The nature and characteristics of problem gaming, with a focus on ICD-11 diagnoses.

PURPOSE OF REVIEW: This review describes the diagnoses related to problem gaming that are included in ICD-11, published by the WHO in 2022. It summarizes the recent literature on the prevalence of Gaming Disorder, its structure, antecedents and comorbidities, and explores whether the range of diagnoses currently available adequately covers the range of experiences seen with problem gaming. RECENT FINDINGS: Overall, between 3 and 6% of the population worldwide are reported to have a gaming disorder as defined by ICD-11 or DSM-5. However, most studies are constrained by methodological issues such as nonrepresentative samples and the use of brief questionnaires to determine prevalence. ICD-11 Gaming Disorder is a psychometrically sound diagnosis. There is no diagnosis that currently captures the experience of harm from gaming, where the requirements for the diagnosis of Gaming Disorder are not reached. SUMMARY: There is evidence in support of the proposed new entity of 'Harmful Gaming', which encompasses mental and physical harm/impairment due to a repeated pattern of gaming, but where requirements for the diagnosis of Gaming Disorder are not met. Such a diagnosis would complete the spectrum of diagnoses available for problem or unhealthy gaming, similar to those for unhealthy substance use, and would provide a framework for a public health approach to reducing the overall harm from unhealthy gaming.

Validation of the ACSID-11 for consistent screening of specific Internet-use disorders based on ICD-11 criteria for gaming disorder: A multitrait-multimethod approach.

INTRODUCTION: With the inclusion of gaming disorder in the ICD-11, diagnostic criteria were introduced for this relatively new disorder. These criteria may be applied to other potential specific Internet-use disorders. The 11-item Assessment of Criteria for Specific Internet-use Disorders (ACSID-11) was developed for consistent screening of gaming disorder, online buying-shopping disorder, online pornography-use disorder, social networks-use disorder, and online gambling disorder. This study tested the construct validity of the ACSID-11, including convergent and divergent measures. METHODS: The ACSID-11 measures five behavioral addictions with the same set of items by following the principles of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ACSID-11 was administered to a convenience sample of active Internet users (N = 1597) together with validated and established measures of each specific Internet-use disorder along with screeners for mental health. Included are the Ten-Item Internet Gaming Disorder Test (IGDT-10), the Bergen Shopping Addiction Scale (BSAS), the Problematic Pornography Consumption Scale (PPCS), the Bergen Social Media Addiction Scale (BSMAS) and the Berlin Inventory of Gambling behavior - Screening (BIG-S). The ACSID-11 was compared convergently and divergently through a multitrait-multimethod approach along with contingency tables with the other Internet-use disorder screeners. RESULTS: The multitrait-multimethod results shows that each behavior assessed with the ACSID-11 has moderate to strong correlations (r's from 0.462 to 0.609) with the scores of the corresponding established measures and, furthermore, positive correlations (r's from 0.122 to 0.434) with measures of psychological distress and further shows that the ACSID-11 can be used for a comprehensive assessment of different behaviors. The contingency tables reveal large divergences between the ACSID-11 and other screening instruments concerning the classification of problematic specific Internet use based on the given cut-off values. CONCLUSION: The current work provides additional validation for the ACSID-11. Accordingly, this tool can be considered as reliable and valid for the simultaneous assessment of different Internet-use disorders: gaming disorder, online buying-shopping disorder, online pornography use disorder, social networks use disorder, and online gambling disorder. With a subsequent clinical validation of the scale and the proposed cut-off score, the ACSID-11 will be a thoroughly validated useful screening tool for clinical practice.

The concept of buying-shopping disorder: Comparing latent classes with a diagnostic approach for in-store and online shopping in a representative sample in Switzerland.

BACKGROUND AND AIMS: Buying-shopping disorder and its transferability to the online sector is controversial. This study investigates in-store and online shopping patterns by comparing data-based modeling to a diagnostic cut-off approach. Further aims were to test model equivalence for gender and identify socio-demographic risk factors. METHODS: In a representative survey, the Bergen Shopping Addiction Scale (BSAS) was applied, using both an online and in-store version. Latent class analyses were followed by multinomial logistic regression analyses to investigate socio-demographic variables. Measurement invariance across genders was tested with multi-group comparisons. RESULTS: With N = 1,012, 3-class solutions provided the best model fit for both in-store and online shopping. Most individuals (76, 86%) were grouped in non-addicted classes, followed by risky (21, 11%) and addicted classes (both 3%). Twenty-eight percent of individuals in the online addicted shopping class remained unidentified using the cut-off. For online shopping, only lower age and education differentiated classes significantly. DISCUSSION: Results indicate a close link between online and in-store shopping, albeit with distinguishing features. The cut-off yielded findings discrepant from class probabilities. That buying-shopping disorder mainly affects younger women of lower educational level must be questioned, given the limited associations identified. CONCLUSIONS: It is important not only to consider different settings of pathological shopping, but also to focus on groups that may not have appeared at risk in previous investigations (e.g., men, older age). The BSAS cut-off warrants further research.

Overcoming the unitary exploration of binge-watching: A cluster analytical approach.

BACKGROUND AND AIMS: Binge-watching (i.e., watching multiple episodes of a TV series in one session) has recently become standard practice among TV series viewers; this expansion generates concerns regarding the potential negative outcomes associated with this habit. However, the investigation of its psychological correlates remains fragmentary, with few initial studies a priori conceptualizing this behavior as a new addictive disorder. This study explored these psychological correlates using cluster analysis of binge-watching behavior based on three key psychological factors: motivations, impulsivity, and emotional reactivity. METHODS: An online survey was completed by 4,039 TV series viewers. Data were analyzed using hierarchical and non-hierarchical cluster analyses, the validity of the clusters being finally determined through mutual comparisons with a selection of external correlates. RESULTS: Four clusters were identified: recreational TV series viewers (presenting low involvement in binge-watching), regulated binge-watchers (moderately involved), avid binge-watchers (presenting elevated but non-problematic involvement), and unregulated binge-watchers (presenting potentially problematic involvement associated with negative outcomes). DISCUSSION AND CONCLUSIONS: This study underlines the heterogeneous and multidetermined nature of binge-watching. Our findings suggest that high engagement in binge-watching is distinct from problematic binge-watching, thus reinforcing the notion that conceptualizing binge-watching as an addictive disorder is of low relevance and might actually lead to the overpathologization of this highly popular leisure activity.

Normative, passionate, or problematic? Identification of adolescent gamer subtypes over time.

BACKGROUND AND AIMS: For most youngsters, gaming is a fun and innocent leisure activity. However, some adolescents are prone to develop problematic gaming behavior. It is therefore important to have a comprehensive understanding of psychosocial and game-related characteristics that differentiate highly engaged gamers from problematic gamers. To that end, this study evaluated the stability and consistency of Internet gaming criteria (as suggested by the DSM-5) and psychosocial characteristics in a two-wave longitudinal study including 1928 young adolescents (mean age = 13.3 years, SD = 0.91, 57% boys). METHODS: A confirmatory factor analysis revealed good stability of the Internet gaming disorder (IGD) construct over time. Latent class analyses revealed three classes for boys (recreational, engaged, and problematic) and two classes for girls (recreational and engaged). RESULTS: Significant differences between classes emerged for problem criteria (conflict and problems in social life), gaming duration, impulsivity, social competence, and attention/hyperactivity. The absence of a problematic gaming class for girls suggests that girls are less likely to develop problematic gaming behavior. DISCUSSION: The IGD criteria as proposed by the DSM-5 are a helpful tool to identify problematic gamers, although the results of this study suggest that using a strict cut-off point might result in false positives, particularly for boys. Problem criteria appeared to be the most sensitive and specific in identifying the problematic gamer, whereas escapism criteria were the least specific and sensitive. Careful consideration of the current proposed criteria to identify problematic gaming behavior could benefit the research and clinical field.

Obsessive-compulsive or addiction? Categorical diagnostic analysis of excoriation disorder compared to obsessive-compulsive disorder and gambling disorder.

Excoriation disorder (ED) is currently classified in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders' Obsessive-compulsive and Related Disorders section (OCRD). However, there remain debates regarding whether ED is related to obsessive-compulsive disorder (OCD) or whether it is better conceptualized as a behavioral addiction. The present research compared the diagnostic overlap and psychiatric comorbidities of 121 individuals seeking treatment for ED (n = 40), OCD (n = 41) and gambling disorder (GD) (n = 40). ED was more likely to overlap with OCD (n = 14) than GD (n = 3). Compared to OCD, ED had similar frequencies of other body focused repetitive behaviors (BFRBs), but higher frequency of addictive behaviors (Odds Ratio - OR = 11.82). In comparison to GD, ED had similar frequencies of addictive behaviors, but higher frequency of BFRBs (OR=19.67). The results support the recent classification of ED as an OCRD. However, ED presents an association with behavioral addictions that suggests a mixed impulsive-compulsive nature. A limitation of the present research was the use of a non-validated semi-structured clinical interview to diagnose impulse control disorders. Future research should examine other characteristics (e.g., epidemiology, neurobiology, genetics, treatment response) to further investigate whether ED should remain classified as an OCRD.

[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.

What type of worker are you? Work-related Inventory (WI-10): A comprehensive instrument for the measurement of workaholism.

BACKGROUND: In literature, there are many instruments for evaluating workaholism; however, they do not have convergent validity, because of the lack of a shared definition of workaholism. OBJECTIVE: We propose a new instrument for evaluating workaholism and work engagement, namely the Work-related Inventory (WI-10), which is based on Loscalzo and Giannini's (2017) comprehensive definition of workaholism. METHODS: We developed a pool of 36 items, covering: 1) addiction symptoms; 2) obsessive-compulsive symptoms, and 3) work engagement. Then, we conducted Exploratory and Confirmatory Factor analyses on a sample of 503 Italian workers (165 males, 337 females, one missing; Mean age = 38.26±10.84) aiming to reduce the number of items. RESULTS: The results showed a 10-items (2 filler) and 2-factor solution: 1) Workaholism and 2) Work Engagement; moreover, the WI-10 has good internal reliability, convergent and divergent validity. CONCLUSIONS: We found good psychometric properties for the WI-10. We also proposed the cut-off scores for the screening of the four kinds of workers proposed by Loscalzo and Giannini (2017): disengaged workaholics, engaged workaholics, engaged workers, and detached workers. The WI-10 will be useful for both research and preventive and clinical purposes.

Severity of Analgesic Dependence and Medication-overuse Headache.

BACKGROUND AND AIMS: Medication-overuse headache (MOH) is a common chronic headache caused by overuse of headache analgesics. It has similarities with substance dependence disorders. The treatment of choice for MOH is withdrawal of the offending analgesics. Behavioral brief intervention treatment using methods adapted from substance misuse settings is effective. Here we investigate the severity of analgesics dependence in MOH using the Severity of Dependence Scale (SDS), validate the SDS score against formal substance dependence diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) and examine whether the SDS predicts successful withdrawal. METHODS: Representative recruitment from the general population; 60 MOH patients, 15 chronic headache patients without medication overuse and 25 population controls. Headaches were diagnosed using the International Classification of Headache Disorders, medication use was assessed and substance dependence classified according to the DSM-IV. The SDS was scored by interviewers blinded to patient group. Descriptive statistics were used and validity of the SDS score assessed against a substance dependence diagnosis using ROC analysis. RESULTS: Sixty-two percent of MOH patients overused simple analgesics, 38% centrally acting analgesics (codeine, opiates, triptans). Fifty percent of MOH patients were classified as DSM-IV substance dependent. Centrally active medication and high SDS scores were associated with higher proportions of dependence. ROC analysis showed SDS scores accurately identified dependence (area under curve 88%). Lower SDS scores were associated with successful withdrawal (P = 0.004). CONCLUSIONS: MOH has characteristics of substance dependence which should be taken into account when choosing treatment strategy. TRIAL REGISTRATION: Based on data collected in previously reported randomized BIMOH trial (; in the present manuscript, Clinical trials registration number: NCT01314768). The present part, however, represents observational data and is not a treatment trial.

Typology of online lotteries and scratch games gamblers' behaviours: A multilevel latent class cluster analysis applied to player account-based gambling data.

OBJECTIVES: Internet gambling is often considered as a risk factor for gambling problems compared with land-based gambling. In parallel, this online activity generates data that can be useful to characterize Internet gambling behaviours. The objectives were to define a typology of online lotteries and scratch games gamblers' behaviours in order to identify early risky gambling behaviours and to classify gamblers in order to identify individuals with global risky gambling behaviours. METHODS: We performed a multilevel latent class cluster based on player account-based data of 10,000 gamblers from a French online operator. RESULTS: We identified seven clusters of online lotteries and scratch games gamblers' behaviours. A small cluster (3%) was characterized by a very high gambling activity, a high probability of chasing behaviour, a large proportion of bets concerning instant lotteries and scratch games, and a high proportion of women. We also found a group of gamblers having an 81% probability of being each month in this cluster. CONCLUSIONS: The identification of distinct clusters of gambling behaviours and of groups of gamblers having different probabilities of being in these clusters through time could allow the implementation of personalized prevention measures according to the gamblers' profile.

Classification of problematic Internet usage types by motives and contexts with elementary and secondary school-aged counseling clients.

BACKGROUND AND AIMS: Past research on the classification of problematic Internet use (PIU) has focused on symptom-based severity and usage motive in order to understand its mechanism. Recently, usage context, such as family or social relationships, has been identified as a key influencing factor of PIU. Therefore, we extended the classification of PIU to include usage context in addition to symptom-based severity and usage motive. METHODS: To classify PIU types, we conducted two studies. First, we performed a clustering analysis, where 265 counseling cases were clustered into usage types in terms of motive and context. After characterizing each usage type, we examined their hierarchical relationships by considering symptoms. Second, we performed a focus group interview with six counselors to increase the transferability of usage types. This transferability was established by matching counselors' quotations to the usage types. When usage types showed consistency between quotations and the clustering analysis, we identified the progression patterns between hierarchical relationships. RESULTS: The clustering analysis of motive and context yielded six usage types with three hierarchical relationships. The focus group interview results verified the transferability of these six types and identified two progression patterns between the hierarchical relationships. DISCUSSION AND CONCLUSION: Although usage motive and context were given equal weight before the clustering analysis, the resulting types revealed that usage context played a greater role in the classification process.

Portraying addiction as a disease: A phenomenological answer.

This paper stems from the concern that, in certain situations, categorization may lead to the annihilation of the subject. It attempts to answer the question whether there is a way of framing addiction without necessarily putting the addicted persons in categories that hurt them. After showing, in the first section, how stigma is part of the process of becoming (and remaining) addicted, I will turn to the phenomenological tradition in order to re-consider the main descriptive categories that have been used so far to capture addiction as a "pathological" or "deviant" experience. The second section addresses addiction as an experience of hetero-transformation of the psycho-physical unity of the individual, which presupposes a genuine sense of the power of the bodily subject, while the third focuses on the modifications of temporality in addiction, especially in the horizon of trauma. The paper concludes that understanding addiction depends on framing the experience of addiction primarily as a non-pathological form of expression and looking at it as an attempt to restore the capabilities of a vulnerable subject.

Is smartphone addiction really an addiction?

Aims In light of the rise in research on technological addictions and smartphone addiction in particular, the aim of this paper was to review the relevant literature on the topic of smartphone addiction and determine whether this disorder exists or if it does not adequately satisfy the criteria for addiction. Methods We reviewed quantitative and qualitative studies on smartphone addiction and analyzed their methods and conclusions to make a determination on the suitability of the diagnosis "addiction" to excessive and problematic smartphone use. Results Although the majority of research in the field declares that smartphones are addictive or takes the existence of smartphone addiction as granted, we did not find sufficient support from the addiction perspective to confirm the existence of smartphone addiction at this time. The behaviors observed in the research could be better labeled as problematic or maladaptive smartphone use and their consequences do not meet the severity levels of those caused by addiction. Discussion and conclusions Addiction is a disorder with severe effects on physical and psychological health. A behavior may have a similar presentation as addiction in terms of excessive use, impulse control problems, and negative consequences, but that does not mean that it should be considered an addiction. We propose moving away from the addiction framework when studying technological behaviors and using other terms such as "problematic use" to describe them. We recommend that problematic technology use is to be studied in its sociocultural context with an increased focus on its compensatory functions, motivations, and gratifications.

The concept of "harm" in Internet gaming disorder.

Internet gaming disorder (IGD) is a proposed condition that refers to persistent gaming leading to clinically significant impairment. However, there have been few attempts to study the different types and degrees of harm caused by IGD. This commentary describes some of the negative intrapersonal and interpersonal effects of an extreme time investment in gaming activities in the context of IGD. Future research should examine the way in which IGD harms may occur at different levels and degrees. This may enhance the screening of individuals whose behavior is suspected to meet the definition of the proposed IGD criteria.

Are Treatment Outcomes Determined by Type of Gambling? A UK Study.

One of the main difficulties faced in treating gambling disorder is compliance with psychological treatment. Gambling takes many forms and can differ greatly in its features such as speed of play and skill requirements. The type of gambling a pathological gambler opts for may play a key role in treatment compliance. The aim of the present study was to determine whether within treatment seeking sample of gambling disorder clients, gambling activity has any correlation with their resultant treatment outcomes. The study incorporated 524 treatment-seeking individuals who are clients of the National Problem Gambling Clinic in London. All of the clients were assessed prior to treatment and fulfilled the Problem Gambling Severity Index criteria for problem gambling. Data concerning clients' gambling behavior over the previous year was gathered using self-reports. Subsequently, the data was fitted to a multinomial logistic regression model, with the treatment outcome (i.e. pre-treatment dropouts, during treatment dropouts, and completed treatment) as the dependent variable and gambling behavior as the independent variable, whilst controlling for socio-demographic factors. The use of gaming machines was a significant predictor of dropping out pre-treatment (p < 0.05, RRR 1.616), whilst betting on sports events was a significant predictor of dropping out during treatment (p < 0.01, RRR 2.435). Treatment outcomes have been found to significantly differ based on participation in certain gambling activities. Further research into the salient features of these gambling activities may help to further explain pre-treatment and during treatment dropouts within this population.

Definition of Substance and Non-substance Addiction.

Substance addiction (or drug addiction) is a neuropsychiatric disorder characterized by a recurring desire to continue taking the drug despite harmful consequences. Non-substance addiction (or behavioral addiction) covers pathological gambling, food addiction, internet addiction, and mobile phone addiction. Their definition is similar to drug addiction but they differ from each other in specific domains. This review aims to provide a brief overview of past and current definitions of substance and non-substance addiction, and also touches on the topic of diagnosing drug addiction and non-drug addiction, ultimately aiming to further the understanding of the key concepts needed for a foundation to study the biological and psychological underpinnings of addiction disorders.

Internet-Related Disorders: Development of the Short Compulsive Internet Use Scale.

The addiction treatment system only reaches a small number of individuals suffering from Internet-related disorders. Therefore, it is important to improve case detection for preventive measures and brief interventions. Existing screening instruments are often time-consuming and rarely validated using clinical criteria. The aim of this study is to develop an optimized short screening for problematic Internet use and Internet addiction (IA). A regression analysis was conducted in random subsamples of a merged sample (N = 3,040; N = 1,209) to examine the item performance of the Compulsive Internet Use Scale (CIUS). Based on the results, a short version of the CIUS was developed and compared with the original CIUS. A fully structured diagnostic interview, covering the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for the Internet gaming disorder with a broader focus on all Internet activities, was conducted. A five-item version of the short screening performed best across the samples. Comparing the area under the curve (AUC) of the receiver operating characteristic between the Short CIUS and the original test revealed no significant difference (AUC = 0.968; 0.977). A cutoff point of 7 turned out to perform best for case detection and yielded a sensitivity of 0.95 and a specificity of 0.87, Cronbach's alpha was 0.77. The analysis showed that the performance of the Short CIUS is just as good in detecting problematical Internet use and IA as the performance of the original CIUS. The Short CIUS provides an economical and valid instrument for the assessment of problematic Internet use and IA.