When addiction symptoms and life problems diverge: a latent class analysis of problematic gaming in a representative multinational sample of European adolescents
Open accessAbstract
The proposed diagnosis of Internet gaming disorder (IGD) in DSM-5 has been criticized for "borrowing" criteria related to substance addiction, as this might result in misclassifying highly involved gamers as having a disorder. In this paper, we took a person-centered statistical approach to group adolescent gamers by levels of addiction-related symptoms and gaming-related problems, compared these groups to traditional scale scores for IGD, and checked how groups were related to psychosocial well-being using a preregistered analysis plan. We performed latent class analysis and regression with items from IGD and psychosocial well-being scales in a representative sample of 7865 adolescent European gamers. Symptoms and problems matched in only two groups: an IGD class (2.2%) having a high level of symptoms and problems and a Normative class (63.5%) having low levels of symptoms and problems. We also identified two classes comprising 30.9% of our sample that would be misclassified based on their report of gaming-related problems: an Engaged class (7.3%) that seemed to correspond to the engaged gamers described in previous literature, and a Concerned class (23.6%) reporting few symptoms but moderate to high levels of problems. Our findings suggest that a reformulation of IGD is needed. Treating Engaged gamers as having IGD when their poor well-being might not be gaming related may delay appropriate treatment, while Concerned gamers may need help to reduce gaming but would not be identified as such. Additional work to describe the phenomenology of these two groups would help refine diagnosis, prevention and treatment for IGD.
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Screening approaches based on the DSM-5 research criteria for Internet gaming disorder may misclassify some highly engaged gamers as disordered.
“Screening approaches based on the DSM-5 research criteria for Internet gaming disorder may misclassify some highly engaged gamers as disordered 189 , in line with experts' observations that some DSM-5 symptoms lack diagnostic utility 178 .”
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Cites
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2013) · doi:10.1176/appi.books.9780890425596 · Cited by 116,369 · see citing works
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Internet Addiction: The Emergence of a New Clinical Disorder
YOUNG, K. S. (1998) · CyberPsychology & Behavior · doi:10.1089/cpb.1998.1.237 · Cited by 5,513 · see citing works
(1991) · Cited by 3,844 · see citing works
Auxiliary Variables in Mixture Modeling: Three-Step Approaches Using M plus
Asparouhov, T., & Muthén, B. (2014) · Structural Equation Modeling A Multidisciplinary Journal · doi:10.1080/10705511.2014.915181 · Cited by 3,634 · see citing works
An effect size primer: A guide for clinicians and researchers.
Ferguson, C. J. (2009) · Professional Psychology: Research and Practice · doi:10.1037/a0015808 · Cited by 3,467 · see citing works
Kardefelt-Winther, D. (2014) · Computers in Human Behavior · doi:10.1016/j.chb.2013.10.059 · Cited by 2,519 · see citing works
Self-citationCuthbert, B. N. (2014) · World Psychiatry · doi:10.1002/wps.20087 · Cited by 1,377 · see citing works
Measuring DSM-5 Internet gaming disorder: Development and validation of a short psychometric scale
Pontes, H. M., & Griffiths, M. D. (2015) · Computers in Human Behavior · doi:10.1016/j.chb.2014.12.006 · Cited by 1,151 · see citing works
Distinguishing addiction and high engagement in the context of online game playing
Charlton, J. P., & Danforth, I. D. W. (2007) · Computers in Human Behavior · doi:10.1016/j.chb.2005.07.002 · Cited by 946 · see citing works
Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research
Billieux, J., Schimmenti, A., Khazaal, Y., Maurage, P., & Heeren, A. (2015) · Journal of Behavioral Addictions · doi:10.1556/2006.4.2015.009 · Cited by 920 · see citing works
Petry, N. M., Rehbein, F., Gentile, D. A., Lemmens, J. S., Rumpf, H., Mößle, T., Bischof, G., Tao, R., Fung, D. S. S., Borges, G., et al. (2014) · Addiction · doi:10.1111/add.12457 · Cited by 919 · see citing works
How can we conceptualize behavioural addiction without pathologizing common behaviours?
Kardefelt‐Winther, D., Heeren, A., Schimmenti, A., van Rooij, A., Maurage, P., Carras, M., Edman, J., Blaszczynski, A., Khazaal, Y., & Billieux, J. (2017) · Addiction · doi:10.1111/add.13763 · Cited by 780 · see citing works
Self-citationThe Internet Gaming Disorder Scale.
Lemmens, J. S., Valkenburg, P. M., & Gentile, D. A. (2015) · Psychological Assessment · doi:10.1037/pas0000062 · Cited by 742 · see citing works
Achenbach, T. M., Becker, A., Döpfner, M., Heiervang, E. R., Roessner, V., Steinhausen, H., & Rothenberger, A. (2008) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2007.01867.x · Cited by 681 · see citing works
Scholars’ open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal
Aarseth, E., Bean, A. M., Boonen, H., Colder Carras, M., Coulson, M., Das, D., Deleuze, J., Dunkels, E., Edman, J., Ferguson, C. J., et al. (2017) · Journal of Behavioral Addictions · doi:10.1556/2006.5.2016.088 · Cited by 629 · see citing works
Self-citationMihara, S., & Higuchi, S. (2017) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.12532 · Cited by 611 · cited 1× · see citing works
“While this is most likely due to the complex causal architecture underlying health conditions at a population scale [59], it reinforces the idea that there are unlikely to be simple one to one relationships between difficulties related to video game play and problems with well-being.”
BackgroundOnline video game addiction: identification of addicted adolescent gamers
van Rooij, A. J., Schoenmakers, T. M., Vermulst, A. A., van den Eijnden, R. J. J. M., & van de Mheen, D. (2010) · Addiction · doi:10.1111/j.1360-0443.2010.03104.x · Cited by 574 · see citing works
Rehbein, F., Kliem, S., Baier, D., Mößle, T., & Petry, N. M. (2015) · Addiction · doi:10.1111/add.12849 · Cited by 567 · see citing works
Müller, K. W., Janikian, M., Dreier, M., Wölfling, K., Beutel, M. E., Tzavara, C. K., Richardson, C., & Τσίτσικα, Ά. (2014) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-014-0611-2 · Cited by 485 · see citing works
Ferguson, C. J., Coulson, M., & Barnett, J. (2011) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2011.09.005 · Cited by 461 · see citing works
Pontes, H. M., Király, O., Demetrovics, Z., & Griffiths, M. D. (2014) · PLoS ONE · doi:10.1371/journal.pone.0110137 · Cited by 453 · see citing works
Griffiths, M. D., van Rooij, A. J., Kardefelt‐Winther, D., Starčević, V., Király, O., Pallesen, S., Müller, K. W., Dreier, M., Carras, M. C., Prause, N., et al. (2015) · Addiction · doi:10.1111/add.13057 · Cited by 451 · see citing works
Self-citationDesai, R. A., Krishnan‐Sarin, S., Cavallo, D. A., & Potenza, M. N. (2010) · PEDIATRICS · doi:10.1542/peds.2009-2706 · Cited by 372 · see citing works
Mild Disorders Should Not Be Eliminated From the DSM-V
Kessler, R. C., Merikangas, K. R., Berglund, P., Eaton, W. W., Koretz, D. S., & Walters, E. E. (2003) · Archives of General Psychiatry · doi:10.1001/archpsyc.60.11.1117 · Cited by 348 · see citing works
Internet Addictive Behavior in Adolescence: A Cross-Sectional Study in Seven European Countries
Tsitsika, A., Janikian, M., Schoenmakers, T. M., Tzavela, E. C., Ólafsson, K., Wójcik, S., Macarie, G. F., Tzavara, C., The EU NET ADB Consortium, & Richardson, C. (2014) · Cyberpsychology, Behavior, and Social Networking · doi:10.1089/cyber.2013.0382 · Cited by 303 · see citing works
Problems with the Concept of Video Game “Addiction”: Some Case Study Examples
Wood, R. T. A. (2007) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-007-9118-0 · Cited by 276 · see citing works
What is “functional impairment”? Disentangling disability from clinical significance
Üstün, B., & Kennedy, C. (2009) · World Psychiatry · doi:10.1002/j.2051-5545.2009.tb00219.x · Cited by 256 · see citing works
A critical review of “Internet addiction” criteria with suggestions for the future
van Rooij, A. J., & Prause, N. (2014) · Journal of Behavioral Addictions · doi:10.1556/jba.3.2014.4.1 · Cited by 237 · see citing works
Social Activities, Self-Efficacy, Game Attitudes, and Game Addiction
Jeong, E. J., & Kim, D. H. (2010) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2009.0289 · Cited by 225 · see citing works
Relative effect sizes for measures of risk
Olivier, J., May, W. L., & Bell, M. L. (2016) · Communication in Statistics- Theory and Methods · doi:10.1080/03610926.2015.1134575 · Cited by 225 · see citing works
Conceptualizing I nternet use disorders: A ddiction or coping process?
Kardefelt‐Winther, D. (2016) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.12413 · Cited by 198 · see citing works
Self-citationColder Carras, M., Van Rooij, A. J., Van de Mheen, D., Musci, R., Xue, Q.-L., & Mendelson, T. (2017) · Computers in Human Behavior · doi:10.1016/j.chb.2016.11.060 · Cited by 166 · see citing works
Self-citationTextbook of Psychiatric Epidemiology
(2011) · Wiley eBooks · doi:10.1002/9780470976739 · Cited by 151 · see citing works
A critical account of DSM-5 criteria for internet gaming disorder
Kardefelt‐Winther, D. (2014) · Addiction Research & Theory · doi:10.3109/16066359.2014.935350 · Cited by 146 · see citing works
Self-citationPROBLEMS WITH COMPUTER GAMES WITHOUT MONETARY REWARD: SIMILARITY TO PATHOLOGICAL GAMBLING
Johansson, A., & Götestam, K. G. (2004) · Psychological Reports · doi:10.2466/pr0.95.2.641-650 · Cited by 125 · see citing works
Scharkow, M., Festl, R., & Quandt, T. (2014) · Addiction · doi:10.1111/add.12662 · Cited by 120 · see citing works
Müller, K. W., Beutel, M. E., & Wölfling, K. (2014) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2014.01.010 · Cited by 106 · see citing works
Kowert, R., & Oldmeadow, J. A. (2014) · Computers in Human Behavior · doi:10.1016/j.chb.2014.05.004 · Cited by 97 · see citing works
Reliabilität und Validität der Skala zum Computerspielverhalten (CSV-S)
Wölfling, K., Müller, K., & Beutel, M. (2010) · PPmP. Psychotherapie, Psychosomatik, medizinische Psychologie · doi:10.1055/s-0030-1263145 · Cited by 87 · see citing works
Risk factors and interventions with statistically significant tiny effects
Siontis, G. C., & Ioannidis, J. P. (2011) · International Journal of Epidemiology · doi:10.1093/ije/dyr099 · Cited by 80 · see citing works
Gamers’ insights into the phenomenology of normal gaming and game “addiction”: A mixed methods study
Carras, M. C., Porter, A. M., van Rooij, A. J., King, D. L., Lange, A., Carras, M., & Labrique, A. B. (2017) · Computers in Human Behavior · doi:10.1016/j.chb.2017.10.029 · Cited by 74 · see citing works
Optimizing Play: How Theorycraft Changes Gameplay and Design.
Paul, C. (2011) · Cited by 72 · see citing works
Keyes, K. M., & Galea, S. (2016) · Epidemiology · doi:10.1097/ede.0000000000000578 · Cited by 61 · see citing works
(2012) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780195390445.001.0001 · Cited by 60 · see citing works
Tzavela, E. C., Karakitsou, C., Dreier, M., Mavromati, F., Wölfling, K., Halapi, E. C., Macarie, G. F., Wójcik, S., Veldhuis, L., & Τσίτσικα, Ά. (2015) · Journal of Adolescence · doi:10.1016/j.adolescence.2014.12.003 · Cited by 54 · see citing works
Ahmadi, J., Amiri, A., Ghanizadeh, A. J., Khademalhosseini, M., Khademalhosseini, Z., Gholami, Z., & Sharifian, M. (2014) · PubMed Central · Cited by 52 · see citing works
Wakefield, J. C. (2015) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12446 · Cited by 50 · see citing works
Subtypes of Adolescent Video Gamers: a Latent Class Analysis
Faulkner, G., Irving, H. M., Adlaf, E. M., & Turner, N. E. (2014) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-014-9501-6 · Cited by 47 · see citing works
Predictors of Problematic Video Game Usage in Childhood and Adolescence
Mößle, T., & Rehbein, F. (2013) · SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice · doi:10.1024/0939-5911.a000247 · Cited by 46 · see citing works
King, D. L., & Delfabbro, P. (2014) · Addiction · doi:10.1111/add.12547 · Cited by 43 · see citing works
Internet use and internet addictive behaviour among European adolescents: A cross-sectional study.
Τσίτσικα, Ά., Janikian, M., Tzavela, E. C., Schoenmakers, T. M., Ólafsson, K., Halapi, E. C., Tzavara, C., Wójcik, S., Makaruk, K., Critselis, E., et al. (2013) · Data Archiving and Networked Services (DANS) · Cited by 35 · see citing works
For DSM-V, It’s the “DisorderThreshold,” Stupid
Regier, D. A., Narrow, W. E., & Rae, D. S. (2004) · Archives of General Psychiatry · doi:10.1001/archpsyc.61.10.1051-a · Cited by 17 · see citing works
How can we conceptualize behavioral addiction without pathologizing common behaviors
Kardefelt‐Winther, D., Heeren, A., Schimmenti, A., van Rooij, A. J., Maurage, P., Carras, M. C., Edman, J., Blaszczynski, A. P., Khazaal, Y., & Billieux, J. (2017) · Addiction · Cited by 16 · see citing works
Self-citationMaking the case for hypothesis-driven theory testing in the study of Internet Gaming Disorder
Kardefelt‐Winther, D. (2015) · Addictive Behaviors · doi:10.1016/j.addbeh.2015.09.012 · Cited by 10 · see citing works
Self-citationFor DSM-V, It’s the “DisorderThreshold,” Stupid—Reply
Kessler, R. C., Merikangas, K. R., Berglund, P. A., Eaton, W. W., Koretz, D. S., & Walters, E. E. (2004) · Archives of General Psychiatry · doi:10.1001/archpsyc.61.10.1051-b · Cited by 6 · see citing works
Introduction to Epidemiologic Research Methods
Lewis, G. (2011) · Wiley eBooks · doi:10.1002/9780470976739.ch1 · Cited by 5 · see citing works
Assessment of Distress, Disorder, Impairment, and Need in the Population
Eaton, W. W., Mojtabai, R., Stuart, E. A., Leoutsakos, J., & Kuramoto, S. J. (2012) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780195390445.003.0004 · Cited by 3 · see citing works
Moderators and Mediators: Towards the Genetic and Environmental Bases of Psychiatric Disorders
KRAEMER, H. C. (2011) · doi:10.1002/9780470976739.ch6 · Cited by 1 · see citing works
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Stevens, M. W., Dorstyn, D., Delfabbro, P. H., & King, D. L. (2021) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867420962851 · Cited by 863 · see citing works
A weak scientific basis for gaming disorder: Let us err on the side of caution
van Rooij, A. J., Ferguson, C. J., Colder Carras, M., Kardefelt-Winther, D., Shi, J., Aarseth, E., Bean, A. M., Bergmark, K. H., Brus, A., Coulson, M., et al. (2018) · Journal of Behavioral Addictions · doi:10.1556/2006.7.2018.19 · Cited by 346 · see citing works
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Granero, R., Fernández-Aranda, F., Castro-Calvo, J., Billieux, J., Valero-Solís, S., Mora-Maltas, B., Rivas-Pérez, S., Valenciano-Mendoza, E., del Pino-Gutiérrez, A., Gómez-Peña, M., et al. (2021) · Addictive Behaviors · doi:10.1016/j.addbeh.2021.107086 · Cited by 23 · see citing works
- Authors
- Colder Carras, M., & Kardefelt-Winther, D.
- Venue
- European Child & Adolescent Psychiatry
- Published
- 2018-01-24
- Volume
- 27
- Issue
- 4
- Pages
- 513-525
- ISSN
- 1018-8827 (ISSN-L)
- 1435-165X
- PMC
- PMC5895528
- OpenAlex
- W2793113489
- Cited by
- 99
- References
- 59
- Citations by year
- 2026: 3 · 2025: 12 · 2024: 6 · 2023: 12 · 2022: 17 · 2021: 22 · 2020: 12 · 2019: 11 · 2018: 4
- FWCI
- 27.82
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- European Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- National Institute of Mental Health (5T32MH014592-39)
- Topics
- Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
- Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
- Social Sciences › Psychology › Clinical Psychology › Sexuality, Behavior, and Technology
- Keywords
- internet gaming disorder, gaming addiction, adolescents, addiction symptoms, psychosocial well-being, misclassification, DSM-5 diagnostic criteria, latent subgroups
- MeSH terms
- Adolescent, Mental Disorders, Europe, Female, Humans, Male, Behavior, Addictive, Video Games, Internet
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