Network Structures of Internet Gaming Disorder and Gaming Disorder: Symptom Operationalization Causes Variation

Abstract

Background: From 2022, the ICD-11 includes the first mental disorder based on digital technology, “gaming disorder”, which was previously suggested as a condition for further study in the DSM-5 (2013). In this study, we provide the first large-scale network analysis of various symptom structures for these constructs to understand the complex interconnections between their proposed symptoms.Methods: Culturally diverse samples of 2,846 digital game players (M = 25.3 years) and 746 esports players (M = 23.5 years) were recruited. Network approach was applied to explore a multiverse of gaming disorder symptom structures, effects of item operationalization, and possible external moderators.Findings: Two symptoms (lack of control and continued use despite problems) present in both, the DSM-5 and ICD-11, were systematically central to most of the analyzed networks. Alternative operationalizations of single items systematically caused significant network differences. Networks were invariant across groups of play style, age, gender, gaming time, and most of the psychosocial characteristics.Interpretation: Our results caution practitioners and researchers when studying and interpreting gaming disorder symptoms. The data indicate that even minor item-level changes can lead to significant network-level changes, thus highlighting the need for careful operationalization. Considering this high sensitivity of the network structure, future clinical validation studies should not be strictly limited to the wordings, criteria, and symptoms of current diagnostic manuals.

Network analysis of additional clinical features of (Internet) gaming disorder

“…Two important findings warrant further discussion: (1) despite ontological discrepancies between ICD‐11 and DSM‐5, IGD and GD constructs exhibited similar behavior within the networks of additional clinical features; and (2) compared to multiple item measures, both single self‐assessment items demonstrated significantly weaker associations with the additional clinical features within the networks. Regardless of the underlying ontology or specific operationalization, both ICD‐11 and DSM‐5‐based GD demonstrated the strongest correlations with all the additional clinical features (i.e., functional impairment). Even though a recent network analysis study (Adamkovič et al., 2023) reports significant alterations in IGD/GD symptoms network structure caused by minor differences in the symptom‐level operationalizations, it appears that, when GD is treated as a single score (instead of a complex mutually interacting system) and contains the pivotal symptoms as stated in the ICD‐11 (i.e., loss of control, preoccupation, and continued use), the effect of specific symptom operationalization is likely negligible. When modeling four IGD/GD scales (GAS7, IGDT10, GDT, and THL1) within one network, Billieux and Fournier (2022) found a strong item‐level construct overlap between the scales.…”

“…However, the usage of screening measures based on different ontologies (including DSM‐5 and ICD‐11) may identify different groups of individuals (Ko et al., 2020a; Starcevic et al., 2020) with distinct psychological and health characteristics (Karhulahti et al., 2022). Moreover, within the same ontological definition, diverse ways of operationalizing the same symptoms can substantially affect the relationships between the symptoms (Adamkovič et al., 2023).…”

Network Analysis of Additional Clinical Features of (Internet) Gaming Disorder

“…When modeling four IGD/GD scales (GAS7, IGDT10, GDT, and THL1) within one network, Billieux and Fournier (2022) found a strong item-level construct overlap between the scales. This, however, does not eliminate the possibility that the scales could identify distinct populations (Ko et al, 2020a;Karhulahti et al, 2022;Karhulahti et al, 2023), potentially due to differing scoring methods (monothetic vs. polythetic cut-offs, different thresholds, etc.). The ICD-11 or DSM-5-based IGD/GD central role in the networks does not appear to be affected by the addition of the additional diagnostic features.…”

“…The DSM-5's description of IGD as a subject for further study with 9 core symptoms have resulted in the development of various screening scales with inconsistencies in symptom selection and operationalization Karhulahti et al, 2021). However, the usage of screening measures based on different ontologies (including DSM-5 and ICD-11) may identify different groups of individuals with distinct psychological and health characteristics (Karhulahti et al, 2022). Moreover, within the same ontological definition, diverse ways of operationalizing the same symptoms can substantially affect the relationships between the symptoms (Adamkovič et al, 2022).…”