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This chapter critically considers the research literature on the experiences and potential effects of gaming among young people. The effects of gaming on young people’s well-being appear complex and multidirectional, and depend on patterns, content, and context of gaming activities. Research into media effects appears to have become specialized in discrete areas (e.g., cognition, mental health, social effects), with few studies synthesizing data across subfields. Priority research areas include studies of short- and long-term effects of gaming; studying artificial intelligence-driven designs, monetized, and gambling-like designs in games; evaluating assessment and interventions for problematic gaming; and testing regulatory measures and safeguards for young users and their families. Methodological improvements include the use of holistic frameworks and designs to examine positive and negative effects; considering gaming activity as a unit of analysis in psychological and social terms as distinct from “screen time;” the use of objective measures to complement self-report measures; and the use of industry data. As gaming products evolve and become increasingly embedded into young people’s lives, understanding the psychosocial effects on young users remains a global priority.

Gaming disorder (GD) screening often involves self-report survey measures to detect the presence of symptoms. Studies have shown that gamers' responses vary greatly across survey items. Some symptoms, such as preoccupation and tolerance, are frequently reported by highly engaged but non-problematic gamers, and therefore these symptoms are thought to lack specificity and are suggested to be less important in classification decisions. We argue that the influence of response categories (e.g., dichotomous responses, such as "yes" or "no" or frequency categories, such as "rarely" and "often") on item responses has been relatively underexplored despite potentially contributing significantly to the psychometric performance of items and scales. In short, the type of item response may be just as important to symptom reporting as the content of survey questions. We propose some practical alternatives to currently used item categories across GD tools. Research should examine the performance of different response categories, including whether certain response categories aid respondents' comprehension and insight, and better capture pathological behaviours and harms., Validerad;2024;Nivå 2;2024-01-16 (hanlid);Full text license: CC BY-NC

Gaming disorder (GD) screening often involves self-report survey measures to detect the presence of symptoms. Studies have shown that gamers' responses vary greatly across survey items. Some symptoms, such as preoccupation and tolerance, are frequently reported by highly engaged but non-problematic gamers, and therefore these symptoms are thought to lack specificity and are suggested to be less important in classification decisions. We argue that the influence of response categories (e.g., dichotomous responses, such as "yes" or "no" or frequency categories, such as "rarely" and "often") on item responses has been relatively underexplored despite potentially contributing significantly to the psychometric performance of items and scales. In short, the type of item response may be just as important to symptom reporting as the content of survey questions. We propose some practical alternatives to currently used item categories across GD tools. Research should examine the performance of different response categories, including whether certain response categories aid respondents' comprehension and insight, and better capture pathological behaviours and harms., Validerad;2024;Nivå 2;2024-01-16 (hanlid);Full text license: CC BY-NC

Gamers with poor self-concept, high social anxiety, and high loneliness are at risk of problematic involvement in massively multiplayer online role-playing games (MMORPGs). There is a research gap concerning treatment approaches to cater to socially anxious MMORPG gamers with problematic patterns of gaming involvement. This study tests the feasibility and initial efficacy of a structured protocol in which socially anxious online gamers are exposed in offline social skills and exposed to real-life social interactions while playing a tabletop role-playing game. Methods: The experiment lasts 10 weeks and involves 10 sessions organized within 3 modules in which participants play the tabletop roleplaying game Dungeons and Dragons. Each module deploys one written role-playing scenario designed to challenge the players in game terms, as well as to involve them in a story based on maturing relationships with other characters and on solving challenges by social means and investigation. Our study uses an experimental single-case design with multiple baselines across groups (4 groups of 5 gamers with problematic MMORPG use and social anxiety) and a 3-month follow-up. Outcomes assessed include social skills, self-esteem, loneliness, assertiveness, and gaming disorder symptoms. Results: Ethical clearance has been obtained. Results are forthcoming as data collection will conclude in July 2023. Results will be available at the time of ICBA2023. Conclusion: Our proof-of-principle study has the potential to provide pilot data that are likely to be used to develop new types of interventions that may be more accessible and engaging for persons having a problematic involvement in MMORPGs.

This paper reports a qualitative survey of experts in problem gaming and/or problem gambling from 19 countries worldwide on the impact of the COVID-19 pandemic on problematic gaming and gambling. Twenty-seven problem gaming experts reported (i) no licensing changes, (ii) few existing or newly introduced policies or regulations, (iii) overall increases in gaming, (iv) adverse health-related outcomes, (v) media coverage of gaming and eSports, (vi) limited health service capacity for treatment and prevention, (vii) difficulty in connecting with patients, and (viii) adaptations including transition to telemedicine. Twenty-eight problem gambling experts reported (i) no changes in policies or regulation, (ii) increased activity of off-shore betting companies, and (iii) increases in online gambling, though (iv) decreased expenditure due to closure of land-based gambling venues, (v) adverse health-related outcomes, (vi) some financial benefits from savings, (vii) few and poorly accessible treatment facilities and (viii) transition to telemedicine. There is a need for: guidelines on the prevention and management of excessive gaming and gambling; studies examining the public health consequences of eSports viewing and participation and closure of land-based gambling venues on other forms of gambling; and longitudinal studies in a number of different areas described herein.

Following the recognition of 'internet gaming disorder' (IGD) as a condition requiring further study by the DSM-5, 'gaming disorder' (GD) was officially included as a diagnostic entity by the World Health Organization (WHO) in the 11th revision of the International Classification of Diseases (ICD-11). However, the proposed diagnostic criteria for gaming disorder remain the subject of debate, and there has been no systematic attempt to integrate the views of different groups of experts. To achieve a more systematic agreement on this new disorder, this study employed the Delphi expert consensus method to obtain expert agreement on the diagnostic validity, clinical utility and prognostic value of the DSM-5 criteria and ICD-11 clinical guidelines for GD. A total of 29 international experts with clinical and/or research experience in GD completed three iterative rounds of a Delphi survey. Experts rated proposed criteria in progressive rounds until a pre-determined level of agreement was achieved. For DSM-5 IGD criteria, there was an agreement both that a subset had high diagnostic validity, clinical utility and prognostic value and that some (e.g. tolerance, deception) had low diagnostic validity, clinical utility and prognostic value. Crucially, some DSM-5 criteria (e.g. escapism/mood regulation, tolerance) were regarded as incapable of distinguishing between problematic and non-problematic gaming. In contrast, ICD-11 diagnostic guidelines for GD (except for the criterion relating to diminished non-gaming interests) were judged as presenting high diagnostic validity, clinical utility and prognostic value. This Delphi survey provides a foundation for identifying the most diagnostically valid and clinically useful criteria for GD. There was expert agreement that some DSM-5 criteria were not clinically relevant and may pathologize non-problematic patterns of gaming, whereas ICD-11 diagnostic guidelines are likely to diagnose GD adequately and avoid pathologizing.

There is substantial clinical and public health evidence that video gaming, particularly online gaming, can become excessive and lead to psychological distress and functional impairment. This has led to the inclusion of gaming disorder as an official mental condition in the International Classification of Diseases, 11th Edition (ICD-11; World Health Organization, 2019). Psychological models recognize the importance of cognitive factors to explain the initiation, development, and maintenance of problematic gaming behaviors. This chapter will summarize some of the known cognitive factors associated with problem gaming and gaming disorder. These cognitions will be divided into two broad categories: (1) cognitive deficits (e.g., impaired executive functioning, hazardous decision-making, or deliberative processes) and (2) cognitive biases (e.g., attentional biases, cognitive distortions, dysfunctional cognitions). This chapter will review and synthesize available research findings and highlight their clinical implications for gaming disorder. The limitations of the research base are considered and some potential avenues for future research are proposed.

In view of the growing interest regarding binge-watching (i.e., watching multiple episodes of television (TV) series in a single sitting) research, two measures were developed and validated to assess binge-watching involvement (“Binge-Watching Engagement and Symptoms Questionnaire”, BWESQ) and related motivations (“Watching TV Series Motives Questionnaire”, WTSMQ). To promote international and cross-cultural binge-watching research, the present article reports on the validation of these questionnaires in nine languages (English, French, Spanish, Italian, German, Hungarian, Persian, Arabic, Chinese). Both questionnaires were disseminated, together with additional self-report measures of happiness, psychopathological symptoms, impulsivity and problematic internet use among TV series viewers from a college/university student population (N = 12,616) in 17 countries. Confirmatory factor, measurement invariance and correlational analyses were conducted to establish structural and construct validity. The two questionnaires had good psychometric properties and fit in each language. Equivalence across languages and gender was supported, while construct validity was evidenced by similar patterns of associations with complementary measures of happiness, psychopathological symptoms, impulsivity and problematic internet use. The results support the psychometric validity and utility of the BWESQ and WTSMQ for conducting cross-cultural research on binge-watching.

The last decade has witnessed the rise of electronic sports (esports), yet little is known about how involvement in intensive esports relates to self-regulatory processes, such as executive functioning (EF). In this paper, we review the evidence on EF in problematic and non-problematic video-game use. We also consider research on EF in traditional sports athletes, as well as in 'exercise addiction'. The focus of the review is on two core components of EF, namely response inhibition and cognitive flexibility. The available evidence suggests that EF is a reliable marker for indexing specific types of sport and video-gaming expertise, but does not appear to consistently delineate maladaptive from adaptive video-game involvement. Future research avenues on EF that characterize esport players are suggested to advance this area.

Learning psycho(bio)logy has developed a solid corpus of evidence and theory regarding behavior control modes. The present article briefly reviews that literature and its influence on recent models in which the transition from goal-directed to compulsive behavior is identified as the main process underlying substance use disorders. This literature is also relevant to non-substance addictive disorders, and serves as basis to propose a restricted definition of behavioral addiction relying on the presence of behavior-specific compulsivity. Complementarily, we consider whether some activities can become disordered while remaining mostly goal-driven. Based on reinforcement learning models, relative outcome utility computation is proposed as an alternative mechanism through which dysfunctional behaviors (even not qualifying as addictive) can override adaptive ones, causing functional impairment. Beyond issues of conceptual delimitation, recommendations are made regarding the importance of identifying individual etiological pathways to dysregulated behavior, the necessity of accurately profiling at-risk individuals, and the potential hazards of symptom-based diagnosis. In our view, the validity of these recommendations does not depend on the position one takes in the nosological debate.

Learning psycho(bio)logy has developed a solid corpus of evidence and theory regarding behavior control modes. The present article briefly reviews that literature and its influence on recent models in which the transition from goal-directed to compulsive behavior is identified as the main process underlying substance use disorders. This literature is also relevant to non-substance addictive disorders, and serves as basis to propose a restricted definition of behavioral addiction relying on the presence of behavior-specific compulsivity. Complementarily, we consider whether some activities can become disordered while remaining mostly goal-driven. Based on reinforcement learning models, relative outcome utility computation is proposed as an alternative mechanism through which dysfunctional behaviors (even not qualifying as addictive) can override adaptive ones, causing functional impairment. Beyond issues of conceptual delimitation, recommendations are made regarding the importance of identifying individual etiological pathways to dysregulated behavior, the necessity of accurately profiling at-risk individuals, and the potential hazards of symptom-based diagnosis. In our view, the validity of these recommendations does not depend on the position one takes in the nosological debate.

There is substantial clinical and public health evidence that video gaming, particularly online gaming, can become excessive and lead to psychological distress and functional impairment. This has led to the inclusion of gaming disorder as an official mental condition in the International Classification of Diseases, 11th Edition (ICD-11; World Health Organization, 2019). Psychological models recognize the importance of cognitive factors to explain the initiation, development, and maintenance of problematic gaming behaviors. This chapter will summarize some of the known cognitive factors associated with problem gaming and gaming disorder. These cognitions will be divided into two broad categories: (1) cognitive deficits (e.g., impaired executive functioning, hazardous decision-making, or deliberative processes) and (2) cognitive biases (e.g., attentional biases, cognitive distortions, dysfunctional cognitions). This chapter will review and synthesize available research findings and highlight their clinical implications for gaming disorder. The limitations of the research base are considered and some potential avenues for future research are proposed.

As a response to the COVID-19 pandemic, many governments have introduced steps such as spatial distancing and "staying at home" to curb its spread and impact. The fear resulting from the disease, the 'lockdown' situation, high levels of uncertainty regarding the future, and financial insecurity raise the level of stress, anxiety, and depression experienced by people all around the world. Psychoactive substances and other reinforcing behaviors (e.g., gambling, video gaming, watching pornography) are often used to reduce stress and anxiety and/or to alleviate depressed mood. The tendency to use such substances and engage in such behaviors in an excessive manner as putative coping strategies in crises like the COVID-19 pandemic is considerable. Moreover, the importance of information and communications technology (ICT) is even higher in the present crisis than usual. ICT has been crucial in keeping parts of the economy going, allowing large groups of people to work and study from home, enhancing social connectedness, providing greatly needed entertainment, etc. Although for the vast majority ICT use is adaptive and should not be pathologized, a subgroup of vulnerable individuals are at risk of developing problematic usage patterns. The present consensus guidance discusses these risks and makes some practical recommendations that may help diminish them.

While certain player vulnerabilities are known to increase risk of gaming disorder (GD), the topic of maladaptive playerxgame relationships in GD has received limited attention. This review aimed to: (1) identify game types associated with GD symptomatology; and (2) evaluate individual differences (e.g., age, personality, depression) in the relationship between gaming and GD symptomatology. A systematic review of six databases identified 23 studies of the relations between game types and GD, including 13 studies employing multivariate analyses. Player vulnerabilities implicated in GD included impulsivity, risk-taking, psychopathological symptoms (e.g., depression, anxiety), and stronger gaming motivations (e.g., escapism, achievement). MMORPG involvement had the strongest positive association with GD. Problematic MMORPG players tend to have a socially anxious profile and may be attracted to the work-like roles and conventions of this genre. Problematic players of shooters tend to score higher on measures of sensation-seeking and impulsivity than other players. These findings suggest that GD may develop more readily and at more severe levels in complex, endless, socially driven games, irrespective of person-level characteristics. Some player vulnerabilities may selectively increase risk of GD for certain game types. Further research should investigate different player-game interactions to refine current models and interventions for GD.

Video games as a consumer product have changed significantly with the advent of in-game purchasing systems (e.g., microtransactions, ‘loot boxes’). This review examines consumer protections related to in-game purchasing by anticipating some of the potential design strategies that might contribute to higher risk consumer behavior. Attention was directed towards the analysis of patents for potential in-game purchasing systems, with 13 identified on Google Patents. The design features were analysed in relation to the consumer rights and guarantees described in the terms of use agreements of the patent assignees. The analysis revealed that some in-game purchasing systems could be characterized as unfair or exploitative. These systems describe tactics that capitalize on informational advantages (e.g., behavioral tracking) and data manipulation (e.g., price manipulation) to optimize offers to incentivize continuous spending, while offering limited or no guarantees or protections (e.g., refund entitlement), with the potential to exploit vulnerable players (e.g., adolescents, problematic gamers). These findings are critically discussed in relation to behavioral economics, addiction psychology, and the clinical conceptualization of gaming disorder. Appropriate policy and consumer protection measures, psychologically informed interventions, and ethical game design guidelines are needed in order to protect the interests and wellbeing of consumers.

The Ten-Item Internet Gaming Disorder Test (IGDT-10) is a short screening instrument developed to assess Internet gaming disorder (IGD) as proposed in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM–5), adopting a concise, clear, and consistent item-wording. According to initial studies conducted in 2014, the instrument showed promising psychometric characteristics. The present study tested the psychometric properties, including language and gender invariance, in a large international sample of online gamers. In this study, data were collected from 7,193 participants comprising Hungarian (n = 3,924), Iranian (n = 791), English-speaking (n = 754), French-speaking (n = 421), Norwegian (n = 195), Czech (n = 496), and Peruvian (n = 612) online gamers via gaming-related websites and gaming-related social-networking-site groups. A unidimensional factor structure provided a good fit to the data in all language-based samples. In addition, results indicated both language and gender invariance on the level of scalar invariance. Criterion and construct validity of the IGDT-10 was supported by its strong association with the Problematic Online Gaming Questionnaire and moderate association with weekly gaming time, psychopathological symptoms, and impulsivity. The proportions of each sample that met the cut-off score on the IGDT-10 varied between 1.61% and 4.48% in the individual samples, except for the Peruvian sample (13.44%). The IGDT-10 shows robust psychometric properties and appears suitable for conducting cross-cultural and gender comparisons across seven languages.

While certain player vulnerabilities are known to increase risk of gaming disorder (GD), the topic of maladaptive playerxgame relationships in GD has received limited attention. This review aimed to: (1) identify game types associated with GD symptomatology; and (2) evaluate individual differences (e.g., age, personality, depression) in the relationship between gaming and GD symptomatology. A systematic review of six databases identified 23 studies of the relations between game types and GD, including 13 studies employing multivariate analyses. Player vulnerabilities implicated in GD included impulsivity, risk-taking, psychopathological symptoms (e.g., depression, anxiety), and stronger gaming motivations (e.g., escapism, achievement). MMORPG involvement had the strongest positive association with GD. Problematic MMORPG players tend to have a socially anxious profile and may be attracted to the work-like roles and conventions of this genre. Problematic players of shooters tend to score higher on measures of sensation-seeking and impulsivity than other players. These findings suggest that GD may develop more readily and at more severe levels in complex, endless, socially driven games, irrespective of person-level characteristics. Some player vulnerabilities may selectively increase risk of GD for certain game types. Further research should investigate different player-game interactions to refine current models and interventions for GD.

Video games as a consumer product have changed significantly with the advent of in-game purchasing systems (e.g., microtransactions, ‘loot boxes’). This review examines consumer protections related to in-game purchasing by anticipating some of the potential design strategies that might contribute to higher risk consumer behavior. Attention was directed towards the analysis of patents for potential in-game purchasing systems, with 13 identified on Google Patents. The design features were analysed in relation to the consumer rights and guarantees described in the terms of use agreements of the patent assignees. The analysis revealed that some in-game purchasing systems could be characterized as unfair or exploitative. These systems describe tactics that capitalize on informational advantages (e.g., behavioral tracking) and data manipulation (e.g., price manipulation) to optimize offers to incentivize continuous spending, while offering limited or no guarantees or protections (e.g., refund entitlement), with the potential to exploit vulnerable players (e.g., adolescents, problematic gamers). These findings are critically discussed in relation to behavioral economics, addiction psychology, and the clinical conceptualization of gaming disorder. Appropriate policy and consumer protection measures, psychologically informed interventions, and ethical game design guidelines are needed in order to protect the interests and wellbeing of consumers.

The Ten-Item Internet Gaming Disorder Test (IGDT-10) is a short screening instrument developed to assess Internet gaming disorder (IGD) as proposed in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM–5), adopting a concise, clear, and consistent item-wording. According to initial studies conducted in 2014, the instrument showed promising psychometric characteristics. The present study tested the psychometric properties, including language and gender invariance, in a large international sample of online gamers. In this study, data were collected from 7,193 participants comprising Hungarian (n = 3,924), Iranian (n = 791), English-speaking (n = 754), French-speaking (n = 421), Norwegian (n = 195), Czech (n = 496), and Peruvian (n = 612) online gamers via gaming-related websites and gaming-related social-networking-site groups. A unidimensional factor structure provided a good fit to the data in all language-based samples. In addition, results indicated both language and gender invariance on the level of scalar invariance. Criterion and construct validity of the IGDT-10 was supported by its strong association with the Problematic Online Gaming Questionnaire and moderate association with weekly gaming time, psychopathological symptoms, and impulsivity. The proportions of each sample that met the cut-off score on the IGDT-10 varied between 1.61% and 4.48% in the individual samples, except for the Peruvian sample (13.44%). The IGDT-10 shows robust psychometric properties and appears suitable for conducting cross-cultural and gender comparisons across seven languages.

Following the announcement that gaming disorder (GD) will be included in the World Health Organization's (WHO) International Classification of Diseases (ICD-11), multiple gaming industry organizations (henceforth ‘the industry’) have issued a statement in opposition to GD. The industry advances several arguments, including the notions that: gaming is predominantly enjoyed ‘safely and sensibly’; gaming has various personal benefits; the GD evidence base is ‘highly contested and inconclusive’; and GD would create moral panic and ‘abuse of diagnosis’. We believe that, regardless of whether GD is embraced by all researchers, arguments highlighting the popularity and benefits of gaming and disputing GD should not enable the industry to ignore the global evidence of gaming-related harms. The industry statement does not recognize clinical and public health needs and evidence identifying the adverse impacts of problematic gaming (e.g. social isolation, displaced sleep, physical inactivity and dietary problems, decreased psychological wellbeing, academic or job interference and interpersonal conflicts). Instead, the industry could reflect upon its strong capabilities to protect vulnerable consumers and its share of responsibility for the reduction of gaming-related harms

The proposed introduction of gaming disorder (GD) in the 11th revision of the International Classification of Diseases (ICD-11) developed by the World Health Organization (WHO) has led to a lively debate over the past year. Besides the broad support for the decision in the academic press, a recent publication by van Rooij et al. (2018) repeated the criticism raised against the inclusion of GD in ICD-11 by Aarseth et al. (2017). We argue that this group of researchers fails to recognize the clinical and public health considerations, which support the WHO perspective. It is important to recognize a range of biases that may influence this debate; in particular, the gaming industry may wish to diminish its responsibility by claiming that GD is not a public health problem, a position which maybe supported by arguments from scholars based in media psychology, computer games research, communication science, and related disciplines. However, just as with any other disease or disorder in the ICD-11, the decision whether or not to include GD is based on clinical evidence and public health needs. Therefore, we reiterate our conclusion that including GD reflects the essence of the ICD and will facilitate treatment and prevention for those who need it.

The proposed introduction of gaming disorder (GD) in the 11th revision of the International Classification of Diseases (ICD-11) developed by the World Health Organization (WHO) has led to a lively debate over the past year. Besides the broad support for the decision in the academic press, a recent publication by van Rooij et al. (2018) repeated the criticism raised against the inclusion of GD in ICD-11 by Aarseth et al. (2017). We argue that this group of researchers fails to recognize the clinical and public health considerations, which support the WHO perspective. It is important to recognize a range of biases that may influence this debate; in particular, the gaming industry may wish to diminish its responsibility by claiming that GD is not a public health problem, a position which maybe supported by arguments from scholars based in media psychology, computer games research, communication science, and related disciplines. However, just as with any other disease or disorder in the ICD-11, the decision whether or not to include GD is based on clinical evidence and public health needs. Therefore, we reiterate our conclusion that including GD reflects the essence of the ICD and will facilitate treatment and prevention for those who need it.

This commentary responds to Aarseth et al.'s (in press) criticisms that the ICD-11 Gaming Disorder proposal would result in "moral panics around the harm of video gaming" and "the treatment of abundant false-positive cases." The ICD-11 Gaming Disorder avoids potential "overpathologizing" with its explicit reference to functional impairment caused by gaming and therefore improves upon a number of flawed previous approaches to identifying cases with suspected gaming-related harms. We contend that moral panics are more likely to occur and be exacerbated by misinformation and lack of understanding, rather than proceed from having a clear diagnostic system.

[EN Gaming disorder (GD) screening often involves self-report survey measures to detect the presence of symptoms. Studies have shown that gamers' responses vary greatly across survey items. Some symptoms, such as preoccupation and tolerance, are frequently reported by highly engaged but non-problematic gamers, and therefore these symptoms are thought to lack specificity and are suggested to be less important in classification decisions. We argue that the influence of response categories (e.g., dichotomous responses, such as ‘yes’ or ‘no’; or frequency categories, such as ‘rarely’ and ‘often’) on item responses has been relatively underexplored despite potentially contributing significantly to the psychometric performance of items and scales. In short, the type of item response may be just as important to symptom reporting as the content of survey questions. We propose some practical alternatives to currently used item categories across GD tools. Research should examine the performance of different response categories, including whether certain response categories aid respondents' comprehension and insight, and better capture pathological behaviours and harms.]