This commentary builds on King etal. (2025) to distinguish benign gaming from harm, framing gaming disorder as a rigid narrowing of experience marked by relational costs, inflexibility, and loss of alternatives. We introduce a concentric three-layer model-subjective symptoms, gaming's symbolic functions tied to vulnerabilities, and its sociocultural context-to guide assessment and treatment as dynamic meaning-making processes. Emphasizing stable functional impairment, loss of alternatives and markers of suffering over temporal cutoffs, this approach calls for interventions centering personal narrative, restoring agency, relatedness and belonging, and recognizing gaming's existential roles within individuals' life trajectories and social ecologies of play.

Problematic usage of the internet (PUI) refers to maladaptive patterns of specific online activities such as gaming, social networking, online shopping, or pornography use. Building on theoretical frameworks such as the I-PACE model and the incentive-sensitization theory, the present multicenter study (N = 1,015) examined automatic approach and avoidance tendencies toward internet-related cues. Using an explicit Approach-Avoidance Task (AAT), reaction times to addiction-related and neutral stimuli were assessed and related to symptom severity, cue reactivity, and outcome expectancies. Across all user groups (non-problematic, risky, pathological), participants displayed relative approach tendencies toward internet-related stimuli, with pathological users showing the strongest differentiation between addiction-related and neutral cues. Associations between approach tendencies and both cue reactivity and gratification were best described as linear, with higher cue reactivity and greater experienced gratification being associated with stronger approach tendencies.For symptom severity, curve estimation analyses provided evidence for significant, albeit weak, quadratic associations, suggesting that at high symptom severity approach as well as avoidance tendencies may occur. Overall, these findings indicate that approach tendencies toward internet-related cues increase gradually with reward experiences and cue-reactivity, while at higher levels of symptom severity approach or avoidance responses may be observed suggesting that motivational responses remain heterogeneous. From a clinical perspective, approach-avoidance tendencies may serve as behavioral markers relevant to the development and maintenance of PUI and may help inform individualized prevention and intervention strategies targeting cognitive-motivational processes underlying problematic internet use.

Gaming is a popular leisure activity among adolescents. Yet, they are especially vulnerable to develop problematic gaming (PG). Those affected are often additionally impaired by deficits in attention, mood, emotion regulation, sleep quality, and social skills. Thus, effective treatment offers should address main PG symptomology and associated problems alike. However, clinical studies on multi-faceted treatments of adolescents are scarce. Therefore, the aim of this study was to preliminarily test feasibility and efficacy of the newly developed, fully manualized CBT-based program Res@t-A to inform future randomized controlled trials (RCTs). 74 adolescent patients with PG (11-19 years) were recruited from the routine psychiatric clinical setting in Germany. Participants attended group therapy sessions weekly over eight weeks. Retention and attendance rates were evaluated as feasibility indicators. Standardized questionnaires were used to explore efficacy modelled as changes in PG symptoms, perceived stress, emotional dysregulation, and emotional, behavioral and sleep problems in an uncontrolled pre-post-follow-up design. Retention rate was only 50% but attendance rate reached almost 80%. Promising signs of efficacy were observed for main PG symptoms and for associated problems with moderate to large effects. Differences in treatment setting played a significant role in the improvement of sleep problems. The present study revealed encouraging first results on feasibility and efficacy for a new comprehensive treatment of adolescents with PG in clinical settings. Together with the priorly published parental program Res@t-P, Res@t-A offers a parallelized treatment within a family-centered approach. RCTs are urgently needed for further investigations.

Internet Gaming Disorder (IGD) and Gaming Disorder (GD) have emerged as significant public health concerns, with studies highlighting their association with substance use. Research on IGD/GD faces challenges due to heterogeneous definitions and measurement tools. While the introduction of DSM-5 and ICD-11 criteria for these behaviors improved research consistency, substance use patterns in individuals with IGD/GD, when defined strictly by these criteria, remain unexplored. Importantly, acomprehensive review of substance use patterns among individuals with IGD/GD based on DSM-5 and ICD-11 criteria has never been conducted. This scoping review aims to map existing literature on substance use in individuals with IGD/GD, focusing on patterns, underlying mechanisms, and moderating factors influencing this relationship. The review adhered to the JBI manual for scoping reviews and PRISMA-ScR standards. A literature search was conducted in August 2025, inseven bibliographic databases, supplemented by citation tracking strategies. Inclusion criteria encompassed empirical studies published post-2013, using scales published after 2013, based on DSM-5/ICD-11 criteria for IGD/GD, and focusing on substance use. A total of 36 studies out of 5,561identified, predominantly cross-sectional, were included. Findings indicated a high co-occurrence of IGD/GD and substance use, particularly among adolescents and young adults. Shared risk factors such as impulsivity, sensation-seeking, and maladaptive coping strategies were identified. Alcohol, tobacco, stimulants, and cannabis emerged as the most commonly used substances, with variations across cultural contexts. Limited longitudinal data underscored the need for research on the progression and interaction of IGD/GD and substance use over time. The findings revealed that individuals with IGD/GD frequently engage in substance use, including alcohol, tobacco, cannabis, and stimulants such as amphetamines. This review highlights critical mechanisms linking IGD/GD and substance use, emphasizing the role of behavioral reinforcement and emotional dysregulation. Future research should focus on longitudinal designs and protective factors to inform tailored prevention and intervention strategies. Systematic screening for substance use is warranted among individuals with IGD/GD.

Behavioral addictions, including problematic internet use, gaming, and gambling, are emerging as significant public health concerns in Africa, driven by rapid digitalization and socioeconomic shifts. This commentary provides a critical overview of the current state of behavioral addictions in Africa, examining prevalence, cultural influences, and systemic barriers to research and intervention. Despite growing evidence of harm, particularly among youth, the continent faces significant challenges, including limited epidemiological data, cultural biases in assessment tools, and an underdeveloped mental health infrastructure. Drawing on regional studies and global frameworks, the need for culturally sensitive research, evidence-based interventions, and robust policy frameworks is highlighted. The paradoxical coexistence of rising addiction risks and minimal regulatory oversight underscores the urgency of addressing behavioral addictions in African contexts.

This commentary builds on Giardina etal.'s (2021, 2024) conceptualization of escapism and escape in the C-DOG model, highlighting unresolved definitional ambiguities. We argue that the distinction between these constructs cannot rely solely on pre-game intentions (expectation to return vs. remain) due to potential cognitive biases and self-deception, particularly among players with Gaming Disorder (GD). Drawing on goal systems theory and research on maladaptive gaming-related beliefs, we propose that the post-game outcome, successful return vs. persistent difficulty disengaging, offers a more reliable criterion. This perspective reframes escapism and escape as goal-driven processes shaped by experiential avoidance and motivational rigidity.

Exercise is recognized as essential for health, but exercise addiction remains a lesser-known phenomenon. Unlike substance addictions, excessive exercise is often celebrated, making it difficult to distinguish between dedication and compulsion. To understand what exercisers perceive as problematic within their exercise context, a qualitative study was conducted investigating personal experiences. Through a reflexive thematic analysis, the present study analyzed 153 narratives from individuals who experienced physical, psychological, or emotional problems due to exercise. Four main themes emerged: (i) The social pressure of a performativity-oriented culture; (ii)Everything seemed to be going well until the injuries appeared; (iii) Time is money: Interpersonal conflicts; and (iv) It is my responsibility: Intrapersonal conflict. The results suggest that a culture of performance provides an interpretive framework that shapes and sustains problematic exercise experiences. Participants internalized performative values, leading to strict demands and fear of failure, resulting in severe injuries in over 70% of cases. In participants' narratives, the forced interruption of activity was associated with the reported emergence of withdrawal symptoms, with health and morality discourses providing the framework for rationalizing their excessive dedication. These findings suggest that problematic exercise is not an individual issue, but an expression of a broader culture prioritizing performance. These results underscore the importance of shifting toward biopsychosocial interventions that foster identity flexibility and prioritize holistic well-being and enjoyment over performance metrics.

Background and aimsDysregulation in instrumental control systems is implicated in compulsivity, a transdiagnostic construct proposed to underlie diverse maladaptive behaviors. While habit formation in reward-based learning is well-characterized, its role in avoidance learning remains less understood. Habitual avoidance may contribute to compulsive symptoms by impairing emotion regulation, a well-established correlate of compulsivity. To define these mechanisms, this study examined negative emotionality as a pathway linking habitual avoidance to compulsive behaviors.MethodsFive hundred adults completed the Avoidance Dynamics Task (ADT), a novel online-administered aversive devaluation paradigm assessing avoidance learning and habit strength, alongside validated self-report measures of compulsive behaviors (alcohol use, binge eating, binge watching, gambling, obsessive-compulsive symptoms) and internalizing symptoms (depression, anxiety). Mediation analysis tested whether internalizing symptoms accounted for associations between habitual avoidance and compulsive behavior severity.ResultsHabitual avoidance, indexed by perseverative responses to devalued threat versus control cues (t = 3.5, p = .002), showed small-to-moderate positive associations with avoidance urges (ρ = .28, p < .001), regulatory control deficits (ρ = .17, p < .001), and internalizing symptoms (b = .15, p = .004). Internalizing symptoms fully mediated associations with all compulsive behaviors (b's = .05–.16, all p ≤ .01). Impaired avoidance learning was modestly associated with greater alcohol use (b = −.12, p = .03) and gambling (b = −.15, p = .02) severity. Exploratory analyses showed distinct avoidance patterns mapped onto cognitive (preoccupation, urges) versus behavioral (control, frequency) components of alcohol-related compulsivity.ConclusionHabitual avoidance may represent a transdiagnostic behavioral marker of compulsivity. These findings underscore distinct vulnerability pathways across compulsive domains and support the use of remote tasks to phenotype maladaptive avoidance and related emotional dysregulation.

BackgroundInternet Gaming Disorder (IGD) is recognized as a significant health issue in adolescents. However, the cross-national comparison and validation remain underrepresented in the literature. Thus, this study aimed to evaluate the symptom prevalence, dimensionality, and measurement invariance of the nine-item Internet Gaming Disorder Scale (IGDS) with data from the 2021–22 Health Behaviour in School-aged Children survey.MethodsRepresentative samples of adolescents aged 11–15 from 12 European regions (N = 44,126) were used. The IGDS was examined using network analyses and factor models with dynamic cut-offs.ResultsGaming intensity was more related to IGDS score than gaming frequency. Non-gaming boys at the time of measurement reported similar IGDS scores as daily gamers. All symptoms were more common in boys; Escapism and Preoccupation were the most common symptoms overall. A unidimensional structure for the IGDS across both genders and all regions was indicated. Only configural invariance was observed across genders, with notable higher roles for “Problems” and “Preoccupation” in boys, suggesting problematic direct gender comparisons. Measurement invariance suggested three relatively homogenous region groups, showing varying levels of invariance, and some groups achieving scalar invariance. Consequently, cross-regional comparisons should be approached with caution.ConclusionsThe findings suggest large differences between boys and girls, moderate differences between age groups, and relatively high differences among regions.

ObjectiveNon-suicidal self-injury (NSSI) constitutes an important public health concern. Here, we systematically reviewed and synthesized existing literature to provide an up-to-date overview of associations between NSSI, problem gambling, problem gaming, and problematic internet use (PIU).MethodsWe searched four databases through April 2025: Web of Science, Scopus, PubMed, and PsycINFO. The Joanna Briggs Institute's tool was used to assess the quality of studies. Empirical studies utilizing quantitative or qualitative methods or case studies that presented evidence on the relationships between NSSI and frequent or problematic gambling, internet use, and gaming were included.ResultsForty studies published between 2009 and 2025 were reviewed. Four investigated the relationship between NSSI and problem gambling, seven focused on problem gaming, and twenty-nine examined PIU. Cross-sectional designs and surveys were common. Findings suggest that at-risk or problem gambling was associated with NSSI in adolescents, college students, and adults. An association between PIU and NSSI appeared moderated by social support, with impulsivity representing a shared factor. Similarly, internet gaming disorder and its severity were linked to NSSI, with anxiety acting both as a mediator and moderator. Limitations entailed self-reported measures, limited generalizability, poor ability to establish causal relationships due to cross-sectional designs, and frequent use of single unvalidated questions to assess NSSI.ConclusionThe review provides a comprehensive overview and suggests complex relationships between NSSI and problem gambling, problem gaming, and PIU. Clinicians and future studies should focus on co-occurring disorders and identify risk factors, predictors, and moderators that influence these relationships.