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  • 1 National Addiction Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, 4 Windsor Walk, Camberwell, SE5 8AF, UK
  • | 2 School of Psychology, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, UK
  • | 3 National Centre for Gaming Disorders, 69 Warwick Road, Earls Court, London, SW5 9HB, UK
  • | 4 Division of Psychology and Language Sciences, UCL, 26 Bedford Way, Bloomsbury, London, WC1H 0AP, UK
  • | 5 Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
Open access

Dear Editors,

Gaming Disorder has only recently been recognised in the addictions field. Characterised by impaired control, prioritisation over other interests, and continuation despite problem escalation causing significant impairment over at least 12 months, Internet Gaming Disorder (IGD) was identified in Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) as a condition for further study. More recently, Gaming Disorder (GD) was included in the International Statistical Classification of Diseases and Related Health Problems (11th ed.; ICD-11; World Health Organisation, 2018).

The measurement, diagnosis and classification of GD/IGD is still subject to open debate (Aarseth et al., 2017; Billieux et al., 2017; Przybylski, Weinstein, & Murayama, 2017; Van Rooij et al., 2018). Some scholars propose that GD should qualify as a mental disorder (King et al., 2018) whilst others argue that it should not (Dullur & Starcevic, 2018). Whilst no single screening tool has thus far been identified in an increasingly crowded field as superior (King et al., 2020), what is apparent is that for a number of gamers, gaming is a behaviour that can become problematic and can contribute to negative social, economic, and health-related consequences.

The first NHS clinic for GD, the National Centre for Gaming Disorders (NCGD) opened in London in October 2019, supporting gamers from England and Wales.

Gamers can either self-refer, be referred by family members, or by other health or social services. Treatment can be offered for gamers and affected others, with different treatment pathways for parents, gamers aged 16 and over, and those aged under 16. Gamers are offered Cognitive Behavioural Therapy either on an individual or group basis, and parents are offered the chance to attend parent support workshops (CNWL, 2021).

Between inception and June 2021, the NCGD received 236 referrals; 128 gamers, and 108 family members (104 parents). Gamers were most commonly referred by a family member (52.3%), or self-referred (13.3%). 78.2% (n = 86) of gamers completed an assessment; following a review by the clinical team, of these 86, 98.9% (n = 84) were offered treatment, and 83.3% (n = 72) accepted.

But what is the profile of those accessing treatment via the NCGD?

Within gamers, 89.8% (n = 115) were male, and 75.7% (n = 86) identified as white British or white other. The mean age at referral was 18.47 (s d. = 8.5, range 12–64); two thirds of referrals were in the 13–18 age category (66.4%), and a further 21.1% were in the 19–25 category. 57.1% (n = 73) were from London or the South-East. 52.3% (n = 67) were referred by family, and 13.3% (n = 17) were self-referred.

Gaming Disorder severity was measured by the Internet Gaming Disorder Test (IGDT-20; Pontes, Király, Demetrovics, & Griffiths, 2014). Gamers recorded a mean score of 66.03 (out of 100, s.d. 15.43, range 30–96), marginally below the recommended cut-off for disorder gaming of 71. Approximately 40% of gamers assessed recorded IGD-20 scores of ≥71. Preferred game showed remarkable variability; 61 different games were identified as a main problem game. The most commonly identified games were Fortnite (14.8%), Minecraft (14.1%), Call of Duty (13.3%) and Roblox (8.6%).

Specific psychiatric comorbidities were identified within the gamers at assessment, including ADHD (11.7%), Depression (10.9%), Autism (8.6), Asperger’s (6.3%) and Anxiety (6.3%). Further issues were identified: 15.6% (n = 23) reported self-harm, 18% (n = 23) reported suicidal ideation, 9.4% (n = 12) disclosed a suicide attempt, 6.3% (n = 8) reported comorbid substance misuse, whilst 8.6% (n = 11) reported a concurrent behavioural addiction. The low prevalence of concurrent substance misuse may be due to the very young age of the patients.

Furthermore, 30.5% (n = 39) reported issues around food and weight with either malnourishment due to gaming or significant weight gain also coinciding with excessive gaming and a sedentary lifestyle. 22.7% (n = 29) disclosed being bullied, 41.4% (n = 53) reported having shown aggression when asked to stop gaming, and 24.2% (n = 37) disclosed resorting to physical violence. Of the gamers referred, 28.9% (n = 37) had experienced financial difficulties related to gaming or had caused financial difficulties to their family members.

Whilst the academic debate around the relative robustness of psychometric properties of screening tools (King et al., 2020), and the strength of the evidence to support the classification of Gaming Disorder as a mental health disorder (Van Rooij et al., 2018) continues, increasing numbers of patients, primarily young males, are experiencing enough harm to warrant seeking treatment at a specialist clinic.

Although it is acknowledged that is not yet clear whether GD is an independent disorder or is symptomatic of a deeper underlying pathology, and the direction of causality in comorbid disorders is unclear, this letter provides a brief snapshot of those accessing the only dedicated gaming disorder clinic in the UK; future papers will communicate treatment data in due course. We hope to have highlighted some features of the profile of those seeking treatment for this emerging disorder.

Authors

Funding sources

The National Centre for Gaming Disorders receives funds from the National Health Service (NHS). There are no other funding sources to declare.

Authors’ contribution

HBJ, BH and RL were responsible for study design. All authors contributed to data analysis and interpretation, and manuscript preparation. 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

SS has received funding from the Society for the Study of Addiction (SSA), the King’s Prize Fellowship Scheme funded by the Wellcome Trust Institutional Strategic Support Fund, and as part of the NIHR Biomedical Research Centre funding for the National Addiction Centre. HB-J is the Director of The National Centre for Gaming Disorders which receive funds from the National Health Service. Board member, International Society of Addiction Medicine, Board member of the International Society for the Study of Behavioural Addictions. President of the Royal Society of Medicine Psychiatry Section. AR, BH, and RL have no conflicts to declare.

Ethics

As this paper reports data collected as routine clinical practice, no ethical clearance was required. However, we have still sought ethics to analyse and report this data, granted by the University of Lincoln School of Psychology Ethics Committee, and appropriate HRA and IRAS approval (Project ID 292516).

References

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  • King, D. L. , Delfabbro, P. H. , Potenza, M. N. , Demetrovics, Z. , Billieux, J. , & Brand, M. (2018). Internet gaming disorder should qualify as a mental disorder. Australian & New Zealand Journal of Psychiatry, 52(7), 615617.

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  • Pontes, H. M. , Király, O. , Demetrovics, Z. , & Griffiths, M. D. (2014). The conceptualisation and measurement of DSM-5 Internet gaming disorder: The development of the IGD-20 test. Plos One, 9(10), e110137. https://doi.org/10.1371/journal.pone.0110137.

    • Crossref
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  • Przybylski, A. K. , Weinstein, N. , & Murayama, K. (2017). Internet gaming disorder: Investigating the clinical relevance of a new phenomenon. American Journal of Psychiatry, 174(3), 230236.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Van Rooij, A. J. , Ferguson, C. J. , Colder Carras, M. , Kardefelt-Winther, D. , Shi, J. , Aarseth, E. , … Przybylski, A. K. (2018). A weak scientific basis for gaming disorder: Let us err on the side of caution. Journal of Behavioral Addictions, 7(1), 19.

    • Crossref
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  • World Health Organization (2018). International classification of diseases for mortality and morbidity statistics (11th Revision). Retrieved from https://icd.who.int/browse11/l-m/en.

    • Search Google Scholar
    • Export Citation
  • Aarseth, E. , Bean, A. M. , Boonen, H. , Colder Carras, M. , Coulson, M. , Das, D. , … Haagsma, M. C. (2017). Scholars’ open debate paper on the World health organization ICD-11 gaming disorder proposal. Journal of Behavioral Addictions, 6(3), 267270.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders fifth edition DSM-5TM. Arlington: American Psychiatric Association.

    • Search Google Scholar
    • Export Citation
  • Billieux, J. , King, D. L. , Higuchi, S. , Achab, S. , Bowden-Jones, H. , Hao, W. , … Poznyak, V. (2017). Functional impairment matters in the screening and diagnosis of gaming disorder: Commentary on: Scholars’ open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal (Aarseth et al.). Journal of Behavioral Addictions, 6(3), 285289.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • CNWL (2021). National Centre for gaming disorders. Downloaded from National Centre for Gaming Disorders | A gaming addiction clinic in the UK (cnwl.nhs.uk) 31/01/2022.

    • Search Google Scholar
    • Export Citation
  • Dullur, P. , & Starcevic, V. (2018). Internet gaming disorder does not qualify as a mental disorder. Australian and New Zealand Journal of Psychiatry, 52, 110111.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • King, D. L. , Chamberlain, S. R. , Carragher, N. , Billieux, J. , Stein, D. , Mueller, K. , … Delfabbro, P. H. (2020). Screening and assessment tools for gaming disorder: A comprehensive systematic review. Clinical Psychology Review, 77, 101831.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • King, D. L. , Delfabbro, P. H. , Potenza, M. N. , Demetrovics, Z. , Billieux, J. , & Brand, M. (2018). Internet gaming disorder should qualify as a mental disorder. Australian & New Zealand Journal of Psychiatry, 52(7), 615617.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Pontes, H. M. , Király, O. , Demetrovics, Z. , & Griffiths, M. D. (2014). The conceptualisation and measurement of DSM-5 Internet gaming disorder: The development of the IGD-20 test. Plos One, 9(10), e110137. https://doi.org/10.1371/journal.pone.0110137.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Przybylski, A. K. , Weinstein, N. , & Murayama, K. (2017). Internet gaming disorder: Investigating the clinical relevance of a new phenomenon. American Journal of Psychiatry, 174(3), 230236.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Van Rooij, A. J. , Ferguson, C. J. , Colder Carras, M. , Kardefelt-Winther, D. , Shi, J. , Aarseth, E. , … Przybylski, A. K. (2018). A weak scientific basis for gaming disorder: Let us err on the side of caution. Journal of Behavioral Addictions, 7(1), 19.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • World Health Organization (2018). International classification of diseases for mortality and morbidity statistics (11th Revision). Retrieved from https://icd.who.int/browse11/l-m/en.

    • Search Google Scholar
    • Export Citation
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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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5223
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2020  
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Impact Factor
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Rank by Psychiatry (SSCI) 12/143 (Q1)
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Citable 86
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Scimago Clinical Psychology Q1
Quartile Score Psychiatry and Mental Health Q1
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Scopus 3593/367=9,8
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2019  
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WoS
2 184
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Immediacy
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75
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67
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8
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Journal of Behavioral Addictions
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Journal of Behavioral Addictions
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2011
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ISSN 2062-5871 (Print)
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Senior editors

Editor(s)-in-Chief: Zsolt DEMETROVICS

Assistant Editor(s): Csilla ÁGOSTON

Associate Editors

  • Joel BILLIEUX (University of Lausanne, Switzerland)
  • Beáta BŐTHE (University of Montreal, Canada)
  • Matthias BRAND (University of Duisburg-Essen, Germany)
  • Luke CLARK (University of British Columbia, Canada)
  • Daniel KING (Flinders University, Australia)
  • Ludwig KRAUS (IFT Institute for Therapy Research, Germany)
  • H. N. Alexander LOGEMANN (ELTE Eötvös Loránd University, Hungary)
  • 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

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  • 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)
  • Judit BALÁZS (ELTE Eötvös Loránd University, Hungary)
  • Kenneth BLUM (University of Florida, USA)
  • Henrietta BOWDEN-JONES (Imperial College, United Kingdom)
  • 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)
  • Anneke GOUDRIAAN (University of Amsterdam, The Netherlands)
  • 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 (Humboldt-Universität zu Berlin, Germany)
  • 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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