DSM-5 Internet Gaming Disorder Criteria Research Articles

Higher striatal glutamate in male youth with internet gaming disorder

Internet gaming disorder (IGD) was included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a research diagnosis, but little is known about its pathophysiology. Alterations in frontostriatal circuits appear to play a critical role in the development of addiction. Glutamate is considered an essential excitatory neurotransmitter in addictive disorders. This study’s aim was to investigate striatal glutamate in youth with IGD compared to healthy controls (HC). Using a cross-sectional design, 25 adolescent male subjects fulfilling DSM-5 criteria for IGD and 26 HC, matched in age, education, handedness and smoking, were included in the analysis. A structural MPRAGE T1 sequence followed by a single-voxel magnetic resonance spectroscopy MEGA-PRESS sequence (TR = 1500 ms, TE = 68 ms, 208 averages) with a voxel size of 20 mm3 were recorded on 3 T Siemens Magnetom Prisma scanner. The voxel was placed in the left striatum. Group comparison of the relative glutamate and glutamine (Glx) was calculated using regression analysis. IGD subjects met an average of 6.5 of 9 DSM-5 IGD criteria and reported an average of 29 h of weekly gaming. Regression analysis showed a significant group effect for Glx, with higher Glx levels in IGD as compared to HC (coef. = .086, t (50) = 2.17, p = .035). Our study is the first to show higher levels of Glx in the striatum in youth with IGD. The elevation of Glx in the striatum may indicate hyperactivation of the reward system in IGD. Thus, results confirm that neurochemical alterations can be identified in early stages of behavioral addictions.

Item Response Theory Analyses of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Criteria Adapted to Screen Use Disorder: Exploratory Survey.

BackgroundScreen use is part of daily life worldwide and morbidity related to excess use of screens has been reported. Some use of screens in excess could indicate a screen use disorder (ScUD). An integrative approach to ScUD could better fit the polymodal reality of screens, and concurrent problems with screens, than a split approach, activity by activity. In that paradigm, a pragmatic and operationalized approach to study a potential ScUD requires the use of common criteria, for all screens and activities done on screens, in a single questionnaire.ObjectiveOur goals were (1) to describe screen uses in a general population sample and (2) to test the unidimensionality, local independence, and psychometric properties of the 9 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) internet gaming disorder (IGD) criteria adapted to screen use in a community sample. We hypothesized that the 9 DSM-5 IGD criteria adapted to ScUD would show unidimensionality, local independence, and good discrimination, with criteria distributed on the severity continuum.MethodsThis cross-sectional survey in a French suburban city targeted adults and adolescents. A self-administered questionnaire covered the main types of screens used and their use for various activities in the past month. Presence of ScUD diagnostic criteria in past 12 months was also self-evaluated in the questionnaire. Factor and 2-parameter Item Response Theory analysis were used to investigate the dimensionality, local independence, and psychometric properties of the ScUD criteria.ResultsAmong the 300 participants, 171 (57.0%) were female (mean age 27 years), 297 (99.0%) used screens, 134 (44.7%) reported at least one criterion (potential problem users), and 5 (1.7%) reported 5 or more criteria and endorsed an ScUD. The most endorsed criteria were loss of control (60/300, 20.0%) and preoccupation (52/300, 17.3%). Screen types used and screen activities differed between participants with no ScUD criteria and those with at least one ScUD criterion. The latter were more likely to have a computer as the most used screen type, and more video gaming, communication/social network, and watching news and research of information as activities. Unidimensionality was confirmed by all fit indices. Local independence was confirmed by the absence of residual correlation between the items. Criteria had relatively high factor loading, with loss of interest in other recreational activities having the highest. However, criteria with the lowest factor loading all remained above the cut-offs, sanctioning unidimensionality. Most discriminating criteria were loss of interests, preoccupation, deceive/cover up, and risk/lose relationship/opportunities, which also provided the most information on the measurement of the latent trait.ConclusionsWe described screen uses in a French community sample and have shown that the adaptation of the DSM-5 IGD to “ScUD” has good psychometric validity and is discriminating, confirming our hypothesis. We suggest to use those criteria to assess potential “ScUD.” Further studies should determine if all criteria are needed and whether others should be added.

Examining the DSM-5 Internet Gaming Disorder Criteria in Filipino Gamers: a Factor- and Person-Centered Approach

Examining the DSM-5 Internet Gaming Disorder Criteria in Filipino Gamers: a Factor- and Person-Centered Approach

Preschool Exposure to Online Games and Internet Gaming Disorder in Adolescents: A Cohort Study.

Objectives: Although considerable evidence has already been collected on the effects of early initiation of drug/alcohol consumption on addictive behaviors in adolescents, little is known about the impact of early exposure to online games during preschool ages on the risk of internet gaming disorder (IGD). We evaluated the effects of exposure to online games before entering elementary school on IGD occurrence during the secondary school years using a community-based longitudinal study.Methods: Data from 1,760 adolescents (seventh grade), who were recruited from the iCURE study and followed for 2 years, were analyzed. A high risk of IGD (HRIGD) was assessed by the Internet Game Use Elicited Symptom Screen, a self-reported questionnaire based on the fifth version of DSM-5 IGD criteria. Early exposure to online gaming was defined as when adolescents played online games during their preschool years. A multivariate generalized-estimating-equation model was applied to examine the independent risk factor of the occurrence of HRIGD during the 2-year follow-up period.Results: As compared with the later-exposure group, those with early exposure to online games showed an ~1.7-fold greater incidence of HRIGD over the 2-year follow-ups after adjusting for potential confounders including baseline IGD scores (adjusted relative risk:1.69; 95%confidence interval:1.08–2.66). Pre-specified sensitivity analyses showed that the results were robust.Conclusion: Exposure to online gaming during the preschool years increases the likelihood of occurrence of HRIGD in adolescence. Restricting exposure to online games during the preschool years should be examined as a way to reduce the risk of IGD in adolescents.Clinical Trial Registration: www.clinicaltrials.gov, identifier: NCT02415322.

Multidimensional family therapy reduces problematic gaming in adolescents: A randomised controlled trial.

Background and aimsSocial variables including parental and family factors may serve as risk factors for Internet Gaming Disorder (IGD) in adolescents. An IGD treatment programme should address these factors. We assessed two family therapies – multidimensional family therapy (MDFT) and family therapy as usual (FTAU) – on their impact on the prevalence of IGD and IGD symptoms.MethodsEligible for this randomised controlled trial comparing MDFT (N = 12) with FTAU (N = 30) were adolescents of 12–19 years old meeting at least 5 of the 9 DSM-5 IGD criteria and with at least one parent willing to participate in the study. The youths were recruited from the Centre Phénix-Mail, which offers outpatient adolescent addiction care in Geneva. Assessments occurred at baseline and 6 and 12 months.ResultsBoth family therapies decreased the prevalence of IGD across the one-year period. Both therapies also lowered the number of IGD criteria met, with MDFT outperforming FTAU. There was no effect on the amount of time spent on gaming. At baseline, parents judged their child’s gaming problems to be important whereas the adolescents thought these problems were minimal. This discrepancy in judgment diminished across the study period as parents became milder in rating problem severity. MDFT better retained families in treatment than FTAU.Discussion and ConclusionsFamily therapy, especially MDFT, was effective in treating adolescent IGD. Improvements in family relationships may contribute to the treatment success. Our findings are promising but need to be replicated in larger study.Trial registration numberISRCTN 11142726.

Factors associated with severity, incidence or persistence of internet gaming disorder in children and adolescents: a 2-year longitudinal study.

This study examined factors associated with severity, incidence and/or persistence of internet gaming disorder (IGD) in children and adolescents. Prospective cohort study with 2-year follow-up study in South Korea. A total of 2319 3rd-, 4th- and 7th-graders enrolled into the internet user cohort for unbiased recognition of gaming disorder in early adolescence [intramural Continuing Umbrella of Research Experiences (iCURE)] and analyzed for the current study. Severity of the IGD features was assessed by the Internet Game Use-Elicited Symptom Screen (IGUESS), a self-reported questionnaire based on the DSM-5 IGD criteria. Participants with IGUESS scores ≥10 were considered to be at high risk for IGD (HIGD). Time spent playing on-line games, game types, depressive symptoms, trait anxiety, attention deficit hyperactivity disorder (ADHD) symptoms, social support, openness of communication with parents, attachment to parents and potential confounders were assessed by self-report. A total of 175 (7.5%) students were classified as HIGD cases upon initial assessment. The independent risk factors of incidence of HIGD included playing on-line games for ≥240minutes/day, playing multi-player games, depressive symptoms and ADHD symptoms [adjusted rate ratios (aRRs)=2.03, 1.63, 2.04, 2.53, respectively; all P<0.05]. Factors related to changing IGD severity scores were playing on-line games for 60-239minutes/day, playing single-player on-line games, higher attachment and social support [adjusted incidence rate ratio (aIRRs)=1.38, 1.22, 0.86, 0.87, respectively; all P<0.05]. Independent predictors of persistence of HIGD were playing on-line games for ≥240minutes/day and ADHD symptoms (aRRs=2.63, 2.14, respectively; all P<0.05). Among adolescents in South Korea, the existence of ADHD symptoms and spending more than 4hours per day playing on-line games were associated with the occurrence or persistence of high risk for internet gaming disorder.

Internet Gaming Disorder Clustering Based on Personality Traits in Adolescents, and Its Relation with Comorbid Psychological Symptoms.

In recent years, the evidence regarding Internet Gaming Disorder (IGD) suggests that some personality traits are important risk factors for developing this problem. The heterogeneity involved in problematic online gaming and differences found in the literature regarding the comorbid psychopathology associated with the problem could be explained through different types of gamers. Clustering analysis can allow organization of a collection of personality traits into clusters based on similarity. The objectives of this study were: (1) to obtain an empirical classification of IGD patients according to personality variables and (2) to describe the resultant groups in terms of clinical and sociodemographic variables. The sample included 66 IGD adolescent patients who were consecutive referrals at a mental health center in Barcelona, Spain. A Gaussian mixture model cluster analysis was used in order to classify the subjects based on their personality. Two clusters based on personality traits were detected: type I “higher comorbid symptoms” (n = 24), and type II “lower comorbid symptoms” (n = 42). The type I included higher scores in introversive, inhibited, doleful, unruly, forceful, oppositional, self-demeaning and borderline tendency traits, and lower scores in histrionic, egotistic and conforming traits. The type I obtained higher scores on all the Symptom Check List-90 items-Revised, all the State-Trait Anxiety Index scales, and on the DSM-5 IGD criteria. Differences in personality can be useful in determining clusters with different types of dysfunctionality.

The Clinical Utility of the Chen Internet Addiction Scale-Gaming Version, for Internet Gaming Disorder in the DSM-5 among Young Adults.

Objectives: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) includes the diagnostic criteria for Internet gaming disorder (IGD). This study evaluated (1) the screening, diagnostic, and prevalence-estimated cutoff points of the Chen Internet Addiction Scale–Gaming Version (CIAS-G) for IGD in the DSM-5; and (2) the differences in the CIAS-G and subscale scores among individuals with IGD, regular gamers (RGs), and other control subjects. Methods: We recruited 69 participants with IGD, 69 RGs, and 69 healthy participants based on diagnostic interviews conducted by a psychiatrist according to DSM-5 IGD criteria. All participants completed the CIAS-G and were assessed using the clinical global impression scale. Results: The optimal screening and diagnostic cutoff points were 68 or more (sensitivity, 97.1%; specificity, 76.8%) and 72 or more (sensitivity, 85.5%; specificity, 87.0%) for IGD based on DSM-5 criteria, respectively. The 76 or more cutoff point had the highest number needed to misdiagnose and was the optimal prevalence estimated cutoff point. Conclusions: The screening cutoff point could be used to identify individuals with IGD for further diagnostic interviewing to confirm the diagnosis in the clinical setting or for two-stage epidemiological evaluation. The diagnostic cutoff point provides a provisional diagnosis of IGD when diagnostic interviewing is unavailable. The prevalence-estimated cutoff point could be used to estimate the prevalence of IGD in large-scale epidemiological investigations when further diagnostic interviewing is impractical. The clinical and epidemiological utility of CIAS-G warrants further study.

Validity, functional impairment and complications related to Internet gaming disorder in the DSM-5 and gaming disorder in the ICD-11.

Many concerns have been raised regarding the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria for Internet gaming disorder and International Classification of Diseases, 11th Revision (ICD-11) criteria for gaming disorder. In this study, we demonstrated the diagnostic validity of each criterion for Internet gaming disorder in the DSM-5 in terms of their intensity and frequency thresholds and evaluated functional impairments, unhealthy behaviors and complications among adults with Internet gaming disorder and gaming disorder. We recruited 69 subjects with Internet gaming disorder, 69 regular gamers and 69 controls without regular gaming based on diagnostic interviewing conducted by a psychiatrist according to the DSM-5 Internet gaming disorder criteria. Except for the 'deceiving' and 'escapism' criteria, all criteria for Internet gaming disorder had a diagnostic accuracy ranging from 84.7% to 93.5% in differentiating between adults with Internet gaming disorder and regular gamers. A total of 44 participants with Internet gaming disorder (63.8%) fulfilled the gaming disorder criteria. In addition, 89% and 100% of the Internet gaming disorder and gaming disorder groups, respectively, had academic, occupational or social functional impairment. Both the Internet gaming disorder and gaming disorder groups had higher rates of delayed sleep phase syndrome and insomnia. The gaming disorder group also had a higher obesity proportion. The 'deceiving' and 'escapism' criteria had relatively lower diagnostic accuracy. Both the Internet gaming disorder and gaming disorder groups demonstrated functional impairments and unhealthy behaviors. They also exhibited complications, such as obesity and sleep disorders. These results support the utility of the DSM-5 Internet gaming disorder and ICD-11 gaming disorder criteria in identifying individuals who need treatment for both gaming addiction symptoms and complications resulting from the addiction.

Retraction Note to: Correlates, comorbidities, and suicidal tendencies of problematic game use in a national wide sample of Korean adults

The authors are retracting this article [1]. After publication they became aware that the criteria they had used for the diagnosis of problematic game use were not the DSM-5 Internet gaming disorder criteria as reported in the article but other similar criteria. As this error undermines the results and conclusions of their study they are retracting this article. All authors agree with this retraction.

The topological organization of white matter network in internet gaming disorder individuals.

White matter (WM) integrity abnormalities had been reported in Internet gaming disorder (IGD). Diffusion tensor imaging (DTI) tractography allows identification of WM tracts, potentially providing information about the integrity and organization of relevant underlying WM fiber tracts' architectures, which has been used to investigate the connectivity of cortical and subcortical structures in several brain disorders. Unfortunately, relatively little is known about the thoroughly circuit-level characterization of topological property changes of WM network with IGD. Sixteen right-hand adolescents with IGD participated in our study, according to the diagnostic criteria of IGD in DSM-5. Meanwhile, 16 age and gender-matched healthy controls were also enrolled. DTI tractography was employed to generate brain WM networks in IGD individuals and healthy controls. The 90 cortical and subcortical regions derived from AAL template were chosen as the nodes. The network parameters (i.e., Network strength, clustering coefficient, shortest path length, global efficiency, local efficiency, regional efficiency) were calculated and then correlated with the Internet addiction test (IAT) scores in IGD. IGD group showed decreased global efficiency, local efficiency and increased shortest path length. Further analysis revealed the reduced nodal efficiency in frontal cortex, anterior cingulate cortex and pallidium in IGD. In addition, the global efficiency of WM network was correlated with the IAT scores in IGD (r=-0.5927; p=0.0155). We reported the abnormal topological organization of WM network in IGD and the association with the severity of IGD, which may provide new insights into the neural mechanism of IGD from WM network level.

The Validation of Structured Clinical Interview for Internet Gaming Disorder (SCI-IGD) and Evaluation of the DSM-5 Internet Gaming Disorder Criteria: Findings from a Community Sample of Adults

개정된 DSM-5에 인터넷 게임장애가 앞으로의 연구를 위해 포함되면서 이전에 비해 보다 합의된 명칭과 진단준거에 따른 진단 및 평가가 가능하게 되었지만, 여전히 진단준거의 적절성/타당성과 관련한 논의가 필요한 상태이다. 따라서 본 연구에서는 우선 DSM-5 진단준거에 맞춰 개발해 청소년을 대상으로 타당화를 거친 인터넷 게임장애 구조적 면담검사(SCI-IGD)를 성인을 대상으로 실시하여 타당화하고, 이어서 DSM-5에 제시된 9개 진단준거의 진단적 특성을 살펴보고자 하였다. 만 19세 이상 38세 미만의 성인 99명을 대상으로 개별면담을 통해 SCI-IGD를 실시하였고 스트레스 척도, 간이 증상평가 척도, 정서조절곤란 척도가 포함된 자기보고식 설문을 작성하게 하였다. 연구 결과, SCI-IGD가 적절한 수준의 구성타당도, 수렴타당도, 변별타당도를 갖추고 있는 것으로 확인되었다. 또한 DSM-5의 9개 진단준거는 모두 유의한 수준의 문항변별력을 갖고 있었지만, 사용시간 속임, 부정적 기분 조절이 상대적으로 변별력이 가장 낮았고 내성 진단문항의 충족률이 정상군 진단군 모두에서 가장 낮은 것으로 나타났다. 끝으로 이전 연구결과와 본 연구에서 얻어진 결과를 비교하고 그 의미를 논의하였다.

Association between Internet gaming disorder and adult attention deficit and hyperactivity disorder and their correlates: Impulsivity and hostility

Internet gaming disorder (IGD) and attention deficit and hyperactivity disorder (ADHD) are associated with impulsivity and hostility. This study evaluated the associations among ADHD, impulsivity, hostility, and IGD. We recruited 87 individuals with IGD and 87 controls without a history of IGD. All participants underwent a diagnostic interview based on the DSM-5 IGD criteria and DSM-IV-TR ADHD criteria and completed a questionnaire regarding impulsivity and hostility. The information from the diagnostic interviews was assessed using the clinical global impression scale. The results suggested that IGD is associated with ADHD among young adults and that young adults with both IGD and ADHD have higher impulsivity and hostility. Furthermore, impulsivity and hostility mediate the association between ADHD and IGD. Thus, ADHD is a common comorbidity of IGD among young adults, and impulsivity and hostility are major factors involved in comorbid ADHD and IGD. Young adults with ADHD should be thoroughly assessed, particularly for their impulsivity and hostility, and interventions for IGD should be developed.

Validation of the Ten-Item Internet Gaming Disorder Test (IGDT-10) and evaluation of the nine DSM-5 Internet Gaming Disorder criteria

IntroductionThe inclusion of Internet Gaming Disorder (IGD) in the DSM-5 (Section 3) has given rise to much scholarly debate regarding the proposed criteria and their operationalization. The present study's aim was threefold: to (i) develop and validate a brief psychometric instrument (Ten-Item Internet Gaming Disorder Test; IGDT-10) to assess IGD using definitions suggested in DSM-5, (ii) contribute to ongoing debate regards the usefulness and validity of each of the nine IGD criteria (using Item Response Theory [IRT]), and (iii) investigate the cut-off threshold suggested in the DSM-5. MethodsAn online gamer sample of 4887 gamers (age range 14–64years, mean age 22.2years [SD=6.4], 92.5% male) was collected through Facebook and a gaming-related website with the cooperation of a popular Hungarian gaming magazine. A shopping voucher of approx. 300 Euros was drawn between participants to boost participation (i.e., lottery incentive). Confirmatory factor analysis and a structural regression model were used to test the psychometric properties of the IGDT-10 and IRT analysis was conducted to test the measurement performance of the nine IGD criteria. Finally, Latent Class Analysis along with sensitivity and specificity analysis were used to investigate the cut-off threshold proposed in the DSM-5. ResultsAnalysis supported IGDT-10's validity, reliability, and suitability to be used in future research. Findings of the IRT analysis suggest IGD is manifested through a different set of symptoms depending on the level of severity of the disorder. More specifically, “continuation”, “preoccupation”, “negative consequences” and “escape” were associated with lower severity of IGD, while “tolerance”, “loss of control”, “giving up other activities” and “deception” criteria were associated with more severe levels. “Preoccupation” and “escape” provided very little information to the estimation IGD severity. Finally, the DSM-5 suggested threshold appeared to be supported by our statistical analyses. ConclusionsIGDT-10 is a valid and reliable instrument to assess IGD as proposed in the DSM-5. Apparently the nine criteria do not explain IGD in the same way, suggesting that additional studies are needed to assess the characteristics and intricacies of each criterion and how they account to explain IGD.

P-78 * THE ASSOCIATION BETWEEN INTERNET GAMING DISORDER AND NICOTINE DEPENDENCE: THE MEDIATING ROLE OF IMPULSIVITY

Introduction. Internet gaming disorder (IGD) was a newly defined behavior addiction. However, its associated with other addictive disorder had not been well investigated. This study aimed at evaluating the association between Internet gaming disorder and nicotine dependence. Methods. The subjects with IGD were recruited by advertising post for heavy online gaming users. They are then interviewed by a psychiatrist to confirm their diagnosis based on diagnostic criteria of IGD in DSM-5. The control group was matched to the IGD group based their gender, age, and educational level. They were arranged to evaluate their diagnosis of nicotine dependence and impulsivity (Barrett impulsivity scale). Results. A total of 91 subjects of IGD (74 males, 17 females) had completed the study and recruited in the final sample. Subjects with IGD were more likely to be diagnosed as nicotine dependence (OR = 6.76, 95%CI: 1.47–31.13). Both subjects with IGD or subjects with nicotine dependence had higher impulsivity. With control of impulsivity, the association between IGD and ND was become insignificant (p = 0.08). Discussion. This result suggested the comorbidity between IGD and ND. Further, impulsivity played a medicating role between IGD and ND. It suggested impulsivity could be the share mechanism between behaviour and substance addiction.