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Policy, prevention, and regulation for Internet Gaming Disorder

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

Author: Daria J. Kuss

In this commentary, I discuss the recent paper by Király et al. (2018), which provides a systematic review of current and potential policies addressing problematic gaming and suggesting current approaches include those (a) limiting video game availability, (b) reducing risk and harm, and (c) supporting gamers. This commentary uses a number of points raised by Király et al. (2018) to address the issue of policy context by discussing (a) the sociocultural environment and (b) the gamer and the game environment to (c) create the case for prevention to reduce risk and harm and to provide support for gamers and their families.

Open access

Abstract

Background and aims: Research suggests that excessive online gaming may lead to symptoms commonly experienced by substance addicts. Since games are particularly appealing to children and adolescents, these individuals may be more at risk than other groups of developing gaming addiction. Methods: Given these potential concerns, a literature review was undertaken in order (i) to present the classification basis of online gaming addiction using official mental disorder frameworks, (ii) to identify empirical studies that assess online gaming addiction in children and adolescents, and (iii) to present and evaluate the findings against the background of related and established mental disorder criteria. Results: Empirical evidence comprising 30 studies indicates that for some adolescents, gaming addiction exists and that as the addiction develops, online gaming addicts spend increasing amounts of time preparing for, organizing, and actually gaming. Conclusions: Evidence suggests that problematic online gaming can be conceptualized as a behavioral addiction rather than a disorder of impulse control.

Open access

Background

Impulsivity is currently more commonly regarded as multifaceted, comprising both motor and cognitive subdomains. However, it is less clear how distinct these subdomains are, and the extent to which they interact and draw upon the same psychological resources.

Methods

The present experiment comprised 70 regular (non-problem) gamblers, and investigated the potential to induce impulsivity transfer effects within an electronic gambling context. Original and existing harm-minimization approaches were tested for their efficacy in inducing motor cautiousness during an electronic slot machine simulation. Participants were exposed to a forced discriminatory motor choice procedure, or pop-up responsible gambling messages that either contained emotive or non-emotive responsible gambling content. The subsequent impact these interventions had on delay discounting and reflection impulsivity was also measured using the 27-item Monetary Choice Questionnaire and Information Sampling Task, respectively.

Results

Findings demonstrated that only original harm-minimization approaches, which force the gambler to engage in discriminatory motor choice procedures during gambling, were successful in inducing motor cautiousness. However, both the discriminatory choice procedure and emotive message harm-minimization approaches were successful in facilitating cognitive choice, even though the emotive message intervention was unsuccessful in facilitating motor response inhibition, suggesting both an indirect motor cautiousness route, and a more direct route to improved cognitive choice during gambling.

Conclusion

This study demonstrated that decision-making during gambling can be improved by making simple structural changes to slot machine platforms, by encouraging active engagement in motor processes, which result in a transfer of cautiousness to wider cognitive domains.

Open access

Background

The umbrella term “Internet addiction” has been criticized for its lack of specificity given the heterogeneity of potentially problematic behaviors that can be engaged in online as well as different underlying etiological mechanisms. This has led to the naming of specific online addictions, the most notable being Internet Gaming Disorder (IGD).

Methods

Using the contemporary literature concerning IGD and cognate topics, issues and concerns relating to the concept of IGD are examined.

Results

Internet addiction and IGD are not the same, and distinguishing between the two is conceptually meaningful. Similarly, the diagnosis of IGD as proposed in the appendix of the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) remains vague regarding whether or not games need to be engaged in online, stating that IGD typically involves specific Internet games, but can also include offline games, adding to the lack of clarity. A number of authors have voiced concerns regarding the viability of including the word “Internet” in IGD, and instead proposed to use the term “video gaming disorder” or simply “gaming disorder,” suggesting addiction to video gaming can also occur offline.

Conclusion

The DSM-5 has caused more confusion than clarity regarding the disorder, reflected by researchers in the field contesting a supposedly reached consensus for IGD diagnosis.

Open access

Background and aims

The current DSM-5 diagnosis of Internet Gaming Disorder (IGD; American Psychiatric Association [APA], 2013) has led to a number of issues and concerns that we highlighted in our recent paper (Kuss, Griffiths, & Pontes, 2017). Experts in the field responded to our evaluation of these issues resulting in six commentaries.

Methods

In this paper, we offer responses to the six commentaries to move the scientific field forward. All of the responses to our original paper highlighted many conceptual, theoretical, and/or methodological problems with the proposed IGD diagnosis as outlined in the DSM-5. We outline some ways forward in overcoming issues and concerns in the gaming studies field.

Results

We argue that rather than stigmatizing gaming per se, the role of scientists and practitioners is to establish a clear-cut distinction between someone who may use games excessively but non-problematically and someone who is experiencing significant impairment in their daily lives as a consequence of their excessive gaming. This responsibility needs to be shared by popular media who are often quick to build a moral panic around gaming behaviors, often based on cherry-picking specific case studies and pieces of research which support their headlines.

Conclusion

Researchers, practitioners, gaming developers, and the media need to work together and collaboratively to build a realistic and comprehensive understanding of gaming as a normal, enjoyable, and often beneficial sociocultural practice, which for a small minority of excessive users may be associated with the experience of addiction-related symptoms that may require professional support.

Open access

Problematic gaming exists and is an example of disordered gaming

Commentary on: Scholars’ open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal (Aarseth et al.)

Authors: Mark D. Griffiths, Daria J. Kuss, Olatz Lopez-Fernandez and Halley M. Pontes

Background

The recent paper by Aarseth et al. (2016) questioned whether problematic gaming should be considered a new disorder particularly because “Gaming Disorder” (GD) has been identified as a disorder to be included in the next (11th) revision of the World Health Organization’s International Classification of Diseases (ICD-11).

Methods

This study uses contemporary literature to argue why GD should be included in the ICD-11.

Results

Aarseth and colleagues acknowledge that there is much literature (including papers by some of the authors themselves) that some individuals experience serious problems with video gaming. How can such an activity be seriously problematic yet not disordered? Similar to other addictions, gaming addiction is relatively rare and is in essence a syndrome (i.e., a condition or disorder characterized by a set of associated symptoms that tend to occur under specific circumstances). Consequently, not everyone will exhibit exactly the same set of symptoms and consequences, and this partly explains why those working in the problematic gaming field often disagree on symptomatology.

Conclusions

Research into gaming is not about pathologizing healthy entertainment, but about pathologizing excessive and problematic behaviors that cause significant psychological distress and impairment in an individual’s life. These are two related, but (ultimately) very distinct phenomena. While being aware that gaming is a pastime activity which is enjoyed non-problematically by many millions of individuals worldwide, it is concluded that problematic gaming exists and that it is an example of disordered gaming.

Open access
Authors: Olatz Lopez-Fernandez, Niko Männikkö, Maria Kääriäinen, Mark D. Griffiths and Daria J. Kuss

Background and aims

Gaming applications have become one of the main entertainment features on smartphones, and this could be potentially problematic in terms of dangerous, prohibited, and dependent use among a minority of individuals. A cross-national study was conducted in Belgium and Finland. The aim was to examine the relationship between gaming on smartphones and self-perceived problematic smartphone use via an online survey to ascertain potential predictors.

Methods

The Short Version of the Problematic Mobile Phone Use Questionnaire (PMPUQ-SV) was administered to a sample comprising 899 participants (30% male; age range: 18–67 years).

Results

Good validity and adequate reliability were confirmed regarding the PMPUQ-SV, especially the dependence subscale, but low prevalence rates were reported in both countries using the scale. Regression analysis showed that downloading, using Facebook, and being stressed contributed to problematic smartphone use. Anxiety emerged as predictor for dependence. Mobile games were used by one-third of the respective populations, but their use did not predict problematic smartphone use. Very few cross-cultural differences were found in relation to gaming through smartphones.

Conclusion

Findings suggest mobile gaming does not appear to be problematic in Belgium and Finland.

Open access

Background and aims

Gaming disorder was recently recognized as a mental health disorder by the World Health Organization and included in the International Classification of Diseases. Extensive research has been conducted with regard to psychosocial correlates and comorbidity, less so for the developmental mechanisms and the processes leading to the disorder. The association between family factors, personality traits, and gaming has been studied independently but not in combination. To fill this gap in knowledge, this study examined (a) the association between parental acceptance–rejection theory and Internet gaming disorder (IGD) and (b) the mediating and moderating effect of core self-evaluations (CSE), a personality construct, on the aforementioned variables.

Methods

The study was quantitative and involved young adults members of online gaming communities (N = 225).

Results

The results showed that parental rejection is associated with the occurrence of IGD, only through the mediating effect of CSE. The moderation model was not confirmed.

Discussion

Findings bridge early emotional deficits with CSE personality traits and IGD, based on two widely acknowledged theoretical frameworks. In addition, they highlight the importance of the father’s role in upbringing.

Conclusions

These frameworks combine cognitive and attachment perspectives and a process-oriented approach to the development and maintenance of IGD. The implications of these findings are discussed in relation to (a) the mechanisms leading to the disorder and (b) providing an evidence base for therapeutic interventions for IGD to go beyond abstinence and include self-esteem enhancement and efficacy contingencies. Directions for future research are also provided in this study.

Open access
Authors: Filip Nuyens, Jory Deleuze, Pierre Maurage, Mark D. Griffiths, Daria J. Kuss and Joël Billieux

Background and aims

Multiplayer Online Battle Arena (MOBA) games have become the most popular type of video games played worldwide, superseding the playing of Massively Multiplayer Online Role-Playing Games and First-Person Shooter games. However, empirical studies focusing on the use and abuse of MOBA games are still very limited, particularly regarding impulsivity, which is an indicator of addictive states but has not yet been explored in MOBA games. In this context, the objective of the present study is to explore the associations between impulsivity and symptoms of addictive use of MOBA games in a sample of highly involved League of Legends (LoL, currently the most popular MOBA game) gamers.

Methods

Thirty-six LoL gamers were recruited and completed both experimental (Single Key Impulsivity Paradigm) and self-reported impulsivity assessments (s-UPPS-P Impulsive Behavior Scale, Barratt Impulsiveness Scale), in addition to an assessment of problematic video game use (Problematic Online Gaming Questionnaire).

Results

Results showed links between impulsivity-related constructs and signs of excessive MOBA game involvement. Findings indicated that impaired ability to postpone rewards in an experimental laboratory task was strongly related to problematic patterns of MOBA game involvement. Although less consistent, several associations were also found between self-reported impulsivity traits and signs of excessive MOBA game involvement.

Conclusions

Despite these results are preliminary and based upon a small (self-selected) sample, the present study highlights potential psychological factors related to the addictive use of MOBA games.

Open access
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