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Inclusion of Gaming Disorder in ICD has more advantages than disadvantages

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

Journal of Behavioral Addictions
Authors:
Orsolya Király
and
Zsolt Demetrovics

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.

Open access

Commentary on: Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research

The diagnostic pitfalls of surveys: If you score positive on a test of addiction, you still have a good chance not to be addicted

Journal of Behavioral Addictions
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.

Methods

We re-visited the theory and basic calculations of diagnostic accuracy.

Results

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.

Conclusions

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”.

Open access

Abstract

Objective

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.

Methods

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.

Results

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.

Conclusion

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.

Open access
Journal of Behavioral Addictions
Authors:
Orsolya Király
,
Joël Billieux
,
Daniel L. King
,
Róbert Urbán
,
Patrik Koncz
,
Eszter Polgár
, and
Zsolt Demetrovics

Abstract

Background and aims

The popularity of video gaming has generated significant interest in research methods to examine motivations for gaming. Current measures of gaming motives are limited by lack of scope and/or their applicability to specific game genres only. We aimed to create a comprehensive motivation inventory applicable to any gaming genre and to evaluate its psychometric properties in a large sample of highly engaged video gamers.

Methods

Stage 1 of this project involved a systematic review that generated the items for the Gaming Motivation Inventory (GMI). Stages 2–4 involved an evaluation of the psychometric properties of the GMI. A sample of 14,740 video gamers (89.3% male; mean age 24.1 years) were recruited via an online survey promoted by a popular gaming magazine.

Results

In Stage 2, twenty-six gaming motives were identified, which clustered into six higher-order dimensions (Mastery, Immersion/Escapism, Competition, Stimulation, Social, Habit/Boredom). In Stage 3, construct validity of the six higher-order motives was assessed by associations with gaming-related, personality, and psychological variables. In Stage 4, the relationships between motives and depression symptoms and gaming disorder symptoms were explored. Although gaming motives had weak associations with gaming genres, they were moderately related to variables such as competitiveness, sociability, and positive and negative affect. Gaming disorder symptoms were directly predicted by depression symptoms and indirectly via Immersion/Escapism, Habit/Boredom, and Competition motives.

Discussion and conclusions

These findings support the notion that motives are one of the primary causes of gaming behavior and play an important role in predicting its problematic nature. The GMI is a psychometrically valid tool that will be useful for gaining insights into factors underlying gaming behaviors.

Open access

A vallásosság szerepe az intenzív osztályon dolgozó orvosok és ápolók véleményének kialakításában az életvégi döntések meghozatalakor

Role of faith in strategies of healthcare professionals in intensive care units in end-of-life decision making

Orvosi Hetilap
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; 162(51): 2047–2054.

Open access
Journal of Behavioral Addictions
Authors:
Belle Gavriel-Fried
,
Meytal Serry
,
Dana Katz
,
Dorottya Hidvégi
,
Zsolt Demetrovics
, and
Orsolya Király

Abstract

Background

Recovery from mental health and behavioral disorders is classically defined as a reduction in symptoms. More recent definitions see it as a process in which individuals improve their health, wellness and other life domains. The inclusion of gaming disorder (GD) in the 11th International Classification of Diseases in 2019 prompted growing interest in GD. However, relatively little is known about recovery from GD, and there is scant literature describing or assessing its course.

Objectives

This scoping review was designed to explore the state of the art on recovery from GD (e.g., terminology and measures used to assess recovery, main topics in studies about recovery from GD).

Methods

PubMed, Web of Science, and Scopus databases were searched and critically reviewed according to PRISMA guidelines. We included empirical studies in English covering individuals across all age groups who met the diagnostic criteria of GD/internet gaming disorder (IGD) according to valid scales that relate to recovery or any change, and were published before February 2022.

Results

A total of 47 out of 966 studies met the inclusion criteria. Recovery as a concept is not explicitly mentioned in GD studies. Rather, changes in subjects' disorders are described in terms of decreases/reductions in symptom severity, or improvement/increases. These changes are primarily measured by scales that evaluate symptom reduction and/or improvement in GD and other psychopathologies.

Conclusions

The concept of recovery is included in the GD field but is not clearly mentioned or used. Therapists and researchers should aim to promote and integrate the notion of recovery in GD.

Open access
Journal of Behavioral Addictions
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.

Methods

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.

Results

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.

Open access
Journal of Behavioral Addictions
Authors:
Chih-Hung Ko
,
Orsolya Király
,
Zsolt Demetrovics
,
Mark D. Griffiths
,
Takahiro A. Kato
,
Masaru Tateno
, and
Ju-Yu Yen

Abstract

Background

The eleventh revision of the International Classification of Diseases (ICD-11) defines the three key diagnostic criteria for gaming disorder (GD). These are loss of control over gaming, gaming as a priority over daily activities, and impaired functioning due to gaming. While this definition has implications for the prevention and treatment of GD, there is significant heterogeneity in the symptoms and etiology of GD among individuals, which results in different treatment needs. Cognitive control, emotional regulation, and reward sensitivity are three critical dimensions in the etiology model for GD. Aspects such as gender, comorbidity, motivation for gaming, stage or severity of GD, and risk factors all contribute to the heterogeneity of etiology among individuals with the disorder.

Method

On the basis of clinical symptoms and comorbidity characteristics among approximately 400 patients with gaming disorder, the present paper proposes a clinical typology of patients with GD based on the authors' clinical experience in treating individuals with GD.

Results

The findings indicated three common types of patients with GD: (i) impulsive male patients with attention deficit hyperactivity disorder (ADHD), (ii) dysphoria patients with dysfunctional coping skills, and (iii) isolated patients with social anxiety. The paper also discusses the presentation and treatment priority for these patients.

Conclusion

Personalized treatments for patients with GD should be developed to fit their individual needs. Future studies should examine the heterogeneity of GD and confirm these types, as well as obtain evidence-based information that can help in the development of personalized treatment. Treatment resources should be developed, and professionals should be trained to provide integrated individualized treatment.

Open access
Journal of Behavioral Addictions
Authors:
Andrea Czakó
,
Orsolya Király
,
Patrik Koncz
,
Shu M. Yu
,
Harshdeep S. Mangat
,
Judith A Glynn
,
Pedro Romero
,
Mark D Griffiths
,
Hans-Jürgen Rumpf
, and
Zsolt Demetrovics

Abstract

The present paper provides an overview of the possible risks, harms, and challenges that might arise with the development of the esports field and pose a threat to professional esports players, spectators, bettors and videogame players, including underage players. These include physical and mental health issues, gambling and gambling-like elements associated with videogames and esports, the challenges arising from pursuing a career in esports, the unique difficulties women face, and a need for supporting professional esports players. It briefly discusses possible responses and suggestions regarding how to address and mitigate these negative consequences. It emphasizes the need for cooperation and collaboration between various stakeholders: researchers, policymakers, regulators, the gaming industry, esports organizations, healthcare and treatment providers, educational institutes and the need for further evidence-based information.

Open access
Journal of Behavioral Addictions
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

Abstract

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.

Methods

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.

Results

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.

Conclusions

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.

Open access