Clinical Characteristics of Diagnosis for Internet Gaming Disorder: Comparison of DSM-5 IGD and ICD-11 GD Diagnosis

Abstract

The American Psychiatric Association (APA) included internet game disorder (IGD) in section III of the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) on the condition that it guaranteed more clinical research and experience. The World Health Organization (WHO) also included Game Disorder (GD) in the 11th final revision of the International Classification of Diseases (ICD-11) and recently recognized it as a diagnosis code. This study aims to compare clinical characteristics and gaming behavior patterns between the IGD diagnosis criteria proposed by the DSM-5 and the GD diagnosis criteria proposed by the ICD-11 based on clinical cohort data (c-CURE: clinic-Cohort for Understanding of internet addiction Rescue factors in Early life) obtained in the Republic of Korea. Psychologists and psychiatrists conducted semi-structured interviews with children/adolescents and their caregivers to identify IGD (Diagnostic Interview for Internet, Game, SNS, etc. Addiction, DIA), and comorbid psychiatric disorders (Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean version, K-SADS-PL). The cohort was divided into three IGD diagnosis groups (Normal, DSM5, DSM5 + ICD11) based on DSM-5 and ICD-11 diagnosis criteria. Internet usage pattern and addiction characteristics and psychiatric comorbidities were compared among the three IGD diagnosis groups. The Normal group consisted of 115 subjects, the DSM5 group contained 61 subjects, and the DSM5 + ICD11 group amounted to 12 subjects. The DSM5 + ICD11 group had a lower age of starting use of Internet/games/smartphones than other groups and the average time of Internet/game/smartphone use during weekdays/weekends was the highest. Also, in the eight items scored, excluding ‘deceiving’ and ‘craving’, the rate of threshold was highest in the DSM5 + ICD11 group, followed by the DSM5 group and the Normal group. On the other hand, ‘deceiving’ and ‘craving’ were the highest in DSM5, followed by DSM5 + ICD11 and Normal. The DSM5 + ICD11 group had significantly higher rates of depressive disorder, oppositional defiant disorder (ODD) and conduct disorder (CD) compared to other groups. This study provides implications for the clinical characteristics of IGD diagnosis in the field by comparing the DSM-5 IGD diagnosis criteria with the ICD-11 GD diagnosis criteria. Furthermore, this study provides empirical evidence that ICD-11 GD emphasizes serious symptoms such as functional impairment caused by excessive Internet/game/smartphone use over a long time, and it supports the validity of the ICD-11 GD diagnosis.