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Dissociation in Problematic Gaming: a Systematic Review
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DOI:10.1007/s40429-019-0237-z
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Dissociation in problematic gaming: A systematic review
Fanny Guglielmucci 1, Massimiliano Monti 1, Isabella G. Franzoi 1, Gianluca Santoro 2,
Antonella Granieri 1, Joel Billieux 3, Adriano Schimmenti 2
1 Department of Psychology, University of Turin, Italy
2 Faculty of Human and Social Sciences, UKE - Kore University of Enna, Italy
3 Addictive and Compulsive Behaviours Lab. Institute for Health and Behaviour. University
of Luxembourg, Esch-sur-Alzette, Luxembourg
Correspondence concerning this article should be addressed to Dr. Fanny
Guglielmucci, Department of Psychology, University of Turin, via Po 14, 10123 Turin, Italy
(e-mail: fanny.guglielmucci@unito.it); or to Prof. Adriano Schimmenti, Faculty of Human
and Social Sciences, UKE - Kore University of Enna, Cittadella Universitaria 94100, R6,
Abstract
Purpose of Review. The present article consists of a systematic review of recent (2007–
2018) empirical studies addressing the relationship between problematic gaming and dissociation. Nineteen peer-reviewed empirical studies that examined the relationship between problematic gaming and dissociation were identified.
Recent Findings. The findings suggest that excessive video game use is linked to a
variety of dissociative phenomena (e.g. depersonalisation experiences, escapism, psychotic-like experiences, game transfer phenomena).
Summary. Dissociative experiences are associated with problematic gaming. The
findings support the hypothesis that problematic video game use can represent a maladaptive coping strategy on which people can rely to escape from disturbing mental states, adverse emotions or real-life problems. In these circumstances, dissociative symptoms might represent the side effects of an alteration in consciousness that is generated by excessive video game use. However, further research (especially experimental and longitudinal) is required in order to establish a potential causal link between problematic gaming patterns and dissociation.
Keywords: problematic gaming, gaming disorder, dissociation, depersonalisation, escapism, psychotic-like experiences, game transfer phenomena
Dissociation in problematic gaming: A systematic review
Introduction
Literature findings point out that the numerous services and applications provided by
the Internet may have addictive properties that could negatively influence individual
well-being [1–5]. In particular, problematic gaming has become a topic of public attention for its
potentially negative impact on health, which led to the inclusion of Internet Gaming Disorder
(IGD) in Section III (conditions for further studies) of the Diagnostic and Statistical Manual
of Mental Disorders, Fifth Edition (DSM-5) [6]. The criteria for this proposed diagnosis
include: (1) preoccupation or obsession with Internet games; (2) withdrawal symptoms when
not playing Internet games; (3) an increased need for time spent playing; (4) failed attempts
to stop playing; (5) a loss of interest in other life activities; (6) continued overuse despite the negative impact on the individual’s life ; (7) lies about Internet usage; (8) use of gaming as a way to relieve anxiety, guilt or to escape problems; (9) lost opportunities or relationships
because of Internet games.
In the last few years, despite the increasing use of DSM-5 IGD criteria (e.g. in the
framework of epidemiological studies), the validity and clinical relevance of this diagnosis
has been criticised [7–11], mainly because these criteria result from a confirmatory approach
that consists of recycling substance use disorder criteria and applying them to video gaming
[12–14]. Typical consequences of such an approach include (1) no consideration of
alternative etiological models (e.g. obsessive-compulsive disorder, impulse-control disorder,
dissociative disorder, or maladaptive coping), (2) an excessive focus on symptomatic
similarities with substance use disorders and neglect of the unique features of video games,
(3) the confusion between high but non-problematic involvement in video games and
pathological (or addictive) use of video games, or (4) the claim that addiction treatment
(GD) was included in the section on ‘Disorders due to substance use or addictive behaviours’
in the 11th revision of the International Classification of Diseases (11) [20]. In the
ICD-11, GD is defined as a pathological pattern of gaming characterised by (1) impaired control,
(2) increasing priority given to gaming to the extent that gaming takes precedence over other
life interests and daily activities, and (3) continuation or escalation of gaming despite
negative consequences. Furthermore, to be considered as GD, the gaming pattern must be
clearly linked with distress or significant functional impairment [21].
Beyond theoretical controversies and ideological debates, a robust corpus of data
supports the proposition that excessive gaming is associated with negative effects across
multiple domains of functioning [22–26]. For instance, it has been observed that excessive
Internet gamers display symptoms that include obsessive thoughts and cravings regarding the
game [27, 28], loss of interests outside gaming, social isolation [29–32], psychological
discomfort and withdrawal when they have to reduce gaming activities, and distress
connected to their intense and recurring online activities [33].
An aspect of online games that is commonly reported by players is a deep and
absorbed state of consciousness, in which they immerse themselves in the virtual world and
project dimensions of themselves onto their in-game characters [32, 34, 35]. These
experiences can sometimes be regarded as genuine dissociative states, which are generally defined as ‘a disruption in the usually integrated functions of consciousness, memory, identity, and perception and environment’ (p. 477) [36]. Dissociative symptoms (such as experiences of amnesia, depersonalisation, derealisation or detachment), while commonly
reported in the general population, may overlap with other psychiatric symptoms [37], and
seem to have a negative influence on treatment outcomes in several psychiatric disorders
[38]. Dissociation is a normal process of the mind that allows individuals to protect
processing, through a temporarily disengagement from reality and a compartmentalization of
behaviors, feelings, thoughts, and memories related to the distressing experiences. However, when dissociation is excessively activated and relied upon as the individual’s primary response to stress, it can obstruct the cognitive and affective processing of information and their integration into the individual’s biobehavioral states, which increases the risk for psychopathology [39]. Accordingly, research shows that dissociation scores are increased in
psychiatric populations, with meta-analytic findings supporting the view that prominent
dissociative symptoms are present in dissociative disorders, posttraumatic stress disorder,
borderline personality disorder, conversion disorder, somatic symptom disorder,
substance-related and addictive disorders, feeding and eating disorders, anxiety disorder, schizophrenia,
obsessive-compulsive disorder, and depression [40].
However, when considering video game use, alterations in the state of consciousness
seem to be linked to both positive and negative outcomes. In fact, while some players may
find relief from stress through immersion and absorption into the game, others lose control,
turning video gaming into a problematic behaviour where the game itself may become a
source of stress [19, 41].
From a clinical and theoretical perspective, the link between problematic online
gaming and dissociation could be reinforced by the fact that virtual worlds may become
places where unintegrated mental states can be represented and expressed [42]. Indeed, new
technologies allow individuals to experience aspects of their personality that are difficult to
access voluntarily in real life [43], coupled with the guarantee of anonymity and the total
control over technological tools [44]. Thus, virtual worlds can be used to withdraw into areas
of the mind populated by ideas that are poorly aligned with reality [42]. It has thus been
suggested that excessive absorption in Internet-mediated activities can be a convenient but
of dissociation is susceptible to result in a vicious circle where immersion in the virtual world
may foster or reinforce psychopathology [42, 45–47].
Despite the importance of these immersive states in virtual worlds, there seems to be a
lack of research regarding the relationship between dissociation and problematic gaming. In
this paper, we present a systematic review of empirical studies that have explored this link in
the last 10 years. Since online gaming has gained specific attention relatively recently, we
chose to include only articles published after 2007, to examine findings that are consistently
related to contemporary gaming practices.
Method
Search strategies
A systematic three-step research strategy was used (for a similar approach, see
Gervasi et al. [48]). In the first step, and in order to identify relevant studies, we used a combination of the keywords dissociat* AND (“internet gaming disorder” OR “video*game addict*” OR “compulsive gaming” OR “problematic gaming” OR “compulsive gamer*” OR “problematic gamer*”). Research first included studies published between January 2007 and December 2017. In mid-October 2018 we ran the same query with a different time frame
(January 2018–October 2018), to check if relevant literature on the topic has been published
in the last year.
Studies were identified by searching the following databases: Scopus, Web of
Science, MEDLINE/PubMed, ProQuest Psychology Journals, ScienceDirect Journals, Taylor
& Francis Online Journals, SpringerLink, SAGE Journals, Directory of Open Access Journals
and Oxford Journals. In the second step, the previous databases were interrogated by using
the names of the authors of all the articles selected in the first step. In the final step,
retrieved by the automatic literature search. Any discrepancy regarding the
inclusion/exclusion of articles was discussed among the research group until an agreement
was reached. Article eligibility was independently evaluated by four of the authors [MM,
IGF, FG, GS]. In case of disagreement, two senior judges were consulted [AS and JB].
Selection criteria
The systematic review was conducted in accordance with the PRISMA (Preferred
Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for search,
systematisation, and report of systematic reviews [49]. Because of the paucity of studies
focusing on the selected topic, we also chose to include qualitative studies. Progressive exclusion was performed by reading the title, the abstract and, finally, the full text.
Inclusion criteria were:
1. publications within the given time interval (January 2007–December 2017;
January 2018–October 2018);
2. articles in English;
3. studies published in peer-reviewed journals;
4. articles focusing on dissociation associated with problematic video game use.
Exclusion criteria were:
1. studies not reporting original results (reviews, letters, editorials and comments);
2. case studies;
3. dissertations;
4. studies exclusively focused on motives for Internet gaming;
6. studies conducted on other types of online activities (e.g. online gambling,
online sexual activities) or on generalised problematic Internet use (not related
to a specific activity).
The electronic databases search initially identified 1,694 records. Following the procedure
presented in the flow chart (Table 1), 19 articles resulting from electronic and manual
literature searches underwent close scrutiny, data extraction, and qualitative analysis.
[Insert Figure 1]
Data analysis
Data analysis was carried out by considering the aims of the studies, the
methodologies employed and the results. Coded data included author(s) of the article, year of
publication, sample characteristics (age, gender, and country), problematic gaming and
dissociation measures, and the main findings of the study.
Results
Articles were classified into four categories according to their focus: dissociative
experiences, escapism, psychotic-like experiences and bodily alteration, and game transfer
phenomena. Table 1 summarises the results of the review. In the following sections, which
summarise the main findings of the studies retained, we will not systematically specify which
instruments are used to measure dissociation and problem gaming symptoms. The interested
reader can find this information in Table 1.
Dissociative experiences
Dissociation ‘may involve a disruption of and/or a discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior’ (p. 291) [6]. Importantly, dissociative experiences can relate to normal developmental processes such as identity exploration and identity achievement during
adolescence and young adulthood, but they might also represent indicators of a deep failure
to bind together the state-dependent aspect of an individual self in a coherent way [50].
Schimmenti et al. [51] performed a two-step Internet-based survey on 250 online multiplayer
gamers, and they selected a sub-sample of 36 pathological gamers on the basis of their high
Internet addiction scores. This sub-sample obtained elevated scores on a dissociation scale,
comparable with those obtained in clinical samples. A large majority of the participants who
screened positive for problematic gaming showed insecure (44.4%) and
unresolved/disorganised (47.2%) states of mind concerning their attachment experiences
during childhood. Moreover, gamers with unresolved/disorganised states of mind regarding
attachment reported the highest Internet addiction scores. In this study, dissociation totally
mediated the relationship between attachment disorganisation and Internet addiction among
gamers, supporting the view that dissociation is a key variable in linking attachment problems
with problematic gaming. Dissociation scores were directly and strongly associated with
Internet addiction scores, and a significant association between the most severe conditions of
pathological gaming and pathological dissociation was found. Likewise, De Pasquale et al.
[52] investigated the prevalence of IGD symptoms and its association with dissociative
experiences in a sample of 221 Italian college students. They found a significantly higher
prevalence of dissociative experiences in young men than in young women. Strikingly, many
college-aged men displayed clinically relevant symptoms of dissociation. Furthermore, the
specific dissociative experiences, such as depersonalisation and derealisation, absorption and
imaginative involvement, and passive influence.
Snodgrass and colleagues [53] examined the effects of dissociative experiences on
players of World of Warcraft via analysis of interviews and survey data. These authors found
that 30% of respondents reported that they became so absorbed in the game while playing
that they were always or often unaware of events happening around them in the actual world.
Losing track of the passage of time while playing online was also common, occurring at least
sometimes to nearly two-thirds of the sample. Although such experiences of absorption could
be considered mainly as reflecting a non-problematic flow state, further analysis showed that
this kind of dissociation was strongly associated with gaming addiction symptoms.
Floros et al. [54] found that image-distortion defence styles, described as ‘the splitting of the image of self and others into good and bad’ (p. 3), which may represent a feature of the identity alteration process observed in dissociative disorders, mediated the relationship
between personality and Internet addiction symptoms among gamers.
Similar to some dissociative experiences of absorption previously described, cognitive absorption is defined as ‘a state of deep involvement with software’ [55]. Cognitive
absorption can manifest itself through temporal dissociation, focused immersion, heightened
enjoyment, control and curiosity [55]. Through surveys of individuals involved in playing
World of Warcraft or Second Life, Barnes and Pressey [56] found that individuals with high
levels of cognitive absorption in goal-oriented virtual worlds showed significantly higher
symptoms of gaming addiction than users of experience-oriented virtual worlds.
Escapism
Escapism, defined as the fact of playing to avoid thinking about real-life problems
[35], is a robust predictor of problem online gaming [57–60]. Ballabio et al. [61] found that
associated with problematic online gaming. The connection between escapism and
problematic gaming seems to be particularly strong among players of massively multiplayer
online role-playing games (MMORPG) [62, 63]. This likely depends on the fact that most
existing research was conducted on this genre, and that less evidence is available regarding
more popular game genres available nowadays, such as multiplayer online battle arenas
(MOBA) or first-person shooters (FPS). Király et al. [63] found that escapism significantly
mediated the relationship between psychiatric symptoms and problematic gaming in a large
sample of online gamers, as well as identifying higher levels of escapism in women. Caplan
et al. [64] considered a broader immersion construct (including escapism, according to the
Yee model [35]) and found that it was a significant predictor of problematic Internet use
among massively multiplayer online game players, after controlling for the influences of age,
Internet usage patterns, and general well-being.
Thus, recent studies emphasised that among gaming motives, escapism was a strong
mediator between psychiatric distress and problematic online gaming [61, 63]. Escapism was
also found to be an important predictor of the intention to play online games [59]. This
relationship was found to be increased among individuals characterised by an external locus
of control [65]. Eventually, Zsila et al. [66] also identified escapism as a predictor of
problematic involvement in an augmented-reality-based game (Pokémon Go).
Psychotic-like experiences and bodily alteration
Psychotic-like experiences (PLEs), that is, subclinical psychotic experiences
involving magical thinking, delusional ideation and hallucination proneness [67], have also
been linked to problematic gaming. Vadlin and colleagues [68] investigated the associations
between problematic gaming and psychiatric symptoms in community and psychiatric
samples. They found that 13.3% of problematic gamers in the community sample and 19.2%
however, did not find an increased probability of problematic gaming in participants with
PLE symptoms.
In a recent study of 432 adolescents, Guglielmucci et al. [69] performed a cluster
analysis on item scores of an Internet addiction measure, and they identified three clusters of
Internet users with different personality profiles. The third cluster, which included
adolescents with higher scores on the measure, was labelled as ‘at risk for problematic Internet use’ and was characterised by online gaming as a preferred online experience, emotional alienation and bizarre sensory experiences. Participants in this cluster were
described as characterised by ego immaturity and difficulty discriminating between online
games and reality (i.e. poor reality testing). Accordingly, they interpreted this cluster as including adolescents at increased risk to ‘escape’ into the virtual world, because these adolescents might experience the game as a safer place than reality in which to test
developing personality features and to live experiences that they lack in the real world [70,
71].
Game Transfer Phenomena
Coined by Ortiz de Gortari [72], the term ‘Game Transfer Phenomena’ (GTP) describes altered sensory perception, mental processes, and behaviour transfer from the
virtual world to real life. Ortiz de Gortari and Griffiths [73], via classification and analysis of 1,022 gamers’ reports on their gaming experiences, investigated the influence of video games on players’ mental processes and behaviour after playing. In a very few cases (n = 12), gamers experienced sensations of derealisation and depersonalisation triggered by external
cues associated with the video game. In another qualitative study, Ortiz de Gortari and
Griffiths [74] reported an increased level of altered body perception in their sample (72.7%).
The most prevalent type of altered body perception was feeling body movement after playing,
Altered perception of time, feeling the body as different after playing a video game, and
feeling tactile sensations associated with a video game occurred in about the half of the cases.
Discussion
This systematic review investigated the link between problematic gaming and
dissociation. Studies were moderately consistent in reporting a positive relationship between
problematic gaming and dissociative experiences [51–55]. Gamers in the various samples
frequently described states of total absorption in the game, to the point of losing track of time.
In the context of problematic gaming, then, it seems that extreme absorption and narrowing
of consciousness are critical features that foster excessive involvement in gaming. This
extreme involvement has been variously described in the clinical literature, but it often
presents itself in the form of trance-like states, to the point that some scholars have described
such an experience as a video-terminal dissociative trance [45]. Also, the origins of extreme
absorption in gaming have been often identified as unprocessed traumatic experiences that
lead the individual to use the Internet and video games as a way to cope with a distressing
internal experience [42, 51]. Cognitive absorption can manifest itself through temporal
dissociation, focused immersion, heightened enjoyment, control and curiosity [55]. High
levels of cognitive absorption tend to correspond to higher addiction levels [56]. The findings
on cognitive absorption can be interpreted within the wider context of dissociative absorption
and escapist motives to play. More precisely, excessive immersion in the virtual world
reflected by the construct of cognitive absorption might play a pivotal role in the
development of problematic gaming, especially for people who use video games as a
preferred way to cope with particularly distressing internal experiences and negative affect
states [64, 75]. Experimental research shows indeed that people with problematic Internet use
may have a specific difficulty in processing negative stimuli [76], and that problematic
[41]. This is consistent with theoretical insights from seminal case studies in problematic
gaming, which suggested that dissociative states in this context might serve a protective
purpose, and specifically that an excessive involvement in video games may protect the
individual from unbearable states of mind related to traumatic or otherwise overwhelming
experiences that damage his or her sense of safety and security [42].
Regarding escapism, the findings in literature are quite consistent, showing a higher
prevalence of escapism among problematic gamers, as well as a predictive link between
escapism and maladaptive gaming [57–59]. Furthermore, a strong link between psychiatric
distress and problematic gaming was found [61, 63]. Research findings seem to support the
idea that the escapism construct lies along a continuum that goes from relaxation to severe
dissociation, as suggested by recent literature [41].
Vadlin et al. [68] also found a relatively high prevalence of problematic gamers who
reported psychotic-like experiences. Likewise, Guglielmucci and colleagues [69] identified a
cluster of adolescents characterised by ego immaturity and difficulty in discriminating
between online games and reality. However, adolescents with psychotic-like experiences did not show a higher probability of problematic gaming in Vladin et al.’s research. These findings may reflect the partial overlapping between psychotic symptoms and severe
dissociative experiences [77], suggesting a need for research to better discriminate between
psychotic-like experiences and dissociation in order to improve prevention programs for
problematic gaming and to develop targeted, person-centered clinical interventions.
Game Transfer Phenomena, described as altered sensory perception, mental
processes, and behaviour transfer from the video game world to real-life contexts [72], also
seem to be linked to problematic gaming. In their study, Ortiz de Gortari and Griffiths [74]
found that a high prevalence of gamers experienced GTP at some point. This might be
alteration of mental and behavioural functioning may occur in the individual at extreme
levels of absorption into the game, due to an alteration in cognitive and affective processing
of information linked to the excessive gaming and a consequent translation of gaming
experience to real life.
Overall, the findings support the hypothesis that an overuse of video games can be
conceptualised as a maladaptive coping strategy on which people might rely in order to
escape from distressing experiences and problems experienced in the real world [8, 13, 15,
52, 60, 62, 68]. In this context, problematic gaming can emerge as a consequence of
underlying problems with the processing of distressing events and internal experiences that
may, in some cases, foster dissociative mechanisms of extreme absorption, depersonalisation,
and derealisation. Accordingly, extreme absorption into gaming, mental confusion involved
in psychotic-like experiences after playing games, and excessive involvement in gaming
more generally, might represent an escape from real life with its problems and difficulties
[78]. Thus, it is possible that sometimes dissociation represents the desired yet unrecognised
effect of excessive gaming, and is actively sought by gamers because it allows them to
temporarily protect themselves from disturbing mental states [42].
Another fundamental aspect of gaming that can facilitate the development of
dissociative states is that the players may feel that their actions are less constrained in the
virtual world than in the real world. Compared to the real world, where individuals must
respond to the difficulties and continuous demands of a sometimes frustrating reality, virtual
worlds can constantly reward the individuals for their efforts (e.g. with new items, clothes for their avatar, virtual prizes, etc.). This mechanism may heavily impact individuals’
self-esteem, granting them a feeling of empowerment that they might lack in the real world. This
reinforcing feature of video games might, in turn, foster a disconnection from the emotional,
Limitations and future directions
The results presented in this review should be cautiously interpreted, considering the
limitations of the studies reviewed. The first limitation concerns the paucity of studies that
consider the construct of dissociation. In this review, we found that most studies analysed
constructs related to dissociation, while studies considering actual dissociative symptoms
were scarce. The second limitation is that, despite being the object of a great variety of
research, we found an inferior number of studies on escapism compared to what we expected. The probable explanation is that our search used ‘dissociation’ and not ‘escapism’ as a
keyword. It is likely, therefore, that we identified only a subgroup of studies on the role of
escapism in motivating gamers that were more directly linked to the dissociation construct. A
third limitation is that most of the studies in this review are correlational, rendering it
impossible to establish causal or predictive links between dissociative phenomena and
problematic gaming. A further limitation is related to the absence of longitudinal studies,
which impedes the verification of more complex explanatory models concerning the
relationship between problematic gaming and dissociation that can lead to identification of
better intervention models. The nature of the samples examined may also constitute a
limitation. Since problematic gaming occurs more frequently in adolescent and young adult
populations, the studies analysed in this review follow this trend in their sampling. This,
however, limits the generalisability of the findings.
Finally, our systematic review conducted may be limited in the following two aspects.
First, we decided to include only articles published within the last ten years. This decision is
based on the fact that the construct of problematic gaming is relatively recent; thus, our
choice allowed us to discuss contemporary research in a more reliable fashion. However, this
approach to the review might have caused us to overlook relevant studies published more
search in order to identify relevant articles, it is likely that further articles have been missed
because they were not indexed in the searched databases or were not identified through a
manual search.
Concerning future directions, we believe that studies specifically addressing the
construct of dissociation are needed in order to better understand the link between
dissociative phenomena and problematic gaming. Likewise, longitudinal studies, along with
studies that control for sociodemographic variables, could shed more light on the factors that
influence the relationship between the two constructs.
Conclusions
In conclusion, research findings are moderately consistent in supporting a positive
relationship between problematic gaming and maladaptive dissociative processes. Our review
of clinical and research literature examining the association between problematic gaming and
dissociation further suggests that the development of dissociative experiences in problematic
gaming can sometimes represent a process by which a virtual world that is used as a source of
enjoyment and relaxation can become a place where the individual can become absorbed as a
way of escaping from personal and interpersonal insecurities, life difficulties, traumatic
experiences, negative feelings, and so on. However, this use of the virtual world is not
necessarily pathological and can be temporarily used as a flexible way to cope with negative
states [80]. Nonetheless, while originally serving both a playful and a cathartic function, for
some individuals this coping strategy becomes so pervasive that it leads to severe dissociative
symptoms, lack of integration between life and in-game activities, extreme absorption in the
video game, and detachment from real-world experiences.
Conflict of Interest
The authors declare that they have no conflict of interest. This article has been edited by Editor-in-Chief Marc Potenza instead of Joël Billieux and Adriano Schimmenti, as Joël Billieux and Adriano Schimmenti are the Section Editors of the “Dissociation and Addictive Behaviors” topical collection.
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.
References
Papers of particular interest, published recently, have been highlighted as * Of importance
** Of major importance
1. Greenfield, D. The addictive properties of Internet usage. In: Young KS, de Abreu CN, editors. Internet addiction: a handbook and guide to evaluation and treatment. Hoboken, NJ: John Wiley & Sons, Inc; 2011. pp. 135–53.
2. Mérelle SYM, Kleiboer A, Schotanus M, et al. Which health-related problems are associated with problematic video-gaming or social media use in adolescents?. Clin Neuropsychiatry. 2017; 14(1):11–9.
3. Morahan-Martin J, Schumacher, P.. Incidence and correlates of pathological Internet use among college students. Comput Human Behav. 2000;16(1):13–29. doi:10.1016/S0747-5632(99)00049-7.
4. Shapira NA, Goldsmith TD, Keck PE, Khosla UM, McElroy SL. Psychiatric features of individuals with problematic internet use. J Affect Disorders. 2000;57(1):267–72. doi:10.1016/S0165-0327(99)00107-X.
5. Carli V, Durkee T, Wasserman D, et al. The association between pathological internet use and comorbid psychopathology: a systematic review. Psychopathology. 2013;46(1):1–13. doi:10.1159/000337971.
6. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.
7. Kuss DJ, Griffiths MD, Pontes, HM. Chaos and confusion in DSM-5 diagnosis of Internet Gaming Disorder: issues, concerns, and recommendations for clarity in the field. J Behav Addict. 2017;6(2):103–09. doi:10.1556/2006.5.2016.062.
8. Kardefelt-Winther D. A conceptual and methodological critique of internet addiction research: towards a model of compensatory internet use. Comput Human Behav. 2014;31:351–4. doi:10.1016/j.chb.2013.10.059.
9. Kardefelt‐Winther D. Meeting the unique challenges of assessing internet gaming disorder. Addiction. 2014;109(9):1568–70. doi:10.1111/add.12645.
10. Kardefelt-Winther D. A critical account of DSM-5 criteria for internet gaming disorder. Addiction Res Theory. 2015;23(2):93–8. doi:10.3109/16066359.2014.935350.
11. Van Rooij AJ, Van Looy J, Billieux J. Internet Gaming Disorder as a formative construct: implications for conceptualization and measurement. Psychiatry Clin Neurosci. 2017;71(7):445–58. doi:10.1111/pcn.12404.
12. Aarseth E, Bean AM, Boonen H, et al. Scholars’ open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal. J Behav Addict. 2017;6(3):267–70. doi:10.1556/2006.5.2016.088.
13. Billieux J, Schimmenti A, Khazaal Y, Maurage P, Heeren A. Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research. J Behav Addict. 2015;4(3):119–23. doi:10.1556/2006.4.2015.009.
14. James RJ, Tunney RJ. The need for a behavioural analysis of behavioural addictions. Clin Psychol Rev. 2017;52:69–76. doi:10.1016/j.cpr.2016.11.010.
15. Billieux J, Philippot P, Schmid C, Maurage P, De Mol J, Van der Linden M. Is dysfunctional use of the mobile phone a behavioural addiction? Confronting symptom-based versus process-based approaches. Clin Psychol Psychother. 2015;22(5):460–8. doi:10.1002/cpp.1910.
16. Deleuze J, Long J, Liu TQ, Maurage P, Billieux J. Passion or addiction? Correlates of healthy versus problematic use of videogames in a sample of French-speaking regular gamers. Addict Behav. 2018; 82:114–21. doi:10.1016/j.addbeh.2018.02.031.
17. Kardefelt‐Winther D. Conceptualizing Internet use disorders: addiction or coping process?. Psychiatry Clin Neurosci. 2017;71(7): 459–66. doi:10.1111/pcn.12413. 18. Kardefelt‐Winther D, Heeren A, Schimmenti A, et al. How can we conceptualize
behavioural addiction without pathologizing common behaviours? Addiction. 2017;112(10):1709–15. doi:10.1111/add.13763.
19. Wéry A, Schimmenti A, Karila L, Billieux J. Where the mind cannot dare: a case of addictive use of online pornography and its relationship with childhood trauma. J Sex Marital Ther. 2018. doi:10.1080/0092623X.2018.1488324.
20. World Health Organization [WHO]. Mental, behavioural or neurodevelopmental disorders. In: ICD-11 beta draft – Mortality and morbidity statistics. 2018.
https://icd.who.int/dev11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f334423054.
21. Billieux J, King DL, Higuchi S, 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. doi:10.1556/2006.6.2017.036.
22. Ferguson CJ, Coulson M, Barnett J. A meta-analysis of pathological gaming prevalence and comorbidity with mental health, academic and social problems. J Psychiatr Res. 2011;45(12):1573–8. doi:10.1016/j.jpsychires.2011.09.005.
23. Kuss DJ, Griffiths MD. Internet and gaming addiction: a systematic literature review of neuroimaging studies. Brain Sci. 2012;2(3):347–74. doi:10.3390/brainsci2030347. 24. Männikkö N, Ruotsalainen H, Miettunen J, Pontes HM, Kääriäinen M. Problematic
gaming behaviour and health-related outcomes: a systematic review and meta-analysis. J Health Psychol. 2017. doi:10.1177/1359105317740414.
25. Mentzoni RA, Brunborg GS, Molde H, et al. Problematic video game use: estimated prevalence and associations with mental and physical health. Cyberpsychol Behav Soc Netw. 2011;14(10):591–6. doi:10.1089/cyber.2010.0260.
26. Van Rooij AJ, Schoenmakers TM, Vermulst AA, Van Den Eijnden RJJM, Van De Mheen D. Online video game addiction: identification of addicted adolescent gamers. Addiction. 2011;106(1):205–12. doi:10.1111/j.1360-0443.2010.03104.x.
27. 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 Psychiatry. 2006;163(3):381–5. doi:10.1176/appi.ajp.163.3.381.
28. Ko CH, Yen JY, Chen SH, Wang PW, Chen CS, Yen CF. Evaluation of the diagnostic criteria of Internet gaming disorder in the DSM-5 among young adults in Taiwan. J Psychiatr Res. 2014; 53:103–10. doi:10.1016/j.jpsychires.2014.02.008. 29. Griffiths MD, Davies MNO, Chappell D. Demographic factors and playing variables
in online computer gaming. Cyberpsychol Behav. 2004;7(4):479–87. doi:10.1089/cpb.2004.7.479.
30. King DL, Delfabbro P. Understanding and assisting excessive players of video games: a community psychology perspective. Aust Comm Psychol. 2009;21(1): 62–74. 31. Peng W, Liu M. Online gaming dependency: a preliminary study in China.
Cyberpsychol Behav Soc Netw. 2010;13(3): 329–33. doi:10.1089/cyber.2009.0082. 32. Yee N. The demographics, motivations, and derived experiences of users of massively
multi-user online graphical environments. Presence. 2006;15(3):309–29. doi:10.1162/pres.15.3.309.
33. Batthyány D, Müller KW, Benker F, Wölfling K. Computer game playing: clinical characteristics of dependence and abuse among adolescents. Wien Klin Wochenschr. 2009;121(15–16):502–9. doi:10.1007/s00508-009-1198-3.
34. Bartle RA. Designing virtual worlds. United States of America: New Riders Pubblishing; 2004.
35. Yee N. Motivations for play in online games. Cyberpsychol Behav. 2006;9(6):772–5. doi:10.1089/cpb.2006.9.772.
36. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
37. Horen SA, Leichner PP, Lawson JS. Prevalence of dissociative symptoms and disorders in an adult psychiatric inpatient population in Canada. Can J Psychiatry. 1995;40(4):185–91. doi:10.1177/070674379504000405.
38. Spitzer C, Barnow S, Freyberger HJ, Grabe HJ. Dissociation predicts symptom-related treatment outcome in short-term inpatient psychotherapy. Aust N Z J Psychiatry. 2007; 41:682–7. doi:10.1080/00048670701449146.
39. Schimmenti A. The trauma factor: examining the relationships among different types of trauma, dissociation, and psychopathology. J Trauma Dissociation. 2018;19(5):552-571.
40. Lyssenko L, Schmahl C, Bockhacker L, Vonderlin R, Bohus M, Kleindienst N. Dissociation in Psychiatric Disorders: a meta-analysis of studies using the Dissociative Experiences Scale. Am J Psychiatry. 2018;175(1):37-46. doi:10.1176/appi.ajp.2017.17010025.
41. Deleuze J, Maurage P, Schimmenti A, Nuyens F, Melzer A, Billieux J. Escaping reality through videogames is linked to an implicit preference for virtual over real-life stimuli. J Affect Disord. 2019;245:1024-31. doi:10.1016/j.jad.2018.11.078.
42. Schimmenti A, Caretti V. Psychic retreats or psychic pits?: unbearable states of mind and technological addiction. Psychoanal Psychol. 2010;27(2):115–32. doi:10.1037/a0019414.
43. Turkle S. Life on the screen: identity in the age of the internet. New York, NY: Simon & Schuster; 1995.
44. Cooper A, Scherer CR, Boies SC, Gordon BL. Sexuality on the Internet: from sexual exploration to pathological expression. Professional Psychology: Research and Practice. 1999;30(2):154–64. doi:10.1037/0735-7028.30.2.154.
45. Schimmenti A, Caretti V. Video-terminal dissociative trance: toward a psychodynamic understanding of problematic internet use. Clin Neuropsychiatry. 2017;14(1):64–72.
46. Schimmenti, A. Unveiling the hidden self: developmental trauma and pathological shame. Psychodyn Pract. 2017;18(2):195–211. doi:10.1080/14753634.2012.664873. 47. Schimmenti A, Passanisi A, Caretti V, et al. Traumatic experiences, alexithymia, and
Internet addiction symptoms among late adolescents: a moderated mediation analysis. Addict Behav. 2017;64:314–20. doi:10.1016/j.addbeh.2015.11.002.
48. 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 Rep. 2017;4(3):293–307. doi:10.1007/s40429-017-0159-6.
49. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097. doi:10.1371/journal.pmed.1000097.
50. Schimmenti A. Psychometric properties of the Adolescent Dissociative Experiences Scale in a sample of Italian adolescents. J Trauma Dissociation. 2016;17(2):244-257. doi: 10.1080/15299732.2015.1064507.
51. *Schimmenti A, Guglielmucci F, Barbasio C, Granieri A. Attachment disorganization and dissociation in virtual worlds: a study on problematic Internet use among players of online role playing games. Clin Neuropsychiatry. 2012;9(5):195–202. The Authors reported that dissociative experiences mediated the relationship between unresolved states of mind regarding attachment and scores on problematic Internet use in a sample of excessive gamers.
52. De Pasquale C, Dinaro C, Sciacca F. Relationship of Internet gaming disorder with dissociative experience in Italian university students. Ann Gen Psychiatry. 2018;17(1):28. doi:10.1186/s12991-018-0198-y.
53. Snodgrass JG, Lacy MG, Francois Dengah, HF, Fagan J, Most DE. Magical flight and monstrous stress: technologies of absorption and mental wellness in Azeroth. Cult Med Psychiatry. 2011;35(1):26–62. doi:10.1007/s11013-010-9197-4.
54. Floros G, Siomos K, Stogiannidou A, Giouzepas I, Garyfallos G. Comorbidity of psychiatric disorders with Internet addiction in a clinical sample: the effect of personality, defense style and psychopathology. Addict Behav. 2014;39(12):1839–45. doi:10.1016/j.addbeh.2014.07.031.
55. Agarwal R, Karahanna E. Time flies when you're having fun: cognitive absorption and beliefs about information technology usage. MIS Q. 2000;24(4):665–94. doi:10.2307/3250951.
56. Barnes SJ, Pressey AD. Caught in the Web? Addictive behavior in cyberspace and the role of goal-orientation. Technol Forecast Soc Change. 2014;86:93–109. doi:10.1016/j.techfore.2013.08.024.
57. Laconi S, Pires S, Chabrol H. Internet gaming disorder, motives, game genres and psychopathology. Comput Human Behav. 2017;75:652–9. doi:10.1016/j.chb.2017.06.012.
58. Männikkö N, Billieux J, Nordström T, Koivisto K, Kääriäinen, M. Problematic gaming behaviour in Finnish adolescents and young adults: relation to game genres, gaming motives and self-awareness of problematic use. Int J Ment Health Addiction. 2017;15(2):324–38. doi:10.1007/s11469-016-9726-7.
59. Chang SM, Hsieh GM, Lin SS. The mediation effects of gaming motives between game involvement and problematic Internet use: escapism, advancement and socializing. ComputEduc. 2018;122:43-53. doi:10.1016/j.compedu.2018.03.007. 60. *Billieux J, Thorens G, Khazaal Y, Zullino D, Achab S, Van der Linden M.
Problematic involvement in online games: a cluster analytic approach. Comput Human Behav. 2015;43:242–50. doi:10.1016/j.chb.2014.10.055. The Authors showed that individuals using video games as a mean to escape from reality spent more time online and reported more negative affects than other gamers.
61. Ballabio M, Griffiths MD, Urbán R, Quartiroli A, Demetrovics Z, Király O. Do gaming motives mediate between psychiatric symptoms and problematic gaming? An empirical survey study. Addict Res Theory. 2017;25(5):397–408. doi:10.1080/16066359.2017.1305360.
62. Billieux J, Van der Linden M, Achab S, et al. Why do you play World of Warcraft? An in-depth exploration of self-reported motivations to play online and in-game behaviours in the virtual world of Azeroth. Comput Human Behav. 2013;29(1):103–9. doi:10.1016/j.chb.2012.07.021.
63. **Király O, Urbán R, Griffiths MD, et al. The mediating effect of gaming motivation between psychiatric symptoms and problematic online gaming: an online survey. J Med Internet Res. 2015;17(4):e88. doi:10.2196/jmir.3515. In a large sample of 3,186 online gamers, the Authors found that avoiding real-life problems (i.e., escapism) was significantly related to psychiatric symptoms and problematic gaming. 64. Caplan S, Williams D, Yee N. Problematic Internet use and psychosocial well-being
among MMO players. Comput Human Behav. 2009;25(6):1312–19. doi:10.1016/j.chb.2009.06.006.
65. Koo DM. The moderating role of locus of control on the links between experiential motives and intention to play online games. Comput Human Behav. 2009;25(2):466– 74. doi:10.1016/j.chb.2008.10.010.
66. Zsila Á, Orosz G, Bőthe B, et al. An empirical study on the motivations underlying augmented reality games: the case of Pokémon Go during and after Pokémon fever. Person Individ Dif. 2018;133:56–66. doi:10.1016/j.paid.2017.06.024.
67. Bentall R. Madness explained: why we must reject the Kraepelinian paradigm and replace it with a ‘complaint-orientated’ approach to understanding mental illness. Med Hypotheses. 2006;66(2):220–233. doi: 10.1016/j.mehy.2005.09.026.
68. *Vadlin S, Åslund C, Hellström C, Nilsson KW. Associations between problematic gaming and psychiatric symptoms among adolescents in two samples. Addict Behav. 2016;61:8–15. doi:10.1016/j.addbeh.2016.05.001. The authors found that more than 10% of adolescent problematic gamers showed psychotic-like experiences in both clinical and community samples.
69. Guglielmucci F, Saroldi M, Zullo G, Munno D, Granieri A. Personality profiles and problematic Internet use: a study with a sample of Italian adolescents. Clin Neuropsychiatry. 2017;14(1):94–103.
70. Curtis AE. The claustrum: sequestration of cyberspace. Psychoanal Rev. 2007;94(1):99–139. doi:10.1521/prev.2007.94.1.99.
71. Toronto E. Time out of mind: dissociation in the virtual world. Psychoanal Psychol. 2009;26(2):117–33. doi:10.1037/a0015485.
72. Ortiz de Gortari AB. Targeting the real life impact of virtual interactions: the game transfer phenomenon: 42 video games players’ experiences (Master dissertation). Retrieved from Digitala Vetenskapliga Arkivet database. 2010;425850.
73. Ortiz de Gortari AB, Griffiths MD. Automatic mental processes, automatic actions and behaviours in Game Transfer Phenomena: an empirical self-report study using online forum data. Int J Ment Health Addiction. 2014;12(4):432–52. doi:10.1007/s11469-014-9476-3.
74. *Ortiz de Gortari AB, Griffiths MD. Prevalence and characteristics of Game Transfer Phenomena: a descriptive survey study. Int J Hum Comput Interact. 2016;32(6):470– 80. doi:10.1080/10447318.2016.1164430. This large online survey on a sample of 2362 online gamers showed a high prevalence of bodily alterations related with Game Transpher Phenomena.
75. Charlton JP, Danforth ID. Distinguishing addiction and high engagement in the context of online game playing. Comput Human Behav. 2007;23(3):1531–48. doi:10.1016/j.chb.2005.07.002.
76. Schimmenti A, Starcevic V, Gervasi AM, Deleuze J, Billieux J. Interference with processing negative stimuli in problematic Internet users: preliminary evidence from an emotional Stroop task. J Clin Med. 2018;7(7):177. doi:10.3390/jcm7070177.
77. Renard SB, Huntjens RJ, Lysaker PH, Moskowitz A, Aleman A, Pijnenborg GH.
Unique and overlapping symptoms in schizophrenia spectrum and dissociative disorders in relation to models of psychopathology: a systematic review. Schizophr Bull. 2017;43(1):108–21. doi:10.1093/schbul/sbw063.
78. Lemma, A. "An order of pure decision: Growing up in a virtual world and the
adolescent’s experience of the body." Psychoanalysis in the technoculture era. Routledge, 2013. 97-118. doi:10.1177/0003065110385576.
79. Schimmenti A, Infanti A, Badoud D, Laloyaux J, Billieux J. Schizotypal personality
traits and problematic use of massively-multiplayer online role-playing games
(MMORPGs). Comput Human Behav. 2017;74:286–93.
doi:10.1016/j.chb.2017.04.048.
80. Turkle S. Alone together: why we expect more from technology and less from each
Table 1. Empirical studies examining the relationship between problematic gaming and dissociation
First Author Sample N
Sample
Characteristics Mean age Country
Dissociation Variables
Problematic gaming measure
Dissociation
Measure Main findings
Ballabio (2017) 327 Online gamers (84% males) 23.1 (SD=7.0)
Italy Motivation to escape
POGQ MOGQ Associations. Escapism (β=.23, p<0.001), fantasy (β=.13, p<.001) and competition (β=.20, p<.001) had weak to moderate associations with total score on the POGQ.
Indirect effect were identified: "psychiatric symptoms → escape → problematic gaming" (β=.08, p<.01) and "psychiatric symptoms → fantasy → problematic gaming" (β=.04, p<.05).
Barnes (2014) 662 302 WoW players (62% males)
360 Second Life players (46% males) Not reported Range= 18-64 years United Kingdom Cognitive absorption
Survey Survey Differences between groups. Higher gaming addiction levels (p < .001) in individuals with high levels of cognitive absorption playing in goal-oriented virtual worlds.
Billieux (2013) 690 Online gamers (87% males) 26.22
(SD = 8.14) French-speaking countries (online study) Motivation to escape
IAT-WoW MPOGQ Associations. An addictive usage pattern was primarily related to escapism motives (r= .48, p < .001). Also, the number of hours devoted to playing WoW was significantly related to escapism motives (r= .26, p < .001).
Billieux (2015) 1057 Online gamers (88% males) 26.01 (SD = 7.96) French-speaking countries (online study) Motivation to escape
IAT-WoW MPOGQ Associations. Cluster analysis identified a group of unregulated escapers (21.67% of the total sample), with 41.05% of problematic game users. Negative emotions ( p<.001) and addictive symptoms (p<.001) were significantly more pronounced in this cluster.
Caplan (2009) 4278 Online gamers (81% males) 32.47 (SD=8.73) Online Motivation to escape GPIUS2 Motivation inventory
Associations. The immersion motivation was a significant and positive predictor of PIU (p <.01). Those who used MMO games for escapism and immersion were more likely to also exhibit PIU, after controlling for the influences of age, Internet use patterns, and well-being.
Chang (2018) 389 Online gamers (72% males) 19.43 (SD=0.67)
Taiwan Motivation to escape
PIU Scale OGM-C Associations. Following examination of a three motive mediator model, escapism was a positive mediator of the relationship between game involvement and problematic internet use. This was observed in the paths from game involvement to escapism (β=0.216, p < .05), and from escapism to PIU (β=0.283, p < .01), with the indirect effects of escapism (β=0.061, p < .05) being significant. De Pasquale (2018) 221 College students (42% males) 21.56 (SD=1.42) Italy Dissociative experiences
IGD9-SF A-DES Associations. Positive and significant correlations between Internet gaming disorder symptoms and dissociative experiences: depersonalisation and derealisation (r between .311 and .322); absorption and imaginative involvement (r between .319, and .403) and passive influence (r between .304 and .386).
Floros (2014) 50 College students who voluntarily presented in the student counseling service because of problematic use of the Internet and personal computers (78% males)
males (mean age= 21.03, SD= 3.15)
females (mean age= 22.64, SD= 4.52).
Greece Image distortion OCS DSQ Associations. Over three fourth (78%) of the sample reported online gaming use. A mediation model showed that the image-distortion defence styles mediated the relationship between personality dimensions (neuroticism-anxiety, impulsiveness and sensation seeking) and problematic Internet use (standardized effect = .08, p <.001).
Guglielmucci (2017)
432
Adolescents (58% males) 14.14 (SD= 0.95)
Italy Bizarre Sensory Experiences and Emotional alienation
IAT MMPI-A
Difference between groups. A cluster analysis showed that the group including gaming as favourite online activity (45.7%), was at increased risk for Internet addiction and reported very high scores in the Schizophrenia (Sc) scale of the MMPI-A compared to other clusters(p<.001). In this cluster, high elevations were found in the subscales Sc6 (Bizarre Sensory Experiences) and Sc2 (Emotional alienation).
Király (2015) 3186 Online gamers (90% males) 21.1 (SD= 5.9)
Hungary Motivation to escape
POGQ MOGQ Associations. Motivation to escape was found to significantly mediate the relationship between psychiatric symptoms and problematic gaming (standardized effect=.14, p<.001).
In the case of MOFPS players, the mediation pathway via escapism had a standardized effect size of .12 (p=.001).In the case of MMORPG players, the mediation pathway via escapism had a standardized effect of .15 (p<.001).
Koo (2009) 576 Online gamers (most respondents in the sample were males)
Most respondents were aged in their twenties
Online Motivation to escape
Survey Survey Associations. Results of a structural equation model supported the links between motivation to escape and intention to play online games (β = 0.41, p < .001), with moderating effects of locus of control.
Laconi (2017) 417 Online gamers (49% females)
22.0 (SD=3)
France Motivation to escape
IGDT-10 MOGQ Associations. Escapism was a positive predictor of IGDT-10 symptoms (p< .001) and was higher among problematic gamers (p< .01)
Männikkö (2017) 271 Video game players 18.7
(SD=3.45)
Finland Motivation to escape
GAS Motivation inventory
Associations. Entertainment-achievement, social and escapism motives significantly contributed to explaining problematic gaming behaviour. The motive
of experience-immersion was not a significant predictor of problematic gaming. As a whole, these variables explained 34% of the variance of problematic gaming (p < .001).
Ortiz de Gortari (2014)
762 Online gamers (90% males) 20.19 (SD=5.71) (only 172 gamers reported their age)
Online Game Transfer Phenomena Forum’s self-reports on playing habits Forum’s self-reports
Associations. Subjective sensations of unreality is one of the 7 GTP categories created through thematic analysis. In 8 episodes, gamers reported feeling in real life as though they were in the videogame. In 4 episodes they reported feeling in real life as though they were a videogame character.
Ortiz de Gortari (2016)
2362 Online gamers (86% males) 46.1% aged between 18 and 22 years (range= 18-54 or older) Online (Mexico 33.8%, United States 20.0%, United Kingdom 11.4%, Sweden 5.4%, and Canada 4.7%) Game Transfer Phenomena Survey assessing Frequencies of Gamer Profile and Gaming Habits
Survey Associations. Altered body perceptions were found in 72.7% of the sample. The most prevalent submodality of GTP was feeling body movements after playing a game (50.9%); the least prevalent was feeling as if the mind had been disconnected from the body (28.5%). Perceiving time and/or feeling the body differently after playing a videogame occurred in 49.3% of cases, feeling tactile touch sensation associated with a videogame occurred in 41.3 % of cases.
Schimmenti (2012)
250 Online gamers (67% males) 23
(SD = 3.7)
Online (Italy)
Dissociation IAT DES-II Associations. The subsample of 36 gamers with high Internet addiction scores also reported elevated scores on the dissociation measure. Also, 25% of these gamers screened positive for dissociative disorders. No differences were detected in the DES-II in relation
Snodgrass (2011) 253 WoW players (80% males) 26.9 (S.D. = 8.37) Online (72.1% U.S.) Dissociation Ad hoc questionnaires Ad hoc questionnaires
Associations. 30% of respondents said they become so absorbed in the game while playing that they often or always became unaware of the events happening around them in the actual world. Losing track of the passage of time was also often (24.1%) or always (15%) reported in the sample.
Logistic regression showed that dissociation was strongly associated with WoW addiction (R2 = 0.72).
Vadlin (2016) 2110 1868 adolescents from the community (46% males) 242 adolescents with psychiatric problems (30% males) 13.9 (SD=1.05) 15.39 (SD= 1.45) Sweden Psychotic-like experiences
GAIT PLEs Differences between groups. Among the problematic gamers, 13.3% in the community sample had PLE symptoms in comparison to 19.2% in the clinical sample (p =.417). Multivariate logistic regression did not find an increased probability of problematic gaming in adolescents with PLE symptoms.
Zsila (2018) 510 Pokémon Go players
(56% males)
26.64 (SD=7.80)
Hungary Motivation to escape
POGQ-SF MOGQ-PG Associations. Weak but significant associations between age and the Social, Escapism (motivation of players to dissociate themselves from reality and real-life problems), Competition, Coping, Fantasy, Nostalgia, and Boredom motives (correlations between r= −0.23 and r= −0.10; all p < .05). Furthermore, Escapism motivation was strongly associated to problematic gaming (p <.01)
Dissociation measures
MOGQ Motives for Online Gaming Questionnaire, MOGQ-PG Motives for Online Gaming Questionnaire - Pokémon Go, PLEs Psychotic-like experiences, DSQ Defense Style Questionnaire, MMPI-A Minnesota Multiphasic Inventory-Adolescents, DES Dissociative Experiences Scale, DSQ-40 Defense Style
Questionnaire-40, OGM-C Online Gaming Motivation Scale Chinese version, A-DES Adolescent Dissociative Experiences Scale
Problematic gaming measures
POGQ Problematic Online Gaming Questionnaire, IGDT-10 Internet Gaming Disorder Test-10, POGQ-SF Problematic Online Gaming Questionnaire –
Short Form, GAIT Gaming Addiction Identification Test, OCS Online Cognitions Scale, IAT Internet Addiction Test, IAT-WoW Internet Addiction Test adapted to World of Warcraft ,GAS Gaming Addiction Scale, GPIUS2 Generalized Problematic Internet Use Scale 2, IAS Internet Addiction Scale, IGD9-SF Internet Gaming Disorder Scale Short Form
