Expert appraisal of criteria for assessing gaming disorder: an international Delphi study
Open accessAbstract
Background and aims: 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. Methods: 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. Results: 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. Conclusions: 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.
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The Delphi study supported the pivotal role of the core ICD-11 diagnostic requirements: loss of control over gaming, persistence despite negative consequences, and functional impairment as a result of gaming.
“On the other hand, this Delphi study supported the pivotal role of the core ICD-11 diagnostic requirements: loss of control (over gaming), persistence despite negative consequences, and functional impairment as a result of gaming.”
Participating experts agreed that the ICD-11 CDDR were likely to identify gaming disorder adequately and more likely to avoid pathologizing intensive but healthy gaming behaviours.
“Participating experts agreed that the ICD-11 CDDR were likely to identify the condition adequately, and more likely to avoid pathologizing intensive but healthy gaming behaviours.”
No consensus emerged among experts regarding the validity and clinical utility of the withdrawal or preoccupation criteria for gaming disorder.
“Furthermore, no consensus emerged among experts regarding the validity and clinical utility of the withdrawal or preoccupation criteria, suggesting that more research was needed before accepting them as diagnostic features of gaming disorder.”
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- Authors
- Castro‐Calvo, J., King, D. L., Stein, D. J., Brand, M., Carmi, L., Chamberlain, S. R., Demetrovics, Z., Fineberg, N. A., Rumpf, H., Yücel, M., Achab, S., Ambekar, A., Bahar, N., Blaszczynski, A., Bowden‐Jones, H., Carbonell, X., Chan, E. M. L., Ko, C., de Timary, P., Dufour, M., Grall‐Bronnec, M., Lee, H. K., Higuchi, S., Jimenez‐Murcia, S., Király, O., Kuss, D. J., Long, J., Müller, A., Pallanti, S., Potenza, M. N., Rahimi‐Movaghar, A., Saunders, J. B., Schimmenti, A., Lee, S., Siste, K., Spritzer, D. T., Starcevic, V., Weinstein, A. M., Wölfling, K., & Billieux, J.
- Affiliations
- Universitat de València (ES)
- Flinders University (AU)
- South African Medical Research Council (ZA)
- University of Duisburg-Essen (DE)
- Reichman University (IL)
- Southern Health NHS Foundation Trust (GB)
- Eötvös Loránd University (HU)
- University of Hertfordshire (GB)
- University of Lübeck (DE)
- Monash University (AU)
- University of Geneva (CH)
- All India Institute of Medical Sciences (IN)
- Ministry of Health (MY)
- Faculty of Science, Brain and Mind Centre, School of Psychology University of Sydney Sydney Australia
- University College London (GB)
- Universitat Ramon Llull (ES)
- St John's Cathedral Counselling Service, and Division on Addiction Hong Kong
- Kaohsiung Medical University (TW)
- Department of Adult Psychiatry Institute of Neuroscience, UCLouvain and Cliniques Universitaires Saint‐Luc Brussels Belgium
- Université du Québec à Montréal (CA)
- Centre Hospitalier Universitaire de Nantes (FR)
- Catholic University of Korea (KR)
- Kurihama Medical and Addiction Center (JP)
- Department of Psychiatry Bellvitge University Hospital‐IDIBELL Barcelona Spain
- Nottingham Trent University (GB)
- Shanghai Jiao Tong University (CN)
- Medizinische Hochschule Hannover (DE)
- University of Florence (IT)
- Yale University (US)
- Tehran University of Medical Sciences (IR)
- The University of Queensland (AU)
- Università degli Studi di Enna Kore (IT)
- The Catholic University of Korea Eunpyeong St. Mary's Hospital (KR)
- University of Indonesia (ID)
- Universidade Federal do Rio Grande do Sul (BR)
- Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School University of Sydney Sydney Australia
- Ariel University (IL)
- University Medical Center of the Johannes Gutenberg University Mainz (DE)
- University of Luxembourg (LU)
- Corresponding author
- Billieux, Joël
- ORCID
- Castro‐Calvo, Jesús
- King, Daniel L.
- Stein, Dan J.
- Brand, Matthias
- Carmi, Lior
- Chamberlain, Samuel R.
- Demetrovics, Zsolt
- Fineberg, Naomi A.
- Rumpf, Hans‐Jürgen
- Yücel, Murat
- Achab, Sophia
- Ambekar, Atul
- Bahar, Norharlina
- Bowden‐Jones, Henrietta
- Carbonell, Xavier
- Chan, Elda Mei Lo
- Ko, Chih‐Hung
- Dufour, Magali
- Grall‐Bronnec, Marie
- Lee, Hae Kook
- Higuchi, Susumu
- Jimenez‐Murcia, Susana
- Király, Orsolya
- Kuss, Daria J.
- Long, Jiang
- Müller, Astrid
- Pallanti, Stefano
- Potenza, Marc N.
- Rahimi‐Movaghar, Afarin
- Saunders, John B.
- Schimmenti, Adriano
- Lee, Seung‐Yup
- Siste, Kristiana
- Spritzer, Daniel T.
- Weinstein, Aviv M.
- Wölfling, Klaus
- Billieux, Joël
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2021-02
- Volume
- 116
- Issue
- 9
- Pages
- 2463-2475
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- PMC
- PMC8451754
- OpenAlex
- W3123800048
- Cited by
- 236
- References
- 65
- Citations by year
- 2026: 34 · 2025: 37 · 2024: 39 · 2023: 48 · 2022: 54 · 2021: 24
- FWCI
- 57.14
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Addiction (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc-nd)
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- Archive ouverte UNIGE (University of Geneva) (publishedVersion, other-oa)
- Repository of the Academy's Library (Library of the Hungarian Academy of Sciences) (acceptedVersion)
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- University of Hertfordshire Research Archive (University of Hertfordshire) (submittedVersion)
- Universitätsbibliographie, Universität Duisburg-Essen (submittedVersion)
- Digital Access to Libraries (Université catholique de Louvain (UCL), l'Université de Namur (UNamur) and the Université Saint-Louis (USL-B)) (submittedVersion, other-oa)
- Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (submittedVersion, cc-by-nc-nd)
- ELTE Digital Institutional Repository (EDIT) (Eötvös Loránd University) (submittedVersion, other-oa)
- ePrints Soton (University of Southampton) (submittedVersion)
- Nottingham Trent University's Institutional Repository (Nottingham Trent Repository) (submittedVersion, cc-by-nc-nd)
- Repository of Digital Objects for Teaching Research and Culture (University of Valencia) (submittedVersion, other-oa)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by-nc-nd)
- Apollo (University of Cambridge) (submittedVersion, cc-by-nc-nd)
- Apollo
- Funders
- Wilson Foundation
- National Center for Responsible Gaming
- Wellcome Trust (110,049/Z/15/Z)
- Australian Government (APP1117188)
- Department of Science and Technology, Ministry of Science and Technology, India
- Monash University
- Magyar Tudományos Akadémia (NKP-20-5)
- Department of Industry, Innovation and Science, Australian Government
- Nemzeti Kutatási Fejlesztési és Innovációs Hivatal (NKP-20-5, NKFIH-1157-8/2019-DT, KKP126835)
- Innovációs és Technológiai Minisztérium (ÚNKP-20-5)
- Medical Research Council
- Australian Research Council
- National Health and Medical Research Council (APP#1117188)
- Defence Science and Technology Group
- Nemzeti Kutatási, Fejlesztési és Innovaciós Alap (NKFIH-1157-8/2019-DT, ÚNKP‐20‐5, ÚNKP-20, KKP126835)
- National Research, Development and Innovation Office (KKP126835, ÚNKP-20-5, NKFIH-1157-8/2019-DT)
- 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
- gaming disorder, internet gaming disorder, diagnostic criteria, DSM-5, ICD-11, expert consensus, diagnostic validity, clinical utility, prognostic value, gaming addiction, escapism, tolerance, deception, pathologization
- MeSH terms
- Delphi Technique, Humans, Disruptive, Impulse Control, and Conduct Disorders, Behavior, Addictive, Video Games, Internet, Diagnostic and Statistical Manual of Mental Disorders
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