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Video Game and Internet Addiction: Is there a Need for Differentiation?

Article  in  Sucht · January 2013

DOI: 10.1024/0939-5911.a000245

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Florian Rehbein Thomas Mößle

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 SUCHT, 59 (3), 2013, 129 – 142

Special Issue

Video Game and Internet Addiction:

Is there a Need for Differentiation?
Florian Rehbein and Thomas Mößle
Criminological Research Institute of Lower Saxony (KFN), Hannover, Germany

Abstract: Introduction: The term Internet addiction encompasses a broad range of activities which in isolation have rarely been studied for
their clinical relevance. This study looks at whether video game addiction and Internet addiction can be regarded as distinct nosological
entities and whether there is a differential impact on those affected. It also aims to describe the type of activities that contribute most to the
addiction. Methods: Data was collected in a school survey of Grade 7 to 10 students (M = 14.5 years; n = 4 436). Besides video game
addiction (CSAS-II) and Internet addiction (CIUS), indicators of media consumption, functional level, well-being, burden for significant
others and psychological strain were collected. Results: Internet and video game addiction can be regarded as two distinct nosological
entities. This differentiation is supported by differences in sociodemographic variables and measures of validation. The subjective suffering
seems to be higher among adolescent video game addicts than Internet addicts. Girls with an Internet addiction cite social networks almost
exclusively as the cause of their problem while boys also name pornography. Discussion: In research on Internet addiction, a greater
differentiation is needed regarding the underlying activities.

Keywords: video game addiction, pathological video game use, online gaming addiction, Internet addiction, social networking addiction

Computerspielsucht und Internetsucht: Ist eine Unterscheidung notwendig?

Zusammenfassung: Einfhrung: Unter dem Begriff Internetsucht wird eine Vielzahl von Aktivitten subsummiert, die bislang kaum in
differenzierter Weise auf ihren Krankheitswert untersucht wurden. In diesem Artikel erfolgt eine differenzielle und empirisch gesttzte
Einordnung der beiden Konstrukte Computerspielsucht und Internetsucht. Computerspielsucht wird dabei als Abhngigkeit von Online-
oder Offlinespielen definiert. Internetsucht wird als Abhngigkeit von anderen Internetaktivitten (nicht Onlinespielen) verstanden. Es
wird berprft, ob sich Computerspielsucht und Internetsucht als distinkte nosologische Entitten voneinander abgrenzen lassen. Ferner
wird untersucht, welche Aktivitten aus Sicht der internetabhngigen Jungen und Mdchen am strksten zu ihrer Sucht beigetragen haben.
Abschließend wird beschrieben, wie stark computerspiel- und internetabhngige Jugendliche durch ihr pathologisches Verhalten beein-
trchtigt sind. Methodik: Datenbasis ist eine Befragung an Schlern 7. bis 10. Klassen (M[Alter] = 14,5; n = 4 436; Rcklaufquote: 84.9 %).
Insgesamt beteiligten sich zehn Schulen an der Befragung (vier Realschulen: 1 286 Schler; vier Gymnasien: 1 815 Schler; zwei Ge-
samtschulen: 1 335 Schler). Erfasst wurden neben Computerspielsucht (CSAS-II) und Internetsucht (CIUS) Primrvalidierungsvariablen
aus den Bereichen subjektive Selbsteinschtzung und Mediennutzung, Maße gesundheitsbezogener Lebensqualitt und Maße des psy-
chosozialen Funktionsniveaus. Zustzlich wurden die krankheitsbedingte Belastung dritter Personen und die subjektive Beeintrchtigung
erhoben. Ergebnisse: Computerspielsucht und Internetsucht lassen sich diagnostisch voneinander abgrenzen und beide Stçrungen bestehen
in den meisten Fllen unabhngig voneinander. Die Abgrenzung beider Stçrungsentitten wird ferner durch soziodemographische Un-
terschiede in den Betroffenengruppen sowie Validierungsmaße gesttzt. Internetschtige Jugendliche sind hufiger weiblich, nutzen ins-
besondere soziale Netzwerke, benennen diese als primr urschlich fr ihre Problematik und ihre Betroffenenzahl nimmt von der 7. bis 10
Jahrgangsstufe tendenziell zu. Computerspielabhngige Jugendliche sind hufiger mnnlich, nutzen insbesondere Onlinespiele, und ihre
Betroffenenzahl nimmt von der 7. bis 10. Jahrgangsstufe tendenziell ab. Insgesamt wird die Nutzung von sozialen Netzwerken vom
berwiegenden Teil der internetschtigen Jugendlichen als urschlich fr ihre Problematik benannt. Internetschtige Mdchen benennen
jedoch hufiger als Jungen soziale Netzwerke als urschlich fr ihre Problematik whrend internetschtige Jungen hufiger als Mdchen die
Nutzung von Internetpornographie dafr verantwortlich machen. Sowohl computerspielschtige als auch internetschtige Jugendliche
erscheinen in Hinblick auf ihre gesundheitsbezogene Lebensqualitt und ihr psychosoziales Funktionsniveau vielfltig belastet. Compu-
terspielschtige Jungen erleben hufiger als internetschtige Jungen Schlafprobleme und mediennutzungsbedingte physische Aggressivitt.
Computerspielabhngige Jungen ußern jedoch in geringerem Maße als internetschtige Jungen Suizidgedanken. Suizidgedanken werden
dahingegen hufiger von computerspielschtigen Mdchen als von internetschtigen Mdchen berichtet. Zudem neigen computerspiel-
schtige Mdchen strker als internetschtige Mdchen dazu, aufgrund der Mediennutzung die Schule zu schwnzen. Insgesamt fllt auch
der subjektive Leidensdruck bei computerspielschtigen hçher als bei internetschtigen Jugendlichen aus. Diskussion: Es zeigt sich, dass
sich Computerspielsucht und Internetsucht sowohl inhaltlich als auch empirisch voneinander abgrenzen lassen. Gleichzeitig weisen Be-
troffene beider Stçrungsentitten in einer Weise Beeintrchtigungen auf, dass von einer klinisch relevanten Problematik ausgegangen
werden kann. Wenngleich die Nutzung sozialer Netzwerke aus Sicht der internetschtigen Jugendlichen am meisten zu ihrer Problematik

DOI: 10.1024/0939-5911.a000245 SUCHT 59 (3)  2013 Verlag Hans Huber, Hogrefe AG, Bern
130 F. Rehbein & T. Mçßle: Video Game and Internet Addiction
beitrgt, sollten weitere Differenzierungen zwischen Subtypen der Internetsucht erfolgen und empirisch untersucht werden. Im Hinblick auf
Internetglcksspielsucht und Internetkaufsucht, die zumindest im Jugendalter kaum zum Phnomen Internetsucht beitragen, sollte alter-
nativ eine Zuordnung zu den bereits etablierten Stçrungskategorien und eine Herauslçsung aus dem Konstrukt Internetsucht geprft
werden.
Schlsselwçrter: Computerspielabhngigkeit, Computerspielsucht, pathologische Computerspielnutzung, Onlinespielsucht, Internetsucht
Introduction
As early as in 1999, Young and colleagues stated that the
Internet enables a range of different activities which can
result in behavioral addiction (Young, Pistner, OMara, &
Buchanan, 1999; see also Brand and Laier in this journal, pp.
143 – 152). Since then, most studies have conceived the
proposed Cyber Disorders as a nosological entity, based on
the assumption that all pathological Internet activities could
be measured as a coherent psychopathological phenomenon
(Rehbein & Mçßle, 2012).
However, recent studies showed that Internet addiction
could be best predicted cross-sectionally by gaming (Meer-
kerk, van den Eijnden, & Garretsen, 2006; Siomos, Dafouli,
Braimiotis, Mouzas, & Angelopoulos, 2008; van Rooij,
Schoenmakers, van de Eijnden, & van de Mheen, 2010) and
longitudinally by the use of pornography (Meerkerk et al.,
2006). Moreover, in a more descriptive manner, the very
recent German PINTA-study (Prvalenz der Internetab-
hngigkeit – Prevalence of Internet Addiction) showed that
social networking is the main activity and online gaming the
second most frequent activity pursued by individuals with
an Internet addiction (Rumpf, Meyer, Kreuzer, & John,
2011). These results, which indicate gaming and social
networking being of particular importance for Internet
addiction, raise the question, whether all activities postu-
lated by Young and colleagues contribute to the concept of
Internet addiction in a significant manner.
Apart from empirical results, the term Internet addic-
tion can be criticized as well (Rehbein & Mçßle, 2012).
Although the term is certainly helpful in order to describe
the breadth of this comparatively new research field, a
number of reasons point to a need for more distinct
definitions:
– The term Internet addiction is vague: A stream of digital
data is just as unlikely to cause a psychological depend-
ency as the consumption about glass fiber cables.
Consequently, no one talks of casino addiction, but
rather assumes that the pathological behavior demon-
strated is linked to the gambling opportunities offered in
such establishments.
– The term Internet addiction can be criticized as infla-
tionary: It places many types of online behavior under a
general psychopathological suspicion. It can be assumed,
however, that many online activities have no significant
impact on human health and do not meet the criteria for
a psychological disorder.
– The term Internet addiction overlaps with certain psycho-
logical disorders which are already recognized (patho-
SUCHT 59 (3)  2013 Verlag Hans Huber, Hogrefe AG, Bern
logical gambling) or whose recognition as an addictive
behavior is also discussed independently of the Internet
(compulsive shopping disorder, sex addiction). In those
cases, the Internet can also be seen as a new venue for
traditional behavioral addictions.
– The term Internet addiction covers video game addiction
only partially: Internet addiction usually includes video
game addiction, but understands the latter exclusively as
an addiction to online gaming. Although the risk
involving online games is particularly high, there is
evidence that games can be used in a psychologically
dependent way without an active Internet connection
(e. g. purely offline games and offline gaming modes).
To further develop a conceptual foundation it appears
useful to identify subforms of Internet addiction and to
study them separately for their clinical relevance. To date,
two main research areas exist in relative isolation from one
another (Rehbein & Mçßle, 2012):
1. Studies on Internet addiction which among other
Internet activities include video game addiction as
online gaming addiction. These studies are subject to
the restrictions outlined above.
2. Studies on video game addiction (online and offline
games) which allow no conclusions to be drawn regard-
ing the clinical relevance of other psychopathological
behaviors arising from Internet and computer use.
Previous research indicated that both, video game and
Internet addiction, reflect a clinical significant phenomenon
(Kuss & Griffiths, 2011, 2012a, 2012b; Widyanto & Griffiths,
2006). Both concepts start at the premise, that media usage
can indeed be pathologic in that way that affected people
experience symptoms of a behavioral addiction, show a
clinical relevant psychological strain and continue their
behavior despite negative psychosocial consequences (Reh-
bein, Mçßle, Arnaud, & Rumpf, 2013). However, both
concepts clearly differ in that Internet addiction comprises a
wide range of Internet activities whereas video game
addiction exclusively covers gaming behavior. Additionally,
the two constructs are not distinct, as online gaming acts as a
behavioral overlap between both concepts (see Figure 1).
As a consequence findings of both research fields are
usually not comparable, what complicates data interpreta-
tion (see for example the review of Kuss & Griffiths, 2012b).
Thus, from the current state of research, it is impossible to
arrive at a differentiated understanding of both concepts
and at a comparative evaluation of the clinical relevance of
video game and Internet addiction.
 F. Rehbein & T. Mçßle: Video Game and Internet Addiction
An initial step could thus involve disbanding the
existing overlap of the two terms Internet addiction and
video game addiction, and recognizing them as two
separate nosological entities. Thus, the aim of this paper
is to arrive at discrete, empirically supported constructs of
video game addiction and Internet addiction. For this
purpose, video game addiction is defined as addiction to
both online and offline games. Internet addiction is defined
as addiction to other Internet activities (except online
gaming) which are to be described in detail.
Research questions
Due to the lack of research distinguishing video game
addiction from the broader concept of Internet addiction,
the study at hand is explorative in nature.
A first aim is to analyze, whether there are indications of
two distinct nosological entities of Internet and video game
addiction. The following research questions are to be
answered:
1. Do video game addiction and Internet addiction occur
independently from one another or are they mainly to
be seen as comorbid?
2. Do Internet and video game addicted youths differ in
sociodemographic characteristics such as gender, age
and educational level?
3. Can the differentiation between video game addiction
and Internet addiction be substantiated by primary
validation measures of self-evaluation and media use?
131
Figure 1. Current conceptualization of
Internet addiction and video game ad-
diction. The dotted line refers to the
common inclusion of online game ad-
diction among the concept of Internet
addiction and thus to the behavioral
overlap of Internet and video game ad-
diction. In the study at hand, Internet
addiction is defined as an addiction from
Internet activities except online gaming.
The second aim is to achieve a deeper understanding of
the heterogeneous construct of Internet addiction. The
following research questions are to be answered:
4. Which Internet activities mostly contribute to Internet
addiction among adolescents?
5. Do Internet addicted boys and girls differ in those
activities contributing to their addiction?
The third aim is to evaluate to which extent video game
and Internet addicted youths are impaired by their
pathological behavior:
6. To which extent do video game and Internet addicted
youths show impairment regarding measures of well-
being?
7. To which extent do video game and Internet addicted
youths show impairment regarding functional level?
8. To which extent do video game and Internet addicted
youths exhibit a burden for significant others and
psychological strain?
Methods
Sample
The sample comprises the first wave of a three-wave
longitudinal study in the region of Hanover, Germany (n =
4 436). The study was conducted as a full survey of all 7th to
10th grade students in ten schools, which were selected by
regional aspects to be spread as evenly as possible in the
urban and rural districts of Hanover (two middle secondary
schools, two high secondary schools and one comprehen-
sive school respectively; 14 schools had initially been
SUCHT 59 (3)  2013 Verlag Hans Huber, Hogrefe AG, Bern
132 F. Rehbein & T. Mçßle: Video Game and Internet Addiction
contacted). The first wave of data collection was conducted
in September 2011. Out of the gross sample of 10 schools
with 196 classes and 5227 students, 186 classes and 4462
students participated. Regarding those 765 students who
did not participate, 172 students could not be surveyed due
to a total loss of 7 classes. Additionally, 316 students were
absent at the day of data collection, 201 students did not
have parental consent to participate and 76 students were
not willing to participate. A further number of 26 ques-
tionnaires had to be excluded afterwards because of
evidently implausible data, thus leading to a sample of
4436 valid datasets (1286 secondary school students; 1815
high secondary school students; 1335 comprehensive
school students). Taking the total loss of 7 missing classes
into account this leads to a response rate of 84.9 percent
(without this total loss the response rate is 87.8 percent).1
The average age of participants is 14.5 years (SD = 1.31).
48.4 percent of the sample are male, 32.4 percent of the
students have a migration background (a migration back-
ground was assumed, if the student or at least one of the
students parents was not born in Germany).
A 31-page standardized questionnaire was adminis-
tered in class context. The questionnaire was completed by
the students on their own, following the instructions of a
trained interviewer. Teachers where present in the class-
room during completion of the survey. Total time for each
data collection was two school lessons (90 minutes). The
study and the associated data protection concept were
approved by the state school authorities. Additionally,
active consent was obtained from respondents parents,
who were explicitly informed about the study a few weeks
prior to data collection. Students, who were not allowed to
participate by their parents, did not take part in the survey.
The students themselves were informed about the study as
well and could deny participation at any point of data
collection, regardless of given parental consent. They were
also informed about their right to refuse answering
individual items and that there are no disadvantages
when refusing participation. Respondents were assured
that their answers would be analyzed only by the principal
investigators, and not shown to their teachers or parents.
Measures
Video game addiction and Internet addiction
Both the video game addiction scale (CSAS-II; Rehbein ,
Kleimann, & Mçßle, 2010) and the Compulsive Internet
Use Scale (CIUS; Meerkerk, Van Den Eijnden, Vermulst,
1
The response rate for school grades and school types in detail:
7th grade: 85.0 %, 8th grade: 88.0 %, 9th grade: 89.3 %, 10th
grade: 77.0 %, secondary school students: 85.6 %, higher se-
condary schools: 89.3 %, comprehensive schools: 78.9 %).
The lower response rates in 10th grade and in comprehensive
schools are due to the fact, that these were mainly affected by a
total loss of classes (without total loss, retention rate in 10th
grade is 89.1 % and 86.5 % in comprehensive schools).
SUCHT 59 (3)  2013 Verlag Hans Huber, Hogrefe AG, Bern
& Garretsen, 2009; German translation: Rumpf et al.,
2011) were used. The two constructs were measured in
sequence in separate questionnaire modules. Before com-
pleting the CIUS, students were told that in this context
Internet meant all online activities except online gaming.
The CSAS-II consists of 14 Items (4-point scale: 1,
incorrect, to 4, absolutely true) and covers the dimensions
preoccupation/salience, conflict, loss of control, withdrawal
symptoms and tolerance (Range: 14 – 56, a = .93). In the
CSAS-II video game addiction can be assumed for students
with an overall total of 42 or more points, by which on
average all items meet with approval (Rehbein et al., 2010).
The CIUS consists of 14 Items (5-point scale: 0, never, to 4,
very often) and covers the dimensions preoccupation, loss
of control, withdrawal symptoms, conflict and coping
(Range: 0 – 56, a = .92). In the CIUS Internet addiction
can be assumed from an overall total score of 30 points. This
classification is in line with the latent class analysis based
PINTA-study classification (Rumpf et al., 2012). Addi-
tionally, to further differentiate students who might show
both, signs of Internet and video game addiction, we asked
all students if they spend most of their time on video games
or on Internet activities such as downloading of data files,
shopping, gambling, social networking or pornography. To
give a broader picture of the perception of their own
addiction, additional data was evaluated only for video
game or Internet addicted students. To avoid inappropriate
labeling, these questions were only presented to students
who regarded themselves as being at least slightly addicted
to the Internet or video games. The relevance of different
Internet activities for Internet addicted students was
measured by asking “Which Internet activity mostly
contributed to your addiction?”: Downloading of data
files, shopping, gambling, social networking or pornogra-
phy.
Primary validation
For a self-evaluation of video game addiction and Internet
addiction, participants were questioned on two 4-point
items (no to severely), “Do you believe you are dependent
on video games, similar to an addiction?” and “Do you
believe you are dependent on the Internet, similar to an
addiction?”. These items were dichotomized, as self-
evaluation of addiction was assumed if students quoted at
least slightly. Participants were also asked to estimate the
time they spent on four different media activities on school
days and on weekend days (15-point scale: 0 minutes to 7
hours and more): Online gaming, offline gaming, social
Internet activities (networking/chatting) and other Internet
activities (e. g. videos, shopping, downloading). For all four
activities, a daily usage time was calculated ([school day x 5
+ weekend day x 2]/7).
 F. Rehbein & T. Mçßle: Video Game and Internet Addiction
Wellbeing
Time of sleep was calculated as the interval between the
time of going to bed the day before and the time of getting
up on the day of the interview (33-point time scale: 15-
minute breakdown). Additionally, participants were asked
whether they had difficulties in falling asleep in the past
week (5-point scale: never to always). Sleep disturbance
was dichotomized and coded if participants quoted always.
To measure the students health-related quality of life in the
past week, three scales of the Kiddo-KINDLR (Ravens-
Sieberer & Bullinger, 2000) were used: Physical wellbeing
(4 items), mental wellbeing (4 items) and self-esteem (4
items). Finally, to measure suicidal thoughts, the item “I
repeatedly think of death or about killing myself” (4-point
scale: not at all to extraordinary) of the depression scale of
the DISYPS-II was used (Dçpfner, Gçrtz-Dorten, &
Lehmkuhl, 2008). Frequent thoughts of suicide was dicho-
tomized and coded, if participants quoted substantial or
extraordinary.
Functional level
To measure the students perception of their own ability to
meet daily challenges, the scale functional level in everyday
life (4 items) of the Kiddo-KINDLR (Ravens-Sieberer &
Bullinger, 2000) was used. To measure academic perform-
ance, participants stated their grades of the last school
report in four subjects: German, Mathematics, English and
Biology (1, very good to 6, inadequate). Based on these
statements, a grade point average was calculated. Students
were also asked whether they had skipped single lessons or
whole school days in the past six months. Based on this
information, the number of skipped lessons was calculated
(school days x 5 + single lessons). Additionally, participants
stated whether media use in form of Internet activities or
gaming (2-point scale: yes or no) was a reason for their
truancy in the past six months. Finally, to also measure
functional impairment of social behavior, we measured
media related aggressive behavior, using the two single
items (2-point scale: yes or no) “Did you ever attack or hurt
another person in order to play video games (e. g. because
that person didnt want you to play that much)?” and “Did
you ever attack or hurt another person in order to use the
Internet (e. g. because that person didnt want you to use
the Internet that much)?”. If a student stated yes in one or
two of this questions, physical assault in order to use media
was coded.
Burden for significant others and psychological strain
To avoid inappropriate labeling, these questions were only
presented to students who regarded themselves being at
least slightly addicted to the Internet respectively video
games. These students were questioned on two 4-point
items (not at all, slightly, considerably, severely) “Do you
133
suffer from your addiction?” and “Do you find your
addiction to give others a hard time (parents, friends,
teachers)?”.
Statistical Analyses
Analyses were carried out with Stata 12 and IBM SPSS 19.
In a first step, t-tests, chi-square-tests and ANOVAs were
performed to test for differences regarding gender, school
year and type of school. To determine whether video game
and Internet addicted youths differ in regard to the
outcome measures of primary validation, media use, well-
being and functional level, ANCOVAs were performed.
For these analyses, a main group of students was used as a
reference group for video game and Internet addicted
students. Only students who in accordance with CSAS-II
(sum score < 35) and CIUS (sum score < 20) were not
classified as conspicuous were assigned to the main group.
To prevent a possible confounding effect of gender, these
analyses were carried out separately for boys and girls. As a
confounding effect of age could also be assumed, age was
controlled as a covariate. Gender differences regarding the
most relevant activities of Internet addicted students were
tested using Fishers exact test. Finally, differences between
video game and Internet addicted youths regarding burden
of addiction for significant others and psychological strain
were tested using chi-square-tests and Fishers-exact test.
Results
The daily average amount of time students spent playing
video games is 1 hour and 38 minutes. Students average
daily Internet use was 2 hours and 53 minutes. Based on the
CSAS-II, 1.3 percent of adolescents (n = 52) are classified
as video game addicted. Based on the CIUS, 4.7 percent
(n = 200) are classified as Internet addicted.
Are video game and Internet addiction
distinct nosological entities?
The first research question is, whether video game and
Internet addiction occur independently from one another
or if they are mainly comorbid. Overall, 13 students are
classified as both, video game addicted and Internet
addicted, while all other students (n = 226) are classified
either exclusively as Internet addicted or exclusively as
video game addicted. Thus, video game and Internet
addiction can – and in most cases do – occur independently
from one another. On the other hand, a relevant comor-
bidity has to be taken into account, as 6.5 percent of the
Internet addicted students (13 out of 200) also fulfill the
criteria for video game addiction and 26 percent of the
video game addicted youths (13 out of 52) also fulfill the
criteria for Internet addiction. In order to precisely allocate
SUCHT 59 (3)  2013 Verlag Hans Huber, Hogrefe AG, Bern
134 F. Rehbein & T. Mçßle: Video Game and Internet Addiction
those 13 cases with dual diagnosis, the time spent with video
games and internet activities was consulted. Ten students
reported spending most of their time on video games and
thus were classified as primarily video game addicted.
Three students reported spending most of their time on
Internet activities and were thus classified as primarily
Internet addicted.
The second research question is, whether Internet and
video game addicted youths differ in sociodemographic
characteristics (see Table 1). Our data indicate that far
more boys (2 %) are video game addicted than girls
(0.5 %). In the case of Internet addiction, the gender
ratio is reversed, with more girls (6.6 %) than boys (2.8 %)
being affected. Regarding school year, Internet addiction
occurs more often in 9th and 10th grade than in earlier school
years, whereas video game addiction occurs more often in
7th and 8th grade than in later school years. This result is also
reflected in the sum-scores of the CSAS-II and CIUS, as
CSAS-II scores tend to be lower with higher school year,
whereas the CIUS scores tend to be higher with higher
school year. However, both disorders appear similar
regarding their occurrence in different school types. The
highest prevalence rates for both disorders are estimated
for secondary school students.
The third question is, whether measures of primary
validation substantiate the differentiation between video
game addiction and Internet addiction (see Tables 2 and 3).
Only about 19 percent of the main group of boys and
2 percent of the main group of girls, but 90 percent of video
game addicted boys and 56 percent of the video game
addicted girls believe that they are addicted to video games.
In a similar way, only about 9 percent of the main groups of
boys and girls but 62 percent of the Internet addicted boys
and 72 percent of the Internet addicted girls evaluate
themselves as Internet addicted. Moreover, video game
addicted boys and girls evaluate themselves more often as
video game addicted than Internet addicted boys and girls.
Regarding Internet addiction, only Internet addicted girls
evaluate themselves more often as being Internet addicted
than video game addicted girls. Internet addicted boys and
video game addicted boys, however, do not differ regarding
their self-evaluation of Internet addiction. Nonetheless, in
the subjective self-assessments, overlaps occur between the
two constructs: A high proportion of those students
classified as video game addicted also see themselves as
Internet addicted (boys: 58 %, girls: 43 %), and a substan-
tial proportion of those classified as Internet addicted also
evaluate themselves as video game addicted (boys: 57 %,
girls: 11 %).
As expected, media use largely corresponds with the
two constructs: Video game addicted youths spend most of
their media time on online games and Internet addicted
youths spend most of their time with social networking.
Moreover, video game addicted students exhibit higher
online gaming times (not offline gaming time) than Internet
addicted students. Internet addicted boys exhibit higher
social networking times (not time on other Internet
activities) than video game addicted boys. Regarding
SUCHT 59 (3)  2013 Verlag Hans Huber, Hogrefe AG, Bern
Internet use, no significant differences could be found
between Internet and video game addicted girls.
Which Internet activities contribute to
Internet addiction in boys and girls?
Overall, Internet addicted adolescents tend to report social
networking as the main cause of their addiction (88.6 %,
see Figure 2). For girls, the picture is very clear, with about
96 percent stating that social networks contributed most to
their addiction. This is different for boys, with about 62
percent citing social networking and about 38 percent citing
other activities, particularly online pornography use
(17.2 %) as the main cause of their problem. Thus, social
networking is more often the main problem for Internet
addicted girls than for boys, the use of pornography is more
often the main problem for boys than for girls. Regarding
the other activities, no differences between boys and girls
could be substantiated.
To which extent are video game and Internet
addicted youths impaired?
With regard to objective measures of wellbeing (see Tables 2
and 3), compared to the main group, video game addicted
youths exhibit reduced time of sleep (only boys), are more
often strained by sleep disturbance, show signs of reduced
physical and mental wellbeing (only girls) and do more
often exhibit suicidal ideation. In a similar way, compared to
the main group, Internet addicted youths show reduced time
of sleep, are more often strained by sleep disturbance (only
girls), show signs of reduced physical and mental wellbeing
and do more often exhibit suicidal ideation. However, no
group differences could be observed regarding self-esteem.
Regarding the measures of wellbeing, the highest overall
effect sizes could be observed for suicidal ideation (boys:
gp2 = .076, girls: gp2 = .048). Comparing both disorders,
sleep disturbance is more often reported by video game
addicted (18 %) than by Internet addicted boys (7 %).
Regarding frequent suicidal thoughts, video game addicted
boys (13 %) are less affected than Internet addicted boys
(31 %) and video game addicted girls (43 %) are more
affected than Internet addicted girls (20 %).
With regard to objective measures of functional level
(see Table 2 and 3), compared to the main group, video
game addicted youths exhibit a reduced functional level in
daily live and a higher grade point average, indicating
poorer school performance. Additionally, video game
addicted youths more often name media activities as a
reason for skipping school lessons in the past school year.
However, skipped school lessons are not significantly
elevated in video game addicted youths. Finally, video
game addicted youths more often state media use related
aggressive behavior (only boys). In a similar way, compared
 Table 1
Age, media use, video game addiction and Internet addiction by sample characteristics

N Age Use time Use time Use time Use time Sum-Score Sum-Score Prevalence Prevalence
Games: Games: Internet: Internet: CSAS-II CIUS Video Internet Addiction
Online Offline Social Other (14 – 56) (0 – 42) Game
Net. Activities Addiction
M (SD) M (SD) M (SD) M (SD) M (SD) M (SD) M (SD) % %

Total Sample N = 4 436 14.5 (1.3) 0:58 (1:31) 0:40 (1:06) 1:53 (1:45) 1:00 (1:11) 5.4 (7.0) 10.2 (9.6) 1.3 4.7
Gender
Male n = 2 129 14.5 (1.3) 1:32 (1:46) 1:02 (1:15) 1:40 (1:41) 1:03 (1:12) 22.0 (7.5) 9.1 (8.8) 2.0 2.8
Female n = 2 271 14.5 (1.3)ns 0:26 (0:59)*** 0:20 (0:48)*** 2:06 (1:47)*** 0:58 (1:09)* 16.3 (4.6)*** 11.2 (10.3)*** 0.5*** 6.6***
School year
7th grade n = 1 072 13.0 (.6) 0:56 (1:25) 0:40 (1:05) 1:23 (1:34) 0:48 (1:04) 19.8 (7.5) 7.9 (9.5) 1.9 3.6
8th grade n = 1 176 14.0 (.6) 0:59 (1:28) 0:46 (1:09) 1:42 (1:35) 0:58 (1:08) 19.5 (7.0) 9.2 (9.1) 2.0 3.5
9th grade n = 1 198 15.0 (.6) 1:02 (1:37) 0:39 (1:06) 2:10 (1:49) 1:08 (1:15) 19.4 (6.8) 11.7 (9.9) 0.5 6.3
10th grade n = 990 16.2 (.7)*** 0:55 (1:33)ns 0:35 (1:06)*** 2:20 (1:51)*** 1:08 (1:13)*** 18.6 (6.3)** 11.9 (9.5)*** 0.6** 5.5**
Type of school
Secondary n = 1 286 14.8 (1.3) 1:19 (1:45) 0:48 (1:15) 2:20 (1:55) 1:17 (1:22) 20.1 (7.6) 11.5 (10.5) 1.9 6.6
Comprehensive n = 1 335 14.4 (1.3) 1:06 (1:39) 0:48 (1:14) 2:10 (1:53) 1:06 (1:17) 19.3 (7.3) 10.0 (9.9) 1.7 4.9
High Secondary n = 1 815 14.3 (1.3)*** 1:38 (1:07)*** 0:29 (0:51)*** 1:23 (1.22)*** 0:45 (0:51)*** 18.9 (6.1)*** 9.3 (8.7)*** 0.5*** 3.4***

Note. Video game addiction was classified if CSAS-II >= 42. Internet addiction was classified if CIUS >= 30. Test of significance of continuous variables for gender by t-test (2-tailed). Test
of significance of continuous variables for school year and type of school by ANOVA. Test of significance for prevalence of video game and Internet addiction by means of Chi Square
Statistic.
*p < .05; **p < .01; ***p < .001; ns, not significant.
F. Rehbein & T. Mçßle: Video Game and Internet Addiction

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135
136 F. Rehbein & T. Mçßle: Video Game and Internet Addiction
to the main group, Internet addicted youths exhibit a
reduced functional level in daily live and a higher grade
point average, indicating poorer school performance.
Additionally, Internet addicted youths more often name
media activities as a reason for skipping school lessons in
the past school year. Corresponding to this result, skipped
school lessons are significantly elevated in Internet addict-
ed youths. Finally, Internet addicted youths more often
state media use related aggressive behavior. Regarding the
measures of functional level, the highest overall effect sizes
could be observed in media use related aggressive behavior
for boys (gp2 = .063) and in functional level in everyday live
for girls (gp2 = .062). Comparing both disorders, media
related aggressive behavior is more often reported by video
game addicted (30 %) than by Internet addicted boys
(19 %). Regarding media use as a motive for truancy, video
game addicted girls (22 %) are more often affected than
Internet addicted girls (9 %).
Regarding the subjective measure of burden for sig-
nificant others, no differences between video game addicted
and Internet addicted adolescents could be observed (see
Figure 3). Some 24 percent of video game addicted and
around 21 percent of Internet addicted students believe
people close to them are either considerably or severely
affected. The vast majority of those affected see their
addiction only as slightly impacting others or not at all.
When it comes to the subjective measure of psycho-
logical strain, significant differences arise between the
groups (see Figure 4). While about 16 percent of the
Internet addicted report suffering either considerably or
severely, the figure for the video game addicted is with 45
percent distinctly higher. However, a large proportion of
video game addicted adolescents, and especially of those
with an Internet addiction, experience psychological strain
only slightly or not at all.
SUCHT 59 (3)  2013 Verlag Hans Huber, Hogrefe AG, Bern
Figure 2. Most addiction-relevant Internet
activities as seen from the perspective of
Internet addicted students (n = 32 boys, n
= 103 girls). Test of significance by means
of Fishers exact test. *p < .05; **p < .01;
***p < .001; ns, not significant.
Discussion
The prevalence figures of video game and Internet
addiction of this study appear to be in line with data of
other studies with adolescent samples in Germany. In the
representative PINTA-study 4 percent of the 14 to 16 year-
olds were classified as addicted (Rumpf et al., 2011). With
4.7 percent Internet addicted adolescents, our prevalence
estimate is only marginally higher. A German-wide
representative survey of ninth graders indicated that 1.7
percent of the students were addicted to video games
(Rehbein et al., 2010). In a representative telephone
survey in Germany 0.9 percent of 14 to 19 year-old gamers
were classified as video game addicted (Schmidt, Drossel-
meier, Rohde, & Fritz, 2011). The prevalence rate (1.3
percent) reported in the present study, thus is in between
these two estimates.
The primary goal was to validate the assumption that
video game and Internet addiction could be diagnostically
distinguished one from another and could be considered as
distinct nosological entities. Our data indicate that most
adolescents could be conclusively classified as either non-
addicted, video game addicted or Internet addicted. Look-
ing at it the other way around, if Internet and video game
addiction were roughly the same, most of the addicted
youths should have been classified both video game and
Internet addicted. This is not the case, as 26 percent of the
video game addicted students also fulfill the criteria for
Internet addiction and only 6.5 percent of the Internet
addicted students also fulfill the criteria for video game
addiction. The remaining overlap between both disorders
could be interpreted as comorbidity that can presumably
arise between various sub-forms of media related addic-
tions. Overall, it seems plausible that despite having
separated video game and Internet addiction, certain
overlaps between both constructs remain: Individuals
with a video game addiction, for example, can build
stronger ties to online friendships and tend as a result to
 Table 2
Comparison of main group of boys, video game addicted boys and Internet addicted boys

Main group of boys Video game addicted boys Internet addicted boys (IA)
n = 1 773 (VGA) n = 47
n = 40
M (SE) 95 % CI M (SE) 95 % CI M (SE) 95 % CI VGA vs. IA Statistics

Primary validation
Self-evaluation: .19 (.01) [.17, .21] .90 (.06)*** [.77, 1.00] .57 (.06)*** [.45 .68] VGA > IA*** F(2, 1714) = 75.71, p < .001, gp2 = .081
Video game addiction
Self-evaluation: .09 (.01) [.07, .10] .58 (.05)*** [.49, .67] .62 (.04)*** [.53 .70] VGA = IA F(2, 1756) = 124.61, p < .001, gp2 = .124
Internet addiction
Online gaming time 1:19 (0:02) [01:15, 01:24] 4:16 (0:15)*** [03:46, 04:46] 2:34 (0:14)*** [02:06, 03:01] VGA > IA*** F(2, 1775) = 76.91, p < .001, gp2 = .080
(h:min)
Offline gaming time 0:59 (0:02) [00:55, 01:02] 1:28 (0:12)* [01:05, 01:51] 1:43 (0:11)*** [1:22, 2:05] VGA = IA F(2, 1774) = 10.90, p < .001, gp2 = .012
(h:min)
Internet: Social networking 1:31 (0:02) [01:26, 01:35] 2:29 (0:15)*** [02:00, 02:58] 3:18 (0:14)*** [2:51, 3:45] VGA < IA* F(2, 1780) = 37.29, p < .001, gp2 = .040
(h:min)
Internet: Other activities 0:56 (0:02) [00:53, 00:59] 2:04 (0:11)*** [01:43, 02:24] 1:46 (0:10)*** [1:27, 2:05] VGA = IA F(2, 1781) = 32.45, p < .001, gp2 = .035
(h:min)
Wellbeing
Time of Sleep 8:13 (0:02) [08:09, 08:16] 7:03 (0:12)*** [06:40, 07:27] 7:32 (0:11)*** [07:10, 07:53] VGA = IA F(2, 1801) = 22.21, p < .001, gp2 = .024
(h:min)
Sleep disturbance .02 (.00) [.02, .03] .18 (.03)*** [.12, .23] .07 (.02)ns [.02, .11] VGA > IA** F(2, 1798) = 17.74, p < .001, gp2 = .019
Physical wellbeing 16.0 (.06) [15.9, 16.1] 15.6 (.41)ns [14.8, 16.4] 14.5 (.38)*** [13.8, 15.3] VGA = IA F(2, 1774) = 7.06, p < .001, gp2 = .008
Mental wellbeing 16.4 (.06) [16.3, 16.5) 15.7 (.37)ns [15.0, 16.4] 14.8 (.33)*** [14.1, 15.4] VGA = IA F(2, 1781) = 13.92, p < .001, gp2 = .015
Self-esteem 14.2 (.07) [14.1, 14.3] 13.2 (.45)ns [12.3, 14.1] 13.6 (.41)ns [12.8, 14.4] VGA = IA F(2, 1737) = 3.45, p < .05, gp2 = .004
Frequent thoughts .02 (.00) [.01, .03] .13 (.03)*** [.08, .18] .31 (.02)*** [26., .35] VGA < IA*** F(2, 1770) = 73.19, p < .001, gp2 = .076
of suicide
Functional level
Functional level 14.3 (.06) [14.1, 14.4] 12.8 (.42)** [12.0, 13.6] 12.6 (.39)*** [11.9, 13.4] VGA = IA F(2, 1743) = 14.06, p < .001, gp2 = .016
in everyday life
F. Rehbein & T. Mçßle: Video Game and Internet Addiction

Grade Point Average 3.0 (.02) [3.0, 3.0] 3.4 (.11)** [3.2, 3.6] 3.3 (.10)* [3.1, 3.5] VGA = IA F(2, 1712) = 7.83, p < .001, gp2 = .009
Skipped lessons 3.8 (.35) [3.1, 4.5] 9.2 (2.33)ns [4.6, 13.7] 11.9 (2.17)*** [7.7, 16.2] VGA = IA F(2, 1805) = 9.28, p < .001, gp2 = .010
Media use related .03 (.01) [.02, .04] .23 (.03)*** [.17, .29] .23 (.03)*** [.18, .27] VGA = IA F(2, 1798) = 44.14, p < .001, gp2 = .047
truancy
Media use related .03 (.00) [.02, .04] .30 (.03)*** [.24, .36] .19 (.03)*** [14., .24] VGA > IA* F(2, 1796) = 60.39, p < .001, gp2 = .063
aggressive behavior

Note. CI = confidence interval. Only students were assigned to the main group who in accordance with CSAS-II and CIUS were not classified as conspicuous (CSAS-II < 35 & CIUS < 20).
Video game addiction was classified if CSAS-II >= 42. Internet addiction was classified if CIUS >= 30. Grades at school correspond to the German grading system: 1, very good, to 6,
inadequate. Test of significance by ANCOVA. All means are adjusted for the effect of age. Post hoc comparisons of main effects with Bonferroni corrected values. In the columns of VGA
and IA, the deviation from the main group of boys is given. In the column VGA vs. IA the deviation of both disorders is given.

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137

*p < .05; **p < .01; ***p < .001; ns, not significant.
 Table 3
138

Comparison of main group of girls, video game addicted girls and Internet addicted girls

Variables Main group of girls Video game addicted girls Internet addicted girls (IA)
n = 1 796 (VGA) n = 143
n=9
M (SE) 95 % CI M (SE) 95 % CI M (SE) 95 % CI VGA vs. IA Statistics

Primary validation
Self-evaluation: .02 (.00) [.01, .03] .56 (.06)*** [.45, .66] .11 (.02)*** [.08, .15] VGA > IA*** F(2, 1471) = 57.98, p < .001, gp2 = .073
Video game addiction
Self-evaluation: .09 (.01) [.08, .11] .43 (.11)** [.20, .65] .72 (.03)*** [.67, .77] VGA < IA* F(2, 1880) = 290.30, p < .001, gp2 = .236
Internet addiction
Online gaming 0:23 (0:01) [00:20, 00:26] 3:52 (0:18)*** [03:17, 04:28] 0:41 (0:05)*** [00:32, 00:50] VGA > IA*** F(2, 1883) = 72.89, p < .001, gp2 = .072
time (h:min)
Offline gaming time 0:19 (0:01) [00:17, 00:21] 0:55 (0:15)ns [00:25, 01:25] 0:24 (0:04)ns [00:16, 00:31] VGA = IA F(2, 1886) = 3.41, p < .05, gp2 = .004
(h:min)
Internet: Social 1:42 (0:02) [01:38, 01:47] 2:50 (0:30)ns [01:52, 03:49] 3:59 (0:08)*** [03:44, 04:14] VGA = IA F(2, 1886) = 151.62, p < .001, gp2 = .139
networking (h:min)
Internet: Other 0:49 (0:02) [00:46, 00:52] 1:20 (0:21)ns [00:39, 02:01] 1:47 (0:05)*** [01:37, 01:57] VGA = IA F(2, 1889) = 54.84, p < .001, gp2 = .055
activities (h:min)

SUCHT 59 (3)  2013 Verlag Hans Huber, Hogrefe AG, Bern

Wellbeing
Time of 8:16 (0:02) [08:12, 08:19] 7:44 (0:25)ns [06:56, 08:33] 7:31 (0:06)*** [07:19, 07:44] VGA = IA F(2, 1895) = 23.10, p < .001, gp2 = .024
Sleep (h:min)
Sleep disturbance .04 (.01) [.03, .05] .22 (.07)* [.09, .35] .11 (.02)*** [.08, .15] VGA = IA F(2, 1894) = 13.04, p < .001, gp2 = .014
Physical wellbeing 15.0 (.07) [14.9, 15.1] 12.1 (.96)** [10.2, 14.0] 12.8 (.25)*** [12.3, 13.3] VGA = IA F(2, 1878) = 41.06, p < .001, gp2 = .042
Mental wellbeing 16.1 (.06) [15.9, 16.2) 13.4 (.88)** [11.7, 15.2) 14.4 (.23)*** [13.9, 14.8) VGA = IA F(2, 1872) = 30.96, p < .001, gp2 = .032
Self-esteem 13.4 (.07) [13.2, 13.5] 11.1 (1.00)ns [9.2, 13.1] 12.1 (.24)*** [11.6, 12.5] VGA = IA F(2, 1839) = 15.57, p < .001, gp2 = .017
Frequent thoughts of suicide .04 (.01) [.03, .05] .43 (.08)*** [.27, .59] .20 (.02)*** [.17, .24] VGA > IA* F(2, 1883) = 47.81, p < .001, gp2 = .048
Functional level
Functional level 13.9 (.06) [13.8, 14.1] 11.4 (.87)* [9.8, 13.1] 11.4 (.23)*** [11.0, 11.9] VGA = IA F(2, 1812) = 60.02, p < .001, gp2 = .062
in everyday life
F. Rehbein & T. Mçßle: Video Game and Internet Addiction

Grade Point 2.8 (.02) [2.8, 2.8] 3.7 (.26)** [3.2, 4.2] 3.3 (.06)*** [3.2, 3.4] VGA = IA F(2, 1804) = 31.52, p < .001, gp2 = .034
Average
Skipped 3.2 (.31) [2.6, 3.8] 6.9 (4.36)ns [0.0, 15.5] 9.9 (1.11)*** [7.7, 12.1] VGA = IA F(2, 1900) = 17.21, p < .001, gp2 = .018
lessons
Media use .01 (.00) [.00, .01] .22 (.04)*** [.14, .30] .09 (.01)*** [.07, .11] CSA > IA** F(2, 1891) = 39.49, p < .001, gp2 = .040
related truancy
Media use related .01 (.00) [.00, .02] .00 (.04)ns [.00, .08] .11 (.01)*** [.08, .13] CSA = IA F(2, 1884) = 34.60, p < .001, gp2 = .035
aggressive behavior

Note. CI = confidence interval. Only students were assigned to the main group who in accordance with CSAS-II and CIUS were not classified as conspicuous (CSAS-II < 35 & CIUS < 20).
Video game addiction was classified if CSAS-II >= 42. Internet addiction was classified if CIUS >= 30. Grades at school correspond to the German grading system: 1, very good, to 6,
inadequate. Test of significance by ANCOVA. All means are adjusted for the effect of age. Post hoc comparisons of main effects with Bonferroni corrected values. In the columns of VGA
and IA, the deviation from the main group of girls is given. In the column VGA vs. IA the deviation of both disorders is given.
*p < .05; **p < .01; ***p < .001; ns, not significant.
 F. Rehbein & T. Mçßle: Video Game and Internet Addiction
be more problematic social media users. Problematic social
network users on the other hand may more likely come in
contact with free-2-play games implemented in social
networking sites or establish contacts, who are themselves
engaged in gaming. Consequently, this finding does not
negate the need for a differentiation of subforms of Internet
addiction.
Furthermore, our data indicate that the two proposed
pathological entities differ in some essential aspects. First of
all, the gender ratio of video game and Internet addicted
students is reversed: Video game addicted students are
mainly male, Internet addicted students are mainly female.
Thus, available data on the gender ratio could be con-
firmed: Most video game addicts are male (Rehbein et al.,
2010), while most Internet addicts are female (Rumpf et al.,
2011). Secondly, even in the comparatively small age
spectrum of 7th to 10th graders of our sample, both disorders
significantly differ regarding prevalence estimates in differ-
139
Figure 3. Burden of addiction for si-
gnificant others from the viewpoint of
video game and Internet addicted stu-
dents (n = 42 video game addicted
students, n = 141 Internet addicted
students). Test of significance by means
of Chi Square Statistic (category se-
vere: Fishers exact test). ns, not si-
gnificant.
Figure 4. Psychological strain of video
game and Internet addicted students (n
= 42 video game addicted students, n =
141 Internet addicted students). Test of
significance by means of Chi Square
Statistic (category severe: Fishers
exact test). *p < .05; **p < .01; ns, not
significant.
ent age groups, yet in opposite directions: Internet addic-
tion occurs more often in older students and video game
addiction occurs more often in younger students. This result
could indicate varying peaks of both disorders in adoles-
cence. Thirdly, both disorders differ on central aspects of
content validity, as video game addicted youths mainly use
online games and primarily reflect their behavior as
addiction to video games, whereas Internet addicted youths
mainly engage in social networking and at least Internet
addicted girls primarily reflect their behavior as Internet
addiction. However, this result is less conclusive for
Internet and video game addicted boys, who do not differ
regarding their self-evaluation of Internet addiction.
To sum it up, the inverse gender ratios, the different age
peaks of prevalence estimates and the limited overlaps in
classification of the two phenomena substantiate our
assumption that video game addiction and Internet addic-
tion can indeed be regarded as distinct nosological entities.
SUCHT 59 (3)  2013 Verlag Hans Huber, Hogrefe AG, Bern
140 F. Rehbein & T. Mçßle: Video Game and Internet Addiction
A clear distinction of both concepts might offer some
advantages in future studies and also in clinical practice:
First of all, studies measuring video game addiction or
Internet addiction (excluding gaming) could be compared
to one another regarding outcomes of burden and strain,
risk factors and comorbidity. Thus, epidemiological data
could be more clearly assigned to specific problematic
behavioral patterns, which could enhance our understand-
ing and classification of these patterns. Additionally,
prevention and intervention concepts might benefit from
more clear-cut outlined pathological entities, as for instance
prevention concepts for video game addiction could focus
on boys and mainly focus on problematic use of online
games while prevention concepts for Internet addiction
focus on girls and problematic use of social networks.
The second aim of the study was to identify which
activities contribute to Internet addiction among adoles-
cents. In this study we chose a new approach: First, video
game addiction was analyzed as a distinct nosological
entity, separately from Internet addiction. Second, we
chose not to look at the most frequent Internet activity, but
at that activity adolescents themselves perceived to be the
main cause of their problem. Thus, these data reflect the
own subjective perception of students of their own
addiction and is based on the assumption, that Internet
addicted students are able to reflect, which activity has the
highest impact on their addictive behavior. The data show
that the majority of addicted girls (96.1 %) and boys
(62.1 %) cited social networking as the primary cause of
their problem. Thus, it might be justified to conclude that –
at least in the case of adolescent girls – it would be more
accurate to refer to the problem as social networking
addiction rather than Internet addiction. Boys, however,
compared to girls less often name social networking and
more often name pornography as their main problem. This
finding highlights the problems associated with the hetero-
geneous construct of Internet addiction: The pathological
behavior does not necessarily have to reflect the postulated
breadth of the construct. Thus, different populations could
widely differ in the behavioral pattern associated with
Internet addiction.
Hence, the findings of this article underline the need to
distinguish between pathological forms of Internet use and
to perform construct specific analyses. Given its relevance,
however, not only video game addiction but also patho-
logical use of social networks should be studied separately
and not intermingled with other forms of Internet use.
Research on the problematic use of pornography and
downloading of data files would also appear advisable, as
these activities are cited at least by a relevant number of
Internet addicted boys as the cause of their problem. For
pornography and downloading, the permanent online
accessibility of new content could be seen as crucial to
lead some people into problematic behavioral patterns.
Thus, these phenomena could be seen as closely related to
Internet addiction. However, studies on problematic use of
Internet pornography should also take into account the
possible proximity to other forms of anomalous sexual
SUCHT 59 (3)  2013 Verlag Hans Huber, Hogrefe AG, Bern
behavior. For other activities such as gambling and shop-
ping, which were rarely be seen as a main problem for the
Internet addicted students, the issue whether existing
disorders could better explain these behavioral patterns
needs to be discussed. For example, it could be imagined
that adolescents with a disposition to problematic gambling
behavior use the Internet to gain first gambling experi-
ences, say with poker or casino websites. Young people
could find it easier to circumvent the age restrictions
applied on those sites than those of gambling establish-
ments in the real world. Thus, it could be more appropriate
to analyze their behavior in terms of them having devel-
oped a problematic gambling behavior or gambling addic-
tion rather than an Internet addiction. The same could be
true for shopping addiction. In this matter, regarding video
game and Internet addiction as distinct entities is only a first
step on the road ahead to differentiate between subtypes of
media associated pathologic behaviors.
As a third aim stress indicators of video game and
Internet addiction were evaluated. To our knowledge, this
is the first study comparing stress indicators of individuals
being classified as video game addicted and individuals
being classified addicted to Internet activities excluding
gaming. Our findings indicate that both groups are strained
in similar ways, at least when it comes to objective
indicators. In contrast to non-addicted adolescents, those
with video game addiction and Internet addiction show
impairments in a broad range of measures of wellbeing and
functional level. Many of these indicators evaluated on
their own might not clearly indicate impairments of clinical
relevance. For instance, it cannot precisely be decided, at
which point a daily sleep time is low enough to be
considered detrimental to wellbeing. A higher level of
suicidal ideation on the other hand can on its own be seen as
a definite indicator for a clinical relevant impairment. In
this study, suicidal ideation is not only elevated in all
pathological groups but also varies with the highest effect
size. As another notable result, the different measures
cumulate to a consistent pattern of impairment of wellbeing
and of functional level for both, video game and Internet
addicted youths. Only a few differences could be identified
for video game and Internet addicted youths: Video game
addicted boys are more susceptible to sleep disturbance
and media use related aggressive behavior but less often
report suicidal thoughts than Internet addicted boys. Video
game addicted girls more often report suicidal thoughts and
media use as a motive for truancy than Internet addicted
girls.
Regarding subjective measures of burden for significant
others and psychological strain, video game addicted and
Internet addicted adolescents present a more diverse
picture. Some of them experience only slight or even no
problems while others experience considerable or severe
suffering or burden for significant others. It could be
assumed that among those who report no detrimental
effects, there are at least some individuals for whom a
diagnosis is not applicable because the effects are not
strong enough to warrant a clinical psychological disturb-
 F. Rehbein & T. Mçßle: Video Game and Internet Addiction
ance. On the other hand, it is also possible that some
adolescents in this age group can be classified as dependent
in terms of a significant number of symptoms, but have not
developed seriously harmful effects yet – or at least none of
which they are aware of. On the whole, Internet and video
game addicted youths are very similar in their subjective
evaluation of burden to significant others, in that they tend
not to see their addiction as a problem for others. Differ-
ences emerge regarding psychological strain, which is
higher in video game addicted than in Internet addicted
youths. This result is somewhat surprising, as Internet
addicted youths tend to be older in age and hence could be
expected to be more capable to attribute personal distress
to pathological behavior. We hope to explain these
diversities and their relevance for the development of
different kinds of addictive behavior in more detail once
the longitudinal survey is concluded.
Some shortcomings of our study should be addressed.
First, our sample is not representative, what has to be
especially taken into account regarding prevalence esti-
mates, which cannot be applied to the whole population of
7th to 10th graders in Germany. Second, we only investigated
video game and Internet addiction among adolescents.
Thus, the results of our study need to be verified in older age
groups. Third, in this paper we focused on a selection of
validation and detrimental measures regarding video game
and Internet addiction and did not analyze other comorbid
disorders as for example depression, ADHS and social
anxieties. Fourth, despite the overall sufficient sample size,
only a small number of video game addicted girls (n = 9)
could be identified. Thus, our group comparisons suffer
from reduced statistical power to uncover differences
between video game and Internet addicted girls. To some
extent this is also true for the boys as can be seen by the
confidence intervals of the measures at hand. This could
only have been avoided by using more liberal cut-off-
values. However, we decided to use official recommenda-
tions for cut-off-values for CSAS-II and CIUS in order to
avoid classifying students as addicted, who fulfill only some
of the diagnostic criteria. It needs to be emphasized,
however, that the cut-off-values for both the CSAS-II and
the CIUS are indeed empirically and theoretically estab-
lished but have not been clinically validated yet. Additional
studies are necessary to decide, which cut-off-values
achieve the best ratio between specificity and sensibility
for both instruments respectively.
Implications for Practice
– Video game addicted adolescents are mainly male
and are particularly prone to pathological use of
online games. Internet addicted adolescents are
mainly female and make intensive use of social
networking which most of them cite as the main
cause of their problem.
– Both disorders can be diagnosed independently
from one another. Video game addicted as well as
141
Internet addicted adolescents exhibit a lower health
related wellbeing and a lower functional level.
Especially video game addicted students perceive
themselves as impaired by their addiction.
– The term Internet addiction prompts questions.
Pathological use of social networks, pornography
and downloading should be studied separately for
their clinical relevance. At least in adolescents,
online gambling and online shopping do not con-
tribute to Internet addiction in a substantial manner.
Acknowledgments
The video game and Internet addiction project on which
this article is based is funded by the Lower Saxony State
Ministry for Science and Culture. No conditions what-
soever were imposed with the financing. We thank all
students who participated in the study and the headmasters,
teachers, and interviewers for helping us to carry out the
study at the schools.
Declaration of Conflicts of Interest
The authors declare that there is no conflict of interest
relating to this article.
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Florian Rehbein
born 1977, is a research associate at the Criminological
Research Institute of Lower Saxony (KFN) in Hano-
ver, where he leads the project Video game and
Internet addiction. He studied Social Education at
the University of Applied Sciences in Bremen from
1996 to 1998 and Psychology at the University of
Bremen from 1998 to 2004. In 2010 he received his
PHD in Psychology from the University of Hildesheim
for his experimental work on the cognitive effects of
violent screen media. He currently conducts research
on the diagnostics, prevalence and the causes and
consequences of video game and Internet addiction.
He has additional research interests related to other
behavioral addictions, epidemiological research meth-
ods and screening tools, criminal psychology and
prevention of mental health problems in adolescents.
Thomas Mçßle
born 1975, is Vice Director of the Criminological
Research Institute of Lower Saxony (KFN) in Hanover
where he is responsible for research on media effects.
He studied Psychology at the Catholic University of
Eichsttt-Ingolstadt where he received his doctorate
(“Zur Entwicklung des Personenwiedererkennens“) in
the Department of Developmental and Educational
Psychology in 2005. He has been a research associate at
the KFN since April 2005. In 2012 he received the
authorization to teach psychology at the University of
Hildesheim.
Dr. Florian Rehbein
Kriminologisches Forschungsinstitut Niedersachsen (KFN)
Criminological Research Institute of Lower Saxony (KFN)
Ltzerodestr. 9
30161 Hannover
Germany
Tel.: +49 (0)511 34836-72
Fax: +49 (0) 511 34836-10
florian.rehbein @kfn.de
Submitted: 04.12.2012
Accepted after Revision: 17.04.2013