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Inclusion of gaming disorder criteria in ICD-11: A clinical perspective in favor

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

Journal of Behavioral Addictions
Authors: Susumu Higuchi, Hideki Nakayama, Satoko Mihara, Masaki Maezono, Takashi Kitayuguchi, and Takuma Hashimoto

Data from a specialist treatment facility for Internet addiction (IA) in Japan showed that (a) the vast majority of treatment seekers are addicted to online games, (b) their symptoms are often quite severe, and (c) there is a significant demand for IA treatment. In addition, systemic obstacles to the delivery of medical services in Japan exist due to the exclusion of IA criteria from ICD-10. Consequently, the inclusion of GD criteria in ICD-11 will almost certainly increase the capacity and quality of treatment through advances in research and possible changes in national medical systems to meet treatment demand.

Open access
Journal of Behavioral Addictions
Authors: Susumu Higuchi, Yoneatsu Osaki, Aya Kinjo, Satoko Mihara, Masaki Maezono, Takashi Kitayuguchi, Takanobu Matsuzaki, Hideki Nakayama, Hans-Jürgen Rumpf, and John B. Saunders


Background and Aims

A definition of gaming disorder (GD) was introduced in ICD-11. The purpose of this study was to develop a short screening test for GD, utilizing a reference GD group. It also sought to estimate the prevalence of GD among individuals, representative of the general young population in Japan.


Two hundred eighty one men and women selected from the general population, aged between 10 and 29 years, and 44 treatment seekers at our center completed a self-reported questionnaire comprising candidate questions for the screening test. The reference group with ICD-11 GD was established, based on face-to-face interviews with behavioral addiction experts, using a diagnostic interview instrument. The questions in the screening test were selected to best differentiate those who had GD from those who did not, and the cutoff value was determined using the Youden index.


A nine-item screening test (GAMES test) was developed. The sensitivity and specificity of the test were both 98% and the positive predictive value in the study sample was 91%. The GAMES test comprised two factors, showed high internal consistency and was highly reproducible. The estimated prevalence of GD among the general young population was 7.6% (95% confidence interval; 6.6–8.7%) for males and 2.5% (1.9–3.2%) for females, with a combined prevalence of 5.1% (4.5–5.8%).

Discussion and Conclusion

The GAMES test shows high validity and reliability for screening of ICD-11 GD. The estimated prevalence of 5.1% among the general young population was comparable to the pooled estimates of young people globally.

Open access