Conceptualization and Measurement of Withdrawal Symptoms in Gaming Disorder and Development and Psychometric...

Gaming disorder (GD) is an emerging issue that leads to significant impairment, yet existing tools for measuring withdrawal symptoms in GD are limited and often fail to capture its multidimensional nature. Most current measures rely on single-item assessments or adapted tools from substance use disorders, overlooking cognitive, behavioral, and physiological components. A comprehensive, multidimensional questionnaire is needed to more accurately assess withdrawal in GD, aiding in early detection and intervention.

The objective of this study was to develop and psychometrically validate a comprehensive measurement tool, the Gaming Withdrawal Symptoms Questionnaire (GWSQ), capturing the multidimensional nature of withdrawal symptoms in GD, including affective, cognitive, behavioral, and physiological components.

A multistage psychometric approach was used, starting with item generation from a scoping literature review. Exploratory factor analysis and confirmatory factor analysis were conducted to refine the questionnaire. Reliability and validity were assessed using 2 cross-sectional studies. Data were collected anonymously via an online survey platform. Participants were recruited from gaming-related platforms and social media (eg, Discord, Reddit, and Facebook) and restricted to actively engaged adult gamers who passed attention check questions to ensure data quality.

Study 1 involved 480 adults (mean age 23, SD 4.96 years; n=327, 68.1% male). Study 2 included 565 adults (mean age 25, SD 5.55 years; n=245, 43% male). Exploratory factor analysis revealed a 3-factor model of withdrawal symptoms: (1) motivational and cognitive symptoms, (2) affective symptoms, and (3) physical symptoms, explaining 54% of the variance. Confirmatory factor analysis confirmed adequate model fit (χ²₂₂₇=887.8; P<.001; comparative fit index=0.91; Tucker-Lewis index=0.90; root-mean-square error of approximation=0.072). The GWSQ demonstrated high internal consistency, with Cronbach α ranging from 0.89 (motivational and cognitive symptoms) to 0.90 (affective symptoms and physical symptoms). Correlations with related constructs (Internet Gaming Disorder Scale-Short Form [IGDS9-SF], Patient Health Questionnaire-9 items, and Generalized Anxiety Disorder-7 items) confirmed convergent validity with moderate associations (eg, IGDS9-SF: r=0.48, 95% CI 0.32-0.61) and discriminant validity, and normative data (sten scores) were established for the general population.

The GWSQ is the first validated multidimensional tool specifically designed to assess withdrawal symptoms in GD, representing a conceptual and methodological innovation. It addresses critical gaps in GD diagnosis and research by capturing a broader spectrum of symptoms beyond affective distress. The questionnaire's tripartite structure provides a framework for advancing theoretical models and informing etiological studies of GD. The GWSQ offers a robust measure for clinical research and enables differentiated assessment of symptom clusters. In real-world contexts, it can serve as a reliable patient-reported outcome tool in forthcoming clinical trials of GD interventions, enabling precise monitoring of treatment effects. Nevertheless, given the nonclinical sample, further cultural validation and studies involving clinical populations are required.