Department of Personality, Assessment, and Psychological Treatments, University of Valencia, Spain.
College of Education, Psychology, and Social Work, Flinders University, Australia.
Addiction. 2021 Sep;116(9):2463-2475. doi: 10.1111/add.15411. Epub 2021 Feb 1.
Following the recognition of 'internet gaming disorder' (IGD) as a condition requiring further study by the DSM-5, 'gaming disorder' (GD) was officially included as a diagnostic entity by the World Health Organization (WHO) in the 11th revision of the International Classification of Diseases (ICD-11). However, the proposed diagnostic criteria for gaming disorder remain the subject of debate, and there has been no systematic attempt to integrate the views of different groups of experts. To achieve a more systematic agreement on this new disorder, this study employed the Delphi expert consensus method to obtain expert agreement on the diagnostic validity, clinical utility and prognostic value of the DSM-5 criteria and ICD-11 clinical guidelines for GD.
A total of 29 international experts with clinical and/or research experience in GD completed three iterative rounds of a Delphi survey. Experts rated proposed criteria in progressive rounds until a pre-determined level of agreement was achieved.
For DSM-5 IGD criteria, there was an agreement both that a subset had high diagnostic validity, clinical utility and prognostic value and that some (e.g. tolerance, deception) had low diagnostic validity, clinical utility and prognostic value. Crucially, some DSM-5 criteria (e.g. escapism/mood regulation, tolerance) were regarded as incapable of distinguishing between problematic and non-problematic gaming. In contrast, ICD-11 diagnostic guidelines for GD (except for the criterion relating to diminished non-gaming interests) were judged as presenting high diagnostic validity, clinical utility and prognostic value.
This Delphi survey provides a foundation for identifying the most diagnostically valid and clinically useful criteria for GD. There was expert agreement that some DSM-5 criteria were not clinically relevant and may pathologize non-problematic patterns of gaming, whereas ICD-11 diagnostic guidelines are likely to diagnose GD adequately and avoid pathologizing.
在 DSM-5 将“互联网游戏障碍”（IGD）确认为需要进一步研究的病症之后，世界卫生组织（WHO）在《国际疾病分类》第 11 次修订版（ICD-11）中正式将“游戏障碍”（GD）纳入诊断实体。然而，游戏障碍的拟议诊断标准仍存在争议，也没有系统地尝试整合不同专家组的观点。为了在这个新障碍上达成更系统的共识，本研究采用德尔菲专家共识方法，就 DSM-5 游戏障碍标准的诊断有效性、临床实用性和预后价值，以及 ICD-11 临床指南，获取了专家组的意见。
共有 29 名具有 GD 临床和/或研究经验的国际专家，完成了三轮迭代德尔菲调查。专家在每一轮中对提出的标准进行评分，直到达到预定的一致水平。
对于 DSM-5 的 IGD 标准，有专家认为其中一些标准具有较高的诊断有效性、临床实用性和预后价值，而另一些标准（例如耐受性、欺骗）则具有较低的诊断有效性、临床实用性和预后价值。至关重要的是，DSM-5 的一些标准（例如逃避现实/情绪调节、耐受性）被认为无法区分有问题和无问题的游戏。相比之下，GD 的 ICD-11 诊断指南（除了与减少非游戏兴趣相关的标准）被认为具有较高的诊断有效性、临床实用性和预后价值。
这项德尔菲调查为确定最具诊断有效性和临床实用性的 GD 标准提供了基础。专家组一致认为，一些 DSM-5 标准与临床无关，可能会将非问题性的游戏模式病理化，而 ICD-11 诊断指南则更有可能充分诊断 GD，并避免病理化。
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