Skip to main content

Advertisement

SpringerLink
Log in

Primary Versus Secondary Disorder in the Context of Internet Gaming Disorder

  • Technology Addiction (J Billieux, Section Editor)
  • Published:
Current Addiction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

We consider the evidence for Internet gaming disorder as a primary or a secondary disorder.

Recent Findings

Findings in this area are mixed. Although it is generally acknowledged that IGD is frequently comorbid with other disorders, there is a disagreement as to whether IGD does or does not appear as a primary disease.

Summary

The question of IGD as a primary or secondary disorder is founded on a presumption of dichotomy. To declare it as belonging in one category or another implies a presumption that it cannot be both. The literature does not place it clearly in either position. IGD is likely best conceptualized as a disorder that can be comorbid or multimorbid, similar to many other mental health disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. Although somewhat peripheral to the discussion here, it is worth mentioning that the symptom of escapism/mood reduction has been the topic of serious debate (c.f., Kardefeldt-Winther et al. [10]; Billieux et al. [11]).

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Lehenbauer-Baum M, Klaps A, Kovacovsky Z, Witzmann K, Zahlbruckner R, Stetina BU. Addiction and engagement: an explorative study toward classification criteria for internet gaming disorder. Cyberpsychol Behav Soc Netw. 2015;18(6):343–9. https://doi.org/10.1089/cyber.2015.0063.

    Article  PubMed  Google Scholar 

  2. Petry NM, Rehbein F, Ko CH, O’Brien CP. Internet gaming disorder in the DSM-5. Curr Psychiatry Rep. 2015;17(9):72. https://doi.org/10.1007/s11920-015-0610-0.

    Article  PubMed  Google Scholar 

  3. Yao YW, Wang LJ, Yip SW, Chen PR, Li S, Xu J, et al. Impaired decision-making under risk is associated with gaming-specific inhibition deficits among college students with Internet gaming disorder. Psychiatry Res. 2015;229(1):302–9. https://doi.org/10.1016/j.psychres.2015.07.004.

    Article  PubMed  Google Scholar 

  4. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013 May 22.

  5. Pontes HM, Griffiths MD. Internet addiction disorder and internet gaming disorder are not the same. J Addict Res Ther. 2014;5(4)

  6. Winokur G, Coryell W, Akiskal HS, Maser JD. Alcoholism in manic-depressive (bipolar) illness: familial illness, course of illness, and the primary-secondary distinction. Am J Psychiatry. 1995;152(3):365–72.

    Article  CAS  Google Scholar 

  7. Brown TA, Campbell LA, Lehman CL, Grisham JR, Mancill RB. Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. J Abnorm Psychol. 2001;110(4):585–99. https://doi.org/10.1037/0021-843X.110.4.585.

    Article  CAS  PubMed  Google Scholar 

  8. Widiger TA, Samuel DB. Diagnostic categories or dimensions? A question for the diagnostic and statistical manual of mental disorders--. J Abnorm Psychol 2005;114(4):494. doi:https://doi.org/10.1037/0021-843X.114.4.494, 504.

  9. Petry NM, Rehbein F, Gentile DA, Lemmens JS, Rumpf HJ, Mößle T, et al. An international consensus for assessing internet gaming disorder using the new DSM-5 approach. Addiction. 2014;109(9):1399–406. https://doi.org/10.1111/add.12457.

    Article  PubMed  Google Scholar 

  10. Kardefelt-Winther D, Heeren A, Schimmenti A, Rooij A, Maurage P, Carras M, et al. How can we conceptualize behavioural addiction without pathologizing common behaviours? Addiction. 2017;112(10):1709–15. https://doi.org/10.1111/add.13763.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Billieux J, King DL, Higuchi S, Achab S, Bowden-Jones H, Hao W, et al. Functional impairment matters in the screening and diagnosis of gaming disorder: Commentary on: scholars’ open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal (Aarseth et al.). J Behav Addict. 2017;6(3):285–9. https://doi.org/10.1556/2006.6.2017.036.

    Article  PubMed  PubMed Central  Google Scholar 

  12. •• Gentile DA, Choo H, Liau A, Sim T, Li D, Fung D, et al. Pathological video game use among youths: a two-year longitudinal study. Pediatrics. 2011;127(2):e319–29. This paper is one of the most important longitudinal studies of IGD providing information on risk factors, how long pathological gaming lasts, the outcomes, and whether it is primary or comorbid.

    Article  Google Scholar 

  13. Brand M, Young KS, Laier C, Wölfling K, Potenza MN. Integrating psychological and neurobiological considerations regarding the development and maintenance of specific internet-use disorders: an Interaction of Person-Affect-Cognition-Execution (I-PACE) model. Neurosci Biobehav Rev. 2016;71:252–66. https://doi.org/10.1016/j.neubiorev.2016.08.033.

    Article  PubMed  Google Scholar 

  14. Przybylski AK, Weinstein N, Ryan RM, Rigby CS. Having to versus wanting to play: background and consequences of harmonious versus obsessive engagement in video games. Cyberpsychol Behav. 2009;12(5):485–92. https://doi.org/10.1089/cpb.2009.0083.

    Article  PubMed  Google Scholar 

  15. • Allen JJ, Anderson CA. Satisfaction and frustration of basic psychological needs in the real world and in video games predict internet gaming disorder scores and well-being. Comput Hum Behav. 2018;84:220–9. This study found that people who are unable to meet their needs online or offline have higher IGD scores than those that can meet their needs in either place. https://doi.org/10.1016/j.chb.2018.02.034.

    Article  Google Scholar 

  16. Choo H, Sim T, Liau AK, Gentile DA, Khoo A. Parental influences on pathological symptoms of video-gaming among children and adolescents: a prospective study. J Child Fam Stud. 2015;24(5):1429–41. https://doi.org/10.1007/s10826-014-9949-9.

    Article  Google Scholar 

  17. Wu A, Lei LL, Ku L. Psychological needs, purpose in life, and problem video game playing among Chinese young adults. Int J Psychol. 2013;48(4):583–90. https://doi.org/10.1080/00207594.2012.658057.

    Article  PubMed  Google Scholar 

  18. Hughes CM. Three measures of coping in video games (CIV-III): the development, construct validation, and profile analysis of the CIV-III. Richmond: Virginia Commonwealth University; 2018.

    Google Scholar 

  19. Gervasi AM, La Marca L, Costanzo A, Pace U, Guglielmucci F, Schimmenti A. Personality and Internet gaming disorder: a systematic review of recent literature. Curr Addict Reports. 2017;4(3):293–307. https://doi.org/10.1007/s40429-017-0159-6.

    Article  Google Scholar 

  20. Kuss DJ, Griffiths MD. Internet gaming addiction: a systematic review of empirical research. Int J Ment Heal Addict. 2012;10(2):278–96. https://doi.org/10.1007/s11469-011-9318-5.

    Article  Google Scholar 

  21. Kardefelt-Winther D. Conceptualizing Internet use disorders: addiction or coping process? Psychiatry Clin Neurosci. 2017;71(7):459–66. https://doi.org/10.1111/pcn.12413.

    Article  PubMed  Google Scholar 

  22. Hussain Z, Griffiths MD. Excessive use of massively multi-player online role-playing games: a pilot study. Int J Ment Heal Addict. 2009;7(4):563–71. https://doi.org/10.1007/s11469-009-9202-8.

    Article  Google Scholar 

  23. Griffiths MD, Van Rooij AJ, Kardefelt-Winther D, Starcevic V, Király O, Pallesen S, et al. Working towards an international consensus on criteria for assessing internet gaming disorder: a critical commentary on Petry et al. (2014). Addiction. 2016;111(1):167. https://doi.org/10.1111/add.13057.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bowditch L, Chapman J, Naweed A. Do coping strategies moderate the relationship between escapism and negative gaming outcomes in World of Warcraft (MMORPG) players? Comput Hum Behav. 2018;86:69–76. https://doi.org/10.1016/j.chb.2018.04.030.

    Article  Google Scholar 

  25. Aboujaoude E, Koran LM, Gamel N, Large MD, Serpe RT. Potential markers for problematic internet use: a telephone survey of 2,513 adults. CNS Spectr. 2006;11(10):750–5. https://doi.org/10.1017/S1092852900014875.

    Article  PubMed  Google Scholar 

  26. Durkee T, Kaess M, Carli V, Parzer P, Wasserman C, Floderus B, et al. Prevalence of pathological internet use among adolescents in Europe: demographic and social factors. Addiction. 2012;107(12):2210–22. https://doi.org/10.1111/j.1360-0443.2012.03946.x.

    Article  PubMed  Google Scholar 

  27. Müller KW, Glaesmer H, Brähler E, Woelfling K, Beutel ME. Prevalence of internet addiction in the general population: results from a German population-based survey. Behav Inform Technol. 2014;33(7):757–66. https://doi.org/10.1080/0144929X.2013.810778.

    Article  Google Scholar 

  28. Müller KW, Janikian M, Dreier M, Wölfling K, Beutel ME, Tzavara C, et al. Regular gaming behavior and internet gaming disorder in European adolescents: results from a cross-national representative survey of prevalence, predictors, and psychopathological correlates. Eur Child Adolesc Psychiatry. 2015;24(5):565–74. https://doi.org/10.1007/s00787-014-0611-2.

    Article  PubMed  Google Scholar 

  29. Rumpf HJ, Meyer C, Kreuzer A, John U. Prevalence of internet addictive behavior (PINTA). Final report for the German Federal Ministry of Health. Lübeck: University of Lübeck, Klinik für Psychiatrie und Psychotherapie; 2011.

    Google Scholar 

  30. Young KS, Rogers RC. The relationship between depression and Internet addiction. Cyberpsychol Behav. 1998;1(1):25–8. https://doi.org/10.1089/cpb.1998.1.25.

    Article  Google Scholar 

  31. Bahrainian SA, Alizadeh KH, Raeisoon MR, Gorji OH, Khazaee A. Relationship of internet addiction with self-esteem and depression in university students. J Prev Med Hyg. 2014;55(3):86–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  32. • Dieris-Hirche J, Bottel L, Bielefeld M, Steinbüchel T, Kehyayan A, Dieris B, et al. Media use and Internet addiction in adult depression: a case-control study. Comput Hum Behav. 2017;68:96–103. This paper indicates that the co-occurrence of depression and IGD is higher than in healthy patients and should be considered when conducting psychiatric treatment. https://doi.org/10.1016/j.chb.2016.11.016.

    Article  Google Scholar 

  33. Jang KS, Hwang SY, Choi JY. Internet addiction and psychiatric symptoms among Korean adolescents. J Sch Health. 2008;78(3):165–71. https://doi.org/10.1111/j.1746-1561.2007.00279.x.

    Article  PubMed  Google Scholar 

  34. Shapira NA, Goldsmith TD, Keck PE, Khosla UM, McElroy SL. Psychiatric features of individuals with problematic internet use. J Affect Disord. 2000;57(1):267–72. https://doi.org/10.1016/S0165-0327(99)00107-X.

    Article  CAS  PubMed  Google Scholar 

  35. Ha JH, Yoo HJ, Cho IH, Chin B, Shin D, Kim JH. Psychiatric comorbidity assessed in Korean children and adolescents who screen positive for Internet addiction. J Clin Psychiatry. 2006;67(5):821–6. https://doi.org/10.4088/JCP.v67n0517.

    Article  PubMed  Google Scholar 

  36. Ryan RM, Deci EL. Intrinsic and extrinsic motivations: classic definitions and new directions. Contemp Educ Psychol. 2000;25(1):54–67. https://doi.org/10.1006/ceps.1999.1020.

    Article  CAS  PubMed  Google Scholar 

  37. • Loton D, Borkoles E, Lubman D, Polman R. Video game addiction, engagement and symptoms of stress, depression and anxiety: the mediating role of coping. Int J Ment Heal Addict. 2016;14(4):565–78. This paper is one of the first to examine the mediating variables between IGD and poor mental health. https://doi.org/10.1007/s11469-015-9578-6.

    Article  Google Scholar 

  38. Allison SE, von Wahlde L, Shockley T, Gabbard GO. The development of the self in the era of the internet and role-playing fantasy games. Am J Psychiatr. 2006;163(3):381–5. https://doi.org/10.1176/appi.ajp.163.3.381.

    Article  PubMed  Google Scholar 

  39. Beranuy M, Carbonell X, Griffiths MD. A qualitative analysis of online gaming addicts in treatment. Int J Ment Heal Addict. 2013;11(2):149–61. https://doi.org/10.1007/s11469-012-9405-2.

    Article  Google Scholar 

  40. Wan CS, Chiou WB. Psychological motives and online games addiction: a test of flow theory and humanistic needs theory for Taiwanese adolescents. Cyberpsychol Behav. 2006;9(3):317–24. https://doi.org/10.1089/cpb.2006.9.317.

    Article  PubMed  Google Scholar 

  41. Wood RT, Griffiths MD, Parke A. Experiences of time loss among videogame players: an empirical study. Cyberpsychol Behav. 2007;10(1):38–44. https://doi.org/10.1089/cpb.2006.9994.

    Article  PubMed  Google Scholar 

  42. Li H, Wang J, Wang L. A survey on the generalized problematic Internet use in Chinese college students and its relations to stressful life events and coping style. Int J Ment Heal Addict. 2009;7(2):333–46. https://doi.org/10.1007/s11469-008-9162-4.

    Article  Google Scholar 

  43. Hetzel-Riggin MD, Pritchard JR. Predicting problematic Internet use in men and women: the contributions of psychological distress, coping style, and body esteem. Cyberpsychol Behav Soc Netw. 2011;14(9):519–25. https://doi.org/10.1089/cyber.2010.0314.

    Article  PubMed  Google Scholar 

  44. Plante CN, Gentile DA, Groves CL, Modlin A, Blanco-Herrera J. Video games as coping mechanisms in the etiology of video game addiction. Psychology of Popular Media Culture. 2018; https://doi.org/10.1037/ppm0000186.

  45. Gentile, D. A., Verheijen, G. P., Plante, C. N. (in preparation). Video games as coping mechanisms in the etiology of gaming disorder: a two-year longitudinal study.

  46. Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: implications for understanding health and health services. Ann Fam Med. 2009;7(4):357–63. https://doi.org/10.1370/afm.983.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Van den Akker M, Buntinx F, Metsemakers JF, Roos S, Knottnerus JA. Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. J Clin Epidemiol. 1998;51(5):367–75. https://doi.org/10.1016/S0895-4356(97)00306-5.

    Article  PubMed  Google Scholar 

  48. Pearcy BT, McEvoy PM, Roberts LD. Internet gaming disorder explains unique variance in psychological distress and disability after controlling for comorbid depression, OCD, ADHD, and anxiety. Cyberpsychol Behav Soc Netw. 2017;20(2):126–32. https://doi.org/10.1089/cyber.2016.0304.

    Article  PubMed  Google Scholar 

  49. Bernardi S, Pallanti S. Internet addiction: a descriptive clinical study focusing on comorbidities and dissociative symptoms. Compr Psychiatry. 2009;50(6):510–6. https://doi.org/10.1016/j.comppsych.2008.11.011.

    Article  PubMed  Google Scholar 

  50. Yen JY, Ko CH, Yen CF, Chen SH, Chung WL, Chen CC. Psychiatric symptoms in adolescents with Internet addiction: comparison with substance use. Psychiatry Clin Neurosci. 2008;62(1):9–16. https://doi.org/10.1111/j.1440-1819.2007.01770.x.

    Article  PubMed  Google Scholar 

  51. • González-Bueso V, Santamaría JJ, Fernández D, Merino L, Montero E, Ribas J. Association between internet gaming disorder or pathological video-game use and comorbid psychopathology: a comprehensive review. Int J Environ Res Public Health. 2018;15(4):668. This paper is the most recent systematic review on IGD and its comorbid psychopathology. https://doi.org/10.3390/ijerph15040668.

    Article  PubMed Central  Google Scholar 

  52. Ryu H, Lee JY, Choi A, Park S, Kim DJ, Choi JS. The relationship between impulsivity and internet gaming disorder in young adults: mediating effects of interpersonal relationships and depression. Int J Environ Res Public Health. 2018;15(3):458. https://doi.org/10.3390/ijerph15030458.

    Article  PubMed Central  Google Scholar 

  53. Schiebener J, Brand M. Decision-making and related processes in Internet gaming disorder and other types of Internet-use disorders. Curr Addict Rep. 2017;4(3):262–71. https://doi.org/10.1007/s40429-017-0156-9.

    Article  Google Scholar 

  54. Marino C, Spada MM. Dysfunctional cognitions in online gaming and Internet gaming disorder: a narrative review and new classification. Curr Addict Rep. 2017;4(3):308–16. https://doi.org/10.1007/s40429-017-0160-0.

    Article  Google Scholar 

  55. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617–27. https://doi.org/10.1001/archpsyc.62.6.617.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Hall W, Farrell M. Comorbidity of mental disorders with substance misuse. Br J Psychiatry. 1997;171(1):4–5. https://doi.org/10.1192/bjp.171.1.4.

    Article  CAS  PubMed  Google Scholar 

  57. Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, et al. Comorbidity of mental disorders with alcohol and other drug abuse. JAMA. 1990;264(19):2511–8. https://doi.org/10.1001/jama.1990.03450190043026.

    Article  CAS  PubMed  Google Scholar 

  58. Müller KW, Wölfling K. Both sides of the story: addiction is not a pastime activity. J Behav Addict. 2017;6(2):118–20. https://doi.org/10.1556/2006.6.2017.038.

    Article  PubMed  PubMed Central  Google Scholar 

  59. World Health Organization. (2017, Jan 21 2018). 6C71 Gaming disorder. Retrieved from https://icd.who.int/dev11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1448597234.

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, Iowa State University, W112 Lagomarcino Hall, 901 Stange Road, Ames, IA, 50010-1041, USA

    Jeffrey N. Rokkum & Douglas A. Gentile

Authors
  1. Jeffrey N. Rokkum
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Douglas A. Gentile
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Douglas A. Gentile.

Ethics declarations

Conflict of Interest

The authors declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Technology Addiction

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rokkum, J.N., Gentile, D.A. Primary Versus Secondary Disorder in the Context of Internet Gaming Disorder. Curr Addict Rep 5, 485–490 (2018). https://doi.org/10.1007/s40429-018-0222-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40429-018-0222-y

Keywords

Search

Navigation