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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 ‘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.
INTRODUCTION
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
field, as it aimed to review two contentious issues, namely
the (i) inclusion of behavioural addictions (andmore specif-
ically IGD) in the latest (fifth) 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 first aim has already received considerable de-
bate elsewhere [3–14].
The present commentary paper has been written by a
group of researchers from a number of different academic
fields with a shared interest in research into online addic-
tion, and more specifically 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
definition of IGD, (ii) on whether IGD should be conceptu-
alized as an addiction, (iii) on whether components such
as ‘tolerance’and ‘withdrawal’should be included as defin-
ing characteristics, (iv) on whether there isa difference be-
tween ‘gaming disorder’and ‘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, first-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
difficulties 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 field 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 ‘consensus’provided by the 12 authors of
their paper does not constitute an international consensus.
Moreover, the published papers by the authors of the ‘con-
sensus’paper relied heavily on survey sample data, and
completely omitted the core issues of clinical assessment
and treatment-seeking patients.
REPRESENTATIVENESS OF THE
INTERNATIONAL GROUP AND
PROBLEMATIC GAMING INSTRUMENTS
ASSESSED
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 ‘consensus’paper 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,111,167–178
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 [16–21].
CRITERIA FOR INTERNET GAMING
DISORDER
The remainder of the present paper discussesbrieflyeachof
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 field of IGD. Additionally, any
new proposed wording should also include the 12 authors
of the ‘consensus’paper 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.
DO YOU SPEND A LOT OF TIME THINKING
ABOUT GAMES EVEN WHEN YOU ARE
NOT PLAYING, OR PLANNING WHEN YOU
CAN PLAY NEXT? (PREOCCUPATION)
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
[23–25].
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 significance 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.
DO YOU FEEL RESTLESS, IRRITABLE,
MOODY, ANGRY, ANXIOUS OR SAD
WHEN ATTEMPTING TO CUT DOWN OR
STOP GAMING, OR WHEN YOU ARE
UNABLE TO PLAY? (WITHDRAWAL)
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 first to note that in addition
to players’self-report, those in the field 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 colleagues—agree that withdrawal should not be con-
flated 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,
anxiousorsadoveraperiodofuptotwodayswhen
attempting to cut down or stop gaming, or when you are
unable to play?). Assessment of the withdrawal symptoms
168 Mark D. Griffiths et al.
© 2015 Society for the Study of Addiction Addiction,111,167–178
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
affective–behavioural outcomes.
Although some in the field (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].
DO YOU FEEL THE NEED TO PLAY FOR
INCREASING AMOUNTS OF TIME, PLAY
MORE EXCITING GAMES OR USE MORE
POWERFUL EQUIPMENT TO GET THE
SAME AMOUNT OF EXCITEMENT YOU
USED TO GET? (TOLERANCE)
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 conflates 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-
forcement(i.e.pleasure)].Ko[29]hasalsonotedthat
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 games’is arguably a poor
indicator of tolerance. The ‘tolerance’criterion 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 [32–34]. 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 Griffiths [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 reflecting
a pathology.
Many people spend a great deal of money on their
hobbies (e.g. fishing 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,111,167–178
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
periods.
DO YOU FEEL THAT YOU SHOULD PLAY
LESS, BUT ARE UNABLE TO CUT BACK ON
THEAMOUNTOFTIMEYOUSPEND
PLAYING GAMES? (REDUCE/STOP)
Many of the present authors felt this criterion of IGD (i.e.
the inability to stop one’s 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 reflect 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 time’spent 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 first
place.
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 [14,22,37–39]. 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 benefits are substantial but the
costs are spread over time and hard to judge—in line with
Heyman’s 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-
cifically, 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
age-dependency.
DO YOU LOSE INTEREST IN OR REDUCE
PARTICIPATION IN OTHER RECREATIONAL
ACTIVITIES (HOBBIES, MEETINGS WITH
FRIENDS) DUE TO GAMING? (GIVE UP OTHER
ACTIVITIES)
A number of the present authors felt that ‘giving up other
activities’is a somewhat weak criterion of IGD for two
main reasons: (i) giving up other activities for gaming
may reflect a normal developmental process, and/or (ii) it
may reflect 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 one’s 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. Griffiths et al.
© 2015 Society for the Study of Addiction Addiction,111,167–178
or ceasing those activities result in other practical ‘harm’to
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 define—for
adolescents—more 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 beneficial to define 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 individual’s
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, reflected 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 individual’spersonal
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 difficulty 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.
DO YOU CONTINUE TO PLAY GAMES
EVEN THOUGH YOU ARE AWARE OF
NEGATIVE CONSEQUENCES, SUCH AS
NOT GETTING ENOUGH SLEEP, BEING
LATE TO SCHOOL/WORK, SPENDING
TOO MUCH MONEY, HAVING
ARGUMENTS WITH OTHERS OR
NEGLECTING IMPORTANT DUTIES?
(CONTINUE DESPITE PROBLEMS)
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
‘normal’players experience the same symptom (i.e.
‘playing through’a certain game after it was released).
There is some literature from the gambling field suggesting
that the perceived seriousness of problems may be tempo-
rally dependent, with adolescents only perceiving long-
term negative consequences [54].
DO YOU LIE TO FAMILY, FRIENDS OR
OTHERS ABOUT HOW MUCH YOU GAME,
OR TRY TO KEEP YOUR FAMILY OR
FRIENDS FROM KNOWING HOW MUCH
YOU GAME? (DECEIVE/COVER UP)
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-
nificantly 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 player’s 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,111,167–178
significant influence 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
reflects more on the parents’perception 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 conflate problems that are less
severe with those that are very severe, and could be used
to inflate the prevalence of true problems.
DO YOU GAME TO ESCAPE FROM OR
FORGET ABOUT PERSONAL PROBLEMS,
OR TO RELIEVE UNCOMFORTABLE
FEELINGS SUCH AS GUILT, ANXIETY,
HELPLESSNESS OR DEPRESSION?
(ESCAPE ADVERSE MOODS)
Gaming as a form of escape has much support in the liter-
ature. For instance, among playersof MMORPGs, escapism
is the most significant 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 specificity (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 profile 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 significant indicator of problematic
gaming if an individual also had low psychosocial
wellbeing. This confirms 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 difficult 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.
DO YOU RISK OR LOSE SIGNIFICANT
RELATIONSHIPS, OR JOB, EDUCATIONAL
OR CAREER OPPORTUNITIES BECAUSE
OF GAMING? (RISK/LOSE
RELATIONSHIPS/OPPORTUNITIES)
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 gaming’in 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 performance’instead 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. Griffiths et al.
© 2015 Society for the Study of Addiction Addiction,111,167–178
present authors believed that problems caused by gaming
should be a requirement criterion.
MOVING TOWARDS CONSENSUS
Some mayargue that it is questionable whether consensus
in the IGD field will ever be possible, given the lack of con-
sensus in other fields 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 field
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 field.
•Host dedicated symposia at international behavioural
addiction conferences that include representatives from
both different theoretical perspectives and different
cultures.
•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 field-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.
CONCLUDING COMMENTS
In this paper, we have attempted to summarize our main
concerns about the IGD criteria in the ‘consensus’paper
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 field 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-
sensual’statements. We hope that our paper willfoster de-
bate in the IGD field 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
None.
Keywords Gaming addiction, gaming addiction assess-
ment, IGD assessment, internet gaming disorder, problem-
atic gaming, video game addiction.
MARK D. GRIFFITHS
1
, ANTONIUS J. VAN ROOIJ
2
,
DANIEL KARDEFELT-WINTHER
3
,VLADANSTARCEVIC
4
,
ORSOLYA KIRÁLY
5
, STÅLE PALLESEN
6
, KAI MÜLLER
7
,
MICHAEL DREIER
7
, MICHELLE CARRAS
8
,
NICOLE PRAUSE
9
, DANIEL L. KING
10
,
ELLIAS ABOUJAOUDE
11
, DARIA J. KUSS
1
,
HALLEY M. PONTES
1
, OLATZ LOPEZ FERNANDEZ
12
,
KATALIN NAGYGYORGY
5
, SOPHIA ACHAB
13
,
JOËL BILLIEUX
12
, THORSTEN QUANDT
14
,
XAVIER CARBONELL
15
, CHRISTOPHER J. FERGUSON
16
,
RANI A. HOFF
17
, JEFFREY DEREVENSKY
18
,
MARIA C. HAAGSMA
19
,PAULDELFABBRO
10
,
MARK COULSON
20
, ZAHEER HUSSAIN
21
&
ZSOLT DEMETROVICS
5
,
Nottingham Trent University, Nottingham, UK,
1
iMinds-MICT-Ghent
University, Ghent, Belgium,
2
Karolinska Institutet, Stockholm,
Sweden,
3
University of Sydney, New South Wales Australia,
4
Eötvös
Loránd University, Budapest, Hungary,
5
University of Bergen, Bergen,
Norway,
6
Mainz University, Mainz, Germany,
7
Johns Hopkins Uni-
versity, Baltomore, MD, USA,
8
University of California Berkeley, CA,
USA,
9
University of Adelaide, Adelaide, Australia,
10
Stanford Univer-
sity, Stanford, CA, USA,
11
Université Catholique de Louvain, Louvain,
Belgium,
12
University Hospitals of Geneva, Geneva, Switzerland,
13
University of Münster, Münster, Germany,
14
Universidad Ramon Llull,
Barcelona, Spain,
15
Stetson University, DeLand, FL, USA,
16
Ya l e
University, New Haven, CT USA,
17
McGill University, Montréal,
Québec, Canada,
18
University of Twente, Enschede, The Netherlands,
19
Middlesex University, Hendon, UK
20
and University of Derby,
Derby, UK
21
E-mail: mark.griffiths@ntu.ac.uk
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GRIFFITHS ET AL.’SCOMMENTSONTHE
INTERNATIONAL CONSENSUS STATEMENT
OF INTERNET GAMING DISORDER:
FURTHERING CONSENSUS OR HINDERING
PROGRESS?
Our recent paper [1] outlined the DSM-5 criteria for inter-
net gaming disorder (IGD), and Griffiths 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,
Revision5(DSM-5)[3].
With regard to their first point, Griffiths 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,isdefined 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
Griffiths 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. Griffiths 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 Giffiths
et al. [2] to be dismissive of what we accomplished, given
other positive reactions to our consensus [5–8]. 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 indefinitely 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 Griffiths
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, Griffiths et al. [10] have called for an aim
common to ours: ‘the gaming addiction field must unite
and start using the same assessment measures’. Neverthe-
less, Dr Griffiths 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,111,167–178
