Daniel Kardefelt-Winther

A conceptual and methodological critique of internet addiction research: Towards a model of compensatory internet use

Internet addiction is a rapidly growing field of research, receiving attention from researchers, journalists and policy makers. Despite much empirical data being collected and analyzed clear results and conclusions are surprisingly absent. This paper argues that conceptual issues and methodological shortcomings surrounding internet addiction research have made theoretical development difficult. An alternative model termed compensatory internet use is presented in an attempt to properly theorize the frequent assumption that people go online to escape real life issues or alleviate dysphoric moods and that this sometimes leads to negative outcomes. An empirical approach to studying compensatory internet use is suggested by combining the psychological literature on internet addiction with research on motivations for internet use. The theoretical argument is that by understanding how motivations mediate the relationship between psychosocial well-being and internet addiction, we can draw conclusions about how online activities may compensate for psychosocial problems. This could help explain why some people keep spending so much time online despite experiencing negative outcomes. There is also a methodological argument suggesting that in order to accomplish this, research needs to move away from a focus on direct effects models and consider mediation and interaction effects between psychosocial well-being and motivations in the context of internet addiction. This is key to further exploring the notion of internet use as a coping strategy; a proposition often mentioned but rarely investigated.

How can we conceptualize behavioural addiction without pathologizing common behaviours

Following the recent changes to the diagnostic category for addictive disorders in DSM-5, it is urgent to clarify what constitutes behavioural addiction to have a clear direction for future research and classification. However, in the years following the release of DSM-5, an expanding body of research has increasingly classified engagement in a wide range of common behaviours and leisure activities as possible behavioural addiction. If this expansion does not end, both the relevance and the credibility of the field of addictive disorders might be questioned, which may prompt a dismissive appraisal of the new DSM-5 subcategory for behavioural addiction. We propose an operational definition of behavioural addiction together with a number of exclusion criteria, to avoid pathologizing common behaviours and provide a common ground for further research. The definition and its exclusion criteria are clarified and justified by illustrating how these address a number of theoretical and methodological shortcomings that result from existing conceptualizations. We invite other researchers to extend our definition under an Open Science Foundation framework.

Problematizing excessive online gaming and its psychological predictors

This study problematizes the common methodology in studies on excessive internet use where psychological characteristics are sought as unique predictors of negative outcomes. It suggests that some predictors may be significant only by virtue of being examined in isolation. In an attempt to add to this methodology the present study explored motivations for a particular online activity, MMO gaming, and the association with excessive use. The study used survey data from players of World of Warcraft (WoW), a popular MMO game. The psychological characteristics investigated were based on previous studies of excessive internet use and included social anxiety, loneliness and stress. The motivations were achievement, escapism and social interaction. The results revealed that although loneliness and social anxiety were correlated with excessive use, they lost significance when stress was controlled for. Furthermore, all psychological predictors lost significance when escapism and achievement were controlled for. These results suggest that psychological characteristics only have an indirect effect on negative outcomes and that this relationship can be better explained by motivations acting as a mediating variable. Based on these results an alternative conceptualization was offered, termed compensatory internet use, emphasizing that excessive use may be more usefully framed and investigated as a coping strategy rather than compulsive behaviour.

A critical account of DSM-5 criteria for internet gaming disorder

Abstract The inclusion of assessment criteria for internet gaming disorder in the DSM-5 appendix means that research in this area is likely to increase. However, a standardized assessment instrument is contingent on identifying criteria that adequately captures the phenomenon. I argue in this article that issues with the proposed criteria are consistently overlooked. First, there has been a tendency to adhere to DSM-4 criteria for substance use disorders or pathological gambling when defining the assessment criteria, rather than aiming to capture the unique determinants of internet gaming disorder. Furthermore, a diagnostic instrument for gaming in particular needs to account for cultural and social divides that are a non-issue when assessing substance use. Finally, some of the proposed criteria make little sense within the context of gaming and seem to be included as residuals from existing disorders. In this article, I discuss critically each proposed criterion. I conclude that deception is socially or culturally subjective and depends on people close to the player, rather than the player himself. Symptoms like preoccupation, withdrawal, tolerance and a loss of interest in other activities may all be preceded by legitimate explanations for excessive use following widespread popularity of online gaming, which makes them unreliable in an assessment instrument. Finally, I argue that tolerance does not make sense within a gaming context and is a residual criterion from substance use disorders. A reappraisal of these criteria would benefit the development of a standardized assessment instrument for internet gaming disorder.

The moderating role of psychosocial well-being on the relationship between escapism and excessive online gaming

The purpose of this study was to empirically test the proposed theory of compensatory internet use, suggesting that people who play online games excessively are motivated to do so because they need to cope with psychosocial problems (Kardefelt-Winther, 2014a; Kardefelt-Winther, 2014b). The study used survey data from players of World of Warcraft (WoW), a popular MMO game. The indicators of psychosocial problems were high stress and low self-esteem and the motivation was escapism. The empirical analysis investigated interaction effects between indicators of psychosocial well-being and motivations. It was hypothesized that the relationship between escapism and negative outcomes would be positive for individuals with high stress or low self-esteem, which would be indicative of escapist online gaming as a coping strategy. However, this was only expected for individuals who experience more negative outcomes from their online gaming, which would highlight an important difference between those who experience many problems and those who experience few. The results showed that both stress and self-esteem moderated the relationship between escapism and negative outcomes as expected. In both cases, the relationship between escapism and negative outcomes was positive in the presence of more psychosocial problems (i.e. high stress or low self-esteem) for those who experience many negative outcomes, but not for those who experience few. The results support the theory of compensatory internet use and suggest that excessive online gaming may be a coping strategy for life problems rather than a mental disorder as proposed in DSM-V.

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.

Meeting the unique challenges of assessing internet gaming disorder

appears to impact youth and young adults to a large extent [6,7], while the vast majority of individuals who seek treatment for gambling are middle-aged or older [3,4]. King & Delfabbro [1] note that a potential differentiation between gambling and gaming relates to skill. Although we agree that one’s success in the outcomes of video games is usually more skill-dependent than in many forms of gambling, the nature of a disorder, and consideration regarding its treatment, generally does not depend upon one’s skills, be they perceived or real. Will focusing upon skill be useful in treating gaming? We are not sure. However, we completely agree that a cognitive intervention adapted from gambling treatment that addresses erroneous beliefs related to randomness, chance and probabilities will not be a primary therapeutic approach for reducing gaming. Just as preoccupation is only one potential aspect of internet gaming disorder, it is only one aspect of other addictions, and psychiatric disorders more generally. Overall functioning is considered in diagnoses, and although irrational beliefs can exist in the context of disordered gambling, these beliefs are not a criterion for that disorder. Diagnostic criteria do not need to cover all mechanisms of a disorder, nor all relevant elements of treatment; instead, their intent is to distinguish reliably and validly between individuals with and without a disorder. Expressions of psychiatric disorders, and their specific symptoms, also vary across cultures and individuals. The goal of psychiatric diagnosis is to transcend some of the inherent individual differences, while classifying clinically problematic expressions. As the field of addictions moves forward, it will be imperative to evaluate empirically similarities and differences across these conditions and their treatment.

A weak scientific basis for gaming disorder: Let us err on the side of caution

We greatly appreciate the care and thought that is evident in the 10 commentaries that discuss our debate paper, the majority of which argued in favor of a formalized ICD-11 gaming disorder. We agree that there are some people whose play of video games is related to life problems. We believe that understanding this population and the nature and severity of the problems they experience should be a focus area for future research. However, moving from research construct to formal disorder requires a much stronger evidence base than we currently have. The burden of evidence and the clinical utility should be extremely high, because there is a genuine risk of abuse of diagnoses. We provide suggestions about the level of evidence that might be required: transparent and preregistered studies, a better demarcation of the subject area that includes a rationale for focusing on gaming particularly versus a more general behavioral addictions concept, the exploration of non-addiction approaches, and the unbiased exploration of clinical approaches that treat potentially underlying issues, such as depressive mood or social anxiety first. We acknowledge there could be benefits to formalizing gaming disorder, many of which were highlighted by colleagues in their commentaries, but we think they do not yet outweigh the wider societal and public health risks involved. Given the gravity of diagnostic classification and its wider societal impact, we urge our colleagues at the WHO to err on the side of caution for now and postpone the formalization.

Conceptualizing Internet use disorders: Addiction or coping process?

This paper problematizes the tendency to study Internet use disorders from a perspective of addiction. It is argued that an addiction perspective, grounded in our understanding of substance use disorders, has not contributed much to an improved understanding of the antecedents and etiology of Internet use disorders. Despite this, researchers continue to frame Internet use disorders as an addiction, recently exemplified by the inclusion of Internet gaming disorder in the DSM‐5 research appendix as a behavioral addiction. This paper claims that the decision to use an addiction framework to study Internet use disorders has consequences for the way in which results are interpreted, which impacts the potential for theoretical and etiological contributions negatively. The paper argues that a perspective of addiction may not be the most useful approach because it causes a mismatch between theory and findings in empirical work: it is not uncommon to find that a study is positioned as a study of addiction, but presents findings more illustrative of coping behaviors. The paper draws on two examples from the literature to illustrate this mismatch and discusses how this hinders theoretical and etiological development. The question that is asked going forward is what alternative explanations we might identify by not exclusively adhering to an addiction framework for purposes of research. Recommendations are given for how to usefully approach the study of Internet use disorders outside a framework of addiction. It also discusses how scholars who still prefer a framework of addiction might strengthen their conceptual position to ensure improved contributions to etiology and theoretical development.

Behavioural Addiction Open Definition 2.0-using the Open Science Framework for collaborative and transparent theoretical development : Commentaries

Behavioural Addiction Open Definition 2.0—using the Open Science Framework for collaborative and transparent theoretical development