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Lost in the chaos: Flawed literature should not generate new disorders

Commentary on: Chaos and confusion in DSM-5 diagnosis of Internet Gaming Disorder: Issues, concerns, and recommendations for clarity in the field (Kuss et al.)

Journal of Behavioral Addictions
Authors: Antonius J. Van Rooij and Daniel Kardefelt-Winther

The paper by Kuss, Griffiths, and Pontes (2016) titled “Chaos and confusion in DSM-5 diagnosis of Internet Gaming Disorder: Issues, concerns, and recommendations for clarity in the field” examines issues relating to the concept of Internet Gaming Disorder. We agree that there are serious issues and extend their arguments by suggesting that the field lacks basic theory, definitions, patient research, and properly validated and standardized assessment tools. As most studies derive data from survey research in functional populations, they exclude people with severe functional impairment and provide only limited information on the hypothesized disorder. Yet findings from such studies are widely used and often exaggerated, leading many to believe that we know more about the problem behavior than we do. We further argue that video game play is associated with several benefits and that formalizing this popular hobby as a psychiatric disorder is not without risks. It might undermine children’s right to play or encourage repressive treatment programs, which ultimately threaten children’s right to protection against violence. While Kuss et al. express support for the formal implementation of a disorder, we argue that before we have a proper evidence base, a sound theory, and validated assessment tools, it is irresponsible to support a formal category of disorder and doing so would solidify a confirmatory approach to research in this area.

Open access

Addressing problematic video game use: A multimethod, dual-context perspective on leisure-time use

Commentary on: Policy responses to problematic video game use: A systematic review of current measures and future possibilities (Király et al., 2018)

Journal of Behavioral Addictions
Authors: Antonius J. Van Rooij and Laura M. Nijkamp

A more integrative approach to the prevention of problematic gaming behavior is recommended in Király et al.’s review. We discuss the Dutch policy responses to problematic gaming behavior and suggest two alternatives to the dominant survey research approach to achieve this. Employing time-use/diary studies allows us to map out the full scope of leisure-time use and employing log-data analysis improves our understanding of gamer behavior within the virtual context. All of these approaches would benefit from accounting for the diversity of within-virtual context behavior. The approach is summarized as a multimethod, dual-context approach to understanding leisure-time behavior.

Open access
Journal of Behavioral Addictions
Authors: Antonius J. van Rooij PhD, Daria J. Kuss, Mark D. Griffiths, Gillian W. Shorter, Tim M. Schoenmakers and Dike van de Mheen

Abstract

Aims

The current study explored the nature of problematic (addictive) video gaming (PVG) and the association with game type, psychosocial health, and substance use.

Methods

Data were collected using a paper and pencil survey in the classroom setting. Three samples were aggregated to achieve a total sample of 8478 unique adolescents. Scales included measures of game use, game type, the Video game Addiction Test (VAT), depressive mood, negative self-esteem, loneliness, social anxiety, education performance, and use of cannabis, alcohol and nicotine (smoking).

Results

Findings confirmed problematic gaming is most common amongst adolescent gamers who play multiplayer online games. Boys (60%) were more likely to play online games than girls (14%) and problematic gamers were more likely to be boys (5%) than girls (1%). High problematic gamers showed higher scores on depressive mood, loneliness, social anxiety, negative self-esteem, and self-reported lower school performance. Nicotine, alcohol, and cannabis using boys were almost twice more likely to report high PVG than non-users.

Conclusions

It appears that online gaming in general is not necessarily associated with problems. However, problematic gamers do seem to play online games more often, and a small subgroup of gamers — specifically boys — showed lower psychosocial functioning and lower grades. Moreover, associations with alcohol, nicotine, and cannabis use are found. It would appear that problematic gaming is an undesirable problem for a small subgroup of gamers. The findings encourage further exploration of the role of psychoactive substance use in problematic gaming.

Open access
Journal of Behavioral Addictions
Authors: Espen Aarseth, Anthony M. Bean, Huub Boonen, Michelle Colder Carras, Mark Coulson, Dimitri Das, Jory Deleuze, Elza Dunkels, Johan Edman, Christopher J. Ferguson, Maria C. Haagsma, Karin Helmersson Bergmark, Zaheer Hussain, Jeroen Jansz, Daniel Kardefelt-Winther, Lawrence Kutner, Patrick Markey, Rune Kristian Lundedal Nielsen, Nicole Prause, Andrew Przybylski, Thorsten Quandt, Adriano Schimmenti, Vladan Starcevic, Gabrielle Stutman, Jan Van Looy and Antonius J. Van Rooij

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.

Open access
Journal of Behavioral Addictions
Authors: Antonius J. van Rooij, Christopher J. Ferguson, Michelle Colder Carras, Daniel Kardefelt-Winther, Jing Shi, Espen Aarseth, Anthony M. Bean, Karin Helmersson Bergmark, Anne Brus, Mark Coulson, Jory Deleuze, Pravin Dullur, Elza Dunkels, Johan Edman, Malte Elson, Peter J. Etchells, Anne Fiskaali, Isabela Granic, Jeroen Jansz, Faltin Karlsen, Linda K. Kaye, Bonnie Kirsh, Andreas Lieberoth, Patrick Markey, Kathryn L. Mills, Rune Kristian Lundedal Nielsen, Amy Orben, Arne Poulsen, Nicole Prause, Patrick Prax, Thorsten Quandt, Adriano Schimmenti, Vladan Starcevic, Gabrielle Stutman, Nigel E. Turner, Jan van Looy and Andrew K. Przybylski

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.

Open access