Gambling und Gaming:
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1 Gambling und Gaming: Anmerkungen zu Definitionen, Diagnostik und Behandlung Experten-Workshop Internetbezogene Störungen BMG, Berlin Prof. em. Karl Mann Senior Professor Central Institute of Mental Health Mannheim Heidelberg University
2 No conflict of interest WHO-ICD 11 Member: Substance Use and Related Disorders Work Group, Speaker: addictive behaviours (with Prof. Wei Hao, China) Participant: -WHO meetings on disorders and health conditions due to addictive behaviours (Tokio, Seoul, Hongkong, Istanbul) Points represent the views of the speaker Beta Draft of ICD-11 (
3 Mental, behavioural or neurodevelopmental disorders Neurodevelopmental disorders Schizophrenia or other primary psychotic disorders.. Disorders due to substance use or addictive behaviours Disorders due to substance use Disorders due to addictive behaviours 6C80 Gambling disorder 6C81 Gaming disorder Impulse control disorders 6D00 Pyromania 6D01 Kleptomania 6D02 Compulsive sexual behaviour disorder 6D03 Intermittent explosive disorder 6C80 Gambling disorder 6C81 Gaming disorder
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5 Grant et al., 2014: PG classified as Impulse Control Disorder ICD-11 Work Group (Impulse Control Disorders) recommends: Impulse control disorders: pathological gambling, pyromania, kleptomania, compulsive sexual disorder, intermittent explosive disorder.
6 Preparing ICD-11 Grant et al., 2014: (Re-)definition of Impulse Control Disorders: Repeated failure to resist an impulse, drive, or urge to perform an act that is rewarding to the person (at least in the short-term), despite long-term harm either to the individual or others. Differs from the DSM-5 definition ( bad behaviours ) Moves definition closer to SUD (rewarding aspect)
7 Impulse control disorders Parent: 06 Mental, behavioural or neurodevelopmental disorders Description Impulse control disorders are characterized by the repeated failure to resist an impulse, drive, or urge to perform an act that is rewarding to the person, at least in the short-term, despite consequences such as longer-term harm either to the individual or to others, marked distress about the behaviour pattern, or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. Impulse Control Disorders involve a range of specific behaviours, including firesetting, stealing, sexual behaviour, and explosive outbursts.
8 Impulse control disorders Parent: 06 Mental, behavioural or neurodevelopmental disorders Description Impulse control disorders are characterized by the repeated failure to resist an impulse, drive, or urge to perform an act that is rewarding to the person, at least in the short-term, despite consequences.. Need to distinguish between reward (positive reinforcement) and relief (negative reinforcement)
9 Baden-Württemberg-Study on DG Funding: State of Baden-Württemberg N = 675 DGs N = 274 HC Questionnaires / Interviews Diagnostic interviews, personality, gambling behaviour, family history, comorbidities Gene blood GWAS / Candidate gene approach N = 106 DGs N = 108 HC Functional Magnetic Resonance Imaging Response inhibition, cue-reactivity, reward processing and motivation Neuropsychological test battery CANTAB: Response inhibition, gambling-task
10 Sample characteristics DGs (mean ± SD) Controls (mean ± SD) p-value (two-tailed) Age (years) 38 (10) 35 (9) <.001* Partnership (%) <.001* Mother tongue German (%) <.001* Divorced / separated (%) <.001* Nationality (German) (%) <.001* University entrance diploma (%) <.001* Education (years) 9.92 (1.45) (1.65) <.001* Average debts ( ) (95150) (21000) Unemployment (%) <.001* Smoking (current; %) <.001* Smoking (FTND score) 5.42 (2.37) 2.28 (2.54) <.001* Mann K et al. (2017). European Psychiatry 42:
11 Comorbid psychiatric disorders (ICD-10) Lifetime prevalence Substance use disorders Nicotine dependence Alcohol dependence Depression Adjustment disorder Anxiety disorders Eating disorders Impulse control disorders Substance Nicotine Alcohol Depression Adjustment Anxiety Eating Impulse use disorder dependence dependence disorders disorders disorders control disorders Mann et al., 2016
12 Psychiatric disorders (ICD-10) first degree relatives * *p 0.05 * * Mann et al. 2016
13 Comorbid Lifetime Axis I Disorders PAGE Study : N = DSM-IV disorders Pathological gamblers 5-10 criteria N = 47 % S.D. Substance use disorders total Substance dependence without tobacco dependence Alcohol use disorders Illicit drug use disorders Tobacco dependence Mood disorders total Major depression Anxiety disorders total Psychiatric disorders total Psychiatric disorders without tobacco dependence Psychiatric disorders without substance use disorders S.D.: standard deviation Bischof et al., 2013
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17 Disorders due to addictive behaviours 6C80 Gambling disorder 6C81 Gambing disorder 6C8Y Other specified disorders due to addictive behaviours 6C8Z Disorders due to addictive behaviours, unspecified
18 Disorders due to Addictive Behaviours Gaming and gambling disorder Harmful gambling and gaming use Hazardous gambling and gaming Use below threshold for harm Non-user
19 Draft ICD-11 Chapter 24: Factors influencing health status and contact with health services Factors associated with health behaviors: - Hazardous substance use Alcohol Nicotine Drugs Opioids Cannabis Hazardous gambling or betting (QE92) Hazardous gaming (QE93) World Health Organization
20 Draft ICD-11 definition of Hazardous gaming Hazardous gaming refers to a pattern of gaming, either online or offline, that appreciably increases the risk of harmful physical or mental health consequences to the individual or to others around this individual. The increased risk may be from the frequency of gaming, from the amount of time spent on these activities, from the neglect of other activities and priorities, from risky behaviours associated with gaming or its context, from the adverse consequences of gaming, or from the combination of these. Hazardous gaming has not yet reached the level of having caused harm to physical or mental health of the user or others around the user. The pattern of gaming often persists in spite of awareness of increased risk of harm to the individual or to others. Exclusions: Gaming disorder (6D11) World Health Organization
21 Disorders due to addictive behaviours Disorders due to addictive behaviours are recognizable and clinically significant syndromes associated with distress or interference with personal functions that develop as a result of repetitive rewarding behaviours other than the use of dependence-producing substances. Disorders due to addictive behaviours include gambling disorder and gaming disorder, which may involve both online and offline behaviour. World Health Organization
22 Gambling disorder: definition Gambling disorder is characterized by a pattern of persistent or recurrent gambling behaviour, which may be online (i.e.,over the internet) or offline, manifested by: 1) impaired control over gambling (e.g., onset, frequency, intensity, duration, termination, context); 2) increasing priority given to gambling to the extent that gambling takes precedence over other life interests and daily activities; and 3) continuation or escalation of gambling despite the occurence of negative consequences. World Health Organization
23 Gambling disorder (continued) The behaviour pattern is of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning. The pattern of gambling behaviour may be continuous or episodic and recurrent. The gambling behaviour and other features are 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. World Health Organization
24 Draft ICD-11 definition of Gaming disorder Gaming disorder is characterized by a pattern of persistent or recurrent gaming behaviour ( digital gaming or video-gaming), which may be online (i.e., over the internet) or offline, manifested by: 1) impaired control over gaming (e.g., onset, frequency, intensity, duration, termination, context): 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 the occurence of negative consequences. World Health Organization
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26 Health Burden of Excessive Gaming Consequent sleep deprivation Day-night reversal Dehydration Malnutrition Seizures Pressure sores Irritability Physical aggression Depression A range of social, academic, and vocatioanal problems Saunders et al. 2017
27 Thanks to Mira Fauth-Bühler Tagrid Lemenager Collaborations: Dr. M. Beutel: Dr. M. Vogelgesang: Dr. K. Wölfling: Treatmentcentre Münzesheim AHG Hospital Münchwies Clinic for Gambling & Gaming Disorders Mainz University
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