1. Gaming disorder and ICD-11 beta
Jung-Seok Choi
Department of Psychiatry
Seoul National University
Boramae Medical Center
2016 Korean Academy of Addiction Psychiatry

2. Key features in ICD-11 beta
Introduction of a section with “Disorders due to substance use and addictive behaviors”
Conceptual integration of “Gambling disorders” with “Disorders due to substance use”
Impulse control disorders in ICD-10
Introduction of a new diagnostic category “Gaming disorder”
Gaming disorder, predominantly online
Gaming disorder, predominantly offline

3. Draft of ICD-11 Disorders due to substance use or addictive behaviors
alcohol
Nicotine…
Disorders due to addictive behaviors
Gambling Disorder
Gaming Disorder

4. DSM-5 in Section 3 (Conditions for Further study)
Internet Gaming Disorder (IGD)
Persistent and recurrent use of the Internet to engage in games, often with others players, leading to clinically significant impairment or distress as indicated by five (or more) of the following in a 12-month period.
Preoccupation with Internet games
Withdrawal symptoms
Tolerance
Unsuccessful attempts to control the participation in Internet games
Loss of interests in previous hobbies and entertainment as a result of, and with the exception of, Internet games
Continued excessive use of Internet games despite knowledge of psychosocial problems
Has deceived family members, therapists, or others regarding the amount of Internet gaming
Use of Internet games to escape or relieve a negative mood
Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of participation in Internet games

5. Definition in ICD-11 beta
Persistent or recurrent gaming behaviour (i.e., ‘digital gaming’ or ‘video-gaming’)
characterised by
impaired control over gaming,
increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities
continuation of gaming despite the occurrence of negative consequences.
The behaviour pattern is of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
Normally evident over a period of at least 12 months in order for a diagnosis to be assigned, although the required duration may be shortened if all diagnostic requirements are met and symptoms are severe.

6. Definition in ICD-11 beta Non-essential Features
Impaired control over gaming
Withdrawal symptoms
Priority in life
Health consequences
Continuation despite problems
Tolerance

7. DSM-5 vs. ICD-11 DSM-5 ICD-11 Preoccupation Withdrawal Tolerance
Criteria
Preoccupation
Withdrawal
Tolerance
Loss of control
Loss of interest
Continued excessive use
Deceived family members
To escape or relieve a negative mood
Lost a significant relationship, job, or educational or career opportunity
(-)
Impaired control
Priority to game than other daily activities
Continuation of game
Significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

8. WHO meetings on behavioral disorders association with excessive use of Internet
On public health implications of excessive use of Internet, smartphone, or similar electronic devices
Tokyo, Japan, Aug 2014
On clinical description, diagnostic guidelines and priorities for international research
Seoul, Korea, Aug 2015
On policy and program response
Hong Kong, Sep 2016

9. 2016 WHO meeting in Hong Kong

10. Neurobiological evidences
Key features in gaming disorder of ICD-11 beta
Impaired control over gaming
Associated with domains as follows:
Impaired response inhibition
Craving, urge, or cue reactivity
Reward sensitivity
Impaired decision making

11. Impulsivity and response inhibition1
Impulsivity and response inhibition
Personality Domain
Higher impulsiveness measured by Barratt Impulsiveness Scale in Internet gaming disorder
Similar features with gambling disorder or alcohol use disorder
Lee and Choi, et al., 2012
Choi, et al., 2014

12. Impulsivity and response inhibition1
Impulsivity and response inhibition
Neurocognitive Domain
Decreased response inhibition ability in Internet gaming disorder measured by Stop signal task
Choi, et al., 2013
Choi, et al., 2014

13. Impulsivity and response inhibition1
Impulsivity and response inhibition
Neuroimaging Domain
Association between local connectivity in the inferior temporal cortex and impulsiveness in Internet gaming disorder
Kim and Choi, et al., 2015

14. Impulsivity and response inhibition1
Impulsivity and response inhibition
Neuroimaging Domain
Association between frontolimbic activity and aggressive stimuli in Internet gaming disorder
Chun and Kim, et al., 2015
Translational Psychiatry (IF=5.538)

15. Impulsivity and response inhibition1
Impulsivity and response inhibition
Neurophysiological Domain
Resting-state beta power decrease associated with impulsivity in Internet gaming disorder
ERP maker changes associated with attention and response inhibition in Internet gaming disorder
Son and Choi, et al., 2015
Park and Choi, et al., 2016
Translational Psychiatry (IF=5.538)

16. Impulsivity and response inhibition1
Impulsivity and response inhibition
Neurophysiological Domain
Delayed NoGo N2 latency and its relationship with severity of IGD and impulsivity in IGD
Kim and Choi, et al.
Under revision in
Scientific Reports (IF=5.228)

17. Craving and Cue reactivity2
Neurophysiological Domain
Increased amplitude of P300 responsive to game-related cues in IGD
Kim and Choi, et al.
Unpublished data

18. Reward Sensitivity Brain Development 3
developments of striatal regions are more active in adolescents rather than frontal regions
Casey and Jones, 2010

19. Reward Sensitivity Neuroimaging Domain PET study 3
Decreased dopamine receptor binding ability in IGD
Kim et al., 2011

20. Reward Sensitivity Neuroimaging Domain PET study 3 Adult Adolescent
Left VC
Right VC
increased FC in frontal and limbic regions
related with reward network
increased FC in sensory regions
related with sensory-motor system
Neuroimaging
Domain
PET study
Increased functional connectivity between the ventral striatum and frontal regions in adolescents with IGD
Kim and Choi, et al.,
Unpublished data

21. Summary
New candidate diagnostic category of Gaming Disorder in the ICD-11 beta
Key features of clinical descriptions such as impaired control, priority in life and continuation despite the problems
Increasing evidences on the neurobiological basis
More extensive field testings to evaluate the validity, reliability and clinical utility of the diagnostic criteria of Gaming Disorder are warranted
2016 Korean Academy of Addiction Psychiatry

22. Jung-Seok Choi, M.D., Ph.D. choijs73@gmail.com
2016 Korean Academy of Addiction Psychiatry