____________________________________________________________ A Clinician’s Guide to the DSM-5-TR
The inclusion of IGD in the DSM-5 reflects growing concern about the potential negative impacts of excessive online gam- ing, particularly among young people. Research suggests that individuals with IGD may experience significant impairment in various areas of life, including academic performance, social relationships, and mental health. However, the prevalence of IGD appears to be relatively low, with studies estimating that between 0.3% and 1.0% of the general population might qualify for a potential diagnosis. The condition criteria focus on Internet games and do not include general Internet use, online gambling, or social media use. While IGD’s inclusion in the DSM-5 has stimulated further research and clinical attention, debate continues in the scientific community about whether gaming addiction should be classified as a distinct mental disorder. As research in this area progresses, our understanding of IGD and its potential impacts on mental health may evolve. Proposed Criteria for IGD Persistent and recurrent use of the Internet to engage in games, often with other players, leading to clinically significant impair- ment or distress as indicated by five (or more) of the following in a 12-month period [1]: • Preoccupation with Internet games. (The individual thinks about previous gaming activity or anticipates playing the next game; Internet gaming becomes the dominant activity in daily life.) Note: This disorder is distinct from Internet gambling, which is included under gambling disorder. • Withdrawal symptoms when Internet gaming is taken away. (These symptoms are typically described as irritability, anxiety, or sadness, but there are no physical signs of pharmacological withdrawal.) • Tolerance—the need to spend increasing amounts of time engaged in Internet games. • Unsuccessful attempts to control the participation in Internet games. • Loss of interests in previous hobbies and entertainment as a result of, and with the exception of, Internet games. • Continued excessive use of Internet games despite knowledge of psychosocial problems. • Has deceived family members, therapists, or others regarding the amount of Internet gaming. • Use of Internet games to escape or relieve a negative mood (e.g., feelings of helplessness, guilt, anxiety). • Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of participation in Internet games.
Note: Only nongambling Internet games are included in this disorder. Use of the Internet for required activities in a busi- ness or profession is not included; nor is the disorder intended to include other recreational or social Internet use. Similarly, sexual Internet sites are excluded. Internet gaming disorder can be mild, moderate, or severe depending on the degree of disruption of normal activities. Individuals with less severe Internet gaming disorder may exhibit fewer symptoms and less disruption of their lives. Those with severe Internet gaming disorder will have more hours spent on the computer and more severe loss of relationships or career or school opportunities. NEUROBEHAVIORAL DISORDER ASSOCIATED WITH PRENATAL ALCOHOL EXPOSURE Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE) is a condition included in the DSM- 5-TR under the Conditions for Further Study section [1]. It is characterized by a pattern of impairments in neurocogni- tion, self-regulation, and adaptive functioning resulting from prenatal alcohol exposure. To meet the diagnostic criteria for ND-PAE, there must be confirmed prenatal alcohol exposure, along with evidence of impaired neurocognitive functioning, self-regulation, and adaptive functioning. Symptoms typically manifest in childhood and lead to significant distress or impairment in social, academic, or other important areas of functioning [1]. Individuals with ND-PAE may experience cognitive deficits, such as planning, attention, learning, and memory difficulties. Behavioral regulation issues, including mood or behavioral regulation problems, attention deficits, and impulse control challenges, can also arise. Additionally, these individuals may face difficulties in adaptive functioning, including social com- munication and interaction problems and impaired daily living skills. Estimates suggest that 2-5% of children in the United States may have a fetal alcohol spectrum disorder (FASD), with ND-PAE being a subset of this group [22]. Diagnosis requires confirmation of prenatal alcohol exposure and a comprehen- sive assessment of neurocognitive, behavioral, and adaptive functioning. Treatment typically involves a multidisciplinary approach that includes educational interventions, behavioral therapies, and sometimes medication for specific symptoms. While ND-PAE is a lifelong condition, early intervention and appropriate support can improve outcomes significantly. Notably, the only way to prevent ND-PAE is to avoid alcohol consumption during pregnancy. This condition represents an effort to capture better the range of effects that prenatal alcohol exposure can have on a child’s development and functioning, extending beyond the physical features associated with fetal alcohol syndrome [1].
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