Prevalence of Internet gaming disorder in German adolescents: diagnostic contribution of the nine DSM-5 criteria in a state-wide representative sample

Background and aims: Internet gaming disorder (IGD) is included as a condition for further study in Section 3 of the DSM-5. Nine criteria were proposed with a threshold of five or more criteria recommended for diagnosis. The aims of this study were to assess how the specific criteria contribute to diagnosis and to estimate prevalence rates of IGD based on DSM-5 recommendations.

Design: Large-scale, state-representative school survey using a standardized questionnaire.

Setting: Germany (Lower Saxony).

Participants: A total of 11 003 ninth-graders aged 13-18 years (mean = 14.88, 51.09% male).

Measurements: IGD was assessed with a DSM-5 adapted version of the Video Game Dependency Scale that covered all nine criteria of IGD.

Findings: In total, 1.16% [95% confidence interval (CI) = 0.96, 1.36] of respondents were classified with IGD according to DSM-5 recommendations. IGD students played games for longer periods, skipped school more often, had lower grades in school, reported more sleep problems and more often endorsed feeling 'addicted to gaming' than their non-IGD counterparts. The most frequently reported DSM-5 criteria overall were 'escape adverse moods' (5.30%) and 'preoccupation' (3.91%), but endorsement of these criteria rarely related to IGD diagnosis. Conditional inference trees showed that the criteria 'give up other activities', 'tolerance' and 'withdrawal' were of key importance for identifying IGD as defined by DSM-5.

Conclusions: Based on a state-wide representative school survey in Germany, endorsement of five or more criteria of DSM-5 internet gaming disorder (IGD) occurred in 1.16% of the students, and these students evidence greater impairment compared with non-IGD students. Symptoms related to 'give up other activities', 'tolerance' and 'withdrawal' are most relevant for IGD diagnosis in this age group.