Issues for DSM-5: Video-gaming disorder?

Australian & New Zealand Journal of Psychiatry, 47(1) Internet addiction is a contentious disorder (Pies, 2009). To date, addiction researchers have questioned its construct validity (Shaffer et al., 2000); the precision of definitional criteria (Blaszczynski, 2008; Czincz and Hechanova, 2009); clinical formulation and overlap with other addictive disorders (Sim et al., 2012); aetiology and risk factors (Kuss and Griffiths, 2012); and, the quality of intervention studies (King et al., 2011, 2012). Vladan Starcevic’s insightful commentary (Starcevic, 2012) continues this line of critical analysis. Starcevic highlights in particular that there is no clear consensus as to whether internet addiction ‘exists’, given the variability in terminology, methodology and psychometric measurement used across studies. Recent developments in regard to the DSM-5 have significant bearing on this debate. On 1 May 2012, the DSM-5 Task Force and Work Groups proposed that internet use disorder, which refers primarily to maladaptive video-gaming (or ‘internet gaming’) behaviour, should be included in Section III of the DSM-5 as the subject of further empirical inquiry. The proposed DSM-5 category of internet use disorder was intended to provide greater clarity to the clinical formulation of internet-related disorders. However, we argue that, in practice, this diagnostic category may promote further confusion with its conflation of video-gaming and internet use for other purposes. The lack of a standard definition for internet-related disorders has led to conflicting accounts of the underlying pathology and its symptoms, and how it should be diagnosed or measured (Griffiths, 2008; Weinstein and Lejoyeux, 2010; Wood, 2008). Thus, while many researchers in the field have called for consensus on the criteria for internet-related disorders, they have meanwhile created their own distinct model of the disorder, often with an accompanying assessment tool. By our count, over a dozen assessment tools for problematic video-gaming have been used in research studies since the year 2000. Starcevic provides an example of this divergence in assessment in citing research by his colleagues on ‘problem video game use’ (PVGU) (Porter et al., 2010). He notes that PVGU criteria differ from prevailing models of ‘excessive’ and ‘pathological’ videogaming. Specifically, the PVGU concept does not refer to tolerance (i.e., the process whereby increasing amounts of video-game play are required to achieve the former moodmodifying effects). Starcevic argues that it is not clear whether tolerance is associated with video-gaming behaviour, and states that the research evidence is ‘equivocal’. To our knowledge, at least three widely used instruments of pathological video-gaming assess tolerance (i.e., Problem Videogame Playing Scale (Salguero and Moran, 2002), Game Addiction Scale (Lemmens et al., 2009), Online Game Addiction Scale for Adolescents (Wan and Chiou, 2006)). Therefore, divergent evidence on tolerance in video-gaming may be a reflection of the fact that differing assessment tools have been used across studies, some of which measure tolerance and some of which do not, rather than representing a true division in empirical findings. This again highlights the difficulty in comparing research findings when different definitions are employed, and thus the need for a standardised approach to classification of internet-related disorders. Another important theoretical issue raised by Starcevic is that internet addiction is a misnomer because it refers to an addiction to a ‘delivery mechanism’. In particular, he states: