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This commentary paper critically discusses the recent debate paper by Petry et al. (2014) that argued there was now an international consensus for assessing Internet Gaming Disorder (IGD). Our collective opinions vary considerably regarding many different aspects of online gaming. However, we contend that the paper by Petry and colleagues does not provide a true and representative international community of researchers in this area. This paper critically discusses and provides commentary on (i) the representativeness of the international group that wrote the ‘consensus’ paper, and (ii) each of the IGD criteria. The paper also includes a brief discussion on initiatives that could be taken to move the field towards consensus. It is hoped that this paper will foster debate in the IGD field and lead to improved theory, better methodologically designed studies, and more robust empirical evidence as regards problematic gaming and its psychosocial consequences and impact.
Working towards an international consensus on criteria
for assessing internet gaming disorder: a critical
commentary on Petry et al.(2014)
This commentary paper critically discusses the recent debate
paper by Petry et al. (2014) that argued there was now an
international consensus for assessing Internet Gaming
Disorder (IGD). Our collective opinions vary considerably
regarding many different aspects of online gaming.
However, we contend that the paper by Petry and
colleagues does not provide a true and representative
international community of researchers in this area. This
paper critically discusses and provides commentary on
(i) the representativeness of the international group that
wrote the consensuspaper, and (ii) each of the IGD
criteria. The paper also includes a brief discussion on
initiatives that could be taken to move the eld towards
consensus. It is hoped that this paper will foster debate
in the IGD eld and lead to improved theory, better
methodologically designed studies, and more robust
empirical evidence as regards problematic gaming and
its psychosocial consequences and impact.
In this commentary, we discuss critically the recent debate
paper by Petry and colleagues [1] which argued that there
was now an international consensus for assessing internet
gaming disorder (IGD). The Petry et al. paper was interest-
ing reading for all of us that work in the gaming studies
eld, as it aimed to review two contentious issues, namely
the (i) inclusion of behavioural addictions (andmore specif-
ically IGD) in the latest (fth) edition of the Diagnostic and
StatisticalManualofMentalDisorders(DSM-5) [2], and (ii)
intended meaning behind the DSM-5 criteria for IGD. The
present paper takes a critical look at the second of these
aims, as the rst aim has already received considerable de-
bate elsewhere [314].
The present commentary paper has been written by a
group of researchers from a number of different academic
elds with a shared interest in research into online addic-
tion, and more specically video game addiction and online
gaming addiction. Our collective opinions vary consider-
ably regarding many different aspects of online gaming ad-
diction, including (but not limited to) (i) the operational
denition of IGD, (ii) on whether IGD should be conceptu-
alized as an addiction, (iii) on whether components such
as toleranceand withdrawalshould be included as den-
ing characteristics, (iv) on whether there isa difference be-
tween gaming disorderand gaming addiction,(v)on
whether IGD is a subtype of internet addiction or video
game addiction, (vi) how relevant IGD concepts are best
assessed, (vii) on whether IGD is properly conceptualized
as a unique condition or the consequence of other underly-
ing mental dysfunction, (viii) whether there is a heteroge-
neity in IGD related to the videogame types (role-playing,
real time strategy, rst-person shooter, etc.) and game play
(e.g. binge gaming, continuous excessive gaming, etc.), (ix)
on whether IGD should be viewed as a parenting issue in-
stead of a form of psychopathology, (x) on whether IGD
might be a coping style for some people with mental health
difculties as opposed to a cause of problems (or even both)
and (xi) whether researchers should use polythetic or
monothetic criteria to assess IGD.
Our varied opinions about the nuances of the research
in the IGD eld notwithstanding, we contend that the pa-
per by Petry and colleagues does not provide a representa-
tive international community of researchers in this area
and that the consensusprovided by the 12 authors of
their paper does not constitute an international consensus.
Moreover, the published papers by the authors of the con-
sensuspaper relied heavily on survey sample data, and
completely omitted the core issues of clinical assessment
and treatment-seeking patients.
The criteria for selecting the members of this international
panel that met to discuss the IGD criteria were not stated
clearly, and we would argue that the panel does not repre-
sent adequately the international community of gaming
researchers. The authors of the consensuspaper came
from nine different countries (i.e. United States, Germany,
the Netherlands, China, Singapore, Mexico, France, Spain
and Australia), with at least one author from Europe,
North America, Asia and Australasia. Africa and South
America were not represented. However, there were no
representatives from countries where many empirical stud-
ies on IGD have been carried out, including the United
Kingdom, Canada, Belgium, Norway, Czech Republic, Tur-
key, Hungary, Switzerland, Taiwan and South Korea. With
regard to the representativeness of the problematic gaming
© 2015 Society for the Study of Addiction Addiction,111,167178
JOURNAL CLUB doi:10.1111/add.13057
assessment scales reviewed, only eight instruments for
assessing IGD werereported. In 2013, King and colleagues
[15] reviewed the 18 instruments that had been developed
to assess video game addiction up to that point, with new
instruments having been developed since, which include
several that have been modelled on the nine IGD criteria
in the DSM-5 [1621].
The remainder of the present paper discussesbrieyeachof
the nine (consensually agreed in Petry et al.s paper) criteria
for IGD. We would also like to point out that as a group we do
not all necessarily agree on the criticismsof each criterion,
which is the point of this commentary. Ideally, we would
have liked to suggest new wordings for each of the IGD
criteria but this was not possible among the 28 authors
of this paper, and again highlights (and reinforces) the con-
tention we are making that there is no consensus on many
issues in the international eld of IGD. Additionally, any
new proposed wording should also include the 12 authors
of the consensuspaper that we are providing critical com-
mentary upon. However, we consider some initiatives for
moving towards consensus later in the penultimate section
of the present paper.
Kardefelt-Winther [5,6] has argued that because gaming
constitutes one of the most popularforms of entertainment
for children, adolescents and adults, it is not entirely
straightforward to assume that a preoccupation with on-
line games is indicative of problematic engagement. Much
like a group of friends who might get together a few times
a week to talk about their favourite soccer team in anticipa-
tion of an upcoming game so, too, might gamers
spend their spare time talking about upcoming e-sport
events or anticipated new video games that are about to
go on sale. Furthermore, gaming is an active hobby in
which a player can exert a great deal of agency and con-
trol, which means that spending time strategizing about
game play or thinking about tactics during times of non-
play is an important part of the play-experience, in partic-
ular for high-achieving and/or professional gamers [28].
This needs to be considered so that highly engaged gamers
are not stigmatized and to reduce the risk for over-
diagnosis. Any high level commitment (e.g. sports, music,
school) will have some detrimental consequences as other
important activities are not given as much priority, but it
would be a mistake to always confuse this with addictive
behaviour. The challenge here seems to be to understand
how to differentiate more clearly between healthy engage-
ment and harmful compulsion [28], which is in line with
what a number of the present authors have suggested
However, the current IGD wording of the preoccupation
criterion does at least acknowledge the view of King and
Delfabbro [23], who have previously emphasized the com-
plexityof the preoccupation criterion. In their view, preoc-
cupation should not be assessed in terms of time alone but
also in terms of cognitive content. In other words, it is just
as important to explore the adaptabilityof cognitions as the
frequency of gaming-related thoughts. However, the cur-
rent wording has removed almost all behavioural elements,
meaning that anygamer who plays all day every day would
not endorse this item because they are constantly playing.
Some of the co-authors of the present paper also note that
assessment of the preoccupation criterion might also in-
clude the signicance attached to gaming. The correspond-
ing questions could enquire whether the person perceives
gaming as central to their lives and/or whether they could
imagine their lives without gaming.
Withdrawal is one of the most debated criteria (especially
among the authors of the present paper), because in the
case of behavioural addictions there is no ingestion of a
psychoactive substance and therefore what the body pro-
duces neurochemically is generated by the behaviour alone
[14]. Pies [26] was perhaps the rst to note that in addition
to playersself-report, those in the eld should use physio-
logical measures such as blood pressure or pulse rate to as-
sess withdrawal symptoms. Some (but not all) of the
present authors, like others [26,27]and including Petry
and colleaguesagree that withdrawal should not be con-
ated with the negative emotions that arise when gaming
is suddenly stopped by an external force (e.g. an angry par-
ent, sibling, partner or spouse). In contrast, unpleasant
symptoms that are experienced for a couple of hours (up
to several days) after stopping playing should be considered
as genuine withdrawal symptoms. Emotions that are felt
days or weeks after gaming has ceased should be charac-
terized as cravings, rather than as part of a withdrawal
syndrome [27]. Therefore, if the withdrawal criterion is to
remain, it should also include some reference to the time-
period (e.g. Do you feel restless, irritable, moody, angry,
attempting to cut down or stop gaming, or when you are
unable to play?). Assessment of the withdrawal symptoms
168 Mark D. Grifths et al.
© 2015 Society for the Study of Addiction Addiction,111,167178
might include an additional question (e.g. Do you stop feel-
ing restless, irritable, moody, angry, anxious or sad when
you are able to play again?) to distinguish withdrawal-
related negative emotions from the occurrence of such
emotions for a different reason. Any criterion for with-
drawal should also include acknowledgement that there
is a difference between consequences that result from psy-
chopharmacological processes and those that result from
affectivebehavioural outcomes.
Although some in the eld (including some of the pres-
ent authors) argue that withdrawal should not be associ-
ated with activities that do not involve the ingestion of a
psychoactive substance, the criterion was one of the three
core criteria of IGD according to a comprehensive literature
review conducted by King and colleagues [15] prior to the
publication of DSM-5. Additionally, this criterion was re-
ported to have high diagnostic accuracy when tested in a
clinical sample [28]. However, this does not necessarily
mean that the criterion has adequate face validity in the
context of IGD, nor that it may usefullydistinguish a highly
engaged player from a player who has lost control. Some of
the present authors would argue that before we understand
why the player becomes restless or irritable when attempting
to stop gaming, the criterion might be limited in its ability to
predict problematic engagement accurately [5,22].
Like withdrawal, tolerance is another highly debated cri-
terion (especially among the present authors), and for
much the same reason (i.e. the lack of an ingested psy-
choactive substance). The criterion also conates a num-
ber of things (time, excitement, type of equipment) and
does not really get to the heart of what tolerance really
means in this sense [i.e. needing to game more often or
intensively than before to gain the desired level of rein-
many individuals with IGD play so excessively that they
are unable to increase the time they play any further. In-
stead, they experience lower levels of satisfaction while
playing compared to when they initially began to play.
The playing of more exciting gamesis arguably a poor
indicator of tolerance. The tolerancecriterion is clearly
a consequence of modelling IGD criteria on that of sub-
stance disorder criteria and grounded in physiological rea-
sons for requiring a greater intake. Consequently, this
may not be as useful an indicator for problematic gaming
as for other addictions [5,6]. This notion was emphasized
in a recent electroencephalograph (EEG) study [30] that
demonstrated that patients suffering from IGD were less
likely to reveal reward sensitivity when playing a simple
video game than healthy regular gamers. This effect
remained stable regardless of the daily gaming amount
of the patients.
Furthermore, excitement is typically a function of do-
ing well in the game, and over time it is the experience
of novelty (along with reinforcement schedules) that will
maintain players gaming for longer periods rather than
the perception of whether one game is deemed as more
exciting than another. However, the wording on the con-
sensually agreed statement also assumes that problem-
atic players will transition from one game to another
to seek out more exciting experiences. The research evi-
dence on dedicated players of Massively Multiplayer On-
line Role-Playing Games (MMORPGs), as an example,
would not support this notion [31]. A number of studies
suggest it is the opposite, and that problematic players
seek out games that make them relax, de-stress and/or
dissociate [3234]. Also, while there is some merit in
tolerance being assessed by the need to use more pow-
erful equipment(among the present authors who think
tolerance is a core criterion of IGD), the criterion would
be better described by using the words frequently
upgrading playing equipment, although such symptoms
are arguably marginal from the perspective of genuine
tolerance. This was pointed out more than 15 years
ago by Grifths [35] in his case studies of individuals
with internet and online gaming addictions. For in-
stance, one of the young males in the study upgraded
his computer 11 times during a 2-year period. However,
as a number of the present authors noted, this might
simply be a consequence of wanting be able to play
the latest and most technologically demanding games
with the best available equipment, rather than reecting
a pathology.
Many people spend a great deal of money on their
hobbies (e.g. shing and motor enthusiasts). Therefore,
some of the present authors do not think this criterion
adequately differentiate fascination from compulsion,
and its usefulness may therefore be questionable
[5,22]. The type of hardware used may also impact
upon how such a question is answered. For instance,
gaming consoles offer only very limited potential for up-
grades compared with gaming on a personal computer.
Given that tolerance is hard to assess in gaming, there
are also those among the present authors who suggest
there could be an additional assessment question such
as: Do you feel that the same amount of time spent
gaming no longer produces the same initial satisfaction
or excitement?. However, a couple of the present au-
thors noted that this depends upon the type/genre of
video game played. For instance, goal-based video games
Assessment of internet gaming disorder 169
© 2015 Society for the Study of Addiction Addiction,111,167178
can become boring after reaching the goal and, similarly,
task-/quest-based games can become boring once the
player knows all the tasks and quests, as playing becomes
repetitive. Competitive team playing (e.g. eSports games)
might remain satisfactory and demanding for much longer
Many of the present authors felt this criterion of IGD (i.e.
the inability to stop ones gaming in spite of a desire to
no longer play) is arguably a hallmark sign of an indi-
vidual with IGD. For instance, in the study by Ko et al.
[28], this criterion (which was labelled continued exces-
sive use) was the best overall criterion of IGD with
100% diagnostic accuracy. However, there were some is-
sues raised, particularly with the consensually agreed
wording. Some of the present authors feel that this ques-
tion does not reect adequately the corresponding DSM-
5 criterion for IGD. The question should also mention a
desire or intention to stop playing, not only to cut back
on the amount of timespent gaming. Also, some of the
present authors thought the question should enquire
about repeated, unsuccessful attempts to stop or de-
crease gaming. Even with such wording, this criterion
may not be endorsed very often. For example, in one
study it was endorsed by only 45.5% of individuals with
problem video game use [36]. In addition, the question
depends upon how much someone is playing in the rst
It has also been noted by a number of authors that
there is no reason that some addictive behaviours cannot
be both destructive to the individual and something they
do voluntarily [14,22,3739]. If an inability to control
gaming could be demonstrated convincingly (beyond
the use of self-report), this would be consistent with a
disease model of addiction. However, in addition to loss of
control, it would be important to demonstrate that
gaming could not be stopped (even in the presence of
alternative rewardingactivities). Moreover, if the long-term
(global) perspective is ignored and the focus is on the short
term, spending substantial time on gaming might very well
be a rational choice, as the benets are substantial but the
costs are spread over time and hard to judgein line with
Heymans argument for the escalation of drug use [38].
One question that is rarely asked in relation to this cri-
terion is why a person feels that they should spend less time
playing games. Societal perceptions of gaming have histor-
ically not been favourable, and it is still considered a lesser
hobby today that holds many negative stereotypes about
such individuals [40,41], an attitude that some authors
of the present paper are working to change. If children feel
pressured to stop gaming because their parents reprimand
them whenever they play, does that indicate that these
children have a problem with their gaming or is it in fact
the parents who are pathologizing the behaviour? If the
same children cannot resist playing because their friends
also spend their afternoons playing, is that really indicative
of problem behaviour? Hypothetically, given the wide-
spread popularity of gaming, if a child stops playing they
might be socially excluded, which can have severe negative
consequences at a younger age. While this criterion
presumes that the individual positively desires to play less,
it fails to consider how that feeling is connected to societal
pressures, parenting styles, friendshipsand a need for social
interaction [5,22].
Finally, the clinicians among the present authors
noted that clinical experience demonstrates that affected
adolescents have a higher subjective view of self-syntony
of the behaviour than those without problems. More spe-
cically, they might be aware of spending many hours on-
line but it never crossed their minds to play less. This
might be due to the fact that negative consequences aris-
ing from the addictive behaviour are of lesser intensity
than within affected adults (e.g. losing their job and/or
family). Thus, it may be worth thinking of a possible ad-
aptation of this criterion in order to take into account
the possible cultural bias, rational choice approach and
A number of the present authors felt that giving up other
activitiesis a somewhat weak criterion of IGD for two
main reasons: (i) giving up other activities for gaming
may reect a normal developmental process, and/or (ii) it
may reect the withdrawal that is associated with major
depression. All activities have associated opportunity costs.
True damage occurs when gaming impacts negatively
overall physical and psychological wellbeing or impacts
very negatively in an important area in ones life (e.g. rela-
tionships, school performance, professional life, etc.), not if
it diverts gamers from other recreational activities. Many
people have to give up enjoyable pastimes for noble pur-
suits, such as school or a demanding job. There is also
the potential for false-positive results, as people may shift
interests and activities routinely as a normal course of life.
Ending participation inone hobbyor activity to spend more
time in another is not, in and of itself, maladaptive or un-
usual. However, should the forsaken activities have been
highly valued by the individual, the loss of them regretted,
170 Mark D. Grifths et al.
© 2015 Society for the Study of Addiction Addiction,111,167178
or ceasing those activities result in other practical harmto
the individual, this criterion may be appropriate. As with
many of the criteria, we are concerned that the distinction
between maladaptive and adaptive behaviour remains
unclear. There is nothing wrong with gaming instead of
spending time on activities that may be felt to be less
enjoyable (e.g. gardening). In fact, the question of age-
dependency again arises. One developmental task for ado-
lescents has to be seen in acquiring autonomy from the
parents. Especially in the phase of puberty, (healthy) ado-
lescents retreat from former activities not originating from
their intrinsic interests but rather as parentally induced
habits. Therefore, it might be necessary to denefor
adolescentsmore detailed types of interests and certain
activities may lose importance. Moreover, as technology
develops rapidly, one has to think of adolescents who never
were motivated to acquire any kind of alternative interests
or activities, apart from going online or playing computer
games. Thus, it might be benecial to dene this criterion
on a broader level and to add the aspect of impaired develop-
ment of interests because of excessive computer game use.
Kardefelt-Winther [5] argues that this is a residual cri-
terion from the behavioural salience item of substance dis-
order criteria that aims to capture the state of mind where
substance use has become the sole focus of the individuals
life to the detriment of everything else. However, unlike
drugs, gaming is not harmful per se [42], and therefore
an intense focus on gaming is not necessarily a problem
[25]. For example, a longitudinal analysis based on avatar
monitoring demonstrated that a high involvement in
MMORPGs, reected by fast in-game rankings progression,
is not necessarily associated with negative outcomes upon
daily living [43]. Some of us believe that the criterion
should assess whether a person is, for example, feeling in-
creasingly lonely or socially isolated due to their gaming
habits, and if this is perceived as a problem by the individ-
ual. Although there is current disagreement as to whether
this is then an effect of the game itself (e.g. operant condi-
tioning) or indicative of underlying problems (e.g. coping),
it would offer a more reliable way to assess whether or not
the gaminghabits lead to problems. In its current state, the
criterion at best manages to assess an individualspersonal
priorities in terms of recreational activities, which is inade-
quate for a criterion included in a psychiatric diagnosis
[39]. Research on decision-making demonstrates consis-
tently circumstances under which healthy people engage
in non-optimal, and often ultimately detrimental, behav-
iours [44]. As described by Van Rooij and Prause [14],
reframing negative consequences as the result of non-
optimal decision-making might well be the more parsimo-
nious approach to interpreting the behaviour.
In contrast to the difculty presented by the suggested
wording in distinguishing normal from abnormal behav-
iour change, the same criterion is essential for diagnosing
(unipolar) affective disorders (e.g. major depression). IGD
and depressive disorders have been demonstrated to co-
occur frequently [20,45,46] and, to some extent, to share
genetic variance [47]. It therefore appears necessary to
regard this criterion as a secondary indicator of IGD.
Among the present authors, very few had any major prob-
lems with this criterion. However, cognitive recognition
and acceptance of the negative consequences associated
with the behaviour are often highly dependent upon the
perceived short- and long-term consequences. The time-
frame and persistence in playing over time is also impor-
tant here. There is periodic/episodic extreme use where
normalplayers experience the same symptom (i.e.
playing througha certain game after it was released).
There is some literature from the gambling eld suggesting
that the perceived seriousness of problems may be tempo-
rally dependent, with adolescents only perceiving long-
term negative consequences [54].
Deception is another controversial criterion in IGD. Tao
and colleagues [49] decided to eliminate this symptom
from their diagnostic IGD instrument, one that served as
a basis for the DSM-5 criteria [50], because the frequency
of deception among online addicts in their sample was sig-
nicantly lower than other IGD symptoms. Also, in an-
other Chinese study deception was reported as having the
lowest diagnostic accuracy and prevalence among adult
players with IGD [28]. Furthermore, in their comprehen-
sive review of problematic gaming screens, King and col-
leagues [15] reported that very few of the 18 instruments
included this criterion.
A key argument against the suitability of this criterion
is that in western societies, gaming takes place typically
in the players home. If the gamer is not living alone, he
or she would not be able to keep the behaviour hidden from
partners or family members [51]. In addition, personal re-
lationships and with whom the gamer resides have a
Assessment of internet gaming disorder 171
© 2015 Society for the Study of Addiction Addiction,111,167178
signicant inuence over this criterion. For instance, single
men or women who live alone mayexperience problematic
gaming but do not have to lie or deceive others about it. A
few of us also noted that there can be much social stigma
against telling lies. To some extent, this may be mitigated
by rephrasing the criterion as concealment or reluctance
to inform others. Kardefelt-Winther [5] also notes that for
children, the need for deception depends heavily upon
whether their parents are opposed to or supportive of gam-
ing as a hobby. If parents complain repeatedly that gaming
is not a useful leisure activity the child may be more likely
to lie about their involvement with games. Therefore, this
reects more on the parentsperception of gaming than a
potential sign of IGD. One of the present authors also noted
that this criterion is more likely to identify children who
have gaming problems as being delinquent or having a
conduct disorder. This may conate problems that are less
severe with those that are very severe, and could be used
to inate the prevalence of true problems.
Gaming as a form of escape has much support in the liter-
ature. For instance, among playersof MMORPGs, escapism
is the most signicant motivational predictor of problem-
atic gaming, suggesting that escapism contributes to exces-
sive gaming-related problems [52,53]. Another recent
study by Király and colleagues [56] demonstrated that es-
capism was both a direct predictor of problematic online
gaming and also a mediator between psychiatric distress
and problematic online gaming. However, a number of re-
cent studies [16,19,28,33] reported that gaming to escape
or relieve a negative mood has low specicity (i.e. a signif-
icant proportion of non-addicted gamers also play to escape
problems in their lives). For instance, the results from a la-
tent prole analysis by Pontes et al. [19] showed that escap-
ing adverse moods is also present in non-disordered highly
engaged players. Additionally, Kardefelt-Winther [39]
showed that a high degree of escapism through online
gaming was only a signicant indicator of problematic
gaming if an individual also had low psychosocial
wellbeing. This conrms earlier research showing that
many non-disordered gamers play video games as a way
to spend time and forget about other problems [34,55].
A couple of the present authors also felt that the crite-
rion is problematic because many gamers are not necessar-
ily aware that the purpose of their gaming is to escape
something. By asking them this question, we may implant
an explanation for their gaming that is not necessarily
accurate. Another problem is that this criterion suggests
implicitly that IGD may be secondary to a primary depres-
sive, anxiety or other disorder.
Despite the above criticism, we feel that this criterion
might offer some utility when investigating if gaming has
become a problem because it is used as the primary way
to avoid difcult life situations [33,39]. In this respect, it
may be likened to a maladaptive coping strategy that might
take up a great deal of time and effort and thus lead to a ne-
glect of other important activities [22,23]. This would ex-
plain both why the behaviour occurs and persists, which
is useful for diagnosis. Therefore, we are not arguing that
this criterion should be removed (as the majority of those
with IGD report playing to escape) but that, as worded, this
criterion does not necessarily differentiate between disor-
dered and non-disordered gamers, and therefore this needs
to be taken into consideration when assessing whether an
individual has IGD.
A recent study with 32 clinical patients that were
being treated for problematic gaming by Van Rooij,
Schoenmakers and van de Mheen [56] demonstrated that
all but one problem gamer endorsed this item. A study by
Domahidi and Quandt [30] reported that most disordered
players presented to the clinical setting with high risk of
jeopardizing relationships and opportunities, but also
found that highly engaged non-disordered players also en-
dorsed this criterion, and therefore it is not necessarily an
exclusive feature of IGD. A few of the present authors also
felt that this item should highlight whether gaming is a
barrier to seeking opportunities (i.e. the difference between
losing something versus impaired capacity to seek out
something), which would be more applicable to those in
an advanced disordered state when most opportunities
and relationships have been lost. Another study [36] re-
ported that fewer than 50% of their sample of individuals
with problem video game use had problems in their signif-
icant relationships. Some of the present authors also
questioned whether the because of gamingin this crite-
rion might be better replaced by because of the amount
of time spent gaming and your preoccupation with
gaming. It might also be useful to simplify and specify this
criterion so that it relates to the negative effects on
school/university or work performanceinstead of risking
or losing job, educational or career opportunities. Overall,
most of the present authors felt this criterion, if worded
appropriately, would be very useful, and a number of the
172 Mark D. Grifths et al.
© 2015 Society for the Study of Addiction Addiction,111,167178
present authors believed that problems caused by gaming
should be a requirement criterion.
Some mayargue that it is questionable whether consensus
in the IGD eld will ever be possible, given the lack of con-
sensus in other elds of addiction. However, we would like
to end on a more positive note, and suggest some initiatives
that might help in taking the lack of consensus in the eld
forward. Underlying all these suggestions is the need for
international groups to be genuinely cross-national and
representative of the research carried out in the IGD eld.
Host dedicated symposia at international behavioural
addiction conferences that include representatives from
both different theoretical perspectives and different
Form an online discussion group including every re-
searcher that has published empirical data on the topic
of IGD.
Propose and contribute to special issues on IGD in high
impact addiction journals.
Carry out more studies from treatment-seeking individ-
uals in the clinical population (i.e. live eld-testing)
rather than further epidemiological studies in countries
that have already carried out such studies. Epidemiolog-
ical studies are not the best place to identifyand examine
new disorders.
Carry out studies on heavy use of gaming among those
without any problems (i.e. high engagement players).
Form an international alliance of IGD researchers to
generate an item pool of IGD items for use in a multi-
national collaborative study.
Form working parties that comprise multi-stakeholders
rather than just academics (e.g. gaming industry,
gamers, psychiatrists, therapists, etc.).
Re-evaluate already existing data on IGD more effec-
tively and critically to help develop consensus (as this
might be helpful for understanding the nature of some
aspects such as withdrawal).
Give further consideration to potential criteria for IGD
that might be unique to this behaviour, rather than de-
riving most or all of the criteria from substance use or
gambling disorder.
In this paper, we have attempted to summarize our main
concerns about the IGD criteria in the consensuspaper
by Petry et al. [1]. We would like to reiterate that we have
wide-ranging disagreements on a number of the issues
raised. We conclude that (i) there is no consensus in the
IGD eld at present on how best to assess IGD, (ii) the
IGD criteria put forward by Petry et al. omit several impor-
tant elements of assessment, such as instructions, time-
frame and response format/alternatives, and (iii) that there
are many problems with some of the items in the new con-
sensualstatements. We hope that our paper willfoster de-
bate in the IGD eld and lead to improved theory, better
methodologically designed studies and more robust empir-
ical evidence with regard to problematic gaming and its
psychosocial consequences and impact.
Declaration of interests
Keywords Gaming addiction, gaming addiction assess-
ment, IGD assessment, internet gaming disorder, problem-
atic gaming, video game addiction.
Nottingham Trent University, Nottingham, UK,
University, Ghent, Belgium,
Karolinska Institutet, Stockholm,
University of Sydney, New South Wales Australia,
Loránd University, Budapest, Hungary,
University of Bergen, Bergen,
Mainz University, Mainz, Germany,
Johns Hopkins Uni-
versity, Baltomore, MD, USA,
University of California Berkeley, CA,
University of Adelaide, Adelaide, Australia,
Stanford Univer-
sity, Stanford, CA, USA,
Université Catholique de Louvain, Louvain,
University Hospitals of Geneva, Geneva, Switzerland,
University of Münster, Münster, Germany,
Universidad Ramon Llull,
Barcelona, Spain,
Stetson University, DeLand, FL, USA,
Ya l e
University, New Haven, CT USA,
McGill University, Montréal,
Québec, Canada,
University of Twente, Enschede, The Netherlands,
Middlesex University, Hendon, UK
and University of Derby,
Derby, UK
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Our recent paper [1] outlined the DSM-5 criteria for inter-
net gaming disorder (IGD), and Grifths et al.[2]
commented upon it. As they note [2], their collective opin-
ions vary considerably, but they contend that our report
does not constitute an international consensus. They also
critique our interpretations of the criteria for IGD in the
Diagnostic and Statistical Manual of Mental Disorders,
With regard to their rst point, Grifths et al. [2] appear
to start fromincorrect assumptions. We did not claim there
was a consensus throughout the world (is there on any-
thing?). We also made no assertion that our group was
representative of all countries or researchers. International,
according to the Merriam-Webster Dictionary,isdened as
involving two or more countries.Clearly,ourgroupisinter-
national. Our group also achieved a consensus, ageneral
agreement about something. Although including more
experts from a greater number of countries may have been
desirable by having more members who are diverse in their
information sources, large groups tend to be too complex for
decision-making, e.g. [4], as appears to be the case among
Grifths et al. [2], who have not agreed upon any aspect of
the criteria. Our goal was to take the DSM-5 as a starting
point and suggest ways in which researchers and clinicians
around the globe could begin to assess these criteria simi-
larly given that framework. Grifths et al.[2]supportour
original intent by continuing the types of discussion that
our paper was promoting.
Although we are encouraged that our report stimu-
lated consideration of the DSM-5 criteria, we found Gifths
et al. [2] to be dismissive of what we accomplished, given
other positive reactions to our consensus [58]. Our paper
provides a guideline for future research to consider more
carefully and consistently what is being measured in the
context of assessing IGD. We did not debate the appropri-
ateness of the DSM-5 criteria, the proposed threshold for
diagnosis, or whether IGD is a behavioral addiction or even
a mental disorder. The jury isstill out on those issues. It will
be indenitely if researchers and clinicians do not begin to
assess the condition in some consistent manner.
In terms of their second point critiquingour interpreta-
tion of the criteria, we believe that some authors of Grifths
et al. [2] may be more in agreement than disagreement
with our consensus based on review of their own publica-
tions. As depicted in Table , a 2015 publication by two of
their authors [9] included manyitems with similar content
to the meanings we recommended [1]. That study [9]
states explicitly that the items are valid, reliable, and
proved to be highly suitable for measuring IGD,soitis
unclear why they now [2] contest the meanings we
concluded represented the DSM-5 IGD criteria.
Furthermore, Grifths et al. [10] have called for an aim
common to ours: the gaming addiction eld must unite
and start using the same assessment measures. Neverthe-
less, Dr Grifths continues to apply disparate tools and
items, some of which appear not to overlap even with re-
spect to meaning. For example, one recent study [11] used
the items: I have tried to control, cut back or stop playing,
Assessment of internet gaming disorder 175
© 2015 Society for the Study of Addiction Addiction,111,167178
... Criticism of the DSM-5 IGD criteria has existed since they were first proposed. A distinction can be made between the general criticism of the IGD construct (e.g., Aarseth et al., 2017) and more specific questioning of the conceptualization or the selection of criteria (e.g., Griffiths et al., 2016). An often-mentioned distinction is made between the "core" and the "peripheral" criteria, which was first introduced by Charlton and Danforth (Charlton, 2002;Charlton & Danforth, 2007), where peripheral criteria, part of which are salience, mood modification and tolerance, indicate high engagement with gaming, whereas the core criteria indicate pathological gaming. ...
... In the field of problematic gaming, tolerance was defined differently, including the need to spend increasing amounts of time playing (American Psychiatric Association, 2013), or in more rare cases, to play more exciting games (Petry et al., 2014) or use more powerful equipment (Petry et al., 2014;Weinstein & Lejoyeux, 2010). The last two definitions seem to be used in questionnaires more rarely, and have been criticized as especially poor operationalizations of tolerance because players often invest their time in a single game or a few games rather than constantly looking for new games, and because the purchasing of new equipment occurs infrequently and has little to do with problematic game play (Griffiths et al., 2016;King, Herd, & Delfabbro, 2017a). The definition used in the DSM-5 (American Psychiatric Association, 2013) and most commonly across published questionnaires, involves the increasing amount of time spent on gaming, where time playing may be understood as "the dosage", similar to an amount of addictive substance which produces the desired effects. ...
... It is questionable then if with the DSM-5 IGD we are at least to some degree diagnosing high engagement, rather than an actual disorder (Kardefelt-Winther, 2015b). It was argued that other criteria such as preoccupation, escapism, withdrawal and giving up other activities (Griffiths et al., 2016;Kardefelt-Winther, 2015a) can be a part of a high but healthy involvement in gaming, as it is with high involvement in other hobbies. For example, a passionate gamer may be preoccupied with gaming, feel frustrated when not able to play and can forfeit other pursuits because of gaming, just like one does while pursuing any other demanding hobby. ...
Tolerance is a controversial but still an omnipresent criterion in measuring problematic gaming and Internet Gaming Disorder (IGD). Despite criticisms, a systematic review of its suitability has not been conducted until now. The aim of this study was to assess the evidence of psychometric validity and the appropriateness of tolerance as a criterion for IGD. A total of 61 articles were included in the review, 47 quantitative, 7 qualitative studies,plus 7 studies that introduce potential item wordings for operationalizing tolerance. Results showed that the tolerance item tends to have acceptable to high factor loadings on the single IGD factor. While tolerance sometimes did not adequately differentiate the engaged gamers from those with a probable disorder, it was endorsed at medium to high levels of IGD severity and had a good performance in the interviews. It, however, showed weak relations with distress and well-being. In qualitative studies, tolerance as currently defined by DSM-5 and measured by questionnaires (i.e., increasing amounts of time spent on gaming) was almost unequivocally rejected by gamers. The solid performance of tolerance in psychometric studies was probably due to deficiencies of the IGD construct, which also contains other disputed criteria. Tolerance lacks relevance in measuring IGD and care should be taken when using and interpreting IGD measures with this criterion.
... En dépit de l'insuffisance des données concernant son diagnostic et son étiologie, cette décision a été prise afin d'encourager la recherche sur ce trouble, d'en améliorer la compréhension d'un point de vue diagnostic et étiologique, ainsi que son traitement (Petry & O'Brien, 2013). Cette entité fait référence aux construits nommés dans la littérature sous les termes d' « addiction aux jeux-vidéos » ou « d'usage problématique des jeux-vidéos » (Griffiths, Kuss & Pontes, 2016) L'intégration de l'IGD dans le DSM-5 a suscité de nombreux débats, ne permettant pas l'émergence d'un consensus en termes de conceptualisation et de mesure (Aarseth et al., 2017 ;Griffiths et al., 2016). La critique principale porte sur la transposition des critères d'addiction à des substances, employés pour définir ceux de l'IGD, approche qui pourrait ne pas être valide pour définir l'engagement problématique dans un comportement, comme le jeu vidéo (Charlton & Danforth, 2007;Deleuze et al., 2018). ...
... En dépit de l'insuffisance des données concernant son diagnostic et son étiologie, cette décision a été prise afin d'encourager la recherche sur ce trouble, d'en améliorer la compréhension d'un point de vue diagnostic et étiologique, ainsi que son traitement (Petry & O'Brien, 2013). Cette entité fait référence aux construits nommés dans la littérature sous les termes d' « addiction aux jeux-vidéos » ou « d'usage problématique des jeux-vidéos » (Griffiths, Kuss & Pontes, 2016) L'intégration de l'IGD dans le DSM-5 a suscité de nombreux débats, ne permettant pas l'émergence d'un consensus en termes de conceptualisation et de mesure (Aarseth et al., 2017 ;Griffiths et al., 2016). La critique principale porte sur la transposition des critères d'addiction à des substances, employés pour définir ceux de l'IGD, approche qui pourrait ne pas être valide pour définir l'engagement problématique dans un comportement, comme le jeu vidéo (Charlton & Danforth, 2007;Deleuze et al., 2018). ...
... Our goal was to use this longitudinal analysis to address various hypotheses: compensation, common cause, bidirectionality, and displacement. In accordance with recent calls regarding the need for industry support of research on problematic gaming Griffiths et al., 2016) and the suggestion that self-reported measures of time spent playing tend to be flawed (Johannes et al., 2021;Parry et al., 2021), in the current study, we capitalized on objective playtime indicators obtained in the context of a specific video game. ...
Les travaux relatifs à la pratique intensive des jeux vidéo en ligne soulignent les possibles conséquences négatives associées à ces pratiques, fréquemment décrites en termes de dégradation de la qualité de vie (QdV). La nature et l’intensité de ces conséquences dépendraient de plusieurs déterminants individuels, et notamment des motivations à jouer. Opérationnalisant cette altération du fonctionnement associée à une perte de contrôle de l’activité de jeu, l’Internet Gaming Disorder (IGD) a été introduit dans la section 3 du DSM-5 en 2013, faisant l’objet de controverses au sein de la communauté scientifique, dont la résonnance s’est amplifiée après l’inclusion par l’OMS du « trouble du jeu vidéo » (TJV) dans la CIM-11 en 2018. Bien que se distinguant sur le plan définitoire, plusieurs critiques ont été formulées à l’encontre de ces entités, notamment en ce qui concerne les risques de pathologisation et de stigmatisation d’usages normaux. Il est donc crucial de les distinguer des usages pathologiques, ainsi que d’en identifier les facteurs de risque et de protection. L’objectif de ce travail est donc d’identifier les déterminants psychologiques et comportementaux du TJV et de la QdV des joueurs, tant dans le cadre d’une approche transversale visant à identifier l’existence et le rôle de profils motivationnels, que dans une approche longitudinale visant à étudier la nature des liens entre patterns d’usage (symptômes du TJV et temps de jeu objectif) et QdV. Une première étude transversale a été réalisée auprès de joueurs ayant une pratique intensive des jeux vidéo en ligne, une analyse de classification hiérarchique a permis d’identifier 3 profils motivationnels distincts parmi lesquels, deux semblaient non problématiques (récréatif et compétitif), comparativement au troisième profil considéré à risque (évitant). Les résultats suggèrent que les scores d’IGD (critères DSM-5), ne permettent pas de différencier les joueurs à risque (évitants) de ceux dont l’engagement n’était pas associé à une dégradation de leur QdV (compétitifs). Les résultats soulignent l’importance de la prise en compte des motivations à jouer dans le cadre d’une approche centrée sur les personnes et d’une mesure du retentissement fonctionnel pour l’évaluation des problématiques d’usage. Une seconde étude longitudinale, réalisée auprès des joueurs les plus engagés dans un jeu vidéo en ligne, a ensuite proposé d’investiguer les liens inter- et intra-individuels entre patterns d’usage (symptômes du TJV et temps de jeu objectif) et QdV, tout en vérifiant si ces effets étaient différents en fonction des profils motivationnels. Les résultats confirment l’existence des trois clusters identifiés dans la première étude, et montrent la seule présence d’effets interindividuels entre symptômes du TJV et QdV. Ces résultats suggèrent que l’association parfois observée entre QdV et symptômes du TJV s’explique par des causes communes (tels que les traits de personnalité et l'impulsivité). Aucun effet n'a été constaté en ce qui concerne la relation entre temps de jeu objectif et QdV, soutenant la distinction importante entre usages intensifs sains et pathologiques. Enfin, ces résultats ne diffèrent pas selon les profils motivationnels. Nous concluons que les efforts en matière de prévention et de traitement devraient se concentrer sur ces causes communes et sur le profil motivationnel des joueurs. Des analyses ont ensuite été menées afin d’investiguer les déterminants des symptômes du TJV et de la QdV, permettant de montrer l’importance des facteurs psychologiques comparativement à ceux relatifs au comportement de jeu. L’ensemble de ces résultats permet d’envisager l’élaboration et l’évaluation de l’efficacité d’une intervention clinique ciblant les processus psychopathologiques associés aux causes communes identifiées, tout en proposant l’intégration d’outils de prévention au sein des jeux. Enfin, une discussion de l’ensemble de ces résultats est proposée.
... In the last two decades, researchers and clinicians have studied and debated the existence and the validity of two possible emerging psychiatric diagnoses, prolonged social withdrawal or hikikomori and the broad category of technological addictions (e.g., internet, videogame, smartphone, social network) (Amendola et al., 2020;Block, 2008;Griffiths, 1995;Griffiths et al., 2016;Kato et al., 2011Kato et al., , 2019Pan et al., 2020;Petry et al., 2014;Stip et al., 2016;Teo & Gaw, 2010). The term hikikomori refers to a psychological condition characterized by prolonged social withdrawal and isolation in one's room or home, for a period of at least six months, associated with significant impairment or distress (Kato et al., , 2020. ...
Full-text available
Objective: Prolonged social withdrawal (PSW) or hikikomori and problematic internet use (PIU) have attracted the attention of mental health experts worldwide. The scientific literature suggests a complex relationship between these conditions and psychotic-like experiences (PLEs) or disorders. In the present cross-sectional study, we tested the role of PIU symptoms as a moderator of the relationship between symptoms of PSW and PLEs in a sample of 238 Italian emerging adults. Method: Data was collected using the 25-item Hikikomori Questionnaire, the Internet Disorder Scale, the Brief Prodromal Questionnaire, and the Brief Symptom Inventory. In addition, lifetime psychological disorders and drug and alcohol use during the last month were explored. No participant reported a lifetime episode of schizophrenia or other psychotic disorder. Results: Symptoms of PSW and PIU were significantly associated with PLEs total distress and PLEs total number of symptoms endorsed, after adjustment for age and symptoms of depression and anxiety. Further, PIU symptoms moderated the relationship between symptoms of PSW and PLEs total distress (b= 2.745, s.e.= 1.089, p= 0.012). However, PIU symptoms did not moderate the relationship between PSW and PLEs total symptoms (b= 0.615, s.e.= 0.349, p= 0.078). This study is limited because the participants were most likely university students and because of the cross-sectional design. Conclusions: Findings from this study partially support the role of high symptoms of PIU as a risk factor in the relationship between symptoms of PSW and PLEs. Future longitudinal research is needed to confirm our findings examining the temporal relationship between PSW, PIU, and PLEs using both dimensional and categorical approaches.
... Escapism is an essential motivating factor contributing to GD and should be included in clinical assessments. However, escapism is common among highly engaged, healthy gamers [23]. Thus, escapism has a lower diagnostic validity (69.6%) in identifying individuals with IGD [1 •, 12]. ...
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Purpose of Review This review explores the differences in approach and diagnostic validity between the International Classification of Diseases, 11th Revision criteria for gaming disorder (ICD-11-GD), and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for internet gaming disorder (DSM-5-IGD). Recent Findings A few studies have demonstrated diagnostic validity and consistency between the DSM-5-IGD and ICD-11-GD criteria. The ICD-11-GD involves a higher threshold for GD diagnosis than the DSM-5-IGD. On the other hand, future studies should evaluate whether the ICD-11-GD criteria could differentiate GD from highly engaged gamers. Hazardous gaming criteria may help identify gamers with risky gaming behavior and compensate for the possible type II errors associated with the ICD-11-GD criteria. Summary Both DSM-5-IGD and ICD-11-GD criteria exhibit adequate diagnostic validity and consistency in general. The criteria for hazardous gaming have clinical utility for implementing the preventive intervention for GD. Additional studies based on the ICD-11-GD criteria, including additional clinical features and boundaries with other disorders, should be conducted to evaluate their validity and utility in determining the GD diagnosis, course, prognosis, and treatment.
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Background and aims Online gaming motives have proven to be useful in differentiating problematic engagement in online gaming. However, the mixture modeling approach for classifying problematic subtypes based on gaming motives remains limited. This study attempted to differentiate heterogeneous online gamers into more homogenous subtypes based on gaming motives using latent profile analysis (LPA). We also compared various psychological and gaming/leisure related variables across the derived profiles. Methods A total of 674 Korean online game users (mean age = 21.81 years, male = 76%) completed self-report questionnaires, including the Korean version of the Motives for Online Gaming Questionnaire (K-MOGQ). After the LPA, the relationships between latent profile membership and auxiliary variables were explored. Results Four latent profiles were identified, that were further classified into one problematic ( highly motivated-dissatisfied gamer), one highly engaged ( highly motivated-satisfied gamer ), and two casual ( moderately-motivated casual gamer and lowly-motivated casual gamer ) gamer profiles. Inter-profile comparisons revealed that highly motivated-dissatisfied gamer had the most pathological profile, characterized by high Internet gaming disorder (IGD) tendency, neuroticism, and impulsivity, but the lowest recreation motive. While highly motivated-satisfied gamer also demonstrated a heightened IGD tendency, they showed positive patterns of psychological and gaming/leisure-related variables, which indicated they could be better considered as high engaged instead of problematic gamers. Discussion and conclusions These results indicate that the recreation motive, in addition to fantasy or escape motives, is an important factor in differentiating maladaptive online gamers. Classifying online gamers based on gaming motives can contribute to a clearer conceptualization of heterogeneous gamers, paving the way for individualized assessment and treatment planning.
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This review is based on empirical research to find out how people get addicted to social media. Then based on the general addiction process, the possible process of getting addicted to social media would be suggested, and Tiktok would be chosen as an example to analyze how people get addicted to short video social media. This literature review would also put emphasis on how social media addiction affects adolescents both in their academic life and mental health. Then, this literature review would critically examine the reasons for social media addiction from family background, schooling environment, and mental health three aspects, and the effects of social media addiction. Finally, this literature review would aim to find prevention for adolescents' social media addiction and possible solutions which are suitable for adolescents to overcome the negative effects of social media addiction.
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The aim of this paper is to study the social representation of Internet Gaming Disorder. For this reason, 286 adults, both male and female, 18-69 years old, participated in the research. The selected method is the free association technique. Underlying assumptions are: On one hand, a strong representation was not expected, given the fact that this disorder has been acknowledged only for the last ten years in the scientific field. On the other hand, addiction is expected to be the central nucleus’ main element. Results confirmed the above assumptions. Indeed, addiction seems to be the core’s main element. Furthermore, “Social isolation” and “Technological means” stood out as main peripheral elements, due to their relatively high frequency. In addition, results suggest that the representation has not yet fully emerged, confirming our first hypothesis. Finally, we must keep in mind that this new concept needs further study. Therefore, alternative proposals and methods for future research are proposed in the last section of this paper, in order to take a broad view of this subject.
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Video games are widely considered an activity with possibly addictive consequences; as a result, behavioural addiction characteristics related to gaming are recognized in the International Classification of Diseases (ICD‑11) and the Diagnostic and Statistical Manual of Mental Disorders (DSM‑5). Specific characteristics of Pathological Game Usage (PGU) still incite debate among researchers across a spectrum of domains. Time Spent Playing (TSP) is one of the most discussed elements in relation to Pathological Video‑Game Use (PGU). The present study involving 140 respondents researched a possible relationship between the average time spent playing over two specific kinds of days. Statistically specific analyzes, such as correlations and regressions were performed between TSP (based on self‑reported data addressing a specific kind of day: free day/ holiday and work/school day) and PGU (based on the scale developed by Gentile, 2009). Results indicate positive correlations between symptoms/elements of PGU and TSP. Additionally, results indicated significantly higher scores on the PGU scale for males suggesting possible gender differences in the presence of problematic use characteristics.
Aim: The high comorbidity rates of internet gaming disorder (IGD) and gaming disorder (GD) with other psychiatric disorders are concerning. A follow-up study of gamers from clinical and non-clinical samples with and without diagnoses of IGD or GD was conducted to investigate the changes in diagnoses over a one-year period, compare their diagnostic stability, and examine the patterns of co-occurrence between IGD and GD with other psychiatric disorders over the same period. Methods: Baseline and one-year follow-up data of 279 participants, including 120 problematic gaming patients and 159 gamers from the general population, were analyzed. Information on demographics, gaming habits, and self-reported psychological status was collected. Additionally, a structured interview was conducted using the Gaming Diagnostic Interview and the Mini International Neuropsychiatric Interview. Results: Although there was no significant difference between the changes in IGD/GD diagnosis during the one-year period, 34.7% of the participants had a change in IGD diagnosis, while the number of GD cases increased to 60.4%. When evaluating the fixed effects of comorbidity on IGD and GD, ADHD had the highest odds ratio for both IGD (75.23, 95% CI 10.67-530.61) and GD (117.02 x106 , 95% CI 2.23 x106 -6,132.64 x106 ). Conclusion: These results revealed that a GD diagnosis might be more prone to change than an IGD diagnosis. GD was also found to be more affected by comorbid psychiatric disorders. This article is protected by copyright. All rights reserved.
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Many games use engagement rewards as incentives for players to engage, e.g., daily login rewards, repeatable challenges, or seasonal rewards like holiday skins. These rewards may serve players by facilitating enjoyment or motivation; however, they may also be considered differently by skeptical players, e.g., as dark patterns that do not benefit players, and may detract from-or even harm-player experiences. As they are widely prevalent in a variety of games, it is important to understand how such rewards are experienced by players to inform potential pitfalls, such as when they are negative for gaming experience or lead to unhealthy gaming behaviours. 178 participants completed a mixed-methods survey and described such rewards in games they play, the tasks required to acquire them, and their experience qualitatively and with validated scales of motivation regulation and passion orientation. We found that players perceived these rewards as beneficial (e.g., as motivation), as negative (e.g., by promoting fear of missing out), or even as an obligation or chore. Quantitative results further support the dualistic experience of such rewards. We contribute findings and design recommendations that are useful for understanding and designing widely used but potentially detrimental reward mechanics.
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The fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes in its research appendix a potential new diagnosis-Internet gaming disorder. This article outlines the debate surrounding non-substance addictions and the rationale for including this condition in the "Conditions for Further Study" chapter in DSM-5 Section III. It also describes the diagnostic criteria that DSM-5 recommends and methods to assess Internet gaming disorder. The paper details international research related to prevalence rates, demographic, psychiatric, and neurobiological risk factors, the natural course of the condition, and promising treatment approaches. The paper concludes by describing important issues for research to address prior to official recognition of this condition as a mental disorder.
Technical Report
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De Clinical Video game Addiction Test (C-VAT 2.0) is een klinische assessment lijst voor het herkennen van gameverslaving. De C-VAT 2.0 werd in dit onderzoek gevalideerd in de verslavingszorg bij 32 gameverslaafde cliënten van 12 tot en met 23 jaar. Deze gameverslaafde cliënten besteden ogenschijnlijk al hun vrije tijd en zelfs een deel van hun schooltijd aan het gamen. De nieuwe Clinical Video game Addiction Test 2.0 sluit volledig aan op de voorgestelde negen symptomen voor Internet Gaming Disorder uit de DSM-5. De C-VAT 2.0 identificeerde 91% van de cliënten correct bij een afkappunt van vijf of meer positieve items, ten opzichte van de negen items in totaal.
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Background The rapid expansion of online video gaming as a leisure time activity has led to the appearance of problematic online gaming (POG). According to the literature, POG is associated with different psychiatric symptoms (eg, depression, anxiety) and with specific gaming motives (ie, escape, achievement). Based on studies of alcohol use that suggest a mediator role of drinking motives between distal influences (eg, trauma symptoms) and drinking problems, this study examined the assumption that there is an indirect link between psychiatric distress and POG via the mediation of gaming motives. Furthermore, it was also assumed that there was a moderator effect of gender and game type preference based on the important role gender plays in POG and the structural differences between different game types. Objective This study had two aims. The first aim was to test the mediating role of online gaming motives between psychiatric symptoms and problematic use of online games. The second aim was to test the moderator effect of gender and game type preference in this mediation model. Methods An online survey was conducted on a sample of online gamers (N=3186; age: mean 21.1, SD 5.9 years; male: 2859/3186, 89.74%). The Brief Symptom Inventory (BSI), the Motives for Online Gaming Questionnaire (MOGQ), and the Problematic Online Gaming Questionnaire (POGQ) were administered to assess general psychiatric distress, online gaming motives, and problematic online game use, respectively. Structural regression analyses within structural equation modeling were used to test the proposed mediation models and multigroup analyses were used to test gender and game type differences to determine possible moderating effects. ResultsThe mediation models fitted the data adequately. The Global Severity Index (GSI) of the BSI indicated that the level of psychiatric distress had a significant positive direct effect (standardized effect=.35, P
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Background: The rapid expansion of online video gaming as a leisure time activity has led to the appearance of problematic online gaming (POG). According to the literature, POG is associated with different psychiatric symptoms (eg, depression, anxiety) and with specific gaming motives (ie, escape, achievement). Based on studies of alcohol use that suggest a mediator role of drinking motives between distal influences (eg, trauma symptoms) and drinking problems, this study examined the assumption that there is an indirect link between psychiatric distress and POG via the mediation of gaming motives. Furthermore, it was also assumed that there was a moderator effect of gender and game type preference based on the important role gender plays in POG and the structural differences between different game types. Objective: This study had two aims. The first aim was to test the mediating role of online gaming motives between psychiatric symptoms and problematic use of online games. The second aim was to test the moderator effect of gender and game type preference in this mediation model. Methods: An online survey was conducted on a sample of online gamers (N=3186; age: mean 21.1, SD 5.9 years; male: 2859/3186, 89.74%). The Brief Symptom Inventory (BSI), the Motives for Online Gaming Questionnaire (MOGQ), and the Problematic Online Gaming Questionnaire (POGQ) were administered to assess general psychiatric distress, online gaming motives, and problematic online game use, respectively. Structural regression analyses within structural equation modeling were used to test the proposed mediation models and multigroup analyses were used to test gender and game type differences to determine possible moderating effects. Results: The mediation models fitted the data adequately. The Global Severity Index (GSI) of the BSI indicated that the level of psychiatric distress had a significant positive direct effect (standardized effect=.35, P<.001) and a significant indirect (mediating) effect on POG (standardized effect=.194, P<.001) via 2 gaming motives: escape (standardized effect=.139, P<.001) and competition (standardized effect=.046, P<.001). The comparison of the 2 main gamer types showed no significant differences in the model. However, when comparing male and female players it was found that women had (1) slightly higher escape scores (on a 5-point Likert scale: mean 2.28, SD 1.14) than men (mean 1.87, SD 0.97) and (2) a stronger association between the escape motive and problematic online gaming (standardized effect size=.64, P<.001) than men (standardized effect size=.20, P=.001). Conclusions: The results suggest that psychiatric distress is both directly and indirectly (via escape and competition motives) negatively associated with POG. Therefore, the exploration of psychiatric symptoms and gaming motives of POG can be helpful in the preparation of prevention and treatment programs.
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Excessive internet use and its problematic outcomes is a growing focus of research, receiving attention from academics, journalists, health workers, policymakers and the public. However, surprisingly little has yet been accomplished in terms of understanding the causes and consequences of this phenomenon. I argue that this is due to the framing of excessive internet use as an addiction, which leads researchers to neglect people’s reasons and motivations for excessive internet use. The perspective taken in this thesis is that excessive internet use may help people to cope with difficult life situations. This explains why people keep using the internet excessively despite problematic outcomes: the overall experience is positive because worse problems are alleviated. Based on the relationship between a person’s well-being, which is the focal point of literature on excessive internet use, and the motivations for media use grounded in uses and gratifications research, this thesis proposes a combined framework to examine if excessive internet use may be explained as a coping strategy taken to excess. This question was asked in relation to three online activities: World of Warcraft; Facebook; and online poker. Each group was surveyed about their psychosocial well-being, motivations for internet use, and any problematic outcomes. Findings showed that interactions between motivations for use and psychosocial well-being were important explanatory factors for problematic outcomes. Respondents with low self-esteem or high stress experienced more problematic outcomes when gaming or gambling to escape negative feelings, while escapist use was less problematic for players with high self-esteem or low stress. This has implications for how society needs to respond to cases of excessive internet use, since such behaviour can be both helpful and harmful. Future studies may usefully move beyond theories of addiction and consider excessive internet use as a coping behaviour that has both positive and negative outcomes.
Background and aimsInternet gaming disorder (IGD) is included as a condition for further study in Section 3 of the DSM-5. Nine criteria were proposed with a threshold of five or more criteria recommended for diagnosis. The aims of this study were to assess how the specific criteria contribute to diagnosis and to estimate prevalence rates of IGD based on DSM-5 recommendations. DesignLarge-scale, state-representative school survey using a standardized questionnaire. SettingGermany (Lower Saxony). ParticipantsA total of 11003 ninth-graders aged 13-18 years (mean=14.88, 51.09% male). MeasurementsIGD was assessed with a DSM-5 adapted version of the Video Game Dependency Scale that covered all nine criteria of IGD. FindingsIn total, 1.16% [95% confidence interval (CI)=0.96, 1.36] of respondents were classified with IGD according to DSM-5 recommendations. IGD students played games for longer periods, skipped school more often, had lower grades in school, reported more sleep problems and more often endorsed feeling addicted to gaming' than their non-IGD counterparts. The most frequently reported DSM-5 criteria overall were escape adverse moods' (5.30%) and preoccupation' (3.91%), but endorsement of these criteria rarely related to IGD diagnosis. Conditional inference trees showed that the criteria give up other activities', tolerance' and withdrawal' were of key importance for identifying IGD as defined by DSM-5. Conclusions Based on a state-wide representative school survey in Germany, endorsement of five or more criteria of DSM-5 internet gaming disorder (IGD) occurred in 1.16% of the students, and these students evidence greater impairment compared with non-IGD students. Symptoms related to give up other activities', tolerance' and withdrawal' are most relevant for IGD diagnosis in this age group.
Recently, the American Psychiatric Association included Internet gaming disorder (IGD) in the appendix of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The main aim of the current study was to test the reliability and validity of 4 survey instruments to measure IGD on the basis of the 9 criteria from the DSM-5: a long (27-item) and short (9-item) polytomous scale and a long (27-item) and short (9-item) dichotomous scale. The psychometric properties of these scales were tested among a representative sample of 2,444 Dutch adolescents and adults, ages 13-40 years. Confirmatory factor analyses demonstrated that the structural validity (i.e., the dimensional structure) of all scales was satisfactory. Both types of assessment (polytomous and dichotomous) were also reliable (i.e., internally consistent) and showed good criterion-related validity, as indicated by positive correlations with time spent playing games, loneliness, and aggression and negative correlations with self-esteem, prosocial behavior, and life satisfaction. The dichotomous 9-item IGD scale showed solid psychometric properties and was the most practical scale for diagnostic purposes. Latent class analysis of this dichotomous scale indicated that 3 groups could be discerned: normal gamers, risky gamers, and disordered gamers. On the basis of the number of people in this last group, the prevalence of IGD among 13- through 40-year-olds in the Netherlands is approximately 4%. If the DSM-5 threshold for diagnosis (experiencing 5 or more criteria) is applied, the prevalence of disordered gamers is more than 5%. (PsycINFO Database Record (c) 2015 APA, all rights reserved).