[Media Literacy Needs Early Guidance and Company]. / Medienkompetenz braucht frühe Anleitung und Begleitung.

Controversies on the effects of media use have a long history and have become even more prevalent in the times of growing digitization. Particularly, potential harms and negative consequences have attracted scientific attention over the past decades. Various research projects have indeed demonstrated, that different negative repercussions can be caused by media use, especially regarding so called "new media" like internet-based computer games and social media. At least in individuals displaying an overuse of these media, research has demonstrated associations with developmental issues, heightened psychopathological symptoms, and problematic or addicted use. Yet, research also demonstrates that these associations are not linear ones but rather follow complex pathways. Thus, simply calling for a complete media abstinence it seems more promising developing pedagogic concepts for enabling children and adolescents using the possibilities of our digital world in a functional and self-determined way.

[Excessive Use Patterns and Internet Use Disorders: Effects on Psychosocial and Cognitive Development in Adolescence]. / Exzessive Nutzungsmuster und Internetnutzungsstörungen: Effekte auf die psychosoziale und kognitive Entwicklung von Jugendlichen.

The growing availability of digital technologies has led to increased rates of using them as a part of daily recreational activity among adolescents. Despite their positive effects, there are ongoing debates of potential harm and health-related negative consequences, particularly when internet activities are performed excessively. This contribution provides an overview on negative aspects of digital technologies by presenting a selection of empirical findings. This overview focuses on a selection of recent methodologically sound studies investigating potential negative effects of digital technologies on the development of adolescents. As main constructs, effects on psychosocial and cognitive development and internet use disorders were investigated. Recently published studies point to substantial associations between internet overuse and negative consequences. Habitual, intense use of the internet is related to higher rates of internalizing symptoms, cognitive distortions, and heightened rates of internet use disorders among adolescents. Given these findings it seems recommendable to provide a close parental monitoring of adolescents discovering virtual worlds. By applying clear rules and supporting development of media literacy, functional use habits can be empowered and harmful effects prevented.The new clinical phenomenon of internet use disorder and its high prevalence among adolescents represents a new challenge for treatment services.

Decreased Occupational Functioning and Increased Physical Health Complaints in Treatment Seekers with Internet-Related Disorders: Compared to Patients with Gambling Disorder.

BACKGROUND: Internet-related disorders (IRDs) as a growing mental health issue will probably be included in the upcoming ICD-11. While research on psychological aspects has progressed, less data are available regarding the physical health status of patients. Thus, we provide new data on physical health complaints, prediagnosed illness, level of functioning, and work ability in a clinical sample. METHODS: From consecutive treatment seekers, we included n = 286 patients with IRD, n = 95 subjects with excessive yet not disordered Internet use, and n = 106 patients with gambling disorder (GD). All 3 groups were compared regarding lifestyle habits, medical history, somatic complaints, sleep disturbances, level of functioning and work ability using standardized self-reports, and clinical ratings. RESULTS: Patients with IRD differed from nonclinical controls by higher somatic complaints, a lower level of functioning, and a higher degree of impairment in social and occupational contexts. Only few differences were found between patients with IRD and GD. CONCLUSIONS: Compared to individuals with excessive, not addictive online behaviors, patients diagnosed with IRD displayed higher somatic symptoms, and more sleep problems. This implies that psychotherapeutic interventions should also consider physical and psychosomatic problems when treating patients. Among patients with IRD, significant social and occupational deficits were comparable to patients with GD. This emphasizes that IRD are causing severe impairment in relevant aspects of the patients' lives.

[Internet-related disorders-old and new challenges. Conference report on the 10th symposium of the German Association on Internet-Related Disorders]. / Internetbezogene Störungen ­ alte und neue Herausforderungen. Tagungsbericht zum 10. Symposium des Fachverbandes Medienabhängigkeit e. V.

Internet-related disorders have become a growing challenge for psychosocial healthcare and society. For ten years, the German Association on Internet-Related Disorders has been a cooperative network, bringing together caregiving professionals and researchers, fostering our knowledge and expertise in facing this health issue. The conference "Categorically after 10 years," held in November 2018, was the annual meeting of these experts.This proceeding aims to depict the history of the conference, by referring to the many national and international experts of the past years that had crucial impact on the growing expertise of the association's members. The current conference mainly dealt with the expected inclusion of "gaming disorder" as a new diagnosis and other internet-related disorders in the ICD-11 that were announced by the World Health Organization (WHO) in summer 2018.Internet-related disorders have been clinically described as excessive and poorly controlled online behaviors that are causing detrimental consequences and result in decreasing psychosocial functioning. The main subtypes of internet-related disorders encompass the uncontrolled use of (online) computer games, pornography, and social networking sites.As in past years, this conference again offered the opportunity for exchange between researchers and healthcare professionals. The program contained an eclectic mix of lectures and workshops, offering a sound review of current developments in internet-related disorders and future perspectives of prevention, diagnostics, and intervention strategies. A particular emphasis was set on the addictive potential of modern computer games, for instance by the implementation of monetarization strategies.

The Berlin Inventory of Gambling behavior - Screening (BIG-S): Validation using a clinical sample.

BACKGROUND: Published diagnostic questionnaires for gambling disorder in German are either based on DSM-III criteria or focus on aspects other than life time prevalence. This study was designed to assess the usability of the DSM-IV criteria based Berlin Inventory of Gambling Behavior Screening tool in a clinical sample and adapt it to DSM-5 criteria. METHODS: In a sample of 432 patients presenting for behavioral addiction assessment at the University Medical Center Mainz, we checked the screening tool's results against clinical diagnosis and compared a subsample of n=300 clinically diagnosed gambling disorder patients with a comparison group of n=132. RESULTS: The BIG-S produced a sensitivity of 99.7% and a specificity of 96.2%. The instrument's unidimensionality and the diagnostic improvements of DSM-5 criteria were verified by exploratory and confirmatory factor analysis as well as receiver operating characteristic analysis. CONCLUSIONS: The BIG-S is a reliable and valid screening tool for gambling disorder and demonstrated its concise and comprehensible operationalization of current DSM-5 criteria in a clinical setting.

Addictive Potential of Internet Applications and Differential Correlates of Problematic Use in Internet Gamers versus Generalized Internet Users in a Representative Sample of Adolescents.

AIMS: This paper examines the addictive potential of 8 different Internet applications, distinguishing male and female users. Moreover, differential correlates of problematic use are investigated in Internet gamers (IG) and generalized Internet users (GIU). METHOD: In a representative sample of 5,667 adolescents aged 12-19 years, use of Internet applications, problematic Internet use, psychopathologic symptoms (emotional problems, hyperactivity/inattention, and psychosomatic complaints), personality (conscientiousness and extraversion), psychosocial correlates (perceived stress and self-efficacy), and coping strategies were assessed. The addictive potential of Internet applications was examined in boys and girls using regression analysis. MANOVAs were conducted to examine differential correlates of problematic Internet use between IG and GIU. RESULTS: Chatting and social networking most strongly predicted problematic Internet use in girls, while gaming was the strongest predictor in boys. Problematic IG exhibited multiple psychosocial problems compared to non-problematic IG. In problematic Internet users, GIU reported even higher psychosocial burden and displayed dysfunctional coping strategies more frequently than gamers. CONCLUSION: The results extend previous findings on the addictive potential of Internet applications and validate the proposed distinction between specific and generalized problematic Internet use. In addition to Internet gaming disorder, future studies should also focus on other highly addictive Internet applications, that is, chatting or social networking, regarding differential correlates of problematic use.

[Psychological Distress and Acceptance of Violence Legitimizing Masculinity Norms among Adolescents]. / Psychische Belastung und die Akzeptanz von gewaltlegitimierenden Männlichkeitsnormen bei Jugendlichen.

The proportion of adolescent migrants in Germany aged 15-20 years has risen to about 29.5% in 2014 according to Federal census statistics. The purpose of the current study was to describe and to compare the psychological strains of adolescent 1st and 2nd generation migrants with non-migrants in a representative school survey. Acceptance of violence legitimizing masculinity norms was explored and its correlation with psychological strain was analyzed. Self-reported data of psychological strain (internalizing and externalizing problems) and acceptance of violence legitimizing masculinity were gathered among 8 518 pupils aged 12-19 years across different school types. Among the surveyed adolescents, 27.6% reported a migration background (5.8% 1st generation migrants; 21.8% 2nd generation migrants). Particularly 1st generation migrants scored higher in internalizing and externalizing problems than 2nd generation migrants or non-migrants. The differences, however, were small. Adolescents with migration background suffered from educational disadvantage, especially 1st generation migrants. Male adolescents reported significantly higher acceptance of violence legitimizing masculinity norms than their female counterparts. Strong agreement with the measured concept of masculinity was found among pupils of lower secondary school and adolescents reported regularly tobacco and cannabis consumption. The acceptance of violence legitimizing masculinity norms was greater among migrants, particularly 1st generation migrants, than non-migrants. Overall, high acceptance of violence legitimizing masculinity norms was related to externalizing problems, which can be understood as dysfunctional coping mechanisms of social disadvantage and a lack of prospects.

The German version of the Perceived Stress Scale - psychometric characteristics in a representative German community sample.

BACKGROUND: The Perceived Stress Scale Cohen (J Health Soc Behav 24:385-96, 1983) is a widely and well-established self-report scale measuring perceived stress. However, the German version of the PSS-10 has not yet been validated. Thus, the purposes of this representative study were to psychometrically evaluate the PSS-10, and to provide norm values for the German population. METHODS: The PSS-10 and standardized scales of depression, anxiety, fatigue, procrastination and life satisfaction were administered to a representative, randomly selected German community sample consisting of 1315 females and 1148 male participants in the age range from 14 to 90 years. RESULTS: The results demonstrated a good internal consistency and construct validity. Perceived stress was consistently associated with depression, anxiety, fatigue, procrastination and reduced life satisfaction. Confirmatory factor analysis revealed a bi-dimensional structure with two related latent factors. Regarding demographic variables, women reported a higher level of stress than men. Perceived stress decreased with higher education, income and employment status. Older and married participants felt less stressed than younger and unmarried participants. CONCLUSION: The PSS-10 is a reliable, valid and economic instrument for assessing perceived stress. As psychological stress is associated with an increased risk of diseases, identifying subpopulations with higher levels of stress is essential. Due to the dependency of the perceived stress level on demographic variables, particularly age and sex, differentiated norm values are needed, which are provided in this paper.

Prevalence and correlates of depersonalization in students aged 12-18 years in Germany.

BACKGROUND: Depersonalization (DP) involves unpleasant experiences of detachment from one's sense of self or unreality in the environment. DP may occur in a broad range of conditions, among healthy persons due to sleep loss, drug induced, secondary to anxiety disorders or primary in depersonalization disorder. Although DP has an early age of onset, little is known about the prevalence and correlates of DP among adolescents. METHODS: Between January and June 2011, we conducted a questionnaire-based representative survey of pupils aged 12-18 years in the federal state Rhineland-Palatinate of Germany. The final sample comprised 3,809 pupils. We analyzed the prevalence of depersonalization and its correlates regarding sociodemographic characteristics, substance abuse, global mental distress and resilience factors. RESULTS: One-third of the sample showed severe global mental distress, and 11.9 % were in the range of clinically significant depersonalization. Depersonalized students were less often living with both parents (67.3 vs. 75.7 %), came more often from an disadvantaged socioeconomic background, had a very severe level of global mental distress (comparable to psychiatric inpatients), were more often smoking and abusing cannabis and they suffered from specific impairments regarding social insecurity, global self-efficacy and active coping abilities. CONCLUSIONS: Experiences of depersonalization were very common among adolescents and may indicate an increased risk for poor academic achievement and mental health in the long term. Prospective studies are needed to investigate the course and clinical relevance of depersonalization for the development of the adolescents.

The mediating effect of after-midnight use of digital media devices on the association of internet-related addictive behavior and insomnia in adolescents.

Background: There is evidence that overexposure to digital media devices (DMD) can not only lead to addictive patterns of internet use, but also cause insomnia symptoms. The aim of this cross-sectional study among adolescents is to provide an estimate of the prevalence of sleep impairments and to explore the mediating role of after-midnight use of DMD between internet-related addictive behavior (IRAB) and insomnia. Methods: 2,712 school students from Styrian schools participated in a population-representative online survey in a supervised school setting in spring 2022. School students were screened using established and validated scales. Data analysis was carried out using multiple imputation, linear multilevel regression and mediation analysis. Results: Prevalence estimation indicates high proportions of clinically relevant moderate [12.6% (11.3%; 14.1%)] and severe [3.6% (2.9%; 4.4%)] insomnia, with an additional 30.6% (29.0%; 32.2%) at subthreshold level. DMD are typically used after midnight an average of 1.66 (1.58; 1.75) evenings with subsequent school day per school week. Linear multilevel regression analysis shows significant associations for sleep disparities as outcome variable e.g., with generalized anxiety [b = 0.329 (0.287; 0.371)], after-midnight use of DMD [b = 0.470 (0.369; 0.572)] and IRAB [b = 0.131 (0.097; 0.165)]. Mediation analysis shows a mediated proportion of 18.2% (13.0%; 25.0%) of the association of IRAB and insomnia by after-midnight use of DMD [Indirect effect: b = 0.032 (0.023; 0.040), direct effect: b = 0.127 (0.083; 0.170)]. Conclusions: Although the cross-sectional nature of this study limits causal inference, the results indicate a need for policies, which are already in preparation in Styria as part of a respective action plan.

Comorbid internet addiction in male clients of inpatient addiction rehabilitation centers: psychiatric symptoms and mental comorbidity.

Addictive Internet use has recently been proposed to be included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Still, little is known about its nosological features, including comorbidity with other mental disorders and disorder-specific psychopathological symptoms. To investigate whether Internet addiction (IA) is an issue in patients in addiction treatment, 1826 clients were surveyed in 15 inpatient rehabilitation centers. Male patients meeting criteria for comorbid IA (n = 71) were compared with a matched control group of male patients treated for alcohol addiction without addictive Internet use (n = 58). The SCL-90-R, the Patient Health Questionnaire, and the seven-item Generalized Anxiety Disorder were used to assess associated psychiatric symptoms and further comorbid disorders. Comorbid IA was associated with higher levels of psychosocial symptoms, especially depression, obsessive-compulsive symptoms, and interpersonal sensitivity. Moreover, the patients with IA more frequently met criteria for additional mental disorders. They display higher rates of psychiatric symptoms, especially depression, and might be in need of additional therapeutic treatment. In rehabilitation centers, a regular screening for IA is recommended to identify patients with this (non-substance-related) addiction and supply them with additional disorder-specific treatment.

Personality traits and their role as risk modifiers in gaming disorder and internet use disorders.

PURPOSE OF REVIEW: After its initial recognition in the DSM-5, Gaming Disorder has now officially been included as a mental disorder in the ICD-11 as a behavioral addiction. In the past decades, research on this phenomenon has increased and in particular theories on its etiopathology have been suggested. In that respect, underlying factors, including neurobiological, social, and psychological factors, have been described. One commonly discussed etiological factor is supposed in specific personality traits. Knowing more about underlying personality factors of Gaming Disorder and other subtypes of internet use disorders would allow for a construction of more sophisticated etiological models, tailored prevention approaches, and would affect the specificity of treatment strategies. This overview provides information on current research on the role of the Big Five personality traits in Gaming Disorder as potential risk modifiers and maintaining factors. RECENT FINDINGS: Research has especially identified high neuroticism and low conscientiousness as correlates of Gaming Disorder. Yet, results based on prospective studies are lacking largely, although there is the first evidence that personality traits might not only act as risk modifying factors but could also be influenced by Gaming Disorder. SUMMARY: Suggestions for future research and the need for a more pronounced perspective taking into account the changing dynamics of personality are presented in this contribution. Addressing personality traits in treatment programs could be a promising approach in preventing patients from premature treatment termination and later relapse.

Is (Disordered) Social Networking Sites Usage a Risk Factor for Dysfunctional Eating and Exercise Behavior?

BACKGROUND: Research over the past years has shown that exposure to thin and beauty ideals in the media can be associated with disordered eating and related variables. Nowadays, interactive media, such as social networking sites, have gained growing popularity and represent a major part of people's lives. It is therefore crucial to investigate how far users might be negatively influenced by social networking sites regarding eating pathology or excessive exercise behavior and if there are particular links to social media use disorder. METHODS: Data were collected by an online-survey encompassing questions on regular social networking site use, eating disorders, and excessive exercise behavior. RESULTS: Analyses showed that disordered social networking sites use was significantly related to eating pathology and a poorer body image in men and women. The frequency of active or passive social networking sites usage however was not associated with exercise behavior. CONCLUSIONS: Our results confirm that disordered social networking sites use represents a risk factor for body image dissatisfaction and associated eating disorders.

The impact of life satisfaction in the treatment of gaming disorder and other internet use disorders: Results from a randomized controlled trial.

Objective: According to ICD-11 gaming disorder is currently defined as a behavioral addiction. While our understanding of crucial aspects of this new condition including other subtypes of internet use disorders is growing, less is known about treatment strategies and their effectiveness. Particularly, dimensions of life satisfaction and their meaning for internet use disorders are poorly investigated. The aim of this study was addressing the role of life satisfaction dimensions in a randomized controlled trial. We examined life satisfaction as an additional treatment outcome and investigated in how far life satisfaction is predictive for symptom reduction and related to personality traits. Methods: A multicenter randomized controlled trial with three measure points (baseline, post-treatment, 6-month follow-up) was conducted based on N = 143 patients aged 17 and above meeting diagnostic criteria for internet use disorders. A cognitive-behavioral disorder specific intervention was applied in n = 72 and compared to a wait list control (n = 71). Endpoints included symptoms of internet use disorders, psychosocial functioning, and life satisfaction. Personality traits were assessed as moderating factors. Results: Life satisfaction (η2 = 0.106) and health satisfaction (η2 = 0.173) significantly increased in the intervention group with large effect sizes. Decreasing symptoms of internet use disorders at follow-up were predicted by life satisfaction at post-treatment (ß = -0.51) with extraversion (B = 1.606) and openness (B = 2.069) moderating this association. Conclusion: Life satisfaction yields additional value as a secondary treatment outcome in internet use disorders and can be therapeutically addressed in order to stabilize treatment effects in the long run. Our study indicates that existing treatment strategies might benefit from explicitly addressing and enhancing psychosocial resources in order to prevent relapses in patients.

[Addictive internet use as a comorbid disorder among clients of an adolescent psychiatry - prevalence and psychopathological symptoms]. / Suchtartige Internetnutzung als komorbide Störung im jugendpsychiatrischen Setting.

OBJECTIVES: Excessive and addictive internet use fulfilling criteria of nonsubstance related addiction disorder is increasingly being discussed by scientists and clinicians alike. Its prevalence of about 3 % among minors points to a relatively frequent phenomenon that can lead to functional impairment and distress. However, there is still no evidence concerning its prevalence among underaged patients in psychiatric treatment. METHODS: 81 patients between the age of 8 and 17 years were screened by a standardized instrument for internet addiction (AICA-S) to assess the prevalence of internet addiction among minors being treated in psychiatric inpatient settings. Their clinical symptoms were examined using Youth Self-Report and Child Behavior Checklist. RESULTS: 11.3 % of the patients fulfilled the criteria of addictive internet use. These patients were older and more often affected by anxiety and depression than patients without internet addiction. CONCLUSIONS: Data suggest that internet addiction is a relevant factor among minors in psychiatric institutions. Those with comorbid internet addiction show distinct patterns of psychopathology and may require disorder-specific treatment.

Nosological Characteristics in Women with Social Media Disorder: The Role of Social Functional Impairment and Agreeableness.

Social media disorder (SMD) is a frequently occurring subtype of Internet-related disorders (IRD), which has recently become a focus of research. It is noticeable that women are among those affected, whose nosological characteristics need to be examined. A clinical sample of n = 294 women (14-68 years, M = 36.88 years) was generated. The questionnaire included questions about demography, IRD, SMD, personality traits, psychopathological distress, functional impairment and comorbid mental illnesses. IRD was found in 17.5 percent and SMD in 12.5 percent of women. Compared to women with global IRD Women with SMD reported lower scores on the personality traits neuroticism and agreeableness. They are more frequently functionally impaired in the social dimension, more often reported comorbid substance-dependency and less eating disorders. The results suggest that although have similar characteristics to the comparison group, women with SMD differ in their nosological characteristics from women with global IRD.

Internet-Related Disorders and Their Effects on Personality Development in Adolescents from Germany-Results from a Prospective Study.

Internet-related disorders (IRD) are increasingly becoming a major health issue. IRD are defined as the predominant use of online content, related to a loss of control and continued use despite negative consequences. Despite findings from cross-sectional studies, the causality of pathways accelerating the development of IRD are unclear. While etiological models emphasize the role of personality as risk factor, mutual influences between IRD and personality have not been examined. A prospective study with two assessments was conducted with n = 941 adolescents (mean age of 13.1 years; 10-17 years). Our aim was to validate etiological assumptions and to examine the effects of IRD-symptoms on the maturation of personality. IRD were measured with the Scale of the Assessment of Internet and Computer game Addiction (AICA-S). Personality traits were assessed using the Brief Five Factor Inventory (BFI). Conscientiousness and neuroticism were predictive for IRD symptoms one year later, and were likewise prone to changes depending on incidence or remission of IRD. Conscientiousness and openness moderated the course of IRD symptoms. Our findings point to complex trait-pathology associations. Personality influences the risk of development and maintenance of IRD symptoms and pre-existing IRD-symptoms affect the development of personality. Adaptations to etiological models are discussed and perspectives for novel intervention strategies are suggested.

Gaming disorder and the COVID-19 pandemic: Treatment demand and service delivery challenges.

Gaming activities have conferred numerous benefits during the COVID-19 pandemic. However, some individuals may be at greater risk of problem gaming due to disruption to adaptive routines, increased anxiety and/or depression, and social isolation. This paper presents a summary of 2019-2021 service data from specialist addiction centers in Germany, Switzerland, Japan, and the United Kingdom. Treatment demand for gaming disorder has exceeded service capacity during the pandemic, with significant service access issues. These data highlight the need for adaptability of gaming disorder services and greater resources and funding to respond effectively in future public health crises.

[Reliability and validity of the Scale for the Assessment of Pathological Computer-Gaming (CSV-S)]. / Reliabilität und Validität der Skala zum Computerspielverhalten (CSV-S).

Growing numbers of young adults are preoccupied with excessive computer gaming. Nevertheless the scientific sight on classification, diagnostics and prevalence of the so called computer game addiction isn't yet clarified. This study was conducted to introduce a validated instrument (CSV-S) with sound psychometric properties to distinguish between regular and excessive computer gaming. The CSV-S was applied in 2 independent samples (N=1,710) of juveniles aged between 13 and 18 years in order to determine validity of the CSV-S in a cross-validation-design. Results emphasize psychometric quality of the CSV-S concerning reliability and validity. The CSV-S provides an useful inventory to assess excessive computer gaming.

[Clinical characteristics of computer game and internet addiction in persons seeking treatment in an outpatient clinic for computer game addiction]. / Klinische Merkmale der Computerspiel- und Internetsucht am Beispiel der Inanspruchnehmer einer Spielsuchtambulanz.

OBJECTIVES: Since March 2008 we have offered outpatient treatment for computer game and internet addiction. This article presents the assessment and clinical characterization of the first cohort of one year. METHODS: The reasons for seeking help (phone consultations, N=346) as well as sociodemographic and psychometric characteristics (N=131) (assessment of computer game addiction; SCL-90R) are presented. RESULTS: Consultation was initiated mainly by relatives--mostly the mothers (86%); 48% report achievement failure and social isolation, lack of control (38%) and conflicts within the family (33%). Two-thirds of the mainly male (96%) patients (N=131) with an average age of 22 (range 13-47) years met the criteria for pathological computer gaming, characterized by an excessive number of hours and preoccupation with gaming, high distress, and unemployment. DISCUSSION: Symptoms resemble those of other addiction disorders. The consequences for disorder-specific treatment concepts and research are discussed.