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  • 1 Region Skåne, Department of Psychiatry Malmö-Trelleborg, Malmö, , Sweden
  • | 2 Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, , Spain
  • | 3 Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, , Spain
  • | 4 Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, , Spain
  • | 5 Region Skåne, Malmö Addiction Center, Malmö, , Sweden
  • | 6 Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, , Psychiatry, Lund, , Sweden
Open access

Abstract

Background and aims

Theoretical background and previous data provide some similarities between problematic gambling and eating behaviors, and a theoretically increased clinical severity in individuals suffering from both conditions. However, large datasets are lacking, and therefore, the present study aimed to study, in a nationwide register material, psychiatric comorbidity, age and gender in gambling disorder (GD) patients with or without eating disorder (ED).

Methods

Diagnostic data from a nationwide register were used, including all individuals with a GD diagnosis in specialized health care in Sweden, in the years 2005–2016 (N = 2,099). Patients with GD and an ED diagnosis (n = 57) were compared to GD patients without ED.

Results

Patients with GD+ED were significantly more likely than other GD patients to also have a diagnosis of drug use disorder, depressive disorders, bipolar disorders, other mood disorder, anxiety disorders, personality disorders, and neuropsychiatric disorders, when controlling for gender. In logistic regression, a comorbid ED in GD was associated with female gender, younger age, depressive disorder and personality disorders.

Discussion and conclusion

In nationwide register data, despite the low number of GD+ED patients, GD patients with ED appear to have a more severe psychiatric comorbidity than GD patients without ED. The combined GD+ED conditions may require particular screening and clinical attention, as well as further research in larger and longitudinal studies.

Abstract

Background and aims

Theoretical background and previous data provide some similarities between problematic gambling and eating behaviors, and a theoretically increased clinical severity in individuals suffering from both conditions. However, large datasets are lacking, and therefore, the present study aimed to study, in a nationwide register material, psychiatric comorbidity, age and gender in gambling disorder (GD) patients with or without eating disorder (ED).

Methods

Diagnostic data from a nationwide register were used, including all individuals with a GD diagnosis in specialized health care in Sweden, in the years 2005–2016 (N = 2,099). Patients with GD and an ED diagnosis (n = 57) were compared to GD patients without ED.

Results

Patients with GD+ED were significantly more likely than other GD patients to also have a diagnosis of drug use disorder, depressive disorders, bipolar disorders, other mood disorder, anxiety disorders, personality disorders, and neuropsychiatric disorders, when controlling for gender. In logistic regression, a comorbid ED in GD was associated with female gender, younger age, depressive disorder and personality disorders.

Discussion and conclusion

In nationwide register data, despite the low number of GD+ED patients, GD patients with ED appear to have a more severe psychiatric comorbidity than GD patients without ED. The combined GD+ED conditions may require particular screening and clinical attention, as well as further research in larger and longitudinal studies.

Introduction

Problem gambling is common, with a past-year prevalence of 0.1–5.8% of the population (Calado and Griffiths, 2016), and gambling disorder (GD) is associated with severe financial and social consequences (Langham et al., 2016) and suicidal behavior (Karlsson & Håkansson, 2018). Eating disorders (EDs) have an estimated lifetime prevalence at around 1%; around 0.2% for anorexia nervosa (AN), 0.8% bulimia nervosa (BN), and 2.2% binge eating disorder (BED), and are 4.2 times more common among women than among men (Qian et al., 2013). EDs are associated with severely decreased quality of life, particularly in patients with binge/purge diagnoses (DeJong et al., 2013), and different addictions are associated with ED (Bahji et al., 2019); patients with ED have higher lifetime and current drug use (Krug et al., 2008). BN and AN–binge–purging (AN-BP) generally present the highest rates, and AN-restrictive (AN-R) the lowest rates.

Several studies have demonstrated associations between GD and ED. ED, especially the binge/purge type characterized by high impulsivity, are common in treatment (Jimenez-Murcia et al., 2013) and community samples (von Ranson, Wallace, Holub, & Hodgins, 2013) of patients with GD. Problematic gambling is elevated among people with BN (Fernandez-Aranda et al., 2006) and BED (Yip, White, Grilo, & Potenza, 2011). von Ranson et al. (2013) found a high rate of current ED psychopathology among 38% of female vs 4% of male community-recruited adults with problem gambling.

Binge eating may be conceptualized as a behavioral addiction similar to GD (Farstad et al., 2015). Addiction-related eating behavior is typically referred to as food addiction (FA) (Gearhardt, Corbin, & Brownell, 2009), with a high prevalence in ED patients, possibly up to 87% (Romero et al., 2019). Like ED, FA is more common in women (Pursey, Stanwell, Gearhardt, Collins, & Burrows, 2014) and in binge disorders (Jiménez-Murcia, Agüera, Paslakis, 2019). In patients with GD, the prevalence of FA in one study was found to be 31% in women and 7% in men (Jimenez-Murcia et al., 2017). A growing body of evidence suggests that BED shares similarities with conventional addictions, and that some forms of excessive overeating might be more appropriately described as an addiction disorder like FA (Davis et al., 2011; Jiménez-Murcia et al., 2019).

Altogether, there are indications of GD and ED belonging to a similar or overlapping disease spectrum, and deeper understanding of this may advise clinicians and stakeholders to improve cross-diagnostic screening (Jimenez-Murcia et al., 2013). For example, if the group with both GD and ED would present with more pronounced clinical problems, this would be a reason to improve structured screening for the combined condition. Still, few studies have analyzed the comorbidity between GD and ED, and larger samples, such as nationwide samples, are lacking. This might be explained by the fact that GD is more frequent in males whereas ED are more frequent in women. The purpose of this study is to investigate, in nationwide Swedish register data, the relationship between GD and the diagnostic group of ED, and to examine whether individuals with both GD and ED have higher psychiatric comorbidity than individuals with GD without ED.

Methods

The present study is a register-based, nationwide study of patients who have received a GD diagnosis in specialized health care in Sweden, a country with problem gambling rates in the mid-range of comparable European countries and within the range of other Scandinavian countries (Calado & Griffiths, 2016). The study uses the Swedish patient register, which includes diagnoses according to the ICD-10 for patients diagnosed in in-patient hospital care or specialized out-patient care, i.e. all out-patient care except primary care (‘GP’) facilities. As the treatment uptake for GD traditionally has been low in Swedish health care, it can be assumed that a minority of individuals with a GD appear in the patient register, and it can be suspected that this cohort is skewed towards a higher problem level than the general population of GD populations, although such comparisons cannot readily be made from available data (Karlsson & Håkansson, 2018). Available data used in the study include all psychiatric diagnoses occurring at any time during the study period (years 2005–2016, categorized into diagnostic categories), as well as gender and age.

The sample used here comprises all individuals with a gambling disorder diagnosis (ICD-10 code F63.0) in the patient register during 2005–2016, and is the same cohort as previously used in nationwide research on GD and mortality. As in previous analyses, the limited number of individuals below 18 years of age were excluded. Legal gambling age is 18 years, and given the close linguistic association between the terms ‘gambling’ and ‘gaming’ in Swedish language, and the limited role of these conditions in mental health facilities traditionally, it was considered hard to exclude that younger individuals with a predominantly gaming-oriented problem could have been mistakenly classified with a F63.0 diagnosis (Karlsson & Håkansson, 2018).

A total of 2,099 individuals with a GD diagnosis were included (23% women, n = 474), with a mean age of 36.5 years.

Statistical methods

The study is a statistical comparison of patients with GD and any occurrence of an eating disorder of any sub-type (GD+ED) during the study period, and patients with GD without an ED. Groups were compared with respect to age, gender, and occurrence of other diagnostic categories during the study period; alcohol use disorders (F10), drug use disorders (F11-19), misuse of non-addictive drugs (F55), psychotic disorders (F2), depressive disorders, bipolar disorders, other mood disorders, anxiety and stress-related disorders (F4), personality disorders, impulse control disorders (other than gambling disorder, F63.0), sexual disorders, and neuropsychiatric disorders.

Group comparisons were made using the chi-square test for categorical variables and t-test for age. Given the strong association between ED prevalence and gender, all other variables were controlled for gender, one by one. Variables with a significant association with the GD+ED group (after adjusting for gender) were entered simultaneously in a logistic regression analysis, including gender and age, with the GD+ED status as the dependent variable. Analyses were carried out in the IBM SPSS software, version 25.0. The level of significance used was P < 0.05. Odds ratios were reported with 95% confidence intervals.

Ethics

This overall project of comorbidity in gambling disorder was approved by the Regional Ethics Board, Lund, Sweden (file number 2016/1104). No informed consent procedure was required for the present study, in line with the decision of the ethics board, as the study did not contain data on identified individuals.

Results

A total of 57 individuals (3%) of the patients with GD also received an ED diagnosis at any time during the study period (8% of women, n = 39, and 1% of men, n = 18, P < 0.001), among them 14 individuals (1%) with anorexia-type eating disorder (F50.1-2), 16 (1%) with bulimia-type disorder (F50.2-3), two (0%) with other over-eating disorder (F50.4), and 45 (2%) with other or unspecified eating disorder (F50.8-9).

GD+ED patients were significantly younger (P = 0.005) and more likely to be female. Even when controlling for gender, GD+ED was significantly associated with drug use disorders, depressive disorders, bipolar disorders, other mood disorder, anxiety disorders, personality disorders, and neuropsychiatric disorders (Table 1). In logistic regression, controlling all significant variables for one another, ED remained significantly associated with younger age, female gender, depressive disorders, and personality disorders (Table 2).

Table 1.

Characteristics of patients with GD with or without ED

GD+ED (n = 57), % (n)GD-ED (n = 2,042), % (n)P valueAdjusted for gender
Female gender68% (39)21% (435)<0.001-
Age, mean32.236.60.005
Alcohol use disorders35% (20)29% (598)0.340.298
Drug use disorders47% (27)25% (507)<0.001<0.001
Substance misuse, non-addictive substances (F55)0% (0)0% (9)1.00*
Psychotic disorder9% (5)9% (191)0.88*
Depressive disorder81% (46)50% (1,027)<0.0010.001
Bipolar disorder26% (15)12% (235)0.0010.023
Other mood disorder18% (10)6% (113)<0.0010.004
Anxiety disorder84% (48)59% (1,204)<0.0010.003
Personality disorder54% (31)18% (377)<0.001<0.001
– Emotionally unstable40% (23)9% (186)<0.001<0.001
– Histrionic4% (2)0% (3)<0.01***
– Paranoid4% (2)2% (32)0.24*
– Schizoid2% (1)0% (10)0.26*
– Antisocial4% (2)3% (53)0.66*
– Anankastic0% (0)0% (3)1.00*
– Anxious4% (2)1% (20)0.12*
– Dependent0% (0)1% (19)1.00*
– Other30% (17)10% (201)<0.001<0.001
Impulse control disorder4% (2)5% (97)1.00*
Sexual disorder2% (1)1% (27)0.54***
Neuropsychiatric disorder30% (17)17% (343)0.010.014

*Variables with low absolute numbers were not run in logistic regression.

**Fisher's exact test.

Table 2.

Logistic regression analysis. Variables associated with ED

OR95% confidence intervalP value
Female gender7.053.81–13.04<0.001
Drug use disorder1.360.74–2.490.32
Bipolar disorder1.410.73–2.730.31
Depressive disorder2.341.14–4.800.02
Other mood disorder1.790.82–3.950.15
Anxiety disorder1.580.72–3.460.25
Personality disorder1.921.02–3.630.04
Neuropsychiatric disorder1.050.55–1.980.89
Age0.950.92–0.97<0.001

Discussion

The current study demonstrates, in a nationwide register sample, that patients with both a GD and an ED during the study period, were more frequently women, younger, and demonstrated a markedly higher psychiatric comorbidity with respect to depression and personality disorders, than GD patients without an ED.

Several studies have shown that impulse-related disorders, such as problematic gambling and compulsive buying, aree associated with greater ED severity and maladaptive personality traits (Alvarez-Moya et al., 2007; Fernandez-Aranda et al., 2006; Jimenez-Murcia et al., 2013); both ED and GD may be associated with high levels of harm avoidance and low levels of self-directedness (Alvarez-Moya et al., 2007). Patients with combined GD and FA have been found to have lower levels of self-directedness (Jimenez-Murcia et al., 2017). Thus, for diverse constructs representing a disordered eating behavior, these may share characteristics with a problematic gambling pattern.

Our results show that patients with GD+ED have higher prevalence of personality disorder (PD). As many around 30% of patients with ED have a diagnosable PD (Godt, 2008), and in a review from Dowling et al. (2015) the prevalence for any PD is 47.9% among treatment-seeking problem gamblers. The well-known pathway explanatory model for gambling suggests a subgroup of gamblers with early onset, severe psychopathology, high levels of impulsivity and high rates of anti-social personality disorder (Blaszczynski & Nower, 2002). Thus, personality disorders are prevalent both in ED and GD, and the fact that PD was even higher in individuals with combined GD+ED may not be surprising. Future studies, involving a larger number of patients and greater statistical power, should attempt to shed further light on temporal associations between GD, ED and PD.

In the Jimenez-Murcia et al. (2017) study, co-occurrence of FA in treatment-seeking GD patients was associated with worse emotional and psychological states, and differences in temperament. In Kim, von Ranson, Hodgins, McGrath, and Tavares (2018) study, individuals with a comorbid binge/purge type eating disorder reported more days gambling. They had more gambling-related cognitive distortions, impulsivity, suicidality, and other current psychiatric comorbidities including other addictive behaviors. In a study with BED patients (Yip et al., 2011), individuals with comorbid gambling problems had lower self-esteem, higher BMI and more substance use. This further points to a more severe clinical picture in patients with both problem gambling and problematic eating, again in line with the findings of the present study.

Depression also was associated with an ED in the previous study, when controlling for gender and other diagnostic groups. Depression is known to be common ED and GD; in a population of individuals with ED, major depressive disorder was seen in 39% of AN patients, 50% of BN patients, and 32% of BEED patients (Hudson, Hiripi, Pope, & Kessler, 2007). In the meta-analysis describing comorbidities in GD (Lorains, Cowlishaw, & Thomas, 2011), major depression occurred in 23%. Depressive symptoms may often develop before gambling problems (Kennedy et al., 2010), and a subgroup of gamblers may gamble to relieve symptoms of depression and anxiety (Blaszczynski & Nower, 2002). Another perspective is that mood disorders are likely to be secondary symptoms of financial losses in GD (Kim, Grant, Eckert, Faris, & Hartman, 2006). Thus, again, given the high prevalence of depression in both GD and ED, separately, it may not seem surprising that the occurrence is even higher in co-morbid GD+ED patients.

The present study may have implications for the clinical assessment and follow-up in problem gamblers, especially women. The study may raise awareness about the rationale for actively screening in patients with either GD or ED, in order to identify the other conditions along with other potential comorbidities (Jimenez-Murcia et al., 2013). Also, based on the present findings, the identification of an ED in a sample of GD patients should lead to further clinical assessments of the higher prevalence of other comorbidities seen here in the combined GD+ED group, and which may or may not cause an even more pronounced clinical problem than the GD or ED themselves. In the treatment of GD, one should be particularly observant about whether there is a parallel ED present, as it appears to be associated with particularly high psychiatric treatment needs. This is of particular importance to highlight in settings where a large part of GD treatment is given outside psychiatry and outside established institutions, and where screening for disordered eating may not typically occur. Our study indicates that the subgroup suffering from the combined condition should be treated where mental illness can be detected and treated, rather than in non-professional treatment such as for example voluntary organizations. Also, ED are more common in women and GD is more common in men. This may limit the awareness of comorbidity between these conditions, and, again, may decrease the likelihood that a patient presenting with one of the conditions is structurally screened for the other. Furthermore, in the line of precision medicine, it is important to be able to identify differentiated phenotypes (and endophenotypes) of patients in order to be able to apply the most indicated treatments in each case, ‘tailored’ treatments, in order to achieve the best result. Thus, there may be a need for systematic routines for screening tools when meeting these patients, in order to ensure a more tailored approach (Kan, Cardi, Stahl, & Treasure, 2019).

Limitations

A registry-based has the limitation of not providing more in-depth medical records. The cross-sectional retrospective cohort design does not allow studies of temporality of the variables. Also, in the comparison of the GD+ED subgroup and other GD patients, the obviously uneven distribution between the two groups presents a challenge to the statistical methods, as compared to a study where two patient groups of equal size are compared. Although register data of a diagnosis is unlikely to reflect a date close to the onset of a disorder, future research should include larger samples where temporal association can be assessed. Also, in a study based on a diagnostic records, less can be known about more sub-clinical levels of gambling or eating problems.

Conclusions

Our findings suggest clinically relevant differences between GD patients with and without ED. Specifically, we found a greater severity of problems in the comorbid group, including higher likelihood of depression and personality disorder. Unrecognized and untreated ED is likely to be associated with a particularly severe clinical picture in GD, potentially affecting prognosis in this condition. Further research using longitudinal and patient-specific methods is required investigating the onset and pattern of comorbid conditions in GD.

Funding sources

The present study was carried out thanks to different co-authors support from CIBERobn and from the state-owned Swedish gambling operator AB Svenska Spel, respectively. The CIBERobn is an initiative of Instituto de Salud Carlos III (ISCIII), Spain.

Authors’ contribution

Study concept and design: LL, FFA, SJM, AH. Analysis and interpretation of data: LL, FFA, SJM, AH. Statistical analysis: AH. Obtained funding: FFA, SJM, AH. Study supervision: AH. All authors had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Conflict of interest

Hakansson has a position as professor at Lund University which is sponsored by the state-owned gambling operator, partly constituting a gambling monopoly on parts of the gambling market. Also, he has obtained funding from the research council of the same state-owned gambling operator, as well as from the research council of the Swedish alcohol monopoly. Other researchers report no conflicts of interest.

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The author instruction is available in PDF.
Please, download the file from HERE

Dr. Zsolt Demetrovics
Institute of Psychology, ELTE Eötvös Loránd University
Address: Izabella u. 46. H-1064 Budapest, Hungary
Phone: +36-1-461-2681
E-mail: jba@ppk.elte.hu

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2020  
Total Cites 4024
WoS
Journal
Impact Factor
6,756
Rank by Psychiatry (SSCI) 12/143 (Q1)
Impact Factor Psychiatry 19/156 (Q1)
Impact Factor 6,052
without
Journal Self Cites
5 Year 8,735
Impact Factor
Journal  1,48
Citation Indicator  
Rank by Journal  Psychiatry 24/250 (Q1)
Citation Indicator   
Citable 86
Items
Total 74
Articles
Total 12
Reviews
Scimago 47
H-index
Scimago 2,265
Journal Rank
Scimago Clinical Psychology Q1
Quartile Score Psychiatry and Mental Health Q1
  Medicine (miscellaneous) Q1
Scopus 3593/367=9,8
Scite Score  
Scopus Clinical Psychology 7/283 (Q1)
Scite Score Rank Psychiatry and Mental Health 22/502 (Q1)
Scopus 2,026
SNIP  
Days from  38
submission  
to 1st decision  
Days from  37
acceptance  
to publication  
Acceptance 31%
Rate  

2019  
Total Cites
WoS
2 184
Impact Factor 5,143
Impact Factor
without
Journal Self Cites
4,346
5 Year
Impact Factor
5,758
Immediacy
Index
0,587
Citable
Items
75
Total
Articles
67
Total
Reviews
8
Cited
Half-Life
3,3
Citing
Half-Life
6,8
Eigenfactor
Score
0,00597
Article Influence
Score
1,447
% Articles
in
Citable Items
89,33
Normalized
Eigenfactor
0,7294
Average
IF
Percentile
87,923
Scimago
H-index
37
Scimago
Journal Rank
1,767
Scopus
Scite Score
2540/376=6,8
Scopus
Scite Score Rank
Cllinical Psychology 16/275 (Q1)
Medicine (miscellenous) 31/219 (Q1)
Psychiatry and Mental Health 47/506 (Q1)
Scopus
SNIP
1,441
Acceptance
Rate
32%

 

Journal of Behavioral Addictions
Publication Model Gold Open Access
Submission Fee none
Article Processing Charge 850 EUR/article
Printed Color Illustrations 40 EUR (or 10 000 HUF) + VAT / piece
Regional discounts on country of the funding agency World Bank Lower-middle-income economies: 50%
World Bank Low-income economies: 100%
Further Discounts Editorial Board / Advisory Board members: 50%
Corresponding authors, affiliated to an EISZ member institution subscribing to the journal package of Akadémiai Kiadó: 100%
Subscription Information Gold Open Access
Purchase per Title  

Journal of Behavioral Addictions
Language English
Size A4
Year of
Foundation
2011
Publication
Programme
2021 Volume 10
Volumes
per Year
1
Issues
per Year
4
Founder Eötvös Loránd Tudományegyetem
Founder's
Address
H-1053 Budapest, Hungary Egyetem tér 1-3.
Publisher Akadémiai Kiadó
Publisher's
Address
H-1117 Budapest, Hungary 1516 Budapest, PO Box 245.
Responsible
Publisher
Chief Executive Officer, Akadémiai Kiadó
ISSN 2062-5871 (Print)
ISSN 2063-5303 (Online)

Senior editors

Editor(s)-in-Chief: Zsolt DEMETROVICS

Assistant Editor(s): Csilla ÁGOSTON

Associate Editors

  • Judit BALÁZS (ELTE Eötvös Loránd University, Hungary)
  • Joel BILLIEUX (University of Lausanne, Switzerland)
  • Matthias BRAND (University of Duisburg-Essen, Germany)
  • Anneke GOUDRIAAN (University of Amsterdam, The Netherlands)
  • Daniel KING (Flinders University, Australia)
  • Ludwig KRAUS (IFT Institute for Therapy Research, Germany)
  • H. N. Alexander LOGEMANN (ELTE Eötvös Loránd University, Hungary)
  • Anikó MARÁZ (Humboldt University of Berlin, Germany)
  • Astrid MÜLLER (Hannover Medical School, Germany)
  • Marc N. POTENZA (Yale University, USA)
  • Hans-Jurgen RUMPF (University of Lübeck, Germany)
  • Attila SZABÓ (ELTE Eötvös Loránd University, Hungary)
  • Róbert URBÁN (ELTE Eötvös Loránd University, Hungary)
  • Aviv M. WEINSTEIN (Ariel University, Israel)

Editorial Board

  • Max W. ABBOTT (Auckland University of Technology, New Zealand)
  • Elias N. ABOUJAOUDE (Stanford University School of Medicine, USA)
  • Hojjat ADELI (Ohio State University, USA)
  • Alex BALDACCHINO (University of Dundee, United Kingdom)
  • Alex BLASZCZYNSKI (University of Sidney, Australia)
  • Kenneth BLUM (University of Florida, USA)
  • Henrietta BOWDEN-JONES (Imperial College, United Kingdom)
  • Beáta BÖTHE (University of Montreal, Canada)
  • Wim VAN DEN BRINK (University of Amsterdam, The Netherlands)
  • Gerhard BÜHRINGER (Technische Universität Dresden, Germany)
  • Sam-Wook CHOI (Eulji University, Republic of Korea)
  • Damiaan DENYS (University of Amsterdam, The Netherlands)
  • Jeffrey L. DEREVENSKY (McGill University, Canada)
  • Naomi FINEBERG (University of Hertfordshire, United Kingdom)
  • Marie GRALL-BRONNEC (University Hospital of Nantes, France)
  • Jon E. GRANT (University of Minnesota, USA)
  • Mark GRIFFITHS (Nottingham Trent University, United Kingdom)
  • Heather HAUSENBLAS (Jacksonville University, USA)
  • Tobias HAYER (University of Bremen, Germany)
  • Susumu HIGUCHI (National Hospital Organization Kurihama Medical and Addiction Center, Japan)
  • David HODGINS (University of Calgary, Canada)
  • Eric HOLLANDER (Albert Einstein College of Medicine, USA)
  • Jaeseung JEONG (Korea Advanced Institute of Science and Technology, Republic of Korea)
  • Yasser KHAZAAL (Geneva University Hospital, Switzerland)
  • Orsolya KIRÁLY (Eötvös Loránd University, Hungary)
  • Emmanuel KUNTSCHE (La Trobe University, Australia)
  • Hae Kook LEE (The Catholic University of Korea, Republic of Korea)
  • Michel LEJOXEUX (Paris University, France)
  • Anikó MARÁZ (Eötvös Loránd University, Hungary)
  • Giovanni MARTINOTTI (‘Gabriele d’Annunzio’ University of Chieti-Pescara, Italy)
  • Frederick GERARD MOELLER (University of Texas, USA)
  • Daniel Thor OLASON (University of Iceland, Iceland)
  • Nancy PETRY (University of Connecticut, USA)
  • Bettina PIKÓ (University of Szeged, Hungary)
  • Afarin RAHIMI-MOVAGHAR (Teheran University of Medical Sciences, Iran)
  • József RÁCZ (Hungarian Academy of Sciences, Hungary)
  • Rory C. REID (University of California Los Angeles, USA)
  • Marcantanio M. SPADA (London South Bank University, United Kingdom)
  • Daniel SPRITZER (Study Group on Technological Addictions, Brazil)
  • Dan J. STEIN (University of Cape Town, South Africa)
  • Sherry H. STEWART (Dalhousie University, Canada)
  • Attila SZABÓ (Eötvös Loránd University, Hungary)
  • Ferenc TÚRY (Semmelweis University, Hungary)
  • Alfred UHL (Austrian Federal Health Institute, Austria)
  • Johan VANDERLINDEN (University Psychiatric Center K.U.Leuven, Belgium)
  • Alexander E. VOISKOUNSKY (Moscow State University, Russia)
  • Kimberly YOUNG (Center for Internet Addiction, USA)

 

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