Expert appraisal of criteria for assessing gaming disorder: an international Delphi study

Jesús Castro-Calvo¹, Daniel L King², Dan J Stein³, Matthias Brand⁴, Lior Carmi⁵, Samuel R Chamberlain^{6

7}, Zsolt Demetrovics⁸, Naomi A Fineberg^{9

10}, Hans-Jürgen Rumpf¹¹, Murat Yücel¹², Sophia Achab^{13

14}, Atul Ambekar¹⁵, Norharlina Bahar¹⁶, Alexander Blaszczynski¹⁷, Henrietta Bowden-Jones^{18

19}, Xavier Carbonell²⁰, Elda Mei Lo Chan²¹, Chih-Hung Ko²², Philippe de Timary²³, Magali Dufour²⁴, Marie Grall-Bronnec^{25

26}, Hae Kook Lee²⁷, Susumu Higuchi²⁸, Susana Jimenez-Murcia^{29

30}, Orsolya Király⁸, Daria J Kuss³¹, Jiang Long^{32

33}, Astrid Müller³⁴, Stefano Pallanti³⁵, Marc N Potenza³⁶, Afarin Rahimi-Movaghar³⁷, John B Saunders³⁸, Adriano Schimmenti³⁹, Seung-Yup Lee⁴⁰, Kristiana Siste^{41

42}, Daniel T Spritzer⁴³, Vladan Starcevic⁴⁴, Aviv M Weinstein⁴⁵, Klaus Wölfling⁴⁶, Joël Billieux^{47

48}

Affiliations

¹ Department of Personality, Assessment, and Psychological Treatments, University of Valencia, Spain.
² College of Education, Psychology, and Social Work, Flinders University, Australia.
³ SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
⁴ General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University Duisburg-Essen, Germany.
⁵ The Data Science Institute, Inter-disciplinary Center, Herzliya, Israel.
⁶ Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK.
⁷ Southern Health NHS Foundation Trust, Southampton, UK.
⁸ Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
⁹ University of Hertfordshire, Hatfield, UK, Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK.
¹⁰ University of Cambridge School of Clinical Medicine, Cambridge, UK.
¹¹ Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany.
¹² BrainPark, School of Psychological Sciences, Turner Institute for Brain and Mental Health and Monash Biomedical Imaging Facility, Monash University, Melbourne, Victoria, Australia.
¹³ Specialized Facility In Behavioral Addictions, ReConnecte, Department of Psychiatry, University Hospitals of Geneva, Generva, Switzerland.
¹⁴ Faculty of Medicine, Geneva University, Geneva, Switzerland.
¹⁵ National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India.
¹⁶ Department of Psychiatry and Mental Health, Hospital Selayang, Ministry of Health, Malaysia.
¹⁷ Faculty of Science, Brain and Mind Centre, School of Psychology, University of Sydney, Sydney, Australia.
¹⁸ National Centre for Gaming Disorders, London, UK.
¹⁹ University College London, London, UK.
²⁰ Faculty of Psychology, Education and Sports Sciences Blanquerna, Ramon Llull University, Barcelona, Spain.
²¹ St John's Cathedral Counselling Service, and Division on Addiction, Hong Kong.
²² Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
²³ Department of Adult Psychiatry, Institute of Neuroscience, UCLouvain and Cliniques Universitaires Saint-Luc, Brussels, Belgium.
²⁴ Université du Québec à Montréal, Montréal, Québec, Canada.
²⁵ CHU Nantes, Department of Addictology and Psychiatry, Nantes, France.
²⁶ Universités de Nantes et Tours, UMR 1246, Nantes, France.
²⁷ Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
²⁸ National Hospital Organization, Kurihama Medical and Addiction Center, Japan.
²⁹ Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.
³⁰ Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain.
³¹ International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK.
³² Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
³³ Laboratory for Experimental Psychopathology, Psychological Science Research Institute, Université Catholique de Louvain, Louvain, Belgium.
³⁴ Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany.
³⁵ Neuroscience Institute, University of Florence, Italy.
³⁶ Departments of Psychiatry and Neuroscience and the Child Study Center, Yale School of Medicine and Connecticut Mental Health Center, New Haven, CT, USA.
³⁷ Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.
³⁸ Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Queensland, Australia.
³⁹ Faculty of Human and Social Sciences, Kore University of Enna, Enna, Italy.
⁴⁰ Department of Psychiatry, Eunpyeong St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
⁴¹ Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
⁴² Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
⁴³ Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul, Brazil.
⁴⁴ Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, University of Sydney, Sydney, Australia.
⁴⁵ Department of Behavioral Science, Ariel University, Israel.
⁴⁶ Outpatient Clinic for Behavioral Addictions, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.
⁴⁷ Institute of Psychology, University of Lausanne, Lausanne, Switzerland.
⁴⁸ Health and Behaviour Institute, University of Luxembourg, Esch-sur-Alzette, Luxembourg.

PMID: 33449441
PMCID: PMC8451754
DOI: 10.1111/add.15411

Expert appraisal of criteria for assessing gaming disorder: an international Delphi study

Jesús Castro-Calvo et al. Addiction. 2021 Sep.

. 2021 Sep;116(9):2463-2475.

doi: 10.1111/add.15411. Epub 2021 Feb 1.

Authors

Affiliations

¹ Department of Personality, Assessment, and Psychological Treatments, University of Valencia, Spain.
² College of Education, Psychology, and Social Work, Flinders University, Australia.
³ SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
⁴ General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University Duisburg-Essen, Germany.
⁵ The Data Science Institute, Inter-disciplinary Center, Herzliya, Israel.
⁶ Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK.
⁷ Southern Health NHS Foundation Trust, Southampton, UK.
⁸ Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
⁹ University of Hertfordshire, Hatfield, UK, Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK.
¹⁰ University of Cambridge School of Clinical Medicine, Cambridge, UK.
¹¹ Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany.
¹² BrainPark, School of Psychological Sciences, Turner Institute for Brain and Mental Health and Monash Biomedical Imaging Facility, Monash University, Melbourne, Victoria, Australia.
¹³ Specialized Facility In Behavioral Addictions, ReConnecte, Department of Psychiatry, University Hospitals of Geneva, Generva, Switzerland.
¹⁴ Faculty of Medicine, Geneva University, Geneva, Switzerland.
¹⁵ National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India.
¹⁶ Department of Psychiatry and Mental Health, Hospital Selayang, Ministry of Health, Malaysia.
¹⁷ Faculty of Science, Brain and Mind Centre, School of Psychology, University of Sydney, Sydney, Australia.
¹⁸ National Centre for Gaming Disorders, London, UK.
¹⁹ University College London, London, UK.
²⁰ Faculty of Psychology, Education and Sports Sciences Blanquerna, Ramon Llull University, Barcelona, Spain.
²¹ St John's Cathedral Counselling Service, and Division on Addiction, Hong Kong.
²² Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
²³ Department of Adult Psychiatry, Institute of Neuroscience, UCLouvain and Cliniques Universitaires Saint-Luc, Brussels, Belgium.
²⁴ Université du Québec à Montréal, Montréal, Québec, Canada.
²⁵ CHU Nantes, Department of Addictology and Psychiatry, Nantes, France.
²⁶ Universités de Nantes et Tours, UMR 1246, Nantes, France.
²⁷ Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
²⁸ National Hospital Organization, Kurihama Medical and Addiction Center, Japan.
²⁹ Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.
³⁰ Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain.
³¹ International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK.
³² Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
³³ Laboratory for Experimental Psychopathology, Psychological Science Research Institute, Université Catholique de Louvain, Louvain, Belgium.
³⁴ Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany.
³⁵ Neuroscience Institute, University of Florence, Italy.
³⁶ Departments of Psychiatry and Neuroscience and the Child Study Center, Yale School of Medicine and Connecticut Mental Health Center, New Haven, CT, USA.
³⁷ Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.
³⁸ Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Queensland, Australia.
³⁹ Faculty of Human and Social Sciences, Kore University of Enna, Enna, Italy.
⁴⁰ Department of Psychiatry, Eunpyeong St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
⁴¹ Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
⁴² Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
⁴³ Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul, Brazil.
⁴⁴ Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, University of Sydney, Sydney, Australia.
⁴⁵ Department of Behavioral Science, Ariel University, Israel.
⁴⁶ Outpatient Clinic for Behavioral Addictions, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.
⁴⁷ Institute of Psychology, University of Lausanne, Lausanne, Switzerland.
⁴⁸ Health and Behaviour Institute, University of Luxembourg, Esch-sur-Alzette, Luxembourg.

PMID: 33449441
PMCID: PMC8451754
DOI: 10.1111/add.15411

Abstract

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.

Keywords: DSM; Delphi; ICD; diagnosis; gaming disorder; internet gaming disorder.

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Figures

**Figure 1**
Experts’ selection process.

**Figure 2**
Flow‐chart of the criteria inclusion, exclusion or re‐rating over the study rounds.

See this image and copyright information in PMC

References

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Expert appraisal of criteria for assessing gaming disorder: an international Delphi study

Affiliations

Expert appraisal of criteria for assessing gaming disorder: an international Delphi study

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources