This paper is a response to a recent debate paper in which Aarseth et al. argue that the inclusion of a formal diagnosis and categories for problematic video gaming or Gaming Disorder (GD) in the World Health Organization’s 11th Revision of the International Classification of Diseases (ICD-11) is premature and therefore the proposal should be removed. The present authors systematically address all the six main arguments presented by Aarseth et al. and argue that, even though some of the concerns presented in the debate paper are legitimate, the inclusion of GD in ICD-11 has more advantages than disadvantages. Furthermore, the present authors also argue that the two GD subtypes (“GD, predominantly online” and “GD, predominantly offline”) are unnecessary and rather problematic; the main category for GD would be perfectly sufficient.
Authors:Aniko Maraz, Orsolya Király, and Zsolt Demetrovics
Background and Aims
Survey-based studies often fail to take into account the predictive value of a test, in other words, the probability of a person having (or not having) the disease when scoring positive (or negative) on the given screening test.
We re-visited the theory and basic calculations of diagnostic accuracy.
In general, the lower the prevalence the worse the predictive value is. When the disorder is relatively rare, a positive test finding is typically not useful in confirming its presence given the high proportion of false positive cases. For example, using the Compulsive Buying Scale (Faber & O’Guinn, 1992) three in four people classified as having compulsive buying disorder will in fact not have the disorder.
Screening tests are limited to serve as an early detection “gate” and only clinical (interview-based) studies are suitable to claim that a certain behaviour is truly “pathological”.
Authors:Chih-Hung Ko, Orsolya Király, Zsolt Demetrovics, Yun-Ming Chang, and Ju-Yu Yen
In 2013, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) included the diagnostic criteria of Internet gaming disorder (IGD). Then, in 2019, the 11th Revision of the International Classification of Diseases (ICD-11) categorized gaming disorder (GD) as an addictive disorder. This review aimed to review the raised concerns, debate, and research of IGD or GD criteria and provide suggestions to resolve them.
A narrative review was conducted, and PubMed was searched for articles mentioning concerns and research on the DSM-5 criteria for IGD, ICD-11 criteria for GD, or criteria for other synonyms, such as problematic gaming or gaming addiction. A total of 107 articles were identified.
Concerns were organized into three categories: conceptual framework, moral panic, and diagnostic validity. Most argumentations supported the proposition that GD and other substance use disorders have similar presentations. A clear definition of GD and adequate public education could prevent rather than exacerbate moral panic. Several researchers reported concerns regarding the nosology, diagnostic validity, and wording of each criterion. However, the threshold, five of the nine criteria with impaired function, demonstrated adequate validity in interview studies.
The current findings support the addiction framework, functional impairment, and validity of the GD criteria. However, further prospective, experimental, and clinical studies validating these findings are warranted. Moreover, an integrative review or debate conference could contribute to the organization of the available results and concept development. Aggregating adequate scientific information could allay or resolve concerns related to the diagnosis of GD.
Authors:Orsolya Szűcs, Léna Szabó, Gábor Élő, Kornél Király, Katalin Darvas, Attila Szijártó, János Gál, and László Zubek
Összefoglaló.Bevezetés: A haldoklást minden korban kulturális és vallási
szabályok vették körül, melyek a mai napig hatnak a társadalomban. A 21.
században számos beteg a kórházban, az intenzív osztályon fejezi be életét, ahol
nem ritkán kerülhet sor életvégi döntés meghozatalára.
Célkitűzés: Vizsgálatunk célja annak feltárása volt, milyen
hatással van az orvosok és ápolók vallásossága a kezeléskorlátozással
kapcsolatos döntésekre az intenzív osztályon. Módszer:
Magyarországi intenzív osztályokon dolgozó orvosok és szakdolgozók körében
végeztünk kérdőíves felmérést a vallás életvégi döntésekre gyakorolt hatásáról.
189 orvos és 105 ápoló által anonim módon kitöltött kérdőívet elemeztünk.
Eredmények: Az intenzív osztályra történő betegfelvételre
nem volt hatással a vallásosság, azonban a szabad ágyak száma a vallásos
orvosokat erősebben befolyásolta, mint az ateista és választ nem adó orvosokat
(<0,0001). A vallásukat gyakorló orvosok szignifikánsan jobban figyelembe
vették a hozzátartozó kérését, mint az ateisták (p = 0,0002). A vallásos ápolók
gyakrabban folytatnák a beteg kezelését a hozzátartozó kérése ellenére is, ha
még látnának esélyt a gyógyulásra, mint a nem vallásosak.
Következtetés: Vizsgálatunk alátámasztotta, hogy a
világnézet befolyásolja az orvosokat és ápolókat az élet végéről hozott
döntésekben. A kezeléskorlátozásról hozott döntés összetett, elengedhetetlen
megismerni hozzá a beteg és családjának haldoklással kapcsolatos vallási
szokásait, mivel jó életvégi döntés a világnézeti szempontok figyelembevétele
nélkül nem hozható. Orv Hetil. 2021; 162(51): 2047–2054.
Summary.Introduction: Death has always been surrounded by habits in all
ages, influenced by cultural and religious differences. Many patients finish
their lives at intensive care units where end-of-life decisions are the part of
everyday practice in the 21th century. Objective: The goal of
our study was to assess how the religious beliefs of physicians and nurses
affect their decision on therapy restriction. Method: We have
performed questionnaire-based enquiries among physicians and nurses working at
intensive care units on how religion affects end-of-life decisions. We have
analyzed the anonymous questionnaires filled out by 189 physicians and 105
nurses. Results: Our results have confirmed the hypothesis that
religion affects decision making about therapy restriction. Patients’ admissions
were not affected by religious beliefs, but the number of available patient beds
influenced the religious physicians more than the atheists ones or the
non-responders (<0.0001). Actively religious physicians complied
significantly better with the relatives than atheists (p = 0.0002). Religious
nurses would continue patient treatment even against the will of relatives more
often than atheists if they see a chance for recovery.
Conclusion: The study supports that religion influences
physicians and nurses in their end-of-life decisions. Decisions on therapy
restriction are complex; it is important to find out religious beliefs and
perception of death among patients and families because good end-of-life
decision cannot be made disregarding religious considerations. Orv Hetil. 2021;
Authors:Orsolya Király, Mark D. Griffiths, Daniel L. King, Hae-Kook Lee, Seung-Yup Lee, Fanni Bányai, Ágnes Zsila, Zsofia K. Takacs, and Zsolt Demetrovics
Background and aims
Empirical research into problematic video game playing suggests that overuse might cause functional and psychological impairments for a minority of gamers. Therefore, the need for regulation in the case of video games (whether governmental or self-imposed) has arisen but has only been implemented in a few countries around the world, and predominantly in Asia. This paper provides a systematic review of current and potential policies addressing problematic gaming.
After conducting a systematic search in the areas of prevention, treatment, and policy measures relating to problematic Internet and video game use, papers were selected that targeted problematic gaming policies (N = 12; six in English and six in Korean). These papers served as the basis of this review.
Policies were classified into three major groups: (i) policy measures limiting availability of video games (e.g., shutdown policy, fatigue system, and parental controls), (ii) measures aiming to reduce risk and harm (e.g., warning messages), and (iii) measures taken to provide help services for gamers. Beyond the attempt to classify the current and potential policy measures, the authors also tried to evaluate their efficiency theoretically and (if data were available) empirically.
Discussion and conclusions
Overall, it appears that although several steps have been taken to address problematic video game playing, most of these steps were not as effective as expected, or had not been evaluated empirically for efficacy. The reason for this may lie in the fact that the policies outlined only addressed or influenced specific aspects of the problem instead of using a more integrative approach.
Authors:Eszter Kotyuk, Anna Magi, Andrea Eisinger, Orsolya Király, Andrea Vereczkei, Csaba Barta, Mark D. Griffiths, Anna Székely, Gyöngyi Kökönyei, Judit Farkas, Bernadette Kun, Rajendra D. Badgaiyan, Róbert Urbán, Kenneth Blum, and Zsolt Demetrovics
Background and aims
Changes in the nomenclature of addictions suggest a significant shift in the conceptualization of addictions, where non-substance related behaviors can also be classified as addictions. A large amount of data provides empirical evidence that there are overlaps of different types of addictive behaviors in etiology, phenomenology, and in the underlying psychological and biological mechanisms. Our aim was to investigate the co-occurrences of a wide range of substance use and behavioral addictions.
The present epidemiological analysis was carried out as part of the Psychological and Genetic Factors of the Addictive Behaviors (PGA) Study, where data were collected from 3,003 adolescents and young adults (42.6% males; mean age 21 years). Addictions to psychoactive substances and behaviors were rigorously assessed.
Data is provided on lifetime occurrences of the assessed substance uses, their co-occurrences, the prevalence estimates of specific behavioral addictions, and co-occurrences of different substance use and potentially addictive behaviors. Associations were found between (i) smoking and problematic Internet use, exercising, eating disorders, and gambling (ii) alcohol consumption and problematic Internet use, problematic online gaming, gambling, and eating disorders, and (iii) cannabis use and problematic online gaming and gambling.
The results suggest a large overlap between the occurrence of these addictions and behaviors and underlies the importance of investigating the possible common psychological, genetic and neural pathways. These data further support concepts such as the Reward Deficiency Syndrome and the component model of addictions that propose a common phenomenological and etiological background of different addictive and related behaviors.
Authors:Olatz Lopez-Fernandez, Daria J. Kuss, Lucia Romo, Yannick Morvan, Laurence Kern, Pierluigi Graziani, Amélie Rousseau, Hans-Jürgen Rumpf, Anja Bischof, Ann-Kathrin Gässler, Adriano Schimmenti, Alessia Passanisi, Niko Männikkö, Maria Kääriänen, Zsolt Demetrovics, Orsolya Király, Mariano Chóliz, Juan José Zacarés, Emilia Serra, Mark D. Griffiths, Halley M. Pontes, Bernadeta Lelonek-Kuleta, Joanna Chwaszcz, Daniele Zullino, Lucien Rochat, Sophia Achab, and Joël Billieux
Background and aims
Despite many positive benefits, mobile phone use can be associated with harmful and detrimental behaviors. The aim of this study was twofold: to examine (a) cross-cultural patterns of perceived dependence on mobile phones in ten European countries, first, grouped in four different regions (North: Finland and UK; South: Spain and Italy; East: Hungary and Poland; West: France, Belgium, Germany, and Switzerland), and second by country, and (b) how socio-demographics, geographic differences, mobile phone usage patterns, and associated activities predicted this perceived dependence.
A sample of 2,775 young adults (aged 18–29 years) were recruited in different European Universities who participated in an online survey. Measures included socio-demographic variables, patterns of mobile phone use, and the dependence subscale of a short version of the Problematic Mobile Phone Use Questionnaire (PMPUQ; Billieux, Van der Linden, & Rochat, 2008).
The young adults from the Northern and Southern regions reported the heaviest use of mobile phones, whereas perceived dependence was less prevalent in the Eastern region. However, the proportion of highly dependent mobile phone users was more elevated in Belgium, UK, and France. Regression analysis identified several risk factors for increased scores on the PMPUQ dependence subscale, namely using mobile phones daily, being female, engaging in social networking, playing video games, shopping and viewing TV shows through the Internet, chatting and messaging, and using mobile phones for downloading-related activities.
Discussion and conclusions
Self-reported dependence on mobile phone use is influenced by frequency and specific application usage.
Authors:Hans-Jürgen Rumpf, Sophia Achab, Joël Billieux, Henrietta Bowden-Jones, Natacha Carragher, Zsolt Demetrovics, Susumu Higuchi, Daniel L. King, Karl Mann, Marc Potenza, John B. Saunders, Max Abbott, Atul Ambekar, Osman Tolga Aricak, Sawitri Assanangkornchai, Norharlina Bahar, Guilherme Borges, Matthias Brand, Elda Mei-Lo Chan, Thomas Chung, Jeff Derevensky, Ahmad El Kashef, Michael Farrell, Naomi A. Fineberg, Claudia Gandin, Douglas A. Gentile, Mark D. Griffiths, Anna E. Goudriaan, Marie Grall-Bronnec, Wei Hao, David C. Hodgins, Patrick Ip, Orsolya Király, Hae Kook Lee, Daria Kuss, Jeroen S. Lemmens, Jiang Long, Olatz Lopez-Fernandez, Satoko Mihara, Nancy M. Petry, Halley M. Pontes, Afarin Rahimi-Movaghar, Florian Rehbein, Jürgen Rehm, Emanuele Scafato, Manoi Sharma, Daniel Spritzer, Dan J. Stein, Philip Tam, Aviv Weinstein, Hans-Ulrich Wittchen, Klaus Wölfling, Daniele Zullino, and Vladimir Poznyak
The proposed introduction of gaming disorder (GD) in the 11th revision of the International Classification of Diseases (ICD-11) developed by the World Health Organization (WHO) has led to a lively debate over the past year. Besides the broad support for the decision in the academic press, a recent publication by van Rooij et al. (2018) repeated the criticism raised against the inclusion of GD in ICD-11 by Aarseth et al. (2017). We argue that this group of researchers fails to recognize the clinical and public health considerations, which support the WHO perspective. It is important to recognize a range of biases that may influence this debate; in particular, the gaming industry may wish to diminish its responsibility by claiming that GD is not a public health problem, a position which maybe supported by arguments from scholars based in media psychology, computer games research, communication science, and related disciplines. However, just as with any other disease or disorder in the ICD-11, the decision whether or not to include GD is based on clinical evidence and public health needs. Therefore, we reiterate our conclusion that including GD reflects the essence of the ICD and will facilitate treatment and prevention for those who need it.