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      Including gaming disorder in the ICD-11: The need to do so from a clinical and public health perspective : Commentary on: A weak scientific basis for gaming disorder: Let us err on the side of caution (van Rooij et al., 2018)

      1 , * , , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 7 , 36 , 30 , 37 , 33 , 30 , 8 , 38 , 30 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 43 , 50 , 2 , 6
      Journal of Behavioral Addictions
      Akadémiai Kiadó
      gaming disorder, ICD-11, clinical perspective, public health

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          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.

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          Most cited references23

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          Scholars’ open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal

          Concerns about problematic gaming behaviors deserve our full attention. However, we claim that it is far from clear that these problems can or should be attributed to a new disorder. The empirical basis for a Gaming Disorder proposal, such as in the new ICD-11, suffers from fundamental issues. Our main concerns are the low quality of the research base, the fact that the current operationalization leans too heavily on substance use and gambling criteria, and the lack of consensus on symptomatology and assessment of problematic gaming. The act of formalizing this disorder, even as a proposal, has negative medical, scientific, public-health, societal, and human rights fallout that should be considered. Of particular concern are moral panics around the harm of video gaming. They might result in premature application of diagnosis in the medical community and the treatment of abundant false-positive cases, especially for children and adolescents. Second, research will be locked into a confirmatory approach, rather than an exploration of the boundaries of normal versus pathological. Third, the healthy majority of gamers will be affected negatively. We expect that the premature inclusion of Gaming Disorder as a diagnosis in ICD-11 will cause significant stigma to the millions of children who play video games as a part of a normal, healthy life. At this point, suggesting formal diagnoses and categories is premature: the ICD-11 proposal for Gaming Disorder should be removed to avoid a waste of public health resources as well as to avoid causing harm to healthy video gamers around the world.
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            Gaming disorder: Its delineation as an important condition for diagnosis, management, and prevention

            Online gaming has greatly increased in popularity in recent years, and with this has come a multiplicity of problems due to excessive involvement in gaming. Gaming disorder, both online and offline, has been defined for the first time in the draft of 11th revision of the International Classification of Diseases (ICD-11). National surveys have shown prevalence rates of gaming disorder/addiction of 10%–15% among young people in several Asian countries and of 1%–10% in their counterparts in some Western countries. Several diseases related to excessive gaming are now recognized, and clinics are being established to respond to individual, family, and community concerns, but many cases remain hidden. Gaming disorder shares many features with addictions due to psychoactive substances and with gambling disorder, and functional neuroimaging shows that similar areas of the brain are activated. Governments and health agencies worldwide are seeking for the effects of online gaming to be addressed, and for preventive approaches to be developed. Central to this effort is a need to delineate the nature of the problem, which is the purpose of the definitions in the draft of ICD-11.
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              Stress and alcohol use: moderating effects of gender, coping, and alcohol expectancies.

              A stressor vulnerability model of stress-induced drinking was tested in a stratified random sample of 1,316 Black and White adult drinkers. Stressors were highly predictive of both alcohol use and drinking problems among men who relied on avoidant forms of emotion coping or held strong positive expectancies for alcohol's effects and accounted for more than 35% of the variance in alcohol use among the subgroup of men who were high in both vulnerability factors. In contrast, stressors were negatively related among men who were low in both and were unrelated among women regardless of their coping or expectancies. These findings suggest that tension reduction theories of alcohol use are overly broad and that individual characteristics must be considered to account for stress-related effects on alcohol use and abuse.

                Author and article information

                Journal of Behavioral Addictions
                J Behav Addict
                Akadémiai Kiadó (Budapest )
                02 July 2018
                September 2018
                : 7
                : 3
                : 556-561
                [ 1 ]Department of Psychiatry and Psychotherapy, University of Lübeck , Lübeck, Germany
                [ 2 ]Department of Mental Health and Psychiatry, Service of Addictology, Geneva University Hospitals , Geneva, Switzerland
                [ 3 ]Geneva WHO Collaborating Center for Training and Research, University of Geneva , Geneva, Switzerland
                [ 4 ]Addictive and Compulsive Behaviours Lab, Institute for Health and Behaviour, University of Luxembourg , Esch-sur-Alzette, Luxembourg
                [ 5 ]Central North West London NHS Trust, Division of Brain Science, Imperial College London , London, UK
                [ 6 ]Department of Mental Health and Substance Abuse, WHO Headquarters , Geneva, Switzerland
                [ 7 ]Institute of Psychology, Eötvös Loránd University (ELTE) , Budapest, Hungary
                [ 8 ] National Hospital Organization Kurihama Medical and Addiction Center , Yokosuka, Kanagawa, Japan
                [ 9 ]School of Psychology, The University of Adelaide , Adelaide, SA, Australia
                [ 10 ]Central Institute of Mental Health, University of Heidelberg , Mannheim, Germany
                [ 11 ]Department of Psychiatry and Neuroscience, Child Study Center, The National Center on Addiction and Substance Abuse, Connecticut Mental Health Center, Yale University School of Medicine , New Haven, CT, USA
                [ 12 ]Centre for Youth Substance Abuse Research, The University of Queensland , Brisbane, QLD, Australia
                [ 13 ]Faculty of Health and Environmental Sciences, Auckland University of Technology , Auckland, New Zealand
                [ 14 ]Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences , New Delhi, India
                [ 15 ]Department of Psychology, Hasan Kalyoncu University , Gaziantep, Turkey
                [ 16 ]Epidemiology Unit and Centre for Alcohol Studies, Faculty of Medicine, Prince of Songkla University , Hat Yai, Songkhla, Thailand
                [ 17 ]Department of Psychiatry and Mental Health, Hospital Selayang , Selangor, Malaysia
                [ 18 ] National Institute of Psychiatry , Mexico City, Mexico
                [ 19 ]General Psychology: Cognition Center for Behavioral Addiction Research, University Duisburg-Essen , Duisburg, Germany
                [ 20 ] Erwin L. Hahn Institute for Magnetic Resonance Imaging , Essen, Germany
                [ 21 ]Integrated Centre on Addiction Prevention and Treatment, Tung Wah Group of Hospitals , Hong Kong SAR, China
                [ 22 ]Department of Health, Hong Kong SAR, China
                [ 23 ]Applied Child Psychology and Department of Psychiatry, McGill University , Montreal, Canada
                [ 24 ] National Rehabilitation Center , Abu Dhabi, United Arab Emirates
                [ 25 ]National Drug and Alcohol Research Centre, University of New South Wales , Randwick, NSW, Australia
                [ 26 ] Hertfordshire Partnership University NHS Foundation Trust , Hertfordshire, UK
                [ 27 ]Department of Postgraduate Medicine, University of Hertfordshire , Hertfordshire, UK
                [ 28 ]National Centre on Addiction and Doping, National Observatory on Alcohol, Italian National Institute of Health , Rome, Italy
                [ 29 ]Department of Psychology, Iowa State University , Ames, IA, USA
                [ 30 ]International Gaming Research Unit, Psychology Department, Nottingham Trent University , Nottingham, UK
                [ 31 ]Department of Psychiatry, Academic Medical Center, Mental Health Care, University of Amsterdam , Amsterdam, The Netherlands
                [ 32 ]Addictology and Psychiatry Department, CHU Nantes , Nantes, France
                [ 33 ]Mental Health Institute of the Second Xiangya Hospital, Central South University , Changsha, Hunan, China
                [ 34 ]Department of Psychology, The University of Calgary , Calgary, Alberta, Canada
                [ 35 ]Li Ka Shing Faculty of Medicine, Department of Paediatrics & Adolescent Medicine, The University of Hong Kong , Hong Kong SAR, China
                [ 36 ]Department of Psychiatry, College of Medicine, The Catholic University of Korea , Seoul, South Korea
                [ 37 ]Center for Research on Children, Adolescents, and the Media, Amsterdam School of Communication Research, University of Amsterdam , Amsterdam, The Netherlands
                [ 38 ]Department of Psychiatry, University of Connecticut School of Medicine , Farmington, CT, USA
                [ 39 ]Iranian National Center for Addiction Studies, Tehran University of Medical Sciences , Tehran, Iran
                [ 40 ] Criminological Research Institute Lower Saxony , Hannover, Germany
                [ 41 ]Institute for Mental Health Policy Research, Centre for Addictions and Mental Health , Toronto, Canada
                [ 42 ]Department of Psychiatry, Faculty of Medicine, Institute of Medical Science, Dalla Lana School of Public Health, University of Toronto , Toronto, Canada
                [ 43 ]Epidemiological Research Unit, Institute of Clinical Psychology and Psychotherapy, Technical University Dresden , Dresden, Germany
                [ 44 ]National Observatory on Alcohol, National Institute of Health , Rome, Italy
                [ 45 ] National Institute of Mental Health and Neurosciences , Bengaluru, India
                [ 46 ] Study Group on Technological Addictions , Porto Alegre, Brazil
                [ 47 ]Department of Psychiatry and Mental Health, SA MRC Unit on Risk & Resilience in Mental Disorders, University of Cape Town , Cape Town, South Africa
                [ 48 ]Network for Internet Investigation and Research in Australia, The Delta Clinic , Sydney, NSW, Australia
                [ 49 ]Department of Behavioral Science, University of Ariel , Ariel, Israel
                [ 50 ]Outpatient Clinic for Behavioral Addiction, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University , Mainz, Germany
                Author notes
                [* ]Corresponding author: PD Dr. Hans-Jürgen Rumpf; Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; Phone: +49 451 5009 8751; Fax: +49 451 5009 8754; E-mail: hans-juergen.rumpf@ 123456uksh.de
                © 2018 The Author(s)

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated.

                : 24 May 2018
                : 28 May 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 31, Pages: 6
                Funding sources: No financial support was received for the preparation of this paper.

                Evolutionary Biology,Medicine,Psychology,Educational research & Statistics,Social & Behavioral Sciences
                ICD-11,public health,gaming disorder,clinical perspective


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