The criteria to diagnose internet gaming disorder from causal online gamer.

Abstract

Professor Petry and her colleagues [1] present an international consensus related to diagnostic criteria for internet gaming disorder (IGD) in the Diagnostic and Statistical Manual for Mental Disorder, fifth edition (DSM-5). This consensus aims to diagnose IGD in a consistent manner around the world. The wording of the criteria exactly reflect DSM-5 criteria as a whole. This consensus is an important work, as the presentation of IGD is highly heterogeneous 1, 2. Online gaming is a popular behaviour in modern society and most criteria could be found in healthy online gamers at a lower frequency, shorter duration or lower intensity. This might explain why five or more criteria are deemed necessary to diagnose IGD 3. One essential task of the criteria is to determine the severity of the disorder and how it departs from normality 4. According to our experiences in evaluating diagnostic criteria 5, the wording of the criteria ought to represent the disorder's pathological feature. For example, thinking about or planning for online gaming when trying to concentrate on other things might represent ‘cognitive salience’ more precisely than thinking about or planning for that when not playing games. Further, most causal online gamers have, at some point, felt that they should play less, but on some occasions failed to do so. We suggest that the question: ‘Have you ever decided to control or cut your online gaming, but failed to do so?’ might represent the pathological feature of criterion 4. Secondly, modifying the intensity in wording could provide more diagnostic value. The recommendation for criterion 9, jeopardizing/losing a significant relationship/job/educational opportunity, represents the severity of the criterion. For criterion 5, loss of interest represents an essential mechanism of addiction, decreased sensitivity of reward circuits and enhanced sensitivity of memory circuits to conditioned expectations to substance 6. Thus, to replace some hobbies with online gaming might just be a normal presentation of most online gamers. Modifying to ‘majorly reduced participation’ might represent the intensity of this criterion. Moreover, subjects who had been diagnosed with IGD and had gone into remission from it could control their online gaming. However, they might continue some limited online gaming. The intensity of ‘continue to play games’ in the wording of criterion 7 should be ‘continue excessive online gaming as before’ to demonstrate the intensity of the symptom. Thirdly, as Petry et al. suggest, frequency is also essential to determine whether or not the presentation for criteria is pathological. The criteria should be determined based on the intensity and frequency of symptoms, rather than on a yes/no response. To evaluate or have a further consensus on the frequency and intensity of individual symptoms might contribute to the diagnostic accuracy of IGD criteria. We agree with Petry and colleagues that immediate reaction to stopping a game should not be interpreted as withdrawal symptoms. However, the wording of criterion 2, withdrawal symptoms, might indicate an immediate emotional reaction. It is true that people suffering from IGD are not able to refrain from gaming for more than 2 or 3 days; but it is extremely difficult to determine the duration required for stopping gaming to provoke irritable emotions because of the complex self-motivation for online gaming 2. We usually query the emotional experience after 2 or 3 days of stopping gaming to evaluate withdrawal symptoms. However, the nature or concept of the emotional presentation with intense desire for gaming after stopping gaming for several hours or 1–2 days should be discussed or evaluated. Further, after stopping gaming for more than 2 weeks, sudden onset of the emotional response mentioned above should be considered to be a craving response, but not withdrawal symptoms. Although the consensus in this study is one of the most practical ways in which to diagnose IGD, the presentation of IGD is varied at different stages or ages, or in different circumstances. For example, subjects who keep gaming all day without external restrictions might experience tolerance as ‘excessive gaming without satisfaction’. The wording used for some criteria in this study should be limited to particular circumstances or a specific age. Further, the essential presentation in different stages, the excluding criteria and the nature of IGD should be determined in future study or consensus. These evaluations could contribute to the improved diagnosis of IGD. None.