Behavioral addiction research has been particularly flourishing over the last two decades. However, recent publications have suggested that nearly all daily life activities might lead to a genuine addiction.
Methods and aim
In this article, we discuss how the use of atheoretical and confirmatory research approaches may result in the identification of an unlimited list of “new” behavioral addictions.
Both methodological and theoretical shortcomings of these studies were discussed.
We suggested that studies overpathologizing daily life activities are likely to prompt a dismissive appraisal of behavioral addiction research. Consequently, we proposed several roadmaps for future research in the field, centrally highlighting the need for longer tenable behavioral addiction research that shifts from a mere criteria-based approach toward an approach focusing on the psychological processes involved.
A positive relationship between problematic gaming and escapism motivation to play video games has been well established, suggesting that problematic gaming may result from attempts to deal with negative emotions. However, to date, no study has examined how emotion dysregulation affects both escapism motives and problematic gaming patterns.
Difficulties in emotion regulation, escapism, and problematic involvement with video games were assessed in a sample of 390 World of Warcraft players. A structural equation modeling framework was used to test the hypothesis that escapism mediates the relationship between emotion dysregulation and problematic gaming.
Statistical analyses showed that difficulties in emotion regulation predicted both escapism motives and problematic gaming, and that escapism partially mediated this relationship.
Our findings support the view that problematic players are likely to escape in online games as a maladaptive coping strategy for dealing with adverse emotional experiences.
Maladaptive Daydreaming (MD) is a proposed mental disorder, in which absorption in rich, narrative fantasy becomes addictive and compulsive, resulting in emotional, social, vocational, or academic dysfunction. Most studies on MD were carried out on aggregated international samples, using translated versions of the Maladaptive Daydreaming Scale (MDS-16). However, it is unknown whether the properties of MD are affected by culture. Thus, we investigated the cross-cultural measurement invariance of the MDS-16.
We recruited both individuals self-identified as suffering from MD and non-clinical community participants from four countries: the USA, Italy, Turkey, and the UK (N = 1,081).
Configural invariance was shown, suggesting that the hypothesized four-factor structure of the MDS-16 (including Yearning, Impairment, Kinesthesia, and Music) holds across cultures. Metric invariance was shown for Impairment, Kinesthesia, and Music, but not for Yearning, suggesting that the psychological meaning of the latter factor may be understood differently across cultures. Scalar invariance was not found, as MD levels were higher in the USA and UK, probably due to the over-representation of English-speaking members of MD communities, who volunteered for the study.
Discussion and conclusions
We conclude that the urge to be absorbed in daydreaming and the fantasies’ comforting and addictive properties may have different meanings across countries, but the interference of MD to one’s daily life and its obstruction of long-term goals may be the central defining factor of MD.
This article suggests that the type of Internet-enabled device should not be prioritised when conceptualizing diagnostic categories of addictive online behaviours. The diagnostic distinction between “predominantly mobile” and “predominantly non-mobile” forms of Internet use disorders (IUD) is not empirically based, may not be clinically useful and may lead to “diagnostic inflation.” Problems with the concepts of smartphone use disorder and IUD on which the proposed distinction is largely based call for their re-examination. Future proposals for the taxonomy of addictive behaviours may not need to be based on online/offline and mobile/non-mobile dichotomies.
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.
Concerns about problematic gaming behaviors deserve our full attention. However, we claim that it is far from clear that these problems can or should be attributed to a new disorder. The empirical basis for a Gaming Disorder proposal, such as in the new ICD-11, suffers from fundamental issues. Our main concerns are the low quality of the research base, the fact that the current operationalization leans too heavily on substance use and gambling criteria, and the lack of consensus on symptomatology and assessment of problematic gaming. The act of formalizing this disorder, even as a proposal, has negative medical, scientific, public-health, societal, and human rights fallout that should be considered. Of particular concern are moral panics around the harm of video gaming. They might result in premature application of diagnosis in the medical community and the treatment of abundant false-positive cases, especially for children and adolescents. Second, research will be locked into a confirmatory approach, rather than an exploration of the boundaries of normal versus pathological. Third, the healthy majority of gamers will be affected negatively. We expect that the premature inclusion of Gaming Disorder as a diagnosis in ICD-11 will cause significant stigma to the millions of children who play video games as a part of a normal, healthy life. At this point, suggesting formal diagnoses and categories is premature: the ICD-11 proposal for Gaming Disorder should be removed to avoid a waste of public health resources as well as to avoid causing harm to healthy video gamers around the world.
We greatly appreciate the care and thought that is evident in the 10 commentaries that discuss our debate paper, the majority of which argued in favor of a formalized ICD-11 gaming disorder. We agree that there are some people whose play of video games is related to life problems. We believe that understanding this population and the nature and severity of the problems they experience should be a focus area for future research. However, moving from research construct to formal disorder requires a much stronger evidence base than we currently have. The burden of evidence and the clinical utility should be extremely high, because there is a genuine risk of abuse of diagnoses. We provide suggestions about the level of evidence that might be required: transparent and preregistered studies, a better demarcation of the subject area that includes a rationale for focusing on gaming particularly versus a more general behavioral addictions concept, the exploration of non-addiction approaches, and the unbiased exploration of clinical approaches that treat potentially underlying issues, such as depressive mood or social anxiety first. We acknowledge there could be benefits to formalizing gaming disorder, many of which were highlighted by colleagues in their commentaries, but we think they do not yet outweigh the wider societal and public health risks involved. Given the gravity of diagnostic classification and its wider societal impact, we urge our colleagues at the WHO to err on the side of caution for now and postpone the formalization.