changes during adolescence. Disadvantageous decision-making and increased risk-taking may lead to problematic behaviors such as substance use and abuse, pathological gambling and excessive internet use. Based on MEDLINE searches, this article reviews the literature on decision-making and risk-taking and their relationship to addiction vulnerability in youth. Decision-making and risk-taking behaviors involve brain areas that undergoing developmental changes during puberty and young adulthood. Individual differences and peer pressure also relate importantly to decision-making and risk-taking. Brain-based changes in emotional, motivational and cognitive processing may underlie risk-taking and decision-making propensities in adolescence, making this period a time of heightened vulnerability for engagement in additive behaviors.
 
Article
This commentary addresses a recent article on the characterization of muscle dysmorphia as an addiction. The commentary examines the larger issue of the possible relationship of compulsions to addictions. It also questions whether understanding the heterogeneity within disorders may be a useful tactic to develop more targeted treatment approaches.
 
Article
Recent work has studied multiple addictions using a matrix measure, which taps multiple addictions through single responses for each type. The present study investigated use of a matrix measure approach among former alternative high school youth (average age = 19.8 years) at risk for addictions. Lifetime and last 30-day prevalence of one or more of 11 addictions reviewed in other work (Sussman, Lisha & Griffiths, 2011) was the primary focus (i.e., cigarettes, alcohol, other/hard drugs, eating, gambling, Internet, shopping, love, sex, exercise, and work). Also, the co-occurrence of two or more of these 11 addictive behaviors was investigated. Finally, the latent class structure of these addictions, and their associations with other measures, was examined. We found that ever and last 30-day prevalence of one or more of these addictions was 79.2% and 61.5%, respectively. Ever and last 30-day co-occurrence of two or more of these addictions was 61.5% and 37.7%, respectively. Latent Class Analysis suggested two groups: a generally Non-addicted Group (67.2% of the sample) and a "Work Hard, Play Hard"-addicted Group that was particularly invested in addiction to love, sex, exercise, the Internet, and work. Supplementary analyses suggested that the single-response type self-reports may be measuring the addictions they intend to measure. We suggest implications of these results for future studies and the development of prevention and treatment programs, though much more validation research is needed on the use of this type of measure.
 
Model fit of the three confirmatory factor analyses estimated 
Music motives as predictors of health indicators and social issues 
Music motives and drinking motives as predictors of health indicators and social issues 
Article
Background and aims: This study investigated whether adolescents who drink and those who are teetotal differ in the link between music motives and health-related outcomes (life satisfaction, self-rated health, school pressure, somatic complaints, depressed and aggressive mood, physical powerlessness, frequency of being bullied and bullying others and evenings spent out with friends). It also looked at whether associations between music motives and health-related outcomes remained significant when drinking motives were included among drinkers. Methods: Confirmatory factor analysis and structural equation models were estimated based on data from 4,481 adolescents from Switzerland (mean age 14.5, SD = 0.9). Results: It was confirmed that the four music motives and the four drinking motives obtained by crossing the valence (positive–negative) and the source (internal–external) of expected change in affect form distinct dimensions (i.e. the 8-factor model best fitted the data). Drinkers and non-drinkers differed in the various links between music motives and health-related outcomes. For example, almost all the links between conformity music motives and the health-related outcomes were significant for non-drinkers but not for drinkers. Enhancement music motives, by contrast, were often significant for drinkers but not for non-drinkers. Coping music motives were significant among both drinkers and non-drinkers. These links were basically unchanged when drinking motives were taken into account. Discussion and conclusions: This study indicates that music serves important functions in the lives of adolescents, even among those who use alcohol for different motives. This makes listening to music a promising potential alternative to alcohol use.
 
Health and well-being measures and problem-gambling severity in fighting and non-fighting adolescents 
Gambling measures and problem-gambling severity in fighting and non-fighting adolescents 
Article
Physical fighting and gambling are common risk behaviors among adolescents. Prior studies have found associations among these behaviors in adolescents but have not examined systematically the health and gambling correlates of problem-gambling severity amongst youth stratified by fight involvement. Survey data were used from 2,276 Connecticut high-school adolescents regarding their physical fight involvement, gambling behaviors and perceptions, and health and functioning. Gambling perceptions and correlates of problem-gambling severity were examined in fighting and non-fighting adolescents. Gambling perceptions were more permissive and at-risk/problem gambling was more frequent amongst adolescents reporting serious fights versus those denying serious fights. A stronger relationship between problem-gambling severity and regular smoking was observed for adolescents involved in fights. The more permissive gambling attitudes and heavier gambling associated with serious fights in high-school students suggest that youth who engage in physical fights warrant enhanced prevention efforts related to gambling. The stronger relationship between tobacco smoking and problem-gambling severity amongst youth engaging in serious fights suggest that fighting youth who smoke might warrant particular screening for gambling problems and subsequent interventions.
 
Article
Background and aims: Past research suggests that sleep problems are associated with increased risky decision-making. Similarly, gambling disorder and alcohol use disorder are also associated with increased risky decision-making. Individuals with gambling disorder or alcohol use disorder have also reported higher rates of sleep problems compared to normal healthy controls. As such, we sought to examine whether sleep problems play a role in the development of alcohol use disorder or gambling disorder. Methods: One hundred and forty-one individuals who gamble and use alcohol, yet do not meet criteria for gambling disorder or alcohol use disorder, were assessed to determine the correlation between sleepiness, amount of sleep obtained, decision-making, and alcohol or gambling behaviors. Results: Our results suggest that inconsistent sleep patterns may be associated with increased frequency of alcohol use and gambling. We did not, however, find a significant correlation between sleep factors and decision-making. Discussion: Further research is needed to examine the specific relationship between sleep patterns and alcohol use and gambling frequency. Overall these data suggest that sleepiness or sleep and risky decision-making is not a significant factor in gambling and alcohol use behaviors in individuals not meeting criteria for alcohol use disorder or gambling disorder.
 
Article
Internet use has become a popular entertainment source and has become highly integrated into daily life. However, some people display problematic or addictive usage of the Internet. The present study attempts to fill current knowledge gaps regarding at-risk/problematic Internet use (ARPIU) and its relation to various health and functioning measures. Online survey data from 755 adults in the United States were analyzed using chi-square and ANOVAs. The ARPIU group did not differ from the non-ARPIU group with respect to substance use. Individuals with ARPIU were, however, more likely to report at-risk/problematic engagement in video-game playing and gambling. Compared to the non-ARPIU group, the ARPIU group reported poorer self-control and higher levels of impulsivity and depression. ARPIU appears associated with other risk behaviors, particularly those that might be performed on the Internet. Future studies should examine the extent to which the Internet may promote engagement in these risk behaviors and the extent to which preventative interventions targeting better self-control or negative mood states might help a range of non-substance-related addictive behaviors.
 
Associations between psychiatric diagnoses and gambling severity among respondents with no/low and moderate/severe pain interference 
Article
A paucity of studies has examined the association between gambling and pain interference. We examined differences in the associations of gambling problem severity and psychiatric disorders among a nationally representative sample of adults with varying levels of pain interference. Chi-square tests and logistic regression analyses were performed on National Epidemiologic Survey on Alcohol and Related Conditions data from 41,987 adult respondents (48% men; 52% women), who were categorized according to two levels of pain interference (i.e., no or low pain interference [NLPI] or moderate or severe pain interference [MSPI]) and three levels of gambling problem severity (i.e., non-gamblers or low-frequency gamblers [NG], low-risk or at-risk gamblers [LRG], and problem or pathological gamblers [PPG]). MSPI respondents exhibited higher rates of PPG than NLPI respondents. Categories of Axis I disorders and clusters of mood, anxiety and substance-use disorders showed similarly strong associations with problem-gambling severity in MSPI and NLPI groups. Similarly strong associations between Axis II disorders (and each cluster - A, B and C) and problem-gambling severity were also observed in MSPI and NLPI groups. Exploratory analyses suggested potentially stronger relationships between PPG and dysthymia, panic disorder, and dependent personality disorder and LRG and specific phobia in NLPI compared to MSPI respondents. While MSPI is associated with PPG, largely similar patterns of associations across pain-interference levels were observed between problem-gambling severity and Axis I and Axis II psychiatric disorders.
 
Article
Background and aims: The aim of the present study was to test the impulsivities and compulsivities of behavioral addictions, including Internet gaming disorder (IGD) and gambling disorder (GD), by directly comparing them with alcohol use disorder (AUD) and a healthy control (HC) group. Methods: We enrolled male patients who were diagnosed with IGD, GD or AUD, with 15 patients per group, as well as 15 HCs. Trait impulsivity was measured using the Barratt Impulsiveness Scale version 11 (BIS-11). The stop-signal test (SST) from the Cambridge Neuropsychological Test Automated Battery (CANTAB) was used to assess the patients’ abilities to inhibit prepotent responses. Compulsivity was measured using the intra–extra dimensional set shift (IED) test from the CANTAB. The Trail Making Test (TMT) was also used in this study. Results: The IGD and AUD groups scored significantly higher on the BIS-11 as a whole than did the HC group (p = 0.001 and p = 0.001, respectively). The IGD and AUD groups also scored significantly higher on the BIS-11 as a whole than did the GD group (p = 0.006 and p = 0.001, respectively). In addition, the GDgroup made significantly more errors (p = 0.017 and p = 0.022, respectively) and more individuals failed to achieve criterion on the IED test compared with the IGD and HC groups (p = 0.018 and p = 0.017, respectively). Discussion: These findings may aid in the understanding of not only the differences in categorical aspects between individuals with IGD and GD but also in impulsivity–compulsivity dimensional domains. Conclusion: Additional studies are needed to elucidate the neurocognitive characteristics of behavioral addictive disorders in terms of impulsivity and compulsivity.
 
Demographic characteristics of all participants 
Means and S.D. of ratings of sexual compulsivity, anxious and avoidant attachment in all participants 
Article
Background and aims: Sexual addiction, also known as hypersexual disorder, is associated with serious psychosocial problems for many people. Methods: This study used questionnaires to investigate the effects of gender, sexual orientation and attachment (avoidance and anxiety) on sexual compulsion among 100 heterosexual and homosexual men and women. Results: A positive correlation was found between anxious attachment and sexual compulsivity (r =0.46; p < 0.01) and a positive correlation between avoidant attachment and sexual compulsivity (r = 0.39; p £ 0.01) in all participants. Secondly, an analysis of covariance showed a gender by sexual orientation interaction effect [F(1,103) = 6.39, p < 0.01] but no attachment effect on sexual compulsivity. A follow-up comparison showed that lesbian women had higher rates of sexual compulsivity than heterosexual women [t(2, 50) = 5.08, p < 0.001] whereas there was non-significant difference in sexual compulsivity between homosexual and heterosexual men [t(2, 50) = 1.30,p = N.S.]. Discussion: The results provide preliminary evidence for an association between attachment and sexual compulsivity and the effects of gender and sexual orientation on sexual compulsivity.
 
Percentage of compulsive buyers by available money and current economic situation 
Two-way analysis of variance (country by gender and available money as a z-scored covariate on the Compulsive Buying Index 
Binary logistical regression "country and gender" predicting percentage of compulsive buying 
Binary logistical regression "country and gender" predicting percentage of compensatory buying 
Article
Background and aims: Few studies about compulsive buying consider the economic framing situation. This study is concerned with the impact of different economic environments - the crisis in Greece vs. the boom in Turkey - on compulsive buying tendencies of students, while taking the role of gender and available money into account. Methods: Compulsive buying was measured by a Greek and Turkish translation of the German Compulsive Buying Scale (Raab, Neuner, Reisch & Scherhorn, 2005) in Greece and Turkey, which enabled an identification of compulsive and compensatory buyers. The questionnaires were administered to 119 Turkish and 123 Greek students (n = 242) enrolled in several universities in Athens and Istanbul. The data collection was conducted in a controlled and standardized way, namely in group-sessions lasting about 5 minutes, which were conducted and supervised by co-workers of the involved universities. Results: The results have shown that the percentage of compensatory buyers, but not compulsive buyers, within the Greek students sample was significantly smaller than within the Turkish student sample. Further as assumed the moderation of the economic situation could be confirmed: More available money only has a facilitating effect on compulsive buying tendencies under a positive economic environment. Conclusions: Anticipations about the financial situation and the general economic climate are more relevant for compulsive buying tendencies than one's actual available money. Compensatory, but not compulsive buying was significantly smaller under crisis.
 
Factor loading and communality of each item 
Factor loading of each item for two oblique rotations 
Analysis of items of the Chinese translation of the German Compulsive Buying Scale (GCBS) 
Analysis of covariance for gender and location, with age as covariate 
Article
Background and aims: Compulsive buying is a severe phenomenon, especially among younger consumers. It is well documented in Western industrial societies like the USA and Germany, and nowadays an increasing interest in compulsive buying in non-Western countries is on the rise. Methods: In the current study, we measured the prevalence of compulsive buying tendencies among Chinese female and male students by using a Chinese translation of the German Compulsive Buying Scale (Raab, Neuner, Reisch & Scherhorn, 2005). We examined the influence of gender, location and age using ANCOVA, and binary logistic regression. Results: Factor analysis identified three factorial dimensions of compulsive buying tendencies which are impairment of impulse control and reactive or compensatory aspects, reduced rationality according to money spending, and post-purchase guilt. Our results indicated that about 6.7% of the sample shows a compulsive buying pattern, and that females are more affected. For location, a geographic difference between Chongqing and Fuzhou was found for the overall compulsive tendencies, but not for the percentages of compulsive buyers. Conclusions: In sum, the existing study provides evidence that Chinese consumers have a factorial structure which differs somewhat in compulsive buying from Western samples. Observations about gender and location were considered. These findings give a deeper understanding of China’s compulsive buying behavior.
 
Results from multivariable modeling: Factors associated with compulsive sexual behavior 
Associations between specific PTSD symptom clusters and compulsive sexual behavior among those with a PTSD diagnosis 
Article
Background and aims: Compulsive sexual behavior (CSB) is highly prevalent among men, often co-occurring with psychiatric disorders and traumatic experiences. Psychiatric disorders and trauma are highly prevalent among military veterans, yet there is a paucity of research on CSB among military samples. The aim of this study was to examine the prevalence of and factors associated with CSB among male military veterans. Methods: Surveys were administered to veterans of Operations Iraqi Freedom, Enduring Freedom, or New Dawn at baseline (n = 258), 3 months (n = 194), and 6 months (n = 136). Bivariate analyses and Generalized Estimating Equations were utilized to estimate associations between CSB and the following variables: psychiatric co-morbidity, childhood physical or sexual trauma, pre- and post-deployment experiences, TV/ Internet usage, and sociodemographics. Associations between CSB and specific PTSD symptom clusters were also examined. Results: CSB was reported by 16.7% of the sample at baseline. Several variables were associated with CSB in bivariate analyses; however, only PTSD severity, childhood sexual trauma, and age remained significant in multivariable GEE models. The PTSD symptom cluster re-experiencing was most strongly associated with CSB. Discussion: This exploratory study suggests that CSB is prevalent amongst veterans returning from combat and is associated with childhood trauma and PTSD, particularly re-experiencing. Conclusions: Further study is needed to identify the mechanisms linking PTSD and CSB, define the context and severity of CSB in veterans, and examine the best ways to assess and treat CSB in VA clinical settings.
 
Article
Background and aims: As only a minority of pathological gamblers (PGr) presents for treatment, further knowledge about help-seeking behavior is required in order to enhance treatment utilization. The present study investigated factors associated with treatment participation in gamblers in Germany. As subclinical pathological gamblers (SPGr, fulfilling one to four DSM-IV-criteria) are target of early intervention due to high risk of transition to pathological gambling, they were subject of special interest. Methods: The study analyzed data from a general population survey (n = 234, SPGr: n = 198, PGr: n = 36) and a treatment study (n = 329, SPGr: n = 22, PGr: n = 307). A two-step weighting procedure was applied to ensure comparability of samples. Investigated factors included socio-demographic variables, gambling behavior, symptoms of pathological gambling and substance use. Results: In PGr, regular employment and non-German nationality were positively associated with being in treatment while gambling on the Internet and gaming machines and fulfilling more DSM-IV-criteria lowered the odds. In SPGr, treatment attendance was negatively associated with married status and alcohol consumption and positively associated with older age, higher stakes, more fulfilled DSM-IV criteria and regular smoking. Conclusions: In accordance to expectations more severe gambling problems and higher problem awareness and/or external pressure might facilitate treatment entry. There are groups with lower chances of being in treatment: women, ethnic minorities, and SPGr. We propose target group specific offers, use of Internet-based methods as possible adaptions and/or extensions of treatment offers that could enhance treatment attendance.
 
Results of hierarchical regression analysis for investigating the relationship between the variables in male and female students 
Coefficients of hierarchical regression analysis for investigating the relationship between the variables in normal and ADHD students 
Article
Background and aims: Over the last two decades, research into video game addiction has grown increasingly. The present research aimed to examine the relationship between video game addiction, self-control, and academic achievement of normal and ADHD high school students. Based on previous research it was hypothesized that (i) there would be a relationship between video game addiction, self-control and academic achievement (ii) video game addiction, self-control and academic achievement would differ between male and female students, and (iii) the relationship between video game addiction, self-control and academic achievement would differ between normal students and ADHD students. Methods: The research population comprised first grade high school students of Khomeini-Shahr (a city in the central part of Iran). From this population, a sample group of 339 students participated in the study. The survey included the Game Addiction Scale (Lemmens, Valkenburg & Peter, 2009), the Self-Control Scale (Tangney, Baumeister & Boone, 2004) and the ADHD Diagnostic checklist (Kessler et al., 2007). In addition to questions relating to basic demographic information, students' Grade Point Average (GPA) for two terms was used for measuring their academic achievement. These hypotheses were examined using a regression analysis. Results: Among Iranian students, the relationship between video game addiction, self-control, and academic achievement differed between male and female students. However, the relationship between video game addiction, self-control, academic achievement, and type of student was not statistically significant. Conclusions: Although the results cannot demonstrate a causal relationship between video game use, video game addiction, and academic achievement, they suggest that high involvement in playing video games leaves less time for engaging in academic work.
 
IADQ responses at onset of treatment 
Comparisons of the means (SD) of IADQ at the fives measurement points 
Article
Background and aims: Internet Gaming Disorder, a subtype of Internet Addiction, is now classified in Section 3 of the DSM-5. Cognitive behavioral therapy (CBT) has been suggested in treating Internet addiction as this modality has been shown to be an effective treatment for similar impulse control disorders. Given the daily and necessary use of the Internet and technology in general compared to other compulsive syndromes, a specialized form of CBT has been developed called Cognitive-Behavioral Therapy for Internet Addiction (CBT-IA). CBT-IA is a comprehensive three phase approach that includes behavior modification to control compulsive Internet use, cognitive restructuring to identify, challenge, and modify cognitive distortions that lead to addictive use, and harm reduction techniques to address and treat co-morbid issues associated with the disorder. Methods: As the first model of its kind, this study examines 128 clients to measure treatment outcomes using CBT-IA. Clients were evaluated using the Internet Addiction Test (IAT) to classify subjects and were administered twelve weekly sessions of CBT-IA. Treatment outcomes were measured at the end of the twelve weeks, one-month, three months and at six month post-treatment. Results: RESULTS showed that over 95% of clients were able to manage symptoms at the end of the twelve weeks and 78% sustained recovery six months following treatment. Discussion and conclusions: RESULTS found that CBT-IA was effective at ameliorating symptoms associated with Internet addiction after twelve weekly sessions and consistently over one-month, three months, and six months after therapy. Further research implications such as investigating long-term outcome effects of the model with larger client populations and treatment differences among the subtypes of Internet addiction or with other cultural populations using CBT-IA are discussed.
 
Flow in relation to video game play. Adapted from Csíkszentmihályi (1992)
Article
Aims: Video games provide opportunities for positive psychological experiences such as flow-like phenomena during play and general happiness that could be associated with gaming achievements. However, research has shown that specific features of game play may be associated with problematic behaviour associated with addiction-like experiences. The study was aimed at analysing whether certain structural characteristics of video games, flow, and global happiness could be predictive of video game addiction. Method: A total of 110 video game players were surveyed about a game they had recently played by using a 24-item checklist of structural characteristics, an adapted Flow State Scale, the Oxford Happiness Questionnaire, and the Game Addiction Scale. Results: The study revealed decreases in general happiness had the strongest role in predicting increases in gaming addiction. One of the nine factors of the flow experience was a significant predictor of gaming addiction - perceptions of time being altered during play. The structural characteristic that significantly predicted addiction was its social element with increased sociability being associated with higher levels of addictive-like experiences. Overall, the structural characteristics of video games, elements of the flow experience, and general happiness accounted for 49.2% of the total variance in Game Addiction Scale levels. Conclusions: Implications for interventions are discussed, particularly with regard to making players more aware of time passing and in capitalising on benefits of social features of video game play to guard against addictive-like tendencies among video game players.
 
A conceptual model of online shopping addiction (OSA)
Article
Background: Compulsive and addictive forms of consumption and buying behaviour have been researched in both business and medical literature. Shopping enabled via the Internet now introduces new features to the shopping experience that translate to positive benefits for the shopper. Evidence now suggests that this new shopping experience may lead to problematic online shopping behaviour. This paper provides a theoretical review of the literature relevant to online shopping addiction (OSA). Based on this selective review, a conceptual model of OSA is presented. Method: The selective review of the literature draws on searches within databases relevant to both clinical and consumer behaviour literature including EBSCO, ABI Pro-Quest, Web of Science - Social Citations Index, Medline, PsycINFO and Pubmed. The article reviews current thinking on problematic, and specifically addictive, behaviour in relation to online shopping. Results: The review of the literature enables the extension of existing knowledge into the Internet-context. A conceptual model of OSA is developed with theoretical support provided for the inclusion of 7 predictor variables: low self-esteem, low self-regulation; negative emotional state; enjoyment; female gender; social anonymity and cognitive overload. The construct of OSA is defined and six component criteria of OSA are proposed based on established technological addiction criteria. Conclusions: Current Internet-based shopping experiences may trigger problematic behaviours which can be classified on a spectrum which at the extreme end incorporates OSA. The development of a conceptual model provides a basis for the future measurement and testing of proposed predictor variables and the outcome variable OSA.
 
Article
Purpose: Evidences indicate that Internet addiction disorder (IAD) has a higher risk of developing aggression and violent behavior. A few correlation studies between IAD and aggression have implicated a common biological mechanism. However, neurobiological approaches to IAD and aggression have not yet been studied. Methods: A literature search for studies for Internet addiction disorder or aggression was performed in the PubMed database and we selected articles about neurobiology of IAD or aggression. Results: This review includes (a) common neural substrates such as the prefrontal cortex and the limbic system between aggression and IAD; (b) common neuromodulators such as dopamine, norepinephrine, serotonin, opiate and nicotine between aggression and IAD. Conclusions: Through reviewing the relevant literature, we suggested the possibility of common neurobiology between the two psychiatric phenomena and direction of research on aggression in IAD.
 
Article
Background: Behavioral addiction is an emerging concept based on the resemblance between symptoms or feelings provided by drugs and those obtained with various behaviors such as gambling, etc. Following an observational study of a tango dancer exhibiting criteria of dependence on this dance, we performed a survey to assess whether this case was unique or frequently encountered in the tango dancing community. Methods: We designed an online survey based on both the DSM-IV and Goodman's criteria of dependence; we added questions relative to the positive and negative effects of tango dancing and a self-evaluation of the degree of addiction to tango. The questionnaire was sent via Internet to all the tango dancers subscribing to "ToutTango", an electronic monthly journal. The prevalence of dependence was analyzed using DSM-IV, Goodman's criteria and self-rating scores separately. Results: 1,129 tango dancers answered the questionnaire. Dependence rates were 45.1, 6.9 and 35.9%, respectively, according to the DSM-IV, Goodman's criteria and self-rating scores. Physical symptoms of withdrawal were reported by 20% of the entire sample and one-third described a strong craving for dancing. Positive effects were high both in dependent and non-dependent groups and were markedly greater than negative effects. Long practice of tango dancing did not modify the dependence rate or reduce the level of positive effects. Conclusions: Tango dancing could lead to dependence as currently defined. However, this dependence is associated with marked and sustained positive effects whilst the negative are few. Identifying the precise substratum of this dependence needs further investigation.
 
Preferred terms (ADRs) included in analysis 
Article
Background/aims: Studies have reported higher prevalences of four behavioral addictions (binge eating, compulsive shopping, hypersexuality, and pathological gambling) in dopamine agonist-treated Parkinson's disease relative to non-dopamine agonist-treated Parkinson's. However, recent case-control and epidemiological studies suggest that prevalences of behavioral addictions in dopamine agonist-treated Parkinson's may be similar to background population rates. This study tests that hypothesis by examining the FDA Adverse Event Reporting System (FAERS) for evidence of these associations, taking into account the potential impact of publicity on reporting rates. Methods: FAERS reports in 2004 (pre-publicity for all but pathological gambling) and 2007 (post-publicity for all four behaviors) were analyzed. A threshold consisting of ≥3 cases, proportional reporting ratio ≥2, and χ (2) with Yates' correction ≥4 was used to detect signals (drug-associated adverse reactions) involving any of five dopamine agonists and any of four behavioral addictions. Results: No reports containing compulsive shopping and no signal for binge eating and dopamine agonists were found in either year. A weak signal was found for hypersexuality in 2004, with a stronger signal in 2007. A robust signal was found for pathological gambling in 2004, with a more robust signal in 2007. Discussion/conclusions: These results suggest that publicity may increase reporting rates in the FAERS. Findings for binge eating, compulsive shopping, and hypersexuality suggest that prevalences of these behaviors among those treated with dopamine agonists may be similar to background population rates and thus may not reflect an adverse safety signal. Further investigation of the relationship between dopamine agonists and behavioral addictions is warranted.
 
Article
Background and aims: Adolescent Internet gambling is associated with concomitant addictive behaviors. This study aimed to assess the prevalence of Internet gambling practices, its impact upon psychosocial development and to evaluate the association between gambling practices and Internet addictive behavior among Cypriot adolescents. Methods: A cross-sectional study was conducted in a convenience sample (n = 805) of adolescents attending selected public schools (9th and 10th grades) in Cyprus. Anonymous self-completed questionnaires were used including the Internet Addiction Test and the Strengths and Difficulties Questionnaire. Results: Among the study population (n = 805), approximately one third (n = 28; 34.9%) reported Internet gambling. Internet gamblers were twice as likely to utilize Internet café portals (adjusted odds ratio for gender and age, AOR: 2.13; 95% confidence interval, 95% CI: 1.56-2.91) for interactive game-playing (AOR: 6.84; 95% CI: 4.23-11.07), chat-rooms (AOR: 2.57; 95% CI: 1.31-4.85), and retrieval of sexual information (AOR: 1.99; 95% CI: 1.42-2.81). Among Internet gamblers 26.0% (n = 73) reported borderline addictive Internet use and 4.3% (n = 12) addictive behavior. Internet gamblers more often had comprehensive psychosocial and emotional maladjustment (AOR: 4.00; 95% CI: 1.97-8.13), including Abnormal Conduct Problems (AOR: 3.26; 95% CI: 2.00-5.32), Emotional Symptoms (AOR: 1.78; 95% CI: 1.02-3.11), and Peer Problems (AOR: 2.44; 95% CI: 1.08-5.48) scores. The multivariate regression analyses indicated that the single independent predictor associated with Internet addictive behavior was Internet gambling (AOR: 5.66; 95% CI: 1.45-22.15). Discussion: Internet gambling is associated with addictive Internet use, as well as emotional maladjustment and behavioral problems, among Cypriot adolescents. Conclusions: Longitudinal studies are needed to elucidate whether Internet gambling constitutes a risk factor for the development of Internet addictive behavior among adolescents.
 
Multiple regression analyses of condition and comorbid diagnoses in predicting BESAA scores a 
Multiple regression analyses of HP severity/distress and comorbid diagnoses in predicting BESAA scores a BESAA Appearance Model 1 
Article
Background and aims: Trichotillomania (TTM) often first presents in adolescence, a developmental period marked by vulnerability in body image. To date, no one has studied the relationship between this disorder and body esteem. Methods: 49 adolescents with DSM-IV TTM or chronic hair pulling (HP) and 23 control adolescents were administered diagnostic assessments and self-report measures of hair pulling and body esteem. Results: HP youth vs. controls reported lower levels of body esteem on all Body-Esteem Scale for Adolescents and Adults (BESAA) subscales (appearance, attribution and weight satisfaction). HP contributed to lowered body esteem, independent of comorbid anxiety or depression. As expected, HP youth with vs. without comorbid anxiety or depression reported lowered levels of body esteem. Further, greater HP severity and distress were significantly associated with lower levels of body esteem. HP severity alone but not distress/impairment predicted lower levels of body esteem, independent of comorbid anxiety and depression. Conclusions: Both hair pulling and comorbid anxiety and depression can independently impact body esteem in adolescent hair pullers.
 
Gambling measures by marijuana-use status 
Gambling measures by marijuana-use status and problem-gambling severity 
Health and functioning measures by marijuana-use status and problem-gambling severity 
Article
Background and aims: Gambling is common in adolescents and at-risk and problem/pathological gambling (ARPG) is associated with adverse measures of health and functioning in this population. Although ARPG commonly co-occurs with marijuana use, little is known how marijuana use influences the relationship between problem-gambling severity and health- and gambling-related measures. Methods: Survey data from 2,252 Connecticut high school students were analyzed using chi-square and logistic regression analyses. Results: ARPG was found more frequently in adolescents with lifetime marijuana use than in adolescents denying marijuana use. Marijuana use was associated with more severe and a higher frequency of gambling-related behaviors and different motivations for gambling. Multiple health/functioning impairments were differentially associated with problem-gambling severity amongst adolescents with and without marijuana use. Significant marijuana-use-by-problem-gambling-severity-group interactions were observed for low-average grades (OR = 0.39, 95% CI = [0.20, 0.77]), cigarette smoking (OR = 0.38, 95% CI = [0.17, 0.83]), current alcohol use (OR = 0.36, 95% CI = [0.14, 0.91]), and gambling with friends (OR = 0.47, 95% CI = [0.28, 0.77]). In all cases, weaker associations between problem-gambling severity and health/functioning correlates were observed in the marijuana-use group as compared to the marijuana-non-use group. Conclusions: Some academic, substance use, and social factors related to problem-gambling severity may be partially accounted for by a relationship with marijuana use. Identifying specific factors that underlie the relationships between specific attitudes and behaviors with gambling problems and marijuana use may help improve intervention strategies.
 
Article
Background and aims: Perceived parental permissiveness toward gambling may relate to adolescents' engagement in various risky behaviors. To examine this possibility, we analyzed data from a high-school based risk-behavior survey to assess relationships between perceived parental permissiveness toward gambling and adolescent gambling behavior, substance use and related problems. We also evaluated predictions that relationships between perceived parental permissiveness toward gambling and risky behaviors would be particularly strong amongst adolescents reporting high sensation-seeking or impulsivity. Methods: High-school students (n = 2,805) provided data on risky behaviors, perceived parental permissiveness toward gambling, impulsivity and sensation-seeking. Bivariate and logistic regression analyses were conducted to examine relationships with gambling and alcohol, cigarette and marijuana use. Results: Perceived parental permissiveness toward gambling related significantly to adolescent gambling, all substance-use behaviors as well as alcohol and drug problems. There were significant parental-permissiveness-by-sensation-seeking interactions in multiple models. Relationships between perceived parental permissiveness toward gambling and alcohol-use frequency were particularly strong among those with high sensation-seeking. This relationship also applied to gambling and heavy cigarette smoking, albeit to a lesser extent. Impulsivity related strongly to drug problems among those who perceived their parents to be more and less permissive toward gambling. Discussion and conclusions: These findings support the relevance of perceived parental permissiveness toward gambling to adolescent risky behaviors. Parenting perceived as less permissive toward gambling appeared to have protective effects on gambling, alcohol and cigarette use, even among those with high sensation-seeking. Reducing parental permissiveness toward gambling may be a valuable intervention goal, particularly for parents of sensation-seeking adolescents.
 
Article
Background and aims: The growing concern over compulsive buying (CB) among consumers has led to vast amount of research examining the antecedents of this maladaptive behaviour. The focus of previous research was, however, mainly on examining the internal, psychological factors contributing to CB. The current research, on the other hand, sheds light on one of the external triggers which can possibly stimulate CB, namely advertising. Methods: An online survey has been conducted to identify the attitudes and scepticism towards advertising as well as ad avoidance and persuasion knowledge among a sample of 582 Belgian consumers. Furthermore, all participants were screened with regard to compulsive buying tendencies. Results: This research provides evidence that positive attitudes towards advertising can lead to CB. An important factor in this relation is persuasion knowledge. Conclusions: The study results lead to the conclusion that people higher in persuasion knowledge dispose less positive attitudes towards advertising which can subsequently prevent them from engaging in CB. Moreover high scores on scepticism towards advertising and ad avoidance among Belgian consumers in our sample point to a need for advertisers to modify their practices in order to gain more trust from consumers. This study also shows that advertising in particular attracts and seems to affect an already disadvantaged group of people - namely compulsive buyers.
 
Summary of linear regression analysis
Mean scores on the Gambling Urge Scale pre- and post-cue exposure by blackjack outcome condition
Article
Background and aims: The current study was designed to assess the impact of wins and losses in simulated blackjack on craving to gamble and to assess the extent to which this craving was associated with actual wagering in an optional gambling task. Methods: Participants were undergraduates attending a large Midwestern university in the United States. They completed the Gambling Urge Scale (GUS) and then were randomized to either a condition in which they would win 15 hands of blackjack (Win condition; n = 41) or lose 15 hands (Lose condition; n = 37) out of a total of 20 hands. After playing blackjack and completing several additional questionnaires, participants had the chance to wager their $5 compensation for the opportunity to win $50. Results: GUS scores increased significantly following blackjack, regardless of condition. We also found that post-blackjack craving was significantly associated with the amount participants wagered in the optional betting task, such that greater craving was associated with higher amount wagered. Conclusions: These findings provide further support for the construct validity of the GUS, provide novel findings regarding the effects of wins and losses when gambling, and provide evidence of an association between craving and a behavioral betting task.
 
Article
Background and aims: Binge eating disorder (BED) is a relatively common condition, especially in young adult females, and is characterized by chronic over-consumption of food resulting in embarrassment, distress, and potential health problems. It is formally included as a disorder in DSM-5 for the first time, an acknowledgement to its debilitating nature. This article explores the overlap between binge eating disorder and substance use disorders (SUD). Methods: The bibliographic search was a computerized screen of PubMed databases from January 1990 to the present. Binge eating disorder, substance use disorder, binging, obesity, food addiction, comorbidity, dopamine, opioid, serotonin, glutamate, and pharmacological treatment were the keywords used in searching. Results: BED shares similar phenomenology to SUD, including significant urges to engage in binging episodes, resulting in distress and impairment. Similar neurobiological pathways are found in both BED and SUD and medications based on similar neurobiology have been examined for both disorders. A subset of individuals with BED may have a "food addiction", but there is no clinical agreement on the meaning of "food addiction". Exploring the relationship between BED and obesity may also shed light on the extent to which BED can be viewed as an addiction. Conclusions: Overall, nascent research regarding BED and SUD suggests an overlap between these disorders, but there are discrepancies between these two disorders that need further exploration.
 
Means and standard deviations of lifting type group differences 
Article
Background and aims: Extensive research has shown that male bodybuilders are at high risk for exercise dependence, but few studies have measured these variables in female bodybuilders. Prior research has postulated that muscular dysmorphia was more prevalent in men than women, but several qualitative studies of female bodybuilders have indicated that female bodybuilders show the same body image concerns. Only one study has compared female bodybuilders with control recreational female lifters on eating behaviors, body image, shape pre-occupation, body dissatisfaction, and steroid use. The purpose of this study was to compare exercise dependence and muscle dysmorphia measures between groups of female weight lifters. Methods: Seventy-four female lifters were classified into three lifting types (26 expert bodybuilders, 10 or more competitions; 29 novice bodybuilders, 3 or less competitions; and 19 fitness lifters, at least 6 months prior lifting) who each completed a demographic questionnaire, the Exercise Dependence Scale (EDS), the Drive for Thinness scale (DFT) of the Eating Disorder Inventory-2, the Bodybuilding Dependence Scale (BDS), and the Muscle Dysmorphia Inventory (MDI). Results: Female bodybuilders scored higher than fitness lifters for EDS Total, BDS Training and Social Dependence, and on Supplement Use, Dietary Behavior, Exercise Dependence, and Size Symmetry scales of the MDI. Discussion and conclusions: Female bodybuilders seem to be more at risk for exercise dependence and muscle dysmorphia symptoms than female recreational weight lifters.
 
Correlations among and descriptive statistics for key study variables 
Multiple regression analyses (Dependent variable = compulsive buying) 
Article
Background and aims: Descriptions of compulsive buying often emphasize the roles of negative moods and trait impulsivity in the development of problematic buying habits. Trait impulsivity is sometimes treated as a unidimensional trait in compulsive buying research, but recent factor analyses suggest that impulsivity consists of multiple components that are probably best treated as independent predictors of problem behavior. In order to draw greater attention to the role of positive moods in compulsive buying, in this study we tested whether negative urgency (the tendency to act rashly while in negative moods) and positive urgency (the tendency to act rashly while in positive moods) account for similar amounts of variance in compulsive buying. Methods: North American adults (N = 514) completed an online survey containing the Richmond Compulsive Buying Scale (Ridgway, Kukar-Kinney & Monroe, 2008), established measures of positive and negative urgency (Cyders et al., 2007), ad hoc measures of buying-specific positive and negative urgency, measures of extraversion and neuroticism obtained from the International Personality Item Pool (http://ipip.ori.org/), and demographic questions. Results: In several multiple regression analyses, when demographic variables, neuroticism, and extraversion were controlled, positive urgency and negative urgency both emerged as significant predictors of compulsive buying. Whether the two urgency variables were domain-general or buying-specific, they accounted for similar amounts of variance in compulsive buying. Conclusions: Preventing and reducing compulsive buying may require attention not only to the purchasing decisions people make while in negative states, but also to the purchasing decisions they make while in positive states.
 
Participation rates for the forms of gambling by sample and PGSI group (%) 
Means and standard deviations on gambling motivation, gambling cognition, and impulsivity 
Summary of logistic regression on PGSI category 
Article
Background and aims: The present study tested whether the associations among motivational, cognitive, and personality correlates of problem gambling severity differed across university student gamblers (n = 123) and gamblers in the general adult community (n = 113). Methods: The participants completed a survey that included standardized measures of gambling motivation, gambling related cognitions, and impulsivity. The survey also asked participants to report the forms of gambling in which they engaged to test whether gambling involvement (number of different forms of gambling) was related to problem gambling severity. After completing the survey, participants played roulette online to examine whether betting patterns adhered to the gambler's fallacy. Results: Gambling involvement was significantly related to problem gambling severity for the community sample but not for the student sample. A logistic regression analysis that tested the involvement, motivation, impulsivity and cognitive correlates showed that money motivation and gambling related cognitions were the only significant independent predictors of gambling severity. Adherence to the gambler's fallacy was stronger for students than for the community sample, and was associated with gambling related cognitions. Discussion: The motivational, impulsivity and cognitive, and correlates of problem gambling function similarly in university student gamblers and in gamblers from the general adult community. Interventions for both groups should focus on the financial and cognitive supports of problem gambling.
 
Schematic overview of the workaholism field, including particular measurements, possible antecedents and consequences (correlates) of workaholism, and potential treatment approaches
Article
Aims: This article addresses the stable tendency of excessive and compulsive working (i.e., workaholism). The main aim is to provide an updated oversight of the research area related to definition, prevalence, assessment, causes, outcomes, intervention as well as proposed future research directions. The target-population is both researchers and clinicians. Methods: The findings are identified by narratively reviewing the literature. Results: Research into workaholism has expanded over the last two decades. Several screening instruments to identify workaholics have been developed. The vast majority of these are based on seemingly atheoretical foundations, lacking convergent validity with each other and with related constructs. Research generally shows that workaholism is related to impaired health and well-being as well as to conflicts between work and family life. Workaholism is probably caused and maintained by a range of factors, although solid empirical underpinnings for suggested antecedents are currently sparse. So far no well-evaluated interventions for workaholism exist. Conclusions: At present, workaholism as a construct lacks conceptual and empirical clarity. Future research efforts should prioritize longitudinal studies as well as studies incorporating unbiased, firm parameters of both health and behavior.
 
Article
Background and aims With the inclusion of gaming disorder in the ICD-11, diagnostic criteria were introduced for this relatively new disorder. These criteria may also be applied to other potential specific Internet-use disorders, which may be classified in ICD-11 as other disorders due to addictive behaviors, such as online buying-shopping disorder, online pornography-use disorder, social-networks-use disorder, and online gambling disorder. Due to the heterogeneity in existing instruments, we aimed to develop a consistent and economic measure of major types of (potential) specific Internet-use disorders based on ICD-11 criteria for gaming disorder. Methods The new 11-item Assessment of Criteria for Specific Internet-use Disorders (ACSID-11) measures five behavioral addictions with the same set of items by following the principles of WHO’s ASSIST. The ACSID-11 was administered to active Internet users ( N = 985) together with an adaptation of the Ten-Item Internet Gaming Disorder Test (IGDT-10) and screeners for mental health. We used Confirmatory Factor Analyses to analyze the factor structure of ACSID-11. Results The assumed four-factorial structure was confirmed and was superior to the unidimensional solution. This applied to gaming disorder and to the other specific Internet-use disorders. ACSID-11 scores correlated with IGDT-10 as well as with the measures of psychological distress. Discussion and Conclusions The ACSID-11 seems to be suitable for the consistent assessment of (potential) specific Internet-use disorders based on ICD-11 diagnostic criteria for gaming disorder. The ACSID-11 may be a useful and economic instrument for studying various behavioral addictions with the same items and improving comparability.
 
Article
Background The recent paper by Aarseth et al. (2016) questioned whether problematic gaming should be considered a new disorder particularly because "Gaming Disorder" (GD) has been identified as a disorder to be included in the next (11th) revision of the World Health Organization's International Classification of Diseases (ICD-11). Methods This study uses contemporary literature to argue why GD should be included in the ICD-11. Results Aarseth and colleagues acknowledge that there is much literature (including papers by some of the authors themselves) that some individuals experience serious problems with video gaming. How can such an activity be seriously problematic yet not disordered? Similar to other addictions, gaming addiction is relatively rare and is in essence a syndrome (i.e., a condition or disorder characterized by a set of associated symptoms that tend to occur under specific circumstances). Consequently, not everyone will exhibit exactly the same set of symptoms and consequences, and this partly explains why those working in the problematic gaming field often disagree on symptomatology. Conclusions Research into gaming is not about pathologizing healthy entertainment, but about pathologizing excessive and problematic behaviors that cause significant psychological distress and impairment in an individual's life. These are two related, but (ultimately) very distinct phenomena. While being aware that gaming is a pastime activity which is enjoyed non-problematically by many millions of individuals worldwide, it is concluded that problematic gaming exists and that it is an example of disordered gaming.
 
Article
The proposed introduction of gaming disorder (GD) in the 11th revision of the International Classification of Diseases (ICD-11) developed by the World Health Organization (WHO) has led to a lively debate over the past year. Besides the broad support for the decision in the academic press, a recent publication by van Rooij et al. (2018) repeated the criticism raised against the inclusion of GD in ICD-11 by Aarseth et al. (2017). We argue that this group of researchers fails to recognize the clinical and public health considerations, which support the WHO perspective. It is important to recognize a range of biases that may influence this debate; in particular, the gaming industry may wish to diminish its responsibility by claiming that GD is not a public health problem, a position which maybe supported by arguments from scholars based in media psychology, computer games research, communication science, and related disciplines. However, just as with any other disease or disorder in the ICD-11, the decision whether or not to include GD is based on clinical evidence and public health needs. Therefore, we reiterate our conclusion that including GD reflects the essence of the ICD and will facilitate treatment and prevention for those who need it.
 
Article
In their position paper, Aarseth et al. (2016) bring to light several timely issues concerning the categorization of gaming disorder as a form of addiction and as a discrete mental disorder. In our commentary, we welcome their caution toward this move and their discussion of the equivocal scientific data in its support and the potential negative consequences for gamers. We suggest that a more heterogeneous approach is required for understanding any behavioral addiction, as concepts from gambling appear to be more relevant for aspects of mobile gaming than for video games more generally. In addition to a greater need for clinical research, we argue that studying gaming at a different level of analysis than the epidemiological study is required to gain a meaningful understanding of the harm video games may or may not entail.
 
Article
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.
 
Article
There has been much debate regarding the extent to which different types and patterns of gaming may be considered harmful from individual and public health perspectives. A recent event in which a hospitalized patient was reported to have died while a care provider was gaming is worth considering as an example as to how gaming may distract individuals from work-related tasks or other activities, with potential negative consequences. As the 11th edition of the International Classification of Diseases is being developed, events like these are important to remember when considering entities like, and generating criteria for, disordered or hazardous gaming.
 
Article
This paper is a response to a recent debate paper in which Aarseth et al. argue that the inclusion of a formal diagnosis and categories for problematic video gaming or Gaming Disorder (GD) in the World Health Organization's 11th Revision of the International Classification of Diseases (ICD-11) is premature and therefore the proposal should be removed. The present authors systematically address all the six main arguments presented by Aarseth et al. and argue that, even though some of the concerns presented in the debate paper are legitimate, the inclusion of GD in ICD-11 has more advantages than disadvantages. Furthermore, the present authors also argue that the two GD subtypes ("GD, predominantly online" and "GD, predominantly offline") are unnecessary and rather problematic; the main category for GD would be perfectly sufficient.
 
Article
There are ongoing controversies regarding the upcoming ICD-11 concept of gaming disorder. Recently, Aarseth et al. have put this diagnostic entity into scrutiny. Although we, a group of Iranian researchers and clinicians, acknowledge some of Aarseth et al.'s concerns, believe that the inclusion of gaming disorder in the upcoming ICD-11 would facilitate necessary steps to raise public awareness, enhance development of proper diagnostic approaches and treatment interventions, and improve health and non-health policies.
 
Article
In their debate contribution, Aarseth et al. (2016) strongly argue against the proposal of WHO ICD-11 (International Classification of Diseases, 11th revision) to include Gaming Disorder as a new diagnostic category emphasizing the fact that no consensus exists on the definition and the risk that gaming will be demonized and gamers stigmatized resulting in a tsunami of false positive referrals to treatment. In this commentary, it is argued that gaming is indeed just another relatively innocent recreational activity with only a small minority losing control resulting in gaming-related problems. It is also argued that - despite a lack of full consensus on the diagnostic criteria - there are clear indications that Gaming Disorder is a relevant clinical entity worldwide and that official recognition as a mental disorder is urgently needed to facilitate the further development, accessibility, and reimbursement of the treatment.
 
Article
Data from a specialist treatment facility for Internet addiction (IA) in Japan showed that (a) the vast majority of treatment seekers are addicted to online games, (b) their symptoms are often quite severe, and (c) there is a significant demand for IA treatment. In addition, systemic obstacles to the delivery of medical services in Japan exist due to the exclusion of IA criteria from ICD-10. Consequently, the inclusion of GD criteria in ICD-11 will almost certainly increase the capacity and quality of treatment through advances in research and possible changes in national medical systems to meet treatment demand.
 
Top-cited authors
Mark D Griffiths
  • Nottingham Trent University
Daria Kuss
  • Nottingham Trent University
Halley M. Pontes
  • Birkbeck, University of London
Marc Potenza
  • Yale University
Daniel L. King
  • Flinders University