Table 3.
Concerns regarding the diagnostic validity of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Internet gaming disorder (IGD) and the International Classification of Diseases, 11th Revision (ICD-11) gaming disorder (GD) criteria and definitions
| Topics | Validity of the diagnostic criteria to identify individuals with GD. | |
|---|---|---|
| Concerns | Related references | |
| Diagnostic validity | Further research may indicate that the diagnostic threshold fails to differentiate nondependent from dependent use and that certain criteria do not increase diagnostic accuracy. | Dowling (2014) |
| Data regarding measures for IGD on predictive validity and interrater reliability is inadequate. | King, Haagsma, Delfabbro, Gradisar, and Griffiths (2013) | |
| IGD risks pathologizing normal behaviors if numerous symptoms that do not indicate pathology are included. Content validity, construct validity, and face validity should be tested. | (Markey & Ferguson, 2017) {Kardefelt-Winther, 2015 #158} | |
| The polythetic, nonhierarchical DSM-5 diagnostic criteria for IGD renders the concept of IGD unacceptably heterogeneous. | Starcevic (2017) | |
| Intensity and frequency measures are required to represent the pathological threshold of each IGD and GD criteria. | Ko and Yen (2014) | |
| Validity of each criterion | ||
| Preoccupation | Preoccupation with gaming or feeling upset when an individual cannot participate to the desired extent are not necessarily indicators of pathology. | Kardefelt-Winther (2014) |
| The cognitive factors related to preoccupation must be clarified. | King and Delfabbro (2014b) | |
| “Distracted by thoughts on gaming which hinder concentration on work or other important tasks” may be more accurate than “thinking or planning when not playing”. | Ko and Yen (2014) | |
| Preoccupation should not be assessed on time alone but also on the cognitive content. “Perceiving gaming as central to their lives” or “whether they could imagine their lives without gaming” could be considered. | Griffiths et al. (2016) | |
| Worse diagnostic accuracy compared with the other IGD criteria. | Király et al. (2017) | |
| Loss of control | A desire or intention to stop playing is required. | Griffiths et al. (2016) |
| Cultural bias, rational choice, and age should be considered. | Griffiths et al. (2016) | |
| Gaming despite negative consequences | Are the negative consequences short-term or long-term? | Griffiths et al. (2016) |
| Withdrawal | The response to an immediate disruption of gaming or prolonged refrainment from gaming (≥2 weeks) may not be withdrawal symptoms. | Ko and Yen (2014) |
| “Over a period of up to 2 days” and “relieved by the ability to play” could be used in evaluating the withdrawal symptoms. | Griffiths et al. (2016) | |
| Current evidence on Internet gaming withdrawal is very underdeveloped. | Kaptsis, King, Delfabbro, and Gradisar, (2016) | |
| Although current evidence is very underdeveloped, the most consistently reported emotional and behavioral withdrawal symptoms were irritability and restlessness, not physical withdrawal symptoms. | Kaptsis, King, Delfabbro, and Gradisar (2016) | |
| Tolerance | Tolerance could be described as “diminished levels of gaming satisfaction because of prolonged gaming activity”. | Griffiths et al. (2016), Ko and Yen (2014) |
| Problematic gamers appear to be driven by a need for higher-quality, rarer, more valuable, more novel, or more difficult-to-obtain rewards. | King and Delfabbro (2016) | |
| Individuals with IGD may have very different and tolerance-unrelated reasons for spending more time gaming. | Billieux, Schimmenti, Khazaal, Maurage, and Heeren (2015) | |
| The increase in time or upgradation of equipment does not necessarily reflect a pathology. | Griffiths et al. (2016) | |
| This criterion excludes gamers that may have played a considerable amount of time over a long period but have not increased their playing time. | Krossbakken et al. (2017) | |
| Deception | This criterion has a considerably lower diagnostic accuracy compared with the other IGD criteria. | Ko et al. (2014) |
| Escape | This criterion has a considerably lower diagnostic accuracy compared with the other IGD criteria. | (Király et al., 2017; Király, Griffiths, & Demetrovics, 2015; Ko & Yen, 2014) {Rehbein, 2015 #227} |
| Low specificity: Nonaddicted gamers also play to escape problems in their lives. Gamers are not necessarily aware that the purpose of their gaming is to escape problems. | Griffiths et al. (2016) | |
| Numerous gamers view escaping and losing time as a positive feature of gaming rather than a negative one. | Wood & Griffiths (2007) | |
| Loss of interest | Giving up other activities for gaming may reflect a normal development process. It may also reflect an association with depression. | Griffiths et al. (2016) |
| Risk or Lose relationships and opportunities | Highly engaged nondisordered players have also endorsed this criterion. | Griffiths et al. (2016) |
| Problems caused by gaming should be a requirement criterion. | Griffiths et al. (2016), Ko (2014) | |
| Including functional impairment and distress to the wording of each criterion would enable differentiation between the engaged and addicted gamers using the same scale. “Leading to clinically significant impairment or distress” could be included in the wording. | Krossbakken et al. (2017) | |
| General concern | The field lacks basic theory, definitions, and properly validated and standardized assessment tools. | Van Rooij and Kardefelt-Winther (2017) |